I'm Tammy Cumming from the UW-Schlegel Research Institute for Aging in Waterloo, Ontario. I'm here to talk a little bit about a program that I'm responsible for there. It's a Ministry of Health and Long-Term Care-funded program called the Ontario Centres for Learning, Research, and Innovation in Long-term Care. This program is co-run by three organizations: the UW-Schlegel Research Institute for Aging in Waterloo, Baycrest Health Sciences in Toronto, and the Bruyère Research Institute in Ottawa.
We've been leading this program for a number of years and we just received renewed funding in the summer of 2017. The program's goal is essentially to support long-term care homes in building capacity by identifying and developing various resources to improve the quality of care and the quality of living for residents in long-term care.
The scope can be pretty broad. Today, I'm just going to talk a little about some of the work we are starting to kick off around supporting indigenous residents in long-term care.
In 2016, there were some identified gaps in some of the work we were doing in terms of addressing indigenous people's needs in long-term care. Stakeholder feedback in long-term care was giving us this information, and then the Ministry of Health and Long-Term Care was also identifying a need for us to address it. Therefore, we conducted a needs assessment, and we finished it in 2017. The needs assessment was basically trying to identify some gaps, and if there was anything that the program could do within its mandate to address those gaps.
The needs assessment involved interviews and meetings with some stakeholders in long-term care, and we had an advisory committee of people who were familiar with indigenous culture and long-term care supporting it as well.
There were a number of key findings and there's a full report about it. Some of the key findings I wanted to bring up today were that indigenous people have unique cultural needs that we need to be addressing and valuing when we're caring for them in long-term care. There's a growing body of evidence that suggests that when we're restoring culture and we're embracing culture, it can contribute to healing, and it may even have a protective factor for worsening health when in long-term care.
The other finding was that there's a lot of history in this country's legacy of colonization, historical trauma, racism, distrust in western medicine, and those are very unique considerations that we need to take into account when we're trying to address indigenous residents in long-term care, as well.
There's a real need to develop and identify resources that are already out there, and spread them across all long-term care homes, not just the long-term care homes that have the bulk of the indigenous residents but all the long-term care homes. This was one thing we heard from some of the stakeholders, the long-term care homes, that they have an indigenous resident moving into their home and they don't know how to ensure that they're supported culturally.
Of course, as always, it's really important for us to be partnering with indigenous people and organizations when we're doing any work.
Following the needs assessment, it was very evident that there was a role for the program in addressing and doing some of this work, but we weren't experts in indigenous culture, so, of course, we needed to identify partners and decided we wanted to form an advisory circle. That's primarily what I am going to talk about for the last few minutes here.
We spent some time thinking about the advisory circle, and we wanted members on the advisory circle to be experienced in long-term care and indigenous culture, but also to be representative of the northern and southern regions of Ontario as well. We began a bunch of phone calls and interviews to identify members for this circle. Without having an advisory circle to guide our work, we decided we'd better have some indigenous people on our team to help us with this recruitment work, so we hired an indigenous project assistant, and we had an indigenous facilitator guiding the process of recruitment. That was really important.
Once we finally identified the 11 members, we formally sent them a letter of invitation and included tobacco ties as a gift to show that we were wanting to incorporate their culture into the work we're doing.
We are happy to say six weeks ago to the day today we had our inaugural meeting. It was really very important for us to have an in-person meeting with the committee members. Nine of the 11 members were able to show up in person. We spent the entire meeting focused on building relationships and defining the way we were going to be working, so essentially an entire meeting about building the terms of reference for that advisory circle.
The meeting was like no other I've attended. I've not sat in on too many conversations about building terms of reference but it was grounded in partnerships and collaborations. Together the advisory circle officially named itself the Ontario Caring Advisory Circle, OCAC is the acronym, and they defined their mandate, which I want to read to you. It is, “The Ontario Caring Advisory Circle demonstrates leadership by guiding the identification and development of culturally appropriate resources to support indigenous residents in long-term care.”
