subjective and structural barriers older migrants face when … · 2019-02-25 · (spanish,...
TRANSCRIPT
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
• Hussein(Underreview)Belongingandsocialisolationatoldage:ThecaseofolderTurkishmigrantsintheUnitedKingdom.
• Oglak,S.andHussein,S.(2016)ActiveAgeing,SocialandCulturalIntegrationofOlderTurkishAleviRefugeesinLondon.JournalofMuslimMinorityAffairs.6(1):74-87.
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