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Better access to aged care for people with diverse backgrounds

Healthcare in the Netherlands has become increasingly decentralized in recent years as a consequence of the Social Support Act (WMO – Wet Maatschappelijke Ondersteuning). It’s not an uncontroversial shift: budgets are being cut and chaotic situations often ensue within organizations. As a result, the aged care needs of certain older groups such as migrants and people who identify as lesbian, gay or bisexual, or transgender (LHBT) are being overlooked. The research group of Vidi grant winner Dr Roos Pijpers is looking at how local care organizations can better meet the requirements of these ageing groups.

Dr Roos Pijpers has a particular interest in the aged care needs of older people who are still living independently. “After my previous research project I was asked if I had a perspective on diversity and I realized I hadn’t. I then decided to focus on people from culturally and linguistically diverse (CALD) backgrounds and people who identify as lesbian, gay, bisexual, transgender and intersex (LGBT). What these two groups have in common is that they cannot sufficiently find the way to professional care, but the reasons are completely different for each group.”

Better access to aged care for people with diverse backgrounds

Shame

“Prior to our study we were already aware that many aging people with migrant backgrounds have issues with Dutch healthcare providers. Many migrants come from a background with a lot of cultural shame and they do not find it easy to talk about psychological problems. Additionally, there are religious differences. For these elderly people it may be so obvious that one fasts during Ramadan month that they do not think to mention it. But the Dutch physician or nurse may not understand why the patient is not getting stronger. Thirdly, migrants always prefer to solve their problems in the family, which places an excessive burden on the informal caregivers in the family.”

Bullying

“The LGBT population of this age group (75 to 90) often experienced active discrimination in the time they grew up in. As a result they avoid medical care out of fear of a negative reaction from the person giving the treatment. I recently spoke with a lesbian woman in a residential care institution and she hadn’t told anyone there that she is attracted to women. She was afraid of being bullied and rejected. Furthermore, LHBT have a different type of social network with less family members and more friends. Which has consequences for the informal caregiving.”

Guidelines for healthcare workers

“The innovative aspect of our research is that we are looking for a better match between what the elderly person needs and what the healthcare worker can offer. For example we don’t have a clear picture of how aging migrants provide for their own care. Formal care is now increasingly being organized in neighborhood teams, bringing together social care nurses, GPs and other healthcare workers. Migrants, however, sometimes reach beyond the Nijmegen area to draw on help from friends and family in for example the Bijlmermeer neighborhood in Amsterdam. We are also going to chart the public spaces where the migrant elders seek each other out on an informal basis. Because social contacts are also beneficial to their health.

For the LGBT community we are going to create communication guidelines for healthcare workers. How encouraging is it when a district nurse actively demonstrates an open attitude to homosexuality, and if this is done, when and how are good ways to do so?’

Participation

In our research we are making use of participatory observations and interviews. On a weekly basis we spend half a day in various meeting centers for the elderly, so that we can acquire a far more complete vision of the situation than through interviews only. We aim to be able to publish the first practical recommendations in social work journals by the end of 2018.

Link

  • "Caring for diversity: meeting care needs of migrant and LGBT elderly in changing local care landscapes"