Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 10
ABORIGINAL AND TORRES
STRAIT ISLANDER ISSUES
The values underpinning both a palliative approach and aged care in Australia are strongly
grounded in the non-Indigenous culture that dominates health and social services. Meeting
the needs of Indigenous Australians requires that non-Indigenous Australian controlled RACFs
adopt a respectful attitude and be directed by the unique values, beliefs and experiences of
Indigenous Australian residents, their family members and community [348,349] (Level EO;
Level EO). For example, a recent study on terminal illness in rural Indigenous Australian
communities found that participants were aware of the availability of health services [350] (Level
QE) but preferred care to be provided by the family for as long as possible, and for some people
dying on their home country had considerable spiritual significance. Willis (1999) [349] (Level
EO) discusses Indigenous Australians’ strong preference for care to be provided by particular
relatives and the importance of traditional healers. Complex family relations may mean that the
appropriate decision-makers are not the immediate caregivers.
From the perspective of a member of the aged care team adopting a palliative approach, the
decisions of Indigenous Australian residents and their family and significant community
members may not be consistent with the views of some team members. However, consistent
with a palliative approach, the role of the aged care team is to work with the resident, family,
community members and relevant services to find ways to enable the resident’s goals to
be achieved. A recent assessment of Indigenous Australians requiring a palliative approach
identified a number of examples of services being able to improve the quality of palliative
services while respecting residents’ wishes to die in a particular community [133] (Level QE).
10.1 BACKGROUND
In addition to their distinct culture, other aspects of Indigenous Australians’ experience have led to
a large burden of unresolved grief and loss that is inherent in Indigenous Australian communities
as a result of premature death, family separation and community breakdown. This can have farreaching
effects and impact significantly on the dying and bereavement experience of Indigenous
Australians and their family members. It also affects the ability of Indigenous Australian health
workers to provide ongoing care. With a life expectancy of 20 years less than non-Indigenous
Australians, and a high burden of chronic illness, health problems usually associated with people
in their seventies or eighties are more prevalent among much younger Indigenous Australians. [133]
A consequence is that Indigenous Australian residents requiring a palliative approach are likely to
be relatively young compared with non-Indigenous Australian residents.
The delivery of a palliative approach among Indigenous Australians is a largely underdeveloped
area of health care. Indigenous Australians tend to access both mainstream palliative services
and RACFs infrequently. Factors associated with this infrequent use of palliative services
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