On June 26, 2025, a surprise inspection of an old age home in Noida, Delhi’s satellite township in neighbouring Uttar Pradesh, uncovered a shocking tale of utter neglect of the elderly. The police raided the facility with members of the Uttar Pradesh Women’s Commission and officials of the State Welfare Department and found over 40 senior citizens living in horrific conditions.

Many of the home’s residents were inadequately clothed or their clothing was soiled. They complained about lack of care and ill-treatment. They were not properly fed and slept on bare mattresses. The facility, operated by a trust, was also not registered.

The revelations, however, were more than just about one facility. They pointed towards the gaps in senior citizens’ care in India: from the lack of familial support and loneliness to infrastructural lacunae and inadequate policy and regulatory frameworks. They rang alarm bells, especially because of the country’s demographic shift towards a rapidly growing elderly population.

India has enjoyed a demographic dividend with a sizeable working age population. But this advantage is already diminishing. Current population trends indicate that India can be described as an ageing country.

According to the United Nations Population Fund, there are an estimated 153 million people above 60, with the number expected to reach 347 million by 2050. As per the Report of the Technical Group on Population Projections released in July 2020 by the Union Ministry of Health & Family Welfare (MoHFW), the number will reach 230 million by 2036.

The Longitudinal Ageing Study of India (LASI) 2021, India’s largest national study on ageing, conducted by the MoHFW, estimates that senior citizens form 12 per cent of the population. It projects the number to reach 319 million by 2050 (19.5 per cent of the total population).

These projected demographic changes present enormous socio-economic challenges. Experts talk about the need for urgent steps to plug infrastructural gaps, especially in healthcare, old age homes, and home-based care. They emphasise a holistic, multidimensional approach that starts with community-level care and goes up to tertiary medical treatment. It is felt that policies must also be devised keeping sociological factors in mind such as the breakdown of the joint family system and migration of the young, which often leaves senior citizens deprived of familial care.

Kunal Kishore, the mission head of agecare at the NGO HelpAge India, said: “India has made meaningful progress in recognising the needs of its ageing population, but the scale of the change ahead means that a great deal remains to be done. The current laws and programmes provide an important foundation; yet the overall framework is still developing and is not applied consistently across all States.”

According to Kishore, a comprehensive approach that integrates healthcare, social security, housing, mobility, long-term care, digital access, and other essential support systems can be transformative: “We need an integrated policy that looks at ageing as a full life course rather than involving separate sector specific responsibilities.”

According to NITI Aayog’s position paper “Senior Care Reforms in India: Reimagining the Senior Care Paradigm” (released in February 2024), there are many challenges due to “the lack of a comprehensive, integrated policy for care and support”. It cites gaps in capacities for elderly healthcare and welfare, evidence-based knowledge repositories for geriatric illness management, frameworks to enable care, and monitoring mechanisms.

Addressing the disease burden of the elderly

One of the topmost concerns is the impact of the disease burden of the elderly on an overburdened healthcare system. The LASI 2021 report estimates that 75 per cent of the elderly have one or more chronic diseases. As per the NITI Aayog paper, healthcare programmes and policies have not paid adequate attention to geriatric care, a relatively new area mainly restricted to cities.

The elderly are predisposed to contracting communicable diseases due to their reduced immunity, and there is a high occurrence of non-communicable conditions such as diabetes, high blood pressure, chronic lung and heart diseases, and bone and joint diseases in them. There is also a significant prevalence of age-related neurological and psychiatric problems such as dementia and Alzheimer’s and mental health issues such as depression and loneliness.

The MoHFW launched the National Programme for Health Care of the Elderly in 2010-11. This was in pursuance of the National Policy on Older Persons, adopted by the Government of India in 1999, and Section 20 of the Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007, which deals with the medical care of the elderly. The programme envisaged setting up primary and secondary care services in district hospitals, community health centres, and primary health centres. Tertiary care is provided in Regional Geriatric Centres at 17 medical colleges and two National Centres of Ageing, one each at the All India Institute of Medical Sciences (AIIMS), New Delhi, and the Madras Medical College, Chennai. The LASI project is the research component of the programme.

The government has taken some measures towards enhancing the availability of specialised geriatric care. The Union Minister for Social Justice and Empowerment in a written reply to a question in the Lok Sabha on March 18, 2025, said that 32 institutes were empanelled between 2023 and 2024 under a scheme that trained 36,785 geriatric caregivers. Union Finance Minister Nirmala Sitharaman announced in the Budget this year that reforms would be undertaken to strengthen healthcare systems and infrastructure for the elderly, with 1,50,000 multi-skilled caregivers estimated to be trained in the 2026–27 financial year.

According to experts, these are welcome steps, but a lot more needs to be done. Geriatrics is still not a widely available specialisation for doctors and nurses, and only a few medical colleges, such as AIIMS, have a geriatrics department.

Dr Meenal Thakral, attending consultant in geriatric medicine, Artemis Hospitals, said that research and specialised care for the elderly are at a nascent stage, with inadequate funding and trained professionals: “India’s ability to train skilled geriatric care workers, build medical infrastructure, and conduct research on the elderly is still limited. India has only about 300–350 geriatricians for more than 150 million elderly people right now. Medical schools offer only about 31 MD [postgraduation in Doctor of Medicine] seats in geriatric medicine across nine colleges.

