Accommodating the Strangeren Casa:How Mexican American Elders and Caregivers Decide to Use Formal Care

Abstract

Mexican American elders have higher levels of functional impairment and chronic illness, yet they use formal home care services less than do non-Hispanic White elders. This article describes the processes by which Mexican American elders and their caregivers decide to use home care services. Interviews were conducted with Mexican American elders (n = 11) and family caregivers (n = 12) for a sample of 23 individuals. The emerging substantive grounded theory included three stages that described the process of deciding to use home care services: Taking Care of our Own, Acknowledging Options, and Becoming Empowered. The processes describe how Mexican American families eventually accept home care services while maintaining their cultural norm of taking care of elders. The theory gives voice to both elders and caregivers in this process, adds to extant knowledge, and shapes interventions to support traditional Mexican American family values such as elders' staying at home as long as possible. The theory meets nursing's goals of reducing health care disparities by improving or sustaining elders' health and functional ability, decreasing the caregiving burden, and reducing health care costs.

Mexican American elders' use of home care services

“…Such an intervention could also address elders’ and caregivers’ confidence in HCS. An earlier study that found that the process of deciding to use HCS was initiated by the caregiver in MA families (Crist, García-Smith, & Phillips, 2006). The fact that caregivers’ but not elders’ responses about Service Awareness were significant demonstrates that elders may need more understanding about HCS, and that caregivers’ awareness about service currently is the key to the use of HCS.…”

“…Use of HCS prevents the onset of acute illness, controls acute illness episodes, and helps manage chronic conditions (Anderson & Horvath, 2002). Recent studies revealed that use of HCS among MA elders is a complex phenomenon that includes caregivers’ perspectives (Crist, García-Smith, & Phillips, 2006). To date, no theory has captured this complexity.…”

Pragmatic Action Research With 2 Vulnerable Populations

“…In this exemplar, various methodologies included ethnography, already briefly described, 6 grounded theory, 14 and model testing. 15 Obviously, retroduction , going back to the community and conducting exploratory qualitative research when more quantitative studies made apparent the need for conceptual exploration and development, was sometimes appropriate.…”

“…Caregivers’ and elders’ social processes shaped families’ overt and covert negotiations about elder care management. 14 Families together negotiated their decision to seek information about home care services, initiating a shift in the family’s level of confidence and trust toward bringing “a stranger” (home care services staff) into the home. Elders eventually accommodated by coming to think of home care services staff as kin, using the culturally specific personalismo (Mexican American priority of establishing a personal relationship over the Anglo focus on a professional relationship).…”

Nativity Status and Sources of Care Assistance Among Elderly Mexican-Origin Adults

“…Mexican-origin elders also tend to underutilize formal caregiving services (Crist, Garcıa-Smith, & Phillips, 2006; A. P. Herrera, Benson, Angel, Markides, & Torres-Gil, 2013), including nursing homes and other long-term private-pay care facilities, even when they suffer a significant decline in functional capacity (Espino, Angel, Wood, Finely, & Ye, 2013).…”