Assisted Living Guide for Hawaiians and Pacific Islanders

For many seniors, assisted living offers the perfect blend of independence and affordability. These communities have staff members who are available 24 hours per day to make sure that residents have access to nutritious foods, enriching social activities and high-quality care. Although assisted living has many benefits, family caregivers often have trouble finding the right community for their loved ones. This is especially true for the families of Hawaiian and Pacific Islander seniors.

This struggle can be especially problematic considering that native Hawaiians and Pacific Islanders have higher rates of obesity, alcohol consumption and tobacco use when compared with other ethnic groups, necessitating specialized medical care.

Additionally, cultural respect plays a significant role in the lives of Hawaiian and Pacific Islander seniors. They may prefer staff members to call them “Uncle” or “Aunty” instead of using their first names, a consideration not all communities may be familiar with. For Native Hawaiians, it’s important to find a community where they can live according to deeply influenced traditional Hawaiian values, such as aloha (love/compassion), malama (caring), ohana (family), laulima (cooperation/helping) and lokahi (balance).

Unfortunately, not all assisted living communities can satisfy these needs, making it even more difficult to find the right community for a Native Hawaiian or Pacific Islander loved one. This guide helps to ease that burden. It introduces some of the challenges that you can expect as a family caregiver for a Native Hawaiian or Pacific Islander who’s transitioning to assisted living. Also, it includes tips for managing cultural guilt, advice on finding the right community and a list of resources to help you navigate the process.

Native Hawaiians value their connections with family members near and far. In fact, family is one of the culture’s core values. Parents, siblings, aunts, uncles, children and other family members enjoy spending time together and sharing time-honored traditions. Kinship is also important for many Pacific Islanders; aunts, uncles and cousins play an important role in the extended family.

These characteristics separate Native Hawaiian and Pacific Islander culture from the traditional culture of the mainland United States, which typically emphasizes rugged individualism. Many Native Hawaiians and Pacific Islanders also see the world through the lens of Indigenous stories, influencing how they interact with others. Below are just a few ways these differences in culture affect decisions related to senior care.

Social connections play an important role in helping Native Hawaiians and Pacific Islanders manage their health. In fact, researchers at the University of Hawai’i discovered that many older patients rely on family members to remind them to take their medications or perform other health-related tasks. As a result, it’s important for seniors to maintain these connections no matter where they’re living.

Family is so important to health management because Native Hawaiians and Pacific Islanders are more likely than other cultural groups to live in multigenerational homes. This means that it’s common for a married couple to live with their adult children and at least one set of their elderly parents. Everyone pitches in to cook meals, take care of the house and handle other responsibilities. Therefore, the idea of moving a loved one to an assisted living community may go against a Native Hawaiian’s or Pacific Islander’s cultural beliefs.

Native Hawaiians and Pacific Islanders also prefer to make important decisions within the family unit rather than consulting outside experts. For example, many seniors are hesitant to meet with an attorney to discuss end-of-life planning. As a result, family members may hesitate to trust assisted living communities when it comes to managing their loved one’s health.

The bottom line is that Native Hawaiian and Pacific Islander families often prefer to care for their older loved ones at home. This creates a few challenges when they realize that living at home is no longer the safest option for an elder.

Even if a family acknowledges that their loved one needs more care than they can provide at home, it’s not always easy to find an assisted living community. Language barriers, cultural differences, socioeconomic conditions and other characteristics may limit available options. These challenges make it more difficult to find a place where a Native Hawaiian or Pacific Islander senior feels comfortable:

In 2019, more than 25% of Asian American and Native Hawaiian/Pacific Islander adults had limited English proficiency. Language barriers make it more difficult to gather information about assisted living communities and determine which one is the best fit.

Native Hawaiians and Pacific Islanders have some of the poorest socioeconomic conditions of any cultural group. As a result, they may not carry health insurance. Even if they do have insurance, they can’t always afford copays, deductibles and other out-of-pocket costs. Poor socioeconomic conditions also increase the risk of homelessness and make it difficult to find transportation to medical appointments. Having a lower income may also lead to poor rates of compliance with treatment recommendations.

