Indigenous and Northern Affairs Committee on June 5th, 2018

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Thank you. I wish I had more time. I have a lot of other questions.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you so much for coming out. We appreciate it. Meegwetch.

We'll take a short break and then reconvene with our second panel.

[The Chair, Liberal, MaryAnn Mihychuk]

Welcome, everybody, to our panel. Today we're talking about Alberta, and earlier about Saskatchewan and Ontario.

We have an hour to discuss long-term care. We have folks on our video screen who are looking much more HD than Saskatchewan was. That's what we were laughing about. You're looking very good. You'd never know it's snowing in Alberta. We have two live people here in Ottawa, and we're very happy to have you too.

We will start with the folks on our video conference, and then you can figure out how it goes after that. At the end, the live people here will conclude.

Normally we give you 10 minutes, but if you take a little longer, we'll be liberal about it because we have three groups in front of us.

Go ahead.

[Jeff Anderson, Chairman, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788]

Thank you, MaryAnn, and good afternoon to everyone.

My name is Jeff Anderson. I am the chair of the Fort Vermilion Seniors' and Elders' Lodge Board 1788. With me on the telephone is Chief Rupert Meneen, chief of Tallcree First Nation, a critical partner of our board, and sitting before you is our treasurer, Mr. Bill Boese; and Natalie Gibson, our researcher and adviser.

It is absolutely an honour to address the Standing Committee on Indigenous and Northern Affairs on the important topic of seniors and elders care.

For over 10 years, the community of Fort Vermilion has actively advocated for a designated seniors live-in care facility in the Fort Vermilion area. We wish to advise of the long-term, unmet need for seniors and elders care beds in the Mackenzie region of Alberta, especially when considering the needs of one of Canada's fastest-growing demographics, the indigenous population.

Our board and first nation partners are requesting that the Government of Canada work with the provinces to meet the needs of those in rural, remote, northern areas that are under-serviced. This includes more than just long-term care. It includes support services that affect one's quality of life.

We have all of the studies showing the need, yet nothing has occurred to date.

In 2014, the Alberta government partnered with Mackenzie County to conduct a regional housing needs assessment study. This $100,000 study determined that there was an existing and projected need for an additional 117 to 200 care beds for seniors between the dates of 2014 and 2031 in our region. It was recommended that eight to 13 assisted-living beds were needed in Fort Vermilion immediately, in 2014, four years ago, and an additional 14 to 24 beds by 2031. In 2031, the population of those who will be 65 years and over is expected to increase 123.8%, to an estimated 2,417 persons.

Since 2014, the inventory of 122 designated care beds in the Mackenzie region has changed only slightly, with the addition of four care beds in 2017. Currently, all designated supportive living facilities in the region are 100% full, and the DSL waiting list is up to two years. In addition, the facilities do not recognize the unique cultural diversity of the region. Seniors are forced to stay home longer, or they have to go out of the region for supportive care. As our people are staying in their homes longer, we encounter other challenges.

We also have a shortage of health care practitioners. We have reports of local nurses not having been able to take holidays in the last two years.

In rural and remote regions, health care services are much more difficult to access. Seniors close to urban centres can hail a cab to go to buy groceries, or a handi-bus to reach a doctor to refill a prescription. In our remote communities in northern Alberta at times, seniors can't even call 911 in an emergency due to a lack of cellular service.

As a group of passionate volunteers, we have formalized the Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788. In your briefing notes, I invite you to see 10 bullet points outlining our progress.

In summary of those bullet points, the board of 13 includes four appointed directors, one from each of the Dene Tha' First Nation, Tallcree tribal government, Beaver First Nation, and Little Red River Cree Nation. Along with our partners, we have fundraised over $200,000 through a community thrift store and donations. We have had land donated, and we have access to two other pieces of land that we can access to build a facility.

We are working hard to build awareness that the standard formulas used for assessment and tracking of health care needs and supportive services do not work well in northern remote communities. We are now part of a large cross-ministry strategic task force with provincial and federal departments, to discuss the gaps in information and service provision. To date, the task force has met three times on three separate calls, with no outcomes yet.

To give a little understanding of our area, in your briefing notes there, we're part of what's called the Mackenzie County. It is the largest geographic county in Canada, about the size of Prince Edward Island. On page two of your briefing notes, you can see the eastern reserve of Garden River. It is approximately two and a half hours to travel to the St. Theresa General Hospital located in Fort Vermilion.

