CCBI News – Complex Issues—Bill 7 (More Beds, Better Care Act); Re-Imagining Long-Term Care; Nunavut—Perils of Climate Change
September 23, 2022 Dear Friends of CCBI, This week we include ethicist Bob Parke’s response…
CCBI News – Jordan’s Principle—Health Care Reform; Home Care Problems; Infection Risk—Unvaccinated; Parks/Health
April 29, 2022
Dear Friends of CCBI,
Jordan’s Principle and Health Care Reform
Bridget Campion, PhD
The Assembly of First Nations (AFN) recently released a Bulletin updating progress on long-term reform to the First Nations Child and Family Services (FNCFS), and on the interpretation and implementation of Jordan’s Principle upon which the reform is based. At the heart of Jordan’s Principle is a tragedy. According to the First Nations Child and Family Caring Society of Canada (Caring Society), Jordan River Anderson “was a First Nations child from Norway House Cree Nation in Manitoba. Born with complex medical needs, Jordan spent more than two years unnecessarily in hospital while the province of Manitoba and the federal government argued over who should pay for his at home care. Jordan died [in 2005] in the hospital at the age of five years old, never having spent a day in a family home.”
At first glance, Jordan’s Principle is meant to ensure that no First Nations Child is ever denied care or services because of jurisdictional disputes. But it became apparent that First Nations children and families were facing discrimination in health care and social services delivery that put their health and wellbeing at risk as a matter of course. Factums were filed by the Caring Society as well as by Amnesty International with the Canadian Human Rights Tribunal in 2014. In 2016, “the Tribunal found the Canadian Government … to be racially discriminating against 165,000 First Nations children and their families in its provision of the First Nations Child and Family Services program and by failing to implement the full scope of Jordan’s Principle.” Since then, the scope and implementation of Jordan’s Principle have continued to evolve.
The Bulletin issued by the AFN, for instance, notes that as of April 1, 2022, “First Nations young adults reaching the age of majority while in care and those who aged out of care will be eligible to continue to access services until their 26th birthday. Those services range from mental health supports to financial literacy to nutrition and cooking classes.” More funding will be available for on-reserve “prevention activities and services” and for research “into a First Nations-led funding framework for FNCFS that emphasizes wholistic wellbeing”.
Jordan’s Principle has been a journey and, according the Bulletin, “The AFN will continue to advocate for a final settlement that reflects First Nations’ priorities and is based on First Nations-led research that addresses systemic discrimination, and supports First Nations children, families and communities to thrive.”
Sources
Assembly of First Nations “Assembly of First Nations Bulletin – Update on Immediate Measures on Long-Term Reform to the First Nations Child and Family Services Program and Jordan’s Principle” April 6, 2022 https://www.afn.ca/assembly-of-first-nations-bulletin-update-on-immediate-measures-on-long-term-reform-to-the-first-nations-child-and-family-services-program-and-jordans-principle/
“Jordan’s Principle A Brief History” First Nations Child and Family Caring Society https://fncaringsociety.com/sites/default/files/Jordan%27s%20Principle%20Information%20Sheet.pdf
(Updated Version) “Jordan’s Principle Ensuring First Nations Children Receive the Services They Need When They Need Them” First nations Child and Family Caring Society https://fncaringsociety.com/sites/default/files/jordans_principle_information_sheet_january_2021.pdf
Home Care Problems
CCBI has always advocated for home care for the elderly and incapacitated where practical, since people overwhelmingly prefer care at home to care in a hospital or long-term care facility. A recent CBC Marketplace investigation revealed that over one million Canadians receive care at home, but it is often shortened, missed or delayed for many reasons, causing severe distress to people needing regular assistance. Marketplace also discovered that for-profit care companies do not always disclose their use of public funds. Lack of accountability for people’s health and safety came to light in other ways during the pandemic and this investigation reveals flaws in the system that have resulted in workers leaving the sector ‘in droves.’ Home care data is not collected as it is in long-term care homes, so methods of delivery are not always carefully monitored. Saskatchewan and the territories take responsibility for delivering publicly funded home care, while the other provinces use private companies. In Ontario, contracts are usually awarded to for-profit companies which are legally shielded from the need to be transparent. Considering what was learned recently about negligence in some homes, this could be another disaster waiting to happen. Why are these homes not monitored properly? Why is proper information not available? Politicians should be held to account (in the name of transparency perhaps, but more essentially for the sake of our elderly and incapacitated) during and beyond provincial elections!
Geriatrician Dr Samir Sinha’s views provide answers: “Our politicians are living on four-year political life cycles and just trying to focus on getting re-elected — rather than figuring out how to create a sustainable health-care system for the future…This is a real example of where the government needs to get beyond politics and understand that Canadians need this system. It has to be functional. And right now it is not.”
Dr Rory Fisher’s research shows how other countries handle these issues, and he has previously cited Denmark’s policies as an example of good care. The Marketplace report confirms his research, noting that in Denmark when people become 80, they are visited by nursing staff to assess their needs and to see if mechanisms could be in place for them to age well at home. Dr Sinha laments that, unfortunately, Canada has developed a “…real culture of institutionalizing people.” He tells us that about one third of the 200 000 Canadians in long-term care homes could have stayed home, given adequate support. A further 50 000 who need long term care are on a waiting list, sometimes being hospitalized while they wait. Clearly, the system is ‘out of whack’ and needs a radical overhaul. The ‘boomers’ are again putting pressure on a system that has known for decades that more beds for long-term care and more funding for home care would be needed, but adoption of short-sighted policies has contributed to the problems now confronting us. We need to demand long-term policies for long-term care!
