An elderly man was found unconscious on a bench in Santa Clara

September 29, 2025 admin 0 Comments

An elderly man was found unconscious on a bench in Santa Clara County, Calif. The person who discovered him called 911.

Taken by an ambulance to Santa Clara Valley Medical Center in San Jose, Calif., the man, who had no ID, “received emergency treatment and was stabilized,” Dr. Gary S. Lee, chief of palliative care at SCVMC, told India-West.

“He was on life support, in between life and death,” Lee said. He added that the man’s ethnicity could not even be determined.

“There was no way he would recover, and we had to make a decision how best to care for him. In a situation like that, it puts (the hospital) in a difficult place. Normally, it is the family or friends who make these decisions.”

A social worker at the medical center took a photo of the man and showed it around at homeless shelters nearby, but the effort proved fruitless.

If no relative could be found, the hospital would have to form a committee to make a life-or-death decision, but that would be a last resort.

The man’s fingerprints were taken and sent to U.S. Citizenship and Immigration Services, resulting in an ID and the revelation that he was an Indian American immigrant.

The identification led to locating and contacting his two daughters, who lived in the Bay Area. They told the hospital that their father had lost his business and become despondent after his wife died. He had been living in the streets for some time.

After speaking with the medical staff about his condition, the daughters gave their permission to take him off life support.

As the South Asian American community increasingly deals with health problems among its growing and aging senior population, more of these types of cases are likely to occur. These families are feeling the stress related to end-of-life decision-making.

According to a 2011 California Healthcare Foundation’s statewide study of 1,669 adult Californians, including 392 respondents who lost a loved one in the previous year, the most import concern for 67% of the respondents was avoiding having a family member be burdened financially by their medical care.

Almost all hospitals in the San Francisco Bay Area have established palliative care departments and are spreading the word to ethnic communities about their resources and facilities.

Palliative care is specialized medical care for those with a serious illness — whatever the diagnosis — allowing them to get relief from symptoms of pain and stress at any stage of their illness. It need not be a pathway to death and patients can improve and return to relatively good health.

Hospice care is end-of-life palliative care meant to enhance the quality and dignity of life for terminally ill patients and their families, either at home or in a medical care facility.

“We have been doing outreach to diverse older adults, including Asian Indians, Latinos, Chinese, and Filipino older adults, to educate them about successful aging and end-of-life decision-making,” said Dr. Vyjeyanthi “VJ” Periyakoil, director of Stanford University’s Palliative Care Education & Training Program.

“We have also been doing interviews to better understand their care needs.”

Periyakoil is co-author and editor-in-chief of an informative document for health professionals, “Health and Health Care of Asian Indian American Older Adults,” which lists the top five causes of death for Indians in the U.S. and how Indian American families can be nurtured by culturally appropriate prevention and care programs.

The paper also explains traditional health beliefs among Indian Americans and discusses culturally-sensitive ways to deal with advance directives and end-of-life decisions. It explains in detail how Hindu, Muslim and other religious practices are to be taken in account in proving palliative and end-of-life care.

“It is not uncommon for older Asian Americans to depend on the family to make medical decisions,” said the paper, issued by the e-Campus geriatrics division of the Internal Medicine department at the Stanford School of Medicine.

“Older Asian Indians are much more likely to subscribe to a family-centered decision rather than making these decisions by themselves…Typically, family members (especially the durable power of health attorney) are key stakeholders in the patient’s current and future well-being.”

“There is ongoing immigration of Asian Indian older adults who are here to live with their children, as they have no social support in India,” Periyakoil noted.

“Some of these immigrant older adults find it easier to assimilate into the American society. Those with limited health literacy and limited English proficiency find it challenging to get quality health care.”

Periyakoil provided excerpts from an interview she conducted with an “octogenarian Hindu male,” who has lived in the U.S. for 19 years.

He contrasted medical care in India and the U.S.

“In India you can straight away go (die). All right, you take a breathing apparatus — something like that — it is easier. But here there are lot of norms and regulations.”

The man feels strongly that patients should be given “the facilities for advanced medical directives. Supposing I am clinically dead. There is no point in prolonging life. So, they must get a declaration…so that their children should not be put into problems…If you sign advance medical directives, you have a sigh of relief.”

The man said his wife recently “was talking (and) suddenly she had a respiratory failure. She (already had) signed (the advance directives),” he said.

“See, after some time, we should not prolong our life unnecessarily…The doctors were able to take a decision after five or six days…Fortunately, they could make a decision. She passed away.”

“Many older adults in the Asian Indian community have very strong spiritual beliefs and practices,” Periyakoil told India-West. “Their spirituality is an important aspect of their daily lives and helps them cope with serious illnesses.”

“In traditional Indian culture, elders are treated with respect and deference. Our data show that providing respectful care is a very important value for Asian Indians.”

Lee told India-West that SCVMC, which started its palliative care program in 2006, sees about 400 patients a year, of which just two to three percent are “East Indian,” despite the fact that Indian Americans make up about 6.6% of the population in Santa Clara County.

In the palliative care unit, about 10% are on Medicare, 10%-20% have private insurance and the rest are “mostly on Medi-Cal or lack insurance.”

“Our institution sees patients from so many parts of the world. I’d like to think that we do just as well as anybody else does.”

Cultural issues often “bubble up,” he added. There are many on the staff at the hospital able to translate in the main Indian languages, but if interpreters happen not to be available for face-to-face interviews, “we contact outside vendors,” he explained.

Lee agrees that Indian Americans, like many Asian Americans, often try to protect their loved ones from hearing bad news directly. “We like to think that we are experts, at least on palliative care, and we will disclose only as much as the patent wants.”

“I think South Asians, like the rest (of the population), are not exactly aware of what palliative care is and how it differs from hospice.”

Lee and Periyakoil agree that the Indian American community, which includes many individuals with IT or medical backgrounds, may be generally more savvy about advanced directives than some of the other immigrant communities.

Still, knowing what should be done and doing it are two different things.

“These people may not be sufficiently prepared for the last chapter of their lives,” Periyakoil said. “It is important to educate the community about using advance directives and POLST as a tool to document their values and preferences for care so we can honor and respect their choices.”

(POLST, or Physician Orders for Life-Sustaining Treatment, gives instructions to doctors about specific treatments. For example, specifying if the patient wants comfort care, limited intervention or a full treatment.)

“What is needed most,” the Indian American doctor added, is “more education in the community, more facilities, better trained medical personnel and translators to serve the palliative needs of the South Asian community.”

“Community in-reach is vitally important, i.e., educating members of the Asian Indian community so that they can reach within and educate their family and neighbors.” Stanford School of Medicine is currently offering a free Web-based mini-fellowship in Successful Aging and End of Life.

About 40 Indian Americans are enrolled in the mini-fellowship doing community service, Periyakoil said. To find out more about it, visit https://suse.qualtrics.com/SE/?SID=SV_0HvJJKtu15VEdg1.