For Elders and older Aboriginal and Torres Strait Islander people, dying on Country isn’t a choice. Andrea Kelly explains why it’s important that aged care delivers on its promise of being culturally safe, particularly when it comes to palliative care.

"Andrea, we want to die on Country." An Elder in remote Western Australia said it plainly. And he wasn't the only one. Throughout her travels as Interim First Nations Aged Care Commissioner, Warumungu and Larrakia woman Andrea Kelly heard it again and again: “We need to return to Country.”

“I'm not leaving Country, because I know I won't come back.”

For many people, being close to family is essential to living and ageing well. For Aboriginal and Torres Strait Islander peoples, that connection runs even deeper. “Our wellbeing is grounded in our relationships with family, Country, community and culture,” Andrea says.

"Being on Country is not only about place, it’s about identity, belonging, and spiritual connection. And for many of our people, dying on Country is a cultural necessity. It ensures a good death: a peaceful return to the Dreaming, where our spirit is reunited with Ancestors and the land that has always held us.”

"Beyond discussions about health and ageing well, the people I met shared the profound importance of dying well," she says. "For many, this comes with a strong desire, even a cultural obligation, to be on Country when their time comes.”

What Country means

Country is more than land. Cultural practices, lore, social systems, traditions, and spirituality come from and are embedded in Country. "These all contribute to what is referred to as the cultural determinants of health,” Andrea says.

Research shows there is a direct relationship between connection to Country and culture and overall health and wellbeing for Aboriginal and Torres Strait Islander people. Connection to Country is one of the most powerful cultural determinants of health, fundamental to living a good and healthy life, explains Andrea.

Andrea met a woman with end-stage kidney disease and cancer living in residential care. When she decided to stop treatment, she had one wish: to return to her birthplace. She was able to die on Country.

"Having that wish respected was incredibly significant," Andrea says. "The dignity that came with having her cultural and spiritual needs accommodated brought peace to her and her family and meant she was able to pass peacefully.”

When Elders and older people can't return to Country, it doesn't just affect them. Communities feel it too. Elders hold cultural knowledge, teach younger generations, fulfil spiritual obligations. Many people told Andrea that when loved ones die far from Country, their spirits get lost. The impact on community wellbeing and cultural identity is immeasurable, says Andrea.

Dying on Country allows communities to undertake Sorry Business, the sacred customs and cultural practices necessary for grieving. When someone dies far away, those protocols can be difficult or impossible to follow, causing more trauma and prolonging grief.

The gap between rights and reality

The new Aged Care Act that started in November contains a Statement of Rights. Aboriginal and Torres Strait Islander people have the explicit right to culturally safe care and to remain connected to Country.

The reality, Andrea says, is more complex.

"There has been very little in the broader reform discourse about mechanisms needed to support people in care to maintain their connection to Country," she says. "If we don't begin making these changes, then the Statement of Rights is not a Statement of Rights at all, but rather, a list of nice ideas."

The barriers are both practical and systemic. Limited palliative care services in remote and regional areas often force people to leave their communities to receive care, severing connection to Country and causing spiritual, emotional, and physical distress.

In many remote communities Andrea has worked in or visited, there are no morgues. Communities lack trained palliative care workers, as well as essential equipment, facilities, transport, telecommunications, pharmaceutical access, and allied health services.

Then there are also administrative barriers. Primary Health Networks, Hospital and Health Networks, state and territory lines; all of these can restrict where and how care is accessed, even when someone desperately wants to return to Country to die.

"We cannot expect palliative or end-of-life care to be culturally safe if it causes this kind of spiritual and emotional distress," Andrea says.

What care on Country requires

Andrea says communities need trained workers who can provide palliative care, along with the basics: equipment, facilities, transport, and the resources to deliver care on Country. Funding models also need to be flexible enough to support people who want to return to or remain on Country.

"We simply cannot say it's too hard," she says.

A different way of thinking

What makes Andrea's approach cut through is her insistence that dying well can't be separated from living well or ageing well.

"The distinctions between primary care, aged care, disability support and palliative care are arbitrary," she explains, "as is the distinction between ageing and dying well.”

Understanding Aboriginal and Torres Strait Islander perspectives means recognising that connection to culture and Country isn't peripheral to health.

Systems need to reflect that, Andrea says. They were never designed with Aboriginal and Torres Strait Islander people in mind, which is why community-controlled care models, local workforces, and flexible approaches matter, particularly in remote and regional communities where mainstream systems often fall short.

Making it real

In February 2025, Andrea released her report, Transforming Aged Care for Aboriginal and Torres Strait Islander people. It draws on consultations with more than 1,000 Aboriginal and Torres Strait Islander people across the country.

The report contains hard truths. People spoke of being taken far from everything familiar when they needed care. Others, already in mainstream aged care facilities, described the loneliness of being disconnected from language, family, and Country.

But there's hope. The National Agreement on Closing the Gap presents an opportunity and an obligation to redesign the systems and make the necessary investments to get this right. Aboriginal and Torres Strait Islander perspectives, including the reciprocal relationship between culture and wellbeing, need to be at the centre of policy development and decision-making. Andrea knows it's difficult work. But she also knows it's necessary work.

"Our old people deserve to live their last years with the strength of culture, the embrace of kin, and the peace of Country," she says. "Let's make sure they can."