Referral for publicly funded aged care services in Indigenous populations: An exploratory cohort study of ethnic variation in Aotearoa New Zealand

Objectives As people age, they are more likely to require support to maintain activities of daily living. Referral for formal assessment of need (assessed using the 'international Resident Assessment Instrument' [interRAI]) is the first step to access publicly funded services in Aotearoa New Zealand (NZ). It is unclear whether ethnic access inequities present in other areas of the NZ health system occur in this referral process. This exploratory research aimed to explore ethnic variation in referrals for interRAI assessment, and associated factors. Methods A retrospective cohort study of all new referrals for aged care services for those 55-plus, received in 2018 by Waitemata District Health Board (WDHB), was conducted. The primary outcome was referral outcome (assessment and no assessment). Secondary outcomes included time from referral to assessment, reason for referral, mortality and, in the assessed cohort, assessment outcome. Results New referrals (n = 3263) were ethnically representative of the general older adult population in WDHB. Maori were younger and more likely to be referred for higher-level care needs than non-Maori, non-Pasifika (NMNP) (p = 0.03). There was no significant difference in referral outcome, time to assessment or mortality between ethnicities. NMNP were more likely to access lower-level care services than Maori or Pasifika older adults (p = 0.002). Conclusions Ethnicity was not associated with aged care service assessment access once people were referred for publicly funded services, nor was it associated with time to assessment or mortality in this exploratory study. Maori had higher care needs than NMNP at the time of referral.