First I'd like to acknowledge my ancestors of this land, the Algonquin Anishinabeg first peoples.
My name is Robin Decontie. I'm the director for Kitigan Zibi health and social services.
I was born and raised in Kitigan Zibi. I left home for 10 years to pursue my education, to then return to work for our community health centre over the past 20 years in different capacities. I'm now the director of our combined approach of health and social services programs. We've been a transferred health services community since 1989, and we're categorized as a high-functioning, low-risk administration community under ISC.
I'm also a member of the board of directors of the First Nations of Quebec and Labrador Health and Social Services Commission. Hence, I have some insight into what challenges there are on a regional basis as well.
With that in mind, today I offer you a community perspective of our challenges in delivering on-reserve long-term care and potential solutions to these issues. We're a community that believes in doing the work for our own people, by our own people. We believe in capacity-building. Policy-level changes impact good practice at the community level; therefore, I'm honoured to be here today to engage in this important topic of long-term care on reserves and I thank you all for this opportunity.
I'll describe challenges to long-term care on reserve and present some solutions for thought.
The major issue we're facing in many areas of service delivery is medicare delegation to the provinces and the associated jurisdiction issues.
Our community members are dependent on the provincial medicare system for our long-term medicare needs, as all Canadians are. We are dependent on our medicare system for our illness and health care. ISC is not a medicare authority in Canada and delegates these authorities to the provinces via the Indian health policy of 1979. This dependence creates issues when we try to work with the provincial medicare system for, one, uniform communication with first nations liaisons positions to facilitate better access to provincial medicare; two, proper health service delivery practice supervision; and three, planning for chronic disease service delivery and health planning.
Concerning uniform communication with first nations liaisons positions within the medicare system, Quebec's provincial ministry of health and social services liaisons within regional health boards do not have a standardized way of communicating and networking with on-reserve first nations providers in their province. We are dependent on each other to provide care to those needing long-term care on reserve, from womb to tomb. There needs to be a better way for on-reserve service providers to communicate with regional health boards in Quebec that would improve the health services access problems we are experiencing in communities.
For example, I have with me a document entitled “Portrait of the Situation for English-speaking First Nations: Accessing Health and Social Services in English in the Province of Quebec”, from the Coalition of English-Speaking First Nations Communities in Quebec. The portrait identifies the need for provincial boards to have a clearer role and responsibility for first nation liaison agents of the health system to work in partnership with on-reserve health services for long-term care. This is one example of an access issues study.
The solution is to obligate the ministry of health boards throughout the provincial ISC services to mandate a standardized first nations liaison that will meet the needs of communicating with first nations on-reserve care systems to allow for greater access to provincial services on reserve. There needs to be an obligation from the ministry of health and social services of the province to their own provincial medicare system to have a solid, standardized liaison practice from one regional health board to the next, to communicate and work in partnership with first nations communities to improve access to their medicare system.
I have this report. It's translated. It's bilingual.
Regarding proper health service delivery practice supervision, currently there are administrative obstacles with the ISC intermediate resource home facilities. These homes are for semi-autonomous people on reserve. This population will eventually have a growing need for care as their independence continues to diminish. A legal opinion that Quebec first nation intermediate resource homes indicated that non-certified ISC-funded homes on reserve are running an illegal practice of care that can be subject to heavy fines from the province if the province wishes to pursue our homes' care activity.
I have a copy of this opinion in English, if you wish me to submit it as well.
This means that the group homes on reserve in Quebec are providing services beyond the ISC levels 1 and 2 care because there is a growing need for these services with our aging populations. In so doing, we are working against provincial medicare law. There needs to be a congruent way to evaluate autonomy of the human condition between the ISC assisted living service and the provincial medicare system. Currently there is no provision to obligate the provincial medicare system to work with the on-reserve service provider to determine definitive levels of care that a client may need.
Currently our community services use a provincial assessment tool, which rates autonomy from levels 1 to 15 rather than the 1 to 5 that ISC uses. The ISC criteria of care between levels 2 and 3 is a grey zone, which leads to the home having to provide more services than it should in providing to clients in this grey zone. Hence comes forward the illegal practice of providing more help and care in these homes than we should, according to the province.
