By : Pradeep Mahapatra, Ph.D.

https://about.me/pradeepmahapatra

December 2021

ABSTRACT

       Retirement Homes as destination of elder-care remain as a novel concept by 2021 in the eastern costal state of Odisha, India. The region is marked with high inequalities in economy, education and health-care among population that slow down the pace of social change. Since elder-care is emerging as a major global concern, innovative approaches are need of the hour to pave the way for gradual adoption of the trend of Retirement Homes in the local level. The paper discusses a hybrid model of serviced studio apartments exclusively for senior citizens in the busy localities in the state capital that have been developed as the medical-hub. In the initial phase, senior citizens from interior parts of Odisha can utilize the facilities as camp residencies for attending health-care and the example can gradually encourage adoption of Retirement Homes as a viable alternative for assisted living during the end-of-life phase.

KEYWORDS:

Retirement Homes, Elder-care, Assisted living, New Normal, Bhubaneswar

EXECUTIVE SUMMERY

       The author of the paper, a retired university faculty of journalism and alternative ageing influencer, an avid observer of elder-care in and around Odisha for four decades since 1982, conceptualized an ideal solution for development and marketing of early projects of Retirement Homes in a tradition bound society.

       With increase of elderly population, rise in longevity and advances in health care facilities, the demand for harmonized affordable elder care gradually turning to be a basic requirement in this part of the county, as elsewhere in the world.

       While the elderly population of Odisha prefer to spend their old age at their homes in familiar environment, serious health problems at the end-of-life period need specialized medical attention and service of skilled professionals, even to lead day-to-day life, such as geriatric nursing, physiotherapy, psychotherapy and palliative care etc. Empirical evidence from developed societies indicates that such long-time-care may extend from 4 to 10 years in the case of at least 10 percent of elders living beyond 85 years.

       Bhubaneswar-Cuttack have been developed as the medical-hub of the state and the interior parts lack such facilities. Since elder-care is in its infancy even at the twin cities by 2021, there is little possibilities of expansion of advanced facilities to the other parts of Odisha in rural setting till the next decade where about 86 percent of families reside. The international trend indicate migration of elderly population to urban centers, who can afford, for better care and Odisha is expected to follow the trend.

       Since Bhubaneswar is identified as the only available elder-care destination in Odisha, creation of residential facilities for senior citizens demand priority in policy formulation in government level. The traditional customs and practices in Odisha may not encourage the elderly to shift to Retirement Homes in a go. Studies nationwide reveal that only about 55 projects comprising of 20,000 units were in operation during pre-pandemic period and an estimated three lakh senior citizens were in various phases of preparation to purchase and move into such facilities. Thus for initial realization of Retirement Homes concept in Odisha one may have to wait till 2030.

However, to facilitate the upcoming innovations in elder-care and benefit early birds living outside Bhubaneswar, pilot projects of development and marketing of serviced studio apartments in the State Capital exclusively for elderly population seems to be a viable proposition.

       The building design for studio apartments should provide limited personal living space and extended common service space such as lobby, recreation, dinning, exercise, geriatric nursing ward for the bedridden along with common kitchen, laundry, security and limited attendant quarters etc. The building should include elder-friendly specifications such as railing, lift, ramp, anti-skid flooring and wheel chair movement facilities. Strict rules for allotting the units to senior citizens or with spouse having combined age of 110 years will be adhered. Efforts should be undertaken to discourage the facilities to be used as real estate investments with objective to reap profits.

       Further, it is important to note that the project of serviced studio apartments for elderly population should be constructed in the central part of Bhubaneswar. Vertical structures in busy locations will ensure easy transportation, accessibility to multiple healthcare facilities, proximity of alternative service providers, enhanced security, public entertainment and liberation from isolation through physically living in midst of crowded places. Moreover such locations will prove to be elder-friendly and ensure easy marketing. Redevelopment of government residential properties may be considered as a viable option.

United Nations has declared 2021-2030 the ‘Decade of Healthy Ageing’ with aim to improve the lives of older people, their families and the communities in which they live. The Decade action areas include creation of age-friendly environment, integrated and long-term care which constitute three out of spelled out four objectives. Older people require “good-quality essential health services that include prevention, promotion, curative, rehabilitative, palliative and end-of-life care”. The proposed hybrid model of Retirement Homes at Bhubaneswar can serve interested senior citizens from interior parts of Odisha to avail best of the health and elder-care services available in the state. The model can be replicated in later phase with appropriate corrections taking into consideration the local conditions. 

Real estate agencies interested in the sector may formulate vision documents to enter into the Retirement Homes projects to benefit the elderly population which will reach 20 percent by 2050 and 34 percent by end of the century as estimated by United Nations Population Fund. Implementation of the model of Retirement Homes at the early stage as serviced elder friendly studio apartments offered to senior citizens may be evaluated about its need and efficacy at various levels and a demand survey may be conducted The hybrid model may be identified as ‘Grey Odisha Model’.

PERSPECTIVES ON RETIREMENT HOMES

       A number of changes are expected in the life-style of the elderly belonging to the category of educated and financially affluent living in nuclear-family-setup during the post-Covid-19 pandemic ‘new normal’. Change in residency norms for the super-seniors can be marked as one among them.

