Planning for Māori Futures: A Scoping Review of Experiences, Priorities and Opportunities for Culturally Informed and Appropriate Aged Care Design

ABSTRACT

Objectives

Developing models of aged care that align with Māori aspirations has been identified as a national priority in a recent report by the New Zealand (NZ) Aged Care Commissioner. We aimed to identify key considerations useful for informing Māori aged care and to identify known gaps and proposed solutions, which could be prioritised in health and social service design, delivery and implementation, and for investigation in future research.

Methods

We undertook a critical review of peer‐reviewed academic and grey literature to identify relevant studies. Studies were grouped into three pre‐defined areas: components and values of care models; physical spaces of care; and infrastructures of care.

Results

We included 45 articles that focussed on diverse areas including broad experiences of older age, quality of life and well‐being, frailty, housing and aged residential care. Findings relating to care models highlighted the aspiration for holistic care models that supported maintaining independence and included meaningful activities. Connection to place and community was important within physical spaces of care and a cross‐sectoral approach that allowed for connected and informed decision‐making and appropriate resourcing was an important infrastructure consideration.

Conclusions

By identifying relevant knowledge relating to models, physical spaces and infrastructures of care, this review provides an evidence base for future health and social service development and identifies gaps in knowledge, which require further research.

Policy Impact

This paper highlights that aged care service model policy should direct the use of holistic models of care that allow for the maintenance of appropriate independence for older Māori. Additionally, policies should span sectors rather than considering only the solutions, outcomes and impacts within health.

Practice Impact

When developing and delivering aged care, providers need to include ways to respond to and support physical, mental and spiritual wellbeing that is cognisant of wider support networks that older Māori exist within.

1. Introduction

As Aotearoa New Zealand (NZ) responds to the realities of an ageing population and inequities in health outcomes between Māori—the Indigenous people of NZ—and non‐Māori, the need for aged care that reflects and upholds Māori aspirations is glaringly apparent. Currently, inequities in access to aged care exist [1, 2]. Māori with daily care needs are half likely as their non‐Māori counterparts to access community‐based aged care [1]. Non‐Māori enter aged residential care (ARC) at a rate of almost twice that of Māori [2]. The risk factors for entry also differ. For Māori, the risk factors include living alone and age, while for non‐Māori, the risk factors are dependence in more activities of daily living and poor self‐rated health [2]. Inequities in access to services are likely influenced by multiple factors, including inequities in referral [3]. These inequities impact wider family structures, with Māori family members being more likely to undertake carer roles than non‐Māori family members [2, 3].

As people age, they are more likely to require support to undertake everyday activities such as showering, preparing meals and maintaining their home environment. Support may be provided ‘informally’ by family members or community and friend networks, or formally through paid carers, including in ARC facilities. Formal aged care, which includes care provided in the community and ARC settings, has benefits across multiple domains of well‐being including physical function, mental health, quality of life and social connectedness, and reduces healthcare utilisation [4, 5]. However, formal care may not align with the expectations or aspirations of diverse cultures [6, 7], and assumptions made about people's right and abilities to make decisions about their care as they age mean they may have less autonomy and choice when engaging with this care [8].

Holistic approaches to aged care and a transdisciplinary approach are increasingly recognised as fundamental yet are often not implemented and do not respond to diverse cultures [9, 10]. Models of aged care need to consider not just health care but also multiple other determinants of health such as housing, employment and activities, leisure, the environment and social relationships [11, 12, 13, 14]. Currently, literature relevant to aged care spans disciplinary boundaries making known issues and potential opportunities for improvement difficult to identify and translate into action. The same can be said when identifying aspects relevant to diverse groups within wider society. Developing models of aged care that align with Māori aspirations has been identified as a national priority in a recent report by the NZ Aged Care Commissioner [15]; however, the research evidence regarding how to do this has not previously been collated and synthesised across the scope of aged care for Māori. Box1 includes a glossary of terms used in this paper (Box 1). In this study we aimed to:

• Identify key considerations useful for informing Māori aged care.

• Identify known gaps and proposed solutions which could be prioritised in health and social service design, delivery and implementation.

• Identify areas for investigation in future research

BOX 1. Glossary of English‐ and Māori‐language terms.

