Aged care for First Nations people is an Australia's welfare topic

The population of Aboriginal and Torres Strait Islander (First Nations) people has a much younger age structure than the non-Indigenous population (see Profile of First Nations people). However, like the general population, the First Nations population is ageing.

Access to aged care services in Australia is determined by need, rather than age. The target population for government-funded aged care services is the First Nations population aged 50 and over and the non-Indigenous population aged 65 and over (Department of Health and Aged Care 2024a). A broader age group is used for First Nations people because of their greater need for care at a younger age compared with non-Indigenous Australians.

This page focuses on First Nations people aged 50 and over and their use of aged care services. For more information regarding use of aged care services, particularly among the general population, see Aged care and the GEN aged care data website.

First Nations people aged 50 and over

Projections from the Australian Bureau of Statistics (ABS) based on the 2021 Census of Population and Housing (medium series) estimate over 197,000 First Nations people aged 50 and over on 30 June 2025 (AIHW analysis of ABS 2023, 2024a). This includes about:

  • 130,900 aged 50–64
  • 63,500 aged 65–84
  • 3,000 aged 85 and over.

First Nations people aged 50 and over are estimated to comprise:

  • 19% of the First Nations population (of all ages)
  • 2.0% of the total Australian population aged 50 and over.

For more information, see Profile of First Nations people.

Use of aged care services by First Nations people

Data on the use of aged care by First Nations people are sourced from the AIHW National Aged Care Data Clearinghouse, made available on the GEN aged care data website. The main types of government-subsidised aged care are home support, home care, and residential aged care. In some cases, these aged care services are provided as part of a separate program, such as one of the flexible aged care programs. For the purposes of this page, the quoted numbers of home support, home care and residential care recipients do not include recipients who received these services as part of a flexible aged care program. These numbers include respite care users, who receive care through home support or residential care, depending on the need of the user.

Among First Nations people aged 50 and over:

  • 23,700 (12%) received home support during 2023–24. This is entry-level support provided through the Commonwealth Home Support Programme, aimed at helping people manage independently at home for as long as possible
  • 8,800 (4.6%) were receiving home care at 30 June 2024. This is a coordinated package of care and services, from basic through to high-level support, based on need, provided through the Home Care Packages Program
  • 2,300 (1.2%) were receiving residential aged care at 30 June 2024. This means staying in a residential aged care facility, on a permanent or temporary basis.

First Nations people using residential aged care tended to be older than those using home care or home support (Figure 1). For example, over half (57%) of the First Nations people in residential aged care were aged 75 and over. The same age group made up around one-third (36%) of all First Nations home care recipients, and 27% of First Nations home support recipients.

Flexible care services constitute, for the purposes of this page, a separate set of aged care services, in which care is provided for special groups or in circumstances where the other aged care services are not appropriate. For example, the National Aboriginal and Torres Strait Islander Flexible Aged Care Program provides culturally appropriate flexible care for First Nations people in locations close to their communities. In 2023–24 this program operated almost 1,700 places across home care and residential aged care (Department of Health and Aged Care 2024a). 

The Multi-Purpose Services Program also funds flexible care services in many rural and remote areas. Among those who received Multi-Purpose Services care in 2023–24, 231 identified as being of Aboriginal and/or Torres strait Islander origin (Department of Health and Aged Care 2025d). 

Figure 1: Use of aged care by First Nations people for selected programs, by age group and program

Column chart showing the number, proportion and rate of First Nations people using home support, home care and residential aged care, increasing with age.

Column chart showing the number, proportion and rate of First Nations people using home support, home care and residential aged care, increasing with age.

Variation by remoteness

Among First Nations people aged 50 and over who used home support in 2023–24 or who received home care or residential aged care on 30 June 2024, most lived in non-remote areas (Figure 2). This is consistent with a higher number of First Nations people living in non-remote areas (Major cities, Inner regional or Outer regional areas of the Australian Statistical Geography Standard (ASGS) Remoteness Structure) than in remote areas (Remote or Very remote areas of the ASGS Remoteness Structure). 

