Evidence of meeting #118 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 community.
A recording is available from Parliament.
Liberal
Mike Bossio Liberal Hastings—Lennox and Addington, ON
Right now you're saying that the big problem is that the province might be willing to give a licence and funding, but they're looking for a partner in that capital funding up front. That typically hasn't been the federal government's role when it comes to long-term care. Are you recommending that the federal government consider a pilot project whereby they take two or three or four different communities around the country and do a pilot around capital expenditure for long-term care beds?
General Manager, Eskasoni Corporate Division
In working with the department, we've talked about that modelling. We talked about and encouraged.... If this is a national issue and a national opportunity, then somebody has to go first. We feel that we're ready, we're capable, we have the management agreement, and at the end of the day, members, we will finance this. With a licence for 20 years, you're able to go to the bank and finance it. We're saying there's a role for the federal government to come in here as a partner to help us bridge that financing.
Thunder Bay—Rainy River, Lib.
Stephen, I don't have to imagine that. I'm the only first nation member of Parliament in Ontario. I have family members in homes, and I know that. I know from our community members that we face that discrimination in homes that are in our communities. There's not that cultural understanding sometimes and there isn't that training.
Liberal
The Chair Liberal MaryAnn Mihychuk
We've run out of time; sorry.
The questioning now goes to MP Cathy McLeod.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you.
I'd like to start with Ms. Decontie.
You talked about an illegal practice of care and a lawsuit. I remember that a number of years ago there were issues in terms of day care because the provincial government had very strict regulations around infant/toddler certificates and early childhood ratios. I know that for first nations communities it didn't always work particularly well, because especially the smaller communities didn't have the right component of ages to meet the standards. It really was a conflict and it was a problem in terms of the licensing standards.
Is this a similar issue? Do you have people in assisted living who are...? Can you explain what this lawsuit is all about?
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
It can be a potential lawsuit. The province can pursue the care activity in our homes. If it's found that a nurse is providing nursing care in an uncertified home.... The issue is that nursing care is being provided in the uncertified group home funded by ISC. Level 1and level 2 care is all we're supposed to provide. However, when the evaluation tool determines that a patient or client in the home needs more than level 1 or 2 care, nurses need to do home visits the same as they do in the other home care programs. Because the resident is living in an uncertified ISC assisted living home, the nurse is not allowed to practise nursing under Bill 90, which is a law in Quebec regulating the reserve duties of health professionals.
It's really a licensing issue. The nurse's licence is threatened if she's found to be providing nursing care in homes uncertified under the province. Our home is accredited by Accreditation Canada. We meet all the safety and quality improvement standards of care. However, that's not enough to deter the threat of a nurse having a licence revoked by the Order of Nurses of Quebec if she's found nursing in these homes. That's a professional order.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Do you see any potential solutions? Are you in conversation with the provincial government to try to resolve these issues? I'm not sure I see a federal role with that particular challenge. Do you see a federal role?
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
The federal role I see is a long-term one involving a discussion of the jurisdiction of medicare in communities. Right now there is no federal jurisdiction of medicare in communities under federal jurisdiction. It's all delegated to the province, correct?
There needs to be some movement now, in these changing times, to explore how to move the responsibility and the practice of medicare on reserve under federal jurisdiction. If we are going to be increasing our services and doing work for our own people, by our own people, how is this going to happen securely and legally without the threat of a nursing licence being revoked or a risk to a family physician or practitioner who infringes on any regulation in that capacity as well?
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
My next question is for both Sharon and Robin.
Probably within your roles you have the opportunity to meet with your colleagues across the country. Are there any jurisdictions or communities that you see are leading the charge on some of these issues you just identified? You talked about where you are at. Have you had conversations in British Columbia, for example, with the First Nations Health Authority? Do you see any activity happening across the country that you want to comment on?
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
I can comment.
There is movement in Quebec right now to develop a governance project that the health commission is undertaking with all first nations health centres of Quebec to determine the best model to use in developing a health authority similar to what B.C. has. It is a work in progress. There are steps being taken for discussion. With the new movements in governance, we're considering that as well: How does that fit into a health authority role in Quebec?
There is movement in Quebec. We have been consulting other provinces as well to find out what we can develop for ourselves in Quebec, so there is movement there on Quebec's part.
