Cultural Consideration

Cultural Considerations

Caring for patients at home requires much more than knowledge of disease processes. When home health care workers enter the home of a patient, they are stepping into an entire social world; and when that patient is from a culture that has customs that vary from those of the visiting caregiver, the potential for problems increases dramatically. Caring for culturally diverse patients is challenging because the rules of appropriate behavior vary tremendously in and among cultures, based on education, social class, length of time spent in the country, the degree to which an individual interacts with members of his or her own culture versus that of other cultures, and personality factors.

Many issues may arise when treating culturally diverse patients in their homes. The following examples are generalizations; they do not apply to everyone. It is hoped, however, that the information below will increase awareness of what may be encountered when providing home health care to members of different cultural and ethnic groups.

LANGUAGE

A common source of problems is language, the most significant being lack of a common tongue. In such cases, interpreters are often used. However, this can also create cultural problems.
For example, most Asian cultures are extremely hierarchical, and it is viewed as inappropriate for a young person to tell an older person what to do. This may be particularly problematic when the home health care nurse or worker tries to communicate with the patient. Because the eldest male is at the top of the social hierarchy, instructions to the patient may have to be conveyed via that family member.

EYE CONTACT

Another aspect of communication which is a potential source of misunderstanding is eye contact. In Anglo American culture, eye contact is seen as an important component of direct and honest communication. Avoidance of eye contact is often interpreted as anything from a psychiatric symptom to evidence of dissembling, or at least, of withholding information. Such interpretations, however, are likely to be incorrect, if the person who is avoiding eye contact is Asian, Middle Eastern, Native American, or possibly Hispanic.

In Asian cultures, to look someone directly in the eye implies equality. The lack of eye contact is used to imply inequality in some situations. For example, a physician or a nurse would be considered superior to a patient, as would a male to a female. Thus, direct eye contact with a superior shows a lack of respect. Many Hispanics will also avoid direct eye contact as a way of demonstrating respect, although Latin cultures lack the rigid hierarchy common to most Asian cultures.

Among many Middle Eastern cultures, eye contact is avoided between men and women out of propriety. Direct eye contact may be interpreted as sexually suggestive, and thus care is taken to avoid such implications. In many Native American cultures, the eyes are believed to be the window to the soul. If you look someone directly in the eye, you could steal their soul. Or they could steal yours. In order to avoid inadvertent soul loss/theft, eye contact may be avoided. Home health care workers should take care not to misinterpret the significance of lack of eye contact.

GENDER

Gender issues can be another source of conflict. In the Muslim Arab culture it is forbidden for a man to look at the body of a woman to whom he is not married. The wise home health agency, recognizing the importance of sexual segregation in many Middle Eastern cultures, will try to send same-sex providers to patients’ homes.

In many Middle Eastern cultures, it is the role of the husband to protect his wife; to act as a buffer and intermediary between her and the rest of the world. Most Middle Eastern women do not see this as sexist or oppressive; rather, they value the protection and care.

If a female home care worker senses that there is essential information that is being withheld due to the presence of the husband, she should insist on examining her privately. Otherwise, it is best to respect the patient’s culture.

TOUCHING

The issue of touching goes beyond gender. Although there is tremendous individual variation regarding people’s comfort level with being touched, there are some cultural patterns. In Middle Eastern cultures, touching between members of the opposite sex is to be avoided, especially touching of females by males. This is also true in the orthodox Jewish religion . In general, Asians may not be like being touched, and physical contact is relatively infrequent in most Asian countries. Although nursing care emphasizes the importance of touch, health care workers must realize that this practice was developed in the context of Western nursing culture, and may not be appropriate for all ethnic groups. Most Hispanic patients, on the other hand, will probably feel quite comfortable with hands-on care.

FOOD

Another issue that frequently arises concerns food. In general, accepting offered food in a patient’s home avoids insult. The rules regarding how quickly you should accept it vary; however, in an African American home, it should be accepted immediately, especially if the visitor is Anglo American. Given the long history of racial discrimination in this country, a white person’s refusal of food from an African American may be interpreted as evidence of racism.