Considering the rate of aged care service use per population, among First Nations people aged 50 and over:

  • Those living in non-remote areas (around 19,600 recipients, 122 recipients per 1,000 population) were about as likely to receive home support services as those living in remote areas (around 4,000 recipients, 128 recipients per 1,000 population) in 2023–24.
  • Those living in non-remote areas (around 7,700 recipients, 48 recipients per 1,000 population) were 1.5 times as likely to receive home care services as those living in remote areas (around 990 recipients, 32 recipients per 1,000 population) on 30 June 2024.
  • Those living in non-remote areas (around 2,000 recipients, 13 recipients per 1,000 population) were 1.3 times as likely to receive residential aged care services as those living in remote areas (around 300 recipients, 9.4 recipients per 1,000 population) on 30 June 2024. 

Figure 2: Variation in use of selected aged care programs by First Nations people aged 50 and over, by remoteness area and program

Columns chart showing the number, proportion and rate of First Nations people using home support, home care and residential aged care by remoteness. Aged care is mostly used more in non-remote areas. 

Columns chart showing the number, proportion and rate of First Nations people using home support, home care and residential aged care by remoteness. Aged care is mostly used more in non-remote areas. 

Changes over time

Home support is delivered through the Commonwealth Home Support Programme. Overall, the number of First Nations home support recipients has increased over the past 5 years – from 21,800 to 23,700 recipients between 2019–20 and 2023–24. However, due to a relatively greater increase in the population size of First Nations people aged 50 and over, the rate of home support service use per population has actually decreased – from 131 to 123 recipients per 1,000 population between 2019–20 and 2023–24 (Table 1).

Table 1: Number and rate of persons aged 50 and over, using home support, by Indigenous status, 2019–20 to 2023–24
Time periodFirst Nations peopleNon-Indigenous AustraliansRate of First Nations people (per 1,000)Rate of non-Indigenous Australians (per 1,000)
2019–2021,791
774,375
131.1
191.1
2020–2122,210
763,755
128.0
183.0
2021–2222,095
761,259
122.5
177.6
2022–2322,292
755,289
119.5
171.4
2023–2423,732
769,385
123.5
169.4

Notes

  1. Rates of First Nations people are calculated using ABS 2021 Census-based population projections (medium series) (ABS 2024a). Non-Indigenous rates are calculated using ABS population calculations for Australia’s population (ABS 2024b), subtracted by First Nations population projections for the same time. 
  2. Indigenous status refers to whether a person has identified as being of Aboriginal and/or Torres Strait Islander origin. Data exclude persons for whom Indigenous status and/or age was not stated or inadequately described. Indigenous status was missing for 4.9% in 2019–20, 4.5% in 2020–21, 4.0% in 2021–22, 4.5% in 2022–23, and 4.8% in 2023–24. 
  3. Dates that home support providers input can reflect dates of data submission rather than dates of service use.

Sources: AIHW National Aged Care Data Clearinghouse; AIHW analysis of ABS (2024a, 2024b).

Between 30 June 2020 and 30 June 2024, the rate of home care use for First Nations people aged 50 and over increased from 21 to 46 per 1,000, with numbers increasing from 3,400 to 8,800 (Figure 3). The number and rate of home care recipients have increased across all age groups, with particular increases seen between 30 June 2021 and 30 June 2023. The collection of Indigenous status (referring to whether a person has identified as being of Aboriginal and/or Torres Strait Islander origin) for home care recipients also improved between 30 June 2020 and 30 June 2024, particularly over the last 2 years. On 30 June 2024 Indigenous status was not stated or inadequately described for only about 1 in 15 (19,000, or 6.9%) home care recipients – down from 1 in 6 (36,500, or 17%) 2 years prior, and 1 in 3 (51,900, or 36%) on 30 June 2020.

Between 30 June 2020 and 30 June 2024, the number of First Nations people aged 50 and over in residential aged care rose from 1,900 to 2,300 (Figure 3). It is worth noting that the number of First Nations people using residential aged care services has only risen for those aged 65 and over, and the rate only for those aged 75 and over. For First Nations people aged 50–64, the number and rate of residential aged care use have generally declined over the same period. Over the past 2 years the percentage of recipients whose Indigenous status was not stated or inadequately described also increased, rising to 8.5% on 30 June 2023 and 10% on 30 June 2024, up from 0.1% in the years prior. 

