The Changing Needs of Chinese Seniors in the Greater Toronto Area

A research study commissioned by the Yee Hong Centre for Geriatric Care

in partnership with the University of Toronto Factor-Inwentash Faculty of Social Work

Working Committee:

Professor A. Ka Tat Tsang, Principle Investigator

Cindy Choi, Research Coordinator

Kwong Y. Liu, Director of Social Services

Maria Chu, Program Manager

Charles Wong, Program Coordinator

Kwok Keung Fung, Program Coordinator

This research study and report were funded by the Ontario Trillium Foundation.

ISBN: 978-0-9869088-3-5

Published by the Yee Hong Centre for Geriatric Care in June 2013.

Foreword

For almost two decades, the Yee Hong Centre for Geriatric Care (Yee Hong) has been serving the communities of the Greater Toronto Area (GTA) with conviction and perseverance. Today, while its four long-term care homes stand proud in the GTA and a comprehensive range of community support services are making impact on the lives of tens of thousands of seniors and their family members, Yee Hong’s unwavering commitment to excellence, quality, and meeting community needs remains the same as our pioneers when they built the first Yee Hong Centre.

“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction, and skillful execution; it represents the wise choice of many alternatives” (William A. Foster). Embracing the Provider of Choice vision, Yee Hong makes no compromise with the quality and relevance of our services to respond to the changing needs of the community, particularly at times of rapidly changing demographics and social structures. To this end, Yee Hong developed a specific strategic direction in our 2010-2015 Strategic Plan to understand the changing needs of Chinese seniors in the GTA.

We are privileged to leverage our partnership with the University of Toronto Factor-Inwentash Faculty of Social Work, under the leadership of Professor Ka Tat Tsang, in conducting the needs study of Chinese seniors. Guided by scientific rigor, the study investigates not only the personal needs of the seniors, but also their interaction with their environment, including family members, service providers, and public policies. The result is a comprehensive depiction of the seniors’ needs not in isolation, but in complex and dynamic interface with their surroundings.

While the study permeates into many aspects of life, one theme has surfaced consistently—“a place like home”. Regardless of whether they live in long-term care homes, on their own, or with families, nothing is more important than “a place like home” for the seniors. The challenge for all service providers and policy makers is how to instigate the sense of homeliness in all aspects of planning and delivery to meet our seniors’ needs. I hope that while providing insights into the changing needs of Chinese seniors, the study will inspire others to pursue further studies to provide needed services to seniors of different communities.

Finally, on behalf of Yee Hong and the seniors we serve, I wish to express our deepest appreciation for the financial support of the Ontario Trillium Foundation to make this study possible. Such financial support serves as a critical catalyst to build and enhance the culture of evidence-informed decision-making in health care policy making, service planning, delivery, and evaluation.

Kaiyan Fu, CEO

Yee Hong Centre for Geriatric Care

Executive Summary

INTRODUCTION

This study aims to identify the changing needs of Chinese seniors who live in the Greater Toronto Area (GTA; specifically Toronto, Markham, Richmond Hill, and Mississauga). Using a mixed methods approach, data were collected from 655 seniors and service providers, caregivers, and other informants at the Yee Hong Centre for Geriatric Care. First, our key findings report on the specific needs of these groups in order to achieve “well-being, quality of life, and life satisfaction” (Chappell, 2005, p. 69).

This study documents the common needs amongst Chinese seniors (seeking help with physical care, mental health issues, spiritual needs, and the final stage of life), giving special attention to (1) changes in circumstances such as demographics and social environment, (2) major transitions in life such as immigration, retirement, or onset of chronic conditions, and (3) needs that emerge as a result of the interaction between service users and the service system, as in cases when new service ideas and programs lead to awareness of needs and new demand for services. The findings also cover the special needs of middle-aged adults and caregivers, the role of gender amongst caregivers as well as the unique needs of Mandarin-speaking seniors and middle-aged adults. Sensitive issues such as elder abuse, sexuality, and attitudes towards death and dying have also been explored. Recommendations are provided to inform further service planning and program development.

