This video-based story explains the side of NRI life many families do not model before they move: what happens when an aging parent gets sick in the US, why the costs escalate, and why the emotional burden becomes a return-to-India question for some families.
This transcript is not really a generic "life in America" episode. It is a hard elder-care story. Suresh Kudu and his wife Yoga describe what happened after his widowed mother fell sick in the US, how long-term care changed the family's life, and why the real cost was not only medical treatment but years of operational strain that many NRIs never budget for.
What to know first: What nobody tells NRIs about living in the US is that the biggest risk may not be your own salary, visa, or taxes. It may be what happens when an aging parent needs years of care in a system where support is fragmented, expensive, and operationally draining. That is the real problem this transcript puts on the table.
If you are deciding whether parents should stay with you in the US permanently, separate three questions before the emergency: who pays for long-term care, who physically executes daily care, and whether India would offer better family support for the same stage of life. Medicare is not a broad custodial long-term-care solution, Medicaid is eligibility- and state-dependent, and private home care can become expensive because ordinary help repeats every day.
Suresh Kudu and Yoga are not speaking as healthcare-policy commentators. They are speaking as a family that lived through the system. He is from Mysore, trained in business management and cost accounting, came to the US on H1B for a manufacturing company in New York, then had to rebuild after the original industry path weakened. Later he shifted into finance and became a CPA at age 48.
That biography matters because he thinks in systems and in numbers. So when he says elder care in the US can destroy the math, he is not talking casually. He is talking after years of trying to make the system work for his own mother.
The transcript earns that line because it is not about aspiration. It is about what happens after the first migration story is already over and family aging begins.
The turning point came in 2015 when his mother, who was widowed and staying with the family in the US, fell in the bathroom. The transcript makes this moment feel chaotic and practical rather than cinematic. He had to get in, stabilize her, call emergency services, and then start dealing with the cascading medical and care decisions that followed.
What comes next is the part most families underestimate. A hospitalization does not end the problem. It often begins the longer one. His mother's condition meant the household had to navigate nursing-home placement, home-support questions, work pressure, sibling limitations, and the emotional strain of hands-on care inside an American setup not designed to feel easy.
The transcript is not saying elder care in the US is impossible. It is saying that one serious health event can convert "we will manage somehow" into years of exhausting logistics.
This is where the conversation becomes unusually valuable. The guest does not speak only in abstract warnings. He gives actual examples from his family's experience and from his New Jersey context.
The point is not whether every family will get his exact numbers. The point is that the expensive part of elder care is often the repetition. Bathing. Lifting. Transportation. Supervision. Managing accidents. Covering gaps when paid care is not enough. Those are not rare emergency costs. They are endurance costs.
The guest also gives a rule of thumb from his own finance lens: think in terms of at least $1.5 million per person if you want the US elder-care and retirement system to feel comfortable. That is clearly a personal threshold, not a universal requirement, and the article treats it that way. But it tells you how serious he thinks the underlying risk is.
This is where the transcript needs careful framing. The guest uses Medicare and Medicaid language in a practical family sense, but the official programs are more technical than everyday conversation makes them sound.
Medicare's official pages say Medicare generally does not cover long-term care when the need is mainly custodial support. Medicare does cover limited skilled nursing and some home health in specific situations, but that is not the same thing as open-ended elder care.
The official Medicare page on home health services also shows why families get confused. Personal-care help can exist, but usually only when it comes with qualifying skilled services and a formal care plan. That is very different from "someone will come every day and handle whatever my parent needs."
On the Medicaid side, the official estate-recovery page says states must seek recovery for certain Medicaid benefits paid for people age 55 or older, including nursing-facility and related services. See Medicaid estate recovery. That is why the guest keeps warning that means-tested support is not a clean free pass.
The transcript's broad warning is right: Medicare is not a simple long-term-care solution, and Medicaid is more conditional and state-dependent than families assume. The exact time limits, asset rules, and services vary enough that you should not lift one family's experience into a universal rulebook.
The story eventually becomes bigger than healthcare policy. It becomes a family-structure question. If you are in America raising children, working hard, and also trying to care for aging parents, you become what he bluntly calls "the sandwiches in between." That single phrase carries the entire episode.
He is not arguing that everyone must leave the US. He is arguing that many NRIs underprice the support gap. If parents stay in India, one problem appears. If they move permanently to the US, another appears. If the children in America are not financially strong yet, or if the family wants to preserve wealth instead of seeing it disappear into care costs, the India option starts to look different.
This is also why his warning about bringing parents permanently to the US lands so hard. It is not anti-parent and it is not anti-America. It is simply a demand that families plan for reality rather than for sentiment.
