Helping Muslim Clients Navigate Cultural Home Care Issues

elder muslim
Cultural sensitivity is key in delivering person centered home health care. Getty Images

When visiting nurse Seana Mohammed set out to find a home health aide (HHA) for an elderly Muslim client living in Queens, the list of qualifications included one requirement that was especially challenging—the aide had to speak Dari. This language, one of the two official languages in Afghanistan, is widely spoken by the Afghani population in the Flushing neighborhood where Seana’s client lives. For many Afghans in the area, including Seana’s client, it’s the only language spoken in the home.

In this article we examine how to help Muslim clients navigate cultural issues in home care delivery.

Though Seana had access to Dari-speaking translators, she knew her home care team would have an easier time gaining the client’s trust if she was able to locate an HHA who could communicate with him directly. Being based in Flushing herself, she also knew that the local Afghani community is accustomed to providing help for elderly residents who didn't speak English. She struck up conversations in the neighborhood and with her own friends and family, including members of her mosque, and finally learned of a woman who spoke Dari and might be seeking employment as a home caregiver. Seana spoke with the woman and found she was indeed willing to train to become an HHA and take on the care of Seana’s client. The aide’s ability to converse directly with the client has allowed her to bridge the communication gap between the client and his doctors and nurses.

His children also feel more at ease, since the HHA can easily explain their parent’s condition to them.

While seeking out a new health care worker based on a client’s language needs is somewhat unusual, honoring the culture of our patients and clients is always a top priority at the Visiting Nurse Service of New York (VNSNY), where Seana and I both work.

Since our clients at VNSNY and Partners in Care reflect the full scope of New York City’s wide-ranging diversity, training our staff in cultural awareness begins on Day One. In meetings throughout the organization, cultural matters are front and center, from discussions about religious issues to learning how to prepare clients’ favorite meals in ways that are tailored to their health concerns. Whatever their own backgrounds may be, our HHAs are trained to respect all of their clients’ cultural and religious practices, as well as their preferences and personal choices.

When caring for our many Muslim clients, this respectful approach includes being aware of the times that daily prayers take place, understanding Islamic dietary rules—such as the need to shop for and prepare meals in the Halal tradition, which prohibits the eating of pork and requires other meats to be killed in a specific manner—and being sensitive to other customs, like the importance of always removing one’s shoes (or putting clean booties over them) upon entering the home of observant Muslims.

“When meeting with a new client, I make sure that both the HHA and the family are there as well,” notes Seana. “This gives us a chance to go over all of the customs related to the client’s religion and culture.” From that point on, she adds, the HHA often takes the lead in making sure these customs are followed. “Our aides know how to shop for Halal meat in the supermarket, and will remind their older clients when it’s time for the afternoon prayer, just like they remind them to take their medications,” she says. “When other VNSNY or Partners in Care staff arrive at the home, the HHA will alert them to take off their shoes, and then guide them to wash their hands in the bathroom, since washing hands in the kitchen sink is considered unclean in some Muslim households.”

Daily prayers offer a particular opportunity for home health aides to assist and bond with Islamic clients. For non-Muslim HHAs who may be asked by clients to help set up their prayer rug, it’s important that they understand how to handle the rug in a way that makes the client comfortable, and that if asked they can also assist in washing the client’s hands and feet before praying.

When our HHAs and other home care staff adhere carefully to these rituals, they’re not merely being polite, but are practicing high quality health care as well. “These customs represent very big things to the client,” says Seana. “If they are not followed, the client will be uncomfortable, and we won’t have a good outcome.” Being keenly aware of such customs is doubly important, she adds, because Muslim clients and their families can be reluctant to correct home caregivers when they misstep. “One of the most important things in the Islamic tradition is not to hurt the feelings of others, so they may not say anything, even if they’re offended.”

Issues around elderly clients can present another delicate challenge when working with families like that of Seana’s Afghan client, especially if they involve cognitive disorders such as Alzheimer’s or other disabling conditions. “Age-related decline can be very hard for people raised in Middle Eastern cultures, as many of our Muslim clients are,” says Seana, “because they grew up learning to respect their elders—and now they’re forced to take on the parent role at times and tell their father or mother what to do.” By being aware of this issue, our HHAs, nurses and social workers can help relieve adult children’s anxieties regarding what steps need to be taken, and can also take extra care to maintain that traditional attitude of respect themselves.

As difficult as it is to accept a parent’s fading health, it can also be hard for culturally tight-knit families to allow someone else to provide care. To help overcome this barrier, our staff is careful to communicate every point of care to family members so that they are fully informed and empowered. If the points of the care plan are too numerous or complex to convey in conversation, our caregivers will make lists for the client's family. Since the family structure in Middle Eastern Muslim cultures is typically centered around the father or the eldest son, particular care is taken to communicate directly with that individual, both so that the family patriarch feels in control, and so that the family as a whole feels that their traditional structure is appreciated and respected.

This cultural understanding extends to our clients themselves, who can often feel anxious or uncertain when inviting a nurse, social worker or home health aide into their home for the first time. As we’ll explore in future posts, many cultures and religions, Haitian, Chinese and African cultures among them, intersect deeply with religious practices and deeply held beliefs about health and end-of-life. When encountering a client from a different culture, the two watchwords for home healthcare workers should always be patience and respect. These two principles are the building blocks for trust and confidence, which in turn are the keys to providing quality care and comfort to all of our clients.

Jennifer Leeflang, Senior Vice President, Partners in Care

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.

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