Exploring Community-Based Aged Care with Aboriginal Elders in three Regional and Remote Australian Communities: A qualitative study

Goetz Ottmann

Abstract


While a small body of literature focuses on various facets of aged care services delivered to Aboriginal and Torres Strait Islander Elders, very little is known about the support needs and preferences of Indigenous Elders who ‘return to country’. This article addresses this gap. It explores the support needs of Indigenous Elders who return to their communities after having lived elsewhere for prolonged periods of time. It provides an overview of the key themes emerging from group sessions and semi-structured interviews with 11 Aboriginal Elders and 12 representatives of regional health and social care providers conducted between 2012 and 2013. The article argues that the quest of Elders to strengthen traditional kinship systems should not be seen as a barrier but as an opportunity to develop aged care services that resonate with the needs of Indigenous Elders and with their kinship network. The findings presented in the article are structured around the themes of empowerment and choice; culturally appropriate care; enhancing program flexibility; case management; and systemic issues. The article recommends that (1) aged care services should work with and support Indigenous Elders in their efforts to strengthen traditional culture. (2) Aboriginal Elders eligible for home care packages should receive services that have the same flexibility and scope as those delivered under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NPFACP). (3) A relaxation of funding guidelines and particularly around the issue of income substitution should be considered for Indigenous Elders. (4) Agency staff should be up-skilled (i.e. cultural safety, culturally appropriate interventions, referral options) and given the authority to support Indigenous Elders to address grief and loss issues in a culturally appropriate fashion. (5) Elders and their communities should be central to the decision making process underpinning their support arrangements and have shared control over services.


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References


ABS. (2013). Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia 2012-2013: Table 7 [data cube] Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument

ABS. (2016). National Aboriginal and Torres Strait Islander Social Survey, 2014-05: Table 19. Selected wellbeing indicators, by long-term health condition [data cube]. Retrieved 20 March 2017, from Australian Bureau of Statistics http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument

AIHW. (2013). Aboriginal and Torres Strait Islander Health Performance Framework 2012: detailed analyses. Cat. no. IHW 94. Retrieved from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458717

Alford, J. (2009). Public Value from co-production by clients. Retrieved from Melbourne: http://igps.victoria.ac.nz/events/downloads/2009/Building%20the%20Public%20-%20Spring%20Series/ALFORD%20-%20Client%20coproducers.pdf

Bell, D., Lindeman, M. A., & Reid, J. B. (2014). The (mis)matching of resources and assessed need in remote Aboriginal community aged care. Australasian Journal On Ageing. doi:10.1111/ajag.12164

Brooke, N. J. (2011). Needs of Aboriginal and Torres Strait Islander clients residing in Australian residential aged-care facilities. The Australian Journal Of Rural Health, 19(4), 166-170. doi:10.1111/j.1440-1584.2011.01207.x

Casey, W. (2014). Strong Spirit Strong Mind Model - Informing Policy and Practice. In P. Dugeon, H. Milroy, & I. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (2nd edition). Canberra: Commonwealth of Australia.

Cotter, P. R., Condon, J. R., Anderson, I. P. S., Smith, L. R., & Barnes, T. (2011). Indigenous aged care service use and need for assistance: How well is policy matching need? Australasian Journal On Ageing, 30(Suppl 2), 38-44.

Dugeon, P., Wright, M., Paradiies, Y., Garvey, D., & Walker, I. (2014). Aboriginal Torres Strait Islander Social, Cultural and Historical Context. In P. Dugeon, H. Milroy, & I. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (2nd edition). Canberra: Commonwealth of Australia.

Dunston, R., Lee, A., Boud, D., Brodie, P., & Chiarella, M. (2009). Co-production and health system reform - from re-imagining to re-making. The Australian Journal of Public Administration, 68(1), 39-52.

Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development. International Journal of Qualitative Methods, 5(1).

Gee, G., Dugeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander Social and Emotional Wellbeing. In P. Dugeon, H. Milroy, & I. Walker (Eds.), Working together. Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.) (pp. 55-68). Canberra: Department of Prime Minister and Cabinet.

Goodwin, M. (1993). Aboriginal aged care. The Queensland Nurse, 12(6), 22-23.

Guba, E. G. (1981). Criteria for Assessing the Trustworthiness of Naturalistic Inquiries. Educational Communication and Technology, 29(2), 75-91.

