Care Across The Cultural Divide

By: Jessica Young Brittle bones and severe arthritis keep Rebeca Salazar confined to her North Riverside home. The 84-year-old can’t manage stairs, even with help, and relies on her walker when shuffling around the house. And now, Salazar is in the beginning stages of Alzheimer’s disease. The combination of physical and cognitive impairments has made it unsafe for Salazar to live on her own. Her son, Juan, moved in with her, and her daughters take turns watching her while Juan is at work. It’s a strain on her children. But talking of nursing homes is taboo in Latino families. “We’d never, ever consider it. She’d probably die there,” said Maria Bazaldua, one of Salazar’s seven daughters. “God, the unbearable guilt we’d all feel over abandoning her like that.” Bazaldua’s conviction is common among Latinos, who have the lowest nursing homes usage rates nationwide. An analysis of federal nursing home data by The Chicago Reporter found: * Ninety-three percent of American nursing homes have fewer than 11 Latino residents. * In Illinois, Latinos make up the majority resident population in just three of the state’s 769 nursing homes for which racial data are available. * In Chicago, nursing homes where residents are predominantly Latino make up just 3 percent of the city’s 91 nursing homes, even though Latinos make up 14 percent of the city’s senior citizens. American seniors are predicted to live to age 84, which is more than two years longer than the life expectancy for a senior in 1980, according to the National Center for Health Statistics. The U.S. Census Bureau projects the Latino senior population will increase nearly 85 percent—from about 2.7 million to more than 5 million—by 2020. Healthcare providers are looking to lure Latino seniors into healthcare facilities and say they can miss out on preventive and life-saving measures by staying at home. For example, at home, seniors might not participate in exercises that stave off dementia. They also could be cared for by inexperienced family members who miss warning signs for serious health conditions and don’t have proper medical equipment. And without respite, these caretakers often experience burnout from tending to a medically fragile parent. Experts say it’s crucial for the nursing home care system to resolve the deep barriers Latinos face in getting integrated into institutional, long-termcare facilities. There are several theories as to why cultural disparities in nursing home utilization exist. Chief among them is the Latino “familismo,” or a set of expectations that family is more important than individual interests. “The Mexican tradition is not to put your loved ones in the care of strangers. It’s just not going to happen,” Bazaldua said. “Of course it gets crazy trying to juggle to make sure my mom is taken care of, but putting her in a home would be like none of us wanted her. And she’d be petrified of being taken out of her safety zone at her age.” Susan Reed, a professor and urban health policy researcher at DePaul University, said this cultural attitude makes multigenerational cohabitation common for Latinos. “There’s an implicit assumption that it’s the child’s obligation to care for elderly parents, and that they should bear the burden of that honorable duty without hesitation,” she said. “Seeking help from a third party is considered a failure, so nursing homes aren’t seen as a viable option.” It’s also a matter of dollars and cents. Hispanic families have less accumulated wealth to pay nursing home expenses. The annual price tag is about $70,000, according to a 2008 market survey of nursing home costs conducted by MetLife Mature Market Institute and LifePlans, Inc., a research and consulting firm for the long-term-care industry. The national median net worth of a Latino household is $21,010—nearly one-eighths that of its white counterpart, which is $163,001. The net worth for an African American household is $17,100, according to the 2007 Survey of Consumer Finances. Medicaid is the only public program that finances long-term care costs. But before it kicks in, individual recipients must deplete much of their assets, having less than $2,000 at their disposal. Even then, most states, not including Illinois, require copayments. Despite the low-income requirement, some Latinos are less likely to be covered by Medicaid because undocumented immigrants aren’t eligible, Reed said. Others who may qualify, but are not proficient in English, can get overwhelmed with the bureaucracy of the application process, she added. Institutional realities are problematic as well. With a scarcity of bilingual nurses and companions, some residents who speak only Spanish are unable to communicate their pain, request assistance or talk with their bed neighbors. The language frustration is further complicated by the clinical, corporate “time is money” environment. But one of the biggest issues is a lack of ethnic food options. When a Latino senior is in the midst of a scary move into a facility, adjusting to a diet of Salisbury steak and mashed potatoes when they’ve been accustomed to a dinner of tamales can add to the shock, Reed said. Center Home for Hispanic Elderly in West Town has worked to cater to the Latino demographic—especially when it comes to menus. “Our philosophy is ‘Let the smell of rice and beans waft through the halls,’” said Administrator Norme Torres. His facility has the highest proportion of Latino clients in Illinois, at 98 percent. “It’s the small touches like offering café con leche and scheduling a salsa or merengue night as opposed to a sock hop. If you allow residents to retain pieces of their cultural identity, there’s security there and that eases the transition for them.” At the center, signs are written in Spanish—baño for bathroom, II piso for second floor and Sabor Latino, or Latin Flavor, for the dining area. Activity calendars and newsletters are printed in Spanish. The recreation room TV is set on Univision’s “Primer Impacto” news program, and domino games—not bridge—are spread out on the tables. The entry to the lobby is flanked with Spanish arches painted in earthy shades of gold and sapphire with cobalt planters squatting in the corners. Framed prints of a field worker and women cooking over a fire hang on the walls. The facility attracts clients from Chicago, its suburbs, parts of Indiana and Puerto Rico. Extended Care Clinical, a healthcare management company, has consulted with Torres about implementing his model at some of its locations. “Elderly Latinos are an untapped market for providers. With a clearer understanding of their needs, we’ll be able to combat that nursing home reluctance,” Torres said. “But just buying some frozen plantains and organizing a Cinco de Mayo celebration isn’t going to address all of the systemic turnoffs for my population.”