Indigenous and Northern Affairs Committee on Sept. 26th, 2018

[Chief Peter Collins]

I had a two-year hiatus and I took a rest, but, you know, it's a tough job. We're in a different position than my friend Duke is, because they have a long-term care facility. We're in the early onset of that and we've been in discussion for quite some time with the provincial government. They are lifting the licence moratorium that's been in place for quite some time, so I think we have finally made some inroads on that. Right now Dilico is pleased to be in the position of entering into phase 2 of the Ministry of Health long-term care allocation on the 96-bed long-term care facility. The development of an indigenous LTC facility will assist Dilico to fulfill its unique mandate to deliver services for the complete life journey of the Anishinabeg nation people. The government should be aware that the proposed facility is closely aligned with several calls to action from the Truth and Reconciliation Commission of Canada, including call to action number 18:

to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties;

call to action number 20:

to recognize, respect, and address the distinct health needs of Métis, Inuit, and off-reserve Aboriginal peoples;

call to action number 21:

to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental,...and spiritual harms caused by residential schools;

call to action number 22:

to recognize the value of Aboriginal healing practices;

and call to action number 23:

to increase the number of Aboriginal professionals working in the health-care field [and] ensure the retention of Aboriginal health-care providers in Aboriginal communities.

Dilico is a leader in the provision of integrated holistic and culturally safe care to urban, rural and remote first nation children, families and communities. Dilico has identified a current need for the development for a 96-bed indigenous-designated LTC facility, which hopefully will be expanded to meet the demand for 128 long-term care beds in the future. The facility will provide LTC services in a culturally appropriate environment to elders aged 55 and over from the 13 communities that are in partnership with Dilico and its organization and partnership with Fort William First Nation as we go forward.

Locating the LTC on the traditional lands of Fort William, on the homelands of Fort William, has advantages, including availability of land and close proximity to complementary health services, including Dilico's health services, indigenous family health teams, traditional healers, home and community care, and personal support services.

One of the only things that divides Fort William and the city of Thunder Bay right now is a river. I won't talk about a bridge, but....

[Voices]

Oh, oh!

[Chief Peter Collins]

In addition would be culturally appropriate recreational opportunities in a partnership with Fort William First Nation and the Thunder Bay Regional Health Sciences Centre. I recently had a discussion with the CEO. He told me that he could fill our 96-bed facility himself because of the burden on the health organization there itself.

In the current landscape, there are significant challenges in determining the number of indigenous elders in Ontario. The health care system is a challenge. To begin, the question of indigenous identity is not asked at the time of application or admission to LTC. According to NorthWesthealthline, there are eight LTC homes, and none provides public information about indigenous identity. Many residents will state that they believe Hogarth Riverview Manor has the highest number of indigenous elders. Hogarth operates a 544-bed LTC facility offering specialized Alzheimer and dementia care for our elderly with higher-intensity medical needs and general long-term care. As of November 30, 2017, there were 629 long-term care homes with 78,943 licensed beds in Ontario. Of those, four long-term care homes are located in first nation communities.

You heard Chief Duke talk about the long-term care facility in his community. The other organization, Six Nations, has 50 beds. Oneida has 64. The Mohawks of Akwesasne have a 100-bed facility.

The number of indigenous youth is growing at a faster rate than any other population in Canada. It's the same with the elderly. In 2006, 4.8% of the aboriginal population was 65 years of age or older. We hold a Christmas party, and we can tell in our community every year that the number of elderly people is growing. We host upwards of 400 people at our Christmas dinners. Our elderly population is growing, and they need a facility to help them to the end of their journey. The population of Métis and Inuit 65 years of age and older could be more than doubled by 2036, according to Stats Canada.

“Canada's most vulnerable: Improving health care for First Nations, Inuit, and Métis Seniors” tells us that first nation communities are responding by implementing and developing a home and community care program and personal support services to keep elders at home in their communities. One of the things we're working on developing right now, once we get the facility up, is a training centre. It will be a training ground not only for our community but for all the shortages in Thunder Bay and throughout northwestern Ontario. We do have a partnership that we're structuring right now with Confederation College to have on-site training for PSWs, dieticians, and all of the stuff that goes hand in hand with a long-term care facility.

