Quiet rise of Bangladeshi-backed home-care agencies in America

Bangladeshi-USA based entrepreneurs have quietly built a growing presence in the USA home-care sector. According to recent data, over 208,000 people of Bangladeshi origin live in the United States, with nearly half residing in New York State. Many have leveraged language skills, cultural fluency, and strong community networks to build home-care ventures that now operate across multiple states.

Examples of this growth include C&T Home Care and M&N Home Care, both based in New York, and Apple Homecare, which operates out of Pennsylvania. C&T Home Care Services was established in Queens in 2016 and serves Bangla-speaking seniors and other vulnerable populations. M&N Home Care, headquartered in New Hyde Park, has scaled more aggressively, listing over 1,000 employees on its LinkedIn profile and operating branches across New York's five boroughs and Long Island. Apple Homecare, while less public in its promotional efforts, has become a reliable player in the Pennsylvania home-care scene since its founding in 2018. There are many more founded or co-founded by Bangladeshi entrepreneurs in the USA.

These firms, often founded by first-generation immigrants, operate in one of the most labour-intensive segments of the US healthcare system-non-medical home-based care. Agencies recruit, train, and deploy caregivers to help elderly and disabled clients with daily activities such as hygiene, meal preparation, mobility assistance, and companionship.

The care continuum— from matching to reimbursement: US home-care systems operate via Medicaid, government insurance, and private agencies. Caregiver candidates must complete state-mandated training (e.g., HHA certification). Agencies identify clients' needs, pair them with qualified caregivers, supervise care delivery, remunerate staff, and bill insurers or Medicaid for their services.

To be eligible, caregivers undergo training to meet state standards (e.g., 75+ hours for HHA in New York). Agencies like Bangla Home Health Services offer bilingual training programmes, supporting new caregivers with English classes before deployment. This ensures competency not only in technical care, but in communication and compliance.

Bangladeshi professionals are integral at every step: night-shift caregivers provide 24/7 support often outsourced to Bangladesh, while US-based employees in advertising, case management, and office roles keep operations smooth.`

In some cases, administrative work is outsourced to teams based in Bangladesh. Many such companies founded or co-founded by Bangladeshi-US entrepreneurs for example, have advertised remote coordinator roles in Dhaka for night shifts. These roles involve managing schedules, maintaining documentation, and acting as liaisons between clients and caregivers in the US time zone. The practice is spreading, with agencies investing in bilingual training centres and IT support operations across Bangladesh.

One night-shift coordinator working from Dhaka shared, "Managing the calls and schedules from here is challenging at first, but once you understand the cultural context and pick up the medical terminology, it becomes second nature." They often have a good salary to start their career in these outsourcing companies.

A caregiver in New York added, "Clients want someone who listens. English is essential, but it's empathy that really helps you bond with the people you're helping."

Adapting to shifts in public programmes: One major challenge these agencies face is navigating changes in public programmes. A key example is the ongoing restructuring of the Consumer Directed Personal Assistance Program (CDPAP) in New York. This Medicaid initiative previously allowed consumers to choose their own caregivers, often family members, and work through smaller home-care agencies known as fiscal intermediaries.

In 2025, New York began consolidating CDPAP under a single entity-Public Partnerships LLC(PPL). This affects over 250,000 consumers and hundreds of smaller agencies, many of which are owned by Bangladeshi entrepreneurs. Critics argue that the rapid shift has caused confusion, delays in payment, and potential disruption to care. While a federal injunction extended the transition period, the long-term impact on small providers remains uncertain. Many agencies are now diversifying into private-pay services or seeking to align with the new intermediary model.

Back-end operations in Bangladesh: Beyond caregiving, Bangladeshi-owned agencies are innovating by establishing remote administrative teams in Dhaka and other urban centres. These teams handle payroll processing, call routing, electronic documentation, and insurance paperwork. Staff are typically fluent in English and trained to handle customer interactions using US-based CRM systems. Some agencies even provide night-shift internships in Bangladesh to support the round-the-clock needs of their American counterparts.

Job postings reviewed on LinkedIn reveal detailed roles requiring fluency in English, time zone flexibility, and knowledge of US healthcare terms. Tasks often include coordinating home visits, updating patient records in real time, and resolving scheduling conflicts. This offshore model has helped agencies reduce costs while maintaining service quality.

Why AI hasn't replaced human empathy: While artificial intelligence and automation have streamlined scheduling, billing, and recordkeeping, the emotional core of home-care remains human. Technology has improved efficiency, but it cannot yet replace the intuition and cultural sensitivity caregivers bring to the job. Many elderly clients prefer aides who share their language and customs, a factor particularly relevant in diverse cities like New York.

Some agencies are leveraging AI to augment, not replace, human roles. For example, chatbots may assist with appointment reminders, and analytics tools can optimise staffing. But the judgment calls-how to handle a confused client, when to notify a family member-still rely on people.

Bangladeshi-founded agencies have embraced a hybrid model. By combining digital tools with hands-on care and remote support teams abroad, they are building a scalable and culturally competent solution. The demand for this model is likely to grow as the US population continues to age.

The road ahead: As policy frameworks evolve and economic pressures mount, the sustainability of these operations will depend on adaptability. Whether through compliance with new Medicaid regulations or building bilingual tech-enabled support teams, Bangladeshi entrepreneurs in the USA are demonstrating that cultural familiarity and business acumen can thrive even in tightly regulated sectors.

Their story is not just one of immigrant success, but a case study in how emerging economies can plug into global service supply chains. The care may be delivered in Queens or Philadelphia, but increasingly, the systems supporting it are running quietly and efficiently from a desk in Dhaka.

rummank@gmail.com