Evidence of meeting #111 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 data.
A recording is available from Parliament.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Thank you.
You talked about the need to change the definition of “assisted living”, that it needs clarification. Can you just tell us a little bit about what that means?
Director of Health, Mohawk Council of Akwesasne
Under the national assisted living guidelines, five levels of care were identified by the federal government back in 1983. Those indicate that type I care is the support of nursing care for under 90 minutes a day. Type II is for under two and a half hours per day. At type III, it jumps up to about five hours. At type IV, it goes to full-time requirements, and type V would be for those who require nursing care 100% of the time.
We need to look more at this because we've been provided a type I or type II facility, but we're giving the care of a type IV facility. With regard to type III, in today's world, we're actually talking about chronic care, and there's nothing in that system.... Bear in mind, when assisted living came through, departments were apart, and I recommend to the committee that it look at re-evaluating them.
Every province and territory has a different definition of levels of care. Some have four, and some have six. The reality is that you can't match them. We're faced with a multi-jurisdictional issue. There is a big difference between Ontario and Quebec with regard to levels of care.
The hardest thing for us is evident in that little map that you see over there. On the right-hand side is a white part, which is Quebec, and a couple of people from our community live there. However, we cannot service them simply because our qualified nurses are mostly from Ontario and are only given a special privilege to work in our community. In fact, there are a lot these standing orders. We've been very grateful that Ontario and Quebec have provided us with the opportunity to get special licences just to work in our communities, but sometimes that impacts the quality of care because we can't reach out to people. Because there's no housing there, we can't go out and service them. We have to send them through the Quebec CLSC network, and we have to make the arrangements with that.
NDP
Rachel Blaney NDP North Island—Powell River, BC
That's amazing.
Grand Chief Benedict, one of the closing comments that you made was about how we share the expertise that we've gathered. As a person who represents very small communities—and you represent a very large one—there is a challenge, and people don't know what's out there.
Do you have any ideas about how to share those best practices?
Grand Chief, Mohawk Government, Mohawk Council of Akwesasne
In our community, we have a very strong governance system, and I attribute that to a lot of the service delivery models, institutions, and partnerships that we have. I know that enough communities struggle with this. We have been telling indigenous services that as they look at transforming the way they fund communities, we are prepared to work with them to also provide support services for governance as well because through the health services we deliver, there's a strong support system around the institution that supports them. It's a very holistic approach.
To a large extent, our organization delivers programs under Jordan's principle, and has for a really long time. When you look at that map and consider some of the examples that Keith described, keep in mind that we cannot compromise safety and well-being based on where a person lives, and we cannot deliver two tiers of service based on where a person lives. It becomes our responsibility, as the Mohawk Council and as leadership, to find a way to deliver that service seamlessly. There's a lot of backroom work that happens in administration, politically, and from the governance level. That's what we offer to the government so that we can learn from one another and support other communities because indigenous communities helping indigenous communities is what we need.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Thank you very much for your very interesting presentation.
I just want to continue on the jurisdictional issue. You've highlighted, or you've mentioned, some of the issues going from Ontario to Quebec—actually, the nurses cannot go to Quebec—but are there any jurisdictional issues with the American side? I'm assuming that some of your reserve members live in the United States. What issues does that bring up?
Director of Health, Mohawk Council of Akwesasne
Most of the time, if there are services that are provided, we have to work on agreements with the American side. Our ambulance services have the capacity—and we have served in the past—to support the services provided on the American side. All of our staff are certified in both New York state and Canada, so we won't have any difficulties.
Again, the complexity, as Chief Benedict highlights, is when we have to bring somebody from one part of our country into Cornwall. The bottom line, again, becomes the issue of customs. It's the question of bringing it in, even on emergency. Up until now we've had a department of health for the American side, under the Indian Health Service. Weekly, I'm in a meeting with the person there to identify.... I've had good discussions with the director, Mr. Cooke, who is my equivalent. Our executive directors have spoken on many occasions, and so have our chiefs.
The question is how to give the best quality of service to our clients, but the bulk of our services and activities... I believe that just on ambulance calls alone, roughly 79% were on the Canadian side. The remainder were on the American side, but that's part of our mutual agreement.
Liberal
Liberal
Director of Health, Mohawk Council of Akwesasne
No. In the United States, they are covered under their own tribal system, so in fact they have their own governance system, whereas Chief Benedict is responsible for the entire Canadian portion. There is a separate portion.
Chief Benedict?
Grand Chief, Mohawk Government, Mohawk Council of Akwesasne
I think that sometimes we are challenged by our contribution agreements, which have stipulations for various things. We do work very hard with our partners at the Saint Regis Mohawk Tribe to find areas that we can work together on, but the end of the day, sometimes we're bound by the agreements we have with the government.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Okay.
