# Caregiving and dementia/Topics/CALD

This NPA focuses on dementia care for culturally and linguistically diverse people.

## Culturally and Linguistically Diverse Communities

The Australian population is diverse and this is reflected in the needs and preferences of older people who require aged care services. Persons from culturally and linguistically diverse (CALD) backgrounds, that is persons who were born, or had parents or ancestors born in countries where English is not the main language spoken, have been defined in the Australian Aged Care Act 1997 as a special needs group, with an expectation that aged care providers offer services that are respectful of, and responsive to, needs that arise from their diverse cultural and religious backgrounds.
The diversity among Australia’s older CALD population is increasing, as different immigrant communities move into older age cohorts at different times. Australia’s population of older people from CALD is expected to increase by over 40% between 2011 and 2026 in line with the overall increase in the older population. By 2026, it is projected that one in four Australians aged 80 and over will be from a CALD background. While people whose main language at home is European will still be the largest group, those who speak Middle Eastern and Asian languages are expected to become increasingly important (Australian Productivity Commission, 2011).
Approximately one in five older Australians were born overseas, however are underrepresented in access to aged care services. Currently available estimates and projections for dementia prevalence and incidence in persons from CALD backgrounds living in Australia are limited (Low et al., 2009).
Factors impeding timely access to dementia specific services include
* poor English proficiency and those who are fluent in English often reverting back to their original language as their dementia progresses
* poor dementia literacy
* demonstrating lack of knowledge of dementia, symptoms and causes
* fear and stigma, resulting in people being marginalised and isolated
* difficulties in accurate assessment and diagnosis
* lack of knowledge of or reluctance to use services
* limited availability of culturally appropriate services, and
* difficulty accessing services.
Often it is a crisis in care, or medical emergency, which results in late diagnosis and service provision (Low, et al, 2009).
Efforts to meet the needs of CALD people with dementia include ethno-specific nursing homes, cluster nursing homes and organising specific days at daycentres for different cultural groups. These services do not meet demand, and mainstream service providers struggle to deliver culturally appropriate dementia care to clients as expected within accreditation standards. Providing written and verbal information and creating opportunities for discussion with clients and families in languages other than English and providing culturally relevant lifestyle choices are the greatest challenges (Productivity Commission, 2011).
A second important concern is the increasing employment of care workers and health professionals who are from CALD backgrounds in aged care and dementia specific services. Little, if any, research is available however formal and informal consultation with aged care providers has raised it as a significant and growing issue. While attracting and retaining bilingual and multilingual staff who can communicate effectively with clients and other staff is a bonus, poor English proficiency of employees, highly accented English, cultural biases of clients, differing cultural beliefs about how older people should be cared for and different beliefs about the causes of dementia have all been listed as causing concern and disruption of good practice within the workplace.
Working with people with dementia can offer the opportunity to develop relationships with many of the people for whom they care and it can provide opportunities for health professionals to use a wide range of their professional skills and judgement in the delivery of quality care. Most older people, regardless of cultural background, want to be cared for by people they trust, who loves and has time for them, who respects their right to make their own decisions and who helps them maintain their dignity and independence. Facilitation of professional development in cultural competency and the provision of culturally competent services have the potential to meet the needs of clients, employees and aged care providers.
There is an increasing awareness of the special requirements for the care of CALD people with dementia. There have been many areas of inquiry into the experiences of CALD communities and the challenges they and mainstream Australians face. The challenges and benefits have been documented, however recommendations and projects to implement recommendations are sparse. Work to date has been carried out in an ad hoc manner, relying on the efforts of a few enterprising individuals and service groups. Finding appropriate resources and accessing training relies heavily on word of mouth (van der Wetering & Batenburg, 2009).
Based on a broad consultation and needs analysis and to meet the most important needs of people living with dementia the first priority is to address the professional and workforce development needs of health professionals working in mainstream health facilities. There are two areas of focus:
* firstly people with dementia from CALD backgrounds and
* secondly health professionals from CALD backgrounds caring for people living with dementia.