Elders sent south suffer from ‘huge cultural gap,’ advocacy group says

Pairijiit Tigummiaqtikkut sends nine-page complaint to MLAs listing problems elders experience when they’re sent south for care

Pairijiit Tigummiaqtikkut’s executive director Rachel Qitsualik-Tinsley (left) and Anne Crawford, an Iqaluit lawyer working on elder care, speak last month during a news conference about a letter sent to the Government of Nunavut regarding elders living conditions at Embassy West Senior Living in Ottawa. (Photo by David Lochead)

By David Lochead

Elders who are sent south are not getting the care they need and the Government of Nunavut needs to do a better job addressing that problem, according to a letter of complaint from the elders society Pairijiit Tigummiaqtikkut.

“The [Pairijiit Tigummiaqtikkut] board were quite flabbergasted with what they were hearing and with what elders were going through particularly at Embassy West,” Pairijiit Tigummiaqtikkut’s executive director Rachel Qitsualik-Tinsley said during a press conference her organization held Monday in Iqaluit.

The letter was addressed to Minister of Health John Main and sent to all members of the legislative assembly last week.

Nunavut elders have been sent down south for years as a result of a shortage of long-term care beds and resources for elder care within the territory.

The letter lists a number of concerns Pairijiit Tigummiaqtikkut board members said they have heard from people who visited Embassy West.

Concerns include a lack of cultural acknowledgement or language barriers, such as elders not receiving country food that was sent to them, not having Inuktitut interpreters at important times or staff not calling elders by their name because Inuit names are too “difficult.” Other concerns include a lack of assistance getting out of bed, consent to how long a resident is staying at Embassy West or psychological assessments without proper interpretation.

The letter also offers suggestions to the GN on how services at Embassy West can be improved, including hiring cooks who can make country food, an increased presence of interpreters, ensuring staff learn residents’ names, having families involved on decisions about how long an elder stays in the south, and ensuring psychological assessments are done by an Inuk.

Embassy West is not an “evil institution,” said Anne Crawford, an Iqaluit lawyer working on elder care for Nunavummiut.

 “We’re just facing a huge cultural gap that’s really inappropriate,” she added.

If families want to take their family member out of Embassy West without medical approval, the GN requires them to sign a waiver. That waiver states the person or people acknowledge the resident being taken out of long-term care is doing so against medical advice and that the GN cannot help that resident’s return home.

But Crawford said it is illegal for the GN to use this waiver because the Canada Health Act states equal access to medical services should be given to everybody. She added the GN has no right to keep someone in a facility like Embassy West so it has no right not to let someone be released.

The larger solution for elder care is not to rely on places like Embassy West but to develop plans for how elders can be taken care of in their own communities, Crawford said.

But in the meantime, elders are stuck down south and there is no immediate plan from the GN to help their situation, Crawford said.

“This is really a time to act on these issues,” Qitsualik-Tinsley said.

Minister Main has received the letter and is currently reviewing it, Department of Health spokesperson Danarae Sommerville told Nunatsiaq News. She added that once Main discusses the issues identified in the letter with his department, he will be responding to Pairijiit Tigummiaqtikkut.

Sommerville also said that elders are sent South because of a lack of available resources for long-term care in Nunavut and that out-of-territory care does not remove an elder or family’s right to autonomy.

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(42) Comments:

  1. Posted by Legal Beagle on

    “ She added the GN has no right to keep someone in a facility like Embassy West so it has no right not to let someone be released.”
    .
    Take what Anne says with a grain of salt. No one has been found to have held someone against their will unless they are mentally incompetent and the GN has guardianship over the individual. There is also no obligation under the Canada Health Act requiring anyone to be flown anywhere for free. Yet the GN does this. If you voluntarily check out of medical services after transport has been provided by the GN under the contract of its medical travel policy, against medical advice, you have no right to transport home. When you sign a contract you are bound by it. The Canada Health Act does not change this. Look around and ask if medical ambulance is free in the rest of Canada. It isn’t. The GN provides this service for some unknown reason but don’t act like it is a a right enshrined under the Constitution.

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    • Posted by Au Contraire on

      If your father (competent or otherwise) was in a Far Away Land. Where his caregivers did not speak his language. Where he didn’t recognize the food he was given. Where he would stay until he died. Where he wanted desperately to come home.

      In that case, if you were told you had to sign a paper to “release” him would you sign? Would you call that a “contract” or would you call that “duress” or even a “ransom note.”

      Just asking for a friend.

