Geriatric Homecare in India: A Perspective

— By Arvindd Narayanan

India has always followed a certain family system since time immemorial with children looking after parents during their old age. Elders were not only respected but also assumed the role of advisors for the younger members of the family. However, this scenario has witnessed a change in the last few years thanks to factors such as a fast-track life and migration to other cities for work. Science and technology have ensured an increase in life spans by providing improved healthcare to all including the elderly.However, this has also brought about isolation and loss of social relevance for the elderly population. There has been a disintegration of the traditional family system wherein the elderly are marginalised. Majority of them spend their last years in the confines of an old age home, where the conditions are nothing short of abysmal, most of the times. All this and the need for care at home has brought players in the home healthcare space into the limelight.

Some statistics

Estimates indicate that the elderly population is set to skyrocket in the next few decades worldwide to about 2 billion by 2050.The 60-plus population is set to grow throughout Asia, especially in Japan and South Korea. As per a report by the UN Population Fund (UNFPA) (India Ageing report 2020), by 2020, there will be 12 million elderly people in India who will be living alone and require assistance even for their daily activities.To exacerbate the situation further, this population will also succumb to chronic ailments such as arthritis, heart disease, diabetes, hypertension, and Alzheimer’s.Studies also reveal that about 50% of the elderly population in India feels lonely with the number higher for urban areas (64%).

Challenges

For the healthcare industry

Among the many challenges facing the Indian healthcare segment are lack of adequate healthcare infrastructure and delivery mechanism, and allow patient-to-doctor ratio both at the rural and urban levels. Availability of affordable health care is another area of concern. Healthcare is a relationship-driven industry with focus on trust and personal care. Nursing, for instance,is associated with empathy, care, and compassion. However, there is a paradigm shift in this aspect today, not to mention shortage of trained health care professionals. This is true not only for doctors and nurses but technicians and nursing attendants as well.

For the elderly

Following are some of the major challenges faced by senior citizens in India.[1]

  • Failing Health – Absence of non-quality, age-sensitive healthcare
  • Boredom – Lack of motivation and purpose in life
  • Neglect – Absence of physical, mental, and emotional care and support
  • Fear – of various things including death
  • Low self-esteem – Due to isolation, neglect, and reduced responsibilities
  • Economic insecurity – Due to lack of support from the close family
  • Isolation –feeling of a deep sense of loneliness
  • Abuse – physical/mental abuse usually from the close family circles
  • Loss of control – Led by loss of resources – body, income, status etc.
  • Unpreparedness in old age – Result of the above challenges

Home healthcare in India: the opportunities and trends

With such alarming statistics and lack of support for the elderly, there is a need to revisit the current pattern of caregiving and focus on the growth of home healthcare in India. The need for elderly care attendants (trained and certified) has been felt for a long time. In the current scenario, a person from the family’s native village is bought to the house, fed and clothed well and asked to take care of their parents (joint family set-up where mostly all young adults are working). However, in majority of the cases, it has been seen that nuclear families struggle with the need to get trained, certified, verified, and trustworthy help.

An informal system of nursing bureaus always existed in India providing nurses (sometimes just experienced people without a degree) to homes. However, the cost of affording a nurse is too high and a caregiver is better suited especially for Activities of Daily Living (ADL). A caregiver is an unpaid or paid member of a person’s social network who helps them with ADLs. Caregiving is most commonly used to address impairments related to old agedisability, a disease, or a mental disorder.[2]

Although at a nascent stage, the home healthcare industry is making pioneering progress in India and Asia. Many startups and companies backed by pioneers in the healthcare industry have made entry into this space to create a difference in the lives of the geriatric population. In light of this, there is an immense potential for growth and innovation in this segment.Research indicates that a home healthcare model enhances the care continuum, produces more satisfying outcomes for those in need, is cost-effective and overwhelmingly preferred by patients, and reduces hospital readmission.

With the growth of a new league of healthcare startups with a keen emphasis on provider-patient relationship and quality, the end-user is getting empowered like never-before. The earning middle class is opening up to at-home care for their parents and weaning away from the age-old system of family service. However, the homecare ecosystem faces a dearth of quality professionals and quality medical care delivery. The key here is to make healthcare personalized by giving the user the opportunity to control his own health outcomes, and the freedom to choose the services and products based on his/her requirements. The healthcare pathway is transforming into a holistic one. This type of care is not just medical or physical but also addresses the patients psychological and emotional needs.

Quality care through quality resources

The key for any geriatric home health care is to have trained, qualified and certified resources that adhere to “Gold standards” of caregiving. The caregiver provides the physical, psychological, and emotional support to the receiver and becomes an important part of their life henceforth. All home care institutions face the daunting challenge of acquiring the right resource with the right attitude for the job. A lot can be written on the standards, curriculum and methodology on training the caregivers, but that is a different topic altogether.

Future outlook

With technology disrupting the home healthcare segment as well, caregivers can now make decisions based on data collected on site. In the West, technological innovations in medical devices are now allowing caregivers to further assist physicians by performing more diagnostic and procedural activity at homes. These concepts may be new but are rapidly catching up in the Asian countries particularly India. Japan has been the trendsetter in using robots and AI to remotely care for geriatric patients specifically. Telemedicine is being used as a powerful tool for consultation and real time diagnosis in the West. Using robots to do basic chores, set-reminders especially related to medication, etc., are just few of the many known applications of technology in geriatric care. The opportunity is immense, and we have just hit the top of the iceberg. It remains to be seen how much technology will be able to replace the “human touch” of a caregiver – something that only time will tell.

[1]Helpage India

[2]https://en.wikipedia.org/wiki/Caregiver

(The author is an expert in social development through Skill Building and heads the Training arm at Winage™)

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