Care, Culture, and Community: Working Towards Equity for Older Adults

“This is part of Black Lives Matter,” says Tracy Schroepfer, MSW, PhD, a professor at the University of Wisconsin–Madison Sandra Rosenbaum School of Social Work.  

“Racism and discrimination are embedded in systems. We need to dig through policies and practices and make changes to meet the needs of all older adults, in particular older adults of color.” 

Schroepfer works with older adults across racial and ethnic communities. She’s part of a collaborative local effort to ensure that older adults in Dane County can receive care that honors their cultural practices and beliefs. 

The project was spurred by a presentation that Schroepfer gave to social workers at NewBridge, a nonprofit formed by the merger of four senior coalitions in the greater Madison area with the Hmong Institute. 

“When I do workshops for social workers, I talk a lot about our professional boundaries and the code of ethics,” says Schroepfer. “The boundaries seem very firm, but there is flexibility within the code of ethics to honor the beliefs and values of different communities.” 

A few days after the NewBridge workshop, Schroepfer received a call from a supervisor there. 

The supervisor told Schroepfer, “Our social workers who are Hmong feel that the code of ethics totally ignores their culture. There’s not the flexibility that they need. They can’t bill for the work they want to do.” 

Schroepfer gently explained that the problem wasn’t the code of ethics. It was the case management standards that had been written as part of NewBridge’s merger process. She suggested meeting with Hmong leaders to better understand the situation. 

“After meeting with the Hmong community, we met with health care leaders in the African American and Latinx communities,” says Schroepfer. “These meetings were very, very illuminating. It became really clear how there could be issues.” 

For example, the case management standards didn’t allow staff to bill for transportation, since that usually involves simply driving older adults to appointments. 

“The Hmong leaders explained the transportation services that case managers provide to Hmong elders often involve counseling,” says Schroepfer. 

“When a case manager drives an elder to Milwaukee for a citizenship test, they are preparing the elder. They’re explaining what’s going to happen, because it’s not clear and the elder is concerned. On the drive back, they’re debriefing with the elder and letting them know what will happen next. It’s not just driving.” 

Another issue was that the case management standards reflected the white dominant culture’s focus on the individual and their independence.  

“The communities we talked to stressed the importance of interdependence,” says Schroepfer. “In some cultures, it’s the individual and their family who make decisions about goals. It’s important to be not just person centered, but family centered, even community centered.” 

The information from local Hmong, African American, and Latinx leaders is now being used to make the case management standards more flexible and responsive to different cultures. 

For example, one of the goals was “to promote and enhance when possible the skills of the client in accessing and utilizing supports and services.” 

“Community leaders told us that due to language differences, elders may not understand the systems here,” says Schroepfer. “They may have come from other countries, where they don’t have Medicare or Medicaid and the health system is very different.” 

The revised goal is “to promote and enhance the client and/or family’s trust in and ability to access and utilize supports and services, including educating on services, systems, and environments with which they’re unfamiliar.” 

In addition to revising the case management standards, NewBridge is committed to engaging diverse health professionals, developing different care strategies, providing ongoing training opportunities that stress cultural humility, and clarifying case manager roles and responsibilities. 

“We all have biases,” says Schroepfer. “What’s really important is that we continue to reflect on them and the role that they play. We look through our own lens. We need to be open to considering other people’s lenses, too.” 

–Diane Farsetta