Indigenous and Northern Affairs Committee on May 31st, 2018

[William Amos, Liberal, Pontiac, QC]

Thank you, Grand Chief and Mr. Leclaire. We really appreciate this testimony. It's eye-opening and really does help us to understand an alternate reality that the vast majority of Canadians don't experience.

I really just want to give you more of an opportunity to talk about the long term, not just about what needs to happen in the next year, three years, or five years. Where do you see long-term health care, and health care more broadly writ, for the Akwesasne community in 10, 20, 30, or 40 years? How does that evolve? What is the vision?

[Grand Chief Abram Benedict]

I think that as we know, in all populations statistically, the population continues to grow whether it be indigenous or non-indigenous. As Chief Maracle testified earlier, housing is a huge component to our communities, including our own. From a service delivery perspective, we outlined that the capital needs are huge as well because the facilities we maintain and operate also have aged and continue to age. We need to be able to meet that need and continue to deliver a service that's expected of us, that's required of us, and that our community expects.

As the government starts looking at ways to transform contribution agreements, looking into flexibility, this also applies to the health care sector as well, because sometimes we end up reporting on things that are probably not all that useful anymore.

We talked about data. Our organization is very large, with eight departments and $100 million in services, but it's sometimes difficult to collect all that data together. It's an engine, though, that does exist to be able to do that. I'm looking at supports. I know other communities have them as well. As we look to grow as an organization, we look at innovative ways to be able to pull that data together, to be able to innovate our services, meeting our accountability and transparency requirements of our funding partners as well as our community—which is absolutely important to us—but also having the flexibility that we need in these long-term agreements as well, for sustainability.

Those are some of the high-level concerns. We know that our community continues to press upon us to provide seniors housing as well as facilities, long-term care facilities, whether it be chronic, acute, or just simply living facilities. As we continue to grow as a community, we continue to plan for this. I'll look to add a bit more on the program delivery side, but that really is the high level of where we're going, our vision, as a community and as a service provider to our people as well.

[Keith Leclaire]

I'd like to also share too, Mr. Amos, that one of the things we look at is culture as the foundation of our health development. For long-term care, we believe in capacity building, having our own members to be able to carry on that activity.

Normally one of the things that we find is that most people don't understand that when we're speaking our own language to give an explanation about what diabetes is. You cannot do that unless you have a thorough understanding from a medical perspective. The definition for diabetes is “you have sweet blood”. That implies something positive. We have to keep on looking at these things. We have to be relevant. The bulk of our elders still speak our language, and we have to make sure that we can accommodate them to understand some of these realities.

The other thing that we're looking at too is the wisdom of how we can pull out additional access resourcing, especially through knowledge. The enhancement of our health programs is going to be done three ways: with improving our knowledge, with improving our skills, and with improving our attitude on how we give service to our community members. A lot of the times, we get mixed up with the numbers. However, the reality for long-term care is that we have to remember that those people who are coming in are in tsiionkwanonhso:te. They're in our home. They're akhsó’tha. They're our grandparents. That's the connection. I can tell you right now, the bulk of our staff are first nations, and the majority, 90% of them, are from the community of Akwesasne.

I hope that answers your question, Mr. Amos.

[William Amos, Liberal, Pontiac, QC]

That's very helpful, thank you.

What role do you see for traditional knowledge in the development of long-term health care planning in your community?

[Keith Leclaire]

Traditional medicine and traditional healing approaches are more extensive, and you get more value out of those than you do if you were to look at simply a dollar sign. The reality is that we need to socialize and make sure there's stimulation of our elders to ensure that they can stay home. Our goal is to keep our elders at home, and we're doing that. The issue that comes up, though, is when the time comes when they require more care.

The reality comes out. How do we do it? They go to these facilities that are in our community, are very community friendly, and use the same language. Most of the people in there are people you've grown up with, you've lived with your entire life. It's an extended family component. That's a priority of what we have to do in other first nations, to keep this going.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you.

