Indigenous and Northern Affairs Committee on June 7th, 2018

[The Chair, Liberal, MaryAnn Mihychuk]

Welcome, everybody. Let's get the meeting going.

We are at the indigenous and northern affairs committee of Canada. Pursuant to Standing Order 108(2), we are conducting a study of long-term care on reserve.

We are actually meeting on the unceded territory of the Algonquin people, a process we always recognize because we have really, I think, sincerely started the process of understanding, recognizing truths, and moving to reconciliation. It's a bit slow in our process of history, but it's always good that we're here.

Presenters will have 10 minutes. When the presentations are done, we will allow for questioning, and that will take up the full hour.

We have Dakota, File Hills, and then Driftpile.

We have three presentations.

We're going to start with Dakota Oyate Lodge. We have Della Mansoff, the director. She is all the way from the great province of Manitoba.

Welcome. You have 10 minutes. I'll give you a signal when you're getting close.

[Della Mansoff, Director, Dakota Oyate Lodge]

Thank you.

I'd like to thank the standing committee for the invitation to present today.

I have listened to some of the previous witnesses to have an idea of what was being presented, and not to say the same things that you've already heard.

I represent the Sioux Valley Dakota Nation. It is the only self-governing first nation in Manitoba, and they have a tripartite agreement for governance. We are in a unique situation. We're able to create our own laws and break a lot of the barriers that my colleagues here are still facing. These are quite difficult issues.

The Dakota Oyate Lodge is a 26-bed personal care home located within the community of Sioux Valley. We're half an hour from Brandon, which is a big city in Manitoba, even though people only know of Winnipeg. We have good access to services in our proximity to the main city and to the hospital, but you would never know we're there.

A lot of the issues we face are that we are still not part of the RHA, regional health authority, so we aren't given the same sort of latitude that the RHA personal care homes or long-term care facilities are given. We don't have the supports and services that the other long-term care facilities have that are just 15 minutes down the road. We don't get OT support, speech-language, dietitian services, rehab services, mental health services. We have to pay for all those things, whereas they are part of the RHA.

We have to pass Manitoba health standards. You have to meet 26 standards and about 500 points to be licensed as a personal care home in the province. Twenty months ago, we completed and passed our standards. For the last 20 months our licence has been sitting on the minister's desk to be signed. We've completed our framework agreement. Both the band and Manitoba Health have agreed to it. It's sitting on the minister's desk.

Without that licence being signed, we aren't able to take what are called level 4 people into our home. We have four levels of care in Manitoba. Level 1 is usually maintained in the home through the home care program. Level 2N, which means they have no behaviour issues, are also looked after by the home care program. Level 2Ys and 3Ys come into our care home. We aren't allowed to accept level 4s, those who are in most need.

We do have a young man in our home right now because it is his home community. He is paralyzed from the neck down due to a head injury. He came home to live in our care home. We have the only facility with bariatric-size rooms in the whole of Prairie Mountain Health, which encompasses a great part of southern Manitoba. This man comes with absolutely no funding. He can't get any assistance from anywhere. He's a man living at home, and he has no money coming in. He stays in our facility for free because he needs to be at home. He needs to be around his family, but because we aren't allowed to accept level 4s, we can't get funding for him. It's a despicable situation, in my mind.

When we speak today, I would ask you to think about your family. Put yourself in the situation. If you got injured today or if you have MS, cerebral palsy, a young child who is autistic, you're going to end up in our home because in a first nation community, there is nowhere else to go. Sioux Valley is embarking on a venture to increase the services around the long-term care process and the chronic care process by adding 12 independent living facilities that will be located on the same property as the long-term care facility.

With home care programs, there are not enough people and not enough money to do around-the-clock care or even evening care for most of the clients. We would reach out and do that from the care home. We're looking at breaking some barriers to change the process. Since we don't have to live within those agreements now, we can make the required changes that work best for the community.

We service only indigenous people. We have people from all the reserves around southwest Manitoba as well as eastern Saskatchewan. We have Dakota, Cree, and Ojibwa people all the time, so we are servicing that cultural piece.

