Nunavut MLAs muddle their way through the elder-care issue
Legislators finally approve 24-bed extended-care centre for Rankin Inlet
After what Nunavut Health Minister George Hickes called “a fair bit of confusion,” MLAs have finally approved the money that the Government of Nunavut needs to start building a 24-bed long-term-care facility for seniors in Rankin Inlet next year.
They did this on Nov. 5, when they passed Bill 30, which contains the GN’s capital budget.
But that happened only after lengthy episodes of grumbling, posturing and confused questioning, dating back to Oct. 24, when MLAs sitting in committee of the whole voted to defer consideration of the Health Department’s capital budget.
They voted for the deferral because they learned the department’s $27.5-million capital budget for 2020-21 contains money to start immediate construction of a long-term extended-care facility for seniors next summer in Rankin Inlet.
That Rankin Inlet facility, which would be ready for occupancy by 2023, represents the GN’s best option for getting started on the 156 extended-care beds for elders that the territory will need by 2035, Hickes said.
It also looks as if the GN will build and run the Rankin Inlet facility themselves—because they’re having trouble finding private entities willing to enter a private-public partnership.
At the same time, the GN will make budget requests next year for a 24-bed facility in Kugluktuk and a big, high-level extended-care centre of up to 108 beds in Iqaluit, Hickes said.
Hickes said later that the future Iqaluit facility, which isn’t funded yet, is the only one that would offer what’s called “level five care”—the type of care that Nunavut seniors can receive only at Embassy West in Ottawa right now.
This news took many MLAs by surprise. And their hostile reaction took Hickes by surprise.
“Suffice it to say, I was shocked that regular members would take the extraordinary move to delay consideration of the health budget because of this project,” Hickes said later, on Oct. 29.
A smorgasbord of complaints
So Hickes ended up responding to a mixed array of sometimes contradictory questions and criticisms from:
• MLAs who fear the closure of small, lower-level elder-care centres that already exist in communities like Arviat and Gjoa Haven.
• MLAs who want small elder-care homes built in their own small communities, and possibly in all 25 communities.
• MLAs who want elder-care centres built simultaneously in all three regions.
• MLAs who champion previous unsolicited schemes, such as the Hamlet of Kugluktuk’s proposal for a 24-bed centre and the Sailivik Society’s proposal for a big centre in Iqaluit, backed by Iqaluit-Niaqunnguu MLA Pat Angnakak.
• MLAs who want the GN to produce a clear long-term-care strategy for seniors.
High-level care available at Embassy West only
At the heart of the issue is that at least 33 elders from Nunavut now receive care at the 112-room Embassy West facility, a former hotel in Ottawa that offers types of care unavailable at any of Nunavut’s small, eight-to-10-bed community-based elder homes.
That’s because the privately owned Embassy West is the only available facility capable of level five care—for seniors who suffer from serious, chronic or unpredictable conditions that require 24-hour-a-day access to registered nurses.
That includes elders who need daily help dressing, eating and bathing and who may be permanently affected by strokes, Alzheimer’s disease and other severe forms of dementia.
To that end, Embassy West provides equipment and amenities not available at any of Nunavut’s lower-level care homes, such as EKG and X-ray machines, an on-site pharmacy and an on-site blood test laboratory. (EKG machines are used to detect heart disease.)
The Embassy West centre employs an in-house doctor and registered nurses who are available 24 hours a day, seven days a week. Their on-site staff includes physicians who specialize in geriatric care, as well as an audiologist, an ophthalmologist and chiropractors.
But Embassy West comes with one drawback, and it’s a big one: limited access to Inuit culture and Inuit life.
Only a few staff speak Inuktitut, and access to country food is limited. For people in most Nunavut communities, getting there requires a long, expensive plane trip.
“Peoples’ parents are probably struggling in Ottawa and it was stated earlier that some people may never see them again, that they will pass away,” Amittuq MLA Joelie Kaernerk said on Oct. 24.
Iqaluit-Niaqunnguu MLA Pat Angnakak weighed in with her own attack on Hickes, making a variety of allegations about how the GN handled a proposal pitched in 2016 by the board of Sailivik, an organization that Angnakak had co-chaired.
And Arviat North-Whale Cove MLA John Main said he feared construction of the Rankin Inlet facility might lead to the closure of Arviat’s small eight-bed elders’ home and a loss of local jobs.
Main then introduced a motion to defer consideration of the Health Department’s capital budget until later.
Hickes clears the air
Faced with all that flak, Hickes employed a rarely used tactic: a reply to the commissioner’s opening address, which has no time limit.
So on Oct. 29, that’s what he did.
On the fate of Nunavut’s existing elder homes, Hickes said it’s a “damaging misconception spread by several regular members” that the GN plans to close them and that his government has no plan to close anything right now.
“We want to build facilities, not close them,” he said.
He did say, though, that in the future, those existing care homes could be used for other purposes, such as for birthing centres or mental health facilities.
On the proposal from Iqaluit’s Sailivik Society, Hickes said the last record of any communication between Sailivik and the GN occurred in June 2017.
He also said that as of July 2017, the Sailivik Society is no longer in good standing with Nunavut legal registries.
As for Kugluktuk’s proposal, Hickes said the GN is still negotiating with the hamlet and has not ruled it out.
But on the possibility of forming partnerships with large companies with experience operating care homes, that’s been difficult, Hickes said.
Earlier this year, the GN asked Partnerships B.C., an agency owned by the Government of British Columbia, to look at the possibility of running extended-care homes through private-public partnerships, or P3s.
But Partnerships B.C. couldn’t find any private companies interested in doing that.
“Unfortunately there was less than favourable interest from industry in providing care in Nunavut. The risks when caring for elders are significant and even large companies that provide seniors care across Canada are hesitant to take on those same risks here,” Hickes said during his lengthy Oct. 29 oration.
Another problem is that because of the large number of recent fires at schools and other buildings, liability insurance and facilities insurance are becoming expensive and difficult to find.
“This is even more challenging when it comes to a privately run elder-care facility,” Hickes said.
But he said the proposed Rankin Inlet facility is capable of being fast-tracked next year, based on a recently completed business case that wasn’t finished until this past Oct. 9.
Earlier this year, a GN spokesperson told Nunatsiaq News the Department of Community and Government Services, which is in charge of procurement, was hoping to get such a business case done in time for the GN’s capital budget.
They managed to do that—but not in time for an in-camera presentation that the Health Department made in late September, when MLAs got a sneak peek at the upcoming capital budget.
So after the business case did arrive, Hickes said he wrote to MLAs to say he was willing to appear before them in camera to explain the late budget addition.
MLAs did not respond.
“Instead, members chose to ask in question period the next day the very questions that could have been answered in those committees. I sincerely hope that this was not merely political grandstanding,” Hickes said.
After more questions, MLAs eventually came around and passed the 2020-21 capital budget, which includes $27.5 million for the Health Department.
Of that, about $9.3 million is to be spent in the Kivalliq region, the location of the Rankin Inlet facility.
In total, the GN capital budget for all departments comes to about $143 million.