Apr 04, 2019

Should Personal Carers Be Required To Pass The Same English Literacy Standards As Nurses?

Australia is one of the most multicultural countries in the world.

With a current population of almost 25 million people hailing from all across the globe, it should come as no shock that one out of every four people who live in this country are actually born overseas, and close to 50% of Australians have at least one parent who was born overseas.

This mix of ethnicities, belief systems, and traditions, has resulted in the current-day melting pot of creativity, vibrancy, and culturally infused flavour, that is weaved throughout the DNA of all of the major cities and suburbs of our great nation.

Brave people from all corners of the globe have made the trek from their homelands seeking the same opportunity and safety that many Australian born citizens take for granted.

These people have been a driving force in the rapid expansion of our cities and the staple of many of our most important industries for over 70 years.

Now in 2019, newly arrived immigrants are the ever-reliable backbone of Australia’s seemingly unreliable aged care system, and it is absolutely undeniable that the lives of many seniors currently living in residential aged care homes would be far worse without the contribution of the hardworking people who were born on foreign shores.

Understandably, English is a second language for a large portion of newly migrated Australians, and with that, can come a variance in accent and a lesser understanding of the terminology that older people in this country can use when speaking.

And while there are a number of non-verbal techniques that can enhance communication, issues that stem from this slight language barrier have been an ongoing gripe for many families with loved ones currently being cared for in aged care facilities, and the problem is almost exclusive to the hardworking individuals who are employed as personal carers.

Despite all of the hard work and good intent of personal carers, we constantly hear stories from members of the public with loved ones living in aged care, who feel that their family members quality of life is actually inhibited by their inability to understand and convey their thoughts to carers who were born overseas.

One anonymous family member told HelloCare “my father is in aged care, and the biggest challenge that he has is trying to understand the staff that looks after him.”

When you have spent some time in an aged care facility, it’s not hard to see how things like this can become a problem.

Older Australians are prone to a number of issues that can impair their ability to understand and effectively communicate in their native tongue, so it is easy to see how throwing in the element of a foreign accent or a limited vocabulary could easily compound their difficulties.

And while the quick-fix solution may appear to simply be, for aged care facilities to hire a workforce that suits their residents from a linguistic point of view, the fact of the matter is, one of the main reasons that the aged care workforce is made up of so many immigrant workers is that they are part of the small and dedicated group of people who are willing to put their hands up to do the job.

Low wages and the unglamorous reputation of the care sector has made it extremely difficult to attract new staff, and the increasing workloads and difficult working conditions have had a negative impact on the industry’s ability to retain current staff.

Minimal training and the lack of registration, coupled with the thirst for employees who are actually willing to do the job, have made the personal carer role a go-to opportunity for many people who have recently arrived on Australian shores.

Despite any problems that may exist relating to language and communication, all personal carers deserve nothing but praise for the amount of responsibility they take on, and when you consider just how much the ratio of personal carers outweigh the level of nurses that are rostered on at aged care homes around the country, you begin to realise just how invaluable this section of the aged care workforce is.

But, at the same time, it is also extremely understandable that families would want to know that their loved one is being cared for by someone that they have the ability to communicate with, and this dilemma has members of Australian Nursing & Midwifery Federation calling for personal carers to be required to pass English language testing standards, similar to those that the nurses in aged care must pass in order to be employed.

What Do The ANMF Say?

Paul Gilbert, Assistant Secretary of the Victorian branch of the ANMF (VB) shared his thoughts with HelloCare on what could be done to improve the issues regarding language barriers between personal carers and residents, and the circumstances that have led to this predicament.

“Fifty years ago, when many of our aged care residents were young adults, only 18% of the Australian population was born overseas-born. At that time, a third (32%) were born in England, with only 1.6% from India and China combined. In the 2016 census, for the first time, most people born overseas were from Asia, not Europe,” said Paul.