The other important piece of that inaugural meeting was that we defined a consensus decision-making model, giving all members an opportunity to speak at all times and contribute to decisions. Given that most of our meetings will be via teleconference, we felt it was really important that we adopted a model where there was an opportunity for everyone to speak at all times and not the type of meetings where two or three people speak and the others are simply nodding in the background. We defined that very clearly. That was very effective in bonding us and feeling coordinated in the work moving forward.
We are six weeks from that inaugural meeting. We've had one teleconference, an invitation to speak in the House of Commons, and we've also been asked to consult in some research projects for another organization. We feel the need is there and that the resource of the circle itself may be the most valuable resource in the spectrum.
At this time, I'd like to pass to Teresa and Vincent, both members of the Ontario Caring Advisory Circle. Teresa is going to speak from her perspective of this experience, and Vincent is here to support her.
Greetings to the chair and members of the Standing Committee on Indigenous and Northern Affairs. Thank you for the invitation to speak with you today.
I have been asked to share some experience of working in long-term care in a facility that is one of very few situated in an indigenous community. As a supervisor in a 50-bed long-term care facility, my role over the past 17 years has varied from that of ward clerk-receptionist to admin assistant to activity aide, to my role now as rec and leisure supervisor.
If you asked for the one decisive factor that I have learned from my experience, it would be this. Time is the one feature that residents in long-term care have an overabundance of during their stay, whereas in contrast, staff members do not have enough time to provide the quality care that residents deserve.
Time as a concept is organic to indigenous peoples around the world. They survived in a natural environment now commonly known as Mother Earth. As well, there are plenty of published anthropological papers and textbooks that indicate how the original peoples survived and appreciated the land they lived on.
Consider in contrast your own concept of time. Do you put a value to it, do you use it wisely, or is it something to be conquered, with a winner and a loser in the end?
While I cannot speak for other indigenous peoples and communities, my insight is gleaned from a retired RPN, whose career started in southern Ontario, then moved to Sioux Lookout, and ended up in British Columbia where she retired on Vancouver Island, who happens to be my mother.
The Thanksgiving address, or the Ohen:ton Karihwatehkwen, is the central prayer and invocation for the Haudenosaunee, also known as the Iroquois Confederacy or Six Nations—Mohawk, Oneida, Cayuga, Onondaga, Seneca, and Tuscarora. It reflects the relationship of giving thanks for life and the world around them. The Haudenosaunee start and close every social and spiritual meeting with this address, sending greetings to the natural world and asking for everyone to use a good mind while business is conducted. In one Mohawk community, an individual was known and recognized to recite this Thanksgiving address every sunrise, to ensure that everyone would see another day.
Indigenous peoples are credited with being the first scientists: geneticists creating hearty seed, my ancestors; physicists, quantum theories abound everywhere now; and mathematicians. The activities of the family evolved around the changing seasons. Faith keepers and knowledge keepers continue to educate and encourage their people today.
Included in the teachings are the rituals or community practices that occur at various times of the year. It is the time of expressing thanks to the natural world, the spirit world, and the Creator, with an appeal to maintain the health and prosperity of the nations. Depending on how the indigenous culture lived on the land—as hunter-gatherers, fishermen, agriculturalists—their calendar of activities was centred in the natural world in order to survive.
I was a participant in a fish study project years ago. Our funding came from Quebec. We were interrupted because, when the geese arrived, our researchers and our goal in the project—everything—stopped. The village said, “You know, nothing is going to happen for the next two weeks, because everyone has gone hunting.”
Community and family was everything to indigenous peoples. Unfortunately, this very important cycle of tradition and teachings has been broken by residential schools, beginning in the early 20th century, and by the sixties scoop, during which children were taken from their families and placed with non-native foster families, to various degrees of failure.
Historically, when nursing homes were first established in western culture the residents played an active part in the operation of the home by working at various jobs in order to pay their way. The residents did chores common to every household, which required everyone to pitch in and share the workload to ensure survival, to have a sense of self-worth, and to contribute to their community. Later, these facilities became dreary places, identified as places where you go to die, until the restorative care incentive was introduced in 2010.
