By Lucas Anderson
It began with necessity, Sam Wan recalls.
In a community forged with unity, in the mid 1980’s Seattle’s Chinese found themselves fragmented. Residents needed a cause to bring them together; a continuous strand that would be able to thread each faction into one. That cause would be the family, and those who are most respected in it: the elders.
Wan is chief executive officer and a founding member of Kin On, an elderly care organization based in Columbia City and created specifically to serve the Chinese community. With a predominantly Chinese staff practicing culturally based care, the Kin On Health Care Center has become a prominent force in ethnic elderly care in King County.
“In the Asian culture, nobody will disagree with you if you want to take care of the elders,” said Wan, who was a planner in the City of Seattle Division on Aging prior to Kin On’s creation, and became the first executive director in 1986, leading the effort for the development of Kin On’s flagship project, its nursing home.
Kin On’s success, Wan explained, would not have been so swift without the help of those who came before it.
Seattle Keiro, a Japanese elderly care organization, is ten years senior to Kin On, and provided infrastructure and an early home for its operations. Occupying one of Keiro’s older buildings, Kin On was able to establish itself and develop its much-needed services.
Over a decade of fundraising, the community raised $3 million in support of moving Kin On out of Keiro. The names of donors are displayed prominently in the entryway of Kin On’s 100-bed facility in south Seattle, built in 1996 as a result of that generous community support.
Each facet of the single-floored capacious facility was designed specifically for its residents. Knowing that most of its clients were of Chinese heritage, Kin On’s planners were able to create an experience in line with the ideas and practices of traditional Chinese culture.
As Wan led a reporter through the facility, he explained the thoughtful yet simple alterations to Kin On that enable that environment: Wide open hallways that can fit five across and an expansive dining room that looks as if the entire facility could inhabit it. Wan says these design features facilitate a “going to the market” concept, reflecting China’s reputation for plentiful and countless farmer’s markets and the community and conversation they encourage.
Emphasizing the communal focus of the building, Wan explained, the single story building has no wings or areas separated by blocking doors, allowing any resident, regardless of reason for stay, to visit any part of it.
“We treat this facility as a community facility,” Wan said. ‘It’s a nursing home; that’s what we do, but our approach is a little bit different.”
Calligraphy and watercolor art created by residents can be seen on the walls around the building, and are augmented at times with traditional Chinese festival displays such as the Dragon Boat Festival in June.
Every night, residents have dinner options that include familiar Chinese dishes such as stir-fried zucchini and cauliflower, winter squash soup, and shrimp tofu.
Kin On’s creation and continuation has had a positive impact on the Chinese community, according to Wan, but it did not come without opposition, albeit a silent one. The mere concept of an elderly care facility works against the strong Chinese traditions of family and caring for one’s elders, he explained.
Armed with this knowledge, and continuing desire to fit the needs of its community, Kin On’s staff created the Kin On Community Care Network, a home care and educational outreach program for families choosing to care for their loved ones at home.
With the help of a GlaxoSmithKline grant, Kin On developed a home care service, a caregiver support system, and hospice services. In addition, the facility added an Alzheimer’s Disease and Dementia Program that was unprecedented among ethnic care facilities in the Northwest.
In Alzheimer’s disease, Kin On faces one of its toughest adversaries. An incurable, degenerative brain disease, Alzheimer’s destroys brain cells and one’s thinking, behavior and memory abilities.
The cultural differences in perception of dementia or Alzheimer’s often create a difficult barrier for a mainstream ‘Western’ care facility to care for ethnic cultures in the United States. For the Chinese, the National Institute on Aging says language and traditional values often interfere with diagnosis and treatment of the disease.
According to a report funded by NIA, “terms used for dementia in Chinese include ones that translate into English as ‘stupid and silly’ or ‘less smart’.” Similarly, the common Chinese characters associated with dementia translate to ‘crazy’ and ‘catatonic’. Alzheimer’s is also often generalized in the Chinese community as psychiatric illness, not as a unique disease.
While these results are not applicable to all Chinese groups or people, Jane Wong, the social services director of the Kin On Community Care Network, has attributed problems of outreach and communication with families in part to these cultural walls.
“It’s hard for them to accept,” said Wong. “In the more traditional Chinese thinking, they don’t know what it is; they don’t see it as a disease.”
Wong said she sees the issue in diagnosis and submission to care, citing a fear of ‘bad luck’ or ‘being possessed’ undermining an acceptance of having the disease. Wong says it will take a lot more time and education before people are completely open to care.
In King County, Alzheimer’s was the fourth leading cause of death from 2003-2007, just behind stroke, and was the seventh leading cause among Asian/Pacific Islanders. Asian Americans have the highest life expectancy of any ethic group (87.4 and 82.1 years for women and men respectively) and Alzheimer’s prevalence increases drastically over the age of 80. However, the rate of deaths due to Alzheimer’s in the county’s Asian population is slightly more than half of that of the entire population, according to the King County Department of Public Health.
Wong and the Community Care Network have made progress through the Alzheimer’s and Dementia Support Program, which provides informational and educational support as well as home visits. Wong, with the help of another co-worker, visits 21 clients throughout King County on average once a month, focusing on helping the caregiver and assessing the needs of the family.
On the educational side, the largest hurdle is language. While nearly all of Kin On’s staff members speak both Chinese and English, many information resources are only available in English. The Community Care Network provides its own materials in Chinese, but PBS’s Alzheimer’s documentary, The Forgetting, for example, either has to be translated, or limited to showings to English speakers.
The nursing home has made novel accommodations for its patients living with Alzheimer’s in the facility. “We felt that it was important for people who have Alzheimer’s that we treat them as part of the community,” said Wan. In the building, frequent color changes and even an outdoor portion diversify the scenery, replacing long, repetitive hallways that can confuse Alzheimer’s patients.
The facility has a very low turnover rate for staff as well, a consistency that Wan believes is important in the care for Alzheimer’s patients.
As it nears its 25-year anniversary, Kin On is still developing and adapting to the needs of its community. Wan said the center dodged a bullet with a recent veto of budget cuts by Governor Chris Gregoire, but has still experienced a funding decline in recent years. Kin On’s funding comes from its residents, mostly through Medicare and Medicaid patient reimbursements from the state, grants, and public donations. While state reimbursement has declined, the beds at Kin On are never empty.
The Community Care Network is funded by client payments through Medicare and Medicaid. Wan believes that if the center provides the services the community needs, the support will be there.
While these struggles continue, Wan is making preliminary plans to build a 50-unit senior housing project, as well as a ‘Healthy Aging Center’ on land surrounding the care facility in Columbia City.
(Lucas Anderson is a University of Washington journalism student. He reported this story in a course on global health reporting.)