ASSESSMENT OF COMMUNITY- BASED SERVICE NEEDS OF ELDERLY IRAQI AND - - PowerPoint PPT Presentation

ASSESSMENT OF COMMUNITY- BASED SERVICE NEEDS OF ELDERLY IRAQI AND BHUTANESE REFUGEES LIVING IN PHILADELPHIA

April 1, 2015

Nicole Matteucci

Capstone Project Thomas Jefferson University

Assessment of community-based service needs of elderly refugees

 Introduction & Definition of the Problem  Methods  Results  Data Analysis  Discussion  Recommendations  Limitations

What is a refugee?

Background: Iraqi Refugees

 US has accepted about 73,000 Iraqi refugees  Political Instability  Economic Stagnation  Violence

Background: Bhutanese Refugees

Elderly Refugees

 UNHCR’s statement on geriatric refugees:

 “It is commonly assumed that older people are more

likely to choose to stay in their place of origin, or, more tragically still, to perish in flight or to pine away and die in exile. In fact, older refugees make up some 8.5

percent of the overall population of concern to

UNHCR, and reach up to more than 30 percent for some caseloads” (2000).

Pennsylvania

 Refugees in PA: 3,033  510 Iraqi  987 Bhutanese  Refugee Resettlement Program

 Case management  Education  Employment  Financial services

Philadelphia

 Refugees in Philly: 774  241 Iraqi  176 Bhutanese

 Local Organizations

What are the major sources of stress for Iraqi and Bhutanese elderly refugees? What types of services and programs do they want and believe will help them to address their needs?

Research Questions

Methods

 Exploratory study  Target population: convenience sample of 6 Iraqi

and 6 Bhutanese refugees

 Inclusion criteria: 60 and above & resettled in

Philadelphia from either Iraq or Nepal within 3 years

 Recruitment: First 2 weeks of January

Semi-structured Interview

1) Participant Background Information 4) Sources of Stress 3) Social Roles & Activities 1) Health & Functional Status 5) Knowledge

• f & Access to

Programs

Data collection took place in participants’ homes in South & Northeast Philadelphia.

January 2015

Data Analysis

 A priori themes (reflected in interview domains)  Data organized in an excel sheet  Opened ended responses were categorized by the five domains &

analyzed for cross-cutting themes

Demographics of Participants

Health & Function

Thematic Analysis

 Health & Functional Status

 Difficulty managing conditions, health literacy, navigating

health insurance

 Social Roles & Activities

 Decreased social engagement, poor mobility, lack of

activity

 Sources of Stress

 Language barriers, concern for family members,

environment, financial uncertainty

 Knowledge of & Access to Programming

 Language barriers, frustration with PCA

Cross-Cutting Thematic Analysis

Health Language Mobility

Managing Conditions Health Literacy Health Insurance Navigation Physical Capability Navigation Challenges

Chronic Dependency Elder and Caregiver Stress Social Disintegration Isolation, lack of engagement

Language

Medical Case Manager, NSC

 “They don’t speak, read, or write English.

This negatively affects every aspect of life, from their ability to schedule sick visits, to taking public transportation, speaking with physicians, understanding printed health information, retrieving and taking their medication, reading recipes and cooking, and participating in classes or social activities with other seniors.”

Health

 Managing Chronic Conditions  Health Literacy  Navigating Health Insurance

 “I would feel good if I knew how insurance

worked, then I wouldn’t have to worry. But the past insurance, the Keystone one, covers a lot, but now the insurance I have doesn’t cover a lot.”

Mobility

 Physical Limitations

 Trauma of Migration  Effects of Aging

 Navigation Challenges

 Public Transportation  Fear of Getting Lost  Change in Environment

“It’s difficult to navigate the city in general, especially for the elderly. For the Bhutanese, back home they were able to walk around, and here it’s a lot harder because the built environment is challenging and the weather is much different.”

Director of JCRH

• Fewer opportunities for integration
• Less exposure to new society
• Single caretaker
• Responsibility for parent = Interpreting,

accompanying parents to appointments, managing health problems, etc.

• Maintaining household, raising children, college

courses, multiple jobs

Overarching Theme: Chronic Dependency

• Different lifestyle in US vs country of origin
• Lack of knowledge of services
• Outreach challenges
• Need for cultural competence training
• Lack of funding

Overarching theme: Social Disintegration

Health Language Mobility Chronic Dependency & Social Disintegration

Now what?

Recommendations: Activities

 A Place for Programming

 Northeast and/or South Philadelphia  Games & Gardening

 Opportunity to connect with peers  Respite for caregivers  Exposure to neighborhood

Recommendations: Classes

 Specialized Instruction

 ESL  Health Literacy/Insurance Navigation  Public Transportation

Recommendations: Health

 Community Health Workers

 Home/follow up visits  Prevention strategies

 Partnership with OT/PT Programs

Immediate Next Steps

 Asset Mapping  Partnerships

 Aging Services Network  Social Service Organizations  OT/PT Programs

 Education/training  Future Research

 Caregiver Focus Groups  Resource Guide

Limitations

 Small sample size  Cultural barriers  Limited Funding

 Used for interpreting informed consent  English speaking family members instead of certified

interpreters

(Thank you)

धनॎयवाद & اركش

References



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

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

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

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