(Bridging Language Barriers in Multilingual Care Encounters

DE GRUYTER MOUTON
DOI 10.1515/multi-2014-0009 Multilingua 2014; 33(12): 201232
Gunilla Jansson
Bridging language barriers in multilingual
care encounters
Abstract: The present case study demonstrates how the multilingual practices
of a linguistically diverse workforce contribute to the functioning of a modern
workplace. Based on ethnographic fieldwork and recordings in a residential
home for elderly people with dementia in Sweden, the article explores how
multilingual immigrant care workers creatively use their language skills to
overcome linguistic boundaries and communicate with an elderly Kurdish resi-
dent. It is shown that despite the fact that the participants do not, or only to a
limited extent, share a common language, the care workers manage to create
multilingual encounters that allow them to perform care tasks in an activity
context where empathy and efficiency are of great importance. Although the
data in this study manifest the struggle of multilingual care workers to bridge
language barriers, the study also highlights the complexity of providing
adequate and well-functioning care in todays diverse society, where linguistic
and cultural matching of clients and caregivers cannot always be obtained.
These results are discussed in the light of new demands on Swedish (and more
broadly Western) care systems to adapt to the increasing number of multilin-
gual older people, who will become residents in care facilities.
Keywords: dementia care, immigrant care workers, language barriers, care
encounters, multilingual practices
Gunilla Jansson: Department of Swedish Language and Multilingualism, Stockholm Univer-

sity, S-106 91 Stockholm, Sweden, e-mail: gunilla.janssson@su.se
1 Introduction
Since the 1980s, the research on workplace interaction in health care settings
has grown considerably. Whereas previous studies mainly focus on professional
monolingual communication (Drew & Heritage 1992), more recent research has
also focused on the multilingual workplace. This paper examines multilingual
language use in the context of care for the elderly, a setting where migrant
workers from overseas have traditionally found employment in Western coun-
tries (Cuban 2009). As Roberts (2007: 405) points out, status and work identity
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202 Gunilla Jansson DE GRUYTER MOUTON
in service industry settings have not been constructed by the workers educa-
tional and background qualifications, but by gaps in the labour market. A doc-
tor might become a care assistant and a teacher might become a postal worker.
Over the past few decades, this downwardly mobile trajectory of migrant work-
ers has transformed the workplace from a monolingual to a multilingual set-
ting. Ever since the late 1970s and the early 1980s there has been growing
interest in the multilingual workplace as a site for indirect discrimination (Gum-
perz et al. 1979; Erickson & Schultz 1982; Roberts et al. 1992). Flattened struc-
tures, more multi-tasking work practices, the introduction of new technologies
and a more textualised workplace described as elements of the new work
order (Gee et al. 1996) have created new language and literacy demands which
affect even the manual worker (Cuban 2009).
The new focus on literacy skills often entails assessment, which juxtaposes
the language skills of immigrant workers with professional expertise in carrying
out work. The function of language as an indirect means of discriminating
minority ethnic workers is explored by Roberts et al. (1992) in their study of
communication in multi-ethnic workplaces. An illustrative example is a case
study of South Asian shop floor workers seeking promotion to foreman. The
authors show how the workers were discriminated by the linguistic demands
and implicit conventions in a mandatory, formal interview in English. The
migrant applicants could communicate clearly and with considerable subtlety
on the shop floor, both in English and in their first language, but were disad-
vantaged in the promotion interviews that required communication skills that
were both different from and more complex than the skills required to do a
foremans job. In addition, Cuban (2010), in her study of female immigrant care
workers in England, points to the deskilling of these workers through unfair
test procedures. The women were confident in their workplace English, but
were constantly made to feel that their English abilities were deficient from
their colleagues and from the public.
As part of the development of new work genres and a new person-centred
care agenda, the care industry increasingly demands complex oral skills (Cuban
2009). Previous research into staffresident interaction in long-term care set-
tings highlights the role of the conversational partner for the implementation
of patient-centred care (Grainger 1993, 1995; Grainger et al. 1990; Carpiac-
Claver & Levy-Storms 2007; Makoni & Grainger 2002). In a similar vein, Carpiac-
Claver & Levy-Storms (2007) stress the importance of nurse aides communica-
tive skills in providing emotional support for cognitively impaired clients.
Grainger (1993, 1995) provides a complex picture of the quality of carerelderly
interaction in which nurse aides engage in nurturing forms of discourse that
foreground both relation-oriented and institutional goals of compliance-gaining

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DE GRUYTER MOUTON Bridging language barriers 203
and control. Characteristic features of a nurturing speech style, also referred to

as elderspeak (Williams 2011), include alterations in emotional tone, simpler
vocabulary and reduced grammatical complexity. Another characteristic feature
that likens this speech register to a kind of motherese, is the use of endearing
terms of address. For example, commands and requests during task completion
are toned down with the use of endearments conveying affiliation with the
addressee. The ultimate aim of such strategies is to re-orient the patient to the
legitimisation of the task. Although elderspeak may be intended to show car-
ing, research demonstrates that it fails to meet the communication needs of
persons with dementia such as supporting the maintenance of the elderlys
cognitive skills (Williams 2011). A core discourse component of nurturing
modes of talk is what Grainger et al. (1990) describe as troubles-deflecting strat-
egies. Grainger et al. (1990) emphasise the carers modes of responding to the
elderlys telling of personal troubles and discomforts, arguing that the degree
of empathy and engagement will impact significantly on the elderlys well-
being. They show how the clients troubles are constantly avoided, made light
of or dismissed through deflective strategies.
Drawing on this research, the aim of the present case study is to demon-
strate how immigrant care workers use their multilingualism as a resource for
dealing with their tasks in encounters with a monolingual Kurdish-speaking
resident in a Swedish-speaking dementia unit. The article considers the creativ-
ity of these workers in using their multilingual skills in client encounters as
well as the complexity of providing adequate care in Swedish residential
homes, where cultural and linguistic matching of staff and residents cannot
always be attained. The specific question the article seeks to address is how
the care workers cope with and get past language barriers, so that they can
perform care tasks in an institutional setting.
The article is organised as follows: first I give a brief overview of multilin-
gualism in healthcare. Then I describe the project on which this study is based
and the language profile of the care workers. Next I present the ways in which
the care workers develop multilingual strategies that positively affect their
interaction with the resident. Finally, I discuss how these practices contribute
to the functioning of the modern diverse workplace.
2 Multilingualism in healthcare
There is a pressing need for research to address the linguistic complexities of
healthcare interactions. A considerable body of research has investigated issues
regarding healthcare for immigrant populations in Europe, the United States

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and Australia, and recently also in Asia, e.g. the need for qualified mediators in
the clinical communication process (see Bridges et al. 2011). From a workplace-
oriented perspective, aspects of multilingual communication have been the
focus of research in a range of healthcare settings, for example in hospital
settings and in clinical consultations (Johnson et al. 1999; Anthonissen 2010;
Meyer et al. 2010). The findings of these studies highlight the potential for a
multilingual workforce to enhance the functioning of organisations given that
adequate interpreter training for bilingual employees is available. In their inter-
view study of bilingual hospital staff in an acute care setting, Johnson et al.
(1999) argue that bilingual workers even with very limited competence in the
patients language are able to contribute to the healthcare service. While a
growing field, the research on caregiving and bilingual communication in
dementia care is still sparse. Mller et al. (2009), in a case study of bilingual
francophone residents in an American nursing home, suggest friendship
between residents who share the same language as a solution to social isolation
but do not touch upon issues related to the caregivers language skills. Multilin-
gual issues are sometimes also noticed in passing, but not explicitly addressed
(e.g. Carpiac-Claver & Levy-Storms 2007; de Bot & Makoni 2005; Makoni &
Grainger 2002). Issues concerning communication training for staff working
with multilingual older people have been approached by Boyd Davis (e.g.
Davis & Smith 2009), who has done extensive work in developing cultural com-
petence in dementia communication care.
In Sweden, as in many other Western countries, the multilingual reality in
older peoples care is becoming increasingly complex (Ekman & Emami 2007;
Ponzio 1996). The proportion of elderly people with a non-Swedish background
is growing, and the number of multilingual residents in care facilities is con-
stantly increasing, many of whom are also given different dementia diagnoses.
The role that language, culture and interaction play for multilingual speakers
with dementia is acknowledged by the Swedish National Board of Health and
Welfare, which recommends that multilingual people with dementia are to be
given the opportunity to perform their religion and to have access to staff who
speak their language (Socialstyrelsen 2010-5-1: 2022). The right for everyone
who has a mother tongue other than Swedish to develop and use their mother
tongue is also secured in a new Language Act that came into force on 1 July
2009 (SOU 2008: 26). Despite these recommendations, multilingual speakers
with dementia often live in ordinary Swedish care facilities, where possibilities
for cultural and linguistic adaptations may be few or even non-existent.
Creating an environment of confidence and trust constitutes an important
part of the care workers professional roles. Previous research on the relation-
ship between Finnish immigrants with dementia and their caregivers has

