India is ageing – and much faster that once thought, according to some estimates. Nearly 20 percent of the population, or 340 million people, will be above 60 by 2050, reports The Economic Times. To put things into perspective, in super-aged Japan, 28% of the population or 35.57 million people are over 65. There is new urgency around how the country will provide aged care for its silver-haired citizens. Arnab Paul, the CEO of Patient Planet, is approaching the problem by bringing healthcare services and management to the patients themselves. His membership-based home care company, based in Kolkata, provides home care services billed on a monthly basis, and provides an option for elderly and less mobile patients to be treated in the comfort of their own homes. He tells Hospital Insider about the barriers that remain against providing effective aged care, and how tech can play an integral role in healthcare management for the elderly.
1. What are the challenges that India faces in delivering aged care?
Demand for elder care in India is exponentially increasing due to the impressive gains that society has made in terms of increased life expectancy. With the rise in elderly population, the demand for holistic care tends to grow. The current and future challenge is not only the huge population of the elderly, but also about our ill-preparedness to deal with this population, both from an economic and social standpoint. The United Health Care Scheme launched by Government of India is a step in the right direction, but we need active involvement of all the healthcare stakeholders and digitisation of health records so that we can better manage the integration of healthcare services and serve people from the lowest denominator of society. Most of the entities work in siloes; in that sense, we in India have a long way ahead. But as I have always believed that no technology can save us. We are only as good as our healthcare team. The efficiency of a home care company is limited or enhanced by the efficiency, expertise and soft skills of the healthcare team. The patient is not bothered about whether their records are digitised or whether the company is accredited – they are only concerned about how they feel once the healthcare team leaves their house after performing their duties, and whether the care was worth it. Secondly, unlike most developed countries, emergency response infrastructure for senior citizens is ill-developed. There is a lack of public ambulances for hospitalisation. Along with the United Healthcare Scheme, the government of India should consider making the availability of ambulances a priority. And finally, many elders who live alone suffer from the lack of companionship, sometimes aggravated by a lack of mobility due to ill health. Loneliness and isolation are major concerns among elderly Indians above the age of 60. Isolation can result in gradual depression and other mental disorders.
2. How is Patient Planet responding to these challenges?
We are providing care to people under a family membership scheme. This way, we can do better resource and manpower allocation and provide optimal services. Care is moving outside of the hospital and into the home and community. We need to understand how to organise care this way because, when you do, it’s more affordable, more convenient, and a better experience for the patient.The challenge now is to use data to activate the right level of care at the right location at the right time. Choosing a post-acute care setting is often based on a patient’s skill requirements and doesn’t take into account what else a patient may need. For example, let’s say that a 65-year-old man who has a knee replacement surgery is recuperating with physiotherapy and can be safely discharged to his home. But there’s other data that indicates he lives alone, is struggling with meal preparation, and can’t manage his ten prescribed medications. How do we use that insight to bring the right level of care to the patient? How do we create a hospital-like experience in his home that is more affordable and convenient, and that may also prevent him from returning to the hospital? This is where utilising the appropriate data comes into play. We are also allocating resources for building a Community Elder Day Care Centre, which is one of the best means of advocating and mobilising resources and manpower for elder care. In this sense, Community Private Partnerships (CPPs) would be an ideal start. Elderly patients from the community would be supplied with free or reasonably priced treatment through the CPP or CSR programmes. How will this work in practice? If I’ve had a heart procedure, for example, someone from my local church is going to knock on my door and make sure I know my medications, help me make appointments, and even see if I need a ride to my next visit to the doctor. So how do we empower these community health workers? We need to put tools in their hands to help them operate at a higher level, and allow them to communicate efficiently with the healthcare team.
3. What are the opportunities in using technology to plug the gaps?
With a wider variety of providers on care teams operating in the digital space, I think it will be vital to pay attention to every perspective. Collaborative and connectivity apps will help providers build a cohesive team in patient care. One major opportunity in implementation of technology in healthcare is in the wearable segment. Implementation of such technology would supplement the management of lifestyle diseases and chronic care management. In view of the changing demographic profile of India, it would be interesting to see how technology improves the clinical outcome and the general well-being of the aging population. Wearables could greatly improve and facilitate in remotely monitoring the patient, recording their vital parameters and also in alerting physicians in time of emergency.
4. How can home help make a difference?
In one case, Patient Planet received a phone inquiry from a lady who lives in Australia. She noted how her 72-year-old unmarried aunt, who lives alone, seems to be forgetful and has isolated herself from friends. She was once independent and active, the caller added. A trip to the emergency room revealed no significant findings, but the aunt was later diagnosed with dementia. Patient Planet RN visited the home, completed a health assessment and developed a private duty care plan that included safety supervision, bathing assist, dressing assist, eating reminders, medication reminders, transportation, and light house cleaning. We created a team of Certified Home Health Aides, including a physiotherapist, and private duty aide services were scheduled for 24/7 care. Shifts were set for 8 hours on weekdays, and 12 hours on weekends. The Health Aides ensured that this patient was safe, properly groomed and dressed, eating, kept all her medical appointments, took medications on time, and maintained social outings. RN also provided frequent aide supervision and ongoing care coordination with her physicians and family. The physiotherapist visited once a week to make her follow a certain exercise routine. The patient was able to live out her days at home, and the niece was able to have peace of mind about her aunt’s care. In another case, a lady requested 24/7 care for her 81-year-old father, who was recuperating after a stroke. He was diagnosed with multiple sensory deficits. Our Home Health Aides provided 24/7 care in the home, and assisted with activities of daily living, including bathing, dressing, incontinence care, repositioning, safety supervision, transfers, feeding assistance and light housekeeping. In addition, vital signs monitoring, oxygen monitoring, and coordination of care with tertiary hospital regarding use of “as needed” medications were provided. Supervisory visits were provided every week and more often as needed.