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      • Posted by Beau Contraire on

        There are lots of choices available. I would work with the physician to see what is required for a release. If a medical provider doesn’t recommend release, then I would listen to medical advice and consider moving there myself.
        .
        Duress implies you have no choice and are pressured into signing. If you know contract law you know it is an absolutely extreme rarity to void a contract on a claim of duress. No one in these cases has a gun to their head. As for a ransom note, it implies someone is being paid to release someone from captivity. This is likewise not what is happening here, despite the rhetoric from individuals like Crawford, using their law degree as a means to appear authoritative, because again no one is held against their will and it is a false and bald allegation to suggest otherwise.
        .
        My own grandparent lives three hours drive from her family in a long term care facility. Although it would be ideal for her to live next door and for an ambulance or taxi to shuttle her or the family back and forth for free, that isn’t how health care and insured services are structured in Canada. The fact the GN provides this service, with the only condition being that you follow medical advice, is a strange thing. They could cut medical travel as a government funded program tomorrow if they actually wanted.

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        • Posted by Mildred Pierce on

          Bear in mind that elder care is not an “insured service” in Canada. Most Canadians pay for elder care. Nunavut is an outlier in this regard.

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          • Posted by Crown Royal on

            Just a different perspective to look at:

            Bear ? in mind, there are LOTS of southerners working for the GN that see half their paychecks go straight to paying for the long-term care facilities that are housing their parents or loved ones. Be grateful for the services available at Embassy West. It is easy to complain about the services received in these facilities, but think of those of us who spend almost every cent we earn to ensure our moms and dads have the services they need to stay alive and well.

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        • Posted by Apple pie on

          3 hour drive, that’s nice and close, not a one or two day flight, I’d love to have a elder care facility just three hours away, I’d skidoo over.

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          • Posted by Three Hours on

            It is 3 hours from Iqaluit to Ottawa so same difference

            • Posted by Ken on

              Yes you are correct, that’s if you are from Iqaluit, How about if you come from Coral, Rankin or Cambridge Bay or Pond? Not a three hour flight, overnight stays and thousands of dollars more for a individual to get to Ottawa.

      • Posted by Make Iqaluit Great Again on

        Some important wisdom I have acquired in my years in Nunavut is as follows: Anne Crawford is a very well intentioned person. She has a big heart and her heart is in the right place. That said, her judgement on matters is usually completely wrong like legal beagle has shown here. My advice in regards to Anne has always been to think the opposite of what she says and that will invariably take you to the correct and well reasoned answer to a particular issue

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        • Posted by Anne Crawford on

          Dear Legal Beagle

          I have always found it much more effective to agree with Anne and to also take Into consideration the views of others. We can always learn.

          On the issue of the Waivers that families are being asked to sign there are three legal reasons why the Waivers the GN asks for are VOID. Not illegal but VOID.

          1. No consideration – that is legal dialect for no exchange of value. It is one of the first principles every lawyer learns in Year 1.
          2. Duress
          3. Canada Health Act.

          As to the moral reasons – they would fill a book.

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          • Posted by Mildred Pierce on

            As noted above, elder care is not an insured service under the Canada Health Act. The Canada Health Act does not state what services must be provided, but only that health care provision should be comprehensive and basically uniform throughout Canada. Provinces set out insured services. Nunavut provides eldercare as a matter of policy, but is under no statutory obligation to do so.

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        • Posted by Anne Crawford on

          I always find it easier to agree with Anne Crawford, although that being said, there is a lot of virtue in listening to the opinions and concerns of others. We can all afford to learn and grow.

          On the legal front, you would need to see the so-called “waivers” to understand how they are, not illegal, but VOID. Some of their terms would surprise even the Minister I suspect. In simple terms there are three reasons why these documents are VOID:

          1. no consideration – which is legal dialect for there was no exchange. The GN gave up nothing when they “required” families to sign these waivers. This is the first principle law students learn in 1st year contracts class. A contract only exists when there is an exchange.

          2. duress – families are told to sign in order to secure the release of their loved one. Consider the disparity of power between the person asking for the signature and the person signing. Of course they sign, under duress.

          3. Canada Health Act – among other items, such as a suggestion that Elders may lose eligibility for Nunavut Health Care coverage or that the Public Trustee may get involved in their decision making, the Waiver suggests that returning elders may not access health care in the same way as Nunavummiut. This directly violates the Canada Health Act and would put all Nunavut Health transfers in jeopardy. I suspect Minister Main would not risk that.

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  2. Posted by 867 on

    So, if a Somali refugee grandmother is in long-term care she should be given services in Somali and given local ethnic somali food? This is entitlement at its finest and Anne Crawford is only hoping for a massive settlement bonus at the end of the tunnel

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    • Posted by Obtuse on

      Are you really unable to discern the difference between these two groups, or are you trolling? Because if you can’t, that is a pretty sad state for you.

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    • Posted by Please Louise on

      If 40 Somali grandmothers are being cared for in a home down south should the government insert clauses into the operators contract requiring culturally appropriate services and foods?

      Yes.

      Next question.

