Culturally Appropriate Care and Support

Scope of this chapter

This chapter will explain what is meant by the term ‘culturally appropriate care and support’ and why it is so important to the service we provide.

Providing care and support that is culturally appropriate is a core principle and value. This means that it applies to everyone and is always relevant when planning for or providing care and support.

Relevant Regulations

Related Chapters and Guidance


New Skills for Care Culturally Appropriate Care guidance was added to the Related Chapters and Guidance section in March 2023.

March 16, 2023

Culturally appropriate care (also called ‘culturally competent care’) is care that is sensitive to people’s cultural identity or heritage. This includes the things you can see and the things you cannot see (also known as cultural values or beliefs).

If care is not sensitive to people’s cultural identity or heritage, the impact can be devastating for the person and their sense of wellbeing.

Everyone is part of a culture, and everyone therefore has a cultural need to be met.

How to be sensitive to cultural identity or heritage in practice will vary from person to person. For some people ethnicity, nationality or religion will be important. For others it might be their sexuality, gender identity or other life experience or event.

You should never make assumptions or generalisations based on what you think you know, regardless of how well informed you may be. For example, not all Asian or African people like spicy food.

It is also important to understand that cultural identity can change over time. This is because life events and experiences can lead to someone changing their beliefs or reprioritising what is important to them. This may be more pertinent when someone has a progressive illness e.g., dementia, or if they are approaching the end of their life or has experienced a significant life event.

To provide care that is truly culturally appropriate, you must therefore be alert and responsive to the aspects of culture or heritage that a person identifies with (or doesn’t identify with) or believes at the time that the care is being provided.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

Providing culturally appropriate care and support is integral to meeting several of the regulations that the service is required to meet.

Regulation 9: Person-centred care

9 (1) (c) states the care must reflect service users preferences.

9 (3) (a) assessments of people’s needs must include all their needs, including cultural, religious and spiritual needs.

Regulation 10: Dignity and respect

10 (1) states staff must respect people’s personal preferences, lifestyles and care choices.

Regulation 13: Safeguarding service users from abuse and improper treatment

13 (4) (a) states that care must not be provided in a way that includes discrimination on the grounds of any protected characteristic (as defined in the Equality Act 2010-see below). 

Regulation 14: Meeting nutritional and hydration needs

14 (4) (c) this includes the meeting of any reasonable requirements for food and hydration arising from preferences or religious or cultural background.

The Equality Act 2010

Under the Equality Act 2010 it is unlawful to discriminate against someone because of any of the following protected characteristics:

  • Age;
  • Disability;
  • Race (ethnicity and nationality);
  • Religion or belief;
  • Sex or gender;
  • Sexual orientation;
  • Gender reassignment;
  • Pregnancy and maternity;
  • Marriage and civil partnership.

A failure to provide culturally appropriate care could also be seen as a breach of the Equality Act 2010.

The Care Act 2014

Under the Care Act 2014, there are 9 categories of individual wellbeing (see table below).

If the service has been commissioned directly by the local authority, or if the person has arranged the service themselves after receiving information and advice from the local authority, you have a responsibility to promote individual Wellbeing.

The local authority will want to know how you have promoted the person’s individual Wellbeing when they carry out a review of their Care and Support Plan.

For further information see: Promoting Individual Wellbeing

Providing culturally appropriate care can undoubtedly have a positive impact on a person’s sense of wellbeing in all categories. Likewise, providing care that is not sensitive to cultural identity and heritage can have a negative impact.

The table below provides just a few examples to demonstrate how culturally appropriate care can have a positive impact on the different categories of individual Wellbeing:

Caption: Culturally appropriate care and wellbeing
Category of Wellbeing The impact of culturally appropriate care

Personal dignity

  • The person feels their cultural identity is recognised and valued;
  • Cultural needs are met in line with individual preferences.

Physical or mental health and emotional wellbeing

  • The person feels happy, content and fulfilled;
  • The person does not feel isolated or ostracised.

Protection from abuse and neglect

  • Protection from discrimination, organisational abuse and hate crime;
  • Poor practices are challenged.

Control over day to day life

  • People are asked what is important to them and how they would like things to be done;
  • People are given opportunities to say if something is not working for them or to change how they would like to be supported to meet a cultural need.

Participation in work, education, training or recreation

  • Engaging in activities at home and in the community that are meaningful to cultural identity and heritage;
  • Staff actively seek out events and activities that may be of cultural importance.

Social and economic wellbeing

  • The person feels part of their cultural community;
  • Cultural identity is celebrated in the service.

