room for improvement? experiences of health and social care services among older people from...

Room for improvement?Experiences of health and social care services among older people from minority ethnic groups

Jo Moriarty

King’s College London

20/04/23 Age Concern Bristol/Brunelcare Research Forum 2

Outline

What are the issues?These will be familiar!

Inequalities in old age

Evidence on services

Making improvements

Background

Race Equality Foundation promotes race equality in social support and social care http://www.reu.org.uk

Funded to develop a national resource to help improve the quality of health and housing provision to black and minority ethnic communities

Includes series of briefing papers containing research evidence, good practice tips, resources, and key messages for practice


Presentation uses….

Asked to do briefing paper on health and social care experiences on black and minority ethnic older people from http://www.reu.org.uk/health/files/health-brief9.pdfCurrently have 13 briefing papers on health and 12 on housingPresentation today is overview of topic, not a single research project


Presentation uses (2)

Evidence from ESRC project on social support and quality of life among older people from different ethnic groupsWork for the former Healthcare Commission

Asked to talk to BME communities as part of a wider review of the National Service Framework for Older People

Practice guide for Social Care Institute of Excellence (SCIE) on user participationWork with SCIE on depression and BME peopleOther literature



Why this topic is important (1)

Increase in older population from minority ethnic groups

Projections influenced by migration history and patterns of settlement

Currently 30 per cent people aged 65 and over in Brent and 20 per cent Lambeth and Hackney (Evandrou, 2000) are from BME communities

And in Bristol?Council’s Improving the Quality of Life of Older People in Bristol Equalities Impact Assessment

BME community in Bristol lower than average overall but very concentrated in certain areasCurrently younger than average but likely to change

Why this topic is important (2)

UK (especially England) is becoming increasingly ethnic diverse

Term ‘super diverse’ is increasingly used

Reflected in work for Healthcare Commission (now CQC)

Focus groups with older people from Yemeni, Somali, Bosnian, and Vietnamese backgrounds



Impact of ageing on ethnic inequalities

Age accentuates health inequalitiesBritish Household Panel Survey data show that inequalities in self assessed health INCREASE with age (Sacker et al 2005)

May experience ageing process at younger age (Ebrahim et al, 1991)

Prevalence of limiting longstanding illnessHigher among Irish, Black Caribbean, Indian, Pakistani and Bangladeshi communities

Lower among Chinese (Evandrou, 2000)


Ageing and health inequalities

Prevalence (frequency) of some age related health problems diseases varies

Coronary heart disease

Diabetes

(Parliamentary Office of Science and Technology, 2007)


Inequalities in access to services

Inequalities in access to health careOver represented in primary care

Under represented in secondary services (Ascheson, 1997)

Inequalities in reports of treatmentPatient surveys suggest older people from BME communities are more likely to report receiving poor care (Healthcare Commission, 2006)


Recognised in policy documents

Legislation and policy guidance recognises differences in treatmentExamples include

Race Relations Amendment Act 2000National Service Framework for Older People (2001)New Single Equality Bill (2009)

Public Sector Equality Duty

Dementia strategy (2009)


But why don’t we know more? (1)

Still neglected issue in mainstream research

Just eight per cent of articles in two old age psychiatry journals included people form a minority ethnic group (Shah et al, 2008)

Presents methodological challengesComplexities of separating out multiple factors

e.g. socio-economic status and ageing


But why don’t we know more? (2)

Studies of older people still have low numbers of older people from minority ethnic groups

e.g. English Longitudinal Study of Ageing

Studies may fail to report differences by age

e.g. studies of depression and ethnicity

But we do know some things….

Differences in access to information

Knowledge and attitudes of staff

Provision of culturally sensitive services

Need to put this into action!'Let's move on': Black and minority ethnic older people's views on research findings (Butt and O’Neill, 2004)



Differences in access to information

Access to information about health and social care services is always variableStudies have shown that BME people are more likely to report they lacked information (Lindesay et al, 1997, Butt and O’Neill 2004)

Specific issues

Lack of access to materials in translation

Content of leaflets may not be relevant

Shortage of good quality interpreting services

Reliance on other family members(Manthorpe et al, 2009)


Dementia

Research has shown that knowledge about dementia is less among Asian and Black Caribbean communities

(Adamson, 2001, 2005, Bowes and Wilkinson, 2003)


Image from Dementia Strategy


Consequences are….