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      • Posted by The Goal Is Clear on

        This is best practice in any healthcare setting – culturally appropriate care has been getting much emphasis for the last 20 years at least.

        It doesn’t matter if you are Somali, Inuit, or one of the many ‘white’ linguistic/cultural minorities in this country – culturally appropriate care is the goal.

        However, some are easier than others. I was involved in an HR capacity a number of years ago trying to find German speakers to provide care for elderly unilingual German-Canadians. Very similar issues to this article – communication difficulties, food, different culture from the staff, etc.

        It was really really hard to find the staff we needed – never did really..

        I can’t begin to imagine how difficult it is to find Inuk staff.

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    • Posted by haha on

      But you are ignoring the facts like Inuit are less then you…News f-in flash, the facts are there…Inuit being the key word. Nonetheless, Somalian’s should be treated just the same as you white ppl. No matter how much Inuit try to be treated just like you, we get backlash. Your simple, blind. And your welcome, you are here because of Inuit, thanks to Inuit you have a cushy job. A job you would never get at your home town.

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      • Posted by Hello Moderator on

        Starting to wonder what the moderator does at all.

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      • Posted by Goes both ways that on

        Funny comment, but I know a lot of, umm… ‘locals’ who would never hold comparable positions or make comparable pay in the south either. Something to think about.

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        • Posted by hooha on

          Its funny, no one wants to work with folk like you down south, no thanks. I stick to where i was born and raised, amongst my ppl. Where is your home and ppl, maybe you would be happier with them instead of following $$$

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          • Posted by Funniest yet on

            Just remember where that money that you like to call ‘yours’ and pretend you ‘deserve’ comes from. It is certainly not generated through the productivity of the north, but is a perpetual handout from southerners, distributed through a glorified welfare system.

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          • Posted by Differing World Views on

            Well, I’m not the poster you were replying to, but try this thinking on:

            My ‘people’ are Canadians – be they anglophones, francos, new Canadians, or pure laine. Whether they trace their ancestry back to Hong Kong, or one of the aboriginal groups – they are all ‘my people’. My home is and always will be Canada – all of Canada. That is my identity. I feel no allegiance to a particular ethnic group. I feel an allegiance to my country and my fellow citizen – my ‘people’.

            I can’t understand the thinking of people like you I’m afraid. Oh well, take comfort in the fact, whether you know it or not, you are one of ‘my people’.

            Enjoy!

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        • Posted by Money for Cushy on

          And that the money for those supposed “cushy” jobs comes froommmmm….. the Southern Provinces! Hurray!
          .
          I like how it is often assumed that qallunaq working in the territory would be homeless or something working in the provinces. It’s like it’s unfathomable that they could actually enjoy living here.

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      • Posted by 867 on

        “haha” i’ll admit that the comparison was not a fair one, but remember that we are one of the few places on earth that offers free health care. Yes, free. There are many improvements needed, but our health care system is already strained enough as it is, so maybe Anne Crawford’s lawsuit should be better geared at negotiating with NTI or ITK to provide for interpreters and country food in health care settings. These groups are more than capable of hiring some of the thousands of Inuit in Ottawa to help out, and unlike the Federal Gov, these organizations are not operating at a deficit.

        Lawyers just look for ways to make the government pay up. Too much of this and way may no longer have free health care.

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        • Posted by correction on

          *we may

      • Posted by 867 on

        “No matter how much Inuit try to be treated just like you, we get backlash” -haha

        I think you are forgetting that Nunavummiut do not pay for Elder Care. “We” on the other hand, have to fork out thousands of dollars a month to put our loved ones in elder care facilities like Embassy West in ottawa, when they are no longer able to do things on their own.

        The north does need a long-term care center though, whether in NWT or NU.

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        • Posted by haha on

          I do pay for elder care, with my taxes, yours as well…HA!

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      • Posted by Job market is tough because we are educated. on

        The job market down south is so tough because our children understand the power of knowledge. There’s more teachers being given diplomas than teaching jobs.

        These problems are the good ones to have.

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  3. Posted by Statistician on

    -total nunavummiut (Inuk and Non-Inuk) transferred for ANY length of time to Embassy?

    -total Nunavummiut (Inuk and Non-Inuk) who died at the Embassy.

    -total amount of money given to Embassy

    -why is there a provincial limit for Ontario for care of elderly of $6,000 a month and for Nunavummiut it is over $16,000 a month?

    What is the rate of Nunavummiut to enter the Embassy in comparison to Ontarians?

    Other info to help shed light on this?

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  4. Posted by Qanuqtuurniq on

    A TEMPORARY solution is to buy or repurpose a long term care facility in Ottawa just as Large or TI exists (except it is not a ‘forever’ place).

    This will allow time to build in Inuit Nunagat wherever is necessary or possible. It will take some years.

