Reuniting with adult children
Anyone who knows Seetha Appana calls her feisty. In her lifetime she’s carved out a successful career in hospital administration, run a single-parent household – no easy feat in conservative 1960s India, and survived several health threats of her own, including heart failure.
Today, at 96, she is the beloved core of her family unit in upstate New York, a magnet who draws friends, extended family, and well-wishers into her circle of belonging. In keeping with the perception of aging in her South Asian culture, Appana is exactly where she needs to be – with her adult children who will care for her and her healthcare needs in her old age.
Thirty-one years ago, Seetha Appana arrived in the U.S. from Chennai, India, to live with her daughter and family after she retired. Moving in with them was a natural next step for the then 66-year-old who like many of her generation was following the norm for aging in her culture. In Eastern collectivist societies, older parents reunite with adult children after retirement or in old age. By tradition, it’s where they belong and where they find kinship and care as they age.
A sense of belonging
“For elders of Indian origin, finding Apnapan – a sense of belonging – is a key component of ensuring wellbeing as they age,” says Annapurna Pandey, an anthropologist at the University of California, Santa Cruz, who studies the changing life experiences of elderly Indian immigrants as they grow old in the U.S.
Her study “Getting Old in North America: The Dilemmas of Diasporic Indians” in Culture Change in India (March 2024), analyzed two waves of Indian immigrants – the generation that arrived as students in the late 1960s and early 70s and, the later life immigrant parents like Appana, who after retirement or death of a spouse, joined their adult children in the U.S.
Another study on Asian Indian American Older Adults edited by VJ Periyakoil, MD, Stanford University School of Medicine, describes these later-life Indian immigrants who join U.S.-based adult offspring as ‘followers of children.’ It reports that almost 14,000 individuals older than 60 immigrated to the U.S. from India in the late 1980s and early 1990s to live with their grown-up sons and daughters.
Changing perceptions of aging
Unlike the ‘followers of children,’ the ‘early life’ Asian Indian immigrants are changing traditional perceptions of aging. They arrived in the U.S. after the Immigration and Nationality Act of 1965 opened doors to a highly educated and skilled global labor pool in science and technology. This early wave of immigrants prefers a more independent lifestyle. Yet, while they rely less on adult children, many still want to age in a place where they feel kinship and connection to their community.
According to Pandey, what differentiates each group is that the professionals who moved to the U.S. in the 1960s showed more competency in leading a life in America, while those who came later relied more on their adult children in learning to acculturate to an American lifestyle. Significantly both groups had strong ties to their roots and heritage that shaped the food, sounds, smells, and social interactions that became important elements of daily life as they aged.
Pandey says that for Indian elders, “Home is not just a brick-and-mortar space but has to do with the people we associate with home. Home is the connection, the bond, the people the warmth, the love, the sentiments, a sense of Apnapan – belonging.”
The intergenerational family unit
“I didn’t mind leaving India and my life there,” says Appana, “because I was coming home to family.”
Her two grandchildren share deep bonds with their Thai (grandmother) who has been an intrinsic part of their life since birth. Appana taught her granddaughter to sing her childhood Kannada bhajans (hymns). Her grandson makes the ‘piping hot’ tea his Thai likes for breakfast. “Being with her makes you realize that older people have their own full life,” he says. “To me that makes older people less invisible.”
“The grandparents’ role in raising the children is highly respected, and they form the linkage to the Asian Indian culture, religion, and heritage,” reports the Asian Indian American Older Adults study, describing the intergenerational setting common to many Asian-Indian immigrant families, where family members pitch in to provide care. Appana’s grandchildren often assist with her medication, wrap her legs in compression bandages to deter the venous ulcers caused by poor circulation, or accompany their Thai to doctor visits. Though she speaks English, Appana’s hearing impairment sometimes causes her confusion when she tries to communicate with medical providers or understand their instructions.
An independent life
However, the study reports that early-arrival Asian Indian elders who have lived in the U.S. for decades typically tend to be more acculturated, affluent, and independent. This makes their “communication skills, clinical decision-making patterns, and clinical adherence patterns” significantly different from later life immigrants like Appana.