Iranians will expect food to be accepted on the second offer. The first time it is offered is out of politeness; the second offer demonstrates sincerity. Such a rule allows the maintenance of social propriety, even when one has no extra food to share.

If the person offering food is Chinese, it is appropriate to accept on the third offer. To accept sooner is seen as rude, although as with all cultures, allowances may be made for outsiders who are not always expected to know the rules. A group of nurses from mainland China once said that one of the biggest problems they had in the U.S. was that when they politely turned down offers of food, a second offer never came Many reported that until they learned the American custom for accepting food, they were constantly hungry.

PSYCHOSOCIAL CARE

Often, issues that arise are more complicated than cultural gestures. An Anglo-American female patient, for example, insisted that her agency not send her Filipino caregivers. After the second experience with a Filipino caregiver, the patient complained to her agency that Filipinos are too cold and reserved. This case actually raises two issues. Filipino nurses are often perceived to be cold and unfriendly because, in the Philippines, nurses are trained only for technical nursing care. The psychosocial aspects of nursing that are important in American culture, are seen as inappropriate and intrusive in the Philippines.

In the United States, there is often no one but the nurse to take care of the patient’s psychosocial needs. The American patient who expects the health care worker to show personal interest may perceive a Filipino nurse — who is trying to behave appropriately — as cold and uncaring. Ideally, health care workers trained in other cultures should be given guidance and training as to what is expected of someone in their position here. Too often, it is assumed that the foreign worker will somehow, “just know what to do.”

The broader, complex issue raised by this example is that of racism. It must be decided whether patient satisfaction is more important than attitudes that promote racism. Generally, the solution is to tell patients that the home health care agency has sent the best person available for the job.

Cold Germs

Cold Germs
Photo Credit: James Gathany

Doorknobs, TV remotes, refrigerator handles and other commonly touched household surfaces are hotbeds of cold germs, which can survive on those surfaces for two days or longer, says a University of Virginia study.

The study included adults with cold symptoms who were asked to name 10 places in their homes they had touched in the preceding 18 hours. The researchers then went to the participants’ homes to hunt for cold germs, the Associated Press reported.

“We found that commonly touched areas … were positive (for cold germs) about 40% of the time,” said ear, nose and throat specialist Dr.Birgit Winther. Cold germs were found on six of 10 doorknobs, eight of 14 refrigerator handles, three of 13 light switches, six of 10 TV remote controls, eight of 10 bathroom faucets, four of seven phones, three of four dishwasher handles, and three of three salt and pepper shakers.

The study was presented in October, 2008 at the National Conference on Infectious Diseases in Washington, D.C., the AP reported.

Safety Measures During Extreme Weather Conditions – Winter Storms

Bad Winter Weather

Safety Measures

  • Heavy snowfall and extreme cold can immobilize an entire region.
  • Gather emergency supplies: A battery powered radio, flash light, food that does not require cooking, your medication, extra blankets, and extra drinking water
  • Keep your home well heated. Stay indoors during the storm. Avoid drinking alcohol.
  • Dress warmly even if you do not feel cold. Wear several layers of loose-fitting, lightweight, warm clothing.
  • Wear mittens or gloves and a hat.
  • Seek immediate medical attention if you have any following signs:
    • Drop in body temperature below 96 degree F, sleeplessness, confusion, slurred speech, stiffness in legs or arms, shivering.
Source: American Home Health's Client Handbook, section Safety Instructions and Guidelines.

Why Home Health?

Home Health

Home health care has emerged as one solution to the complex problems in health care delivery. Technological advances allow sophisticated medical treatment to be performed in the home. Home health care is a safe and less costly alternative to hospitals and nursing homes. A changing health care focus towards self-care, independence and cost containment has once again made the home a place to be born, a place to recover and heal, and a place to die.

