Evidence of meeting #113 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 elders.
A recording is available from Parliament.
Liberal
William Amos Liberal Pontiac, QC
Thank you.
Perhaps I'll invite our witnesses who are on video conference to share their experience in the areas of traditional knowledge or if, in the practice group within the institution they work in, there is that kind of approach to engaging traditional healing. Perhaps you could give us a specific example of how traditional healing might be incorporated into the long-term care context.
Councillor, Driftpile Cree Nation
We most definitely, through our health centre, have utilized traditional healers along with western healing practices. The doctors who come into our community have been very open to learning from the traditional healers. Our people live by the medicines that are picked yearly. They practise what has been taught to them when they were younger. We need to keep carrying forward those teachings, to preserve our way of living, to preserve those natural healing practices that are within us as indigenous people. It's a natural process that we navigate to when we're not well and when we need to heal ourselves. We have been very fortunate that we've had the University of Alberta come into our community to do research with our diabetics. We've had several doctors, and Dr. Winterstein is going to be starting in our community to do specialized work with diabetics.
Long-term care is an area. Our elders need to have a place where healing is going to continue, where it's dignified and they're in the surroundings they grew up in. They want to feel that comfort. They talk often of not wanting to leave the place where they were born, where they taught their children, and where they themselves learned as children. They want to be able to remain on that land. The minute they hear that they need to travel away from the community to a long-term care facility, you often see that look in their eyes where it just comes to a halt, where they don't want to leave. To them there's no sense in going forward, because it's not a dignified death or way of healing for them.
Councillor, Driftpile Cree Nation
It's very important that communities like ours in Driftpile...we've done the studies; we've had doctors; we've had professors; we've had specialists who have done the stats.
I really appreciated when Chief Bellegarde stated that they've had stats done. We've also done that.
Liberal
The Chair Liberal MaryAnn Mihychuk
Thank you so much for answering the question, but we've run out of time.
To all of you, on behalf of the committee members, we want to thank you for participating.
Thank you very much.
Meegwetch.
You're welcome to stay. We're going to have another panel and continue the information sessions after this. We'll take a short break.
Liberal
The Chair Liberal MaryAnn Mihychuk
Welcome, everybody.
We have three presenters in this panel.
We have with us from the Sioux Lookout First Nations Health Authority, John Cutfeet, and from the Nishnawbe Aski Nation, Deputy Grand Chief Derek Fox.
Derek and John are here in Ottawa.
Then we have Heart River Housing, which is by video conference, and then Chief Delorme.
The way the agenda is lined up, we are starting with John Cutfeet, board chair, and Deputy Grand Chief Derek Fox.
Does that work for you?
Deputy Grand Chief Derek Fox Deputy Grand Chief, Nishnawbe Aski Nation
We were going to reverse the order, if that's okay with you.
Liberal
The Chair Liberal MaryAnn Mihychuk
I go with the flow. It's all right.
You have 10 minutes. I'll try to give you a signal if we're getting close. After everyone presents, we'll have some questioning from the members of Parliament. Please go ahead.
Deputy Grand Chief, Nishnawbe Aski Nation
Good afternoon, everyone. My name is Derek Fox. I'm deputy grand chief of Nishnawbe Aski Nation. My home is Bearskin Lake First Nation, the community that is the second-farthest north in northern Ontario.
For those who don't know, Nishnawbe Aski Nation makes up two-thirds of the Ontario land mass. We have 49 first nations and 50,000 people, and we have 32 remote communities. Many of those people would tell you that we're the remote ones, not them. They're very proud of their homelands. They're very proud of the makeup of their homelands, the river systems, the muskeg, and the swamps. It's home to them. It's home to us. It's home to all of us.
Before I forget, I would like to acknowledge my colleagues who are here: our health director, James Cutfeet, and John Cutfeet, who is a man of many talents.
As you know, we're here today to talk about elder care. Our theme is, “I want to go home”. The main concept, idea, and vision is for our elders who want to go home, who want to spend their last years at home, within their lands that I just spoke of. We don't want to see them lonely and sick. I'm sure many of you can relate. Many of you have parents and many of you have had grandparents, and you wanted to ensure that their last years were comfortable and they weren't lonely.
