THE new sunday express Voices Devdutt Pattanaik Sathya Saran Ravi Shankar S Vaidhyasubramaniam Dr Ramya Alakkal Mata Amritanandamayi MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment march 29 2026 SUNDAY PAGES 12 The Grey Emergency As India ages at an unprecedented pace, millions of seniors are trapped in a catastrophic caregiving system that lacks meaningful regulation, trained professionals, and agency accountability By Suruchi Kapur Gomes 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 `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 65year-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 `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 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. 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 raises her arm. Outside, the city moves at through proximity and intuition rather its usual unsparing pace, indifferent to than training, and receiving almost what is happening inside these walls. nothing in return—not wages that reflect Here, 189 abandoned seniors live, many of the weight of the work, not insurance, not whom were brought in by the police after career progression, not recognition. “They found alone or destitute. Some sit quietly, don’t have medical insurance, formal withdrawn into themselves. Others carry education, or career progression,” says simmering anger at life’s betrayals. Rows Jamuna Ravi of Bangalore-based geriatric of beds hold residents battling illness, care NGO, Vayah Vikas. Burnout is disability and despair. In one corner, a endemic. Social protection is essentially physiotherapy session is underway But . non-existent. Pavitra Reddy, COO at Vayah the facility is barely holding together. The Vikas, argues that the sector urgently doctor has left. The pharmacy is strugneeds mandated standards that protect not gling to keep up and the kitchen is short of just the elder but the caregiver too. “GDAs, supplies. This is not simply a story about or General Duty Assistants, must be longevity and pathos. Indian caregiving infrastructure is so threadbare it borders Seniors rescued fron an illegal Noida geriatric care home where they were ill-treated and ignored 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 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 profes. sional, 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 Turn to page 2 4.3 million seniors caregivers needed for 36,000 currently available India’s elderly population 23 crore by 2036 Nurse to patient ratio 1:670 52% of aged Indians are women Almost 40% of injury related deaths of seniors is from falls