By Matt Perry
California Health Report
Two immigrant populations – older adult refugees from war-torn Afghanistan, and the Sikh parents of Silicon Valley-bound tech workers – have found a haven in one southern Alameda County city committed to fostering cultural harmony among its ethnic seniors.
In diverse Fremont, the cornerstone of this harmonic convergence is the city’s innovative outreach effort CAPS – Community Ambassador Program for Seniors – which recruits leaders from local ethnic communities to guide members through the labyrinth of available healthcare and social services.
For these mostly faith-based ethnic centers, CAPS has been a true godsend.
“It’s amazing what CAPS has done,” says Asha Chandra, who manages the program. “Bringing all these organizations, cultures and faiths together… they’ve become friends in the process.”
A decade ago, Muslim refugees from Afghanistan and Sikh immigrants from northern India were both suffering similar fates in their adopted country: intense depression and anxiety sprung from acute social isolation.
Fremont’s Sikh community is typical of many immigrant populations. Traditional family roles are often shattered once children move to the United States from the northern India province of Punjab. Cut off from a deep cultural heritage, older adults become socially and economically dependent on their children.
“They were abandoned,” says Jagmeet Kaur, Fremont site coordinator for the Sikh community. “They had issues but they didn’t know where to go to.”
The problems were replicated in other Fremont seniors from more traditional cultures – Pakistan, China, Taiwan, Russia, and the Philippines – also suffering the physical and social ailments of culture shock.
Workers drawn by the promises of Silicon Valley found Fremont a welcome community with its affordable housing, good schools, safe streets, and spacious parks – as well as its connection to mass-transit BART.
As their tech-savvy children adopted work and consumer culture as their new deity, older adults lost connection with the intimate social fabric of their homeland.
“They’re really working as glorified babysitters for their grandchildren,” agrees Chandra.
Lacking access to healthcare and other social services, rates of heart disease, hypertension, diabetes, obesity, and other chronic diseases – made worse by social isolation – were often dangerously high.
Once 80% Caucasian, today about one-third of the city’s population is white.
“We’ve had this crazy demographic shift over the past 20 years,” says Karen Grimsich, administrator for Fremont’s Aging and Family Services.
Instead of a melting pot of cultural riches, the city of over 200,000 had become a stew of segregated ethnic communities.
As a result, in 2004 Fremont and its progressive Pathways to Positive Aging initiative held focus groups in nine different languages with over 2,000 Fremont citizens to answer this question: “How can the city of Fremont help seniors better?”
The results were both revealing and disturbing.
Immigrant communities were baffled about social services – at both the state and local levels – and wanted city officials to actively reach out to them: in homes and faith centers representing Hindus, Muslims, Sikhs and Christians.
“It seems so simple now,” laughs Grimsich. “You have to go where the seniors are.”
These ethnic groups also wanted to recreate the close community ties of their homelands.
This feedback spawned the cutting-edge CAPS program in 2007. Its community ambassadors help clients solve a dizzying array of modern social problems. Transportation, healthcare and immigration often top the list.
After Najiba Azimi’s 19 year-old son was killed in Afghanistan, she and her husband – who is blind – relocated to California and lived with her daughter’s family until her son-in-law gave the couple a cruel ultimatum: “You have one week to move out.”
Azimi, now 66, was referred to the Afghan Elderly Association, a Bay Area support group incubated in Fremont that now has over 600 members. The association paired Azimi with one of its seven “health promoters” – outreach specialists who help older Afghanis access healthcare, take them to appointments, and translate from English to Dari.
“Every time for one year when I went to visit them, she was crying and her husband was crying,” recalls Azimi’s health promoter Nasrin Daoud Mohammadi.
Fremont’s intricate web of collaborations also gave Azimi speedy access to a CAPS ambassador.
“Everything I have, I have it after that day,” she smiles through her interpreter Mohammadi.
There are now 138 CAPS ambassadors serving 10 ethnic communities speaking more than a dozen languages – and many more dialects.
CAPS ambassadors receive 40 hours of training about social services ranging from Medi-Cal, social security, hospice care, Meals-on-Wheels, assisted living, Supplemental Security Income (SSI) and a variety of other services.
“Who can I turn to for help in navigating this maze?” explains Chandra.
Cordelia Shieh, a native of Taiwan, reluctantly became a CAPS ambassador when she was convinced by a community elder that it was a calling for her generation to care of older adults.
She quickly discovered that ambassadors commanded respect with government agencies.
Shieh called unsuccessfully on behalf of one her clients who had extensive medical problems, yet was denied continuing Medi-Cal benefits because of a lost form.
“Tell them you are the community ambassador,” she was told.
Two weeks later her client received a simple letter: “Your Medi-Cal benefits will continue unchanged.”
“Over the years, the community ambassadors have become known by these agencies,” says Chandra.
Besides working one-on-one, the ambassadors also organize “outreach events” where service experts explain programs for housing, transportation and other services.
Fremont’s efforts have received kudos both locally and nationally.
Neighboring Santa Clara County adopted an ambassador program using CAPS as its guide. CAPS is “cutting edge because it is designed to serve diverse populations,” says Lori Andersen, of the Aging Services Collaborative of Santa Clara County.
Fremont was also chosen as one of just 16 Community Partnerships for Older Adults funded nationwide by the Robert Wood Johnson Foundation.
Fremont has added a number of other initiatives including a Senior Help Line staffed with volunteers speaking English, Spanish, Mandarin and Farsi. The city also targets chronic disease with its Self Disease Management program – pioneered at Stanford University. A mobile health team with staff psychiatrist and counselor makes house calls for 80 clients.
The city’s commitment to older adults springs largely from the passion of Suzanne Shenfil, long-time director of its Human Services Department.
Shenfil says her goal is to overcome the shortages in state funding using a simple local formula: “Train them in culturally aware ways and then let people work on solving their own problems.”
Supporting Shenfil is the Fremont city council, which unanimously passed a resolution to foster “an aging friendly community… where information and services are easily available for all seniors… and where meaningful exchanges between cultures and generations exist…”
Fremont’s community ambassadors and a growing web of partnerships has particularly welcomed the Sikh community – estimated at 20,000 for the “tri-city area” of Fremont, Newark and Union City – one of the largest Sikh enclaves in the country.
The three cities have formed another area collaboration – the Tri-City Elder Coalition – that weaves together more than 60 organizations including hospitals, businesses, long-term care facilities and cultural organizations to provide senior support programs. Altogether, narly 800 volunteers help serve the aging.
Recently, 80 different ethnic and health organizations joined together for Fremont’s “Four Seasons of Health Expo” held on the banks of local treasure Lake Elizabeth, which borders the Fremont senior center.
“The city has involved the neighborhoods and different ethnic groups to learn about their values and principles,” says Kaur, a 16-year citizen. “I’m totally blessed to be in Fremont. There’s nothing like this anywhere.”
“This is our community,” echoes Shieh. “We are just a piece of the puzzle picture. When there is a piece missing we cannot see the beauty of the puzzle. We cannot miss any piece. Everybody needs to be there together.”