With the provision of more long-term helping services in the group homes beyond levels 1 and 2 come nursing services that the professional Order of Nurses of Quebec restricts in these homes. According to Bill 90 of the Quebec health act, nurses are not allowed to practise services in intermediate resource homes that are not certified by the province. Hence, we have inadequate supervision available to us by the provincial medicare system as needed. Nursing licences can be revoked by the Order of Nurses of Quebec if nurses are found practising nursing in group homes that are not certified by the province.
Currently our Kiweda group home, funded by ISC's assisted living program, is not a certified home under the province, but we are accredited by Accreditation Canada. Nonetheless, there is no legal provision in Quebec to secure any nursing services we may need to provide to the client in this home. This has always been a contentious issue for our health care team when deciding what care we can provide on reserve to our own people legally.
Our community mirrors the aging population situation, as in the rest of Canada. More aging people will be needing more care in the future, up until the next generation. Nursing home care, which is currently regulated by the province, will be the next set of residential services that we will need to provide to our community members on reserve. We need to ensure that nursing care licensing and certification processing for these homes is better facilitated between the provincial medicare system and first nations service providers on reserve, so that we can provide long-term care by our own people for our own people.
A solution perhaps is to provide the budget resources for assisted living homes to become certified in a culturally appropriate manner, equal to the province. This would mean infrastructure funding to upgrade our homes to meet provincial certification standards, and changes to scope of practice would need to happen to allow for cultural activity. For example, proper sprinkler systems for fire safety would need to be installed in homes, and certification would be needed to allow wild meats to be eaten in these homes, which is not allowed by current provincial certification. The province should be obligated to allow capacity-building approaches for our own community workers to provide the work for our own people by our own people in certified homes as well.
As well, provide the budget to allow first nation home and community care services to expand their hours of service delivery as needed to help community members remain at home and out of the provincial hospital care system as long as possible.
With regard to planning for chronic disease service delivery and health planning, there are other conditions besides elderly aging that constitute the need for long-term care on reserve. There are emerging concurrent disorders needing long-term care, such as people with mental health disorders and physical disabilities and people with chronic concurrent pain crisis management and addictions.
Those struggling with these mental health conditions concurrently with their physical conditions have very limited capacity for decision-making and are dependent on service provision, because they cannot live on their own. With the onset of the opioid crisis that we're experiencing in North America, we are observing the need for long-term care for community members struggling with addictions to have a place to go to so they don't die young.
The Chair: You have 40 seconds
Ms. Robin Decontie: Forty seconds?
The Chair: Yes.
Ms. Robin Decontie: For solutions, obligate the first nations liaison to configure aggregate public health and medicare data to be accessible for first nations communities to determine what chronic diseases the communities are dealing with, for a better medicare system and better health planning for long-term care.
Here is our conclusion.
Improve the obstacles between the provincial medicare partners and first nations who are capacity-building to provide care for our own people by our own people. Federal funds are disseminated to the province to provide first nation care; therefore, there should be more accountability as to what the province is providing to first nations in medicare.
Provide law changes to the provinces to allow for more jurisdiction and decision-making authority to first nations on-reserve services regarding medicare services development. The province must be open to working with first nations on reserve under federal jurisdiction to create and sustain safe medicare for those communities that are ready to provide medical practice themselves for long-term care.
We are in changing times now. Our community members are becoming more educated in health fields. We need to look at how we can provide better services to our elderly, chronically ill community members, prenatal and postnatal mothers, and children with chronic care needs.
Currently the province is able to deny service delivery on reserve due to our communities being under federal jurisdiction. It's observable, and data is available proving our province is not understanding that we do not have jurisdiction over medicare in our communities. They have been redirecting our people back to services on the reserve because we live on federal lands. There needs to be an obligation for the provincial medicare system to work in partnership—not simply to discard the responsibility—with on-reserve service delivery providers to create, sustain, and practise medicare in our communities, for those communities that are ready to take on that challenge.
