Posted in Caregiving, International Campaigns, Research & Best Practice, The Built Environment

Nursing homes for all: why aged care needs to reflect multicultural Australia

Do nursing home staff know and respect your cultural background or language? Here’s why that’s important.
from www.shutterstock.com

Helen Rawson, Deakin University

This week, the aged care royal commission looks at diversity in aged care, an issue becoming increasingly relevant to both residents and the staff who care for them.

Diversity includes gender, sexual orientation, religion and social background. The issue is important because if we aim to offer older people and families choice and control in aged care, we must meet the diverse needs of all older people.




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Australia’s rich diversity is reflected in its older population. In 2016, more than one-third (37%) of Australians aged 65 and over were born overseas and one-fifth (20%) were born in a non-English speaking country.

These figures have increased continually since 1981, when one-quarter (25%) of older people were born overseas.

Diversity within diversity: culture and language

Culture is important for every person. It indicates a way of life based on customs, beliefs, language and experiences shared with family and a wider community or group.

According to the Federation of Ethnic Communities’ Councils of Australia, many people from culturally and linguistically diverse backgrounds don’t want to move to a nursing home. This is for a number of reasons.

They may not want to be away from family and community, they might speak a different language to staff and other residents, and homes may not understand or meet their individual cultural needs.

Our previous research showed living in an aged care facility could make some older people feel disempowered. Language and cultural diversity can further add to that disempowerment. For the older people we studied, communication, companionship, and staff knowing them as individuals was very important.




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Language is particularly important for older people’s physical health and well-being. Many culturally and linguistically diverse older people say they speak English well. However, with age and cognitive decline, they may lose the ability to communicate in English and revert to their first language.

And as more than half of nursing home residents have dementia, with the associated deterioration in language and cognition, communication can be more difficult still.

Appreciating someone’s cultural background can help residents make friends.
from www.shutterstock.com

Being aware of their peer’s culture and language can help residents build relationships with each other, family and staff.

Different cultural expectations and language barriers can create misunderstanding and resident and family dissatisfaction. This can affect residents’ care and quality of life.




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How can we support appropriate care?

Aged care needs to be responsive, inclusive and sensitive to a person’s culture, language and spiritual needs. So it is important for nursing homes to understand those needs.

For those who are culturally diverse, government-funded support and culturally specific nursing homes can help. These include services for Greek, Italian, Dutch, Jewish and Chinese older people, reflecting post-war migration.

However, organisations like these cannot meet everyone’s needs. So all residents need care that respects cultural and social differences, works with older people and family, and supports choice.




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What might appropriate care look like?

Staff need ongoing cultural competence training to deliver appropriate and supportive care.

Staff cannot know everything about the many cultural and language groups in Australia. They can, however, practise in way that is culturally appropriate, by:

  • never making assumptions about someone’s culture, heritage, language or individual needs. No two people are the same, even if they are from the same culture and language background

  • talking to the resident with an interpreter, if needed

  • learning what is important to the resident. For example, staff could ask family members or close friends to bring in photos or mementos important to the older person

  • talking with family of residents who are unable to communicate in English to make a list of key words or phrases for staff. This could include how to say “hello”, or how to ask “are you comfortable?”, or “are you in pain?”

  • making sure the older person isn’t isolated in the nursing home. This could involve working with the local community of the person’s culture, and asking for volunteers who could come and visit the older person.

Family members can be a huge help to staff in understanding the resident’s language, culture and preferences.
Nadya Chetah/Shutterstock

Appropriate and respectful aged care is a human right

Culture and language diversity in aged care is a fundamental human right. Embedding diversity in all aspects of aged care is also recognised by government, and in how the quality of aged care is assessed.

New aged care quality standards, which came into effect this July, include being treated with dignity and respect, with identity, culture and diversity valued, and all residents able to make informed choices about the care and services they receive.




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If the outcomes of this royal commission are to benefit Australians now and especially in the future, older people from culturally and linguistically diverse backgrounds must not be an afterthought in the aged care discussion. They must be part of the planning.The Conversation

Helen Rawson, Senior Research Fellow, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving, International Policies, Research & Best Practice, The Built Environment

Empathy, a key ingredient in culture change

News Release
April 2019 | University of Pennsylvania – Empathy and cooperation go hand in hand

Taking a game theory approach to study cooperation, School of Arts and Sciences evolutionary biologists find that empathy can help cooperative behavior ‘win out’ over selfishness.

