Beyond Cultural Sensitivity: Universal Issues in Caregiving

Looking for differences, finding similarities. Despite their ever-increasing numbers, older adults from minority ethnocultural groups are still under-represented in most research and practice models on aging or caregiving. This situation exists even though we can no longer think of the North American elderly population as mainly a homogeneous group, in which older adults of Western European extraction arc die norm. This population shift poses new challenges to research and practice. The place of culture and social structure in our understanding of caregiving in minority ethnocultural groups based on studies undertaken in Quebec, Canada, is the focus of this article. While no statistics have been compiled on the number of frail and disabled elderly among the minority ethnocultural groups in Quebec, we can surmise that their proportion is similar to that in the general population, estimated at 41.6 percent, of whom just over half have moderate or serious disabilities (Institut de la Statistique du Quebec, 1998). It is thus reasonable to assume that a large number of older adults from ethnocultural groups need help in remaining in the community and that their access to healthcare and social services is limited, as demonstrated in the majority of studies on this issue (Harel, McKinney, and Williams, 1987; MacLean and Bonar, 1987). These elders are most probably dependent on their families. The reality of caregiving to a disabled family member is now a central issue in gerontological research and practice. However, not enough is known about the specific situation of caregiving in families of minority ethnocultural origin. What literature does exist on ethnocultural groups discusses ethnicity principally through the perspective of understanding cultural difference, that is, how people from ethnocultural minorities differ from those of the majority group. It should be noted, on the one hand, that the notion of difference was an important perspective to develop in the face of dominant assimilationist positions that suggested that immigrants and second- and third-generation citizens of non-European descent should simply adapt and become "one of us" (us, of course, generally being people of white Western-European descent). Researchers in this realm did undertake invaluable work to bring to light specific ethnocultural characteristics in the areas of aging, health, family practices, and service utilization to inform and transform practice (Bennctt, 1986; Cohen-Emerique, 1993; Devore and Schlesinger, 1987). On the other hand, in our guest to show openness to diversity, to be sensitive to differcncc, is there not the danger of situating members of minority cthnocultural groups principally as "other" rather than simply as "another" -someone who, while different, has many things in common with us? This theme of differences and similarities and the place of ethnocultural groups in our understanding of some of the major issues facing gcrontological practice is an important one. While clearly refuting an assimilationist perspective, we would like to raise the question of the risks inherent in a position mat emphasizes only differences, notably that of the "ghcttoization" of health and social services to minority cthnocultural groups. How can we understand ethnicity from a perspective that balances differences and similarities? A body of research that we have carried out over the past ten years can be used to help answer this question. We undertook studies of caregiving in Haitian and Italian families and help-seeking behaviors and relations to support systems among Chinese elders, with the express purpose of seeing whether differences existed among these groups. Our findings are also interesting in light of earlier work we conducted to lcam about these issues in the majority culture. In the late 8os and early 90s, we co-authored several qualitative studies on family carcgiving involving mostly respondents of the majority ethnocultural group in Quebec, French-Canadians, the findings of which were generally corroborated by most North American studies on the subject. …