Academic journal article Care Management Journals

Cultural Responsiveness in Long-Term-Care Case Management: Moving beyond Competence

Academic journal article Care Management Journals

Cultural Responsiveness in Long-Term-Care Case Management: Moving beyond Competence

Article excerpt

Case mangers must deal with the ever-changing makeup of their client population as well as those who provide managed services to these clients. There is great ethnocultural diversity in the elder population, and statistics contend that it will only increase with time. Similarly, the majority of long-term-care providers have been consistently female and of color. Providing culturally competent services becomes more complex when long-term-care providers and clients possess different identities, countries of origins, and social statuses. This article examines a framework that addresses the complex, multidimensional, and bidirectional process that occurs between providers and consumers of any cultural makeup called cultural responsiveness.

Keywords: diversity; older adults; cultural competence; multiculturalism

Case managers are responsible for coordinating services for a diverse clientele. Most recently, the elder population has required more services because of their longer life span. Case managers are aware of the graying of America and, in fact, of the industrialized world. It is unquestioned that the number of people who reach advanced age in the United States will grow both quickly and substantially as the post-World War II baby boom moves into the service-intensive stage past 75 years of age. What is less recognized is the degree to which the "face" of contemporary older America will change to become far less White, appreciably refl ective of an even more rapidly growing proportion of African Americans, Latinos, and Asians. While the number of non-Hispanic White older adults (65 and older) is projected to grow from approximately 29 million to nearly 53 million between 2000 and 2050, the proportion of the population age 65 and older represented by these older non-Hispanic Whites will shrink from over 83% to about 64%. At the same time, the number of non- Hispanic Black elders will more than triple from about 2.8 million to nearly 10 million, representing an increase in the proportion of Black elders from 8.1% to 12.2%-a 50% increase. Asian and Pacifi c Islander elders will grow in number from about 820,000 in 2000 to 5.3 million by mid-century, representing 6.5% of all older adults. Hispanic elders will increase in numbers from just less than 2 million to more than13.4 million, and their proportion of the older population will increase from 5.6% to 16.4% during this time period (U.S. Census Bureau, 2000).

Even by 2025, an estimated one in four older adults will be identifi ed as a member of a minority group (Federal Interagency Forum on Aging Related Statistics, 2000). By 2028, the Administration on Aging (AoA, 2007) estimates that Hispanic elders will represent the largest racial/ethnic minority among older adults. "The demographics of an aging population are making it impossible for providers to deny the changing face of those they serve" (Stanford & Schmidt, 1995, p. 20). But the meaning of these changes for case management goes far beyond the simple count. The changing face of older America will also require an equally robust and fl exible change on the part of case management service providers to respond to the increases in diversity that are represented by these new elders.

Adapting to the changing demographics will go beyond the recognition of the racial/ethnic groupings refl ected by the Census Bureau. The growth in the government's recognized ethnic groups does not begin to refl ect the tremendous diversity that must be addressed in clinical care because of the within-group diversity found in each population (Pardasani, 2004). This is true within ethnic groups of color as well as within "White ethnics." These differences are rooted in the degree of acculturation that one has experienced in socioeconomic status and in education. These differences may be amplifi ed when the two parties to a care interaction may each be using a "second" (or third) language and be unfamiliar with the cultural norms and expectations of one another (Yeo, 1996). …

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