Elder Care Needs Mapping

As we grow older our health and wellbeing needs keep changing. Though the basic needs of the ageing process have not changed much but some new needs have emerged over the past few decades. The graph on mapping the Aged Care needs is an effort to show the progression of the levels of care with respect to ageing in years.

Pankaj Mehrotra

The document can be accessed on:

3.1 - Eldercare Needs Mapping

The document can be accessed on: Eldercare Needs Mapping Download

Fruits Bingo For Mental Wellbeing

Mental Health is a cause of concern amongst the caregivers especially those working in the field of ageing. To keep the mental faculties active and to improve memory amongst the elderly, recreational and activities managers keep developing new ways to stimulate the mind. Fruits and vegetables Bingo has been around for a while. In the chart attached, I have tried to make an Indian version of the same with a few punchlines of my own. This type of game could be good for people with Alzheimer's or other Dementia causing diseases.

Pankaj Mehrotra

The document can be accessed on:

3.2 - Fruits Bingo

The document can be accessed on: Fruits Bingo Download

Senior Living Formats

Senior Living in India is witnessing a positive growth with various projects coming up across the country. Operators are experimenting with various formats ranging from Independent Living, Assisted Living to Specialized Care. Though some formats are popular amongst the private players due to their financial viability, however I feel that other non-revenue generating formats also needs to be developed.

An attempt has been made to identify and document the various senior living needs/ formats which is attached for reference. International operators looking at entering the Senior Living market in India or the Central / State Governments can evaluate these formats.

Pankaj Mehrotra

The document can be accessed on:

3.3 - Senior Living Formats

The document can be accessed on: Senior Living Formats Download

Senior Living Models & Scope of Intervention

Senior Living and Elder Care in India is going to witness an exponential growth in the next two decades. The new crop of urban Seniors would be financially sound and will be willing to spend on themselves, rather than leaving a legacy for their children. They would be technologically savvy and would be more demanding about the competence levels of service providers.

There is a great opportunity for Senior Care operators to explore the large market which consists of approximately 9% of the present population. At present the senior care market is largely unregulated, which in my opinion would start maturing with the introduction of National Standards & Guidelines. The chart presents the existing models and the scope of intervention in the Senior Living space.

Pankaj Mehrotra

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3.4 - Types & Scope of Intervention

The document can be accessed on: Types & Scope of Intervention Download

Senior Living Database - The Disadvantaged Elderly

I was searching for the list of Elder Care Homes in India. To my surprise, I could not find a single website which offers an accurate database in searchable format.

While on one hand, India is seen as the software hub of the world but unfortunately we don't have a simple software.

I am sure it is not difficult to capture real time data on the facilities, services, charges and occupancy levels of 900 odd senior living facilities.

A project like this will help elders who are either homeless, destitute, isolated, neglected or facing abuse.

In-case anyone can help please forward this to companies under their CSR activity. A sample is being shared.

Pankaj Mehrotra

The document can be accessed on:

3.5 - Senior Living Database

The document can be accessed on: Senior Living Database Download

The Need for Senior Living Initiatives in India

Internationally Senior Living and Home Care is a well-developed sector/industry. Countries like USA, Canada, UK, Australia, Europe and a few South Eastern countries have well defined laws and legislative acts which regulate the functioning of the sector.

India is also seeing a growth in the Aged Care sector but unfortunately there are no national standards and guidelines. As the elderly population is growing at a much faster pace as compared to the other age groups, it will become imperative and critical to bring all the existing and future senior care operators under the same umbrella.

I have made an attempt to compile the necessary intervention areas that require immediate attention. I hope that quality information and knowledge can be shared with all stakeholders by the concerned authorities and ministries.

Pankaj Mehrotra

The document can be accessed on:

3.6 - Need for Senior Living Initiatives

The document can be accessed on: Need for Senior Living Initiatives Download

Senior Living Project Costing - Sample Format

Off late I have been receiving a lot of queries about Senior Living by Hotel Groups, Real Estate Developers and High Net worth Individuals.

My typical response to them is;

1) Senior Living is not a hotel business where the customer rents a room for a few days, here the residents are long stay family members and not customers.

2) If one is looking at this model like a typical startup and expecting the valuations to multiply in a short span then this is not the game they should play.

3) Companies should be willing to look at it as a long term opportunity in order to succeed.

4) This is a business which requires passion and empathy without them it won't last long.

To give an idea of the overall business model, I have prepared a sample costing and revenue format. These costing are estimated figures and would differ from city to city.

While this takes care of the middle and upper middle-income groups but unfortunately the poor would have to depend upon the Government support.

I would be happy to incorporate relevant inputs and feedback.

Pankaj Mehrotra

The document can be accessed on:

3.7 - Sample Project Costing

The document can be accessed on: Sample Project Costing Download

Senior Living Costing Comparison - Staying at Own Home Vs. Retirement Home

The decision to relocate to a retirement community is never easy. Our emotions attached to the house besides uprooting oneself from familiar surroundings can be a challenging decision to make.

I always suggest seniors to do a needs gap analysis before deciding. We normally compare the financial implications of shifting to a senior living facility but rarely do we put a value to the safety, well-being and health care. Living amongst like-minded people in a vibrant sheltered housing can have it's own advantages.

To give an idea on the comparative expenses, I have attached a slide showing a typical middle class home expenses.

Hope it can help seniors who are unable to make an informed decision. The costing are generic and would differ from city to city and household to household.

Pankaj Mehrotra

The document can be accessed on:

3.8 - Comparative Costing - Home Care Vs Care Home

The document can be accessed on: Comparative Costing - Home Care Vs Care Home Download

Senior Living - India Scenario

Senior Living is a slightly tricky business in India. The market dynamics are completely different in comparison to the socially developed countries.

At present most senior living projects are concentrated in cities like Bengaluru, Pune, Chennai, Hyderabad, Coimbatore and parts of Kerala. This basically shows that the concept is more acceptable in South than North.

In my personal opinion, there is a difference in mindset of senior's of South India as compared to Northern States. In South, elders are relatively more open to shifting to a retirement community, whereas up North the ideology is somewhat different.

In the Northern belt, the stigma associated with the term "Old Age Home" is still haunting the growth of the sector. Mindset of families, "What will friends and relatives think if I shift to a retirement community", becomes the deciding factor rather than the actual need.

India has approximately 60-70 thousand beds under different formats of senior living. While majority of them fall under the free/charitable basis, however over the past 15 years around 9-10 thousand units have come up in the middle and upper middle income group segment. This works out to 1 bed for 1600 people above the age of 60.

On one hand the well-established senior living brands tend to get sold out faster whereas others have to struggle for getting in the residents.

The dilemma of the middle class is even more complicated, they can't live in charitable homes due to social status issue, yet they don't have the resources to afford the middle segment facilities.

Another strange aspect is, a lot many charitable homes have low occupancy levels. The homeless people living on the streets do not like to live in a free senior living facility, reason is loss of income from begging.

In a nutshell, senior living in India has tremendous opportunity to be tapped, however one needs to be careful while planning. The complexities of the industry need to be researched and understood properly.

Pankaj Mehrotra

Senior Citizen Homes - Budget Allocation Vs. Budget Spent

FY - 2021-2022
A budget of Rs.10,517.62 crore was allocated for the Department of Social Justice and Empowerment for financial year 2021-2022.

Atal Vayo Abhyuday Yojana (AVYAY), formerly National Action Plan for Senior Citizens (NAPSrC) which is the Centrally Sponsored Scheme, was assigned a total budget for the welfare of Senior Citizens at Rs.533.81 crore for FY - 2021-2022.

Amongst other welfare schemes for the elderly, there was a proposal for grant to set up / fund existing or new 163 Senior Citizen Homes. The total budget allocation for funding new / existing residential facilities for senior living was Rs.55.09 crore for FY - 2021-2022.

FY - 2020-2021
A budget of Rs.8207.56 crore was allocated for the Department of Social Justice and Empowerment for FY - 2020-2021.

In National Action Plan for Senior Citizens (NAPSrC) 2020-2021, the annual budget allocated was Rs.365 crore.

Amongst other schemes, there was a proposal for grant to set up / fund existing or new 250 Senior Citizen Homes. The total budget allocation for funding new / existing residential facilities for senior living was Rs.67.15 crore in 2020-2021.

The larger point of debate and concern is, where and which are the 163 and 250 Senior Citizen Homes for the FY 2021-2022 & 2020-2021?

How does the industry and concerned citizens get to know of the actual development / progress on the ground??

I hope this year's budget allocation for Elderly Care is proportional to the population of Senior Citizens in the country.

As the country moves towards a digital friendly format, it is important to have a transparent system of showcasing the amount spent from previous budgets and the progress / number of beneficiaries impacted.

Pankaj Mehrotra

Home Care to Care Home

It seems India market is gradually realising Senior Care as a growing sector.

The number of Home Care providers and Care Home operators are increasing by the day. This means investors are seeing the Indian Seniors as the next target segment.

The term Old Age Home is slowly being replaced by Care Homes, Assisted Living and Retirement Homes, which is definitely a positive step in the right direction. For decades we were stuck with the taboo word Old Age Home, but now the awareness of independent living supported by care is the new norm.

Having seen the industry/sector grow from its inception stage, one of the learning is, there is still a visible divide in the level of senior care services.

Most of the new companies are targeting the segment with purchasing capacity, which is but natural being in business, but my views are what are we doing for the underprivileged, poor and destitute??

Should we solely depend upon NGO's or it is high time that the respective States start taking Elderly Care seriously.

The next 10 years will witness a major population boom of people above 60 years. The point of debate and implementation is are we prepared and heading in the right direction.

Pankaj Mehrotra

Snapshot of All India Senior Citizen Homes

John F. Kennedy said, “Ask not what your country can do for you – ask what you can do for your country,”, somehow his words made an impact to my outlook.

This snapshot of the Elderly Care Homes / Senior Citizen Homes, is my way of contributing to society.

Since I was struggling to find the all India district wise statistics on senior care homes, I decided to compile the same myself.

In my opinion if any sector has to grow, then people need to share their learning for the larger cause. It is always better to share the knowledge and be of help rather than taking all the knowledge and learnings to the grave.

Though the data on senior citizen homes was/is not easily available and accessible, however I would like to thank the Senior Citizen Homes, District Magistrates, District Collectors who responded to my queries.

I personally feel the tides are changing for the better. India could become one of the most advanced countries in the world with a well developed Senior Care sector, provided we take corrective steps as of yesterday. Though it is still a long way to go but the next 10 years will surely see great progress.

I hope this snapshot of Assisted Living Homes / Care Homes can give some direction to the policy makers, decision makers, investors and concerned citizens.

It will be great to see that each district has one SCH which is recommended in the National guidelines. If educated people like us do not raise the issues on behalf of the underprivileged then who will??

Pankaj Mehrotra

The document can be accessed on:

3.12 - Snapshot of All India SSCHs

The document can be accessed on: Snapshot of All India SSCHs Download

Kerala - Senior Living Scenario

Kerala is called "God Own Country", no wonder it has 31% of India's Senior Citizen Homes.

