By MILLIE MUROI, Economics Writer
As much as it is a privilege, caring for our parents and grandparents – the people we have relied on – can be confronting. We see their vulnerability, their pain, and we have to step up in ways we’re often unprepared for.
But ageing is a process most of us are at least somewhat familiar with, especially as life expectancy in Australia has eclipsed 81 years for men and 85 for women. For some communities, though, the experience of aged care is a historic first.
Speaking at the Independent Health and Aged Care Pricing Authority’s conference in Adelaide last week, Stan Grant – distinguished professor at Charles Sturt University, and a Wiradjuri, Kamilaroi and Dharrawal man renowned for his journalism – pointed this out.
“I stand here today older than both of my grandfathers were when they died,” Grant, 61, said. “It’s an incredibly sobering thought that as First Nations people, we are experiencing the first generation of ageing.”
Grant’s father, who is 85, has lived well beyond the 71-year life expectancy for First Nations men. But if not for some key factors, Grant reckons he would probably have died earlier.
“My parents have had to bury nieces, nephews and grandchildren,” he said. “Just a week ago, we had to bury a nephew of mine who was just 40 years old.”
One of the most important factors behind his parents outliving the national average is tied to a challenge facing the entire nation – but especially First Nations Australians – according to Grant: housing security.
“Every Aboriginal person like me who has closed the gap, every single one, has two things in their life: home ownership and an education,” Grant said.
Owning a home to live in, and to be cared for in, has been crucial – not only for his parents’ ability to live at home in their old age and be around family and their community, but also to Grant’s own personal success.
“I could go to sleep at night [as a kid] and know I wasn’t going to be woken at midnight to pack up and move somewhere,” he said.
After he moved school 14 times before even entering high school, Grant said his parents getting their own home meant he finally got to play in the same football team, get a tutor and have friends for more than six months.
The home ownership rate among First Nations Australians was 42 per cent in 2021 compared with 67 per cent in the broader Australian population.
Research last year found that among the broader population, older Australians who rent their homes tend to live shorter lives and have fewer years of good health compared with home owners – even after accounting for factors such as income and education.
University of Wollongong lecturer in statistics and data science Dr Kim Kiely said the research highlighted the need for more policies aimed at making housing secure and affordable, allowing people to stay connected to their community as they age.
Home or community-based care is especially important for many First Nations people, said Andrea Kelly, the interim First Nations aged care commissioner.
“Aboriginal and Torres Strait Islander people are often disconnected from country as they age,” she said, preventing elders from passing down knowledge, providing leadership and care, and safeguarding family, community and intergenerational wellbeing.
Kelly also said many stolen-generations survivors avoided mainstream services, because of a shortfall in trauma-aware care and because these environments could often resemble institutions these people were placed in as children.
“The lack of cultural safety is the primary deterrent for older Aboriginal and Torres Strait Islander people not accessing aged care,” she said, also noting the interpersonal and structural racism reported by First Nations people when accessing standard aged care.
While many Australians take for granted a level of familiarity, ease and comfort with aged care systems, Grant pointed out these were often not aligned with how First Nations families and communities are structured.
“The government very generously provides an allowance for the primary carer,” he said. “But we don’t have a singular primary carer. We have primary carers.”
Grant said it was invaluable for his parents to have the choice of medical services that didn’t require linguistic or cultural translation.
“My parents were within an hour’s drive of an Aboriginal medical centre where they felt comfortable, respected, and cared for,” he said. When they could no longer drive, the nurses came out to visit them.
These Aboriginal Community Controlled Health Organisations – known as ACCHOs – are run by Aboriginal and Torres Strait Islander communities and show an “incredible amount of innovation and entrepreneurship” distinguished professor and health economist Jane Hall said.
Kelly said the government should support and encourage more partnerships between these organisations and mainstream service providers until they could be better funded.
The Productivity Commission, in its final report before the productivity roundtable next week, also backed this suggestion and said these organisations needed to be sufficiently resourced.
While data is important for measuring outcomes and progress, Grant also spoke about the need to look beyond overall statistics which could mask inequalities among First Nations people, and flagged the need for policies to account for differing circumstances.
“The first or second generation Aboriginal middle class, who may be more literate, have greater access and live in more affluent areas, enjoy very different lives from communities including such as the one I’m from,” he said, with some people requiring more support than others, but those with access to resources tending to be better placed to receive that support.
Grant also stressed the importance of leaning into the expertise and strengths of First Nations people in improving the aged care system.
“We need Aboriginal people who have experience, who can bring that nuance and knowledge, understanding and cultural knowledge to bring better outcomes,” he said.
“It’s such a shame that during the Voice referendum we never got to talk about love and care, about health and ageing. We frittered away so many opportunities talking about petty politics and culture wars. Imagine having an entity with Aboriginal input that understands the intricacy and changing needs of our community.”
There is also a strong sense of community, family and responsibility towards elders embedded in many First Nations cultures which may be difficult to quantify but is crucial to our understanding and development of aged care.
“There is no way my parents would have been able to stay in their own home, as hard as that has been, if it wasn’t for the love, resilience and strength of their community,” Grant said. “You go to an Aboriginal person’s home, you’ll never be turned away. There’s always somewhere to sleep, there’s always another seat at the table, there’s always going to be enough food.”
While there is plenty left to do to improve the aged care system – especially for First Nations people – Grant’s father, the oldest man in his family’s history, is a picture of hope.
Grant’s experience is also a reminder that we are – in many ways – all in this together, with an important opportunity to connect, empathise and learn from one another.
“After my dad had had his first brain surgery, I had to help my father to the bathroom, and I’d never held that level of vulnerability before,” Grant said. “My dad, who was always an incredibly strong, powerful, muscled man … I felt how his arms were soft, how his legs shook uncontrollably. This is what people are experiencing right across Australia: the intimacy of care that none of us are really prepared for.”
