What does cultural competence mean in elderly care?
By sima kornbluth · Published 2025-10-19 · Last reviewed 2026-09-18
Cultural competence in elderly care means staff understand and respect a person's faith, language, food, customs and identity, and build them into daily care. In England, care homes and home care services registered with the CQC must provide person-centred care that reflects each person's preferences, and assessments should cover cultural, religious and spiritual needs. Equality law also protects older people from discrimination.
Cultural competence in elderly care means care staff understand and respect who your relative is: their faith, language, food, customs, family traditions and identity, and build these into everyday care. In England it is not an optional extra. Care homes and home care services must provide person-centred care that reflects each person's needs and preferences, and the regulator expects assessments to cover cultural, religious and spiritual needs.
This guide explains what that looks like in practice, what the law requires, and how to make sure your relative's background is known and respected.
What does cultural competence mean in elderly care?
Cultural competence is the ability of a care service to deliver care that fits the person, rather than expecting the person to fit the service. It covers much more than ethnicity. For an older person it can include:
- Faith and belief: prayer times and space, religious festivals, fasting, modesty, and care around death and dying.
- Food: halal, kosher, vegetarian or other dietary rules, familiar dishes, and how food is prepared and served.
- Language: some people with dementia who learned English later in life find it harder to use and rely more on their first language.
- Personal care: preferences about the gender of carers, washing routines, hair and skin care.
- Identity: sexual orientation, gender identity, and relationships that the person may not have been able to be open about for much of their life.
- Life history: where they grew up, work, migration, family roles and what gives their day meaning.
None of this depends on guessing from someone's background. Good services ask the person and their family, write the answers down and act on them.
What does the law require care services to do?
In England
Care homes and home care agencies registered with the Care Quality Commission (CQC) must meet the fundamental standards, set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three are especially relevant:
- Person-centred care (Regulation 9): care must be appropriate, meet the person's needs and reflect their preferences.
- Dignity and respect (Regulation 10): people must be treated with dignity and respect at all times.
- Consent (Regulation 11): care must only be given with the consent of the person, or someone legally acting for them.
The CQC's guidance on Regulation 9 says assessments should include all of a person's needs, "including health, personal care, emotional, social, cultural, religious and spiritual needs". It also says that where a preference cannot be met, the provider must explain why and explore alternatives.
Equality law
In England, Scotland and Wales, the Equality Act 2010 protects people from discrimination by service providers, including care homes. The protected characteristics include age, disability, race, religion or belief, sex, sexual orientation and gender reassignment. Northern Ireland has its own equality laws.
Scotland, Wales and Northern Ireland
- Scotland: services are inspected by the Care Inspectorate against the Health and Social Care Standards, which focus on care that meets the person's needs and involves them fully in decisions.
- Wales: Care Inspectorate Wales inspects care homes and home care against Welsh regulations built around well-being.
- Northern Ireland: the Regulation and Quality Improvement Authority (RQIA) inspects services against the Department of Health's care standards.
The wording differs, but in every nation the expectation is the same: care should be built around the individual.
Why does it matter so much for older people?
When care ignores who someone is, the effects can be serious even if the physical care is good. A person may refuse food they cannot eat for religious reasons and lose weight. They may become distressed if personal care is given in a way that feels immodest. Someone who cannot make themselves understood may be wrongly judged as confused or "difficult".
For people living with dementia, familiar music, food, language and rituals can be a source of comfort and calm. Alzheimer's Society describes person-centred care as understanding a person's history, lifestyle, culture and preferences, and recommends tools such as its "This is me" leaflet so staff know the person beyond the diagnosis.
How does good practice look in a care home or home care service?
Look for these signs:
- A detailed assessment before care starts that asks about faith, diet, language, personal care preferences and important dates, not just medical needs.
- A care plan that records the answers in specific terms ("prefers a female carer for washing", "prays five times a day and needs a quiet space") and is reviewed regularly.
- Food that matches the plan, with clear arrangements for how special diets are sourced and prepared.
- Help with communication: staff who speak the person's language where possible, professional interpreters for important conversations, and translated or picture-based materials.
- Respect for faith: access to a place to pray, visits from faith leaders, and recognition of festivals.
- Staff training in equality, diversity and person-centred care, with managers who check it is put into practice.
- A welcoming approach to all families and partners, including same-sex partners, and staff who do not make assumptions.
Should family members interpret?
Relatives often help day to day, and that is natural. For medical appointments, capacity assessments and decisions about care or money, a professional interpreter is usually better. It protects your relative's privacy and avoids putting you in the position of both translator and decision-maker.
How can families help staff get it right?
You know your relative best. You can help by:
- Writing a one-page profile: their preferred name, language, faith practices, diet, routines, favourite music and foods, and anything that upsets them.
- Bringing familiar items: photographs, religious objects, music, clothing and bedding that feel like home.
- Asking to see the care plan (with your relative's consent, or if you hold a lasting power of attorney for health and welfare) and checking that the details are right.
- Meeting the key worker early and agreeing how you will share information.
- Raising concerns promptly, calmly and in writing if needed.
What can you do if cultural or religious needs are ignored?
Start with the manager of the service and explain the problem and the change you want. Most issues are resolved this way. If not:
- make a formal complaint using the provider's complaints procedure, which every CQC-registered service must have;
- if the council or NHS arranges or pays for the care, you can also contact them;
- in England, if the complaint is not resolved, you can take it to the Local Government and Social Care Ombudsman;
- tell the regulator (the CQC, Care Inspectorate, Care Inspectorate Wales or RQIA) about poor care. Regulators do not usually investigate individual complaints, but they use the information in their inspections.
If you believe your relative has been discriminated against, Citizens Advice or the Equality Advisory and Support Service can explain your options. This article is general information; for legal action, get personal advice.
Frequently asked questions
Can a care home refuse to provide halal or kosher food?
A care home must meet each resident's nutritional needs and reflect their preferences as far as is reasonably practical. Ask before you choose a home exactly how it would provide the diet your relative needs, and get the answer in writing. If a home cannot meet an essential religious requirement, it may not be the right home.
What if no staff speak my parent's language?
Ask how the home will communicate, including whether it uses professional interpreters for important conversations, and whether it can recruit or roster staff who share the language. Picture cards and translated signs help day to day, and regular visits from family and community members can make a big difference.
Are there care homes for particular faiths or communities?
Yes, some homes are run by or for particular faith or cultural communities. They must still be registered and inspected like any other home. Check their latest inspection report in the same way as any other service.
Does cultural competence matter in home care as well?
Yes. Home care agencies in England are regulated by the CQC and must meet the same fundamental standards, including person-centred care. Ask the agency how it matches carers to clients and how it records preferences such as the gender of carers.
My dad is gay and worried about moving into a care home. What should we ask?
Ask how the home trains staff on equality and diversity, how it supports residents' relationships, and whether it has policies that protect residents from discrimination by staff or other residents. Sexual orientation is a protected characteristic under the Equality Act 2010 in England, Scotland and Wales.
Key takeaways
- Cultural competence means care built around your relative's faith, language, food, identity and history.
- In England, CQC-registered services must provide person-centred care that reflects people's preferences, including cultural and religious needs.
- Equality law protects older people from discrimination by care providers.
- Give the service a clear written profile and check the care plan reflects it.
- If needs are ignored, raise it with the manager, then use the complaints process and tell the regulator.