As Parents Age, Asian-Americans Struggle to Obey a Cultural Code
By TANZINA VEGA

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 by Penn 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.”

亞裔漸老 照護面臨困境

全美亞太裔社區的老人人口增加迅速，但語言障礙和文化隔閡使這些老人無法適應主流社會的養老院、輔助看護中心，針對他們特定需求的老人看護服務應運而生，未來並將持續擴增。

由於老人人口增加，部分華人社區已逐漸出現針對華人需求的養老院和輔助看護中心，亞裔退休社區也愈來愈受歡迎，僅在數年前，此現象根本不存在。

紐約時報引述衛生與福利部老人局的統計指出，至2020年，65歲以上亞太裔人口預期增至250萬，2050年增至760萬，而2000年，這類人口還不到100萬人。

報導還指出，75歲以上亞太裔婦女自殺率幾乎是其他族裔的兩倍；此外，在2012年，65歲以上亞裔有12.3%生活貧困，比率遠高於全美同年齡層的9.1%。同時，全美1730萬亞裔人口近四分之三在外國出生，這些數據正反映出亞裔老人面臨的困境。

北卡三角洲國際研究資深研究分析員馮占聯（Zhanlian Feng）表示，深受儒家思想影響的中華文化，敬老尊賢根深柢固，子女視照顧年邁雙親天經地義，然而隨著家庭成員分散各地，或夫妻兩人都須工作養家，想要親自照顧家中老人，通常心有餘而力不足。

照顧亞裔老人時，看護業者必須面對文化敏感問題，例如稱呼對方不帶姓氏是否妥當，詢問歷經戰亂的老人有關戰爭創傷問題是否合宜。全美亞太裔耆老中心東北地區協調員張昆（Kun Chang）並指出，對於不諳英語，仰賴子女幫忙熟悉環境的亞裔老人，語言隔閡也是一大障礙。

張昆說，年紀較長的亞裔，英語能力有限是他們面臨的首要問題，他說：「如果你無法和他人溝通，如何取得需要的資訊？」

因應亞太社區此項需求，賓州亞裔耆老服務中心（Penn Asian Senior Services，簡稱PASSi）為說華語、韓語、越南語等亞洲語言的人提供居家看護訓練。越裔費城居民盧鳳也參加該課程，以便學習在家照顧罹患失智症的81歲母親。

即使掌握了看護技巧，看護的壓力依然沉重。盧鳳說：「即使我不上班，每天仍筋疲力竭，有時壓力大得令我發瘋。」但她說，如果母親不由她照顧，就得送到養老院，盧鳳說：「但在目前，住進養老院會讓她害怕。」

盧鳳和其他亞裔面臨的這類困境，凸顯出亞裔需要考量文化語言障礙的老人看顧服務。PASSi的韓裔創辦人崔英佳（Im Ja Choi）指出，她創立該中心就是為了她罹癌母親的需求。

她說：「母親生病後，我沒法把她放在養老院，我的文化背景不允許我這麼做，這是亞裔無法避免的掙扎，他們把勤奮工作、子女就學、照顧父母都視為天職，若讓父母住在養老院，無異於任由他們孤苦伶仃。」而該中心提供的服務可以讓亞裔耆老住在家中，說自己的語言，吃家人烹煮的食物。

張昆預期，將會有更多社區團體嘗試提供這類特定需求的服務，同時，主流社會的長期看護業者也已開始留意到亞裔社區的這項需求。美國中老年人協會（AARP）近來更頻繁與全美亞太裔耆老中心等團體進行交流，盼更了解亞裔耆老的需求，並招募符合此需求的人力。

原文參照：
http://www.nytimes.com/2014/01/15/us/as-asian-americans-age-their-children-face-cultural-hurdles.html

紐約時報中文版翻譯：
http://cn.nytimes.com/usa/20140116/c16asian/zh-hant/

2014/01/15 世界日報 編譯中心 賓州14日電