|Amal Kumar Dasgupta, 94, and wife Indrani, 83, get their blood pressure checked at their Golf Green home. Their daughter, a Lake Gardens resident, engaged
Tribeca Care for the Dasguptas in consultation with their US-based son. Two ayahs come to look after the elderly couple in shifts. Picture by Sanjoy Chattopadhyaya
The Chatterjees of Jodhpur Park live on their own. The husband, a diabetic in his 70s, is recovering from a hip surgery. He has a nurse coming in every day to monitor his parameters and medicine intake, while a physiotherapist makes him do the mandatory exercises. A doctor drops by when the nurse flags for attention. His son, living away in the UK, does not have to depend on his weekly calls back home to find out how his father is doing. An emailed report reaches him every Saturday, with details of his medical status. It is not his mother who sends the mail but a homecare agency which he has engaged for his parents’ care. He can rest easy that they will take steps in case of a medical emergency as well.
With children flying the nest in search of career opportunities, the elderly in Calcutta are living alone at home in greater numbers. And to look after them, private agencies are coming up with far better management and accountability than the local nurse-ayah centres.
According to market analyst Frost & Sullivan, the Indian healthcare industry was valued at $79 billion in 2012 and is expected to reach $160 billion by 2017. The largest slice of the pie comprises healthcare delivery services.
“India has a 144 million geriatric population, second only to China. Fifty-one per cent of this number die of chronic diseases like cancer, diabetes and cardiac ailments. Because of advanced diagnostics, diseases are getting detected early and people are living longer. So there is a long period over which disease management is required,” said Ganesh Krishnan, co-founder and chairman of Portea Home Medical Care Services. In his estimate, the home healthcare market is worth about $2-4 billion and in the next 10 years the size of the industry would grow to over $15 billion in India.
The IIM Calcutta graduate, based in Bangalore, who calls himself a “serial entrepreneur”, detected this demand after selling off his last online venture, Tutorvista, in 2013 for $213million in what he says is the largest ever exit in the education sector in India.
Portea is already present in 18 cities, including Calcutta. “Seventy per cent hospital visits can be treated at home,” he said.
An NRI trio of Elina Dutta, Prateep Sen and Tamojit Dutta, along with a couple of friends, started Tribeca Care, a healthcare-at-home platform. They launched the facility in Calcutta last year with Prateep relocating to the city from the US. “We want to make it viable here before expanding to other cities,” said Elina, a former advertising professional who shuttles between Dubai and Calcutta.
Mission Arogya, an NGO which has set up the Kolkata Medical Emergency System website (www.kmes.in) with a Rockefeller Foundation centennial grant it won last year providing people with real-time data on ICCU bed availability in hospitals, is also venturing into this sector with Arogya Homecare Services, which will see a formal launch on August 1.
“We have started providing continuity of care for patients returning from hospitals. This way, patients need not overstay at hospitals, thereby raising their bills. Hospitals too can admit new patients if beds get vacated sooner,” said Mission Arogya co-founder Rajib Sengupta. Their second service in the pipeline is emergency retrieval. “We are tying up with institutions with advanced life support ambulances, which have ICU monitor and resuscitation kits, other than the usual oxygen and stretcher. We are training paramedical staff so that they can rush with an ambulance if a situation arises.”
Nurse with GPS-enabled device
And Calcuttans are ready to pay for such a service. “When we wanted to come here, everyone warned us that Calcutta is price-sensitive and price realisation would be lower. If you look at e-commerce figures for instance, the city lags behind even Chandigarh and Pune. But we have got the biggest response from here,” said Krishnan of Portea.
“It proves Calcuttans are ready to spend for what they perceive is important. Since it is usually the children who engage such services on behalf of parents, it shows family values and attachment are higher here than in other metros,” he added.
Perhaps the number of children having left home in search of jobs too.
What is novel about these companies is the professional approach they bring to a traditionally unorganised sector. “For every patient getting discharged from hospitals to our care, we appoint a care transition manager. He is responsible for setting up the infrastructure at the patient’s home — the bed, devices, oxygen cylinder… whatever his needs be,” said Tamojit Dutta.