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shown that verbal communication in the clients native language makes it

easier for caregivers to promote care recipients experience of trust, autonomy
and integrity (Ekman 1993; Ekman et al. 1993). This in turn enables the client
to disclose more of her/his latent capacity. As put forward by Ekman (1993) and
Ekman et al. (1993), caregivers communication skills and their capacity for
sensitive listening and accepting the clients perspective are important prere-
quisites for adequate care actions. They have shown that care workers who can
understand and speak the language of the resident manage better in this
respect than care workers who do not. While the bilingual caregivers relation-
ship with the clients was characterised by disclosure of respect, commitment
and joy, severe communication problems occurred with the Swedish-speaking
caregivers. The findings of Ekman (1993) and Ekman et al. (1993) emphasise
the vulnerability of multilingual elderly people with dementia and their need
for support. These findings are most relevant for the focus of research in the
present study, as they illustrate the benefits of bilingual older people having
access to carers who speak their mother tongue.
3 Participants and research site

The participants in this study are three multilingual care workers (under the
pseudonyms Leila, Nasrin and Selma), all females, employed in a ward in an
ordinary residential home located in a suburban multilingual area in Sweden.
The ward hosted eight residents diagnosed with different forms of dementia
diseases. Seven members of staff were working in the ward (five with an immi-
grant background, one with a FinnishSwedish background and one native
Swede, both born with Swedish as their first language). Leila and Selma were
registered assistant nurses and Nasrin was an elderly carer. All three had been
born and socialised in a country outside Sweden. Swedish was their second or
third language. None of them described themselves as having problems with
their Swedish when communicating with the Swedish-speaking residents on
the floor. While they perceived their oral skills as functioning well, they were
not as confident when it came to reading and writing. Only Leila described
herself as skilled in paper work. She regularly helped all her colleagues in the
ward in writing reports and implementation plans.
The analysis below focuses on the care workers multilingual practices in
interactions with one of the residents in the ward, a Kurdish-speaking woman
in her late eighties (under the pseudonym Fariba), who was diagnosed as suf-
fering from dementia. Fariba, who had immigrated from rural Turkey to her

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relatives in Sweden during old age, did not speak Swedish at all except for a
few words like e.g. hej / hello, tack / thank you and ja / yes. When the study
was carried out, the woman had spent two years in the dementia unit. She also
suffered from stress-related symptoms caused by traumatic memories from her
country. Agitated behaviour occurred frequently during care, particularly if the
care worker was new to her, and/or if the resident noticed that the care worker
did not understand her language.
Only Selma was a native speaker of Kurmanji,1 describing herself as a profi-
cient speaker of that language. She was the residents contact person and was
responsible for the implementation of her care plan. The other workers in the
dementia unit had no or very limited competence in the residents language.
This varying level of competence in Kurmanji between the care workers was
based on their own reports in interviews. Although all carers who were not
Kurmanji-speaking reported that they picked up some words in Kurmanji, the
immigrant carers seemed to be more eager than the Swedes to use multilingual
resources in communication with Fariba.
4 Method and data

The data in this study are drawn from a project2 about immigrant care workers
communicative practices in three nursing homes in Sweden (Jansson & Nikolai-
dou 2013). One of the issues raised concerns how the diversity of language
competence among staff is used in the workplace. The overall aim of the project
was to identify the central dilemmas in care work and to find out how these
constrain the care workers everyday communication with the elderly. Data col-
lection methods included participant observation, audio/video recordings and
interviews with the staff. I conducted ethnographic research in the nursing
homes, several hours each week over the course of one year (in the unit that
hosted the Kurdish resident over the course of four months) during day and
evening shifts. My participant-observation research included shadowing care
workers during their shifts at work and spending meals and breaks with them.
During some of my observations, I also recorded the care workers interaction
1 In this article I will use Kurmanji and Kurdish interchangeably when referring to the resi-
dents mother tongue.
2 The study described here is part of a larger project, Care work as language work: Affordan-
ces and restrictions with Swedish as a second language in the new work order. The project
consists of two parts: one focusing on oral interaction and the other on written communication
in eldercare. This article reports on the oral communication study.

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with the residents during their work. For most of the time, I used audio equip-
ment, but in some cases I also had permission to videotape the interaction.
The primary focus of the current study is the care workers multilingual
practices in encounters with Fariba and how these practices are used as resour-
ces for coping with mundane care tasks. The design of the study is built upon
the principles of linguistic ethnography (e.g. Tusting & Maybin 2007), which
argue for a close analysis of situated language in order to gain a better under-
standing of the social and cultural mechanisms of everyday activity. In the
present study, reports from interviews with the care workers and field notes
from participant observations are used in combination with analyses of tran-
scription excerpts from audio and video-recordings of the care workers interac-
tion with the Kurdish woman (approximately 90 minutes). The analysis of the
recorded data is informed by Conversation Analysis (e.g. Sacks 1992), which
means that talk is studied as practices accomplishing social action within
sequences. Such an approach entails a detailed focus on sequential patterns.
Transcription conventions are adapted from Atkinson & Heritage (1984) with
some modifications, and are found at the end of the article. As the article
adopts a method that emphasises an interdisciplinary approach to the study
of the multilingual workplace, less emphasis is paid to the micro-analysis of
interaction here. In line with the ethnographic design of the study, the inter-
view data are given rather high status in the analysis, in order to provide an
understanding of the care workers perspective.
Material in Kurmanji was first translated and glossed into Swedish by a
professional interpreter and language consultant, also a native speaker of Kur-
manji. Translations and glossings were then translated into English by the
author and proofread by a bilingual EnglishKurmanji speaker. For material in
Persian and Arabic a proficient speaker of those languages was consulted for
translations and glossing into English. The material in Swedish was translated
and glossed into English by the author. Two translation glosses are provided
under each example. The first gloss is a word-for-word translation following
the word order of the transcribed language(s). The second gloss is an idiomatic
translation to English. In some cases the idiomatic translation from Kurmanji
to English seems rather free in relation to the word-for-word translation. Over-
all, the glosses have been governed by the translators choices.
The study was approved by the Regional Committee for Research Ethics.
The staff, the residents and their relatives were informed by means of a letter
about the aims of the study and their rights as participants. During the observa-
tions and recordings, I was cautious, being on the alert for any signs of the
residents unwillingness to be observed or recorded. To protect the participants
identity, all names are pseudonyms.

