Today, more than 140 million Indians are over the age of sixty. By 2036, that number could cross 230 million.

And all of those people need care.

Traditionally, families provided that care, but now families are getting smaller. More women are joining the workforce. Children are moving outside for work.

So who's stepping in?

An entire caregiving industry. There's thousands of agencies that provide attendants and caregivers.

But in India, hiring a caregiver can feel like a leap of faith.

There's little standardisation and limited regulation. Prices can vary wildly, and from the caregiver's perspective, conditions can be less than ideal, too.

So what's it gonna take to build a caregiving workforce to take care of India's elders?

That's what we explore in the latest episode of The Signal Brief.

The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

NOTE: A machine transcribed this episode. A human has looked at this text but there might still be errors. Please refer to the audio above, if you need to clarify something. If you want to give us feedback, please write to us at feedback@thecore.in.

TRANSCRIPT:

Kudrat (Host): Lopamudra Ghatak’s father suffered a stroke when he was in his early 80s.

He needed round-the-clock at-home care.

Lopamudra lives in Noida while her parents stayed in Kolkata, so she hired an at-home attendant from an agency her friend recommended.

The experience was challenging, to say the least.

Lopamudra: So if you are hiring someone and that person decides not to show up, if that person's shift is at 9:00 and he's messaging, or calling my 70-year-old mum at 9:15 saying, "I'm not going to come." That's when you feel that sense of helplessness. Sometimes I've been here in Noida and they've been in Calcutta, trying to run those things.

Kudrat (Host): She was paying the agency around Rs 800 a day. Not something that would break the bank, but not peanuts either.

She had expected the attendants to arrive with basic training in handling elderly patients.

Yet she and her mother often found themselves teaching the caregivers fundamental things.

Lopamudra: Dementia patients tend to get a little physically aggressive. They can become delusional. They suffer from time warp. So they may be... Like my dad used to be stuck in his last... Sometimes he would retrace his steps to the time he retired. So in that case, the best way to deal with such things is just agree with what the patient is saying. Whatever you say, if you have a contrarian point of view, it will be very difficult to convince that person.

So there was one thing we saw, that most of them, except for the attendants who were, say, 35 plus, who would have probably had one or two such stints earlier...

The rest of them, obviously the younger ones, they did not come from a similarly trained background. So they would obviously argue with him, keep arguing, and then we would have to step in and say, "Okay, just let it be. He will not remember this in the next 10 minutes. Or later, if you ask him this, he's not going to remember. So just let it be. Don't argue with him. Whatever he's saying, just say yes and do it."

Kudrat (Host): At first glance, this may sound like one family’s bad experience.

But spend a few minutes online and you’ll find dozens of similar stories: families struggling with unreliable attendants, caregivers with little formal training, and agencies charging wildly different prices.

This is a serious issue–India is getting older. Families are getting smaller. Children are moving away for work.

So as our population gets older and traditional family structures change, who will care for India’s elders?

Kudrat (Host): My name is Kudrat Wadhwa and you’re listening to The Signal Brief. We don’t do hot takes. Instead, we bring you deep dives into the how and why of consumer trends.

In this episode, we look at why one of India's fastest-growing care industries is still finding its feet, why hiring a caregiver can feel like a leap of faith, and what it will take to build the workforce that millions of Indian families will soon depend on.

Kudrat (Host): India needs this care urgently. The numbers tell a clear story.

Right now, people aged 60 and above make up a little over 10% of our population — that’s more than 140 million people.

By 2036, experts project this number will cross 230 million.

By 2050, it could reach nearly 20% of the total population.

Southern states like Kerala are already feeling this — one in five people there will be over 60 by 2036.

Families are shrinking and dispersing through migration, so the old model of multi-generational homes caring for elders is breaking down.

And the elderly require very specific care.

I spoke to Dr. Akash Jaiswal, a geriatric specialist, to understand this better.

Dr. Akash: See, elderlies are difficult to manage. In a way, they are less moldable. At times, with this dementia and other psychiatric or neuropsychiatric illnesses which they face later in life, they can have agitative behavior, they can have apathy, they can have impulsive behavior at times. They can be aggressive.

So they have to have a lot of patience to tackle senior citizens, and at the same time they have to be qualified in taking care of all the different healthcare needs which these senior citizens have. Even basic things like how to hold them, how to shift them from bed to chair, how to hold them properly so that they don't develop any dislocation of the shoulder, and how to talk with them, how to not engage with them unnecessarily in arguments.