Dilico serves many elders through the home and community care and personal support services program, and knows how many elders refuse to go to nearby cities to avoid the possibility of being put in a permanent long-term care arrangement or refuse to receive medical care and attention for fear of the outcome of being placed permanently in a foreign institution.

Why have an indigenous long-term care facility on a first nation? In June 2017 North West LHIN, Chiefs of Ontario, first nation chiefs, and senior officials from the Ontario Ministry of Health and Long-Term Care, Health Canada, and Indigenous and Northern Affairs formed a tripartite working group for first nation long-term care. I was part of that working group. We made some inroads, but what we're trying to do through the process we're working on—Mohawks of the Bay of Quinte and Fort William First Nation in partnership with Dilico—is to have phase 1 of the approval done and then try to get through the next two phases. We'll be laying down a foundation for others to develop long-term care in their communities, and we've done a lot of legwork on that aspect.

The working group determined that four themes emerged from the discussion: improved access to services, improved capital planning and financing, strengthened decision-making, and improved data collection. Fort William First Nation and Dilico are committed to these priorities and to working in partnership with Canada and Ontario to realize the full potential of elder care in our communities.

The tripartite working group tells us about the population demographics of first nations in Canada and Ontario and the population health needs, providing necessary context for the discussions on availability and the need for health services in first nation communities. In 2011 the median age of first nation people in Ontario was 29.4 years old. The off-reserve population was 29.8 and the on-reserve population was 27.4.

First nation and other indigenous people are younger than non-indigenous, whose median age is 40.2. That's Don's age now.

[Voices]

Oh, oh!

[Chief Peter Collins]

In 2016, 236,685 people identified as first nation people. A little under two-thirds—64%, or 151,210—reported being treaty Indian, a registered Indian, as identified by a racial piece of legislation called the Indian Act. Just under one-quarter—23%, or 54,000—of all first nation people reported living on reserve.

Overall, indigenous people in Canada have higher rates of chronic conditions such as diabetes. The prevalence of diabetes is three to five times higher among indigenous people as compared with the general population.

Of Canadian children diagnosed with type 2 diabetes, 44% are of indigenous descent.

Diabetes has long-term health consequences, including increased risk of cardiovascular disease, renal disease, and amputation. In 2013, the Health Council of Canada published "Canada's most vulnerable: Improving health care for First Nations, Inuit, and Métis seniors” , which discussed the common challenges faced by indigenous seniors.

[The Chair, Liberal, MaryAnn Mihychuk]

Chief, you need to wrap up.

[Chief Peter Collins]

Yes. I'm just about at the end of it. I'm not looking at you because I want to see this.

[Some hon. members]

Oh, oh!

[Chief Peter Collins]

As Ogimaa Duke said, we travelled a long way to have our voices heard. I'll try to cut to the back end and why Fort William in collaboration is the ideal leader.

Fort William First Nation and Dilico have over 30 years of experience developing programs, services, and governance. They've developed comprehensive and integrated services for Anishnabe people. Dilico as an agency has specialized in the expert knowledge and delivery of responsive health care. The value of the project is far-reaching and will service an underserviced, often vulnerable, population.

Indigenous seniors struggle with many issues, including not accessing health care, mental health, and end-of-life care. An indigenous long-term care facility would address physical and mental health, the effects of colonization and residential schools, language, our foods, our teachings, our properties, and our lands.

There are lots of different aspects of long-term care and why it is important to be built in our community. As I said, Ogimaa Duke has one in his community. We're on the verge of having one. We need the federal and provincial governments to look at a contribution of infrastructure dollars. That's what we're here for. We're hoping our voices are heard loud and clear—

[The Chair, Liberal, MaryAnn Mihychuk]

Well, let's see.

[Chief Peter Collins]

—throughout this organization and throughout the structure.

I'll cut it off there.

[The Chair, Liberal, MaryAnn Mihychuk]

Okay, Chief. You'll have an opportunity to continue, perhaps, with the questions coming from MP Rusnak.

[Don Rusnak]

Thank you, Chiefs, for travelling a far way. It's a trip I'm well used to. I do it twice a week.

I've been to both of your communities: Wikwemikong, a large community on Manitoulin Island and, of course, Fort William First Nation in my riding, my largest first nation community.

