When 80-year-old Rukmini Amma fell and broke her leg at her home in Rajajinagar, her husband, 86-year-old Srikantan, called their neighbours for help. Neighbours helped Rukmini Amma get admitted to hospital, and informed her son who lives in Pune, and daughter who’s in Canada. Both rushed home, and helped her get the best treatment and surgery, and brought her back home.

When it was time for them to go back, they weighed their options. Finally they brought a new person home – 55-year-old Kuppamma, a trained geriatric care personnel, who would stay full-time and care for Rukmini Amma. A caterer takes care of food, doctors come home to treat Rukmini Amma, and a physiotherapist helps her walk again.

Rukmini Amma is among the many elders in the city who are now opting for trained professionals who give healthcare at home. While untrained and unskilled carers from the unorganised sector still dominate the home care market, more players are now entering the organised sector.

Bengaluru is one of the key cities that’s driving the elder care market in India, mainly through home healthcare services and retirement homes for seniors. These facilities benefit seniors who have mobility issues and need long-term healthcare. There are hardly any hospitals in the city with facilities for continuing care for chronic diseases; hospital care is expensive too. Now, seniors can opt for home care services when needed, or, if they live alone, shift to a retirement home where their basic healthcare needs will be taken care of.

The advantage of home healthcare facilities is that seniors with debilitating illnesses are spared the inconvenience of routine doctor appointments and lab tests. They don’t have to depend on their children to arrange the logistics of these trips either. In short, home health care allows seniors to live with dignity, in their familiar home environment, without having to move to an institution for full-time care.

In case of home healthcare, the routine care and monitoring increases the chance that an issue is diagnosed quickly and treatment given on time, which reduces the risk of hospitalisations. It also promotes the emotional well-being of both the patient and the caregiving family members. Home care segment in Bengaluru is nascent, but growing rapidly.

Doctors, lab tests, attendants, ICU at home

Portea Medical, which started in 2013, was among the earliest companies in the home healthcare segment in Bengaluru, and a large section of their customers are senior citizens. Their services include doctor visits for checkups, post-hospitalisation cardiac care, long-term care for cancer, diabetes etc.

Portea’s other home services include physiotherapy, lab tests, medicine and equipment delivery, and nursing care by registered nurses and therapists. The company has separate care packages for the elderly – seniors who need help with daily living are assisted by trained attendants. It also has tie-ups with hospitals like Fortis and Manipal. As of mid-2017, Portea was arranging over five lakh monthly home visits in Bengaluru. Companies like India Home Health Care (IHHC) and Health Care At Home (HCAH) provide similar services. Many of these companies even have home ICU services.

Manjula Sridhar, Founder of Vaishnavi Medicare at Malleswaram, says that there is huge demand for home healthcare services now. Vaishnavi Medicare arranges trained care attendants and nurses who have completed ANM (Auxiliary Nursing and Midwifery) or GNM (General Nursing and Midwifery) courses, for their homecare clients.

“Our attendants provide full-time care including services like washing, diaper change, giving insulin injections and checking blood pressure. Nurses are required for services like tracheostomy, putting IV etc. Sometimes, if a patient who already has a care attendant requires a nurse for a procedure, we arrange this too,” says Manjula.

The monthly charges for a care attendant is Rs 18,000. For nurses, monthly charges can range from Rs 16,000 to Rs 40,000, depending on the condition of the patient. The organisation gets 18-20 new clients every month now, says Manjula. They also provide medical equipments – oxygen cylinder and hospital cots for rent, and suction machine (aspirators) for sale.

One-stop senior citizen services

There are also companies like Anvayaa that provide one-stop services for elders who live by themselves. Anvayaa, which serves over 500 seniors in Hyderabad, started operations in Bengaluru just this month. The company essentially aggregates services of companies in multiple domains like healthcare, housekeeping etc, in addition to giving personalised care to seniors through ‘care managers’.

The care managers are like “virtual sons and daughters” of the clients, says Prashanth Patkar, Head of Operations at Anvayaa. Each senior citizen is allotted a care manager who is available on call to do chores for the senior or to coordinate the services he needs. For instance, if the client is to undergo a surgery, the care manager would take him to the hospital, stay with him through the hospitalisation and take him back home afterwards.

Clients can opt for one of the company’s healthcare packages. In the healthcare domain, Anvayaa has partnered with homecare providers like Portea, and with some hospitals like Apollo. The company also has a helpline that the senior can call in case of a medical emergency.

“We have mapped ambulances, specialty hospitals etc close to our clients’ homes, and match these with our clients’ profiles. So we have an emergency plan for each client. If they call the helpline, their care manager would take them to the hospital as per the emergency plan,” says Patkar. ElderAid Wellness is a similar company that works on the “proxy child” model.

Aggregating good quality services could be a challenge for companies like Anvayaa. “There is a long way to go before India has good quality services in the formal sector for housekeeping, domestic work etc. There are issues in the service sector, but we deal with this by doing an interview of the allotted person ourselves, and calling the client afterwards to check if the service was good,” says Patkar, adding that they don’t hire freelancers at all.

There are also companies like Rehamo that focus exclusively on medical equipment and aids for assisted living. Founded early this year, this company also helps clients choose the right device and guides them on how to use it. Rehamo’s products include mobility equipments like wheelchairs, diagnostic devices, equipments for fall prevention and pain management etc.

Even though home healthcare services are growing in demand, it may be some time before these services become more streamlined and popular.

Lack of continuity and reliability affect patients

Even though home healthcare services seem very convenient, not all clients are happy. Yashaswini Sharma, an architect and researcher who has used multiple home healthcare companies for her parents, says that the quality was mostly poor. She says that companies send good staff initially, but not afterwards. Staff are changed very frequently, sometimes once every 2-3 days.

“So we had to keep teaching new people again on how to care for our father. We also had to constantly monitor them to ensure that they did their job,” says Yashaswini. Her father, who suffered from Parkinson’s Disease, had availed the services of care attendants and nurses from two companies last year.

“First, we hired 24-hour care attendants from a company. The first attendant they sent was alright, but he just disappeared one day; the next person they sent used to get drunk. After that we opted for a different company, and also opted for day carers instead of 24-hour carers,” she says.

The services of the second company – a well-known brand – was better, but inconsistent. “The nurse from this company didn’t know how to put an IV, and we had to take father to the hospital for this. There was only one good staff – an attendant – from this company; but whenever he took days off to go to his hometown, the company refused to send a replacement, saying that he hadn’t notified them about his leave,” Yashaswini says. She adds that the independent attendants she hired were even worse.

She says that the best service she got was from a home care service provided by a corporate hospital, for her mother. “The nurse was very good, and she also coordinated with the hospital on my mother’s dialysis appointments. So we didn’t have to worry much,” she says. However, this nurse cost Rs 60,000 per month, higher than a nurse or attendant from a regular home healthcare company.

The online reviews of home healthcare companies also reflect a range of opinions. Yashaswini says one has to be cautious in hiring these services. “Check online reviews first. If the nurse you hired is with the patient during a hospitalisation, you can get an opinion from the hospital doctor or nurse about her capabilities. Also, it’s better to hire carers who work in shifts – no one can work for 24 hours.”