"Baat hoti hai, baat-cheet nahin hoti hai. Agar dekhbhal hoti hai toh paisa chahiye.”
Words are cheap. Care is expensive. Listen to the refrain of India’s wisdom generation—over-sixties who saw the country sprinting toward modernity while leaving them at the kerb. India, engineered by demographic accident into the world’s youngest major nation, is ageing faster than it is preparing to care for its elderly. The stories of lack of care are stark and tragic; a couple of weeks ago, UP Police rescued 42 elderly people from an “illegal” old-age home in Noida, many of them locked away or tied up, and wallowing in filth. Frequent news reports mention increasing cases of digital arrest of vulnerable seniors—an elderly doctor couple in South Delhi lost nearly Rs 14 crore which was transferred to criminals. A 60-year-old man in Madhya Pradesh was assaulted and dragged behind a motorcycle after refusing a demand for alcohol. A 70-year-old man and his 65-year-old wife were assaulted with a sickle by their son and daughter-in-law in Uttar Pradesh, in a dispute over property. By 2046, India will have more elders than children aged below 15.
Such cases and the absence of physical and medical protection reflect a grim future for India’s elderly. By 2036, nearly 230 million Indians—about 15 per cent of the population—will be over 60. By 2050, that number could cross 20 per cent. This transformation—India’s “silver shift”—is not simply a story about longevity. It is the ‘crisis of caregiving’; a little acknowledged predicament.
Take 42-year-old Deepa Kamat who lives in Bengaluru, who watched her mother’s dementia deepen while simultaneously managing children, a husband, in-laws and a career. She hired a general duty attendant for Rs 20,000 a month and wound up having to train the caregiver herself. She is what sociologists now call a member of India’s “sandwich generation”—adults compressed between the needs of children below and parents above, with no institutional support on either side. The emotional toll is enormous and almost entirely unacknowledged. There is no policy for her exhaustion. There is no helpline for the specific grief of watching a parent disappear into dementia. Such a complex challenge reveals a profound structural vacuum: the absence of a mandatory regulatory framework for senior living and caregiving. Access to dignified ageing is often directly proportional to the size of the bank balance. For the middle class and the poor, this means a relentless struggle to survive with dignity.
Helping them to do so is Santosh, an ex-Air Force officer who set up AIR Humanitarian Home. He can be seen coaxing movement from bodies that have mostly given up on the idea, or leading a group of residents through hesitant exercises. A man on crutches attempts a tentative step. A woman in a wheelchair raises her arm. Outside, the city moves at its usual unsparing pace, indifferent to what is happening inside these walls. Here, 189 abandoned seniors live, many of whom were brought in by the police after found alone or destitute. Some sit quietly, withdrawn into themselves. Others carry simmering anger at life’s betrayals. Rows of beds hold residents battling illness, disability and despair. In one corner, a physiotherapy session is underway. But the facility is barely holding together. The doctor has left. The pharmacy is struggling to keep up and the kitchen is short of supplies. This is not simply a story about longevity and pathos. Indian caregiving infrastructure is so threadbare it borders on civilisational negligence: 4.3 million trained caregivers needed, 36,000 available, and a government still treating the gap as if it is invisible. The country’s much-celebrated youth bulge is already beginning to grey at the temples. AIR’s caretaker Abha Sharma describes the arithmetic of survival: “We rely entirely on donations. We urgently need medicines and 1,800 diapers every month, because most residents are incontinent.” Elder care does not win elections. It does not trend. It accumulates, quietly and invisibly, in places like this.
