Elderly Care in the Bhutanese Diaspora

When the third-country resettlement programme relocated Lhotshampa refugees from Nepal's camps beginning in 2007, it relocated them as a community that included all ages — including elderly adults who had spent fifteen to twenty years in camp conditions and who arrived in Western countries in their sixties, seventies, and sometimes eighties. For this generation, resettlement represented not a new beginning but an extraordinarily disorienting late-life transition. The structural supports that had organised their existence — the camp community, the extended family network, the social roles of elder and grandmother and religious elder — were fragmented by the dispersal of resettlement. What replaced them, in many cases, was an apartment, a government benefit, and a world conducted in a language they had no possibility of learning.

Academic researchers, public health practitioners, and community workers have described the situation of elderly Bhutanese refugees as one of the most challenging unmet needs within the broader resettlement population. A 2022 study published in Aging & Mental Health (PMC) documented the compounding effects of past trauma, resettlement stress, and pre-existing health conditions on the mental health of older Bhutanese adults in the United States and Canada. A 2023 study in PMC found that mental health challenges among older Bhutanese refugees included depression, anxiety, and suicidal ideation at rates substantially above both the general US population and younger Bhutanese refugee cohorts.

Challenges

The challenges facing elderly Bhutanese refugees are structural as well as individual:

• Social isolation: Elderly community members who cannot drive, read English street signs, or navigate public transit systems are effectively confined to their apartments when younger family members are at work or school. The community's tradition of multigenerational cohabitation provides some protection, but in resettlement cities where apartment sizes limit crowded living, the elderly may spend much of the day alone. A 2022 PMC study on coping and meaning-making among older Bhutanese used the phrase "we are all under the same roof" to describe the communal orientation that camp life had reinforced — an orientation that resettlement's spatial dispersal directly undermines.
• Loss of social role: In Bhutan and in the camp communities, elders held respected and functional positions — as religious leaders, as grandparents who managed household religious practice, as community mediators and storytellers. In resettlement cities, these roles are structurally unavailable. Elders who cannot communicate with neighbours, teachers, or service providers find their social role reduced in ways that carry profound psychological consequences.
• Mental health: The Bhutanese refugee community as a whole has experienced elevated suicide rates, with CDC research documenting rates significantly above the US average. Among the elderly, this risk is compounded by isolation, loss of role, grief for lost homeland and community, and the particular difficulty of accessing culturally appropriate mental health care. A 2025 SAGE/PMC study on socioeconomic status and cognitive health among older resettled refugees documented that Bhutanese elders show "diminished returns" — lower cognitive health outcomes relative to their socioeconomic level — compared to non-refugee populations, a finding attributed to the cumulative effects of displacement.
• Healthcare navigation: Western medical systems, with their emphasis on individual decision-making, written consent forms, digital appointment booking, and specialised care pathways, are extraordinarily difficult to navigate without language proficiency and cultural familiarity. Preventive care appointments are frequently missed; chronic conditions including diabetes and cardiovascular disease — prevalent among older Bhutanese due to years of inadequate camp nutrition — are managed less effectively than in the general population.

Research and Programmes

The academic response to the needs of elderly Bhutanese refugees has been substantial. Project Bhalakushari, an NIH-funded study led by researchers including Dr. Bhuwan Gautam at Harvard and Boston College, has examined the wellbeing of ageing Bhutanese refugees in the US and Canada, producing research that has informed both clinical practice and community programme design. Community health worker models — in which bilingual community members are trained to provide health information, navigation assistance, and social support to elderly community members — have been developed in several cities and evaluated in academic literature as among the most effective interventions for this population.

Parangkush Subedi's mental health training programmes, which have addressed elder mental health as a specific priority, represent another community-led response. Faith communities — Hindu temples and Buddhist practice groups — also provide informal social support and structured occasions for elderly community members to participate in meaningful communal activity.

See also

• The Problem Was Never the Home Care
• Child Care and Protection Act of Bhutan 2011
• Child Care and Protection Act of Bhutan
• Bhutanese Diaspora Youth in Higher Education
• Lhotshampa Name Reclamation in the Diaspora

References

1. "Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience." Aging & Mental Health, PMC, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9386683/
2. "'We are all under the same roof': Coping and meaning-making among older Bhutanese." PMC, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9412077/
3. "Mental Health Among Older Bhutanese with a Refugee Life Experience: Mixed Methods Latent Class Analysis." PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10330824/
4. "Socioeconomic Status Among Older Resettled Refugees: Older Bhutanese Refugees' Diminished Returns on Cognitive Health." SAGE / PMC, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12264397/
5. "Addressing the mental health needs of older adult refugees." PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10559761/