‘It’s about having that knowledge, tino rangatiratanga!’ Understanding structural barriers to accessing aged residential care services among older Māori in New Zealand

Abstract

ABSTRACT New Zealand’s older Indigenous people (Māori) are underserved and underrepresented as consumers of aged residential care services (ARC). This study seeks to ascertain, from the perspectives of older Māori and whānau (family), the influence of structural factors that impact the process of seeking aged residential care. This study used a qualitative Kaupapa Māori research approach. In-depth interviews were undertaken with older Māori (n = 30) and whānau members (n = 18). Interviews were audio recorded and transcribed with themes identified using thematic analysis. Structural barriers related to ‘Navigation’ and ‘Service design and locality’ were identified by older Māori and whānau which provide insight into the oppressive nature of structural racism and highlighting various factors that affect older Māori and whānau access to ARC. Equity approaches that focus on optimising Māori access to ARC are needed in order to move ARC services towards equity. ARC services provide an important service for older New Zealanders. Our findings challenge and disrupt the universalistic nature that underpin New Zealand health structures. Health decision-makers should consider these findings to address the powerful and damaging effects structural racism has that compromise older Māori and whānau uptake and access to ARC services. Glossary of Māori terms: Hapū: subtribe but can also mean to be pregnant; Harakeke: flax. In the context of the research, harakeke means to weave using flax; Kaumātua: an older Māori person of status, either male or female who are knowledgeable in tribal history and traditions; Kaupapa: topic, matter of discussion, plan, purpose, proposal, agenda, theme, issue, initiative; Kaupapa Māori Research: Kaupapa Māori Research is an Indigenous Māori research framework or methodology for undertaking research by Māori, with Māori for the benefit of Māori, an approach underpinned by Māori values; generally utilised by researchers who are Māori, and who are undertaking research with, and for Māori; Māori: Indigenous New Zealander, Indigenous people of New Zealand; Mahi: to work; Ngai: prefix for a tribal group. For example, Ngai Tahu refers to the tribal group of people who descend from the eponymous ancestor known as Tahu Pōtiki. In some instances, the names of ancestors may be shortened; Ngāti: prefix for a tribal group. For example, Ngāti Porou, refers to the tribal group of Porou which is shortened to refer to the eponymous ancestor known as Porourangi; Pākehā: person of European descent, foreigner, introduced from another country, or can be used to imply a Westernised Eurocentric view of the world; Te Reo Māori: Māori language, or to speak in the Māori language; Te Tiriti o Waitangi: Te Tiriti o Waitangi is the Treaty of Waitangi, also referred to as te Tiriti or the Treaty signed in Waitangi, New Zealand in 1840 between the British Crown and a large number of Māori chiefs; Tikanga: Māori customary system of values and practices that have developed over time and are deeply embedded in Māori social contexts; Tino rangatiratanga: chieftainship, right to exercise authority, chiefly autonomy and ownership. Tino rangatiratanga is also used to acknowledge Māori self-determination in a way that aligns with their customs, values and aspirations by having the ability to make decisions over their affairs including health; Te Tairāwhiti: also referred to as (Tairāwhiti) is the customary Māori name for the Gisborne region which is located on the east coast of New Zealand's North Island; Whānau: family unit, not always immediate family and may include those that are family or by marriage, adoption, fostering, or from other close relationships. In the context of the research, whānau also includes a group of people who are not related but who are bound together to fulfil a common purpose to assist older Māori family members and friends who may need help with daily living activities; Whakapapa: geneology, descent, family tree, ancestry, origin; Whakawhanaungatanga: refers to the process of forming and establishing relationships with others by providing a foundation for unity and cohesion. Process of establishing relationships which usually involves reciprocal information being shared to establish and build relationships.