When Anant Kumarâ€™s mother underwent knee replacement surgery in 2011, he found it extremely difficult to find a home caregiver for her.
In the process, the award-winning founder CEO of a social enterprise maternity hospital chain noticed huge challenges and a lack of professional support for families with seniors who are immobile or have had a recent health episode.
â€śThis puts physical, emotional and sometimes financial pressure on the family, and the senior is not able to get the best of care possible as the family is not equipped with the knowledge to understand some of the progressing conditions (e.g., dementia). In this context, I decided to work on a home nursing and caregiving model for seniors,â€ť Anant says.
In 2013 along with his wife Priya Anant, he founded LifeCircle, a provider of home nursing and caregiving services for seniors.
Indiaâ€™s senior citizen population of 103 million is the second largest in the world and growing rapidly, with half of them suffering from at least one chronic disease and non-medical implications of ageing. However, the Indian medical system caters to seniorsâ€™ episodic health needs in a fragmented manner at high cost.
Going beyond senior citizens
Not just elders, any patient who has undergone recent serious surgery or is bedridden often needs such care too.
V Thiyagarajan faced a similar issue when helping his friend find a nurse for his ailing mother. â€śWhen we had to find someone to take care of my friendâ€™s mother, we found there was a dearth of people skilled in geriatric care. There were not enough professionals available to expend quality healthcare services in the comfort of oneâ€™s own home. Hence I realised it was a business opportunity,â€ť he says.
Thiyagarajan then founded India Home Health Care (IHHC) in 2009 along with his wife with the idea of personalising healthcare and delivering it at the patientsâ€™ doorstep. â€śI wanted to bring nurses, medicines, the required equipment and other medical services under one roof, and disburse it to patients at a nominal charge,â€ť he adds.
At LifeCircle, while care is coordinated by the personâ€™s family, LifeCircle helps the family with it. It creates a patient care plan for the sick senior citizen, which identifies the health and personal care activities that are to be carried out with the patient through a typical working day. This is used as a shared tool between LifeCircle and the patientâ€™s family to guide the caregiverâ€™s performance.
A caregiver is typically at least a class 8 pass, 17 to 25-year-old first time worker from a poor background, who is travelling from another city to work.
â€śA twin objective is to ensure that the caregivers who work with seniors have a dignified job and a clear career path,â€ť LifeCircleâ€™s Priya says.
Anant and Priya of LifeCircle
The caregiver undergoes a four-month training from a Government of India approved institution. Caregivers may be placed in live-in or live-out models, each working out to an 8-hour shift. The caregivers are trained and supported on the job by qualified nurses who conduct home visits on a schedule.
IHHC has placed stringent hiring standards in place, which include credential verification and background checks of all applicants. All nursing professionals are supervised by a senior registered nurse who makes regular home visits to ensure the health and safety of elders.
â€śWe recruit and train our staff for certain roles from a public-private agency called Healthcare Skill Sector Council, which is dedicated to upskilling high school graduates to fulfil gaps in the Indian healthcare system,â€ť Thiyagarajan adds.
IHHC is backed by US-based BAYADA Home Health Care, which is a leading provider of healthcare. It caters to various services such as those needing post-surgical care with short-term and long-term treatment goals, critical care that includes bed sore care, critical care nutrition, fluid management, stoma care, ICU infrastructure, ICU equipment, wound care, enteral feeding, physiotherapy, infusions among others; cancer care, palliative care, which is to help reduce the patientâ€™s symptoms, cardiac care and stroke rehab.
Unlike IHHC, LifeCircleâ€™s focus is on providing care for senior citizens. It gives seniors professional caregiving services, which assists seniors with activities of daily living (ADLs) at home. Then there are nursing services, which provide medical and nursing attendants for seniors, such as measuring blood sugar, wound dressing, injections and insulin administrations at home.
Patients are referred through relatives or partner organisations like hospitals, specialised institutions (dementia care/palliative care) and NGOs.
LifeCircle is currently available in Hyderabad and Delhi, and generates revenue from the services it offers to patients. Additional revenue is also generated through sale of medicines, disposables and diagnostics. It also runs a caregiver training centre in Assam.
Having worked with over 600 caregivers from across the country, LifeCircle has provided over 300,000 hours of care to seniors across the two cities.
For IHHC, which has a presence across Chennai, Bengaluru, Hyderabad, Mumbai, Pune and Trivandrum, 40% of the revenue comes from the critical care services, 30% from the clinical care services and the remaining 30% from the non-clinical and non-critical care services. It has served more than 20,000 customers in clinical care in India.
The home healthcare market
The home healthcare market in India is estimated to be around $5-6 billion and is expected to grow to $10 billion by 2018. Apart from these two startups, another major player in the market is Portea Medical, backed by marquee investors such as Accel Partners, Qualcomm Ventures and World Bankâ€™s IFC. It has just raised $26 million in a Series C round led by new investors Sabre Partners and MEMG CDC. Existing investors have participated in the round as well.
Given the increasing incidence of chronic diseases and rising demand for affordable healthcare delivery systems, there is immense scope for such startups.
According to LifeCircleâ€™s Priya, what sets them apart is their focus on providing seamless continuum of medical and social services to seniors, as opposed to their competitors who provide all kinds of home healthcare services.
Thiyagarajan says that IHHC benefits from the expertise of BAYADA, including industry best practices and standards. Going forward, IHHC wants to consolidate its position in the critical care segment and venture into chronic care management at home segment. The idea is to be a pioneer in the critical care chronic care segments in Asia.
V Thiyagarajan, Managing Director, India Home Health Care
There are over 50 cities in India with a million plus population. For LifeCircle, the goal is to reach 20 of these cities by 2020. In 2015, there were 1.2 million immobile seniors. This is expected to grow 4.5 times by 2025.
â€śWe want to build out the services for non-paying seniors from low income contexts. We want our institution to be a sought after one for caregivers from across the country,â€ť Priya says.