India’s elderly population stood at about 153 million in 2020 and is projected to more than double to 347 million by 2050, nearly one in five Indians. For majority of them, the most important choices on how and where they will spend their later years will be made in the back of a car following a medical emergency, in a hospital corridor, or when a parent makes an unexpected announcement that shocks everyone, including themselves. Not because families do not care. However, they never discussed it. The real crisis in Indian elder care is not a shortage of beds or facilities; it is a shortage of conversations. India added around 25% dedicated senior living facilities in five years (Dsouza et al., 2023) . Yet there is no equivalent count of families that sat down and asked an ageing parent what they actually wanted. One of these things is measurable. The other, perhaps more imperative one, is not, and that invisibility is itself the problem.India is building more senior living facilities than at any point in its history. According to a joint report by JLL India and the Association of Senior Living India, the sector is projected to grow by over 300% by 2030, reaching USD 7.7 billion. More than 20,000 specialized senior living units now exist across the country, with a 27% compound annual growth rate expected through the decade. Investors are pouring in, over USD 40 million in institutional investment in the last two years alone. Gurgaon’s rise as the hub of Indian senior living is not accidental. Haryana approved a dedicated Retirement Housing Policy as far back as August 2021 , one of the earliest such frameworks in the country, making the region an attractive destination for developers and investors alike, and, as recently as April 2026, revised it further, raising building density norms specifically to attract more developers into this segment (Economic Times, April 2026). And yet, there is a crisis that no construction crane can address. The real deficit in Indian elder care is not a shortage of beds. There is a shortage of conversations.India’s primary care system for centuries was the joint family, which functioned not because it was legally structured but rather because it was rich in communication, with generations living under one roof continuously and informally negotiating ageing, disease, dependency, and death. The framework has been dismantled as and when the society transitioned to a nuclear family structure, but unfortunately, the conversation has not been replaced. Research studies (Dsouza et al., 2023) document directly how this shift has led to a substantial decline in intergenerational communication, with older adults increasingly experiencing isolation and health issues.What can possibly fill that emptiness? Mostly silence, a unique kind of silence that Indians have perfected. Parents reassure with “Don’t worry,” while children interpret it as “Something’s wrong.” Everyone avoids direct communication. A 2026 guide for NRI families, published by Samarth , which describes itself as “India’s leading elder care organization, serving over 30,000 senior citizens nationwide,” highlights the issue with disturbing precision: ageing parents frequently neglect their medications, hide falls, and dismiss loneliness as “just part of ageing” to avoid burdening their children. Meanwhile, adult children living in Mumbai, Bengaluru, or abroad steer clear of conversations about ageing, as culturally it feels like wishing decline upon their parents. As a result, the first serious discussion about care often takes place in a hospital corridor or when a parent reveals a decision that has already been made. By the time this conversation happens, it has shifted from a dialogue to a mere reaction.Although this problem is not limited to India, the country faces distinct challenges that worsen it. Studies conducted in Singapore, which has a family culture similar to that of urban India, reveal that both elderly parents and their adult children rarely engage in conversations about end-of-life care preferences, even when the parents have privately made their decisions clear. The primary obstacle is the belief that “it is not yet time” (Lee & Ng, 2020) . According to the Longitudinal Ageing Study of India (LASI) , more than a quarter of the urban elderly population does not have assistance from their children or other family members, a number that is expected to continue to rise. However, there is no equivalent Indian study that assesses how many of these individuals have had meaningful conversations with their families about their desires. We do not even quantify this gap, and that itself is a major issue.As a communication scholar, I argue that Indian families do not suffer from a lack of love, intention, or even awareness. What they truly lack is a shared language to talk about ageing or for negotiating intergenerational care discussions. According to Communication Accommodation Theory, by Howard Giles (2025) , families often struggle to discuss ageing effectively. Adult children may over-accommodate by speaking slowly, simplifying, or they may fail to accommodate at all, discussing the elder with doctors and siblings instead of engaging directly with them about their own lives. Both behaviours convey the same message to the elder: ‘you are no longer an active participant in decisions concerning your future’.The older generation has often been conditioned to remain silent, having grown up in an era where self-reliance was paramount, and they built their lives and families without seeking assistance. Consequently, they find it difficult to ask for help now. This leads to a threefold silence: the elder remains quiet to avoid being a burden, the adult child refrains from speaking to avoid confrontation, and siblings do not communicate with each other because caregiving responsibilities, such as who visits, who makes decisions, and who covers expenses, are assumed by default rather than through design. What appears to be a family caring for its elderly members is frequently a family evading the discussions that could enable them to provide better care.The solution does not come from Western influences. American-style advance care planning directives, typically signed in a lawyer’s office, are not suitable for a society where care is based on relationships, family, and context. What is required is a more natural approach: integrating discussions about ageing into relationship conversations rather than framing them as medical or legal issues. Research on ‘communication non-accommodation in family’ , shows that adapting our communication style in family interactions, focusing on how we speak, not just the content, significantly enhances constant engagement in health-related talks. This skill can be taught. The conversation should not begin with “what happens when you die,” but rather with “what would make your days enjoyable?”Institutions have the potential to foster the right environment for this. Human Resources departments in major Indian corporations, where many employees belong to the sandwich generation, balancing raising children and elder care, could incorporate family communication workshops into their employee wellness initiatives. Hospitals might not only educate doctors in geriatric care but also in engaging families in open, respectful dialogue. Additionally, communication departments at Indian universities and institutions could convert some of their significant efforts toward the kitchen-table discussions that will influence the lives of 347 million people by mid-century. Senior living facilities could also enhance their approach. Currently, their main focus is on adult children, highlighting aspects like safety, amenities, and reassurance. Their brochures or conversations rarely start with the elder’s viewpoint, or address the very first question: what does your parent truly want?The expansion of senior living facilities nationwide is a positive development. These specially designed communities, which provide medical care and social engagement, among many other things, represent a significant improvement over what was available in the past. This is definitely worth celebrating. However, a well-designed apartment cannot replace a family that, long before this transition, understood their parent’s desires and made decisions based on that understanding. While one can be created with financial resources and construction, the other demands time and the will to ask. Building beds for the older adults is essential, but building conversations that respect them is imperative at the moment.(Writer is assistant professor, strategy and general management, Institute of Management Technology, Hyderabad)
