Why does India need a trained workforce for elderly care?

Why in news?

Budget 2026-27 announced training 1.5 lakh caregivers under NSQF, as NITI Aayog report frames caregiving as economic activity.

UPSC Relevance

Prelims – Care economy, schemes associated. 

Mains  

GS1: Role of women, population and associated issues.

GS2: Welfare schemes for vulnerable sections (elderly, persons with disabilities), issues relating to health.

GS3: Inclusive growth, employment, skill development

What is the Care Economy?

• Meaning – All work that goes into looking after people – children, the elderly, the sick and persons with disabilities. It includes both paid work (nurses, domestic workers, ASHA and Anganwadi workers) and unpaid work done mostly by family members.
  • Direct care – Hands-on work like feeding, bathing, giving medicines.
  • Indirect care – Cooking, cleaning, and fetching water – all that makes direct care possible.
• Invisible work – Unpaid domestic and care services within a household are not counted in GDP under the UN System of National Accounts. So the largest part of the care economy does not show up in national statistics.
• Care ecosystem – Families, the State (schemes, hospitals, Anganwadis), the market (agencies, old age homes, start-ups) and the community (SHGs, NGOs, volunteers) together form the care ecosystem.

Why India needs a care ecosystem now?

A. Demographic shift

• Ageing population – India’s 60+ population was about 149 million in 2022 and is projected to reach 347 million by 2050, about 20.8% of the population.
• Feminisation of ageing – Women live longer, so a growing share of the very old are widows – often with no income or property of their own.
• Health burden – The Longitudinal Ageing Study in India (LASI) found that about three out of four elderly persons have at least one chronic disease. Alzheimer’s and Parkinson’s add mental and behavioural care needs, not just physical ones.
• Disability – About 26.8 million persons with disabilities (Census 2011) depend largely on family members for care.

B. Social change

• Decline of the joint family – Earlier, three generations under one roof acted like an informal insurance system. Nuclear families and migration of the young to cities and abroad have left many elderly alone.
• Burden on women – With smaller families, care falls mostly on housewives, who learn by trial and error. The NSO Time Use Survey shows women spend about 299 minutes a day on unpaid domestic and care work, against 97 minutes for men.
• Caregiver burnout – Family caregivers face physical exhaustion, mental stress and loss of income, with no support system. 

C. Economic logic

• Women’s workforce participation – Female LFPR has risen to about 41.7% (PLFS 2023-24) but is still far below men. Care duties are among the biggest reasons women stay out of paid work or drop out mid-career.
• Job creation – The Economic Survey 2023-24 noted that investing 2% of GDP directly in public care services could create almost 11 million jobs, nearly 70% of them for women.
• Viksit Bharat link – A country cannot reach high-income status while half its potential workforce is tied down by unpaid care.
• Silver economy – Home healthcare, assisted living, geriatric products, tele-medicine and assistive devices form a fast-growing market. SAGE was launched to back such start-ups.
• Global demand – Ageing countries like Japan, Germany and Israel need caregivers. Japan’s Specified Skilled Worker category includes nursing care. Like India’s nurses, trained Indian caregivers could find work abroad.

Existing initiatives

• Budget 2026-27 – Training of 1.5 lakh caregivers aligned to the National Skills Qualifications Framework (NSQF).
• Kudumbashree K4 Care (Kerala) – Launched in February 2024 to train SHG members as certified geriatric, patient and disability care executives. Only 838 people had completed the course – slow progress.
• ASHA workers – NHSRC has prepared a Training Manual on Elderly Care, delivered through Ayushman Arogya Mandirs (Health and Wellness Centres). Data on how many ASHAs have been trained is not public.

Challenges

• Invisibility – Unpaid care is not counted in GDP and is taken for granted as women’s natural duty. 
• Shortage of care specialists – 1.5 lakh trained caregivers against an estimated 146 million informal caregivers is a drop in the ocean. There are Vvery few geriatricians, geriatric nurses and dementia care professionals, mostly concentrated in cities
• Informality and low pay – Paid care workers – domestic workers, home attendants – are largely informal, with no fixed wages, job security or social security. India has not ratified the ILO Domestic Workers Convention (C189).
• Scheme workers undervalued – ASHA and Anganwadi workers carry heavy care duties but get honorarium, not salaries. The Supreme Court in 2022 had to hold that Anganwadi workers are entitled to gratuity.
• No standard curriculum – There is no common national standard for caregiver training or certification; home-care agencies are barely regulated.
• Costs – Out-of-pocket spending on elderly care is high; long-term care insurance hardly exists in India.
• Social stigma – Old age homes and paid carers are often seen as a sign that children have failed in their duty.
• Fragmented policy – Elderly care, childcare and disability care sit with different ministries with little coordination.

Way Ahead

NITI Aayog – Reimagining Care: Strategies for Empowering Caregivers in Viksit Bharat@2047 (Aug 2026)

• Caregiving as economic activity – For the first time, a national policy document treats caregiving as economic activity and not just welfare work.
• National Caregiver Council – An apex body to set benchmarks, supervise skilling, update training modules, standardise curricula and run a national portal of certified caregivers.
• Recognise informal caregivers – Validate and train millions of unpaid family caregivers into recognised caregivers.
• Go global – Position India as a source of trained caregivers through migration and skill agreements, as with nurses.

ILO 5R Framework

• Recognise, Reduce, Redistribute – Recognise, reduce and redistribute unpaid care work (between women and men, and between families and the State).
• Reward and Represent – Reward paid care workers with decent pay and conditions, and give them representation and social dialogue.

The care economy is not a cost but an investment. If Budget announcements are followed by strong implementation on the ground, India can turn informal dedication into professional skill – bringing dignity to caregivers, better care to the elderly, and more women into paid work.

Mains Practice Question

Q. “Transforming India’s care economy is an economic strategy waiting to be unlocked.” In the context of India’s ageing population, discuss the need for a formal caregiving ecosystem. Examine the challenges involved and suggest measures to build it. (15 marks, 250 words)