Unique Challenges of Caregiving Among Aging Immigrants

In this Health Affairs journal article, Julia Alvarez writes eloquently about the additional difficulties in providing care for aging parents among immigrant populations in the United States. In this case, her parents chose to return to their native Dominican Republic to live as they grew older. Due to subsequent health issues, this long distance relationship between her parents and her sisters created many challenges in providing appropriate care. Alvarez points out that in addition to generational differences, the family had many cultural differences to address as well. When her parents announced their decision, she and her sisters were upset, Alvarez writes.

"It’s not fair," my sisters and I protested. We were still in the middle of busy professional and familial lives. Couldn’t they come live where it would be easier for us to stay connected to them?

Just their astonishment was a sign of the cultural gulf between us. We were thinking in that First-World way where the young are the focus and fuel in our fast-paced, youth-obsessed U.S.A. But our parents were formed in that old-world culture where the elders hold the power and the young respect their wisdom and defer to their wishes. Even the physical layout of our houses when I was a young child in the Dominican Republic showed this different power arrangement: my grandparents lived in the central house with all their adult children’s houses built as satellites around theirs. In this country we live in our individual houses and apartments, scattered from our birth families, with our elders segregated in their residences and nursing homes, at a distance from us. No wonder my parents wanted to go back to a more simpatico, companionable way of growing old, surrounded by their young.

Our clamoring self-centeredness as their children and their nostalgia and yearning for an older way of life for their older lives obscured the simple, most obvious fact: their young—now not so young—were all here now.

"You’re grown up. You can take care of yourselves," my mother kept reminding us, even as she swept back hair from our eyes or brushed the lint from our winter coats. But, in fact, the issue we were soon to face was not whether we could take care of ourselves, but how we were going to take care of them as they began to decline.