People from Ethnic Backgrounds in Commonwealth funded Residential Care

People from Ethnic Backgrounds in Commonwealth Funded Residential Care—Victoria

A Report funded by the Reichstein Foundation for Australian-Polish Community Services Inc. February 2008

TABLE OF CONTENTS

EXECUTIVE SUMMARY ................................................................................................................. 1

RECOMMENDATIONS.................................................................................................................... 3

BACKGROUND............................................................................................................................... 7

FINDINGS........................................................................................................................................ 8 Negative experiences of CALD residents ............................................................................................. 8 Common observations .......................................................................................................................... 9 Positive experiences ……. .................................................................................................................... 9

DISCUSSION................................................................................................................................. 10 More than language services required ............................................................................................... 10 Role of Accreditation Agency and User Rights measures ................................................................... 10 User Rights measures underused by CALD residents and representatives ....................................... 10 Information is power ........................................................................................................................... 11 Feeding concerns up the line ............................................................................................................. 11 Complaints Investigation Scheme ...................................................................................................... 11 Connections between CIS and the Agency ......................................................................................... 12 Language Services.............................................................................................................................. 12 Agency Processes … .......................................................................................................................... 12 The Accreditation Standards .............................................................................................................. 13 Limited assessment of CALD considerations ...................................................................................... 13 Twelve accreditation reports compared for CALD considerations ...................................................... 13

COMMENT ON AGENCY REPORTS............................................................................................ 19 Breadth of reporting ............................................................................................................................ 19 Assistance with communication .......................................................................................................... 19 Regulatory compliance........................................................................................................................ 20 Wording of accreditation reports ......................................................................................................... 21

STRENGTH IN NUMBERS AND ACTION .................................................................................... 21

REFERENCES............................................................................................................................... 22

APPENDICES Attachment 1. Schedule 1 — Specified care and services for residential care services Attachment 2. The Accreditation Standards Attachment 3. The Charter of Residents' Rights and Responsibilities Attachment 4. Information sheet for CALD residents and representatives Attachment 5. Initiatives taken by providers to accommodate CALD residents Table 1. Number of permanent residents, preferred language by sex and state 1999 and 2006

The Attachments can be separated from the main document for use as a reference for prospective and existing CALD residents and their representatives.


A Report funded by the Reichstein Foundation for Australian-Polish Community Services Inc. Page 1

EXECUTIVE SUMMARY

Agencies supporting ethnic communities continue to report incidents of poor care or insensitive treatment of their client groups in residential aged care facilities funded by the Australian Government. A common theme is difficulties with communication.

With funding from the Reichstein Foundation, this project confirmed that culturally and linguistically diverse (CALD) residents have experienced inappropriate care, poor care, neglect, isolation, aggression, anger and withdrawal. Conversely, other CALD respondents reported satisfaction with their care.

Although the lack of a common language was seen to be the principal contributing factor in the cases of poor care, this was not always the case as some CALD residents received poor care irrespective of language services being used and care needs known. Inadvertently, CALD residents or their representatives compounded their situation by not using, or under using, the user rights measures established under the Aged Care Act 1997 and Principles to obtain the services and care to which they are entitled including those involving language and cultural considerations.

CALD residents and their representatives need to use internal feedback systems in homes and be more proactive about obtaining language services before resorting, if necessary, to internal and external complaints schemes. Support from the Commonwealth funded advocacy service, Elder Rights Advocacy (ERA), is available for these purposes. Language services can be requested.

On the question of language services, assistance with communication arising from a lack of common language is included in Specified care and services for residential care services contained in the Aged Care Principles of the Aged Care Act 1997 which forms the legislative basis for Commonwealth funded residential services. These specified services must be provided for those who need them in a way which meets the Accreditation Standards. Accordingly, formal and informal interpreters, translators, word boards etc are already accommodated in federal legislation and in the Accreditation Standards.

The Aged Care Standards and Accreditation Agency (the Agency) assesses homes’ compliance with the Accreditation Standards. In this capacity, however, it is not the default system for detecting cases of poor care as they occur, hence the importance of residents or their representatives taking their own action to obtain appropriate care and services.

Although the Agency assesses homes’ compliance with a “Cultural and spiritual life” (outcome 3.8), an examination of several accreditation reports indicates the Agency’s consideration of CALD residents would be enhanced if:

(i) assistance with communication, ie language services, was assessed not only against outcome 3.8 but also against outcome 1.8 — Information systems — in Standard 1 (Management systems, staffing and organisational development) because of this outcome’s relevance to consumer feedback systems, care planning, implementation and review across all the standards;

(ii) assistance with communication, ie language services, was considered in connection with outcome 1.2 — Regulatory compliance; and

(iii) cultural, ethnic and linguistic factors were consistently considered against all the standards rather than a select few. CALD residents and their representatives need to raise their expectations of residential aged care. To obtain care that is appropriate to their needs, they need information, courage, persistence and support.

The main sources of information include the Resident Agreement relating to CALD people’s residential care facilities, the handbook of the homes, the Specified Care and Services for Residential Care, the



Accreditation Standards and the Charter of Residents’ Rights and Responsibilities. The last three are attachments to this document and have been supplemented with an information sheet for CALD residents/representatives and a list of initiatives introduced by some providers for CALD residents as examples of what has been done and what is possible.

CALD residents are able to influence service delivery in their facility. Numbers are now on their side.

Nationally, between June 1999 and June 2006 the total number of residents in permanent care across Australia increased by 14.6% whilst the number for whom English is not the first language increased disproportionately by 63.3% (AIHW).

The corresponding increase in the number of residents in permanent care for whom English is not the first language in Victoria was 64.7% compared to NSW’s 60.7% (AIHW).



RECOMMENDATIONS

The provision of culturally and linguistically appropriate care for residents from an ethnic background in Commonwealth funded homes depends on several key stakeholders, namely residents and their representatives, the Aged Care Standards and Accreditation Agency, the Commonwealth Department of Health and Ageing, ethnic support groups, the Elder Rights Advocacy service, Council on the Ageing and residential care providers.

The following recommendations are intended to enhance their role in the provision and maintenance of quality care for CALD people.

CULTURALLY AND LINGUISTICALLY DIVERSE RESIDENTS AND REPRESENTATIVES Residents and representatives should become their own consumer advocates so that their needs are known and acted on. To achieve this, they should: • Become informed on residents’ rights and care expectations in residential aged care as per the

following: - the Resident Agreement associated with the residential care service; - the Residents’ Handbook associated with the home. If this is not in the community language of

choice, ask the provider to register at www.culturaldiversity.com.au to have this done free of charge;

- www.health.gov.au for aged care information including advocacy, complaints, useful telephone numbers, the Community Visitors Scheme, and the Charter of Residents’ Rights and Responsibilities in 17 community languages. The links are: consumers, ageing, support for people with special needs;

- Specified care and services for residential care. Refer to Attachment 1. They can also be seen in the Aged Care Principles at www.comlaw.gov.au;

- Aged Care Information line on 1800 500 853. An interpreter can be requested; - Carelink on 1800 052 222. An interpreter can be requested; - Elder Rights Advocacy on 1800 700 600. An interpreter can be requested; - the Complaints Investigation Scheme on 1800 550 552. An interpreter can be requested; and - examples of measures taken by providers in caring for CALD residents. Refer to Attachment 5.

• Ask for access to an interpreter during the care planning and review processes so that medical information is conveyed accurately and personal issues can be discussed privately and independently.

• Use the feedback mechanisms available in homes. These might include resident/carer discussions, resident/management meetings, resident satisfaction surveys, suggestion boxes and focus groups.

• Use the Elder Rights Advocacy service to help approach providers or the Government’s Complaints Investigation Scheme of concerns.

• Use complaints systems within the home. • Use the Complaints Investigation Scheme conducted by the Commonwealth Department of Health

and Ageing. • Provide feedback to the Accreditation Agency when it visits a home. • Consider forming a CALD consumer group within a home. • Visit local federal ministers to explain the situation of CALD people in Commonwealth funded

residential care using examples of poor care and suggestions for improvement. • With the assistance of ethnic support groups, contribute to government enquiries when their terms

of reference cover the care of residents in Commonwealth funded homes.

http://www.culturaldiversity.com.au/

http://www.health.gov.au/

http://www.comlaw.gov.au/



THE AGED CARE STANDARDS AND ACCREDITATION AGENCY • Ensure that a full translation of the Accreditation Standards in community languages appears on its

website. • Ensure flyers in community languages are posted in homes prior to accreditation visits so that as

many residents and their representatives can be present at the time of visits. • Ascertain the numbers of CALD residents in a home at the time of assessment and interview at

least 10% of them or their representatives. • Keep up to date on best practice relating to the care of CALD people in residential care. • Ensure assessors are skilled in care issues for CALD people. • Ensure assessors are trained in the use of interpreters. • Conduct regular best practice seminars on the care of CALD residents. • Respond to ethnic, cultural and linguistic considerations in respect of CALD residents against all

the Accreditation Standards. • Assess assistance with communication arising from a lack of common language against outcome

1.8 — Information systems. The Results and Processes Guide for this outcome should be altered to give sufficient emphasis to the timely, accurate and appropriate acquisition of information in cases where English is not the first or preferred language of residents.

