In my opinion, in the service industry, whether it is elder
care or kinder care, cultural competence is the nexus that can determine
success and satisfaction in any service business. I learned this fact early in
my education as a recreation therapist. I had to understand the specific
cultural interests of each population so that I could engage clients in
meaningful activities in which they felt connected. For example, my Hispanic
students wanted to learn the salsa and liked the upbeat tempo of that genre. My
African American students wanted to listen to hip-hop and dance like Michael
Jackson. We all compromised and had fun and a lot of laughs learning the
various styles of dance and music.
Likewise, as a recreation therapist in a nursing home, I had
to provide a variety of activities which would connect to a multitude of
cultural interests. The religious activities were where I saw the most
distinguishable segregation in cultures. The African American religious groups
were more robust, loud, and lasted hours. Whereas, the non-Hispanic white
religious activities were conservative and quick. The Catholics preferred to
take Mass in their room. We had both an English-speaking priest and a Spanish-speaking
priest who would visit the Catholic residents in their room.
I have always worked in very culturally rich locations and
have been mindful of cultural differences both in the client population and the
workforce. In fact, in the Northern
Virginia market, a common complaint among patients is that they don’t
understand the staff. In our demographic area, many African workers from Sierra
Leona have a strong dialect and speak broken English. We also have many
Hispanic workers and Filipino workers. There exist language barriers between
staff and residents who are of not a minority background. Equally, many of our workforces are Muslim, and employers have had to adjust workflow
to accommodate Muslim traditions and religious observances. So, as a health
administrator, I have had many experiences
with implementing cultural competencies to serve
minority elders effectively. I
equally have had to apply cultural appreciation and diversity training to
my non-minority elders and workforce to get along with and accept the cultural
differences of our minority workforce.
Competencies Needed in Skilled Nursing
Facilities
There
are three competencies that I believe skilled nursing facilities in culturally
rich areas could do more to integrate into their healthcare settings. These
include coordinating with traditional healers, incorporating culture-specific
attitudes and values into health promotion tools, and locating clinics in
geographic areas that are easily accessible for specific
populations.
Many
years ago, I contracted with a massage therapy school to provide therapeutic
massage to our bedridden and chronic pain residents. For me, massage is healing
to the body and mind and works much better for my aches and pains than pain
medication. Traditional healing methods offer a holistic approach to healing.
Common traditional healing methods
include acupuncture, sauna and steam baths, herbal teas, and herbal or mineral body
scrubs. When I think of traditional
healing and the elderly, I think of the power of touch and the power of
spirituality. Sometimes, a hug or sharing a prayer is all that is needed to
ease some pain and suffering of our fragile elders. Bearing in mind the
variances in cultures where touch or eye contact may be offensive or an
untoward expression.
In
the context of meeting a specific cultural need, there are practicing
traditional healers for the African populations, the Chinese populations, and
Native American populations. In my opinion, skilled nursing facilities should
consult with residents and families to see if they have these specific
preferences and make the accommodations, as feasible, to provide traditional
healing to these residents.
Preventive
medicine, healthy lifestyle choices, and chronic disease management are how we will help the influx of the older
population age well. The use of health promotion tools such as educational
seminars and workshops, published literature, e-health, m-health, telemedicine,
and health screenings are all useful
tools to manage our aging population. However, if we don’t implement cultural
sensitivity into the tools, the message
will be lost on the minority elder population.
Something
as simple as the standard rehab ladder could reflect cultural sensitivity. How
difficult would it be to ask the patient what their rehab goals are and
establish a personal ladder of achievement? Maybe there is a grandchild’s
graduation in the future? Perhaps there
is a 50th wedding anniversary party? Maybe
it is to golf or possibly swim? I use
this as a simple example of a complicated issue. However, awareness is half
the battle.
As
a skilled nursing facility provider, I would like to see more referrals being made to outpatient therapies, home-health
agencies, physicians and specialists, and social workers who share not only the
demographics of the discharged patient but also the culture. Most insurance
companies include in their directory of providers the languages that the
provider speaks. I think the same should be
included in a list of home health
agencies, outpatient therapy clinics, and enrichment programs for the elderly.
Cultural Sensitivity & Patient-Centered
Care
To
conclude the discussion of cultural competencies, I would be remiss not to
parallel cultural sensitivity to patient-centered care. Both models aim to
improve healthcare. Whereas,
“the primary aim of the cultural
competence movement has been to balance quality, to improve equity and reduce
disparities by specifically improving care for people of color and other
disadvantaged populations. [And] the primary aim of patient-centeredness has been to individualize quality, to
complement the healthcare quality movement’s focus on process measures and
performance benchmarks with a return to an emphasis
on personal relationships and customer service. As such, patient-centeredness aims to elevate quality
for all patients” (Saha, Beach, & Cooper, 2010, p. 9).
About the Author
References
Saha, S., Beach, M.C. & Cooper,
L.A. (2010, February 18). Patient centeredness, cultural competence
and healthcare quality. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824588/
Contributed by Donna Rein, Graduate Student, MHA Program, Saint Joseph's College
