Cultural Considerations in Care: Building Inclusive and Compassionate Care in the Home

Written by Joanna Wilkins

In order to deliver truly person centred care it is crucial to factor in any elements of life that are of importance to the individual. If we don’t get this right we run the risk of delivering the basics of care without the right conditions to enable a person to flourish. This isn’t new to the care sector, in fact it has been at the forefront of best practice for many years, but there still remain barriers to delivery and we still hear a number of astonishing examples of cultural needs not being met. This can often be due to time pressures, ineffective training, poor recruitment or a lack of leadership. It is vital to take the time to really ensure that in considering the needs of the client we consider the whole person and not just their clinical needs.

The Care Quality Commission is clear that providers do not need to be experts on different cultures, but to have an understanding of how different cultures may affect different aspects of care and care delivery. The most important principle is to ask people questions, or ask their representatives, especially if you are unsure.

Meeting the cultural needs of client

The importance of asking questions was highlighted by Rebecca Hancock, Care Manager at Bush and Co Care Solutions when I asked her about how she meets the cultural needs of the clients she supports.

“I have a couple of clients who observe Ramadan/Eid etc, and how I ensure to consider this in the work that we do is firstly, education. One of my clients verbalises what his religion means to him, so I make sure I ask him about his mosque visits when I see him. I also had a teams call with him alongside his team a couple of weeks ago, and asked him to tell me all about his fasting, the times and the reasons behind it, so that I can understand and best support him. His team includes family members, but it’s little things like checking his gym sessions aren’t too heavy when he is fasting, and asking what lovely things he is having when they break their fast, that mean the world to him. He is proud to be Muslim.”

Rebecca went on to say “This forms part of our service and what we should be about, asking the question is simply the first part - you never know what you might learn!”

These points were very much echoed by Care Manager, Gareth Hankin. “I always ask in any pre-assessment when first meeting a family if there is anything I might need to be aware of like taking shoes off when I enter etc. I always include cultural needs around their religion in the care plan. For example attending church or synagogue and staff supporting them in this, also cultural foods.”

Cultural considerations when recruiting care
in the home

Beyond the assessment and care planning process, both managers spoke about the importance of considering culture in recruitment and including their clients in this process. Rebecca voiced “It’s also important when recruiting to consider culture, and I was particularly proud of some recruitment I did last year, where they got to meet and greet stage, and it went so well. It’s about ensuring that when you interview, there is no unconscious bias present, but that we think about appropriate matches when we look at potential staff for our teams, because for some families, it’s really important that the staff understand their culture.”

Despite the progress being made, the evidence tells us that cultural barriers to accessing care remain very real. A survey of over 3,400 unpaid carers found that just 16% of those from Black, Asian and minority ethnic communities had been signposted to support by their local authority, compared to 31% of white carers and only 6% had received any support from councils at all. These are not simply gaps in provision; they reflect a system that is still not reaching everyone equally, and a reminder of why culturally competent practice is not a nice-to-have, it is a necessity.

The significance of training

Training remains an essential part of ensuring that we consider the whole person when meeting their needs. It's also important to review what the training outcomes are that we are hoping to achieve. Whilst e learning has become a significant part of training delivered to the care workforce, it is important that this is supplemented with in person training where questions can be asked and conversation can aid learning. Gareth recognised this when I spoke with him.

“In one of our managers meetings we invited two team members of the Muslim faith to come in to discuss their faith and how things might affect how we interact with families. Important information like you must only ever touch the Quran with clean hands. They told us all about fasting and how people with illnesses or disabilities can abstain and pay the duty back later in the year or make a financial contribution to charity if they could not fast.”

Gareth reflected that this had guided his practice and provided vital insights that had not been obtained from previous training.

The importance of getting it right

The stakes of culturally competent care are often at their highest when we consider the end of life. People from ethnic minority backgrounds often experience poor access, inadequate communication, and unmet spiritual and social needs at this culturally significant time. Whilst conversations about culturally appropriate care at the end of life can be challenging to have, understanding how these inevitable needs will be met must not be shied away from. Getting end of life care wrong, even through ignorance rather than indifference, can cause lasting harm to families at their most vulnerable. The key element, is conversation, asking questions and deepening understanding of what a good death looks like for the individual. These conversations, if held sensitively are an act of profound respect.

Cultural competence should be a key factor in everything we do, from assessment through to care planning, recruitment and the end of life. It is not a training module to complete and move on, it should be present in all our interactions and practices. The CQC is clear that meeting this need is everyone’s responsibility, and simply by asking questions, being curious and listening, we can improve the quality of care we provide to all we support.