Talking about aged care in multicultural families can be hard but these tips may help

Vinh Dao remembers his mother bedridden in hospital, both hands clutching a sheet of paper tightly to her chest.

On it were phrases, translations between English and Vietnamese:

"I need to drink."

"Please get up."

"I feel too hot."

Without them, Hoi, who does not speak English, would feel "completely lost", Vinh said.

About 30 years ago, Hoi and her husband migrated to Australia to be reunited with their sons, who fled Vietnam after the fall of Saigon in 1975.

The family wanted Hoi to live with Vinh until her final days — like their father did.

But that all changed when, at 97, she had a fall and broke her hip.

As Hoi's care needs became more complex, the question moved from whether she should go into aged care, to where.

Discussing aged care is taboo among many multicultural families where there are strong cultural obligations to look after parents.

This often means that conversations about aged care options are delayed until there is no other choice.

According to a 2023 Australian Institute for Health and Wellbeing (AIHW) report, one in three people supported by aged care services in Australia were born overseas.

The report, How do overseas-born Australians use aged care services?, found that elderly people from Asia, North Africa, and the Middle East were most likely to live with family.

The AIHW report also found that seniors from East Asia sought aged care services at a later age and required more language support.

The data reflects patterns of European and Asian migration to Australia during the 20th century, and has the potential to help the aged care industry plan for future needs.

Finding cultural supports

There remains a stigma around aged care in the Vietnamese community, with many families seeing it as abandoning their responsibilities as children.

But when it came to the crunch, Vinh's family took a pragmatic approach.

Still, finding somewhere to care for Hoi was daunting. 

"Her time in hospital told us how scared [and] how uncomfortable she was in that environment, where the culture was completely different," Vinh said.

In the end, they decided on Mekong Vietnamese Aged Care in Melbourne, which caters specifically to people from Chinese and Vietnamese backgrounds.

Visiting his mother is a two-hour round trip, but after seeing her relax when she arrived at the facility, Vinh said it was the "obvious choice".

"The menu is what she ate at home, the staff spoke to her in her own language, and they treated her like their own family," he said.

"They treated her like a grandma."

Hoi, now 104 years old, said she was not scared.

Rebecca Smith, interim chief executive of Geelong multicultural aged care service Cultura, said transitioning to formal aged care was a big decision that could be stressful.

She encouraged families to visit aged care services to have a look.

"They have a preconceived notion of what it is, and they do come out quite surprised," she said.

Rebecca said often, people had very different perceptions of aged care based on experiences in their home countries.

"They're often surprised to see the programs, residential facilities … and the range of services that we offer that do support their cultural needs," she said.

Grappling with reluctance

Meita Soekotjo, whose family is from Indonesia, remembers feeling "awful" about the conversation she needed to have after her mother — who was living in her own unit — fell and broke her hip.

It was during the height of the pandemic when COVID-19 outbreaks in aged care were rampant.

"I felt guilty because you want to try and foster independence for as long as possible, and I knew that that's what mum wanted," Meita said.

"So I didn't feel as though I was living up to a cultural expectation."

Her mother, Ade, said the guilt was mutual.

"I feel I'm a constant trouble to her because I know she's got her own family," the 86-year-old said.

Besides the guilt, Ade said the decisions involved with her move into care were rushed and it felt "overwhelming".

Like many older Australians, Ade had not made plans about aging.

"Because I was quite happy, I didn't think about it," she said.

"I lived in a nice unit, I have good friends, and my husband was still there then."

For Meita the delicate nature of the topic meant that it was only ever "touched on" casually — until Ade's fall.

Even after her fall, their discussions were limited due to pandemic restrictions that prevented Metia from visiting Ade in hospital or in rehab.

"Any kind of conversation that we had was simply by mobile phone, which was under duress because Mum was going through physical challenges with her hip."

Meita suggests that families navigating this life change approach it early so parents could have as much ownership of the decision as possible.

"It's a very delicate conversation to have, but you don't have to have the conversation in a way that creates fear and paranoia of being locked away."

Rebecca from Cultura agreed families should explore their options early.

Filipino psychologist and nurse Mila Cichello said the reluctance to discuss aged care was an issue for many Australians, but the conversations became easier as people learned more about the available services.

"Connect them to others so that they don't feel alone," Mila said

Many migrant families were also unaware that aged care facilities had waiting lists, leaving them unprepared when needs became urgent, she said.

Navigating the bureaucracy of assessment criteria, superannuation and financial costs, as well as paperwork that assumes a certain level of English and digital literacy, can become additional barriers some families are unprepared to deal with.

"We have a lot more women who are aging, who are seniors, who have very little superannuation, very little savings to their name," Mila said.

Reframing aged care conversations

Counselling psychologist Priyanka Malhotra, who practises family therapy, said all families should have conversations early.

She said culturally diverse families in particular, who felt a moral duty to take care of the elderly, needed to explore their understanding of aged care and any associated feelings of conflict before approaching their parents.

Priyanka said people should ask themselves questions like, "Am I doing the right thing for my parents?" and, "Am I doing the right thing for my family culture?"

But she said families also acknowledge if they were being stretched.

Without laying this groundwork, which established why such conversations needed to occur, she said parents could feel like they were being abandoned.

Priyanka said it was often adult children in culturally diverse families who initiated these conversations, as parents could be unaware of the available supports if they did not exist in their home country.

Priyanka advised people to reframe the conversation with their parents around what a supportive and inclusive quality of life would look like, rather than the aged care service itself.

In Asian families, where elders were at the top of the hierarchy, she said it was important to show respect and learn from their wisdom.

"Ask them, what did they see while they were caring for their elders? Because there's always a care pattern that is given," she said.

"You have a family narrative, you have experiences … What worked? What didn't? Then you go back to the drawing board around, 'What can we do better?'"

Another suggestion she made was to use superannuation and retirement plans as prompts to discuss quality of life and future care.

"Everybody has a future life plan, so it's a nice way to weave our generations earlier into that conversation," she said.

Taking ownership of your care

Suong Pham, 75, is one of the few residents of Melbourne's Mekong Vietnamese Aged Care who took the initiative to move into aged care on her own.

Suong said the decision was easier for her than most because she did not have strong family ties, and did not want to be a burden on anyone.

After retiring as a maternity nurse in Vietnam, she migrated to Australia in 2007 to be reunited with her cousin and two adopted children.

When she became unwell about two years ago, she decided to move into residential aged care, where she would have privacy and be looked after well.

"[I] didn't want to bother [my cousin] — that's why [I] chose to go to Mekong," she said through an interpreter.

"[My family] respected my decision because they knew that they couldn't care for me at that time."

Mila said for senior Australians, there was never a good time to talk about aged care, so it may as well happen now.

"Who do you call? What choices do you make?"

She encouraged people to learn about available services and to connect with others.

"Treat your neighbourhood as your own community," she said.

"Look after your health, stay connected, plan early."