A Research Project on Aging Funded by School of Social Work, the University of Maryland, Baltimore Health and Social Needs Assessment of Japanese Older Adults in the Washington D.C. Metropolitan Area Principal Investigator: Mitsuko Nakashima, MSW, PH.D. Assistant Professor School of Social Work, University of Maryland, Baltimore Research Assistant: Ayumi Sawa, MSW Graduate of School of Social Work, UMB 2005 October 22 presentaion at Japanese Americans' Care Fund
Purpose of this Study This research explored health and social service needs of older adults in Japanese communities in the Washington D.C. metropolitan area. More specifically, the objectives of this proposed study were to: · Profile the health and social service needs of Japanese older adults in Washington D.C. and surrounding counties in Maryland and Virginia; · Provide information to guide program planning for the DC Japanese community; · Identify salient health and social services issues from the perspectives of older adults, their caregivers and the DC Japanese community leaders and use this information to develop an understanding on targeted issues. Background Asian elders have rarely been included in research for planning health and social service provision for older adults. The rationale has been that Asian subgroups were too small to provide valid data (LaViest, 1995). However, existing studies indicate that Asian Americans elders increasingly become vulnerable to physical and mental ailments. Asian Americans typically experience illnesses such as heart disease, cancer and diabetes as they age (Park, Yokoyama & Tokuyama, 1991). Depression is experienced among Asian American elders at a higher rate than the general elderly population (AAFNY, 2003). As such, omission of Asian American elders from research has a significant negative impact on current levels of service provision as well as on preparation for future service needs. The landmark study conducted by The Asian American Federation of New York (AAFNY) on Asian American elders’ health and social needs and quality of life reported that even in an urban area where various Asian communities are more established in terms of existing services and social infrastructures, their Asian American elders experience greater socio-economic vulnerability and have fewer options for culturally and linguistically responsive health care and social services than the general elderly population in the city. The populations of Asian American in the Metropolitan Washington DC area grew by 53% from 204,466 in 1990 to 379,949 in 2000 (US Census, 2002). Japanese residents are widely dispersed geographically without densely populated communities (U.S. Census, 2002). In the Japanese communities of the Metropolitan Washington D.C. area, there has been a rising concern about the lack of culturally sensitive health and social services for elders. The projected demographic change for Asian older adults in this area will have a powerful impact on policy and the provision of health and social services as the volume of need among an important and often overlooked aging minority population increases dramatically. Main Interview Questions · What are some major challenges and needs among senior citizens in the DC Japanese community? · How much do senior citizens and their family members know about existing health and social services in the DC community that are available for older adults and caregivers? How do they see them as helpful or not helpful? How about these services’ availability, accessibility, affordability, and acceptability? · What is lacking in the DC Japanese community in terms of providing good social and health services for older adults and caregivers? · What is an ideal community where older adults in the DC Japanese community can live with an excellent quality of life? What do members of DC Japanese community want to see happen to improve their seniors’ quality of life in the near future? Results Some Prominent Characteristics of the DC Japanese Senior Citizens 1. Women vs. Men According to the U.S. Census 2000, there are approximately 13,000 Japanese individuals who live in the Washington Metropolitan Area. The number of females is reported as 8,082 which exceedingly surpasses the size of Japanese male population that is reported as 4,881. Among those who are 55 year old or older, there are more men (2,717) than women (2,095). The census also reported that there were 862 households that were resided by Japanese older adults. Among them 478 households were single person dwelling residences. 2. High socio-economic status Among Asian ethnic groups, Japanese older adults enjoy a much higher socio-economic status. About eighty percent of men who were 65 year old or older had obtained their education that was a college level or higher. Ninety three percent of this group has at least a high school diploma. Among female older adults in the same age group, approximately 25% people had obtained higher education. Over 80% of the older Japanese women in the DC area has obtained at least a high school level education. Among the households that were headed by Japanese individuals whose age were between 65 and 74, 60% of them had income that was higher than $30,000. The thirty percent of this group reported in 2000 that their income was higher than $70,000. 