It’s a big part of what makes us human: we cooperate. But humans aren’t saints. Most of us are more likely to help someone we consider good than someone we consider a jerk.

Two figures have heated discussion as a third in the middle observes
Taking the perspective of another can help foster cooperation in a group, according to a new study by Penn evolutionary biologists.

How we form these moral assessments of others has a lot to do with cultural and social norms, as well as our capacity for empathy, the extent to which we can take on the perspective of another person.

In a new analysis, researchers from the University of Pennsylvania investigate cooperation with an evolutionary approach. Using game-theory-driven models, they show that a capacity for empathy fosters cooperation, according to senior author Joshua Plotkin, an evolutionary biologist. The models also show that the extent to which empathy promotes cooperation depends on a given society’s system for moral evaluation.

“Having not just the capacity but the willingness to take into account someone else’s perspective when forming moral judgments tends to promote cooperation,” says Plotkin.

What’s more, the group’s analysis points to a heartening conclusion. All else being equal, empathy tends to spread throughout a population under most scenarios.

“We asked, ‘can empathy evolve?’” explains Arunas Radzvilavicius, the study’s lead author and a postdoctoral researcher who works with Plotkin. “What if individuals start copying the empathetic way of observing each other’s interactions? And we saw that empathy soared through the population.”

Plotkin and Radzvilavicius coauthored the study, published today in eLife, with Alexander Stewart, an assistant professor at the University of Houston.

Plenty of scientists have probed the question of why individuals cooperate through indirect reciprocity, a scenario in which one person helps another not because of a direct quid pro quo but because they know that person to be “good.” But the Penn group gave the study a nuance that others had not explored. Whereas other studies have assumed that reputations are universally known, Plotkin, Radzvilavicius, and Stewart realized this did not realistically describe human society, where individuals may differ in their opinion of others’ reputations.

“In large, modern societies, people disagree a lot about each other’s moral reputations,” Plotkin says.

The researchers incorporated this variation in opinions into their models, which imagine someone choosing either to donate or not to donate to a second person based on that individual’s reputation. The researchers found that cooperation was less likely to be sustained when people disagree about each other’s reputations.

That’s when they decided to incorporate empathy, or theory of mind, which, in the context of the study, entails the ability to understand the perspective of another person.

Doing so allowed cooperation to win out over more selfish strategies.

“It makes a lot of sense,” Plotkin says. “If I don’t account for your point of view, there will be many occasions when I judge you harshly when I really shouldn’t because, from your perspective, you were doing the right thing.”

To further explore the impact of empathy on cooperation, the researchers looked at a variety of frameworks, or social norms, that people might use to assign a reputation to another person based on their behavior. For example, most frameworks label someone “good” if they reward a fellow “good” individual, but social norms differ in how they judge interactions with a person deemed bad. While the “stern judging” norm labels “good” anyone who punishes a bad actor, the “simple standing” norm does not require this punitive approach: A “good” person can reward a bad one.

Plotkin, Radzvilavicius, and Stewart discovered again that capacity for empathy mattered. When populations were empathetic, stern judging was the best at promoting cooperation. But when a group was less willing to take on the perspective of another, other norms maximized rates of cooperation.

This result prompted the team to ask another evolutionary question—whether empathy itself can evolve and become stable in a population. And under most scenarios, the answer was yes.

“Starting with a population where no one is empathetic, with people judging each other based on their own perspective, we saw that eventually individuals will copy the behavior of those who judge empathetically,” says Plotkin. “Empathy will spread, and cooperation can emerge.”

This was the case even when the researchers accounted for a degree of errors, noise, and misperception in their models.

The findings open up a new area of research for both evolutionary theory and empirical studies into how societies behave.

“Empathy is completely foreign to game theory,” Radzvilavicius say. “In a way this is finding a new niche for research to progress to in the future, accounting for theory of mind.”

Looking ahead, the Penn team hopes to pursue such questions, perhaps by pitting different social norms against one another and eventually by testing their ideas against observations from real people, either through experiments they design or through data collected from social media.

“It’s obvious that in social media people are acutely aware of their public persona and reputation and curate it carefully,” Plotkin says. “It would be fascinating to analyze these evolutionary dynamics as they play out in online interactions.”

The study was supported by the David and Lucile Packard Foundationand the U.S. Army Research Office (Grant W911NF-12-R-0012-04).

Joshua B. Plotkin is a professor in the Department of Biology in the University of Pennsylvania School of Arts and Sciences. He has secondary appointments in the Department of Mathematics and the School of Engineering and Applied Science’s Department of Computer and Information Science.

