Background: Despite the multitude of cultures and languages that co-exist across the world, and the increasing impact of the ageing population and dementia on societies, public services, and economies, there is a dearth of evidence on the subject of linguistic and cultural congruity in the care of people who live in care homes. This is particularly true in Wales, where 19% of the population speaks Welsh, varying significantly according to region.

Aim: To review the available relevant literature, and to subsequently investigate the well-being of Welsh-speaking residents with dementia in care homes, in relation to the culturo-linguistic congruity of the environment they were living in.

Design: Scoping review (paper 1), documentation search and multiple embedded case study (paper 2).

Data Sources: Published literature in English and Welsh between 1990 and 2016 from Medline, CINAHL and ASSIA, key journals and citation tracking; Documentation search for national and local policies surrounding the issue of cultural and linguistic congruity in the care of older people in care homes at case study, regional and national levels; Direct observational work at two care homes in North Wales, followed by semistructured interviews with 6 each of residents, relatives, and carers in each home, as well as the manager in each home.

Results: The scoping review suggests that culturo-linguistic congruity is beneficial (and that its absence is detrimental) towards the well-being of people with dementia who live in care homes across the world. This appears to be due to the dementia process leading to a loss of familiarity with the person’s second languages and cultures, with resulting communication and cultural barriers within the care environments. Where congruity is provided, the person experiences an improvement in the care experience and their well-being due to enhanced communication and cultural understanding, allowing appropriate care, social stimulation and happiness. The review also found a comparative lack of research in relation to culturo-linguistic congruity for people with dementia living in care homes,
particularly for those who are first language Welsh.

The documentation search and case study found that a presence of linguistic congruity (and to a lesser extent, cultural congruity) are of great importance in the care and well-being of first language Welsh residents with dementia living in care homes, by facilitating Homeliness and Familiarity, Appropriate Care and Understanding, Happiness and Calm, and Social Stimulation. By providing congruity, a care home may be allowing an older, cognitively impaired resident continued access to a homely, safe place in their own biopsychosocial
structure. This, in turn, may provide a frail individual with the baseline well-being needed to navigate their lives. It was also found that a lack of linguistic congruity for these residents poses significant detriment to their well-being. Providing culturolinguistic congruity is challenging for care homes, mainly due to logistical problems such as training and workforce issues.

Conclusion: These findings should form the foundation of future discussion regarding the care of frail, elderly people in relation to language and culture, especially in Wales. At international, national, regional and local levels, the following should occur: the mapping of capacity and gaps in the provision of congruity; recruitment of culturo-linguistically competent carers; and relevant culturo-linguistic
competency training. Research also needs to occur at these levels, particularly to understand the attitudes towards these requirements, as well as social care workforce studies of the prevalence and training of culturo-linguistic competencies. In Wales, a priority should be to urgently ensure the provision of at least one member of staff on each shift, who is culturo-linguistically competent for residents in care
homes whose first language is Welsh.