> Inclusion & Diversity
> Cultural Competence
This section presents information and resources for developing an awareness of the beliefs, needs and preferences of different cultural groups and their impact on providing care and services that are culturally appropriate for diverse older adults.
Also discussed are the care and service provision challenges presented by some other older adult groups including recent immigrants, people with disabilities and people with mental illnesses.
The Need for Cultural Awareness
A recent Institute of Medicine (IOM) report focusing on unequal health care in the United States found that whites receive more care and more culturally appropriate care than other racial or ethnic groups, even after taking into account patterns of unequal burden of disease and unequal access to care.
The authors hypothesize that one of the primary mechanisms linking social inequality to health care use is the behavior of clinicians and practitioners.
Practitioners who lack knowledge of other cultural traditions may ask clients fewer and less relevant questions in interracial or inter-ethnic encounters.
The care of older adults of color is further compromised by encounters in which providers rely on stereotypes, collect inadequate information, or misinterpret information while forming diagnoses and treatment recommendations.
The notion of “cultural competence” suggests that there are ways for providers to address these challenges.
What is “Cultural Competence?” Cultural competence is the possession of knowledge and skills that enable providers to deliver culturally appropriate care and services, understand the preferences of older adults, and be aware of customary practices of specific racial, ethnic and cultural groups.
Cultural competence advocates suggest that a way to improve the health and functional status of traditionally excluded older adults is to design and implement approaches that include the elder’s culture in the relationship with service providers.
This relationship is greatly influenced by the perceptions that service providers have about older adults which impact the clients’ health outcomes. Cultural competence approaches are an effort to eliminate inaccurate assumptions or ideas that result in older adults receiving suboptimal health care, long term care or supportive services
Cultural competence is achieved by:
- developing an understanding of individuals and groups of people;
- incorporating that understanding into practices and policies used in appropriate cultural settings.
Cultural competence goes beyond cultural awareness, respect and sensitivity. It also means using that knowledge and respect effectively in cross-cultural situations.
Cultural competence efforts alone cannot overcome the cumulative impacts of social dynamics that create greater risks for disease and death for elders of color. It is likely, however, that cultural competence initiatives used by service providers can play an important role in reducing health disparities and improving interactions between providers and clients.
Cultural Competence vs. Cultural Humility
Cultural competence approaches can help service providers to consider and include older adults’ cultural backgrounds in the service relationship. Cultural humility approaches seek to incorporate the characteristics of the service provider and the older adult in a mutually beneficial and balanced relationship. This section describes both approaches and offers an example of using the cultural humility approach in partnership meetings.
A Diverse Workforce Caring for Older Adults
Demographic changes in the United States, particularly in terms of race and ethnicity, are reflected in the diversity of the long term care and supportive services workforce. Cultural differences can create difficulties for older adults and their caregivers in receiving needed services and care. As a result, health care, long term care and supportive services providers are developing methods of recruiting, retaining and managing a workforce that mirrors the diverse population of older adults. This section discusses some of the issues that arise from an increasingly diverse workforce and offers resources for learning more about them.
Diversity training is focused on incorporating awareness of, and respect for, the cultural differences among people into the policies and practices of organizations. This section discusses some of the standards and training materials that community partnerships can use to help people and organizations develop an awareness of diversity.
This section discusses the importance of older adults’ ability to obtain and understand health information, such as instructions from doctors and nurses, from health care systems (e.g., Medicare and Medicaid) and on medication containers. Also included is a resource for learning more about providing interpreter services to non-English speakers.
Religion and World-View
In the United States, many religions and belief systems play a role in the way that older adults, their families and caregivers understand health-related issues, the aging process and the meanings of illness and death. This section discusses the implications that religion and world-view have on aging, caregiving and end-of-life decisions.
Older Adult Immigrants
In addition to the challenges and changes of aging, older adult immigrants also face obstacles posed by a new language, culture, government and health care system. This section discusses some of those challenges, including the fact that many immigrant elders have little or no access to health care services because they are not covered by Medicare.
Older Adults with Disabilities
Chronic illnesses and conditions may limit older adults’ ability to carry out ordinary tasks, such as personal care and household chores. Disability may also contribute to feelings of loss of empowerment and autonomy, particularly in terms of elders’ opportunities to make decisions about their own health and long term care. This section discusses some of these challenges and describes an approach for integrating
consumer-driven disability services into a community setting.
Cultural Issues in Mental Health Services
Mental illness is an important health concern among older adults and there is a need to address the unique mental health needs of racial and ethnic groups. Of key importance is the fact that members of such groups are less likely than whites to seek mental health treatment and to use outpatient treatment services. This section discusses the need for culturally competent mental health care, the mental health challenges of a few racial/ethnic groups and suggestions for improving the provision of mental health services to diverse older adults.