The damning interim report from the Royal Commission into Aged Care Quality and Safety has raised significant issues within First Nations aged care services.

Entitled Neglect, the report highlighted haunting accounts of elder abuse, neglectful care in places of trust and poor leadership underpinned by Australia’s ageist mindset.

“Older people deserve so much more,” the report’s Foreword read.

“We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens.”

The interim report dedicated a chapter to Aboriginal and Torres Strait Islander aged care and addressed the ongoing issues and interrelated infrastructure problems Indigenous Australians experience when trying to engage with the system.

A key issue identified in the report was that the aged care system “fails to grapple with the realities of the barriers” Indigenous Australians face.

The Commission addressed the merits of certain organisations and services that deliver services to Indigenous Australians as well as identifying many flaws in aged care services as a whole.

Accessibility was a significant factor, with the report demonstrating that despite Indigenous Australians experiencing disproportionate levels of disability and illness that renders them more likely to enter aged care earlier, they are underrepresented in the system.

Barriers to access included a lack of awareness of available services, system services not being easily accessible to those whose first language isn’t English and the lack of mainstream services perceived as culturally safe.

Other factors addressed in the chapter included:

  • The significance of place-based models
  • Lack of services and programs tailored specifically to Indigenous Australians
  • Cultural safety and trusted relationships
  • Importance of Country and culture
  • Trauma-informed care for members of the Stolen Generations
  • End of life and palliative care for Indigenous Australians
  • Workforce challenges in remote and regional areas.

The report identified that the historical mistreatment and racism toward Indigenous Australians have resulted in an environment of distrust around institutions, making trusted relationships a significant issue for many First Nations people in Australia.

Indigenous Australians told the Commission of their desire to receive aged care services from organisations that are Indigenous-controlled and staffed, or at least by organisations they know and trust.


Place-based is best

The Commission found positive examples in place-based care frameworks and the merits of a local workforce that provides culturally appropriate services.

A shining example of this was Bidyadanga’s Home and Community Care (HACC) Centre.

Two-hundred kilometres south of Broome, the Bidyadanga community’s HACC Centre is a community centre run by locals and supported by Kimberley Aged and Community Services (KACS).

HACC Centre Manager and Karajarri woman, Faye Dean said the centre currently cares for about 12 people out of a population of 750 to 800 and is a positive environment for Bidyadanga’s old people.

“They can come to talk to each other, feel safe or just have a shower. People tell me they feel like they have friends with the centre, and that it has helped with their feelings of loneliness and depression,” Ms Dean said at the Commission’s Broome hearing.

Place-based models integrated with other health and social services were highlighted by many at Royal Commission hearings as the way forward for Indigenous aged care as it allows older community members to remain on Country.


Trauma-informed care

An important statistic the Commission raised was that by 2023, all Aboriginal and Torres Strait Islander people who were part of the Stolen Generations (approximately 17,150 people) will be eligible for aged care.

Trust was highlighted as an inherent issue within this group and that creating culturally safe care must involve an acute awareness that some may have lost connection to Country and be without extended support and kinship.

Plainly stated in their report, the Commission said, “service providers and their staff should not assume anything about the cultural status of members of the Stolen Generations.”

“Going into care can be re-traumatising, so care must be properly trauma-informed,” the interim report said.


Workforce woes

The workforce delivering aged care services to First Nations people also poses a considerable problem in Australia’s aged care industry.

For non-Indigenous workers, there is often a lack of cultural awareness, necessary training and trust – with many workers being fly-in, fly-out, therefore making it difficult to build trusted relationships with older community members.

For Indigenous workers, there are barriers to employment that prevent the growth and strength of local Indigenous workforces.

A major difficulty was obtaining criminal history clearances due to Australia’s inherent issue with the over-representation of First Nations people in the criminal justice system.

The need for culturally appropriate training and local employment strategies were also identified.

Employees with cultural obligations like men’s business, women’s business or sorry business were also highlighted as a factor that makes maintaining a steady Indigenous workforce difficult in aged care.

Although several barriers were identified, particularly for Indigenous aged care workers, the Commission heard examples of strong local employment – namely a 60 percent Indigenous workforce at NPY Women’s Council in the Northern Territory and an 80 percent Indigenous workforce at Star of the Sea in the Torres Strait.

The Commission concluded that First Nations aged care must be “delivered in ways that are flexible, adaptable and culturally safe,” including the development of dedicated, multidisciplinary models, and that support must also be given to Aboriginal and Torres Strait Islander aged care workers to address retention issues.

By Hannah Cross