       The concept of Retirement Homes took its roots during post-World War II, both in the western as well as eastern developed economies. It became popular in United States, Britain, Germany and Europe along with Japan and China. Though Retirement Homes are confined to about 55 projects in India by pre-pandemic period, it was calculated by real estate consultancies that the industry will increase 20 fold in five to ten year time period.

       Relevance of Retirement Homes made it’s way into public discourse in India by the beginning of Twenty-First Century. Mostly urban centered parents of non-resident Indians those who have settled outside the country were the first batch of entrants to the Retirement Homes. As such category of people frequently visited foreign countries to reach to their children, had opportunities of being influenced by western philosophy on ageing. But by the time marketing of the concept of Retirement Homes took momentum, disruptions in the real estate industry by demonetisation, introduction of Goods and Services Tax and implementation of first ever Real Estate Regulation Act resulted in meltdown of the efforts. The specialized projects of Retirement Homes could not take it’s wings.

       Professional geriatric service remained in its nascent state in India by 2021. All the initiatives in the category are novel. Traditionally elder-care is considered as a family responsibility. Establishment and management of limited number of old age homes on philanthropic basis, both by the government and non-government sector, are the only alternatives for relocation of dependent elders. On the other hand the concept of Retirement Homes enables the elderly to outright purchase or acquire on long term lease basis to live at assisted living facilities. As a number of senior citizens gather at one place to lead rest of their lives, it becomes easy to arrange elder-friendly services and the inmates avail opportunity of cohabitation with the peers.

       Factors such as increase of older population, rise in longevity, financial security and change in perspectives on life encourage elderly to evaluate the role of Retirement Homes in the emerging social scenario. United Nations Population Fund estimates the population over 60 year in India at 12 crore by 2021, which will encircle 20 percent of the total population by 2050. A calculation published in the international medical journal Lencet in October 2020 noted that during three decades longevity of Indians has increased up to 10 years. While longevity in 1990 calculated to be 59.6 years, it reached 70.8 years in 2019. The nuclear family setup and migration of family members to different geographies create new equations for the elderly in search of better living standards at the end-of-life period.

       The compulsion of maintaining social distance for a prolonged span of time during the Covid-19 pandemic has greatly affected the lifestyle of the elderly worldwide. Both the singles and couples living alone faced difficulties in management of daily life including healthcare, transportation and security. Some of them may seek alternative approaches to lead life at Retirement Homes in the post-pandemic scenario. However, successful implementation of full-fledged Retirement Homes concept may take a decade or so in the tradition-bound social structure in Odisha. It is only after the concept becomes popular in neighbouring states, it may influence the locals.

       However, implementation of the projects of Retirement Homes in the post-pandemic markets elsewhere in the country may prompt the entrepreneurs of Odisha to formulate preliminary plans. Success of pilot projects will greatly depend on facilitation of the trend. If the initial projects fail in the commercial launch, it will adversely affect the business model. In such a situation, due consideration should be attributed to a few important aspects relating to promotion of Retirement Homes in Odisha.

       First of all, who are the prospective buyers of such properties ? A single unit costed between 20 lakh and 1 crore 50 lakh with monthly maintenance charges ranging Rs 4,000 to Rs 60,000 in the pre-pandemic Indian market. Such an investment is possible by economically strong customers and such properties will be considered as additional homes for those who own their primary residences elsewhere. In the preliminary stage it is unthinkable that the beneficiaries will sell off their own residences to move into Retirement Homes. Then, the question will arise with what objectives people will purchase such properties ?

       Vertical structures in the crowded spaces at Bhubaneswar, in the form of serviced studio apartments, seems to be an ideal model for preliminary version of Retirement Homes in Odisha. People from different parts of the state depend on specialised medical care at twin cities of Bhubaneswar-Cuttack. The experiences of pandemic has highlighted the importance of health care, specially for the elderly. Senior citizens living outside Bhubaneswar who visit the city repeatedly for ongoing medical treatment and those who can afford for an additional property at the state capital will not hesitate to acquire such camp-residency facilities on permanent basis. While such category of beneficiaries have ready finance, implementation of such projects will face no problem of investment stress.

       But there will be caveat that in case such serviced studio apartments are constructed in the suburban areas or cottage models are adopted for early batchs of Retirement Homes in and around Bhubaneswar, the fear of business failure will hang around. The elderly beneficiaries out of Bhubaneswar, the potential customers will look for other amenities such as proximity to downtown markets, choice of food-joints, entertainment, rail and air stations along with cultural engagement etc. which are available in the heart of the city only. The cost of the land may be high in the crowded localities. But those who are ready to invest 20 lakh, they can also invest 25 lakh for preferred properties.

       The proposed model does not satisfy the criteria for Retirement Homes. However, for favourable marketing opportunity the early batch of projects may adopt such an “hybrid model”. In traditional societies enriched by thousand years of civilization, it is not easy for the elderly to leave their home and settle down in Retirement Homes instantly. Shift from private life to a community life may need a transitory option to smoothen the process.

