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Why Elder Care Services is Unexplored in India

prasad1

Well-known member
Elder care in India is a slightly dichotomous term at the moment. On one hand, there is the looming statistics which suggests that this nation needs to gear up for a crisis (by 2050, the no. of elderly in India would be 308 million which would be 20% of the population) while on the other hand there still exists the dilemma of feeling judged (or judge) and stigmatized for seeking professional (additional) help for looking after their old parents.

Elder care is as much a sociological issue as that of access or affordability. We are conditioned to feel guilty if we hire a professional to give our 85-year old mom a bath and not do it ourselves. There is a reason why multi-specialty hospitals have a long list of empanelled specialists but not a single geriatrician.

The current (and future) challenge is not only the sheer no. of seniors but also about our ill preparedness to deal with this population, both from an economic and social standpoint. Increased life expectancy, reduced fertility rates, changing family structures, women joining the workforce & the middle class moving abroad, are all contributors to the immense burden on the current workforce and resources planned (or not) for the elderly.

But, as a culture, for generations we have always looked after our elderly- so what is the issue right now?
People are living longer, yes but are they living healthier lives?
The question we have to ask is: Is longevity synonymous with healthy ageing? Do we have the right to celebrate a long life if it’s not a happy one?

According to the WHO, Healthy ageing is defined as “the process of developing and maintaining the functional ability that enables well-being in older age”. Healthy ageing also impacts Quality of Life - a term, which needs to go hand in hand with longevity.

Strictly speaking, currently the life expectancy in the urban population stands at around 71 years and rural population at 66 years (SRS, UNDP report). Having said that, it is not so difficult to come across a 85 year old now a days, but almost instantly we wonder what is the health status of this elderly? This is largely because we do not fathom that this 85-year could be disease free, healthy and happy. Fact is, in an ideal world, old age is not always accompanied by ill health & sickness, frailty-yes but disease –no.

Unfortunately at the moment, increased life expectancy is accompanied by the presence of multiple medical conditions, dementia, decline in mobility, poor vision & hearing, a decrease in socializing and in a large no. of cases- loneliness.
Decades of conditioning have prevented us from seeking professional help and considering options like home care services, retirement communities, day care centers or assisted living homes. The feeling of ‘abandoning’ your parent sneaks in. But at the same time it is not fine to leave an ailing parent without adequate care, company and help, at home. The HelpAge India report (2015) reveals that the daughter-in-law and son emerged as major abusers and in certain cases, the daughter and grandson were also reported as abusers.

 

prasad1

Well-known member
To solve all these challenges we need to begin with awareness and acceptance, as a first step. Awareness, about the spectrum of challenges that are faced by the elderly today and acceptance, that the family alone cannot solve these. It takes an entire eco system to ensure that an old person is well looked after and their emotional, psychological, social, financial & physical needs are taken care off. The need for professional services for elderly is going to be huge. Just like children, the nature of issues faced by an old person is nothing similar to that of an adult. Geriatric physicians, nurses, physiotherapists, psychologists, nutritionists, social workers and even chiropodists are all well-established medical fields in the west and they exist for a reason.

Lack of trained resources forces us to solve issues through trial and error or simply overburden the primary caregiver into being the all-rounder. It is a vicious cycle of demand and supply- lack of awareness precipitates to lack of services. It is imperative that courses in gerontology are included in the curriculums of all physicians, nurses and paramedics so we start preparing towards a larger workforce from today. Normalizing and de-stigmatizing old age homes from the common perception that they are dark, dingy and only for destitutes needs to start happening now.

There will always be a beginning and the good news is that the ball has started rolling. People are slowly willing to fight perceptions in order to get better care for their parents. In the last five years we do see a spurt of elder care services spring up slowly and steadily. The industry although still fragmented is growing. Elderly healthcare expenditure in India is expected to grow from $24bn to almost $44bn (Source: FICCI Deloitte report 2014)

One can already see several models of the residential care services to choose from, day care centers, as well as home care services addressing both chronic physical conditions to the much-needed companionship. The young elderly (between 60 & 70) no longer expect the children to be the sole providers and are increasingly becoming open to accepting care from outsiders and remaining independent.

It is only a matter of time when elder care breaks the shackles of societal norms and gets recognized for what it is: caring for and loving the elderly. After all as Tia Walker says in her book The Inspired Caregiver: “To care for those who once cared for us is one of the highest honours.”

 

prasad1

Well-known member
Elderly care: Why India is one of the worst countries to grow old in
We have the second highest population of elderly people in the world, projected to rise to 12% of the total population by 2020. Therefore, under some definitions, we are an ‘ageing population’.

Picture this: My father, his best friend and I are chilling over glasses of single malt in the living room during his recent visit. My father brings up a development project in Calcutta that sounds interesting which has state-of-the-art facilities plus an on-call doctor and on-site nurse, fully serviced apartments from cleaning to linen changes and cooks. My uncle looks at him askance and says disdainfully, “You’re just describing one of those new-fangled old age homes. That’s not for me.” My father doesn’t press the point, but it appears clear that he is in favour of such a residential arrangement for himself, at the right time of course.

