Abstract
To identify: 1) best practice aged care principles and practices for Aboriginal and Torres Strait Islander older peoples, and 2) actions to integrate aged care services with Aboriginal community-controlled primary health care. There is a growing number of older Aboriginal and Torres Strait Islander peoples and an unmet demand for accessible, culturally safe aged care services. The principles and features of aged care service delivery designed to meet the unique needs of Aboriginal and Torres Strait Islander peoples have not been extensively explored and must be understood to inform aged care policy and primary health care planning into the future. The research was governed by leaders from across the Aboriginal community-controlled primary health care sector who identified exemplar services to explore best practice in culturally aligned aged care. In-depth case studies were undertaken with two metropolitan Aboriginal community-controlled services. We conducted semi-structured interviews and yarning circles with 46 staff members to explore key principles, ways of working, enablers and challenges for aged care service provision. A framework approach to thematic analysis was undertaken with emergent findings reviewed and refined by participating services and the governance panel to incorporate national perspectives. A range of principles guided Aboriginal community-controlled aged care service delivery, such as supporting Aboriginal and Torres Strait Islander identity, connection with elders and communities and respect for self-determination. Strong governance, effective leadership and partnerships, Aboriginal and Torres Strait Islander workforce and culturally safe non-Indigenous workforce were among the identified enablers of aged care. Nine implementation actions guided the integration of aged care with primary health care service delivery. Funding limitations, workforce shortages, change management processes and difficulties with navigating the aged care system were among the reported challenges. These findings contribute to an evidence base regarding accessible, integrated, culturally safe aged care services tailored to the needs of Aboriginal and Torres Strait Islander peoples.
Highlights
The life expectancy of Aboriginal and Torres Strait Islander peoples is improving in Australia, resulting in growing numbers of elders (AIHW, 2015)
This study aimed to explore the overarching principles, practices, enablers and challenges of Aboriginal community-controlled services that provide aged care tailored to the needs of older Indigenous peoples and examine the aged care planning activities and implementation actions that guided the integration of aged care service delivery within the Aboriginal Community Controlled Health Organisations (ACCHOs) primary health care model
The Leadership Group recommended that the research team explore best practice principles and practices in culturally aligned aged care provided by Aboriginal community controlled services since ACCHO service delivery models are infrequently described within academic reports and publications
Summary
The life expectancy of Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) peoples is improving in Australia, resulting in growing numbers of elders (AIHW, 2015). While the total Indigenous population is projected to increase by 59% between 2011 and 2031, numbers of older Indigenous peoples (≥65 years) are projected to grow by 200% (Biddle, 2013). Indigenous elders ‘play a vital role in sustaining strong cultural practices and traditions within their communities with important roles and responsibilities such as passing on knowledge, languages and customs, participating in decision-making ceremonies and looking after country’ (Commonwealth of Australia, 2013: 38). This is despite burdensome health and social challenges: compared with non-Indigenous Australians, older Indigenous peoples experience greater comorbidity, disability, racism, financial insecurity, homelessness and challenges to health and social services’ access (AIHW, 2019). An estimated 13 800 (14%) of older Indigenous peoples (≥50 years) in 2014–15 were part of the ‘Stolen Generations’ (AIHW, 2018b) who, as children in the 20th century, were forcibly removed from their families under successive government policies (Human Rights and Equal Opportunity Commission, 1997)
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