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Countering incontinence with patience

Understanding cultural differences is important when dealing with older people from different ethnic backgrounds. By Cathy Wever.

When providing community care to an elderly Arabic woman whose daughter was struggling to manage her incontinence, Lana Belleville from Just Better Care, Macarthur, had to think creatively.

“This lady also had dementia, so it was a difficult situation for her daughter/carer. In the end, I suggested she cut up some old white towels into small squares and let her mother use those, just as you would use cloth nappies on a baby, then soak them in the laundry and pop them in the wash.”

While such an approach may not suit many older Australians, in this case it was ideal. Reverting to memories from her youth, the Arabic woman was confused by commercial incontinence pads. The white towels were a familiar way to cope with bodily fluid, and a method she had used as a young woman in her home country.

Belleville says this kind of flexible, creative approach is critical when managing incontinence in older people from culturally and linguistically diverse (CALD) backgrounds. Belleville’s Just Better Care franchise is close to multicultural Campbelltown, and also near Villawood Detention Centre.

Belleville and her team regularly provide in-home care to older people from a wide variety of backgrounds including Greek, Italian, Chinese, Indonesian and Middle Eastern.

“We find that people from CALD backgrounds who suffer from incontinence benefit from simple strategies. We work hard to find out as much about each individual as we can. The level of family or other support they receive makes a big difference to the sort of approach

Groups respond to findings

Managing incontinence within CALD communities has been in the spotlight of late, following the release last year of Awareness of Incontinence in Ethnic Communities, a report published by the Victorian Continence Resource Centre (VCRC) in partnership with the Ethnic Communities Council of Victoria and Monash University’s School of Nursing and Midwifery.

Among the report’s findings were that elderly persons from CALD backgrounds who are experiencing incontinence find it hard to talk about with health professionals due to language barriers, cultural misconceptions about incontinence and religious or gender concerns. The report made a number of recommendations including producing a glossary of common incontinence-related terms translated into a range of languages.

Continence nurse consultant/manager at the VCRC, Susan McCarthy, says the report has been well received and has resulted in the development of several education programs for organisations that work with CALD clients.

“We recently ran a very successful event with the Italian community, and had more than 70 people attend to learn more about this issue. In addition, we have partnered with the Centre for Cultural Diversity in Ageing and the Continence Foundation of Australia (CFA) to explore how better to communicate about incontinence to CALD communities.”

Resources available

The VCRC is also developing a range of print and digital resources and is working on the glossary recommended in its report.

A continence nurse adviser at CFA, Lisa Churchward, says the common perception that incontinence is just a normal part of ageing is completely untrue.

“There are several possible causes of incontinence including pelvic floor stress and bladder issues. Incontinence can be treated or managed irrespective of your background. The difference is in the sensitivity health professionals need to apply to diagnose the problem and work out a management approach.”

Churchward encourages carers to contact CFA and discuss options. “CFA has translators available and it is no problem for us to arrange for people with incontinence to have a phone conversation about the issue in their own language.”

Belleville agrees that language barriers can be a huge obstacle to overcome. Just Better Care in Macarthur tries to match staff to care recipients who speak the same language, but Belleville says this is not always possible.

“I find cue cards help a lot. I have a set that I photocopy for my staff because they are so handy for communicating across a language barrier.” Belleville says using cue cards to help discuss incontinence could be useful “if the pictures were creative enough”.

“Another simple but vital strategy is just patience. It takes more time to establish the needs of individuals from CALD backgrounds, get around the language barrier and obtain the complete picture on any cultural practices or customs that may impact their care needs.”

Diversicare in Queensland provides culturally appropriate in-home care to people and their carers from CALD backgrounds. Silvia Borges is a PICAC (partners in culturally appropriate care) officer and says there is no one-size-fits-all strategy when it comes to managing incontinence in CALD populations.

“Each individual needs to be assessed so that an appropriate strategy can be developed,” Borges says. “It might be that a person’s culture contributes to their feelings of embarrassment about their incontinence, or it might be something that they only feel comfortable discussing with health professionals of the same gender.

“We find some CALD community members also have difficulty accessing health services in the first place, due to language barriers or because they don’t know such services exist.”

Diversicare is in the process of developing a workshop for aged care service providers to CALD communities, in conjunction with the Blue Care Continence Advisory Team.

“The workshops will include strategies that may work in different cultures. For example, hygiene systems are not standard across different societies. Some use toilet paper, others use water, and toilets are designed differently depending on which country you’re from. Understanding a person’s experience of hygiene can help when managing any continence issues they may be having.”

Educating families

A continence nurse adviser CNC from the Continence Advisory Service at Blue Care Mt Gravatt, Karen Matthews, says educating CALD families and carers is vital. “We need to promote the message that incontinence is not a normal part of ageing. It is very treatable and there are many products available that can help.”

Matthews says some people from CALD backgrounds come from less prosperous countries and need education about incontinence products such as pads, which they may initially view as wasteful.

Victoria’s Centre for Cultural Diversity in Ageing is collaborating on a workshop on continence care of older people from CALD backgrounds. Senior project officer Tonina Gucciardo-Masci, says the VCRC report has presented a unique opportunity to imbed culturally inclusive practices within continence management.

“Nothing like [this report] has ever been done before and we are integrating a lot of the material from the research into our workshop. Having said that, our approach is based on person-centred care and we think it’s important to perceive someone as an individual first, before looking at their culture or ethnicity.”

Gucciardo-Masci says many of the issues older people have with incontinence may not be related to their culture or background.

“Issues of shame or guilt and hiding the problem of incontinence are not culturally based – they are universal,” explains Gucciardo-Masci. She says language and attitude play a major part in managing the issue with someone from a CALD background. She points professionals to the Centre for Cultural Diversity in Ageing’s website (www.culturaldiversity.com.au) for a list of more than 1000 words relating to aged care, translated into 20 different languages.

“Lots of healthcare terms are complex and don’t translate easily. We want to eliminate confusion about incontinence so we have added words related to this condition to the list.”

Gucciardo-Masci says dealing with incontinence can be especially difficult for carers of elderly people from CALD backgrounds who are still living at home. “Informing elderly people from culturally and linguistically diverse backgrounds about incontinence, the services available and providing adequate support remains a challenge for carers and service providers across the board.”

Home care boost welcomed

Belleville, who has spent her life working in aged and community care, says she welcomes the recent announcement that funding for in-home aged care will be increased, but she says the reforms in the federal government’s new Living Longer, Living Better aged care reform package won’t provide enough help for older people from CALD backgrounds.

“One thing that is never factored in is the additional time it takes to properly care for someone from a CALD background. You might be able to take Mrs Jones off to her appointment with the incontinence nurse then back home via the shops to collect her milk and bread all within 90 minutes, but with her neighbour who is from a CALD background it takes you an hour just to get her out of the house because of the language barrier and the time it takes to explain what’s going to happen.”

“CALD carers need to be really patient and think on their feet. The system also needs to allow for the fact that more experienced carers are much better at meeting the needs of CALD members of the community.”

The low wages received by staff providing community aged care are a disgrace, adds Belleville.

“The staff at the coalface are just angels,” she says.

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