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5 Analysis of multilingual practices in care

encounters
Subsequent analyses present the different multilingual practices that the car-
ers, Leila, Nasrin and Selma, adopt in encounters with Fariba. The examples
selected for analysis focus on situations where Fariba contacts the care workers
and complains about pain or other discomfort, a situation that occurred during
care on a daily basis. In the analysis I demonstrate how verbal resources from
the residents language and from other languages are used in combination with
non-verbal cues as strategies to cope with the residents expressions of com-
plaint and worries.
In what follows the carers multilingual practices have been categorised
based on the interactional work that they perform. From a Conversation Ana-
lytical perspective, when establishing the function of a contribution to talk, it
should be related to preceding as well as subsequent turns, in line with the
next turn proof procedure (Sacks et al. 1974). Utterances are linked to and form
a response to something that someone else has previously said, at the same
time as they shape the context for new contributions (Heritage 1984: 242).
Although the transcripts are not multimodal, non-verbal features are taken into
consideration in the analysis. Apart from speech, other cues like body move-
ment, prosody and facial expressions have been considered in the analysis as
resources that contribute to the accomplishment of social action within sequen-
ces. In two of the examples presented below, where there was no video of the
interaction, the categorisation is based on what can be perceived from the
audio tape complemented by information from ethnographic field notes. Analy-
ses of the data revealed three different multilingual practices: building rapport,
coping with troubles-talk and affiliating with the resident. Each practice will
be presented below and exemplified by means of a transcription excerpt. The
excerpts analysed in the article were selected as they clearly represent the phe-
nomena discussed here.
5.1 Building rapport

Previous research has shown how playful recycling of rituals and routines pro-
vides frameworks for young learners participation in classroom conversation
before they master the language (Cekaite & Aronsson 2004; Rampton 2002). In
the analysis below, it will be shown how similar features are used as resources
for participation in multilingual care encounters. Leila, who is Arabic speaking,

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had no command of Kurdish but had learnt some phrases from her husband,
who is Kurdish. The analysis below will focus on settings when these memo-
rised phrases are used as frameworks for building rapport and expressing social
affiliation.
Excerpt (1) below, which begins with Nasrins interaction with Fariba, is
drawn from a video recording of a planning meeting early in the morning.
Leila, Nasrin and Anna, a Swedish carer who worked only temporarily on the
ward this day because the ward was short of staff, are sitting around a table in
the kitchen. They are planning the days work schedule and work tasks. All the
residents apart from Fariba, who is sitting alone at a table eating her breakfast,
are still in their bedrooms. This is the context of the conversation that unfolds
below. Fariba has come over to the table where the staff are sitting:
(1) Report meeting in the kitchen (L = Laila; N = Nasrin; A = Anna; F =

Fariba).
[---] ((Greeting sequence omitted))
5.N: i 3 Fariba?
what Fariba
whats the matter Fariba?
6. (1.0)
7. F: ne titek e (.) kes xuya nake (.) kes [nine
not something is (.) people appear not (.) people no
((stretches out her arms))
its nothing / I cant see anybody / there is nobody
8. N: [ja
yes
yes
9. N: m: m:
10. N: kes nine?
people no
is nobody here?
11. (0.3)
12. F: ja
yes
yes
13. N: de e vi (0.3) som e hr,
it is we (0.3) who are here
its us who are here
14. (1.3) ((F looks around the table))
15. F: he he he=
3 See the transcription conventions, Appendix 1.

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16. L: =$es hez ji te dikim$ ((leaning forward towards F, smiling))

I love for you do
I like you
17. (1.2) ((Fariba sits down in an armchair beside the table))
18. L: ((singing and clapping hands on the table))
es hez ji te dikim ez ji te xeribim ez daim male
I love for you do I for you foreign I go- home
I like you I miss you I go home
19. (0.5) ((L reorients body posture to colleagues))
20. L: de hr e p kurdiska (0.3) hon frstr de hr
it here is on Kurdish (0.3) she understand they here
orden fr att min man e
word+article for that my husband is
this is in Kurdish she understands these words because my husband is
21. kurd (0.3) s jag har lrt mej dessa ord (.) jag frskte
kurd (0.3) so I have learnt me these word and I tried
liksom (0.2) e::: (0.5) s:: (0.3)
like+as (0.2) e:: (0.5) s::
a Kurd / so I have learnt these words and I tried somehow to e:::
22. koppl- eller samla ihop dom dr ordena (0.5) som
con- or collect together they there word+article (0.5) as
en sng eller melodi
a song or melody
con- or gather those words as a song or melody
23. fr att jag kommer ihg (.) vad betyder dessa (.)
for that I come in+mind (.) what mean these
in order to remember what mean these
24. L: ((leaning forward towards F, smiling))
s nr jag sjer s hr (.) till henne (0.2) Fariba (0.5)
so when I say so here (.) to her (0.2) Fariba (0.5)
$es hez ji te dikim$
I love for you do
so when I say like this to her Fariba I love you
25. F: e?
what
what?
26. L: $es hez ji te dikim (0.8) ez ji te xeribim$
I love for you do (0.8) I for you foreign
I like you I miss you
27. (1.3)
28. F: allah ((stretches up her right arm and looks at Leila))
God
God
29. L: allah akbar allah ((stretches up her arms, smiling))
God great God
God is great

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30. [mashallah mashallah mashallah mashallah mashallah mashalla::h

what+will+god
God bless you/God bless you/God bless you/God bless you/God bless you
31. [((staff laughing))
32. L: ((0.7, L is smacking her lips as if she is kissing))
33. L: du r gelek bai ((leaning forward towards F))
you are very good
you are very good
34. (0.4)
35. F: i?
what
what did you say ?
36. L: du r gelek bai
you are very good
you are very good
[---]
In the sequence above, the staffs attention is drawn to Fariba, who is standing
with her walker in front of the table, where they have their planning meeting.
The carers are looking at Fariba and smiling. Fariba, who has been left alone
while the staff are occupied with their duties, is obviously seeking contact with
the care workers. After a greeting sequence (not shown here), Nasrin asks the
resident what is troubling her by means of an open-ended question (Boyd &
Heritage 2006) produced with an element that is common in Persian and Kur-
manji, i (what) and the residents first name, i Fariba? (Whats the matter
Fariba?, line 5). Faribas answer in Kurmanji, its nothing / I cant see any-
body / nobody is here, is accompanied by non-verbal cues. She stretches out
both her arms, and looks at the empty tables, where the residents on the ward
normally eat their meals. All these cues signal Faribas anxiety about not seeing
any of the other residents in the kitchen. In line 10, after an acknowledgement
token, Faribas complaint is taken up by Nasrin by means of a confirmation
check, kes nine? (is nobody here?) that recycles the Kurdish phrase kes nine
(nobody is here) from Faribas prior turn in line 7. In line 13, after Faribas
affirmative response, Nasrin makes a pointing hand gesture and answers in
Swedish its us who are here. Fariba responds with a chuckle and looks
around at the staff sitting at the table. This short question/answer sequence is
quite understandable in the context of caring for the elderlys well-being. By
use of a word segment that is common in Persian and Kurmanji, i (what),
and by the method of format tying (Goodwin & Goodwin 1987; Anward 2004),
i.e. by means of the recycling of elements in the prior speakers turn, Nasrin
manages to attend to the residents concerns.
In line 16 there is a frame shift, to use Goffmans (1974) terminology, accom-
plished through playful language use. Leaning forward towards Fariba and

