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Aug 9, 2011

Caring for older Australians: one family’s journey highlights the need for culturally appropriate care

The Productivity Commission’s report, Caring for Older Australians, was released yesterd

The Productivity Commission’s report, Caring for Older Australians, was released yesterday and makes 19 pages of recommendations. Links to some of the coverage and analysis are at the bottom of this post.

Below is a personal account which highlights the importance of these issues, as well as the need for culturally appropriate care and services.

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Learning from one family’s journey

Jenny Taing writes:

Almost two years ago I was faced with the difficult task of having to find a nursing home for my Dad.  His condition had deteriorated so significantly that he found himself in the intensive care unit for several days and subsequently a rehabilitation centre for several months.

It was hard to accept that Dad at the age of 61 would never come home again and that I, at the age of 27 had to take on all the responsibilities that arrives when a parent becomes an invalid.

As the eldest daughter in a Chinese family, responsibility was not new to me, but having to put Dad into a nursing home, a course of action that many Chinese don’t traditionally take, was the most difficult to accept.

When searching for a nursing home for Dad, I knew I had to find one that not only catered for his required high level of care, but one that was culturally specific to his needs.  Dad came to Australia as a refugee from Cambodia in the seventies and his English was limited.

Like many other refugees and migrants, he had over time reverted back to his native tongue as part of the aging process.  Dad is also a very traditional man; he has always consumed a traditional Chinese diet.  Like with many other cultures, food and the act of eating is an important part of our culture and heritage.

I wanted to find a place where the residents were from a similar cultural background, who he would have a lot in common with, could talk to and befriend.

I wanted to find a place where the staff were bilingual so he could communicate with them and have some dominion and control over his care.  I did not realise that this would be such a difficult task.

As it turned out, there was only one Chinese specific nursing home in Victoria that could cater for my Dad’s high care needs, which had a 12- 18 month waiting list.

This evident demand and lack of supply for culturally specific nursing homes is not unique to the Chinese community, but an issue for many communities, in particular those more established migrant groups such as the Greeks and Italians that came during the post war period and experiencing an aging population.

Currently, not for profit community organisations such as CO.AS.IT which is providing valuable services to elderly Italians, are playing an important role in meeting this strong demand.  But from talking to various communities and from submissions that have been made to the Productivity Commission as part of its inquiry into aged care, it is clear that there is an issue with timely access to culturally appropriate aged care services and that without action, this problem will only worsen over time.

The Productivity Commission projects that the number of older Australians from non-English speaking backgrounds (NESB) will increase by over 40 per cent between 2011 and 2026 and that by 2026, 1 in 4 Australians aged over 80 will be from a NESB.

Aged care has often been viewed through the prism of a western perspective.  These statistics clearly indicate that this monolithic perspective is no longer sustainable.

Currently the Aged Care Act 1997 identifies those from a NESB as ‘people with special needs.’  The aged care accreditation process requires under Accreditation Standard 3.8 that “Individual interests, customs, beliefs and cultural and ethnic backgrounds are valued and fostered.”

Further to this, the Productivity Commission Draft Report makes a number of recommendations including providing interpreter services to convey information to older people and their carers to enable them to make informed choices, ensuring that diagnostic tools are culturally appropriate for the assessment of care needs and ensuring staff can undertake professional development activities which increase their cultural awareness.

These recommendations along with others contained in the Draft Report are important, as it directs us to examine the way aged care is provided from a culturally diverse point of view.  The challenge is how do we ensure that the existing requirements and the recommendations translate into meaningful changes at a grassroots level for residents like my Dad?

Many public hospitals have a cultural diversity plan which sets out the strategies and measures regarding how the hospital and its services will cater for a diverse population.

Perhaps, as a starting point, aged care services and nursing homes could develop a similar document.  Having interpreters on hand when important information needs to be communicated is vital, but so is having bilingual staff so that communication is there on a day to day basis.

The issue is how do we create a supply of aged care workers that are bilingual?  Many of those that are currently working in the aged care sector are newly arrived migrants and are bilingual.  Perhaps there is a way we can leverage off existing skill sets.  An official program or incentive for people working in the aged care sector to learn another language or become accredited as interpreters would have mutual benefits.

Reforming the culture of aged care services so that they take into account the needs of a culturally diverse population is important, but there is the broader issue of supply.

The Productivity Commission has projected that the number of people over the age of 85 in Australia will more than quadruple (from 0.4 million to 1.8 million) between 2010 and 2050.

No doubt the demand for aged care services is on the increase and long term strategies need to be in put in place to ensure that such demand can be managed and met.  Whatever long term strategies that are articulated, they must be in consultation with cultural communities and take into account their needs.  Trends that show that the proportion of older Australians being from a NESB is on the substantial increase are trends that we cannot afford to ignore.

• Jenny Taing is a lawyer and a Commissioner of the Victorian Multicultural Commission. This article was written before the release of the final Productivity Commission report.

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Links to coverage

The Government’s response to the report’s release

A transcript of the press conference

• Colleen Doyle, Principle Research Fellow in Service Development and Evaluation at University of Melbourne, writes at The Conversation

• Coverage by the Australian Ageing Agenda

• A report from ProBono News

• Release from the University of Sydney’s Professor Marian Baird

• Statement from the Australian General Practice Network

The Australian General Practice Network [AGPN] says the Productivity Commission report, Caring for Older Australians is geared for Medicare Locals to help to improve the access, accountability and choice of services that should be available for older Australians requiring aged care services.

AGPN Chair, Dr Emil Djakic said for too long the health and aged care sectors have not coordinated well to streamline services which is fundamental to providing a better standard of care for older Australians.

“The Commission’s concepts around a Gateway will provide the right platform for Medicare Locals to work with the aged care sector and to ultimately link the primary health care sector with aged care services,” Dr Djakic said.

“The report’s recommendation that the Gateway agency be aligned where possible, with Medicare Local and Local Hospital Network boundaries, is a significant step towards creating an aged care system that is easier to navigate for consumers and users.

“These structural reforms will also bring about an aged care system that is geared more towards community care and helping older Australians stay at home longer with greater independence, which is fundamental to the mental and emotional wellbeing of older Australians.

“Any structural reform that provides models of care designed to keep people out of hospital and cared for in their homes longer through GP-led multidisciplinary primary health care teams, should be the cornerstone of any aged care system,” Dr Djakic said.

AGPN also welcomed the report’s:

• recognition of the need for health and aged care sectors to work more closely together

• recognition of the need for increased remuneration for GPs providing care service to Ageing Australians

• recommendation of an independent review of the Medicare Rebate for GPs providing services in Residential Aged Care Facilities as well as in people’s homes

• recommendation for people to be able to discuss their end of life care plans and for more health care works and GPs to be up-skilled in palliative care approaches.

“Medicare Locals along with Local Hospital Networks, will be ideally placed to work closely with the Gateway agency to ensure there is effective regional coordination of health and aged care services that meet the needs of ageing Australians across the country,” Dr Djakic said.

“AGPN’s response to the report will very much focus on how Medicare Locals and the Gateway agencies can work together on innovative prevention and primary health care oriented solutions for Australia’s new system for aged care,” Dr Djakic said.

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Update:

• More expert reaction at The Conversation

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