Meeting the Care Needs of Clients in a Culturally Diverse Environment.

        2.1. Effective communication.

         You may be thinking: Why do I need to know about the different cultural backgrounds of clients? By becoming more aware and appreciative of the cultural differences among the clients, you will be better able to show respect for individual clients, provide assistance in ways that are culturally familiar to clients and develop positive relationships with clients.

        Throughout our history, many people from many different backgrounds have come to live in the United States. Historically, a number of people have come from other parts of the world to make their home in the United States. There are people of different races. There are people practicing in many different religions. Some speak a language other than English. Many have different beliefs, values, ways of communicating and ways of thinking based on their cultural background. In order to provide the best quality care and give everyone the respect they deserve, it is important to understand how culture affects the way we live our lives every day.

What is culture?

        First, let’s take a closer look at the meaning of culture. Culture is a set of values, beliefs, and behaviors. Culture is the “truths” that are accepted by members of the group. Most cultural rules are not written down. We learn from other members of the group. Culture is like the air that we breathe. It is something that we do not think about directly. We take it for granted.

        For example, in some cultures, older people are the most respected age group in society. Older people are valued for the experience and wisdom they have gained during their long lifetime. The place of honor in the family goes to the oldest person. Members of the family seek the advice of the older persons. Older people are proud of their age. This cultural belief is true in many Asian cultures like Chinese or Japanese cultures. Yet, in other cultures, youthfulness is valued more than older age. People try to stay young as long as they can. Hair coloring and plastic surgery may be used to maintain a youthful appearance. Older people are thought to be “out of touch.” Children hold a special place in the family. This belief is strongly held by many in the United States.

        We also see some differences between cultures in terms of attitudes and behaviors related to caring for older adult members of families. In some Asian and Latino cultures, for example, when parents get older they typically move in with one of their children, who are expected to care for them. Such expectations are less common in the U.S.

        Culture is very important because we tend to interpret other people’s behaviors through our own culture. We expect others to think and act the way people in our culture think and act. We even interpret their behavior through our own expectations. When people from a different culture act differently than people in our own culture, we may consider their behavior to be strange, inappropriate or even wrong. The important thing to remember is that differences in cultures are not good or bad; differences in cultures are not right or wrong. They are just different ways of doing and thinking. Direct care staff persons need to understand and be respectful of cultural differences.

Examples of cultural differences

        What are some cultural differences you might experience with personal home care clients? Many cultural differences are related to how we talk and listen. You have learned about the importance of good communication skills in earlier modules. Now we will learn about communication skills as they relate to cultural differences.

Eye contact:

        One area is eye contact. Research has shown that when Americans talk to one another, they tend to look at each other directly in the eye. This sends the message that the other person is listening to you and is interested in what you have to say. It is a sign of respect. Yet, in some cultures looking directly in the eyes of another person may be a sign of disrespect. This is particularly true when the person is speaking to someone in a position of authority, such as a doctor, a nurse or a caregiver. Direct eye contact may be interpreted as being a challenge to one’s authority. Looking down or at the floor may be a way of showing respect for the person in authority. People from Latino cultures, such as Mexico and South America, may practice this cultural behavior. Therefore, when you are giving them instructions, they may not look you in the eye while you are talking. This may be a sign of respect for your authority.

        In some Middle Eastern cultures, direct eye contact between a man and a woman is considered a sexual invitation. In general, direct eye contact should be avoided with Middle Easterners of the opposite sex.

Direct and indirect styles of communication:

        The use of directversus indirect styles of communication is another difference in cultures. Many Americans tend to use a directstyle of communication. They tend to be open, honest, direct and precise. Assertiveness is respected. If you have a problem with someone or something, it is okay to speak directly about the problem and try to get it worked out. The belief is that trusting relationships are built on openness and honesty.

        However, people in many cultures use an indirect style of communication. In these cultures, it is very important to avoid embarrassment for oneself and for the other person. Therefore, one may use a roundabout way to let the other person know there is a problem. This can be true for many people from Asian and Latino cultures. Rather than saying directly that there is a problem, the resident may hint at the problem. It will be important for you as a direct care staff person to pick up on the hint. If you are uncertain, it is best to ask questions to try to understand the message the resident is really trying to convey.

Use of the word “yes”:

        Use of the word “yes” as an answer to a question can sometimes be tricky. In some cultures, particularly Asian cultures, people may try to avoid saying “no.” The use of “no” may cause embarrassment for the other person. Therefore, a person may simply say “yes.” In this case, “yes” may not mean that the person agrees or even understands. It may simply mean that the person acknowledges your statement. To find out if the person really understands or agrees, you may need to ask more specific questions to test their understanding or agreement.

