Cultural Considerations in the Delivery of Homecare Services:

"Beyond 2 kitchens and a disability/ pi di due cucine e disabilit".

by

(Hedy) Anna Walsh

A thesis submitted in conformity with the requirements

for the degree of Doctor of Philosophy

Factor-Inwentash Faculty of Social Work

University of Toronto

Copyright by (Hedy) Anna Walsh (2014)

ii

Cultural Considerations in the Delivery of Homecare Services:

"Beyond 2 kitchens and a disability/ pi di due cucine e disabilit".

Doctor of Philosophy

(Hedy) Anna Walsh

Factor-Inwentash Faculty of Social Work

University of Toronto

2014

Abstract

This study explored the experiences, interpretations and cultural beliefs of older

Italian immigrants who were receiving culturally specific formal homecare services

through an assisted living facility in Ontario, to examine how their identity and life

history influenced their experiences of receiving care.

The current study builds on the existing body of knowledge about Canada's older

Italian immigrants, in particular their caregiving traditions and current need for formal

care. This research study employed phenomenology to explore the subjective experiences

of Canadian Italian older immigrants who were receiving formal homecare services to

capture the personal meanings and interpretations of their immigration experiences, as

they related to their need for formal homecare services.

Interviews were conducted with 25 older Italian immigrants over the age of 75

that were receiving culturally specific homecare services. The participants shared their

immigration stories, fears, work history, healthcare challenges and descriptions of arrival,

family, losses, and life in Canada. The Life Course Framework was selected to guide this

research study, to represent the process of aging and human development that

iii

continuously occurs across the life span. The Social Identity Theory was also used to

provide additional guidance in understanding the social, cultural and historical influences

of their life histories, as they related to their living arrangements in an assisted-living

facility in Ontario and need for caregiving services.

Three major themes emerged: 1. the importance of communication and

relationship building in the provision of care and the barriers in accessing health care

services, 2. retaining identity and control, and 3. facing an uncertain future. These themes

reveal the importance of language, cultural practices and residential location. At the

micro level, these findings demonstrate the importance individuals assign to their

immigration history and cultural traditions. At a macro level, the findings reveal the need

to provide cost-effective care that enhances the physical and mental well-being of

individuals.

These findings also reflect the importance assigned to the home environment and

the need for workers to develop relationships with clients that are reflective of their

cultural needs. Social workers have the ability to appreciate the historical context of

Canada's immigrants; to develop policies in support of their cultural practices, traditions

and acculturative interests, and the ability to appreciate the aging process and the

associated need for formal services. As Canada's multicultural population continues to

grow, social workers will be increasingly challenged to deliver culturally competent

healthcare services. The findings are intended to offer additional guidance into the

meaning of culture and its importance in furtherance of these goals.

iv

Acknowledgements

This PhD program and dissertation could not have been completed without the

ongoing support and encouragement from my husband Jerry Silverberg and son Jason

Silverberg. I thank them both with all my heart for believing in me and for giving me the

courage that I needed to make this dream come true. Thanks are also extended to my

parents Sonia and Mike Walsh, who taught me from an early age to believe in myself and

to never give up. My mother's educational pursuits and my father's ongoing courage as a

Holocaust survivor, taught me the value of hard work and survival. To my sisters Yona

and Sheila and their families, I am forever grateful to them for all their encouragement

and love. Special thanks are also extended to my extended family and friends.

I carry in my heart, the undying spirits of my late grandparents, Shloime and

Chaya Diament whose stories of survival encouraged me to go forward. I am also guided

in life by the spirits of my father's late parents Chaya and Shaul Waks, and family who

perished in the Holocaust. Special thanks go out as well to the memory of my husband's

grandparents Augustina and Salvatore Curreri whose second kitchen inspired this study.

I am especially grateful to Dr. Faye Mishna, my supervisor who encouraged me,

and guided me in achieving my goal. Words cannot express the extent of my gratitude for

all her assistance and support. I am also indebted to the other members of my committee,

Drs. Cheryl Regehr, Sheila Neysmith, Atsuko Matsuoka for their helpful and constructive

comments and encouragement and to Dr. Jane Aronson the external reviewer, whose

thoughtful feedback and review were so much appreciated. I am also grateful to Drs.

Adrienne Chambon and Aron Shlonsky who believed in my ability and encouraged me

onward.

v

Special thanks are also extended to Dr. Dena Taylor, who provided me with

assistance in the editing of my dissertation. I would like to also thank Sharon Bewell and

Angela Umbrello at the Factor-Inwentash Faculty of Social Work and the office staff for

all their support and assistance throughout.

I would also like to thank Rita Iaconetti and Lina Telesca for their assistance in

this initiative. Special thanks are also extended to the late Dr. Thomas Fried and to Helen

Jensen and to all my former colleagues at the former Workers Safety Insurance Board

Hospital who provided me with years of encouragement and support.

Finally, I would like to thank the Administrative staff and the participants at the

Assisted Living Facility, for all their time and assistance. I hope that I was able to do

justice to the many immigration stories that were shared with me. I am also especially

thankful to Adora Grijalvo Leyson who taught me the value of homecare assistance.

vi

Table of Contents

Abstract .......................................................................................................................... ii

Acknowledgments ......................................................................................................... iv

Table of Contents .......................................................................................................... vi

Chapter 1: Introduction and Background Information .............................................. 1

Background .................................................................................................................... 2

Problem .......................................................................................................................... 7

Study Objectives .......................................................................................................... 14

Culture ......................................................................................................................... 15

Homecare and Community Care ................................................................................... 17

Canada's Homecare Models .......................................................................................... 19

Ontario's Assisted-Living Formal Homecare Program .................................................. 20

The History of Italian Immigrants in Canada ................................................................ 21

Aging and Immigration ................................................................................................ 23

Limitations in the Existing Research Literature ............................................................ 25

Theoretical Framework ................................................................................................. 26

Conclusion ................................................................................................................... 28

Chapter 2: Review of the Literature .......................................................................... 30

Introduction .................................................................................................................. 30

1. Provision of Homecare Services in Canada ............................................................... 30

Figure 1. Anderson Newman Model ............................................................................ 32

1. Utilization of Homecare Services .............................................................................. 33

vii

2. Rapport between Provider and Recipient .................................................................. 36

Formal Homecare Assistance ...........................................................