Geraldine Visser Expertise Center on Informal Care Netherlands Institute for Care and Welfare Utrech

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Geraldine VisserExpertise Center on Informal
CareNetherlands Institute for Care and
WelfareUtrecht, The Netherlands

• Migrant family carers

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Why attention for informal carers from ethnic
minorities?

• These carers have extra care tasks (e.g.
  interpreting).
• In the country of origin people are not familiar
  with long-term care. They are not prepared for
  care needs / unfamiliar with the Dutch health
  care system.
• Older people from other cultures are less healthy
  than native older people.
• Generation gap older people expect their
  children to care. But their children are not
  always able and/or prepared to care.
• Language barrier and different communication
  styles

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Numbers of older migrants in the Netherlands

• The migrant population is younger than the native
  Dutch population. However, until 2015 it is
  expected that the number of older people from
  non-native origin will increase from
• 116.445 in 2003 (2,9 of total older
  population) to
• 261.995 in 2015 (5,2 of total older
  population)
• Migrant older people are overrepresented in urban
  areas.
• There are no data about numbers of migrant family
  carers (an estimated 35.000 to 70.000 carers)

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Health of older migrants

• However, it is important to give notice to older
• migrants and their carers now. They are less
  healthy
• than native older people
• Severe physical problems
• 60 of Moroccan older people (65)
• 47 of Turkish older people (65)
• 34 of Surinam older people (55)
• In comparison native older people 20
• Migrant older people suffer from more chronic
• diseases than native elderly
• Diabetes
• Heart failure
• Migraine
• Rheumatoid arthritis
• Back problems
• Intestinal problems

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Explanations for health problems of non-native
elderly

• Lower socio-economic status (SES)
• Heavier working circumstances
• Marriage within families higher risk for
  hereditary diseases
• Excessive consumption of sweetness and fat
• Stress caused by migration

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Health care use of migrants

• Non-native older people visit the general
  practitioner
• sooner and earlier, and use more medication than
• native older people.
• Visits to GP
• 74 Turkish 65
• 73 Moroccan 65
• 70 Surinam 65
• In comparison 53 native older people
• Migrant older people do not use more assistance
• from medical specialists, hospitals and home care
  
• than native elderly. The GP acts as a gate-keeper.

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Explanations for low use of professional home care

• Unfamiliarity with (existence of) professional
  home care
• Dutch health and social services are not very
  well attuned to the needs of older migrants and
  their carers
• High use of informal care

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Use of informal care

• 54 of Moroccan older people (12,000)
• 30 of Turkish older people (8,000)
• 21 of Surinam older people (6,000)
• In comparison 10 of native older people

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Explanations for high use of informal care

• Expectations
• Older migrant people expect care from their
• family members, especially from daughters (in-
• law). A combination of formal and informal care
  does
• not occur very often.
• Need for care
• Especially Moroccan and Turkish older people
• suffer from more health problems than native
• older people.

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Burden of informal care

• There has been no scientific research about the
• situation of informal carers of older migrant
• people. However, there are signs that especially
• Moroccan, Turkish and Surinam family carers
• (women in particular) have problems and need
• support.
• Psychological and physical stress (e.g. fatigue,
  back problems)
• Sandwich problems care for their own children
  and for parents (in-law), and jobs
• Moral/emotional stress Problems between
  generations. Children want to meet their parents
  expectations, but also want to considerate their
  own interests. Discussing alternatives about care
  may be conceived as lack of respect for parents.
• Limited freedom

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Informal care needs

• Migrant family carers need support with
• Information
• e.g. about health and social services, about
  diseases, combining work and care etc.
• Practical support
• e.g. with household, personal care,
  administration, taxes, finances and other paper
  work
• Emotional support
• e.g. group meetings provide carers with the
  opportunity to meet others in a similar
  situation Getting to know others and being able
  to 'speak your mind' with those who understand
  realizing they are not on their own they give
  carers confidence / positive impact on their self
  worth. Others prefer individual emotional
  support, because they fear gossiping.

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Examples of support services for migrant family
carers

• Support centre for informal carers (information,
  advice and discussion groups for specific ethnic
  groups), Gooi Vechtstreek
• Respite care e.g. Kraka e Sewa, Amsterdam
  Meeting Centers for Surinam people with dementia
  and their carers
• Turkish carers support Living room meetings
  (Public health service, Utrecht)

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Examples of respite trips for Turkish family
carers
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Steps in support

• When professional health and social services want
  to
• develop special support services for migrant
  family
• carers, they need to follow the next six steps
• Make contacts with migrant families via
  intermediary (key figures in ethnic community or
  mosque)
• Contribute to conversations about seeking help
  outside the family
• Give advice and information about health and
  social services. Try to challenge the negative
  image of the Dutch health care system.
• Assess the needs of migrant families
• Try to judge whether existing support services
  meet these needs
• If necessary, adjust the support services to the
  needs of migrant families.

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Recommendations

• More attention for migrant older people and their
  carers in policy and practice
• Carers are unfamiliar with the Dutch health care
  system.
• Their attitudes towards care differ from native
  people.
• The health care system and policy are saturated
  with native values.
• There may be a lack of understanding due to
  barriers of language.
• Among the different ethnic cultures there are
  many differences with regard to care attitudes
  and values.
• Training for professional workers about problems
  of and support for migrant family carers

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More information?

• G.visser_at_nizw.nl
• Reference
• Schellingerhout, R. (ed.). Health and well-being
• of migrant older people. Gezondheid en welzijn
• van allochtone ouderen. The Hague, SCP, 2004.
• Pictures carers support Center Gooi
  Vechstreek
• http//www.mantelzorggooi.nl/index2.php?paginapag
  es/fotoalbum