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Nursing homes adapt to a growing population of foreign-born
patients By
Donna Kiesling,
The Star Entering
a nursing home can be a difficult transition under the best of
circumstances, but doing so in a foreign land can be especially
unsettling. Besides
facing language barriers, patients often leave not only their homes and
belongings behind, but their familiar customs as well. Now
comes the realization that traditions and rituals can bring comfort and
even help the healing process, bolstered by a study by the Illinois
Council on Long Term Care that stresses the importance of accommodating
ethnic practices and incorporating them into patient care whenever
possible. The
council is a professional association encompassing more than 200 Kevin
Kavanaugh, director of public affairs at the privately funded,
Chicago-based organization, called immigration statistics
"jaw-dropping." According
to The Metro Chicago Immigration Fact Book, published in June by the
Institute for Metropolitan Affairs at The
report also states that immigrants in the area increased by 537,000 in the
1990s, with the greatest concentrations coming from The
trend affects city and suburbs alike, with In
the past five years, the number of Caucasians in nursing homes has
decreased, while African-Americans, Hispanics, Asians and Indians are on
the rise, according to the Illinois Department of Public Health. All
of which confirms what Kavanaugh long suspected. "I've
seen more and more foreign-born residents," Kavanaugh said of his
decade of experience in long-term care. "Then, I received the
statistics. Now it's just beginning to emerge as a hot topic." Coupled
with the fact that people are living longer, health care for older
immigrants is a subject that must be addressed, he said. "We
are looking at a radically changing population — the foods they like,
are their spiritual needs being met. The implications of this are
tremendous." Kavanaugh
and Susan Gardiner, director of clinical services for the council,
embarked on the study of culturally sensitive nursing care in June,
surveying 10 nursing homes to find out how they deal with diverse patient
populations. Nursing
director Carol Catlett said Mercy houses one Polish, two Haitian and
several African-American residents. Catlett,
also an African-American, said she experienced firsthand a cultural clash
when her father, who had been living at Mercy, died. "African-Americans
keep a vigil at the bedside (when someone dies)," she explained.
"We sit together and discuss what they did in life. There were like
27 of us in the room, waiting for them to take the body away. I thought it
was normal." But
Catlett learned it's not "normal" for everybody when she put out
refreshments for the family of another staff member upon the death of that
worker's mother-in-law, who also lived at Mercy. "They
said, 'What are you doing?' " she recalled. Catlett
also had to deal with African-born employees whose customary
"aggressive" and "authoritarian" methods of
communication led to disciplinary action. She also has honored the wishes
of the Polish and Haitian patients, who prefer to be cared for by women,
rather than men. Then
there was the Haitian woman's belief that she became ill because she had
divorced her husband and that he put a spell upon her. "She
put a belt around her neck and said her husband did it," said
Catlett, who calls dedication to cultural care "very important."
"It
interferes with taking care of the residents when they're not
comfortable," she said, but admitted taking such differences into
consideration is a new idea. "(Staff
members) figure everybody's the same," she said. For
families of immigrants, nursing homes may be an unfamiliar concept. Nigerian-born
Mary Okolo, a nurse's aide at Mercy, said Nigerians do not enter nursing
homes but are taken care of by family instead. Food preparations also
differ, said Okolo. Nursing
homes are not an option in her native "The
elderly stay home, family takes care of them," she said. Patients'
relationships with doctors also differ, Kacius said. "In
this country, you can't blame the doctor," she said. "In In
previous jobs, Kacius used gestures to communicate with patients who spoke
only Russian and had an Egyptian client who specified a female therapist,
she remembered. Such
anecdotes interest, but do not surprise, Kavanaugh. "We
went into this thinking we would be helping the staff because we would
have helpful charts – if they're Chinese, do that – but we realized we
can't do that. I've seen such charts. I don't agree with them. There are
many for whom the recommendations don't apply. Each person is an
individual. They need to learn the questions to ask, things to look out
for. They shouldn't be stereotyping. "We
like to put things into boxes. Human nature is such that we can't put
people into boxes." The
Kavanaugh-Gardiner study focuses on an issue that's been around for a
while. "Facilities
have been doing pretty tremendous things on their own for years,"
Kavanaugh said. "One has a Korean unit, one an Indo-Pakistani
program. There also is one for the deaf. Facilities have hired chefs from
different backgrounds. "It
helps families when they are able to find facilities experienced in
working with their cultural background. It goes beyond language. It goes
to traditions, to quality of life and being recognized for who they are
and the life experiences they have had." Cost
should not be prohibitive, according to Kavanaugh. "It
isn't that costly to hire staff from different backgrounds," he said.
"It takes a willingness of the facility to do their homework." Gardiner
said culture traditionally has been a factor in dietary and activity
departments, "but the thing that always hit me was nursing." "Grab
any nursing book," she continued. "Nowhere will you find a
reference to variations in culture. Many facilities held back because of
what had been done in the past." For
example, Chinese people often regard cold as the cause of illness, but see
heat as having healing properties. When
one such patient, who had not been taking fluids, was switched to warm
liquids, "they couldn't keep enough tea and hot water in the
room," Gardiner said. "If
you touch someone on the head in the Thai culture, it's
disrespectful," she said. "At least give an explanation of why
it's done first. The sole of the foot is considered dirty in some
cultures. It's the very last thing to wash." Medicines
and physical therapy can be scheduled around prayer times, she said. Gardiner
sees this cultural revolution as part of an evolution in nursing care. "We're
aware of the emotional, now we want to be aware of the cultural," she
said. "It's the little things that matter the most. For Russians, it
has to be an odd number of flowers (in their rooms), otherwise it's bad
luck." To
that end, the council has developed a cultural assessment form it hopes
will be routinely adopted by nursing facilities in the same way pain and
fall assessments are conducted on incoming patients. "Nurses
are very open to it," Gardiner said. "Nurses are more open to
going in different directions than doctors are, but the whole American
culture is more open to nontraditional (methods) than ever before." "We
hope the study serves as a catalyst," Kavanaugh said. "We will continue to visit facilities. The end goal is to further the sensitivity and understanding of our staff so they will provide more culturally competent care."
Copyright
© 2002 Global Action on Aging |
