1. Care needs of older migrants: Perceptions and challenges
Bernhard Perchinig, Katharina Schaur

2. Project overview Time of implementation: June 2014 - Dec 2015
Donor: European Funds for Integration (EIF)
Desk research
Dataanalysis
30 Expert- interviews in Vienna and Linz (public administration, service providers, academia)
8 focus groups with 7 – 10 participants (2 gender mixed groups, 6 gender seperated groups, all in mother tongue of participants)
Countries of Origin: Former Yugoslavia, Philippines, Turkey

3. Main questions Quantitative dimensions of care needs of older migrants
Providers´ views of and reactions on growing diversity among their (potential) clients
Older migrants´ usage of care provisions
Knowledge about existing support structures and institutions among migrants
Expextations of older migrants with regard to care
Estimated care needs for persons born abroad 2025: , of whom mobile care

4. The migrants´ views

5. Access hurdles: Lack of information
Perception of only two options: „At home“, „retirement home“
Main source of information: Relatives and friends
Other relevant information sources: Family doctors,hospitals
Often distrust against information from public services
„We (Turkish people) also cannot ask the right questions. Thus we do not get the right information:“
„If you go somewhere to collect information, and they realise, that you do not speak German well.... It depends on the person sitting there if you will get the information or not.“

6. Access hurdles: Lack of multilingual information
Role of mother tongue
Necessary in case of low level of proficiency in German
Care as sensitive issue
Language as element of trust
Language as sign of acceptance
Information leaflets
Need for mother tongue leaflets
But not sufficient as information
Need for individual counselling
What information is relevant in my case?
„(The person at the counter) does not want to be bothered with an explanation, and does not want to listen to you as long as necessary to understand what you really want.“

7. Access hurdles: Finances
Precarious financial situation
Low incomes and pensions
Inequal distribution of household income
Women receive lower percentage of income than men
Lack of solidarity in poor hoseholds
Even low contributions too high for small incomes, indirect discrimination of women
„I have got the information that I could go to the care centre during the day, but it costs are Euro 7.- per hour I have to get from my husband. How shall I make it with my pension of Euro monthly?“

8. Expectations and fears
Expectations regarding family members and relatives
Care at home is the ideal
In-patient care in an retirement home is regarded as deportation from the family
Ambivalene:
Expectations to be cared for by children contrasted with
Knowledge about societal changes regarding
Children
Spouses
From extended family to nuclear family
„The children are not anymore what they used to be.“

9. Expectations and fears
Reservations against retirement homes
Reservations against public institutions
Image of old-age care based on image in countries of origin
„A home for the elderly is a place where people are trashed.“

10. Expectations and fears
Mother tongue proficiency of care-wokers
Element of trust
Fear not to be understood
Fear to be at the mercy of staff
Persons speaking the mother tongue as trusted person
Language as tool for contacts
Communication with care-giver
Fear of social isolation in retirement-homes
„We fear, that we cannot speak the language well and thus cannot communicate our problems.“
„I cannot talk with othera or enter into a friendship if there are no people speaking my language around.“

11. Expectations and fears
Food
Religious and cultural traditions (rice instead of bread, halal food)
Religion
Prayer rooms, religious celebrations and holidays
Gender
Gender match with care-givers
Linguistic, religious and cultural acceptance
„For me it is important that staff members accept and respect my culture, religion and eating habits. It makes you feel comfortable, if oyu know, that staff are people accepting other cultures.“

12. Overlapp of expectations ans fears
Conclusions
Overlapp of expectations ans fears
Sensitive and personally challenging issue
Relevance of language issues
Fear not to be understoof – in terms of language and culture
Fear of prejudices and lack of acceptance
Feeling welcome as migrant?
Unresolved access hurdles and expectations interact
Lead to low level of usage of existing services
Expert interviews confirm results of focus groups
Limited institutional and political responses on challenges

13. The providers´ views

14. The Austrian care system
Fragmented responsibilities:
Nine provincial governments responsible for both mobile and in-patient care: Lack of cooperation and exchange
Neither common standards nor common training
Complex landscape of public and private care providers, dominated by large institutional care providers, most of them close to churches or political parties
Access to care, funding of care and care standards differentiate from province to province, leading to difference in quality of care based on place of residence
Migration regarded as relevant challenge in all provinces, but no cooperation in development of migrant-sensitive care, no common capacity development
Reluctance to involve migrants´ organisation in care planning and delivery

15. Information Duty of the clients to collect information
Providers have multilingual information most often only in print.
First contact usually through doctors and hospitals
No systematic contact management
No evaluation of information access
Migrant status often no category for evaluation of service
Migrants often not regarded as group with specific information needs
Low level of service uptake usually explained with reference to migrants´ culture (care as family duty, religion)
Only limited discussion about intercultural adaptation of services

16. Culture and Language Language Culture
Communication in client´s language seen as relevant for trust
„Language matching“ regarded as impossible in mobile care, but in favour of language matching in in-patient care
Ad-hoc solutions and lay-interpreting in practice
Different opinions on language matching as element of care quality (from symbolic element to relevant)
Culture
Culture = Religion
Only limited training in religious norms and rules
Limited contacts with representatives of non-Christian faiths
Reservations against Muslim care-institutions

17. Care and Migration: Main challenges
Migration perceived as main challenge for care system
Strategy of postponement: Challenge for years 2025 ff., “trial and test” period until 2025
Common perception of a lack of knowledge of migrants
Limited knowledge on care needs of migrants in own area of service
No or very limited outreach activities to migrants
No or very limited contact to migrants´ organisations
Migrants´ organisations not seen as competent partners
Ad-hoc strategies dominate
Providers: Positive view of ad-hoc strategies, scepticism vis-à-vis strategic development
Positive image of ad-hoc-strategies as legitimation of lack of planning

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19. Bernhard Perchinig Research and Documentation
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