“My patients ask me – if they become dependent, who will take care of them?” says Dr Prasun Chatterjee, who leads the geriatrics unit at Apollo Hospital in Delhi.
Others worry about something more immediate – who would take them to hospital if they fell ill in the middle of the night.
Many of his patients live alone after losing a spouse or seeing their children move away.
Dr Chatterjee also points to a wider gap in India’s healthcare system: too few geriatric specialists, with many older people still relying on services not designed for their needs.
He says what is needed is a broader support network, from day-care centres and community spaces to accessible primary healthcare and opportunities for older people to stay socially connected.
“No single department can do all of that,” he says.
Alongside these plans, questions remain over whether Kerala’s new department has the resources to match its ambitions.
The state has allocated 100 million rupees ($1.06m; £802,605) for elderly welfare this year, a figure some have described as largely symbolic.
Kelkar says the funding is meant to build coordination capacity, support pilot projects and develop the data systems needed for a longer-term response.
“The government views ageing not as a short-term project but as a long-term development priority,” he adds.
Some experts also argue these policy steps alone are not enough. They point at a need for private facilities and adoption.
“There is still no properly regulated market for senior care,” says Srinivasan Govindaraj, CEO of Athulya Seniorcare, which operates senior-living facilities across several states, including Kerala.
“There are many small players, but no uniform standards or quality measures.”
He says Kerala’s ageing population will need not just welfare schemes but a trusted and regulated care ecosystem that can support families who cannot afford private solutions.
For MSR Dev, an 82-year-old retired scientist, the question is also about something simpler – whether older people remain connected to the world around them.
He believes Kerala can draw lessons from countries such as Sweden, where community support systems help older people remain active and independent.
“Communication is essential,” he says.
“Not just food or health services. As social beings, people need places to connect.”
Back in their home, Dominic and Martha are not waiting for policy to catch up. They depend on neighbours, as they always have.
What they want, Martha says, is not complicated – someone to call who can actually come.
Whether Kerala’s new department can help provide that support, in a state where families are often separated by oceans and time zones, remains to be seen.
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