Splayed on 75-year-old Kamala Krishnan’s bedside table are three books: Life After Death by Deepak Chopra, Reaching to Heaven by James Van Praagh, and Love and Death by P. Rajagopalachari. These books are a constant reminder that the hereafter is no further than an arm’s reach away.
Krishnan’s is the typical story of the elderly Indian American immigrant. After the death of her husband, she moved to America to live with her daughter. “Truly, I wish to die and not trouble her like this,” says Kamala Krishnan, with a betraying quaver to her voice.
Krishnan’s daughter, Kshetra Srinivasan, admits that this exhortation frequently occurs and usually accompanies a disagreement over something as trivial as a dinner menu that might consist of something as egregious as a green salad. “In India, only cows eat raw food like let-tooce. Here…” Krishnan shakes her head with patent dismay. It’s not really the salad that is the subject of the discourse between mother and daughter. The subtext is helplessness, loss of independence, cultural chasm, and a normalizing process that is frighteningly unfamiliar.
Seniors who immigrate to the United States to live with their children face the daunting challenge of having to adapt to a new way of life. Their frame of reference is limited to their families who, more than likely, are ambivalent custodians of tradition and culture. These seniors face language problems; receive limited or no economic or health benefits; encounter family conflicts; are not fully aware of programs for seniors and are at a loss to spend their time productively. They feel lonely and fall victim to depression and delirium.
Dr. Rita Ghatak, Director of the Geriatric Health Services at Stanford University Medical Center, confirms the cultural issues embedded in older adult care. “Listening and quiet acceptance go a long way,” she replies to my question of how our generation should cope with supplanted elderly parents.
The brochure that is handed to Stanford Hospital patients has this introduction to her program: “Welcome to Aging Adult Services (AAS) at Stanford. This is a program devoted to meeting the needs of older adults and their families and providing them a continuum of care with support and resources.” What leaps out at me is the phrase “and their families.” It seems a much-overlooked aspect of adult care. “The family is the advocating unit for adult care,” Ghatak emphasizes.
Medical Needs
Usually medical advice is sought as a last resort among South Asian families. As adults age, common symptoms like tiredness, apathy, and memory loss mask parameters of more chilling diseases such as Alzheimer’s, dementia, and chronic depression. Families are fooled into believing that these issues are part of the natural process of aging. “Besides, anything to do with mood and cognition has stigma associated with it,” Ghatak adds. So even if families are in the know, they sometimes don’t seek medical attention.
Ghatak relates a case where the parents immigrated to the United States to live with their children. The father, who had undiagnosed borderline dementia, had trouble adjusting into the affluent (and isolating) neighborhood, which exacerbated his condition. The family was forced to address the father’s ailment the day he went for a walk, got lost, fell, injured himself, and was taken to Stanford Hospital. The doctors at the emergency diagnosed and put him on a treatment course for dementia, which worked well. But once he got discharged the follow-ups were not performed. Besides overcoming the stigma surrounding the diagnosis of dementia there was the more practical issue of medical insurance coverage.
Insurance Complications
Insurance is such a huge problem that internist Caroline Stratz blames the system for failing the elderly, calling it, “the Mediocrity of Medicare.” In a heartfelt piece she wrote for the Los Altos Town Crier on January 20, 2010, Stratz agonized about having to withdraw from Medicare because of the steep drop in reimbursement rates. “When I started my practice nearly 10 years ago, colleagues advised me against accepting MediCare patients because reimbursement rates are low.” But Stratz held on to her ideals about the kind of medicine she would practice. Then this year, Medicare reimbursements dropped by a further 20 percent and she could no longer justify the lowered compensation.
The price of healthcare is so steep that, without insurance, the elderly have few options. It is estimated that in 1996, average annual managed care spending for depression was $6,777 and for dementia it was $11,114.
So what is the solution? According to Ghatak, to forestall medical costs, the elderly need a regimen of good diet, good exercise, and engagement with the family, community, and society.
Social Implications
Sarada Sankaran’s story is a textbook case of engagement. She is 71 years old and is a self-confessed computer addict. She habitually delves into the brightly lit stratum of our sphere that we call connectivity via cell phone, email, Facebook, and a blog. She drives, watches CNN/MSNBC, practices yoga daily, goes to the library, and is currently working on a Tamil drama script. She is sprightly, alert, and converses with her college-age grandchild well beyond the midnight chime of the grandparent clock. “I’ve adapted to this culture,” she says, “I have no qualms about shedding the sari and donning sweatpants. I’m in this country for my grandkids and I need to be able to relate to them. I believe in the power of now.” Truly amazing! But hers is not the typical story; it is the inspirational one.
