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Cultural Sensitivity as a Means of Survival

November 1, 2002
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Keys to managing cultural-diversity issues By Annaliese Impink, ESQ.
Cultural sensitivity is not only good unto itself, but an essential tool in risk management and successful staffing

by Annaliese Impink, Esq.
The United States has experienced a significant increase in the number of new immigrants entering its borders each year, either legally or illegally, and a resulting growth in the range of cultures. While cultural diversity is the platform upon which this country was built, failure to understand and appreciate cultural differences can, and often does, "unstabilize the melting pot" and cause anger, frustration and diminished self-worth.

This is particularly true among the more fragile members of our society, such as the elderly or individuals who are mentally or physically disabled-and these feelings can be further exacerbated when they cannot provide for their own needs independently and are forced to rely on caregivers in a residential or institutional setting. Individuals often express anger or withdraw and retreat into themselves when they are unable to communicate with their caregivers or when they feel threatened by those who are responsible for meeting their needs. Sometimes this frustration and anger results in allegations of abuse and neglect against care-givers, which might have been avoided had providers been attuned to the cultural challenges and barriers that many of our new immigrants routinely face.

During the past several years, federal and state governments have taken a more aggressive approach to preventing abuse, neglect and mistreatment in nursing homes and other long-term care settings. The federal government, for instance, recently provided detailed protocols for state nursing home inspectors to follow to determine whether abuse, neglect or mistreatment is occurring in skilled nursing facilities. In the past two years, the use of these protocols has produced a significant increase in the number and amount of civil money penalties levied against nursing homes.

Neither the protocols nor federal regulations, however, address the correlation between cultural norms, preferences and expectations, and the increase in alleged incidents of abuse, neglect and mistreatment among different races, classes and religious groups in long-term care facilities. Facilities and providers are left to address each case ad hoc, rather than stepping back to assess the situation and adopt more effective methods of educating staff, residents and families to prevent these incidents.

The purpose of this article is to enlighten providers concerning cultural factors, differences and distinctions that might affect their ability to care for frail, elderly and disabled individuals of various ethnic groups, and to guide them in the development of culturally sensitive programs for the people they serve, staff and volunteers.

Important Cultural Factors
Most astute providers recognize that language barriers can-and do-impact their ability to provide care and understand signs and symptoms of physical or mental decline. Providers often don't consider language barriers and other cultural factors, though, in preparing such management directives as staff schedules and staff assignments. This often leads to significant communication problems that, if left unresolved, might evolve into allegations of abuse, neglect and/or mistreatment.

Elderly immigrants often rely on family members for translations. Many family members, though, can't be available to translate on a daily basis, nor do facilities generally provide translators unless they are readily available on staff. For this reason, administrators, program managers and qualified mental retardation professionals (QMRPs, or case managers) should be trained to ascertain, prior to or upon admission, whether individuals are capable of speaking and understanding English. In geographic areas with large concentrations of ethnic groups for whom English is not the primary (or even secondary) language, facilities should develop networks with government, private and volunteer agencies that can help with communication issues.

Facilities must also be sensitive to cultural differences and barriers that staff can face on a daily basis. If non-English-speaking staff members are unable to understand what is required of them, they will be unlikely to provide the expected level of care or service. This situation can be profoundly complicated if both the caregiver and resident are non-English-speaking and are unable to communicate with each other (e.g., Hispanic caregiver and Asian resident). Administrators, program managers and QMRPs must watch for these situations and ensure that some level of communication can be established before making any staff assignments.

A number of other, less obvious, cultural factors might affect the provider-consumer relationship in institutional and residential settings. Cultural assimilation is a stressful, often painfully slow, process under the best of circumstances. An individual's ability to adjust to a new culture can become intensely more complicated if that individual is unable to fully control his or her life choices and decisions, as is often the case in long-term care facilities. This assimilation process can cause extreme anxiety, frustration and depression in individuals with mental and physical disabilities and in frail and elderly immigrants living in long-term care settings. These individuals can become completely despondent and withdrawn or exhibit inappropriate behaviors to gain needed attention. New immigrants might also develop a sense of paranoia, believing that their caregivers are, in some mysterious way, attempting to cause them harm.