India's ageing population calls for a new social contract on elderly care

India’s ageing population is putting its traditional model of familyled care under strain. Nuclear families, migration and longer life expectancy are creating an urgent need for trained caregivers, community support and new models of elderly living. The answer lies in reimagining the entire ecosystem of care, says Rohini Nilekani, chairperson of Rohini Nilekani Philanthropies, in a conversation with Lijee Philip.

Edited excerpts:

India's traditional model of elderly care, centred on children and families, is under strain. Are we ready to accept that children cannot be the default caregivers anymore?

We have to make a complete societal transition along with our demographic transition. Earlier, it was assumed that the family and community would take care of the elderly. But with nuclear families and working couples, it is increasingly difficult to expect families to shoulder this responsibility alone.


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We should not put too much guilt on children who may be living abroad or in different cities and cannot physically look after their parents. All four of my parents lived and died under my care, and I was fortunate to be able to do that. But today, at 67, I do not expect my children to do the same for me. If they do, it will be a bonus, but if they don't, I will understand.

The family will remain important, but it cannot be the only answer. We need a new social contract in which communities, the state and the market also take responsibility.

If families cannot do it all, can communities become the missing link, particularly in addressing loneliness and mental well-being?

We are already seeing healthier older people helping those who need assistance. Some are experimenting with living together, sharing activities and building new social bonds. We need to encourage these forms of community and intergenerational connections.

I particularly like the Friendship Bench project pioneered by Dr Dixon Chibanda in Zimbabwe. It is a community-led initiative in which trained older women sit on benches in neighbourhood parks and offer a listening ear to people dealing with loneliness, anxiety, or depression. They are trained to recognise signs of mental distress and help people access appropriate support.

I think we can create our own version in India, harnessing the empathy, experience and wisdom of older women and men to support other senior citizens. We tend to see older people only as recipients of care. But they can also be caregivers, mentors and contributors.

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India faces a serious shortage of trained caregivers. How do we transform caregiving from an undervalued domestic work into a recognised profession?

We need to communicate the dignity of this work and, equally importantly, the dignity of the people who do it. A caregiver is not a servant. This is someone you depend on, often at your most vulnerable.

All four of my parents initially found it difficult to accept that someone else would look after them. But over time, they developed close relationships with their caregivers. I remember Suman, who looked after my mother. My mother was initially reluctant to have anyone around, but within 15 days, Suman had become more important to her than I was!

There was a bond of mutual respect and comfort. We need to tell more such stories, including those from caregivers' perspectives. They must be recognised for the emotional support and companionship they provide, not just the physical work. They also need better training, professional recognition and protection of their rights.

Can technology help bridge India's caregiving deficit? What else must change to ensure older people can age with dignity and independence?

We cannot train 10 million caregivers overnight. This is where technology, particularly AI, can help accelerate training and build skills. We need positive use cases for AI that address India's unique challenges, with appropriate safeguards. But we must be technology-enabled, not technology-led.

We also need public infrastructure that allows older people to retain their independence-good footpaths, wheelchair access, parks and public spaces where they can meet others and maintain social connections. These do not necessarily require massive budgets. They require a shift in priorities.

We must also move away from the assumption that older people are necessarily dependent. Many have decades of experience and still want to contribute to society and the economy. We need to harness that experience. Ultimately, we have to design our cities and society for an ageing population, so that growing older does not mean losing one's independence, dignity or sense of purpose.