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Are We Taking Care of Immigrant Elders?

Are We Taking Care of Immigrant Elders?

Magazine, Living Well

What lessons can we learn about the lives of immigrant elders from the tragic mass shootings in Monterey Park and Half Moon Bay? Uncharacteristically, the hand that clutched the weapon in two recent mass shootings in California was that of an elderly man. Most mass shooters are young men. The real reasons behind the shootings still elude authorities, but society is still reeling from the tragedy. This is a demographic of our population that is largely invisible — not just AAPI elders but many immigrant elders from all backgrounds — who keep their stories to themselves. Invisibility reinforces their sense of isolation and with the isolation comes fear. More often than we realize, elders are the targets of violent crime. According to the National Council on Aging, suicide rates are high among this group: they comprise 12% of the population, but make up approximately 18% of suicides. Although many find ways to break through the isolation on their own, like the people killed in the Monterey Park ballroom, there’s no quick fix- not mental health care nor gun control, or ballroom dancing salons. This is about us, our society. America is no country for old men. There’s a call to action to serve our elders better.

Helen Zia, Asian American author, journalist, and activist shared her personal perspectives via video. A personal testimony on the invisibility of immigrant Elders.

You know my most recent book last boat out of Shanghai. I interviewed a few hundred elders. Chinese immigrants in their 70s 80s and 90s and over and over again, I would ask them about their lives and the things they experienced as children, as migrants, as exiles growing up in times of war and trauma and many of them talked to me and said, “I’ve never told anybody this, I never told anybody how I walked to school and I saw dead children in the street with dogs chewing on them or how they saw people being beheaded, or how they had to walk hundreds of miles not knowing when they would get another meal, and this wasn’t just the people I interviewed. The vast majority of Asians in America are immigrants and in order to come from where they came from they went through a lot and so many have gone through war, starvation, civil war, great trauma, and witnessed terrible terrible things. And so these people I interviewed would say
“I’m telling you this for the first time. I’ve never told anybody”, and I would say to them, “you didn’t tell your children, your adult grown children this? And they would say, “no, I don’t think anybody wanted to hear this. I don’t think anybody wants to listen. You’re the first person who ever asked me”.And so I would be privileged to know to hold their stories, but their stories of pain. And so is it any surprise that within our communities there are people,  elders who have been made invisible and treated not even as human beings who feel isolated and yes, experience mental health issues like any other community that would be invisible and isolated? And I just want to say too you can see the fear. The fear of so many people who heard about what was happening in Monterey Park and Half Moon Bay and so many other places in America where seniors have been attacked, our immigrant seniors, and too many of them have been killed or terribly injured. And so when Monterey Park and Half Moon Bay happened, automatically people just recoiled. It triggered all of that fear, all of that isolation, and none of that is good for anybody’s mental health. But you know, I was going through this booklet that I’d like to share with people, is Vincent Chin’s Legacy guide which has a whole section in it about people who have been attacked and hurt and so many of them have been our immigrant elders, 84-year-old Veta rats impact or Yikoi Wang 89 years old or when you look at the women who were killed in Atlanta. Three of the six Asian women who were killed were over the age of 60 and they were working for FedEx workers in Indiana. Among the Sikh workers who were killed, several were over 60 because many of our elders are still working. With the Asian stereotypes, if they’re not invisible, it’s also viewed that, oh! they all must be laying back eating bonbons or something like that, but it’s just simply not true. So I think it’s so important that you are looking at this and raising the question what about our immigrant elders and our Asian American elders? It’s just sort of multiplied double and triple jeopardy and for our women elders, there is also the gender aspect too. And when I think about things I saw about how my own mother and father were treated, it just breaks my heart every time and so that’s what all of these incidents have brought up for me and I’m so glad that you’re addressing it and other panelists are going to be talking about that. I think there are things we can do to address this, and number one is what you’re doing, shining a light on it. How do we fight invisibility in isolation? We make people visible. We tell their stories. We look at them. We see them. We don’t assume anything about them. We ask them the people that I spoke to, but nobody asked them about what they had experienced, my own mother, I asked her a question that I hadn’t asked in 40 years and then she told me a whole story that if I had never asked her I would have never learned this about her and her being able to tell me what she had experienced. I could see it. She was becoming lighter because she could share something about herself. And I think that was true for everybody I interviewed and I think it’s true for these elders. We shouldn’t have to wait until they’re shot in a mass shooting to see that they find ways of breaking their own isolation and going out and b, ballroom dancing. Why does become a story now? I think my pain and seeing these stories get amplified because I don’t see the stories of the victims told or even the attackers what pushed them to that. What about the people who were hurt? What about their families? Why are they working as farm workers in their 70s ? Living in trailers? Why do we not know about them? And so it’s really up to us in our communities to actually look at their lives to see them, to tell their stories and I understand how hard it is for families of victims to want to speak at a time of terrible grief, but so others in our communities should try to humanize them to make them real people to others. When I see, for example, Vincent Chin’s mother was exceptional in that way through her grief and through her pain. She wanted people to know so did Emmett Till’s mother and that maybe will shock people into actually seeing all these very real very beloved, very important people in our communities, our elders, and to actually look at them, to see their real lives and to let them know we see them and we do care. And until they see that, they’re going to continue thinking, ‘nobody cares about my story, my life, and anything about me’ and until we act like we do, um, that’s what it’s going to take to change that.