• Include assistance with communication arising from a lack of common language in the assessment of regulatory compliance.

• Ensure reports include comment on whether “available” resources are actually provided. • Assess outcome 1.8 — Information systems — more rigorously because of the high incidence of

complaints about communication and consultation in residential care services.

THE COMMONWEALTH DEPARTMENT OF HEALTH AND AGEING • On the first page of its website, indicate where information can be gained in community languages

on aged care matters. • Include a full translation in community languages of the Accreditation Standards and the Specified

Care and Services for Residential Care on its website. • Promote the use of the new Complaints Investigation Scheme to its stakeholders, particularly

consumers. • Ensure Complaints Officers are trained in the use of interpreters. • Add to the number of community languages in which information is translated. (The Commonwealth

Ombudsman uses 36 languages compared to DoHA’s 17.) • Expand the Community Visitors Scheme to ensure isolated CALD residents are matched with

visitors who speak their preferred language. • Privacy considerations permitting, code the care recipients connected with information or

complaints lodged under the CIS scheme, according to their cultural background. This could be done on consumer feedback survey sheets and could include all special needs groups such as veterans, socially and financially disadvantaged persons, CALD people and Aboriginal and Torres Strait Islanders. This is intended to track any complaints trends in respect of special needs groups which DoHA targets in funding approvals rounds.



ETHNIC SUPPORT GROUPS People from a CALD background are assuming a greater proportion of the residential care population. In an environment where 96% of homes meet the accreditation standards, ethnic support groups need to keep a watching brief on how CALD residents are really faring, given the continual reports of poor care. • Continue to seek funding to improve CALD people’s access to aged care services and promote

culturally appropriate care. • Take advantage of the introduction of the Commonwealth Department of Health and Ageing’s new

Complaints Investigation Scheme (CIS) and where appropriate, provide information to the Scheme. • Organise a user rights conference or function for CALD consumers and their representatives.

Promote the CIS and Commonwealth funded advocacy service and ask the Federal Minister for Aged Care to launch it.

• Encourage CALD residents to use the feedback mechanisms at their disposal within homes to make service deficits known, and to make use of the local advocacy service, Elder Rights Advocacy, if necessary. Failing this the residents should consider accessing internal complaints systems or CIS, again with the aid of the advocacy service, Elder Rights Advocacy.

• Campaign for the holistic care of CALD people in residential aged care and the judicious use of interpreters in assessments of care through membership of industry or ethnic aged care groups.

• Promote and use the Elder Rights Advocacy service. This service is more removed from government and might be viewed more favourably by ethnic groups.

• Arrange for information on aged care to be printed in newsletters targeting the adult children of elderly CALD people. This could take the form of good practice, “Did you know ...” questions, or positive experience of consumer feedback or complaining etc.

• Continue to identify CALD residents who have no family or friends and recommend them for the Community Visitors Scheme.

• Arrange for questions to be asked in Parliament about care issues relating to CALD people in Commonwealth funded residential care, eg the use of interpreters and other language services; the actual use of ethno-specific places, or the proportion of the entire residential care population that CALD people occupy. This is intended to raise the profile of CALD residents.

• Seek out Members of Parliament with an interest in aged care and inform them of the situation of CALD people in Commonwealth funded residential care using examples of poor care and suggestions for improvement.

• Conduct a rolling program of open lines attracting comment or complaint from specific ethnic groups on the care of CALD people in residential care. Feed the results back to government through the Complaints Investigation Scheme or the new Office of Aged Care Quality and Compliance with a drop copy to the Victorian State Office. This could be advertised through newsletters, radio or whatever is available to the ethnic support groups and could be managed by volunteers.

• Elicit feedback from complainants on their experience with internal feedback systems in homes and their use of the Government’s complaints scheme.



ELDER RIGHTS ADVOCACY Elder Rights Advocacy already targets ethnic groups in its outreach information program. It should continue to: • Provide informed advice, support and advocacy on consumer rights to improve the quality of care

for consumers. • Provide accurate and accessible information on aged care, quality and consumer rights to

consumers, potential consumers and their representatives, including those with special needs. • Raise the profile of ERA with its client group and the relevant stakeholders such as CIS, the

Accreditation Agency and providers. • Provide education on consumer rights to its stakeholders. • Promote continuous improvement in aged care quality by identifying and presenting systemic

issues arising from advocacy, education and information strategies.

PROVIDERS In Victoria, providers of Commonwealth residential care for the aged have already introduced a variety of measures to provide CALD residents with culturally and linguistically appropriate care. These initiatives have been listed in Attachment 5. In the meantime, providers and care managers need to: • Be aware of their contractual obligations towards CALD residents in their Resident Agreement and

act on them. • Consider how they meet CALD residents’ needs across all the Accreditation Standards when they

complete their self-assessment form in respect of the accreditation process. • Become accustomed to accommodating a significant number of CALD residents, given their

increasing numbers in Victoria. • Embrace the notion of becoming a culturally competent organisation as espoused by Aged and

Community Services Australia. • Use and build on the initiatives already undertaken by providers to care for their CALD residents. • Consider maintaining a register (maybe through an industry group) of bilingual nursing staff who, in

the absence of interpreters, can be contacted in emergencies or when health issues arise suddenly.

Given that this report is about the experience of CALD residents in Commonwealth funded homes in Victoria, it is suggested that a steering committee of relevant Victorian organisations and individuals be established to work on implementing the recommendations. The Council on the Ageing Victoria seems well placed as an independent and representative organisation for all aged people to lead, influence and drive the required changes together with the Ethnic Communities’ Council of Victoria.



BACKGROUND

Agencies supporting ethnic communities continue to report incidents of poor care or insensitive treatment of their client groups in residential aged care facilities funded by the Australian Government. They have cited individual cases and general concerns about their client group in high and low care services. A common theme is difficulties with communication.

In 2006 the Australian-Polish Community Services Inc received a grant from the Reichstein Foundation to: • Document the experiences of elderly ethnic residents in residential aged care facilities where

appropriate language and cultural support has not been provided, or neglectful behaviours have been experienced.

• Develop recommendations with the aim of improving the responsiveness of residential aged care facilities in the delivery of culturally and linguistically appropriate care to the ethnic elderly.

• Contribute to better monitoring by the Aged Care Standards and Accreditation Agency of the provision of professional language services for residents speaking a language other than English (LOTE).

• Promote the need for the Federal Government to include the provision of professional language services to residents as an Accreditation Standard in residential care.

The focus of this project is on culturally and linguistically diverse (CALD) residents in aged care services funded by the Australian Government in Victoria.

INFORMANTS In documenting the experience of CALD residents in aged care homes funded by the Commonwealth Government, interviews were conducted with: • 4 residents/family representatives • 3 providers of Commonwealth funded residential aged care services (RACS) • 3 care managers of Commonwealth funded RACS • 2 lifestyle coordinators of Commonwealth funded RACS • 3 former nursing staff of Commonwealth funded RACS • 1 professional contractor who visits several RACS.

Written comments were provided by a coordinator of a Community Visitors Scheme. Contributions were made by the groups which were represented on the steering committee of the project, namely: • Australian Croatian Community Services • Australian-Polish Community Services Inc • Victorian Immigrant and Refugee Women’s Coalition • Australian Polish Benevolent Association • Macedonian Community Welfare Association • CELAS (Spanish speaking welfare agency) • Centre for Cultural Diversity and Ageing • Ethnic Communities’ Council of Victoria • Western Aged Care Assessment Team • Marina RACS whose approved provider is TLC • Ardeer Nursing Home

Six homes were visited. One was ethno-specific and the rest were general purpose. All had CALD residents. One accommodated residents from 15 different ethnic groups.



FINDINGS

Negative experiences of CALD residents

Aggression, frustration and anger: this was borne of an inability to express needs in a common language. One man was treated as aggressive until a speaker in his first language was obtained. His bitterness remained while he could not communicate with care givers and others.

Withdrawal: in one case, a male resident was withdrawn because of an inability to convey details of a specific medical condition to staff. When a speaker of the resident’s first language was eventually produced, there was a remarkable transformation in his demeanour. This man’s English was competent but he felt inhibited in an Anglo-Australian environment.

Isolation: one alert resident whose English was good, was isolated in a home because he could not communicate with other residents. He needed intellectual stimulation which was eventually provided by a visitor who spoke his first language. His isolation was not helped by broken dentures which took a long time to repair. (Respondents cited broken glasses and dentures as additional factors contributing to isolation.)

A CALD resident found himself isolated in a home even though he wanted to go to the cinema occasionally. His visiting wife was too frail to organise this. He did not socialise much within the home and for him there was no culturally appropriate care. He was not prepared to complain because he did not want to be a bother. A visiting daughter had not been given the opportunity to contribute to care planning.

Inappropriate Care: one resident who requested a specific religious and cultural dietary practice was told it had been met by the home when it had not.

In another case, the spouse of a CALD resident was used as an interpreter to advise on terminal care and other medical matters. The partner manipulated the situation for self serving purposes.

Avoidance: there were two separate reports of small groups of CALD residents forming a clique because of a lack of attention from their home. Language services were not provided. In one group, some basic care needs such as skin care, hygiene or activities were not observed. In the other, which comprised people with dementia, the residents were left to occupy themselves during the day.

