Older people have the right to speak up about the care they are receiving.

Providers must ensure that every older person has the ability to raise concerns about their care regardless of culture, language, impairment or other factors. If these barriers impede the person’s ability to access the complaint system, the provider is expected to link them to extra support that enables them to do so (ACQSC 2024a).

Furthermore, providers should readily inform older people about the complaint process, as well as access or advocacy services available to them (ACQSC 2024a).

It’s essential that each older person is given equal access to the complaints system (ACQSC 2024a).

Advocates and Language Services Under the Strengthened Aged Care Quality Standards

Standard 1: The Person - Outcome 1.3 Choice, independence and quality of life (Action 1.3.4) of the strengthened Aged Care Quality Standards requires providers to support older people to access advocates of their choice (ACQSC 2024b).

Furthermore, Outcome 1.4: Transparency and agreements (Action 1.4.2) highlights the importance of older people being supported to understand all information provided to them; this means older people from culturally and linguistically diverse (CALD) backgrounds may require interpreters (ACQSC 2024b).

Standard 2: The Organisation - Outcome 2.6 Feedback and complaints management (Action 2.6.3) states that older people should be supported to access advocates and language services in order to raise and resolve feedback and complaints (ACQSC 2024c).

Who May Need Extra Assistance?

Older people may encounter barriers to accessing the complaint system such as sensory impairment or language and may require additional support due to their background or situation (ACQSC 2024a).

Older people who may require extra assistance include:

• Aboriginal and Torres Strait Islander people
• People from culturally and linguistically diverse (CALD) backgrounds
• People living in remote or regional areas
• People living with disability
• People of diverse sexual orientation and gender identity
• Care leavers (Forgotten Australians, Former Child Migrants and Stolen Generations)
• Veterans, war widows and widowers
• People who are financially disadvantaged
• People who are homeless or facing homelessness.

(My Aged Care n.d.a)

What Are Advocacy Services?

People being integrated into an unfamiliar and fast-paced care environment are often vulnerable and may require extra support to help them navigate and find their voice (Crocker & Crocker 2019).

An advocacy service will provide the person with an advocate to stand alongside them and assist in the complaint resolution process and other discussions (ACQSC 2022).

The advocate is an impartial party who works on behalf of the older person, helping them to achieve the best possible outcome. They represent the wishes of the older person and ensure theu understand their rights and are able to have a say in decisions (ACQSC 2022; My Aged Care n.d.b).

One of the main goals of advocacy is to empower the older person to find their voice and speak up about their care, enabling them to feel more confident and autonomous. This, in turn, relieves the stress put onto healthcare staff and resources, who are constantly being stretched to meet demands (Crocker & Crocker 2019).

The three main roles of an advocate are:

1. Negotiating to reach an outcome in a harmonious and effective way. This may involve:
   • Making phone calls on behalf of the older person
   • Researching
   • Establishing a collaborative network of health professionals to support the older person.
2. Mediating to create common ground between the older person and the provider (or another party).
3. Interceding to ensure the older person is satisfied with the support they are receiving and is able to have their say.

(Crocker & Crocker 2019)

Any person receiving Australian Government-funded aged care services (either residential or at home) is entitled to free, independent and confidential advocacy, delivered by the Older Persons Advocacy Network (OPAN) (ACQSC 2022).

What can Advocates do?

• Inform the older person about their rights and responsibilities
• Empower the older person to uphold their rights and responsibilities
• Support the older person in decision-making
• Listen to the older person’s concerns
• Discuss the older person’s options
• Support the older person in making a complaint
• Help the older person resolve complaints
• Speak to providers on behalf of the older person, at their direction
• Help the older person increase their skills and knowledge so that they can advocate for themselves.

(ACQSC 2022; My Aged Care n.d.b; Seniors Rights Service 2024)

Advocates must not:

• Make treatment or medication decisions on the older person’s behalf
• Tell the older person what decisions to make
• Act as the older person’s substitute decision-maker
• Diagnose the older person
• Provide treatment to the older person
• Offer legal advice
• Adopt the role of a counsellor or social worker
• Take any other actions that extend beyond their brief.

(Crocker & Crocker 2019)

What are Language Services?

Being able to effectively communicate with older people is integral to positive health outcomes and delivering safe, high-quality care (NSW Health 2017).

Language services support older people from culturally and linguistically diverse backgrounds to access and navigate aged care (DoHaAC 2024).

Older people who have difficulty speaking or understanding English are able to access interpreters who will help them communicate with their provider (My Aged Care n.d.a).

Interpreters can help older people participate in a variety of conversations, including:

• Discussions about care needs, services and preferences
• Discussions about fees
• Developing or reviewing care documents
• Discussions about participating in social and cultural activities and maintaining independence.

(DoHaAC 2024)

Eligible providers can use the government’s Translating and Interpreting Service (TIS National) for free, allowing older people to access immediate, pre-booked or on-site language services (DoHaAC 2024).

Do not assume the person is linguistically competent without assessing their English ability. The person must be able to fully understand and communicate; being able to talk about everyday topics does not necessarily mean they understand medical situations and terminology (NSW Health 2017).

Working With Interpreters

The following is some practical advice for working with interpreters.

• Confirm the older person’s preferred language or dialect, gender preference and other preferences when finding an interpreter.
• Do not allow the older person’s friends or relatives to act as an interpreter - this is not appropriate.
• Book interpreters as far in advance as possible to ensure they will be available.
• Brief the interpreter before the session. The briefing should include:
  • Context of the discussion
  • Outline of the provider’s objectives
  • Parameters (e.g. mode of interpreting, seating arrangement)
  • Cultural background information, if required
  • Any forms or assessment tools that are to be used
  • Any potential risks (e.g. behavioural issues)
  • Whether the matter is sensitive (e.g. traumatic situations).
• Remember that interpreters speak in first person (i.e. as the older person).
• Speak to the older person rather than the interpreter.
• Ensure seating arrangements are appropriate (this is the provider’s responsibility).
• Ask the interpreter for cultural information during the session, if required.
• Debrief the interpreter after the session and clarify any issues. You may seek feedback from the interpreter.

(NSW Health 2017)

It is also important to note that the older person may refuse the assistance of an interpreter. In this case, you should discuss this with the person and explain how an interpreter may be helpful. However, the person has a right to decline assistance if they wish to do so (NSW Health 2017).

Conclusion

Effective communication between older people and providers is an essential component of delivering safe and high-quality healthcare.

Therefore, it is crucial to recognise older people who may require extra assistance, ensure they are able to access this assistance and provide this assistance if required.