"Despite their aroha and willingness to provide full-time care, sometimes whānau have to step back and get support. "

There is an anticipated 40 per cent increase in older Māori deaths between now and 2038. In today’s busy world it is not always easy for whānau to sustain long term care of an older person with a complex illness (stroke or advanced dementia, for example). Historically, older Māori have not tended to use Aged Residential Care Facilities (homes) as much as non-Māori families. Some people believe that placing an older person in a care home may signal that they do not love and value their kaumātua and that they have abandoned them. However, complex medical needs and the requirement for specialist 24 hour supervised care can put a huge strain on caregivers.

Getting professional support may well be the most loving, caring thing for whānau to do. Furthermore, many contemporary whānau do not have the large pool of whānau resources to draw from to support 24-hour care at home. In reality, the privilege of caregiving often falls to one or two primary carers to carry out or a small handful of people. Caregiving becomes even more difficult to achieve when whānau manaaki care for someone else who is ill, or they may have a new baby to care for, or the primary caregiver may be unwell.

Some kaumātua and whānau may include other people in their community to be part of their whānau manaaki (friends, neighbours, colleagues); it can take a community to care for someone at end of life. Kaumātua may be fortunate and live somewhere where a compassionate community approach is being actioned. This approach can be very helpful as it uses existing community groups (not necessarily health focused) to support people within the community. Sometimes the support comes from a health or social care professional:

Pato (health care assistant) helps patients to resolve any concerns/worries they have and how best to discuss them with their whānau:

I like to chat with my patients... I like to see how they really are. You know, and sometimes they won’t speak because of the family members. So, it’s good to have the family members move aside [and]… more comes out. [For] all of my terminally ill patients…that’s how it’s been. They wait until the family member goes away for an hour or so, yup.

If they want me to do something about it [their worries], I will, they will tell me. And that’s where I have to think of a way [how to help] … without treading on [the] family’s feet, or upsetting the household… But I get the [patient] to help me, to make that decision. And to think of a way to sort this problem out.

In some circumstances a care ‘home’ will be the best end of life care support available for kaumātua. Some ‘homes’ are very welcoming and are culturally aligned with Indigenous values which can make the home feel safe and, the staff, trustworthy. For example, culturally safe facilities generally have a high number of Māori staff (increasing the opportunity of kaumātua hearing te reo Māori!); they are more likely to observe Māori protocols and practices such as ensuring kaumātua and whānau manaaki are appropriately welcomed with a mihi whakatau (formal introductions) and they provide kai (food) kaumātua are familiar with. Given it is likely that kaumātua may need to use these facilities in the future (increasing numbers of kaumātua with dementia, for example), Aged Residential Care facilities could ensure they are well resourced to provide culturally congruent care.

When Pato (health care assistant) arrives at her home visits she likes to sit and talk with whānau before starting her mahi:

…. when I go in [to see families] it’s just, “How is your day?” “How was your weekend?” And things like that, that’s how it starts. I don’t just get straight into my work, its happy-happy joy-joy, you know, “Do you wanna cuppa tea first before we start?” Or, things like that. And then I’ll start my mahi, which could be a bed bath, or a shower, depending on how the patient is. If it’s a bed bath, we have joy with that, ’cause we, you know, you gotta roll them, wash them, you know, do this and that.

Recommendations

For residential aged care homes, we recommend:

  • Implementing cultural competencies to help meet the cultural and physical care needs of kaumātua and their whānau who require a high level of cultural safety using those services. It is likely that more kaumātua and whānau manaaki may wish to use an Aged Residential Care Home in the future.
  • Ensuring staff have the opportunity to increase their cultural competency as this will undoubtedly have benefits to kaumātua and their whānau.

For health and palliative care services and professionals:

  • Ensuring that kaumātua and whānau manaaki have access to needs assessment services and supporting them through the assessment process by advocating for their needs if required.
  • Providing access to information about Residential Care Homes would be helpful to assist kaumātua and whānau in their decision-making. It is up to kaumātua and their whānau to decide what is best for them.

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