In terms of demographics, do you anticipate, based on the demographic research that you've done, that there will be a wave of older citizens who are going to need long-term care in the future? How is that looking for your reserve?
Director of Health, Mohawk Council of Akwesasne
What we see right now is that this is going to be the trend. I don't think it's going to be as fast as the Canadian system, but the reality is that we've been very fortunate multi-jurisdictionally. We're hoping to develop something sort of like what we have with our public health. We have an agreement between the Government of Quebec and the Government of Ontario that administer that component, and there's actually cost-sharing, with Quebec giving to Ontario, to provide that. Immunizations and any outbreaks in any of our facilities are handled by those components. We have to keep on looking at who our partners are and how we can make it better so that we're serving the community. We're definitely not shy about starting up memorandums of agreement or finding ways to improve the service.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
You mentioned earlier difficulty in collecting data. I believe you said that when you asked—I assume it was the Canadian government—the person said it was too complicated. Do you have a general idea of what elements or variables you'd like data on?
Director of Health, Mohawk Council of Akwesasne
What I'd like to do is look at the indicators of the major issues in dealing with our elders. With the ambulance, where we do have a good system of components, the bulk of our elders are dealing with two major issues: respiratory and abdominal pain. If you think about these two components, do you know what they're caused by? Mental wellness and stress: “Who's going to come visit me? Who's going to help me get stuff?” These are the issues, and nobody's concentrating on them or looking at them. I think we're fortunate that we have the information and the data, but we're so small. I'd love it if you could recommend that the rest of Canada really start asking, “What are the indicators that make people well?” That I would very much appreciate, Mr. Vandal.
Liberal
Dan Vandal Liberal Saint Boniface—Saint Vital, MB
Okay. Good.
On home care, according to my briefing note, you have in-home nursing care—an entire home care program.
Liberal
Director of Health, Mohawk Council of Akwesasne
It's one of our nine programs within the department of health. We include not only the nursing care; we also provide the service for at-home care. In fact, we have an interesting challenge because of the distance. To go from the left-hand side of the area, where you have Cornwall, to the farther tip of Snye, which is on the far right, that's roughly a 35- to 40-minute jaunt.
When we send out our nurses, we usually have to identify who's going to be covering off in what district. The bottom line is that we have limited resources. Financially, we can locate additional people to provide the services, but we're going to manage with what we have. We're going to be able to provide the best service we can, but we definitely are looking at how we can do a good analysis to be able to show those activities that are being done.
If you look at the home care results right now, what are we talking about? How many people are there? What is the percentage of time per person? Those are good, but it doesn't give any indication of what the major issues are. Are there problems right now with potable water? Are there problems with rats and rodents? What exactly is the leading cause of the diseases? Those are the things that I would like to see worked on, and I recommend that this be considered when you develop your proposal.
Thank you, Mr. Vandal.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
First of all, thank you for a very informative presentation.
As I look at that map, I think of how it would be easier just to move the lines than to deal with what you have to deal with every day. I just can't imagine those jurisdictional challenges that you've faced for a long time. I also really welcome your invitation. Hopefully, either our committee or even some of us individually can come out at some point and have a look at what you're doing out there.
Here's the first area that I was wondering about. We've come to this data issue a few times. I can remember that in British Columbia the care cards had some identification, so for first nations there was the ability to collect data related to care cards. Then there was a really big concern amongst first nations in terms of the government collecting data.
How do you do that respectfully? I hear your interest in having data in terms of what you do, how you do it, and how you deliver it, but I'm not sure that you want the government doing that. Has there been any work around the development of some kind of first nations institute for data collection? I know that it was a very sensitive issue in British Columbia. Are there any comments on that particular area?
Director of Health, Mohawk Council of Akwesasne
I'd be more than happy to share with you, Mrs. McLeod, that one of the things we believe in for first nations to function is the concept that for any data, the ownership, the control, the access, and the possession should remain with the first nation.
The bottom line that really comes out is that is if somebody is collecting it, a protocol should be prepared and identified. If you're giving a person the responsibility of carrying out information gathering, right now what we expect is a clear delineation of what it's going to be used for, what's going to be the result, how the community will be involved in the analysis, and how the community will be involved in the dissemination of that information.
Once that's over, we expect them to ensure that all of that information collected by outside researchers is totally returned and the property remains within the community. Part of the agreement we sign, if we have somebody on the outside coming in to do it, is that they have to give all of the data back to us so that it's safe, and they are to delete anything that's in their records.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
If it's not related to research and more for your planning purposes, do you see it being done at your council level or by a broader group of first nations coming together? Can you drill down a bit? Have you done anything on that?
