| Author | Jayeeta Rajagopalan (Care Policy and Evaluation Centre, London School of Economics and Political Science) |
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| Overview | Currently, India does not have an organized formal long-term care system. The existing services are fragmented and vary significantly across the country; concentrated in certain states, large metropolitan areas and are often associated with significant out-of-pocket (OOP) costs [1, 2]. Families (particularly women) remain the primary providers of long-term care (LTC) [3]. This responsibility is reinforced by sociocultural and legal factors that require for families to support their older relatives [4]. Formal services are often considered as a last resort, even among families who can afford and access them [5]. However, this dependence on informal care arrangements is becoming less sustainable due to several factors including migration, shifts in family structures (from multigenerational setups to predominantly nuclear ones), and the rising involvement of women in the service sector [1, 6, 7]. |
| Governance and system organisation | There is no nationally coordinated system that governs existing LTC services in India. Several government policies and programmes under the Ministry of Social Justice and Empowerment (MSJE) and the Ministry of Health and Family Welfare (MoHFW) address support needs for older people, people with disabilities and people with terminal illnesses. Notable national programmes and policies include the National Policy for Older Persons (NPOP, 1999), Maintenance and Welfare of Parents and Senior Citizens Act (2007), the National Programme for Health Care of the Elderly (NPHCE, 2010), National Policy of Senior Citizens (2011), the National Programme for Palliative Care (2012) and the Atal Vayo Abhyuday Yojana (AVYAY, 2021). [8-13] As health is a state subject under the Indian Constitution, individual states also have specific programmes or policies tailored to the needs of their local population. Kerala, for example, has implemented several initiatives. See more under new models of care and innovations. |
| Financing and coverage | There is no dedicated national long-term care financing mechanism in India. Some LTC services may be funded through specific government programmes (as mentioned in the governance and system organization section). Providers include the government, charitable organizations or the private for-profit sector; the latter is associated with considerable OOP costs. [14, 15] In 2021-2022, the total health expenditure was estimated to be 3.8% of the Gross Domestic Product [16]. increasing from 29% to 48% between 2014-2015 and 2021-2022 [16]. In the same period, out of pocket expenditure (OOPE) has declined from 62.6% to 39.4% [16]. The decline of this OOPE can be attributed partly to the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme launched in 2018; a health insurance scheme that covers annual secondary and tertiary hospitalization hospital costs of up to INR 500,000 per family [17]. While this was initially only for socioeconomically disadvantaged groups, this health insurance scheme was expanded to cover hospitalization costs of all older people over the age of 70 in September 2024 [18]. Other health insurance schemes also exist for government employees and their families which cover costs of medical expenses [1]. However, only a very small proportion of the Indian population (approximately 20%) is covered by any health insurance scheme [1, 19]. Existing health insurance schemes do not provide coverage for LTC services. Agarwal et al., 2022 [1] reports that there are newer private health insurance schemes targeted towards older people in the country, but they either have poor coverage, do not include LTC or palliative care in their plans or have a long waiting period to avail benefits.
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| Service Delivery | |
| Service Delivery Overview | According to the International Alliance of Carer Organizations [20], there are an estimated 138 million unpaid carers in India, which accounts for approximately 10 per cent of the population. The long-term care system in India relies primarily on care provided by these family carers. Even if formal LTC services were to become more accessible and affordable, institutional care is likely to remain unpopular in the Indian context due to sociocultural norms that dictate for adult children to care for their older parents, a practice that is also legally supported by the Maintenance and Welfare of Parents and Senior Citizens Act (2007) [4, 9]. This legislation mandates for adult children to financially support to maintain the well-being of their older parents [9]. However, awareness of this legislation is quite low among the general public — with a nationally representative survey reporting only 12% of people over the age of 60 were aware of this Act in 2020 [21]; indicating that it is possibly sociocultural norms and limited availability of LTC services that contribute to low usage [4, 5]. |
| Community-based care | Community-based care services include day care services, paid attender (care worker) agencies and domestic helpers. Day care services for adults are generally limited in number; offered by private and voluntary sector organizations in some metropolitan cities, for example dementia-specific day centres run by Alzheimer’s and Related Disorders Society of India [22]. In recent years, there has been an increase in private sector organizations offering home-based care services, but these services, concentrated in cities, are associated with significant costs [1; 23] and often employ untrained care workers [24]. These agencies are unregulated contributing to large variations in costs and quality of services provided [24]. Domestic helpers, commonly found in Indian households, who often take on household responsibilities such as cooking and cleaning, may also be tasked with providing personal care for individuals with care needs [25]. They constitute an informal workforce which also remains unregulated [26]. |