From Fox Lake, just a little south of it there on your map, via a barge, it's three to four hours to get to Fort Vermilion. High Level, which is towards the left of that little map and in the centre, has a hospital and a proposed lodge with a 25 DSL room project under way. Even with that new facility our needs are far from being met.

[The Chair, Liberal, MaryAnn Mihychuk]

Jeff, I wanted to let you know that we actually don't have your presentation. It's still in translation. We don't have your map, but we're imagining. We're there with you, Jeff.

[Jeff Anderson]

Okay, it looks like this. It's right about here.

[The Chair, Liberal, MaryAnn Mihychuk]

That's the ticket. That helps a lot.

[Jeff Anderson]

I'm sorry, MaryAnn. I emailed that out to Mike this morning.

[The Chair, Liberal, MaryAnn Mihychuk]

Keep on going. You have another four minutes.

[Jeff Anderson]

I thank you for that. Actually, your timing was impeccable. That was the end of my piece for now. I'd like to hand it over to Chief Meneen. He had a few words he'd like to say.

[Chief Rupert Meneen, Tallcree First Nation]

Good afternoon, all. Thank you, all, for giving us this opportunity here today.

My name is Chief Rupert Meneen. I'm from the Tallcree Tribal Government. I have been part of this group for the last 10 years, working on this culturally inclusive facility that we're talking about.

I'm one of the four chiefs who form the North Peace Tribal Council, which includes the Dene Tha', Tallcree Tribal, Beaver First Nation, and the Little Red River Cree Nation. We represent a population of approximately 7,500 on reserve and almost 4,000 off reserve, many living within the Mackenzie region, and including the Métis population. Over 40% of the Mackenzie region is indigenous.

We have a dire situation in the north. We have elders who are in overcrowded homes and are not being afforded the opportunity to live out the rest of their lives in a place where they don't have to cook or fight for a bed to sleep in. They do not and will not move into a facility with unfamiliar surroundings that is out of their home region and away from loved ones.

We have elders in long-term beds in our hospital because there are no supportive living beds for them. Our elders and spiritual leaders are respected in first nations' communities, and I feel that it is my job as a chief to do what I can to make sure they are treated with the respect that they deserve.

It used to be that the younger generation would care for our elders, but now with the social crisis around addictions, opioids, housing shortages, and unemployment it has created an environment where the younger family members can't care for our elders.

We think it is important for this standing committee to look at the broader picture of the actual needs for care within our region. Long-term care is one component. Another is home care. Another is housing. I am in support of a culturally inclusive facility right now based on our infrastructure. The location is best-suited to be within Fort Vermilion. We live in rural and remote areas where health care is challenging, so health care includes both the facilities and care prior to entering the health care system.

Our life expectancy is lower in the north than in many other regions due to poor socio-economic conditions, and residents need seniors' lodges 10 or more years earlier than the non-indigenous population. The reason we are getting overlooked so much is that the data between Alberta Health Services and Health Canada is not captured or tracked in the same way, and the funding formulas are largely focused on urban populations.

What we want and what is needed right now, number one, is for the Government of Canada and the respective provincial government to get on the same page in gathering and tracking data in rural, remote, and northern communities. Number two, there should be several business cases, including one in Fort Vermilion, that review public-private partnership to deliver culturally inclusive health services. Number three is to build capacity, train the people needed to build the facilities and to staff, manage, and support seniors' and elders' care.

Again, I want to thank you, all, for allowing us to present on this much-needed facility. I thank you again for allowing us this time with you.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you. Meegwetch.

Now we're over to the two of you.

Natalie.

[Natalie Gibson, Research and Advisor to the Board, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788]

My name is Natalie Gibson.

I'd like to reiterate what both Jeff and the chief said regarding the data. The Mackenzie regional housing strategy was done. Our needs assessment was done four years ago. It stated there was a need for 117 to 200 beds in the region, and it still continues at this stage, four years later.

When we started looking at the data, we noted that Health Canada and Alberta Health Services data were different in measuring, and as well, the Statistics Canada versus municipal affairs data for the region were out by as much as 2,000 people. This comes into consideration when you use the funding formulae that are based on population, and also the indigenous population is measured in quadrants of three age brackets versus seven to 10 in the general population.

