International Institute for Population Sciences
Deemed to be University (An Autonomous Organization of Ministry of Health & Family Welfare, Government of India)

The Indian state Kerala has had the early advantage of demographic transition, celebrating the advanced human development indicators, reaping the dividend, often lauded for gaining international attention for its ‘Kerala Model of Development, is now on the verge of its much-anticipated demographic challenge: The Ageing Population. Based on this context, the present study aims to examine the role of the decentralised governance mechanism in delivering elderly care services through Local Self-Government (LSG). The institutional frameworks and key initiatives, notably the Vayomitram Project, Pakal Veedu, and the much-appreciated community-based Palliative Care Programme. These initiatives, although intended to promote healthy ageing in place, have a direct impact on family-based care, assigning caregivers, often family members themselves, the primary caregiving role. The initiatives, though, are meant to supplement and alleviate the responsibilities of informal caregivers. By successfully enhancing the service availability for older people, its support for the primary caregivers is often insufficient and negligible. This is in the context where primary caregivers are often children of older people who face the double burden of caregiving, the paper attempts to critically unfold the role of the system, which is itself constrained by resource limitations, including both financial and infrastructural constraints (such as nursing homes and the institutional model of care). Additionally, the law prohibits sending older people to OAHs. This not only imposes constraints on caregivers by imposing physical, emotional, and financial tolls, but also questions the long-term sustainability of the LSG’s decentralised service framework.