How Eldercare Market Is Evolving In 2021 India has the largest aging population in the world. According to 2011 census data, the count of senior citizens was above 100 million in the country. The figures are expected to increase in the upcoming census. The size of the eldercare business is estimated to be $5billion in India.

India is poised as the country with the maximum youth population in the world. Directly proportional to youth is the old population. The technology boom and a globalised world opened a plethora of opportunities for people the world over, India was in a bright spot. Literacy and employability rate became much better than ever before, spoiling the Indian youth for options and opportunities.

This led to the young shifting base from their hometown and leaving their families - elderly parents - behind. In a traditional joint family system, the elders receive care from the family members. However, fragmenting of this system has left the elders alone, vulnerable and neglected left to fend for themselves. Further, the looming shadow of retirement adds to their anxiety, marring the fun of unwinding with family and friends.

As for senior-aged Indians, a grave cause of concern is coping with rising bills on reducing income. The elderly need care and support. A companion and someone to help them in a health emergency. This became an opportunity for a startup in the elder health care segment.

With the 2021 Union Budget around the corner, there are expectations and hope among startups. "We need a better India that provides basic amenities and dignity to our elderly - for society is best judged by how we treat the aged. Budget 2021 has an enormous opportunity in delivering that dream for our often-forgotten Senior Citizens," say the founders of TriBeCa Care, one of the largest eldercare service providers in India since 2014.

Stressing on the need to include elderly care programs under the universal healthcare initiatives by governments at centre and states. "We also expect the government to announce budgetary measures covering home healthcare as a part of the universal healthcare programmes for the elderly in the post-pandemic world as hospitals prove to be high-risk areas for them," says COO of Portea Medical, one of India's largest outside of hospital healthcare provider focusing on elder care since 2013.

Size of business and issues being addressed

India has the largest aging population in the world. According to 2011 census data, the count of senior citizens was above 100 million in the country. The figures are expected to increase in the upcoming census. The size of the eldercare business is estimated to be $5billion in India. A large part of the sector is unorganised and disintegrated remains untracked by the formal economy.

As the prevailing system has been for years, home care workers (not trained in health care) are locally employed via informal networks and get paid in cash. These workers tend to be underpaid and overworked. Consequently, "100 million senior citizens continue to receive poor quality services from ill-trained personnel," says Prateep Sen, co-CEO, TriBeCa Care.

Then, there is underlying social pressure. Families are judged on yardsticks of how they care for their aged relatives. Often being criticised if the aged incapacitated member is attended by hired workers and not relatives. In a typical family setting, the younger members are either studying or working which means they are always on tight timelines. It is challenging for them to provide round-the-clock caregiving to the elders, who need sensitive handling.

"One of the biggest challenges faced in elderly care is the societal mindset which looks down upon families if their bedridden family members are attended by outsiders instead of relatives. Thus, the care becomes not only a cost for the concerned family but also a bigger challenge. This is because the family members are usually not professionally trained in taking care of the patient and they have other things to take care of," says Vaibhav Tewari, co-founder and COO, Portea Medical.

That home-based health care is neither covered by any health insurance nor healthcare programmes by the government is a big impediment. Therefore, making home-based services more expensive and impractical for families who prefer hospital treatments where they can settle the bills via their insurance scheme and save on-the-spot payment.

The systematic home care market, though growing fast, is still in the nascent stage. The newcomers are implementing training protocols, verifications, the latest technology and last-mile logistics to enhance the quality of service and care monitoring. IoT enabled personal alarms and sensors are being used to improve safety and emergency response for senior citizens.

There are purpose-designed residentials that provide specialised care for senior citizens. "For years the sector had seen little innovation or improvement. But now many well-funded, professional, tech-enabled startups are starting to disrupt this space," says Tamojit Dutta, co-CEO, TriBeCa Care.

Tapan Mishra, Co-founder, Seniority, said the issue of loneliness and social isolation, which has been accentuated due to the pandemic in the last few months, has resulted in mental health problems like depression and anxiety among senior citizens. To address this problem, we have introduced Evergreen Club, a unique digital platform for adults aged 55 years and above. Evergreen Club is an industry-first offering that helps senior citizens become a part of an online community through participation in various interactive and informative activities, while also helping them lead an independent and active lifestyle from the comfort of their homes.

