In Conversation with Dr Teagan-Jane Westendorf

Aboriginal and Torres Strait Islander peoples have specific needs that must be considered in the national reform of Australia’s aged-care system.

In 2018, the National Advisory Group for Aboriginal and Torres Strait Islander Aged Care (NAGATSIAC) was established to develop the Aboriginal and Torres Strait Islander Action Plans for the Commonwealth’s Aged Care Diversity Framework. Since then, the group has worked closely with the Commonwealth and Royal Commission to inform aged-care policy.

Reaching Aboriginal and Torres Strait Islander communities across Australia, NAGATSIAC’s working group comprises in-home and residential aged-care service providers, as well as researchers affiliated with multiple research institutes, cross-disciplinary research projects and health practitioners across Australia.

Hospital + Healthcare spoke with NAGATSIAC Senior Policy Officer Dr Teagan-Jane Westendorf about how the aged-care redesign can improve Indigenous access to appropriate aged-care services and safeguard against people ‘falling through the cracks’.

What are the specific needs of Indigenous Australians when it comes to aged care?

Indigenous Australians have higher rates of chronic illness and an associated higher mortality rate compared with their non-Indigenous counterparts, but this is not reflected in additional or even equal service provision in our aged-care system. The lack of parity is the result of a range of factors that can be linked back to vulnerabilities resulting from our colonial history.

What factors must be addressed in the aged-care redesign?

Significant gaps in disability, chronic illness and mortality exist between Indigenous and non-Indigenous Australians. The aged-care sector redesign must address the lack of parity in aged-care service access and provision between these two cohorts. If equity and dignity are to be afforded to Indigenous people, the system must be redesigned to accommodate their vulnerabilities and needs at every stage, from application and assessment through to service delivery.

Indigenous Australians are significantly underrepresented in aged-care services. We estimate that service delivery to this cohort would have to increase by 40.4% to achieve parity of need to service use/delivery between the two cohorts.

What is the need of service delivery to Indigenous compared with non-Indigenous Australians?

Significant differences exist between need and service delivery for older Australians in the non-Indigenous and Indigenous cohorts.

Although we do not have the data to inform the true need of the Indigenous cohort, we can assume it is at least the same as the known need of the non-Indigenous cohort: 34.5%.

The known, unmet need of the non-Indigenous cohort is 1.8% compared with at least 11.2% in the Indigenous cohort.

What impedes access to aged-care services for Indigenous Australians?

Indigenous Australians commonly experience three key factors that make it harder for them to access services:

1. Vulnerabilities: Indigenous Australians experience significantly higher rates of disability, homelessness, co-morbidities and early onset dementia, which inhibit the My Aged Care application process. These vulnerabilities correlate with decreased education, capacity and resources, which make it harder to navigate the system.

2. Cultural safety: Cultural safety training is currently not mandatory for service providers or assessors working for Aged Care Assessment Teams or Regional Assessment Services. The online application — and often engaging with assessors by phone or in person — exposes people to questions and staff that have not been qualified by cultural safety training and principles. Access pathways can therefore make people vulnerable to re-traumatisation, and incorrect assessment, which can deter people from applying or progressing their applications.

A lack of cultural safety training means that assessors commonly do not understand the specific needs of the person and their Community, which can be very different to non-Indigenous people with the same affliction due to Indigenous communities needing ‘family centred care’ rather than ‘person-centred care’ to accommodate their needs.

3. Complexity of need and trauma: Indigenous Australians are recognised as experiencing complex needs and trauma, particularly the Stolen Generations. This commonly involves a distrust and fear of processes that could lead to institutionalisation by the government in the name of providing care. This results in people choosing not to apply for aged-care services that they need. In other cases, people do apply and then experience racism or a lack of cultural safety in interactions with systems and staff who have not undergone cultural safety training, or who assert racist ideas or assumptions, which then deters these people from progressing their application or engaging with the system in future.

How important are Indigenous organisations in system reform?

NAGATSIAC advocates that achieving equilibrium in access to and delivery of aged-care services can only be achieved by enabling Indigenous organisations (Aboriginal Community Controlled Organisations, ACCOs) and staff to deliver assessments and services to local Elders.

To achieve this we need to enable growth in the ACCO aged-care sector by enabling more ACCOs to deliver more, and better, culturally safe services to more Elders in their local region.

We believe that this growth can be achieved by adjusting the funding model of the aged-care system so that it enables ACCOs that have demonstrated the greatest capacity to build and operate an Indigenous workforce to provide culturally safe assessments and aged care in their local areas. This will allow the aged-care system to establish a culturally safe, trauma informed, Indigenous workforce to provide the care Elders want, need and have the right to choose as their first preference.

*Indigenous Australians aged 50 years and over (Elders) are eligible for aged care; non-Indigenous Australians aged 65 years and over are eligible for aged care.

Image credit: ©stock.adobe.com/au/Rafael Ben-Ari