I was asked to talk on Cultural & Linguistic Diversity. It is reprinted here in case it is of some help for Diversional Therapists and other health carers.
Cultural & Linguistic Diversity (CALD) in
My name is Solange Kindermann and I have been working in the aged care industry for the past 25 years.
Currently, I work as a Diversional Therapist for the Berlasco Court Caring Centre in Brisbane.
Berlasco is a high care facility with 60 beds accommodation and managed by the Ethnic Communities Council of Queensland.
Our residents come predominantly from multi-cultural backgrounds and currently we have residents from 26 different nationalities. Management employs not only bilingual but also multicultural staff and currently our workforce comes from 18 different countries. Berlasco is a great place to work, the best I have experienced. The place seems to have a dynamic feel to it. There is often unusual and interesting music to listen to. The residents seem contented and completely at home. Exotic food is sometimes brought by relatives and shared among staff and residents bringing people together and inducing harmony. The energy and enthusiasm of staff and residents celebrating religious events and national and regional festivals reassure and validate the administration’s efforts in providing a cultural inclusive atmosphere for all to enjoy.
I am going to share with you my views on how I perceive and understand the work offered in a Multicultural facility such as Berlasco.
I will start with:
- Understanding Cultural Differences,
- Effects of Culture and Language Diversity in Aged Care Facilities and
- Cultural & Linguistic Competency followed by the
- The Assessment of Clients in a Multicultural Facility and
- Social & Cultural Wellbeing Techniques.
Understanding Cultural Differences
Cultural differences in aged care are currently a topic of great interest. In Australia, one in every four people was born overseas. As the population ages there are more and more people from different cultural background entering our institutions. The call to understand cultural differences in our country is pressing.
What do we know?
- Little research in this area - Research in this area is still in its early years in Australia. Some studies have pointed out that staff education is a central theme for improving care of residents from diverse cultural background.
- Few multicultural models - Even though the Australian Government funds a number of aged care homes run by ethnic communities’ organizations, the reality is they are not enough and the result is that lot of people are going into facilities that are ill equipped to care for them. In the past few years there has been a concerted effort among Government organisations and private enterprises to identify the industry’s weak points and provide what is needed to create awareness in the workplace.
- Application of general services is not appropriate for multicultural aged care – Standardised methods are not suitable of multicultural facilities. There are differences and we must learn to work with this, rather than include everyone in a generic model. To have a basic understanding and respect for cultures, traditions and values plays an essential part in providing optimal care.
Effects of Culture and Language Diversity
In Aged Care Facilities
As our population gets older, not everyone is able to remain at home. Illnesses, frailty, dementia and other problems arise and many people are compelled to seek alternative care. There are many options to choose from depending on the health status of the person. On the other hand, with the trend in Australia for maintaining elderly people for as long as it is possible in their own home; by the time they are ready to go into institutions they are usually feeble and in quite poor health.
For the majority of people the prospect of entering institutional care can be very distressing. They may have to deal with:
- Declining health and cognitive states
For the non-English speaking clients however the situation often compounds. Poor communication and staff’s lack of experience weighs heavily on both parties. The result is that clients’ burden is increased through:
- Social Isolation due to language difficulties
- Lack of empathy -Discrimination
The lack of communication can be particularly distressing for residents. It may lead to confusion, aggression, apathy and despondency. Interaction between resident and staff should go beyond words and into nuances of language, tone of voice; demeanour, body language, touch. Interpreters and translators are not readily available leading to assumptions and wrong deductions. Deliberate planning and education should be a priority to resolve the communication gap lest staff and residents are doomed to prolong their social estrangement. Solving it is not only an obligation but a course that leads to good work practice.
Culture, religion and spirituality can be powerful forces in a person’s life. Care providers see residents express their regional customs and familial folklore on a daily basis:
- Male/female interactions/treatment
- Religious/end of life practices that does not fit the western mould
- Consumption of ethnic foods
- Preferences for home remedies (often refusing medications)
- Amulets, good luck charms for good health
- General hygiene - e.g. insistence on one shower a week
- Attire - e.g. women to be covered up
- Modesty. Women will not be attended by male nurses.
For the residents, the expression of these values and other needs can be met with an assortment of reactions that range from mild amusement to plain hostile response.
The reasons staff cannot always be sensitive to cultural differences are many and one of them is that they themselves have to be aware of the cultural assumptions that drive their own thinking and behaviours. Another reason is the broad assertion that “people who live in Australia should be/do as Australians”. In reality the core beliefs and values of people rarely change. They do adapt and accommodate many situations when living away from their culture for a long time but a lot remains unaffected.
We should also remember that the problem is not always between staff-residents sometimes it is residents-staff as some cultures may not perceive the western’s way of life as a model for the rest of the world.