Poor Care/Neglect: this was evident in several cases where emerging health concerns, particularly in respect of deteriorating skin conditions and the after effects of strokes were neither investigated nor pursued by the home. Language services were not used in most cases. In another case, however, an English speaking relative had to push for medical assessments and organised treatment outside the home. The relative used the internal survey system but got no feedback.

One resident with a speech impairment was thought to be incapable of communication until such time as he came into contact with a person who could speak his first language.

Another resident without a supportive family relied on friends to liaise with the management of his home. The friends were not listened to and the man’s supply of clothes became exhausted. His food preferences were not observed. He was not put in contact with a speaker of his first language.



Common observations

Inappropriate interpreters used: staff have been used inappropriately as interpreters in health matters. They were not nurses or personal carers and for that reason were unlikely to be familiar with technical medical terminology.

Bilingual staff have been called on to interpret for an ethnic group in the belief that their first languages were similar when they were not.

Activities: only Australian activities are provided in some homes irrespective of whether they are relevant or liked by their CALD residents.

Some homes pay lip service to the social support of their CALD residents. They may organise and document one activity through an ethnic organisation but that is the sum total of their involvement over an extended period of time. This is dressed up to influence assessors from the Accreditation Agency.

Food: ethnic food is not served often enough.

Identification of needs: community visitors have a better idea of the daily needs of their residents.

CALD residents are reluctant to comment or complain about the lack of service provision relevant to their needs.

Positive experiences

Some CALD residents or their representatives were very happy with all aspects of their care. The residents varied in their frailty but they were able to exercise choice, independence, and decision-making in their life at their home. Their cultural and linguistic preferences were observed. If they had concerns with their care, they would be prepared to make this known to the staff at the home. One had, in fact, used this process with a positive outcome.

Other respondents reported that “little things” went a long way such as the lemon in the tea instead of sugar, or a preferred choice of bedding. Some CALD residents were particularly fond of staff who spent some personal time with them and made the effort to say a few words to them in their first language.



DISCUSSION

More than language services required

The cases of poor or insensitive treatment cited above confirms that not all CALD people receive the care and services to which they are entitled in residential aged care services funded by the Australian Government. Although the absence of language services is seen to be the principal contributing factor, this is not the case in all instances. Rather, CALD residents can receive poor care irrespective of language services being used and care needs known. Sanctions imposed by the Commonwealth Department of Health and Ageing (DoHA) on ethno-specific homes in respect of poor standards compliance are evidence of this. The question then becomes how CALD residents can redress this situation so that aged care homes provide services that not only meet the required standards of care but meet them in a way that meets the cultural and linguistic needs of their ethnic consumers.

Role of Accreditation Agency and User Rights measures

Although the Aged Care Standards and Accreditation Agency (the Agency) monitors standards of care in homes funded by the Australian government, it cannot be expected to detect individual cases of poor care as they occur. Its presence in homes is infrequent, averaging 1.75 visits per year. Despite this, there are several user rights measures articulated under the Aged Care Act 1997 and Principles which complement accreditation processes in identifying service deficiencies and achieving compliance with the standards. These include feedback systems and complaints mechanisms within homes, the aged persons’ advocacy service funded by the Australian Government and the external complaints system administered by the DoHA. These are free of charge.

User Rights measures underused by CALD residents and representatives

Despite these measures, it is remarkable that of all the cases of poor care reported in this project, only a few residents or their representatives had approached staff with their concerns. When they had, they had received little or no response and had not persisted with their concerns. There were no reported instances of residents or their representatives asking for an interpreter and only one case of the advocacy service for aged care residents being used. There was one case of DoHA’s Complaints Investigation Scheme being contacted.

The advocacy and complaints systems have been in existence for over 15 years but CALD residents reportedly underuse them, possibly because of language barriers but also because they “don’t want to be a bother” or fear retribution. The following figures lend support to this view. In 2005/2006, Elder Rights Advocacy (the Victorian advocacy service for care recipients receiving aged care funded by the Australian Government) had 815 clients, 53 (6.5%) of whom were from a CALD background. A more representative figure would be 13%. Of 1,024 information calls, 127 were from CALD people. Where the Department of Health and Ageing’s complaints scheme is concerned, in 2005/2006, only 18 people out of the 71% of complainants (not care recipients) who returned consumer surveys nationally indicated they were from a non-English speaking background.

To overcome this reluctance in using internal feedback and complaints systems, CALD residents and their representatives need information, courage, persistence and support in obtaining care that is appropriate to their needs. This is consumer empowerment in a literal sense, using the legislatively mandated means available to all residents in a home. Support is available in the form of advocacy services, interpreter services and information services.



Information is power …

In terms of information, CALD residents and their representatives need to be clear on what they can expect in the way of care and services in their home. Their Resident Agreement (mostly in English) should clarify this. Resident handbooks provided by homes can also help, particularly those which have been translated into community languages by the Centre for Cultural Diversity in Ageing.

The legal requirements are set out in the Aged Care Act 1997 and Principles, more particularly the Accreditation Standards (in English), the Specified Care and Services for Residential Care (in English) and the User Rights Principles (in English) including the Charter of Residents’ Rights and Responsibilities, and information on accessing the local advocacy service (both translated into 17 community languages). Information help lines (with interpreters) can also assist. Information on initiatives introduced by some providers for CALD residents might also help in letting representatives know what is possible and what might be suggested for their service.

The Specified Care and Services for Residential Care, the Accreditation Standards, the Charter of Residents’ Rights and Responsibilities, an information sheet for CALD residents/representatives and a list of initiatives introduced by some providers for CALD residents have been provided as attachments to this document.

Feeding concerns up the line

In any service, unmet needs should initially be brought to the attention of the provider because the provider will be the primary source of any remedy. This is a preferred approach which, if handled by the provider as a means of improving the service, should be all that is necessary to achieve change. If necessary and appropriate, concerns can be channelled through residents’ and management meetings and during accreditation visits. The next step up the hierarchy in articulating unmet needs is the internal complaints system operating within a home and failing that, the Complaints Investigation Scheme (with access to interpreters) conducted by the Department of Health and Ageing. Throughout these processes, the local aged care advocacy group can be used. It also has access to interpreters. (In 2005/2006, Elder Rights Advocacy (ERA) increased promotion to clients from culturally diverse groups, including collaboration with service providers, to ensure maximum availability of information.)

Internal feedback mechanisms and complaints systems are included in the Accreditation Standards and outcomes. There is an expectation that they be used so that providers can improve their service according to continuous improvement practice.

Complaints Investigation Scheme

Although CALD residents or their representatives might resist using complaints mechanisms, other consumers have not been so reluctant. For example, in 2005-2006 Victorians accounted for 33% of complaints received in Australia by the Complaints Resolution Scheme conducted by the Department of Health and Ageing. By comparison, New South Wales accounted for 27% of complaints. Nationally, 63% of complaints were lodged by relatives, 13% by care recipients, 3% by staff, 2% by ex-staff and friends, 1% by advocates and 10% by ‘others’ including professionals visiting facilities.

Ninety-seven percent of complaints were in respect of residential care. Clinical care and communication were the most complained about matters.

The new Complaints Investigation Scheme (CIS) which was introduced in May 2007 is said to be more responsive than the Complaints Resolution Scheme which it replaced. It is now possible for callers to provide information about a home rather than a complaint. If a complaint is lodged, it can be done openly or anonymously. The CIS can investigate information or complaints about cases where an approved provider is not meeting its responsibilities under the Aged Care Act 1997 (the Act).



Where CIS finds that a provider has breached its responsibilities, it will tell the provider what it has to do to address the issue and specify the time frame in which this must be done. Because the CIS database will record details of information or complaints, trends should be evident. The Aged Care Commissioner will report to Parliament each year on the Scheme. The local advocacy service, ERA, can assist residents or their representatives make complaints.

Connections between CIS and the Agency

Another reason for using CIS is its connection to the Aged Care Standards and Accreditation Agency. The Department of Health and Ageing liaises with the Agency and refers matters which suggest broader or systemic problems in homes for possible investigation. If the Agency follows up with a visit, it is more focused enabling a closer examination of the issue. In this way, consistently reported matters such as the social isolation of CALD residents, lack of culturally appropriate activities, lack of consultation about care and the inability to communicate care or social needs because of language barriers can receive closer scrutiny.

Language Services

In matters of care, there is an assumption that the CALD residents or their representatives can articulate their needs and concerns. If they have difficulty in doing this, however, help is available. This is another area where residents and their representatives can become more proactive in seeking language services to overcome difficulties in communication.

The Charter of Residents’ Rights and Responsibilities makes it clear that each resident has the right to keep the language of his or her choice without discrimination. In addition, assistance with communication features in the Specified care and services for residential care in the Quality of Care Principles of the Aged Care Act 1997 must be provided in residential care for those who need it.

For CALD residents, assistance with communication can include formal interpreters or informal interpreters such as care staff or family members, translators, word or phrase boards and so on. Residents are best placed to determine whether they require such assistance. If they do, they should ask for it so that the provider can make suitable arrangements or obtain it themselves. If residents are unclear or tentative about taking this kind of action, they should consult the Elder Rights Advocacy service. If a provider does not provide assistance with communication when it is required, that in itself is worthy of being followed up through the internal comments/complaints system or DoHA’s Complaints Investigation Scheme. Once again the Elder Rights Advocacy service can be consulted on this issue.