       Pandemic highlighted challenges in the lifestyle of the elderly population. While in one hand it becomes impossible for elderly to handle medical emergiencies, on the other hand in Europe, Britain and United States spread of Covid-19 infection and loss of life in elder-friendly communities raises big questions on safety issues at Retirement Homes. Studies reveal that long life lead to about 10 years of ill-health and up to 4 years of housebound or bedridden life. To confront the challenges of near-death-life preparation for building infrastructure both at personal and social life demands importance. In Odisha situation, it is time to plan for experiment facilities between home and hospitals, similar to ‘Care Home’ model of Britain.

It was reported in the British Newspaper The Guardian in May 2021 that as the post-Covid-19 pandemic economic slump affected business in high-street area in London, the buildings used as malls and shops are being re-modelled as Retirement Homes for the elderly. Traditionally such facilities were located in the sub-urban London or in the rural areas. But as the elderly population prefer to be relocated in busy areas. Retirement Homes came up in down town and the trend has become popular, A few established builders started projects to construct 3,000 to 5,000 units each during next five to ten years. It may seem illogical to compare Britain with Odisha. But nobody can deny that international trends do spread influence everywhere. Post-pandemic “new normal” is expected to open a new chapter for the concept of Retirement Homes worldwide.

CRITICAL ASPECTS IN IMPLEMENTATION OF RETIREMENT HOMES PROJECT

       Importance is being laid upon retirement home, care home, nursing home, palliative and hospice care for the elderly. Care of elders become essential even to lead daily life for the super-seniors who are bedridden or capable of having limited mobility. Traditionally care of the elders was considered as the responsibility of the extended joint families. But spread of industrial civilization resulted in rise of nuclear family setup. With organised employment and migration, both human capital and time became scarce for honouring responsibilities in elder-care. Support of the professionals needed. Gradual increase in longevity during post-World War II resulted in rise of population of older persons and development of infrastructure for elder-care demanded urgent attention of the society.

Older persons in United States, Britain, European Union, Canada, Australia, China and Japan, the countries considered as leaders in professional elder-care, about 80 percent prefer to lead their old age in their homes in midst of familiar neighbourhood. It leads to requirement of infrastructure for home-based elder-care facilities. However, near-death health complicacies compel them to move into hospital, care home, nursing home or hospice. Such experiences lay importance for the educated, economically empowered and independent minded categories of people who have approached or approaching old age to plan out strategies for building community level infrastructure, both at personal and collective level.

Though traditional Odia culture promote joint-family and oppose western concepts, the contemporary reality in the society in relation to elder-care compel the thought leaders of the State to consider on alternative ageing methods. A few progressive families have started adopting available elder-care facilities such as service of professional bed-side-assistants for the older persons to attend to day-to-day life requirements mostly in Bhubaneswar since beginning of the second decade of present century. Though plans were mooted for Retirement Homes the disruptions caused by a series of developments including demonetisation, introduction of Goods and Services Tax, implementation of Real Estate Regulation Act and at the top of it effects of Covid-19 pandemic barred any progress till 2021. It is expected that the real estate entrepreneurs may be interested to venture beyond residential projects in the post-pandemic “new-normal” and retirement homes, as a special category, will attract attention. Real estate consultancies calculate that there is demand up to 10 times of available Retirement Homes units available till pre-pandemic period and there is possibilities of increase up to 20 times during next 5 to 10 years as per surveys conducted by them.

Retirement Homes create facilities for assisted living for the elderly. It becomes problematic for the people in advanced age to arrange and manage professional care-givers in absence of supervision by third parties. Such difficulties are easily sorted out at Retirement Homes. Further, providing service for a number of elders gathered at one place creates opportunity for quality improvement and affordable price tag. Since Retirement Homes will be a novel approach by 2021, a few critical aspects need to be addressed for early batches of projects implemented at Bhubaneswar.

First, Retirement Homes should be located in the central part of the city. Urban setting provide better elder-care in comparison to the rural area. Similarly the central part of the city can provide better amenities in health-care, transportation and security. Elderly population have limited life span in comparison to general age categories, hence they would certainly prefer for readily available facilities rather than settling in the suburban areas hoping for improvement in future. Thus, the first batches of Retirement Homes projects those come up in the suburban areas may not get customers.

Second, super seniors, the targeted beneficiaries of Retirement Homes in Odisha are expected to lead most part of their lives either housebound or bedridden. In such situation neighbourhood will play a major part for the mental health. Here the concept of ‘community building’ comes to forefront. If likeminded inmates will  congregate at a particular Retirement Home, life will be harmonized. Efforts should be undertaken to select and allott elderly people with similar perspectives on life to live together. It should be monitored from the very beginning of the project implementation.

Third, financial security for maintenance of the Retirement Homes is yet another area needs to taken care of. Since common services such as house keeping, kitchen and security etc. will be met from the monthly subscription of the inmates, due procedure to be adopted from the beginning for easy flow of funds. Collection of deposits from the allotees and investing the amount for regular income for the housing society is an easy option.

Fourth, all the members who purchase or lease an unit at a Retirement Home may not prefer to shift to the properties immediately in local situation prevailing by 2021. To overcome the problem, a harmonized plan should be adopted to segregate allocation of units among the categories of beneficiaries who are ready to move-in immediately, those who agree to live in the units periodically and those who plan to move at a later date, may be after a couple of years.