Understanding their diseases, that yes, this can be part of the disease which can happen, and how to take care of patients who are bedridden. How to wipe off their buttock areas, how to keep it dry after passing motion, how to take care of certain tubes if they might be there, how to feed them. That is also at times required.

Kudrat (Host): Because the care is so specialised, it becomes important to understand who is actually providing it. Families often use the words attendant, caregiver and nurse interchangeably — but they’re not the same.

An attendant is usually someone who helps with daily activities — assisting with movement, meals, and basic companionship.

A caregiver goes a step further; they often receive some training in personal care, dementia support, or basic medical monitoring.

And a nurse is a qualified medical professional who can handle clinical tasks like administering medicines, wound care, or monitoring vital signs.

The lines sometimes blur in practice, and that confusion itself creates problems for families trying to hire the right person.

Kudrat (Host): Despite this lack of clarity, demand for home care is clear and growing.

Hundreds of caregiving companies now operate across India, and the at-home care sector is expanding fast.

Industry reports place the Indian home healthcare market at several billion dollars worth already, with a projected growth of 12.9% annually in the coming years, driven by an ageing population and preference for home-based care.

You see, families overwhelmingly prefer aging in place. They want their elders to stay at home rather than move into institutions.

And studies too show that elderly people often do better at home — they experience lower rates of depression. They maintain stronger social connections, and report higher overall well-being when they remain in familiar environments with consistent support.

On paper, everything points in one direction. India needs more home care. Families want it. And the market is growing rapidly. So you'd expect caregiving to be a well-defined profession by now.

But it isn't.

Pankaj: See, the first challenge is unregulated service providers. Unfortunately, what has happened is we are growing, but there is no regulation, there is no registration, there's no monitoring, and there's no redressal process in this particular field.

Kudrat (Host): That was Pankaj Mehrotra. He runs Elderly Care India, a free resource for families navigating senior care.

You see the results of this lack of standardisation everywhere: no clear definitions, confusion between attendants, caregivers and nurses, pricing that changes wildly from one agency to another. And, consumers are left completely confused.

Families often don’t know whether the person they hire has undergone proper background verification. They have little clarity on the quality of training the caregiver has received, or whether there is any certification at all. There is rarely a reliable replacement policy if the attendant doesn’t show up. And grievance processes are almost non-existent — if something goes wrong, families, more often than not, have nowhere formal to turn.

This leaves people vulnerable at the exact moment they need reliability the most.

Lopamudra saw a lot of this herself.

Lopamudra: So there was no parity. I'll tell you, when we started, I was paying about, I think, Rs 700 for an attendant for 11 hours. In Calcutta, the duty range is 11 hours. So it was from 9:00 in the morning to 8:00 in the evening, that kind of a thing.

Then the second agency... The first agency did not charge GST from me. The second agency, every month, would charge about Rs 3,500 or Rs 4,000 of GST, and their charges went up to Rs 850. So from Rs 700, I go up to Rs 850.

The third agency, and the final one... And this is all within just about a year's time, right? The third agency, I ended up paying about Rs 900 for the attendant, and Rs 950 was for the nurse that came.

So for me then, I couldn't figure out... It's the same kind of services you're offering, but there is no uniformity in the pricing.

Kudrat (Host): Now those in charge are aware of the importance of eldercare.

Prime Minister Modi has spoken several times about the need to support senior citizens, promote the silver economy, and ensure dignity in old age.

NITI Aayog has also released detailed position papers calling for comprehensive senior care reforms.

Kerala, for example, has introduced certification programs for caregivers. The central government has rolled out training initiatives.

Here’s Pankaj again.

Pankaj: See, the training courses have typically been a course called GDA, General Duty Assistant, and then again a little longer course. The government has done it under the aegis of the Ministry of Social Justice and Empowerment, and NISD was formed at the National Institute of Social Defense. They have been running these kinds of courses.

But the biggest issue is that when a person joins a particular government course or gets into the field, they are young. So it is not the only course they have joined. Typically, most of these courses are subsidized either by CSR or by the government. So the pinch to the pocket is not that much, and it should not be, because these people come from a little lower-income group.

So again, I'm saying, out of 100 people, if you really look at the statistics across all these institutions, the number of people who are getting into the field for full-time work in this area is less, and the people who last are even fewer. So it is something which has to be taken up seriously by all stakeholder levels, and a solution has to be found as to what can be done.

