While Nunavut struggles with elder care, Sailivik offers a solution

Since arriving at the Nunavut Legislative Assembly in 2014, Rankin Inlet South MLA Alexander Sammurtok has been constantly calling for a 24-hour care centre for elders in Rankin Inlet. (FILE PHOTO)

Pat Angnakak of the Sailivik Society appearing before Iqaluit City Council in January 2016, when council gave their support to Sailivik’s proposal to build a big continuing care facility in Iqaluit that would serve all of Nunavut. Angnakak, who is also the MLA for Iqaluit-Niaqunnguu, says Sailivik can begin negotiating with the GN as soon as their business plan is completed. (FILE PHOTO)

Here’s the eight-bed $1.5 million continuing care centre in Gjoa Haven that the Government of Nunavut opened in 2010. It offers 16-hour-a-day Level 4 care, similar to an eight-bed continuing care centre in Igloolik that the GN opened around the same time. However, these centres don’t come close to meeting the exploding number of elders and others who require round-the-clock care for medical issues that include cognitive conditions like dementia. (GN PHOTO)

It’s no secret the Government of Nunavut struggles with the burden of caring for the territory’s rapidly growing number of elders who need care the GN is not able to provide.

Recent complaints about Embassy West Senior Living Centre in Ottawa, are just one example of the hostility that this practice generates.

That facility, located just west of downtown Ottawa, cares for elders who suffer from serious conditions that can’t be treated in Nunavut, such as dementia.

But despite all the complaints, the GN has no choice but to send such people, who need 24-hour-a-day care in a secure facility, to centres in Ottawa, Edmonton or Churchill, with the consent of family or legal guardians.

Pat Angnakak, an MLA from Iqaluit and a board member for the Sailivik Society, which proposes development of a large continuing care centre in Iqaluit that would serve all of Nunavut, says she understands the GN’s problem.

“There’s a lot of pressure right now on government not to send people down south. People get so upset over this,” Angnakak said.

“And yet there is really nowhere in Nunavut right now, when you talk about dementia care, there is really nowhere in Nunavut to send anybody. So I think the government is in a hard situation and the expectations are very high.”

Can Sailivik help the GN?

Angnakak believes her group is well on its way toward helping the GN find a fix that could see many Nunavummiut brought back to the territory from the South and others taken off lengthy waiting lists.

Under their proposal, Sailivik with the support of the GN, would build a large care centre in Iqaluit capable of holding up to 72 beds. It would offer all levels of care, including dementia care and palliative care.

“We’re actually very excited and we can see the piles going in for this building this fall,” Angnakak said.

That might seem optimistic, but Angnakak said GN representatives are enthusiastic about the idea.

“I have found the Department of Health to be very helpful, very supportive, the legislative assembly and the cabinet as a whole very supportive,” she said.

That’s more less consistent with what a spokesperson for the GN’s health department told Nunatsiaq News in an email last week: that sending patients out of Nunavut can’t go on forever and Nunavut must develop sufficient long-term care capacity within the territory.

“Over the longer term, the Department is exploring the best models for adding new long-term care facilities within the territory. The work is only at the preliminary stage at this point… We now need to do additional work to develop a detailed plan for this and seek government approval of this plan,” the GN spokesperson said.

And a 2015 GN report called “Continuing Care in Nunavut: 2015 to 2035” says more long-term care beds must be created in Nunavut, especially a unit devoted to caring for people with dementia.

“Is strongly recommended that a secured dementia care unit be created in Nunavut,” the report said.

Elder population expected to explode?

Numbers that the GN generated in 2014 demonstrate the urgency of the situation:

• in July 2014, the number of Nunavut residents older than 80 years was about 150 but in 20 years that number will rise to about 600;

• as of December 2014, there were 32 people in Nunavut on waiting lists for long-term care and 15 of those people exhibited symptoms requiring Level 4 or Level 5 care;

• as of December 2014, seven people were located out-of-territory, but that number is growing; others take up beds at Qikiqtani General Hospital and Kivalliq Regional Health Centre that are supposed be used for short-term acute care; and,

• some people stay up to 1,000 days on waiting lists before they are placed in long-term or continuing care.

