Anu’s phone rang incessantly while she was in the middle of a client presentation. A panicked voice on the other side informed her that her 85-year-old mother had collapsed in the bathroom. As Anu raced to the hospital, she wondered how bad her mother’s condition would be? Would she need serious surgery and home-based care? Would she be able to find trained caregivers, or would she need to quit her job to look after her?

Unfortunately, similar scenes play out across the country almost everyday. So many of us have either experienced it ourselves or know of someone struggling to provide adequate care to an ageing loved one.

The demographic shift no one is planning for

For decades, India has focused so intently on its demographic dividend that it has barely noticed its ageing population. By 2050, 20% of India’s population is expected to be over 60. However, our policy landscape seems remarkably indifferent to the needs of this demographic transition.

It is not just about the fact that people are living longer, it is about the quality of life as people age and how we support that journey as a nation. Today, many elderly live with multiple chronic illnesses and loss of mobility, cognitive ability and agency. 

Changing care structures

India’s joint family structure – once the default eldercare system – is fading fast. As per the United Nations Population Fund (UNFPA), India’s total fertility rate has dropped below replacement levels and stood at 1.9 in 2023. Young adults today could be many miles, continents and time zones away from their ageing parents. Which means many elderly people, especially in urban areas, will live with minimal support or completely alone. 

In cases where the elderly live near, or with, their adult children, caregiving responsibilities fall on women, who are already balancing work, children and household responsibilities. 

This means that many women end up exiting the workforce to look after ageing parents, their resumes bookended by gaps taken for child or eldercare. While some men too struggle with these pressures, the onus is disproportionately placed on women.

Anecdotal evidence shows that India now has a large cohort of the ‘sandwich generation,’ that is looking after ageing parents and children, holding down high-pressure jobs, and saving for their own old age. 

For middle class India, one of the biggest financial goals today is to save enough money to ensure they don’t become a financial burden on their children in the winter of their lives. 

But when the average monthly cost of medicines for treating diabetes, hypertension, cardio-vascular and other common chronic diseases could exceed Rs 5,000, and an additional Rs 40,000 on average for caregiving services in urban areas, even the most prudent nest egg will not suffice in the future. 

Policy gaps 

What India lacks is not compassion – it is policy focus. The government schemes and legislation that do exist are well-intentioned, but fragmented.

The Maintenance and Welfare of Parents and Senior Citizens Act (2007) Act legally obliges children and heirs to provide maintenance to senior citizens. The Act provides that parents can take their children to court to obtain a maintenance allowance from them. However, social norms and complicated legal proceedings stop most parents from turning towards the law.

The National Programme for Health Care of the Elderly (NPHCE) focuses on hospital-based care and doesn’t cover home-based long-term care that most seniors need today. A private members bill introduced in 2019 for elder care and protection is languishing in a parliamentary database.

While there is some awareness about the impact of chronic diseases on our elderly population, there is hardly any discussion about other issues faced by them and their families.

For example, India currently has approximately 8.8 million people living with dementia – and is expected to reach 16.9 million by 2036. The lack of awareness around this issue means most people don’t know how to recognise early signs of cognitive decline or access care before the disease worsens. 

Family members struggle with the emotional fallout of watching a loved older person go from a strong, independent member of society to someone unable to recognise her own home or children. Shouldn’t a 79-year-old nation be better prepared to handle ageing with dignity?

What next?

Today, most caregivers are untrained, underpaid workers who work in an unregulated ecosystem. There is an urgent need to formalise the paid caregiving sector. 

Policy must mandate institutions like the National Skill Development Council to train and certify paid caregivers and agencies so that they provide quality services and receive fair compensation.

Insurance companies could run pilots for long-term care insurance schemes that cover in-home caregiving and assisted-living facilities and create products that address the financial needs of an ageing cohort. 

Corporates could use their Corporate Social Responsibility funds to create community day-care centres for seniors – especially those with dementia – to provide respite to the elderly, and their caregivers. 

Technology too can play a transformative role in the eldercare framework. Hemesh Chadalavada, a 17-year-old from Guntur, Andhra Pradesh, created a compact device designed to detect falls or prevent people with Alzheimer’s from wandering  to safeguard his grandmother. If a teenager could make such a contribution to eldercare, shouldn’t India, the software engine of the world, be incentivising research into such tech solutions that focus on ease of ageing?

Finally, India urgently needs a National Eldercare Policy based on expert inputs and the lived experiences of India’s ageing population and their families. A policy that looks at various aspects of healthy ageing from the perspective of care, financial support, capacity-building, and infrastructure. 

A dignified and healthy old age should not be restricted to the top 1% of the population, who can afford the care the elderly deserve. It should be a right and it is time we created the policy guardrails for it.

Barkha Deva was Associate Director, RGICS, and is currently a Public Policy Consultant.

This article went live on September third, two thousand twenty five, at thirty-seven minutes past nine in the morning.

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