For decades, Indian healthcare has worked on a simple assumption: you fall ill, you go to a hospital, you get treated, you go home. That assumption served a country with a young population reasonably well. It will not, however, fully serve an ageing one.
By 2050, one in five Indians will be aged 60 or above—347 million people, up from ~149 million, according to the UNFPA India Ageing Report 2023. More than 75% of India’s elderly already live with at least one chronic condition, and only 18% have any form of health insurance, NITI Aayog’s 2024 position paper on senior care notes. The numbers are familiar by now. What remains under-examined, is the mismatch they expose.
Gaps in the system
Our healthcare system is designed to treat diseases. Ageing is not a disease: it is a phase of life marked by many layered conditions that unfold across years and across clinical specialties. Take for instance, hypertension alongside early Parkinson’s alongside mild cognitive decline in a single 78-year-old patient. A hospital-first model has no coherent way to hold that complexity together. The result is predictable. Manageable conditions quietly escalate into preventable hospitalisations. Families absorb the shock. Everyone calls this outcome of gaps in our care model “bad luck”.
What needs to change
Fixing this gap in long-term care (LTC) infrastructure for seniors requires redesigning four things in parallel: workforce, digital infrastructure, supply chains, and financing.
When it comes to the workforce, India’s geriatrics care pipeline is thin by any measure. We have fewer than a thousand certified geriatricians for a population of over 150 million seniors, with training seats in geriatric medicine remaining few enough that the specialty struggles to attract talent at all—just 80-85 as per the estimates presented by the ASLI-PwC report 2025 ‘Silver Surge: 347 million Reasons to Rethink Capital Allocation’.. But the long-term care gap cannot be closed by geriatricians alone. It needs a trained cadre of nurses, therapists, and care companions who understand both the clinical and emotional dimensions of ageing. Short certification programmes are a start. But, what India needs are accredited skilling pipelines, supported by the Healthcare Sector Skill Council (HSSC), along the lines of our SAMARTH programme—long enough to be rigorous, structured enough to produce consistent quality.
On digital infrastructure, remote monitoring and teleconsultation tools must be built for continuous chronic care, electronic records need to follow the patient across home, clinic and hospital, ideally anchored to the Ayushman Bharat Digital Mission.
In supply chains, reliable delivery of quality drug formulations, consumables and assistive devices into tier-two and tier-three cities is still treated as an afterthought; this should not continue.
Why this is urgent
A well-managed chronic condition at home can prevent an acute episode that lands a senior citizen in the ICU. Take post-surgical recovery: a senior discharged after a hip replacement, whose recovery is supported in a transition care facility or at home by a trained nurse, a physiotherapist and remote monitoring, is far less likely to be readmitted for an infection or a fall. That step-down care costs a fraction of a re-hospitalisation, and, importantly, it prevents the kind of setback a senior may never fully recover from. Insurance will cover the readmission without question. It will rarely cover the care that prevents it. The cost logic is already clear. The coverage has not caught up.
The real need is continuity between settings; step-up and step-down pathways that move a patient from hospital to transitional care and back home, guided by a consistent care team and shared records. Care at home, assisted living, and specialised care homes are not competing models. They are sequential stages in a single continuum. A care system that cannot move patients smoothly between them cannot claim to be designed for ageing at all.
The cultural shift
For India, the most interesting shift, though, is cultural. A decade ago, seeking professional care for an ageing parent was often viewed as abdication in our country. Today, more families see senior care as a responsible choice, an informed extension of care, not a replacement for it. The conversation I hear most often now is no longer “should we spend on this?” but “where do I find the right provider”. This is a significant marker, and it is running ahead of the system meant to serve it.
The market is catching up. NITI Aayog estimates India’s home healthcare market will grow to $21.3 billion by 2027. The senior care industry as a whole is pegged at roughly $30 billion, with room to multiply. Capital is arriving, regulation is beginning to form, and a generation of urban, informed, longer-living seniors is asking pointed questions about where and how they will age.
The path ahead
What India needs next is not only more hospital beds, but also a long-term senior care ecosystem including integrated care hubs that bring assisted living, day care and rehabilitation under shared standards, connected to home-care teams, telehealth, and community outreach, and governed by common protocols for safety, dignity and continuity. Even as large hospital chains enter tier-two and tier-three regions to bridge healthcare gaps, it is important to ensure that seniors’ dignity, independence and joy is retained in these systems. A hybrid senior care model suited to Indian families, incomes and geographies is the need of the hour, not a copy of another country’s template.
The country is ageing faster than its systems are adapting. Treating disease will always matter, but it is no longer enough.
(Ishaan Khanna is CEO of Antara Assisted Care Services—the assisted care arm of Antara Senior Care. ishaan.khanna@antaraseniorcare.com)