Somewhere in a corporation ward in Kollam, an elderly woman waits. Not at a hospital, not in a queue, she waits at home because the Vayomithram mobile clinic will come to her. Every fortnight, a van pulls up, a familiar face asks how she has been sleeping, a check-up is done, and medicines are dispensed. It sounds modest, but for a frail senior living alone, it is the difference between dignity and distress.
Kerala built this system years ago; Tamil Nadu is building its own now, and the rest of India is observing and taking notes as these two southern states make senior care a core welfare pillar. What’s unfolding here is a preview of what every Indian state will need within a generation.
India’s ageing transition is underway: by 2050, the senior population (aged 60+) will double to approximately 347 million. This process is not uniform across India, as southern states see a faster pace. An RBI-cited analysis estimates that Tamil Nadu will formally enter the 'ageing category' as early as this year, and by 2031, the share of seniors is projected to reach 18.2 per cent. Kerala will hit the 20 per cent mark by 2036. The divergence is stark when compared to Bihar (7.7 per cent elderly share) or Uttar Pradesh (8.1 per cent). Tamil Nadu and Kerala are not just older states, they are the earliest mirrors of India's 2050 reality. Their path to preparedness offers valuable lessons for other states as their populations age.
Start the marathon early
The most unambiguous learning is: build systems before the wave hits. The Vayomithram project, run by the Kerala Social Security Mission, offers free medicines, mobile clinic visits, palliative care and help-desk services to seniors above 65 in urban local body areas. It is community-anchored, publicly funded and designed to reach the most vulnerable.
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The impact is measurable. Reviews of Vayomithram and associated programmes like Vathilpadi Sevanam document improvements in psychological well-being, social engagement and access to health services. Kerala's broader community-based palliative care network has helped reduce unnecessary hospitalisation and improve continuity of care for bedridden and high-need seniors — easing pressure on an already stretched hospital system.
But even Kerala faces gaps. Coverage remains uneven, digital literacy is low among older cohorts, and caregiver burden is high, particularly among ageing spouses and adult daughters. These challenges, documented in caregiver burden studies, will be amplified in states that have not yet begun to plan.
The lesson is not that Kerala has solved ageing. The lesson is that starting early gives you time to course-correct.
Invest in creating a care continuum
Tamil Nadu's high NCD burden — diabetes, hypertension, cardiovascular disease, cancer — makes it a frontline state for long-term and post-hospital care. Seniors living with multiple chronic conditions benefit from long-term care that grows with their needs, in addition to short-term institutional care for acute illness (hospitalisation). This means preventive health check-ups, clinically guided lifestyle modification, rehabilitation after acute episodes, and transition care.
The National Programme for Health Care of the Elderly (NPHCE) provides a federal backbone for this approach with specialised geriatric care mandated at multiple levels of the health system. But national programmes require state-level acceleration to reach their potential.
UNFPA India’s ageing analysis consistently notes that India will need preventive, promotive, rehabilitative and long-term care capacity at scale to avoid a care crisis by 2050. The magnitude of this requirement cannot be met by the government alone, at the Centre or state level. Participation from private entities and NGOs is vital to meet the scale and complexity of India’s senior care needs.
Alleviate caregiver burden
Perhaps the most important shift that Kerala and Tamil Nadu are modelling for the rest of the country is as cultural as it is systemic. Both states are moving toward the idea that professional care is not a replacement for family responsibility; it is a partner to it.
Tamil Nadu’s State Policy explicitly envisions public-private partnerships as central to its age-friendly society framework. Kerala’s palliative care network, supported by local bodies, NGOs and volunteer networks, has demonstrated that decentralised, community-anchored care can outperform centralised, hospital-centric models for long-term and end-of-life needs.
The evidence on caregiver burden is important here. Studies in Kerala show that caregivers who feel a high burden report significantly lower health-related quality of life. Planned, professional care does not weaken family bonds. It protects the people doing the caring while improving outcomes for the people being cared for.
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The states that are already running the ageing marathon are showing the rest of India what the course looks like. Here’s what we see: First, we need a nodal agency to anchor the needs of the senior care sector, so private players can take the baton from government bodies to build scale with speed. Second, states must develop their own senior care policy that treats long-term care as essential infrastructure. Third, acknowledge the need for blended care ecosystems — government, private and civil society co-designing standards, financing and referral pathways. Fourth, families and communities need support to plan professional care, honouring elders in a country that is ageing faster than its systems are ready for.
Chennai sits at the intersection of these forces. It has a dense, high-quality private hospital sector, a high NCD burden, an ageing population and the institutional appetite for innovation. It is, in that sense, a microcosm of what India's major metros will all face within a generation.
(Ishaan Khanna is the CEO of Antara Assisted Care Services)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
