Nursing Home Placement When There are Culture and Language Concerns

Before Placement

The most important factors in choosing a nursing home are the same for all families: a location that encourages visiting, medical services and specialized programs (i.e. Alzheimerís programs) and a comfortable atmosphere for your loved one. Religion, culture and language factors can also be important. When placing a relative or friend who speaks little or no English or whose ethnic background differs from the majority of the residents in the home you are considering, you might want to ask the following:

• How are the language needs met for medical care, for social needs, in emergencies, etc?
  
• How many of the staff speak your relative’s language? Do they include doctors, social workers and other professionals?
  
• If the bilingual staff is limited, what happens when they are sick, on vacation or off duty?
  
• How may residents share your loved oneís language and ethnic background?
  Is there evidence of sensitivity to language needs- translated signs, menus, activity schedules?
• Are any community resources being utilized to meet the language and social needs of an underserved language group?
  
• Are there religious services, recreational activities, language or national clubs that cater to the differences in cultures and languages?
  
• What holidays are celebrated?
• Do foods served reflect the ethnic backgrounds of residents?

After Placement

It is rare to find the perfect nursing home for a loved one. Families and friends must often choose the best available home after balancing many positive and negative factors. If you have placed a loved one in a home that does not respond to cultural and language needs adequately, you can still act to improve things.

• Tell social service and floor staff if you expect language difficulties. For example, they should know if your loved one does not speak any English, loses English when agitated, or is reluctant to admit how limited it is.
• Find out who serves as interpreters and observe them working. Make sure you loved one is comfortable with them and that the interpreting is complete and accurate.
• Be extra vigilant about weight loss. Check menus and observe how much food is eaten. If necessary insist that menus reflect the residentís food preferences.
• Talk to the social services and activities staff if activity schedules seem to leave your resident out. They are likely to welcome suggestions of holidays, activities, and social events drawn from your relativeís background.
• Use the family council or support groups to connect with other families. Support each other in improving cultural resources for all residents. Seek out the families and friends of other residents who share your cultural background or concerns. You could suggest, or create, a culturally-based activity for residents and their visitors such as a music performance or church service scheduled at a common visiting time.
• Connect the home with community resources that can help meet the resident’s needs. If you or the family council canít do this, social service providers serving your ethnic community might help.
  

Use Comprehensive Care Planning (CCP)

Families of nursing home residents need to know what type of care will be provided at the point of entering a nursing home and on an on-going basis.

A Comprehensive Care Plan meeting offers an opportunity for relatives to ask questions about and understand the residentís care plan. The first meeting takes place 3 weeks after admission and then annually, family representatives meet with nursing home staff from all of the different departments including social work, rehabilitation, nursing activities, and dietary. The meeting also provides the only opportunity to make sure all care team members know about a residentís habits, preferences and needs. Without this knowledge, it is hard to provide the individualized care that is legally required.

Relatives can not contribute meaningfully when meetings are limited by time, include too few members of the care team, or when professional/medical jargon predominates. This exacerbates language problems making an interpreter necessary even for someone who can use English satisfactorily in most contexts.