Indian elderly need people to talk to, places to go to and feel needed, says Asheesh Gupta, founder of Samarth Eldercare at Senior Well-Being Summit by TOI

To guarantee that India's aging population leads happy and respectable lives, it is becoming increasingly important to pay attention to their health, wellness, and community involvement. This entails enhancing geriatric care services, creating easily accessible infrastructure, ensuring seniors' financial security, and offering them mental health support. The cooperative involvement of community workers, policymakers, healthcare experts, and caregivers is necessary for this multifaceted strategy. The Right To Excellence - Senior Well-Being Summit is presented by TOI with the goal of addressing the issues that older adults experience and creating a long-term plan for their well-being. Experts in healthcare, politics, and business will convene to exchange knowledge and suggestions regarding ways to enhance the standard of living for the elderly.

At the same event, Asheesh Gupta, founder & CCO, Samarth Eldercare; Pro-Vice Chancellor, JKLU, and Industry Scholar was asked about the common challenges families face when selecting elder care services for their loved ones, the advice he would give to organizations and CHROs considering elder care benefits for their employees, and how policymakers could address the elder care challenge in the country from a larger perspective.

Asheesh Gupta started by revisiting what the panelists at the event had said previously, "I will just echo what people before me said: this initiative from TOI is really something which was, I think, waiting to happen, and it brings together ideas and thoughts from different perspectives. It is a very hard act to follow when you have some of the doctors up on the stage. I am a learner; I still consider myself a student, so I am going to use some cheat sheets to talk about the points which were raised. I do not think I need to underscore the importance of seniors as a segment. I think the growing population of older adults above 60, changing family structures, and migration, etc."

"There are enough reasons for us to appreciate why it is becoming very important. There are advances in health care, and if you were to listen to Dr. Mishra, this is only going to go up. Economic and technological developments enhance longevity. All of these make this what I feel is the challenge of this initiative. As we talk about global warming, I think in the same way we should think about what aging is going to do to the world and more closer to home, to our country. In our country, offering a safe, comfortable, and dignified life and care to seniors becomes even more challenging because of three major constraints. There is a very high plus deficit, and this we see and live every day of our lives," he added.

Gupta continued on the elderly care gap considering the geographical factors, "There is poor care talent, which was already talked about, with no formal profession for providing care in our country. So, nobody wants to get into care, and it's left to oftentimes family and, more importantly, women to take care of it, with very limited resources. We don't have the ability or resources like those in Scandinavia and some developed countries. If you couple that with the need to get more women into the workforce and a changing dependency ratio which will start declining from 2040, we have the perfect storm. So in this context, we can ill afford to sit and wait for this time bomb to explode or even waste what are already scarce resources on initiatives that are not optimal. When you have less, you have to make it work harder; you have to make it go further."

"And in a situation like this, for all of us stakeholders, we need to be extremely deliberate and razor-sharp on how we tackle this challenge, as well as actively address the opportunities that arise from this dramatic change, and that's where I'm going to address some of the things. For the last eight years, we had some of them focused on this mission. We say we are going to work towards changing the way people age in India, and we are trying to do this with a lot of research and consumer-backed insights. One of our biggest research shows, surprise surprise, that there's a big difference between the needs and desires of seniors and what others think they are. A lot of effort, therefore, goes towards addressing what organizations, policymakers, and governments feel are the problems and not necessarily what are the real problems. Therefore, our core thesis in this 123 manifesto is that designing services and products around the needs and desires of seniors will ensure the desired outcomes in terms of improving the quality of life for all segments in these cases," he added.

Explaining the real need of elderly care, Gupta said, "So really, it's very simple. It's saying, look, understand what the real needs and desires are, and let's make sure that we work towards that. And I'm going to take some time to present some research and some data around there. The 123 manifesto is really a simplified articulation of our thesis, which has informed our approach at Samarth and has validity for all stakeholders in this ecosystem, whether it is children who want to extend care to their interests, companies who want to take advantage of the opportunities that this segment presents, employers who want their employees to be caregivers as well as productive employees at the same time, and the government and institutions who aim to shape policy for this sector. So it is really about the needs and desires that affect seniors, their behavior, choices, and sense of energy, and this is what we call their one wish, two concerns, and three joys."

"That's the 123 manifesto, and ladies and gentlemen, when we provision care, when we build products and services for seniors, when we create policies and invest sometimes national resources, or even when we support our own parents and elderly, keeping these at the center of our actions can ensure that our initiatives are well-directed and impactful. When we started Samarth, we conducted major research with elderly in India, children in India and overseas who had parents to more sharply understand the problem we were trying to solve, and so we asked a simple question. We said, look, what is the big worry, what is the big challenge with healthcare? So children, people like us who had elderly parents who were working in this area, talked about a bunch of things. They said, look, they should be secure. If somebody can handle emergencies, if somebody can take care of health problems or take them to the hospital when it is needed, keep them safe, keep them secure, everything focused around their physical needs."

Answering what elderly needs really are, Gupta said, "When we asked the elderly the same question, the answers were very different. Their big desires and needs were around social and emotional needs. As we researched and learned more, these boiled down to really three things: people to talk to—this is intuitive, we all know that there's a need to talk to people, there's a sense of isolation sometimes—places to go to—we hadn't realized how important that was for the elderly, they need to continue to have mobility and go to places—and third, and perhaps the most important one, was the desire to continue to be needed. Like you can be related to have a purpose, and we talk about these as the three joys: people to talk to, places to go to, and to be needed or to have a purpose. An intrinsic joy, we found, is crucial for seniors' emotional and well-being, and this, therefore, formed the first leg of our framework, which is what we call the three joys."

