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active ageing caregiving continuous learning financial security and planning geriatric care mid-life planning physical health and fitness quality of life travel and mobility

Longevity Dividend & The 100 Year Life

Designing for a 100 Year Life.

People around the world are living longer thanks to advances in medicine, public health and other factors.

  • Is living longer a gift or a curse?
  • What happens if more of us live till 100 years?
  • What does research around the world say?
  • How are countries, societies, businesses and individuals adapting to it?
  • How can you redesign your life for a 100 year life?

In this essay, which is broken into sections, I look at India’s longevity dividend (does it exist?) and highlight research around a 100 year life.


📫 Silver Angels Newsletter

The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.

🧠 Thoughts, feedback or comments? Want to connect?

Feel free to reach out at any time via email: mahesh@silverangels.in

Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in

Categories
interviews mid-life planning quality of life senior living

Eldercare Expert Interview: P S Srikumar

P S Srikumar (“Sri”) is the founder of Chennai-based Integrated Eldercare Solutions, which provides senior and assisted living, home healthcare and advisory services to individuals, families and organizations. An ex-COO of Randstad, Sri quit his job to become the primary caregiver for his mother. This life event triggered his passionate journey into the eldercare space seven years ago.

In this interview, I chat with Sri to understand the his experiences and draw key insights from his varied experience.

Sri, you are very passionate about the eldercare space and have traversed different parts of it. Could you give us a short background of the last seven years?

I had a very eventful 7 years in this space. I was lucky to have people who mentored me and gave me opportunities to understand different aspects of senior space that included projects in retirement community (CEO of one of the leading retirement community brands in India), launching and running the top products space in Chennai for a client – where we ran a shop in our office for a year on a build operate and transfer model, handling audit of day-care centres and old age homes funded by the Govt of India – Ministry of Social Justice for their partner, training primary care givers in specific areas of memory care and palliative care,  partnering with the largest and only exhibitions and conferences business in the eldercare space, working on assisted mobility and working with parents with children who had disabilities. Each of these projects were intense and spanned over a year each, as it involved strategy and implementation.

Simultaneously, I worked with senior groups – individuals and communities. In the last five years we have helped over 5000 families find solutions to the day-to-day challenges they face in taking care of their loved ones.

Covid has had a big impact on the sector, particularly the rise in home eldercare and senior living space. What are the fundamental shifts you are seeing among families and elders?

Covid had impacted seniors significantly. It is a paradox that in spite of the family being at home, elders felt lonelier during the last two years, than ever before. Earlier, elders used to have “me time” once the children left for work and grandchildren left for school. This wasn’t available during the “work from home or study from home” situation. Besides this, was the need for silent homes. Absence of home help in most cases had elders finding difficult to manage and maintain homes.  

Covid confined seniors to a space. Walks in the evenings, meeting with friends and relatives became impossible. And everything online was something they were not prepared for. 

This is a time that the demand for senior living and assisted living saw a rise – because of the perceived personal space it offered, besides the safety.  Unlike the west, the number of people affected by Covid in communities was very negligible in India. The communities exchanged ideas on how to protect seniors. Even vaccinations were done at these communities. From groceries to medicines, home banking to housekeeping, seniors woke up to a world that was now looking more secure and comfortable.

Access and affordability of care rose significantly – especially for elders affected with Covid with no one to take care of their daily needs. Cost of care almost doubled for people.

We were able to provide support and help to the elder community during this time. Some challenges that elders faced was to learn smart phone and applications like Zomato, Swiggy or grocery ordering – as they became necessities. Reluctance to learn gave way to necessity. 

Intergenerational bonding increased (grandparents and grandchildren), though elder’s privacy in many cases was lost. Increased opportunities in area of home food catering helped many to overcome these difficulties. For many business it was disruptive time and for many others it was an opportunity.

You were a CEO of Covai Care, a pioneer among India’s retirement communities, and have work with leading players in the broader senior living space. Can you give a glimpse into how senior living offerings have changed over time?

I was fortunate to work with Col. Sridharan – who is a pioneer in the concept and founder of Covai Care. Retirement communities started off as extension of real estate. Till recently, in my opinion, many of them did not anticipate the ageing needs nor were prepared for ageing related requirements. Advertisements flaunted healthy ageing.

(Elder) Care meant an ambulance or a medical station. However, many things changed for better in recent years. From a customer perspective, the awareness and acceptance of senior living (which was often confused with old age home) has certainly increased. People accept this as choice. The taboo around the concept was giving way to acceptance. One good aspect was that different forms of living coming up be it independent living, co-living spaces, assisted living, memory care, palliative care, etc. 

