[Music] [Laughter] [Music] welcome everyone to this very important webinar in relation to understanding the assessment processes and care planning when working with older people their families advocates and carers we've got some great community leaders here angela and paulina have done amazing work in the field working daily with vulnerable communities and families in the assessment process in order to get people's needs met and also to understand it from a cultural safety perspective and a cultural lens so we're really excited to collaborate with angela and paulina and of course all graduates so before we hear from angela and paulina i'd first like to give you a bit of an overview of the center for cultural diversity in aging so our vision is that all aged care consumers in australia experience inclusive and accessible care that they feel safe that they feel respected and that their culture and lifestyle and identity is recognized we want to do that by building the capacity and capability of aged care providers to deliver services that are welcoming inclusive and accessible and we do that through things like this workshops and training to people that work directly with older people across australia training and advice to aged care providers and diversity consulting and we also have resources on our website multilingual resources which we went through in our previous webinar with sinisha but welcome you to to visit our website because that's where we have a hub of information about aged care in many many different languages so the center for cultural diversity and aging is part of the picac alliance the partners in culturally appropriate care and we are funded by the department of health and the picac alliance has a member in each state and territory so the center is the victorian member but if you go onto the picac alliance website you'll be able to see the member in that state and territory that you reside in and and feel free to reach out to that member and get advice about culturally appropriate caring aged care as well so um that's just a little bit of an overview of how the center situates itself within the aged care sector and funding programs and now i'll pass it over to angela thank you thanks lisa so um there's 18 acas departments um in victoria so both paulina and i um are from two separate um a cast departments um i'm located at bandura a cast which is in the northern suburbs of metro melbourne and paulina is at north west a cass which covers some of the north and the west catchment so our team is made up of multi-disciplinary team so we've got about 28 staff which includes registered nurses social workers i've got a couple of ot speech therapists dietitian geriatrician and also administration staff um we assess about 3400 people per year approximately um and we're also located at northern health service so we're affiliated with a large public hospital health service in the north we have a high proportion of cold clients um approximately we use between 60 to 70 percent of our clients do require interpreters um and for us our particular organization we actually have an in-house interpreter service that has approximately 40 staff and we also use telephone interpreter services and also on call if we're not able to access interpreters through our organization the sort of languages that are included in our catchment includes arabic assyrian turkish italian greek macedonian bosnian serbian croatian persian mandarin cantonese vietnamese punjabi hindi nepali and urdu acas pays for the use of interpreters and usually our bookings for an assessment are around 90 minutes for community assessments sometimes we may request longer if it's a couple and then in the hospital setting as well we usually take about 30 to 60 minutes to conduct our assessments with an interpreter thank you angela as angela mentioned i work at a different team and we've recently changed our name to aged care assessment services and this is because we traditionally only manage the north west aged care assessment team which cover the local government area of moorland mooney valley hume and city of melbourne here in victoria but recently in the last six months we've also taken over doing assessments at regional assessment services in the hume region of melbourne health we're in the middle of sort of the north west corridor um of melbourne and we have bundura a cast who are to the right of us and western acas to the left now our team we also have um registered nurses social workers occupational therapists physiotherapists geriatrician and administration at the moment we have around 21 staff for our eft is around 29 we assess approximately around 5031 people per year um that's for the acas team and for the regional assessment services even though we've just taken over it we look at about a thousand assessments a year in the hume region we are located at melbourne health service and sit under the royal melbourne hospital and we're the second highest use of interpreters team in victoria the 80 percent plus of our clients require interpreters and we do have quite a new emerging refugee population in the hume region uh we do lots of assessments in the hospital setting and the royal melbourne hospital do have some in-house interpreters but we do actually broker out our interpreters for community assessments which is quite different to to northern health and bundura acas we do face-to-face assessment telephone and also tele-health assessment and the languages that we predominantly use in the northwest would be italian greek arabic assyrian and mandarin however we also have a smaller population of eastern european languages thank you angela so just some background to what acas and a cat [Music] includes so the acas stands for the aged care assessment service and this is also interchangeable with the a cat so it's the aged care assessment team in victoria we're called the a cast but the other states within australia are called an a cat so depending on what state you're residing in you'll have interchangeable names but that means the same program um so it's a nationally funded program by the commonwealth since 1985 it's an independent assessment agency in victoria the majority of the 18 acas departments are affiliated with a public health service um in victoria but in other states this may be different so there may actually be affiliated with private organizations um so my aged care is the overarching body so it's more like a gateway where people can access um information and also have referral to have an assessment done so there's in my aged care contact center um i think currently there's two locations one in brisbane and one in box hill so there's a national phone number that clients or carers can contact if they want to be registered and have an assessment and then we've got two arms of assessment so i've got the regional assessment service which is the raz and the acas which is the aged care assessment service and like pauline had already mentioned her organization has both arms um and there's been some changes over the past sort of 12 months in regards to the a cases and the raz merging and that's what they're looking at towards the future having only one's assessment service that will combine both the raz and the acas so my aged care is the gateway um and our services that we approve for in regards to the acas are under the aged care act of 1997. um and there's it helps with the interface between hospital community residential care home care packages and also access to commonwealth home support programs so they're the sort of assessments and referrals that we would get through my aged care so the function of the acas is to complete a comprehensive assessment um and what we focus is on wellness and also re-enablement um part of our process once an assessment is done we do a case conference and our teams are made up of multi-disciplinary health professionals as well so the approvals that an acas would do in regards to programs include include permanent residential care but that's for those people that want to enter a residential care facility they will need an approval under the aged care act residential respite care so there's two different types that we would differentiate with so we have high or low approvals and this entitles a person up to 63 days per year to access respite care in a residential care facility the other programs that we do approvals for include the transition care program um and this is for people that are still have goals um they're in hospital and they have goals to