New India Manifesto – Chapter 2 : Care System Institutionalisation

Introduction

Care system institutionalisation refers to providing housing and personal care for those needing more assistance in their daily lives. Care facilities are part of the care system designed to recreate the good social environment found in homes. Assistance with eating, walking, showering, dressing, using the restroom, or taking medicine are all examples of personal care.

We can hope no older adult will ever need to end up in old age homes, and the emotional, physical and bonding relations a person finds in the family are challenging to be recreated in an outside institution. However, times have changed to the point where many families consider the vulnerable such as older adults, a liability. It is time for the government to step in and provide an alternative solution for the home concept to such vulnerable sections by creating a care system.

Care system institutionalisation aims at national-level government-funded support for vulnerable sections by establishing many care institutions all over India and regularising it by infusing it as part of our culture.

There are different types of care systems worldwide, and India should adopt the best elements from all care systems that can be implemented within our spending limit. Continuing Care Retirement Communities or CCRC is a type of care system encompassing many features, including assisted living to nursing homes, all on one campus.

Seniors Care System

Care of senior citizens at institutional facilities is essential instead of providing the same to each home. Currently, only the upper middle class and wealthy can provide care services in their own home. The cost increases manifold when the government needs to fund each older adult at their own home. The senior’s care system is a futuristic way of ensuring that the lives of the ageing population are safer in a new India. Anyone afraid of who will look after them if they are bedridden in the future can be assured that the state will take care of them. The existence of these care facilities is the most tremendous confidence any government can instil in its citizens.

Why is Institutionalisation Opposed?

Institutionalisation is often associated with issues like loneliness, depression and other social problems. Relocating individuals to a new environment is considered to infringe on their liberty and freedom.

Why is the Futuristic Care System Model for Seniors a Necessity?

It is essential to ensure that the future population of older adults can be accommodated in care facilities and that the funding requirement of such facilities can be met. The nation can reduce outward foreign remittance; the nation can be prepared to assist older people beforehand if such a model is developed now.

Global statistics of the increasing older adult population are alarming, and the inability to create infrastructure beforehand will lead to tremendous problems later. If a country and its citizens are super rich, they can afford to hire non-citizen healthcare professionals. Only a few countries will have that privilege in the future. Countries like India can establish institutionalised infrastructures now for the future elderly population. Instead of criticising the probability of isolation created by institutionalisation, the nation should create a situation as homely at an institutionalised facility. Whenever new issues arise government can correct course in the process. Moreover, movement is not restricted but instead promoted at such a care facility, whereas families are the ones that limit the movement of parents in the name of liability.

One healthcare professional can manage and care for many individuals in an institutionalised facility. Governments and private individuals can save money without compromising the quality of care facilities.

Elderly abuse can be prevented in a monitored environment like an institutionalised facility. However, if healthcare professionals are allotted complete freedom in their actions in a home environment, they may engage in activities that endanger older people.

The role of gossip, social status and trash-talking are all vital parts of taking care of parents. In societies, if parents are sent to older adult care homes, society will look down upon the children as bad people. At the same time, if the same children do not care for their parents in their own homes, others are not much concerned. So, government creating machinery to help the elderly is a necessity. It will change the perspective of people towards such facilities. In the future, people will not see such places with aversion; instead, older people will like such places.

The problem with existing old age homes in India is that they do not incorporate fun and entertainment, as most old age homes struggle to provide three meals. So, we cannot expect such old age homes to offer the older population outing trips and other entertainment activities. However, a futuristic care system model can ensure that leisure activities and fun trips are included as necessary.

Care System Institutionalisation Authority

The care facility will become a separate entity affiliated with National Healthcare System. There will be different authorities under the care system institutionalisation authority for seniors care, hospice care, child care, disabled care and many others.

Each care facility built under institutionalisation will be a standalone facility with a partial self-governing board working under the government’s guidance and following the provided rules and regulations.

The facilities will be associated with hospitals under the national healthcare system to ensure that they receive regular checkups from doctors and deal in case of medical emergencies.

The kitchens that prepare the food for the national food bank of India will be associated with these care homes and deliver food to these facilities. The care homes will also have a kitchen area for making hot beverages, as NFBI kitchens will only deliver three meals.

Benefits of Common Institutionalisation

The health condition frequently deteriorates for older adults, and the rich getting advantage over the poor at home is discriminatory. Poor are suffering and shuttling between hospitals to care for the more ageing population. The welfare of each citizen is the responsibility of the concerned family and the state.

Building new houses under government schemes does not stop older people’s woes as they face health issues and will find it difficult to do various jobs. So, government should promote care homes instead of building homes for older people. However, if older people are ready to work daily, then the government can consider building a house for them.

Sometimes, another member must stay home to look after an ill family member. So that another member cannot go to work due to caring for the bedridden member. Care facilities solve this issue, and many women looking after bedridden can join the workforce.

Exclusions and Conditions for Admitting People

Crossing 60 years and becoming senior citizens does not give them an automatic right to join these facilities for free. These facilities are mainly for people with difficulty in mobility, who are bedridden and need support from others to carry out basic human needs. If healthy individuals above 60 want to join this facility, they must pay and use it. There will always be options for paid independent living option inside the facilities.

Different wings can be created within each facility to serve people with different needs, such as memory care. However, people facing any severe illness, such as the highest stages of Alzheimer’s and Parkinson’s, will be accommodated in care facilities irrespective of age.

Who Will Pay for Institutionalisation?

A. Tax on Religions and Affiliated Activities

All religions and affiliated organisations should be taxed at least 18 per cent of their income as GST. The amount should be directly used for the healthcare sector, including the ageing population.

B. Paid by Themselves

People who are healthy and are willing to move to institutional facilities based on personal interests can pay by themselves, and is a source of income for the facility.