Industry organizations like the Association of Senior Living ( ASLI) and CII’s senior forum played a very important role.  People started recognizing best practices. Eligibilities became entitlements. If you are on social media like Facebook or LinkedIn, it is very common nowadays to see advertisements of such facilities available. The overall understanding of this space has increased. International players have recognized India as one of the key markets, given the demographics.

Today the senior space has spread across segments like affordable senior housing and elite ones.   Now standards for senior care are being looked at.  The South had more than 65 % – 70 % of the market share. However, projects are coming up across the country, as the need for the segment has been felt by its stake holders. The market is surely expanding. Brands like Godrej, Tata Housing, Max, Columbia Pacific, LIC, Shriram Group etc., have forayed into the segment.

During our chat, you mentioned the need for more assisted living spaces and particularly those that cater to dementia and other mobility-related issues faced by elders. How big or small is this opportunity

The opportunity is large and substantial.

As living spaces become smaller, providing care for a person with mental health (Alzheimer’s or Dementia) or terminal illness (including Palliative Care), or for persons with disabilities becomes a major challenge. Post-operative care, step-down care or care continuum is a huge area that needs attention and prioritization.  

The options available are very limited and information is also not readily available to the common man. At a stage, a person may not be in a position to manage a property by himself.  Besides will need assistance for day to day activities. Affordability and access become a challenge. Even in a retirement community a person may have to move from an independent state to a dependent state. The community may not be equipped to handle the requirement.  With less than 1 % of the elder population in a formal community environment, the challenges for the rest 99 % are humongous.

Memory care is another area which is very acute. We have had situations where except for the patient with dementia, the near family is not in India and a normal assisted living or senior community will not admit such a person. Parkinson’s, muscular dystrophy, terminal illness, visual impaired elders…the need is just huge and there is not much offer available today.

I work with the visually impaired, it is sad when one of my customers told me that after 60, they are considered a burden by the family (many of them don’t marry) and they don’t have a place to opt for. The Government runs a few facilities, but it does not suit many. It is time the society, business and government come together to address this issue. Besides a huge business opportunity, it is also a humanitarian need.

Carefinder.in is one of your digital products and you have assisted over 4000 customers make informed decisions about on a variety of aspects. How big of a challenge is lack of quality and reliable information in making decisions around living arrangements, etc?

Access to reliable information is still a challenge. But this is changing as the sector is moving into an organized set up. Very slowly. The share of unorganized market is almost 70% of the inventory that is available.

Web searches takes people to a number of options. But many sites provide information that have not been updated. And a lot of information is also obsolete so reliance is still on experienced people for suggestions. One of the biggest challenges is the fact that a choice of a community depends on many factors, specifically the social and economic background of the resident.

When one makes a decision, it is important to understand perspectives and the age of entry. A normal retirement community is wonderful if you enter at around 60 or 65 years of age. It helps you build friends for the next twenty years and adapt to the living.   However, as you age, it becomes more difficult to accept and adapt to a community.  Background of the promotors, organization structure, continuity of service and exit options are all key factors. There are hidden costs like a onetime non-refundable deposit or a medical deposit, and all this will have to be kept in mind while deciding on selecting a place.

Apart from working closely with businesses, you also provide 1-on-1 consultations to families seeking support for their parents and elders. Can you expand on the common queries, and how you think one should go about planning for later life living arrangements?

Many people are still not clear what type of living they need. All our consulting is on a 1 – 1 business. We do not believe that “one shoe fits all”. We probe. We put our understanding in writing and send it to the customer to validate our understanding. The common query is can you suggest a retirement community. This is an open-ended question. We need to understand their budgets, we need to understand and advice on buy vs. rent options, health and financial background of the persons, access to near blood relative in case of extreme situations. Some retirement communities have age barriers for entry and some others have health barriers. For example, not many communities accommodate elders with mental health issues or elders with children with disabilities. As a consultant, we need to know what to suggest and what would be a good fit. In many cases, the solutions we give are very different to what they came to us initially for. And to offer solutions, we need to understand the business also and hence, there is a B2C and a B2B connect here when we provide solutions. 

For many seeking help on home health care, we have suggested assisted living – considering the support and economic reasons of these persons. We suggest people who are apprehensive to do a short stay in the communities and decide only when they are convinced that this is the best option.

It is important to plan a retirement living when you are around 45 years of age. 50 to 60 years is a very vulnerable age and this is where many businesses cash in. In this age group, one is into a midlife situation. Senior position in organization with work pressure and priorities, growing up children, ageing parents and personal health and hence a getaway to a distant place is what many think of. However, above 70, the need reverses. They like to hear noise; they like to meet with younger lot and not live in secluded places (most of them).  This is one of the reasons that stand-alone communities are giving way to integrated living formats now.

You are active in many forums – CII, ASLI, Tamil Nadu govt, etc. What are three takeaways from that vantage point?

