Evidence of meeting #109 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 terms.
A recording is available from Parliament.
Senior Director, Social Policy and Programs Branch, Education and Social Development Programs and Partnerships Sector, Department of Indian Affairs and Northern Development
No, they're not evenly distributed. There certainly are a fair number of them in Quebec, and in Yukon as well.
Liberal
Senior Director, Social Policy and Programs Branch, Education and Social Development Programs and Partnerships Sector, Department of Indian Affairs and Northern Development
Manitoba has 10 facilities on reserve.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Okay. I'll have more on that later.
On home care, I have experience with home care through my mother, who lived in an urban setting—she has since passed—where the workers came every day and went home at the end of the day. It was fairly simple and very valuable. How does it work on an isolated reserve?
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
As I mentioned, the band is funded through the contribution agreement. They set up their home and community care program. They hire the nurses and the home support workers. They manage the program.
The program was nicely designed. Certain things have to be seen. For example, the nurse needs to do an assessment of the individual and what their care needs are.
Liberal
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
They could live in the community. They could visit the community. A recurring theme is that you'll see various models. In isolated communities it's much like nursing stations, with issues in terms of trying to recruit and retain nurses.
Generally speaking, the program is similar to what you would see or what you would have experienced with your mother.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Okay.
Your departments are not involved in the actual hiring of the workers. You contract with the bands and first nations across the country.
Acting Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
Correct. Through contribution agreements, the communities and the leadership and the health department will determine how they manage and deliver the home care program. Ideally they're hiring local people. They're employing nurses who are part of the community, optimally.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Is that the same model for the facilities, or do the bands and the first nations operate the facilities themselves?
Senior Director, Social Policy and Programs Branch, Education and Social Development Programs and Partnerships Sector, Department of Indian Affairs and Northern Development
They do.
Conservative
Kevin Waugh Conservative Saskatoon—Grasswood, SK
Thank you, Madam Chair.
Welcome to all.
To pick up on Mr. Vandal's questions, I've seen the gaps here. It's Monday through Friday, nine to five, with no night coverage, no weekends, and no holidays. Nine to five is nothing, but that's 5:01 p.m. till the next morning. We probably have no weekend service in a lot of these communities. We have no holiday service.
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
No, you're right. When the program was originally designed in 1999, we ran with a budget of $90 million every year—Keith will correct me if I'm wrong—until budget 2017. There was no increase. I think the branch worked really hard to find additional money to insert into the home care program. With budget 2017, we now have the additional resources, so communities will get that. Hopefully, there will be opportunities to extend services and provide the physiotherapy that wouldn't have been there previously.
Often what happens after hours in a remote and isolated community is that the senior citizen would need to visit the nursing station to receive care. If you're not mobile, sometimes that's challenging. For sure there have been significant gaps.
Conservative
Kevin Waugh Conservative Saskatoon—Grasswood, SK
I take it that's $36 million per year over the next four years. I've done the division.
Who decides where that goes?
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
Maybe Keith will expand on that.
It's a formula that's based on population size and the remoteness. That's how the funds are divided.
Acting Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
Basically, yes. We work with our partners in each region and territory to look at the best way of allocating. It is a formula-driven process to ensure that there's some equity across the board. It's also to ensure that for the smaller communities, there's a base with at least one full-time home and community care nurse as opposed to half-time.
To go back to your earlier question, whilst nine to five sounds so black and white and so rigid, I don't think it's the reality in a number of communities. They might start at eight, end at four, or go into the evening, depending on the need. Robin can correct me on this, but I think another aspect that's important to note is that home care nurses work with the families. They work with the daughters and the sons and the aunties to help out on the basic administration of bandage replacements or what have you. It doesn't end at five, per se.
Again, the band determines, with their local health department, what the best regime is. They will adjust and be flexible. Nine to five sounds too “clinical”, or whatever the right word is. I don't think it's the reality in terms of what the communities want and need.
Generally, with the new investments you'll see a lot more mobility and flexibility in terms of design and hours. That's important to note.
Conservative
Kevin Waugh Conservative Saskatoon—Grasswood, SK
Thank you for that.
Who's responsible for the education? I just came up from Nunavut, and there are communities of 200 and 300 who can't speak a language other than their own. Who's in charge of training these people? We've often heard that language is a barrier, so it would be a big barrier in health. Who's in charge of the education aspect of training, not only for first nations but also Inuit, Métis, and other languages?
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
Who's responsible for the training of the people delivering the services in those communities?
Conservative
Kevin Waugh Conservative Saskatoon—Grasswood, SK
Yes. Let's say I want to be in Chesterfield Inlet, or heaven knows, with a population of 400.
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
With our home care program and with our regions, we have regional staff who would work to support the communities.
Conservative
Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Indian Affairs and Northern Development
Sure. Indigenous Services Canada has headquarters—that's us—here in Ottawa, and then there are regional offices. For example, in Manitoba it's in Winnipeg. Staff there are responsible for working with the bands and the communities that have been funded to deliver home care. They work with them to take care of the education that's required of the nurses, the ongoing education to make sure that they have the competencies they need to be able to deliver the services.
One thing Keith spoke about was the importance of hiring locally. Speaking to the language issue, you're more likely to be able to hire somebody who would speak the language that's spoken in the community if you hire locally. The region works with the band and the community to make sure that the individuals are trained.
