Challenges and opportunities for caring for elders in northern Ontario - a CBC series
Aboriginal long-term care experts call for beds, housing
More cultural sensitivity also needed, experts say
Nov 29, 2013
Janet Gordon, health director for the Sioux Lookout First Nations Health Authority, has been looking into other long term care options for remote communities in northwestern Ontario. (CBC)
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Experts in Aboriginal health say that home care for seniors is failing to meet the needs of remote First Nations communities, citing needs for more beds, better housing and greater cultural sensitivity.
More from CBC Thunder Bay's Aging Alone series:
- Ontario turns attention to aging Aboriginal seniors
- First Nation elders appeal for long-term care home
- First Nations seniors forced to leave communities
- Long-term care lacking in remote First Nations
"Our communities want to see a system that could support the elders better at the community level. They would like to keep their elders at home as much as possible," said Janet Gordon, health director of the Sioux Lookout First Nation Health Authority.
Gordon says the federal government's current Home and Community Care program misses the mark.
"It's really looked at as short-sighted services that is trying to be put in," she said. "So in the long run, it doesn't meet the needs of any of the communities."
Gordon says more services, including long-term care beds, are needed to help seniors live longer in their homes.
Need for long-term care beds
David Murray, CEO of the Meno Ya Win Health Centre, says that it doesn't have enough beds to serve the whole of northwestern Ontario.
"We've done a study that shows that we should have 100 long-term care beds in our area to bring it to kind of the same service level that is enjoyed by Thunder Bay or Kenora or Rainy River," Murray said.
David Murray is CEO of Meno Ya Win Health Centre. He would like to build a second long-term care home in Sioux Lookout with culturally appropriate services. (CBC)
"So, we're tremendously under serviced in the number of beds we have."
Along with beds, Murray says that improving housing in these remote communities is a necessary firs step so that seniors have somewhere to stay.
"If the elderly come down to our hospital, often times they go home and somebody has moved into their house, because housing is so crowded and there's so much sub-standard housing," he said.
Cultural sensitivity
Because of the lack of beds and services at the Meno Ya Win Health Centre, Murray says seniors from Sioux Lookout and remote communities further north end up going elsewhere, to places where the care is not culturally appropriate.
He says the centre has staff interpreters and traditional foods for its residents.
"We think that we do a good job of providing culturally appropriate care, but unfortunately, it's just so limited that many of our people are forced to go to other communities," Murray said.
Teresa Trudeau, traditional coordinator with Anishnawbe Mushkiki in Thunder Bay, would like to see Aboriginal seniors living together in a facility with culturally appropriate care. (CBC)
Teresa Trudeau, a coordinator at the Anishnawbe Mushkiki clinic, also points to a greater need for cultural sensitivity among people who provide care to Aboriginal seniors - many of whom are survivors of residential schools.
"We need to consider that their memories are changing as they age...Their memory of that will be like it happened yesterday," Trudeau said.
She says it would also help to have all Aboriginal seniors under one roof.
"Our seniors are spread out in different long term care homes throughout the city," Trudeau said. "They need to be somewhere where they can be together, because that's what enhances their health, is not being socially isolated."
More funding, support
Experts say the main challenge to improving level of senior care in these remote northern Ontario communities is a lack of funding, both federal and provincial.
Gordon says there are jurisdictional issues that need to be addressed and that the federal government isn't providing enough support.
"I think our community members are still Ontarian's, but it certainly doesn't negate the federal government from providing health care services at our community level," she said.
Gordon also identifies ways the province can help Aboriginal seniors stay in the comfort of their own homes, such as helping identify needs in the community, helping families provide for elderly relatives, and planning for more appropriate services that could be delivered at the community level.
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Aboriginal seniors have harder time staying healthy
Poverty, poor housing and diet, especially in remote areas, hurts health of aboriginal seniors
The Canadian Press Posted: Nov 28, 2013
Accessing health care can be physically, emotionally and financially challenging for many aboriginal seniors, who may have to travel to urban centres for services that are unavailable in remote or isolated communities, a new report says. (Darryl Dyck/Canadian Press)
Challenges Faced by Aboriginals with Dr. Alika Lafontaine (Extended interview) 27:09
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First Nations, Metis and Inuit of advancing years often have poorer health than their non-aboriginal counterparts but don't receive the same level of health-care services as other Canadian seniors, a report says.
The Health Council of Canada report, released Thursday, says the health of aboriginal seniors can be compromised by poverty, inadequate housing and poor diet, especially for those living in remote areas where nutritious foods may be prohibitively expensive.
