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I know that the hourly pay for an aide at even the highest level nursing home is very low. And, it's not a great job, to say the least. But, still....when an aide has such a thick accent that I cannot understand what the aide is saying, let alone my mother who is 91 and hard of hearing, it seems to me that the aide should not be working there.


The accents are one issue. I understand that aides are low paid, but why is it my problem, and my mother's problem, to try to understand an aide who has a thick accent?


The ability to appropriately speak to a hard of hearing resident/patient is another issue.


I have been told, more than once, that all staff is trained to get within 3-4 feet of a hard of hearing patient when speaking.....and speak directly.....not to say something when walking out of the room or when moving around the room. But, that's not what happens. I have seen it. Countless times.


Please don't....even with the best of intentions...mention hearing aids. We tried that. My mother is fine with the phone and with the TV and when someone speaks directly to her close enough.


All I want is for the staff to get close enough to my mother and actually look at her and speak to her directly.


And, yes......after 3 years of home health care givers, and now almost 2 years of nursing home aides, not all of which...but many of which....have accents that, as I have said already......I cannot deal with this.


Any advice?

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I had just posted on her about the aides where my Mom is, and how they can't be understood, and they don't understand me.
I know how you feel, and what you're talking about. The language barrier is a big one. It wears me out just trying to ask a question and not being understood. I repeat the question many time, and rephrase it, hoping they understand me.
If I wanted my Mom to be in a home where a different language was spoken, I would have searched it out. In a era where everyone is hollering for their rights, the elderly are being left behind. How can anyone expect them to learn a new language, or understand a heavy accent?
I guess the only way to get things straightened is to contact an Ombudsman, Adult Protective Services, and the Department of Human Services. Keep bringing attention to the problem until it's resolved. If the caregiver can't communicate well, how are they going to know about medications, health problems, and caring for the patient with Alzheimer's? I've had to ask the doctors to make Mom's pain medication a scheduled dose, instead of a prn. The caregivers didn't understand when Mom when was in pain.
I've sent an email to the owners of the home, asking that they make sure the caregivers LISTEN to Mom. Don't just smile and nod!
When my Dad passed away in April, my Mom was so grief stricken it broke my heart. I couldn't be there every moment of every day, so I was hoping the caregivers would console and comfort her. Instead, I would find Mom in her room crying all alone, not knowing where Dad was.
I'm sick of all of it.
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I grew up in Hawai'i, and live in California. I've always been surrounded by many, many accents ... and yet ... I've learned that many others can hear only a severely limited number of accents, and, perhaps, even only one. Hearing and cognitive impairments may not allow a person to understand *anything* but the precise voiceings they are accustomed to.

I really, really wish that somebody comes up with an app, or a device, that would translate a clinician's own voiceings into a more neutral one, and/or into writing, for those who can read. Or, perhaps, for common phrases, it could translate into pictures.
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The accent thing is, well, difficult. Most of our loved ones are going to have problems hearing and processing verbal info. Insert an unfamiliar accent? Well double the issues.until these facilities PAY more, you general you, are going to get what's served up.

There are many native Born Americans who have difficult accents. Parts of Boston, new York, the Carolinas, Virginia, Arkansas, Louisana, Alabama, my own state in Oklahoma.

If one's ear is already attuned to a dialect it is easier, if not, well...

Op, this issue will only get more pronounced.
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Tothill, both my boss and I have issues with people talking too quickly, and it is mainly the young people. It's like they have to catch a train or something, they are in such a rush.

Like when someone on the phone give me a telephone number, all I get it is the first number, as it is rattled off so quickly, and then the person on the other end of the phone gets irritated when I ask them to repeat it several times over. Please slow down.
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Tothill Jul 2019
I had a job where I had to leave telephone messages to remind people of appointments. I made a point of repeating my name and the telephone number twice in each message and spoke very slowly. I know that people are often not ready to write down a message when they listen to them. It gave them time to get a pen and hear what I was saying.
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I have not read all the replies, but want to share something that may put some of this into perspective.

I have family living on 4+ continents and the Antipodes. We are in shades ranging from incredibly pale to dark skinned. Some like me are spotted (freckles everywhere). All of us speak English, many one or more additional languages some with different alphabets or character sets.

I just had a wonderful week with my niece from New Zealand. She cannot use Siri on her iPhone as it does not understand her accent.

I have a beautiful friend from Nigeria. People do not accept that English is not only her first language, it is her only language.