Tribeca has divided the city into sectors and created a panel of 15 general physicians. “These days it is tough to make doctors come on call. Our empanelled doctors will do home visits for emergencies in their area,” Elina said.
Each of Portea’s health workers carries a GPS-enabled smartphone. “Thus we know how far he is from the patient’s home. We have developed an app by which the readings get recorded in our centralised database. If a patient’s blood sugar level, for example, is found to be high, the system issues an alert and the doctor in our headquarters has a discussion with the on-site health worker about remedial measures. The patient’s son sitting in the US gets to know that his mother’s sugar has been checked and the findings are sent via email and SMS,” said the Portea chairman.
Mission Arogya, which has a no-profit no-loss revenue model, wants to ensure that the service stays within the reach of the middle class as well. “Ours is a pay-for service model, not a subscription-based one. If a client wants us to scale up in any way, like use webcam and video conference to provide regular health updates to near and dear ones, we will do so,” says Sengupta, a Jadavpur University software engineer who is also pursuing research in bio-medical informatics at the University of Nebraska, Omaha.
Hospitals are largely welcoming of the development. “All these years we had no such service in Calcutta. People are at last thinking about it. With the number of patients with chronic illnesses on the rise, this is the answer,” said Arindam Kar, director, critical care, Medica Superspeciality Hospital, who has voluntarily trained a team of advanced nurse practitioners of the hospital to look after released patients at home for over two years now.
“This is a pay-for service and the patients are taken to the hospital if needed,” Kar added.
Each nurse is in charge of about five-six patients and is the one-point contact for all their medical needs. They instruct the ayahs engaged by the patients on duties like changing of oxygen cylinders, taking a call on whether a doctor needs to be called and facilitating appointments and blood sample collections.
Explaining why domiciliary disease management is beneficial to hospitals, he says the average realisation per occupied bed is far less for patients with chronic illness like Parkinson’s disease or bed sore than for those with acute illness requiring operation or investigations.
“After two days of stay in a hospital, if a patient with urinary tract infection is prescribed an antibiotic which has to be infused over an hour, he would find it taxing to stay back just for that. In such a case, it would suit both him and the hospital to have him treated at home,” Kar said.
Quality of caregivers
One problem area seems to be the lack of quality and accountability of the primary caregivers. At Tribeca, the senior-most nurses are direct employees of the company but the rest are sourced from nurse-ayah centres. “In the first batch of ayahs that we trained, a lot either left soon after or did not deliver,” Tamojit recalled. Tribeca Care tried out about 40-45 agencies from which the number of supply points has now been filtered down to 15. “We can’t handle a 300-strong ayah workforce. We’d rather have 30 nurses in our employ and work with agencies that we trust.”
But Portea does not believe in outsourcing. “We give the health workers a three-month training at a centralised location spending a lot of money. We can’t control quality unless they are our own people,” Krishnan said. The company has a 700-strong workforce across the country.
This lack of accountability has kept Mission Arogya from including ayahs in its portfolio of services. “Our nurse will teach the ayah engaged by patients how to take care of them, like changing the catheter,” said Sengupta.
Elderly patients are asking for more. Mission Arogya will soon start delivering laboratory services and medicines to the doorstep. They will also take orders for medical equipment like medical mattress, Nimbus bed, bipap ventilation and insulin.
“We are trying to do dialysis at home but that will depend on logistics and location of the client,” said Sengupta. Portea also offers equipment on hire and pharmacy deliveries.
Tribeca Care is even devising a package that will include services of lawyers and accountants. “For the elderly, tax returns to groceries, everything is a problem. They are requesting for these services. We help with technology, too, like setting up Skype for clients to talk to relatives abroad,” Elina said.
“We even dabbled in property management as some clients needed help in disposing of property. We are also thinking of starting packaged tours for the elderly who are fit to travel,” said Prateep.
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