Subjective and structural barriers older migrants face when … · 2019-02-25 · (Spanish,...

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Subjective and structural barriers older migrants face when accessing and receiving health and care services Dr Shereen Hussein Principal Research Fellow King’s College London

Transcript of Subjective and structural barriers older migrants face when … · 2019-02-25 · (Spanish,...

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Subjective and structural

barriers older migrants face

when accessing and receiving

health and care services

DrShereenHusseinPrincipalResearchFellowKing’sCollegeLondon

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Acasestudy:OlderTurkishMigrants

•  Sometimescoinedas‘invisibleminorities’

• Differencesandsimilarities•  Subgroups:Turks,CypriotsandKurds• Migrationhistory•  Labourmarketparticipation•  Socialnetworksandkinshipstructure•  Cross-nationalties

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Theresearch

•  Interviewsandfocusgroupdiscussionswith:•  OlderTurkishmigrants

•  66participants(34women,32men;meanageof72.3years;13Turkish,24Cypriotand29AleviorKurds)

•  TurkishcareworkersandTurkishcommunitycarecoordinators•  32participants

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Atthebeginning…

• Pre-migrationhistory

• Motivesandprocessofmigration

•  IhadheardfrommyfriendthatthetailorsearngoodmoneyinLondon.ButIwasilliterate;IhadnevergonetoprimaryschoolhoweverIlearntit[makingdresses]bymyself.ItookmylittledaughterandcametoLondon.NextdayIbegantoworkinagarmentworkshop.(Evren,72oldTurkishwoman)

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Crossingthroughyouthfulyears

•  Levelofengagementwiththewidersociety

• Workandfamilylife

•  Identity..Isitlinkedtogeographicallocationorastateof•  Howcongruentare‘home’and‘place’inones’

perception•  Transnationalbelongings• Mobility(transitanddiasporic)

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Workismuchmore..butalsomuchless

‘Nextday[afterarrivingtoLondon]Ibegantoworkinagarmentworkshop.IdidnothavetospeakEnglishbecauseeveryoneherespokeTurkish.Myfriendhadarrangedaroomforus.’.(Evren)

‘IhavebeenlivinginEnglandfor35years;Iamilliterate,Ididnotgotoelementaryschoolbecausetherewasnotaschoolinourvillage.Ihadworkedasa‘chef’inaTurkishrestaurantfor21years.IdidnotknowEnglishexcept‘yes’and‘no’.IhadneverneedforspeakingEnglish.’(Aktas,66yearsAleviman)

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Enclaveeconomies•  Safetynetandsupportmechanisms

• Noneedtoadoptorchangeculture,behaviourorlanguage

•  Collectivecommunitysupport

• But…theprotectivebubbleisnotalwaysgood•  Prolongedisolation•  Inter-dependency•  Empowerment(andlackofit)

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Theageingjourney

•  Virtualvs.realproximities

•  SocialConstructofageing

•  Belongingandidentity

•  Theway‘home’isconstructedandexperienced

•  Adjustmentandnostalgia

•  Theroleoffamilyandinter-generationrelations

•  Relativeandabsoluteexclusionfromwidersociety

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Ageingprocess

•  ‘Silent’ageing

•  Continuedrelianceonaclosednetwork

•  Littleawarenessof‘outside’facilitiesandactivities

• Moreinfluencedbycountryoforigin(throughcableTVandcommunityassociations)thanbywidersocietyofactualplaceofageing

•  Suddenrealizationofagewithonsetofdiseaseorself-dictatedceaseofemployment

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Perhapsanunplannedarrival

•  Acceptanceoflosses(asoftheworkroleandimportancewithintheTurkishcommunity)

•  Limitedresourcesandabilitiescreatingasenseofhelplessness.

