(Editor’s note—The following article is final installment of a three-part series on Japanese American caregivers. It was made possible through the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.)
By ELLEN ENDO, Rafu Contributing Writer
Recent statistics paint a bleak picture of the challenges facing family caregivers, particularly in the Japanese American community, the nation’s fastest aging population. The often inevitable decision of when, where and if to place an aging parent into a care facility is compounded by financial issues and cultural mores.
According to the United States Census 2010, one in five JAs is over age 65 (21.5 percent), compared to the general population (13 percent). As reported earlier in this series, Sansei Baby Boomers have become wedged between paying for college for their children and caring for an elder parent like the Spam between two layers of rice in a musubi. Increasingly, Sansei are confronted with their parents’ depleting resources and the prospect of leveraging their own retirement.
“It can be difficult for a family to deal with,” explains senior living advisor Lin Imamura Hammer. “Care needs can run well beyond the abilities and resources of family caregivers, yet they face the added pressure of cultural expectations that presume families will take care of their own forever.”
Hammer, a Yonsei (fourth-generation JA) has worked for A Place for Mom, a private referral service, for the past three years.
According to Hammer, two key issues have emerged in her efforts to help families find eldercare solutions. “The first is the growing number of seniors with dementia, Alzheimer’s or other diseases that affect memory. I speak to many families facing this, and it’s not only heartbreaking for families to watch their loved ones slip away, it’s stressful for everyone involved with their care.”
Often the elder is physically fit, Hammer points out, but the mind is slowly fading. “Wandering, agitation and the loss of the ability to perform basic tasks can happen over time or quickly…and can require having someone with them 24/7.
“The second issue is financial. As people are living longer, many are outliving their retirement and don’t have the money to cover the cost of their care when they can no longer live alone. Many adult children are finding themselves dipping into their own retirement savings to help cover the costs of caring for their parents – whether that’s to cover in-home care services or an assisted living community,” Hammer says.
She points that there are many things to consider when choosing a place for a loved one, including an assessment of the person’s needs and preferences to determine what environment may be best.
“For example, a person who may not have memory issues but has significant mobility problems may be a better candidate for a residential care home (RCH), where there are generally only six people in a large home and there is less square footage to navigate. To get to the dining area may be a matter of a few steps versus long hallways. Many of the RCH administrators are very accommodating and will often try to have culturally diverse menus as well,” Hammer states.
“(On the other hand), if a person has memory issues and is prone to wandering, a secure environment with relevant memory therapy programs will be required.” Hammer says that social tendencies and hobbies should also be considered. “If Mom or Dad is an avid gardener, I (would) look for a place that has a garden area for residents. Or maybe mahjong is their passion. I would inquire to see if there are other players so Mom or Dad can join the group.”
Her first glimpse into the world of eldercare occurred at age 14. As part of a community involvement project, her youth group visited residents of a well-known Japanese American nursing facility. “Their faces would light up when we visited,” she recalls.
Born and raised in Los Angeles, Hammer moved to San Diego after she married and now lives in Encino. Her mother and father are from Maui and Oahu, respectively.
“As a Yonsei, I know the cultural dilemma many of us face,” says the mother of two. Her grandmother lived alone (in Hawaii) for a long time. “She was 95 when she fell and broke her hip. I didn’t have the knowledge I have now. I couldn’t be of help to my mom,” Hammer remembers.
Today, she has successfully placed dozens of individuals. One particularly memorable case involved a man who was “wheelchair-bound and miserable.” Hammer referred the man to a benefit coach, who helped him obtain approval for veteran’s benefits he didn’t know he had. “His first check was $11,000,” she recalls.
Hammer says that families generally want the best for their parent. They want them to be comfortable. “But sometimes what the (adult) child wants is to feel better themselves,” she observes.
“The most important thing,” she recommends, “is going out and visiting places to see first-hand what is offered and really get a feel for the atmosphere and other residents.”
Hammer can be reached at firstname.lastname@example.org.
American Association of Retired Persons (AARP) notes that there are numerous eldercare options. Among them are:
Assisted Living Facilities – While assisted living facilities differ in terms of services, they generally are able to care for elders who are still able to live somewhat independently but may need assistance with bathing, meal preparation or taking medications.
Nursing Homes – There are generally two types: Short-term, rehabilitative care; and long-term care for chronic conditions. In addition, nursing homes are staffed to provide for daily medical needs and can accommodate patients who spend most or all of their time in a bed or wheelchair as well as those with moderate to severe dementia.
Hospice – Generally thought of as end-of-life care, hospice services are provided by nurses, social workers, home-health aides, spiritual leaders, and others whose goal is to keep the elder patient as content, comfortable, and pain-free as possible. Hospice care can be provided at home or in a facility. Services typically extend to support for the entire family, not just the patient.
Adult Day Care – These programs provide care and socialization, including activities, meals, and certain health-related services during the day. Adult day care can offer an occasional respite to family caregivers, allowing them to go to work, run errands or simply get a break from caregiving chores.
Residential Care Home (RCH) – A person who does not have cognitive issues but has significant mobility problems may prefer an RCH, where there are generally only six residents in a large home. Getting to the dining area may only be a few steps versus long hallways.
Some facilities are “continuum of care communities” capable of accommodating residents with a continuation of services as residents’ needs change, ranging from independent single apartments to assisted living to skilled nursing care.
Following is a list of free resources:
eldercare.gov – a public service that aids in finding local agencies as well as home and community-based services.
BenefitsCheckUp.org – provides information regarding eligibility for existing federal, state, and local programs.
Benefits.gov – official benefits website of the U.S. government, providing citizens with an online eligibility prescreening tool, but does now allow an individual to apply for benefits.
eBenefits.va.gov – Veterans Administration and Department of Defense portal, a one-stop shop for benefits-related online tools. Information may also be obtained by calling the National Hotline for VA benefits at (800) 827-1000.