India’s demographic is greying at an alarming rate. 110 million of the population is already 65 years +, projected to reach 170 million by 2025 and 240 million by 2050. Of the six million known cases of Alzheimer’s or dementia in India as of 2016, most are being taken care of by in-home care and home health care services, due to the lack of communities offering memory care services. Thus, senior housing is an emerging opportunity area for the builder and development community. Abdulla Kagalwalla, MD, Signature Senior Living India, a consultancy for the senior housing and living industry, examines the senior living and care options available in India
Senior living in India is often wrongly referred to as an ‘old age home.’ Indian laws and various acts also carry the same terminology of ‘old age homes.’ The picture and perception of old age homes and therefore senior living is that of a grey and decrepit place run by charitable institutions for the homeless, destitute and elderly. The images that come to mind are not pleasant.
Coupled with this perception and lack of awareness is the
associated cultural and social taboo of ‘not taking care of your parents or elderly’ if they were to reside in a senior living community away from home. These are the major causes that have stymied the growth of much needed senior living communities in India.
Let us look at ‘adoption’ from a different perspective and try to untie the knot that has kept Indian seniors from availing and enjoying world class senior living communities.
Provision of care for a loved elderly in familiar and comfortable surroundings of home with privacy and familial atmosphere is ideal. As they age, ensuring our parents or elderly loved ones independence for as long as possible at home is always the first choice.
However, there comes a time of objective evaluation where the level of care and assistance required for your loved elderly cannot be effectively provided at home.
The key to healthy ageing is to extend the independence of the elderly for as long as possible. Extending independence is not just a mere function of provision of medical care or of assistance, but is of ‘overall wellness’ which includes social, physical, intellectual, spiritual and emotional stimulation and care.
In the simplest sense, ‘senior living’ consists of independent living, assisted living and memory care housing and care services.
Apart from these, senior living and care spectrum include:
- Residential care homes
- Continuing care retirement communities
- Nursing homes
- In-home care
- Home health services
- Adult day care
- Respite care
- Hospice
The senior living spectrum graphically relates acuity levels with senior service classification and corresponding costs.
Senior living communities are designed and purposely built to accommodate the varying needs of its residents spanning from being independent to requiring high levels of care (high acuity levels) in a resort type atmosphere geared to overall wellness and healthy ageing in place. The communities incorporate a host of equipment, appliances and technology to ensure the safety of its residents whilst ensuring delivery of care and services.
Residents enjoy a host of social, physical, intellectual, cultural activities with personalised service of care and prepared meals as per their dietary requirements. Care and services are provided 24 hours, 365 days a year. With a host of amenities available, these communities ensure that the residents are engaged and live their retirement life with choice, dignity, freedom and independence.
Independent living
Independent living as a form of senior living is suitable for elderly who are generally independent and carry the ability to do activities of daily life by themselves. When one refers to activities of daily life, it generally includes dressing, grooming, bathing, personal hygiene, mobility, medication management and other personal activities.
In an independent living atmosphere, seniors are attracted by the prospect of enjoying the companionship of same age group residents along with a host of services that allow them to live in a carefree environment.
Independent living comes in various flavours depending on the physical build, configuration and the services provided. These are retirement communities, 55 + living, active senior communities, active senior living, senior apartments, retirement homes and comfort homes.
In developed countries like the US, independent living is typically on a rental (lease) model with monthly charges based on the community and kind of unit.
Independent living in india
India has witnessed a gradual emergence of independent living, mostly in the form of comfort homes, retirement communities and senior apartments. Even today, a majority of the new developments are retirement home communities and senior apartments with a few being truly independent living communities.
Typically, most of the projects offer general security, general maintenance and housekeeping services with a club house for resident activities. Dining services are available for residents on a chargeable basis. Practically all projects have tie ups with medical facilities; most have on call doctor, community doctor visits and nurse stations manned by registered nurses.
However, as perception towards senior living undergo a change, so do the trends.
Growth of independent living in india
The growth of independent living in India is directly related to its adoption by not only the Indian seniors but also by their families and loved ones. The pressing need for adoption is being driven by rapid economic development, changing socio-economic and cultural factors. This, combined with 110 million 60 + population growing to 170 million by 2025 and to 240 million by 2050 is compelling. Awareness, a well-educated and globally connected senior population desirous of availing post retirement services and the breakdown of social taboo are factors that will drive demand.
The builder and development community has realised the impending explosion of this asset class. This was very evident at the National Conference of CREDAI in August 2016 held at Shanghai where senior housing was one of the two emerging opportunities focused on.
The supply side is witnessing new projects being introduced adhering to international standards and world class senior living services.
India is on the cusp of witnessing a dramatic shift in the very near future where early stage retirement homes concept is being replaced by full-fledged independent living communities.
Assisted living
Assisted living is for seniors who require various levels of assistance with their daily activities of life. When one refers to activities of daily life, it generally includes dressing, grooming, bathing, personal hygiene, mobility, medication management and other personal activities.
