Abstract
New Zealand's older Indigenous people (Maori) are underserved and underrepresented as consumers of aged residential care services (ARC). This study seeks to ascertain, from the perspectives of older Maori and whanau (family), the influence of structural factors that impact the process of seeking aged residential care. This study used a qualitative Kaupapa Maori research approach. In-depth interviews were undertaken with older Maori (n = 30) and whanau members (n = 18). Interviews were audio recorded and transcribed with themes identified using thematic analysis. Structural barriers related to 'Navigation' and 'Service design and locality' were identified by older Maori and whanau which provide insight into the oppressive nature of structural racism and highlighting various factors that affect older Maori and whanau access to ARC. Equity approaches that focus on optimising Maori access to ARC are needed in order to move ARC services towards equity. ARC services provide an important service for older New Zealanders. Our findings challenge and disrupt the universalistic nature that underpin New Zealand health structures. Health decision-makers should consider these findings to address the powerful and damaging effects structural racism has that compromise older Maori and whanau uptake and access to ARC services.Glossary of Maori terms: Hapu: subtribe but can also mean to be pregnant; Harakeke: flax. In the context of the research, harakeke means to weave using flax; Kaumatua: an older Maori person of status, either male or female who are knowledgeable in tribal history and traditions; Kaupapa: topic, matter of discussion, plan, purpose, proposal, agenda, theme, issue, initiative; Kaupapa Maori Research: Kaupapa Maori Research is an Indigenous Maori research framework or methodology for undertaking research by Maori, with Maori for the benefit of Maori, an approach underpinned by Maori values; generally utilised by researchers who are Maori, and who are undertaking research with, and for Maori; Maori: Indigenous New Zealander, Indigenous people of New Zealand; Mahi: to work; Ngai: prefix for a tribal group. For example, Ngai Tahu refers to the tribal group of people who descend from the eponymous ancestor known as Tahu Potiki. In some instances, the names of ancestors may be shortened; Ngati: prefix for a tribal group. For example, Ngati Porou, refers to the tribal group of Porou which is shortened to refer to the eponymous ancestor known as Porourangi; Pakeha: person of European descent, foreigner, introduced from another country, or can be used to imply a Westernised Eurocentric view of the world; Te Reo Maori: Maori language, or to speak in the Maori language; Te Tiriti o Waitangi: Te Tiriti o Waitangi is the Treaty of Waitangi, also referred to as te Tiriti or the Treaty signed in Waitangi, New Zealand in 1840 between the British Crown and a large number of Maori chiefs; Tikanga: Maori customary system of values and practices that have developed over time and are deeply embedded in Maori social contexts; Tino rangatiratanga: chieftainship, right to exercise authority, chiefly autonomy and ownership.
Tino rangatiratanga is also used to acknowledge Maori self-determination in a way that aligns with their customs, values and aspirations by having the ability to make decisions over their affairs including health; Te Tairawhiti: also referred to as (Tairawhiti) is the customary Maori name for the Gisborne region which is located on the east coast of New Zealand's North Island; Whanau: family unit, not always immediate family and may include those that are family or by marriage, adoption, fostering, or from other close relationships. In the context of the research, whanau also includes a group of people who are not related but who are bound together to fulfil a common purpose to assist older Maori family members and friends who may need help with daily living activities; Whakapapa: geneology, descent, family tree, ancestry, origin; Whakawhanaungatanga: refers to the process of forming and establishing relationships with others by providing a foundation for unity and cohesion. Process of establishing relationships which usually involves reciprocal information being shared to establish and build relationships.