New governance arrangements needed for culturally safe aged care

Andrea is a proud Warumungu and Larrakia woman. Andrea commenced as Interim First Nations Aged Care Commissioner in January 2024, tasked to lead public consultations about the design and functions of a permanent Commissioner and identify, promote and contribute to the changes needed to improve Aboriginal and Torres Strait Islander people’s access to culturally safe aged care.

By invitation, Andrea shares a message with Aged Health readers for the May 2025 edition, which has a focus on governance.

Thank you for inviting me to contribute to this edition that has a focus on governance.

As we embark on significant policy and program reforms in aged care, governance is a vital conversation. Ultimately, governance is not just a bureaucratic issue — it’s a human one. It’s about who gets to decide, whose knowledge is valued, and whose voices are heard.

In February this year, I released my report ‘Transforming Aged Care for Aboriginal and Torres Strait Islander people’. It was the culmination of over 70,000 kilometres of travel, countless conversations, and deep listening to older Aboriginal and Torres Strait Islander people, their families, communities, and Aboriginal and Torres Strait Islander community-controlled organisations and aged care providers across the country.

One message came through loud and clear: the current aged care system does not work for Aboriginal and Torres Strait Islander people.

For too long, Aboriginal and Torres Strait Islander peoples have faced a system built without us — one that does not reflect our cultures, our values, or our right to age with dignity on our own terms.

While there are aged care providers doing important and respectful work, systemic change will not come through goodwill alone. It requires structural reform. And that includes reforming how decisions about care are made and who holds the power in those decisions.

That’s why my report calls for stronger governance arrangements between aged care providers and Aboriginal and Torres Strait Islander families, communities, and organisations.

This is not a new idea. It is grounded in the Priority Reform One of the National Agreement on Closing the Gap which recognises that unless Aboriginal and Torres Strait Islander people are at the table — with power, not just presence — governments and mainstream institutions and organisations will continue to design policies and services that miss the mark.

Priority Reform One requires structures that empower Aboriginal and Torres Strait Islander people to have a genuine say in the decisions that affect our lives. The same principle must apply to aged care.

In practice, this means aged care providers must embed governance structures with local Aboriginal and Torres Strait Islander communities. It means establishing formal advisory groups, shared leadership models, and mechanisms for community involvement — not as a tick-box exercise, but as a non-negotiable foundation for culturally safe care.

Families and Aboriginal community-controlled organisations told me they feel shut out of the decisions that determine where and how their loved ones are cared for. They spoke of being sidelined, of feeling powerless when raising concerns, and of cultural protocols being ignored or misunderstood. They also spoke about the pain of being forced to choose between care and cultural connection — especially when older Aboriginal and Torres Strait Islander people are relocated far from their community or island home to receive support.

These outcomes are not accidental; they are the result of governance systems that exclude us.

The need for structural change is now also embedded in law. The new Aged Care Act 2024 introduces a Statement of Rights that affirms every person’s right to culturally safe, trauma-aware and healing-informed care.

This is a landmark shift. But rights must be backed by action — and governance is where action begins. Unless Aboriginal and Torres Strait Islander people have a formal role in how services are designed, delivered and reviewed, these rights will not be fully realised in practice.

If we are serious about closing the gap in aged care access and outcomes, then we must build a system in which power is shared — where Aboriginal and Torres Strait Islander people can lead and work in partnership with providers on the care that they need and deserve.

Importantly, this is not just about respecting culture; it’s about improving quality of care. We know that culturally safe and responsive care leads to better outcomes — greater trust in the system, improved health and wellbeing, and longer engagement with services.

We also know that many providers want to do better. But wanting is not enough. They need to commit to deep and enduring partnerships with local Aboriginal and Torres Strait Islander stakeholders, backed by formal governance arrangements, training, and resourcing.

My report outlines practical steps to support this shift — such as requiring cultural safety governance frameworks as part of provider accreditation, mandating cultural safety training for all staff and leadership, and increasing support for Aboriginal and Torres Strait Islander-led aged care services.

We cannot deliver culturally safe aged care without governance structures that reflect the communities being served.

Shared decision-making must become the norm, not the exception. Because when our older Aboriginal and Torres Strait Islander people are respected, heard, and cared for in ways that honour who they are and where they come from, we all benefit.