‘Communities Should Build Elderly Services Pipeline Early’: Anni Chung, Self-Help For The Elderly

Estimated reading time: 10 minutes

Self-help is the best help

The Indian diaspora is aging. A 2023 study estimates that about 13 percent of Indian immigrants to the U.S. are over 65 years of age. Many younger immigrants urge their aging parents in India to move to the U.S.  so they can care for them. 

This creates a demand for culturally and linguistically appropriate care – a critical challenge given the rising shortage of caregivers in the U.S. For newly arrived seniors, adjusting to a new culture and language and relearning how to be self-reliant can be trying.  To tackle a similar challenge in the East Asian community, Self-Help for the Elderly, a non-profit that began in San Francisco’s Chinatown in 1966, offers senior immigrants multicultural and multilingual services – such as culturally-appropriate caregiving and professional training – helping them find their feet in a new country. The organisation serves older adults in five Bay Area counties – San Francisco, San Mateo, Santa Clara, Alameda, and Contra Costa. Self-Help has senior centers in Millbrae, San Mateo, Sunnyvale, San Jose and several in San Francisco. They also have affordable housing in San Francisco and Oakland. 

Speaking to India Currents on the sidelines of the state’s recent California Connects regional convening in San Francisco, hosted in partnership with American Community Media, President and CEO Anni Chung said communities should anticipate the future needs of an aging population and start training service providers early.

The interview has been edited for brevity and clarity.

India Currents: Which immigrant groups does your organization serve?

Anni Chung: We primarily serve Asians. We serve close to 50,000 plus unduplicated seniors a year because we run very large healthcare and nutrition programs. About 70% of the seniors we serve are from China, including mainland China, Hong Kong, Taiwan, or Singapore, while the rest might be from Vietnam and the Philippines.

IC: Do the immigrants you serve generally come to the US later in their lives?

AC: Yes. They come here usually when their children sponsor them. Aging parents come over because they want to live and spend the rest of their time here with family. 

IC: What are the challenges that you see older immigrants face when they come here?

AC: Let’s say, their child sponsored them to immigrate to San Francisco, which has a large Chinese population, so they feel comfortable. But their children might be working down in Silicon Valley or San Jose, where they have good tech jobs. The elderly parents now have to drive an hour to come back to the core Chinese community. So they’d rather live by themselves in San Francisco. A lot of older adults find life is not as good as what they had pictured, especially when their family might live an hour or two away. So they have to adapt.

IC: So they come here because their children sponsor them, but they choose to live apart?

AC:  Yes, sometimes. When the children move out to the suburbs… San Jose is okay because it has a large Vietnamese and Chinese population. But all the Chinese groceries and restaurants are concentrated in San Francisco Chinatown or Oakland Chinatown. So they like to live close by, and they prefer to rent a little room in these areas and see their children or grandchildren over the weekends. 

IC: Do they find paid work here ? 

AC: At Self-Help we know that older adults need five to 10 years of employment history before they get Social Security and Medicare when they turn 65. Many older immigrants don’t know that. So they think, ‘I’m 60 now, so at 65 I’ll have my Medicare and then I get 80% of my medical expenses covered’.  But they have never worked here, so when they apply for the benefits, they are told to pay thousands of dollars as premium. If older adults come here, we need to give them some vocational training, like home health aids or housekeepers, or restaurant work, so they can prove that they have 10 years or 40 quarters of employment.

IC: And that is something older immigrants are able and willing to adapt to?

AC: Depends on their health. If they arrive in their late fifties, they’re still healthy. There are many Chinese families that need to hire a home health aid to watch over their aging parents. So we train licensed home health aids and then find them jobs. 

IC: Are the older immigrants who need employment typically from lower-income backgrounds, or do you see this in all economic strata?

AC: Every year, about  20,000 people immigrate from China to various parts of the United States. But gradually they make their way back to the West Coast because of the nice weather, family, or jobs. So we see immigrants of all kinds of income levels. The lower-income immigrants are usually farmers or teachers who don’t have the resources of, say, engineers or doctors or lawyers. They usually still look for jobs.

IC: How do you work with immigrants who come later in their lives, when work is probably not an option for them?

AC:  If they have almost no income, no retirement income from their country of origin, then they use Medi-Cal for health coverage. If they don’t qualify, they could buy Covered California. Maybe the children will chip in. 

