International Journal of Migration, Health and Social CareEmerald Article: Challenges and barriers to services for immigrant seniors in Canada: "you are among others but you feel alone"Miriam Stewart, Edward Shizha, Edward Makwarimba, Denise Spitzer, Ernest N. Khalema, Christina D. Nsaliwa

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To cite this document: Miriam Stewart, Edward Shizha, Edward Makwarimba, Denise Spitzer, Ernest N. Khalema, Christina D. Nsaliwa, (2011),"Challenges and barriers to services for immigrant seniors in Canada: "you are among others but you feel alone"", International Journal of Migration, Health and Social Care, Vol. 7 Iss: 1 pp. 16 - 32

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Challenges and barriers to services forimmigrant seniors in Canada: ‘‘you areamong others but you feel alone’’

Miriam Stewart, Edward Shizha, Edward Makwarimba, Denise Spitzer, Ernest N. Khalemaand Christina D. Nsaliwa

Abstract

Purpose – This paper seeks to explore varied interrelated challenges and barriers experienced by

immigrant seniors.

Design/methodology/approach – Senior immigrants representing diverse ethnicities (Chinese, Afro

Caribbean, Former Yugoslavian, Spanish) described their challenges, support needs, and barriers to

service access. Service providers and policy makers from organizations serving immigrant seniors were

interviewed to elicit their views on barriers to access and appropriateness of services for immigrant

seniors. Qualitative methods were employed to enhance understanding of meanings, perceptions,

beliefs, values, and behaviors of immigrant seniors, and investigate sensitive issues experienced by

vulnerable groups. The qualitative data were subjected to thematic content analysis.

Findings – Seniors reported financial and language difficulties, health problems, discrimination, family

conflicts, and social isolation. Although most immigrant seniors appreciated the standard of living in

Canada and the services provided to seniors, most believed that support received was inadequate.

Seniors encountered systemic (e.g. government policies), institutional (e.g. culturally inappropriate

programs), and personal (e.g. transportation, language problems) barriers to accessing social and

health services. Service providers and policy makers faced high costs of programs, inadequate

financial and human resources, inadequate information about needs of immigrant seniors, inadequate

geographical coverage, and lack of inter-sectoral collaboration.

Practical implications – The challenges experienced by immigrant seniors have implications for

programs and policies and can inform the development of culturally sensitive and appropriate services.

Social implications – The barriers encountered by service providers in assisting immigrant seniors

point to the importance of inter-sectoral coordination, cultural sensitivity training, and expansion of

service providers’ mandates.

Originality/value – This study revealed numerous unmet needs for successful acculturation of

immigrant and refugee seniors in Canada. It also reveals that the most cogent and sustainable

approach to close this chasm of support deficits, unattended challenges, and complex stressors is

to implement a model that simultaneously addresses the three levels and use a multisectoral

approach.

Keywords Immigrants, Seniors, Services, Access barriers, Canada

Paper type Research paper

Several studies reveal that the needs of senior immigrants pertaining to health care (Eapen

et al., 2002), transportation, housing, income supplements (Leung, 2000), isolation (Yeh and

Lo, 2004), and quality of life (Eapen, 2003), are similar to all seniors. However, ethnic seniors

encounter unique problems such as inadequate language and literacy skills (Barrio et al.,

2007; Au, 2003; Walls and Sashidharan, 2003), discrimination, cultural barriers, lack of

translators (Barrio et al., 2007) and low self-esteem (Eapen, 1998). Research that specifically

identifies the settlement/acculturation challenges of immigrant seniors, their attendant

support needs, and their barriers to use of support programs and services is rare.

To our knowledge, no studies have examined the perspectives and experiences of

immigrant seniors, service providers, and policy makers regarding challenges, support

PAGE 16 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE j VOL. 7 NO. 1 2011, pp. 16-32, Q Emerald Group Publishing Limited, ISSN 1747-9894 DOI 10.1108/17479891111176278

Miriam Stewart is based

in the Social Support

Research Program, Faculty

of Nursing and School of

Public Health, University

of Alberta, Edmonton,

Canada. Edward Shizha is

based in the Department of

Contemporary Studies,

Wilfrid Laurier University,

Brantford, Canada.

Edward Makwarimba is

based in the Social Support

Research Program,

University of Alberta,

Edmonton, Canada.

Denise Spitzer is based in

the Faculty of Social

Sciences, Institute of

Women’s Studies,

University of Ottawa,

Ottawa, Canada.

Ernest N. Khalema is an

Assistant Professor in the

Faculty of Social Work,

University of Calgary,

Calgary, Canada.

Christina D. Nsaliwa is

based at the Edmonton

Immigrant Services

Association, Edmonton,

Canada.

Funded by Alberta HeritageFund for Medical Research andCanadian Heritage.

needs, and factors influencing use of health and social services. Moreover, most studies on

older adults with a cross-cultural component tend to focus on instrument validation and/or

cultural adaptation (Paskulin and Molzahn, 2007). Consequently, this qualitative study was

designed to fill these research gaps by examining the perceptions of immigrant seniors from

four different ethnic groups and of service providers and policy makers regarding

challenges, support needs, and barriers to services.

Informed by our previous research that revealed diverse support needs experienced by

young and middle age immigrant and refugee populations (Simich et al., 2003), and by

family caregivers of immigrant seniors (Simich et al., 2005), the objective of this study was to

identify the challenges, support needs, and access barriers experienced by immigrant

seniors from different ethnic groups.

Relevant literature

Senior immigrants prefer culturally and linguistically congruent services but are limited in

their access to services by language barriers (Barrio et al., 2007; Polyakova and Pacquiao,

2006). In Canada, many immigrant seniors do not speak either English or French, the

country’s two official languages (Eapen, 2003). Senior immigrants need linguistic skills to

access social support resources and health services (Fenta et al., 2007; Gorospe, 2006).

Communication difficulties minimize social contact and interaction and increase social

loneliness and isolation (Hall and Havens, 2001; Jang et al., 2006; van Baarsen et al., 2001).

The problem is compounded by inter-generational differences between seniors and their

children and grandchildren who have adapted to the Canadian society. Lack of available,

appropriate, and affordable transportation is an impediment to elderly people’s mobility and

to accessing social support (Barrio et al., 2007; Jang et al., 2006), and contributes to

restricted access to services for immigrant seniors. These problems make it difficult to meet

daily needs; limit prospects for social activities and integration; and, increase risk of social

isolation (Jang et al., 2006).

