Is the Race of Your Home Health Care Provider an Issue?

 New America Media Article: The Color of Care in Aging America

The article below appeared recently in New America Media.  The author found that there was very little overt racism expressed by seniors needing home care.  However, he did find a sometimes surprising combination of wonderful and not so terrific results when paid care givers of one culture were working with patients of a different race, religion, or ethnicity. 

John Booker has seen it throughout his 35 years as a caregiver.

He recalls meeting an Orange County, Calif., woman whose son moved her from facility to facility hoping to find quality care. Finally, she was placed in the hands of Booker – who is African American.
“She needed help getting to the toilet, and she didn’t want a damn n----r to do it,” laughed Booker.

“After she attacked me, I knew my reaction was extremely critical at that point. I put my best professional face on.”

Afterwards, the tearful woman thanked Booker for his help, as did a young man standing outside the room who watched the interaction – her son was also an owner of the long-term care facility.

Overt racism, while rare, is indicative of the continued struggles Americans face when it comes to race – particularly in an intimate relationship like caregiving.

During his own long career, Booker noted, who founded the National Association for Direct Care Workers of Color, “I would say 40 percent of the time there was some initial friction [over race].”
Booker said his typically female colleagues – Latinos, Filipinos, Caribbean Islanders and recent African Immigrants – are acutely aware of race in the workplace.

“They will get some of the same racial slurs and looks,” he said. “You hold back your emotions and continue to give quality care.”

Cultural, Religious Impacts

A Stanford University researcher says that race and ethnicity are often linked to cultural and religious views – which may affect care. In fact, her study of multicultural nurses in long-term care settings found something shocking: During end-of-life care, some foreign-born Catholic nurses felt the dying experience shouldn’t be altered by using painkilling analgesics.

“They felt that experiencing pain and suffering at the [end of life] afforded the dying patient an important opportunity for spiritual redemption,” reads the small study of 45 Filipina nurses, led by V.J. Periyakoil, MD, director of palliative care education and training at Stanford’s School of Medicine. “None of the U.S.-born nurses endorsed this concept.”

Periyakoil – who admitted “we were pretty surprised” at the results – described the concept of “redemptive suffering” in this way: “Sometimes people feel that God is giving them these experiences, and part of their faith is to bear these experiences with as much patience as they can. How the religious beliefs of an individual nurse – or doctor – affects how they provide care is a bit of an unknown.”

She continued, “We do not know how a nurse or doctor who believes in the concept of redemptive suffering may respond to a dying patient in pain.... ... it is possible that they may unconsciously withhold pain medicine to give the patient an opportunity to redeem themselves.” In fact, she said, some patients welcome this sense of redemptive pain, but doctors and nurses need to give a patient the choice.

In another example of the enormous influence of cultural and religious views on care, Periyakoil described the family of a Chinese American patient with esophageal cancer. He feared that if he died on an empty stomach “he would wander throughout eternity as a hungry ghost,” she said. He was given a feeding tube.

Periyakoil adds that cultural differences strongly influence caregiving behaviors.

Caregivers who acknowledge “familismo” and “respecto” within more collective, group-oriented Latino families will gain their trust. Conversely, Periyakoil said, more individualized cultures like Germans thrive on care that fosters patient autonomy and more direct, factual communication.

Compassionate Care Despite Language Limits

To many, cultural differences can actually prove beneficial.

Carla Troutner said her tiny 4-foot-11-inch mother had two homecare aides in the San Francisco Bay Area – one white, the other Haitian. While the white caregiver provided acceptable care, the Caribbean caregiver offered a uniquely calm disposition her mother adored.

“She just followed her around the house,” Troutner said of her mother.

Sadhna Diwan recalled a long-term care facility staffed almost entirely with Latino caregivers – some who spoke virtually no English.

“This became a real bone of contention between the families and the hired caregivers,” said Diwan, director of the Center for Healthy Aging in Multicultural Populations at San Jose University’s School of Social Work.

Yet the Latino workers’ compassionate care happily countered the language barrier. “The love and affection and care they show for my parents – even I don’t do that,” stated Diwan.

To read the rest:  http://newamericamedia.org/2013/08/the-color-of-care-in-aging-america.php