How Cultural Values Influence Hispanic Views on End-of-Life Care
How Cultural Values Influence Hispanic Views on End-of-Life Care
Raquel Vasquez
Department of Psychology, Rockland Community College
PSY 20300 Sec 811 Developmental Psychology
Prof. Linda Alvira
December 1, 2023
1
How Cultural Values Influence Hispanic Views on End-of-Life Care
2
Abstract
Hispanic families are less likely to use nursing homes and hospice care for elderly or ill family
members. This reluctance stems from deep-rooted cultural values such as strong familial bonds,
language barriers, dietary preferences, and religious beliefs. This paper details how these cultural
values influence Latino views on nursing home care, what can be done to implement policies and
procedures to target the needs of this minority population, and the implications of not addressing
Hispanic concerns.
Keywords: Hispanic, Latino, cultural values, end-of-life care, long-term care, nursing
homes, familial bonds, language barriers, dietary preferences, religious beliefs
How Cultural Values Influence Hispanic Views on End-of-Life Care
3
How Cultural Values Influence Hispanic Views on End-of-Life Care
Placing a loved one in an end-of-life care facility is often a difficult and emotionally
charged decision. In the Latino community, it is especially so due to cultural implications.
Research indicates that Hispanic families provide more thorough caregiving in terms of time and
level of care dedicated than other populations, and are less likely to use nursing homes and
hospice care. Instead, they prefer to employ alternative care options for elderly or ill family
members. Some of the key factors behind this reluctance include familial ties, language barriers,
dietary concerns, and spiritual beliefs.
Familial Ties
Strong familial ties and support have a significant role in Hispanic culture. Traditionally,
caring for elderly parents is considered a collective familial responsibility rather than an outside
obligation. As such, Hispanic families often turn to nursing homes as a last resort, favoring athome care for their loved ones. This value was expressed by a Hispanic female interviewee who
delayed placing her husband into a home, despite his suffering from beginning stage 6
Alzheimer’s disease – a stage that is characterized by severe cognitive decline including lack of
awareness of surroundings, personality and behavior changes, near-total assistance with activities
of daily living, and incontinence. The interviewee expressed feelings of guilt leading up to and
after her husband’s admission. As his wife, she believed she should shoulder the burden of his
care. With time, their children helped her resolve these feelings of guilt, and she now feels
relief that her husband is receiving optimal care in a long-term-care facility (Clara S., personal
communication, October 4, 2023).
Even when circumstances require placement in a nursing home, the Hispanic family's
involvement remains strong. Family members continue to act as advocates for their loved ones
by communicating with healthcare providers, ensuring that cultural needs are met, and
How Cultural Values Influence Hispanic Views on End-of-Life Care
4
monitoring the quality of care being provided. They also provide emotional support to their
loved ones by visiting regularly. Moreover, Latinos often consult with other family members to
make group decisions, ensuring that they align with cultural values and beliefs. For example,
according to Cardenas et. al, “Hispanic families may collectively agree to hear about medical
news before the patient is informed so that they can shield the patient or deliver the news
gradually” (2007).
Language Barriers
Language barriers are another area that can deter Hispanics from placing loved ones in
long-term care facilities. First, it hinders effective communication between Spanish-speaking
patients and predominantly English-speaking health care staff at nursing homes. This can lead to
misunderstandings and errors in treatment. According to Squires, the largest group of immigrants
to the United States in the past 30 years are Spanish speakers. However, only five percent of
health care staff speak Spanish. The result of language disparity is reflected in patient outcomes.
For instance, it has been shown that miscommunication increases the risk of infection, falls,
pressure injuries, surgery delays, and medication non-compliance (2018).
Secondly, the linguistic divide can affect a patient’s mental health by causing feelings of
isolation and frustration. A Spanish-speaking elderly resident who is unable to express their
needs, concerns, or medical history accurately, may feel excluded from activities or
conversations due to their limited English proficiency.
Finally, language barriers hinder access to information about healthcare rights and
options, which affects the ability to make informed health care decisions. Many Spanishspeaking patients, especially the elderly, find that they struggle to understand the litany of
medical procedures, terminology, instructions and consent forms.
How Cultural Values Influence Hispanic Views on End-of-Life Care
5
To address language barrier challenges, a few steps can be taken. One is for nursing
homes to prioritize hiring bilingual staff members or interpreters who can bridge the
communication gap. Another is providing translated materials to increase the understanding of
important information. As the Hispanic population continues to grow, it is crucial to address this
issue to ensure effective communication and quality care for this vulnerable group.
Dietary
Dietary cultural differences are another factor that discourages Hispanics from using
nursing homes. Not only do many Latinos, especially the elderly, value communal family dining
experiences where they can share meals with loved ones, they also prefer traditional Hispanic
cuisine which includes homemade meals made with staple ingredients. For example, Hispanics
from Caribbean islands tend to favor dishes containing rice, beans, meats, and root vegetables
such as plantain and yucca, seasoned with core spices such as cilantro, oregano, garlic, and
onions. These foods and spice combinations are not readily available or catered to in most
institutional settings. Not having access to Dominican cuisine was one reason an interviewee
cited for her mother’s weight loss. She expressed that when her mother would be admitted to a
nursing home for rehabilitation after a hospital stay, she would lose weight because she disliked
the food (Dulce V., personal communication, October 4, 2023).
