Meeting the needs of Chinese older people

Work with Chinese older people has found that many of them are isolated from both the Chinese community and mainstream society. The study examined the caring needs of Chinese older people from a user's perspective and examined a number of aspects of life for the Chinese community which particularly affect older people. One hundred Chinese older people in South Yorkshire, London and Glasgow were interviewed, either individually or in focus groups. The study found:

• The common causes of older people's detachment from the mainstream community included: language barriers; insufficient knowledge of social and public services; lack of awareness of social rights; low expectations of their life in the UK; negative experience of retirement; poor mental and physical health; and poor self-image.
• Nearly all the respondents (97 per cent) said they found it difficult to use social services. Difficulties included: inability to speak English and particularly to understand social services jargon; lack of information about services and older people's rights to these; and the costs of using services.
• Respondents' self-esteem was low. Sixty-five per cent thought that they were seen as 'useless' and 'burdens' because they no longer made any contribution to society and their family. Over half of the respondents described their mood as a little sad or very sad most of the time.
• Factors leading to older people's detachment from the Chinese community included inadequate support from their family, low physical mobility and poor social networks.
• The study found that the ability of middle-aged Chinese people to care for older dependants is often exaggerated. In common with older people, they face difficulties in using formal caring services, such as language barriers, lack of knowledge of social services and difficulties in expressing health concepts from their own cultural perspective. They also have to deal with their own problems, such as economic pressures and occupational hazards.
• The focus groups (which also involved professionals) suggest that services need to look at: increasing Chinese older people's participation in society, raising the visibility of their needs, improving access to services, raising their expectations of retirement and providing life-long learning opportunities.

Based on the belief that Chinese older people in the UK should have the opportunity to voice their views and to be listened to, this study aimed to examine their caring needs from a user's perspective. One hundred Chinese older people over the age of 60 in South Yorkshire, London and Glasgow were interviewed both individually or in focus groups. They expressed their views on public and social services, their life in Britain, their self-image and their family relationships. To varying degrees, the respondents shared a common experience of feeling detached from mainstream society, from the Chinese community or in some cases from both. The study also explored a number of aspects of life for the Chinese community and their impact on older people.

Detachment from the mainstream community

The majority of respondents (97 per cent) found it difficult to use social services. Common difficulties included: inability to speak English and particularly to understand the terms and jargon of the public and social service system; lack of information about social and public services and older people's rights to these; and the costs of using social and public services:

I don't know even a single English word; how can I use the services. I will use what they give me.

 

Of course, the more service the better. But I hate filling in forms. I also hate asking people to fill in forms for me. If you ask people for help, you will become their burden and sooner or later annoy them.

 

I am afraid of being sent to older people's home because I don't know English. I would be seen as an idiot and soon become a real idiot.

 

I don't want to tolerate their (workers') unfriendly attitude. It doesn't matter to use more or less services. Dignity is the most important thing to me.

 

Many respondents were not satisfied with their life in the UK. Ten refused to discuss their view. Thirty-five shared explicitly negative views, including the following:

• Life in the UK is boring. There is little entertainment for Chinese older people. It is difficult to pass the day when there is nothing to do.
• Living in the UK means speaking a second-class language and being given only second-class citizen status.
• Some respondents said that they were waiting for three things: 'waiting to eat, waiting to sleep and waiting to die'.
• Some described themselves as 'half deaf and half blind' because of language barriers.

In general, respondents' self-esteem was low. Over half (65) thought that they were seen as 'useless' and 'burdens' because they no longer made any contribution to society and their family. Only a few (7) saw themselves as citizens, enjoying the same rights as members of the mainstream community. Moreover, over half of the respondents (55) described their mood as a little sad or very sad most of the time. Over one-third thought their future was full of uncertainty, which raises mental health concerns.

Sixteen interviewees compared the services they were using with those provided for older people in Hong Kong. They thought they were better off in Britain because they had a pension and free hospital services. Ten of the Yorkshire and Glasgow respondents complained that the services they received were not as good as those provided in London and Manchester. None of the interviewees compared themselves with older people of other ethnic groups.

Detachment from the Chinese community

There has been some shift in emphasis in service delivery from assimilation to cultural pluralism: more attention is given to the cultural way of life of minority ethnic communities. However, too much stress on cultural factors may easily lead to over-emphasising the caring capacity of the Chinese community and neglecting divisions between Chinese people, such as divisions between professionals and non-professionals, between places of origin, social class and gender.

Most Chinese people identify themselves as the same group culturally and they occasionally come together to celebrate Chinese festivals. However, these kinds of interaction and contact are exceptional rather than part of daily life. Many Chinese families run Chinese take-aways to earn their living. Commercial competition makes them keep each other at a distance and thus reduces social interaction. Few Chinese people deal with their problems on a community basis or actively promote their interests as a community. Most of their concern is limited to their family. Little attention is paid beyond this boundary.

