Family Dynamics
in Ethnic Populations
Presenter: Coalition of Limited English
Speaking Elderly (CLESE)
• CLESE – the Coalition of Limited English
Speaking Elderly - was formed in 1989 by
immigrant and refugee group of community
leaders as a result of an extensive ethnic
elderly needs assessment conducted by the
city of Chicago. Findings proved that lack of
language proficiency and cultural barriers
prevent ethnic seniors from getting services
they need.
• CLESE membership is comprised of 54 ethnic,
community based providers of services
• CLESE members represent over 50 ethnic
groups and speak over 70 different languages
• CLESE is nationally recognized as a unique
model of care delivery which can be expanded
or replicated
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Arab
Afghan
Assyrian
Bhutanese
Bosnian
Burmese
Cambodian
Chinese
Cuban
East Africans
Ethiopian
Ethnic Chinese from South East Asia
Filipino
South and Central American
Ukrainian
Vietnamese
Greek
Haitian
Lithuanian
Mexican
Herzegovinian
South Indian
Japanese
Pakistani
Polish
Puerto Rican
Korean
Lao
Romanian
Russian
Serbo-Croatian
CLESE and members agencies
• Coalition of ethnic providers
of services
• Provides leadership,
education and advocacy to
members
• Educates members about
policy changes and has
impact on shaping policies
in the state
• Helps members navigate
system change
CLESE and ethnic elders
• Serves limited Englishspeaking older adults
• Helps ethnic elders navigate
the LTC system
• Explains new policies and
impact they have on their
lives
• Educates lawmakers about
the needs and unique
contributions of ethnic
elders
• CLESE member agencies serve over 200,000 clients
per year out of whom about ¾ are people 60+
• CLESE providers serve close to 18,000 LEP elders in
HCBS in Illinois (out of 90,000); CLESE providers
employ over 9,000 home care aides
• CLESE has extensive experience in administering
programs, providing technical assistance and support
and through the network of providers educating
ethnic elders about changes to LTC system
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Alzheimer’s Disease Education in Ethnic Communities
Bright Ideas Curriculum
Health Education Projects
Depression in Ethnic Elderly: Toward Understanding,
Acceptance and Treatment
• Refugee Agricultural Partnership Program
• Creating Dementia Capable State of Illinois
• Illinois Transition to Managed Care
• Often the only way most limited English
speaking elderly receive services is through a
provider that speaks their language and
understands their culture. CLESE assists ethnic
agencies to apply for funding, and provides
technical assistance and support to home and
community based service providers
• Ethnic Minority Seniors remain invisible for
the broader society; socially isolated or
dependent on family for income, support,
companionship, language, transportation and
help with navigating the system.
• They experience barriers to services such as:
language, transportation, shame of asking for
help, and health concerns.
• Language
• Transportation
• Shame
• Health concerns
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Status in Family and Community
Home
Country
Social contacts
Friends
Mobility
…plus other losses of aging
• In 2013, Illinois had over 200,000 Spanish
speaking persons 55 and older and over
100,000 persons of Asian origin (Chinese,
Filipino, Indian, Japanese, Vietnamese, Native
Hawaiian and Pacific Islanders and other
Asian)
• They all are foreign born in the baby‐ boom
cohort between 1946 and 1964.
• Minorities now roughly one‐third of the U.S.
population are expected to grow by 2050
• The non‐Hispanic, single‐race White
population is projected to be only slightly
larger in 2050 by 3 million
• 85 and older population is expected to more
than triple from 6 million to 20 million
between 2010 and 2050
• Hispanics are becoming the largest of the
minority groups in the country
• Asian population is projected to climb in the
nation from 15.5 million to 41 million by 2050
• Health disparities will continue as well as life
expectancy and minorities are expected to live
longer with disabilities
Challenges to services identified by ethnic
providers
• Transportation services to necessary medical
appointments, etc.
–(Ethnic Seniors Don’t Drive!)
