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Aged Care Strategy Consultations - Summary Report for People from Culturally and Linguistically Diverse (CALD) Backgrounds

PDF printable version of the FECCA Report on CALD Strategy - Attachments A to D (PDF 783 KB)

FECCA Report on CALD Strategy - Attachments A to D

• Attachment A
• Attachment B
• Attachment C
• Attachment D

FECCA undertook a total of 13 consultations with stakeholders from the CALD aged care sector. Two initial consultations were held in Melbourne on 4 September 2012 and Sydney on 5 September 2012.

Eleven subsequent consultations were held around Australia in October and early November to inform the draft of the National Aged Care Strategy for People from Culturally and Linguistically Diverse (CALD) Backgrounds prepared and provided by the Department of Health and Ageing (DoHA) on 10 October 2012.

Written submissions were invited through the FECCA and DoHA websites alongside the face-to-face consultations. The key themes raised in the written submissions reflected feedback from the face-to-face consultations.

This summary report provides an overview of this feedback from the face-to-face consultations. Attachment C presents individual reports on each face-to-face consultation and Attachment C offers an in-depth summary of feedback received from written submissions.

Key Themes / Issues Raised

1. The language of the Strategy

Participants frequently commented that the language of the Strategy, particularly in the Goals section, was too passive. Participants were concerned that many goals currently sounded non-committal and were unlikely to result in action unless more proactive language, including more active verbs (such as “support” and “involve” rather than “promote”, “encourage” and “explore the possibility of”) was used.

2. Diversity within diversity

Most groups argued that the Strategy must more clearly address the issue of multiple diversities; that is, how the aged care needs of people belonging to multiple special needs groups, such as an LGBTI person from a CALD background, would be addressed in the Strategy.

The issue of the complexity of crossing between care systems, for example from the disability care system to the aged care system, was also suggested for inclusion in the Strategy. While these issues were not seen as being specific to CALD communities, the complexity of crossing between care systems was potentially amplified for people from CALD backgrounds.

Participants wished to see the issue of diversity within diversity addressed under the Goals, as well as elaborated upon in the Context section.

3. Regional areas

Most groups argued that the Strategy, and Government policy in general, needed to better acknowledge locational diversity in Australia, particularly in relation to addressing CALD aged care needs in rural, regional and remote areas.

Participants argued that the Strategy must more clearly acknowledge that the demography of CALD communities varied considerably across Australia and that services and funding must be better tailored to address the unique needs of rural, regional and remote communities.

Key issues identified were that services were generally lacking in regional areas and that many regional centres (including Darwin, Cairns and Shepparton) had small but very multicultural populations. This created challenges in addressing the diverse needs of a number of small CALD populations.

Participants at regional consultations often argued that more flexible policies and services were needed to meet the needs of regional and rural demographics, as the creation of ethno-specific services was often not viable in such small communities.

Vulnerability to social isolation was also frequently identified as an issue in regional areas. Many older peoples’ children have moved away and they consequently felt isolated within very small communities and with few culturally and linguistically appropriate services available to them.

4. Information and education

The issue of cultural resistance to formal aged care services was frequently raised, particularly in relation to more recently arrived immigrant communities who were only just beginning to require aged care services. Participants argued that the Strategy should include an action item focused on overcoming cultural taboos and community shame that was preventing many older CALD people from accessing aged care services. This issue also placed a significant burden on family carers, who felt unable to seek support and assistance. Some participants suggested that older CALD people, their families and carers needed to be given “permission” by community leaders to use formal aged care services. The Strategy should therefore focus on building partnerships with CALD communities and using community leadership structures to help overcome cultural resistance to formal aged care.

Similarly, many participants argued that the Strategy should more clearly support the use of CALD communities to assist in disseminating information to consumers. While participants clearly stated that DoHA should take responsibility for the production of culturally and linguistically appropriate information materials, they suggested that CALD community organisations could greatly aid in ensuring that information about the aged care system reached CALD older people. Community organisations required Government support to assume this role.
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5. Language services and communication

A frequently raised issue related to the need for policy to recognise that language services were about broader cultural communication rather than language alone. Participants frequently noted that even when bilingual information was available, it was often not expressed in a way that is easily understood by the older generation. Similarly, while many older CALD people were able to read in English, there was a frequent complaint that government-produced information was expressed in formal, difficult to understand English laden with acronyms and medical terminology. Participants suggested that information written in English should be expressed in simple, vernacular language.

Many participants asserted that bilingual information should be highly visual, and must be made available in both written and non-written mediums in order to access the whole older CALD community, as many older CALD people were not literate in their native language.

Availability of interpreting services was a common concern, particularly in regional areas. A number of groups noted that it was common for family members to act as interpreters when interpreters were not available. Participants argued that this was extremely inappropriate and placed older people at risk of elder abuse; when information is filtered by carers and family members, the preferences of the client are often not directly communicated to service providers. Several groups also noted that interpreters not being familiar with medical terminology was a common issue that affected communication.

6. Workforce

Workforce issues were a major theme of every consultation and many submissions. Every consultation group argued that the Strategy, and Government policy in general, must facilitate mechanisms to attract more bilingual workers to the aged care sector. There was a strong agreement at every consultation that bilingual workers who understood a person’s culture and were part of their community were far more effective than telephone interpreting services. Key issues raised included the ones listed below.

1. At present, barriers such as lack of workplace flexibility, lack of transport and onerous written English exams were preventing many CALD people from accessing work in the aged care sector.
2. The Strategy should address the need to recruit a bilingual aged care workforce in each area that matches the linguistic demography of their clients. For example, participants at several consultations noted that most Greek- speaking interpreters and aged care staff were now ageing themselves and that there is an acute shortage of aged care staff who spoke key CALD aged care languages such as Greek, Italian, Dutch and German.
3. Workforce planning should respond to the changing demography of the CALD older population. For example, over the next decade the need for bilingual staff from Chinese, Vietnamese and Indian backgrounds would increase and workforce recruitment priorities should reflect this.

7. Cultural competency

The issue of cultural competency training for aged care workers was raised at every consultation. Participants universally supported the idea of implementing compulsory cultural competency training as part of workforce training. Such training must be continuous in order to address the issue of high staff turnover in the aged are sector.

There was also a need identified for more culturally-specific training that educated workers about the specific beliefs and preferences of different cultural groups.

Related issues that were frequently raised were:

1. the need to provide aged care workers from CALD backgrounds with training about Australian culture and workplace culture, as cultural and linguistic miscommunication between CALD aged care workers and their non-CALD clients is common; and
2. the need to provide additional funding to improve CALD aged care workers’ English language skills.

8. Community consultation

Most participants argued that more detail needs to be provided in Goal 1. In particular, participants wished to ensure that any consultative mechanism would be flexible enough to address the diversity of needs in different areas, rather than applying a uniform approach across Australia. This concern was particularly strong in regional locations.

Participants also commented that any consultation mechanism should reach directly to personal care workers, since they had the most direct contact with and understand the experiences of their CALD clients, rather than simply consulting with service
provider managers. Direct consultation should also occur with older CALD people, their families and carers.

9. Elder abuse

The issue of elder abuse was frequently discussed at the consultations and participants wished to see it addressed in the Strategy. Participants suggested that frameworks needed to be put in place to protect against elder abuse. They also noted that a lot of work had been done around elder abuse nationally by community organisations. Key issues raised were:

1. professional interpreters, rather than family members, must be used to communicate clients’ wishes;
2. the Government should work with CALD communities to encourage older people to write down their wishes and care preferences (including their preferences for dying) before they were unable to articulate their preferences themselves, so that clear records exist; and
3. a strong assessment framework must be in place at the stage of initial assessment to ensure that all care decisions were based on the preferences and best interests of the older person, rather than of family members or other parties.

10. Capacity building and partnerships

In relation to Goal 5, many consultation groups and submissions suggested that the Strategy should include a goal that promoted and provided support for the formation of partnerships between CALD communities and larger generalist service providers. Such partnerships would provide a vehicle for CALD communities seeking support and guidance to develop culturally and linguistically appropriate aged care services for their communities and for generalist service providers seeking guidance on how to implement more culturally and linguistically appropriate service practices.

Participants also sought more clarity from Goal 5 on whom specific capacity building initiatives would be targeted at (such as families, communities or service providers) and on how capacity building would be supported by the Government.