Fifth, transparent legal standard operating procedure are to be laid down for allocation, transfer and resale of the properties in the Retirement Homes. Lack of caution may lead to disputes which may pollute the peaceful environment. If the allottees of properties in the Retirement Homes can be treated as investors in the housing society, rather than customers, transfer of properties can be restricted at the individual level. The properties are to be leased out for a price, rather than out right sold to the allottees.

Sixth, the size of the Retirement Homes will determine its efficacy in delivering services. In case a large settlement is not possible, similar units added in due course of time to a common management may yield better results in a Retirement Homes cluster.

Earlier batches of Retirement Homes in Bhubaneswar should aim to provide the facilities of nursing homes and care home such as psychotropic, dementia and hospice services. Though the concept of Retirement Homes has proved to be the leading commonly available elder-care facility worldwide, spread of Covid-19 infection in such facilities have raised questions in its safety parameters.

A report published in high end health care journal Lencet March 1, 2021 edition analysed data collected through studies conducted among 2,15,000 inmates living in 8,500 Retirement Homes in 14 nations. Among them about 25,000 were infected with the Corona virus and treated during the first wave of Covid-19. It was found out that the infected older persons are more likely to be hospitalized and succumb to death in comparison to the younger population. Since the inmates of the Retirement Homes come in close contact with the service providers, medical staff, managers and visitors in large numbers and many of such personnel are engaged at multiple facilities, the process was identified as a potential cause for spread of the infection. Lack of sufficient number trained service providers in Retirement Homes also attributed to inadequate management of the pandemic.

Another news report published in the New York Times edition dated June 1, 2021 revealed that among the total infected till that period, while only 4 percent belonged to residents of Retirement Homes, death rate claimed 31 percent of the total mortality in the United States. The death rate among the infected general population was calculated to be 2 percent, but in case of the residents of Retirement Homes it was five times higher reached to 10 percent. It clearly showed that the health care facilities in the Retirement Homes need better infrastructure and management. Such initiatives may need more finance, but it is wiser to invest in for end-of-life care facilities.

GUIDELINES FOR DEVELOPMENT OF RETIREMENT HOMES

       Ministry of Housing and Urban Affairs, Government of India issued ‘Model Guidelines for Development and Regulation of Retirement Homes’ during November 2019.

       Cover page of the document reproduced a quotation of Narendra Modi, Prime Minister, “Today, if we are able to work so rapidly to create a new India, it is because of the foundation our senior citizens laid. The value and wisdom of our senior citizens are important for us. We have given top most focus for dignity, financial security and well-being of our senior citizens”.

       Hardeep S. Puri, Minister of State (Independent Charge), Housing and Urban Affairs mentioned in his message, “The withering away of the joint family resulted, however, in an unintended and unfortunate consequence, the slow neglect of the elderly. We have still not fully realized the enormous coliateral damage to society through this neglect. There is now a slow and growing realization that there is pressing need to pay attention to the wellbeing of the elderly”.

       “The issues of the elderly especially relating to their place of residence is an area which comes within the domain of the Ministry of Housing and Urban Affairs. Several concerns were brought to my notice thus triggering an exercise to put in place a set of guidelines that will ring fence the difficulties faced by the elderly residing in housing societies especially when they are short changed by vested interests. ”

       In his Forward, Durga Shankar Mishra, Secretary, Ministry of Housing and Urban Affairs pointed out, “United Nations has projected that India’s population of ‘Senior Citizens’ will cross 24 crore by the year 2050. A large number of these senior citizens are economically independent and likely to choose a dignified lifestyle and prefer to live independently in communities of likeminded people. However, they have special needs and require professionally managed services. ”

       “Ministry of Housing and Urban Affairs took a note of the growing demand for professionally developed and managed ‘Retirement Homes’ in India. Accordingly, a committee was constituted to examine the needs of the senior citizens and other related apparatus that deals with the subject. ”

       “Ministry has recognized that such projects are a special category of real estate projects and need to be suitably dealt under the Real Estate (Regulation and Development) Act, (RERA) as well as other relevant laws.”

       “It is envisaged that these Guidelines will enable the States / UTs to establish transparency and accountability with redressal of issues pertaining to Retirement Homes. It will enable an appropriate regulatory environment wherein the rights of senior citizens are protected and their special needs are addressed. It will bring investment in this special category of real estate, wherein demand is expected to grow steadily.”

       Constitution of India mandates social justice, which includes the care of the elderly, belongs to concurrent responsibility of the central and state governments. Article 41 stipulates, “The State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in case of unemployment, old age, sickness and disablement, and in other cases of underserved want”.

       Government of India enacted ‘Maintenance and Welfare of Parents and Senior Citizens Act (MWPSCA) 2007’. Ministry of Social Justice and Empowerment formulated ‘National Policy for Senior Citizens’ in 2011 that proclaims provision of institutional care for the needy senior citizens. Under ‘Integrated Programme for Old Persons (IPOP)’ support provided for establishment and maintenance of old age homes, day-care centres, mobile medical units, regional resource and training centres and formation of senior citizen associations. The state governments are expected to establish and maintain old age homes. All districts should be covered with at least one such facility with 150 inmates.