If they have savings, then they look for a community-based group like us; when they need a doctor or a dentist, or when they need to socialize, where do they get a group of people that look like them, talk like them, and organize activities that they enjoy? Then they reach out to community centers like ours, so they are not as lonely when the children go out to work. Community centers play multiple roles. For the low-income, we find them jobs, we train them, we find them income, and then we help them get government benefits. The middle-income immigrants and retirees look for more social engagement and new skills, such as learning to use a computer or the internet. 

IC: As a non-profit, how do you work with the state government? 

AC: We are a partner with the OCPSC  (Office of Community Partnerships and Strategic Communications). For the past two years, we have received grants from them for outreach work. We also work with our state legislators; sometimes it’s not the funding but policies that are not helpful for the aging.

IC: Could you give an example of a policy that you found impeded the elderly?

AC: There are plenty.  Ageism is still big in the workplace. After a certain age, they let you go. It’s subtle; they don’t do it outright. There are many ways to do this – you can say the job ended or there’s no funding for this position any longer…I have been told that at certain offices, you are just expected to resign or retire once you are close to 60. We urge the Employment Development Department to scrutinize employers that don’t have HR policies in place against discrimination. They should weigh the person by their capability, not by their age. 

IC: What challenges have you faced when helping older immigrants adjust culturally? Their children adapt to the American way of life, which can be jarring for their parents who arrive later in life…

AC: Yes. There’s a lot of adjustment. Many parents come here to reunite with their children, who now have their own lives and priorities. So sometimes they choose to live apart. We have elderly people who wait for a phone call every Mother’s Day or Christmas. Sometimes the call doesn’t come because people get busy. So we encourage seniors to be self-sufficient. If you don’t have high hopes, then you won’t be too sad, right? You say, okay, I have my own circle of friends, and I could go to a senior center and celebrate Mother’s Day. You don’t need to get dressed and wait by the door for your son or daughter to take you for yum cha.

They build their own community, and if the children call, they’re very happy. If they take them out, they’re very happy. But if they don’t, it’s okay. 

The elderly have a travel group with our staff. We take them to China or Vietnam. They don’t need to depend on their children as long as they can pay for it. We once organized a tour to Europe, where one of the members went to every museum and wrote a whole diary about it! He said it was the happiest time of his 80+ years of life. 

They didn’t need to depend on their children. We were there.

IC: Has language been a barrier for older immigrants in your community? 

AC: That’s a barrier for almost all Asian immigrants because two-thirds of us speak a language that’s not English at home. We call it Limited English Proficiency. Whether they want to attend classes or access public services or even attend a public hearing to speak up for affordable housing, usually, there’s a language barrier. San Francisco has been very good about this; when the population of a community in the city reaches 6,000 [revised down from 10,000] or more, like the Hispanic, Chinese, and the Filipinos, the “top-tier” government agencies –  like the departments of police, health and housing – will provide material in all three languages. Vietnamese is next. 

IC: Do you also help older immigrants with languages? 

AC: Yes. We conduct  ESL (English as a Second Language) classes. We work hard to get them proficient in it because Green Card holders wanting to become citizens must take the oral exam in English. 

IC: Culturally appropriate care for the elderly is also a challenge. The Indian diaspora is beginning to provide retirement homes geared towards the needs of the community.  Do you have retirement homes or assisted living facilities for your community members? 

AC: Yes, we have an assisted living facility, but with only 15 residents with Alzheimer’s. We’re in the Western Addition area in San Francisco, and we charge 40% of the market rate for memory care. So our home is always full. Long-term care is very expensive. Assisted living is totally unaffordable. 

If you are, say, a Chinese family, and in need of a caregiver for an elderly family member, you could hire from us. 

IC: In our community, it is a challenge to get culturally and linguistically competent elder care…

AC: It will be good if the South Asian community starts training caregivers, so if and when the elderly need a caregiver who speaks their own language, you have a pipeline. We saw this gap about 30 years ago, so we started training then. If the therapist and the clinicians or the caregivers don’t speak the language you know, then the care is not as good. 

IC: Do you receive any assistance from the state to train caregivers? 

AC: The workforce development money comes from the federal Department of Labor. We provide funding to train licensed home health aids, nursing aids and culinary workers. 

IC: But federal funding could get cut.. 

AC: Yes, it is threatened to be eliminated. We are waiting…

IC: Does the state help with your training needs? 

AC: The state is big on employment development, but it looks more at policies, like ageism. The actual money to hire a teacher or a nurse to train our home health aid class comes from the Department of Labor. I don’t think they will cut it all because then the whole country will be affected, right? But it will mess with the funding. 

This article was produced as part of the American Community Media (ACoM) California Connects – San Francisco Regional Fellowship.