Tazuko Shibusawa, Ph.D.
With increasing costs of
institutional care, in-home care is viewed as a viable alternative to ensure
independent living among frail elderly (Benjamin, 1993). While research is available on the
cost-effectiveness of home care services, there has been little research that
reflects the perspectives of elders who seek home care assistance (Applebaum
& Phillips, 1990). In addition, very
few studies examine the effects of ethnicity and culture on attitudes towards
seeking formal care, i.e., help from non-family members (Noelker et al.,
1998).
In traditional Asian
cultures, adult children were expected to care for frail parents. Seeking help from non-family members is,
therefore, a new concept for many Asian American elders. How do Asian American elders feel about seeking
paid help from non-family members? Are
they willing to receive help from workers of a different ethnicity or from
those who do not speak the same language?
Do they want to be cared for by their adult children or do they prefer
to receive care from a non-family member?
The purpose of this study was to address these questions among Japanese
American older adults.
Because of immigration
patterns, Japanese American elders have the highest proportion
of
U.S.-born elders among Asian Americans.
Recent figures indicate that 63 percent of Japanese American elders are
U.S.-born in contrast to 16 percent of Chinese American elders (Elo,
1997). Investigating Japanese American
elders can, therefore, lend potentially useful information on the effects of acculturation
among Asian American elders.
According
to previous research Japanese American elders have retained cultural values of
their country of origin and are comfortable towards depending on their adult
children for care (Kiefer, 1974; Osako, 1979). It is important to note, however, that these
studies were conducted over twenty years ago when the Japanese American elderly
population composed primarily of first generation immigrants known as Issei, who were born in the late 1800s
and early 1900s. Today most Issei have passed away, and the majority
of the elderly in the Japanese American community are those born in the
Structured interviews were conducted with a
community sample of 131 Japanese American elderly (53 males and 78 females), 60
years of age and over. In addition to
obtaining basic demographic information, respondents were asked about their
health and mental health status, social support, and social network. Attitudes towards help-seeking were measured
by asking if the respondents agreed or disagreed to an index of 16 statements
pertaining to seeking help for personal care from family and non-family
members. Varimax factor analysis
extrapolated three factors that consisted of 10 statements (alpha =.79). The three factors were conceptualized as 1)
preferences for helper characteristics (alpha =.67), 2) interpersonal
concerns toward the helping relationship (alpha =.67), and 3) attitudes
towards depending on family members for care
(alpha =.62). Preferences toward helper
characteristics included willingness to seek help from those who did not speak
their language or were of a different ethnicity or sex. Concerns toward the helping
relationship included reluctance to seek help because of fear of losing
personal control, having to burden the caregiver, and fear of losing privacy. Attitudes towards depending on family members
included concerns toward being too dependent or being a burden on family
members.
Multiple regression analyses
were conducted to examine the effects of the demographic and cultural variables
on each of these three factors. Results
show that acculturation was associated with all three aspects of
help-seeking. Elders with lower levels
of acculturation preferred helpers of the same cultural and linguistic
background and of the same sex, had concerns about the interpersonal aspects of
the helping relationship, and did not feel comfortable towards depending on
family members for support. Elders with
low income were also reluctant to seek help because of concerns about the
helping relationship, and did not want to depend on family members for support.
The results of this study
confirm previous studies that identify acculturation as an important predictor
for help-seeking. Older adults who are
less acculturated are reluctant to seek help from someone of a different ethnic
and linguistic background, have more concerns about the helping relationship, and
are reluctant to become too dependent or a burden on their family members. Given their language preference it is
understandable that they prefer help from someone who speaks the same language. They are also more at ease with people of the
same cultural background, which may make them reluctant to receive help from
someone of a different ethnicity.
Concerns over the helping relationship may be due to the lack of models
in non-kin helping relationships in traditional Asian cultures. Elders may not be used to asserting their
needs and negotiating for what they need from the helper. Furthermore, when
elders feel that they may not be able to reciprocate for the help they receive,
they may be more reluctant to become dependent on their family members. In addition,
elders may feel that their children are more acculturated than they are, and do
not retain the cultural values of filial obligation. The narrower range of
acceptable help for elders who are less acculturated places them at risk for
not obtaining necessary services.
Another important finding
was the association between low income and concern about the helping
relationship, and reluctance to depend on family members for support. Low-income elders may be reluctant to seek
help because their services are paid thought SSI. They are not able to select and chose the
help they want, and they also may feel disempowered in the helping relationship
because of their income status. They may also be more reluctant to become
dependent on their children, because they have limited resources to share with
their adult children. The results of the
study indicate that social workers need to be sensitive to socioeconomic
factors as well as cultural factors when assisting elders to seek home
care.
The study's principal investigator is Tazuko, Shibusawa, Ph.D.
This study was conducted with the collaboration of Hisanori Ishikawa,
Ph.D., Department of Social Work,
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