2 3 4 5 6 Chapter 1 INTRODUCTION The phenomenon of global aging (Armas, 2001) is occurring at a rate never seen before and the number of people age 65 and older more than tripled over the past half-century, to a record 420 million worldwide. The number of people in the U.S. over age 65 is projected to reach 55 million by the year 2020, with those over 85 expected to grow from 3 million to more than 13 million. These aged members of our society use the lion’s share of long-term care services with diversity of needs ranging from differing personal values and considerable disagreement about what constitutes an optimum quality of life. The diverse needs of the long-term care consumers can no longer be cared for in a “one size fits all” (Pratt, 1999) healthcare service delivery system for their needs are as diverse as where they are coming from. There has to be new ways to accommodate and address their diverse healthcare needs in the long-term care setting. Filipinos were ranked as the 2nd highest in number among the Asian population (US Census, 2000) residing in the United States. They are also recognized as one of the five largest contributors to the nation’s Asian-born population and are expected to have one of the biggest percentage increases between now and 2030. As the rate of Filipino population increases, so does the aging population and yet no known non-profit medical model of geriatric healthcare setting imbedded with ethnic-specific, psycho-socio-emotional, religious and culturally-sensitive services is in place, especially in the Bay Area and San Francisco, to respond to their needs. Filipinos bound for institutionalized healthcare setting, just like their Asian counterparts, still carry with them a “cherished culture” despite their being acculturated and assimilated into the mainstream society. The following Table 1 (National Federation of Filipino-American Associations, 2004, p.1) suggests where most of the Filipinos live in the United States. The table also indicates that California has the most Filipino population; hence, it is likely to be the first and best option to start establishing a Geriatric Healthcare Center for Filipinos followed by Hawaii, Illinois, New Jersey and New York. Statement of the Problem The current long-term care system seems to be a “one size fits all” healthcare model that is not culturally-sensitive to meet the healthcare needs of its culturally- diverse consumers (Ward et al, 1997). This brings about a lack of greater interest in formulating a healthcare model that provides culturally-sensitive services, more so, the establishment of a non-profit medical healthcare facility, to benefit in particular the Filipino aging population living in the United States. 7 In response to this concern, the writer was prompted to study and seeks to propose a business plan for the establishment of a Geriatric Healthcare Center for Filipinos. Specifically, this study will attempt to address the following key issues: 1. What is the proposed business plan model for a Geriatric Healthcare Center for Filipinos? 2. What kinds of services are required to meet and be responsive to the needs of Filipino Elders in the long-term care setting? 3. What are some of the Filipino cultural values that one needs to be aware of as service delivery is being provided? 4. How can an awareness of these cultural values be useful to provide quality of care among the Filipino Elders in the Center? 8 Need for the Study It has been a common belief that Filipinos belong to a group who could assimilate easily in the mainstream society because they are acculturated faster than their Asian counterparts. They are said to be resilient and blend well within their new ways of life that they have chosen to live with. However, the truth remains that although it is true they assimilate within the new culture, it is also equally true that they are within them “very much” Filipinos as manifested in their own way of thinking and feeling, and so their aspiration as a people remains to be ideal, a Filipino in America. This brings with them, the Filipino in America, deep in their heart and soul until their hair turns gray and become old unable to take care of themselves but expect their children and/or family to take care of them due to filial responsibility (Cole, Van Tassel and Kastenbaum, 1992) This expectation creates conflict within the family for it brings unnecessary difficulty in their new lifestyle of working hard to survive and meet the necessities of life dictated by their new ways of looking at things such as: materially meeting all the amenities needed for them to live life in a more comfortable manner. They turn to each other and seek a way to find an appropriate placement for their aging parents who need long-term care but feel very concern they wouldn’t be as comfortable as when they are “at home” in their own family. Since the current healthcare system does not provide culturally-sensitive