Why Insurance Should Pay for Tele-Rehab, not just Stents
By Arunima Rajan
PMJAY @7 meets ‘70+’: Are private hospitals geriatric-ready for the next demand wave?
India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) has completed its seventh year, a milestone, that comes with celebration and scrutiny. Last year, the government announced the inclusion of senior citizens under its flagship scheme. All citizens aged 70 and above, regardless of their income or socio-economic status, are entitled to healthcare coverage of up to ₹5 lakh a year.
The numbers, however, tell a different story. While states like Uttar Pradesh lead with the highest number of cards issued, in others such as Bhopal, only one in six hospitals registered under PM-JAY offers specialties required for the older population. Access has undoubtedly expanded, but the question remains: can the system meet the needs of the nation’s elders?
“The elderly population (60+ years) is projected to reach nearly 20% by 2050, translating to over 300 million people. The life expectancy at birth rose from 35.8 in 1950 and projected to reach 75 years in near future, whereas total fertility is coming down from 5.9 in 1950 to 2.0 as per current SRS data. This demographic shift will impact all aspects of society in general and senior citizens in particular. Despite this specialised geriatric services are limited to a few tertiary hospitals, while most primary and secondary facilities lack infrastructure, trained manpower, and dedicated geriatric units. Preventive, rehabilitative, and palliative aspects of elder care are poorly integrated into mainstream health services,” says Girdhar Gyani, Director General of Association of Healthcare Providers India.
Most Tertiary Hospitals not on Panel Due to Low Reimbursement Rates
He continues: “Our healthcare system as such will face numerous challenges in providing affordable and accessible healthcare services to older adults more so with their diverse physical and mental needs along with their social and financial challenges. While Ayushman Bharat scheme provides cover up to 5-lakhs and in some states up to 10-lakhs, most of tertiary care hospitals are not on the panel due to low reimbursement rates, there is need to promote senior citizens to take private insurance. Some of the insurance companies offer specialised health insurance plans, there is need for comprehensive and integrated insurance products for seniors which include; OPD care, diagnostic care and preventive care etc,” adds Gyani.
He points out that the National Medical Commission (NMC) can play a pivotal role in strengthening geriatric care. It should mandate the inclusion of Geriatric Medicine as a core component in the MBBS and nursing curriculum, emphasizing practical exposure to elder care. NMC can also promote interdisciplinary training modules involving internal medicine, psychiatry, physiotherapy, and community medicine to foster holistic care.
He also adds that considering that more than 75% elderly people suffer from chronic diseases, there is huge potential of home-based care, which is partially organised yet largely unorganised. Health technology in terms of wearables and telemedicine to an extent can bridge the gaps.
Systemic Gaps
Santhosh Abraham, CEO and co-founder of Elder Aid Wellness, a private eldercare services company, points out that there are three systemic gaps he repeatedly sees when seniors enter private hospitals. “Admission processes focus on diagnosis and vitals but miss frailty, cognitive baseline, or functional status. Hence Delirium, pressure injuries, and medication mishaps appear within 24–72 hours because staff don’t know who’s high risk. For example, A mildly confused patient is treated as “just old” rather than flagged for delirium prevention. Distributed accountability of mobilisation, hydration, and reorientation are “everyone’s job,” hence no one’s job. This can result in patients who spend >20 hours/day in bed; post-discharge, they’re weaker and often fall within weeks,” he adds.
He points out that meds for chronic conditions are continued automatically, and new ones added for hospital symptoms (sleep, BP, constipation) without review. Consequence: Adverse drug reactions and delirium; confusion often mislabelled as dementia.
“A 5-minute, nurse-led, multidisciplinary huddle each morning (charge nurse, doctor, physiotherapist, aide) reviewing : Mobility level, Cognition/behaviour changes, Medication or other alert. This helps in real-time accountability for delirium prevention and mobilization can reduce the falls and new delirium within months. Needs no new technology — just a checklist and consistent team ritual,” he explains.
