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U.S. Muslims Confront Taboo on Nursing Homes

BROOKLYN PARK, Minn. As a founder of the growing Shiite Muslim community here, Hussein Walji oversaw the building of the area's first mosque. He directed construction of its youth center, and followers hailed him as a visionary for adding an auditorium for ecumenical functions like the M&M picnic for Muslims and Methodists.

But even family members find Mr. Walji's latest expansion uncomfortably American: he is developing plans for an assisted living and nursing complex in this Minneapolis suburb.

"I could never do it," said Mohamed Remtula, Mr. Walji's brother-in-law, his ailing mother at his side in his living room as he and Mr. Walji discussed the planned complex. "It just is not in our culture."

Such uneasy discussions are taking place in Islamic enclaves around the country as more families try to reconcile religious teachings on caring for elders with the modern realities of their hectic American lives.

Muslim leaders from Florida to California are eager for a successful approach to the issue. But early efforts have been a tough sell. Sajda Khan and her husband, Rahmat, opened Fonthill Gardens, a six-bed assisted living home in Hawthorne, Calif., for the Los Angeles area's aging Muslim population. They found a contractor to provide halal meats, included a prayer room and made enthusiastic presentations to area mosques. A year later they have cared for two Christians and one Buddhist, but no Muslims.

"People feel that others will criticize them," said Mrs. Khan, who is from Pakistan. "You know, 'So and so left her mother in a facility, and now look at her looking fashionable at the mall.' It's very frustrating."

For generations, immigrant groups have grappled with the American concept of housing for the elderly, tailoring it to meet their ethnic, cultural and religious needs. But for many Muslims, the idea of placing parents in facilities is still unthinkable, seen as a violation of a Koranic obligation to care for one's elderly relatives.

"This change will be difficult, but it is inevitable," said Mr. Walji, 54, who is also president of the North American Shia Ithna-Asheri Muslim Communities Organization, an association of mosques in the United States and Canada. "Someone has to make the first move." If families are being forced to consider outside care, he reasoned, having a facility affiliated with the mosque might ease the pain of the decision.

In Ohio, the Islamic Center of Greater Toledo approved a proposal in May to develop elder housing near its mosque.

The Henry Ford Hospital in Detroit is establishing a program to help the area's Muslim and Arab population address end-of-life issues.

"Our immigrant Muslim populations are totally unprepared to deal with this," said Dr. Hasan Shanawani, a critical care specialist who is starting the program. "We talk about respect for our parents, but in the name of love and tradition we are often neglecting our loved ones. We have to accept that there are some things we just can't do on our own."

The need for skilled care outside the home is, for an increasing number of Muslims, an unavoidable passage in the immigrant experience. Like many other American families, first- and second-generation adult siblings in Muslim families are often spread out around the country, struggling to balance the demands of dual-income marriages, work and children. Medical advances have enabled people to live longer, but often with chronic conditions that require more care than can easily be provided at home.

The Koran does not directly deal with how to care for aging parents. But prophetic teachings emphasize children's responsibility to care for parents as they were cared for as infants. Traditionally, families and religious leaders have interpreted this as a duty to care for parents at home.

"Yes, it is a mandate to take care of one's parents, but it is not explained how to do that," said Shakeel Syed, executive director of the Islamic Shura Council of Southern California, an organization of mosques. "You can keep your parents at home and not truly be caring for them, if you cannot meet their needs."

Other traditional teachings have been updated to meet contemporary needs, Mr. Syed said. Day care and baby-sitting help, also once thought of as a violation of religious obligation to family, are now accepted by many working Muslim families.

Mr. Walji's brother-in-law is not the only member of the family to have to consider the issue of elder care. Two years ago, Mr. Walji's wife's family made the tough decision to move an elderly aunt, with congestive heart failure, diabetes, leg problems and no children, into a local nursing facility.

Sitting on her bed recently at the Maranatha Care Center in a neighboring suburb, three doting nieces at her side, the aunt, Zera Suchedina, said with a resigned nod that the place was "O.K. Fine." But of roughly 90 residents in the complex's nursing care wing, Ms. Suchedina, 75, with limited English language ability, is the only Muslim.

She conducts her daily prayers alone in her room, she must accept care from male nurses which she finds religiously unacceptable and she eats vegetarian meals because no halal meats are offered.

A Muslim woman on the kitchen staff keeps her company and warms up the curries that her nieces bring her. Still, Ms. Suchedina said: "I would feel more at home to be with people I can relate to. It would be good to be with Muslims."

For advice on developing such a place, Mr. Walji has turned to the Lutheran Church, which helped his family settle in the Minneapolis area in 1972, after the dictator Idi Amin of Uganda expelled them and other ethnic Asians from the country.

The Augustana Care Corporation, run by Lutherans, has provided health care to the elderly for over a century. Tim Tucker, its president, has offered to assist Mr. Walji with development and management of his project and with updating facilities to better meet the needs of Muslims. Over lunch in the dining room of Augustana's main elder care complex in Minneapolis, Mr. Tucker listened to Mr. Walji's wish list: communal prayer space, halal foods and same-sex nursing care.

Mr. Tucker then posed a host of questions. What was the proposed size and budget for the project? What levels of care would the new facility offer? Would it be better to build a new building or buy an existing space? Would the new organization also provide day care for the elderly, or at-home services, which might be less objectionable?

The lunch ended with the bulk of questions unanswered, but with a shared resolve. "This initiative will improve the way we think about care across the board," Mr. Tucker said. In recent decades, Asian and Hispanic immigrants have influenced the elder care industry, developing their own health services or adding multilingual staff members and a more diverse array of foods, activities and aesthetic touches to facilities.

In Toledo, Manira Saide-Sallock is a supporter of her mosque's efforts to build an assisted living and nursing center. A retired teacher, Ms. Saide-Sallock, 66, is the primary person responsible for the care of both her mother and her mother-in-law, one weakened by a stroke, the other from a serious fall.

"This level of care takes its toll physically and emotionally, and having a facility that was part of the mosque would be such a help," she said, adding, "Not that my mother or mother-in-law would ever go there."

Though his family is struggling to manage, Mr. Remtula, Mr. Walji's brother-in-law, is adamant that his home is the only viable base of care for his mother, Sakina, 86, who has Alzheimer's and Parkinson's diseases and who now wears a motion sensor to sound warnings of her frequent and dangerous wanderings.

Razia Remtula, Mr. Walji's sister, said that her brother's project, while controversial now, might one day ease the burden and guilt for her own children. "I know how hard it is for me to provide this care," she said, "and I don't want my children to struggle with these decisions."

Her son, Sibtain, 27, listening intently from across the room, seemed puzzled by the discomfort surrounding his uncle's venture. "I think, in fact, it might be a better way to live when you are older, to be with your own peer group," he said. "If it was there, near the mosque, why not? I would definitely look into that."

Unsurprised by his nephew's response, Mr. Walji said: "You see? Inevitable."


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