Culturally Sensitive Long-Term Healthcare Services for Japanese Canadians -Understanding the needs of care recipients and family caregivers-

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Culturally Sensitive Long-Term Healthcare
Services for Japanese Canadians-Understanding
the needs of care recipients and family
caregivers-

• Naoko Metz
• NET Masters Trainee
• MA in Counselling Psychology, Trinity Western
  University
• Thesis Supervisors
• Dr. Marvin McDonald, Trinity Western University
• Dr. Maria Cristina Barroetavena, BC Cancer Agency
• NET Research Day
• June 6, 2006

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Background Seniors in BC

• BC has one of the most rapidly aging populations
  in Canada

• It is estimated that seniors (65 years and
  older) will make up
• approximately 24 percent of the total population
  of BC in 2031

• 13.3 percent of BCs total population is over 65
  years and
• Immigrants made up a total of 36 percent of
  senior population (2001)

• Large number of seniors whose mother tongues
  are other than English, especially Asian
  languages are prominent in BC

• Race and ethnicity continue to function as
  systematic barriers to accessing and providing
  health services including long-term care
  services
• (A profile of seniors in British Colombia)

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Background Japanese-Canadians (JCs)

• Approximately 37,300 of Japanese-Canadians reside
  in BC (total JC population 73,300)
• About 65 of Japanese were born in Canada, the
  highest proportion of all visible minority groups
  
• The percentages of intermarriage are the highest
  of all the ethnic groups (95)

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Background Japanese-Canadians, cont.

• The number of Japanese immigrants has remained
  constant (1300/yr) but the number of people with
  mixed Japanese ancestry has nearly doubled in 10
  years
• Exhibit high level of social integration
• High percentage of them holding professional
  and/or managerial jobs
• Low unemployment rate and high educational level
• (Statistics Canada, Census 2001)

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Background Japanese-Canadians (JCs), Cont.

• Inter-group differences among Asian cultures in
  conflict resolution
• Japanese infrequently use assertive mediation
  techniques such as criticism, education, and
  disputant separation
• Japanese are more apt to rely on nonassertive
  techniques such as gathering information from the
  disputants, listening to opinions, and relaying
  these between disputants
• Japanese approach is significantly less assertive
  than that used by the Chinese or the South
  Koreans (Callister and Wall, 1997)

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Characteristics of Traditional Japanese Culture

• Giri refers to obligation/duty, the expectation
  that all help would be provided from within the
  family may result in resistance to obligating
  oneself to an external help
• Gaman refers to perseverance/self-control
• Enryo refrain from imposing self-interest or
  needs, self-restraint/reserve
• Haji refers to shame/disgrace (Kobayashi, 1999)

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Traditional Japanese View for Caregiving

• Oya koh koh -filial obligation/piety
  (Kobayashi, 1999 Hashizumi, 1998 Young,
  McCormick and Vitaliano, 2002)
• Sekentei -conformity to the society/community
  in general and how it relates to specific norms
  (filial obligation) or more general norms such
  as self-sacrifice, endurance
• Obasuteyama- the legend in old Japan in rural
  poor area that they used to leave elders in the
  mountain to starve them to death. Obasuteyama
  is also used as a symbol of self-sacrifice from
  elders point of view, in order to avoid being a
  burden to others (Young et al, 2002 and Saldov
  Kakai, 2004)
• Shikataganai-refers to the view that the
  situation cannot be helped and nothing else can
  be done. (Flanagan, 2003)

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Study Overview

• Purpose This qualitative study was designed to
  investigate issues faced by Japanese- Canadia
  n (JC) family caregivers and care recipients
  and to explore culturally distinctive
  adjustment and coping behaviours in the
  context of long-term care services
• Study location Vancouver lower mainland, BC
• Recruitment Local news papers and community
  centres

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Study Overview, cont.

• Participants
• Adult Japanese-Canadians who are/were family
  caregivers, care recipients, or professional
  caregivers in a long-term care setting
• Interview Procedure
• Demographic, confidentiality and consent form,
  followed by individual semi-structured interview
  (JP/EN)
• Data Analysis
• Phenomenological analysis-Primary and shard
  themes were identified

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Definitions

• Japanese-Canadians Those who consider
  themselves as Japanese or Japanese-Canadian,
  including 1st and 2nd generation
• Family Caregivers Those who consider themselves
  as primary family caregivers who are currently
  or have provided care in the past for their
  family members at home and/or at a care facility
• Care Recipients Those who are currently
  receiving care either at home or at long-term
  care facility due to old age related health
  concerns, chronic and/or life threatening
  illness. Anticipated future care recipients were
  also included in the study

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Family Caregivers Demographics

• Total of 6 family caregivers, all females
• Age ranged from 40s (3) and 60s (3)
• All born in Japan with the length of residency 5
  to 48 years
• Married with child(ren) (4), widow (1), divorced
  (1)
• English proficiency bilingual (3), mid (1),
  beginner (2)
• Education high school diploma (1), collage
  diploma (3), university degree (2)

