- The elderly Indian population is one of the fastest growing in the world.
- At 110 million, India has the second largest global population of ageing citizens.
- By 2050, that number will probably increase to 240 million.
Yet, India lacks basic infrastructure and expertise to support the health & welfare of our elderly.
According to multiple surveys across the country, for most Indian senior citizens, the biggest concerns are: Healthcare costs, Lack of financial support and Isolation. In addition, most of the aged are not accorded the dignity of care they deserve in later life.
Lack of physical infrastructure is a major deterrent to providing comfort for the aged. There are few purpose-built Care Homes or even public ramps available for the less mobile older citizen – for example those needing wheel chairs access. With increasing longevity and debilitating chronic diseases, many elder citizens will need better access to physical infrastructure in the coming years. This would be both at their own homes and in public spaces, including roads and malls.
Very little information and knowledge exists about specific geriatric diseases. Mental health issues are rarely discussed and the country is ill-prepared to deal with the increasing incidence of Dementia, Alzheimer’s and depression amongst the elderly. There are few facilities and experts who can manage geriatric health effectively even in major metros.
In addition, there is little public or private financial support for the elderly. Research shows that of the 450 million Indians who are working, not more than 45 million are eligible for pension. Senior Care Health Insurance has very low penetration and has extremely poor pay-out history. Yet, health costs keep rising in old age.
Unlike most developed countries, Emergency Response infrastructure for senior citizens is ill-developed, including availability of public ambulance for hospitalization. One of the biggest fears for most senior citizens living alone is how to access an Emergency facility, if required, especially at night.
Rapid socio-economic change, including more nuclear families, is also making Elder Care management difficult, especially for busy adult children responsible for their older parents’ wellbeing. Managing Home Care for the elderly is a massive challenge as multiple service providers, who often do not talk to each other,are involved in providing that care -nursing agencies, physiotherapists, medical suppliers. Most of these providers are small, unorganized players who extend sub-optimal care quality.
Most senior citizens who live alone suffer due to lack of companionship – sometimes exacerbated by lack of mobility due to ill health. Loneliness and isolation are major concerns among elderly Indians above the age of 60. Isolation can result in gradual depression and other mental disorders in the elderly. Developing a strong bond with older parents and involving them in your life could be beneficial for all. Even if you stay far away or have busy lives, it is possible to be in touch with them more fully – by visiting them often during holidays, encouraging the children to call them, helping them with a shared hobby possibly, connecting through Skype, teaching parents the joys of e-mailing or sometimes sending “surprise” gifts. Basically anything that shows you care and have been thinking about them.
What happens if your favorite grandparent develops Dementia? How do you provide effective Home Care and deal with her hallucinations and delusions? Though Dementia develops from irreversible causes, it is possible to help her function well for as long as possible. But in India, there is little organized support to actively manage these conditions. Ideally professionals should be involved with the family to develop a daily routine, encourage independence and provide different therapies with proper Dementia care (e.g. cognitive stimulation, behavioral therapy, music therapy). Trained care workers should be engaged to provide companionship and help in daily activities – bathing, eating, dressing and exercising. Care workers are also important in creating a safe home environment that helps her sleep well and keep her out of harm’s way.
Another common problem in old age is bed-wetting or incontinence. Women generally suffer from incontinence due to weaker pelvic muscles while men tend to develop it due to enlarged prostate glands. Incontinence is embarrassing for seniors and maybe tough for the carer to tackle. But it is important to talk about incontinence and understand its causes. Stress incontinence is caused by laughter, bending or sneezing. Urge incontinence is caused by sudden bladder contractions while functional incontinence is caused by conditions like Dementia when she forgets to go to the bathroom. But whatever the cause, it is possible to tackle incontinence proactively. Whether it be strengthening of pelvic muscles through Kegel exercises, helping seniors eat and drink the right kinds of food or liquids, creating charts of “leaking times” so that they can be encouraged to visit restrooms more frequently – professional help can improve manage the condition. Use of adult diapers or medication could be other solutions to tackling incontinence.
In the larger scheme, the government should look at Elder-friendly policies and develop a better social infrastructure to reduce private costs. Currently, less than 4% of India’s GDP is allotted to the healthcare sector. In addition, even amongst senior citizens who are eligible, less than 5% is covered by the health insurance scheme of the government.
Given the pressures on government finances, the private sector needs to step in with innovative, scalable & affordable Elder Care solutions. From Financial Services to Home Care to Mobile Health solutions for the Elderly – the opportunities are massive.
However, the nascent Indian Elder Care industry is fragmented and offers poor quality services. Sensing the opportunity for both social good and economic returns, private companies are now providing more comprehensive Elder Care outside a hospital environment including Home Nursing, Rehabilitation centers and Intellectual Companionship.
TriBeCa Care: In-Home Companionship, for example, is Eastern India’s largest professional Elder Care Company. Launched as a social enterprise in 2013, TriBeCa Care provides Medical, Non-Medical & Emergency Response support for the elderly in Kolkata. Run by global professionals – with many years of senior management experience – TriBeCa Care brings “one-stop” Elder Care to busy families. Offerings like TriBeCa Care’s makes it easier for families to manage the entire spectrum of care for their elderly loved ones.
India’s demographic dividend, of being a ‘young’ country, will soon turn into a demographic nightmare if infrastructure and services are not developed quickly enough for our ageing population. Private companies will play an increasingly important role in bridging the massive gap between investments & expertise needed and what is available from public & NGO sources.