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The Interim Report by the Aged Care Royal Commission reveals a substandard residential aged care sector plagued by poor care and safety standards.
As Australia looks at improving the care of our ageing population, it must also consider the complex cultural needs of our multicultural seniors.
Some innovative providers are recognising the importance of intergenerational interactions.
Statistics from Dementia Australia shows that 52 per cent of residents in aged care facilities are affected by dementia.
Many overseas-born seniors will lose their English language skills and revert back to speaking their mother tongue as their cognitive abilities decline, thus demanding culturally competent care in nursing homes.
However, Sydney University’s aged care and dementia expert Associate Professor Lee-Fay Low says ethno-specific care isn’t always available.
“So the more established communities are more likely to have ethno-specific services and also if you live in the city where there’s large populations. I think that it’s a big challenge if you come from a small cultural group where you live in a country to find culturally competent care.”
Sydney’s Campsie-based Chinese Australian Services Society, also known as CASS, co-locates a nursing home, a kindergarten and a community centre for healthy seniors next to one another.
Its senior executive officer of home ageing services Ivan Wong explains the benefits of intergenerational engagements.
“We notice that a lot of them have a lot of barriers like language barriers, and barriers in their cultural heritage, and as a result, a lot of them are very isolated from the community, and therefore, in our service, we emphasise the seniors people have contact with other peers or with other members in the community like the children and other volunteers so that they will be integrated rather than isolated in the community."
The last Census shows that nearly one in five older people speak a language other than English at home.
In New South Wales, for example, almost one in eight of the Chinese seniors aged over 70 are not fluent in English.
CASS delivers its aged care services primarily to cater to older people of Chinese backgrounds.
“A lot of them come to Australia when they were maybe at their middle age or even older, and as a result, a lot of them are not educated or brought up in the local environment, and therefore, English to them is a second language, as a result, they have difficulties in communicating with other members in the society.”
Wong says it’s hard for seniors to compromise their cultural needs especially after developing a life time of traditional habits and practices.
“Say, for the Chinese seniors people, if they are used to having rice, hot food, it’s really very hard for them to go into residential service which provide them with say, sandwich; and of course, there are some other things like celebration of traditional festivals. We have celebration there so that they can feel the joy and that they continue their practice to celebrate those traditional customs.”
The Aged Care Quality and Safety Commission received 7828 formal complaints in 2018-19, 73 per cent of all complaints were about residential care.
The most common problems were medication administration and management.
Dr Low explains a key reason why nursing homes are struggling to cope with the complex medical needs of the elderly residents.
"The data on the profile of the average resident in the nursing homes is actually showing that they are sicker and frailer than they were before which means that families are actually maintaining people at home for longer.”
An earlier study on the interactions between residents and staff at nursing homes showed that residents are alone 40 per cent of the time.
New South Wales-based aged care provider Scalibrini is combating this sense of isolation and loneliness with intergenerational playgroups and residential arrangements.
Its CEO Chris Grover explains.
“We are trying to create facilities that are part of a community and merely because people are going into a facility should not mean that they abandon their engagement in a community. So prior to coming in they would have had intergenerational interaction anyway by virtue of where they were living beforehand.”
More than half of Scalibrini’s residents are of Italian heritage.
It also accommodates residents of various cultural backgrounds.
Last year, it teamed up with Sydney University to pilot what it calls the “Gold Soul Companionship Program” offering four accommodation places to allied health students at the residential care facility in return for 30 hours of voluntary service a month.
Tanveer is a 24 year old post-graduate student in physiotherapy who started living at Scalibrini Bexley in July.
“I see myself going into aged care after graduating. It was just really for my own personal and professional growth.”
A regular resident Tanveer hangs out with is 72-year-old Patricia who enjoys the refreshing company of young university students.
“We chat, we have a cup of coffee, we do craft together and it’s really really great because it’s informal and we just talk and it’s really good for the morale of the residents having someone coming from outside the staff.”
With the Aged Care Royal Commission’s Interim Report describing the aged care sector as “a shocking tale of neglect”, CEO of Aged and Disability Advocacy Australia Geoff Rowe says changes can only happen when consumers and their families start demanding that certain standards are met.
He encourages starting by holding providers accountable to the newly updated Charter of Aged Care Right
“The Charter is incredibly important because historically, we haven’t talked about older people having rights in aged care so it’s changed the conversation. It’s stepped it up. It’s given power to the older people, to their families, to their carers to ask the hard questions. To ask “what we can expect?”. To ask “how will you provide a culturally appropriate service for my mum, my dad, or for myself?”. It’s giving people a tool that we really haven’t had access to before.”
Associate Professor Lee-Fay Low is predicting a shift away from traditional nursing home settings to houses with rooms people can cohabit in as Australia’s ageing population relies more on residential aged care in the future.
She dreams of a home-like environment where the people, the food and activities make sense to someone like her own ageing mother.
"When I go in, it would look a bit Chinese maybe Australian-Chinese but it would look Chinese. I would smell rice. I would hear mahjong tiles. It would feel like a home so it wouldn’t look like a hospital at all. Maybe it would look like a big house with rooms. There would be people who spoke Chinese to my mother and it would make sense to her especially I suppose if she had dementia and she remembered her life growing up and that it would make sense to her and she wouldn’t feel like she was living in a foreign place.”
Dr Low hopes the Aged Care Royal Commission would encourage a shift in focus from minimum standards to quality care.
“And that cultural safety, cultural competency, and really, I guess, tailoring the care we provide so that we do see more innovative models especially models that can help people who don’t speak English well or come from a cultural minority group to get better care to get the care that they want or they need.”
In Queensland’s Sunshine Coast, NewDirection Care Founder and CEO Natasha Chadwick won the Telstra Business Woman of the Year for her innovative Microtown aged care model which took her eight years to develop.
Chadwick says carving out a new model of aged care not only requires courage but also a completely new way of thinking.
“I had to retrain my brain the way that I thought about what we did and how we did certain things. So it was a learning process not just for myself but everyone who was part of the team and so our mantra if you like became, ‘Is that normal? Would I do that in my own home? Would I do that in my own community? What would I want? And that’s pretty much how we went about then designing and developing the Microtown. How would I want to live if it was me?
To find out what rights you have under the newly updated Charter of Aged Care Rights, visit the Older Persons Advocacy Network website or call 1800 700 600 from 8am to 8pm Monday to Friday for more information.