Evidence of meeting #112 for Indigenous and Northern Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was facilities.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Tammy Cumming  UW-Schlegel Research Institute for Aging
Bonita Beatty  Professor, University of Saskatchewan, As an Individual
Jeff Anderson  Chairman, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788
Rupert Meneen  Tallcree First Nation
Natalie Gibson  Research and Advisor to the Board, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788
Bill Boese  Treasurer, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788

4:15 p.m.

Professor, University of Saskatchewan, As an Individual

Dr. Bonita Beatty

Yes, it's similar to the way home and continuing care started. I think you need similar standards, especially on reserve, because this is federal jurisdiction and indigenous governance, so you need to look at the standards of palliative care so that you can provide that on reserve. I think it can have similar standards across the board, and as I said, it can also be made distinct by the providers themselves. We can work with standards.

4:20 p.m.

Conservative

Kevin Waugh Conservative Saskatoon—Grasswood, SK

Thank you. I'm out of time.

4:20 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

Thank you.

Questioning now moves to MP Rachel Blaney.

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Thank you.

Thank you, all, so much for being here today.

Teresa, if you don't mind, I'd love to start with you. First of all, I want to thank you for your good orientation. I really appreciated the way that you spoke through your presentation. I think it oriented people in a really pleasant and important way.

One of the things you talked about was the story about asking for hot water but actually wanting medicinal tea, and the other thing you talked about was how the elders have a lot of time but the care workers don't have a lot of time. I think those two things intersect in an important way.

I'm just wondering if you have any suggestions or ideas about how to build an environment where that asking for water becomes an asking for the medicinal tea?

4:20 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

Are you asking the people in Saskatoon?

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

I'm asking Teresa. That's how I started.

4:20 p.m.

Teresa Doxtdator David

Right now, because of the act, we're task-oriented. We have 20 minutes to provide care to a resident. In our home we have what we call pods. We have one staff member to 10 residents. You have to come in at seven and get 10 residents up and ready for breakfast—washed, dressed, whatever they want. There's not a lot of time for interaction. My role in activities is to try to create cues and tools that staff can use. So if you go in and a resident can't remember the names of their grandchildren, on the wall there may be a cloth quilt with pictures of the grandchildren with names on there. That allows the PSW to ask how so-and-so is doing today, or whether they've heard from them lately, because the PSWs just don't have the time to provide the interaction that's needed.

They also don't have the time to pick up the cues when someone's in distress. We're taught to be aware of pain and to look at the resident's face, look at their body language, but when you have somebody sitting on a toilet, somebody ringing, and then there's an emergency bell, staff assist, and everybody runs. There just isn't time, so this person feels lonely and unworthy.

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Thank you.

Tammy, you talked about the work that you're doing that is Ontario-focused. I'm just wondering if the framework that you're looking at in terms of this new circle is going to be shared across the country. Is there any model for that to happen?

4:20 p.m.

UW-Schlegel Research Institute for Aging

Tammy Cumming

There's an appetite for sharing resources and ideas across the country, so, yes, we're funded to stay specific to Ontario, but absolutely there are opportunities for a spread. The RIA's mandate is national and global, so that does happen, yes, for sure.

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Would you say there's a little gap maybe in funding in terms of having a federal process to share these kinds of models to make sure we're doing the parts around reconciliation that need to happen?

4:20 p.m.

UW-Schlegel Research Institute for Aging

Tammy Cumming

Absolutely, yes.

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Thank you.

I'm wondering, though. In the work that you're doing, are you focusing on rural, remote communities as opposed to urban communities, which have very different realities?

4:20 p.m.

UW-Schlegel Research Institute for Aging

Tammy Cumming

Yes, we do, but there is an increased focus on northern and rural and smaller long-term care homes. You tend to get the bigger homes and the more open homes adapting some of the change. So yes, there's an increased focus on that with the renewed funding.

4:20 p.m.

