Ethnic-focused nursing homes put a Canadian face on filial piety

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It's 11:41 a.m. and In Chung Yee's kitchen is buzzing with the lunch rush. He pours a bowl full of cracked eggs into one of the kitchen's "turbo woks": a 32-inch beast with capacity for 100 servings of fried rice – which sizzles and spits as he vigorously tosses in cooked rice, shrimp and steamed vegetables.

Earlier that day at the Yee Hong Geriatric Care Centre in Mississauga, a group of seniors gathers to perform a seated adaptation of tai chi. A few days later, they are belting out Chinese opera into karaoke microphones.

This is life at the ethnoculturally focused nursing home geared toward the Chinese population, one of the fastest-growing minority groups in Canada.

Some have endured a five-year wait (and counting) for the privilege of living here, and waited 10 years for a space in Yee Hong's Scarborough-McNicoll location. It's not just comforts of cultural accommodation that attract ethnic minorities to these specialized homes. Research is emerging that there's a significant health benefit, with the familiar mitigating the culture shock, social isolation and confusion that can come with being transplanted into a mainstream nursing home.

Within the field, Yee Hong has emerged as an innovator in care, routinely boasting lower rates of depression, falls, skin ulcers and hospitalizations among its residents, compared with those living in mainstream homes. Susan Griffin Thomas, Yee Hong's Mississauga director of care, attributes its success to high staff retention rates and a commitment to seeking out best practices from other homes across the country.

Ben So, whose mother and father-in-law live at Yee Hong Mississauga, agrees that the centre is far superior to a typical home.

"When you see an elderly person going to a nursing home they'll say, 'Oh, you poor thing, your kids don't want to look after you.' In our community, when you hear, 'You're going to Yee Hong' they'll say, 'Congratulations.'"

Staff culture also has a lot to do with Yee Hong's success, said Karen Kobayashi, a University of Victoria sociologist and research affiliate at the school's Centre on Aging. "They specifically screen for care workers who have the same philosophy around care as the home does and they drill that into their staff," Dr. Kobayashi said. "You don't see that at other mainstream homes."

When the first ethnic-focused nursing home for Asians opened in Vancouver in 1978, it was a hard sell to a community that followed the old model of filial piety. But attitudes among immigrants have shifted in the past three decades as second-generation children adopt North American values.

Ten such Asian-focused nursing homes now exist in Canada, focused mostly on Chinese and South Asian communities, but the growth doesn't come close to meeting demand. In Ontario, the average wait for a spot in a mainstream nursing home is 113 days. At Yee Hong's Scarborough-McNicoll facility, some have waited for a decade.

With the country's senior population expected to more than double to between 9.9 million and 10.9 million in the next quarter-century, provinces are scrambling to develop care strategies. While Ontario Health Minister Deb Matthews has said the province will focus its resources on home care in the next two decades, in British Columbia the plan is to revamp mainstream homes and properly staff them to meet the needs of all ethnicities.

But researchers and seniors advocates argue ethnic-focused facilities should be a priority for all provinces as they map out strategies. The most recent projections from StatsCan suggest the country's South Asian population could balloon from 1.3 million in 2006 to 4.1 million in 2031. The Chinese population, also 1.3 million in 2006, is expected to reach three million in the same time frame.

With culturally appropriate homes offering welcoming environments, the families of these seniors have accepted them as a way to honour their parents in old age. It's filial piety redefined, Dr. Kobayashi said.

Accounting for Yee Hong's excellence

Paying attention to residents' cultural needs and innovative, attentive staff make for a winning combination

How did Yee Hong build a better nursing home? In addition to focusing on their residents' cultural needs, its staff is constantly experimenting with projects that target specific health indicators, searching for improved care.

"We don't actually use the provincial average as a benchmark," said Susan Griffin Thomas, Yee Hong Mississauga's director of care. "If we did, we'd all sit back and say, 'Oh, our job is done here.'"

Instead, they look to other facilities that perform well in certain categories and try to figure out their best practices. This has resulted in measurable improvements in three indicators of overall health: weight loss, depression and fall rates.

