The ICAS Lectures

No. 2000-0818-ASY

Long Term Care
for the Korean-American Elderly

Ae-Sook Yoon

ICAS Summer Symposium
Korean Diaspora: Challenges facing the Korean-American Community (KAC) in the New Century

Yuong Sang Presbyterian Church Mission Center
706 Witmer Road, Horsham, PA 19044
May 1, 2000

Institute for Corean-American Studies, Inc.

965 Clover Court, Blue Bell, PA 19422

Tel : (610) 277-9989; (610) 277-0149
Fax: (610) 277-3992

Biographic Sketch: Ae-Sook Yoon

Long Term Care for the Korean-American Elderly

Ae-Sook Yoon R.N., BSN

Aging is an inevitable part of life. Unfortunately the older we become, the more likely the effects of aging will result in chronic illness and less independent functioning. It is hard to accept the loss of health, physical abilities, loved ones and independence. Therefore, we need to support an elderly adult through one of the most difficult times in his or her life.

The aging population is growing fast. The number of Americans over age 65 is expected to double in the next 30 years, from 34.7 millon in 2000 to nearly 70 millon by the year 2030. Because of it, the need for long term care facilities continues to swell.

What is long term care? Long term care(LTC) is the broad range of medical, personal and environmental services for individuals who have lost their ability to remain completely independent in the community. LTC refers to care provided for an extended period of time, normally more than 90 days. Depending on the severity of individuals' physical or mental impairments, LTC services are delivered in many types of facilities and settings. LTC options include:
Home Health Care : Care provided in the patient's home. It can include skilled care (such as nursing, rehabilitative or physical therapy care ordered by a doctor) or unskilled care (such as help with cooking or cleaning). Continuing Care Retirement Communities : Are geared to residents' full time needs, both medical and social. Residents are guaranteed access to multiple levels of care and services, including nursing home services, for as long as they remain in the community.
Assisted Living Facilities : Are not nursing homes, but are referred to as "residential care" or "board and care" facilities. Appropriate for people who do not need intense medical care but are unable to maintain independence and who require ongoing assistance with activities of daily living.
Adult Day Care Centers : During normal working hours, provide a safe environment for elderly or disabled persons while their primary caregivers (usually family) are absent.
Hospices : Hospice care is designed for those persons who are certified as terminally ill.
Alzheimer's Centers
Nursing Homes

How much do nursing homes cost? Today, the national average cost for a one- year stay in a nursing home is $46,000 , according to The Wall Street Journal. There are 3 basic ways to pay for LTC in a nursing home ; Medicare, Medicaid or private pay (out of pocket or by using LTC insurance).
1. Medicare : Medicare is a federal health program designed for those aged 65 and older, for those of any age who suffer from chronic kidney disease,or for those who are receiving Social Security disability benefits. Medicare pays for but one type of nursing home stay, skilled nursing care provided at a Medicare-approved facility. To qualify for nursing home reimbursements under Medicare, the resident must have been hospitalized for at least 3 days within the prior 30 days. Medicare will only pay up to 100 days in a nursing home. Medicare pays 100% for the first 20 days, beginning on day 21-100 there is a copayment required with Medicare. Medicare supplements will pay in conjunction with Medicare. Once Medicare stops paying for care, most supplements will not continue to pay. 2. Medicaid : Medicaid is a medical welfare program funded jointly by the federal and state governments. Given the state governments' involvement, the eligibility rules for receiving benefits vary from state to state. In order to qualify for Medicaid, an individual must have assets as low as the state's defined poverty level and have very limited income in order to qualify for benefits. Medicaid covered for LTC possesses some advantages. Some care may be covered at 100%. Once you qualify, no time limits on receiving benefits are imposed. However, not all nursing homes accept Medicaid.
3. Your Savings and Assets
4. Long Term Care Insurance

The Needs for Long Term Care Facilities for the Korean-American Elderly

The Korean-American community has been growing to become an integral part of America. Among many challenges ahead, LTC for the elderly unquestionably is a major issue.

The majority of Korean-Americans still regard it as natural for adult children to be responsible for the aging parents and provide care for them at home. Caregivers providing assistsance with daily living are usually women and have daily jobs in addition to their caregiving. They have a conflict with their caregiving and their jobs because this work can require a high level of devotion and patience, and an extraordinary commitment of time and energy. It is emotionally and financially draining effort. Even the closest and most supportive families discover it is difficult and stressful to provide care of loved one everyday. Sometimes the support and care for the aging parents can be an unbearable burden to descendants even though it is traditionally expected of them to take care of their aging parents.

