Puerto Rican immigrant Juan Suarez raised seven children in this Northeast industrial city, and it was understood that his children would care for him when he got older.
So the fact that Mr. Suarez now spends his days in a nursing home will never sit right with family members, who felt they had no choice when a medical condition made it difficult for Suarez to be cared for at home.
The retired fisherman and his family symbolize slowly changing attitudes about nursing-home care within minority communities. But while the situation is becoming more common, it still meets a great deal of resistance. Many cultures, such as Hispanic and Southeast Asian, consider it a breach of familial responsibility to place someone in a home.
"We were raised to believe we must care for the elderly," says Helen Suarez, Suarez's daughter.
"We'd like to have him here at home but he needs extra care," she says. "We cried a lot when the social worker told us he needed a nursing home. I still cry a lot, but I couldn't maintain the care."
Ms. Suarez says she tried as long as she could to care for her father. Each day she placed freshly laundered and pressed clothing on his bed, just like her parents did for her grandparents in Puerto Rico. She bathed him and cooked all his special meals.
However, Juan Suarez needed medical care and couldn't be left alone for any length of time.
Piatas at Christmas
"Latinos really believe in the extended family, in keeping the families together. But right now there is need for [both] husbands and wives to work, so they must bring their parents or grandparents to the nursing homes," says Isabelle Melendez, director of the community center in Lawrence, Mass.
"I come from Puerto Rico. My grandmother lived to 105 and never was in a nursing home. Everyone took care of her, the grandkids, the nephews, and the nieces. Here life is different."
Because of these lifestyle differences, many nursing homes across the country have begun to reach out to minority communities. It is becoming more common to find nursing homes that offer everything from traditional meals to piatas at Christmas.
"This will be reflected in the rest of the country. The baby-boomer population is aging. All over the country [we] need to understand how different cultures treat their aged," says Ray D'Aiuto, administrator of the Wood Mills nursing home facility, in Lawrence, Mass.
Lawrence, a working-class town north of Boston, is an example of what is happening in small towns and sprawling cities from coast to coast. Here the number of Hispanic residents over 65 increased 31 percent from 1990 to 1995, according to the Massachusetts Institute for Social and Economic Research.
Meanwhile, the number of Hispanics between 20 and 39 years of age has increased by just 6 percent over the same five-year period. In other words, in coming years there will be more elderly Hispanics than there will be young family members to care for them.
No one at home all day
The Hispanic population has long opposed the idea of placing a relative in a nursing home. Indeed, 20 years ago there were hardly any Latinos in nursing homes, says Betty Mills, a nursing-home administrator in Blen, N.M. Extended families were the norm, and each generation cared for its elderly.
However, these days most family members are working or in school. There is no one at home to care for their aged and infirm relatives.
Even so, as with families of whatever background, placing a relative in a nursing facility is a decision that can be fraught with guilt.
"We see a lot of fear and confusion on their faces when they arrive, so gaining their trust is a big thing," says Pat Kidder, administrator of the Heritage Nursing Home in Lowell, Mass. "The children don't often come out and say they feel guilty, but it is obvious."
To help alleviate anxiety, nursing-home staffs encourage family members to attend support groups and learn that they are not alone in their choice.
In addition to support groups, or access to social workers, many nursing homes strive to create a more welcoming atmosphere for residents of different ethnic backgrounds.
At Wood Mills, 75 per cent of the staff is bilingual and, with the aid of Microsoft's translation software, all memorandums are issued in Spanish and English.
Religious services are held in Spanish, and residents are provided with Spanish-language books and newspapers. Residents attend Spanish education groups, and listen to music and weather on the local Spanish radio station. They also worked with the facility's dietitian to create Spanish meals, consisting largely of rice, beans, and chicken, which are served three times a week. Having familiar meal choices helps prevent weight loss, sometimes a problem for the elderly.
"We needed to redefine what we do because of the area we are in," says D'Aiuto, who came to Wood Mills two years ago. "We are a provider in a community which is Spanish-speaking, and we need to give our residents a greater sense of respect and dignity."
They speak the language
A common goal for nursing homes with non-English-speaking residents is finding staff who can communicate.
In Pico Rivera, Calif., a predominantly Hispanic community outside of Los Angeles, 90 percent of the residents are Hispanic, says Jean Doerfler.
She, like other administrators, encourages staff members to learn another language because, while many residents are in fact bilingual themselves, "as they get older they revert to their roots and like to speak only Spanish."
It's the same in Lowell, which has a large concentration of Southeast Asians, says Ms. Kidder.
"Out of 142 beds, perhaps six are occupied by Vietnamese, Thai, or Cambodians," Kidder says. "That may be a small number, but one person's needs can be great, especially if they are not understanding you."
Aside from overcoming any language barriers, Kidder says nursing home staffs must learn that cultures have different attitudes toward medical care, and a failure to understand these viewpoints will only add to the residents' and families' stress.
Despite these many steps to reach different cultures, "I truly believe that certain ethnic groups only care for their relatives at home," says Rose McGary, nursing home ombudsman for the Massachusetts Department of Elder Services.
"They cannot fathom [why] the care is not exactly the same as it as at home. They want the one-on-one care. I can't tell you how many complaints I get that say the homes aren't doing a good job," and then they pull relatives out of care against our advice, she says.
These situations arise from a deep-seated abhorrence of nursing homes in cultures where extended families still live in close proximity, if not under a single roof.
"When my grandmother was ill, the idea of a nursing home never came up," says Martha Velez of the Lawrence Council on Aging. "She had three daughters living in Lawrence, and we all took care of her."
No substitute for family
Ms. Velez, who grew up in a three-family home in town, says that when families don't consider the option of placing a relative in a nursing home, it's because they think: "No one loves you more than your family, there is a big language barrier, and the food isn't good."
And while nursing homes are trying to be more accommodating, in many people's minds they can never replace home or the responsibility of children to care for their parents.
"Elderly care is like child care. You have a child, you work your schedule around its care," Velez says. "I think the same respect is due to your parent."
However, there are cases where that is not enough, says Linea McQuade, administrator of a nursing home in Fall River, Mass. Ms. McQuade has lived and worked in the largely Portuguese community for the past decade.
"You'll hear a resident's daughter say, 'My mother took care of me her whole life, and now I take care of her.' But sometimes that is no longer possible," says Ms. McQuade. "The mother or relative needs more attention than can be given at home. They need 24-hour care."
Nursing-home administrators say that families who come from minority backgrounds are more likely to visit on a daily basis than are those in the Caucasian population.
Indeed, Helen Suarez visits with her father each evening after she finishes English classes at the local college. Her daughter, too, visits often, as do her brothers.
"To a certain extent there is much more involvement with the Hispanic community versus the Anglo population," says Doerfler, the administrator in Pico Rivera, Calif.
"Daughters and sons routinely come during mealtimes to help out, they participate in the activities. There is a strong bond with the elderly."
(c) Copyright 2000. The Christian Science Publishing Society