Whānau systems of care

Each whānau has their own tikanga and ways of doing things

Kaumātua and whānau do not see themselves ‘as an illness’ and neither should health professionals. They see themselves in the fullness of their lived lives, histories, and futures. If you work in the health field you will know that every whānau wants the best for their kaumātua who is ill or dying.

The way whānau express this and the way they want you to support them will reflect both personal and family preferences – these will often be influenced by many things including their cultural identity and specific tikanga (customs) preferences.

Kuia K. spoke about the relationship between tikanga and values and ‘tikanga’ and ‘kawa’ within the context of whānau:

When we talk about tikanga, this question mark in our minds [is], ‘What is tikanga? Whose tikanga are we referring to?’ But when we talk about [tikanga], when we put values to it, everyone understands what values are. So, to me values and tikanga goes together because tikanga is about having it right and values are what is right in our lives.

[W]hen we look at the word ‘tikanga’, it’s about rules, it’s about getting things right. Tikanga. Do it right eh? Doing it right for who? Eh? It’s not doing it right for them, it’s doing it right for you. Doing it right for your whānau. So, I’ll give you another example, here in [region of iwi], I hear, ‘What’s [name of iwi’s] kawa?’ Nobody knows what [iwi’s] kawa is, but you ask this whānau, ‘What’s your kawa on such and such a thing?’ Well they can tell you what that is. You can tell that family what that is. So, what I found, kawa and tikanga is pertaining to the family. If it doesn’t work in, then that’s our [health and social care providers’] problem…

Care roles within whānau

Some whānau are large and collectively have a vast range of cultural skills and knowledge to offer. Caring for a loved one may be organised within a broad system of whānau care where whānau members have different roles. Grandchildren (mokopuna) have a special role to play with their kaumātua. Kaumātua often refer to their mokopuna uplifting their spirits, amusing them, or providing practical help, as they get older. When these tasks and roles are shared across the whānau, it can lighten the responsibility of caregiving.

Rochelle and Christine [both rongoā practitioners] spoke about mokopuna having a role in caring for a māuiui whānau member:

Rochelle: Yeah and [kaumātua need] someone that is very- has a clear line, a relationship with them, that can handle being told off [and then] being loved, looking after them, all their bodily functions with no problems. Because it’s not good for the whānau if there’s issues with that person and they can’t handle accidents and, they’re still trying to deal like [with] their own grieving. Because it’s about that whānau member being able to express themselves. That’s why I think often mokopuna are really good in that stage. Because mokopuna often have a straight line of contact with their grandparents in terms of wairua [connection].

Christine: The parent, actually likes the grandmokos better [laughs].

Roles

Whānau may have a designated person or people to take care of medical appointments or carry out personal cares. Another person may tend to financial matters and someone else may do clothes shopping, for example. These roles will often fall to those who naturally possess those qualities, or they may be people who have been chosen by the kaumātua or the family to do so. The whānau know who these people are. Health professionals have an important role to play in supporting whānau who are not in a position to provide this level of wrap-around care. When health and social care services’ employment contracts are flexible this can help staff meet the needs of kaumātua and whānau in culturally appropriate and timely ways.

When Mary Te Awhi (hospice kaitakawaenga) was offered a new role by hospice, they explained they wanted to meet the needs of Māori whānau. She said she needed flexibility in her role to support her community appropriately:

I said ‘what’s flexi? What does that mean?’ And she [manager] said ‘look, I understand somewhere that your role can’t be a 9 to 5. And it’s a part-time role but we can build on that for you if you feel you need it, because I understand that somewhere you might have to step outside the normal, which is what happens.’ Now it’s not a big hugie, but I sometimes do say to whānau ‘look, don’t disrupt your day to meet me. It’s about you, it’s not about me. If you want me to come and visit you at home at 5o’clock in the evening. I will come.’ So, I’ve got the flexibility to be able to make it work.

Becoming an extended member of the care family

Each whānau is different and so there will be variations among families; so, having learned about a particular whānau’s protocols does not mean you automatically know what is right for another whānau. In addition, some whānau may be feeling uncertain or disconnected from their tikanga, which in itself can cause stress and conflict. Health and social care professionals can help by becoming part of the whānau manaaki care system.

Matilda (community health care assistant) explained that because local whānau know who she is she becomes part of the whānau manaaki care system:

[T]hey know who I am. I’m family. And, and it’s just yeah. ‘Matilda’s here.’ ‘Matilda’s coming. Yeah, I just rung her, she’s coming’. Yeah, sort of thing. Just to be there… ‘It’ll be alright.’

Matilda provides whānau with reassurance by letting them know that she will always be there for them:

Well it’s [important] that family know that it’s not a struggle. It’s not a struggle to be at - with your loved ones at the end of their time. And, I’ll always be there. I’ll always, I’ll always make myself available...

Matilda explained that when she visits whānau it is important for her to work with all whānau members:

I’d say ‘teamwork’, for want of a better word, is to work with the children. The children, if we work together so that, that it’s going to be peaceful, [a] peaceful cross over...”

Using 'teamwork' helps to build confidence and trust within the whānau commented Matilda:

… [We] engage in the family. We’re just all working, working for the comfort and for the client. I don’t know what it is, sort of you get their confidence if you’re trusting... Engage the family and then we teamwork with the client and yeah. ‘It’s going to be okay...’

Assessing kaumātua and whānau needs

Developing a comprehensive overview of the needs of a kaumātua and their whānau will require an inter-disciplinary team approach as this will likely get the best results (matching expertise with health area) and will help with formulating and carrying out care plans. A comprehensive assessment will be helpful when changes happen, and new things need to be adjusted or put into place.

Recommendations

For health and palliative care professionals, we recommend:

Conduct cultural and social assessments to understand the physical, social, cultural, spiritual and psychosocial well-being and worldviews of kaumātua and their whānau.

For health and palliative care services, we recommend:

Implement staff palliative care cultural safety training to ensure the cultural and spiritual needs of kaumātua and whānau are supported when using health services.

Māori diversity