The transcript does not provide a formal checklist, but it clearly points toward one. If you are deciding whether parents should live in the US with you, these are the real questions underneath the emotion.
Occasional stays and permanent relocation are not the same decision. The care burden changes completely once parents age in place inside the US system.
Who will bathe, lift, supervise, transport, and sit with the parent when the hospital phase ends? This is where most of the hidden burden lives.
Do not say "Medicare will handle it" or "Medicaid will cover it" until you know what those statements mean in your exact context.
The transcript is very honest about this. Family members may care deeply and still be unable to shoulder the daily load.
This is the question that keeps pulling the episode back toward India. Sometimes the better answer is not more insurance. It is a different care environment.
If your family is already weighing the healthcare and retirement side of the return, our guides on Medicare for NRIs in India, health insurance after moving to India, and real retirement-care economics in India versus the US give you the next layer of detail.
The FAQs below focus on elder care, parents, long-term support, and what the US system does not automatically solve for NRI families.
A fall, hospitalization, or sudden decline can turn into months or years of daily support decisions. The expensive part is often not one hospital bill. It is bathing help, supervision, transport, nursing-home placement, home-care scheduling, and the working family member becoming the default care coordinator.
Medicare generally does not cover long-term care when the need is mainly custodial daily support. Limited skilled nursing or home-health situations are different from open-ended elder care, so NRIs should not assume Medicare will handle years of parent care.
Medicaid can cover nursing-facility services for eligible people, but it is means-tested, state-specific, and tied to rules such as estate recovery. Treat it as a complex eligibility path, not an effortless backup plan.
Home care becomes expensive because ordinary tasks repeat. Paying for shower visits, hourly caregiver time, transport, supervision, or respite coverage can stack into a large monthly burden even after the medical emergency has passed.
Not without a long-term-care plan. Short visits and permanent relocation are different decisions. Before parents move permanently, model care costs, benefit eligibility, sibling support, housing, work flexibility, and whether India would give better daily support.
This episode is not a complaint about America. It is a complaint about unexamined assumptions. Many families model salaries, schools, and home prices in extreme detail. Then aging hits, and the real fragility of the system appears all at once.
If your parents are aging and your NRI life depends on them joining you in the US, this is the conversation to have before the emergency, not after it.
This is one of the hardest return-to-India questions because it mixes money, guilt, logistics, siblings, healthcare, and time. It should not stay vague.
This is especially useful if your decision involves parents, retirement timing, and whether the US support system really fits your family's next stage.
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0:00 You know, it approximately costed me for a 7 year stay close to half a million just to give her a shower. For each shower, they will charge you $125 then just shower only. So, underlying factor is you should have at least, you know, for each person because I'm a finance person, a minimum of a 1 and 1/2 million dollars. >> This is the side of NRI life nobody talks about. Today, we are going to discuss what happens when your parents get sick in the US. And how much it really costs for the elder care in the United States. >> My name is Suresh Kuduvalli and she obviously is Yoga Kuduvalli. So, we are basically from Mysore in Karnataka and I am by profession I did my Bachelor of Business Management and then ICWAI, which is called as cost accounting. And then I was into manufacturing cost accounting basically.
1:01 The initial, I would say, 6-7 years was
1:04 A super struggle because I was in a back in India, I was already a senior manager and part of the top management. Here, you have to start from scratch, right? They don't care who you are. So, you got to prove your metal and then come up the ranks. That was an adjustment. And on top of that, you know, it was I was not making that kind of money. During those time, I used to make something like 60-70 grand. And for a family of three and my mom also joined me because my mom was a widow. There was nobody else to take care of her. So, she also joined me. It was a real super struggle, I would say. My brother started telling, "Okay, come over to US and then try here, you know, whatever it is." Then, okay, I got my H-1B visa for a manufacturing company called Wings Digital Corporation. That was in Hicksville, New York.
1:50 So, they sponsored me then I came here on the H-1. As a cost accountant for that plant. But then what happened is 2000 it happened and as soon as I came, I don't know you guys in tech can understand that at that time there came a company called Napster. I don't know if you remember that. They flipped the business upside down of the CD manufacturing. Yeah. Because overnight it it moved from hardware CD manufacturing from tape recorders to CDs CD it went to MP3 or whatever that format is you know that all the CD manufacturing started vanishing from United States. So that is all started going to Korea Korea and then China. So the fate was written that the company is going to close down sooner than later.
