A woman sat in a wheelchair intently reading a story in a Korean-language newspaper about an earthquake that had ravaged a part of her native land.
Other grey-haired residents at the Lorien Columbia skilled nursing center clapped their hands as they sang a traditional Korean song about feeling sentimental for one’s hometown. Some watched a Korean-language news channel on a flat-screen television.
The elderly men and women live on a wing of the nursing facility that caters to Koreans — a unique, but growing, concept that helped Lorien Health Services tap into an underserved population.
Lorien opened the specialized unit, which now has 53 beds, four years ago to better reflect the local community.
In Howard County, 16.2 percent of the population is Asian, including 4.2 percent who are Korean, according to 2015 U.S. Census estimates. That’s up 33 percent since 2010, when Asians made up 13.3 percent of the population. Dispersed throughout the county are Korean enclaves, including in Columbia and Ellicott City. The state’s Department of Transportation earlier this year named a five-mile stretch of U.S. 40 “Korean Way” because of the heavy concentration of Korean businesses along the corridor.
“I think the wing is a good reflection of the community and it serves a need,” said Eric Grimmel, the nursing home’s administrator.
Those who live on the wing are immersed in Korean culture. A Korean chef cooks staples unique to the country, like kimchi, a spicy fermented cabbage dish, or bulgogi, a marinated beef or pork dish prepared on a grill. Korean pastors come in and host religious ceremonies. Residents play traditional Korean games such as Yoot, a board game played around the Korean New Year, where wooden sticks are used like dice. Little English is heard on the floor.
While there are religion-based retirement communities — think Catholic or Lutheran homes — nursing care is often less culturally focused. But more facilities are adapting to the nation’s growing ethnic diversity, hiring multilingual staff, serving multi-ethnic foods and in some cases devoting whole floors to one culture.
The focus on culture and ethnicity is an example of how nursing homes are looking at innovative ways to better better serve the communities where they are located, those in the nursing home industry said.
“It is very important for nursing homes to innovate with regards to diversity and inclusion, not just because it is what is expected by patients and family, but also because it is what is necessary in regards to a demographically changing America,” said Joseph DeMattos Jr., president and CEO of the Health Facilities Association of Maryland, which represents the state’s nursing homes.
New federal guidelines that take effect next week require nursing homes to pay more attention to the ethnic, religious and cultural background of their clientele. Being culturally inclusive helps improve the quality of life of seniors who already may feel vulnerable and socially isolated after moving out of their homes, said Janine Finck-Boyle, director of health regulations and policy for LeadingAge, which represents nonprofit nursing homes and providers that serve seniors.
“You are going to take care of their medical care,” Finck-Boyle said. “You are going to make sure you take care of their disease process and that they have a shower or bath. But you need those other things that contribute to their quality of life.”
Many of the nursing homes doing this are located in areas, often big cities, where there are pockets of ethnic communities, said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association. Gifford recently visited a nursing home in Brooklyn with a floor that catered to Chinese patients. All the signage was in Mandarin and the staff also spoke the language. A chef cooked traditional food from the region.
In Baltimore, Levindale Hebrew Geriatric Center and Hospital has catered to the Jewish population for 125 years, even though 50 percent of its population is not Jewish. The medical facility has a kosher kitchen and a synagogue where a weekly Sabbath service is held. All the major Jewish holidays are celebrated.
“You want to meet the needs of the population you care for,” Gifford said. “If you are in an area that has a large ethnic group, you better figure out how to care for them.”
Yon Song moved her 81-year-husband, Jai Song, onto the Korean wing at Lorien eight months ago after he had back surgery. She said she thought he would be more comfortable around other Koreans and in a place that served Korean food. Jai Song agreed.
“I very much like living here,” he said.
Sue Song gave Lorien the idea for the Korean wing while she was president of the Korean American Community Association in Howard County. When she came to the United States in the 1980s, she noticed many Koreans weren’t assimilating into American culture. Over the years, she helped some of them navigate their new world and, as they aged, she saw a new need for nursing home services.
She first helped establish a phone service with Lorien that connected elderly Korean-Americans and their families with culturally sensitive long-term care resources in the area.
Yet Grimmel and the rest of the management at Lorien Health Services, an Ellicott City-based firm that owns the Columbia nursing facility and nine others across the region, weren’t completely sold at first on the idea of a Korean wing.
“Everybody wants to talk about diversity, but they don’t want to think outside of the box,” Song said.
And indeed, the management at Lorien thought Song’s idea was innovative, but risky.
“We knew how to take care of the clinical needs, but not the cultural component that helps make a person healthy,” said Lorien Health CEO Lou Grimmel Sr. “When we started talking about a unit, it was a little scary.”
Instead, Lorien started with five beds in 2013 and encountered some stumbling blocks. For one, Song didn’t know the Korean menu needed to meet certain nutritional guidelines to be approved by state health officials. At first, she brought her rice cooker from home, when state rules required a commercial cooker.
The staff also had to learn to contend with cultural differences. A couple of years after the wing was opened, they noticed the rate of falls was high. It turned out that many of the residents with dementia were getting out of bed and sleeping on the floor, because they slept that way in Korea.
Michele Haile, a Lorien social worker, said she has to think about cultural differences when working with Korean residents and families. For instance, it is the spouse or children who under Maryland law are typically the lead surrogate that makes decisions on behalf of a patient. In Korean culture, it is the oldest male child who makes the decisions and Haile has made sure advance directives reflect that.
“I have to make sure I am getting documents that are compliant with Maryland law, but respectful of Korean culture,” she said.
Other obstacles also can arise when catering to a particular ethnic group. Nursing homes have to make sure they have enough patients to justify the investment, Gifford said. And finding staff that understands the culture and is trusted by the community can be hard.
Today the Korean unit has a waiting list and Lou Grimmel said they are looking to expand it. Lorien offiicials said they also have been approached about creating a wing aimed at people from India, that they are considering.
Lou Grimmel credits a staff, including Song, who knows the Korean culture well and speaks the language.
“That is key,” he said. “You have to have someone who is in touch with the culture and the families.”
Kim Hyea’s face lights up when she is asked about living on the Korean wing while reading the newspaper one afternoon.
Dressed in a pink sweater with a blanket across her lap, she said she most likes the food. But she also likes living among so many other Koreans and that the staff is attentive to her medical needs. The 82-year-old, retired from government work, said she never wants to leave.
“This is heaven,” Hyea said through a translator. “This is paradise. I want to die here.”