End of life care (EOLC) is the support provided to the patient surrounding the time of death. Bereavement care is the support provided to family, friends and community after a person has died. Culture plays a critical role in how patients, families and health care providers view end of life and provide culturally sensitive and appropriate care.
The following information contains links to resources for bereavement service providers that aim to raise community awareness and understanding of the needs and preferences of community members from varying cultural backgrounds, to assist in improving end of life and bereavement support for migrants and refugees in Tasmania.
There are five key areas that inform culturally appropriate EOL and bereavement care: cultural competency, counselling services, use of interpreters, information in additional languages and financial considerations.
Cultural Competence
Cultural competence enables practitioners to provide bereavement support to meet the needs of clients from multicultural backgrounds. The two strategies that are effective to evaluate practitioners’ values and to facilitate cultural responsiveness to end of life care and bereavement support for migrants and refugees are Self-Reflective Tools and Education.
Resources and information for health care professionals on cultural responsiveness is available on the Palliative Care Victoria These include: Cultural perspectives and values from 10 CALD communities, and Death and dying – religious and cultural considerations.
Self-Reflective Tools
Self-Reflective Tools can be used to evaluate the Practitioners own values and facilitate the service provider’s cultural responsiveness to EOLC and bereavement support for migrants and refugees.
This self-reflective tool is mapped against national standards to help organisations meet their existing requirements. This is a free online Australian resource available from Embrace Multicultural Mental Health via the Mental Health Australia website.
Education
Education can inform practitioners of migrant and refugee belief systems and bereavement experiences to provide culturally appropriate services. Fact sheets, checklists, bereavement courses, screening tools and information are all useful strategies for developing cultural sensitivity.
Below is a Checklist of questions that can help the bereavement practitioner understand the cultural needs of the client. This checklist has been modified to remove some medical terms.
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1a. What is most valued:
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1b. What obligations are felt:
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2a. What to do with the dead:
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2b. Should the dead be:
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3. Who should be mourned:
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4. What to do with emotions:
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5. Should mourners be:
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6. Does religion or other belief system:
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Bereavement courses
The Australian Centre for Grief and Bereavement (ACGB) is an independent, not for profit organisation. It provides a directory of education and training available. Training may focus on multi-cultural grief and bereavement.
Screening tools
Beyond Blue has Culturally adapted screening tools for anxiety and depression to be used by health professionals working with older Chinese Australians.
Information
Australian Child and Adolescent Trauma Loss and Grief Network (ACATLGN) can direct members of the community to accurate and reliable information about child and adolescent trauma, loss and grief via their Refugee children and families webpage.
Counselling Services
Counselling enables people to have access to emotional support and discussion of strategies for bereavement during and after end of life care. Counselling provides an opportunity for migrants and refugees to discuss interventions for physical and emotional impacts of their experiences – including past trauma.
Maybe something doesn't feel quite right, or things just seem too much and that may leave you feeling anxious or overwhelmed, maybe even depressed.
A comprehensive list of services and support is listed in our BCN Directory.
Beyond Blue can be used in conjunction with Translating + Interpreter Services (TIS). The Beyond Blue Support Service is available 24 hours a day, seven days a week. All calls and chats are one-on-one with a trained mental health professional, and completely confidential. Although they may ask for the client’s first name and some general details, the client can let them know if they would like to remain anonymous. If support is needed call 1300 22 4636. Find out more about this service here Get immediate support with chat online or online forums.
The Migrant Resource Centre Tasmania’s Phoenix Centre provides support services to people and communities who have experienced torture and other traumatic events in their country of origin or while fleeing those countries. The Centre delivers counselling and a wide range of training and projects which support the health and wellbeing of individuals and communities. The Phoenix Centre has staff based in Hobart and Launceston and provides services statewide
The Specialist Palliative Care Service provides comprehensive information, referral, advice and support for Health Practitioners and Patients, Carers and Families across Tasmania on understanding and managing issues arising from a life limiting illness.
The Advance Care Planning Australia organisation helps you think about and document your preferences for future health care. It prepares you and others for a time when you may no longer be able to communicate those decisions and contains information on Advanced Care Directives, Enduring Power of Attorney and more.
Use of Interpreters
A key issue is language barriers preventing communication on cultural differences between health care professionals, the patient and family members. When conducting end of life care discussions, a service provider can contact the Translation and Information Service (TIS) to remove this potential barrier. It is suggested that bookings for TIS be made prior to the discussion and involve key family members so that correct information is given to the family at one time.
The Translating and Interpreting Service (TIS National) is an interpreting service provided by the Department of Immigration and Border Protection for people who do not speak English and for agencies and businesses that need to communicate with their non-English speaking clients.
Free translation support may be provided in the form of:
Service Providers will need to contact TIS for required costs associated with this service.
Information in Additional Languages
Language barriers prevent access and understanding of end of life care. If clients are to make an informed choice, then it is vital that clients understand service providers scope of practice, and current legal and end of life care practices in Tasmania. Information in languages other than English should be available to inform the client, their family, and communities of available bereavement services. The following are current bereavement information resources in languages other than English.
Fact sheets
Palliative Care Victoria provides end-of-life care resources and podcasts in 19 languages other than English. They encourage health professionals to use trained interpreters.
Palliative Care
Multi-cultural Practice Guidelines for palliative care for the following cultures - Arabic • Bosnian • Chinese • Croatian • Greek • Hindi • Italian • Japanese • Khmer • Korean • Macedonian • Maltese • Persian • Polish • Portuguese • Russian • Serbian • Spanish • Turkish • Vietnamese.
Financial Considerations
Financial hardship is identified as a risk factor that can negatively impact end of life care and can complicate grief experiences. If migrants and refugees are to access end of life care and bereavement support that is effective and culturally sensitive, then financial stress will need to be addressed.
Questions to consider are:
- Is the client able to afford a funeral?
- Does the terminally ill client and/carer have appropriate Centrelink allowances?
- Does the client have access to secure housing – to provide EOLC at home?
- Is the client able to access transport for medical interventions and/visitations?
- Is the client able to pay rent, purchase medicines and/clothing?
- Has the client completed their will with EOLC wishes and Power Of Attorney?
Centrelink
Centrelink provides information about payments to help when some-one close dies including Bereavement Payment and Bereavement Allowance. This information is available in the following languages: Arabic, Chinese, Croatian, Greek, Italian, Korean, Macedonian, Farsi, Spanish and Vietnamese.
People can also talk to someone in their language Monday to Friday between 8 am to 5 pm by calling:
- Multilingual Phone Service to speak with us about Centrelink payments and services
- the Translating and Interpreting Service (TIS) National to speak with Centrelink about payments
Advance Care Planning Australia
The Advance Care Planning Australia organisation helps you think about and document your preferences for future health care. It prepares you and others for a time when you may no longer be able to communicate those decisions and contains information on Advanced Care Directives, Enduring Power of Attorney and more.
A team from the Centre for Rural Health, School of Health Sciences at the University of Tasmania and the Tasmanian Bereavement Care Network (BCN) partnered on a state-wide project to explore the bereavement care experiences of migrants and refugees in Tasmania and how their care experiences can be improved during bereavement. An important part of the project was to develop publicly accessible online resources to help service providers and the wider community. For further information on the project please contact the Centre for Rural Health. If you would like to provide feedback about any of these resources, please contact the BCN.