Silver Market Opportunities in Southeast Asia & India · Southeast Asia & India Eldercare...

Prepared for: ELDEX 2019 Date: 8 November 2019

Prepared for:

Prepared by: Spire Research & Consulting

Date: 8 November

Silver Market Opportunities in

Southeast Asia & India

Eldercare Exhibition & Conference

Asia (ELDEX) 2019

White Paper


Research and Consulting Solutions

COMPETITOR ANALYSIS

BUSINESS

PARTNER SELECTION

CORPORATE SOCIAL

RESPONSIBILITY CONSULTING

CHANNEL HEALTH

MANAGEMENT

SUPPLY CHAIN MANAGEMENT CONSULTING

KNOWLEDGE

PROCESS OUTSOURCING

SALES LEAD HANDLING

GEO-MARKETING

MARKET SIZING AND FEASIBILITY

PRICE RESEARCH

MARKET ENVIRONMENT

RESEARCH

THOUGHT

LEADERSHIP CONSULTING

CUSTOMER DECISION

DYNAMICS ANALYSIS

COUNTRY RESEARCH

CONSUMER RESEARCH

GO-TO-MARKET

PLAYBOOKS

VALUE CHAIN ANALYSIS

ANTI-

COUNTERFEIT CONSULTING

HOLISTIC MARKET ENVIRONMENT RESEARCH

ETHNOGRAPHY

CROSS-BORDER

CONSULTING


Indonesia has the largest elderly population in ASEAN, but…

Source: Worldometers, Statista 2019 and Spire estimates

7.4

16.0

8.6

15.8

15.4

29.6

5.4

10.1

1.8

4.2

Population of 65 &

above in 2019 (million)

Population of 65 &

above in 2035 (million)

Country Consumption

Spending

World (aged 60 &

over) 2020 USD10 trillion

USA (Aged 50 &

above) 2015 USD8 trillion

Japan (aged 60 &

over) 2014

Yen115 trillion/

USD 1.06 trillion

0.5

1.7


…Singapore (27%) and Thailand (23%) will have the highest

proportion of elderly residents in 2035

Country 2019

(Population & Yearly %

Change)

Population of 65 &

above in 2019

(% of population)

2035

(Population & Yearly %

Change)

Share of population

65 & above in 2035

(% of population)

Indonesia 269,536,482

(1.03%)

15,363,579

(5.7%)

304,758,627

(0.61%)

29,561,587

(9.7%)

Philippines 108,106,310

(1.5%)

5,405,315

(5.0%)

132,667,616

(1.14%)

10,082,739

(7.6%)

Vietnam 97,429,061

(0.97%)

7,404,609

(7.6%)

108,988,478

(0.5%)

16,021,306

(14.7%)

Thailand 69,306,160

(0.18%)

8,593,964

(12.4%)

69,199,658

(-0.12%)

15,777,522

(22.8%)

Malaysia 32,454,455

(1.29%)

1,849,904

(5.7%)

38,380,670

(0.84%)

4,221,874

(11%)

Singapore 5,868,104

(1.32%)

547,854 (in 2018)

(13.7%*)

6,479,855

0.43 %

1,723,641

26.6%

Source: Worldometers, Statista 2019, Secondary Data, *: ratio based on Resident Population (SingStat)

Population

Across many ASEAN countries, the 65 and above age category is projected to double from 2019 to 2035.

Singapore and Thailand are the fastest ageing markets in the region. Other countries like Malaysia, Vietnam,

Indonesia, Philippines are all ageing, albeit at a more moderate pace.

ASEAN countries have been advancing the ASEAN Economic Community (AEC), which aims to reduce barriers to

trade in good, services and the movement of persons, as well as advance the harmonization of standards. Four ASEAN

countries signed up to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership ("CPTPP") in 2018 –

Brunei, Malaysia, Singapore and Vietnam.

Many ASEAN countries are under severe pressure to innovate so as to finance,

support and employ a growing elderly population


ASEAN is a familiar, investor-friendly region for global companies

Country FDI Flows 2018 (USD

million) - Inward

FDI Flows 2018 (USD

million) - Outward

FDI Stock 2018 (USD

million) - Inward

FDI Stock 2018 (USD

million) - Outward

Indonesia 21,980 8,139 226,335 72,279

Philippines 6,456 602 82,997 51,902

Vietnam 15,500 598 144,991 10,668

Thailand 10,493 17,714 222,733 121,358

Malaysia 8,091 5,280 152,510 118,886

Singapore 77,646 37,143 1,481,033 1,021,124

Source: United Nations Conference on Trade and Development

FDI Flows & Stocks

With a combined GDP of $2.4 trillion, ASEAN is strategically

important to U.S. interests.

ASEAN countries are also collectively the United States‟

fourth-largest trading partner in the world. For years, US

citizens have been travelling to and settling in ASEAN

countries, especially the Philippines and Thailand.

Country Number of Citizens

Indonesia (2016) 2,072

Philippines (2016) Est. 220,000

Singapore (2018) Est. >30,000

Thailand (2010) 40,230

Malaysia N/a Nu

mb

er

of

US

Citiz

en

Ab

roa

d

In 2018, FDI flows to Thailand hit USD10.5 billion, while flows to Malaysia reached about USD8 billion and flows to

the Philippines were almost $6.5 billion.

Alongside Singapore, in 2018 Indonesia and Vietnam were among top 3 largest recipients in ASEAN, with FDI

flows hitting USD 22 billion and USD15.5 billion respectively.

Indonesia and Thailand had highest the FDI stock in 2018 with more than USD226 billion and USD222.7 billion.

ASEAN has emerged as a key market and investment hub for international

companies, gaining from the current geo-political tensions


World Asia-Pacific (APAC)

USD860 billion in 2018

Being ranked in the top 3 largest nursing care markets

in the world with CAGR of 14.6% in comparison

with the world average of 8.6% from 2018-2022.

USD165 billion in 2017

USD7.65 billion in 2018 with a CAGR of

5.7% to reach USD10.1 billion by 2023. Fastest

growing market for anti-aging products and devices due

to increasing medical tourism; growing aging population;

increasing number of cosmetic procedures; and rising

awareness among consumers.

USD4.7 billion by 2020

USD 0.6 billion in 2018 with a CAGR of

8.2% to hit USD 0.9 billion by 2023.

Fastest growing regional market in the world.

USD12.6 billion in 2018 USD3.8 billion in 2018 (more than 30% of global

revenue).