  • Understanding the industry and needs better
  • Understand other issues affecting the senior community in large, than just living
  • Prioritising requirements of a larger community and working on policy level suggestions to the government.

You can check out Sri’s work here, connect on LinkedIn or write to him directly at srikumar@carefinder.in.


Silver Angels Newsletter

The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.

Categories
50 plus mid-life planning

Rise of the Empty Nesters

Edition #31: Mid-life transitions, longevity planning, active ageing and much more!

According to the Global Parents Survey by the Varkey Foundation, Indian parents spend the most time on the homework of their children in the world.

62% of Indian parents spend on an average 12 hours on their children’s homework, almost 2.5 times over the global average for this cohort.

The success or failures of our education system, or the socio-economic realities of parenting, are not really the parts I want to dissect.

  • What happens when all the homework there is to be done, is actually done?
  • What when there is little dependence on parents for children to get on with their life?
  • What happens when children grow up and move out of the house?
  • What happens to the parents who now have all the time to themselves

Welcome to Empty Nesting.

“Empty nest syndrome isn’t a clinical diagnosis. Instead, empty nest syndrome is a phenomenon in which parents experience feelings of sadness and loss when the last child leaves home. Recent studies suggest that an empty nest might reduce work and family conflicts, and can provide parents with many other benefits. When the last child leaves home, parents have a new opportunity to reconnect with each other, improve the quality of their marriage and rekindle interests for which they previously might not have had time.”

Source: Mayo Clinic

For the sake of discussion, let us take a couple that has just arrived in the empty nesting zone. They have worked hard and (continue to) lead busy professional lives and are financially secure, healthy, socially well placed and have all the good things that life has to offer. They have just realized also that they will be living by themselves, and a whole new world is ahead of them. It is like ground zero all over again, and a bit similar to the time when they started out their lives, and since navigated the many life events and milestones together.

While there is no one-size-fits-all solution, and I won’t even attempt one, (empty nester) families are likely to (re)imagine their future as they see fit, and shift some of their thinking around what matters most to them, as individuals, a couple and as a family.

This is likely the commencement of a conversation around the next decade and more, on how to live and plan for the future ahead. This may manifest in exploring new activities and adventures, and commencing passion projects, independently or together. These conversations and experiences are likely to take many shapes and forms, and sometimes none at all, given many factors leading up to this stage. For example, business or joint families are less likely to go through these transitions as there is a fluid continuity in mid- and later life transitions while professionals with more demarcated boundaries of private space, independence, and slightly codified family relationships may face a different set of challenges. Family, particularly parents and their lives, is likely to shape some of this thinking, and thus influence these decisions.

Empty nesting is an interesting trend that is likely to rise given the structural changes in the Indian family over the last three decades (nuclearaziation, urbanisation, economic upsides, etc), and with longevity (increase in average lifespan of general population), it is likely to be an interesting space to watch!

You may want to check out some relatable essays,

Longevity Finance: Impacts on Retirement Planning

Silver Generation: The Original Disruptors

Future of Ageing: An India Perspective

🌍 Do subscribe to this interesting newsletter – Fintech for Longevity – an effort by Dr Ira Sobel, founder of a global platform shaping the conversations around financial technologies and financial inclusion focused on ageing and longevity.


📫 Silver Angels Newsletter

The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting. No advertising or sponsorship.

🧠 Thoughts, feedback or comments? Want to connect?

Feel free to reach out at any time via email: mahesh@silverangels.in

Silver Angels is an independent platform tracking the Silver Economy in India with focus on ageing journeys, longevity impacts and seniorcare. You can find more information on www.silverangels.in

Categories
financial security and planning mid-life planning quality of life

Longevity impact on retirement planning

Thanks for reading! In this newsletter, I try to breakdown longevity impact on planning, and how decisions you make today can have a compounding return on your future life.

Now, let’s dive in!

Retirement planning, and missing pieces

Retirement plans put a smile on everybody’s face. For many that can afford to stop working, it is the culmination of family and work responsibilities, and the start of a new journey. It may result from the natural end of a career (60 to 65 years) or through a planned event (early retirement, etc). Each individual and family plans differently and have a set of different priorities. Some people look forward to it with a fresh set of plans, others intend to spend more time with their family and friends, and some others prefer to take it easy. Without going into nuances, Aegon’s 2015 Retirement Readiness survey points to Indians having a very positive perception of retirement, and a majority are comfortable with their retirement plans.

Over the last decade, one can notice the professionalisation of retirement planning, thanks to more financial products and services, and rise in SEBI registered financial advisers, and this has allowed for investments in market-linked returns adjusted to risk profiles. These options through conventional institutions and new digital platforms, aided by rise in economic opportunities, could be reasons for such optimism among the young. Traditional media and aggregator platforms continue to cover this space through various articles, insights and tools.

