Thanks for having me.
I was really excited to hear that this discussion was happening, that the question was on the floor. I know from the stories that were just heard from our previous presenters that this discussion has been going on for a long time. Trying to problem-solve issues for our elders at home as much as we can with the no-action piece of it has been the frustrating part over probably the last generations.
I'm a registered nurse, a nurse practitioner. I am the president of the B.C. nurses here in B.C., specifically to advocate for the indigenous health portfolio piece. I'm also on chief and council and on the board for my tribal council to continue that advocacy piece around health in our rural setting. I have done a lot of legwork in that area and there is a lot of frustration and a lot of lack of action in that area, so it was good to hear the stories of the people before me.
When I think about long-term care in our first nations communities, I instantly go to my nurse's lens. We work as nurses to keep people at home as long as possible as safely as possible. Quite often doing that means relying on a team in the community and in the acute care setting. We're fortunate enough in my rural community of Alert Bay, which is a small island with a population of about 1,500 literally split down the middle between off-reserve and on-reserve, to have a provincially funded hospital on reserve. I work in acute care. It has a full ER trauma room and acute care beds, as well as a 10-bed multi-level care area. That was really built with discussion with the community, with the Namgis First Nation. As it went, it fell into the province running those services. We weren't able to utilize those beds for our people. We had to put our people into the pool like everybody else in the province, so out of the 10 beds, I think at this moment we have three local people, which I think is one of the higher numbers I've had. I've been working there for the last six years.
Quite often we have to send our residents to a hospital somewhere else off reserve, quite often hundreds of kilometres away. Once we had to send someone to a completely different province until we could figure out some of the bedding issues and get them back. That's really difficult on the patient and the families, because as indigenous people, we're very person-oriented and we need to be with our families.
I'm a master's prepared nurse, a nurse practitioner. I was working originally in indigenous communities with primary health care. My mom, who is a residential school survivor, got really sick and it got to a point where the community health services and the acute.... She had to move out of the village into Alert Bay and I had to move to Alert Bay to be with her because she was falling through the cracks so much. As a result of that—there's nowhere to be a nurse practitioner in Alert Bay—I ended up having to lose my licence for it. The lack of services and the lack of space and the opportunity to try to keep her safe and well at home as long as possible affect me personally and professionally. They've had a significant impact on my family and on me as a professional.
The big thing I notice on the island where I work is the jurisdictional issue. The island is literally split in half. We do rounds every morning with our community health nurses and our physicians, and sometimes our mental health team comes over from another location. We talk every morning about care plans and people in the community and how we can best provide those services for them. The band-hired nurses are unable to provide services to our people who live off reserve. My mom happens to be one of them because, geographically, the church had come in, and there is a big lot of land right in the middle of our reserve that is church land, so she's technically not on reserve and she cannot access those services. That was a big gap for her where she fell through those cracks. It became unsafe for her at home and in the community. I had to come home and step in.
We tried to readjust things as well as we could. In all honesty, my heart goes out to the nurses. They try to bend the rules as much as they can, but that jurisdictional issue leaves opportunity for such unsafe environments for our elders and for our community in general, because they can't cross that jurisdictional line, and it's vice versa for the provincial community health nurses who provide services across the whole island.
However, they only come over once a week, quite often once every two weeks, and sometimes once a month. They literally have to take a ferry. They come over on the nine o'clock ferry. They have to leave on the three o'clock ferry. By the time they sit down and do rounds, they really have one or two hours to spend with those individuals when they're trying to keep them home and safe and well as long as possible, before they have to go into a long-term care issue.
The other big issue I see all the time at home is the respite issue. We work really, really hard with our communities to try to build capacity and support families as much as we can for people to stay home as long as they can and as safely as they can. However, it leads to caregiver burnout all the time. It's so difficult on the family members. There are no services or support systems in place for those individuals carrying that burden. We have no respite bed in our hospital. When an individual brings somebody in for respite for a week, three days, or five days if they have to go to a medical appointment or somewhere else, we end up having to send that person to another facility completely off the island, or down-island 100 kilometres away, where there is an official respite bed. That's difficult for both the patient and the family.
The big thing I notice with that transitional piece for our elders and people who need long-term care services is that the composition of nursing services and health interprofessionals does not fit the needs. I think the team before me touched on that a bit. The composition doesn't fit the needs of the people. For instance, the FNIH nursing program is kind of baby nurses, immunizations, a little bit of wound care, and this and that. However, they're not really built for that kind of long-term care and chronic disease management and the critical situations our people are in, which puts a lot of burden on them professionally.
When we talk about elders right now, we're talking about my mother and also my mother's mother, who is not alive now. My mother is a survivor of residential school. Those elders above her and that generation before her are the ones who had their children taken away. When we talk about the composition of care and care plans, whether it's in long-term care facilities, getting them into long-term care, or preventing them from going into long-term care, we don't touch on any of that. When the system is not set up for that huge mental health piece—I appreciate how, at the beginning, it was acknowledged that we're working towards reconciliation—that is massive. We have to define that within the health care system, because it's not working. Quite often, that generation and the generation before them....
I'm the first generation out of residential school. That intergenerational trauma exists. The general feeling overall that I have experienced in my practice is that individuals don't have trust. They have a lot of fear, and they absolutely have a difficult time accessing services or entering these facilities or institutions. It triggers them, I'm sure. They avoid them as much as they can, and then they get into a critical state in the community where they come in and we are actually having to try to resuscitate them and kind of revive them physically through their chronic disease issues and get them safe again.
I feel like we're in a cycle. We need to be approaching it from a multipronged perspective. RNBC, the association I work for right now, just did a breakdown of all the designations of nurses. Licensed practical nurses, registered psychiatric nurses, nurse practitioners, and registered nurses all have a scope to help contribute to this. When we look at the composition of FNIH, the provincial services, and the community health nurses, we see that the LPNs and the RPNs are completely underutilized or not utilized at all. When we're talking about reconciliation, residential school survivors, wellness, and mental health wellness, we're not even using our psychiatric nurses, who are built specifically for that. I think we have to really untangle the composition of the service providers, whether it's in-house in long-term care facilities, preventing individuals from going into them, or just maintaining them at home as long as we can.
I hope I'm okay for time.