I know we only have 10 minutes. The basis of this presentation is going to go to John Cutfeet, so I'll pass it over. I just want to say meegwetch, and thank you for having us here today.
Liberal
The Chair Liberal MaryAnn Mihychuk
Thank you. We will be coming back to presenters during the question period.
John Cutfeet.
John Cutfeet
Meegwetch.
[Witness speaks in Oji-Cree]
Thank you. I greet you, all.
I'm from Kitchenuhmaykoosib Inninuwug. It's about 600 kilometres northwest of Thunder Bay. The English name for it is Big Trout Lake. It's a beautiful place, a beautiful spot. It's very hard to leave that place, so you can imagine how our elders feel when they have to leave home to go to a long-term care facility away from what they're used to.
I have a small presentation that I'll read to you, but before I do that I would like to mention our health policy and advocacy director for NAN, James Cutfeet. We're related, if you haven't picked that up by now. He's my brother.
John Cutfeet
As the deputy grand chief mentioned, the title of our presentation is “I Want To Go Home”.
When care and the associated provisions of health services become unavailable, our eldest must leave their home communities to be institutionalized at urban long-term care facilities. Their new surroundings are unfamiliar. The elders strive to adjust in their new settings, but they yearn to be home with family, amongst their grandchildren, the familiar surroundings of their community, to be able to speak in their own language, and to be able to commune with the land they're familiar with.
When at long-term care institutions, the phrase we most often hear of the elders is, “I want to go home.” It's a simple request coming from our elders, yet impossible to comply with. Why is that?, you may ask. In our presentation we'll provide you, the members of the standing committee, information regarding the challenges that prevent us, as first nation leaders and health practitioners, to fulfill our elders' requests of “I want to go home.”
The deputy grand chief gave a bit of a background. The Nishnawbe Aski Nation represents 49 first nations out of the 133 first nations in Ontario. it comprises two treaty areas: Treaty No. 9, and it also straddles Treaty No. 5 within Ontario. Geographically, NAN is the size of France. Thirty-two of the 49 first nations are remote access only, and accessible by air year-round. Road access to the 32 remote communities is usually available by winter road for about four to six weeks, depending on the climate change phenomenon.
On July 23, 2017, Nishnawbe Aski Nation signed the Charter of Relationship Principles governing health system transformation in Nishnawbe Aski Nation territory, with Canada's Minister of Health at the time, Jane Philpott, and Ontario's Minister of Health and Long-Term Care at that time, Eric Hoskins. The principles outlining the transformation of health and its design will be determined by the people of NAN through community engagements, which are very critical. It is highly expected that elder care will be one of the priority issues raised during the community engagement process. The topic of elder care was first presented at a NAN assembly 17 years ago. Now the cause is being renewed to address elder care in NAN communities.
The care of our elders is largely done by family members who often take turns providing care to their aging elders, and do so without formal training or essential supports. Respite care does not exist in any of the communities to provide relief to family caregivers. The only time relief comes to family caregivers is when the aging elder is admitted and sent out of the community to an urban hospital. This usually happens when the elder's care needs can no longer be met in the community as only basic assistance is available, or because the family caregiver's health is failing due to the neglect of their own well-being and the family caregiver is no longer able to provide care.
A minimal amount of home care support exists in NAN communities. We say this because provincial funds were increased this fiscal year to all 133 Ontario first nation communities. However, it is not enough, and culturally safe human resources remain a challenge. Qualified personal support workers are scarce in the communities. The workers assisting elders in the NAN communities learn on the job, unlike the PSWs in urban long-term care institutions who must be certified.
Home care support in first nation communities is only offered Monday to Friday, 9 a.m. to 5 p.m., weekly. On weekends, it is the family caregiver's responsibility to provide care. There are numerous challenges associated with the elders saying they want to go home. There are jurisdictional issues and underfunding. First nation needs are often caught between the responsibilities of the two governments, and entanglement continues due to the federal division of responsibility: Indians and lands reserved for Indians. Long-term care beds do not exist in NAN first nation communities. The recent provincial approval of 106 long-term care beds is for urban institutional settings. Two hospitals will receive 76 and 30 long-term care beds within the NAN territory.