       A review of ‘Integrated Programme for Old Persons’ was conducted by the Parliamentary Standing Committee on Social Justice and Empowerment in 2014. A major recommendation was put forth to define minimum standards for old age homes across the country. In the meantime, a Public Interest Litigation (PIL) was filed in Madras High Court with a request to direct the state government “to frame regulation and appoint regulatory authority to monitor the functioning of the senior citizen homes.” As a result the Social Welfare and Nutritious Meal Programme Department of Government of Tamil Nadu issued a Government Order (GO) for compulsory registration of old age homes defining minimum standards. However, the paid facilities in the category were not covered under the order. This is considered as the first ever attempt by the government effort to regulate the Retirement Homes in the country.

       Growing number of senior citizens all over the country belonging to high and upper middle income categories are gradually expressing interest for purchase of residencies in the Retirement Homes to avail elder-friendly services. They are ready to invest a portion of their earnings, pension and savings for assisted living facilities in their later period of life. But in absence of regulatory mechanism in few cases the beneficiaries suffer neglect or get cheated by the promoters of the Retirement Homes.

       Development of Retirement Homes comes under purview of ‘Real Estate (Regulation and Development) Act 2016’ and considered as ‘Special Category’. The state governments are in the process to build-up the regulatory framework for implementation of the central act by 2021. Thus issue of Guidelines during 2019 seems to be a welcome step to be vigilant about the Retirement Homes enterprise which is expected to take wings between 2022 and 2027.

       Second, the Guidelines emphasis on qualifications for eligible resident of Retirement Homes. It should be primarily for use of the senior citizens above age of 60 years. In case of living with spouse, the combined age would not be less than 110 years. The allocation to be carried out through lease, ownership or reverse mortgage  procedure. The residents need to pay Refundable Interest Free Maintenance Security Deposit and Maintenance Charges. Location of Retirement Homes will be encouraged to come-up near orphanages, child-day-care centres to explore the possibilities of cohabitation of the inter-dependent age-groups. The state governments may prefer to offer special initiatives for promotion of Retirement Homes industry.

       Third, indicative norms for Retirement Homes as Group Housing has been recommended for coverage of 30 to 80 squre meter per unit. A project may contain around 150 units. Physical standards and norms should confirm advisories mentioned in ‘National Building Code’, ‘Model Building Bye Law’ and ‘Harmonized Guidelines and Space Standards for Persons with Disability and Elderly Persons’. Retirement Home buildings should emphasise on green environment, stairs with handrails, ramps, lifts, corridors, bathrooms with anti-skid tiles, grab rails, lighting, power backup facilities, ventilation, exercise centres, medical rooms, community space and attendant staff accommodation etc. Adequate care giving facilities, single-window helpdesk, transport and mobility assistance, security provisions should include as common basic services for all the residents.

       Fourth, it will be mandatory for Retirement Homes operators to offer basic maintenance and personal care services which may include on-site monitoring. Spelling out the role and responsibilities of service providers are left to respective state governments or UTs considering the local conditions. Where the promoters or developers are not able to provide such services, they may choose to appoint Service Providers or Retirement Homes Operators in order to perform responsibilities towards the residents.

       Fifth, development of Retirement Homes should attract compulsory registration with the respective state governments under ‘Real Estate (Regulation and Development) Act 2016’. They should also enact appropriate mechanism for monitoring of Retirement Homes and redressal of grievances arising in the field.

       Since ‘Model Guidelines for Development and Regulation of Retirement Homes’ has been issued for protecting the rights of the senior citizens living in such facilities, efforts should be taken to pressurise the state governments for early enactment of appropriate laws and regulations. Senior Citizens who are capable of organising such activities should volunteer. Strategically planned campaign both at personal and collective level will certainly bear favourable results.

References :

UN Decade of Healthy Ageing

https://www.who.int/initiatives/decade-of-healthy-ageing

‘Second innings’: India’s new-age seniors splurge on themselves, drive growth of silver economy. www.newindianexpress.com. March 14, 2021

https://www.newindianexpress.com/magazine/2021/mar/14/second-innings-indias-new-ageseniors-splurge-on-themselves-drive-growth-of-silver-economy-2275377.html

Kollewe, Julia. How retirement villages becoming part of high street life in the UK. www.theguardian.com. May 24, 2021

https://www.theguardian.com/business/2021/may/24/how-retirement-villages-are-becoming-part-of-high-street-life-in-the-uk

Hashan, Mohammad Rashid (et.al.) Epidemiology and clinical features of Covid-19 outbreaks in aged care facilities: A systematic review and meta-analysis March 01, 2021

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00051-1/fulltext

Nearly one-third of US Cornavirus deaths are linked to nursing homes. June 01, 2021

https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html

Ministry of Housing and Urban Affairs, Govt. of India. Model Guidelines for Development and Regulation of Retirement Homes. 2019.

https://mohua.gov.in/upload/uploadfiles/files/Retirement%20Model%20Guidelines%20Book.pdf

Dr Pradeep Mahapatra

August 2022

Celebration of 75th anniversary of India’s independence Azadi Ka Amrut Mahotsav coincided with turning 75 year old by ‘middle-old’ population. The category of elderly between 75 and 84 year claim 1.27 percent of the total population. The category of people who took birth 10 years before independence, those reached ‘post-old’ above 85 year account 0.42 percent and others who were born 10 years after the independence ‘pre-old’ between 65 and 74 year embress 3.77 percent. If ‘independence’ means in simple terms ‘to lead an independent daily life’, the elderly life in contemporary India raises questions on several unsolved problems.