As per my calculations, Kerala has 754 care homes for seniors spread over 14 districts with a combined bed capacity of 38,000.

India has approximately 757 districts with approximately 2,300 assisted living / care homes with a combined bed capacity of 1,21,000. This means 1.7% of the districts of Kerala has 31% of the country's Senior Citizen Homes.

The larger point of debate being, is Kerala much more advanced than the rest of the country or it is due to the younger generation who have migrated outside India for job, leaving behind their old parents.

Does education play an important part in the willingness of Seniors to relocate to a Assisted Living Facility or it is out of necessity.

I guess the policy makers and planners in India need to take a cue from Kerala on how to develop a robust Senior Living sector.

Pankaj Mehrotra

The document can be accessed on:

3.13 - Kerala Senior Living

The document can be accessed on: Kerala Senior Living Download

Co-living for single elderly people

I had suggested to a few friends that with our advancing age we should pool in resources and setup a 4-5 BHK house in a peaceful and scenic location.

After much deliberation and thinking, I don't think that will be practical given the health conditions associated with ageing and the new lifestyle diseases.

The reason to opt out from the co-living model is simple. Starting a greenfield project sounds good in theory but with lack of construction experience, labour related issues, permissions, buying land etc may not be practical.

1) Language barrier will be the first problem since all of us will be outsiders.

2) Buying land and getting it constructed itself is a challenge, even though the architects will be of help but eventually it is the senior citizen who will have to do most of the coordination.

3) Finding domestic support will always remain a constant challenge. Especially if one is not equipped to do cooking then it will be a major logistical nightmare during the sunset years.

4) Relocation to a new place will always be a mental challenge about the big decision of selling existing assets to build something new.

5) Driving to the city for doctor consultation, other daily groceries etc is again going to become a challenge especially with knee problems and decline in motor skills.

6) Last but not the least, what if there is difference of opinion between friends, which in my view is bound to happen sometime or the other. In that case who will leave the house and who will manage the place.

I think it is more practical to invest into an Assisted Living Home, Retirement Home, since they are equipped to take care of our ageing needs and emergencies.

There are many options in the market, it can be a purchase option / lease or rental. The decision will depend upon the purchasing capacity and the level of care that would be required.

These are my personal views and nothing against the Senior Living sector.

Pankaj Mehrotra

Senior Citizen Homes in India – Status Quo

It is difficult to paint India’s Senior Living scenario in one colour, all one can assume and hope for is, that the overall dynamics are improving and welfare schemes are slowly having a positive impact.

Central government has various schemes for the benefit of the elderly population however its implementation on ground level can be debatable. Each state is supposed to follow the central government guidelines on elderly care but then end of the day it is the effective governance of the state governments which defines the outcome.

According to the Report of the Technical Group on Population Projections for India and States 2011-2036, there were nearly 138 million (13.8 crore) elderly persons in India in 2021 and is projected to be 193.8 million (19.38 crore) in 2031.

During 2011 to 2021, the general population has increased by 12.4% while the elderly population has risen by 35.8%. It is projected that while the general population in the country will rise by 8.4% during 2021 to 2031, the population of elderly in India will grow by 40.5%.

As regards to rural and urban areas, as per 2011 census, 71% of elderly population resides in rural areas while 29% is in urban areas.

The life expectancy at birth during 2014-18 was 70.7 for females as against 68.2 years for males. At the age of 60 years, average remaining length of life was found to be about 18.2 years and that at age 70 was 11.6 years.

The larger point of debate is, do we require Right to Information or the Judiciary to intervene to know about the status on Senior Citizen Homes (SCHs) in the country? Is it that difficult to compile a central database of 2 thousand odd SCHs?

Another point of debate is, if the Government and the media keeps writing the word “Old Age Homes”, then how is the nation supposed to overcome the taboo associated with it? Why can’t we simply write Senior Citizen Homes or Elderly Care Homes?

The population boom of senior citizens will become a big challenge in the next decade or two. If the statistics are to be believed then India will have a humongous task to cater to the residential, medical, social, financial and wellness needs of the elderly.

In my opinion, if we do not act in a time bound manner to pull up the socks and take corrective actions then the senior citizens of our country could face a multitude of problems like poverty, homelessness, isolation, neglect, depression etc.

Eventually it is the people's power which should define the future of the country.

Pankaj Mehrotra

** The articles in the slide have been randomly selected and are not biased towards any state government.

The document can be accessed on:

3.15 - Senior Citizens Homes - Status Quo

The document can be accessed on: Senior Citizens Homes - Status Quo Download

Ageing and Loneliness

There is enough research about ageing and loneliness. Though a lot of people keep writing about loneliness, somehow I think loneliness is underestimated.

In my views, a person who is lonely actually understands the true meaning of loneliness. Loneliness is not only dependent upon external factors, it is an individual mindset.

While it is easy to advocate about elders being lonely and isolated but I feel we undermine the damage caused by loneliness.

The larger point of debate is, how many of us feel lonely in a crowd or being surrounded by friends and family? Can loneliness be classified as a disease similar to depression?

To be honest my personal view is, a lot of us feel lonely at some point. The question being, is it natural to feel that way and for how long!! I have no answers to that.

All I can say is, it is not only the elderly who feel lonely and isolated, we all feel lonely. Loneliness needs to be addressed at the beginning stage otherwise it can lead to bigger issues like depression, suicidal thoughts, negativity etc.

Social media has helped a lot of people from feeling isolated and neglected but then it comes with its own set of drawbacks.

As they say an empty mind is a devil's workshop. I am sure these old idioms have some weightage in them.

Pankaj Mehrotra

What Elderly Parents Fear the Most

Children expect their parents to understand their new age lifestyle yet they rarely want to accept their parents outlook. I guess it is a natural phenomenon which is probably called generation gap.

We all think our parents are Superman or Superwoman, the harsh reality is, in their golden years children need to accept responsibility and try to be helpful rather than being a burden.

In my views some of the biggest concerns of parents are;

1) If a child has special needs then who will look after him or her after their demise.

2) If a child is single or unmarried then how will they manage on their own.

3) Parents normally do not pass on their tensions on children but children expect their parents to understand and listen to their issues.

Parents who have dependent children have a lot of mental baggage which is a real concern and not philosophical. Though they may not say it on the face but internally they go through a lot of trauma and sense of helplessness.
Sometimes life is not straight forward, there are circumstantial issues which neither the parents nor the children can resolve. I guess one has to live with it and make the best of the situation.

We tend to overlook that ageing of parents is a natural progression, yet we expect them to always remain strong and young. Probably it is the fear of children who don't want to acknowledge and expect that caregiving is a two way street.

No parent wants to die an unhappy death or with guilt, all one can do is to try to keep them emotionally happy if not being around to help them when they need us the most.

Pankaj Mehrotra

Do we get grumpy and cranky with age?

While there is a lot of literature available about senior care, the point I wanted to debate is, do we tend to become grumpy and short tempered as we grow older.

I think grumpiness and crankiness needs more attention than just the physical health of a senior. It is the emotional state of mind which probably plays a major contributing factor.

Normal course, most seniors are able to handle the ageing process quite well but then there are a lot of them who are not so blessed.

Lower patience level, argumentative nature, irritability, suspiciousness, demanding nature, rigidness, stubbornness, nervousness etc are some of the common traits I have seen. Here i am not talking of issues related to Dementia which could instigate a lot of these personality issues.

The larger point of concern is how to care for seniors who show these traits? Can we harness the power of Artificial Intelligence, Machine Learning or in short Internet of Things?

There are many apps which are being created and are available for the health and wellness of seniors but are they advanced enough to capture personality changes.

If one is aware of such apps which can capture data related to personality changes please do educate for the benefit of the larger cause.

Maybe some grumpy old man like me can benefit....

Pankaj Mehrotra

Estate Planning and Ageing

India is a complicated country, parents may not get along with their children, yet they want to leave their property to their children.

Estate planning is not only about big bunglows or palatial palaces. It also means whatever small real-estate or other assets one has, that needs to be sorted out before one kicks the bucket.

Though I have very limited knowledge about investments and succession planning, one thing I know that is, if the documents are not in place then it is going to be a harrowing time to get what is legally yours. This is more prevalent in the rural areas.

I always propagate the concept that elders should not hand over their assets to the children while they are alive, because then one is at the mercy of children.

Having said that, it is very important to have a clear cut registered Will which can avoid most disputes. In my limited understanding even a registered will can be disputed, that is where "Probate of Will" comes into picture.

Getting back to the larger issue, how important is succession planning? Though even a hand written document holds good in our country yet at the same time even a registered document can be disputed. I have seen many cases which have got under dispute just because the Will was not registered or it was not clearly divided.

I think our seniors need to start thinking about their own welfare and enjoy their hard earned money rather than leaving it for their next of kin, unless the children are dependent.

Wills and legacies have not taken the driving seat in India but I am sure as the Nation matures, senior living sector will also mature.

Pankaj Mehrotra

Caregiver Burnout

IEmotional stability of one's own self is critical especially if one is a caregiver. It is natural to burnout if the caregiving continues for years at a stretch.

An article by Cleveland Clinic from 2019 is a very good synopsis of the challenges and symptoms faced by caregivers.

The document can be accessed on:

Link: https://my.clevelandclinic.org/health/diseases/9225-caregiver-burnout

Death & Dying - Guilt, Regrets and Wishes

Most of us take life for granted due to which we land up procrastinating the real & important aspects of life. In my opinion, dying guilt, regrets and unfinished wishes are aspects which needs to be addressed for a peaceful death.

When we say "May his / her Soul rest in peace" it actually may not be some Mambo Jambo, there could be a deeper meaning to it.

Suppose one fine Saturday morning the doctor gives me only 24 hours to live, what should be my reaction.

Do I rush to the lawyer to get a "Will" drafted, go to another doctor for a second opinion, call up friends and family to close pending matters or simply spend time with immediate family members?

A new virtual reality experience simulates what it looks and feels like to die. The simulation also features an out-of-body portion, allowing users to look down on their dead bodies as they float above.

Near death experiences are many and in most cases people have found themselves with a renewed sense of purpose in life. Though on the other hand, one can also suffer from Post-traumatic stress disorder (PTSD) but then this is still a grey area which needs more research.

The larger point of debate being, is there anything called as "Rest in Peace"? How can one ensure that our dying process is peaceful without any pending matters to be closed before dying.

I feel that quality of death is equally important as the quality of life. On one hand we spend our entire lifetime in ensuring a safe, healthy & happy life then why should we not work towards a peaceful & happy death.

India clocks 97,78,073 deaths per year, 26,789 deaths per day, 1,116 deaths each hour and 19 deaths each minute. Are these just numbers or do policy makers actually see them as human lives? The moment we convert these numbers into emotions, feelings, relationships and friendships the social systems and world order will have a new meaning.

