Caring for Our Elders: Aged Care for Aboriginal & Torres Strait Islander Communities
Aboriginal and Torres Strait Islander Elders are the knowledge keepers, cultural custodians, and spiritual heart of their communities. Aged care for First Nations Australians requires not just medical competence but deep cultural safety — understanding Country, kinship, Sorry Business, and the historical trauma that shapes every interaction with government services.
Aboriginal and Torres Strait Islander people experience the chronic diseases of ageing earlier than non-Indigenous Australians. The life expectancy gap of approximately 8 years means aged care needs begin earlier — which is why First Nations Australians can access aged care services from age 50, not 65. Rates of diabetes are 5 times higher, kidney disease 3 times higher, and dementia is significantly more prevalent. Yet aged care services remain underutilised by First Nations communities, largely because of justified distrust of government institutions, culturally unsafe service delivery, and the disconnect between Western medical models and Aboriginal holistic health concepts. This guide covers the aged care services specifically designed for First Nations communities, culturally safe care principles, government programs, and how daily welfare calls can support Elders in remote and regional communities.
First Nations Ageing: The Numbers
eligible for aged care (not 65 like non-Indigenous Australians)
life expectancy gap compared to non-Indigenous Australians
higher rates of diabetes in Aboriginal and Torres Strait Islander people
higher rates of kidney disease requiring dialysis
Aged Care Eligibility from Age 50
The Australian Government recognises that Aboriginal and Torres Strait Islander people experience the health effects of ageing earlier than non-Indigenous Australians. As a result, First Nations Australians can access most aged care services from age 50, including:
| Service | Eligibility | What It Provides | How to Access |
|---|---|---|---|
| My Aged Care Assessment | From age 50 for Aboriginal and Torres Strait Islander people | Comprehensive assessment of care needs, referral to appropriate services, Home Care Package eligibility | Call 1800 200 422 and identify as Aboriginal or Torres Strait Islander. Aboriginal liaison officers available. |
| Home Care Packages (Levels 1-4) | From age 50 | Funded in-home care: personal care, domestic help, nursing, allied health, transport, meals, home modifications | My Aged Care assessment. Packages range from ~$9,500/year (Level 1) to ~$55,800/year (Level 4). |
| Commonwealth Home Support Programme (CHSP) | From age 50 | Basic support services: domestic assistance, personal care, social support, transport, meals, nursing | Contact My Aged Care. Faster to access than Home Care Packages. Small co-contributions may apply. |
| Residential Aged Care | From age 50 | Full-time residential care when living at home is no longer safe or possible | ACAT assessment via My Aged Care. Seek facilities with cultural safety training and Aboriginal staff. |
| NATSIFACP (Flexible Aged Care) | From age 50 | Culturally appropriate aged care in remote and very remote areas where mainstream services are unavailable | Contact local ACCHO or My Aged Care. See NATSIFACP section below. |
Aboriginal Community Controlled Health Organisations (ACCHOs)
ACCHOs are primary healthcare organisations governed by Aboriginal and Torres Strait Islander communities. They provide culturally safe healthcare delivered by Aboriginal health workers and culturally trained staff. There are over 140 ACCHOs across Australia, and they are usually the best first point of contact for aged care support for First Nations Elders.
| State/Territory | Peak Body (Affiliate of NACCHO) | Contact | Key ACCHOs |
|---|---|---|---|
| NSW/ACT | Aboriginal Health & Medical Research Council (AH&MRC) | (02) 9212 4777 | Aboriginal Medical Service Redfern, Awabakal, Katungul, Bulgarr Ngaru, Pius X AMS |
| Victoria | Victorian Aboriginal Community Controlled Health Organisation (VACCHO) | (03) 9411 9411 | Victorian Aboriginal Health Service (Fitzroy), Rumbalara, Budja Budja, Moogji, Gippsland & East Gippsland ACCHO |
| Queensland | Queensland Aboriginal & Islander Health Council (QAIHC) | (07) 3328 8500 | Institute for Urban Indigenous Health (IUIH), Apunipima, Gurriny Yealamucka, Wuchopperen |
| South Australia | Aboriginal Health Council of SA (AHCSA) | (08) 8273 7200 | Nunkuwarrin Yunti, Pika Wiya, Pangula Mannamurna, Tullawon Health Service |
| Western Australia | Aboriginal Health Council of WA (AHCWA) | (08) 9227 1631 | Derbarl Yerrigan, Kimberley Aboriginal Medical Services (KAMS), Ngaanyatjarra Health Service, Geraldton Regional AMS |
| Northern Territory | Aboriginal Medical Services Alliance NT (AMSANT) | (08) 8944 6666 | Danila Dilba, Central Australian Aboriginal Congress, Miwatj Health, Wurli Wurlinjang |
| Tasmania | Tasmanian Aboriginal Centre (TAC) | (03) 6234 0700 | Tasmanian Aboriginal Centre — health clinics in Hobart, Launceston, and NW coast |
NACCHO: The National Voice
The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national peak body for 140+ ACCHOs. Website: naccho.org.au. NACCHO advocates for Aboriginal health policy, funds workforce development, and coordinates national programs. If you don't know which local ACCHO to contact, start with the state/territory peak body listed above or call NACCHO on (02) 6246 9300.
