Phase III of the Centers for Medicare and Medicaid Services (CMS) Requirements of Participation requires that nursing centers ensure that services provided or arranged for by the facility, as outlined in the comprehensive care plan, are culturally-competent and trauma-informed.
Cultural and linguistic competency is defined as the capacity for individuals and organizations to work and communicate effectively in cross-cultural situations. Cultural and linguistic competency occurs through adopting and implementing strategies to ensure appropriate awareness of, attitudes toward, and actions about diverse populations, cultures and languages.
Over the years, the United States has become an increasingly diverse nation and is home to many racial, ethnic, ancestral and tribal identities. America is prosperous with individuals of different religions, values, languages and beliefs. Health care organizations must prepare to meet the needs of an ever-changing population, and this may be accomplished by integrating cultural competency into everyday practice.
Cultural competency in health care describes the ability to provide care to patients with diverse values, beliefs, and behaviors, including tailoring health care delivery to meet patients’ social, cultural and linguistic needs. The skilled nursing center must understand the diverse patients and the community it serves. The organization must prepare their team to interact with patients of diverse backgrounds to increase patient engagement and education and to help eliminate racial and ethnic disparities in care.
The National Committee for Quality Assurance prepared for CMS a Practical Guide to Implementing the National CLAS Standards for health care providers to utilize to become a culturally competent organization. This guide consists of toolkits and training materials to assist the organization while training and implementing the program and changing the culture.
Health care disparities are defined as differences in the way the person receives or experiences an overall quality of care. These experiences are not always due to access or the clinical need but are sometimes due to the communication. If patients can’t understand the clinician or patients are unable to communicate their medical concerns effectively, they won’t be receiving the same quality of care.
Team members who do not understand cultural and linguistic competency may struggle when trying to accurately assess and develop a person-centered plan of care for a resident that is from a different culture or ethnic background. The resident may not receive the necessary treatment, and his/her values and beliefs may not be taken into consideration when creating treatment plans, leading to poor outcomes. Cultural competency training is a vital part of providing person-centered care.
The Office of Minority Health at the Department of Health and Human Services developed the Nationally Culturally and Linguistically Appropriate Services (CLAS) Standards in 2000 to guide the health care profession in giving respectful, understandable, effective, and equitable services. The National CLAS Standards are a set of 15 action steps that provide a framework for health care organizations to implement culturally and linguistically appropriate services. These Standards were then updated in 2013 to reflect the changes and advancement of cultural competence in health care.
Providing culturally competent care and honoring how a resident’s culture impacts the resident’s preferences and care needs is broadly mentioned in numerous F-tags across Appendix PP of the State Operations Manual. Every resident should be evaluated upon admission to determine if he/she is culturally diverse and if he/she requires Language Assistance Services (LAS) due to limited English proficiency. Information that is obtained regarding the resident’s cultural preferences and beliefs should be incorporated into the resident’s treatment goals and plan of care.
A culturally competent facility should strive to have:
- A culturally and ethnically, diverse staff.
- Qualified interpreters and translators to provide LAS when needed.
- Comprehensive training for staff to help them understand different cultures and build communication skills.
- Written instructions in the resident’s languages that are consistent with their cultural norms.
All staff can advocate for cultural competence within the facility. The National CLAS Standards also recommend that health care facilities develop meaningful community partnerships with other facilities and community assets such as cultural centers, professional organizations, and local businesses.