It's hard for anyone to care for an ailing, aging family member, but Im Ja Choi faced extra challenges when her mother's stomach cancer was diagnosed in 2002.
Choi's mother, who had come to the United States from Korea in 1978 to help raise Choi's children, had never learned to speak English or enjoy American food. Choi thought she would be miserable in a nursing home.
But her mother weighed 62 pounds and had a colostomy bag when she got out of the hospital. Choi and her husband both worked. They needed help to keep Choi's mother at home. That presented another problem. Choi could not find a Korean-speaking aide. After months of looking, she snatched up an aide who was moving to the Philadelphia area from Connecticut.
Then her friends started asking where they could find someone to care for their parents.
Choi, a former real estate agent who earned a master's degree in organizational dynamics at the University of Pennsylvania, saw a need and an opportunity.
She founded Korean American Senior Services, a home-health agency aimed at clients like her mother, in 2004. Soon she was hearing from Chinese families with similar problems. She changed the name to Penn Asian Senior Services and reached out to immigrants from other countries. Penn Asian now has clients from China, Vietnam, Cambodia, and India, plus a sizable group of people who were born in this country.
Last year, the Jenkintown agency's multicultural workforce served 430 people, 47 percent more than in 2010. Choi is shopping for a bigger office. She wants to open a day center because she recalls how her homebound mother loved weekly outings to her church.
Her agency is capitalizing on two big trends: the increase in the country's Asian population and the aging of baby boomers.
The desire to age at home cuts across all demographic groups, and home care is a hot field. In 2012, personal care and home health aides topped the U.S. Bureau of Labor Statistics' list of fastest-growing occupations. In Pennsylvania, there are 1,259 home-care agencies like Choi's, which do not provide skilled nursing services. The state began licensing such agencies in 2009 and receives 20 new applications for licenses a month.
According to the U.S. Census Bureau, the number of Asians in the eight-county region increased 62 percent between 2000 and 2011, from 170,966 to 277,697. Close to 18,000 people over age 65 in the region speak an Asian language. More than 80 percent of them speak English "less than very well." In Philadelphia alone, nearly 6,000 people fall into that category.
Choi said there was a growing recognition that the language and cultural differences of aging immigrants required new approaches. "If you cannot communicate," she said, "how could you care for somebody?"
Joanne Kline, executive director of the Montgomery County Office of Aging and Adult Services, said that her organization could get immigrants the services they need, but that the care was not always culturally appropriate. Budget cuts have made addressing special needs difficult.
Local experts on aging said a few other agencies in the region make an effort to work with Chinese, Russian, and Korean immigrants. Larger home-care agencies say they work with these populations by using translation services and hiring employees who speak key languages.
Forty of the 180 residents of the Gwynedd Square Nursing Center in Lansdale are Korean immigrants. The home has hired Korean staff and chefs, and offers Korean worship services, arts and crafts, and bingo.
Administrator Morris Kaplan said the approach had been a hit with local Koreans. "When you revere their elders, they revere you," he said.
Rorng Sorn, executive director of the Cambodian Association of Greater Philadelphia, could not find that kind of care for her husband's grandmother, who died in a nursing home in 2009. The elderly woman was depressed in a place where communicating was difficult and where she found the food unappealing.
Sorn said many elderly Cambodians were "kind of vulnerable and homebound and depressed." Many do not live with family and are reluctant to ask for help. They don't want to be a burden to their children or the government.
Choi's agency provides training for aides, some of whom go to work in other settings. Many of her aides do not speak English much better than the clients. She says it is good entry-level work for immigrants. Aides make $10.50 an hour. "Even if you don't have an elementary school education, you can take care of your mother when she is sick," she said.
The agency can also help people use a state program that lets those eligible for Medicaid and nursing home care pay friends and relatives for care.
She gets around the obvious communication barriers by hiring bilingual coordinators for each group. That's an expense most home-care agencies would not have. Grants - last year hers totaled $700,000 - allow her to stay in business.
She says Asian clients respond better to aides who know to remove their shoes in the house and who already know how body language differs by culture. Her agency has received a grant to help change attitudes toward dementia, which Asians often still consider shameful.
Her approach has drawn national attention. The Robert Wood Johnson Foundation gave her a Community Health Leader Award in 2011. The Agency for Healthcare Research and Quality profiled Penn Asian last year as an example of innovative service.
One of her aides, Ly Bui, has worked with a Vietnamese couple, Bach Do, 92, and his wife, Lieng Ho, 79, for more than a year. They are the only Asians in a large senior apartment building in Philadelphia. Do has heart disease and asthma. He is on oxygen and needs a wheelchair. Ho has arthritis and moves with difficulty. She uses a walker.
None of them could speak English well enough to be interviewed, so coordinator Phoi Troutman translated for them.
Bui helps the couple dress. She does their grocery shopping and makes them Vietnamese food for lunch. Do is happy with Crunchy Nut cereal for breakfast. She cleans their apartment and takes them outside when weather permits. She reads to them in Vietnamese.
The couple has children, but they want their independence. Ho said she was afraid at night and when an aide can't come. She worries about her husband. "I'm just afraid he'll fall," she said. "I cannot lift him."