What it costs to care for aged parents in India today

Oct 30, 2023

How do you decide on a comprehensive financial plan? That’s easy. Just list out your financial goals. Household expenses, school or college fees, foreign studies, annual vacations, life and health insurance plans, and an emergency fund. Estimate the inflation-adjusted corpus needed and, accordingly, plan your investments to build the required corpus. Think you got it all covered? What about dependent, elderly parents?

Geriatric care has turned out to be a major financial expense that almost often never makes it to people’s financial plans. Geriatric care refers to providing for the well-being of elderly people. And their budget depends on a host of factors, including whether they are staying with you or elsewhere, or are admitted to an old age home, suffer from any illness, or need any caregivers. And it matters if they get any pension or have any other source of income.

“Geriatric care is neither time- bound nor certain. You can never anticipate whether your parent will need caretakers at a later stage and how much it can cost. For these reasons, people don’t think of it until it really matters," said Kalpesh Ashar, a registered investment adviser (RIA).

Given the high healthcare costs and lack of social security in India, geriatric care demands massive financial commitment. Take the case of Bengaluru-based Darshana Dattani and Thejesh Balakrishnan. Thejesh’s sexagenarian mother, Radha, has a chronic kidney ailment and the couple spends nearly ₹80,000 every month on her dialysis and other costs. “Until last year, her treatment was based on medication. But, one day, she collapsed and had to be hospitalized, Now, she needs dialysis thrice a week. One session costs ₹3,000," said Darshana.

Besides, the couple spends about ₹1 lakh each year on tests and doctor visits. Thejesh’s medical insurance provided by his employer has covered the dialysis cost so far, but inflation is hurting. “The per session cost of dialysis is getting revised to ₹4,000 and the insurance amount will fall short," said Darshana.

The challenges of looking after elderly parents increase manifold when you live in different cities. Mumbai-based Shantanu Bhattacharya, 50, knows this too well. Bhattacharya’s parents live in Kolkata in their own home but are financially dependent on him. Though he has always provided for them, the distance has started posing special challenges as his mother, a cancer survivor, has become partially immobile. “They now need constant care and physical support, which is difficult to monitor from here. Also, for medical check-ups, she feels comfortable going to the hospital with me," he said.

Shifting them to Mumbai is not financially feasible for him currently. “The expenses of ₹60,000-65,000 per month in Kolkata will jump to over ₹1 lakh in Mumbai given the higher cost of living here. I know that I have to move them here eventually, but that may take some time," he said. Inflation has not spared Shantanu either. Until a year back, he spent about ₹30,000 on their medicines every month, which has now increased to ₹45,000.

For people with dependent parents, the first step should be to get them medical insurance early. This takes care of any sudden hospitalizations and related treatment costs. Dilshad Billimoria, managing director and principal officer, Dilzer Consultants, suggests if there is a medical history of diabetes, arthritis, dementia, etc, in the family, it would do well to buy a critical illness cover as well for the parent.

However, insurance does not cover at-home care services, like an attendant or home nurse, and costs of medical equipment installed at home, if any. A full-time attendant can charge ₹25,000-30,000 a month in a metro, while it is ₹15,000-20,000 in tier-2 cities. For a skilled nurse who can assist with domiciliary treatments, this cost goes up by 25-40%.

Planning early will help since geriatric financial responsibility generally happens around the same time as some other financial goals, and being unprepared for this can impact the monthly budget. Billimoria said people should start a parents’ contingency fund earlier. “This should be separate from the emergency fund for oneself," she said.

Ashar said that people rarely keep aside money for their parents‘ medical emergencies. “So, it will be at the cost of foregoing some lifestyle expenses or a cut in some investments, but one should not wait for the illness to accelerate," he said. Geriatric care can’t be treated as an emergency that will pass because the condition of the elderly, in most cases, doesn’t improve. “The condition either remains the same or deteriorates with time; saving for it should not be delayed," said Ashar.

Darshana is doing just that for her mother-in-law. “Last year, a sudden hospitalization set us back by ₹3 lakh. We want to be better prepared for such an exigency next time," she said.

Finances aside, taking care of an elderly parent is a demanding journey involving intangible challenges that can’t be quantified. Delhi-based Manjeet Singh recalls how difficult it was for him to find a ward boy for his bedridden father soon after his surgery. Manjeet’s father was treated at a government hospital that required the family to hire a private ward boy to assist him during nights. “Government hospitals don’t have dedicated nurses or ward boys like private hospitals. The elderly care services sector is unorganized and it was difficult to compare prices and quality across different agencies," he said.

The same also holds true for the process of renting or buying medical equipment. Some reputed hospital chains provide these services but they are 25-40% expensive (see graphic).

A solution to this problem is shifting the elderly to a senior care facility that provides all such dedicated services. However, this is still a taboo in India. Many are unwilling to shift their parents to such homes for fear that they will be scorned. “My mother, at the age of 61, put her own mother at one such facility as she couldn’t shoulder the responsibility any longer and yet some relatives make her feel guilty about this," said Darshana.

However, there are senior care facilities for post-hospitalization recovery that requires a temporary stay of 3-8 weeks. Here, the patient gets a separate room with round-the-clock care by nursing attendants. Besides regular doctor visits, medicines and necessary equipment are organized by the institution. KITES Senior Care is one such option. “Rehab and palliative care costs about ₹3,000-4,000 per day, whereas charges for dementia care in our centre is ₹1,500 to 2,000 per day," said Rajagopal G, co-founder and CEO of KITES Senior Care.

“The stigma of senior care homes needs to go. In a household where both spouses work, it’s difficult to provide constant care to the elderly. A senior care facility can give better services," said Manjeet.

For working couples, the responsibility can also get overwhelming sometimes. Darshana said their personal lives and health have been impacted with all the running around that is needed. “My husband and I recently took one night out after almost 18 months as we don’t want to leave my mother-in-law alone."

Costs are just one part of geriatric care, said Shantanu. “It’s not just about keeping them alive. You also have to ensure quality, hygienic care and other recreational activities to keep them engaged."