My grandmother was an immigrant. Her only language until age 70 was English, but she used different phrases and expressions than my Canadian born Granny.

I went on a road trip through 11 states and 4 provinces in May/June. Where ever you go there are accents, even within the US and Canada.

India is the largest English speaking country, population wise, in the world.

I am slowly losing my hearing. Not to the point of needing hearing aides yet, but I often have to ask people to repeat themselves, not due to their accent, but due to my hearing loss.

I cannot hear a conversation in a busy, noisy, location. I apologize to whomever is speaking to me and ask if we can go to a quieter area to converse.

I truly feel that phrasing it as I have the issue of hearing loss and requesting an accommodation, then thanking the person who accommodated me, goes a really long way to building community.

In one of the earlier replies, I do not remember whose it was, there was a comment about an in home aide not knowing the difference between pickles and olives. I remember the first time I was given a fresh fig to eat, I had never seen one before, I had no idea how to eat it and felt completely out of my comfort zone. The woman who gave it to me only spoke Italian, but with gestures we were able to communicate and I learned to enjoy fresh figs.

I can understand the frustration of being hard of hearing and needing people to look me in the face when speaking to me, but accents are not an issue for me. Talking too quickly, or quietly is more of a problem.
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I can relate to you!!!! My grandma used to ask me what did she say and I had to tell her gram sorry I didn't understand her either!!!! 😆My gram stayed short term in a facility that 95 percent of the aides were Jamican/ Haitian. I am not making this up nor am I am racist!!!! SO DONT GO THERE!!!!! I even had a hard time understanding them. I put up a memo on grams board that was hard to miss. In big letters it said" I am hard of hearing," come closer with a smiley face. I also had the nurse document it. I also became friends with the aides and visited gram very day.
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Lymie61 Jul 2019
I put a big note up behind Mom's bed "Deaf in the right ear 50% in left, speak slowly and face me" the problem with my mom is her default is to pretend she heard and understood everything unless one of us is in the room. She has been deaf in that right ear since she was a child. She typically agrees and just says yes too so someone asks "do you understand"? and she nods "yes" so I can't blame people who don't know her she fools us too! We have become pretty skilled at knowing when she didn't follow though and how to test it. Maybe helping the staff learn how to communicate with mom by "interpreting" when you are there. I used to look at the aid when I sensed Mom didn't actually hear them I would then face her and speak up the way mom follows best and get her response. Then I would remind them of her issue and clue them in that all you need to do is face her and speak up slowly but you want to make sure she understands because she will default to agreeing. "Did you eat a good dinner?" she says yes when in fact she hadn't even gotten it yet! Lol
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Have you ever heard a rural Louisiana accent?
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anonymous896861 Jul 2019
No.. but now I want to! 😊
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You know, my mom was in a non diverse, Lily white memory care facility. All aides Caucasian. But man they could butcher the English language. When she was still with it cognitively, she would correct their grammar.
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Regarding accents, my Mom always had difficulty understand people who had accents even if the person was from the southern part of the U.S., people from Boston and even New York City... [sigh].

My Mom even had issues with my mother-in-law who had a French accent mixed with a southern drawl as she came to the U.S. when she was in her 20's, a war bride.

The kicker here is that Mom parents were from eastern Europe and had a very thick accent. You would think she would have had a better ear for language.
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Maybe this needs to be discussed in a separate thread. Just FYI the U.S. has no official language nor religion. There's a reason for that.

My mom in SNF late 2016 into early 2017. Some of her best aides were Jamaican and Bahamian. Thick accents. Great caregivers. This was high end place, which we were lucky to get a spot for SNF.

Some of you complaining maybe have never been abroad where signs are in 6 languages and dialects are as varied as cuisine.

Also, learning a second language might be good for cognitive sharpness.
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worriedinCali Jul 2019
I agree with you Seg, and that’s an excellent point about other countries being multi-lingual. Canada has 2 officials languages, right? French and English. The USA might as well follow their lead and make our languages English and Spanish because those are the 2 most spoken languages here. English is one of the most difficult languages to learn as well, that’s why I dislike people saying to learn it or leave the USA. It’s a difficult language to learn.