A large proportion of older adults in India continue to co-habit homes with their families, and manage their expenses with returns from fixed instruments (FDs, senior citizen schemes, etc) or through pensions and rental income, where available. They have very little wiggle room when it comes to deviation from their planned finances.

With average lifespans rising by almost 10 years in two decades, the impact on longevity on such plans are largely underestimated. While most (retirement) planning calculations work on simple inputs – age of retirement, life expectancy, inflation, expected rate of return, current savings, future expenses, etc, – they also tend to look at life after retirement as a stable set of years with an incremental rise in household/family spend.

Today, it is not difficult to find a bunch of retirement calculators with such simplistic assumptions. The question is, what are they missing?

Health spending, medical debt and out-of-pocket expenditure

According to the LASI study, it is estimated that by 2030, 45% of India’s health burden will be borne by the older population. Low levels of public spending (particularly in geriatric care), longer lifespans, rise in chronic conditions (cardiovascular diseases, hypertension, diabetes etc.) and multiple co-morbidities will further push the cost of healthcare for very many of us.

In 2019-20 alone, 5.5 crore Indians were pushed to poverty by medical debt, which can be attributed to many factors including lack of insurance coverage, limited coverage, high cost of care, medical inflation, etc. The out-of-pocket (OOP) expenditure on health care depends on many factors; household income, type of illness, age, sex, type of health facility and quality of care. OOP expenditure on health stands at a worrying 60-65 percent, the highest in the world. While private sector dominance in healthcare provision in urban India (out-patient care, hospitalization, etc) is well known, lack of serious healthcare/medical regulation is unlikely to bring such expenses down in the near future.

According to this study, the monthly per capita expenditure (MPCE) of elderly households is higher than that of non-elderly households possibly due to higher health spending of elderly households compared to non-elderly households (3 times more).

Impact of medical debt and OOP expenditure can be particularly acute in elderly households and households with elders given their sources of revenue are limited and/or fixed.

Health insurance market, medical inflation and treatment costs

With only 137 million lives covered in FY20, India is also a largely underserved market for health insurance. As per the LASI study, only 18.2% of those aged 60 years have health insurance; it is at 23% for those in 45-59 age group; overall 21% of those aged above 45 years are covered by insurance.

This article highlights the market failure and unimpressive outcomes from opening up the health insurance market more than two decades ago, and the rise in cost of insurance premiums.

Retail health insurance has always followed an ‘age-band pricing’ approach where policyholders in a particular age band pay an identical premium and see their premium jump as they move bands, especially amongst higher age groups. Adding to this is the premium revision by insurers, usually in a block of two-four years to keep pace with medical inflation. These factors together can see premiums jump to as high as 50 percent on renewal leading to large risks of selective lapsing.

Deepti Bhaskaran, ORF Expert Speak

Premium revision linked to medical inflation and age-band pricing can have a particularly negative impact on insurance premiums of older adults. Furthermore, health insurance purchase is an onerous task for older adults without family or professional support. While exclusions for older adults have improved over the years, insurance sales, repurchases and claims processing continues to be a very messy operation, and infrequently regulated by IRDAI.

report by Mercer Marsh Benefits said forecasted medical trend rate will be 10 percent in India, while inflation will be at 5 percent. With respect to the diseases, respondents from Asia (including India) said that increased non-communicable diseases will increase employer-sponsored healthcare costs over the next 3 years. These diseases include heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer’s disease, mental illness and kidney diseases.

The cost of healthcare, and particularly medical treatment, has been rising in India, and has particularly accelerated due to the pandemic. Higher hospitalization charges due to covid-related protocols, additional procedures, etc. have been par for the course. It is estimated that the healthcare expenditure will rise two-fold, and form 11% of private consumption expenditure from the current 5% thus sucking away hard-earned rupees away from other expenditure items. While healthcare facilities and access to modern medicine have improved significantly, affordability continues to be a major challenge. For example, a major medical treatment expense can affect a well-planned retirement plan. An expert tracking the space advised purchase of health insurance early on (to avail differential pricing) and a medical treatment corpus as two ways to deal with such emergency situation. There are likely other options to be explored in the context of one’s support system. For example, Beshak’s Critical Illness Handbook provides a deep-dive into insurance options as an independent and unbiased voice of experts, and is thus highly recommended.

Source: Beshak.org

In conclusion…

Planning for retirement is different from planning for a better quality of life. Apart from sound financial health and early planning, it is also important to consider options associated with age-linked care assistance (home care services), short- and long-term medical care, alternate living/custodial arrangements, and other later life transitions. While there is no perfect algorithm that can help arrive at the right plan, it is also never too late to ponder over the question, be it 40 or 75!