The Importance of Cultural Awareness in Aged Care
Interim findings of the Royal Commission into Aged Care have reported Australian aged care services have not been meeting the needs of culturally and linguistically diverse residents.
In Australian aged care facilities, residents will come from vastly different backgrounds and will have varied life experiences. Having knowledge of and respecting an individual’s cultural background is crucial to being able to provide person-centred care.
The necessity of cultural awareness in aged care is reinforced by The National Aged Care Quality Alliance’s definition of quality care:
- ‘Services that are consumer-driven, have a wellness and reablement approach, are affordable, sustainably provided, and are inclusive of the diversity of older people according to their needs.’
(Royal Commission into Aged Care 2019
Late last year the Royal Commission into Aged Care Quality and Safety looked into diversity in aged care. Diversity, in this context, represents gender, sexual orientation, religion, and social and cultural background.
The interim report released in October, titled ‘Neglect’, found that Australian aged care services were not meeting the needs of culturally and linguistically diverse residents (Royal Commission into Aged Care Quality and Safety 2019).
In the Broome hearing of the interim report - in which culturally safe care to First Nations people was a primary focus - Graham Aitken, a Yankunytjatjara descendant and Chief Executive Officer of Aboriginal Community Services explained what culturally-safe care should look like:
- ‘The judge of what is culturally-safe is up to the individual. We will speak to the Elder about what they need for us to be culturally safe or appropriate. It’s a respect that we treat everyone as an individual and with dignity and to us that’s what cultural safety is about.’
(Transcript, Graham Aiken 2019)
The perception of aged care facilities from people from culturally and linguistically diverse (CALD) backgrounds is far from positive. Reports from the Federation of Ethnic Communities’ Councils of Australia find that many people from CALD backgrounds do not wish to go into a nursing home (Rawson 2019).
Culture is fundamental to how we live our lives. It informs our way of life, based on customs, beliefs, language and experiences shared with others (Rawson 2019).
As a health professional and care worker, you can make a difference in the lives of residents in your care by doing your own research (see SBS's Cultural Atlas) and by incorporating cultural awareness into your care.
Cultural Diversity Numbers in Aged Care
A lack of cultural awareness and sensitivity is surprising given the prevalence of diverse cultures in our aged care facilities. In 2016, more than one-third of Australians aged 65 and over were born outside of Australia and one-fifth was born in a non-English speaking country (Rawson 2019).
Older Australians have long expressed their difficulty in accessing care that meets their diverse needs and is sensitive to their background and particular circumstances. The government has signalled its commitment to helping people from CALD backgrounds to access care that meets their needs through the Aged Care Diversity Framework.
This Framework is a set of principles that intends to ensure an accessible aged care system in which everyone, regardless of their social, cultural, linguistic, religious, spiritual, psychological, medical and care needs can access respectful and inclusive aged care services (Australian Government Department of Health 2017).
Languages in Aged Care
It is the responsibility of aged care facilities to do what they can to support people from culturally diverse backgrounds. Government funding is available to support facilities to care for people of specific cultures. These include services for Greek, Italian, Dutch, Jewish and Chinese older people - these services reflect post-war migration (Rawson 2019).
Language barriers can significantly reduce the experience of care in aged care facilities. Older people with English as their second language report losing their ability to communicate in English as they age and experience cognitive decline, and so will often revert to their first language (Rawson 2019).
A Case Study From the Royal Commission into Aged Care
In the Royal Commission's interim report, the importance of connection and communication was reinforced by witness George Akl in his account of his late father’s experience of residential aged care while also living with Lewy body dementia.
Mr Akl’s father was born in Egypt, his first language was Arabic and he also spoke English fluently. However, following his diagnosis of dementia, his ability to speak English decreased. As this occurred, Mr Akl had to be the intermediary between his father and the facility’s staff (Royal Commission into Aged Care Quality and Safety 2019).
Mr Akl explained that when speaking Arabic, his father was significantly happier, prouder and more alive. As his father’s disease progressed, he became more attached to his culture, particularly through language, food, and sounds. Studies into dementia show that sounds, food and culture enliven the minds of those living with dementia (Royal Commission into Aged Care 2019
The following is crucial to provide effective care for residents from culturally and linguistically diverse backgrounds:
- Consult with residents and their families/carers about aspects of their cultural traditions or religion that are important to them.
- Access resources that can help you gain insight into different languages, ethnicities or religious traditions and migration/refugee experiences of older migrants in Australia.