Home care support, as mentioned earlier, is lacking and fails to address after-hours monitoring. On occasion, when elders suddenly pass from this world in their homes and apartments, they're not found until the next day.
I only have two minutes, so I have to move forward. We've outlined some points and put information in this research document for you to read later about some of the things that are required in the communities to improve access to services. Due to the social determinants of health, barriers to health services, and a number of other factors, there's a need for long-term care homes in first nation communities, because a majority of these homes are, as I said earlier, in urban settings, and that's where we have to send our elders when they can no longer have the care that's required in the community.
Recently, when we had a meeting with our leaders just these past few days, we heard comments from Chief Lorraine Crane of Slate Falls Nation that their elders want to stay home with their families. Chief Ignace Gull from Attawapiskat First Nation says their elders are a priority, and there is no medical support, and that should be a priority. Chief Wayne Moonias from Neskantaga First Nation says that elders have challenges while in urban care and that they would not treat our elders the way they are treated.
There are concerns with the care our people are receiving. Our elders are often returned home in a coffin without an explanation of how they died. How many more elders will we lose before the plan is done? It saddens us when our elders are sent out to homes that are not culturally appropriate and families are disconnected. That's why it is very important that we focus on the requests of our elders to respect and to maintain the dignity of our elders when they say, “I want to go home”.
That's the theme of our presentation, and I thank you for the opportunity to let us speak with you today.
Meegwetch.
Liberal
The Chair Liberal MaryAnn Mihychuk
Our next presenter is Lindsay Pratt from Heart River Housing.
You have up to 10 minutes.
Lindsay Pratt Administrator, Heart River Housing
I'd just like to take the opportunity to thank you for allowing our voice to be heard from out here, and hopefully any information I can give can be of some assistance to you guys.
Basically, Heart River Housing is a non-profit management body established by the province to manage low-income family housing, provincially owned buildings and lodges. We are not, generally speaking, in the health care business. We do have four lodges in our area.
Our area runs from the community of Fox Creek, Valleyview, all the way down to High Prairie and Slave Lake. Most of our communities are under 2,500 people, so again, we're a very small, spread out area. I think we cover over 40,000 square kilometres of area within our region.
We are also very close to five first nations and three Métis settlements that call High Prairie and Slave Lake their main trading centre, so we do have lots of interaction with the first nations in our region. Eighty per cent of our family housing units have indigenous families in them, so again, our record of working with indigenous families and peoples is really, I think, very good.
On the seniors side, we are seeing more seniors coming into our lodges, who we are trying to accommodate on the cultural side, but again, right now there is not that.... We are concerned about why they are not coming in. I do understand the concept of not leaving home and I can appreciate everything that Mr. Cutfeet has explained about seniors not wanting to leave their supports, although our communities are very close with the bands and the settlements, and I think there is a bit more flexibility in that area.
On the long-term care side of things, the community of High Prairie just had a 64-bed long-term care facility built. They had talked about it taking up to five years before it would be full and it took about three and a half months until all the beds were full. Again, that puts a lot of pressure back on the seniors lodge facilities because we are delivering level 2 care to our facilities. We would be open to delivering level 3 care in a more home-type environment versus an institution. I can appreciate what my former colleague said about moving people to an institution-type setting. Our lodges are not like that. We consider them homes and we try to make them as comfortable as possible without having a hospital-type setting.
We manage about 900 units, and 175 of those are seniors lodge facilities. About 125 are seniors apartments. Again, our experience and our workload on the health side of things is not as deep as we would like it to be because we think we could be of more help.
I am going to cut my time short there and open it up for some questions after if I can be of some support.
Administrator, Heart River Housing
I should have told you that ahead of time and I could have passed my minutes on to somebody else.
Liberal
The Chair Liberal MaryAnn Mihychuk
That's a lot of innovation all in one meeting. We'll have to see where that goes.
We're going to do the 10 minutes for our last presenter, Chief Delorme.
You have up to 10 minutes.
Chief Cadmus Delorme Cowessess First Nation
Thank you, Madam Chair.
Cowessess First Nation is in the Treaty 4 territory. I see one of my colleagues, a tribal chief. Edmund spoke earlier. We're from a similar area.