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Chronic conditions such as obesity, diabetes and heart disease are more prevalent among aboriginal Canadians, compared with the general population, and those disorders can worsen with age.
"The challenge with First Nations, Metis or Inuit is that many of those seniors have lived in poverty throughout their lifespan," said Dr. Catherine Cook, vice-president of population and aboriginal health for the Winnipeg Health Region and a councillor with the Health Council.
"So the challenges will have compounded in that," said Cook, who is Metis. "For example, if you've been eating a diet that is low-cost but high in carbohydrates, you may have acquired some of the illnesses that are chronic in nature, so you may be further down that spectrum of illness."
Mental health issues
Many older aboriginal Canadians also carry the scars of rampant societal racism and the trauma of being torn from their families to live in residential schools, where abuse, neglect and substandard health care were pervasive within the system.
The report says those experiences have resulted in lingering mental health issues for some elders, such as depression or even post-traumatic stress disorder.
Aging Alone
CBC Thunder Bay explores what happens to First Nations residents as they age and require long-term care. Read about the special series here.
But accessing health care can be physically, emotionally and financially challenging for many aboriginal seniors, who may have to travel to urban centres for services that are unavailable in remote or isolated communities.
A lack of access to primary physicians and specialists can lead to worsening health problems, said Wenda Watteyne, director of Metis Nation of Ontario's health and wellness program.
"Oftentimes, complications related to chronic diseases aren't being diagnosed, treated or screened, so oftentimes those diseases reach a point of urgency and people are being treated in emergency wards once it reaches a crisis point," Watteyne said from Ottawa, referring to such complications as kidney failure from diabetes.
Ineligible for program
The Health Council says difficulties obtaining care are exacerbated by confusion over which level of government is responsible for which services and for which aboriginal groups.
For instance, First Nations and Inuit are covered by federal non-insured health benefits, but the Metis are ineligible for that program. The exclusion of First Nations from some provincial programs available to all other provincial residents is also contentious.
"You have a health-care (system) that has completely fragmented service for indigenous people," said Cook, associate dean of First Nations, Metis and Inuit health at the University of Manitoba.
Like many other aboriginal Canadians, Metis often have limited incomes, said Watteyne. "But what is distinct is the Metis' inability to access those non-insured health benefits. So that creates even greater pressures on limited incomes that are there.
"So just the ability to pay for expensive prescriptions, the ability to even cover the cost of transportation to see doctors and specialists (are difficult) because that's not covered either."
Support programs
While the report details the barriers many aboriginal seniors face in accessing health care, it also lists examples of programs begun across the country to provide culturally appropriate services for these "respected and honoured" elder members of indigenous communities.
Metis Nation Ontario has developed 18 community support programs across the province that help seniors access care, said Watteyne. For example, volunteer drivers will transport seniors in northwestern Ontario to Winnipeg for cancer and other specialized care.
Marney Vermette, a registered nurse who oversees an educational program for personal support workers in several reserves in northwestern Ontario, said the key is teaching community health providers to take a holistic approach to seniors' needs.
"So not only looking at the physical aspects of your client, but the spiritual, the mental and emotional, and how important that is in caring for your client," said Vermette, who is the liaison for the Saint Elizabeth First Nations, Inuit and Metis Program, Wabauskang First Nation.
Moving to city a blow
"The goal of this course was to provide health-care providers with the knowledge they would need to keep their elderly clients in the community safely for as long as possible."
But if an elderly person becomes so sick and frail they require specialized care, it could mean moving to a long-term facility in a city, which can be a blow for the individual, their family and the whole community, noted Vermette.
For the senior, "they're put into homes that are very foreign to them in the way care is provided. They're away from their families, they're lonely," she said. "Even for family members to go visit them, its very costly and I know that it's very difficult."
The senior can feel isolated and adrift because care providers in the long-term care home may not speak their language, the food would be "very different" and the likely regimented routine in the facility would be unfamiliar, she said.
"In my experience, it is also very sad for the community. It is a loss because not only is it a family member, but a lot of times these elders have a lot of (cultural) knowledge that's taken with them."
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Ontario turns attention to aging Aboriginal seniors
Health Minister Deb Matthew, Chiefs of Ontario to meet in new year
Posted: Nov 28, 2013
Ontario Health Minister Deb Matthews said she will meet with Aboriginal leaders to discuss how to provide long-term care for seniors living in First Nation communities. (Frank Gunn/Canadian Press)
The Ontario government says it's working closely with First Nations to find ways to serve Aboriginal seniors in remote communities.