Bathroom & Toilet Assist

Devices

Anti-aging market

Nursing care

The Asia-Pacific region is the third largest region for aging product

revenues but also the fastest growing one

Source: Multiple published sources, Spire estimates

Prominent Product

Categories

Adult diapers


Aging Nation - Population and % of

total population >65

Prioritized

Product

Categories

Strategic Goal

Current Situation

& Problems

2019: 15.4m /5.7%

2035: 29.6m /9.7%

2019: 5.4m /5.0%

2035: 10.1m /7.6%

2019: 7.4m /7.6%

2035: 16.0m /14.7%

2019: 8.6m /12.4%

2035: 15.8m /22.8%

- Insufficient infrastructure

and investment in silver

care

- Relatively high cost of

elder care and geriatric

healthcare, which is

leading the government to

turn to technology

- High income and wealth

inequality

- Policies for elder care

as opposed to social

welfare are less

developed

- Poverty remains a big

problem affecting senior

citizens

- Healthcare financing

and elderly chronic

conditions are challenges

- Government is like to

welcome a bigger role for

the private sector in elder

care and financial

solutions, eg annuity plans

- The elder care industry is

rather developed compared

with other ASEAN countries,

serving both locals and

foreigners

- But existing laws and

policies on ageing are not

always put into practice

- Improving social

perception toward old

people

- Increasing the

accessibility and quality of

healthcare

- Reducing poverty and

enhancing safety nets

- Increasing the access

and quality of senior

care

- Improving the social

security system

- Improving the senior

care sector by adopting

good practices from

developed countries

- Developing the local silver

industry

- Becoming a hub for

healthcare and retirement

living for local and foreign

senior citizens

• Healthcare

• Nursing home

• Medical devices

• Geriatric care

• Niche, high-end private

nursing homes and AI

• Healthcare

• Nursing home

• Senior and assisted

living

• Healthcare

• Nursing home

• Geriatric care

• Financial solutions

• Health supplements

• Senior and assisted

living & technologies

• Healthcare

• Robotics, IoT and AI

• Nursing home

• Senior and assisted living

Key Takeaways by country


Aging Nation - Population and % of

total population >65

Prioritized

Product

Categories

Strategic Goal

Current Situation

& Problems

2019: 1.8m /5.7%

2035: 4.2 m /11.0%

2018: 0.5m /13.7%

2035: 1.7m /26.6%

2019: 74.7m /6.1%

2035: 150.9 m /9.6%

- Moderately good social security

system for seniors

- But there is a need to raise

standards across elder car providers

and promote senior employment

- High and increasing aging

population

- Among the developed

countries with the lowest

spending on healthcare

- Shortages of facilities,

manpower and the challenge of

incomes relative to prices, with

many nursing homes being

charities rather than being

corporates

- Large and increasing aging

population

- Beginning to develop an

industrial framework to address

the aging society by encouraging

foreign participation and

experimenting with the Western

model of senior living

- Lack of government policy

support social security and

geriatric medical services

- Lack of long-term and palliative

care facilities for the seniors

- Improving the standard of care

and quality of life of seniors

- Applying technology to healthcare

- Senior employability

- Increasing healthy years and

active aging for the elderly

population

- Senior employability

- Addressing the systemic

challenges facing the long-term

care sector

- Extending healthy living years

and aiming for active aging

- Improving the quality of life for

the elderly

• Healthcare

• Nursing home

• Telemedicine and online health

portals

• Elder living Infrastructure

• Training and Talent

• Technology and Innovation

in elder-care

• Home healthcare

• Assisted living

• Palliative care

Key Takeaways by country


Silver Industry: Expert‟s Regional

Perspective – Southeast Asia


Major Silver Product Categories across ASEAN

Nursing homes, healthcare and insurance are among top promising sectors

Nursing homes

Healthcare-Hospitals & Clinics

Insurance

Market size: estimated over 100 million USD for Thailand

Growth rate: 5-8% per year

Trends:

Location of nursing homes close to hospitals

Emergence of „telemedicine‟ - technologies that allow healthcare providers to evaluate,

diagnose and treat patients using video conferencing and smartphones.

Reasons to invest:

Low cost of investment

Government regulations – not too strict now but could change in the future

Rising ageing population in the SEA region

Market size: estimated at 45 million USD for Thailand Growth rate: 3-5% per year Trends: Increasing focus on wellness, anti-ageing and rejuvenation treatments Reasons to invest:

Lack of geriatric care in the hospitals

High cost of care at the hospital limits access

Growth rate: 3-5% per year Trends: Most SEA countries are under-insured and there is a lack of awareness and

acceptance of insurance, but the aging trend is changing this. Reasons to invest:

The state‟s social security system in most SEA countries is not highly developed, making private insurance an attractive sector

Source: Spire analysis of primary Interviews with experts

Top potential


Insurance

Healthcare

Nursing homes

Penetration Strategy

ASEAN Silver market penetration strategies need to be country-specific

•Understand the needs of different elderly segments - healthy, semi dependent, entirely dependent.

•Develop different strategies for each segment, aimed at improving quality of life.

•Segment by income.

Understand the patients

•Invest in R&D and customization of new technologies.

Importance of Technology •Focus healthcare not

only treatments but also wellness and anti ageing.

Key to winning

•Set up a business which is respectful of the values and culture of SEA countries.

Understand the market

•Understand the needs of the elderly - nutrition, care, training, communication

Strong Value proposition

•Invest in proper training for care personnel in Geriatric & palliative care.

Key to winning

•Understand the reasons for the low cultural acceptance of insurance due to delayed benefits.

Nature of the Market

•Create awareness and trust among target customers through marketing communications and social media engagement.

•Focus on healthcare insurance, to address care costs.

Areas to focus •Make wellness and rejuvenation affordable for many.

Key to Winning



Sector Insights

Business and government are driving demand for technologies and innovation

in the SEA silver market

New technologies: Wearables for the elderly like activity

trackers and senior safety systems.

Innovations: Telemedicine and tele consultants can help

provide medical assistance to the elderly at care homes with

less cost and no need for travel.

Business models: Businesses should focus on a model that

digitizes senior care and makes nursing homes increasingly

digitally connected. The role of IoT in elder-care is set to

increase.

New technologies

There is a growing demand for patent engagement as

education and healthcare literacy rises.

Patient portals are automated systems for ordering

tests which use personal action plans and trigger

patients to go for tests or see their doctors.

Innovations:

Virtual Reality Experiences may be an area for

innovation in the coming years, with a focus on

alleviating isolation and promoting wellness.

Business models:

Hospitals will need to leverage ever larger pools of

data to forecast health trends and recommend

services and actions for patients.

Nursing homes

Healthcare-Hospitals &Clinics


Top potential


Sector Insights

The SEA silver market will see major unmet needs and challenges in the years ahead

Key unmet needs are: funding, capacity, affordability and training of

manpower to raise productivity.

Eco-system stake-holders will need to expand access to telemedicine

and telehealth services. (The RUSH Act recently introduced in the US aims

to expand access to emergency telehealth for seniors.)

State healthcare systems have insufficient capacity for chronic and

palliative care in SEA.

Healthcare systems will increasingly face challenges from “superbugs”,

antibiotic resistant strains of bacteria.


Nursing homes


Top potential


Sector Insights

Healthcare financing systems/affordability explain why technology and innovation

have not been embraced in SEA to the same extent as in Japan and Korea

The cost of innovative

technology is very high.

State financing schemes for

nursing care are less well

developed, limiting the

potential base of

deployment for new

technologies.

Local R&D and production

is limited

High-tech innovations are

mainly found in a small

number of private specialty

hospitals, not in the general

tertiary care sector.

Weak pension

systems and patchy

health insurance limit

access to quality

care in countries such

as the Philippines and

Thailand.

Nursing homes



Top potential


Silver Industry: Opportunities and

Challenges by Country


• Thailand is among the fastest ageing nations in Asia after Japan, Hong Kong, and Singapore

• The population of foreign retirees on long stay visas has also increased substantially.

• Almost half of the elderly continue to work after 60, usually till their late 60s, whereas the rest rely on family support.

Current Situation

• Thailand has attempted to create work and education opportunities for older adults, alongside long-term care plans and age-friendly housing options.

• However, existing laws and policies on ageing are not always effectively implemented on the ground.

Problem

• Better care support for older people.

• Improving medical care extending life expectancies and healthy living years.

• Thailand becoming a centre for elder-care services, as it already has the necessary healthcare and medical infrastructure

Expected Condition

Thailand Silver Industry Overview

Thailand has a large elder population and relatively high purchasing power. It aims to

become a retirement and medical tourism hub.

Precondition:

Rapid aging population

+ increasingly popular

retirement option for

foreigners

Thailand seeks to become a centre of excellence for elderly healthcare and retirement living for local and foreign senior citizens

Strategic Goals

Source: Spire analysis of published reports and government publications


Legal Framework

Establishing the “National Committee of Senior Citizens” to help implement the Second National

Plan for Older Persons (2002-2021).

In line with the Second National Plan for Older Persons, progress has been made at many levels

toward building an aging-friendly society.

Providing primary health services through networks of “ Health Centres ” and Primary Care Units

(PCU) run by The Ministry of Public Health (MoPH) and “ Community Health Centres ”, which are

available only in Bangkok. These are generally staffed by 1-3 physicians and allied healthcare

personnel. These centers, however, rarely offer rehabilitative services.

Promoting physical and mental health among the elderly by encouraging the establishment of

more clubs, or centers, where the elderly can join social activities and events in local

communities.

Provide greater occupational opportunities for the elderly.

Promoting positive public attitudes toward elderly persons.

Providing social protection for the elderly including social pensions.

National Initiatives and

Policy Development

Policy Analysis

Thailand‟s government has been rolling out policies geared to an aging society for a

long time; its Second National Plan for Older Persons kicked off in 2002

Segmentation

In 2011, Thailand rolled out a plan to make Thailand a center for medical and healthcare service,

offering support to establishments in the industry.

Thailand had about 400 healthcare service businesses and the majority of them are located

in Bangkok.

Since 2016, 442 businesses have been developed as professional medical or healthcare

businesses.

Among those, 55 companies have passed an international test and been accepted under

an international standard.

Healthcare



Legal Framework

Product Category Analysis

Thailand sees technology playing a crucial role in elder-care

Categories

In order to deal with the challenges that a greying population would place on the

healthcare system, Thailand has been developing healthcare robots that integrate with

people‟s lifestyle.

