From Senior Living to Care in India – An Evolution

Date: 19 April 2019

“Nothing is permanent in life. Change is the only constant factor!”

About fifteen years ago, old age homes provided shelter to the elderly who were from the financially disadvantaged class and those who were destitute. Old age homes continue to take care of the elderly from that segment of society and are mostly run by charitable institutions/NGOs. These homes are the only hope for many elderly persons who have nowhere to go.

We also have “shelters” that provide very basic requirements in life – a cot, common toilets, food and a roof over the head. If someone falls sick, they are moved to Government hospitals. There are also old age homes, which depend on charity for every meal, clothing etc. Dedicated NGOs and charitable institutions who run these facilities are messiahs to the elderly, physically and intellectually disabled persons, those who could not bear physical abuse from their kith and kin and many who have been thrown out by their children. Old age homes have better accommodation than shelters, some of which have only temporary overhead protection. What is inadequate in terms of comforts and infrastructure is compensated by love and community life and more importantly, a secure life.

Seventy-five years ago, old age homes and shelters did not exist. The need was not there. We had joint families and it was taken for granted that elders in the family would be taken care of by the younger generation. The breakup of a joint family system, evolution and acceptance of nuclear families, the attitudinal change to values and disregard to customs and traditions as well as children going away for livelihood away from homes led to a situation that made life in old age a cause for concern – both for the elderly and for the children.

This is India where 130 million elderly population live. The numbers are going up year after year. Thanks to longevity and access to health care, the life expectancy is increasing by the year and by 2050 the elder population would constitute about 20 % of the population of India. 70 % of elders live in rural areas. We are expected to have a very young population of 35 years constituting 65% of our population

Old age homes did not suit the requirements and lifestyle of Middle and Upper Middle-Income Group senior citizens. These old age homes lack the ambience and comforts as well as the class that we see today in privately run retirement communities. These old age homes have a stigma attached and neither the Middle nor Upper Middle-Class citizens want to live in these homes nor are their children wanting their parents living in them since it affects their social standing in their circle of friends.

Around the Year 2000, old age homes were re-modelled to suit the requirements of Middle and Upper Middle-Class citizens. This process of change was due to various factors as given above. Children getting a better education and moving far away from parents in search of greener pastures especially in the wake of Y2K, made this class of people sit up and look as to who will take care of the seniors as they age.

The parents could not move with the children as they missed their lifestyle in the place that they had lived their lives. They missed their friends, relatives and more importantly, their routine. They missed their independence and freedom. Living, as one aged, was a problem both for the parents and also for the children. Both the parents and the children did not know how to fill this void between dependency and inter-dependency. In many cases, it was considered improper for parents to expect money or support from children, especially when the children were girls, who got married and moved to their husbands’ homes or set up their own homes, far away from their parents.

The initial retirement communities that were modelled for senior citizens were on stand-alone mode, away from the city centres. Ashiana in Bhiwandi, Haryana experimented with their first senior living project and was an instant hit. Athashri by Paranjpe Group in Pune was one such facility, which was accepted and has grown exponentially. Vanaprastha and Dhyanaprastha in Coimbatore were the ones based on such a model. Covai Property Centre (I) P Ltd in Coimbatore set up their first project in 2004 called Soundaryam Comfort and Retirement Homes, which was a stand-alone community about 12 kms from the city centre. Covai called it “Comfort and Retired Homes” in order to remove the stigma of “old age homes” from the minds of the residents.

These Comfort and Retirement Homes gave birth to retirement communities, also called “senior living communities”. The name “home” was also dispensed with. Retirement communities are not extensions of real estate. The core competency lies in providing services and care to seniors with passion and compassion and, ensuring their freedom and independence. In a real estate model, the developer exits after the project are handed over.

Retirement communities are based on “relationship for life and beyond”. Unlike in Western countries, retirement communities in India are not impersonal and segmented. Our retirement communities come with emotions and much higher expectations. It is in our heritage and culture to look after our elders. Family ties and bonds between the family members in a society, which is now nuclear, are still strong. Go to any marriage or death and, you will see this bond.

From being in a stand-alone mode, senior living communities are now part of large townships. We see a mix of young and the old. This trend is mainly because of longevity since an elder citizen may live over 30 years in his or her post-retired life. With awareness and being conscious of wellness, physical fitness and good nutrition, senior citizens are more active and do not want to be counted in the category of “retired.” Age is only a number is the belief and that number can stagnate if one takes care of his or her health.

Even in retirement communities, we notice two distinct groups – those below 75 years and those above 75 years of age. Subject to not being seriously disabled, the “younger seniors” or the “millennial seniors,” have high awareness levels and knowledge of technology. They desire to be part of the group of people who are young, play games, go to regular gymnasiums, run a marathon, drive cars, love pasta and burgers (!) and in effect continue to do what they did before the age of 60. And they do so until their physical or mental conditions permit them. They have money and have planned their retirement better than the “older seniors.”

