Shaista Kazmi started an agency for caregivers out of necessity.
Her dad was diagnosed with a debilitating neurological condition in 2009, and as a physical therapist, he knew he eventually would be bedridden. Around the same time, Kazmi’s mother-in-law, recently widowed, was moving in with her from Pakistan.
Kazmi was pregnant, working, and already had two children under 4. To meet the demands of both households, she contacted local senior care companies. Finding one that could actually help her Pakistani Muslim family was tough.
There were language and cultural barriers and home aides who couldn’t properly prepare her mother-in-law’s meals.
“If Mom was doing some prayers, and they would come in, it was just kind of irritating for her,” Kazmi said. “When I came home, I’d have to restart the day.”
It was a frustrating and exhausting few years with a revolving door of caregivers.
Kazmi decided to quit her job in 2014 and start Apna Ghar senior care agency. She wanted to be a resource for other ethnic minority families. Kazmi says her West Bloomfield, Mich., agency is the first, if not only, in the country to provide in-home caregiving specifically for older South Asians.
“I thought: I couldn’t be the only person in this situation.”
She wasn’t. Kazmi discovered that hiring culturally competent caregivers was a common concern among those of South Asian descent, some of whose parents were immigrants who didn’t speak English. She found that many caregivers aren’t bilingual.
AARP found that 42% of Asian American Pacific Islanders who responded to a survey provide care to an older adult, compared to 22% of the general population. Similarly, Asian Americans are more likely to live in multigenerational households; 17% polled in a Pew Research Center survey reported doing so, compared to 7% of the total population.
Asians, particularly women, tend to adhere more to cultural norms of familism, which prioritizes family over self, and filial obligation, which suggests loving children honor their parents’ care by returning the caregiving for them as they age and cannot live independently. These female caregivers also are more likely than others to work outside the home, which brings additional challenges, even for those like Kazmi, a former researcher in neurosciences who attended medical school.
In Asian nations, caregiving is more a community effort, with extended family members springing into service, neighbors pitching in or government assistance filling in the gaps. A sense of community in the U.S., however, isn’t as common. Cultural norms mean Kazmi’s business can be a hard sell, even in a graying America. In the United States, the Asian population was the nation’s second-oldest race group in 2020 and among the fastest growing.
The home aides for Apna Ghar (Hindi for “my home, your home, our home”) help with everything from cooking and light housekeeping to grooming and ambulation. Most clients need in-home assistance 12 to 24 hours a day.
“We’re allowing our parents to age in place with dignity and respect,” Kazmi said.
After eight years in business, Kazmi’s company has grown to average 30 to 40 employees. Most of them are bilingual people of color with diverse cultural backgrounds, well-suited to serve clients who’ve immigrated from India, Pakistan, Bangladesh, Sri Lanka and eastern Europe and brought their religious and cultural practices with them. Awareness of the company has spread through word of mouth.
Kazmi averted the challenges of the paid caregiver shortage by reaching out to the American Red Cross in Hamtramck, which has a large Bengali community, and offering to pay the $1,500 tuition for women who were interested in the certified nursing assistant and home health aide training program. That netted 10 caregivers. She also recruited refugees and women who were victims of domestic violence and paid them a competitive wage. In turn, they agreed to stay with the company for two to three years. She also kept client fees lower than competitors’, she said, to serve communities where many seniors don’t qualify for Medicaid or other government programs. Caregivers are assigned to just one family at a time.
At the height of the pandemic, Apna Ghar flourished. Competitors with employee shortages and workers who didn’t want to serve Detroit folded. Apna Ghar was so successful, Kazmi was able to help other Medicaid-funded staffing companies serve clients. Her business also has grown enough for the company to serve the entire state, add business partners and field inquiries daily from around the country.
“I have a client right now in Ohio. Mom has a brain tumor. They needed somebody who speaks Gujarati. We placed someone there. The lady speaks Gujarati and will be with her until the end,” Kazmi said.
More important than the caregiving, Apna Ghar provides companionship during a “loneliness epidemic,” which former U.S. Surgeon General Vivek Murthy said affects the 56 million Americans who are 65 and older.
“Social isolation, depression and the prevalence of that within elderly ethnic minorities is huge and has never been addressed,” Kazmi said. “By having culturally similar and culturally competent caregivers who can provide the care, you can see a decrease in that.”
Naina Rao contributed to this report.