Pensions, market-linked insurance schemes and retirement plans cover a small subset of the population in India. For millions of elders, Government social protection programs and family support continue to be the lifelines, and keep them away from old age poverty.
Do we truly understand the multi-dimensionality of the longevity challenge?
What are the financial and social costs of longevity?
Are our social protection schemes addressing more contemporary needs?
Have pension reforms been meaningful in the Indian context?
In this essay, I look at the Indian experience and pension reforms from the lens of accumalating longevity risks.
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in
Serena Williams, one of the greatest tennis players of all time, recently announced her retirement from professional tennis. Interestingly, the winner of 23 Grand Slam tennis tournaments, had this to say,
“I have never liked the wordretirement. It doesn’t feel like a modern word to me. I’ve been thinking of this as atransition, but I want to be sensitive about how I use that word, which means something very specific and important to a community of people. Maybe the best word to describe what I’m up to isevolution. I’m here to tell you that I’m evolving away from tennis, toward other things that are important to me. A few years ago, I quietly started Serena Ventures, a venture capital firm. Soon after that, I started a family. I want to grow that family.”
The average age of retirement for professional tennis players is around 30 years, and lesser for women, and this makes transition into the non-playing world that much more vital. For example, Serena is 40 years old and has dedicated a large part of her life (and time) to the sport, and in the process, achieved tremendous financial success. Agreed that not everybody is Serena and has the resources at her disposal, however, it sparks an interesting question about how individuals perceive themselves and plan for their future.
Research globally indicates that there is a tendency for people to underestimate their longevity, and thus they are likely to pay little attention to different life stage transitions. Although India does’t face the same demographic transitions like much of the US, Europe and some parts of Asia, the absolute number of people entering their third (50+) and fourth stages of life (75+) is on the rise. This requires us to think beyond the traditional binaries of work and retirement, and evolve a much more nuanced understanding of longevity – a longevity mindset.
A longevity mindset is one where you decide and wholeheartedly believe that longevity is normal and attainable. With a longevity mindset, aging is abnormal, and longevity is what’s considered healthy. This mindset permanently benefits the way you live, think, and act.
Staying optimistic and planning for life stages is one way to evolve this mindset into a healthy living code. An earlier article on 100 Year Life highlights some of the research and work around this aspect.
If you want to break #AgeBias and foster intergenerational diversity, sign up for the GenConnect initiative now! https://longevityhub.in/genconnect/
Aamod Wagh is Pune-based founder of Tigertech Labs and Rhemos Health, with a career spanning 25 years in IT Consulting across Australasia, Europe, and USA. Tigertech Labs was setup in 2016 upon his return to India to develop remote health and safety monitoring devices for senior and dementia care. TigerTech also transitioned to Telehealth in 2019 with RHEMOS – an acronym for Remote Health Monitoring System – to deliver hospital grade care at home using affordable & easy to use medical devices.
Today, Aamod and his team serve over two lakh customers every month and their products are available through their website and also on e-commerce portals like Seniority. RHEMOS also works directly with 100+ hospitals, seniorcare companies, rural care foundations & telemedicine companies to further the mission of providing digital and remote health solutions to all, across the country.
Aamod, it was pleasure speaking with you earlier. Tell us a little bit about how you ended up creating Tigertech Labs. What triggered your decision?
I was based in the US for an extended period of time and would travel to India once a month for business. During every trip, I couldn’t help notice that a significant number of seniors in India lived alone, as their children were in another city or country and had little or no family support locally. It was also apparent that – while western countries had significant number of products and solutions available for assisted living & senior care, the same was missing in India. That was the spark that ignited the fire and the genesis of TigerTech.
You started with smart living solutions. How has this journey evolved and what are your core solutions today?
For us “smart living” encompasses personal safety, security & health and all our technology solutions resonate around this thought.
We launched India’s first senior care wearable devices called TigerTRACK & TigerFIT Pro. These were loaded with features & designed to provide 24X7 location tracking, automatic alerts on fall detection, SoS button, built-in cell phone, anti-wander sensors, monitors for heart rate & blood pressure and also instantly send alerts if an emergency is detected or if the user exits their home. The devices are designed to work independently and without any user interaction and can be monitored and controlled remotely by family and/or caregivers through an App.
Our products were welcomed with open arms by customers & we work with some of India’s largest senior care & home care companies, who use our devices to provide emergency support and care services to seniors across the country.
While our wearable products continue to do well, we also found that 70% of our seniors suffer from NCD’s like diabetes & hypertension and need to receive quality care at home. This got us exploring the possibility of providing high quality healthcare in the comfort of people’s homes and adding the benefit of remote health monitoring by doctors. This was the genesis of our RHEMOS Health product.
Today RHEMOS Health enables patients to receive “hospital grade” care at any location – in their homes and also in remote villages – without the presence of doctors or medical professionals. RHEMOS devices can measure 8 to 16 critical vitals within minutes using touch sensors. The smart technology also transmits the results instantly to an App & Cloud for remote access by doctors so that they can provide an accurate diagnosis & prescribe appropriate medications. RHEMOS also analyses all the vitals and generates a “health score” for each user to ensure that any preventive health indicators are provided well in time.
RHEMOS’s mission is to provide easy and affordable access to high quality healthcare at any location, for all and we are proud to have met and exceeded our mission.
You develop medical-grade devices for remote and digital health, including wearables. The overall awareness among consumers is still not as high and there is a lot of false advertising too. If I were purchasing a wearable device for an older family member, what should I look out for?
