Family as primary unit of care

The family is the most important social and economic unit in Chinese and Asian cultures. Traditionally, and currently it is still common for three generations to live together, with parents having the highest authority in the family.

Although there are clear guidelines for relationship and roles in Chinese (and other East Asian cultures) families, when there is a disability in a family, these customs become blurred and boundaries are pushed to new limits; sometimes new patterns of relating and obligation emerge.

Generally, the mother is the caregiver in the family, and in the case of disability, because of the blame often attributed to her, the mother will shoulder most of the responsibility. Fathers are usually less involved, with some remaining absent or not supportive because of the shame associated with a disability. Fathers tend to be more involved with the non-disabled children (especially in disciplining) in public settings. Holroyd (2003) reports in research conducted with Chinese families with disability, that some husbands felt so ashamed that they left their wives, and some grandmothers dissociated themselves from the family because of the shame. She cites other examples where mothers are more realistic about prospects for the child whereas fathers continue to hope for a cure and remain in denial of decline, but that despite the differences in beliefs about obligations those parents remained united in the face of their challenge.

Whilst the elders in the family are often the decision makers, they may not be the carers. Ensure that carers are involved in support and interventions. The hidden nature of informal care-giving often leaves carers burdened and isolated, particularly for migrants who don't speak English in New Zealand; they may need support themselves.

Traditionally, in Chinese culture (and most collective cultures) it is common for people to sacrifice their own needs and goals for the benefit of the family. So it is usually extended family that steps in if the mother or father is not able to meet obligations. Help from immediate and extended family is preferable to seeking help from neighbours, commu¬nities, or health services. Seeking help from social welfare or receiving benefits from the government can be very intimidating, particularly for migrants, and is often seen as shameful.

Let families know that it is common practice and acceptable to receive help from services or the government in New Zealand. Many migrants may be without extended family.

Since respect for elders and filial piety is so important, it is critical for healthcare practitioners to establish a working relationship with parents or significant extended family members (if available) as their involvement will be vital to the success of the treatment or support process.

Whilst Japan is a conformist and collective culture, and respect and relationship is of utmost importance, there is a radical and rebellious younger generation for whom many traditional values and practices are no longer relevant. This often presents major challenges for families.