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latching on to Faribas chuckling in line 15, Leila smilingly addresses her with
a Kurdish phrase that she has learnt from her husband, es hez ji te dikim, I like
you, with elevated pitch and volume. The body movement and exaggerated
intonation of the speech delivery of the Kurdish phrase mark a redirection of
the conversation. She then conjoins this phrase with two other phrases in Kur-
manji and starts to sing the whole song with an embellished voice in a melody
inspired from Kurdish folk music (line 18), I like you / I miss you / I go home.
In the meantime Fariba has sat down in an armchair beside the table where
the staff are sitting. After this playful song, Leila reorients her body posture
towards her colleagues and addresses Anna, the carer who is working only
temporarily on the ward on this particular day and who does not know Fariba,
with a switch to Swedish, now using her normal intonation (lines 1920). While
gesticulating and smiling, she gives an account of her multilingual strategy, for
example how she has learnt the Kurdish phrases and how she has composed
the song. After this meta-comment, which in fact portrays Leila as a person
who puts effort into accommodating the language of Fariba, Leila re-addresses
the resident (line 24). She switches back to the same body posture and the
same stylised intonation as adopted previously, smilingly recycling the phrase
I like you in Kurmanji as if she would like to demonstrate to her colleagues
that her strategy is sucessful. When Fariba displays affiliation with her care-
giver by stretching up her right arm and calling for God by using the Muslim
word for God, Allah, Leila responds by delivering a second pair-part that aligns
with the residents social behaviour (stretching up both her arms and exclaim-
ing Allah). In overlap with her colleagues laughter, she recycles another social
phrase from the Muslim world, mashallah / god bless you with a delighted
voice (lines 3031), whereupon she makes smacking sounds with her lips, as if
she were kissing. After this playful introduction, Leila continues the conversa-
tion with Fariba by use of another phrase in Kurmanji that she has learnt from
her husband, gelek bai, very good (line 33; the continuation of the conversa-
tion is not shown here).
Through this frame shift, Leila manages to bridge the language barrier that
usually restricts her communication with Fariba. The song lines provide a
framework for Leila to participate in interaction with the resident in her lan-
guage. By means of these memorised song lines she introduces Kurmanji as
the language of interaction that contrasts with Nasrins language choice of
Swedish in the preceding turn (see line 13, its us we are here in Swedish).
Although not addressing the actual content of Faribas concerns, Leila manages
to connect with the resident through use of playful language. The use of singing
and laughter in dementia care has been described in previous research as a
common strategy for affective communication (Carpiac-Claver & Levy-Storms

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2007). The current example demonstrates how singing some phrases in the
residents language is used as a strategy in a situation where the resident seeks
contact with the staff and calls for their attention. At the same time, in line
with previous research on nurse aides use of speech accommodations in com-
munication with nursing home residents with dementia (Williams 2011), it
could be claimed that Leilas shifts in prosody and body posture can be inter-
preted as a way of orienting to Fariba as a cognitively impaired person. This
issue will be returned to in the discussion part of this article.
My next example provides an illustration of how playful language could be
used as a resource for coping with the residents complaints in another work
context, when Selma was off work. In the interviews, Leila describes how she
developed strategies to prevent communicative breakdowns when Fariba com-
municated her displeasure. During one of my observations, Leila instructs a
Swedish carer, who was new at the ward, about this strategy: Hug her, be
kind, say to her there you are and show her where her room is, otherwise
there will be havoc (extract from video recording, translation from Swedish).
One component of this strategy was recycling of the song lines used in excerpt
(1). This will be illustrated in example (2), which is drawn from field notes and
a video recording during observation of evening work. Here, Leila, who is the
only care worker in charge at the ward on this particular evening, is preparing
the evening tea in the kitchen. Fariba enters the kitchen, moaning and mum-
bling something in Kurdish. When Fariba enters the kitchen looking unhappy,
Leila embraces her, smilingly recycling the song lines in Kurdish, es hez ji te
dikim ez ji te xeribim ez daim male, I like you, I miss you, I go home. After
this playful address,4 Leila says to the resident in Swedish that she will have
tea in the television room. Afterwards she moves back to the dishes with
cheeses. The video recording starts from here.
(2) Fariba and Leila in the kitchen (L = Leila; F = Fariba).

1. ((L moves to a bench, arranging cheeses on a dish))
2. L: bixwe mm: ((blows a kiss)) xwee mm: gelek-
eat tasty mm: very
eat very tasty mm:
3. (0.8)
4. F: tack ((smiles))
thank you
thank you
4 Unfortunately, the beginning of this episode could not be recorded due to technical prob-
lems.

Authenticated
5. L: m: ((holding up a cheese, blows a kiss)) gelek xwee

m: very tasty
m: very tasty
6. F: tack
thank you
thank you
7. L: va:rsgo::d
be+so+good
help yourself
8. (1.9) ((L arranges dishes))
9. L: m. tack tack, (.) m. tack tack, ((playfully))
10. (1.9) ((L arranges dishes))
11. ((8 s, L goes out and calls for another resident))
12. L: ((L comes back to F, leans forward towards F))
here Fariba here
go Fariba go
go Fariba go
13. (1.8) (L embracing F))
14. L: serke televzione vi kommer ((embraces F))
look television we come
look television, we are coming
In line 2, Leila, while she arranges cheeses on a dish, blows a kiss to Fariba
and says in Kurdish eat. Fariba, looking happy, thanks Leila in Swedish (lines
4). Leila, holding up a piece of cheese and blowing a kiss, says very tasty in
Kurdish with a bright voice and with exaggerated intonation. This is followed
by Faribas tack (thank you) in Swedish. Leila aligns her choice of language
to Fariba and responds with a second pair-part in Swedish, varsgod (help
yourself). After a 1.9 second pause, when Leila is occupied with the dishes,
she playfully recycles the Swedish phrase m tack tack (m thank you thank
you). After a short side sequence, when Leila calls for another resident, she
turns back to Fariba in the kitchen and instructs her to go to the television
room. This task is accomplished by means of body language and language
mixing. In line 12, Leila addresses Fariba by using a verb phrase in Kurdish
and an address term, here Fariba here (go Fariba go). After a 1.8 second pause,
while embracing Fariba, she expands her turn by use of an imperative phrase
in Kurdish, serke televizione (look television), followed by a switch to Swedish,
vi kommer (we are coming). After this sequence, Fariba eventually goes to the
television room.
In the current episode, Leila, by using playful resources, manages to invite
Fariba to evening tea and directs her to go to the television room in a setting
where the resident seeks her contact. As can be observed, Fariba shows her
caregiver social affiliation by thanking her in Swedish when she invites her to

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evening tea. After this episode Leila reported that she felt satisfied that she had
made Fariba happy and that Fariba finally went to the television room. She
was relieved that she could help Fariba this time. Since the Kurdish-speaking
care worker is not in charge, Leila has to manage the residents discomfort by
herself. There are of course many factors that may have impacted on the situa-
tion, for example Leilas pleasant manner in general. It is therefore difficult to
make a strong claim that it was precisely the use of Kurmanji that made Fariba
compliant. As can be observed from the transcript and from the analysis, apart
from verbal language, Leila resorts to a range of empathic moves, like embrac-
ing Fariba, holding up a piece of cheese and blowing a kiss. All non-verbal
moves accompanied by language mixing and playful recycling in Kurmanji and
Swedish provide resources for building rapport and displaying engagement.
In interviews with Leila it became obvious that it was important for her to
adopt a communicative style that Fariba would appreciate. She had experi-
enced that singing for Fariba in her language or just being able to say some
phrases was a successful strategy that made the resident feel comfortable. How-
ever, Leila also describes challenging situations, when her use of Kurmanji did
not help at all, for example when Fariba was agitated and blamed her for hav-
ing stolen her clothes. (This was due to traumatic memories from Kurdistan
where Turkish soldiers robbed Faribas home.) When Leila was newly recruited
to the ward, she brought pieces of papers with Kurdish phrases in her pocket
for use in encounters with Fariba. By using these phrases, she desperately but
unsuccessfully tried to reassure the resident when she was upset:
So when I came here she said AA:::[shouting] you know she pointed at her clothes and
I could not understand what she said ... but I tried somehow to talk to her with those
small words that I know in Kurdish but she couldnt understand me so she sat on the
floor and cried ... (quote from audio-recorded interview, translation from Swedish)
5.2 Coping with troubles-talk

