ForSrijita Basak, a resident of Kolkata, the cost of looking after her elderly parents over the past three years has run into lakhs. And there is no end in sight. “My mother had replacement surgeries on both her knees and my father has had multiple operations for his back issues after he had a fall and hurt his spine. For both, while a bulk of the surgery and hospital costs were met through insurance, none of the aftercare at home has been covered. We have incurred massive costs for home nurses, medicines, a hospital bed for home, physiotherapy and care,” said the 31-year-old, private company employee. 

Srijita’s case is not unique: with India’s life expectancy having increased from 41 years in 1950 to 72 in 2024, Indians are living longer, but not necessarily healthier. Our senior citizen population is expected to touch 347 million by 2050, our metabolic disease burden is amongst the highest in the world, and the country accounts for 11% of the world’s road traffic accidents. Taken together, these facts mean that a significant number of citizens need health care at home, sometimes for a short period and in other cases, long-term. According to market research company IMARC Group, India’s home healthcare market was valued at USD 16.3 billion in 2025 and is expected to reach USD 74.57 billion by 2034. And yet, insurance models have not kept pace with these needs, home healthcare services are expensive, unregulated and often unqualified, and community healthcare services are scarce. 

As healthcare increasingly shifts from hospitals to patients’ homes, doctors, geriatric care specialists and patient advocates are calling for health insurance policies to expand beyond hospitalisation and cover home-based care, which they say, has become a critical part of modern treatment and recovery.

After a hospital stay

For many, the end of the hospital signifies the end of costs. For some, however, the financial burden becomes worse after hospitalisation, says Pavithra Reddy, chief operating officer of Vayah Vikas, a Bengaluru-based organisation working with senior citizens. “Older adults recovering from strokes, fractures, surgeries or serious illnesses frequently require nursing support, physiotherapy, wound care, mobility assistance and medical equipment at home. Yet these services are rarely covered by insurance. Families often spend between ₹30,000 to ₹1 lakh a month on post-hospitalisation care.” 

A caregiver supporting a family member with dementia in Karnataka said they currently pay ₹36,000 a month for a full-time attendant. “We have no choice because the caregiver gives us peace of mind, but the costs are substantial and there is virtually no insurance support,” the caregiver said.

Srikala Bharath, geriatric psychiatrist who was formerly with NIMHANS, Bengaluru, said continuity of care remains one of the weakest links in India’s healthcare system. “Healthcare and insurance systems continue to focus on acute care and hospitalisation, while chronic conditions place the greatest long-term financial and emotional burden on families. Recognition of home care as a component of holistic healthcare is essential,” she said.

Ramani Sundaram, executive director of Dementia India Alliance, said families caring for persons with dementia face particularly high costs. “Long-term nursing support, medication management and caregiver assistance are almost entirely funded out of pocket. Home healthcare remains underinsured and inadequately regulated,” she said.

The insurance gap

India’s health insurance architecture is built predominantly around acute hospitalisation episodes. This means that the ongoing care needs of a burgeoning elderly population who might need support for home-based rehabilitation or chronic care are largely ignored. 

“This is a critical gap in our health financing system which neither insurance companies nor the government has chosen to address. These problems are only going to worsen,” a Kerala-based health financing expert said.

What is offered by Indian health insurance companies for home-based care -- domiciliary hospitalisation —  is a specific, narrow provision offered for short-term care at home, which the treating doctor must prescribe and certify. Even with this however, insurance companies have tightened exclusion clauses and have brought in restrictions. “Many are not offering domiciliary hospitalisation cover at all because these claims are very hard to verify and there have been many fraudulent claims. Many now cap it at a percentage of the sum insured,” said Stanley Wilson, business associate, New India Assurance company.

The lack of training

The expense apart, families noted that home nurses provided through agencies are often unqualified and untrained. 

When his father was diagnosed with Alzheimer’s disease, Prakash, a government employee in Thiruvananthapuram, decided to look for dedicated caregivers for him. “I wanted him to be taken care of at home. But it was not easy. I discovered that there were no qualified home nursing care providers and none of the ‘home nurses’ that I hired had any idea how to manage a dementia patient. They would all leave within two days of being hired, complaining that my dad was a “difficult” patient and that he was “non-cooperative”. We could not make them understand that my father needed compassionate care and that he seemed to be “difficult” because he was losing his comprehension skills and memory day by day.”

Over the next few years, Prakash hired a string of home nurses – all of whom, he said, expected to merely help elderly people, not care for them professionally. “None of them knew how to give insulin shots or to even give medication based on the prescription,” he said. 

The burden becomes even heavier when children live abroad and their elderly parents at home require care, an issue that is raising serious social concerns in many parts of the country. 