I’m left a little bewildered by this exchange. Like most of the families I know, we’re a nuclear family – I grew up with mom and dad, moved abroad, and now live in India with my own nucleus in a different city from my parents. Coincidentally, my brother and his wife and kid also live in my city. My parents, though, are happily entrenched in Calcutta, living the golf club life while still actively working. They’re in their mid-60s and have no intention of retiring – not in this lifetime anyway by the looks of it. We all know that at some point they will need to be minded though. It never occurred to me that I would not be the one doing the minding, although I hadn’t considered the possibility of moving to their city to do it. I just assumed they’d come to me. All of this got me thinking - what are the options today for the elderly when they reach that stage of becoming dependent?

With the descent of the joint family concept, with more and more seniors remaining active for much longer and preferring to be close to their own lifelong friends and communities, and with more children leading increasingly hectic lives where both spouses earn and with no experience of caring for an elderly person, there is a gradual erosion of the tradition of family support in India.

Here's some interesting data in this area. In the Global Age Watch Index 2014, India ranks 71st out of 96 countries on elderly (60 years plus) care. We have the second highest population of elderly people in the world, projected to rise to 12% of the total population by 2020. Therefore, under some definitions, we are an ‘ageing population’. 80% of our elderly are in rural areas with 40% below the poverty line and over 73 % illiterate. Scarily, about 90 % of them have no official social security (i.e. no PF, gratuity, pension, etc). 73 % of deaths among the elderly are related to heart disease, smoking and cancers. 20% of doctor’s visits, 30 % of hospital days and 50% of bedridden days are ascribed to elderly patients. So our elderly require many levels of care in inaccessible locations.

Who is going to look after all these people and who is going to pay for their care? A universal health insurance and pension scheme would certainly be a welcome move in our country and several advocacy groups have been working towards promoting a governmental policy on this.

For those who can afford it, particularly in the urban areas, one option is the many ‘new fangled old age homes’ out there. These are often termed ‘retirement resorts’ with round-the-clock ‘assisted living’ facilities. The arrangement involves the elderly staying permanently at a residential facility for a monthly charge that can range from Rs 4000 to Rs 30,000 and several lakh of rupees as deposits. Waiting lists for the more affordable rooms and the free homes (only a few hundred at last count in the whole country) run into hundreds. Companies like Aamoksh and Signature have significant investments in this space. Many old folk though prefer to continue to live at home for as long as is possible. For such people, companies such as Portea and ElderAid provide different packages of care, from nursing to paying the bills, depending on the level of support required.

For those who can’t afford to pay for these homes, the dismal government funding is a continuing problem. NGOs such as HelpAge India, Agewell India and Dignity Foundation provide support but rely on charitable funding to sustain their care levels.

Recently, I heard a horror story about a grand-aunt of mine who I was quite close to as a child. I remember, she used to make paneer ladoos for me. One of her sons was settled abroad and another in North India. When she became too old to care for herself, and possibly too much of a burden, the son flew in from abroad and dumped her on the threshold of the son in North India. The latter didn’t even bother to open the door for his unwelcome visitor. On the opposite end, I see my uncle and aunt care for my fragile grandmother through fall after fall, illness after illness, with never a murmur of complaint about the toll it may take on their own health and lifestyle. In either event, this is a stark rejoinder to us all to make appropriate arrangements well in time for our own care.

This article was written in 2014, the cost must have doubled by now.
 

prasad1

Well-known member
90% of India's elders work to survive
Global survey on the well-being of the elderly has ranked India 73rd among 91 countries.

Home to about 100 million elderly, India is one of the worst countries to grow old in. A first-of-its-kind Global AgeWatch Index that assessed countries on the basis of social and economic well-being of its elderly has ranked India 73rd out of 91 countries way below China (35), Sri Lanka (36) and Brazil (31).
The age index was released by HelpAge International to mark the UN International Day of Older Persons. It compiles data from the UN, World Bank, World Health Organisation and other international agencies.
The age index looked at four key domains – income security, health status, employment and education and enabling environment. And India scored poorly in all the four domains. With poor access to healthcare facilities, India ranked 85th in health status.

Clearly, the country remains very unprepared to take care of its elderly despite the fact that the number of adults aged 65 years and above is set to outnumber children under the age of 5 within the next five years.
The survey states that India’s strong economic performance and its already large and growing population of older people has not yet resulted in widespread income security and access to healthcare in older age. Almost 90% have to continue to work if they have to survive.
Though ranked among the lowest overall, India fared a bit better than neighbouring countries like Nepal (77) and Pakistan (89).

Afghanistan was ranked as the worst place for older people, while Sweden was rated as the best country to grow old in.
“Many countries are facing large scale increases in their ageing population. Policies which support these people to stay healthy, work if they want to, and play a pivotal role in their family and society, are needed alongside pension and care provision. Older people are part of the solution,” said Mark Gorman, director of strategy, HelpAge International.
Top 10

1.
Sweden

2. Norway
3. Germany
4. Netherlands

5.Canada
6.Switzerland
7. New Zealand

8. USA
9. Iceland
10. Japan

Bottom 9

1.
Afghanistan
2. Tanzania
3. Pakistan

4. Jordan
5. Rwanda
6. Malawi

7.Nigeria
8.West Bank and Gaza
9.Montenegro.

 

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