Judith A. Davey
We are all well aware that populations are ageing, but this trend is increasing at a faster rate for Māori than for the rest of the NZ population. The proportion of Māori aged 65 plus is expected to almost double in the near future, increasing from 50,000 in 2019 to 90,000 in 2029. As people age, Māori are more likely to require support, including aged residential care (ARC). Māori are currently under-represented in this form of care, with only 3% aged 65+ in ARC. The rate of admission to ARC for Māori is only half that for non- Māori, but, with the expected increase in the older Māori population, the demand for ARC is expected to grow significantly.
Changes in life expectancy contribute to this. Over the last two decades Māori life expectancy at birth has grown from 66.6 years for men and 71.3 years for women to 73.4 years for men and 77.1 years for women. This compares to figures of 81 years and 84 years for pakeha men and women. Combined with reduced fertility this means that the 85 plus age group, the group most likely to need ARC, is growing rapidly for both groups.
Lack of data based on ethnicity makes it difficult to compare differences or inequities in the quality of ARC care, but international studies show important areas which need attention: ensuring services are accessible, improving social support networks, building community capacity; a wellness-based approach; and preservation of cultural values. Here are some of the major themes from a recent New Zealand report.[1]
Acceptability
Lack of Kaupapa Māori services may make older Māori reluctant to enter ARC – Māori may need to see, hear, and feel the presence of Māori cultural values and practices in an ARC environment. This calls for greater Māori leadership in the development and delivery of ARC. Largely negative expectations of ARC are widespread in the community in general. Fears of being admitted to ARC for older Māori include being forgotten by their whānau and being lonely, not being cared for properly and having nothing Māori to make them feel welcome.
Staffing
ARC workforce training, relevant to residents’ needs, including cultural needs, is central to ensuring their wellbeing. There is no data on the ethnicity of ARC staff, but 40% of caregivers and 39% of registered nurses are currently on migrant temporary or permanent visas and the majority come from the Philippines and India. Training documents may omit issues relating to Māori and health equity. This may be especially relevant for palliative and dementia care. Cultural safety training may be mentioned in training policies and procedures in ARC, however the implementation and measurement of its impact is not often evident. There is the potential for Māori-led training organisations to support ARC workforce development.
Co-design
We know that older Māori are more likely than non-Māori to be cared for by ‘informal’ caregivers, often whānau, at home. This knowledge provides opportunities for whānau members to contribute to training and treatment programmes in the ARC sector. Co-design and partnership with Māori in development and administration will be essential to meet the needs and expectations of older Māori.
Data
As already mentioned, there is limited information available regarding ethnic variation in quality of care and health outcomes in ARC.
Funding
New Zealand Aged Residential Care is mainly funded through contracts between providers and DHBs. There is increasing privatisation within the sector, linked to increased size of facilities to produce economies of scale. There are concerns that funding has not increased corresponding to growing dependency among residents.
Means-testing means that nearly all ARC residents make a contribution towards the costs of their care and the proportion making the maximum contribution is increasing. If this cannot be met by regular income, homes may have to be sold. Where homes are on Māori land or occupied by extended families this may produce difficulties for whānau. Collective ownership and guardianship of land and property for Māori needs to be considered in the context of ARC.
Access and choice
If a kaumātua is assessed as requiring ARC, questions then arise about cost, choice of provider, location, accessibility for whānau and quality of care, especially about cultural support. This may be difficult for whānau especially in rural areas. The report calls for work to ensure Māori are well informed of ARC options, including the potential benefits and the financial implications of both at home care and residing in ARC. Māori also need to have the ability to influence and lead the development and delivery of new models of care.
Māori-led models of aged care – examples from the report
Hoani Waititi, a pan-tribal marae includes housing for kaumatua adjoining the marae. and there are similar models across the country. These allow kaumātua to participate in the day-to-day activities of the marae and to be acknowledged for their knowledge.
Project Toru arranges weekly visits by school students, who can speak te reo, to talk and interact with Māori ARC residents. This is not only an intergenerational programme of learning and of cultural support, but also provides potential employment opportunities as young people learn the basics of caregiving. Participation in this programme qualifies for NCEA credits.
The Māori Health Authority – Te Mana Hauora Māori
The Māori Health Authority, according to a statement by the Department
of the Prime Minister and Cabinet in 2021, “will support the Ministry of Health
in shaping system policy and strategy to ensure performance for Māori, and will work in
partnership with Health NZ to commission care across New Zealand, ensuring that the needs
and expectations of Māori communities (are met)”. This presents an opportunity for Māori-led development and delivery of services that will deliver equitable health outcomes in ARC.
[1] Joanna Hikaka and Ngaire Kerse (December 2021) Older Māori and aged residential care in Aotearoa | Ngā kaumātua me te mahi tauwhiro i Aotearoa.
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