- Use culture-specific information as a guide to facilitate questions - as not all people from the same cultural or religious background identify in the same way.
- Always avoid stereotyping and making assumptions about someone else’s culture, heritage, language or needs.
- Be aware of judging other people's behaviour and beliefs according to your own life experiences.
- When required, involve an interpreter in someone’s care. If this isn’t possible, work with their family to create a list of important words or phrases for staff. They may include: ‘Are you comfortable?’ Or ‘Are you in pain?’.
- Ensure the resident is not isolated in their care. Ways to prevent this may include, engaging with their cultural community, or asking volunteers to visit the older person.
(Centre for Cultural Diversity in Ageing n.d.; Rawson 2019)
Culture-specific information allows us insight into the lives of people who share ethnicity, language, religion or other characteristics that individuals identify with or groups that they belong to (Centre for Cultural Diversity in Ageing n.d.).
While, culture-specific information will inform your work with individual residents, keep in mind that within any cultural group, peoples' values, behaviour and beliefs can vary greatly (Centre for Cultural Diversity in Ageing n.dABCD for Cultural Assessment
Learn and remember the ABCD model of Cultural Assessment of Kagawa-Singer & Backhall (2001), make it part of your routine to take time to discuss the following with residents in your care and their family:A - Attitudes
- Traditional healing practices as well as Western healthcare.
- What illness and care mean to them and their family.
- How they prefer to communicate about diagnosis and prognosis.
- The resident and their family’s religious and spiritual beliefs - particularly in relation to death, dying, the afterlife, and healing.
- How they and their family cope with suffering.
- How you can accommodate and support their spiritual and religious needs.
Determine the historical and political context of the resident’s and their family’s lives, this may include:
- Place of birth;
- Refugee or immigrant status;
- Socioeconomic status;
- Experiences of discrimination;
- Health disparities;
- Language/s spoken; and
- Degree of support from and integration with their cultural community and the degree of assimilation into Western culture.
Within their culture, find out how decisions regarding healthcare are made in the family, whether they prefer to make decisions as a group or if it is mostly up to the individual.E - Environment
Determine whether there are community resources available to residents and their families.
(Kagawa-Singer & Backhall 2001 quoted by Levett-Jones 2016)
Remember respecting the dignity and human rights of each resident is fundamental to providing quality care
- Cultural Insights, http://www.cultura.org.au/insights
- My Aged Care, ‘Support for People From Culturally and Linguistically Diverse Backgrounds’, https://www.myagedcare.gov.au/support-people-culturally-and-linguistically-diverse-backgrounds
- SBS Cultural Atlas, https://culturalatlas.sbs.com.au/
- The Aged Care Diversity Framework, https://agedcare.health.gov.au/sites/default/files/documents/04_2018/aged_care_diversity_framework.pdf
- Australian Government Department of Health 2017, The Aged Care Diversity Framework, Australian Government Department of Health, viewed 9 January 2020, https://agedcare.health.gov.au/sites/default/files/documents/04_2018/aged_care_divers ity_framework.pdf
- Centre for Cultural Diversity in Ageing n.d., Practice Guide, Centre for Cultural Diversity in Ageing, viewed 9 January 2020, http://www.culturaldiversity.com.au/images/Practice_Guides/Culture_specific_information_2018.pdf
- Levett-Jones 2016, 'Cultural Competence and Patient Safety - ABCD for Cultural Assessment', Ausmed, viewed 13 January 2020, https://www.ausmed.com.au/cpd/articles/cultural-assessment
- Rawson, H 2019, ‘Nursing Homes for All: Why Aged Care Needs to Reflect Multicultural Australia’, The Conversation, viewed 13 January 2020, https://theconversation.com/nursing-homes-for-all-why-aged-care-needs-to-reflect-multicu ltural-australia-123373
- Royal Commission into Aged Care Quality and Safety 2019, Interim Report: Neglect, Volume 2, Hearing Overviews and Case Studies, Royal Commission into Aged Care Quality and Safety, viewed 13 January 2020, https://agedcare.royalcommission.gov.au/publications/Documents/interim-report/interim-report-volume-2.pdf
- Transcript, George Akl, Sydney Hearing, 6 May 2019 at T1151.44-1152.31.
- Transcript, Graham Aitken, Broome Hearing, 17 June 2019 at T2072.17-21.
(Answers: a, d, a)
Ausmed Editorial Team
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