For wearable devices – especially for seniors – the most critical points to consider are (a) the size/weight & “wearability” of the device, (b) the ability of the device to do its job as an independent and stand-alone device. i.e. it should have zero dependency on the user carrying a cell phone, etc. and (c) ease of use including having little or no interaction with the device or technology – except pushing a button in case of emergency. All these factors determine whether seniors will use the device regularly.
For medical devices, the most critical point to consider when getting any medical device is that it should have at least 1 international certification – viz. CE-MED and/or FDA. These are mandatory for selling the devices in any EU country and in N. America. The rigor, dependability & accuracy of their certification processes ensures that the CE-MED certification is also acceptable across almost all other countries.
Other important points to consider for medical devices include (a) the ease of use, (b) whether the device is internet connected and automatically shares test results with your Doctor or your family, and (c) whether it can handle multi-functions to measure 7 to 8 vitals rather than having to buy 7 to 8 separate devices to do the same tests and finally (d) does the device provide any value added information after testing your vitals, that assists you in keeping a track of your daily health and provides you with any early warning information for preventive care.
What is Rhemos? How does it work? What parameters does it help measure? How can this information be used?
RHEMOS is an acronym for Remote Health Monitoring System. Its mission is “Healthcare. Anywhere” and its vision is to enable easy access to affordable & personalized care to all Indians at any location.
RHEMOS Health Ecosystem combines portable hand-held medical devices with an App/Cloud & health analytics to provide a comprehensive telehealth solution. The devices can be taken to any location to measure 8 to 16 vitals with hospital grade accuracy & transmits them instantly to All/Cloud for remote access by Doctors to conduct an accurate diagnosis.
The health monitor is a single pocket-size device that measures 8 vitals in 2.5 seconds. These include BP, Heart rate, ECG, Heart rate variability, Respiratory rate, Blood oxygen, Body temperature & blood glucose. Rhemos also provides small blood analyzers to conduct blood tests for Haemoglobin, HbA1c & Lipids at home in minutes and our digital stethoscope measures heart & lung sounds. All readings are instantly transmitted to remote doctors with alerts in case readings are abnormal. This allows people with chronic conditions like Diabetes, Hypertension or Cardiovascular disease to test & monitor themselves at home – while being monitored remotely by family & by their physicians.
I understand you work with the rural health system. Can you tell us how your solutions impact rural health?
RHEMOS identified some of the biggest issues faced by care providers in delivering healthcare to rural India. Some included availability of qualified doctors, nurses, medical infrastructure, power, wifi, vitals testing capabilities, etc. Also many rural hospitals face high traffic of 500-1000 patients a day which is difficult to manage. Finally, the biggest health issues in rural India are inability to detect comorbidities & NCD’s like diabetes & hypertension and women’s & children health issues like anaemia, pre/post-natal care. The RHEMOS solution was then designed to directly address each one of these issues.
RHEMOS does not need power or wifi and can be used by ASHA workers to check vitals for each patient – including blood tests & chest sounds. This ensures that hospital grade care can now be delivered to the deepest parts of the country even without presence of local doctors & nurses as remote doctors can now take care of patients & prescribe medications. A single RHEMOS device can handle 150-170 patients/day to handle high traffic. And, the multiplicity of tests conducted by RHEMOS also ensures easy identification of most comorbidities to enable personalized care & also conducts detection camps for diabetes, hypertension, anaemia, etc.
You mentioned that you partner with seniorcare organizations. How do these partnerships impact the quality of life of the end customer?
Many senior care organizations leverage our technology to provide their customers with additional services based on our devices. E.g. they run emergency response services that are connected to our devices and monitor all location alerts, fall alerts, health condition alerts and provide timely response services. The end customers and their families can now live with complete peace of mind that their lives are secure and that – if required – help is literally a click away.
It has been 8 years in this journey for you. How has the landscape changed? What are the trends that you observe today?
When we launched our products 6 years ago in 2016, the senior care & eldercare sector was just about starting to gather steam, and senior care products were limited to grab bars & wheelchairs. We were the pioneers in leveraging wearable technology to bring safety & health to our seniors in India. Also when it came to healthcare, telemedicine was a just glorified video call & most doctors & patients insisted on physical examinations as the only way of good treatment.
Today – especially post pandemic – the home care, senior care & telehealth sector has mushroomed and is now being accepted as mainstream by doctors & patients both. Also the awareness about using technology & the availability of products like ours has increased multi-fold.
People have started to recognize that products like RHEMOS plug the gaps that exist in telemedicine today and can ensure that telemedicine can actually provide comprehensive care remotely.
You can order these products from the Tigertech website and learn more about RHEMOS here.
The newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in
A recent study mentions that India, home to over 100 million adults over the age of 60 years, produces 20 geriatricians annually due to limited availability of post-graduate seats, and has limited functioning geriatric departments under public healthcare.
Given the increasing lifespan of general population, and the fact that India is projected to have a significant population of older adults, and particularly those with high-risk of comorbidity and other ailments, how can Comprehensive Geriatric Assessment (CGA) screening help? How is it different from a general health check? Are Indian hospitals prepared for such screening? Can we adapt them to primary care settings? In this short essay, I try to review the limited literature that is available in India.