Since 2009, CT Asia Robotics company has been developing the Dinsow robot to look after

the elderly by monitoring body movements and vital signs with sensors that link to portals for

telemedicine with doctors.

Medical robots have been used and promoted in Thailand in many areas, including in

surgery, diagnosis, rehabilitation and services

The Mongkutwattana General Hospital deployed three “robot nurses” in 2018. These

are mainly being used to dispense medication and make deliveries across the eight

stations of the hospital.

In future, the second generation of service robots is expected to offer telemedicine services

for patients who live far away from city centres and hospitals. They can even help provide

care for the elderly and Alzheimer‟s patients, with new features using artificial intelligence.

The Smart City Association (SCA) of Thailand is one of the stakeholders that The Thai

government is working with to provide smart healthcare, which involves using the Internet of

Things (IoT) to collect patient data remotely through sensors.

Many corporates are developing IoT healthcare wearable devices which collect data for

analysis via Artificial Intelligence (AI).

Robotics, Iot

and AI



Categories

Thailand is said to have sufficient hospitality facilities to serve an increasing number of senior

citizens, many of whom have high reasonably spending power and are in need of healthcare

and medical service. Many foreigners choose to use these services in Thailand each year due to

perceived good quality and low cost.

According to immigration bureau data, the number of foreigners over 50 who have applied for

retirement visas to stay in Thailand almost doubled to nearly 73,000 in 2017 from fewer than

40,000 in 2013. Each year, more than 4 million foreigners who travel to Thailand use medical or

healthcare services there, a testament to the success of Thailand‟s medical tourism effort.

Jin Wellbeing County is a “medical city” for Thai and foreign retirees being built by Thonburi

Healthcare Group Pcl across more than two hectares (5 acres) on the outskirts of Bangkok. The

first of nearly 500 housing units being sold in an initial phase are being marketed for nearly

USD130,000, plus additional fees of 7,000-8,000 baht (USD224 - 385) a month for meals and

services ranging from fitness sessions to excursions.

A residential project worth USD160 million by developer Magnolia Quality Development

Corporation, which is scheduled to open in 2022, will include a wellness center offering elderly

care services with specialist physicians in practice areas such as dementia.

Assisted Living

Services

Thailand has around 800 nursing home operators, of which the majority are SME‟s. Large private

hospitals have started to venture into the nursing home business targeting high income clients. The

number of operators is expected to increase in the near future as there is still unmet demand.

Thai people spend on average THB15,000 -30,000 for nursing home care every month and THM700-

1,200 for daily care.

Nursing Home


Thailand is becoming an increasingly popular retirement destination for foreigners



Experts‟ Comments


Businesses and services to tap the

local elderly market, particularly

related to nursing homes, have

blossomed in the past 4-5 years

since 2015 as entrepreneurs have

sought to cash in on Thailand's

demographic changes.

Thai Elderly Promotion and

Health Care Association

(Tephca)

SCG is dipping its toes into the health

arena, starting with its DoCare Project

(a health and safety monitoring

system for elderly who want special

care at home) initiated in 2019.

SCG Cement-Building Materials Co

Navasri Nursing Home & Living Well Co

Demand for elderly services has

continued to increase since I

entered the business in 2012. Our

new nursing home will be

developed under a clean and

green concept. It offers various

activities, a different atmosphere

from living in a hospital and

original nursing homes. With local production, the cost of

such robot development is

relatively low compared to the

imported ones. This means more

opportunity for patients to have

access to robotic therapy.

Investment Services Center -

The Board Of Investment Office

Of The Prime Minister

In addition to robotics, Artificial Intelligence (AI)

has played a more important role in research and

development (R&D) and in assisting doctors in

performing complicated surgery.

Until 2018, senior living developments was not a market

that many developers tapped due to the complicated

nature of implementation; however, as the general

housing market eventually peaks, senior housing needs

may grow out of a niche and into a mainstream market

segment big enough that some pioneering developers

will create solutions for implementation.

CBRE Thailand


• There were nearly 550,000 elderly (65 and above) in Singapore in 2017 (13.7% of the population); the ratio will hit 26.6% in 2035.

• Singapore‟s silver industry is ranked third out of 15 Asia Pacific countries

• Singapore spent less than 2.2% of GDP on healthcare in 2018, which is among the lowest for developed countries

Current Situation

• The elderly share of population is rising fast

• More capacity is in urgent need of being built in nursing homes, senior care facilities.

• The nursing home industry faces manpower shortages and the challenge of insufficient incomes relative to prices, with many nursing homes being charities rather than being corporates

Problem

• In elder-care, Singapore is focusing on:

• Increasing capacity

• Raising quality standards

• Raising productivity

• Innovating with new business models at various price points, working with both social enterprises and companies

Expected Condition

Singapore Silver Industry Overview

In the elder-care space, the Government is trying to shift from a stress on healthcare

towards health in old age and active aging

Context:

SPRING Singapore set up a

Silver Industry Standards

Committee to develop and

facilitate the

implementation of

standards in order to

support active ageing

initiatives.

Increasing healthy years and active aging for the elderly population

Addressing the systemic challenges facing the long-term care sector

Strategic Goals



Legal Framework

In 2007, the government formed a Ministerial Committee on Ageing to coordinate ageing

issues across all government agencies. The Committee pursues four initiatives:

Allowing seniors to stay employed and remaining financially independent;

Enabling the elderly to age in their own communities in a barrier-free environment and

with a transportation system that allows them mobility;

Maintaining a healthcare system that gives seniors access to care for their particular

needs at an affordable price; and,

Promoting active ageing by encouraging physical and mental well-being and the ability

to continue to contribute to society.

The Agency for Integrated Care (AIC) was set up in 2009 to effect the integration of primary,

intermediate- and long-term care sectors. AIC coordinates and facilitates placing of elderly

sick into nursing homes, with community providers and in day rehabilitation centres

The government is particularly interested in helping seniors remain in their homes and with

their families. Incentives include a SGD120 grant to hire a maid to help with care of a senior

and a new subsidy to install elderly-friendly features in the home.

A Community Functional Screening Program aims to help seniors (60 and above) detect early

signs of functional decline

SPRING Singapore, a state SME-development body, set up a Silver Industry Standards

Committee (SISC) in 2011 to develop and facilitate the implementation of standards in order

to support active ageing initiatives and the growth of the silver industry. Its focus is on

liveability in the community, nutrition and healthcare.


Policy Development

Policy Analysis

Government has established various organizations and built standards to support

elders and focus on eldercare in Singapore



Categories

Singapore has insufficient capacity for aged care for the rapidly ageing population. The Government

targets to have 6,200 daycare places, 10,000 home care places and 17,000 nursing home beds by

2020.

Therefore, there are many opportunities for companies in these areas:

The building of aged care facilities under a build-own-lease model

Adding more hospital beds

Developing housing that incorporates aged care facilities

Designing retirement housing

Companies can provide management and consultation services for nursing homes that will be built in

next few years. The state is seeking to attract innovative, high-tech, highly productive business models

that are manpower-light.

The government is experimenting with assisted living.

Healthcare and elder

living

Infrastructure

There are 11,000 workers in long-term care and MOH has spent USD 24 million to attract talent into this

manpower-starved industry

Specialist training for medical students, doctors, nurses, and caregivers is a key area where industry

players can look to utilize their expertise. There will be room for specialist training providers in the field

of training for healthcare professionals, including allied healthcare personnel.

Moreover, companies can offer consulting services which set or build standards or guidelines in

eldercare, as the government seeks to form and enforce quality standards.

Training and Talent


Infrastructure, training and talent, and technology and innovation are three areas

where Singapore‟s silver industry needs investment

To address the problems of manpower and quality, the government is seeking to explore collaborative

possibilities among industry participants and healthcare providers such as medical devices, apps,

platform, etc. Healthcare monitoring technologies, assistive living technologies and smart living

technologies are expect to solve various problems of the industry

Caregiver Asia, myHealth Sentinel, and Cadi Scientific are leading players who provide technologies in

elder care in Singapore

Technologies and

Innovation



Experts‟ Comments


There will be strong demand for

aged and elderly care facilities

and services. The government is

aiming for people to age in place

and make use of home care

rather than building more beds,

but there's room in the market for

a range of options for people with

different abilities to pay.

To overcome the manpower challenges of an

ageing population, the next opportunity is

technology innovations that enable older adults

to age at home. This is the opportunity for

healthcare monitoring technologies, assistive

living technologies and smart living technologies.

