By Arunima Rajan

Rising elderly population, increasing urbanisation, and evolving family structures have made specialised eldercare startups essential for India’s ageing demographic.

*Sonal Singh, 65, spent her childhood in a small village in Uttar Pradesh. Growing up in a close-knit community, she witnessed firsthand the traditional ways in which families cared for their elderly. However, as she moved to New Delhi in her later years, she found it increasingly challenging to manage her health and daily activities without family nearby.

"The support system is completely different for those living in the city," she says. Nevertheless, "the emergence of elder care startups has been a blessing," she adds.

Elderly individuals across India, like Singh, are turning to these innovative startups for the support they need. These startups offer a range of services, from personalised medical care to social engagement programmes catering to the unique needs of seniors.

According to the Report of the Technical Group on Population Projections for India and States 2011-2036, India's elderly population reached nearly 138 million in 2021, comprising 67 million males and 71 million females. The elderly population has increased by approximately 34 million since the 2011 census.

As India's elderly population continues to rise, projected to increase by another 56 million by 2031, the demand for comprehensive elder care solutions is more pressing than ever. These startups are leveraging technology and innovative approaches to enhance the quality of life for seniors, ensuring they receive the care and attention they deserve in a rapidly changing socio-economic landscape.

The India Senior Living Market size is estimated at USD 11.16 billion in 2024 and is expected to reach USD 17.99 billion by 2029, growing at a CAGR of 10% during the forecast period (2024-2029). A report from the Financial Express indicates that data from Tracxn reveals a significant increase in funding for Indian elder care companies, which reached $23.8 million in 2023. The increase is notable compared to $13.4 million in the previous year and just $1.5 million the year before.

Factors Driving the Rise of Startups

The Longitudinal Ageing Study of India (LASI) 2021, conducted by the Ministry of Health & Family Welfare, sheds light on the conditions faced by India's ageing population. The report reveals that 75% of elderly individuals suffer from one or more chronic diseases. Furthermore, 24% have at least one limitation in Activities of Daily Living (ADL), and 48% need help with Instrumental Activities of Daily Living (IADL). Depressive symptoms are reported by one in three seniors, with 32% expressing low life satisfaction.

Regarding social protection, the report notes that only 18% of older adults have health insurance, while 28% are aware of concessions available for senior citizens. Additionally, 24% encounter challenges in providing the necessary documents to access services. The study also highlights that 70% of older people depend on others for daily needs, and 78% live without pension coverage.

Case Study I

These findings underscore the significant gap in elder care services in India, which led to the establishment of Athulya Senior Care. Recognising the urgent need for specialised senior care, Athulya began its journey with a single home care client in 2016. Since then, it has expanded to over 1000 senior-friendly rooms across nine facilities in five South Indian cities, serving more than 25,000 seniors. This growth reflects the broader industry trend of increasing demand for comprehensive and specialised elder care services.

According to Srinivasan G, CEO of the startup, the growth of eldercare startups in India is driven by a rapidly ageing population, increased life expectancy, and the rise of nuclear families where children often cannot provide the required care. Higher disposable incomes and changing societal attitudes towards professional eldercare are significant contributing factors.

Negative Stigma

One major challenge faced by eldercare startups is raising awareness and changing perceptions of eldercare, as many people associate these facilities with a negative stigma. Another significant challenge is recruiting skilled staff, which is addressed by establishing training programs to ensure a steady supply of qualified caregivers.

Technology also plays a crucial role in operations, with startups developing software to manage services, from patient care to facility management, efficiently. The innovations include emergency call systems, 24/7 security, on-call medical assistance, electronic health records, and advanced real-time monitoring systems to track residents' health.

More Support Needed

While these technological advancements have significantly enhanced his company's service delivery, Srinivasan notes that government policies and initiatives provide some support to the eldercare sector through schemes and subsidies, but more is needed. Comprehensive policies offering financial incentives, tax benefits, and subsidies for eldercare facilities could significantly boost the sector. Additionally, government-backed awareness campaigns could help change societal perceptions and encourage more families to consider professional eldercare services.

Increased investor interest simultaneously helps Athulya secure funding to expand its facilities and improve services. Srinivasan advises new startups seeking funding to have a transparent business model and demonstrate the growing demand and scalability of their services. Networking and participating in startup programs can provide valuable exposure and opportunities to connect with potential investors.

Senior care ventures are also focusing on personalised care, community engagement, and continuous improvement based on feedback to enhance their services.

"Emerging trends in India's eldercare industry show a growing demand for specialised services like memory care, rehabilitation, palliative care, and tech-integrated solutions. Athulya is expanding its facilities and using proprietary software for efficient management while engaging with the community through recreational activities and local partnerships. In the next two years, we plan to add 2000 to 2500 rooms in South India, focusing on transition, palliative, and memory care and improving our technological infrastructure. Innovation and ensuring the well-being of seniors remain our top priorities," says Srinivasan G.

Case Study II

Santhosh Abraham, CEO and co-founder, ElderAid.in

Santhosh Abraham, CEO and co-founder of ElderAid.in, shares that ElderAid was inspired by his and Vandana Nadig Nair's personal experiences. They struggled to balance their careers while caring for their parents, highlighting the need for quality eldercare services. ElderAid aims to address the loneliness, health issues, and logistical challenges seniors face through personalised care plans and a dedicated Care Manager, or 'proxy child,' who serves as the single point of contact for all senior care needs.

