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When Soviet Jews arrived in the United States, many joined an already thriving Russian community in the Brooklyn, New York, area. Those folks are still there, and as they age, their distinctive cultural desires present challenges to those who provide them with home healthcare.

Fewer Coming to the Shores

"When it was the USSR, everyone called themselves Russian, but now they are just as likely to consider themselves Ukrainian or Latvian," says Marina Yankelevich, RN, BSN, MBA, vice president of Business Development and Operations, Prime Home Health Services, Brooklyn, N.Y. She participated in the Conference of the Russian American Health Coalition that met recently to discuss the issues and challenges encountered by those who offer care to the Russian-speaking community. She notes that some sources estimate the size of this group to be between 3% and 4% of the New York City population. One of the most critical needs providing home care is for home health aides to be fluent in Russian. Second-generation Russian-Americans, one possible source of such workers, are choosing other types of careers. As with so many other waves of immigrants, their success meant that they would be less available to aging parents, more mobile in general, and less likely to take these positions. At the same time, the wave of Russian immigration has slowed to a trickle, and for this reason, another traditional source of nonprofessional Russian-speaking caregivers becomes more limited every year.

Cultural Differences

Healthcare providers have become more culturally sensitive. This means that they are able to offer care that the client can appreciate, and there is a greater chance of compliance with sometimes complex treatment regimens. This is especially critical in home care, where the care provider enters the patient's environment and works within his or her parameters.

"Russian people believe in fresh air," says Yankelevich. "[Being] outside in the sunshine is an important part of recovery for these patients. If they are able to go outside, it should not necessarily mean that they are not homebound under the Medicare regulations."

Medications are seen somewhat differently, and nurses who care for these patients must thoroughly review all medications every time they make a home visit. The Russian people trust herbal cures and believe in alternative medicines. When they hear that a friend or neighbor is feeling better, they may ask to borrow some of whatever the person has been taking, whether it is prescription, over-the-counter, or an "old-country" traditional remedy imported from Russia. It is important to explain how this interacts with the treatment plan that the primary healthcare provider recommends.

The language barrier is the biggest block to teaching, and Yankelevich dryly notes that no matter how loudly one speaks English, it will not be understood by someone who speaks only Russian. Visiting when family members are available to translate is helpful, but it is very important to be sure that the person doing the translation understands the teaching. Yankelevich relates that illiteracy is nearly unheard of in Russia, and that most of these patients are educated. This makes it easier to help them find their way through the maze of community programs in some ways, but they need help to make the calls that initiate the service referrals.

Assumptions are dangerous, and the dietary proclivities of the Russian population are legion. The Russians pickle everything from herring to watermelon, says Yankelevich, and if the nurse who is teaching a low-sodium diet doesn't specifically identify these items as high-sodium foods, the patient may well not limit them when making food selections. Asking clients to show the nurse what they had for breakfast, for example, may help clarify what is actually on the menu. Added to this are dietary restrictions that are followed by the many Jewish individuals in this community. Then there are the strictly American foods that are unfamiliar and strange to them.

"A nurse might suggest tapioca pudding, for example," says Yankelevich, "and the patients might nod and agree without having the slightest idea of what tapioca pudding is."

The Dumping Ground

Two of the biggest issues for N.Y.'s aging Russian-American population are the concepts of long-term care and rehabilitation. In the Soviet Union, nursing homes were dumping grounds for the unfortunate sick and elderly who had nobody to care for them. Families may be insulted if they do not understand the purpose of subacute rehabilitation, and patients themselves may be fearful. Careful explanations will alleviate the anxiety for everyone. The patient needs to understand that this is only a stop on the way home, and the family members must be reassured that the patient is expected to regain function and leave the facility.

Home care, although the preferred situation, is not always the safest for the patient. Yankelevich notes that long-term care is an emotionally loaded concept; family members may be ashamed that they cannot manage the patient, and they will be fearful for the patient's safety and well-being. The patient may become depressed and despondent. Supportive services like counseling may be helpful. It may also be helpful to support the family in an attempt to manage the patient at home. By offering them as much home service and assistance as possible, they may feel that at least they tried, and so feel better about ultimately placing the patient.

Peeling away layers of the Russian culture is like taking apart their native nesting dolls. Each aspect is a little different than the one before, and each fits together to make a rich and layered whole. Keeping these patients in their home environments and in the care of their families contributes to that fit.

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Marylisa Kinsley, RN, BSN, is a contributing writer for Nursing Spectrum.

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