The Opportunity in Geriatric Care in India

Old age in India is looked upon as a time meant for quiet contemplation, remembering the almighty and spending time harmlessly pottering around with ones grandchildren. While this idyll exists for some, the sad reality is that old age often means deteriorating health and illnesses. As one grows older the mind loses its agility, the body loses its vigour and diseases set in.

With nuclear families and double incomes being the norm in urban India, children caring for their parents find the going tough. It is not that they do not wish to look after the elderly, the problem is that juggling careers, children and parents needing constant medical attention becomes a difficult task. The situation gets further compounded if the elderly require constant medical attention.

Home care hardly exists in India. Even in a city like Delhi, getting adequate nursing care at home is next to impossible. While a handful of nursing services exist, their services are unreliable and offer dubious quality of care. These centres do not employ nurses trained in geriatric care, most of them are rejects from big hospitals and land up in these places because no one else is willing to hire them. Trusting, them to look after the elderly at home is a huge risk.

Old age homes too are hard to find. A quick look up on Google threw up just 5 centres in Delhi, most run by NGO’s as not for profit centres. These homes too are more in the nature of shelters for the aged and are not equipped with round the clock medical care. If this is the state of affairs Delhi, one can easily assume the situation to be a lot worse elsewhere in the country.

To my mind this is a significant business opportunity, which can only grow.

Specialised Geriatric Care centres, will provide comprehensive care to the elderly. This would include day care as well as residential care centres. These centres need not be hospitals in the strictest sense of the word but specialised care centres equipped to take care of the day-to-day medical needs of the aged. Unlike hospitals these centres will not be only for those who are sick with a debilitating or terminal illness but for all those who need assisted living. Thus these centres will offer continuous care both in terms of managing day-to-day chores as well as state of the art medical care.

These centres can also run home care services for the elderly. They can provide trained people to look after the aged at their homes, particularly when the children are at work or traveling on business. This can work well for folks, who have family around them and would like to spend their remaining days at home with them. It would also take away the feeling of guilt that most children, unable to take adequate care of their elderly parents, suffer from.

A business model can be developed along these service lines and may include monthly charges for the stay in the centre and using its facilities and separate charges for medical interventions as and when needed. While these centres should be ’for profit’, one has to handle the business sensitively. Compassion, kindness and a missionary sense of doing good must be critical business drivers along with profits.

I am of the view that these aims can be easily balanced and a ‘for profit’ organisation with compassion and kindness at its heart can be built and sustained.

Hospital Pricing Must be More Transparent

Most people in India are scared of hospitals, more for the unpredictable financial implications that hospitalisation engenders than anything else. While most folks stoically accept the medical outcome, many find accepting the hospital bill far more difficult. This should not be the case.

Hospital pricing in India continues to be shrouded in mystery and one pays pretty much whatever the hospital asks. Most people do not even have elementary knowledge about how the hospital charges. At the time of admission, the hospitals proffer an estimate of expenses for what they assume would be an uneventful stay in the hospital. The patients expect that the hospital bill would be around the indicated estimate and plan accordingly. They do not realise that a hospital estimate has a large number of variables, which can often lead to a higher bill and what the hospital is indicating is the best case scenario and what they need to be prepared for is perhaps the worst case scenario.

While there are often legitimate instances where one can understand the initial estimate going haywire, sadly their are also cases where the hospitals deliberately mislead the patient to make a fast buck. When my mother underwent a bypass surgery, she also contracted a serious chest infection and we had a very difficult time. The hospital did its best to see her through and the expenses mounted. However, in this instance since I was aware of the risk of infection, and had decided to go ahead with the surgery, paying more did not bother me and I certainly never felt that the hospital had cheated us.

While a few good, well established hospitals do not try to ‘reel in’ patients by indicating a lower than expected expense at the time the patient is making up his mind about the hospital, many unfortunately deliberately mislead the patient. This is a pernicious practice and actually amounts to taking undue advantage of the patient. Some hospitals also quote a higher price if a patient has an insurance cover and a much lower one if they are paying on their own. This is unfortunate and self defeating as insurance companies will soon start tightening the screws and once they have sufficient strength, they will drive a very hard bargain, which will have the hospitals cutting corners and the hapless patients paying the price literally and figuratively.

In the mad scramble for patients, hospitals have also started bargaining. As the patient walks in the hospital, the executives will discuss the likely expenses and if they find that the patient is likely to go ’shopping’ to other hospitals, will make an instant offer much lower than quoted initially. This is largely to entice the patient to choose their hospital. It works well as the patient is spared the hassle of going to other hospitals and he believes he has got a bargain. What he does not know is that at that price the hospital is likely to compromise on consumables like implants, which may later on have serious medical consequences. I remember a few years ago we had a patient at Artemis Hospital from Bangladesh for a cardiac valve replacement surgery, for which the hospital had quoted an estimate and explained to the patient in detail the implants it proposed to use and all the other associated costs. The patient went shopping and landed at another hospital in Delhi, where he was quoted a price roughly 50% of what we had quoted. He had no idea of the quality of the implant proposed by this hospital but felt he could trust the doctor and the hospital (in that order). He went ahead with the surgery not knowing that he would probably require corrective surgery in a few years, which would be a lot more expensive and riskier.

The answer to all this madness lies in a better educated customer and more hospitals with a conscience. Hospitals must spend in educating customers about the likely costs, the risk factors, which can push the costs up and explain the possible consequences of choosing a cheaper, though a sub optimal treatment option. Transparency and honest intent are the key to winning a patient’s confidence. And of course they should be driven by a motive, which is more than profits at all costs.

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