11. Research and data collection

Every discussion group provided diverse feedback on Goal 6. Key points included:

1. the bodies identified in Goal 6.1 were too narrow and should be broadened to include smaller bodies at local and state levels that also collect data, such as Medicare Locals;
2. existing data, such as information on service uptake and ancestry data in each area, was very difficult to access, particular for smaller community organisations. This data should be made freely available to the CALD and aged care sectors;
3. there was strong support for the establishment of a central Data Clearing House that included research from all sources that is freely available.
4. Goal 6 focused too strongly on data, to the exclusion of qualitative research.

The Strategy should commit DoHA to encouraging more needs-based research on CALD aged care.

12. Reporting

Groups frequently discussed the need for a comprehensive reporting and evaluation framework that focused on producing continuous improvement. A number of participants representing service providers argued that reporting must be compulsory and easy to do, without creating an additional administrative burden on service providers. Many participants suggested that reporting mechanisms should seek feedback directly from consumers, their families and carers and their personal care workers as well as service provider management.

Some Overall Observations

1. Overall, there was a general feeling of welcoming the initiative of a CALD strategy for ageing and aged care.
2. Participants frequently commented that carers, volunteers, dementia and palliative care issues lack adequate mention in the Strategy.
3. There was a general sense of scepticism that the Strategy goals would be implemented and become more than an aspirational document.
4. There was a clearly expressed concern among every group, in one form or another, that many Strategy goals will not be implemented due to a lack of funding and clear policy directions. Participants universally wished to see more specific and action- oriented goals, as well as a comprehensive evaluation and reporting mechanism. All goals must be underpinned by resources to carry them out.
5. There was frequent discussion, and often mixed opinions, around whether CALD issues should be treated as a separate issue within aged care, or whether mainstream policy principles and practices should simply be made more inclusive.
6. A common observation was that low level services such as centre-based day care services were extremely valuable in CALD communities and must continue to be funded and expanded, as they provided an appropriate starting point for CALD older people and their families to become more comfortable with the idea of formal aged care services and to transition into the system.
7. There was frequent criticism of the Community Visitors Scheme. While participants strongly supported the idea of such a scheme, they frequently commented that CALD older people were not given equitable access to the CVS. Some participants suggested that funding social groups in CALD communities would be more effective in reducing social isolation among older CALD people than expanding the CVS.
8. The majority of groups emphasised the need to move toward a system that supported a seamless continuum of care as consumers move between levels of care. They noted that the current system had a tendency to operate in isolated ‘silos’ that created barriers to delivering seamless services as consumers’ care needs change.

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National Aged Care Strategy for People from Culturally and Linguistically Diverse (CALD) Backgrounds

Additional points (especially from written submission as part of the consultation process) that might be considered for inclusion in the final Strategy

Diverse Australia

Include as a new penultimate paragraph:

Carers perform a valuable role in providing care and support for older people from CALD backgrounds. CALD carers can experience greater difficulty in accessing and navigating the aged care system - many CALD carers are ‘hidden’ carers who are more likely to experience barriers related to differences in language and culture.

Principles

Empowerment

Add to final dot point:

“are free from elder abuse”.

(This point would then read “Older people from CALD backgrounds have human rights respected and are free from elder abuse.”)
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Quality

Add to second dot point after “aged care worker”: “and volunteer”
(This point would then read “Aged care service providers have the structural capacity and resources to develop organisational competency to support culturally and linguistically appropriate care. This includes development of aged care worker and volunteer skills and knowledge that enable appropriate consumer directed care to older people from CALD backgrounds.”)

Strategic goals and actions

Goal 2

Add new final dot point 2.6:

“Develop, resource and deliver appropriate health literacy programs for CALD people.”

(This was viewed as a vital component of the transition to consumer directed care).

Goal 3

Amend 3.1 to read:

“3.1 Ensure that the Aged Care Gateway has the capability to accommodate the cultural, linguistic and spiritual diversity and literacy among CALD communities from the entry point, by ensuring that Gateway services have the expertise to deliver culturally and linguistically appropriate services by providing language services where people have limitations in English, through use of bilingual staff and interpreters. At the initial contact point with the Gateway, if CALD people so choose, they can be referred for assessment to specialist agencies with cultural and linguistic experience and proven capacity to deliver access to the Gateway.”

(This is consistent with the current thinking of the Gateway Advisory Group at its meeting on 9 November 2012). Add additional points:
“3.7 Work to ensure that appropriate health and disability services are available to older people from CALD backgrounds.”

“3.8 Develop its own cultural competence to support and drive this Strategy.”

Goal 5

Amend 5.5 to read:

“5.5 In partnership with the CALD sector, develop targeted communications to encourage members of CALD communities to consider employment, volunteering and training in the aged care sector.”

Goal 6

Amend 6.3 to read:

“6.3 Develop, in collaboration with FECCA and research organisations a program of research to inform equitable, quality, effective, inclusive and accessible aged care services to CALD communities.”

Additional Resources

• Living longer. Living Better aged care reform package;
• Quality of Care Principles 1997
• The People of Australia – Australia’s Multicultural Policy;
• Charter of Public Service in a Multicultural Society, Department of Immigration and Multicultural Affairs, 1998;
• The National Framework for Action on Dementia;
• National lesbian, gay, bisexual, transgender and intersex (LGBTI) Ageing and Aged Care Strategy;
• Access and Equity for a multicultural Australia – inquiry into the responsiveness of Australian Government services to Australia’s culturally and linguistically diverse population;
• The Universal Declaration of Human Rights;
• Respect and Choice – A Human Rights Approach for Ageing and Health;
• State and Territory Ageing and Aged Care strategies;
• National Mental Health Strategy 2012;
• Cultural competency in health: a guide for policy, partnerships and participation, National Health and Medical Research Council 2006;
• The Statement for Australia’s Carers (s. 2.2 of Carer Recognition Act 2010);
• Australian Charter of Healthcare Rights, Australian Commission on Quality and Safety in Healthcare July 2008;
• Community Common Care Standards (CCCS) 2011

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CALD Aged Care Strategy Consultations: No 3

Date: Friday 12 October 2012

Location: FECCA House, 1/4 Phipps Close, Deakin, Canberra

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Capacity building

One of the main issues raised related to capacity building in CALD communities. The participants suggested that CALD community leaders could play a vital role in raising awareness of and promoting the use of aged care services in CALD communities.

They also expressed a wish for Government support to foster partnerships between established service providers and CALD communities, to provide CALD communities with the resources and expertise needed to develop more culturally and linguistically appropriate services in their area.

A new Principle was suggested:

5.3 CALD community leaders can play a vital role in helping to raise awareness and deliver services in partnership with service providers.

2. Community consultation

This group argued for more clarity with regard to Goal 1.1. They suggested that:

1. This Goal needs to be more specific and action-oriented, particularly with regard to ensuring that rural/regional areas are adequately consulted and represented.
2. Consultation must take place at state and city levels annually.
3. Any consultation mechanism must recognise the diversity of issues across Australia and be tailored to local issues and needs.

The group also argued, in relation to Goal 6, that research needs to engage directly with consumers. Qualitative research as well as quantitative data is needed.

3. Cultural sensitivity

The group argued that the Strategy needs to include more emphasis on cultural sensitivity. They suggested that there is a need to address cultural resistance to formal aged care and particularly residential care in CALD communities, including shame in many communities toward dementia and mental health issues.

4. Language services

This group argued that telephone interpreter services are generally ineffective, as the real need is for bilingual workers who understand the culture and are part of the community.

They also argued that even in one’s native language, the kind of language used in aged care is confusing and difficult for both interpreters and older people to understand; language needs to be simple and in the vernacular.

The group commented that Goal 3.5 needs to be more specific. A major issue is that the reliance on translated written information is preventing many older people who are illiterate in their own language from accessing information.

5. Cultural competency

The group suggested that Goal 4.3 needs to be more specific and action-oriented. They suggested that the following issues are particularly important:

1. Cultural competency training for all staff. This training needs to be culture- specific as well as focused on more general principles of cultural sensitivity. Staff need to learn details such as specific cultural preferences.
2. Training of overseas staff to ensure that they understand Australian culture and the Australian service system.

Other Considerations

9. There was a general view that concrete Government policies and allocation of resources are needed to give life to many goals, particularly in relation to Goal 5.