Arunas L. Radzvilavicius is a postdoctoral researcher in Penn’s Department of Biology.

Alexander J. Stewart is an assistant professor at the University of Houston and a former postdoctoral researcher at Penn.

Posted in Ageing & Culture, Caregiving, International Campaigns, International Policies

Where do Asian immigrants go when we have dementia?

My husband and I have been talking about kids for a long time now, and I’m certainly not getting any younger. As the days tick by and my facebook is filled with walls of baby photos in my activity feed, I wonder about having my own. On top of that I wonder what the future will hold for my children? I am Singaporean, my husband is Australian, our racial and cultural differences are vast. We look like chalk and cheese and our cultures are chalk and cheese. I am born and raised in Singapore and proud of it.

Looking back at my youth when I was growing up, the house was filled with an orchestra of languages. Instead of the wind, brass, drums and percussions, we had English songs from Abba, Michael Jackson, Kenny Rogers, playing on the radio. I remembered my mum even attended a Debbie Gibson concert. That was really cool! I remembered the souvenir she brought back, it was a fan in the shape of a blue hand, sounds odd now but when I was a kid, that was possibly super cool.

There would be English in the background, my great grandmother speaking in the Teochew dialect, my mum in Mandarin and my dad would speak in either English or Teochew. Sometimes I hear him speaking Malay to the man who comes to collect the payments for our daily newspaper. Singapore was an amazing melting pot of cultures and languages, and I embraced every crumb of the colourful heritage that I can call my own. There was never a dull moment growing up in Singapore, my childhood was certainly a happy one.

Image from abusymom.wordpress.com

My child will have an Asian migrant parent depending on where we will reside when we retire, and I often wonder what will happen to my children when I have dementia. Will they be able to speak my language if I regress to Mandarin or Teochew? Will I lose the ability to communicate because there will be no one who can understand me? I remember caring for a lady who spoke Russian and I would carry a notebook with me with some basic words like “dobroye utro” or good morning, “Da” for yes and “Net” for no, and about 20 other phrases for different times of the day and meals.  I wondered if her children could speak the language?

Sometimes I watch the western videos on nursing homes or visit residential aged care homes and I think, I’m never going to be comfortable in a place like this. It’s beautiful, no doubt about it, but there’s nothing familiar in the four walls. Even the people look foreign, no one speaks my language, the food is all wrong and if I were to live in a residential aged care facility, it would be like living in a foreign television show. I would think I was on the Truman show or something. I have only seen one Asian nursing home in Australia, the home is lovely, with Asian staff and sumptuous simple Chinese meals, with menus beautifully printed in Mandarin, but the environment itself looks like community hospital on the inside with nursing reception counters and a very modern western feel.

There are 10.6 million Asian immigrants in the United States of America in 2009, in the United Kingdom almost 10% of immigrants are from South Asia and in Australia a million immigrants were from Asia according to the statistics in 2011.

I wonder if I am the only person with these worries and thoughts? I wonder what happens to Asian immigrants who work long and hard to bring their children to the west, only to live out the end of their lives in confusing and disorientating environments? What can we do for them, and how can we make their lives better? Will there be more places that can cater for Asian migrants? Where can we go to feel at home when we have dementia?

I have no answers and only questions, hopefully, time will tell.

References:

Australian Bureau of Statistics 2004, ‘Where do the Overseas-born population live?’ in Australian Social Trends, cat. no. 4102.0, viewed: 18 May 2012, <http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/4102.0>.

Department of Immigration and Citizenship, Booklet 6, General Skilled Migration, viewed: 24 April 2012, <www.immi.gov.au>.

Australian Bureau of Statistics 2010, Migration, Australia, 2009-10, cat. no. 3412.0, viewed: 18 May 2012, <http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3412.0Main+Features12009-10>.

Salt, J. “International Migration and the United Kingdom, 2010.” Report of the United Kingdom SOPEMI correspondent to the OECD, Migration Research Unit, University College London, 2011.

U.S. Department of Homeland Security, Office of Immigration Statistics. 2010 Yearbook of Immigration Statistics.

I’ve attached a video that I found very moving about the trials and tribulations experienced by migrant parents to help people understand the difficulties of resettling and raising children in a foreign land. I also found a funny video about the same group of kids and parents imitating each other and that’s actually really funny.


Children Of Asian Immigrants Reveal Sacrifices Their Parents Made

Asian Moms And Their Kids Imitate Each Other