New research in the Cultural Care area of focus in Flinders University’s Caring Futures Institute is exploring how to support mainstream health care workers provide culturally safe care.

In Australia, about 30,000 First Nations people received subsidised aged care in 2022, mostly through home or community services rather than residential care. However, First Nations people are markedly under-represented in mainstream residential aged care, despite experiencing higher levels of chronic illness, earlier disability and more complex care needs.

Associate Professor Nina Sivertsen – an Indigenous Sámi woman from Norway who is now in Nursing at Flinders University – is leading research aimed at addressing this imbalance by strengthening education for culturally safe and responsive care in the mainstream workforce.

“A key concern is that although most First Nations people assessed for aged care are approved, fewer than 55% go on to use any service,” she explains.

“This points to major barriers to access—not a lack of need.”

Many First Nations people only enter residential care very late, often during crisis or at end of life, and usually into mainstream facilities that are not designed to meet cultural, spiritual and relational needs.

“Our focus on providing culturally safe care is about ensuring older First Nations people can age with dignity, cultural safety and proper care – something that everyone wants for their own families.”

First Nations people in Australia can access aged care from the age of 50, which is 15 years earlier than non-Indigenous Australians. “This reflects the cumulative impacts of health and social inequities arising from colonisation and its ongoing effects. Despite this, First Nations people are less likely to enter residential care and more likely to do so only when needs become acute.”

Indigenous-specific residential aged care options remain extremely limited. South Australia has only one Aboriginal Community Controlled residential aged care facility, which means that most Aboriginal people must rely on mainstream services.

“At the same time, the mainstream system is not fully prepared. The aged care workforce is large – about 549,000 workers nationally – but less than 3% of these workers are First Nations health workers, and in residential care, about 30-35% of staff have overseas training or come from culturally and linguistically diverse backgrounds. This presents additional challenges, as many workers may have limited understanding of the Australian context, the ongoing impacts of colonisation, and what constitutes culturally safe care for First Nations peoples.”

“Many staff in aged care report that they have limited preparation to deliver culturally safe, trauma-aware care.”

Without introducing change to aged care, this situation creates risks of cultural harm for older First Nations people

Associate Professor Sivertsen says new Caring Futures Institute research will identify what mainstream aged care staff need to provide culturally safe care and highlight gaps in existing training, leadership and organisational systems. It moves beyond one-off cultural awareness training to focus on system-level change, which includes supervision, governance and workforce support.

“Through this, older First Nations people will receive improved care that respects their culture, identity and wellbeing,” she says.

Positive change will have far-reaching effects, beyond assisting people in aged care. Families and communities may place greater trust and engagement with aged care services; aged care workers will receive clearer guidance and better support; and aged care service providers and policymakers will be able to refer to evidence that will guide meaningful reform.

“The need for change is growing across Australia,” says Associate Professor Sivertsen. “About 18.4% of First Nations people are aged 50 and over, and more than two-thirds live in urban and regional areas, where mainstream aged care services dominate the available care options.”

While Associate Professor Sivertsen’s findings are strongly focused on South Australia, their influence will be relevant nationally, and potentially internationally, where similar challenges exist in many countries to deliver culturally safe care to Indigenous populations.

This work spans multiple sectors and perspectives, including:

• Aged care providers
• A workforce of more than 500,000 people
• Personal care workers who deliver day-to-day care
• Policy and regulatory bodies responsible for implementing new aged care reforms
• First Nations leaders, older people and communities whose lived experiences are central to their ongoing health care
• Advocacy and peak bodies, such as those supporting First Nations ageing and aged care

“Collaboration across these groups is essential to ensure solutions are practical, culturally grounded and sustainable,” says Associate Professor Sivertsen.