The Many Cultures of Caring

In Hawaii, where many people come from AsianOur Lives" (2008), celebrated different musical
cultures, multiple generations often live together, andgenres, such as soul in February, which provided a
cherishing and respecting elders, a concept calledchance to link activities to Black History Month.
kupuna, is a key value, says Marketing ManagerWhile Celebrations may seem more about
Gwen Trowbridge of Kisco Senior Living. So whenentertainment and continuing education for all
the Carlsbad, California-based senior-living residenceresidents, it also affords opportunities for residents
conceived Ilima at Leihano, a 40-acre CCRC inand staff from different cultures, religions, and
Kapolei, a suburb of Honolulu, they sought toethnicities to feel honored and share their unique
embrace that connection of ohona (family) byexperiences with others, says Sara Terry, vice
partnering with another developer to build Maile atpresident of Optimum Life, which administers
Leihano, a sister residential community, in which adultCelebrations.
children and grandchildren can live near their loved"[Because of Celebrations], every day, directors of
ones.lifestyle programs have an opportunity to recognize
Buildings are designed in the islands' uniqueand utilize residents' cultural experiences for programs
architectural style, characterized by outdoor andand events," she adds. "We can tap residents to
interior spaces interconnecting seamlessly. Amenitiesshare their cultural or historical perspective based on
at the Leihano Clubhouse will feature a pond with koia theme and use them as teachers."
fish, symbols of love and friendship in Japan. ActivitiesAccommodating the needs and desires of people
also reflect the anticipated diverse resident mixfrom different cultures and religions is also a priority in
including not just Hawaiian ukulele, hula, and lei-makingBrookdale's dining program, Hajdu says. The company
classes, but also Chinese games of mahjong andhas developed an in-house, proprietary menu-planning
classes on Japanese kanji writing and Chinese tai chi.tool for 10 different ethnic menu regions, including
Dining options reflect Japanese, Chinese, Thai, Filipino,Southern, Tex-Mex, and Old World, which
Hawaiian, Asian-fusion, and Continental cuisines, andincorporates many Jewish specialties such as matzo
Ilima also will offer "Pau Hana," a Hawaiian happy hourball soup, Gefilte fish, and matzah brei. While
with "pupu" appetizers. Holiday celebrations will includecommunities are initially assigned a menu category
Hawaii's Kamehameha Day, Kuhio Day, and Lei Day;based on region, they can choose to switch to
Chinese New Year and Lantern Festival; and theanother one better suited to their resident
Japanese Obon Festival to commemorate deceasedbreakdown. For example, a Florida community
ancestors and Keiro No Hi to show respect for theassigned the Sunbelt menu can opt for Old World if it
elderly and celebrate longevity.has a substantial Jewish population.
"Our associates, also at the heart of our ohana, willBrookdale's menus also are not hard-and-fast rules,
no doubt be sensitive to the various culturesbut rather starting points, Hajdu emphasizes. A New
represented at Ilima," Trowbridge says. "Not only willEngland chef can prepare a Tex-Mex recipe and vice
Kisco Senior Living hire local residents of Hawaii whoversa. Finally, to be absolutely sure that all residents
will encompass this sensitivity, but it will also be parthave a say in what's served, seniors can make
of their training for all levels of care."special requests, including their own cultural favorites,
While most senior living communities don't go so farat the host stand, and Brookdale will fulfill all
in serving the needs of seniors from multiculturalreasonable ones within 10 days. And residents can
backgrounds, many companies are finding creativesubmit their favorite recipes to be added to the
ways to customize their resident-care strategies andnational database.
offerings to ensure seniors from various racial,"This is where my job becomes so much fun," Hajdu
religious, and ethnic groups feel right at home.says. "It also teaches our managers and associates
Caring for Customsthat it's all about a resident's choice."
Nonprofit religious organizations have long establishedHajdu warns, however, that ethnic specialties such as
communities in which people of the same faith cankosher or Asian food preparation are not typically
retire together. A handful of specialized communitiestaught in mainstream culinary schools. "I hired a new
also have sprung up for ethnic groups, such aschef at one of our large, mostly Jewish communities,
several Japanese residences in San Francisco andand he had never made a matzo ball," he adds. "Each
Native American communities in Alaska and Canada.culture has its own eating and drinking preferences
However, in most cases, seniors from diverse culturaland holidays. A Jewish resident may expect to get a
backgrounds are minorities in a larger community, soSeder meal. Residents in the Southwest may
cultural sensitivity should be integrated with adefinitely look for Southwestern or Tex-Mex food. It
company's core values and incorporated into staffdoes require extra training and understanding."
