Loneliness of older foreign immigrants

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United by their loneliness, America’s elderly Indian immigrants......PATRICIA LEIGH BROWN

They gather five days a week at a mall called the Hub, sitting on concrete planters and sipping thermoses of chai. These elderly immigrants from India are members of an all-male group called The 100 Years Living Club. They talk about crime in nearby Oakland, the cheapest flights to Delhi and how to deal with recalcitrant daughters-in-law.

Together, they fend off the well of loneliness and isolation that so often accompany the move to this country late in life from distant places, some culturally light years away.

“If I don’t come here, I have sealed lips, nobody to talk to,” said Devendra Singh, a 79-year-old widower. Meeting beside the parking lot, the men were oblivious to their fellow mall rats, backpack-carrying teenagers swigging energy drinks.

In this country of twittering youth, Devendra and his friends form a gathering force: the elderly, who now make up America’s fastest-growing immigrant group. Since 1990, the number of foreign-born people over 65 has grown from 2.7 million to 4.3 million — or about 11 per cent of the country’s recently arrived immigrants. Their ranks are expected to swell to 16 million by 2050. In California, one in nearly three seniors is now foreign born, according to a 2007 census survey.

Many are aging parents of naturalized American citizens, reuniting with their families. Yet experts say the ethnic elderly are among the most isolated people in America. Seventy per cent of recent older immigrants speak little or no English. Most do not drive. Some studies suggest depression and psychological problems are widespread, the result of language barriers, a lack of social connections and values that sometimes conflict with the dominant American culture, including those of their assimilated children.

The lives of transplanted elders are largely untracked, unknown outside their ethnic or religious communities. “They never win spelling bees,” said Judith Treas, a sociology professor and demographer at the University of California, Irvine. “They do not join criminal gangs. And nobody worries about Americans losing jobs to Korean grandmothers.”

Many who have followed their grown children here have fulfilling lives, but life in this country does not always go according to plan for seniors navigating the new, at times jagged, emotional terrain, which often means living under a child’s roof.

Devendra Singh grew up in a boisterous Indian household with 14 family members. In Fremont, he moved in with his son’s family and devoted himself to his grandchildren, picking them up from school and ferrying them to soccer practice. Then his son and daughter-in-law decided “they wanted their privacy,” said Devendra, an undertone of sadness in his voice. He reluctantly concluded he should move out.

So when he leaves the Hub, dead leaves swirling around its fake cobblestones, Devendra drives to the rented room in a house he found on Craigslist. His could be a dorm room, except for the arthritis heat wraps packed neatly in plastic bins.

“In India there is a favourable bias toward the elders,” Devendra said, sitting amid Hindu religious posters and a photograph of his late wife. “Here people think about what is convenient and inconvenient for them.”

Sociologists call Devendra Singh and his cohort the “.5 generation,” distinct from the “1.5 generation” — younger transplants who became bicultural through school and work. Immigrant elders leave a familiar home, some without electricity or running water, for a multigenerational home in communities like Fremont that demographers call ‘ethnoburbs’.

A generation ago, Fremont was 76 per cent Caucasian. Today, nearly one-half of its residents are Asian, 14 per cent are Latino and it is home to one of the country’s largest groups of Afghan refugees (it was a setting for the best-selling book The Kite Runner).

Along the way, a former beauty college has become a mosque; a movie house became a Bollywood multiplex; a bank, an Afghan market, and a stucco-lined street renamed Gurdwara, after the Gurdwara Sahib Sikh Temple.

Reliant on their children, late-life immigrants are a vulnerable population. “They come anticipating a great deal of family togetherness,” Prof. Treas said. “But American society isn’t organized in a way that responds to their cultural expectations.”

Hardev Singh, 76, and his wife, Pal Keur, 67, part of Fremont’s large Sikh community, live above the office of the Fremont Frontier Motel, its lone nod to a Western motif a dilapidated wagon wheel sign.

They rented the fluorescent-lighted apartment after living for three years with their daughter, Kamaljit Purewal, her husband, his mother and two grandchildren. As the children grew, Hardev and Pal were relegated to the garage, transformed into a room. As Hardev said, “in winter it was too much cold.”( Their daughter, Purewal, said that she “tried to give them a better life,” but felt unappreciated because her parents favoured her older brother in India. “If you’re a happy family, a small house is a big house,” she said. )

Fraught family dynamics when elderly parents move in with children often leave older members without a voice in decision-making, whether about buying a house or using the shower.

