Given the demographic realities, it’s time to move culturally and linguistically diverse older people to the centre of aged care planning and policy, and abandon the ‘special needs’ tag, writes Pino Migliorino.
Over the course of 2013 I had the privilege of speaking and presenting on aged care issues facing culturally and linguistically diverse (CALD) older people in many industry and carer/consumer conferences and workshops across the country.
A key underpinning of the information, data and perspectives I delivered in those presentations, and my general advocacy, was my intention to move the discussion of CALD aged care issues away from the margin and into the centre of aged care discussions. In doing this, I also questioned the ongoing relevance of the labelling of this group with a ‘special needs’ tag.
Arguably, the inclusion of CALD older people as one of the ‘special needs’ groups within the Aged Care Act 1997, was at that time both structurally and symbolically important to get CALD issues on the aged care agenda.
The current question is whether this classification is still relevant? I don’t believe it is and, for me, the arguments are clear.
In the first instance, the CALD segment is numerically large. While at the time of the commencement of the Age Care Act 1997, CALD older people already represented 18 per cent of the over-65 population, this figure is now 23 per cent and set to rise to 30 per cent by 2021. This will represent an increase of 66 per cent, which dwarfs the comparative projected increase of 23 per cent for the total population. I believe that maintaining this group as a ‘special needs’ group provides an excuse not to position CALD issues as a key component of any planned approach, or at least as one of the priority segments.
The second argument focuses on the relative failure of the aged care system to meet the needs of CALD older people and their carers, regardless of whether their needs are special or not.
Across a range of data sets the picture that emerges is that CALD older people often live outside the aged care system and therefore the use of a ‘special needs’ tag has arguably not improved their access to services.
There is ample evidence, including from the Australian Institute of Health and Welfare, that CALD older people underutilise a range of community and home-based services including HACC services and respite residential care. The only two services that do not follow this trend are packaged care and home nursing services.
CALD older people display a much lower uptake of residential aged care. Among those aged 85 and over the use rate of residential aged care was 184 per 1000 people, compared with 238 for English-speaking immigrants and 248 for Australian-born people.
A high degree of informal care is provided at home by family members as carers who underutilise care supports and domiciliary services. Many CALD carers are spouses or partners of the care recipient and are themselves aged over 65. A quarter of older CALD carers are ‘hidden’ and unknown to care providers because they do not seek
As a result, many older CALD people living at home tend to delay seeking formal care support until their care needs become acute and they have no choice but to seek formal assistance or move into residential care.
So, CALD older people get less community care, delay or bypass residential care and are often cared for at home by people who lack support or resources and who may themselves have unmet needs.
It is a truism that in many CALD communities, families shoulder the responsibility for care of their older members. While this role for CALD families and carers cannot be overstated, it must not justify an abdication of responsibility by governments and care providers for supporting them in providing care when this support is required.
Given this range of structural deficits and underutilisation, the argument that this segment should be given mainstream priority is greatly enhanced.
The third argument is a more subtle one, based on both perception and a pervasive service orthodoxy that equates ‘special needs’ with the need for extra resources. Within the current narrative, existing service models are currently based on a ‘typical’ older person who is English-speaking, familiar with existing services and comfortable with the aged care service set on offer. CALD clients represent the anomaly. They need different service skills that may include language and culture, they need different food, and they practice different religions. So for aged care services to deal with these differences they need more resources to complement their service model or offer.
Not enough has been done to compel service providers to design and deliver services for the one in four who will soon represent one in three. In the current demand-supply relationships, there are neither the requisite sticks nor carrots to compel service agencies to truly mainstream the capacity to be responsive to the basic needs of CALD older people.
The final argument is about the status of current concerns, even in the CALD sector, that if we rock the boat too far, there is a risk that it will be capsized. In service speak, this translates to the concern that if the ‘special needs’ categorisation is removed do we in fact relieve service providers of the responsibility to even consider this group? This is a legitimate question and deserves a clear answer.
The reality is that the aged care system needs to squarely face this compelling data and the issues it articulates, and do more to bring the issues of CALD older people, as a legitimate core segment, to the centre of aged care.
The National CALD Ageing and Aged Care Strategy, launched in December 2012 by the previous Federal Government, was an attempt to do so. The strategy development, of which I was part, sought to address key structural issues around planning, allocations, nature of service delivery and, most importantly, community capacity building. In essence, it understood that to achieve change, the government needed to direct the sector through its policies, programs and funding approaches to compel change, and that capacity in ethnic communities and CALD older people themselves should be enhanced, so that they can demand the services and service types that they need from the aged care system.
The plan exists, now the only question is whether there is the political will to make it happen and move CALD considerations from ‘special needs’ to core considerations.
Pino Migliorino is managing director of Cultural Perspectives/DiverseWerks and honorary president of the Federation of Ethnic Communities Councils of NSW.