training from day-one staff orientation, says JimMulticultural Memory Care
Concotelli, vice president of resident programs forInvolving families is particularly important when it
Tampa, Florida-based Horizon Bay Seniorcomes to cultural issues for Alzheimer's and
Communities, which operates 74 senior livingdementia-care residents, says Stephen F . W inner,
communities in 13 states.cofounder and chief of culture for San Juan
At Horizon Bay, those values are integrity, respect,Capistrano, California-based Silverado Senior Living,
responsibility, professionalism, and teamwork, and thewhich operates 20 memory-care communities in
two most connected with diversity are respect andCalifornia, Utah, and Texas. Because people with
professionalism. "Out of respect for our residents, wedementia live in their long-term memories, their
feel it's our responsibility to provide care that meetsexperiences growing up in a different country,
the integrity of the resident and also honors theirchurch, or cultural environment may be among their
history and background," he explains. "In terms ofmost vivid recollections, he explains. They often
professionalism, we make sure that our staffremember the words to old-time songs or the Lord's
understands a resident not only at their cultural levelPrayer, and customs, ceremonies, and cuisine may
but also [through] their background and history."provide comfort in what is now a confusing world,
Concotelli says he has not seen a lot of prejudice byWinner says.
other residents for their neighbors from differentSilverado communities make just as much of an
backgrounds. Instead, most seniors enjoy learningeffort as any other assisted living residence to stage
about other ways of life, he adds, noting thatholiday celebrations, provide religious services, and
residents of private-pay retirement communities suchserve culturally familiar meals. Residents are
as Horizon Bay tend to come from well-educatedencouraged to share stories about items in their
professional backgrounds and have had previousmemory boxes that pertain to their cultures. When
exposure to a variety of cultures and individualsactivities with a cultural bent are planned, such as a
different from themselves.cooking club where residents learn to prepare a dish
To ensure that everyone's traditions are respected,from another country, every effort is made to
Horizon Bay lets seniors take the lead in decidingevoke a complete ambiance of that culture. For
what multicultural activities they would like to see inexample, a Mexican meal will be accompanied by such
their communities. Learning what cultural traditions areprops as maracas, sombreros, and mariachi music.
important to a resident is a key part of the initialDiscussing cultural issues and potential conflicts with
interview and move-in process.families upfront can be particularly important in a
"Generally, we'll have a resident group take amemory-care environment, Winner says. He cites a
leadership role in designing and offering what theypossible example of a Jewish family who wants their
feel is appropriate," Concotelli says. "Then staffloved one to maintain Jewish religious services but
supports them to provide the space they need orthen observes or learns that the resident wandered
any particular types of menu items. Even if there isinto a Christian event.
only a small group, we provide the support to honor"It's an educational process with the family that [the
their traditions as we would for anyone in ourresident is] just enjoying the music and the
communities."socialization, not the philosophy or some sort of
One reason why fewer Asians and Latinos may livesoul-saving," Winner says. "Most families get it when
in senior living is the value those cultures place onyou spend the time to explain that it's not a
younger generations caring for their elders, Concotelliconversion."
observes. However, Carrington P oint in Fresno,When Silverado staff invite outside clergy to visit,
California, is an exception, with a growing Asianthey take the extra step of asking that they not
population. "One family's loved one moved in aboutdeliver a sermon and instead just include a general
five years ago, and word spread within the Buddhistopen prayer or hymn that anybody of any religious
community that this was a nice place," he says.background could join with comfort. "If a family really
Since many of the residents belong to a specificsays they don't want the resident involved, we
Buddhist group, Horizon Bay turned to its leaders foralways make sure that there's another activity
in-service and education for staff. With their help, theplanned or that we direct them to another area,"
company added an outside meditation garden andWinner stresses.
has incorporated Buddhist ceremonies, customs, andIn another issue with some Jewish residents with
cuisine into programming and dining.dementia, seemingly difficult behavior during activities
Celebrating Differencessuch as bathing may have their roots in concentration
At Chicago-based Brookdale Senior Living, observingcamp experiences, Concotelli says. Horizon Bay offers
multicultural traditions is at the heart of thecaregivers an educational in-service at communities
"Celebrations" program, which incorporates dining,with Jewish residents not only to help them
socializing, themed activities, events, andunderstand Jewish traditions but also to teach them
entertainment at all its approximately 419to identify such behaviors appropriately and take
communities, says Joska Hajdu, senior vice presidentspecial care with personal care activities for Holocaust
of dining services and a key player in creating thesurvivors. To teach the class, the company reaches
program. "[Celebrations] is all about celebratingout to local Jewish groups and aging services.
cultures and our differences, not just of residents butSome small touches can go a long way, Winner says.
also associates," he adds. "It's more an event than aBecause Alzheimer's and dementia-care residents
program and really ties together the entirealready are confused by normal communication, it's
programming of all our activities and programs thatmore essential that staff speak English, so that is a
happen at the community level."firm requirement for staff from all ethnic
Each year's activities are centered on an overarchingbackgrounds, Winner says. Likewise, when a resident
theme, with mini-themes for each month. Fordoesn't speak fluent English, family members are
example, in 2004, Celebrations focused explicitly onasked to help assemble communication boards with
cultural origins with "Journeys to America." Eachkey phrases from that person's native language.
month celebrated a different geographic area fromHowever, when Silverado is able to assign a primary
which residents or their ancestors immigrated andcaregiver who comes from that same culture, a truly
included an Italian month, an African-American month,special connection often transpires.
an Asian-American month, and a Jewish month."It's really neat to see residents share their memories
"Celebrations Around the World" (2007) centered onand then see staff from the same background share
international holidays such as Brazil's Carnival ortheir memories," Winner says. "It's often a real mixing
Germany's Oktoberfest. Another program, "Music ofof ages, too.