Updated Topic Name - Reimagining Long Term Care Facilities within an Urban

Context

Issues faced by the elderly -

1. Lack of Physical Infrastructure –

 There are just a few purpose-built care homes or public ramps that available for older citizens
who are unable to move, like those who need wheelchair access.
 Presently, with increasing longevity and debilitating chronic diseases, many of the elder citizens
will need better access to physical infrastructure in the coming years.

2. Financial Challenges -

 Lack of Financial Support - Only a small percentage of working Indians are eligible for pension.
In general, senior health insurance has a low penetration rate and a bad pay-out track record.
Despite this, health-care expenses continue to rise as people get older.

 Low funding: India spends only 1% of its gross domestic product on pensions. India’s income
support systems in their current form are not even capable of catering to the elderly when their
proportion of the population is only 8.6%.
 Mitigating the fiscal costs: The Indian economy still needs to mitigate the fiscal costs that arise
from a rising old-age dependency ratio.
Source - https://blog.forumias.com/elderly-population-in-india/

3. Health Related Challenges

Lack of Emergency Response Infrastructure –

 In India, the emergency response infrastructure for senior citizens, particularly the provision of
public ambulances for hospitalisation, is underdeveloped.
 One of the major concerns for most senior individuals living alone is accessing an emergency
facility, especially at night.

Knowledge of Specific Diseases –

 There is a scarcity of data on certain geriatric disorders.

 Mental health difficulties are clearly under-reported, and our country is unprepared to deal with
the rising rates of dementia, and depression, among the elderly.

4. Social Challenges and their status within the society –

I. The rapid socio-economic change -

 basically, includes more nuclear families making elder care management further difficult,
especially in the case of the busy NRI children, responsible for their older parents’ well-being.
 No doubt managing home care for the elderly is a massive challenge as multiple elderly home
care service providers, including nursing agencies, physiotherapists and caregivers, etc who often
do not talk to each other are involved in providing that care.

II. Lack of Companionship –

 Most senior citizens who probably live alone suffer due to lack of companionship sometimes
exacerbated by lack of mobility due to ill health.
 Loneliness and isolation are definitely a major concern among elderly Indians who are above the
age of 60.
 Isolation can result in gradual depression and other mental disorders in the elderly.

III. Ill treatment of the elderly by the younger sections of the society –

 Most of the aged people are not accorded the dignity of care they deserve.
 Seniors are experiencing isolation and disconnection – a form of social segregation, leading to
negative health outcomes.

Studies presented by UN

According to the sources of United Nations, by the year 2050, 20% of the world population will be at
the age of 60 and over. In the developed countries this percentage will be 33% of the total population.
Source - Population Division of the Department of Economic and Social Affairs of the United Nations
Secretariat, “World Population Prospects: The 2004 Revision and World Urbanization Prospects:
The 2003 Revision”, http://esa.un.org/unpp, accessed on15 May 2005
In order to emphasize the effect of ageing, the examples from plans, principles, frameworks and
assemblies on ageing presented by UN are investigated. Some of them are as follows:
I. Vienna International Plan of Action on Ageing (1982),
II. United Nations Principles for Older Persons (1991),
III. Conceptual Framework for The International Year Of Older Persons (1999),
IV. Second World Assembly on Ageing, (2002).
It was in the agenda of United Nations that there is a need for developing policies and programmes for
the ageing sector of the society as an important part of comprehensive plans for economic and social
development. In their 84th plenary meeting on Dec.14th, 1978, The General Assembly of UN
decided:
“to organize, in consultation with Member States, specialized agencies and organizations concerned, a
World Assembly on the Elderly in 1982, as a forum to launch an international action programme
aimed at guaranteeing economic and social security to older persons, as well as opportunities to
contribute to national development.”
Source - United Nations General Assembly-Thirty Third Session,
http://www.un.org/documents/ga/res/33/ares33r52.pdf, accessed on March 2006.
 I. Vienna International Plan of Action on Ageing (1982),
It is reported that Vienna International Plan of Action on Ageing was the first international instrument
on ageing, guiding thinking and the formulation of policies and programmes on ageing. This plan of
action was endorsed by the United Nations General Assembly in 1982 (resolution 37/51), having been
adopted earlier the same year at the World Assembly on Ageing at Vienna, Austria.
Source - Vienna International Plan of Action on Ageing,
http://www.un.org/esa/socdev/ageing/ageipaa.htm, accessed on March 2006.
The primary aim was to strengthen the capacities of governments and civil society to deal effectively
with the ageing of populations and to address the developmental potential and dependency needs of
older persons.
It is stated in the UN’s resources that this plan is part of an international framework of standards and
strategies developed by the international community in recent decades. It is noted that this plan should
be considered in relation to agreed standards and strategies in the areas of human rights, advancement
of women, families, population, youth, disabled persons, sustainable development, welfare, health,
housing, income security and employment, and education.
In its content there are 62 recommendations. The areas of concern to ageing individuals are described
as follows:
1. health and nutrition
2. protection of elderly consumers
3. housing and environment
4.family
5.social welfare
6.income security and employment
7. education

