INAN Committee Report

The Challenges of Delivering Continuing Care in First Nation Communities

Dissenting Report of the New Democratic Party (NDP)

Although the NDP mostly agrees with the recommendations of the study, there are some glaring absences in the report that lead us to write a dissenting report. The main issues are as follows: the lack of time to do the meaningful study the motion asked for, and the lack of acknowledgement of the high level of support that the spirit of Jordan’s Principle be used.

Acknowledgement of General Problems Regarding the Study

The original motion concerning this study read:

• That, pursuant to Standing Order 108(2), the Committee undertake a comprehensive study of long-term care on reserve; that the scope of the study include and not be limited to, elder care, persons living with chronic illness, palliative and hospice care and culturally relevant practices and programs; and that the witness list include First Nation community representatives, First Nation organizations responsible for delivering long-term care services, and groups and organizations affiliated with service delivery; and that the Committee report its findings to the House.

The motion clearly states that this study should have been ‘comprehensive’. However, the length of the study was far too short to comprehensively look at the issue of Long-Term Care and other healthcare needs and services for First Nations. Additionally, the House of Commons has never done a study on this issue before, making it even more important that comprehensive time be given to it. This simply did not occur, as the study only lasted for 8 sessions hearing from witnesses, from the end of May to the start of October, with a long break over the summer taking up over 2 and half months of the overall study period. To wholly fulfil the goals of the motion a longer and more comprehensive study was needed, supporting this, on June 14^th, in response to being asked if she thinks the study should be extended, Tania Dick stated to the Committee:

• “I think it's a complex issue, particularly looking at it through that reconciliation lens, with the trauma that we carry as indigenous people in those generations right now, the residential school survivors. It is so desperately needed because from palliative care to chronic disease management to long-term care to acute care, we have less than adequate access to services, not only by choice but also since systems don't provide it. We have to look at it from both perspectives.
• If we're not getting down to those layers and having that comprehensive discussion about it, we're not going to have the impact and the action that really are needed by our communities across the country. We have to pull back those layers much further. I think a huge discussion is so desperately needed if we are going to have an impact on the quality of life for this generation and the generations to follow.”

The short length of the study has left the committee insignificant time to study: chronic illness, palliative care, hospice care, culturally relevant practices and programmes. There was no significant study of dementia or regional responses either. Nearly all of these issues were specifically named in the original motion.

The NDP’s Dissenting Report Recommendation

• 1. That Indigenous Services Canada work with First Nations to develop and expand Jordan’s Principle for continuing care on and off reserves that applies to all First Nation members.

What is Jordan’s Principle?

The Canadian Human Rights Tribunal (CHRT) defines Jordan’s Principle as:

• “Jordan's Principle provides that where a government service is available to all other children, but a jurisdictional dispute regarding services to a First Nations child arises between Canada, a province, a territory, or between government departments, the government department of first contact pays for the service and can seek reimbursement from the other government or department after the child has received the service. It is a child-first principle meant to prevent First Nations children from being denied essential public services or experiencing delays in receiving them."

Therefore, Jordan’s Principle can be summarized as a system of care in which the needs of those seeking care are put first. As Tania Dick stated to the Committee on the 14^th of June:

• “An important lesson to learn in our practice is about the spirit or the foundation of Jordan's principle. Let's get rid of the boundaries, provide the care, and figure it out later, rather than having people turned away or ignored or not looked at.”

Connecting Jordan’s Principle to Social Determinants of Health

Jordan’s Principle essentially exists to help remedy the vulnerability that First Nation members face. This vulnerability arises through many different aspects of life such as housing, employment, healthcare, mental health, food and security. These poor social determinants of health denote that First Nation peoples’ health can deteriorate to a great extent at any age, meaning that considerable vulnerability does not just exist amongst First Nation children but often lasts through a lifetime. Furthermore, for children who need continuing care, those vital services can be cut off when they turn eighteen meaning they are left living within the jurisdictional cracks.

Therefore, the jurisdiction of Jordan’s Principle must be expanded to include all First Nation members, to remedy vulnerabilities faced and to prevent First Nation members of all ages from falling through the system into critical circumstances.