•  Limitedlanguageskills•  barriersactingonatleastthreelevels:pre,during

andpostcommunications

•  Onsetofdisease

•  Socialisolationandloneliness

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InvisibleandRecognisedCareneeds

•  Largegapsbetweenactualhealthneedsandperceivedcareneeds• Mayleadtocrisissituationsandintensivecare

needs

•  Importanceofculturallysensitiveservicesandperceptionsoflimitedchoices

•  Socialconstructofageing•  Lackofphysicalactivities•  Awarenessofownneeds

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Supportmechanisms

• Roleandavailabilityofclosefamilyespeciallyspousesandoffspring•  Expectationsofthefamilysystemandrealities•  culturallydefinedrightsandduties

• Wheretogo,whotoaskandwhatcouldbedone…

•  Self-esteemandempowerment

• Genderdifferences

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Preferencetostayinone’scomfortzone

•  ‘Ifeelmorecomfortable,safeandsecurewithTurkishcareworkers’(Aisha,73yearsAleviwoman)

•  "MyCompany[homecareagency]alwayssendsmecareworkersfromdifferentcountries(Spanish,Russian,Jamaican,Somali).Theytreatmebadandhavenegativeattitudes.IwouldpreferTurkishwomen,theywouldknowmyneedsmore.(As’ad,85yearsTurkishman)

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Familytiesandbi-directionalbenefits

• Nefisawasa102oldTurkishwomanwholiveswithherdaughter(Suraya)andson-in-law.Sheusedtoreceiveformalcarethroughahomecareagencybutshewasquitedissatisfiedwiththeserviceshereceived.NefisawasthenofferedapersonalbudgetthroughwhichshehasaskedSurayatolookafterher,shealsoreceivedhousingfromthelocalcouncilwherebothofthemlived.BothNefisaandSurayaspokebrokenEnglishandtheyseemedtohavelittleknowledgeaboutsuitableservicesintheirlocalarea.

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Careandsupport•  Expectationsofthefamilysystem

•  Inlinewithotherresearchoncollectivisticsocieties

•  Inter-changeablecareresponsibilitiesfromandforolderpeople

•  Familyisanimportantblockincareprovision-BUTthisisnotalwaysavailable•  Generationalrelocation•  Inabilitytoprovidecare

•  Dementia•  Complexcareneedsetc.

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Whentheassumeddoesn’twork

•  ‘They[sonanddaughter-in-law]don’tgivemeanyrespectasaperson,Ifeelveryaloneinmyhome.Inevergoout,IamalwaysathomeandfrontoftheTV’.(Frieda83yearsTurkishwoman)

•  Neglectandemotionalabuse

•  Thecomplexitiesoffamilyrelations

•  Howandwithwhomtovoiceconcernsandtowhichresults

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Formalsupport•  Someweredismissalofavailable‘formal’or

outsidethefamilycircleactivitiesandservices

•  Fearoftheunknownanddifferent•  Lackofawareness

•  Referencing‘badstories’•  Quicklyexchangedandemphasised•  Thepowerofclosedsocialnetworksinexchanging

information•  Buttheirlimitationsinreflectingthewider

experienceofotherolderpeople.

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Careresponsibilityandthewelfarestate

•  Themajorityofolderpeopleperceivedthe‘UKGovernment’asmainplayerinlongtermcareprovision•  IamsogratefultotheEnglishgovernmentfor

providingmewithcare

• However,thereareclearbarriers•  They[theGovernment]thinkthatourelderly

peoplestaywithus,butthisisnotalwayspossible(TurkishCareCo-ordinator)

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Barrierstoaccessandreceivingcare

•  Languagebarriers•  ‘Wedon’tknowwhatareourbenefitsorrights

duetolanguagebarriers’(Woman,74)•  ‘Idon’tknowEnglishandIcannotexplainmy

problem’(Woman,63)

•  Culturalpreferences;especiallyiftheydonotrequirelongtermcare•  Ifeelmorecomfortable,safeandsecurewith

Turkishpeople(woman,60)

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Socialisolation•  Afeelingoflimitedavailabilityof‘suitable’activatesthat

areculturally,languageandagesensitive

•  ManyofolderTurkishpeopleintervieweddidnotacquireEnglishlanguageskillsdespitetheirresidencyintheUKforconsiderablylongperiodsoftime