Recently, residents were interviewed and participated in a food service satisfaction survey in the home where I work. A lifelong farmer asked, “What happens to the food I don't eat? Where does it go?” When he learned that the food was thrown away, he remarked, “We should have pigs. Feed them the leftovers and then slaughter them in the fall.” Does this sound like a person just waiting to die?
Anyone over 18 years of age can be admitted into a long-term care facility. Taking care of indigenous residents is not limited to the frail elders. With the breakdown of the family unit, poor lifestyle choices are made by individuals who would benefit from a holistic treatment. Most traditional medicine ceremonies and teachings consider the whole person when trying to help. This includes the social, physical, emotional, spiritual, and intellectual parts of the person. When their minds and bodies have not had the opportunity to deal with the trauma inflicted by generations of abuse, they may be diagnosed with diseases that are directly related. Unfortunately, some health services are geared to preventive measures for community members, and requests for residents living in long-term care can be ignored.
Growing up and being told “what happens in this house stays in this house and no one else needs to know” leaves caregivers and family members struggling to keep their loved ones at home. It is a shame to ask for help. It is admitting defeat.
The health care team in long-term care homes involves the health professionals and the family members working together to educate and provide the resident with the care and treatment he or she desires. For example, in my experience, an elder female resident was not feeling well and asked for a cup of hot water. In reality, she wanted to make a cup of cedar tea, but did not have the resources, ability, or autonomy to ask for what she wanted. Her mother was a well-known, respected herbalist and healer. This was a lost opportunity to learn about herbal medicines.
Fifty years ago, as part of a church youth group, I took part in a Christmas visit to a nursing home in an indigenous community. My mother had learned that a childhood friend and neighbour was now living there, and she tasked me with finding him and reading a letter to him. Because I was 11 years old, this was not something that I wanted to do. I remember being taken to a dimly lit ward with two rows of metal frame beds lined against both walls. As I approached the sleeping individual lying in bed, the staff member called out, “Percy John, you have a visitor”, and promptly left. Not knowing if he was asleep or not, I read the letter out loud, never taking my eyes off the pages. In the letter, my mother reminded Percy who she was, indicated who I was, shared some childhood reminiscences, and ended with wishing him a merry Christmas. Relieved to have accomplished this task, I looked up finally to see great tears rolling down wrinkled, withered cheeks. Not knowing what to say, I left the letter on his bed and left.
That same experience could have happened last week, as the residents I now care for exhibit the same signs of loneliness: sitting near the front doors, waiting for someone to come to talk to them.
The newly formed Ontario Caring Advisory Circle on indigenous long-term care was created in April this year at the birthing centre in Toronto, Ontario. The individuals who came together for this session have made their own two- or three-year commitment to the group. Nine individuals started a journey at the beginning of that day. By the end of the day, a team—including the two absent members being “voluntold”—agreed to work together and made a schedule to meet in the coming months.
Indigenous culture celebrates a new life with family and friends. An individual who chooses to die in his own bed is surrounded by family, and they are supported spiritually by community. When a cycle of life reaches its end, this time is also marked with what society is now calling a celebration of life, where family and friends come together one more time to honour the deceased.
For the nursing professionals, who are basically scientists, death is considered a failure. The gap between the generations in indigenous families now has an opportunity to close with information and guidance. Instead of young people being afraid of the frail elders, especially when the elder no longer lives in his or her own home, generations are encouraged to share stories and eat a meal together, a universal expression of love. The communal celebrations could be hosted by the indigenous residents in the long-term care residence to accommodate those family members and community.
The backgrounds of the OCAC members are varied by their geography, nationhood, and experiences. However, their goal is the same: to demonstrate leadership by guiding the identification and development of culturally appropriate resources, to ensure that indigenous culture is recognized as a valuable aspect of health care in long-term care, and that the tools and resources are identified to the health care provider.
Is it okay to end with a Bible quote?
I would like you to consider this, and don't forget I'm from the seventies:
||To every thing there is a season, and a time to every purpose under the heaven:
||A time to be born, and a time to die;
The key issue here is addressing long-term care on reserve. I come to this presentation through both research and experience.