The older seniors are those above 75 years of age, wanting a more sedentary retired life with fixed timings for everything. They are conservative and traditional and, are unwilling to experiment. This group may have serious disabilities or age-related issues, which prevents them to continue with such physical or routine activities, which they could do before. Their longevity and life in the times of reduced bank interest rates and higher tax regime have eroded their net worth. They worry about expenses for care, which they may need to cater for the future with advancing age. Thus, we witness retirement communities having young and old seniors and this is bound to continue so long the cycle of life and death remains.

While moving into a retirement community seem to be a viable option for seniors to live, the trend now is to postpone such a move, so long as one is physically and mentally active. The age of entry into retirement communities is now increasing from 55 to 65.

Current Trends:

Preference is to shift to a retirement community that is part of a large township. These have the following advantages:

  • Senior citizens can have their freedom and independence as they have amenities specially designed for use only for them.
  • Seniors get to mix with others instead of being only in the company of similar people of their age.
  • They can enjoy other amenities available in the Township.
  • With longevity, many of them can play games like Tennis or badminton or take a swim and use Gymnasium or take part in a marathon or walkathon.
  • If the children also reside in the same township, it fulfils their emotional quotient and at the same time, they can lead their own life.

With longevity and access to better health care, vanilla retirement communities with shelter, security, food, basic medical facilities and some entertainment will not be enough. Once an elderly person enters a retirement community, the expectation is that he or she gets access to various facets of services and care that one may need with advancing age. Use of technology for quality services and care is a must. It is these expectations that made Covai to become CovaiCare.

Thus, care assumes importance with advancing age and services take a back step. So what type of care do the elders expect?

Chakras of Care by CovaiCare:

Team Covai Care, in its endeavour to provide total services and care to the elders in the various communities of Covai, has been working on different types of care that may be necessary as one age. These care requirements have been experiential. It is based on the actual needs that we have seen emerge in the cycle of ageing with elders. While working out the Chakras of Care by CovaiCare, the factors considered were as follows:

  1. Longevity makes it imperative that senior living communities provide or assist elders in that community to move to such care centres, where the specific type of care that may be necessary, is provided.
  2. Care is an essential part of senior living. If elders have to lead an active life, care – be it preventive or short or long term, is necessary. Disability is differently abled and needs, different types of care. This is not generic. When and what type of care would be necessary cannot be predicted.
  3. Every senior living community may not provide all types of care, but it is essential to provide assisted care and assist the elders to move into other types of care or provide the same as one would get in home care.
  4. Not all elders will need each type of care but some may need one or more.
  5. Care is expensive. In the context of declining savings bank interests, savings of elders get affected with advancing age. Therefore, the cost of care needs to be kept in mind without compromising the quality.
  6. Not all elders live in a senior living community. Most of them (28% of urban seniors) live in their own dwellings. This is where Home Care assumes significance and the challenge of quality home care at affordable cost is contingent upon the availability of skilled and trained caregivers. This is a big challenge in India.
  7. In most cases, primary caregivers (children, spouse, close relatives) provide care to the elderly. They need counselling and training, which is very inadequate today in India.
  8. Gerontology is still nascent in India and access to geriatric specialists in hospitals is woefully inadequate in cities as well as in rural areas.

CovaiCare encompasses not only retirement or senior living communities but also care for the elders in various manifestations. Team CovaiCare realizes that elderly living without care is like living in a dwelling without furniture. We call the various types of care as Care Chakras and together they form elder living and care.

Components of Covai’s Care Chakra:

As shown above, various care components have become or becoming an essential part of living.

The Future of Elderly Living and Care

From Old Age Homes/Shelters to Comfort and Retirement Homes to Retirement or Senior Living Communities to Senior Care Centres has been the journey of senior living and care in India over the past fifteen years or so. It is still nascent. Nothing much has happened for the elders in the rural sector and the requirement is large. The steady increase in urbanization of the rural areas, access to better health care and education, the societal change that the urban areas witnessed are already making inroads into the rural areas. While the problems of the elders of the rural areas over the next 30-40 years will be similar to the ones faced by the urban elders, the numbers would be very large. Unfortunately, nothing much is happening to the rural elders.

Merely 1-2% of elders may be living in retirement communities in the next 30 years. But longevity makes care centres very relevant. The shift of the elders may happen directly to the requisite care centres. However, many would like to move into a retirement community at some point of time for getting services such as housekeeping, security, food as well as social life in the company of like-minded people. Retirement communities take away daily hassles of seniors including routine and emergency medical care, take away boredom and create group cohesion and a sense of belonging.

We may see home care segment being strengthened with trained staff through various skill-development programmes of the Government. The statistics are staring at us and the elderly segment will need more attention especially in rural areas.

We need to find solutions to the issues that we are likely to encounter. Through discussions, the involvement of all stakeholders including the government both at the Centre and the States, we should find solutions to the subject of elder living and care. Already some States are seized of the problem and are applying their mind to the emerging problem of elder living and care. Surely others can follow.

With proper care and use of technology, It is possible for a man who is 85 years of age, suffering from Diabetes and affected by Parkinson’s disease and Stroke, dependent on 24X7 caregiver and on a wheelchair to be able to walk without a walking stick by proper rehabilitation through physiotherapy, wellness and change in lifestyle including diet.ByTEAM COVAICARE

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