Changing Needs Emerging from:

1. Changing circumstances: Demographics and social environment
2. Transitions in life: Immigration, retirement, children leaving home, loss of partner, onset of chronic conditions, etc.
3. Interaction with service system: Changes in policy, service philosophy, perspectives, conceptualization, and actual programs

NEEDS AND CHINESE SENIORS IN THE GTA

Seniors in Canada accounted for 14.8% of the national population in 2011. While the Canadian population as a whole increased by 5.9% between 2006 and 2011, the number of seniors aged 65 and over increased by 14.1% (Statistics Canada, 2012e). The aging population in Canada is expected to accelerate in the coming years as the first wave of middle-aged adults or “baby boomers” (born between 1946-1965) reached 65 years of age in 2011 (Statistics Canada, 2012d).

We recognize that “seniors” as a category is arbitrary and socially constructed. It is important to distinguish the terminology between seniors and middle-aged adults, and to recognize that definitions around aging are constantly changing due to culture and social circumstances. For example, the needs study conducted by the Yee Hong Centre for Geriatric Care in partnership with the Faculty of Medicine at the University of Toronto in 1989 defined seniors as individuals aged 60 years and over. In the Budget 2012, the Government of Canada has gradually adjusted the age eligibility for the Old Age Security (OAS) pension and the Guaranteed Income Supplement (GIS) from 65 to 67 years of age. Even if the definition of aging is constantly changing, the fact that Canada’s aging population growth will accelerate in the coming years remains unchanged. Statistics Canada estimated that the number of people aged 65 and over in Canada will reach 10.4 million by 2036. Approximately one in four Canadians is expected to be 65 years or over by 2051 (Statistics Canada, 2013b). According to Statistics Canada, factors that are related to Canada’s aging population growth include low fertility rates, an increase in life expectancy, and the aging of those from the baby-boom generation. This trend in aging is an indicator for an ongoing need for sufficient and appropriate services to help seniors to maintain an adequate standard of life.

The definition of “senior” often implies not only the individual’s physical and mental states and their interaction with the environment, but also their own perceptions around what it means to be part of this age classification. Emergence of needs is often the result of the interaction between the individual and the environment and, to a certain extent, it is a function of what is available. Certain needs are not easily expressed when there is an absence of relevant services. The presenting problem (expressed needs) is often only the starting point in addressing a long list of underlying needs. Service providers who are sensitive and responsive to the needs of clients should remain open to emerging needs and address them as resources allow, but they should also advocate for the implementation of new or increased resources when they see the needs arise.

Being sensitive to the unique needs of seniors by means of combining instrumental care with emotional care can help to provide the highest level of care for seniors. This could include transportation to medical appointments by someone familiar and trusted, which would decrease mobility and physical barriers and could ease stress and anxiety. It could also include a medication reminder phone call delivered in a gentle and caring tone, which would provide seniors with a sense of specialized care and attention with the management of health issues. Furthermore, establishing and nurturing trusting relationships between service providers and clients should be maintained as the hallmark of quality social service. Staff should remain open and sensitive to clients’ changing needs and, similarly, ongoing assessments should ensure that these needs are considered in quality assurance and improvement. Finally, mechanisms for effective communication and knowledge access for both caregivers and seniors should be put into place.

Yee Hong’s recent efforts have helped to develop an empowerment-based model of service delivery providing outreach to middle-aged adults and seniors alike. Thus, it is this very mission that makes Yee Hong a provider of choice amongst Chinese seniors in the GTA.

PAST RESEARCH ON THE PROBLEM

In 1989, the Yee Hong Centre for Geriatric Care (previously called the Chinese Community Nursing Home for Greater Toronto) commissioned a needs study in partnership with the Faculty of Medicine at the University of Toronto. Subsequent to that study, the Yee Hong Centre developed its first culturally and linguistically appropriate nursing home for Chinese seniors with a community centre attached to it. Since then, it has expanded to four long-term care centres offering a wide spectrum of services for seniors with a diverse range of needs in terms of health, abilities, and assistance requirements. The Yee Hong Centre began servicing three areas in the GTA: Scarborough, York Region, and Mississauga. Moreover, these services included outreach support to help prepare younger seniors for healthy aging and to empower family caregivers for senior care at home.