10. In relation to Goal 5.4, there was a suggestion to explore new training options to encourage people from CALD backgrounds to seek employment in aged care, such as bilingual training programs.

11. There was a suggestion that Goal 6 needs to be more explicitly linked to the Principles.

12. In relation to reporting, there was a general concern that service providers will need to write more reports in response to the Strategy. The group suggested that reporting on the Strategy should be required by law and not difficult to do.
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CALD Aged Care Strategy Consultations: No 4

Date: Monday 15 October 2012

Location: Multicultural Aged Care Inc., 94 Henley Beach Road, Mile End, Adelaide

List of Participants: Appendix 1

Consultations Outcomes

Key Themes / Issues Raised

1. Capacity building

This group argued that the Strategy should elaborate on the points under Goal 5. They suggested more clarity around who specific initiatives would be targeted at, for example individuals, communities, service providers.

The group suggested that the Strategy should support the formation of partnerships between communities and service providers as a capacity building mechanism.

2. Diversity within diversity

There was a general discussion about the need to emphasise diversity within diversity, and how multiple diversities (such as LGBTI people from CALD backgrounds) will be addressed in the Strategy. The group suggested that diversity within diversity could be further clarified and elaborated on in the Context section. The group suggested that the Strategy should explicitly state that ‘special needs’ groups are not mutually exclusive and that CALD- appropriate services must also be able to support additional special needs factors within the broader CALD umbrella.

3. Locational diversity

The group argued that the Strategy, and policy in general, needs to better acknowledge the locational diversity in Australia. They agreed that services are generally lacking in rural and regional areas, and that the diversity of these areas must be recognised in order to deliver appropriate services across Australia.

4. The language of the Strategy

The group argued that the Principles and Goals need to be more action and policy-oriented in order to give them meaning. There was one suggestion to add sub-policies within the broader Strategy framework.

The group suggested that a statement about positive ageing and living as an older person in the community should be included in the Strategy. This could be a reference to the Living Longer Living Better statements on ageing. However, the group also suggested that in order to clearly express the aims of the Strategy, references to ageing rather than aged care in the Principles and Goals should be removed.

The general need for consistency of language was raised. The group suggested using the phrase “CALD consumers and carers” uniformly throughout the document.

5. Advocacy

The group argued that policy design and the Strategy must recognise the subtle difference between the interests and aims of the community and those of the individual, as these aims and interests can differ. Advocacy services must recognise that providing effective service is ultimately about the needs of the individual and the family rather than the community.

6. Language services

The group was concerned about the differences in available interpreting services from state to state, in relation to issues such as which budget the cost of interpreting services comes from. The group suggested including a passage in the Strategy about uniformity of translating and interpreting services nationally.

The group discussed communication issues and agreed that language services are about broader cultural communication rather than just language. The group discussed the issue of illiteracy among older CALD people and supported the need for verbal communication and dissemination of information to ensure that people actually understand the aged care system and their care, rather than just delivering written documents in other languages.

7. Workforce

The group agreed that there is a need for policy geared toward developing a culturally competent, bilingual workforce, particularly in rural/regional areas. One participant raised the concern that there is a tendency for the term “CALD” to lump diverse groups together, often to the exclusion of smaller groups and people with multiple diversities. There was a strong agreement that workforce issues need to be closely examined and should be included right across the Strategy.

The group suggested that volunteers should be better supported by policy, particularly as most volunteers are themselves seniors.

The group was in general agreement that some form of cultural competency framework for workers should be developed. Several participants suggested that rather than being culture- specific, this training should follow the Cultural Intelligence model, which focuses on general sensitivity to all cultures.

8. Evaluation and reporting

This group argued that a comprehensive evaluation framework should be developed to accompany the Strategy. Several participants suggested the following:

1. A reporting mechanism aligned with the Strategy should be developed and all CALD providers should be compelled to use it.
2. The Aged Care Accreditation Standards should be reviewed to include special needs groups’ status.

9. Research

The group argued that the bodies identified in Goal 6.1 are too narrow. They noted that many smaller bodies such as Medicare Locals collect their own valuable data and that smaller research/data sources such as this should be acknowledged in the Strategy.

The group agreed that Goal 6 focuses too strongly on the collection of data, to the exclusion of the need for needs-based qualitative research.

Other Considerations

1. There was a comment that in the SA Department of Health, Access and Equity is treated as an over-arching principle. It was suggested that this should be made Principle 1 so that the other Principles to flow from this over-arching statement, or that it should be treated as an over-arching statement which precedes the Principles.
2. There was general discomfort with the use of the term “special needs”. Some participants also argued that CALD-appropriate care should be treated as “integral” to general care practice rather than viewed as an add-on. There was a general consensus that the Principles should be relevant to all care recipients, not just people from CALD backgrounds.
3. One participant suggested that religious and racial discrimination should be acknowledged somewhere in the Strategy, and that this could be linked to the Commonwealth commitment to equality, access and equity.
4. One participant argued that the Strategy should include a point around how to maintain social interaction for CALD people as they age and potentially move into residential care. Particularly if they move into generalist residential care, resources are needed to help individuals maintain a sense of connection to their community and to avoid social isolation.
5. The group agreed that there is a tendency for services to be delivered in blocks or “silos”, rather than as an inter-connected continuum of care. They suggested that the Strategy should emphasise the need for this seamless continuum.
6. There was a general concern that there is a pattern of constant consultations and pilot programs, with no ongoing action and resources form the Government. The group argued that all goals in the Strategy need to be underpinned by ongoing funding.

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CALD Aged Care Strategy Consultations: No 5

Date: Wednesday 17 October 2012

Location: Multicultural Council of the Northern Territory, Shop 15 Malak Shopping
Centre, Darwin

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Locational diversity and flexibility of services.

One of the key issues raised was that of locational diversity. Many participants noted that Darwin’s population is very multicultural and is made up of many small CALD communities, each with different aged care needs. The group argued that many common CALD aged care issues, such as finding appropriate service providers and interpreter services, are intensified
by Darwin’s small but very multicultural population.

They noted that it is difficult to provide appropriate services to every community given their small size. They argued that the Government therefore needs to support the development of flexible multicultural services to provide appropriate services to small and/or remote CALD communities.

The group suggested that an action point focused on developing alternate models of care for CALD people should be included in the Strategy. They argued that the development of ethno- specific services is generally not viable given Darwin’s small population. It is therefore most relevant to develop more multicultural and cluster service providers, and investigate possible partnerships between CALD organisations and generalist service providers as a model appropriate to rural/regional locations with many small CALD populations such as Darwin.

2. Capacity building

This group argued that Principle 5 and Goal 5 on capacity building should include an emphasis on encouraging partnerships between service providers and CALD communities, in order to support the development of more and better aged care services for those communities.

3. Consultation

This group suggested that Goal 1 needs to include more specific information about the proposed consultative mechanism, such as how it will be implemented, where and how it will take place and how it will address the shortage of staff able to attend consultations.

4. The Gateway

Concerns were raised about the design of the Gateway. The group was concerned that a non- face-to-face entry point into the aged care system would disadvantage older people from CALD backgrounds. The group supported the idea of utilising existing groups with CALD expertise and argued that reforms around the Gateway must involve the development of new services as well as ensuring that CALD communities are aware of the existence of current services.

5. Palliative Care

The group noted that it is difficult to meet unique preferences for end of life care for CALD people in Darwin. They also noted that it is difficult to find aged care workers who are willing and able to support older peoples’ preferences to die at home.

6. Cultural competency

This group expressed support for the idea of cultural competency training for all staff. They noted that this training must reflect the reality of multiple diversities within the CALD umbrella. They suggested that the Strategy should address the following issues:

1. How often the training will occur.
2. Given the high turnover of aged care staff, regular training is necessary to ensure that all new staff members receive training.
3. Cultural competency training must be accompanied by ongoing monitoring and evaluation to ensure its effectiveness and implementation.

Some participants suggested that ATSI-specialist service providers can provide a good model for staff recruitment and cultural competency that may be useful in the CALD sector.

7. Language services

The group argued that the Strategy should include a greater emphasis on interpreting services. The group agreed that the linguistic backgrounds of aged care staff from CALD backgrounds working in Darwin do not align with those of the older population needing interpreting services. The group argued that:

1. There is a need for a targeted employment drive to attract workers from the right language groups (such as Greek and Italian) to the aged care sector.
2. Resources should be put into developing the bilingual and bicultural capacities of existing staff.

