Dimly lit, poorly kept rooms, unkempt elderly sitting or lying listlessly in their beds surrounded by smell of decay mixed with strong disinfectant, some knick-knacks lying around to fill the available space, and disinterested staff talking among themselves or shouting at the elderly, going about their business of managing things. This is the image that generally comes to mind when one thinks of old age homes. Having visited scores of senior living facilities around the country as part of my work in building Samarth Eldercare, I can say this is not too far from reality for a very large number of places. Many old age homes are run by trusts and charities where the visionaries, management and benefactors who started it with noble intentions are gone and the support since has dwindled. The situation described above applies to a large number of such places. I have also come across a number of old age homes and facilities which have well-intentioned owners and management but the situation is still not very different. In these cases, it is not for lack of means, but for lack of know-how about how these places can be operated to make them vibrant abodes for elderly where they live life rather than pass their days. At the other end of the spectrum, there are now luxurious communities which provide the best of comfort and care – both for independent and assisted living, to those who can afford and have the inclination to make a new place their home in their twilight years.
The last few decade have seen major socio-economic changes such as increasing need for women to become economically active and become part of the workforce, increasing mobility leading to more nuclear households, altered social norms of care of elderly in the family, and the increased financial capacity of ageing urban elderly to fulfil their need to live independently. These changes have accelerated rapidly in recent years and will do so even faster in coming years, making it even more important for elderly to have options where they can lead a life of dignity, security and happiness on their own terms. This need is not limited to the wealthy. A growing section of elderly across the economic spectrum have need for senior living facilities that suit their budgets.
Now let us look at some numbers. India, with elderly (people over 60 years of age) constituting 8.6% of the total population, is classified as an ‘aging country’ according to the United Nations. One in 6 adults in India is elderly. We will add 12,000 elderly every day on an average for the next 10 years! By 2040, our demographic dividend will come to an end and the dependency ratio will start increasing. By 2050, we will be a super-aging country according to the UN classification with elderly making up 20% of our total population. For comparison, there are only 7 countries today with elderly population above 20% (led by Japan at about 28%). The percentages often hide the reality of actual numbers. With above 100 million seniors, we have more elderly than US and Japan combined today.
The senior living capacity available for this massive need is grossly inadequate. Samarth conducted the first comprehensive study of the situation with support of Tata Trusts and UNFPA, taking a data-based approach to develop a robust estimate of available supply. This study looked at both old age homes and senior living real estate developments in India across 83 cities. It projected the data and arrived at a present capacity which, believe it or not, is enough to house less than 100,000 elderly for a population that is above 100 million. Driven by increasing number of elderly and changing norms, we estimated that the need for senior living would rise to around eight to ten lakh beds in the next 10 years, which is an eight to ten-fold increase over the current base implying a compounded increase of ~25 % annually each year.
A big part of the answer in solving for this challenge lies in developing standards for senior living facilities. It is obvious that there is a need and market for many types of facilities: from basic to uber luxury. On the demand side, users and customers are constrained by the lack of factual assessment of the facility which signals quality versus cost and clearly defined expectations that it will meet. Much like what we see in hotels or hospitals, where the customer proposition is a combination of infrastructure and service, a standard gradation of senior living facilities will bring the necessary transparency to encourage and assure consumers. On the supply side, standards provide a way for senior living facility owners, management and operators to clearly articulate the proposition and price it accordingly. Very importantly, presence of graded standards for various levels of such facilities will also serves as a useful guide for owners and managers for improving quality. For example, If I have an old age home that is rated 1-star, and I know what 2-star and 3-star would need, I get a clear idea of what I should do if I want to upgrade my quality. I may also choose to be a solid 1-star old age home which has its own clientele and market and know the standards I must meet.
As part of our work we evaluated various models and implementation approaches used globally for senior living facilities and developed a solution for India with its diverse needs, administrative structures and development goals. The proposed framework which is based on 5 key areas, namely Infrastructure, Physical needs of elderly, Safety and security, Dignity and respect and Management of facilities, and comprises of 28 performance parameters within these areas, is now a public resource for policy makers, owners, managers and developers. Our next goal is to help create model facilities as per these standards, which can serve as operating benchmarks and learning resources to help current and future owners and managers bring quality and transform the landscape of senior living facilities in India.
Asheesh Gupta is Industry Scholar at Cornell Institute of Healthy Futures, Cornell University, and the Founder of Samarth Eldercare, which is India’s leading national organisation reaching nearly 10 million elderly in India through its various initiatives providing care, nurturing elder communities and operating the national helpline for senior citizens in multiple states.