For Immigrants, Agony Over Ailing Parents

As a maudlin telenovela flickered inside her Rosemead home, Maria Vasquez’s eyes widened and her mouth went limp.

Moments later, the octogenarian was found by a daughter, propped like a board against the sofa--crippled by a stroke.

Three years ago, the Vasquez children were thrust into a painful but common scenario as they took their mother in and out of hospitals. A year later, they faced an even more confounding question: Whether to put her in a nursing home.

Back in El Salvador, from which Vasquez and her family emigrated about 20 years ago, the decision would have been easy. There, you took care of your parents at home “even if they died sooner because of it,” said the youngest daughter, Leticia Brenes.

But Brenes’ older brother and sister were unwilling or unable to take care of Vasquez. Deciding the fate of her mother fell to Brenes, and she was increasingly dependent on a wheelchair herself because of a childhood bout with polio. She also had two adolescent children and a husband to worry about.

And so, two years ago, Brenes made a decision that did not feel right but seemed to make the most sense: She put her mother in a nursing home.

“We both cried, my mother and I,” Brenes said. “I think I made the right decision, but I feel like I let her down, like I made her world crash on top of her.”

Placing a relative in a nursing home is difficult for almost any person of whatever race or ethnic group. But for newer immigrants, it can trigger a deep sense of guilt--or an enduring stigma--when a person becomes the first in a family to be admitted there.

And for those immigrants sent to a nursing home, being ripped out of a “cohesive, tightly knit situation is a mortifying, devastating experience,” said William Thomas, a rural New York-based geriatrician.

With the fastest growing elderly populations in California, members of the Latino and the Asian communities are increasingly grappling with the question of how to care for aged loved ones when they become ill, incontinent or even inconvenient to have around.

Traditionally, the decision to put an elderly parent or relative in a nursing home has been seen by these communities as a kind of familial treason.

In families where parents almost never kick their children out when they reach adulthood, the largely unstated law of reciprocity holds that the good son or daughter takes care of his or her aged parents no matter the cost.

Kim Miller, an associate director at the Edward R. Roybal Institute for Applied Gerontology at Cal State L.A., tells the story of a Korean woman who had to “hide her face” after putting her husband in a nursing home. Surprised at a Los Angeles restaurant by acquaintances, she was asked how she could dine there when her husband had to eat his meals in an institution.

Yet, as Latinos and Asians become more Americanized, a number of factors will make it more difficult to keep older relatives at home, experts say. Assimilation also means rising divorce rates, more dual income and smaller families, and children who live farther away from the parents’ home.

“It hurts me to say, coming from a fantastic extended family myself, but there’s no economic imperative for this level of family cohesion,” Thomas said. “In fact, it’s a drain on economic performance. I mean, can you imagine telling your children not to move across the country if there’s a job there? Can you imagine telling them to quit making more money so they can take care of you?”

Taking the Blame for Parent’s Death

Audrey Leung decided to put her father, an Alzheimer’s patient, in a nursing home after agonizing reflection. But like others in her situation, she worried about the care her father would receive.

She had sacrificed a successful real estate career to care for her father day and night for more than two years. But after her father’s erratic, increasingly hostile behavior drove her mother back to Hong Kong, Leung was at her wit’s end.

In the traditional Chinese way of thinking, the decision was clear-cut: She was duty-bound to care for her father, to weave to the rhythm of his ragged life, even if she had to spend years and years caring for a man whose mind was so ravaged that he once introduced Leung as his wife.

Fighting through depression, Leung finally put her father, Wai Sang, 75, in a Canoga Park nursing home. She steeled herself by thinking of all the bad things her father ever did. She allowed “no pleasant memories of my father to occupy my mind.”

The nursing home raised a sobering reality--her father would be the lone “Chinese face” in the facility. The manager of the nursing home told Leung it would be best not to visit for two weeks so her father could get acclimated.

As she left, Leung heard her father, shouting through a locked door, “Let me out, let me out!”

Leung visited her father after the second week. Depressed and no longer eating, he had deteriorated. By the third week, he was dead.

“It seems I’m the one who killed him,” Leung said, explaining that his death apparently was accelerated not by his illness but by the alienation of the nursing home experience.

For a while, Leung was driven to visit nursing homes like a ghost, walking the halls and reflecting on what had happened to her father.

