This paper reports on a study of the health and social care of indigenous adults in Taiwan with a specific focus on the Paiwan group. This is an undeveloped area of research and the researcher is himself Paiwanese. The study aims to explain which approaches are most appropriate for the delivery of health and social care services to a minority group. It uses secondary data to assess the wide range of inequalities experienced by the Paiwanese and the lack of available resources. The study then uses an ethnographic approach to understand Paiwanese experiences and perspectives. Purposive and snowball sampling were used to identify interviewees in both a rural village and a major city. Forty-seven people were interviewed including 11 policy makers, 4 Paiwanese cultural workers/researchers and 32 Paiwanese older and disabled people. An additional three focus groups provided data from older and disabled Paiwanese people and three more supplied information from service providers. Interviews were analysed thematically. The findings confirm that the Paiwanese traditional model of care has come under threat, not only from Japanese and Chinese invaders but also from modernization, Western medicine and the movement of young people to the cities. It is argued that there are on the agenda two approaches to remedying this situation. One involves seeking to ensure that full citizenship rights are achieved for the community, the other the devolution of control over services to the community itself. It will be argued that an appropriate policy needs to combine both of these approaches to secure multicultural citizenship.