Hunter, S., & Ritchie, P. (2007). Co-Production and Personalisation in Social Care: Changing Relationships in the Provision of Social Care. London: Kingsley, Jessica.

Lindeman, M. A., Taylor, K. A., Kuipers, P., Stothers, K., & Piper, K. (2012). 'We don't have anyone with dementia here': a case for better intersectoral collaboration for remote Indigenous clients with dementia. The Australian Journal Of Rural Health, 20(4), 190-194. doi:10.1111/j.1440-1584.2012.01284.x

Loeffler, E., Parrado, S., Bovaird, T., & Van Ryzin, G. (2008). 'If you want to go fast, walk along. If you want to go far, walk together': citizens and the co-production of public services. Retrieved from: http://www.govint.org/good-practice/publications/if-you-want-to-go-fast/

LoGiudice, D. C., Smith, K., Shadforth, G., Lindeman, M., Carroll, E., Atkinson, D., . . . Flicker, L. (2012). Lungurra Ngoora--a pilot model of care for aged and disabled in a remote Aboriginal community--can it work? Rural And Remote Health, 12, 2078-2078.

McBain-Rigg, K. E., & Veitch, C. (2011). Cultural barriers to health care for Aborigianl and Torres Stait Islanders in Mount Isa. Australian Journal of Rural Health, 19, 70-74.

McGrath, P., Patton, M. A., McGrath, Z., Olgivie, K., Rayner, R., & Holewa, H. (2006). 'It's very difficult to get respite out here at the moment': Australian findings of end-of-life care for indigenous people. Health and Social Care in the Community, 14(2), 147-155.

Milroy, H., Dugeon, P., & Walker, I. (2014). Community Life and Development Programs - Pathways to Healing.

Needham, C. (2008). Realising the Potential of Co-production: Negotiating Improvements in Public Services (Vol. 7, pp. 221-231): Cambridge Journals Online.

Ottmann, G., Allen, J., & Feldman, P. (2013). A systematic narrative review of consumer-directed care for older people: implications for model development. Health & Social Care in the Community, 21(6), 563-581.

Ottmann, G., Allen, J., Laragy, C., & Feldman, P. (2011). Coproduction in Practice: Participatory Action Research to Develop a Model of Community Aged Care. Systemic Practice and Action Research, 24(5), 413-427.

Peeters, L., Hamann, S., & Kelly, K. (2014). The Marumali Program: Healing for Stolen Generations. In P. Dugeon, H. Milroy, & K. Kelly (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (2nd edition) (pp. 493-507). Canberra: Commonwealth of Australia.

Peeters, L., & Kelly, K. (1999). Reclaiming Identity Through the Pain: What Hurts and What Helps. A model of healing for the Stolen Generation. Paper presented at the NSW Aboriginal Mental Health Conference, Sydney, 1-3 September.

Pollitt, P. A. (1997). The problem of dementia in Australian aboriginal and Torres Strait Islander communities: an overview. International Journal Of Geriatric Psychiatry, 12(2), 155-163.

Smith, K., Flicker, L., Lautenschlager, N., Atkinson, D., & LoGiudice, D. C. (2008). Dementia and cognitive impairment in remote Indigenous Australians - Evidence of different patterns of risk factors and increased prevalence. Neurology, 71(19), 1470-1473.

Smith, K., Grundy, J. J., & Nelson, H. J. (2010). Culture at the centre of community based aged care in a remote Australian Indigenous setting: a case study of the development of Yuendumu Old People's Programme. Rural And Remote Health, 10(4), 1422-1422.

Stewart, J., Lohoar, S., & Higgins, D. (2011). Effective practice for service delivery coordination in Indigenous communities. Resource Sheet no 8. Closing the Gap Clearinghouse. Retrieved from Canberra ACT: www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/.../ctgc-rs08.rtf

Stoneman, A., Atkinson, D., Davey, M., & Marley, J. V. (2014). Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Services Research, 14, 481-481. doi:10.1186/1472-6963-14-481

Zurbrick, S. R., Shepherd, C. C. J., Dugeon, P., Gee, G., Paradies, Y., Scrine, C., & Walker, I. (2014). Social determinants of social and emotional wellbeing. In P. Dugeon, H. Milroy, & I. Walker (Eds.), Working together. Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.) (pp. 93-112). Canberra: Department of Prime Minister and Cabinet.


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