Most elderly parents in the South Asian community help the family unit in definable ways: housekeeping, cooking, babysitting, helping with homework and, in some cases, driving grandchildren to activities. It is when role, responsibility, and ownership are not clearly defined that problems crop up. When Krishnan moved into her daughter’s house, she happily took on the task of cooking for the family. However, as the grandchildren grew into teenagers, the idea of eating grandmother’s freshly prepared Indian meals daily challenged their assimilated palates. Krishnan’s role in the household slowly began to erode, leading to her morbid fascination with death and despair.
Isn’t depression just part of aging? According to National Institute of Mental Health, temporary emotional experiences of sadness, apathy, grief, and despondency are normal. However, if these conditions persist, and they interfere significantly with the ability to function, then treatment should be considered. To recognize that a problem exists is the first step to a cure. In most cases, that is probably the hardest step. When parents are burdened with the demands of jobs and rearing young kids, the needs of elderly grandparents are bundled and swept behind the phrase “when I have the time.”
There is a glow in Krishnan’s eyes as she returns from a trip to the grocery store. “The girl there recognized me,” she says sounding breathlessly like a young girl herself. “She gave me this packet free!” Krishnan reaches inside her bag and pulls out a packet of biscuits. Such a small gesture, with such a large reach.
According to Himanshu Rath of Agewell, a charity providing support to the elderly in India, “Collectively we celebrate the old. At home, we often ignore them. We say: ‘Have you had your medicine? Have you eaten?
Here is the remote control.’ And then we get on with our own lives.”
Managing Expectations
Initiator of the punctuated Google group, THATHA’s “R” US (thatha means grandfather in Tamil), Krishnamachar Sreenivasan understands how easy it is to fall into a blue state. His resume lists The Mitre Corporation, SRI, Hewlett Packard, and Agilent as employers. He is considered an expert in the field of computer performance evaluation and analysis of multiprocessors. The weeks following his retirement, however, his achievements were cold comfort. “I woke up in the morning and the only thing I changed was my remote battery.” It took great effort and considerable control before he came to grips with his changed situation. “I realized that there’s an unfavorable bias towards seniors. I had to do something to impact people around me.” He started a radio show on KLOK 1170 AM, a community service call-in program that airs every Wednesday from 11 to 12 pm every week, which aims to connect volunteers with those who need help.
Shifting the lens to the other end of the generational view, I queried some teenagers on living with elderly grandparents. “I love my grandmother, but I don’t understand her and she doesn’t understand me,” said a 14-year-old, adding, “She obsesses about food.” A college graduate explained that it was nice to find the warmth of her grandparents when she came home from school. “Not that I shared deep emotional moments with my grandparents,” she added. Her grandparents were there through her middle school and high school and she grew up with lots of religious events, good Indian food, Indian music, and Indian television.
Hesitatingly, she admitted that she’d been more attuned to their company when she’d been younger, but by the time she left for college, there was a large language, cultural, and generational barrier. “I did envy my Caucasian friends who were able to share a deeper emotional bond with their grandparents that was not complicated by language and culture.”
In September 2009, New York Times columnist, Patricia Leigh Brown wrote an article about the 100 Years Living Club, an all-male Sikh group of elderly immigrants. The group meets regularly at a mall in Fremont, Ca. to stave off feelings of isolation and alienation. According to Brown, late-life immigrants come to the country clinging to hopes and dreams of family togetherness, only to find that American society isn’t responsive to these cultural expectations.
A Growing Trend
Studies indicate that America’s ethnic elderly are the most isolated group in America and, yet, this group continues to grow. According to the 2007 census, one in three California seniors is foreign-born. It is estimated that the elderly constitute four percent of the global population (419 million) and there are approximately 350,000 Indian American elders, nationwide.
In his book gravely titled The Gray Dawn, Peter G. Petersen argues that, with the increase in life expectancy and decline of birth rates, the numbers of seniors will continue to grow, creating a demographic shift. The magnitude of this shift will result in seniors outnumbering the working age population. This will have a dire consequence on the economies of developed nations. This is partially borne out in Japan where it is predicted that, by 2015, one in four Japanese citizens will be 65 or older. As this shift in balance continues to dilate, Japan is looking at its trade surplus withering into deficit, driving industry and innovation overseas.
As public policy shifts are considered, ethnic seniors need to be part of the proviso. This group’s spiritual, physical, and psychological well-being becomes a critical parameter to social and economic prediction.
