Taking utmost home care of elders

Neha Sinha had not planned to become an entrepreneur. She had trained to be a clinical psychologist and had worked for a few years with a non-profit Sanjivini Society for Mental Health before she joined Gurugram-based Epoch ElderCare, then a home-care and companionship provider, as an elder care specialist, early 2012.

Soon she was heading operations at the organisation, drawing up care plans for the elderly people who had signed up with the organisation. Care plans involved taking the seniors for doctor visits and social outings, including shopping and movies as well as providing intellectual companionship.

Over the next year or two, Epoch ElderCare, originally founded by Kabir Chadha, a Delhi boy who had returned home after studying economics at Stanford and doing a stint at McKinsey, decided the model needed to change. Although the organisation has some 300 seniors signed up with them across the National Capital Region, Mumbai and Pune, many were also dropping out. About 40 per cent of the elderly clients had dementia and they needed full-time care.

That’s when Kabir and team at Epoch realised that their model of providing home-based care and companionship will not work for seniors with dementia. Such elders required full-time supervision and care that could be provided only in a home with trained nurses and care givers. Finances were not a problem — Epoch had raised angel investments in 2013. But investors needed to be convinced about a change in the model from companionship service to assisted living services.

Now, Kabir was not confident that he had the skill sets required to run homes that provided assisted living services.

The entrepreneurial journey

“Kabir is a business guy, he was conscious of the fact that assisted living required someone with domain expertise and somebody with more day-to-day operations knowledge. He decided to step down as the CEO and go back to the US but he remains on the board as an adviser. My entrepreneurial journey started with assisted living,” said Neha, who is now a co-founder and CEO of Epoch ElderCare. She had to not just learn the ropes of running a business but also figure out a template for assisted living homes. There were no templates in India to replicate.

The first home was set up in 2014 in Gurugram with 13 rooms for elderly residents. “It was hugely loss-making in the initial years. But we have learnt to make it a sustainable model.” Success depended on the quality of care that was provided and that depended in the quality of talent at the home. Good talent cost a lot of money. “Thankfully, the model worked and we are set to break-even this year,” she adds.

Learning from Hong Kong

But getting there took a lot of effort. To begin with, Neha decided to travel to Hong Kong to understand how assisted living homes are run. She spent a fortnight at one such home, doing day shifts and night shifts and understanding the job description of everyone from a nurse to a laundry person, learning how food should be served to a dementia patient and what cutlery had to be used. That learning had to be implemented at Epoch.

“The first year of setting up the home was an interesting phase. We set our own rules as there were no industry benchmarks.”

Though quite expensive, there were many takers for assisted living services. But there were new challenges to deal with – death of residents from their illnesses. While the passing away of a resident is emotionally upsetting for the caregivers, Neha and the team at Epoch realised that they also need a change in their approach to looking after those who were in the terminal stages of their life. The question is always: should the person continue to be given full medical treatment or palliative care? “The advice given to families on such decisions has to be objective assessment. It required understanding some of the ethical principles that must be the basis for stopping medical treatment and switching to palliative care.”

After attending an eight-week course in Stockholm and visiting several palliative care homes in Sweden, Neha decided that when needed, she would advise families on switching to palliative care. “ The Scandinavian healthcare system thinks differently. It is person- centric and policies are about quality of life and what the person needs.”

Epoch now has three assisted living homes — two in Gurugram and one in Pune. The second home in Gurugram opened last October and it is filling up. The investors are happy with the model Epoch has chosen and see it as a model that can be scaled up. Another round of funding is planned for this year.

On the agenda are plans to set up larger homes – ones that can take in 30-50 residents against the maximum of 14 currently. While the locations are still being finalised, it would definitely be in Tier-I cities initially. Tier-II cities would be considered next year. A few years from now, Neha would also like to start a more affordable line of care homes. “The demand is huge but the supply is short.” And, it would be as Indians are living longer now thanks to advances in medicine.

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