“So it would not be at all surprising that the workforce in aged care would reflect the make-up of the broader Australian population. Statistically, that would mean one in five aged care residents would be born outside Australia, and about half of all aged care workers would be born overseas or their parents were born overseas.”

“With the private aged care sector offering significantly less attractive wages, conditions and staffing level than hospitals, the industry is becoming increasingly reliant on overseas migration to fill their vacancies, which would result in a higher proportion of overseas workers than the general population.”

One topic of conjecture for many with an interest in the aged care sector is the fact that personal carers do not face the same level of accountability and ongoing scrutiny that aged care nurses do.

Australian nurses must be registered with the Australian Health Practitioner Regulation Agency (AHPRA) which ensures a standardised level of training and education, which is something that is not required by personal carers, and Paul Gilbert believes that this is where these sorts of problems stem from.

“For registered and enrolled nurses, the Nursing and Midwifery Board of Australia requires all applicants for initial registration to demonstrate English language skills to be suitable for registration,” said Paul.

“Broadly, nurses must demonstrate English language competency through either having had a large proportion of their primary, secondary or nursing education taught and assessed in English (regardless of which country they were born in) or achieve the required minimum scores in the International English Language Testing System (academic module) with a minimum overall score of 7 and a minimum score of 7 in each of the four components (listening, reading, writing and speaking) or the Occupational English Test with a minimum score of B in each of the four components (listening, reading, writing and speaking). “

“These requirements only apply to nurses, and not to personal carers or nursing assistants, who increasingly make up the majority of the private aged care nursing workforce.”

“An aged care resident, or their family, whose first language is not English may find it more difficult to understand a staff member who also has English as a second language. One in ten over-65s and one in three over-85s have dementia. Aged care residents with dementia often revert back to their first language. This can make even basic communication more difficult.”

“Engagement between aged care residents and the staff is crucial for resident’s psycho-social wellbeing, and of course for their capacity to request assistance and explain their needs.”

What Does A Provider Say?

Anton Hutchinson, whose family has proudly owned Canberra Aged Care Facility for over 30 years, has been a long time contributor to many of the articles, discussions, and topics, across HelloCare’s platforms.

Being a provider, Anton knows first hand, the value and need for quality aged care staff, and according to him, immigrant Australians are a valuable asset to any aged care facility, and language barriers should be the least of worries.

“Our facility is essentially like most others and has an extensive array of nationalities in our resident base, you know, multiculturalism.  It is a distinct advantage to have alternative cultures caring for residents from like origins,” said Anton.

“An Italian or Greek resident could have difficulty with an English speaking nurse, but it’s important to acknowledge that most Homes have a variety of resident nationalities, and I can imagine at times, they can become frustrated but that is a management tool; allocate the right staff to the right residents – We do it.”

When asked whether or not he believed that this language barrier was an issue for residents in aged care environments, Anton felt that this was not an issue at all, and the main culprit for the majority of problems within the sector is underfunding.

“No, I don’t believe it is an issue, there will always be an Australian working alongside a Zimbarbian or an Asian etc nurse to reach out to if required,” said Anton.

“We live in a multicultural society and that is apparent when walking through most facilities, it would be perverse to have only English as a first language staff to provide care for our residents.”

“The only real issue is the underfunding of RACS, and again the Liberals have brought this about, A minimum of 43% of facilities are running in the red, the ones making a profit are returning reportedly -5%”

When asked about the ANMF’s suggestion that personal carers be held to the same level of English literacy testing as aged care nurses, Anton offered this response.

“Nurses or carers from other countries need to pass an English competency to gain residency in Australia. As you know this test is at the discretion of the Australian Government. Does the ANMF want to discriminate and hold these individuals to a higher standard?”

“So my answer is No. Are doctors going to be kept to this standard as well?… of course the ANMF would say that is a totally different scenario but it is simply another group delivering a service.”

The Verdict

Australia is extremely lucky to have an influx of people from other countries who are willing to care for its elderly people, and to be honest, Australians could probably learn a lot about respect and valuing the elderly from these cultures.

