Coffee Chat: Elder Care in America

Exploring the cultural difference and current dynamics surrounding elder care

Bryant: Welcome to another coffee chat. I’m here with Ray and Chloe and we’re gonna talk about aging and elder care in America. Chloe and I worked on a documentary regarding this topic. Chloe, why don’t you tell us about it?

Chloe: This documentary is focused on Japanese American elderly folks living in the Bay Area. Specifically, we follow the lives of elderly people at Umenoki Gardens, a senior home in Union City.

We filmed during COVID-19, of course following all CDC rules and precautions, and at a time when anti-Asian hate crimes were on the rise. It was impactful to hear how this was not the first time that these elders had experienced anti-Asian hate. Many of them were either born in or grew up in Internment Camps. It was harrowing to hear some interviewees liken their elder care experiences to Internment Camps: they were forced to move away from their homes, were forced to eat the same non-Japanese foods every day, and were told what activities to do.

With this in mind, we wanted to focus on how Asian American communities care for their elders and the differences there might be between different cultures. 

Bryant: Ray, considering your stage of life, do you have any thoughts on aging?

Ray: Growing up, my grandparents frequently visited America and played a significant role in my upbringing. However, as they age, they are more reluctant to come to America primarily due to healthcare reasons. Lacking insurance, they cannot access the American healthcare system effectively. Nowadays, I mainly visit them in China, where they live with my uncles and aunts. The Chinese healthcare system, tied to their pensions, makes it convenient for them to get procedures and regular check-ups. 

Bryant: When we were filming the documentary, we learned from Dr. Fumi Ikeno at the Stnford Center for Asian Health that it was uncommon in Japan for elderly people to go to nursing homes. This is changing, though with some guilt associated with it. Ray, did you notice similar trends during your visits to China?

Ray: I think there’s a cultural difference in how the East and West view aging. I grew up in an Asian-dominated community where there’s the mentality that, because our parents took care of us when we were younger, we will be the ones taking care of them in the future. While in America, there might be some stigma against sending parents to nursing homes, in Asia, particularly China, elderly care remains a predominantly family responsibility. 

Bryant: From my clinical experience, it’s very common for American seniors to move to senior nursing facilities or assisted living, especially those with memory issues like dementia. Chloe, you’ve frequently traveled to the Philippines for medical missions. Can you compare the situation there with what we see in the US? 

Chloe: I wish I knew more about what senior care looks like in the Philippines, because I can only speak on what I’ve witnessed in my own communities.

Similar to Ray’s experience, the onus of elderly care often falls to the younger generation. I don’t think I’ve heard of Filipino senior care homes the same way I hear about other culturally-tailored care homes in the Bay Area.

It’s also interesting, because we’ve previously discussed how many elder homes in the US are run by Filipinos. So many adult Filipino people leave the Philippines as “overseas workers,” who work abroad and send money back home to theeir loved ones. So what’s often left in the Philippines are the children and elderly family members. There’s always this sense that each generation has responsibilties to the generations before and after their own.

Bryant: It’s definitely fascinating, the dynamics of elder care, particularly the exporting of workers, which significantly impacts the US. We face a large perceived and actual gap in our ability to provide for our elder generation. Medicare doesn’t cover home care in California, and medical providers give limited support—it’s a mostly cash-pay system. In addition, the cost of in-home care, which used to be around $16,000 to $20,000, has surged to about $24,000 a month for full-time care in the Bay Area.

This high cost drives the shift towards more affordable assisted living and skilled nursing facilities, which despite being cheaper, still operate on an à la carte basis—you pay separately for lodging, food, and each level of required care.

These facilities can provide complete assistance, but for more intensive medical needs like specific medications or wound care, a skilled nursing facility is necessary. This creates an equity issue, where only wealthier families can afford such care, and others must provide it themselves, leading to what is called the “squeezed generation.” These are people who are sandwiched between caring for their aging parents and their children. I find myself in this squeezed generation, managing care for both my children, who are still at home, and my aging parents. Ray, any thoughts as a student and future doctor? 

Ray: As a future doctor, I find the term “squeeze generation” very relatable. This concept will definitely influence how I approach my medical career: there is a need for more comprehensive elder care solutions. 

Bryant: There are currently large demographic changes across the globe, which will lead to the population pyramid being inverted. With more older people than younger people, we need systemic changes to ensure proper elder care. This challenge will fall to the next generation to resolve. Thank you for joining us!