“India will need tens of thousands of geriatric specialists in the next few decades to help seniors with chronic diseases, dementia, and the disabilities that come with getting older.”

The urban-rural divide, especially, is seen as a major factor determining access to healthcare for senior citizens. Poonam Muttreja, executive director of the NGO Population Foundation of India, said: “The rural dimension of ageing is critical. For the nearly 70 per cent of elderly Indians in rural areas, access to healthcare, transportation, pensions, and social services becomes much more difficult.”

Muttreja suggested that primary healthcare centres be strengthened to provide geriatric care, chronic disease management, and regular screening. Telemedicine, she said, can also be helpful in bridging geographical barriers.

“Hiring and training more community health workers such as ASHAs [Accredited Social Health Activists] to identify elderly people with health or social vulnerabilities and connecting them to services is essential. Ageing must be integrated into existing rural health and community programmes,” she said.

Regulating functional old age homes

Another major area of concern is the shortage of old age homes and their inadequate regulation. According to government data, under the Centre’s Integrated Programme for Senior Citizens Scheme, as of August 2025, 696 senior citizen homes operated with the government’s support, and additionally, 84 new homes were selected for support in 2025–26. As per the 2024 NITI Aayog paper, the MWPSC Act has a provision for State governments to set up at least one old age home in every district, housing 150 senior citizens each. However, a 2021 Standing Committee report on Social Justice and Empowerment notes that fewer than 500 districts in India even have old age homes.

A study by Tata Trusts, Samarth, and the United Nations Population Fund on old age facilities in India published in 2018 analysed a sample set of 480-plus old age homes and over 60 senior living developments in 84 cities, towns, and districts. It projected the sample against the population data from the 2011 Census, arriving at an estimated requirement of around 1,150 facilities housing around 97,000 people. It forecast “a crying need to enhance the capacity 8- to 10-fold over the next decade”.

The study also revealed a huge gap between expectations and delivery of services. It found that homes run by private organisations and charities addressed only the needs of a small fraction of the elderly population and that there was no way of evaluating their quality and appropriateness. It recommended mandatory implementation of a set of minimum standards—compulsory registration, annual filing of financial details, and periodic inspections—ensured by a combination of an independent regulator and a voluntary ombudsmen or its equivalent from civil society.

Kishore emphasised that going forward, India should put a clear national framework in place that promotes uniform standards: “As there is no one regulatory body or framework, the structures and operations of old age homes remain varied with various estimates on the number of such facilities. The Ministry of Social Justice and Empowerment has issued minimum standards for old age homes, and the facilities registered with district social welfare departments are to follow these guidelines. Even so, the levels in which the standards are monitored and the consistencies in their implementation vary from place to place.”

The need for “home-based” care

There is a growing realisation that home-based care with an active involvement of the local community can provide an effective way to look after the elderly.

The NITI Aayog in its position paper said that “ageing in place” or “home-based care” has gained prominence as a policy response: “This refers to an older person’s ability to live in their own home and community safely, independently, and comfortably regardless of age, income, or level of intrinsic capacity.”

Muttreja too pointed out that home-based care is becoming increasingly important as families get smaller and urban migration separates generations, but she said that the home-care sector in India is still largely limited and unregulated, with varying training standards.

“In India, most elderly people prefer to age within their communities and families. Countries such as Japan and the Netherlands have invested heavily in community-based and home-based care systems. India too could strengthen community care networks, day-care centres for the elderly, and support systems that allow older people to age with dignity in their own environments,” said Muttreja.

At the heart of any discussion about the elderly is the issue of their loneliness, often accompanied by depression, low life satisfaction, and safety concerns. The WHO identifies isolation as a growing public health concern, particularly amongst older people.

Kishore said: “Isolation often results in loneliness, depression and other mental health challenges, especially for seniors living alone or left behind due to family members’ migration. While health systems largely prioritise physical ailments and clinical mental health conditions, psychosocial well-being remains significantly neglected.”

The key to addressing socio-economic disparities and the urban-rural divide in elderly healthcare is ensuring social security networks. According to the LASI 2021 report, 78 per cent of senior citizens do not have pension cover and only 18 per cent are covered under health insurance. While there are government schemes and legal provisions for social security for the elderly, studies show that there is either low awareness or senior citizens find the process to avail themselves of benefits cumbersome.

Dr Thakral said: “India does have some basic laws and policies: the MWPSC Act is one of the most important ones among them. It says that children or heirs must support elderly parents financially. The National Policy on Older Persons, 1999, and the National Policy for Senior Citizens, 2011, aim at providing older people with social security, healthcare, and safety. However, the country’s social safety nets are not very strong. The present system is not good enough to handle the quickly growing elderly population’s needs.”

Experts, meanwhile, also underline the need to look at ageing not just as a welfare issue but a core development priority with socio-economic advantages.

Muttreja said: “India has to urgently start thinking about ageing in terms of the ‘silver dividend’: the economic and social opportunities that arise when older adults remain healthy, productive, and socially engaged. Just as the demographic dividend depends on investing in young people and the gender dividend on investing in women and girls, the silver dividend requires investing in healthcare, lifelong learning, financial security, and community participation for older citizens.”

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