The aged care system has failed Aboriginal people. Here's what Elders say needs to change

The Royal Commission into Aged Care Quality and Safety recognised the aged care system has failed to provide culturally safe care for Aboriginal and Torres Strait Islander people as they age. It recommended major reforms, including active partnership with Aboriginal and Torres Strait Islander people.

The Australian government has also committed more funding for Aboriginal and Torres Strait Islander aged care services, with a focus on boosting the role of Aboriginal community-controlled organisations.

So what do older Aboriginal people need to age well? And how can aged care funding and systems enable that?

This was at the centre of our study, led by the Dharriwaa Elders Group in its long-term partnership with UNSW, known as Yuwaya Ngarra-li. The study involved speaking with 22 Elders in the remote New South Wales town of Walgett about what ageing well means to them.

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Elders are the ‘wellspring’ for younger people

Aboriginal Elders play an important role as community leaders and protectors of cultural heritage. This involves passing down knowledge and stories, leadership, care-giving and safeguarding family, community and intergenerational wellbeing. Supporting this aspect of ageing well is crucial. As one Elder explained:

Talking about our stories and storylines, and telling those stories […] It’s Aboriginal culture – it’s an oral system of educating people and giving people information. It’s part and parcel of Aboriginal life […] you know your stories, you know where you come from.

For Elders who have worked away from Walgett in various careers, this means a kind of “active retirement” – returning to Country to bring back knowledge and continue a legacy for future generations.

One said:

Once you have an education, you take it back to your community.

Addressing the ongoing impacts of colonisation

Elders explained how community health and wellbeing continue to be harmed by dispossession and climate change, drought and water insecurity:

When I think about ageing and culture, I think one of the big things that is on people’s minds, especially elderly Aboriginal people, is the fact that the rivers have dried up, and how that affects culture. To me, it’s like another wave of destruction of our culture.

Many Elders described experiencing institutional racism in mainstream services, including aged care services, and identified that current systems are not designed with consideration of the wellbeing of Aboriginal people:

I think there’s always been a difference in the aged care needs of Aboriginal people. We’re in a system, an English system, and I think our care needs are different. Not that we need to be in a building with four walls and just sit there. They don’t understand the Aboriginal way because they never learn it, we learnt their way.

Elders highlighted the need to acknowledge the intergenerational trauma of being placed in institutions for Aboriginal people, especially for survivors of the Stolen Generations who were taken from their families and put in government and church-run institutions.

A holistic concept of wellbeing

For Elders, wellbeing isn’t just about individual health. It also involves social, mental, physical, cultural, spiritual, political, family and community dimensions.

They saw the Dharriwaa Elders Group Centre – a space used for daily meetings, events, cultural exhibitions and other community activities – as vital:

People tell jokes, you come in here and have a yarn about different things. Makes you feel good when you come in here and talk to people.

Another said:

I think the Elders Group is important, that we have this organisation here, we’ve got people together of the same age group, the same mindset. You see it when older people are just around young people, they aren’t exercising their minds as much because they don’t know what they’re talking about. The older person doesn’t understand, and they’re just left there wondering. So if you’ve got similar age, similar thinking, they can have a conversation.

Elders saw staying politically engaged and active in the community through Aboriginal community-controlled organisations as crucial to wellbeing.

A culturally safe model of aged care

Elders talked passionately about how culturally safe aged care means being truly cared for, not just having your needs met. They described the traditional way of caring as based on being loved, valued, respected and safe. A culturally safe model of aged care would integrate these values into practice.

Elders felt strongly that mainstream models didn’t help show what aged care should look like. One said:

They’ve had the royal commission, and the report […] They did do some investigation of ageing Aboriginal people, but how do they fully know what to look at? Come and talk to us. What I mean by this is Closing the Gap – well, there is no such thing for ageing […] Because non-Aboriginal people, we can see they’re getting a bad deal.

Many feared becoming dependent on the aged care system.

Building community capacity in aged care

Walgett is a small remote community, which presents service delivery challenges. But enabling Elders to age on and care for Country, and to stay connected to extended family, would bring many benefits and opportunities.

For example, unemployment among Aboriginal people in Walgett is high; family and community members could be trained and employed to provide in-home support and transport for Elders:

Aboriginal people know their people […] Racism is a big thing and it does rear its head in ageing. Aboriginal people understand the way a person speaks, what they might mean, as opposed to say, a non-Aboriginal person, they wouldn’t understand it. Aboriginal people are closer to the language, to the extended family. They’d be good, to be trained up in aged care.

Local community-controlled organisations are ideally placed to do this, with appropriate resourcing.

What now?

Aged care reform is underway. The Dharriwaa Elders Group and others have raised concerns about a fee-for-service aged care funding model with NDIS-like individualised entitlements.

Elders’ perspectives could guide a different kind of policy and service design reform.

The Dharriwaa Elders Group is an example of how Aboriginal community-controlled organisations provide places to gather and connect, and share knowledge and humour. They can be a hub for community leadership and advocacy. Governments could resource such organisations across Australia to support Elders to age well on Country.

A whole of system approach is required. Elders told us any policy reform must focus not just on aged care, but also on the health, housing and social sectors. This is vital as a non-medical approach to ageing well, enabling Elders to stay on Country, in their community, connected to peers.

This research is leading to possible solutions already. For example, an award-winning Masters project arising from this research drew on what Elders said they needed to design a culturally led model of housing that could be built in Walgett and other remote communities.

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This article is republished from The Conversation is the world's leading publisher of research-based news and analysis. A unique collaboration between academics and journalists. It was written by: Ruth McCausland, UNSW Sydney; Peta MacGillivray, UNSW Sydney; Sacha Kendall Jamieson, University of Sydney, and Virginia Robinson, Indigenous Knowledge.

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Ruth McCausland receives funding from the Paul Ramsay Foundation and National Health and Medical Research Council, and is on the Board of the Community Restorative Centre.

Peta MacGillivray receives funding from the Paul Ramsay Foundation and is affiliated with the Community Restorative Centre (CRC NSW) as Chair of the Board of Directors.

Sacha Kendall Jamieson receives funding from the National Health and Medical Research Council and through the Westpac Safer Children, Safer Communities grant scheme

Virginia Robinson is Secretary of the Dharriwaa Elders Group