Australia’s ageing population

Position Paper on Australia’s ageing population

Australia’s population is ageing and increasing in ethnic diversity. Approximately 30% of Australia’s population was born overseas, and over 300 identified languages are spoken in Australian homes (ABS, 2021). With the number of cultural and linguistically diverse (CALD) Australians set to increase further, and people living longer than ever before, further aged care reforms are drastically needed. While aging presents a variety of challenges for all, these challenges can be exacerbated for older people from CALD backgrounds, who are required to navigate and engage with services and systems not specifically designed with them in mind.

MCC acknowledges the efforts made by government and aged care sector to respond to the needs of older CALD people. However, as highlighted during the Covid 19 pandemic and recent Royal Commission into Aged Care Quality and Safety, there remains much to do for the aged care sector to better meet the needs of this group.

Older CALD usage of aged care services: Access and Equity Issues

Research has shown that older people from CALD communities generally prefer home care services and rely more heavily on family members for support, due to safety and cultural reasons. This is more evident in emerging ageing CALD communities such as Middle Eastern and African communities. Yet, the number of care packages available to older people in the community is inadequate to meet current need, an even greater issue for older CALD people who may require specialised services or care workers. As at the end of 2020, 97 000 older people were on the wait list for a Home Care Package (HCP), with waitlist times approximately 8-12 months for HCP at level 2-4.

When older CALD people do consider residential care – due to necessity or choice, their preference and that of their families is for ethno-specific or multicultural services rather than mainstream services. Research indicates that the cultural and linguistic needs of older CALD people in mainstream aged care services often go unmet. Overall, in mainstream aged care services, there are few bilingual staff; acknowledgement of peoples cultural and culinary needs and preferences are limited; people tend to be isolated from coresidents from their ethnic group; and many have limited proficiency in English. While there are some reports that high quality care for CALD older people can be provided in mainstream services by clustering together residents with similar ethnicity or cultural backgrounds or through person-centred, individualised care, uptake of such initiatives remains limited.

There are concerns that there is an overreliance on CALD families to care for older members of their family. Capacity for families to exclusively care for older relatives and extended family support is reducing over time due to intergenerational change, such as participation of women in the workforce, people living in smaller houses, smaller families, changing cultural values and increased migration (Sagbakken et al., 2018).

Research shows that access and equity issues for CALD older people extend across the aged care sector. This is evident through the use of complex language and excessive hyperlinks on the My Aged Care website, long wait times on the hotlines for interpreters, inconsistency and lack of transparency in fee structures and general lack of culturally appropriate services.

Recommendations:

  • Greater attention is needed to the practices and location of aged care in Australia from institutionalised to home-based care models to better meet the preferences of older CALD people, but also Australians in general who also prefer to age at home.
  • Greater recognition, through adequate funding and resourcing is needed to support the important role ethno-specific and multicultural services play in meeting the needs of older CALD people.
  • More support and resources are needed for family carers in CALD communities, and carers in general.
  • Interpretation and translation extend throughout the whole aged care process from enquiry, to assessment and service provision.

Maintaining culture is an important source of wellbeing for older CALD people For many older CALD people, maintaining culture in a broad sense is an important source of wellbeing. In attending to cultural needs of older CALD people, policy makers and service providers often reduce culture to single dimensions such as language, cultural values, or country of birth, rather than accounting for culture as something that is lived and linked to people, places, and time. Currently, the way in which the cultural needs of older CALD are meet is variable, and often lacking at different points in the system. While the Government has invested in different initiatives to support providers in attending to the diverse needs of service users such as cultural competency training and action guides significant policy to practice gaps remain. Cultural competency training was introduced to address the cultural needs of older CALD people. However, questions have been raised as to how effective “cultural competency” training is, as training

tends to occur as a one off, within a short time frame, leaving little scope for reflection and development of practical strategies for changing practice. There is also a lack of follow up assessment and evaluation following this training. Furthermore, the predominant CALD community groups accessing aged care change with time, and training does not always keep pace with the cultural needs and norms of new and emerging migrant groups.

Recommendations:

  • Culture needs to be recognised as more than language or values alone, and more than outward engagement in activities and practices, it is embodied and entangled with people, places, and time.
  • Shifting from ‘cultural competency’, to ‘cultural responsiveness’ will help to recognise the provision of culturally appropriate care is a process involving flexibility, adaptation, self-reflection and lifelong learning rather than a skill perfected at a particular point in time.
  • Greater consistency is needed in meeting older CALD people’s cultural and linguistic needs across the system, such as entering the system, and when support needs or care workers change.

