Paraprofessional mediators in the care of elderly migrants in Germany

The project examines the practice of cultural mediation and the role of cultural brokers in the care of older people, focusing on services and projects in Berlin, Dortmund/Leverkusen and Frankfurt am Main, locations with historically large migrant populations. In health and social care, cultural brokers act as paraprofessional mediators who raise professionals’ awareness of patients’ cultural backgrounds, linguistic needs and religious beliefs and help service users navigate the system. Little is currently known in Germany about their importance and practices. It is equally unclear how relationships are structured between institutions and professionals (case managers, care staff, etc.), informal cultural mediators and service users; what challenges arise; how these are addressed; whether conflicts occur; and how they are resolved. It is important to understand the way in which mediators conceptualise cultural differences in their work. The project examines local practices of cultural mediation, including the approaches developed by the respective service providers. The aim of the project is to critically reflect on strategies and practices and, together with the relevant stakeholders, to revise existing approaches or develop new ones and thereby positively influence health care.

Studies point to the challenges faced by health and care institutions in providing services in increasingly diverse societies (Bradby et al. 2015; Phillimore 2015). Research in this field seeks to identify how services can improve their capacity to respond appropriately to different forms of diversity.

The aim is to examine the forms, functions and organisational embedding of cultural brokerage in the care of older migrants.

The project is exploratory in nature. Qualitative interviews with professionals and laypeople who perform different forms of cultural mediation in the care of older migrants in the regions under study serve as the main research instrument. The interviews are intended primarily to examine these actors’ perceptions, experiences and views.

The findings show that cultural brokering extends far beyond language mediation. Cultural brokers act as key interfaces between older migrants, their families and the care system: they provide information, help people navigate the system, accompany them to appointments and facilitate access to care services through relationships of trust.

At the same time, cultural brokering remains largely project-based and institutionally marginal. Despite its considerable importance for care provision, it often depends on temporary funding and lacks structural recognition. This creates a central tension: paraprofessional mediators perform tasks that are essential to the system and compensate for structural gaps in care provision, yet have limited institutional security and recognition.

The findings therefore demonstrate that cultural brokering is an indispensable but insufficiently institutionalised component of access to care for older migrants. At the same time, there is a risk that mediation work may conceal structural shortcomings in the care system and permanently shift responsibility onto individual mediators.