Health

Challenges Faced by Asians and Latinos at End of Life Care (Part 3)

Published

6 years ago

December 27, 2018

JoAnn Mar

Seniors at On Lok Senior Health Services

The end of life is not easy for most Americans nearing death. The good news is that up to 90 percent of pain and suffering can be controlled. But the bad news is that over half of all dying Americans experience unwanted pain and suffering during their final days.
And the numbers are even greater for people of color. African-Americans, Asians, and Latinos have less access to the pain medication and comfort care that hospice can provide at the end of life compared to whites.
Asians, Latinos, and other ethnic minorities whose second language is English face additional challenges. Language barriers and cultural traditions can inhibit awareness of and discussions about end-of-life options and are often compounded by poverty and lack of education.
In many traditional Latino and Asian cultures, speaking openly about death is taboo, especially when a loved one is seriously ill. Latinos and Asians are less likely than whites to discuss their end-of-life preferences or engage in advance care planning (end-of-life conversations with family or health providers).
Patients who engage in advance care planning are less likely to die in the hospital or to receive futile intensive care. Family members have fewer concerns and experience less emotional trauma if they have the opportunity to talk about their loved one’s wishes.
Family plays an important role in the end-of-life decision-making process in both Latino and Asian cultures. Among Latino families, a male member, usually the oldest son or uncle, is responsible for making decisions on behalf of the dying family member.
The expectation is that if the elected caregiver respects and loves the dying patient, they will insist the hospital “do everything” to keep the patient alive—this can mean another round of chemotherapy or multiple emergency room visits.
The children of a Chinese parent will often advocate for aggressive, life-prolonging treatment out of a sense of filial duty.
“In our own family, we don’t talk about death definitively,” said Julie Thai about her family in Vietnam. In the case of Thai’s 85-year-old grandfather, he had no end-of-life discussions with her aunt, who was in charge of decision-making.
Thai and her mother were close to her grandfather, who told them on the telephone he wanted a natural death and did not want to be resuscitated.
But when he was taken to the hospital for the last time, her aunt asked the hospital to do everything to keep him alive. “He was very upset, he was crying, he was pulling the IVs out, he was spitting up the food,” said Thai. “He just didn’t want anything they were giving him.”
Despite the attempts to save his life, her grandfather went into cardiac arrest, and he died 24 hours later. “He was caused more pain by them imposing these heroic measures on him, as opposed to just letting him go, which is what he would have wanted,” said Thai.
Trained medical professionals and social workers can make a critical difference in reaching out to ethnic patients and their families and helping them prepare for the end of life. Professional translators are essential to assist medical staff and families and help them overcome language barriers and facilitate conversations with patients.
On Lok Senior Health Services provides low-income, frail seniors with comprehensive services that allow them to stay at home. These services include home visits and clinical care, meal deliveries, transportation, and adult day care. The majority of On Lok’s seniors are low-income Chinese and Latinos living in three Bay Area counties.
Dr. Alana Shpal, a primary care physician at On Lok, says conversing with her Spanish-speaking patients can often be challenging, especially if cultural norms prohibit patient autonomy and discussing death. “Even though it’s taboo, I usually say ‘I’m your doctor and this is my job and I need to know what you want or what you don’t want’,” said Shpal, “It’ll put their family in a harder place later on and that often helps because they see their family struggling to make a decision and they don’t want to be a burden.”
On Lok currently serves over 1,500 frail elders and at the end of life, provides them with comfort care similar to hospice. On Lok’s innovative program has now been replicated in 30 states.
This story is part of a series examining racial disparities in accessing hospice and comfort care at the end of life. JoAnn Mar’s report was produced as a project for the USC Annenberg Center for Health Journalism’s 2018 California Fellowship

JoAnn Mar

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Activism

Oakland NAACP President Stands on the Frontlines for Equity

With education as a cornerstone, Adams emphasized the importance of youth having access to quality kindergarten through 12th-grade education along with college or vocational programming beyond high school. “I feel that it’s so important for our children to get a good education in K-12th grade, along with the colleges of their choice, especially with the HBCU’s (Historically Black Colleges and Universities).”

