Something more must be done to address the health challenges of Aboriginal seniors

Dr. Catherine Cook, councillor with the Health Council of Canada, is also a family physician, researcher, health care manager, and Métis. She currently has a joint role with the University of Manitoba and the Winnipeg Regional Health Authority. At the University of Manitoba, Dr. Cook is the Associate Dean for First Nations, Métis and Inuit Health in the Faculty of Medicine and is currently a leader of the newly established Section of First Nations, Métis and Inuit Health in the Department of Community Health Sciences, Faculty of Medicine. 

 First Nations, Inuit and Métis seniors are indeed Canada’s most vulnerable population. We know that they do not receive the same level of health care as non-Aboriginal seniors. Interviews with key stakeholders, literature searches and consultations across Canada, undertaken by the Health Council of Canada during the winter and spring of 2013, confirmed some glaring facts:

• Access to care is an issue. Most need to travel to urban areas for anything beyond the most basic care, with significant disruption to their lives.
• They often fall victim to the vagaries of government policies at the federal and provincial levels as to what costs are covered by whom and who is eligible for what services.
• There is little or no communication and coordination between services supported by governments, regional health authorities, and communities.
• Many Aboriginal seniors don’t have the same level of care in their communities as non-Aboriginal Canadians, so their health conditions can become more severe, increasing the amount of care they need. 

The situation is exacerbated by the impact of colonization, residential school experiences and by determinants of health such as poverty, poor housing, racism, language barriers, and cultural differences. Geographic isolation also comes into play: Aboriginal seniors are also more likely than younger generations to live in rural and remote communities where the majority of the population is Aboriginal, and where they can be connected to their culture. The result is that they have more complex health needs and are often living in regions where it is more challenging and expensive to provide care.

The Health Council report provides context on these challenges and why it is important to provide additional support and seamless care to First Nations, Inuit, and Metis seniors.  Without this, an already vulnerable population is at even greater risk. This issue that requires immediate attention by Canadians and governments alike.
However, there are some promising examples from across Canada where governments, health regions, and Aboriginal communities have formed partnerships to improve health care for Aboriginal seniors. I invite you visit www.healthcouncilcanada.ca/innovation to read about these practices. 

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Online education about elder care for community-based health care providers

Marney Vermette, Engagement Liaison, Saint Elizabeth First Nations, Inuit, and Métis Program

In my previous role as a nurse supervisor for a First Nations home and community care program, I saw that there were major challenges in finding affordable, accessible, and culturally appropriate health care provider training that meets the needs and realities of the First Nations people. Receiving an education within the community was not often an option for health care providers, and leaving the community for education and training had several negative impacts on the health care provider and the community—it affected the continuity of care for their clients, increased the burden on the family and community, and was a financial drain on already exhausted community budgets. These problems were especially common in remote communities.

It would take community home care staff several years to obtain their Personal Support Worker certificates. They would leave their families, communities, and positions for weeks at a time. If there were a crisis or a death in a community they would return home, losing out on training and delaying their education. In addition, many times nurses come to communities without a proper understanding of the importance of culture and protocol and of building relationships within the community.

Saint Elizabeth offers a First Nations Elder Care Course, one of several online professional development programs available at no cost to community-based health care providers across Canada. The course provides evidence-based, culturally sensitive education about First Nations history and culture, as well as clinical information on health topics related to elder care such as falls, medication, nutrition, depression, Alzheimer disease, elder abuse, and caring for yourself as a health care provider.

We were cautious not to develop a pan-Aboriginal approach. A key message spread throughout the course is the need to understand that every community is unique. Health care providers need to build relationships with the communities to learn more about community-specific cultural practices and protocols. They need to seek guidance from a community champion to learn about the culture, traditions, and practices within a community.

Our program uses a unique model involving First Nations health care providers, elders, and specialists in the development and review phases of our courses. Our goal was to ensure that we had comprehensive information to meet community needs and to develop relationships of mutual trust and respect.
The course was released in January 2013 and has received an enthusiastic response. Community representatives appreciate that the course provides their staff with understanding and knowledge to provide a safe environment along with respect and protocols in caring for the elders. The goal in many communities is to keep elders in their homes for as long as possible instead of moving them to long-term care facilities.

The online training means that health care providers don’t have to leave their communities to develop the knowledge and skills they need to care for elders. Health care providers are sometimes intimidated by online training, but most of them know how to use Facebook and once they realize it’s just as easy, they are very enthusiastic.

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Community health aides help with nursing shortages and cultural safety

Tina Buckle, Community Health Nursing Coordinator, Nunatsiavut Department of Health and Social Development

In Nunatsiavut, we use Community Health Aides to support nursing staff in remote communities. We have a challenge recruiting and retaining nurses, and the aide position has allowed us to manage with fewer nurses. It’s a model that borrows from Labrador in the past and from Alaska in the present, where community health aides, local people from the community, help to deliver health care in remote communities.  In Nunatsiavut, the community health aide has a role in both public health and home and community care.

In the Home and Community Care program, the community health aides function as the nurses’ “right hands.” They manage the home support workers, go with the nurse to client visits as needed, order equipment and supplies, schedule appointments, sterilize equipment, complete month-end reports, and anything else that doesn’t require a nurse to do. The nurse is then able to concentrate on direct client care. The aides also do independent home visiting to support the programs, both when a nurse is in town and when the position is vacant.

Just as important, the aides are the cultural advisors to new nurses. They are so trusted in the community that any new nurse is immediately accepted if accompanied by the aide. From a senior care perspective, the aides have the ability to spend more time with seniors than the nurses do; also, they have personal connections and speak the language. We have also given the community health aides tours of the regional health and long-term care centres in Happy Valley-Goose Bay so that they can describe them to seniors and their families and help them become comfortable with the transition.

It’s hard to quantify or even to put into words the value of community health aides —essentially, we would not be able to deliver care without them and clients would not be as willing to receive care. It’s hard to understand why this model hasn’t spread to other parts of the country, particularly since it’s also well known in Alaska. I think there’s almost a strange fear that by allowing this kind of practice we’re encouraging people to be community health aides instead of going into the health professions, but that’s not what it’s about at all. There is an incredibly valuable role for these people at the community level that no one else can fill like they do.

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