I grew up on a northern reserve. I still have a home on the northern reserve and I do a long commute to where I work.
I've done my Ph.D. on health care services and looking at first nations' health care services and its development. When we took over health transfer, back in the early nineties, we saw there were a lot of elderly people. When I speak of the term elderly, we know that the pension age of 65-plus is considered senior and people normally look at it as 65. Some now, due to the generally poor health status on the reserves, use 55 years or some even younger.
What we were finding was that there were a lot of elderly people. I like to use the term elderly or elder. They are mostly in their seventies, but particularly in their eighties is when they become the most frail.
At that time, we were on the development edge of developing home and continuing care services and what that would entail. My experience was that, in developing that, I never dreamed that I would one day come to use those very same services for my own parents. You just never think of those things, but I did. Over the past 10 years, both parents have gone and passed away in their eighties, along with my aunts and my uncles. What I have found, with my own community and having worked with the provincial first nations health organization as well, is that a lot of the same issues that my parents faced and I faced in our care of them were the same experiences that first nations families all over had. Also, there were other non-indigenous families as well, who experienced similar types of challenges, particularly when their loved one ended up with dementia and things like that. This is a common thing for all of us in Canada.
I am speaking to you from the Treaty No. 6 territory, which is in Saskatoon. My own band, the Peter Ballantyne Cree Nation, also come from a Treaty No. 6 territory. It's the treaty with the medicine chest clause that we have interpreted as the holistic comprehensive health care. We are looking at the care of the person—before they're even born, to the time they pass on. We talk about the seasons of life and those are the necessary seasons that we all have to go through. However, as citizens of this country, we should all expect to be cared for, to go in dignity, and to be treated with respect.
Those are the end goals that I'm looking at. I'm just going to go through this presentation, particularly to promote the need to build long-term care homes on reserves that are properly subsidized, that can be maintained and sustained, and to ensure that the elders we have can access sustainable long-term care facilities in, or at least near, their homes and families.
We just have to look at the media to look at the stories with elders who have been placed in Ottawa from Nunavut, for example. People are placed from my own isolated northern communities into the urban centres and whether it's people who don't understand their culture.... Even with well-meaning health professionals, they just don't understand and can't relate and communicate and work with families in a way that is respectful and is also most effective in terms of care.
In placing our first nations elderly, one of the things we have to consider is that the demographics are growing. The indigenous population is growing overall. Certainly what we've found now as well is that the seniors population is growing. In 2011, the estimates through Statistics Canada suggested that there is about 6% of seniors in the 1.4 million aboriginal population. By 2016, that had grown to 7.3% of the total 1.7 million. It's continuing to grow. Some projections estimate that, by 2036, the seniors population is going to double or more than double.
Obviously, the situation is not going to improve unless there are some dedicated resource investments and dedicated strategies to address that continuum of care on and off reserve, because basically you're trying to address that person, that individual, and that individual is not ever alone. They come in a package, a family package, and they also come in a first nations community package. With that, there are a lot of traditional values that are unique and distinctive. There are regions across Canada; we're not all the same. That's one of the things when you're dealing with culturally appropriate programs and services and their development.
Sometimes people assume that everybody is the same, but they have different backgrounds. They have different languages and they come from different areas. Their experiences as children are also the same, although they might have had experiences with.... This is, I guess, the tragedy of it. A lot of these elders that even go into dementia may have gone through the residential schools system or they might have gone through the TB sanatorium system that we're finding out about now. They also might have gone through some of these Indian hospitals that they recall. There are a lot of areas where, as children or adults, they might have experienced trauma that comes back along with other things through the years of life.
These are the things that we have to consider even as families looking after our loved ones. I know that the one question that was asked.... I have done a lot of studies in long-term care research and program development research as well as caregiving research. I go to these research things not because I'm asking a question, as most researchers would do, but because it's been placed before me by the communities and people whom I work with and it's become a need that needs to be addressed. We're just trying to find out as much information as possible about it, which is what research is, being informed to be able to make the most balanced and cost-effective and quality type of decisions.