and I don’t know if it’s just California or maybe just my county but.....there are a LOT of Filipino caregivers here. And they are wonderful at what they do, despite their accents. They are nurses, CNAs, and medical assistants. Most medical assistants at the doctors offices are Hispanic-not necessarily Mexican because we have a lot of people from El Salvador and Guatamala here too. But in my lifetime as a Californian, most medicinal staff I encounter do not speak English as their first language. Sure they mispronounce common “American” names but they are still good at what they do.
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I do not think the lady asking the question is ractist. My employers are from India and they speak English just like me and they speak their language as well. If you come into this country you need to speak English simple as that. I have many customers come in where I work who can’t speak English....not my worry I can’t understand you while your vehicle overheats outside and don’t have a winter coat and can’t communicate. Learn English or go home. Or make them pay for an interperator to teach them English, they shouldnt get everything for free coming over to America.
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worriedinCali Jul 2019
Why do you need to speak English if you come to this country? English isn’t the official language here. Why do you assume people come here so they can get everything for free?
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I’ve been away since I posted early on, and I am sorry that this thread has become so complex. The OP has been told that the facility has a policy that workers will move close to the resident and speak directly to them, and not to speak while moving around the room. The problem is that the policy is not being followed. The solution is to get the facility to follow up on reinforcing the policy.

Workers with a non-English speaking background often work with others who share the same accent, and it is hard for them to realise that it is difficult for 'outsiders' to understand. I volunteered with a conversation group to help migrants speak English, and eventually realised that a particularly difficult guy from south India had actually learned his English there from local teachers who used the same accent! He was adamant that he was pronouncing things accurately, even though he knew he had been turned down for jobs because he couldn’t make himself understood. Communicating in a different way from what a worker thinks is ‘normal’ needs practice, and that is what the facility should be helping with. Just complaining to individual workers is far less effective.
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I know exactly what you mean, my mom is deaf in one ear and has about 50% in the other and has a hard time with some accents as well. I will say however that it seems to work better when the person speaks to her, she has used a mixture of reading lips and hearing bits for many years and it also helps when the nurse, CNA, doctor uses ques about the topic as well. It isn't just international accents that can be hard to understand for a hard of hearing elderly person English speaking dialects can be hard too, it can be for me sometimes and I don't have a hearing problem.

Is it possible the caregivers, especially CNA's who aren't giving meds or recording information don't take the time to speak directly to her and interact more directly because she has visitors and they don't want to interrupt for something that isn't particularly important? I mean asking if she needs anything or telling the room when dinner is coming for instance may be as much for your benefit and something you can convey rather than stepping in front of you to face her and speak loudly. I can imagine that being the case depending on the person, I also have to say that I as I think about it when I'm in the room an any care attendant, even doctors she doesn't really know, would come in and talk to mom and she looks to me to "interpret" accent or not.

Maybe you could let the people you have issue with know either by stepping back or saying she's hard of hearing and you really need to face her, "speak to her loudly and slowly so she has a better chance of understanding". You could even say, "I think she has a particularly hard time with your accent and it might help if you showed her what your talking about too...for instance stand by or point to the chair as you ask if she wants to sit in it or stand by/point at the curtain when you ask if she wants you to open or close it, big smile as you say how are you today...take the toiletries over or in your hand as you say it's bath time"... that sort of thing. Then if they don't take the care and time to try and be aware of the communication problem and mom is complaining about it or you see it's having a real negative effect on her care take it to the supervisor. We all have an accent to someones ear, it's more about how we try to deal with that as caregivers.
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The thing is, we need to leave the ethnic stuff out of the equation.

It is not unreasonable for CNAs to check that their clients understand what they have said.

Focus on that issue.
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anonymous903302 May 2019
Thank you.

My concerns have nothing to do with ethnicity. I am kind of amazed at some of the implicit comments that I am some kind of racist. After several years of in-home and now nursing home caregivers, I know that there are some accents that are very hard to understand -- not just for my elderly mother --- but also because I cannot understand them, and I have no hard of hearing issues or dementia.

It's not about race or ethnicity.

I agree: all caregivers should care whether their patients/clients/residents can understand them.
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It still shocks me to read this thread.

Prejudice against skin color and accents? Is this group in a pre-civil rights time warp? Haven’t we seen the horrors of hate and cultural insensitivity enough lately?

Our society (and world) has become very international. Look around.

Signs all over the U.S. are now bilingual, product packaging is multilingual.

Many of our best medical researchers, doctors and nurses in hospitals (as well as medical students) were born abroad. I’m sure many of you have gratefully received the benefit of their care. I bet you weren’t complaining when you did.

We should all cooperate and be thoughtful to one another, sensitive to cultural differences, and color blind to differences in skin tones.