ElderAid offers a comprehensive range of services tailored to the diverse needs of senior citizens. These include the Care Manager Service, Care Friend Service, and arranging Caretakers and Registered Nurses. Care Managers develop personalised care plans, coordinate medical visits and treatments, run errands, and serve as the 'proxy child,' acting as the single point of contact for families. Care Friends provide emotional support and engage seniors in enjoyable activities, acting as the 'proxy grandchild.' Caretakers assist with daily tasks such as bathing, hygiene, feeding, and mobility, addressing all aspects of a senior's life. Additionally, nursing staff are available for medical needs like IV drips, cannulas, and feeding tube management.

Abraham explains that India's demand for eldercare services has significantly evolved, especially post-COVID-19. The pandemic highlighted seniors' vulnerabilities, revealing that many struggled with daily tasks and essential activities like doctor visits and grocery shopping. This experience increased awareness of the need for holistic eldercare, leading to greater demand for services that ensure seniors' health, safety, and well-being.

Santhosh Abraham shares, "I've supported many seniors, including the parents of a client named Renuka, who lives in the US. I accompanied her father to Chennai for his visa interview and cared for them during multiple surgeries, allowing their children to stay in the US."

Challenges

Abraham explains that scaling their operations has brought challenges, such as managing logistics and ensuring consistent training across locations. They addressed these by implementing standardised protocols, investing in technology, and fostering a culture of empathy and excellence. Abraham notes that they recruit Care Managers through references to ensure maximum safety, although this approach makes finding suitable candidates more difficult.

"We have partnered with staffing agencies who are well aware of our varying needs to ensure we provide the best possible caregivers. We follow a stringent selection process to find the best fit for the client, the elder or the family member to interact with the caregiver before the placement is done. Our Care Managers constantly communicate with the family and the caretaker to ensure seamless service. We also welcome feedback from families who can share their experiences, helping us continuously improve our services and promptly address any concerns. We use various digital tools to monitor our seniors' health and communicate with seniors and their families. The website is informative and easy to navigate; seniors and their families can learn more about us and contact us. We also have a customised CRM to monitor the visits of Care Managers so that we can get timely updates and proper documentation," explains Abraham.

Sukino Healthcare Solutions

Currently, hospitals and unorganised players dominate the eldercare market. Approximately 36% of the market is concentrated in the top 10 cities, and this strong growth is expected to continue in these areas. "The rapid growth presents a significant opportunity for organised players like Sukino. The current state of the market resembles the diagnostic market's growth over the past decade. Sukino plans to invest in growth capital to expand capacities and meet the increasing demand. The goal is to support over 25,000 unique patients annually across our continuum care centres and in-home care services. Alongside geographical expansion, Sukino aims to introduce new care services in oncology, elective surgeries, and digital therapies to cater to a broader range of patients. In terms of vertical expansion, we intend to add more services, such as recuperative care, rehabilitative care, and specialised physiotherapy. We also plan to offer onco-care and high-density care units. Additionally, we will introduce related devices to accurately predict health issues and provide skilled manpower to assist patients in overcoming them during therapy. For instance, we are implementing hydrotherapy at some centres due to its significant benefits," says Rajinish Menon, CEO and founder of Sukino Healthcare Solutions.

"Technological advancements like Big Data, remote monitoring, and advanced rehabilitation using robotics are crucial in the elder care segment. Big Data's success lies in improving patient outcomes and enabling clinicians, therapists, nurses, and caregivers to be more efficient and accurate in their diagnoses, treatments, and daily care routines. Data collection can enhance clinical outcomes, leading to further innovations and creating a new cycle of care. Additional measures include using virtual reality in rehabilitation, remote health monitoring and consultation, and telemedicine," adds Menon.

He also mentions that Sukino, as a comprehensive care provider, addresses all aspects of the continuum of care for individuals aged six to sixty. Their holistic approach covers minor issues to serious conditions like neurological disorders, cancer, and cases with high comorbidities. Their therapy services include AI-integrated devices, representing a new approach to using AI in physiotherapy. Sukino ensures that patients receive all necessary medical aid during their recuperation or rehabilitation without needing to go elsewhere. "Sukino's services cost one-third of what patients would pay in a hospital setting. Our transparent pricing has made us a preferred choice for many. However, the eldercare market, Sukino's focus area, is becoming increasingly competitive with many new entrants, and customer needs are continuously evolving," he explains.

The High Cost and Inconsistency of Eldercare Services

However, only some are satisfied with this model. *Soumya, who used multiple eldercare startups for her terminally ill father, points out that many of these startups are extremely expensive and lack consistent service. Consequently, she turned to a local agency, where the cost averaged around 700-750 rupees daily. Soumya ended up paying approximately 90,000 rupees per month for the service.

*Nalini, who is in her 70s, also spends around a lakh per month to care for her bedridden sister, who is in her late 60s. "We have two helpers: a full-time BSc nurse and a caregiver. However, we request the agency to change them every one or two months because their bedside manners often deteriorate over time. Whenever I notice rude behaviour towards my sister, I ask the agency to replace them," she adds.

Ultimately, while eldercare startups are stepping up to address the needs of India's ageing population, the accessibility of these services remains a significant concern due to high costs. “Many Indians find the price of these services, which can reach up to 90,000 INR per month per person, prohibitively expensive. For individuals without children, like myself, planning for such expenses becomes a daunting task. For instance, if the cost for both my wife and me is around 200,000 INR per month currently, considering inflation and increasing service costs, this could skyrocket in the next 30 years. The challenge then becomes not just about providing innovative eldercare solutions but also making them affordable and sustainable for the average Indian. As the sector evolves, it will need to address these financial barriers to truly revolutionize eldercare in India,” says *George, a HR professional.

India’s Booming Eldercare Startups: Growth and Challenges