Some elderly Australians may face difficulty communicating with their personal carers, but at this point of time, with the industry in the shape that it’s in, and the overall reluctance of young people who are willing to make this a career choice, we need to appreciate anyone and anyone that is doing their best to care for older people.

Testing the English literacy skills of personal carers would definitely weed out people who may have difficulty with communicating in English, and the effects of this level of testing may force many to improve upon their English skills, but it would also reduce the amount of good-natured and well-intentioned people who are willing to fill an ever-increasing void.

It doesn’t seem as though the wages of aged care staff are going to rise any time soon, and this will continue to make it hard to attract a greater number of candidates to choose from when employing people to care for the elderly.

If the time ever does come when we can implement increased English learning to go along with personal carer training, this just might increase the level of effectiveness and comfort that foreign-born carers feel when doing their job.

But for now, we need to appreciate what we have, and do our best to help them in their journey as carers.

“Language difficulties can often be overcome with the support of family members, particularly those who are bilingual, being an active partner in assessment and care planning,” said Paul Gilbert.

“Aged Care Staff are Gods creatures, they provide care without the glamorous title, they care for the residents in ways that most couldn’t imagine. On a daily basis I see nurses get pinched and punched and yet there is always a cuddle and time for a chat,” said Anton.

 

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  1. I recently spent 5 weeks respite care in an aged care facility. Not one of the staff had English as a first language and many were difficult to understand For people who are already somewhat disorientated and in some cases very disorientated having staff around not speaking English must be extremely distressing and would add to their stress of having been placed in a facility away from all that is familiar. so yes all staff in the medical area must be able to speak English not just for the comfort of patients but also to be able to understand instructions etc

    1. My Mum is in RACF and has dementia and it also comes down to simple things like understanding what the food options are and being able to have a relaxed chat without everything being task oriented or an effort to understand. All of us are guilty of asking someone how they are but not caring or listening to the response if it is other than “fine, thanks”

  2. I really appreciate the focus of this article. I am an LLN specialist, with 20 years’ experience working with people from Culturally and Linguistically Diverse (CALD) backgrounds teaching English as a Second Language (ESL), now working in aged care training. While still immersed in the ESL teaching context I regularly proposed teaching English for Aged Care and I still believe that this addition to aged care training would be an absolute bonus for everyone in the industry. While the need was always acknowledged, the funding for special focus classes was never available.
    Most personal carers would enter the field with a Cert 3 in Individual Care, and I believe that the care industry would benefit from the inclusion of a specific language development component, or something offered as an auxiliary training component. While the Cert 3 includes a unit on communication, much more is needed, in particular scripts and roleplays that allow students to develop mastery in the conversations they will have in the workplace with staff and clients. A specific language focus in training gives the opportunity to address pronunciation and intonation aspects of oral communication that can make it difficult to understand speech that is actually grammatically correct (or close to!).
    An IELTS score of 6.5 across the board (no skill less that 6) is required for Bachelor of Nursing, but is quite an unreasonable goal for carers from CALD background. In line with the Cert 3 level of training, Levels 3 (Australian Core Skills Framework) across oral communication, reading, writing and numeracy would be an adequate measure of English proficiency for the communication tasks involved in the day-to-day carer role.
    I advocate that government funding be allocated to language development specifically for carer contexts: aged care in residential facilities, home and community care and disabilites.

    1. Problem is Paula that many carers just don’t perform ‘day to day’ tasks. Their roles are evolving in the workplace in order to fill the gaps that cant be filled by RNs/ENs. If this practice continues then the need for English skills will be paramount. Assessing an individual in a classroom situation or even during mandatory work placement hours does not mean that the individual will display the same behaviours once they have completed their training.

  3. My wife has just completed the Cert III in Aged Care and was required to pass a Literacy & Numeracy test prior to commencement.