Recent research indicates that senior immigrants have lower socio-economic status than

other older people (de Valk and Schans, 2008) and are over-represented among vulnerable,

marginalized and disadvantaged populations, primarily due to restrictive immigration

policies, and lack of integration strategies (Bolzman et al., 2004). Increasing poverty among

elderly immigrants exacerbates their settlement problems (Grant and Grant, 2002). Low

income levels and lack of pension benefits (Lewin and Stier, 2003) limit immigrant seniors’

opportunities to access health and other services.

Services are not consistently accessible to immigrant seniors in Switzerland (Bolzman et al.,

2004), the USA (Wong et al., 2006a; Gorospe, 2006; Ajrouch, 2005) and Canada (Lai and

Leonenko, 2007) due to lack of knowledge, language barriers, discrimination, cultural

incompatibility, bureaucratic procedures, and costs. Our previous studies focused on

immigrants and refugees (Simich et al., 2003) and caregivers of immigrant seniors (Simich

et al., 2005) document the effects of cultural barriers on mobilization of formal supports.

Other key barriers to services and support programs for immigrant seniors include lack of

information about available services (de Valk and Schans, 2008), poor understanding of the

needs of immigrant adults by service providers, scarcity of culturally competent services,

and inappropriate provider attitudes (Barrio et al., 2007).

Major gaps in research include limited attention to the unique challenges faced by immigrant

seniors. While recent studies on older immigrants examined relevant individual issues such

as filial obligations (de Valk and Schans, 2008), health care system access (Wong et al.,

2006b; Gorospe, 2006), and of living alone (Lai and Leonenko, 2007), this study explored

varied interrelated challenges experienced by immigrant seniors, and has potential to inform

comprehensive intersectoral policy initiatives.

The three research questions guiding the study were:

RQ1. What are the challenges experienced by Chinese, Afro-Caribbean, former

Yugoslavian, and Spanish-speaking immigrant seniors?

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 17

RQ2. What are the support needs of these immigrant seniors?

RQ3. What are the barriers to access and use of services for these immigrant seniors?

Methods and research approaches

Qualitative methods were employed to enhance understanding of meanings, perceptions,

beliefs, values, and behaviors of immigrant seniors, and investigate sensitive issues

experienced by vulnerable groups (Sandelowski, 2000, 2010). Consistent with participatory

research principles (Gottlieb, 2000), participants were asked to specify their challenges,

support needs, and barriers to access. In participatory approaches, people whose lives are

being studied take an active role in defining their needs (Beazley and Ennew, 2006; Stewart

et al., 2008a, b). A Community Advisory Committee consisting of ten policy influencers from

agencies serving seniors and immigrants provided advice to the research team throughout

the study. Approval was granted by the university ethics committee.

Phase 1: immigrant seniors

Sample

Purposive and snowball sampling methods were used to obtain a representative sample (in

terms of sex, education, years lived in Canada, living situation) immigrant seniors (of equal

representation of Chinese, Afro-Caribbean, former Yugoslavian, and Spanish) living in

Alberta. Selection was limited to immigrants who were 55 years and older. Sampling ensured

diversity in age, gender, and marital status. Community partners knowledgeable about

immigrant seniors from the four immigrant groups facilitated recruitment of participants.

Community agencies serving the respective ethno-cultural groups and community research

assistants’ outreach efforts helped to identify potential participants. Equal numbers of

women and men were recruited for the study. The sample comprised 48 immigrant seniors

(24 men, 24 women).

Data collection

Fourcommunitybrokers (one fromeachethno-cultural community)were recruitedascommunity

research assistants. They completed 12 hours of training to conduct face-to-face interviewswith

immigrant seniors in their native language. Training focused on: recruiting participants;

completing the demographic data questionnaire; administering the semi-structured interview

guide; overcoming difficult interview situations; and tape recording and transcribing interviews.

The training helped to instill confidence in the community research assistants in qualitative data

collection and enhanced their competence in interviewing skills. A community broker whowas a

member of the Community Advisory Committee assisted the investigators with the training

workshop.

Individual interviews were conducted in the participants’ own language, and in locations

convenient to the participants including their homes. The interviews were tape recorded and

lasted one hour. Community research assistants interviewed seniors from their ethno-cultural

group. As interviewers came from the same ethnic communities as seniors, language, and

cultural barriers were overcome. The individual interviews elicited in-depth data from

immigrant seniors about their challenges, support needs, and barriers to access of services

and supports. Individual interviews facilitated one-on-one communication and fostered

confidence, trust, and disclosure.

A semi-structured interview guide was designed to reflect the research questions

encompassing open-ended questions with appropriate probes. The initial interview guide

was reviewed by the Community Advisory Committee and modified based on their

suggestions. The interview guide was translated into the four languages of the immigrant

seniors and subsequently back translated into English to ensure that all versions were

consistent and accurate in meaning. The revised interview guide was pilot-tested with one

immigrant senior from each ethnic group.

PAGE 18 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj VOL. 7 NO. 1 2011

Participants also completed a demographic data form to elicit information regarding age,

sex, language, living arrangements, length of stay in Canada, and other factors relevant to

support needs of immigrant seniors. All immigrant senior participants received a token of

appreciation to compensate for their time and expenses. Bus tickets were provided to

seniors requiring transportation assistance. Five partner organizations offered space for

these interviews. Field notes were generated by interviewers to document observations of

the interview conditions and factors which might have influenced the individual interviews.

Phase 2: service providers and policy influencers

Sample

Group interviews were conducted with service providers and policy makers to elicit their

perspectives on:

B availability of services and programs in health and social sectors for senior immigrants;

B appropriateness and relevance of these services and programs; and

B barriers to support and service provision.

Service providers (n ¼ 26) were selected from agencies/institutions/organizations in diverse

sectors (e.g. health, settlement, social) that provide services to immigrant seniors and

purposively sampled to represent different disciplines (e.g. physicians, social workers).

Strategies for identifying service providerswereguidedby theCommunity AdvisoryCommittee.

Data collection

Group interviews conducted with service providers were co-facilitated by two research team

members, tape recorded, and transcribed. Interviews, approximately 1.5 hours in duration,

yielded a broad scope of perspectives on immigrant seniors’ support needs and barriers to

useof servicesandprograms. The interviewguide includedninequestionsdesigned to solicit

information regarding formal support services available to immigrant seniors, services used

by immigrant seniors, relevance, and appropriateness of these formal support resources and

barriers to services. This guide was reviewed by the Community Advisory Committee.

Data analysis for phases 1 and 2

The taped individual and group interviews were transcribed, and the qualitative data were

subjected to thematic content analysis (Hsieh and Shannon, 2005) of challenges, support

needs, and barriers to services encountered by immigrant seniors. Inductive analysis was

used to create a coding framework and recurrent themes were systematically compared to

identify substantive categories and potential theoretical codes. The coding framework was

transferred to QSR N7e qualitative data analysis software to enable data management. The

coding process entailed extraction of significant statements from transcripts and

classification into appropriate categories.