enable them to achieve maybe better function um or organize more time for them to make a decision on whether they need can return home or not and it really includes allied health import nursing and also geriatricians as well to support people post discharge from hospital so transition care program is an approval um that we would only do for a hospital assessment um and the client has to be in hospital to have this approval completed the next one is home care packages which are packages that are available to clients in their home and these home care packages are made up of four different levels depending on the client's needs so we have levels one two three and four and this will be determined by the assessor and the multi-disciplinary team in regards to where the person's care needs fit and we're guided by using a home care package matrix to assist with our decision making and we also determine whether they're eligible for a home care package and the sort of things that people can access through home care packages um include like personal care meal assistance domestic help transport social support flexible respite um in the home and then the last program that we do approvals for is a short-term restorative care program um and this particular program is only for eight weeks so it's actually to help people um improve their function while they're at home and this might include having some allied health input social work might be involved in a in their gp and to give short intensive therapies to people in their home and to prevent them from being admitted to hospital or into residential care unnecessarily so in regards to having an aged care assessment approvals under the act we do we talk about eligibility so the clients that we would assess are older people that have to be over the age of 65 um occasionally we do assess people under 65 and these are those that may have chronic conditions or under the national disability service as well so they may be transitioning across to aged care because their care needs can't be met under disability um we also assess the aboriginal torres strait islanders that are over 50 years of age vulnerable groups so clients that may come from cold backgrounds refugees homeless care leavers stolen generation and people from the lgbti communities complex and people at risk and access to commonwealth home support services as well so we can do approvals for those particular services in the community i think angela's given quite a nice overview of what acas does and i just wanted to briefly give you some information about what the regional assessment team do and what the difference is between the two and so the regional assessment service they also conduct aged care assessments but they really look at those entry-level home support services across australia they can be linked with private organizations linked with councils and also with health services like they are in our team um and the regional assessment service would refer to commonwealth home support program which is the chisp services which really looks at those entry-level services like planned activity groups domestic assistance personal care flexible respite meals home modifications access to allied health the real big difference between the entry level services and the home care package is that we would like to see people commence on entry-level services to meet a specific need and then if they're needing some more coordination or flexibility in the care that they need to receive that's when they could move on to have an assessment and have a home care package we could still provide those services but in a more coordinated approach um important to note that acas assesses tertiary trained in victoria the raz assessors are also tertiary trained but this may also differ um from state to state so i know that in some other states raz assessment officers would only have um i guess certificate qualifications so the the focus of the assessment is quite different um the acas assessment is quite comprehensive so you may find that the clinician is has a stronger focus on cognition health concerns coming from more of a clinical perspective rather than just looking at a home support need thanks angela and just a little bit about the raz function um the raz assessors would undertake a home support assessment um underpinning as well on the wellness and reablement approach so we're really trying to improve people well-being um living at home and ensure that clients can live independently in the community of their choice we would use the same assessment tool um and develop a support plan which really identifies the person's strengths and goals and match them to appropriate services within my aged care but also explore services in the community outside of my aged care thanks just a little thanks angela yep a little bit of a flow chart um angela's already touched on this about the my aged care assessment and service referral pathway but i thought i would just include a bit of a visual here so um on the left hand side you can see the blue box that's the my aged care contact center so that's sort of the first layer of the pathway and that is where registration and screening of clients occurs so clients can refer themselves to my aged care their representatives can call in or a health professional or a service provider and they can make a referral for someone needing some supports and this can be done either by a phone call or a web referral and then the my aged care contact center would do the registration of the client and do some general screening about to determine which assessment pathway would be the most appropriate for the client so if they're just needing some entry level services and they're just entering the aged care pathway they would generally be referred to the regional assessment service which would look at the home support needs and refer to home support programs so the basic level low-intensity home support services and really focusing on that wellness realm focus if there is a lot of complexity lots of hospital admissions vulnerabilities that this my aged contact center may refer directly to acas for a comprehensive assessment and the acat team would still look at those home support program needs but also look at the commonwealth subsidised programs that angela mentioned that are under the act such as residential aged care home care packages and transitional care and we would generally say that in the pathway if someone comes through to the acat team initially we would want to make sure that they have a ras assessment first to make sure that there are their needs are being met immediately with those entry-level services before we look at any further approvals but that does change from client to client thanks angie yeah um so this just gives you sorry so just before we go into the next one i just got a quick question that's come through from one of our interpreters does this information apply to western australia is this a national approach yes my understanding it is a national approach both states have raz and also acas so the the my hkey contact center will screen and then determine um which will be the most appropriate pathway depending on the the referral and the client's needs okay thank you very much for that so all clients need to be registered with my aged care prior to being able to access a res or an acas assessment um and they're all given an individual identification number which we call an ac number um so if they need to access their assessment post having an assessment they can use that particular id number um to have a look at their information on my aged care there's been lots of changes to the my aged care website um and the portal um so there's the professionals got a one particular access um clients can access via their portal and then there's also provider portal as well that looks a little bit different so this particular screenshot i've got up here is for clients to access and there's lots of information on there about what costs how to find a service provider information about aged care help at home and then what you're eligible for as well and then there's the referral pathways which pauline has already mentioned um so this just gives you an example of what we see um it's called our dashboard which is the assessor portal providers have a different version and i'm sure the contacts seem to have something else as well but they're all linked in together so we can find clients if we do a client search we've got the orange car there that which shows our referrals