Family-Centered Care at Heart of Latino Elder Initiative

By Buffy Gilfoil

Photography by James Chance

This article was written on assignment for Health Elevations, a quarterly journal published by The Colorado Health Foundation.

In July 2014, 83-year-old Catalina Gonzalez was in a tough situation: A paperwork glitch left her without Medicaid and without benefits through the Medicare Savings Program, which helps income-qualifying seniors with their premiums. Her daughter, Wendy Evangelista, tried to get the coverage reinstated but online applications were rejected twice.

Later that year, with help from the Colorado Latino Age Wave initiative, the Colorado Gerontological Society hired Leslie Ojeda, who not only has a solid background in human services but also speaks Spanish.

About the same time, Gonzalez, who speaks little English, heard about the society through a friend. She contacted the organization and was put in touch with Ojeda, who visited Gonzalez at her home and completed a hard-copy application in less than a week. Evangelista hand-carried the application to the county, and Gonzalez’s coverage resumed weeks later.

Gonzalez is typical of the quickly growing group that the Colorado Latino Age Wave initiative seeks to help.

The initiative was begun in 2011 after national research by Hispanics in Philanthropy identified unique needs and challenges facing the elderly. With past support from the Colorado Health Foundation, the initiative currently relies on a partnership among Hispanics in Philanthropy, the Rose Community Foundation and the Latino Community Foundation of Colorado.

The first action taken by the initiative was to conduct a community assessment. It found the number of Latino elders in Colorado increased by 76.9 percent between 2000 and 2010 compared with a 51.9 percent increase for all races in the same age group. By 2030, the Latino population of all ages is expected to grow by 174 percent compared with a 31 percent projected growth for the white non-Hispanic population.

We’re the fastest-growing minority elderly group – nationally and in Colorado,” said Cec Ortiz, project manager of the Colorado Latino Age Wave initiative.

Compared with other older Denver adults, Latino elders face additional challenges, according to the assessment. But “they also possess cultural values and assets that can enrich the aging experience for Latinos as well as enhance the new narrative of aging that is currently being written by all older adults at this time in our nation’s history.”

Access to Resources in Latino Communities

One important lesson the assessment highlighted, according to Ortiz, was a disconnect between agencies providing services to Latinos and those providing services to older adults. Latino-serving agencies have historically had little access to resources dedicated to older adults, while service providers for seniors have not had training in providing culturally appropriate services to Latinos.

To address this and other findings, the initiative funded a grantee cohort to understand and improve practices.

The cohort comprised three agencies that serve Latinos – Colorado Impact: Center for Economic Prosperity, Latino Task Force of Boulder County and Sisters of Color United for Education – and two that serve older adults – Catholic Charities of the Archdiocese of Denver and the Colorado Gerontological Society.

These agencies completed more than 50 hours of structured cultural competency training and participated in more than 300 community events that marketed services to 1,762 Latino elders, their caregivers or both. They continue to work together and learn from each other.

In addition, three fellows, all over age 55, studied a different issue. Transit and mobility expert Mary Young focused on access and affordability. Among other achievements, she examined leveraging family and community assets. Vietnam veteran Jose Aguayo worked on veteran awareness, appreciation and services. His actions in support of Latino veterans included producing a 32-page resource guide. Michael Cortes, clinical assistant professor at the University of Denver’s Graduate School of Social Work, supported the initiative’s policy work by testifying before legislative committees on the consequences of poverty on older Latinos and other issues. His accomplishments included a presentation at the American Society on Aging’s annual conference.

As the grantee cohort and the fellows gathered information, they heard about the importance of family among Latinos and the challenges of caregivers.

“For Latino elders, the family is the nucleus of care,” said Lori Ramos Lemasters, adding that Latino caregivers have the same challenges and struggles as other caregivers, but the two groups are affected differently. Lemasters, a caregiver herself, conducted seven two-hour focus groups with 84 adult caregivers of Latino elders. She left her job in the mortgage business when her mother, now deceased, had a stroke.

Service delivery providers sometimes think language is the only barrier to delivering care to Latinos, Lemasters said. “It’s so much deeper than that.”

Lemasters said she met many naysayers when she was planning the focus groups. “When we first started and decided to hold focus groups, they said caregivers wouldn’t come, especially not Latino caregivers. And if they would come, they wouldn’t talk.”

But she worked with organizations that already had ties to the Latino community and conducted outreach through churches, doctors’ offices and other trusted sources. She followed up by mail and phone. Caregivers not only came, but they opened up.

Trust is an important factor among Latinos, Lemasters said. A caregiver may tell outsiders she loves taking care of her parents, that she’s doing fine and feels no pressure or stress. “In a different setting, she might admit she cries herself to sleep she’s so tired,” Lemasters said.

Lemasters also worked with a naturally occurring retirement community in Wheat Ridge to increase the involvement of Latino elders. “We did lots of community engagement,” she said.

Last summer, Lemasters oversaw a three-month peer-to-peer pilot program that focused on resources in three areas: access to services, respite and transportation. The ultimate goal, Lemasters said, was “to empower caregivers to find their own resources, understand their stresses and give themselves permission to take care of themselves.”

The program was organized into two groups with five caregivers each. All received resource kits with books on caregiving, resource lists, chocolates and blank care plans. For one group, all the help they received was in the kit; the second group received support from caregiver mentor Josephine Bachicha, who cared for her now-deceased mother and continues to care for her adult son Dominic, who has Down syndrome. Bachicha had initial and ending visits with members of her group and a few phone calls in between. They talked about care plans, which included identifying challenges. She also administered before and after assessments of the caregivers’ ability to access resources.

Results of the pilot are not yet available, but Bachicha observed that caregivers are fully dedicated to caring for loved ones but minimize their own needs and pressures. “(Caregivers) almost feel selfish if they feel a need to ask for services for themselves,” she said.

Ortiz said the initiative will build on its successes to date to further develop models that help Latino elders thrive in their communities with the support of family-centered care. It will also continue to focus on the needs of caregivers.

Meanwhile, Gonzalez described the treatment she received from the Colorado Gerontological Society as “excelente.”

Ojeda said of Gonzalez, “She’s very dear to my heart. She has a dynamic personality. I feel good knowing she’s getting the help she needs.”