•  Socialisolationatolderageappearstobeacontinuationoflimitedinvolvementinthecommunityduringyoungerages

•  Manyofthosewhoworkedduringyoungerages,workedwithinethniccommunitiessuchasshopsandrestaurantswithlimitedopportunitiesforimprovingEnglishlanguage

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Culturalissues•  Someevidenceofpatriarchic,maledominantsocial

interactions•  Olderwomenfaceamoresociallyisolatedscenariosand

aremoredependentonoff-springandhusbands•  Fewopportunitiestoparticipateinthewider

community,throughvolunteering,forexample

•  Somefeartoaccesshealthservices:•  Mainlyforlanguagebarriersandabeliefthat

translationsareusually‘notgoodenough’;‘mostofthetranslatorsfromCypriansandtheydon’tspeakinTurkishverywell’

•  Butalsoforabeliefthatsomeservicesarenotculturallysuitable

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Theroleofculturecentres

•  AnimportantpartofolderTurkishmenandwomen

•  However,feweractivitiesforwomen

•  Linktotheoutsideworld,especiallyinrelationtoinformationonhealthandcareservices

•  However,notalwayshavethelatestinformationandunderstandingofnewpolicies

• Moreeffortsareneededtocreateopportunitiesofwidercommunityinvolvementthroughcollaborationwithculturecentres

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Webofnetworks

Self

Family&Friends

Community-Kingroup

Welfarestate

Countryoforigin

HostCountry

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Socialandeconomicimplications

•  Considerablehealthcostimplications•  theimportanceofearlyinterventions•  fewrealisedtheiractualhealthneedsorthe

importanceofactiveageingonphysicalandmentalwell-being

•  EffectonyoungerTurkishpeoplewhousuallyprovideinformalcare

• Psychologicalwell-being

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Subjectivebarrierstoaccessinghelp

• Assumptions

•  Fear

• Belonging–usandthem

• Awarenessandknowledge

•  Inter-dependency

•  Lackofvoice

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Structuralbarrier

•  Language

• Reachingout

•  Lackofopportunitiestointegrate

• Accessibilityofservices

• Availabilityofaccessibleinformation

• Person-centeredpractice

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Keypoints•  Thedifferencebetween‘sociallocation’andwider‘geographical

location’

•  Generational‘solidarity’ismanifestedthroughfamilyexpectationsandastrongroleofculturalcentres

•  Oldageidentityinfluencedbycountryoforiginmorethanhostcountrydespitedecadesofresidency

•  Considerablecostimplicationswithvalueforearlyinterventionandpreventativemeasures

•  Yetthewelfarestateisassumed‘actual’responsibilityforcareprovision

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Messagestopractice•  Theneedtoworkcloselywithcommunities

•  facilitateaccesstodifferentsocialandhealthylivingactivities

•  raiseawarenessofavailableservicesandtheimportanceofqualityoflifeingeneral

•  Facilitatecommunityactivitiesthathavebenefitsforbroadaspects;social,healthandwellbeing;particularlyforolderwomen

• WorkwithTurkishsecondgenerationstoimproveknowledgeandaccessforfirstgenerationmigrants

•  Respectmigrant’sownidentityanddon’tmaketoomanyassumptions

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Acknowledgment&Disclaimer

Thisisresearchformasub-studyoftheLongitudinalCareWorkStudy,whichisconductedbyateamofresearchersattheSocialCareWorkforceResearchUnit,King’sCollegeLondonandledbythefirstauthor.

ThestudyisfundedbytheEnglishDepartmentofHealthaspartoftheUnit’scorefunding.TheviewsexpressedherearethoseoftheauthoraloneanddonotnecessarilyrepresentthatoftheDepartmentofHealth.

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Thankyou

•  [email protected]

• Hussein(Underreview)Belongingandsocialisolationatoldage:ThecaseofolderTurkishmigrantsintheUnitedKingdom.

• Oglak,S.andHussein,S.(2016)ActiveAgeing,SocialandCulturalIntegrationofOlderTurkishAleviRefugeesinLondon.JournalofMuslimMinorityAffairs.6(1):74-87.

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