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in
Nidhi Chawla is co-founder of Silver Talkies, India’s leading active ageing company focused on 55+ adults. Individuals can opt in for subscriptions to access curated content, a community of like-minded individuals, events, and a host of other community activities for healthy and happy ageing. Silver Talkies has engaged with over 20000 older adults, both digitally and in physical formats across India. The Silver Talkies magazine, with a subscriber base of 8000 adults, is one of India’s leading active ageing publications focused on older adults. Based in Bangalore, Nidhi previously worked with McKinsey & Company and is a pioneer in the active ageing space.
An active proponent of healthy and happy ageing, Nidhi is co-authoring a book for Penguin Random House on how the landscape of ageing is shifting in India. Nidhi has been the recipient of leadership awards for her work in the eldercare space and is currently a member of the CII Seniorcare committee. In this interview, I chat with Nidhi to understand active ageing, why it is more relevant than before, and how Silver Talkies is shaping those conversations.
Nidhi, we first met in early 2020 and I recall you speaking passionately about the eldercare ecosystem and particularly about active and happy ageing. What do you mean by active ageing? Why is it important, particularly for older adults and seniors?
As per International Council of Active Ageing, active ageing rests on 7 pillars – physical, intellectual, emotional, social, vocational, spiritual and environmental well-being and if you were to ponder over these aspects deeply with regards to the elders in your own life you would find that each and every pillar is vital for an older adult’s well-being. We discovered this through our own experience with our ageing parents at home. Their intrinsic well-being needs to be complemented with extrinsic factors, including how our system, society and infrastructure supports them with their ageing needs.
With age comes natural physical changes which are often accompanied by decline in mental, social and emotional well-being due to various reasons like empty nests, nuclear families, shrinking social circles due to death and disabilities, lack of engagement opportunities etc. Early retirement age, increased longevity, progress of technology leaving seniors behind have only added to this mix, thereby making it increasingly important that we address these issues exclusively for our seniors.
We must give them opportunities for social and intellectual engagement, looking beyond their physical health and catering to their holistic well-being. We must empower them with the necessary skills, information and opportunities so they continue to stay included in our society and age gracefully, happily and with dignity. It’s time to redefine ageing and make it a lively experience despite the inevitable downgrade in health and abilities.
You have seen the evolution of the eldercare space in India over the past decade. What has changed over the past few years, and what hasn’t?
Back when we started out there were hardly any players in the eldercare space, many of them being in the unorganized sector. Over time we saw many companies with interesting concepts come and go, either because the market was not ready for the idea or there was no funding available to scale up.
The focus continued to be on physical health and senior living. Concepts like companionship, second careers and engagement continued to be unheard of. Over the years the landscape has been evolving and hopefully shifting for the better. Even the healthcare and senior living sector is seeing more depth in terms of the kinds of offering that are coming up in the market. Home healthcare, transition and palliative care are emerging; assisted living and ageing in place concepts are being introduced and are better understood. However, there still remains a large unexplored territory that can lend heavily into an older adult’s overall well-being. Focus on physical health continues and active ageing centers are far and few.
Pandemic has put a spotlight on the needs of seniors like never before, prompting organizations, government as well as investors to take a serious look at the sector as a potential opportunity. However, success will still be hard to come by unless a mindset shift happens where there is an increased awareness about the positive impact that all these services can have on the lives of older adults. With the next generation used to a different lifestyle, have better financial freedom and a stronger desire to stay well and independent, we are likely to see adoption of these services much more quickly.
Silver Talkies has gone through different phases of evolution. What are the core activities you undertake, and who is your target audience?
Silver Talkies has three main verticals.
Our digital magazine covers topics across four main categories – health & wellness, money matters, living and people & stories. Our magazine features original and well researched content generated either in-house or through our contributing experts and members, across topics that would be of relevance to seniors and their caregivers. We also shine light on awe-inspiring seniors and focus on positive ageing stories.
Our community invites older adults to join Silver Talkies Club – a safe space for seniors to discover themselves as well as find new friendships across geographies. Our club members enjoy exclusive events, learning opportunities, meet-ups, buddy support, expert help, partner offers and vocational opportunities. They also contribute to our magazine and share their skills and knowledge with other members.
Our workshops and weekly classes are open to both club members and non-members and cater to different interests and needs. Our awareness sessions are also open to all.
Our target audience is anyone who is 55+ residing anywhere on the globe. Our current offerings are available only in English language. In the near future we plan to introduce programs in at least a couple of Indian languages as well.
With longer lifespans, older adults prefer assisted living arrangements or ageing-at-home services to support activities of daily living (ADLs), nursing and attendant care needs, mostly in urban areas. Do you work with such partners to support healthy ageing?
Yes indeed, these are practical needs of any older adult. We are working at meeting all needs of seniors under one roof by having strategic tie-ups with carefully selected and leading players across different segments of eldercare. We already have tie-ups in the healthcare, tech assistive devices and lifestyle segments and in the due course will be buffering up this strategic pool of partners. We also facilitate connecting our members to right experts and service providers in the senior living sector as and when requested.
Can you expand on the general customer profile of Silver Talkies members? How do they benefit from your membership services? Any anecdotes would be much appreciated.
Silver Talkies members come from varied backgrounds and consist of homemakers to lawmakers; introverts and extroverts. Diverse personalities have found home at Silver Talkies Club. They are well-educated and cosmopolitan in their attitude. They may be 55+ but they are young at heart with great zeal towards life. They are adventurers and lifelong learners, willing to experiment and explore new horizons.