Aroha	Love
Kaumātua	Older Māori person/people
Kaiāwhina	Support staff
Kaimahi	Workers, staff
Kaupapa Māori	A Māori way
Mana	Prestige, authority
Manaakitanga	Hospitality, caring
Mātauranga Māori	Māori knowledge
Mate wareware	Dementia
Pakeke	Older Māori person/people
Papakāinga	Housing development on ancestral lands
Te ao Māori	Māori world/worldview
Tino rangatiratanga	Sovereignty
Wairua	Spirit
Wairuatanga	Spirituality
Whānau	Family
Whānaungatanga	Establishing and maintaining connections

2. Method

We undertook a scoping review using published literature, which included research team expertise and community engagement to inform content and contextualisation. This scoping review, with the addition of a critical approach, aligned with our intention to identify multiple sources of unlinked data where we would identify findings from single research studies and develop an understanding of relationships between data [16].

We did not publish or register the study protocol.

2.1. Search Strategy and Study Selection

We searched the following databases: Ovid Medline, New Zealand Collection (Informit); Australia and New Zealand database (ProQuest), and Gale OneFile Australia and New Zealand from January 2014 to January 2024. Search terms related to ‘older adults’ AND ‘New Zealand AND/OR Māori AND/OR rural’. No limits were placed on study or publication type. Studies were limited to the English language. Titles and abstracts were initially reviewed by one researcher to remove clearly irrelevant articles. The remaining titles and abstracts were reviewed by three of the team together to select articles for full‐text review. Full‐text review was completed by one researcher who then undertook a grey literature search of the first 100 items returned on Google, which led to the inclusion of further papers and reports to April 2024. We included reports identified from researcher knowledge of relevance to the review topic and hand‐searching reference lists.

We included all study designs and took an inclusive approach to study eligibility, as follows:

2.2. Participants and Setting

Study populations had to include Māori and had to have some focus on older people (as defined by individual studies; no set age limit was applied). Aged care could be community or home based or residential aged care settings in NZ.

2.3. Intervention

Studies did not have to be interventional. The topic of the study should relate to those who had care needs, or who had anticipated care needs, which could include, for example, universal design concepts whereby considerations of future care needs in older age were included.

2.4. Comparator

No comparator was needed.

2.5. Outcome

Any outcomes could be included.

We took an inclusive approach to the search strategy and initial study selection because we recognised there would be a likely paucity of information, and that various literature may contain information relevant to our area of investigation even if it was not the main focus of the literature.

2.6. Data Extraction

A study‐specific data extraction form was created in Excel to extract objective/s, study description, population, setting, methods, key findings, limitations and other relevant notes. Initial data extraction was undertaken by MD and TA, with JH completing further extraction as needed to contextualise findings.

2.7. Literature Analysis

Prior to undertaking the literature review, members of the research team were involved in community events where aged care experiences and expectations were discussed (Ethics approval for those discussions was granted by the NZ Health and Disability Ethics Committee and is currently being drafted to be reported elsewhere). There were three key domains of interest identified prior to undertaking the literature review. These domains were: components and values of care models; infrastructure for care; and physical spaces for care. Findings from literature were iteratively grouped under these domains into subdomains by JH and TA, and current areas of knowledge from the literature were highlighted.

JH presented the suggested subdomains to the community groups via zoom for further refinement and contextualisation. Subdomains were also presented at two community wānanga in the rural location involving a larger group (n = 16) of Māori and non‐Māori researchers, clinicians, carers and older people to ascertain relevance and appropriateness based on their personal and professional experiences of aged care. Feedback at the community wānanga on the domains and subdomains and suggested relevance and contextualisation were documented by wānanga facilitators and incorporated in a further iteration, which was then presented to the research team for finalisation.

3. Results

We identified 377 articles or theses and, after excluding for duplicates, screened 292 articles from which 36 articles and theses were selected for inclusion. A further nine records were included from grey literature searching and hand‐searching of reference lists, giving a total of 45 articles for inclusion in this review (Figure 1).

FIGURE 1.

Flow of data sources.