Some of the common themes I looked at, one of the questions that came out, especially with the seniors, concerned the frail elderly when they're feeling vulnerable. I talk to the most vulnerable population, not just the elderly who go into long-term care facilities but also disabled youth sometimes. Nonetheless, they're vulnerable populations and they have things, as somebody mentioned—loneliness, isolation, abandonment. One of the questions that comes out over and over again, and I've heard in visiting elderly and my loved ones as well, was “Who will take care of us when we get old, when we're no longer able to help ourselves?”.
It's a question all of us ask, I suppose, but when you're at a vulnerable season, that becomes a time then to gather the resources and bolster the foundation that will help provide for them, so that they're well cared for until they go on.
This is one of the reasons I wanted to come here, the current status of continuing care services. Typically in Canada we refer to them as a basket of services. We know them to include home care, long-term care, respite, palliative, but for reserves, that basket is particularly small. The current stats show long-term care on reserves is fragmented. Some first nations are very fortunate to have long-term care facilities. It's not a common thing. I know in Saskatchewan we have maybe three for a population of over 90,000 indigenous people. You have to look at that.
The current status of long-term care in the western provinces is much the same. There's no dedicated funding for the development of these facilities on reserve. There are no subsidy programs, like the provincial and the territorial programs might have, that ensure sustainability and maintenance of these facilities. That all has to do with jurisdiction and the policy directions that government has taken.
One of the other things is the whole affordability issue, with provincial facilities based on various income-testing formulas. Pensions are the most common form of income for first nations. For example, in our case, Standing Buffalo First Nation in southern Saskatchewan is really struggling at the moment. It houses a 22-bed facility, and it also deals with disabled youth in that same facility, so there are a lot of issues there. We've been working to try to address that.
The long and short of it is that with the rising issues involving first nations seniors care, a national strategic plan is definitely needed, one that envisions long-term care on reserve as part of a compassionate and seamless health care continuum of services that places the seniors and their needs first.
That is it.
I wish I knew. It's always an ongoing development, right?
For lack of a better word we looked at something called “blended caregiving”. We've overused the word “caregiving”, but blended care is when you work with the local health professionals on the reserve. I'm looking at other reserves or rural reserves because that's the area I've done a lot of research in and have experience in.
When you're looking at the situation at home and working with the families of the patients—the clients, the elders—and working with the professionals, at the end they often have to be placed, whether they go on respite for two weeks, whether they are being assessed for long-term care placement, especially if they have something like dementia, or whether they are no longer able to be looked after without medical risk at home. When they leave the reserve in that transition when they are placed, they can't just be plopped in a long-term care facility far away. We all know that.
What happens is that you have to work with those professionals within that facility—those nurses, those home health care aides, and all those people—so families also become a part of that continuum, so that blended care between at home health, the family, the patient, and the long-term care facility off reserve in the city, that kind of relationship building has to occur. That's a case management approach. It's a blended care approach.
What happens is that we always have common meetings. Usually a family—in my case we were always keeping the communication loop open, because you have to know what prescriptions that elder is taking, what doctors they have, all that medical history, and also their background. What background did they have? Are they Cree speakers only? Are they Dene speakers only? Language becomes an important part of it. Their cultural values as well as their beliefs also become important.
A lot of it is really training the health professionals. I was just talking to them a few weeks ago, and that's exactly what they said, “We need to be trained; we need to know the background of those elders who are coming in.” We, ourselves, don't even know, as first nations people, where the elders are in the province of Saskatchewan. Even in our own band we had to go looking for them, because right now they are being placed out.
The situation there becomes a matter of blended care and not leaving those people off their reserve and off their home list just because they are placed in a long-term care facility off reserve.
It's all a matter of linkages. I think that has worked in several key instances now, so we're continuing to work with it.
Thank you, MaryAnn, and good afternoon to everyone.
My name is Jeff Anderson. I am the chair of the Fort Vermilion Seniors' and Elders' Lodge Board 1788. With me on the telephone is Chief Rupert Meneen, chief of Tallcree First Nation, a critical partner of our board, and sitting before you is our treasurer, Mr. Bill Boese; and Natalie Gibson, our researcher and adviser.
