Another form of diversity refers to the geographical location where whānau live. Kaumātua may have multiple homes; an urban dwelling, ancestral homes (sometimes more than one), as well as the homes of other family members. Mobile kaumātua may move around the motu as they reconnect with whānau one last time before they become too unwell too travel. Rural whānau may encounter issues, as they do not always have access to palliative care services. Urban whānau can live at a distance to ancestral lands and homes, and this may affect their cultural participation at their marae, or they may be unable to afford to travel long distances to attend a tangihanga (funeral). A huge responsibility is placed on the shoulders of the few who still live rurally, to care for kaumātua. Some communities have special people who dedicate their lives to helping kaumātua as they age.

Kim (community worker whānau manaaki) talked about the changes her community is facing and the financial hardships associated with having fewer people in the community to care for kaumatua. Pooling resources can help to make things work:

Kim: Oh no I can tell you how things have changed, why things have gotten really hard, is financial reasons. And, there’s not as many people here so that’s where we’ve seen the changes. So when we were growing up they had big families and you know you had a lot of whānau that could go and do a lot of these things like Matua and I we come from a family of six; our parents [had] 16 brothers and sisters and yet we’re the only two people living here… You know and that’s the brothers and sisters, that’s not all the mokos. You know… that’s the families, because of the finan[cial], you know work and whatever [they] have had to go overseas-

Marina: Survival.

Kim: So, we’ve all had to pull together whereas you might have been just, ‘oh the [name of] family have enough,’ you know, and the [whānau name], you know. But now we have to join all our whānau[s] together because there’s not as many people, and people are working afar… whereas before they were all living close. So, we’ve had to pool all our resources together to make it work sort of thing.

When health and social care professionals take the time to build relationships with kaumātua and their whānau manaaki they are in a good position to support the whānau if they need their help in the future.

Mary Te Awhi (hospice kaitakawaenga), highlights how she allocates time to connect with kaumātua who have life limiting illnesses in her community.

So, you know I loosen up my role. I have, every now and again and I’ve got a lovely little group of kuia. At the moment they are almost house bound really due to their illnesses. And they just love, the visit. … Some of my work, it’s literally social for some of our people. Yes, they’ve got busy families around them. Yes, there are other health professionals coming in to help them, but the thing is I go there, and we just sit and talk. And we have a cup of tea and I go ‘oh, but I’ll make it’ you know. ‘You’ve got to let me make it you know.’ And so, we’ll sit and have a cup of tea, so they are some of my kuia at the moment… I allocate time for them. I don’t specify [time limits] for some of our whānau. And in fact, for most of those that I do visit in the community, I don’t specify time. I allocate the time for them.

Joy (health professional) said that it is becoming more important, especially for Oncologists to see where whānau live to give them some appreciation of the distances people travel to receive medical support and also of their lifestyles. She provided an example of a staff road show:

...We did a road show a couple of years ago and the oncologists, we went up to [name of place] and we had a pōwhiri up there for them and, and [a]get together. And had a drive around the areas that some of our patients come from so they have a good understanding. Because that’s what it is sometimes. Health professionals are too, you know, stuck in the hospital. They don’t see what’s out in the community. But it’s becoming more important especially for oncologists to, to see that, and to understand.

...we only went around in the community, drove around so they understand and know what, how people live. The houses that are out there. The distances they have to travel to get down to [the hospital].

Recommendations

For health and palliative care professionals, we recommend:

  • You support kaumātua and whānau who live rurally to access the palliative care support they need by ensuring they understand what they are being asked to do.
  • Follow up with kaumātua before the appointment to ensure they have what they need to attend their appointment (transportation, for example). Not everyone has a reliable vehicle and petrol in the tank and not everyone can afford a bus ticket. Some kaumātua may not have anyone to accompany them.
  • Liaise with a Māori health worker or find a cultural navigator to help you support rural whānau if you need support.
  • Who can you find to support kaumātua and whānau manaaki as they begin to process how to organise and action arrangements for returning and reconnecting with their ancestral homes (iwi, hapu and whānau?). This could help to settle their wairua (spirit) before they die, and it could support them to plan their tangihanga. Discuss the wishes of the kaumātua and their whānau with your Māori health team, kaumātua or Māori spiritual care workers. Local hospices may also have Māori staff who could provide some helpful advice.

For health and palliative care services, we recommend:

  • Building working relationships with Māori and community health providers

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