[In a country that is growing older and more diverse, elder care
issues are playing out with particular resonance for many Asian-Americans. The
suicide rate for Asian-American and Pacific Islander women over 75 is almost
twice that of other women the same age. In 2012, 12.3 percent of
Asian-Americans over 65 lived in poverty, compared with 9.1 percent of all
Americans over 65. Nearly three-quarters of the 17.3 million Asians in the
United States were born abroad, and they face the most vexing issues.]
By Tanzina Vega
 |
| Oun Oy, 90, right, lives with her son and his family. A home health aide helps them care for her. Jessica Kourkounis for The New York Times |
SOUDERTON,
Pa. — Two thick blankets wrapped in a cloth tie lay near a pillow on
the red leather sofa in Phuong Lu’s living room. Doanh Nguyen, Ms. Lu’s
81-year-old mother, had prepared the blankets for a trip she wanted to take.
“She’s ready to go to Vietnam,” Ms. Lu said.
But Ms. Nguyen would not be leaving. The doors were locked from
the inside to prevent her from going anywhere — not into the snow that had
coated the ground that day outside Ms. Lu’s suburban Philadelphia home, and
certainly not to her home country, Vietnam.
Ms. Nguyen has Alzheimer’s disease, and Ms. Lu, 61, a manicurist
who stopped working two years ago when her mother’s condition worsened, is her
full-time caretaker. In Vietnam, children must stay home and care for their
aging parents, Ms. Lu said. Elders “don’t want nursing home,” she said: Being
in a nursing home creates “trouble in the head.” The family now relies
financially on Ms. Lu’s husband, a construction worker.
In a country that is growing older and more diverse, elder care
issues are playing out with particular resonance for many Asian-Americans. The
suicide rate for Asian-American and Pacific Islander women over 75 is almost
twice that of other women the same age. In 2012, 12.3 percent of
Asian-Americans over 65 lived in poverty, compared with 9.1 percent of all
Americans over 65. Nearly three-quarters of the 17.3 million Asians in the
United States were born abroad, and they face the most vexing issues.
Language barriers and cultural traditions that put a premium on
living with and caring for the elderly further complicate the issue at a time
when the population of older Asian-Americans is surging. According to the
Administration on Aging, an agency of the Health and Human Services Department,
the number of Asian, Hawaiian and Pacific Islanders over age 65 is
expected to grow to
2.5 million by 2020 and 7.6 million by 2050, from fewer than one million in
2000.
Asian-Americans are hardly alone in their desire to care for
aging relatives themselves. Many Hispanic families share a similar
commitment. But despite those expectations, more Latinos are
entering nursing homes, and facilities that specifically serve Latinos are
increasingly in demand. Also, finding a home health aide or nursing home
supervisor who speaks Spanish is usually easier than finding one who speaks,
say, Khmer.
Zhanlian Feng, a senior research analyst at RTI International who has studied
demographic shifts, said that filial piety, or respect for one’s
elders — a concept based on Confucian philosophy — was a large part of
Asian-Americans’ cultural expectations.
“This idea that the younger generation is culturally mandated to
take care of their parents is deeply ingrained in the Chinese culture,” Mr.
Feng said. “Children are supposed to take care of older parents in need.” But
that tradition is being eroded, he said, by the increasing number of families
that are geographically dispersed or in which both spouses have to work.
That is changing somewhat, both here and in Asia. The aging
population has forced some communities in China to create nursing homes and
assisted-living facilities, which barely existed there years ago, Mr. Feng
said. And retirement communities for Asian-Americans are increasingly popular.
Health care providers in the United States confront culturally
sensitive questions like whether to address patients by their first name or
whether to ask someone who may have been a refugee about war trauma. Language
barriers are another hurdle, said Kun Chang, Northeast regional coordinator at
the National Asian Pacific Center on Aging.
Mr. Chang said limited English proficiency among older
Asian-Americans was “the No. 1 issue.” “Are we able to address that culturally
and with linguistic services?” he said.
For Ms. Lu, putting her mother in a nursing home where she would
be unable to communicate with the staff is not currently an option. Instead,
through a program offered byPenn Asian
Senior Services, known as Passi, she is learning to care for her
mother at home. But despite Ms. Lu’s sunny demeanor, the strain is evident.
“I don’t work, but I’m so tired,” she said. “Sometimes it makes
me crazy, too.”
She began to lock the doors after Ms. Nguyen left one night and
walked a few miles before the police found her. Ms. Nguyen has also been known
to remove framed family portraits from the living room wall to take on her
imaginary trips to Vietnam.
“If I can’t take care,” Ms. Lu said, she will have to consider a
nursing home. “But not now,” she said. “In the nursing home, she’s scared.”
The challenges Ms. Lu and so many others are facing underscore
the need for culturally competent elder care services for Asian-Americans, said Im Ja Choi,
founder and executive director of Passi, which trains home health aides who
speak languages including Korean, Mandarin and Vietnamese.
Ms. Choi founded the organization after her own mother developed
stomach cancer. “When she was sick, I could not just abandon her at a nursing
home,” she said. “That’s not in my culture, either.” She added: “That’s the
agony of Asian-Americans. They have to work, and their children go to school
and their parents remain at home by themselves. They put them in a senior
housing complex, and there they are alone.”
The need for services that would let Asian-Americans keep their
loved ones at home, where they can speak their own language and eat familiar
foods, has influenced Ms. Choi’s organization. It is expanding to a new
two-building, 29,300-square-foot facility in Philadelphia, where it will
provide ethnic meals, a community center, counseling, caregiver training and
other activities for clients of a variety of Asian nationalities. Ms. Choi said
the center would also serve non-Asian clients.
“I am a proponent for home care because my mother, who everybody
predicted wouldn’t live more than two months, lived eight years under my care,”
she said. “That’s living proof.”
Pheng Kho, 68, came to the United States from Cambodia in 1981
with his wife, his two children and his mother, Oun Oy. In 2012, Ms. Oy, 90,
had a stroke that left her unable to perform many daily tasks. “After she left
from the hospital, at that time she cannot stay home alone,” Mr. Kho said.
He and his wife tried to care for Ms. Oy alone but soon realized
that while they did not want to send her to a nursing home, they needed help.
In the summer of 2012, they contacted Passi, and a Cambodian home health aide
now visits twice a week.
Mr. Chang of the National Asian Pacific Center on Aging said
that as the Asian-American population aged, he expected to see more community
groups and nonprofits trying to provide tailored services. Mainstream elder
care providers are just beginning to realize the challenges in serving this
demographic, he said.
“They haven’t figured this out because they have to think in a
very different way,” Mr. Chang said. “They have to hire more bilingual staff to
design these services. It’s a cultural change.”
AARP is also setting its sights on Asian-Americans, said Daphne
Kwok, the organization’s vice president for multicultural markets and
engagement for Asian-Americans and Pacific Islanders. It has been meeting with
groups like Mr. Chang’s to learn more about the needs of the population and to
recruit members.
Ms. Kwok described the term “caregiving” as “mainstream
terminology.” For Asian-Americans, “it is what is expected of us,” she said.
“We don’t see it as caregiving in the American definition of caregiving.”