3. Adjustment to the American Society and Life Style Preferences Japanese senior citizens have well adjusted to American society and are leading a well balanced bi-cultural lifestyle. These study participants preferred Japanese style clothes and food but enjoyed amenities and space that the U.S. society offers. In terms of socialization, Japanese older adults socialize in small groups and there are many pockets of these social groups geographically all over the DC and surrounding areas. Unlike Koreans, Chinese and other Asian ethnic elders, Japanese older adults socialize with both Americans and Japanese on daily basis. Because of their sufficient proficiency in English language to operate in their daily lives, Japanese seniors have an informal support network that consists of both Japanese and American friends and neighbors. Many of the adult children of Japanese older adults in the DC areas live outside of this area; many of them live in foreign countries. Again, unlike other ethnic groups, Japanese older adults do not have frequent face-to-face contacts with their adult children and/or grandchildren. They keep contact with their family members mainly by phone calls and e-mail. These Japanese older adults have less expectation compared to their peers in other Asian ethnic groups in regards to receiving care from their adult children and/or grandchildren when their health fails. Two Major Issues Addressed during the Focus Group Interviews 1. Advance Care Planning A very few participants in this study stated that Japanese older adults in the DC area are well prepared for the coming years of frailty. In general, Japanese senior citizens are bewildered by American legal and health care system that is very complex and not friendly to its consumers. Negotiation with health insurance companies is especially painful as mailed insurance statements are frequently very difficult to understand and expenses for health care services are very high. Even though these older adults feel confident in speaking English in their daily lives, using specialized terms and negotiating with American workers seems to be a huge challenge. The seniors often lack knowledge regarding in-home services and long-term care facilities. They prefer to depend on friends and Japanese organizations in the DC area rather than asking their adult children who are out of the DC area. These Japanese seniors, to our surprise, have much less expectations out of their adult children to become direct caregivers when their health status declines and they start requiring much hands-on care. 2. Mental Health Issues and its Impact on Quality of Life Many study participants voiced their wishes to develop an interdependent senior support network which can provide various kinds of supports for its members. They seem to be very enthusiastic to be an active part of such enterprise because associating with other Japanese seniors promotes their psychological well-being and gives them some assurance of having a safety net while their out-of-state children are not readily available. They also expressed their wish for Japanese associations to develop a Japanese senior citizen center where seniors can socialize through different activities and education seminars. Japanese older adults are very eager to learn information that prepares them for later years and enjoy obtaining such information from their Japanese peers because they tend to believe that Japanese sources are more credible in providing more trustworthy information. Finally, there was a consensus among study participants that they were willing to use services provided by Japanese mental health professionals who are specialized in geriatric psychiatric care as Japanese native speakers prefer to discuss sensitive issues in Japanese such as end-of-life issues, bereavement, and other mental health issues. RECOMMENDATIONS 1. Developing Expertise in the DC Japanese Community to Assist their Seniors and Caregivers to Develop Advance Care Planning. #Create an information clearing house to provide accurate and abundant information on in-home services and long-term care facilities. Japanese older adults have a tendency to obtain information from their informal networks and the information is often incorrect. Publicize this service once the system is established. #Develop a counseling system where a professional counselor who is knowledgeable about the cultural differences between Japanese and Americans as well as American legal, medical and social service system. This is called care management service in the U.S. and the demand for this type of counseling service for caregivers is on a steady increase. #Collaborate with some retirement communities in the DC area to see if they could make efforts to provide culturally sensitive and competent services for Japanese seniors. # Also, collaborate with assisted living facilities. Compared to a nursing facility, their residents require less care as they are physically and mentally more independent compared to nursing home residents. An assisted living facility provides: - Nursing care for 24 hours/7days. - Cleaning, meal, laundry, shopping services. - Dispensing medications. - Assistance with bathing, eating and transfers. - Assistance with changing clothes, brushing teeth and toileting. - Night rounds. 2. Improving Services in the Field of Mental Health # Establish a Japanese senior center where any Japanese older person can stop by to relax and socialize. Hire a coordinator who can create and organize different activities such as educational seminars, volunteering, recreational activities and so on. # Many Japanese older persons wish to not burden their out-of-town children unless they develop a serious care problem. Create a interdependent volunteer group where volunteers can help one another with different tasks such as house chores, shopping, and exchanging information. # Recruit Japanese mental health professionals who can provide counseling in Japanese. Also, develop a volunteer program so that there will be some “friendly visitors” who can provide emotional support for home bound seniors. ©Mitsuko Nakashima. All rights reserved.

