​Envision a place where stories from every part of the world come together—diverse languages, traditions, and beliefs woven into daily life. As health care providers navigate the distinct needs of residents from diverse backgrounds, the challenge becomes obvious. We must deliver not only medical care, but compassionate, culturally aware, and appropriate care that honors each resident’s identity. Achieving this balance, in addition to promoting health equity, is key to ensuring every resident feels valued.

Cultural competence and health equity are progressively more relevant in long term and post-acute care settings due to the growing diversity of the aging population and the increased focus on reducing health disparities. These settings often care for vulnerable populations, such as older adults, individuals with disabilities, and those with debilitating chronic conditions, who come from different backgrounds. Providing culturally competent care ensures that we respect residents’ preferences, beliefs, and traditions. Focusing on health equities addresses disparities in access to quality health care and resources in a progressively evolving medical landscape. 

Cultural Competence

Every resident has their own preferences that should be respected. According to the State Operations Manual from the Centers for Medicare & Medicaid Services,¹ cultural competence in health care means providing high-quality, respectful, and equitable care to residents from different cultural backgrounds. It often also requires recognizing and addressing cultural, social, and linguistic differences that can influence resident care and, ultimately, health outcomes.

Health Equity

Health equity ensures that all individuals have fair and impartial access to health care resources and addresses insecurities, regardless of race, ethnicity, age, socioeconomic status, gender, disability, or geographic location. It aims to eliminate disparities in health outcomes so that residents receive culturally appropriate and equal-access care.

Importance in Long Term and Post-Acute Care

Diversity presents unique opportunities and challenges in health care settings. Providers must appreciate that residents have distinct health risks, chronic disease burdens, cultural health beliefs, and barriers to accessing care, such as language or socioeconomic disparities. Additionally, cultural traditions often influence how families manage aging, caregiving, and end-of-life decisions. Thus, we must prioritize culturally competent care and develop policies that promote health equity for older adults across all racial, ethnic, and cultural groups. A resident is much more likely to trust a provider who respects their culture, values, and practices. 

Challenges in Meeting Diverse Needs

Racial disparities can lead to several challenges: cultural incompetence, implicit or unconscious biases, a lack of trust because residents may feel less comfortable with care staff who do not share their cultural background, and health disparities. Studies have shown that Black residents often receive lower quality care than white residents, especially in the areas of pain management, pharmaceutical intervention, and end-of-life care.² Here are some other challenges:

• Language barriers: Residents may struggle to communicate symptoms, understand diagnoses, or follow treatment plans.
• Health literacy: Residents may misunderstand medical instructions, refuse preventive care, or manage chronic conditions poorly.
• Cultural misunderstandings: Differences in beliefs about health, health practices, or even values may give a false impression of residents’ needs or behaviors.
• Implicit or explicit biases: Biases can greatly affect clinical decision making and interactions with residents.

Barriers to Accessing Care for Underserved Populations

Underserved populations, based on socioeconomic status, race, ethnicity, and geography, face significant barriers when accessing health care, contributing to persistent health disparities. Tackling health equity helps shrink these disparities and improves public health across the board for everyone. Barriers may include the following:

• Social determinants of health: Unstable housing, poverty, insufficient food, and lack of education directly impact health, and potentially access to care.
• Financial barriers: Lack of insurance or being underinsured combined with high out-of-pocket costs makes health care unaffordable and discourages individuals from seeking care.
• Geographic barriers: Underserved urban or rural areas may have only a few health care facilities and providers, and lack of transportation further restricts access.
• Systemic barriers: Complicated health care systems and lengthy wait times can deter care-seeking.

Role of Caregivers and Strategies for Improving Cultural Competence and Equity

Ensuring fair and equal access to quality care for all residents requires addressing both systemic barriers and individual needs. Providers must recognize factors such as income, housing, transportation, and lack of food and collaborate with community resources to address these challenges. They should ensure that residents with physical disabilities have accessibility and those in rural or underserved areas know how to leverage telehealth. They can track health outcomes using demographics to identify gaps in care and use the data to guide quality-improvement initiatives. In addition, they can involve residents in care planning to make sure treatments meet both their preferences and their needs.

Increasing racial diversity in health care workers will lead to more culturally competent care naturally and can aid in better health care outcomes with lower mortality rates for underserved populations. However, a health care team, whether diverse or not, needs cultural competence training to collaborate effectively and address the needs of residents. Training helps providers avoid misunderstandings and recognize implicit biases and stereotyping. It also improves the ability to tailor care to meet each resident’s unique needs and thus increases satisfaction. Education opportunities should be ongoing and incorporated through workshops, webinars, and professional development opportunities.

Training programs should include these elements:

• Cultural awareness training to help providers recognize their own biases and understand how cultural differences impact health care interactions.
• Communication skills that focus on techniques for surmounting language barriers, such as using interpreters and culturally appropriate communication styles.
• Diversity education to provide insights into the health beliefs, traditions, and needs of various cultural groups.
• Role playing or case studies to offer practical real-world scenarios to apply cultural competence concepts in clinical practice.
• A health-equity focus to emphasize addressing barriers and social determinants of health.

Conclusion

By understanding and respecting cultural differences, using simplified communication and visual aids, and providing clear, culturally appropriate materials, health care providers can better address health disparities and improve resident outcomes. Strategies such as staff training, tracking and addressing gaps in health outcomes, interpretation services, and inclusive care practices help build an environment where all residents feel understood and valued. Cultural competence and health equity can help reduce the number of preventable health conditions and hospital readmissions, and their associated costs, benefiting both residents and facilities.

References
1.    Centers for Medicare & Medicaid Services. (2024). State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
2.    Schoenthaler, A., & Williams, N. (2022). Looking beneath the surface: racial bias in the treatment and management of pain. JAMA Network Open 5(6): e2216281. https://doi.org/10.1001/jamanetworkopen.2022.16281 

Lauren Stenson, MSN, RN, CNDLTC, QCP, DNS-CT, is a curriculum development specialist at the American Association of Post-Acute Care Nursing (AAPACN).