Academic journal article Generations

The Importance of Cultural Competence in Caring for and Working in a Diverse America

Academic journal article Generations

The Importance of Cultural Competence in Caring for and Working in a Diverse America

Article excerpt

Communication across cultural differences is the key to managing eldercare in our increasingly diverse society.

As the forecasted need for healthcare workers to care for the aging baby boomer population approaches, the focus on cultural competence in the healthcare workforce has also increased. Unfortunately, much of the focus on cultural competence over the past ten years has concerned matters such as the implementation of CLAS1 (Culturally and Linguistically Appropriate Services) standards in acute- and ambulatorycare settings. There has been less exploration of the potential cultural-competence needs in age-segregated settings, where many aging people receive services (e.g., nursing homes, adult day health, homecare, assisted living). Moreover, the U.S. Department of Health and Human Services' recent call for public comment on CLAS standards implies that to more fully address the many types of encounters occurring in healthcare settings, the prevalent concept of cultural competence needs expansion and elaboration. This article explores the implications of the increasingly diverse populations of both elders and eldercare providers, for an evolving concept of cultural competence. It will also look at implications for workforce development in this area.

Increasing Diversity

The aging population is becoming increasingly diverse, as are the people who work as care providers for this population-whether in institutional, congregate, or individual living arrangements. At the same time, trends such as increased female workforce participation and increased migration raise the chance that elders will be cared for, at least some of the time, by non-family caregivers who may be members of a different cultural community. Much of the literature regarding cultural competence in healthcare is explicitly limited to the need for professional caregivers to respond to the diversity within the client population. The increasing diversity within the healthcare workforce itself has received much less attention. Yet without attending to the increasing diversity in both groups, it is unlikely that efforts to improve cultural competence will be fully successful.

The population of those older than age 65 is becoming more ethnically diverse. Based on 2000 census data, demographers expect that between 2000 and 2030, the percentage of minority elders will increase. For Hispanics, the expected increase is 328 percent, for Asian and Pacific Islanders, 285 percent, for American Indians and Aleuts, 147 percent, and for African Americans, 131 percent, compared to 81 percent for Caucasians. American communities increasingly reflect multiple ethnic histories and values (Hayes-Bautista et al., 2002). Not surprisingly, these population changes are also affecting the composition of facilities that care for older adults with functional limitations. Nursing home use rates among whites have been decreasing since the mid-1970s, while rates among other racial or ethnic groups have been increasing (Wan et al., 2005). A recent review suggests problems exist in delivering the best quality care to non-white elders in longterm- care facilities because facilities are unable to meet the range of language, cultural, and religious needs of this population (Mold, Fitzpatrick, and Roberts, 2005).

Furthermore, demographic projections indicate that over the next fifteen to twenty-five years, long-term-care residents will be increasingly dependent upon members of established communities of color and immigrant communities to provide hands-on care. Research from the late 1990s found that 30 percent of nursing assistants were racial or ethnic minorities, and more than 12 percent were born outside the United States (Yamada, 2002).

While racial or ethnic diversity among certified nursing assistants (CNA), and other healthcare workers has the potential to produce highly effective work groups, these differences may lead to breakdowns in feedback and communication, making jobs less satisfying. …

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