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Beyond Age Discrimination

Religion & National Origin

Comments from Executive Director Tom Thompson and Hmong Liaison Sue Mua, Galtier Health Center

From the Rights Stuff Newsletter, July 2009

Caring for the Hmong

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Sue Mua and Tom ThompsonIf you are Hmong and in need of long-term nursing care, there is a good chance you may end up at a facility tucked into a neighborhood just a few blocks west of the State Capitol, which has more Hmong senior citizens than senior care program in Minnesota.

Galtier Health Center is the place a hospital calls when looking to refer a Hmong patient for nursing home care. Not that all its residents are Hmong—Vietnamese, Somalis, Hispanics, as well as Caucasians have been among its clientele. "We specialize in diversity. Whatever race they are, we take them," says Tom Thompson, Galtier Health Center administrator. But the 125-bed facility is unique in having 16 staff who speak Hmong, and at present, 32 Hmong patients in their Southeast Asian Program, which has been admitting and caring for elders in the Hmong community since it started nine years ago.

"The population is a challenge," says Galtier Hmong Liaison Sue Mua, who has been with the facility since the program began. "This is the first generation in which a family member went to a nursing home. It’s a challenge for families as well. Everything has changed."

Traditionally, as in many cultures, Hmong elders who become unable to care for themselves have been cared for at home, by family members. But as the Hmong population has adapted to American society, for many families home care for an aging parent with serious medical issues is no longer a realistic option. That leaves many families feeling regret and perhaps some guilt, as they turn to a nursing home—even one with a program designed to meet their specific needs. "It is really difficult for them accept, but they know there is no other way," says Mua.

Often, when physicians first suggest a senior care facility, Hmong families will decline and try to care for Mom or Dad at home. But the results can be frustrating, and sometimes tragic. "A lot of them (Hmong elders) don’t take their blood pressure medicine when they are home—they don’t believe so much in Western medicine. So they end up with strokes," Mua explains.

It is not unusual for Galtier to get a series of calls from a hospital seeking a place for a Southeast Asian patient. There will be the first call inquiring if a bed is available. "Then the hospital will call back and say the family took them home." Before long, the aging parent will be back in the hospital, and the hospital will call Galtier again. The family may make several attempts to care for the parent, who will be in and out of the hospital, until the finally agree to a nursing home.

At least at Galtier, they will have a staff with whom they can communicate in their native language, and caregivers who understand and respect their cultural and spiritual traditions. "Sometimes the Hmong end up in other centers, and nobody can speak to them—nobody speaks their languages," says Mua.

The facility provides for spiritual needs, whether residents are Christian, or practice traditional Hmong beliefs, as do 90 percent of the facility’s Hmong population. A Christian minister visits some of the patients, but a Shaman provides spiritual guidance and comfort for most.

Traditionally, the Shaman was the healer, who would provide herbal remedies, and Hmong elders may still trust traditional healing more than Western medicine. "Their whole life, they have used herbal medicine. They think the new medicine might not help them," says Mua. Her job includes explaining in detail how the medicine can help, and when appropriate, to discuss alternatives for care, including hospice. "They might not know what a hospice is," she says. There is no word in Hmong for hospice. And if there was such a word—and a pamphlet translated into Hmong that explained what it meant—it would not be helpful to most Galtier Hmong elders, who cannot read.

The culture’s oral tradition poses other challenges as well. Hmong elders do not eat "American" food, but strongly prefer their traditional cuisine and cooking methods. "For a long time we looked for a Hmong cookbook, but we couldn’t find one," says administrator Thompson. "But one just came out, we bought it, and we’re going to make some Hmong recipes."

It may be just in time—diet is a major concern among the residents, and while some may have adapted and accepted much, including Western medicine, they are not about to compromise at mealtime.

"Of course, we have to have rice at every single meal," says Thompson, who has a large rice cooker in the kitchen. He recalls one time, about four years ago, Galtier ran out of rice on a Sunday. The Hmong residents were appalled—and ready to demand their dietary staple." "They wanted to march to the Capitol—they were so upset that we didn’t have rice," Thompson remembers. "We haven’t run out of rice, since."

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