Examples of culturally appropriate care

Helping people keep up religious or spiritual practice can be important to their wellbeing. These are some of the ways you can help people practise their beliefs.

• Encourage people to have any religious or spiritual items in their room. Things like pictures, prayer beads, spiritual statues or holy books - like the Bible or the Quran - can give comfort.
• Many places of worship are streaming prayers, services and other events because of the pandemic. This could create new opportunities for people who could not attend in person before. These places include churches, gurdwaras, mosques and temples.
• People who follow some religions - for example practising Muslims - may wish to get up early to pray. They may also want a chosen space to pray in. They might need to eat at different times during religious festivals like Ramadan.
• You may need to make sure hair care is in keeping with people's religious and cultural expectations. This might include beard grooming and hairstyles.
• In some South Asian cultures, the right hand is seen as clean and the left is seen as unclean. People's access to bathing facilities has not always been as good as it is now. In the past, the left hand would be used for cleaning after going to the toilet. Because of this, some people will not want food to passed to their left hand. They may also like the fingernails of their right hand cut before the left.
• In some South Asian cultures, people see nail polish as unclean because it is not water-soluble.
• It's important to ask people how they want to follow their religion in practical ways. There are many differences within religions. For example, the Christian Church has different branches or denominations.
• It can make a big difference to someone's wellbeing if they're in touch with their local priest or religious leader. The priest or religious leader may also be able to give you advice. They could tell you about practical steps you can take to support the person's daily religious or spiritual practice.

• Do not make assumptions. For example, not all South Asian or African people like spicy food.
• If people are not eating or drinking well, be curious and ask questions.
• If someone follows a Kosher or Halal diet, you may need to prepare their food differently to avoid cross contamination. They might need reassurance about this before they're happy to eat. For example, you could take them to the kitchen so they can see how their food is prepared.
• Involve people in meal planning and think about variety. For example, if someone is a vegetarian and from a South Asian or African culture, only having English vegetarian dishes might be boring.
• In some cultures, it's polite to refuse food and drink the first time they're offered. This means you might need to offer more than once. For example, someone might not accept a cup of tea until you've offered 3 times, which might mean they do not drink enough. It's best to learn what works for them.
• Think about the way you present food. This also varies in white British culture. In some cultures, people eat with their hands and may not want to eat with a knife and fork. Or they may prefer to eat with a spoon.
• If someone appears to have changed their cultural preferences – for example, a person living with dementia decides to eat something not normally allowed under their faith – it might be important to consider whether the Mental Capacity Act applies. Use this to help you determine whether the person lacks capacity or has just changed their mind.

• Check if medicines contain animal products, for example gelatine capsules. Gelatine is not Kosher or Halal, and it will not be suitable for vegetarians or vegans. So you'll need to discuss it with anyone that needs an alternative.
• Some people may want to fast during Ramadan, so the timing of their medication may need to be changed. A GP may need to review any changes to make sure they're safe.
• There are no animal products in COVID-19 vaccines. But some people may be anxious about accepting a vaccine if they are unsure. Information for older people is available in different languages and alternative formats: COVID-19 vaccination: guide for older adults - GOV.UK (www.gov.uk).
• If someone lacks mental capacity to consent to a decision about a particular care or treatment option - including vaccination - it’s important to apply the Mental Capacity Act. When assessing if someone lacks capacity or giving information to support someone to make a decision, you should take cultural factors into account. Using the Mental Capacity Act to make a 'best interests' decision must include considering the person's beliefs and values.
• Some people may want to use complementary or alternative remedies. For example:
  • some West African people use the kola nut to aid digestion. If someone wants to use the kola nut, you can discuss it with them as part of their care planning. You should also consult healthcare professionals where needed.
  • miswak are traditional herbal chewing sticks that help oral hygiene. They're popular in India, Pakistan, most Arabian countries and several African countries. Some studies have suggested miswak are as effective or more effective than using a toothbrush. You could consider letting someone use miswak if they want to. You should consult healthcare professionals if you have any concerns about this.

What people wear is a very individual thing. It varies from person to person - and day to day. It's important to give people a choice of what to wear, and listen to them and their families.

• The sari is a traditional Indian women's garment. Some people wear them every day. Others only wear them on special occasions. It could depend different things like what region of India they're from, their family history and their own preferences.
• The dashiki, kanga and the gomesi are colourful garments from different parts of Africa. Some African people wear them on special occasions.
• While some Muslim men wear a shalwar kameez every day, others do not. Muslim women who are widows might only want to wear certain colours. There are many different types of head covering (hijab) worn by Muslim women. But not all Muslim women wear them.
• In some cultures, how people dress in public is different from how they dress in private. This might be important if you are arranging a video call between a person and their family. It also varies according to personal preference.

