Taking a step further in providing care services to those who need them most, culturally competent care attempts to look beyond the general processes and standards of adult social care. By focusing on the human within the patient, cultural competency in care offers an inclusive way forward for the care industry.
Understanding the necessity to meet diverse needs
Culturally competent care, also termed ‘culturally appropriate care’, refers to the need to be sensitive and accommodating to cultural identity, differences, conventions and beliefs when caring for patients. With the constant cross-border movement of individuals, families and communities in today’s globalised world, culturally competent care is now more relevant than ever. Care providers are now increasingly meeting patients from diverse backgrounds possessing distinct cultural and linguistic identities.
Skills for Care has further nuanced and identified several cultural and linguistic factors that determine one’s identity and suggests that these preferences should be principally taken into consideration in the provision of care to residents. They are, namely,
- sexual orientation
- gender and gender identity
- economic status
- religion and spiritual practice
- region of country
- language/ accent/ dialect
- age and life experiences
- food and drink
The Care Quality Commission (CQC) State of Care report for 2019/2020 identified that care providers in England rated cultural competence as one of the top three areas where support and improvement were required. CQC further informs that Black, Asian and Minority Ethnic (BAME) groups are less likely to express concerns about the quality of care they receive than non-BAME groups, particularly in relation to mental health needs. Accordingly, while persons belonging to BAME groups may possess fewer opportunities to speak up about their experiences, paradoxically, CQC states that such groups potentially have the most concerns about the general quality of care, amounting to over 84% of residents. In comparison, only 63% of non-BAME groups have expressed mental health hardships, depicting systemic gaps in recognising minority concerns.
Since the pandemic, there has been more attention drawn to the importance of cultural competence in adult social care in the UK. CQC recognises that this may be mainly due to care patients having less contact with those who understand and affirm their culture, lacking access to their culture or community outside of the home, spending more time with those who do not share their culture within a care facility, and experiencing more culturally significant life events, such as approaching death or losing a loved one.
Meeting regulatory standards
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identifies three main regulations as being relevant in setting legal guidelines for providing culturally appropriate care.
- Regulation 9: Person-centred care
The purpose of this regulation is to guarantee that residents using care services or treatments possess the opportunity to receive care while it is tailored to their individual requirements. This outlines the steps that care providers must take to guarantee that each individual receives appropriate person-centred care and treatment that is founded on an evaluation of their needs and preferences. This regulation establishes that providers must work in unison with patients in making the latter understand the scope of their treatment and help them make informed decisions to help the patient feel empowered in deciding for themselves the available options and to make appropriate modifications. In addition, the planning, management, and review of patients’ care and treatment must involve either themselves or a person legally acting on their behalf, and providers must consider patients’ capacity and ability to consent.
- Regulation 10: Dignity and respect
This regulation sets out to safeguard the respect and dignity of persons who receive adult social care services at all times. To comply with this regulation, care providers must ensure that their residents are treated with dignity and respect throughout their period of treatment or care. This involves treating all patients equally, ensuring that they have privacy when they need and want it, and offering them whatever assistance they might require to be autonomous, independent, and engaged in their local community.
- Regulation 11: Need for consent
Regulation 11 attempts to make sure that all individuals receiving care services, and those lawfully acting on their behalf, have given permission before any care or treatment is delivered. Care providers must ensure that they acquire the permission lawfully and that the person who consents possesses the appropriate knowledge and understanding of the care and/or treatment that they are receiving. Although obtaining consent is a crucial part of delivering treatment, there are times when doing so will prevent certain other requirements from being completed. And furthermore, this regulation requires more caution when exercising, ensuring that care facilities do not offer any treatments or care that may be deemed risky or unsafe to the patient simply because the patient or someone acting on their behalf has provided informed consent.
The UK regulations on health and social care operate in tandem to create an environment of culturally competent care in care homes. Person-centred care puts the individual at the heart of the service, ensuring that their unique needs and preferences are respected and considered. This approach fosters a collaborative relationship between care providers and residents, where residents’ cultural backgrounds are acknowledged and integrated into their care. Similarly, dignity and respect are fundamental rights that all individuals are entitled to receive, and they are particularly important in the context of culturally competent care. Care homes prioritising these values can create an environment that is welcoming, inclusive, and culturally sensitive, promoting trust, comfort, and a sense of belonging among residents from diverse cultural backgrounds. Likewise, the need for consent ensures that residents have a say in their treatment, regardless of their cultural or economic background. By respecting residents’ autonomy and providing clear communication about their treatment plans, care homes can build trust and promote culturally sensitive care delivery, ultimately leading to improved outcomes and overall quality of life for residents.