We also do all the palliative care. There is no funding for it, no training for it, but as a nurse, you do what you have to do, and we do it.

We have residents who have critical wounds. As I'm sure most of you are aware, diabetes is so rampant that wounds become stage 4, which are extremely deep and difficult to deal with. We can't get proper dressing supplies. We basically have gauze, tape, and saline. To get the proper dressing supplies that we need, we have to fill out paperwork to send to first nations and Inuit health branch, and if they approve it, then we get it, but it's only for a certain amount of time and then we have to reapply and show the need and the cause, or we send the person out of the community to be treated in the city.

Again, at their worst, they're not allowed to be at home. As we all know, none of you would want to be shipped to Toronto if you couldn't be cared for in Ottawa. That just wouldn't cut it.

Dialysis service is another issue. We have service in Brandon, but we don't get transportation to take our people to dialysis because technically you are supposed to live within a half hour of the facility from which you are getting the treatment. Well, we do. In Sioux Valley we do live a half hour away, but they still don't see that as right. They expect everyone to move from their home in Sioux Valley to Brandon to be near the hospital. Dialysis treatment takes about three hours, three times a week, and for the rest of the time patients are supposed to live in a city where their families may or may not be able to come to visit on a regular basis.

Our residents struggle with the ghosts of the past. We still have adults in there who have been through residential school and certainly the sixties scoop. All of these issues are still alive and well in their memories today. They have difficulty with care from non-indigenous people, and the women definitely don't want to have care from men. We have to do a lot of work around being culturally appropriate even in the world of today where a nurse is a nurse and if you're a health care aide, it doesn't matter if you are male or female, you do the work. However, we are very conscious of the culture and of making sure that our residents receive the care they are most suited to and are comfortable with.

A benefit of not being part of the RHA is that we we are able to work with our residents as their needs present. We do have the policies and we do have the rules that we have to follow because of standards, but at the same time, for our residents, it's very much central that they come first.

Just to wrap up, I'm very honoured to be here. This is a nice step in going forward and at least understanding what is happening out there.

When anyone is in Manitoba, please come and visit us.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you.

Our second presenters are from File Hills Qu’Appelle Tribal Council. We have Chief Bellegarde and we have Gail....

Hi, Gail. Is it Boehme?

[Gail Boehme, Executive Director, File Hills Qu'Appelle Tribal Council]

That's pretty good.

[The Chair, Liberal, MaryAnn Mihychuk]

You're being very generous.

You have up to 10 minutes, and I'll give you a hint when we're getting close.

[Chief Edmund Bellegarde, Tribal Chief, File Hills Qu’Appelle Tribal Council]

Thank you, Madam Chair.

Good afternoon to the committee.

I appreciate the invitation to come and address you on one of the foundational and critical matters of quality of life, and that's public health care. That's an issue we take very seriously, and we are taking a lot of measures and a lot actions into our own hands to address some of the issues and the gaps that I'll talk about.

File Hills Qu'Appelle Tribal Council is located in Treaty No. 4 territory in Saskatchewan. Treaty No. 4 territory spreads throughout much of southern Saskatchewan into central west Manitoba, and tips into Alberta, up close to Medicine Hat. Treaty No. 4 was entered into in 1874. Our tribal council has 11 first nations. Nine are parties to Treaty No. 4 and two are not treaty parties. We have Cree, Soto, Nakoda, Dakota, and Lacota first nations as part of our tribal council. We are reforming our governing structures based on indigenous governance principles. We're reawakening that spirit of that alliance that existed on the great plains prior to Canada's existence and prior to contact from European nations. That confederacy model will continue to drive and bring forward our solutions and our legal and policy frameworks in a contemporary sense. That's the important work we're doing today.

We've forwarded a couple of reports on long-term care and some of the challenges. You'll see that all of the statistics and the indicators of health for indigenous people and on the indigenous population side, all of the problems, all of the challenges, in terms of access, the eligibility and ineligibility, the procedures, the different programs, the different ministries at a local, provincial, and federal level are symptoms of public policy and policy frameworks that are ineffective and, I will say, failing indigenous people.