The big statement here is that we don't know what we don't know. When we get asked by provincial and federal governments how many beds we really need, to look at a flexible model in today's market, we don't really know.

The other big issue, as Jeff mentioned, is workforce in the region. Approximately 40% of the population—where we can track the numbers—is in long-term and supportive care and maintenance. As far as the 13 reserves or four first nations are concerned, we have very little data to go on to amalgamate as a region. As the chief mentioned, whether it's on reserve or off reserve, we think as a region. In the Métis population, there are more than 1,000 indigenous people living within the community and, of course, the community of Mackenzie as an area as a whole.

I have a lovely little table to illustrate, when you do find the briefing notes. That gives an indication that there are 450 to 500 people already in home care. Within-home care is the next step to maintenance in the health care system. It's in that particular area where we're short of staff—health care aides, nurses in general. Also, when it comes to the responsibility, we've met with the province on more than one occasion, as well as here in Ottawa, and we find that this particular lodge is being passed from person and jurisdiction to jurisdiction. As the chief mentioned, we need to partner on this, so we're looking at innovative ways for a public-private partnership to give the opportunity for seniors and elders to age gracefully in place.

[Bill Boese, Treasurer, Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788]

Hi. My name is Bill Boese. I guess I'm the story they're talking about. We moved to Fort Vermilion in 1963. I grew up there. My parents started a farm up there. When they retired, they had to go south for health care reasons. With no options up north, they ended up in Red Deer.

I don't think a lot has changed. Several facilities have been built up there since then. They're full. They're extremely hard to get into and it's still happening. The aging parents of a number of my friends are still moving away to live in care facilities. That's what happens up there.

There are dozens of stories such as my family's, and I expect an even higher number on the first nations. They don't want to move away from their family, or their cultural roots as well.

You don't have our notes and we have a few things listed here, so I'll read them out in conclusion.

We recommend the establishment of northern metrics with quantitative and qualitative data that truly reflects realities in northern areas and its specific needs, to promote a sustainable, culturally and gender-sensitive designated senior living facility, especially for the numerically dominant local first nations and Métis people. The Government of Canada should work with their provincial counterparts to actively collaborate to standardize the core datasets and ensure accurate regional data by including northern metrics with a focus on unmet needs and underserved populations.

For the development of a Fort Vermilion and area culturally inclusive DSL facility, a cross-ministry partnership task force should develop a business case with the relevant northern metrics, providing staff with accountability and authority to make decisions in the direction of expanding their circle of influence as opposed to referring responsibilities to other departments. The business case would provide scenarios on a culturally inclusive facility that promotes sustainable, culturally and gender-sensitive DSL facility development, especially for the numerically dominant local first nations and Métis people. The business would include innovative public and private partnership options and incorporate employee retention and attraction strategies.

We would like to be one of the 100 recipients that Mr. Keith Conn referred to in the May 24 meeting in which he mentioned a grant-like arrangement for a 10-year period to respond to community needs based on their priorities. The business case would consider economic development options within the facility and/or with service provision options. The business case would include options to provide the right level of service at the right time for the right patient.

Address the gaps in information data. We need a solution to resolve the immediate need for a DSL facility in Fort Vermilion.

Third, to build capacity in the health care workforce, there is a strong need for federal and provincial governments to increase commitment for training and outcomes in rural and northern regions. Employment attraction and retention can link to entrepreneur development by privately providing services.

We have a good example of that up north right now where an entrepreneur has gone out and is building ready-to-move houses. They're being built by people on the reserve to be moved back onto the reserve. That's a really good example of what could happen if we can do it.

Additional training can support first nations' capacity to efficiently deliver health care in their communities.

Lastly, the quantitative direct benefits would be datasets relevant to the region; strategies to incorporate traditional and non-traditional partners into a sustainable facility; a sense of local ownership, employment, and entrepreneur development opportunities; a sense of indigenous pride by incorporating inclusive values in the facility and study development; and promotion of aging with dignity and the promotion of the Fort Vermilion and area DSL facility as a model for other isolated or remote rural northern Canadian communities.

In addition, opportunities exist to develop partnerships with the private sector for corporate funding and branding, and with regional community colleges offering skills training in the required jobs.

