We examine the emergence and evolution of collective action frames in the palliative care movement in Kerala, India. We do so by leveraging secondary data published over seventeen years as well as interviews with thirty movement actors. Our findings suggest two key themes: First, frames that emerge at the grass-roots level, and in many occasions from bystanders, can become dominant frames of a movement. Second, frame alignment processes may be directed by non-elites towards the elites. These findings diverge from prior literature which emphasizes roles of movement leaders and key actors in framing issues and strategies.