Published

2 days ago

January 7, 2025

Oakland Post

NAACP Oakland President Cynthia Adams. Photo Courtesy of Cynthia Adams.

By Carla Thomas

For Cynthia Adams, president of the Oakland chapter of the NAACP, fighting for the rights of Black people comes naturally. With southern roots in Arkansas, Adams experienced firsthand the injustice and unfairness of racism.

“Growing up in the Jim Crow South, I experienced the unfair treatment of people of color and how faith can inspire communities to bring about positive and long-lasting change,” said Adams. Adams says a combination of her family and faith has kept her strong in the face of adversity and inspired her life’s work of advocacy.

Adams chose education as a career path — and a means to achieve equity and overcome racism. She earned her bachelor’s degree at the University of Arkansas at Pine Bluff and later received an advanced degree from California State East Bay.

Adams’ experience as an Oakland Unified School District (OUSD) recorder, a counselor, a researcher, and a college recruiter has allowed her to be laser-focused on youth. She also served as the chairperson for the Oakland NAACP youth.

“The mission of the National Association for the Advancement of Colored People is to ensure the political, educational, social, and economic equality of rights of all persons and to eliminate race-based discrimination. We want to ensure our citizens have equal rights and opportunities without discrimination based on race.”

As a partner with the State of California’s Stop the Hate campaign, Adams says the initiative is a step in the right direction. “It’s great that our governor and state created the Stop the Hate campaign and provides resources for victims of racism and other hate crimes,” said Adams. “The racism toward Black people has increased and our children are being targeted,” she continued.

“We, at the Oakland branch, created a declaration on racism that will amplify the needs of our community to combat racism,” continued Adams. “That declaration was adopted nationally.”

Bridging communities and collaborating is also a strategy for moving society toward justice, according to Adams.

“Through the NAACP, we build connections between communities and advocate for the rights of historically marginalized and oppressed individuals,” said Adams. “Collective action is the only way to advance civil rights and promote social equity.”

By taking stands on supporting former Oakland Police Chief LeRonne Armstrong to supporting the recall of a mayor faced with a scandal that brought negative national press to the city of Oakland, Adams has always demanded more for her people, and better for Oakland, the city she calls home.

She expressed pride in the national organization’s announcement of a $200 million fund designed to empower Black funders nationwide. “We all know the health of a community begins with economics,” said Adams.

Adams says that strengthening Black businesses automatically sustains a community. “We’ve also got to educate our community on opportunities and teach our children critical thinking so that they can provide the next generation of solutions for society,” said Adams.

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Activism

January Is Mental Wellness Month

Mental illness affects people differently. Children ages 6-17 are three times more likely to repeat a grade if they have mental, emotional, developmental, or behavioral problems. Those with severe mental illness have a life span of 10 to 25 years shorter than the general population. 64% of jail inmates have a mental illness compared to 21.6% of the general adult population.

Published

3 days ago

January 6, 2025

Oakland Post

iStock,

By Scott Knight

January is a time to recharge and recover from the holidays. It is also National Mental Wellness Month, which recognizes the importance of mental health and aims to reduce the stigma associated with mental illness.

According to the National Institutes of Health, 57.8 million adults lived with some form of mental illness in 2023. The severity varies from person to person. Understanding mental health statistics in the U.S. can raise awareness and garner support for those in need.

Anxiety disorders are the most common form of mental illness and women are more likely than men to experience depression. 17% of adolescents ages 12-17 experienced a major depressive episode. And 33.5% of adults with living with a mental illness also has a substance use disorder.