Rita Medina, Deputy Director of State Policy and Advocacy at the Coalition for Humane Immigrant Rights Los Angeles (CHIRLA)

I will just start by saying that I really appreciate and I want to kind of piggyback off the comment specifically that was just made question that was asked in looking at some of the last tragedies specifically the one in Half Moon Bay this question of why were people still working in their 70s and I lead with that because this is actually something that at the Coalition for Humane Immigrant Rights we are turning our attention to the next several years. For the last decade or so we’ve been working and organizing to expand access to a variety of benefits in California for undocumented individuals. We’ve talked about children. We’ve talked about families, and mothers, but where we still see a gap in the telling of stories, the spotlight on the population is really with our senior population. It started to pick up a little bit in the last couple of years with the fight to expand and now Implement access to Medical for folks who are 50 and over, as the discussion of food benefits. I’ll get into that in a second. But really what is California doing as a state to shine a light on this population that is only gonna continue to grow and grow undocumented because of the absence of any real solutions at the federal level? I think so much of this ties back into why folks continue to work into what should be their golden years, you know, that’s the phrase we have here because they have to, they don’t have access to Social Security benefits at retirement in a real formalized way. And so they have to work. I say that and I’ll just share a few statistics, and I apologize for some of these in advance but I will share the links to where everything comes from it’s all information that comes out of the 2019 American Community survey. So, you know in a portion of the census but in 2019, it was spotlighted that there were about 16,000 800 undocumented seniors and seniors in this particular sense. When we looked at it through the center for migration studies it was 65 and over. So we’re looking at almost 17,000 folks in 2019 who are undocumented in 65 and over in California, and we know that this is followed by a large number of folks who are 50 and over, you know, getting close to that 65 year age and we highlight the 65 year age because that is the age where typically people think about access to retirement and again for our folks, that is not something that is necessarily coming. Looking at another data source, the migration policy Institute looks at that 2019 moment and they know that individuals who are 55 and over also undocumented in California are about 239,000. So people can see there’s quite a bit of data, but it is a large number of folks that we’re talking about. People who continue to age again in the absence of any kind of immigration reform waiting, you know, in some cases over a decade because they’re not able to adjust their status and in different levels of employment. We are talking about everything from domestic workers, farm workers, street vendors, and construction workers and part of the reason that Shirley had decided to actually make this pivot and to talk about our community more is that all of the jobs I just mentioned I can point to individual chair members who have been engaged with us, organizing with us for in some cases 10-plus years, who are still waiting to adjust their status. They continue to be undocumented. Some of them are alone here in this country and their bodies are physically breaking down because of the work that they’re doing, knee problems from bending and construction, back problems, and working as domestic workers and we’re really thinking about how we turn our attention to uplift their stories. As I mentioned we know that we have a recent medical expansion here in California. And when that was first something that came to the forefront of the policy world, I think it was estimated about 230,000 people was the general estimate of folks who would benefit and as of October of this past year we know that we have gone almost 50,000 individuals more than that estimate.So we know that the need is out there for people who need in case medical support. We’re looking right now at expanding food benefits to seniors who are undocumented, 55 and older was a commitment that the governor made in this past budget. That’s now