Khmer Buddhist Temple, housed in a former church in Lynn, Mass. (Provided by The Pluralism Project, Harvard University)

The staff of Chaparral House, a skilled nursing facility in Berkeley, California, noted a positive attitudinal change in an elderly Japanese resident when she was given a pair of chopsticks with which to eat her meals. Such sensitivity is one small outcome of "Spirituality and Aging in the Japanese Experience," a series of graduate-level training modules that were funded by the Japanese American Religious Federation of San Francisco (JARF)—an interfaith consortium of 11 Buddhist, Christian, Shinto, and independent faith traditions that was organized in 1948 to coordinate the housing needs of Japanese Americans who were returning home from the internment camps—in partnership with the Stanford Geriatric Education Center (SGEC) and the Graduate Theological Union (GTU). The course introduces seminarians to the practical tasks of elder ministry and provides comprehensive and continuous in-service training for the healthcare team of Kokoro Assisted Living, a project of the Japanese community.

Kokoro and the training modules are responses to a community-wide concern over the care and housing needs of frail elders who had been pressing their congregations and the community since the late 1980s to build or acquire a culturally and spiritually sensitive residence. Fortuitously, in 1997 the San Francisco Redevelopment Agency offered JARF land in Japantown and planning began in earnest. From its inception, the JARF congregations insisted that the spiritual and cultural component should be integral to the design of the facility, staff training, services, and administrative policy. While the immediate goal is to provide optimal care, especially at the end of life, the community envisions the Kokoro facility becoming its spiritual heart.

Kokoro, the name chosen for the facility, connotes both the affective heart and the rational mind. In the present context, kokoro evokes a heartfelt appreciation for the sacrifices the first- and second-generation immigrants endured to make a home for themselves and for their progeny in a foreign land. The facility is also the concrete expression of the third and fourth generations' gratitude to their forefathers and mothers. Caring for elders is the one virtue all of the JARF faith traditions and the community agree on.

Aging in Community
The GTU's 1999–2000 course catalog described "Spirituality and Aging in the Japanese Experience," as "an interdisciplinary, multi-faith and cross-cultural exploration of the spiritual/cultural needs of older persons, which integrates medical/scientific and spiritual/cultural understanding of aging within a living community." It was divided into equal sections: (1) medical perspectives on health and aging and (2) religious perspectives on health and spirituality. The former familiarized students with the physical, medical, ethical, and legal issues related to aging of Asians and Asian Americans, with a particular emphasis on Japanese and Japanese Americans. The focus was on culturally appropriate geriatric care, assessment, healthcare interventions, access, and utilization. The second section explored Japanese Buddhist, Christian, and Shinto reflections on aging and the human spirit. It covered family dynamics, community, health, dying and death, grieving, rituals, and alternative health practices. The goal was to sensitize students to the spiritual and cultural needs of older persons.

The yearlong, two-semester course consisted of six daylong modules, offered one weekend each month. Friday sessions were devoted to the medical and scientific aspects of aging; Saturday sessions provided instruction on religion and culture. The last hour of both days was set aside for activities such as calligraphy, massage, tea ceremonies, storytelling, folk singing, and hand dance, which offered a peek into Japanese life. Students welcomed the participatory sessions after a long, information-filled day. At the final session of each semester, students presented their research and reflection at a community forum. Stanford University offered continuing education credits in nursing and social work. Continuing education credits for nursing home administrators were also available.

"Spirituality and aging" was understood to be a living, organic, and ever-changing reality that engages medicine, health care, and cultural and religious traditions in concrete and pressing ways. When possible, the course applied narrative to exemplify these concerns. We are the stories we tell. Spiritual experience is inseparable from the story embodied by an individual's history, cultural background, and current context. Buddhist, Confucian, Shinto, Taoist, and folk beliefs, as well as the massive displacement of the community during World War II, are part of the Japanese American experience. During our first module, five elders vividly addressed the question, "To what do you attribute your health and longevity?" While their attitudes toward modern medicine and the healthcare system, and the role of their faith, were of particular interest, their narratives interwove encounters with the U.S. government, societal discrimination, tensions of traditional culture with modernism, and intergenerational conflicts. The elders' experiences were instructive and inspiring, and helped to shape subsequent modules.

Sharing Tea, Telling Stories
The success of the course was due in part to the student demographics, instructors, and instruction venue. Each module, averaging twenty-five participants, included seminarians, healthcare professionals, JARF clergy and lay leaders, potential community volunteers, concerned families, and seniors themselves. While Marita Grudzen of SGEC and I were the primary instructors and coordinators, we enlisted the expertise of instructors who worked and lived in the community. We assumed that the people who were known and loved by the community would be the best teachers. Moreover, since elder care is a community effort, it is important to utilize the wisdom of organizations and individuals committed to providing geriatric care. Thus, a geriatrician who practiced in Japantown offered insightful observations on the particular health concerns of elders, and suggested medical and community responses that a disinterested researcher would have missed.

Instruction was given at various sites within walking distance of each other. Our lesson on Buddhism was given at the San Francisco Buddhist Church. Our introduction to the tea ceremony was held at the Nichibei Kai's (Japanese American Society's) fine tearoom, led by eighty-eight-year-old Sekino Kikuyo sensei, a master of her art and a model elder. Alternating the sites of instruction engaged the community.

Cognizant of the plurality of faith traditions and diversity of cultures, we provided instruction on different faiths and rituals, which are especially important during a resident's later and last stages of life, and on helping families cope with grief and mourning. The Euro-American Christian clerics felt acutely the need to sensitize non-Asians about how to fulfill the unique needs of Japanese Americans. Clerics of Buddhist and independent faith traditions whose congregations are becoming increasingly acculturated to the American lifestyle and who also serve a growing non-Japanese membership appreciate the importance of knowing the faith of their neighbors. To this end, during a module on spirituality, Buddhist, Christian, and Shinto clerics each gave a mini sermon on "The Story of a Pheasant," a popular folktale. This exercise revealed the characteristics of the respective faith traditions. Subsequently, the entire afternoon was devoted to different mortuary and memorial rites.

San Francisco's Japanese community has embarked on a unique experiment in elder care. In addition to honoring religious and cultural diversity, the community is attempting to engage the wisdom and experience that it has readily available in organizations and individuals committed to providing geriatric care. Care for elders is a community wide effort which all spiritual traditions embrace. "Spirituality and Aging in the Japanese Experience" attempted to crystallize this vision.