We should be as patient with them as we hope they will be with our loved ones.

Expectations that healthcare workers (or anyone, for that matter) speak fluent, articulate, perfect English (with no accent) are unreasonable and out-of-date.
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Isthisrealyreal May 2019
You act as though they aren't prejudice against English speaking people, if they weren't they would learn the language after 25 years here. It has nothing to do with what you are implying, it's about respect all the way around. I don't care what you look like, or what your 1st language is, if you move to a country you learn the language of the land, don't think for one minute if you went to the country they left that you not speaking the local language would get you anything but the run around. It is a sign of respect in other cultures to at least attempt the language.

I am sick of people trying to make me feel bad for being a white, English speaking American. I have nothing to apologize for and I will call you on rude, disrespectful behavior even if you're purple. It is about human dignity and it goes both ways.
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The nursing home that my Mom is in has hired CNAs that can't speak English and only speak Spanish. The question is How in the
world are only English speaking patients suppose to be able to communicate with them? It's tough enough that the patients are old and much slower in being able to express themselves, but if they need something, they won't be able to communicate with some of the staff if the staff can't speak English. To me this is a dangerous situation.

My Mother has been in this nursing home for about 3 years now so some of the longer-term employees know of her. Currently she has declined a lot and I do not believe she will be with us much longer, otherwise I believe I would voice my concern to the Administration and probably try to contact the Executive office. I feel sorry for many of the elderly folks in the nursing homes today. To understand how I feel, all you have to do is visit a nursing home once in a while and observe the interactions of the staff with the elderly folks. As it is, the nursing homes seem to always be understaffed. I'm certainly not looking forward to going to a nursing home in the future. I pray every night that my Mom will be treated with dignity and checked on on a regular basis.

I pray that God watch over all the nursing home patients and give the staff patience, tolerance, and empathy when dealing with their patients.
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I sympathize. It's really difficult to even mention this without being labelled an insensitive bigot, but it it a legitimate concern. My mom was visually impaired as well as hard of hearing so she couldn't even watch for visual clues. The empathetic caregivers are fully aware and willing to repeat or try different ways to help people understand, but unfortunately not all caregivers are suited to the job. The good and bad of living in a facility is that there will be a mix of both kinds of people there, the best we can hope for is that being pleasant and appreciative to all of them will be reciprocated.
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Caring for the elderly is a sad job. It is difficult to be on the front lines watching people decline. It is hard work to change their diapers, to shower them, to move them in bed when they can’t budge, help them up when they can’t stand. It must be devastating to slowly watch them lose their skills, their language, their functioning. I know healthcare workers that needed to change professions because they were depressed after losing patients they were caring for.

Can you imagine going to another country, learning another language, cleaning up after their elderly and then being criticized about the way you pronounce words?

Kindness goes a long way! There are some healthcare workers that you must like more than the others. Be friendly and kind to them. Treat them how you would like to be treated. Ask them about their family (they are helping you with yours). Challenge yourself to make them smile. They will sparkle.

Turn this situation around for yourself and your loved one with positivity.
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JoAnn29 May 2019
But accents are very hard for those who have hearing problems. My husband hears words different then they actually sound to us. Throw in an accent, forget him being able to understand. Anyone working with a patient/resident has to look at them and make sure they are understood. I go thru this all the time with my husband with people who were born and raised in the US. Its very frustrating and has caused problems because people don't take the time to make sure they r understood.
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3 to 4 ft is not close enough for a person with hearing problems. My husband reads lips and can't read accents. They form words different.

I would feel the same way u do about accents. I tell them sorry, I cannot understand you. Please repeat.
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Have you sent a letter to the administrator explaining that you have addressed this issue and are not receiving any assistance and that it is affecting the care your mom is receiving, not to mention that it is a degrading and demeaning way to treat another human being.

Name names and give specific information about when, who, what and where.

Ask them to advise you how they plan to get their employees treating the paying customer with dignity. Ask for the correspondence to be done in writing. This will create a written record that you can then use to go further up the chain of command.

I have had run ins with individuals that barely speak English and they are so prejudiced against white people that they go out of their way to be rude,if this is what you believe is happening, speaking up should get some attention to the unprofessional behavior of the aids and others.
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anonymous903302 Apr 2019
Thank you. I am going to do that, in writing. Issue? All of the staff wears hanging plastic badges, but they are always turned around, so none of us can see their names. I have asked about that. And, been told it's just accidental, that the badges are backwards. So, when there is a big problem, I call the nursing supervisor, who knows who is on every shift, to find out who is taking care of my mother. It is exhausting, honestly, and the excuse that the badges somehow magically turn backwards so you cannot see names is pure BS.