The Substance Abuse and Mental Health Services Administration (SAMHSA) collects data on substance use and mental health. Their 2023 National Survey on Drug Use and Health reported that multiracial people had the highest rate of mental illness at 36.7%, followed by Whites (24%), American Indian/Alaskan natives (23.5%), Hispanics (20.6%), Blacks (19.4%), and Asians (18.1%).

National Mental Wellness Month involves highlighting the resources available to equip individuals with the capacity to cope with life’s difficulties; have healthy relationships and take care of their mental well-being before issues arise.

Wellbeingtrust.org tells us that having a purpose in life offers many benefits, including being happier, living longer, sleeping better, and improved heart health. To find that purpose explore your interests, volunteer, consider what you love to do, talk to friends and family, and try new experiences.

The National Alliance on Mental Illness reports that 46% of people who die by suicide had a known mental illness.

The Jason Foundation is a valuable resource if you feel that a friend or loved one is struggling with a mental illness. JFI is dedicated to the awareness and prevention of suicide through educational programs that equip youth, parents, educators, and the community with the tools and resources to identify and assist those who may be struggling mentally.

Visit www.jasonfoundation.com to learn how to make a difference and find the closest Jason Foundation Affiliate Office.

About the Author

Scott Knight is the Education Specialist at the Jason Foundation.

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Activism

2024 in Review: 7 Questions for Former Assemblymember Chris Holden

While in office, Holden championed efforts to improve education outcomes for students and advocated for social and racial justice. Legislation he wrote or sponsored also focused on, innovation in transportation, protecting developmental disability service providers and improving public health, more broadly.

Published

3 days ago

January 6, 2025

Oakland Post

Hon. Chris Holden. File photo.

By Edward Henderson, California Black Media

In 2012, Assemblymember Chris Holden was first elected to the California State Assembly representing the 41^st District in the San Gabriel Valley.

He was re-elected to that position for the following four terms.

Holden, a graduate of San Diego State University, lives in Pasadena with his wife, Melanie, and children Nicholas, Alexander, Austin, Mariah and Noah. Holden is the son of former State Senator and LA City Councilmember Nate Holden.

Before he closed out his final year of service in the Assembly, California Black Media (CBM) spoke with Holden. He reflected on his accomplishments this year and his goals moving forward.

Looking back at 2024, what stands out to you as your most important achievement and why? 

A project I’ve been working on for well over 36 years — the light rail system — made its way into Pasadena from downtown LA. Now it’s making its way through the San Gabriel Valley to Pomona.

How did your leadership and investments contribute to improving the lives of Black Californians? 

Having an opportunity to represent a multi-ethnic and diverse district is exciting, but to be able to bring a voice for a lived African American experience from the San Gabriel Valley is very important.

What frustrated you the most over the last year?

I still am frustrated that we aren’t seeing the kind of progress on affordable housing to allow underrepresented communities to be able to afford to live in the community that they grew up in.

What inspired you the most over the last year?

There has been a lot of movement around reparations through community engagement. Dr. Shirley Weber put forth the bill to establish a reparations task force and that task force met for a number of years. Two members of our caucus served on it, Sen. Steven Bradford and Assemblymember Reggie Jones-Sawyer. A thousand-page report and a hundred recommendations or more came out of that. And now we’re in the process of finding ways to implement some of those recommendations. It’s going to be a longer process, but I’m hopeful because California, once again, is on the front end of taking on a really challenging issue.

What is one lesson you learned in 2024 that will inform your decision-making next year?

Always be mindful how quickly the winds can change. We’ve gone from 10 years of having budget surpluses to this year having a $45 billion deficit.

In one word, what is the biggest challenge Black Californians face?

Inequality.

What is the goal you want to achieve most in 2025?

Well, I won’t be in the legislature in 2025, but I love public policy. I’d like to find myself in a position where I’m continuing to have an influence on how public policy is shaped and formed. I’m just looking forward to being a vital voice going into next year in a different role. It will also be an opportunity to lay a foundation to take another run, possibly for a seat on the LA County Board of Supervisors in 2028.