Findings

Challenges experienced by immigrant seniors (RQ1)

(Exemplar direct quotes from immigrant seniors, service providers, and policy influencers

are included in Table I).

Unfulfilled immigration expectations. The decision to migrate is based on expectations

about their new country. Immigrants look forward to a high standard of living and

employment opportunities in their country of destination. However, these expectations were

typically not fulfilled upon arrival. Some immigrant seniors expressed frustration and

disappointment at the unanticipated problems they encountered in Canada.

Difficulty adjusting to climatic conditions. Winters in Canada can pose a physical hazard

for all seniors. Most immigrant seniors were not used to the cold climate and were afraid of

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 19

Table I Exemplar direct quotes from immigrant seniors and service providers access barriers

Challenges (RQ 1)Unfulfilled immigrationexpectations

‘‘People who work hard for a living, like immigrants [. . .] take home close to minimum wage [. . .] ‘where is thewealth that is talked about?’ I’m working hard, but I don’t seem to [be] getting the rewards for it(Afro-Caribbean No. 06)’’‘‘For me Canada was a land of promises and I thought that all my problems would be solved once I came here.I thought that I would have job opportunities and that everything is different in Canada. However, when I camehere I was very disappointed. I came at a somewhat elderly age and it was difficult for me to find a job(Yugoslavian No. 04)’’

Difficulty adapting toclimate

‘‘Well the climate is different, because I am used to the sun and to be outside, here I have had to learn to liveinside [during] snow [time]. It is difficult to go out, and I am scared to slip and fall in the snow and on the ice(Spanish No. 10)’’‘‘In the summer I try to stock up on groceries so that I don’t have to go outside in the winter. Throughmy churchor [. . .] my daughter, I also ask for their help with groceries in the winter. Here, there is not that support, at leastthey have not informedme about that kind of support, because in other seniors’ homes [. . .] they offer that kindof service so that seniors that need to go outside in the winter to buy groceries [. . .] get offered transportation.This helps them get their groceries and they are also accompanied by someone wherever they need to go [. . .]they get transportation too (Spanish No. 07)’’

Lack of employmentopportunities

‘‘I was not that old and I felt like I was full of energy to go out and work. I did not want to live on socialassistance. I came here to assure a better future for myself by working. However, because of my facialappearance, wherever I went to look for a job, I was turned down. As an excuse for rejecting me they wouldusually say ‘this is too difficult for you,’ ‘this is not for you,’ or ‘we will call you’ (Yugoslavian No. 04)’’‘‘The bar is set so high for you to migrate to Canada in terms of what qualifications or what skills you have. Yet,when you reach here those same qualifications don’t qualify you to get into a lucrative position or one thatrecognizes those same qualifications [. . .] I find that a contradiction (Afro-Caribbean No. 06)’’

Poverty and financialdifficulties

‘‘I have financial difficulties. I live on social assistance receiving $1,000 per month. I spend about 60 percent ofmy income on rent only. I have to pay for cable TV. My power bill is also very high. I have very little left to try tomake something in my life (Yugoslavian No. 06)’’‘‘What I was telling you before the interview is about the dentist [. . .] that it’s too expensive here. If I go to thedentist so he can check a tooth because it has a cavity it will cost me $500 and where am I going to get that?(Spanish No. 05)’’‘‘Another place for support is the [community agency]. It should be free [. . .] They want us to donate $5 or $10.I don’t have money. This is not good (Chinese No. 12)’’‘‘My feeling is that if you asked a lot of immigrant seniors, their preference would be to simply havemore moneythemselves so they could make their own choices about how they got services they needed. Wealthyimmigrants can pay people in all kinds of a range of ways without depending on – they may still come tohuman services organizations for things by choice, but the great majority of immigrant seniors areeconomically way too poor, they do not have the dignity in their lives to be able to make choices around this.They’re trapped now because they’re all living in poverty (Service provider/policy influencer)’’

Physical and mentalhealth challenges

‘‘The only thing that needs to be improved is to shorten the waiting time to see a doctor. The second, seniorimmigrants are charged 30 percent for medicine expenses. It is possible to charge less. They don’t have anyincome but still have to pay [. . .] It should be changed. I think 20 percent [should] be the maximum (ChineseNo. 07)’’‘‘We see a lot of people with mental illness, and a lot of our immigrant seniors have [it]. We see a lot ofpost-traumatic stress disorder, and they are sometimes isolated from the rest of their groups, their culture. Andsome, because there is not that information or it’s not in the culture that somebody is suffering from a mentalillness, so basically, those seniors are isolated from the rest. So we see a lot of that [. . .], a lot of addiction(Service provider/policy influencer)’’

Dependence on others ‘‘Receivinghelp fromothers is very hard forme. I donot feel comfortable. I havebeenworkinghardallmy life andhelping others. I have been taking care of my family all my life. Now I have to request assistance. I do not feelcomfortable asking others to help me because everyone is working to provide for his or her own future. I feeluseless. This is an unpleasant feeling [. . .] It very much affects my health and wellbeing (Yugoslavian No. 04)’’‘‘I believe that what I am receiving is fair, I should not hope for more because I am not working and not providingany services to this country, with respect to work. [I] do not want to be a burden [. . .] or if I am a burden then I donot want to be an even heavier burden for the government (Spanish No. 02)’’

Language ‘‘Language is my biggest challenge. We can’t understand, and can’t speak. We also have difficulties when wego to see doctors. When I had appendicitis, I went to the hospital. I couldn’t understand what they said, andthey couldn’t either [. . .]. It is better now because some of them, including my family physician, can speakChinese (Chinese No. 05)’’

(continued)

PAGE 20 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj VOL. 7 NO. 1 2011

Table I

‘‘The only thing I am concerned about is the language. If you speak the languagemany doors will open for you.If you don’t speak English, well [. . .] you will have to fight to survive (Spanish No. 05)’’‘‘I am not able to go see my doctor on my own because I cannot express myself. Now I speak a bit of English[. . .] but it is still difficult for me. Whether I want to go to the bank or to the doctor I always have to havesomebody by my side. This is because I do not feel comfortable because [. . .] I may not understand whatothers tell me (Yugoslavian No. 04)’’‘‘Some of them [seniors] obviously do come by themselves; they’re very proficient in the English language andthey can make their own decisions, but we do get a fair number coming in with family members just to interpretinformation (Service provider/policy influencer)’’‘‘We find that immigrant caregivers are the most hidden of all caregivers, and the reason for this is that [. . .]their language skills in Canada are marginal, so they’re not quite sure how they could access the system withtheir language problem [. . .] (Service provider/policy influencer)’’

