Aug 31, 2022

To help us understand the importance of culturally responsive older adult behavioral health supports, we interviewed Nandy Barbosa, a bilingual homecare case manager and member of the Older Adult Behavioral Health Network’s Diversity, Equity, and Inclusion Workgroup.

To help us understand the importance of culturally responsive older adult behavioral health supports, we interviewed Nandy Barbosa, a bilingual homecare case manager, Boston University (BU) School of Social Work student, intern at BU Center for Aging Disability Education and Research, and member of the Older Adult Behavioral Health Network’s Diversity, Equity, and Inclusion Workgroup.

Nandy and other members of the workgroup advocate for culturally responsive behavioral health supports and raise awareness of the impact of race, ethnicity and culture on older adult behavioral health.

What is your role at Boston Senior Home Care?

I have been with BSHC since 2019 as a Bilingual Geriatric Support Service Coordinator (GSSC) in the Senior Care Options department working with Spanish-speaking and Cape Verdean-speaking older adults.

Blog author Nandy Barbosa and her grandmother

Nandy Barbosa with her grandmother, Maria Dos Reis Alves (known in the community as Djedje)

How does your personal experience inspire your work?

When I migrated to the U.S. with my family in 2000, I met a lot of individuals who had never heard of Cape Verde. Because of the high influx of Cape Verdean migrants in Boston, our city established an environment that felt like home to most. I lived off Dudley Street in Uphams Corner most of my life. My grandmother attended the Cape Verdean Adult Day Health (CVADH) on Bowdoin Street and she receives services from an Aging Services Access Point (ASAP) to this day.

Cape Verdeans are prideful people. Our history is rich as the older generations lived through slavery, political unrest, and famine to name a few. My parents knew the U.S. was where their children needed to grow up to have a fighting chance in this world.

I am proud of my roots. I was raised to respect elders because they paved the way for us. My grandmother was like a second mother to me and that was vital for my growth as a person.

I am inspired to do this work because of other vovos (grandmothers) and donos (grandfathers) who left their lives behind to provide a future for their children and grandchildren. Cape Verdeans find it difficult to ask for help. I, too, know what that means seeing it firsthand, so I aim to be the help that does not need to be asked or begged for, but that is there for you whenever you are ready for it.

Tell us about the people you work with. What are some of their strengths?

What I admire the most about the population I serve is their willingness to never give up. I have met individuals with severe medical conditions that still remain positive. Most Spanish-speaking and Cape Verdean-speaking people that I work with come from a healthy support system and emphasize how grateful they are for having family members who are exceptional caregivers.

What are some of the challenges that older adults who are people of color face?

For older adults who do not speak English, being able to advocate for their needs can become an unbearable task. Many people, even some who can speak English, but cannot read or write, will call me so that I can help them reapply for MassHealth or put together documents for housing, food stamps, or other personal care services.

Some of these individuals don’t want to ask a busy family member, so they try to figure it out themselves, which sometimes means asking a case manager to help. Being a case manager who can speak the language is beneficial to the older adults I serve, because I am able not only to speak and understand their languages, but I am also able to be culturally responsive to their needs.

“I am proud of my roots. I was raised to respect elders because they paved the way for us. My grandmother was like a second mother to me and that was vital for my growth as a person.”

Why is it important that behavioral health supports are culturally responsive?

Research shows that people of color in the United States have more stigma related to mental and behavioral health than white people. This may account for why people of color are less likely to use mental and behavioral health services.

Being Cape Verdean myself, and being raised in the culture, older adults in my community do not discuss issues related to behavioral health and often turn to other coping methods, such as substance use, social isolation, and disregard to their situations. As our society becomes more culturally diverse, human service workers and health care workers have a responsibility to address disparities as it affects all those who are unrepresented.

Do you have any policy recommendations to promote culturally responsive aging and mental health services?

The COVID-19 pandemic brought to the forefront critical issues such as a shortage of personal care workers, home health aides, and case managers. The pandemic also highlighted the ongoing disparities individuals face in the healthcare system, which especially affects people of color.

Behavioral health workplaces and academic institutions need to cultivate and support a diverse workforce to better reflect the population served. All social and human service workers, particularly those working with culturally diverse individuals, should be trained in cultural humility as well as behavioral health. By training staff to effectively assess and relate to those from different backgrounds, we are better equipped to address issues of mental health, substance use, social isolation, and loneliness. We also need to invest in the workforce, providing a sustainable living wage for people who care for older adults.

IMG 5174

Nandy Barbosa hugging her grandmother, Maria Dos Reis Alves (known in the community as Djedje)

As part of the Older Adult Behavioral Health Network’s Diversity, Equity, and Inclusion Workgroup, I helped successfully advocate for the inclusion of language in the most recent Elder Mental Health Outreach Team (EMHOT) RFP to require applicants who apply for funds to support older adults with behavioral health conditions to demonstrate their ability to support underserved groups. As we grow our network of accessible older adult behavioral health support, it is critical that we prioritize the needs of cultural and ethnic individuals so that vovos, donos, abuelos, nanas, papas, and each and every older adult has their needs met.

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