Expanded elder care in Nunavut will require training, regulation

Territory's leaders must take steps now to protect vulnerable elders from abuse and negligence

This sign, posted at the back lot of the Nunavut legislature during Nunavut Day activities on July 9, 2011, expresses Nunavut’s profound regard for elders. But is the territory ready to take on new high-level continuing-care homes? (File photo)

By Jim Bell

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.

Growing numbers

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.

Non-government partners

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.

And just last fall, a group comprising more than 200 families filed a lawsuit against three private corporations that operate long-term care homes.

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

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(7) Comments:

  1. Posted by Stalin on

    Nunavut has realized that it needs stores, schools, police and health care, not just in regional centers, but in all communities. The GN must realize that it needs elder care in every community in Nunavut.

    Nothing else will work. Elders can only be elders when they are involved with their families. Remove elders from their families and communities and they become nothing but pieces of meat – and an income stream for those who get paid to keep them alive.

    The difference in quality of life for an elder removed from his or her family and community and moved to a regional center is not much different than being moved to Ottawa or anywhere else in the world.

    A regional center can offer country food and Inuktitut speaking care givers. That can be done in Ottawa, too.

    Which dialects will spoken by the care givers outside the elders home community? Not the ones used by most of the elders. The country food will not taste right, either.

    How often will families travel to the regional center to visit? How much will that travel cost and who will pay for it? All that travel money will leave the territory, no matter if the travel is to Cambridge Bay or to Ottawa.

    The money costs might seem higher for an elder care in each community, but those wages will be paid to Nunavummiut living in communities in Nunavut.

    In the end, keeping elders in their communities will cost less, provide better care and strengthen the communities.

    Many of the elders suffered through residential school. Ottawa has apologized for residential schools. Now you want to do it again to those same people at the other end of their lives.

    Have you consulted with those in their 50s, 60s and 70s?

    Enough!

    • Posted by Please Advise on

      “In the end, keeping elders in their communities will cost less, provide better care and strengthen the communities”

      Do you have any data to support the claim that it will cost less. I am very skeptical about it.

      • Posted by God on

        You want data to support the future.

        It just so happens that I have it.

        I’m sure you are aware of the parallel universe concept. Every time there is a choice, the universe splits. In one universe choice “A” is made and in the other universe choice “B” is made.

        I ran the experiment and observed both alternatives 5, 10, 20 and 50 years out. The data was conclusive. All elders sent to Ottawa was cheapest at 5 years. All elders in regional centers was cheapest at 10 years. All elders in their home communities was cheapest at 20 and 50 years out.

    • Posted by Rob M Adams on

      Thank you for your meaningful and considerate comment Stalin. It was helpful for me.

      Rob

  2. Posted by kugluktuk on

    Kugluktuk had it all planned out and support from the old GN government, even training dollars from BTI.
    New government and Angnakak put a halt, SAD, SAD, SAD.
    In the meantime the elders aren’t getting any younger and would like to be closer to home.

  3. Posted by Putuguk on

    Let us get cause and effect straight here.

    Some Elders are being neglected and abused now as they struggle, as long as they are able, to maintain an independent life in their own homes.

    Fraud, assault, intimidation, denying the necessities of life, theft. These are all crimes now. There is no new law needed. What is needed is more people, especially grandchildren, being made to obey the law.

    Moving an elder to another community or down south for care is traumatic for that person. But it can also be a great relief for them to get away, anywhere, out of a bad home situation.

    Never, ever tolerate Elder abuse in your community when you see it.

    GN might be jabbering up and down about this issue now, but they could have agreed to the Kugluktuk proposal almost 2 years ago and we would be in a much better situation today.

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