EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
There are eligibility criteria under the travel policy guidelines that are available and the escort has to meet the criteria as well.
Whether the patient gets an escort or not follows strict policy criteria.
Medical travel clients are eligible if they need legal consent by a parent or guardian; have a mental or physical condition preventing them from travelling without assistance; a unilingual Inuit language speaking client travelling to an approved centre where interpretive services are not available and the client escort under those circumstances are required to speak full English and the language of the client; a unilingual Inuit language speaking client that is 65 or older and a client escort is required to participate in the client’s treatment program and will receive instructions on specific and essential home medical nursing procedures that cannot be given to the client alone.
It’s often the case that southern physicians may recommend an escort for a medical travel client, but only a Nunavut practitioner can officially endorse the escort request and seek approval.
The challenge we sometimes encounter is that southern medical professionals don’t understand our policy for one because they’re not Nunavut practitioners and two, as I had mentioned in an earlier response a couple of days ago, the Department of Health is again coming back to the legislature with a supplementary appropriation for medical travel costs.
What I can’t understand is at the end after the Department of Health spends, let’s say, $10,000 for that patient just on medial travel, they finally approve the patient to go with an escort and they get their treatment. I still can’t understand why.
If they had sent the patient with an escort in the first request, that patient would have been treated and the Department of Health would have saved themselves $8,000 for that person.
Maybe the policy is different from the southern jurisdiction, but I think you guys will need to look at this a little more closely in order to save more money in regard to this.
Under our medical travel review, I’m sure that topic will come up.
To my favourite topic.
On your priorities for 2017-18, “Assess population needs and develop a long-term plan to expand the continuing care sector in Nunavut.”
Now, in April of 2015 a report was tabled, Continuing Care in Nunavut 2015 to 2035.
My question is: why another assessment for a report when they already know there are elder requirements for continuing care?
One of the main focuses when we’re looking at continuing care, especially within the community, is there are changing parameters and different numbers that are changing.
As demographics change, we want to make sure that we’re providing the supports through our home care services. We’re continuously looking for partnerships to look at utilizing outside facilities or partnerships within different communities on providing elder care on a fee-for-service basis.
As the member is very aware, I know he has been arguing logically for a continuing care facility in his community of Rankin Inlet for three plus years that I have been sitting in this legislature with him.
I don’t think the need can be argued.
What can be challenging is finding the capital dollars for the government to build a facility like that and the length of time it takes to put it through the capital planning process.
We get numerous questions across the government from different departments on different pieces of infrastructure that are needed across this territory.
It’s not to begrudge the need of a long-term care centre specifically in Rankin Inlet, but there are also opportunities for partnerships that could be explored with other organizations or societies that we can continue to explore.
Our Continuing Care in Nunavut, which was tabled in the 2016 sitting, was not an evaluation of capital infrastructure.
I know I have asked this question in the House before, how many elders need to get out of Rankin Inlet before Health would consider building a new facility.
It doesn’t have to be in Rankin Inlet.
It could be anywhere else in the Kivalliq.
Right now in Ottawa we’ve got four, Tommy Partridge, Mary Anawak, Bernadette Henrie, and Bernadette Irkootee; Arviat, we’ve got Tony Manernaluk; Gjoa Haven, there’s Connor Issigaitok; Baker Lake, Eva Howard, Lizzie Ittinuar, and Ms. Akerolik. That’s eight people out of Rankin Inlet.
How many more people do we need to send out of Rankin Inlet for care in other communities before you guys start considering building anything in my hometown?
In this report also where you guys are sending the elders to the province of Ontario, Ottawa, they’re going to get short for elders’ care facilities too.
I encourage the department to start looking very seriously in building another facility for Nunavutmiut particularly in the Kivalliq. (interpretation) Thank you, Mr. Chairman.
Chairman: It’s getting into a capital-related item, but if the minister would like to answer. Minister Hickes.
I recognize the member’s passion behind this topic; I share it.
Again, when we’re talking about capital dollars, it’s a challenge to access.
In addition, two of the facilities that the member mentioned are in the Kivalliq. There’s a facility in Baker Lake and there’s a facility in Arviat.
It is a shame that we have to send people outside of their home community to access the level of care that they need, that they’re assessed at medically.
Until such time as we do have the capacity within an individual’s community, we’re going to have to continue to explore options of sending people outside their home community to other care facilities in and outside the territory.
I do know I met with a couple of different groups across the territory quite recently. The member from Iqaluit-Niaqunnguu has mentioned herself that she’s part of the society that’s interested in building a long-term care facility and providing services out of there on a fee-for-service basis.