As testimony received from Deputy Chief Derek Fox on June 7th shows:

• “When we talked about the social determinants of health, I would say that 90% of those would make up our issues. You're talking about education, infrastructure, and social challenges. All these things combined lead to health issues, whether they're for youth, elders, our people, and so on.“

Similarly, on September 26^th, Sharon Rudderham stated:

• “Even when you look at children with disabilities, and when they reach the age of 18 then what's going to happen to them? If Jordan's Principle is providing tons of support to the family because of the jurisdictional barriers around their care, then what's going to happen when these children age out of Jordan's Principle? Who is going to be responsible?”

Expanding Jordan’s Principle is particularly important for First Nation members in rural and remote settings that lack the necessary transport, infrastructure and supports to access adequate healthcare services nearby.

Testimony received from Jeff Anderson on June 5^th demonstrates this:

• “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.”

Applying the Lens of Reconciliation to Jordan’s Principle

Expanding the jurisdiction of Jordan’s Principle is also necessary from the lens of reconciliation. Many First Nation people already adamantly avoid using healthcare services, due to the traumas they have experienced through interactions with residential schools and non-indigenous society and institutions. The jurisdictional mess which currently exists only serves to further confirm feelings of isolation and abandonment, as when First Nation people are turned away from services they become even less likely to return to them despite it becoming critical to their health and well-being.

Therefore to truly begin to fulfil the obligation of reconciliation, Jordan’s Principle must be expanded to all First Nation members. With easier access to services and less bureaucracy and denial of services, First Nation members may start to feel more secure both in regards to accessing healthcare and their place in Canadian society as a whole.

Chief Edmund Bellegarde confirmed this at the Committee on June 7^th, stating:

• “It's that institutional aversion, skepticism, or fear for our people; it's access. Some of the stats don't capture all the people falling through the jurisdictional cracks, because the system is overly complex. There's a lot of procedure and policy and paperwork to it, and they don't have all the navigation services or supports they need. When there's transition between reserve and off reserve, especially in more southern communities where that transient lifestyle is very prevalent, those are challenges. They get lost because, are they federal or provincial?”

The importance of expanding Jordan’s Principle with regards to reconciliation is further confirmed by the Truth and Reconciliation Commission of Canada’s Calls to Action. Call to Action 20, under the category of Health states:

• “In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect and address the distinct health needs of the Métis, Inuit and off-reserve Aboriginal peoples”.

Further supporting statements from testimony:

Deputy Grand Chief Derek Fox, 7^th June: “As I mentioned earlier, we have 32 remote communities and 49 altogether. You asked us about what conditions are like. As Mike alluded to earlier when we talked about the social determinants of health, I would say that 90% of those would make up our issues. You're talking about education, infrastructure, and social challenges. All these things combined lead to health issues, whether they're for youth, elders, our people, and so on.”

Tania Dick, 14^th June: “I'm the first generation out of residential school. That intergenerational trauma exists. The general feeling overall that I have experienced in my practice is that individuals don't have trust. They have a lot of fear, and they absolutely have a difficult time accessing services or entering these facilities or institutions. It triggers them, I'm sure. They avoid them as much as they can, and then they get into a critical state in the community where they come in and we are actually having to try to resuscitate them and kind of revive them physically through their chronic disease issues and get them safe again.”

Grand Chief Constant Awashish, 1^st October: “We are about 60 to 70 years behind socio-economic development. How are we going to assert this problem? Here we have a lot of very smart people around this table and I'm sure we can find something good for our future. Like I said, where do I go to speak to different organizations, or when I do not know where to go? We want to be able to feel good. We want to be able to have a sense of belonging to the society so we can contribute to the protection of this land, the protection of the country. There's no contradiction to be sovereign within the state here.”

Conclusion

The report fell down significantly by not allowing for meaningful time to study the full motion. With those significant gaps, the NDP has concerns that the study’s recommendations are not as comprehensive as they should be. The exclusion of the many testimonies on Jordan’s Principle is concerning. At the heart of this principle is the point: people before jurisdiction. As elders and seniors are falling between the cracks of this system the honoring of humanity is key. By leaving this out, the continuation of families suffering in a broken system will continue.