The average longevity of people remained at 32 years level by the time India achieved independence and by 2022 calculated to be 70 years. The elderly growth rate has surpassed the growth rate of general population. Census data of 2001 and 2011 reveal that the elderly population over 60 years grew at the rate of 35.5 percent in comparison to 17.7 percent of general population. Growth rate of elderly in Odisha is above the national average. About 9.5 percent of population are above 60 years. Such statistics explain that since one-tenth of the society are old and their number rise on one-third basis every decade, serious introspection on the elderly life claims priority.

Traditionally, care for childhood and old age remained family-dependent. On one hand, elderly in the post-modern social norms consider such a trend acts against personal independence. A question arises, why after a person spending a lifetime in building his or her own personality, accumulating wealth and engaging in various social contributions will seek pity from others to lead a daily life in his near-to-death post-old days ? Lack of social support system is strongly felt. On the other hand, a better child-care system has been evolved due to reduction of birth-rate and improved public health facilities. But factors like rise of nuclear family set-up, small dwelling units, renewed lifestyle, urbanisation and migration of family members for employment to distant places resulted in neglect for providing support to dependent elderly. Keeping  apart the reasons responsible for development of the trend behind, call for brain storming on the preventive measures makes sense.

In absence of family-support for dependent elderly-life, engineering social measures is the only alternative. During first two decades of twenty-first century, the older people in the developed nations preferred to age in their homes as far as possible and move to ‘care homes’ when they attend the phase of a dependent-life. Their later part of life is spent with care provided by professionals in ‘care homes’. Some senior citizens who have to live single due to demise of spouses, meet with serious health problems or a few due to their personal choice prefer to move to retirement communities much in advance. All the basic facilities for leading a standard daily life are provided for payment in market terms which enables a senior citizen to age independently.

Quality amenities for elderly living in developed nations is yet to be available in our country. A section of experts on elderly housing estimated that by 2021 about 20,000 units were available in retirement colonies in India. However, taking into consideration the number of economically sound elderly population living alone in urban locations as potential clients for such facilities exceeded 88,000. They predicted that about 1,25,000 units in retirement colonies will be functional by 2031 registering a tenfold growth. The concept of British model of Care Homes, exclusively to take care of the dependent elderly during later part of the life, is yet to be introduced here. The prevailing practice is to admit the bed ridden senior citizens for a short period of time in nursing homes and hospitals bearing huge expenses. Moreover, it needs supervision of others, which ultimately is a blow to independent living of the elders.

One confronts many barriers for promotion of elder-friendly residency in Odisha. First, the state is rural oriented. While 83 percent of families live in rural setting, only 17 percent of families live in urban locations. Second, majority of population are economically backward. As per government statistics 50 percent of urban and 75 percent of rural households procure ration with government subsidy. Third, educational marginalisation result in considering relocation for elder-friendly living as an act of helplessness in personal life and loss in family reputation. All such problems may restrict the emerging concept for implementation among the general population.

However, time is ripe for promotion of care home and retirement colony concepts for the elite, educated, economically well-off cross-section of Odisha. It is a societal necessity for providing facilities for independent ageing for the generation those were born a decade before and after independence of India in 1947. Experiment carried out for the privileged group will pave the way for building models for disadvantaged sections of the society with efforts by government and non-government sector.

A proposal on building and marketing of serviced studio apartments in the busy localities of Bhubaneswar as a hybrid model for senior residency has been submitted to Odisha State Housing Board by an elder welfare think tank during December 2021. Bhubaneswar-Cuttack has been developed as the medical-hub and elderly population from all the corners of Odisha repeatedly visit the twin city for health care on long term basis. They need camp residential facilities in the state capital on affordable cost in business terms and such housing projects can be an instant success.

Government of Odisha have taken a policy decision to raze 410 quarters in Unit-2 and redevelop in PPP mode as per announcement made in the 2022 monsoon session of the legislative assembly. Odisha State Housing Board can negotiate to procure a piece of land in Unit-2 to build elder-friendly apartments. Since busy localities can only provide easy transportation, multiple health-care opportunities, socialization, security and ready-to-move-in facilities, it can be considered as USP for success of the project. Retirement colony and care home needs a number of infrastructural facilities which may prove hard to provide in the preliminary level. A hybrid model of serviced apartments between ordinary residential unit and care home is an ideal solution taking into consideration the local conditions.

India is celebrating ‘Azadi Ka Amrut Mahotsav’ in 2022 and United Nation have earmarked 2021-30 as the ‘Decade of Healthy Ageing’. The occasion creates an opportunity to emphasise upon independent ageing for the growing senior population in Odisha.

