Source: MIL-OSI Submissions
Source: Health Quality and Safety Commission
New research published today by the Health Quality & Safety Commission (the Commission) is the first of its kind to better understand, raise awareness of and start discussion about the quality of care for Māori and aged residential care (ARC).
Co-authors Drs Joanna Hikaka and Ngaire Kerse from the University of Auckland were commissioned to produce the Older Māori and aged residential care in Aotearoa report, which describes that fewer Māori than non-Māori enter ARC, that there is a lack of kaupapa Māori aged care services and that, for many, ARC is a second choice to staying at home and being cared for by whānau.
The report presents information gathered from published literature, supported by thoughts from Māori and non-Māori who research and work in the ARC sector. The report combines their professional experience with personal whānau experiences of Māori realities of ageing and ARC. The authors highlight that further work needs to be done in this area to elevate and give power to the voices of kaumātua and whānau in these discussions.
Commission board chair Dr Dale Bramley says, ‘We welcome this research. It’s an important first step in understanding issues for Māori in using ARC services and we recognise it has highlighted broader implications for ageing Māori.’
Co-author Dr Hikaka says, ‘Māori are under-represented in ARC, with currently 2.98 percent of the total Māori population aged 65 or more residing in ARC, whereas 7.60 percent are expected by population proportion alone. If the trends in ageing and ARC access continue, the expected number of older Māori accommodated in ARC will increase fourfold by 2038.
‘This highlights a large increase in the number of Māori who could potentially benefit from increased support.’
She says older Māori can be reluctant to enter ARC due to a lack of culturally safe care. Kaumātua need to see, hear and feel the presence of Māori cultural values and practices to thrive in ARC.
The report provides positive examples where incorporation of Māori values in ARC care provision have improved resident and staff satisfaction. It also highlights the importance of a sustainable Māori workforce in ARC, which is well resourced in a way that acknowledges both clinical and cultural expertise.
The report emphasises the importance of Māori governance and leadership in the development and delivery of care, and the need for different models of service provision to meet both care and cultural needs of kaumātua and their whānau.
‘It is likely for many that these types of services will ideally sit outside the traditional ARC model and instead be more aligned with traditional Māori models of whānau living and thriving together as a community. I look with hope to the health reforms to provide mechanisms where this can be better recognised and achieved’, says Dr Hikaka.
The report also discusses that care patterns differ and government expenditure for care is lower for Māori than non-Māori. When the informal care of kuia and kaumatua required from whānau potentially increases, this increase is not reflected in the corresponding financial resourcing being offered.
Dr Bramley says the Commission will be encouraging a focus on the recommendations not only for ARC, but right across the health system.
‘As part of our ongoing planning, we will consider extending our current ARC-focused quality improvement work more broadly, to incorporate the quality of services for older people, regardless of where these are delivered. The Commission fully supports the recommendations made by the authors.’
The full report can be found on the Commission’s website:
The recommendations include the following.
-A requirement for pro-equity policy and monitoring at all levels, and across all services.
-Commissioning for services must put quality first. This means enabling care delivery that puts the person and their whānau in the centre, that accommodates more than just clinical needs, and that is flexible across localities and across different groups.
-Tikanga Māori, te reo Māori and Māori cultural values need to be incorporated into care models in an authentic way with the involvement, and resourcing, of appropriate expertise.
-There is a need for kaumātua-led and Māori-led models of care, and other kaupapa Māori care models that provide options for Māori. We also have to recognise the diversity of Māori and that appropriate models of care will vary for different regions, different whānau and individuals, and are likely to change as different cohorts of Māori age.
-There is a need for a workforce that can deliver culturally safe care to Māori, and where both clinical and cultural skills are valued and appropriately remunerated.
The report includes case studies from Te Whānau o Waipareira Trust in West Auckland, Rauawaawa Kaumātua Charitable Trust in Hamilton, Goodwood Seadrome Resthome and Hospital in Auckland and the CARE Village in Rotorua.
