What elder care in India costs NRI families, and how to pay for it

Elder care in India costs about ₹20,000 to ₹1.2 lakh a month for assisted living, ₹15,000 to ₹70,000 for home care, and up to ₹1.8 lakh for dementia care. At roughly ₹95 to the dollar, that's $210 to $1,900. The fee is the easy part; paying it from the US is where families slip.

What elder care in India costs by city

The city sets the baseline, and care level moves you up or down. Metro providers typically quote 20 to 50% above the national average, and a private room costs 30 to 80% more than a shared one. Picking a retirement city comes before any of this.

Assisted living, city by city

These are monthly rates for a single occupant, based on 2024 to 2025 provider pricing.

Standard assisted living clusters at ₹50,000 to ₹60,000 in Bengaluru, Chennai and Hyderabad. Delhi-NCR sits higher, and quality facilities in Gurgaon and Noida run ₹90,000 to ₹1.5 lakh. South Mumbai starts around ₹1.2 lakh.

Home care, priced by the hours you need

Elder care services in India are billed by shift at home, and the shift length drives the price more than the city does.

• A 12-hour attendant costs ₹15,000 to ₹30,000 a month.
• A 12-hour nurse costs ₹25,000 to ₹40,000.
• Live-in nursing around the clock costs ₹40,000 to ₹70,000.
• A local care coordinator adds ₹8,000 to ₹15,000 on top of direct care.

Senior citizen care in India usually costs less at home for a parent who needs help with bathing and meals but not clinical care. Once you need 24-hour nursing, it lands in the same range as standard assisted living.

Dementia care costs 20 to 40% more

Memory care runs ₹60,000 to ₹1,80,000 a month, which is 20 to 40% above a standard assisted living fee in the same city. Dementia care at home carries a similar premium of 20 to 35% over standard home care, because the caregiver needs specific training.

Budget for the diagnosis before it happens. A parent who moves from standard assisted living to memory care changes your annual spend, and your US filing position, in one step.

What the monthly fee leaves out

A quoted fee usually covers the room, three to four meals a day, housekeeping, basic health monitoring and 24/7 staff. Specialist visits, physiotherapy, incontinence supplies, special diets and a private caregiver are typically billed on top.

• Monthly medicines run ₹2,000 to ₹10,000 or more.
• Physiotherapy costs ₹500 to ₹1,500 a session.
• A special diet adds ₹2,000 to ₹8,000 a month.

Add-ons can raise the bill by 15 to 40%, so a ₹60,000 base fee becomes about ₹85,000. Fees also rise 8 to 15% a year, and hospital stays, ICU care and surgery usually fall outside the package.

How to pay from the US without a tax surprise

Money you wire to a parent is a gift, and gifts have rules on both sides. India doesn't tax a gift from a child to a parent, with no cap, because a parent counts as a relative under the Income-tax Act.

The Liberalised Remittance Scheme (LRS) doesn't apply either, since it covers residents sending money out of India. Ask your US bank to use RBI purpose code P1301 for family maintenance, and keep the SWIFT receipt.

Gift tax: $19,000 per parent

A US citizen, green card holder or US tax resident can give each parent $19,000 in 2026 without filing anything, under the IRS annual exclusion. Above that, you file Form 709 by April 15, and no tax is due until you've used the $15 million lifetime exemption.

The full gift tax limit rules apply to a wire of any size. A married couple can elect gift splitting to reach $38,000 per parent, which needs both spouses to file Form 709.

Pay the provider directly

A payment made directly to a medical care provider isn't a gift at all under Treas. Reg. 25.2503-6, so it doesn't count toward the $19,000 and needs no Form 709. The payment has to go to the provider, because reimbursing your parent doesn't qualify.

A care home's bundled fee covers room and meals as well as care. Whether those count depends on whether your parent is there mainly for medical care, so ask for an itemised invoice and have your preparer confirm the split.

Power of attorney and FBAR

Care paperwork can create a filing duty for you. If you're a joint holder on a parent's Indian account, or hold power of attorney with signatory authority over it, you report that account on the FBAR at its full value. The trigger is more than $10,000 across all your foreign accounts.

A willful miss can cost the greater of $100,000 (before annual inflation adjustments) or 50% of the balance, and family money transfers raise the same question.

A worked example: elderly care in Hyderabad

Priya lives in Seattle, and her mother needs standard assisted living in Hyderabad at ₹60,000 a month. With add-ons the bill reaches ₹85,000, or ₹10.2 lakh a year, which is about $10,700 at ₹95 to the dollar. That's under $19,000, so Priya can wire it to her mother's account with no Form 709.

Two years on, her mother needs memory care at ₹1.8 lakh a month. That's ₹21.6 lakh a year, about $22,700, and wiring all of it to one parent crosses $19,000. Paying the care provider directly, or filing Form 709, becomes the decision.

Who this applies to

The gift and FBAR rules apply if you're a US citizen, green card holder or US tax resident. If you live in the UAE, UK or Canada and aren't a US person, US gift tax and the FBAR don't reach you, though your own country's rules may.

The India-side points apply to everyone: no Indian tax on the gift, no LRS cap, and the same provider quotes. A parent who moves in with you in the US takes the care cost out of this picture entirely.

What to do about it

1. Get itemised written quotes from two providers in your parent's city, with room, meals, care and add-ons priced separately.
2. Ask each provider what happens to the fee if your parent's care level rises.
3. Pick the payment route: direct to the provider for medical care, or a wire to your parent of up to $19,000 a year each.
4. Keep the invoice, the SWIFT receipt and a short gift letter for every transfer.
5. Check whether a joint account or power of attorney puts a parent's account on your FBAR.

Set up medical oversight and the legal papers before the first wire, because supporting parents from abroad is mostly logistics.

Two misreadings that cost money

• "LRS caps what I can send." It doesn't. LRS governs residents of India sending money out, so an NRI wiring money in faces no LRS cap and no TCS.
• "Reimbursing my mother counts as paying the provider." It doesn't. Only a payment made directly to the provider is excluded, and a reimbursement is a gift.

Start with the itemised quote

Ask two providers in your parent's city for an itemised written quote this week, with medical care split from room and board. That split decides whether you pay the provider directly or wire to your parent.

I'd pay the provider directly whenever the invoice is mostly care, and I'd talk to InvestMates before wiring more than $19,000 a year to one parent.