JUDY WOODRUFF: Now a different look at providing care to those in need. It’s part of our occasional series on aging and the challenges of providing long-term care.
Tonight, we focus on Latinos, who will comprise 20 percent of the elderly population by the year 2050.
The “NewsHour”‘s Mary Jo Brooks has our report.
MARY JO BROOKS: Seventy-six-year-old Nicolasa Romero still gets teary when she talks about how much her life has changed after suffering a stroke eight years ago. A legal resident who immigrated from Mexico, she had been living with her daughter in suburban Los Angeles. But the stroke forced her into a long-term care facility.
NICOLASA ROMERO (through interpreter): Because of my stroke, I can’t walk. I can’t move one arm. My daughter lives on a second floor, and I couldn’t go up and down the stairs anymore.
MARY JO BROOKS: Romero is part of a trend among Latino senior citizens. Traditionally, they lived their final years with family members, who served as their caregivers. But as more and more Latino couples are working outside the home, there’s no one left behind to care for elderly parents. And so they are going into nursing homes.
In fact, there’s been a 58 percent increase in Latino admissions compared to a 10 percent decrease for whites. Rashmi Birla, who’s been a nursing home administrator for 14 years, has seen firsthand the surge in interest by Latinos, although she knows it remains culturally a tough choice.
RASHMI BIRLA, Nursing Home Administrator: It really is not easy for family members when they’re touring the building and they’re in tears and they’re crying, and just to kind of rub their shoulder and say, it’s OK, I understand it’s difficult, we will help you through this.
MARY JO BROOKS: Birla is now the director of the Country Villa Plaza in Santa Ana, a 144-bed facility where 70 percent of the residents are Hispanic.
In the past, many nursing homes haven’t welcomed minority residents, but, here, they have gone out of their way to provide cultural amenities, including entertainment, special food, and, of course, competitive games of loteria, a Mexican version of bingo.
RASHMI BIRLA: We get them involved, so it’s not that they are just sitting in their rooms. And that’s really what we’re trying to aim at, is saying that you can have a homelike environment, but yet still be able to read your newspaper with your coffee in the morning, and have those little comforts. But then you can have a big fiesta feast and with a mariachi band.
And all of that makes a huge difference in how they feel and the happiness that they have and the comfort they have.
MARY JO BROOKS: Romero says the people at Country Villa have become her new family and she never wants to leave.
NICOLASA ROMERO (through interpreter): I want to spend the rest of my days here. I want to die here, because, when you die, you should be in a peaceful place. And this is a peaceful place.
MARY JO BROOKS: But centers like this, which cater to Hispanics and offer high-quality care, are still far too rare.
A Brown University study three years ago concluded that minorities, far more than whites, live in facilities that are substandard, suffer from staffing issues and poorer quality of care. It’s one of the reasons Al Mendez says he won’t consider the idea of a nursing home. For more than four years, he has helped care for his 77-year-old father, Jaime, who suffers from Parkinson’s. Jaime lives in a small cottage behind his son’s house.
AL MENDEZ, Son of Elderly Father: He’s my father. I want to care of him forever. And that’s the way we were always — we were raised that way, to take care of each other. So, he just wants us to — he wants to — he’s always with us.
MARY JO BROOKS: But a year-and-a-half ago, a social worker told Mendez that his father’s health might actually improve if he spent a few hours during the day at a senior health facility.
Now, three times a week, Jaime rides a shuttle to a PACE center just two miles from his house. PACE, which stands for Program of All-Inclusive Care, was started in the 1970s in California. There are now 98 such centers across the country. This and five others in the Los Angeles area are run by a nonprofit managed care group called AltaMed, which caters to poor and underserved populations.
The centers accept only patients who have been certified by the state as eligible for a nursing home, but it is a day center only, so patients can continue to live at home with family. PACE centers are often located in impoverished neighborhoods and they reflect the ethnic background of those residents.
Here at the El Monte center, the population is 88 percent Latino. They offer exercise and physical therapy, breakfast and lunch, numerous social activities, and full medical care.
JAIME MENDEZ, Attends Daily Care Center (through translator): I like coming here because I get lots of attention, and that’s good. The staff takes very good care of me.
MARY JO BROOKS: On the day we visited, there was an elaborate celebration for the Feast of Our Lady of Guadalupe, which included a Catholic mass, an outdoor procession and mariachi music.
Dr. Esiquio Casillas, medical director for AltaMed Senior Services, says taking part in a broad array of social and cultural activities is key to improving health and well-being.
DR. ESIQUIO CASILLAS, Medical Director, AltaMed Senior Services: The World Health Organization estimates that only 10 percent of a person’s well-being is really impacted by medicine and medical care, whereas the social determinants of health, nutrition, where they live, poverty, environmental factors, impact much more of their well-being.
When they come here, obviously, they get to do the important socialization with other people, and do the cognitive activities to maintain their cognitive functioning and obviously their physical activities as well.
MARY JO BROOKS: For 86-year-old Eva Alegria, the PACE program literally saved her life. She had lived in her own home for 60 years, but was growing more and more depressed as her health failed.
EVA ALEGRIA, Attends Daily Care Center: I was very depressed. I was ready to go.
EVA ALEGRIA: In fact, believe it or not, I asked my friend who does wedding dresses, I told her how I wanted to be buried.
MARY JO BROOKS: But her sons had other plans for her. They enrolled her in the PACE program, kicking and screaming, she says. Within weeks, though, she’d had a complete turnaround. Now she loves coming for the food, the parties, the camaraderie. She hopes that if she keeps exercising, she may even get out of her wheelchair to dance with the mariachis.
EVA ALEGRIA: I told that guy up there, I said, wait a little while longer.
MARY JO BROOKS: Patients at the center must use AltaMed physicians, rather than outside doctors, which discourages some from joining. The tab for the services is picked up by Medicare or Medi-Cal, California’s version of Medicaid. Still, it’s expensive to start a PACE program, which may explain why there aren’t more of them.
DR. ESIQUIO CASILLAS: There is a lot of investment up front to get these programs started. Many of them take four or five or even more years to start up. It’s a multimillion-dollar investment. But I think things are changing a little bit. There’s been quite a bit of interest in the past few years. There’s quite a few new programs started in California.
And I think the health plans and the state are realizing that this is really the ideal program for these very frail patients who are not yet in a nursing home and who can be kept out of a nursing home with the right resources.
MARY JO BROOKS: Californians do have other options for adult day facilities, but state funding for those programs was severely cut three areas ago and will be at risk again next year. It’s a situation that could become one of the country’s biggest challenges: how to provide quality long-term care for an elderly population that is expected to double in the next 15 years.
JUDY WOODRUFF: What can you do to keep yourself happy and healthy in old age? We prepared seven tips for successful aging recommended by the people featured in this segment. You can read those on our Rundown.