Included studies were diverse in nature. Some studies explored broad experiences across older age [15, 17] while others focussed on housing [18, 19, 20, 21, 22], quality of life and well‐being [23, 24, 25], specific clinical contexts such as frailty [26, 27], palliative care and end‐of‐life [28, 29, 30, 31, 32, 33], pain [34] and mate wareware (dementia) [35, 36, 37] and specific settings such as aged residential care [2, 33, 38, 39, 40, 41, 42, 43] (Table S1).

The literature was grouped into the three domains, which were identified prospectively through community and kaumātua engagement (Table 1). The three domains are defined under each of their headings below.

TABLE 1.

Domains and subdomains identified in the literature on care for older Māori.

Components and values of care models	Physical spaces of care	Infrastructures of care
Holistic well‐being Kaupapa Māori aged care Kaiāwhina Activities are important in kaumātua aged care Whakawhanaungatanga (establishing connections) with and amongst providers Whānau carers	Housing Connection to place	Information Financial resourcing Workforce

3.1. Components and Values of Care Models

This domain included the key parts that should make up how care is delivered and organised, including who should provide care, as well as the principles and beliefs that guide how care should be provided.

3.1.1. Holistic Well‐being

Holistic care recognises that care models need to address multiple dimensions of wellbeing, including physical, mental, spiritual and social wellbeing. Many studies described the importance of aged care services for Māori to take a holistic approach [15, 27, 28, 30, 34, 35, 44, 45, 46, 47, 48]. One paper specifically stated that, currently, holistic care seems to be extraordinary, whereas holistic care needed to become business as usual [28]. Some studies highlighted the importance of wairuatanga in kaumātua care [37, 44], noting the connection between wairua and well‐being for kaumātua [44]. As the health of whānau is an important component of holistic well‐being, some kaumātua may put the health and well‐being of whānau ahead of their own individual needs [45]. In the context of palliative care, it was noted that the care extends past the life of the kaumātua by continuing to support whānau [30]. The biomedical approach to health, which focussed on physical and mental deficit, was contrasted to a strength‐based approach to kaumātua care, noting a desire for self‐determination in health delivery [34] and that strength‐based care would lead to improved outcomes and the potential to support kaumātua mana motuhake [23, 24, 26, 34]. This concept of reframing ‘disease‐states’ is expressed beautifully in the consideration of dementia for Māori as a ‘natural expression of human existence’ in te ao Māori [35].

Specifically, the importance of good food for older Māori has been noted [40], as has the ability for kaumātua to access rongoā (Māori system of healing) within aged care contexts [44].

3.1.2. Kaupapa Māori Aged Care

The subdomain of kaupapa Māori aged care relates to Māori ways of providing care and includes Māori leadership and governance. Aged care services in Aotearoa need to include kaupapa Māori services and facilities [15, 39, 49] and have the potential to meet the needs and aspirations of non‐Māori as well [50]. Kaupapa Māori models of care need to include Māori governance [46] and, particularly in aged care, should include kaumātua throughout (including those accessing care), determining what services are provided, how and whether these are successful [15, 17, 39, 41, 46].

Māori cultural practices of care were recognised as integral in kaumātua care [32, 48]. It was acknowledged, however, that these care practices will differ between iwi, hapū and hapori [39], and also within whānau [30]. One study highlighted that some older Māori preferred to have access to Māori needs assessors when care planning was being undertaken [49]. The heterogeneity of Māori and diversity within communities was also noted, highlighting that models of care need to be flexible and responsive to account for these differences and provide kaumātua with options [23, 39]. Similarly, although the incorporation of te reo (Māori language) and tikanga (cultural practices) into care models is seen as fundamental [39, 50], thought needs to be given to those who, due to the impacts of colonisation and institutional racism, have grown up without strong connection to Māori culture and language to ensure that burden and whakamā (embarrassment) is not increased [18].

3.1.3. Kaiāwhina

This subdomain describes how kaiāwhina (community workers providing care and support) can provide advocacy, support and navigation skills for kaumātua accessing and receiving aged care services [15, 40, 46, 50]. Kaiāwhina can support the delivery of culturally safe care while also navigating gaps at transitions of care between primary, secondary and aged residential care and can include kaumātua themselves as kaiāwhina [40].

