Coming to America
In 2006, 71-year-old Sarada Ramachandran left India to live with her daughter, Jaya Padmanabhan, in the Bay Area. Jaya hoped her Amma (mother), affectionately known as Paati (grandma) to family and friends, would spend her later years surrounded by loved ones, secure in the care, companionship, and support of family.
Inviting an aging parent to be part of the household is not unusual in South Asian families; it reflects deeply rooted traditions that emphasize family responsibility, respect for elders, and strong intergenerational bonds.
Jaya and Paati’s story illustrates the emotional and practical challenges immigrant families face as they navigate the limitations of U.S. health and eldercare systems, which are often ill-equipped to meet the cultural, linguistic, and social needs of South Asian seniors.
What neither mother nor daughter could foresee at the time was the complex, often disruptive arc of aging that would eventually take Sarada from India to America and back again, as the realities of caregiving, declining health, and fragmented support systems reshaped their plans.
Living in America
At first, Paati remained largely independent.
“She was my support system when I needed her, and I was hers,” recalls Jaya.
Paati helped with meals, laundry, and household chores. She even attended her granddaughters’ basketball games and plays.
Speaking English posed challenges. A native Tamil and Malayalam speaker, she moved as a young bride from her familiar South Indian village to a remote part of West Bengal, where she did not know the local language, so she taught herself to read and speak some English.
In the U.S., she could explain her ailments to doctors in simple English and even passed her U.S. Citizenship test at age 79.
“She was so determined,” says Jaya.
Uprooted
Yet beneath that resilience was a lifelong sense of displacement that formed in childhood and followed Paati into her adult years. Jaya says her mother never developed the skills needed to cope independently. Without strong social networks, she grew dependent, first on her husband, and then on her daughter.
“Moving to the U.S. meant her entire support system was reduced to one person – and that was me.”
Paati formed connections to her new environment through food. She cooked traditional South Indian dishes for her family. “It’s something she could call her own,” says Jaya. She loved spicy, yogurt-based dishes like pulinji and even taught her caregiver to cook her favorite meal archi khali, made with yogurt, ground coconut, and green chillies.
Once her daughters left for college, Jaya noticed her mother’s world was shrinking. She had fewer daily interactions with people. “I realized that really, she was not meeting people on her own,” despite efforts to encourage her to join a local yoga class.
She worried her mother’s emotional state was contributing to depression.
“There was just this feeling of complete malaise. I think it may have been her personality.”
She increasingly communicated through Jaya. “I was her interpreter. I would translate things that she was saying, anticipate her needs. All my mother wanted was me.”
Trying Independent living
Hoping to expand her mother’s social world, Jaya arranged for Paati to spend two weeks at Priya Living, an independent living facility for Indian-origin seniors in Milpitas, while the family was away on vacation.
“She hated every minute of it,” says Jaya.
Paati showed little interest in socializing with other residents. She refused to cook food for herself and disliked the Indian vegetarian meals Jaya had delivered to her because they were Gujarati, rather than the Tamil cuisine she preferred.
Technology posed another challenge. Paati relied heavily on television but struggled with unfamiliar controls. “There were multiple steps she just couldn’t figure out,” says Jaya. At home, Paati’s remote turned on the TV with one press of a button.
Friends who visited Paati at Priya Living said she had “her bags packed and waiting at the door.”
“That actually goes to the heart of it,’ says Jaya. “An essential part of my mother’s well-being was being around me.”
The experience convinced Jaya that independent living facilities were not necessarily suitable for people experiencing cognitive decline and who depended on familiar routines and caregivers.
After the Fall
In 2020, as the pandemic surged, Paati had a serious fall that left her with multiple pelvic fractures.
“2020 just completely changed our lives,” says Jaya.
As her mother struggled through recovery, Jaya realized she had become a full-time caregiver while continuing to work long hours.
To combat her mother’s growing sense of isolation, Jaya would come home after work and insist on taking her for drives “even if she was not willing.”
Cooking homemade meals became increasingly difficult. Once a week, Jaya ordered South Indian food from Mylapore Express, a local catering service. Paati enjoyed unpacking the containers to discover what was inside, but didn’t like the food itself. Paati’s eating patterns limited Jaya’s choices when she later explored care homes for her mother.
As her health declined, Paati became less able to manage the activities of daily living. She needed Jaya’s help with bathing, meal preparation, medications, and doctor appointments. The onset of dementia compounded those challenges.
“That’s when we hired a caregiver,” says Jaya.
Finding a caregiver
Jaya’s search began at the height of the COVID-19 pandemic. When Jaya contacted Santa Clara County’s In-Home Supportive Services (IHSS) program, she received no response.
“I called a couple of times, but (I think) it was operating in a very threadbare way during COVID.”
Eventually, she stopped trying.
Instead, she turned to care.com to find a caregiver on her own. She included Paati in the interviews to observe how she engaged with prospective caregivers.
“She had a good sense of how people would react to her,” says Jaya.
