Reaching Out: Houston and Maui Partnerships Tailor Efforts to Serve Elders in Key Cultural Groups

Partnerships in culturally diverse communities are seeing the benefits of targeted, creative outreach to better serve older adults.

Stakeholders in places as disparate as Houston and Maui, for example, are tapping resources, developing strategies and implementing tactics to reach distinct groups, such as Houston’s growing Asian populations and rural Maui’s native Hawaiians.

“No matter the size of your community, the excellent progress in Houston and Maui demonstrates the value of proactive, creative thinking to improve long term care and supportive services systems­­­­­­­­­­­­­­,” says Elise J. Bolda, national program director for the Community Partnerships for Older Adults program (CPOA).

The Robert Wood Johnson Foundation, through its CPOA program, recently awarded four-year, $750,000 implementation grants to Houston, Maui and six other sites to implement the activities described in the community-wide plans they produced as development grantees.

Houston – Outreach to Asian older adults

Houston, with a population of 1.9 million—including 252,000 adults older than 65—is the largest city in Texas and the fourth largest in the United States. And it’s becoming increasingly diverse. Seniors in Harris County, which includes Houston, primarily are white, African American or Hispanic, but the fastest-growing group is Asian older adults. Indeed, Asians over 65 now represent nearly 4 percent of the county’s older adult population, or 9,927 people—a whopping 140 percent jump from 10 years ago.

That rapid increase is among reasons the Houston partnership for older adults has made outreach to the Asian community a priority, since Asian seniors face language or cultural barriers to accessing services and information.

“Given Harris County’s diversity, we knew we needed to seek out the leadership of organizations and agencies representing minority groups,” says Dianne Long, project coordinator for Sheltering Arms Senior Services, the lead agency of a 79-member coalition partnering under the name Care for Elders. “We are committed to ensuring our initiatives are culturally relevant.”

The first step was to solicit involvement from Asian leaders in the Houston partnership’s huge service area, which covers 41 municipalities, 1,700 square miles and 103 zip codes. Two organizations proved to be especially helpful: the Chinese Community Center and the Asian American Family Counseling Center.

“When we were developing our Consumer Advisory Council, we contacted the leaders of Asian groups and asked them to recommend people from their community to serve on the council,” Long says. “They provided us with suggestions, and we brought them on board.”

The contrast between American and Asian cultures was apparent from the start, when the proposed Care for Elders logo—which used the number “4” as a graphic element—was distributed for internal review.

“Very late in the process, an Asian [representative] called us and said, ‘You know, you can’t use the number 4. It means death in certain Asian languages,’” Long recalls. “So we came up with a different logo. That was huge in gaining credibility, because the Asian community realized we were listening.”

That credibility has led to working in tandem to raise awareness among Asian older adults about Care for Elders’ programs and initiatives. “If we do a radio ad in English, they will do the voiceover [translations] and provide it to the proper media outlets,” says Long. “Or they’ll say, ‘We know the editor of the Asian newspaper that most of the people read.’ So we’ve used those types of contacts as other links to the community.”

Another initiative, set to launch early next year, is cultural-sensitivity training for in-home health-care workers. Members of the Chinese Community Center will provide insight to caregivers about Asian customs, such as removing shoes before entering a home, and stressing that Asian male elders don’t want to be bathed by a female.

“Providing personal care is difficult when you’ve got a male trying to live in his own home and most of your workforce is female,” Long says. “But it’s important to recognize these differences and [work toward] better understanding.”

“If you don’t ask for input from different cultures, you can’t learn,” she adds. “You have to be proactive.”

Maui – Outreach to Hana’s isolated older adults

Maui, meanwhile—a locale vastly different from Houston in size, geography and ethnic makeup (the island has just 118,000 residents)—is also making outreach to specific groups a priority, particularly regarding in-home services.

“Many elders feel that their only choice if they become frail and infirm is a nursing facility,” says Tony Krieg, executive director of the Maui Long Term Care Strategic Planning Partnership. “So there’s a great deal of confusion, and we’re trying to address that by raising awareness of home- and community-based options.”

Alternatives are especially important in places like Hana, an isolated, picturesque village on Maui’s eastern shore that’s home to 144 people aged 65 or older, the majority of whom are native Hawaiian or part Hawaiian and have high rates of hypertension, heart disease, stroke or diabetes. (Hana has the state’s second-highest percentage of native Hawaiians, at 34.5 percent, and almost two-thirds of the village’s multi-racial people define themselves as part Hawaiian.)

And isolated isn’t an understatement: Hana is 57 miles from the closest town, and the only road has 697 turns and 54 one-lane bridges, translating to a typical drive of two hours or more. Because Hana doesn’t have a nursing home, frail Hawaiian seniors have to be transferred elsewhere on Maui to receive long term care.

“It can be devastating,” says Ray Henderson, the partnership’s community coordinator in Hana. “They are not in familiar surroundings, and they usually don’t last very long.”

As a result, the partnership has identified three priorities for Hana: keeping “kupuna”(Hawaiian Elders) home as long as possible by retrofitting their houses, creating a home care or foster family program in the village, and investigating the feasibility of building a nursing facility.

The retrofitting project is already under way, with 19 homes slated for alteration by students from the local high school’s building and trades program. Provided at no cost, the retrofits will include raising toilet seats, putting rails beside lavatories and in showers, and building access ramps so seniors can get around more easily.

The need for foster care is gaining momentum as well. Several families already have expressed interest in participating and will attend workshops to learn more. “We’re looking for families—perhaps community members whose kids are grown—who are willing to take in two or three elders,” Henderson says. “If we can have at least one foster care home here by next summer, I’d be happy.”

The third priority, assessing the feasibility of a nursing facility in Hana, is part of a longer-term goal of creating an option modeled after the Greenhouse Project in upstate New York. “It would have a 24-hour staff, but feel more like a home than a clinical setting,” says Henderson. “Residents would have their own bedrooms, and share a kitchen, dining room and living area.”

In the meantime, he is optimistic that the needs of Hana’s kupuna finally are being addressed. “It’s something people always worried about here, but no one took on a leadership role,” Henderson says. “Now, with the help of the partnership, we have a process to move forward.”

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