Enhancing Cultural Humility in San Diego County's Assisted Living Communities

Ethnic diversity is already present in San Diego County and will only grow. Immigrants from other nations, including refugees, make up 25.1% of the county population.¹ The number of older adults over 65 years of age is growing at rates never seen before in American history, both locally in the county and nationally.² Many things draw diverse individuals to the county, including its closeness to the international border, the fact that it is home to one of the nation's largest military communities, the variety of food and dining options, employment opportunities, and a wonderful climate. There are neighborhoods in the county where ethnically and culturally diverse groups of people have congregated, like National City, Barrio Logan, Mira Mesa, and El Cajon. Among these communities, there are Residential Care Facilities for the Elderly (RCFE) serving aging populations and adapting their care and services to be culturally competent for the residents in their communities. 

RCFE providers may host cultural events, curate inclusive meal plans using traditional ingredients, and include activities from ethnic and cultural groups represented in their residents. Administrators can seek suggestions and participation from their residents’ family members to develop familiar cultural activities they might enjoy. For example, each of the residents' families can help develop a cookbook by adding a beloved recipe and host a dinner party to try out the recipe for everyone to enjoy. When the basics of proper care, adequate staffing, and meaningful activities meet the needs of the residents, everyone benefits.³ The quality of care and the environment are crucial to how residents' lives will be determined in the RCFE setting.

A Choose Well member shared how they help their residents with minority health by bringing aspects of cultural awareness and humility into the care and services provided to their residents. The Senior Living Norwoods administrator spoke about a Christmas party they held for their residents. She introduced her Armenian culture to the residents with Middle Eastern dancers and Mediterranean food. She mentioned how her residents enjoyed the cultural activities and different food items on the menu. She explained how chefs from different cultural backgrounds at her homes help create a diverse food menu that showcases a variety of foods and brings awareness to each culture. Potlucks are encouraged in her homes to allow families and caregivers to learn about different cultural and ethnic backgrounds among the residents. This creates a sense of community and gives residents the opportunity to tell stories of their cultures and past experiences, which allows both staff and residents to team-build and bond. 

A challenge is that most minority groups do not have proper access to RCFEs due to barriers like language, finances, a lack of resources, and room availability.⁴ Families and individuals also have difficulty finding communities out of the over 500 licensed assisted living communities in the county that share their cultural similarities. Minority groups may be accustomed to keeping their older loved ones at home to be cared for by family members. This can cause a lack of demand for RCFEs to be created, which can lead to a limited amount of available RCFEs within communities that are predominantly serving minority groups when individuals or families do decide to live in an assisted living community. RCFE providers already serving these areas or nearby neighborhoods can become more culturally competent by offering services, different languages, and activities to become more inclusive and help close this gap. The Choose Well San Diego website lists the languages spoken and the level of care offered at facilities that are participating in the program. Visitors can use the website to look for RCFEs that best meet their needs for themselves or a loved one.

Most facilities specializing in providing care to minority groups are known by their community members and obtain their referrals through word of mouth. In order to provide better care for their residents and impress the families visiting their facilities, RCFE providers should become informed about the health disparities in the communities they serve.⁵ This will allow them to provide the best possible care and support for their communities as their local population ages and diversifies. The need for placement will increase in the coming years due to an aging population that is also diverse. RCFE providers who understand cultural humility will be better positioned to meet this need.

Sources: 

1. https://www.census.gov/quickfacts/fact/table/sandiegocitycalifornia/PST045222

2. https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_health_statistics/SeniorData.html

3. https://academic.oup.com/gerontologist/article/47/suppl_1/110/614160

4. https://www.tandfonline.com/doi/abs/10.1300/J083v36n01_06

5. https://www.nimhd.nih.gov/resources/understanding-health-disparities/minority-health-and-health-disparities-definitions.html