Care needs of older migrants : Perceptions and challenges

1. Care needsofoldermigrants: Perceptions and challenges Bernhard Perchinig, Katharina Schaur 23.03.2018

2. Project overview • Time ofimplementation: June 2014 - Dec 2015 • Donor: European Funds for Integration (EIF) • Desk research • Dataanalysis • 30 Expert- interviews in Vienna and Linz (public administration, service providers, academia) • 8 focusgroupswith 7 – 10 participants (2 gendermixedgroups, 6 genderseperatedgroups, all in mothertongueofparticipants) • Countries ofOrigin: Former Yugoslavia, Philippines, Turkey

3. Main questions • Quantitative dimensionsof care needsofoldermigrants • Providers´ viewsofandreactions on growingdiversityamongtheir (potential) clients • Oldermigrants´ usageofcare provisions • Knowledge aboutexistingsupportstructuresandinstitutionsamongmigrants • Expextationsofoldermigrantswithregardto care • Estimated care needsforpersonsbornabroad 2025: 60.100, ofwhom 20.500 mobile care

4. The migrants´ views

5. Access hurdles: Lack ofinformation Lack ofinformation • Perceptionofonlytwooptions: „At home“, „retirementhome“ • Main sourceofinformation: Relatives andfriends • Other relevant informationsources: Family doctors,hospitals • Oftendistrustagainstinformationfrompublicservices „We (Turkishpeople) also cannotasktherightquestions. Thus we do not gettherightinformation:“ „Ifyougosomewheretocollectinformation, andtheyrealise, thatyou do not speakGerman well.... Itdepends on thepersonsittingthereifyou will gettheinformationor not.“

6. Access hurdles: Lack of multilingual information Roleofmothertongue • Necessary in caseoflowlevelofproficiency in German • Care as sensitive issue • Language aselementoftrust • Language assignofacceptance • Information leaflets • Need formothertongueleaflets • But not sufficientasinformation • Need for individual counselling • Whatinformationis relevant in mycase? „(The person at thecounter) does not wanttobebotheredwith an explanation, anddoes not wantto listen toyouaslongasnecessarytounderstandwhatyoureallywant.“

7. Access hurdles: Finances Precariousfinancialsituation • Low incomesandpensions • Inequaldistributionofhouseholdincome • Women receivelowerpercentageofincomethanmen • Lack ofsolidarity in poorhoseholds • Even lowcontributionstoo high forsmallincomes, indirectdiscriminationofwomen „I havegottheinformationthat I couldgotothe care centreduringtheday, but itcostsare Euro 7.- per hourI havetogetfrommyhusband. Howshall I makeitwithmypensionofEuro 450.- monthly?“

8. Expectationsandfears Expectationsregardingfamilymembersand relatives • Care at homeisthe ideal • In-patient care in an retirementhomeisregardedasdeportationfromthefamily • Ambivalene: • Expectationstobecaredforbychildrencontrastedwith • Knowledge aboutsocietalchangesregarding • Children • Spouses • Fromextendedfamilytonuclearfamily „The childrenare not anymorewhattheyusedtobe.“

9. Expectationsandfears Fears • Reservationsagainstretirementhomes • Reservationsagainstpublicinstitutions • Image ofold-age care based on image in countries oforigin „A homefortheelderlyis a placewherepeoplearetrashed.“

10. Expectationsandfears Mother tongueproficiencyof care-wokers • Element oftrust • Fear not tobeunderstood • Fear tobe at themercyofstaff • Personsspeakingthemothertongueastrustedperson • Language astoolforcontacts • Communication with care-giver • Fear ofsocialisolation in retirement-homes „Wefear, thatwecannotspeakthelanguagewellandthuscannotcommunicateourproblems.“ „I cannottalkwithotheraorenterinto a friendshipiftherearenopeoplespeakingmylanguagearound.“

11. Expectationsandfears Food • Religiousandculturaltraditions (riceinsteadofbread, halalfood) Religion • Prayerrooms,religiouscelebrationsandholidays Gender • Gender matchwith care-givers • Linguistic, religiousandculturalacceptance „Formeitisimportantthatstaffmembersacceptandrespectmyculture, religionandeatinghabits. Itmakesyoufeelcomfortable, ifoyuknow, thatstaffarepeopleacceptingothercultures.“

12. Conclusions Overlappofexpectations ans fears • Sensitive andpersonallychallengingissue • Relevanceoflanguageissues • Fear not tobeunderstoof – in termsoflanguageandculture • Fear ofprejudicesand lack ofacceptance • Feeling welcomeasmigrant? • Unresolvedaccesshurdlesandexpectationsinteract • Lead tolowlevelofusageofexistingservices • Expert interviewsconfirmresultsoffocusgroups • Limited institutionalandpoliticalresponses on challenges

13. The providers´ views

14. The Austrian care system • Fragmented responsibilities: • Nine provincial governments responsible for both mobile and in-patient care: Lack of cooperation and exchange • Neither common standards nor common training • Complex landscape of public and private care providers, dominated by large institutional care providers, most of them close to churches or political parties • Access to care, funding of care and care standards differentiate from province to province, leading to difference in quality of care based on place of residence • Migration regarded as relevant challenge in all provinces, but no cooperation in development of migrant-sensitive care, no common capacity development • Reluctance to involve migrants´ organisation in care planning and delivery

15. Information • Dutyoftheclientstocollectinformation • Providers have multilingual informationmostoftenonly in print. • First contactusuallythroughdoctorsandhospitals • Nosystematiccontactmanagement • Noevaluationofinformationaccess • Migrant status often no category for evaluation of service • Migrants often not regarded as group with specific information needs • Low level of service uptake usually explained with reference to migrants´ culture (care as family duty, religion) • Only limited discussion about intercultural adaptation of services

16. Culture and Language • Language • Communication in client´slanguageseenas relevant fortrust • „Language matching“ regardedasimpossible in mobile care, but in favouroflanguagematching in in-patient care • Ad-hoc solutionsandlay-interpreting in practice • Different opinions on languagematchingaselementof care quality (fromsymbolicelementto relevant) • Culture • Culture = Religion • Only limited training in religiousnormsandrules • Limited contactswithrepresentativesofnon-Christian faiths • Reservationsagainst Muslim care-institutions

17. Care and Migration: Main challenges • Migration perceived as main challenge for care system • Strategy of postponement: Challenge for years 2025 ff., “trial and test” period until 2025 • Common perception of a lack of knowledge of migrants • Limited knowledge on care needs of migrants in own area of service • No or very limited outreach activities to migrants • No or very limited contact to migrants´ organisations • Migrants´ organisations not seen as competent partners • Ad-hoc strategies dominate • Providers: Positive view of ad-hoc strategies, scepticism vis-à-vis strategic development • Positive image of ad-hoc-strategies as legitimation of lack of planning

18. Webpage • http://research.icmpd.org/fileadmin/Research-Website/Project_material/BEMIG/BEMIG_final_report_final.pdf

19. Bernhard Perchinig Research and Documentation Telefon: +43 1 504 4677 0 Fax: +43 1 504 4677 2375 E-mail: icmpd@icmpd.org Gonzagagasse1, 5. Stock 1010 Wien http://research.icmpd.org/