Marsh & McLennan

Singapore is projected to spend

on average USD37,427 on

healthcare for each elderly

person by 2030, the highest in the

region. Elder care spending will

skyrocket to USD49 billion per

year by 2030. Singapore is strengthening efforts

in three areas: Empowering

seniors to stay healthy and active,

enabling communities of care,

and evolving new models of

ageing in place.

As for new models of ageing in place, the Build-

Own-Lease (BOL) framework and funding model for

nursing homes will continue to be reviewed to ensure

residents can access good and appropriate care at

affordable fees.

Locally, we have not felt the pickup of telehealth yet,

but we think we will. We are collaborating with a

Japanese medical device manufacturer to offer blood

pressure monitors with bluetooth connectivity, which

can connect easily with smartphones. We are also

developing a new health data interface which can be

taken at home and shared with doctors when needed.

Aging Asia

Deloitte South-east Asia

Ministry of Health

(MOH)


• Caring for the elderly is still traditionally embraced through a family support system.

• Malaysia‟s social security provision for older people is quite modest compared to other middle-income countries.

• Long-term care is offered by government welfare homes (public sector), private nursing homes and care centres (for-profit) and voluntary aged care organizations and centres (non-profits and charities).

Current Situation

• More families find themselves unable to cope with elder-care due to higher living expenses which require both primary caregivers to work, or having to juggle between caring for their elderly family member and their own young children.

• Poverty, lack of education and poor social support still dampen the well-being of the country‟s older population.

• Opaque and uneven standards of care are on offer in public, private and voluntary long-term aged care facilities.

Problem

• The Malaysian government is seeking to enhance:

• Capacity-building/investment in health and welfare for senior citizens.

• The accessibility of the build environment for seniors and persons with disabilities

Expected Condition

Malaysia Silver Industry Overview

Despite having a relatively modest social security provision for older people,

Malaysia is conscious of the need to invest more in elder care as the population ages

Precondition:

Increase Life Expectancy Elderly

Population increase

Improving quality standards in the elder-care industry and making the built environment far more elder-friendly/accessible to PWDs

Strategic Goals



Policy Analysis

Malaysia‟s government is rolling out new practical guidelines for elder-care, while

also seeking to create a greater role for insurance in the elder-care eco-system

Legal Framework

Physical Planning Guidelines for the Elderly are being drafted by the Urban Wellbeing,

Housing and Local Government Ministry. The plans will guide government agencies, local

authorities, developers, private companies and non-governmental organizations in

developing settlements and facilities for senior citizens.

The guidelines ill focus on site planning, building design and provision of facilities in three

types of settlements for the elderly, namely, new housing construction and retrofitting of

existing homes, senior care centres and retirement villages.

The guidelines will also aim to provide protection for different contingencies such as

disability, with the sate working with Social Security Organization (SOCSO) and the state

retirement fund (pension and EPF).

The government sees a greater role for risk-pooling and insurance in catering to the needs

of an aging population. Malaysia, like most emerging and middle-income Asian countries,

remains under-insured.

National

Initiatives and Policy

Development



Legal Framework


The government is seeking more private sector involvement in the elder-care

industry, particularly in respect of usage of technology

Categories

Realizing the fact that a growing senior population will eventually drive up demand for

healthcare, since 1997, the Malaysian government launched Telemedicine Blueprint with the

aim to lead the country‟s healthcare into the information era.

In Malaysia, telemedicine is seen as the use of technology to deliver healthcare services and

information at a distance in order to improve access, quality and cost. To many experts,

technologies such as the Internet of Things (IoT) and information and communications

technology (ICT) will enable more precise and better service delivery to patients, especially

senior citizens.

In early 2017, DoctorOnCall.com.my was launched as Malaysia‟s first online telehealth platform

that connects patients with an extensive network of doctors and medical practitioners.

In the years to come, through telemedicine, elderly people in Malaysia will be offered the

possibility of healthcare services such as remote diagnosis, monitoring and treatment being

delivered irrespective of geographic boundaries.

Companies in this space are encouraged to be delivering care through telehealth, mHealth,

and EMR/PHR, as well as incorporating wearables and social media into their care plans to

deliver value.

Healthcare Telemedicine

Until 2017, senior living remained a relatively new concept in Malaysia, with nursing homes run

mostly by charitable organizations providing the final stages of care to the elderly. However, with the

rapid growth of Malaysia‟s elderly population, industry is adapting by raising capacity.

As Malaysia‟s ageing population increases steadily, demand is high for such nursing homes as

traditional cultural mores change.

The Green Leaf company offers one example of senior living in Malaysia. Just like in the USA these

complexes are self-sufficient and offer a full range of services for elderly people.

Nursing home



Experts‟ Comments


Adoption of technology in the healthcare sector of any country is critical

in enhancing delivery of quality healthcare services. Malaysia practices

a dual healthcare delivery system. Both the public and private sectors

are central players in Malaysia’s healthcare delivery system.

Parkway Pantai Healthcare

– Malaysia Division

Medicine and Health

Sciences - Monash

University Malaysia

Technology such as the

Internet of Things (IoT) and

information and

communications technology

(ICT) will enable more precise

and better service to the

patients. As telemedicine

offers the possibility of

healthcare services such as

remote diagnosis, monitoring

and treatment being

delivered irrespective of the

geographical boundary, it

increases its availability and

accessibility. Any effective

healthcare solution via IoT

can be mass-produced at

reasonable cost.

Malaysian healthcare must tackle

traditional thinking among

hospital players, elevated costs,

more training, partial digital

conversion, the system’s 100%

dependency, and confidentiality

Prince Court Medical

Centre

Healthcare providers and stakeholders must look to

eliminate waste and explore alternative care delivery

models like retail clinics, telehealth, and medical

tourism for “everywhere care”.

Health Care Asia Magazine


• The population is aging quickly and the social security system is not yet able to meet the health care needs of the elderly.

• 30% of the elderly do not have any kind of health insurance and 54.6% need on-going medical treatment for chronic conditions.

• The pace of aging is placing pressure on existing sources of healthcare financing.

Current Situation

• 95% of the elderly have diseases, mainly chronic non-communicable diseases and 50% of them cannot afford healthcare.

• While demand for nursing homes is on the rise, there are still many regulatory obstacles to establishing more high-quality nursing facilities.

• Existing laws and policies on ageing are not always pro-business.

Problem • Establishing many facilities

and hospitals dedicated to elderly patients.

• Better access to healthcare services across all provinces.

• More involvement of the private sector in the silver care industry, which may in future encompass a role for financial risk-pooling.

Expected Condition

Vietnam Silver Industry Overview

Policymakers aim to benchmark countries like Thailand to foster a successful aging

society, with a stress on engagement.

Precondition:

The aging rate of

Vietnam's population

is among the highest

in the world

Ensuring older people are able to achieve financial security (with healthcare insurance) and are actively engaged in social activities

Adopting good practices/learning from similar countries‟ social and

cultural experiences (like Thailand) regarding aging

Strategic Goals



Legal Framework

Ratifying the Law on The Elderly to provide a legal framework for elderly care.

Ensuring minimum living standards and shelter for the elderly, including via nursing homes.

Prioritizing health check-ups, issuance of health insurance cards and activities in elderly health

clubs.

Authorities at all levels are tasked to make sure that 100 per cent of elderly people have

health insurance cards by 2025, and that 80 per cent receive at least one medical check-

up a year, so as to maintain up-to-date health profiles.

Issuing preferential policies towards the elderly in public services such as transportation,

sightseeing, holidays.

Encouraging all city-level and provincial-level hospitals to have a gerontology faculty and a

separate specialist centre for older patients.


Policy Development

Policy Analysis

The pace of aging in Vietnam, as in Singapore, placed pressure on Vietnam‟s

healthcare infrastructure

Segmentation

The Vietnamese state is clearly conscious of the need for capacity-building in elder-care. Many

observers see a greater role for the private sector, as has occurred in other national policy fields

such as the development of transport infrastructure.

Earlier in 2015, The Chandler Corporation acquired an 80% stake in the Hoan My Medical

Corporation, Vietnam‟s largest private hospital group.

In another effort to collaborate with the Ministry of Health, Novartis, a global healthcare

corporation, has committed to providing access to high-quality and advanced healthcare

services.

Healthcare



Categories

Life insurance is another potential growth sector for the silver industry. Currently there are 18 insurance

companies in Vietnam offering young Vietnamese a choice of annuity packages

Financial Services

The demands for nursing homes is increasing, as many Vietnamese live and work in cities, away from

their parents in rural areas. Many older Vietnamese are also attracted to the idea of retirement

communities, for social reasons.