Pravinchandra Patel, the 84-year-old founder of the ‘100 Years Living Club’, intervened when he heard that the son in one family was taking his parents’ monthly Supplemental Security Income check, for $658, then doling out $20 for spending money.

“I ask the son, ‘How much money do you figure you owe your parents for your education?’ “ he said.

Fremont, 40 miles south of San Francisco, is now the Bay Area’s fourth-largest city, with voters from 152 countries. Physical distances can be compounded by psychic ones: 13 per cent of the city’s immigrant seniors live in households isolated by language. Theirs is a late-life journey without a map.

For the men in the ‘100 Years Living Club’, the road leads to the Hub, where they have been meeting for 14 years, since the Target store was a Montgomery Ward. Patel, who was an herbal doctor in India, started the group after he noticed his friends were in “house prisons,” as he put it, without even the confidence to use a bus. The men keep their spirits alive by sharing homemade chaat snacks. They are the lucky ones.

http://www.indianexpress.com/news/united-by-their-loneliness-americas-elderly-indian-immigrants/510590/

Loneliness creeps up on Delhi's elders’

NEW DELHI: On the face of it they're busy and happening at 60: exercise regime, social work, satsang, paying bills, housework and the works. Yet, in a disturbing way, loneliness is increasingly creeping up on the old in Delhi, making them feel isolated. A study on the elderly conducted by NGO Agewell Foundation shows that about 80% of the surveyed Delhi residents in their 60s reported feeling isolated despite an active life. While only 11% of old who live in joint families experience loneliness, in nuclear families, more than 70% feel isolated.

Reduced interaction with family emerges as the greatest factor leading to feeling isolated. Differentiating between emotional and social isolation, the study — conducted in January this year among 10,000 citizens above age 60 in 20 states across all economic strata — found that 44% in cities such as Delhi, Mumbai, Chennai and Kolkata felt both social and emotional isolation. Social isolation stems from a dwindling friends circle, immobility and a feeling of being ignored socially, while emotional isolation results from strained interpersonal relations within family.

Himanshu Rath, founder Agewell explains that at home, younger members are "always bone-tired and too busy" to spend time with the old. "It's not that there's no concern. Even where nuclear families do all that needs to be done for the old, life is too hectic and tough for them to give time," he says.

Additionally, adds Rath, their stagnant incomes and growing costs of living especially in the last two years have led to much self-denial, also resulting in feeling alone, says Rath. "Last two years' slowdown has hit the old hardest. Interest rates have slipped. Monthly yields are reduced. The pressure's tremendous," he says.
Rath gives an example of the stress an average middle-class 65-year-old faces. "With longer life-spans, and given that today, a 65-year-old's wife will be to 6 to 12 years his junior, the retired man believes he has to secure finances for the wife for at least 20 to 30 years." With skyrocketing costs especially for medical, conveyance and food, the feeling of helplessness is strong.

There may be better medical facilities today, but they're expensive. Neighbourhood GPs are a thing of the past, points out Rath, a simple blood test will cost Rs 200 at least. "They cut down on the simple things. A third biscuit can mean Rs 1.50 more. I'm talking upper middle-classes who've had a certain lifestyle," he says. Saving for a rainy day, the old are cutting down on socializing also to avoid expenditure. Understandably, loneliness among elderly in Delhi increases with age.

Further, in cities many oldies, says 81-year-old Carol H. Barbosa, have had to financially pitch in to help children who have suffered setbacks and job losses due to recession. "They encash FDs, send money. The financial pressure has grown. It takes a toll, it's like a physical and mental breakdown," says Barbosa, who lives by herself in a South Delhi apartment complex that houses several retired people.

The report, conducted via interviews in urban and rural randomly selected districts found that at nationally, 87% of those in their 70s reported loneliness. Interestingly, rural old reported lesser levels of loneliness at 78% than urban ones (90%). At 97%, the loneliest were individual elderly who lived by themselves.

IT talent shortage hitting healthcare hardest

With IT staff shortages a reality for CIOs in most industries, healthcare – driven by federally mandated incentives for such IT-intensive projects as Electronic Health Records – is experiencing even more of an IT labor crunch. Is poaching experienced IT talent from other industries the answer?

Healthcare is continuing to experience a shortage of qualified health IT staff that, in the view of some observers, is growing worse. But few healthcare organizations believe that the solution is to lure IT pros away from other industries. In fact, most hospital systems and large physician groups would prefer not to hire any IT person who doesn’t have extensive health experience. 