so they come through and then we triage them depending on the information that's provided um we also have reviews where we go in and update people's referrals if they want additional services assessments right on the on the right side the yellow one that's where our assessors will be provided a list of the clients that have been allocated to them so then they'll get clients into their into their portal um and once one thing that is a little bit different to the acas is that we have delegate decisions so for any approvals under the aged care act we have a delegate that needs to ensure that the information that's provided in the assessment determines that it is correct and also the person is eligible for that particular approval so um that we have a delegate and they are actually the representative from canberra to ensure um that what we're doing and diligence in regards to assessments and that they meet the criteria for an approval and the delegates undergo specific training um and have to have experience as an acas assessor and there's a couple of few other functions on there but that just gives you an overview of what we use and that's national so this is the same nationally so this is just some locations in regards to where you may be asked to attend an assessment we probably do at our particular assessment agency we do about 70 in clients homes within the community and then hospitals we do about 30 but each acas is different depending on where they're located um whether they're regional or metro other locations you may need to attend might be at retirement villages or srs um which are supported residential services so they're more like lodges um you may need to attend in a residential care facility as well and then there's the hospitals or inpatient units too so that might include acute subacute both public and private as well so we do assessments in both public and private hospital settings uh paulina um and just a little bit about the actual assessment tool that we use so um when we're asking for interpreter to come out on an assessment this is really what the tool that we use to gather our information until we assess the client um it is embedded within the portal that ann showed you before um and it the assessment takes around 90 minutes um and most of when our assessors would try to uh i guess ask a lot of the questions in these different domains more in a conversation style um rather than make the client feel like we're doing an assessment um but just some of the domains that we cover um is the social domain which really looks at the family supports and any other support networks that the client may have um and the activities that they may be involved um socially and in the community we also look at the carer and if there are any carer concerns so um are there any formal supports for the carer who identifies an as an informal carer um the details of the care support that they are providing um and how sustainable that caring arrangement is we also look at whether the actual client is a carer for another person in their household as well focusing on what kind of care they're providing and is this a sustainable arrangement um we focus a lot on the medical aspect which is about the gp connections do they have a regular gp are they how often are they seeing this gp are they receiving any other supports from specialist services or any other clinics um any recent hospitalizations and what that means for the person whether they've had any health or functional decline and also their health conditions and really focus on how those health conditions are impacting their well-being and what kind of supports they're needing to manage those health conditions we look at as well the physical component which has quite a few areas in it one being the functional section so we really look at you know how the person is managing at home general activities of daily living are they able to mobilize are they able to transfer they able to manage their personal care toileting are they continent how they're managing their medications can they manage the domestic tasks things like cleaning and cooking or can they get out in the community themselves also look at the physical component which is their medications any sensory needs or do they have any concerns with their vision or hearing any communication difficulties is there a history of falls and is there any concerns with their driving ability if they are driving and also personal health which looks at their oral health any swallowing concerns pain sleeping physical activity skin integrity and nutrition akas also have a strong focus on looking at the psychological section and which looks at cognition psychosocial and psychological and that really looks at um you know are there any cognitive changes have there been any diagnosis of uh dementia or any cognitive concerns that's impacting their safety at home um you know as the are there any um they had any supports or any assessments of their cognition are family concerned about the changes um and how the person is managing um have there been any changes in personality or behaviors is there any anxiety social isolation and really focusing on those psychological aspect of you know short-term memory loss long-term memory loss judgment looking at if there's any aggressive behaviors hallucinations wandering confusion so we do look at that in quite a lot of detail and we do use some supplementary assessment tools as a screening tool to help us identify if there are any cognitive concerns but also ask the question of how those concerns may be impacting the person's safety and their ability to manage at home another aspect of the assessment tool is home and personal safety so really assessing what the home environment is like and seeing if there's any concerns or risks for example the falls if someone is having lots of falls at home we want to make sure that the home environment is safe and if it's not whether we need to refer on to any community services for example for an occupational therapist to come out and review the home set up and also personal safety is their safety to the person themselves and this is an area where we may discuss if there's been any concerns raised around i guess elder abuse or any concerns raised around the person's safety managing tasks at home if there is a cognitive impairment um as angela mentioned there are some complex complexity indicators and vulnerability um that we look at in the assessment common vulnerability risks and they are things like inadequate housing so is someone at a risk of homelessness insecure tenure or hoarding and spoiler uh is there a risk of or confirmed abuse um is there any emotional or mental health issues that significantly limit self-care capacity so it's not really you know if someone just has a diagnosis of depression that wouldn't necessarily fall under a complexity indicator would be more if they have a significant concern or issue around that area that really impacts their safety living at home financial disadvantage any adverse effects of institutionalization so for example people who have been in prison foster care or any other care institution any drug alcohol concerns and any significant cognitive issues that also limit the person's ability to manage their self-care tasks and the vulnerability risk um the commonwealth is um i guess identified that older people who fall under the um vulnerable group may require additional supports and short-term management um to access services so we do like to check if anyone falls under this group so we know how to support them better in the community as an answer ange mentioned them earlier but they are the aboriginal torres strait islander group veterans refugees asylum seekers the lgbti community the cold community and also the socially isolated community now when we do our assessment um we do use some additional tools um to support the information that we've gathered through the assessment process so through the conversation but also through observational skills that we our clinicians use to assess how the person is functioning or the home environment and some of the tools that we use is the mini mental status examination that assesses a person's cognitive ability the rudus which also is used for cognition the gds which is the geriatric depression scale which focuses on mood the care strain index so if we've identified that the carer is under stress we may decide to do a care strain index uh the genogram i think and your team uses that more it's not embedded within the nsaf