Fertility has declined significantly across the socioeconomic spectrum in the south Indian state of Tamil Nadu, which has the potential to increase the strains of support provision for family members and to limit support for dependent older people. We used a qualitative approach to explore the challenges that adults (N ​= ​113) from varying socioeconomic backgrounds (urban/rural and socioeconomic status) in Tamil Nadu experience when supporting their older relatives, and to understand how they cope with these challenges. While the broad challenges mirrored those seen elsewhere in India and globally (e.g., role conflict), some were particular to the context of contemporary Tamil Nadu (e.g., difficulties around supporting son/child-less or non-co-resident elders). The challenges experienced were qualitatively similar across socioeconomic groups but affluent families had more coping strategies available to limit the negative outcomes of support provision. We highlight the potential value of universal health coverage for promoting family-based support for older Indians, the urgent need for strategies to ease the challenges for lower socioeconomic status families, and the importance of wider socioeconomic policy to reduce the financial and time pressures that restrict the support that much of the population can provide each other.