NDP

Rachel Blaney NDP North Island—Powell River, BC

Good. I represent a rural and remote riding, and often people from indigenous and non-indigenous communities are pushed to go somewhere else and lose all of their social infrastructure. I think this is something that the federal and provincial governments need to be collaborating on, especially around indigenous issues.

Bonita, I just wanted to say that I read your paper and you mentioned that the nation had actually put together an ideal care management scenario or scenarios. Can you tell us a bit more about that? Have you had any cases that have received that final goal of an ideal care management scenario?

4:20 p.m.

Professor, University of Saskatchewan, As an Individual

Dr. Bonita Beatty

I wish I knew. It's always an ongoing development, right?

For lack of a better word we looked at something called “blended caregiving”. We've overused the word “caregiving”, but blended care is when you work with the local health professionals on the reserve. I'm looking at other reserves or rural reserves because that's the area I've done a lot of research in and have experience in.

When you're looking at the situation at home and working with the families of the patients—the clients, the elders—and working with the professionals, at the end they often have to be placed, whether they go on respite for two weeks, whether they are being assessed for long-term care placement, especially if they have something like dementia, or whether they are no longer able to be looked after without medical risk at home. When they leave the reserve in that transition when they are placed, they can't just be plopped in a long-term care facility far away. We all know that.

What happens is that you have to work with those professionals within that facility—those nurses, those home health care aides, and all those people—so families also become a part of that continuum, so that blended care between at home health, the family, the patient, and the long-term care facility off reserve in the city, that kind of relationship building has to occur. That's a case management approach. It's a blended care approach.

What happens is that we always have common meetings. Usually a family—in my case we were always keeping the communication loop open, because you have to know what prescriptions that elder is taking, what doctors they have, all that medical history, and also their background. What background did they have? Are they Cree speakers only? Are they Dene speakers only? Language becomes an important part of it. Their cultural values as well as their beliefs also become important.

A lot of it is really training the health professionals. I was just talking to them a few weeks ago, and that's exactly what they said, “We need to be trained; we need to know the background of those elders who are coming in.” We, ourselves, don't even know, as first nations people, where the elders are in the province of Saskatchewan. Even in our own band we had to go looking for them, because right now they are being placed out.

The situation there becomes a matter of blended care and not leaving those people off their reserve and off their home list just because they are placed in a long-term care facility off reserve.

It's all a matter of linkages. I think that has worked in several key instances now, so we're continuing to work with it.

4:25 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

That's wrapped up your time, just about.

We are moving to MP Mike Bossio.

June 5th, 2018 / 4:25 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Thank you, Chair. I know I only have two minutes.

I have one question. We were very fortunate to hear from Grand Chief Abram Benedict last week. We also heard from Chief R. Donald Maracle from the Mohawks of the Bay of Quinte. I know right now they are in the process of wanting to bring about a long-term care facility for their community, actually for the surrounding region itself.

For first nations such as the Mohawks of the Bay of Quinte and others, what do you consider the most important factors and gaps to overcome to successfully attain and then operate a long-term care facility? That's to Ms. Doxtdator or Mr. Lazore, either one of you, whichever one feels comfortable answering that.

4:25 p.m.

Vincent Lazore

I think an important aspect of that is to make sure there's a 20-year plan and a 25-year plan. Then, have funding to sustain the infrastructure. Buildings age, and then there's no money to repair. That's what I think is important, in order to keep looking into the future, infrastructure support.

4:25 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

In the optimum ratio of support workers to patients, Teresa, I know you mentioned that this is a difficult area. What would you say the optimum ratio should be? Right now you said it's 1:10.

4:25 p.m.

Teresa Doxtdator David

In our home it's 1:10, and we're fortunate. If you go to a larger home, it's less than that.

4:25 p.m.

Vincent Lazore

It's sometimes one support worker to 20 patients.

4:25 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Do you think 1:10 is a manageable ratio?

4:25 p.m.

Teresa Doxtdator David

Yes.

4:25 p.m.

Vincent Lazore

It's manageable, but it could be improved due to burnout, due to shortage of staff.

4:30 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

That's good to know.