INSPIRING DIVERSITY IN AGED CARE Hello my name is Gerard Mansour and I am the CEO of Aged and Community Care Victoria. I am very pleased to be able to talk with you today as part of the Cultural Diversity in Ageing 2007 National Conference. Aged and Community Care Victoria is the single voice for service providers within the sector following a merger last year of our two former organisations. We are now very fortunate to have the strength and capacity that comes from being the single voice, we of course have the benefit of pooling our resources and we have a passionate belief in the importance of creating a single national voice for aged and community care. Why do we in Victoria want a single voice to Government, our community and key stakeholders like yourselves? Because it is our belief that only through united action can we achieve our full potential as a sector – and in that I include providers, residents, clients, families, volunteers, our staff, management, Directors, Boards and all the many stakeholders who provide support, care or are actively engaged with our elderly here in Victoria. ACCV now brings together the unity of focus and commitment from all our member organisations. That is, our small community organisations, CALD specific providers, small private business owner operators, rural, regional or public providers, medium to larger size privates, corporates and church charitable organisations – big or small. I would like to take this opportunity to say a bit about us, about our new organisation here in Victoria. We are still building, we are still evolving, but our core Mission, Vision and Values are very clear and I would like to share them with you. Our ACCV Mission ACCV exists to promote, encourage and assist the health and care needs of the aged and community care clients. We provide support to our members in a professional and ethical manner. We are committed to provide leadership in the aged and community care sector as well as the key day to day tasks of giving our members accurate relevant resources, advice, services and information. Our vision is that ACCV will: • Become the influential voice for aged and community care in Victoria • Contribute positively to the improvement of aged and community care practice • Present information in a meaningful and credible manner • And make a positive contribution to the improvement of aged and community care practice on both a state and national level. And finally our ACCV values are vitally important. These are central to our role as a membership organisation because each of these values is part of the Code of Conduct which binds all our members. These values include: • Professionalism, openness, objectivity, integrity and adherence to high ethical standards • The diversity and individuality of our members and their clients • The willingness of individual member organisations to contribute to the aged and community care sector • Commitment to the enhancement of skills and expertise both within ACCV and within our member organisations I am extremely pleased today to speak about a specific Issues Paper prepared by one of one of our former organisations – VAHEC – on an issue that we continue to pursue with fervour. This report came as a result of the dedication and commitment of many of our members. The Issues Paper, initially launched at the end of 2005, is titled “The provision of aged and community care services to people from culturally and linguistically diverse backgrounds”. Why am I talking about this report nearly two years later – because many of its key messages are more relevant today than they were even then. I would like to share with you, as a lead into this Issues Paper, part of my experience. It sets a context for why I believe strongly in the principles underpinning cultural and linguistic diversity. About the importance of our own backgrounds, our own history, our own culture no matter what. In my family my great grandfather came from Lebanon to Australia as a free settler back in the early 1900s. My great grandfather was an optometrist and traveled country Victoria. His wife died giving birth to twins – children number 9 and 10. One twin died and the other lived. The children were scattered among the uncles and aunties who lived in various parts of Victoria. Before my own father died nine years ago I can vividly recall him sharing his own story. The frustration of being a very young child within a family who predominately spoke Arabic. But they felt then, and we are talking about the mid to late 1920s, that being new settlers to Australia the best thing they could do for their children was to make sure they only spoke English. This was a real measure in their view of being Australian. And my father recounted how the family elders would sit around after dinner and share stories that he could not understand. He would comment that he felt as if he lost much of his cultural background in just one generation – he simply missed out on being able to listen to and understand their stories as a child. When I think of my own father I can imagine the experience of some of our elder citizens here in Victoria today. Who find themselves in the situation that they cannot understand others, or that we cannot understand them. But it is not just about language, it is about life and who we are. One of the factors uniting providers, including CALD service providers is the recognition that a greater focus on implementation of effective CALD strategies is necessary. Responsiveness to individual culture and background is an integral aspect of planning and provision of care. Slide 2 The Issues Paper initially launched in 2005 recognises: ‘Culture’ is not a mere ‘add-on’, but rather informs the whole experience of CALD clients. Good care depends on fostering a sense of belonging in whatever