1 / 35

Jo Moriarty King’s College London

Room for improvement? Experiences of health and social care services among older people from minority ethnic groups. Jo Moriarty King’s College London . Outline. What are the issues? These will be familiar! Inequalities in old age Evidence on services Making improvements. Background.

malo
Download Presentation

Jo Moriarty King’s College London

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Room for improvement?Experiences of health and social care services among older people from minority ethnic groups Jo Moriarty King’s College London

  2. Outline • What are the issues? • These will be familiar! • Inequalities in old age • Evidence on services • Making improvements Age Concern Bristol/Brunelcare Research Forum

  3. 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 Age Concern Bristol/Brunelcare Research Forum

  4. 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.pdf • Currently have 13 briefing papers on health and 12 on housing • Presentation today is overview of topic, not a single research project Age Concern Bristol/Brunelcare Research Forum

  5. Presentation uses (2) • Evidence from ESRC project on social support and quality of life among older people from different ethnic groups • Work 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 participation • Work with SCIE on depression and BME people • Other literature Age Concern Bristol/Brunelcare Research Forum

  6. 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 areas • Currently younger than average but likely to change Age Concern Bristol/Brunelcare Research Forum

  7. 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 Age Concern Bristol/Brunelcare Research Forum

  8. Impact of ageing on ethnic inequalities • Age accentuates health inequalities • British 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 illness • Higher among Irish, Black Caribbean, Indian, Pakistani and Bangladeshi communities • Lower among Chinese (Evandrou, 2000) Age Concern Bristol/Brunelcare Research Forum

  9. 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) Age Concern Bristol/Brunelcare Research Forum

  10. Inequalities in access to services • Inequalities in access to health care • Over represented in primary care • Under represented in secondary services (Ascheson, 1997) • Inequalities in reports of treatment • Patient surveys suggest older people from BME communities are more likely to report receiving poor care (Healthcare Commission, 2006) Age Concern Bristol/Brunelcare Research Forum

  11. Recognised in policy documents • Legislation and policy guidance recognises differences in treatment • Examples include • Race Relations Amendment Act 2000 • National Service Framework for Older People (2001) • New Single Equality Bill (2009) • Public Sector Equality Duty • Dementia strategy (2009) Age Concern Bristol/Brunelcare Research Forum

  12. 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 challenges • Complexities of separating out multiple factors • e.g. socio-economic status and ageing Age Concern Bristol/Brunelcare Research Forum

  13. 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 Age Concern Bristol/Brunelcare Research Forum

  14. 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) Age Concern Bristol/Brunelcare Research Forum

  15. Differences in access to information • Access to information about health and social care services is always variable • Studies have shown that BME people are more likely to report they lacked information (Lindesay et al, 1997, Butt and O’Neill 2004) Age Concern Bristol/Brunelcare Research Forum

  16. 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) Age Concern Bristol/Brunelcare Research Forum

  17. 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 Age Concern Bristol/Brunelcare Research Forum

  18. Consequences are…. • May contribute to poorer outcomes • Later access to dementia services • Prevents benefits of early intervention • Can lead to increased carer stress (Bowes and Wilkinson, 2003) • Dementia strategy Age Concern Bristol/Brunelcare Research Forum

  19. 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 Age Concern Bristol/Brunelcare Research Forum

  20. Resources may already exist Alzheimer Scotland has a set of translated leaflets on dementia which can be downloaded free from their website Age Concern Bristol/Brunelcare Research Forum

  21. Improving access to information (2) • 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 Age Concern Bristol/Brunelcare Research Forum

  22. Improving access to information (3) • 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) Age Concern Bristol/Brunelcare Research Forum

  23. Also remember that… • Access to information varies • History 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 Age Concern Bristol/Brunelcare Research Forum

  24. 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 Age Concern Bristol/Brunelcare Research Forum

  25. 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) Age Concern Bristol/Brunelcare Research Forum

  26. 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 Lichwala Poland Age Concern Bristol/Brunelcare Research Forum

  27. Increasing professionals’ knowledge • Consider content of professional qualifying programmes • Role of guidelines for measuring ‘cultural competence’ as in the US? • Training across the workforce • Access to training among (non professionally qualified) care workforce Age Concern Bristol/Brunelcare Research Forum

  28. 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!) Age Concern Bristol/Brunelcare Research Forum

  29. 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) Age Concern Bristol/Brunelcare Research Forum

  30. However…. • Relationships with ‘link’ people and/interpreters may be ambivalent (Chau, 2007) • Benefits of improving workforce diversity • Importance of recruiting bilingual workers • ‘El Portal’ Age Concern Bristol/Brunelcare Research Forum

  31. 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 Age Concern Bristol/Brunelcare Research Forum

  32. 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) Age Concern Bristol/Brunelcare Research Forum

  33. 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) Age Concern Bristol/Brunelcare Research Forum

  34. 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 Age Concern Bristol/Brunelcare Research Forum

  35. New challenges? • Increasing diversity • Presentation 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? Age Concern Bristol/Brunelcare Research Forum

More Related