When we look at health care, we see some of the international aspects of the United Nations Declaration on the Rights of Indigenous Peoples, which the House just had third reading on. There are two particular articles, articles 23 and 24, that address health care. The declaration itself is a framework for reconciliation for Canada and the first peoples of this territory. The Truth and Reconciliation Commission calls to action, specifically calls to action 18 to 24, address health care and all of these jurisdictional challenges.

There are challenges that are often exacerbated by ineffective policy stacked upon another ineffective policy, stacked yet again on another ineffective policy. Throw in disputes around jurisdiction between federal and provincial responsibilities and Indian people. Then you get into on-reserve and off-reserve eligibility, and ineligible aspects, the lack of compatibility across the policy framework when it comes to Indians and health care on reserve. There are many challenges, and the public policy frameworks are not compatibly designed between federal and provincial orders of government. You throw in these challenges, and access, and not being eligible or covered, it's like Jordan's principle 10 years ago, and that young first nations boy from northern Manitoba. Ten years later, we're still facing those policy challenges in those jurisdictional gaps between provincial and federal orders of government.

That's really what is precluding or determining poor outcomes for health for our people. It's really access to that care, that discriminatory practice that's maybe not meant in the policy frameworks, but those are the outcomes.

When we look at that, we look at it from our perspective. Health care is about dignity. Access to primary acute care services, to long-term care homes, that dignity of life and that caring for our people, is critical. What we're looking to do and what we're leading is indigenous-led policy frameworks, research that's indigenous-led under indigenous research methodologies. Those are our ontologies, our epistemologies. In short, those are our ways of knowing, our ways of sharing, our ways of speaking, our ways of analyzing when it comes to research. We have the All Nations Healing Hospital, an acute care facility that blends traditional healing, and our White Raven Healing Centre. We have community health and we have palliative care, all on a reserve, the Treaty 4 reserve right in the town of Fort Qu'Appelle in Saskatchewan.

This is a new public policy framework. We're just coming to our 14th anniversary of operating. Now we are starting to drive public policy. We are driving a new model of care in health care. We're driving ways, innovations on traditional medicines, traditional healing practices, our concepts of health care and access to it. We're dealing with those practical realities of trying to integrate on the foundations of public health care, acute care and community health, traditional healing and our ideologies around health care, our ways of knowing, our ways of healing, our ways of teaching this, our medicines, our natural medicines. There is the spiritual context of health, the mental context of health, and the emotional context of health. The western side is the physical side of health.

We're bringing models into a public debate, into a public policy space, that actually integrate and respect and bring forward the strengths of all of these aspects. Our hospital is a public hospital. We treat anyone and everyone who presents for care. We serve the local catchment area. It's pretty complex in terms of our funding. We are federally funded through Health Canada and the first nations and Inuit health branch. We are funded by now the Saskatchewan Health Authority. That's a regional health authority provincial model. We get different programs. There are many unique things that are happening in Fort Qu'Appelle at the All Nations Healing Hospital. We're an innovation site. We're leading public policy change by bringing practice, by bringing experience, by bringing data, by indigenous-led research.

In fact, we are working on a research project right now with the Johnson Shoyama Graduate School of Public Policy in Saskatchewan at the University of Regina and the University of Saskatchewan. It's about the Indian solution to the policy problem, developing an indigenous policy-making model to address first nations health disparities.

We're bringing solutions to strengthen public policy models in this country when it comes to indigenous health. We're taking down barriers. We're building bridges to close those gaps in jurisdictions. We figured it out through practice the last 14 years. How do we get the federal-provincial jurisdiction gaps closed? We're operating in between that space and we're operating very effectively.

We have had an exemplary accreditation standing with Accreditation Canada for the last eight years. We work hard at that because we know that we have to earn the confidence of the public that we serve, the town of Fort Qu'Appelle and the surrounding area. We work hard at that. The public is now seeing that new model of care in our women's health centre, the birthing units, the long-term care and our care of our elders. Those are our teachers and our professors.

