Culturally Appropriate Care: An Essential Component of Quality Care for Long-Term Care Residents

According to the Administration on Aging, between 1999 and 2030, the minority population of adults age 65 and older is projected to increase by 217%, compared with 81% for the older white population.¹ In the US nursing home population, the percentage of black residents has increased in recent years (12.2%), approaching national norms, and black Americans aged 65 to 74 years old are more likely than white Americans to be admitted to a nursing home. Similarly, the proportion of Hispanic Americans over the age of 65 who reside in nursing homes is also increasing.²

These demographic shifts are a significant factor in providing quality long-term care (LTC), as residents and families of different ethnicities, cultures, and religious backgrounds may feel uncomfortable with or misunderstand certain aspects of healthcare that are common in the United States. This can affect residents’ and families’ understanding and acceptance of approaches to care and decision-making.

To aid practitioners in providing culturally appropriate care, the American Geriatrics Society (AGS) has just released the second edition of its widely used publication, Doorway Thoughts: Cross-Cultural Health Care for Older Adults. Written by professionals with expertise in the care of older adults of diverse backgrounds, the publication is so named because it examines factors that healthcare providers should reflect upon before walking through the doorway into an examining, consultation, hospital, or nursing home room.

Doorway Thoughts addresses numerous ethnic and cultural groups and offers in-depth information, covering preferred forms of address, appropriate verbal communication and body language, and the history of each group’s migration to the United States, if relevant. Also covered are culture-specific health risks, gender issues, traditions and health beliefs, and many other issues helpful to decision-making and care quality.

Using the information in Doorway Thoughts, nursing home administrators, medical directors, directors of nursing, and others can work with the entire interdisciplinary care team to promote culturally competent care in LTC facilities.

Here are few examples of issues around culturally sensitive care from the introductory section of Doorway Thoughts.³ These and many other issues are discussed in detail in chapters specific to 24 different cultural groups:

• Cultural groups differ widely in their approach to decision-making. It is important for healthcare providers to determine whether a resident wants to involve family and friends, or completely defer to others. Being sensitive to cultural and religious differences around end-of-life care decisions and practices is particularly important. Many older adults and their families may seek counsel and support from their religious and spiritual counselors when sensitive issues such as withholding artificial nutrition and hydration are involved.

• Many cultures ardently avoid direct discussions about death and dying and may avoid or procrastinate such conversations until the very end. Also, in many cases, ethnic residents and families may prefer group decision-making and thus avoid naming a single person as a surrogate. To ensure that end-of-life plans and decisions reflect an individual’s rights and wishes, healthcare providers must strive to understand residents’ and families’ overall approach to life and death, and, as far as possible, provide care that is congruent to their values.

• Patients’ or families’ concerns may go unexpressed, which can have an impact on the success of care plans for nursing home residents. These concerns might include fears about medications and adverse events, a lack of trust in healthcare providers, a fear of discrimination, concerns about the costs of LTC, and unfamiliarity or discomfort with the Western biomedical belief system.

The new electronic edition of Doorway Thoughts, which addresses these and many other issues around cultural aspects of quality care for older adults, is now available via the AGS’ GeriatricsCareOnline.org. Also available is an updated version of AGS’ Geriatrics Cultural Navigator mobile app for iPhone, iPad and Android devices.

The Doorway Thoughts updates were made possible through a generous contribution from AARP. We encourage you to take a look at these valuable resources, which can support the provision of sensitive, individualized care for nursing home residents from diverse cultural backgrounds.

­­­­­­­­­­­­­References

1. Administration on Aging. Diversity. www.acl.gov. Accessed October 29, 2014.
2. Flaherty E, Resnick B, eds. Geriatric Nursing Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing. 4th ed. New York: American Geriatrics Society; 2014.
3. Brangman S, Periyakoil VJ, eds. Doorway Thoughts: Cross Cultural Health Care for Older Adults. 2nd ed. New York: American Geriatrics Society; 2014.