Indigenous and Northern Affairs Committee on June 14th, 2018

[The Chair, Liberal, MaryAnn Mihychuk]

The questioning now moves to MP Cathy McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you to both our presenters today. It was great to hear from you both. Since you're on video conference, I want to note that in our audience today in Ottawa, we have a whole class of nurses from British Columbia. It's good to see young nursing students here learning about both the challenges and the opportunities.

I'm going to start with Tania.

Ten years ago, I remember there was a situation in which there was a federal government nursing station beside a health authority station. The nurses for the indigenous communities were trained in immunization but the nurse for the health authority wasn't, and they were having someone from the health authority drive out to, I think, two babies who needed immunization. It was quite crazy that the jurisdictional barrier created just enormous costs, and frankly, a waste of money.

What you're telling me with your story about your mother is that this situation has not changed. I had hoped and I had been optimistic that with the First Nations Health Authority, there would be increased flexibility for some of those jurisdictional issues. Can you tell me whether there has been any improvement, and if there are still these huge jurisdictional issues in terms of what makes sense for a community? What would you recommend that we as a committee suggest to the government?

[Tania Dick]

I've been a nurse for 13 years now. My mother was a nurse as well. I think in the 13 years I've been practising, the jurisdictional issues have been there. They're not as bad as when I first started, and in defence of the First Nations Health Authority, that whole transformation in the delivery of services from the nursing perspective has not fully happened yet.

I know the conversation is still happening, and they're working really closely with the provincial health authorities. My whole cup is beyond half full around those changes occurring and pushing that change to happen, but yes, issues do still occur.

As for what I'd say you should recommend, I think all the other provinces and territories across the country don't have the same privilege we do as the First Nations Health Authority to go through that transformation stage.

As for FNIHB, the First Nations and Inuit Health Branch, I've never been a part of that organization federally, as a staff member or in discussion. I don't know how often they revisit that.

My interpretation of services coming in and being delivered to first nations communities is just “We're here, and we will do it this way.” There was no discussion. There was no dialogue. There were no negotiations. There was no needs assessment. Historically, for generations, it has been this way. I think it's changed a little bit over my time, but I think it needs to change a lot more. If we want full empowerment and ownership of our health, we need to be able to have that conversation with whoever is delivering those services to us.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Would it be accurate to say that it's really the capacity to deal with the chain, as opposed to...? In the past there were federal government boundaries and rules. Is the reason that a nurse from the on-reserve community can't take care of your mother related to the change not having happened, although the barrier is not there anymore? Would that be accurate?

[Tania Dick]

I think that from a policy perspective the barrier is still there, but we as nurses are bending the rules. We are adjusting ourselves. We have a conversation at the table, “Oh, she's on reserve? Oh, she's off reserve?”, and we come through another door. We just get creative with our practice to bypass those barriers. We look the other way.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Could the First Nations Health Authority make a decision? I guess maybe a better question is whether they would be able to make a decision that the money should follow the patient in terms of services.

[Tania Dick]

I'm hoping so. I'm definitely hoping that they can be a big part of this conversation as well, because I think the rest of the provinces and territories are looking to this rolling out and are not wanting to recreate the wheel but to get it right the first time. They want to help each other across the country to get this right and figure it out.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

I would like to chat with our witnesses from Loon River for a minute.

Part of this motion is about palliative care and looking at the ability to provide palliative care either in facilities or at home. We heard from the department that their home care nursing services are provided from Monday to Friday from nine to five, which of course does not work for palliative care. Is that the reality where you live in terms of the support you can provide on evenings and weekends for people who choose to die at home?

[Beverly Ward]

Yes.

[Kirsten Sware]

That is the reality. Thanks for your question.

We are able to provide care from Monday to Friday from nine to five. I know that some of your previous witnesses indicated that there was a funding increase in budget 2017 specific to home care, palliative care, and perhaps occupational physiotherapy. By the time the amount allocated nationally gets down to the communities here, I can tell you that for the five communities and a population of 5,000 we've seen an augmentation to our budget of about $50,000. Let me tell you that when you get into the north, five hours from an urban centre, $50,000 spread across a big geographic area that has no specialized services doesn't get you very far.

We are still operating from Monday to Friday from nine to five. The palliative component is very heavily carried out by family, supported from Monday to Friday by our staff, who always go above and beyond their duties and answer their texts day and night, even on days off and during vacations, to support those families. That's our reality.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you.

The questioning now moves to MP Rachel Blaney.

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

Thank you, everybody, for being here.

I would like to start with the Loon River First Nation. I also represent a riding that has a lot of rural and remote communities, and I definitely know about the challenges of being far away and having to access services, and the limits there.

You mentioned that when there is a large area to serve, with many people spread over a large space, that bit of money doesn't spread across it. Can you chat for a second about the challenges for rural and remote communities when the dispensing of money happens, what the impact is, and how often—in my opinion—rural and remote communities are left behind?

[Kirsten Sware]

Thank you, MP Blaney. I'll speak briefly to it.

The money comes as it is allocated, and there are various formulas that do take into consideration a base and then some indices for remoteness and isolation. However, when you look at what $50,000 can do way out in the north in an isolated area compared to what $50,000 can do half an hour from the city of Edmonton, there's a lot of difference.

