Across the sun-faded living rooms of southern India’s Kerala, a quiet crisis is unfolding. For 70-year-old TO Dominic, every morning opens the same way: with a quick phone call to one of his two adult sons. One son built his career in neighboring Karnataka, while the other sought work opportunities in the Middle East. Both left their childhood home years ago, leaving Dominic and his 70-something wife MJ Martha to navigate daily life entirely on their own.
These daily calls bring small comfort, filled with routine checks on health and casual chatter about the weather. But when the couple faces a broken pipe, a medical appointment, or even just need an extra pair of hands to carry groceries, their sons are thousands of kilometers away, unable to step in. Once, their home echoed with the noise of growing children; today, long stretches of silence fill most days. “We rely completely on our neighbors for help,” Dominic explains. “Our children can only visit once every few years, and we have no close relatives living nearby. Every year, daily tasks get just a little bit harder.” Martha nods beside him, adding that persistent loneliness has become an inescapable part of their old age.
The Dominics’ story is far from unique. For centuries, multigenerational cohabitation was the unbroken norm across India, with adult children caring for aging parents in the family home. But decades of out-migration for work and higher education have steadily eroded this centuries-old tradition, particularly in Kerala — India’s fastest-ageing state, where demographic shifts and labor mobility have left a growing share of the elderly population living alone. To confront this rapidly growing public challenge, the Kerala state government announced last month the launch of India’s first standalone government department dedicated exclusively to senior citizen welfare.
Dr. Rathan Kelkar, the head of the newly formed department, outlines that the agency’s core strategy centers on the principle of “ageing in place” — a framework designed to help older adults remain in their own homes and local communities, rather than relocating to institutional care facilities. The department’s rolling policy agenda includes expanding affordable community and in-home care services, rolling out “social prescribing” initiatives that connect isolated seniors to regular group activities and social outlets, launching a state-certified caregiver training program to build a professionalized care workforce, and constructing new public infrastructure including elderly-focused parks, senior day-care centers, and accessible fitness facilities. A comprehensive statewide survey of the senior population is also underway to lay the groundwork for a long-term national “Silver Economy” development roadmap.
Kelkar emphasizes that ageing can no longer be sidelined as a narrow social welfare issue: “It intersects with every sector of public life — healthcare, housing, transportation, local governance, technology, employment, public safety, financial services, and community connection.”
Kerala already holds the distinction of having the highest share of elderly residents among all of India’s major states. A 2026 analysis from the Reserve Bank of India projects that by 2036, nearly one in four Kerala residents — 22.8% of the total population — will be over the age of 60, compared to a projected national average of just 14.9%. This rapid demographic shift stems from two overlapping trends: social progress and persistent out-migration. Decades of improved public healthcare have pushed life expectancy higher, while falling birth rates have slowed population growth, naturally aging the state’s population pyramid. At the same time, generations of working-age Keralites have left the state to seek higher-wage work in the Middle East, Europe, North America, and other parts of India, often leaving aging parents behind.
While remittances from these migrant workers have lifted household incomes and overall living standards across Kerala, they have also created this growing social gap: millions of older Indians now spend their final years geographically separated from their children. For migrant children living abroad, the distance brings its own emotional toll. A Keralite IT professional based in Sydney, who asked not to be named, explains: “I send money home every month without fail, but financial support is never enough. Being there in person — for a medical emergency, or just to sit with them when they’re lonely — that’s something money can never replace.” When his parents fell ill with a viral infection last year, he could only coordinate care via phone and video calls from 10,000 kilometers away, saying, “I felt completely helpless, and that feeling never really goes away.”
Kelkar notes that Kerala is not starting from zero in its response to the ageing crisis: the state already runs successful existing programs including universal old-age pensions and the widely studied Vayomithram community palliative care initiative. What was missing, he argues, was a single centralized authority to coordinate across fragmented government sectors, close service gaps, and align long-term planning. “Before this, there was no single institutional body responsible for bringing all these different departments together, identifying unmet needs, building cross-sector convergence, and planning for decades to come,” he says.
Even with this new institutional structure, Kelkar acknowledges that bricks-and-mortar infrastructure and formal services alone cannot solve the crisis of senior isolation. “Loneliness and social disconnection have become one of the defining challenges of ageing in modern Kerala,” he says. To address this gap, the department is building out statewide volunteer networks and community connection programs to reach isolated seniors. “Our vision is simple: no elderly person in Kerala should feel invisible or abandoned, no matter where their children live.”
Medical experts across India warn that the crisis Kerala is now confronting is a preview of a coming nationwide challenge. Dr. Prasun Chatterjee, who leads the geriatrics unit at Delhi’s Apollo Hospital, says the question he hears most from his older patients is, “Who will take care of me when I can no longer take care of myself?” Many of his patients live alone after losing a spouse or watching their children relocate for work, and even minor emergencies become overwhelming: “They don’t just worry about long-term care. They worry about who will drive them to the hospital if they get sick at 2 a.m.”
Dr. Chatterjee also points to a critical systemic gap across India’s healthcare system: a severe shortage of specialized geriatric care providers, meaning most older adults rely on general healthcare services that are not designed to meet their unique physical and medical needs. He argues that what India needs is a broad, cross-sector support network that includes accessible day-care centers, community gathering spaces, age-friendly primary healthcare, and structured opportunities for seniors to maintain social connections. “No single government department can solve this problem on its own,” he notes.
Even with the launch of the new department, questions remain about whether Kerala’s ambition matches its available resources. This year, the state has allocated just 100 million rupees (approximately $1.05 million) to the new department, a figure many policy analysts call largely symbolic. Kelkar pushes back on this criticism, explaining that the initial funding is earmarked for building coordination capacity, supporting innovative pilot projects, and building the population data infrastructure needed to scale long-term policy. “The government views ageing not as a short-term welfare project, but as a long-term development priority for the entire state,” he says.
Some industry experts add that policy alone is not enough to address the gap. Srinivasan Govindaraj, CEO of Athulya Seniorcare, which operates assisted living facilities across India including in Kerala, argues that India still lacks a properly regulated private senior care market. “There are dozens of small, local providers across the country, but there are no uniform national quality standards or accountability measures,” he says. For Ker ala’s growing ageing population, he says, what is needed is not just government welfare schemes, but a trusted, regulated care ecosystem that can support low- and middle-income families who cannot afford full private pay care.
For 82-year-old MSR Dev, a retired scientist who lives in Kerala with his wife, the core of the issue is simpler than policy and funding: it is about keeping older people connected to the world around them. He says Kerala can draw lessons from nations like Sweden, where robust community support systems help older adults stay active and independent well into their later years. “Communication and connection are just as essential as food and healthcare,” Dev says. “As social beings, we all need places to go and people to talk to.”
Back in their small home, Dominic and Martha have not waited for government policy to improve their circumstances. Like many other elderly couples in Kerala, they continue to rely on the generosity of their neighbors, as they have for years. What Martha wants is not a grand policy overhaul, she says: it is just having someone they can call who will actually show up when they need help. Whether Kerala’s new dedicated department can deliver that simple promise, in a state where thousands of families are separated by oceans and time zones, remains to be seen.