Cowessess First Nation has 4,259 citizens. Just under 1,000 live on the homelands, and everybody else lives nomadically throughout Treaty 4 and beyond. Our average age at home is around 35, and we have a lot of baby boomers wanting to move home or living at home.
I have three quick stories which will give you more of a personal touch.
A man named Bruce who passed away in October got dementia about two years ago. He was a leader for many years in the community. He passed away when he was 69. In his last year he was admitted to Broadview Centennial Lodge, a residence about 23 kilometres north of Cowessess. He was a harmless person, but because of dementia, he had a few aggressive moments, unfortunately. Sometimes he would be tied to his wheelchair because the nurses didn't know what to do. He was trying to leave and stuff like that. It was very emotional for the family to see a loved one being treated like that. I have no disrespect for the lodge; I know they had very limited resources.
Bruce was conscious enough that he knew he wasn't at home on the reserve. Every day he would have that drive to try to get back home. All he wanted was to be back home. Unfortunately, the dementia got the best of him, and then he passed away.
The second story is about a lady by the name of Maggie Redwood. She passed away about a year ago. She was 101. Her family refused to put her in a home. She was at the stage where her family did everything for her. They changed her and bathed her. They pretty much fed her. The family got very fatigued in the last two years of her life, only because they had to sacrifice their own jobs and their own personal time. They refused to allow her to live in a home off the reserve. It took a toll on the family to honour their grandmother, great-grandmother, great-great-grandmother, but they allowed her to live out her days in a standard house on Cowessess, giving that stage 3 support from within their means.
The last one is Harold Lerat. He is currently with us. Harold thinks he's on the reserve, but he's in a home. You talk to him, and he says that his horses are outside, and his reserve house is there. It gets to the family once in a while when they have to go to Broadview again but they don't want to break his heart, and tell him he's not at home.
Those are three stories to start, given the need that long-term care definitely has to make its way back to the homelands.
In Cowessess we separate them into three age categories. The under 21 and the 22 to 54 have certain needs and wants in life. The 55-plus want two things. They want security and they want to know that someone's looking after them. Sometimes when you get to stages 2, 3, and 4, some of them will not say much because they don't want to fear getting removed from their house and put into a lodge. It's to the point where they will hurt themselves trying to pretend that everything's all right. The ultimate thing is they don't want to leave. They don't want to be looked after off the reserve. They want to stay home.
We have different categories. We have some in stage 2 that require some basic needs. Maybe they don't need to be in permanent long-term care, but definitely need something close to home where they could go on a daily basis, even if it's a nurse or constant updates and things like that. They still can maintain a basic life.
When it comes to emergency services when we talk about long-term care and the goal to get more on the reserve, you have to assess the emergency services, and how long it will take an ambulance to get to the reserve, how long it takes to find the location. We're being a little more proactive about it here on Cowessess First Nation.
The next one is partnerships. Reserves, first nations, and bands can't do this alone. On Cowessess First Nation we have neighbouring nations—Sakimay, Kahkewistahaw, Ochapowace. We're dealing with this long-term care thing together. We're discussing it and seeing how we can partner to have economies of scale.
Even beyond that, there are jurisdiction differences because the first nation is on status land. As my friend said earlier with respect to lands set aside for Indians, there's sometimes a jurisdiction issue when it comes to the province.
One thing Cowessess First Nation is doing is meeting with its provincial partners to let them know we don't need to talk about jurisdiction since we know we have differences, and to see if we can get some care on the reserve, respect jurisdiction, and try to figure it out. Those conversations are starting to happen.
Cowessess First Nation has citizens who are RNs and LPNs. They have the qualifications. Some are working in the local lodges in the cities. The human capital is already there, and they're ready to move home.. It's just a matter of getting a little more overall capital infrastructure, if that's the goal.
I go to the home quite regularly just to visit, and many people there, first nation and non-first nation, are forgotten. Some of them don't get visits and some get very few visits. When you walk into a long-term home, they're so excited to see you. They all want to talk to you. One thing Cowessess does is hold a local powwow at the Broadview Centennial Lodge just to bring a little bit of culture to them and get them visiting.
