Cultural competency is defined as the capacity for individuals or organizations to work and communicate effectively in cross-cultural situations through the adoption and implementation of strategies to ensure appropriate awareness, attitudes, and actions and through the use of policies, structures, practices, procedures and dedicated resources that support this capacity.


An individuals culture is more than simply the Town or Country in which they grew up.  Ones race and ethnicity, language, geographic “home”, ability and disability, religion and spirituality, and socioeconomic status all have a part in creating the Culture with which a person identifies.


Medicare-Medicaid beneficiaries are a diverse group.  In nursing facilities nationwide, such diversity means:

  • 71% identify as White

  • 15% identify as Black or African American

  • 4% identify as Hispanic

  • 1% identify as Asian


The US Administration on Aging estimates between 1.7 and 4 million LGBT Americans are age 60 and older and as many as 200,000 may need long term care as they age.  70% of older LGBT individuals state they will not inform long term care providers of their sexual orientation due to discrimination they have experienced throughout their lives.  LGBT are more likely to live alone, live in poverty, have no children and be estranged from other family members.


In many locations religious intolerance remains a problem impacting people who identify with any given faith community—Muslim, Hindu and Jewish believers are discriminated against with greater consistency but people of all faith traditions—and those who chose not to believe in a Higher Power—continue to be subject to intolerance ranging from overt acts of hostility to dismissiveness and everything in between and beyond. 


As a temporary employee in a client community, you will provide care and services to people who are different than you.  They may be a Kansan just like you.  They may be a Methodist just like you.  But, unlike you, they may have been a college professor who traveled the world or a dry-land farmer who never left the home he grew up on or a Lesbian who was driven away by a family who rejected her and returned home to receive support from a great-niece who is a last surviving relative. 


In order to provide care that is culturally competent, a caregiver must first commit to providing person-centered care.  Person-centered care requires putting the individual and their needs, wants, desires and goals as the focus of the care interventions being offered.  That is hard enough to do when you understand that care should be provided the way the resident wants it rather than the way that makes it easiest for you to get tasks completed.  It is even harder when you are providing services to someone with whom you are in conflict because of their race or religion or who they’ve married or choices they’ve made in the past. 


The client community in which you are working is required to assure that resident’s with limited English proficiency are able to communicate their needs to staff.  Spanish, far and away, is the most prevalent non-English language you will likely encounter but some communities have significant populations of Asian or African immigrants and older members of these groups may have limited English language skills.  Ask the staff for any care plan tips they can offer to help you communicate with someone who has reverted to their native language or who may never have learned English. 


You will find providing culturally competent, person-centered care is easier if you are:

  • Honest—be honest with yourself about your own beliefs and biases—we all have them, what are yours and how do they impact your attitude toward others who are “different”

  • Curious—when engaging with someone different than you—and isn’t everyone different than you—focus on learning about them—where they’re from, what brought them here—what did they do for a living—etc., etc., etc.Never make assumptions about a resident or their beliefs.Ask them.And listen.

  • Knowledgeable—especially if you will be working several shifts with a client community, spend a few minutes learning more about the acquaintance you’ve made in a new resident—if they’re a vegan, for example, spend a few minutes learning about maintaining health nutritional status for older vegans

  • Honorable—everyone of us is worthy of being treated with dignity and respect simply because we are human—it is hard to treat someone with dignity if we have disdain for where they were born or who they’ve become

  • Understanding—in the Culture with which your resident identifies, seek to understand the roles of men and women, be sensitive to birth-order hierarchies of some cultures, perceptions of illness and infirmity, the acceptance of touching, the importance of eye-contact are some of the many discrete variables that exist within each culture


This general overview of Culturally Competent Care is meant to introduce you to the concept and create the awareness that 1) people who are “different” are often challenged to find caregivers who will provide them person-centered care, 2) institutions are responsible, through training and monitoring and correcting performance, for assuring culturally competent care is provided and, 3) individual employees and their biases are the biggest barrier to providing culturally competent care.

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