The most frequent situation the staff had to cope with on a daily basis was
when Fariba expressed complaints about having pain (she suffered from
chronic aches in her back and fingers) and repeatedly asked for her medicine.
The staff then had to deal with Faribas expressions of distress and her repeti-
tious questions. It should not be forgotten that Fariba was diagnosed with
dementia and her repetitious verbal behaviour might thus be a sign of the
disease (Guendouzi & Mller 2005). Since the carers who did not share a lan-
guage with Fariba had to rely on body language, they could never definitely
know whether their guesses were right or wrong. Nasrin, whose first language

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was Persian, was able to benefit from the fact that Persian and Kurmanji belong
to the same language family (Iranian languages). In the analysis below I dem-
onstrate how Nasrin manages to cope with the residents troubles-talk by mak-
ing use of this intelligibility between the languages.
Excerpt (3) below is drawn from an audio recording during observation of
morning care. Nasrin is in the kitchen, assisting some residents with the break-
fast. Her colleagues Sally and Rana, are washing the dishes. Fariba comes along
with her walker, making a moaning sound of pain. Rana, imitating the resi-
dents moaning sound, comes forward and asks her in Swedish cheerfully Vad
e de med dej igen? (Whats up with you again?). While the resident does not
answer this query, she continues her moaning. Finally, Rana tells her in Swed-
ish that she has already taken her medicine and returns to the dishes:
(3) Morning in the kitchen (N = Nasrin; F = Fariba; R = Rana)

1. R:Fariba du har ftt medicin ((returns to the dishes))
Fariba you have got medicine
Fariba you have taken your medicine ((returns to the dishes))
2. (2.1) ((noise from the dishes))
3. N: i Fariba?
what Fariba
whats the matter Fariba?
4. (0.7)
5. F ?: (xxx)
6. (1.2)
7. F: diem
it pains me
Im in pain
8. (0.8)
9. N: har ont?
have pain?
in pain?
10. F: ja, (0.3) ja her s.
yes (0.3) yes all three
yes/yes all three
11. (0.6)
12. N: ((shows fingers))
her s.
all three
all three
13. (0.3)
14. F: her s=
all three
all three

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15. N: ((shows fingers))

=i:o =i:o 5
it here it here
this one this one
16. F: ja
yes
yes
17. N: kej. (.) men,
okay but
okay but
18. F: ((shows her fingers))
ew nikay bijin j::
these not can live either
these cannot live either
19. N: men Fariba, (.) du har ftt heb.
but Fariba you have got tablet
but Fariba you have taken your tablet
20. (0.4)
21. F: heb?
tablet
tablet?
22. N: ja (.) du har ftt.
yes (.) you have got
yes you have taken
[conversation continues]
In this piece of talk we see Nasrin displaying orientation to the residents con-
cerns by use of similar strategies as described in excerpt (1). She produces her
responses to Faribas contributions in Kurmanji by the method of format tying
(Goodwin & Goodwin 1987; Anward 2004), that is, she ties her turn not only
to the type of action produced by last speaker but also to the particular of its
wording (Goodwin & Goodwin 1987: 216). Most material in Nasrins responses
to the residents complaints of pain is in Swedish, except for a few phrases in
Kurmanji. These phrases appear to be sequentially relevant to the care workers
management of the residents displeasure. First of all, Nasrins initial address
to the resident, i 6 Fariba?, whats the matter?, is launched with a word seg-
ment that is common to Kurmanji and Persian. The open-ended design of this
question (Boyd & Heritage 2006) provides an opportunity for the resident to
talk about her pain, which she does. In line 7, she initiates a troubles-telling
5 The element i:o is probably a hybrid form between Persian ino / this one and Kurdish w /
that one, both deictic pronouns. The segment -o in ino is an accusative ending.
6 i (Engl. what) in Kurmanji is an interrogative pronoun. In Persian the corresponding word
for what is almost the same, e.

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sequence by indicating that she is in pain, diem (I have pain). Nasrin

responds by means of a request for clarification in Swedish, har ont? (have
pain?), recycling an element (pain) from Faribas contribution in Kurmanji (I
have pain), and thereby acknowledging the fact that Fariba is in pain. She also
provides the turn with a new intonation contour. As can be seen (line 10),
Fariba confirms Nasrins query with an affirmative in Swedish, ja (yes). After
a 0.3 second pause, she expands on her assertion by specifying the location of
her pain, her s. (all three). The numeral phrase her s (all three), exists in
both Persian and Kurmanji. This expression is picked up by Nasrin who
responds by recycling the wording in Faribas turn in line 10, her s. (all
three), while showing three fingers (line 12). After a 0.3 second pause, Fariba
responds by recycling the wording in her prior turn, her s s (all three),
thereby reasserting her pain. Nasrins response in line 15 is latched to Faribas
turn. Here, the carer reinforces her orientation to the residents pain by recy-
cling the deictic phrase i:o i:o (this one this one), a hybrid form between
Persian and Kurmanji, and simultaneously stretching up her arm and showing
three fingers. As can be observed, Fariba confirms the carers assertion with an
affirmative token in Swedish, ja (yes). In line 17, Nasrin responds with a
sequence-closing third (Schegloff 2007) delivered in Swedish, kej (.) men.
(okay but), thereby indicating a possible closure of the complaint sequence.
Fariba, however, does not seem to accept this move to closing. In line 18, she
upgrades her pain by claiming that her fingers cannot live while showing her
aching fingers to the carer, ew nikay bijin j:: (these cannot live either). How-
ever, this challenge is not picked up by the carer, who responds by referring
to the administration of her medication, but Fariba you have taken your tablet
(line 19), thereby bringing the pain topic to an end. Nasrins response is deliv-
ered in Swedish except for the noun phrase heb (tablet). This word in Kurdish,
which is salient to the topic of interaction, is repeated in the residents repair
initiation in line 21, heb? (tablet), produced with rising intonation, to which
the carer responds in Swedish by reaffirming that she has taken her medicine,
ja (.) du har ftt (yes you have taken).
In the excerpt analysed we see the resident and her carer negotiating com-
mon understanding by means of body language and modified recycling of pre-
ceding turns. Nasrins display of concern for the residents trouble is mainly
accomplished with a few word segments that are similar in Kurmanji and Per-
sian. Her responses provide slots for the resident to assert, expand on and
upgrade her pain. Although the carer finally resorts to a sequence-closing prac-
tice (Schegloff 2007), her supportive responding mode prolongs the residents
troubles-telling, since it leads to re-initiated sequences of painful self-disclo-
sure. This way of supporting a clients troubles-talk contrasts with prior

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research on staff-resident interaction. For example, Grainger et al. (1990) have

shown that deflection is a routine pattern of troubles-talk management in insti-
tutional care. By contrast, Nasrin does not avoid Faribas complaints for exam-
ple by trivialising or making light of her pain.
After a sequence, where Nasrin, with support from Sally, seeks to reassure
the resident in Swedish that she has taken the medicine (excerpt omitted), the
following exchange between Nasrin and Fariba unfolds:
(4) Conversation continued from excerpt (3) ((eight lines of transcription

omitted))
26. N: bad,7 (0.8) klockan (.)
then (0.8) clock+definite article
then at oclock
27. N: saet dwanzdeh.
clock twelve
at twelve oclock
28. (1.8)
29. N: saet dwanzdeh.
clock twelve
at twelve oclock
30. (0.8)
31. F: saet end e?
clock how is
what time is it?
32. N: e:::: noh.
e:::: nine
e :::: nine
33. (1.2)
34. F: neh
nine
nine
35. N: noh e.
nine is
its nine
36. F: yanzdeh = dwanzdeh.
eleven twelve
eleven twelve
37. (0.5)
38. N: deh, (0.2) yanzdeh = dwanzdeh.
ten (0.2) eleven twelve
ten eleven twelve
39. (0.9)
7 The word segment bad is Persian and means then.

