INAN Report 17: The Challenges of Delivering Continuing Care in First Nations Communities


Report of the Standing Committee on Indigenous and Northern Affairs

Honorable MaryAnn Mihychuk, Chair

Indigenous health outcomes tend to be poorer than the Canadian average. The underlying factors are complex and include historical and intergenerational trauma attributed to colonialism and discriminatory policies, as well as social determinants of health, the current legislative and policy frameworks and gaps in existing federal programming. In addition, First Nation members are more likely to have chronic conditions at a younger age, and the care available in First Nation communities is often limited compared with the care offered to the non-Indigenous population in urban centres.

For First Nations with more complex health needs, access to continuing care on reserve is essential to their well-being. Continuing care covers a range of services, including home care, community support services, long-term facility-based care, respite care and palliative care(1). Continuing care services are not only for seniors: they are for anyone, of any age, with chronic medical conditions. These services are part of the continuum of care to which all Canadians are entitled until the end of their lives.

Over the course of its study, the House of Commons Standing Committee on Indigenous and Northern Affairs (the Committee) learned that the barriers associated with continuing care on reserve are partly due to the complexity of overlapping responsibilities and current policies between levels of government. Currently, the responsibility to provide health care on reserve is unclear, and the provision of those services is currently shared among the federal and provincial governments, First Nations organizations and communities, and third-party services providers, resulting in a complicated and ambiguous framework. Because both levels of government are “passing the buck,” First Nation communities have trouble obtaining the support they need to offer health care services on and off reserves(2). Continuing care is no exception.

In an effort to address the problems with continuing care on reserve, the federal government put programs in place to provide home care and community care on reserve and to subsidize some expenses in care facilities. As it stands, these programs and the jurisdictional framework are lacking. Current resources for home and community care cannot meet the growing demand for these services on reserve; there are very few long-term facilities on or near reserves; and the services provided in off-reserve care facilities is often very far from First Nation communities and fails to include culturally appropriate care.

Little research has been done on continuing health care services on First Nation reserves. However, First Nation members are “just as human as any other individual” and are entitled to the same level of care as other Canadians(3). That is why, on 1 February 2018, the Committee passed the following motion :

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 purpose of the study was to consider the main barriers that seniors and those with chronic illness face in obtaining continuing care on reserve (including care provided in long-term care facilities on or off reserve). The study also addressed palliative care and the need for programs and practices adapted to First Nations’ cultures and values. The Committee held eight public hearings and heard 48 witnesses, including representatives of the federal government, First Nation communities and organizations, tribal councils, service providers, health authorities and independent experts. Five briefs were also submitted to the Committee.

While the study focused on continuing care on reserve, the Committee recognizes that some of the issues identified during the study also affect the general Canadian population. However, some challenges are unique to First Nation members living on reserve, such as the ambiguity over responsibility of health care provision and the importance of having access to culturally appropriate care. The Committee believes that these issues require special and immediate attention from the federal government and that access to culturally appropriate care should be taken into account at every stage of the continuum of care on reserve.

The Committee also recognizes that the shortage of long-term care facilities on reserves and the gaps in care services offered through federal government programs are not the only barriers. The disproportionately high poverty rates and the greater infrastructure and housing needs on reserve are some of the many issues that must be taken into account when considering strategies for delivering health care, including continuing care in First Nation communities(4). Nevertheless, the Committee hopes that the evidence heard and the recommendations given will open the door to reforming the current policies and practices governing continuing care on reserve.

Download Report 17: The Challenges of Delivering Continuing Care in First Nations Communities


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