Informal and Formal Support among Community-Dwelling Japanese American Elders Living Alone in Chicagoland: An In-Depth Qualitative Study

Abstract

A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders' attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.

Long‐term care planning and preferences among Japanese American baby boomers: Comparison with non‐Japanese Americans

“…In traditional JA families, paid home care seems to be particularly challenging given the Japanese value of privacy and the reluctance to disclose family matters to outsiders . Even when Nikkei (JA) families decide to use formal care, service providers at non‐Japanese‐specific facilities might not know the wishes of Nikkei older adults due to enryo – hesitation or restraint in asking others to do something for them because of their reluctance to cause inconvenience to others . Because of the shared cultural value, Japanese and JA know how to deal with enryo , and encourage older adults to receive the care that they want and deserve.…”

“…19 Even when Nikkei (JA) families decide to use formal care, service providers at non-Japanese-specific facilities might not know the wishes of Nikkei older adults due to enryo -hesitation or restraint in asking others to do something for them because of their reluctance to cause inconvenience to others. 20 Because of the shared cultural value, Japanese and JA know how to deal with enryo, and encourage older adults to receive the care that they want and deserve. In this aspect, the cultural barrier of enryo was one of the principle reasons behind the development of Japanesespecific LTC services in the USA.…”

Colorectal Cancer Knowledge, Attitudes, Screening, and Intergenerational Communication Among Japanese American Families: An Exploratory, Community-Based Participatory Study

“…If more than one parent or offspring met the eligibility criteria, the family chose the participant based on availability. We restricted our study to English-speaking individuals because over 95% of Nikkei adults living in Chicagoland were known to be English proficient according to prior research projects (Lau, Machizawa, & Doi, 2012) and JASC's 65-year history of serving the Chicagoland's Nikkei community. Institutional Review Board approved this study; parents and offspring consented to participate in the study.…”

Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

“…The race and ethnicity of veterans in the HBPC, CLC, and CNH cohorts mirror the distribution of veterans nationally, with 4.5% of veterans of Hispanic ethnicity and 0.3% of Asian descent . In contrast, MFH veterans were significantly more likely to be Asian or Hispanic, two cultures that have historically valued family caregiving and home care over nursing home placement . Several explanations may contribute to this finding.…”

“…34 In contrast, MFH veterans were significantly more likely to be Asian or Hispanic, two cultures that have historically valued family caregiving and home care over nursing home placement. [35][36][37][38][39][40][41] Several explanations may contribute to this finding. One intriguing explanation may be that veterans with these backgrounds and their families sought the MFH program as a more-acceptable alternative to nursing home placement.…”