industry & reform
Diversity in aged care
Palliative care, advance care
planning and aged care for
every Australian, regardless
of background or identity.
By Georgia Rowley
E
ach older Australian living in the community or in residential
aged care has different needs towards the end of life. Older
Australians reflect the diverse experience of all Australians.
Many are born in different countries, speak languages other than
English, and adhere to diverse spiritualities or faiths (or to none).
Older Australians may identify as lesbian, gay, bisexual, transgender,
or intersex (LGBTI) and may be care leavers (Forgotten Australians),
veterans or carers. Many live rurally or remotely, with disability and/or
social or financial disadvantage, or at risk of homelessness.
There is also staff diversity in the aged care workforce, which can
impact the care provided to older adults, particularly where staff
values and preferences may not align with those of the people they
care for. Providers and services must consider multiple types of
diversity at once, in line with an intersectional approach, to ultimately
provide best practice advance care planning, aged care and palliative
care for all older Australians.
Vulnerable individuals who identify with one or more minority
groups or marginalised identities and backgrounds often face
barriers in accessing information, services and support. They may
feel disadvantaged or discriminated against or lack representation
in their communities or wider society. A person-centred approach
to care, in line with the Aged Care Quality Standards, can ensure the
delivery of safe and inclusive services to people with diverse needs
and life experiences.
For the sector to provide culturally safe and appropriate care, the
specific preferences and concerns of each person must be at the
forefront. People inevitably have different preferences about what
constitutes healthy ageing and a good death.
Standard 1 of the Quality Standards relates to valuing the identity,
culture and diversity of each consumer, to deliver culturally safe care
and services. In this context, cultural safety is determined by the
consumer. It reflects their experience of how the care and services
provided to them acknowledge their culture and how it is respectful
of differences in planning and delivering care and services.
Our personal characteristics and experiences shape our thoughts
and responses to death, dying, palliative care and grieving. We all
deserve safe quality care, regardless of our specific backgrounds
and preferences. Subsequently, care alternatives need to be flexible,
respectful, inclusive, and sensitive to meet the diverse needs of
Australia’s older population.
The interim report from the royal commission into aged care
found evidence that Australia’s aged care system is failing to meet
the needs of older vulnerable people, particularly at the end of life.
The Aged Care Diversity Framework provides a welcome guide for
providing appropriate care and aims to support an aged care system
where older Australians receive quality care, regardless of their varied
life experiences and needs.
End of Life Directions for Aged Care (ELDAC) is a national project
funded by the federal health department to empower the aged
care workforce in delivering quality end-of-life care. The ELDAC
website (www.eldac.com.au) is a free resource connecting health
professionals to best practice on aged and palliative care. New
evidence-based pages relating to population diversity provide an
overview of the aged care and end-of-life considerations needed
when providing care to individuals from diverse backgrounds.
These pages include resources to assist health professionals in
providing appropriate, person-centred care. They provide insights
into the care needs of Aboriginal and Torres Strait Islander people,
care leavers, carers, culturally and linguistically diverse people,
financially or socially disadvantaged people, those at risk of
homelessness, LGBTI people, those living in rural and remote areas,
those of different spirituality and faith groups, and veterans.
To achieve a better life and death for all older Australians, health,
aged and palliative care should not differ in availability, accessibility
or quality. For example, Aboriginal and Torres Strait Islander people
experience ageing at younger ages, and often have unique concerns
about cultural safety, in addition to particular considerations for
appropriate end-of-life care (e.g. dying on ‘country’).
Similarly, care leavers, or Forgotten Australians, may feel especially
wary of aged care or palliative care, due to prior experiences of
forced institutionalisation, making trauma-informed care especially
important. Carers of older Australians may require additional
support, especially in community settings when caring for individuals
remaining at home and especially at the end of life, where carer
burden is likely to increase.
Older CALD adults often face barriers in accessing aged and
palliative care, due to cultural, linguistic and religious differences.
For adults experiencing financial or social disadvantage, this
disadvantage often extends into aged care and palliative care
settings, meaning people may not receive adequate care, or may feel
discriminated against when attempting to access services.
Older LBGTI individuals require care which is sensitive to their
preferences, involving the active inclusion of ‘family of choice’ in
traditional care and support models. Older people’s spirituality or
faith often impacts their thoughts and values at the end of life and
may have implications for advance care planning and palliative care
preferences. There are different funding models for veterans in aged
care. Acknowledging the impact of veterans’ prior life experiences is
crucial in delivering sensitive care towards the end of life.
Health professionals and aged care staff should reflect upon
diversity and strive to provide culturally safe person-centred care.
ELDAC can provide further information on aged care and end-of-life
considerations for individuals identifying with various backgrounds
and identities, as well as organisational and individual-level reflection
points for consideration. We want to help you to better support your
clients and residents at the end of life. ■
Dr Georgia Rowley is a research associate at ELDAC, Flinders
University, Adelaide.
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