The questioning now moves to MP Kevin Waugh.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

Welcome. I want to thank you, Grand Chief Benedict, for your presentation. It was very good. And you too, Mr. Leclaire.

This is an interesting topic, this long-term care on reserve, because when we go off reserve—and I have a number in my city of Saskatoon—all we get now is foundations. They are out of money. The provincial government isn't giving them any more so now we have a pyramid of foundations. They're always fundraising. What do you do?

There are eight facilities in my riding alone. Everyone has a foundation. Everyone is raising money. The provincial government is giving them less, and they have to go out and raise money.

How do you raise money? Do you have foundations? Do you have pyramids where you can go out and partner and all that?

[Grand Chief Abram Benedict]

On occasion we do hold bake sales and things like that, but they don't amount to very much, maybe the fuel for the bus to go to the park or something.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

You know where I'm coming from here, though.

[Grand Chief Abram Benedict]

One of the things we're fortunate to have.... The Mohawk Council is a delivery agent for a number of services in partnership with the federal and provincial governments. We deliver a lot of programming. The long-term care facilities are facilities for our elders, and they are a huge priority to our community. They are our elders. That's where we began. They are the knowledge keepers. They are the language keepers. We have the ability to be able to support the facilities a bit more than if they were stand-alone facilities.

By integrating some of the services that may come into the facility, whether it be though another partnership with Health Canada or a partnership through the province, we are able to support one another through a holistic approach.

Not all communities have the ability to do that. There are shortcomings. By far the capital is one of the areas we face a challenge with. Is our facility generating profit? Absolutely not. Is it supposed to be? No. Is it breaking even from the contributions? No. Is it because it's a priority, and we have the ability to finance it other ways? Yes. We're able to do that.

That's how our community can, but for facilities that are stand-alone, it's very challenging. It comes down to community priorities. If a council is running a long-term care facility, and it's between shutting the doors in a long-term care facility or providing new homes, sometimes it goes into continuing the facility to operate.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

I would think you're way above the national average. I've counted over 100 beds you have, including one facility that was built in 1990, which is 20 beds. Now you have gone from set funding to block funding. What's the difference?

[Grand Chief Abram Benedict]

I think it's the flexibility that exists within that, but, again, to my earlier comments, it's only flexible to a certain amount. I know the federal government is looking at grant-like contributions for longer periods of time. Those sorts of initiatives will give the community a better ability to plan longer term and to be able to prioritize longer term.

Block funding has assisted to a certain degree, but it's not the answer to keeping the fundraising from happening.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

Mr. Leclaire, you have talked about culture, about foundation, which is very important. We are looking at long-term care on reserve. In my province, we always want to ship them out of their community. We have the first plane on the runway, to bring them to Saskatoon or Prince Albert. That's probably not the right answer, but that's what's happening in our province right now. It's a different culture. I don't think we're there yet in my province.

How do you do it? You're working with Quebec. You're working with Ontario. You have the border.

[Keith Leclaire]

We believe in partnerships. If we have an issue, we are going to identify that issue. We're going to find out the trigger; why is this problem arising? Then we're going to look at the basis: what causes it?

You gave a good example when you described that everybody in Saskatoon was asking for money and they have all these foundations. If I were in your shoes my question to them would be: what do you need the money for? Because you have so many small groups, maybe there is a need to do what we have done in Akwesasne—come together and prioritize the need, and then work on that.

I'm very proud to say that we run ambulances, and the reality is that when we needed a new ambulance, our community came through and provided over $200,000 to be able to purchase a new one and to give the best cardiac monitoring machines to go into each one.

We can sit down as a group, and we can haggle. Sometimes it's longer than days, but once we come up with the priority, we come with one mind.