II. United Nations Principles for Older Persons (1991)

After this plan of action, in 1991, the United Nation’s General Assembly adopted the United Nations
Principles for Older Persons (resolution 46/91). There are five main categories in which 18 principles
take place.
1. independence
2. participation
3. care
4. self-fulfilment
5. dignity
General Assembly of UN encouraged governments to incorporate these principles into their national
programmes whenever possible.
Source - United Nations Principles for Older Persons,
http://www.un.org/esa/socdev/iyop/iyoppop.htm , accessed on March 2006.

III. Conceptual Framework for The International Year Of Older Persons (1999)
Another instrument was The Conceptual Framework for the International Year of Older Persons
prepared in 1999 (document A/50/114) and based on the Plan and Principles. It comprised four facets:
• situation of older persons
• individual lifelong development
• relationship between the generations
• interrelationship of population ageing and development
Source - International Year of Older Persons, A Society for All Ages,
http://www.un.org/esa/socdev/iyop/index.html, accessed on March 2006.

IV. Second World Assembly on Ageing, (2002).

Later, Second World Assembly on Ageing was held in Madrid, Spain on 8-12 April 2002, under the
concept of ‘Building A Society for All Ages’. According to the Second World Assembly on Ageing
Adopts Madrid International Plan of Action and Political Declaration, world governments set out a
blueprint for an international response to the opportunities and challenges of population ageing in the
twenty-first century and the promotion of the concept of a ‘society for all ages’ - the main theme of
the event. It was stated that:
“As the demographic changes are expected to be the greatest and most rapid in developing countries,
where the older population is expected to quadruple by 2050, the Assembly recognized the
importance of placing ageing in the context of strategies for the eradication of poverty, as well as
efforts to achieve full participation of all developing countries in the world economy. The texts
promoted a new recognition that ageing was not simply an issue of social security and welfare but of
overall development and economic policy. They also stressed the need to promote a positive approach
to ageing and overcome the negative stereotypes associated with it.”
Source - Second World Assembly on Ageing, Madrid International Plan of Action, Concept of Society
for All Ages, http://www.un.org/ageing/coverage/pr/SOCM22.htm, accessed on March 2006.

Conclusion - My intake on this –

As noted from the above studies, the growing interest in the sphere of ageing and its process has
compelled professionals to focus on the issues associated with the it, one of which is 'housing'.
Several countries consider the prospect of housing and care for the elderly as a contemporary problem
for which, they propose modern and progressive residential environments as an alternative to
institutional living which include private residences with different levels of supportive services. While
individualsenjoy their privacy in their own flats, they also get to socialize with others. However, in
India, the only form of accommodation for the elderly is institutional living, and housing units with or
without care units. Hence new alternatives for the care of the elderly by defining housing options
specially designed for elderly people can be looked further into.
 Considerations when designing for the elderly -

The need to recognize the loss of the physiological capacity in all design considerations. Specific
requirements can be summarized as the following:
1. Privacy: the elderly need a space of their own. must respect resident living habits, preferences, and
privacy.
2. Social interaction: a lonely life is very harmful to the physical and mental health of the elderly as
they themselves have the need for social interaction. Therefore, when considering the residents there
should be space for social interaction space and exchanges between residents.
3. Clear direction and logo system: the elderly, because of identification problems and memory
recession, require that their environment offers clear direction and a legible marking system guiding
them to event locations.
4. Security and comfort: all designs for the elderly need to provide a safe indoor environment which
provides a sense of security and meets their physical and psychological comfort requirements.
5. Disability and universal design: indoor spaces for elderly activities require good accessibility.
6. Familiarity and continuity: the design of senior housing should contain certain local tradition and
offer the residents self-decoration spaces for the placement of familiar personal items, such as photos,
which serve as reminders of earlier days.
Source - https://ufdcimages.uflib.ufl.edu/AA/00/06/16/51/00001/Chen_Kezhen-Final-MRP.pdf

Demographic Data

the report said there will

be 93 million males and
101 million females in
2031 — up from 67
million males and 71
million females in 2021.
The report published
Thursday cited findings
from the Technical
Group on Population
Projections for India and
States 2011-2036 for its
predictions. The NSO,
which falls under the
Ministry of Statistics and
Programme Implementation (MoSPI), sought to provide insights about the problems and status of
elderly persons in the country, and help in policymaking. The report stressed the 2017 United Nations
Report on World Population Ageing, which claimed that by 2030 the people aged 60 years or above
are expected to outnumber children under age 10.