Figure 3: Residential aged care and home care use by First Nations people aged 50 and over, by age group and age care type, 30 June 2020 to 30 June 2024

Line chart showing number and rate of home care and residential care use among First Nations people over time. While home care use has increased, the trend for residential care is more complex.

Line chart showing number and rate of home care and residential care use among First Nations people over time. While home care use has increased, the trend for residential care is more complex.

Following an announcement that the Government would provide funding to expand the National Aboriginal and Torres Strait Islander Flexible Aged Care between 2018–19 and 2021–22 (Department of Health 2018), the program has significantly increased in size. The commitment to continue expanding this program, which provides First Nations people with access to culturally appropriate home care and residential aged care services, has extended beyond the initial period (Department of Health 2020b; Department of Health and Aged Care 2022b), and the program has grown by more than 30% (an increase of 395 places), from 1,264 to 1,659 places, between 30 June 2020 and 30 June 2024 (Table 2). 

Table 2: Number of places funded for National Aboriginal and Torres Strait Islander Flexible Aged Care Program, 30 June 2020 to 30 June 2024

Date

Residential care places

Home care places

Total number of places

30 June 2020

494

770

1,264

30 June 2021

480

824

1,304

30 June 2022

475

835

1,310

30 June 20234898951,384
30 June 20244721,1871,659

Sources: Department of Health 2020a, 2021a; Department of Health and Aged Care 2022a, 2023a, 2024a.

Comparisons with non-Indigenous Australians

Except for use of residential aged care among people aged 75 and over, rates of aged care use were higher for First Nations people than for non-Indigenous Australians across all age groups and care types (Figure 4). 

Among people aged 65–74, compared with the rate among non-Indigenous Australians, First Nations people were:

  • 2.6 times as likely to use home support in 2023–24 (8,300 First Nations recipients, receiving care at a rate of 186 per 1,000 population, and 175,000 non-Indigenous recipients, receiving care at a rate of 70 per 1,000 population)
  • 5.0 times as likely to use home care, as at 30 June 2024 (3,300 First Nations recipients, receiving care at a rate of 74 per 1,000 population, and 37,100 non-Indigenous recipients, receiving care at a rate of 15 per 1,000 population)
  • 2.6 times as likely to use residential aged care, as at 30 June 2024 (740 First Nations recipients, receiving care at a rate of 17 per 1,000 population, and 16,100 non-Indigenous recipients, receiving care at a rate of 6.5 per 1,000 population).

Figure 4: Rate of aged care use (per 1,000 population) among persons aged 65 and over in selected programs, by age group and Indigenous status

Column chart showing the rate of First Nations and non-Indigenous aged care services. First Nations people generally use aged care services at a higher rate than non-Indigenous people.

Column chart showing the rate of First Nations and non-Indigenous aged care services. First Nations people generally use aged care services at a higher rate than non-Indigenous people.

Aged care specially designed for First Nations people

In Australia, the aged care system offers options to meet the care needs of individuals. To help ensure aged care services are appropriate to the diverse needs of all people, the Aged Care Act 1997 specifies 10 groups of people for whom additional consideration in the planning and delivery of appropriate aged care services is needed. First Nations people are one such group (Aged Care Act 1997: s11–3). 

In the context of First Nations people, challenges for the aged care system include ensuring access to culturally appropriate care, especially for those living in remote and very remote areas (ANAO 2017). In 2019, the Australian Government published Actions to support older Aboriginal and Torres Strait Islander people, developed under the Aged Care Diversity Framework. These outline actions to support more inclusive and culturally appropriate care for First Nations people (Department of Health 2019). 

The Royal Commission into Aged Care Quality and Safety (Royal Commission) also identified areas of importance in providing aged care to First Nations people.

