Building Bridges of Trust-Cultural Sensitivities in Home Health Care

Part One in a Series

In a person-centered culture, guess who's in the center!!!. © Marc Rosenthal

Since she was a child, Jun has lived in the same part of Chinatown: Little Fuzhou, a pocket of Chinese-Americans who speak the Fuzhounese dialect. In her old age Jun moved into her daughter’s home, where she receives care for various medical issues. While Jun doesn’t speak English, a number of medical professionals attending to Jun are fluent in Chinese. However, they all speak either Cantonese or Mandarin—the two most common Chinese dialects, both of which are distinctly different from Fuzhounese.

As a result, Jun finds it difficult to communicate with the doctors and nurses treating her. Fortunately, her home health agency has a Fuzhounese volunteer who checks in with her regularly by telephone to clarify medical directions, remind Jun to take her medications and generally reassure her that she’s in caring hands.

Having home health aides and other staff who speak a variety of languages is one way that home health agencies form essential connections with people of different cultures and personalities. For less common languages, phone or computer-based interpreter services are also available. This approach is especially important in large urban settings like New York City metropolitan area, where the patient population reflects the city’s remarkable diversity. The 2010 Census put New York City’s non-English speaking population at 1.8 million people—a group consisting mainly speakers of Spanish or Chinese dialects, but that also includes significant numbers of Polish, Russian, Korean, Yiddish and Bengali speakers.

Since the flow of care can be disrupted when patients and home health aides have difficulty communicating, one of the most important steps in providing care is pairing non-English speaking patients with an in-home caregiver whose language skills match theirs.

“Over 90 percent of the people we serve are non-English speaking,” explains Hing Lin “Helen” Sit, a licensed clinical social worker who works with seniors in New York’s Chinatown community.

“Sometimes they ask us to call to make doctor’s appointments or speak to government agencies on their behalf. For patients with very limited Cantonese and Mandarin, we depend on the home health aide or volunteers who speak the client’s dialect.”

Being attuned to cultural sensitivities also requires understanding each client’s religious customs and cultural norms. In addition to being respectful of such traditions, home health aides also need to know how to work within them to provide effective care. As the largest employer of certified Home Health Aides in New York State, the agency where I work, Partners in Care, takes this very seriously. All of our home health aides receive specialized training that teaches them how to recognize cultural differences that could potentially create friction or misunderstandings. From big issues such as dietary restrictions to subtler differences like clothing choices, our aides are taught to recognize and respect the practices that will make their patients most comfortable.

For a variety of reasons, Asian as well as Muslim families will request that visitors remove their shoes when entering the home, so home health aides are asked to carry a pair of slippers on such visits. In traditional Chinese culture, white is considered a funereal color and a reminder of one’s mortality, so our aides avoid white attire when caring for patients from this background. By making an effort to understand and adapt to customs like these, home health aides develop a bond of trust with their patients that can form the foundation for a caring, nurturing relationship.

One of the most important roles that home health aides play — and where culture is a key factor — is managing diet. Meals must be healthy and adjusted to the needs of each individual while still appealing to the patient’s palate. Many religions have periods of fasting, which may involve forgoing food during the day or eating only certain foods. Kosher and Muslim dietary restrictions carry their own requirements. There are also challenges in matching medical dietary needs with cultural eating patterns. Favored foods like sausage or salted fish can pose problems for people with hypertension and high cholesterol, while rice presents a challenge for diabetic clients. If an aide is knowledgeable about cultural tastes, her or she can pick out popular dishes that also meet nutritional and health needs.

During holidays, food becomes an even trickier issue. For example, Mooncakes, which are baked to celebrate the Asian Moon Festival each fall, are beloved treats, but they also need be eaten in moderation since each doughy pastry can hold up to four egg yolks. An aide with an understanding of the culture will recognize the risk of this hidden cholesterol and limit patients’ portions accordingly.

In the months to come, I will be discussing a range of different cultural issues as they pertain to home health care—from working around the rituals of Passover and Ramadan, to tips on keeping the fat, sugar and sodium content low in favorite ethnic dishes, to understanding how different cultures approach aging and the challenges related to caring for an older relative. As you will see, when our home health aides are able to recognize and embrace the cultural traditions of their patients, it not only enhances their ability to connect with and care for these individuals, but also opens the door to new shared experiences that enrich caregiver and patient alike. We hope these insights will translate to helpful strategies that you can put to use as well.

Jennifer Leeflang, RN, heads Partners in Care, a licensed home care agency which is a part of the Visiting Nurse Service of New York (VNSNY),  the nation's largest not for profit home and community care organization.  Ms. Leeflang joined Partners in Care in 2003 and has held a number of different roles during her tenure of nearly 12 years.  In this position, Jennifer provides leadership and corporate oversight of all of Partners in Care operations.  She became Director of Private Care Services in 2008, and served as Senior Director of Private Care Services from 2013 until stepping into her current role as Senior Vice President. Ms. Leeflang holds a Bachelor of Science and an MBA from St. Johns University.

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