The study in 1989, entitled “Health Care Needs of the Chinese Elderly Population: A Needs Assessment”, collected data through archives and background research, personal interviews conducted with non-institutionalized seniors, and questionnaires completed by seniors and their family members (The Health Care Research Unit, 1989). We can see that some seniors’ needs have remained unchanged, such as their need for dealing with mental health concerns (e.g. loneliness, isolation, and depression) and needs for home care and transportation services. However, it is clear that there have also been significant changes. In 1989, the majority of participants expressed their need and desire to use senior centres. However, participants in this 2012 study articulated a strong need for more varied services and activities. Another example of changing needs reflects more recent immigration trends as the Mandarin-speaking Chinese seniors in this study expressed their needs for services that have specific regional cultural sensitivity (e.g. the culture of Mandarin-speakers from Northern China). This was not an issue raised in the previous study. Furthermore, seniors’ day care was not recognized as a significant need in the 1989 study but it is now widely regarded as a helpful resource for supporting seniors aging at home.

There were also linguistic changes since the previous study was conducted. In 1981, 60,275 of those living the city of Toronto selected Chinese as their mother tongue compared to 420,000 in 2006. The number of Mandarin-speakers in the city of Toronto in 2011 had the fastest growth rate of 32% out of all ethnic language groups. Varying levels of education and competency in the English language are factors that can help explain this significant increase.

RATIONALE FOR STUDY

As part of the Yee Hong Centre’s strategic planning and in collaboration with the Factor-Inwentash Faculty of Social Work at the University of Toronto, a grant application to the Ontario Trillium Foundation was approved to conduct a study on the changing needs of Chinese seniors in the GTA. The study attempts to explore the changing demographics of Chinese seniors in the GTA and their health and social needs. It also attempts to provide knowledge to bridge the gaps in existing gerontological literature amongst this population. Its aim is to provide an account on the changing needs of Chinese seniors in the GTA to assist the Yee Hong Centre in facilitating service planning. Other service providers may also benefit from the findings in this report.

In Ontario, Chinese, not otherwise specified (N.O.S.), (1.6%) and Cantonese (1.5%) were the second and third most common mother tongues respectively in 2011. Of those who spoke Chinese regularly at home, 37% spoke Cantonese while 28% spoke Mandarin. In Toronto, Mandarin as a language spoken at home increased by 32% between 2006 and 2011 (the fastest growth rate amongst the top 15 non-English languages spoken at home in Toronto); Cantonese, on the other hand, decreased by 11% (City of Toronto, 2012a).

Chinese as an ethnic group are very diverse. Mandarin-speaking Chinese from the People’s Republic of China (PRC) are a rapidly growing population in Canada. This study found that Mandarin-speaking Chinese seniors are in need of services, programs, and activities that are culturally appropriate for them. Many Mandarin-speaking seniors did not find services and programs previously designed for Cantonese-speaking seniors relevant to their needs and preferences. Needs include dealing with frustrations due to family tension, managing disappointment with the change of social status during immigration (many expressed their need for social recognition), and facing discrimination in Canada or from the Cantonese-speaking community.

PURPOSE

The study aims to explore and better understand the changing needs of Chinese seniors and middle-aged adults in the GTA. In the study, focus groups and one-on-one interviews are used to explore the relationship between Chinese seniors and their caregivers while acknowledging intersecting groups within this population (e.g. gender, Mandarin-and Cantonese-speaking, age) and their social and physical environments as well as the needs (physical, psychosocial, and existential/spiritual) of this group.

RESEARCH QUESTIONS

This study consists of focus groups, one-on-one semi-structured interviews, and supplementary survey data. Topics that were explored include general opinions of needs and expectations of those needs, health, housing, home care, economic status, social aspects of life, service interaction, transitional planning (e.g. retirement), and personal life. Additionally, the needs of Mandarin-speaking seniors, caregivers, and middle-aged adults were explored (see Appendix I).

