Here's what the future of the senior living industry looks like for 25% of India’s population

• India is sitting on a demographic time bomb. People over the age of 60 are expected to account for 25% of India’s population by 2050.
• The concept of senior living has been gaining traction in recent years owing to the migration of Indians and the breakdown of the joint family model.
  
• However, most senior care options are mostly geared towards the upper-middle class. The low-cost options leave a lot to be desired.

My father was 64 when he had his first heart attack in September 2015. He downplayed the pain and told my brother and I, who were 23 years old at the time, that it was just acidity. We didn’t know better. Four days later, on his 65th birthday, the heart attack led to a stroke, which affected a small part of his brain that dealt with his speech and comprehension.

Following his discharge from the hospital, my brother and I worked out an arrangement with our respective employers wherein we worked from home on alternative days so we could take care of him.

My father slowly regained his verve and became somewhat self-sufficient by the end of 2015. However, he suffered another stroke and an epileptic seizure in April 2016.

After my father suffered a third stroke in February 2017, the idea of putting him in an assisted living facility was floated by my uncle. My brother was living in Bombay by this point and I was spending more time at work so it seemed like the sensible thing to do.

The concept of senior living, while relatively new to India, has been gaining traction in recent years and with good reason. There were 103.8 million citizens above the age of 60 in India in 2011, according to the Ministry of Social Justice and Empowerment, and the number is expected to reach 143 million by 2021 and 173 million by 2026.

Concurrently, as nuclear families are in vogue, the safety net afforded to old people by the joint family model is disintegrating. India has also seen a wave of migration in the last few decades as young people have gone to big metros as well as foreign countries in search of better opportunities, leaving their parents behind. More and more old people are living alone- which makes them vulnerable to crime and depression.

And the problem will only get worse. People over the age of 60 are expected to account for 25% of India’s population by 2050.

India’s emerging market counterparts like Brazil and China are also sitting on a similar demographic time-bomb resulting from decades of exponential economic growth, improved health outcomes and stretched budgets. While Western countries like the US and UK started laying the foundational groundwork for their senior care industries in the latter half of the 20th century, BRIC countries only began developing an industrial framework to address the problem in the recent past - that too, by encouraging foreign participation and co-opting the western model of senior living which marries real estate development with at-home care.

The Senior Care Act

The Indian government has made some noticeable interventions but they haven’t produced the desired results.

For example, in 2007, there government of India passed the Maintenance and Welfare of Parents and Senior Citizens Act. The act requires children to take care of their parents in old age. It also mandates the establishment of old age homes by state governments. The act has failed on both fronts. Senior citizens neither have the knowledge of their rights or the will to take their children to court. As of mid-2017, only 360 homes had been built by state governments with central funding under the Integrated Programme for Older Persons (IPOP), according to data from the social justice ministry.

India’s private sector takes the lead

However, India’s private sector has spotted the gap in the market, taking inspiration from the US’s $300 billion senior living industry.

By 2013, India had 30 assisted living projects in India, with another 30 in the pipeline, according to Jones Lang Lasalle, a commercial real estate firm.

There are a number of developers building “retirement resorts” in North India to cater to the high-end segment. Max India, a healthcare giant, has a 200-block senior living facility called Antara on the outskirts of the city of Dehradun. Pitched as the confluence of lifestyle and life care, the community boasts state-of-the-art medical facilities with in-house doctors as well as a a fitness centre, which includes a gym, spa and a swimming pool. Prices for a property here start at a cool $300,000.

However, the senior living trend actually took flight in south Indian states like Tamil Nadu, Karnataka and Andhra Pradesh, where a large number of non-resident Indians (NRI) hail from, before spreading to the North. In recognition of their high purchasing power, Covai Care, a Coimbatore-based developer, launched S3 Retirement Homes, one of India’s first retirement projects, according to its general manager, S Prabhakar, in 2007 to cater to this market. While the senior living market has doubled since then, says Prabhakar, it is still in a nascent stage.

Covai Care primarily offers three forms of care facilities for its residents- assisted care for senior residents, palliative care for terminally ill patients and memory care for patients with dementia or Alzheimer's with properties in Bangalore, Mysore, Coimbatore and Pondicherry.