With Silver Talkies’ engagement opportunities our members have been able to fulfil their dormant desires and also acquire new skills. They have found multi-city friendships and managed to banish the loneliness blues. They have been able to get and give advice, share their own skills while also learning from others in the group. They have learned to dance, sing, act and walk the ramp! They have discovered the writer in them and have become digitally literate. With the common interest groups like gardening, quiz, literary, wellness they have found shared interests with other members and actively interact with them on these topics.
Anecdotes are plenty, sharing a couple of them.
Sunita Thakker a member from Mumbai who was experiencing the empty nest syndrome after her only daughter’s marriage is now an active and exuberant member of Silver Talkies community. She has not only found multi-city friends who are ever ready to host her when she is in their town, she has also found a new passion for painting and music. Thakker has also been taking care of her physical health through online fitness classes. She is a regular at monthly quiz and storytelling sessions and makes it a point to attend as many activities as possible, as the virtual format allows her to fit them into her schedule easily. She is just one shining example of a senior who has found a new zeal of life after joining a community like ours.
Col. Tavamani who served the nation all his active years, now lives alone while his married daughter lives some distance away. Col. Tavamani was dependent on his wife to take care of him and the household. He didn’t even know how to make a cup of tea. So, when she passed away, he found himself spiraling into depression. In his words becoming part of Silver Talkies rescued him and he is now an active learner and member. Col. Tavamani has benefitted from the tech classes and now proudly considers himself tech literate.
How big is your team and what is next in the journey for Silver Talkies?
We are currently a ten-member team including the core operations and the tech team. The year 2020 was a silver lining for us amidst the dark clouds. The pandemic pushed us to pivot our model from being a Bangalore only community to becoming a pan-India virtual community. Currently we have members from 12 different cities. With the help of our technology partner, we are working at offering our services through both web and mobile channels, making our services easily accessible through preferred channels. We would continue to simplify accessibility while leveraging technology to scale up and positively impact lives of seniors across the globe.
Our vision is to be a global platform with city chapters, offering our engagement modules virtually while holding city meet-ups quarterly. Currently, we are working at enhancing our value proposition and introducing the missing building blocks of the active ageing framework. We envision an empowered society of older adults who have learnt to take care of themselves and are able to age with grace and dignity.
Silver Talkies invites non-members to experience the benefit of the club membership via a 30-day preview offer where they can attend member exclusive events and learning modules and participate in all member activities. All details are available at www.silvertalkies.com
The newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
With longer lifespans, just a retirement plan may not be enough anymore.
Retirement planning is a healthy exercise to undertake as it helps ensure financial security and offers peace of mind around later life. However, with increasing lifespans, shifting the lens from retirement to longevity planning spread across different life stages may lead to better quality of life.
In this essay, I have identified 9 parameters that can help think through longevity plans in the context of retirement planning.
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in
Vandana Mahajan is a palliative care counsellor with a post graduate diploma in integrative counselling. She is trained in palliative and bereavement counselling. She is associated with a Mumbai-based cancer non-governmental organization named Cope with cancer-Madat Trust. She works as a volunteer counsellor at the Tata Memorial Hospital , Mumbai and also provides cancer counselling to patients and caregivers across India and abroad via online platforms.
Vandana is a cancer survivor and a cancer coach who has been conducting motivational talks at various forums, and provides support to breast cancer patients through interactive sessions at TMH. She is a strong advocate for women empowerment and conducts women safety training sessions in corporate houses.
I understood from our call that palliative care is more than just pain management and deals with emotional distress. Can you give a little insight into how it works?
“We can’t change the outcome, but we can definitely affect the journey” said Dame Cicely Saunders who is the founder of the hospice movement. When a person is diagnosed with a terminal illness or is dealing with a chronic illness, in addition to the physical manifestation of the disease there is lot of emotional distress that comes as a package deal. This is both for the patient and the caregivers. Whilst the physical symptoms are treated, unfortunately the emotional burden is overlooked.
While the clinician takes care of the physical pain and the physical symptoms, it is a counsellor/ psychologist who can address the emotional burden. Therefore, palliative care is not only pain management, it also includes emotional management, which can be provided by a palliative care counsellor. The emotional drain and the emotional strain also need to be addressed.
Let’s talk about Mrs Shilpa (imaginary patient) who’s has just been diagnosed with advanced cancer with a poor prognosis. In addition to the to the treatment that she goes through, (which is very painful and has a lot of side effects) she also starts carrying an emotional burden. This can be in the form of fear, anxiety, depression, panic, feeling lost and sometimes even wanting to end one’s own life. This can break her down mentally. At this point it is very important that counselling is integrated into the treatment plan. Just because a person is dying or is living with a chronic illness doesn’t mean we give up on that person. Everyone who has a life limiting condition deserves to be treated with love, empathy and compassion. Living with illnesses is very tough. If we can handhold the person diagnosed with an illness and walk with them, they feel wanted, they feel recognised and they feel that they’ve not been abandoned. I have seen many patients whose disease is well managed but emotionally they are a wreck. The same is applicable to the caregivers. Care giving is a huge responsibility which can take an emotional toll on the caregivers.
If I am the primary caregiver for a family member going through a chronic illness like cancer, what should I do outside ensuring appropriate clinical care?
I’ve been working with cancer patients for over 8 years now, and I firmly believe that cancer is not a disease of just the patient alone. Cancer is a disease that affects the entire family. Caring for a person diagnosed with cancer can be demanding both emotionally and physically.
