More than ever before, Canadians are receiving health care services in their homes.
Home care patients are generally happier and healthier than those in hospitals. The services they receive tend to be less costly, which means big savings for governments. It’s no wonder health care is shifting out of traditional settings.
But what do these changes mean for First Nations communities?
Due to existing barriers, First Nations people have unequal access to health care in Canada. This is especially true for those in remote communities. Increasingly, Canada’s federal and provincial governments are acknowledging this fact.
Politicians are beginning to address inequality, but there’s still a long way to go. And as the demand for home care rises, new questions emerge.
Will the home shift occur in remote First Nations communities? If so, will the effects be wholly positive, or will there be negative impacts as well? This post will consider these questions.
The Challenges of Remoteness
Many people were shocked by the story of 5-year-old Brody Meekis, who died of strep throat in 2014. Doctors were among those who could hardly believe that such a treatable infection had lead to tragedy.
The problem? The Meekis’s lived in Sandy Lake, a Northern Ontario reserve where they didn’t have access to adequate health care. The Globe and Mail notes that unreliable medical transportation and a poorly-staffed nursing station likely worsened Brody’s condition.
Sandy Lake is far from unique. Many remote First Nations communities rely on understaffed stations. In some cases, the nurses and other workers who provide care haven’t received sufficient training.
Earlier this year, a doctor working in Attawpiskat First Nation criticized the government’s delivery of on-reserve health care.
Dr. Mike Kerlew told a parliamentary committee that where he practices, medication shortages are common. The doctor also stated that many communities lack services such as mental health care and speech language therapy.
Sadly, this isn’t entirely surprising. In places where basic health care needs are often unmet, the likelihood of finding specialists is low.
Those who go to get treatment outside of their communities often have to do so alone. Usually, when a patient travels to the city, the government doesn’t pay for a loved one to join them.
Support from those who care most can have a huge positive impact on people receiving medical treatment. Can policies that separate families be said to put patients first?
Of course, logistics are part of the problem. Many northern communities are accessible only by plane, or by long stretches of highway. Remoteness is directly connected to many barriers to access – from medical supply shortages to high nurse turnover rates.
But it would be wrong to ignore factors specific to the care of Indigenous patients. Systemic racial prejudice isn’t a thing of the past.
To improve health care for those living in remote First Nations communities, government leaders must consider more than logistics. They need to think carefully about the ongoing impacts of colonial attitudes.
Home Care: A Good Fit for Remote Communities?
Often, federal and provincial governments are said to “throw money” at First Nations communities. Looking closely at government spending, this just isn’t accurate.
Indigenous health care advocates say many Canadians are misinformed about funding for First Nations patients. Cindy Blackstock has found that, for nearly a century and a half, the federal government provided 30% less funding for on-reserve child health care.
Even if funding were equal across Canada, care provided in these communities could still fall short of national standards.
At the committee where Dr. Kerlew shared his experiences, several First Nations leaders also spoke. One of these leaders was Ontario Chief Isadore Day.
Day noted that health care in remote communities “cannot be based on budgetary limits; it has to be based on the needs of the region.”
Slowly but surely, Canadian governments seem to be getting the message.
Over five years, the federal government will provide $270 million for First Nations health care facilities and workers. In June, Justin Trudeau announced an additional $70 million for mental health services.
In Ontario, health minister Eric Hoskins has promised $222 million for the province’s First Nations Health Access Plan.
The funding is desperately needed. But how will it be allocated?
Notably, the Ontario plan includes funding to improve access to home care and expand telemedicine networks.
This is a very good thing. Home and community care, along with the technologies that support them, have massive potential for positive change. Carefully-planned home care can be truly patient-centred.
In Canada, the shift is occurring. Health ministers from every province and territory recently met in Vancouver. One of the major priorities they agreed on was home care.
Historically, First Nations communities haven’t benefitted from advances in care as much as other groups in Canada. But why should that be?
We live in a time when past injustices are slowly being recognized. Why can’t health care in remote First Nations communities be not only adequate, but innovative?
Making It Work
Of course, overhauling policy is never easy. And a lot of funding will be needed to meet even basic health care needs in Canada’s remote communities.
When many doctors can’t immediately access medications to help those in pain, the technologies behind telemedicine may seem like a luxury.
But dollars invested in home care – whether they’re for training or technology – may stretch further than those put into traditional care. They decrease reliance on more costly services, such as hospital stays.
In other words, well-managed home care initiatives can provide bigger benefits for less money.
It’s not just about ensuring that care for Indigenous patients develops alongside care across Canada (though that’s certainly important). It’s about seeing a larger positive impact overall.
Because, let’s face it. Recent funding represents a step in the right direction. But it’s not enough to fully address the most significant health care issues in many regions.
Home care can fill some of the service gaps associated with remoteness.
The costs of major care infrastructure overhauls – including the creation of state-of-the-art facilities and interdisciplinary staffs – are extremely high. Of course, the government won’t undertake this in every community.
Because home care is reliant on manpower (in the form of qualified professionals), it requires initial investment. But this investment pays off.
The presence of qualified at-home caregivers in remote communities should be a top priority for decision-makers. Providing nurses with the right training to work in remote locations – and greater incentives to stay – could result in major improvements.
That said, many nursing stations are likely to remain at least somewhat understaffed. Specialist care will continue to be scarce in many northern communities.
And of course, no matter how efficient home care becomes, some patients will have to travel to receive treatment. This means people will continue deal with the emotional toll of undergoing medical procedures far away from home.
Luckily, home care can be supplemented by technology to improve the problems associated with these issues.
Systems that support telemedicine can connect nurses to patients when in-person visits aren’t possible. Through videoconferencing, patients and the practitioners who treat them can have face-to-face conferences with specialists.
From a patient perspective, communication technology can improve quality of life. Social media and other easy-to-use tools can connect people who travel for procedures with their loved ones.
In remote communities, motivated professionals armed with innovation can provide more affordable and effective care.
Towards a Healthier Future
Home care is the future – and it’s the preference of most patients. It’s a less expensive way of delivering services. Done right, it has a lot of potential to bridge some of the gaps in service in remote regions.
But at-home care is only part of the solution. A holistic approach – one that strives to care for the complete, ongoing wellbeing of patients – is best.
In remote First Nations communities, this means ensuring everyone has access to healthy living spaces and clean water. It means making nourishing food available at affordable prices. It means understanding the psychological effects of historical trauma and how they can impact individuals throughout their lives.
Many government decision-makers are showing a willingness to respond to the needs of remote First Nations communities. This is cause for optimism.
Feature Image: camerazn