Seen, Known, and Cared For

The Case for Cultural Competence in Caregiving

What Cultural Competence Actually Means

The term is often used in healthcare settings. It appears in mission statements and staff training modules. It is often checked off and moved past.

But cultural competence is not a box to check. It is an ongoing practice that is specific and deeply personal.

At its core, cultural competence in caregiving means understanding and honoring the full human context of the person being cared for. That context includes:

Cultural, racial, and ethnic identity: Who this person is, where they come from, what that heritage means to them, and how it shapes their daily life and their expectations of care.

Language and communication: Not just whether someone speaks English, but how they express pain, ask for help, show respect, and receive comfort. Language is not just logistics; it is identity.

Religious beliefs and practices: Faith is not an add-on to a person’s life. For many older adults, especially those of the generation currently in care settings, it is the organizing principle of everything. It shapes how they understand illness, suffering, death, and meaning.

Cultural healing beliefs: What does this person believe about medicine? About the body? Who has the authority to make decisions about care? These beliefs vary enormously across cultures and must be understood, not overridden.

Family systems and values: In many cultures, care is a family matter, not an individual one. Decisions are made collectively. The eldest son speaks for the family, and the daughter moves in. To treat the older adult as an isolated individual in these contexts is to

fundamentally misread the situation.

Nutritional traditions and food practices: Food is culture made edible. It is memory, comfort, identity, and love. What someone eats, and what they will not eat, matters enormously to their quality of life.

Lifestyle and habits: The rhythms of a life, built over decades, are not incidental. They are the person.

When cultural competence is absent, care suffers. When it is present, something wonderful can happen.

When the Match Is Right

I once worked with a Latino client whose care was transformed the moment a Latino caregiver was placed with him.

The change was immediate and profound.

They spoke Spanish together — not as accommodation, but as natural expression. The caregiver cooked the food he had eaten his whole life. They shared cultural reference points, humor, and a way of being in the world that needed no translation.

There is something worth noting here beyond the warmth of connection: speaking two languages — moving between Spanish and English — is genuinely good for the aging brain.

Bilingualism has been associated with cognitive resilience. In honoring his cultural identity, his caregiving situation also helped protect his cognition.

But beyond the neuroscience, what struck me most was simpler:

He was seen. He was known. He was cared for by someone who understood not just his needs, but his world.

This is an example of what person-centered care really looks like.

When the Match Is Imperfect, and What Goodwill Can Build

Not every caregiving relationship begins in cultural alignment. And that is not necessarily a failure, as long as both people are willing participants.

A Polish caregiver was placed with a client whose culinary traditions were entirely different from her own. She cooked what she knew, like herring, borscht, and cabbage rolls. The client, let’s call her “Mom,” (because that is how her family spoke of her), wanted absolutely no part of it.

There was tension, resistance, and some difficult days, but over time, things eventually shifted.

The caregiver liked Mom a lot and wanted to make it work, so she started asking a lot of “culinary” questions. She tried unfamiliar recipes, imperfectly at first, then with growing confidence. And Mom eventually noticed the sincerity of the effort. While the meals were never quite right in Mom’s eyes, she, too, adapted.

What grew between them was not seamless cultural alignment. It was something arguably more human: the willingness to reach across differences with patience and respect. Mom and the caregiver eventually became the best of friends and stayed together for the rest of her days.

The lesson here is not that a cultural match is always necessary. It is that cultural awareness, which is the acknowledgment that what someone eats, how they cook, what flavors mean home, matters enough to try.

The Woman in the Geri-Chair

Bliss erupted on the woman’s face.

She had end-stage dementia. She was confined to either her bed or a geri-chair, largely unreachable by the usual measures of connection, like mutual conversation, recognition, and response. The skilled nursing facility that cared for her was not unkind, but it was not imaginative either.

I asked her daughter a simple question: Did her mother enjoy music?