Geetha Iyengar is one of those early Asian Indian immigrants. She arrived from India at age 20 in 1967 to join the University of Minnesota as an electrical engineering student. After graduation, she married and raised her family in Ohio. In 2020, after her husband passed away, Iyengar moved to her son and his family in California. But in an unusual decision, prompted by a healthcare dilemma, Iyengar left her son’s Bay Area home for an independent retirement community in nearby Santa Clara.
Though Iyengar loved being part of the intergenerational dynamic of her son’s Asian Indian household, the hilly setting of her son’s house made it difficult for her to venture out by herself for daily walks. “It was hard to stay active inside the house,” she adds.
The sari-clad Iyengar whose vibrant personality and trim frame belie her 79 years, says her overall health is good. She takes medication to control her blood pressure and walks every day to keep fit. Her other passion is Indian classical Carnatic music. “I want to keep mentally and physically active,” she smiles.
A fear of isolation
What both the early- and later-life Asian Indian immigrants have in common says Pandey, is a strong need for communal living in familiar settings that remind them of home. The need for ‘apnapan’ reflects their fear of social isolation.
“My children took great care of me, but when they went to school and work, they left at 8 in the morning, and came home in the evening. You’re alone at home,” says Iyengar. “The main things for seniors and people as they get older are loneliness and insecurity. Loneliness kills more people than any disease.”
So, her family explored suitable retirement home options where their mother could enjoy independence among people she felt comfortable with. Iyengar rejected American-style facilities because she thought she would have little in common with the residents. What helped her decision to move out was the Indian-inspired surroundings she encountered when she first walked into Priya Living.
“I thought I’d be more comfortable with living with Indians. There was this welcoming, well-maintained courtyard, beautiful flowering plants of jasmine and roses, and herbal plants like chili and coriander.” Iyengar immediately knew she had found the right place to spend her retirement years, filled with people and familiar scents that reminded her of home.
A place to call home
According to Pandey “Elders nurture a yearning for the place they grew up in, the familiar language, food, smell, sound, and touch. This yearning comes in many forms.” They express distinct values and expectations of growing old in America.
Though Iyengar has lived in the U.S. for over 50 years she is deeply rooted in her Indian identity. Even in the 1960s, she would go to work dressed traditionally in a sari with her hair in a long braid. Though she sought an independent living option, Iyengar’s upbringing in a joint family in Karnataka, India, and her experience of a collectivist culture, fuels her need for the comfort of a close-knit community around her as she grows older.
“At Priya Living, you get to meet people from different parts of India, “ Iyengar says. “You hear different languages – Punjabi, Tamil, Malayalam, Bengali. You see the friendly faces. Everybody brings their own rich experiences. When I’m walking they’ll open the door, say ‘Hi Geetha’. You feel a sense of belonging.”
Priya Living’s cheerful Director Mahesh Nihalani explains the thread of kinship woven into the concept of aging independently, Indian style. Founder Arun Paul created this space with a clear vision to provide a retirement home for his aging parents to enjoy among a community of people with a ‘desi’ (Indian) background of culture, food, and traditions, said Nihalani. “He wanted an Indian-inspired place to provide a place of fun and happiness, and no loneliness for people of our desi community.”
Priya Living offers cultural celebrations which are very important to its residents. In addition to chair yoga, meditation, art classes, and music-inspired therapeutic classes in a community of people with a similar Indian heritage, Nihalani says, “When you open your front door, you can go and have a chat with anybody you want.” Residents gather in the courtyard every Wednesday for a communal ‘Chai & Chat’ – tea, snacks, and conversation.
The looming caregiver crunch
Though Appana and Iyengar have found a sense of belonging in their lives, new health challenges loom as age takes its toll. According to Pandey, whether these elders moved from India in the 1960s or more recently to be with their children – whether they live with their family like Appana or independently like Iyengar – one inescapable fact is that as they age, they will become more dependent and require more assistance.
Asian Indians, one of the fastest-growing ethnic groups in the U.S. today, represent the second-largest U.S. immigrant group with a current population of 4.8 million. Thirteen percent of Asian-Indians are over the age of 65, reflecting the demographic trends and needs of the aging American population.
According to ACL in The Profile of Older Americans, Americans 65 and older are expected to increase to 94.7 million by 2060. This aging population will need services to cope with the increasing prevalence of chronic illnesses, as declining cognitive and physical health impairs their ability to function independently.
As their numbers steadily increase, this growing wave of Asian Indian immigrant elders will fuel the need for culturally congruent services.
