NZ is eyeing reform of its strained aged-care system. How might a reset deliver for Māori?

The New Zealand government has received a comprehensive list of recommendations to overhaul its struggling aged-care system. The Ministerial Advisory Group on Aged Care's report highlights 40 suggestions, including a focus on integrating care and enhancing services to enable older individuals to age at home. Crucially, the report acknowledges disparities in how Māori access and experience aged care, advocating for a culturally responsive system that embeds cultural safety in every aspect of service delivery.

Associate Health Minister Casey Costello acknowledges the current funding model is outdated and the system's siloed structure. Officials are now evaluating the recommendations before formulating future policy and funding decisions. This presents an opportunity to reconsider how aged care services cater to Māori, drawing insights from our recent research.

Historically, Māori with daily care needs have faced significant inequities. They are less likely to access community-based and residential aged-care services compared to non-Māori. However, as the population ages, more Māori will require residential care in the next two decades, often with higher and more complex needs. These inequities are linked to systemic barriers, earlier onset of long-term conditions, and challenges in timely assessments and care provision.

Moreover, Māori may be less likely to receive referrals for funded services, and access to carers and facilities varies across regions. Some kaumātua may prefer to be cared for at home by their whānau (extended family), requiring support for various tasks such as meals, housework, transportation, and personal care. Often, these needs exceed what whānau can provide, leaving them feeling guilty.

Effective aged care must acknowledge and support the role of whānau carers through appropriate training and resources, ensuring external help is available when necessary.

Beyond physical care, the report emphasizes the importance of maintaining independence, relationships with whānau and community, cultural identity, and connection to place. Policymakers should consider whether the redesigned system will adopt a holistic approach to care, incorporating physical and mental health alongside cultural and whānau wellbeing.

Services should facilitate ageing well in place, enabling older people to remain at home for longer as their needs evolve. This includes ensuring a workforce proficient in te reo Māori and tikanga (customary practices), access to rongoā Māori (traditional Māori healing), and culturally appropriate food.

Policymakers must also ensure care is accessible and affordable, allowing kaumātua to remain connected with their whānau, friends, and communities. Residential care should offer activities that people find meaningful, and all forms of care must provide a safe environment. Clear, accessible information is crucial for kaumātua and whānau to make informed decisions about their care options.

While not everyone will require additional support in later life, conversations about preferences and priorities should commence well before formal care becomes necessary. The Aged Care Commissioner's 2024 report, which included input from thousands of older people, whānau, carers, and service providers, has echoed many of these concerns.

As the government considers these recommendations, there is an opportunity to address long-standing shortcomings and foster more Māori-led approaches to aged care, ultimately empowering kaumātua and their families to thrive.