I encountered the need for paid care first time in my life nearly 14 years ago when my mother-in-law was sick and bed-ridden for about 3 years. It was expensive and very difficult to get. The willingness of a care worker also depends on the family conditions of who needs the service. As I have crossed the age of 60, my current investment plan is to buy/book a slot in a good old-age home. 

The demand for care-givers is growing globally, and mostly in the developed world which has witnessed an increase in the share of older people in the population. However the supply of trained care workers faces several constraints. There is a need to match the supply with the demand. This is important not only for those who need care. This can also enhance the employment opportunities  for a significant share of the population. Such care work is the one that may not be affected by the development of AI and other technologies. 

There are interesting aspects regarding the international market for care workers. I am told that a section of students who go for higher education (probably in liberal arts and science degrees in not so reputed universities) in countries like the UK take up care work as a way of earning an income to live in the host country. The cost of this participation in care-labour market is higher. On the other hand, boys and girls from poorer and less privileged communities in India who can easily acquire the skills (and attitude) for such care work may not get opportunities in the developed world. This is a missed opportunity due to institutional constraints. 

It is well known that the care work requires close interaction between human beings and this can lead to a higher level of apprehension on the part of care-giver and receiver. This may be one reason (in addition to social norms which reduce the work participation rate of females) in India for the inadequate supply of paid care-givers. India is also not that good in enhancing the capacities of youngsters from poorer and less-privileged families to take up work such as home-based nursing and related jobs, and encouraging them to migrate to places where their services are needed. (Philippines and other countries are relatively better in this regard). 

Kerala is one state where migration has benefitted the mainstream population. However the gains from migration are limited for Dalits even when they are educated. The lack of not only financial capital but also social capital and networks play an important role in this regard. There could be a socio-economic mobility for the less educated youngsters from under- privileged groups, if the government can train them to be good care workers, and support them in the search for and to take up care-jobs wherever these are available. 

The demand for care work is increasing in India too and that too at a faster rate where the demographic transition is advanced. However family-based care is still the most preferred form. We should understand the diseconomies in this regard. A bed-ridden patient needs three shifts of care-givers ideally. The cost per patient becomes very high and only a few families can afford to have three care-givers. When only one care-giver is hired, she has to work for more than 12-14 hours per day, and she may not able to sleep properly, and that will show up in the care. Moreover, when the care depends on one person, there is a much higher chance of (emotional) incompatibility between the care-giver and receiver and this too can affect the quality of care. 

In fact a care-giver usually can take care of 3 or 4 patients (barring those very few cases where the patient needs constant attention), and if it is done, the cost per patient for three shifts of care workers will come down. However this will become feasible only in the case of institutional care (or old-age homes). However, such care is yet to become socially acceptable in India. 

The availability of old-age homes is substantially lesser than the need in India (and I am not using demand here intentionally). Though there are a few care homes (run by governmental and non-governmental organisations) catering to the poor who cannot afford to pay, these are very few, and many aged people among the poor suffer due to the lack of adequate care. There are a few organisations which provide institutional care to the middle-class people who can afford to pay, but the availability of such a service is also limited (considering the need). There has to be a substantial expansion of care homes and that may require changes in both demand and supply.

This expansion of care work can be an important economic activity. If we consider those who can afford to pay, an increase in their willingness to pay and use of care homes, and the consequent expansion of this service can be a major driver of economic and employment growth in the economy. (Some money/wealth stuck for inheritance can flow towards and contribute to the economic growth through this process).

Social and cultural changes have to happen though this is happening among the middle-class gradually. Using institutional care should be seen as a better way of dealing with old-age (and not as an inferior solution when children fail to provide the care). There have to be attitudinal changes to treat care-workers with respect, and with due regard for their freedom and independence. Many more boys and girls should see care-giving as a respectable job. There should be a higher degree of professionalisation of care work without loosing the human touch or emotional connect. When they see the care work as a viable job, a set of them can benefit from global opportunities too. This can be a booming service sector that can benefit the less privileged sections of Indian society.  

End Note: The content and opinions expressed are that of the author, and are not necessarily endorsed by/do not necessarily reflect the views of Azim Premji University