Culture and home health care policy implementation: A comparative study of the United States and Puerto Rico

This study examines home health care programs formulated in an Anglo dominated American culture when they are implemented in two settings with distinct cultural traditions, Puerto Rico and Indiana. Puerto Rico is a predominantly Hispanic territory of the United States that is subject to American national laws, and Indiana is a Midwestern state that is immersed in American culture, mostly white and culturally Anglo. Using these significant cultural differences as a starting point, this study investigates how variations in culture affect home health care programs in Indiana and Puerto Rico. The study takes note of the limitations in the policy implementation literature and addresses the scarcity of studies examining the effects of social culture on the implementation of policies and programs. The data presented in this study were collected through interviews with elderly patients, their unpaid primary caregivers, and paid home health aides employed by home health care programs covered by Medicare in Indiana and Puerto Rico. The research hypothesized that culture does influence the implementation of federal programs to serve the elderly when the same policies and programs are implemented in culturally different locations. Quantitative and qualitative data were used to determine differences between participants in both regions. Some of the hypotheses were confirmed, some were disproved: As expected, the data showed that (1) dissimilar cultural values influence unpaid care of the elderly in Indiana and Puerto Rico, and (2) that the elderly people in Indiana and Puerto Rico identify different aspects of the home health care program as criteria for satisfaction. The data weakly supported the hypothesis that elderly patients in Puerto Rico are more likely to feel closer to their home health aides and familial caregivers than their elderly counterparts in Indiana. The data also showed that (1) home health aides in both places behaved in similar ways toward the provision of care to the elderly, and (2) that elderly patients in Indiana and Puerto Rico are likely to be satisfied with the same qualities in their home health aides