There are quite a few challenges facing staff to cross the barrier of prejudice, intolerance and misconception. One of these challenges is the question of trust. For many, authority figures bring back painful memories of what they witnesses or suffered in the hands of authorities in their own countries. So the mistrust may be instinctive and very real.
Eliminating bias through education is in the best interest of all concerned and should take precedence to stress good communication. Fortunately the industry as a whole recognises more and more that understanding culture is imperative to good work practice. Change is happening and it should be evident in Policies, procedures and administration. However there is a big difference between preaching diversity and living it. At Berlasco, Management has managed to embed it in the fabric of everyday life through education programs, workshops, videos, policies, procedures and a positive attitude. We deem it our role to provide our residents with emotional, social and spiritual care based on cultural values on the individual’s ethnic background. The Berlasco administration ensures that staff has a certain amount of skills and tolerance to deal not only with residents but also with their own culturally diverse colleagues.
Cultural and Linguistic Competency
Definition: Cultural & Linguistic Competency is the ability of health care providers and health care organizations to understand and respond effectively in cross-cultural situations.
Competency has been defined as “the awareness, knowledge, and skills necessary to work effectively and ethically across cultural differences.”
In other words it is the deliberate seeking of knowledge of another culture with the purpose of understanding and enhancing the lives of those we care for.
Cultural, racial and ethnic disparity exists in all layers of society. However the attempt to eliminate it is very worthwhile when the outcome is high quality care.
To be able and willing to accept what makes people different from one another requires education, awareness, sensitivity and attitude. True cultural competence recognises that cultural beliefs and values have profound implications for the efficient and effective delivery of care.
Strategies that will assist competence:
Embrace diversity. In other words, consider the cultural differences as strengths. Find out how cultural differences can add depth and humour to the fabric of life. Stop theorising and move into practice. Carry out the changes that will make a difference to the people you car for.
- Staff Recruitment
Employing bilingual/bicultural staff and volunteers skilled in providing care helps to enhance social awareness. They may be able to assist with translations. Use interpreters for formal and legal matters.
- Education & Training
Align yourselves with Government organizations which have the expertise to assist you such as Diversicare, Trauma Care, Dementia Care Pty., Alzheimer’s Australia, Volunteers Queensland and many others. Develop a self-assessment tool so that staff can reflect on their own practices and behaviours.
- Resident Focus
Have an emphasis on Residents Rights. Assist in promoting their independence and allowing them to express their needs. Resident’s preferences should be recognised and staff should have the flexibility to deal with it.
Communication should be: Formal such as memos, improvement logs, handover, checklist and Informal such as morning teas, white board, graffiti board. Encourage staff to engage in creative action relating to good communication. Give out prizes e.g. ‘Employee of the Month’. Support all input enthusiastically.
Summing it up, the truth is there is no magic formula to competence. It is an ongoing process that develops to suit different trends as time goes by. Education seems to be of paramount importance and should reflect Policies and Procedures. Vigilance and perseverance is required to maintain ongoing quality assurance.
The good news is that it can be done. The Berlasco’s administration has managed to establish the facility with a way of life that is absolutely resident focus. The ethos is compassion, tolerance and respect for multiculturalism and diversity.
Assessment of Clients in a Multicultural Facility
Social & Cultural wellbeing
Where to start?
A thorough assessment of clients is one of the most important tools health care providers can have. It is an important document for Diversional Therapists when they collate the information for the Social/Leisure Care Plan.
The assessment material is a combined effort among health care providers, resident and family.
- Start with the resident: When seeking an interview with the resident, state your purpose and ask for a suitable time thus creating an atmosphere of respect. One element which is of vital importance when interviewing is careful listening. The body language, the tone of voice, the choice of words can reveal hidden clues. Use a translator if necessary and keep away from questions that require only yes or no answers. Ask evocative questions (to produce memories, feelings) and don’t be afraid to leave the questions to go on a tangent. You may find out things you never thought of asking. Focus on finding out your client’s deepest wishes and desires.
- Observe the resident: What is their demeanour? What sort of behaviour does she/he display? Do they show apathy, agitation, anxiety, potential for wandering/absconding? How often do they smile? Do they seem relaxed or nervous? Do they have any concern about another resident or a staff member? Do they dislike crowds? Do they come willingly to the activities room; do they require a lot of encouragement? What sort of deficit they have that could impact their involvement in activities?
- Interview family and friends: The family can provide information about the life and routines of the residents. Was the person outgoing or shy? What sort of past time did she/he enjoy most? Ask the family to complete the ‘Cultural/Social Profile’ form where important personal questions are asked. Talk to her/his friends; they may know different facets of their personalities.
