A conversation on culturally appropriate care
Location: Kensington Health, Yee Hong Centre for Geriatric Care, Toronto, ON
What do equity, diversity, and inclusion (EDI) look like in long-term care?
With an ever-changing demographic landscape, how do we provide culturally appropriate care that can be tailored to individual needs? And with an increasing reliance on newcomers to Canada within the caregiving workforce, how do we ensure we are creating inclusive and welcoming work environments?
These questions are top of mind with leaders and care providers today – not only in Canada, but around the world. Two leaders in long-term care in Ontario that operate in culturally diverse communities joined the Ontario Long Term Care Association’s Coming of Age podcast to discuss balancing the cultural needs of their communities with person-centred individual care for the people their organizations serve.
The following article is adapted from a podcast conversation in 2023 with Adil Khalfan, President and CEO of Kensington Health, and Dr. San Ng, CEO of Yee Hong Centre for Geriatric Care.
“Culturally specific care is actually rooted in resident-centred care. You can’t have one without the other.” – Adil Khalfan
Defining Culturally Appropriate Care
Adil Khalfan: From my perspective, culturally specific care is actually rooted in patient-centred care or resident-centred care. You can’t have one without the other. If we are really going to be a patient- or resident-centred organization, and a health care system, then we really need to understand that individual and their family – and part of that is their unique identity and their culture.
Kensington Health’s long-term care home, the Gardens, is in one of the most culturally diverse pockets of downtown Toronto. Not only do we have an incredibly diverse resident population, but we also have very diverse teams, with more than 20 different languages spoken in our home.
We try to understand the people coming to us way before they come to our home. And that makes the transition better for them, their families, and for our staff, so that we’re aware and we can start to enhance and really provide that quality of life for them when they arrive.
Dr. San Ng: Yee Hong is known as primarily an Asian-serving organization because that was our roots – to remove barriers to access for individuals who do not speak English as their first language, who have certain values, customs and beliefs. Yee Hong actually supports many different Asian populations.
We care for a large Chinese-Canadian population but we also have a dedicated floor for Japanese Canadians, and provide care and services for other Asians including South Asians and Filipino individuals as well. We also support partners such as the Indigenous communities, and we’ve worked with the Jamaican Canadian population as well.
Ultimately, we want to understand where a person is coming from, what’s important to them, what gives them a sense of meaning, and what a high-quality life looks like for them.
That’s not a simple thing. Culture is not homogenous. You’ll hear us say that a lot. In China, there are 23 provinces. There are many different dialects, different attitudes and beliefs towards seniors care, towards family values, and towards what independence means.
Those differences are out there across all of Canada’s population. It isn’t something that’s unique to Yee Hong, or Kensington Health, or in Ontario.
Supporting Individuality in a Highly Regulated Environment
Dr. San Ng: There’s no question we have certain regulations regarding staffing and programs – the government wants to help ensure that our spaces are safe and comfortable for the residents and clients.
However, we also need to understand what people need to live their lives the way they want. And that means, choice and flexibility in their own homes – and long-term care homes are their own homes. I don’t think that’s well understood.
People want to wake up when they want to wake up in the morning. People want to eat when and what they want. People have certain preferences with respect to worship or their religion.
Is there the ability to do that? Smudging, for example, is such a fundamental practice for the Indigenous population. For some Buddhists, it’s burning incense. Can we allow that within the regulations?
How do we make that happen?
I think we can meet the standards but also provide some flexibility. But in order to do that, we need to have the ability to relax some of the restrictions and to also have resources to dedicate towards that.
As another example, providing kosher meals or Asian meals requires different types of techniques and different kinds of food, and sometimes that’s more costly. We need funding dedicated towards that.
Adil Khalfan: I agree.
One of our residents was from the Indigenous community. He had lived proudly within that community and then came to our home. One of the things he really wanted to do was continue to take part in smudging.
So how are we going to allow this individual to continue to express their cultural identity, feel safe and cared for in their home, while working within the regulations? We found a way to connect with community organizations who could help us understand how to carry out the ceremony.
This type of sensitive and supportive care is also important to staff – they feel like this is exactly what we should be doing for the people we care for. It’s not an extra. And families are asking for it too.
Leadership in Equity, Diversity and Inclusion
Adil Khalfan: I think you cannot advance the EDI work unless you can build trusting relationships. It’s in the ethos of what we do, building trusting relationship within our teams, our family and resident councils, the community organizations we work with.