Need for transportation ‘‘I cannot say transportation because you gonna say to meDATS but I [. . .] personally don’t like DATS. Becauseyou have to call them three daysbefore [. . .] You have to be ready but they are never there on time [. . .]. Let’s saythey come to pick you up, and you’re not ready, they leave (Afro-Caribbean No. 02)’’‘‘When I need to go visit an office nobody takes me and in my condition [. . .] at my age, I cannot take buses.Maybe I can call a taxi, but financially that becomes too expensive for me (Spanish No. 02)’’‘‘The other thing is the accessibility, too. There are a lot of different services out there for seniors, but it’s difficultfor them to get to access it: mainly transportation and language barriers (Service provider/policy influencer)’’

Perceived racism anddiscrimination

‘‘No matter what we do or how we do it, we don’t seem to be able to get the people to understand that we didn’tdrop off the boat, so to speak. They want to believe that there is either one country in the Caribbean, which isJamaica’’‘‘I experienced negative attitude in job situations [. . .]. I also had an instance where I was in the garden,playing a little bit of music when this guy said Why don’t you shut that thing off, where you come from in thebush they don’t have those kinds of things (Afro-Caribbean No. 03)’’‘‘There is racism and there is discrimination, and they don’t sometimes make people feel very comfortable. Sothere’s a lot of education needed to help the people that go to mainstream agencies understand and be moreaccepting of people from other cultures. And that’s a big issue. Those white Anglo-Saxon seniors are nottolerant. No, they’re not, and they don’t like change. We see it a lot of times in our care centres (Serviceprovider/policy influencer)’’

Immigrant seniors’ support needs (RQ 2)Family conflicts ‘‘And I guess there’s so many different forms of abuse. Like, there’s people or kids who take advantage every

day of their parents. Maybe not slapping them or anything, but they take advantage. That’s why they like tocome to class. Just to get away from them! To get out of the house for a couple of hours (Serviceprovider/policy influencer)’’‘‘Some had the problem with their family since they were brought here, and then they were here to baby-sit.They got tired of it and they moved to a seniors’ residence, they paid low rent, and they got access to someincome, then they were happy to be on their own, but they were isolated, and the relationship with their familywas [awful] (Service provider/policy influencer)’’

Depleted socialnetworks

‘‘This is something horrible. You are among others but feel alone. When the kids get married and leave thefamily it is very difficult, not to mention in foreign countries where you do not speak the language and have noconnections. People working in this support program need to be social workers so that they can approachpeople professionally and passionately. They also need to have a ‘natural sense’ for the [. . .] profession [. . .] tobe loving and caring (Yugoslavian No. 11)’’‘‘For example, here neighbors do not relate much. Back home, every morning when you see your neighbor yougreet and ask about life, have coffee together, particularly on weekends and holidays. Here, this is not the case(Yugoslavian No. 07)’’‘‘The psychological problems are always there. I don’t want to stay here. I want to go back [. . .] I haveeverything, including retirement benefits in China. I don’t want to stay here. I don’t feel that this is my place[. . .]. I was very active in China. I was an editor and a reporter [. . .] I had many activities [. . .] But I don’t havethe[m] here (Chinese No. 06)’’‘‘In my tradition parents always live with their children. If they have more children, they stay with one. This ishow it was with my father, with me and with my brothers and sisters. This is our family tradition. [. . .] Before thewar in our country we had nursing homes but there was not much of a need because seniors were taken care ofby their adult children (Yugoslavian No. 05)’’‘‘Given the history of the inner city, we see a lot of people with mental illness, and a lot of our immigrant seniorshave [it, or] post-traumatic stress disorder, and [. . .] are sometimes isolated from the rest of their groups, theirculture (Service provider/policy influencer)’’

(continued)

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 21

Table I

Barriers to use of services and supports (RQ 3)Negative attitudes ofservice providers

‘‘Some of the people up front behave just like owners and if they see you and they don’t like you or they figureyou don’t know what’s happening [. . .] they can make life miserable for some people [. . .] [. . .] if I came to anoffice where you are working and I show you my Social Insurance Number or even tell you my Social InsuranceNumber and I have a photo, citizenship photo ID and at the same time I have a driver’s license [. . .] andsuppose I didn’t have a passport, what would happen? I should be helped [. . .] but some don’t help you [. . .](Yugoslavian No. 06)’’‘‘In China we got help from the community and our employers if we needed it, so I didn’t feel like a burden toanyone [. . .]. I hope I can find a simple job and earn some money for us to visit China. However, I can’t do this.I went to look for a job but they wouldn’t hire me because I am too old. They didn’t say they wouldn’t hire me;they just let me wait after they said they would call me. But I never got a call. If I were 24, they would hire me(Chinese No. 06)’’

Waiting time ‘‘The most unsuitable thing is health services [. . .]. Seniors have many diseases. They can’t wait as usual,making an appointment, and then wait. They need to see the doctors as soon as possible. It is hard to do this inCanada. If possible, it is better to have a hospital only for seniors to provide quick treatment to the seniors whoare in need (Chinese No. 03)’’‘‘Seniors have difficulties in seeing a doctor. We have to wait for a long time to see a doctor. Every visit takesover 3 hours (Chinese No. 07)’’

Inappropriate servicesand programs

‘‘The workshop [by a government department] [. . .] doesn’t help me [. . .] period [. . .] so I don’t know who ithelps [. . .] maybe it [depends on] who is running it [. . .] I am sure they get paid from the government [. . .]because they publish it in the paper and that’s where I saw it, so when I phone them up they say ‘come in,’I figure more [or]less that I would be getting a job now [. . .].but when I go there they showedme a whole bunchof papers and [. . .] there are no job (Afro-Caribbean No. 07)’’‘‘Here doctors do not help people I feel that the illness is spreading and spreading. I spend a lot on naturalmedicine, in tea, on herbs, I have a book on natural medicine and I spend money on it, because they make mefeel better. There is one named Mangostin that is very good for one’s health; it is good for blood pressure andkidneys. It is expensive though, $50/bottle, but it is good. My husband takes it and it does him good. Thedoctor never gave me vitamins so I have to buy natural medicine, I am always spending money on my health,I always try to stay healthy (Spanish No. 06)’’

