Linguistic diversity in aged care

With great diversity in Australia’s population, health care services are increasingly supporting patients from culturally and linguistically diverse backgrounds. Whatever the setting, high quality support depends on the ability of health professionals and those seeking support to engage effectively. However, the setting in which this is arguably most challenging is aged care.

Ageing is a complex and often challenging experience, and older people from non-English speaking countries are likely to experience challenges accessing and receiving aged care. In Australia, most aged care services are provided in the community (ie, in people’s homes). However, the bulk of government funding goes into residential aged care, which provides high intensity support and care for those who can no longer live independently. 

Consistent with Australia’s migration patterns, a growing number of people living in residential aged care were born in a country where English was not the dominant language and have a preferred language other than English. Despite a clear expectation that services and support accommodate the cultural and linguistic diversity among aged care residents (eg, the Aged Care Diversity Framework and the report of the Royal Commission into Aged Care Quality and Safety), there are significant gaps in how residents with diverse needs and preferences are supported.

Overall, residents who are born in non-English speaking countries may have higher needs for functional, behavioural and complex care. Low English proficiency, a common barrier to timely and appropriate support, has broader implications for positive health outcomes and is strongly associated with feelings of loneliness and social isolation. Cross-cultural communication challenges with staff, in particular, have a deleterious effect on the health, wellbeing and quality of life of older adults who prefer to speak a language other than English. In addition to language barriers, available aged care services may not be culturally appropriate, or may fail to meet the person’s needs. Particularly vulnerable are those living with dementia.

The extent of language diversity in aged care

In order to address these gaps in policy and practice, we need to better understand the extent of language diversity of aged care residents.

We undertook a secondary analysis of 2020–21 data from the Australian Institute of Health and Welfare (AIHW) National Aged Care Data Clearinghouse to identify the country of birth and preferred language of older adults living in residential aged care in Australia. Our findings were published in the Australasian Journal on Ageing in January 2024.

Our analysis identified the number of speakers of the top 20 preferred languages and sole speakers of a language in their facility, by state or territory. We distinguished between residents who were born in a main English-speaking country (such as Australia, the United Kingdom, the United States, Canada or New Zealand) and a non-main English-speaking country. However, we caution against assuming that a particular country of birth necessarily indicates language preference: people born in a main English-speaking country may prefer to speak a language other than English, while those born in a non-main English-speaking country may speak English as a first language. We also note limitations in our analysis due to missing or inconsistent data.

Through our analysis, we identified that permanent aged care residents represented 185 different countries and 80 language preferences. Of those, the 20% of residents who were born in a non-main English-speaking country would make up the entire population of, for example, Wangaratta (Victoria), Griffith (New South Wales) or Gympie (Queensland). Consistent with country of birth, patterns of migration and ageing in Australia, the most preferred languages other than English were Italian, Greek and Cantonese.

These speakers comprised half of all residents with a preferred language other than English. Looking further down the list, more than 500 residents spoke one of the top 12 languages other than English. One-fifth of those who spoke one of the 20 most preferred languages was the only person speaking that language in their facility. These numbers highlight the importance of culturally competent aged care.

Creating culturally appropriate care

In addition to language, person-centred care requires a clear understanding of a person’s cultural context. For example, there can be significant regional linguistic differences – including dialects – of the same language. Similarly, speakers of one language may come from culturally and linguistically diverse countries. As a result, even residents who share a language preference could be at risk of social isolation.

It is important to note that ethno-specific aged care is not necessarily the answer. Over the years, different studies have revealed contrasting findings on the extent to which ethno-specific and/or mainstream services can meet the cultural and linguistic needs of residents. Further, even if there is a preference for ethno-specific care, this is often not available to the majority of older people.

So, where does it leave us? The bottom line is that holistic and culturally appropriate care for linguistically diverse populations requires significant investment and innovation. We need to recognise and better support families of non-English speaking residents and facilitate cross-community and cross-facility cultural and linguistic connections.

We must continue building the capacity of aged care staff and leverage their cultural and linguistic skills more effectively. It is also crucial that we collect consistent and timely data on the cultural and linguistic backgrounds of both residents and staff and use that knowledge to optimise care. This information could be used more broadly to inform the ways of sharing multilingual care workers in the same region. The use of interpreters is an option, albeit less immediate.

Finally, investment and innovation must be based on robust data and clear evidence. Our work is one small step in that direction.

Dr Monica O’Dwyer is a Research Fellow at the Monash Centre for Occupational and Environmental Health, Monash University.

Dr Meg Polacsek is Communications, Advocacy and Grants Manager at the Australian Association of Gerontology.

This research was conducted in collaboration with colleagues Nikolaus Rittinghausen and Lisa Tribuzio  at the Centre for Cultural Diversity in Ageing and Tabitha Porter.