Meeting elderly care challenge: Union Budget a beginning in right direction

Pratima Kishore & Dr Abhishek ShuklaIndia is ageing faster than we are prepared for. Today, more than 140 million Indians are above 60. Within the next decade, older people are expected to make up nearly 15% of the population.
By 2050, almost one in five Indians will be elderly. This is not a distant demographic concern but an unfolding structural shift that will redefine healthcare, labour systems, social protection and family life.The Union Budget 2026 acknowledges this transition. Its emphasis on strengthening the health system, expanding allied healthcare training and building caregiver capacity signals the intent.The proposal to add nearly one lakh allied healthcare professionals over five years and to train 1.5 lakh caregivers reflects an understanding that India's ageing population will require a larger and skilled support workforce. These are important steps, but it is just the beginning.India's elderly do not require more hospitals but continuity of care. A typical older patient lives with multiple chronic conditions – hypertension, diabetes, arthritis, declining vision or hearing, and reduced mobility.Many visit public health facilities only to collect medicines rather than receive comprehensive assessments.Diagnostic gaps, irregular medicine supply and limited specialist availability often push them towards private providers or delay care.Strengthening workforce numbers without redesigning care pathways will not be enough. What is needed is a structured geriatric care framework integrated into primary health systems.District hospitals should have dedicated geriatric outpatient services. Primary health centres must be equipped to manage chronic disease follow ups and frailty screening. Referral systems should be streamlined so that older adults are not left navigating fragmented services.Equally critical is the effective implementation and expansion of existing programmes such as the National Programme for Health Care of the Elderly.Integration with Ayushman Bharat and health and wellness centres can help embed geriatric assessment, rehabilitation and palliative care into routine service delivery. Care for older adults must also extend beyond clinical services.Long term care, home-based support and caregiver training need structured policy backing. A significant proportion of elderly health needs do not require hospitalisation. They require assistance with mobility, medication management, nutrition, physiotherapy and basic daily activities.Without formal systems, this responsibility continues to fall on families, particularly women, who shoulder a disproportionate burden of unpaid caregiving.This invisible labour has consequences for women's health, employment and economic security.Palliative care remains another critical gap. As life expectancy increases, so does the prevalence of chronic and life-limiting illnesses.Integrating palliative services into district level systems and primary care can prevent unnecessary hospital admissions and ensure that older adults receive comfort focused, dignity centred care when cure is no longer possible.The Budget also gestures toward technology and digital innovation. While digital health platforms offer efficiency, we must recognise the widening digital divide.Many older persons struggle with technology due to limited access and lack of age friendly training. Digital solutions must be accompanied by assisted access models and community support systems to prevent exclusion.Public spaces, transport systems and emergency response mechanisms remain inadequately adapted for an ageing population. Age friendly infrastructure is not an urban luxury, it is foundational to enabling independence and reducing preventable injury.Geriatric care must be reframed as a development priority, not merely a medical specialty. Rising out of pocket expenditure for chronic illness, recurrent hospitalisations due to weak primary care and absence of long-term support increase financial vulnerability among older households. When ageing is unsupported, poverty deepens and intergenerational strain increases.India still has a window to act. Unlike many high-income countries that aged before becoming wealthy, India is ageing while still strengthening its public health and social protection systems.If investments made today are directed toward integrated long-term care, primary level strengthening, rehabilitation, palliative services and caregiver support, India can build a system that enables older adults to live healthier and more independent lives.The Budget signals recognition. What must follow is coordinated implementation. Ageing cannot remain confined to tertiary centres or isolated schemes. It must be woven into district planning, community health delivery and social protection architecture.How India chooses to respond to its ageing population will shape not only health outcomes but economic stability, gender equity and the resilience of families in the decades ahead. The first step has been taken. The journey now requires sustained commitment, structural reform and political priority.(Pratima Kishore is a public health professional and researcher working on geriatric care and health systems; Dr Abhishek Shukla is a geriatrician and member of the Rajya Parishad for Senior Citizens)