The caregiver, in all of this, is the most invisible figure of all. They are the first line of defence in elder care and the least protected participant in the system. Undertrained, underpaid, often working without formal contracts or benefits, frequently expected to double as domestic help—their labour is what holds everything together. Across the country, thousands of bhaiyas and didis are already the invisible backbone of elder care, learning on the job, absorbing expertise through proximity and intuition rather than training, and receiving almost nothing in return—not wages that reflect the weight of the work, not insurance, not career progression, not recognition. “They don’t have medical insurance, formal education, or career progression,” says Jamuna Ravi of Bangalore-based geriatric care NGO, Vayah Vikas. Burnout is endemic. Social protection is essentially non-existent. Pavitra Reddy, COO at Vayah Vikas, argues that the sector urgently needs mandated standards that protect not just the elder but the caregiver too. “GDAs, or General Duty Assistants, must be thoroughly vetted and their criminal record checks are a must. But I also find the handover process, followed in home care, lacking clarity. We need to examine what facilities are there in one’s home for the caregiver, too.” For some caregivers like Pooja Thakur, the satisfaction of the job comes first. She says, “It doesn’t feel like just a job. I’m part of each elder’s family. There’s responsibility, and over time, a deep bond develops.” Her work is of profound social value, which the system mostly fails to notice.
We rely entirely on donations. We urgently need medicines and 1,800 diapers every month, because most residents are incontinent.
Abha Sharma, caretaker
The nurse-to-patient ratio tells an important part of the story with cold efficiency: 1:670, against the World Health Organisation’s recommended 1:300. As India’s elderly population is projected to triple its demand for care by mid-century, the country has fewer than 36,000 trained caregivers to answer the call. This is not merely a gap. That is a chasm. The arithmetic of the future of elderly care makes it deeper: an 80-plus population growing by nearly 279 per cent by 2050. The darkness that lies ahead for them is dementia, Alzheimer’s, Parkinson’s, stroke, depression and terminal illnesses. An estimated four million Indians are living with dementia today—a number expected to swell past 13.4 million within three decades. Yet the ecosystem meant to address this—senior living communities, caregiving agencies, home care services—operates in a policy grey zone so murky it barely deserves to be called a system at all. There have been calls for a separate elder-care ministry, mandated caregiver training and regulatory frameworks. But between political rhetoric and structural change lies a vast, unaccountable middle distance in which millions of elderly Indians are quietly left to fend for themselves. “The volumes demand something fundamentally different,” says Saumyajit Roy, founder and CEO of Emoha, a company that provides caregiving at home. “The need cannot be met by a few centres, self-regulation and lack of legislation,” he warns.
One of such whose needs have to be met lives in Delhi; Palki Desai is 75 years old. She has seen revolving door of caregivers who lack meaningful medical knowledge. “I have had seven attenders, none with any medical knowledge. Two ran away with gold and money. The agency disappeared.”
India’s caregiving deficit is staggering. The country currently has a shortfall of 4.3 million trained caregivers. There is sad similarity between Desai and Jenna Mistry. Mistry, a Mumbai-based professional, cares for her elderly father and special-needs brother. She paid a registration fee to an agency but the caregiver they sent lasted just a few days. “He stayed for a few days and left. The agency vanished, and my refund was lost. We were back to square one.” The same pool of caregivers circulates between agencies across cities, often unverified and untrained. Fraudulent operators collect fees from both job-seeking caregivers and fee-paying families, then disappear. Thangamma, who runs Divine Care in Bengaluru, recounts a recent incident with barely concealed outrage: “Some boys started an agency, promised jobs to 15 carers, collected registration fees from both attenders and clients, and disappeared.” In Kochi, a woman caregiver was caught on camera assaulting an elderly person in her charge. The harsh truth is impossible to ignore. For millions of Indians over 60, ageing is not simply about growing older—it is about navigating a daily maze of physical decline, emotional isolation, financial strain and social invisibility. And far too often, they do it by themselves. India’s caregiving economy is dominated by placement agencies of varying degrees of legitimacy, house helps pressed into service as medical attendants, informal geriatric homes operating with no oversight, and high-priced elder-care chains whose self-regulation amounts to guidelines they wrote for themselves.
I have had seven attenders, none with any medical knowledge. Two ran away with gold and money. The agency disappeared.
