The United States’ image of itself as a melting pot of different cultures has been popular since the early 1900s. More recently, this image has faced criticism for implying that immigrant and minority cultures are lost or absorbed into one homogenous culture. Perhaps a salad bowl is more appropriate, some argue. Whether you prefer to view the U.S. as a salad bowl or a melting pot, it’s becoming clear that America’s healthcare system for elders embodies the melting pot image, with some significant negative effects.
What kind of effects? Let’s take a look using a recent episode of the PBS series “Life (Part 2)”, which focuses on issues in aging in the United States, particularly for Baby Boomers. PBS host Robert Lipsyte held a roundtable discussion during the episode with leaders in the geriatric field: Dr. Jerry C. Johnson, chief of the division of geriatric medicine at the University of Pennsylvania; Melvin Delgado, Professor of Social Work at Boston University; and Dr. Giang T. Nguyen, Assistant Professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania. They looked at the way different immigrant and minority cultures in the United States view elder care and how the healthcare system caters to certain cultures’ perspectives on aging. Below, we’ve pulled out the highlights on how certain ethnic minorities view the role of an elder, and how America’s elder care system addresses race and age.
Cultural Barriers in Facilities
The episode opened with the story of a Korean woman in Philadelphia caring for her 92 year old mother. In her words, “The doctor advised me to send her to a nursing home, but if I send her there, she would not get Korean meals…and she would not be able to communicate at all.”
This sentiment encapsulates one of the biggest problems we face when we think about ethnicity and aging, and particularly aging in America: most facilities are not run with different cultures and ethnicities in mind, even with regard to the food served and the languages spoken by staff. Nguyen and Johnson noted that in certain East Asian cultures and in African American culture, allowing one’s family member to go into a nursing home would be viewed very strongly as a sign of neglect. Many East Asian cultures still adhere to the concept of filial piety, and the African American community has suffered historically in the United States’ healthcare and medical systems, leading to a general lack of trust.
Individualism vs. Collectivism
Another theme that emerged during the roundtable discussion centered on the idea that different cultures view family health care as a collective burden rather than an individual one. Delgado explained that, “It’s not unusual for an older Latino to go to a medical appointment and have 4-5 people with them…it’s a clash of individualism vs. interdependence. In many other cultures we’re talking about interdependence. It’s ‘I’m not sick, we’re all sick.’”
Nguyen was quick to point out the benefits of a more collective approach to family caregiving, but when it comes dealing with the healthcare system, many ethnic families struggle with the way information is shared. Johnson brought up that “the health professions have to recognize that families have variable definitions. The important members of the family may not live in the same house. They may be either gender, they may be cousins…who is accorded respect? With whom is information communicated? I think we have to be more expansive with those answers than we have in the past.” By expanding those definitions when speaking with families who view caregiving more collectively, those families may feel more comfortable allowing an elderly family member to reside in a facility.
The discussion also turned to acculturation (the psychological change that takes place when two cultures meet), and its impact on mental health. Nguyen explained that immigrants may have ideas about the way they’ll age and the proper role of elder family members, but those ideas may clash with the way their adult children, who have grown up with the American healthcare system, see that relationship. The group mentioned that acculturation has affected lifespan and diet; immigrants who begin to follow a more Western diet, including processed foods, do not live as long as those who stick to the diet of their own culture. Johnson made note of the effect acculturation has had in in the African American community: “The acculturation has resulted in African Americans being more like mainstream in their thoughts than some of the other ethnic groups. One of the places where that does not hold true is a general sense of belief or trust in the healthcare system, and that presents challenges for health professionals.”
Alternatives to Facility Care
As a member of an ethnic minority family, Delgado laid down an edict of: “Either the system is going to have to accommodate, or we’re going to have to change.” While facility care use is still low among minorities, the landscape of elder care is shifting from being primarily facility-based toward community and home-based care. Thinking about the issues brought up in the PBS episode, it’s easy to see why home care might appeal to families from immigrant cultures or ethnic minorities more than facility care. Not only is it often less expensive than institutional care, but it also might appeal to the more collective mindset surrounding family caregiving if a professional comes to a senior’s home where many family members might be present. It’s also possible that hiring a professional caregiver to help a family elder rather than moving them into a facility helps to dissipate feelings of guilt or perceived neglect within minority cultures.
Diversity and race are hot button issues in the United States, and the next few years will show whether the healthcare system, and particularly the elder care system, responds to the growing need for attention to issues of aging and diversity.
Did you grow up in a family where elders had a different cultural role than in many American families? How does your culture view aging? Do you see the healthcare system improving for immigrant and minority elders in the next few years? Share your stories and your thoughts in the comments below.