Local programs like the Community Ambassador program for Seniors (CAPS) and the India Community Center(ICC) offer a plethora of possibilities for seniors. ICC’s seniors program is designed around clubs and activities from simple socialization, yoga, and Bollywood dancing to round table discussions. Sankaran is an active member of the ICC senior program. Krishnan is a registered member, but finds it difficult to make it to the sessions. Krishnan informs me that conversations at the ICC Senior Center are wince- and wonder-worthy, ranging from daughters, daughters-in-law, financial crises, recipes, oil spill, medical problems, travel to India, and Bombay Jayashree ( a Karnatik music vocalist). Everybody is encouraged to participate.
One Friday afternoon I see Outreach cars pull in like grand limousines at the ICC-Cupertino parking lot. From these cars the elderly slowly emerge like stars, dressed in swathes of silk and serge. They grandly ascend the steps to the facility. I watch the way they enter and mingle with each other. This time, place and moment is theirs. They own it. I quietly leave, reminding myself that my time is just around the corner.
(Names of seniors have been changed at their request to preserve anonymity)
Jaya Padmanabhan is a prize-winning fiction writer and is currently in the process of writing a novel.
Institutionalized Living
Hindi movies like Baghbaan and Lage Raho Munnabhai pillory the boomer generation for contemplating nursing homes, assisted living facilities, and retirement homes for their elderly parents. Newspapers decry the oursourcing of senior care with articles titled “Old Age Homes Against Our Culture.” But the times, they are a-changing. The harsh critical glare of disapproval is dissolving under the circumstances of nuclear double-income family units. Living in elderly group housing with nurses and doctors on call and the ability to talk about “the old days” is sounding more and more attractive. Canadian resident Saroj Sood voluntarily opted to live in a South Asian Assisted Living facility in Surrey, UK. She quoted the Vedas as justification for her move. Sood explained how the last of the four stages of a Hindu life, the “sanyasa” stage, requires renunciation of society and meditative solitude.
In the United States, South Asian elder institution options are limited to just a handful. In my research, I was able to source only two: AristaCare Nursing Homes, catering to elderly Indians, with three locations in New Jersey and Pennsylvania, and a retirement facility, ShantiNiketan, in Tavares, Florida. ShantiNiketan is advertised as a retirement community for Seniors of Indian origin. Iggy Ignatius, the founder of the community project, says that he wanted to give it an “ashram” feel. The gated property consists of 54 condominiums, 35 of which are sold. There are Assisted Living facilities in the Bay Area catering to other ethnicities: Aegis Gardens in Fremont for elderly Chinese and On Lok Senior Health Center in Oakland for Filipino Americans, but none for South Asians. Is our diaspora equipped to handle the growing numbers of elderly?
Resources
Northern California
Outreach
Outreach’s Senior Transportation Program offers transportation options for seniors that can take them to any destination within the county. http://www.outreach1.org/seniors/seniors_mainpage.html. (408) 436-2865
India Community Center
With locations in Milpitas, Cupertino and Fremont, the India Community Center offers yoga classes for seniors, round table discussions, Jollywood dance classes opportunities to participate in theater, knitting club, bridge club or even a computer class. Subsidized lunches are provided to seniors as part of the program.(408) 934-1130 or check the website: http:indiacc.org/node/293
CAPS – Community Ambassador for Seniors Program
CAPS ambassadors serve seniors and their families by assisting with questions related to identifying local resources, programs, and services in the Tri-City area (Fremont, Newark, and Union City, Ca). Senior Helpline: (510) 574-2041
Stanford’s Adult Aging Services (AAS)
Stanford’s AAS program offers consultations, assessments, home visits, and general outreach assistance. Here is a list of some of the options:
• Geriatric Out-Patient Clinic and Consultation Service (650) 387-6777
• Dementia Support Program (650) 723-1303
• Partners in Caring (650) 725-4137: A program that helps older adults in their homes
• Strong for life (650) 725-4137: A muscle strengthening exercise program
Southern California
National Indo-American Association for Senior Citizens (NIAASC)
National Indo-American Association for Senior Citizens (NIAASC) started in 1998, serves Indian American seniors across America, “through information, referral and advocacy services.” http://www.niaasc.org/
Southern California
Dial-a-Ride services
Most cities in Southern California offer Dial-a-Ride transportation services to senior citizens (60 years of age or older), and individuals with disabilities.http://dpw.lacounty.gov/PDD/Transit/Page_01.cfm
Neighborhood Activities and Nutrition (NAAN)
Seniors are encouraged to visit Artesia’s Senior Center where they can form clubs and intermingle. The two big deterrents for South Asians, language and diet, were addressed by the Oldtimer’s Foundation, a community-based organization that began serving a weekly vegetarian Indian meal, cooked by a local restaurant owner and paid for by the county’s office of aging. (662) 272-5276