The Royal Commission into Aged Care Quality and Safety

In its Final Report, the Royal Commission into Aged Care Quality and Safety identified that Aboriginal and Torres Strait Islander people have specific needs when accessing aged care. The report makes several recommendations, covering topics such as:

  • the importance of culturally appropriate and safe care – including growing the First Nations aged care workforce through targeted programs and providing interpreter services for First Nations languages
  • the requirement for trauma-informed approaches to providing care, particularly with members of the Stolen Generations
  • the need to increase facilitation of provision of care on Country (or with options to return to Country where this is not possible)
  • the potential to integrate aged care with existing First Nations organisations such as healthcare providers, disability services and social service providers (RCACQS 2021).

In response to the Royal Commission, the Australian Government promised $572.5 million to ensure First Nations people can receive quality, culturally safe aged care, can access advice to make informed decisions about their care, and will be treated with dignity and respect (Department of Health 2021b).

The Elder Care Support program was established in 2023 and is available through Aboriginal Community Controlled Organisations and affiliates of the National Aboriginal Community Controlled Health Organisation (NACCHO) (Department of Health and Aged Care 2024a, 2024b, NACCHO 2024). This program is funding a workforce of 250 full-time equivalent staff positions across Australia to support First Nations people and their families in understanding, navigating, accessing, and choosing aged care services and providers suitable for them. 

The Department of Health, Disability and Ageing released the Aged Care Data and Digital Strategy 2024–2029 in July 2024. Under its action plan, the AIHW is responsible for the Aged Care National Minimum Data Set (NMDS) and the National Aged Care Data Asset (NACDA). These initiatives will improve the available data on aged care – including with respect to First Nations recipients (for more information, see the data improvements on the GEN aged care data website).

A new Aged Care Act

Following several years of development, the Aged Care Bill 2024 was introduced in Parliament 12 September 2024, and passed Parliament as the Aged Care Act 2024 25 November 2024 (Department of Health and Aged Care 2025b). The development of the Act was performed by the Department of Health, Disability and Ageing in consultation with a range of stakeholders (Department of Health 2021c; Department of Health and Aged Care 2025c). The Aged Care Act 2024 will come into effect 1 July 2025, and replace the following Acts: 

  • Aged Care Act 1997
  • Aged Care (Transitional Provisions) Act 1997
  • Aged Care Quality and Safety Commission Act 2018.

The Aged Care Act 2024 implements a number of the recommendations of the Royal Commission, and intends to ensure accountability, respect, and quality of life. Within it, the Statement of Rights outlines what aged care service recipients can expect when seeking government-funded aged care services (Aged Care Act 2024: s23). The Aged Care Act 2024 also includes programs previously excluded from the Aged Care Act, such as the Commonwealth Home Support Programme and the National Aboriginal and Torres Strait Islander Flexible Aged Care program (Department of Health and Aged Care 2025a). 

An addition to the Aged Care Act 2024 is the role of First Nations Aged Care Commissioner, based on one of the recommendations of the Royal Commission. The Commissioner will work for the interests of First Nations people accessing aged care services, helping provide culturally safe aged care services to First Nations people. As of January 2024, an Interim First Nations Aged Care Commissioner has been appointed (Department of Health and Aged Care 2023b, 2025e).

Key data gaps and data improvement activities 

The collection of Indigenous status has varied across years and service types for aged care services in Australia. In many cases, the number of aged care recipients whose Indigenous status was not stated or inadequately described is greater than the recipients established to be of Aboriginal and/or Torres Strait Islander origin. 

Residential care used to have the lowest level of recipients whose Indigenous status was not stated or inadequately described, below 0.2% of the total number of residential care recipients for a number of years. However, over the past 2 years, the number of recipients whose Indigenous status is not stated or inadequately described increased to 8.5% on 30 June 2023 and 10% on 30 June 2024. Government efforts have, however, improved the collection of Indigenous status for home care recipients, where the percentage of recipients whose Indigenous status was not stated or inadequately described has gone down to 3.8% on 30 June 2023 and 6.9% on 30 June 2024, following 4 years where the percentage of home care recipients whose Indigenous status was inadequately described ranged between 17% to 36%.

Where do I go for more information?

For more information on First Nations people aged 50 and over and aged care use among the First Nations population, see:

For more information on this topic, see Aged care and First Nations people.