Later, she started the Asianic, a Monterey Park-based organization that tries to mentally prepare elderly Asians for the possibility that they may not live out their years at home with their children.

Leung does not want them to wither away like her father did. And she does not want her children to feel the guilt she did if, one day, they find they cannot take care of her.

Some Families Hire a Sitter

Pu-Chan Shang, 97, has lived at the El Monte Convalescent Hospital for the last two years. A friendly Shanghai woman--a sort of bodyguard against the withering effects of cultural isolation--stands ready to serve or simply speak in Shang’s Taiwanese during marathon shifts six days a week.

Daughter Li-Ying Chen and her eight siblings pooled money to hire the “sitter.” Chen had been concerned that her non-English-speaking mother wouldn’t live long in the nursing home with no one to talk to.

Shang ran a business in her country, a place where elders held a singular place of honor. Good treatment or no, Shang does not want to be here, and she lets her daughter know it.

Shang is here because of a broken hip and because Chen thought her mother could get better care in a nursing home. Most of Shang’s children are spread out across the United States and Taiwan. Often, Shang complains to Chen because her other children do not visit much.

“She gets frustrated and angry. I try to visit her often and comfort her,” Chen said. “Everything, she wants to control. It’s very hard for her because she really expected her kids to be with her.”

Anguish for the Family

Nothing was the same after the armored truck broadsided the car carrying Dionicio and Matilde Rodriguez in April 1987.

Matilde suffered brain injuries and slipped into an unresponsive state. A thin, low-key woman, Matilde had been a devoted grandmother--”Nobody baby-sits but me,” she used to tell her children. But after the hospitalization, she could only occasionally mutter words or groan when being turned in her bed. Her children put her in the El Monte nursing home.

Dionicio also deteriorated. He was diagnosed with cancer. He started to lose control of his body functions. He became bedridden at the home of his daughter, Helen Gomez.

“I remember having to clean him after he’d soil himself and he could see my eyes getting wet. He said, ‘I’m so sorry.’ I’d tell him, ‘Dad, don’t worry about it.’ ”

A year after his wife was admitted to El Monte, Dionicio was carried into the same facility by his son, Manuel. “No me lleves mijo,” Manuel remembers his father crying, asking him not to take him away.

“I know I wouldn’t want to go into one of those places,” said Manuel, 68. “I know it wasn’t the right thing to put him there, but there was no one to take care of him at home the way he was.”

Six months later, Dionicio died of pneumonia at the age of 82. It’s unclear whether the husband ever visited his wife. The remorse of the accident weighed heavily on Dionicio and might have kept him away from Matilde, family members say.

Manuel visits his mother, 93, a native of the Mexican state of Guanajuato, once a month, but it is his sister Helen who has kept a decade-long ritual, visiting practically every day.

Gomez, along with her son and daughter, were the only family members present when Dionicio died in 1988. Even now, the memory of her ailing father’s departure to the nursing home makes her choke with sobs.

Some family members have suggested it would be emotionally better for Gomez if she did not visit her mother every day. Gomez disagrees.

“Why not? The pain is not going to go away,” she said. “I don’t want her to feel alone. I clean her nails. I can talk to her, I can touch her, I can kiss her.”

Greater Numbers of Asians, Latinos

Like many nursing homes, the El Monte Convalescent Hospital has the look and feel of a mini-hospital, a 99-bed facility with a tiny courtyard in the middle. More than half the patients are white, and the number of Latinos has grown gradually, now making up a third of the residents.

The most dramatic increase, however, is in Asian American residents. Administrator Jesse Telles said Asian patients were virtually nonexistent there five years ago. There are now about a dozen patients at the home.

A 1996 report on the nursing home population statewide, the latest one available, showed this breakdown: 76.7% white, 9% Latino, 8.5% black, 4.8% Asian / Pacific Islander and 1.1% Native American or others.

Inquiries from Asians and Latinos about nursing homes are growing dramatically, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

“People are calling about putting their loved ones in nursing homes, or to find ways to keep them out of nursing homes,” McGinnis said.

About 75% to 80% of the patients at El Monte are poor enough to qualify for long-term coverage under Medi-Cal, said Telles, with the government paying about $2,400 a month per person. Almost everyone else is covered by Medicare, which provides shorter term coverage.