Five interviews later, Jaya hired Angie Marquez.
Conventional wisdom often suggests culturally aligned caregivers, but the Indian caregiver approach did not work out for her mother.
At the rehab facility, Paati’s Indian caregiver would frequently ignore her questions.” She would not engage with my mother,” observed Jaya. Another Indian caregiver was constantly on the phone with her family.
“Suffice to say, my mother told me she did not want anybody Indian!” says Jaya.
Angie Marquez remained Paati’s caregiver until she returned to India for the last time.
“Angie had a very gentle manner that my mother responded to,” says Jaya. “I actually have to give my mother a lot of credit because sometimes it’s not learned knowledge, but this understanding of who will work best with you.”
“She took one look at Angie’s calm, measured way – she said, I like her.”
The Onset of Dementia
As her dementia progressed, Paati grew more demanding.
“There were days when she would call Angie’s name every 30 seconds,” recalls Jaya.
Angie worked about 4-5 hours a day, 5 days a week, at an hourly rate of $20; weeknights and weekends became Jaya’s responsibility. It was a problem when Jaya worked late “because there was nobody to take care of her in the evenings.” It was too expensive to get caregiver coverage for those hours.
As Paati’s hearing loss accelerated, Jaya noticed her mother stopped watching television and listening to the Carnatic music she once loved.
“Her hearing completely disappeared,” says Jaya. “She couldn’t bear it, and that’s when the decline started.”
The moment Angie left each day, Paati would constantly call out for Jaya.
She started experiencing severe bouts of insomnia, and the medications she took triggered hallucinations. “She was seeing monkeys in the house and screaming my name. It got so, so bad.”
If Jaya left the house, Paati demanded to know her whereabouts, when she would return, and who would be at home.
“It became one of those situations where I just could not think about going anywhere or doing anything. I found myself unable to cope at times.”
Why Jaya took Paati back to India
As caregiving demands intensified, Jaya began considering alternatives.
“I started thinking about other solutions.”
At that time, assisted living facilities for South Asians were nonexistent in the Bay Area. The facilities Jaya explored were expensive, costing between $100,000 and $150,000 annually, while offering limited food options.
At one facility, Jaya tried to negotiate food deliveries from Mylapore Express but was told staff would not open or store outside meals.
“That’s when I began to think of India … people speak the same language, the food is the same, it’ll be better.”
Still, Jaya had reservations. In one of her lucid moments, Paati had once told Jaya, “I’m a lot of trouble for you, can you move me to India?” That attempt revealed the difficulties of that option.
In 2018, before the pandemic, Jaya had taken her mother to India. believing Paati would be happier near extended family. Instead, Paati struggled with the basic skills of independent living. “She had no idea how to sign a check or go to the bank,” says Jaya.
The arrangement collapsed after Paati developed shingles. “She battled through it completely on her own. It was a miserable situation.” Jaya brought her mother back to California.
No Off Ramp
By 2021, caregiving pressures overwhelmed Jaya, affecting her health. Her cholesterol spiked, and she developed plaque deposits around her eyes.
“I didn’t have the wherewithal or the mental space to take care of myself,” she says. “There wasn’t a day off.”
“I just felt like there was no off-ramp.”
With few alternatives available, Jaya decided to take her mother to India. In January 2022, they flew to Chennai, where Paati moved into the 24-hour Athulya assisted-living facility that offered Tamil-speaking caregivers and South Indian vegetarian meals.
“She was so unhappy with her life. Ultimately, I just wanted her to be happy,” says Jaya.
The outcome was heartbreaking.
Once Jaya left, Paati lost interest in food; she felt confined by her bed’s safety rail, developed bed sores, and lost her peripheral vision. Another resident texted Jaya that Paati’s assigned caregiver had laughed and hidden from Paati when she called for help.
Jaya says she called her mother twice a day, but thinks Paati felt abandoned.
“There came a time when some days she refused to talk to me.”
Eight months after moving to India, Paati passed away.
A Growing Need
Paati’s story reflects a growing challenge facing multicultural communities across the United States. As ethnically diverse, aging populations grow, so will the need for culturally responsive healthcare and caregiver support services.
But what does culturally responsive caregiving really look like, and what kinds of support are most effective? How can healthcare systems meet the diverse needs of South Asian American families instead of treating them as a single cultural group?
In The Aging with Dignity series, we will examine these questions and more. Through personal stories and community perspectives, we will explore some of the most promising caregiving solutions for aging parents. We will highlight programs and approaches being developed within South Asian and other communities to address gaps in care while responding to the cultural, linguistic, and social needs of older adults.
Our focus will be on practical, innovative models that could lead to more accessible and effective support for families navigating the challenges of aging and caregiving.
Looking back, Jaya wishes she’d found an assisted living facility in the Bay Area specifically for older South Asians, with trained caregivers and culturally familiar support.
“If there had been something like that,” she says, “I think I would have jumped at it.”
This story was written with support from the Solutions Journalism Network.