It is absolutely an honour to address the Standing Committee on Indigenous and Northern Affairs on the important topic of seniors and elders care.
For over 10 years, the community of Fort Vermilion has actively advocated for a designated seniors live-in care facility in the Fort Vermilion area. We wish to advise of the long-term, unmet need for seniors and elders care beds in the Mackenzie region of Alberta, especially when considering the needs of one of Canada's fastest-growing demographics, the indigenous population.
Our board and first nation partners are requesting that the Government of Canada work with the provinces to meet the needs of those in rural, remote, northern areas that are under-serviced. This includes more than just long-term care. It includes support services that affect one's quality of life.
We have all of the studies showing the need, yet nothing has occurred to date.
In 2014, the Alberta government partnered with Mackenzie County to conduct a regional housing needs assessment study. This $100,000 study determined that there was an existing and projected need for an additional 117 to 200 care beds for seniors between the dates of 2014 and 2031 in our region. It was recommended that eight to 13 assisted-living beds were needed in Fort Vermilion immediately, in 2014, four years ago, and an additional 14 to 24 beds by 2031. In 2031, the population of those who will be 65 years and over is expected to increase 123.8%, to an estimated 2,417 persons.
Since 2014, the inventory of 122 designated care beds in the Mackenzie region has changed only slightly, with the addition of four care beds in 2017. Currently, all designated supportive living facilities in the region are 100% full, and the DSL waiting list is up to two years. In addition, the facilities do not recognize the unique cultural diversity of the region. Seniors are forced to stay home longer, or they have to go out of the region for supportive care. As our people are staying in their homes longer, we encounter other challenges.
We also have a shortage of health care practitioners. We have reports of local nurses not having been able to take holidays in the last two years.
In rural and remote regions, health care services are much more difficult to access. Seniors close to urban centres can hail a cab to go to buy groceries, or a handi-bus to reach a doctor to refill a prescription. In our remote communities in northern Alberta at times, seniors can't even call 911 in an emergency due to a lack of cellular service.
As a group of passionate volunteers, we have formalized the Fort Vermilion and Area Seniors' and Elders' Lodge Board 1788. In your briefing notes, I invite you to see 10 bullet points outlining our progress.
In summary of those bullet points, the board of 13 includes four appointed directors, one from each of the Dene Tha' First Nation, Tallcree tribal government, Beaver First Nation, and Little Red River Cree Nation. Along with our partners, we have fundraised over $200,000 through a community thrift store and donations. We have had land donated, and we have access to two other pieces of land that we can access to build a facility.
We are working hard to build awareness that the standard formulas used for assessment and tracking of health care needs and supportive services do not work well in northern remote communities. We are now part of a large cross-ministry strategic task force with provincial and federal departments, to discuss the gaps in information and service provision. To date, the task force has met three times on three separate calls, with no outcomes yet.
To give a little understanding of our area, in your briefing notes there, we're part of what's called the Mackenzie County. It is the largest geographic county in Canada, about the size of Prince Edward Island. On page two of your briefing notes, you can see the eastern reserve of Garden River. It is approximately two and a half hours to travel to the St. Theresa General Hospital located in Fort Vermilion.
From Fox Lake, just a little south of it there on your map, via a barge, it's three to four hours to get to Fort Vermilion. High Level, which is towards the left of that little map and in the centre, has a hospital and a proposed lodge with a 25 DSL room project under way. Even with that new facility our needs are far from being met.
Good afternoon, all. Thank you, all, for giving us this opportunity here today.
My name is Chief Rupert Meneen. I'm from the Tallcree Tribal Government. I have been part of this group for the last 10 years, working on this culturally inclusive facility that we're talking about.
I'm one of the four chiefs who form the North Peace Tribal Council, which includes the Dene Tha', Tallcree Tribal, Beaver First Nation, and the Little Red River Cree Nation. We represent a population of approximately 7,500 on reserve and almost 4,000 off reserve, many living within the Mackenzie region, and including the Métis population. Over 40% of the Mackenzie region is indigenous.