care setting CALD elderly may choose. For this to occur the person’s sense of self and cultural history must inform individual care plans and a variety of strategies directed at their care. Many of our care recipients (clients and residents) are already frail and can find life challenging. Cultural or language differences can make communication a challenge if understood from the older person’s own perspective. Some of these difficulties can be persistent factors while other factors might be transient. Can I share my experiences and interact with you? Can I communicate some of my most basic needs or wants? The paper prepared by our industry resulted from our recognition that we have a challenge to able to respond to diversity in its many forms Much can be conveyed without language -yet there will be many times when language is critical to understanding and accurately meeting people’s needs. Our member organisations continually commit to improving our responsiveness to the diverse human experiences of our elderly including their culture, language spoken, religion or country of birth – all these impact on our ethnicity. Today is an opportunity to re-visit this important piece of work. It needs to be revisited, for four reasons • The first is because ACCV as an industry peak body is committed to the CALD cause as consequence of its own Vision Mission and Values which promotes the improvement of aged and community care practice Slide 3 • A second reason is because of the imperatives brought about by an ageing CALD population. The paper draws our attention to demographic change. • The third reason is that substantial challenges lie ahead for our providers of aged and community care. This includes the twin challenges of: -Building Organisational Capacity; and -Workforce development. This challenge is even far broader than aged care providers, it is a challenge for all our organisations to respond to these key demographic changes. Our CALD Issues Paper assumes a model of care that: • provides for the whole person and does not see them simply as a composite of ‘needs’; • focuses on the individual and their specific care needs; · places culture at the centre of service planning for CALD elderly; • care engages the client in decision making about where and how their needs will be met; and • family members and ethnic communities in the provision of engages appropriate care. At its heart, the Issues Paper considers that a key outcome is to achieve Slide 4 appropriate CALD care [that] is focused on reducing social isolation and cultural dislocation. It seeks to achieve circumstances in which clients can effectively exercise their rights and experience positive health outcomes. The key issue is: cultural awareness and the implementation of culturally appropriate strategies to provide best practice care for CALD elderly. Culture, linguistic usage and communication are seen as crucial issues for the development of policy, for service strategies and for promoting CALD access. 38 recommendations were made under which I will now present as they appear in the report under eight categories: GOVERNMENT One of the most heightened concerns is the absence of an adequate national planning framework to address the specific needs of CALD elderly. Federal policy remains fragmented at the Federal level, the RCS, Accreditation Standards, activities of the Aged Care Accreditation Standards, as well as those of PICAC, should reflect a common policy orientation to provide consistent practice guidelines. The case for culturally sensitive care has not yet received the same policy attention as say dementia or palliative care. There are still a lack of resources available to all providers as well as a lack of appropriate tools for aged care organizations to measure organizational capacity to meet CALD needs (including the Aged Care Accreditation Standards) I would like to read from the Issues Paper: page 19 “Overall it should be noted that the Federal Government has recently announced important policy intentions … [however] effective implementation strategies are not yet in place for CALD appropriate care. One the one hand, there are generic system issues that affect the delivery of care to all elderly citizens, but which doubly impact on CALD elders. On the other hand, CALD specific policy intentions need to be concretized in detailed implementation and accountability strategies. Service providers are already pressured to find ways to overcome inherent system problems. These system issues include resource problems and the non uniform requirements for client assessment and reporting over the various systems and programs. Energy and resources are used to manage complex administrative matters and to juggle inadequate budgets when the time and energy expended here could be better used in effective service delivery. In respect of specific CALD policy, it is now time to devise the necessary resourcing, targeting and accountability measures that would unite the industry around common practices of CALD appropriate care and facilitate transparency and compliance”. In my view these words, which will shortly be two years old, are even more relevant to us today. Slide 5 And so key recommendations in relation to the Government are: 1. The development of a national planning framework 2. Improved support for infrastructure so that organizations can better meet CALD needs of their residents or clients. 