Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 11
CULTURAL ISSUES
Australia has a rich multicultural population. According to the 2001 census, 22% of Australia’s
population was born overseas representing over 200 different ancestries. [352] Recent statistics
indicate that 25% of permanent residents in RACFs were born overseas and 13.6% were from
countries or regions other than Oceania, the UK, Ireland and North America. Almost 60% of
these residents live in either New South Wales or Victoria. [353] As migration to Australia is as
old as European settlement itself, many other residents would have had parents or grandparents
born in these other regions, although a statistical enumeration is not available. Residents and
family members from culturally and linguistically diverse populations may have particular needs
that members of the aged care team should address in order to provide compassionate and
effective palliative approach to care.
Definitions of culture refer to a set of beliefs, values, norms and practices that are learned,
shared, and dynamic and which influence individuals’ thoughts, expressions and actions in a
patterned way. Culture is not static; it changes over time and place and between and within
persons. No individual can be reduced either to a simplistic set of cultural norms or to a set of
exotic or quaint rules.
Multiculturalism is now a defining characteristic of contemporary Australian life. Not only
are there many cultural groups but, importantly, many relationships exist between groups.
Within nations, societies and communities there are dominant and marginalised cultures. The
dominant culture of an RACF may favour certain styles of behaviour and ways of talking and
interacting, and privilege certain residents over others.
Conflicting points of view often centre on what the notions of equality and equity involve. Some
argue that it means treating everyone in the same way. Others argue that it means acknowledging
difference, especially when that difference is associated with disadvantage. However, one of the
issues that is clear in Australia is that power is not distributed evenly within or between cultures.
The dynamics of power relationships and the way they affect individuals and groups must be an
integral part of our understanding of cultures. Such an understanding is essential for the creation
of RACF environments and guidelines that will value diversity, and thus promote the emotional
and physical health of all members of that community.
All residents require careful assessment to ensure that assumptions are not made for cultural
needs based on a resident’s language abilities alone. The need for the aged care team to
understand the health and caring perspectives of different cultural groups is especially
important in the context of a palliative approach. It is often at this stage that residents and
families turn to more culturally familiar and comforting beliefs and practices. It is considered
that the aged care team cannot provide a sensitive palliative approach to minority ethnic groups
unless there is a greater understanding about the meaning of death and dying from the cultural
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