Invisible care, visible crisis: Rethinking India’s approach to special care needs

As India’s population ages and its social structures evolve, a silent crisis is taking root within households, the growing gap between the need for special care and the availability of caregivers.

- PALASH BARUAH AND D.L. WANKHAR

Special care, encompassing assistance during illness, injury, or for persons with disabilities, remains a largely invisible but indispensable form of work. Recent household data from the Time Use Survey (TUS-2024) reveal a telling pattern where 1.9% of Indian households require such special care, yet 15.5% of these households lack a caregiver from within the family. Behind the numbers lies a person — a bedridden father, a differently-abled child, an ailing spouse — and often, an unseen person, mostly women, holding it all together. The figures, though numerically modest, illuminate a deepening challenge for a family-based care support amid rapid socioeconomic change.

RURAL - URBAN: RESILIENCE AND STRAIN

A closer look at the rural-urban divide reveals contrasting dynamics. Rural India, where 2.0% of households report needing special care, fares marginally better in terms of availability where 14.1% of the households lack an in-house caregiver. In urban India, where 1.7% of households require such care, 18.6% report no family member available to provide it. This disparity underscores a structural shift. Rural households, often larger and more interdependent, still retain vestiges of joint family systems and informal care-giving norms. In contrast, urban families are increasingly nuclear, with dual-income earners and migratory lifestyles that fragment care-giving responsibilities. This troubling paradox would further widen, wherein rural India still retains a network of extended family support, urban India is witnessing a collapse of informal family-based care systems.

ECONOMIC GRADIENTS OF CARE