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

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Yes. I would—

[Stephen Parsons]

That being the case, the process is to negotiate a cost of the services provided to the facility, based on the number of beds. That's a provincial negotiation.

We have homes in our province ranging from 20 beds to 300 beds. In order to provide and operate the facility, that's a formula that they use—per diem, per day, per bed, to offset the operating costs of the facility. There's a range, depending on the level of service.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

What about from the federal level? To me, it sounded like a similar program, but it starts at the other end, right? It starts from the individual, and then works it way towards the facility.

[Stephen Parsons]

Those discussion have not been had at the federal department level because, from what we were being told when we initiated this four years ago, long-term care is a provincial issue and a provincial responsibility, and some of those costs have been downloaded to the province.

In terms of a recommendation, absolutely.

[Sharon Rudderham]

I do agree with our counterpart here as well. Provincial and federal standards need to be changed to meet the needs of our indigenous people.

I'll give you an example. We just built a brand new $7-million health centre in our community. Already, I'm full to capacity. This building—

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

I'm sorry. I'm out of time. Perhaps my colleague will—

[The Chair, Liberal, MaryAnn Mihychuk]

I'm sorry. We're out of time, as the whole session has come to an end.

I want to thank you for coming out and presenting.

[Stephen Parsons]

Chair, could I make one last comment? It will just put things into perspective for members.

We heard a key message when we did our assessment, and not until you hear these words can you really get an appreciation.

Our elders of today are residential school survivors. It was brought to our attention that when they go to these homes as elders, we're re-institutionalizing them. I want to say that again: We are re-institutionalizing them.

That's the opportunity. I heard today that it doesn't pay to create a program. Programs are designed by thinking outside the box. If there's a need, if a proper assessment has been done, if it has been vetted, if you're organized and prepared to go down the road, then collectively, we need to think outside of those proverbial boxes.

Thank you.

[The Chair, Liberal, MaryAnn Mihychuk]

That concludes the remarks.

Thank you, everyone, for coming out and presenting.

We will have our second panel.

Thank you very much.

[The Chair, Liberal, MaryAnn Mihychuk]

Chief Peltier, why don't we get started? You'll have 10 minutes to present to us. Then it will go to Chief Collins. Then we'll go into questioning.

You have 10 minutes to present. As soon as you're ready, you can get started, and after the two presentations we'll have the questions from MPs.

Welcome.

[Chief Ogimaa Duke Peltier, Leader, Wikwemikong Unceded Indian Reserve]

Meegwetch. [Witness speaks in Anishinaabemowin]

Thank you, everyone, for allowing me the opportunity to come and make a presentation in regard to some of the services that we provide to the elders and seniors in our community, mainly from two perspectives—long term care programming as well as a long-term care home that we operate in our community.

I'll begin there. I am Duke Peltier, the elected chief in my community. I've been in that position now for six years. I just recently got re-elected, and I'm in my fourth consecutive term now. I thank you for the opportunity to make this presentation.

The current long-term care program services that are in our community provide services for longstanding chronic illnesses, which include services for frail elders, complex clients, and clients who are palliative. Programs have been funded through the Ontario Ministry of Health and Long-Term Care since 1997, and since then our services have witnessed the need for delivery of services to the aging population. Our nursing services and personal support workers are slowly shifting to evening and/or weekend work to accommodate the demand for the services required. A generic transportation program has also increased to full-time hours due to the demand of the clientele.

Palliative care is a service also provided to our clients wanting to stay at home during this time. Although many of the families do take the lead role in caring for their family members at home, supports are provided through our health centre and offered by the nurse and/or personal support workers. It would be preferred if hospice services were available through our long-term care home, which is a 24-7 long-term care facility that we've been operating since 1972.

Currently the Ministry of Health and Long-Term Care provides funding to support our clients to remain at home for as long as possible, but not through a 24-7 operation. The budget that we have to service our community is just a little over $1 million, which does not allow for the delivery of the services 24-7.

One of the issues that we experience in operating our long-term care home—I might be bouncing back a little bit here, so please bear with me—is through the admissions process. It is a challenge to our home from mainly an operational perspective, because that admission process is conducted by the Community Care and Access Board and through the LHINs. In those kinds of situations, because there's advanced funding provided to our home—100% funding based on the number of beds that we are licensed at—each day that each bed sits empty reduces our operational dollars. That's one of the issues that we don't have any control over, and it's something that we'd like to consider, especially when a member of our community does have a request to enter into the home to receive services within our community.

The intent back in 1972 was to have that home to care of our elders and to service them in their own language and through the diets that they're accustomed to. I appreciate the comments from the earlier presentation in regard to the traditional foods. That is a challenge. We've had to eliminate those from our menus because the existing provincial regulations do not allow for our own foods to be served within the home. The existing regulations dictate that most of the diet that's required to be served in the home is processed food, which many of you wouldn't appreciate eating every day either. If we have a donation of fish that comes from the lake and is freshly caught, they still can't serve it.