but um and the bartel and awes is really a functional screening tool so when we're looking at how the person is managing their day-to-day activities so when we gather all the information and like i mentioned before the assessment would take about 90 minutes we gather all that information and we also request some medical information from the gp or if they've had a recent hospital admissions we would review the medications and the discharge summary when we gather all that we create a support plan which is really a summary of what we've recommended to the client so we would discuss things like recommendations for the approvals under the aged care act so what the person is eligible for and can also make some recommendations based on those entry-level chest services that they can access to help them um in the interim while they're waiting for example for a home care package and also making sure that we're addressing any other concerns that may have come about from the assessment and looking at linking them in with community health services or specialist clinics in the community to meet their need um am i able to ask a few questions paulina sure thank you very much um just a few here as an interpreter if i feel that a person is under any threat or violence do i disclose this information to the service provider following on and if the age person has asked the interpreter not to disclose that he is under threat or violence what to do that's a good question um i look i i mean i would look i think i'm the well the first question i think if someone discloses that they're they're feeling that they're unsafe um it is really important to let them know that this is a safe space um and that we do have some supports that we can access and to let the assessor the clinician know um you can always ask the client consent if they're happy for for the person to for the interpreter to share that information with us um but i think as well it's really important to address some of these elder abuse or safety issues because you know if it's not addressed and they're just telling the interpreter where does that go we might you know the interpreter may not know exactly where to link this person into so it's just making sure they're aware that this is a safe assessment and that we can help them through this process um thanks just in regards to the interpreters approach i mean we are uh guided by the aussie code of ethics and there is a confidentiality um principle there now if we have to interpret everything that is said so if the uh aged person the cold client has said something we do have to interpret that but even if they say don't interpret it we do have to um say in an introduction everything in this room will be interpreted and kept confidential so we do have to interpret whatever's being said also don't forget that if you look at the confidentiality principle of the aussie code of ethics it says you know where it's requested by law um we can disclose information so that actually implies that if we think that there is a life under threat or someone's freedom is at stake or someone's health is at stake we can actually break that confidentiality principle um which falls under our duty of care uh so that is something to take into consideration and like we'll talk about the debriefing coming up as well uh but you know if if i guess the interpreter is feeling that the person's health freedom or life is in danger disregarding the confidentiality principle they are actually required by law on the duty of care to disclose that information if they um have this information uh and i hope i hope that clarifies that uh that answers that question thanks betsy that's excellent thank you thanks hansen um just one more question before you move on first of all a comment saying great flow charts well done okay um is the referral to home support services mean tested means tested i don't i don't think it it means is there is a fee that they would have to pay um but it's up to the provider to if someone you know had some financial um issues they may actually be able to waive the daily fee so for example if they required domestic assistance and it was going to cost ten dollars they may actually um only charge them five dollars depending on their financial circumstances um the means testing would occur for home care packages and residential care approvals so if they enter into agreement with a particular provider they will ne they need to lodge a means test assessment through center link and that that will be determined by the government how much funding they will receive from the commonwealth and how much they would be out of pocket so that's for the home care packages in regards to home care but under the chest providers it it's not means tested so um and then i think that's also why in a lot of cases we actually recommend some clients stay on chip services because they um may be out of pocket a lot more on a home care package so they're actually more suitable to stay on to services if they're able to from a financial point of view all right thank you very much angela and paulina there's quite a few more questions but i'll let you continue if we have time at the end i'll direct them to you if not like i said earlier we'll answer these questions in a written format and get them back to you in an faq style all right thank you very much i'll let you continue thank you fati um just a quick flow chart just so you um have a bit of an idea we we for the nsaf the assessment tool the call center the raz team and the acas team actually use the same assessment to gather their information and to put in their information into my aged care but it's just got a little bit of flowchart so you can see how that assessment builds over the different i guess components of the pathway so looking at the left hand side of the purple you have the screening so the contact center would do all that reason for contact screening details current supports very brief functional overview and an action plan so who they're referring to then the home support assessor would also use the nsaf and some of those domains that i mentioned earlier um to gather their information and record their information so all that functional profile cognition health and lifestyle profile family community engagement and support profile and then they would gather that information and develop a support plan and when it comes to the comprehensive assessment on the right we would build on that information that's there and also have a more comprehensive um more comprehensive information about the medical domain the physical domain social psychological and developer support plan from that so it's it's been developed really to build from that entry point through to raz through to a cass thanks paulina um now i just wanted to touch on the supplementary assessment tools that we commonly use and really the one that we would most commonly use with interpreters and in most assessments would be the geriatric depression scale which is the scale that looks at um identifying any symptoms of depression in older adults um there are many instruments out there that measure depression however the gds has been tested and used extensively in the older population and it's actually been a tool that's been around for quite a long time it was first created in 1986 um and it can be used with healthy medically ill or people with mild to moderate moderate cognitive impairment older adults and it has been extensively used in the community acute and long-term care setting so lots of tests done to it and it has been validated to about 92 percent sensitivity to identify if there's any um mood concerns it is not to be used as a substitute um for a diagnostic interview so it's not a diagnostic tool it really just allows us to identify and do a screen on someone's mood and see if there are any concerns or risk of depression that needs to be followed up by a health professional who can do a quite a thorough mental health assessment so it is an assessment it's quite easy to administer it's 15 questions um and it looks at how the person's been feeling in the last week and the answers are yes or no responses only um the only thing about this tool is that it hasn't been validated for use in the cold clients but unfortunately there hasn't been anything developed thus far that has been validated to use in the cold community thanks bench so you do have some of these tools attached to your resources but as you can see this is what it looks like um so we're asking how the person has felt um in the past