Elder Care in COVID-19: Navigating Filial Duty and Loss


BY JOCELYN S. CHUNG

This piece was published in the 32nd print volume of the Asian American Policy Review.

With Asian Americans and Pacific Islanders constituting the fastest growing ethnic group sixty-five years and older in the US today, and the projection that fifteen percent of the total US Asian Pacific Islander population will be over the age of sixty-five by 2050, there is a unique and growing need for services to assist Asian American elders.


All my life, I was convinced that my grandparents were invincible. My paternal grandma, Keico A-ma, was a self-made entrepreneur who had lived and worked in Taiwan, Japan, Costa Rica, and Canada before immigrating to Southern California to be closer to us after my grandpa passed. When I thought of her, I viscerally heard hot oil crackling on the stove and her belly-shaking laughter as she cooked turnip cakes. My maternal grandpa was a chemical engineer turned custom broker who was charmingly eccentric, an avid tennis player, and a lover of bulk buying at Costco. He brought a Chinese chess set wherever he went in the hope of encountering new friends. My maternal grandma is a pianist and piano teacher, passing down her love of music to a roster of students spanning sixty years. She worked at a Japanese gem shop in Oahu, speaking in Japanese while simultaneously learning conversational English before leaving Hawaii to join the family in Southern California. All of my grandparents grew up under Japanese rule in Taiwan and witnessed the Chinese-led Kuomintang Party come to power after World War II. I marveled at the breadth of their resilience and knew there were bookshelves of stories behind their eyes. To me, they were invincible, until the pandemic came.

The realities of elder care during the COVID-19 pandemic have implications of navigating filial duty amidst loss—loss of presence, loss of safety, loss of social community, loss of health, and loss of life. The reciprocity of care for one’s elders is the foundation of intergenerational relationships in many Asian American households. Reciprocity is viewed from the perspective of interdependence, in which mutual dependence is emphasized as essential for family life.1 But as I write this, the COVID-19 pandemic has taken the lives of over 5 million people worldwide. Furthermore, the November 2021 Stop AAPI Hate National Report states that there have been 9,081 incident reports of anti-Asian racism since March 2020, with elderly Asians experiencing 13.5 percent more physical assaults than the overall Asian American population.2 Tangentially, existing discriminatory health practices based on ageist perceptions treat elderly lives as less valuable. Amidst the COVID-19 pandemic there are, unfortunately, additional widespread experiences among Asian American elders: barriers to familial collectivity, loss of intergenerational and social relationships, food insecurity, and social as well as linguistic isolation.3

Even so, there is little documentation of or research on the intersectional realities of Asian American elder care, advocacy, and loss during the pandemic. In Caring Across Generations, Dr. Grace Yoo and Dr. Barbara W. Kim explain that children of immigrants bridge and broker on behalf of their parents in cultural, linguistic, financial, emotional, social, and medical decisions through childhood and then into adulthood as their parents age and face greater illness and health needs.4 In the pandemic, Asian Americans continue to navigate filial duty and intergenerational care in visible and invisible ways whether family members are geographically near, at a distance, or involuntarily separated by closed borders.

Like many other families, my family has faced unexpected illness, caretaking, and loss amidst the pandemic. We first lost my paternal grandma, Keico A-ma, to COVID-19 in September 2020. Due to social distancing and hospital protocols, we were unable to provide her care, advocate for her needs to doctors, or even be present in the final months of her life. Seeing her once in six months was heartache enough, but finally receiving permission to see her after she had already passed was shattering. The memory of her dying alone on a hospital bed haunts our memories. We joined many others in navigating the jarring task of grieving and honoring the fullness of her life while troubleshooting how to stream her funeral on Facebook Live. We toiled through the logistics and cultural compromises that felt like compounding layers of loss—for example, instead of honoring our guests with a traditional post-funeral banquet, we opted to gift our few guests with an individually packed bento to take home. The loss of Keico A-ma propelled our attention towards my maternal grandparents, A-gong and A-ma, and envelop them with as much support and care as we could provide.

