Program Pays People to Care for Older Adults at Home

As the only living son in his family, Hemant Ghising, who came to Burlington as a Bhutanese-Nepali refugee in 2011, is duty-bound to care for his aging father. 

Ghising’s father, 73, fell off a moving truck in his native Bhutan in 1976 and never fully recovered from his injuries. He now has diabetes and high blood pressure and struggles to walk unsupported.

“He needs help with everything,” said Ghising, 52. He helps his father dress, walk and eat. He takes him to medical appointments and keeps track of his medication. 

The work competed with the demands of Ghising’s job as an education counselor at the Vermont Student Assistance Corporation. Yet there was never a question of whether he would care for his father. In their culture, “it’s a must,” Ghising said. “There is no option.”

But thanks to a program called Vermont Comforts of Home, Ghising is now compensated for that caregiving.

Funded by Medicaid and the state, the program pays people to provide nursing home-level support so that patients can remain in their homes. The annual, tax-free stipend that caregivers receive can range from $29,000 to more than $70,000 per year, depending on the patient’s needs, according to Mary Mougey, the program’s intake and outreach coordinator.

While the program is available to any adult who has Medicaid and needs this level of care, it has been especially popular in Burlington’s tight-knit Bhutanese-Nepali community. Of 126 total participants in the northern half of the state, 84 are Bhutanese-Nepali. Ghising and his father enrolled in 2021.

“It’s a win-win for me,” Ghising said. “I’m more focused on my dad because I’m getting paid for looking after him. The other part is, culturally, there is a strong expectation for sons to take care of their parents, so I’m fulfilling that duty.

“I think that’s why this program seems to be very successful in my community,” Ghising said. “Because it is culturally very, very relevant for us.”

Vermont Comforts of Home opened in 2017 as part of Upper Valley Services, a state-designated agency that administers the Medicaid Choices for Care Program, a long-term program for people who need nursing home-level care. A separate nonprofit in Springfield serves the southern half of the state.

The program has grown quickly from an initial annual budget of $85,000 to $11 million today. Word spread rapidly in the Nepali-Bhutanese community, where families often balance the work of caring for older relatives with other jobs.

“I realized quickly we needed to hire Nepali staff,” said Marie Zura, the program’s director. Most of the case managers at Vermont Comforts of Home charged with supporting care providers and patients in the program are now Nepali, as is the business manager. But Zura says the program is available to all who need it.

In Vermont, which has one of the oldest populations in the country, finding long-term care is a huge and growing challenge.

A January 2025 report by the State Long-Term Care Ombudsman Program, which oversees the quality of long-term care in the state, found that while most older adults prefer to remain at home as long as possible, staffing shortages for home-based care have made that “extremely difficult.” 

Instead, people are forced into nursing homes, where staffing shortages of their own can harm the quality and availability of care. Complaints to the ombudsman’s office jumped by almost 40 percent in 2024 compared to 2023, and most were about residents’ struggles to get basic needs met.

The report recommended several avenues of relief, including supporting “family caregivers as much as possible.”

Zura, the director of Vermont Comforts of Home, sees the program as an ideal solution to the long-term care crisis and a more affordable alternative to housing people in nursing homes, which in Vermont costs Medicaid $164,000 a year on average for a shared room.

“There are many families taking care of parents that don’t know this program exists and that they could get the support and potentially the income to help them stay home and care for a relative,” she said. “Some people say, ‘Well, I would do it, but I’ve got to work.’ This is the possibility of doing both.”

Not every participant is being cared for by a relative. The program also helps match people with caretakers from the general public, who sometimes host patients in their own homes. In every case, the provider must pass a background check and a housing inspection.

Providers don’t have to be medical professionals, but they receive mandatory training from Vermont Comforts of Home staff in CPR and other skills as needed to meet the needs of their particular patient.

A case manager from the nonprofit stays in regular touch with both patient and provider and does a home visit at least once a month. A nurse on staff keeps track of each patient’s medical appointments and medication schedules and is available for consultations. 

“We provide a lot of support, because we don’t want people to get overwhelmed,” Zura said.

Providers are expected to be available 24-7, but they also receive a respite budget to pay for someone else to take over when they need a break or go on vacation. Some people work other jobs part time, but caregiving “has to be their primary focus,” Zura said.

Vermont is home to roughly 2,000 Bhutanese-Nepalis who resettled here as refugees starting around 2008. Most have since obtained U.S. citizenship.

Many had lived in refugee camps in Nepal for decades after being forcibly expelled from Bhutan in the 1990s. That’s when King Jigme Singye Wangchuck implemented the “One Nation, One People” policy that stripped ethnic Nepali residents of their Bhutanese citizenship and banned their language and cultural practices.

Bidur Rai remembers being beaten in school in Bhutan for speaking his native Nepali. He and his family fled to a refugee camp in Nepal and lived there for 23 years, holding onto hope that one day they would be able to return to Bhutan.

But as his relatives resettled in the U.S. and the prospect of returning home faded, Rai finally decided to leave. In 2015, he arrived in Burlington, where he now lives with his wife, their four children, his sister-in-law and his 93-year-old mother, Dil.

Bidur’s mother lived for years with her other son, in Pittsburgh. But she was spending too much time alone while her son and his family worked. After a visit to see Bidur in Burlington last year, she decided to move to Vermont.

Shortly after she arrived, she had a stroke. At the time, she was receiving care from another home-based program that did not meet the family’s needs, Bidur said. A friend recommended Vermont Comforts of Home. 

Bidur quit his job as a family support consultant for the Vermont Family Network. He now cares for his mother full time. Every month, he submits a report on her medications and hospital visits.

“What I really appreciate with this organization is that for the first time, I got training on how to take care of my mom,” Bidur said.

Aside from tending to her medical needs, Bidur often takes his mother on drives along the Winooski River, which reminds her of Bhutan. She’ll sometimes ask him to stop so she can walk out and look at the scenery. She was a farmer back home, and she advises Bidur and his family on how to tend their backyard garden.

They take several walks a day, and she prays morning and evening to the Hindu gods arranged at an altar in her bedroom. He feeds her the familiar food of her home country: rice, vegetables, lentil soup.

“That’s something she would miss” if she had to be in a nursing home, Bidur said.

On a recent weekend, relatives from all over the U.S. came to his home to celebrate Dashahra, a festival in which elders bless the younger generations. Nearly 20 people crammed into Bidur’s home. One by one, Dil blessed them all. 

“I like it here because I have my son and family around me,” Dil said on a recent afternoon, speaking through an interpreter. “I forget a lot; I keep forgetting things. But I’m happy now.”

The original print version of this article was headlined “Culture of Care | A program that pays people to care for older adults at home is especially popular in Vermont’s Bhutanese-Nepali community.”

This article appears in Oct 15-21 2025.

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