Attitudes to long-term care in India

Objectives: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long-term care (LTC) facility use. We investigated the usage frequency and attitudes to LTC in India. Methods: We conducted secondary analyses of: (a) The LASI (Longitudinal Ageing Study in India) 2017-18 cross-sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households; and (b) Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC. Results: Of 73,396 LASI participants, 40 were considering moving to LTC; 18,281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, was living in LTC. Whilst rare overall, LTC use and consideration of use were more likely to be in urban areas, in middle-richest income quintiles with higher levels of education, and for those who were more likely to rate their health as good or very good. We identified three themes from qualitative data: 1. LTC as a last resort, describes how LTC could be acceptable if care at home was “impossible” due to the person’s medical condition or unavailability of the family carer, for example if they lived abroad. 2. Social expectations of care at home from family members and paid carers and; 3. Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Conclusions: Preference for intergenerational community care, limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home, supporting care in the community, and bolstering respite and LTC services when other options are not available.