“Be Brave”: First Nations Aged Care Commissioner aspires for change

Interim First Nations Aged Care Commissioner, Andrea Kelly, expressed her fears over the current trajectory of the aged care system, sharing that she is worried “we’re not thinking ahead” where culturally appropriate care is concerned. 

Having only taken on the position in January, Ms Kelly jumped headfirst into her role, conducting over 130 community consultations with First Nations older people, their families, carers and providers across Australia. That’s an average of five consultations per week, on top of travel to some of the more remote corners of the country.

“It’s important for me to acknowledge the generous contributions of Aboriginal and Torres Strait Islander people who’ve so far shared their lived experiences of the aged care and health system. By sharing their experiences they have provided the foundations for my report to Government. Their contributions are the evidence and the momentum for change,” Ms Kelly shared at ARIIA’s 2024 conference.

This evidence includes highlights such as emerging examples of culturally aware care, plus lowlights like workforce shortages and a lack of understanding. 

Ms Kelly had a targeted approach to her community consultations, visiting communities in every state and territory. Many locations were off the beaten track where governments have rarely gone just so she could enable more voices. As the Interim Commissioner explained, she is not reporting to Government with her voice, but the voice of the people. 

“In Broome, there was a beautiful old man insistent on talking to me. He was from one of the western desert communities and he sat down and said ‘I want you to go back to Canberra to give this message to Government’. […] ‘I want you to tell the Prime Minister we want to die on country’,” Ms Kelly explained.

“Then he pulled out his phone and started showing me photos of his mother’s country, his father’s country and amazing places he’d been to in the world. We had a chat for about an hour […] then he turned to me and said ‘Andrea what is it you have to tell the Prime Minister?’. I said that you want to die on country. 

“This old man was testing me. He told me what he wanted me to tell Government and then diverted my attention. But it came back to the very point of what he wanted. He was seeing if I was listening to him. His words will feature in my report.”

Uncovering an unsuitable system 

As Ms Kelly recounted her interactions, the importance of her role – recommended by the Royal Commission into Aged Care Quality and Safety – became more prominent. 

“The Royal Commission [into Aged Care Quality and Safety] was clear in its assessment that the aged care system did not ensure culturally safe care for Aboriginal and Torres Strait Islander people and was poorly placed to meet projected growth and demand for aged care services for our communities,” she said.

“We know the current health inequalities that many Aboriginal and Torres Strait Islander people are living with are deeply rooted in the legacy and ongoing impacts of colonisation and genocide. […] This history is even more of a reality for the survivors of the stolen generations, who are now over 50 and eligible for aged care.

“Stolen generation survivors bear an even higher burden of complex chronic health issues and are at an even greater risk of developing dementia as they age. Mainstream pathways, assessments and referrals are unlikely to deliver culturally safe trauma-aware and healing-informed care and support. My appointment is a positive step forward, however, we know there is much work to be done.”

This work includes a report, due to be handed to Government by August, recounting all of Ms Kelly’s learnings and recommendations.

It will surely not be a small report.

As she said, there is much work to be done, and it appears to be a sector-wide problem. For example, there is a lack of choice for many Aboriginal and Torres Strait Islander people who want to access community-controlled services within their own communities, but there are not enough of them. 

There are not enough opportunities to recruit First Nations people into aged care so they can also give back to their communities who want trusting, familiar faces providing care and support. Many individuals are from the Stolen Generations and are scared of entering what they perceive as institutionalised care in a foreign setting. 

Ms Kelly also said there are low levels of awareness with the aged care system, and that it is highly inaccessible for Aboriginal and Torres Strait Islander people with limited online literacy and resources.

“The system’s incomprehensible and exclusionary. Our Government programs lack the flexibility for providers to deliver the care the individual needs. If we’re talking about a future state where the system is about the individual then we have to make sure the funding that goes with it is flexible to deliver for the individual’s needs,” she added. 

So, what are the solutions to a problem like this? Ms Kelly said healthy ageing policies and programs must be grounded in ways of knowing, being and doing that align with First Nations people. Elders need to remain connected to their communities as they have support systems and cultural obligations. 

She added that aged care has to open its eyes, have conversations and build relationships with services that are already delivering culturally appropriate care. 

“Be brave. People often don’t know where to start but we have to start [somewhere]. We have to understand why the old man in residential care doesn’t sleep on a bed and why he likes to sit on a mattress all day,” she said.

“That old man has been sitting on a mattress outside since he was a little boy and all of a sudden we say ‘Now you have to sleep on a bed. It’s not safe to sit on the floor.’ For that old man, it is safe, that’s where he feels safe.”