Assisted living communities are an ideal solution to assist seniors to maintain their independence for as long as possible while offering them activities of daily life services. It is a great bridge to fill the gap between independent living and n nursing homes. It is by no means an alternative to nursing homes.
Seniors who are not in requirement of constant medical care, intensive care or skilled care but require intermediate or lower long term care are typically residents of assisted living communities. These communities work to ensure that senior residents continue enjoying a rich social and independent lifestyle filled with friendship, activities and events whilst providing benefits of having the extra care and support that they need round the clock.
The physical layout of assisted living communities are numerous ranging from tall buildings to flat single story structures depending on a host of factors, chiefly being the cost. Almost all the assisted living communities have apartments of various sizes with attached senior friendly bathrooms in one or two bedroom configurations.
Redefining senior care
Aassisted living is the fastest growing long-term care option. Seniors who are still independent but anticipate needing care in the not-too-distant future typically select assisted living over their current home.
Assisted living communities recurring charges comprise two basic components namely; room and board and level of care charges. The room and board component covers the rent and meals whereas the level of care charges covers the resident care component for personal and other services provided. The level of charges varies based on the amount of care required.
The scenario in India
The current availability of fully operating assisted living in India is negligible with a few communities spread thinly. There are less than 70 independent communities in operation and under development. However, there are encouraging signs of new assisted living communities being designed, developed, built and will be operated based on international standards which bodes well for Indian seniors. Just as it is the fastest growing segment in the developed world, assisted living could witness the same trajectory in india.
India’s demographic, social and cultural changes due to industrialisation and urbanisation are giving rise to the ‘need’ driven assisted living services. The growth in assisted living services is evident from the spurt of in home services organisations across major metro’s and tier II cities that have recognised the need and void and are offering at home assisted living services. The services offered are in the form of providing care givers and nurses for assisting the elderly in their activities of daily life at their place of residence.
It is but a matter of time, that India will witness a growth in assisted living communities that offer a comprehensive and whole ‘wellness’ package thereby addressing the need of senior’s requiring assistance while maintaining their independence.
In-home care and home health care services
Care provided at home for a loved elderly is referred to as in-home care. In-home care has the advantage of being private and personal in the comfortable surroundings of one’s own home. The type of care provided varies from person to person as also the frequency of care. Care is provided by caregivers (ward boys) and nurses and is typically non-medical in nature. In-home services are provided more preventively and are focused on helping the individual maintain independence and keep them at their optimal level of functioning by providing basic services and supervision.
Home health services are similar to in-home care where skilled nursing services are provided to the patient. Here the provision of services is by licensed personnel and generally cover pain management, infusion therapy, heart disease, psychiatric services, COPD, diabetes, chronic kidney disease, and oncology.
Both in-home care and home health care service provision is on the rise as an industry in india. Even in the space of senior living especially for assisted living and memory care, there has been a marked and significant increase in service offerings which are a direct result of the demand metrics that are being witnessed.
Memory care
Memory care communities are designed and operated to take structured and programmed care of seniors affected with memory loss due to Alzheimer’s or dementia.
Dementia is impairment in cognitive function that affects memory, personality and reasoning. Alzheimer’s disease is by far the most common form of dementia affecting the elderly accounting for more than three quarters of all dementia cases. The symptom progression is typically very slow occurring over an extended period of time.
With the progression of Alzheimer’s or dementia, the level of care and assistance a senior requires also increases.
At communities offering memory care, specially trained staff is available 24 hours a day to monitor residents and assist them with daily activities such as taking medications, bathing, grooming, eating, and dressing. Care programmes and activities are geared specially to those with dementia, and may include art and music therapy. Skilled nursing care is also generally available to those who need it.
The physical design of memory care communities contain resident units in a secure area with the intention of preventing wandering off and getting lost which is a common and dangerous symptom of this disease.
Memory care offers 24-hour supervised care with meals, activities and health management. Charges are usually all inclusive consisting of room, boarding and care or separate with two major components being room and board and care level charges.
The India story
In the past, majority of indian families failed to recognise dementia as a disease. The social and cultural taboo associated with the same prevented families from seeking appropriate guidance and importantly learning about care provision. Today, dementia is recognised as a disease and there is an increased amount of awareness on the subject. There are six million known cases of Alzheimer’s or dementia in india as of 2016. Today, most of the care for seniors afflicted with dementia is provided care at home. Apart from home care, there are some medical related institutions, spread thinly across the country, taking care of dementia patients on a long term basis.
Due to the lack of communities offering memory care services, care for elderly afflicted with various degrees of dementia is sought from providers of in-home care and home health care services. The need is evident from the growth of in-home and home health providers memory care offerings especially in metros and tier II cities.
However, there are encouraging signs of new assisted living communities with memory care wings being designed, developed, built and will be operated based on international standards which augurs well for indian seniors in need of these services. Senior Living Communities play a vital role not only addressing the needs and wants of its residents but also providing comfort to their families. Promoting overall wellness, they foster healthy aging in place with dignity, choice, freedom and independence. With increasing life expectancy and proportion of aging population in the next few decades, the growth and importance of senior living is inevitable.
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