Attitudes to long-term care in India: A secondary, mixed methods analysis

ObjectivesIn India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long-term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India.MethodsWe conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC; and (b) The Longitudinal Ageing Study in India (LASI) 2017-2018, cross-sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households.ResultsWe 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 family members lived overseas or interstate. (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. 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, lived in LTC. LTC use was rare. While a third of participants with a living parent lived in urban areas, 14/24 of those with a parent in LTC lived in an urban area, supporting our qualitative findings that LTC is mainly accessed in urban areas.ConclusionsPreference for intergenerational community care combined with 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 and in the community, and bolstering respite and LTC services as a last resort. In India, the demand for long-term care (LTC) facilities is low, with only a small number of people residing or considering residing in one. Most people prefer intergenerational community care at home. Contrary to the population as a while, more people who had a parent living in LTC were residing in urban versus rural areas; in qualitative interviews, family carers and healthcare professionals of people with dementia reported having less access to LTC in rural areas, which may be linked to increased financial challenges and limited resources for more specialised care. Given the strong preference for care at home over LTC, initiatives are needed to increase community resources for family carers of older adults with unrecognised and undiagnosed conditions such as dementia. Additionally, there should be improved access to LTC for those with fewer financial resources.