In Hawaii, where many people come from Asian cultures, multiple generations often live together, and cherishing and respecting elders, a concept called kupuna, is a key value, says Marketing Manager Gwen Trowbridge of Kisco Senior Living.
So when the Carlsbad, California-based senior-living residence conceived Ilima at Leihano, a 40-acre CCRC in Kapolei, a suburb of Honolulu, they sought to embrace that connection of ohona (family) by partnering with another developer to build Maile at Leihano, a sister residential community, in which adult children and grandchildren can live near their loved ones.
Buildings are designed in the islands' unique architectural style, characterized by outdoor and interior spaces interconnecting seamlessly.
Amenities at the Leihano Clubhouse will feature a pond with koi fish, symbols of love and friendship in Japan.
Activities also reflect the anticipated diverse resident mix including not just Hawaiian ukulele, hula, and lei-making classes, but also Chinese games of mahjong and classes on Japanese kanji writing and Chinese tai chi.
Dining options reflect Japanese, Chinese, Thai, Filipino, Hawaiian, Asian-fusion, and Continental cuisines, and Ilima also will offer "Pau Hana," a Hawaiian happy hour with "pupu" appetizers.
Holiday celebrations will include Hawaii's Kamehameha Day, Kuhio Day, and Lei Day; Chinese New Year and Lantern Festival; and the Japanese Obon Festival to commemorate deceased ancestors and Keiro No Hi to show respect for the elderly and celebrate longevity.
"Our associates, also at the heart of our ohana, will no doubt be sensitive to the various cultures represented at Ilima," Trowbridge says.
"Not only will Kisco Senior Living hire local residents of Hawaii who will encompass this sensitivity, but it will also be part of their training for all levels of care.
" While most senior living communities don't go so far in serving the needs of seniors from multicultural backgrounds, many companies are finding creative ways to customize their resident-care strategies and offerings to ensure seniors from various racial, religious, and ethnic groups feel right at home.
Caring for Customs Nonprofit religious organizations have long established communities in which people of the same faith can retire together.
A handful of specialized communities also have sprung up for ethnic groups, such as several Japanese residences in San Francisco and Native American communities in Alaska and Canada.
However, in most cases, seniors from diverse cultural backgrounds are minorities in a larger community, so cultural sensitivity should be integrated with a company's core values and incorporated into staff training from day-one staff orientation, says Jim Concotelli, vice president of resident programs for Tampa, Florida-based Horizon Bay Senior Communities, which operates 74 senior living communities in 13 states.
At Horizon Bay, those values are integrity, respect, responsibility, professionalism, and teamwork, and the two most connected with diversity are respect and professionalism.
"Out of respect for our residents, we feel it's our responsibility to provide care that meets the integrity of the resident and also honors their history and background," he explains.
"In terms of professionalism, we make sure that our staff understands a resident not only at their cultural level but also [through] their background and history.
" Concotelli says he has not seen a lot of prejudice by other residents for their neighbors from different backgrounds.
Instead, most seniors enjoy learning about other ways of life, he adds, noting that residents of private-pay retirement communities such as Horizon Bay tend to come from well-educated professional backgrounds and have had previous exposure to a variety of cultures and individuals different from themselves.
To ensure that everyone's traditions are respected, Horizon Bay lets seniors take the lead in deciding what multicultural activities they would like to see in their communities.
Learning what cultural traditions are important to a resident is a key part of the initial interview and move-in process.
"Generally, we'll have a resident group take a leadership role in designing and offering what they feel is appropriate," Concotelli says.
"Then staff supports them to provide the space they need or any particular types of menu items.
Even if there is only a small group, we provide the support to honor their traditions as we would for anyone in our communities.
" One reason why fewer Asians and Latinos may live in senior living is the value those cultures place on younger generations caring for their elders, Concotelli observes.
However, Carrington P oint in Fresno, California, is an exception, with a growing Asian population.
"One family's loved one moved in about five years ago, and word spread within the Buddhist community that this was a nice place," he says.
Since many of the residents belong to a specific Buddhist group, Horizon Bay turned to its leaders for in-service and education for staff.
With their help, the company added an outside meditation garden and has incorporated Buddhist ceremonies, customs, and cuisine into programming and dining.
Celebrating Differences At Chicago-based Brookdale Senior Living, observing multicultural traditions is at the heart of the "Celebrations" program, which incorporates dining, socializing, themed activities, events, and entertainment at all its approximately 419 communities, says Joska Hajdu, senior vice president of dining services and a key player in creating the program.
"[Celebrations] is all about celebrating cultures and our differences, not just of residents but also associates," he adds.
"It's more an event than a program and really ties together the entire programming of all our activities and programs that happen at the community level.
" Each year's activities are centered on an overarching theme, with mini-themes for each month.
For example, in 2004, Celebrations focused explicitly on cultural origins with "Journeys to America.
" Each month celebrated a different geographic area from which residents or their ancestors immigrated and included an Italian month, an African-American month, an Asian-American month, and a Jewish month.