Authenticated
40. N: [(s saet.)

three hour
three hours
[conversation continues]
Nasrins task in the excerpt above is to communicate to Fariba the time of her
next drug distribution. This is managed through the use of numerals, word
segments that Kurmanji and Persian have in common. In addition, modified
recycling of material in preceding turns (Goodwin & Goodwin 1987; Anward
2004) is a salient strategy for moving the interaction forward in this example.
The carer begins with a language mix between Persian and Swedish, bad
klockan (then at clock), which is followed by an adverbial phrase in Kurmanji,
saet dwanzdeh (at twelve oclock), which is the time for Faribas drug distribu-
tion (line 27). After a 1.8 second pause, having got no response from the resi-
dent, Nasrin then repeats the adverbial phrase saet dwanzdeh (at twelve
oclock). In line 31, after a 0.8 second pause, Fariba asks for the current time,
saet end e? (what time is it?). Nasrin responds with a numeral phrase com-
mon to Kurmanji and Persian, e:::: noh (e :::: nine), prefaced by a turn-initial
delay (Schegloff 2007). The numeral noh (nine) in Nasrins turn is repeated in
Faribas turn in line 34, which is produced in a low voice after a 1.2 second
pause. In line 35, Nasrin recycles her prior turn in line 32 but with a slight
modification she adds the present-tense copula e (is) that is common to
Kurmanji and Persian, noh e (its nine). When Fariba initiates a counting prac-
tice in Kurmanji in line 36, yanzdeh dwanzdeh. (eleven twelve), Nasrin
responds by adhering to the same practice, but with a slight modification she
starts from ten instead of nine. In the turn on line 38, Nasrin repeats Faribas
turn in a modified form by adding the numeral deh (ten) in the initial part of
the turn. In line 40, after a 0.5 second pause, she adds the numeral phrase s
saet (three hours), the time remaining to Faribas next medication time at
twelve oclock.
In interviews, Nasrin stated that she did not master Faribas language. This
and the preceding example illustrate how similarities between Nasrins own
language and Faribas afforded her with an ability to deal with the residents
distress in care work. Since the numerals are the same in Persian and Kurmanji,
she managed to communicate with the woman about her medication times.
Rana, whose language is dissimilar from Kurmanji,8 could not benefit from the
same strategy and sticks to Swedish in this setting.
8 Ranas mother tongue is an African language.

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The care workers struggle to negotiate meaning about Faribas medication

hours in the excerpt above could also be claimed to be related to Faribas
dementia disease and not only to a lack of linguistic knowledge in a multilin-
gual encounter. As can be observed from the transcript, the design of the turns-
at-talk is characterised by many inter-turn gaps, when Faribas response is
delayed. In the interviews, all the care workers describe the language barriers
as a burden that added to the already heavy load of caring for a person with
dementia. When the Kurdish-speaking colleague was off work, they had to rely
on their restricted repertoire. As Leilas quote above illustrates, for the carers
the most challenging situation to manage was when Fariba communicated her
displeasure through crying or through other behaviours such as aggression.
Frequently, they could not guess the reason for her unhappiness. The carers
felt that they had to comply with societys expectations and demands to carry
out their daily tasks with efficiency, caring, love and respect for the residents
integrity, even if they did not or only partly understand the residents language.
This is evidently the carers perspective, but it carries important implications
for the challenges that health care systems need to face. Although the carers
depicted many encounters with Fariba as challenging and distressing, they
rarely complained about their situation. Besides carrying out mundane care
tasks, they were cast into the role of language learners on the work floor. They
even competed as to who was the most skilled in Kurmanji, and who was best
at communicating with Fariba.
5.3 Affiliating with the resident

The last example highlights the affordances provided by the fact that the partic-
ipants share a common language. The analysis focuses on Selmas affiliating
practices (e.g. Pomerantz 1978) in another setting, when Fariba complains of
feeling pain and asks for her medicine. By virtue of her language skills in
Kurdish, Selma gained a specific position in the ward, and in the nursing home
community, as a consultant and a cultural broker. Her language assistance was
often requested by the other workers, when they encountered difficulties with
Fariba. In interviews, Selma emphasised that she was the only one on the
dementia unit who could talk with the resident about memories and traumas
from her home country, e.g. her childhood and her mother who was killed in
the civil war between the Kurds and the Turks. Since Kurmanji was her native
language, which she used with her family on a daily basis, she could communi-
cate with Fariba in a range of situations and about topics not necessarily
restricted to the instrumental task at hand. The example below illustrates how
Selma makes use of her competence in Faribas language in her care work.

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Excerpt (5) below is drawn from a video recording during the observation
of daytime activities. Rana, Leila and Selma are preparing the afternoon coffee
in the kitchen and Fariba is knitting in an armchair. Nasrin and a Kurmanji-
speaking trainee assistant nurse are sitting at a table nearby. When Fariba
expresses complaints of pain in her fingers, Selma sits down at her side and
helps her with the knitting. She tells her in Kurmanji that knitting is good for
her fingers. After a while, Fariba asks for her medicine. When Selma involves
her colleagues in the conversation about Faribas medication, Nasrin tries to
tell Fariba by way of body language and language mixing that Leila has already
given her the medicine and that the time for her next drug distribution will be
at four oclock. This is the context for the conversation that unfolds below:
(5) Selma and Fariba in the kitchen (F = Fariba; S = Selma; N = Nasrin;

T = trainee).
[---]
6. F: dibe i?
say what
what does she say?
7. N: saet [ar ((shows four fingers))
clock four
at four oclock
8. S: [dibe saet ar tu wergir heba
say clock four you get/eat tablet+plur. ending
she says you will get tablets at four oclock
9. S: tu nuha xwarin
you just now eat
youve just taken one
10. (0.6)
11. F: dibe te na xwarin?
say you not eat
is she saying I didnt take one?
12. S: te xwarin anuha
you eat just now
youve just taken one
13. (0.5)
14. F: di saet aran?
at clock four+at
at four oclock?
15. S: saet ar careke din dide te
clock four once more time give you
at four oclock she will give you one again
16. (0.8)
17. F: careke din. =
once more time
again.

Authenticated
18. S: =e (.) careke din.

yes once more time
yes again.
19. F: Xwed 9 bide te ((raises hands))
God give you
may God give you
20. (1.0)
21. F: Xwed i te rast bne (.) (Ays 10)
God work your right become (.) (Ays)
may God bless your work (Ays)
22. S: ye min [j? ((looks up from the knitting at F))
to me too
mine too?
23. F: [ye temama.
to whole+adj.ending
for everybody
24. F: ((nods)) ha ye temama.
yes to whole+adj.ending
yes for everybody
25. S: [ye temama ((looks at Nasrin and the trainee)
to whole+adj.ending
for everybody
26. N: [he he he
27. N+T: ((smiling))
[---] (six lines of transcript omitted; Fariba continues her praying for her caregivers)
34. F: dri suxule guneh we wek kecike minin. ((looks at S))
away from work sin you like daughter my
I did not give birth to you but still you are like my daughters
35. S: Xwed ji te rast bne Fariba ((smiles and looks at F))
God also you right become Fariba
God bless you too Fariba
In the excerpt above, Selmas task is to explain to Fariba in Kurmanji what

her colleague is trying to tell Fariba. In line 6, Fariba signals problems with
understanding and asks Selma what Nasrin said to her. By the use of non-
verbal cues (stretching up her arm and showing four fingers) and two word
segments that are common to Persian and Kurmanji, Nasrin makes a renewed
attempt to negotiate the time for her next drug distribution (line 7). Here, Nasrin
adopts similar strategies as shown in excerpt 3 (line 12). Selmas response to
Faribas request for repair is delivered in lines 89, in overlap with Nasrins
contribution, she says you will get tablets at four oclock, and youve just
9 Xweda represents the Christian God in Kurdish.