Many Native Hawaiians and Pacific Islanders prefer to use natural remedies to treat illnesses and injuries. In some cases, they combine natural remedies with prescription medications and other Western medical treatments. Some elders are hesitant to move to senior living communities because they don’t want Western doctors to look down on them for using natural remedies or visiting traditional healers.

The Native Islander and Pacific Islander designation includes more than 50 ethnicities and 100 languages. Just because someone belongs to this large group, it doesn’t mean that they have the same needs and preferences as everyone else. Many hospitals and senior living communities struggle to tailor their treatment programs and social activities to each person’s unique needs.

Native Hawaiians and Pacific Islanders make up just 0.4% of the U.S. population according to recent data. As members of a minority group, they face may discrimination in a variety of settings, including courts, hospitals, banks and workplaces. Due to this history of discrimination, an older adult may be hesitant to move to a senior living community with residents who have differing ethnic and racial backgrounds.

Because caring for family is such an important value in Native Hawaiian and Pacific Islander cultures, some people experience a sense of shame or guilt when they have to move their elderly loved ones into assisted living. They may feel that community members look down on them for not following through on their obligations or that they’re tossing their loved ones aside. Here’s what you can do to overcome any guilt you feel about helping your loved one get the best possible care:

• Ask for help: Instead of trying to carry the burden on your own, talk to a friend or family member. Once you let them know how you’re feeling, give them a chance to comfort you and encourage you.
• Assess the situation: If you feel guilty about your decision, observe your loved one at home. Make note of all the struggles that crop up during a typical day, such as difficulty getting out of bed or preparing a nutritious meal. Remind yourself that moving to assisted living is the best way for your loved one to stay safe.
• Give yourself grace: Guilt, just like other emotions, is normal. When you truly love someone and want what’s best for them, it’s natural to feel guilty about not being able to provide everything they need. Just remember that you’re doing the right thing for your loved one’s health, safety and social well-being.
• Include your loved one: To lessen your feelings of guilt, include your loved one in every step of the decision-making process. Asking for their input makes it easier to feel like you’re helping them rather than taking away their independence.
• Compare alternative scenarios: If you’re having trouble letting go of your guilt, think about what could happen if you decided to let your loved one stay in their home or asked them to move in with you. Is there a chance that they could fall and break a hip, slip in the shower or encounter some other type of hazard? If so, moving them to assisted living is likely the right decision.
• Spend plenty of time together: It’s easier to let go if you know that you’ll see your loved one as often as possible. Before they move, spend time going through photos or sharing some of your favorite memories. Once they’re settled in an assisted living community, visit them regularly.

If you believe that assisted living is the best option for your loved one, it’s important to find a community that respects the cultural values and traditions of Native Hawaiian and Pacific Islander residents. We put together this checklist to help you find a safe, comfortable residence for your family member.

Hawaii has the highest cost of living in the United States due in part to how difficult it is to deliver goods to the group of islands. In fact, Sperling’s BestPlaces estimates that the overall cost of living in Hawaii is about 65.7% higher than the U.S. average. As a result, assisted living and other senior care options are more expensive than they are in most states.

According to Genworth’s Financial Cost of Care Survey, Hawaii residents paid an average of $5,375 per month for assisted living in 2021. The national average is $4,500 per month, making Hawaii about 19.4% more expensive. California, which also has high costs of living, is slightly less expensive than Hawaii, averaging $5,250 per month. Washington is the only state on the Pacific Coast that has higher costs than Hawaii, as seniors there pay an average of $6,000 per month for assisted living.

Assisted living staff members may help residents with activities of daily living (such as reminding residents to take their medications), but assisted living isn’t a medical service. Therefore, it usually isn’t covered by Medicare and other health insurance plans. If your loved one has Medicaid, coverage depends on the rules in their state of residence. Some seniors also use long-term care insurance or veterans benefits to get the care they need.

Government agencies and nonprofit groups provide a variety of free resources to help seniors learn more about available benefits and access supportive services in their community. Seniors and families can get started by contacting the organizations below.