Abraham continues: “Here’s the pattern: older adults come in with an acute event (NSTEMI, hip fracture, minor stroke), recover medically, then decline functionally and return within three to six months, leaving ICUs and step-down units clogged with low-acuity but high-dependency patients; the impact is that about 20–25% of cardiology and orthopaedic beds are effectively blocked by patients who are medically stable but not fit for discharge; the issue is ward teams aren’t trained in geriatric syndromes, small dips in cognition or mobility delay discharge, families want ‘fully well’ before going
home, homes aren’t ready, discharge planning doesn’t start on day one, and there are no formal links to home care or transitional rehab, so one in three readmissions in older adults is functional rather than medical; the fix is to invest in transitional care and step-down facilities, build integrated home health and rehab pathways, and train ward teams in geriatric functional care to unblock acute beds, reduce readmissions, and build brand stickiness around safe ageing; additionally, implement a ‘Geriatric First 48 Hours’ protocol (screen frailty, cognition, function; route to the right ward; start early physio/OT), use a ‘Family Readiness Checklist’ in discharge planning, create bundled payments that include post-discharge rehab or home support, track a Geriatric Safety Index (falls, new delirium, length of stay, readmissions, family satisfaction), and link discharge to a 30-day tele-rehab or nurse call program.”
Plug-and-Play Plan for Hospital CXOs
Abraham’s three-point plug-and-play plan for a private hospital CEO is simple. “First, set up a ‘Silver Responders’ geriatric consult team that can be on call within 24 hours for every admission over 65, using existing physicians, physio, a clinical pharmacist, and a senior nurse to review frailty, delirium, mobility risk, medication reconciliation and deprescribing, plus early mobilization and a nutrition plan; add a ‘Geriatric Consult’ checkbox in the EMR, run a daily multidisciplinary silver round on flagged patients, and track impact through length of stay and readmission rates for patients over 65. Second, guarantee a structured 24 to 48 hour post-discharge check-in by a nurse or physiotherapist, virtual or at home, using a 10-point script that covers medications and adherence, mobility, wound care, red-flag symptoms, and follow-up bookings; start by training two to three transition nurses redeployed from quality or OPD teams and focus initially on cardiology, orthopaedics, and post-stroke discharges, while documenting outcomes in the EMR and monitoring 30-day readmissions, unplanned ER visits within 7 days, and caregiver satisfaction. Third, publish a one-page senior-friendly hospital scorecard that displays five geriatric safety and function indicators on notice boards and the website to drive transparency and behaviour; use existing quality data to report quarterly on falls per 1,000 bed-days, new symptoms, mobility gains, length of stay, and readmissions, review this at clinical governance meetings, and align nursing, rehab, and administration around shared metrics that also serve as proof of ‘Age-Safe Hospital’ credentials.”
Hospitals are Built for Observation, Not Movement
Eric Race, CEO and founder at Atlas Mobility seconds his views.
“Preventing falls for older adults starts long before the moment of the incident. I would say it begins with designing hospitals around mobility rather than immobility. Too often, hospitals are built for observation, not movement. A fall-preventive design integrates environmental, cultural, and technological elements that make safe mobility second nature.
From an environmental standpoint, we emphasise clear sightlines, non-slip flooring, adequate lighting at all hours, and grab-and-assist points built seamlessly into patient rooms and hallways, not as afterthoughts. At Atlas Mobility, we often see the biggest gains when hospitals dedicate specific mobility zones within patient units that encourage movement under supervision rather than confinement to bed.
Equally important is workflow design. Every patient should have a mobility plan visible and actionable by nursing and ancillary teams. Technology like real-time mobility tracking helps staff identify who needs assistance, when, and how often; turning design and data into proactive fall prevention. Ultimately, a hospital designed for mobility is one that reduces not just falls, but also pressure injuries, delirium, and length of stay,” he explains.
Got a story that Healthcare Executive should dig into? Shoot it over to arunima.rajan@hosmac.com—no PR fluff, just solid leads.