COVID-19 Underlines the Need for Culturally Appropriate Interventions in New York City
Prompted by the pandemic, Prof. Jinyu Liu produced a bilingual guide for Chinese seniors with dementia.
Picture this: An older Chinese man with dementia accompanies his daughter, who is also his caregiver, on trips to the local grocery store in Chinatown, New York City, where they together enjoy picking out his favorite foods for his weekly meals.
But then the coronavirus pandemic hits. Father and daughter have no choice but to give up these excursions as the father is in the high-risk category for the virus.
With this vignette in mind, you can begin to understand the kinds of concerns that preoccupied Associate Professor Jinyu Liu as the coronavirus blazed through the city this past March. Liu, a gerontologist and faculty affiliate of the Weatherhead East Asian Institute, the Columbia Population Research Center, and the China Center for Social Policy, performs research on providing culturally appropriate supports for dementia caregivers in New York City’s sizable community of Chinese residents. Since her receipt of a K01 grant from the NIH last year, she has engaged with various social service agencies to develop and pilot a peer mentoring program to reduce the stress of those providing care for Chinese seniors with dementia.
New York City contains by far the highest ethnic Chinese population of any individual city outside Asia, estimated at 628,763 as of 2017. Within that population, seniors are a vulnerable and growing group requiring additional attention from health and social services planners, providers and policymakers. Critical issues affecting their well-being include poverty, low educational attainment, language barriers (many Chinese are isolated in ethnic enclaves), and immigration status. Such problems are only compounded once these seniors develop Alzheimer’s or related dementias.
The coronavirus arrived in the city with such speed and force, Liu knew right away that Chinese seniors would be especially vulnerable. “Suspension of the usual daily routine and activities may cause more behavioral problems, faster cognitive deterioration, and greater caregiver burden,” she says.
She also knew that it would not take long for the virus to overwhelm the city’s social safety net, which, even at the best of times, struggles to tailor its services to meet the needs of particular ethnic or immigrant groups. Returning to our opening example: Liu notes that social services may advise the caregiver of the man who can no longer visit the grocery to enroll him in an in-home meal delivery program. But then what happens when the meals arrive, the food turns out to be American style, and the man, who has eaten Chinese food all of his life, refuses to partake?
“What works for one ethnic or immigrant group may not work for another,” Liu observes, adding that her research advocates for social service agencies to take a whole-person approach, one that “associates the mental health issues of older adults with their previous life histories, relationships, cultural background, and the physical and social context.”
Watching as the speed and scale of the pandemic disrupted the life of nearly everyone in the city, Liu resolved to contribute her skills both as a social work practitioner and an academic researcher, to help alleviate the situation for Chinese seniors and their caregivers.
Concerned about the lack of Chinese-language supportive materials, she set out to create a bilingual guide with suggestions for culturally meaningful indoor activities—from listening to Chinese opera, to playing mahjongg to conducting Tai chi or meditation sessions. Tips for Caregivers: Indoor Activities for Older Adults with Dementia is the product of a collaboration among Liu and two of her students. Liu takes credit for the text, while Rebecca Chen (MSW’20) produced the cartoon-like art and PhD student Yifan Lou helped with the translation between Chinese and English.
For distribution of the booklet, Liu turned to CaringKind, New York City’s leading resource center for Alzheimer’s and dementia caregivers and the organization she has been partnering with for her NIH-funded research.
While putting together this practical guide, Liu also worked on starting up a research project to assess the impact of COVID-19 on community services for homebound older adults, looking at the specific case of Village View NORC, at University Settlement, one of oldest organizations for supporting immigrants and low-income families in New York City. The study, now under peer review, examines the period from March to May, when the city had the highest numbers of confirmed infections and deaths due to the virus. A principal finding is that, although psychological services were reduced to about half, the agency and its clients struggled to embrace telehealth as an alternative platform for delivering services—hence the need for a stronger and more resilient safety net.
Liu’s on-the-ground colleagues are full of praise for her efforts. Weijing Shi, who manages Chinese outreach for CaringKind, says that attention from a researcher like Liu has been invaluable in helping the agency respond to the increased numbers of Alzheimer’s cases in the city’s Chinese neighborhoods. “We have a lack of support and community resources,” she says. “You need someone at the research level to know the needs, challenges, and difficulties families face.”
For Bing Ji, a program director at Village View NORC and an instructor in our School’s Motivational Interviewing lab, Liu’s COVID research is just the latest example of the important work she is doing to expose the burdens faced by frontline social workers as well as family caretakers. “She has done a tremendous job employing her expertise and mobilizing changes at the programmatic level,” Ji says.
Several of Liu’s colleagues at the School of Social Work echo this enthusiasm. “Professor Liu engages in research on the most important challenges to our society and mental well-being,” says Dean Melissa Begg. “Through her novel intervention for dementia caregivers in New York City’s Chinese American community, and now her latest work in response to COVID, she has become a leader in the work of promoting culturally-appropriate interventions to support older adults and their families across cultures and societies.”
Professor and Senior Associate Dean Julien Teitler says, “I am impressed by how quickly Jinyu Liu has responded to the coronavirus pandemic with a rigorous and impactful research project, looking at the barriers to providing necessary services during this critical period as well as the virus’s disproportionate impact on at-risk individuals, many of whom have experienced decreased access to services, adverse economic and behavioral health issues, and an increased exposure risk.”
For Professor and Dean Emerita Jeanette Takamura, Liu’s research focus on older Asian populations in New York City addresses a critical gap in social services. “While the numbers of elderly New Yorkers overall have been in decline, the numbers of Asian senior citizens in the city has been growing rapidly, and many of them have limited means and limited English-language proficiency,” she says. “Professor Liu’s work, examining the cultural appropriateness of formal and informal health and social supports, with a focus on the needs of family caregivers, is sorely needed. And her work to help this particular population, by extension, stands to benefit all of the city’s elderly residents, by expanding the menu of culturally appropriate choices that are available.”