It is worth reiterating that internal feedback and complaints forms are used by the Aged Care Standards and Accreditation Agency to check if providers do enable residents to have their say or complain. They are also an indicator of whether providers practise continuous improvement.

Agency Processes

Agency assessors, when they visit, speak with staff, management, residents and their families, to determine whether the home meets all the Accreditation Standards and expected outcomes. The Agency then makes a decision about how long a home is accredited.

Homes assessed as complying with all 44 expected outcomes and with a good track record of compliance and continuous improvement generally can expect three years' accreditation. Otherwise, shorter periods of accreditation are considered appropriate. Homes with major or persistent non-compliance may receive shorter periods of accreditation or have their accreditation reduced. Accreditation may be refused or revoked where non-compliance is not remedied and there is a risk to residents' health, safety and wellbeing.



Even after a home receives accreditation, the Agency continues to monitor homes to ensure residents continue to receive a high level of care and that all standards continue to be met.

Homes must also show to the Agency that they regularly seek feedback from staff, residents and their families, and look at ways they can improve.

The Accreditation Standards

There are four Accreditation Standards:

• Management systems, staffing and organisational development.

• Health and personal care.

• Resident lifestyle.

• Physical environment and safe systems.

Within the four Accreditation Standards are 44 expected outcomes. The full list of standards and their associated outcomes appears at Attachment 2.

Limited assessment of CALD considerations

There is some concern amongst ethnic community support groups that findings associated with cultural and linguistic considerations are reported predominantly against outcome 3.8 which is expressed as follows:

3.8 Cultural and spiritual life

Individual interests, customs, beliefs and cultural and ethnic backgrounds are valued and fostered.

There is further concern that this outcome is not assessed in much depth and that it is easy for providers to dress up infrequent cultural events to influence assessors.

The experience of CALD residents in an aged care facility cannot be summarised in a few lines against outcome 3.8 which tends to focus on recreational and spiritual matters. If CALD residents are expected to be consulted on, exercise choice and participate in all aspects of life in an aged care home, it is reasonable to expect cultural, ethnic and linguistic factors reflected in reports against several outcomes across all the standards such as clinical care, behaviour management, nutrition, palliative care, sleep, independence, choice, comments and complaints, emotional support and living environment.

In addition, if providers are serious about catering adequately for their CALD residents, this should also be evident across a range of outcomes such as planning and leadership, education and staff development, continuous improvement, human resource management information systems, comments and complaints, living environment and clinical care.

Twelve accreditation reports compared for CALD considerations

This was put to the test with an examination of twelve accreditation reports of residential aged care facilities in metropolitan Melbourne where CALD residents could be expected to reside. Eleven out of the 12 homes met all the 44 outcomes. The remaining home met 43 out of the 44 outcomes.

The names of the homes have not been given to preserve the privacy of the assessors but the comments are direct quotes from accreditation reports which were current as at November 2007. Only those comments which make reference to language, ethnicity or culture have been included where they appear against the various standards and outcomes.



Home 1:

Outcome 3.3 Education and staff development

Education sessions provided include approaches to cultural diversity, the importance of supporting resident decision-making, emotional support and independence. Outcome 3.5 Independence

Residents are encouraged to attend culturally specific groups in the community. Outcome 3.8 Cultural and spiritual life

Residents’ backgrounds are culturally and linguistically diverse. Lifestyle programs are designed with consideration and focus on meeting residents’ individual interests, customs, beliefs and cultural and ethnic backgrounds. Specific cultural days are commemorated and celebrated. Specific lounge areas within the home have designated themes including Asian, European and historical Australia with memorabilia and pictures of interest. Residents and relatives confirm their satisfaction with the home’s values and fosters their individual interests, customs, beliefs, cultural and ethnic background. Outcome 3.9 Choice and decision-making

Residents’ choices in care planning, dietary preferences, cultural preferences and lifestyle activities are identified and documented on admission and reviewed as circumstances change. Outcome 4.4 Living environment

There are a number of small lounges on both floors with some decorated in themes reflecting the residents’ cultural backgrounds.

Home 2:

Outcome 3.8 Cultural and spiritual life

On admission residents are assessed and the following information documented: their ethnic background, language requirements, preferred cultural celebrations and religious affiliations. This is then developed into a comprehensive cultural and spiritual care plan. Staff could say how they would access information for residents from a non-English or non-Christian background. There is bilingual staff available and the home has access to an interpreter service. Residents said staff are meeting their cultural and spiritual needs.

Home 3:

Outcome 2.4 Clinical care

The home accommodates residents with high and low care needs, Italian residents in a cultural specific wing, and residents with dementia specific needs in a secure environment. Outcome 2.16 Sensory loss

Culturally specific word pages, translation of documents and staff fluent in Italian assist with communication in the Italian specific wing. Outcome 3.8 Cultural and spiritual life

Lifestyle staff consult with each resident or representative regarding cultural and spiritual values. The home has a number of Italian residents who reside in the Italian specific community within the home; some staff within this community speak Italian. An Italian church service takes place on a regular basis and an Italian menu has been introduced. Religious and cultural days of significance to residents are celebrated. Residents are satisfied with the cultural and spiritual life at the home.



Outcome 4.1 Continuous improvement

Recent improvements include: introduction of an Italian menu following consultation with residents and relatives. Outcome 4.8 Catering, cleaning and laundry services

Residents’ meals are prepared according to food safety regulations, and the menu offers variety, and incorporates a culturally diverse menu.

Home 4:

Outcome 3.5 Independence

Residents’ lifestyle needs and preferences, such as social, cultural, spiritual and community interests are assessed on entry to the home and regularly reviewed. Outcome 3.8 Cultural and spiritual life

Residents’ files showed that their cultural and spiritual wishes are documented on entry to the home, and residents are supported to maintain their religious beliefs. Clergy, community and cultural groups visit monthly; residents are encouraged to discuss their needs with staff to ensure appropriate arrangements can be made for them. Days of cultural and spiritual significance are celebrated throughout the year, and residents stated they were happy with the way their cultural and spiritual life was supported.

Home 5:


The cultural and spiritual preferences of residents are documented by the lifestyle coordinators who liaise with religious and cultural organisations to provide wider contact with the community. Celebrations of specific cultural festivals or significant days are a component of the activities program and have recently included Valentines Day, Chinese Lantern Day and Australia Day.

Home 6:


Continuous improvements undertaken in respect of the home include: • The implementation of specific cultural days has increased staff and residents’ cultural

awareness. • The introduction of a specific cultural men’s activity in the dementia wing.

Outcome 3.3 Education and staff development

Staff knowledge of respecting privacy and dignity, choice and decision-making and cultural needs are assessed through residents’ and relatives’ surveys. Outcome 3.4 Emotional support

A social and cultural history of residents is obtained from residents with family and friends’ input to provide staff with greater understanding catering to residents’ needs. Outcome 3.7 Leisure interests and activities

Activities staff compile a monthly activities calendar from a review of residents’ cultural and social profiles and input received from residents and relatives at meetings and planning days.




Residents’ religious and cultural preferences are identified during the initial assessment at admission and recorded in care plans. The home has a cultural care kit and cultural box available to enable staff to provide culturally specific care to residents. Special days of significance, birthdays, religious and cultural days are celebrated by those who choose to participate.

Home 7:


There is an increased use of language specific talking books for residents. Outcome 3.3 Education and staff development

Staff have completed sessions regarding cultural awareness and lifestyle training. Outcome 3.4 Emotional support

Information is provided to residents/representatives before admission and review of residents’ records show social, cultural and spiritual support needs are identified on admission to the home. Outcome 3.7 Leisure interests and activities

Recreation activity officers have sourced resources to ensure they are aware of cultural and other events of relevance to residents. There is a large collection of reading and talking books that are sourced in other languages. Outcome 3.8 Cultural and spiritual life

Residents’ cultural and spiritual needs are fostered through the identification and communication of residents’ individual customs and religions during the home’s assessment processes. Their needs are documented in leisure programs. Recreation activity officers maintain a list of all religious affiliations of each resident, cultural backgrounds and individual interventions are provided accordingly. Residents and relatives are satisfied that their religious and cultural requests are met.

Home 8:


Recent improvement activities include: • In response to residents’ needs, the sourcing of a Russian Orthodox priest to attend the home. • Residents from culturally and linguistically diverse backgrounds receive pastoral care visitors.


Residents’ cultural and spiritual needs are identified on admission and recorded in the formation of leisure and lifestyle plans to help complete the individual care plan. There are a number of culturally diverse residents within the home; resources such as interpreters are available if required. The home celebrates significant cultural days, has an Italian club, men’s club and contacts with the Returned Services League of Australia and Polish clubs. The home would like to establish links with other communities such as the Maltese. Residents and relatives are satisfied with the support and respect given for their cultural and spiritual needs.