services to respond and meet the ethnic-specific needs of its consumers, the researcher sees the need to design and establish a Geriatric Healthcare Center for Filipinos to address the issue of providing culturally-sensitive services in a homelike environment, thus making them feel “at home away from home”. Basic Assumption of the Study It is the assumption of the field study that the Geriatric Healthcare Center for Filipinos shall, in addition to compliance with CCR Title 22, Div. 5, Chap. 3 and OBRA 87, to: • be oriented towards meeting the quality of care per JCAHO’s standard and shall become a JCAHO accredited facility (Kern, 2004); • be operated as a non-profit medical healthcare facility, under the corporate management of CYDF USA, Inc. (Mendoza, 2004) and that, • Filipino elderly in the long-term care setting would require culturally- sensitive services to meet their healthcare needs. Goal and Objective of the Study The primary goal of this field study was to develop a business plan for the establishment of a non-profit medical healthcare facility, to be named as Geriatric 9 Healthcare Center for Filipinos, that is imbedded with ethnic-specific psycho-socio- emotional, religious and culturally-sensitive services. The study was to complete a comprehensive review of the current literature, deemed not only relevant to the business plan but related to ethnogerontology, with a specific focus on Filipino cultural values in order to address the assumption that Filipino elderly in the long-term care setting would require culturally-sensitive services to meet their healthcare needs. Limitation and Delimitation of the Study The proposed Geriatric Healthcare Center for Filipinos seems to be a gigantic undertaking; it is, however, a doable and feasible plan because it is being undertaken in the spirit of a genuine effort to provide healthcare service in a non- profit environment. For purposes of this study, the Center to be established shall be a Long-Term Care Facility that is in compliance with CCR Title 22, Div. 5, Ch. 3, and OBRA 87. It shall provide culturally-sensitive services to effectively meet and respond to the healthcare needs of the Filipino elderly in the long-term care setting. The Center shall be oriented to respond beyond compliance when it becomes fully operational and doing business as (d.b.a.) of a nonprofit corporation CYDF USA, Inc. It shall eventually aim itself to pursue and become a JCAHO accredited facility, as it consistently provides culturally-sensitive services to its target population. Definition of Terms • Asian-American is a term that technically includes, to name a few: Chinese, Filipino, Japanese, Asian Indian, Korean, Vietnamese, Laotian, Cambodian, Hmong and Thai people. (Holmes, 1995). • Culture is a set of learned values, beliefs, customs, and behavior that is shared by a group of interacting individuals (Mosby, 1998). • CYDF USA, Inc. is the sister Foundation of Calantas Young Dreamers Foundation, Inc. (a Philippine-based nonprofit corporation; founded on August 21, 2000 and registered at the Securities and Exchange Commission (SEC) on August 16, 2002). CYDF USA, Inc. (California Registration In-Progress) was organized on August 7, 2004, in San Jose, California, to carry on its third objective as specified in its Articles of Incorporation that reads: “To establish a non-profit social and medical model healthcare center for Filipinos, imbedded with ethnic-specific psycho-socio-emotional, religious and culturally-sensitive services.” (Mendoza, 2004) 10 • Ethnicity refers to (1) group membership based on (b) the integration of (c) values and feelings and (d) practices and behavior that (e) arise through historical roots in the family of origin and (f) through common cultural, religious, national, and/or linguistic background and (g) culminate in a shared symbol system and (h) a sense of shared identity. This approach suggests that ethnicity is a living reality, a way of life. (Holmes, 1995). • Geriatrics is the branch of medicine dealing with the physiologic characteristics of aging and the diagnosis and treatment of diseases affecting the aged (Mosby, 1998). • Gerontology is the study of all aspects of the aging process, including the clinical, psychological, economic, and sociologic issues encountered by older persons and their consequences for both the individual and society (Mosby, 1998; Green, 1993). • JCAHO is an acronym for Joint Commission on Accreditation of Healthcare Organizations. It evaluates and accredits nearly 16,000 healthcare organization programs in the United States. It is an independent, not-for-profit organization and is the nation’s predominant standard-setting and accrediting body in healthcare. Since 1951, JCAHO has maintained state-of-the-art standards that focus on healthcare and its comprehensive accreditation process evaluates an organization’s compliance with these standards and other accreditation requirements.