Kudrat (Host): The reality is that few of the people currently working as attendants or caregivers receive this kind of structured training. And even when they do, many don’t stay in the profession for long.

Caregiving is emotionally and physically demanding. Experts call it caregiver burnout — long hours, the intensity of looking after someone with dementia or who is bedridden, low pay, and little recognition. Over time, that combination leads many people to leave.

I spoke to Rita Biswas–she’s 56 and has been working in caregiving for about six years now. Before that she worked as a nanny.

Rita: देखो, हम तो कुछ दे नहीं पाते। हम गरीब आदमी हैं। हमारी सेवा से किसी को मदद हो जाए, वही मेरे भगवान का काम बहुत है। यही सबसे मेरे को अच्छा लगता है, माताजी का काम करने के लिए।

Kudrat (Host): Rita prefers eldercare to looking after children because, as she puts it, there’s a lot more running around with kids.

But the work still takes a toll.

She talked about difficult physical conditions — bad beds that strain her back – and the money.

The agency charges the family around Rs 30,000 a month, but she receives only Rs 21,000.

Stories like Rita’s show how hard it is to build a stable workforce when pay is low and conditions are tough.

India needs caregiving to become a real profession — one with recognised qualifications, clear career paths, better wages, and public trust.

Here’s Dr Akash talking about this.

Dr Akash: In this industry, they have to provide very good training, very robust training to the caretakers, and they should be under the supervision of seniors first. Even after a certification course, they shouldn't be allowed to start independently taking care of the elderly. They should be under the supervision of seniors, learn how seniors are managing, and all. So that way the system has to be made. They are bound to do some internships before they are independently handling senior citizens. So that is a big area.

Kudrat (Host): And that brings us to the other side of the coin.

Better training deserves better pay.

Better pay means higher costs.

And for many Indian families, elder care is already expensive.

I spoke to P. Srikumar. He runs Carefinder, an organization that helps families find and manage caregivers, especially in Tamil Nadu. His journey into this work started more than 12 years ago after he faced challenges while caring for his mother.

Today, Carefinder and similar organizations charge anywhere from Rs 30,000 a month, depending on the level of care required.

They screen agencies, blacklist unreliable ones, and provide some training themselves on dementia care, emergency response, and patient interaction.

But Srikumar often has to turn people away or offer alternatives.

P Srikumar: So there are people who can't afford it. See, I'm saying Rs 30,000 today for a normal household is quite a lot of money, especially if there's only one person earning. It becomes a very heavy expenditure.

Kudrat (Host): Srikumar added that in addition to strengthening the supply side with better training and regulation, the government also needs to help the demand side. That families should not have to choose between financial ruin and inadequate care.

He suggests models like a Red Cross-style organised service that can deploy trained caregivers with proper benefits and oversight. He also talks about insurance products that cover long-term home care, similar to what exists in many developed countries.

Look at places like Japan, Germany, or even parts of the US and UK.

They face their own ageing crises, but they have built structured systems — government-backed insurance schemes, regulated home-care agencies with minimum standards, subsidies for middle-income families, and clear career ladders for caregivers.

The argument is straightforward: without some form of state-sponsored support — whether through insurance, public-private partnerships, or subsidised community models — the gap between what families need and what they can actually access will only grow wider.

Here’s Dr Akash again.

Dr Akash: This is a very pertinent question at this point of time. With our increasing population, which is going to be elderly in the coming time, we have to prepare proactively rather than react at a later stage when there are a lot of elderly people whose children are not here to take care of them. Then it becomes a very difficult situation.

We will hear news here and there that they are suffering due to improper care by their caretakers, or at times they are alone, they have fallen, and they have not been taken to the hospital properly or at the right time.

So if we start preparing now, it's still not too late. We will be better prepared to take care of our elderly, who have given their lives, given us a lot of wisdom throughout their lives, and helped us build this country. So it's our time to take care of our elderly by building this workforce with the help of the government, doctors, geriatricians and geriatric nurses. We should be able to build a proper ecosystem for eldercare.

Outro: That's all for today. You just heard The Signal Brief. We don't do hot takes. Instead, we bring you deep dives into the how and why of consumer trends. The Core produces The Signal Brief. Follow us wherever you get your favourite podcasts.

To check out the rest of our work, go to www.thecore.in.

If you have feedback, we'd love to hear from you. Write to us at feedback@thecore.in or you can write to me personally at kudrat@thecore.in.

Thank you for listening.