10 Ays is the name of the prophet Mohammeds wife.

Authenticated
taken one. In line 11, Fariba makes a request for clarification, is she saying I
didnt take one?. Selma then recycles her prior answer, youve just taken one.
Faribas query, at four oclock? (line 14), can be interpreted as a request for
confirmation whether she took her medicine at four oclock. However, the time
of Faribas previous drug distribution was actually at twelve oclock, while this
interaction takes place at two oclock. This disorientation in time could be a
sign of Faribas dementia disease. In response, Selma aligns with the residents
viewpoint by telling her in Kurdish what will happen at four oclock, at four
oclock she will give you again (line 15). As can be observed, Fariba recycles
the last element again in Selmas answer with falling intonation to which
Selma responds with an affirmative and recycling of the element again. Here,
the participants seem to have reached some sort of common understanding. In
the closing sequence of this excerpt Fariba expresses her gratitude to the carers.
In lines 1921, when Fariba prays to God to bless the carers work (Fariba is a
faithful Christian Orthodox), Selma affiliates with the resident through pursu-
ing an expansion. She looks up at Fariba from her knitting, and asks her in
Kurdish if she is included in the blessing, mine too? (line 22). When Fariba
includes in her prayer the care workers by calling them her daughters, Selma
delivers a second pair-part that adheres to the same practice: she prays for the
resident (lines 3435). Through this reciprocal praising, the participants show
each other social affiliation and appreciation, when common understanding
has been manifested. The other workers are also included in this mutual prais-
ing. When Fariba nods and confirms that the blessing is for everybody, Selma
turns to Nasrin and the trainee and recycles the phrase ye temama (for every-
body) in the residents prior turn (line 25). In response, Nasrin and the trainee
smile (line 27).
6 Concluding discussion
The present article has investigated the multilingual practices employed by
three multilingual care workers in encounters with a Kurdish-speaking woman
in a Swedish residential home as mundane tasks are to be carried out. The
woman was also diagnosed as suffering from dementia, which might affect the
interaction in different ways.
Analysis revealed three different practices that the carers, Leila, Nasrin and
Selma, used in their interaction with the Kurdish woman, Fariba: building rap-
port, coping with troubles-talk and affiliating with the resident. Although the
data analysed only comprised a small number of staffresident interactions, it

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is argued here that the different practices are nonetheless of interest, as they
say something about the preferences of the carers in using their multilingual-
ism in different work contexts. In line with the methodological framework of
the study, participant observation and ethnographic interviews have been uti-
lised to inform the analysis of recordings of multilingual practices. Although
the structured tools of conversation analysis draw out the patterned nature of
the care workers practices, they provide a perspective which draws the analy-
sis away from the participants understandings. To address this issue, a combi-
nation of data collection methods has been used. The interview data highlight
the care workers perspective, which is not always visible in the transcripts. At
the same time there is a risk that transcripts are approached with pre-conceived
notions, and that the analysis does not do justice to the interactional phenom-
ena that the participants make relevant by means of a next turn proof proce-
dure (Sacks et al. 1974: 728.). This methodological tension between a more
closed focus on linguistic text and a more open sensitivity to context is an issue
that is often centralised in linguistic ethnography (e.g. Tusting & Maybin 2007).
My aim has been to negotiate the relative weight of the care workers and my
own perspectives as an analyst and linguist in producing analytical representa-
tions of the multilingual reality under study.
The findings from this study highlight the care workers creativity in using
multilingual resources (see also Nelson, this issue) to handle demanding care
tasks. It is shown that despite the fact that the participants do not, or only to
a limited extent share a common language, the care workers manage to create
multilingual encounters that allow them to perform care tasks in an activity
context where empathy and efficiency are of great importance. Strategies such
as recycling of elements in the prior speakers utterance and playful language
are here used as significant resources for negotiating common understanding
and creating social affiliation. Similar strategies have also been described as
resources for foreign language learners participation in multiparty conversa-
tion in classroom communities (Rampton 2002; Cekaite & Aronsson 2004). It is
shown how a multilingual repertoire consisting of a limited set of word seg-
ments from Kurmanji, hybrid forms and mixes between languages is utilised
for various purposes in different work contexts. For example, Nasrin (see
excerpts [1], [3] and [4]) both attends to the residents complaints and brings
the pain topic to an end, by use of numerals and a few other word segments
common to Kurmanji and Persian that are recycled from Faribas prior utter-
ance. It could be argued, then, that Nasrin, apart from non-verbal communica-
tion (such as showing three fingers), can also benefit from linguistic resources
for dealing with the details of the actual problem expressed by Fariba. Rather
than trivialising the worries of the older resident, which is described as a rou-

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tine pattern among nursing home staff in previous research (Grainger et al.
1990), Nasrin invites Fariba to express discomfort. As for Leila, her memorised
chunks, including the religious routines, appear at first sight to have a
restricted function that does not go beyond the playful frame. However, they
provide meaningful resources for the care worker in managing a linguistically
asymmetrical situation. The same can be said of the religious routine phrases
in Arabic. In the context of caring for the elderly, where rapport-building and
social affiliation are of great importance for task accomplishment, they provide
frameworks for displaying engagement and sympathy.
As demonstrated, all three care workers benefit from their multilingualism
in work contexts, but not in the same way. Leila, who has learnt some phrases
in Kurmanji from her husband, hardly addresses the actual content of Faribas
concerns. For her, being able to say some phrases in the residents language
enables her to create some rapport with Fariba. Nasrin, who can benefit from
the fact that her first language Persian and Kurmanji have much in common, is
active within a somewhat wider work context, not solely restricted to affective
communication and rapport-building. Despite her limited understanding of
Kurmanji, she manages to negotiate her concerns with Fariba, using vocabulary
that Fariba recognises. Her knowledge of Kurmanji, although very limited,
enables her to address topics such as her medication hours and her pain, in
settings when Fariba expresses complaints and/or seeks the care workers con-
tact. Selma, finally, is the only staff member who is a native speaker of Faribas
language. The last excerpt illustrates how this linguistic matching between the
participants benefits the interaction. Similar to Nasrin, Selma addresses the
actual content of Faribas contributions. Besides doing this, she adapts to Fari-
bas viewpoint, when Fariba displays disorientation in time. What is also promi-
nent in the last transcription excerpt is the way the participants show each
other social affiliation when common understanding is restored. One way of
understanding this could be that Selmas competence in the language makes
her better equipped to create a trustful relationship and to adapt to the resi-
dents viewpoints and wishes, a line of reasoning that conforms to previous
research (Ekman 1993; Ekman et al. 1993). The research of Ekman (1993) and
Ekman et al. (1993) even suggests that there is a risk that older bilingual people
might be perceived as more heavily affected by their dementia disease than
they actually are, when they interact with people who do not speak their
mother tongue (Finnish).
It is not only the multilingual practices, but also many other resources that
need not be purely verbal that help the workers to adopt a person-centred care.
As was displayed in the analytical section, apart from multilingual resources,
Leila and Nasrin resort to a range of empathic moves that help them to some-