3. That the Aged Care Standards & Accreditation Agency (ACSAA) enhances assessors’ awareness of culturally appropriate care. 4. That the federal Government systematically funds high quality research to explore a range of issues relating to CALD appropriate aged care. 5. Regularly publish information on services funded to target CALD communities and measuring their usage 6. Establish mechanisms to monitor that targeted beds or packages are used by targeted groups The second set of recommendations relates to Providers Slide 6 -Providers It is true that many Victorian providers of aged and community care services are making positive progress in the development of effective tools and practices to meet the needs of those from CALD backgrounds. Yet the demographic trends, and sheer weight of numbers, means there is a need for both increased capacity and attention to the special needs of CALD clients. Providers will need to be even more active in planning. Planning will include active monitoring of, and engagement with, government initiatives, and in particular, attention to program standards, access issues, education and staff training. The recommendations made are: 7. Acknowledging demographic change and planning for the provision of appropriate CALD services/care especially standards, access, education and staff training. 8. Providers consider establishing partnerships with CALD representatives to improve targeting of CALD communities and encourage best practice in the delivery of care to CALD clients; 9. Service providers consider establishing advisory committees with appropriate CALD representation Slide 7 -Industry INDUSTRY Peak bodies such as ACCV, its state counterparts, and federal national peak bodies, ACSA and ACAA are well positioned to continue to raise the profile of the needs of CALD elderly within the aged care industry. This should be done as part of an integrated industry effort to address the range of service issues that follow from an understanding of CALD needs, as mentioned earlier, not merely as an add-on but an integral aspect of care. I am very pleased to be able to inform you that there is in fact a single national industry campaign between our two federated peak bodies in the lead up to the federal election. Importantly, CALD issues do in fact feature in our national campaign priorities and campaign materials. “There are many people who face additional difficulties in accessing the care and support they need. This can be due to being homeless, having a different cultural background or because they live in a rural or remote area where there are fewer service options. Create a cultural funding pool to improve services for culturally and linguistically diverse clients.” The Issues Paper also canvasses the idea that Peak Bodies play a key role in holding forums for discussion and consultation across the industry, instigating research, conferences, working groups, taskforces, seminars and papers, and undertake a broader role in educating government and community through publication and media statements. The recommendations are : 10. That our industry body (now ACCV) broadly disseminates the paper for discussion. 11. The Federal peak bodies assist in the development of a National papers on CALD issues (ACSA has already been provided with a copy and undertaken the development of a national paper). 12. Influencing government for both change and to raise public awareness of the specific issues facing CALD elderly. PLANNING Slide 8 -Planning Training and ongoing staff development are integral aspects of effective CALD care. Educational providers should be encouraged to further develop CALD- sensitive training packages. This includes nurse education, diversional therapy / leisure & lifestyle and training for personal carers. Further research into existing curricula is needed and industry consultation in this regard should be expanded. Mechanisms for increasing the participation of bi-cultural and bi-lingual staff should be investigated and enhanced. Staff should be encouraged to participate in ongoing staff development through the use of short courses, enhanced provider induction processes and other sources of information and training. Adequate resourcing needs to be made available to recognize the role of ethnospecific service providers in this regard. Providers may need to enhance strategies of connecting with local ethnic communities to gain adequate CALD representation. Building cultural awareness at senior executive and Board or Director level is crucial for CALD service strategies to be sustainable over time. The recommendations made are: 13. That industry works with nurse educators to fully integrate CALD sensitivity into nursing curricula, and; 14. Similarly that gerontic nursing courses include specialist training in working with CALD elders. 15. Industry works with training providers to develop and monitor the quality of certificate courses, especially in the area of CALD- appropriate care. 16. Staff development in cross-cultural awareness and care strategies is made available for staff working for organizations who receive place allocations targeting CALD clients. 17. Commonwealth incentives for service organizations to offer language and cross-cultural awareness classes to staff. 18. Federal Government examines the Victorian HACC strategy for recruiting bi-lingual and bi-cultural staff as a model for Commonwealth-funded programs. 