As Tania mentioned, you have to be very innovative in your work. Also, we just can't find the professionals who want to work in our northern and semi-isolated areas. It's not a location of choice, so there's only a very small group who are willing to work there.

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

Thank you.

I'd like to go to you, Tania. It's good to see you.

[Tania Dick]

Hi, Rachel.

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

I hope everything is wonderful back home.

One of the things we've heard from a couple of witnesses is that we need to look at Jordan's principle in a different way. When you're talking about the jurisdictional issues, I hear that loud and clear. One of the challenges for indigenous communities is the definition of “home is home”, so if you live a few blocks away, when you want to get the support you need.... I we really need to be looking at this aspect, so I'm wondering if you could talk a bit about Jordan's principle, and how maybe focusing on service should be the key and figuring out who pays for it should happen afterwards.

[Tania Dick]

It's been an interesting process watching Jordan's principle roll out. Working within a system that really didn't understand, it has made our thought process change about that access piece. I think overall across society, when it comes to the disparities in indigenous health, an important lesson to learn in our practice is about the spirit or the foundation of Jordan's principle. Let's get rid of the boundaries, provide the care, and figure it out later, rather than having people turned away or ignored or not looked at.

I'm not sure what else to say, other than that it's had a profound impact on me within my practice to see other health professionals struggle with what Jordan's principle is and really break it down and fully understand the purpose if it.

More times than not, I hear other professionals say that it's just another handout, just another freebie for them, rather than really breaking that down and getting into the reconciliation mode when we're untangling it, really looking at it from a culturally safe perspective and understanding that we all deserve the care that everybody else gets across this board.

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

I think your example really spoke to it. Especially in rural and remote communities, it isn't always just about indigenous people. It's about what services are available, who's allowed to access them, and why those barriers are there in the first place. I really appreciate your bringing that out.

I know your area fairly well, and I know that you work on the tribal council. One of the things we've heard a lot about is access to funding for long-term care facilities, specifically for indigenous communities. Could you talk about how big the need is, especially for those remote communities? What are the challenges of bringing multiple nations together to agree on where that location would be?

[Tania Dick]

It is a huge challenge, because in the tribal council I exist under, the reserves are geographically in very different places. As I think someone said, home is home. If I'm in Kingcome, that is home. If I'm in Alert Bay, it's a little bit different. If I'm in Port McNeill, it's way different. It would be difficult to come to terms with where the best access point would be to build a long-term care facility.

It is something that is so desperately needed, whether you look at it from the perspective of different levels of delivery of care or whether it's full-on long-term care. Assisted living is huge in our communities. There are so many people who are coming into our acute care setting and through our emergency department and taking up acute care beds. It is costing unbelievable amounts of money, and they could really be dealt with by having a safe environment like in an assisted-living facility, and then having another level of care, such as long-term care, when it's just not safe for them to be on their own or at home.

I'm an acute care nurse, an emergency nurse, and a lot of my time goes towards chronic disease management and issues that are costing 10 times more than they really should cost.

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

For us today, this is the last half-hour of three and a half sessions, but I think this study should last so much longer. One of the members here in front of other witnesses put forward a motion to ask us to extend this study. I'm just wondering if you could talk to us about why this is so important and how it would benefit communities like yours if we looked at this situation in a more comprehensive way.

[Tania Dick]

I think it's a complex issue, particularly looking at it through that reconciliation lens, with the trauma that we carry as indigenous people in those generations right now, the residential school survivors. It is so desperately needed because from palliative care to chronic disease management to long-term care to acute care, we have less than adequate access to services, not only by choice but also since systems don't provide it. We have to look at it from both perspectives.

If we're not getting down to those layers and having that comprehensive discussion about it, we're not going to have the impact and the action that really are needed by our communities across the country. We have to pull back those layers much further. I think a huge discussion is so desperately needed if we are going to have an impact on the quality of life for this generation and the generations to follow.

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

Tania, thank you so much for your time. I always appreciate it.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you.

Now questioning moves to MP Gary Anandasangaree.

[Gary Anandasangaree, Liberal, Scarborough—Rouge Park, ON]

Thank you, Madam Chair, and thank you to the panel for joining us.

I'm going to start with Loon River. I'm wondering if the chief could speak to the current model of long-term care provision in Loon River and how it presently meets the needs of the community, or if it doesn't meet those needs.

Second, what are some of the challenges members of the community frequently face? What role is there for the federal government to fill in these gaps?

[Beverly Ward]

We don't have long-term care in the community. Obviously it's something we want to have one day. There's no money for capital, and that is what's needed in order to have it in our community.

Loon River is centrally located within the KTC member nations, as I said earlier. We have support from our KTC member nations to have a facility in our area. What we have right now is the continuing care that Health Canada provides us for home care, but as I said earlier, although we have nursing and health care aides, there is no long-term care.

The other thing I want to say is that once the capital funding is in place, what's needed is a continuum of care. We would need to look at that when we're looking at this project we're working on.

I don't know if this is the appropriate time, but I would like to thank MP Arnold Viersen for his letter of support a few months back in response to the letters we sent to the health ministers. Thank you, Arnold.

I hope that answers your question.