STUDY FINDINGS AND RECOMMENDATIONS

Our findings show that strategies for effective health management are required along with support around day-to-day responsibilities such as cooking and household duties. Seniors additionally need support around dealing with fear, frustration, and social isolation, complicated feelings towards family and friends, and their own changes in health. This study has identified that many seniors need assistance in maintaining their mental well-being, mostly to overcome loneliness, depression, and anxiety. Some Chinese seniors expressed a desire to live happier lives independent of their children. Interestingly, they viewed this as a Canadian way of life rather than a traditional Chinese way of life. The pursuit of better quality of life was related to positive attitudes towards aging.

COMMON NEEDS AMONGST CHINESE SENIORS

Our study revealed common needs shared amongst Chinese seniors who participated in this study. These include such topics as seeking help around mental health issues, spirituality, end of life, and sexuality and intimacy.

Seeking Help with Mental Health Issues

Barriers Chinese seniors are facing when they access mental health services include: lack of adequately trained mental health clinicians and services that provide ethno-culturally-specific care, language and information barriers, decline in individual self-worth, reliance on ethno-specific community agencies that are designed to provide formal mental health care, and fear of rejection and stigma (Khamisa and Koehn, 2010).

Some Chinese seniors are hesitant to seek professional help because they feel shame around mental health issues and diagnoses. Due to the stigmatization of mental health issues, increased culturally and language-specific psychoeducation, programs, and support would be beneficial for this community. Other seniors who are suffering from stressors of everyday life, such as dealing with anxiety, fear, and loneliness, are also in need of support. Appropriate supports and services can better be developed and planned if one is able to communicate one’s needs in a non-judgmental and safe environment.

Spiritual Needs and the Final stage of Life

Values, spirituality, and beliefs contribute to positive attitudes around the final stage of life. Many respondents in this study expressed the need to leave this world with dignity. Contrary to traditional Chinese practice, seniors were willing to discuss their own fears of death openly. When the opportunity to review information and arrangements regarding end of life arose, some seniors found themselves beginning to think, understand, and eventually accept the reality of death in accordance with their own life values.

CHANGING CIRCUMSTANCES

Human needs emerge within specific environmental and social contexts. Macro level factors such as government policies and collective lifestyle changes can influence demographics, social environment, and cultural conventions. The seniors and middle-aged adults who participated in our study found themselves in an ever-changing social context in which they had to learn how to adapt and navigate. For instance, immigration patterns and housing market forces have worked together to produce a growing number of seniors living in suburban neighbourhoods around Toronto that are not served by public transportation provided by the Toronto Transit Commission (TTC). The more costly and less convenient service can have significant impact on the lives of the seniors in terms of increased isolation and helplessness, and therefore contribute to more unmet needs (for independent living, socializing, activity, and so on).

TRANSITIONS IN LIFE

Individual and transitional needs include those during transitional stages in life (e.g. housing and living arrangements, relocation, settlement, etc.), personal experiences with elder abuse, and sexuality and intimacy.

Positive factors that contribute to overall life satisfaction for seniors include exploring sources of support, e.g. family, friends, and community, positive attitudes towards life and spirituality, providing recommendations to health care and social service practitioners, improving attitudes and knowledge around sexual and intimacy needs, exploring different service models, positive impacts of cultural identity, and the use of senior centres and nursing homes.

“When I first arrived, I tried to make friends, mostly immigrants. We were helping each other, spending time together. The environment here was new to all of us. So we learnt new things together, like taking English lessons. Gaining more friendship, exchanging more information, and staying connected with society, I found my knowledge in many respects gradually expanded.”

Transitional Needs

Current studies on the well-being of seniors focus on problem causes or categorical contributing factors, and researchers often overlook that aging itself is a dynamic transitional process. The satisfaction of individual seniors’ lives is always contingent upon multiple and changing factors including the changing social circumstances (e.g. long settlement processes), life stages (e.g. children leaving home, down-sizing from a house to an apartment, loss of spouse, divorce, and remarriage), and their interaction with existing social forces, perspectives, and service options (e.g. openness in talking about taboo subjects). Not all changing needs will be discussed in this report but factors voiced by the participants of this study will be highlighted.

