You can get quality elder care but be prepared to pay for it. SOUMYA NAIR

  

Aged care in a care facility is no more cheap. But when you think about it you are paying for somewhere to live, your meals, laundry, electricity and a number of people to look after you around the clock. The good news is that it is actually a lot of comfort and support in the fag end of life when the aged person needs assistance with daily living. Majority starts cribbing about the cost as if they are caught unawares.

Sharon D’Souza never dreamt that elder care can be such a difficult thing. Past two years with her bed ridden mother’s long term care, she learnt a different lesson. Sharon’s mother is bed ridden and needs round the clock care. But when a care home bill tops 45000/- a month, the best-laid plans get tossed aside unless you anticipate. Like others faced with the stunning cost of elderly care, Sharon did the math and realized that her mother could easily outlive her savings, a nightmare haunting her. Experience taught her She had followed the expert advice, planning ahead in case she wound up unable to care for herself one day.

Even with her mother’s savings, 78 year old Mrs. D’Souza, a rheumatoid arthritis patient who is bed ridden past two years still had to top up with around 15000/- every month to cover her care in a care home in Pune. "An awful financial situation," said her daughter, Sharon. For the two-thirds of middle class Indians over 70, who are expected to need some long-term care, the costs are increasingly exorbitant. The cost of staying in a decent care home has climbed at twice the rate of overall inflation over the last five years, according to our experience. One year in a private room now runs a median Rs. 300000/- a year, while annual cost for home-health aides runs Rs. 250000/-.

"If you have any money, you're going to use all of that money," a frustrated Sharon said. "Just watch how fast it goes." Sharon wonders how people manage the widening gap between their savings and the high cost of caring for the elderly? In India insurance doesn't cover long-term stays, so a large swath of elderly people wind up on the personal savings and ‘beg for charity from children’.

"Within the first year most people are tapped out," said Philip Cherian, a practicing chartered accountant and the director of two retirement homes in Bangalore. "Middle-class families, though cash rich, just aren't prepared for these costs." Cherian sums up.

Everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Remember plans that looked solid on paper are no match for their bills. Cherian says plans for care and finance are equally important to prevent unpleasant happenings and inferior care.

Many of the retirement homes in the country just provide accommodation, housekeeping, food and this will be included as basic cost. Linen, laundry, physiotherapy, medical, consumables, TV, internet, grooming, maintenance, etc., are all charged extra and considered as hidden charges. On average, a shared room in a nursing home costs anything between 20k to 40 K without care. A private room, or a studio apartment can still costs higher. All the facilities collect deposits with various modes of deductions. Deposits range anything between 2 lakhs to 60 lakhs, depending upon the facilities and the size of accommodation.

Now comes the variables of the long term care industry. "The amount of care you need dictates the price," said Swetha Banerjee, a geriatric care manager in a care home in Kolkotta, "and there aren't that many ways around it."

Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid a minimum of 15000/- a month in some parts of the country to 35000/- in few metropolitan cities. But hiring them to work around the clock is often the most expensive, Swetha said. "Needing help to get out of bed to use the bathroom in the middle of the night or patients with peg feeding or sleep disturbances means you need at least two attenders round the clock and in that case better to choose a nursing home," she said. She also points out to other costs like physiotherapy, and consumables like diapers, gloves and masks, catheter management, and other paraphernalia associated with long-term care. Last but not at all the least, now a day, as the medicines in old age are costly. Many elders have multiple conditions necessitating the consumption of many costly drugs.  This adds up to the cost.

Sushma Kavale, another Bangalore expert in long-term care has a different take on this so-called ‘awful financial situation’. According to her, for those solidly in the middle class, however, the answer is actually not very complicated, rather a hype. ‘Anticipate cost, and be prepared to spend and expect rising trend to continue’, she asserts.

After a close look at Sharon’s mother’s financial situation, there is no grim picture as the way it made out to be. Taking Sharon’s case study, Sushma wants to dispel the myth of ‘finance crunch’ for a middle class family. They have too much money for all the luxuries  under the sun but not enough to cover the typical few years of care of their ‘beloved’ mother.

When I told Sushma about me writing an article on the financial distress faced by many families, as a veteran in long term care, Sushma too admit that it is no easy affair, unless the old man/women plans well in advance. ‘You can get quality elder care but be prepared to pay for it’. Financial distress is the result of many factors. It can be the actual crunch. But according to her, majority of middle class and above have sufficient means or income but not willing to pay up.

Older adults those are deprived of the qualitative health care at their fag end of life, citing reasons like "too expensive" "poor affordability" "siblings doesn't go dutch" are unlikely and unconvincing excuses. Most elderly parents are made poor during infirmity by draining them off their resources by the children or immediate families. Many elders have some savings, assets or some little fall back from their life long hard work and earnings. In a household when the elderly parent retire from active life, assets and savings are parted among children either by persuasion or parents willingly share. In few cases parents hold some of their assets and savings. In a phase where they are infirm and bedridden no more able to run their finances on their own children chose how much to spend or what kind of quality care to offer, sadly its Price that's preferred over Quality leaving the older parent to inferior care. Considering a middle class elderly parent in India, majority got some assets or meager savings which actually can take care of their rainy days in a most dignified and graceful manner. Yet, they elders get deprived of it because their old age care is not their choice but their children's or someone else's.     

Having money and not spending it may be a problem lots of caregivers wish their families had, but it’s a problem nonetheless. “Money is a very emotionally charged issue,” Ms. Sushma said. “It’s hard for rationality to rule.” “I can’t afford it” provides a good all-purpose excuse.