In large part, our particular ways of viewing life and the world surrounding us originate in our cultural heritage. Cultural attitudes, beliefs, and traditions are deeply ingrained in each of us and can affect all aspects of our personality and life, including our attitudes toward health and disease. Conflicting cultural values are prevalent in the United States. As the first generation of Korean immigrants, they brought their culture with them to America, and their bond to their ethnic heritage is still strong. They don't like American food and know little of American customs. They enjoy listening to Korean songs, reading Korean newspapers, and watching Korean videos. They have their favorite ways to celebrate their holidays. They need to follow their culture throughout their life. Therefore, the constant pressure to fit in American culture, health care, and long term care can be overwhelming for many Korean-American elderly.

A large number of the Korean-American elderly do not speak English fluently and can not adjust well in American LTC facilities. They can not understand the spoken words in English and have difficulty with verbal expression. They can not even communicate their basic needs for eating, toileting, bathing, or transferring. When they experience mental or physical discomforts, the Korean-American elderly can not report to the medical staff and are impossible to receive an appropriate medical treatment promptly. They can not participate in group activities or church services. They can not make close friends with whom they can socialize regularly. They are completely isolated from the surrounding environments because of their language barrier. These situations can increase their anxiety, frustration, feelings of helplessness, or depression.


A lot of people say, "I may never need LTC." Everyone hopes they will never need LTC. But if you happen to need LTC in the future, where do you want to be placed? What about your aging parents, your spouse, or your descendants? Building LTC facilities could be one of our great achievements and American Dreams for the Korean-American Community. We all need to participate in the building of LTC facilities for the Korean-American elderly. Thus, we can maintain their optimal level of functioning, promote respect and dignity, accept normal life changes, and encourage daily enjoyment and quality of life.


1. Educating about Long Term Care : Some Korean-American elderly tend to streotype that the elderly in LTC facilities are poor and abandoned to there, instead of being taken care of by their children. This perception can be partly from cultural differences and partly from misunderstanding about American LTC. They need to accept the modern trend in care for the elderly that is moving away from the traditional reliance on the family toward utilization of LTC facilities. We need to educate people about several different LTC options, American insurance systems, retirement planning, needs for building LTC facilities, etc.

2. Retirement Planning : Most of us have great trouble thinking about the long term and preparing for it. Maybe because we're too caught up in daily life. However, thinking in advance and acting on those thoughts are keys to being ready for the future. How much can we count on from Social Security? How much will we need for our retirement in order to live comfortably? The financial factors are important determinants of our future retirement and LTC planning. We should discard our attitude of financial dependency on children and develop an independent attitude to make the last stage of life rewarding. We can plan our retirement by investing in 401(K), IRAs, mutual funds, bonds,stocks,etc. Also, we can prepare for the costs of LTC by purchasing LTC insurance. Planning ahead for LTC does make a difference.

3. Establishing a Creditable Nonprofit Organization : In the Korean-American Community, we have so many organizations directing toward various objectives or interests. When you name and count each of them, you may come up to tens, or hundreds....!? A few of churches and organizations begin to acknowledge the inevitable challenges that confront the Korean-American Elderly. But, they don't quite seem to understand about American LTC ( types of LTC facilities and settings, costs of LTC and its coverage under Medicare and Medicaid, rules and regulations by the federal and state governments, etc.). As an important first step in that direction, we need to establish a creditable nonprofit organization that is well fit in American system and can be funded by the state and federal governments. All Korean-Americans should participate in this challenging task because we all will be benefitted from LTC facilities from generation to generation.

Let's empower ourselves for our future!


We care a lot about our little children who are dependent on us and can achieve our American Dreams in the future. But, what about our aging parents? They suffer from a sense of being lonely, powerless,and useless because of their language barrier and their inability to adjusting in American culture, health care, or long term care. We should listen to their screaming and crying for help and their sincere praying for dying with dignity without being a burden to their loving children. We need to build long term care facilities for them. There's nothing more rewarding and meaningful than helping the elderly complete their journey in peace and with the dignity that they so richly deserve.

This page last updated 8/31/2000 jdb


ICAS Fellow