Understanding dietary preferences for Hispanics in nursing homes is crucial for providing
appropriate care. Of course, priority should always be given to providing diets that cater to the
individual’s health needs, but long-term care facilities can meet the patient halfway by modifying
their menu offerings to include traditional recipes and promoting communal dining experiences
with family involvement. In this way, nursing homes can ensure the well-being of their Hispanic
residents while honoring their cultural heritage.
How Cultural Values Influence Hispanic Views on End-of-Life Care
6
Spiritual Beliefs
In many Hispanic communities, religion plays a considerable role in shaping thoughts
and actions. Specifically, familial bonds and community support are often highly emphasized in
spiritual teachings. This leads to the belief that it is the family’s responsibility to care for aging
and infirm family members. Additionally, nursing homes are viewed as impersonal institutions,
lacking the familiarity and warmth of at-home care. Being surrounded by loved ones is not only
critical for emotional health but is equally important for spiritual well-being. The fear of losing
this spiritual connection is therefore a large factor in the end-of-life care decision-making
process.
Another aspect to consider is that religious practices such as prayer and attending church
services can be deeply embedded in many Hispanic households. These ritualistic activities
provide solace during challenging times such as old age. For those Hispanics who are devoutly
religious, staying at home affords them the flexibility to continue practicing their faith without
restrictions that may be imposed at an institutional setting.
It is difficult to change religious practice traditions, especially for some that have been
decades long in the making. However, there are many ways institutions can address the spiritual
needs of not only their Hispanic population, but also of all their residents. According to Kuepfer,
et al, there are a variety of methods that can be utilized to address religious practices. These
include having non-denominational worship services, hymnal or inspirational music sessions,
guided prayer gatherings, literature-based activities such as Bible study, religion centric book
clubs, spiritual support/discussion groups, arts-based opportunities focusing on religious arts or
movies, and encouraging multi-faith observances such as Judaism’s weekly Shabbat, Islam’s
Salah daily prayer, and Christianity’s Sunday worship (2022).
How Cultural Values Influence Hispanic Views on End-of-Life Care
7
Implications
A 2017 poll conducted by The Associated Press-NORC Center for Public Affairs
Research highlighted that nursing home admission rates for Hispanics are far below other ethnic
groups. The study showed that 49% of the Hispanics surveyed have encountered language and
communication barriers, and cultural misunderstandings with healthcare providers. Only 16% of
Hispanics were confident a nursing home could accommodate their cultural needs. Finally, 62%
of Hispanics felt that the United States was not prepared to meet the overall needs of its aging
population.
Thomeer, et al, discussed how Hispanic’s reluctance to use nursing homes is valid,
however the traditional expectations that parents and ill family members should be cared for at
home are becoming increasingly unrealistic (2015). Many Latinos are finding that singlehandedly taking care of a chronically ill loved one at home, while working and parenting, can be
a monumental challenge. In their home countries, Hispanic families often had collective support
from family and even neighbors, to assist with caretaker responsibilities. In the United States,
those communal ties and support are significantly reduced. This means that while well-intended,
at home care may not be enough for sick or elderly family members that require more
comprehensive institutional care.
In conclusion, the reluctance among Hispanics to use nursing homes stems from deeprooted cultural values such as strong familial bonds, language barriers, dietary preferences, and
religious beliefs. Recognizing these factors and introducing reform is crucial for healthcare
providers aiming to bridge the gap and provide culturally competent care that align with
Hispanic values.
How Cultural Values Influence Hispanic Views on End-of-Life Care
8
References
1. Cardenas, D., Garces, C., Johnson, D., Montes, K., West, L. (2007). End-of-life care: The
Latino culture. University of Washington Medical Center.
https://ogg.osu.edu/media/documents/sunset/End%20of%20Life%20Care
2. Kuepfer, J., Schmidt, A., O'Connor, T. S. J., & James, M. (2022). Promise, provision and
potential: A hopeful trajectory for spiritual care in long-term care. The Journal of
Pastoral Care & Counseling: JPCC, 76(2), 105–113.
https://doi.org/10.1177/15423050221090870
3. Long-term care in America: Hispanics’ cultural concerns and difficulties with care.
(2017). AP-NORC Center for Public Affairs Research.
https://www.longtermcarepoll.org/long-term-care-in-america-hispanics-cultural
4. Squires A. (2018). Strategies for overcoming language barriers in healthcare. Nursing
Management, 49(4), 20–27.
https://doi.org/10.1097/01.NUMA.0000531166.24481.15
5. Thomeer, M. B., Mudrazija, S., Angei, J. (2015). How and why does nursing home use
differ by race and ethnicity? Journals of Gerontology: Series B: Vol. 73, No. 4,
e11–e12. https://doi.org/10.1093/geronb/gbv056