How Home Care Agencies Manage Ethnicity Issues


Home care companies strive to provide elders with compatible caregivers, which can mean matching schedules, personalities, experience, familiarity with certain customs, as well as personal needs and sensitivities.

When a caregiver arrives, some elders may see only differences, such as skin color or cultural background. Transcending racial, ethnic and cultural differences does not come easily, but over time, a caregiver’s commitment and consistency translates into trust and can chip away a great deal of a senior’s obstinacy.

With training, time and generous doses of sensitivity and compassion, professional caregivers and the people they care for can bridge divides in admirable and sometimes surprising ways. The secret lies in commitment, trust, respect and constant communication.

It's important for the caregiver to maintain a consistent message: I am here for you, and I'm not going anywhere. This can help a senior adjust to a new aide more quickly, regardless of their respective backgrounds.

Cultural sensitivity begins with the employee, who is trained to respect all cultures, customs, preferences and personal choices. They are specifically taught to put a premium on sensitivity and respect, emphasizing that the relationship with an elder might not be a two-way street in every case, and that they shouldn't take things personally if an older adult's behavior towards them seems unappreciative.

This training went a long way for Delvina, a Jamaican native who has been a home health aide with Partners in Care for nearly a decade. She was recently assigned to care for an elder of Hispanic origin, who refused her service because Delvina was African American.

“I stayed calm, stayed professional and kept asking what I could do to help her,” Delvina recalls. “I asked, ‘Can I make you breakfast?’ and ‘Can I help you get dressed?’ I tried to make her comfortable.”

The supervisor was called to help sort things out, but in the end, the client was unrelenting. In this case, Partners in Care worked with the client to assign a different caregiver who better fit their unique needs. Although this can be an uncomfortable process for everyone involved, the end result is what matters. With this change, Delvina was free to care for other clients who were accepting of her services, and her original client began care with someone she was more comfortable with.

“It happens,” says Delvina. “I know I'm there to care, and a client's behavior doesn't change that fact. I try to remain positive every day, every time I go to the job.”

If issues like this arise, the home care company you choose should work closely with you to remedy the situation. The bottom line is caregivers are going into someone else's home and must always respect that person's wishes. This could mean taking off shoes at the door or removing an earring if it could be interpreted as culturally offensive.

As with many issues in elder care, communication is key.

Home care professionals, as well as those whose loved ones are in need of home care, should bear in mind that, when someone is suffering from a combination of diseases and discomforts, pain and confusion can undermine civility and courtesy—as anyone who's suffered from a bad flu will know.

In addition, the elders we attend to are facing a precipitous loss of independence and privacy, even as our care strives to keep them as safe and independent as possible in their homes. Sometimes inflexibility or outright rudeness can signify underlying health problems.

For example, another Partners in Care aide named Juliet was caring for an elder who suddenly became verbally abusive, including hurling racial epithets at her. Juliet followed protocol and reported the situation to her supervisor, who sent a nurse to the home for an assessment. The nurse discovered that there was a problem with the elder's medications and alerted the elder's doctors. Once the medication regimen was corrected, the first thing the elder did was request Juliet's return to her care team.

In the end, it's the care in your heart, not the color of your skin that matters.

Renata Gelman, RN, B.S.N., is assistant director of clinical services at Partners in Care, an affiliate of the Visiting Nurse Service of New York (VNSNY). In this role, she coordinates patient care and manages a multi-disciplinary team of field nursing and home health care professionals in the clinical area of a VNSNY’s private care division.

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Communication is indeed key. A heavy accent or lack of mastery of English can get in the way of that very critical element. I have seen elders objecting to certain aides not because of their skin color or clothing but because they can't understand them. Most of us can listen carefully and eventually get into the rhythm of the speaker even if the English is less than perfect. But when you are hard of hearing and a little confused to start with, hearing unfamiliar vocabulary spoken with an accent can totally ruin communication.

No matter how much you care in your heart, you have to be able to communicate in a way the care recipient can understand.

I don't want to deny anyone employment. I don't say your English should sound like a native in order for you to work! But to work with elderly persons in a role where communication is critical, one of the requirements should be spoken language that is easily understood by the clients.
I agree that a strong accent or limited English can be a barrier. However, many cultural differences- between caregiver and client and caregiving agency and caregiver- are the result of subtle differences in communication styles and perceptions. I once gave a seminar to caregiver agencies on cross cultural communication and they were amazed on how their perceptions based on their own socialization could distort how they saw the caregivers that worked for them.
Agencies need to take a firm stand against racial/ethnic discrimination, bottom line. They legally cannot and should not make assignments based on race/ethnicity. The patient/family should be told that fact. If the patient/family insists that the agency assign them someone based on race/ethnicity, they should be offered a referral to another agency. Putting this burden on the aide - to be "more sensitive" and "not take things personally" and "understand the elder and sickness" is totally inappropriate. Aides should not be subject to a "hostile work environment," which includes being assigned only to "certain" clients and the expectation to put up with client hostility based on race/ethnicity. Get some integrity and backbone, home care agencies!!