Because many Nunavummiut born in the baby-boom era, roughly 1946 to 1964, are now heading into their final years, Nunavut may need as many as 75 more long-term care beds.

That’s nearly double what’s available right now. Gjoa Haven and Igloolik each have a 10-bed continuing care centre capable of offering what’s known as Level 4 care, the second highest level of care, offered daily by nurses.

The GN will look at options for expanding the Igloolik centre and also “come up with the best approach to adding beds to existing facilities,” the health department spokesperson said.

And by the end of February, the previously unused second floor of the Cambridge Bay health centre will be transformed into another seven-bed continuing care centre, also at Level 4.

In each of three communities, Arviat, Baker Lake and Iqaluit, there are eight-bed “elders home” facilities offering lower forms of care, Level 2 and Level 3.

Out-of-territory care expensive, unpopular

But because of the pressing need for secure care for people living with dementia and other cognitive and physical conditions requiring Level 5 care not now available in the territory, the GN has sent such people to centres like Embassy West, and to other centres in Edmonton and Churchill.

They know that most Nunavummiut don’t like that practice.

“Being placed out of territory is not the first choice for most Nunavummiut and their families due to the Inuit history with residential schools and tuberculosis sanitariums,” the 2015 continuing care report said.

And they also know how expensive it is.

At Embassy West, which received its first Nunavut patient in May 2015, the GN negotiates an individual contract for each Nunavut resident sent there for care.

The approved maximum cost for such care is up to $13,360.67 per month, or up to $160,328 each year per patient, though costs for each patient vary, the GN spokesperson said.

At the same time, they’re feeling pressure from people who complain that out-of-territory patients don’t get enough exposure to the Inuit language and to country food, such as Manitok Thompson.

Partly in response to such concerns, the Ottawa Health Services Network Inc. has hired an Inuktitut-speaking personal support worker who will start soon at Embassy West.

And elder Peter Irniq now visits three times a week and is working to arrange the provision of country food at least once a week, the GN said.

Also, students from Nunavut Sivuniksavut visit the elders at Embassy West.

“EWSL [Embassy West Senior Living] has demonstrated that they are making great efforts to ensure there is always bilingual staff on shift during the residents’ waking hours,” the GN said.

But Angnakak said if the GN adopts Sailivik’s proposal for a big Iqaluit care home, in the future they won’t need to send people to places like Embassy West.

“I don’t think there’s going to be, at least not for the first 10 years, no need to be sending anybody down south once this is built.”

That project has the support of Iqaluit City Council, who endorsed the idea in January 2016.

Business plan, lot selection underway

The next big step is the generation of a business plan—because after that, Sailivik can start negotiating with the GN, Angnakak said.

“It’s going to be the key to identifying what’s needed and identifying what we, the Sailivik Society, will be able to build and offer in terms of programs and services. It will be the key for the government to look at what we are proposing to do,” she said.

Sailivik has also decided not to locate the building on the lot they had first identified: on the beach at Lower Base, near the sealift laydown area.

That’s for two reasons: one, a sewer line cuts through the middle of that lot and moving it could cost $2 million to $3 million; the other reason is the risk of soil contaminated by hydrocarbons, a problem that’s prevalent throughout Lower Base.

“Funders get very nervous when we talk about building on a lot that might be contaminated,” Angnakak said.

So the group is now looking at two lots that Nunavut Construction Corp., their builder, has offered them.

One is located near the Road to Nowhere overlooking the valley and river. The other is located near Nunavut Arctic College, near where some condominiums have been recently constructed.

And Angnakak remains optimistic that the work will get done. At the same time, she says the model Sailivik proposes could be used in other Nunavut regions and the group is willing to share its experiences.

“We can’t just wait for government to do everything. We have to come together and look for a solution ourselves. Gone are the days when you expect government to do everything. It’s partnership time,” she said.

“It’s not necessarily about money. It’s about service, quality service.”