[The Chair, Liberal, MaryAnn Mihychuk]

That's very good. Thank you very much.

We're going to start the rounds of questioning. Again I remind you to direct your questions to whomever you wish to speak to.

MP Will Amos will start us out.

[William Amos, Liberal, Pontiac, QC]

Thank you, Madam Chair, and thank you to all our witnesses. This is a really great set of presentations. It's helping us understand some of the needs, particularly in more isolated communities.

Chief Meneen, what are you hearing from elders in the community? What do they share with you about the needs, about their needs as they age, not just in relation to the hard infrastructure that might be necessary but in terms of the way they want to live, the way they want to age in their communities? What's your view on the best way that the federal government can support that?

[Chief Rupert Meneen]

I think in our culture our elders love being around their grandchildren and their children and just being a part of their family and included in everything that goes on. I think that having to move away from our communities to be two and a half or three and a half hours away where they're not part of the family anymore.... As first nations we are brought up to be one big family, so I think if they can be near home, where the parents, children, and grandchildren can still visit and be part of that, then as the elders age, they age gracefully.

I think it is important, from what they are telling me, that they be in a culturally inclusive facility that includes foods they like and where they can be part of a group of people who they can intermingle with, because our culture is all about talking, laughing, and visiting. That's just the way we are. I think having that facility where they can live their lives out that way is very important and having this group of people around me—with Jeff, Bill, and Natalie—and being able to bring that facility in.... Also, there are the Métis and not leaving people out. Our culture doesn't leave people out. It's including everybody to be part of this.

I think it's very important to have this facility, especially in our north country. We see the big need and our elders see the need, and they push us to be able to try to get this facility happening.

Thank you for that question.

[William Amos, Liberal, Pontiac, QC]

Thank you.

What are some of the things the federal government might wish to avoid doing as it considers the report we pull together? We'll take evidence from all across the country, from indigenous groups from coast to coast to coast. I'm sure there have to be some good suggestions around how you don't want the federal government to move forward with long-term health care if it determines that this is the direction it wants to pursue.

[Chief Rupert Meneen]

I think what I see as a first nations person and as a chief is that usually we are told how to do something. I have been telling the ministers that we want to be included in the planning and talking stages on what this facility should look like. We want to be a part of it, we want to build it, and you should just let us build it. It will follow whatever it is we need to follow, but don't tell us how to build it. We will build it.

[William Amos, Liberal, Pontiac, QC]

Last week we learned that by 2036 the number of seniors on reserve across Canada could more than double. I can't even imagine what it means to deal with that demographic bulge coming down the pike. How do you see your community dealing with the increasing population of elders in need of that kind of care? I open that question to the others, as well.

[Chief Rupert Meneen]

From my end, I don't think we have the capacity. We have the shortage of housing. We have overcrowded housing. We need facilities like this to put our elders in where they will be taken care of. We cannot take care of them because of all the issues we have to deal with already. I think it is important that we have facilities like this for our first nations elders to go into and be happy.

[William Amos, Liberal, Pontiac, QC]

Thank you.

Do any of the others have comments on that question?

[Natalie Gibson]

Yes, I do, if I may.

I think the consideration is that there are over 12,000 first nations people living within the region, as well as 1,000 Métis, so the trade area population is about 24,000. What is very important to consider in a facility is not only the construction of the facility but how flexible the facility is to fit the demographics in five, 20, or 30 years to be sustainable.

From first-hand experience working with a Métis nation, I know of a long-term facility that was built with approximately 20 units that is underutilized. They also have difficulties in getting nursing staff and in getting individuals to provide security 24-7. As well, something as simple as a food-handling licence has become a bottleneck to how many individuals can be in that facility.

With consideration to what the chief is suggesting on capacity, one of our recommendations is to take a look at training capacity at different levels that you don't usually anticipate with health care when you're doing the long-range planning. We have the boards, the province, and you, but it is very important, as well, to look at another model that is like a public-private partnership that would come in and consider all of those.

[William Amos, Liberal, Pontiac, QC]

Thank you.

If I have any remaining time, Madam Chair, I'd like to pass it off to my colleague, member Robert-Falcon Ouellette.

[The Chair, Liberal, MaryAnn Mihychuk]

You have about 30 to 45 seconds.