Expanded elder care in Nunavut will require training, regulation
Territory's leaders must take steps now to protect vulnerable elders from abuse and negligence
Well before the 2017 territorial election, the development of high-level extended care homes for elders within each Nunavut region was a huge priority for nearly all Nunavummiut, likely ranking well above most, if not all, other priorities.
It’s no surprise, then, that figuring out how to plan, build and operate such facilities has become a preoccupation for the current Government of Nunavut and most members of the legislative assembly. Premier Joe Savikataaq said as much last month after a meeting with Prime Minister Justin Trudeau.
Few other societies on the face of the Earth put more value on the elderly than the people of Nunavut.
At the same time, the number of elders who need advanced forms of health care to get through their final years is growing rapidly. Although they represent just a tiny proportion of Nunavut’s population at the moment, they’re likely to become far more numerous in the near future.
According to Statistics Canada, the number of Nunavummiut aged 80 or more was estimated in July 2014 at fewer than 150. That’s the age group most likely to require continuing care.
But a 2015 GN report on continuing care estimates that number will double by 2024 and double again by 2035.
This suggest that the age demographic most in need of care will quadruple in 20 years.
As well, the number of elders who suffer from heartbreaking infirmities like dementia is also growing rapidly. And although the GN is able to look after some through home care, many must spend their final years in southern Canada, far from their homes and families.
As evidence of this rapid growth, consider that in December 2014, only seven Nunavummiut were receiving out-of-territory care.
Now, just four years later, the number of elders staying at the Embassy West extended care home in Ottawa has risen to at least 28.
These are people who require the highest level of care, known as “Level 5.” According to the GN’s definition, these people need “significant medical and nursing support” and have been diagnosed with different forms of dementia and Alzheimer’s disease.
No facility in Nunavut is capable of offering that level of care right now.
And a GN report on continuing care estimates that by 2035, the GN will need between 53 and 72 more residential beds than are now available.
“Demand for residential long-term care for seniors will continue to grow, driven by an aging population, increasing life expectancy and a projected increase in the number of Nunavummiut living with dementia over the next 20 years,” the 2015 report said.
At the same time, Nunavut’s current facilities cannot meet that need.
Three elder care centres with a combined total of 28 beds—in Cambridge Bay, Igloolik and Gjoa Haven—offer Level 4 care, which means “moderate professional nursing care.”
And three elders’ homes, in Arviat, Iqaluit and Baker Lake, offer care to elders who require lesser forms of daily support. But the facility in Baker Lake, the Martha Taliruq Centre, was forced to close last year because of a fuel spill.
To create and run the many new high-level continuing-care spaces that Nunavut needs, the territorial government will seek partnerships with non-GN entities, such as private companies and hamlet governments, Health Minister George Hickes said last month.
Contracting services through third-parties may not be ideal, but it’s likely Nunavut’s most affordable solution right now.
There are obvious financial transparency issues the government must consider when entering into partnerships with non-GN entities, which we don’t have room to talk about here.
But what other issues must the GN consider?
Training Nunavut workers
One, obviously, is staff training. The continuing-care centres that the GN is contemplating are more than just elders’ homes. They’re full-blown health-care facilities.
And to staff them, the GN must hire compassionate, reliable well-trained personal care workers, orderlies and nurses who understand Inuit culture and who speak the Inuit language. They’ll have to hire lots of them. Since one major goal of the exercise is to rescue elders from an unfamiliar, alienating southern environment, this is essential.
The “three-pillar” plan for the addiction and trauma treatment system in Nunavut that the GN is working on with Nunavut Tunngavik Inc. proposes an Inuit counsellor training program and a step-by-step Bachelor of Social Work program.
These would run concurrently with the development of a 32-bed recovery centre in Iqaluit and an on-the-land healing camp for each of the three regions.
We’re not experts at planning such things, but it would seem that the GN should look at a similar approach to the training of elder care workers—and that NTI should think about prying some dollars out of its Makigiarvik training fund to help pay for it.
Protection against negligence, abuse
Another issue is regulatory: who will set standards of care for these new elders’ centres? Who will inspect them? Who will enforce those standards?
This is a serious issue. In other Canadian jurisdictions, conditions inside long-term care homes for the elderly have produced multiple controversies and scandals. These controversies usually feature the mistreatment and abuse of vulnerable senior citizens, including negligence and assaults by staff.
In the most egregious recent case, an Ontario nurse was convicted of murdering eight senior citizens and attempting to murder six others at a long-term care home operated by a private company called Caressant Care.
So the GN must take steps now to protect vulnerable Nunavut elders from abuse and negligence while they’re in care.
This likely means a review of any regulations that may exist now and, possibly, the creation of a new standalone law that would set out rules for extended care facilities. As we’ve said, it’s essential to rescue elders from an unfamiliar, alienating southern environment. It’s also essential to ensure that they be protected from abuse and negligence.
In committing to the creation of high-level continuing-care facilities for elders, the GN has taken on a lot of work. But it’s work that’s worth doing. JB