Balwant Dixit, Pittsburgh, PA E-mail: bdixit@pitt.edu
In recent years, many reports describing the beginning of a new era in providing much needed shelter, well prepared meals and affordable basic medical care to an estimated 100 million senior citizens of India have appeared in Indian papers and magazines. Not to be outdone, several Indian publications and organizations in the USA have given glowing reports of the retirement communities established in India. Simultaneously, in the USA efforts are underway to build retirement communities for Indians with great enthusiasm. Such stories in print give Indians living outside India and in India a sense of accomplishment and make them feel confident that the problems senior citizens in India are facing will rapidly be solved by just building a few more retirement communities in India. However, if one looks at the ground reality in India one cannot escape the conclusion that the solutions to the difficulties the 100 million seniors in India are facing today are far from being realistically addressed to.
The majority of India’s current population is less than 30 years old. The traditional joint family system that works in safeguarding the social and economic security of the seniors has been lost. With the emergence of nuclear family, many seniors are exposed to emotional, physical and financial insecurity. In countries like India the magnitude of economic insecurity is very high with more than half of seniors in India are dependents.
According to the 2012 census, the population of India was 1210 million, with a close to 100 million (8.6%) seniors. By 2026 the population of seniors expected to increase to 175 million. Currently, there are 35-40 large independent retirement facilities or communities in India, located in Bangalore, Hyderabad, Dehradun, Chennai, Delhi, Coimbatore, and Pune and in few other cities. The cost of 1BR and 2BR condos in these communities ranges from Rs. 45 lakhs ($50,000) to Rs. 15 crores ($250,000). In addition, monthly service charges range from Rs. 35,000 to 80,000. However, the demand is outstripping the supply by such a wide margin that facilities are sold out before even they are completed. Assisted care, Nursing Care, Alzheimer and Memory Care services are also now available at some of the retirement communities, but costs are very high. Nationally, with the average occupation ranging from 300 to 600 seniors in each of these facilities they can accommodate not more than 15,000 seniors. Usually, the buyers of condos in such facilities are from the top 1% of the Indian population or rich NRIs returning home or some of them buying condos for their old parents living in India. Most of such facilities are located within or near the large urban areas, with relatively easy access to hospitals and large shopping complexes.
Apparently, there is a significant need for these types of relatively high priced facilities in India. For example, a new private, not-for-profit trust, Age Ventures India (AVI), has recently been established to start planning construction of retirement facilities in Bengaluru, Ahmedabad, and Greater Gurgaon area. AVI is partnering with HelpAge India for knowledge sharing and with the USA based Pacifica Senior Living for various aspects of strategic planning. AVI plans to offer comprehensive services necessary for the welfare of the senior citizens
In addition to these large retirement facilities, almost every city in India such as Pune, Mumbai, Delhi, Chennai, Bengaluru, Mysore, Kolkata, Hyderabad have 15 to 20 small retirement facilities offering a mix of amenities such as long or short stay, assisted care, memory care, hospice care with 2 to 4 beds in each room. The quality of bedroom furnishings and associated furnishings vary significantly from one to the other. Meals are usually provided and the monthly service fee ranges from Rs. 40,000 to 70,000 and some facilities even charging up to Rs. 50,000 to get on the waiting list. Such small facilities are always located within the city limits for easy access to medical care and other amenities. These small size facilities can accommodate an additional estimated 6000 seniors.
HelpAge India is a leading charitable organization working with and for seniors and older people in India for the past 40 years. It runs a gamut of programs with the aim to serve needs of elders in a holistic manner, enabling them to live active, dignified and healthier lives. HelpAge India has established 26 old age homes for the seniors in places such as Patiala, Tamil Nadu, Mumbai, and Kolkata accommodating estimated 2,000 seniors and old age persons. Their facilities can provide comprehensive support to their inhabitants at a relatively low costs since HelpAge operates principally on donations they receive from individual donors, corporations and Trusts & Foundations.
All these facilities collectively can accommodate a total estimated 30,000 seniors, i.e. about 0.003% of the total senior population, leaving 99% of the seniors in need of affordable retirement facilities. How that can be done is a big question that defies easy answers since verifiable data on the needs of seniors is not available.
There are several hurdles in the planning of future facilities in India. No oversight agencies or regulations to monitor the financial stability of the retirement communities. Nearly a total lack of reliable data about the living and economic conditions, social profile, and assistance available for the activities of daily living (ADLs), the primary caregiver and the health and nutrition across the population of seniors. There is no standardization of services and costs associated with them. The Indian population is divided into rural (65-70%) and the urban (35-30%). Only scant data are available is on a small sample of the urban population. The value system and family dynamics is different in many respects when one compares the rural and urban population of seniors.
The relevant questions that need to be answered are: How many of the estimated 100 million seniors can afford to move away from their current place of residence and live away from their relatives to live independently? How many can afford to pay for their health care?
In India there are laws that allow the parents to sue their sons and daughters who refuse to provide financial support to them. In cities like Delhi, Mumbai and Pune there are examples of aged parents suing and winning cases against their children for kicking them out. In some of the metropolitan areas and in rural communities there are cases of sons or daughters dropping or abandoning their elderly mothers where they are given help by NGOs and Mandirs for survival.
In 2016 the Tata Institute of Social Research completed a survey, “The Situational Analysis of Elderly in Pune City†about the seniors in Pune City on the conditions senior citizens are living and the difficulties they are experiencing on a day to day basis. The survey evaluated (i) Living conditions (ii) Economic conditions (iii) Social profile (iv) Activities of daily living (ADLs) and instrumental activities of daily living (v) Primary caregiver (vi) Health and nutrition.
This type of study is a rare in India, while a lot of credible studies related to the problems faced by seniors have been conducted in the West. The Pune City was selected because it is one of the fast growing cities in India and has been touted as the retirement capital of India. In 2016, the population of Pune was 6 million, with seniors estimated at 500,000 (8.5%); greater than 30% of them living in slums.
Currently there are four (55+) independent living retirement facilities (Athashris) and an estimated 20 small Continuing Care Retirement Community (CCRC) type facilities in Pune. The cost for a one BR condo is about Rs. 45-60 lakhs in Athashris. Monthly service cost in a CCRC type of facilities varies from Rs. 35,000 to 45,000. All these facilities together can provide housing for only about 2000 seniors i.e. for 0.005% of the estimated population of seniors in Pune.
The main conclusion of the survey indicates a very difficult situation being faced by seniors in Pune, with the conclusion that these types of facilities are unaffordable for the 99% of the seniors in Pune. To make the situation worse politicians of every political persuasion announce before the election that they intend to build retirement facilities in every town and villages in India if elected, and after getting elected, they comfortably forger there promises. $$$$