We have a dire situation in the north. We have elders who are in overcrowded homes and are not being afforded the opportunity to live out the rest of their lives in a place where they don't have to cook or fight for a bed to sleep in. They do not and will not move into a facility with unfamiliar surroundings that is out of their home region and away from loved ones.
We have elders in long-term beds in our hospital because there are no supportive living beds for them. Our elders and spiritual leaders are respected in first nations' communities, and I feel that it is my job as a chief to do what I can to make sure they are treated with the respect that they deserve.
It used to be that the younger generation would care for our elders, but now with the social crisis around addictions, opioids, housing shortages, and unemployment it has created an environment where the younger family members can't care for our elders.
We think it is important for this standing committee to look at the broader picture of the actual needs for care within our region. Long-term care is one component. Another is home care. Another is housing. I am in support of a culturally inclusive facility right now based on our infrastructure. The location is best-suited to be within Fort Vermilion. We live in rural and remote areas where health care is challenging, so health care includes both the facilities and care prior to entering the health care system.
Our life expectancy is lower in the north than in many other regions due to poor socio-economic conditions, and residents need seniors' lodges 10 or more years earlier than the non-indigenous population. The reason we are getting overlooked so much is that the data between Alberta Health Services and Health Canada is not captured or tracked in the same way, and the funding formulas are largely focused on urban populations.
What we want and what is needed right now, number one, is for the Government of Canada and the respective provincial government to get on the same page in gathering and tracking data in rural, remote, and northern communities. Number two, there should be several business cases, including one in Fort Vermilion, that review public-private partnership to deliver culturally inclusive health services. Number three is to build capacity, train the people needed to build the facilities and to staff, manage, and support seniors' and elders' care.
Again, I want to thank you, all, for allowing us to present on this much-needed facility. I thank you again for allowing us this time with you.
My name is Natalie Gibson.
I'd like to reiterate what both Jeff and the chief said regarding the data. The Mackenzie regional housing strategy was done. Our needs assessment was done four years ago. It stated there was a need for 117 to 200 beds in the region, and it still continues at this stage, four years later.
When we started looking at the data, we noted that Health Canada and Alberta Health Services data were different in measuring, and as well, the Statistics Canada versus municipal affairs data for the region were out by as much as 2,000 people. This comes into consideration when you use the funding formulae that are based on population, and also the indigenous population is measured in quadrants of three age brackets versus seven to 10 in the general population.
The big statement here is that we don't know what we don't know. When we get asked by provincial and federal governments how many beds we really need, to look at a flexible model in today's market, we don't really know.
The other big issue, as Jeff mentioned, is workforce in the region. Approximately 40% of the population—where we can track the numbers—is in long-term and supportive care and maintenance. As far as the 13 reserves or four first nations are concerned, we have very little data to go on to amalgamate as a region. As the chief mentioned, whether it's on reserve or off reserve, we think as a region. In the Métis population, there are more than 1,000 indigenous people living within the community and, of course, the community of Mackenzie as an area as a whole.
I have a lovely little table to illustrate, when you do find the briefing notes. That gives an indication that there are 450 to 500 people already in home care. Within-home care is the next step to maintenance in the health care system. It's in that particular area where we're short of staff—health care aides, nurses in general. Also, when it comes to the responsibility, we've met with the province on more than one occasion, as well as here in Ottawa, and we find that this particular lodge is being passed from person and jurisdiction to jurisdiction. As the chief mentioned, we need to partner on this, so we're looking at innovative ways for a public-private partnership to give the opportunity for seniors and elders to age gracefully in place.
Hi. My name is Bill Boese. I guess I'm the story they're talking about. We moved to Fort Vermilion in 1963. I grew up there. My parents started a farm up there. When they retired, they had to go south for health care reasons. With no options up north, they ended up in Red Deer.
I don't think a lot has changed. Several facilities have been built up there since then. They're full. They're extremely hard to get into and it's still happening. The aging parents of a number of my friends are still moving away to live in care facilities. That's what happens up there.