A Research Project on Aging
Funded by School of Social Work, the University of Maryland, Baltimore

Health and Social Needs Assessment of Japanese Older Adults
in the Washington D.C. Metropolitan Area

Principal Investigator: Mitsuko Nakashima, MSW, PH.D.
Assistant Professor
School of Social Work, University of Maryland, Baltimore

Research Assistant: Ayumi Sawa, MSW
Graduate of School of Social Work, UMB

2005 October 22 presentaion at Japanese Americans' Care Fund

Purpose of this Study

This research explored health and social service needs of older adults in Japanese communities in the Washington D.C. metropolitan area. More specifically, the objectives of this proposed study were to:
· Profile the health and social service needs of Japanese older adults in Washington D.C. and surrounding counties in Maryland and Virginia;
· Provide information to guide program planning for the DC Japanese community;
· Identify salient health and social services issues from the perspectives of older adults, their caregivers and the DC Japanese community leaders and use this information to develop an understanding on targeted issues.

Background

Asian elders have rarely been included in research for planning health and social service provision for older adults. The rationale has been that Asian subgroups were too small to provide valid data (LaViest, 1995). However, existing studies indicate that Asian Americans elders increasingly become vulnerable to physical and mental ailments. Asian Americans typically experience illnesses such as heart disease, cancer and diabetes as they age (Park, Yokoyama & Tokuyama, 1991). Depression is experienced among Asian American elders at a higher rate than the general elderly population (AAFNY, 2003). As such, omission of Asian American elders from research has a significant negative impact on current levels of service provision as well as on preparation for future service needs. The landmark study conducted by The Asian American Federation of New York (AAFNY) on Asian American elders’ health and social needs and quality of life reported that even in an urban area where various Asian communities are more established in terms of existing services and social infrastructures, their Asian American elders experience greater socio-economic vulnerability and have fewer options for culturally and linguistically responsive health care and social services than the general elderly population in the city.

The populations of Asian American in the Metropolitan Washington DC area grew by 53% from 204,466 in 1990 to 379,949 in 2000 (US Census, 2002). Japanese residents are widely dispersed geographically without densely populated communities (U.S. Census, 2002). In the Japanese communities of the Metropolitan Washington D.C. area, there has been a rising concern about the lack of culturally sensitive health and social services for elders. The projected demographic change for Asian older adults in this area will have a powerful impact on policy and the provision of health and social services as the volume of need among an important and often overlooked aging minority population increases dramatically.

Main Interview Questions

· What are some major challenges and needs among senior citizens in the DC Japanese community?
· How much do senior citizens and their family members know about existing health and social services in the DC community that are available for older adults and caregivers? How do they see them as helpful or not helpful? How about these services’ availability, accessibility, affordability, and acceptability?
· What is lacking in the DC Japanese community in terms of providing good social and health services for older adults and caregivers?
· What is an ideal community where older adults in the DC Japanese community can live with an excellent quality of life? What do members of DC Japanese community want to see happen to improve their seniors’ quality of life in the near future?

Results
Some Prominent Characteristics of the DC Japanese Senior Citizens

1. Women vs. Men
According to the U.S. Census 2000, there are approximately 13,000 Japanese individuals who live in the Washington Metropolitan Area. The number of females is reported as 8,082 which exceedingly surpasses the size of Japanese male population that is reported as 4,881. Among those who are 55 year old or older, there are more men (2,717) than women (2,095). The census also reported that there were 862 households that were resided by Japanese older adults. Among them 478 households were single person dwelling residences.
2. High socio-economic status
Among Asian ethnic groups, Japanese older adults enjoy a much higher socio-economic status. About eighty percent of men who were 65 year old or older had obtained their education that was a college level or higher. Ninety three percent of this group has at least a high school diploma. Among female older adults in the same age group, approximately 25% people had obtained higher education. Over 80% of the older Japanese women in the DC area has obtained at least a high school level education.

Among the households that were headed by Japanese individuals whose age were between 65 and 74, 60% of them had income that was higher than $30,000. The thirty percent of this group reported in 2000 that their income was higher than $70,000.