A caregiver is so rightly referred to as a silent patient. You don’t have to suffer – if you are unable to cope up, seek help. Do not feel guilty about seeking support from friends, religious or spiritual advisors, counsellors, and health care professionals.
While the patient’s physical symptoms are being attended to by the clinician, there are certain things that a caregiver can provide as per the needs of the person with cancer. These can be any of the following or all of the following:
Emotional support – while the treatment takes care of the physical symptoms resulting from the treatment and the disease, the emotional distress the patient goes through may not be visible. As a primary caregiver, you can keep an eye out for any behavioural changes and then raise it with the treating team.
Help with financial and insurance issues
Help with medical care
Bridge the gap between the patient and the health care team by being the communicator.
Try to ensure, if possible, that the person with cancer has an active role in decision-making and the discussion that takes place.
Caregiving is challenging and when the person with cancer is struggling with the disease and its side effects, it can be frustrating for the caregiver. At this point, it’s important to recognise that your loved one is dealing with a lot – physically and emotionally!
Recognize your own strengths and weaknesses as a caregiver. This allows you to set boundaries and know when to ask for help so that you do not feel burned out. Remember as a caregiver, you can care for your loved one only if you are emotionally and physically capable in doing so. Taking care of yourself is important.
Be aware of the disease, its treatment, and the prognosis. It can help not only you but also your loved one who’s been diagnosed with cancer deal with the disease and its outcomes much better.
You mentioned palliative care is a multi-team approach. Can you tell us who the key stakeholders are in such care management?
To understand palliative care, it is very important to understand the concept of ‘Total Pain’. Total pain means approaching pain from all aspects of life. This includes physical, psychological, social, and spiritual aspects. Palliative care aims to improve quality of life of the patients and their family who are facing life-threatening illnesses by providing holistic healing or support to them, irrespective of the intent of the treatment.
This can be done by the treating clinician or the physician who provides relief from physical symptoms, a counsellor / psychologist who provides emotional support, a priest or a chaplain who provides for them spiritually and social workers who can help in various ways. All of them together form the palliative care team which should ideally be integrated into the treatment plan at the time of initial diagnosis!
General awareness of palliative care is low in India. Is this changing? How big is the gap when it comes to awareness and access to care professionals?
Palliative care continues to be the most misunderstood arm of healthcare. I will talk from the perspective of someone who works with cancer patients. As of today, I would say majority of cancer hospitals do not have a palliative care team working with cancer patients. Palliative care still continues to be a care which is associated with the dying cancer patients essentially focusing on only pain relief and symptom relief towards end of life. The moment we talk of palliative support for the family, the first thing that the family understands is that the patient is going to die. Unfortunately, there are many doctors also who are not aware of the real meaning of palliative care.
There is a change happening. There are many renowned palliative care professionals working towards bringing about this much needed change in our health care system.
“Less than 1% of India’s 1.2 billion population has access to palliative care. The efforts of pioneers over the last quarter of a century have resulted in progress, some of which hold lessons for the rest of the developing world.”
Dr M R Rajagopal, Founder-Chairman, Pallium India
We still have miles to go before we are able to finally reach that place where palliative care is well understood and attainable to everyone who goes through a life limiting condition or a chronic illness. I have patients who live in remote areas of India where there is no access to palliative care teams. There are some with whom I stay connected till death but there are many who die in want of Palliative support.
Palliative care is largely regarded as something older people may need but you mentioned the rise in the number of younger people (or their families) that seek palliative care. What are the more common cases you see?
This is a very interesting question you’ve asked. Rightly said that palliative care is still associated with geriatric patients.
Older adults are often dealing with a variety of aches, pains, and discomforts in addition to serious health conditions like cancer, respiratory diseases, Alzheimer’s, osteoporosis, diabetes, influenza and Pneumonia and cardiac conditions. The medical treatments to cure or reverse these health conditions can affect older bodies more harshly and are more likely to cause significant side effects. In such cases, the efforts are directed towards improving their quality of life. Hence the need for palliative care for them.
I work with cancer patients and cancer is not an age-specific disease. A lot of the patients that I work with are young. Sadly, cancer doesn’t care about the age! The treatment is harsh and leaves the person affected, with many unpleasant side effects. While it’s the patient who is diagnosed with cancer, the families are also affected in various ways!
That’s why I talk of palliative care for younger people (and caregivers). Younger people go through far more complex emotional upheavals. While an 80-year-old adult knows that death is inevitable, for a young 30-year-old who is being denied a chance at life because the cancer is incurable, Palliative care becomes very important. They need a lot of hand holding. They need answers to their questions. There are some married young people who know they’re dying and they’re leaving behind young spouses and young kids, elderly parents so it becomes a very big emotional challenge to deal with these patients and their families.
Every person diagnosed with a terminal illness, irrespective of the age, deserves empathy, compassion and love, therefore palliative care is not only for older people. It should be accessible to very human being may- a toddler or a younger adolescent or 30-year-old or someone who is 80 years old. Here I would also like to mention that palliative care is also for people living with mental health problems, the LGBTQI community and for those who are affected by a humanitarian crisis (like in Ukraine).
Conversations around death. This is a very sensitive topic for most families and most would say that there is no way to prepare for death. However, in your line of work, you are in situations where you deal with terminal conditions quite often. How does palliative care help in such situations?
Those who are born, will die. This is the eternal truth of our existence! While every birth is celebrated, no one talks of death. It seems everyone wants to live for ever. Is that even possible? The problem is that we do not acknowledge death as an inevitability. No one talks about it.
