Aging and Culture by Eskinderart

Our Research Journey

A special thanks to everyone who helped in this project, especially our interviewees.

AGING AND CULTURE

Eskinder Abebe, Cambel Konrad, Michael Murphy, RaeVan Parson, Dara Rossi

Human Centered Design SMU, MADI, 2017 2

HUMAN CENTERED DESIGN

ABSTRACT

Human Centered Design (HCD) is a powerful tool used to solve the seemingly unsolvable. It is the intersection of human desirability, technical feasibility and financial viability. HCD takes complex and ingrained problems through directed design methods in order to achieve innovative solutions and inciteful frameworks. HCD places the human at the forefront of the problem solving process to apply empathy in order to solve the most ambiguous parts of the problem(s). Being a human centered designer means maintaining an active cognizance of the varying historical, cultural, political, emotional, ecological and contextual environments in which a problem is set. This Human Centered Design research project is the result of learning about the experiences seniors have when transitioning from a life of independence to dependence.

TABLES OF CONTENT INTRODUTION

Secondary Research

Research Process

Interviews

CASE I: AMERICAN PERSPECTIVE

Thick Description

Photos

CASE II: ETHIOPIAN PERSEPECTIVE

Thick Description

Photos

ANALYSIS

Framework

CONCLUSION-- So What?

How Might We?

Ideation

“We Want to Understand How Two Cultures Manage Elderly Care Differently.”

OBJECTIVE 8

BIG ISSUE

SECONDARY RESEARCH

Caring for elders is a big, complicated issue involving many stakeholders. The issue is growing as the elderly population continues to expand. The expansion of this population is mainly due to the aging Baby Boomers, decreasing birth rates, and increasing life expectancy. These influences apply globally, nationally, and locally. This research focuses specifically on Texas

SENIORS IN TEXAS2 BY THE NUMBERS The oldest Baby Boomers turned 65 in 2011, and by 2030 the entire cohort will be 65 years and older.1 That means, that in 2030, over one in five people in the U.S. will be over 64 years of age.

*4 Million

12 Million

2016 *Texas has the third largest elderly population in the U.S.

2030

ELDERS 65+ NEEDING LONG TERM CARE

70%

No matter where they age, about 70% of elders will need long term care, which means nearly 8.5 million here in Texas will be dependent by 2030.3

An Aging Nation: The Older Population in the United States https://www.census.gov/prod/2014pubs/p25-1140.pdf

Aging in Texas: Introduction http://demographics.texas.gov/Resources/publications/2016/2016_06_07_Aging.pdf Long Term Care https://hhs.texas.gov/services/aging/long-term-care

2 3

● 1800+ A.L facilities ● 2nd largest Immigrant population

“Ultimately, how societies care for their elders depends on many factors, most importantly, it depends on whether or not old people are respected or rejected.”4

The aging population will impact all of us. This impact is far-reaching and will increase demands and opportunities for a host of individuals and services in order to meet the needs of the elderly. For example:

A strong majority of seniors want to age in place, that is, they want to live in their own home as they age.5 However, with over 1,800 Assisted Living (AL) Facilities in Texas6, that is not the current situation for many. Living in these facilities is costly—starting around $40,000 annually. Some elite facilities can well exceed $100,000. Texas also has the second-largest population of immigrants in the country, which lends the opportunity to better understand the role of culture in caring for elders.7

• individual/family caregiving • businesses who employ or cater to elders • neighborhoods/faith-based organizations • in-home and facility health care • healthcare insurance providers8

Diamond. J. (2012). The world until yesterday. New York: Penguin Group Aging in place: Home by Choice! https://www.elderoptionsoftexas.com/article-aging-in-place.htm 6 Texas Healthcare Association https://txhca.org/quick-facts 7 American Immigration Council www.americanimmigrationcouncil.org 4 5

Aging and Caregiving in Texas https://static1.squarespace.com/static/581d29a76a49638d95070b71/t/58a72bd786e6c0df23babe7d/1487350746786/Aging+and+Caregiving+in+Central+Tx+2017.pdf 8

FAMILY CAREGIVERS One group that is particularly impacted is the family caregiver. It is estimated that there are 3.4 million family caregivers in Texas.9 These caregivers play an important role in for the individual receiving the care, but they also reducing the strain on the health care system. On the flip side, there are potential negative impacts. For example:

Emersive Participation

• the caregiver’s physical and mental health can suffer

Secondary Research

• they can experience financial strain • caregiving for a family member require sacrifices in work and personal activities • caregivers who don’t take time for themselves develop chronic health problems at nearly twice the rate of non-caregivers.

