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India gears up for rising ageing population with old-age homes and apps for elder care

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Ms Ivy Poulose, an 81-year-old widow, in her two-bedroom apartment at Rahel Homes. ST PHOTO: DEBARSHI DASGUPTA

KOCHI/BANGALORE - Ms Ivy Poulose, an 81-year-old widow, lived in what she thought was a secure bubble - a villa in Ernakulam in the southern Indian state of Kerala, accompanied by a full-time domestic help and watched over by closed circuit television cameras.

But this bubble popped one day in 2020 when a friend requested for her famed mutton briyani. None of the utensils she needed were around.

Someone had emptied her cupboard of all its utensils. "Nothing was there…. I felt scared," said Ms Poulose, who has limited mobility because of osteoarthritis.

She decided soon after that she would no longer stay in the villa. Neither did she want to move in with her three married daughters.

Ms Poulose opted to live in a retirement home, a decision that a growing number of Indians are taking. She picked Rahel Homes, set up for affluent Indians in January last year, overlooking rolling hills on the edge of Ernakulam.

"Here I have got my freedom," said Ms Poulose, seated in her two-bedroom apartment dotted with flower pots. "I can go to sleep whenever I want; I can have my food, whatever I like."

With over half of India's population below the age of 30, the country enjoys a demographic dividend. But an emerging challenge India must brace for is its growing elderly population.

There are around 138 million Indians aged above 60 today. There will be close to 194 million by 2031 - more than the current population of Germany, France and Poland put together. People over the age of 65 will also become the fastest-growing age group by 2050. This will add further pressure on India's weak social security and public health system, especially when filial bonds are loosening their reassuring hold in contemporary India.

Kerala, whose youth emigrate in droves for employment and where good healthcare ensures India's highest lifespan, will have the highest proportion of elderly in its population in the country.

More than a fifth of its population will be 60-plus by 2031, in keeping with the trend of southern India ageing faster than the rest of the country with its lower fertility rates. "This is an issue of the future but it is one for which we need to take action now," said Mr Biju Mathew, the Kerala state head for HelpAge India, a non-profit organisation.

Across Kerala, old-age homes are popping up with greater frequency, going from 517 registered in 2014 to 639 this year. But they include paid homes too that hardly address the poor, who are left to the mercy of charity-run homes or the 16 government-run old-age facilities that do not charge for a place.

"Those who cannot afford to pay are suffering quietly in their old age," said Mr Kuruvilla M George, secretary of Alwaye Fellowship House, a public charitable trust  that manages one of Kerala’s oldest retirement homes - Chacko Homes, set up in 1998. 

Staying at a studio apartment here for life involves a relatively low one-time cost of 1.5 million rupees ($26,846) along with a recurring monthly expense of around 5,000 rupees for food and electricity per person. It has a waiting list of more than 100 people. 

"The need for quality retirement homes and day-care centres is very high. Either the government or NGOs have to start addressing this problem," added Mr George.

When Covid-19 struck, the struggles of solitary elders came under the spotlight. There were only around 1,100 old-age homes catering to about 10,000 people in 2019, a Tata Trust study found.

Residents at Chacko
Residents at Chacko Homes, one of Kerala's many retirement homes aimed at upper middle class Indians. ST PHOTO: DEBARSHI DASGUPTA

The worrying gap has prompted at least a dozen Indian start-ups to offer digital platforms for "ageing in place", aimed at seniors who want to remain in the comfort of their home.

Going beyond institutional care or real-estate solutions, these companies have reimagined elder care through mobile apps and in-person assistance. The apps have doctors on call and offer interactive sessions. Representatives check on their aged subscribers every day on the phone, or at home.

"In Asian cultures, sons or daughters care for their aged parents, but this may not be easy, affordable or practical today for many reasons. And many middle-class elders can't afford the minimum 3 million rupees for retirement homes in gated communities or don't feel comfortable there," said Mr Atul Jagadish, who founded Alserv with his senior citizen father.