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Family Caregivers Demographics

• Occupation Homemakers with retired spouses (3),
  part-time job (1), family-owned business (1),
  writer (1)
• Religion Christian (5) and none (1)
• Relations to the CR mother-in-law (2), parent
  (2), spouse (2)
• Type of illness stroke, cancer, dementia,
  accident related severe injury including head
  and/or hip injury
• CRs outcome death (5) and partial recovery (1)

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Care Recipients Demographics

• Total of 4 care recipients male (2) and female
  (2)
• Age from 60s (1), 70s (1), 80s (1), 90s (1)
• Receiving care at home (1), at the Japanese
  assisted care home (1) and prospective care
  recipients (2)
• Born in Japan (3)/Canada (1) with residency from
  13 to 90 years
• English proficiency Bilingual (1), mid (1),
  beginner (2)

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Care Recipients Demographics, cont.

• Occupation All retired (home maker, agricultural
  business owner and university professor)
• Education high school diploma (2), 2 year
  collage (1), and graduate degree (1)
• Health concerns cancer, hearing and walking
  difficulties, heart condition, high blood
  pressure, and arm/hip/leg pain and diminished
  usage
• Religion Christian (3) and none (one)

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Themes
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Language Barriers

• Key underling issue affecting the overall
  long-term care experience of JapaneseCanadians
• Primary themes
• Communication difficulties with medical/legal
  personal
• Being a liaison, advocate on behalf of a care
  recipient
• Concerns/hesitation for living in a mainstream
  care home
• Limited opportunity for socialization (isolation)
  
• Limited availability in language-matched care
  services
• Inter-generational communication gap

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Language Barrier, cont.

• At the hospital, there was a lack of
  translator. Everything fell upon us. In the last
  3 weeks of my fathers life we were at the
  hospital 24/7. There were the rounds of doctors
  to explain the situation but also for the sake
  of my fathers comfort. We always feared to miss
  something important. Without our help my father
  would have signed papers without knowing what
  they were. So this was a big issue. And I was
  thinking Oh my God. What about all of the
  patients who are alone and do not speak
  English! (Family Caregiver)
• It is miserable to live in a care home where
  one can not speak in Japanese. Even those who
  used to speak English (when they were young)
  tend to forget English as one gets old. So,
  language is the most significant aspect of our
  daily life.
• (Care Recipient)

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Culturally Rooted Culturally Accommodating
Coping Stances

• Culturally rooted coping stance
• Gaman (self-sacrifice/endurance)
• Shikataganai (acceptance)
• Enryo (self-refrain/hesitation)
• Culturally accommodating/ mainstream coping
  stances
• Being assertive and proactive in protecting ones
  rights
• Being assertive in voicing ones needs and
  demanding better service

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Culturally Distinctive Coping Stances

• I dont want to be too arrogant, you know, then
  nobody comes near me or be scared of me. So, I
  dont want to be too arrogant. I want to keep a
  low profile. I try not to ask much, I try not to
  be a burden to anyone. (assisted care home
  resident)
• I think its a Japanese personality trait, we
  Japanese release stress and tension by crying or
  do a bit of mumbling, you know somewhat passive.
  But in the North American main culture, there is
  a mentality like be strong and fight back when
  you are faced with adversity. It has more
  positive and assertive connotations. This is not
  a typical Japanese way of coping. (Family
  Caregiver)

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Culturally Accommodating Coping Stances

• Caregivers should make sure to write a detailed
  journal about the treatment the patient is
  receiving. One should make sure to read and
  understand all the documents before signing them.
  If you need a translator, ask for one. It is
  important to know that one needs to protect the
  rights of ourselves and family.
• (Family Caregiver)
• And also, this can be observed even among
  Japanese who has been living in Canada for a long
  time, that they feel shame in expressing when
  faced with life challenges or hide any problems
  from outsiders. I dont think these are good. I
  think things should be different. When we faced
  with challenges, it is important that we deal
  with them in a assertive way.
• (Care Recipient)

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Imprecations for Policy Making and Community
Support

• Need for a centralized and bilingual (JP/EN)
  information service regarding the long-term care
  services
• Need for professional medical interpreting
  services
• Need for increased Japanese speaking home visit
  care professionals with better accessibility

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Imprecations for Policy Making and Community
Support, Cont.

• Need for support for family caregivers (i.e
  helpline)
• Education for awareness building concerning
  depression among elderly and implementation of
  check-up system on elderly persons who live
  alone
• Need for a language/culture appropriate
  comprehensive long-term care facility

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Acknowledgment

• Study Participants
• Dr. Marvin McDonald (Trinity Western University)
• Dr. Maria Cristina Barroetavena (BC Cancer
  Agency)
• New Emerging Team, BC Cancer Agency
• National Association of Japanese-Canadians
• Trinity Western University
• Tokachi Kirin Japanese Restaurant

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Question Time

• For further inquiry, please contact
• Naoko Metz
• Metz_n_at_hotmail.com
• Masters in Counselling Psychology
• Trinity Western University, Langley BC
• Thank you