Domestic, family and personal relationships

  • Families feel welcomed into the service;
  • Families are encouraged to share information about cultural identity and heritage;
  • Families help staff to understand how best to meet cultural needs.

Suitability of living accommodation

  • People are encouraged to have items of cultural importance in their rooms;
  • Nothing about the way the accommodation is decorated devalues cultural identity or heritage.

Contribution to society

  • People volunteer in activities to support their cultural community e.g., church events, fundraising or working in a charity shop that raises funds for refugees;
  • People feel fulfilled and valued as part of their cultural community.

The following are some examples of culturally appropriate care that you may need to provide. Remember, this will vary from person to person and generalisations should not be made:

Caption: Examples of culturally appropriate care
Area of potential need Examples of culturally appropriate care

Food and drink

  • If someone follows a Kosher or Halal diet, food may need to be prepared differently to avoid cross contamination;
  • Food may need to be presented in a certain way;
  • Certain utensils may need to be provided, and some people may prefer to eat with their hands;
  • If someone is from a culture where it is polite to refuse food the first time they are offered, you may need to offer the food 2 or 3 times;
  • People may wish to change their clothes before or after eating or to wash their hands and face.


  • Use the right language - learn some key words and phrases;
  • Use interpreters and advocates to support communication needs;
  • Provide literature or access to TV shows with subtitles or in a language that the person can understand.

Religion and spirituality

  • Providing religious or spiritual items like pictures, prayer beads, spiritual statues or holy books;
  • Support to attend church, gurdwaras, mosques or temples. This may include allowing time before or after a service to talk with their religious community;
  • To access online services as an alternative to face-to-face services;
  • Support to pray at certain times, and have a suitable space to do so;
  • Support to eat at different times or a different diet during religious festivals like Ramadan or Chinese New Year;
  • Support to ensure hair / beard is maintained in line with cultural expectations;
  • To arrange for a local priest or religious leader to visit the home.

Health care

  • Checking if medicines contain ingredients such as gelatine or other animal products. These may not be suitable for people following a Kosher or Halal diet and will also not be suitable for vegetarians or vegans;
  • Reviewing medication timings with a GP to support the person to take part in Ramadan or another cultural event where the effectiveness of the medication could impact their ability to engage in the cultural event;
  • Consulting with a GP to support someone to take complementary or alternative medicines in line with their cultural beliefs. For example, Kola Nut or Miswak.

Clothes and personal presentation

Supporting people to dress in line with their culture. This could be everyday or for family visits or special events.

Personal and shared space

  • Supporting people to personalise their room with objects that are important to them;
  • To decorate and furnish shared spaces in ways that promote the culture of people living there and do not cause offence.


  • Watching particular TV shows or listening to important music;
  • Playing a particular game with cultural importance;
  • Arranging entertainment such as Bollywood events or dancers.

Community connections

  • Support to visit a community event like a carnival, Mela or art event;
  • Support to volunteer in a charity shop or at a charity event;
  • Support to fundraise for a charity closely associated with someone’s culture.

Emotional support

Supporting someone to talk about past events and memories if they want to, or facilitating access to emotional support to deal with traumatic experiences.

End of life

  • Reading particular prayers;
  • Arranging for a priest or religious leader to visit the home;
  • Arranging for a family member to stay in the person’s room;
  • Arranging funerals and burials in line with cultural beliefs and customs.

The following are examples of different values and beliefs a person may hold because of their cultural identity or heritage, and considerations you may need to make to provide culturally appropriate care. Remember, values are the things we do not always see or know about.

Caption: examples of different values and beliefs
  Different values Guidance for culturally appropriate care

Being or doing?

Some cultures value being. For example just sitting watching the world go by, talking to people or listening to music.

If someone values being, try not to push them to get involved in things if they do not want to.

People from a different culture may see this as laziness and prefer to be on the go all the time.

If someone values doing, they are likely to get bored watching TV or sitting for long periods. Introduce them to new activities and opportunities.

Cooperative or competitive?

Cooperative cultures value collaboration and cooperation. They are less likely to confront things.

Make sure people are given opportunities to express their views and be included.

People from a competitive culture will speak up if they are unhappy or feel left out. They also often need to be recognised for performance or achievement.

Give lots of opportunities to get involved in and influence activities. Set goals and recognise achievements.

Non-expressive or expressive?

In non-expressive cultures people may be quiet and hide their emotions. They may also feel uncomfortable or threatened around someone who is very expressive.