week yes or no responses you know are you basically satisfied with your life have you dropped many of your activities or interests do you feel that your life is empty do you often get bored are you in good spirits most of the time are you afraid that something bad is going to happen to you do you feel helpless do you prefer to stay at home rather than go out and do new things do you feel that you have more problems with memory than most do you think it is wonderful to be alive now do you feel pretty worthless the way that you are now do you feel full of energy do you feel that your situation is hopeless do you think that most people are better off than you are that's what the tool looks like um i guess some feedback that we've had from interpreters in the past is that question 8 and question 14 the question about helpless and hopeless um can be quite challenging to interpret in different languages um and this is like why i mentioned before that it hasn't been validated for the cold community um and also sometimes people find it really difficult to just answer yes or no so they might start talking about oh well you know i felt like this this day and try to explain that sometimes but it's really important um to just follow the assessor's lead and just say you know it's just a yes or no answer now that we have these assessments on our screen as well i think uh if you haven't already done so dear interpreters um and like we said we you have access to these uh in our handouts as well it might be a good idea to actually maybe translate them beforehand so you're not put into put on the spot it might be a good idea um to see if on the internet some of these assessment tools i have found on the internet have already been translated into other languages and so you might have a look and see if it's already been translated in your light and and you know chat with other colleagues about how they would translate certain things you know for example uh that question number 14 and was it question number eight um you know just you can you can chat with your fellow colleagues about how they would translate things or interpret things um so that's why we're here today we've got the language uh specialists here within regards the assessment tools and the assessment tools themselves um so please make sure that you do download those and maybe um start doing a little bit of translation and you might even take it into the next aged care assessment that you go to so that it's nice and ready there for you uh and it would be a good uh good good reference for you uh during the assessment thanks fatih thank you and i just wanted to briefly touch on the standardized mini mental state examination it's not one that we commonly use with the cold population but sometimes it is used i just wanted to touch on it really briefly and you do have a copy of that as well to go through um it is a tool that is really commonly used as a to screen cognitive function um and like mentioned before not commonly used with the cold community and it's not really a tool that is diagnostic it really just helps us to identify if there are any concerns um in the cognitive domains so it can indicate a presence of cognitive impairment such as a dementia or following a head injury but it doesn't mean that someone does have a dementia so if we do do administer this tool it just allows us to look at whether they need any follow-up and any further investigations it's pretty quick and relatively easy to perform but the disadvantages of this tool is that it is biased against people with poor education um due to elements of language and mathematical testing it's not great for people with visual impairments and as mentioned before it hasn't been validated with the old community either thanks ange so i've just attached what it looks like um the different domains cognitive domains that it looks at is orientation registration so really that immediate and delayed recall so short-term memory attention and calculation and language um you know following three stage commands and also visual spatial concerned so being able to copy an image on the page thanks ang um the roland university dementia assessment scale the rudas as we referred to it is really the assessment that would be good if you got familiar with as as it is a cognitive screening instrument designed to minimize the effects of cultural learning and language diversity on the assessment of baseline or cognitive performance it is a validated assessment tool for cold groups um and it assesses cognitive impairment of people from all educational cultural and linguistically diverse backgrounds and it's had lots and lots of different studies done on it and it's been reviewed by cultural advisory groups for ease of translation and it's also been validated in multi multicultural groups in australia so it is a really common tool that we use when seeing people from a cold background so this is what the tool looks like um you do have a copy i'm a bit mindful of the time so i won't go too much into it but it does look at memory body orientation so can a person show you their right foot their left hand are they understanding that information and being able to carry out that task praxis so looks at copying what the assessor is doing with their hands the drawings are they able to copy an image on the page looks at adjustments that provides a scenario to a person and asks them to respond and what they would do in that situation um memory um so ask them to repeat some of the tasks or items that they were asked to remember at the start of the assessment and also language so a lot of animal naming in 60 seconds okay thank you very much paulina we've got a few questions coming in in regards to these tools now they are available on that tip sheet that we have uploaded to our webinar it says tip sheet cognitive assessment and you'll get the full list of all the um assessment tools that paulina has been talking about you've got the rudest there the minimental there as well as the gds there so they are there some of them have been translated into other languages you'll find links there uh some of them may not officially be but you can search the internet for uh pre-existing translations but the idea is that you now have the tools in english so you can start translating them yourself in regard for for preparation because it's very important for us interpreters to be well prepared before any assignment so if you look at your job offer and it says an aged care assessment then you will know that you're more than likely be um working with one of these tools right paulina that's right yes yeah so if you see that on the job offer it's an aged care assessment you take out these tools that you've either downloaded or found on the internet or you've translated or you've found a translated version already um and then you you prepare yourself and you might even take those with you for reference during your job all right but now we know exactly what question is trying to achieve and we literally physically will have the tools as well and i think that would help immensely in our preparation for these assessment assignments yep and fatigue i think it's important as well to mention that the interpreter is not um you're not going to be administering the assessment tool we've been trained to administer administer these screening asses these tools so it's really more about i guess having the language and being aware of how to interpret some of that information so it's really important to interpret back exactly what the person is saying even if the interpreter may not think it's relevant because it actually could be quite relevant to the screening um so really just following exactly what we say word for word in these assessment tools uh that's right so uh the at the end of the day the assessor is uh running the actual assessment so yes we will interpret everything that is said the way it is said uh in that line with our accuracy principle of the aussie code of ethics but you know it's um a very very good tool to have in order to prepare for these assessment tasks so that we know what kind of questions will be asked and i think you know as a practicing interpreter and as a trainer i find it very very useful to know that what i'm going to be interpreting and if i have access to it beforehand it makes some really really uh great preparation material and you know makes it really easy as interpreters for us to uh on our on our memory skills as well as our anticipation skills um which is going to be making your interpreting