A blog post written by Dr. Georgia Rowley
Anonym
In this blog, a recently published paper by Dr Georgia Rowley, Professor Jennifer Tieman, and Dr Kelly Jones is discussed. The paper relates to work conducted for End of Life Directions for Aged Care (ELDAC) project, funded by the Department of Health to support the provision of quality care for older Australians at the end of life, by connecting aged care staff with palliative care and advance care planning information, resources and services.
The Royal Commission into Aged Care Quality and Safety provided evidence of the importance of population diversity for consumer directed, person-centred care within the aged care sector. This blog reflects on the development and utilisation of informational webpages for the aged care workforce supporting diverse populations. Content was created for the ELDAC website, based on rapid review findings relating to barriers and limitations for people accessing equitable aged care and palliative care. Australia’s future population will age with increasing diversity markers, with implications for aged care and palliative care service provision. Workforce access to up to date, relevant and evidence informed information on best practice non-clinical support for individuals from diverse backgrounds towards the end of life is required. Webpages contained embedded links to useful content and resources for health professionals and care workers who work with older diverse adults. Data shows that these webpages are being utilised increasingly over time and are filling a gap in accessible end of life resources which has been missing from the Australian aged care and palliative care workforce.
Older people are diverse in terms of their culture and language, gender and sexuality, socio-economic background, religion and spirituality, geographic location and life experiences. Australia’s legislative, policy, system, and societal responses to ageing acknowledge a human right to person-centred care reflecting diversity of individual identities. Despite expectations that aged and end of life care provision will address people’s unique requirements, there are currently gaps in access and provision of culturally appropriate and safe care. Older people with diverse needs often have challenging experiences accessing and receiving optimum end of life care or experience disparities in the quality and safety of health care. Differing levels of disadvantage may apply across different groups and to differing levels across individuals.
The Royal Commission has highlighted diversity as critical to the aged care system and to providers. The Aged Care Quality Standards stipulate that older Australians with different social, cultural, linguistic, religious, spiritual, psychological, medical and care needs and life experiences should be able to access respectful, appropriate, fair, inclusive, sensitive, culturally safe and trauma-informed care. The principles of the diversity framework also need to be applied to an end-of-life context, where equitable care is paramount to health and quality of life. Person-centred care for older Australians in this context means being supported to live in accordance with their preferences, needs, and goals (including culture, language, sexuality, faith and identity) towards the end of life and having greater choice and control of their care.
Enabling access to trustworthy online resources and developing specific resources and hosting information that is relevant for the aged care workforce and services is an essential precursor to knowledge uptake and knowledge application within aged care. By creating diversity specific webpages with implications for end-of-life care, aged care organisations, providers, services and staff can build their personal knowledge, develop local guidance or support broader service and organisational initiatives around diversity, equity and access. Access to relevant information and tailored approaches for those with diverse requirements is fundamental to care planning and delivery for individuals at the end of life, and promotes engagement with the Aged Care Standards by supporting person-centred care.
The specific groups of older Australians identified for the development of information on the ELDAC website were based on the Aged Care Act 1997’s recommendations, namely, people from Aboriginal and Torres Strait Islander communities, non-English speaking backgrounds, people living in rural or remote areas, financially or socially disadvantaged individuals, veterans, people who are homeless, care leavers, and the LGBTI community. ELDAC recognised carers and those with diverse spirituality and faith beliefs as additional groups for whom tailored information was needed.
Webpage content was informed by individualised rapid reviews of existing literature and resources, with searches primarily focusing on the intersection between ‘diversity’, ‘aged care’, ‘palliative care’ and ‘advance care planning’. Google Analytics monitored patterns of use as an indicator of user and sector engagement with the webpages. Analytics show that the webpages resulted in 5,283 new website users during a one-year period and attracted 22,815 page views. The CALD and Aboriginal and Torres Strait Islander webpages attracted the highest views over the reporting period.
It is a societal expectation that health professionals and aged care staff will provide equitable care to all older Australians. Being marginalised or identifying with diverse identities is often a barrier to receiving appropriate care and support as an older adult and towards the end of life. Caring for all older adults towards the end of life requires staff to be aware, sensitive and empathetic to different life experiences and backgrounds. These ELDAC webpages and their use since publication highlight the recognition of the aged care workforce on respecting diversity of individuals and address some of the key considerations towards end of life for various groups.
Culturally safe and trauma-informed models of care are essential in building trust, facilitating communication and social connection, and appreciating culture and other forms of connection with people of shared experience and background. A systemic response is required to appropriately care for those with diverse needs and to appreciate the intersectional experiences of exclusion, discrimination and stigma experienced by many older Australians over the life-course.
Access to information and resources are a critical first step in providing culturally sensitive and trauma-informed care in aged care settings. Many workers feel ill prepared for such considerations, especially when working with older diverse adults at the end of life. To learn more, visit the webpages: https://www.eldac.com.au/tabid/5031/Default.aspx, or download our paper: https://www.publish.csiro.au/PY/justaccepted/PY21084
Dr. Georgia Rowley
Research Fellow (SWIRLS), College of Education, Psychology and Social Work, Flinders
Member, RePaDD