Mobility and Language Barriers

For those who have immigrated to the GTA, mobility and language barriers can be a daily concern that can cause stress and anxiety amongst other challenges. Many Chinese immigrant seniors shared stories about their past struggles, joys, and successes in adjusting to their new lives in Canada. Many respondents expressed feelings of loss and regret after immigration due to different barriers they encountered in Canadian society. These barriers hinder seniors from performing everyday tasks such as running errands and navigating their social environment. For example, transportation service and interpreters are required when seniors make doctor visits.

Lack of transportation support is a contributing factor to the under-utilization of health services by older Chinese immigrants in Canada. Additionally, the ability to speak English is an important factor for effective access to health care services, especially for newcomers and immigrant seniors. Lack of communication skills in English (e.g. with the police, medical professionals, etc.) further increases the chance of experiencing mental distress and feelings of isolation, loneliness, anxiety, and insecurity, thus compromising their overall life satisfaction.

Residential Care

“When you enter the room, you smell the rice cooking. It is such a comforting feeling. It makes me feel like home.”

Seniors require a living environment that is safe and favourable to their physical well-being and mental health, and more importantly, a residence that feels like home and allows certain degree of autonomy. Our findings show that cultural factors are better predictors of preferred living arrangements than health- and need-related factors. Many seniors prefer Yee Hong residential care mainly because of their need for a culturally familiar living environment. Such an environment includes Chinese food, familiar faces, local dialects, similar shared experiences from their home country, and more. Higher attachment to one’s Chinese ethnic identity is also a significant predictor in applying to a long-term care (LTC) home.

This study found that the deliberation process between seniors and their caregivers is a long one that includes contemplating adjustment and potential struggles around various living arrangements when considering residential care. During the transition to senior care homes, seniors anticipate many challenges and difficulties. For example, seniors who have just moved into assisted living residences often need to adjust to their smaller living spaces and may experience anxiety about relationships with neighbours. Soon after arriving, one may feel a sense of loss including loss of ownership of residence, separation from partner and familiar faces, loss of privacy, lack of choice, and loss of some degree of autonomy.

Meanwhile, caregivers are also required to deal with the separation and change in addition to a mixture of emotions during this transition. Although they recognize that their aging parents may have increased attentive care in their new homes, they may feel guilty about their inability to provide them with the care to age at home. Therefore, a longer period of psychological preparation and emotional support for both seniors and their caregivers is necessary. However, there were individuals who did perceive this transition in a positive way (e.g. safer environment, less social isolation). Lastly, participants expressed their frustration with long waiting periods for nursing homes, which is not surprising as demands for LTC beds in Ontario have increased dramatically in recent years.

Aging at Home

Seniors require a certain level of comfort while adjusting to new environments because they may be required to change homes temporarily or permanently and have interfaced with different levels of support. These are often based on health conditions and available family support. This study found that family members provide significant help and care for seniors aging at home.

Chinese seniors in Canada tend to live with children even when their partners are still living; their sons and daughters-in-law are often involved in caregiving. Even though more daughters are involved in providing care than daughters-in-law, family relation is not the most important factor in this role. It was found that caregiving is best provided by those whom the seniors trust and are comfortable with.

INTERACTION WITH THE SERVICE SYSTEM

The expression of needs is often affected by whether the needs would be recognized or accepted by the service system. Certain needs, such as sex and protection from abuse, are not easy to talk about. Public education information (e.g. on elder abuse) can promote awareness while available service programs (e.g. those addressing sexuality or mental health issues) help to legitimize such needs, thus facilitating their articulation and expression.

Needs often emerge with new or improved service programs. Service providers who interact with clients on a daily basis are in a privileged position to observe such needs. A sound service system is one that can take full advantage of such information.

SPECIAL FINDINGS

Unique Needs of Middle-Aged Adults

“You would be surprised that many of us [middle-aged adults] have so many professional skills and talents. We are looking for changes when we can contribute, and we can be valuable resources for serving seniors.”

