By Dr Sabine Wardle, Lecturer in Social Work and Human Services in the Charles Sturt University School of Humanities and Social Sciences in Wagga Wagga.
I welcome the findings and recommendations made by the Royal Commission into Aged Care Quality and Safety – a few even recognise the recommendations I made a submission for. There are many wins when it comes to the Commission’s final report. But shortfalls also exist, particularly when it comes to providing culturally-safe aged care.
Last week I found out that recommendations 78, 79 and 80 within the Commission’s final report recognise the submission I made for mandatory minimum qualifications for personal care workers and the review of certificate-based courses for aged care. In recommendation 79, the emphasis is on regularly reviewing the content in Certificate III and IV courses and considering the need for additional units of competency, such as cultural safety.
I also welcome recommendation 80 for implementing regular training about dementia and palliative care for all workers involved in direct contact with people in the aged care system by 1 July 2022. However, the Royal Commission has not dictated what content this training should include.
It is essential that the principles of culturally appropriate and psychosocial-spiritual care, including the importance of human connection and the centrality of relationships despite the language barriers, are incorporated in upskilling the aged care workforce. We must ensure this is done through attention to deep listening and empathy.
Research I have conducted has shown vulnerable elderly service users, mainly from immigrant culturally and linguistically diverse (CALD) backgrounds, find it challenging to navigate Australia's aged care system. It can be difficult for them to understand certain information about aged care as they lack knowledge about the Western aged care system and the terminology used within palliative care service delivery. It is commendable that the Commission (in recommendations 1,2,3) has acknowledged the concerns related to cultural safety and culturally appropriate care by emphasising the right to equitable and non-discriminatory access to care services. The Royal Commission has also recommended that one of the functions of the Australian Aged Care Commission should be to manage the information on services and providers. However, it remains crucial that the information on services and providers is made available in languages other than English, especially addressing the needs of burgeoning CALD population groups in regional and rural locations.
To achieve a more consistent understanding of the concept of palliative care and share what it offers and aims to deliver, there needs to be a more consistent definition at a state and national level. This definition needs to be compatible with the international understanding of the concept and needs to rule out the core confusion about using the term. We need clarity on whether it is only specialist palliative care services that provide palliative care, or whether all services meeting the needs of a person with a life-limiting illness can be considered palliative care. When this confusion gets resolved by a unanimous understanding of palliative care, the information needs to be shared with the community in English and languages appropriate for CALD population groups.
Recommendation 19.1.b. within the final report is another shortfall. It specifies that an individuals’ meals should meet their personal preferences and religious and cultural needs, however, this is only a recommendation for the Minister to review by Thursday 15 July 2021. There is nothing specified that a change must be made, which therefore ensures the meals provided are culturally appropriate.
Provisions, such as periodic audits of residential aged care facilities (RACFs), to determine the extent to which services provide appropriate food according to residents’ cultural and religious preferences needs consideration as part of the review. This is of particular significance towards the end of life in palliative care.
Research I’ve been involved in has shown eating certain types of food or food that is inappropriate to one’s faith brings more suffering and pain at the end of life. The cultural and religious beliefs of a number of CALD groups dictate the need to remain spiritually connected at the end stage of life. This is to ensure a pain-free transit to a good afterlife. The limited English language literacy among the immigrant service users from CALD backgrounds, combined with pre-planned meal menus available in English at RACFs, are likely to compromise the food requirements and informed consent to consume certain types of food.
Spirituality has a significant positive correlation with palliative care. Yet this crucial and integral element of care does not seem readily available for certain CALD groups in regional locations. As the Commission’s recommendations emphasise ‘quality care’, it is incumbent upon service providers to facilitate change at end-of-life care provision. With this in mind, broadening the scope of pastoral care so it provides inclusive spiritual care, to service users from various religious and cultural backgrounds, is recommended.
The Royal Commission is a good start, and as much as I as applaud many of its recommendations, it is also necessary for me, as an allied health professional, to draw attention to the areas it has missed or needs to improve upon.