The organized retail market opportunity for seniors is largely untapped, and Seniority has been able to create a disruption in the ecosystem with its unique offerings. Our aim is to gradually evolve into a holistic health & lifestyle platform with differentiated offerings for our consumers.

What solutions are in demand

The shift in family lifestyle and rise in population has prodded the need for comprehensive services for the senior family members. The Covid-19 pandemic amplified the demand for home-based health services. Home healthcare services and chronic disease management are the predominant requirements of seniors in India.

The immobile or bedridden patients need support and assistance in doing their routine functional tasks and living with dignity. The service providers offer many services like therapies, home diagnostic, diabetes management and taking care of the nutritional needs of the elderly. "Portea Medical offers support to the elderly in the form of referrals, hospitalization and rehabilitation care as well.

Our specialized services include critical care at home, respiratory services (home ventilation), sleep apnea care, palliative care, cancer support services, and pulmonary, neuro and cardiac rehabilitation as well as end of life care for the terminally ill patients," says Vaibhav.

Generally, seniors aged 70 and above need support such as companionship, specialised assistance for dialysis and chemotherapy. While many elderlies who are independent and agile, but live alone need support in emergencies. Families' requirements are for a user-friendly platform, a single-point service provider who can deliver complete care for the elderly in the family.

"At TriBeCa Care, the biggest demand is for end-to-end managed care services for the elderly. Families want an easy-to-use platform that will cover all the Care needs of the elderly - be it companionship, help with hospitalisation, nursing, physiotherapy, dementia care or ICU set up at home. They want one provider who can coordinate, deliver and monitor comprehensive care for their elderly loved ones," says Tamojit.

Customer base who uses such care services

Home-based care services are developed for aging people who need support to live independently with dignity. It includes assistance in managing chronic health issues, convalescence care, people with special needs or disabilities. The services are provided by trained, professional caregivers such as nurses, attendants, doctors and therapists.

With the unprecedented circumstances thrust by the Covid-19 pandemic, senior citizens were declared as a vulnerable category. Worldwide, doctors asked elderlies to stay at home, irrespective of them suffering from any disease or not.

They were advised to opt for telemedicine, home diagnostic and care at home as a visit to the doctor's chamber or hospital would expose them to the risk of getting infected. "In the wake of the pandemic, we have been providing care to several elderly COVID-19 patients by managing their home isolation processes and offering them as well as their family members support as well as information related to the pandemic do's and don'ts, etc," says Vaibhav.

Similarly, Tapan says the firm has fair share of customers aged 50 years and above, who are typical users of our assistive and lifestyle products, and an almost similar number of customers in the 25-45 years of age bracket, who are caregivers to their parents & grandparents and want to ensure convenient living facilities for them. We have a 40:60 ratio of customers from Urban metros & Tier I cities vs. Tier II and Tier III cities. Our Evergreen Club services are available for people aged 55 years and above, who have been largely restricted indoors due to the pandemic lockdown.

Startups envisioning the elder healthcare market

"The elder care market is poised for an explosion of innovation over the next decade. The macro factors - increase in senior population and longevity, nuclearisation of families, elder safety concerns, affordability of hospital care - are driving the urgent need for innovation," views Tamojit.

The prevalent hospital-based medical care system is both costly and inconvenient for senior citizens. TriBeCa Care founders expect specialised startups disrupting this care delivery mechanism. From telehealth for seniors or connected personal alarms for an emergency response to palliative care services at home – there is vast potential in this segment.

"Focussing on long term health will need a lot more dependence on continuous monitoring on IoT devices, wearables such as watches, smart cameras, etc. And behind this, will be strong AI/ML-based monitoring with an army of care providers who will know just when to intervene. The continuum of technology, data science, monitoring, intervention, and treatment will become standard in our lives. As in any other consumer industry, health tech will find the most expedient, convenient, and cost effecting method to connect healthcare providers to their patients," says Prateep.

While technology is expected to play a huge role in the escalation of home-based eldercare services through real-time data, customer insights and care-worker training. Startups, government regulators, healthcare majors, insurance companies and families altogether are part of the elder care ecosystem that will determine change.