2:35 Then I found my value in but I am a cost accountant by profession. I said why not I look into an area either there was again a choice there. Again go back to India or stay and find another job because we had we had already invested here. My son was here in the school and all that is again keep on it's difficult to uproot people, right? So I said no, I need to find a stable industry where you need to have a foothold where you know you can stay longer time. So the only thing that was I I identified was you go to IT then you got to keep on upgrading yourself. That's also kind of very kind of very dynamic. The next industry was pharma industry or the third is finance. The finance is where my strength is, right? So I started focusing on wealth management industry. When I 48 years old I did my CPA exams.
3:28 >> Yeah. >> I passed it you know that was kind of a record. I think in my batch when I passed like very few people were 45 plus you know 48 plus you know I was 48 and I passed that exam then became a CPA. Then I've been in this company since then. Now it's right up to this year December I'm going to retire. The reason why I wrote in the website
3:53 That I need to come back to India is there is a big life lesson that I learned in my life. My mom was I told you was staying with me, right? She had a lot of health issues. Then it so happened in 2015 so she was staying with me she had whatever that known that day like she had and then she went to the toilet and fell down. She had blood pressure, she had diabetes. You know, you name it and she had it cholesterol and all that. And then when she fell down she fell down in such a bad way like she couldn't even open the door because you know, in America the the toilet opens inward right not outward, you know, so she I cannot even because her body was there to push the door. Somehow I got in stabilized her called emergency and all that.
4:38 Then when when the medical emergency comes they kind of separate the husband and wife and ask them what happened. The reason is there is elderly abuse they call it as. You know, that could be there then you know, you will go to jail. So that's there's something that everybody should know. You know, it was luckily we answered the questions in the same way. Even if you deviate a bit then then they will they will flag it. Mhm. To the to whichever the department is then then she was taken from to hospital and then she was hospitalized. Then they they said that she lost the control base down. There was no way. And if you come back home then we said that then our world turned totally upside down in 2015.
5:25 So because of this then finally I found a nursing home which is managed by Indians. Gujarat that was a Jewish nursing home in which one particular floor was taken over by Indians. The Indian community also. And luckily I had got my mom Medicaid. You know, there's a difference between Medicare and Medicaid, right? Medicaid is for low-class income mom did not have any assets because you cannot have more than $3,000 to your name if you want to get Medicaid. And there is a look back period. That means they look back for 10 years and and make sure that she doesn't have so much of money. My mom did not have anything because we were from lower middle-class family in in India. So, she we didn't have any assets. So, we she went to the hospital. She had Medicaid, but the problem is that Medicaid covers only so much.
6:18 >> Mhm. >> Like just to give you an example, the the they give you a shower, right? So, if Medicaid is there, they'll give you a shower only once in 2 weeks. >> So, but if you want the regular care, then you have to pay It's like a la carte. You want to do any services, pay me for that. >> Okay. >> Even clipping the nails, they used to charge. So, then our life kind of so I have a brother who is here, but he has his own problems, you know, like he had his own family's issues. My sister is there in Bangalore, and she had her own family's issues. They could not step up to take care of my mother. So, it fell on my shoulder and her shoulders. And Yogamba, what she did is after my mom moved back, you know, she tried her She was also working at that time.
7:05 So, it's difficult to manage work, taking care of mom full time, like you know, you have to put the diapers on. And you know, American bathrooms are not like Indian bathrooms. It's very difficult here. You have lived here. You know how hard it hard it is. And you cannot even throw the water, like you know, everything has to be done in a proper way. And while all these obligations of elderly care, it was becoming difficult. Then ways down, it was totally unmanageable.
7:32 Example, tomorrow got far better. I and Yogamba, both of us become incapacitated and we had to go to the nursing. Okay, if we go to the nursing home Medicare covers you for only certain months, like 12, 14 months or 12 months or whatever the time limit is. That keeps changing. So, 14 months, let's assume Medicare will kick in and they'll pay. Then after that they'll stop paying. What they will do is they will give you the care but then they will attach your assets. You see what I'm saying? Like they'll come after your assets. And in some states your primary home will be saved. Not to the end. And once everything is done they will complete the whole process and come back and sell the home, they recover their money and give the balance to your kith and kin or whomever you have nominated. Mhm. That is the process. This is one reason why it's very hard if you have not sufficient money in your account to retire in America.
8:33 So, if you have millions of dollars then it's fine. Then what happens to elderly care is the next question, right? And how will you going to manage? >> The best thing is to stay at home and get care within the home. For that you should have taken long-term care insurance. That kicks in. But that again has limitations. Now, you know, they all the long-term care insurance companies started going belly up because people are living longer. >> Longer. >> Not like what it is, right? Their math is not working. So, what do they do? They are putting a lot of limits. So, you can get the care. And just to give you an example, when my mom was at home, we used to get her a care person just to give her a shower. For each shower they will charge you $125 then, just shower only.