Palki Desai, 75, on caregivers who lack meaningful medical knowledge
Old age isn’t so bad if one can afford it. “Senior care is not a commercial venture,” insists Rajit Mehta, MD and CEO of Antara Senior Living and chairman of ASLI—the Association of Senior Living India. “Treat elder care differently.” At Antara Dehradun, the starting property price is Rs 2.3 crore to Rs 3.5 crore: these are upmarket retirement communities with on-call nurses, physiotherapy, dementia protocols and curated social programming. The promise is “independence with safety.” The Golden Estate in Faridabad is a boutique, premium facility offering 24/7 medical care, personalised care plans, and luxury hotel-style services. Monthly rentals here start around Rs 83,500 for single occupancy. The luxury old-age home Aurum offers “aesthetic and comfortable interiors that focus on hygiene, safety and privacy”—sip macha tea in the landscaped terrace garden here, or workout at the gym, relax with physio care or a massage and enjoy a gourmet meal overlooking the fountain in the 40,000 sq. ft. residence. Serene Communities by Columbia Pacific, which has multiple care needing communities across Bengaluru, Chennai, and Pune, is the largest senior living provider in India where the starting package is Rs 68 lakh. According to Wealth Monitor app Deservz, there are currently two popular plans in India: buy a villa or apartment costing anywhere between Rs 50 lakh to Rs 3 crore, or pay a monthly maintenance or rental that includes all living costs. A person anticipating retirement 10 years later, may have to pony up Rs 7.4 crore for double occupancy with an annual increment of 7 per cent. Even at these price points, operators must navigate a labyrinthine regulatory void. The luxury senior living sector is also an investment opportunity due to high demand and low supply; current luxury facilities are more than 2 per cent of the potential demand. This is a boon for realtors and the luxury items market who enjoy multiple streams of returns from property price appreciation, rentals yields, monthly maintenance charges, healthcare partnerships, and premium services. Elder care is not formally recognised as a sector, which means providers must curry favour with various authorities simultaneously. Assisted living attracts 18 per cent GST. Healthcare facilities in such homes are also chargeable separately: 10-15 per cent of the annual living cost. Many retirement homes ask for a one-time security deposit of 3-6 months of monthly charges. The policy signal being sent here, whether intentional or not, is that keeping old people comfortable is a luxury. Mehta flags a more immediate concern: geopolitical disruptions affecting LPG supply are creating shortages that impact senior care communities—a reminder that the sector’s vulnerabilities span the macro and the mundane.
For tracheostomy, suction or catheters, there is a scarcity of professional nurses. We’ve to make do with poor quality care. The government must start certified courses.
Thangamma of Divine Care in Bengaluru
But for people who cannot afford to pay for macha tea or a deluxe massage, the inventory gap is grotesque. India will need more than two million senior living units by 2030. Roy’s Emoha—“a home” spelt backwards—has built a platform that now operates across 40 cities, with 8,000 caregivers supporting more than three lakhs elders living independently at home. He estimates that India’s required true caregiver number is between 100 and 150 million trained professionals. But the mathematics of a nation of 1.4 billion people, ageing rapidly, with crumbling family structures and a near-total absence of institutional infrastructure, doesn’t leave much room to argue. Roy entered this space through the door of personal grief. His mother’s struggle with Alzheimer’s and the impossibility of finding adequate care for her led him to build Emoha. His is a recurring pattern: personal catastrophe as the founding document of India’s elder-care industry. Roy’s model is built around the concept of hyperlocal care—“care buddies,” trained “Emoha daughters,” nurses backed by tech-enabled monitoring and a 24-hour helpline. In 400 neighbourhoods, the company has tried to manufacture the kind of closeness that was once normal in extended families. The Emoha Geriatric Academy in Gurugram now trains caregivers across nine modules: clinical care, emergency response, disease literacy, social and home skills, hygiene and technology. The programme is specifically designed to accommodate trainees from disadvantaged backgrounds with limited formal education. The goal is to create 100 newly trained caregivers per month. Against 4.3 million needed, it is at least a start.
What can dignified, well-executed care actually do for a person? Says Bisham Malkani, an Emoha subscriber in Pune who was sunk in the kind of grief that calcifies into something resembling the end of a person after losing his wife, and then his only son. “Emoha was a turning point in my life. Medical support, a care daughter, and social activities helped bring me back to life. It healed me.” Stories like his exist alongside the AIR Humanitarian Home’s rows of abandoned beds. Bani Jain, secretary general of the Association of Senior Living India (ASLI), is pushing for formal recognition of elder care as a sector with binding standards. “Without a regulatory body that sets mandatory guidelines, rules and standards, where do senior living communities register?” she asks. “Who regulates the caregiving gig economy?” The questions are rhetorical only in the sense that nobody currently has to answer. Certain unspoken norms do exist in the sector: no male attendant is sent to an elderly woman and no female caregiver is sent alone to an aged man but these are informal conventions, not enforceable rules. The difference matters enormously when things go wrong.
