Culturally Competent Caregivers

The rapid increase in racial and ethnic minorities has put the United States on a fast track toward “majority-minority” status, when less than half of the U.S. population will be non-Hispanic white. The 2010 Census Bureau projections show the country passing that threshold in 2042. Therefore, the demand for culturally competent caregivers is on the rise.

The rapid growth in the U.S. Latino population during the past several decades has been one of the most significant demographic trends in U.S. history. In 2010 there were 50 million Hispanics living in the United States, making up nearly one in six U.S. residents. Between 2000 and 2010, the non-Hispanic white population fell from 69 percent to 64 percent. Overall, minorities accounted for 92 percent of the total growth in U.S. population during the past decade, and Hispanics accounted for over half of the increase. Asian American population growth matched that of Hispanics, with a 43 percent increase since 2000. Between 2000 and 2010, the number of Asians added to the population (4.3 million) exceeded the increase in African Americans (3.7 million).

While home health aides cannot know the nuances of all cultures, it is evident that optimum homecare includes being culturally sensitive to our clients. So how do home health aides become culturally competent caregivers?

Awareness of and Respect for Cultural Values

Misunderstandings about care preferences are common among diverse cultural groups. Caregivers often underestimate the importance elderly adults place on a variety of care issues, and this often exacerbates the caregiver burden. When caring for a client of another faith tradition or ethnic culture, open and respectful conversations can help to dispel misperceptions and reduce negative outcomes. Homecare aides can enhance communication and understanding among clients about care preferences and work together to develop a care plan that demonstrates respect and acceptance of the client’s cultural origins and values.

Understand How Culture Influences Client Beliefs, Attitudes and Behaviors

Every person’s cultural background influences his or her beliefs, attitudes and behaviors. As part of their work, homecare aides should consider the cultural values, norms and beliefs that shape the client’s understanding of their illness. Cultural values and practices will influence the client’s desire for and selection of support services, family support groups and other forms of organizational support. Cultural beliefs may also reduce or contribute to a client’s anxiety regarding their medical condition, including any problems with care or feelings relating to their personal wellbeing.

What are some areas that require sensitivity? Here are a few:

• Family: What is family? Which family member is the dominant personality? How and when should you communicate with family members? Is a family member providing care for the client? How does that affect the home health aide’s role?
• Communication: What is the proper form of address for the client? For other family members? When is physical contact—such as a handshake or an embrace—acceptable or prohibited? Should eye contact be avoided? When? What do certain gestures mean, and which ones are unacceptable?
• Diet: What are the client’s food customs? What foods are prohibited?
• Time: How is time viewed in their particular culture? When are good or bad times? What are the client’s expectations about time?
• Space: What are the cultural and/or religious customs regarding personal space and contact? What are the client’s preferences regarding communication distance?
• Social Customs: What dates are important to the client and their family? Why? What is the importance and use of rituals? How does this affect the home health aide’s ability to provide care?
• Health traditions: What is the meaning of health and illness? How are they defined? By whom? What practices are prohibited?

A Deliberate Move Toward Cultural Competency

Cultivating behaviors that enable cultural awareness, sensitivity, and competence are important for culturally competent caregivers because illness and caregiving mean different things to different people. It must be understood that not all people are fixed in cultural traditions and unable to modify their behavior or learn new ways. However, knowledge of common practices, viewpoints and customs provides a foundation for a mutually beneficial caregiver and client relationship. In short, knowledge, patience and respect for everyone is a solid beginning. It is often said that in the caregiving profession, learning never stops. That must include making a deliberate and focused effort to become educated on the rich diversity surrounding us.