Unsupported at Home: Poor translations could impact CALD aged care access

Academics worry that failure to address cultural inclusion challenges linked to aged care assessment tools could continue to impact access to quality care for culturally and linguistically diverse (CALD) older people when Support at Home is introduced.

The research paper Towards cultural inclusion for older adults from culturally and linguistically diverse communities: A commentary on recent aged care reforms delved into the current state of play for culturally appropriate assessments.

It found that Support at Home is at risk of missing the mark if beneficial co-production collaboration is not embraced. 

The report’s authors include PhD student Samuel Dakey, from Western Sydney University’s MARCS Institute for Brain Behaviour and Development. He is also the Project Lead for the Brain Health Hub’s Rethinking Reablement project which aims to create a culturally informed wellness and reablement framework that can be translated into several languages. 

Mr Dakey told Hello Leaders he believed developing culturally tailored assessment tools that consider linguistic and cultural factors is necessary.

“Assessment frameworks determine what services culturally diverse older adults are eligible for. They also determine their needs, which is important for things like the upcoming Support at Home program,” Mr Dakey explained.

“The necessity arises from the opportunity. If we don’t do it, culturally diverse older adults and their support networks will not get the services they require to continue living at home. This could include necessary, critical services that need to be addressed for cultural and linguistic reasons, but they otherwise miss out on.”

Previous Western Sydney University research looked at co-production processes to translate psychosocial assessment tools to effectively evaluate social engagement and quality of life in older adults receiving aged care services.

The research found that many questions are inappropriate or hold negative connotations when translated into languages other than English.

“The recent trial of a single assessment tool revealed ‘unreasonable translated materials’. These were the words of assessors trying to use these materials,” Mr Dakey added.

Mr Dakey said questions such as ‘Do you get to yarn with your family and friends?’ did not align well with most culturally diverse older First Nations people. Meanwhile, ‘Are you valued by your family?’ also received negative responses.

Another question concerning ‘love and pleasure’ was misinterpreted when translated into Chinese as it was associated with sexual experiences when the real intent was to reflect enjoyment and happiness. 

“You can imagine how tense and uncomfortable these assessments were. Some of the assessment questions drew negative responses from older adults” Mr Dakey added. 

With an increased focus on ageing in the home, Mr Dakey said these issues could prevent older people from accessing aged care. 

“It’s not obvious how questions are understood when translated, especially to CALD communities which may have some scepticism about aged care. Some of them think aged care is synonymous with residential aged care. These are some of the challenges we are dealing with currently,” he explained. 

To combat this, Mr Dakey and his peers would like tailored assessment tools that utilise bilingual questionnaires and culturally responsive communication materials.

There is also a strong preference to include older people from CALD communities in the co-design process of these materials. 

This would help reduce the amount of time spent on assessments. Mr Dakey explained that assessments involving translators (in-person, over the phone or virtual) can last up to four hours. This is twice as long as assessments without interpreters. 

“While interpreters are useful and their access is being enhanced in remote areas, there’s evidence that community-based resources and face-to-face assessment are less stressful,” he said.

He is hopeful that aged care stakeholders will recognise the benefits of translated assessment tools sooner rather than later. 

“When you co-produce assessment frameworks with culturally diverse older adults, we know that that leads to better assessment experiences,” he added.

“But that’s not what we see in the Support at Home program. I think the program is lagging behind the evidence. It must catch up with the co-production strategies which reveal improved assessment experiences.”

Mr Dakey called on aged care stakeholders to be bold and work towards creating co-designed assessment tools with older CALD people. 

His latest project, Rethinking Reablement, is an opportunity for that to happen. The research project involves interviewing English-speaking and culturally diverse clients and service providers on their thoughts about existing and future wellness and reablement programs. 

The goal is to create a culturally informed framework that can be translated into Chinese, Vietnamese, Indian and Arabic and be used for wellness and reablement services. 

For more information on Rethinking Reablement or to register your interest, visit brainhealthhub.com.au/projects/rethinking-reablement.