About the SeniorAdvisor.com 2014 In-Home Innovation Scholarship: We started the scholarship program to bring awareness of the unique benefits and challenges of in-home caregiving for seniors to younger generations. The questions posed by the scholarship encouraged our nation’s future caregivers to present solutions for improving home care in the United States. College-aged students were required to answer one of the three essay topics below and provide a short bio as part of their scholarship application. Read the winning essays here.
What is the top challenge facing in-home care in your city, and what is your proposed solution?
Essay response by Ashley Cosner, Indiana State University
The need for qualified in-home caregivers continues to rise as Baby Boomers age and as the demand for in-home care increases. In response, agencies hire minimally qualified individuals to assist seniors in living out the last days of their lives. Qualifications for many positions only require the completion of week-long, health care training courses, but these courses do not prepare caregivers to meet the social-emotional needs of the elderly client.
The population of people served in homebound care settings is changing and becoming more diverse. Traditionally, those receiving services included senior citizens who could afford the service. Now, insurance allows more economically diverse individuals to access in-home care; varying economic statuses also present greater diversity in races and cultures served. We are also seeing a greater increase in the number of children and younger adults receiving services with the desolation of state mental hospitals. Entry-level caregivers are educated on basic patient rights, privacy practices, and physical care techniques. However, because of the diverse population we serve, the physical, social, and emotional care required for individual patients is not the same. For example, individuals from African American cultures may hold different beliefs and attitude
To become a caregiver within a professional organization, one only needs to have completed a high school diploma; beyond that secondary education, potential caregivers will be trained in basic care techniques, first aid practices, and privacy requirements. The do not, however, receive any education on the cultural differences of the patients with which they will be working, creating a cultural gap and lack of caregiver-patient understanding. This gap may create frustrations for both the caregiver and the client. A client may refuse simple treatments or care because of a cultural hindrance; for example, while I was working as an aide in a long-term care facility, one client repeatedly refused the assistance of a male aide because, she explained, her generation saw men caring for women as immodest and inappropriate. Sociocultural ideologies are not limited to skin color; differences in viewpoints also exist between genders, age groups, religions, diagnoses, and geographical locations. The caregiver who has spent most of his or her life in one location interacting with people similar to him or her may not adequately understand the differences of other cultures. To close this ideological gap, we need to provide more culturally focused education in the initial training process and create a staff that better represents various minority groups.
While cultural competency may sound like an unimportant issue to address, studies have shown that positive social interactions are positively correlated with positive health outcomes, lower rates of morbidity, and decreased rates of mortality (Uchino, 2006). Positive social interactions with in-home caregivers may then be especially important to a client who likely has few opportunities for other social interactions. Those in need of medical care are also likely to experience more stress that comes with illness, dependence, and aging. Stress itself has the capability of causing further physical health complications. However, positive social interactions have been shown to lower the pathological effects of stress (Cohen & Hoberman, 1983).
To create these positive social interactions for caregivers and clients, training should be focused on cultural competence and understanding the unique needs of various clients. On the national level, regulations, including those stating that patients have a right to receive care based on their own cultural health beliefs, have already been created to reduce cultural health care disparities in health care organizations; however, those regulations have failed to trickle down to the organizational level in many instances (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003). To make staff more culturally aware, agencies should educate staff on potential sociocultural barriers of the clients they serve.
My problem and solution focus more on the intangible aspects of in-home care, but cultural competency is just as important as physical care. Beliefs and attitudes associated with healthcare vary among cultures, making understanding crucial. Sociocultural understanding helps make staff more empathetic and clients more receptive to care. On the social level, positive interactions with in-home care staff helps reduce stresses associated with illness and creates a greater sense of genuine care while possibly also providing positive pathological outcomes. On the human level, culture is a large part of who we are as individual people. Misunderstandings in culture make the individual himself feel misunderstood, which may lead to further physical and mental health problems. Ultimately, I wish to better the quality of care as well as the quality of life for individuals receiving in-home care services by making caregivers more culturally competent.
Ashley is in the process of pursuing an M.S. in Applied Health Sciences/ Public Health from Indiana State University. Ashley’s ultimate goal is to better the quality of life for individuals, families, and communities.