Elderly care in India

(Reposted here from my LinkedIn article)

According to the UN and other sources, by 2050, India will have the peak working age population of 72% which is extraordinary! If at all we have a shot at Viksit Bharat anytime this century, it could very well be that timeframe.

According to NITI Aayog and various other sources, by 2050, one in four Indian will be a senior citizen!

Think of it this way: currently we have about 52% of population in working age (20-59 years), and about 9% of population as senior citizen (60 years or more). In 2050 (which is the peak of our demographic dividend), we will have about 72% of population in working age, and about 27% of population as senior citizen.

If you are in the age bracket which makes you a senior citizen by 2050 (or before), you should be worried by this 3 times increase in people needing senior care, because it doesn’t seem like we are geared to handle such a growth. Capacity building takes time, and as I will argue below, it also requires social engineering in addition to capacity-building, which takes much more time.

If you don’t feel worried, please go ahead and read this old report from State of Elderly in India by HelpAge India (2014), the UN’s World Population Prospects (2019), and Senior care reforms position paper by Niti Aayog (2024).

My personal experience with elderly care

I experienced the challenge with elderly care services and products first hand when my mother had to undergo spine surgery and had a long recovery process (still going on), which required us to figure out everything from moving bedridden patients inter-city to finding after care professionals which are affordable and trustworthy.

We have made a lot of improvement in availability of products for elderly (walkers, sitting cushions, back support belts, physiotherapy equipments, etc.). However, I could see that services and infrastructure are a problem. Even in a place like Hyderabad, I encountered restaurants, temples, diagnostic centers, physiotherapy centers which were not wheelchair-accessible, getting reliable 24×7 support was a challenge, getting doctors who visit home was very hard, ambulances were inadequate when the patient had to be 100% bed-bound.

The situation is quite grim, we are not at all ready for the volume that is coming, because we need such services in Tier 2 and Tier 3 cities to cater to the volume.

The social changes will magnify the problem

Niti Aayog paper provides a good deal of details on the key trends of challenges and opportunities, and is a good source of information for anyone interested in understanding this space deeper. They also talk of business opportunities in elder care and and the market size and potential (which sounded a bit out of place).

However, one of the areas that I was hoping it would cover was around design of habitats – the urban and rural planning – that can make offering elder care services easier. It doesn’t talk anything about planning of habitats. Rural planning is important too because 70% the elderly reside in rural setup and this is not going to drastically change over these years.

While the family is still the primary care provider for elderly and will continue to be for some time, we will see a large number of elderly who will not have such option or will prefer to live on their own. This is because of the trend of nuclear family – when kids leave home, the couple stays alone, and they will want to continue to stay alone and in a place where they want to (or kids may continue to follow the trend of nuclear family and focus on their own kids rather than parents).

Elderly care solutions require social engineering

The elderly will want to age in place (be where they want to be, and not be driven to where the care provider resides). To enable this at scale, I believe what we need to build is a concept of a ‘socially smart’ city which makes it easier for the elderly (60-80+) to live comfortably in a habitat of their choice, without forcing them to do things like staying in a care home, moving to where the kids are (if they are able and willing to support the parents), etc.

Such a ‘socially smart’ city (and towns) needs to address the following questions:

1. How do we enable easy access to affordable healthcare? Good hospitals tend to be in crowded areas of the city, and it can be hard to access them for senior citizens, even if they can afford it.
2. How do we enable access to affordable service providers (cooks, maids, cleaners, helpers, drivers, etc.)? If they live close by, their cost of living is high, which drives the service costs up. If they live far, access becomes a problem.
3. How do we enable a good quality of life for them? Healthy senior citizens are assets to the society and they would want to work in some capacity, build a community around them, and engage with people who are not senior citizens. How do we make it easy for them to work, engage with others (say kids or young adults), build a community, and overall improve their quality of life.

It is good to see startups coming up to offer elderly services and products, but we also need large scale interventions and investments in urban and rural planning to support this.

Are our elderly happy?

There is some good news though. The World Happiness Report (2024) says this for India:

Older age is associated with higher life satisfaction in India, refuting some claims that the positive association between age and life satisfaction only exists in high-income nations.

So there is a good chance that these people will be happier than the other 75% of the population.

Of course, this report places India at an abysmal position of 126 (out of 143 nations) which is nothing to be happy about (and if in case you are the type who cribs about such abysmal rankings of India in such reports, do read the report and judge for yourself whether the world is out to malign us unnecessarily and then have a good debate on merits). So elderly being happier than others is relative to a very low base of happiness index.

Call for action

The world happiness report says that “satisfaction with living arrangements” is the topmost predictor of life satisfaction (for older population). So investment of ideas and resources in improving the living quality for elderly will go a long way in getting them a satisfied life.

Socially smart cities and towns are the way to go.

This requires some significant investment from the government and private institutions – currently our investment for the elderly is miniscule (much less than 1% based on the helpAge report).

Maybe it is time to have a ministry of senior care (or some fancier name) which can focus on this problem and drive a concerted effort towards a vision of happy and satisfied senior citizens in 2040-2050 decade.