Aging Without Support: The Neglect of Punjab’s Elderly

“Old age is the crown of life: the final act in the play of life.” — Marcus Tullius Cicero

-Pushpinder Singh Gill

The words carry timeless wisdom, yet in Punjab today this “crown” often feels more like a burden borne in silence. Aging here is rarely about honor or celebration; it is about endurance. In a land once celebrated for its joint families, fertile fields, and intergenerational bonds, the elderly now face an uncertain twilight. India already has over 104 million people above the age of sixty, and this number will swell to 319 million by 2050. Punjab, with its unique social and migratory patterns, stands at the forefront of this challenge. Waves of younger Punjabis have settled in Canada, the UK, and Australia, leaving behind parents and grandparents who must navigate frailty with little support, pensions that fall short, and institutions unprepared to fill the gap.

The structural inadequacies are stark. By law, every district is meant to have at least one old-age home for 150 residents, but across India fewer than 500 districts meet this requirement. Punjab is no better. In rural areas—home to nearly sixty percent of its people—the absence of facilities is glaring. Health infrastructure is equally stretched: Sub-centers, Primary Health Centers, and Community Health Centers number far below what is required, and those that exist often lack basic features such as wheelchair access, non-slip flooring, or age-friendly toilets. For an elder with failing joints or poor eyesight, the walk across a corridor can be as dangerous as crossing a highway.

But even where facilities exist, what is missing is the human presence that makes old age bearable. Care managers, often called “proxy children,” step into roles once naturally performed by sons and daughters. They escort elders to dialysis sessions, organize medicines, arrange physiotherapy, and manage emergencies. And yet, institutions cannot recreate the intimacy of family life, especially when the joint family system has withered and villages echo more with silence than with children’s laughter. Many elders live in a limbo—too frail to live independently, too proud to accept institutional life, too lonely to thrive.

Staff shortages deepen the crisis. Nearly half of Punjab’s sanctioned medical posts remain vacant. Young doctors prefer better pay and career progression in other states, leaving geriatrics—already an underdeveloped specialty—practically absent. India has fewer than a thousand trained geriatricians for its massive elderly population. Nurses and caregivers, overburdened and underpaid, face burnout and high turnover. Without physiotherapists, occupational therapists, or counselors, care homes lack the team-based approach essential for elderly well-being.

The medical load is relentless. Most institutionalized elders live with multiple chronic diseases—hypertension, diabetes, heart disease, arthritis—and require five to seven medications daily. Alongside come mental health challenges: depression affects nearly 38% of elders in institutions, while dementia and anxiety quietly erode others. Yet such conditions are often brushed aside as “normal aging.” Stigma ensures silence, while the absence of trained psychiatrists or counselors ensures neglect.

The economics of eldercare are equally unsustainable. With 78% of India’s elderly lacking pensions and only 18% covered by insurance, institutions rely heavily on charitable donations or fragile state support. Out-of-pocket payments dominate, forcing many families to withdraw elders from formal care. Government schemes exist, but they are underfunded and poorly implemented. Welfare often translates into token pensions or one-off freebies that grab headlines but do little to build lasting systems of care.

The greatest barrier, however, is cultural. In Punjab, putting one’s parents in an old age home is still viewed as abandonment. Families delay the decision until circumstances become unmanageable, by which point elders arrive already weakened. I recall my father, at eighty-five, learning that a friend of his had been admitted to such a facility. Deeply disturbed, he asked me to take him there. Meeting his old companion, he made an extraordinary offer: “Come live with me in my kothi. My son will look after both of us. I cannot see you ending your days in such a place.” His words carried the weight of a generation for whom institutional care was not refuge but exile, a mark of broken bonds. That stigma continues today, even as the social realities that once sustained elders—large families, shared households—have vanished.

Migration has compounded this loneliness. Money from abroad arrives regularly, but companionship does not. Festivals are marked by video calls, not shared meals. Parents sit in homes built with foreign remittances but devoid of laughter. Their only daily contact is with neighbors or an occasional caretaker. For many, the phone call has replaced the chithi, and silence has replaced both.

The contrast with other nations is sobering. Japan, where almost thirty percent of the population is elderly, has invested in community-based day-care centers, long-term care insurance, and technology like fall sensors and telemedicine. Germany and Sweden have integrated eldercare into social insurance, ensuring financial sustainability. Singapore has pioneered “active aging” hubs that blend healthcare, recreation, and social connection. India has the demographic signals flashing bright red, yet Punjab continues with patchwork schemes and symbolic gestures.

There are, however, models of hope within India. Organizations like HelpAge India and the Nightingales Medical Trust in Bengaluru have demonstrated what is possible—mobile health vans for rural elders, dementia-care facilities, and volunteer-driven companionship programs. Their reach remains limited, but they prove that innovative, compassionate solutions are possible and replicable if supported with funding and policy backing.

Punjab, in particular, must rethink how it allocates its resources. Each year, crores are spent on electricity subsidies, farm loan waivers, and other short-term welfare schemes. Redirecting even a fraction of these funds to eldercare—retrofitting homes, building community centers, funding mobile health services, training caregivers—could create long-term impact. Equally, eldercare should be encouraged as a private-sector opportunity. With the right incentives, entrepreneurs could build retirement communities, assisted-living centers, and home-care services that generate employment for youth while providing dignity to elders. Training programs for geriatric nurses, caregivers, and therapists could both fill the care gap and reduce unemployment.

Technology, too, can be harnessed. Wearable devices that monitor vital signs, AI-assisted reminders for medications, and tele-consultations with doctors can make care accessible even where staff are thin. In rural Punjab, mobile vans equipped with diagnostics and connected to telemedicine hubs could bring healthcare to villages where permanent facilities remain scarce.

Community and cultural institutions have their role as well. Gurdwaras, already central to social life, can host day-care programs, community kitchens, and companionship groups for elders. Panchayats can integrate elder welfare into village planning. Training and respite support for family caregivers can ensure that elders remain longer in familiar environments without exhausting their children or daughters-in-law.

The path ahead requires courage: to admit that Punjab’s elders are being neglected, to challenge stigma, and to build structures of dignity rather than patchwork charity. This is not only a question of healthcare or policy; it is a moral imperative. Those who tilled Punjab’s fields, fought its battles, built its prosperity, and nurtured its families now face the harshest years of their lives. If they are abandoned, we lose not only individuals but also the very roots of our culture.

Punjab stands at a crossroads. It can continue with token gestures, or it can build a compassionate system that recognizes elders not as burdens but as blessings. In the words of a Punjabi proverb: “Bazurg sirf saddi virasat nahin, oh saddi barkat ne.” Elders are not just our heritage, they are our blessing. To forget them is to forfeit both memory and morality.