Who Cares for the Carer? The Real Dilemma Behind Kerala's Home-Nursing Economy

Two Legitimate Needs, One Household

Imagine Both Sides of the Door Inside, a

family in Kollam has a mother who can no longer get out of bed. The children work in another city or another country. They need one person who is always there, through the night, at a price they can afford. Kerala's ageing population and youth out-migration make this family increasingly common.

About 2.2 million Keralites live abroad, according to the Kerala Migration Survey 2023. At the door is the caregiver, usually a woman placed by a private agency. She needs sleep, proper food, a toilet she can use at night, a written contract and a day off.

Two caregivers in the Hindu report describe being denied exactly these things. One was hit and accused of theft. Another was refused nutritious food and subjected to casteist abuse. The easy answer would be to call it exploitation and regulate it away.

But the caregiver herself says most employers are neither abusive nor unreasonable and some have treated her like family. This is not a story of villains. It is a genuine conflict between two legitimate needs.

Why Both Sides Have Real Weight **If the

State regulates firmly, with fixed hours, a weekly day off, overtime and contracts, as the unenacted Kerala Domestic Workers (Regulation and Welfare) Bill, 2021** proposed:

• Round-the-clock care would need two or three workers, not one.
• Costs would rise and some families, especially pensioners, could no longer afford paid care or would turn to unregistered workers outside any rules. If the State does nothing:
• The worker's dignity depends on the character of each household.
• The agency, which according to SEWA's Sonia George often keeps about half of what the family pays and charges registration fees, faces no rules at all.
• The worker has no channel to complain. Behind both sits a hard fact: the State cannot easily inspect a private home. That is part of why domestic workers have long been left out of laws built for factories and offices.

Where the Law Stands The Supreme Court, in **Ajay

Malik v. State of Uttarakhand (2025), recognised domestic workers as a vulnerable class and directed the Union to set up an expert committee on bringing them under labour law and regulating placement agencies. India voted for ILO Convention 189** in 2011 but has not ratified it.

Kerala's 2021 Bill had a stakeholders' meeting and then stalled. The Labour Department now says a framework is being considered, with no timeline.

A Defensible Resolution

The answer is neither full regulation overnight nor continued silence. It is a non-negotiable floor plus a fair price:

• Regulate the agency first. Licensing, a cap on its share of the fee and a written tripartite contract cost families little and protect workers a great deal.
• Set a minimum floor for live-in work: a guaranteed rest period, food and a toilet and at least a monthly rest day, as Singapore has required since 2023.
• Share the cost publicly. Offer relief caregivers or support for low-income households, so that dignity for the worker does not mean abandonment for the patient. The sacrifice is real: some families will pay more and full weekly limits on hours will take longer than workers deserve. But leaving dignity to luck is not neutral; it simply places the whole cost on the person with the least power.

Why This Matters for the Exam

GS4 rewards answers that hold two goods in tension and still decide. This case is about the care economy, about dignity of labour and about the duty of a caring State in an ageing society.