Culturally Safe Care: What It Means in Practice
Cultural safety goes beyond cultural awareness. It requires recognising the power imbalance in healthcare, understanding historical trauma, and ensuring the Elder feels safe, respected, and in control of their care. These principles should guide all interactions.
Connection to Country
For Aboriginal and Torres Strait Islander people, health is inseparable from Country. Being displaced from Country — whether through historical removal, moving to a city for medical treatment, or entering residential care far from home — causes spiritual distress that directly impacts physical and emotional health. Aged care planning must consider the Elder's connection to Country. Can care be provided on Country? If the Elder must move for medical reasons, how can connection be maintained? Some ACCHOs arrange regular visits to Country for Elders in urban areas.
Kinship and Family Involvement
Aboriginal kinship systems are complex and extend far beyond the Western nuclear family. Aunts, uncles, cousins, and community members may all have significant roles in an Elder's care. Care planning must include the Elder's identified family and community, not just their biological next of kin. Family meetings should be offered, not just one-on-one consultations. Decision-making may involve multiple family members over multiple conversations — this is not delay, it is cultural process.
Sorry Business (Bereavement)
When a community member dies, Sorry Business may involve extended periods of mourning, travel to Country, ceremony, and avoidance of the deceased person's name, image, and sometimes their possessions. Aged care providers must understand that during Sorry Business, an Elder may withdraw from services, refuse to eat, or become profoundly distressed. This is not depression requiring clinical intervention — it is cultural grieving. Services should be paused and resumed sensitively, with guidance from the Elder's family.
Historical Trauma and Institutional Distrust
The Stolen Generations, forced removals, mission life, and systemic racism have created justified distrust of government institutions among Aboriginal and Torres Strait Islander people. Aged care is a government-funded institution. An Elder being assessed by a government representative, asked to provide personal information, and told they need "care" may trigger trauma responses rooted in lived experience of removal and control. Assessors must build trust over multiple visits, ideally accompanied by an Aboriginal health worker or liaison officer.
Elders in Decision-Making
Elders hold a position of authority and respect in Aboriginal communities. Aged care models that treat elderly people as passive recipients of care — making decisions for them, using diminutive language, or bypassing their authority — are culturally unsafe. Elders must be central to all decisions about their care. Their knowledge, preferences, and cultural authority must be respected. "Person-centred care" in an Aboriginal context means Elder-led care, supported by family and community.
Government Programs for First Nations Aged Care
NATSIFACP — National Aboriginal & Torres Strait Islander Flexible Aged Care Program
The NATSIFACP provides culturally appropriate aged care in remote and very remote communities where mainstream aged care services are unavailable or culturally inappropriate. Key features:
- Services delivered by Aboriginal community-controlled organisations
- Flexible service model that adapts to community needs and cultural practices
- Care delivered on Country wherever possible
- Includes personal care, domestic assistance, social support, meals, allied health, nursing, and respite
- No means testing — services are free to eligible Elders
- 30+ NATSIFACP service providers across Australia, primarily in remote areas
Access: Contact your local ACCHO or My Aged Care (1800 200 422). Ask specifically about NATSIFACP services in your area.
Closing the Gap — Aged Care Targets
The National Agreement on Closing the Gap (2020) includes targets directly relevant to Elder care:
- Target 1: Close the life expectancy gap within a generation (by 2031)
- Target 2: By 2031, increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91%
- Target 14: Significant and sustained reduction in the rate of self-harm and suicide of Aboriginal and Torres Strait Islander people towards zero
- Priority Reform 2: Aboriginal and Torres Strait Islander people have access to, and the capability to use, parsing their data to inform decision-making
The Closing the Gap framework prioritises Aboriginal community control of services and shared decision-making with government. Progress reports are published annually at closingthegap.gov.au.
My Aged Care for Aboriginal Australians
My Aged Care has specific provisions for Aboriginal and Torres Strait Islander people:
- Aboriginal liaison officers: Available to help navigate the system. Ask for one when calling 1800 200 422.
- Face-to-face assessment: Assessment can be conducted at the Elder's home, at an ACCHO, or at a community venue — not just by phone.
- Cultural assessment: Assessors are required to consider cultural needs, connection to Country, kinship obligations, and language needs.
- Interpreter services: Available for Aboriginal language speakers (via TIS 131 450).
