Diverse Population Groups
ELDAC organisational resources to support inclusive end of life care:
Older Australians are diverse
Australia is a diverse nation. Australians identify with more than 300 ancestries, speak more than 400 languages (including Aboriginal and Torres Strait Islander languages) and more than three million Australians speak a language other than English at home. Many older Australians speak little or no English, and may adhere to diverse spiritualities or faiths.
According to the ABS (2018), of Australia’s more than 25 million population:
- Over 124,000 older individuals identify as Aboriginal and/or Torres Strait Islander, and nine in ten Aboriginal and Torres Strait Islander individuals over 55 have a long-term health condition (ABS, 2016).
- Almost 19,000 older Australians are at risk of, or are experiencing homelessness, and one in six homeless people are aged 55 and over (ABS, 2016).
- Approximately 11% of the Australian population identify as lesbian, gay, bisexual, transgender or intersex (LGBTI) (Department of Health, 2019).
- More than 500,000 Australians are care leavers.
- More than 201,000 older adults aged 65 years and above receive a pension from the Department of Veteran Affairs, representing about 1.0% of the whole Australian population (ABS, 2017).
One in seven Australians are currently aged 65 and over (ABS, 2016). There are 3.8 million people in this group, of which:
- One third were born overseas.
- One in five are from Culturally and Linguistically Diverse (CALD) backgrounds.
- One in ten lives with cognitive impairment or dementia.
- One in three older carers are primary carers.
Older Australians may live in rural and remote areas, and may be socially or financially disadvantaged.
When caring for an older person, it’s important to remember that the needs of each person, even for those within a specific population group, will vary considerably.
Diversity exists both within and across groups
Older Australians are from many different backgrounds, so each person will express their identity in different ways. Being part of a group with others from the same background can help to connect people, but diversity within groups and across groups also exists. This is called ‘intersectionality’. Many people may not feel they belong to any group. It’s for this reason that health professionals and care workers need to focus not only on one type of diversity, but on multiple types all at once.
Intersectionality considers a person’s many characteristics and how they relate to one another to create their identity. These characteristics might include:
- cultural background
- visa status
- language spoken
- socio-economic status
- sexual orientation
- geographical location
Many of these characteristics may increase an individual’s risk of discrimination, and the feeling that they are not represented or do not belong. Intersectionality helps us to consider how these characteristics might build on each other to make it difficult for an individual to access services (e.g. health care) and how this might increase their risk (e.g. of poor health, isolation and other related problems). Individuals who fall under multiple forms of minority group status are among the most vulnerable.
Many people have experienced negative situations as a direct result of their characteristics and may be carrying these memories and feelings into their interactions with others. It’s important for health professionals and care workers to ask older Australians about their preferences and concerns about their care, and to consider how their individual needs can be met by the organisation, service provider, carer and family. This is essential especially at the end of life.
The more intersectionality characteristics and experiences a person has, the more likely they are to experience discrimination and disadvantage. There are many different characteristics that can increase a person’s risk of intersectional disadvantage, including:
Being aware and considering how these characteristics affect an older person is important. For example, consider how many types of discrimination an older lesbian woman of colour may deal with (gendered, racial, sexist, homophobic and ageist). These characteristics and experiences may make it difficult for many older Australians to access the information, care and support they need.
When providing care to an older Australian, it’s good practice to consider how the individual’s characteristics and experiences have shaped the way they relate to their carers and their care. A person’s unique social and cultural background can influence how they think about, speak about (or not speak about), and respond to death, dying, palliative care and losing someone close to them.
There are differences between people who share the same characteristics, and while people may look similar on the surface, it’s important that you don’t make assumptions about the care a person may need or want based on their physical or social characteristics. Instead, it is best practice to ask each person about their beliefs and preferences. Meaningful Ageing Australia’s ‘See Me. Know Me.’ campaign is founded on the idea of making identities visible, and provides a good example of how unique and varied the life experiences of older Australians are. We all deserve inclusion, care and support which is tailored to our individual needs.
Under the Aged Care Act 1997, people with special needs are those who identify with or belong to one or more of the following groups:
- people from Aboriginal and Torres Strait Islander communities;
- people from non-English speaking (culturally and linguistically diverse) backgrounds;
- people who live in rural or remote areas;
- people who are financially or socially disadvantaged;
- people who are veterans, including the spouse, widow or widower of a veteran;
- people who are homeless, or at risk of becoming homeless;
- people who are care leavers; and/or
- people from Lesbian, Gay, Bisexual, Transgender and Intersex communities.
This ‘special needs’ status recognises that people from these groups may find it difficult to access information and services appropriate to their needs.
The ELDAC website can help you to care for people from these population groups, as well as carers, people with dementia, and those with particular spirituality and faith beliefs. Click on specific pages to learn more about aged care and end of life for each population group.
The following related resources will also be useful for you to consider when providing care to meet the unique needs of older Australians.
The Aged Care Diversity Framework
Launched in December 2017, the Aged Care Diversity Framework
provides a guide for appropriate care. Its vision is
to create an aged care system where older Australians, regardless of their social, cultural, linguistic, religious, spiritual, psychological, medical and care needs and life experiences, can access respectful, appropriate, fair, inclusive and sensitive care. The framework takes an empathetic, individual human rights based approach in line with key World Health Organization principles.
Aged Care Diversity Framework action plans
Action plans have been developed under the Aged Care Diversity Framework to help aged care service providers to address specific barriers and challenges faced by older people.
Find out more about the Aged Care Diversity Framework action plans.
Aged Care Quality Standards
Diversity is woven through the Aged Care Quality Standards
to ensure the delivery of safe and inclusive services to people with diverse needs and life experiences. Standard 1 relates to valuing the identity, culture and diversity of each consumer
, to deliver culturally safe care and services.
Illustrated storyboard examples of consumer dignity and choice
(pdf, 4MB), and dignity of risk
(pdf, 4.4MB) can help aged care staff to better apply the Quality Standards in their day to day work.
Diversity considerations in palliative care
Living and dying in comfort is a basic human right. Older diverse Australians often face barriers in accessing palliative care services. The Department of Health and Aged Care has released an exploratory analysis of barriers to palliative care summary policy paper, which contains approaches for improving access and quality of care for vulnerable populations in Australia. The Department of Health and Aged Care has also released an associated literature review of barriers to palliative care for diverse Australians. Organisations and services and those who work in them need to consider and respond to individual need, especially at the end of life. How people think about death, dying, and end of life differs and there is no ‘one-size-fits-all’ approach. There are many ways to help people with palliative needs feel welcome, heard and supported. One way to be flexible and responsive to diversity is to adopt person-centred and family-inclusive approaches to care. This includes ‘families of choice’. Palliative care models should aim to deliver care that is both culturally appropriate and culturally safe. As health professionals and care-workers, adopting tailored care plans based on the specific needs of each individual is recommended. Spend time listening and learning about your clients and residents, and ask them about their unique preferences.