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Supporting Indigenous Culture in Ontario's Long-Term Care Homes

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Supporting Indigenous Culture in Ontario's Long-Term Care Homes Supporting Indigenous Culture in Ontario’s Long- Term Care Homes Needs Assessment and Ideas for 2017-18 Sue Cragg Consulting and the CLRI* Program March 27, 2017 *funded by the Government of Ontario through the Ontario Centres for Learning, Research and Innovation in Long-Term Care. Opinions expressed in this report are those of the authors and do not necessarily reflect those of the Government of Ontario. Acknowledgements It is with sincere gratitude that the Project team Advisory Group acknowledges the contribution of the Project Special thanks are also due to the hard working Advisory Group, the Talking Circle and Interview members of the project advisory group: participants and reviewers of the draft • Janet Gordon, Director of Health Services, documents. Their time and thoughtful input to Sioux Lookout First Nations Health Authority; the project are truly appreciated. Particularly, we • Gerri Yerxa, Psychogeriatric Resource Lead, wish to acknowledge: Canadian Mental Health Association, Fort The staff (administration, recreation, volunteer Frances; coordination, spiritual care, resident services, • Lorraine Purdon, Executive Director, Family activation staff, clerical, nutrition coordination, Councils of Ontario; nursing, PSWs and others), residents and family • Keli Cristofaro, Stroke Community members of: Engagement Specialist, NWO Regional Stroke • Sioux Lookout Meno Ya Win Health Centre; Network; • Kensington Gardens Long-Term Care Home, • Kevin Chony, Community Care Manager, Toronto; North West Community Care Access Centre; • Birchwood Long-Term Care Home, Kenora; • Anita Cole, Regional Manager of Patient Care, and South West Community Care Access Centre; • Hogarth Riverview Manor, Thunder Bay; • Barry Lazore, Administrator, Mohawk Council And key informants who represent: of Akwesasne & Ontario Association of Non- • The Toronto Indigenous Health Advisory profit Homes and Services for Seniors; Circle; • Vinita Haroun, Ontario Long Term Care • The Native Canadian Centre of Toronto; Association; • Anishinawbe Health, Toronto; • Josie-Lee Gibson, Ontario Association for • The Thunder Bay Regional Health Sciences Resident's Councils; Centre; • Lisa Petagumskum, Consultant and • The LHINs in Thunder Bay, Toronto and Facilitator; Ottawa; and • Isis Cowley, Ministry of Health and Long-term • The Wabano Center for Aboriginal Health, Care; and Ottawa. • Marney Vermette, Wabauskang First Nation, Ontario Engagement Liaison, First Nations, Inuit & Métis Program, Saint Elizabeth Health Care Executive Summary Ontario’s Indigenous people have unique • Identify opportunities to partner for cultural requirements that must be supported innovation that benefit Ontario’s long-term by health care, including long-term care. A care sector. legacy of colonization, historical trauma, racism, It achieved this through a literature review, distrust of western medicine and ways, and discussions with a wide range of stakeholders sometimes geographic isolation impact this and guidance by an expert Advisory Group. population like no other. Respect for treaty rights and jurisdictional issues also need to be This report is intended to inform future work considered in planning for care and supporting around developing tools and resources to the culture of this population. support Indigenous culture in long-term care and to scale-up existing successful practices. All The need for long-term care is increasing and future work will be undertaken in collaboration long-term care homes are challenged to with Indigenous organizations and sector recognize and support the culture of their Associations. residents at a time when their health needs are increasing. A growing body of evidence suggests There is a need to share evidence-based that when people are given the freedom to information, successful practice, resources, tips return to their cultural ways, health will and tools. The following types of support improve. opportunities have been identified: • Cultural safety training for all staff. This The three Centres for Learning, Research and work should not be the work of the CLRI Innovation in Long-Term Care (CLRIs) have Program, rather Indigenous organizations identified the support of Indigenous culture in should be the primary creators. The long-term care as an area in which innovation Program could lend some dissemination or and capacity-building are needed. This project knowledge broker support. was undertaken towards the end of the first • Ways to connect to community care 5.5-year mandate of the Ontario CLRI Program providers to ease the transition from (2011-2016) to inform work planning in this community services to those provided important area for the next mandate of the within the long-term care home. Program. It assumes program renewal for a • Tips and ideas for helping residents stay in second, multi-year mandate. touch with their families and community This project set out to: more generally. • Explore the unique needs of Indigenous • Information about ways for homes to work people in Ontario’s long-term care homes; with Indigenous community organizations, • Identify opportunities for the Centres for Friendship Centres, Healing Lodges etc. to Learning, Research and Innovation in Long- connect residents to their services. term Care Program to contribute to • Information about traditional medicines. supporting the culture of Indigenous • Information about navigating jurisdictional people in long-term care for the CLRI 2.0 issues and different payment sources. work plan; and • Information about cultural values, Identified opportunities for incorporation into a traditions and beliefs in a general way. CLRI 2.0 workplan include: • Information about ways other • Continued advisory committee guidance organizations support smudging, fires and and further stakeholder outreach; tobacco burning. • Support for an independent Resource • Promotion of culture specific information Council that would provide long-term care about dementia care, palliative care and homes with cultural information; end-of-life practices. • Ongoing information gathering; • Recipes for traditional foods, and menu • Ensuring a cultural lens in all CLRI activities; ideas for incorporating them along with • Ideas for resources to fill identified gaps; ideas for sourcing traditional foods. • Ideas for education and training; • Tips for engaging and working with • Ideas for research projects. interpreters. The activities are described in detail, along with • The creation and sharing of printable cards principles of a dissemination plan and with pictures and words in the language of evaluation. All work must be done in close the resident for activities of daily living and collaboration with Indigenous organizations, other important words. long-term care Associations and other • Tips for training and engaging Indigenous stakeholders to ensure relevance, uptake and care staff, supervisors, board of directors implementation. members and volunteers, including visiting Elders. Table of Contents Introduction .................................................................................................................................................. 1 Project purpose and goals ........................................................................................................................ 1 Background ............................................................................................................................................... 1 Individual and Family Considerations ................................................................................................... 4 Spiritual Considerations ........................................................................................................................ 5 Physical Considerations ........................................................................................................................ 5 Community Considerations................................................................................................................... 6 Provincial and Federal Considerations .................................................................................................. 6 Cultural Competence, Cultural Responsiveness and Cultural Safety ....................................................... 7 Methodology ............................................................................................................................................... 10 Literature Scan ........................................................................................................................................ 10 Advisory Group Formation and Activities ............................................................................................... 11 Data Gathering ........................................................................................................................................ 11 Vetting Findings ...................................................................................................................................... 12 Findings ....................................................................................................................................................... 13 Supporting Emotional Well-being ........................................................................................................... 14 Supporting Spiritual Well-being .............................................................................................................. 15 Supporting Physical
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