India's booming health system holds a huge gap due to the lack of home nursing assistants trained to provide non-medical care. The country's elderly population, which was 138 million in 2021, is projected to reach 109 million by 2031, according to the National Bureau of Statistics. Increasingly, older people are forced to take care of themselves, either because they live alone at home or because they have qualified caregivers at work at home. This demographic change promotes the need for home-trained caregivers. The incidence of chronic diseases such as diabetes, hypertension, cardiovascular disease and cancer has caused more than 60% of Indian deaths among older adults, increasing the need for ongoing support at home.
In India, many home caregivers work informally without structured training, leading to inconsistencies in the quality of care and potential risks to patient safety. Most trained nurses, including myself, get calls frequently from patient attendants and doctors who require trained nurses to provide non-medical residential care to their patients. Even if the wages are high, nurses should not be allowed to work as assistants. India must launch formal certification programs regulated by nursing councils such as the US, UK and Australia to ensure standardized training for patient care.
There is a huge shortage of nurses all over India. The ratio of nurses to population in India is 1:670, which is well below the WHO recommended 1:300. Even states such as Tamil Nadu have only two nurses per 1,000 people. It should be used to fill the gaps by using certified home health assistants (CHHAs) to provide essential home care. They are caregivers who provide non-medical support to individuals in their homes and support daily activities such as personal care, basic health monitoring, and home tasks. They supply patients with food and medicine at the right time, take them for walks, and call their families when there is an emergency. Beyond physical help, they provide important relationships and emotional support, ensuring that their clients remain independent. Though not a medical professional, CHHA is essential to improving quality of life and alleviating the burden on families.
According to research Nester, the $6.2 billion home market in 2020 is expected to grow at a CAGR of 19.2% through 2027. India has a surplus of healthcare job seekers, and the expected growth of the home care market shows how structured training programs consistent with international standards can help many university dropouts to find jobs in India and abroad. Furthermore, the increased integration of technologies, including telehealth and remote monitoring, allows CHHA to work more effectively with physicians and nurses to improve the quality of home care.
However, these skills come with training. The training and certification of CHHA in India is within the scope of the National Skills Development Corporation (NSDC) and Healthcare Sector Skills Council (HSSC), not the Nursing Council. This leads to a contradiction between national training standards and certification processes. Unlike registered nurses who are subject to strict licensing requirements, India's CHHA lacks a formal licensing agency, affecting the quality of care and limiting opportunities for professional accountability and career advancement.
In the US, Canada, and Australia, Class X students train for 120 hours, six months, or one year, respectively. Certificates are given by state or national institutions. In these countries, the role of home health assistants is clearly defined, reducing ambiguity and ensuring that both caregivers and the families they serve have clear expectations. There is also some form of regulation and monitoring. Home health services are often integrated into the broader health care system, with CHHA working as part of a team that includes nurses, doctors and other health professionals. These countries often provide a clearer career pathway to their home health aides, allowing them to specialize or advance their skills. This increases job satisfaction and retention. The focus is on providing patient-centered care. In other words, CHHA is trained to focus on each patient's individual needs and preferences.
Bringing CHHA training under the state Nursing Council can improve patient safety by establishing accountability measures for home caregivers, creating clearer career paths for CHHA, and opening international employment opportunities for these healthcare professionals to Indian CHHA training to global standards. This includes the development of national competency-based guidelines and the obligations of a state or national licensing of CHHA. Through the collaboration between NSDC and HSSC, this training is integrated with the state Nursing Council to ensure quality control and establish a formal licensing system, just like other healthcare professionals.
It is important to expand the role of CHHA with specialized certification in areas such as dementia care, palliative care, and postoperative support, and formally recognize CHHA as part of Indian healthcare workers. Finally, technologies such as e-learning, virtual simulation, and AI-driven evaluation can increase the efficiency of CHHA training.
(The author is a registrar of the Nurse and Midwife Council in Tamil Nadu)
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