3.1.4. Activities Are Important in kaumātua Aged Care

The subdomain relating to activities discusses the role of occupational and recreational activities in Māori aged care. Providing activities for residents in ARC and older people in the community is known to be important to maintaining well‐being and preventing loneliness and social isolation, and for older Māori has been shown to have a positive benefit on holistic well‐being [23]. For older Māori, activities should align with Māori ways of being [35, 51], and incorporation of Māori ways of being should be viewed as best practice [36]. Cultural practices are protective [36] and can improve cultural connection which is associated with increased quality of life (QoL) [52]. Cultural activities can both improve the functioning of kaumātua within whānau and communities [36] and contribute to the cultural wellbeing of community and marae [45].

Activities need to be meaningful, support kaumātua identity [51] and research in the context of dementia notes activities should be aimed at enhancing mana [37]. Activities can be enriched by being undertaken as a shared experience [47]. Activities that allow continuation in occupational activities, such as gardening and household duties, help retain kaumātua identity [35]. These everyday types of activities have also been noted to be important in maintaining physical health specifically, as has participation in formal exercise [44].

Intergenerational knowledge sharing between Māori and younger generations has been noted in several studies as a very important activity for kaumātua [23, 44, 53, 54]. Activities in aged care need to support this knowledge transfer and may include knowledge transfer outside of whānau connections. There is a need for flexibility in how these are delivered as difficulties maintaining connections to whānau can occur when there are geographical distances to overcome, as well as the potential for busy lives to prevent frequent/desired contact [30]. Whānau connection can also be affected by elder neglect or abuse [30].

Activities should support the development and maintenance of meaningful relationships, which enhance quality of life [52] and the success of this should be evaluated on the desired amount of connection rather than external perceptions of the ‘right’ amount of connection [52]. These connections extend beyond human–human and human–environment but also with other living beings, and there are calls for ARC policies to allow for pets to be present in facilities [18].

3.1.5. Whakawhanaungatanga (Establishing Connections) With and Amongst Providers

This subdomain describes the importance of care and health providers developing meaningful relationships with kaumātua, whānau and between themselves. A scoping review by Pene et al. describes how meaningful connections can be developed between residents and care staff, highlighting the importance of communication in the development of relationships, and the need to appreciate different worldviews as well as the wider context that care is provided in, recognising the impact of health services and the health system on connections [55]. In addition to building relationships with those that are provided care, whānau relationships with staff also need to be nurtured [43]. For those in community settings, connection to and involvement in community groups foster connections to others [23].

Iwi, hapū and health providers need to be supportive and cohesive in their response to kaumātua well‐being [45]. The idea that there is alignment and agreement of care values and principles between ARC facilities and external service providers is also important [33].

3.1.6. Whānau in Caring Roles

The ways in which whānau provide support and caring to older family members are described in this subdomain. For many older Māori who require care, remaining at home with whānau is seen as the optimal caregiving environment [36, 39] and care is provided with aroha (compassion and empathy) and Manaaki (respectful, generous, kind and welcoming) [36]. For older Māori, living alone is associated with higher levels of admission to ARC, although this is not the case for older non‐Māori [2]. In palliative care contexts, it has been noted that whānau collective acts as a support to older Māori carers and that these carers often have high levels of knowledge of customary care practices [56]. Although whānau play an important role in care provision for kaumātua, there are a number of reasons this is not always possible including whānau not living close by, having other responsibilities or when care needs extend beyond whānau capacities and capabilities, and this deviation from the ‘cultural norm’ can be associated with guilt [36, 39]. Kaumātua perceptions of being a burden can reduce their QoL [52] and sometimes whānau relationships can be negatively affected by some challenging behaviours associated with dementia [36].

Wiles et al. described three key components of whānau care models for older Māori: knowing (access to information, sharing knowledge and special information about kaumātua), doing (activities of care) and negotiating (juggling multiple other commitments, managing conflicting types of care practices or values) [31]. These should be considered when developing new models of care, and perceptions of the benefit of models of care on the whānau carers should be examined while studies are occurring rather than retrospectively [31].

Complexities of balancing individual kaumātua rights, whānau wishes and consent processes were highlighted in regard to sexual intimacy. The right for kaumātua to be sexually intimate highlighted broader issues regarding consent [42]. Consent was complicated when people had dementia; the concept of upholding kaumātua wishes and mana, respecting whānau wishes and complexities when care staff were from different cultural backgrounds was voiced [42].

