Segregated Nursing homes: Your opinion Please!

[kwagner_51]

I got this in an email from google alerts for nursing.

I know what my opinion is, I would like yours.

Thanks!

Posted on Wed, Mar. 10, 2004

Segregation of patients by ethnicity in nursing homes praised, criticized

BY COLLEEN MASTONY

Chicago Tribune

CHICAGO - (KRT) - Sung Y. Kim, an 83-year-old native of Korea, spends days shuffling from room to room in slippered feet, rallying her fellow nursing-home residents for a game of Korean cards or a trip to the dining hall for some steaming seaweed soup.

On her fourth-floor hallway, everyone, including the nurses and doctors, is Korean. But taking the elevator down three floors is like stepping into a different country.

There, on a wing for Indian and Pakistani residents, Syed Shah, 57, sits with friends who speak Urdu over a meal of spicy dal and fresh roti like their families used to cook for them at home. Though Kim and Shah live in the same nursing home, separate cultural programs make their worlds seem oceans apart.

It is a new phenomenon in the nursing-home industry, where amid the universal signs of old age - the wheelchairs and walkers, IV bags and bedpans - administrators have increasingly grouped residents by culture and ethnicity, down to providing separate staffs, activities and meal plans.

As such programming becomes more common, a debate is growing about whether it is appropriate.

Such living areas help centralize bilingual staff and make residents feel at home, proponents say. But critics argue the approach is unnecessarily polarizing and even offensive to American ideals.

"One part of the debate says: `Here we are in America. It is the melting pot. Aren't we supposed to bring people together?' " said Melanie Chavin, vice president for program services at the Alzheimer's Association in Illinois. "The other half of the debate, especially when you are dealing with memory loss, is that people might not remember they are even living in America. Why not give them what they are familiar with?"

At Lake Shore HealthCare and Rehabilitation Centre in Chicago, where Kim and Shah live, Koreans are on the fourth floor while Indian and Pakistani residents live on the first. Other parts of the nursing home are integrated.

On a recent afternoon, a group of Korean seniors played a rousing game of Yoot (a Korean game played with four sticks). Meanwhile, Indian and Pakistani residents had their own activities, such as performances of traditional dance.

The only culture clash, according to administrators, came when the Filipino nursing staff developed a taste for sticky rice and the Korean cook refused to give them any, saying she didn't have enough for staff and residents. The incident was settled with the purchase of a second rice cooker.

"I called it the rice war," said Judy Lewis, the assistant administrator.

The culinary tussle highlights a shift in diversity at nursing homes facilities.

In Illinois, the percentage of white residents in nursing homes declined by 6 percentage points between 1997 and 2001, while the number of Indian, Asian and Hispanic residents increased yearly, according to a report by the Illinois Department of Public Health.

Immigrants from Europe still make up the largest group of foreign-born seniors, accounting for 1.2 million of the 3.3 million immigrants older than 65 in the United States in 2002, according to the U.S. Census Bureau. But those from Asia numbered 770,000 in 2002; those from Latin America - many are from Mexico - numbered 1.1 million, according to the Census Bureau.

In the face of these changes, grouping residents by ethnicity makes sense, said Shiva Singh Khalsa, who runs the Indian and Pakistani program at Lake Shore.

"If someone is confused - maybe they have dementia - and they don't see anyone who looks like them, it can be scary," he said.

For generations in their home countries, large extended families have taken care of their parents and grandparents. When families immigrate, expectations from the old country collide with the reality of life in America. Here, relatives often live far apart, and two-career families work long hours, making it difficult to care for aging or sick relatives at home.

After Vinita Parsram's husband suffered a stroke a decade ago, she couldn't afford to stay home, and she couldn't lift her partially paralyzed husband. Yet few understood her decision to put him in a nursing home.

"They would say, `You put your husband in a nursing home!' " said Parsram, 56, of Lincolnwood, Ill. "My daughter came home crying, saying, so-and-so said, `Look what your mother has done.' "

Places such as Lake Shore help smooth the transition and ease the guilt, many families say.

On a recent day, the Pakistani cook at Lake Shore was preparing potato and pea subjee, basmati rice and kheer (a rice pudding). The pudding is a favorite of Parsram's husband, Chan, 64, who said he had been depressed while living in an integrated nursing home before the family found Lake Shore.

Still, critics bristle at the idea of grouping people by ethnicity.

"We should not be stereotyping, and we should not be segregating," said John Marc Sianghio, administrator of Harmony Nursing and Rehabilitation Center in Albany Park in Chicago.

Residents at Harmony - many of whom are Asian - are paired with a roommate who speaks the same language and are provided with bilingual nurses and doctors. But the rooms are interspersed throughout the facility, because, Sianghio said, "that is the American way."

Yet culturally specific nursing-home care is nothing new.

At the turn of the century, when the country was receiving waves of new immigrants, ethnic and religious organizations started the first nursing homes, according to Celia Berdes, a professor at the Buehler Center on Aging at Illinois' Northwestern University.

The rise of the commercial for-profit industry in the 1960s and gentrification of old immigrant neighborhoods forced many large ethnic nursing homes to close or, like their immigrant residents, integrate into the larger culture, Berdes said.

Minorities and immigrants are still more likely to keep their elderly relatives at home, Berdes said, but attitudes are changing.