session a lot easier i also just wanted to make a point that um with practicing it even with a family member or someone else that speaks the language and then going through the questions as well helps i think as assessors we even practice um using these tools with each other when we first started out so using it as a as a practice session um with each other also could help as well just getting your confidence on what the questions are and how to translate them that's a great idea just a little bit of role play at home uh and you know once you do a couple of those especially for those interpreters that might not be so experienced um with aged care assessments it would be a really plus to go in there kind of expecting what's going to be said [Music] yeah great point angela well done thank you very much angel and paulina next slide i've just actually included um a link to a video that you can watch in your own time um of someone actually administering the rudos so if you'd like to see how it's done um before the assessment then you've got that link there that you can go into and have a look at um so you know what's involved in this in the screening tool yep so like i said earlier for dear interpreters uh this has been uploaded the slides have been uploaded and it has active hyperlinks on the slide so if you go to slide 27 on your presentation slides that we have given you on this webinar app you just have to click on this hyperlink and it will take you to the video it goes for about 20 minutes and it it really is a good watch because it'll go through step by step exactly how the rudes is uh implemented um and i think you'll find that very useful all right um so i'm just going to go over some information around briefing and debriefing um just part of you know usual practice um attending an assessment so the purpose of the briefing um is for the acas assessor and the interpreter to a shared understanding of the process um of what's going to be interpreted the communication what the respective roles are and also the goal of the discussion with the cold client um and also just to give an indication of what assessment tools may be used during the assessment um just to help the interpret interpreter know ahead of time in preparation um there's also just some information there from the offset code of ethics um that briefing is is important to to occur as well prior to work i think just from my previous experience when i would attend an assessment at someone's home i would you know introduce myself let the interpreter know the name of the client what the purpose of the assessment is so for example if i already knew that they're looking at a home care patches package i'd explain that who else would be attending the assessment as well in the home um just so that they know that there might be a partner there or another family member as well um and what the assessment will be about in regards to you know what our approvals are um and how long it should take so that's good just to have that communication prior um to attending someone's home in the community i think um it's it's well no thank you very much for bringing that up angela i think it's very important for us to have that even if it's a walk and talk of two minutes um you know that is the the the strawberry on top of an interpreter's uh preparation i think you know as an interpreter you might have formal training you might have gone to um a university or a tertiary institution studied for three four years five years you know that's preparation and then you've got your webinars you attend to pd sessions you attend to that's further preparation you get your job offer and then you've got oh aged care assessment and then you go and do more specific preparation maybe the week before or the day before a few days before uh coming to this particular assignment and then all this preparation adding on top of each other building like a lovely mountain of knowledge that two-minute walk and talk just before the actual assignment really makes it all come together you know knowing that um you know having this discussion with the assessor of what we're trying to do what the aim and purposes are you know if it's a if it's a home visit uh we meet the assessor outside maybe um you know i always try to find a car park behind them if i if i'm there after them or i also make sure just to introduce myself before we go in and even if it's that walk and talk of a couple of minutes i think it really puts everything in the context and really helps us to complete that preparation before going to that assessment and one other point um especially if i know that the person may have a cognitive impairment or dementia i probably would also let the interpreter know that because they may be trying to interpret in a particular language but the client isn't understanding because of their cognition not because of the language barriers or you know changes in dialectal um instead so if i did know that information i would also share that with the interpreter as well um just so they know what to expect that's great because there's so many things in the in those last few minutes that can be shared between the assessor and the interpreter i think definitely will affect the outcome of that particular assessment and i think it's a collaborative uh assignment as well when it comes to assessments like this um especially with the information that's given by the assessor as well as the information about potential uh issues with the client or the culture that could be given by the actual interpreter you know it could be the fact that the um the the person who's being assessed the the client uh might be illiterate for example or they might have some kind of speech impairment that the assessor might not be aware of and these things kind of could be shared as well and and even though it is the assessor who's driving the assessment and and they are trained to do so i think the interpreter plays a vital role in completing that assessment sharing that kind of information um in some cases during the briefing and in some cases uh in the debriefing thanks fatty thank you so the next point um is just in relation to the debriefing so this will occur after the assessments occurred um and just gives the opportunity for the interpreter and the acas assessor um to give some feedback on the session and also ask feedback from the interpreter as well because there might be some you know cues that they may have picked up um or things that they felt that they might have been uncomfortable with or need more information to exchange this this after the assessment but also included as you know i suppose a mutual learning um process too and will enhance the quality of service delivered both from the assessor and also the interpreter for future assessments um as well so certain aspects might include the client's education level which fatsy already mentioned and if there's any cultural issues that might have been indicated during the assessment and these can be discussed after the debriefing session as well um yeah like before we started today we were talking about what some of those questions and the you know and i've done my share of these um assessments as well as an interpreter in regards to you know sometimes you don't find equivalence because of a cultural matter or you don't find equivalence before because of a linguistic matter and i think it's really important to speak about that in the debrief with the assessor for example i always found that was very difficult to interpret no ands ifs or buts i know that minimental is not used a lot these days and it's more the rudest but i always found that very hard to interpret and you know i said to the assessor afterwards i said look i don't know what the aim and purpose of this particular question is um but you know it's it's a difficult one to interpret and uh it was a really good way of sharing that information with the assessor and then it's up to the assessor to do what they wish to do with that information um you know whether they include that question in the assessment um or not but i think it's very important for us to share this kind of information i did another one where um there were a lot of animals that was being shown to the clients but some of those cli animals were um like uh walruses or or um you know opossums i think it was like an american-based uh assessment and there were quite a lot of animals there that just culturally uh we would not see it on an everyday basis especially if it's someone who wasn't very well educated