Elder Care Crisis: Tamil Nadu's Growing Senior Population Needs Trained Assistants

Living alone is increasingly the reality for many senior citizens, by choice or compulsion. In the absence of sufficient affordable senior living facilities for middle-class and less affluent individuals, solo living is the default. In Tamil Nadu, the population is projected to touch 78 million by 2030, up from 72.1 million in 2011, with the present age distribution showing 10 million people above age 55, according to state planning commission reports.

The silver streak in demographics has left many lonely, old and infirm individuals looking for paid help, including a trained 24x7 assistant at home. A digital-first society is too complex for thousands who lack the experience or even the tools such as smartphones and computers to transact with banks, insurance companies, online stores, pension agencies and mobility companies. Cyberfraud remains a constant fear.

It is this isolated elderly population, many in their 80s and even 90s, who form the market for service agencies that provide stay-at-home assistants, at costs ranging from Rs.500 to Rs.1,200 a day. The young men and women signing up for this assignment keep arriving in the bigger cities in the south from states such as Odisha and Bengal.

The majority of these migrant candidates are encouraged by the stories of quick prosperity narrated by their friends, of high wages, immediate placement and decent working conditions. There is only one problem: they have no specific skills, and many are from rural areas where they have little understanding of urban facilities and lifestyle requirements.

In 2024-2025, the Union govt issued updated guidelines under a scheme to address certain aspects of this issue. Titled PM-SPECIAL: Training of geriatric caregivers under the Union ministry of social justice, it envisages a training system for attendants of senior citizens who can perform varied tasks, primarily paramedical, and extend companionship for overall well-being. These trainees would fall within the basic to intermediate skill levels on the national skills qualification framework and would be prepared through coursework for clinical geriatric care work and non-clinical, home-based duties.

In Tamil Nadu, the relevant umbrella govt agency, TN Skill, has a list of institutions advertising training courses in elder care, many of which are categorised as ‘general duty assistant’. Training programmes extend from 240 hours to 420 hours, and are run by hospitals, NGOs and trust institutions in Chennai and smaller cities and towns such as Coimbatore, Tiruchirapalli, Tirunelveli and Virudhunagar. Typically, there are a couple of 100 vacancies in each. There are fewer agencies preparing candidates for work as housekeeper-cum-cook, another category of helpers sought by senior citizens who are in better health and do not require a full-time attendant.

A faculty member of an NGO based in Krishnagiri, training general duty assistants in the town and in Chennai, says the youth are taught to assist qualified nurses in a clinical setting or to attend to the sick in need of home care. Those who qualify are not full nurses, however.

The curriculum used for training includes such things as measuring blood pressure and blood glucose for record keeping and dispensing of medicines, helping to pursue activities such as walking, gardening, hobbies, imparting knowledge of computers and mobile devices, aiding emergency and disaster management, and helping manage chronic conditions such as dementia, depression, Parkinson’s and Alzheimer’s disease.

This would be the basic skill set that any senior citizen requiring an assistant would like to see, but the supply of such workers is woefully short, while wages continue to rise and mushrooming agencies have entered the market offering to train and place attendants at fees that are between Rs. 25,000 and Rs.50,000 a month.

What makes the TN Skill programme stand out is the full subsidy it has given to the trainees, making the programme free, says the NGO faculty.

The Union govt’s goal may be to bridge demand and supply, but that task is being performed by an unregulated sector of agencies. A girl who arrived in a metro from interior Odisha and interviewed in a south Indian city was found to have no specific skill, could not take basic health readings and faltered in communicating with the senior citizen.

Given the high fees charged by informal and branded agencies providing home-based care, state agencies should create a marketplace of certified agencies with transparent qualifications and adequately trained staff. A standardised procedure for hiring trained help would professionalise the sector across various skill levels — from non-clinical geriatric assistants to home nurses.

A Tamil Nadu population pyramid published by the state planning commission, based on 2017 data, shows a youth population of 3.1 million men and 3.2 million women aged 20-24. That figure doubles when those aged 25-29, the largest cohort, are included.

Given the wages of between Rs.15,000 and Rs.36,000 currently paid for help that is often untrained, this sector is clearly a major service sector opportunity for youth. It could partly offset the disadvantage of in-country arbitrage exploited by agencies that source cheap labour from some states to corner hefty commissions. It would also enable reliable, decent work for women caring for elderly women living alone.

While the middle class can afford reasonable wages for such help, others may require a subsidised plan. More so because of proposed labour code changes that favour minimum wages for all workers. The key factors determining the candidate’s suitability would be aptitude, supplemented by rigorous training and the standardisation of protocols. It is salient that even in the absence of such arrangements, the market continues to absorb weak candidates with a positive outcome only for arbitrage agencies.

The data published by the National Skill Development Corporation (NSDC) points to low enrolment levels in training, certification, and placement for general duty assistants, geriatric care assistants, and home health aides, which stands in contrast to TN Skill, which lists many more seats.

Tamil Nadu, along with Kerala and a few other states, is projected to have a significant number of elderly residents by 2036, according to the official Population Projection Report, 2020. TN also has a lower birth rate and a higher life expectancy than the national average. This is a good opportunity for the state to use its university system, healthcare institutions, charitable organisations, and a prosperous industrial and corporate base to become a leader in training workers for the elder care sector. This would be consistent with the UN’s goal of a Healthy Ageing decade 2021-30, and WHO’s Integrated Care for Older People protocol. The state planning commission’s 2022 report on healthcare mentions the coming challenge of geriatric healthcare. With its higher base of social capital, TN can help evolve a model for all states.

Sunset years, sunrise sector

Challenge: To train general duty assistants to perform non-clinical duties for the elderly at home and in institutions.

Current situation: TN skill coordinates training through its portal for these non-nursing attendants, but demand outstrips supply. Thus workers arrive from other states to metro cities and are deployed through private agencies without basic training.

Compensation: Informal agencies and health start-ups charge Rs.900 to Rs.1,500 per day to provide a full-time home attendant. Many are nursing students from other states coming for a short stint or untrained workers. Language barriers reduce efficiency.

Way forward: A more regulated approach to training, professional certification and expansion of institutions can bridge demand and supply. Manpower agencies, vacancies and charges could be listed on a portal.

(The writer is a Chennai-based journalist)