The cultural whisper in our ear : intercultural dementia care in a Jewish long-term care facility

Long-term care facilities are becoming more representative of the diverse ethno-cultural demographics of Canadian society in the make-up of residents, family and staff that live and work there. Therefore, it is entirely likely that care given and received in these facilities will be intercultural in nature. That is, the people caring for them may be from different ethno-cultural, racial and religious backgrounds than the people they are caring for. The impacts of this phenomenon on care provision within elder care settings, such as long-term care have not been adequately explored in the research literature, especially in a Canadian context. The purpose of this qualitative, ethnographic research study was to explore the impact of these intercultural dynamics on care for people with advanced dementia. This study took place over 9 months on a care unit based in a Jewish long-term care facility. The choice of an ethno-culturally specific facility allowed for an exploration of the culture concept in a setting in which culture and cultural identity are deeply embedded within daily life. Field work included approximately 210 hours of participant observation, 21 interviews with a diverse mix of staff and family members, 20 Dementia Care Mapping sessions with residents, and document analysis including resident care charts, and facility-based and systemic policies and procedures. The findings from this study illustrate the ways in which individuals and groups utilize the culture concept in a myriad of strategic and resourceful ways. They include: helping to secure scarce resources; to make sense of the differences that exist within the health care interactions and dementia care; to help position and locate oneself within the context of an overtly ethno-cultural and medical setting; and to challenge more dominant Western, medical paradigms about dementia, personhood and care that are specific to the end of the dementia process. Dementia care acted as a discursive space through which intercultural dynamics and negotiations were played out that represent and reflect the world outside of the facility. While this study was specific to a Jewish facility, the intercultural dynamic is applicable to a myriad of elder care settings which have different cultural configurations, inferring that the findings could be of benefit to recognizing and further exploring this topic.

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