However, finding caregiving support for aging parents is a mounting challenge. The U.S. faces a critical shortage of trained caregivers.
Culturally congruent care
In its recommendation for culturally appropriate geriatric care, the Asian Indian American Older Adults study suggests that it’s important for providers to be familiar with the traditional health beliefs of older adults from Asian Indian backgrounds to ensure effective care. For instance, Asian Indians may use traditional Ayurvedic healing practices concurrently with Western medicine, so providers need to educate their patients about any potential herb-drug interactions. In other cases, older Asian Indian adults may refuse surgery on days or times they consider ‘inauspicious.’
As they grow older, at least 70% of people over 65 in the U.S. will need some type of long-term care support in their remaining years. Asian Indians who are at greater risk for chronic conditions like diabetes, cardiovascular disease, and hypertension also will need assistance with the activities of daily living or with disease management.
Most Asian Indians prefer to ‘age in place’ at home or in a facility that meets their food, language, and culture needs. However, families are often reluctant to place their aging parents in skilled nursing and assisted living facilities because those settings do not offer culturally congruent care. They prefer to care for their parents with the help of extended family and caregiver support. For now, Appana and Iyengar are relatively healthy; their families and living arrangements in the U.S. meet their needs for a culturally congruent lifestyle.
A complex situation
But in her South Bay home in California, Minnie Dayal* manages a complex caregiving situation. She looks after her parents and her 80-year-old mother-in-law who came to live with the Dayals in the early 2020s. Illness and the death of a spouse made it challenging for them to live in India without family support.
Dayal’s mother-in-law is hearing-impaired. During medical check-ups adds Dayal, “Even with a hearing aid it’s difficult. She needs somebody to repeat things for her or she’s not able to understand.” Her mother-in-law needs help with insulin for her diabetes and also with her heart medication.
Dayal has a helper to look after her 87-year-old father who has dementia. His condition is progressively worsening. He uses a walker and has fallen a few times. “For 70% of the time, he has to be fed,” says Dayal “His speech is getting a little more garbled and more difficult to follow.” Her mother (81) suffers from arthritis and both parents have been diagnosed with hypertension. Dayal mentions she does ‘80 percent’ of the cooking in the household, preparing simple Indian dishes like dhal, rice, and sambhar for her vegetarian family.
Dayal found her helper Blanca on the neighborhood app Nextdoor, in an ad posted by the daughter of an Alzheimer’s patient who wanted her mother’s former helper to find a job. “I was lucky,” says Dayal who made futile attempts to find a suitable paid caregiver through several agencies. She communicates in Spanish with Blanca using Google Translate.
Blanca works weekdays from 7.30 am to 3.30 pm; when she leaves caregiving responsibilities fall to Dayal and her husband who both work from home. The couple have not had a vacation since 2022. “Yeah. It’s a lot,” says Dayal.
The burden of care takes a toll
Families like the Dayals struggle because community support networks lack affordable caregivers trained in cultural competency. Few families can afford the exorbitant price tag of private health care. The lack of culturally competent caregivers and associated high costs puts an exhausting burden of care back on families, which takes a physical, emotional, and financial toll.
“We know there’s a shortage of caregivers,” says Mahesh Nihalini, who suggests that one solution is for the U.S. to tap into the global labor force and give visas to trained caregivers from other countries. “Otherwise, the way the baby boomers are increasing in this country, we will have quite an issue on our hands in a short few years.”
Families of Asian Indian immigrant elders find purpose and meaning in giving aging parents a sense of belonging. Appana and Iyengar exemplify how elders can age well if they have support while they remain fit and able. But as more people need care, and fewer potential family members are available to provide that everyday help, the looming care gap will amplify the impact of disease or disability on families.
Despite creating a sense of belonging, the health and well-being of caregivers and their loved ones is at stake.
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The John A. Hartford Foundation.
- name changed at request
References
Getting Old in North America, The Dilemmas of Diasporic Indians, by Annapurna Devi Pandey, Culture Change in India. 1st Edition. 2024. Routledge India.
Periyakoil VJ, MD, & Dara, S, MD, MA: Health and healthcare of Asian Indian American Older Adults in https://geriatrics.stanford.edu/ethnomed/asian indian. In Peryakoil,VS, eds. eCampus Geriatrics, Stanford CA 2010.