By 2050, one in every five Indians will be over 60, around 347 million people, larger than the entire population of the United States today. And India faces this shift with a particular disadvantage: we are ageing before our institutions are ready, and at lower incomes than the societies that aged before us, as Sivaramakrishnan emphasises in her 2018 book, As the World Ages. A demographic shift this compounded and enormous is not confined to numbers alone, but is reshaping caregiving, residential living, technologies and related markets. The senior-care market already stands at $ 7 billion (2024 NITI Aayog report) and is projected to cross ₹1 lakh crore by 2030 (2026 Colliers). These markets should be built on evidence India currently lacks: affordability, service-delivery models, and the long-term sustainability of senior-care services.
Developers and investors are committing significant capital in institutional care infrastructure, senior living and gerotechnology. The standards, regulations and expectations that are set in this segment will shape the rest of the sector, while also affecting how ageing is experienced in India. These emerging questions lead us to borrow from management research to examine how this sector is being built: what care models fit Indian realities, what financing makes them affordable, what partnerships between state, market and community can work, and what delivery structures could scale. Hence, ageing is as much about broader economic and social transformation as it is about health and wellness.
While the biomedical lens helps us understand the health consequences and care needs of ageing, it tells us less about how care is organised, paid for and delivered. The challenge is not only to strengthen geriatric care, but to make our institutions and systems age-inclusive while the transition is still under way. Simply replicating dominant care models from other contexts is unlikely to work in India due to lack of universal health coverage, underdeveloped infrastructure for assisted living and a fragmented senior care industry. Despite the shift from joint to nuclear households, most older adults in India continue to rely primarily on their families for care, and that reliance is unlikely to disappear even as living arrangements change. For this, we need workable models and frameworks that will strengthen existing structures rather than replace them, combining family-based care with institutional and community options. This also means building a geriatric care workforce, beyond the family that barely exists today.
Such provision is also shaped by policy architecture that has not kept pace. India’s ageing policy architecture still rests largely on the 1999 National Policy for Older Persons. This was built on an underlying assumption of co-residence with no private senior-living or home-care sector, and long-term care finance was not contemplated at all. These assumptions no longer hold. As previously referred to, the market segmentation that has been attracting billions annually, however, operates without a dedicated framework. We now need quality standards for care providers, a regulatory framework for a senior-living sector attracting crores in investment, and a financing mechanism for the years of care many families will need. Policies have not moved at the speed of these demographic, economic, technological and social shifts; and nowhere is the lag so visible than in financing.
Several older adults, especially in informal sectors, have no pension coverage and depend largely on family support for care needs. Insurance, savings and social security schemes should account for the vulnerable segments, ensuring that quality care is accessible to all. It is also crucial to expand health insurance beyond hospitalisation to include daily assistance required by older adults. The question around who pays for long-term care, which can run for years rather than for episodes, currently remains largely unanswered. And as the ratio of working to retired Indians shifts, financing later life stops being only a household concern and becomes a question of public finance, one that will shape fiscal and monetary choices for decades.
That absence of income security has another consequence, one that unsettles how we picture later life altogether. For those in the informal sector, a significant portion of older adults continue to work past 60, the recent Longitudinal Ageing Study in India (2017-18) shows. Many of those who continue working do so in the informal sector, out of necessity rather than choice. This calls for rethinking senior employability, employment law, pension design and retirement policies. While skilling and re-employment schemes continue to focus entirely on the young. These discussions around later life employment sit awkwardly with both academic and policy discourses that refer to seniors as dependents and frail beings.
As the senior-care market expands, what we need are frameworks for financing, for care delivery and for quality standards. None of this will arrive on its own. So far, policy has followed the market rather than shaped it, and markets build where purchasing power is: a system assembled piece by piece, by whoever can pay and whoever can supply. Building an age-inclusive society instead requires understanding how this market is being built, for whom it works, and how older people across all segments can be included. The 347 million Indians who will be over 60 in 2050 are already alive today. They are the generation that powered India’s demographic dividend, and they will spend their later lives in the system we build now.
(The authors are associated with the Senior Care Advancement through Learning and Evidence (SCALE) Initiative at Max Institute of Healthcare Management, Indian School of Business.)