3.2. Physical Spaces

The domain of physical spaces refers to built environments where people live and where care is provided. It may include private or shared spaces, places of residence and care provision and the broader environment in which these places are situated. In addition to discussing these physical spaces, this domain also incorporates how people connect to these places. Cultural identity, connection to whenua (land) and good health are all interconnected.

3.2.1. Housing

The subdomain of housing explores the impact of housing on health, and the concepts of housing design that should be considered when thinking about aged care and changing needs. Poor housing negatively affects kaumātua health [44]. There are a number of studies, which look at kaumātua housing, and although they do not focus on aged care specifically, some do include the need for universal design, and there are general concepts, which are important when thinking about Māori aged care, including residential care. Having spaces in a housing environment for whānau to visit and stay, including within ARC, is also important [55].

Universal design principles in housing developments, whereby modifications can easily be made to existing homes, or there is flexibility to move to different housing options within immediate communities, are important for community level housing developments [18]. This can reduce the cost of care and also reduce the need for care (or extent of care) [18]. Mixed aged communities can also mean that younger generations may be available to take on caring roles, again reducing the need for external support [18]. Universal design is supported by co‐designing housing with kaumātua and also fosters feelings of belonging and connectedness [18, 21]. Belonging and connectedness can help foster a sense of home, which is important in rental housing too. One study in Auckland found that older Māori who rented often liked where they lived and wanted to stay there [19]. Further research is needed to understand how rental accommodation can support cultural identity and there is the potential that insights from current kaumātua housing initiatives may be useful. In addition to supporting kaumātua, kaumātua housing has been noted to support community and marae revitalisation [18]. Research regarding kaumātua needs within papakāinga notes that these offer an ability to act as kaitiaki, which provides an avenue to undertake meaningful activities, which was discussed earlier [22]. The accessibility to suitable housing for kaumātua in papakāinga is also important, as is the security of community within these developments [22].

3.2.2. Connection to Place

Connection to place is important for kaumātua, as is the connection of physical spaces for care with the wider community, supporting access to resources, which provide security and nourishment [57]. Connection to place can also support the maintenance of a secure identity allowing kaumātua connection back into the wider community, further supporting autonomy during the time of kaumātuatanga [57].

The concept of ‘ageing in place’ is a key tenet of Aotearoa's Healthy Ageing strategy; however, ageing in place or at home for Māori does not necessarily mean staying in their current house [17, 39]. For many kaumātua, ageing at home may mean ageing in the lands to which they whakapapa and have connection to the whenua [44], although this does not mean other places and housing are not also important [19]. Kaumātua may have left their ancestral whenua due to colonisation and urbanisation but may return for retirement or in the later stages of life [44]. Being able to form a connection to place is associated with wellness [58] and, in dementia, connection to place has been shown to be ‘nourishing’ for wairua [37]. In contrast, disconnection from the whenua, sacred places and whānau may increase feelings of social isolation and loneliness [29].

Urban papakāinga need a connection back to the wider community [22]. Also when housing sits outside marae, connections back to the marae can support contribution to meaningful activities and also contribution to the wider community [51]. Physical connection to outdoors, nature, neighbourhood and communities is important for kaumātua, although the extent and type of activities, which best promotes this requires further investigation [58].

3.3. Infrastructure of Care

The underlying systems and resources, which support, enable and enhance aged care are discussed in the infrastructure of care domain and include technology, workforces, transport infrastructure and information systems.

3.3.1. Information

The information subdomain relates to knowledge and data and how this is communicated. Te Tiriti o Waitangi guarantees Māori the right to be informed in relation to health, as well as having access to care [59] options. Kaumātua need access to good information to make informed decisions about their care options [2, 39]. The potential benefit of kaiāwhina has been discussed earlier, and their role in the ability to provide accessible information to make informed decisions has also been noted [41].

Research from Rauawaawa Kaumātua Charitable Trust focussing on palliative care discussed the need for resources to support kaumātua and whānau health literacy [32]. The same organisation has also contributed to a comprehensive research‐informed ‘Housing Toolkit’ resource, which supports housing development between multiple entities and provides a resource for meaningful and authentic co‐design in the process [20].