English translation of opinion feature published in the op-ed page of Odia daily ‘The Samaja’ edition dated August 15, 2022

References:

Kashyap, Ashutosh. Senior living in post pandemic world. Colliers India. September 27, 2021

https://community.nasscom.in/communities/current-issues/senior-living-post-pandemic-world

410 Govt. Quarters at Unit-2 in Odisha capital to be razed, redeveloped : Govt. in Assembly. Odisha Bytes

https://odishabytes.com/410-govt-quarters-at-unit-2-in-odisha-capital-to-be-razed-redeveloped-govt-in-assembly/ 

Dr Pradeep Mahapatra

March 2023

A section of elderly population, both in the western hemisphere USA, UK, Europe and eastern hemisphere Japan, China lay emphasis on spending their advanced age in retirement colonies. Experts speculate that the concept of retirement relocation of the senior citizens that gained popularity during post-second world war era may be further accelerated in the post-Covid-19 pandemic environment. It is a fact that a large number of inmates of retirement colonies, care-homes and nursing-homes faced mortality being infected by coronavirus in the initial phase of the pandemic in Europe and the other places. But elder-care facilities at retirement homes assure better living conditions at the end of the life, that is not guaranteed elsewhere. Such reasoning convince people the importance of retirement colonies.

Covid-19 pandemic impacted the elderly population at the highest level all over the world. By beginning of the fourth year of pandemic, in February 2023, World Health Organisation calculated that among all coronavirus induced deaths, elderly above 60 years population constituted 80 percent. An opinion piece published by international news agency Bloomsberg revealed that by the first week of February 2023, every day 500 people died due to Covid-19 in United States. Out of 10 deaths, nine were elderly aged over 65 years. Such developments compel people to give utmost priority to health-care facilities and elderly-care. The organised system in retirement colonies naturally attract people to spend their final days to take benefit out of available resources at a centralized location.

Ministry of Statistics and Programme Implementation, Government of India calculated that by 2023 about 13 crore 94 lakh people above 60 years lived in the country. While 10.1 percent of the population belonged to elderly category, it will reach 13.1 percent by 2031. Increase in number of economically prudent families in the emerging economics may result in pushing a sizable elderly population towards retirement colonies in their golden years of life. Various estimates reveal that in the pre-Covid days about 20 thousand units operated through 55 projects were fully functional and 4,500 units were available for sale in the senior living market.

Retirement colony projects usually specialize in four areas (i) independent living, (ii) assisted living, (iii) nursing care and (iv) memory care. Elderly singles or couples who can lead their daily life on their own prefer ‘independent living’ facilities. But those who need others help and supervision go for ‘assisted living.’ Some of the seniors in ill health and long term medical treatment require ‘nursing care’ and those with memory loss problems live in ‘memory care’ specialities. Each of the senior living categories offer different life style assistance to inmates.

It is improper to define retirement colonies as housing with lesser carpet area clustered in a locality. Building infrastructure and offering management of elder-care, both are integral part of the project. Senior living in our country is gradually emerging as an industry and expected to expand at the rate of four percent on year to year basis between 2018 and 2027, forecasted a consultancy firm. Ministry of Housing and Urban Affairs published ‘model guidelines’ for development and management of retirement homes and advised the state governments to formulate rules and enact laws.

In our country about 70 percent of retirement projects are developed in the southern states. Bengaluru, Chennai, Puducherry and Hyderabad claim the majority of such facilties. Delhi, Chandigarh, Dehradun in north and Mumbai, Pune, Ahmedabad, Surat, Panaji in west follow. However, the eastern states lag behind. The lead entrepreneurs in the field include Antara Senior Care, Columbia Pacific Communities, Ashiana Housing Ltd, Paranjpe Scheme (Construction) Ltd., Covai Property Centre (i) Pvt. Ltd., Oasis Senior Living, Primus Life spaces Pvt. Ltd., Golden Estate, Tata Sons Pvt. Ltd., Brigade Enterprises Ltd., Ananya’s NanaNani Homes and ANAROCK Property Consultant Pvt. Ltd. etc. as per industry reports.

In Odisha, though initiatives to build retirement colonies, comparable with national standards, were taken-up by several parties during the first two decades of 21st century, could not be materialized. Life Insurance Corporation of India started a project at Bhubaneswar along with Bengaluru, but prematurely entangled into litigation. Absence of buyers and wrongly location choosen are the main reasons for failure of projects envisaged by the local entrepreneurs in the field.

On analysis of the possibilities of building and marketing of retirement colonies, a few fundamental questions come to the forefront. First, does traditional Odia society is prepared for relocation of the elderly population for better elder-care to retirement colonies ? Second, in the post-Covid national market an unit in a standard retirement colony costs 40 lakh plus 10 lakh as one time deposit for maintenance charges, total 50 lakh investment is needed. How many families can afford or like to share for such a purpose ? Third, unless the retirement colonies offer specialised elder-care facilities, such as assisted living, nursing care or memory care; who would like to move into dwelling facilities of lesser carpet area. Retirement colonies are beyond real estate projects.

