What is culturally safe care?
Culturally safe care ensures that older people in aged care receive palliative and end-of-life care that respects their background, traditions, and beliefs. [1] The Aged Care Quality and Safety Commission (ACQSC) defines culturally safe care as care that is free from racism and discrimination, where individuals feel respected, valued, and safe to express their cultural identity. [2] This includes recognising diversity beyond culturally and linguistically diverse (CALD) populations to encompass Aboriginal and Torres Strait Islander peoples, LGBTQI+ communities, care leavers, and other underserved groups. [2,3]
Why culturally safe care matters in aged care
Cultural safety addresses systemic inequities, power imbalances, and past experiences of discrimination in healthcare, ensuring that palliative care environments foster respect and inclusivity. The Aged Care Quality Standards require culturally safe care to be embedded in practice, ensuring services align with a person’s cultural, spiritual, and social needs at the end of life (Standard 1). [4] This extends beyond awareness and competence, focusing on meaningful engagement and trust-building with diverse communities. Aged care providers play a key role in fostering a sense of safety and belonging, which can improve access to quality palliative care for older Australians. [3-5]
Culturally safe care allows older people in aged care settings to receive care that aligns with their values, traditions, and personal histories. Many older individuals, particularly those from Aboriginal and Torres Strait Islander, CALD, and LGBTQI+ communities, have experienced discrimination in healthcare settings, contributing to distrust in services. [6-10] Ensuring cultural safety in palliative care may help restore trust, enhance engagement with care providers, and support overall wellbeing at the end of life. [1]
Aged care services that integrate cultural safety approaches in palliative care can reduce distress and social isolation by recognising and respecting cultural identity. [1-3] Providing culturally safe care aligns with the Aged Care Quality Standards, which emphasise inclusive, trauma-aware and healing-informed, and person-centred approaches to end-of-life care (Outcome 1.1). [4] By embedding cultural safety into practice, palliative care providers in aged care create environments where older Australians feel valued and empowered to express their care needs.
What the evidence tells us
Culturally and linguistically diverse (CALD) communities
Older people from CALD backgrounds often face barriers in accessing culturally appropriate palliative care in aged care settings. These challenges include language barriers, unfamiliarity with healthcare systems, and differing cultural beliefs about death and dying. [11-13] Limited access to interpreters and translated materials can hinder communication, affecting decision-making and care preferences. [11,13] Additionally, traditional health beliefs and spiritual practices may not always be accommodated within standard palliative care models. [12]
Providing culturally responsive palliative care involves engaging CALD communities in advance care planning, respecting cultural and religious end-of-life rituals, and ensuring aged care staff receive training on culturally sensitive communication. [11] Multilingual staff, culturally adapted palliative care resources, and partnerships with CALD community organisations can help improve care experiences for older people from diverse backgrounds. [11]
Aboriginal and Torres Strait Islander peoples
Cultural safety for Aboriginal and Torres Strait Islander peoples in palliative care requires recognising the significance of connection to Country, community, and spirituality in end-of-life care. [14,15] Access to culturally appropriate services, including Indigenous liaison officers and traditional healing practices, strengthens trust in palliative care systems. [14,15] Trauma-informed approaches acknowledge the lasting effects of colonisation and intergenerational trauma, ensuring services are welcoming and safe. [14,15] Inclusive palliative care models should also support cultural traditions, such as smoking ceremonies and family-led decision-making. [14,16]
The National Aboriginal and Torres Strait Islander Flexible Aged Care Program provides funding to support culturally safe care models that respect these traditions. Ensuring aged care staff receive training in Aboriginal and Torres Strait Islander cultural safety can support trust and engagement in palliative care. [14,15]
LGBTQI+ individuals
Older LGBTQI+ individuals often experience discrimination in healthcare settings, making cultural safety an important consideration in palliative care in aged care. [8] Fear of stigma may lead some individuals to conceal their identity, affecting their ability to receive affirming care at the end of life. [17,18] Person-centred approaches that respect chosen names, pronouns, and non-traditional family structures contribute to inclusive palliative care environments. [17] Training aged care staff in LGBTQI+ competency, including the historical challenges faced by older LGBTQI+ people, may help improve palliative care quality and reduce bias. [17,18]
Care leavers
Older people who have experienced institutional care, including foster care, orphanages, and out-of-home care, often face challenges in engaging with aged care services due to past trauma and mistrust of institutional settings. Many care leavers have a history of disrupted attachments, loss of family connections, and limited social support, which can impact their experiences in palliative care. [19-21]
Trauma-aware and healing-informed approaches in aged care can help address these challenges by recognising past experiences and providing safe, supportive environments for care leavers. [19-21] Staff education on trauma-informed care and strategies for building trust are critical for improving engagement with palliative care services for this group. [19]
Dementia-specific culturally safe care
Providing culturally safe care for older people living with dementia in aged care settings requires a comprehensive approach that integrates cultural identity, language, social norms, and traditions into daily care and end-of-life planning. [22] For older people from Aboriginal and Torres Strait Islander or CALD backgrounds, these considerations are essential in ensuring dignity, comfort, and a sense of belonging in their final stages of life. [22,23]
Challenges to culturally safe dementia care in aged care settings include limited access to bilingual staff, difficulties in recognising culturally specific expressions of distress or dementia symptoms, and the lack of culturally appropriate dementia assessments. [22,24] Traditional decision-making practices, where family or community elders play a key role, may not always be acknowledged in mainstream palliative care approaches. [7,22]
Culturally responsive dementia care involves developing dementia assessments that account for linguistic and cultural differences, employing multilingual and culturally trained staff, and adapting palliative care environments to align with familiar cultural practices. [7,22] Incorporating traditional healing practices, ensuring access to culturally meaningful activities, and facilitating spiritual or religious support can further enhance care experiences for older people with dementia. [7] Environments that reflect cultural familiarity - such as dietary accommodations, appropriate music, and storytelling traditions - can reduce distress and create a supportive setting, particularly in end-of-life care. [7,22]
Implications for families and carers
Families and carers play an important role in supporting older people from diverse backgrounds in palliative care. Recognising the importance of cultural traditions and community connections in care planning can improve experiences for both older individuals and their families. [25] Families may require additional support in navigating palliative care services, particularly when language or cultural differences create barriers to accessing care. [25,26]
Aged care providers should facilitate open communication with families and carers, ensuring their involvement in decision-making and care planning. Providing education on palliative care in multiple languages, engaging culturally specific support services, and acknowledging the grief and bereavement needs of diverse families can enhance culturally safe care for both older people and their loved ones. [25,26]
Page updated 01 April 2025