Health Minister Deb Matthews told CBC News that she plans to meet with the Chiefs of Ontario in the new year after the topic of long-term care came up at a recent meeting.
These new discussions come six years after the province first launched its Aging At Home strategy, a program that aims to provide home care and support services for seniors who want to remain in their communities.
"We had some big issues we had to solve. We didn't have enough doctors. We had crumbling infrastructure," Matthews said. "Now we're able to really focus on things that we simply couldn't before, because we were focused on really keeping our system functioning."
The province supports four long-term care homes in First Nation communities in southern Ontario, but there are no such facilities in remote northern Ontario communities.
Creating models for care
Matthews admits that providing long-term care in remote northern areas is not the same as providing care in the south - for example, seniors in northern Ontario's remote regions often live in crowded homes without indoor plumbing.
She says that models for providing care need to be tailored to the specific kinds of communities.
"The long-term care homes on reserve in [southern Ontario] tend to have around 60 people in them," she said. "That's not a reasonable number in the more remote communities. So if there are only 1,000 people living [on the reserve], you need to have a different model."
- Listen to part 4 of CBC Thunder Bay's Aging Alone series on Superior Morning
- Report finds aging Aboriginal Canadians have harder time staying healthy
One solution to the lack of services in remote communities, Matthews suggests, is training more First Nations members as health care providers.
"They will be able to deliver that culturally appropriate care so much more naturally than someone who's been trained to do that - almost as a second language - later in life," she said.
Matthews says providing long-term care services in remote First Nation communities would cost the government less than not providing that care.
"There's no question that the federal government has fiduciary responsibilities for people who live on reserve," she said. "Having said that, the province supports that work as well."
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First Nation elders appeal for long-term care home
Seniors want to stay in their communities, but government won't invest in long-term care buildings
CBC News Posted: Nov 27, 2013
Ellen Neshinapaisc doesn't want to leave her community when she's too old to look after herself. She has been asking the leaders of Eabametoong First Nation to build a long-term care home for 10 years. (Melanie Ferrier/CBC)
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First Nations in northwestern Ontario lack long-term care facilities - and neither the provincial nor federal government will pay for them.
The health director for Eabametoong First Nation said the elders' centre in his community closed 10 years ago due to lack of funding.
"A lot of the people didn't like that," Robert Baxter said. "I think they still want a facility here, in our community."
Robert Baxter is the health director in Eabametoong First Nation. He says it's not likely the community will find the funds to build a long-term care home. (Melanie Ferrier/CBC)
Baxter and others have been trying to get a new facility built, but are coming up empty in their search for funding.
In an email to CBC News, Health Canada said "provinces and territories are responsible ... for providing funding for higher levels of care."
But provincial health officials told CBC News that the North West Local Health Integration Network doesn't fund buildings - it only supports services.
"[It's] just like pulling teeth when you want to get something from those people. It's very hard," Baxter said.
Given the challenges, Baxter said he feels it's unlikely a facility will be built in this remote community.
'Nobody can help me'
It's not good news for Ellen Neshinapaisc, a 77-year-old living in Eabametoong First Nation.
She has lived in Eabametoong since 1964, raised five children there and spent a lot of time on her family's trap line.
"My life right now is so miserable. I can't do anything. Not like I used to back then. I get lonely. I don't know what to do," she said. "I don't know how long I'm going to be able to do what I used to - like cleaning up. If I get sick, nobody [can] help me."
Provincial health officials say a traditional long-term care facility, similar to one found in an urban setting, wouldn't be economical in a remote community. (istock)
Neshinapaisc said she knows of other seniors who have had to move out of the community for long term care.
"I don't want to be like that or go out there and live out there. I want to stay here on the reserve," she said.
"I'm always talking about getting the home care for the elders so that they can be here in their own community."
Buildings not funded
Baxter said Eabametoong's respite centre was a place where seniors could stay when their caretakers needed a break, such as when they needed to go hunting in the summer.
"It ended up being almost like a long-term care facility after a while," Baxter recalled.
"They just couldn't get those people out of there. They just stayed there until they passed away. I know one lady from Mishkeegogamang ... I think she was there about the longest ... maybe two or three years she was there, or even longer."
The home operated for about 10 years, but began to run into financial difficulties.
"Bills started piling up," Baxter said.
"The only thing that they could do was keep paying the people's wages. Then, they finally had to shut it down."
Susan Pilatzke, a senior director with the North West Local Health Integration Network said she's heard from remote First Nation communities that are interested in building long term care facilities in their communities
But when communities express this kind of interest, the LHIN gives them this advice: "We don't fund buildings ... through the LHIN mandate, we help support services."
