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

Subjective and structural

barriers older migrants face

when accessing and receiving

health and care services

DrShereenHusseinPrincipalResearchFellowKing’sCollegeLondon

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

•  Shereen.hussein@kcl.ac.uk

• Hussein(Underreview)Belongingandsocialisolationatoldage:ThecaseofolderTurkishmigrantsintheUnitedKingdom.

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

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