LeadingAge Magazine · September-October 2019 • Volume 09 • Number 05

Cultural Competence for an Inclusive Staff

September 17, 2019 | by Kenya McCullum

Experts suggest strategies for managing a diverse workforce.

With more and more workplaces making diversity and inclusion a priority, providers are trying to create workplace environments that reflect the cultural diversity found in the communities they work in. And for good reason: Cultural diversity not only creates comfort among residents and clients, who are becoming increasingly diverse, it also helps an organization in several key ways.

In a study, “Filling the Care Gap: Integrating Foreign-Born Nurses and Personal Care Assistants into the Field of Long-Term Services and Supports,” the LeadingAge LTSS Center @UMass Boston found that when these organizations hire foreign-born care workers, they get employees who have characteristics that make them well-suited for the LTSS sector, including a willingness to learn new skills, a strong work ethic, and loyalty to the organization. Foreign-born workers also can create a pipeline of workers to fill labor shortages. In addition, depending on the country these workers come from, they may already be accustomed to caring for the kinds of clients their employers serve.

“A lot of organizations describe very good relationships between the staff and recipients of care because some of the cultures where people come from really revere older adults, so they have some natural skill sets in doing this type of work,” says Natasha Bryant, managing director/senior research associate at the LTSS Center.

Although hiring employees from different backgrounds can be beneficial, it does take understanding, dedication, and patience, because several challenges can come up when managing this type of workforce.

Managing a Diverse Workforce

There are several challenges that can arise when a melting pot of employees work together under one roof. The following are some of these challenges, as well as solutions for leaders to consider.

Challenge: Language barriers. The most fundamental challenge senior care organizations face when hiring foreign-born workers is the fact that these workers may not be proficient in English. Although employees may otherwise be good at their jobs and have a willingness to learn, this communication barrier can make it difficult for them to fully work up to their potential.

Solution: In addition to the standard training that all employees receive during the onboarding process, employers can provide additional language training, as well as enlist other workers and even residents to provide extra help to these employees as needed. Also, when providing training, it can be helpful to use visuals as much as possible, so the concepts being taught can be more easily understood.

Challenge: High employee turnover. Although high turnover is an issue providers face whether or not they have an inclusive culture, immigrant workers may feel especially undervalued in these tough jobs because of their unique circumstances—which can exacerbate problems an organization has with retention.

“When you’re dealing with a demographic that faces a whole range of other structural barriers because of their race, because of their limited English proficiency, because of structural inequality, or because of bias in the workplace, all of those challenges magnify,” says Robert Espinoza, vice president of policy at PHI, a national organization that focuses on strengthening the quality of jobs for direct care workers around the country. “It becomes especially more difficult to recruit and retain immigrants, even though they are the future of this sector.”

Solution: To address this problem, employers should make jobs more attractive by giving workers opportunities to advance within the organization, so they know that they can learn and grow if they continue working there. Espinoza suggests that providers create clear career paths for workers to follow, which will encourage them to invest more time into the organization and create a mindset that they are not just working a job they can get anywhere, but instead they have a career that they can stay in for years to come.

Challenge: Culture clashes based on differing ideologies. It’s important for organizations to remember that every culture has a different view of issues that come up in the workplace—such as death, dying, and the nature of hospice care—so it’s important to understand where these workers are coming from in addition to familiarizing them with U.S. customs and organizational policies.

Solution: Training that increases awareness about these issues is the key to ensuring that although differences are acknowledged, they do not get in the way of getting work done.

“One of the things that we advocate is doing more cultural competency training that really helps these workers understand issues like the role of older adults, how to [serve] them, what our death and dying practices are, and how to interact with a person who may have dementia,” Bryant says.

Challenge: Disrespect from residents and their families. In some cases, it’s not the staff or administrators that people have to worry about when it comes to discrimination—it’s the seniors they care for every day, or even their family members. Sometimes residents, as well as families, who have not been exposed to people from different cultures may be afraid to receive services from them—and this can manifest in discriminatory behaviors against the care workers.

