The experiences and expectations of care and support among older migrants in the UK.

This paper reports and critically discusses, against the literature on culturally sensitive and cultural competency practices, the findings of a qualitative study which explored the needs and expectations of older people and their carers from eight different migrant communities and the white British majority. The study investigated the accessibility and acceptability of care and support services in Bradford, UK, a city with a large migrant population. A total of 167 study participants were recruited from February 2008 to October 2008; of these 134 were older people and 33 carers. The age ranged from 25 to 90 years. The study found that older migrants and their carers described expectations of services as complex constructions of ‘abstract expectations’, the study participants’ general beliefs regarding what services should be about, and ‘pragmatic expectations’, their specific views about how they would like to receive care and access services. All groups, irrespective of their ethnic background, expressed three ‘abstract expectations’: high standards of good practice; cultural understanding; and responsiveness to individual expectations. This similarity did not imply a similarity in their preferences for how services should provide for their ‘abstract expectations’. Dignity was a central expectation for all older people in the care of their bodies. However, a number of culturally specific ‘pragmatic expectations’ emerged in the practices that older people and carers associated with maintaining dignity in older age. Nevertheless, differences could not always be explained as an outcome of different cultural backgrounds, but were rather linked to individual characteristics and life experiences. This study indicates that whether and how older migrants’ knowledge systems inform their expectations of care and support should be objects of investigation rather than taken for granted, as implied in some literature on culturally sensitive practices. Exploration of older migrants’ knowledge systems may help us to understand if older migrants’ expectations differ with regard to what they expect to receive from a certain service, their ‘abstract expectations’, and/or how they expect to receive it, their ‘pragmatic expectations’. This information should help to identify if different communities require different culturally competent interventions and of what type: interventions at the organisational level, at the structural level or at the clinical level. [ABSTRACT FROM AUTHOR]