India’s social protection story is often told through scale. We have built large platforms to deliver food, cash, pensions, and services to millions. But there is a quieter crisis that these platforms still do not fully address, the daily realities of older people who live alone, are socially isolated, or struggle with chronic illness and limited mobility.

India is rapidly ageing. The number of people aged 60 and above will rise from 149 million in 2022 to 347 million by 2050, which will be over one-fifth of the population. A pension can prevent hunger, but it cannot address loneliness, ensure medicines are taken on time, or help someone reach a clinic. As India ages, social protection must move beyond cash transfers to care, something long treated as a private family responsibility.

Global evidence shows that societies that age well do not rely only on hospitals or families. They build a community layer of support. The World Health Organization calls this long-term care, not just nursing homes, but a continuum of home and community support that helps older adults maintain functional ability and dignity.

India does not yet have such a system at scale. But it does have something equally powerful: a nationwide network of women’s collective institutions that already reach the last mile.

A familiar platform for a new mission

Self-help groups (SHGs) are among India’s most successful state-supported institutions under the National Rural Livelihoods Mission (NRLM). Today, they bring together over 102 million women into more than 9.2 million groups across India. They are trusted, locally rooted, and experienced in last-mile delivery, whether it is financial inclusion, enterprise promotion, nutrition, or convergence with government schemes.

The missing layer of care

NRLM has already expanded into areas of food, nutrition, health, and sanitation through its interventions. These systems mobilize households, facilitate access to services, and enable convergence with frontline workers such as ASHAs and Anganwadi workers.

However, what remains largely missing is a structured layer of continuity of care.

Current systems are effective in awareness and service linkage, but they are episodic. They do not provide sustained support such as regular check-ins, monitoring of functional wellbeing, or ongoing assistance for individuals who require continuous care. This gap is particularly visible among elderly individuals living alone or in migration-affected households, where the challenge is not only access to services, but consistent, trust-based engagement.

India does not need to build a new system from scratch. It needs to extend the one it has already built.

Building a care layer on existing systems

India should use the SHG platform under NRLM to create a new layer of social protection: community-based elder care delivered through trained SHG members and existing cadres, linked to local health systems.

NRLM’s strength lies in its structured community institutions and cadre-based approach, which enable regular, last-mile interaction at scale. The design challenge, therefore, is not to create a new parallel cadre, but to build on these existing structures.

Community cadres can be equipped with additional tools and protocols to support basic care functions. This could include regular check-ins for vulnerable elderly individuals, early identification of risks, assistance with accessing entitlements, and facilitation of linkages with health systems. The role remains non-clinical, focused on care

coordination and functional support. Embedding this within the FNHW platform ensures that care becomes part of a broader wellbeing agenda, rather than a standalone intervention.

Importantly, this approach fills a clear functional gap. While ASHAs, Anganwadi workers, and ANMs are critical for health and nutrition service delivery, they are not structured for sustained, non-clinical engagement such as regular social check-ins, functional assistance, or long-term follow-up. NRLM’s community institutions are better positioned to provide this continuity.

From pilots to scale

India already has working precedents. Models such as Pune’s Vriddha Mitra and Kerala’s Kudumbashree show that community-based elder care can be organised, skilled, and delivered. The next step is to treat it as a core social protection function and design it for scale.

A phased, targeted approach is a practical starting point. The greatest need is in migration-prone and remote areas, where older adults face isolation and limited access to services. Prioritising such geographies allows the model to be tested where need is highest.

At the same time, rural India is not uniform. The approach must be guided by local realities, identifying where support gaps exist and building accordingly.

A solution with multiple dividends

A community care layer delivered through SHGs can deliver benefits far beyond elderly welfare:

First, it closes a major gap in the safety net. Pensions protect consumption, but not daily functioning. Without support for mobility, treatment adherence, or access to services, many older people remain effectively unprotected.

Second, it creates dignified local jobs. Formalising care through SHG cadres turns unpaid work into trained, paid roles for women, making this a livelihoods intervention as much as a welfare one.

Third, it reduces avoidable strain on the health system. Many hospitalisations among older adults stem from missed follow-ups and late referrals. A well-run cadre improves adherence, flags early warning signs, and closes referrals, which is far cheaper than treating complications.

Fourth, it addresses loneliness and mental health. Social isolation affects many older adults, and regular check-ins can restore dignity and a sense of belonging. From a cost perspective, this model is viable because it builds on existing systems, keeping costs relatively low compared to facility-based care.

Designing for sustainability

For this to work, care must be treated as a core function, not an add-on. It requires trained cadres, clear roles, supervision, and predictable compensation, which NRLM is well equipped to support. There are risks, including overburdened workers, uneven quality, and coordination challenges, but these are manageable within a system that has scaled complex interventions before.

India has shown it can reach the last mile. The next step is to ensure social protection safeguards not just incomes, but dignity, functional ability, and wellbeing. The foundation exists. What remains is to build the missing layer of care.

Aadil is Senior Manager and Mishra is Senior Manager, MicroSave Consulting

Published on April 6, 2026