been delayed until 2027. And so there’s still this gap. You know, we think of disasters especially climate disasters that have recently happened in our state. We think of the Central Valley and the Farm Workers who are not able to work, and maybe need to resort to a different type of work while the fields were flooded. What about the senior Farm Workers in that case? What options do they have? And so, you know highlighting all of these because that is sort of the state of senior immigrants. I think with some basic data I will also highlight that it’s really hard to find good data on our immigrant seniors for a lot of the reasons that were mentioned; people don’t want to talk about it unless they’re asked right, they put their heads down, they’re doing their work, they’ve been doing this work. And so we just feel like there’s this moment, this opportunity to lift up this back, that there is no retirement., there is no nesting. There’s no concrete monetary support that is available for our undocumented immigrants. Yes, and how do we create that in a state like California? That’s the work that we’re going to be turning to in the next several years, looking at folks who have been sometimes working in pain into the system. We know folks are paying taxes, but they are not able to access Social Security benefits because they are undocumented and I want to be really clear that even if somebody does reach the point where they can adjust their status, do you know they can eventually have access to benefits? It could be that this person has worked jobs that are low wage or you know inconsistent for most of their life so that this benefit is not really something that is going to sustain them financially and we really have to look at this whole picture of what is somebody’s work history here in the United States and you know what that looks like at the end of their ability to work. I also want to point out there are a couple of things that California is working  in its master plan for aging. suppose I were to talk to some of the Departments or agencies or even the governor’s office. In that case, I think I would ask very plainly where we can highlight specifically what California is doing and planning for immigrant seniors and undocumented seniors and that is something that we are also going to be asking so I wanted to just kind of paint that fuller picture. It takes us a little bit away from the narrative around isolation and some of the mental health pieces, but I would also argue that all of these things are the stressors of working until one is, you know, older and unable to de-stress. There’s physical stress on the body which is also one of these components that play into this larger piece that we’re talking about our seniors possibly just a group of folks who are unwell at the moment and really need our care and support and so I would just say in closing, please be on the lookout, and the next I would say, a couple of months. We are going to be launching an education campaign uplifting stories of our individual chair members and just really looking at their Journey from entering into the United States, working and where they are now, what they see as their prospects as they’re getting older and then what they’re hoping for in the future.

Laura Som, MAYE Center for healing of survivors of trauma, systemic racism, oppression, inequity, Long Beach

This is extremely important for our communities. I am Cambodian Chinese and I’m a former Refugee of the committers genocide. I came to Los Angeles when I was about 10 years old among hundreds and thousands of other Cambodian, and Cambodian Chinese escaping the genocide, and currently, Long Beach has the largest Cambodian population in the nation. Many of these refugees experienced extreme violence and traumas during the genocide, many had and have PTSD including me. Our community has struggled with mental health for many decades in America since then. As a 1.5 generation, I grew up in America witnessing my elders and my communities’ mental health deterioration from the aftermath of wars, extreme violence, and neglect by the mainstream community. Some of the symptoms of these traumas are hatred, violence, rage, and depression. Little has been done to shield young children from it. As a young child, I had hoped that by studying hard I could heal myself and bring healing resources to my community because I couldn’t afford to wait.