"Healthcare organizations are looking for healthcare-experienced people," says Frank Myeroff, president of Direct Consulting Associates, a health IT staffing firm in Solon, Ohio. 

Ernie Hood, senior research director for the Advisory Board Co., a large healthcare consulting firm based in Washington, D.C., agrees. In fact, he says, healthcare organizations are generally uninterested in graduates of health IT training programs, even if they have IT experience in other industries. "It doesn't substitute for the actual field experience working in healthcare," he says. 

It’s not about the Benjamins 

The workforce shortage in healthcare does not seem to be related to the salaries of health IT professionals. According to arecent Computerworld/IDG Enterprises survey, a CIO in health/medical services earns an average of $173,941 annually. [Computerworld and CIO.com are both owned by IDG Communications.]The same position is worth $146,111 in computer-related services/consulting, $151,889 in education, $133,972 in government, $191,762 in legal/insurance/real estate, and $192,885 in manufacturing (non-computer related). Lower-level health IT staffers are also paid fairly well, compared to those in other industries. 

As you would expect, some healthcare organizations pay better than others. Myeroff attributes much of that differential to how much individual organizations know about current information technology. In addition, small, rural hospitals don't pay as much as large, metropolitan healthcare systems, notes Hood. But overall, he says, "I don't see health IT staff fleeing to other industries, so that makes me think that the compensation is somewhere in the ballpark." 

[Related: IT continues to struggle to find software developers, data analysts] 

How bad is the current health IT staff shortage? A third of healthcare managers said they had to postpone or scale back an IT project because of inadequate staffing, according to a 2014 survey by the Health Information Management and Systems Society (HIMSS) [Note: PDF download]. But this may not be because healthcare organizations couldn't find the people they needed, Hood says. 

"This could be an indication that there's greater demand [for health IT] than the budget allows for," he points out. "Is the barrier, 'I can't find people with the skills I need,' or is the barrier, 'I don't have the resources from the organization to execute what they're asking me to do?'" 

Moreover, he says, the availability of outsourcing has to be factored into the equation. While outsourcing was not the preference of most CIOs in a recent Advisory Board Co. survey, three-quarters of the healthcare executives who responded to the HIMSS survey said they had outsourced at least some IT. The top areas for outsourcing were clinical application support, project management, and system design and implementation. 

From bad to worse? 

In Myeroff's view, however, health IT shortages are substantial and growing. "Technology is moving forward, and we don't have the staff for it," he says. "Tens of thousands of jobs are going to be needed and we don't have the people for it." 

[Related: In the IT talent wars, businesses need to sweeten the pot] 

One major reason for these shortages, he says, is the government's incentive program for electronic health records (EHRs). That initiative has resulted in the majority of hospitals and physicians acquiring EHRs in the past several years. Known as the "meaningful use" program for the criteria that providers must meet to obtain the financial incentives, this program is now in the penalty phase: For the next few years, Medicare will cut its payments to organizations that do not show meaningful use of EHRs. 

Another IT-intensive government program requires all healthcare providers to move to a new diagnostic coding system in October. This shift entails internal and external software testing, not only with health plans and claims clearinghouses, but also with other trading partners. 

In addition, doctors and hospitals are grappling with the transition to an entirely new method of payment, known as "value-based reimbursement," that rewards healthcare providers for quality and efficiency. The data aggregation and analysis needed for success in this game require specialized IT staff such as data analysts, who are in short supply. 

Because of government-mandated time frames, Myeroff interprets the HIMSS survey results differently than Hood does. Whether or not a healthcare organization has the budget to hire more IT people, he notes, it must achieve certain objectives by a specific date. For example, stage 2 of the meaningful use program requires hospitals and physicians to meet its criteria this year. "To meet those stringent deadlines, you need IT staff," he says. 

Is in-house training the key? 

To close the workforce gap, many healthcare systems are developing additional IT workers internally. These staffers – typically nurses – take IT courses offered by vendors or professional associations. But most of their training occurs on the job. 

Hood says  this is not a very sophisticated approach. No healthcare organization that he knows of has a formal in-house training program. Most of the lower-level clinicians who take on roles in IT are super-users who often function in a help-desk capacity to help other users, he says. 