Photocards

• almost 70 percent of family caregivers experience depression or anxiety

OUR PROCESS After the secondary research, our process continued primarily focusing on interviews. During the interviews, data was collected using an interview protocol, picture cards (a design method that allows the interviewee to visually express thoughts), and participant observations. We used affinity mapping to gather and organize our data for sense making. Combining what we saw and heard with our current knowledge base allowed us to construct initials insights. This synthesis processes was revisited numerous times throughout the project.

Interviews

Observations

Synthesis

Service for Caregivers https://hhs.texas.gov/services/aging/services-caregivers

INTERVIEWS AfricanAmerican 16

American Working in AL

American Living in AL

Taiwanese AL Worker

MexicanAmerican

EthiopianAmerican 17 16

Out of the three elderly Americans interviewed, two of them were living in assisted living facilities

AMERICANS ASSISTED LIVING HOME 18

Out of the eight elderly Ethiopian-Americans interviewed, seven were living at home with other family members

ETHIOPIANS ASSISTED LIVING HOME 19

We focused on the role culture plays in the care of seniors from an insight we gleaned early in our process. We continued to collect data from all 17 interviewees. Due to our timeframe, and instead of generalizing to all the cultures in our interview pool, we decided to highlight the perspective of two distinct cases that were particularly impactful.

DISTINCT CASES 20 20

Case 1 - American Case 2 - Ethiopian 21 21

NANCY “I started going there so much I began to meet a lot of the staff; I built close relationships with my mother’s care providers.”

ancy, 71, is more than just an American resident at Edgemere’s Plaza, an affluent assisted living community in Dallas, TX. She has a mission to memorialize her career as a powerful entrepreneur, leader, and elementary school principal. How is she doing that? She is Edgemere’s first and only resident event coordinator. To Nancy, action and activity go hand in hand with her love for being engaged in her community. Upon meeting Nancy on the second floor Edge22

mere resident lobby, we were greeted as if we were long-time friends. That warm treatment and hospitality continued throughout our time with Ms. Nancy as she led us into her beautiful living quarters. Surrounded by intricately placed mahogany wood furnishings and gold lined framed pictures of Nancy’s family, we began our 3-hour interview and lunch.

The first thing Nancy wanted to make sure she told us was, “you know, I am second generation here at Edgemere; my mom used to live here.” The sense of love, pride and reminiscence that flushed over Nancy’s bright grin, resonated deeply with us. To Nancy, living at Edgemere is like wearing a badge of honor and is a powerful representation of Nancy’s family legacy. In 2008, Nancy’s mother chose to move from Colorado to Dallas and into Edgemere to be

closer to extended family living in the area. Nancy began to travel as much as possible back and forth from Colorado to Dallas to visit her mother. “I started going there so much, I began to meet a lot of the staff; I built close relationships with my mother’s care providers and they are now my providers,” the importance of relationships with her caregivers and her friend became particularly evident when Nancy told us that her daughter only visits about 3 times per year. 23

Nancy explained to us that the only reason she was able to live in a place like Edgemere was because she had purchased long term health insurance early in her career. What does it mean to have long term care? It means providing elders with the type of intimate care that people with chronic illnesses, disabilities or other conditions need on a daily basis over an extended period of time. The type of help needed can range from assistance with simple activities—such as bathing, dressing and eating—to skilled care that’s provided by nurses, therapists or other professionals. While the environments of ALs differ in each community, Nancy is representative of 99% of the American culture within Edgemere, while the other 1% of residents is Asian. The idea of this American representation was confirmed in interviews with Edgemere’s multicultural staff.

valued spaces and objects that profoundly act as memory capsules. To this American woman, her upbringing in valuing being able to afford assisted living care meant being a part of continuing her family’s legacy and preserving important experiences she had with some of the closest people in her life. Edgemere’s level luxury has allowed for Nancy to live fruitfully, but moreover, it is a symbol of an emotional connection that Nancy cherishes with her legacy, family, and home.

As we enjoyed lunch with Nancy, she noted that “This is the seat that my mom sat in when she lived here.” We learned that not only is Edgemere the memory of her last experiences with her mother, but also there are

“Moving to Edgemere was like coming home to family.”