Fernando Torres-Gil, director of UCLA’s Center for Policy Research on Aging, said that the growing presence of Latinos and Asians, two populations with a special aversion to nursing homes, may push legislators to more closely examine in-home care alternatives, which he calls more cost-effective and humane than convalescent homes.

Other specialists in the field say that the quality of the nursing homes must improve. A recent study by the federal General Accounting Office found that one of three nursing homes in California have problems that could jeopardize the health and lives of their residents.

Even in good nursing homes, with caring staff, patients can suffer from a feeling of disconnection from loved ones, and for the most mentally alert, a feeling that illness, both physical and mental, surrounds them.

For Latino and Asian patients, the isolation can be even more severe, particularly if they do not speak English or do not have their staple foods available, experts said.

Perhaps mindful of that situation, Asian and Latino children tend to visit more frequently than others, bringing food, music and grandchildren with them.

In the future, it’s a drill that more people in the immigrant-heavy communities will probably learn.

A Fear for the Future

It’s a Saturday and Leticia Brenes, 46, maneuvers her wheelchair down the El Monte nursing home hallway to visit her mother, Maria Vasquez, 84, the soap opera fan. She visits her mother at least once a week.

About 20 years ago, Vasquez, her late husband and children coordinated the trek north to America from El Salvador. The oldest son, Alejandro, stopped in Mexico and stayed there. Vasquez says that she would like to see him before he, or she, dies. But that is no longer possible: Alejandro died of cancer in October and Vasquez has not been told.

Vasquez clings to a lingering hope: Being able to walk. “This is what makes me angry,” Vasquez says, pounding at her legs and crying. “My daughters can’t take care of me. If I could walk I would be with them. But I can’t.”

Brenes doesn’t have the heart to tell her mother that she will never walk again. Or ever come home.

Brenes sometimes wonders what kind of bargain she has struck for her own future. Did she unlock a once-untouchable option for her U.S.-born children when she too gets old and frail?

Will she, like her mother, measure her life by the intervals between her children’s visits?

Brenes fears that the forlorn old woman in Room 7B will one day be her. Her 12-year-old son has made her a promise. “He told me that if he can’t take care of me personally, that he’ll hire someone to take care of me at home,” Brenes said.

“I tell him, ‘I hope it’s how you say, mi hijo, because look at your grandmother. See how sad she is.’ ”

At times, when Vasquez gets frustrated and cries, Brenes takes her mother’s hand and says:

“No mami, take things with calm. Ask God for patience.”

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Information on Facilities for the Elderly

The differences among retirement communities, convalescent homes and nursing facilities are not always clear. Retirement homes are geared toward active people; convalescent hospitals are for those requiring constant medical attention. Between those two types of facilities lie numerous choices in skilled nursing or board-and-care facilities.

A nursing home (licensed and inspected by the state Department of Health Services) is for patients with chronic conditions who must be monitored and have their medications administered but who are not sick enough to need hospital services. There are two types of nursing homes: intermediate-care facilities, which offer eight hours of nursing a day; and skilled nursing facilities, which provide around-the-clock nursing care.

Board-and-care homes, also known as residential homes or community care facilities (under the supervision of Community Care Licensing, state Department of Social Services), are designed for people who need assistance in such daily activities as dressing, getting out of bed, eating and getting to and from doctor’s appointments but who do not need constant medical attention.

Help is available in planning for old-age care. Here are some free service organizations that monitor the quality of care homes and provide counseling and information.

* WISE Senior Services, a nonprofit private organization assisting senior citizens with questions or complaints about convalescent or nursing home care through their long-term care ombudsman program. (310) 394-9871 or (800) 334-9473.

* Connections Referral Services, an agency licensed by the Department of Health Services to provide information and referral to retirement, board-and-care and nursing homes, and facilities for Alzheimer’s patients throughout Southern California. (800) 330-5993.

* Health Insurance Counseling and Advocacy Programs, which provides objective information, counseling and assistance to Medicare beneficiaries and their families regarding Medicare, managed care, long-term care insurance and other related health insurance issues. For information call (800) 434-0222.

* California Advocates for Nursing Home Reform, a nonprofit organization that tracks deficiencies and violations in skilled nursing facilities. (800) 474-1116.

Source: Los Angeles Department of Aging