and maybe didn't see so many um david attenborough specials you know and they were given all these potential african animals and they just they just didn't know and it's not because they didn't remember they probably never seen a giraffe um you know what i mean and i think it's really important for us to speak about these potential issues after in a debriefing so um my fellow interpreters uh yes briefing and debriefing is very important if you can't get it in do get it in it doesn't take too long a few minutes before and a few minutes after thank you fetch you can't just add something in relation to the topic of cultural issues um because i feel like it's it's such a broad topic and i'm curious as to find out what are those cultural issues um from our work at the center for cultural diversity and aging we look at the way in which assessments and care planning can be conducted taking into consideration cultural issues and diversity issues so i guess from our perspective you know it could be things like the way in which clients connect with government services at large do they feel trusted do they feel safe in actually disclosing their information to a government body for example other things such as gender you know do people need to feel comfortable um disclosing personal and intimate issues with someone from the opposite gender to them do they need someone from the same gender for example as it relates to female issues hygiene etc um other things like decision-making um within the assessment process so does the the family member make the decisions on behalf of the um the older person's behalf how do we manage those decision-making and roles within families etc etc but also open to perhaps hearing further about what those cultural issues might be because it's such a big topic and it's really important that it's not a one-size-fit-all approach even though we do have the assessment tool which is a one size fit all the process and the experience for the client is very very different according to their cultural background their life experiences their history of trauma and discrimination um and of course what fetty mentioned around illiteracy or understanding the content but also things like dementia is not um always understood within within all cultures and also mental health is a very um sort of arbitrary kind of concept in the sense that not everyone wants to disclose um their mental health issues so just a few things to touch upon i think is really important that it's not just the actual language that we need to look at but also the cultural um perspective as well um thank you very much lisa so please if you have any comments about this or questions put them through uh i probably won't be able to answer them or i won't be able to direct them to uh presenters today um but um i will direct those questions to uh angela polina and lisa and of course that are interpreting related myself and we'll get back to you in a written format within the next week or so i do know that we are running out of time and we've still got a few slides to get through so thank you very much lisa and back to you paulina so oh sorry it's angela here again so looking at some strategies for difficult situations um so it's important just to introduction um to the clients what the interpreter's role is at the assessment ensuring that we acknowledge the client during the assessment and interpret the information asked by the assessor just also be aware that sometimes a family may be providing additional information and they may also try and interpret over the interpreter so there might be multiple conversations going at once that can be quite difficult and just ensuring that we're clearing you know speak clearly adjust the space and location if needed as well especially if someone may have some hearing impairments or have visual impairment and they prefer to be a bit closer or the space arrangements in a particular area a couple of other things so just ensure that the role interpreter is to interpret exactly what has been said by the assessor and what the response of the client is important and just an example of some positioning of where the interpreter should sit so it's best to be in a triangle sort of positioning shape so the interpreter the client and the interviewer can all see each other during the assessment um angela can i comment on this as well just very quickly i think where possible it's very important that we do take this uh triangular position and in the interpreting world we call this the golden triangle um and what it does is um it also shows impartiality you are equal distance with as an interpreter you are equal distance from the assessor from the client um and uh especially with the non-english speaking client you know they can see that uh there is no taking sides and uh everyone can see each other clearly and everyone can see each other and hear each other clearly as well so where possible uh the triangle is uh definitely the best uh positioning for the interpreter um thank you very much just one other additional comment i want to make that during our covert times there has been additional challenges during assessments so here in victoria majority of our assessments um that have occurred face to face both the assessor and the interpreter have had to wear a face mask and possibly even a face shield um during an interaction um so that has sort of you know can affect the clarity of the conversation um especially if someone may have some hearing impairment but it also affects you know the visual cues as well from people's facial so they can't see us and there might be some mistrust there because we're wearing you know all this ppe um even in the home environment so that has been something that um you know has affected our um interactions with clients um especially in the community but generally most most people have been understanding and you know they probably feel um that you know by us putting ppe on is actually protecting them from any exposure to so they do understand that there isn't for it when there's ppe required do the acat team members provide the ppe for the interpreter as well at our organisation because we use a lot of in-house interpreters their department had actually ordered and purchased ppe so their interpreters are given packs um of equipment to take with them um however we always if we've got an interpreter that we know we're going to an assessment with an interpreter we would bring additional ppe with us okay that's great yeah yeah we've always got extra stock yeah that's great because i know that most people would have face masks these days i mean i've got a packet in every bag or in every corner i go to at home but the face shield is not something that everyone might have so it's it's really good to know that you guys will um have some backup in case uh the interpreter doesn't have it yeah on what the policies are through each organization and what's happening in the community amount you know depending on how much ppe we need to where um the regulations change daily so yeah that's right and for uh for our organization we reverted to doing tele health assessments and news and also telephone assessments and even though we've started going back out into the community um we haven't in we're not going out with interpreters yet just to minimize the amount of people that are in the household so we are um using interpreters still via the phone even though we're at the client's house but we do have some extra video interpreting is also an option these days as well that's probably been quickly taking over the whole telephone scene as it as it hopefully should eventually one day um but you know uh video interpreting is also a good uh alternative these days to face to face when it is not ideal and look i mean each state will be different you know they're guided by what their department of health or advising regards to contact and and ppe and number of people in um in people's homes too so um just have to review that um just so just some additional challenges for the cold um consumers so um over the past 12 months we have been undertaking um a lot more tele health like paulina has already mentioned um sometimes there can be some issues in regards to having multiple people on a three-four way conversation um using tele-health can affect the communication and you also can't visually see the person sometimes if it's only using phone interpreting um if there's a disability there so whether they may not be able to you know understand or have some learning issues that