Indigenous and Northern Affairs Committee on Oct. 1st, 2018

[The Chair, Liberal, MaryAnn Mihychuk]

I call the meeting to order.

Welcome, everybody. Pursuant to Standing Order 108(2), we will be continuing our study on long-term care on reserve.

Before we get started, as a practice of reconciliation we always point out that we're on unceded territory of the Algonquin people. It's important for us to remember that, and to reflect on its significance to our history and reconciliation.

The way the process works is that you'll have 10 minutes to present. I have two presenters on the telephone and one presentation will be done here in person.

We're going to begin with the Grand Chief here in Ottawa, and then go to the phone presentations. When you speak, please identify yourself. This will help the translators and the transcript that we'll be producing from the meeting. We will then proceed to rounds of questioning from MPs.

Grand Chief, welcome to our committee.

[Grand Chief Constant Awashish, Conseil de la nation Atikamekw]

Thank you, Madam Chair.

Thank you, honourable members of this committee, for allowing me to speak to you on matters of great importance to us as a first nation.

If you allow me, I will speak French since I feel more comfortable speaking French, even though I'm able to speak English. Administration terms or financial terms are always harder in English.

I am Constant Awashish, Grand Chief of the Atikamekw Nation. I represent a nation that now has nearly 8,000 individuals, 70% of whom are 34 years old or younger, and 32% of whom are 14 years old or younger. In other words, there are many young children in our communities.

Today, the committee is studying the issue of long-term care in communities, specialized care and care specially for older people. Later, I will share with you a situation that happened to me as an individual, as a member of the Atikamekw Nation and as an indigenous person. I had to deal with a situation that caused me some trouble, given the state of care in our community.

Currently, the major problem in terms of health care is really the infrastructure. We are short of houses. There is a major shortage of housing in our communities, which generates many social problems. When we talk about creating places or offering a place for people who are sick, elderly or those who are losing their autonomy, it is important to understand that the houses are not necessarily adapted. There is a problem of overcrowding. Logically, it is understandable that housing people with severe physical disabilities or who are severely dependent on others in an overcrowded home creates many problems. This is what we experience in our communities.

It is also important to understand that, given the remoteness, access to health care is problematic. The geographical remoteness of the Atikamekw communities makes access to long-term care difficult.

Earlier, I mentioned the state of housing. Home care is another problematic issue. In fact, all the problems currently occurring in indigenous communities are due entirely to a lack of infrastructure, whether it is housing, education or health. It all revolves around that. I'll let you judge what the solution might be. There will be no perfect solution, that's for sure. A perfect world is difficult to access, but it could be much better in our community.

It is also about recognizing our specialists, training and skills. Again, our remoteness means that, in many cases, people don't have the necessary training to provide appropriate care in the community.

Let me give you some concrete examples. Currently, in the community of Manawan, one of the communities I represent, there are no homes for seniors. Nor are there any for palliative care or for people with loss of autonomy. In the community of Wemotaci, there is a home for seniors, but there is no infrastructure for people with serious illnesses. In the community of Obedjiwan, there is a seniors residence. Obedjiwan is my home community. My grandmother currently lives in this house. She is still able to move and talk, her mind is still sharp. As a result, she is qualified to reside in this seniors' home.

Let me tell you about my grandfather, who died almost two months ago now.

Two years ago, in winter 2017, while he was living in the seniors' home in our community, my family and I received a call and were told that a family meeting was needed. I went into the community to meet with the authorities of the seniors' home. The whole family was there. The authorities told us that they could no longer take care of my grandfather because he was beginning to have Alzheimer's disease. He was already at a fairly advanced stage of the disease, but the authorities realized that Alzheimer's had taken over. There was no infrastructure or competent people to take care of him. These people told us that he could no longer stay in the seniors' home. Who was going to take care of him? Were we going to send him to an urban hospital? This was another problem: often there are waiting lists, and you aren't always able to get a person into them.

We held a family meeting. As I told you earlier, there is a lack of housing and space in our community. So the responsibility fell to me. I was the one who took care of my grandfather for 13 months, while I was in my position as Grand Chief, while I was a hockey coach and while I was a member of the minor hockey team. I held several positions and, on top of that, I had to take care of my grandfather, who lived with us. Of course, I received incredible help from my little family and my wife. Still, I bathed him, shaved him, dressed him, fed him, got him up twice during the night to take him to the bathroom. That's what I had to deal with for 13 months, until his death recently. These are very unfortunate situations. He certainly had an incredible last year. I had the chance to be with him.

