Integrating India’s elder-care ecosystem

The Supreme Court’s recent directive to the States to provide details about the number of age-old homes and facilities currently available across the country is a timely intervention aimed at prioritising care for elderly people in the country’s welfare measures. The Association of Senior Living in India (ALSI) flagged the widening care gap for the elderly population in its latest report, reinforcing the urgency of judicial intervention to bridge this deficit. Moody’s Ratings projects that India’s fertility rate falling below the replacement level will lead to a critical demographic shift, resulting in a much older population in the latter half of this century, which has raised alarms about the urgent need to recalibrate resource distribution for pensions and healthcare. These projections demand that the central government and the states prepare for an anticipated future where a smaller labour force will be compelled to keep the economic engine running to support an expanding elderly population. The ASLI report ‘Silver Surge 2.0: From Places to Care – Building India’s Senior Care Continuum’ emphasises on the importance of creating “integrated ecosystem where independent living, assisted living, rehabilitation, memory care and home care are available as needs evolve.” This approach underscores the need to move beyond traditional old age homes or focus on pension amounts and innovative approaches of combining real estate, healthcare and social welfare to accelerate the growth of such organised senior living to facilitate elderly people to live an independent but active life by owning a private apartment, on-call medical assistance, security, wellness activities, etc. The traditional old age home provides basic beds and subsidised food and primarily accommodates elderly people lacking family support, with limited income or no pension. Its primary focus is to provide safety and basic needs. Elderly residents have few personal choices, despite carers’ and authorities’ best efforts to support them, meet their healthcare needs, and provide warm, personal care. Modern market economies require younger members of families to migrate to places far away from home to work, and often the elderly are left to live alone with limited choices available to continue an active life or seek timely or emergency medical care. The ASLI highlights a significant gap in elderly care: only 1.5% of the elderly population has access to organised senior living that offers an integrated care and support system, despite their numbers having surged to 166 million in the country. The elderly population is projected to rise to 347 million by 2050 (21% of the total population), according to ASLI, reflecting the mounting challenge of building a robust social security system to support a rapidly ageing society. The central government formulating and circulating Model Guidelines for the Development and Regulation of Retirement Homes to all States and Union Territories is anchored on the objective of promoting safe, accessible and dignified living conditions for senior citizens. The government informed the parliament that the Model Guidelines prescribe essential standards to ensure that retirement homes are designed to meet the needs of senior citizens. These include the provision of wheelchair-accessible ramps and lifts, wide corridors with handrails, uninterrupted water supply, power backup facilities, ambulance services and in-apartment panic alarm systems to facilitate prompt emergency response. The guidelines are aimed at creating elderly-friendly infrastructure that promotes safety, accessibility and independent living for residents and the government. While policy support is already available, affordability of the retirement homes is a key determinant for deeper penetration to match the rapid rise in elderly people. For elderly people with no pension and family support, buying or renting accommodation in retirement homes is beyond their reach. This situation calls for remodelling the conventional government-funded old age homes on the lines of retirement homes or organised senior living so that the elderly population from marginalised households are not deprived of living a dignified life of making independent choices and quality healthcare and support. The central and state governments undertaking a review of current welfare measures aimed at supporting the elderly population and weighing options to reallocate some of these resources to remodel the age-old homes into retirement homes can facilitate the desired transition from basic shelter-based support into an integrated ecosystem of care and support as recommended by ASLI for elders with low income. Encouraging all households to spare income shares for savings to fund organised living or contribute towards government-funded retirement homes is essential to prepare the society for the demographic shift and associated challenge of mobilising resources for the care and support of the elderly. The demographic shift is a reality that cannot be wished away. Preparing for robust elder care in India is no longer a choice but an urgent necessity to prevent the drift into a crisis.