Someone to call who can actually come
In Kerala, India's fastest-ageing state, the quiet departure of children toward distant cities and foreign shores has left a generation of elders in homes that once held many voices. The state government has responded with what it calls India's first dedicated elderly welfare department, built around the principle that people should grow old within their own communities rather than be moved away from them. It is a policy answer to a profoundly human question: when the bonds of family stretch across oceans, who remains to answer the door at three in the morning?
- By 2036, nearly one in four Kerala residents will be over 60, and the traditional safety net of children living with parents has quietly unravelled under the pressure of migration.
- Elderly couples like Dominic and Martha depend on neighbours for the help that family once provided, while children abroad watch their parents' health crises unfold through video calls, helpless across time zones.
- Kerala has launched India's first dedicated elderly welfare department, promising home-based care, volunteer networks, social prescribing, caregiver training, and a Silver Economy roadmap to hold the strategy together.
- The state's initial allocation of roughly one million dollars has been called largely symbolic, and experts warn that no single department can bridge the gap between ambitious vision and the daily, unglamorous work of care.
- The deeper challenge is not infrastructure but trust — a regulated, quality-assured care ecosystem does not yet exist, leaving families without private means to navigate a fragmented and uneven market.
In a house in Kerala, TO Dominic and his wife MJ Martha live with the silence left behind by two sons — one in Karnataka, one in the Middle East. Phone calls come regularly, but calls cannot fix a broken pipe or ease the weight of a difficult day. They rely on neighbours now. It is an arrangement born of necessity, not choice.
Kerala is ageing faster than any other Indian state, its longer lives and better healthcare colliding with a migration wave that has hollowed out the multi-generational household. Remittances have brought wealth; they have also brought loneliness. By 2036, nearly one in four residents will be over 60, against a national average far lower.
Last month the state announced a dedicated department for elderly welfare — the first of its kind in India, according to officials. Its guiding philosophy is 'ageing in place': keeping older people in their homes and communities rather than moving them into institutions. The department's head, Dr Rathan Kelkar, describes a sweeping agenda covering healthcare, housing, transport, technology, and social connection, including certified caregiver training, elderly parks, day-care centres, and a statewide survey to shape a Silver Economy roadmap.
But the emotional reality resists policy language. An IT professional in Sydney who sends money home regularly says it cannot replace presence — when his parents fell ill, he could only watch through a screen. Dr Prasun Chatterjee, a geriatrics specialist in Delhi, hears the same fear from patients across India: who will take me to hospital in the middle of the night?
Kerala already has pension schemes and the respected Vayomithram palliative care programme. What was missing, Kelkar says, was a single institution to coordinate them, identify gaps, and plan. The new department's initial budget — around one million dollars — has been called largely symbolic by some, though Kelkar frames it as seed funding for coordination and pilot projects rather than a final answer.
Industry voices point to a deeper structural problem: there is still no properly regulated market for senior care in India, no uniform standards, no quality benchmarks. For families who cannot afford private solutions, that gap is enormous.
Dominic and Martha are not waiting for policy to catch up. They have their neighbours. What Martha wants, she says simply, is someone to call who can actually come. Whether Kerala's new department can one day be that someone — in a state where families are separated by oceans — is the question the years ahead will answer.
TO Dominic and his wife MJ Martha sit in a house that once echoed with the voices of children. Now the silence is the thing they notice most. One son works in Karnataka, the other in the Middle East. They call regularly—conversations about health, about weather, the small anchors of connection across distance. But when something breaks in the house, when Martha needs help, when Dominic feels the weight of the day, the phone calls cannot fix it. They depend on their neighbours, people who are not family, because family is elsewhere, chasing better paychecks and better futures.
Their situation is no longer unusual in Kerala. India's southernmost state is aging faster than anywhere else in the country, and migration has hollowed out the traditional structure that once held elderly Indians upright: the multi-generational household, children living with parents, the assumption of care flowing naturally from one generation to the next. Better healthcare and longer lives have made Kerala older. Remittances from the Middle East, Europe, and beyond have made it wealthier. But they have also made it lonelier. By 2036, nearly one in four people in Kerala will be over 60—22.8 percent, compared to a national average of 14.9 percent.