There’s another community in the Kitikmeot that I’ve had very serious discussions on the same type of initiative where an outside organization or society would build the infrastructure and we would utilize the services on a fee-for-service basis.
Going forward, again, we have a continual challenge for providing infrastructure across the territory.
Until such a time as a project like that can get on the capital plan, we’re left to whatever options we have available to us.
Mr. Sammurtok (interpretation): Thank you, Mr. Chairman. (interpretation ends) I realize I was talking about the capital plan, but it’s a part of the... .
It is so frustrating, especially when they’re coming from my community and going to the other communities.
The other communities could be using their own facilities to care for their elders.
From Arviat, they send them to... . If I’m not mistaken, they were sent down to Ottawa. They could have been staying in Arviat.
I encourage the health department to really talk with the federal government so that will be able to keep our elders in Nunavut.
Chairman: The minister wants to answer the comment.
Like I said, I empathize with the member because I am passionate about the same thing.
One of the ways that we are combating this issue is by working at providing a higher level of home care and care in the community so that people can age at home for as long as they can before they have to enter a care facility of any sort in any location.
That’s where we’re focusing a lot of our energies until such time as we can access dollars to be able to actually construct facilities.
Chairman: Next name on the list, Mr. Mikkungwak.
I would like to start off with a question that my colleague spoke about previously, medical travel patients that have to go south to go see doctors.
If you look at it from the other side, I would like to talk about it in another way and ask a question.
Sometimes it becomes very expensive when bilingual people like myself… .
For example, when I first became elected, I went on medical travel because I needed surgery.
The doctor was not my surgeon and they told me I was not allowed to carry anything heavy after my surgery and I couldn’t hold anything for six months.
From that, I believe the Medical Travel Policy needs to be amended because many people see the actual surgeon and they tell us we need to come with an escort.
If you don’t have someone to come and carry your bags, then the surgery will not be done and you will be sent back home.
That wastes a lot of money for the Department of Health.
When the minister was responding to questions earlier, he said he will be reviewing and working on the Medical Travel Policy.
We’re anticipating it to be complete in fiscal year 2017-18.
Earlier you indicated, “approved by a Nunavut practitioner.”
At the same time when you have a contradicting situation where a surgeon from the south whom you have sent a patient for medical to and the surgeon will not do the operation, as the surgeon indicates, “to ensure proper recovery, you must not handle anything 10 lbs. or more for a period of six months.”
Which one is going to override, the surgeon or the Nunavut practitioner?
Is it the surgeon who is operating or the Nunavut practitioner who covers the cost?
A southern practitioner can recommend an escort for a patient, but a Nunavut practitioner has to approve it because they are fully aware of our Medical Travel Policy and our escort policy.
There may be instances, as the member is speaking from personal experience on, where the aftercare for treatment may restrict somebody’s ability to lift bags.
Those services still are provided through medical transport when people are travelling for medical purposes.
When somebody goes down on medical travel, they’re typically not taking a great big heavy bag if they’re just down there for a few days.
I do understand, with our high cost of living here, people do like to go down and take advantage of southern shopping opportunities. At the same time, if people do decide to take that, that can’t be a medical expense.
I do understand the member’s personal situation.
At any time, if somebody feels that the medical practitioner that is not authorized and Medical Travel is making an error, or there may be other additional information that they may not be aware of, there is an appeal process that is in place that people can appeal the decision and it will move it up the chain.
I was just using myself as an example.
There were many other people who received the same surgery as I did.
I didn’t know that at that time, but I was glad to survive that operation.
I’ll move on to something that my colleague from Coral Harbour spoke about. Right now in the Kivalliq there is just one airline that handles medical travel to the south and I always see my constituents using that airline.
I know I have asked questions about this and the minister will remember.
The escorts will be carrying the oxygen tank for the patients.
However, sometimes the Department of Transportation or the airline takes their time and we have to wait. When the oxygen tank is not plugged in, it has a limited battery life.
Can you think about this?
A patient that needs oxygen may have to travel from Rankin Inlet to Winnipeg, which is more than a two-hour flight.
More and more people are travelling that need an oxygen tank.
Sometimes they can carry it on the aircraft, but most times they have to leave it behind in the terminal and they use a little portable one.
Have Calm Air and the Department of Health put any more consideration on the matter?
This is the first I have heard of it being an issue.
Most oxygenators that are portable do have a fairly extensive battery life before it would run out.
If somebody is travelling specifically with a tank, I’m sure there are extra tanks that could be travelled with, with the patient if there are delays.
I’ll have my officials look into the situation a little bit more detailed.
