The Keralan Geriatric Care System’s Shifting Paradigms

The passing of renowned Malayalam director K G George in Kerala sparked a discussion about nursing homes and geriatric care. George passed away at a Kochi nursing home on September 24, which unexpectedly sparked a social media discussion. Salma, George’s wife, was drawn into the unpleasant situation surrounding her husband’s passing in institutional care as if she had abandoned him. Salma had been living in Goa.

Salma and Thara, their daughter, were forced to provide explanations in response to the scrutiny. They emphasized how happy and comfortable George had been when he was receiving institutional care. Salma and Thara both clarified that George took this decision voluntarily. He wanted to pass away in the comfort of institutional care. The versatile director essentially intended to maintain his flexibility even in his private life.

However, this discussion exposed a long-standing social stigma Kerala has about nursing homes and institutional care for the elderly. Institutional care, sometimes known as “old age homes,” is frequently seen as a place where families throw away their elderly loved ones.

The state ranks first in the nation for the percentage of senior persons, making about 16.5% of the total population, according to the 2022 Kerala Economic Review. According to projections, this percentage will reach 20.9 percent in 2031. The old population is expected to expand at an annual rate of 3.28 percent at the national level and 3.96 percent in Kerala.

In recent years, the proportion of old people has been gradually rising throughout the whole nation, and this trend is anticipated to continue in the years to come. According to projections, the percentage of people over 60 will increase from 8% in 2015 to 19% in 2050. According to Census 2011, Kerala has a higher proportion of people aged 60 and above than the national average of 8%, with 12.6% of the total population. Kerala had a dependence ratio of 19.6%, whereas India had one of 14.2%. The most often used measure for tracking changes in the population’s age structure is the Old Age Dependency Ratio (OADR), which is calculated as the proportion of people 65 and older to every 100 people 20 to 64 years old.

The Old Age Dependency Ratio (OADR) is predicted to reach 20,1% nationally by the year 2031, according to the Kerala Economic Review of 2022. The Old Age Dependency Ratio is anticipated to be much higher in the state of Kerala, standing at 34.3% at that time. The Old Age Dependency Ratio in several Indian states likewise exhibits a starkly obvious gender inequality. Particularly, as compared to their male counterparts, states like Kerala, Tamil Nadu, Himachal Pradesh, and Punjab showed a much higher female old-age dependence ratio.

Recent patterns show a notable shift in the state’s viewpoint on geriatric care. There is a pressing need to remove the stigma attached to the phrase “old age homes” in a culture where migration is common.

The word “old age home,” according to George Mathew, a Malayali IT professional living in the United States of America, is the root of the issue. He argues that this term gives the impression that elderly parents are forced to live there against their choice, and that this idea has to be rethought.

George goes on to describe his own circumstance, saying, “My sister and I, both of us living outside Kerala, had the task of taking care of our aging parents. Despite owning a large family home in our hamlet, we looked into institutional care for our parents since no family members were available to look after them. His parents, retired government employees, age 72 and 65, made a deliberate decision to live in a nursing home rather than their own house in their town.

Although K G George’s wife and daughter, Salma and Thara, experienced internet abuse, there was a significant outpouring of sympathy for them. Social media platforms were inundated with personal accounts from those who made the deliberate decision to place their elderly parents in institutions instead of leaving them in homes with inadequate care. Many Malayali expats have voiced their satisfaction at having access to reputable retirement communities inside the State, giving them the choice to commit their parents to institutional care.

It is important to note that those with money often have access to these choices. Data from the government emphasizes that the private sector dominates institutional care in the state. Only 16 old age homes are under the control of the Department of Social Justice, while 623 old age facilities are run by private organizations that have registered with the Orphanage Control Board, a section of the Department of Social Justice. The figures show a constant increase in the population of these homes, indicating a cultural change in favor of institutional care. There were only 19,149 people living in state-run nursing facilities during the fiscal year 2016–17. This number increased to 28,029 by 2018–19, and it reached 30,105 by 202–21.

People who can afford it often choose premium Institutional Care to old age facilities that are run by the government or privately. In Kerala, a growing sector provides lodging in pristine apartment buildings located in both urban and rural settings. Real estate tycoon P K Abraham sees this trend exploding in popularity over the next ten years. These flats may be rented out, enabling occupants to remain for as long as they choose. According to Abraham, the high standard of services provided and easy access to medical facilities are the causes of the soaring demand for these homes.

Old-age pension plans offered by the government are a crucial lifeline for many in Kerala who cannot afford private institutional care. These programs provide Rs 1,600 per month to each of the 28 lakh elderly adults in the State who are covered by them. According to the Department of Social Justice, despite the fact that this program is intended to be a centrally supported project, the State Government provides the majority of the funds, or Rs 1,400, with the Union Government only paying Rs 200 per individual.

An organization devoted to empowering women and ending poverty, Kudumbashree, has started the creation of neighborhood organizations specifically for the elderly, transgender, and physically and mentally challenged. The Kudumbasree Directorate reports that there are already 25,992 geriatric neighborhood organizations operating with 2,83,615 members. These groups work alongside traditional neighborhood groups. 525 micro-enterprises have been developed via these organisations. Additionally, with the assistance of regional authorities and healthcare facilities, the three tire systems of Kudumbasree—the Area Development Societies (ADS) and Community Development Societies (CDS)—conduct medical camps at the ward level and at the Grama Panchayat level, respectively.

Geriatric care will be one of the top needs worldwide in more than a decade, according to the global demographic change documented in the United Nations’ World Population Prospects 2022 study. It is predicted that there will be 8.5 billion old people on the planet by 2030 and 9.7 billion by 2050. This transition, known as “population aging,” which is defined by a population distribution that favors older age groups, has occurred recently all across the globe. Reduced birth rates and longer life expectancies as a consequence of better economic conditions and healthcare infrastructure are generally blamed for this phenomena.