We are bringing models to public policy. Public policy has to change.

I would leave this final statement to the committee and the hon. members here: Canada, it's time to create effective policy frameworks that serve indigenous interests and impact us.

Thank you.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you very much.

Now we're going to Alberta, and we have two people on our video conference, Florence Willier and Sandra Lamouche. You have 10 minutes to present.

[Sandra Lamouche, Health Director, Treaty 8 First Nations of Alberta, Driftpile Cree Nation]

Hi. I'm Sandra Lamouche. I'm the director of health for the Treaty 8 First Nations of Alberta, and with me is Florence Willier, who is a Driftpile First Nation council member.

Driftpile got an invitation to be a witness, and we're going to talk about something new. They actually do not have a long-term care facility in Driftpile, but they want to be a pilot location, and they have already started the research process.

The two folks who were just talking, who I believe are from Dakota and Fort Qu'Appelle hospital, represent the two systems we need to learn from. Dakota is facing challenges, and we see those challenges in Alberta as well with our health centres. It's something that we need to learn as a type of best practice, and we need to look at Fort Qu'Appelle's success story.

Driftpile is working in partnership with the Province of Alberta and the funding agency in the federal government to start a pilot project in continuing care for an elders lodge. The two will be working together, side by side, utilizing health services such as nursing through the health unit right in Driftpile, and will hopefully be building this facility near the health centre.

That's the project we're looking at, and Treaty 8 is helping out. We're the folks bringing the two parties together. That's my job.

Florence is sitting here, and I'm going to give her the floor for a bit to describe where they are with the project, and to describe her community in a little more detail.

[Florence Willier, Councillor, Driftpile Cree Nation]

Good afternoon, MaryAnn and committee members.

My name is Florence Willier. I am a member of the local government leadership. My community has about 1,050 to 1,100 people living on reserve and an equal amount living off reserve, for about 2,800 altogether.

I'm not sure if anybody has heard about Driftpile previous to this, but in our community we have a large population of diabetics and a large population of people who are over 55 years of age and are now in need of long-term care.

We have a health centre that is staffed with a nurse, and we do have a doctor that comes in weekly, but most of our people have to travel out for all the specialized care such as dialysis and long-term care. They have to leave the community and be housed in a provincial system. Right now in Treaty No. 8 near Driftpile, there is no long-term care facility we can access. There are provincial long-term care facilities with a huge waiting list. We are usually put at the bottom of the list.

Acquiring those services is a very lengthy process. A lot of times we have to seek other first nation long-term care facilities that are hours and miles away from Driftpile. People have to basically pack up and leave, and a lot of them end up dying in those facilities without coming back home.

One of the wishes of a lot of the elders is to die at home. It has been a pressing task and goal for the leadership to get this long-term care facility built on our nation's land to service the people, to get all those essential services that every Albertan and Canadian receives: OT, PT, speech and language, and dialysis. We have a large population of dialysis clients who have to travel out three times a week every day of the week.

We've always had a large dialysis population. A new hospital has been built 30 minutes away from us. The unfortunate part about it is that there is no dialysis in that brand new hospital, so again we have to travel out for that specialized care.

The greatest need for our community right now is the long-term care facility. We have 11 members who are accessing services miles away from home, as I've said, and we have at least an equal amount still waiting in our community to be put into long-term care.

We have completed a feasibility study. We are nearing our business plan and architectural plan, which is ready to be brought out. I guess our greatest task that we're trying to achieve is to go into a pilot project with the province. We have been working with Alberta Health Services, and we have been at the table numerous times. It is a very good working relationship, and we hope that we can continue working with Alberta Health Services and the province to make this a reality for Driftpile Cree Nation.

Meegwetch.

[Sandra Lamouche]

Thank you for listening. I think we went a bit over our time limit.

[The Chair, Liberal, MaryAnn Mihychuk]

There's a bit more time for questions, and then you'll have an opportunity to provide more detail through that process.

