NZ is eyeing reform of its strained aged-care system. How might a reset deliver for Māori?

New Zealand is examining sweeping reforms to its aging and increasingly strained aged-care system, with a particular focus on addressing longstanding disparities faced by Māori. The Ministry of Health has received a comprehensive set of recommendations aimed at transforming the sector into a more integrated, person-centered approach. These proposals come from the Ministerial Advisory Group on Aged Care, which has outlined 40 key changes, emphasizing the need for a system that better reflects the diverse needs of older New Zealanders. The group's 168-page report underscores persistent inequities in how Māori access and experience aged care. It advocates for a more culturally responsive framework, integrating cultural safety into every aspect of service delivery, from initial assessments to ongoing care planning. The report also highlights that Māori are significantly less likely to receive community-based aged care or enter residential care compared to non-Māori, despite projections indicating that more Māori will require residential care in the coming decades. This trend is linked to historical systemic biases, early onset of chronic conditions, and challenges in accessing timely care. Associate Health Minister Casey Costello has acknowledged the outdated nature of the current funding model and the fragmented structure of the aged-care system. Officials are currently evaluating the recommendations, which could influence future policy and resource allocation. This moment presents a critical opportunity to reshape aged care in a way that better serves Māori, particularly given the growing recognition of the gaps in existing services. As New Zealand’s population continues to age, entrenched inequalities in healthcare and access to care risk worsening in later life. Many aged-care services still operate within a predominantly Western paradigm, which may not align with the values, traditions, and lived experiences of Māori elders. Research indicates that Māori with daily care requirements are approximately half as likely as non-Māori to access community-based care and even less likely to enter residential care. This disparity is compounded by a range of factors, including limited referrals for funded services, uneven distribution of carer support across regions, and a lack of alignment between formal services and Māori expectations of care. For some Māori elders, staying at home with family, whānau, is a preferred option. However, this often requires extensive support, ranging from assistance with meals and household tasks to transportation and personal hygiene. In many cases, these needs surpass what family members can provide, leading to feelings of guilt and isolation. To address this, the report emphasizes the importance of recognizing and supporting the vital role of whānau caregivers through adequate training, resources, and external assistance when necessary. Beyond physical care, the report stresses the significance of preserving independence, maintaining connections with whānau and community, and upholding cultural identity and ties to land. The concept of “ageing well in place” is central to the proposed reforms, aiming to enable older individuals to remain in their homes for longer as their needs evolve. This includes facilitating a return to ancestral lands and communities for some elders. Aged care for Māori must thus encompass more than medical services, it must consider housing, transportation, and access to culturally appropriate care. The report also calls for a workforce trained in te reo Māori and tikanga, alongside access to traditional Māori healing methods and culturally suitable food options. Equally crucial is ensuring that care supports elders in maintaining autonomy and engagement with family and community life. Physical or cognitive limitations should not hinder participation in meaningful activities, whether through domestic tasks or sharing knowledge with younger generations. Policymakers now face the task of assessing these recommendations, with the potential to implement transformative changes that better serve Māori elders. The path forward involves not only revising service models but also embedding cultural responsiveness and equity at the core of aged-care provision.