'I think there's money somewhere.'- Felicia Sagutch, a band councillor in Eabametoong First Nation
Pilatzke said a traditional long-term care facility, similar to one found in an urban setting, wouldn't be economical in a remote community because a certain number of beds is needed to pay for around-the-clock care. She said she doesn't think there would be a need to have that many beds in a remote community.
Something 'for the elders'
Felicia Sagutch, a band councillor in Eabametoong First Nation responsible for the community's health portfolio, said she's spoken to a number of elders who want a long-term care home in the community.
Felicia Sagutch, a band councilor in Eabametoong First Nation, said she's spoken to a number of elders who want a long-term care home in the community. (Melanie Ferrier/CBC)
"It is unfortunate that we don't have a place for them. They passed on [away from the community]," Sagutch said.
"You know, the last message I got from one of the ladies that was in hospital was, 'Get something for the elders. It's sad to be here ... to be away from family.' That's what she said. 'Work on it. Get a place for your elders. They need to be home.'"
Sagutch said she's determined to work on getting a facility, even though she knows it won't be easy to get the money.
"You never know how much support we're going to get," she said. "That's my thoughts. Money ... I think there's money somewhere. That's my feeling. There's got to be money somewhere."
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First Nations seniors forced to leave communities
Government home care program not adequate to keep aging seniors at home, critics say
Nov 26, 2013
Clara and Tenna Boyce live in Eabametoong First Nation. They want to stay in the community, but Tenna may soon need more home care than the local Home and Community Care program can provide. (Melanie Ferrier/CBC)
Seniors in Eabametoong First Nation are struggling to stay in their community as they age.
A federally funded home care program operates five days a week, but the co-ordinator of care in Eabametoong says the program doesn't help seniors live longer in their own homes.
"There's only so many hours that we can offer during the week," Nancy Keeskitay said. "Then, when holidays come, it gets harder for them."
Keeskitay said seniors have to move to Thunder Bay if they require around-the-clock care. With more support in their own community, she said, some of these seniors could age at home instead.
Currently the Home and Community Care office in Eabametoong isn't equipped to operate 24-hours a day. The office operates from Monday to Friday, from 9 a.m. to 5:00 p.m.
"We [don't] have the people to look after them or the facility to put them in - especially an elder with dialysis," said Felicia Sagutch, a community councillor in charge of health services.
Sagutch said Eabametoong needs more financial support to make that happen.
Daily care can be problematic
Felicia Sagutch, Ann Waswa and Nancy Keeskitay are in charge of home care in Eabametoong First Nation. They say services provided through the Home and Community Care program help take the stress off caregivers, but don't necessarily help seniors live longer in the community. (Melanie Ferrier/CBC)
In an email to CBC Thunder Bay news, Health Canada says its First Nations and Inuit Home and Community Care program "helps to prevent or delay health deterioration and complications."
The funding provides "home care services to more than 26,000 First Nation and Inuit clients and provides over 2.5 million hours of service annually," according to the federal government. In addition to the care for the elderly, this includes support for people of all ages with "chronic and acute illness or disability to safely live in their homes and communities."
Nevertheless, elders in Northwestern Ontario have to move hundreds of kilometres away from their homes when they need care beyond what is provided in their communities.
That could one day be the case for Tenna Boyce, a 78-year-old living in Eabametoong with his wife, Clara, their foster daughter and her two children. He has lived in Eabametoong his whole life.
Boyce's kidneys don't work properly and he has to give himself dialysis four to five times a day - a task he performs by flushing fluids through a tube in his stomach. A personal support worker comes a few times a week to change the bandages around that tube.
Boyce said he doesn't know how much longer he'll be able to do dialysis for himself. Lately, he's been forgetting to do it.
"I have to tell him when to do his dialysis," said Clara. "He has trouble remembering."
Taking stress off families
Keeskitay said Eabmetoong's Home and Community Care tries to do what it can with three personal support workers, two home management workers, two home support workers and one mental health worker.
Services include changing bandages, administering medications, foot care, bathing, preparing meals, chopping wood (many homes are heated with wood furnaces), boiling water (not all tap water is safe to drink), laundry, cleaning floors, winterizing the house, and so on.
Despite what they are able to do, Keeskitay said she's not sure they're helping elders stay in their homes in the community.
"It's pretty hard to say. I can't be certain and say, 'Yes, we are' ... because I don't know," she said.
Home care nurse Ann Waswa, who works five days a month, said the care provided takes stress "off families who have been trying to assist to assist their loved ones at these times of their lives."
