Evidence of meeting #115 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 services.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Tania Dick  President, Association of Registered Nurses of British Columbia
Beverly Ward  Director, Health and Social Services, Loon River First Nation
Kirsten Sware  Director of Health, Kee Tas Kee Now Tribal Council, Loon River First Nation
Holly Best  Home Care Coordinator, Kee Tas Kee Now Tribal Council, Loon River First Nation

3:30 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

I call the meeting to order.

We are here at the Standing Committee on Indigenous and Northern Affairs, looking at a study of long-term care on reserve. Today we have guests who are on video conference. Welcome, everybody.

Before we get started, we recognize that we're on the unceded territory of the Algonquin people here in Ottawa and under Parliament and thinking about truth and moving through a process of reconciliation.

Part of that is to look at the services that the federal government provides and at areas that we must address, so we are looking for your advice and wisdom in that endeavour.

The way it works is that you'll have an opportunity to present for up to 10 minutes. We'll go to the next presenter for up to 10 minutes, and after that we'll go to a round of questioning from the members here in Ottawa.

I understand we have with us two groups, the Loon River First Nation and the Association of Registered Nurses of British Columbia.

Does that seem logical?

3:30 p.m.

Tania Dick President, Association of Registered Nurses of British Columbia

Yes.

3:30 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

I'm going to ask you to time yourselves. If not, just look once in a while and I'll try to indicate how many minutes you have left and when you need to wrap up.

First up is the Loon River First Nation. Go ahead.

3:30 p.m.

Beverly Ward Director, Health and Social Services, Loon River First Nation

Thank you, Madam Chair.

First of all, on behalf of our chief and council and our elders, home care clients, and community members, I'd like to say thank you for providing us the opportunity to do this presentation on the long-term care project that we've been working on.

I'll tell you a bit about our community. Loon River First Nation is a semi-isolated community with a population of approximately 650 people. We are located next to the hamlet of Red Earth Creek.

Loon River has a group of companies that are a separate entity comprising six companies. We are constantly moving forward toward becoming a self-sufficient nation. Loon River is part of the Kee Tas Kee Now Tribal Council, the KTC, which comprises five member nations. Loon River is centrally located within the KTC geographic area. The distance from each of the other four nations is approximately 45 minutes.

Loon River First Nation's overall goal is to construct and operate an accredited on-reserve continuing care facility that would meet the needs of KTC first nation members and be open to other surrounding communities. This facility would allow KTC members to receive care in a location convenient to their communities and their families, with services delivered in a culturally safe and respectful manner. This would most certainly add to the quality of life for those in need of continuing care.

It has been our vision to have a facility near home for our elderly clients and other home care clients who may need this service. We believe that having such a facility in our geographic area is absolutely critical to the health and well-being of our community members who are living with disabilities or chronic illnesses at any time in their lifespan. Access to this type of facility close to home will make a different to this clientele and their families. There are a number of elders in facilities as far away as 262 kilometres, in a German Mennonite community.

The process of our long-term care project started back in 2013. There was a call-out through the health services integration fund for communities to submit an expression of interest to develop a sustainable first nations continuing care model that would ensure delivery of a seamless continuum of health care and support services. Loon River seized the opportunity and submitted a letter of interest. Our plan was to have our own long-term care facility located on reserve or nearby, which would be open to KTC member nations and to other communities outside of KTC as well.

We realized that this was a kind of over-the-top project; however, we moved forward with it and were selected as one of the communities to start exploring this possibility with the health services integration fund. Since then, numerous attempts have been made to have government on board at all levels, meaning locally, provincially, and federally. Access to government funding is needed to make this dream a reality for our KTC member nations.

A feasibility study was completed, along with a business plan. A letter was sent to the previous government's health minister, Stephen Mandel, as well as the current Minister of Health, Sarah Hoffman. We've had no responses to these letters.

We have a steering committee comprising two members of chief and council; an HR and admin staff member; one elder; two caregivers; me, the KTC director of social services; and the director of health. We were seeking the province's support and to identify at least two people who could sit on this committee to assist us with this project. This never occurred.

In terms of our current state, Loon River First Nation is unique in that we have both health and social services under one department. We provide home and community care services that include nursing care and personal care provided by a health care aide.

We also have the assisted living program services from Indigenous Services Canada. We have access to the provincial seniors special needs assistance program as needed for various expenses the elders have, including home renovations. We have also accessed the residential access modification program; if the eligibility criteria are met, this program helps people with mobility challenges to modify their homes to be more accessible. Juggling numerous programs from various department sources and strict eligibility criteria is always a challenge.