Research indicates that according to international standards, more than half of aged care residents live in facilities with unacceptable levels of staffing. To address this issue, and also attend to the diversity in Australia’s ageing population, governments have focused on facilitating pathways for migrant job

seekers into aged care. Approximately one third of the aged care workforce are migrants and culturally and linguistically diverse (CALD) workers. While this helps to address shortages in the workforce, it raises other issues. For instance, the ability to match cultural groups across workers and clients varies across CALD populations due to trends in migration. Asian migrant care workers are well represented in aged care, with personal care assistants primarily drawn from India and the Philippines. Increasingly care workers are being drawn from newer migrant groups such as Iraq and Sudan. This raises difficulties for cultural matching between aged care workers and older European and Anglo-Celtic older people.

Covid 19 has helped highlight the long-standing problem of problematic working conditions in the aged care workforce. The workforce is becoming increasingly diverse on the frontline, with most migrant workers employed as personal care attendants. Most of these workers are casually employed, work long hours for low wages, with few benefits such as leave entitlements or career pathways and have limited training and support. It is well established that staff ratios and staff skills and capabilities directly affect the quality of care and worker wellbeing. The Government has expressed a commitment to growing and upskilling the workforce to improve care for older Australians with an investment of $402.2 million over three years, from 2022–23 to 2024–25. However, a shortfall remains in terms of what is needed to address the breadth of workforce issues in aged care.

Recommendations

  • Work conditions in aged care need to be significantly improved to attract workers to the sector. This requires better pay, better training, better career progression opportunities, and a better work environment for all.

Data collection lacks nuance and insight into the needs of older CALD people There is a lack of linkage across existing data sets to assist with analysing trajectories and characteristics of older people using aged care, the needs of older CALD people and family carers. The ABS CALD measure provides insight into CALD diversity, but not on the needs of the CALD population. Research into ageing and related issues for CALD groups is also limited due to many studies reliant on participants being proficient in English, therefore the experiences of a significant proportion of the Australian CALD population is excluded.

As statistical measurements of CALD are often limited to country of birth and language spoken in the home, these measurements do not capture English proficiency, or capacity for engaging with mainstream services. These measurements also exclude people born in Australia who strongly identify with a particular culture.

Recommendation:

  • Measurements of CALD, should be augmented with measures such as Interpreter required, Preferred sex of Interpreter or Care Worker, Cultural or Ethnic Identification, including spirituality/religion and year of arrival
  • Research with CALD people need to be adequately funded to include the cost of interpreters and translators to ensure equity in representation of the CALD population

Longstanding problems in funding shortfalls for the aged care system, impact negatively on older CALD people

Australian residential care has become more privatised and marketised over the past 25 years, increasing competition within the sector. Concerns have been raised for the viability of ethno-specific and multicultural service providers competing in a model entirely funded through consumer-directed care.

The Australian government spends less on aged care than similar countries with good aged care systems. The Royal Commission identified a shortfall of approximately $10 billion per year funding shortfall, for the aged care sector. The shortfall equates to 100,000-person home care waiting list (with CALD older people over-represented in use of HCP), shortage of 70,000 aged care workers, and lack of qualified nurses on site 24/7 in all residential care homes. In response to the recommendations of the Royal Commission into Aged Care Quality and Safety, the Australian Government has implemented the first year of an $18.8 billion, five year aged care reform program. The funding reforms are based on five pillars – home care, residential aged care services and sustainability, residential quality and safety, workforce and governance – to deliver respect, care and dignity for older Australians. As part of these funding reforms, the Government Government is ensuring the AN-ACC funding model Base Care

Tariffs increase funding and support to regional, rural and remote services, reflecting their additional costs of care delivery. Ethno-specific and multicultural organisations also incur additional costs in care delivery due however, there is no mention in the budget of changes in funding to organisations that specifically service Australia’s older CALD population.

Recommendations:

  • Restructures and reforms of the aged care sector need to attend to the balance between cost and profit for providers and quality and outcomes for older people.
  • Reforms of the aged care sector need to attend to the sustainability of ethno-specific and multicultural aged care service providers.
  • Block funding is a way to ensure that ethno-specific and multicultural organisations remain sustainable in a competitive marketplace, of individualised funding and consumer directed care.

Dr Marika Franklin PhD Honorary Consultant Multicultural Communities Council of NSW 30th March 2022