19. That PICAC-Vic continues to target training programs in CALD awareness to aged care boards, committees, proprietors and managers. BENCHMARKING Slide 10 Benchmarking of CALD appropriate service delivery is essential for the delivery of adequate care and industry-wide standards of care. Further consultation and research nationally, internationally and at the state level is required if appropriate benchmarks are to be established. RESIDENTIAL The accreditation process has a positive role to play in assessing compliance with CALD-appropriate care strategies. In many instances the Accreditation Agency does not have access to interpreters when assessing the appropriateness of CALD care in aged care settings. Appropriate benchmarks should reflect the overarching principles of appropriate CALD care. They should include but not be limited to: · ethnic and national culture · language use · communication difficulties · religion · gender Recommendations in the Issues Paper related to the ACAR bed and package allocation process have actually occurred this year. It is very positive that in most regions “Ethno Specific” is seen as a special needs group. However, the new ACFI, as anticipated when this report was prepared, fails to provide any funding recognition for CALD issues. Under the current RCS, although not well rewarded in the points system, residential care providers could make some points claims towards a funding category based on CALD needs. In practice, however, this would have had minimal positive funding impact. The new ACFI, with its domains: · Activities of Daily Living · Cognition and Behaviour · Complex Health Care move away from recognizing or rewarding any cultural supportive practices, due to its core focus on behaviour and complex care needs. The recommendations made are: 20. That the Federal Government in consultation with the industry reviews accreditation standards ensuring appropriate outcomes are developed relating to the language and communication needs of CALD elders. 21. That the proposed New Funding Instrument (ACFI) for residential aged care recognizes the cost of care strategies focused on the social, communicational and cultural needs of CALD clients. Community Care HACC has achieved a noteworthy increase in participation by CALD elders. HACC’s initiative should be further encouraged to reflect the full demographic mix of CALD populations. The extent of utilization of CACPs by elders from CALD backgrounds is not clear. Awareness and monitoring of CALD needs should be built into CACP provision. Moreover the work undertaken by ACCV in the past 12 months of both a major issues paper on Community Aged Care Packages and a survey covering 1/3 of CACPs in Victoria has highlighted the major funding shortfalls that the inadequate indexation has accrued over the past 10 years. There are five recommendations related to in home care to enhance in home care for CALD clients (Nos. 22 to 26) CULTURE AND COMMUNICATION Cultural awareness strategies should be implemented for staff at all levels and from all backgrounds. The employment and training of bi-lingual and bi-cultural staff is seen as a key strategy. Bi-lingual and bi-cultural community members should be encouraged to take up training opportunities and industry bodies should work to further such opportunities. A major workforce program for attracting and training bi-lingual and bi-cultural staff should be developed. Accurate and appropriate communication between providers, clients and family members is crucial at key moments, e.g. assessment and the development and review of care plans. Where interpreters are used, providers and interpreters need to be aware of the range of issues that might arise, e.g. the use of dialect and the need to convey complex matters in ways that are appropriate to the educational backgrounds of CALD clients. Slide 11 The recommendations made are: 27. Benchmarks clearly reflecting a concept of culture as an all- encompassing framework rather than culture being an ‘add-on’ to existing services and standards. 28. Language and communication as central service strategies for the care of CALD elderly. 29. A peak body facilitated discussion with interpreting services about educating interpreters and translators in CALD aged care issues, including dementia and palliative care. 30. That funding models for interpreting services be explored (urgently), especially the HACC line of credit model. Slide 12 ACAS ASSESSMENT ACAS plays a crucial role in linking clients to appropriate services. It is recognized that many ACAS are under-resourced and may need to respond on a crisis basis. In this context CALD issues may not be adequately taken into account in client assessment and referral. CALD awareness needs to be further developed and enhanced among ACAS staff and relevant literature be made available to families and clients. Slide 13 SERVICE MODELS Four residential models are outlined in this Issues Paper for consideration: -ethno-specific; -clusters (where three or more of same background grouped); -multi-cultural; and -generalist These reflect past and recent history. The characteristics and relative strengths of each model have been noted in the report. Importantly give the rapidly growing and diversifying CALD clientele, research and funding initiatives are needed now to determine how the industry might develop the models most suited to particular ethnic communities. Slide 14 PROGRAM PRACTICE ISSUES The final set of recommendations relate to key practice issues related to dementia and palliative care. Dementia presents particular issues for the care of CALD elderly. Language and the cultural setting of care are especially important. AND SO WHERE TO FROM HERE Overall the CALD Issues Paper identifies the key issues for aged and community care providers, not only within Victoria but Nationally. Clearly we need an overarching national policy framework as well as a substantial increase in funding and resources to be made available by Government. Slide 15 Two other very important issues relate to -Organisational Capacity to respond to CALD issues over the long term, and -Workforce Development I focus today on these two issues because they are key mainstream industry issues that are simply exacerbated when we seek to address the challenges that lie ahead in catering for the growing number of our older citizens who are from CALD backgrounds. When we consider organisational capacity and readiness, we need to draw from mainstream thinking about organisational development. Dreaschlin provides such a framework for us in the development of “Diversity Leadership and