Home 9:

Outcome 1.4 Comments and complaints

Residents and relatives are encouraged to complete “have your say” forms that are available in both English and Italian. Outcome 1.6 Human resource management

Many staff are long-standing employees and speak Italian. Outcome 1.8 Information systems

Information is provided in Italian for residents who are not fluent in English, for example the Charter of Residents’ Rights and Responsibilities and complaints brochures. Outcome 3.2 Regulatory compliance

The Charter of Residents’ Rights and Responsibilities is displayed in both English and Italian. Outcome 3.5 Independence

Residents, through the lifestyle program, are encouraged to participate in decisions about their physical, intellectual, emotional, cultural and social care. Outcome 3.6 Privacy and dignity

Staff demonstrated consideration of the specific cultural and spiritual need of residents at all times. Outcome 3.8 Cultural and spiritual life

The home assesses and communicates residents’ individual interests, customs, beliefs, cultural and ethnic backgrounds through individualised care plans. The home is predominantly Italian and residents’ cultural and spiritual needs are met through the celebration of events and practices that are of importance to residents as a group or individually. Cultural theme days are celebrated. Outcome 3.9 Choice and decision-making

Residents presenting with reduced decision-making and limited language skills are identified and their authorised representatives are involved in making decisions about their care. Outcome 4.4 Living environment

An Italian flag flies at the front of the building, and throughout the home there are many pictures, posters and maps with an Italian theme. Outcome 4.8 Catering, cleaning and laundry services

Fresh fruit is provided daily, and an Italian chef provides authentic Italian dishes.



Home 10:

Outcome 2.9 Palliative care

Records show that care is provided to ensure the residents’ comfort, and to manage pain or cultural needs. Outcome 2.10 Nutrition and hydration

Residents’ assessments identify preferred food and fluids, culturally specific requirements, method of eating, assistance required and environmental factors. Outcome 3.1 Continuous improvement

Resource material on caring for Jewish residents has been made available to staff. Outcome 3.3 Education and staff development

The diversional therapist recently attended an education session on caring for Jewish residents and resource material is available to all staff. Outcome 3.6 Privacy and dignity

Cultural practices related to resident privacy are observed. Outcome 3.7 Leisure interests and activities

The team observed a visiting Jewish group, the music therapist conducting individual sessions with residents and a large group activity. Outcome 3.8 Cultural and spiritual life

Residents and relatives reported satisfaction with the way in which staff assist residents to maintain their religious beliefs and cultural customs. Residents’ religion and cultural needs are identified through the assessment process. The home currently has residents from several different cultural backgrounds. Two residents receive kosher meals and the menu incorporates dishes from other cultural backgrounds. Community visitors from other ethnic backgrounds visit individual residents. Staff reported they have access to resources should they need assistance with communication and/or specific cultural needs. Outcome 3.9 Choice and decision-making

Assessment tools used by staff are designed to elicit residents’ preferences for information about individual preferences relating to rising and settling, showering, food preferences, lifestyle, cultural and spiritual needs and terminal wishes.

Home 11:


The diversional therapist consults with each new resident or representative on entry to the home regarding cultural life however a more detailed assessment is yet to commence. The home has residents from non-English-speaking backgrounds who have access to radio and reading material in their community languages. The home has bilingual staff who are able to speak the community language of some residents. Religious and cultural days of significance to residents are celebrated. Residents and relatives are satisfied with the cultural and spiritual life at the home; however management and the diversional therapist have plans to improve this aspect of the home’s services.



Home 12:

Outcome 2.9 Palliative care

Residents’ terminal care wishes are explored and documented on admission that includes personal, religious and cultural preferences. Outcome 2.10 Nutrition and hydration

Residents’ dietary needs and preferences are documented following assessment that includes personal and cultural preferences, medical conditions that may compromise adequate intake, and special aids to assist residents to continue feeding themselves. Outcome 3.7 Leisure interests and activities

Planned interventions reflect each resident’s physical, cognitive, cultural, social and emotional needs and are overseen by a qualified diversional therapist. Outcome 3.8 Cultural and spiritual life

Residents’ cultural and spiritual needs are identified through the lifestyle assessment process as well as the initial assessment and care planning period.

COMMENT ON AGENCY REPORTS

The examples above indicate marked differences in reporting against the standards and their associated outcomes in respect of CALD residents. It is interesting to note the breadth of some reporting, the paucity of comment on language services, silences in regulatory compliance entries, and the actual wording of the accreditation reports. These are discussed below.

Breadth of reporting

Cultural, ethnic and linguistic considerations were reported: • Solely against outcome 3.8 (Cultural and spiritual life) in 3 of the 12 homes. • Against 2 or more outcomes in Standard 3 (Resident lifestyle) in 4 homes. • Against a range of outcomes in one or more of the Standards other than Standard 3, ie Standard 1

(Management systems, staffing and organisational development), Standard 2 (Health and personal care) and Standard 4 (Physical environment and safe systems) in 5 homes.

Where the broader reporting occurs, the expected outcomes for CALD residents are more convincing. This is an important feature if reports are used to help potential consumers make a choice of home, or to provide existing residents with feedback on their home’s accreditation status.

In its April 2007 edition of The Standard, the Agency indicated that outcome 3.8 (Cultural and spiritual life) was linked (depending on individual circumstances) to other outcomes in Standard 2 (Health and personal care) and Standard 3 (Resident lifestyle). This principle appears in the Agency’s Results and Processes Guide. As some of the reports used in this exercise demonstrate, the connections can extend to all the Standards. By comparison, those reports which comment on cultural, ethnic and linguistic considerations solely against outcome 3.8 are too limited in scope and do not demonstrate that all the standards for CALD residents are met.

Assistance with communication

Six out of the 12 sample reports made reference to assistance with communication such as bilingual staff, “resources”, translations of written material, word boards and kits. Four reports mentioned language assistance against outcome 3.8, one against outcome 2.16 (Sensory loss) and one against 1.8 (Information systems).



In the same article mentioned above, the Agency indicates that where outcome 3.8 is concerned, assessors should consider how homes assess and communicate residents’ individual interests, customs, beliefs and cultural and ethnic backgrounds, and the way that this should be reflected in care and services provided. Part of this assessment includes the identification of language assistance required for effective communication and access to appropriate service or support staff such as interpreters.

Despite this guide, it is not surprising that comments on communication appear against a range of outcomes because communication is relevant to all of them. For this reason, it would be appropriate for communication issues to be assessed against the outcome which covers information systems.

Outcome 1.8 — Information systems — appears in the category of outcomes relating to “Management systems, staffing and organisational development”. This is an overarching standard which applies to all the home’s activities. The expected outcome for information systems is that “effective information management systems are in place”. It is against this outcome that assessors mention, amongst other things, clinical and lifestyle documentation systems, assessment and care planning tools/processes, performance information, minutes of residents’ and relatives’ meetings, surveys, the Resident Agreement, the residents’ handbook, newsletters and information on noticeboards.

Information involves two-way communication between providers and consumers. For this reason, comment should be made in accreditation reports on the efficacy of English information systems for all the stakeholders in homes. What measures have been implemented to ensure non-English speakers are able to understand what is going on around them, express themselves and be understood by their carers and vice versa? The measures to ensure effective communication might be many and varied but it is critical in identifying individual needs and appropriate interventions. For providers, the duty of care element is also paramount when addressing matters such as the management of critical incidents, complaints, behaviour, medication and pain.

Six of the sample reports made no reference to assistance with communication for CALD residents. If no assistance was required with the current cohort of CALD residents, this should be mentioned as a check that it was, in fact, assessed.

“Information systems” may well be an underrated standard generally. Evidence of this might be found in the annual reports of the Office of the Commissioner for Complaints in which “communication” features as one of the top matters complained about in residential aged care facilities funded by the Australian Government.

Regulatory compliance

“Regulatory compliance” is another outcome which receives a fairly routine response in accreditation reports. There is comment on how providers keep up to date on changes in legislation and some comment on how providers ensure they are adhering to their current legislative obligations through, say, regular audits. Medication management and changes to the law on the reporting of abuse receive comment but not communication.

Part of the legislation providers must meet is the Specified care and services for residential care services (Specified care and services) contained in the Aged Care Principles. These services must be provided in a way which meets the Accreditation Standards. In Part 2, under the heading of “Daily living activities assistance” is “Personal assistance, including individual attention, individual supervision, and physical assistance, with communication, including addressing difficulties arising from impaired hearing, sight or speech, or lack of a common language (including fitting sensory communication aids), and checking hearing aid batteries and cleaning spectacles.”

The Specified care and services are not obscure, little used entries buried in the Aged Care Principles. Three of the sample accreditation reports used for this project referred to the Specified care and



services against outcomes 3.1 — Continuous improvement, 3.2 — Regulatory compliance and 3.10 —Resident security of tenure and responsibilities. The report which mentioned the Specified care and services against outcome 3.2 did so in the context of them being part of the Resident Agreement at the home. Indeed, the Specified care and services form part of the draft model Resident Agreement developed for the industry group, Aged and Community Care Victoria, in respect of Australian Government funded residential care.

Because the Aged Care Principles state that the Specified care and services must be provided in a way which meets the Accreditation Standards, it is appropriate that compliance with them be assessed in the course of an accreditation visit.

Wording of accreditation reports

Another noticeable feature of the sample accreditation reports was their wording, especially in respect of the documentation of CALD residents’ beliefs, customs and practices. Much is said about wishes being recorded during the initial care planning process, and later when activity programs are developed, but few reports comment on whether these are actually acted on. The same could be said about ‘the availability’ of interpreters or cultural resources, but are they ever used?

