Cultural Competence & Training Immigrants in Home Care

In 2015, a nonprofit organization in Albuquerque, New Mexico, Encuentro, created a culturally and linguistically competent home health aide training program for Latino immigrants. In New Mexico, 8,000 home health aides assist older adults and people with disabilities with daily tasks like eating, bathing, and dressing. They might also take on some clinical tasks (like reading blood pressure) under the supervision of a licensed professional.

The innovative 15-week program is conducted in Spanish, and Encuentro provides enrollees with scholarships to cover the costs of tuition and childcare. It includes 12 all-day training sessions, held on Saturdays, facilitated by trainers at Central New Mexico (CNM) Community College, and 15 weekly evening sessions led by Encuentro staff. Encuentro recruits all program participants through their relationships with Latino immigrants in New Mexico.

During the first evening session, Encuentro staff provide a thorough orientation to the format and expectations of the training program—most enrollees have less than a high school education, so attending a community college course may seem daunting at first. Once learners start training at CNM, Encuentro staff use the weekly evening sessions to facilitate small group work, case scenarios, and other adult learner-centered activities to reinforce topics covered in the training and to educate learners on their legal rights as workers. Adult-learner centered activities differ from more didactic approaches by helping learners apply their existing knowledge to new situations and experiences.

Ninety-four people have enrolled in the program to date, and all of them have graduated with a home health aide certificate. Graduates are qualified to provide state and federally-funded personal care and home health aide services in New Mexico.

I spoke with Andrea Plaza, Executive Director at Encuentro, and Leah Steimel, a consultant who oversees Encuentro’s home health aide training, to discuss this successful program.

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Graduates of Encuentro’s home health aide training program pose with their certificates of completion in the spring semester of 2017. Following the 15-week course, graduates are qualified to provide personal care and home health aide services in New Mexico. (Photo credit: MediaDesk NM)

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Stephen Campbell: Why did Encuentro create the home health aide training program?

Andrea Plaza: A few women in our English classes started complaining about back pain. When we asked them about it, they told us they were working as caregivers, but they hadn’t received any training. They had been hired by families to perform domestic work like housecleaning, but as they developed closer relationships with these families, they had started providing care for an older adult in the household.
I also remember one woman who was caring for someone with Down syndrome under a Medicaid waiver. I asked her about the training she had received. She said it was in English, and she could only understand the content when the instructor mimed tasks or drew pictures. She told me how inadequate that was.

Leah Steimel: That’s right. They wanted to learn how to stay healthy and provide quality services to their clients. I also remember early on, we had a conversation about how home care workforce development was important because of the market in our state. New Mexico is going to have a large older adult population because of our local population, and because people move here to retire.

SC: What challenges did you face in starting your home health aide programs? How did you address those challenges?

AP: It was a steep learning curve moving into this field. The National Domestic Workers Alliance (NDWA) was instrumental in helping us find resources that we could use to build our curriculum and design our program.

LS: CNM already had a curriculum that we could use for the Saturday classes, but we helped translate the materials into Spanish. NDWA connected us with Casa Latina in Seattle. They offer a home care training program like ours, and we use parts of their curriculum in the Wednesday class.

AP: Fundraising was challenging, too. We felt strongly about providing scholarships to students so that tuition and childcare wouldn’t be barriers. We’re able to frame funding proposals around workforce development and family economic security. Latino immigrants will provide a lot of the care for the growing population of older adults. If these workers aren’t well-trained, older adults are not going to get the care they need.

We also learned that it’s hard for people to afford care. I expected our graduates would be able to find full-time caregiving jobs, but most families can’t afford a full-time caregiver. We’re asking ourselves, how do we create employment options that help aides piece together clients and job opportunities?

LS: The employment conditions are challenging, too. It can be an oppressive industry to enter, and two-thirds of our students don’t have work authorization so they can’t work for an agency. We make sure they understand what their rights are. We also launched a new matching service called EnCasa Care Connections in October of this year to help workers find self-employment opportunities. Workers usually prefer self-employment, too, because they can earn more than they would with an agency.

SC: How does EnCasa Care Connections work?

LS: Consumers submit an online form with their care needs, and graduates of the home health aide program submit an online form with their skills, experience, and availability. Both groups tell us their preferred language. When people request a caregiver, we send them resumes for three or four aides whom they can interview, but we aren’t involved in the interviewing and hiring process because we’re not an agency.

AP: The EnCasa website is also an educational tool for workers and consumers. Leah included sample interview questions and mock contracts. We recommend consumers pay the aides $15 an hour.

SC: What has been the impact of your home health aide training program and EnCasa Care Connections?

LS: I was walking across the community college campus with one of the program participants. We had just finished a tour of the campus so the students would know where to go on the first day of class. She told me: “This is my life’s dream. This is what I’ve waited all my life to be able to do—to take this kind of training and to do this kind of work.” I’ve heard a lot of participants say that. Many graduates were already working in this field and the training helps them feel more confident.

Consumers are grateful, too. One person needed services for her mother, so she turned to EnCasa Care Connections. As she interviewed one of our graduates, she was so impressed that the aide thought of creative ways to help her mother stay socially active. The aide was also caring for an aging father, and she offered to arrange social activities for the two of them. This client had asked a home care agency to provide more socialization opportunities for her mother, but they had never acted on her requests.

That client’s mother was a Spanish speaker. We don’t tailor our services to Spanish-speaking older adults, but some people have approached us because our aides are Latino immigrants. Consumers who are Latino immigrants themselves often face cultural and linguistic barriers, which isn’t the case when they work with our aides.

SC: What have you learned through your home health aide training program and EnCasa Care Connections?

AP: I have been humbled by the complexity of this industry. We need better information on how older adults can navigate resources in their community, and access subsidies and waiver programs to pay for their care. People want to use EnCasa Care Connections, but they don’t know how to afford services. It’s a big challenge that impacts employment opportunities and the family economic security for our students.

SC: What is one hope you have for immigrants in home care in the future?

LS: Home care workers face challenging work conditions, and immigrants face added difficulties related to discrimination. The home care industry needs to improve these jobs to resolve issues around discrimination and a lack of understanding about how to approach language barriers.

AP: I agree. I would add that our graduates have so much heart and so much care that they invest in their work. They often sacrifice a lot for themselves and their own families because of the number of hours they are investing in this work. We need to pay these workers a dignified wage to reflect their commitment to their jobs.

Graciana Davila and her client play Lotería, a Mexican board game similar to Bingo. Davila graduated from Encuentro’ s home health aide training program in the spring semester of 2017. (Photo credit: MediaDesk NM)