COVID-19 Study: The Unvaccinated Increase Infection Risk for the Vaccinated
The Canadian Medical Association published a study on April 25 saying the unvaccinated contribute ‘disproportionately’ to the risk of infection among the vaccinated population. Currently, levels of transmission are higher than that at any time before the Omicron variant. It is true that symptoms tend to be less serious and there have been fewer deaths, nonetheless there is a sharp increase in hospitalization. The Globe and Mail informs us that there are nearly 7000 people in hospital, with 60-70 people dying daily. The article states:” Not being infected is still better than being infected,” and urges continuing protection for the vulnerable, the elderly, the immunocompromised and all those who are at higher risk of being infected or reinfected. Higher rates of vaccination would help, but government and public health messaging in this regard is waning while the safety of the elderly and the vulnerable does not appear to register as an important concern for the young and the healthy. Still, senior citizens and boomers tend to vote. They do have influence. They have a voice and can speak for themselves. Let’s hope their voice is heard!
Sources
Stuck in bed 23 hours a day: What’s wrong with home care in Canada and how another country changed course | CBC News
‘That breaks my heart,’ says Canadian geriatrician – Margot Algie suffers from a neurodegenerative disease and needs home care for all her daily activities. But she’s often only up for only one hour a day before another home care worker arrives to put her back to bed. A leading geriatrician says Canada needs to take a page from Denmark.
Why home care is failing thousands of Canadians | CBC.ca – Why home care is failing thousands of Canadians. 1 month ago; News; Duration 2:14; Experts and documents obtained by Marketplace reveal a system with few checks and balances, a crisis in care.
Impact of population mixing between vaccinated and unvaccinated subpopulations on infectious disease dynamics: implications for SARS-CoV-2 transmission | CMAJ
Unvaccinated disproportionately risk safety of those vaccinated against COVID-19, study shows – The Globe and Mail
Opinion: Reinfections are the latest COVID-19 curveball – The Globe and Mail
Parks Are Good For Our Health
Bridget Campion, PhD
April 26, 2022 marks the 200th anniversary of Frederick Law Olmsted’s birth. A visionary landscape architect, Olmsted designed such urban centrepieces as Central Park in New York City and Mount Royal Park in Montreal. But for Olmsted, parks were not simply aesthetic exercises. According the Audra D.S. Burch in a recent New York Times essay, “Olmsted understood the promise of the park as a social force that would become an amenity in city life over the decades. In his view, parks were imbued with an exquisite kind of healing power.”
The health benefits of urban green spaces like parks are substantial. Research undertaken by Marianne Kingsley and EcoHealth Ontario found that having access to green space “can promote physical activity, contribute to social interaction and cohesion, increase access to healthy food, and contribute to stress reduction and cognitive restoration.” A study by Ruth Hunter, Anne Cleary and Claire Cleland contends that urban green spaces have “an important contribution to make to public health with potential physical, psychological, social, economic and environmental benefits.” This is especially true for vulnerable populations. Well designed parks that encourage and accommodate mobility and social interactions can contribute to the health and wellbeing of older individuals, staving off the physical, emotional, and psychological decline that can come with isolation and loneliness.
The physical activity associated with visiting a park can help people attain a healthy weight and improve cardio and respiratory function. But Hunter, Cleary and Cleland point out that simply being exposed to urban green spaces can improve mental wellbeing, leading to “improved mood, self-esteem, reduced stress, reduced cognitive fatigue and greater attentional capacity and well-being….” On a broader scale, urban green spaces have “an important role to play in creating a ‘culture of health’, including the social health of neighbourhoods and communities.”
Burch notes that it was during the pandemic that many of us came to appreciate parks and their importance to our wellbeing. As she writes, Olmsted’s “parks helped sustain America’s mental and physical health and social connections during the dark days of the pandemic. As Covid-19 lockdown unlaced nearly every familiar aspect of life, parks were reaffirmed as respite, an escape from quarantine.”
As oases of calm, beauty and nature, parks hearken back to the original Garden and original wholeness. They are good for our health.
Sources
Marianne Kingsley “Commentary –Climate change, health and green space co-benefits” Health Promotion and Chronic Disease Prevention in Canada Vol. 39, No. 4, April 2019 https://www.canada.ca/content/dam/phac-aspc/documents/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-39-no-4-2019/4-Kingsley-vol-39-no-4-2019-eng.pdf
Audra D.S. Burch, “Olmsted’s Enduring Gift” The New York Times “The MorningNewsletter” April 23, 2022 https://www.nytimes.com/interactive/2022/04/22/us/frederick-law-olmsted-american-parks.html?campaign_id=9&emc=edit_nn_20220423&instance_id=59308&nl=the-morning®i_id=140232249&segment_id=90073&te=1&user_id=39f997d68713401fb5832255980a07a6
Ruth Hunter, Anne Cleary and Claire Cleland “An evidence review on the environmental, health ad equity effects of urban green space interventions” Appendix 1 of Urban Green Space Interventions and Health: A review of impacts and effectiveness World Health Organization Regional Office for Europe 2017 https://www.euro.who.int/__data/assets/pdf_file/0010/337690/FULL-REPORT-for-LLP.pdf
Pope Francis’ Intention for April
Let us pray for health care workers who serve the sick and the elderly, especially in the poorest countries; may they be adequately supported by governments and local communities!
Moira, Bambi and Bridget