• Need for affordable housing
• Financial support for ethnically appropriate
mental health services
• Intergenerational conflict resolution
• Culturally and linguistically sensitive health
promotion services
• Better outreach to frail elders
• More bilingual staff hired in all levels of
seniors services (ethnic agencies are
fundamental in filling up this systemic gap)
Managed
Care
Organizations
CLESE
CLESE
Members
Providers of
Services
State
Agencies
Lawmakers
Discussion
• CLESE Representatives:
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Awilda Gonzalez Lana Ananich Lori Long Jahnavi Bavisi Itedal Shalabi -
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American Indian/Alaska Native,
African American/Black,
Asian American,
Native Hawaiian/Pacific Islander,
Hispanic/Latino American,
and White/Caucasian American
• Vast differences or heterogeneity are found
between and within race and ethnicity
categories related to health beliefs and
practices, access and utilization of health care,
health risks, family dynamics, caregiving,
decision making process and priorities.
• Family dynamics are the patterns of relating,
or interactions, between family members.
Each family system and its dynamics are
unique, although there are some common
patterns.
• Family dynamics are one part of a larger
system, defined by the individual members'
relationships with each other - alignments,
hierarchies, roles…
• Dynamics are affected by many factors,
including age, number people in the family,
and the culture.
Some of the factors impacting family dynamics:
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nature of the parents' relationship
number of children in the family
personalities of family members
an absent parent
the 'mix' of members who are living in the same household
level and type of influence from extended family or others
a chronically sick or disabled child or parent within the family
events which have affected family members, such as an affair, divorce, trauma, death,
unemployment, homelessness
other issues such as family violence, abuse, alcohol or other drug use, mental health
difficulties, other disability
family values, culture and ethnicity, including beliefs about gender roles, parenting practices,
power or status of family members
nature of attachments in family (i.e. secure, insecure)
dynamics of previous generations (parents and grandparents families)
broader systems- social, economic, political including poverty
Polish
130,000
Latino
200,000
LEP Older
Adults
South
Indian
10,000
60 years and
older
Chinese
Russian
15,000
24,000
Arab
5,000
In Northern
Illinois
Major Groups of Limited English Older Adults
Mexican, Puerto Rican
Polish
24%
36%
Chinese, Indian, Korean
3%
7%
13%
14%
Former Soviet Union
(Russian, Belorussian,
Ukrainian, Lithuanian)
Arab
Other
LEP elders living alone
Asian
Indian 4%
Mexican
7%
Puerto Rican21%
Arab 9%
Polish
22%
Russian, Ukrainian, Lithuanian
33%
Income and Housing Cost: 56% of LEP elders pay more than
30% of their income for housing
70%
60%
50%
Puerto Rican
40%
Mexican
30%
Chinese
20%
Asian Indian
10%
Russian
Arab
0%
Receive SSI or
Other Public
Benefits
Housing Cost
Education
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Puerto Rican
Mexican
Chinese
Russian
Asian Indian
Arab
High School
Education
Bachelor's Degree
or Higher
Poverty Rate: LEP elders have poverty rate that is double the
rate for other older adults
35.00%
30.00%
Puerto Rican
25.00%
Mexican
20.00%
Chinese
15.00%
Russian
10.00%
Asian Indian
5.00%
Arab
0.00%
Poverty Rate
Mainstream
Elders
Would those statements be applicable to the represented
cultures, and how?
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After immigrating to the U.S., families
stray away from regular role division.
A common conviction exists, that the
marriage should rely on partnership,
and the man and woman should
make decisions together in important
issues. It also happens that the role
of the “head of the family” is fulfilled
by the woman. Matriarchy however is
not very popular and not many men
would honestly admit that it’s not
them who are ruling the household.
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The traditional family has a
hierarchical order with the man as
the head of the family tagged with
the responsibility of breadwinning.
This responsibility also grants him the
authority and the final say in the
affairs of the family.
The role of an older adult in the family…
Caregiving roles
Factors that influence family decision about care for elderly:
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Personal beliefs
Family expectations
Generational role models
Family structure and size
Resources available
Level of acculturation
Language barriers
Concept of illness
Cultural factors impacting caregiving
• Time: what is the meaning of time in various cultures?
• Space: what are the cultural or religious beliefs regarding
personal space?
• Communication: what is the proper form of addressing the
person? Handshake, hugs are accepted or prohibited
• Family involvement: who is the identified decision maker?
• Social organization: what is the importance of family rituals
and religious beliefs?
• Diet: what are the family’s food customs?
• Health traditions: what is the meaning of health and illness?
And what are the beliefs about using medications?
• Questions?