Multiple Jeopardies and Home Care

1. Multiple Jeopardies and Home Care Presentation to The Ontario Community Support Association Symposium Women & Home Care: The Facts, The Issues, The Future November 21, 2005

2. Presentation to The Ontario Community Support Association Symposium Women & Home Care: The Facts, The Issues, The FutureJanet M Lum jlum@ryerson.ca November 21, 2005

3. What are multiple jeopardies? • Multiple jeopardies present challenges to effective home care: • Female • Elderly • Low income • Live alone • Not proficient in speaking and understanding English • Not familiar with mainstream culture • Belong to an emergent ethno-racial community

4. Broader policy context • Home care recipients in the future will be increasingly characterized by multiple jeopardies. • Canada is drawing immigrants mainly from Asia and South East Asia. • Recent announcements to increase immigration not matched with funds for settlement and integration. • E.g., ESL, training –disproportionately affects newcomer women. • Isolated, belong to emergent communities with few resources and weak social infrastructure.

5. How do multiple jeopardies affect home care? • Why should health and community support providers be concerned about multiple jeopardies, and especially differences in language and culture? • A vet does not have to speak “dog.” • A broken arm is a broken arm.

6. Awareness and access • Differences in language and culture affect health status and the ability to be aware of, and to access home health care. • Lack of a coordinated information system is a general problem for all home care users. • Elderly, low income woman living alone will more likely need home care but will face greater barriers navigating the system and accessing home care, especially if she is not proficient in English as compared to someone who is younger, middle class and proficient in English.

7. Effective communication • Effective care is premised on good, ongoing, communication between recipient and home care organization/staff. • Effective communication contributes to: • involvement of home care recipient in decision-making around care issues; • reduced anxiety and frustration around care issues. • Challenges are greater when providers and recipients don’t speak the same language or share the same culture.

8. What to do?Translation services • Facilitate effective communication by making professional translation services available to home care workers. • Translators bridge language and culture gaps. • Often, those working in the community in home care do not have ready access to translators as compared to those working in hospitals and long term care facilities.

9. Informal translators • Rely on informal translation by family (often children) or friends. • Problems? • Breech confidentiality. • Inability of children to translate nuanced and complex meanings. • Unwillingness of clients to disclose details in the presence of a friend or family member who is translating. • But if effective communication is seen to be critical in the provision of effective home care, shouldn’t translation services be made available to those who provide home health services?

10. Retain experienced home care workers • Anecdotal evidence: • Experienced home care workers, particularly those with language and cultural skills start off in the community, gain experience, then move to the institutional sector which pays higher salaries. • Home care sector loses experience, language and cultural skills; recipients lose continuity of care. • Perverse outcome--most marginalized health sector is subsidizing the mainstream.

11. How to retain experienced home care workers? • What needs to be done to retain home care workers in the community sector? • Competitive salaries and working conditions between community and institutional sectors. • See home care as an integral part of the continuum of care.

12. Case managers • Active intervention by intensive case managers is critical for multiple risk seniors. • Particularly effective in mediating cultural or linguistic barriers (through outreach work, connections with ethno-specific communities) to facilitate the provision of culturally and linguistically appropriate home care services. • Especially true for seniors from emergent communities. • i.e., new immigrant communities –Ethiopian, Somali, Afghani, Tamil, Sri Lankan, Iranian and Mandarin-speaking Chinese. • Characterized by relatively weak social infrastructures.

13. Enhance supportive housing • Our research suggests that case management is more likely in supportive housing than in unsupported housing, making it a viable alternative to institutions for aging in place. • Supportive housing allows for a range of home care and support services to be coordinated around the needs of the individual in a cost effective way.

14. Challenges of multiple jeopardies to effective home care? • Multiple jeopardies posed by seniors who are frail, live alone, socially isolated, have low incomes, different cultural backgrounds, who cannot communicate fluently in English, and belong to emergent ethno-racial communities present challenges to effective home care. • This cluster of risk factors affect: • Awareness • Access • Effective ongoing communication • Effective course of care.

15. Action? • Make translation services available to health workers in the community. • Make salaries and working conditions between community and institutional sectors comparable. • Recognize the critical role of case managers and community service agencies in mediating multiple jeopardies. • Enhance funding to supportive housing.

16. Presentation to The Ontario Community Support Association Symposium Women & Home Care: The Facts, The Issues, The FutureJanet M Lum jlum@ryerson.ca November 21, 2005