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Understanding Aged Care Use by Older Chinese-Speaking Immigrants in Australia

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Understanding Aged Care Use by Older Chinese-Speaking Immigrants in Australia Understanding Aged Care Use by Older Chinese-Speaking Immigrants in Australia Dolly Hsiao-Yun Huang Submitted in total fulfillment of the requirements of the degree of Doctor of Philosophy. December 2016 Department of Social Work School of Health Sciences Faculty of Medicine, Dentistry & Health Sciences The University of Melbourne Abstract The world’s population is ageing rapidly, so how to provide quality health and aged care to an increasing elderly population has become a critical issue facing many countries. In Australia, one in four persons is born overseas. With a significant number of older people from diverse ethnic backgrounds, it is even more challenging to provide quality care that can meet their specific cultural needs. Evidence suggests that older people from culturally and linguistically diverse (CALD) backgrounds are more likely to be socially and financially disadvantaged and to under-use aged care services. However, there is a lack of detailed information on individual ethnic groups in relation to their specific care needs and service utilisation. This thesis sought to examine the characteristics of older Chinese-speaking immigrants, particularly those who migrated at an older age, and explore the experiences of aged care service use by this population in Melbourne, Australia. The Andersen Behavioural Model was the analytic framework utilised to understand factors associated with aged care use by this population, focusing on the concepts of predisposing, enabling, and need factors. This model was applied using an intersectionality perspective, highlighting how the interaction of various differences among older Chinese-speaking immigrants created unique experiences of ageing and aged care use. An interviewer- administered survey was conducted with 120 older Chinese-speaking immigrants between December 2009 and January 2011. Participants were recruited from four ii metropolitan areas in Melbourne using a quota sampling method to ensure representativeness. The study found that older Chinese-speaking participants used significantly more social support services and significantly less allied health and home care support services, compared with older Australians. The use of aged care services was best explained by predisposing and enabling factors, rather than need factors. Filial piety (a predisposing factor) and the availability of family carers (an enabling factor) were found to have negative effects on use of aged care services, while other enabling factors such as social support, adaptation of Australian culture, retention of Chinese culture, and awareness of existing services were found to be positively associated with aged care use. Having a lower score on activities of daily living (a need factor) was also found to increase the likelihood of using aged care services. The findings suggest that older Chinese-speaking Australians who are relatively recently arrived immigrants have a greater need for social support services. To improve the uptake of aged care services, policy makers and service providers need to better understand the effects of filial piety and family resources on aged care use, as well to encourage them to strengthen links with both local Chinese communities and the wider Australian society. This study contributes to a greater understanding of the influence of culture and recency of immigration on aged care use by the older Chinese-speaking population in Australia, and assists service providers and practitioners in better planning and delivery of culturally appropriate aged care services. iii Declaration This is to certify that: i. the thesis comprises only my original work towards the PhD, ii. due acknowledgement has been made in the text to all other material used, iii. the thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices. Signed: Dolly Hsiao-Yun Huang iv Acknowledgements My eight years of doctoral studies has been a long but fruitful journey. While conducting this research and writing the thesis, as an immigrant myself, I have also experienced the birth of two children, the start of my first social work job, and voluntary participation in the establishment of two not-for-profit organizations. Without the people and support given to me, I do not think that I could have survived. First and foremost, I would like to express my sincere gratitude to my three supervisors for their continuous support, encouragement and guidance during my PhD journey. Professor Daniel Fu Keung Wong, now working in the University of Hong Kong, accepted me as his first and last PhD student at the University of Melbourne. I was honoured and blessed to have the opportunity to be supervised intensively by Daniel in the first one and a half years of my doctoral studies. His knowledge and determination helped me to move productively toward confirmation of candidature and approval of my ethics application, which laid the foundations for this thesis. I am heartily indebted to Professor Elizabeth Ozanne and Professor Louise Harms for their immense patience, constant support, and invaluable advice. The writing process has been the most difficult part of my studies, not only because I had to write the thesis in a second language that satisfied academic standards but I also had to learn to take ownership of my writing and be more confident and authoritative about it. Elizabeth offered great assistance in improving my English skills and motivated me to become proficient in academic writing. Lou taught me that writing a thesis is like telling a story v and you as an author have to guide your readers through it. This may sound simple and easy but it took me a couple of years to gradually grasp how to achieve it. In addition, their invaluable and constructive feedback on the initial approach I took in interpreting the data encouraged me to rethink my arguments and theoretical and conceptual framework. This is evident in the methodology and discussion chapters of the thesis. I am deeply grateful for Elizabeth and Lou’s supervision and wisdom that have supported and inspired me to grow and develop as a writer and a researcher. I would like to extend my gratitude and appreciation to the advisory committee Dr. David Ross for his advice, support and encouragement, and The University of Melbourne which awarded me a Faculty Research (trust funded) Scholarship during candidature. My special thanks must go to the participants who kindly offered their time and energy to complete the survey and the gatekeepers of the Chinese seniors clubs, social service organisations, and associations where participants were based. Without their assistance and generosity this research would not have happened. I heartily thank all my fellow PhD students, work colleagues, and close friends for their encouragement, friendship and support, which have made this journey less lonely and more inspirational. Finally, but most importantly, I thank my parents, parents-in-law, dear husband and two beautiful daughters for their sacrifice, tolerance, and endless emotional and practical support. They are the ones that have kept me going when I was down and did not believe in myself. There are no words to express my gratitude for their immense contribution to my PhD journey. I love you and thank you for always being there for me. vi Table of Contents Abstract ........................................................................................................................... ii Declaration ..................................................................................................................... iv Acknowledgements ......................................................................................................... v Table of Contents .......................................................................................................... vii List of Tables ................................................................................................................. ix List of Figures ............................................................................................................... xii List of Appendices ......................................................................................................... xii Chapter 1: Introduction ................................................................................................. 1 1.1 Motivation for this study .................................................................................... 2 1.2 Ageing in multicultural Australia ...................................................................... 4 1.3 Ethnicity and aged care use................................................................................ 8 1.4 Research aims and questions ........................................................................... 12 1.5 Terminology used in this study…………………………………………... ….15 1.6 Structure of the Thesis ................................................................................... 156 1.7 Summary .......................................................................................................... 17 Chapter 2: The ageing experience of older Chinese-speaking Australians ............. 19 2.1 Defining Chinese ethnicity: ancestry, language, or nationality?...................... 19 2.2 Trends in growth of the older Chinese population ........................................... 23 2.3 The impact of migration on the ageing experience .......................................... 27 2.4 Cultural and family influences on
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