She did. Jewish sacred music, especially. The hymns and melodies of her faith — the ones she had heard her whole life, that lived somewhere deeper than memory, deeper than language, deeper than the disease that had taken so much else.

We loaded an iPod shuffle (I’m dating myself here!) with as many of her favorites as we could find, and slipped on the headphones. Then it happened before my eyes. When the music began, her eyes opened, and her face lit up. An experience I have obviously not forgotten.

Whatever had been locked inside her, and whatever the institution had not known how to reach, came flooding back through the music of her faith.

Her environment was finally resonating with her, and she felt safe.

This is yet another example of what cultural competence looks like in practice. It’s not a policy or checklist.

It’s a daughter who knew what her mother loved. An advocate willing to ask, and a woman with no words left who still had a soul that recognized home.

End-stage dementia. A geri-chair. A facility that was doing its best within its limits.

And a face that opened like a window when the music of her faith filled her ears through a pair of headphones.

What reached her, in the end, was not a protocol, a care plan, or a clinical intervention. It was the knowledge held by her daughter, activated by a simple question, that her religious identity was not incidental to who she was.

It was who she was.

Cultural competence did not cure her dementia. It did not restore her language, memory, or mobility.

It gave her bliss.

In a geri-chair, in a nursing home, at the end of her life, she was seen, known, and cared for in the fullest sense of those words.

That is what we owe every person in our care.

Not just safety or cleanliness. Not just the absence of harm.

But the profound dignity of being fully known.

When the System Fails

Not all stories resolve so warmly.

I once knew a home care aide who was somewhat chastised by the family she worked for because she did not know how to use a vacuum cleaner. The family, in fact, found it appalling.

The caregiver was from the West Indies, and vacuum cleaners were not part of the household reality she had grown up in. She had never laid eyes on a vacuum cleaner before. Never.

Is this the caregiver's fault? Absolutely not. Was it reasonable for the family to believe that the caregiver would know the basics of household cleaning? In this case, yes, but they were wrong to take out their frustration on the caregiver. This was the fault of the homecare agency that employed the caregiver, without a doubt.

She had not been trained on basic household appliances by the agency that placed her. She arrived ready to work, proud of her abilities, committed to the family in her care, and was made to feel incompetent and ashamed over a piece of equipment she had simply never encountered.

Her feelings were hurt deeply because she took enormous pride in her work.

This was not her failure.

This was a systemic failure by the agency that placed her without adequate preparation, and by a set of assumptions so embedded that no one thought to question them.

Caregivers need to be set up for success when they begin caring for a new family member. No excuses.

That means agencies must provide appropriate cultural preparation for the aides they place and for the families who receive them. It also means families must examine their own assumptions about what “good care” looks like and where those assumptions come from. It means we cannot place people into care relationships and assume that shared humanity is sufficient preparation.

What This Asks of All of Us

Cultural competence is not the sole responsibility of the caregiver.

It is a shared practice among families, care professionals, agencies, and facilities. It requires everyone in the caregiving ecosystem to ask questions they may not have considered before.

For families:

• What does your loved one need to feel at home in their care? What foods, what language, what music, what rituals?

• What does your family’s cultural background mean for how decisions get made, and who needs to be at the table?

• What assumptions are you bringing about what “good care” looks like, and are those assumptions shared by the people you’ve hired?

For care professionals:

• What do you know about this person’s cultural, ethnic, and religious identity, and have you asked or assumed?

• How does this family make decisions? Who holds authority? How is that expressed?

• What would it mean for this person to feel truly known in their care? Not just safe, not just clean and fed, but known?

For facilities and agencies:

• Are your staff trained not just in tasks, but in cultural humility — the ongoing practice of recognizing that every person carries a world you may not fully understand?

• Are you setting your aides up for success, with adequate preparation, clear communication, and the tools they need to serve the people in their care?

We can always do better.

Note: The people in these stories are real. Their names and identifying details have been changed to honor their privacy.