Indigenous and Northern Affairs Committee on May 24th, 2018

[Romeo Saganash, NDP, Abitibi—Baie-James—Nunavik—Eeyou, QC]

One of the important considerations for these types of services relates to rural and remote communities. Services there are lacking, definitely. Is there a plan to that effect as well?

I'll give you an example. The nutrition north program applies to communities that are isolated and not accessible by road. That program specifically applied to those communities. Are we thinking along the same lines in terms of the services you're talking about?

[Keith Conn]

I'll take a crack at that. Thank you for the question.

From my experience in listening and working with a number of communities across the country around the issue of long-term seniors care, I think it's safe to say, and a number of them have also said, that depending on the size of the communities and the location, it's not feasible to have a long-term care facility in each and every community, obviously. Where there is critical mass, it might make sense.

For example, in Ontario—and I hate to use Ontario as an example continually, but it's my experience—Wikwemikong is a large community on Manitoulin Island. Also, Six Nations obviously has a sizeable population. Oneida has a really wonderful facility, with both indigenous and non-indigenous patients, as does Akwesasne, of course. They have the critical mass to have the business case to have a facility in those communities. There might be others.

From what I'm gathering, people want to look at different options and modalities—a hub and spoke model, for example.

Think of Sioux Lookout, for example. There is a high population of northern indigenous Oji-Cree community members in and out of Sioux Lookout, or living there. At least they would have more accessibility if they had a long-term care facility, which is what they're promoting right now. The Town of Sioux Lookout, the Sioux Lookout First Nations Health Authority, and a number of the chiefs have been looking at a model that could serve northwestern Ontario.

I think it will have to be nimble and will have to be innovative in terms of different approaches for rural and remote communities. It's the issue of accessibility, however. We have many fly-in communities and not everybody can afford the air flight.

[Romeo Saganash, NDP, Abitibi—Baie-James—Nunavik—Eeyou, QC]

I asked the question because when you spoke about the gap that needs to be filled, you mentioned in your presentation some of the barriers that exist. What are you doing to address those barriers at the moment? That's why I used the word “plan”.

[Robin Buckland]

What are we doing to address the barriers? Probably the first thing I'd like to say is that one thing we're trying to do in terms of the continuum of care is to make sure that we're investing to allow community members to stay in their homes as long as they can and as long as they want to—in their homes and their communities—but in instances when that is no longer possible, we're trying to make it a little bit closer to home.

Through the work we're going to be doing looking at long-term care over the next couple of months ourselves, we're hoping to be able to better articulate what the barriers are, and with our partners and community members, identify what the solutions are. That's the approach we're taking: trying to find out from community members what the issues are—some of them are known and some of them we may not know—and then identify the best solutions to meet them.

My hope is that over the next couple of months we'll be able to better answer that question and better determine, with our partners and with first nations, how to address these issues.

[The Chair, Liberal, MaryAnn Mihychuk]

Questioning now moves to MP Gary Anandasangaree.

[Gary Anandasangaree, Liberal, Scarborough—Rouge Park, ON]

I'll defer to MP Harvey.

[The Chair, Liberal, MaryAnn Mihychuk]

We will switch up and move to Mr. T. J. Harvey.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

Thank you, Madam Chair.

Thank you, witnesses, for being here.

I want to start with talking a bit about this idea of institutional care in terms of level 3 or level 4 long-term care. What has been the determined threshold for the size of a community, numbers wise, that it would take to sustain a facility like that?

Normally, I know in New Brunswick, which is where I'm from, you need to have a population centre of 4,000 to 5,000 people with an outlying population to support a facility of that size. What is that number that you think will work, and then how does that look? Is it a combined facility that takes into account assisted living and then level 3 care and level 4 care as a total overarching approach to end-of-life care, or is it different conceptual models that will work within a community or group of communities? How do you see that?

I'm really concerned about the viability of building facilities. It's great if communities can afford to build the facilities on their own. I know there are some communities that have chosen to do so, but just because they've chosen to do so doesn't mean it's necessarily a viable option. Of course, in New Brunswick, we have the exact opposite problem. Except for indigenous communities, we have a declining population. We're building for the top of the bell curve knowing full well that 15 to 20 years from now, the older of our long-term care facilities are actually going to be decommissioned or turned into something else because we just won't have the population we need to sustain them. Could you just speak on that?

[Keith Conn]

I'll do a quick thing, and then Robin can do it. That's very interesting.

The viability in my humble estimation.... For example, the long-term care facility in Oneida in southwestern Ontario has a mixed model, i.e., it is long-term care living, assisted living, and level 3 and 4 institutional care. They have a mixed portfolio, if you will use that term, to make it viable and sustainable.