Today, I’m the executive director of the MAYE Center, and also the founder of a trauma Healing Center in Cambodia town in Long Beach, California. The MAYE Center provides an organized culturally appropriate means for mental health and wellness for refugees and immigrants. My background is in biochemistry and holistic trauma healing. The majority of our members are in the same age group as the victims and perpetrators of the Monterey Park and Half Moon Bay mass shootings. They’re grieving and in fear. Our community is deeply saddened to hear the news, but we are not shot. Because of the inadequate resources provide to our communities to address mental health disorders and the lack of gun regulation in this country we live in fear when we have to leave the safe space in our homes and communities just to venture into the general public means facing the epidemic of mass shootings in our community. This is a time of intense and deep emotions for all of us, especially the families of the victims and perpetrators, a time for healing. It would be too easy for all of us to just blame the perpetrators, but little closure would come from that. We should start by asking ourselves what are the underlying issues that lead one human being to disregard life and commit a mass killing. We bear witness, silent witness to the shootings in schools and in places where seniors seek refuge. When we start our investigation we learn how we can improve our community and how to improve our country. This is how we build our resiliency against trauma and break the chain of traumas for generations to come. We know what to do, and our politicians and leaders know what to do. But leadership without the courage to truly protect our children, our elders, and our communities is merely bureaucracy serving only the ambitions of the very authorities. They’re supposed to protect us. It’s an old story that we all can no longer be allowed to substitute for strength and courage to do what’s necessary. Within the past nine years of advocating for seniors and working at the Maye Center, we discovered many things are preventing seniors from seeking timely and appropriate help to address mental health disorders such as inappropriate uses of Western approaches in Asian communities. We need more Horticulture therapists for seniors and therapists that can speak our language. We have very few therapists that even speak Cambodian and so there had to be an interpreter, there are difficulties with the translation, a lack of linguistic and cultural sensitivity and competency at all levels, lack of investments and existing resources within the communities of color by funders foundations and government leaders lack health insurance coverage for non-traditional services that are traditional within the Asian community. Lack of gun regulations, the lack of mental health wellness, and integrated Green Space in parks of recreation, senior housing complexes, and communities. This is a call to action for all of us residents, city leaders, housing developers, and policymakers. Everyone is a part of this. Everyone is part of a solution to prevent these tragedies from happening again. You could use your voice and exercise your rights to vote for policies and initiatives that align with our community’s needs for wellness and well-being. Advocate for legislation but more importantly organize your community and whatever level meets people where they are refusing to accept the war not excuses of politicians. So-called leaders that the substance of change is now somewhat unattainable and I believe when we started the May Center no one would help us. No one would fund us. We were poor Asian refugees who didn’t speak the language and we were immersed in the traumas we brought with us.

But I as a 10-year-old kid living on the streets of Long Beach learned through every avenue I could find, even watching closed caption cartoons, I gradually began to grow and then flourish to graduate from Long Beach Poly High School with a 4.0 GPA and majored in Biochemistry at UC Riverside. So too can even be the most destitute and their communities.

Start by identifying the most urgent needs in our community, in your community, and then find all the people around you who might be willing to work on these issues then learn how the power structure works and educate yourselves until you know, too well what to do and how to do it, demand, enforce that your local leaders, council members, and mayors, representatives, and national leaders invest in communities of color and provide resources for integrated mental health services that are linguistically and culturally appropriate for the Asian communities and for gun regulations. Above all, I want to thank all the leaders and politicians that really worked with the Maye Center to help transform trauma into activism like Congressman Robert Garcia, Lina Gonzalez, and Lena Gonzalez, and above all, I want to thank the Los Angeles supervisor Janice Hahn and her field Deputy Helena Chico for supporting and advocating for culturally appropriate means for trauma healing by saving the growing experience urban farm from demolish.

Dr. Brett Sevilla, Medical Director of the Asian Pacific Counseling and Treatment Centers, Los Angeles

Our agency is a nonprofit Community Mental Health Organization primarily serving monolingual Asian immigrant families here in Southern California. We operate eight sites across Los Angeles and Riverside counties. One of which is located just one mile from the second dance studio that the gunman targeted that night.

