The senior living sector in India is at a crossroad. With the recent relaxation of FDI restrictions on investments in the sector and a population of seniors… there clearly exists an untapped opportunity for investment and development in this sector

Private equity players, especially those with NRI connections, are displaying newfound interest in the ‘senior living’ sector. There is a sudden flurry of activity ever since Jyotiraditya Scindia, India’s minister of state for commerce and industry, announced on 30 November 2011 that the conditionalties on 100% FDI (foreign direct investment) will not apply to FDI in ‘old age homes’ and investment by NRIs, in a written reply to a Rajya Sabha question.

On 7th December, there was a presentation by a US legal firm Dechert LLP, and on 12th came a 32-page research report from property firm Jones Lang LaSalle India (JLLI) titled “Senior Living Sector in India”. The former focused on structuring the business of senior living and its financing options while the latter concentrated on the customer segments, their needs, market demand, formats and typologies and key best practices that promoters of such real-estate projects need to adopt.

Although middle-class senior citizens are not yet a politically heavyweight lobby in India, changes in our demographic profile, noted by the 2011 Census, are forcing the government to recognise the emergent needs. Mr Scindia is reported to have said that “with growing urbanisation, there is an increasing demand for old-age homes to cater to the needs of senior citizens. The physical infrastructure in this area also is short of the requirements. Hence, it has also been decided to exempt old-age homes also from the general conditionalities applicable to the construction development sector.”

As per census projections, increasing longevity has resulted in elders (seniors above the age of 60 years) increasing to about 76 million in 2011. Estimates indicate that as a percentage of the country’s total population, they would jump from 7.4% in 2001 to 12.4% in 2026 and touch 19.7% in 2050; their numbers will grow to 173 million by 2025, further increasing to about 240 million by 2050.

Companies are recognising that seniors (especially urban) are a customer segment whose needs and wants are different from seniors in earlier times. Today, there is a larger percentage of educated seniors than ever before; a significant section is not necessarily dependent on children. A Moneylife survey on retirement planning, quoted in our cover story “Should You Go for Pension Plans” in the issue dated 15 December, 2011, shows that out of 634 senior citizens, only 5% depend on children’s support. They are financially stable, well-travelled, socially connected, and have well developed thoughts about how to live post-retirement. Additionally, urbanisation, nuclear and ‘taller families’ (where two generations or more may be dependent on a single child), have created a huge, as yet unsatiated and unsegmented, demand for senior living residences. Moneylife, in a first, had done a Cover Story “Retirement Havens” for issue dated 15 July 2010. You can read it at http://www.moneylife.in/article/7160.html. The scenario has changed rapidly since then.

Susan Hendrickson, partner at the law firm of Dechert LLP, presented a history of senior living in the US. She said that what started as interventions of religious groups and charities in early- to mid-20th century, to cater to housing and care for seniors has metamorphosed into a business. Many such ventures are now run by for-profit companies while some still operate as not-for-profit. She said that the senior care/senior housing sector is a $260 billion industry in the US, and growing. In 2008, there were 28,000 assisted living facilities caring for more than one million seniors.

Ms Hendrickson described five kinds of senior living models in the US, recounting them as they evolved:
1.    Nursing homes – where people move in, often, not out of choice but because of their healthcare needs.
2.    Adult day-care centres – where people spend the day while their children are at work; these cater for the emotional and socialising needs of seniors.
3.    Assisted living communities (ALCs) – there has been an explosive growth in this segment—they are individual residences with shared common spaces such as dining and recreation areas.
4.    Independent living communities (ILCs ) – these are the ‘resort’ type residential spaces where all the household management facilities and comforts are provided for – these cater for high-end customers and have a high quotient of lifestyle.
5.    Alzheimer’s and dementia care centres – these are for specialised healthcare.

ALCs and ILCs offer all the benefits of being in your own home, without the worry of maintenance, chores and even cooking. They offer lifestyle choices, including senior-friendly floor plans, a variety of meal plans and menus and service options to meet residents’ wellness needs. ILCs have greater possibility of ‘striking roots’ and growing old in the community; so they may have designated areas with possibilities for medical care or greater assisted living – these focus more on community activities and recreation.

Ms Hendrickson also pointed out that government funding is available for only for nursing centres. In the vast majority of ALCs, it is a private pay market with some small research/demonstration projects funded by government payment programmes, including Medicaid and Supplemental Security Income programmes. She said that there have been some experiments, of late, in affordable ALCs where people can pay for these from their social security entitlements.

Seniors’ housing projects are not yet rated like hotels in the US; they go by ‘market perception’; hence, companies spend a lot of effort on branding and marketing. Many companies have also gone for franchisee arrangements—but she explained that the corporate structure of the ventures vary—there are property companies (which she called prop/cos) that own the property, and operating companies (op/cos) that manage them and there would be various services companies that would be contracting their services to the op/cos, like employee leasing companies or even caregiver or nursing companies.

Almost all of senior living projects are on rental model—not ownership—but there have been cases where, if the period of occupancy is brief, a part of the residual value is passed on to successors—and those calculations are based on actuarial calculations. Such facilities are often referred to as ‘Continuing Care Retirement Communities’. She said that efficiencies of scale are maximised often at a facility of about 100 apartments and they are not too far away from residential parts of cities as people are reluctant to move away from familiar surroundings. Sunrise Senior Living is one of the largest branded companies in this space. According to her, they were among the founders of assisted living model and have diversified into specialty segments of the seniors market. Some Sunrise Independent Living communities also offer a home purchase option.

In the US, caregiver agencies are licensed by government agencies with annual reviews; the certification of caregivers, too, is reviewed periodically. But these are not segmented especially for senior citizens—they are specialised more according to the type of service required. The contractual arrangements often include a base rate + a-la-carte menu of services that are paid for on an ‘as needed/as used’ basis.

The JLLI report noted that in India, the negative perceptions and stigma associated with ‘old-age homes’ had prevented the senior living sector from developing, until recently. It stated that “The senior living sector in India is at a crossroad. With the recent relaxation of FDI restrictions on investments in the sector and a population of seniors… there clearly exists an untapped opportunity for investment and development in this sector. Unlike western countries where the senior living industry has gained maturity, India provides an opportunity to developers, service providers, healthcare players and operators to create solutions specific to India while leveraging learning from across the world.”

Urbanisation and employment mobility has changed the way middle- and upper-middle-class Indian families manage the generational relationships. A large segment of seniors today are living alone; many of them are well-to-do and prefer to move to resort-type residences where they can have all the comforts of urban social life without the responsibility of managing household chores. For this segment, the availability of healthcare and assisted living facilities at some future date is important; but the need is for hassle-free, comfortable lifestyle.

As the JLLI report shows, for the 12.8 million households representing senior citizens, demand for formal senior living facilities from across varying income sections stood at 312,000 units.

The report urged real-estate developers to understand and acknowledge the unique needs of the elderly while catering to the sector—these have to be addressed not only through the architectural designs and housing materials used, but also in the provision of services. The report provides a break-up of types of occupants of senior living spaces and then goes on to recommend the facilities they would require.