Letting people personalise their rooms gives them somewhere they can express their culture.

It's important to think about the shared space too. Think about how it's decorated and what pictures there are, as well as the outside space. Does it reflect the culture of everyone that uses it? Can you involve people using the service to make the environment more meaningful to them.

If you use CCTV, it's important to think about whether cultural factors affect consent. For example some Muslim women may not wish men to have access to CCTV footage in private areas such as bedrooms. Or they might not want anyone to look at images that show them without a headscarf.

Think about people's interests and their culture when you plan shared activities. For example, there are board games that come from different cultures.

You can plan culturally specific reminiscence activities. Think of ways you could involve everyone in these. Look at SCIE's resources on reminiscence for ideas.

People in some cultures might want to take part in things like activities just with people of their own gender. But it's important to let people make their own choices, as they may form friendships across differences like gender.

Even in the pandemic, you can bring communities into your setting - instead of taking people out into the community. For example you can:

• celebrate festivals by arranging special food, films and entertainment. You can even deliver special food to people's rooms if they are self isolating.
• think about how the diversity of your staff can contribute. They might volunteer to organise something, give a talk or put on an event that comes from their culture. In one care home, we saw staff of different ethnic backgrounds and lesbian, gay and bisexual staff contributing to events.
• put on entertainment in the garden so people can watch it from a distance or from their rooms. We saw a care home for older Gujarati people organise Bollywood Saturdays with entertainers in the garden.
• find radio stations from different cultures that people can listen to in their rooms.

When the government lifts restrictions, think about:

• arranging a visit to a place of worship. This might be a temple, mosque or church service. You might need to coordinate this with people at the service to manage potential disruption. Or you could arrange a special service that's tailored to people's needs.
• visiting community events like carnivals, Mela or art events.

Cultural values can affect communication in many ways.

• All cultures have rules about politeness that affect the way people communicate. Again, it's best to be curious and ask questions. For example, it's important to address people in the way they prefer.
• You may need an interpreter if you are communicating about important things with people who speak a different language. Examples might be care plan reviews or medical appointments. While some people are comfortable using family members to help, this might not suit every situation. Family members are not professional interpreters and there may be conflicts of interest. 
• In day to day communication across languages, there are some simple things you can do that will help:
  • allow enough time for communication
  • listen to the words a person uses and try to use their vocabulary
  • use plain English and avoid jargon or specific expressions
  • check the person has understood you and that you have understood them
• Use the language skills among your staff. Staff that share a language with someone that uses the service sometimes help other staff to learn a few useful phrases.

Some people living with dementia revisit memories that are specific to their culture. It might be something that makes them upset, even if you're unaware of it. It's best to talk to the person and their family so you can support them.

• One example is the Partition of India and Pakistan - and later Pakistan and Bangladesh. Some people might have been part of the actual migration and left one area for another. People might talk about childhood homes with a sense of bereavement or loss for their home, family and friends.
• Sexual crimes were committed against women during the Partition. Some women might have been actual victims or witnessed this first hand. It might have an effect on the way they behave or what they say, or it might cause anxiety.

Understanding people's wishes at the end of their life is always important. It can be particularly important if the person using the service and staff do not share the same culture.

• Involve people's families in planning as appropriate. But be aware of potential family tensions. This might particularly be the case for older LGBT people, for example.
• In Jewish and Islamic faiths, burial needs to take place quickly. This is another reason why it's important to have a plan.
• Prayers and rituals can bring comfort to people. You should agree these with the person or their family or representatives. If it is not possible for a faith leader to be present, think about whether there are alternatives. For example, a member of staff from the same culture might be able to read prayers. Or you might be able to use a recording.
• Always doing the same things to mark the end of someone's life may not suit a particular person's religion or preferences. For example, in some cases you might open a window to let someone's spirit fly away. But other people might not hold this belief. It's best to discuss customs and preferences with the person and their family. You should do this as part of end of life care planning.

• Include cultural competence in training for care staff and providers.
• It might be helpful to match staff with people from the same culture, for example as a keyworker. But it's important you give the person a choice and do not assume it's what they want. You should discuss it both with them and your staff member.
• Some services make use of skills their staff have that are not strictly part of their job. For example, a member of staff who shares a language with someone using the service could teach their colleagues a few useful phrases. It's important to ask them first if they're happy to do things like this.
• You can organise events in your service that recognise the cultural backgrounds of your staff as well as people using the service. This can help people to understand each other better.
• Racism and other forms of discrimination towards staff from people using the service can take place. It's important to have an open staff culture so staff can raise this with managers to work out solutions.