9:18 But if you want a care person to be with you then they will come and stay with you and they will they they the going rate is something like $35 an hour for them. To pay plus you know, they're going to be there with you then all the time you cannot have, right? You know, then your math becomes too hard to manage. >> Long-term care insurance is for one person premium per year is $10,000. I'll give you my example. $10,000 per year and you have to pay for 9 years, which is $90,000. Right? And the deal is, if I get into nursing home, right? They adjust it to some cost of living index. And today, for example, tomorrow I get into the nursing home.
10:04 And they will pay for 45 months, every month $5,000. I would take long-term care insurance, especially the moment you are 50. And also remember, the long-term care insurance premium goes up the moment you start crossing 50 years of age. It goes up. The premium. So, you're smart enough when you're able to get it
10:23 At a younger period. You can leave a country, a country will never leave you. You know, that's so what? That's 100% truth, especially from my generation of people. I'm born in 1960, right? So, I lived when I came to United States, I was something like 38. So, you know, you come to United States at the age of 38. You have lived 38 years in India. You know, how can you just let go of that? You know, the thought keeps coming back. When my mother was in nursing home, when we were doing two jobs, and there is one old age NRI ashram, mostly run by Vaishyas. That means there are a lot of merchant community of Telugu who live in Karnataka. So, they are also vegetarians and they are merchant community, they are very rich. The second thing is my mom never wanted us to stay there. I said, "I won't come back. I want to be with you." So, what can you do? You know, I said, "When she came back." It depends. For example, I might have a million dollars, right? Then my mindset is, okay, you know, why do I
11:24 Want to go back to India? Maybe my children are here. I want to stay with them. I don't want to go. I'll somehow pull on here. Somehow, you know, I will exist here. Some people might think, hey look, it's $1.5 million, so then then if I go to India, maybe I can give it to my children. They may not be doing so well. I can bequeath it to them. So that, you know, it becomes good for them and I am anyway okay whether I'm old, whether I live in India or America, doesn't matter. So if I go and live a decent facility where I can, you know, what do I need? I need two square meals and a place to rest, right? So in some engagement, if that is there, why not I go there, you know? My relatives, friends are still there. So it depends, you know, it it is very complex, you know, it >> Yes.
12:10 >> never once said one shirt suits all kind of situation. You know, what do we depends. Even for me, I'm telling you, I and Yogamati keep on debating
12:18 Whether to go or not to go. That discussion will come at least once in a while. If you are living in America on green card or whatever, and if your parents are in India, don't bring them here. Because, to be very frank, taking care of my mother, it approximately theoretically, you know, it approximately costed me for a 7-year stay close to half a million dollars. Okay, over a period of 7 years. All kinds of expenses, you know, that needs to be paid off. God gave me the grace. My wife was there to support me. We paid off. Okay? But not everybody can do it. You know, it's hard. Okay, you can put them on Medicaid. Again, it depends on state. Some states might be able to take. I know, for example, I know somebody was telling me in Phoenix and all that everything is free.
13:07 I don't know that. I'm talking about New Jersey. It's expensive. So be be careful, you know, be thoughtful before you bring them here to permanently stay with you. And nowadays the immigration is also getting on. Now they're increasing. Now when my mom came here, the $3,000 to your name look back period was something like 18 months. Now they have made it 5 years and now they have also linked your passport to Indian Indian passport and American database, I believe it talks because I'm a CPA. I know what they do is they will go they will be able to check your assets in India. >> then they will reject reject all kinds of benefits. It is complex, you know, you don't want to get into the trouble at all.
13:54 >> You somehow make an arrangement, you go and take care of them. Or they come here as long as they can once in a while. Because they are loved ones, right? That's one thing. Number two is if your situation is such that if your children are not doing that great and you want to give pass on your wealth to them, then it's a good idea to move back to India. Because the your if something happens to you, all the money you can still protect and then get let go of your to your children. Instead of that going to government. >> We come here, it will be only one idea we have to do well in our life. >> Right? When we come over from India. But from moving here, it's so many things will be there. We have to look after our kids, our parents, everything. We are the sandwiches in between that.
14:43 >> Thanks a lot you know for taking the time and sharing your story and especially bringing some of these things on the medical side, right? I think you know the experiences you had with your mom and all that stuff. So really appreciate being very open and transparent and sharing that information to us today. >> Thank you. I appreciate it.
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