Care managers' experiences of cross-cultural needs assessment meetings: the case of late-in-life immigrants

Aging with my family: a grounded theory approach on the role of family when aging as foreign-born

BACKGROUND

Research indicates that it is the quality of the closest relationships in the mixture of social relations that matters most for older adults. For older foreign-born, especially those who migrate late in life, the family is often the only socioeconomical resource they can lean on. This study aims to explore how older foreign-born perceive the role of family as they age.

METHODS

The study design has a grounded theory approach. Data consist of individual open-ended interviews with 15 foreign-born informants aged between 60 and 85 years old who migrated to Sweden as adults from various parts of the world.

RESULTS

The findings demonstrate that family was an essential part of the informants' lives as they lived for their families and their families lived for them. Family solidarity was described as a cultural heritage they took over from their original families and a cultural heritage they wished to pass on to their future generations. They found that this was what separated them as foreign-born from native-born. Memories of their parents reminded them of their biological, social, and cultural heritages. The intimate relationship with their spouses in a life course had served as a source of validation of their individual identities and promoted personal growth and self-esteem. The role as a loving and caring parent entailed a sense of accomplishment and satisfaction for the life lived. And now as grandparents, the role as a link between the family's historical heritage and the future generation entailed not only a sense of coherence as they aged but also hope and meaning beyond their own lives.

CONCLUSIONS

The older foreign-born experienced life satisfaction as they aged with their families. Family meant community and solidarity. It was in the family that they found their distinct roles that had defined them. Family was an indispensable part of their social identity. The findings highlight the importance of older foreign-born being studied from a family and lifetime perspective.

Swedish experts' understanding of active aging from a culturally sensitive perspective - a Delphi study of organizational implementation thresholds and ways of development

BACKGROUND

International migration and aging populations make for important trends, challenging elderly care regimes in an increasingly globalized world. The situation calls for new ways of merging active aging strategy and cultural sensitivity. This study aim to illuminate the gap between cultural sensitivity and active aging to identify perceived thresholds by Swedish municipal officials in the understanding of older late-in-life-immigrants situation.

METHODS

Delphi methodology in three rounds. Twenty-three persons in municipal decision-making positions participated and generated 71 statements, of which 33 statements found consensus.

RESULTS

The 33 statements show that the decision makers prefer not to use cultural sensitivity as a concept in their work, but rather tailor interventions based on individual preferences that may or may not be present in a certain culture. However, as the complexity of care increases, emphasis drifts away from personal preferences toward text-book knowledge on cultures and activity.

Use of long-term care services in a universal welfare state - On the importance of age at migration

There is broad agreement in the international literature that there are significant barriers to the use of long-term care services (LTCS) by older migrants in various contexts. However, there is a lack of comprehensive study in this area, and particularly concerning the diversity of migrants from different sending countries and the heterogeneity of their migration trajectories concerning the age at migration. Barriers to the use of care might be intensified for persons migrating at an older age, resulting in lower use of care. However, it is still unknown whether late-in-life migrants are underrepresented as users of LTCS in comparison to Swedish born and migrants arriving at younger ages. We study the likelihood of using any (1) LTCS, (2) residential care, and (3) personal and domestic care among older foreign-born, compared to Swedish-born older persons. Secondly, we study the likelihood of care across different birth countries compared to older persons born in Sweden. Thirdly, we investigate the likelihood of LTCS among migrants arriving at different ages. The total population of all persons 65 years and over in Sweden, is studied using register data with almost two million observations. The central findings of this study show that there is substantial heterogeneity across and within different birth countries regarding utilization of LTCS, residential care and personal and domestic care. The results from this study also suggest that late in life migration does not have to imply lower utilization of LTCS, residential care and personal, and domestic care. However, results show a slight over-representation of personal and domestic care among those who have migrated later in life. Further, there is an under-representation of residential care among late-in-life migrants. Our findings thus suggest that caution is needed when generalizing about levels of formal care use in migrant populations.