Inaccessibility ofprogramsand services

‘‘[. . .] the government now doesn’t want to give anything if you are living in your own place or such like it [. . .]So far, nothing [no help] really comes. Once you turn a senior [. . .] the social supports are cut off [. . .] [and] youno longer have access to AISH or EI, even if you are working (Afro-Caribbean No. 03)’’‘‘My wife is very interested in learning English, but the hours she got were not enough. She learned the basic,but it is not enough. The government still did not give her more hours, because [the policy is that] if a husbandmakes more than $6,000 in five months, the wife is not eligible for [government-sponsored] school programs(Spanish No. 05)’’‘‘I was hoping to get widower’s pension when I turned 55. Unfortunately, this did not happen because thegovernment cut off widower’s pension completely. Yet, I remain sick; I cannot work and I have no other optionbut to stay on social assistance. Who knows how long I will stay on welfare? (Yugoslavian No. 00)’’‘‘But a lot of the immigrant seniors that we’re involved with [. . .] [are] losing out on services that, as part of thecommunity, have a right to. And in many cases, they’re highly educated, highly competent immigrants whohave had very successful and prominent careers and lives in other parts of the world. The only single issue forthem here is not having access to be able to work in their own language [. . .] (Service provider/policyinfluencer)’’

Cultural barriers tosupportseeking

‘‘So we find that a whole group of things are forcing them to hold back in accessing things: cultural reasons,personal reasons. Some countries they’ve come from, they’re suspicious of government becausegovernment’s used information about them to throw people in jail. I mean, there’s a whole [lot] of reasons(Service provider/policy influencer)’’‘‘The other thing is the accessibility, too. There are a lot of different services out there for seniors, but it’s difficultfor them to get to access it [. . .]. Some of it is also cultural norms; some people look at things done in a differentway not the same as it’s normally done in their culture, they kind of tend to just sit back. Even if they need it, let’ssay, really badly, it’s really a huge thing (Service provider/policy influencer)’’

Access barriers (RQ 3)Lack of informationabout services

‘‘I would like to know if there is information pertaining to [. . .] things like that [. . .] that we as people from theislands could use [. . .] (Afro-Caribbean No. 04)’’‘‘The government takes tax from everyone that works in this place and I think the government should have [. . .]programs for other ethnic groups [. . .] but there are no programs for the English-speaking Caribbean oractually [. . .] anyone from the Caribbean community (Afro-Caribbean No. 03)’’‘‘We serve immigrant seniors, and a lot of them don’t come to our program because of the language barrier,and also sometimes they don’t know about services [. . .]. So the ones that get in touch with us learn about theservices, but there are a lot that still don’t know about it (Service provider/policy influencer)’’

(continued)

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slipping and falling on snow or ice. Consequently, they stored groceries to avoid going

outside. This challenge is intertwined with transportation problems.

Lack of employment opportunities. Employment is an important ingredient in integrating

immigrant seniors into the Canadian society. Some immigrant seniors were disappointed

that they were unable to work because of old age, as perceived by prospective employers.

For some seniors, credentials obtained before coming to Canada were not acceptable to

employers in Canada making it exceedingly difficult for them to start new careers.

Poverty and financial difficulties. Given discrimination by potential employers and failure to

secure jobs, many seniors did not have adequate income to support themselves and lived in

low-income housing. Some were on waiting lists for cheaper housing because of financial

difficulties and increasing rents. Immigrant seniors were required to pay for some services and

programs offered by organizations. As some depended on their children or family for financial

support; they wanted affordable services. Most Afro-Caribbean and former Yugoslavian

seniors reported financial difficulties and poverty. They complained about expensive services

provided by the community service providers. Poverty and financial difficulties, however, did

not seem to pose a problem for the Chinese and Spanish-speaking seniors.

Table I

‘‘We might offer a lot of knowledge and a lot of service to immigrant seniors; they’ll never, ever know about it,cause they can’t read our newsletter because it’s in English. But you can definitely see that if they never knowthat the programs are out there, you can have every program in the world, but if they don’t either speak Englishor write English, then it doesn’t matter what’s available if they don’t find out about it (Service provider/policyinfluencer)’’‘‘Even though Canada provides very good services, since I don’t understand the language, I don’t feel they arevery good. They are difficult for me (Chinese No. 08)’’

Funding ‘‘You talked about funding; just out of our office, we spend $32,000 a year just on interpreters. And in someagencies, that’s a position, that’s a salary. So, it’s very complicated. [. . .] (Service provider/policy influencer)’’‘‘Again, did I mention that in the funding? No, because what I was asked is to create a [. . .] in order to be able tobring my tai chi, my income-generating project. Because if they give you $25,000, they’d say [. . .] That’s tooexpensive for one senior. But from that group that’s being given $25,000 funds, what happens here is you areserving them one-on-one. And if you look at that, a counselor is paid, what? $75 an hour? Okay, how manydoes she serve during the day? So if we try to start bringing that into funding that really is the kind of supportyou would really want (Service provider/policy influencer)’’

Lack of resources ‘‘Nowadays, as with all non-profit organizations, the challenges that we face is funding [. . .] We need to havethe funding to carry on with programs. Our seniors’ program has just stopped because of lack of funding.So, sometimes it’s very difficult (Service provider/policy influencer)’’‘‘At this time, economic boom, it seems that also our manpower is also a very challenging factor in thiseconomic boom. To get the right person to do the right job at the rate paid by self-help organizations [. . .] isalso another factor. So, I think these are the essential challenges facing the non-profit organizations [. . .] now(Service provider/policy influencer)’’

Lack of culturallyappropriate services

‘‘So, we support them when they probably otherwise would have to be in a nursing home. And that’s verytraumatic when you speak a different language and the food is unfamiliar. There is no leeway to provide aspecial kitchen, for instance, to look at culturally sensitive diets (Service provider/policy influencer)’’

Lack ofintersectoralcollaboration

‘‘I think something that we’ve tried to do and has been a really huge challenge [. . .] was to [. . .] connect withmost of the mainstream service providers out there [. . .] to come out and offer presentations on how to accesstheir services to our community members, the program participants. It’s sometimes a challenge to getsomeone from big institutions or big service providers to come out and just talk about what they do or what theyoffer to people out in the community. So, these kinds of things [. . .] need to be addressed on a really kind ofupfront [. . .] effort [. . .] [I]t’s just sometimes frustrating to be doing that all the time, and there’s not thatresponse sometimes (Service provider/policy influencer)’’‘‘So part of what I do at the coordinating council is trying to figure out how we can, as a sector, make somechanges and help the seniors-serving agencies to adapt their programs and to do more outreach into thecommunities. I’m working right now with [. . .] [name of agency] and [. . .] [name of agency] and [. . .] [name ofagency] to do a project where we’re looking at building a resource bank for seniors-serving organizations sothat they would know, first of all, what communities exist in their area, whether there’s a large population, say, ofSpanish seniors, or what have you, and help them make those connections with the communities tounderstand what the needs are of the community and to see if there’s some way that they can offer maybe toshare their space or their resources with those communities (Service provider/policy influencer)’’

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 23

The challenges of low income were echoed by service providers and policy influencers. In

their view, immigrant seniors depended on community organizations for services, but could

not access other mainstream services due to financial constraints. Indeed, some immigrant

seniors were homeless and dependent on community organizations for food, clothing, and

other basic needs.