Chennai-based Alserv's mobile app brings medical care, food, security, home maintenance, and a concierge to the senior's doorstep in south Indian cities like Bengaluru, Kochi and Mysore.

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Falls account for 20 to 30 per cent of injuries among the elderly, and for 50 per cent of injury-related hospitalisation, according to studies by the All India Institute of Medical Sciences. So the companies also visit the subscriber's home, assess vulnerabilities like slippery floors, stairways, and disability access and recommend fixes.

"Healthcare and emergencies are the foundational pillars, but eldercare is also about addressing loneliness. We want to help seniors lead an active life," said Mr Saumyajit Roy, who founded senior-care start-up Emoha in 2019 in Gurgaon.

Emoha's hyperlocal model creates neighbourhood groups in 80 locations across India.

Mrs Mona Rolston, 78, a librarian for 36 years at the Indian Institute of Technology, Kanpur, grew quiet after her husband died four years ago. The singer found her voice again when she met her "gang of seniors" in Gurgaon through Emoha.

"I was a little nervous about the digital apps at first, but the relationship manager helps with any technical difficulties," she said.

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Ms Mona Rolston (second from right) sings an old Bollywood classic at a party in Gurgaon thrown by friends she made through Emoha. PHOTO: MONA ROLSTON

When Mrs Rolston moved in with her son in Singapore in March, her Emoha friends threw her many teary farewells. She remains a member because "children, however loving, are busy and can never replace a supportive peer group".

For many age-tech companies, the pandemic was a test by fire as it bared how vulnerable seniors were, not only to the coronavirus but also to the effects of isolation.

"Fear had gripped our minds during the pandemic," said Mr Subhash Bansal, 71, a retired project manager who worked at many multinational companies and who now lives with his wife in Gurgaon.

Their sons are in Singapore and Toronto, but "living abroad at an advanced age without medical insurance, in a totally new setting, is a challenge", Mr Bansal said. He subscribed to Emoha in February 2020 to help ease his  anxieties and those of his sons.

The elderly subscribers even found timely help when they needed it most.

Mrs Rolston had pressed the red button on her Emoha app when she fell in her Gurgaon home at 2am last year. There was an ambulance and medic by her side within an hour. The app had her medical profile, insurance details and contacts of her sons, aiding quick hospitalisation.

At the end of her phone interview with The Straits Times, Mrs Rolston broke into a Bollywood number "Dil-e-nadaan, dil ki dua kya hai?" - Oh innocent heart, what do you desire?

"All I want," she said, "is to celebrate my last years."

India's elder-care start-ups appoint 'daughters' for seniors

Before Ms Paulami Paul makes her daily phone calls to 35 seniors every day, she pauses for a moment to do what she considers the most vital part of her job.

"I recall each of their unique personalities, who likes to be complimented on dance, who is into online shopping, and who is into recipes, and who will want to talk about their grandson or discuss the Ukraine war," said Ms Paul, a Mumbai resident.

As the relationship manager at Indian senior-care start-up Emoha for a year now, the English literature graduate and former salon manager handles the affairs of septuagenarians in three Indian cities.

She arranges for their cabs, wheelchair assistance and medical check-ups, but also helps organise vacations, and teaches them how to use their smartphone. During the pandemic, she said the company had minimised home visits.

Emoha calls representatives like Ms Paul "daughters" because they must bring a personalised, empathetic and familial air to the care work.

"Some seniors have insomnia, some are depressed, some are excited about a grandchild's gift. Understanding a senior's mindset can be a little difficult but I must mould myself to fit the shape of the container," said Ms Paul.

Eldercare can be an emotional rollercoaster, with guilt, worry, love, and duty guiding many decisions by the adult children and their ageing parents, but she sees herself as a neutral go-between.

Seniors sometimes hide falls, chronic pains or loneliness from their family, Ms Paul said, but she mentions crucial aspects in her monthly reports to the next of kin.