8. Workforce

The group argued that there is a strong need to attract more workers from appropriate cultural and linguistic backgrounds to the CALD aged care sector. There was a general consensus that the Government must develop new ways to encourage people from CALD backgrounds to work in the aged care sector, as well as policies to support and educate workers once they are employed.

9. Research

The group felt that aged care planning and workforce data are currently not made freely available, and that having access to such data would be very useful for planning and effective service delivery. They noted that both quantitative data (on issues such as carers and demand for services) and qualitative research (for example, on needs and models of care) is needed. The group suggested the following initiatives:

1. Making all research (performed by many different groups, from a local to a national level) freely available through a data clearing house.
2. Commissioning needs-based research to inform aged care planning processes.

Issues identified as key areas in need of further research included:

1. carers’ support needs
2. demand for services in each local area c. innovative models of care
3. the disconnect between the linguistic backgrounds of CALD aged care workers and their clients
4. future demographic shifts

Other Considerations

1. This group suggested that the synergy between the Principles and Goals should be reviewed. At present they do not align; for example, the group observed that Principle 4 centres on quality, however Goal 4 is mainly just about monitoring rather than developing service capacity.

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CALD Aged Care Strategy Consultations: No 6

Date: Thursday 18 October 2012

Location: Ethnic Communities’ Council of Western Australia, 20 View St, North Perth

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Flexibility

This group argued that service providers already try to follow the key Principles outlined in the Strategy. However, they are hindered by policy frameworks that do not allow flexibility in services and adequate hours of care. The group noted that being able to provide adequate care hours for each client is key to providing quality care.

The group also argued that given the perceived government push to reduce the overall number of service providers nationally, best-practice policy should support the development of multicultural service providers that are able to provide culturally and linguistically care to multiple ethnic groups, rather than putting resources into establishing more ethno-specific service providers.

There was a general consensus that the overwhelming preference among older people from CALD backgrounds is to stay at home for as long as possible rather than receive care in nursing homes. The group argued that resources should therefore be directed toward developing community care options rather than residential facilities.

2. Access and Equity

One participant argued that access and equity should not always be “lumped together” in government policy documents. This participant suggested that equity is generally inadequately considered as a result, and that none of the Principles in the Strategy can be achieved unless the principle of equity is thoroughly considered and incorporated throughout the document. This participant suggested splitting access and equity into two separate principles.

3. Choice

The group discussed what the principle of choice really means in practice. They agreed that an essential focus of the Strategy must be on providing a genuine selection of different services to everyone.

4. Language services

The group argued that a lot of translated material produced by the government is not suitable for its intended audience of older people from CALD backgrounds. Comments included:

1. Language use varies across the generations within a particular language group. A lot of translated material is aimed at the younger English-speaking generation within CALD communities, rather than their grandparents. Translated information materials need to use the language of the current older population; these groups themselves should be engaged to produce materials that are culturally and linguistically appropriate to their age group as well as ethnic background. While a younger translator may think a particular piece of translated material is excellent, their grandparents may find the use of language inappropriate or even offensive.
2. There are many cases of CALD sector organisations having to re-translate inappropriate materials, with no financial support from the Government. It was suggested that this point be inserted into Goal 1.

The group suggested that the Strategy must explicitly ensure that language services are fully funded by the Government. They argued that professional interpreters are vital to ensure that an individual’s concerns and preferences are accurately communicated, rather than filtered by family members and others who may act as informal interpreters when professional services are unavailable. The group asserted that the use of family members as interpreters is inappropriate and that this should be recognised as an issue of equity and discrimination. There was a perception among the group that since a person’s children are often the main communicators, the children’s preferences are often reflected in care assessments, even if these are different to the client’s.

The group also commented that:

1. Illiteracy in one’s own language is a significant issue among older CALD people and that non-written sources of information must therefore also be made available.
2. The actual language needs of clients are not always being picked up the initial assessment level, since language spoken, ethnic background and country of birth can all be different and lead to misunderstanding of a client’s needs.
3. Interpreters should establish links with the particular community they are providing services for, such as existing community groups, in order to ensure culturally appropriate communication.

5. Accreditation standards

The group argued that the language issues above need to be incorporated into accreditation standards for translators and interpreters, including a requirement to take proper records of a person’s language and cultural background. One participant suggested that Goal 3.6 should refer to translation services in a person’s language and culture, including dialect.

The group also commented that comprehensive cultural competency principles need to be embedded throughout all aged care accreditation standards, rather than being isolated to points relating to food and religion.

6. Partnerships

The group argued that the Government should make resources available to support partnerships between established generalist service providers and CALD communities wanting to develop services. The group commented that many smaller CALD communities are ready to develop aged care services; however they need support from partners. A participant representing a generalist service provider commented that they are constantly receiving calls from people from CALD communities wanting to develop a particular community service; however the service provider does not have the time or resources to help them since there is no support available to develop such partnerships.

7. Advocacy

The group discussed the role of advocacy. Opinions relating to the appropriateness of advocates in CALD communities differed, with some participants arguing that advocacy by outsiders was inappropriate given the central role played by the family in CALD communities. However, there was universal support for client-centred care, with the group agreeing that the underlying principle of any advocacy program must be that the client’s preferences (either for family or outside advocacy) must come first.

The group also commented that the Department of Immigration and Citizenship has previously had a big focus on support and advocacy services for older immigrants; however, this focus has now shifted entirely to supporting recently arrived immigrants. The group commented that from their perspective, there are no new government-funded advocacy services appropriate for older CALD people, and that advocacy services for older people in Perth are inappropriate for CALD people.

8. Information and promotion of services

The group argued that aged care services must be promoted to CALD communities as beneficial, friendly and culturally sensitive, and that this is currently not being achieved through any Government initiatives or information sources. They commented that the Government should implement a drive to promote aged care services to older CALD people who do not yet need them, in order to encourage people to understand their options and make a plan for their old age care while they are still healthy and able to do so, so that their wishes are written down.

9. Partners in Culturally Appropriate Care (PICACs)

The group suggested that decisions regarding who receives funding as the PICAC in each state should be negotiated between DoHA and FECCA. One participant was particularly concerned that in some cases PICAC funding is awarded to generalist service providers who are then tasked with educating multicultural providers about culturally appropriate care.

10. Research

This group made the following comments on Goal 6:

1. The focus on the ABS and AIHW in Goal 6 is too narrow, and should be broadened to include information sources from state and local levels, such as local and state health departments and HACC.
2. Research and data is largely inaccessible to small organisations and the Strategy must address this.
3. There is a need for speedier distribution of reporting. At present, it often takes 12 months to access evaluation information through annual reports.
4. Research and data collection and dissemination must strike a balance between big picture information and quality, focused data on a local level.

Other Considerations

1. There was a brief discussion on the importance of recognising multiple diversities and special needs, particularly within the context of assessment.
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CALD Aged Care Strategy Consultations: No 7

Date: Monday 22 October 2012

Location: The Hills Holroyd Migrant Resource Centre, 1 Horwood Place, Parramatta, Sydney

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Principle 1 – Inclusion

The group discussed Principle 1, Inclusion, and made the following comments:

1. Some reference should be made to people with cognitive impairments or dementia in this section.
2. One participant suggested that the use of “home” in Principle 1.1 should be clarified and that this point should include reference to residential care.
3. Clarity around the use of the word “representative”, and possible inclusion in the definition section, would be useful.

2. Principle 4 – Quality

1. The group made the following comments on Principle 4:
2. This section needs to include reference to “background, culture and beliefs” (rather than religion).
3. Principle 4.2 is too long.

3. Workforce

The group argued that the issue of workforce should be coupled with a point about building the capacity of CALD communities to run services. They suggested that an additional point about workforce capacity building should therefore be included under Principle 5, Capacity Building. The group suggested that policy should focus on supporting CALD communities to build work force capacity from within by encouraging community members to seek employment in aged care. This would involve encouraging community support for aged care services, recruiting staff from CALD communities and training of staff. The following words were suggested for an additional point:
5.3 CALD community capacity is strengthened to develop the workforce and to deliver culturally and linguistically appropriate services.

4. Research

This group argued that Goal 6 should address the current difficulty faced by communities and smaller organisations in accessing existing data and research, including that produced by the ABS.

