Thank you, Madam Chair. Good afternoon.
Thank you for the opportunity to appear before the committee regarding long-term care on reserves. It's obviously an important subject for all communities, Canadians and indigenous peoples alike, in terms of the need for long-term care.
Obviously, elders or seniors are an important aspect in indigenous cultures in terms of knowledge keepers. They also play an integral role in terms of the vitality and well-being of communities writ large, as part of families, in guiding young people and young families, and for the strength of communities and nations. Indigenous peoples turn to their elders as key sources of traditional knowledge, wisdom, and cultural continuity.
I've been told quite clearly, in my travels and in other business meetings with communities and leadership, that first nations individuals and families want to be able to live at home as long as possible, and if and when they require additional supports, to stay in their own communities close to their loved ones. We've heard this time and time again as a common thematic message.
Many first nations individuals, of course, who are no longer able to live at home safely due to complex illnesses or disabilities, must leave their communities to access appropriate housing and care. For those who were previously forced to leave their communities to attend residential schools, in some instances this can be a re-traumatizing experience. That's something we need to think about.
In terms of needs for services, it's important for all of us to keep in mind that the demand for long-term care facility beds is affected by both the number of seniors in a population as well as their overall health status. While the percentage of the on-reserve first nations population over 65 is relatively small, it is growing quickly. By 2016 the proportion had risen to about 28,000 individuals. According to projections, the number of seniors could be more than double by 2036, to almost 75,000 first nations seniors on reserve likely requiring some level of support in terms of housing or assisted living, home and community care, and/or long-term care.
In addition to the increasing numbers of first nations seniors, it is important for us to consider the nature and complexity of the health conditions they face. Compounding the rising size of first nations senior populations, as I mentioned, is the fact that first nations often have more chronic health conditions—as we've all heard, probably, in previous submissions—than non-first nations seniors. By age 60 approximately half of the first nations adults on reserve have been diagnosed with four or more chronic health conditions. My friend and colleague Robin will get into some of that detail.
Our short-term remarks this afternoon will provide you with an overview of the current existing services, along with the continuum of continuing care, the situation in terms of long-term care, and the future opportunities, including current policy development work being led by Indigenous Services Canada.
Before we get deeper into the subject matter, I'd like to clarify for the purpose of the presentation that we're looking at the term “long-term care” to mean “facility-based long-term care”, actually a structure or facility with a team of expertise. It's a term that is used differently across the country, as we can imagine you'll probably hear from different jurisdictions, and territories and provinces. However, we'll use the Canadian Healthcare Association's definition:
Care is provided for people with complex health needs who are unable to remain at home or in a supportive living environment. Health service is typically delivered over an extended period of time to individuals with moderate to extensive functional deficits and/or chronic conditions.
That's the classical, Canadian Health Care Association's definition that's guiding some of our discussions.
The association itself uses the term “continuing care” to define a system comprised of four elements: home care, which is a big area of interest and investment from Indigenous Services Canada's perspective that we are currently in, and Robin could get into some of that detail; community support services; supportive and assisted living; and long-term facility-based care. Continuing care is a system, in our minds, of service delivery encompassing a range of health and social services that address the holistic health, social, and personal care needs of individuals who do not have or who have lost some capacity for self-care.
These integrated services are designed to improve individual functioning and to provide culturally sensitive support and care in the community where possible, through different stages of aging and illness, up to and including palliative and end-of-life care.
Also, for clarity, I think it's important that since the study is on long-term care on reserve, our response will be focused on needs and programs specific to first nations.
Now I will turn this over to my colleague, Nurse Robin Buckland, to provide you with a brief overview on the home and community care program and the assisted living program, which are two major instruments or initiatives that are funded in terms of first nations on reserve.