STRENGTH IN NUMBERS AND ACTION

CALD residents’ rights to assistance with communication and to culturally appropriate care is embedded in legislation and protected by user rights measures and monitoring practices which are all interlinked. By using these measures CALD residents or their representatives can hold providers and external agencies more accountable for their care in residential care services. CALD residents are able to influence service delivery in their facility. Numbers are now on their side as the following figures show.

Nationally, between June 1999 and June 2006 residents in permanent care for whom English is not the first language have increased both in absolute numbers and as a proportion of the total permanent resident population (AIHW).

During this period whilst the total number of residents in permanent care across Australia increased by 14.6%; the number for whom English is not the first language increased disproportionately by 63.3% (AIHW).

The corresponding increase in the number of residents in permanent care for whom English is not the first language in Victoria and NSW was 64.7% and 60.7% respectively (AIHW).

CALD demographics also show some remarkable trends in Victoria. The state Department of Human Services’ publication Cultural Diversity, ageing and HACC: trends in Victoria in the next 15 years, 2006, indicates that from 1996 to 2011, the CALD population will grow by 71% to reach 31% of the total aged population, making Victoria the most culturally and linguistically diverse of all the states.

Compared to the state as a whole, CALD communities will account for 38% of the total population aged 65 and over in Melbourne in 2011. In 2001, this percentage was higher in some local government areas. For example, in Brimbank it was 65.6% and in Dandenong it was 45.3%.

This means that the pool from which CALD residents will be drawn is expanding significantly and that in some areas, the concentration of elderly CALD people will make CALD residents core business rather than optional consumers in general purpose homes.



REFERENCES

Aged Care Standards and Accreditation Agency www.accreditation.org.au

Australian Government response to the Senate Community Affairs References Committee’s report of the Inquiry into Aged Care Quality and Equity in Aged Care, Australian Government, September 2007

Australian Institute of Health and Welfare (AIHW) 2000, Residential Care in Australia 1998-1999: A statistical overview. AIHW cat. no. AGE 16. Canberra: AIHW

Australian Institute of Health and Welfare 2007, Residential Care in Australia 2005-2006: A statistical overview. Aged care statistics series 24. Cat. no. AGE 54. Canberra: AIHW

Bennett W Culturally & Linguistically Specific Community Visitors Scheme Programs: A NECESSITY, NOT A LUXURY, Australian-Polish Community Services, Footscray, Victoria, 2007

Brough C Language Services in Victoria’s Health system: Perspectives of Culturally and Linguistically Diverse Consumers, Centre for Culture Ethnicity & Health, Melbourne, Victoria, Australia, 2006

Centre for Cultural Diversity in Ageing www.culturaldiversity.com.au

Department of Health and Ageing www.health.gov.au

Department of Health and Ageing, Aged Care Act 1997 and Principles 1997, Australian Government

Department of Health and Ageing, Office of the Commissioner for Complaints Annual Report 1 July 2003 – 30 June 2004, Australian Government



Department of Health and Ageing, Report on the Operation of the Aged Care Act 1997 – 1 July 2005 to 30 June 2006, Australian Government

Elder Rights Advocacy Annual Report 1 July 2005 – 30 June 2006, Melbourne, Victoria www.era.asn.au

Howe AL Cultural Diversity, ageing and HACC: trends in Victoria in the next 15 years

Victorian Government Department of Human Services, Melbourne, Australia, March 2006

Power and Powerlessness Report of Multicultural Council of Tasmania Inc. 2006 available at www.mcot.org.au/downloads/Powerandpowerless.pdf

State Government of Victoria www.vic.gov.au

State Government of Victoria, Department of Human Services www.dhs.vic.gov.au

http://www.accreditation.org.au/

http://www.health.gov.au/

http://www.era.asn.au/

http://www.mcot.org.au/downloads/Powerandpowerless.pdf

http://www.vic.gov.au/

http://www.dhs.vic.gov.au/

Attachment 1

Specified care and services for residential care services Schedule 1

Hotel services — to be provided for all residents who need them Part 1

Quality Of Care Principles 1997 Page 23

Schedule 1 Specified care and services for residential care services (section 18.6)

Note Subsection 18.6 (1A) provides that the care and services listed in Schedule 1 are to be provided in a way that meets the standards set out in Schedule 2 or 3 (as the case requires).

Part 1 Hotel services — to be provided for all residents who need them

Col. 1

Item

Column 2

Service

Column 3

Content

1.1 Administration General operation of the residential care service, including resident documentation

1.2 Maintenance of buildings and grounds

Adequately maintained buildings and grounds

1.3 Accommodation Utilities such as electricity and water

1.4 Furnishings Bed-side lockers, chairs with arms, containers for personal laundry, dining, lounge and recreational furnishings, draw-screens (for shared rooms), resident wardrobe space, and towel rails

Excludes furnishings a resident chooses to provide

1.5 Bedding Beds and mattresses, bed linen, blankets, and absorbent or waterproof sheeting

1.6 Cleaning services, goods and facilities

Cleanliness and tidiness of the entire residential care service

Excludes a resident’s personal area if the resident chooses and is able to maintain it himself or herself

1.7 Waste disposal Safe disposal of organic and inorganic waste material

1.8 General laundry Heavy laundry facilities and services, and personal laundry services, including laundering of clothing that can be machine washed

Excludes cleaning of clothing requiring dry cleaning or another special cleaning process, and personal laundry if a resident chooses and is able to do this himself or herself

1.9 Toiletry goods Bath towels, face washers, soap, and toilet paper


Care and services — to be provided for all residents who need them Part 2


Col. 1

Item

Column 2

Service

Column 3

Content

1.10 Meals and refreshments (a) Meals of adequate variety, quality and quantity for each resident, served each day at times generally acceptable to both residents and management, and generally consisting of 3 meals per day plus morning tea, afternoon tea and supper

(b) Special dietary requirements, having regard to either medical need or religious or cultural observance

(c) Food, including fruit of adequate variety, quality and quantity, and non-alcoholic beverages, including fruit juice

1.11 Resident social activities Programs to encourage residents to take part in social activities that promote and protect their dignity, and to take part in community life outside the residential care service

1.12 Emergency assistance At least 1 responsible person is continuously on call and in reasonable proximity to render emergency assistance

Part 2 Care and services — to be provided for all residents who need them

Col. 1

Item

Column 2

Care or Service

Column 3

Content

2.1 Daily living activities assistance

Personal assistance, including individual attention, individual supervision, and physical assistance, with:

(a) bathing, showering, personal hygiene and grooming

(b) maintaining continence or managing incontinence, and using aids and appliances designed to assist continence management

(c) eating and eating aids, and using eating utensils and eating aids (including actual feeding if necessary)

(d) dressing, undressing, and using dressing aids

(e) moving, walking, wheelchair use, and using devices and appliances designed to aid mobility, including the fitting of artificial limbs and other personal mobility aids


Care and services — to be provided for all residents who need them Part 2


Col. 1

Item

Column 2

Care or Service

Column 3

Content

(f) communication, including to address difficulties arising from impaired hearing, sight or speech, or lack of common language (including fitting sensory communication aids), and checking hearing aid batteries and cleaning spectacles

Excludes hairdressing

2.2 Meals and refreshments Special diet not normally provided

2.3 Emotional support Emotional support to, and supervision of, residents

2.4 Treatments and procedures

Treatments and procedures that are carried out according to the instructions of a health professional or a person responsible for assessing a resident’s personal care needs, including supervision and physical assistance with taking medications, and ordering and reordering medications, subject to requirements of State or Territory law

2.5 Recreational therapy Recreational activities suited to residents, participation in the activities, and communal recreational equipment

2.6 Rehabilitation support Individual therapy programs designed by health professionals that are aimed at maintaining or restoring a resident’s ability to perform daily tasks for himself or herself, or assisting residents to obtain access to such programs

2.7 Assistance in obtaining health practitioner services

Arrangements for aural, community health, dental, medical, psychiatric and other health practitioners to visit residents, whether the arrangements are made by residents, relatives or other persons representing the interests of residents, or are made direct with a health practitioner

2.8 Assistance in obtaining access to specialised therapy services

Making arrangements for speech therapy, podiatry, occupational or physiotherapy practitioners to visit residents, whether the arrangements are made by residents, relatives or other persons representing the interests of residents


Care and services — to be provided for residents receiving a high level of residential care

Part 3


Col. 1

Item

Column 2

Care or Service

Column 3

Content

2.9 Support for residents with cognitive impairment

Individual attention and support to residents with cognitive impairment (eg dementia, and other behavioural disorders), including individual therapy activities and specific programs designed and carried out to prevent or manage a particular condition or behaviour and to enhance the quality of life and care for such residents and ongoing support (including specific encouragement) to motivate or enable such residents to take part in general activities of the residential care service

Part 3 Care and services — to be provided for residents receiving a high level of residential care

Col. 1

Item

Column 2

Care or Service

Column 3

Content

3.1 Furnishings Over-bed tables

3.2 Bedding materials Bed rails, incontinence sheets, restrainers, ripple mattresses, sheepskins, tri-pillows, and water and air mattresses appropriate to each resident’s condition

3.3 Toiletry goods Sanitary pads, tissues, toothpaste, denture cleaning preparations, shampoo and conditioner, and talcum powder