The group suggested that the Data Clearing House in Goal 6.1 should include training materials that could be used by the CALD aged care sector.

The group argued that Goal 6 should include a reference to the importance of translating research into practice.

5. Issues missing form Strategy

There was a general consensus among this group that adequate reference to dementia, palliative care and carers’ issues is lacking from the Strategy. The group also commented that while these issues should be addressed in the Strategy, it should not be too specific.

Other Considerations

1. One participant suggested that the Palliative Care Framework should be added to the Policy Frameworks section.
2. One participant noted that a figure on the Greek population should be added to the demography section. 59.2% of the Greek population is currently aged over 65.
3. It was suggested that Goal 2 lacks adequate reference to residential aged care.
4. The group suggested that Goal 2.3 be modified to include reference “to all other advocacy-related services” in addition to the National Aged Care Advocacy Program, in order to cover services such as the HACC Multicultural Access Project (MAP). Some participants wished to know what would happen to HACC MAP services following the transfer from state to Commonwealth funding.
5. In reference to Goal 2, a number of participants argued that the Healthy Ageing Flexible Fund should be mentioned, and were concerned that the Strategy did not adequately address the situation of organisations that do not receive government funding.

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CALD Aged Care Strategy Consultations: No 8

Date: Tuesday 23 October 2012

Location: Multicultural Communities’ Council of the Illawarra, 117 Corrimal St, Wollongong

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Consumer Directed Care

The group noted that there is general confusion surrounding what consumer directed care will mean for the aged care sector. The group suggested expanding the definition of Consumer Directed Care in the Terms and Acronyms section.

2. Continuous improvement

The group argued that an emphasis on review of existing programs and continuous improvement should be incorporated throughout the Strategy. It was suggested that this should be added to Goal 1.2.

3. Information

Discussion focused on the importance of both delivery and quality of information. This group argued that the Strategy must recognise the difference between making information available and ensuring that the information itself is culturally and linguistically appropriate, as this is essential to ensuring that information is understood. The group also argued that increasing the range of service options available is essential to providing genuine “informed choice” (Goal 2).

The group favoured the use of the words “informed decision-making” as appropriate language to capture the goals of information dissemination.

The group also argued that all reference to information should note that information must be “bilingual and bicultural” in order to achieve an adequate level of understanding in the community.

Literacy was identified as a key issue. Several participants noted that among older CALD people who are able to read English, most read at the level of an 11 or 12 year old; therefore the use of English in information sources must be simple and in the vernacular to facilitate understanding. This issue should be addressed in Goal 3.2.

4. Capacity building

The group commented that the wording of Principle 5 is very good, as it is more positive in tone than the other Goals. They also noted that Principle 5 should explicitly state that capacity building should be targeted at both ethno-specific and multicultural services.

The group argued that supporting the recruitment and development of bilingual staff is important and this should be emphasised in the Strategy.

5. Funding

The group regularly commented that many of the Principles and Goals need to be clearly supported by appropriate resources.

6. Research

The group argued that the Strategy must include words to ensure that research and data is freely available to the community and CALD aged care sector.
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CALD Aged Care Strategy Consultations: No 9

Date: Wednesday 24 October 2012

Location: Rydges Plaza Cairns Hotel, Spence St, Cairns

List of Participants: Appendix 1

Consultations Outcomes

Key Themes / Issues Raised

1. Cultural perceptions of aged care

This group argued that strong cultural resistance in many CALD communities to seeking formal help with aged care for elderly relatives is a major barrier to accessing the aged care system. These cultural taboos compromise the aspirations embodied in Principle 2 that older CALD people will be empowered to access services and express their views. It was suggested that Principle 2 is too aspirational rather than grounded in reality.

The group noted informal carers often face enormous stress in these circumstances. They are crucial to the welfare of the older person, however cultural taboos surrounding formal aged care services discourage carers from seeking help. The group pointed out that it is carers who need to legitimise the use of formal support services in CALD communities.

The group also noted that CALD communities have a different concept of human rights that affects access to and uptake of care services. For example, in Western culture the right to formal aged care support may be seen as a human right, however in another culture receiving aged care from one’s children may be considered a right. The group notes that CALD people will not seek services until the community (through community and religious leaders) legitimises the use of care services, thereby granting community members “permission” to access the aged care system. One participant suggested that the best way to encourage greater acceptance of aged care services is to give CALD communities ownership over small projects in order to encourage acceptance and familiarity with the system.

The group argued that encouraging community acceptance of formal aged care services is particularly crucial in rural far North Queensland, as many older CALD people are left vulnerable to social isolation and inadequate care. Their children have generally absorbed Australian culture and often moved away to seek work elsewhere. These older people are therefore left with little family support as they age; however they are reluctant to seek support services due to cultural taboos surrounding formal aged care.

The group also noted that the Government should use appropriate community avenues (that differ among communities) to empower older people. For example, the Catholic Church is the focal point for guidance in Pacific Islander communities.

2. Access to services in rural areas

This group consistently emphasised that many of the issues commonly brought up in other consultations are amplified in rural areas due to the smaller size of CALD communities, geographical isolation and the difficulty of stretching scarce resources over a large geographical area.

3. Qualifying age for aged care services

The group noted that there are a number of new and emerging CALD communities in the Cairns and Townsville areas, such as the Indonesian, Bhutanese and Pacific Islander communities. Several participants noted that while most members of these communities are aged under 70 and therefore not considered seniors by accepted Australian definitions, the difficult life experiences faced by many people in these communities means that many need to access aged care services at a much younger than average age. One participant pointed out that many Bhutanese immigrants are aged between 50 and 60, which is already considered elderly in their culture. However, they do not qualify for aged care support services in Australia and are left vulnerable by a lack of social support. This situation compounds problems related to cultural resistance to seeking services outside the family.

One participant pointed out that indigenous Australians are entitled to senior’s services from the age of 50, reflecting the reality of earlier ageing among indigenous people and their earlier need for services. They suggested that aged care policy should reflect the reality that in some CALD communities the Australian legal definition of an older person does not apply and services are need at an earlier age.

4. Workforce

The group suggested that an additional point be included under Goal 5 to cover workforce issues, particularly the need for appropriate training for aged care workers and greater recruitment of workers from CALD backgrounds.

The group pointed out that poor written English often acts as a barrier for many CALD people wanting to enter the aged care workforce. Participants noted that many CALD people struggle with written English exams (the major form of assessment at TAFE in Queensland) when training to work in the aged care sector. They suggested that written exams may not always be the most appropriate method of assessment given that almost all communication with clients in the aged care sector is through spoken language.

5. Language issues

The group commented that there is a shortage of onsite interpreter services in far North Queensland.

The group noted that inter-generational communication is an issue in many communities. In some CALD communities, such as the Tokelau community in Townsville, younger English- speaking people are now unable to communicate with their grandparents. This communication issue puts older people at greater risk of social isolation and being vulnerable to not having their care needs met.

6. Unmet need for services among non-permanent residents

The group argued that many people migrating to Australia from the South Pacific under the Trans-Tasman immigration agreement are bringing their ageing parents. These older people will never become permanent residents of Australia and are not entitled to the aged care pension or any aged care services under their visa conditions, despite the fact that they pay taxes.

The group suggested that this is a new and emerging issue that has the potential to lead to social isolation issues and significant care burdens on the children of these older people. The noted that although the Strategy is about aged care services for Australian citizens and permanent residents, cultural ties dictate that CALD communities cannot ignore the needs of non-permanent older residential. This care burden will therefore exist within the community; however the whole community will also benefit from any policy changes.

7. Overlap between CALD and indigenous issues – potential for lesson sharing

Some participants commented that the separation between CALD and indigenous issues in policy/advocacy streams is not always productive in far North Queensland. For example, one participant noted that in Cape York the special needs policy focus is entirely on indigenous aged care issues, while CALD issues come under the mainstream umbrella. The group argued that many of the issues faced by both groups are the same; however advocates and policy- makers representing each group meet separately and address issues separately. The group emphasised that while they were not suggesting that CALD and ATSI aged care policies should overlap, a greater level of communication and lesson-sharing would be helpful.

8. Research and consultation

The group suggested that an additional action area should be added under Goal 1 that reflects the need to identify demographic needs in each local area in order to provide services that are culturally and linguistically appropriate.

