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Cultural Considerations in the Delivery of Homecare Services

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Cultural Considerations in the Delivery of Homecare Services Cultural Considerations in the Delivery of Homecare Services: "Beyond 2 kitchens and a disability/ più di due cucine e disabilità". by (Hedy) Anna Walsh A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Factor-Inwentash Faculty of Social Work University of Toronto © Copyright by (Hedy) Anna Walsh (2014) Cultural Considerations in the Delivery of Homecare Services: "Beyond 2 kitchens and a disability/ più di due cucine e disabilità". Doctor of Philosophy (Hedy) Anna Walsh Factor-Inwentash Faculty of Social Work University of Toronto 2014 Abstract This study explored the experiences, interpretations and cultural beliefs of older Italian immigrants who were receiving culturally specific formal homecare services through an assisted living facility in Ontario, to examine how their identity and life history influenced their experiences of receiving care. The current study builds on the existing body of knowledge about Canada's older Italian immigrants, in particular their caregiving traditions and current need for formal care. This research study employed phenomenology to explore the subjective experiences of Canadian Italian older immigrants who were receiving formal homecare services to capture the personal meanings and interpretations of their immigration experiences, as they related to their need for formal homecare services. Interviews were conducted with 25 older Italian immigrants over the age of 75 that were receiving culturally specific homecare services. The participants shared their immigration stories, fears, work history, healthcare challenges and descriptions of arrival, family, losses, and life in Canada. The Life Course Framework was selected to guide this research study, to represent the process of aging and human development that ii continuously occurs across the life span. The Social Identity Theory was also used to provide additional guidance in understanding the social, cultural and historical influences of their life histories, as they related to their living arrangements in an assisted-living facility in Ontario and need for caregiving services. Three major themes emerged: 1. the importance of communication and relationship building in the provision of care and the barriers in accessing health care services, 2. retaining identity and control, and 3. facing an uncertain future. These themes reveal the importance of language, cultural practices and residential location. At the micro level, these findings demonstrate the importance individuals assign to their immigration history and cultural traditions. At a macro level, the findings reveal the need to provide cost-effective care that enhances the physical and mental well-being of individuals. These findings also reflect the importance assigned to the home environment and the need for workers to develop relationships with clients that are reflective of their cultural needs. Social workers have the ability to appreciate the historical context of Canada's immigrants; to develop policies in support of their cultural practices, traditions and acculturative interests, and the ability to appreciate the aging process and the associated need for formal services. As Canada's multicultural population continues to grow, social workers will be increasingly challenged to deliver culturally competent healthcare services. The findings are intended to offer additional guidance into the meaning of culture and its importance in furtherance of these goals. iii Acknowledgements This PhD program and dissertation could not have been completed without the ongoing support and encouragement from my husband Jerry Silverberg and son Jason Silverberg. I thank them both with all my heart for believing in me and for giving me the courage that I needed to make this dream come true. Thanks are also extended to my parents Sonia and Mike Walsh, who taught me from an early age to believe in myself and to never give up. My mother's educational pursuits and my father's ongoing courage as a Holocaust survivor, taught me the value of hard work and survival. To my sisters Yona and Sheila and their families, I am forever grateful to them for all their encouragement and love. Special thanks are also extended to my extended family and friends. I carry in my heart, the undying spirits of my late grandparents, Shloime and Chaya Diament whose stories of survival encouraged me to go forward. I am also guided in life by the spirits of my father's late parents Chaya and Shaul Waks, and family who perished in the Holocaust. Special thanks go out as well to the memory of my husband's grandparents Augustina and Salvatore Curreri whose second kitchen inspired this study. I am especially grateful to Dr. Faye Mishna, my supervisor who encouraged me, and guided me in achieving my goal. Words cannot express the extent of my gratitude for all her assistance and support. I am also indebted to the other members of my committee, Drs. Cheryl Regehr, Sheila Neysmith, Atsuko Matsuoka for their helpful and constructive comments and encouragement and to Dr. Jane Aronson the external reviewer, whose thoughtful feedback and review were so much appreciated. I am also grateful to Drs. Adrienne Chambon and Aron Shlonsky who believed in my ability and encouraged me onward. iv Special thanks are also extended to Dr. Dena Taylor, who provided me with assistance in the editing of my dissertation. I would like to also thank Sharon Bewell and Angela Umbrello at the Factor-Inwentash Faculty of Social Work and the office staff for all their support and assistance throughout. I would also like to thank Rita Iaconetti and Lina Telesca for their assistance in this initiative. Special thanks are also extended to the late Dr. Thomas Fried and to Helen Jensen and to all my former colleagues at the former Workers Safety Insurance Board Hospital who provided me with years of encouragement and support. Finally, I would like to thank the Administrative staff and the participants at the Assisted Living Facility, for all their time and assistance. I hope that I was able to do justice to the many immigration stories that were shared with me. I am also especially thankful to Adora Grijalvo Leyson who taught me the value of homecare assistance. v Table of Contents Abstract .......................................................................................................................... ii Acknowledgments ......................................................................................................... iv Table of Contents .......................................................................................................... vi Chapter 1: Introduction and Background Information .............................................. 1 Background .................................................................................................................... 2 Problem .......................................................................................................................... 7 Study Objectives .......................................................................................................... 14 Culture ......................................................................................................................... 15 Homecare and Community Care ................................................................................... 17 Canada's Homecare Models .......................................................................................... 19 Ontario's Assisted-Living Formal Homecare Program .................................................. 20 The History of Italian Immigrants in Canada ................................................................ 21 Aging and Immigration ................................................................................................ 23 Limitations in the Existing Research Literature ............................................................ 25 Theoretical Framework ................................................................................................. 26 Conclusion ................................................................................................................... 28 Chapter 2: Review of the Literature .......................................................................... 30 Introduction .................................................................................................................. 30 1. Provision of Homecare Services in Canada ............................................................... 30 Figure 1. Anderson Newman Model ............................................................................ 32 1. Utilization of Homecare Services .............................................................................. 33 vi 2. Rapport between Provider and Recipient .................................................................. 36 Formal Homecare Assistance ....................................................................................... 37 Family and Informal Care ............................................................................................ 39 2. Homecare Use in Canada by Diverse Ethnic Groups ................................................. 40 Culture ......................................................................................................................... 42 Acculturation ............................................................................................................... 43 Cultural Competency ..................................................................................................
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