May contribute to poorer outcomes

Later access to dementia servicesPrevents benefits of early intervention

Can lead to increased carer stress (Bowes and Wilkinson, 2003)

Dementia strategy

Improving access to information (1)

There are many ways in which improvements can be made

Why reinvent the wheel?Costs of preparing and translating leaflets are high

But there are many resources that exist already


Resources may already existAlzheimer Scotland has a set of translated leaflets on dementia which can be downloaded free from their website



Different media formats may work better

DVD may work better than leaflets for some communities, especially if they are not literate in their own language

Consider content – using simple language and avoiding jargon

SCIE guide – use of ‘jargon busters’ from community groups



Health and social care services are making increasing use of advice lines

May actually INCREASE inequalities“There is lack of information in Gujarati on benefits, social and health care services to this particular over-50s women’s group. The women say that there is no system where they can just pick up the phone and get help from services.”

– (Manthorpe et al, 2009)


Also remember that…

Access to information variesHistory of migration meant many older people worked in health and social care

Older Black Caribbean women had better levels of knowledge (Moriarty and Butt, 2004)Experience of member of advisory group at Carers’ Group very negative



What role do our expectations play?

Differing expectations may influence help we seek/expect (Chahal and Temple, 2005)

Existence of stigma?

Preferences for different types of treatment?

Lack of cross cultural studies in this area


Attitudes of professionals

Professionals may also create barriers to accessing and using services

Stereotyped expectations about extent of family support (Katbamna et al, 2004)

‘They look after their own’ classic phrase

Existence of racism (Butt and O’Neill, 2004)

Unspoken issue (Culley, 2006)

Diversity among workforce

Workforce may not share same cultural backgrounds

Image from Simon Rawle’s photographs taken for International Migrant Workers’ day for UNISON http://www.unison.org.uk/file/MWphotoexhib.pdf


Katrzyna LichwalaPoland


Increasing professionals’ knowledge

Consider content of professional qualifying programmes

Role of guidelines for measuring ‘cultural competence’ as in the US?

Training across the workforceAccess to training among (non professionally qualified) care workforce

Emphasising that it is an important component of the work…

2006 Social Work recruitment campaign featured older Black Caribbean man

(But celebrity culture in 2009!)


Making services more accessible

‘Link workers’ can improve experiences of GP services, hospital appointments

Role of community groups providing advocacy and outreach

(Moriarty & Butt, 2004, Manthorpe et al, 2009)



However….

Relationships with ‘link’ people and/interpreters may be ambivalent (Chau, 2007)

Benefits of improving workforce diversity

Importance of recruiting bilingual workers

‘El Portal’

Providing culturally specific services

Role of culturally specific services?

Most often for day care/lunch clubs

Sometimes for home care


Image from Age Concern Lewisham and Southwark Black Elders Mental Health Day Centre


However….

How can we bring culturally sensitive services into the mainstream?

Issues about funding (Butt and Mirza, 1996)

Groups may be in competition with each other (Bowes, 2006)

Making mainstream services more culturally sensitive

In addition to using knowledge of workforce….

Learn from expertise of people using services

Dietary advice from Black Caribbeans (Brown et al. 2007)


Increasing public engagement

Different methods of consultation are needed for different communities

Events versus surveys may get better response


Photograph from ‘Listening event’ for Healthcare Commission

New challenges?

Increasing diversityPresentation for Making Research Count

London borough high proportion of bilingual/bicultural workers – challenges of new languages

Effects of personalisation?Will it improve services or increase inequalities?


room for improvement? experiences of health and social care services among older people from...

Documents

research evidence

single research project

minority ethnic older

age sacker et

younger age ebrahim

quality of health

ethnic inequalitiesage

older population