Migrants and aged care
It’s been decades since Tinie Nieuwenhoven lost her mother, but she still recounts those final days with sadness.
“I had a good mother,” she said. “She developed cancer – I’ve forgotten the name – and then she got better … But when my father died, she got the cancer back again and she became quite incapable of looking after herself; she was too frightened.”
It was the late 1980s when Nieuwenhoven and her siblings began to notice their mother could no longer communicate with them in English.
“She couldn’t speak the language at all, and she was quite fluent in English,” Nieuwenhoven told the Royal Commission into Aged Care Quality and Safety late last year. “But my brother said one day, ‘For goodness sake, go and see Mother, I can’t understand her at all. She is yabbling away in Dutch.’ ”
Having emigrated from the Netherlands to Australia with her husband in 1956, Nieuwenhoven’s mother began to revert to her first language as her health deteriorated – a common occurrence among elderly migrants. At the time, she was in hospice care.
“Which I thought was very sad,” said Nieuwenhoven. “Because in her dying days, there was nobody that could assist her.”
Nieuwenhoven told the commission there was a lack of culturally appropriate services to care for her mother, and it was this gap that prompted her to set up an aged-care home in Adelaide in 1993 to specifically address the needs of elderly Dutch migrants.
Yet the challenges experienced by Nieuwenhoven and her family more than 30 years ago still affect many older migrants. Several organisations representing elderly people from culturally and linguistically diverse (CALD) backgrounds are now calling on the royal commission not to overlook the needs of these communities.
According to the national body representing Australians from migrant and refugee backgrounds, the Federation of Ethnic Communities’ Councils of Australia (FECCA), a third of older Australians are from a CALD background.
FECCA chair Mary Patetsos says Australians from these communities face inequitable access to aged-care services, which includes “the unavailability of culturally sensitive care and the loss of English language proficiency, which is common in those with dementia”.
While ethno-specific residential aged-care facilities with bilingual staff do exist, these are largely limited to established migrant groups such as the Greek, Lebanese and Italian communities. Newly emerging groups, including Horn of Africa communities, lack access to such services.
The federal government has acknowledged the importance of having bilingual workers to help meet the demands of an ageing population.
“Aged-care providers have identified a need for bilingual carers, as elderly people or those with dementia may revert to their native language or lose the ability to speak a second language,” said Minister for Immigration, Citizenship and Multicultural Affairs David Coleman.
However, in a statement to The Saturday Paper, a spokesperson for the federal Department of Health says the government “does not currently have any training program in place specifically targeted at aged-care workers who speak languages other than English”.
“Older CALD Australians in care need fully funded interpreter services available to help them properly communicate with medical practitioners and other essential service providers to ensure their needs are met,” says Patetsos.
In late October, the aged-care royal commission tabled its interim report, prompting the announcement of a new $537 million package from Prime Minister Scott Morrison.
Patetsos says she was disappointed that issues relating to older Australians from culturally diverse backgrounds were not addressed in the interim report, nor in the government’s response. She remains hopeful, however, that these issues will form part of the final report.
According to research conducted by the University of New South Wales, nearly 40 per cent of front-line care workers in Australia in 2016 were foreign born, up from about 30 per cent five years earlier.
This number is likely to grow. In 2018, the federal government introduced a special visa targeting overseas workers to support older Australians from multicultural backgrounds.
At the time, Minister Coleman said the visa arrangements would “allow aged-care facilities to access a personalised visa arrangement to hire employees with the skills to cater for the needs of their communities’ elderly”.
But Patetsos says attracting more aged-care workers on skilled visas is not the solution. “There needs to be a focus on developing the capability of the workforce, which itself is one of the most diverse in the nation,” she says.
Mary Karras of the Ethnic Communities’ Council of NSW agrees.
“Building the capacity of our local workforce needs to be the priority,” she says. “I think what’s important is having those cultural sensitivities and having that cultural knowledge and understanding, and that might not necessarily involve speaking the language.”
While policymakers deliberate on how best to address these challenges, some community groups are taking matters into their own hands.
In a small room at the back of a community centre in Melbourne’s south-east, 20 sprightly elderly men from the local Sri Lankan Tamil community have gathered to play cards and board games. On one side of the room is a small table adorned with plastic flowers and foil bunting stuck on the wall with “Happy Birthday” scrawled across it. A small whiteboard marks that one of the members is celebrating his 67th birthday. Namasivayam Balasubramaniam, 90, is playing bridge with a few friends and says he’s been coming to the weekly gatherings since the mid-1990s.
“We’re all seniors, we celebrate our birthdays,” says Balasubramaniam. He tells me he lives by himself because his wife is in an aged-care home. Although the council sends a van to assist him with his weekly grocery shopping and cleaning, he says it does get quite lonely.
“Here, we come and talk and relax and we feel very happy. It’s talking to people, otherwise you feel very tense staying alone,” he says.
Dr Amirthalingam Thevathasan agrees. “After retiring, I was just staying at home. I felt I was too old and got depressed with nothing to do. After coming here … I am energised,” he says.
The men are members of the Tamil Senior Citizens Fellowship of Victoria. The group holds weekly and monthly events to engage its members in mentally stimulating activities. The group has been operating for more than three decades and comprises about 300 retirees between the ages of 60 and 90.
Fellowship president Ponniah Anandajayasekeram says the organisation has been able to provide culturally appropriate support to seniors in the Tamil community in home care.
“Traditionally, our elders don’t go for aged-care homes. We believe in the extended family system and the children taking care of their elders. In Sri Lanka, it’s very rare for people to be sent to aged-care homes. They also have a community of friends and relatives so that they are not isolated, and they are never alone,” he says.
He adds that the support system changes with migration. “First generation manage to keep the elderly parents with them. But the socioeconomic situation is changing. Increasingly, both husband and wife have to work, and they have their own kids. There are so many demands on their time, although there is a willingness. But they are physically and economically unable to. So increasingly our people will end up in aged-care homes,” he says.
Anandajayasekeram hopes the royal commission takes into consideration the role community organisations play in supporting the elderly. “Those organisations that are established by the communities on a voluntary basis complementing the aged-care facilities should be supported,” he says. “We wanted to make sure the royal commission does not bypass that particular step.”
The aged-care royal commission is set to provide its final report by November 12, 2020.
This article was first published in the print edition of The Saturday Paper on Jan 25, 2020 as "Language warriors". Subscribe here.