Provide opportunities for people to say how they are feeling. Be mindful of your own body language and expressiveness so you do not make them feel uncomfortable.

Expressive people will use and respond to different tones of voice and hand / face gestures.

Make sure the tone you use is warm and encouraging and that you do not use gestures the person could find cold. For example, waving a finger.

Accept authority or question it?

Some cultures place an emphasis on status. In these cultures, people are less likely to challenge those they see as in charge. There could be a clash with someone with opposite values, whom they may see as disrespectful.

Encourage the person to express their views and show that what they have to say makes a difference by acting on them.

Some cultures see equality and shared decision making as important.

Involve people in group decisions and ask for feedback. Make sure the person knows how to provide feedback so this is done respectfully.

Avoid uncertainty or be comfortable with it?

In some cultures people want to try new things and take risks. They value flexibility and are able to adapt to change. They may see people from other cultures as uptight or boring.

Provide opportunities for the person to try new things and involve them in conversations that may change routines and other aspects of the service.

People who are less comfortable with uncertainty prefer to avoid change and do not manage unexpected or sudden change well. This applies equally for good and bad change.

Support the person to prepare for change before it happens. Understand what may be worrying them about it and reassure them about what they will expect.

Under regulation 9 (3) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) the service must understand any cultural, religious and spiritual needs as part of the assessment process. 

Cultural needs should be recorded on the person's individual care or support plan, along with information about how individuals and the wider service should meet those needs. 

Everyone is personally responsible for making sure they understand the cultural needs of a person before providing them with support. This will involve reading the individual care or support plan but could also involve doing some independent research into specific cultural practices, to increase your knowledge, understanding and confidence. However, when doing so remember not to make generalisations or assumptions.

Because cultural needs can change over time, it is important that these needs are reviewed regularly.

These reviews do not have to be formal and can be a simple conversation with the person (or their representative if they lack the capacity to make decisions about their needs) to obtain their views on the matter.

These conversations should identify:

  • Whether there has been a change in cultural need;
  • What action the service may need to take to adapt to any changes;
  • How well the service is meeting cultural needs; and
  • Any improvements that need to be made to how cultural needs are being met.

If a person’s cultural needs change, their individual care or support plan should be updated to reflect this and all staff supporting the person must quickly be made aware of the changes.

Everyone should:

  • Ask questions about cultural needs, especially if unsure;
  • Try to understand and meet people’s preferences at all times;
  • Be curious about what the important things are to help people live their fullest lives.

Top tips

  • Encourage people to be open about their cultural identity and heritage;
  • Provide a safe and secure space for the person to express their views openly and honestly;
  •  Do not just ask about needs around religion or nationality, remember things like age, family, employment history, neurodiversity, religion, disability, gender and sexuality can all be important aspects of a person’s culture;
  • Ask people about their preferences often, in recognition that cultural needs can change over time;
  • Ask people if they are happy about how their cultural needs are being met.

If the person is finding it difficult to understand what is being asked of them, or if you cannot understand what they are telling you, you must not assume they do not have capacity to make decisions about how their cultural needs are met. Instead, you must explore available options to support communication. Depending on the specific circumstances, this could include involving a family member or friend who understands their communication needs, or arranging for an advocate, interpreter or Speech and Language Therapist (SALT).

When involving family members, be aware of any potential conflict or disagreement between their views and those of the person. 

See Section 6, Disagreement with family members 

If the person has appropriate support and is still having difficulty understanding or communicating, a mental capacity assessment may be necessary.

If they lack capacity, you will need to work through the best interests process as set out in the Mental Capacity Act 2005.

See: Mental Capacity

You must be respectful of other people’s cultural needs, identity and beliefs, even when these may be in direct conflict with your own personal beliefs. This is called a non-judgmental and non-biased approach.

This applies to the cultural identity and beliefs of the people being supported by the service, and also of colleagues.

You must never act in a way that could make anyone else feel that their cultural identity or belief is wrong, misplaced or not important. Neither must anyone else act in such a way towards you. 

Such behaviour is discriminatory. If you witness such behaviour you must report it.
See: Whistleblowing

Wherever possible a proactive approach should be taken to celebrating cultural identity.

The staff team should be aware of, and encourage people to participate in:

  • Local events that are taking place, such as festivals, carnivals etc.;
  • Religious and cultural events of importance, such as Ramadan, Chinese New Year and Pride;
  • Other activities that may be of interest, such as TV shows, radio broadcasts or podcasts.

The involvement of family members is normally invaluable in supporting the service to understand cultural needs and provide good culturally appropriate support.