Sreejaya, originally from Kerala and now in Dubai, took several months off work to care for her ailing mother-in-law, after none of the caregivers she hired proved to have any training. And her experience was similar even at a senior living facility. “The living facilities were fine, but for the care of patients like Amma, who is close to 90, has lost her eyesight to glaucoma and has a host of other ailments, they did not have professionally trained caregivers. They were also depending on agencies to supply them with “home nurses” who had no knowledge or training,” she said.

The impacts

Members of families where one person requires long-term care often have to give up their jobs to care for the sick relative themselves, because outside help, even if untrained, is prohibitively expensive. This creates immense socio-economic and psychological stress, said Subarna Goswami, a senior physician and public health administrator, based in Kolkata.

Financial constraints also often force families to cut back on essential rehabilitation, nursing visits, and follow-ups, Dr. Goswami pointed out. “This compromises recovery, leading to avoidable complications like infections, permanent functional disability, and preventable hospital readmissions. It also overburdens hospital resources by driving up dependency on inpatient services. Ultimately, underinvesting in home care paradoxically spikes total healthcare costs,” Dr. Goswami added. 

What is needed

Home-based care can significantly reduce not only medical expenses but also the indirect costs associated with illness. “When one family member falls sick, caregivers often lose workdays and household productivity suffers. Home care has the potential to reduce these burdens while ensuring continuity of treatment,” said U.S. Vishal Rao, group director for head and neck surgical oncology and robotic surgery at HCG Cancer Centre, Bengaluru.

What is required, said the Kerala health financing expert, is a model that blends both traditional health insurance and welfare provisions, to address the increasing long-term care needs of senior citizens, people with disabilities or conditions and injuries. Japan and Germany for instance, have long-term insurance care policies that take this into account. This is an issue that has begun to figure in policy discussions on the demographic crisis and the consequent needs of the elderly population

From a financial planning perspective, Priyanka Rana Patgiri, consultant, geriatrics at Apollo Hospitals, Chennai, pointed out, it may be advisable for families to consider adding a domiciliary floater cover to a health insurance policy. 

While post-operative extended convalesce is mostly covered post major surgeries conducted in hospitals, utilization of this remains limited as these work mostly on a reimbursement, not cashless basis, said Arti Malik, chief technology officer, Universal Sompo General Insurance. However, more people now want cover for both active hospitalisations and extended convalescence and recovery, she noted.

When it comes to training, Ms. Sreejaya said that there was an urgent need for caregivers who are well -versed in dealing with patients, able to understand doctors’ instructions and manage aspects like patient hygiene, dressing wounds, preventing bed sores, checking blood sugar and pressure, checking for vitals etc.

Home care organisations face problems of shortage of staff as there is often no dignity of labour, noted Dr. Patgiri. Training of staff, proper communication and better salaries would help address such issues, she said, adding that effective home care should go beyond medical treatment to include assistance with daily activities, social engagement and caregiver support. “Accreditation of home care organisations by the National Accreditation Board for Hospitals and Healthcare (NABH) will pave the way for greater standardisation of care. This can help improve the quality of care and achieve maintainable benchmarks,” she stressed.

Community care

Going forward, a community-based model integrating healthcare, social support and caregiving services will be essential to help older adults age with dignity at home. Hospital admissions in older adults are often diagnosed in the emergency room, but they begin at home months earlier, Dr. Patgiri pointed out.

In this regard, Kerala, which leads the country both with the highest prevalence of chronic, non-communicable diseases and with top-performing public health infrastructure, is now taking the first step towards creating a brigade of professional nursing care service providers by launching a government-approved six-month ‘Caregiver Certificate Course’, in government and private nursing colleges, as well as in selected hospitals, aimed at ensuring professional care for those in need and providing dignified employment. 

In the private sector, an NGO, Self Employed Women’s Association (SEWA) has joined hands with palliative care organisation, Pallium India, to train women in giving professional palliative/nursing care to those who require it. SEWA’s Secretary, Sonia George says that the first batch of 30 women are now rendering professional caregivers’ service in hospitals and homes and that the demand for the service has been so huge that they have not been able to keep pace. Such an initiative could be modeled across the country

Apart from rehauling insurance models, policies from the government for training of workers to build a skilled cadre, regulations for wage guarantees and rules to ensure the safety and dignity of both patients and those providing care, financial aid for family caregivers and setting up provisions for respite care could all go a long way towards helping families and societies care for their aged and disabled, say experts. 

The problem is growing. Our financial and care models need to catch up.

(With inputs from C. Maya in Kerala, Afshan Yasmeen in Karnataka, Shrabana Chatterjee in West Bengal, Serena Josephine M. in Tamil Nadu and Bindu Shajan Perappadan in Delhi.)