| Residential care settings | Residential care facilities funded by the government are meant for low-income groups. The Integrated Programme for Senior Citizens (IPSCr), now under the national Atal Vayo Abhyuday Yojana scheme, requires for the government to provide financial maintenance to voluntary sector organizations to run old age homes for people who are economically disadvantaged. These homes provide food, shelter and care to older people with care needs [12]. More recently there have also been paid services to cater to people from high income groups who can afford such services [2] in metropolitan cities. These services remain largely unregulated and there is significant variation in the costs and quality of care provided across states [27]. Given the lack of regulation of such services, the exact number of residential care facilities in the country is unknown. However, a 2009 report from HelpAge India estimated that there were 1,279 old age homes in India [2]. |
| Assistive technology | Two national schemes provide aids and assistive devices to certain population groups: Under the Department of Empowerment of Persons with Disabilities, the Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances established in 1981, provides aids such as wheelchairs, prosthetics and hearing aids [28]. Under the Ministry of Social Justice and Empowerment (MSJE), the Rashtriya Vayoshri Yojana (RVY) provides aids and assistive devices (walking sticks, crutches, walkers, hearing aids, wheelchairs, dentures etc.) to older people from low-income groups [29]. |
| Workforce | Little is known about the workforce in the LTC sector as existing services are unregulated. There have been several efforts to increase training in geriatric care among the existing health workforce via the National Programme for Health Care of the Elderly (NPHCE, 2010) [10]. Under the NPHCE it was proposed to start training for postgraduate medical students in geriatric medicine in regional institutes along with in-service training of health professionals from district hospitals [2, 30]. An article published in 2022 [30], indicates that three types of training modules have been developed, which are directed towards physicians, nurses and community-based workers to provide geriatric care, with few states having completed state level training of trainers. The Medical Council of India has also included incorporated seats for geriatric medicine as part of their post graduate curriculum [30]. In addition, the National Institute of Social Defence (NISD) under the Ministry of Social Justice and Empowerment is responsible for implementing training programmes aimed at developing a trained workforce in geriatric care [12, 31]. The uptake and implementation of these courses is unknown, however, clear physical and financial targets to be achieved by the NISD with respect to geriatric care training is outlined in the Atal Vayo Abhyuday Yojana scheme [12]. Some non-governmental organizations may also be involved in providing training programmes in long-term care, such as Nightingale’s Medical Trust in Bangalore [2]. |
| Information systems | Currently, there is no national information system for long-term care in India. |
| New models of care and innovations | National level In June 2021, the Ministry of Social Justice and Empowerment [32] launched the ‘Senior Care Aging Growth Engine’ to encourage entrepreneurship; providing funding to select start-ups that provide innovative products or services for older people related to health, housing and care. A total of 100 crore INR (USD 13.7 million) has been allocated to this initiative [2]. State level example Kerala is a state in South India, which has the highest proportion of older adults (over 60 years) in the country, at 16.5% in 2021 [33] and is recognized as the most advanced state in terms of epidemiological and demographic transition along with health and care infrastructure [34]. The state has a well-established community based palliative care programme through an approach known as ‘Neighbourhood Network in Palliative Care’, which provides community led, home-based care services for people with terminal illnesses since 1996 (primarily was for people with cancer but has expanded to other conditions including dementia) [35]. It has been described as a model of palliative care delivery in low-resource settings [35]. Other initiatives to support older people, people with disabilities and low-income groups have also been initiated by the state. Some key examples include:
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| Performance | |
| New reforms and policies | National level In 2021, the Ministry of Social Justice and Empowerment introduced the Atal Vayo Abhyuday Yojana (AVYAY). AVYAY is an umbrella scheme that brings together schemes for older people in one document and outlines the plan of the government for their wellbeing. It brings together current/existing schemes as well as future plans/targets with respect to shelter, food, financial security, healthcare etc. [12]. State level example Tamil Nadu, a state in South India, has the second highest proportion of older people in the country after Kerala, at 13.6% in 2021 [33]. Acknowledging this demographic transition, in 2022, the state government drafted a ‘State Policy on Senior Citizens’. This draft policy outlines the government’s plan to work across sectors (government, academic institutions, medical professionals and civil society organizations) to ensure that older people have “access to food and nutrition, healthcare services, safety and protection from abuse, information, social security measures, housing and enabling environment, and legal assistance” [39, pp.3]. Some of the relevant key initiatives outlined under this policy include ensuring geriatric care is a department in district government hospitals, establishing specialized centres for older people (day care centres), increasing pension, with a differential system based on age group and developing guidelines for establishing old age homes in rural and urban areas with standards operating procedures and compulsory registration [39]. |
| Suggested Citation | Rajagopalan, J. (2025) Long-Term Care System Profile: India. Global Observatory of Long-Term Care, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://goltc.org/system-profile/india/ |
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KEYWORDS / CATEGORIES | |
| Countries | India |
