Trading Places

Last Feb. 23, 2007, I had the opportunity to speak about my cultural background and how it relates to attitudes about healthcare, role-reversal, and high-performance buildings built with the associated needs in mind. (In this case, Assisted Family Living facilities.) I had a very engaging and enthusiastic audience---the staff of the Alzheimer's Association Desert Southwest Chapter in Arizona.

When I got the invite from the Alzheimer's Association to be their speaker, I thought to myself, why me? I'm in architecture, what can I speak of about caring for the elderly? Then I realized, why not me?

I can draw from my personal experiences of the gradual role-reversal that I am currently experiencing with my aging parents. Plus, I have briefly worked on Assisted Living Facilities projects of Taliesin Architects, so I can draw information from these. My topic centered on how typical Filipino families deal with aging and a growing disease called dementia.

Elderly healthcare in Filipino communities, whether they are living on-shore or part of the Pinoy diaspora, is strongly driven by cultural traditions and values. There is a strong dependence on family which, more often than not, results in financial, emotional, and cultural stresses on the family member acting as care-giver. This is further compounded by societal pressures associated with a close-knit family culture and the emphasis given on respect for elders. Filipino parents have a difficult time letting go of grown-up children, which is why we often see them still living with the parents as long as they want. Children normally keep their close relationship to their parents by staying until at least before getting married. This creates a unique dynamics in the Filipino family where it is common to see grandparents living with grown-up children with their own families.

The advancement of science and technology enables humans to live longer in this day and age. By year 2010, it is estimated that there will be twice as much Filipinos at age 65 who, at the same time, will be at risk of developing Alzheimer's Disease (based on the Philippine Government statistics). This necessitates that urgent considerations be made on how we deal with healthcare issues associated with a longer lifespan and aging. Philippine president Gloria Macapagal-Arroyo issued Proclamation No. 1136 declaring an Alzheimer's Disease Awareness Week occuring every third week of September every year. However, based upon inter-disciplinary considerations, there is still limited access to facilities in the Philippines that cater to this growing disease normally associated with aging. This presents extremely synergistic challenges to Filipino healthcare professionals and architects who must work in this healthcare arena strongly driven by cultural attitudes, information or lack thereof, and economy.

Cultural Attitudes

Because of the tradition of a close-knit family, the Filipino family provides most of the healthcare of elders. This forms their support system. Traditional long-term care is disregarded or unheard of. There may also be reluctance in seeking professional services for impared elders due to the cultural perceptions of stigma and shame associated with having an impaired family member. These family member-caregiver who are not skilled to care for those dealing with Dementia and Alzheimer's Disease often dismiss the ailment as forgetfulness---a part of growing old.


Some Filipinos would rather ask their neighbor or friends about health issues and its treatment rather than seek professional help. Also, the facilities that cater to this societal market is a very small fraction of business that appears unappealing to developers in Asian markets who want a quick return on their investment. There needs to be a balance of communities that cater to both start-up families and to those in their golden years.


The average Filipino parents are not trained by their parents to put money away for something like this because their major concern is to live and survive on a day-by-day basis. Therefore, healthcare is limited to those who can afford it.

Two sides of the Coin

As far as the Filipino's approach to healthcare is concerned, I am in a strategic position to be able to view two sides of the same coin. I live permanently in the USA and will soon be part of the growing population of dual-citizenship holders in Filipino communities. So for me, healthcare is as important as having a paycheck.

It is the driving force for people to seriously consider their retirement plans. There is a boom in the market of Adult Living Communities. Asian communities who carry with them cultural baggages in their approach to healthcare are realizing the need for a good healthplan and health insurance benefits.

More on this topic in my next posts...


Cinti Agbayani said...

Lira, Cinti (nee Vic) Agbayani here. (The change of nickname is a strategic move to differentiate myself from the penny-a-dozen "Vinces" and the not-as numerous-but-still-sizable number of "Vics" that populate the American landscape!)

We - my wife and I - can definitely relate to your experience and punto-de-vista.

I am back in QC for what might be either a short or longish visit depending on what happens to our application to care for the developmentally disabled in NJ.

We, as I might have intimated in my previous emails to you, have opted to come live nearer our grandchildren - and, consequently, their parents - in Manhattan in pursuit of the extended-family "ideal" that is embedded in our family life and culture.

In the process, we have seen fit to try to be gainfully occupied (we were already semi-retired back home)by providing what I think should be the hallmark of our contribution to the globalizing world: CUSTOMER CARE par excellance! To the C-hallenged (physically, mentally, spiritually, morally), the A-ging, the R-ecuperating, the E-ducable. (Large bite, I should say; hope we can swallow.)

In my view, this is the Filipinos' comparative advantage and NO service, no matter how menial the short-sighted want to portray it (e.g. domestic), is to be ashamed of or frowned upon but rather extolled and bannered to high heavens if it is performed with the utmost devotion - not only to the task but, more importantly, to the recipient of the care!

So much for now. As soon as we have need of your services for tailoring our "home" and its amenities to the needs of our wards we will come a-begging...

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