Share of population

 The report said there is likely to be an increase of nearly 34 million elderly persons in 2021 as
compared to 2011 (104 million). This is projected to rise by around 56 million over the next
decade.
 The percentage share of the elderly population in the total population is said to rise from 8.6
per cent in 2011 to 10.1 per cent in 2021 and projected to touch 13.1 per cent in 2031.
 Census 1991 showed the elderly female population (29.4 million) outnumbered elderly males
(27.3 million). The NSO report said this trend has strengthened in the last two decades. The
elderly female and male population is now projected to rise to 100.9 million and 92.9 million,
respectively, in 2031.
 The elderly population’s decadal growth (population growth rate over a 10-year period)
compared to that of the general population showed a huge contrast.
 While elderly decadal growth is predicted to rise from 35.5 per cent in 2001-11 to 35.8 per
cent in 2011-21 to 40.5 in 2021-31, the growth is said to decline from 17.7 to 12.4 to 8.4 per
cent in the general population, respectively.
 The average annual growth rate of the elderly population as compared to the Population
Census 2011 is 3.28 per cent.

State-wise data

 According to the report, Kerala currently has the highest elderly population (16.5 per cent),
followed by Tamil Nadu (13.6 per cent), Himachal Pradesh (13.1 per cent), Punjab (12.6 per
cent) and Andhra Pradesh (12.4 per cent) in 2021. 
 Bihar, Uttar Pradesh and Assam have the least proportion with 7.7 per cent, 8.1 per cent and
8.2 per cent, respectively.
 A decade from now, the same five states are projected to have the maximum proportion of
elderly people in its population — Kerala (20.9 per cent) followed by Tamil Nadu (18.2 per
cent), Himachal Pradesh (17.1 per cent), Andhra Pradesh (16.4 per cent) and Punjab (16.2 per
cent).
 Over the last decade, the highest average rise was observed in Delhi (6.60 per cent), Gujarat
(4.88 per cent) and West Bengal (4.27 per cent). The least average increase has been seen in
Uttar Pradesh (2.16 per cent) followed by Bihar (2.28 per cent) and Madhya Pradesh (2.53 per
cent).

Economic status of elderly population

 The report noted a significant increase in the old-age dependency ratio, which rose from 10.9
per cent in 1961 to 14.2 per cent in 2011 and is projected to increase to 15.7 per cent and 20.1
per cent in 2021 and 2031, respectively. 
 The dependency ratio for female and male is expected to reach 14.8 per cent and 16.7 per
cent, respectively, in 2021.
  The old-age dependency ratio is defined as the number of persons aged 60+ per 100 persons
relative to the age group 15-59.
 Census 2011 showed the overall old-age dependency ratio varied from 10.4 per cent in Delhi
to 19.6 per cent in Kerala. This is further projected to vary from 12.7 per cent in Assam to
26.1 per cent in Kerala in 2021. 
 For 2031, the old-age dependency ratio could vary from 15.6 per cent in Bihar to 34.3 per
cent in Kerala.
 The report noted that the female old-age dependency ratio as compared to male is
significantly high in states like Kerala, Tamil Nadu, Himachal Pradesh and Punjab in 2021.

Other indicators

 The report said literacy levels among elderly males and females have improved over time in
both rural and urban areas, but it noted a huge gender gap, with only 28 per cent female
elderly literate as against 59 per cent males (Population Census 2011). 
 The difference is even starker in rural areas where 51 per cent males were literate against 18
per cent of women.
 The average number of years in formal education among persons aged 60+ is the highest in
Chandigarh (12.7 years) followed by Delhi (10.7 years) and is the lowest in Sikkim (6.2
years), followed by Mizoram (6.3 years) and Daman & Diu (6.5 years).

Source - https://theprint.in/india/indias-elderly-population-to-rise-41-over-next-decade-to-touch-
194-mn-in-2031-govt-report/710476/

Key Points Derived from the Demographics

The collective data and research concerning the aging population lead to several key
conclusions:
 Due to longer life expectancies, and advances in health care and education, the population of
older generations in the india is increasing at a rate that is significantly greater than the
general population.
 As families have become more mobile and communities have dispersed, greater numbers of
elderly are living alone, putting them at risk for isolation and access to care and amenities.
 The increasing aging population leads to a host of social and economic issues, as witnessed
by facts such as disability and dependence concerns.
 Although senior care facilities and institutions can satisfy needs of the aging, particularly with
respect to medical care, and have become a viable path of housing for many, it cannot be
assumed that continued trends toward housing in such facilities is a responsible or sustainable
solution, while, even if such housing is made available, it may not be affordable for many
sectors of the aging population.
 Solutions that work with existing community attributes can not only address the needs of the
aging population but might result in a demographically robust environment overall.
Government schemes and initiatives towards the betterment of the elderly
population

