CHAPTER – 14
Institutionalising Compassionate, Structured, Professional Elder Care
By Dr. Karthik Narayan
Founder & Managing Director, Athulya Senior Care
Ageing is an inevitable journey – one that deserves dignity, independence, and community. In India, the way we navigate this phase of life is quietly, yet steadily, undergoing a transformation. The traditional notion of ageing within the care of joint families is giving way to more structured, professional models of senior living – ushering in a new era of support, wellness, and purpose for the elderly.
Unseen shift: why we missed the signs
To many in urban India, retirement communities were long seen as a Western concept. There was a collective assumption that institutional elder care was something needed “elsewhere” – in third-world nations grappling with social disintegration perhaps, not here at home, where family systems are presumed to be strong.
But malnutrition, chronic illness, loneliness, and inadequate geriatric care often remain hidden behind closed doors, even in so-called well-off homes. The shift in how India views elder care is a response, not just to demographic numbers, but to lived realities that are slowly, and undeniably, changing.
Take the case of Raghavan, a retired bank officer in Bengaluru. The 76-year-old embraced a new chapter in life by moving into a senior living community, curious about what it might have to offer. What began as a step into the unknown soon turned into a vibrant routine – he now leads a book club, takes music lessons, and enjoys the rhythm of shared meals and stories. His journey reflects the growing possibilities of ageing with purpose and connection.
India has a rising aging population and life expectancy has improved marginally from the 1970s. But the quantity of years is only part of the story. The more pressing question is – are we making those years count? Healthy life expectancy – that is, years lived without debilitating disease or disability – lags behind life expectancy (70), at just over 60 years. This gap of a decade between life expectancy and healthy life expectancy highlights a critical challenge: the need to not just add years to life, but life to years as well. Promoting nutrition, early intervention, mental well-being, and accessible geriatric care must now become national priorities.
A day in the life of a senior living resident
“Structured senior care is now being seen not as giving up, but as stepping up and ensuring elders receive the professional, round-the-clock support they need and deserve.”
Walk into a senior living facility today and the first thing one notices is not sadness, but structure. Mornings begin with yoga or physiotherapy, followed by balanced meals tailored to individual health needs. Community areas buzz with conversations, laughter, and shared activities – be it gardening, storytelling circles, or festival celebrations. On-call medical professionals, regular check-ups, and therapeutic sessions ensure both preventive and responsive care.
Residents often speak of these facilities as of finding a second home – a place where their individuality is respected, their ailments are monitored, and their loneliness addressed. “I used to sit by the window all day. Now I have friends again,” says one octogenarian at a centre in Tamil Nadu.
These homes do not simply replace families; they recreate community.
In later life, human connection becomes as vital as medicine of nutrition. Research shows that older adults with strong social bonds are significantly less likely to experience depression or cognitive decline. In senior living communities, group activities, shared rituals, and meaningful peer interaction offer more than just engagement – they create a sense of belonging. For many residents, these connections are not only uplifting but transformative, replacing solitude with companionship and purpose.
Breaking the stigma
For years, the very idea of senior living faced deep-rooted resistance. To move one’s parents into a facility – however well-equipped – was seen as abandonment of filial responsibility. Social guilt, bolstered by cinema and collective memory, reinforced the image of dutiful children as sole caregivers.
But as dual-income families, geographic separation, and nuclear households become the norm, families are reevaluating their stance. Structured senior care is now being seen not as giving up, but as stepping up and ensuring elders receive the professional, round-the-clock support they need and deserve.
The shift has not been swift. But it is now unmistakably underway.
For Meera and Arvind, a working couple in their thirties, the decision to move Meera’s mother into a senior care home was fraught with emotion. “We were scared of being judged,” Meera admits. But seeing her mother thrive, join art classes, receive expert care, and form new friendships, at the home, brought relief and reassurance.
What began as a movement in urban pockets is now reaching smaller towns and districts too. The emergence of senior living communities in tier-II and tier-III cities such as Erode in Tamil Nadu reflects a change in mindset amongst citizens.
Traditionally viewed as bastions of family-based elder care, these towns are now at the frontlines of the evolution of eldercare. Families here are increasingly acknowledging that love and care also mean ensuring elders receive professional medical attention, nutritious food, mental stimulation, and emotional support.
That this acceptance is growing in non-metro regions speaks volumes.
Systemic gaps persist
Even as the private sector innovates, systemic challenges remain. India’s healthcare infrastructure lags in geriatric readiness:
- There are only 1.5 hospital beds per 1,000 people, against the World Health Organization’s recommended five.
- A severe shortage of geriatricians in both public and private sectors persists.
- Fewer than 10% of hospitals are equipped with elder-friendly facilities.
- There is little policy direction on end-of-life care – an area the needs both sensitive and urgent attention. There are very few providers engaging in discussions around post-life needs, bereavement support, or legacy planning.
This vacuum is slowly being filled but a lot remains to be done.
Looking ahead
The future of elder care in India lies in embracing a model that is medical, emotional, social, and spiritual: one where ageing is not feared but celebrated; where growing old does not mean growing alone. This is not just about infrastructure. It is also about mindset.
With India poised to become one of the world’s largest ageing populations, the question is not whether we will adapt. The question is how fast – and how fairly – we can adapt.