Older adults can test the facility by staying for two months and must move in permanently only if interested. After that, they can sell off their property and assets and move there. In case of inability to find a buyer, government will purchase it under National Housing System or sell it via an online auction system. They will pay for longer terms, such as 15 years, and the years of stay after 15 years till death will be free with the same facility. If they die before 15 years, the remaining amount will not be returned to the family members and will be used by the care system.

They can keep the remaining amount from the property sale. However, if any employees or residents of the facility or relatives of a person try to trick older people into giving away their money, it will be seriously dealt with. They can give the remaining amount to their children or immediate family members, or they can keep it. A law will be made to ensure negative external influences in financial transactions are thoroughly investigated.

C. Private Sale

Corporates and rich people can purchase a facility and replace that particular facility’s board. It should be charity-based and not money based. In case established rules and regulations are breached, they should hand back. No existing facilities and features of residents can be reduced even after purchase.

The income from the sale can be used to build another facility. The meals can be provided from food bank kitchens for free or can be paid if that is what the private party wants.

Some rich people like to do charity activities, and purchasing a care system is an opportunity for such rich people to serve the community.

D. Paid by Children

Children should provide good care for their parents at their house, which will be cross-checked by the inspection authorities from the healthcare sector and social workers. If their children breach established rules and regulations in caring for older people, they will be shifted to care homes, and children will be asked to pay for their parents.

If children want their parents to have premium facilities inside care homes, they can pay additionally for that person.

Reverse Claim

Consider the following scenarios.

Some individuals look after their parents only for their ancestral/inheritance property and are not interested in the parent. Their love for their parents ends once the property is sold, and later on, they purchase property in their name and do not want to take care of their parents anymore.
Some people, even if their parents have property, will abuse their parents and force them to take loans on the property or sell the property.
When the father is dead, the children inherit the property after getting the signature from the mother and leave the mother homeless.

These scenarios prove the necessity of care facilities all over India.

Every family will be asked to create a will, including how parents will be cared for when they are old. The government will also make a general law that includes reverse claims. If children possess their parent’s property, they are liable to look after them gracefully or pay for care facility expenses, and failure to pay will result in property confiscation. In case of non-payment for more than one year, the value of the parent’s share of the property will be confiscated.

If children do not have inheritances, then also children should pay for the care facilities. However, confiscation of property will not be applicable, and the amount will be smaller. Actions will be taken against them only if non-payment exceeds five years. The actions include allocating a forced personal loan with the amount required to pay.

In case of proven parental abuse, such children need not pay for their parents. However, the lawsuits filed by children should be before they turn 16. Children deserted by their parents can also be excluded from payment.

Greed for money has resulted in issues like chaining older people to beds or floors, seen in various places in India. The government will transfer such affected parents to care home facilities and claim their share in the property and also share of children in the property in such cases instead of asking for monthly payments. The government will be footing the expenses of such people, and the property shares will be transferred from their children to the government. If parents have no property, children will be asked to immediately remit large amounts or forfeit their property. This applies only to bedridden parents who are chained or cruelly beaten up by children, and there is sufficient evidence.

If parents are brought to a care facility after regular elderly abuse at home, then all the children of that parent need to pay a fixed amount and not just the son or daughter involved. This is because other children have failed to prevent it from happening, and they are equally responsible for the plight of their parents. It means that if there are three children, all three will pay. However, if they are unwilling to pay, other children must also forfeit the received ancestral/inheritance properties.

Children who cannot pay for their parents due to their financial condition need to register for jobs under the national employment system, and a percentage of their salary will be cut regularly.

E. Donations to Each Facility

The government will regularly request public and wealthy individuals to contribute a sum of their income as donations to these care facilities.

F. Temporary Respite Care Services

Short-term and time-limited breaks are required for caregivers in families. Therefore, care systems will be equipped to accommodate such temporary residents for a shorter duration, and care facilities will get paid for their services.

G. Continuing Care Retirement Community

By developing the CCRC campus, the government can sell independent houses or flats to older adults at a profit margin and use that money to fund care facilities.

Together Institutionalisation

A. Mutually Beneficial Caring

A son/daughter looking after a bedridden mother/father can join a facility if they want. Son/daughter will also be paid for working in such facilities and trained to do various works professionally. They will also be taking care of other people if they want to opt to stay inside the facility. In addition, basic nurse training will be provided to them. The salary will be provided after reducing the institutionalisation charges of their sick parent.

B. Joint Partner Accommodation Facility

If both partners want to live together inside the care home, there will be a facility to do so.
If older people find companions at an older age, such facilities will also support their marriage and provide joint partner accommodation facility.

Employment

Senior’s institutionalisation will provide direct and indirect jobs to 1 crore Indians. Students can be given part-time jobs to organise entertainment activities inside care facilities and spend time with older adults. 1 lakh students can be provided part-time jobs annually in such a manner.

Voluntary caregivers can be recruited from the public who will do social services for free. They will receive a certificate for recognition of their voluntary services if requested by them.

Reversal Payment System

In most cases in existing and previous generations in India, parents fund children’s education in schools and colleges. We should establish a system in which education is free for students till class 12. Students can support college education by doing part-time jobs, and the new parents will only have a little expense in terms of education compared to earlier generations. So, it is correct to ask new parents to pay for their older parents, as old parents were the ones who funded new parents’ education and looked after them in the past.

Other Care Systems

Similar to the senior care system, other care systems for traumatised individuals and different sections will be developed.

Special Note: This is the second chapter of the book New India Manifesto by Blessen T. Sam. The concepts introduced in this book are unique, and referencing the book and the author is appreciated. Support the hard work of the author to modernise India by purchasing a print copy of the book from Amazon or Flipkart. For research collaborations, contact the author at blessentsam@gmail.com.