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Supporting Racialized Populations in Long-Term Care: Spotlight Report

This spotlight report examines gaps in cultural and mental health supports for racialized and marginalized residents in long-term care homes and highlights recommendations, findings, and best practices for improving equity and quality of care.

Prepared by: Sunita Lad, MSW (August 2022)

Glossary of Terms

Racialization – The process by which a group of people is defined by their “race,” resulting in racial inequalities embedded in systems and structures.
Marginalized Populations – Groups that experience discrimination and exclusion (social, political, economic) due to unequal power relationships.
Cultural Competency – The ability to understand, appreciate, and interact with individuals from cultures or belief systems different from one’s own.

Introduction

Quality of care is central to resident wellbeing in long-term care homes (LTC). With Canada’s diverse population, it is important to understand the experiences of residents from racialized and marginalized communities and ensure equitable access to supports that improve quality of life.
This report highlights gaps in LTC homes—particularly in cultural and mental health resources—and draws on research demonstrating the importance of cultural competency, language supports, and appropriate mental health care.

Cultural Awareness

Cultural representation and rituals are important parts of identity and should be acknowledged within LTC settings. Access to culturally relevant services often depends on a home’s geographic location.
Research shows that cultural food items, communication, and culturally informed care practices influence resident satisfaction and wellbeing. As Ontario’s LTC population becomes increasingly diverse, low cultural competency can lead to disparities in care.

Recommendations & Suggestions

  1. Cultural competency – Use as an educational strategy tool.

  2. Organizational changes – Integrate cultural diversity into policy-making, administration, strategic planning, and mission statements. Include training for staff and identify staff support needs.

  3. Leadership – Senior management should reinforce the importance of cultural diversity.

  4. Getting to know residents – Meet caregivers, speak with residents, and learn about their cultural needs.

  5. Creating supportive spaces – Ensure the home environment is welcoming and culturally inclusive.

  6. Cultural language – When possible, communicate in residents’ preferred languages or involve staff who can assist.

Mental Health Awareness

There is limited literature on mental health resources for culturally diverse and marginalized LTC residents. Stigma within many ethnographic communities contributes to underreporting and under-support.
Research indicates a need to address cultural and systemic barriers to mental health services and provide culturally appropriate clinical supports and practices.

Recommendations & Suggestions

  1. Training on mental health services – Help staff understand how to communicate with diverse residents and caregivers.

  2. Education materials – Use posters and resources to define and normalize mental health concepts.

  3. Communication – Understand what mental health means to different residents and caregivers.

  4. Improving lifestyle and social support – Provide psychosocial supports, which can help improve mood and behavior among older adults.

Results from the Project

A survey was conducted to understand the experiences of racialized and marginalized caregivers supporting a family member or friend in LTC.

  • 7 surveys were received.

  • 5 of 7 caregivers recommended additional supports.

  • 6 of 7 caregivers were unaware of mental health resources in the LTC home.

  • Respondents were evenly split between private and public LTC homes.

Recommendations from Respondents

  1. Access to a social worker for bereavement, palliative care, cultural recognition, and wellness support.

  2. Air conditioning in rooms during warmer months.

  3. More food options and activities.

  4. Recognition of essential caregivers as part of the care team.

  5. Greater cultural variety in celebrations, activities, and food.

  6. Updated programs and improved food options.

  7. Inclusion of cultural services and mental health supports/counselling.

  8. Participation in cultural services.

Best Practices for Family Councils

Family Councils bring together family members and friends of LTC residents for peer support, education, and advocacy.
This creates opportunities to identify challenges affecting racialized and marginalized residents and to raise awareness about the need for cultural and mental health supports. New dialogue can highlight important changes required in LTC homes.

Critical Reflection

This report encourages reflection on systemic gaps in LTC and highlights the importance of ensuring services are available for all residents. Collecting more data on caregiver and resident experiences and conducting program evaluations can help determine what is working and what needs improvement.

Questions for Reflection

  1. Is your LTC home providing these cultural and mental health services?

  2. How can you contribute to raising awareness about this topic?

  3. Does the LTC home offer cultural and mental health supports (reviewing home websites may help)?

References

Chiu, M., Amartey, A., Wang, X., & Kurdyak, P. (2018). Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada. Canadian Journal of Psychiatry, 63(7), 481–491. https://doi.org/10.1177/0706743717741061

DeAngelis, T. (2015). In search of cultural competence. American Psychological Association, 46 (3), 64. Retrieved from: https://www.apa.org/monitor/2015/03/cultural-competence#:~:text=Cultural%20competence%20%E2%80%94%20loosely%20defined%20as,practice%20for%20some%2050%20years

Glossary of Essential Health Equity Terms. (2022). National Collaborating Centre for Determinants of Health. Retrieved from: https://nccdh.ca/glossary/entry/marginalized-populations

Mental Health Issues in Long-Term Care Homes: a guide for seniors and their families. (2009). Canadian Coalition for Seniors’ Mental Health. Retrieved from: https://novascotia.cmha.ca/wp-content/uploads/2017/12/Mental-health-Issues-in-Long-Term-Care-Homes-booklet.pdf

Race, Racialization and Racism. (2022). The University of Winnipeg. Retrieved from: https://libguides.uwinnipeg.ca/c.php?g=370387&p=2502732

Scott, M. M., Mayhew, A., Jeong, A., Shaver, N., Lapenskie, J., Hsu, A. T., Tanjong-Ghogomu, E., Tanuseputro, P., Huang, E., & Welch, V. (2022). Access to Long-Term Care for Minority Populations: A Systematic Review. Canadian Journal of Aging, 1–16. DOI: https://doi.org/10.1017/S0714980822000046

Supporting Cultural Diversity in Long-Term Care: Needs Assessment and Work Plan for 2017–18. Sue Cragg Consulting and the CLRI Program. http://www.the-ria.ca/wp/wp-content/uploads/2017/06/CLRI-on-Supporting-Cultural-Diversity-Long-Term-Care.pdf

Syed, S. T. (2021). Impact of Culture on Resident Centered Care and Meal Satisfaction in Long Term Care [Doctoral thesis, Mount Saint Vincent University]. http://dc.msvu.ca:8080/xmlui/bitstream/handle/10587/2188/SafuraSyedMScAHNThesis2021.pdf?sequence=1&isAllowed=y