Vietnam aims to open nursing homes in every province and city. It will also open more services

supporting the elderly population in each area and encourage more investment from the private

sector. Investors are expected to enjoy preferential policies in tax duties or land rent in the future.

Over 30 private nursing homes have been established, but none in poorer regions.

Nursing homes


Vietnam is benchmarking policy approaches to aging seen in developed countries

Categories catering to older consumers have been growing. Sugar-free liquid milk increased by

over15%; instant porridge grew 25%; adult diaper sales grew 70%.

Health Supplements

Until 2018, there were over 100 healthcare centers with an inpatient elder care ward in Vietnam.

Geriatric healthcare has started to receive more attention from both local governments and the

central government, with many community-based care models being implemented.

Currently, throughout the country, only 49 out of 69 city-level and provincial-level hospitals have

gerontology faculties, and only three institutes offer gerontology studies, which is grossly inadequate.

Geriatric Healthcare

With increasing incomes, better health awareness and more time to take care of themselves after

retirement, many senior citizens seek access to the internet, smart phones and other advanced-

technology platforms.

For the same reasons, elder demand is growing for wellness and lifestyle products to support physical

activities, beauty care products (aging prevention) and home entertainment products.

Assisted Living Services &

Technologies



Experts‟ Comments


The government should reorient the

delivery system from the intensive

use of hospital care to greater

reliance on improved primary care

and reform provider payment

mechanisms from fee-for-services to

case-based approaches.

World Bank‟s Regional

Lead Economist for

Human Development

for the East Asia and

Pacific Region

Geriatrics is still pretty new in Vietnam. Medical schools only started this

program about 10 years ago. Furthermore, there’s the lack of a

dedicated medical facility for the elderly. At this point in time, only

certain hospitals have wards dedicated for geriatric care, and this is just

in Ho Chi Minh City, which has the best standards for geriatric care in

Vietnam.

Victoria Healthcare Vietnam

Ministry of Labour, Invalids and Social Affairs

Demand for nursing homes has

increased from many people

whose children work and live far

away. There are also people who

still live with their children but want

to experience the nursing home

model and meet their peers.

The nursing home system in Vietnam is very weak. Until 2018, about 102

facilities have elderly care wards in Vietnam but there are only 32

nursing homes which are often operated by private investors. There are

no nursing homes in disadvantaged areas. Vietnam aims to open

nursing homes in every province and city. It will also open more

services that are compatible with the elderly population in each area

and encourage more investment from the private sector.


• Elder-friendly healthcare facilities are not yet sufficiently available

• Policy makers are conscious of the gap in the policy eco-system around the promotion of active aging, geriatric care and healthy living in old age

Current Situation

• Degenerative diseases are on the rise as the average age rises

• High costs are associated with the treatment of degenerative diseases

Problem • Availability of health care facilities

that can provide standardized and efficient elderly healthcare

• Improved awareness of public services for elderly health and welfare

• A healthy, active and productive elder population

Expected Condition

Indonesia Silver Industry Overview

Indonesia‟s government has been grappling with the challenge of providing cost-

effective elder care

Source: Ministry of Social Affairs of the Republic of Indonesia

Context:

Government efforts to

reduce the cost of

healthcare delivery

Improved and efficient primary and secondary healthcare as well as long-term care for the elderly, including the management of degenerative/chronic conditions

Strategic Goals


Legal Framework

Enhancing regulatory and institutional frameworks by integrating ageing concepts into the

National Development Agenda, National Action Plan on Human Rights and National

Strategy on Ageing.

Improving the functioning of the National Commission for the Elderly; and establishing a

cross-functional working group on ageing.

Developing a database and registration system for elderly citizens.

Continuing the implementation of social assistance as a social safety net program

Improving human resources for social services and care, including professional workers

(doctor, nurse, occupational therapist, nutritionist, and social worker) and non-professional

workers (nurse assistant, paid care giver and family care giver).

Enhancing the community-based care system such as community health centers

(Puskesmas) and integrated service centers for the elderly (Posyandu Lansia).

Developing an integrated system of referral and services (SLRT) at the district level.

Investing in elder-friendly city design.

Developing elder primary health servics.

Increasing health referral centers for elderly through the development of integrated

geriatric services In hospitals.

Increasing community empowerment through integrated health posts for elder citizens

(Elderly Groups / Posyandu Lansia).

Increasing home care services that are integrated in public health.

Developing long-term care services.

Increasing health services with other programs using a life cycle approach.

Increasing partnership with other sectors (inter-sectoral approach): NGOs, education, and

research institutions.

National


Development

Policy Analysis

The government is taking the lead to stimulate investment in the elder-care industry



Categories

There are a number of major developers who are operating in the field of healthcare services and

aiming to build high-end senior living facilities centred on clustered housing estates for elderly

care.

Recently, Australian aged care provider, Living Well Communities (LWC) entered the Indonesian

market through JV partnership with the Jaya Property Group.

Leisure Care USA, a One Eighty company and leader in retirement community management, has

been appointed as consultant to RUKUN Senior Living home. The retirement complex covers 35

hectares outside Jakarta and aims to provide a luxury lifestyle complete with beautifully

landscaped gardens, a swimming pool, a jogging track and even fishing facilities.

Assisted Living

Companies are building private nursing homes targeting high-income customers.

Japanese company Long Life Holding Co Ltd has established joint-venture cooperation with

Jababeka (a property developer) to build a nursing home, Senior Living D‟Khayangan, in the

Cikarang area.

Nursing Homes

Demand for physiotherapy equipment, mobility aids and other rehabilitation products for home care is

expected to surge. Medical Devices


Indonesia needs major capacity-building in qualified nursing care personnel,

healthcare service delivery, nursing homes and usage of advanced medical devices

There is a need for capacity-building in the professional training of geriatric nurses and caregivers

because of the rising demand for professional nursing care personnel in the country.

Geriatric Hospital Care



Experts‟ Comments


The level of disability for older

people in Indonesia is relatively

high with multi-pathology chronic

diseases. Geriatric clinic

availability is low and there is a

lack and inequitable distribution

of health services across

Indonesia, including geriatric

nurses.

There is many opportunities

in the aged care industry in

Indonesia including:

- Professional training of

geriatric nurses and

caregivers

- Medical devices

- High-end senior living

facilities centered on

clustered housing estates

- Aged-care counseling

services

- Consulting services to

help Indonesia’s

retirement residences,

nursing homes and aged

care facilities reach

international standards

It will take some time to convince

people to put their parents in

nursing homes. Nevertheless,

taking into consideration the

demographic trend in which the

elderly population is continuing to

grow, we see market potential for

nursing homes in the future.

Cushman & Wakefield

Indonesia

Nursing homes could see greater demand in

the near future, especially in Greater Jakarta.

Indonesia'€™s elderly population will continue to

expand and some 10 % of them live in

Greater Jakarta.

It is argued that the shortage of health practitioners who

are responsible for delivering services, including services

for the elderly in community centres, is one of the

challenges found in the field.

School of Nursing (Community Health

Nursing Department) from Faculty of

Medicine, Hasanuddin University

Australia Trade and Investment

Commission


• Filipino elderly have historically been dependent on their children or co-resident kin for economic, social and physical support.

• A major area of policy focus for older Filipinos is in social welfare.

• The nation is not prepared to meet the challenge of longer-term aging.

Current Situation

• The number of older people is growing and many are in need of care and support.

• In 2015, it was estimated that 27% of people who are aged 60 years or older were living in poverty.

Problem

• More social protection for elderly Filipinos.

• Social welfare and wellness programs should be expanded to offer coverage to more aging Filipinos

• Better access to healthcare services

• Better policies to protect the welfare of formal caregivers

Expected Condition

Philippines Silver Industry Overview

The Philippines, while still a young society, is trying to address poverty and lack of

access to care among elderly citizens

Precondition:

Philippines is still far from

hitting the 7% threshold for

over 65 residents; it is still a

young society with an

extremely high TFR and age-

dependency ratio.

Raising awareness of elder-care and aging issues so as to mobilize support for intervention across society in the longer-term.

Reducing poverty and increasing access to elder health care

Strategic Goals



Legal Framework

Providing a social pension of 12USD (Php500) per month to poor older persons aged 77 and

over who are not yet receiving any government or private pension

Establishing a senior citizens center in all cities and municipalities of the Philippines, and

appropriating funds to finance these.