Director of Health, Eskasoni First Nation
Also, in Nova Scotia we have obtained support and resolution from all the leadership for the establishment of a Nova Scotia Mi'kmaq health authority. We have informed the current political government in Nova Scotia. They have been advised by our leadership that we are proceeding down this road, and plans for discussions are under way, I guess. That is progressing as we speak.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Would you envision the health authority starting with some of the current roles—for example, public health, and home and community—and then as capacity increases, that being the model for assuming more responsibility in different areas? Is that what the long-term vision is?
Director of Health, Eskasoni First Nation
It's true. We do have.... I didn't bring any of my documentation with relation to that.
Often the challenges we face in first nations communities are around the availability of data to support our stories. With the data linkage project we did in Nova Scotia, the data then began to open the door and open discussion to have government officials understand clearly what we were trying to express—the current rates of cardiovascular heart disease, etc., and all the chronic diseases that were currently being measured within Nova Scotia for the general population.
Data, we understand now, is an extremely important component to documenting the needs of our fist nations communities. That has primarily been our focus for the last 10 years. Now that we have the data linkage completion, we are beginning to look at the establishment of a governance process.
Thank you.
Liberal
The Chair Liberal MaryAnn Mihychuk
Thank you, Sharon.
The questioning now moves to MP Rachel Blaney.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Thank you.
Thank you all for being here with us today on this really important issue.
Robin, I will start with you.
One of the things we've heard very clearly across this study is that jurisdiction is just a continuous issue. You talked about medicare and how it would be good to see the provincial—if I'm saying it wrong, tell me—government more accountable to the federal government for the medical care that is needed on reserve. You talked about people actually being denied and sent back to the reserve with nothing, and you guys don't have the power. Could you talk a little bit more about that? Also, you said that you have data that backs up some of these claims. Could you talk about that?
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
I indicated that the provinces should be more accountable to the federal government as to what medicare they are providing to first nations. Right now when we try to find data to find out what service delivery is happening for first nations in Quebec, it's not there. It's not readily available. There should be some more accountability on their part to provide that data. There should be some sort of reporting system in place that the provinces need to submit to the federal government for the funding they are receiving to provide service delivery to us.
I'm sorry; what's the second part of your question?
NDP
Rachel Blaney NDP North Island—Powell River, BC
You talked about how people are sent back. Are you collecting any data on people who are coming back to the community and saying they tried?
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
I can submit this report to Mike MacPherson, perhaps. I'm not sure how to submit reports. This is a study of the English-speaking first nations of Quebec to define what access issues they are experiencing and how at the community level, the grassroots level, they are experiencing being sent back to reserve communities that don't have medicare authorities to provide treatment and whatnot. There is some evidence there.
The power of observation in our community, as well, is on a continual basis. We receive community members back from trying to access CLSC services and provincial care services, with these types of services referring them back to our health centre that does not have the same mandate, the same level of authority to provide medicare.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Thank you.
One of the things we have heard a couple of times in this report is that Jordan's principle needs to be applied a lot more broadly, because it becomes that jurisdictional issue instead of just serving the client and figuring out who pays for it later.
I would love any of you to speak about how you feel about that.
Director, Kitigan Zibi Health and Social Services, Kitigan Zibi Anishinabeg First Nation
I have a bit of an opinion on that. Jordan's principle, with the immense work that happened there proving there are some disparities in service delivery for first nations children, actually applies to adults in similar situations as well. I'm sure the data can be found as to the arguments that happen with jurisdictions as to who's paying for these chronically ill needs that are long term and prevent some adults from returning to their communities. They are stuck in the provincial medicare system.
I share your perspective on that. There needs to be some way to ensure the jurisdiction issue doesn't impede the wellness of the community member and their return to the community after having secured medicare.
NDP
Director of Health, Eskasoni First Nation
As to Jordan's principle, yes, I'm in agreement. Even when you look at children with disabilities, when they reach the age of 18, what's going to happen to them? If Jordan's principle is providing tons of support to the family because of the jurisdictional barriers around their care, then what's going to happen when these children age out of Jordan's principle? Who is going to be responsible?
I guess it does become a federal government responsibility to work with the provincial governments to resolve these jurisdictional issues, because right now they are not being adequately resolved.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Another thing we've heard through this committee and through the people who have come to see us is that data continues to be a challenge. You talked about the Nova Scotia first nations client linkage data, I think for elders as they age, really being able to show what's happening, being able to identify that some of those health concerns happen a lot earlier, as you said, than in the rest of the Canadian population.
Could you talk a little bit about the journey of how you guys put that together and some of the results?