3.3.2. Financial Resourcing

The financial resourcing subdomain relates to the funding and financial supports that enable services and care to be provided effectively and sustainably. Complex and inflexible funding arrangements currently exist in the ARC sector and this has implications, especially for Māori and tangata whaikaha (people with disabilities) [15, 39]. There is limited financial resourcing for kaupapa Māori providers [60] and a lack of adequate resourcing is a major barrier to better kaumātua‐specific care [17]. Additionally, rigid age restrictions that limit access to care until a certain age is reached are raising barriers and causing inequity in access to care, variable needs, lived experiences, life expectancies and rates of ageing and morbidity across different population groups.

3.3.3. Workforce

The workforce subdomain presents information about those who provide formal, paid care to older Māori and considers skill level, diversifying the workforce and the role of Māori and non‐Māori providers. The aged care workforce needs to provide culturally safe care for kaumātua. There has been a call to increase the Māori health workforce, particularly rural GP workforces [15]. Māori providers of aged care are likely to lead to increased trusting relationships and cultural responsiveness of care as well as culturally innovative and culturally supportive aged residential care environments [41]. Māori staff who provide expertise in culturally safe care should be appropriately remunerated [39]. As noted earlier in regard to consent, care staff from culturally different backgrounds may have different values systems, which translate into how care is provided [42] and the need to train workforces who can deliver culturally safe care is recognised at a national level [15].

Non‐Māori workforces should also be provided with appropriate training to improve abilities to deliver culturally safe ARC. This needs to occur in both formal education pathways and practical placements, with incongruences between the two previously noted [38]. The Health Quality and Safety Commission have recently redeveloped the Frailty Care Guides, designed to support ARC staff to deliver high‐quality care, to support culturally safe care [27]. Aged care facilities should invest in opportunities to improve cultural safety of ARC health professionals [39, 41].

An organisational‐level approach is needed to improve ARC for Māori [15, 39, 41], and organisational culture has been identified as either an enabler of, or barrier to, high quality ARC for kaumātua [41]. Transformational leadership is required to support organisational change and is also likely to increase the Māori workforce [41]. Keelan et al. provide in‐depth thought on organisational culture in relation to Māori ARC [41]. The need to invest in Māori leadership to drive this change is recognised at a national policy level [15].

For the following infrastructure subdomains, there are limited pockets of literature in relation to older Māori, and therefore, the brief snippets of findings are included without defining the subdomains and are identified as areas requiring further research in relation to Māori aged care.

3.4. Topics Requiring Further Research

3.4.1. Technology

Technology refers to digital tools, devices and systems. The role of technology in kaumātua care highlighted the fact that many kaumātua engage with smart devices and these can be used for health monitoring [44] and the fact that younger generations have existing roles supporting kaumātua to become ‘tech savvy’ [23].

3.4.2. Transport

Kaumātua in rural areas are at increased risk of isolation through reduced transport options [29].

3.4.3. Discourse Related to Ageing and kaumātua Care

Māori ageing and the potential for aged residential care to play a role in kaumātua life needs to be discussed throughout the life course [17, 39].

3.4.4. Cross‐Sectoral Engagement

Cross‐sectoral engagement is necessary for high‐quality kaumātua care [17, 39].

3.4.5. Appropriate Mechanisms to Evaluate Success

Monitoring for equity of access to aged care and quality of outcomes is essential for equity focussed actions and interventions in ARC [39, 41]. Evaluation of care needs to focus on kaumātua experiences rather than the perceptions of others [25].

3.4.6. Structural Racism

The health system in Aotearoa exists within a colonial system and structural racism also impacts kaumātua care and equity. Approaches are needed to increase Māori access and outcomes in aged care [39, 41]. Implementation science can and should be informed by Māori values. There is the potential that the recently published implementation framework, founded on Te Tiriti o Waitangi, could have value in developing new pro‐equity models of kaumātua care [61].

4. Discussion

This critical review has brought together literature describing key components and values in models of care, physical spaces of care and care infrastructure useful for older Māori, which can be used to inform Māori aged care. Key findings are that Māori aged care needs to include holistic models incorporating Māori cultural practices, values and workforces. Care needs to be connected to place and communities and that cross‐sectional infrastructure, including housing, transport, digital access and health services, facilitates quality care.