- Other Health Providers: Confer with the Nurse Consultant or RN in Charge and find out any issues that could hinder the person’s engagement in activities. Is this person prone to depression? Ask what sort of safety issues the recreation staff should be alerted to. Is dementia a problem? Even mild dementia plays havoc to the person’s social life and often propels the person to revert to their mother tongue. Do they need supervision when walking? AINs, physiotherapist, podiatrist and music therapist may discover something important to add to the assessment. Kitchen staff and cleaning staff can also be part of this team work effort.
What do we want to know?
The ‘Social/Cultural Profile’ form should be given to the resident and/or family to be filled in the first week or second week of admission. The following is only an example of some of the data that is significant to the Diversional Therapist.
A comprehensive information collection would explore:
- Past and present skills and interests:
What sort of skills and interests/hobbies did they have? Obtaining a list of interests is not enough. We should also find out what aspect of the interest/hobby/job the person enjoyed. We should not assume that because a resident was a dressmaker she will enjoy needlework. The reality may be that it was financial hardship which compelled her to take up this occupation and she may even resent it.
- Religious and Spiritual needs:
This plays a central role in the lives of many older residents. Spiritual and religious needs may be met by providing transport to services outside (Russian church, Greek Church, mosques) the facility, as well as providing in-house services of various religious denominations. Important too is the need to have ministers of religion and lay people (preferable fluent in the language of the resident) to make individual visits to residents. Providing information to broadcast or telecast of religious programs. Find out weather the person enjoy radio or TV and provide an ethnic ‘Radio & TV Program’ guide.
- What abilities they have:
- Physical: mobility, dexterity
- Sensory: sight, hearing, touch, smell, taste
- Psychological: attention span
- Cognitive: Are they able to read, write. Can they follow instructions without hesitation?
- Family Dynamics:
What role they played in the family: mother/father, older sister, Bread winner
- Personality: What sort of personality: sensitive, loving, controlling. Sensory loss can affect the personality of certain people. Some may become embarrassed, others angry and aggressive by their illnesses or deficit.
- Problems forecast:
Does the resident have any concern about the facility? Can she/he foresee any problems coming his way relating to the facility?
- Community Affiliation:
How strong is their cultural identity? Did they belong to clubs, choirs, and folk dance groups in the past? Would they like to continue to do so? Would they like someone from their cultural background to come and visit (volunteer, friends)? Would they enjoy celebrating their country traditional holidays? Is ‘name day’ important to them?
- Past Memories (Reminiscing):
Is there anything in the familial folklore that should be noted? E.g. superstition, painful memories. Do they mind talking about their memories of WWII? Is there any estranged member in the family?
- End of life arrangements
Is there anything significant procedure staff should know about it?
Social & Cultural Wellbeing Techniques
Once the assessment in completed Diversional Therapists develop care plans where interventions are based on the cultural values of individuals. They can also liaise with other organisations and use ingenuity to engage others in the community to join in the leisure and social life of the people they care for.
Here are some of the practices used by staff at the Berlasco Court Caring Centre:
- Engage in relationships with community organizations and clubs i.e. Greek Club, ‘Co.As.It’. (Italian Club), Senior Citizens Clubs, Folkloric musicians and ethnic dance groups. Ask them to come and demonstrate how to play ethnic games, songs, poems.
- Develop a Care Plan that is compatible with your client’s community affiliation.
- Learn key words in different languages to better communicate with clients
- Include traditional holiday’s celebrations of ethnic backgrounds of our residents in monthly Program ‘Activities Planner’.
- Contact your nearest High School and invite (preferable bi-lingual) teenagers to visit residents once a month for half an hour/45 minutes. They can help the residents with a special activity, take them for a wheelchair stroll or just have a chat.
- Accept that religion, spirituality and other beliefs may influence how families respond to illness, disease and death.
- Use visual aids, touch, gestures and physical prompts in interaction.
- Provide books, videos, magazines and other reading matters in a variety of languages.
- Contact the Music Department of your nearest primary school and invite them to rehearse their choir, band or singing in your facility.
- Have religious services in at least 4 denominations to cater for spiritual needs.v
- Stimulate the senses with regular ethnic cooking activities. (Berlasco has bread baking daily and cakes, biscuits and savouries at least twice a week in the recreation room).
- Display pictures, posters, art work and photos that reflect the cultures of people you care for.
- Start a ‘Volunteer Program’ to engage bi-lingual people in assisting with leisure activities.
- Invite your local kindergarten for morning tea once a month. (This activity works beautifully in Berlasco; we have a large carpet especially for the toddlers and lots of toys).
- Engage residents in gardening activities at least a couple of times a month.
- Ask you management for permission to acquire a pet dog or cat for your facility. (Berlasco has two small dogs and their popularity never wane).
- Print a ‘Radio/Guide’ for each resident where ethnic broadcasting program of their choice is listed with dates and time.