ASNI, KURI & YESHI “A child who does not take care of their parents is cursed.”

n Dallas, Texas, in a home that they have only recently moved into, live two proud parents, their three children, and two grandmothers. They are all of Ethiopian origin, but the parents have been here for many years and the children were born in the United States. It is an exceptionally close-knit family that still fosters strong ties to their Ethiopian heritage, but they have welcomed our presence with open arms and great patience. 28

Both the father, Mesfin,

and mother, Asni, work fulltime jobs; their children are all busy in their different levels of formal education; and their two recently immigrated grandmothers stay at home assisting with various chores during the day. The grandmothers, Asni’s mother Yeshi and Mesfin’s mother named Kuri, are 75 and 80 years-old respectively. Yeshi has lived in the United States with her family for nearly 10 years, but Kuri has only recently come to join her family.

It is a Saturday morning, so we first talk with Yeshi first, while we wait for Kuri to return home from church with her younger brother. The family provides their guests with a spread of fresh coffee, fruits, and nuts traditionally served to guests in Ethiopian households. While we interact with the other members of her family, Yeshi diligently roasts, grinds, and prepares fresh Ethiopian coffees for her guests. It’s evident that the elders in this household not only

provide love and warmth to their family, but also provide invaluable assistance in daily household chores and activities. As immigrants, the elders of the household have had to adjust to some big differences in day-to-day life here in America, but there’s one concept that they cannot even fathom adapting to in their new home. The concept of putting one’s parents in an assisted living community as opposed to taking them into your 29

“A child who does not take care of their parents is cursed.” own home is not only foreign in their culture, but also laughable to Kuri and Yeshi. “A child who does not take care of their parents is cursed,” echo both Kuri’s daughter and Yeshi’s son in separate instances. A “curse” in this instance is not meant in a magical or metaphysical manner, but rather it is manifested in a social stigma or a rejection from the community. It’s difficult for the family to imagine circumstances that would excuse the possibility of ever putting an aging family member into one of the 300+ and growing communities in the Dallas-Fort Worth area. Furthermore, Yeshi’s daughter works in a senior care facility, but never considered setting up her aging mother in a similar situation, “we are the assisted living for

them: the family,” she states matter-of-factly. It’s evident that the family enjoys their current arrangements and wouldn’t trade it for the nicest senior care facility in the world. Hypothetically, the question is posed to Yeshi, as to how she would react to the news of being put into an assisted living home. She assures us, “I’d go back to Ethiopia,” before her family would even have the chance. Towards the end of the visit, a meal is served. It is nearly 3pm, but the family has waited patiently for Kuri to return from church. Coming together for meals is an important time for the family, and it appears to be worth the wait.

“We are the assisted living for them: The Family ” 30

This framework is designed to organize the responses our interviewees had in regards to their aging transition. This is a subjective scale ranging from positive to negative responses--the more positive starting on the left while the negative being on the right. The Ethiopian quotations and experiences are marked in orange, while the American quotations are marked in blue.

ANALYSIS 34

The following framework is helpful in that it gives a vast range of responses and shows the emotional contrast from our interviewees.

POINTS FOR COMPASSION

Residents, family members, or friends of residents are able to rank employees of assisted living systems for their level of physical and emotional care.

FOR EMPLOYEES

FOR AL FACILITIES

Higher wages, recognition, job security rankings, and gradual increase of benefits

Surveillance on employee’s work, guarantee of safe, and proper care

• Perks for training

•Ability to see employees’ ranking among residents

• Additional work incentives • Benefits for continuation

• Quality trained employees provide compassionate care for residents

LESSONS FOR LIFE

Community centers, libraries, churches, mosques, or temples adopt an elderly resident of an A.L. Said respective community engages elder in their programs and activities. FOR ELDERS Fight against emotional isolation and increase in social skills. Provide a new family for seniors who have lost touch with theirs.

Students from various backgrounds from local school districts. They start out as pen pals, then move onto friendships via visitation every month.

•A sense of purpose

•Primary resource for historical research

•A chance to mentor •Additional socialization

FOR STUDENTS

• Knowledge beyond their years

CONCLUSION The purpose of this research is to support the body of knowledge around senior caregiving. We hope to incite and inspire conversation, continued thought and eventually action, that will improve the lives of the people involved.