    The building can be converted or sold when no longer needed, as the old Large was sold or repurposed for TI. this was also done for the old Southway Inn that was bought privately into a homecare facility.

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    • Posted by agree on

      AGREE. a solution for now to buy time and avoid what is happening now yes, i know, we need trained staff but that can also be worked on

  5. Posted by Crystal Clarity on

    We need to realise that our population is aging rapidly and the percentage of people living longer is increasing and they will need to live in an extended care facility if they are not able to look after themselves anymore or family is unable to care for them 24/7.

    It easy for armchair critics to find fault in people complaining about their elderly grandparents or parents being shipped off to the south for extended care but this is a terrible situation for families. If you had a parent or grandparent 1000’s of miles away and had to shell out thousands just to go and visit them once in a while you might have a different view of the world. People just want their loved ones closer to home and receiving reasonable care in their twilight years. Most Nunnavumiut can not afford to travel to Ottawa to see loved ones and support them as much as they would like to. It is so foreign, frightening and depressing for those elderly people being taken away from everything that is familiar to them. I am sure it must affect their health and well being enormously not to mention the shame and guilt their families must feel.

    There are a few long term care facilities in Nunavut but obviously it is not enough when we have to send our elders south. Planning needs to get in the works to expand our own long term care facilities which currently exist and to look at a plan at attaching and staffing long term care beds to health centres so that elders can stay in their home communities.

    We are going to hit a critical point with this situation. We need to get things in the works now.

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    • Posted by Inuk guy on

      Normally “Crystal Clarity” you have smart intelligent replies but this one takes the cake. There are millions of people across North America that live 1000’s of miles from their grandparents. Should the Gov in their jurisdictions have to pay for their personal flights to go visit their grandparents?

      Also, there is a Elder’s Care home under construction in Rankin Inlet as we speak. So I think it’s fair to say that planning is underway.

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      • Posted by Crystal Clarity on

        Picture this…..you are 70+ years old accustomed to living in a little community like Kugaaruk for example. Unilingual, lived in the same little town surrounded by the same friends and relatives your whole life, only accustomed to eating traditional food from the land/sea/sky. You made meaningful contributions to your community your whole life, hunting and providing for others, helping others when they needed help. Then, now that your health is failing or you can’t live by yourself anymore “someone” decides that you should be placed in an elder’s facility 2000 km away. You are sharing a room where your “bed” is with strangers, and other strangers are bringing you food you don’;t recognise, You can’t talk to anyone because no one else speaks your language and you don’t know their language etc…..We hear a lot of words about respecting our elders and looking after them etc but this doesn’t fit the bill for me. We will all be old one day and being sent far from home and feeling abandoned It is not the retirement I want to see for myself or anyone else.

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        • Posted by Observation Post on

          You’re right on the mark with this Crystal, it is an absolutely tragedy and a disgrace that so many have been placed in the position you’ve described, absolutely heartbreaking and a complete moral collapse on the part of successive governments.

    • Posted by 1000Miles on

      I pay thousands of dollars to fly south to see my grandparents. I also support them in long term care for the difference after the province takes their OAS and CPP. Not just Inuit deal with this. The only difference is the GN pays for this

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  6. Posted by tuktuborel on

    I think the bottom line is we have to have a facility (s) in Nunavut that can provide the needed care and attention required for Nunavut residents. Money has to be found to make this happen. This is a issue that has been not addressed for a long time. As time time moves on there will be an increased need for these services.

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  7. Posted by George on

    The goal (and it’s very achievable) should be to keep elders of any colour in their own communities and in their own homes for as long as possible. I’m quite sure that this would be very cost-effective as compared to spending many thousands of dollars per month in fees to long-term care homes.

    There are presently only minimal financial supports for elders to remain in their own homes. Those living in private homes have saved the government a lot of money over the years. Time to give some of it back.

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    • Posted by 867 on

      The “goal” to keep Elders in their community as being cost-effective is a pipedream. Once any specialised medical intervention is needed, keeping them in a small community would need tons of staff. 25 communities will need round the clock Geriatricians, support-staff, physicians, specialists, the list goes on.

      Next is the housing requirements of all these staff. Staff Housing is already really limited in the north. and with the number of babies being born in NU we are heading into a “Tsunami” as MLA Towtoongie puts it.

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  8. Posted by Simple Simon on

    All institution care is inferior. Everywhere.

    All institutional care risks abuse. Everywhere.

    The whole approach to elder care needs to change and this discussion is happening across Canada.

    Let the discussions in Nunavut begin.

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  9. Posted by Bottom line on

    Bottom line is our GN can do much better, for the amount they pay each year to Embassy for so many years y could of planned and work towards building a facility in Nunavut not thousands of miles away.
    Get your crap together GN and start doing something right,

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