Authenticated
how handle Faribas expressions of discomfort. In the analysis, both physical

and vocal resources have been highlighted as vital for expressing empathy. For
example, Leila uses both stylised prosody and body language in combination
with linguistic resources to display her empathy for Fariba. Nasrin uses hand
gestures as supportive moves to express her concern for Faribas pain. The
importance of body language for affective and rapport-developing communica-
tion has also been stressed in previous research on dementia interaction (Car-
piac-Claver & Levy-Storms 2007; Ekman 1993). Ekman (1993) and Ekman et al.
(1993) have shown how the promotion of trust and intimacy in encounters with
bilingual older people in dementia care is made possible by the synchronisation
of verbal and non-verbal language. In the present study there is evidence of
how verbal and non-verbal cues are used as resources to show care and create
a multilingual encounter, when the participants share a common language only
to a limited degree.
As for the Swedish-born care workers, a relevant question is why they did
not seem to develop multilingual practices in the same way as Leila and Nasrin.
One reason for the immigrant workers eagerness to bridge language barriers
might be their compliance to societys expectations. Another reason might be
that their multilingual background, and perhaps also their background as lan-
guage learners, made them better able to accommodate to Faribas language.
Since Kurmanji has more in common with Persian than with Swedish, Nasrin
was able to make use of mutual intelligibility between languages in her care
work more extensively than her Swedish colleagues. These possible differences
in attitudes and preferred strategies for coping with linguistically asymmetrical
settings constitute a focus for future research.
The language skills of immigrant carers are often represented as deficient
and are a possible explanation for the reports of poor care standards at nursing
homes in Sweden. In the present study, the multilingual staff creatively use
their linguistic skills in various ways that are beneficial to the resident. In doing
so, the study provides an additional perspective on the understanding of the
multilingual workplace, one that highlights the benefits offered by multilingual
staff members in workplace communication. Being a multilingual speaker of
immigrant languages in care settings in todays globalised society should be
seen as an asset and a unique opportunity to provide quality care to clients
with a non-Swedish background. However, as long as residents and carers are
not properly matched linguistically and culturally, the problems associated
with diversity will outweigh the prospects. Although the data in this study
underline the positive aspects of a multilingual workforce, the excerpts also
highlight the complexity of providing adequate care in todays diverse society.
Both the transcription and the interviews manifest the struggle of care workers

Authenticated
to care for a person with an immigrant background in a multilingual setting,

where there was a lack of linguistic matching between participants, as most of
the carers only had a very limited understanding of the clients mother tongue.
The interviews contain ample evidence for the stress felt by the carers, when
they had to cope with Faribas unhappiness and displeasure by using their
restricted knowledge of Kurmanji. The different strategies that they had devel-
oped did not always help them to deal with their assignment to provide well-
functioning care. Similarly, the care Fariba receives is filtered through the barri-
ers that have been discussed in this article. The lack of linguistic knowledge
added a further burden onto the care workers already heavy load in establish-
ing a decent quality-of-life where values of human rights are maintained. The
importance of this latter issue is also explicitly expressed and stressed in the
guidelines for dementia care as stated by the Swedish National Board for Health
and Welfare (Socialstyrelsen 2010-5-1). The analyses also cast light on another
problem associated with diversity. At the same time as the carers put a lot of
effort into showing empathy, they also resort to speech accommodations that
are strikingly similar to what previous research (Grainger 1995; Williams 2011)
has described as forms of elderspeak, a speech style that is prevalent in demen-
tia care institutions. For example, Leilas alterations in emotional tone and
Nasrins oversimplifications in syntax and vocabulary, are characteristic fea-
tures of a nurturing and patronising speech style that may even reinforce the
perception of the older adult as sufferering from dementia. Nonetheless, these
accommodations provide resources to get past language barriers. This seems to
be the carers way of coping with an imperfect care system in settings with few
possibilities for linguistic adaptation.
Considering the complexity of providing effective care in multilingual
encounters, this case study carries implications for care systems and for train-
ing. The examples analysed illustrate the importance of linguistic matching
between residents and carers for meeting clients needs for emotional support.
Twenty years ago, Ekman (1993) and Ekman et al. (1993) already stressed how
the language competence of care-giving staff is vital to creating a trustful rela-
tionship between carers and residents, which positively affects the identity and
well-being of the elderly being cared for. Not only language but also culture
plays a major role in the appropriate interpretation of the clients desires and
needs, and subsequently in the care systems intervention and responses to
these needs. Meeting clients communication needs, as well as making sure
that mundane tasks are correctly executed can be difficult even when the
interactional encounter is monolingual. When the encounter is multilingual
and affected by dementia, the situation becomes even more complex. At issue
here is how society can meet these challenges, for example through the devel-

Authenticated
opment of policies that recognise and utilise existing skills and functions of
multilingual care workers. In Sweden, some solutions have begun to arise that
perhaps are possible alternatives to ordinary Swedish residential homes,
where cultural and linguistic matching of staff and residents cannot always be
obtained. After the successful introduction of ethnically profiled care facilities
for the Finnish and Finland-Swedish population in Sweden in the 1990s, pro-
filed residential homes have recently started to emerge for a few other ethnic
and cultural groups (e.g. older persons with a Persian or Arabic background).
Another possible alternative is provided by private home-help companies that
offer services carried out by staff with specific linguistic and cultural competen-
cies. The setting described in this article will be increasingly common in
Sweden and the rest of Europe in the near future. It is therefore a matter of
great concern as to what can be done by society in terms of supporting the
carers, who do not share the language of clients. Davis (2009) reports on a
project to infuse cultural competence training about dementia care communica-
tion into assistant nursing curriculum. Interpreting training for bi-/multilingual
staff in age care is an additional aspect that is worth consideration (Meyer et
al. 2010). Perhaps such projects can support the provision of culturally and
linguistically appropriate services in dementia care considering the growth of
multilingual older people.
Bionote
Gunilla Jansson is a Senior Lecturer of Swedish at Stockholm University. Her
research interests include communication in health professions, training and
education of healthcare professionals and multilingualism in the workplace.
Her PhD thesis was within pragmatics and dealt with cross-cultural writing
strategies in second language students essays. Her current research focuses on
communication and interaction in elderly care and methodological issues of
ethnography and conversation analysis.
Appendix 1
Transcription conventions
ca::re Extension of preceding sound. The more colons, the greater the elongation.
now- A hyphen after a word part or a word indicates a cut-off or self-interruption.

Authenticated
= An indication that utterances follow immediately on each other with no discernable

silence between them.
[ A point of overlap onset.
((nods)) Marks comments on how something is said or what happens in the context.
(1.6) Elapsed time in silence by tenth of seconds.
(.) Micropause (a tiny gap within or between utterances).
(xxx) Something being said, but no hearing can be achieved.
Talk markedly softer or quieter than the adjacent talk.
Yes Emphasis.
.,? Falling, slightly rising and rising intonation.
$yes$ Smiley / stylised voice (used here to denote exaggerated intonation).
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DE GRUYTER MOUTON

DOI 10.1515/multi-2014-0009 Multilingua 2014; 33(12): 201232

Gunilla Jansson: Department of Swedish Language and Multilingualism, Stockholm Univer-

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and control. Characteristic features of a nurturing speech style, also referred to

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shown that verbal communication in the clients native language makes it

3 Participants and research site

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4 Method and data

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5 Analysis of multilingual practices in care

5.1 Building rapport

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(1) Report meeting in the kitchen (L = Laila; N = Nasrin; A = Anna; F =

3 See the transcription conventions, Appendix 1.

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16. L: =$es hez ji te dikim$ ((leaning forward towards F, smiling))

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30. [mashallah mashallah mashallah mashallah mashallah mashalla::h

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(2) Fariba and Leila in the kitchen (L = Leila; F = Fariba).

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5. L: m: ((holding up a cheese, blows a kiss)) gelek xwee

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5.2 Coping with troubles-talk

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(3) Morning in the kitchen (N = Nasrin; F = Fariba; R = Rana)

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15. N: ((shows fingers))

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sequence by indicating that she is in pain, diem (I have pain). Nasrin

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research on staff-resident interaction. For example, Grainger et al. (1990) have

(4) Conversation continued from excerpt (3) ((eight lines of transcription

7 The word segment bad is Persian and means then.

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40. N: [(s saet.)

8 Ranas mother tongue is an African language.

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The care workers struggle to negotiate meaning about Faribas medication

5.3 Affiliating with the resident

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(5) Selma and Fariba in the kitchen (F = Fariba; S = Selma; N = Nasrin;

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18. S: =e (.) careke din.

In the excerpt above, Selmas task is to explain to Fariba in Kurmanji what

9 Xweda represents the Christian God in Kurdish.

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how handle Faribas expressions of discomfort. In the analysis, both physical

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to care for a person with an immigrant background in a multilingual setting,

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= An indication that utterances follow immediately on each other with no discernable

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