I'll just introduce myself. My name is Sharon Rudderham and I'm the health director of Eskasoni First Nation.
Eskasoni is the largest first nation or Mi'kmaq community east of Montreal, in Nova Scotia. It has a population of 4,500 people. Half of our population, about 2,200, are young people in our community, so we have a significant youth population.
As you know, I'm here today to talk about long-term care and the needs related to it. We know that the impacts of the Indian residential school system have created an unwillingness by our people to access long-term care services outside of our communities. They prefer for services to be provided within our communities.
We've been working collaboratively with the Province of Nova Scotia in trying to resolve what we believe to be discriminatory policies that exclude provision of care to first nations people within Nova Scotia.
I also want to reference in my presentation—and I'm not sure if you're aware—that when the Health Council of Canada did a research study in 2012 and surveyed aboriginal people across this country, they found that aboriginal people feel fearful, powerless, and discriminated against, and have little trust in the public health system as it exists outside of our first nations communities.
I want to reference some data specific to our communities here in Nova Scotia. This data comes from what's called the Nova Scotia First Nations Client Linkage Registry. It's a unique identifier that allows first nations to extract data from provincial data sources. This was done through an agreement with our provincial government and our first nations communities.
Death before the age of 75 is considered premature. Between 2004 and 2013, 80% of deaths in our first nations communities were considered premature in comparison to the rate for Nova Scotia, which was only 30% premature deaths.
As you all know, the rates of diabetes are significant in our communities, with the rate almost double or triple the provincial diabetes rates.
I know we have limited time. I have some statistics. I'm referencing the importance and need around chronic disease management and the supports that we need to have in place and in process within our communities to support our population affected by these diseases.
Looking at heart attacks and heart failure, within our first nations communities the median age of someone who has a heart attack is 56. In Nova Scotia, the average age is 69. For heart failure, the average age was 67 years compared to 78 years for Nova Scotia overall.
You're probably wondering where I'm going with this. It's to give you an example of the need and the differences that exist between aboriginal and non-aboriginal communities. We do have a young population in our communities, but we have higher rates of chronic disease and disability that are being created because of these high rates of chronic disease.
We have small numbers around Alzheimer's and dementia, but when we look at the premature death rate that exists, if 80% of the people in our communities die before the age of 75, people are not getting diagnosed and not reaching those ages in the same manner that the entire country is reaching those ages and filling our long-term care facilities.
My name is Steve Parsons. I am the general manager of Eskasoni corporate services. My job in this whole team concept is to help negotiate with the province, on behalf of the band, for a long-term care facility.
It is important for members to understand that we're the model for Nova Scotia and that we could potentially be the model for the country. There's no such mechanism, no such long-term care, in the province of Nova Scotia as it exists today. One of the reasons this is a priority of the chief and council is that we do have a population of elders who need this care. We have had elders staying in existing non-first nations long-term care facilities, and they're struggling. Members need to understand that they want to come back to their communities because of cultural differences and language differences.
Take palliative care. Death in first nations communities is different from death in non-native communities. Palliative care is very important. When somebody is dying in our community, they are supported by family. When they go to our regional hospitals, the staff get inundated because they can't handle the number of people coming in to support the person who's dying. These people are dying in long-term care facilities and they want to be able to live in their communities. There is no mechanism in place when you go, and because people don't understand the language, they're fearful of it. Therefore, they stop going to the non-aboriginal homes. The support then can't be there.
We're currently negotiating with the Province of Nova Scotia. The fact that they have recognized and are negotiating a 48-bed facility for our community.... It's not just for our community. We've created a model that is for all Mi’kmaq in Nova Scotia. There are approximately 15,000 first nations people in Nova Scotia.
We have submitted our presentation for your reading at bedtime, or whenever you want to do it. We're creating a model that reflects the need of the community. We even went so far as to pre-empt this by training 10 continuing care workers in our community three years before we started the negotiation. Why? These are employment opportunities for our young people—which we have—who can participate in employment opportunities and give back to their people in a setting and in a service that we can provide ourselves.