3. Adjustment to the American Society and Life Style Preferences
Japanese senior citizens have well adjusted to American society and are leading a well balanced bi-cultural lifestyle. These study participants preferred Japanese style clothes and food but enjoyed amenities and space that the U.S. society offers. In terms of socialization, Japanese older adults socialize in small groups and there are many pockets of these social groups geographically all over the DC and surrounding areas. Unlike Koreans, Chinese and other Asian ethnic elders, Japanese older adults socialize with both Americans and Japanese on daily basis. Because of their sufficient proficiency in English language to operate in their daily lives, Japanese seniors have an informal support network that consists of both Japanese and American friends and neighbors.

Many of the adult children of Japanese older adults in the DC areas live outside of this area; many of them live in foreign countries. Again, unlike other ethnic groups, Japanese older adults do not have frequent face-to-face contacts with their adult children and/or grandchildren. They keep contact with their family members mainly by phone calls and e-mail. These Japanese older adults have less expectation compared to their peers in other Asian ethnic groups in regards to receiving care from their adult children and/or grandchildren when their health fails.

Two Major Issues Addressed during the Focus Group Interviews

1. Advance Care Planning

A very few participants in this study stated that Japanese older adults in the DC area are well prepared for the coming years of frailty. In general, Japanese senior citizens are bewildered by American legal and health care system that is very complex and not friendly to its consumers. Negotiation with health insurance companies is especially painful as mailed insurance statements are frequently very difficult to understand and expenses for health care services are very high. Even though these older adults feel confident in speaking English in their daily lives, using specialized terms and negotiating with American workers seems to be a huge challenge.

The seniors often lack knowledge regarding in-home services and long-term care facilities. They prefer to depend on friends and Japanese organizations in the DC area rather than asking their adult children who are out of the DC area. These Japanese seniors, to our surprise, have much less expectations out of their adult children to become direct caregivers when their health status declines and they start requiring much hands-on care.

2. Mental Health Issues and its Impact on Quality of Life

Many study participants voiced their wishes to develop an interdependent senior support network which can provide various kinds of supports for its members. They seem to be very enthusiastic to be an active part of such enterprise because associating with other Japanese seniors promotes their psychological well-being and gives them some assurance of having a safety net while their out-of-state children are not readily available. They also expressed their wish for Japanese associations to develop a Japanese senior citizen center where seniors can socialize through different activities and education seminars. Japanese older adults are very eager to learn information that prepares them for later years and enjoy obtaining such information from their Japanese peers because they tend to believe that Japanese sources are more credible in providing more trustworthy information. Finally, there was a consensus among study participants that they were willing to use services provided by Japanese mental health professionals who are specialized in geriatric psychiatric care as Japanese native speakers prefer to discuss sensitive issues in Japanese such as end-of-life issues, bereavement, and other mental health issues.

RECOMMENDATIONS

1. Developing Expertise in the DC Japanese Community to Assist their Seniors and Caregivers to Develop Advance Care Planning.
#Create an information clearing house to provide accurate and abundant information on in-home services and long-term care facilities. Japanese older adults have a tendency to obtain information from their informal networks and the information is often incorrect. Publicize this service once the system is established.
#Develop a counseling system where a professional counselor who is knowledgeable about the cultural differences between Japanese and Americans as well as American legal, medical and social service system. This is called care management service in the U.S. and the demand for this type of counseling service for caregivers is on a steady increase.
#Collaborate with some retirement communities in the DC area to see if they could make efforts to provide culturally sensitive and competent services for Japanese seniors.
# Also, collaborate with assisted living facilities. Compared to a nursing facility, their residents require less care as they are physically and mentally more independent compared to nursing home residents. An assisted living facility provides:
- Nursing care for 24 hours/7days.
- Cleaning, meal, laundry, shopping services.
- Dispensing medications.
- Assistance with bathing, eating and transfers.
- Assistance with changing clothes, brushing teeth and toileting.
- Night rounds.

2. Improving Services in the Field of Mental Health
# Establish a Japanese senior center where any Japanese older person can stop by to relax and socialize. Hire a coordinator who can create and organize different activities such as educational seminars, volunteering, recreational activities and so on.
# Many Japanese older persons wish to not burden their out-of-town children unless they develop a serious care problem. Create a interdependent volunteer group where volunteers can help one another with different tasks such as house chores, shopping, and exchanging information.
# Recruit Japanese mental health professionals who can provide counseling in Japanese. Also, develop a volunteer program so that there will be some “friendly visitors” who can provide emotional support for home bound seniors.

©Mitsuko Nakashima. All rights reserved.