Myeroff says that many healthcare systems have done a good job of developing in-house IT talent. The problem he sees is that clinicians who take on IT roles don't have all of the competencies required. Health IT professionals who know healthcare but are not clinicians may supply these missing skills. "But neither one of them can do the whole job." 

A number of medical schools now offer medical informatics courses that train physicians in some areas of health IT. But while these programs produce informaticists and chief medical information officers (CMIOs), they don't help in other areas such as security and EHR operations, Hood notes. 

[Related: 10 startups that are disrupting healthcare IT] 

The skills and experience gap between IT and healthcare persists, he says, but more and more clinicians are filling it. Hood cites the growing number of CIOs who are physicians with experience working on IT projects. This can be especially important in change management, he notes, where a hospital's management needs to persuade physicians to support an IT program that may change their workflow and even their practice patterns. 

Both Hood and Myeroff emphasize that health IT pros must understand how technology can be used to improve healthcare. Older professionals who can't do that may not be able to keep up, notes Hood. To succeed in this new era, IT staff must be very receptive to what physicians and nurses want, Myeroff adds. "You need the clinician mind to tell them what they're building."

Business problem that needs a solution: Child Care Is Biggest Expense For A Growing Number of Families

More working families than ever are spending more of their income on child care than any other household expense.

For many parents the cost is greater than housing, transportation or utilities.  In some places its even more expensive than college. And with rising child care costs the number of parents paying more for care than anything else is going up, according to the newly released Child Care in America: 2015 State Fact Sheets from Child Care Aware of America.

“We are in a child care crisis,” says Michelle  McCready, deputy director of policy Child Care Aware of America. “Child care costs are on the rise for American families and parents are spending the majority of their family budget on it.”

Every week in the United States, child care providers care for nearly 11 million children younger than 5 whose parents are working. As defined by the report, child care is any licensed child care-program. That can include anything from a traditional day care center to small in-home care as well as some child-care centers that have Head Start or are combined with Pre-K.

Married couples who both work will spend up to 15 percent of their income on child care, nationally. But finding and paying for affordable and quality care is particularly hard on single women. For single mothers, because of pay disparities between men and women and their sole breadwinner status, the portion of their budget that goes to child care can climb as high as 65%  nationally.

McCready says child care takes such a large chunk of family’s budgets because parents are paying as they go. While child care costs as much as public college in 31 states families have not saved up for child care like they may for college.

“One challenge is that there are a lot of systems in place for saving for college and parents have an 18-year runway to save up,” she said highlighting 529 savings plans, college funds and other savings vehicles. “But early child care is such sticker shock right away when you have a baby and you’re trying to go back to work and make it work. There are so many options and and it is so expensive.”

The importance of quality safe child care is well documented. The report says, “the science is clear: there are long-term positive outcomes for children who begin learning from birth … the child care setting is an opportunity to learn and set healthy habits for life.”

Decades of research that demonstrates how quality child care has a lasting positive impact on children and shows that child care is a wise investment. According to the President’s Council of Economic Advisors’ 2015 report, the Economics of Early Childhood Investments, investments in high-quality early education generate economic returns of over $8 for every $1 spent.

Sadly, the opposite is true as well. Poor-quality care has negative impacts on development — especially for low income and minority children. According to a March 2014 U.S. Department of Education report, boys and African American children are disproportionately expelled or suspended from early care and education programs. For preschool programs outside state prekindergarten systems, the rates were far higher. Thirty-nine percent of child care providers reported at least one expulsion in the past year, an expulsion rate more than 13 times higher than in K through 12 schools.

There have been some recent improvements in the quality of care, says McCready.

With the reauthorization of the Child Care and Development Block Grant in November, 2014, “we’ve seen drastic improvements on health safety and quality measures for child care,” she said. 

More training is now required for safe sleep practices and CPR, comprehensive background checks are bolstered and inspections are more often.

But how can families get the quality care they deserve at a price they can afford?

Every state and every community is going to face their own solutions,” says McCready. “Some are work-based, some a stipend for care. Some states take on a quality ratings system so lower income children are only eligible for quality care. The military has a strong model that offers assistance to their families and ensures the care is of high quality.”

“What we do know is that parents really care about the cost of care and they have a huge need to know their kids are in a safe nurturing enviornment while they are working to give them their piece of mind.” If those needs aren’t met, she said, there is a possibility parents will leave the work force, which can hurt the family and the economy. “It is a smart business investment for our families, employers and our economy to invest in our littlest learners and invest in their brains. It leads to better outcomes over all.”