As they say death does not come with an appointment yet we overlook one important fact i.e. The Mortal Being, which means when we are born the print on the package mentions the date of manufacture and best used before date.

Death is a touchy topic in many cultures and even after knowing that there is an expiry date, unfortunately humans tend to be blindfolded with the obsession of becoming immortal.

History has documented proof on the guilt, regrets, last wishes of people but then we tend to not learn from the inevitable truth.

On one hand we give convicts the capital punishment and ask them for their last wish, but if a person is suffering from a non-reversible killer disease we do not promote assisted dying. Even though "Living Will" has been introduced however I am not sure how many people have actually benefited from it.

Dignity in dying is a human right and as a developed country we should work towards promoting a safe and peaceful journey for everyone.

Pankaj Mehrotra

Senior Citizens Investment Schemes in India

To ensure a financially safe retirement life one needs to plan in advance. Old age is often called as "Golden Years" however without money there is nothing Golden about it.

Majority of Seniors in India have worked in the non-pension paying jobs hence for them the only way to survive is through their hard-earned savings.

There are many investment options and schemes available in India which are focused to give additional benefits to Senior Citizens. I have tried to document some of the schemes which could be evaluated by the Seniors.

Since I don't have much financial domain knowledge or scheme specific details hence it is recommended to consult an investment advisor before investing.

The schemes which are shared have been collated from various websites of Banks, Post Office and others.

This information is only to give an overview about some of the investment schemes and is not a market comparison. The interest rates are subject to change hence before investing the new rates and terms should be understood.

Hope this effort is of help for the larger cause.

Pankaj Mehrotra

The document can be accessed on:

3.22 - Senior Citizens Savings Schemes
3.22A - Senior Citizens Savings Schemes

The document can be accessed on: Senior Citizens Savings Schemes Download

The document can be accessed on: Senior Citizens Savings Schemes Download

Elderly Care in India - Advocacy or Action

If eldercare sector in India has to flourish, then it is important to weed out loopholes in the care delivery system and implement processes which can give a voice to the underprivileged and suppressed elderly also.

India is not only about metro cities and urban areas; the reality lies in the rural belts, which are the food bowl and the working engines of the country. While there has been a lot of development in the rural areas, yet there is a huge gap in elderly care. The elders who are in the hinterlands also require systematic care that is on par with urban centres.

Though private sector companies are investing into Senior Care and are trying to do their part, however there is very limited movement at the State level.

On one hand, there are regular announcements regarding the opening of senior citizen homes and/or senior care initiatives, but unfortunately the situation seems to be status quo. Lack of transparency and accountability is not a great confidence booster, especially in the area of eldercare.

The point of debate is: as a nation, who is really accountable for the welfare of the elderly? Is it only the government's responsibility to care or should civil society and concerned citizens shoulder the responsibility?

Though it is easy to question the authorities about social welfare, but as common citizens, do we not have the right to be concerned about our future?

There is definitely a positive undercurrent in the country, which can be seen in the form of social venture startups; however at the country level, the state welfare schemes are still struggling to find a foothold.

Since not many state governments have the bandwidth to develop their own standards, processes and guidelines, hence it is critical that necessary steps should be taken by the central government to ensure standardisation of eldercare.

As one of the fastest-growing economies in the world, we need to figure out two important points:

1) Do we need to wait for World Elder Abuse Awareness Day to take preventive and corrective actions to stop elder abuse?

2) Do we need to wait for International Day for Older Persons to start caring for our elders?

End of the day, if we ourselves are not concerned about the policies and legislations that would impact our own future, then I wonder who would be?

I feel time has come to change the hats of advocacy and awareness and get into the mode of implementation and measurable results.

Pankaj Mehrotra

The document can be accessed on:

3.23 - Advocacy or Action

The document can be accessed on: Advocacy or Action Download

Gurugram - Is it becoming the epicenter of Elderly Care Homes in Delhi-NCR region?

Elderly Care is gradually picking up steam in India which is quite evident. Whether it is about Senior Citizen Care Homes or Home Care (Domiciliary Care) the number of investors showing interest and also investing into Elderly Care is definitely a positive sign.

Till a few years back most Care Homes were primarily concentrated in Southern and Western India, however with the growing demand and higher purchasing capacity of elders, the investors are now looking at North and East India also.

North India and tier-II cities were not the most popular retirement destinations in the past however off late the trend seems to be favouring these locations.

Cities like Chennai, Bengaluru, Coimbatore, Pune may still be the most preferred locations to retire, however places like Gurugram, Noida, Dehradun, Mysuru, Kolkata, Hyderabad etc are now being taken seriously by senior citizens as well as senior living operators.

The larger point of debate is, why is Gurugram becoming a hot spot for Care Homes for the Elderly?

Since there are already 5-6 high end assisted living / high dependency care homes then why are investors still wanting to bet on the crowded market.

In my opinion, people staying and working in Gurugram have high disposable income which is much higher in comparison to other cities of National Capital Region.

Secondly, the locational advantage of Gurugram by virtue of being closer to Delhi airport adds to the market dynamics. Lastly the well-travelled and aware children want to see their parents in a branded care home rather than the typical old age home.

I feel it's high time that Haryana Government develops state level guidelines for Elderly Care Homes which is in line with draft policy for Retirement Housing in the State of Haryana under the provisions of Haryana Development and Regulation of Urban Areas Act, 1975 to cater to the ageing population and their specific needs.

As a Nation if we don't address the residential, health, recreational and social care needs of the booming elderly population, then in the next decade our policy makers will have an uphill task and will probably not be able to create the required infrastructure, policies, standards and guidelines overnight.

Pankaj Mehrotra

140 Million Elderly - Are We Equipped?

As per reports, India’s elderly population i.e. 60+ years is projected to touch 194 million in 2031 from 138 million in 2021, which will be a 41% increase in next 10 years.

The larger point of debate is, how well are we prepared to address the pressing needs of the elderly population of India.

Since welfare is a State subject hence it is important that all 28 States and 8 Union Territories should move in the same direction.

At the central level, Ministry of Social Justice & Empowerment is the nodal agency, but unfortunately they don't have any control over the state social welfare departments. This becomes a precarious situation, because without ownership of the actual development work at the ground level, it is just paper work without any accountability .

On one hand India has progressed exponentially, however when it comes to Aged Care we are completely clueless. While sending satellites and rockets to the moon is also important, unfortunately it has no value if ordinary citizens are deprived of welfare schemes.

India has about 766 districts and each district has a website. At the state level, the social welfare department is supposed to upload relevant welfare schemes and guidelines to support the development at the district level.

After personality reviewing 700 odd district websites, I feel that, India is not geared up in the area of Eldercare. 99% of the districts do not talk about elderly care and 99% of state social welfare departments do not have any published standards or guidelines for promoting old age care.

In my opinion, as a society if we do not take corrective actions today, then in the next decade we will have a bigger problem which will become difficult to digest.

I have taken a random district website of Chennai and state social welfare department of Tamil Nadu as reference. It has no political or hidden objective.

Pankaj Mehrotra

The document can be accessed on:

3.25 - 140 Million Elderly

The document can be accessed on: 140 Million Elderly Download

Corporate Social Responsibility (CSR) & Elderly Care

Out of the 1 lakh crores (INR) of CSR expenditure in 5 years (2016-2021), unfortunately there is still no accurate data on how much was actually spent on Eldercare.

As per the CSR website, Old Age Homes is clubbed with three other causes i.e. Gender Equality, Women Empowerment & Reducing Inequalities. Technically the heading should be Elderly Care or Senior Citizen Care yet at the national level we are still stuck with the word Old Age Homes.

Of the 14 main development sectors listed in the CSR website, it is heartbreaking to see that, Indian corporate sector is completely out of sync about the needs of the elderly of our country who are the 10+% voting population.

The reason for my being so vocal about the cause of Senior Citizens is simple, "It is my future which is at stake and I have paid enough taxes to be cared for in my old age".

The big question is, what if I don't have the resources to survive in my old age? Should I depend upon the government or the corporate sector CSR?

Assuming that 25% of the amount under the group heading of "Gender Equality, Women Empowerment, Old Age Homes, Reducing Inequalities", was spent on Elderly Care, the total amount comes to 716 crores over a period of 5 years, which is only 0.69% of the total expenditure of CSR in 5 years.

CSR report by Samihta highlights that, the total amount spent on Elderly Care between 2014-2020 was only 177.36 crores which was just 0.19% of the total amount spent on CSR amounting to 92,793 Crores over 5 years.

Is the cause of old age so untouchable that corporate sector also does not want to invest into their own future?

It seems Eldercare is not a CSR priority in India. To be honest, why should the corporate sector be concerned about Ageing, afterall none of the management or the staff would be requiring any govt aid or private sector support in their golden years.

If concerned citizens who are educated & in a position to influence the policies do not come forward, then in my opinion this sector will remain unattended.

As a country, if we do not make course correction today then in my view, we will have a high percentage of the 200 odd million elders in the next decade who will be without any social security nor will be able to afford elderly care services.

Either the entire country is oblivious to the hard facts of elderly care needs or there is some major data mining error.

All I can say is, don't be an ostrich and bury your head in the sand, hoping your problems will disappear. Problems of such magnitude do not disappear overnight, they have to be addressed that too before the problem gets out of hand.

Pankaj Mehrotra

The document can be accessed on:

3.26 - CSR Elderly Care

The document can be accessed on: CSR Elderly Care Download

Should Dementia Care be registered under Mental Healthcare Act 2017?

The past decade has witnessed many Senior Care operators investing in the Memory Care business.

High Dependency Care including Dementia/Alzheimer's care is the cash cow of the Aged Care sector, probably that is why specialized care homes are mushrooming all over the country.

While most of them are doing great work, the larger question is, which government department is regulating them? Another important question is, under which Legislative Act should Memory Care be registered.

Unfortunately, no documented discussion is available on the service delivery implications of care homes or home care for Dementia / Alzheimer’s.

Mental Healthcare Act 2017 is "An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare
and services and for matters connected therewith or incidental thereto."

Though dementia is not a mental illness, yet it is/can be a condition which may impact a person's mental capacity.

Section 2 of MHCA, under sub clause (s) states “mental illness” means a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, ............"

Though MHCA does not talk about mental health of older people or defines Dementia, yet in the definition of mental illness it states "memory that grossly impairs judgment". In my opinion these words can also be interpreted w.r.t mental capacity.

As per MHCA, “Mental health establishment” means any health establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy establishment, by whatever name called, either wholly or partly, meant for the care of persons with mental illness, .......... are admitted and reside at, or kept in, for care, treatment, convalescence and rehabilitation, either temporarily or otherwise; and includes any general hospital or general nursing home .........."
The point of debate is, if Ayurveda, Yoga centers can come under Mental Health Establishments, then why should Senior Citizen Care Homes which are involved with Dementia Care not come under the purview of MHCA?

As per MHCA, "No person or organisation shall establish or run a mental health establishment unless it has been registered with the Authority under the provisions of this Act."