The Department of Social Welfare and Development in coordination with other

government agencies, NGOs and people‟s organizations shall provide the

necessary technical assistance in the form of social and recreational services,

health and personal care services, spiritual services, livelihood services and

volunteer resource services.

Government agencies and instrumentalities should allocate one percent of their

total budget to programs and projects for older persons and persons with disabilities.

Approving and directing the implementation of the program providing for group homes and

foster homes for neglected, abandoned, abused, isolated and poor older persons and

persons with disabilities.

Ensuring priority for community-based approaches which are gender-responsive, with

effective leadership and meaningful participation of senior citizens in decision-making

processes, both in the context of family and community.

Ensuring active aging for senior citizens where healthy lifestyle habits are emphasized in

communities and where health services are accessible, affordable and available.

Providing health care services for poor older persons such as free medical services in

government hospitals, discounted services in private hospitals and clinics, free vaccines,

discounted medicines and mandatory PhilHealth coverage.

Declaring the first week of October of every year as “Elderly Filipino Week”.

National


Development

Policy Analysis

Government plans to act on longer-term social protection enhancement



Categories

Older people in the Philippines often suffer from both degenerative and communicable diseases

due to the ageing of the body‟s immune system. The government is trying to improve the country‟s

healthcare system to be resilient to the demands of an aging population.

In 2017, the private sector played a key role in advancing healthcare in the Philippines,

accounting for 63.9% of total healthcare expenditure (USD8.2 billion). Private healthcare services

are well-established and growing in the Philippines through specialist clinics, private hospitals and

satellite clinics in commercial establishments and malls.

Since 2018, Philippine healthcare institutions have started to utilize cloud technology. A new

hospital information system will be rolled out. This is expected to help smaller and mid-sized

hospitals improve productivity and quality.

Healthcare

In recent years, a growing number of private nursing homes have been established catering to the

middle-class who could afford professional care. The idea of professional care in nursing homes has

gradually became widely accepted in the Philippines.

Home Health Care Inc. (HHC), started in 2004, is an example of a home care provider, attending to

seniors and persons with disabilities (PWDs).

Nursing homes for foreigners are on the rise. In 2014, another nursing home for Germans was

established in Iloilo while nursing homes for foreign retirees will soon be built in Cebu and Metro

Manila.

Nursing Home


Nursing homes and geriatric healthcare are growth industries.

This is still an emerging sector but experts see opportunities for first mover advantage by working with

real estate developers and major conglomerates to provide services for the foreign expatriate

community and more affluent locals.

Senior and Assisted Living



Experts‟ Comments


The country is moving toward an "aging"

population, with the number of senior citizens

projected to surpass 8 million by the end of

2018. The ballooning figures will impact the

economy, as the government needs more

funding for their medical and financial needs.

The Commission on

Population

Population aging is not a bad thing. It

represents a story of our collective success as

Filipinos. It means that we were able to

conquer the challenges such as those related

to income, health, and education.

Philippine Institute for

Development Studies

(PIDS)

Retirement and Healthcare

Coalition (RHC)

A nursing home is not a solution;

it’s an option. And usually a

nursing home is used when there’s

no other option anymore.

The geriatric care sector was being served by 20 to 25 private

nursing homes, with a combined capacity of between 300 beds

and 500 beds. Five years from 2016, I think you are looking at

somewhere between 3,000 and 4,000 beds.

A commission would be “more

focused” to policy-making and

lobbying for legislative action that

would benefit the senior citizens.

Department of Social

Welfare and Development

(DSWD)


• There were 103.8 million citizens above the age of 60 in India in 2011, and the number is expected to reach 143 million by 2021 and 173 million by 2026.

•Elderly people will account for 25% of population by 2050.

•India began developing an industrial framework to address the aging society by encouraging foreign participation and co-opting the Western model of senior living which marries real estate development with at-home care.

Current Situation

•62% of elderly in India lack

access to long-term and

palliative care in 2018.

•The elderly are living longer but

with more health issues, severe

loneliness and lack of awareness

on accessing long-term care.

•The government has made

noticeable interventions like

issuing The Senior Care Act but

they have not produced the

desired results.

•There is a lack of capacity in

government-supported social

security and geriatric medical

services.

Problem

•Increasing public and private investments in the elder-care sector.

•Increasing manpower capacity for the elder-care sector.

•Addressing the emotional, psychological, social, financial & physical needs of elderly citizens

•Cheaper elder-care offerings for the middle class.

Expected Condition

India Silver Industry Overview

India‟s senior population is predicted to treble to 300 million by 2050, highlighting the

need for massive investment in infrastructure and services to support this segment

Precondition:

Large and increasing

aging population India is aiming for a healthy aging society that enables well-being in older age; a key focus will be capacity-building.

Strategic Goals



Legal Framework

In an anticipation of the rising geriatric population in India, the Central government

constituted the National Policy for Older Persons in 1999 to promote the health and welfare

of senior citizens in India. A major plank of this policy is to encourage families to take care

of their older family members.

In 2007, India passed the “Maintenance and Welfare of Parents and Senior Citizens Act”.

The act requires children to take care of their parents in old age. It also mandated the

establishment of old age homes by state governments.

As of mid-2017, 360 homes had been built by state governments with central funding under

the Integrated Programme for Older Persons (IPOP), according to data from the social

justice ministry.

The Central Government formulated the National Programme for the Health Care of Elderly

(2011) to provide easy access to preventive, curative and rehabilitative services to the

elderly along with specialized long-term and short-term training of healthcare

professionals.

The government has been encouraging the growth of private sector healthcare by

releasing prime building land at low rates (as long as a quarter of patients are treated free),

by exemptions from taxes and duties for importing drugs and high tech medical

equipment, and through concessions to doctors setting up private practices and nursing

homes.

National


Development

Policy Analysis

Elder-care is emerging as a key policy agenda issue in both public and private

sector circles.



Legal Framework

Product Category Analysis: Home Healthcare

Thanks to high hospitalization costs, India‟s home healthcare sector is booming.

Categories

An ageing population and high hospitalization costs is causing rapid growth in the home

health care services sector.

In 2018, it is estimated that 60-80% of home care demand originated from seniors citizens.

Home health care facilities were first started in India by India Home Health Care in 2009. The

sector now has many establishments following in its footsteps like Health Care at Home,

Zoctr, Portea, Care24, etc.

In the USD100 billion Indian healthcare market, the share of home healthcare was around

USD3.2 billion. The sector is expected to reach USD6 billion by 2020 from a USD2 billion

market opportunity in 2014.

Home healthcare involves providing doctor consultancy at home, post-natal care at home,

skilled nursing and efficient physiotherapy.

In 2018, the Medica Group of Hospitals launched a new suite of home care services, which

aimed to help patients save 20-50 % of cost as compared to regular hospital treatment,

depending upon the services used.

The number of senior citizens will vastly increase in the years to come. This will require more

in situ medical attention and care than what is needed today.

The increasing number of people suffering from chronic diseases including cancer, kidney

failure, Alzheimer‟s disease and others will benefit immensely from home care.

The Indian government plans to lay down a "strict and transparent mechanism and

licensing system" to regulate home health service businesses. Also policies will aim to

encourage insurance companies to cover home care cost.

Home

Healthcare



Categories

As at early 2019, there were approximately 20,000 assisted living units operational, under

construction, or in the planning phase in India, while the urban demand is for 240,000

houses.

There are a number of developers building “retirement resorts” in North India to cater to the

high-end segment. Max India, a healthcare giant, has a 200-block senior living facility

called Antara on the outskirts of the city of Dehradun. Prices for a property here start at

USD300,000, offering state-of-the-art medical facilities with in-house doctors as well as a

fitness centre, which includes a gym, spa and a swimming pool.

In southern Indian states like Tamil Nadu, Karnataka and Andhra Pradesh, the senior living

trend has taken flight. Covai Care, a Coimbatore-based developer, launched S3 Retirement

Homes, one of India‟s first retirement projects. Covai Care primarily offers three forms of

care facilities for its residents including assisted care for senior residents, palliative care for

terminally ill patients and memory care for patients with dementia or Alzheimer's with

properties in Bangalore, Mysore, Coimbatore and Pondicherry. The properties‟ prices range

from USD60,000 to USD150,000 depending on size. Residents also have to pay around

USD270-300 a month for medical and maintenance fees.