This is the first I’m aware that this is an issue.
Mr. Mikkungwak: Thank you, Mr. Chairman. I thank the minister and officials that are going to look into that.
It would add more security to clients/patients who are travelling with oxygen tanks.
Moving on, as the minister is very well aware, we do have an elders facility which the department is going to soon be taking over from Family Services.
Your 2017-2020 business plan includes a future priority for the 2018-19 fiscal year to address the need for dementia care.
Can you describe the current need for dementia care across Nunavut and provide further detail on how it is currently being provided to Nunavut residents who need it?
The numbers are fluid, as cases get identified, as people access treatment facilities that are available.
I do have a long-term care wait-list for confirmed or suspected dementia. As of early February, it was 12 individuals. At the same time that has probably changed since then, even just due to placements in facilities for people in care.
We’re always exploring opportunities to be able to provide… .
An example with the preplanning, again I’m going to delve into the capital side of things just for a moment.
In our preplanning in the Igloolik facility, we’ve got some preplanning dollars set aside to examine an expansion of that facility that could be carried over to a similar facility in Gjoa Haven, the data from that.
I’m looking at having that information available to us so that we can make some decisions ongoing on accessing the level of care in the territory.
In your business plan for 2017-18 it also states that right now the health department is taking over the responsibility of elders facilities from the Department of Family Services.
Does the health department have a good foundation to take over the elders facilities in Nunavut? With respect to the foundation that you will be creating to take proper care of elders who live in elders centres, are you working on that this winter or are you just in the initial stages?
When the responsibility was diverged from Health and from partial programming under Health and partial programming under Family Services, I think it was an unintended consequence of that departmental division that the programs and care got split up with the departments.
We have taken some on our territorial care coordinator and some of the positions that we have in there have been assisting the transfer.
We’ve had a transition team that has been in place for most of the year now, if not longer, on the transition of these facilities back into the care of Health or back in the responsibility of Health.
That is where the expertise is and that’s where the health professionals are.
That is, to me, the best location for responsibility and I’m very much looking forward to taking responsibility for those facilities as well.
Just as an example, we just had a position for a territorial executive director of continuing care.
We just had that position filled and the person just started today as a matter of fact.
In my community the Martha Taliruq Centre is the elders facility.
It has been in operation for many years and the staff is undergoing training.
I know that sometimes the board members change, but they have a solid foundation and they have been functioning and operating smoothly.
However, the facility maintenance is where the problem is occurring.
I know that the Department of Health is responsible for the care of seniors for the whole of Nunavut.
Are they going to consult with the board members and the staff of the elders facility or will you be meeting with them this coming winter?
Just for the member and everyone else’s information, part of our transition team with the Department of Family Services has already met with board members of that facility and we’re continuing to go forward.
As an example, $200,000 is being transferred from Family Services’ budget over to Health to cover any maintenance or potential renovations that might be needed.
If we identify, in collaboration with Community and Government Services, any additional needs that need to be met for the health and safety of the residents of facilities such as the one in Baker Lake, that is something we will bring forward to our capital planning or through our small capital process of making sure that any renovations that need to be done will be done as monies are available.
My time is running out, but this is my last question.
As a member for the Kivalliq and also a resident coming from Baker Lake, I know that patients have had problems with the Winnipeg boarding home.
I keep telling you about the complaints that I have received and I have also relayed them to the patient relations office.
Sanikiluaq is also a community that has problems or they have concerns about the boarding home. It seems that we keep talking about the issues that arise.
I want the Minister of Health and his officials to know that the patient relations office is popular with the people of the Kivalliq, particularly Baker Lake residents.
It would make sense if you can consult with those communities about their concerns while you consider a boarding home for the Kivalliq or to investigate the problems experienced by medical clients.
It is after all in your best interest to do so.
The patient relations office should lead this investigation because of the complaints they already receive.
They are connected with the medical travel clients and health centres in the communities.
I’m just offering a suggestion and I would be happy if you can follow it up with an investigation Thank you very much, Mr. Chairman.
Any time we receive concerns brought to the department’s attention or to my attention or to the patient relations attention, they’re dealt with right away.
I know there have been a number of issues that have been talked about by members from that region about that specific boarding home.
The biggest advice I can give you all is that any time there’s an issue that gets brought to your attention, you bring it to our attention, you contact the office of the patient relations, or through yourselves, you contact me or through the department.
We take every complaint or every concern very seriously, but at the end of the day it takes people bringing forward specific examples for us to be able to continue dialogue with the contract holder of any boarding home that we have. I know, within Winnipeg, there have been discussions with the management team of that facility.