Our priority is to have a first nations-staffed facility located close to home, which is what is needed to achieve seamless health care delivery for our continuing care clients. Being placed in an unfamiliar place is very stressful on our first nations clients. Not only is there a language barrier, but cultural sensitivity is also lacking at the urban facilities. All of this is a factor in the rapid deterioration of our first nations community members once they are placed in urban long-term care or assisted living facilities.

In terms of gaps, there is a significance to family closeness in first nations people, and distance is a factor when a client is placed off reserve, as family members are not able to visit. Other gaps are wait times, funding sources, and provincial and federal jurisdiction policies with respect to a facility being situated on reserve. In addition, many years ago, Aboriginal Affairs and Northern Development Canada placed a moratorium on new capital projects for continuing care. This has largely added to the ever-growing gap.

Thank you for your time. I'll pass this on to the director of health for KTC, Kirsten Sware.

3:40 p.m.

Kirsten Sware Director of Health, Kee Tas Kee Now Tribal Council, Loon River First Nation

Thank you for having us here today and for the ability to present to you.

I have just a few more minutes to add to Beverly's presentation. I'm from the tribal council. She's given you an overview of what the Loon River First Nation has been looking for in terms of long-term care on reserve. Five years of work has still netted nothing, so I think we need to look at the obstacles and opportunities that are in front of us, along with our realities.

I've had the opportunity to read some of the previous comments in presentations. While it's true that there are some facilities on reserve striving to meet the needs of the members, there is no designated capital fund available. What we desperately need is some supportive living and extended and comprehensive complex care facilities that can house our clients coming from the reserves. Part of our discussion in getting ready for today was that we need you to understand who goes into long-term care and why.

I also noted from some of the previous documentation that you were looking for statistics and data and were questioning whether that was out there and how you could get it. It's not formally out there, as you've probably discovered.

Going beyond that, I think, is looking at the numbers and why we have people who aren't going into care. I think it's because the care is not responsive to what we need and it's not located where we need it. We need it in the right place at the right time. We need it at the community level and we need it to be culturally relevant to how our communities, families, and extended families live and support each other. Unfortunately, the policies and programs are sometimes in conflict with that philosophy, that holistic view.

That's all I would like to add at this time. We prepared and sent a presentation. I know that it was sent late, and I apologize for that, but it may still give you additional information for your work.

3:40 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

Yes, we do have your presentation. It's helpful.

We're now going to our next presenters, and then MPs will have a chance to ask you more detailed questions or to focus on a particular topic.

Now we're moving on to Tania Dick, who is representing the Association of Registered Nurses of B.C.

Welcome.

3:40 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

Thanks for having me.

I was really excited to hear that this discussion was happening, that the question was on the floor. I know from the stories that were just heard from our previous presenters that this discussion has been going on for a long time. Trying to problem-solve issues for our elders at home as much as we can with the no-action piece of it has been the frustrating part over probably the last generations.

I'm a registered nurse, a nurse practitioner. I am the president of the B.C. nurses here in B.C., specifically to advocate for the indigenous health portfolio piece. I'm also on chief and council and on the board for my tribal council to continue that advocacy piece around health in our rural setting. I have done a lot of legwork in that area and there is a lot of frustration and a lot of lack of action in that area, so it was good to hear the stories of the people before me.

When I think about long-term care in our first nations communities, I instantly go to my nurse's lens. We work as nurses to keep people at home as long as possible as safely as possible. Quite often doing that means relying on a team in the community and in the acute care setting. We're fortunate enough in my rural community of Alert Bay, which is a small island with a population of about 1,500 literally split down the middle between off-reserve and on-reserve, to have a provincially funded hospital on reserve. I work in acute care. It has a full ER trauma room and acute care beds, as well as a 10-bed multi-level care area. That was really built with discussion with the community, with the Namgis First Nation. As it went, it fell into the province running those services. We weren't able to utilize those beds for our people. We had to put our people into the pool like everybody else in the province, so out of the 10 beds, I think at this moment we have three local people, which I think is one of the higher numbers I've had. I've been working there for the last six years.

Quite often we have to send our residents to a hospital somewhere else off reserve, quite often hundreds of kilometres away. Once we had to send someone to a completely different province until we could figure out some of the bedding issues and get them back. That's really difficult on the patient and the families, because as indigenous people, we're very person-oriented and we need to be with our families.

I'm a master's prepared nurse, a nurse practitioner. I was working originally in indigenous communities with primary health care. My mom, who is a residential school survivor, got really sick and it got to a point where the community health services and the acute.... She had to move out of the village into Alert Bay and I had to move to Alert Bay to be with her because she was falling through the cracks so much. As a result of that—there's nowhere to be a nurse practitioner in Alert Bay—I ended up having to lose my licence for it. The lack of services and the lack of space and the opportunity to try to keep her safe and well at home as long as possible affect me personally and professionally. They've had a significant impact on my family and on me as a professional.