3.4 Goods to assist residents to move themselves

Crutches, quadruped walkers, walking frames, walking sticks, and wheelchairs

Excludes motorised wheelchairs and custom made aids

3.5 Goods to assist staff to move residents

Mechanical devices for lifting residents, stretchers, and trolleys

3.6 Goods to assist with toileting and incontinence management

Absorbent aids, commode chairs, disposable bed pans and urinal covers, disposable pads, over-toilet chairs, shower chairs and urodomes, catheter and urinary drainage appliances, and disposable enemas

3.7 Basic medical and pharmaceutical supplies and equipment

Analgesia, anti-nausea agents, bandages, creams, dressings, laxatives and aperients, mouthwashes, ointments, saline, skin emollients, swabs, and urinary alkalising agents

Excludes goods prescribed by a health practitioner for a particular resident and used only by the resident



Part 3


Col. 1

Item

Column 2

Care or Service

Column 3

Content

3.8 Nursing services Initial and on-going assessment, planning and management of care for residents, carried out by a registered nurse

Nursing services carried out by a registered nurse, or other professional appropriate to the service (eg medical practitioner, stoma therapist, speech pathologist, physiotherapist or qualified practitioner from a palliative care team)

Services may include, but are not limited to, the following:

(a) establishment and supervision of a complex pain management or palliative care program, including monitoring and managing any side effects

(b) insertion, care and maintenance of tubes, including intravenous and naso-gastric tubes

(c) establishing and reviewing a catheter care program, including the insertion, removal and replacement of catheters

(d) establishing and reviewing a stoma care program

(e) complex wound management

(f) insertion of suppositories

(g) risk management procedures relating to acute or chronic infectious conditions

(h) special feeding for care recipients with dysphagia (difficulty with swallowing)

(i) suctioning of airways

(j) tracheostomy care

(k) enema administration

(l) oxygen therapy requiring ongoing supervision because of a care recipient’s variable need

(m) dialysis treatment

3.10 Medications Medications subject to requirements of State or Territory law



Part 3


Col. 1

Item

Column 2

Care or Service

Column 3

Content

3.11 Therapy services, such as, recreational, speech therapy, podiatry, occupational, and physiotherapy services

(a) Maintenance therapy delivered by health professionals, or care staff as directed by health professionals, designed to maintain residents’ levels of independence in activities of daily living

(b) More intensive therapy delivered by health professionals, or care staff as directed by health professionals, on a temporary basis that is designed to allow residents to reach a level of independence at which maintenance therapy will meet their needs

Excludes intensive, long-term rehabilitation services required following, for example, serious illness or injury, surgery or trauma

3.12 Oxygen and oxygen equipment

Oxygen and oxygen equipment needed on a short-term, episodic or emergency basis

Attachment 2

The Accreditation Standards

The Accreditation Standards are set out in Schedule 2, Part 3 of the Quality Care

Principles 1997 made under subsection 96-1 (1) of the Aged Care Act 1997.

There are four Accreditation Standards:

! Management systems, staffing and organisational development

! Health and personal care

! Resident lifestyle

! Physical environment and safe systems.

Within the four Accreditation Standards are 44 expected outcomes.

Standard 1: Management systems, staffing and organisational development

Principle: Within the philosophy and level of care offered in the residential care service,

management systems are responsive to the needs of residents, their representatives, staff

and stakeholders, and the changing environment in which the service operates.

Intention of standard: This standard is intended to enhance the quality of performance

under all accreditation standards, and should not be regarded as an end in itself. It

provides opportunities for improvement in all aspects of service delivery and is pivotal to

the achievement of overall quality.

Expected outcomes

1.1 Continuous improvement

The organisation actively pursues continuous improvement

1.2 Regulatory compliance

The organisation's management has systems in place to identify and ensure compliance

with all relevant legislation, regulatory requirements, professional standards and

guidelines

1.3 Education and staff development

Management and staff have appropriate knowledge and skills to perform their roles

effectively

1.4 Comments and complaints

Each resident (or his or her representative) and other interested parties have access to

internal and external complaints mechanisms

1.5 Planning and leadership

The organisation has documented the residential care service's vision, values, philosophy,

objectives and commitment to quality throughout the service

1.6 Human resource management There are appropriately skilled and qualified staff sufficient to ensure that services are

delivered in accordance with these standards and the residential care service's philosophy

and objectives

1.7 Inventory and equipment

Stocks of appropriate goods and equipment for quality service delivery are available

1.8 Information systems Effective information management systems are in place

1.9 External services

All externally sourced services are provided in a way that meets the residential care

service's needs and service quality goals

Standard 2: Health and personal care

Principle: Residents' physical and mental health will be promoted and achieved at the

optimum level in partnership between each resident (or his or her representative) and the

health care team.

Expected outcomes

2.1 Continuous improvement The organisation actively pursues continuous improvement

2.2 Regulatory compliance The organisation's management has systems in place to identify and ensure compliance

with all relevant legislation, regulatory requirements, professional standards, and

guidelines, about health and personal care



effectively

2.4 Clinical care Residents receive appropriate clinical care

2.5 Specialised nursing care needs

Residents' specialised nursing care needs are identified and met by appropriately

qualified nursing staff

2.6 Other health and related services

Residents are referred to appropriate health specialists in accordance with the resident's

needs and preferences

2.7 Medication management Residents' medication is managed safely and correctly

2.8 Pain management All residents are as free as possible from pain

2.9 Palliative care The comfort and dignity of terminally ill residents is maintained

2.10 Nutrition and hydration Residents receive adequate nourishment and hydration

2.11 Skin care Residents' skin integrity is consistent with their general health

2.12 Continence management Residents' continence is managed effectively

2.13 Behavioural management

The needs of residents with challenging behaviours are managed effectively

2.14 Mobility, dexterity and rehabilitation

Optimum levels of mobility and dexterity are achieved for all residents

2.15 Oral and dental care

Residents' oral and dental health is maintained

2.16 Sensory loss

Residents' sensory losses are identified and managed effectively

2.17 Sleep

Residents are able to achieve natural sleep patterns.

Standard 3: Resident lifestyle

Principle: Residents retain their personal, civic, legal and consumer rights, and are

assisted to achieve active control of their own lives within the residential care service and

in the community.

Expected outcomes

3.1 Continuous improvement

The organisation actively pursues continuous improvement

3.2 Regulatory compliance

The organisation's management has systems in place to identify and ensure compliance


guidelines, about resident lifestyle



effectively

3.4 Emotional support

Each resident receives support in adjusting to life in the new environment and on an

ongoing basis

3.5 Independence Residents are assisted to achieve maximum independence, maintain friendships and

participate in the life of the community within and outside the residential care service

3.6 Privacy and dignity Each resident's right to privacy, dignity and confidentiality is recognised and respected

3.7 Leisure interests and activities Residents are encouraged and supported to participate in a wide range of interests and

activities of interest to them

3.8 Cultural and spiritual life

Individual interests, customs, beliefs and cultural and ethnic backgrounds are valued and

fostered

3.9 Choice and decision-making

Each resident (or his or her representative) participates in decisions about the services the

resident receives, and is enabled to exercise choice and control over his or her lifestyle

while not infringing on the rights of other people

3.10 Resident security of tenure and responsibilities

Residents have secure tenure within the residential care service, and understand their

rights and responsibilities

Standard 4: Physical environment and safe systems

Principle: Residents live in a safe and comfortable environment that ensures the quality

of life and welfare of residents, staff and visitors.

Expected outcomes

4.1 Continuous improvement The organisation actively pursues continuous improvement

4.2 Regulatory compliance The organisation's management has systems in place to identify and ensure compliance


guidelines, about physical environment and safe systems



effectively

4.4 Living environment

Management of the residential care service is actively working to provide a safe and

comfortable environment consistent with residents' care needs

4.5 Occupational health and safety Management is actively working to provide a safe working environment that meets

regulatory requirements

4.6 Fire, security and other emergencies

Management and staff are actively working to provide an environment and safe systems

of work that minimise fire, security and emergency risks

4.7 Infection control

An effective infection control program

4.8 Catering, cleaning and laundry services

Hospitality services are provided in a way that enhances residents' quality of life and the

staff's working environment

10.13 The Charter of Residents' Rights and Responsibilities

Note: Below the term ‘residential care service’ means the same as ‘aged care home’

A. Each resident of a residential care service has the right:

! to full and effective use of his or her personal, civil, legal and consumer rights;

! to quality care which is appropriate to his or her needs;

! to full information about his or her own state of health and about available

treatments;

! to be treated with dignity and respect, and to live without exploitation, abuse or

neglect;

! to live without discrimination or victimisation, and without being obliged to feel

grateful to those providing his or her care and accommodation;

! to personal privacy;

! to live in a safe, secure and homelike environment, and to move freely both within

and outside the residential care service without undue restriction;

! to be treated and accepted as an individual, and to have his or her individual

preferences taken into account and treated with respect;

! to continue his or her cultural and religious practices and to retain the language of

his or her choice, without discrimination;

! to select and maintain social and personal relationships with any other person

without fear, criticism or restriction;

! to freedom of speech;

! to maintain his or her personal independence, which includes a recognition of

personal responsibility for his or her own actions and choices, even though some

actions may involve an element of risk which the resident has the right to accept,

and that should then not be used to prevent or restrict those actions;

! to maintain control over, and to continue making decisions about, the personal

aspects of his or her daily life, financial affairs and possessions;

! to be involved in the activities, associations and friendships of his or her choice,

both within and outside the residential care service;

! to have access to services and activities which are available generally in the

community;

! to be consulted on, and to choose to have input into, decisions about the living

arrangements of the residential care service;

! to have access to information about his or her rights, care, accommodation, and

any other information which relates to him or her personally;

! to complain and to take action to resolve disputes;

! to have access to advocates and other avenues of redress; and

! to be free from reprisal, or a well-founded fear of reprisal, in any form for taking

action to enforce his or her rights.

