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.
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