Background

According to estimates, there were around 281 million international migrants worldwide in 2020; in total, around 3.6 per cent of the world's population and 33.7 million people with a migrant background were aged 65 and above. In 2022, a total of 22.3 million people with a migrant background will be living in Germany. Access to nursing and medical information, medical care and various care services is particularly difficult for people with a migrant background, i.e. people who no longer live in their country of birth, especially due to language barriers, cultural differences and a lack of necessary information compared to natives.

It is evident that culturally sensitive medical and nursing care and multilingual information materials have not yet been standardised. In the future, the number of older people in need of care will grow. In view of demographic change, the number of people with a migrant background in need of care in old age will increase.

By 2020, more than four and a half million people will have immigrated to Germany as part of the influx of (late) repatriates.^[1]From the group of migrants in Germany, the planned research project is focussing on the late repatriates, who are the second largest migrant group in the Federal Republic of Germany and have been rather underrepresented in the context of care.^[2]

Knowledge of the individual everyday preferences of older people in need of care forms the basis of person-centred care, which can help to improve general care and maintain the quality of life of older people. Person-centred care can be defined as care that respects and responds to individual preferences, needs and values so that it has a positive impact on the person's well-being and satisfaction with care.

Little is known about the care preferences of older repatriates from the former Soviet Union. Lack of familiarity with the healthcare system, different perceptions, cultural and language barriers often lead to lower utilisation of healthcare services, and unknown care preferences hinder or may even prevent person-centred care from taking place [30].

In the course of a pilot study dealing with the translation and psychometric testing of an instrument to assess preferences for the daily lives of older people in different care settings, it became clear that migrants and people from ethnic minority groups were not considered in the research project from the perspective of recipients of care services for older people. An exploratory literature review showed that there is no systematic overview of the care preferences of older migrants and ethnic minorities currently described, and it was particularly noticeable that the existing studies on the care preferences of different migrant groups, such as late repatriates from the former Soviet Union states, have not been investigated.

To date, there are no instruments for healthcare professionals to systematically record preferences in relation to the nursing care of people with a migration background and ethnic minorities, in particular ethnic German repatriates from the former Soviet Union, which focus on the different thematic priorities of the respective nursing settings. Various studies have recorded preferences in relation to the nursing care of previously defined target groups, but there is no overview of existing preferences.^[3] In addition, there does not currently appear to be an overview explicitly focussing on the preferences in the care context of older ethnic German repatriates with care needs. As a result, it seems unknown which preferences exist in relation to the care provision of older ethnic German repatriates from the former Soviet Union with care needs, how these are categorised and prioritised by them and whether a survey of preferences in the form of an instrument is possible.

Aims of the project

The aim of the planned research project is to identify and structure preferences in relation to care provision in the home of elderly repatriates from the former Soviet Union living in North Rhine-Westphalia, Germany, who are in need of care. First of all, the preferences of this group are to be recorded descriptively.

In a further step, the aim is to systematically synthesise and examine the extent to which the identified data is compatible with the existing PELI-D instrument and how it can be adapted [34].

In summary, this leads to the following research questions in the project:

• „Which preferences in relation to the nursing care of people with a migration background are described, categorised and prioritised in the literature?”
• „What preferences can be identified, categorised and prioritised in relation to the nursing care of elderly repatriates from the former Soviet Union in their homes in NRW?”

Methods

For the planned research project, the narrative interview is chosen with the help of a semi-structured guideline. The aim is to find out the biographical data and life stories of the elderly late repatriates with care needs and their family caretakers, Experts by Experience. An expert interview is conducted with the Experts by Profession using a semi-structured guideline. An expert interview is conducted with the Experts by Profession with the help of a semi-structured guidline. It is expected that the experts have as neutral and broad a view as possible of what is happening.

The sample of participants consists of:

1. older repatriates: 1st generation[4] (with own migration experience) with care needs in the home;

2. family carertakers of older repatriates: Relatives of the participating older repatriates or relatives without a family relationship[5] to the interviewee; relatives with or without their own migration experience, and

3. professional carertakers: Persons with a migration background with or without their own migration experience or professional carers who have experience in caring for elderly repatriates in need of care or other persons with a migration background [without having a migration background themselves], who report on the care process and the associated preferences.

The sample is recruited exclusively in NRW, firstly because NRW is the federal state with the highest number of late repatriates - 731,000,000 in 2020 - and secondly to minimise possible access barriers due to long distances.

For the interview sample, it is planned to include approx. 10-15 late repatriates (1st generation) with care needs in the home or day care as well as approx. 10-15 family members and carertakers of late repatriates and approx. 10-15 professional carertakers.

Expected results

The following results are expected:

• The identification, categorisation and prioritisation of preferences from the perspective of late repatriates as well as family carertakers and professional carertakers in relation to the nursing care of late repatriates from the states of the former Soviet Union with care needs in the care setting of the home and day care;
• A synthesis or modification of the existing PELI-D care preference survey instrument for the systematic survey of preferences in relation to the nursing care of repatriates with care needs in the home and day care setting.

The results can be used in the future to systematically identify preferences in the area of nursing care for older repatriates with care needs. Based on this, person-centred services could be developed for the care of late repatriates with care needs. For repatriates with care needs, this would be accompanied, among other things, by an increase in participation in the activities offered and thus lead to an increase in quality of life or satisfaction due to care provided on the basis of care preferences.

The planned research project will close an existing research gap, as no studies on preferences in the care context have been realised to date and the need remains unmet. The planned work can therefore be used as an initial basis for further research projects with this target group or on the topic of preferences in the context of care for people with a migration background.

[1] According to the legal definition of the Federal Expellees Act, late repatriates are German ethnics and are “ethnic Germans born in Russia [and living there]” who left the republics of the former Soviet Union after December 31, 1992 through the admission process and settled in within six months settled in Germany. The term includes not only the German-born residents of Russia, but also of Ukraine, Kazakhstan and other former Soviet republics [18. Russian Germans in the states of the former Soviet Union

Number and age structure, social and political position (2022).] [3.   Federal Office of Statistics. Population and employment. Population with a migrant background - results of the 2021 microcensus. Federal Statistical Office 2021.].

[2] Until the end of 1992, the legal category for accepting “German nationals” from the (former) Soviet Union and other Eastern European countries was called “repatriates”. Since January 1, 1993, the correct term has been “late repatriates”. The bracket form (late) repatriates expresses that Germans from Russia fall into both categories. Since the majority of Russian-German immigrants fall into the category of “late repatriates” and this term is also strongly associated with this group in general usage [19.  Panagiotidis J. Post-Soviet migration in Germany: an introduction: Federal Agency for Civic Education; 2021.], I will continue to speak of “late repatriates” without separating the words with brackets, whereby this refers to repatriates from the earlier phase as well as family members who did not receive their own late repatriate status.

[3] Scoping review with the title: “Care preferences of older migrants and minority ethnic groups with various care needs: a protocol for a scoping review” is currently being finalized and will soon be submitted to the journal.

[4] The 1st generation refers to those older (late) repatriates who were born in one of the former states of the Soviet Union and have their own migration experience to the Federal Republic within the framework of the Expellees Act (first version of the law of May 19, 1953).

[5] It is not absolutely necessary that the caring relatives interviewed have a family relationship with the older repatriates in need of care who have already been interviewed.