When I talk about a cultural perspective, as the Mohawks of the Gayanashagowa, we believe we're following what's known as the Great Law of Peace, which indicates there are five main tenets that we have to follow in our daily lives. One is peace: we have to be at peace with ourselves and at peace with others; we have to have respect: respect for ourselves and respect for others; kanikonriio,which means we have to be of good mind and we have to come together because we know we can't solve it, and if we can't, we're going to get stuck, and we're going to be in our own areas; the fourth tenet is being responsible: we know our responsibility and how the other people we're working with have to be responsible; and accountability: every government has it and that is one of our main tenets as well.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

We just heard about this ambulance. How much does it cost your reserve to use the ambulance? That is an issue on every other reserve in this country.

[Keith Leclaire]

Every province provides funding in a different manner. If you're on the Quebec side the charge is a $125 flat rate to leave, and it's $1.85 or $1.90 per kilometre to get to the closest health facility.

[The Chair, Liberal, MaryAnn Mihychuk]

Sorry, we've run out of time, Kevin.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

That would have been a great answer.

[The Chair, Liberal, MaryAnn Mihychuk]

Let's conclude with the great answer, and then we'll move on. I don't want to shortchange Rachel.

Do you want to complete?

[Keith Leclaire]

Maybe I can just follow with the ambulance. The most important thing I want the committee to know is that last year we had 156 ambulance calls in our community, and 48% of them were for elders 65 and over.

I challenge everybody here to ask those ambulances that service the communities of other first nations, what is that level? I think one of the things is that we're talking here from a federal perspective, but we don't have the information from the provinces because all of them are provincially run.

I challenge Mr. Waugh to take a look at that.

Thank you, Madam Chair.

[The Chair, Liberal, MaryAnn Mihychuk]

MP Rachel Blaney is next.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you so much for being here with us today. I appreciate your presentations and the information you're sharing.

One of the things you both talked about was the preventative method, and that we need to be looking at how we're going to see more prevention. It came back to that part of how we have that support to collect data.

I represent over 20 very small indigenous communities, and that is a huge challenge. Anecdotally they can tell you a lot of stories, but meaningful data collection is just not there.

I'm wondering if you could tell me a little about why you feel they said it was too complicated, and whether you have any thoughts on what data we need to collect.

[Keith Leclaire]

Most of the time if you speak to an epidemiologist and people who are looking from a research perspective, research dollars are usually very generalized in the number of years they can do it.

The last time anything was done specifically on diabetes for first nations, I think it was done under the old national health research and development program in the early eighties when there was a five-year study. Every other one since then has only covered two or three years. I think the bottom line that comes out of it is, where do we go forward?

We need to ask what the indicators are for prevention to succeed. Most of the time, the indicators we're collecting now are more financially related so we can share with the government, obviously through Treasury Board. At the provincial level it's the same thing.

Maybe we need to think outside the box, and look at a way that it can be done so it can be much clearer. That's the point we're looking at right now.

I'll go with another good example. If we look at home care and home care services, what are the indicators? The indicators are: how many people they went to; how many people they saw; and how many times they went to see them. My only concern is, what are they going there for; what is the issue; and what is the general state of health of that individual elder? That's not really accommodated because we're more fiscally accountable than we are to the best case management of the individual's health.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

The other thing I have a question about is caregiver burn-out. I'm just wondering about the challenges that you face with respect to people who do caregiving. We heard stories from the last witnesses, and this is a growing concern, so I'm just wondering if you could share a little bit about that.

[Keith Leclaire]

One of the very fortunate things about our community is that of our five physicians, two are first nations and they understand the language. They do home visits as well, along with our home care nurses.

We need to do this: if there is a problem and they're starting to burn out, we will pull them into our elders lodge. We know that's an excess burden on our staff, but we feel it's important. We can bring them in for either the weekend or a short period of time, upon the approval of the physician, and we ensure that we have the staff to take care of them.

Bear in mind that when it comes to respite, we're bringing somebody in who's already being followed by the home care nurses and a physician, and it's on the physician's recommendation. It's not for the individual care of the elders; it's for the individual care of the caregivers, the family members. That needs to be looked at more because, again, we're too focused on.... We have to think outside the box, and that's what we do in Akwesasne.