Lam Lai Han thought she would have some respite from the 24/7 care she was providing for her husband, who has Parkinson’s disease, when they were approved for government-funded home visits by care aides in 2017.
But the added help forced Ms. Lam to take on a new role: translator. Until recently, the couple often had to deal with different aides, and Ms. Lam, with her limited English, had to communicate her husband’s situation every time. Their two sons live in Hong Kong.
“I am very exhausted,” said Ms. Lam, 74.
Ms. Lam’s husband, Lam Ming Hong, has not been able to walk since 2016. She said they appreciate the help, but their needs are sometimes overlooked.
Thousands of seniors in BC receive provincially subsidized home-care support, but the province’s Seniors Advocate says people who speak little or no English have trouble receiving those services in their native tongue. That leaves them with home care that can’t meet their needs, or unable to obtain such help in the first place.
“There are two issues: You don’t get it, or you’re getting it but it’s more frustrating for you,” said Isobel Mackenzie, BC’s Seniors Advocate.
That reality has prompted calls for more provincial funding to increase the availability of culturally and linguistically appropriate services for seniors. But Ms. Mackenzie argues that the system needs a fundamental redesign.
Twenty per cent of home support clients in the province do not speak English, she said, compared with about 30 per cent of British Columbians who primarily communicate in other languages.
“So what that is telling us is that there would appear to be people disproportionately not accessing home support who speak an immigrant language primarily.”
The paucity in service pushed the Lams to seek help elsewhere. The couple is among more than 80 families in BC that have been assisted by the Gaia Community Care and Wellness Society, a Richmond-based charity dedicated to supporting Chinese and other seniors and family caregivers who belong to minority ethnic groups.
The organization’s volunteers have paid about 240 home visits to seniors of Chinese descent since November, many of whom live in single-room dwellings in Vancouver’s Chinatown.
Language “is a very big issue,” said Gaia’s executive director Percy Wong, adding that the vast majority of seniors they help have encountered language barriers.
Dr. Karen Kobayashi, a professor in the Department of Sociology and a research affiliate with the Institute on Aging and Lifelong Health at the University of Victoria, said much of the government’s funding goes toward standardized services that aren’t tailored to the individual needs of patients.
“You cannot send in a non-Chinese-dialect-speaking or a non-South-Asian-dialect-speaking worker into the home of older immigrant adults from these communities and expect them to thrive or to benefit from the service to the same degree as if you feel a front-line worker who was from their own ethnic, cultural background,” she said.
Both Dr. Kobayashi and Mr. Wong, who has extensive experiences in senior care domestically and abroad, are calling on the government to hire more staff that can provide linguistically and culturally appropriate services.
“The government needs to provide more resources … because the population is going to become increasingly diverse,” Dr. Kobayashi said. “I think the changes that we need to make is to unstandardize these programs and services. In other words, we need to, first of all, create a more equitable system.”
A survey conducted by the Seniors Advocate office shows that among staff for long-term care and assisted-living facilities, 76 per cent considered English to be their first language, 21 per cent did not, and 3 per cent preferred not to answer. But neither it nor the province’s Ministry of Health has data on the language proficiency of home support caregivers.
Ms. Mackenzie said she does not think there has been a proper inventory of language proficiencies among home-care aides in a formal way. “And that would be helpful.”
She agrees that hiring more staff who can provide culturally and linguistically appropriate services could also be beneficial, but added that in practical terms it’s going to be challenging for some of the less-common languages.
A better approach, she said, would be for the government to allow direct funding to clients, so that families can hire their own care aide if their loved ones don’t speak English.
Sharon Koehn, adjunct professor in the Department of Gerontology at Simon Fraser University, said language is just one piece of improving cares for seniors from minority ethnic communities.
“Everyone talks about language and language is huge, but it’s not the only thing. It’s more about having quality care that is consistent, that is respectful. It is anti-oppressive in its orientation.”
Based on her years of research on long-term care and assisted living, Dr. Koehn believes those “big, systemic” issues in the care system, such as the lack and inconsistency of staff, disproportionately disadvantaged elders with minority backgrounds.
They particularly need time with the same caregivers because of their communication issues and cultural differences, she said.
“It’s not just a minority problem. It’s an everybody problem, but it’s especially that for ethnocultural minorities.”
The BC government is examining options to improve and expand home health services, including suggestions from the Seniors Advocate related to direct client funding and improving continuity of care providers, the Ministry of Health said in a statement, adding that health authorities assign home support workers based on language preference whenever possible. In 2020/2021, according to a Seniors Advocate report, 132,801 people received professional home care services.
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