A demographic mismatch between culturally and linguistically diverse client groups and the current migrant workforce will require the sector to take a closer look at how it provides culturally appropriate care and manages its workforce, reports Jackie Keast.
Contained in the workforce challenges that will emerge as the population ages is providing culturally appropriate care to the increasing number of older Australians born overseas.
Currently, one in five people aged over 65 was born in a non-English speaking country, and by 2021, Australian Census figures show that this will increase to one in three.
One strategy to providing culturally appropriate care is matching culturally and linguistically diverse (CALD) clients with workers of the same background. This has been seen as favourable as workers may better understand the client’s cultural norms and language, especially given that with conditions such as dementia, people can often revert to their first language.
The 2012 National Aged Care Workforce Census and Survey found 16 per cent of direct care workers in community services were both born overseas and spoke a language other than English. In addition, two-thirds of community care workers who spoke another language used it in their job and saw it as making a significant contribution to the quality of care provided.
Most ethno-specific services in community care are focused on the migrant groups who came to Australia post World War II, such as Italians, Greeks and Eastern Europeans, who are now approaching old age.
However, sociologist and co-author of the workforce census, Associate Professor Debra King, says that increasingly the sector’s migrant workforce is attracting people of Asian backgrounds, who do not have the language or cultural skills sought by these specialised services.
“There’s a disconnect between who’s getting old, the kind of culturally-specific services they want and who’s coming into the workforce in terms of their cultural diversity,” King tells Community Care Review.
This may mean, for example, that an organisations has to guide a worker from an Indian background through an Australian culture of care, while also teaching them to deliver that care in a way that an older Italian person may find appropriate.
Rosa Colanero, chief executive officer of Multicultural Aged Care, the Partners in Culturally Appropriate Care (PICAC) Program in South Australia, says demographic mismatch leads to a “complexity of challenges” for clients, workers and managers. This was especially so as CALD clients continued to report that they would prefer services by professionals who spoke their language.
Subcontracting CALD workers
Trainer and consultant Jenny Bray says this mismatch between cultural and linguistic supply and demand will be ongoing.
However, she has already heard anecdotally of some strategies to overcome this, including brokerage of CALD workers between agencies in order to fill a client’s package requests.
“Some language groups are getting harder to fill than others. [Organisations] may have bilingual, bicultural workers but their time is fully taken. So what’s happening is, providers are going to other agencies that have bilingual, bicultural staff and they essentially subcontract,” she says.
Bray says more research is needed to understand how widespread subcontracting is across the sector, as well as to understand if it is more cost-effective for some organisations to broker ready-trained CALD staff rather than go to the effort of recruitment and training.
However, brokerage implies that organisations that have CALD staff could have a competitive advantage, says Bray. It may also allow workers themselves the potential to capacity build and maximise where they choose to work in the sector, especially when the market liberalises in 2017.
However, even with brokerage arrangements, it is unlikely that the sector will always be able to source workers of similar backgrounds to their clients.
It’s for this reason, says Bray, that the sector needs to ensure all workers are trained to work in cross-cultural environments, recognising that both clients and colleagues may come from a different background than themselves.
Rosa Colanero also emphasises that all workers – not just those from CALD backgrounds – require cultural competency training.
“We’ve got to be aware that all of us are cultural beings and what we know best are our own cultural frameworks,” she says.
She says it is unfortunate that at present, cultural competency tends to be done on a voluntary basis, and given workplace pressures may not take priority.
“What the PICACs would advocate is that there’s a more co-ordinated, concerted approach to doing cultural competency training for all workers, so that it is valued and so that they have the knowledge, skills and competencies to deliver culturally-targeted care.”
However, Bray says that cultural competency has improved across the sector in recent years. Organisations were less likely to assume that because a CALD worker comes from the same country as a client, or because they speak the same language, that they are best placed to provide care.
For example, religion, nationality, and generational differences can make people who share a language very different, she says.
Valuing migrant workers
Debra King, who is also the Dean of the School of Social and Policy Studies at Flinders University, says organisations are becoming increasingly aware that CALD workers are not a homogenous group, and developing better skills to manage a multicultural workforce.
“However, I think it has taken aged care by surprise that the growth in the workforce necessarily means managing quite different groups of migrants and what this means for service delivery,” she says.
King says the workforce census showed that the employment of migrants within community care was not as widespread as in residential care, and suspects this is because residential services can often offer better job security, supervision and structure.
Attracting migrant workers to fill workforce growth may require a shift in the way community care is thought about, as well as the training and supports given to workers, she says.
More structured management processes and support of workers on entry to an organisation could be useful, as well as greater acknowledgement within training that migrant workers have to manoeuvre through multiple cultures, including organisational culture and cultures of care.
“Culture goes beyond people just dealing with someone having a different language or different approach.
“It’s a lot for someone to deal with if they’re going into a new job, in a new country, in a new work culture. How we ‘do’ aged care in Australia can be very different to how it is done in their home country,” she says.
“To minimise the newness of everything and to maximise the extent to which you can get the best out of your CALD workers, you need to provide good supports for them to learn what their job in an Australian aged care organisation entails.”
Another broader issue King sees is that the language and cultural skills that CALD workers are employed for are not always valued within the pay scale. However she notes this can often be out of a single organisation’s control, especially if it isn’t recognised in enterprise bargaining agreements or award structures.
Colanero promotes induction training in order to help CALD workers further familiarise themselves with the Australian aged care system. Further, she says recognising at an organisational level that CALD workers are valuable, adding to the knowledge, skills and competencies of the organisation is vital to maximising their benefits and helping them to connect to the work itself.
“If you value diversity and show appreciation for it, you’ll find that workers will be more open and prepared to share their knowledge. That can be a huge value-add to the service delivery of that organisation,” says Colanero.
This means ensuring that policies, practices and procedures across the organisation explicitly and congruently recognise cultural diversity, she says.
Jenny Bray says the challenges of managing a diverse workforce are outweighed by the benefits CALD workers bring to an organisation.
She notes that when staff from a particular CALD community are recruited, they often become a conduit for both awareness of the organisation and aged care in general, resulting in more people from that community accessing the service.
“They are a magnificent kind of resource in our sector,” she says. “The benefits aren’t just for your branding and marketing … all of your staff benefit from each other’s cultural diversity and are able to take this into their workplace.”
Further, CALD workers don’t just benefit CALD clients, as many clients of Australian-background are used to diversity and enjoy the experience of cross-cultural exchange, she says.
It’s Bray’s view that workplaces that employ multicultural staff have an advantage both now and into the future, noting it would serve all organisations to recognise that the ‘mainstream’ client base is multicultural.
“A whole lot of multicultural organisations are absolutely excited about the opportunities of 2017.
“They are in contact with the community and they’ll know before ACAT does when there’s an older person who’s requiring support. If they learn how to harness those connections, they’re going to have an edge.”
This feature article appears in the current edition of Community Care Review magazine.
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