Keiro’s constituency is expanding to potentially the over 70,000 Japanese American or Japanese older adults, their families and caregivers in Los Angeles, Orange, and Ventura counties.
However, financial and staffing resources are finite. Thus, the Keiro Board wants to achieve maximum impact by prioritizing how Keiro can best serve those with the highest needs. Here are characteristics of some of the most vulnerable older adults in Our Community:
Low income. Statistics can be misleading. Although overall, Japanese Americans have one of the highest average incomes of Asian American groups, there are many Japanese Americans and Japanese older adults with very limited income or savings, or may only have the asset of their home. A medical or other type of emergency can tip the balance and quickly erode financial resources.
Older adults with limited financial means are at risk for not being able to provide for their basic needs (e.g., food, housing, or healthcare). They are not able to contract for support services in the home, either to help during a critical episode or on a regular basis due to overall declining health or loss of mobility. Cultural norms and a sense of pride and responsibility to care for oneself, can mask the vulnerability of very limited resources and make it challenging to connect with outside assistance.
Isolation. Isolation is one of the most under-recognized issues facing all older adults, including Japanese American and Japanese seniors. Research has linked the lack of regular social interaction to depression, despondency, serious erosion of health status, early onset of mental disorders or mental loss, and even premature death. Older adults, including Japanese American and Japanese seniors can get isolated and cut off when they:
- Have reduced social support systems as they age, with the passing of spouse, friends and relatives
- Have family at a geographic distance (e.g., out of the region or out of country) and thus, cannot play a role in caregiving or emotional support
- Have moved from their long-established homes to reside with their adult children and have not been able to create a new circle of friends and familiar community connections
- Reside in facilities but are without visitors
Multiple Health Conditions. It is common for older adults, especially those over 75 years of age, to be grappling with 4 or more conditions, often with interconnected complications requiring multiple medications. This complexity puts pressure on personal financial resources and requires high levels of physical support. It affects family caregivers, and needs only worsen over time.
There is also very little in-home monitoring to identify challenges or barriers for older adults including: home safety, adequacy of caregiver support, and lack of mobility that threatens nutrition and compliance with health care regimes.
Memory and Cognitive Disabilities. Older adults with declining mental capacity, especially those experiencing dementia and Alzheimer’s, are among the neediest populations. Memory loss and cognitive disabilities place enormous stress on family caregivers, both physically and also psychologically. Not only is their family member’s condition steadily worsening, but caregivers are also battling the emotional loss of recognition of their relationship to their loved one. In fact, research demonstrates that the stress on family caregivers, resulting from the support they provide to an older adult with memory or cognitive disabilities, leads to the decrease in their own health status and even premature death.
Monolingual Japanese. Older adults with limited English proficiency may not be comfortable speaking and communicating in English and can face intense barriers in accessing care and services.
In addition, familiarly with the culture, infrastructure and service delivery models are critical to participating and functioning within society. For example, in Japan health and support systems are the responsibility of the government and every citizen is entitled to appropriate and comprehensive care. In the U.S., the system requires elaborate application, a maze of eligibility challenges, and tiered, non-standardized services. Individuals with permanent residency status who have earned benefits like Social Security and Medicare might not be accessing these benefits due to confusion or cultural stigma. Cultural differences are as important as language barriers.
Immigration Status. Many Japanese older adults living in the U.S. for many years often wrestle with challenges of immigration status. Examples include losing essential paperwork to validate entitlement to services or a lapsed visa. This can cause individuals to live outside the system, not utilizing social services or health care, and allowing health conditions to worsen rather than seeking early intervention. Although resources might be available to them without a negative impact to their immigration status, cultural norms often create barriers in asking for help, further complicating anxiety about immigration status and fear of possible deportation.
Oldest of the Old. The group of older adults who are 85+ years old is growing proportionally at the fastest rate of all subsets of older adults. They face much more serious and pressing issues than the younger, healthier senior population. Challenges include: physical (e.g., frailty, loss of mobility, multiple and complicated health conditions, end-of-life related issues, and limited access to care due to lack of transportation), mental health (e.g., loss of mental capacities, grief and depression due to loss of spouse/family/friends), and higher incidence of social isolation and neglect.
The vulnerabilities described above are not exclusive and often overlap. Keiro’s Board and staff will be developing ways to support the highest needs of Japanese American and Japanese older adults, their caregivers, and their support systems to positively impact the health and wellbeing of Our Community.