Activities that embrace Asian culture.

The United States has a long history of welcoming immigrants and refugees from other nations around the world. As these new Americans built lives in their adopted homeland, many of them held on to their native languages and treasured traditions. But over the years, careers, lifestyles, and mobility tended to disconnect subsequent generations from their ancestral roots and cultural duties, such as caring for their elderly loved ones at home.

Not so long ago, even to consider long-term care placement of an elderly family member was deemed shameful in some of these cultures, but today, for newer generations of Americans, ancestral roots often take second place to 21st-century mores. And while some cultures, such as Japanese, Chinese, and Hispanic, previously dismissed the idea of care provided outside the home, it is now being accepted as a beneficial alternative.

In Seattle, Washington, Nikkei Manor provides assisted living and adult day care services to its predominantly Asian population. One of its main focuses is to provide Japanese cultural, social, and spiritual influences in its activities programming. This emphasis is meaningful to the facility's Japanese and first-and second-generation Japanese-American residents who, as they age, long to reconnect with their childhood memories.

According to Naoko Ulstein, Nikkei Manor recreation services coordinator and Kokoro Kai (adult day program) director, the facility's both the assisted living and adult day care options are designed to offer Japanese elderly an alternative place to receive care. She says, "Currently, most of our residents are Japanese, but we welcome residents of all ethnicities. Our goal is to surround our Far Eastern residents with the sights, sounds, and memories of their Asian heritage."

"Kokoro Kai, which translates to 'meeting of hearts and minds,' is offered weekly on Monday, Wednesday, and Friday," Ulstein explains. "Its goal is to help the elderly still residing in the community maintain their independence, and it is designed to improve their quality of life and promote wellness, while giving family caregivers an opportunity to enjoy a bit of free time." From Japanese sing-alongs to games of rummi kub (a version of gin rummy played with tiles), Nikkei Manor's assisted living residents join the Kokoro Kai group in a variety of activities that accent their heritage. As an additional emphasis on shared heritage, communication, and culture, many of the staff at Nikkei Manor are bilingual. There are quite a few staff who speak English and Japanese and other staff who speak English along with other languages.

"We offer our clients the standard activities found in long-term care, such as bingo, horticulture, and music, but whenever possible, we give these activities an Asian twist," explains Ulstein. For example, one activity of the horticultural program is to plant Asian vegetables and herbs that later are used in a cooking activity featuring Japanese cuisine, such as miso soup, sushi, soba noodles, and other dishes.

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Another horticultural activity is flower arranging. "Japanese arrangement tends to be very streamlined," explains Ulstein. Although various shapes and sizes of vases are used, one of the most interesting presentations uses a flat, shallow, box-like vase filled with water to create an aquatic display (figure 1). "Everyone is invited to participate; even non-Japanese residents enjoy learning about the culture through these activities and how it might differ from or parallel their own," says Ulstein.

In the morning, teatime is conversation time. Nikkei Manor enjoys a strong corps of Japanese-speaking volunteers. They chat with residents over steaming cups of Japanese tea, and they keep the residents informed about and involved in what is happening in Seattle's Japanese community. "Conversation during teatime is stimulating, enlightening, and entertaining," observes Ulstein.

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At other times, residents get together to practice shuji, a Japanese style of calligraphy sometimes called "brush writing" (figure 2). Everyone is encouraged to try. "In shuji, there are three different kinds of writing: two types of alphabets and kanji [a system of writing using Chinese characters]," explains Ulstein. To introduce this art to the uninitiated, the calligraphy instructor writes a simple saying in stylized Japanese writing for students to copy and practice. "Most residents use larger brushes to write large characters on the paper, which are also easier to handle for those who have unsteady hands," adds Ulstein. "Residents who are experienced in shiju are often given smaller, more precise brushes with which to write the more intricate haiku."

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Art at Nikkei Manor is not only personal but also public. "One of our art projects was a gift to the community. Residents painted six large wooden boards with Japanese designs (figure 3), which were installed as a decorative element in a nearby bus shelter," says Ulstein.

The Japanese cultural imprint at Nikkei Manor goes beyond recreation; it also has a highly spiritual influence. Twice a month, residents attend Howa Kai, a Japanese Buddhist church service conducted by either an English-or Japanese-speaking Buddhist priest. "A special aspect of this service is that church members from the community also attend, reuniting with residents who previously attended the church."

According to Ulstein, although Nikkei Manor residents still enjoy their families, they also seem to take pleasure from living with their peers, with whom they have formed strong friendships. Times have changed and, as demonstrated by Nikkei Manor's residents and their families, long-term care living is becoming an acceptable--and at times preferable--way of life for first- and second-generation Americans from many cultures.

For more information on Nikkei Manor or the Kokoro Kai program, call [phone] or visit www.nikkeiconcerns.org. To comment on this article, please send e-mail to [e-mail].

BY SANDRA HOBAN, MANAGING EDITOR