Organisational Transformation: Performance Indicators of Health Service Organisations.” Her framework sought to address demographic change The key demographic trend driving select health services organisations to assume the strategic position of diversity leadership is the changing racial and ethnic composition of both patients and workforce She further goes on to make the point that the goodness of fit between organizational strategy and the business environment is most certainly affected by these demographic shifts. In other words, it makes good business sense for diversity management to be part of an organisation’s and sector’s diversity management. Slide 16 Janice Dreaschlin has proposed a framework for measuring Diversity – in a five- stage model based on her case study research of health care organisations. The five steps are: 1. Discovery – an organisation’s emerging awareness of cultural diversity as a significant strategic issue. • Routinely gather information about cultural diversity of the local population in your services catchment areas • Acknowledging the need for training to manage a culturally diverse workforce and to provide culturally appropriate care 2. Assessment – a systematic review of organisational climate and organisational culture with regards to cultural diversity. • Measures of employee and client satisfaction across cultural groupings are conducted and are openly communicated to employees/ the community • A committee or taskforce monitors the cultural diversity climate of the organisation 3. Exploration – systematic training initiatives to improve the organisation’s ability to effectively manage diversity • A systematic assessment of the organisations climate and culture is used to design diversity training which uses a peer learning model. • Resistance to training is discussed openly 4. Transformation – fundamental change in organisation practices resulting in organisational climate and culture where organisational diversity is valued and, Human Resource • There is systematic identification and support of culturally diverse employees with potential for advancement to more senior roles Care • Corrective action is taken on complaints when frequency or type of complaint varies by culture Leadership • Organisation executive management is enthusiastically committed to a diversity agenda 5. Revitalisation – Renewal and expansion of cultural diversity initiatives. That is, diversity management is embedded within the organisation for the long haul. The importance of an investment in continuing to build organisational capacity was clearly identified the Hogan report “Reforms in management capability are fundamental to the development of the capacity of the industry to meet future challenges”. I mentioned earlier that the issues facing our CALD clientele are magnified by issues of inadequate resourcing within the industry now. One of the most significant challenges facing our industry is a chronic workforce shortage. Slide 17 – Workforce development It is ACCV’s view that the time has come for Government to substantially increase its investment in aged and community care with a core focus on building industry sustainability. Warren Hogan commented about our industry. “Within the industry there is a growing number of innovative, high performing facilities of all sizes, in all geographic regions and with a strong consumer focus. Relieving immediate pressure will result in some short term improvements. But it will do little to hasten industry maturity if no other action is taken.” He goes on to recognise; “An adequate and professionally trained workforce is critical to improving quality and level of service, and to lay the groundwork to meet increasing demand in the future. With respect to aged care alone, the Review estimates that the annual shortfall in commencing registered nurses over the next decade will be over 750.” And so, our capacity to fully address the challenges raised in the CALD Issues Paper is substantially tied to our ability ensure we have a sustainable long term industry – and our workforce development is central to this goal. The recently released report from the 19 organisations in the Victorian Community Care Coalition – titled ‘Moving to Centre Stage’ – noted key measures already identified as priorities in the Productivity Commission. These include: • Training more health care workers; • Utilising skilled overseas workers; • Increasing focus on health promotion; • Addressing key issues of recruitment and retention; • Job redesign; and • Increasing the efficiency and effectiveness and responsiveness of the current workforce. Let us not underestimate the workforce challenges facing priorities. Also, let us not underestimate the vital importance of the Government addressing key issues related to red tape. At the recent launch of our state election campaign, one resident asked to speak. She said: “I wish the staff had more time to care for me instead of being caught up in paperwork. Just a bit more time would be great.” A collaborative and consistent strategy between Government and providers is essential. We each have our respective roles and responsibilities – we need to share a common vision and action plan. However, in the lead up to this year’s federal election, the time has come in our view for aged and community care to be a central issue for all political parties. CALD issues and diversity in aged care are part of our industry priorities and commitments. In conclusion: Slide 17 Culture is patterned, it is not arbitrary. It involves rituals actions, shared understandings and expectations,. Cultural rules govern the most ordinary actions, including those actions which we take for granted and that affect our health: how we eat, rest and recreate. We are all of and within culture. Thank-you ladies and gentlemen.