For more information, please visit American Home Health @ www.ahhc-1.com

SENIOR CITIZEN ASSESSMENT FREEZE HOMESTEAD EXEMPTION

Senior Celebration

HERE’S ANOTHER WAY TO SAVE MONEY IF YOU ARE SIXTY-FIVE OR OLDER.  THE INFORMATION BELOW IS FOR RESIDENTS OF KANE COUNTY. INCOME MAXIMUMS AND DEADLINE DATES VARY FROM COUNTY TO COUNTY.  CONTACT YOUR COUNTY ASSESSMENT OFFICE FOR INSTRUCTIONS AND THE APPROPRIATE FORM.  INFORMATION AND FORMS ARE ALSO AVAILABLE ON THE INTERNET. 

 IF YOU ARE NOT ELIGIBLE, THINK ABOUT YOUR PARENTS OR OLDER FRIENDS.  TELL THEM ABOUT THE PROGRAM.  HAVE THEM CONTACT THEIR COUNTY ASSESSMENT OFFICE.  REMEMBER THAT INCOME MAXIMUMS AND DEADLINE DATES VARY FROM COUNTY TO COUNTY.

IF YOU OR YOUR PARENTS OR OLDER FRIENDS WERE NOT AWARE OF THE PROGRAM AND FAILED TO APPLY, HAVE THEM CONTACT THEIR ASSESSOR’S OFFICE.  IT MAY BE POSSIBLE FOR THEM TO SEEK THE BENEFITS RETROACTIVELY FOR AT LEAST A FEW YEARS. 

SENIOR CITIZEN ASSESSMENT FREEZE HOMESTEAD EXEMPTION

 Are you upset that your real estate tax bill keeps increasing each year?  Are you sure that you are getting all the exemptions for which you qualify?  Are you aware of the Senior Citizen Assessment Freeze Homestead Exemption for property owners over 65?

What is the “Senior Freeze” exemption?

The Senior Citizen Assessment Freeze Homestead Exemption reduces the Equalized Assessed Valuation (EAV) of a home by the difference of a home between the 2016 Equalized Assessed Value and the Equalized Assessed Value of the “Base Year.”  The base year generally is the year prior to the year the taxpayer first receives the exemption.  This exemption does not freeze the amount of a property tax bill, which could change if the tax rate changes.  The assessment and tax bill may increase if improvements are added to the home.  oswHowever, if the Equalized Assessed Value of the home decreases in the future, the taxpayer will benefit from any reduction.

Who is eligible?

At least one of the owners of the property must

  • Be sixty-five or older by December 31, 2015.
  • Own the property or have an equitable interest in it by written instrument or had a leasehold interest in the single family home.
  • Use the property as his principal residence on both January 1, 2015 and January 1, 2016.
  • Have a total household income of $55,000 or less in 2015.

What is a household?   

A household means the applicant, the applicant’s spouse, and all persons who use the residence of the applicant as their principal dwelling place on January 1, 2016, whether they pay rent or not.

What is included in household income?

Household income includes your income, your spouse’s income, and the income of all persons living in the house.  Examples of income are listed below:

  • Alimony or maintenance received
  • Annuity benefits
  • Black Lung benefits
  • Business income, including capital gains
  • Cash assistance from the Illinois Department of Human Services and/or any other governmental cash assistance
  • Cash winnings from other such sources as raffles, lotteries, and gambling
  • Civil Service benefits
  • Damages awarded in a lawsuit for nonphysical injury or sickness (for example, age discrimination or injury to reputation)
  • Dividends
  • Farm income
  • Illinois Income Tax Refund
  • Interest, including interest received on life insurance policies
  • Long term care insurance (federally taxable portion only)
  • Lump sum Social Security payments
  • Miscellaneous income from rummage sales, recycling aluminum, baby sitting, etc.
  • Military retirement pay based on age or length of service
  • Monthly insurance benefits
  • Pension and IRA benefits (federally taxable portion only)
  • Railroad Retirement benefits
  • Rental income
  • Social Security income
  • Supplemental Security Income (SSI) benefits
  • Unemployment compensation (all)
  • Wages, salaries and tips
  • Workers’ Compensation Act Income
  • Workers’ Occupational Disease Act income

What is not included in household income?

Examples of income that are not included in household income are listed below.