Physical and mental health problems. Seniors are facedwith amultitude of health challenges.

This problem is worse for immigrant seniors due to barriers that impede them from using health

services. Health challenges experienced by immigrant seniors include limited mobility and

physical activity; nutrition deficiencies; mental health problems particularly post-traumatic

stress disorder among seniors from war-torn countries; and injuries caused by falls.

Dependence on others. Some seniors reported that theywere no longer in control of their lives

and had to depend on other people. Seniors revered their culture which emphasized the

importance of hard work and self-reliance. Hence, they preferred to be self-reliant rather than

dependent, believing that reliance onotherswas not empowering. Immigrant seniorswere also

unhappy about being care receivers in Canada. Somewere reluctant to seek support because

they worried that they would likely be a financial burden to the government or a psychological

burden to their families and friends. Some believed that it was their personal responsibility to

take care of themselves and seek assistance only in desperate circumstances.

Service providers noted that immigrant seniors often babysit their grandchildren and have

no time for themselves until their daughters come home to take care of the children.

Consequently, seniors’ ability to access beneficial social programs depended on their

children’s schedules. While some immigrant seniors were optimistic and believed that there

were mutual benefits, others perceived that they were a burden for their families. For some

seniors, independent living was virtually impossible due to poor health, limited mobility, or

government policies that prohibited them from working. Moreover, their activities were

restricted by lack of financial autonomy.

Language difficulties. Language ability played a pivotal role in immigrant seniors’ settlement

and integration and exerted amajor impact on socializingwith neighbors; seeking employment;

navigating confusing systems to access services; and, maintaining self-identity, social status,

family cohesion, andcivicparticipation. Inability to speakEnglish emergedas amajor challenge

that affected access to services and social support. While Chinese, Spanish-speaking, and

former Yugoslavian seniors identified language proficiency as a significant barrier to

communicating with service providers and accessing services, Afro-Caribbean seniors

reported that mainstream Canadians only had difficulty understanding their accent.

Owing to language difficulties, many immigrant seniors had to rely on family members or

community agencies for assistancewith form completion, and interpretation of information and

documents received from service providers and government. Without face-to-face

communication using a common language, these immigrant seniors felt disempowered and

lacked control.

Service providers reiterated the challengearound languageproficiency, indicating that inability

to speak or understand English prevented immigrant seniors from accessing available

services. To overcome the language barrier, some agencies lacking multilingual personnel

reached immigrant seniors through family members, especially children who often spoke

English better than seniors. Although paid interpretation services in hospitals and health

centers were recently initiated, family members had to interpret in medical appointments and

community events, andhelpagencies toaskculturally appropriatequestions.However, service

providers indicated that familymemberswho acted as interpreters sometimes did not correctly

convey information between service providers and seniors.

Need for transportation. Transportation is vital for seniors’ mobility. Access to social activities

and health services was not possible without transportation. Owing to restricted mobility,

immigrant seniors seldom socialized with people outside their family circle and

neighborhood. Lack of transportation also restricted them from participating in community

events, resulting in limited social contact. Immigrant seniors indicated that lack of

transportation was a major factor contributing to their isolation.

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Service providers and policy makers affirmed that transportation challenges hindered

immigrant seniors’ access to available services. Only two organizations provided

transportation to seniors for health care and shopping.

Perceived racism and discrimination. Perceived discrimination emerged as a challenge for

the Afro-Caribbean seniors primarily. Service providers noted that racism and discrimination

were major issues, particularly for immigrants who resided in ‘‘mainstream’’ seniors centers.

Most immigrant seniors, however, observed that they were treated fairly by the majority of

Canadians and that those who discriminated against them were in the minority. Seniors

described institutional discrimination in their quest for employment due to old age or

perceived disabilities. Employment discrimination increased the insecurity of the of older

immigrants’ economic situation. Institutional discrimination also posed a barrier to accessing

support services and programs.

Immigrant seniors support needs (RQ2)

Family conflicts. Although immigrant seniors were happy to be reunited with their families,

they reported family ties that generated conflicts and abuse. This was a sensitive issue for

immigrant seniors. Service providers noted that seniors were unlikely to report or admit that

they were abused. Some seniors were brought to Canada to provide child care and could not

enjoy relaxation or entertainment due to lack of financial independence. Moreover, some

seniors’ financial support from government was taken by their children. Service providers

noted that English as a second language classes and social programs provided the only

opportunities to escape fromhomeandabuse for some immigrant seniors. Seniorswhowould

not tolerate familial abuse and moved into seniors’ homes were often isolated and lonely.

Depleted social networks and social isolation. Loneliness and isolation emerged as the

greatest challenges faced by immigrant seniors. In Canada, these immigrant seniors

experiencedchanges in family dynamics, disintegrated family ties, depleted social networks,

intergenerational differences, and family conflicts. Loneliness was exacerbated by

challenges of adapting to the new environment. While seniors received support from

children and friends,most reported that their social networks hadbeen depleted bymigration

to Canada and resultant distance from their homeland. Participants contended that theywere

moresocially connected in their homecountries, indicating that it wasdifficult to establish new

social networks due to language difficulties and other cultural barriers in Canada.

Furthermore, family conflicts and negligence contributed to experiences of isolation among

seniors. Some seniors, who had no families or were abandoned by families, did not have any

social contacts beyond those with service providers.

Mental health issues, associated with post-traumatic stress disorder for some seniors,

coupled with lack of access to services at heath facilities also contributed to social isolation.

Immigrant seniors reported isolation and exclusion from social activities which led to feelings

of depression and homesickness. Service providers supported immigrant seniors’ accounts

of social isolation.

Barriers to use of services (RQ3)

Lack of information about services. Challenges are exacerbated by lack of information about

available resources. Many immigrant seniors did not have sufficient information about

services. Service providers acknowledged that some seniors are uncertain about available

services and their eligibility. Language barriers were intertwined with lack of information

because senior immigrants could not understand newsletters and booklets written in

English. The Afro-Caribbean seniors were not aware of support services that targeted their

community. They believed that services for seniors were not equitably distributed across

people of different cultural backgrounds, and were critical of the city’s limited support

programs for their ethnic community in contrast to other cultural communities.

