The growing numbers of ethnic seniors throughout the United States continue to experience a litany of problems when accessing services. Among them, language and cultural barriers, a fragmented service
delivery system, and a lack of properly trained bilingual staff.
Compared to Japan, one of the world’s oldest countries with 21.6 percent of the population 65 years and older, the US is considered ‘young’ with less than 13 percent age 65+. However baby boomers who will begin to turn 65 in 2010 will change that significantly. The percentage of persons age 65+ will rise markedly to 20 percent over the next twenty years. This aging boom will have serious implications for health and family support systems, work and retirement. Florida, whose age 65+ population accounts for 24 percent of its population, is already experiencing many of the challenges the rest of America will soon face.
To compound the problem, Florida is a multicultural community with all the implications that this brings. Over one million individuals in Florida over the age of 60 are Hispanic. An advantage of catering to Hispanic elders is what it is commonly called the “Hispanic” paradox. Hispanics, despite their socio-economic hurdles and lack of access to health care, live longer than African Americans by seven years and non-Hispanic Whites by five years. Overall, Hispanic seniors are much healthier than expected and the reasons for this paradox are still a matter of debate. Many suggest that factors such as diet, lifestyle choices and strong social-support networks are key in understanding Hispanics’ better-than-expected health. Another favorable condition for Hispanics in Florida includes declining disability rates, lower rates of Medicaid use, and low utilization of nursing home care among this population.
In the eyes of policy makers, however, seniors, and in particularly ethnic seniors, remain an invisible group. Language barriers and a lack of culturally sensitive trained staff, with time to adequately evaluate and advise clients are parts of the problem. The fragmented system and absence of information on what services are available to these seniors and how to get them further contributes to keeping these seniors marginalized and neglected.
For example, I found Vera roaming the halls or sitting in the library of her independent elderly-designated public housing building. Vera was a real bright spot in this building; she loved to paint and play the piano, and she had been quite a well-known artist in Cuba. She was always smiling and had cheerful comments for the staff and other residents. She had lived at Town View Terrace since 1992 as a widow, living on a social security pension after many years of working. She had no family except for a nephew that only came once a month to ask for money.
The manager of Town View Terrace called the local agency to determine Vera’s needs and what services were available for her. It took more than a month for the case manager to come and visit Vera and she spoke no Spanish, although a request had been made for a bilingual manager. The interview did not go well as Vera did not trust government staff and was afraid to discuss her limitations and believed she would be evicted from Town View Terrace as a result.
Vera was moved to a nursing home soon after because she was having difficulty cooking and cleaning in addition to forgetting to take her medications daily. Her nephew was in no position to take her in and we had concerns that if she moved in with him she could be neglected. Her life and her close friends were at Town View Terrace. She lost her entire community as a result of her move.
Several months later I had the opportunity to visit her in the nursing home. I found her sitting in a chair beside her bed, looking like she had lost her best friend. In fact, she had pretty much lost all her friends. She said she had been asked not to walk around and visit with other folks as they didn’t have enough staff to keep track of all the residents if they didn’t stay in their rooms or as a part of organized activity. While she still appeared to be healthy, she was definitely sad and lonely. My heart ached for her. I visited Vera once more and was extremely saddened to see her still sitting in the same chair with no spirit left in her. She barely smiled when I walked in the room.
Vera died in the nursing home alone and without her friends around her. The majority of our ethnic senior public housing residents are in similar predicaments as Vera was, and many live every day in fear of the day they will be forced to move to a nursing home and lose their independence, friends and community ties. It was her plight that pushed me to establish the first public housing assisted living facility: Helen Sawyer Plaza in Miami, Florida.
I established Helen Sawyer Plaza Assisted Living Facility in 1995 in a suburb of Miami known to locals as “the war zone”. This 1971 senior-designated public housing building had been poorly maintained and the County had decided to sell, it claiming lack of funds for building rehabilitation. At that time, as it is the case today, there were very few affordable assisted living facilities in the county due to the low reimbursement rates that the state offers but also because of the hurdles involved in working with the Medicaid program. These are the main reasons why the private sector in Florida as well as in other states are reluctant to provide services to the low income seniors and do so only when experiencing high vacancy rates. However, in the case of Miami, there are a multitude of ethnic private sector providers filling the gap by providing homemaker services, establishing private clinics and senior centers.
The main impetus in the establishment of the Helen Sawyer model was to eliminate the problems faced by the growing number of ethnic seniors. Within Helen Sawyer Plaza, a bilingual case management office was created and trained in cultural sensitivity. They had small caseloads to adequately evaluate and advise clients. They were trained to understand the role of the family, cultural differences in food choices, cleanliness and alternative medical treatments. We developed a concentrated public education effort designed with the help of our residents and their families that resulted in increased information about the services that were being provided and how to access them. At the end of six months, all 100 units at the facility were full with over fifty prospective clients on a waiting list.
Despite the challenges that were part of creating a new way of caring for low income seniors, the Helen Sawyer Plaza is living proof that catering to the specific needs of seniors and improving their lifestyles results in considerable savings to the health care system by reducing emergency room admissions, hospital stays, and the volume of prescribed drugs. The example of Helen Sawyer has made it possible for us to replicate the model in central Florida and in twenty-one other states. Magnolia Gardens, in St. Petersburg and Palm Avenue Baptist Tower in Tampa, Florida, have been built on the success of Helen Sawyer Plaza.
Conchy Trelles Bretos is the CEO of MIA Consulting Group, Inc., a for-profit corporation founded in 1995 to create public housing and affordable assisted living facilities.
1The Seattle Times, “Hispanic Paradox: Income May Be Lower But Health Better Than Most.”
Juliet Chung. August 29th, 2006