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New Frontiers
Recognizing cultural differences
By Dwayne J. Clark, Aegis Assisted Living
 As we watch
the development of assisted living slow to a crawl, stock prices continue their slide, and
many companies merge in order to keep some buoyancy, we must be wondering, "What will
be the next frontier for our industry?"
In an effort to define ourselves, we've broken our industry down into market segments,
such as high-end or affordable, and given them descriptive labels like Chevy and Mercedes
models and so forth. We've split the market by acuity levels into skilled, assisted,
active retirement and the combination of all three. We've addressed markets such as
Alzheimer's and investigated many other special-need populations. At this time we have to
ask ourselves, "Where are we going next? What is the next step? Is there something
more we should be considering?" I think there is, and it happens to be in the
for-profit sector of our industry. Although we have stepped to the front of the class in
meeting housing and wellness needs, we have not addressed the cultural requirements of
many of our diverse populations. Of course we will always welcome everyone to every
community, but instead of being so general in our cultural attentions, we will concentrate
on needs that are going unfulfilled.
You may be asking yourself, "Aren't all cultures already being served within our
homes?" If that is what you're thinking, just walk around the average assisted-living
community in this country and notice the sameness.
The U.S. population is comprised of international backgrounds--the melting pot. The
result is the belief that there is a basic "Americanized" common culture and
this is what we see in our communities. In our belief that this "covers it all,"
we have overlooked the needs that may fall outside this blend. For instance, Asians,
African-Americans and Mexican-Americans are some of the population groups with specific
unblended identities that may not be met. A resident from one of these groups could find
that things like traditional food and activities that have always been a part of their
lives are probably not available in most assisted-living communities. Living in an
atmosphere where one's traditions are neglected could make a person feel adrift and
isolated.
Not all companies are ignoring cultural differences. For some time now, non-profits
have been ahead of the game in recognizing this market need, and many have served it well.
For example, the Jewish homes for aging have buildings throughout the United States. These
homes, although not restricted to people of the Jewish faith, certainly cater to spiritual
and cultural needs.
Economic factors may still limit the cultural diversity in an area. It is an
unfortunate fact that all ethnicities have not gained equal average income levels.
Consequently, they do not have large enough populations to influence the culture in many
of the neighborhoods in which assisted-living communities are built so the unique needs of
some of your residents may be overlooked.
When Aegis made the decision to look at unique and unmet needs, we reviewed the
demographics in California because that is one of our targeted states, and we recognized
that there was a major Asian population there. We started researching profit and
non-profit Asian Communities around the country and found some very good non-profit ones.
In the Northwest, there is Nikkei Manor in Seattle, which is an assisted-living community
that honors the Japanese culture. It's operated by Nikkei Concerns. There is also Legacy
House, a nursing center dedicated to the Chinese culture and operated by Elder House
Northwest, and the Seattle Chinatown International District Preservation & Development
Authority (SCIDPDA). None of these communities are operated by for-profit multi-building
companies. The for-profit part of our industry just seemed to have passed these cultural
needs by.
We concluded that there was both need and opportunity, so we started to research how
and what to do to begin our entry into this market. Aegis has now been involved in the
research of this project for more than two years. By the time this article reaches print,
we will have broken ground on Aegis Gardens in Fremont, Calif. We are very proud that this
will be our first culturally diverse community. It will support a Chinese-American
culture. The San Francisco- suburban area was chosen because more than 40 percent of San
Francisco is comprised of Asians.
After we decided to address this need, we started to develop our first communication
piece. You would think that the obvious and most difficult issue to deal with would be the
language, and that certainly was important, but there is more. Think about the steps you
take when you create a piece of collateral information. You come up with a concept that
serves a need for the population you serve. You write your copy and decide what pictures,
photo shoots or graphics you want to use to convey your message. You pull it all together,
stylize your ideas, lay it out and send it off to the graphic-designer. They work on it
and make it fit, send it back for your editing and eventually your final approval.
Eventually, it is sent out for film and then on to the printers. Press checks follow, and
your print piece is sent to the binders for folding and/or binding to make the job
complete.
With a Chinese piece, there is a little more to it; I am understating when I say
"a little." First of all, the colors of the piece are of critical importance.