The group also commented that there is a need for open, transparent research that is not influenced by political pressures. Other gaps in research data collection identified were:

1. Data on service uptake in CALD communities
2. CALD-specific data sets, particularly those that use ancestry data, that is published and available to the community and aged care sector

Other Considerations

1. The group argued that the language of Goal 1.1 should be altered to specifically include rural and regional areas in the consultative mechanism.
2. The group suggested that a key value missing from the Principles is respect for diversity/difference. The group noted that this is not an assumed part of frontline services and that often the expectation is that CALD clients will assimilate to mainstream culture in the aged care system. It was suggested that a sixth principle could be added to cover respecting diversity and cultural values.
3. The group commented that the Strategy lacks attention to the needs of carers.
4. The group commented that policy, and particularly government consultation with communities, needs to reach down to every level of the aged care workforce, including personal care workers. The group agreed that it is the people that provide everyday care, such as showering and cleaning that most closely observe and understand the experiences of their clients.
5. The group commented that the language of government documents is generally technical and difficult for most people to understand. They suggested that the
6. language of documents such as the Strategy must use straightforward, plain English to aid understanding.
7. The group discussed the issue of elder abuse. They suggested that involving advocates from outside the family is very important to protect older people from abuse by their carers, particularly financial abuse.
8. The group discussed the need for transparency and accountability in reporting on the Strategy. They argued that the Strategy should include an action point around monitoring that incorporates feedback from the community.

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CALD Aged Care Strategy Consultations: No 10

Date: Thursday 25 October 2012

Location: Diversicare, 49/51 Thomas St, West End, Brisbane

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Partnerships

This group argued that government policy should support partnerships between CALD
organisations and generalist service providers to facilitate capacity building.

2. Principle 4 – Quality

There was a discussion around whether policy directed at workforce training should single out CALD aged care workers as a group in need of separate or additional training. Some participants argued that there are no real differences across the workforce; however, others asserted that CALD workers have different training and support needs and that at present, a large proportion of funding for up-skilling is spent on improving workers’ English language skills.

The group also commented that Principle 4.2 is too long. They suggested that it should be either modified to more clearly communicate workforce needs, or broken up into two separate points.

3. The Gateway

The group discussed the development of the Gateway. Several participants called for the development of a dedicated multicultural portal modeled on existing services such as Ethnic Link Services in South Australia.

The group suggested that Goal 3.3 should be split into two separate points; one dealing with multicultural access to the Gateway and another discussing the up-skilling of aged care staff.

4. Translation services

The group argued that information on the aged care system targeted at CALD people must be available in both written and verbal formats, as not all older people from CALD backgrounds are literate in their native language.

Other Considerations

1. The group noted the effectiveness of centre-based day care services and the importance of continued funding for these services. They argued that day care services are important in CALD communities as they act as a vehicle for CALD people to transition into the aged care system, therefore offering a particularly good model in CALD communities where there is resistance to formal aged care services.
2. The group was supportive of Goal 6.1, which suggests the creation of a Data Clearing House. They group also argued that data and research must be made publicly available to the community.

CALD Aged Care Strategy Consultations: No 11

Date: Tuesday 30 October 2012

Location: The Baha’i Centre of Learning, 1 Tasman Highway, Hobart

List of Participants: Appendix 1

Consultant Outcomes

Key Themes / Issues Raised

1. Elder abuse

The group argued that human rights and freedom from abuse, such as financial abuse by carers, should either be included in Principle 1 or 2, or given its own section. Some participants noted that a lot of work has been done around elder abuse nationally, so it would be appropriate for the Strategy to include an emphasis on this. It was also suggested that elder abuse should be included in the definition section. The group also noted that in a CALD context, elder abuse issues are closely linked with communication and language issues.

2. Recognising diversity

The group argued that the action areas under Goal 1 should more adequately address the breadth of diversity both across Australia and within particular cities. They asserted that any consultative mechanism must recognise the fact that demographics, needs and key issues vary across Australia, as well as the fact that smaller cities such as Hobart are populated by many smaller CALD communities.

3. The Gateway

The group suggested that Goal 3.1 should discuss the most essential services that must be included in the Gateway. They noted that this is preferable to a long list of aspirations or a general statement about inclusion, since not all aspirations can be achieved.

4. Monitoring and evaluation

The group argued that the reporting and evaluation mechanism linked to the Strategy must include room for direct consumer feedback. The group also suggested that the Strategy should more clearly communicate that monitoring should be linked with evaluation and action in order to strive for continual improvement.

The group argued that cultural competency training programs already exists through the network of PICACs. They suggested that reforms around cultural competency training should focus on reviewing existing training mechanisms rather than inventing new ones.

The group suggested that reports on the Strategy should be made available in other languages in order to be accessible to CALD people.

Other Considerations

1. The group commented that in relation to reporting on the Strategy, feedback should come directly from consumers as well as service providers.
2. Participants commented positively on the community development and empowerment aspects of the Strategy, noting that this is the best direction for government policy.
3. Participants consistently commented that many points are too general and need to be more specific and action-oriented. They commented that points such as Goal 3.3 are too general and therefore risk being unachievable; instead, action points should be clear and specific.
4. There was a general comment that while the Principles are written in an active manner, the language used in the Goals is too passive.
5. The group discussed the Community Visitors Scheme and noted that CALD older people are often not recipients of this scheme. They commented that this issue should be addressed at a later stage of the aged care reforms.
6. The group commented that the action areas under Goal 5 relating to supporting capacity building in CALD communities should be elaborated on and strengthened, as they are currently too brief and too passive.

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CALD Aged Care Strategy Consultations: No 12

Date: Wednesday 31 October 2012

Location: Ethnic Communities’ Council of Victoria, 150 Palmerston St, Carlton, Melbourne

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Consultation

The group suggested that a point be added to Goal 1.1 about strengthening departmental capacity to involve consumers in consultation processes. It was also suggested that any consultative framework should include dedicated consultation on specific issues such as dementia and carers.

2. Information

One participant noted that CALD community organisations can help disseminate information to consumers; however it should be the responsibility of the Department of Health and Ageing to develop appropriate materials.

The group also argued that Goal 2 and/or Goal 3 should include a point about the importance of improving health literacy among consumers.

3. The Gateway

The group raised a number of general queries over the Gateway development process. They noted that it is difficult to provide comment on the Strategy when the ‘nuts and bolts’ of the Gateway have not yet been established. The group argued that the Strategy should include more information and direction about the Gateway.

4. Cultural competency in the Department of Health and Ageing

The group argued that Goal 4 should include a commitment by DoHA to develop its own internal cultural competency protocols, in order to promote the development of assessment standards that incorporate CALD considerations across all policy areas.

5. Workforce

The group suggested that Goal 5 should explicitly promote the development of a bilingual aged care workforce. The following words were suggested:

Develop structural pathways to facilitate the employment of bilingual people in aged care.

6. Research and data collection

The group noted that data needs to be collected on CALD people using generalist aged care services as well as ethno-specific services.

They also argued that since data on uptake of services is already collected by DoHA, this must be made easily available to the sector.

Other Considerations

1. One participant suggested that the Aged Care Accreditation Standards should be translated into community languages as well as general aged care information.
2. The group was of the opinion that action areas around DoHA’s dissemination of information in CALD communities, such as Goal 2.2, should be re-phrased to reflect a partnership between DoHA and CALD communities and to allow CALD communities to take ownership of certain initiatives.
3. The group argued that the Strategy should be inclusive and relevant to all aged care services, including generalist services, instead of CALD issues being treated as separate/an adjunct to core sector policies and issues.
4. The group suggested that the Ethnic Communities’ Council of Victoria’s health literacy policy paper An Investment Not an Expense: Enhancing Health Literacy in Culturally and Linguistically Diverse Communitiesbe added to the resources list.

CALD Aged Care Strategy Consultations: No 13

Date: Thursday 1 November 2012

Location: Ethnic Council of Shepparton, 158 Welsford St, Shepparton, Victoria

List of Participants: Appendix 1

Consultation Outcomes

Key Themes / Issues Raised

1. Information and education

Information and education was the major theme of this discussion. A general concern among participants was that older CALD people do not understand the aged care system, its procedures and confusing acronyms, and that accessing services takes too long.

The group suggested that the government should utilise CALD community networks to encourage older people to access formal services.