For the middle class, Age Ventures India (AVI), a non-profit organization that petitions

builders to develop properties, works with developers to build elder care homes and

communities by sharing best practices and identifying project locations. These homes are

modestly priced, with a 1BHK apartment starting at USD22,500 at the organization‟s first

project in Bangalore.

Ashiana Housing, a Delhi-based real estate developer, pitched its retirement communities

to the middle class in tier-1 and tier-2 cities. The prices range between USD45,000 and

USD100,000 for the units.

At the lower end of the spectrum, there are government-operated old age homes, which

feature dormitories instead of rooms. There are a number of cheaper nursing homes that are

run by private owners, however quality is still an issue given the lack of government-

imposed industry standards .

Assisted Living

Product Category Analysis: Assisted Living

Assisted living has begin to take off in India, with various providers catering to a wide

range of price points.



Experts‟ Comments


Though the stigma associated with senior

living is fading, several people were averse

to the senior tag. It is important for the

expanding industry to provide services that

cater to emotional and mental well-being,

besides other facilities such as specialized

care for illnesses and tourism services.

Ignox Consulting

The requirement for medical attention and services will keep growing in India. It

would be foolish to expect that roads would be widened enough to prevent traffic

jams or getting to visit a queue-free hospital billing counter will be possible in the

near future. Keeping these aspects in mind it is safe to say that the need for home

healthcare will increase in the coming years.

Multi-disciplinary approaches to

geriatric care can be fostered by

collaborative training among

medical, paramedical and other

professionals. Future care giving for

the elderly will also require models of

both formal and informal care and

systems for supporting caregivers.

Department of Community

Medicine, Smt. Kashibai

Navale Medical College, India

Elderly healthcare expenditure

in India is expected to grow

from USD24bn in 2014 to almost

USD44bn.

Deloitte

India Development

Gateway (InDG)

Location, weather, healthcare,

facilities and reputation of the

builder are five key factors to

decide on the right choice for a

senior living accommodation.

Eden Retirement

Homes


Lessons From the Korean Silver

Town Model


Legal Framework

Korea aims to improve care and support for seniors living at home by:

Announcing a blueprint for expanding care services to seniors in their homes, with a

view to its realization by 2025. The plan is envisaged in the framework of the

“Community Care” program, an alternative to confinement in medical institutions or

nursing homes for seniors and dependent persons staying at home.

Subsidizing the cost of housing for seniors who could not afford it by offering 40 000

units of public housing for 2022. Among them, 5 000 “public silver houses” will be

reserved as a matter of priority for low-income older people living alone. Those

houses will be located near public health care establishments and equipped with

safety devices such as automatic gas cutoffs.

Increasing the number of older people receiving home health care services from

doctors and nurses from 1.25 million to 3.93 million by 2025.

Expanding the network of community health care centers throughout the country,

establishing the “Community Care” policy.

Promoting life care insurance for senior citizens is a policy priority:

Korea aims to increase the ratio of aged people being covered by life care

insurance in order to meet the Organization for Economic Cooperation and

Development standards.

The Korean government works closely with industry to develop a series of interlinked plans

to boost development and uptake of smart technologies in the senior care sector.

Supporting the robotics industry and AI technologies in elder-care has been a policy goal

as robots continue to get up close and personal within the human household.

National


Development

Policy Analysis

As a “super-aged” society, taking care of senior citizens is a national priority in Korea,

one which is addressed by both the public and private sector through the “Community

Care” framework.



Silver Towns

Korea‟s government has been initiating Silver Towns since the early 1990s in response

to growing concern over Korea's fast aging population

According to Statistics Korea, in 2018, more than 14% of

Koreans were aged 65 or older and this figure will soon

reach 24.5% in 2030.

Korea is considered an aged country in 2018 and is

expected to become a supper-aged nation by 2020.

The rapidly increasing aging population combined with a

lack of aged care facilities in Korea has led to the

development of silver towns.

South Korea‟s Population Aged 65 and over (%)

12.8 14.1 14.3 20.0 24.5 32.8 41.0

2015 2017 2018 2020 2030 2040 2060

Aged 65 and over Others

A silver town is a residential community or housing complex designed

for older adults who are generally able to care for themselves.

Assistance from home care agencies is allowed in some communities.

Activities and socialization opportunities are often provided.

1. Idyllic Detached

Housing Complex (IDHC)

2. Senior Welfare House

(SWH)

3. Senior Community

Home (SCH) Source: Spire analysis of published reports and government publications


Silver Towns

xxx

1. Overview Housing type Detached House High-rise condominium Multi family-housing

Privacy Very high High Low to medium

2. People

Age restriction for residents No Over 60 Over 60

Age range 55~70 65~80 70~85

Health level requirement High Medium Low

3. Cost

Can people own the property Yes No No

Price/Tenancy Deposit US$ 300,000 ~ 500,000 US$ 100,000 ~ 400,000 US$ 3,000 ~ 10,000 (for

paid Senior Community Home)

Monthly administrative fee NA US$ 1,300 ~ 2,300 US$ 500 ~ 1,000 (for paid

Senior Community Home)

Economy level of the residents

High High Very Low ~ Low

4. Facilities

& Services

Central management No Yes Yes

Community restaurant No Yes Yes

Organized Activities & socialization

Low High Medium

Level of amenities Low High Medium

Personal caring NA Low Medium

5. Statistics

(2018)

Number of houses/buildings 61,950 35 355

Number of people 79,242 6,398 13,598

% of senior population (over 65)

1.04% 0.08% 0.18%


Opportunities

Increasing numbers of seniors who choose not to depend on their children led to the

introduction of the all-in-one silver town model

The concept of all-in-one silver towns in Korea was

born out of the inevitable need for more service

industries to cater to senior citizens, who are fast

increasing in number and want to stay independent.

According Korea Silver Industry Association, all-in-

one silver towns should be a place where senior

citizens can feel at home, with all the entertainment

they desire, from sports to hobbies, while at the

same time they have access to medical care.

The premises of these silver towns are open to all so

younger people may come in and enjoy the

facilities and naturally mingle with the elderly.

Homes in the towns are advised to be close to

hospitals.

Providing healthy

diets

Providing hobbies

and entertainment

Providing sufficient

medical services


Opportunities

information technology penetration and usage are high in Korea and fast rising in the

Korean elder-care sector

Korea has one of the most active online

populations in the world. In 2018, the internet

penetration rate of the country was estimated

at nearly 96%. This receptivity underpins the

integration of assistive technologies in silver

towns in the form of various devices and

services for the elderly.

Silver towns are said to increasingly feature

substantial embedding and adoption of

smart information technologies and devices

to support independent living by seniors.

Categories Technologies used in Silver Towns

Technology in

Individual

Living Unit

For care

• Nursing & Emergency

call

• Movement detection

sensor

• Portable emergency

pager

• Real-time health check

• Tracking system

For

environment

control

• Remote inspection

• Indoor Air Quality

control (only air supply

system)

• Home network system

• Lighting control/

Energy saving

• Elevator call

For security • Card key

• Monitoring

Technology in

Communal

Facilities

• CCTV

• Movement detection

sensor

• Parking control


Prepared for:

Prepared by: Spire Research & Consulting

Date: 8 November

Eldercare Exhibition & Conference

Asia (ELDEX) 2019

ELDERCARE EXHIBITION & CONFERENCE ASIA 2019


Research and Consulting Solutions

COMPETITOR ANALYSIS

BUSINESS

PARTNER SELECTION

CORPORATE SOCIAL

RESPONSIBILITY CONSULTING

CHANNEL HEALTH

MANAGEMENT

SUPPLY CHAIN MANAGEMENT CONSULTING

KNOWLEDGE

PROCESS OUTSOURCING

SALES LEAD HANDLING

GEO-MARKETING

MARKET SIZING AND FEASIBILITY

PRICE RESEARCH

MARKET ENVIRONMENT

RESEARCH

THOUGHT

LEADERSHIP CONSULTING

CUSTOMER DECISION

DYNAMICS ANALYSIS

COUNTRY RESEARCH

CONSUMER RESEARCH

GO-TO-MARKET

PLAYBOOKS

VALUE CHAIN ANALYSIS

ANTI-

COUNTERFEIT CONSULTING

HOLISTIC MARKET ENVIRONMENT RESEARCH

ETHNOGRAPHY

CROSS-BORDER

CONSULTING


Table of Contents

I. Demographics of Aged People and Social Change

II. Long-Term Care Insurance (LTCI)

III. Retirement village in Korea

IV. Senior Welfare House


Demographics of aged people

and Social Change


4.53

3.43

2.82

1.66 1.57 1.63 1.47

1.08 1.23 1.24 1.17 1.05 0.98

62.3 64.2

66.1

68.9

71.7 73.8

76.0 78.2

80.2 82.1 82.4 82.7 82.7

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

55.0

60.0

65.0

70.0

75.0

80.0

85.0

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2016 2017 2018

Life Expectancy and Total Fertility Rate

Total Fertility Rate Life Expectancy

• Life Expectancy has increased over 20 years in 50 years.