At Kensington, we’re taking a three-level approach to EDI.
One is having clinical champions really looking at how are our medical staff and clinical staff are providing equitable care for people with different needs and from various walks of life.
A second area is were looking at is staff awareness and education and creating a safe and inclusive work environment for them. Equally important is encouraging people to speak up and safely express when they don’t know something…
I myself, as a leader, don’t know everything about equity, diversity and inclusion. I’m saying publicly that ! don’t know it. I’m nervous sometimes – but I’m learning. And when staff and people see me say that aloud, I think it creates an environment where it’s safe to express your learning needs and that we’re going to learn throughout our lives.
The other part is really trying to be courageous and fearless in advancing this journey towards equity and justice. not just accommodating the rules that we have, but looking at how we are wiping out those rules to create opportunities for all walks of life for those who live and work in our homes. We’re actively looking at ways of building our senior team to reflect the cultural and gender diversity of the people we serve.
Dr. San Ng: I think we also have to have humility. It’s about having that ability to look at yourself and say.
“You know what, maybe we’re not as diverse, equitable or inclusive as we thought we were.”
In fact, maybe we need to unlearn. At Yee Hong, we provide the care that we do because many individuals came from the same cultural background. But not everybody wants that. Not everybody prefers that. And to assume is something that is not helpful, actually, for advancing EDI.
What don’t we know? What are our unconscious biases? How do we go about asking those really tough questions, about racism and about really different political ideologies, about different ways of being and acting? And are we making assumptions about how people are?
My dream is that EDI is not a flavour of the moment, but instead it’s embedded within each and every one of us. That we treat each other with the respect that everyone deserves. And we behave in ways that honour the individual and their needs and preferences.
Supporting Culturally Diverse Staff
Adil Khalfan: We have a very culturally diverse population of staff. Many of the staff are new Canadians. We’re trying to connect with community agencies and community organizations to help new Canadians and new residents, foreign trained, to be able to settle their lives.
This is not only to their benefit – when their lives are settled, they’ll be able to deliver better care. I don’t think we’ve done enough to help with that as an organization. I think there are many agencies out there that are set up to support them and we, as employers, need to help connect those agencies to our foreign trained staff.
I used to work in the Middle East, and when we were bringing in foreign trained workers, there was more of a focus on, ‘here’s how we’re going to help you stay here.” In North America, it’s a bit more of an independent culture. “You’re here, go figure it out.” I think that’s an important element. I don’t think we’ve sorted it out yet and it’s an area that we need to look at seriously as leaders and as long-term care operators.
Dr. San Ng: It weighs heavily on my mind. At the same time though, there are individuals who do want to make a life in Canada and we need to think about how we can support them to come to seniors care and long-term care specifically because we are a sector that is facing extreme shortages.
We need to change the profile of how rewarding it is to work in this sector. We attract individuals who have a safe place to learn about being a personal support worker, learning to be a leader, learning other types of skill sets and obtaining certifications, in a way that is delivered sensitively to them. We also have culturally sensitive preceptors and onboarding programs.
We need collectively to look at how we bring people in and not just expect that everyone will know how to figure things out on their own while encouraging them to join the seniors care sector.
Measuring Success in EDI
Adil Khalfan: You do need to have an understanding of who’s in your community – understanding the cultural makeup of our residents and our staff.
The data gathering of this type of information is new. We’re going to continue to evolve our thinking, our understanding, and our quantitative and qualitative understanding of describing culturally safe care.
Part of our equity, diversity and inclusion strategy is a more robust way of doing data collection, holistically for both the community we serve and the people inside, so that we can actually set measurable benchmarks. With each point of the data work that we’re doing right now. we’re being very upfront and honest that this is not the be-all and end-all way of doing it, but it will help guide our approach towards advancing this journey of more culturally safe care.
You’ll see the equity, diversity and inclusion work being put into various accountability agreements that we have with the province and our funders. We have a concerted effort in describing it from a data perspective, from a performance perspective, and our communities are asking for it.
I think it’s the right time to really push the gas pedal, accelerate and describe these successes, but be humble enough to learn from other jurisdictions that are further ahead than we are.
Dr. San Ng: I’d like to add that qualitative data should not be discounted. We want to be sure to include the lived experience of individuals and their family members and caregivers. EDI is not a simple concept to grasp.
There’s so much richness and, complexity in a person’s life that. makes them who they are. We need to put a face on this because we all have backgrounds, where we come from and how we grew up, that affect how we want to live as we age.