In 2011, the government introduced a National Policy for Older Persons. The key objectives of the
policy are,

 To encourage individuals to make provisions for their own and their spouse during old age
 To encourage families to take care of their older family members
 To bring non-governmental organizations for caring for older persons
 To provide healthcare facilities to the elderly
 To create awareness regarding elderly persons and to develop them into fully independent
citizens

Apart from that, the government introduced other measures, such as,

 Indira Gandhi National Old Age Pension Scheme (IGNOAPS) – The scheme provide an
old-age pension for persons above the age of 60 years and belongs to the BPL category.
 Rashtriya Vayoshri Yojana (RVY) – The scheme provides Physical Aids and Assisted-
living Devices for Senior citizens belonging to the BPL category.
 Pradhan Mantri Vaya Vandana Yojana – The scheme aims to provide social security
during old age. It also protects elderly persons aged 60 and above against a future fall in their
interest income due to uncertain market conditions.
 Senior care Ageing Growth Engine (SAGE) Initiative and SAGE portal– It aims to help
startups interested in providing services for elderly care.
 Elderline – a toll-free helpline number for elderly persons to provide emotional care, health
and legal assistance through dedicated call centers.

Source - https://blog.forumias.com/elderly-population-in-india/
The Current Model: level of Senior Care Facilities

Source - https://www.seniorliving.org/care/cost/

1. Retirement Communities - Own or rent in a community just for seniors. Access to social
activities, valet services and often an emergency call system.
2. Senior APARTMENT - Total freedom access to other seniors
3. Senior Co-op - Non-profits owned and controlled by senior residents offers socially
supportive cooperative communities.
4. Congregational - Faith-based senior living within the comforts and freedom of independent
or assisted living facilities.
5. Active senior - Designed active and healthy seniors with the desire and ability to live
independently on their own and stay engaged.
6. Adult Day Care - Low cost-day-time socialization, entertainment, and supervision
7. Independent living - Complete freedom and private quarters with access to amenities like
housekeeping, social activities, transportation, emergency help and security. This autonomous
approach is most fitting for maturing seniors that are equipped for living mostly in
independence.
8. CCRC - Seniors buy-in for care for the rest of their lives. Includes all levels of care from
independent living to skilled nursing care in one location
9. Respite care- Includes a wide range of temporary care in a facility. Respite care is for people
who are in transition of care stages, or need brief care, normally running from days up to a
month, contingent upon their circumstance. In many cases, these types of stays may simply be
a test run to get better acquainted to senior living, before moving in
10. Personal Home care - Help with meals hygiene, entertainment and transportation
11. ASSISTED LIVING - PCM care including ADLs plus help with medication and finance
(paying bills). Often includes more socialization. seniors will not require the amount of
support provided in a nursing home, but be that as it may, residents of this care level may not
 be able to perform routine tasks without assistance. This level of care is intended for seniors
who look for an active and dynamic life, yet require more hands-on with day-by-day activities
and schedules compared to individuals in in-home caregiving.
12. PCM CARE - Assistance with ADL’s and medical related needs under the care of skilled
professionals.
13. Dementia/ memory Care - Assisted living plus High level of daily supervision. For memory
debilitation, it is encouraged to execute planned, round-the-clock care and organized exercises
to guarantee their well-being and personal satisfaction. 
14. Nursing Home - Rehabilitation and 24-hour supervision by a skilled nurse. this approach is
suggested for seniors that routinely require hospitalization, their condition is worsening, and
when previous senior care is no longer an option.
15. Hospice Care - End-of-life support at home or at a special care facility

The Distribution of Old Age Homes

 As per the website dadadadi.org, there are 728 Old Age Homes in India today.
 Information of 547 homes is available and out of these, 325 homes are free of cost while 95
old age homes are on pay & stay basis, 116 homes have both free as well as pay & stay
facilities and 11 homes have no information.
 A total of 278 old age homes all over the country are available for the sick and 101 homes are
exclusively for women.
 Kerala has 124 old age homes which is maximum in any state. Also, research conducted by
Tata Trusts estimated that the total capacity across senior living facilities is currently at
97,000 beds (rounded).
 The study indicates that the need for senior living may rise to around 8 to 10 lakh beds in the
next 10 years, which is an 8 to 10 fold increase over the current base implying a compounded
increase of ~25 % annually each year.
https://wishesandblessings.net/blog/old-age-homes-in-india/

History of old age homes in India

http://youngarenalitigators.blogspot.com/2016/10/evolution-of-concept-of-old-age-homes.html\