Forum For Culture-Sensitive Care In Old Age

Warum wurde diese Initiative implementiert?

In 2008 approx. 1 million migrants aged 60+ were living in Germany, representing the first wave of ‘guest workers’ recruited between 1955 and 1973. While a steady increase in the number of older migrants can be observed, their propensity to return to their countries of origin is declining. Reasons for the latter trend include: family ties, age-related diseases, restricted mobility rights and dependence on the German social welfare system (Yildiz 2010). Health and social care institutions for older people in Germany fail to address the cultural, religious and language needs of older migrants adequately. According to research by Gün (2003), equal access to out-patient and in-patient services is regularly not ensured. Migration-related problems that aggravate their situation include lower educational level, lower income, former hazardous working conditions with long-term impacts on health as well as experiences of discrimination. In order to address these problems adequately, an intercultural opening in service provision was needed. Both the institutions and the older migrants themselves are target groups of the Forum.

Beschreibung

As a first step, a ‘Memorandum for a culture-sensitive care in old age’ and a ‘Support manual for a culture-sensitive care in old age’ (Arbeitskreis Charta für eine kultursensible Altenhilfe, 2002) were developed to assess older migrants’ specific needs and to promote adequate framework conditions for these to be addressed. Core themes are: the right of people in need of care to live in accordance with their individual, cultural and religious values; participation of the target groups to ensure their conceptual involvement; personnel development and training in health and social care institutions; and political and financial support.

In 2004 a public campaign under the auspices of the Minister for Family, Seniors, Women and Youth was launched, in cooperation with partners from Austria and Switzerland. For 15 months, five suitcases with materials for actions, projects and trainings, accompanied by practical guidelines and working aids, were sent en route through the three German-speaking countries to publicise culture-sensitive care principles. They are currently updated and used, in for example public information events, conferences and workshops as well as in the vocational training for staff of health and social care providers in old age:

• Suitcase 1 addresses health and social care issues, and it promotes a ‘welcoming culture’ for service users from ethnic minorities;
• Suitcase 2 aims at developments in the social community;
• Suitcase 3 contains examples of good practice and policy recommendations;
• Suitcase 4 provides multi-lingual materials on medical issues and LTC;
• Suitcase 5 is targeted at health and social care provision specifically for senior migrants from Turkey.

The materials include textbooks, practical guidelines, training modules on CD, checklists for outpatient and inpatient services, brochures on intercultural competences, books and videos with interviews and life stories. In order to carry out networking, lobbying, public relation and training activities, the Forum is organised by a central coordination group and four regional groups. The website offers regular training and the suitcases. The Forum is a member of ENIEC, the European Network for Intercultural Elderly Care. As the Forum has no funds of its own, staff have been appointed from the member organisations to carry out the tasks in the central and regional coordination groups. In order to finance materials, an appeal for money appears on the website.

 

Welche Effekte wurden erzielt?

A formal evaluation of the outcomes and impacts of the campaign has been performed in the framework of a Master’s thesis in 2006. During 15 months, 206 events took place including exhibitions, conferences, trainings, workshops and festivals. 167 service providers, municipalities, senior councils, migrant councils and associations as well as experts signed a commitment to implement culture-sensitive care principles. Four large German welfare associations (Caritas, Diakonisches Werk, German Red Cross, Arbeiterwohlfahrt) as providers of out-patient and in-patient services are Forum members. Because of this impressive activity and the connections that have been established, the campaign has initiated important first steps towards a sensitivity in this area (Kunkel, 2006).

In the meantime, three more national conferences were organised by the Forum, and its members have continued to represent their aims in public events and committees. From the growing number of requests for advice, a rising awareness through a growing number of local concepts, projects and training has been noted. But culture-sensitive care in old age cannot yet be considered mainstreamed at the time of reporting (January 2011). The Forum’s demands to define specific service initiatives for older migrants in need of care as a compulsory quality standard for funding according to the LTC insurance Law, or to establish promotional programmes for a reimbursement of the initial costs of service providers for the training of their staff and tailored measures for migrants have not been successful. Hence the systematic impacts remain limited.

Regarding potential sustainability it must be acknowledged that efforts to enhance culture-sensitive care in old age have been on-going for more than 10 years despite the absence of external funding. This suggests an urgent need for institutions to adapt to a different sort of clientele through training and support for practical implementation, and the Forum is gradually responding. The participation of Austrian and Swiss organisations in the 15-months campaign and the on-going status as partners of Pro Senectute, Cura Viva and the Swiss Commission for Migration Issues demonstrate that the initiative can be implemented well in other countries. This is especially true when the materials are adaptable to different languages.

Worin bestehen die Stärken und Schwächen der Initiative?

The work of the Forum is still characterised by high motivation and creativity and considers itself as a bottom-up innovative movement with interdiscipinary and cross-sectoral support structures. But it is also facing resistance of service providers who question the necessity of efforts to introduce and implement intercultural issues. Moreover, the Forum’s work is lacking a reliable financial basis. The most important strength of the approach of culture-sensitive care as such lies in its evidence about the daily practice of health and social care organisations. When senior migrants make use of services, the absence of interventions addressing their specific needs becomes obvious. Older migrants are still underrepresented in the clientele of the service providers compared with their share of the older population.

Unfortunately, the initiative’s main weakness at present is its low political status with no legal imperative to change. Culture-sensitive care measures are still considered highly innovative if not ‘exotic’. Their coverage is not everywhere and so characterised by limited access.

One of the opportunities arising from culture-sensitive care in old age is the reversal of a deficit in how migrant care workers are perceived. If culture-sensitivity was a respected care issue, migrant carers would be needed as experts. Not only would their employment chances increase but they could also function as key people in multi-ethnic teams in which intercultural competences could be developed. These additional efforts in quality development, however, will need incentives.

Without adequate financial and political support there is the risk that only financially well-off migrants in need of care can afford specialised services with many older migrants being unable to make use of them.

Impressum

Autor: Karin Stiehr, Institut für Soziale Infrastruktur
Reviewer 1: Pieter Huijbers
Reviewer 2: Marion Repetti
Verified by: Gabrielle Zanier (contact person of the regional group midth/south)

Links zu anderen INTERLINKS-Initiativen

• A new national model of needs assessment implemented by local governments

Externe Links und Literatur

• Website of the "Forum für eine kultursensible Altenhilfe" (German only)
• Arbeitskreis Charta für eine kultursensible Altenpflege / Kuratorium Deutsche Altershilfe (2002) Für eine kultursensible Altenpflege. Eine Handreichung.  
• Forum für eine kultursensible Altenhilfe (2002) Memorandum für eine kultursensible Altenhilfe. Ein Beitrag zur Interkulturellen Öffnung am Beispiel der Altenpflege.
• Gün, Ali Kemal (2003) 'Therapie und Rehabilitation' in: Beauftragte der Bundesregierung für Migration, Flüchtlinge und Integration (ed) Gesunde Integration. Dokumentation der Fachtagung am 20. und 21. Februar 2003 in Berlin. 
• Bundesweiter Arbeitskreis Migration und öffentliche Gesundheit, Bonn Kunkel, Klaus Heinrich (2006) Evaluation der Kampagne für eine kultursensible Altenhilfe. Eine qualitative Untersuchung zur Kampagne für eine kultursensible Altenhilfe in Deutschland. Magisterarbeit an der Universität Bremen. 
• Yildiz, Yalcin (2010) 'In der Diskussion: Ältere Migranten in Deutschland' in: Bundeszentrale für Politische Bildung (ed.) Newsletter Migration und Bevölkerung 2/2010. 

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