However, the lack of skilled personnel and infrastructure is problematic. If we want appropriate care, we have to go outside the communities, which isn't always possible. So what should we do? When someone is at the end of their life, palliative care is sought, but there is a problem with that, too: there is one pharmacy in the community that sells drugs for chronic diseases or emergencies, but there are no drugs for palliative care. What happens to people who are at the end of their lives and in palliative care, who want to live out their lives at home, even if it is not necessarily adapted to their condition? There are no adequate medications for palliative care. It always takes some time for the doctor to agree with the pharmacy to have it ship the drugs to the community. This creates tremendous stress for our members and families.

It's not complicated, everything revolves around these problems: remoteness, the state of housing, the lack of training, the lack of people with the necessary skills in our community. There must be adequate resources to train people in our communities to acquire these skills. Often people cannot leave the community to go to the city because they have to take care of their families and children, who go to school. They can't leave everything to take training.

In communities, the vulnerability of seniors living in family homes is problematic. There is a lack of suitable facilities. We are talking about chronic diseases affecting First Nations people. Additional resources should be allocated and investments made in healthy lifestyles, physical activity and nutrition. These are important things.

I will now present our recommendations. We were asked what was important to us, so here is what we recommend.

First, investment in housing is needed.

We would also like to have an accompaniment service for people who have to leave the community to go to a hospital in an urban area.

In addition, upstream prevention and intervention should be carried out.

We should also have the means to provide culturally appropriate care in our communities. For example, in our facilities such as seniors' homes, we would like to offer food that reflects our culture, but regulations prohibit it.

We would also like more autonomy in the management of long-term care and health care. We spend so much time on accountability that we are experts in the field. I don't think there is an organization across Canada that can call itself as good as First Nations in terms of accountability. We spend 80% of our time on it. First Nations should have more autonomy and flexibility in managing programs.

It is also very important to harmonize approaches with the province. We are often caught between a rock and a hard place. We are caught between the province and Canada, both of which are passing the buck. There should be better collaboration between the two levels of government, so that we are not caught in the middle.

Thank you.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you very much.

We turn now to our teleconference guests, Véronique and Julie.

I'm not sure which one of you will be presenting, or if both of you will. Please just indicate who is speaking.

Go ahead.

[Véronique Larouche, Director, Health and Community Wellness, Pekuakamiulnuatsh Takuhikan]

Good afternoon, kuei. I am Véronique Larouche.

I would like to thank Grand Chief Awashish for his most relevant testimony.

I would also like to thank you for having us here.

I am the director of health and community wellness here, in Mashteuiatsh. With me today is Julie Harvey.

[Julie Harvey, Director, Seniors' Health, Pekuakamiulnuatsh Takuhikan]

Good afternoon. My name is Julie Harvey. I am the director of seniors' health, which includes the nursing home and home care.

[Véronique Larouche]

I would like to thank the committee for its welcome today.

We will present the long-term care challenges facing our community here, in Mashteuiatsh, a First Nation with 6,644 members. Of that, 2,085 live in Mashteuiatsh; the others are outside.

There is a significant and rapid aging of our population. In Mashteuiatsh, we have gone from 155 seniors in 2001 to 240 in 2011. So that's a very significant increase in the number of seniors.

We have a private non-plan nursing home, the Tshishemishk Centre. This centre houses about twenty seniors from the community. In addition to accommodation and meal services, this centre offers all nursing and psychosocial services thanks to funding from the Indigenous Services Canada assisted living program. We also have an interdisciplinary team that provides home care, also funded by Indigenous Services Canada. A community organization, the Coopérative de solidarité Nimilupan Nitshinatsh, rounds out our service offering. This cooperative offers domestic help services, including meal and home management.

That was an overview of our services.

Besides the aging of the population, in Mashteuiatsh, there is an increase in the number of people losing their autonomy. There are many people who suffer from chronic diseases. For example, one in four people is diabetic. The complexity of cases, the exhaustion of caregivers and the lack of diversified professional resources all complicate the response to the needs of seniors here in Mashteuiatsh.

Here are the main challenges we are facing.

The first challenge is that funding for the assisted living program is limited based on the hours of care required by individuals. The Province of Quebec is responsible for housing people who require a higher level of care. In practice, this means that people should be removed from their surroundings and our community when they need more services.

We think this situation is detrimental to our seniors. Whether at home or in a nursing home, we should be able to allow our seniors to stay here, close to their families, close to their children and grandchildren, in their community, with respect for their culture and by offering them culturally relevant services.