We know that the negotiations are provincial, but there is a role for the federal government. The role is to help with capital infrastructure. These things aren't cheap to build. You all come from communities where infrastructure is built. Infrastructure is the primary focus. You can't have a home to provide the service unless you have a home.
We have three full-time doctors in our community. A natural progression in our community is from primary care to long-term care. In a lot of first nations communities today, there is a housing opportunity. Elders are living with large-sized families, and the level of care that they need is not there. We have 400 people in our community who require home care. The natural progression for these people is that they end up in a long-term care facility. Right now in Nova Scotia—I know it's a provincial issue—we have a waiting list not only in our region but in our province. There are 3,500 Nova Scotians right now on a waiting list for a home. Identifiably, the need is there.
We're saying that we could be the model for Nova Scotia first nations Mi'kmaq. We could provide that service in our community no differently than we do for alcohol and drugs for Nova Scotia Mi'kmaq. We do that out of our community. We're a large and progressive community. We want to be able to do this in conjunction with federal and provincial help and our own community chief and council.
We're willing to finance this. The need is there. We've costed it out, and we have an operating partner. We know we can't do this ourselves. We have an operating partner agreement with Shannex, the largest operator in Atlantic Canada for long-term care facilities. Their name is in our report. Shannex provides services for thousands in Atlantic Canada right now.
We knew we couldn't do it ourselves. We don't have the expertise or the capacity. We married that up with a joint venture. We have a management contract for a term. We want to get our people up to those administrative jobs. We have nurses and PCWs in our community today. What we're trying to do is take it to the next level and provide the services beyond “A”, which is there. The band did a feasibility study that cost $30,000. Why? We needed to understand the proper scope of the province.
We made a pitch to our provincial government to be a partner, in a per diem per day of 48 beds: If these beds are not filled by all first nations people, we're willing to help out the present waiting list. Empty beds don't pay the per diems that you need to operate. We set this up so that this is not a burden on the band and it's not subsidized by the band annually. It has to run on its own operationally. That's why we went out and got a partner—to create those opportunities, provide the service, and create the jobs for young people that are desperately needed as well.
As to the long-term care process right now, we have no other choice but to work through the process of standardization with the province as far as homes are concerned. The province basically had to sign off on everything from the management agreement to the staffing levels to the operations—the whole gamut. There's really no role, as we're told by the province as it relates to....
The province has the authority to grant a licence. Our goal is to garnish that licence for 20 years. In order to finance such a project, we need per diems based on our model for 20 years. Our project is shovel-ready. Yes, we go through the process of acquiring the licence, signing off on permits and so on and so forth with every department within the government from environment to agriculture and so on. That will take its course. This is territory where we've never been. No first nations in the province have gone down this road; we're the first.
We've had communications with the department, and we've had communications with our local MP. The role of the federal government here, knowing that decision-making process has been turned over to the province to administer, would be to help support that through a partnership not only in working with provincial counterparts, but at the end of the day we feel that the federal role here is one that could help establish the home. Whether a committee and/or the federal Department of Health wants to go back and engage with the province, I can't shed any light on that, on how to improve that, because I don't know that. I know that we've created a model. There's a role for the federal government and there's a role for the provincial government. That's why we're here hoping to encourage our MPs who are sitting on this committee to talk.
I want to back up just for a second. It really brings to light what members need to understand. I have a lot of friends who work in long-term care as staff. Not knowing the first nations, not understanding them, not knowing their traditions or their culture is really a sin. It's somewhat degrading when families of first nations go to visit their elders in homes and the staff say, “Oh my God, here they come again.” You really need to understand that. Picture your own family going into a home. It's inevitable that people, when they get elderly, need services. That's what governments do. That's what we all do collectively; we provide for that. Imagine families coming in from Eskasoni, and the staff says, “Oh my God, here they come again.” That's worrisome.
Thanks to all three of our witnesses.
I'll start by reacknowledging the fact that we are on traditional and unceded Algonquin territory.
It's a real privilege to have you here with us, so meegwetch, Ms. Decontie. Thank you also for being an important leader in the health and social services field in KZ. I know you're on the board of the Wanaki Centre, so your responsibilities are actually really broad—a substance abuse centre and the health and social services centre.