Service providers noted that many seniors who did not visit community agencies lacked

information on available services. Moreover, when service providers communicated with

immigrant seniors through letters or phone calls in English, seniors had to seek help with

interpretation and explanation of the information.

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 25

Negative attitudes of service providers. Service providers who had not been trained in

multicultural sensitivity were viewed as a major barrier when immigrant seniors sought help

from government departments and service agencies. Some seniors commented that service

providers were insensitive to their needs and provided insufficient information. Government

workers were often unaware of the prejudice and discrimination experienced by ethnic

minority residents and did not provide adequate support.

Waiting time. Immigrant seniors were unhappy about the length of time they had to wait to

access health services. They complained about delays in getting appointments with medical

specialists and did not receive timely treatment.

Inappropriate services and programs. Immigrant seniors expressed differing sentiments

regarding the suitability and appropriateness of support services and programs available to

them in the study site. Some seniors were dissatisfiedwith the provision of support, particularly

from government departments. The major criticism focused on the suitability of services and

programs. Some Afro-Caribbean seniors needed job-related programs, which available

servicesdid not provide. TheChinese andSpanish-speakingseniorswere not satisfiedwith the

health care system which, in their view, ignored culturally appropriate medicines.

Systemic barriers. Immigrant seniors expressed resentment toward some government

policies which prevented them from seeking gainful employment or obtaining affordable

housing. These policies combined with reductions in government support to the health and

social services sector resulted in cancellation of programs or fees for programs. Ineligibility

to access certain programs and services was another great concern. Service providers

identified other systemic factors that made some programs and services inaccessible to

immigrant seniors, including the fact that most services are provided in English or French.

Immigrant seniors had to seek support from community organizations to overcome barriers

to services (e.g. health care, pension) that are easily accessible to Canadian seniors.

Cultural barriers. Service providers and policy makers noted that some services were not

used by immigrant seniors due to cultural barriers. Cultural beliefs (e.g. protecting family

secrets from younger people or people from another cultural background) acted as barriers

to accessing services. As some immigrant seniors had never sought assistance due to

cultural norms, it was challenging for them to start seeking services in Canada. Some

cultures restricted the movement of women, making it difficult for them to access services.

Immigrant seniors who came to Canada as refugees were fearful and even suspicious of

government services due to their negative experience with their home government. These

seniors chose avoid government programs due to fear that their case might be investigated.

Limited financial and human resources. Service organizations and community-based

agencies play an important role in the adaptation process of immigrant seniors. Although

interpretation services were reported to helpful, they are costly. All agencies reported lack of

funding for such programs/services due to funding cutbacks. The recent population boom in

the study site increased costs of renting homes and increased numbers seeking community

resources such as low-income housing. Many health and social service agencies noted

decreased financial and human resources, limiting their ability to address unmet needs of

the senior immigrant population.

There is a growing need to accompany immigrant seniors to service appointments and help

with basic communication, yet funding for such services is uncertain. Resource cut backs

during recent years have created problems for immigrant-serving organizations which affect

both quality and quantity of services provided. Most service providers noted that they do not

have adequate human and financial resources to serve their clients.

Lack of culturally appropriate services. Many organizations were aware of the diverse

cultural profiles in their communities, but delivery of culturally appropriate services to

different cultural groups was challenging. Given the diverse languages (over 50) of

immigrant seniors in this study site, the need to provide information in the language of choice

for cultural communities was emphasized by service providers. Almost all information

regarding resources/services was written in English and, therefore, not accessible for the

intended population. Participants reported that there were insufficient culturally appropriate

PAGE 26 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj VOL. 7 NO. 1 2011

services for immigrant seniors due to the small numbers of professionals from different

ethno-cultural communities. Participants agreed that it is difficult for non-profit organizations

to attract qualified staff because of limited funding.

Lack of intersectoral collaboration. Few multicultural liaison workers represented some

ethnic groups, and service providers had limited resources to support cross-organizational

cooperation needed for effective service provision. Service providers and policy makers

emphasized the lack of collaboration across health and social services at municipal,

provincial, and national levels. Intersectoral collaboration, in their view, would help reduce

costs for individual agencies and promote sharing of expertise and resources.

Discussion

This study of Chinese, Afro-Caribbean, former Yugoslavian and Spanish seniors in a major

urban centre of Canada revealed settlement challenges, attendant support needs, and

barriers to support seeking and service provision for immigrant seniors, from the diverse

perspectives of immigrant seniors, service providers, and policy makers. Varied interrelated

challenges emerged from this unique study which explored both immigrant seniors and

service providers’ perspectives (see Table II for comparison of perspectives). Studies on

immigrant seniors (Acharya and Northcott, 2007; Barrio et al., 2007; Polyakova and

Pacquiao, 2006; Bowes andWilkinson, 2003) focus on a single challenge and a perspective.

Table II Comparison of challenges and barriers identified by immigrant seniors and service providers

Immigrant seniors Service providers and policy influencers

Challenges (RQ 1)Unfulfilled immigration expectationsDifficulty adjusting to climatic conditionsLack of employmentLonely, distance from friends/loss of friends IsolationPoverty and financial difficulties PovertyPhysical and mental health challenges Post-traumatic stress and mental illnessLack of independence and control Seniors provide family child care restricting access to beneficial social programsReluctant to seek support/worried about beingfinancial burden

Dependence on family and community organizations

Language difficultiesLack of interpretation services

Language barriers

Limited transportation Transportation challengesNeeds (RQ 2)Lack of information about services Seniors do not visit community agencies

Print material in English or FrenchFamily conflicts Seniors unlikely to report family abuseLoneliness and isolation Social isolation and exclusionDepleted social networks Depleted social networksMental health issues Post-traumatic stress disorder, depressionPerceived discrimination by minorityTreated fairly by the majority

Racism and discrimination particularly for immigrants who resided in seniors centers

Employment discriminationBarriers to services (RQ 3)Institutional discriminationNegative attitudes of service providersWait timesInappropriate/unsuitable services and programs

Lack of community awareness of immigrant senior challenges

Policy barriers to employment and affordablehousing

Information/services provided in English or French

Cultural pride Cultural barriers to service useLack of informationHigh cost of programs

Service provision barriers: high costs of programs, lack of resources, lack of culturallyappropriate services, limited mandates or geographical coverage, lack ofintersectoral collaboration

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 27

Despite resentment about expectations that were not realized, and frustration and

disappointment regarding unanticipated challenges encountered upon arrival in Canada

among some immigrant seniors, individual interviews revealed positive sentiments and

appreciation of the living conditions in Canada. Transportation emerged as a central issue in

these immigrant seniors’ lives, restricting access to services, community and civic activities,

and contact with friends and family and contributing to social isolation. Such findings

supplement other recent studies (Lai and Leonenko, 2007; Barrio et al., 2007; Jang et al.,

2006). These insights call attention to the importance of available, affordable, appropriate,

and convenient transportation services for immigrant seniors.

