Transportation difficulties disproportionately affect lower income racial and ethnic minority elders, many of whom do not have automobiles and, even more importantly, may not have the language skills and information necessary to get a driver's license and navigate through their community. Many of these elders also experience confusion regarding public transportation and other resources available to help them access services. Some barriers to services can be considered 'internal' because they are characteristics of the minority groups, and they include styles of interaction and expectations, as well as misconceptions. Traditional Chinese culture, for example, values shielding patients from discussing the full severity of an illness, which is in direct conflict with contemporary Western medical practices. The most common cultural misconception among policy makers, program planners and service providers is an underestimation of the needs for formal support for ethnic elders.
Research does confirm that a significant proportion of minority elders live with their family.
There is reason to question whether the existence of a family living arrangement precludes the need for formal service support for minority elders. Research shows that the many responsibilities of minority families may make caregiving for ethnic elders overwhelming without any additional support. Clearly, health disparities, and other disparities which set racial and ethnic minority populations apart from the mainstream, are due, at least in part, to problems experienced in accessing and effectively utilizing health and human services. However, a solid and growing body of evidence indicates that one of the major reasons that services remain inaccessible and under utilized is because they are not responsive to the needs of the groups being served, they are not culturally competent. D. Research on Cultural Competence Comprehensive research on health and social services and minority elders is scarce.