The changing needs of seniors are often related to transitions during major life stages. Our findings show that the current group of middle-aged adults (those under the age of 65 years in 2012) generally have a greater capacity for self-fulfillment, higher levels of education, and higher expectations for the quality of care provided by social services. They also strive for more independence and prefer having more choices with regard to the services they use, and are generally more assertive about their needs. They expressed a need for building relationships with family, friends, and other social networks as well as being active participants in different interest groups, social circles, and religious organizations. Middle-aged adults appeared to use their own capacity for satisfying deeper needs, building identity, and gaining self-fulfillment and satisfaction in their lives. Some of these include acknowledging the need to feel pleasure, taking leadership roles, learning new things, volunteering, and so on.

Middle-aged adults voiced concerns over the need to deal with employment-related stress and pressures of unemployment, financial support, and the need for additional support from personal support workers (PSWs) and adult day programs when providing care for seniors at home. Additionally, they voiced a need for management strategies when dealing with chronic health issues. Furthermore, the majority of middle-aged adult respondents anticipated changes when transitioning to becoming seniors themselves. Many believed it would be a time to plan for the future, thus requiring information about senior welfare and senior housing applications. Middle-aged adults also generally have higher levels of education and service expectations than older people, revealing their capacity and self-efficacy to seek strategies to manage their health to achieve healthier lives later on. Therefore, they may benefit from increased opportunities to use these strengths when offering support to seniors.

The husband said, “Those PSWs have long become my emotional support. When they came over, they talked to me and comforted my wife. They try to help me occasionally.”

Unique Needs of Caregivers

Practical and Emotional Needs of Caregivers

This study found that self-care is important to the caregiver’s own physical and emotional well-being. Often, a senior can become a caregiver of another senior who has greater needs. Those senior caregivers often feel stressed and worried about their own physical condition, which may affect their capacity for caring for another senior. Caregivers can benefit from receiving emotional support through the care of social workers, other support staff, and social support networks.

“I told myself: I cannot collapse; even if I don’t take care of myself, I need to take care of my aging parents and my family.”

Role of Gender amongst Caregivers

Our findings show that gender plays a role in the needs of seniors. Contrary to traditional stereotypes, middle-aged male participants in this study were relatively expressive in terms of their personal emotions, relationships, and sexuality and intimacy. Middle-aged male adults who were recently retired found it helpful to express negative emotions with regard to their previous career struggles in Canada. Male caregivers expressed embarrassment around having to touch their mother’s body while bathing or changing their diapers. Some of them expressed the need for female PSWs to take over the more personal caring tasks.

Some female caregivers voiced concerns around the unfair gender division of labour. They were expected to be responsible for providing care to senior family members mainly because they were daughters or sisters.

Unique Needs of Mandarin-Speaking Seniors and Middle-Aged Adults

Mandarin-speaking seniors appeared to have different needs. The most frequently indicated needs voiced by most Mandarin-speaking seniors in this study were the needs to (1) overcome mobility barriers, (2) increase physical activity, (3) increase coping with long-term health issues, (4) adjust to new social environments, and (5) manage and deal effectively with mental health issues. Another important need reported by most Mandarin-speaking middle-aged adults in our study was self-esteem. Other needs include getting along well with family members, feeling a strong sense of self-acceptance and efficacy, and participating in social networks and making friends.

Elder Abuse

Another area of concern that has not been widely discussed publicly nor documented accurately in existing literature is the subject of elder abuse. Some seniors found it easier to talk about individual experiences when they learned that elder abuse not only includes physical abuse, but also psychological, emotional, verbal, and financial abuse. Although Chinese social norms largely inhibit any experiences of shame to be heard by others, in a relatively safe environment, seniors may be inclined to gradually reveal their experiences in their own indirect, subtle ways.

RECOMMENDATIONS FOR SERVICE PLANNING AND DELIVERY

Findings from this study show that instrumental care and psychosocial care are not separate and independent of one another, but integrated. When seniors are provided with instrumental care such as being driven somewhere by someone they know and trust, it can also be experienced as a form of emotional care and psychosocial support, which may lead them to feel less isolated and helpless.