In this study, language ability emerged as a pivotal challenge affecting the settlement

experiences of senior immigrants, because it intersected with other barriers to navigating

service systems, seeking employment, and civic and community participation. This finding

extends other studies (Lai and Leonenko, 2007; Polyakova and Pacquiao, 2006; Barrio et al.,

2007). In contrast to previous research, the experiences of four different cultural/immigrant

groups were compared. Although all experienced language difficulties, language

proficiency was the primary perceived challenge for Chinese, Spanish-speaking, and

former Yugoslavian seniors, unlike Afro-Caribbean seniors.

The heavy reliance of seniors on familymembers and interpreters, according to both immigrant

seniors and service providers, made seniors feel powerless. Seniors experienced lack of

controlbecauseofdependenceonotherpeople. Theirdesire for independencewashampered

by lack of financial autonomy. One recent study linked financial limitations to diminished sense

of control among Korean-American seniors in the USA (Jang et al., 2006). Our study

supplemented these findings by identifying lack of employment opportunities and inadequate

incomes as factors preventingmost immigrant seniors (particularly Afro-Caribbean and former

Yugoslavian seniors) from meeting their basic needs (e.g. housing, food, health care), and

thereby diminishing sense of control. These findings call for measures to ensure that adequate

financial resources are available to immigrant seniors so that their dignity and independence to

make choices about basic needs and services is restored through financial autonomy.

A cluster of challenges impede immigrant seniors’ access to formal services and programs

and thereby increase unmet needs. These include lack of information about services and

entitlements, racism and discrimination, negative attitudes of service providers, prolonged

waiting times, and culturally inappropriate services. Lack of information regarding services,

and programs was intertwined with language difficulties, because information is typically

distributed in English. Afro-Caribbean seniors were not aware of services that targeted their

cultural community, and viewed this gap as discrimination. Lack of information about

available services has been identified as a challenge in previous studies (Barrio et al., 2007;

Lai and Leonenko, 2007; Wong et al., 2006b; Bolzman et al., 2004).

Perceived racism and discrimination were prevalent among Afro-Caribbean seniors;

particularly those residing in seniors’ homes. One recent study revealed a potential

relationship between perceived discrimination and psychological well-being among

immigrant university students in Britain (Jasinskaja-Lahti et al., 2006). Although institutional

discrimination regarding ineligibility to seek gainful employment because of old age and

perceived disabilities affected most immigrant seniors in our study, Afro-Caribbean seniors

were negatively affected to a greater extent. This systemic barrier negatively influenced

seniors’ ability to obtain housing. Barriers to employment and access to welfare resources for

immigrant seniors were noted in one study conducted in Europe (Bolzman et al., 2004).

The significance of culturally suitable services and programs, including service providers from

thesamecultural communitywhospoke thesame language,wasstrongly related toserviceuse

in our study. The revelation that some immigrant seniors were abused by family members

deserves further exploration. Some seniors experienced loneliness and social isolation

because theydidnot have familymembers, haddepleted social networks, orwere abandoned;

yet others who had family networks were being abused. This insight is not reported elsewhere.

Another unique contribution of this study is the examination of personal and cultural barriers

to support seeking. Barriers rooted in cultural norms and values influenced these immigrant

PAGE 28 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj VOL. 7 NO. 1 2011

seniors’ response to the cultural relevance of services and programs available to immigrant

seniors.

The inclusion of service providers in this study yielded new insights regarding barriers to

provision of culturally appropriate services and supports. The challenges reported by

service providers and policy makers attempting to facilitate settlement of immigrant seniors

included high cost of programs, gaps in resources, culturally inappropriate services, and

insufficient intersectoral collaboration. These barriers experienced by immigrant-serving

agencies underscore the importance of reviewing policies affecting immigrant seniors, and

their access to health and social services.

Conclusion

Immigrant seniors faced six major challenges that have implications for practice, programs,

and policies:

1. providing culturally sensitive and appropriate services and programs;

2. making services and programs linguistically appropriate by employing professionals who

speak multiple languages;

3. increasing transportation for seniors to participate in social and recreational activities and

access services;

4. reducing costs and waiting time for services;

5. expediting applications for citizenship to facilitate access to government benefits; and

6. enabling immigrant seniors to obtain employment thereby diminishing financial burden

on sponsors and alleviating poverty.

This study revealed numerous unmet needs for successful acculturation of immigrant and

refugee seniors in Canada. The interrelated challenges exist at three levels: micro

(e.g. one-to-one interactions),meso (e.g. interactionswith service/community organization or

government), andmacro (e.g. government policies that influence entitlements to government

resources and services, legal status, and settlement). The most cogent and sustainable

approach to close this chasm of support deficits, unattended challenges, and complex

stressors is to implement a model that simultaneously addresses the three levels and use a

multisectoral approach. Moreover, immigrant seniors need input into provision of pertinent

services, programs and policies. In Canada, strategies that strengthen ethnic community

resources and widen the reservoir of support for immigrant seniors are timely.

Implications for practice

Service providers and practitioners in health and social sectors can:

B Consult with immigrant seniors about their service needs.

B Engage family members.

B Ensure that interpretation services are available for verbal communication or that staff and peer

helpers from the ethnic communities are multi-lingual to ensure that services and programs are

culturally sensitive.

B Use simple terminology in the languages of populations served and pictures for brochures and

written communications.

B Arrange for transportation to services and programs.

B Create peer support groups of immigrant seniors.

B Collaborate with service providers in other agencies and sectors as teams to promote

comprehensive services that meet the multi-faceted needs of seniors including those derived

from employment and financial challenges.

B Advocate for policy changes that meet the unique support needs of immigrant seniors.

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 29

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making connections to community resources’’, Qualitative Health Research, Vol. 12 No. 6, pp. 751-68.

VOL. 7 NO. 1 2011 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj PAGE 31

Spitzer, D.L., Neufeld, A., Harrison, M., Hughes, K. and Stewart, M. (2003), ‘‘Caregiving in transnational

context: ‘My Wings Have Been Cut, Where Can I Fly?’’’, Gender & Society, Vol. 17 No. 2, pp. 267-86.

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family caregivers in Canada: implications for policies and programs in health and social sectors’’, Health

and Social Care in the Community, Vol. 14, pp. 329-40.

Corresponding author

Miriam Stewart can be contacted at: miriam.stewart@ualberta.ca

PAGE 32 j INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CAREj VOL. 7 NO. 1 2011

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