    1. I’ve just completed Cert III in Individual Care. Several of the students that had ‘passed’ the numeracy and literacy test did not speak English at a level that the rest of us (native & non-native speakers) understood. I got the impression that the government is so desperate for people in this industry that they are willing to overlook basics. How can it be right from an OHS aspect that you have people looking after some of our most vulnerable that cannot be understood by the people they are caring for, nor they understand their charges.

  4. Of course there are some aged care staff who do a great job despite poor English language skills.

    However the nurses are correct. If we want a good quality and safe aged care system then English language skills are essential.

    There will be some culturally based providers who may be able to prove an exemption but providers who do not use care staff with proven English language skills would find it very hard to argue that they are acting in the best interests of their residents.

    Consumers [I include families and appointed representatives] are now seeing that they do not have to accept 3rd or 4th best care. It is only a matter of time before these issues are tested in court and I think that providers who cannot meet the required standards would be wise to leave the sector as quickly as they can find a buyer.

  5. I am Australian and work with mainly Filipino and Indian carers. Language could become a worrisome barrier if staffing levels continue to be low. Carers appear to be taking on some nursing duties and if written & or verbal english skills are not of standard, this is a dangerous combination.
    As usual, with all industry, it’s about the dollar.
    The above put aside, if careers are continually working within their boundaries, low staffing levels ( which appear to be the norm) prevent any meaningful conversation anyway, as careers are rushed to complete ADLS
    I feel mostly, migrant workers are task orientated/ focused than person centred. Even if you did start out person focused, the workload quickly makes that a challenge

  6. A big YES, my experience shows that being able to speak and understand English is a MUST IN CARING FOR THE ELDERLY,. Many residents in aged care wear hearing aids. Tying to understand many “migrant “ carers who are not good at English would be and is very very difficult or many. The resident gets upset because they are not understood, this “carer” gets frustrated because they have such a heavy workload, this creates a very unsatisfactory and unhappy situation for all. I believe the holy dollar is more important to Owners and managers of Nursing Homes, than the people they are supposed to provide “good” care for. Way too much goes to jazzing up buildings than providing decent care. What happens to all the funds they take from Residents and families. The interest alone on these funds must be enormous.

  7. As an RN I receive handover from the previous shift. If this shift is my first shift back on duty from days off I’m in trouble if a particular RN is providing this ‘handover’. She is a caring, compassionate and empathic nurse but in my opinion, her English skills place all staff at risk with misinformation being shared due to her lack of understanding from the previous shift or even using the incorrect resident’s name or room number. Its an incident-in-waiting. Her clinical judgement is fine, its her ability to communicate this judgement to staff who may not question or query ‘something’ that sounds incorrect or unusual
    Clearly spoken English is a necessity in the aged care workplace no matter how multicultural our society is. What next, will we accept documentation written in a foreign language. What languages are spoken outside the workplace I have issue with, in the workplace its must be English, and English that is comprehensible

  8. Clear, concise communication in English is essential. Clear understanding of Australian ‘norms’ is also essential. So much is lacking in care workers ‘education’, so much unintended elder abuse occurs as the result.

  9. There are registered nurses coming through Australian universities who cannot read and write English and can barely speak English and are being registered by APHRA. How can this be safe. One rule for all.

  10. Lack of English, clear communication skills & the inability of so many aged care staff to truly relate to residents creates a range of issues. In many instances residents can not understand simple instructions from staff creating frustration on both sides. The lack of all these skills mean that aged care staff can often be restricted to a task driven functional role. In most cases this is all aged care homes want from them. Person centred care approaches are sadly beyond them.

    I have had aged care staff outline how money can buy their way through the various stages with migration agents between their home country & gaining a job. They also say the English language standards have been lowered to allow easier entry. Those personal carers entering in this manner are also willing to work for incredibly low wages & are fearful of losing these lowly paid roles as no other profession would would employ them & maintaining their work status is a condition of their visa.

    This suits the aged care industry as it wants compliant workers who will do the work nobody else wants who cost them as little as possible.

    The losers in this whole scenario are the residents & families who often pay huge $$$’s & ongoing fees. Expectations are not met.

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