Match multicultural clients with aides

Don’t sacrifice aides’ rights in meeting client needs

Private duty clients want providers who are sensitive to their needs. But what happens when your clients are of diverse cultures? Several providers and experts on cultural diversity offer Private Duty Homecare some suggestions:

• Assign aides to the case who are the same culture of the client or who share some of the same cultural background.

Matching ethnic clients with aides of their own culture or with experience in their culture has obvious advantages. Many elderly ethnic minorities, even if they have lived in the United States for many years, find comfort in aides preparing their ethnic foods and speaking their native language, says Lea Armstrong, president/project director of Armstrong Uniserve, a personal care business with offices in Tacoma, Kent, and Seattle, WA.

"It makes them feel better, and they can recover faster from whatever illness they have," she adds. "It’s a fringe benefit."

Armstrong Uniserve has a significant ethnic minority client population of about 30%. For the most part, aides for these minorities share the same culture as their clients or have previous experience with that culture. Most speak the same language.

"It goes back to the fundamentals of home care," says Laura Najera, RN, MPA, administrator for Stat Health Care in New York City. "Clients are opening their homes and their safety to a stranger, to a strange agency, to replacement people who also are strangers. I think the issue is about safety, vulnerability, and perception. There is a perception of comfort with people of similar origins."

Don’t automatically assume, though, that a patient will relate well to an aide of his or her own culture, or vice versa. "You can have immigrants who have come to this country and have assimilated into American culture and, in fact, look down on the people from their native country," says Sondra Thiederman, a trainer in cross-cultural health care in San Diego.

On the other hand, assuming that a client of a certain ethnic background will act in a particular way can be patronizing, Thiederman says. "It’s better to go in and find out about that specific family with an eye toward knowing that maybe those differences are there and maybe they aren’t."

To prevent this problem, Armstrong’s supervisors, many of whom are multilingual, accompany the potential aide on an initial visit to the client. On these visits, the client will tell the aide what he or she wants in terms of care. "It’s like a blind date," Armstrong says. "We will change aides if they don’t like each other."

Don’t step on aides’ rights

Providers also need to ensure that meeting the needs of clients doesn’t compromise aides’ rights, says Najera.

"Just because someone is not from Jamaica does not mean they cannot learn to prepare the foods [from that culture] properly," she explains. "If it’s not a language issue, and the aide could learn the diet, I wouldn’t want to think we were shortchanging someone an opportunity to work and take really great care of this person because of their background. We possibly step into dangerous territory, but even short of stepping into a danger zone, I think ethically and morally we might not be doing justice to the aide group."

"If you are a home care nurse who is qualified in home care, [the agency] should be able to send you out," says Elberhoumi. "If the family really wants the care, they should accept it. There shouldn’t be a problem with cultural diversity."

• Educate your staff.

Instead of trying to find aides who share cultural backgrounds with ethnic clients, some private duty providers turn to education for existing staff, such as inservices that describe food preparation or religious beliefs for certain ethnic groups.

The initial problem may be to get staff to accept that cultural differences are OK, says Paula Elberhoumi, RN, BSN, MS, owner of The Creative Pen, a business in New York City that contracts with home health care agencies to provide educational services. "Then zero in on the specific population that they are having problems with." (For tips on serving diverse cultures, see above.)

"Making people more sensitive to cultural diversity means discussing where the differences are and where the similarities are," Elberhoumi continues. "First you talk about similarities. They see all the differences first, so you start focusing on what the similarities are and then bring the differences in. Try to get it into the staff’s minds that people are people — they have pain, they feel happy, they feel sorrow, they feel all the same kinds of emotions, and they have the same basic needs."

But changing opinions is not always possible. That’s why Thiederman advises hiring or using aides for these cases who are open to ethnic differences. "It’s not ethnicity that matters; it’s their attitude towards the families they care for," she explains. "You want people who are confident enough to ask questions, to observe, and to form decisions on an individual basis. If you hire people who can’t stand it when people talk with an accent or eat different foods, that’s what gets you into trouble with these cases."

Aides don’t need to learn the specifics of every culture, Thiederman adds. "They can pick that up when they get [to the home]."