Caring for migrant older Moroccans with dementia in Belgium as a complex and dynamic transnational network of informal and professional care: A qualitative study

BACKGROUND

Due to its labour migration history, Belgium is confronted with an increasingly older population of people of Moroccan background who have been diagnosed with dementia. These migrants came to the country during the labour migration wave of the nineteen-sixties and seventies to work in mines and other industries and they are now ageing. Yet little is known about how dementia care is provided to this older population.

OBJECTIVES

This study explores how dementia care is provided to these Moroccan older people with dementia, and what challenges do caregivers face in providing care.

METHODS

A qualitative study including 31 informal caregivers of older Moroccan migrants with dementia and professional caregivers in the field of dementia care in several Belgian cities was conducted. After an initial focus group including 6 informal and professional caregivers, individual in-depth interviews were held with 12 informal caregivers of Moroccan decent and 13 professional caregivers. In order to be included in the study, informal caregivers had to have a recent experience in caring for an older family member with dementia. The professional caregivers had to be active in the field of dementia care (General Practitioners, nurses, psychologists,…) and have experience with older migrants with dementia.

RESULTS

Analyses of the collected data reveal that current dementia care is a challenging, complex and dynamic search process. This process is shaped by (1) multiple factors reflecting the changing care needs of the care recipient during the course of the dementia, (2) the individual (transnational) recourses of the informal caregivers and the (3) current (lack of) accessibility of professional dementia care (driven by the absence of an accessible migration-, culture- and religion-sensitive professional care). The limited professional service-use is predominantly compensated through the search for transnational external helpers. The limited migration, cultural and religious sensitivity of current dementia care is often overlooked by professional caregivers.

CONCLUSION

The study provides a better understanding of the complex reality of dementia care for older migrants in which these different aspects intersect. This understanding enable health professionals and policy makers to develop a better suited care for older migrants with dementia.

Older people in Sweden without means: on the importance of age at immigration for being ‘twice poor’

This paper examines immigrant poverty at an older age in Sweden with an emphasis on late-in-life immigrants. We analyse tax data for the entire Swedish-born and non-Swedish-born population. The poverty status of a household is assessed using two criteria. First, the disposable income of the household in which the person lived in 2007 must be below 60 per cent of the median equivalent income in Sweden as a whole. Second, to be classified as ‘twice poor’ a household's net assets must be below SEK 10,000. The results indicate that three out of four Swedish-born older persons were not classified as poor by either of the criteria, and only 1 per cent by both criteria. In contrast, among older persons born in low-income countries almost three out of four were classified as poor according to one of the criteria and not fewer than one in three according to both. Results of estimating logistic models indicate that the risk of being considered poor according to both criteria is strongly positively related to one's age at immigration. Our results indicate that it is crucial that migrants, particularly those who arrive after age 40, be better integrated into the Swedish labour market. To alleviate poverty among those migrants who are already of older age, increased transfers are probably the only possible alternative.

Processing older persons as clients in elderly care: A study of the micro-processes of care management practice

Elder care has undergone a marketization in recent years in which various models for care management have been introduced with the aim of making assessments efficient. This article investigates the effects the care management model has on resource allocation for home care when handling the requests of older persons in the needs assessment process. Sixteen tape-recorded assessment conversations with associated case-file texts were analyzed through discourse analysis. The results show that a managerialist thinking has had a partial impact on the assessment process where the documentation requirements have entailed bureaucratization in terms of the transfer that occurs from talk to text. The findings from the study nevertheless indicate that the assessment conversations have clear elements of an individual-centred perspective in which there is room for a care rational dialogue. This constitutes a welfare policy dilemma today. Providing for older people's requests should be on the basis of quality and an individual-centred perspective and care management has had a contrary effect in which focus is directed instead towards needs assessment and bureaucratic processes.