As I was saying before to the individuals from Eskasoni here, I am Ontario's only first nation member of Parliament. I understand the difficulties, having family members of my own going to facilities that aren't culturally relevant to them and having individuals at certain facilities saying, "Oh, here come those Indians again” and “They're taking advantage of our system”, and being treated unfairly.

That, of course, can be remedied by having facilities within our own communities that are culturally relevant and responsive to the needs of our elders, especially—and I believe it was Mr. Parsons who said this—our elders who are survivors of residential schools.

What is your ask of the federal government in terms of these facilities? What is most important? As part two of the question, what would you ask of the provincial government? We of course report back to Parliament, but we can be influential in provincial legislatures.

I'll start with Chief Ogimaa Duke Peltier. Those are two questions.

[Chief Ogimaa Duke Peltier]

Two questions on what we are asking....

Well, I think the federal government likely has a role in assisting first nations in creating long-term care regulations and laws in collaboration with us and funding services appropriately, because in terms of the services that are required within our home, the province is very slow in responding to on-reserve servicing, for whatever reason. It's jurisdictional issues....

However, a person is a person. We need to provide that care. I think that's the approach that is solidified in case law now, through things like Jordan's principle and other human rights cases: that we are just as human as any other individual.

That would be one—work in collaboration with us—but also, institute a full funding regime in regard to prevention-type servicing. That would alleviate a lot of the issues we're experiencing with regard to early onset chronic care. We would be able to tackle the issue in my community of 15% of the population experiencing diabetes. That's obviously a large number.

I think there has to be a fundamental paradigm shift with regard to health delivery and collaboration with first nations.

The current system, whether you talk about a justice system or a health system, is all loaded on the back end when issues happen, as opposed to appropriately funding issues that are preventive in nature, such as children's programming. Introduce them to sports and physical activity and have those types of programs funded appropriately.

If I'm looking at diabetes-type programming in my community, we're funded with $53,000 annually to service 3,500 residents. That's obviously not enough. When we're talking about some of the professionals that come in to do some of that servicing, we can't even afford to pay them with that amount.

That's one of the things I would like to see.

[Chief Peter Collins]

I'll make my answer shorter.

[Voices]

Oh, oh!

[Chief Peter Collins]

I'm more direct and to the point anyway.

What I'm looking for here is help to assist us in getting a facility built. We're going to finance a $23.3-million project here, and without any federal money or provincial help for the infrastructure.... What we're looking for is for the federal government to make a contribution to help with the infrastructure dollars and the O and M dollars for the long term, for an evergreening. That's what we're looking for here today.

[Don Rusnak]

Well, in terms of an infrastructure program, I guess for Chief Peltier it would be an infrastructure program for renewal of the facilities and possible expansion, and for Fort William new construction...?

[Chief Peter Collins]

Yes. For Fort William, it would be a brand new structure, a brand new facility.

[Don Rusnak]

In terms of your dealings with the provincial government, you mentioned a bit of that in your presentation. We have a new provincial government in Ontario. How have those conversations progressed with the new government in power? Is there push-back on plans that you have going forward, or is everything staying the same?

[Chief Peter Collins]

Well, we haven't had any push-back from the province as of yet. The last message I got from Sharon Lee Smith, the ADM there, was that this thing will continue forward. The government is trying to find their way through the system right now in terms of how to deal with it. When you look at their announcements, you see that they're still announcing several long-term care beds in Ontario.

Our project is in the works. From our perspective right now, it's still moving in the right direction. We haven't had a new discussion with the new government. That's where we're at right now. We're waiting for that to balance out, to figure out where they are, so we can get back to that table.

[Don Rusnak]

There's still—

[The Chair, Liberal, MaryAnn Mihychuk]

You have about 30 seconds.

[Don Rusnak]

They're still reviewing. Essentially, you haven't had conversations, but in terms of the administration, I guess the bureaucrats are still on hold until the provincial government does their review of whatever they're doing a review of.

[Chief Peter Collins]

That's absolutely where it is right now. We're just waiting for it all to pan out. As I said, they're still making those commitments to long-term care, and hopefully we're still in that. We passed the first phase of their approval process in advance of the election, but we'll see where it goes now.