Africana Studies and Research Center, Cornell University, Ithaca, NY, USA; Cornell Center for Cultural Humility, Cornell University, Ithaca, NY, USA.
Department of Sociology, Cornell University, Ithaca, NY, USA; Biology and Society, Cornell University, Ithaca, NY, USA.
J Aging Stud. 2022 Jun;61:101023. doi: 10.1016/j.jaging.2022.101023. Epub 2022 Mar 29.
As the overall U.S. population grows older and increasingly diverse, greater focus is needed on the various Home and Community-Based Services (HCBS), such as home health care, case management, meal delivery and preparation, and personal care, required to address the unique social and medical complexities of diverse older adults. Presently, however, there has been limited research on needs and broader dynamics associated with HCBS facilitation in this population. To address this gap, we sought to contextualize practices and barriers to care coordination for diverse homebound older adults, conducting semi-structured interviews with 41 providers of HCBS, including older adult care coordinators, in-home care workers, and physicians in greater Chicago, Illinois. Common care coordination practices included fluid processes related to engendering racial concordance in care, facilitating linguistic adaptations, and navigating relationships with clients' families. However, in certain circumstances, these practices are hindered. For example, broad client-level challenges included racialized dynamics of distrust and limited health literacy, and organizations cited ongoing obstacles recruiting and retaining diverse staff and finding HCBS providers to service low-income, minority communities often burdened by high crime rates. Continued efforts need to be made to better understand the HCBS needs of diverse homebound older adults and the associated challenges of providing culturally humble programming to this population.
随着美国总人口的老龄化和日益多样化，需要更加关注各种家庭和社区为基础的服务（HCBS），如家庭保健、病例管理、送餐和准备、个人护理等，以解决不同老年人群体独特的社会和医疗复杂性。然而，目前针对这一人群的 HCBS 促进相关需求和更广泛的动态，研究有限。为了弥补这一空白，我们试图将实践和障碍纳入语境，以协调多样化的居家老年人的护理，对 41 名 HCBS 提供者（包括老年护理协调员、家庭护理工作者和伊利诺伊州芝加哥市的医生）进行了半结构化访谈。常见的护理协调实践包括与护理中的种族一致性相关的灵活流程、促进语言适应以及与客户家庭建立关系。然而，在某些情况下，这些实践会受到阻碍。例如，客户层面的广泛挑战包括不信任和有限健康素养的种族化动态，组织指出，在招募和留住多样化员工以及为经常受到高犯罪率困扰的低收入少数族裔社区提供 HCBS 服务方面，仍然存在持续的障碍。需要继续努力，以更好地了解多样化居家老年人的 HCBS 需求，以及为这一人群提供文化谦逊方案的相关挑战。
