Case study investigates gap in quality of life for Hmong nursing home residents

While a growing body of research has revealed racial disparities in the quality of life for nursing home residents, few studies have focused on Hmong residents in these facilities. A new University of Wisconsin–Madison case study is filling that gap with key insights into the population’s needs that aren’t being met in the nursing home setting.

Mai See Thao, a medical anthropologist and professor at UW–Madison, along with researchers at the University of Minnesota and the University of Iowa, studied a nursing home in Minnesota to learn more about Hmong residents’ experiences. Their paper, recently published in the Journal of Applied Gerontology, explores significant shortcomings in care and quality of life.

“The residents in this space felt that they lived like they were in captivity,” says Thao, who is Hmong. “A lot of the work as an anthropologist is to bear witness to people’s stories and to tell [them], especially the stories of people who are being marginalized or who feel completely isolated in these spaces.”

The study’s key findings, based on many hours of observation and interviews with nursing home residents and staff, include:

• Language can be a barrier to belonging. Especially for Hmong residents who have limited or no English language knowledge, being in a nursing home without access to other Hmong speakers or a translator can be isolating and lead to neglect. Without easy methods of communication with staff and other residents, Hmong residents can lack community and connection.
• Meaningful activity and relationships are important. A lack of everyday activities that interest and engage Hmong residents can stunt meaningful interactions. Sometimes, visitation protocols can also make it difficult to maintain meaningful relationships with family members. These also influence feelings of community and belonging, which contribute to overall quality of life.
• Access to food that brings enjoyment is necessary. Lack of enjoyment of food options is a common complaint among nursing home residents of all ethnicities. For Hmong residents, lack of access to culturally relevant food can be especially isolating and negatively impact quality of life.
• Diversity in staff is not enough to address inequities. Even though the nursing home employed a diverse staff that included Hmong individuals, Hmong nursing home residents reported lower quality of life than their white peers. Thao says it’s necessary to take both a cultural and systematic approach, supported by proper funding and resources, to improve nursing home quality of life.

Thao’s research interests consider the position of Hmong people as a historical refugee community to apply a critical lens to science, medicine and the inequities in health care spaces.

Thao believes it’s essential to factor in refugees’ past experiences as they age in care facilities, to avoid reproducing feelings of isolation, abandonment and uncertainty. With Wisconsin being home to one of the largest populations of Hmong in the country, Thao notes that the study’s findings can translate to nursing homes in the state.

She also thinks that these critical insights can improve care for not only Hmong residents, but also for other underserved populations.

“It is oftentimes through the eye of ‘the other’ that we’re able to see clearly what we don’t even realize,” she says, adding that it’s important to reflect on how medical care is practiced every day, especially in nursing homes.