Attachment 3

Page 34

B. Each resident of a residential care service has the responsibility:

! to respect the rights and needs of other people within the residential care service,

and to respect the needs of the residential care service community as a whole;

! to respect the rights of staff and the proprietor to work in an environment which is

free from harassment;

! to care for his or her own health and well-being, as far as he or she is capable; and

! to inform his or her medical practitioner, as far as he or she is able, about his or

her relevant medical history and his or her current state of health.

Page 35

PEOPLE FROM ETHNIC BACKGROUNDS IN COMMONWEALTH FUNDED

RESIDENTIAL CARE - VICTORIA

AJ Hughes December 2007 Page 36

Attachment 4

INFORMATION SHEET FOR CALD RESIDENTS AND REPRESENTATIVES

This information sheet is intended to assist people from a non-English speaking

background obtain the services and care to which they are entitled in aged care facilities

funded by the Australian Government.

It hopes to encourage culturally and linguistically diverse residents become active

participants in their care so that they feel comfortable in expressing their needs and

pursuing them when they feel they are not being met. This includes assistance with

communication and culturally appropriate services.

To achieve this, they should:

! Become informed on resident’s rights and care expectations in residential aged

care through the following resources:

! the Resident Agreement pertaining to the residential care service;

! the Residents’ Handbook associated with the home. If this is not in the

community language of choice, ask the provider to have this done by

Partners in Culturally Appropriate Care free of charge;

! www.health.gov.au for aged care information including advocacy,

complaints, useful telephone numbers, the Charter of Residents’ Rights

and Responsibilities in 17 community languages. Navigate using buttons

for consumers - ageing – support for people with special needs;

! Specified care and services for residential care - see Attachment 1. This

can also be seen in the Aged Care Principles on www.comlaw.gov.au or

www.scaleplus.gov.au

! the Accreditation Standards – see Attachment 2;

! the Charter of Residents’ Rights and Responsibilities – see Attachment 3;

! Aged Care Information line on 1800 500 853. An interpreter can be

requested;

! Carelink on 1800 052 222. An interpreter can be requested;

! Elder Rights Advocacy on 1800 700 600. An interpreter can be requested;

! The Complaint Investigation Scheme on 1800 550 552. An interpreter can

be requested;

! examples of measures used by providers in caring for CALD residents -

see Attachment 5.

! Ask for access to an interpreter during the care planning process so that medical

information is conveyed accurately and personal issues can be discussed

privately;




! Use the feedback mechanisms available in homes. These might include

resident/carer discussions, resident/management meetings, resident satisfaction

surveys, suggestion boxes and focus groups;

! Use the Elder Rights Advocacy service to help approach providers or the

Government Complaints Investigation Scheme of concerns;

! Use complaints systems within the home;

! Use the Complaints Investigation Scheme conducted by the Commonwealth

Department of Health and Ageing;

! Provide feedback to the Accreditation Agency when it visits a home;

! Consider forming a CALD consumer group within a home;

! Visit local federal ministers to explain the situation of CALD people in

Commonwealth funded residential care using examples of poor care and

suggestions for improvement;

! With the assistance of ethnic support groups, contribute to government enquiries

when their terms of reference cover the care of residents in Commonwealth

funded homes.




Attachment 5

INITIATIVES TAKEN BY PROVIDERS TO ACCOMMODATE CALD

RESIDENTS

With the exception of the ethno-specific service visited in the course of this project, all

facilities accommodated residents from several different CALD backgrounds in addition

to Australian born or English speaking residents. In suburban Melbourne, this is a sign of

the times.

There was generally a good knowledge of Partners in Culturally Appropriate Care

(PICAC) and experience in using information or services from ethnic community groups

to make their home more culturally appropriate for their residents. All employed staff in

different capacities from non-English speaking backgrounds but not necessarily all from

the countries of their residents’ birth, culture or language.

Measures taken to cater for CALD residents included:

! recognising the CALD demographics of the area in which the home is located and

preparing for a resident intake representative of this population;

! facilitating guided tours over the home by elderly CALD people from clubs to

help overcome resistance to residential care;

! factoring in language and cultural considerations from first contact with residents.

This covered all aspects of care across the clinical, social, spiritual and civic

domains;

! obtaining a full life history of the CALD individual over time including childhood

experiences, significant events like war and trauma, migration experience,

education, employment, and family background;

! employing staff who spoke the language of the residents;

! using interpreters on admission despite having bilingual staff to ensure the

independence and accuracy of the information received about residents;

! using one of the clinical nurses employed by the home as a nurse educator for all

staff on culturally appropriate service delivery;

! attempting to have all shifts covered with staff who could speak the language of

CALD residents;

! employing lifestyle coordinators to research and organise culturally appropriate

activities for CALD residents;




! responding to some staff’s request to learn the language of an ethnic group

represented in a home;

! experimenting with ethnic food provision using home cooks from the cultural

group in question;

! conducting small but special lunch occasions when ethno-specific food was

provided;

! providing ethnic food regularly for CALD residents;

! employing a chef from the country of the predominant ethnic group;

! providing reminiscence groups in which CALD neighbours also participated;

! accessing ethno-specific books, talking books, videos, music, DVDs and

memorabilia;

! accessing ethno-specific radio and television programs;

! researching culturally important factors associated with CALD residents and

arranging special events and activities;

! using ethnic community support groups to assist in identifying significant cultural

issues associated with the care of their client groups;

! using Partners in Culturally Appropriate Care (PICAC) to provide cultural

awareness training for care staff and managers;

! consulting the “Cultural Care Kit” published by Residential Care Rights (now

Elder Rights Advocacy) in Victoria;

! using (i) the All Care nursing cue cards to assist them understand residents’

presenting care issues, or (ii) accessing PICAC’s glossary of aged care terms in

community languages;

! using CALD special events in the home as a cross cultural learning experience for

other residents;

! providing forms seeking feedback, comment or complaints in the languages of the

home’s community;

! responding to the ‘smallest’ cultural consideration such as clothing preferences or

hair washing practices;




! making use of external ethnic clubs for activities outside the home;

! liaising with the local and/or ethnic church groups for spiritual and community

support;

! creating word or phrase boards translating from a first language to English;

! organising a community visitor for CALD residents without friends of family;

! accommodating residents from the same ethnic group near each other (assuming

they are compatible);

! attracting volunteers from ethnic groups to assist with activities.

Homes varied significantly in their adoption of measures for CALD residents but those

listed above show what is possible and what has been attempted.



A J Hughes December 2007 Page 41

Table 1. Number of permanent residents, preferred languagea by sex and Stateb 1999 & 2006

Australia % NSW % Vic % Year

Females

English 90,028 93.8 31,795 93.6 21,309 91.0 30 June 1999

c

99,086 91.1 33,664 90.8 24,290 87.5 30 June

2006d

All other 5,996 6.2 2,181 6.4 2,098 9.0 30 June

1999

9,676 8.9 3,423 9.2 3,457 12.5 30 June 2006

Total F 96,024 100 33,976 100 23,407 100 30 June 1999

108,762 100 37,087 100 27,747 100 30 June

2006

Males

English 33,518 92.1 11,910 92.3 7,839 88.1 30 June

1999

38,160 88.8 13,018 88.6 9,196 84.1 30 June 2006

All other 2,878 7.9 993 7.7 1,058 11.9 30 June 1999

4,815 11.2 1,678 11.4 1,741 15.9 30 June 2006

Total M 36,396 100 12,903 100 8,897 100 30 June 1999

42,975 100 14,696 100 10,937 100 30 June

2006

All Persons

English 123,546 93.3 43,705 93.2 29,148 90.2 30 June 1999

137,246 90.4 46,682 90.1 33,486 86.6 30 June 2006

All other 8,874 6.7 3,174 6.8 3,156 9.8 30 June 1999

14,491 9.6 5,101 9.9 5,198 13.4 30 June

2006

Total P 132,420 100 46,879 100 32,304 100 30 June

1999

151,737 100 51,783 100 38,684 100 30 June 2006

(a) ABS 1997 (b) 'State' refers to the location of the facility (c) Table 2.12 Residential Aged Care Facilities in Australia 1998-99: A Statistical Overview. Aged care statistics series no. 7, Australian Institute of Health and Welfare, June 2000 (d) Table 4.15 Residential aged care in Australia 2005-06: a statistical overview. Aged care statistics series no. 4, Australian Institute of Health and Welfare, June 2007

People from Ethnic Backgrounds in Commonwealth funded Residential Care

Documents

Transcript of People from Ethnic Backgrounds in Commonwealth funded Residential Care