As irony would have it, Pauline Whiteduck once worked with my father before I was even born, so there's a little connection there.
I wanted to bring in Mr. Parsons' comment around the need for capital infrastructure and bring that question to you and ask you to put it in a Kitigan Zibi context. If the federal government were to be asked by Kitigan Zibi to enable capital infrastructure investments to enable greater long-term care, is that something that's in the field of dreams, something that is sought?
I have a sense of the complexity of the relationship between CISSSO, the regional health authority in KZ, and it's complicated for everyone without even introducing the federal government into the equation. I almost want to park that issue of jurisdiction and just go to an area where the federal government might have a more direct play, which is to finance needed infrastructure. What does Kitigan Zibi need and want when it comes to long-term care infrastructure?
[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!
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.
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—
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.
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.
We fit into the grand scheme of things, as I believe we've essentially been grandfathered in because our facility was built in 1972. It's one of the earlier ones—actually, one of the first ones—across Canada that was built in a first nation.
The approach at that time, as I indicated earlier, was to have a place for our own community members to go to if they didn't have supports at home. We wanted it to be culturally responsive, where the community members could have their own food and be able to speak their own language with staff members who also spoke the language of our community.
So, from that perspective, it had been operating as it should. Then, in 2007, new regulations came in with the provincial ministry's Long-Term Care Homes Act, which essentially placed our home in non-compliance for a number of reasons. One of the main ones was the diet that we were feeding the community members. Typically, the diet was traditional foods. We had cooks from the community who were adept at preparing the traditional foods, and these foods were the main staple of the daily diet.
Once the regulations came in, we weren't allowed to do that anymore, although, essentially, it was cost-saving in nature because we were able to use the local game and fish. We were able to have that available for the individuals. Now we have to get everything transported in, and it's all processed stuff.
The regulations have really challenged our home because of training requirements and staffing requirements. People with the training qualifications that are required for people in administrative-type positions with regard to the care of the elderly are not readily available close to home or in other first nations. The opportunities aren't necessarily available for our younger generations to come and fill those gaps that exist. Because we've been operating since 1972, many of those individuals are now getting to retirement age, but we aren't able to fill the vacancies.
There are sources. There's the Institute for Clinical Evaluative Services. It has kept records and they are accessible, at least to our first nation. They categorize them that way. We do have records for the time period of 2002 to March 31, 2015, for all services obtained by our people within the North East LHIN and within Ontario.
It has given us a whole wide range of statistics, but we do know from them that we're 1.9 times more likely to have hospitalization in the first year after diagnosis of diabetes. We're 3.3 times more likely to have an emergency department visit in the first year following diagnosis. We're also 1.3 times less likely to have a non-urgent visit in the first year following that diagnosis. The people with diabetes in my community at one time were 1.9 times more likely to develop heart disease or stroke.
These are critical numbers that we have to deal with. The one that really strikes us is that people in my community are 10.8 times more likely to have an amputation. I'm now seeing amputations on individuals younger than I am. I'm not very aged, and they're younger than me, and that's a cause for concern. I grew up with some of these individuals. Why is this happening?
We know about it from the data that exists and from ongoing monitoring. In fact, working with the province, we initiated.... In 2016, we wanted to establish dialysis services in our community because we had 13 individuals who were travelling two hours each way for dialysis. They didn't have much of a quality of life. We were lobbying and advocating for them to have services within the community. We had to have a requisite number to provide those services in our community because they were doing it in other locations. During the time period when we were advocating for that, in a two-and-a-half-year time period, we lost eight of those 13, because they just gave up.
We've made it an issue with the Ontario Renal Network. We started a screening process. We know who has early onset diabetes and who's at risk. We know how many diabetics are in the community because we've made it a point to assess as many individuals in our community as possible. Now we know we're sitting at about 60% of our population that is diabetic. That's where I'm coming from.
In order to alleviate the long-term care services in the future, we need to do something about the diabetes complications, because they're coming.