I think the same principle applies to the other facilities I mentioned earlier. It's mixed. It's not all level 3 or 4. That just doesn't make sense for that population locally, but there is also a catchment area that they're trying to serve. Obviously they'll need to look at the diverse needs within that catchment area to make it viable and sustainable, and it has worked obviously for a number of years. But again, those are exceptional, high-population communities. I think we need to look at some variations in approaches for sure.

Robin.

[Robin Buckland]

I don't think I have a lot to add to that. I think that it really makes sense. Certainly we've heard from some first nation communities who are thinking about the opportunities in building long-term care facilities where they're not just serving first nations. So there's a business opportunity too for first nation communities. I think that the models are from A to Z. I think we can look at the possibilities. Again, the most important thing is first nations determining what's best to meet their community's needs. I think there are lots of opportunities.

[Brenda Shestowsky]

Yes, I would agree with that. I think we have seen already a number of different models across the country ranging from those that are really built on a business model where communities serve off-reserve populations as well, and mainstream populations, so I think there are different models. As my colleagues have said, it really depends on the communities and how they see their populations projecting out and growing and what their needs are.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

I wanted to touch on something quickly that MP McLeod had mentioned earlier around accessibility and the idea of keeping people in their homes as long as they so choose.

I know my family had that opportunity. My grandmother wished to stay in her own home as long as possible, and she was able to do that for about five additional years by making a few simple upgrades to her home. One thing that we've talked a lot about in this committee is housing on reserve and how we should be building housing on reserve with accessibility in mind, so at the very least a minimum of visitable housing. This is the idea that every home that's constructed meets the criteria to have zero-barrier access, wider doorways and hallways, and a ground level washroom facility so that we can plan for the future and allow people to stay in their homes.

I'm wondering if that's something you feel should be taken into consideration and how that could be approached with the communities looking to build housing, because we know that there is a significant need within a lot of communities to build new housing. Maybe it's something that should be suggested or thought about in terms of the long term.

[Keith Conn]

That's a really great question, because first nation leaders, through various fora, discussion documents, and resolutions have called for affordable safe housing for seniors and the elderly in communities, and on those very points of accessibility and non-barrier homes, etc. Communities have taken initiatives as well in terms of developing seniors' complexes or elders' homes. They have all kinds of terminology for it, but it's exactly that.

I think it's certainly something that we should be looking at in terms of a larger, holistic approach to housing. It's not just about long-term care. It's about adequate and safe affordable housing for seniors. This has come to us directly from communities in terms of the need to look at that.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

Even from a non-indigenous standpoint it's something that just makes common sense. One of my best friends is a C5 quadriplegic. You would never know that he was in a wheelchair unless you met him. His home has been constructed in such a way that there's zero-barrier access.

The point is that if we construct homes the right way at the point of construction, there is no significant cost but the long-term benefit to those communities is immeasurable because it's going to allow so much more flexibility.

[Keith Conn]

Exactly.

[TJ Harvey, Liberal, Tobique—Mactaquac, NB]

That's it.

[The Chair, Liberal, MaryAnn Mihychuk]

The questioning now moves to MP Viersen.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Thank you, Madam Chair, and thank you to our guests for being here today.

On assisted suicide, that was one of the first bills we worked on when I got here. Do you keep any records as to how that's affecting our first nation communities?

[Robin Buckland]

That's a tough question. In terms of medical assistance in dying, certainly it's quite obviously a delicate question.

From a home care perspective—recognizing that it's the area I'm most directly responsible for—the way we have been looking at it within that program is in terms of the importance of making sure we have good investments in palliative care and end-of-life care prior to having the discussion about medical assistance in dying.

I guess I don't have an answer for you, other than to say it's a question that we need to explore further and talk about with our partners.

[Keith Conn]

In all my privileged travels in this country, I have not heard of any requests for or intervention in supporting an individual in community for medical assistance in dying. I'm not aware of any particular requests. If I had, it would certainly be out there, to be honest. It would be like, “Pardon me...?”

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Yes, because we've heard that....

[Keith Conn]

Palliative care is the way. We've been directed by the communities that we need a strong palliative care program for dying with dignity in the community, with family.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

I'm glad to hear that.

You were mentioning that there are several on-reserve facilities already. How does a community go about acquiring the necessary funds to start one of these? I have 14 first nations, and I know that a number of them.... One is 200 kilometres from any major centre and they've been petitioning the province in particular to help them build a facility. Are there funds available through one of your streams?

[Keith Conn]

Do you want to take a stab at that, Robin?

[Robin Buckland]

No, you go ahead.