2. Translation and interpreting services

The group was very supportive of volunteers doing translating and interpreting. However, they argued that a major issue is that many volunteer interpreters do not understand “medical jargon” used in aged care. In this case, there is a need for professionals with the requisite training.

The group also commented that there are issues around accreditation for interpreters. Many bilingual volunteers want to become accredited interpreters; however parts of the accreditation exam are too onerous and exclude them. One participant also commented that the demands of the exam often make the accreditation process unsuitable for volunteers working part-time on the side. The issue of different dialects within a language group was also raised.

3. Communication

The group suggested that in addition to communication issues presented by a lack of bilingual information, government produced information is often inaccessible to CALD older people who speak English as the language used is too formal. The group stressed that information needs to be expressed in easy to understand plain English.

4. Advocacy that supports independence

The group discussed the need for advocacy services that are able to strike an appropriate balance between providing older people with advice and advocacy when necessary but also ensuring they are supported to be independent and exercise choice whenever possible. This advocacy needs to be available and appropriate to older people as well as their families/carers.

The group also commented that a solid assessment framework needs to be developed to protect against elder abuse and ensure that decisions are being made in the best interests of the older person when initial aged care assessments are made.

5. Social and linguistic isolation

The group commented that social isolation among older people is a significant issue in Shepparton and other rural/regional areas. Many older CALD people’s children have moved away, leaving them living alone with little support. The group noted that many other support services, such as face-to-face health and car insurance services, have also been moved to major cities; everything is now done via telephone and internet, creating more challenges.

There is a significant need for information in rural areas that is accessible and understandable to older CALD people, meaning that it must be bilingual and expressed in a clear, simple manner. The group commented that older people with no family in the area tend to rely in the Ethnic Council of Shepparton and their neighbours since they face “linguistic isolation”.

6. Diversity of services

The group commented that due to a lack of streamlining in the aged care system many providers in regional Victoria are providing the same services; currently, providers are not encouraged and supported to offer different services to provide greater choice to the community.

7. Settlement funding

The loss of settlement funding for immigrants was raised as an issue. The group argued that DoHA is not good at understanding these issues. They commented that many CALD people who have now lived in Australia for decades lost their settlement funding long ago, and became absorbed into general pension entitlement categories. 50 years later these people are getting older and the settlement issues they faced decades ago, such as language and cultural integration issues, are now re-emerging as they age and their first language and culture re- asserts itself. However, the general government aged care funding that these people are entitled to is not equipped to deal with these issues.

8. Cultural competency for aged care workers

The group was very supportive of the need for appropriate cultural competency training for aged care workers.

Other Considerations

1. The group commented that issues relating to carers and other informal representatives of older people should be addressed more thoroughly in the Strategy.

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Summary of Written Feedback on Draft National Aged Care Strategy for People From Culturally and Linguistically Diverse (CALD) Backgrounds

Thirty-one (31) written submissions from voices in the CALD aged care sector were received alongside the face-to-face consultations. In general, the written Feedback reflected the key themes discussed at the face-to-face consultations, as outlined in Attachment A. This summary provides an overview of points raised in the written submission that were not discussed in depth at the face-to-face consultations. For this reason, this summary should be read in conjunction with Attachments A, B and C.

Written feedback on the Strategy was received from:

1. ACH Group
2. Advocare Inc.
3. Anglicare Southern Queensland
4. Assessment and Case Management Services (South), Tasmania
5. Australian Finnish Rest Home Association Inc.
6. Bankstown Area Multicultural Network Inc. (BAMN)
7. Carers NSW
8. Carers Queensland
9. Catholic Care Wollongong
10. COTA Australia
11. Dementia Collaborative Research Centre, University of NSW
12. Diversicare Townsville
13. Dutch Care, Victoria
14. Ethnic Link Services, UnitingCare Wesley Port Adelaide
15. Fronditha Care
16. Good Neighbour Council of Tasmania (GNC) Launceston Branch Inc.
17. HACC Multicultural Access Project Network, Ethnic Communities’ Council of NSW
18. Health Care Consumers Association ACT
19. Leading Age Services Australia (LASA)
20. Leading Age Services Australia (LASA) Victoria
21. Migrant Information Centre (Eastern Melbourne)
22. Multicultural Aged Care Inc. SA
23. National Ageing Research Institute (NARI), University of Melbourne
24. National Cross Cultural Dementia Network, Alzheimer’s Australia
25. Nick Mersiades, Catholic Health Australia
26. Open Training and Education Network (OTEN), TAFE NSW Western Sydney Institute
27. Partners in Culturally Appropriate Care (PICAC) Northern Territory
28. Professor Graeme Hugo, University of Adelaide
29. Resthaven Incorporated
30. Shamsul Khan and Mahjabeen Ahmad, University of South Australia
31. Volunteering SA-NT

Key Suggestions

1. Suggested policy frameworks

- Australian Charter of Healthcare Rights, Australian Commission on Quality and Safety in Healthcare (July 2008)
- Community Common Care Standards (CCCS) 2011
- National Mental Health Policy 2008
- National Palliative Care Strategy 2010
- The Statement for Australia’s Carers
- All state and territory strategies e.g. NSW Ageing Strategy

2. Suggested legislation

- Carer Recognition Act 2010
- The Universal Declaration of Human Rights

3. Suggested resources

- The CALD HACC Working Party for Volunteering (auspiced by Volunteering SA-NT)
- The Not-for-Profit Sector Reform Council (this group, which reports to the Office for the Not-for Profit-Sector in the Department of Prime Minister and Cabinet, is looking at current workforce pressures and opportunities for the not-for-profit sector and their work regarding volunteers could inform the Strategy).
- Ethnic Communities’ Council of Victoria, An Investment Not an Expense: Enhancing Health Literacy in Culturally and Linguistically Diverse Communities
- Wall. S, Santalucia. Y, Salem. M, Giacomin. D, McDonald. R and Bosnjak. F (2011), Enhancing the Lives of Older Refugees, Sydney South West Area Health Service.

4. Goal 1 – Consultative mechanism

- Existing community advocacy networks should be mobilised and strengthened as part of the consultative mechanism.
- The Strategy should explicitly state that advocates from minority CALD groups as well as larger groups will be consulted.
- The consultative mechanism should be flexible enough to include the views of consumers who do not speak English.

5. Goal 2 – Information dissemination

- Information should not only be multilingual but highly visual and available in a variety of print and electronic media.
- Aged care service providers should be encouraged to work in partnership with advocates from CALD communities to disseminate information about the services available, as “contact is often only between the client and family, and not necessarily between communities and service providers” (Health Care Consumers’ Association ACT).
- It is important to identify and use the preferred media of each CALD community in planning strategies for information dissemination, as these are different for each community. For example, Resthaven Inc. notes that “in working with the Serbian community we have learned that the ethnic radio plays an important role within their community, while the Czech community in SA do not have a radio program but they rely on their ethnic newspapers”.
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6. Carers

- The Strategy includes little discussion of the issues affecting carers of older people from CALD backgrounds. In line with the Commonwealth Carers Recognition Act 2010, carers should be recognised as “individuals with their own needs, and acknowledgement of CALD carers in the context, principles, goals and reporting sections of the Strategy” should be included (Carers NSW).
- “An additional action item under Goal 3 addressing respite and other carer support services should be included” (COTA). There is currently little mention of “the role of carers and how they need to be supported to continue their caring role”. Further, “the attitudes towards caring and the use of services such as respite vary enormously across cultural groups and this should be addressed in the Strategy”.
- Carers NSW notes the following definition of a carer: “A carer is an individual who provides unpaid care and support to a family member or friend who has a disability, mental illness, drug and/or alcohol dependency, chronic condition, terminal illness or who is frail”. See the Carers NSW submission (Appendix 2) for key statistics and information relating to carers.
- The Strategy should address the issue of ‘hidden’ carers, as they “are more likely to experience barriers related to differences in language and culture” (Carers NSW). The concept of ‘carer’ is not always easily understood by other cultures, and many carers from CALD backgrounds consequently miss out on services they are entitled to.
- A heading titled ‘Carers in Culturally and Linguistically Diverse (CALD) Communities’ should be added under the Context section of the Strategy. It should discuss relevant issues relating to carers, particularly this issue of ‘hidden’ carers and limited access to support and respite services.
- It is essential that carers of older people from CALD backgrounds are consulted with during the report review process, and this should be included in the Strategy.