Since the mid-70s APCTC has not just provided treatment in our clinics, but we have mobilized in response to crises that impact Asian-American communities. We went out into the valley after the 94 Northridge Earthquake. We worked in Koreatown after the civil unrest in 92.

We’ve been supporting our clients and community through the wave of anti-Asian hatred and violence of recent years and sadly now we must step up again in response to the tragic violence in Monterey Park a majority Asian Community celebrating the Lunar New Year.

When we learned that the apparent gunman was an older Vietnamese man targeting other Asian elders our collective hearts sank. How do you respond when both the victims and the perpetrator are part of your extended cultural community?

How do you simultaneously support those who are grieving and those who may be struggling with feelings of rejection, victimization resentment, and even ideas of revenge?

For those who are grieving, we have coordinated with other Asian community organizations to provide immediate emotional support while other agencies were stationed at the community center in Monterey Park. Our bilingual staff went into the nearby schools assessing and supporting about three dozen students identified as struggling with their emotions.

Fortunately most reported feeling better by the end of the week. But reactions to trauma can be delayed, can be stoically denied, and can appear in the guise of physical symptoms. So it’s likely that we won’t see the full impact of this tragedy for quite some time. And we will never see many who are suffering because they simply won’t come to us.

Now I have to emphasize that I have never assessed the man accused of the shooting so I can’t say anything specific about his mental health, but speaking in general, the kinds of behaviors that have been reported in the press, complaints about fraud and poisoning, irritability perceiving hostile intent and others withdrawal and hoarding weapons are all potential red flags for neurological or psychiatric illness, substance use or potential criminal violence. You know granted a psychiatric assessment may not have prevented the tragedy. Someone with those symptoms is likely to reject treatment and even an involuntary hold for assessment only lasts 72 hours. I don’t know that man’s history, but most of the elders that we see from Vietnam, Cambodia, and Laos are still struggling with PTSD 40 to 50 years after the wars and revolutions that forced them to flee as refugees. Many of them still worry about Communists coming for them in the United States, fears that are often reinforced by fervent and communist rhetoric in many Vietnamese enclaves. After seeing videos of attacks on Asian Elders many are afraid to leave home. One Cambodian woman I work with was convinced that the Khmer Rouge had come here to launch another revolution. I tried to reassure her otherwise, but who am I to tell her that 10 innocents being slaughtered doesn’t resemble what she witnessed at the hands of Paul Posh soldiers?

And among our eldest immigrants, we still see the lingering effects of the cultural revolution in China and the Korean War both of which were followed by decades of hardship. But even the elderly who have not been exposed to trauma still experience multiple stressors that jeopardize their mental health. Monolingual elders are typically dependent on family for transportation, translation, and assistance. They may be unable to communicate with their grandchildren or their in-laws or their traditional authority in the family may not be respected. When younger generations move away for work or education, the elders may feel disrespected, abandoned, or become isolated due to limited acculturation and lack of assistance. Illness tends to increase with age as does disability and death resulting in the loss of family members, the status of professional identity of ability, and mobility. Many cannot access health care because of language, transportation Insurance, and financial hardship. And while these barriers apply to mental health care as well, there’s an even bigger barrier to that. We face the stigma of mental illness. Any psychiatric condition no matter how wild is equated with being crazy and is considered shameful not just for the person with the symptoms, but for the whole family. Thus when confronted with behavior changes or psychiatric symptoms, families will first try to contain the problem and the person at home. If they struggle they might seek support from clergy in an ethnic church or Temple. If that isn’t enough a primary care physician might be consulted. But Primary Care Providers may not recognize the psychiatric issue because the complaints are more often physical than psychological. In addition, the doctor may hold stigmatized beliefs about psychiatric illness and fail to diagnose an underlying depression or anxiety disorder. If they eventually do see a psychiatrist the person is often severely impaired, angry about being accused of being crazy and the family is exhausted. Medications may be rejected or not taken consistently as Western medication is believed to be too strong or even a cause of mental illness. Psychotherapists are unfamiliar and encounter intuitive given that one should not talk about personal problems outside of one’s family.

