How do you care for an aging population?

The scope of services provided in the home has expanded from assistance with activities of daily living to routine nursing care and specialized care. According to a NITI Aayog report, healthcare delivered at home can replace up to 65 percent of unnecessary hospital visits and reduce hospital costs by 20 percent.

However, care practices at home are not well defined and standardized. Caregivers who are well trained and empathetic are in short supply and often complain of abuse by families. There are no specific complaints mechanisms for either users or healthcare providers. In addition, the costs of hiring a home care provider are significant. Currently, it is the private, for-profit sector that provides the majority of these services. Market estimates predict that the home care industry will grow 15 to 19 percent annually, from nearly $6 to $7 billion in 2021 to $21 billion in 2027.

Some policy interventions are needed to better organize care at home. First and foremost, recognize “home” as a place where care is provided and as a “workplace” for caregivers. This has consequences for the rights and security of both users and providers. The Insurance Regulatory and Development Authority of India (IRDAI) recognizes home hospitalization under certain circumstances.

Secondly, care at home is a different story than in an institution such as a hospital or a retirement home. The terms of assignment and treatment protocols must be tailored to the home environment.

Third, to meet the growing demand for trained healthcare providers, their professional training, nomenclature, roles, and career development must be streamlined. Finally, all this should be brought together in the context of a comprehensive policy on home care, which would include aspects such as a register of providers of such services; ensuring transparency and accountability; establishing grievance redressal mechanisms; and insurance coverage, among others.

The policy must also take into account the fact that women in India live an average of three years longer than men. The sex ratio of elderly people is expected to rise to 1,060 by 2026. Because women in India are generally younger than their husbands, they often spend their later years as widows. Therefore, policies should primarily target the more vulnerable and dependent older single women, so that they can lead a respectable and independent life.

The Ministry of Health and Family Welfare (MoHFW), Ministry of Social Justice and Empowerment (MSJE) and Ministry of Skill Development and Entrepreneurship (MSDE) are playing a crucial role in this matter. Better cooperation between them could bring about the required reforms. The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Act, 2019 seeks to regulate home care for the elderly. It proposes the registration of institutions providing home care services and the prescription of minimum standards for the same. However, it has not yet been adopted since its introduction in Parliament in 2019.

While the emphasis on making India’s youth population ‘future ready’ is welcome, it should not overshadow an equally critical group that needs attention. The experience of countries like Japan shows that systems for caring for the elderly are essential for the younger population to contribute to the country’s economy. Furthermore, it is the moral and ethical responsibility of a society to care for its people beyond their prime, reciprocating their lifelong physical, social, emotional, and economic investments in society.

The writer is a specialist, Health Systems Governance, Health Systems Transformation Platform