India’s booming health system has a significant gap due to the absence of trained home nursing assistants to provide non-medical care. The nation’s senior citizen population, which was 138 million in 2021, is projected to reach 194 million by 2031, according to the National Statistical Office. Increasingly, the elderly population is living alone in their homes or is forced to care for themselves as eligible caregivers at home are at work. This demographic shift is fuelling the need for trained caregivers at home. The high incidence of chronic diseases such as diabetes, hypertension, cardiovascular diseases, and cancer — responsible for more than 60% of deaths in India among the elderly — has increased the need for continuous assistance at home.
In India, many home caregivers work informally, without structured training, leading to inconsistencies in care quality and potential risks to patient safety. Most trained nurses, including myself, frequently receive calls from patient attendants and doctors requesting trained nurses to offer non-medical domiciliary care to patients. Even with higher pay, nurses must not be allowed to work as assistants. India must start a formal certification programme regulated by nursing councils, like in the US, UK, and Australia, to ensure standardised training for patient care.

There is a huge shortage of nurses across India. India’s nurse-to-population ratio is 1:670, which is far below the WHO-recommended 1:300. Even in states such as Tamil Nadu, there are just two nurses per 1,000 people. Certified home healthcare assistants (CHHAs) must be used to bridge the gap by providing essential home-based care. They are caregivers who provide non-medical support to individuals at home, assisting with daily living activities like personal care, basic health monitoring, and household tasks. They would feed patients food and medicines at the right time, take them for walks, or call families when there is an emergency. Beyond physical help, they offer crucial companionship and emotional support, enabling clients to maintain independence. While not medical professionals, CHHAs are vital for improving quality of life and easing the burden on families.
The home care market, valued at $6.2 billion in 2020, is expected to grow at a CAGR of 19.2% until 2027, according to Research Nester. India has a surplus of job seekers in healthcare, and the expected growth of the homecare market shows how structured training programmes that align with international standards will help many college dropouts find jobs in India and abroad. Moreover, the increasing integration of technology, including telemedicine and remote monitoring, allows CHHAs to collaborate more effectively with doctors and nurses, enhancing the quality of at-home care.
However, these skills come with training. The training and certification of CHHAs in India fall under the purview of the National Skill Development Corporation (NSDC) and the Healthcare Sector Skill Council (HSSC), not the nursing councils. This leads to inconsistencies in training standards and certification processes across the country. Unlike registered nurses, who are subject to stringent licensing requirements, CHHAs in India lack a formal licensing body, affecting the quality of care and limiting professional accountability and opportunities for career advancement.
In the USA, Canada, and Australia, class X students undergo training for 120 hours, six months, or a year, respectively. The certificate is given by a state or national body. In these countries, the roles of home healthcare assistants are well-defined, which reduces ambiguity and ensures that both the caregivers and the families they serve have clear expectations. There is also some form of regulation and oversight. Home healthcare services are often integrated into the broader healthcare system, with CHHAs working as part of a team that includes nurses, doctors, and other healthcare professionals. These countries often provide clearer career pathways for home healthcare aides, allowing them to specialise or advance their skills, which improves job satisfaction and retention. There is an emphasis on providing patient-centred care, which means that CHHAs are trained to focus on the individual needs and preferences of each patient.
Bringing CHHA training under state nursing councils could improve patient safety by establishing accountability measures for home caregivers, creating clearer career paths for CHHAs, and aligning India’s CHHA training with global standards could open international job opportunities for these healthcare workers. This involves creating national competency-based guidelines and mandating state or national licensing for CHHAs. Integrating this training with state nursing councils — through collaboration between the NSDC and HSSC — would ensure quality control and establish a formal licensing system, like other healthcare professions.
Expanding CHHA roles with specialised certifications in areas like dementia care, palliative care, and post-operative support, and formally recognising CHHAs as part of India’s healthcare workforce is crucial. Lastly, leveraging technology, such as e-learning, virtual simulation, and AI-driven assessments, can enhance the efficiency of CHHA training.
(The writer is a Registrar of the Tamil Nadu Nurses and Midwives Council)
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