The big thing I notice on the island where I work is the jurisdictional issue. The island is literally split in half. We do rounds every morning with our community health nurses and our physicians, and sometimes our mental health team comes over from another location. We talk every morning about care plans and people in the community and how we can best provide those services for them. The band-hired nurses are unable to provide services to our people who live off reserve. My mom happens to be one of them because, geographically, the church had come in, and there is a big lot of land right in the middle of our reserve that is church land, so she's technically not on reserve and she cannot access those services. That was a big gap for her where she fell through those cracks. It became unsafe for her at home and in the community. I had to come home and step in.

We tried to readjust things as well as we could. In all honesty, my heart goes out to the nurses. They try to bend the rules as much as they can, but that jurisdictional issue leaves opportunity for such unsafe environments for our elders and for our community in general, because they can't cross that jurisdictional line, and it's vice versa for the provincial community health nurses who provide services across the whole island.

However, they only come over once a week, quite often once every two weeks, and sometimes once a month. They literally have to take a ferry. They come over on the nine o'clock ferry. They have to leave on the three o'clock ferry. By the time they sit down and do rounds, they really have one or two hours to spend with those individuals when they're trying to keep them home and safe and well as long as possible, before they have to go into a long-term care issue.

The other big issue I see all the time at home is the respite issue. We work really, really hard with our communities to try to build capacity and support families as much as we can for people to stay home as long as they can and as safely as they can. However, it leads to caregiver burnout all the time. It's so difficult on the family members. There are no services or support systems in place for those individuals carrying that burden. We have no respite bed in our hospital. When an individual brings somebody in for respite for a week, three days, or five days if they have to go to a medical appointment or somewhere else, we end up having to send that person to another facility completely off the island, or down-island 100 kilometres away, where there is an official respite bed. That's difficult for both the patient and the family.

The big thing I notice with that transitional piece for our elders and people who need long-term care services is that the composition of nursing services and health interprofessionals does not fit the needs. I think the team before me touched on that a bit. The composition doesn't fit the needs of the people. For instance, the FNIH nursing program is kind of baby nurses, immunizations, a little bit of wound care, and this and that. However, they're not really built for that kind of long-term care and chronic disease management and the critical situations our people are in, which puts a lot of burden on them professionally.

When we talk about elders right now, we're talking about my mother and also my mother's mother, who is not alive now. My mother is a survivor of residential school. Those elders above her and that generation before her are the ones who had their children taken away. When we talk about the composition of care and care plans, whether it's in long-term care facilities, getting them into long-term care, or preventing them from going into long-term care, we don't touch on any of that. When the system is not set up for that huge mental health piece—I appreciate how, at the beginning, it was acknowledged that we're working towards reconciliation—that is massive. We have to define that within the health care system, because it's not working. Quite often, that generation and the generation before them....

I'm the first generation out of residential school. That intergenerational trauma exists. The general feeling overall that I have experienced in my practice is that individuals don't have trust. They have a lot of fear, and they absolutely have a difficult time accessing services or entering these facilities or institutions. It triggers them, I'm sure. They avoid them as much as they can, and then they get into a critical state in the community where they come in and we are actually having to try to resuscitate them and kind of revive them physically through their chronic disease issues and get them safe again.

I feel like we're in a cycle. We need to be approaching it from a multipronged perspective. RNBC, the association I work for right now, just did a breakdown of all the designations of nurses. Licensed practical nurses, registered psychiatric nurses, nurse practitioners, and registered nurses all have a scope to help contribute to this. When we look at the composition of FNIH, the provincial services, and the community health nurses, we see that the LPNs and the RPNs are completely underutilized or not utilized at all. When we're talking about reconciliation, residential school survivors, wellness, and mental health wellness, we're not even using our psychiatric nurses, who are built specifically for that. I think we have to really untangle the composition of the service providers, whether it's in-house in long-term care facilities, preventing individuals from going into them, or just maintaining them at home as long as we can.

I hope I'm okay for time.

3:50 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

You're almost at the very end. You have 20 seconds.

3:50 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

Okay. I'll just shut it off there.

3:50 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

I think you caught the attention of the members of the committee, so I'm sure there will be questions.

Our first questioner is MP Mike Bossio.

3:50 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Thank you, Madam Chair.

Thank you to all of you for being here with us today and for your testimony. It does add to the value of the witnesses we heard previously and expands upon that. It's the personal stories that resonate so much with all of us and that will help us to inform how we move forward with this report and this study.