Our agency’s approach to overcoming these barriers includes locating our offices in Asian enclaves placing staff and local schools providing culturally affirming services and the client’s native language linking families to Community Resources for practical support offering vocational rehabilitation, housing, and psychosocial recovery programs, conducting community outreach education and prevention programs, and negotiating in a common understanding of what may be causing their problems and what can be done about it through culturally respectful dialogue. And what gives me hope is the fact that an increasing number of our referrals come to us by word of mouth. That tells me that people in the community are not just satisfied with our services, but that they are actually starting to talk to others about their own mental health and how this treatment has helped them, and to me, that’s a sign that we’re making progress in raising awareness. To decrease stigma and provide hope that’s what we intend to keep doing in the wake of this latest tragedy.

On issues of the race or ethnicity of the shooter, I do have to admit that I think for a lot of us our initial inclination when we heard about the shooting was that this was another incident of anti-Asian hatred another hate crime.

Linda Yoon, Co-founder of the Yellow Chair Collective, culturally responsive Asian American therapy

Hi, my name is Linda just briefly into this myself again. I’m the founder of Yellow Chair Collective and we also have a non-profit sector called Antoine Community, which I co-founded. They’re both Asian American mental health and educational providing agencies.

And after the Monterey Park shooting, since we’re located in Los Angeles, we have responded by providing pro bono services to those who have been directly impacted and we have been serving clients who haven’t been directly impacted and even if it has been very challenging work for us. There are more personal observations as a social worker and mental health provider. I’ll be kind of focusing more on like why there may be a lack of resources to take care of our other immigrant authors, especially those I do have. The Asian immigrant population is very vulnerable, but others and seniors in America are vulnerable as well and they’re been very invisible, and unseen, the resource survey was limited when I chose to become a social worker as a college student.

I remember taking the class intro to social work and the professor was doing a survey on what population we wanted to serve,  and every single hand went up when the professor asked who wants to serve children and teen families. And then no one raised their hand when she went to serve seniors. I didn’t even raise my hand because I didn’t even know you could serve seniors, that was not something that I had awareness about. And the professor was disappointed and let us know that baby boomers, you know the silent generation. We’re having a lot more seniors who are aging and will need services and support. However, a lot of young people don’t even have the awareness that this is a population that is in big need and I remember that really stood out to me. However, my next four-five years and my Master in social work program holders and seniors were never really talked about again. In my classes that was not a requirement. There was an elect but not many people chose to do it. When we were required to study children, family, and teens those were required and we studied a lot about so I ended up graduating with not much knowledge on how to work with seniors at all, and accidentally, my first job was in senior care right after grad school not intended. It was just that they needed Asian speaking social worker, and I spoke Korean. And they did let me know how hard it was to find a Korean social worker.

Just in general and they’re so happy to find me there or like you don’t have any senior or experience. It’s okay. We need you. So I ended up working with them for a while. And there I served around 500 seniors, most like 90% were Asian ethnicity speaking different languages, but mainly Korean at this housing. And I did one of the tasks that I was given doing assessments, wellness check every year, going to home businesses, or every single residence.

We will go over these questions and they will be able to start talking to me about their trauma. Things they just never shared with their children. they shared things that embarrassed them because I warmed up to them and they had never done so with anybody else even though I was a young worker. So that was an interesting dynamic that I got to experience.

There was just so much hidden trauma, isolation, and loneliness that I was able to witness and I went on still serving other immigrants in different capacities the themes were loneliness, and isolation, due to many many factors already talked about such as language, immigration, culture, a lot of innovational conflicts as well, especially their children and their current children born in the United States have different mindsets. But also I had a lot of challenges as a social worker and other all the elderly. Providers also share the same. We all kind of get together and kind of complain that there is so much lack of resources for all the opportunity seniors. And when I moved my service to serve more children and families, I was kind of shocked at how many resources were available for children and families compared to seniors they were just hard to find at the time and I continued to kind of see that in this day.

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