The Importance of Cultural Awareness in Home Care

Care clients come from vastly different backgrounds and have varied life experiences. Having knowledge of and respecting an individual’s cultural background is crucial to being able to provide person-centred care.

Diversity in Home Care

As a healthcare worker, you should be able to appropriately and sensitively care for clients of all backgrounds, including:

• People from culturally and linguistically diverse (CALD) backgrounds
• Aboriginal and Torres Strait Islander peoples
• Members of the LGBTQI community
• People living in rural or remote areas
• People living with mental illness
• People living with cognitive impairment (e.g. dementia)
• People living with disability
• People who have been separated by their parents by forced adoption or removal
• Care leavers
• People who are homeless or at risk of becoming homeless
• Veterans
• People living in socio or economic disadvantage.

(DoH 2017)

Cultural Awareness in the NDIS Practice Standards

Individual values and beliefs is a requirement of the NDIS Practice Standards under Core Module 1: Rights and Responsibilities.

This Practice Standard aims to ensure that NDIS participants receive supports that respect their culture, diversity, values and beliefs (NDIS 2020).

NDIS providers must meet the following quality indicators:

• Participants’ cultures, diversity, values and beliefs are identified and responded to sensitively, at the participants’ direction
• Participants are supported to practice their culture, values and beliefs whilst receiving care.

(NDIS 2020)

What is Cultural Awareness in Healthcare?

Culture is fundamental to how we live our lives. It informs our way of life and is based on customs, beliefs, language and experiences shared with others (Rawson 2019).

Cultural awareness involves being mindful of the similarities and differences between cultures, and using this to inform your care of and communication with members of different cultural groups (HETI 2018).

When caring for clients, it is essential to act in a way that recognises, respects and nurtures their identity, while ensuring you meet their needs, expectations and rights. Instead of working from your own perspective, it is important to consider the cultural perspective of the person you are caring for (HETI 2018).

You can make a difference in the lives of your clients by doing your own research (see SBS's Cultural Atlas) and by incorporating cultural awareness into your care.

Cultural Diversity in Numbers

Almost 30% of Australians were born outside of Australia (ABS 2021), and almost 18% were born in a predominantly non-English speaking country (PHIDU 2017).

Language Barriers in Home Care

Language barriers have been found to have significant adverse effects on care, including:

• Increased difficulty accessing healthcare
• Poorer health outcomes
• Reduced satisfaction for both the client and staff
• Decreased quality of care
• Increased costs and time required for services due to the need for interpreters.

(Shamsi et al. 2020)

Providing Culturally Safe Care

The following is crucial in providing effective care to clients from culturally and linguistically diverse backgrounds:

• Consult with clients and their families/carers about aspects of their cultural traditions or religion that are important to them
• Access resources that can help you gain insight into different languages, ethnicities or religious traditions and migration/refugee experiences of older migrants in Australia
• Use culture-specific information as a guide to facilitate questions - as not all people from the same cultural or religious background identify in the same way
• Always avoid stereotyping and making assumptions about someone else’s culture, heritage, language or needs
• Be aware of judging other people's behaviour and beliefs according to your own life experiences
• When required, involve an interpreter in the client’s care. If this isn’t possible, work with their family to create a list of important words or phrases for staff. They may include: ‘Are you comfortable?’ Or ‘Are you in pain?’
• Ensure the client is not isolated in their care. Ways to prevent this may include engaging with their cultural community or asking volunteers to visit the client.

(Centre for Cultural Diversity in Ageing n.d.; Rawson 2019)

Culture-specific information allows us insight into the lives of people who share ethnicity, language, religion or other characteristics that individuals identify with, or groups that they belong to (Centre for Cultural Diversity in Ageing n.d.).

While culture-specific information will inform your work with individual clients, keep in mind that within any cultural group, peoples' values, behaviour and beliefs can vary greatly (Centre for Cultural Diversity in Ageing n.d.).

ABCD for Cultural Assessment

Learn and remember the ABCD Cultural Assessment Model developed by Kagawa-Singer & Backhall (2001). Make it part of your routine to take time to discuss the following with the clients in your care, as well as their families:

A - Attitudes

• Traditional healing practices as well as Western healthcare
• What illness and care mean to them and their family
• How they prefer to communicate about diagnosis and prognosis.

B - Beliefs

• The client and their family’s religious and spiritual beliefs - particularly in relation to death, dying, the afterlife and healing
• How they and their family cope with suffering
• How you can accommodate and support their spiritual and religious needs.

C - Context

Determine the historical and political context of the client and their family’s lives. This may include:

• Place of birth
• Refugee or immigrant status
• Poverty
• Socioeconomic status
• Experiences of discrimination
• Health disparities
• Language/s spoken
• Degree of support from and integration with their cultural community and their degree of assimilation into Western culture.

D - Decision-making style

Find out how decisions regarding healthcare are made in the resident’s culture and family, whether they prefer to make decisions as a group or if it is mostly up to the individual.

E - Environment

Determine whether there are community resources available to clients and their families.

(Kagawa-Singer & Backhall 2001, cited in Levett-Jones 2016)

Remember respecting the dignity and human rights of each resident is fundamental to providing quality care.

Additional Resources

• Cultural Atlas | SBS
• Advocates and Language Services | Ausmed Article
• The Health and Care of First Nations Australians | Ausmed Article

References

• Australian Bureau of Statistics 2021, Migration, Australia, ABS, viewed 28 June 2021, https://www.abs.gov.au/statistics/people/population/migration-australia/latest-release
• Centre for Cultural Diversity in Ageing n.d., Practice Guides, Centre for Cultural Diversity in Ageing, viewed 9 January 2020, http://www.culturaldiversity.com.au/service-providers/practice-guides
• Department of Health 2017, Aged Care Diversity Framework, Commonwealth of Australia, viewed 28 June 2021, https://www.health.gov.au/sites/default/files/documents/2019/12/aged-care-diversity-framework.pdf
• Health Education and Training Institute 2018, Cultural Awareness, New South Wales Government, viewed 28 June 2021, https://www.heti.nsw.gov.au/education-and-training/courses-and-programs/international-medical-graduate-information/cultural-awareness
• Levett-Jones 2016, 'Cultural Competence and Patient Safety - ABCD for Cultural Assessment', Ausmed, viewed 13 January 2020, https://www.ausmed.com.au/cpd/articles/cultural-assessment
• NDIS Quality and Safeguards Commission 2020, NDIS Practice Standards: NDIS Practice Standards and Quality Indicators, NDIS Quality and Safeguards Commission, viewed 22 July 2021, https://www.ndiscommission.gov.au/sites/default/files/documents/2019-12/ndis-practice-standards-and-quality-indicators.pdf
• PHIDU 2017, People Born in Predominantly Non-English Speaking Countries, 2016, Torrens University Australia, viewed 28 June 2021, https://phidu.torrens.edu.au/notes-on-the-data/demographic-social/nes-countries
• Rawson, H 2019, ‘Nursing Homes for All: Why Aged Care Needs to Reflect Multicultural Australia’, The Conversation, 7 October, viewed 13 January 2020, https://theconversation.com/nursing-homes-for-all-why-aged-care-needs-to-reflect-multicultural-australia-123373
• Shamsi, H A, Almutairi, A G, Mashrafi, S A & Kalbani, T A 2020, ‘Implications of Language Barriers for Healthcare: A Systematic Review’, Oman Medical Journal, vol. 35, no. 2, viewed 28 June 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/