However, the study found that the ability of Chinese women and middle-aged men to provide care for dependants is often exaggerated. In common with older people, they face a number of difficulties in using formal caring services, such as language barriers, lack of knowledge of social services and difficulties in expressing health concepts from their own cultural perspective. Moreover, they have their own problems to deal with, such as the 'generation gap' between themselves and both their parents and children, economic pressures and occupational illness and hazards.

My right elbow really hurts when I do stir frying and chopping. Sometimes, I can't even lift up my arm, let alone carrying heavy items. I know this is typical among Chinese people in the catering industry. The doctor advised me to take at least three months off to let it recover. How can it be possible? My whole family relies on this business to pay for the expenses. Even, I don't eat, I have the entire family to feed. Chinese restaurant owner/chef, aged over 50.

In order to keep in touch with their culture, a number of older people interviewed in London regularly spent their leisure time visiting the Chinatowns. However, with few specific facilities for older people, many spent the whole day in McDonald's restaurants and casinos. A group of Chinese older people at a McDonald's restaurant said that they spent almost every afternoon there. They enjoyed the freedom to come and go at anytime and the fact that nobody bothered them to fill in any forms. It was also convenient to shop in Chinatown.

Suggestions for better practice

In focus groups for the study, older people and professionals made the following suggestions for improving the position of Chinese older people. The suggestions stress participation, visibility of needs, access to services, expectations and life-long learning opportunities.

Increasing participation

• Organise a national forum to promote older people's rights and to voice their demands for caring services;
• Set up fact finding and inspection teams of Chinese people to assess formal caring services for Chinese older people;
• Discuss with professionals how to improve communication and develop an effective and equal relationship;
• Develop a training menu for professionals from a user's perspective;
• Provide more opportunities for older people to take an active role in the interpretation process: for example, helping them understand the role played by interpreters and its limitations;
• Teach older people to use the complaints system for formal caring services;
• Encourage older people to take part in voluntary work (for example, teaching cooking skills, Chinese culture and Chinese languages in community centres).

Raising visibility of needs

• Give older people the right to choose their own diets in residential homes;
• Provide more 'walking wardens' to visit them regularly;
• Help older people solve family problems, such as difficulties communicating with grandchildren, and make their families aware of their needs and problems;
• Make the public aware of the importance of promoting mental health and of the Chinese way of defining and expressing mental illness and mental health;
• Invite active users of caring services to act as exemplars so as to encourage more older people to use services;
• Encourage interpreters to develop common terms for expressing Chinese concepts of health.

Improving access to services

• Provide more social and community services in the Chinatowns;
• Subsidise the purchase of Chinese herbs and consultation with Chinese medicine practitioners;
• Provide more residential homes;
• Run courses to teach older people to fill in application forms for social services;
• Open social centres in the evenings, when family members are likely to be working;
• Sponsor family members to receive interpretation training;
• Employ more bilingual workers in the formal caring services;
• Provide Chinese television programmes to promote services;
• Provide 'hot line' services to answer enquiries about social services and to discuss rights;
• Provide more opportunities for people to join luncheon clubs;
• Set up information counters for promoting services in the Chinese people's meeting points (such as McDonald's restaurants in London's Chinatown, casinos and churches);
• Establish 'sales' teams to contact Chinese older people individually to introduce formal caring services;
• Teach Chinese older people to use emergency services such as the alarm bell at home;
• Run more case conferences to share the experiences and skills for meeting the needs of Chinese older people with mental illness;
• Provide more outreach workers to identify and meet the needs of homebound older people.

Raising expectations

• Subsidise older people to travel to different cities and visit different Chinese communities;
• Help Chinese older people to evaluate their working life more positively and to have higher expectations of retirement;
• Provide opportunities for them to contact older people from other ethnic groups to enable them to understand their common needs and rights.

Encouraging life-long learning

• Provide opportunities for learning English and other languages;
• Provide more skill training programmes to help them find jobs.
• Provide training courses for both Chinese older people and middle-aged groups to prepare for retirement, and to understand the welfare rights of retired people;
• Invite Chinese older people to teach professionals about Chinese culture and their ways of defining and meeting needs.

About the study

This study is based on interviews in 1998 and 1999 with a hundred Chinese older people in London, Glasgow, Rotherham, Doncaster, Sheffield and Barnsley. The research also included a survey of the health of Chinese women, a review of the Home Affairs Committee Report on Chinese people, a study of the needs and problems of middle-aged Chinese people, a study of Chinese ex-mental ill patients, a study of the attractiveness of meeting points for Chinese people, and a study of the views of professionals on the improvement of the social and economic position of Chinese older people.