"The second leg is about two worries. These come up in research after research, poll after poll, which we do in our community effectively on a three-month basis. The first is something we all get, we all understand. It's about health. Please note that increased longevity does not translate into healthy aging. But there's another very interesting counter-intuitive insight worth noting: the presence of a chronic condition does not necessarily lead to a poor perception of health."

"I may have a disease; I still don't feel that I'm in bad health. In a global survey—and this is not only in India—more than 40% of all respondents who reported having a chronic disease still perceived their health as good or very good, which clearly shows us that there is something more than just healthcare. In India, interestingly, the perception of health profile over old age is, in fact, better than the world average, which means that in India, even with disease, people feel that they are in a better state of well-being or health. And this underscores the importance of context over the generally considered metrics of wellness or health being one of them. By the way, this global survey is not a small survey. It had 19,000 respondents across the country. It was done by McKinsey in 2022, and they worry about health. They worry whether they can take care of themselves, that they stay physically and mentally capable. They also worry about unexpected expenses that can arise from health events. Their second worry is financial. Like the majority of the elderly, they feel financially insecure, and it manifests in many ways."

"It manifests in the worry that the resources can take care of them for the rest of their lives. It manifests itself in the worry about unexpected expenses, the quite strong aversion to spending on themselves, which is even more pronounced in India, and sometimes if they have a lot, it is the worry of passing it on to their children. We have found this to be quite universally applicable. It is not one region versus the other or one economic state versus the other. It is very universal. And another somewhat counter-intuitive insight related to that: financial independence rates higher in the overall driver of independence for the elderly, even higher than the decline in health or decline in mobility. This means people are somewhat okay with a decline in health and decline in mobility, but the thing they worry most about is financial independence. This makes up the second leg of the framework, which is what we call the two worries," quipped Gupta.

"So three joys, two worries. The third part of the senior cycle, which affects how we provision care and think about their well-being, is what we recognize now as their one wish or one need, and that is to stay and be independent. And this so dominates their world that we have found that most seniors who have the means will prefer to deal with the challenges and inconveniences of staying alone rather than moving either with their children or into institutional settings. It is the sense of control they feel over the environment they like. And once again, it's not difficult to imagine. Dignity and independence are two sides of the same coin. When people feel independent, they feel that their dignity is protected. The sense of agency is one of the highest priorities for seniors, and data time and again shows this."

"There was a quote that Dr. Mishra had put up in his presentation right at the beginning, where somebody was saying, 'Look, the one thing that I want to do is to stay independent.' So this really completes our—the three legs of our framework, which is the one wish, the two worries, and the three joys. There are two more aspects to this manifesto: the enablers, this trust, which I think already has been spoken about. The importance of trust for this segment is disproportionate. The second is tech and touch. In the previous session, there was a discussion about where tech would come and where tech should come. I think it's very important to understand, and we've kind of probably learned it over the years, that to serve the elderly in any form requires a combination of tech and touch. You can't do it without touch, but you can only scale with tech, and I think intelligently mixing and combining the two is what is required."

Coming to the conclusive part, Gupta said, "Finally, we need to look at ecosystem solutions, integrating disparate point solutions. Dealing with uncertainties which arise at the intersections of these point solutions is not what we have seen seniors enjoy. You could even say that they don't want to play the role of integrator anymore. They've done a lot of that in their younger years. Ecosystem solutions require collaboration. They require people and organizations to work together, leverage each other's strengths, create comprehensive propositions, and take responsibility for trust. In any solution, if there's trust in one part and not in the whole, then it takes away the whole thing, and this is something we've seen with the elderly time and again."

"And I give this example. If you have to go, do you not take a taxi somewhere? If you and I have to take a cab, we'll say, 'Okay, which one is less likely to cancel: an Ola or an Uber?' and we will call that. Many times, the seniors will take the third call. They'll say, 'Look, neither Ola nor Uber. They are not trustworthy. Let me not go at all.' Time and again, you see seniors taking the third choice, and what it means is that their quality of life reduces, their activities begin to constrict bit by bit, and that's the big challenge to enhancing well-being and quality of life. This manifesto is really at the heart of what we do, which we've taken to the elderly across the country, the Indian diaspora, corporations, etc. around the world, and I think it's equally applicable to stakeholders around. There are implications for individuals as they provision care for their elderly, for their parents. There are implications for employers who need to think of and understand the value that provisioning care for their employees creates for their organizations."

"A lot of progressive organizations we work with have understood that, but there's a lot of scope here in the industry. There is a huge opportunity to serve this very underserved segment. As we think about creating products and services, we need to build them around these desires and needs. We learned it the hard way. We went in trying to do what we thought was right, and very quickly we learned that this is not what the elderly need. For the policymakers, there is an important implication. This is a very different segment in one sense. This is a segment different from a lot of others where we need both welfare-based mechanisms and market-based mechanisms."

He concluded by saying, "There are some needs which are going to be based on welfare-based mechanisms, and for some things, you need market-based mechanisms. Policymakers, particularly the government, need to think about that and delineate those areas. Wherever there's a need for welfare-based solutions, the government will need to step in. We will need public-private partnerships; we will need CSR. Equally, there are opportunities for market-based interventions and market-based propositions where policymakers and government need to just enable that to happen. This has been a bit of our thesis. It has, touch wood, worked for us a little bit, and I think it simplifies as we think about serving this market and serving the elderly in these ways."

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