One of the topics we haven't heard directly addressed yet in this study is the mental health of employees in LTC facilities and health care workers who are in the long-term care field. Specifically for nurses and workers in the LTC fields, how have you managed the issue of the mental health of your members in your association or workers within your communities?

I pose that to both groups.

3:50 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

Literally just last week I came from my facility, where we have been trying to build capacity within the city for more local indigenous people working with the groups. The experience of loss we have with people who are in our facility is....

We just had this big fight in B.C. about the PTSD presumptive legislation in which nurses are not included. A whole bunch of staff had a big conversation about the impact and about how mental wellness and mental health are affected for those service providers. Regardless of whether you're a care aide, an LPN, a registered nurse, or an ambulance driver, those losses and that weight of....

We see them coming into our facility in a critical state. They avoid the facility as long as they possibly can, because quite often they just don't trust it. We're really working on that internally, because I don't see that support coming from the health authority provincially. In B.C. we're under the First Nations Health Authority. That isn't happening quite yet. I know it's on the table and there's a lot of conversation about it, but there's a lot of work to be done. I see turnover within our staff constantly from burnout and just not wanting to bear that load.

3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Please go ahead, Loon River.

3:55 p.m.

Holly Best Home Care Coordinator, Kee Tas Kee Now Tribal Council, Loon River First Nation

I was elected to speak to this, MP Mike Bossio.

I'm a community health home care nurse. I'm not with a long-term care facility, but we have the same issues in that we are doing one-to-one care and we can have our clients for 10 years and then we lose them. We do have psychologists in our facilities who are routinely there every week. That helps if we access them, but a lot of times we compartmentalize our loss when we lose our clients.

We deal with this individually and sometimes as a group, because in some communities there are only one or two people in the home care situation who do the visits and stuff, so we have a very small team. In some places there's only one nurse or one health care aide most of the time. We work as a team, and that's how we support each other, but we do go to the psychologist when we have a loss.

3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Actually, that was something I was going to add to my question. As we work toward reconciliation, how can we ensure that the long-term care system is working toward reconciliation, and what steps can we take toward better psychiatric care?

Tania, I think you mentioned this in your statement. How can we do a better job in that area?

3:55 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

I think it's the composition of the teams we have. When we look at FNIHB or FNHA, the federal health providers for the communities, I think those systems have not changed enough to utilize the full scope of all nursing designations or other interprofessional individuals. I don't have the privilege or opportunity to see a psychologist when things hit the fan for us, and literally nine out of 10 people who walk through the door are related to me. That has a significant impact on my mental wellness and my mental health, because when I'm resuscitating and so on, it's difficult. There's huge burnout, huge turnover.

3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

It's not just physical and the hours that you put in, but the emotional burnout as well, right? It's almost a PTSD-type situation because it is family members you're dealing with. You're in a crisis situation, both in the moment and afterwards, personally.

3:55 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

Yes. One of the truth and reconciliation recommendations is for more indigenous nurses and increasing numbers and capacity of health providers. If we don't have a system set up to protect them from those experiences, we're setting them up for failure. We're setting them up to be hurt is what we're doing.

June 14th, 2018 / 3:55 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

This partially feeds off from where this discussion started. Witnesses have told the committee that long-term care on reserve is about “empowering and enabling” indigenous people to develop new and holistic models of care by building institutional capacity that meets health standards and that incorporates traditional knowledge, healing, and medicine into western health care practices.

What types of supports need to be provided to ensure that indigenous communities have the capacity to design and deliver health services that incorporate indigenous knowledge, healing practices, and medicine, and in turn help deal with some of the mental health issues? I know that a lot of indigenous cultural healing practices specifically address the wellness piece of it.

3:55 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

You have about 45 seconds.

3:55 p.m.

President, Association of Registered Nurses of British Columbia

Tania Dick

I'm going to give you one quick story. I've been advocating for my hospital to have traditional food in the long-term care facility. I just spoke with the national dietitians. They don't even allow us to bring in salmon, elk meat, or anything. You have to follow their policy. Our traditional foods are medicine for our people, and we're not allowed to utilize them. It drives us crazy.

4 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Maybe, Loon River, you could give a quick comment as well on that.

4 p.m.

Director of Health, Kee Tas Kee Now Tribal Council, Loon River First Nation

Kirsten Sware

Sure. Thank you.

Bring post-secondary education close to home and integrate that within our facilities. We have to educate our own. They won't come from somewhere else.

4 p.m.

Liberal

The Chair Liberal MaryAnn Mihychuk

Okay.

4 p.m.

Liberal

Mike Bossio Liberal Hastings—Lennox and Addington, ON

Thank you all so much.