Aged care has failed older First Nations people; a new report has the solutions

Interim First Nations Aged Care Commissioner Andrea Kelly has outlined a potential-filled path forward for how the aged care system supports older Aboriginal and Torres Strait Islander people.

Following months of consultation, research and engagement, her assessment of the aged care system reinforces that it does not meet the needs of Australia’s First Nations people. She called for immediate action to address a swathe of barriers.

Key points

• Transforming Aged Care for Aboriginal and Torres Strait Islander people states that the aged care system does not currently meet the needs of Aboriginal and Torres Strait Islander people
• There are additional barriers and challenges facing Aboriginal and Torres Strait Islander people with many services still culturally unsafe and inflexible
• The lack of culturally appropriate communication has influenced the understanding and access to the aged care system, with the issue compounded by a disconnection from Country as Aboriginal and Torres Strait Islander people age
• Key recommendations include the creation of a co-designed 10-year transformation plan that articulates an Aboriginal and Torres Strait Islander people aged care pathway

“Sadly, the aged care system was never designed with older Aboriginal and Torres Strait Islander people in mind,” Ms Kelly stated. 

“My consultations revealed that not enough has changed for Aboriginal and Torres Strait Islander people since the Royal Commission into Aged Care Quality and Safety (Royal Commission) 4 years ago. 

“The aged care system has failed, and continues to fail, older Aboriginal and Torres Strait Islander people. The system is still not providing culturally safe care and is poorly placed to meet projected growth in demand of aged care services for older Aboriginal and Torres Strait Islander people.”

Meanwhile, Ms Kelly’s role as Interim First Nations Aged Care Commissioner has been extended until June 2026. This long-term appointment will enable her to establish an office for a permanent commissioner.

An unsafe and alienating system

The Transforming Aged Care Report ultimately produced 14 key findings related to Aboriginal and Torres Strait Islander people and their experiences with aged care, including: 

• Aboriginal and Torres Strait Islander people entering the aged care system face additional barriers and challenges compared to other Australians
• Many aged care services are culturally unsafe
• There is a lack of flexibility in the aged care system and services to respond to their needs
• There is a lack of culturally appropriate communication that supports understanding and access
• Stolen Generations survivors continue to face significant challenges in accessing aged care
• Many Aboriginal and Torres Strait Islander people are disconnected from Country as they age
• There is a significant lack of Aboriginal and Torres Strait Islander specific data inhibiting informed policy and program decisions

Common themes highlighted by Ms Kelly include older Aboriginal and Torres Strait Islander people not feeling valued, respected or listened to across the aged care system. Issues with aged care assessors, service providers and even the Aged Care Quality and Safety Commission were prominent. 

Communication was another pressing issue, including during the complaints process. Older First Nations people lacked knowledge and information about care services, eligibility, entitlements and access, often because they found the language and processes used ‘complex, confusing and overwhelming’. Problems are exacerbated for those whose first language is not English.

Many providers also cited inflexible funding as a barrier to creating more inclusive and culturally appropriate care. 

Despite this, Ms Kelly found numerous examples of tailored, safe and culturally responsive aged care models. She said most were provided by Aboriginal Community Controlled Organisations (ACCOs).

“This is not surprising as evidence shows ACCOs achieve better outcomes due to their community-led approach. Aboriginal and Torres Strait Islander people are more likely to engage with services delivered through ACCOs, as they are accountable and connected to their communities,” she explained.

Examples included a provider offering healthcare, pharmacy, dental and aged care services in one location, which meant older people did not have to seek multiple transport options or coordinate appointments in different areas.

Another provider adopted inclusive language to convey the positive impact of their services. Meanwhile, building design played a major role in connection to Country for a third provider. 

“This residential aged care building is positioned with respect to earth, air, fire, and water, and are designed to honour Ancestors. The site features rammed earth walls, open spaces, a pond, and Aboriginal art. Activities and events are hosted around the fire pit to celebrate friendships and cultural connections while enjoying johnny cakes and damper,” Ms Kelly added. 

A detailed approach to improving aged care

In her report, Ms Kelly said those involved in aged care must recognise the unique barriers and adverse outcomes experienced by older Aboriginal and Torres Strait Islander people, especially Stolen Generations survivors, veterans, and the LGBTIQ+ community.

With lower rates of aged care access, she views an equity-based approach to ensure aged care can meet all their unique needs. To support this, and deliver meaningful change, she recommended that:

• The Australian Government commits to develop a 10-year transformation plan co-designed with First Nations people to articulate a culturally appropriate aged care pathway
• The Government agrees in principle to the proposed model for an Aboriginal and Torres Strait Islander Commissioner
• Time-sensitive and urgent recommendations and actioned as a priority 

“The recommendations in my report are clear. I call on the Australian Government to accept and act on them,” Ms Kelly said. 

“Without significant change including an equity-based approach, the aged care system will not meet the current or projected growth in demand of aged care services for older Aboriginal and Torres Strait Islander people. I have outlined a plan to achieve this, which starts with genuine partnership with Aboriginal and Torres Strait Islander people.

“I am hopeful the reforms underway will incorporate Aboriginal and Torres Strait Islander experiences and perspectives to meet their needs.

“I would like to thank all the Aboriginal and Torres Strait Islander people, their families and communities, service providers, advocates and representatives who I met with throughout the year.”

Ms Kelly produced a list of 27 time-sensitive recommendations which include mandating minimum cultural safety training for all aged care workers, developing a designated funding stream to support and retain a connection to Country, explicitly referencing cultural safety in the new Aged Care Act and reviewing government systems and communications to ensure they are understandable and accessible. 

By extending Ms Kelly’s role as the Interim First Nations Commissioner, the government has already acted on the recommendation to establish a permanent Commissioner.

This is a positive step, however, a recurring theme in the Report is that more immediate action is required.

“I’m sick of good intentions, the slowness of the jurisdictions. They just have to get much better at embracing change and changing the way they work with our people… There is too much slippage by the states and territories, they need to step up and take a greater leadership role in terms of the whole of government,” National Aboriginal Community Controlled Health Organisation Chief Executive Officer and Lead Convenor, Coalition of Peaks Pat Turner AM stated.

Click here to read Transforming Aged Care for Aboriginal and Torres Strait Islander people in full.