A-gong and A-ma lived a five-minute drive away and became part of our “quarantine bubble.” My memory of the last two years are vivid with their presence: steam rising from hot soup on the stove, Tupperware meal deliveries to relatives, A-gong and A-ma learning how to answer a video call, updating family across the Pacific on Zoom calls and LINE messages, the smell of fish wafting through my disposable mask at 99 Ranch Market, the sounds of Taiwanese Hokkien and NHK news, A-ma scolding A-gong for going to a crowded Costco, A-gong lifting his hat for his temperature scan at the doctor’s office, nurses insisting that “only one person is allowed to accompany the patient,” the steady beeping sounds in the hospital and its consistently sterile smell, black masks to match all-black outfits, live-streaming funerals and memorial services, socially-distanced grieving.

Not one month after Keico A-ma passed, we learned both A-ma and A-gong had cancer. The diagnoses fractured whatever was left of my fantasy of their invincibility. Prior to the pandemic, they were heavily involved in the Taiwanese American community in Southern California. They joined daily tennis and exercise groups at their local park, independently ventured for groceries at the local 99 Ranch, and had consistent touchpoints of community through attending bi-weekly church activities and choir at the Formosan Presbyterian church they had attended for over three decades. My A-ma still taught piano lessons to her roster of students and was a mentor to these young musicians. These activities are more than placeholders in the schedules of older Asian immigrants; rather, they are essential spaces of linguistic and social connection.

Ada C. Mui and Tazuko Shibusawa explain how elders with small social circles are particularly vulnerable. Communities promote a sense of social integration by providing elders group membership and a place to maintain social roles.5 The majority of Asian immigrants immigrate in mid-life, and a third do so after the age of sixty, resulting in the loss of existing social support networks. Those who immigrate in their mid to later life are more likely to have a smaller social network due to discontinuity and severed relationships, a weakened support system, and networks that are often stretched thin because of geographical distance. Consequently, the creation and maintenance of social networks is both difficult yet essential to the lives of Asian elders. While there is a lack of reporting and research on how isolation during COVID-19 has affected the mental and emotional health of Asian elders, we can infer that the loss of social community experienced by our elders only add to the existing difficulties of living in a pandemic. A Los Angeles Times article interviewed Asian elders 65 and older at the beginning of the COVID-19 pandemic. Respondents expressed feelings of isolation, loss of routine, weakening connections with their communities and social circles, and anxiety about distance from family members across the Pacific.6 In addition, an August 2021 US Census Bureau survey found that Asian Americans are more likely to report fear of going out as a reason for food insufficiency during the pandemic.7 Likewise, social distancing mandates, limited gatherings, and pandemic-related fears either disrupted or completely extinguished essential life-giving activities my grandparents engaged in.

With the loss of my grandparents’ daily routines and social community, my family navigated their dual cancer diagnosis through caregiving, companionship, and medical advocacy. A 2020 report by the National Alliance for Caregiving found that the number of Americans providing unpaid care has increased over the last five years with nearly one out of five Americans (21.3 percent) providing unpaid care to an adult.8 A previous AARP report on Caregiving Among Asian Americans and Pacific Islanders also found that Asian Americans (of Japanese, Korean, Chinese, Filipino, Vietnamese, and Asian Indian ethnic backgrounds) were twice as likely to be caring for a parent and were simultaneously juggling work and caregiving responsibilities of both older and younger family members.9

My family joined numerous other families who navigated the world of caregiving amid added pandemic limitations. We adjusted to working and schooling from home, translating and advocating at doctor’s appointments and on phone calls with health insurance companies, mediating the emotional and mental well-being of family members, and coordinating drop-offs for food and groceries. However, after a year-long battle with cancer, A-gong passed away in September 2021. His loss reverberated through our family as we had to navigate again the painfully recent realities of grieving and funeral planning for another grandparent. Even as A-ma continues to battle cancer and the pandemic continues to persist, my childhood perspective of my grandparents’ invincibility has been eclipsed by the sobering understanding of their fragility.

