Long‐term care in India: Capacity, need and future

Abstract

The family is the dominant player in India’s current long‐term care (LTC) system. Yet informal family‐based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non‐familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross‐state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC.

Attitudes to long‐term care in India: A secondary, mixed methods analysis

“…1,2 Similar to other low-and middle-income countries, there are limited resources in India to address the rise in prevalence of chronic conditions and disabilities associated with an ageing population. [2][3][4][5] In 2020, nearly 9 million Indian people were estimated to have dementia, and this is expected to treble by 2040. 6 Multigenerational cohabitation or joint family structures are the traditional, primary support network for providing care to older adults in India.…”

“…6 Multigenerational cohabitation or joint family structures are the traditional, primary support network for providing care to older adults in India. 3 With modernisation and globalisation, more nuclear family structures are emerging. 7 Family carers, usually women, are increasingly balancing caregiving responsibilities with employment, or providing care at a distance due to emigration.…”

“…10 The Indian LTC system is fragmented, unregulated, and usually run with untrained staff or unreliable funding. 1,3,7 LTC facilities in India include private facilities for middle-class and elite populations, government-and charityfunded facilities for destitute peoples (very poor), and religious facilities (ashrams and temples), usually also for poor people. 11 One survey estimated that there were 1176 privately-owned LTC facilities in India, with the highest number in Kerala.…”

“…Due to declining birth rates and increasing life expectancies, one in five Indians will be aged 60 years and above by 2050 1,2 . Similar to other low‐ and middle‐income countries, there are limited resources in India to address the rise in prevalence of chronic conditions and disabilities associated with an ageing population 2–5 . In 2020, nearly 9 million Indian people were estimated to have dementia, and this is expected to treble by 2040 6 …”

“…There is currently limited research to guide policymakers in their decision‐making 10 . The Indian LTC system is fragmented, unregulated, and usually run with untrained staff or unreliable funding 1,3,7 . LTC facilities in India include private facilities for middle‐class and elite populations, government‐ and charity‐funded facilities for destitute peoples (very poor), and religious facilities (ashrams and temples), usually also for poor people 11 .…”