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Tuesday, August 9, 2022

Speaking the same language: the incredible importance of embedding linguistic services

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Culturally and linguistically sensitive care is not just a nice thing to have in aged care: it is a vital component of ensuring equitable health outcomes for all elders, no matter their origins.

This is a point recently confirmed by new research from the CMAJ (Canadian Medical Association Journal), that showed that older, culturally and linguistically diverse (CALD) patients who received care in their first language had shorter stays in hospital, fewer falls and infections, and were less likely to die within the study period.

And these benefits were anything but insignificant.

CALD elders receiving care in their first language, where that language was one other than English or French (Canada’s two most dominant languages), saw a 54 per cent reduction in risk of death.

These are staggering findings that make a strong case for providing care in the same language for linguistic minorities in hospitals.

University of Ottawa’s Dr Peter Tanuseputro

Harms while in hospital were also substantially reduced for patients who received language-concordant care.

Dr Peter Tanuseputro, co-author of the study and public health and preventative medicine researcher at the University of Ottawa, says that these findings are an eye-opening insight into how cultural dimensions can make tangible impacts on health care outcomes.

“These are staggering findings that make a strong case for providing care in the same language for linguistic minorities in hospitals,” he says.

Emily Seale, lead author of the study and medical student at the University of Ottawa, says that these findings show the importance of embedding linguistic services within healthcare practice.

“We need to do more to make sure that patients are heard and understood, whether that’s by referring to physicians who speak the same language or by using interpreter services.

“This is not only good patient-centred care, but our research shows that there are grave health consequences when it doesn’t happen.”

Slovenian-born writer and translator Danijela Hlis is a member of the Federal Government’s Council of Elders, and has been advocating for this for years.

We need to do more to make sure that patients are heard and understood, whether that’s by referring to physicians who speak the same language or by using interpreter services.

University of Ottawa’s Emily Seale

She tells Aged Care News that this is a pertinent issue for the 30 per cent of Australians who primarily speak a language other than English.

“Imagine being stranded in a foreign country, let us say Japan, feeling lost and unwell,” she explains.

“You stop a passer by and ask for a doctor, a toilet, hospital.

“People look at you and don’t speak English. They attempt to reply, but you cannot understand; they speak Japanese.

“You may just collapse, feeling scared and unwanted.

“Now you may understand how some 30 per cent of senior Australians feel: unwanted, scared, misunderstood, because of language or cultural difference.”

Danijela Hlis is a writer, bi-cultural support worker and aged care advocate, and says that care provided in an elder’s first language can have a transformative effect on their health outcomes.

Having worked as a bi-cultural support worker, Hlis says that she has personally experienced the degradation in health outcomes indicated by the Canadian study, whereby linguistically appropriate care is denied.

“Clients become incontinent earlier, because their simple request to help them find a toilet is not understood by staff.

“Those in early stages of dementia see the illness progress much quicker, because they are left alone and unsupported, not understood, for long periods.

“I have seen clients placed in dementia units where they did not belong. A client died of heart attack that was mistakenly diagnosed as sadness,” she says.

“I met families where the father stopped talking, because he had reverted to his mother tongue and no one could speak it, and mothers were prescribed antipsychotics just because they screamed in frustration, when all they asked for was to be allowed to pray before being put to bed.

“The sad stories — there are too many.”

In response to this, Hlis advises that the system needs to innovate immediately, developing new ways to integrate CALD care as a right for all elders receiving aged care.

“We have to accept responsibility and legislate, not recommend,” she says.

Clients become incontinent earlier, because their simple request to help them find a toilet is not understood by staff. Those in early stages of dementia see the illness progress much quicker, because they are left alone and unsupported, not understood, for long periods.

Writer and translator Danijela Hlis

“We can avoid misdiagnosis, even death. We can manage pain better. We can differentiate between depression and anxiety attacks.

“Above all, we can show each other that we care. That we accept that we all have equal human rights to healthy living and quality care.”

Hlis comes to the table with a list of key recommendations that she hopes government will take heed of:

  1. Inclusion in a health professional’s duty of care the need to engage an interpreter as soon as it is clear the patient/client proficiency in English is insufficient.
  2. Training in ethnic specific care and cultural diversity for aged care management as well as workers in all organisations providing care to elders.
  3. Development of an online library that lists all available bi-cultural tools, apps, programs, resources and facilities.
  4. More research that includes participants from First Nations and CALD backgrounds, with close attention to their personal, lived experiences.
  5. Policy makers need to genuinely visit communities and ask First Nations and CALD Australians as to what they need. This can be assisted via organisations such as FECCA, PICAC, the Centre for Cultural Diversity in Aging, NARI, state level ethnic councils, etc.
  6. Bi-cultural workers should be commonly employed in aged care, and be a requirement for accreditation where a service provider is claiming to be “ethnic specific”.

“It may look difficult to achieve,” Hlis says.

“It has been put into the too hard basket for decades, but it is only a matter of whether we care or not.”

It is not possible that we all speak many languages, but it is necessary that we all make an effort to communicate better, to use bi-lingual tools and apps, that important information is translated, and that we use interpreters.

Hlis says that she understands that aged care workers may find it difficult to attune themselves to added cultural and linguistic needs on top of their current workloads, but says every little effort helps.

“It is not possible that we all speak many languages, but it is necessary that we all make an effort to communicate better, to use bi-lingual tools and apps, that important information is translated, and that we use interpreters.”

“Staff willing to learn just six or seven major words in a client’s language will have a happy client and therefore an easier workload.

“And, of course, the use of universal body language is a must.

“Words must say the same things as body language.”

CALD specific care, maintains Hlis, is a vital part of elevating Australia’s aged care system from barely scraping bare minimum, to a system providing genuine care and comfort for the older generation.

“From my personal experience, when an elder or a senior receives care that is appropriate to his or her language and culture, the person is likely to blossom.”

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