Pap is married to a Romanian man in the construction industry, a handy profession when you’re remodeling a house to accommodate a licensed care facility, she notes. The family lives in a separate wing with their three children — another asset in the world of senior care. “The residents love to watch them play,” Pap says. An assistant also lives on the premises.
Marketing her business is another collaborative effort, says Pap, who recently partnered with six other second-generation providers on a collective brochure and website. “It unites us,” she says.
Exploiting traditional values and relationships gave Romanians a head start in the marketplace. So did contemporary public policy. In 1981, Oregon became the first state in the country to allow Medicaid waivers to pay for community-based alternatives to nursing homes. A few years later, policymakers passed a law allowing nurses to delegate nursing tasks to non-medical service providers.
The pioneering legislation gave dependent seniors the option of living in homelike, non- medical settings and helped build adult foster care as a “fresh industry,” says Simmons.
Enter the Romanians, who had come to the right state at the right time. One man in particular looms large. In the late 1970s, Nicky Pop immigrated to Portland, part of the first significant wave of Romanians fleeing Ceausescu. Pop eventually founded the Philadelphia Romanian Pentacostal Church in Southeast Portland, and in the 1980s and 1990s, he sponsored over 16,000 Romanian refugees, helping establish Portland as one of the four biggest Romanian communities in the country. Today, the church is another example of how enmeshed the foster care business is in the Romanian community. It serves as the gathering space for the monthly meetings of the Independent Adult Foster Home Association.
Pop, who is still the church pastor, also owned a foster care home for many years.
Such is the nature of immigrant business development, observes Elizabeth Radulescu, an employment counselor at the Immigrant and Refugee Community Organization (IRCO) and a Romanian. “One or two people start something, then everybody else goes in that direction.”
Public and private agencies also played a role. Multnomah County’s Department of Aging Services offered the Romanian arrivals English classes. Senior placement agencies distributed American cookbooks “to teach them how to do a meatloaf,” says Monika Gartner, owner of Care Service Options.
Then there was Orvalee Farris, an American nurse who opened one of the state’s first foster homes in 1979 and eventually trained “hundreds of Romanians,” she says. “I heard about the plight of the refugees and met Nicky Pop,” says Farris, adding that she started the foster care after taking her grandmother out of a nursing home, attracting the interest of a state delegation.
Three decades later, the Romanians largely control the market, with a reputation for stellar home cooking and houses so spotless “you don’t want to touch anything, ” says Amie Clark, owner of the Senior Resource Network. It’s the kind of success that boosts an entire community. Today, the Romanian per household gross income is relatively high compared to other refugee communities, with some families earning more than $100,000 a year, says Radulescu. Foster care providers have also helped fund about 10 Romanian churches statewide, which cater to the majority Pentecostal and minority Orthodox populations.
It remains to be seen whether Romanians will retain their hold on the marketplace as a third generation grows up in Portland. Adult foster care also faces increasing competition from corporate-dominated assisted-living facilities, which offer private apartments for dependent seniors, as well as residential care facilities, which often specialize in care for people with Alzheimer’s or dementia.
Regardless, the story of Romanian foster- care providers unfolds as a kind of fable about the U.S. health care system, past and future. By 2030, the number of people 65 and older is expected to double, with the fastest growth among those over 85. Accommodating a burgeoning senior population requires rethinking a host of issues: the medicalization of the aging process, the enormous costs associated with long-term care institutions, and the tendency to devalue jobs that involve caring for vulnerable and dependent populations.
The success of the adult foster-care model as practiced by the local Romanian community showcases a refreshing Old World alternative to the New World issues facing the nation’s health care system. A network of relatively affordable commercial residences, staffed by small business owners, has cut costs without sacrificing quality. It may not be the only solution, but health care reform going forward likely will require hundreds of such small-scale initiatives and experiments.
Oregon pioneered the idea of licensing home-based care environments, but it took a group of church-going, back-to-basics Eastern European émigrés to make that vision a reality.