But Waswa noted that, while providing "a little nursing care" and some general house cleaning, is helpful for their clients, she isn't sure it's enough to keep them in their homes.
Respite services also need to be expanded, said Waswa.
"You can let someone take a two-hour nap or you can let them go out to the store by staying with their elder," she said. "But I think respite really [should] be a week or more."
Meanwhile, the Boyces are coping as long as possible on their own, delaying the decision to move to Thunder Bay.
"I don't know whether I'll be happy or said if I have to go to the city, said Tenna Boyce. "I know that I won't be able to see the people that I know."
This is the second story in a CBC News series examining long-term care in remote First Nations. Wednesday's story looks at EabametoongFirst Nation's plans to keep its senior citizens in the community.
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Long-term care lacking in remote First Nations
"Aging Alone" series looks at the challenges of providing culturally appropriate long-term care
Posted: Nov 25, 2013
Florence Twance lives at Dawson Court in Thunder Bay because there are no long-term care homes in her home community of Pic River First Nation. She says she was very lonely when she first moved to the city. (Melanie Ferrier/CBC)
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Some First Nations in northwestern Ontario are looking at home-grown options for long-term care.
Every year, elderly aboriginal people - many of whom come from remote communities - are admitted to nursing homes in Thunder Bay.
They come to be cared for in their old age, but when they arrive, they often find a culture that is different from what they've known for most of their lives.
Florence Twance moved to Dawson Court in Thunder Bay from her home of Pic River First Nation near Marathon, Ont.
"At first I didn't like it," she said. "I cried for the first two weeks."
Twance said she wasn't mistreated at the home - just lonely. She said the language, food and activities she experienced were unfamiliar to her.
"My son said, 'Mom, why are you so lonely?'" Twance said. "'You got to get out of your room. You have to move around and see who you can find for friends.'"
'Huge culture shock'
Twance isn't alone in her struggle - Thunder Bay's Local Health Integration Network (LHIN) doesn't know exactly how many aboriginal seniors are living in Thunder Bay nursing homes, but most estimates place the number between 60 and 80.
'They feel out of place because they're not home. They're not among their people.'- Shannon Gustafson, Anishnawbe Mushkiki clinic
Workers at Dawson Court say about 10 aboriginal residents live there, with most coming from remote communities such as Eabametoong (Fort Hope) First Nation.
"I see it being a huge culture shock for them," said Shannon Gustafson, health promotion co-ordinator with the Anishnawbe Mushkiki clinic in Thunder Bay, which focuses on aboriginal health.
"They feel out of place because they're not home," she said. "They're not among their people."
Gustafson visits two long-term care homes in Thunder Bay each month to do traditional crafts with the residents.
The Anishnawbe Mushkiki clinic has been running the program, called Kichewyajig, for the past eight years.
"It's about making them feel comfortable and wanted and needed," she said. "Showing them that we care for them and that they're not forgotten because to me, it seems like they are forgotten because of the lack of ... services."
Gustafson said she wishes she could visit more homes more often, but she doesn't have the funding.
'It's like I've opened up a shell'
One home in the region that is doing more to make nursing home care culturally appropriate is William George Extended Care in Sioux Lookout, where June Wynn acts as a translator.
Wynn, who is the mother-in-law of CBC Thunder Bay's Elliott Doxtater-Wynn, said an incredible change comes over the residents when they learn she speaks their language.
June Wynn works full-time as a translator at the William A George Extended Care facility in Sioux Lookout. She says it makes Aboriginal residents feel at home when they can speak to her in their own language. (Melanie Ferrier/CBC)
"It's like I've opened up a shell," she said. "They just open themselves up and say, 'Oh! This lady can talk in both languages, so I'll just say whatever I want to say.'"
But the William George home is small, with only 20 beds, and a five-year waiting list.
CEO David Murray said most people on the list will die before they get into the home.
One way to shorten that list would be to provide service in remote communities, but right now there is little home care - and no long-term care - in any of the northern First Nations.
Janet Gordon, health director for the Sioux Lookout First Nations Health Authority,. is trying to do something about that.
In September, First Nations in the region asked the health authority to look into other long-term care options, citing concerns about the care seniors get in places like Thunder Bay.
"Most people from our communities, they would like to see their elders stay in the community, if at all possible," said Gordon.
She said she hopes to have a detailed list of recommendations by the end of the year.
This is the first in a CBC News series examining long-term care in remote First Nations. Tuesday's story looks at long-term care in Eabametoong (Fort Hope) First Nation.