may also affect the interaction if there's any conflict with additional next of kin that might be at the assessment um who also speak the language of the client so this sometimes can be noted that you know family member that might be under a lot of care stress there might be some arguing during the assessment um and usually the assessor would try and calm the situation and just explain that you know we're here for the client we understand what's you know your perspective as well um but you know we're just trying to gather as much information we can to help the situation so usually would be the assessor that would guide um the scenario if there was a bit of conflict or arguing during assessment as well um dementia that can also pose some challenges so when you're interpreting um the client might not actually understand what you're saying if it's in their first language and then maybe the responses might actually not make sense either um in regards to what you're interpreting back so usually interpreter would say look i don't i don't understand what they're saying um and you know it doesn't make sense um to what what they're replying family dynamics as already just mentioned hearing impairments is a big thing sometimes we may take some equipment to enhance the volume if someone's got hearing impairment and also speech impairment so that could impact if they've had a stroke and their ability to express themselves when they communicate so you know might be the language but also whether they've actually got a speech impairment too that could impact on the information that's provided in the exchange during the assessment um the other couple of things were smaller populations the interpreter may actually know the family or the client so sometimes this most you know there might be a bit of a conflict of interest yeah um that can occasionally occur um like i said the smaller cold populations the only available interpreter is actually a family member that knows their clients and i think what's really important is that the interpreter discloses this conflict of interest you know if you know the person that you're interpreting for we always say when we're teaching the first thing you do is you disclose yes i know this person and the second thing you do is you disclose the level of acquaintance you know how close are you with this person are you a cousin are you someone who went to school with them is that person your best friend's dad you know so we need to really tell the um assessor uh the level of acquaintance we have and then we always say it's up to everyone in the room so the assessor they got to be happy with it um the client's got to be happy with it the non-english speaking client maybe they don't want you around because they're not comfortable sharing things um with you around there and uh thirdly the interpreter has got to be okay with it too so maybe you don't want to be interpreting for this person okay and we always say that as long as all three people involved are happy to go ahead uh even though there's a conflict of interest then it could go ahead but if any one of these people aren't happy um something else might need to be organized like getting a telephone or a video interpreter or maybe even um rescheduling the appointment you know but i think disclosure is very very important there yeah definitely it doesn't happen that often but it can't can occur in certain cultural groups where there's limited interpreters available as well and it's a small community living in a similar area um so finally i'm just going to look at a quick case scenario um and this just just to give you some background of some of the issues that might arise during an interaction with um an assessor an interpreter and a client and just some of the consequences as well so um so this is when family members interpret for a client so the acas administration booked an interpreter for mrs gregorio using the in-house interpreter that has been scheduled to interpret it the client's home um but when she gets there the client tells her not to worry about it because her daughter is already there and will interpret so some of the issues that can be posed in this sort of situation is that um there's you know a lack of medical terminology um there might be some emission of the information um impartiality conflict of interest privacy of the information are some of the areas that would affect this situation the assessor may not be able to differentiate between the information from the client and the family member because it might just be the family member's perspective um information they're providing the client may also end up being excluded from the conversation because the family member's interpreting a client may also refuse the services of a professional interpreter because they might feel a bit more easy and comfortable with a family member being there and interpreting um and the interpreter is there to offer a service to the clinician and the client alike so a client dismissing interpreter does not mean that interpreting is not required so our policy is that we would recommend having an interpreter present in some cases that we may not have one available and the clients consenting to a family member then we may actually use a family member depending on the circumstances but if there's a conflict of interest that we know of or a complex case then we would definitely ensure that we have a interpreter available angela i think this happens quite often you know more than we'd like it to happen but i think what we as interpreters need to remind ourselves is that we don't have just the one client we have two clients we have the assessor or the professional client and we have the non-english speaking client so the called client and our services are there for both of them not just for one of them so if the family member or or the called client says well i don't want an interpreter um we need to also keep in mind that in the does the assessor still need the interpreter okay so we need to make sure and in most cases 99.9 yes the assessor is going to need the interpreter so just because the call client says i don't need one uh it doesn't mean that uh you know we say okay see you later always keep in mind that we have two clients one is the professional client and one is the non-english speaking or the cold client and we are there to provide services for both of them not just the one of them and like angela was saying in most cases they are going to have our back they are going to say no you might not need the interpreter but i need the interpreter because i need to make sure that all the medical terminology is interpreted correctly and that it's interpreted impartially all the other reasons that angela showed in the previous slide thank you um so it's just important the information you know that could be withheld from the client assessor could be compromising care so that's one of the consequences of this situation um and sometimes that you know in certain circumstances a family member may even provide unsolicited information like hints or answers especially when um a company screening tool like the rudas has been conducted um i think both pauline and i have experienced that previously where family members have given hints and it will actually affect um the overall um for someone that may actually have you know a cognitive impairment there um and also it also exposes the organization to some liability as well um if something you know is not interpreted correctly in a professional manner with an actually professional trained interpreter um so some of the solutions is that the interpreter should cautiously explain to the client the family member that's in everybody's interests um that a professional interpreter is present during the medical examinations um and that's also just reiterating what that's he just said that you know you've got two clients so that's the client and also the health professional at the assessment just state that the presence of a professional interpreter is a hospital policy um and if the family member insists on doing interpreting just explain that they you know will sit in the room as well and will intervene when communication is compromised so you can still you know remain present um because you are also there for the health professional as well um and the interpreter's role is integral part of of the patient care as well just to explain that component um and it's also safer for that professional interpreter to also be doing the interpreting [Music] [Laughter] [Music] you