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“ Right now they all speak good English and have an understanding of Australian culture ,” Phiri said . “ But if they become cognitively impaired , they ’ ll go back to the things they knew before .”
Culture shock
The challenges for migrants in their end of life .
By Caroline Riches
Within the next five years , one in four Australians aged 80 or over is expected to be from a culturally and linguistically diverse ( CALD ) background . As they near the end of their lives , there may be challenges both for them and the aged care system supporting them .
Many migrants worry whether their needs , their beliefs , their values and even their language will be understood as they become more dependent .
And many don ’ t want to enter Australia ’ s residential aged care system at all .
Bunbury nurse Gertrude Phiri says when she arrived in Australia from Zambia in 2003 , it was a “ cultural shock ” to see elderly and sick people in care homes .
“ In many African countries , there are no aged care homes , just hospices ,” she told Nursing Review . “ When people in our family are old and frail , it is our responsibility to look after them .”
With African communities growing in Australia , Phiri decided to undertake a PhD at Edith Cowan University looking at how these migrants are preparing for their end of life in Australia , and how our aged care system can better meet their cultural needs .
For her pilot study , she focused on three migrants in their 50s – a woman from Zimbabwe , a man from Zambia and a woman from Malawi – who have lived in Western Australia for more than 15 years .
All now have children , step-children and grandchildren here and can ’ t bear to leave them . Yet when Phiri asked about advanced care plans , she was surprised to discover none had even considered one .
“ Their focus is more on what happens when they die , not before they die , because traditionally , all the decisions around finances and their care are made by the community or extended family .”
WHO WILL TAKE CARE OF ME ? In Africa , ageing people are often cared for by siblings or cousins . If they can ’ t be supported by someone they know , they prefer an older person of the same sex to look after them .
“ Being cared for by someone of a different sex in their 20s fills them with horror ,” Ms Phiri said . “ They think younger women cannot see them without their clothes on . Culturally , that ’ s not appropriate .”
All three participants in the pilot study planned to bring extended family here to care for them .
If they are forced to go into residential aged care , there are other concerns , such as whether or not their beliefs will be respected . This may include the need to see a pastor , to take communion or to have someone with them when they die .
There ’ s also a fear that dementia could cause them to revert to their native tongue , enhancing feelings of isolation .
HOMES FOR DIFFERENT CULTURES In recent years , a number of aged care facilities aligned to certain cultures have popped up around the world .
Residents living with dementia at Hogeweyk in the Netherlands are housed according to their lifestyle : Goois ( upper class ), homey , Christian , artisan , Indonesian and cultural .
Closer to home , Perth offers a couple of aged care homes to serve its ageing Italian diaspora who arrived in the 1950s and 1960s .
At Italian Village Fremantle , 90 per cent of residents are Italian . They have Italian speaking staff , Italian singers to entertain them , Italian food , and a Catholic mass on Friday .
Chief executive Fifi Schirripa told Nursing Review that a cultural and linguistic understanding is crucial to their care .
“ Our residents revert to their old language and culture . Some have gone from being fluent in English when they arrived to years later not being able to speak a word .”
Ms Schirripa believes culturally appropriate aged care may benefit other minority groups .
Since the 1970s , Australia has welcomed more people from Asian backgrounds and has seen increasing migration from the Middle East and Africa .
But despite higher numbers of ageing migrants , aged care trends have not necessarily accommodated them . Ms Schirripa says she ’ s seen a trend towards prioritising the aesthetics of the home rather than its cultural element . “ People are now looking for new developments with pretty rooms in a pleasant location . They ’ re leaning towards a better physical environment rather than what happens inside the four walls .”
From her early research , Phiri can see the benefit of culturally appropriate care in helping to meet the wishes and needs of migrants . She ’ s keen to conduct a bigger study on how aged care systems can better care for African Australians .
“ A migrant story is a migrant story , whether you ’ re from Africa , from Asian or from Europe ,” she said .
“ People leave family behind so their end of life may take a different flavour , but it ’ s still a migrant story .” ■
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