Use of first names:

        Another area in which we see cultural differences is in the use of first names. Many Americans tend to use a direct and informal style of communication. This is true even when they first meet someone or have known them only for a short time. One of the reasons for doing this is to show friendliness. Yet, in some cultures, calling someone by their first name is a sign of disrespect. Many people from Latino, Arab and African American cultures prefer the use of a title, such as Mr., Mrs. or Miss, when they are addressed. Using the title helps the person maintain a sense of dignity. A title should be used until a resident asks you to use his/her first name.


        Another area of cultural differences is in the way we touch one another. Most Americans do not mind having someone touch their shoulder or arm as a gesture of friendliness. However, the amount of touching that is considered appropriate varies among cultures. In many Asian cultures, casual touching may be uncomfortable and should be avoided, especially in public. Yet, people from Latino backgrounds may be much more comfortable with casual touching and hugging. In fact, a Latino may offer a hug instead of a handshake as a greeting.

        Touching may also be restricted by religious rules. For example, members of the Orthodox Jewish religion are prohibited from touching members of the opposite sex in public. This rule is similar for Muslims. This rule even extends to shaking hands when meeting and greeting. Therefore, if a female direct care staff person extends her hand to greet an Orthodox Jewish or Muslim male and he does not extend his hand in return to shake hers, she should not be offended. It does not mean he has any ill feelings toward her. He may simply be practicing the rules of his religion.


        Every culture has its own unwritten standards about how much personal space feels right and comfortable. Many Americans feel comfortable when standing about an arm’s length away from the next person. In some cultures, such as the Japanese culture, an even greater amount of distance between people is desired. Yet, in other cultures, such as Latino and Arab cultures, people are very comfortable standing very close to one another.

Review of some key points about cultural differences:

        There are many differences in cultural practices. Few, if any, people will know everything about every culture. What is important is being aware that a client’s behaviors and beliefs may be different than your own. This may help you to be more sensitive. Try not to jump to conclusions and label behaviors that are different from your own as wrong or bad.

        It is important to recognize when different cultural behaviors and practices come into conflict. When you interact with other people, be aware that cultural differences may be coming into play when you experience such feelings as confusion, frustration, misunderstanding, tension or impatience. Ask questions to make sure that you understand the meaning of behavior that seems out of place. Seek additional information about the culture to gain a better understanding of the behavior.


        One thing that can stand in the way of our being respectful to others is stereotyping. Stereotypes are fixed assumptions made about all members of a certain group. Stereotypes are a rigid way of thinking that does not take into account the differences among people in a group. For example, “All older people are frail and sickly” is a stereotype. While some older people are frail and sickly, many older people are strong, active and in good health. Some other examples: “You cannot teach an old dog new tricks.” “All homeless people are drug addicts.” “All boys who live in the inner city are members of gangs.” “All females gossip.”

        We have so much information coming at us that our brains can only pay attention to a small percentage of it. Stereotypes help us sort large amounts of information into a smaller number of categories. The unfortunate part, however, is that they tend to discourage considering people as individuals rather than as faceless members of the group being stereotyped. We mistakenly begin to assume that everyone in the group has the same characteristics.

        Of course, if we stopped to think about it, we would have to admit to ourselves that stereotypes are not true descriptions of every person in a group. Even the good stereotypes are not true of everyone in a group. The stereotypes that we hold about people play an important part in how we communicate with and treat people. If you do not stop to consider the real possibility that the resident you are working with may not fit the stereotype category, you may not treat him/her in a respectful and appropriate manner. It is important to remember that there are always differences between individuals. It is always a mistake to stereotype people based on appearance.

Communicating with non-English speakers:

        The number of people in this country who speak a language other than English is growing. Communicating with people whose first language is not English can take special effort. The following guidelines can be helpful.

  • Speak clearly and a little more slowly than you usually do. Sometimes we tend to speak quickly. For people who speak English well, the fast speed may not be a problem. But a slower pace will give non-English speakers more time to process your message.
  • Do not shout. Raising your voice or shouting will not increase understanding. Speak in a normal tone of voice.
  • Pronounce your words clearly. Avoid running words together.
  • Avoid slang or jargon. Americans have many expressions that are understood by those in our culture. However, they may make little sense to those from other cultures. Examples include: “Completing that job was a piece of cake.” “Thanks a million.” “The birthday celebration was a real blast.” Expressions like these may only confuse a person who is just learning English.
  • Use the written word, draw pictures or show with demonstrations. These techniques may help to increase understanding.
  • Pay attention to body language. Notice the facial expression or use of arms or gestures of the person with whom you are speaking. These may help you to determine if the person understands what you are saying.
  • Take time to consider how your words might be understood by someone who is not completely familiar with your language.