Identifying strategies for success to implement culturally competent care
A noteworthy start to providing culturally competent care is to build cultural awareness among staff members. This involves providing training on cultural competence, diversity, and inclusion, which can help care providers understand and respect residents’ cultural backgrounds, beliefs, and values. For example, staff members can be trained to understand the cultural significance of certain practices, such as prayer or dietary restrictions, and integrate these practices into residents’ care plans. In addition, language and communication-related training can also help care providers better connect with residents who may have limited English proficiency or may come from cultures with different communication styles.
- Providing access to interpretation services
Language barriers can be a significant obstacle to providing a high standard of care. Care providers can provide access to interpreters or translators who can assist with communication between staff and residents. This can help residents from diverse cultural backgrounds communicate their needs and preferences effectively, and it can also help care providers better understand residents’ perspectives. For example, a care home may have a contract with a language services provider who can provide interpreters in person or over the phone. Technology such as language translation software or apps can also be used to help caregivers to communicate effectively with patients who speak a different language. This technology can help to ensure that patients receive the care they need, regardless of their language or cultural background.
- Creating an inclusive care facility
Creating a welcoming and inclusive environment within the care facility is another important aspect of culturally competent care. This can involve creating spaces where residents can practice their cultural customs or celebrate cultural holidays, providing culturally appropriate food options, and ensuring that the care home policies and practices are inclusive of all residents. For example, care providers can work with residents and families to understand the significance of certain foods and incorporate these into the care home menu. Care providers can also ensure that the care home policies and practices respect residents’ cultural beliefs and practices.
- Collaborating with family and community
Care providers can collaborate with families and community members to understand and incorporate residents’ cultural traditions and preferences into their care plans. For instance, care providers can work with families to understand the significance of certain cultural practices, such as prayer or dietary restrictions, and integrate these practices into the resident’s care plan. Care providers can also work with community members, such as religious leaders and ethnic or gender identity advocates, to create a supportive and inclusive environment for residents.
- Employing care staff that encompasses diverse backgrounds
The recruitment of a diverse care staff possessing different backgrounds is a potential measure to improve culturally competent care. Care staff who share a similar background and culture with their patients are often better aware and equipped to understand and meet their patients’ needs. For instance, staff members who speak the same language as their patients possess better faculties to communicate more effectively and build better rapport with them. It is likely that care residents who reside in such care facilities may find the space more accommodating and feel an improved sense of comfort during their period of stay This allows staff members who are familiar with their patients’ cultural traditions and practices to provide care that is respectful, sensitive and in line with the expectations of their patients.
- Using Electronic Health Records
Electronic Health Records (EHRs) are valuable tools in improving culturally competent care. With EHRs, care providers can easily access patient health information and medical history consolidated within a common system. This enables care providers to gain a comprehensive understanding of a patient’s health needs and medical history, including any cultural considerations that may impact their care. They can also facilitate communication and collaboration between care providers and patients, particularly when there may be language barriers or cultural differences. For example, EHRs can be configured to display patient information in multiple languages, enabling patients who speak a language other than English to access their health information easily. Further, EHRs can also be configured to include cultural competency training modules and prompts that remind care providers to consider cultural factors in their care delivery. This can help care providers deliver more personalised and culturally competent care while helping to build trust and improve the patient-provider relationship.
Providing access to culturally accommodating education materials
These materials are designed to provide care providers with information about the cultural beliefs, practices, and values of their patients, as well as strategies for providing care that is respectful and sensitive to those beliefs and values. Such educational materials can take many forms, including online modules, printed materials, and in-person training sessions. These materials may cover various topics, such as cultural humility, communication skills, and cultural competency best practices. By offering care providers a comprehensive understanding of cultural competency, these materials can help to improve the quality of care delivered to diverse patient populations. In addition to providing education and training to care providers, these materials can also be provided to patients and their families. This can help to promote patient engagement and enable patients to take an active role in their own care. For example, patient education materials that are provided in multiple languages can help to improve patient understanding of their health conditions and take a more active interest in the engagement of their own care.
Accordingly, culturally competent care is critical to providing high-quality care for all patients, regardless of their cultural differences. Culturally appropriate care recognises that cultural factors can impact a patient’s health and healthcare experience and aims to provide a standard of care that is respectful, responsive, and tailored to their unique needs and preferences. To achieve this, policymakers have set guidelines in place to inform and direct a standard of care that goes beyond general practices and processes. However, actualising this requires a concerted effort by care providers, policymakers, staff and other stakeholders to promote an inclusive and culturally responsive care system. By working together, the capability to improve the quality of care delivered to diverse care resident groups is certainly attainable, ensuring that everyone has access to the highest possible standard of care that meets their needs and expectations.