India’s increasing demographic of the elderly needs long-term care, daily support and palliative services. While national policies emphasise care at home, government data show that access to such services remains limited.

With older adults projected to account for nearly 20% of India’s population by 2050, as we reported in March 2024, the gap between policy intent and care on the ground means many older adults are dependent on hospitals or family support.

As India ages, national policy increasingly positions home-based palliative and elder care as a way to reduce suffering and avoid unnecessary hospitalisation. Our reporting suggests these services reach only a limited share of older adults.

In this concluding story of a two-part series, IndiaSpend explains how gaps between policy design and delivery shape where care is provided, how households absorb costs, and who bears responsibility when care does not reach home. You can read the first part here.

Home-based palliative care is a core component of India’s elder care framework, designed to reduce suffering among older adults with chronic and life-limiting conditions by providing care where people live.

Under the National Programme for Palliative Care, states are expected to plan and fund services through the National Health Mission. The programme envisions trained primary healthcare workers delivering symptom management, basic nursing care and caregiver support through...

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