Yes, unfortunately it is true. There is prejudice against white people. Even 80-100 year old seniors in nursing homes who are ill and defenseless, even if they have issues that cause them to be demanding or difficult. And, not PC to ever say that there is prejudice against white people among the staff.

But, interestingly, in many nursing homes, all of upper management is white. And, the staff, from nurses to aides to housekeepers and laundry helpers.....not white. Why?
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Your first sentence about “great nursing home” should be your focus.

Almost all of us are descended from immigrants. We are so lucky that enterprising, hard working individuals are willing to get their CNA licenses and help us care for our parents. This is physically and emotionally stressful work. We couldn’t do it without them.

This kind of feedback is not constructive —it only serves to humiliate the individuals that are giving you service and may be counterproductive.
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Isthisrealyreal Apr 2019
Treating a senior citizen in a degrading attitude is unacceptable and should not be tolerated. If people don't want to do the job, they should get in a different line of work.

An azzhole is an azzhole in any language.
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Maybe Flash Cards or index cards with questions written out? Something simple.

I definitely understand your concern as your mother needs the care and they need to understand each other.
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My advice would be (as well as Margaret's excellent suggestion to nudge the facility's managers) to engage with individuals and tell them what you would like them to do. Nicely.

E.g. "my mother understands you better if she is face to face with you, and you speak slowly."

The accents issue is an interesting one. The choice you have is not between aides who speak standard English or aides whose English is heavily accented. It is between the heavily-accented aides or no aides at all. No it shouldn't be your problem or your mother's, but that is the choice. We haven't trained enough aides from our own countries, and we haven't treated elder care as a respected vocation. Pay peanuts, and begrudge them even the peanuts, and you're not going to get talented linguists with high levels of interpersonal skills and self-sacrificing compassion who are also prepared to handle incontinence.

But the reason I say it's interesting is that it is remarkable how quickly we do adapt to different pronunciations. I don't speak a word of Hindi - except those which have been adopted in English, like shampoo - but I can perfectly well understand even newly-arrived Indian people who are speaking English, even if their accents are so thick they make their relatives cringe. It is a human tendency to think "oh I can't understand this person" and stop listening; but in fact if you ask the person to repeat what s/he said you will get the hang of the differences before you know it.

You might also bear in mind that these people are trying to learn, and out of ordinary charity help them with that. It is fine, if you do it kindly, to correct pronunciation by repeating words so that they can imitate you. It is also an excellent way of building positive relationships.
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worriedinCali Apr 2019
“We haven’t trained enough aids from our countries”. Curious what you mean by that? I know you aren’t in the US, but the OP is and our country is a beautiful melting pot and English is not our official language. There are many people who are from this country (born here) and speak English as a second language.
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It sounds as though the facility should run a short training session for all the Aides about communication. They have the policy right, and it isn’t being followed. ‘Reminder’ training sessions are quite normal, and would be the best way to get all the Aides to be more conscious of what they should do.
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Can you tell the aid directly when you see them doing it? Basically call them on the carpet and tell them you know that they are supposed to get 3-4 feet away and speak directly to the resident.

I have a very hard time understanding any accent, so I am constantly asking people to please slow down and repeat what they said. I do this with the attitude that it is my problem, which it is, light or heavy accents throw me, but I think that being kind when calling them on their behavior will get better results.

Also, thank them when you see them taking good care. It is a tough environment to work in and it's a tough environment for all people with foreign accents right now.
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anonymous903302 Apr 2019
Thank you. I appreciate your response.

Yes, I do all of that, when I am there, in person. And, I have brought up the issue at plan of care meetings. And raised the issue on the phone with the floor nurse and the nursing supervisor.

If I cannot understand an accent, I always ask, politely and calmly, to please speak slower and repeat. In person and on the phone. And, I do say please and thank you, all the time. And, I do give praise. Even when someone is just doing their job, not doing anything special or extra.

Fact is, some of the aides just don't care enough. Because they are getting paid (as some other poster said) peanuts, and the job can be horrible.

I place double blame: on the nursing home for not paying enough attention, and on the aides who know....and they do know....that their residents cannot understand their accents.
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