I feel it is important that in-depth research is required on the legal implications of Dementia Care & national standards should be developed w.r.t Memory Care.

An interesting article by Harbishettar V, Gowda M, Tenagi S, Chandra M. - "Regulation of Long-Term Care Homes for Older Adults in India". Indian J Psychol Med. 2021;43(5S):88S–96S. is attached for reference.

Pankaj Mehrotra

3.27 - Regulation of Long-Term Care Homes in India

The document can be accessed on: Regulation of Long-Term Care Homes in India Download

or the website at : https://journals.sagepub.com/

Affordability of Senior Living in India

India has a complex social fabric, the middle class thinks they are equivalent to the rich, yet they don't have the purchasing capacity, whereas the poor accept anything which comes free irrespective of the quality.

The cost of basic living is somewhat same across all economic strata, however the affordability of specialized care is the differentiating factor. Unfortunately cost of basic food items do not differentiate between the poor and the rich.

Talking about Old Age Care, Senior Living is going to become a big industry in the next 2 decades. Unfortunately many of us will not be able to afford living in Sheltered Housing or other formats of Housing with Care. The logic is simple, most of us will not have the money to afford living in senior citizen care homes.

In today's time, an average lower middle class senior living facility costs about 25-40 thousand, the so called middle class facilities are pegged at 50-75 thousand and specialised care or the high end senior living facilities charge anything between 90 thousand to 1.5 lakh per month.

The larger point of debate is, how many senior citizens will be able to afford Senior Living in the coming decades? Since 70% of India resides in the rural areas, majority of them will not have the financial bandwidth to afford senior living in their golden years.

Assuming that an elder requires supervised care for 10 years, as per back of the envelope calculation, it will cost them anywhere between 75 lakhs to 2 crores over a period of 10 years.

Looking at these figures, I really do not know, how many of us will be able to afford supported residential care in the next decade.

If the government or private sector do not come up with affordable senior living options, then in my views, majority of older people will be living alone without any supervision.

As a country, if we do not wake up to the ticking and exploding problem, then it is quite possible that we might see the middle class and the underprivileged elderly living on the roads, outside hospitals or in charitable shelter homes.

Pankaj Mehrotra

Ideal Location for Retirement Living

Some people construct large houses in remote areas thinking that, once they "Hang Up The Boots" they can live a happy and peaceful life.

Many seniors wish to live amidst nature and in picturesque surroundings like mountains, hills, beaches, lakes etc.

While it is good to live in peaceful, serene and pollution free locations, however one needs to understand the practical aspects of these places.

Many people get swayed by idealistic and philosophical desires in life, due to which they invest their hard earned money in constructing large multi-storied houses. Big houses have their own advantages however as we grow older the same houses becomes difficult to maintain.

Many seniors build homes in off-beat locations which gives them happiness in their young-old age (65-75), unfortunately as they become oldest-old (85+) they tend to regret their decision.

The larger point of debate is, how important is site location w.r.t retirement homes? In my opinion, location is the most important element in the overall planning for retirement living.

As the world is facing the brunt of climate change, it is becoming even more critical that senior living facilities should be planned keeping a few key factors into consideration, i.e.;

1) The Golden Hour Rule

Retirement community or independent houses should be close to a multi-speciality hospital or a Nursing Home. If medical attention is not received within an hour then precious time will be lost.

2) Disaster Preparedness

Site should not be in low lying areas, or very close to riverbeds/lakes and should not be too high up in the mountains. Incase of floods, fire, earthquake etc elders take longer time to be evacuated.

3) Transportation

Since children may visit only for a few days in a year hence accessibility to airport, railway station and/or bus stand becomes important.

4) Cultural & Social Interactions

Peaceful surroundings are good but too much peace and isolation can be detrimental. Ensure that there are entertainment centres and market places in the nearby vicinity.

5) Staff Availability

Idealism will not help in sourcing domestic support services. If the location is remote and inaccessible then getting qualified manpower will become a challenge.

These are some of the basic site planning/identification features in my experience.

When I retire, I will go on holidays to the mountains, beaches etc but live in habitable places which have medical, transport, health, social, staff and recreational support.

Pankaj Mehrotra

Respite Care - A Caregivers Dilemma

One of the biggest concerns of being a caregiver is, can we leave our loved ones alone?

In my opinion, taking a break for our own well-being is extremely important as caregivers. Taking care of parents can be a full-time job, but then it can take a toll on our own mental and physical health also.

I really wonder how our parents had the patience to bear our eccentricities for years that too without taking any breaks. When it comes to reciprocating the same care for our parents, we start talking about caregivers respite and requiring a break in life.

There are days, when as caregivers we need to take a break, probably that is why Respite Care came into existence.

The word Respite Care may sound American, but then, it is natural to get exhausted taking care of our parents.

Respite Care is extremely important for both the parties i.e. the person who needs care and the person who is giving care.
It is natural to put one's hands up and say, I don't care anymore, however it is those weaker moments that as caregivers we need support and help ourselves.

Being a strong advocate of Dementia and Alzheimer's, I feel Respite Care is extremely important. If the caregivers don't get respite then it may harm them and/or the person who needs care.

Pankaj Mehrotra

Elderly Care Legislation in India

Maintenance and Welfare of Parents and Senior Citizens Act, 2007, states that;

"The State Government may establish and maintain such number of old age homes at accessible places, as it may deem necessary, in a phased manner, beginning with at least one in each district to accommodate in such homes a minimum of one hundred fifty senior citizens who are indigent."

The moment a legal document like a Legislative Act, writes words like"may" or "as it may deem necessary" then it is not a legal binding on any state authority, it is only a suggestion which may or may not be followed.

The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019 was introduced in the Lok Sabha on 11-12-2019, and seems to have got an "In principle approval" but then, Ageing is not a trending topic due to which, even after 3.5 years the (Amendment) Bill is still being debated.

On one hand there is a lot of positive development happening at the ground level w.r.t senior citizens care and welfare, however if simple policy amendments starts taking 3-4 years, then it may not be helpful for the poor and/or the underprivileged elderly.

NGO's and concerned citizens need to come forward to support the cause of Aged Care and help the government with necessary academic information and also support in giving feedback about the ground level issues.

Why do we require the judiciary to intervene on social welfare schemes, care and well-being should function on auto-mode and not be pulled up by the judiciary.
Feedback on the current status of Amendment Bill will be appreciated.

Pankaj Mehrotra

3.32 - The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019

Parents Last Wishes

India has a complex intergenerational culture, especially when it comes to relationship between parents and children.

Parents are obsessed to see their children get settled in life. For them getting settled in life typically means getting the children married and seeing their grandchildren before they die.

There is no doubt that parents love their children, probably at times tend to overlove them, but then at what cost and at who's expense.

The larger point of debate is, do parents become over demanding and/or use emotional blackmail as a tool, especially when they are in their last stages of life.

Recently, I met someone who was emotionally blackmailed to get married because his mother was on the deathbed. While his mother passed away peacefully but now his peace of mind is troubled because of the unscheduled marriage.

Though times are changing and the concept of getting settled has changed, yet the pressure of parents dying wishes will always remain.

The societal urban fabric might have changed over the past two decades however the rural areas are still battling with the concept of responsibility of children especially the daughters.

On the rural front, parents become grandparents by the age of 45-48 years, whereas in the urban areas children do not even get married till their parents become 55-60 years.

This visible divide of intergenerational culture and responsibilities between the rural and urban areas has its own limitations w.r.t Ageing Process.

Urban class is facing a lack of family caregivers whereas, parents in the rural areas have atleast one child in the village/ town to take care of family affairs including caregiving.

While it is easy to judge how parents react to the responsibility of children, but then if children are seen as a responsibility then no one can remove the sword of guilt till the so called responsibility is over or if the parents die (whichever comes first).

In my opinion, we all have our own destiny, what will eventually matter is, how responsible we were for our children and how responsible they are towards us in our old age.

Pankaj Mehrotra

Urgent need for Registration of Senior Living Facilities

Presently Senior living sector in India is a free-for-all game. There are no checks and balances to regulate the service quality and the rights of elderly residents.

In order to bring some legality and responsibilities in the overall framework of Aged Care, it is imperative that registration of mom and pop shops should be made mandatory across the country.

Unfortunately most states are either not interested or probably not competent to understand the criticality of eldercare due to which the sector is largely unregulated.

The Madras High Court through its ruling dated 30.06.2022 has directed the Tamil Nadu Govt. to ensure that all old age homes and retirement homes in the state are registered with relevant departments.

In their important judgement, Justices R. Mahadevan and J. Sathya Narayana Prasad upheld the constitutional right of the State government to issue executive orders with respect to management of even private old age / retirement homes. It has ordered that the government must ensure registration of every such home and periodical collection of details regarding the inmates, as well as the management.

The court ruling concluded the case, stating that, in the above background, this Court would deem it fit to issue the following guidelines. Relevant judgement points (iv & v) are shared in verbatim:

1) The State Government shall take steps to inspect all old age homes within the State......

2) After inspection, the State Government may issue directives to be complied with, and deficiencies, if any, to be rectified by the old age homes / retirement homes....

3) The non-compliance of the directives / non-rectification of the deficiencies as pointed out, must entail civil consequences for the retirement homes / old age homes, including cancellation of registration.

4) The State Government must ensure that every old age home / retirement home within the State is registered with it and the Government must maintain records of its inmates as well as the persons involved in the Management.

5) The State Government must ensure that non-registered homes do not continue to function within the State, and must act on any complaint by any person in this regard, after necessary inspection.

6) The State Government must maintain a grievance cell for senior citizens....

7) It is only appropriate that the substance of the impugned executive order may be well made part of a legislation.....

The larger point of debate is, do we need the judiciary to intervene in every aspect of social welfare? Why are State Authorities not interested in the welfare of Senior Citizens?

In my opinion, as a nation we need to go back to the drawing board and review the whole issue on National Policy and Service Delivery Framework for Older People.

Pankaj Mehrotra

Age is not just a number

Over the past few decades, medical technology and lifestyle changes have seen drastic improvements. Advancements in technology is not only impacting the longevity of life but it seems the so called quality of life (QoL) is also improving.

Our outlook in life about the Ageing Process has also been changing over the years, the concept of "Age is just a number" has taken the driver seat and the negative image associated with old age has moved to the passenger seat.

The larger point of debate is, is it really true that "Age is just a number" or in reality "Age is a problematic number"?

While words like Active Ageing, Positive Ageing, Ageing in Place, Independent Living sounds good in the overall fabric of Ageing, but do these words hold true for older people who start to gradually shift from the assisted living phase to the dependent stage?

Till the time our physical and mental health faculties are running well, most people feel Age is just a number, but then, the moment pain, agony, dependency, loss of motor capabilities starts to become dominant, Age starts to feel like a problematic number.

How many people who are in their 80s-90s who were happily playing golf, self driving, socializing, still feel "Age is just a number", especially when they suddenly start losing their independent lifestyles, starts falling on the floor regularly or are unable to open a simple bottle cap?