Solution: These are delicate situations because organizations need to balance the comfort levels of both their patients and workers. First and foremost, it’s imperative to explain to clients that discrimination against people who are different from them will not be tolerated. Discriminatory acts can be addressed through education and one-on-one interaction between the staff members and care recipient/family members involved. Once those boundaries are made clear, it may be necessary to make accommodations, such as workers being reassigned so that the client gets care from someone they feel more comfortable with. But if the bad behavior continues, workers’ ability to do their jobs without discrimination has to be put first, and organizations must be prepared to tell clients that they cannot provide services to them based on their conduct.

Challenge: LGBT workers feeling the need to hide their orientation. In some cases, care workers who are members of the LGBT community may not feel comfortable disclosing this very important part of their lives for fear of how their employer, peers, or residents will react.

“Some sectors of senior living and long-term care can be rather conservative, so people may not feel comfortable being out to their coworkers,” says Tim Johnston, senior director of national projects at SAGE, an organization dedicated to improving the lives of older members of the LGBT community. “Things we’ve seen for many years are people not disclosing that they have a partner, playing what we call ‘the pronoun games’ to mask the gender of their partner, or perhaps not having pictures on their desk.”

And workers are not the only ones who may feel reluctant to discuss being LGBT. Johnston notes that in some cases, patients may also feel apprehensive to share this part of themselves for fear that they may be treated differently and not given the same level of care as other clients.

Solution: Have open conversations. In order to address the concerns of LGBT workers, it’s important for employers to educate themselves about the issues and then have honest conversations with the staff. Also, these kinds of conversations can be had about the unique needs of LGBT residents—even if the organization has never tackled this issue before.

“I found that when you can really connect with someone and get them to understand what it would be like to be living in a community afraid to be yourself, afraid to talk about your past, most people who are committed to the caring profession want to have the skills to make sure that is not happening to any of their residents,” Johnston says.

In order to more effectively handle these conversations, as well as any problems that may arise in the workplace, it’s also important for organizations to add language that addresses the concerns of the LGBT community in their inclusivity policies. Not only does this make workers and patients feel more comfortable, it can also boost a provider’s reputation as an employer. In fact, Johnston has observed that organizations with policies that outline how to have appropriate interactions with members of the community can actually attract LGBT staff—as well as their friends, family, and allies—and improve overall worker satisfaction and retention.

Challenge: Not considering how different age groups view diversity. As Generation Z comes of age and enters the workforce, companies have the challenge of managing more age groups than ever before. Each generation sees the world in a much different way—and their views about diversity are no exception.

Solution: As the workplace evolves, managers should consider just how different each generation is, make them all part of the diversity conversation, and tailor programs to their needs.

“As we embrace Generation Z, what it means for them to belong and feel welcome may look and feel very differently than what a Generation X or baby boomer may experience,” says David Boyd Williams, director of global diversity at Sodexo. “We are constantly evolving to understand the needs of our workforce, and developing mentoring programs to help our diverse workforce find opportunities to feel welcome in ways they may not have the opportunity through their daily routine.”

Challenge: Fear of discussing cultural differences in the workplace. Discussions about cultural differences can be difficult, and in some cases, extremely painful, so in order to prevent workers from feeling uncomfortable, leaders may choose to avoid these conversations altogether—which in turn makes it even more difficult for workers to share their problems and concerns.

“There’s a lot of fear that talking about differences is somehow going to be awkward or difficult, or people are going to say the wrong thing,” says Victoria Parker, associate dean for graduate education and faculty administration, and associate professor of management, at the University of New Hampshire. “As a result of that, sometimes instead of talking about differences, people make assumptions and that can lead to all kinds of misunderstandings.”

Solution: In order to solve this problem, organizations must make these conversations a priority—and a group effort.

“Part of this is just making these differences discussable and realizing that everyone is different,” says Parker. “A lot of times, the difference gets assigned to the person or people who are in the minority, but in reality, everybody has differences.”

Although managing a diverse workforce is not an easy endeavor, organizations find that it is worth the effort they put into creating a culture of inclusion and acceptance. Most importantly, having an environment of inclusivity helps these organizations meet their primary mission—to provide quality care to their patients.

“When we strengthen the quality of direct care jobs, we ultimately strengthen the quality of care for everyone,” says Espinoza. “When you respect the value of direct care workers, you ultimately improve the quality of care that all of us receive and all of us deserve.”

Kenya McCullum is a writer who lives in San Francisco, CA.