Journal article
The Invisible and Racialized Labor of Culturally Sensitive Care: A Hmong Nursing Home Case Study
Social science & medicine (1982), Vol.388, 118751
01/2026
DOI: 10.1016/j.socscimed.2025.118751
PMCID: PMC12814872
PMID: 41223775
Abstract
Globally, the number of adults aged 80 years and older is projected to triple by 2050, increasing the need for long-term care, such as in nursing homes (NH). In the United States (U.S.), racially/ethnically minoritized NH residents disproportionately experience poorer quality of life and care. Workplace initiatives addressing health disparities often promote culturally sensitive care (CSC) as a solution, tailoring care to residents’ cultural characteristics that include norms, values, beliefs, and social-historical experiences. Yet, CSC theories lack empirical data and assume health providers are members of the normative/majority racial/ethnic group. This assumption overlooks the U.S. and NH context, where NH careworkers are often immigrants and women of color. Our case study applies an intersectional examination of CSC as practiced by racially/ethnically minoritized careworkers caring for racial/ethnically concordant NH residents. Drawing on ethnographic research conducted in 2017 in a U.S. Midwest NH with a high proportion of Hmong residents and staff, we frame CSC as carework that is invisible and racialized labor. From our findings, we provide a prospective model of CSC consisting of 1) negotiating the whiteness and biomedicalization of NH culture, 2) generative labor of educating majority NH staff and activating racially/ethnically minoritized residents and family while facing constraints, and 3) emotional (dis)regulation of performing CSC. We argue that CSC overlooks the intersectional dynamics that shape and constrain the labor of “making care culturally sensitive.” Future policy work should recognize CSC as labor and address the need for institutional and policy supports, with consideration of its inequalities.
•Culturally sensitive care is invisible and racialized labor.•Hmong nursing home staff members negotiate dominant NH cultures.•They activate nonHmong staff and Hmong residents and families to care for residents.•Culturally sensitive care also involves emotional (dis)regulation.•Antiracism, compensation, and structural support are needed for this labor.
Details
- Title: Subtitle
- The Invisible and Racialized Labor of Culturally Sensitive Care: A Hmong Nursing Home Case Study
- Creators
- Mai See Thao - University of Wisconsin–MadisonHeather Wood Davila - Iowa City VA Health Care SystemTetyana Shippee - University of Minnesota
- Resource Type
- Journal article
- Publication Details
- Social science & medicine (1982), Vol.388, 118751
- DOI
- 10.1016/j.socscimed.2025.118751
- PMID
- 41223775
- PMCID
- PMC12814872
- NLM abbreviation
- Soc Sci Med
- ISSN
- 0277-9536
- eISSN
- 1873-5347
- Publisher
- Elsevier Ltd
- Grant note
- National Institute On Minority Health And Health Disparities of the National Institutes of Health: R01MD010729
We thank the people, nursing home staff members, residents, and resident family members who shared their lives, stories, and everyday experiences of trying to improve the quality of care and life for NH residents. We thank Claire Wendland who provided comments on an earlier draft of this paper. We also thank our reviewers for their careful and constructive feedback that has greatly improved this paper. The research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R01MD010729. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Language
- English
- Electronic publication date
- 11/07/2025
- Date published
- 01/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985027363502771
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