"Celebrations Around the World" (2007) centered on international holidays such as Brazil's Carnival or Germany's Oktoberfest.
Another program, "Music of Our Lives" (2008), celebrated different musical genres, such as soul in February, which provided a chance to link activities to Black History Month.
While Celebrations may seem more about entertainment and continuing education for all residents, it also affords opportunities for residents and staff from different cultures, religions, and ethnicities to feel honored and share their unique experiences with others, says Sara Terry, vice president of Optimum Life, which administers Celebrations.
"[Because of Celebrations], every day, directors of lifestyle programs have an opportunity to recognize and utilize residents' cultural experiences for programs and events," she adds.
"We can tap residents to share their cultural or historical perspective based on a theme and use them as teachers.
" Accommodating the needs and desires of people from different cultures and religions is also a priority in Brookdale's dining program, Hajdu says.
The company has developed an in-house, proprietary menu-planning tool for 10 different ethnic menu regions, including Southern, Tex-Mex, and Old World, which incorporates many Jewish specialties such as matzo ball soup, Gefilte fish, and matzah brei.
While communities are initially assigned a menu category based on region, they can choose to switch to another one better suited to their resident breakdown.
For example, a Florida community assigned the Sunbelt menu can opt for Old World if it has a substantial Jewish population.
Brookdale's menus also are not hard-and-fast rules, but rather starting points, Hajdu emphasizes.
A New England chef can prepare a Tex-Mex recipe and vice versa.
Finally, to be absolutely sure that all residents have a say in what's served, seniors can make special requests, including their own cultural favorites, at the host stand, and Brookdale will fulfill all reasonable ones within 10 days.
And residents can submit their favorite recipes to be added to the national database.
"This is where my job becomes so much fun," Hajdu says.
"It also teaches our managers and associates that it's all about a resident's choice.
" Hajdu warns, however, that ethnic specialties such as kosher or Asian food preparation are not typically taught in mainstream culinary schools.
"I hired a new chef at one of our large, mostly Jewish communities, and he had never made a matzo ball," he adds.
"Each culture has its own eating and drinking preferences and holidays.
A Jewish resident may expect to get a Seder meal.
Residents in the Southwest may definitely look for Southwestern or Tex-Mex food.
It does require extra training and understanding.
" Multicultural Memory Care Involving families is particularly important when it comes to cultural issues for Alzheimer's and dementia-care residents, says Stephen F .
W inner, cofounder and chief of culture for San Juan Capistrano, California-based Silverado Senior Living, which operates 20 memory-care communities in California, Utah, and Texas.
Because people with dementia live in their long-term memories, their experiences growing up in a different country, church, or cultural environment may be among their most vivid recollections, he explains.
They often remember the words to old-time songs or the Lord's Prayer, and customs, ceremonies, and cuisine may provide comfort in what is now a confusing world, Winner says.
Silverado communities make just as much of an effort as any other assisted living residence to stage holiday celebrations, provide religious services, and serve culturally familiar meals.
Residents are encouraged to share stories about items in their memory boxes that pertain to their cultures.
When activities with a cultural bent are planned, such as a cooking club where residents learn to prepare a dish from another country, every effort is made to evoke a complete ambiance of that culture.
For example, a Mexican meal will be accompanied by such props as maracas, sombreros, and mariachi music.
Discussing cultural issues and potential conflicts with families upfront can be particularly important in a memory-care environment, Winner says.
He cites a possible example of a Jewish family who wants their loved one to maintain Jewish religious services but then observes or learns that the resident wandered into a Christian event.
"It's an educational process with the family that [the resident is] just enjoying the music and the socialization, not the philosophy or some sort of soul-saving," Winner says.
"Most families get it when you spend the time to explain that it's not a conversion.
" When Silverado staff invite outside clergy to visit, they take the extra step of asking that they not deliver a sermon and instead just include a general open prayer or hymn that anybody of any religious background could join with comfort.
"If a family really says they don't want the resident involved, we always make sure that there's another activity planned or that we direct them to another area," Winner stresses.
In another issue with some Jewish residents with dementia, seemingly difficult behavior during activities such as bathing may have their roots in concentration camp experiences, Concotelli says.
Horizon Bay offers caregivers an educational in-service at communities with Jewish residents not only to help them understand Jewish traditions but also to teach them to identify such behaviors appropriately and take special care with personal care activities for Holocaust survivors.
To teach the class, the company reaches out to local Jewish groups and aging services.
Some small touches can go a long way, Winner says.
Because Alzheimer's and dementia-care residents already are confused by normal communication, it's more essential that staff speak English, so that is a firm requirement for staff from all ethnic backgrounds, Winner says.
Likewise, when a resident doesn't speak fluent English, family members are asked to help assemble communication boards with key phrases from that person's native language.
However, when Silverado is able to assign a primary caregiver who comes from that same culture, a truly special connection often transpires.
"It's really neat to see residents share their memories and then see staff from the same background share their memories," Winner says.
"It's often a real mixing of ages, too.
"