In Odishas’ social fabric, where materialisation of retirement colonies is a distant dream, at least not before 2030, amidst rapidly expanding elder care facilities in the New Normal at the international and national level, Grey Odisha, a think tank dealing with alternative ageing in and around the state developed a concept of hybrid model of retirement colony in 2021. It approached the Odisha State Housing Board with a concept paper to consider building and marketing of the hybrid model of serviced studio apartments for senior living in busy localities in the state capital Bhubaneswar. Copies of the proposal were despatched to ministers of concerned departments, few legislatures and the chief minister’s office by registered post. Only Chief Ministers Office acknowledged receipt of the communication and forwarded to Housing and Urban Development Department and Secretary of the Housing Board in September 2022 as per available information. Details on the concept paper is available at https://www.greyodisha.in/updates

The proposal reviewed a few relevant issues relating to elder-housing scenario in New Normal in Odisha. First, looking back on the history of failed initiatives to implement retirement colony projects, the need arise to identity the first group of beneficiaries who can invest money into such projects and prioritise their preferences and requirements in project formulation. Bhubaneswar-Cuttack has been developed as the health-care-hub and elderly people belonging to the economically prudent families from all corners of Odisha come to the twain-city for specialised treatment. Such journeys are repeated and occasionally the stay prolongs. Such a category will like to have an own place at Bhubaneswar and will not hesitate to invest around 50 lakh rupees for the purpose. Housing Board was requested to initiate a survey to test the potential of the hypothesis. Building elder-friendly serviced apartments exclusively for the senior citizen category may not satisfy all the criteria of retirement homes, but serve as a hybrid model to bridge a traditional society to a futuristic endeavour. Success of the pilot project will encourage both private and government sector to enter into senior residency in the state.

Second, as the hybrid model of retirement colony will be built for senior citizens living outside Bhubaneswar, all the precautious should be undertaken to ensure how it will not be misused by non-elderly category. Experience at various projects depict that once ‘small living facilities’ termed as ‘retirement homes’ are sold to the senior citizens, in cases they rent it out to non-elderly category. The practice makes the environment polluted for the elderly residents of the colonies. Importance should be laid upon instead of traditional 1 BHK, 2 BHK model units, single rooms attached with wide veranda, toilet and balcony civil structures to be designed along with enough common use space. Housekeeping and maintenance of the dwelling units are to centralised added with kitchen, laundry and security facilities governed by the housing society. To make such service mechanism sustainable, advance non-refundable deposit of 10 lakh rupees should be collected at the time of sale.

Third, the proposed hybrid model of serviced studio apartments need to be located in the busy localities. It will enable beneficiaries living outside the city easy transportation and proximity to multiple health-care service providers. Government of Odisha has taken policy decision in 2022 to demolish government quarters in Unit II and redevelop vertically for public purpose. Housing Board can negotiate with the state government to procure a portion of land to build and market senior housing, in a centrally placed busy locality. 

Fourth, Housing Board is a civil construction organization. Building and managing retirement homes may not suit to its routine operation. However, in the process of creating housing facilities for various categories of population, senior housing may be considered as a priority. On the other hand, when about a hundred senior citizens live in a community, facilities of elder-care can grow-up in an organic manner. In the post-Covid 19 New Normal elder-care is an emerging sector and the proposed hybrid model is expected to facilitate the process which will ultimately benefit the society to promote alternative ageing in the state.

Fifth, Housing Board can create senior living facilities and tie-up with national level private elder-care service providers to assist the housing societies for management of such colonies. Strategic partnership with experienced entities, building-up infrastructure for added technological innovations such as humanoid robotic care possibilities, can open-up a new chapter in elder-care in Odisha. United Nations has designated 2021 to 2030 as ‘The Decade of Healthy Ageing’. Senior housing is one of the focal objectives of the Decade celebration. Thus, 2023 is a proper time to call the attention of policy makers to the subject.

English translation of the un-edited version of op-ed article published in Odia daily The Sakala, edition dated March 16, 2023

References:

https://www.who.int/health-topics/ageing

Flam, Faye. Older Americans need more protection from Covid-the pandemic isn’t over for people over 65 (Opinion) Bloomberg

https://www.bloomberg.com/opinion/articles/2023-02-09/us-covid-death-rate-among-older-people-is-unacceptable?leadSource=uverify%20wall

India senior living market analysis-industry report-trends, size and share. Mordor Intelligence

https://www.mordorintelligence.com/industry-reports/india-senior-living-market  

West Bengal Housing Infrastructure Development Corporation Limited’ has developed a senior residence colony at New Town, Kolkata. A short video can be assessed in the following link :

Watch ‘Snehodiya – A Luxury Retirement Home’ on YouTube (3.52 m.)

https://youtu.be/WOOEbElC4DI

Department of Social Welfare, Government of NCT of Delhi materialized a similar project. A short video report is available in the following link :

Watch ‘Delhi Ahead : Delhi Govt. Introduces Old age Homes, Accommodates 1,000 senior citizens’ on YouTube (4.52 m.)

https://youtu.be/yDg2DoYwtzk

‘Jagriti Dham’, a luxury old age home opened during April 2023 in the neighborhood of Kolkata claims to be equipped for independent and assisted senior living (5.42 m.)

Take a tour of Your Gold age Home

https://youtu.be/3RMxY1d3yWs

CNN’s World’s Untold Stores : Dementia village Hogewey, a small village in Weesp, the Netherlands, where every resident has severe dementia (23.48 m.)

https://youtu.be/LwiOBlyWpko