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 • • • • • • • • • • • • • • • • 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 • • • • 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 • • • • • • • 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: • • • • • Awilda Gonzalez Lana Ananich Lori Long Jahnavi Bavisi Itedal Shalabi - • • • • • • 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: • • • • • • • • • • • • • 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? • 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. • 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: • • • • • • • • 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?