The properties don’t come cheap either. With prices ranging from $60,000 to $150,000 depending on size, residents also have to pay around $270-$300 a month for medical and maintenance fees. Prabhakar maintains that these costs are in line with the average cost of living for these patients anyway. He also expects the demand for these properties to be robust, citing the increase in life expectancy and growing trend of senior citizens who crave independence.

The middle ground

India is striving to create cheaper offerings for the middle class too.

Arun Gupta, the chief executive of Age Ventures India (AVI), a non-profit organisation that petitions builders to develop properties, echoes Mr Prabhakar’s beliefs about the industry’s prospects. “The senior citizen population is growing at a rate of 3.8% per annum, while the overall population of India is growing at 1.8%” he says.

For a small consulting fee, AVI works with developers to build elder care homes and communities by sharing best practices and identifying project locations. These homes are modestly priced, with a 1BHK unit starting at $22,500 at the organisation’s first project in Bangalore.

Ashiana Housing, a Delhi-based real estate developer, pitches its retirement communities to the middle class in tier-1 and tier-2 cities . The price ranges between $45,000 million and $100,000 for the units, and that demand for them follows the same pattern as the housing market. Amit Dogra, the sales manager for Ashiana's senior living segment, doesn’t think much of India’s cultural aversion to old age homes. “98% of our residents chose senior living independently. They were not forced by their children.”

Abhishek Mohanty, a facility design and marketing consultant at Epoch Elder Care, feels otherwise. “Social stigma, especially from relatives, is more of a problem than affordability”, he says. “This is why we target higher-net-worth individuals and NRIs as they are more open to the idea of senior living and are willing to spend the money”.

Founded in 2011, Epoch Elder Care originally started as a provider of home care services and personnel before transitioning into the assisted living space. It follows a rental model, entailing a one-time deposit and monthly rental fee, which is better suited to middle class customers. Epoch has three retirement homes with monthly fees of $1,800 for short-term single occupancy guests and $1,350 for long-term guests, which excludes the rather-high 18% GST rate on senior living.

Around 60% of Epoch’s residents are dementia patients, which limits the amount of residents per facility. Mohanty is optimistic about his company’s prospects given the country’s increasing awareness about dementia and the growing number of senior citizens. By 2022, Epoch plans to have as many as 12 facilities, with an average of around 50 guests each, operating all over India.

The sense of stigma attached to senior living, while declining, is still a consideration for the relatively well-off. Rachna (name changed), a corporate lawyer in her 40s, says that the decision to send her father to a retirement home outside Gurgaon last year was not an easy one. “My friends felt that I was relinquishing my sense of duty,” she said, “and my father likened the experience to being sent to jail”. However, she feels that it was the best option since she and her husband had full-time jobs and two teenage children to take care off. Now, her father, a former stroke victim and arthritis patient, benefits from round-the-clock care and companionship in the facility.

No respite at the bottom

Senior living seems to be an effective solution for people who can afford it, but for the hundreds of millions that can’t, their options are few and far between.

At the lower end of the spectrum, the government-operated old age homes, which feature dormitories instead of rooms, are understaffed and in a deplorable condition, according to Matthew Cherian, the chief executive of HelpAge India.

There are a number of cheaper nursing homes that are run by private owners, however quality is still an issue given the lack of government-imposed industry standards. And some of these also operate without licenses and accreditation. In 2012, 68 nursing homes were found to be operating illegally in Pune. A variety of non-profit organisations like HelpAge India also run and support old age homes, but the supply of beds in such homes is drastically outweighed by the number of people that need them.

As I write this, it’s been more than 13 months since my father’s last stroke. He’s in good spirits. He’s been eating well and going for walks every evening with other senior citizens in our gated community in Gurgaon. He has moved past his initial resistance and softened his stance towards senior living facilities, in anticipation of my eventual departure from home.

“If I have to go one day, I’ll go”, he says. “Maybe I can get my friends to come with me too”.

If only other Indians like him had the same option.