However, the preferences expressed, and daily choices made by the person using the service may sometimes be out of sync with the information provided by their family. This can lead to disagreement and/or conflict between the person and their family, or between the family and the service.

The risk of conflict increases when the person has chosen not to engage in an aspect of cultural practice that is very important to their family, wants to do something that is not in line with strict religious protocol or wants to be part of a culture that their family does not approve of.


  • The person is Muslim and wants to eat pork products;
  • The person identifies as LGBT+ and wants to attend a Pride festival.

In these circumstances, all reasonable attempts should be made to talk through differences and find a resolution that works best for the person being supported. 

It is important to remember that the service is supporting the person, not the family member. If the person has the capacity to make their own decision about how to meet their cultural needs, their wishes are paramount and of utmost importance.

If a person appears to have changed their cultural preferences to something not in line with their previous beliefs, you must consider whether the Mental Capacity Act 2005 applies. An example of this could be if a person from a Muslim culture says they now want to start eating pork products.

If the person has capacity, they have simply changed their mind and their wishes should be respected.

If the person lacks capacity, you must always apply the best interests principle, as set out in the Mental Capacity Act 2005 before deciding the best way to provide support.

See: Mental Capacity

If the circumstances are complex or the disagreement persists, it may be necessary to seek the support of a social worker or other professional to work through the issues and determine what is in the person's best interests. In extreme cases, where disagreement persists, professionals may decide to take the matter to the Court of Protection for a resolution.

Sometimes the views and beliefs held by a person using the service may be so different to the views and beliefs expressed by other people being supported by the same service, that a clash can be anticipated.

It is important to be aware of any differing views and beliefs and to take steps to minimise potential risk of culture clashes that could have a negative impact on either party.

Managers should both create and take advantage of opportunities to promote culture and culturally appropriate care.

Examples could include:

  • Discussing culture and how to meet cultural needs in supervision and staff meetings;
  • Being aware of community networks and events that can support the service to provide culturally appropriate care;
  • Promoting effective communication with families when planning how to best meet cultural needs;
  • Celebrating good practice within the service;
  • Seeking feedback from people using the service and their families, and using this feedback to learn;
  • Understanding cultural differences within the staff team, and using the cultural knowledge and skills of the team in a positive way.

As part of their core training, all staff should receive training about working in a person-centred way that incorporates providing culturally appropriate care and support. 

If staff are completing the Care Certificate this topic is one of the standards covered. If not, managers will need to identify and support access to appropriate training opportunities.

Managers should review the learning needs of staff and arrange suitable refresher training as necessary.
Managers should also identify any specific training or development that staff may need to meet a specific cultural need a person may have. 

For further information about training see Section 8 of this handbook: Learning, Development and Supervision

It might be helpful to match staff with people from the same culture, for example as a keyworker or to support with a particular cultural activity.

However, do not make assumptions about this. There are nuances within cultures that may make a match not as appropriate as first thought.

It is important the person has a choice and does not object to the proposed match.  
The staff member should also be aware of the proposed match and be able to express a view about the appropriateness of this.

If the service is consistently unable to meet a person’s cultural need this should be acknowledged, and reasonable adjustments explored to meet the need.

Depending on what adjustments are needed, it may be necessary to consult with the commissioning body.

Where adjustments cannot be made and the service continues to be unable to meet a cultural need, the impact of this on the person’s individual wellbeing should be established. Where there is a negative impact consideration should be given to terminating the service and supporting the person to transition to a more suitable provision.

Managers should take steps to ensure that the cultural identity and heritage of the staff team is also recognised, valued and celebrated. Embedding a whole-service culture of valuing and celebrating cultural identity and heritage in this way will help ensure that the cultural needs of people using the service are met as a matter of course. 

Some ideas for recognising, valuing and celebrating staff culture include:

  • Having a clear policy and zero tolerance approach to all racism and discrimination;
  • Addressing quickly any racism or discrimination felt by staff from colleagues, people who are receiving support or the public;
  • Talking about cultural identity in supervision and finding out if the staff member has any unmet needs;
  • Inviting staff to talk to colleagues about their culture and heritage to provide a more understanding, inclusive and supportive culture;
  • Organising in-service activities that recognise the cultural events and celebrations that are important to staff members;
  • Making use of the skills staff have that are not strictly part of their job. For example, a member of staff who shares the same language as someone using the service could teach their colleagues a few useful phrases or demonstrate how to prepare an authentic meal (It's important to ask them first if they are happy to do this and not assume that they would be).

Last Updated: March 16, 2023