In my view, when all is going well, Age seems to be just a number, but when pain and suffering sets in, Age seems to be a rude reminder that, Old Age is not simply a number, it is a reality of life.

Maybe a visit to a Hospice Care Home / End-of-life centre can support my thought process.

Pankaj Mehrotra

3.35 - Age is not just a number

Caregiving - What goes around comes around

Dear Son,

I am feeling a bit nervous today, can you please hold my hand for a few minutes .....

Can you please check my phone internet, it has not been working for a few days ....

Can you please write a short letter for me .....

Can you please check if there are any pending bills or taxes to be paid ....

Can you please get my car serviced .....

Can you please remove the gift box from the top cupboard ....

Can you please take me to the hospital for my cancer test .....

These are real examples which family caregivers face everyday.

On one hand we rarely thanked our parents for the small munde tasks they did for us when we were dependent upon them, but as our parents become dependent upon us, they tend to thank us for every small act of ours.

Caregiving is not only about giving personal care assistance, at times emotional assurance of simply being around for our parents is more important than providing physical support.

Since none of us can escape from the tentacles of Ageing, hence it's better we embrace it and become empathetic towards older people.

End of the day, what goes around comes around.

Pankaj Mehrotra

3.36 - What Goes around comes around

CLoneliness is not a disease

Loneliness, isolation and neglect are the three main hurdles which elders face from family and community at large.

While on one hand, India is actively working towards becoming an inclusive society but unfortunately many seniors are deprived of programs which promotes active ageing, participation and inclusiveness.

Though at the grassroot level, Central Government and State Government programs on health and medical care are available but unfortunately social care, emotional well-being and recreational care is largely unaddressed.

Loneliness is not only a rural phenomenon, it impacts all sections of society including urban elderly. The rich too are not spared from feeling lonely and isolated.

During our professional career we are surrounded by many people, but after retirement our social circle gradually reduces and eventually we find ourselves feeling alienated from active participation in society.

Rural elderly women are more prone to feeling neglected since their husbands are mainly migrant workers who work outside their villages or states.

Though the community fabric is stronger in the hinterlands as compared to urban areas however that does not mean elders in remote areas don't feel isolated or neglected.

If India wants to become the third largest economy, then financial might is not the only parameter of evaluation, social care especially care for the vulnerable older persons should be a priority area.

Time has come to genuinely start working upwards from the bottom of the pyramid rather than a top down approach and getting stuck in the middle of the pyramid.

Pankaj Mehrotra

A Caregiver's Dilemma

Long distance caregiving has its own emotional tides, some days it's the high tides and some days low.

When we are with our dependent parents, we feel secure about their well-being but the moment it's time to say goodbye, it's an emotional dilemma.

The guilt of what will happen in our absence looms over the head like the Sword of Damocles. The only way to win the battle of emotional turmoil is to put on the armour of hope, pick up the shield of bravery and fight like a lion.

The big question is, when we have to leave our parents for a few days, how do we overcome the sinking feeling in the heart? What if I get the dreaded final call when I am not around?

Mind games starts playing the devil's advocate, thoughts like will my parents be able to manage without me? Will they be taken care of? How and who will come in case of an emergency? Who will pick them up in case of a fall etc etc. starts corrupting the grey cells.

Just before the hugging and goodbyes, tensions flare up on both sides, irritability and blood pressure shoots up like a mercury thermometer.

Last minute arguments and advices are a result of nervousness and fear which I guess are a precursor before saying au revoir.

Last minute concerned advice to parents is like a mother giving instructions to her children;

Please walk slowly and carefully, don't fall again like last week.

Don't have cold water because your throat is giving trouble.

Try sleeping in the middle of the bed so you don't fall in the night again.

Please don't mix up your blood pressure and cholesterol medicines again etc etc.....

I guess as caregivers our only wish is to remain being a Caretaker irrespective of the stress involved and not become an Undertaker.

Pankaj Mehrotra

The Elderly Widows of Vrindavan

Vrindavan is supposed to be one of the holiest cities in India, but unfortunately it has a dark side which most of us prefer to overlook.

The city is not only know for it's spiritual and religious importance, it is also known as the "City of Widows".

While most of us love our mothers and are concerned about their well-being, however there is a small percentage of children who prefer to disown their mothers and throw them on the roads.

A walk down the streets of Vrindavan is witness to thousands of homeless elderly widows.

Elderly women dressed in white clothes and either begging or singing religious songs used to be a common sight in the city. Luckily this trend is changing and many of them are slowly reuniting with their families.

The estimated number of elderly widows in Vrindavan are in thousands however a realistic estimate should be 3000-5000.

Most of the elderly widows came from the states of West Bengal, Assam and Odisha. They came to Vrindavan a few decades ago and today many of them are in their 70s-80s.

Most of the elderly widows were conveniently either thrown out of their homes or were convinced by their children and family into leaving their house to go to Vrindavan in the ‘name of God’.

No one knows why so many widows had started going to Vrindavan but it has been going on for centuries. Unfortunately the mindset of India was different in that era which was not very women centric.

India is home to nearly 55 million widows, most of whom live in terrible conditions. Luckily the state government, NGOs and temple management have been doing some good work in supporting the elderly widows.

Since it is the festival season and most of us would be celebrating with our families, but then we should not forget that there are thousands of elderly women who may not be so lucky to enjoy any family celebrations or reunions.

I only hope that may this Durga Puja bring some relief and a sense of closure to our country's grandmothers.

Pankaj Mehrotra

Grandparents on Rent

A few years back when parents in Japan started hiring Grandparents on rent it used to sound hilarious.

The concept of rental grandfathers or grandmothers who could play with children is not a page from a comic book, it is actually a disturbing reality.

If we fast forward the trend of grandparents for hire in the Indian context, one can see that we are not too far from facing the same problem.

A Tokyo firm, Japan Efficiency Corp., is doing booming business renting families to the lonely. For example, a couple in their mid 20s with a 2-year-old son rented an older pair of stand-ins to play their child’s grandparents, who live far away and are too old and feeble to visit.

In India, the concept of rental grandparents may sound ridiculous but then the idea of having a robot as a care companion may sound even more bizarre.

In nursing homes throughout Japan, an interactive, therapeutic robot is helping provide care to elderly residents. The robot’s name is Paro, and it looks like a baby harp seal, complete with fur, soulful eyes, and even whiskers.

The larger point of debate is, is our social fabric eroding to such an extent that even after being the most populous country in the world, we are losing family connections.

The scarcity of grandparents is common to the urban and rural areas. In the urban scenario, children have migrated due to over-education whereas in the rural areas the migration is mainly due to under-education and need for basic survival.

Due to the changing family dynamics the collateral damage is faced by the grandchildren.

Unfortunately many grandchildren are being deprived of the love and care of their grandparents simply because we have stopped attaching value to the emotional connect.

Having said that, the question is, do we have to deprive ourselves of our parents and/or grandparents love? Is work life more important than family bonding?

Intergenerational bonding is not a cliché word, it is supposed to be a natural progression of life. Most of us realise the importance of parents and grandparents either when we are in trouble or in need of emotional support.

The way we are headed, it seems that Grandparents may soon become an endangered species and we might have to take our children to the zoo to show them how grandparents look and behave.

Pankaj Mehrotra

Caregiving Stress - Children Versus Elderly

Why is "Caregiving Stress" generally associated with the care of elderly and not with the care of children?

The mindset during a caregiver's journey is rather strange. While most of us are happy taking care of our dependent children but when it comes to taking care of our elderly parents, we tend to portray as if we have been tasked with the responsibility of saving the world.

Senior citizens who get into the "Oldest Old" stage of life, the chances are that many of them would start behaving like children.

As people grow older the commonalities in personality traits like becoming adamant, throwing tantrums etc etc. starts to become more common between a child and a dependent elderly.
The larger point of debate is, do we have double standards when it comes to taking care of our children versus our parents?

Typically when a child is born, most parents are happy to spend sleepless nights caring for the young, but somehow when it comes to our elders, we start talking about caregiving stress and project our caregiving responsibilities as if we are doing a great service for mankind.

We do not think twice to change a child's diaper but when it comes to changing the same for our parents, we prefer a professional caregiver to do it for us.

In my opinion, there is no right or wrong in this gradual change of caregiving mindset, I guess that's how most of us are programmed to behave.

Since India is posed to becoming an international juggernaut, there is a strong possibility that many children will not have the time to take care of their elderly parents.

In situations like this, India would require a huge force of professional and experienced caregivers who can step in as qualified, trained and empathetic support systems.

I genuinely feel that, if as a country we do not lay a strong foundation for Aged Care as of yesterday, then the chances are that, not only will our own future be at stake but it could be in the hands of those who won't even know the ABCD of caregiving.

Pankaj Mehrotra

The Fear of Dying

Majority of us humans tend to be scared of dying, it is but natural.

There are many instances in life where I have come across extremely strong willed people, who don't give up on life, no matter how difficult the situation maybe. These situations could be financial difficulties, emotional, medical or any other but then not everyone is strong willed.

There is another set of people who are so scared of dying that they are not willing to let go of their physical body. This is more prevalent in older adults and/or those who are suffering from life threatening diseases.

Even after years of being medically bedridden, these people are so attached to life or rather scared of dying, that inspite of being in and out of hospitals and the doctors having informed the family, that the time is near; they refuse to let go.

Somehow the “inevitable” becomes indefinitely prolonged, taking a toll on the family as well as the individual themselves.

In order to help such people who are on their deathbed but are not willing to let go, there are professionally trained people who can help ease the transition. These people come in the form of priests, guru's, doctors, social care workers etc.

These people don't do any magic, but are trained professionals who help ease the fear of death. They might hold the person's hands, read out verses from religious books, depending upon the faith of the person or use psychology to give confidence and courage to the individual who is dying.

Professional counsellors instill confidence amongst those who are in their last days that's it's ok to die. They counsel and assure them that their families will still manage to survive without them, and dying is a natural part of life.

There are many family members who are the primary caregivers for their near and dear ones, however due to the stress involved with caring for a last stage family member, caregiving takes a toll on their mental and physical health also.

While it is easy to write about the stress involved with caregiving but then it is important that family members need to take care of themselves also. Caregiving cannot be done if the caregiver himself/herself needs to be cared for.

Death and dying is an uncomfortable subject in India and most of us tend to shy away from discussing about it, but then not taking about the same can have bigger implications like pent-up fear, depression, negativity and short tempered nature.

My advice to people who are in palliative or hospice care is, "Death is God's way to end the sufferings in life", so embrace it as a solution and not as a problem.

Imagine if one has to face all the pain and agony from the day we are born, so be thankful that we have to face the sufferings only for a few years and not from the day we open our eyes.

Pankaj Mehrotra

The Rise of Senior Living Sector in India

The Indian Senior Living Sector seems to be gradually shedding it's negative image associated with the word Old Age Home.

