The action plan to support older people from diverse backgrounds helps providers identify how to deliver more inclusive and culturally-appropriate services, writes Mary Patetsos.
Aged care provision must be accessible and equitable to all. Everyone must be afforded care which is appropriate to their health as well as their social, cultural, spiritual and economic needs. Under the Aged Care Quality Standards, aged care providers will be required to show that “each consumer is treated with dignity and respect, and their identity, culture and diversity is valued.”
Of the 3.7 million Australians aged 65 and over, 1 out of 3 were born in a non-English speaking country. Culturally and linguistically diverse Australians have over 270 ancestries and 300 languages.
It is important that aged care service providers of home care packages and residential care facilities understand the challenges and inherent difficulties faced by consumers from culturally and linguistically diverse (CALD) backgrounds. They need to actively work towards the provision of culturally inclusive care and supports.
The Action Plan for CALD people can assist providers to identify action they could take to deliver more inclusive and culturally-appropriate services for consumers. There is no one-size-fits-all approach to diversity and each provider starts from a different place and operates in a different context.
The action plan has helped articulate the common needs of CALD consumers and guide aged care providers to practice person-centred care.
Plan targets barriers and challenges
Many older CALD Australians are less likely to use supports and services that could contribute to better health outcomes.
Key barriers include:
- a lack of awareness and knowledge of the services that are available
- system complexity
- language barriers
- a lack of culturally and linguistically appropriate aged care providers.
In June 2015, only 18 per cent of people in permanent residential aged care were from non-English speaking countries. This does not reflect the number of older CALD people in the wider community and highlights the barriers they experience when accessing residential care.
Also in June 2015, 26 per cent of total home care recipients were older CALD Australians, the annual Aged Care Financing Authority’s report shows. This indicates a preference to remain at home with additional assistance and support, which also indicates that caregivers need to be supported in their role.
Navigating the aged care system can be daunting and the challenges become more pronounced for a CALD consumer. I’d like to cite as an example the experience of a metropolitan-based organisation providing community services support for CALD older Australians, including Chinese, Italian, Spanish, Serbian and Croatian.
The majority of their CALD clients are above 65 years old, many in their 70s and 80s, physically frail and needing support, but a proportion of those accessing My Aged Care and using services is very small – less than 20 percent. When surveyed regarding the low participation in My Aged Care, the primary response was due to language barriers, low computer literacy and lack of understanding of the system.
The main source of information regarding My Aged Care for them is their community organisations and their peers who have experience accessing the system.
Another problematic area is the availability of professional accredited interpreting services to people accessing aged care services. There is inconsistent use of interpreters in the assessment process itself.
Providers have access to government funded interpreting services as part of their operational requirements, for example, in negotiating a Home Care Agreement, co-designing a care plan or budget and discussing a consumer’s monthly income and expenses statement.
However, the cost of an interpreter required in the delivery of personal care and services in the agreed care plan must be met by the consumer out of their own money or their home care package funds.
Cultural awareness is also low and the cultural requirements of people from CALD backgrounds have not been significantly or consistently addressed. Providers need to be aware of and respond to the cultural needs of older CALD people.
These include understanding that there are cultural attitudes to family and caring responsibilities, and particular beliefs, behaviours and preferences. For example, older CALD people may have preferences about the gender of their carer(s), concerns about privacy, mistrust or fear of authority figures.
Many people can struggle if the services do not cater to their specific cultural needs. CALD consumers face further issues such as dementia resulting in loss of acquired language skills, post-traumatic stress disorder and particularly among refugees and asylum seekers, loss of culture and intergenerational culture change, isolation and fewer peers and being in rural or remote location.
Using the action plan
The need to deliver safe and inclusive services to people with diverse needs and life experiences is embedded in the aged care standards.
The action plan provides a guide for service providers at any level they are in their journey. To help consumers make informed choices, providing simple, understandable information that is translated into their preferred language is basic, foundational action, for example.
Among the most vulnerable CALD consumers, it is rudimentary to have providers that understand culturally-specific needs in relation to palliative care, end of life and funeral arrangements.
Across all outcomes for consumers, putting in place a system for employing bilingual, bicultural staff that reflect the cultural and linguistic profile of consumers is an ideal goal that reflects leadership.
Steps providers can take
The action plan provides key steps for each of the outcomes defined in the Aged Care Diversity Framework. I would like to emphasise that it is important for providers to engage CALD consumers and their carers on a regular basis to gather feedback and solutions to challenges.
The concept of a consumer-directed care remains farfetched if the older person from CALD backgrounds are not empowered to engage. Creating a safe environment for feedback is a very important action.
Aged care providers need to think about the long-term viability of their business. Focusing on the so-called mainstream consumers and ignoring the increasingly diverse profiles of the ageing population will not make good business sense.
As the market changes, the perception that it costs more to cater to culture and language specific needs of CALD consumers and to invest in hiring and developing bilingual, bicultural staff will no longer hold in the long run.
The action plan to support CALD people is available in more than 25 languages. Access it here.
Mary Patetsos is a member of the Aged Care Sector Committee Diversity Sub-group and chairperson of the Federation of Ethnic Communities’ Councils of Australia (FECCA).
This article first appeared in Australian Ageing Agenda magazine (July-August 2019).