Addressing Diversity and Settlement Issues

Immigrant seniors would find it beneficial to have effective ways to adapt to their new lives in Canada (e.g. connecting to the community, building social support networks, reconnecting to home cultures, and learning new social and occupational skills). Those who have been successful in settling in their new environments have experienced less stress and shorter adjustment periods. Chinese immigrant seniors need services to help them adjust to living in Canada. The needs for transportation and culturally and linguistically appropriate services have remained salient since 1989. Further information about social services and resources to assist in overcoming everyday barriers would be beneficial. Increased programs and services should be reconfigured to factor in diverse aspects of Chinese culture and its community in order to engage with a greater proportion of Mandarin-speaking Chinese seniors due to their growing numbers in the GTA.

Recommendations for Addressing Life Transitions

Middle-aged adults are an age group with great capacity for self-efficacy. More activities that provide them with opportunities to participate and contribute to the community and society as a whole are required. Through this, they can achieve greater self-satisfaction and a stronger sense of identity. Besides the need for more activities, more information and educational opportunities are necessary to assist seniors in life planning. Volunteering can become a viable option that is mutually beneficial to the individual and organizations. Thus, leadership training and volunteer development are required. Promoting a positive aging attitude: “starting a new phase of life” (人生再啓航), which is the current position adopted by Yee Hong rather than “the end of life”, would be beneficial. For those middle-aged adults who have stronger consumer awareness and higher service expectations, there should be more choices consistent with Yee Hong’s aspiration to be a “provider of choice”. It also means that the next cohort of seniors will have higher service expectations and demands, and Yee Hong’s service programs will have to be enhanced and improved to meet them.

Psychosocial Well-Being

Effective strategies are required for coping with declines in health and for empowerment with regard to seniors’ own health conditions. Thus, empowerment and capacity building approaches should be considered in program and service design. Yee Hong’s health education programs and Chronic Disease Self-management Program can help meet these needs.

For seniors aging at home, increased practical and emotional support for caregivers, especially senior caregivers, is vital. More caregiver education promoting assertiveness and self-care is needed. Yee Hong’s expanded Caregiver Support Services are anticipated to meet this need.

For older seniors living in assisted care settings, a strategic battery of care and services are required. This includes building a culturally appropriate living environment and transforming the collective residential environment into more home-like environment. For seniors and caregivers who experience a sense of loss during the seniors’ transition to residential care homes, a longer period of psychological preparation before and more support after the transition are necessary for positive adjustment.

SUGGESTIONS FOR FURTHER INQUIRY

Relevance for Other Growing Asian Populations in the GTA

The largest visible minority group in Canada was that of South Asians, representing 25% of the visible minority population in 2006; Chinese were the second largest group. There was a 51% increase of the population who reported speaking Mandarin. However, the second fastest growing language group in Canada was the Philippines-based language Tagalog, which had an increase of 64% (Statistics Canada, 2013c). Due to the changing diversity of the Canadian cultural and social landscapes, the Yee Hong Centre has already moved beyond the Chinese community in service provision plans and this information may be useful in planning future program development and implementation.

Sexuality and Intimacy

Sexuality and intimacy needs of seniors are often regarded as a taboo in Chinese society. However, during the course of this study, it was realized that with open and non-judgmental spaces for dialogue, seniors were willing to indirectly or subtly express their need for physical comfort in efforts to rebuild intimacy in their marriages. In addition to securing a comfortable space with privacy, providing educational opportunities for both staff and community members around this area would help address and respond to concerns around the sexual and intimacy needs of seniors.

Gender

Since gender plays a significant role in caregiving responsibilities, the Yee Hong Centre may wish to plan appropriate services for female caregivers and the transition between home and LTC for their aging parents or family members.

 CONCLUSION

This study attempts to highlight the needs of Chinese seniors and middle aged adults as well as caregivers through narrative exploration and supportive findings in existing gerontological literature and supplementary survey data. Findings confirm the changing, fluid nature of the needs of seniors and middle aged adults, contingent upon circumstances, transitions to different life stages, and interaction with the service system. They are the subjects of care and their needs are in constant dynamic interaction with current senior care services. It would be a disservice not to incorporate these unique and valuable experiences and interactions to guide the direction of future services. As the Yee Hong Centre for Geriatric Care continues to be a provider of choice and is committed to responding to those needs and aspirations of their service users, engaging with client needs amidst changing social and service landscapes shall remain a salient character.