Our corporate colors are navy and gold, but in the Chinese culture dark blue represents
death; not a message you want to convey to frail elderly when you are trying to get their
business. So carefully consider how cultures respond to color. Next, you draft what you
want to say and have it translated by someone in tune to the basic knowledge of what your
company wants to convey. The translator needs to know the intent of the piece and its
messages, so that the most appropriate translation is used, not necessarily the most
literal. It has to be meaningful to the reader from the designated culture.
Appropriate pictures and graphics need to be selected or created. This is a wonderful
opportunity to display the richness and variety of the Asian culture, color preferences,
specific clothing styles and so forth. Here again, they must be authentic.
Once the translation is complete, create your layout, and place the colors and the
photos. It is critical that the characters in the translation be in the correct placement
and align with the meaningful pictures. You cannot casually text-wrap characters the way
you can when you are using the English language. When you get the draft back, proof it.
Unless you are fluent in the alternate language, this presents a problem. How do you know
if you have conveyed the philosophy and mission of your company? Have you used the correct
words, or do they have other meanings in another language? Are the things that are
important to one culture important to another?
We realized we were not qualified to answer these questions, so we searched for help
and found a great Chinese consultant. He went through our training academy to become
familiar with our company, our story, and what was important to us. We also have a Chinese
board member who is involved in Chinese healthcare. These two people have helped us
tremendously. The point is, things that you may do with relative ease in your typical
community may require extra planning for one that is dedicated to serving another culture.
In our research, we found that a major identified difference was food and its
preparation. Focus groups have always told us that a good food program was a primary
factor of selection for people moving into any community. It was so important to people in
our Chinese cultural focus group that most said they would not move into a Caucasian
retirement community because the food did not please their tastes. Participants craved
fish and chicken, fresh vegetables and rice--lots of rice--and preferred stir-fry and
family-style service.
The need for different food created a kitchen-design issue. It had to accommodate the
different preparation needs. Extra areas needed to be allocated to accommodate the
chopping of vegetables. Special steamer kettles needed to be added to handle the amount of
rice that would be cooked. We learned that herbs and seasonings are different, and that
less food is frozen and more is refrigerated.
Building design was also an issue, so we hired a Feng Shui consultant. Feng Shui is
usually described as the "Art of Placement." It is important to the Asian
culture and includes among other things, placement of doors and windows. Building
alignment is based on placing the entrance in a favorable direction. Your development
officer may need to go to the planning department and tell them the back door could not be
placed somewhere because it violates Feng Shui law. Feng Shui placement has a grid that is
laid out on the site and that grid represents certain aspects of your life, i.e.,
financial prosperity, health, etc. The building is then set on this grid, always keeping
the entrance to the home in the front of your mind.
Choosing numbers (i.e., numbers for the address and phone number) created another
concern, too. For Asians, certain numbers have very negative connotations. It can
literally make the difference between whether or not someone chooses your community.
All of these things have to be taken into account for the customer to be happy with the
product.
There are so many things you need to consider. An article could be written just about
what type of garden areas you should have, or the direction of how the water should flow,
or what type of games you should have on your activities calendar. These things all must
sound like big stumbling blocks, but remember, we started this article by describing the
next frontier. If it were easy, everyone would be doing it.
I am sure a few months from now, when our first building dedicated to the Asian culture
is complete and operating, we will find there are many, many things we haven't even
considered. Part of this is because it is a new opportunity for us, and along with this
comes the challenge to do it right. The other part is that although cultures are steeped
in tradition, they are also always in the evolution of change and growth. A part of our
growth will be knowing the right questions to ask.
Dwayne J. Clark is president and chief executive officer of Aegis Assisted Living,
a start-up assisted-living company based in Redmond, Wash. With more than 13 years of
assisted-living experience, Mr. Clark is a former executive vice-president of Sunrise
Assisted Living, a founding member of the Assisted Living Federation of America (ALFA) and
past president of NorALFA, the regional affiliate of ALFA. Within the next five years,
Aegis Assisted Living plans to build 35 to 40 communities throughout the Western United
States, emphasizing optimal living for its residents and creative care for Alzheimer's
disease. Mr. Clark may be con- tacted via e-mail at dwayne.clark@aegisal.com.
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