Obviously, we still allow our seniors who wish to stay here in Mashteuiatsh to do so, despite the provincial rule that applies and the fact that we do not receive funding for people who need more services. We allow them to stay here, but it is clear that our services are limited due to lack of funding. We believe that our seniors should be entitled to equitable services in their communities on the same basis as all seniors in Canada.

The assisted living program also does not allow our partner, the Cooperative, to offer domestic help services to the entire population. Once again, there are criteria that make these services reserved for people with loss of autonomy. All meal and home support services can't be provided to the entire population. We do not have the funding to provide them to our entire population. Yet it is allowed elsewhere in Quebec: cooperatives offer services to the entire population. In our opinion, this is another inequity in terms of the services that can be provided outside and those that we can provide here in the community.

The infrastructure of our nursing home, the Tshishemishk Centre, is another major challenge for us. This centre was built more than 20 years ago and is in great need of renovation and expansion due to insufficient space. Some seniors even have to eat their meals in the hallway. In addition, we must comply with building safety standards to ensure the safety and well-being of seniors. We would greatly need funding in this regard.

We would like to offer our seniors a friendly and family-friendly place where they can access community and cultural activities. We would like to offer more housing units to meet the needs of seniors and prevent them from being uprooted and deprived of their culture when they go outside. The funding we are currently receiving does not allow us to have such aspirations. Our funding agreements do not include infrastructure construction and expansion.

In addition, the needs of our seniors are growing. Access to specialists such as occupational therapists and physiotherapists is often difficult and very expensive. The same applies to all the specialized equipment that seniors need because of the state of their health. Several specialized pieces equipment are required. Our seniors should have access to these services immediately and free of charge, just like First Nations children. This is an important issue for us.

Traditional foods represent another major challenge. Grand Chief Awashish talked about that earlier. Indigenous Services Canada's environmental public health program does not allow us to serve game meat or wild fruit. We are not allowed to prepare moose, beaver, goose or berries, among other things. Our elders are being prevented from maintaining their eating habits, even though that food has always been part of their life. When they come to the nursing home, they're told that these types of meats can no longer be served to them.

Yet it is recognized that a traditional diet has a beneficial effect on their health. In fact, Canada's Food Guide tailored to first nations, Inuit and Métis recommends that elders eat traditional meats, regardless of their age. We think there is a way to find solutions to allow elders to eat wild meats and fruits while following reasonable sanitation and hygiene rules.

In closing, we have a few recommendations for you on the future and the well-being of our elders.

First, government programs should earmark additional funding to enable us to provide home care and accommodations for all elders who want to remain in their community, regardless of the level of care required. That includes funding for infrastructure.

We also recommend that caregiver and home support programs be created or improved. The objective is to focus on prevention and to keep people at home. We want to provide the entire population with home care services, so that elders can stay at home longer.

We also want sanitation and hygiene standards to include exceptions, so that we can continue to provide traditional food in nursing homes.

In addition, funding should be added to promote access to specialized services for elders.

Moreover, there should be funding for community and cultural activities for elders.

On that note, we thank you for taking the time to hear from us. We hope this information will help you better understand the situation.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you very much.

When we go to questioning, I'd like you to direct your questions to one of the three individuals who presented.

We will start with MP Mike Bossio.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Thank you very much, Chief and others who are on the phone line, for being with us here today. I apologize that I don't speak French. It would be even better if I could converse in your native tongue, but unfortunately I can't.

That was some great testimony and sharing of stories from your community. It really helps us to see through your lens the existence that you have day to day for your seniors and your loved ones.

From the testimony we've heard from you and others, it seems that today the federal level doesn't have very much involvement on the long-term care side of things. That's the nature of this study: to determine whether we should be more involved, even if it's from an infrastructure standpoint.

However, you also speak to challenges at the provincial level in terms of culture, food and traditional healing practices. Your community in particular, Grand Chief, has self-determination. You declared that in 2014. Would it be preferable for your own community to manage providing these services directly to your community—to your elders—rather than having the province do it?

[Grand Chief Constant Awashish]

Of course it would be preferable for us. We always have to give a report for every little penny we spend. We spend so much time doing this. That's one of our biggest problems. Most of our resources are wasted on constantly writing those reports. At least 50% of our time and resources are put into just doing that. To find a way to better this situation, to be more autonomous and have more flexibility and more self-determination in that matter is a great question, but as I said, it's whether all of us here believe it.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

I apologize, because I meant to say at the very top of my questioning that I'm sorry about the passing of your grandfather. I could tell it was very emotional for you. I'm sorry to have heard that. I express my condolences.

