Two Ways to Look at Growing Old: Pay the Person, or Expect the Family
Neither picture has a villain. Hal and Vi are protecting their daughter's time.
Here is a picture, made up to show two ideas side by side. It is not a report on any real family.
Picture a couple named Hal, 71, and Vi, 69, in an American city. Each month a payment from the Social Security Administration arrives in their bank account. They have savings. They talk about the day one of them needs daily help, and they have a plan: a good assisted living community, paid from the savings. Vi told their daughter, "We don't want to be a weight on you."
Now picture a family in a city in India. A grandmother of 80 lives in the family home with her son, his wife and their children. Her own income is small. Her son's household gives her meals and help on the stairs. When she was ill last winter, the family worried most about the hospital bill.
Neither picture has a villain. Hal and Vi are protecting their daughter's time. The family in India is doing what it believes a family does.
"Where else would she be?" the son said, when a neighbor asked if the house was getting crowded.
I wrote in another piece what I heard in India. The idea, as I understood it, is that the family looks after what it can, and the government looks after what a family cannot. The United States looks to me close to the other way around. Here is what the sources show about each.
| United States | India | |
|---|---|---|
| Who gives income | Social Security pays the person | The central government's old-age pension pays Rs 200 a month at ages 60 to 79 and Rs 500 from 80, with states adding to it. The family is the main source |
| Who gives daily care | The person's savings, or the family, or Medicaid for people who qualify. Medicare does not pay for custodial care if that is the only care needed | The family. About 68% of people 60 and older lived with their children (our sum of two groups in a 2017-18 national survey). 5.7% lived alone |
| What the law says | Varies by state. See the piece on laws that ask children to help | A 2007 law makes children responsible for maintaining parents |
| Health cover | Medicare for people 65 and older | Only 18.2% of people 60 and older had any health insurance in 2017-18. Since October 2024 a government scheme covers everyone 70 and older, up to Rs 5 lakh a year |
(India figures: Longitudinal Ageing Study in India, 2017-18; Parliament replies; Maintenance and Welfare of Parents and Senior Citizens Act 2007, via PRS India. "Rs" means rupees; a lakh is 100,000.)
Each way asks for something. In the first, a person plans money while well, and may pay a high price when care arrives. In the second, a family plans its home and its days, and the government's health cover is still being built. The grandmother's monthly check is small, and Hal and Vi lean on savings in place of a shared household.
You could…
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Ask each member of your family what they picture for the later years, and listen to the whole answer.
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Write down which parts of your plan depend on money, and which on people.
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Read how the country you are considering treats foreign residents who need daily help.
What have you seen in another country that changed how you think about growing old? Share it here. Someone reading may be choosing between two pictures.
Figures are estimates for planning, based on public data. Sources: Longitudinal Ageing Study in India (2017-18); Government of India Parliament replies and cabinet decision on Ayushman Bharat (2024-2025); PRS India summary of the 2007 Act; Medicare.gov.
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