That's definitely a challenge, and I think it's definitely one of the issues that needs to be considered in any approach nationally.

Part of our challenge with services in long-term care and in the home is behavioural supports. Ontario does provide some supports to the home on a monthly basis; however, there is a need for funding to have on-site training of staff members due to the increasing number of responsive behaviours they're experiencing from clients who are attending our homes.

Additionally, there are language barriers with residents who are coming into the home. Our staff do not have access to any interpreters, in particular those who speak the French language or an indigenous language other than the one we speak in our community. Funding is required to have access so we can provide appropriate support to those with communication challenges. Perhaps some of those supports could be provided via Skype or video conferencing technology, which are widely available nowadays.

We do experience staffing challenges, in particular with regard to the director of care, who operates the long-term care home. It's a regulated position that clearly defines how a director of care is to operate within the home, and, in particular, the qualifications that are necessary. What we've been experiencing over the last six years is that at times we continually get written up for being non-compliant mainly from that perspective, because the director of care is required to have experience in an existing home or a home prior to coming into the position of director of care. The challenge is that many of the people who have experience as a director of care are already in positions, and if they're leaving, they're retiring.

There are no training opportunities for any young first nation nurses who wish to have that ability to be one of the lead administrators and lead caregivers of our elders in our community. If there are available training opportunities for qualified first nation nurses to become directors of care, I'd like to know where they are, because those are the supports that are necessary to allow that capacity to be available in our community or in any other first nation community that operates a long-term care home.

There are additional staffing challenges in terms of personal support workers. They're in high demand across the province, and access to that education is limited in our area.

Even though our friends from northern Ontario say that we're in southern Ontario, our southern Ontario friends say that we're in northern Ontario, so we're caught in the middle. We're on Manitoulin Island, and we just do not have the numbers necessary to allow on-site training opportunities for these positions.

These are also very demanding positions. It takes a special breed of individual to want to do this kind of work, and typically they're paid a very limited wage.

These kinds of supports are necessary in order for an individual to aspire to this type of work, not only in a long-term care home but also within the community through long-term care services.

Some of the demographics we're experiencing in long-term care are changing. We're no longer servicing just our grandmothers and grandfathers. We're seeing younger generations requiring long-term care now as a result of a number of issues, whether it be behavioural issues or mental health issues, including autism and fetal alcohol spectrum disorder issues. Those are now being experienced in our community. The younger generation is growing up, so now they also require that kind of care in the community.

We do struggle to get access to services for our residents who have these challenges. We don't get support from the medical teams when sending residents for psychiatric evaluations. My community has a resident population of 3,500 within the community on reserve. We look at some of our neighbouring municipalities that have populations of 400 or 500 and see that they have family health teams available to them.

Our community is one that does not have a family health team. We've been making requests over the last 10 years to provincial and federal officials to allow for that family health team to be funded in our community, but that is one of the challenges. We think that many of the supports and services necessary for our community could be alleviated through the introduction of a family health team.

Many of the regulations that exist within the North East Local Health Integration Network are very prescriptive and do not allow for consultations within the regulations that exist within the Ministry of Health and Long-Term Care Act. There are many things...many areas that have us....

I'm not used to this.

[Voices]

Oh, oh!

[Chief Ogimaa Duke Peltier]

I've travelled a long way to speak. I'll try to speed it up. I'll get to some of the other points here.

Our home is currently classified as a “C” home. It was constructed in 1972. We are required by provincial regulations to redevelop and renovate prior to June of 2025. Otherwise, we risk losing the licence to have these services available in our community. We're currently working on a feasibility study to increase the number of licensed beds to roughly a hundred beds. We've previously applied for an increase. That still hasn't been accepted. One of the things that—

Oh, they're turning the lights off on me now too.

[Voices]

Oh, oh!

[The Chair, Liberal, MaryAnn Mihychuk]

I need you to wrap up.

[Chief Ogimaa Duke Peltier]

There is a high need to establish a full-time diabetes program, not only in my community but in many other communities. That's where we seeing the results of early onset long-term care for many individuals, because diabetes is being experienced by many of the younger generation. There's the recreational prevention aspect of a program—

[The Chair, Liberal, MaryAnn Mihychuk]

Chief Peltier, we normally give 10 minutes. You're now at 12 minutes.

[Chief Ogimaa Duke Peltier]

I started late.

[The Chair, Liberal, MaryAnn Mihychuk]

We do want an opportunity for members to ask you questions.

[Chief Ogimaa Duke Peltier]

Go for it. I'll cover them off then.

[The Chair, Liberal, MaryAnn Mihychuk]

All right. You do that. Remember the rest of your comments. We'll get there.

Now we want to hear from Chief Collins.

[Chief Peter Collins, Fort William First Nation]

Thank you, Madam Chair. Like Chief Duke, I've travelled a long way to have our voice heard here.

[The Chair, Liberal, MaryAnn Mihychuk]

Yes.

[Chief Peter Collins]

I've been a chief in my community for 18 years now. It's been a long journey, to say the least.

[Don Rusnak]

You had a little break.