While talking about death and dying might be uncomfortable or upsetting, research has shown that having these conversations within families and communities and with the health care providers can help people prepare emotionally for their own deaths and that of others’, and helps prepare for medical care they would prefer receiving at the end of their lives.
End-of-life care refers to health care for a person nearing the end of their life or in the advanced stage of a terminal illness. Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. This is where the multi disciplinary palliative care team steps in.
Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counselling. It offers a support system to help patients live as actively as possible until death and their caregivers post the death of their loved ones.
You can connect with Vandana on LinkedIn or follow her on Twitter to get some insights and practical tips.
Book Recommendation: Walk with the Weary by Dr M R Rajagopal, father of palliative care in India, from Flipkart or Amazon.
You may also want to check out this Silver Angels essay on palliative care, an attempt to lay out palliative care in the Indian context.
Silver Angels Newsletter
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
Chirag Shah is 26 years old and co-founder of Rymo, which is on a mission to transform India’s rehabilitative care infrastructure. Chirag and his team are building robotic solutions focused on rehabilitative care and their first product “Mobi-L” is also India’s first robotic and VR based technology for upper and lower limb rehabilitation.
I had the opportunity to chat with Chirag on this very unique product journey that is filled with passion, learning and experimentation.
Chirag, pleasure to connect. Tell me a little bit about yourself and the journey so far. How big is your team?
Hello Mahesh, glad to connect with you and Silver Angels. I am an electronics and telecommunication engineer and during college was fascinated by the potential of robotic technology in improving human lives.
A visit to our neighbouring physiotherapy college gave me a chance to see the difficulty of patients with limited physical mobility and turned out to be a tipping point. That day, I decided to use my engineering skills, time and efforts to build something useful for physiotherapists and the patients undergoing physiotherapy and help physiotherapists in their effort to spread the joy of independence and good health.
A small research project which we started back in 2018 slowly matured into a product with the help of 250+ physiotherapists and occupational therapists whom we spoke to better understood the problems various stakeholders in the rehabilitation ecosystem face.
Going forward with Rymo and our team comprising 8 members we aim to make the best and most advanced rehabilitation tools accessible for every patient undergoing rehabilitation and increase their chances of living an independent life.
Why rehabilitation? How big is this market as you see from your vantage point? Who is your primary user – physiotherapist, family member or the patient?
In the initial phases of development, we got a chance to visit 100+ physical rehabilitation centres in 6 different cities. One of the learnings for us was that majority of the patients undergoing rehabilitation visit private physiotherapy clinics and a small minority go to larger centres in big hospitals. As big hospitals have more space and higher budgets some of them are able to provide technology aided rehabilitation which helps in faster recovery.
As per our research there are 10,000+ rehabilitation centres in India and less than 1% of these rehabilitation centres can accommodate imported robotic solutions due to the which there is a huge gap in the market which can be filled by a portable and affordable rehabilitation solution like Mobi-L.
Mobi-L’s primary beneficiary is the patient who is undergoing rehabilitation. Our solution makes it possible for the patient to measure their recovery objectively, have fun while exercising and also recover faster due to increased compliance and high intensity rehabilitation sessions which Mobi-L can facilitate.
R&D, prototyping and assembling – everything is being done in-house. What has been your learning on this front?
R&D, prototyping and assembling in-house has proved to be of great benefit for us. It has allowed us to keep listening to our user’s feedback and have the bandwidth to keep improving the product.
We have so far made 7+ major electromechanical iterations and 50+ software updates for our users. This has also helped us zero down on the most important features which will become a part of our final iteration before a nation-wide launch.
The long-term advantage for Rymo is that we now have a diverse engineering team with expertise in mechanics, electronics, robotics, software and game development and this allows us to continue to innovate, learn and grow.
Rymo office in Mumbai
Rymo’s software toolkit includes an Android-based app, games and much more. Can you expand why this is important? How does it improve the overall experience of the user?
Our software toolkit was built for Android with the objective of making operation of the device intuitive and minimize training required for the same. As most individuals are comfortable with using smartphones our software toolkit which runs on a 10.1inch Android Tablet can be used very easily.
The software ensures that the physiotherapist and patient get continuous visual and audio feedback while exercising. This not only makes the rehabilitation session goal based and measurable but also keeps the patient motivated to comply to the rehab session as prescribed.
The software toolkit also has multiple games and simulations of various activities of daily living which further make the rehab sessions fun filled and something that the patients can look forward to, and enjoy.
What are the different stages of rehabilitative care and recovery with Mobi-L? Could you please break that down?
Physical rehabilitation of upper and lower limbs generally starts with physiotherapist assisted exercises especially in the initial stages followed by active exercises where the patient is exercising independently.
These assistive and active exercises help the patient to regain full range of movement of the affected joint and recover one of the major aspects of mobility.
Once the desired range of motion is achieved the focus shifts to strength training which includes training with resistance, isometric exercises and doing exercises with varying resistance.
In order to meet the varied needs of the patients at different stages of recovery, Mobi-L can be setup with different protocols for training including assistive, active, resistive and isometric exercises. Thus, making it useful throughout the patient’s rehabilitation journey
As with most medical and health related fields, there is a shortage of physiotherapists in India. How does Mobi-L fit into this landscape? Say in a hospital or a rehab centre.