[Grand Chief Constant Awashish]

Thank you.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Now, in taking it to the next level, if indigenous communities are to take control, do you within your own community have the resources and the capacity? You mentioned more professionals, more experts, more trained staff. Would you have those resources available within your community to provide those services?

Maybe you could just give us a general sense of whether you find that your community is moving in this direction, toward training more local resources.

[Grand Chief Constant Awashish]

Right now we're working really hard on education. We're trying to give the youth a mission to better their future and better the future of the nation.

Of course, the infrastructure is deficient right now. We don't have all of the houses necessary to accommodate the specialists who would come and work and would also give better education. If we wanted to have a training program in our community, it would be a problem right now. We don't have the infrastructure for it. We talk about competence and we talk about having all the human resources. We have all the human resources, but now we have to work with them to give them training, to give them education, so that they can give better services to the community.

We are starting at the base. That's how it works. When you build a house, you have to work on the base and then you build your house. With all the history that we all know and we all share—we've been talking for the last 10 years—we've gotten that message. We're working hard on the ground level to make sure that everybody understands their mission and what they can do for the nation.

As I said, there are a lot of resources missing in terms of infrastructure. We are working on it. Hopefully, that will move faster with time.

Another part of your question was about when we ask a professional doctor or nurse to come and work in our community and they also face a housing problem. They don't have a place, so they don't stay.

As well, it's not something that is friendly for them. When they're used to living in Ottawa, Montreal or Quebec, they don't like coming into a small community and staying very much. It's one of the problems we're facing.

Maybe there could be more flexibility with education. Right now the government is financing university studies and it's financing college studies, but it's not financing anything other than those two—for instance, if you wanted formation professionnelle.

That's how we say it in French. I don't know how to say it in English.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

You mean professional accreditation and training.

[Grand Chief Constant Awashish]

Yes.

We are working on this, but we have to bring them outside. We have a very particular situation with the Atikamekw nation in that 98% of our people still speak our language, so there is a little bit of a barrier with the language. They can have problems a little bit.

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

Chief, I'm sorry, but I have just a few seconds left. I want to get one more question out there that I think would be valuable to you.

One thing I've been trying to put forward is that the federal level of government needs to be directly involved in this from an infrastructure standpoint in providing funds—

[The Chair, Liberal, MaryAnn Mihychuk]

Sorry; you've run out of time—

[Mike Bossio, Liberal, Hastings—Lennox and Addington, ON]

—so would you agree that we should have a pilot program for this?

[Grand Chief Constant Awashish]

With the Atikamekw nation? I totally agree.

[The Chair, Liberal, MaryAnn Mihychuk]

Thank you very much.

You handled that so diplomatically.

The questioning now goes to MP Cathy McLeod.

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

Thank you for all the testimony here today.

You know, when I look at the scope of the study and at the time we've actually committed to the study, I think it's absolutely massive. Chronic illness, palliative care, long-term care—I think we could have taken any one of these areas and certainly focused in on it for a number of meetings and done perhaps a more comprehensive job and analysis. I think we're sort of doing a skiff on each of these very important subjects. If I could convince my colleagues that we need to look very methodically at each, I think it would be important.

My first question is for you, Ms. Larouche. I know that there are issues with country food and traditional food in terms of provincial regulations and provincial facilities. You talked about an issue that sounded as though there were some federal regulations. Can you quickly tell me what that was again? It was in relation to some facilities that you have in your community.

[Véronique Larouche]

Are you talking about sanitation standards?

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

You mentioned a regulatory framework to be able to provide traditional food in facilities. Were these federal regulations? In your community.... I know that it's an issue with provinces, but I was not as familiar with the issues federally. You talked about a certain regulation. Can you tell me what it was, and whether it was on-reserve?

[Véronique Larouche]

The environmental public health program, which is administered by Indigenous Services Canada, provides that we must respect provincial rules on food safety. The Quebec Department of Agriculture, Fisheries and Food, the MAPAQ, issues the rules. Pursuant to the environmental health program and our agreement with Health Canada, an environmental health officer visits our facilities to ensure that we are following provincial rules on food safety.

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

Thank you. That clarifies it.

Grand Chief, I know the health minister meets regularly with her provincial counterparts. Have they ever invited any first nations representation to these meetings to discuss some of these issues and concerns? Obviously, with the interconnection between the federal government, the provinces and your communities, I think the provinces need to understand these issues. Do you ever get invited to the table for those conversations? Have there been any special meetings with, say, provincial health ministers over the last couple of years?