- ACCHO-based assessors: In some areas, Aged Care Assessment Team (ACAT) assessments can be conducted by ACCHO staff, which is less intimidating than a government assessor visiting the home.
Health Conditions Affecting Aboriginal & Torres Strait Islander Elders
| Condition | Prevalence (vs non-Indigenous) | Impact on Independent Living | Key Support |
|---|---|---|---|
| Type 2 Diabetes | 5× higher prevalence | Vision loss (diabetic retinopathy), kidney failure requiring dialysis, amputations (diabetic foot), cardiovascular events | NDSS registration (free supplies), Aboriginal Health Worker support, podiatry, regular eye checks |
| Chronic Kidney Disease | 3× higher prevalence; leading cause of dialysis in remote communities | Dialysis requires travel to regional centres (3× per week), causing displacement from Country and family. Fatigue limits daily activities. | NATSIFACP, patient travel schemes, dialysis support accommodation in regional centres |
| Cardiovascular Disease | 1.5× higher mortality rate | Heart failure limits physical activity, stroke causes disability, medication management is complex | Aboriginal Health Worker monitoring, Closing the Gap PBS co-payment for medications |
| Dementia | 3-5× higher prevalence in remote communities | Loss of language, cultural knowledge, ability to participate in ceremony. Wanders from home. Requires full-time supervision. | Culturally specific dementia programs, NATSIFACP residential care on Country, family/community support |
| Eye Disease | 3× higher rates of vision impairment | Cannot read medication labels, cook safely, or navigate home. Untreated trachoma in childhood causes blindness in older age. | Brien Holden Foundation, Fred Hollows Foundation, Aboriginal eye health programs |
| Mental Health & Trauma | Significantly higher rates of depression, anxiety, PTSD, and substance use | Social withdrawal, self-neglect, refusal of services, increased fall risk from substance use. Intergenerational trauma from Stolen Generations. | Aboriginal mental health workers, Healing Foundation programs, Social and Emotional Wellbeing services |
How KindlyCall Daily Calls Can Support First Nations Elders
Remote Community Connection
In remote and very remote communities, aged care services may visit only weekly or fortnightly. Between visits, an Elder living alone has no daily welfare check. A daily phone call fills this gap — detecting falls, illness, or distress that would otherwise go unnoticed until the next service visit. For Elders on dialysis who travel to regional centres, a daily call provides continuity of connection when they are away from home and Country.
Family Alerts Across Distance
Aboriginal families are often dispersed across vast distances, with family members living in different communities, regional centres, or cities. A daily call provides structured health updates to family members wherever they are. This is particularly important when an Elder's children have moved to urban areas for work but remain responsible for their parent's welfare. Consistent information reduces the anxiety of distance and helps families coordinate care.
Gentle, Respectful Monitoring
KindlyCall's daily calls are designed to be warm, caring, and non-intrusive — qualities that align with respectful communication with Elders. The call does not feel like a government assessment or a medical interrogation. It feels like a friendly check-in. For Elders who are wary of formal services due to historical trauma, a daily phone call is a low-barrier form of support that builds trust through consistency and kindness.
Cultural Limitations & Our Commitment
KindlyCall currently operates in English, which limits its usefulness for Elders who speak primarily Aboriginal languages. We acknowledge this limitation and are actively exploring partnerships with Aboriginal language services and ACCHOs to develop culturally appropriate call content. We also recognise that an AI-powered service cannot replace the cultural knowledge and connection that Aboriginal health workers and community members provide. KindlyCall is intended to complement — never replace — community-based care. We welcome guidance from Aboriginal communities on how our service can best support their Elders.
Key Contacts & Resources
| Organisation | Phone | What They Provide |
|---|---|---|
| My Aged Care (Aboriginal liaison) | 1800 200 422 | Aged care assessment from age 50, Home Care Packages, CHSP, NATSIFACP referral. Ask for Aboriginal liaison officer. |
| NACCHO (National peak body) | (02) 6246 9300 | National coordination of 140+ ACCHOs. Can direct you to your local ACCHO. |
| 13YARN (Crisis support) | 13 92 76 | Free 24/7 crisis support line staffed by Aboriginal and Torres Strait Islander people. Culturally safe alternative to Lifeline. |
| Healing Foundation | (02) 6272 7500 | Supports Stolen Generations survivors and their families. Healing programs, advocacy, Link-Up (family reunification). |
| Carer Gateway | 1800 422 737 | Support for family carers including respite, counselling, emergency assistance. Aboriginal-specific resources available. |
| DVA (Veterans) | 1800 555 254 | Aboriginal and Torres Strait Islander veterans may access DVA services. Dedicated Indigenous liaison officers available. |
| Translating and Interpreting Service | 131 450 | FREE interpreting for Aboriginal languages when calling government services or medical providers. |
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