We're going to start with MP Danny Vandal.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Thank you very much for your presentations. They were very interesting. It's always nice to see a fellow Manitoban at the table. There are two of us on this side of the table, and Saskatchewan's close to Manitoba.

Let me start with a question for you, Della. You mentioned you're not a member of the RHA, the regional health authority. Is that because you don't want to be? Can you give me a little bit of context there?

[Della Mansoff]

For Sioux Valley, being on a first nation, the care is covered under the RHA, but in terms of a nursing facility or a long-term care facility, we would be maintained as a private facility, just like other allied facilities like Salvation Army's Dinsdale Home, Hillcrest Place, and Centre Park Lodges, those sorts of things. They're independent of the RHA.

Once we become licensed, then we would have a service purchase agreement with the RHA so that we can access more services, and we can be part of the long-term care network, leadership committees that the RHA has, their pharmacy and therapeutics committees, and things like those.

Right now, we're not even part of their panel process. When we have an admission come into the facility, we follow all the Manitoba Health rules and applications, but the RHA won't even review our applications.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

You mentioned in your presentation that in terms of licensing, you've been waiting for 20 months. I believe you said your application was on the minister's desk. Is that the provincial minister?

[Della Mansoff]

Yes.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

I assume you've called and you've made requests. What sort of response did you get?

[Della Mansoff]

They're just waiting. I'm not sure what his reason for not signing is, but it was.... He's getting to it. He apologizes for the delay.

We have met all the criteria. When they do a licensing visit, Manitoba Health sends out two representatives from Manitoba Health who come to the facility and spend, in this case, a day and a half reviewing charts, talking to residents, talking to staff, and looking at our evidence, and then they let us know what we pass or fail at.

They took some of our policies to use as training in other provincial homes across Manitoba.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

Okay.

[Della Mansoff]

I wanted to hit the gold standard, and we went platinum with the work we did. In terms of that, when you're involved in this process, it took us three years. There are six other first nation personal care homes in Manitoba who have been working on this for more than 10 years, and they're trying to get close, but since the government changed, the initiative has not been respected.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

You mentioned the other care homes in Manitoba. Do you communicate with them regularly?

[Della Mansoff]

Yes. I am part of the first nations personal care home network group. Until very recently, I was one of the co-chairs. We meet on a monthly basis. We work together on standards, and we work together on political issues like this, and wanting to be heard.

When this opportunity came forward, it was very timely, because we are really trying to push for people to hear our concerns and that we are being treated less than—

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

I understand.

I don't have a lot of time, so I'm going to move on.

Our Canadian Department of Indigenous Services provides home and community care through the first nations and Inuit home community care program.

Chief Bellegarde, are you familiar with this, and have you been working with them over the years?

[Chief Edmund Bellegarde]

Yes, we do deliver home care programs through our community health services, but there are still challenges. There are various ministries at a provincial level. Then there are different requirements or eligibility aspects and different perimeters around funding and what's eligible. It gets pretty complex in a very short period of time.

For an average citizen who is looking to access services, it becomes a challenge. There's a real need for navigation through the system, because you have stacked or tiered levels of service. Something might be ineligible for this, but it may be eligible to access it through a different program or even through a different jurisdiction, provincial versus federal. We're really challenged with that type of access.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

If you were to give us a recommendation on how we could provide better service and amend what we're doing as a federal government, what would that recommendation be?

[Chief Edmund Bellegarde]

It would be to recognize our rights as indigenous peoples to lead the policy-making process and we will come forward with policy solutions that are much more effective in changing the long-term health indicators for our people. We'll do it because we understand our ways, but we're also experts on the public standards, because we have been forced to live with these for 150 years. We've been forced down this road. We operate in that space of federal and provincial public health standards through our acute-care hospital.

We already have the practice. We're starting to shape different models of care where the public—not only indigenous people, but now the public—is starting to access the care of traditional healers through our spiritual practice combined with western medicine. There are protocols between our traditional healers and our attending physicians and nursing staff. We're bringing models of care that are actually strengthening public policy overall, and not just for indigenous people.