We all know technology is a huge enabler to improving work efficiency. For a software developer a high-end workstation will make his job faster and allow him to improve his productivity. Similarly, in a rehabilitation centre where a therapist is seeing multiple patients over the days or even at the same time our machine reduces not only the physiotherapist’s physical effort but also offloads significant efforts that go into engaging a patient to undergo his daily dose of rehabilitation. It helps improve their work efficiency and energy levels throughout the day.
With COVID, most of us have seen the difference that an objective measure makes in the diagnosis and treatment of a disease. A rapid antigen test for COVID 19 and the patients’ symptoms together provides an approximate idea of the diagnosis but a RT-PCR test helps the doctor to be more confident regarding the correctness of the diagnosis and also severity of the same. Similarly in rehabilitation a therapist’s experience and patients’ word regarding his physical condition is good to make an approximate guess regarding one’s condition and progress but a tool like Mobi-L validates the same and gives more confidence to the patient and the therapist.
Home-based care is on the rise in India, and particularly the demand for eldercare services. Do you see an opportunity here? How can Rymo solve some of the challenges here?
Some of the biggest challenges in long term rehabilitation are the need to travel regularly to physical clinics which might not be in immediate vicinity of one’s place of abode. This results in economic, time and logistics overhead on the family.
Rehabilitation at home is possible but especially for neuro rehabilitation it can also reduce the quality drastically as the tools that can be made available at home are limited. We believe our product can be used in a home setup and benefit the patient greatly as the space occupancy is minimum and operation is easy but it would need a physical therapist’s continuous guidance to maximise clinical results.
Going forward once Rymo is associated with a larger network of rehabilitation professionals we foresee collaboration opportunities that can be leveraged to deliver the most advanced rehabilitation at home.
What’s on the cards for Rymo this year?
This year Rymo is on route to complete its industrial design and launch its first product Mobi-L in India and make it available to 100+ rehabilitation centres. We have a goal to reach and positively impact the lives of at least 4000 individuals by 31st March 2023. These are a few baby steps which will help us democratise technology in physical rehabilitation and move forward in our goal to make India’s rehabilitation infrastructure one of the most advanced globally.
You can learn more about Rymo’s robotic rehab solutions here and connect with Chirag on LinkedIn.
Silver Angels Newsletter
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
P S Srikumar (“Sri”) is the founder of Chennai-based Integrated Eldercare Solutions, which provides senior and assisted living, home healthcare and advisory services to individuals, families and organizations. An ex-COO of Randstad, Sri quit his job to become the primary caregiver for his mother. This life event triggered his passionate journey into the eldercare space seven years ago.
In this interview, I chat with Sri to understand the his experiences and draw key insights from his varied experience.
Sri, you are very passionate about the eldercare space and have traversed different parts of it. Could you give us a short background of the last seven years?
I had a very eventful 7 years in this space. I was lucky to have people who mentored me and gave me opportunities to understand different aspects of senior space that included projects in retirement community (CEO of one of the leading retirement community brands in India), launching and running the top products space in Chennai for a client – where we ran a shop in our office for a year on a build operate and transfer model, handling audit of day-care centres and old age homes funded by the Govt of India – Ministry of Social Justice for their partner, training primary care givers in specific areas of memory care and palliative care, partnering with the largest and only exhibitions and conferences business in the eldercare space, working on assisted mobility and working with parents with children who had disabilities. Each of these projects were intense and spanned over a year each, as it involved strategy and implementation.
Simultaneously, I worked with senior groups – individuals and communities. In the last five years we have helped over 5000 families find solutions to the day-to-day challenges they face in taking care of their loved ones.
Covid has had a big impact on the sector, particularly the rise in home eldercare and senior living space. What are the fundamental shifts you are seeing among families and elders?
Covid had impacted seniors significantly. It is a paradox that in spite of the family being at home, elders felt lonelier during the last two years, than ever before. Earlier, elders used to have “me time” once the children left for work and grandchildren left for school. This wasn’t available during the “work from home or study from home” situation. Besides this, was the need for silent homes. Absence of home help in most cases had elders finding difficult to manage and maintain homes.
Covid confined seniors to a space. Walks in the evenings, meeting with friends and relatives became impossible. And everything online was something they were not prepared for.
This is a time that the demand for senior living and assisted living saw a rise – because of the perceived personal space it offered, besides the safety. Unlike the west, the number of people affected by Covid in communities was very negligible in India. The communities exchanged ideas on how to protect seniors. Even vaccinations were done at these communities. From groceries to medicines, home banking to housekeeping, seniors woke up to a world that was now looking more secure and comfortable.
Access and affordability of care rose significantly – especially for elders affected with Covid with no one to take care of their daily needs. Cost of care almost doubled for people.
We were able to provide support and help to the elder community during this time. Some challenges that elders faced was to learn smart phone and applications like Zomato, Swiggy or grocery ordering – as they became necessities. Reluctance to learn gave way to necessity.
Intergenerational bonding increased (grandparents and grandchildren), though elder’s privacy in many cases was lost. Increased opportunities in area of home food catering helped many to overcome these difficulties. For many business it was disruptive time and for many others it was an opportunity.
You were a CEO of Covai Care, a pioneer among India’s retirement communities, and have work with leading players in the broader senior living space. Can you give a glimpse into how senior living offerings have changed over time?
I was fortunate to work with Col. Sridharan – who is a pioneer in the concept and founder of Covai Care. Retirement communities started off as extension of real estate. Till recently, in my opinion, many of them did not anticipate the ageing needs nor were prepared for ageing related requirements. Advertisements flaunted healthy ageing.
