02 - 2003
Growing older in Germany
In the care of foreigners
by Karin Nungesser
At present there are half a million immigrants aged 60 or older living in Germany. This number will probably double within eight years. Since even among second-generation immigrants fewer and fewer women care for their relatives at home, the need for professional care is increasing, especially in the large cities. Caring for elderly persons from another culture requires special awareness. A way of caring must be developed which is sensitive to cultural differences.
Today she is having a good day, but even so, Mrs. Kaya is not well. At 58 she struggles with pain in her spine and thick, swollen elbow and knee joints, and has trouble breathing. "I used to be happy going to work,” she says, "but now — all broken down.” It is not only hard work which has left its mark. Like most migrant workers, when the Kayas came to Germany in 1967 they had a definite goal. They planned to work five years to save enough for an apartment in Turkey. But the cost of living here was higher than they expected, parents-in-law and brothers and sisters back home needed support, so they prolonged their stay. Their children were born here and knew their parents’ home only from holidays. Gradually it crept up on the Kayas that their interlude here had become the last stop. They had grown old. But they never really felt at home.
Gradually worsening depression is the diagnosis for over 90% of the patients in the care of Nurse Nare Yezilyurt-Karakurt’s home nursing centre in Berlin. Many are widowed, have no relatives in the city and often hardly any contact outside their homes. Besides the typical wear and tear diseases from years of shift duty and piece-work, psychosomatic illnesses are among the most common complaints. "Homesick-sickness, we used to call it,” says Yezilyurt-Karakurt, "and that really still describes it well.” Thus the importance of making her patients feel a bit more secure, besides providing medical help and support.
For this purpose, Yezilyurt-Karakurt founded her Deta Med Care Centre three and a half years ago, to offer home care suited to the needs of Turkish and Arab immigrants. The care personnel know and respect not only the language, but also the cultural needs of the patients, whether they are Sunni, Shiite or Alevite Muslims. Every two days they help each patient to prepare fresh food, taking care that meat is first cleanly cut and washed free of blood, as prescribed by Muslim rules. As in many Mediterranean countries, breakfast is soup instead of bread and butter, even though not really allowed for in the calculations of health insurance companies and district authorities. The same goes for personal hygiene: "We are supposed to allow eight minutes to change the diapers of a bedridden patient,” Yezilyurt-Karakurt explains, "but that is nowhere near enough for Muslim patients”, because they must be washed under running water, not simply with a washcloth and basin. Hygiene too is culturally determined, and doesn’t simply work according to Plan F.
There is a great need for culture-sensitive nursing, as health care professionals call it. For economic reasons alone, more and more private nursing services and homes for the elderly are getting interested in the concept. Peter Zeman of the German Centre for Concerns of Aging says elderly immigrants are not the only ones who benefit. "In the end it amounts to a general modernisation. In future, care of the elderly overall will have to be better oriented to the backgrounds and histories of the patients.”
How little this has been the case until now, Mrs. Kaya, the Turkish widow with a German passport, found out before she changed to Deta Med. The foreign food didn’t agree with her, and conversations with nursing personnel broke down due to misunderstandings and lack of time. Despite her requests, the social welfare centre kept sending a male staff member to bathe her, although she lives alone. Today she is happy about the change. "I’ve only ever allowed one man to see my body, and that was my husband.”
This article appeared in Ver.di Publik, a magazine of the United Service Industries Trade Unions, in April 2003.