An ambulance on the ready, a medical centre with a doctor and two nurses visiting on alternate days, home healthcare services for those who need it – these are some of the medical facilities at Athashri, a retirement community in Whitefield, Bengaluru. Athashri, a retirement home for senior citizens aged above 65 years, has good medical facilities, says H Kishore, president of the resident welfare association here.

The apartment has 118 units, of which nearly 80 are occupied currently. About 15 residents here are availing the home services of care attendants and nurses from Nightingales Home Health Services. “We have tied up with Columbia Asia and Narayana Hrudayalaya hospitals which are nearby. Our residents have a card from these hospitals, so that in case of emergencies, they get immediate care,” says Kishore. The apartment units have an alarm that the residents can ring in case of emergencies. There are four guest rooms, where residents’ children can stay temporarily if they come to visit a parent.

Over the past decade, apartments or villas for senior citizens have been popping up in the city. The idea behind these homes is to create a community of like-minded seniors who can socialise with each other, age actively, and ‘retire’ from routine chores like housekeeping. Most retirement homes offer basic medical support, food, maintenance, housekeeping and recreation, for which monthly charges are collected. In most cases, developers themselves provide these services. Luxury homes may have swimming pools, clubhouses etc.

These homes usually have senior-friendly infrastructure like hand railings, non-slippery flooring etc. Medical facilities include regular health checkups, doctor on call, ambulances and access to hospitals. Most retirement homes have tie-ups with couple of hospitals. These facilities are a boon for seniors who have no children or whose children live separately. In addition to getting routine medical checkups, they don’t have to worry about being alone in case of an emergency.

Bengaluru a booming market for retirement communities

As per the 2017 study ‘Retirement homes in India’ by Moneylife Foundation, these homes are catering largely to affluent and middle income seniors who are well-travelled, socially connected, and want to live independently. As per the report, Bengaluru, Pune and Coimbatore are the cities driving the senior living segment in India. The majority of retirement homes currently are targeted at seniors who are relatively healthy and independent.

As per CII’s Senior Care Industry Report India 2018, the average price of a senior living unit in India is Rs 45 lakhs. Seniors usually either buy the property or take it on lease. The CII report says there are 10 players in the senior living segment in Bengaluru. These include Mantri Primus, Tata Housing, Paranjape (that owns Athashri) and others. Bengaluru is the city with the second highest number of players, after New Delhi.

In India overall there are about 20,000 senior living units, including those under construction, whereas the demand for these homes in urban India is about 10 times more – 2.4 lakh units, says the CII report. The sector directly employs around 4500 care workers currently.

The sector is growing, with foreign investment too. Last year, Columbia Pacific, a global healthcare and senior living company, acquired Serene Senior Living which owned four retirement communities in South India. Columbia Pacific, the parent company of Columbia Asia hospitals, had then announced its plans to expand aggressively in India’s senior living market.

Some developers like Vedaanta have also started catering to seniors who need assisted living and palliative care. But this segment is not expanding quickly since developers have to invest heavily in medical facilities and equipment, and need to appoint qualified doctors. Finding and retaining trained personnel, like nurses, is not easy either. Even if these facilities are set up, industry leaders are unsure if seniors will be able to afford homes with these facilities.

Flipside of the business

A Moneylife Foundation survey showed that, out of 340 residents of retirement homes across India, over half – 53% – were unhappy with the services provided. Specifically, 61% were dissatisfied with medical services. The study found cases of retirement homes not having their own ambulances or even wheelchairs, or being located in remote areas with poor access to hospitals. However, about 73% seniors said they’d recommend living in retirement homes to others, implying that what’s needed is regulation on the sector, says the report.

Kishore says, “Many of retirement homes in Bengaluru are located on the outskirts, some near the international airport. They are very secluded, and far away from hospitals and other facilities. Some also consist of villas located in a vast space, at a distance from each other. In such communities, seniors become isolated rather than being part of a community.”

He opines that finding a good resident doctor is difficult too. “Most doctors would want a private practice, but we can’t allow the public on campus because of security issues. Finding a good resident manager is also difficult – ideally the person should be a senior citizen to understand our concerns, but he should also be able to help a senior in case of emergencies,” says Kishore.

The problems with retirement homes had got serious attention when 80-year-old S Krishnamurthy, a resident of Dhyanaprastha retirement home in Coimbatore, filed a PIL in Madras High Court in 2015. Dhyanaprastha home had been built with deposits collected from resident-members, but they had no say in the project; even their lease agreements weren’t registered, which affected their legal rights. The developer was registered as a non-profit “Trust” and got tax exemptions, but was actually a commercial enterprise. The developer didn’t maintain or audit accounts properly, provided poor services, and the staff harassed seniors who voiced grievances.

Minimum requirements for retirement homes

Based on court’s directions in this case, Tamil Nadu government passed a Government Order laying out minimum requirements for retirement homes, and mandating the registration of agreements between developer and the senior citizen. But no such regulations exist in Bengaluru or the rest of the country on quality of services, transparency, or resolution of residents’ grievances. Even in Tamil Nadu the order has been poorly implemented, says the Moneylife report.

The Moneylife Foundation survey showed that many residents were highly vulnerable. Even though monthly maintenance charges would increase over the years, 81% said they couldn’t afford a hike of more than Rs 5000. And 71% had no contingency plan for when the charges would increase. Nearly two-thirds of residents had not signed a proper contractual agreement, and nearly the same number of residents didn’t know how to terminate or transfer their property title. Lack of regulations had led to issues like seniors not being able to get their refunds when opting out of the homes, unreasonable escalation of monthly charges forcing seniors to vacate etc.

The CII report says that the lack of personnel trained in professional geriatric care is a challenge in the senior care sector. This shortage is more among the middle to low skilled personnel, like nurses, lab technicians, housekeeping staff and assistants. Currently, companies hire teams from domains like healthcare and hospitality, and give them on-the-job training. But this isn’t good enough since the team members need to also be empathetic, capable of behaviour and stress management, and provide social support., for the emotional well-being of the senior citizen.

Kishore says there’s an urgent need to regulate the sector. “Many retirement homes are exploitative and give poor services. They know that an 80-year-old person is not going to file a case against them. We’re now trying to get different RWAs together, and develop model rules for the sector that we can put forth to the authorities,” he says.