I guess it's been too long that society has been stuck with the assumed taboo linked with Old Age Homes or Vridhashram.

As the urban population realises the importance of Senior Citizen Care Homes, Assisted Living, Retirement Homes, Memory Care Homes etc, hence the demand for such facilities are slowly gaining traction.

It is not that as if Senior Living is a recent phenomenon, such homes have been around for centuries but unfortunately we all associated such places to be meant only for the poor, destitute and homeless older people.

As they say "only the wearer knows where the shoe pinches" the same holds true for senior living also.

In earlier days, most of us used to look at Old Age Homes through the lense of pity and sympathy, however when we started requiring the same facilities for ourselves we want an image makeover and branding of the same facilities.

The rise of senior living market in India can be a tricky business, probably that is why private sector is focusing on the urban areas and the upper middle class segment.

Not everyone in India is blessed to be able to afford private Senior Living facilities hence it is important that government and CSR should do a deep dive to understand the volcanic needs of the rural and poor elderly before the boiling lava of Aged Care erupts, engulfs and destroys the social balance and fabric of welfare policies.

A recent report by JLL titled "The rise of senior living market in India" is attached for a quick read.

Like a typical consulting firm they have done a great job but unfortunately there is no mention, statistics or recommendation on how to address the Aged Care needs of 90 odd million elders who are living in the rural areas and the hinterlands of the country.

Pankaj Mehrotra

Care of Elderly Women in India

I am sure no one in the world would like to see their mothers being abandoned, destitute and helpless because of circumstances or otherwise, but unfortunately the other side of the coin has a different story to tell.

There are millions of elderly women who are still facing the brunt of societal discrimination and economic deprivation, it is those mother's who need our maximum support.

The attached document "Innovative practices for Care of Elderly Women in India" which was prepared with support from United Nations Population Fund (UNFPA) and Stree Shakti – The Parallel Force is a good read.

The aim behind the initiative was to promote the rights of ageing women and showcase effective models that are dedicated to restoring their dignity.

Though the report is slightly dated, however a lot of water has flown under the bridge since then, but that does not mean that the undercurrent is not flowing.

Women who are single, abandoned (‘half widows’) or widowed face multiple barriers due to illiteracy, malnutrition, abuse, isolation, ill health, lack of housing and exclusion from economic benefits are the ones who are always facing the blazing Sun.

While the elderly face a number of challenges, the situation is worse for elderly women.

Many women face bias and discrimination throughout their lives and most of the time they either succumb to it or do not raise their voices against it.

The Global Report on Ageing in the 21st Century reinforces the observations made in India that older persons, particularly older women, experience multiple discriminations, including access to jobs and health care, abuse, denial of the right to own and inherit property, and lack of basic minimum income and social security.

While on one hand we are celebrating the growth story of India, in my opinion we should also ensure that the marginalized, underprivileged and those stuck with bad luck or circumstances should also be respected and included in the landscape of the country with due dignity and care.

Since the Government cannot do everything on their own, hence concerned citizens, Civil Society and Corporate Houses under their CSR need to look at Elderly Care with the binoculars of Empathy, Respect, Responsibility and Concern.

Pankaj Mehrotra

or the website at : https://india.unfpa.org/en

Quality of Life Versus Quality of Death

Most of us work hard throughout our lives to improve our Quality of Life (QoL), but I wonder how many of us actively work towards improving our Quality of Dying and Death (QoDD).

As per Google definition" QoL means "the standard of health, comfort, and happiness experienced by an individual or group".

Whereas the general meaning of QoDD as per Google is "the degree to which a person's preferences for dying and the moment of death agree with observations of how the person actually died, as reported by others".

While there are different measurement scales to evaluate QoL and QoDD, the larger point of debate is; Is Quality of Life more important or Quality of Death?

Since dying and death is not a cocktail party discussion hence most people and communities shy away from talking about this subject, I guess it's natural.

An interesting point of reality is, most people who have faced near death experience, somehow their outlook in life changes after such experience.

Near death experience people who were either depressed, lost in life or living without any aim or motivation in life, come back to life with a renewed sense of spirituality and a sense of purpose.

Does the experience of dying rings as a wake-up call that there is more to life than simply living like zombies?

As children, many of us are taught about good and bad deeds and the eventual appraisal by the higher power. Probably in a way it is like the carrot and stick story. I guess the fear of being reprimanded after death is something which keeps most of humanity under control.

Coming back to the Quality of Dying and Death, I feel it is an important aspect of living. No one wants a painful death but at the same time we do not want to do anything to work towards a happy death.

In my opinion, a person who dies with a smile on his/her face has a better chance of a peaceful death and the journey towards the next phase of consciousness.

No wonder we all say - Rest in Peace (RIP).

Pankaj Mehrotra

The Doctors Touch and Older People

There is no rocket science to see the correlation between Ageing and frequent visits to the doctor.

As people grow older the probability of visiting hospitals and physicians also increases, I guess it's a part and parcel of the ageing process.

The larger point of debate is, with the growth of technology a lot of health and medical supervision is being done online, is this a positive or negative trend in the overall well-being of older people?

While on one hand, most people tend to avoid going to the doctor unless it is absolutely unavoidable, however on the other hand, there are many Seniors who like to go and see the doctor for every small issue.

If one has to understand as to why Seniors prefer to visit the doctor instead of online consultation, an interesting fact will be seen;

"The comfort and assurance which older people feel when told by the doctor that all is well whilst holding their hand, cannot be replaced by any online consultation".

When older people visit the doctor, it is like the Midas Touch for them, even if the doctor gives a calcium tablet the "Placebo Effect" works wonders for their well-being, this mainly comes from the reassurance of the human touch.

The psychology behind the feel good factor of visiting a doctor is not just about health or medical care, it originates from the need for interaction, physical movement, socializing and most importantly a sense of being alive.

I am sure we all must have faced similar feelings when we have to interact with Automated Response System or Interactive Voice Response System (IVRS).

The satisfaction and assurance of talking with a human in a call centre is similar to talking to a doctor on a one-to-one basis in comparison to talking to a computer generated voice.

I only hope that, as the world progresses we should not lose the human connect, but then the past 200 years of evolution has proved how humans have advanced with our unique sense of development.

Pankaj Mehrotra

Ageing in Rural India

65% Indians out of the total population of 142 crores (1.42 billion) lives in rural areas, this translates to 92 crores (920 million).

Assuming the elderly population to be 11%, which means the rural elderly constitutes 10 crores (101 million) out of the total elderly population of 15.6 crores (156 million).

The larger point of debate is, are senior citizens just numbers in the larger landscape of India or they are seen as the future rather than the past?

Do we see elders as a spent force who are now obsolete or unproductive, or do we see them as people who made the foundation for the nation and will always remain the pillars of support.

47% of India's population depends on agriculture, which means 4.7 crores (475 million) elders had contributed to ensure three square meals on our plates.

The estimated dementia prevalence for adults ages 60+ in India is 7.4%, which means about 1.1 crore (11.5 million) Indians older than 60 years live with dementia. This means 75 lakhs (7.5 million) elders in rural areas live with Dementia.

As per estimates 12% of the total population lives below the poverty line, which means 80 lakh (8 million) rural elders are extremely poor.

In a nutshell, 6 lakh (0.6 million) older people in the rural areas are poor and have dementia.

In my opinion, as a country we need to understand the gravity of the situation otherwise the rural poor older people especially women will be deprived of basic care and a dignified living.

Pankaj Mehrotra

Emotional Anxiousness amongst Senior Citizens

It is never an easy decision to leave one's house, neighborhood, friends & family and relocate to a Senior Citizen Care Home.

When someone is faced with the big decision to move into a residential facility (retirement home, assisted living, specialised care home), it can be a difficult and anxious time for them and their families.

Since in India more and more elders are moving into Senior Care Homes, hence it is extremely important for the home management and the staff to be sensitive, empathetic and trained in supporting people at the start of their care home journey.

Once the senior citizen or their family members start exploring various residential and care options, it can be an overwhelming experience.

Questions like, will the caregiver be trained, is the home management actually concerned about the elderly residents or are they purely business oriented in their dealings etc etc. These are just examples on the types of questions and concerns which typically goes through the minds of the elders and/or their family members.

Since it is critical that each resident and his/her family members are made comfortable at the time of "Entering Care" hence it is always advisable to have a "welcome kit".

The objective of a welcome pack/kit is to give potential residents and family members regarding what they can expect from life at the Senior Citizen Care Home.

It is a brief document which is like a brochure with checklist and home policies and guidelines for all prospective residents.

A welcome document not only helps in understanding the ethos and guiding vision of the Care Home, it is also a document which prospective residents can carry with them and discuss it with their family and friends at their own convenience.

Welsh Government has published a short guide titled "Supporting people at the start of their care home journey". It is a good read for all stakeholders who are involved or have keen interest in Eldercare.

Pankaj Mehrotra

What are we doing for Elderly Care in India?

The not so surprising fact in India is, many of us are already contemplating moving into a retirement home / care home in the near future and/or are looking at moving into one, but then most of us do not have much idea or interest in what standards or quality assurance to expect.

Internationally, the Senior Citizens Care sector is well defined and regulated, but then in India, the fifth largest economy is finding it difficult or rather struggling to develop National Standards, Policies, Guidelines and Training.

The Americans call it Long Term Care, Assisted Living, Veteran Affairs, Australians call it Aged Care, Hong Kong calls it Care for Elderly, United Kingdom calls it Care Homes and Care for Older Persons etc etc.

Unfortunately in India we have still not been able to decide on a common term and keep talking about Senior Citizens, Old Age Homes, Vridh Ashram, Elderly etc.

In my limited views, till the time like-minded individuals do not come forward and start a movement for the welfare of poor, underprivileged, destitute older people especially care for the elderly widows in India, till then we will keep having cocktail party discussions over Wine and Caviar on the plight of the poor elderly and the lack of International level standards and quality framework.

The larger point of debate is, on one hand most of us want to do good and want to contribute for the larger cause, but then when it comes to taking time out from our so called busy schedules, our priorities suddenly change.

If a few of us can spare 4-5 hours a month on Senior Citizen Care instead of going to the Multiplexes and the food courts, then I am sure we can not only secure our own future but also of future generations.

I strongly believe in one point:

"If people like us don't bring about a change, then I really wonder who will?

Pankaj Mehrotra

Senior Living and Urban Planning

Most children want to be the perfect support system for their parents, especially when the parents get "Old Old" and "Oldest Old", the question is, is it that simple to be around our parents on a 24x7 basis?

In the Indian context, I keep telling my parents, they should be happy that I was not intelligent / bright enough, if I was, probably I too would have been living in a foreign land and would have been forced to outsource my caregiving responsibilities.

The larger point of debate is, who is right or wrong? Are children who are physically around with their parents the ideal children or those who are concerned children but had to move out of the country or the city due to work compulsions/opportunities?

In my opinion none of us are wrong, it is just a matter of circumstances which puts us into situations which are beyond our control.

There used to an old saying in the villages, if a child studies little bit then he or she will leave the house (basically will not work in the fields) and if children study more then he or she will leave the village.

I guess this logic holds true even in the urban settings, the harsh reality is, the complexity of Indian family system is difficult to analyse.

Children who are not financially sound tend to stay with their parents, in my opinion there is nothing wrong with it. End of the day it is an arrangement of convenience and our deep rooted culture of boys staying with parents whereas daughters get married and moves out.

An interesting part is, there are many regions in India where the boy moves out of his parents house and goes to live with the wife's family.
The larger point of debate is, India has been witnessing a shift in the living patterns of families. In today's time many parents prefer to live separately yet close to their children.

This trend of parents and children living seperately yet nearby, calls for a serious debate on how to create residential facilities for the older people within the neighbourhood and urban setting.

I guess as a country we need to go back to the drawing board and define a roadmap for urban planning especially w.r.t Senior Living.

Pankaj Mehrotra

Who is regulating Senior Citizen Care Homes in India?

A 95 years young lady called to ask if I could visit her and pull-up the Care Home Management for the sub-standard food and unprofessional service levels.

What she said really brought out the reality about the lack of Care Home Quality Assurance mechanisms in India.

She said the food is sub-standard and only when the owners visit the Care Home, then only the residents get something special and good quality, which is also rare.

Though she has been staying in an upmarket Care Home in Delhi from the past 15 years and has been paying a substantial monthly fees, but then, she has been complaining about the poor food quality and low service standards from the past few years.

Another point she said was deeply disturbing, she said, since I don't have any other place to go, hence I am dependent upon the Care Staff and have to silently accept their unprofessional and rude behaviour.

The larger point of debate is, if a well known Care Home in the heart of Delhi, the Capital of India has no systems to check the service level standards then one can imagine what must be the situation in smaller towns and in the hinterlands.

The question here is not whether the food quality is bad or the staff are rude to the residents, the main cause of concern is, who will listen to the grievances and complaints of Elderly residents?

Since there are no systems to check or audit a Care Home for deficiencies in service levels hence it is actually a free for all game. Unfortunately the residents have no say and no-one to compliant to.

It is very concerning to visualise living in a Care Home and at the mercy of the staff while silently accepting whatever little they give and whatever they want to charge.

The sad part is, even with money in old age one is not assured about the service levels and there is no one to regulate them.

Pankaj Mehrotra

How many people are bothered about Ageing in India?

There is definitely a positive movement in the Aged Care sector which has been simmering for sometime now and hopefully the boiling point is not too far away.

While on one hand, Ageing Policies and Legislative Acts impact each and everyone in the country, yet there seems to be a high level of ignorance, lack of awareness and/or unconcerned attitude on this subject.

The larger point of debate is, is it only the responsibility of a few policy makers to decide the future of 1.4 billion citizens or is it also the collective responsibility of all of us who are actually going to be impacted by the decisions of a few people?

India as a country is shining on the global map, but then there are certain important welfare areas where it needs to improve upon, one critical area is Elderly Care.

It is easy to complain about lack of welfare policies in the country but then how many people are actually bothered to understand their implications?

Most of us do not bother about welfare policies and programmes because we tend to think that they are only meant for the poor and underprivileged, the harsh reality is, most educated, urban and well-to-do class are financially stable hence do not really bother about such welfare schemes.

Since many young citizens are showing keen interest in the field of Senior Citizens Care, I am sharing the timelines on how the welfare initiatives in the country have developed over the years.

Anyone who is interested in Eldercare sector can have a look and in case I have missed out on something please do share your feedback.

Pankaj Mehrotra

Senior Citizens Demographics in India

Elderly population is no more an insignificant number in the larger landscape of India, they are now a sizeable force to be reckoned with.

While there are numerous projections as to how 1 in every 5 Indians will be above 60 years by 2050, but then are we prepared to handle such a large population boom of Older People in the next 25 years?

The dynamics of Indian family structure will drastically change in the next 20 years, as a result there will be more Elderly living alone, especially older women.

The larger point of debate is, are these population demographics meant only for the census data or we do we see them as living beings who need and will need care?

India has approximately 1 Lakh Senior Citizen Care Homes Beds (0.10 million) for a Elderly Population of 140 million, which means there is 1 Bed for every 1400 senior citizens.

The stark reality is that, if as a country we do not start creating infrastructure and facilities which can cater to the growing population of Senior Citizens then we may have a big task at hand at a later date.

Today's reality is tomorrow's future which will not only affect the poor and underprivileged but also the middle class and the rich.

Pankaj Mehrotra

Rocking Chairs & Older People

Though we all dream to have an ideal retirement life of sitting on a rocking chair and reading our favourite book or listening to our favourite music, but then is sitting on a Rocking Chair really advisable for Older People?

The larger point of debate is, is a Rocking Chair actually stable and easy to sit and get up especially for Seniors who have knee problems or gait / physical stability issues?

As per an article in LPA Medical inc, According to a clinical study of a clientele with a loss of autonomy, frequent use of a rocking chair improves balance and blood circulation, reduces muscle pain, anxiety and depression.

"A very popular stereotype of elderly people involves them rocking on their veranda with satisfaction," says Nancy Watson, a researcher at the University of Rochester School of Nursing.

"It turns out that this activity really brings greater peace of mind to many people." "It has been very well documented that a gentle repetitive movement provides a soothing effect to infants. We have shown that the same is true for an elderly population suffering from emotional distress."

Another important question is, though a Rocking Chair may be good for mental health and physical balance, but it advisable for elders to use it all by themselves without any supervision?

Though there have been few researches on the benefits of using Rocking Chairs, but then I feel when it comes to older people who have Dementia, Parkinson's there is need for more in-depth research especially for the oldest old.

No wonder they say "Keep Rocking in Life".

Pankaj Mehrotra

Identifying the Best Care Home

Finding a suitable Care Home for our parents or ourselves can be a challenging task, it's an important decision both for the senior citizen as well as for the family members.

Questions like, am I taking the right decision, what if the Home turns out to be just a dumping ground for parents etc etc will keep bothering us till the time we don't pay the deposit or buy the Retirement Home.

Since Care Homes are mushrooming across the country, hence it is important to take an informed decision before entering Care.

While the serene location and the smiling staff may look glamorous on first sight, but then, the big question will always remain i.e. why did we not use a checklist to evaluate the critical aspects of the Care Home services and facilities before deciding.

Though there are numerous guidelines and checklists for selecting a Care Home, but for the convenience and easy read I am attaching Age UK - Care Home Checklist.

Age UK have put this checklist together to help you find the best care home for seniors and family.

The first section covers some of the things worth evaluating before considering a move. It suggests questions one may like to ask while visiting care homes.

The second section is there for when you’ve picked a care home that’s suitable for you. It covers some of the things you might need to do before making the move.

Though some parts of this checklist may not be relevant in the Indian context yet in the overall sense, the document covers most of the important questions to be asked.

Pankaj Mehrotra

or the website at : https://www.ageuk.org.uk/

Reverse Mortgage - A good concept but non-starter

Reverse Mortgage was launched in India with a lot of fanfare but unfortunately the scheme was a non-starter and could not meet it's intended objectives.

The concept of Reverse Mortgage was conceptualized internationally to help senior citizens who are asset rich but cash poor.

The objective of this scheme is to help elders remain in their own homes at the same time, earn from the property till they are alive.

Some key points of the scheme are;

1) Periodical payments or a lump-sum for a maximum period 20 years.
2) Borrower(s) continue to stay in the house till they are alive or permanently move out of the house.
3) Borrower is not required to service the loan during his/her lifetime.
4) Loan amount is dependent on the value of house, age of borrower(s) & prevalent interest rate.
5) Loan amount may be used by the borrower for varied purposes including up-gradation/ renovation of residential property, medical exigencies, etc.
6) No capital gains tax

The larger point of debate is, why was Reverse Mortgage not accepted by the industry and by senior citizens themselves.

I guess the following reasons can be attributed depending upon the lender:

1) Only max 50% lump sum or max 15 lakhs
2) Max monthly receipt capped at ₹50,000/-
2) Typical loan amount given by the bank is 60-80% of house value
3) Maximum loan between 75 Lakhs - 2 crores
4) Very low loan amount from low value properties
4) Total interest payment to be paid to bank comes to 50-55% of the loan amount received
5) House should not be older than 20 years
6) 2-3% more expensive than normal home loan.

To conclude, Reverse Mortgage is a great concept which needs to be taken back to the drawing board, revised and updated for the benefit of Older People in India.

Pankaj Mehrotra

Impact of Divorce on Elderly (Silver Divorce)

Divorce and broken families have never been easy topics of discussion, especially in public forums, yet they are the underbelly of our society which we often find uncomfortable to debate upon.

The past few decades has seen a paradigm shift in the family dynamics, divorce rates have gone up, single parents have become an acceptable norm, broken families is not something looked down upon.

The interesting part is, many homes and families have complicated relationships and living arrangements, but then it is generally a hush hush affair and/or something to be handled behind the curtains.

The larger point of debate is not about regrets of getting married or the good and bad points of marriage, the question is, what is the impact of Divorce on Older People?

Divorce has multiple implications on the overall well-being of Senior Citizens, be it financial, emotional, health, social etc, each element has a direct impact on a senior's life.

The attached article "The impact of divorce on the elderly in India", by Ms.Kumari Shalini, a fourth-year student of Lloyd Law College on the website of Aishwarya Sandeep, an Advocate, is a great read and interesting research.

As per her article, two interesting points stood out:

1) While a decreasing proportion of adults are choosing to age alone, at the same time, an increasing number are getting divorced, getting married again, entering into romantic relationships outside of marriage, or choosing to remain single.

2) Another interesting point is, The Function of Parent-Child Disconnection of adult children.

When parent’s divorce, adult children respond in different ways, while some people are angry about their parents divorcing after a lengthy marriage, others are understanding or supportive of
their parents’ divorce.

Adult children may be unhappy about their parents’ split or want to spend less time with them so they won’t have to deal with their parents’ arguments. This decreased parent-child interaction occurs at a time when parents may be most in need of adult children’s support and guidance as they work through a divorce.

In my opinion, "Silver Divorce" may be on the rise but then, there are enough couples who stick around with their unhappy marriages only for the sake of their children, but then, the question is, is it better to call it quits and live happier lives separately or live under one roof yet be miserable "day in day out"?

Pankaj Mehrotra

or the website at : https://aishwaryasandeep.in/the-impact-of-divorce-on-the-elderly-in-india/#:~:text=Emotional%20Toll,care%20they%20traditionally%20depended%20on.

Do we really require Retirement Communities?

Globally Residential Care for the ageing population is straining the finances of state sponsored Elderly Care, due to which many countries are re-evaluating the service delivery models to care for the elders.

From the brick and mortar model of Residential Care many countries have started promoting "Ageing in Place".

The idea behind this shift of strategy is to reduce the burden of payout by the exchequer for government funded Congregate living.

Scarcity of care staff, real estate and high cost of manpower is affecting the sustainability of Senior Living sector in many socially developed countries.

While the international senior living models are broadly divided into three verticals, Independent Living, Assisted Living and Nursing Care, however in India in my opinion there is nothing called Independent Living.

India has seen exponential growth of group housing / condominium living projects over the past 2 decades, and is still growing by leaps and bounds.

As these houses gets old and the residents get older, is it advisable to leave the house for a new nest especially at such late stage of life?

Is it easy or advisable to leave one's neighborhood, friends and own house just for health, caregiving, social interaction and food and dinning support?

Why can't these housing societies develop a care model where seniors can continue living in their own homes yet have the assurance of professional care?

Most upmarket group housing projects have a club house and offer a range of services and facilities, some have in-house dining facilities also, in such setups should the elders move out just because of the lack of grab bars or limited movement of wheelchairs?

Though many senior living projects in India have changed gears and are setting up senior specific towers in integrated projects, but then the larger question still remains, why should one shift out of one's own house if the same services can be received at home.

I guess it's time for the society at large to think of realistic and practical solutions to keep our elders safe, secure, healthy and happy.

Today's cost of assisted living and high dependency care is anywhere in the range of 75 thousand to 1.5 lakhs and home care services of caregivers and nurses are between 40 thousand to 1 lakh, I really wonder how many of us will be able to afford these services in the next decade?

In my opinion, living in one's own house, sharing caregiving services, drivers, domestic help, visiting nurse, visiting doctor, social engagement within the community will be the most affordable way in the future.

Pankaj Mehrotra

Can a person with Dementia be convicted for Crime?

What happens if a person with Dementia physical abuses a women?

Dementia and police cases can be a tricky legal complication both for the police and for the judiciary.

Incase a person with Dementia has to be put behind bars, in that case, what are the provisions under Mental Healthcare Act to evaluate their mental capacity or mental soundness?

Since there is no mention of Dementia or Alzheimer's in the Mental Healthcare Act in that case what are the rules for Dementia with respect to criminal proceedings?

If Mental Healthcare Act does not mention Dementia or Alzheimer's and talks only about mental illness then what are the legal implications for a person with dementia incase of outraging the modesty of a woman?

An interesting article "Assessment of Dementia Under Prevailing Indian Laws and Its Implications" posted on Pubmed Central states;

The most common offenses by patients with Dementia include violence, sexual offense, and drugs-related offense. Others include theft, sexual harassment, and traffic offenses.

The larger point of debate is not about the crime but about the mental capacity of the person with Dementia to justify his/her case.

As per the article, a small number of elderly being sent to jail were unable to plead “not guilty because of Dementia” when committing their crimes.

Another critical aspect to consider in this context is the fitness of the elderly offender to plead and stand trial.

The trial procedures are often complicated and time-consuming, and the elderly offender with cognitive impairment may not understand the process well.

In addition to impairment in several cognitive domains, their physical conditions such as frailty, hearing, and visual impairment might also affect their ability to instruct their lawyers.

While on one hand, to evaluate the Dementia stage of a person through "Indian disability evaluation and assessment scale (IDEAS)" but then are the evaluators in rural areas and in the hinterlands competent to actually assess the level of memory impairment as there counterparts in the urban areas?

In short the critical questions are, can a person with Dementia be tried under IPC Section 376 (Rxpe) or IPC Section 354 (Outraging Modesty of Women).

I guess the policy makers and judiciary needs to take this grey area a bit more seriously and come out with clear cut rulings for future reference.

Pankaj Mehrotra

National Policy for Older People in India

Well-being of Senior Citizens is a constitutional mandate which needs to be implemented in full spirit to have a visible impact.

The first policy on older people was introduced in 1999 and post that no other national policy has been implemented.

According to a report by the Parliamentary Committee on Government Assurances, the Ministry of Social Justice and Empowerment has given 11 assurances in Parliament since 2011 about bringing in a new policy. However, a draft of the National Policy for Senior Citizens from 2011 is yet to be finalised.

The delay in implementing a revised policy reflects the level of importance and value we attach to Senior Citizens of India.

The need for revised policy and focus on issues of eldercare cannot be overlooked anymore. Policy makers and stakeholders need to understand the importance and prioritise Aged Care in the overall development plans of the country.

The attached Standing Committee Report Summary on Implementation of Schemes for the Welfare of Senior Citizens by PRS Legislative Research confirms that no official policy for Senior Citizens has been approved post 1999.

It is surprising to see that even after 24 years of implementing the first National Policy, as a developing Nation we are struggling to implement a revised and updated policy.

In my opinion, individual stakeholders who are passionate about the cause of Aged Care need to invest their time and intellectual bandwidth to support the government in developing a realistic and implementable person-centered policy.

Pankaj Mehrotra

Why Single Room Assisted Living is not advisable for couples

* Why Senior Living Couples unit should have 2 rooms?

* Why elderly couples need two separate rooms in retirement homes?

These are questions and answers which we learn from experience.

As we grow older we develop our own patterns of daily living, one of them is need for personal space.

Many senior living projects in India were initially planned and constructed based on the model of single room units. This was primarily due to cost constraints and to a certain extent lack of understanding of the varied needs of elderly couples.

As the industry grew and the learnings were implemented, developers and facility operators started realising the importance of converting single room units into two room suites.

The logical reasoning is simple, a couple who has spent 40-50 years together want their own individual spaces. I guess too much love can be acidic, at the same time no two people can live in a confined space for eternity.

This acidic situation happens because of Corrosive Nature's of two different people living in the same room on a 24x7 basis. As an individual, a single elderly person can be seen to be happy but the moment he or she is put in the same room with the other partner, fireworks starts. This is where the importance of two separate rooms in senior living comes into the picture.

Be it watching TV, socializing with close friends, sleep habits or simply not wanting to step on each other toes, every individual needs personal space.

Sometimes the collective Ageing process of couples can be a conflict of personalities, as a result the living situation becomes like "can't live together yet can't leave each other".

There are many cases where elderly couples simply live together because of compulsion rather than out of happiness. The larger point of debate is, as planners how seriously do we look at person-centered care for couples? Do we club the couple needs as one family need or do we respect each individual for who he or she is?

There is very limited research on the percentage of couples versus single elderly who live in senior living facilities, however if some researcher or an organisation puts in a little bit of effort, I am sure the insights will be interesting.

If affordability is not much of an issue, then in my opinion a simple wall within a senior living unit can probably help maintain the balance of equilibrium for elderly couples.

Pankaj Mehrotra

Dialysis - Is it a new lifestyle?

Like a layman I too was not aware of what dialysis meant and how it used to work.

Luckily or unluckily when a few family friends and relatives got into the routine of dialysis, I got to see firsthand how the procedure worked and why is it so important.

As per Google info, Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. It often involves diverting blood to a machine to be cleaned.

Life expectancy on dialysis varies depending on your other medical conditions, how well you follow your treatment plan, and various other factors. The average life expectancy on dialysis is 5-10 years. However, many patients have lived well on dialysis for 20 or even 30 years.

A typical dialysis session lasts for 3-4 hours and is generally done 3 times a week.

The larger point of debate is not about the medical dissection of kidney related problems, the question is, is dialysis becoming a new lifestyle normal?

I know of family friends who have accepted the dialysis routine as part of their life and are continuing to play golf and living a positive life, on the other hand there are people who get into depression and see dialysis as the dooms day.

In my limited understanding, dialysis treatment is permanent and one cannot say, oh i forgot to take my dialysis sessions for a few days, it's not a medicine which one can forget.

With the new lifestyle diseases one has to get accustomed to becoming dependent upon Medication, Assistive Technology, Assisted Devices and other support functions.

I guess this is where the importance of Assisted Living comes into picture. For people in the Independent Living mode, they do not require special support except for social care, food and dinning services etc, whereas Assisted Living offers support which are typically non-medical but are critical to keep an individual independent to the best of their capabilities.

Having said that, in my experience, anyone who is looking for retirement homes should look for Independent Living, Assisted Living and basic Nursing Care within the same retirement housing project.

I guess that's why the concept of Continuing Care Retirement Community (CCRC) came into existence. CCRC is also known as Life Care Community, Age-restricted Communities, Active Adult Communities, 55+ Communities, Retirement Villages etc.

Coming back to the regular sessions for dialysis, it is important to stay in a Retirement Community which offers support to take you to the doctor, dialysis centre, visit family and friends and manage errands.

In the future, even the family members will not have time to do baby sitting for their parents, hence paid support which is qualified, trained and most importantly experienced will become the support systems.

Pankaj Mehrotra

Effects of Humour on Ageing

Sense of humour is not of the same level for everyone, it varies with our temperament, our mindset, attitude & the phase of life one is going through.

Unfortunately there is limited research on Ageing and Humour especially in India, which in my opinion needs to be taken seriously because, "a good laugh is no laughing matter".

The attached article by Gil Greengross posted on karger.com, Humor and Aging - A Mini-Review, is a great read & I am sharing a few snippets from that.

One of the most consistent findings about humor & aging is that humor appreciation increases with age, but at some point, roughly around 60 years of age, enjoyment of humor starts to decline.

In addition, while humor appreciation increases with age, comprehension of humor declines. It has been suggested that there is an inverse U relationship between cognitive demands & humor appreciation.

One study with 80 subjects' ages 17-79 found that frequency of laughter was negatively correlated with age. Most of the decline occurred in the evenings, when elderly people tended to laugh half as much as the young population. The decline was also more prominent among elderly women.

Humor is often used to deal with stress and life's adversities, and there is some evidence suggesting that elderly people tend to use humor as a coping mechanism more often than the younger population.

The ability to enjoy humor and the diverse ways it is consumed can reveal important facets of the aging process and has the potential to positively affect healthy aging.

The high cognitive demands that humor appreciation & production require might also help delay the cognitive decline associated with aging, similar to other cognitive activities that were found to help thwart the decline in cognitive abilities among the elderly.

I guess understanding the Ageing process should not be limited to Geriatric Medicine or pure Gerontology, staff needs to be trained on the finer aspects of Social, Recreational & Well-being of Seniors.

Pankaj Mehrotra

or the website at : https://pubmed.ncbi.nlm.nih.gov/23689078/

Retired or Re-attired

The word retirement may sound very cool but then it comes with its own set of problems. The biggest issue is, What to do the whole day?

Quite a few people are hanging up their boots much earlier than regular retirement age, in my opinion it causes more damage in the long run rather than enjoying the so called retired life.

A person should be involved with some hobby or work till the time the body supports, otherwise one will eventually become retired mentally and physically.

A wise person becomes re-attired rather than becoming retired. The day a person feels that they are retired and not re-attired then the downhill road is not very far.

Ageing is a gradual process which needs to be taken in the stride, it should not come as a surprise.

Health and medical issues would always pose a challenge but then it is the personal wisdom which differentiates between ageing gracefully or ageing with complaints.

Pankaj Mehrotra