  • Cash gifts and loans
  • Child support payments
  • Circuit Breaker grants
  • COBRA Subsidy Payments
  • Damages paid from a lawsuit for a physical injury or sickness
  • Energy Assistance payments
  • Federal income tax refunds
  • IRAs “rolled over” into other retirement accounts, unless “rolled over” into a Roth IRA
  • Lump sums from inheritances or insurance policies
  • Money borrowed against a life insurance policy or from any financial institution
  • Reverse mortgage payments
  • Spousal impoverishment payments
  • Stipends from Foster Parents and Foster Grandparent programs
  • Veterans’ benefits

When must I file?

If you are eligible for the Senior Citizen Assessment Freeze Homestead Exemption, you should file the appropriate form with the County Assessment Office by July 1, 2016.  You must file an application every year to continue to receive an exemption.  The eligibility requirements under “Who is eligible?” must be met each year.  Additional documentation (i.e., birth certificates, tax returns, etc.) may be required by the County Assessment Office to verify the information on this application.

What if I need additional assistance?

If you have questions, please contact the Kane County Assessment Office at (630) 208-3818.

 by Karen Centowski

 

 

UP A CREEK WITHOUT A PADDLE – Nursing Talk

Nursing Talk

Dear Cassandra,

The Client Service Coordinator told me I cannot work because my CPR card has expired. The local hospital won’t be offering a class for a month. The fire department just had a class, but I missed it. I know how to do CPR. What’s the big deal? The same thing happened when my license needed to be renewed. I knew that my license was going to expire, but I bought a pair of $500 shoes. Then I didn’t have the money to renew the license. American Home Health wouldn’t let me work until I had a current nursing license.

Frustrated in Chicago

***********************************************************************

Dear Frustrated,

As they say, you are up a creek without a paddle. You are in an awkward position with no easy way out. You cannot work without a valid license and CPR card.

Would you let your driver’s license expire and continue to drive? What would happen if you got stopped? One night you and a friend go to Pizza Hut for the large Supreme pan pizza for $10.00. You are feeling great because the pizza was wonderful and the price was awesome. As you drive along the highway, you are pulled over by a police officer, who noticed your tail light was burned out. He asks for your driver’s license.Yikes! Now you have a ticket and have to go to traffic court. You miss a day of work and lose a day’s pay and, of course, you have to pay to renew your license.

What if you had been in a serious accident, and your passenger was killed? Say the accident was your fault. The liability would be tremendous. You had no valid license. Will your insurance company be happy to have you as a customer? Will they renew your insurance at the same premium? Not a chance. Soon you’ll be spending your free time calling Geico, Travelers, American Family Insurance, State Farm, and every cut rate insurance company in the phone book.

Having a valid nursing license is required by the Nurse Practice Act. The State of Illinois Department of Specialized Care for Children, one of our funders, requires that the personnel file of each nurse contains a copy of the nursing license, the on-line verification of the license at the Illinois Department of Financial and Professional Regulation Website, and copies of the front and back of the CPR card. The back must be signed by the nurse. The State of Illinois will not accept on-line CPR classes.

Think of the financial liability the agency would face if a child died under questionable circumstances, and the nurse had no valid license or had no valid CPR card. The parents would sue. The failure to be properly certified would feature prominently in a trial. The bad publicity and financial loss could destroy the whole company. You would be out of a job, and over two hundred other nurses would need to find another employer.

By the way, why did you need a pair of shoes that cost $500? I don’t know anyone who has shoes like that. Once I heard an exotic dancer say that she had spent $500 for a pair of shoes to wear to work. She was a poor, misguided soul. You can be sure that not one of the patrons of that establishment was looking at her shoes.

—Cassandra

Note: First published on American Home Health's news, September 2010.

Reminder for RNs – License Renewal 2016 (State of Illinois)

AnnouncementAll Registered Nurses (RN), it’s time to renew your license. Please ensure a copy is sent to the office after you receive your new license from the State of Illinois. If your license has not been renewed by 05/31/16, you will not be allowed to work as a nurse until the license has been renewed. Please visit www.idfpr.com for more information. Also, remember to complete your 20 CEUs. Here a few websites where you can obtain FREE CEU credits:

Updated 04/15/2016

Please see below a step by step instructional video on how to print your nursing license: