Graying population, strained welfare system in Telangana

Girija (name changed) spent years working as a domestic worker before broken knees made it difficult for her to continue. Hoping to find a more viable way to earn a living, the 60-year-old borrowed money from friends and set up a roadside vegetable stall. But another health problem appeared, which made it difficult to keep the business going.

“She came to know that she was suffering from urinary incontinence. Taking frequent toilet breaks while running the stall was not practical and eventually she decided to close the shop, losing her source of income,” says Gurajada Sobha Pernidevi, founder and president of Telangana Stree Seva Samstha, a voluntary organization working for the welfare of women.

For older people with limited financial means, a health problem can cause more than just physical discomfort; it can take away their livelihood, independence and opportunities for socialization. Conditions that are difficult to discuss, such as urinary incontinence, are often endured in silence because of the embarrassment and cost of managing them.

Unlike diseases that require joint replacement surgery or cardiac stents, these less visible problems of aging often receive little attention despite their potential to disrupt daily life. However, as Telangana’s share of the elderly population grows, addressing these overlooked needs will become increasingly important.

Telangana’s population aged 60 and above is projected to grow from 12.5% ​​in 2026 to 17.1% in 2036, according to a Reserve Bank of India report titled “State Finances — A Study of Budgets of 2025-26: Demographic Transition in India — Implications for State Finances”.

The state is expected to fall into the aging category, with seniors making up at least 15% of the population. The projected demographic shift raises questions about how health care, care and community support can keep up with the needs of older people, especially those who live alone or cannot afford private services.

Associations working with seniors say problems range from getting medication and reaching hospitals to finding reliable carers and accessing mental health support.

P. Shyam Kumar, country project coordinator at HelpAge India, says medical services, including palliative care, could make healthcare more affordable. Nutritional supplements and drug delivery through accredited social health activists could also help older people manage their health.

“Without adequate support, their condition may worsen, leading to more hospital visits, additional expenses and greater dependence on family members. So providing medication through accredited social health activists can work in this direction,” he adds.

Pace mismatch

Access to health care is not just a matter of ordering or obtaining medication. Older people who depend on younger family members for hospital visits may have to wait for someone to take time off work to accompany them.

Members of several associations say that the availability of a family member often influences whether and when an older person seeks medical help. People with reduced mobility may need transport, a wheelchair or stretcher. In a multi-story building without a proper elevator, even getting someone down can require extra help and planning. Hospital visits can involve long walks between wards, diagnostic tests and consultations, making them particularly difficult for those who have no one to accompany them.

The problem does not end at the hospital gate. For older people who cannot leave home, it can be equally difficult to find a doctor willing to make a home visit. “This is a vital demand of those who cannot step out of their house,” says Sobha.

For older couples whose children have moved away for work, one partner may become ill, leaving the other struggling to coordinate treatment, travel and follow-up visits. The absence of accessible transportation and medical services at home can turn routine health care into an exhausting exercise.

Shanti, a trustee and volunteer at the Roshni Trust, which organized mental health camps in Bastis, says Hyderabad’s urban spaces do little to promote inclusion and social interaction among the elderly. “The city is designed for isolation and does not promote inclusivity,” he says.

Shanti demands government centers at the Basti level, on the lines of Anganwadis, where the elderly can access basic facilities, attend health camps and receive nutritious food. Such centers could also offer a place to meet others, reducing isolation among those who spend most of their time at home.

Finding reliable care

For older people who need help with daily activities, finding a caregiver presents its own difficulties. Volunteers point to the need for people who understand the physical and emotional needs of seniors, as well as safety concerns when elderly couples live alone and their children live elsewhere. Sobha recalls the case of an elderly woman who sleeps during the day and stays up at night to watch over her caregiver, fearing for her safety.

“This fear weighs on many elderly people who live with hired help,” he adds.

Through the Telangana Stree Seva Samstha, along with more than 80 volunteers, she distributes adult diapers, commode converter seats, walking sticks, books and other resources to those in need.

S. Bhooma Reddy, 78, editor of the Voice of Senior Citizens magazine, says the demand for carers is high and some families hire them even if their children live in the same building. “Nurses receive a monthly salary of around ₹25,000, apart from being provided food and accommodation,” he adds.

However, such arrangements remain beyond the reach of many households. Families from financially disadvantaged backgrounds often live in cramped homes and with limited resources, juggling work, domestic responsibilities and caring for parents or in-laws.

V. Manjula, president of Gruha Karmikula Union-Telangana, says opening community halls where regular food and medicine are provided to the elderly would be a significant source of support for people from poor backgrounds.

The consequences of insufficient family support can be more serious than the absence of daily help. The association reports cases of elderly people being abandoned in hospitals, railway stations and bus stops. They also cite cases of elderly parents neglecting to transfer property to their children. Physical ailments aren’t the only problems that can go unnoticed as people age. Depression and dementia can also go undiagnosed because their early symptoms are mistaken for normal aspects of aging.

K. Chandra Sekhar, 70, founder and director of ASHA Hospitals, says families often seek professional help only after symptoms worsen. Forgetfulness, which can be an early symptom of dementia, is often dismissed as a natural consequence of aging. Such assumptions can delay diagnosis and prevent older people and their families from accessing appropriate support.

“Early diagnosis can improve quality of life and help caregivers prepare for the support that may be required as the condition progresses,” she says.

Dr. Chandra Sekhar points out that loss of interest in activities that were previously enjoyed, decreased appetite and weight loss, less social interaction and numerous physical ailments can be symptoms of depression. Elderly people suffering from forgetfulness can consult a neurologist or psychiatrist.

While health camps often screen for physical ailments, camps aimed at identifying mental health issues are rarely organized, he says.

Aarathi Bellary, MD and co-founder of Aayu Geriatrics, says some older people ignore age-related health problems even when symptoms show up.

“While physiological problems receive attention, mental health issues in old age are hardly discussed. We should not dismiss every problem as an inevitable part of aging. It is important to consult relevant medical specialists,” he says.

Dr. Bellary also encourages older people to pursue hobbies, maintain an active social life and participate in activities that allow them to share their knowledge and experiences. Such engagement can help them stay socially connected rather than being defined solely by their health needs.

Assisted living planning

For those who need more permanent support, assisted living and other residential care options could fill the gap between hospital treatment and independent living. However, Hyderabad has only a few such facilities.

Ambati Rampapa Rao, chairman of PACCS Healthcare Pvt Ltd, which has a subsidiary Ucchvas Transitional Care Centres, says longer life expectancy has forced planning for the changing needs of the elderly, especially when their children move out of their hometown.

Aging can bring a number of difficulties, including reduced physical strength, tremors, weight loss, malnutrition, and emotional or psychological problems that affect a person’s ability to perform daily activities.

Dr. Rao outlines three broad categories of elder care. Transitional care provides support immediately after discharge from hospital, ranging from a few weeks to several years, with some degree of medical supervision; assisted living cares for those whose age and medical history require monitoring and preventive care; and senior facilities serve people who remain mobile but have less health problems.

“When designing spaces for seniors, social and aspirational security must be considered to meet their emotional and intellectual aspirations. This needs to be planned for people from all financial segments,” he says.

As businesses explore investments in the sector, the number of devices could increase. However, affordability remains critical to whether these services reach those who need them most.

Care beyond the family

The Telangana government has sanctioned 37 multi-purpose day care centers for the elderly, of which 32 are functioning. Run by NGOs with full financial support and monitoring by the government, the centers encourage social interaction and provide nutritious food, indoor games and basic medical check-ups once a week.

However, for older people who are dependent on regular meals or health monitoring, the reliability of these services is just as important as their availability. One elderly woman says she fears health problems could jeopardize her access to the centre.

“My sugar level goes up when I don’t have food on time. Someone else may develop other health problems. If we get sick at the centre, our children may see us as a problem and ask us to stop going,” she says.

Her concern points to a larger dilemma: services designed to support older people may not be enough if families perceive the time and effort involved in accessing them as a burden.

As Telangana’s elderly population grows, the challenge will be to make care accessible not only to those who can afford paid assistance, but also to people whose health problems, limited mobility or financial situations threaten their independence.