A major review of Aotearoa’s aged-care system is calling for sweeping reform, but for Māori health researcher Dr Joanna Hikaka the conversation also raises a more fundamental question: what does growing older actually look like for Māori, and is a system largely designed around Western definitions of ageing capable of meeting the needs of kaumātua?
Dr Hikaka, Director of the Centre for Co-Created Ageing Research, joins Radio Waatea as the Government considers the findings of A Place to Grow Old: Securing the Future of Aged Care, the independent Aged Care Ministerial Advisory Group report released this month.
The report contains 40 recommendations and describes an aged-care system facing mounting pressure from bed shortages, service closures, struggling carers, fragmented services and rapidly increasing costs. The advisory group warns aged-care costs could almost double during the next 20 years without substantial reform.
But for Māori, the challenge is not simply building more rest-home beds.
It is ensuring the system understands who our kaumātua are, how Māori experience ageing and what whānau-centred care should actually look like.
What does looking older look like?
The question sounds simple.
What does growing older look like for you?
But the answer can be very different depending on culture, health, income, whakapapa and whānau.
Within te ao Māori, becoming a kaumātua is not simply reaching an arbitrary birthday.
Kaumātua, kuia and koroua can hold important roles as repositories of whakapapa, mātauranga, tikanga, reo and collective memory.
They can be leaders, teachers, carers and connectors between generations.
That means an aged-care system focused predominantly on frailty, dependency and the management of disease risks overlooking the contribution older Māori continue making to whānau, hapū and iwi.
Ageing well for Māori can therefore mean more than remaining medically stable.
It can mean maintaining mana, whakapapa, whanaungatanga, cultural identity, connection to whenua and the ability to participate in whānau and community life.
Māori can experience ageing differently
There is also an equity problem with defining aged care almost entirely around chronological age.
Māori experience significant inequities in health across the life course, meaning illness, disability and the need for additional support can occur earlier.
That creates an obvious policy challenge.
If access to services is designed around assumptions about when an average New Zealander becomes old, Māori experiencing age-related health needs earlier can potentially find themselves poorly served by the system.
The Government itself has previously acknowledged that access to appropriate aged-care services is inconsistent and inequitable across different populations and parts of the country.
The issue is therefore not simply whether Māori live as long as other New Zealanders.
It is whether the health system recognises the different journey Māori may experience getting there.
A system under enormous pressure
The wider aged-care challenge is substantial.
The Ministerial Advisory Group describes the existing system as fragmented and under increasing financial pressure, with shortages capable of flowing directly into hospitals, general practice and whānau care.
Its recommendations include creating a more integrated and people-centred system, strengthening services that allow people to remain at home, reforming contracting and regulation, changing funding arrangements and creating additional residential-care capacity.
The report also emphasises something many whānau already know — most people want to remain independent and close to those they love for as long as possible.
That requires substantially better home-based support and greater recognition of the people providing unpaid care.
For Māori, that can mean designing services around whānau rather than expecting whānau to navigate a collection of disconnected providers.
Ageing in place — but whose place?
The report puts significant emphasis on ageing well in place.
That is potentially important for Māori.
But it also raises another question: what does place mean?
For one person, it may simply mean remaining in their existing house.
For Māori, place can carry much deeper relationships involving whenua, marae, hapū, whakapapa and whānau.
Keeping a kaumātua technically living at home while they become increasingly isolated from those relationships may not necessarily represent successful ageing.
A genuinely Māori approach needs to consider not only where someone lives but whether they remain connected to the people, culture and places that sustain their wellbeing.
More Māori-led solutions
That is why the future of aged care cannot simply involve taking the existing model and attempting to make Māori fit into it more comfortably.
There is an opportunity to build more Māori-led and kaupapa Māori models of ageing and care.
That could include greater investment in Māori providers, culturally grounded home and community services, papakāinga and kaumātua housing, stronger whānau support and services connecting clinical care with cultural and social wellbeing.
The Advisory Group itself sought input from Māori expertise as part of its work, alongside aged-care specialists, clinicians, consumer representatives and other parts of the health system.
The next test is whether that expertise is reflected in what governments actually implement.
Whānau are already part of the workforce
Aged-care policy also needs to recognise that a substantial amount of care never appears on a hospital roster or rest-home payroll.
It happens inside whānau.
Adult children support parents.
Mokopuna help grandparents.
Whānau organise appointments, medicines, transport, kai and household tasks.
As formal aged-care capacity comes under increasing pressure, there is a danger governments simply assume whānau will absorb more responsibility.
The new report instead recommends better support for carers and whānau as part of strengthening the ability of older people to remain at home.
That distinction matters.
Whānau involvement should be enabled and supported, not treated as free capacity capable of filling gaps in an under-resourced system.
Who pays for the future?
Then comes the difficult question of money.
The Advisory Group recommends reconsidering how the costs of aged care are shared between individuals and the State, arguing those who can afford to contribute should do so.
Its modelling estimates the broader reform package could avoid more than $830 million a year in unnecessary growth in taxpayer costs by 2037/38.
But any move towards greater individual contributions will require careful scrutiny through an equity lens.
Wealth is not distributed evenly across generations or communities.
For Māori, historic land alienation, income inequalities and lower accumulated household wealth mean apparently neutral financial rules can produce unequal consequences.
A sustainable system therefore also needs to be a fair one.
Kaumātua are not a burden
Perhaps the most important shift required is in the language surrounding ageing itself.
An ageing population is frequently discussed primarily as a cost.
More hospital beds.
More carers.
More residential facilities.
More taxpayer funding.
All of those pressures are real.
But reducing older people to a future fiscal liability misses what kaumātua represent within te ao Māori.
They are holders of history.
They transmit language and tikanga.
They connect mokopuna with whakapapa.
They provide care, leadership and stability within whānau.
They are not simply recipients of services.
They remain contributors to the wellbeing of generations around them.
That is why the question facing Aotearoa is bigger than how many aged-care beds we will need in 2040.
It is about what kind of ageing we want to make possible.
For Dr Joanna Hikaka and those working to rethink ageing through Māori and co-created approaches, the starting point may be deceptively simple:
What does growing older look like for you — and have we actually built a system that allows our kaumātua to grow older with mana, connection, choice and dignity?
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