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This exploratory study investigated reasons why Filipinas in Hawai'i have become the primary caregivers of elders in residential care homes and if they thought their children would follow them in this profession. A random sample of 173 Filipina care home operators (CHO), of which 95% were first-generation immigrants, was interviewed using telephone survey methods. Data were collected: to profile caregivers; to identify motivations for becoming a care home operator; and to gauge if they or their children would continue in this line of work. The sample was composed of middle-aged Filipina CHO with training and experience in elder care who concurred that the job fit their cultural values. About a third also felt that this job was open to immigrants and helped them buy a house. Twenty percent or less felt discriminated against because of this work. Although half the sample felt that women were better caregivers than men, only 38% felt that caregiving was primarily the responsibility of women. Almost 90% planned to continue with this work, but only 12% said it was likely that their children or grandchildren would become CHO, supporting the notion that choosing this profession had less to do with cultural values and gender expectations than with economic opportunities available to the current cohort of CHO. Given these findings, Hawai'i's capacity to meet future residential long-term care needs is discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many Americans die in pain, without hospice, and without regard to advance directives, suggesting a need to improve end-of-life (EOL) awareness and services. OBJECTIVE: This paper describes Kokua Mau, a community-state partnership to improve EOL in Hawaii funded by The Robert Wood Johnson Foundation (RWJF). Coalition activities were guided by innovation-diffusion theory, targeting 'innovators' and 'change agents' within communities and organizations willing to learn about and facilitate improvements to EOL care. DESIGN: Evaluation of a community-wide intervention to improve EOL care. SETTING/SUBJECTS: Honolulu, Hawaii. MEASUREMENTS: We tracked dissemination of campaign messages by counting numbers of coalition members (including innovators and change agents to carry on the work), individuals reached through awareness and educational offerings, and new EOL projects initiated during and after the initial 3-year RWJF funding. To measure change, we counted the number of legislative policies that were modified by the coalition as well as indicators of hospice utilization, advance directive (AD) completion, support for physician-assisted death, and place of death. RESULTS: In the first 3 years of the project: coalition membership grew to 350 members; EOL care curricula were developed and offered to various target audiences; 17,000 individuals attended educational events; policy changes were facilitated; decreases were seen in proportions of residents supporting physician-assisted suicide; and increases were seen in advance directive completion rates and hospice utilization. Most importantly, after the grant period, coalition members went on to develop and implement new programs to improve care to the dying. CONCLUSIONS: Although it will take several years to effect comprehensive and sustained changes in the way death is perceived and the dying process is facilitated, findings suggest that programs based on innovation-diffusion theory can increase EOL awareness and help develop the change agents and role models needed to affect community-wide change over the long term. [ABSTRACT FROM AUTHOR]

Among ethnic minorities, the Asian and Pacific Islander (API) American group is the fastest growing and, as a whole, is quite longevous. Although there is a significant literature on the history and religious traditions of API cultures, little has been published on death rituals and beliefs of the American descendants of these groups. The purpose of this study was to begin to explore cultural variations in response to the process of dying and grieving among four Asian American populations--Chinese, Japanese, Vietnamese, and Filipino. To this end, key informants and focus group interviews were conducted with members of these ethnic groups, and significant differences among, and within, groups were found. The small size and Hawaiian base of the sample preclude generalization of findings to the United States as a whole. However, this study provides health care workers with information that can increase their awareness of and sensitivity to Asian American approaches to death and dying. [ABSTRACT FROM AUTHOR]

This study tested the impact of a case managed, in-home services program on caregivers' perceptions of burden, satisfaction, and health. Over their first 6 months with the program, caregivers reported spending less time in patient care activities. Subjective burden and symptoms were reduced initially, but climbed to original levels by the 6-month reassessment. Satisfaction scores did not change significantly. Social work's role in the program is discussed. [ABSTRACT FROM AUTHOR]

Context: Historically, Native Hawaiian elders have been recognized as the major sources of wisdom and transmitters of knowledge and training to younger generations. Yet, concerns exist today for these elders who experience shorter life expectancies, poorer health and greater disability than elders in other ethnic groups in Hawai`i. Objective: We describe Ha- Ku-puna: National Resource Center for Native Hawaiian Elders, established at the University of Hawaii to address disparate health and improve the access and delivery of services to these elders. Method: Ha- Ku-puna is described in accordance with the principles of community-based participatory (CBP) research with its unique emphasis on culturally competent practice. Results: Application of the CBP approach is illustrated in the following steps: community engagement; development of an infrastructure; implementation and dissemination of research and technical assistance projects; and evaluation. Discussion: The CBP approach is highly relevant for Native Hawaiians because of its alignment with cultural values, the mobilization of the community and the emphasis on reducing health inequities through social change. In adhering to a CBP approach to improve the health of elders, Ha- Ku-puna seeks to perpetuate the culture through the transmission of ha- (breath) from older to younger generations. [ABSTRACT FROM AUTHOR]