• Total Fertility Rate has decreased from 4.53 to 0.98 in the same period.

• The Fertility Rate of 0.98 is the lowest in the world. 200th out of 200 countries .

(http://worldpopulationreview.com/countries/total-fertility-rate/).


World's shortest time to be an aged society

Ageing is fastest in the world

2018

2028

Korea 2000 2018 2025 (Est.) 14.4% 18 7

• Korea reached aging (7%, 2000), aged (14%, 2018) and will be super-aged (20%, 2025).

• It took 18 years to be an aged society but will only need 7 years to be a super-aged society.

• This is shortest time needed to reach aged and super-aged society in the world.


Who looks after seniors?

Government replaces family for senior care

8.1 9.6 7.8 12.7

16.6

19.4

89.9

70.7 63.4

36.0 31.7

26.7

2.0

19.7

28.8

51.3 51.7 54.0

0.0

20.0

40.0

60.0

80.0

100.0

1998 2002 2006 2010 2014 2018

Who shall look after?

Themselves Family Government

30.8 24.6

21.8 17.5

14.6 12.0

19.4 14.5 14.9 12.3 10.3 8.1

44.9

56.7 56.3 62.8

66.0 69.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

1998 2002 2006 2010 2014 2018

Who live with seniors?

Eldest Son Other Son Daughter

None Others

• The willingness of senior care by a family has decreased sharply (89.9% 26.7%).

• People are asking the government to take care of seniors (2.0% 54.0%).

• The seniors who are living without their adult children has increased (44.9% 69.5%).

• The eldest sons are not obligated to look after their parents anymore (30.8% 12.0%).


The needs for Long-Term Care Insurance

Seniors cared for by society

Issues Contents

Demographics • Increased life expectancy, decreased total birth rate • Ageing (2000), Aged (2018), Super-Aged (2025) Society • Increased number of people over 65 years old

Social and economic phenomenon

• The number of seniors living without family increased including single-person households seniors

• Families do not support seniors as they did in the past • Majority of seniors have no sufficient economic preparation

for retirement • A large % of seniors are not properly cared for

High caring cost

• Senior care needs US$ 1,000 ~ 2,500 per month

• Many seniors on an average income can not afford to maintain themselves

High medical expenses • Many Seniors having no family support are admitted to

geriatric hospitals for general caring. An unnecessary increase in medical expenses


Long-Term Care Insurance (LTCI)


Introduction

History

Qualification:

• Elderlies who can not maintain a healthy life due to old age or geriatric disease.

• Income is not an eligibility criterion.

Purposes

• To improve old-age health and stable living.

• To decrease the burden of a family.

• April 2007: The Elderly Long-term Care Insurance Law (LTCI) was passed.

• July 2008: The national mandatory elderly LTCI was established.

• After July 2008: Nursing care for the elderly was open to all elderly Koreans.

Outline


Item National Health Insurance Long-Term Care Insurance

Benefits • Medical services and operation • Care service to elderly

Eligibility • Anyone is eligible for National

Health Insurance.

• People who are over 65 years old or

having geriatric diseases

Service cap • Until the end of the medical

service to fix the problems • Monthly maximum celling amount

Service providers

• Medical professionals a doctor, nurse, pharmacist, etc

• Care taker

Service providing

facilities

• Hospitals, clinics, pharmacies • Nursing home, group home,

day/night care center

• Home care service with facilities

Comparison between NHI vs LTCI


Beneficiary


Insurance benefit types


Expansion of long-term care beneficiaries

Expansion of long-term care beneficiaries by year 2022

From '8.0% (2017) to 9.6% (2022), strengthening the role and protection as a social insurance

6.11% 6.57% 6.96% 7.49% 8.00% 8.70% 9.09% 9.28% 9.47% 9.63%

LTCI Beneficiaries


In-Home Care 2009 2011 2013 2015 2017

Total Number (unit) 19,072 19,505 19,732 22,921 26,574

Capacity (person) 32,979 23,370 27,896 42,075 68,692

Home-Visit Care Number (unit) 8,446 8,709 8,620 10,077 11,662

Home-Visiting Bathing Number (unit) 6,279 7,162 7,146 8,253 9,357

Home-Visit Nursing Number (unit) 787 692 597 574 650

Day and Night Care Number (unit) 1,106 1,321 1,427 2,018 2,795

Capacity (person) 18,302 21,324 24,286 39,270 66,607

Short-Term Care Number (unit) 1,368 234 368 299 218

Capacity (person) 14,677 2,046 3,610 2,805 2,085

Medical supplies Number (unit) 1,086 1,387 1,574 1,700 1,892

Statistics of facilities

Facilities

Facility Care 2009 2011 2013 2015 2017

Total Number (unit) 2,629 4,061 4,648 5,085 5,304

Capacity (person) 88,191 123,712 140,019 159,368 174,543

Nursing home Number (unit) 1,695 2,489 2,498 2,935 3,289

Capacity (person) 80,218 110,387 121,349 140,788 156,862

Group home Number (unit) 9,34 1,572 2,150 2,150 2,015

Capacity (person) 7,973 13,325 18,670 18,580 17,681


Demand estimation

Estimated demand for long-term care infrastructure

5324 5756

6180 6595

6999

3742 4062 4381 4700 5020

2018 2019 2020 2021 2022

Long-term care facility

Care facility Day / Night Care

364,391 396,297

430,111 463,925

497,739 531,553

0

390,886 417,381 443,876 470,371

496,866

2017 2018 2019 2020 2021 2022

Nursing care worker

Demand Expected

The Direction of Long-Term Care Infrastructure Expansion

Facility

• New buildings

• Increasing utilization rates

Manpower

• Education and training

• Good Treatment


Retirement village in Korea


What is a retirement village

Retirement village

• A retirement village is a residential community or housing complex designed for older adults

who are generally able to care for themselves

• However, assistance from home care agencies is allowed in some communities

• Activities and socialization opportunities are often provided.

5 Keywords of retirement village


Three types of retirement villages

Retirement Village

• Senior welfare house is similar to a retirement home which is a multi-residence

housing facility intended for the elderly.

• Each person or couple in the house has an apartment-style room or suite of rooms.

• Additional facilities for meals, gatherings, recreation activities are provided within the

building.

• A place in a SWH can be paid for on a rental basis or bought in perpetuity on the

same basis as a condominium.

• Senior community home is accommodation for low-income seniors with little family

support.

• SCH offers guidance and counseling and provides a communal living environment

that creates mutual care and support in their community home.

• Regular activities are organized to maintain physical, mental and social well-being.

• Idyllic detached housing complex consists of multiple detached houses in an idyllic

suburb near Seoul and other big cities.

• As the complex is too far from the cities for daily commuting to work so retired

people moved in.

• There is no central administration governing the complex like a Senior Welfare House

or Senior Community Home.

• Residents are independent in daily living although they have a close attachment

with neighbors.


Comparison of three types of retirement villages


Senior Welfare House


Location

Location

Seoul: 11 out of 35

Gyeonggi Province: 12 out of 35

3 Different types by location

City

Suburban

Countryside

Type Number

14

9

12


Management

Management of Senior Welfare

House

Public Organization


Cost Range


Advantage • Green environment • Very high privacy

• Central management • Good facilities and

service

• Central management • Relatively low cost

Disadvantage

• Expensive • No service provided • No modern life

• Expensive • No permanent

residency

• Isolated • Low privacy

Limitations

• Limited to healthy,

active and affluent seniors

• Limited to affluent seniors

• Misunderstanding as a Senior Community Home

• Limited government

budget • Social prejudice

New trends & initiatives

• Social activities & Hobbies

• 2nd income • Trips to the city

• Mixed-use apartment • Home service

• Government initiates comprehensive care offering programs at

home

Retirement villages overseas

• 60.1 % Koreans are interested in living overseas after retirement. • Expected monthly living costs: US$ 2,000~4,000. • Anticipated difficulties: a language barrier, loneliness, high living costs • If the retirement villages are affordable, well organized & managed then there

is a good potential to attract Korean retirees.

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