In general the feedback I’m getting is that most of the issues have and are continuing to be dealt with.
As further issues, if any, come to your attention, please let us know.
We need specifics.
To sit here and talk about issues in a facility in a general manner is very difficult for me and my officials to deal with.
The more specific of an occurrence that we can get information on helps us in our investigation to make sure that contracting obligations are being followed.
We’re on page H-6. Health.
Health Care Service Delivery. Mr. Enook.
Before I move on to my question, I believe you were responding to Ms. Angnakak when you stated that the Medical Travel Policy is currently being reviewed.
Perhaps you alluded to this earlier, but let me ask you: when will you complete the review and when do you expect to report back about the results of the review and recommendations?
I’m sure the member and all my colleagues here can understand the complexity of a medical travel review. There are so many different components to it that we are undertaking. It has started already and we’re looking at a final report in the next fiscal year, 2017-18.
We’re just ending this fiscal year in another month, so it’s in the upcoming fiscal year that the report will be finalized.
We are looking at a couple of different components to it. One is internal to make sure that we’re identifying all the efficiencies that are available. As well there’s a working group with Health Canada also because they’re directly involved through NIHB.
There has been more and more recognition on their part of the challenges that we have with medical travel and escalating costs. There are other people that are at play within the review itself.
I sincerely look forward to the results of that report sooner rather than later.
Do I understand that the report will not be tabled within this current government and that it will probably be tabled in the next government?
Realistically chances are it will be in the next government.
Although I don’t want to go into detail of the contents, while I have the opportunity, I would like to say that I might not be re-elected to the next legislature because we don’t know what the future holds.
The issue that I hear frequently in my community is the seniors. I know that the legislation states that if you are 60 to 65 years old, you are allowed an escort and if you’re a unilingual person at the age of 60 to 65, you can ask for an escort.
The issue that always occurs is if these individuals at that age are bilingual, they don’t require an escort according to the policy.
If you’re going to have an escort, it breaks the policy right away if you’re bilingual. This creates some problems.
When they’re around that age, they tend to get tired easily and they’re physically weak. They usually have a heart condition. They’re required to travel by themselves and carry their luggage, and so on, as long as they’re bilingual.
I urge you to review this carefully. I know that we just put our elders out there because they’re bilingual, that it’s okay for them to travel alone. The cases are exactly the same, whether they’re unilingual or bilingual.
My question is in regard to Mr. Mikkungwak’s comment about the Inuit centre in Winnipeg. They hear about the problems over there. Also at the Baffin region boarding home, Tammaativvik in Iqaluit, Mr. Keyootak hears about problems or complaints made by the patients.
When we hear about the complaints and issues at Tammaativvik, who is going to resolve them?
Is it your department or the management of the boarding home?
It’s both of us. It’s collaborative.
There are regular meetings that do occur, minimum quarterly, but as issues arise, if there’s a need to meet more frequently, we do. The next scheduled meeting is in March.
One of the main issues that I hear out of Tammaativvik… . The food was a new one, so that’s something we’re looking into. There is a schedule for meals that are available for people who are early risers.
There are cereals, bagels, and toast and that that are available throughout the morning. There is a schedule for breakfast, lunch, and dinner.
There are snacks in between, a mid-morning snack and a mid-afternoon snack that are available. Typically they try to have country food available at the afternoon snack as well there’s another one around nine o’clock in the evening. There are a number of different avenues that way.
One of the most common issues or concerns that I get is the overcrowding and that is not an easily remedied challenge.
The first recourse is to hotels.
Iqaluit is a very busy city and there are a lot of different events going on that put strain on existing hotel infrastructure.
There are bed and breakfasts that are utilized.
Some of the members may have noticed a few weeks ago in the media that there was an article about Tammaativvik putting out a call for additional billets, people that have available bedrooms that they’re willing to open their house to on a paid-for basis.
I do know that there have been some discussions of the existing contract holder to look at an expansion plan, so I look forward to hearing more information on that to address the need.
The stats that I have are that the facility is overbooked 30 percent of the year.
They have approximately 23,000 room nights per year and it has booked over 30,000.
It’s a continual challenge just to have the room available.
I can’t tell you how difficult it is when I see pictures from residents and colleagues of an elder sleeping on a blanket on a floor.
The facility does request people to volunteer their bed for an elder.
For people that are listening, I hope you seriously consider that out of your own medical needs taken into consideration, of course, if an elder needs a bed, they please help our elders.
I’ll move on to another topic.
Mr. Chairman, please advise me if I make a mistake.
I have a question about the healing centre that’s utilized in Ottawa by Inuit, which was temporarily closed.