"They are adjusting to American life. Every year, they are accepting more," said Dr. Yong Chun, 59, who treats Korean residents at Lake Shore.

Won Hong, 64, visits his 90-year-old mother at Lake Shore, rubs her arms and brushes her hair from her forehead. After a stroke, she was left partially paralyzed, unable to speak and almost completely unresponsive.

"I felt like I lost her," said Hong, of Bartlett, Ill. But a few weeks ago, she began responding to the Korean nurses.

He believes having people speak Korean to his mother helped coax her back from the edge of death. "Korean elders need to be taken care of in their own way," he said. In a dayroom, where nurses have pushed his mother's bed to be in the afternoon light, he stands next to his mother and holds her hand. Sometimes, he said, she squeezes back.

"A huge improvement," Hong said.

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© 2004, Chicago Tribune.

Visit the Chicago Tribune on the Internet at http://www.chicagotribune.com

[traumaRUs, MSN, APRN]

Wow - and in Illinois too. Not sure how I feel about it. However, I do think LTC is very much different than acute care. A nursing home is just that, a home for the elderly and infirm. It should be about the resident, not the staff. If being culturally segregated is what the resident wishes, then fine. However, it must be a free choice. Personally, I would think a demented elderly Korean or Indian person would maybe feel more comfortable if surrounded by a familiar language and food. I think its a good idea.

[Tweety, BSN, RN]

The way I look at it. Persons from other cultures have always segretated themselves into neighborhoods where they are comfortable. There are ethnic neighborhoods, ethnic churches, ethnic organizations. If a private nursing home offers a only unit, then why not, if it makes them more comfortable. By the time they get to a nursing home, that may not be the time force assimilation, as they haven't been doing it in their private lives up until then.

I think it's a great idea. But it does run into problems of discrimination. Should a person be turned away from a nursing home if they aren't the same ethnicity of the majority of the residents there?

[Dixen81]

I think it's a great idea for the reasons mentioned in the article! It must be comforting for these elderly people to be surrounded by familiar customs, language, and foods. For those who oppose it, they can always go to a different floor or facility. I hope we see more facilities like this in the future.

[jkaee]

I work in LTC, and I never even thought about a facility like that. It certainly has it's benefits for the residents, and it would probably work best in larger cities where there is a more diverse group of people (I wouldn't really know, I work in the country). It would definitley be interesting to read more about facilities like that and see how it alters their QI stats.

If I worked there, I guess I'd be stuck on the "Italians only" floor, and be surrounded by my mom and grandma for over 8 hours! :chair: (If you know old Italian ladies, you'll know what I mean)

I think I'll stay where I'm at! :chuckle

Jennifer

[jyoung1950]

I say leave the political correctness out of it and let Koreans be with Koreans and so on.

These folks are in the last stage of their lives. Things are hard enough in a nursing home; why should we force them to add communication problems in addition to their own health problems and being somewhere they don't want to be in the first place.

[Gldngrl]

I think there may be legal implications surrounding these practices, for both the residents and staff. If the facility is accepting any outside aid (as opposed to an exclusively private pay facility without any federal/state aid), there is a duty to conform with the federal/state statutes prohibiting racial discrimination. If a patient requires a bed in the facility, but is refused because there are no beds on the floor of his/her particular ethnicity/race, that is discrimination. If there are advertisements for staffing and then a refusal to hire based on race, that is discrimination. There needs to be a balance between resident rights and desires and the rights of others who need to enter a facility or wish to work in LTC.

[fergus51]

Is it discrimination if it is voluntary or private?

[Gldngrl]

It is discriminatory behaviour, but I honestly don't know the legal ramifications for a private facility that doesn't receive govt aid....I would think that one could pursue a discrimination claim...I think of as an example private colleges that are historically black that may have "voluntary segregation" from personal preference, but still can not disallow a person of any race from attending. Or country clubs that use their own "legitimate" data for determining admission and a discriminatory effect occurs if only one race is admitted. But to add confusion to the mix, there are clubs that promote ethnicity and the purpose is to preserve their culture and practices and that' s not necessarily discrimination in the same sense.

It'll be interesting if the facility's policies were challenged...

[Gldngrl]

Couldn't a facility lose its government funding if found that its engaged in discriminatory conduct? Anyone know?

[Spidey's mom, ADN, BSN, RN]

Is it discrimination if it is voluntary or private?

ahh Fergus . . kinda opens a can of worms here. :)

Boy Scouts of America is a private organization and yet is called discriminatory for not allowing homosexuals to be leaders.

Someone already mentioned private country clubs.

Private schools.

If I was a member of that nursing home I'd be visiting a different group every week. Little white girl here and I would love love love to learn about the different groups, not to mention the great ethnic food!!!

Wish we all felt more comfortable with each other that this was not necessary. Maybe it is generational. Baby Boomers would be less apt to segregate when we get to the nursing home but the WWII generation folks who came to American speaking another language and were never really assimilated are the folks who are utilizing this home.

This will probably die a natural death as boomers head in so I say leave it alone.

steph

[Gldngrl]

Stevielynn-homosexuality doesn't have the same constitutional protections as race,which is why Boy Scouts could lawfully disallow from joining, although with changes in the law, that may change.