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.’
Ko tētahi rangahau hou e pānuitia ana i te rangi nei e te Komihana Kupu Taurangi Hauora Aotearoa, he momo rangahau tuatahi kia pai ake ai te māramatanga, te piki mōhiotanga me te tīmata hoki ki te kōrerorero mō te kounga o te mahi tauwhiro mā ngāi māori ki ngā whare tauwhiro kaumātua (ARC).
I komihanatia ngā kaituhi a Tākuta Joanna Hikaka rāua tahi ko Tākuta Ngaire Kerse nō Waipapa Taumata Rau kia tuhia te pūrongo Older Māori and aged residential care in Aotearoa, tēnā e meatia ana ka tokoiti a ngāi māori i ngā tāngata anō mō te uru ki ARC, he korenga hoki e kitea he ratonga tauwhiro kaupapa Māori, ka mutu, mō te nuinga o ngā māori ko ARC te whiringa tuarua, ko te whiringa tuatahi ko te noho ki te kāinga kia tauwhirotia e te whānau.
Ka whakatakotoria i te pūrongo nei he mōhiohio i kohia ai i ngā mātātuhi kua tāngia, me ngā whakaaro o ngāi māori me ngā tāngata nāna nei i rangahau, i mahi hoki i te rāngai ARC. Ka tuitui te pūrongo i ō rātou wheako ngaio me ngā wheako whaiaro o te whānau mō te kaumātua haere me ARC. Ka whakakaha ake ngā kaituhi i te whakaaro he mahi atu anō hei mahi i tēnei wāhi ki te hāpai me te whakamana i te reo o ngā kaumātua o te whānau hoki i roto i ēnei kōrerorero.
Ko te heamana o te Komihana a Tākuta Dale Bramley e mea ana, ‘Ka mihia tēnei rangahau. He kōrero nui kia mārama haere ki ngā take mō ngāi māori e whai ana i ngā ratonga a ARC, ka kitea hoki e mātou kua āta tuhia ngā wero whānui ki ngā kaumātua Māori.’
Ko Tākuta Hikaka tētahi o ngā kaituhi e kī ana, ‘Tokoiti te Māori e kitea i roto i ARC, arā, i tēnei wā e 2.98 ōrau o te taupori Māori e 65 tau neke atu rānei e noho ana ki ARC, engari e ai ki te wāhanga taupori ia e 7.60 ōrau ka taea. Ki te haere pēnei tonu te āhua o te kaumatua haere me te whai wāhi ki ARC, hei te tau 2038 kua whakarea ki te whā te pikinga ake o ngā kaumātua Māori e noho ana ki ARC.
‘Mā konei ka kitea te kaha pikinga ake o ngāi māori e whai painga ai pea ina nui atu te tautoko.’
Ko tāna anō, ka horokukū ngā kaumātua ki te uru ki ARC nā te korenga o te tauwhiro haumaru, haumaru ā-ahurea. Me kite, me rongo ā-taringa, ā-ngākau hoki e ngā kaumātua he wairua Māori, he uara ahurea Māori hoki i ARC hei tiaki i a rātou.
Kei te pūrongo ētahi tauira huapai mō te whakauru i ngā uara Māori ki ARC kātahi ka mākona pai te ngākau o ngā kainoho me ngā kaimahi. Ka kī mai hoki te pūrongo he mea nui kia whai mahi tūturu te Māori i ARC, i te mea he nui ngā rawa hei tautoko i ngā mātanga tauwhiro me ngā mātanga ahurea.
Ka kaha kī mai hoki te pūrongo he mea nui kia whakahaeretia, kia ārahina hoki e te Māori te whanaketanga me te kawenga o te mahi tauwhiro, ā, me whai hoki i ngā huarahi rerekē mō te whakarato tauwhirotanga e tutuki ai te tiaki me ngā hiahia ā-ahurea o ngā kaumātua me ō rātou whānau.
‘Tēnā pea, mō ētahi o ēnei momo whakaratonga ka noho i waho atu i tā ARC tikanga, kia hāngai kē ki tā te Māori tikanga noho ā-whānau kia tipu hei hapori. Ka titiro ahau me te tūmanako ki ngā mahi whakahou hauora e puta ai ngā huarahi hei tautohu, hei whakatutuki’, ko tā Tākuta Hikaka.
Ka matapaki hoki te pūrongo i te rerekētanga o te tauwhiro me te iti o te pūtea a te kāwanatanga mā ngāi māori i tērā mā ngā tāngata anō. Ka piki ake ana te tauwhiro noa a ngā whānau i ngā kuia me ngā kaumātua, kāore e kitea te pikinga hoki o te pūtea hei tautoko.
Ka kī mai a Tākuta Bramley ka whakatenatena te Komihana kia arotahi atu ki ngā tohutohu kaua mō te ARC anake engari mō te pūnaha hauora katoa.
‘Hei wāhanga o tā mātou mahi whakamahere, ka whakaarohia kia whakawhānui atu i ā mātou mahi whakapai i te kounga a ARC kia whakauru i te kounga o ngā whakaratonga mō ngā kaumātua ahakoa kei hea. Kei te tautoko katoa te Komihana i ngā tohutohu i tuhia ai e ngā kaituhi.’
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.
Contact for enquiries
Victoria Evans, Health Quality & Safety Commission director of communications (021 532 649).