There are dozens of stories such as my family's, and I expect an even higher number on the first nations. They don't want to move away from their family, or their cultural roots as well.
You don't have our notes and we have a few things listed here, so I'll read them out in conclusion.
We recommend the establishment of northern metrics with quantitative and qualitative data that truly reflects realities in northern areas and its specific needs, to promote a sustainable, culturally and gender-sensitive designated senior living facility, especially for the numerically dominant local first nations and Métis people. The Government of Canada should work with their provincial counterparts to actively collaborate to standardize the core datasets and ensure accurate regional data by including northern metrics with a focus on unmet needs and underserved populations.
For the development of a Fort Vermilion and area culturally inclusive DSL facility, a cross-ministry partnership task force should develop a business case with the relevant northern metrics, providing staff with accountability and authority to make decisions in the direction of expanding their circle of influence as opposed to referring responsibilities to other departments. The business case would provide scenarios on a culturally inclusive facility that promotes sustainable, culturally and gender-sensitive DSL facility development, especially for the numerically dominant local first nations and Métis people. The business would include innovative public and private partnership options and incorporate employee retention and attraction strategies.
We would like to be one of the 100 recipients that Mr. Keith Conn referred to in the May 24 meeting in which he mentioned a grant-like arrangement for a 10-year period to respond to community needs based on their priorities. The business case would consider economic development options within the facility and/or with service provision options. The business case would include options to provide the right level of service at the right time for the right patient.
Address the gaps in information data. We need a solution to resolve the immediate need for a DSL facility in Fort Vermilion.
Third, to build capacity in the health care workforce, there is a strong need for federal and provincial governments to increase commitment for training and outcomes in rural and northern regions. Employment attraction and retention can link to entrepreneur development by privately providing services.
We have a good example of that up north right now where an entrepreneur has gone out and is building ready-to-move houses. They're being built by people on the reserve to be moved back onto the reserve. That's a really good example of what could happen if we can do it.
Additional training can support first nations' capacity to efficiently deliver health care in their communities.
Lastly, the quantitative direct benefits would be datasets relevant to the region; strategies to incorporate traditional and non-traditional partners into a sustainable facility; a sense of local ownership, employment, and entrepreneur development opportunities; a sense of indigenous pride by incorporating inclusive values in the facility and study development; and promotion of aging with dignity and the promotion of the Fort Vermilion and area DSL facility as a model for other isolated or remote rural northern Canadian communities.
In addition, opportunities exist to develop partnerships with the private sector for corporate funding and branding, and with regional community colleges offering skills training in the required jobs.
I'm toggling through my mind to decide where to start.
I'll give you a quick little testimony. We have a lady who's very near and dear to us, Marguerite Peecheemow. She's in her mid-eighties. She grew up in Fox Lake. That's one of those communities you have to barge across or fly across to, or wait for the winter road to be built.
She was at the long-term care facility in La Crete, which distanced her by about three or four hours from her core family and friendship group. Because of, if I can be so bold as to say so, a lack of cultural inclusivity, many of us would travel to La Crete to spend time with her in lieu of her family, who were not able to make it because of economic conditions and problems of accessibility.
I'll say it this way. She gracefully broke her hip, and they had to move her into Fort Vermilion. She is actually much happier, because she is a bit closer to her family.
The broken hip came because of overstuffed facilities, according to her testimony, and people not being able to really get to her and look after her. As I said earlier, we have staff shortages. One of our three recommendations is to look at how we can bring more education and training into the area. It's a kind of cumulative effect that has caused people such as Mrs. Peecheemow to sustain hip injuries.
I was talking to one of her family members just a couple of weeks ago. They would love nothing more than to be much closer to Marguerite. The reality is that many first nations might not even have a car, and to be able to see their family, even from two or three hours away let alone nine hours away, can sometimes be an impossibility. In talking to this person, I found they hadn't seen their own mom for two and a half years, and that's just within the region, let alone considering cases out of the region.
I don't know how else to say it to you. I know I'm getting caught up in the passionate anecdotal type of stuff here, but that's what I would like to share on that, Rachel.