“Even if we want help, there is no help”: Exploring Perceptions and Barriers in Home Care Services within the South Asian Communities

Abstract \nBackground: In Canada, the demand for home care services continues to increase due to the ongoing growth of the aging population. This aging population is marked not only by the increase in the number of older adults but also by its significant diversity (National Advisory Council on Aging, 2005). There is a growing need to address disparities in the utilization of home care services among immigrant older adults (Wellesley Institute, 2016). Despite the importance of home care services, little is known about how ethnic minorities perceive home care services in Ontario, specifically South Asian communities – who are the largest minority in Canada. Therefore, recognizing this overarching context, my research aimed to explore South Asian communities’ nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. \nSpecific Aims: The study aimed to explore South Asian communities' nuanced perceptions about home care services in Ontario and the barriers they experience when they access home care services. Additionally, it sought recommendations from these communities on how to enhance home care services for older adults, aiming to improve the provision of culturally aligned home care services for South Asian communities in Ontario. \nMethods: This study employed an exploratory qualitative research design to investigate the nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Thirteen participants, including seven care partners, three South Asian older adults, and three social workers who engaged with South Asian older adults, contributed to the study. A Reflexive Thematic Analysis was utilized to engage with the data and generate themes for the study. This method facilitated a rigorous and reflexive examination of participants' narratives, enhancing the depth and richness of the study findings. \nResults: The participants emphasized a significant demand for home care services within South Asian communities. In shedding light on the barriers faced by these communities in accessing home care services, various challenges experienced by care partners and older adults in Ontario were revealed. The findings also revealed the impact of duration of residency in Canada on openness to formal home care, the presence of stigma hindering care-seeking, and a lack of awareness about available home care services. Evolving gender roles and care partner burdens were discussed, emphasizing the necessity of culturally tailored support services. Preferences for culturally competent and humble care, language concordance, and alignment with care providers' gender and ethnicity emerged as significant themes. Additionally, the study participants offered valuable recommendations to improve home care services for South Asian communities. These suggestions, ranging from enhancing accessibility to customizing services, aim to align with the cultural needs of the South Asian communities. \nDiscussion: The study reinforced the notion that the South Asian communities are a diverse and heterogeneous group. Perceptions of home care services differed based on the extent of Western cultural adaptation and lived experiences. The research also underscored that while the general population faces obstacles in accessing home care, these challenges are more pronounced within the South Asian communities due to factors like cultural expectations, language barriers, and financial constraints. Additionally, it highlighted the need for culturally tailored home care services to meet the specific needs of an increasingly diverse aging population. \nConclusion: This study significantly contributed to ethnogerontological knowledge by examining South Asian communities' nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Recommendations included targeted awareness strategies and culturally sensitive services for South Asian communities. The study advocated for a holistic home care model, patient-centered care, and cautioning against reliance on cultural stereotypes. Future research suggestions included exploring perceptions among recent immigrants, those with dementia, and an intersectional analysis. Additionally, investigating cultural factors like filial piety and their impact on long-term care decisions within the South Asian communities is recommended.

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