Edition #14: Shifting the conversation around ageing, dignity and care.
Thanks for reading! The conventional ‘old-age home’ model is evolving into various senior living and care formats. In this newsletter, we look at key developments shaping this transition in the following two sections.
Now, let’s dive in!
The senior care ecosystem in India is undergoing a shift and so is the language around ageing and care. In this section, we look at how conventional ‘old age homes’ are likely to give way to regulated, branded, standarised and specialized formats of care.
HelpAge estimates that India has 1279 old age homes split between paid, free and mixed models, and also those that provide medical care and are exclusive to women.
Their 2019 report on homecare highlights the acute shortage of infrastructure, geriatric care facilities and trained manpower, and in particular number of beds per hospital at the district-level.
According to M H Dalal, Founder and Chairman of the Association of Senior Living in India (ASLI), the broader senior living market is split into eight different formats (illustration provided below). He also articulates the need for regulation to keep in mind the different formats of care as is the case in globally evolved markets, and that the same facility may offer more than one format.
In this LinkedIn post, Pankaj Mehrotra, a consultant on senior living and elder care services, identifies four broad formats and multiple sub-formats within the senior living space.
Our Take: The elder care and senior care market in largely urban areas, while still nascent, has the potential to in the next couple of years thanks likely to an enabling ecosystem. We could also see a rise in both government and private sector models (and likely PPP, similar to skill development) emerging in rural and peri-urban centres to fulfill the demand. States like Kerala with a larger proportion of older adults are already seeing a substantial increase in number of applications for old age homes.
The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019 in PRS India website
Our Take: The bill, introduced in the Parliament in 2019, replaces the term ‘old age homes’ with more suitable language (senior citizens care homes, multi-service day care centres) along with provisions for minimum standards for food, infrastructure, medical facilities, recreation, staff, safety and security, and other aspects. Similarly, the bill also introduces requirement of registration and basic standards for home care services,makes it mandatory for healthcare facilities (hospitals) to provide relevant facilities for senior citizens and codifies police protection at a station-level. Given the low number of such government run homes (482 in 2019), the bill allows for care homes to be setup by the central or state government, or any other organization. With the passing of the bill and subsequent notification of the Act, it will bring existing and new elder and senior care service providers under the ambit of the law while ensuring basic standards and safeguards.
India to require 9 lakh beds for elderly by 2027 against 97,000 by Chittaranjan Tembhekar in Times of India
Our Take: A 2018 report prepared by Tata Trusts, UNPF and Samarth estimated that India would need 9 lakh beds by 2017, three times the availability, extended across both care homes and living facilities to meet the demands of elders. Basis a sample set of 480+ old-age homes and 60+ senior-living developments in India cutting across geographies, size, cost, facilities, ownership and management, the study identified 5 key result areas (infrastructure, management of facilities, dignity and respect, safety and security and physical needs) and 28 performance metrics to ensure comprehensive, measurable and practical standards. These and other recommendations could play a key role in shaping both infra-led and ageing-in-place care for elders.
Retirement home guidelines are finally here by Meera Siva in The Hindu
Our Take: A Moneylife-HDFC study in 2019 found that around 65% of senior citizens living in such facilities did not sign a contractual agreement on the services and their rights, and 100% of them wanted to see regulation of retirement homes. Considering these inputs, the government, in 2019 recognized retirement homes as a separate asset class thus making such developments subject to the Real Estate (Regulation and Development) Act, 2016. Further, the government also published a well put laid out model guidelines for development and regulation of retirement care homes including service standards for various facilities (medical, fitness, security, etc). The report has an excellent comparative of the two payment options (lease/deposit, ownership) prevelant in senior housing models, advantages and their disadvantages.
Emerging models, new initiatives and best practices that influence or drive the Silver Economy.
Senior Housing search tool by Samarth
Goto https://www.samarth.community/senior-housing and look for a senior living facility or old age home for you or your family. It is a easy-to-use tool and they advise users to make personal enquiries upon locating a facility.
Sukh Dukh Helpline by Pallium India in partnership with MIND India, Caregiver Saathi and Edjacklegs.
HUL and Portea partner to drive Mission Hope in Delhi and Bengaluru
All of us likely read about the unfortunate death of a 30-year old woman from Kerala, in Israel recently. Here are four stories picked up from mainstream newspapers and magazines, and the parts marked in yellow refer to her occupation in these articles.
This difference in reference also highlights the general lack of awareness of the differences between various jobs (domestic help, caretaker, caregiver, nursing attendant, etc) and activities involved in providing (elder) care.
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