And things do go wrong. Identity fraud by unscrupulous caregivers—fake Aadhaar cards handed over to people left alone with seniors—is not uncommon. “Make it mandatory to inform the nearest police station after hiring a caregiver,” advises Joyce Kurien of Vayah Vikas, an advocacy and research organisation focused on ageing. “Agencies must be monitored on standards. Let carers have a qualifying exam.” Thangamma is brutally open about the sector’s inadequacies. “For tracheostomy, suction or catheters, there is a scarcity of professional nurses. We’ve to make do with poor quality care. The government must start certified courses.”
The 2026 Union Budget has proposed training 1.5 lakh caregivers—a cup of water against a forest fire; directionally correct, numerically insufficient. Apollo Med Skills, Tech Mahindra, Vayah Vikas and the Skills Council are all running training programmes. Courses range from fifteen days to a year, with varying fees and minimum qualification requirements that screen out many of the people most likely to do the work. These produce wildly uneven results. ASLI is consulting with international bodies—the UK’s ARCO, New Zealand’s Retirement Villages Association—to begin building minimum standards for a sector without any. Santosh Abraham, CEO of ElderAID, which operates across Bengaluru, Hyderabad, Kochi and Chennai, has built his model around a single insight: most facilities are completely unprepared for medical emergencies, and the gap between a senior in crisis at home and a senior receiving appropriate hospital care is why people die. “We step in with care managers during emergencies,” he says. His care managers are trained to serve as “proxy children”—a single, consistent, trusted point of contact. Roy believes preventing falls must become central to any caregiving system. “We have to transition from ‘B2B’—bed to bed,” he says, referring to the punishing cycle where seniors move from bed at home to hospital beds and back again. “Falls account for nearly 40 per cent of all injury deaths.” A hospitalisation bill of Rs 15–20 lakh can often be saved with preventive monitoring and care subscriptions that run just between Rs 5,000 and Rs 15,000 a month. The economics of prevention are straightforward. The political will to build the infrastructure for it is another matter.
Make it mandatory to inform the nearest police station after hiring a caregiver. Agencies must be monitored on standards. Let carers have a qualifying exam.
Joyce Kurien of Vayah Vikas
Kerala, almost inevitably when it comes to progressive action, offers a model that outlines what is possible in senior care: free medicines, counseling and caregivers, and mobile clinics for the bedridden. The Arike project for geriatric care is successful with volunteer-supported home visits as a service with focus. “We give Rs 10,000 per person, and in 180 old age homes, it is free of cost,” says Babu Joseph, president of the Senior Living Association of Kerala. “Volunteers involve the marginalised from villages by offering them free meals to engage in daycare of seniors.” District Collector Prem Kishan of Pathanamtitta says the state has built one of the most robust community-based care systems in India by treating elder care as a public responsibility rather than a private transaction. But all caregivers do not reflect this story. SG Soorej from Pallakad, who cared for his elderly father who died at 92, recalls the nightmare of hiring one at home. “They are so difficult to manage. They come at 9 am and leave at 6 pm with lunch and tea breaks in between. They charged Rs 18,000 a month which wasn’t worth it.” He went through about six to seven caregivers before giving up.
India’s relationship with elder care has always been embedded in the idea of familial duty: the moral architecture of the joint family and the unspoken compact between generations. Nearly 4.3 lakh adults aged 60 to 70 are themselves caring for older parents—a generation of the elderly caring for those even more elderly, in a country with almost no infrastructure to support either. Only 14.4 per cent of seniors have even one caregiver. The rest manage alone.
What India needs to solve this vast dilemma is a national framework, mandatory standards, a regulated workforce, and a caregiving economy that treats its workers with the dignity it asks them to extend to others. This requires the political will to stop treating the old as invisible. Caring for them is not a private matter. It is a national reform, already overdue.