For people with dementia and their family carers it is essential that they know about, and are able to access, the range of dementia-related services available to them. This is often particularly challenging for people from culturally and linguistically diverse (CALD) communities who may lack information about such services or may not perceive the relevance of the services to their situation . Australia is a highly multicultural society and the number of older people from CALD communities with dementia will continue to increase . It is therefore essential that policy makers and service providers have as clear an understanding as possible of the issues confronting people from CALD communities so that dementia-related services are relevant and accessible to people from these communities.
Much of the research into the dementia-related service needs and service provision within multicultural communities has been undertaken in the US or United Kingdom . Some of the key findings from this work are that: differences in language and cultural background of the person living with dementia (PLWD) and the clinician conducting the dementia assessment may impact on accuracy of the diagnosis ; CALD communities may have different understandings of dementia than the Western medical understanding and this may affect their approach to services ; stigma, lack of knowledge about and negative experiences of services and language barriers all contribute to a low use of services [6, 7].
Mukadam, Cooper and Livingston  reviewed 13 papers on how and why people from CALD communities present to specialist dementia services. They concluded that people often present to dementia services later in the condition and that there are a number of barriers that people face. These include: not conceptualising dementia as an illness; believing dementia was a normal consequence of ageing; thinking dementia had spiritual, psychological, physical health or social causes; feeling that caring for the person with dementia was a personal or family responsibility; experiences of shame and stigma within the community; believing there was nothing that could be done to help; and negative experiences of healthcare services. Recognition of dementia as an illness and knowledge about dementia facilitated accessing help.
Cooper et al  undertook a systematic review and meta-analysis of ethnic differences in the use of dementia treatment, care and research. They included 33 papers in their review. They concluded that – compared to the general population – people from CALD communities accessed diagnostic services later in their illness, and once they did receive a diagnosis, were less likely to access anti-dementia medication, research trials and 24-hour care.
Although some of the issues identified by US and UK researchers may apply to CALD communities in Australia, similarities should not be assumed, both because of the make-up of the communities and differences between health systems in the different countries (Barker, personal communication, 2010). Australian research findings include that: CALD communities have lower use of services [10–13]; and CALD people living with dementia present with more advanced symptoms and in poorer health than Anglo elderly [12–14].
One body of Australian literature, focusing on residential aged care, examined the relative roles of ethno-specific (services catering for a specific CALD group) and mainstream services. Westbrook and Legge  found that both CALD residents and family caregivers preferred ethno-specific services, because of the food provided and because the facilities encouraged family members to be involved in care.
Studies have shown more positive outcomes for CALD residents of ethno-specific facilities, compared to those in mainstream facilities. Runci, Redman and O’Connor  identified that residents in ethno-specific homes were prescribed less benzodiazepines and engaged in more social interaction than residents of mainstream homes. Goh, Low and Brodaty  compared levels of depression amongst Chinese residents in ethno-specific and mainstream facilities. They found that while the rates of depression were similar, the drug treatments used to treat depression were more appropriate and effective in the ethno-specific settings.
The potential for mainstream facilities to provide culturally appropriate care has been outlined  and other authors have argued that there is a need for both ethno-specific and mainstream facilities as well as a partnership model where both types of facilities support each other and work together for the benefit of clients and families .
Australian studies examining the perceptions and use of dementia services can also be found in the grey literature (written reports that may not be publically available or published in academic peer-reviewed formats). This literature suggests that CALD communities underutilise services in comparison to Anglo populations , due to a lack of knowledge of dementia as a disease, and families being unaware or unwilling to use services . Some CALD communities are willing to use services such as community nursing and culturally specific respite, but not residential aged care [21, 22].
While there has been a certain amount of research undertaken – as outlined above – further research on the use of dementia-related services amongst CALD communities has been put forward as a priority research area . This is particularly the case in view of the projected increase in people with dementia from CALD communities over the next forty years .
In response to this identified need, we undertook a study of dementia caregiving in the Arabic, Chinese, Italian and Spanish-speaking communities living in south western Sydney, Australia. These communities were chosen because they are some of the larger groups in the local area and are distinct from each other in terms of language, migration history and acculturation. One broad aim of the study – and the focus of this paper – was to explore the perceptions and experiences of CALD family carers and a range of health professionals with regards to the use of dementia-related formal services. The research questions this paper aims to address are:
What dementia-related services do people from CALD communities use?
What issues do people from CALD communities face in using dementia-related services?
How can the provision of dementia-related services to CALD communities be improved?
Data was gathered from family carers, bi-lingual general practitioners, geriatricians and bilingual/bicultural workers providing a health or welfare service to one language community or CALD communities generally. The range of dementia-related services covered in this project included in-home personal care, in-home domestic help, in-home and centre-based respite, and residential care. Ethno-specific services provide care to one cultural or language community; multicultural services provide care to several different CALD communities; and mainstream services cater to the whole broader community.