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Senior Care Is an Established Industry In the Western World. How Will the Industry Evolve In India? Technology and data will be critical, and India will leapfrog many western economies in building a robust senior care industry that is rooted on the behavioural aspects of the Indian seniors.

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Senior care in the USA is an established industry, valued at $740 Billion currently and growing at 6 per cent a year. It is estimated that 1 in 5 Americans will be a senior citizen by 2030. Assisted Living, day care centres, rehab facilities form over 80 per cent of the industry. Independent Living or Home Care forms the rest.

The traditional American family structure promotes nuclear living. Hence most older parents stay in different households to their adult children.

Purpose built Assisted Living facilities in the US have been popular for many reasons – sense of community, well organised infrastructure, cheap housing in certain states, access to trained caregivers, increased comfort and oversight. Effectively, the American care industry applied the same rationale to senior care through the Assisted Living facilities, as they did to manufacturing in the auto industry. Efficient, Economic and Scalable.

Independent Living or Home Care, on the other hand is provided by a myriad of care agencies. These agencies often have lowly paid, less trained care workers extending sub-standard services. This coupled with escalating costs and Medicare restrictions means that while ageing at home is the most preferred option for the seniors themselves, it is not a viable option for many.

A slew of start-ups are trying to dislodge existing incumbents through digital and online platforms - thereby improving quality & productivity standards for the industry. But the going is difficult. After all it's not too easy to change the direction of a 3-tonne elephant.

Indian Senior Care market will evolve fast

India on the other hand is very different. 60+ seniors form 8 per cent of the population (100 Million). This is slated to grow to 250 million in a decade. By 2050, seniors will be 20 per cent of the population. Given the size of the expected tsunami, the Indian senior industry is sub-optimal and ill prepared. We estimate the Indian senior care market is only about $7 billion – 1 per cent of the US market size.

In India, the care provided is mostly at home, often in a multigenerational setting. Traditionally India had the benefit of cheap, abundant caregivers – albeit with low levels of training and motivation. Families have solved for this by "over-building" their infrastructure and creating redundancy. It is common for an elderly middle-class widow to have 2 maids-cum-caregivers and a driver for her needs.

Social structures in India are however undergoing tectonic changes, and the affluent metro based middle class is beginning to resemble the US more. An aging population, increase in nuclear families, children migrating for professional reasons – factors such as these are causing rapid social changes. At the same time, the care-giving workforce is shrinking, as younger people prefer working in restaurants, malls and IT. Changing an adult diaper will not be a profession of choice anymore.

So how will the Indian senior care market evolve?

Home will continue being the preferred place to grow old

Seniors will choose to continue staying in their own homes, their places of comfort. There could be downsizing of the home and apartments could be made more age friendly. More professional senior care companies will evolve to provide comprehensive home care solutions - trained carers, 24/7 emergency response, senior transportation, well-being services, tele-medicine consultations- in the comfort of their own homes.

Senior Living Facilities will develop, but adoption will be different to the US

Senior Living facilities will be built, but the penetration will initially not be as high as the US. They will probably be built nearer larger cities with good healthcare facilities. They may have more multigenerational facilities. Both these factors will allow seniors to live close to an extended family set up. The pace of adoption will be slow, till the time that the management of such facilities are made more professional. Professional care management firms will manage the facilities.

Caregiver skilling and training

Without good caregivers, the senior care market will struggle. There needs to be a massive push towards building a large and productive carer workforce. This will be operationally intensive and require committed, passionate entrepreneurs that leverage a cohesive government policy. Technology will also improve productivity and monitoring of care workers in the industry.

Digital solutions will help senior citizens access Healthcare remotely

The 75+ find it difficult to use technology, but the 65+ can call an Uber and order groceries through Grofers. In years to come, AgeTech companies will create solutions that leverage ubiquitous platforms like Alexa to make tech adoption easier for seniors. IoT devices, sensors, and other voice/motion activated technology will alert carers of incidents at home, without the senior having to "learn" technology. Centralised Patient monitoring and management platforms, as well as tele-consultation platforms, will help professionalise the senior care industry.

Depression, dementia and mental health are common issues with seniors. This is compounded by social isolation, and often the elderly cannot engage with social media like their younger counterpart. There will be an increase in tech enabled solutions to manage or reduce the incidence of mental degradation. From simple phone based Psychological Support helplines to AI-powered cameras that connect at-risk seniors remotely to psychiatrists; a whole host of innovations are being used globally. In Japan and China, conversational robots are being programmed to provide tailored conversations and engage with seniors who are at risk of social isolation.

Overall, we expect the Indian senior care industry to grow rapidly – upwards of 20 per cent annually. Yet, that growth requires investment and commitment – in building infrastructure, training people, developing protocols and creating technology. Technology and data will be critical, and India will leapfrog many western economies in building a robust senior care industry that is rooted on the behavioural aspects of the Indian seniors. It will take brave entrepreneurs and patient investors to bring change to an essential but an unglamorous sector.

Prateep Sen & Tamojit Dutta

Co-CEO, TriBeCa Care

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