Assignment task:
Summary:
Although the general health of seniors in the United States is improving, studies have found that minority elders are less likely to receive routine medical care, and the care they do receive is of poorer quality than care received by white elders. Healthcare disparities in elders occur by race, ethnicity, sex, socioeconomic status, and sexual orientation, primarily because of inequities in screening, treatment, and mortality across many common diseases, including cancer, diabetes, heart disease, and HIV/AIDS.
Given these healthcare disparities, diverse elders' health and functionality are typically lower than those of white elders, increasing minority elders' need for long-term care. Consequently, it is incumbent on long-term care managers and providers to understand the health needs and preferences of this emerging majority of diverse elders to ensure that home/community and residential long-term care meet their cultural needs and preferences. Culturally competent long-term care can help to mitigate some of the noted health disparities among this emerging majority of diverse elders. This chapter provides an overview of the cultural needs and health disparities among diverse elders with a managerial focus on ways to deliver culturally competent long-term care in home- and community-based and residential settings.
For Discussion:
1. Define the following social constructs related to diversity: gender, ethnicity, race, and sexual orientation.
2. Explain the demographic trends associated with the growing number of diverse elders.
3. Explain how elder women's longevity relates to their long-term care needs.
4. Why do diverse elder women face more obstacles in aging than their white counterparts?
5. Discuss health disparities affecting Hispanic/Latino elders.
6. Discuss health disparities among the older American Indian or Alaska Native (AI/AN) population.
7. Discuss health disparities among the older LGBTQ population.
8. Many groups of diverse elders have high incidences of chronic disease. Choose two groups of diverse elders, and discuss how their illnesses affect their long-term care needs.
9. What obstacles do LGBTQ elders face in being accepted as residents in long-term care facilities?
10. How does language affect the abilities to obtain services for the aging?
11. For what diverse elder groups are poverty and lack of access to healthcare services a major issue?
12. What role do culturally competent providers play in reducing health disparities among diverse elders?
13. Discuss long-term care preferences among diverse elders that are likely to affect residential or home and community-based long-term care services.
Case Study: Culturally Sensitive Palliative Care
Palliative care takes a team-based approach to help people with serious illnesses manage their symptoms and pain. The focus of palliative care is on the quality of life of the patients and their care partners. The palliative care team consists of a range of professionals such as physicians, nurses, psychiatrists, counselors, and social workers. The coordination of palliative care is based on the assessment of physical, psychological, and spiritual needs of the person, and it can be provided at any point during the illness (American Psychological Association 2019).
Many older adults in need of long-term care have to stay in control of their symptoms and pain, and therefore they can greatly benefit from palliative care. The increased demand for long-term care, including palliative care, as the US population ages also creates a greater demand for culturally sensitive palliative care to meet the needs of the increasingly diverse older population.
Palliative care is based on the person's subjective assessment of pain and other quality of life issues that are shaped by one's cultural beliefs and practices. For example, there is substantial cultural variation in how people express and communicate their pain with healthcare professionals. Some cultures tend to be very stoic with regard to paid and discourage people from admitting it to others. People with limited language proficiency may also experience difficulty in expressing their pain to healthcare providers who do not understand their language of culture (Givler et al. 2022).
The palliative care program in Los Angeles, California, called lyashi (the Japanese word meaning "to heal") is an example of a culturally sensitive palliative care program - in this case, one specifically tailored for Japanese Americans and Japanese older adults (Keiro 2022). Iyashi provides a team-based outpatient program that includes a wide range of services such as 24/7 telephone support, pain and symptom management and consultation, emotional and spiritual support, and home safety evaluation. These services are available with Japanese language support as needed. The providers are also familiar with Japanese cultural values that often praise endurance through difficult times (gambaru) and accept the current situation as something beyond their control (shikata ga nai).
Given that the older population is becoming increasingly diverse culturally, there is a great need for palliative care programs that are sensitive to older adults' values and preferences so that their pain and symptoms are properly managed in the way that is more suitable for them.
Case Study Questions:
- What is palliative care, and how is it important for older adults with long-term care needs? Want Online Tutoring?
- Why is it important to provide culturally sensitive palliative care?
- What should be provided as culturally sensitive palliative care for older adults with chronic health problems?