(Elder) Care meant an ambulance or a medical station. However, many things changed for better in recent years. From a customer perspective, the awareness and acceptance of senior living (which was often confused with old age home) has certainly increased. People accept this as choice. The taboo around the concept was giving way to acceptance. One good aspect was that different forms of living coming up be it independent living, co-living spaces, assisted living, memory care, palliative care, etc.
Industry organizations like the Association of Senior Living ( ASLI) and CII’s senior forum played a very important role. People started recognizing best practices. Eligibilities became entitlements. If you are on social media like Facebook or LinkedIn, it is very common nowadays to see advertisements of such facilities available. The overall understanding of this space has increased. International players have recognized India as one of the key markets, given the demographics.
Today the senior space has spread across segments like affordable senior housing and elite ones. Now standards for senior care are being looked at. The South had more than 65 % – 70 % of the market share. However, projects are coming up across the country, as the need for the segment has been felt by its stake holders. The market is surely expanding. Brands like Godrej, Tata Housing, Max, Columbia Pacific, LIC, Shriram Group etc., have forayed into the segment.
During our chat, you mentioned the need for more assisted living spaces and particularly those that cater to dementia and other mobility-related issues faced by elders. How big or small is this opportunity
The opportunity is large and substantial.
As living spaces become smaller, providing care for a person with mental health (Alzheimer’s or Dementia) or terminal illness (including Palliative Care), or for persons with disabilities becomes a major challenge. Post-operative care, step-down care or care continuum is a huge area that needs attention and prioritization.
The options available are very limited and information is also not readily available to the common man. At a stage, a person may not be in a position to manage a property by himself. Besides will need assistance for day to day activities. Affordability and access become a challenge. Even in a retirement community a person may have to move from an independent state to a dependent state. The community may not be equipped to handle the requirement. With less than 1 % of the elder population in a formal community environment, the challenges for the rest 99 % are humongous.
Memory care is another area which is very acute. We have had situations where except for the patient with dementia, the near family is not in India and a normal assisted living or senior community will not admit such a person. Parkinson’s, muscular dystrophy, terminal illness, visual impaired elders…the need is just huge and there is not much offer available today.
I work with the visually impaired, it is sad when one of my customers told me that after 60, they are considered a burden by the family (many of them don’t marry) and they don’t have a place to opt for. The Government runs a few facilities, but it does not suit many. It is time the society, business and government come together to address this issue. Besides a huge business opportunity, it is also a humanitarian need.
Carefinder.in is one of your digital products and you have assisted over 4000 customers make informed decisions about on a variety of aspects. How big of a challenge is lack of quality and reliable information in making decisions around living arrangements, etc?
Access to reliable information is still a challenge. But this is changing as the sector is moving into an organized set up. Very slowly. The share of unorganized market is almost 70% of the inventory that is available.
Web searches takes people to a number of options. But many sites provide information that have not been updated. And a lot of information is also obsolete so reliance is still on experienced people for suggestions. One of the biggest challenges is the fact that a choice of a community depends on many factors, specifically the social and economic background of the resident.
When one makes a decision, it is important to understand perspectives and the age of entry. A normal retirement community is wonderful if you enter at around 60 or 65 years of age. It helps you build friends for the next twenty years and adapt to the living. However, as you age, it becomes more difficult to accept and adapt to a community. Background of the promotors, organization structure, continuity of service and exit options are all key factors. There are hidden costs like a onetime non-refundable deposit or a medical deposit, and all this will have to be kept in mind while deciding on selecting a place.
Apart from working closely with businesses, you also provide 1-on-1 consultations to families seeking support for their parents and elders. Can you expand on the common queries, and how you think one should go about planning for later life living arrangements?
Many people are still not clear what type of living they need. All our consulting is on a 1 – 1 business. We do not believe that “one shoe fits all”. We probe. We put our understanding in writing and send it to the customer to validate our understanding. The common query is can you suggest a retirement community. This is an open-ended question. We need to understand their budgets, we need to understand and advice on buy vs. rent options, health and financial background of the persons, access to near blood relative in case of extreme situations. Some retirement communities have age barriers for entry and some others have health barriers. For example, not many communities accommodate elders with mental health issues or elders with children with disabilities. As a consultant, we need to know what to suggest and what would be a good fit. In many cases, the solutions we give are very different to what they came to us initially for. And to offer solutions, we need to understand the business also and hence, there is a B2C and a B2B connect here when we provide solutions.
For many seeking help on home health care, we have suggested assisted living – considering the support and economic reasons of these persons. We suggest people who are apprehensive to do a short stay in the communities and decide only when they are convinced that this is the best option.
It is important to plan a retirement living when you are around 45 years of age. 50 to 60 years is a very vulnerable age and this is where many businesses cash in. In this age group, one is into a midlife situation. Senior position in organization with work pressure and priorities, growing up children, ageing parents and personal health and hence a getaway to a distant place is what many think of. However, above 70, the need reverses. They like to hear noise; they like to meet with younger lot and not live in secluded places (most of them). This is one of the reasons that stand-alone communities are giving way to integrated living formats now.
You are active in many forums – CII, ASLI, Tamil Nadu govt, etc. What are three takeaways from that vantage point?
Understanding the industry and needs better
Understand other issues affecting the senior community in large, than just living
Prioritising requirements of a larger community and working on policy level suggestions to the government.
The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.