The need for values‐led, holistic models to support Māori flourishing has been well‐described in the literature previously [53, 62, 63]. Holistic approaches include whānau in care, support and social interaction, which were also highlighted in this review. Inclusion and involvement of whānau need to be considered within physical spaces and infrastructure, such as appropriate resourcing. Additionally, the ability for Māori to access culturally safe care is a right in accordance with the Treaty of Waitangi (NZ's founding document) [59]. This review supports the fundamental incorporation of te reo and tikanga into care for older Māori in the context of diverse Māori realities. Acknowledging diverse realities of Māori [64] means that the particular cultural practices and understandings will vary between people. Therefore, holistic models need to incorporate flexibility in the delivery to meet the diverse expectations and aspirations of older Māori.

Indigenous models and values can be beneficial to Indigenous and non‐Indigenous populations, guiding practices and the way care is delivered [28]. This finding positions Indigenous knowledge systems as important to national and international health and encourages broader applications of relational and value‐based care. Durie describes the valuing of Indigenous and non‐Indigenous ways as working at the ‘interface’, being complimentary and synergistic rather than competitive [65]. There is the ability for care to be provided in ways that are clinically and culturally safe, leading to better health and social outcomes [66, 67], which can be applied when developing Māori aged care models.

Literature showed that for older Māori, physical spaces in which care was accessed, received and provided were important. Physical design of housing needs to consider the potential for changing need over time, including the concept of universal design where environments and products are useable independent of age and abilities [68]. In addition to individual and family benefits, there are economic and sustainability benefits to universal design [68] and this should be considered by developers, refurbishers and policymakers. This is relevant in aged residential care settings as well as home settings, enabling people to stay longer within their communities, another factor identified in this review as important to physical spaces of care.

This review additionally highlights the need for holistic approaches across multiple domains of society. The benefit and value of kaiāwhina have been shown in other settings [62, 69] and have been identified as important within aged care models for older Māori. Their abilities to navigate and connect across multiple systems and sectors would help support a cross‐sector approach. However, an appropriate and engaged workforce alone is not adequate in advancing care models. As described in the Aged Care Commissioner's report [15] appropriate resourcing, cultural and technology infrastructures are needed to support aged care models to respond. These infrastructures would support transitions of care, innovative models, maintenance of independence and equitable access to home and community services to support ageing in place [15].

4.1. Strengths and Limitations

We took a broad approach to inclusion criteria and data collection, drawing on transdisciplinary literature, which reflects the realities of intersecting systems that support flourishing in older age. The addition of the grey literature added valuable nuance to the review. We may not have captured all sources as some literature, which contained important and relevant information may not have had highlighted search terms in titles, keywords or key findings. We did not prospectively publish the review protocol. Literature was grouped under domains that were identified prospectively; although these were broad, some literature relevant to Māori and aged care, which fell outside these domains may not be appropriately represented within this review. The sparsity of literature relating to infrastructure limited data synthesis in this section and the broad approach to literature inclusion means that there is not always a flow of concepts through the results section.

4.2. Future Research

This scoping review provides a resource to support researchers and service developers to design aged care in the community and residential care settings. It is clear that aged care models need to respond holistically in a way that recognises Māori cultural values while supporting and maintaining kaumātua autonomy and independence as appropriate to the aspirations of them and their whānau. Further research is needed in regard to how physical spaces and infrastructure can be used as tools to deliver these aspirations.

5. Conclusions

Holistic care models that incorporate Māori values, practices and workforces are integral to Māori aspirations for aged care models. Care models need to consider the sense of and connection to place, with a supportive cross‐sectional infrastructure. By identifying relevant knowledge relating to models, physical spaces and infrastructures of care, this review provides an evidence base for future health and social service development and identifies gaps in knowledge, which require further research.

Funding

This research was funded by the University of Auckland through a Research Development Fund (3728991) and Centre for Co‐Created Ageing Research Seed Fund, and through a Health Research Council Māori Postdoctoral Fellowship (23/053).

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1: ajag70147‐sup‐0001‐supinfo.zip.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.