With Asian Americans and Pacific Islanders constituting the fastest growing ethnic group sixty-five years and older in the US today,10 and the projection that fifteen percent of the total US Asian Pacific Islander population will be over the age of sixty-five by 2050,11 there is a unique and growing need for services to assist Asian American elders. As Asian Americans continue to navigate loss, filial duty, and caregiving for their elders during the COVID-19 pandemic, there is a compounding need for research and visibility regarding the complexities of these experiences. In addition to Tupperware soup deliveries, we need to make visible new instantiations of and extensions to filial duty to our elders during and beyond the pandemic. Ultimately, the flourishing of our elders ensures the flourishing of us all. Despite the disorientation of the past two years, my grandparents modeled unwavering resilience and love that filled the voids of displacement and loss. And perhaps it is here that I understand their invincibility anew.


JOCELYN CHUNG is a lettering artist, graphic designer, author, and a master’s candidate in Asian American Studies at San Francisco State University. She is the proud daughter and granddaughter of Taiwanese immigrants, a boba enthusiast, and artivist (artist-activist). Her forthcoming children’s book, When Love is More Than Words, is set to be released in 2023.


References

[1] Ada C. Mui and Tazuko Shibusawa, “Informal Support and Intergenerational Relation- ships,” in Asian American Elders in the Twenty-first Century: Key Indicators of Well-Being (New York Chichester, West Sussex: Columbia University Press, 2008), 106, https://doi. org/10.7312/mui-13590-007.

[2] Aggie J. Yellow Horse, Russell Jeung, and Ronae Matriano, “Stop AAPI Hate National Report (3/19/20-9/30/2021),” Stop AAPI Hate, 18 November 2021, https://stopaapi- hate.org/wp-content/uploads/2021/11/21-SAH-NationalReport2-v2.pdf.

[3] Kris Pui Ma et al., “The Impact of Structural Inequities on Older Asian Americans during COVID-19,” Frontiers in Public Health 9 (August 16, 2021), https://doi.org/10.3389/ fpubh.2021.690014.

[4] Grace J. Yoo and Barbara W. Kim, Caring across Generations: The Linked Lives of Korean American Families (New York: New York Univ. Press, 2014).

[5] Ada C. Mui and Tazuko Shibusawa, “Informal Support,” 106.

[6] Anh Do, “Coronavirus Means Fear and Isolation for Many Asian American Seniors,” Los Angeles Times, 12 March 2020, https://www.latimes.com/california/story/2020-03-12/ asian-seniors-coronavirus-threats-los-angeles.

[7] Daniel J. Perez-Lopez and Lindsay M. Monte, “Asian Population More Likely to Report Fear of Going out for Food as Reason They Did Not Have Enough to Eat during COVID,” US Census Bureau, 15 October 2021, https://www.census.gov/library/stories/2021/08/ asian-households-cite-fear-of-going-out-as-reason-for-food-insufficiency-during-pandemic. html.

[8] “Caregiving in the US 2020,” The National Alliance for Caregiving, 11 May 2020, https://www.caregiving.org/caregiving-in-the-us-2020/.

[9] “Caregiving Among Asian Americans and Pacific Islanders Age 50+: An AARP Report,” AARP, November 2014, https://www.aarp.org/content/dam/aarp/home-and-family/ caregiving/2014-11/report_caregiving_aapis_english.pdf.

[10] Robert Gebeloff, Denise Lu, and Miriam Jordan, “Inside the Diverse and Growing Asian Population in the US,” New York Times, 21 August 2021, https://www.nytimes.com/ interactive/2021/08/21/us/asians-census-us.html.

[11] Victoria A. Velkoff, Jennifer M. Ortman, and Howard Hogan, “An Aging Nation: The Older Population in the United States,” US Census Bureau, May 2014, https://www.census. 18 gov/prod/2014pubs/p25-1140.pdf.