The invisible and racialized labor of culturally sensitive care: A Hmong nursing home case study

Globally, the number of adults aged 80 years and older is projected to triple by 2050, increasing the need for long-term care, such as in nursing homes (NH). In the United States (U.S.), racially/ethnically minoritized NH residents disproportionately experience poorer quality of life and care. Workplace initiatives addressing health disparities often promote culturally sensitive care (CSC) as a solution, tailoring care to residents' cultural characteristics that include norms, values, beliefs, and social-historical experiences. Yet, CSC theories lack empirical data and assume health providers are members of the normative/majority racial/ethnic group. This assumption overlooks the U.S. and NH context, where NH careworkers are often immigrants and women of color. Our case study applies an intersectional examination of CSC as practiced by racially/ethnically minoritized careworkers caring for racial/ethnically concordant NH residents. Drawing on ethnographic research conducted in 2017 in a U.S. Midwest NH with a high proportion of Hmong residents and staff, we frame CSC as carework that is invisible and racialized labor. From our findings, we provide a prospective model of CSC consisting of 1) negotiating the whiteness and biomedicalization of NH culture, 2) generative labor of educating majority NH staff and activating racially/ethnically minoritized residents and family while facing constraints, and 3) emotional (dis)regulation of performing CSC. We argue that CSC overlooks the intersectional dynamics that shape and constrain the labor of "making care culturally sensitive." Future policy work should recognize CSC as labor and address the need for institutional and policy supports, with consideration of its inequalities.