Last month, the state government announced something it says is the first of its kind in India: a dedicated department for elderly welfare. The announcement came with a strategy called "ageing in place"—the idea that older people should remain in their homes and communities rather than being moved into institutions. Dr Rathan Kelkar, who heads the new department, describes the scope as vast: healthcare, housing, transport, local governance, technology, employment, safety, financial services, community life. The plans include expanding home-based care, introducing "social prescribing" to connect older people with meaningful activities, launching a certified caregiver training programme, and building elderly parks and day-care centres. A statewide survey will eventually inform what officials are calling a Silver Economy roadmap.
But the challenge runs deeper than infrastructure. An IT professional based in Sydney, whose parents live alone in Kerala, sends money home regularly. Yet money, he says, cannot replace physical presence. When his parents fell ill, he could only watch through video calls from thousands of kilometres away. "I felt so helpless," he says. This is the emotional architecture of modern migration—the guilt, the distance, the knowledge that love and financial support are not the same as being there. Dr Prasun Chatterjee, who leads the geriatrics unit at Apollo Hospital in Delhi, hears the same fear from his patients across India: if they become dependent, who will care for them? Who will take them to hospital at three in the morning?
Kerala is not starting from nothing. The state already has pension schemes, the Vayomithram programme—a community-based palliative care system that has been widely studied—and other welfare initiatives. What was missing, Kelkar says, was a single institutional mechanism to bring them all together, to identify gaps, to plan. The new department is exploring volunteer networks and community programmes to tackle isolation directly. "Our vision," Kelkar says, "is that no elderly person in Kerala should feel invisible or abandoned, regardless of where their children live."
Yet questions linger about whether the vision can be funded. The state has allocated 100 million rupees—roughly 1.06 million dollars—for elderly welfare this year. Some have called this largely symbolic. Kelkar argues the funding is meant to build coordination capacity, support pilot projects, and develop the data systems needed for a longer-term response. He insists the government views ageing not as a short-term project but as a long-term development priority. But Dr Chatterjee points out that no single department can do all that is needed—day-care centres, community spaces, accessible primary healthcare, opportunities for social connection. The gap between ambition and resources is real.
Srinivasan Govindaraj, CEO of Athulya Seniorcare, which operates senior-living facilities across several states, argues that Kerala's ageing population will need more than welfare schemes. It will need a trusted and regulated care ecosystem. "There is still no properly regulated market for senior care," he says. There are many small players, but no uniform standards or quality measures. For families who cannot afford private solutions, this matters enormously.
MSR Dev, an 82-year-old retired scientist, thinks Kerala can learn from countries like Sweden, where community support systems help older people remain active and independent. "Communication is essential," he says. "Not just food or health services. As social beings, people need places to connect." Back in their home, Dominic and Martha are not waiting for policy to catch up. They have their neighbours. What they want, Martha says simply, is someone to call who can actually come. Whether Kerala's new department can help provide that support—in a state where families are often separated by oceans and time zones—remains to be seen.
Notable Quotes
We depend entirely on our neighbours. Our children visit very rarely and we don't have relatives nearby to assist us. Things are becoming increasingly difficult.— TO Dominic, 70-year-old Kerala resident
Even though I regularly send money home, financial support alone is not enough. Being physically present during important moments is something money cannot replace.— Sydney-based IT professional whose parents live alone in Kerala
Our vision is that no elderly person in Kerala should feel invisible or abandoned, regardless of where their children live.— Dr Rathan Kelkar, head of Kerala's new elderly welfare department
The Hearth Conversation Another angle on the story
Why does Kerala matter as a case study? Isn't aging a problem everywhere?
It is, but Kerala is ahead of the curve. By 2036, one in four people there will be over 60. That's not a distant problem—it's arriving now. And it's arriving in a place where the traditional safety net has already been cut.
The safety net being family?
Exactly. For generations, elderly Indians lived with their children. That was the assumption, the structure. Migration broke it. Better jobs overseas meant better money at home, but it also meant parents aging alone.
So the department is trying to replace family?
Not replace. Supplement. The real challenge is loneliness—the emotional weight of aging apart from your children. You can build day-care centres and hire caregivers, but you can't legislate connection.
Is the funding adequate?
No one thinks so. A hundred million rupees sounds like a lot until you realize it's meant to coordinate existing programmes and pilot new ones. The real test is whether the government actually commits more money over time.
What would success look like?
An elderly person in Kerala feeling less invisible. Having someone to call who can actually come. Having places to go, people to see. It sounds simple because it is simple. The hard part is building it at scale.
And if they don't?
Then you have a state full of people like Dominic and Martha—financially secure, but emotionally stranded. That's a different kind of poverty.