One of our action plans is to have a long-term home on Cowessess, and we have it in our plans to put a day care with it. When it comes to seniors, one of the best medicines is their grandkids, great-grandkids, and children. To have a long-term care facility in the same building as a day care, where our next generation is getting primed up to be leaders, provides a balance and interaction between the two.
Sometimes there's culture shock when seniors have to leave the reserve. When you have a certain lifestyle and you maintain a certain character, whether it's humour or intergenerational trauma if it's related to residential school, there's culture shock. Sometimes in these provincial areas, nurses who are taught to deliver services are sometimes not taught the cultural awareness. That culture shock means a lot, and I notice it's also something that has to be included.
I can't figure it out, but the reality is that a senior in long-term care has no problem being buried at home or finding a final resting place, but when it comes time for those last five years of their life, they are not allowed to be on the reserve because we don't have the services. There's something not correct in that area, and I know that when we put all our minds together, we can figure it out.
Finally, I just want to say that I'm really excited to be a part of this. I want to end off by saying that it's not just about long-term care of our seniors. Cowessess also has some adults in stage 3 and stage 4 who live with their grandparents, and to some degree it's elder abuse because the elders don't know what to do with their grandkids. I know this may not be the committee that talks about that part, but I just wanted to throw that in there. When it comes to stage 3 and stage 4 long-term care, there are others on Cowessess who aren't elders and whose situation also needs to be addressed, so we need to figure this out. We can't forget that younger generation.
Thank you.
Liberal
The Chair Liberal MaryAnn Mihychuk
Meegwetch. That's a very good point, and it is part of our study, for sure.
Now we're moving on to the questioning, and we are going to start with MP Mike Bossio.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
Thank you, Chair.
Thank you all so much for being here today.
As a committee, we had the benefit of going to Sioux Lookout, and we were treated very well, I have to say. It was a tremendous experience during which we were introduced to a lot of different services provided at the hospital, at the elder lodge, and by the health services branch.
I have to say that the biggest impression I was left with when we departed was the burnout rate of your PSWs and health service personnel. When we met with the health authority, that was one of the messages I came away with, and by the sounds of what John was saying, it hasn't changed.
It sounds like a multi-faceted issue in that there's a shortage of available people with the right skills to provide the services, and there's a shortage of training and skills development when trying to train individuals as quickly as possible to deliver on those services.
Is the shortage within the community itself? Are a number of health professionals being brought into the community, or are we now finally reaching the point where we're training people within the community to deliver on those services?
Deputy Grand Chief, Nishnawbe Aski Nation
I'm going to have James answer that question.
John Cutfeet
As we move forward in undertaking our health care, one challenge we have is human resources capacity. One way of addressing that is to build and refresh the existing capacity we have on the professional side. On the other side, we undertake more programming to try to develop professionally designated first nations people.
The other challenge in getting people into the community, to live in the community, is the accommodation side. You probably have heard numerous stories about lack of housing. That is going to be compounded as well, because we will need professionals and resource people to be in our communities.
Yes, human resources development is a major concern at this point in time, and we need to start addressing how we're going manage that.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
It comes back to what we've heard in so many different sites we've done, which is about the social predeterminants, starting with education. If we don't have the education to train individuals, not just in health but as carpenters, electricians, and builders, what we need to do goes all the way down the line, because we need to build houses. If we don't have houses, then we can't bring in health professionals, but we also need to train those health professionals to make them available. It always becomes much more complicated than simply saying that if we just had more health professionals we could actually deliver on these services. The challenge is getting to that point.
I wanted to see if this is making a difference. Sioux Lookout First Nations Health Authority recently secured funding for a mobile indigenous interdisciplinary primary care team. Once implemented, how will this service support long-term care needs in the communities you serve?
John Cutfeet
Once it's operational, the mobile unit will be helpful. Again, to have professionals go into a community en masse, the challenge is how we accommodate them all.
When I was in Big Trout as the chief of the community a year ago, we were fortunate to be approved for a new health centre. We urged the federal government, Health Canada, to expand the office space, especially the exam rooms that are needed. We have nurses who are on site, and then we have doctors coming in and other visiting professionals who need rooms. At least we're trying to see how we can expand those facilities as new ones are being approved for construction in the communities.