WEIGHT: 6.7 per cent of residents in mainstream Ontario nursing homes experienced weight loss between April and June of last year, compared with 2.55 per cent at Yee Hong's locations.

That can be largely attributed to the fact that most residents enjoy what they eat, routinely consuming three meals a day.

"Most of our residents when they're admitted gain weight. They may have been home, isolated, or in a home where they didn't have food preferences met," Ms. Griffin Thomas explained. "When you offer a Chinese senior a baked potato for supper, it's not what they want. They want congee for breakfast, rice for lunch and dinner."

Sharon Koehn, a research associate at Providence Health's Centre for Healthy Aging in Vancouver, has prepared reports for B.C.'s Health Ministry on the link between food and well-being among South Asian seniors. She says proper food is usually the top requirement in care when visible minorities check out homes for their parents.

"It's very unsettling to be in a place where you simply cannot get psychologically, emotionally, the things that comfort you most. For some groups, it is so strongly embedded in their culture and their religion that they will not eat rather than have something [culturally inappropriate]"

All the food prepared at Yee Hong goes through rigorous taste-testing and review before it makes it onto the menu, and no cultural detail is overlooked. Hours before meal time at Yee Hong Mississauga, water is boiled and set aside and milk bags are heated in a hot water bath, to ensure both will be optimum temperature. Cold beverages are bad for "chi" – the sense of inner balance and body temperature.

DEPRESSION: 25.1 per cent of Ontario's nursing home residents reported worsened mood from symptoms of depression after admission. At Yee Hong, the average is 3.35 per cent.

Staff credit the culturally focused programming and the simple fact that residents can comfortably communicate with staff and other seniors. In mainstream care, visible minority seniors often grapple with social isolation.

"When you transition into a place where there is absolutely no familiarity of language and we talk about the environment being very sterile and not a warm environment, this is why you see a rapid decline in mental health in older ethnic minority adults," said Karen Kobayashi, a sociologist and research affiliate at the University of Victoria's Centre on Aging.

Yiu Kuen Chen, 100, remembers the language barrier of the mainstream homes he lived in before he was transferred to Yee Hong.

"The simple [English]words I had no problem with ... but they ignore you," he said. At Yee Hong, he continued, "We're living here like a family."

Siu Tin Ho, 87, spent 10 days in hospital more than a year ago, after a knee operation. When she was released, she moved into Yee Hong's Mississauga location, where her husband already lived. With a network of peers and regular schedule of social programming, such as a Chinese reminiscence group and cooking classes, living at a nursing home is much better than the monotony of being cooped up in the house. "I don't want to live with my children," she said.

PHYSICAL CARE

The average fall rate at Ontario's mainstream homes over four months was 13.6 per cent. At Yee Hong's centres, it was 8.9 per cent. The rate of nursing home residents reporting pain across Ontario is 11.6 per cent, compared with 4.4 per cent at Yee Hong.

In addition to benefits of a good diet resulting in fewer falls, Maureen Lynn, the executive director at Yee Hong Mississauga, credits the centre's interdisciplinary approach to care.

For example, if a resident has skin ulcers, it's all hands on deck, she said. A registered dietician recommends protein powder, nurses ensure the resident takes it and activation staff and occupational therapists lead the resident through customized exercises.

"For everything, as much as we can, we involve the team," Ms. Lynn said.

Staff also see great value in restorative care programs for seniors living with Parkinson's, dementia or who have suffered strokes. The exercises are always culturally appropriate.

On a recent day, as part of the program, a woman gave much consideration to which shade of blue crayon she should use to fill in the scales on a picture of a dragon. A few seats away, a man with a furrowed brow struggled to complete a Sudoku puzzle.

For the speech therapy program, Yee Hong sourced flash cards from Hong Kong featuring pictures of woks and traditional cooking utensils, Ms. Griffin Thomas said.

"There's no point flashing pictures of things from here because it's meaningless to them. It's really paying attention to what are the residents' cultural and linguistic needs."