7. Inclusion of smaller CALD communities in policy development

- A number of submissions noted that smaller minority groups are generally not consulted and are inadequately addressed in the Strategy. They highlighted the importance of better including smaller CALD communities in consultation and policy-making processes, rather than including mainly larger cultural groups and assuming that CALD communities have been represented. For example, one small ethno-specific provider commented on the Strategic Goals: “We do not believe that they will positively assist our aged population as we are a small migrant group in comparison to others and are often not included/invited to participate in projects to improve information sessions and other important research due to our numbers” (Australian Finish Rest Home Association Inc.). Another submission noted that in order for smaller CALD communities to take advantage of capacity building opportunities facilitated by the Strategy, they must first be informed that these opportunities exist.

8. Consumer Directed Care

- The Strategy should address how it will fulfil expectations of Consumer Directed Care.

9. Spiritual needs

- Insufficient attention is paid to spiritual needs in the Strategy and existing policy.
Consultation should include spiritual representation from CALD communities to address consumers’ religious needs. It was noted that spiritual needs are generally not fulfilled in nursing homes in the Northern Territory (PICAC NT).

10. Goal 3.4 – Community Visitors Scheme (CVS)

- The CVS needs to be re-introduced with new funding and auspice arrangements.
One submission suggested that developing the skills of CALD volunteers through the CVS will help build their capacity to enter the aged care workforce.
- The CVS should be promoted to all CALD communities and people from CALD
backgrounds should be encouraged to participate in the CVS.

11. Translating and interpreting services

- Goals 3.5 and 3.6 should address the difficulty in accessing interpreter services.
Translating and interpreting services should be “significantly expanded and available outside normal office hours” (Health Care Consumers’ Association ACT).
- Booking interpreter services can be difficult; therefore a “one stop shop”, where CALD communities can access all information and book services, would be helpful.
- While free translating and interpreting services are available for people who are already engaged in the aged care system, the high cost of these services is prohibitive for people who are planning but yet to engage with aged care services. One submission noted that for the purposes of the Strategy, there are three main issues present in relation to translating and interpreting services: “it is about increasing access to interpreter services for older people and their families, promoting information about interpreter services, and ensuring there are sufficient interpreters of the required languages” (Resthaven Inc.).
- The additional barriers faced by people in regional areas in accessing language and interpreting services (such as high costs, travel times and the reluctance of interpreters to accept jobs in outlying areas) must be recognised and addressed. Technology may be a useful tool to overcome these barriers, such as video- conferencing through the National Broadband Network when it becomes available.

12. Aged Care Complaints Scheme

- Goal 4.2 should emphasise the importance of making information about the Aged Care Complaints Scheme available to CALD communities. Residential care facilities must offer all residents and their families information about the scheme. It should be promoted as a positive scheme that will not result in adverse treatment of the resident.
- Under Goal 4.3, informing consumers about the Aged Care Complaints Scheme should form part of cultural competency training for aged care workers.

13. Cultural competency

- Cultural competency training for aged care staff should include mandatory training about the appropriate use of interpreter services.
- Cultural competency training should “extend beyond competency in aged care to capacity building, healthy ageing and developmental ageing in order to improve the access of older people from CALD backgrounds to opportunities for restorative support, engagement and learning and opportunities to age well” (ACH Group).
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14. Crossing between care systems

- “The ageing and disability interface, particularly what happens to people with a disability as they age and how their needs will be met needs to be identified and discussed. These issues are not specific to CALD communities but the complexity of crossing between care systems could potentially be greater for this group” (COTA).

15. Aged care assessment

- Intake and assessment tools need to be reviewed and further developed in order to be inclusive and enable adequate planning.

16. Aged Care Accreditation Standards

- “The current regulatory framework relating to the Accreditation process is silent on the importance of language and cultural identity in service delivery and the experience of CALD older people” (Fronditha Care). Fronditha Care suggested that the Accreditation Standards need to be reviewed, and the following issues need to be acknowledged and addressed in the Strategy:
- Only 1 out of 44 accreditation outcomes makes reference to cultural identity and there is no mention of performance benchmarks in relation to language, communication and assisting residents to maintain links with their community if they wish.
- The concept of culture is inappropriately dealt with in the accreditation standards, with “cultural needs” separated from other outcome standards that are inexplicably linked with culture such as leisure, privacy, dignity, emotional support and palliative care.
- “‘Cultural needs’ should be featured strongly in each of the standards and agencies should be asked to demonstrate how they respond to a specific client’s cultural needs within each of the 44 standards, as this reflects a ‘whole organisation approach’ to cultural care” (Fronditha Care).
- The ability to communicate with the resident in a language they understand is not mentioned at all in the accreditation standards, and yet the standards “assert the resident’s right to be involved in their assessment, in developing care plans and in exercising their right to choose between options” (Fronditha Care).
- “The Accreditation Agency often does not use interpreters when assessing facilities and hence cannot obtain adequate feedback from residents on whether their needs are met” (Fronditha Care).

In response to these limitations, Fronditha Care recommends the inclusion of the following action items:

4.1 The Accreditation Standards should be reviewed and that specific outcomes be introduced relating to meeting the language and communication needs of CALD older people.

4.2 A 10th outcome standard is included in the overarching Accreditation Standard 1 relating to “management systems, staffing and organisation development”. Such an outcome should ensure a whole of Accreditation Standards approach to cultural sensitivity, meaning cultural sensitivity is embraced across all relevant outcomes in Accreditation Standards 2, 3 and 4.

4.3 A clearly designated position to represent and advocate on behalf of CALD older people be established on the Board of Directors of the Accreditation Agency. If this is not effective, explore other models.

4.4 (Goal 4.2) Ensure that the Aged Care Complaints Scheme is promoted to CALD communities and accessed by older people from CALD backgrounds, including through the use of a dedicated interpreter credit line.

17. Goal 7

- Fronditha Care recommends the inclusion of a seventh goal:

Goal 7 – Acknowledge the relative merits of the existing aged care service models, and establish benchmarks for assessing and monitoring the capacity of aged care service providers to care for older people.

This goal would facilitate strategies to support each type of service model type to deliver care that is culturally and linguistically appropriate and provides real options to the community. See the Fronditha Care submission (Appendix 2) for details.

18. Age limitations on access to aged care

- The Strategy should acknowledge, under the Diversity within Diversity heading in the Context section, that older people are diverse in their state of ageing and that services entitlements (including entry in to the aged care system) should be based solely on personal need rather than on numerical age.

19. Volunteers

- “The Strategy misses the opportunity to capitalise on the participation of older volunteers as a component of the aged care workforce” (Volunteers SA-NT).

Encouraging volunteering later in life is also an important healthy ageing initiative. The following is recommended for inclusion as a new Principle:
2.3 Older people from CALD backgrounds have the capacity to engage with, contribute to and shape the development and delivery of aged care services through volunteering.

20. Research

- A number of submissions highlighted the need for qualitative research to be supported and resourced alongside quantitative data collection.

21. Reporting

- Greater clarity around the reporting process is needed, particularly in terms of depth. “It is important that data is collected from the recipients of care, and not just from stakeholders. Genuine cultural inclusion in aged care requires a diverse reporting process which includes individuals and smaller groups, who may have missed out on receiving the quality consumer-centred care to which they are entitled under the Australian Charter of Healthcare Rights” (Health Care Consumers’ Association ACT).
- “The review by key stakeholders should be widened to include representatives from smaller CALD communities as well as larger ones; it would be appropriate to include family representatives too” (Health Care Consumers Association ACT).

22. Community resistance to care services

- In order to overcome community resistance to non-family members caring for older people in CALD communities, a well-structured education program is needed to explain the availability of services. “The benefits of accessing healthcare services are not always apparent to people who have never had any opportunities of support from outside their immediate community. This could help alleviate the social isolation experienced by some of the older people in these communities” (Health Care Consumers Association ACT).

23. Definitions

- A definition of a “person-centred approach”, as referred to in Principle 3.3, should be included in the Terms and Acronyms section.

24. Flexibility

- “Flexibility” should be incorporated into the Principles. The National Ageing Research Institute suggested the following alterations:

3.1 Culturally and linguistically appropriate and flexible aged care is available across generalist, multicultural and ethnic specific service types to all maximum choice for CALD age care recipients.

4.1 Standards of care and services are culturally and linguistically appropriate and flexible to the needs of older people from CALD backgrounds.
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