Experiences of historical trauma, social marginalization, poverty, cultural disruption and racism all negatively impact the ability and desirability of accessing health and/or caregiving services and resources. Issues that challenge the ability to provide sustainable caregiving include:
- First Nations and Inuit have the lowest life expectancy of all groups in Canada.
- Lack of stable housing with severe shortages, overcrowding, substandard construction, needs for major repair, and lack of basic utilities
- 71% of First Nations seniors did not complete high school, leading to low levels of literacy
- 50% of First Nations adults aged 18-54 have not competed high school
Complicating these issues, First Nations communities offer fewer health services, often at a greater geographical distance, than other communities in Canada. Those living in remote and isolated areas may have substantial barriers to sustainable caregiving including: lack of roads and efficient transportation, high cost of transportation for medical supplies, inability to access rehabilitative services, adequate palliative or respite care and the lack of available health professional requiring frequent travel to urban centres, the incurrence of greater financial expenses, and lengthy wait times (Assembly of First Nations, 2007).
The First Nations population age 55+ will increase more than 230% over the next several decades. While life expectancy is anticipated to improve, so too will a corresponding rise in chronic illness. First Nations people have higher rates of chronic illness such as diabetes, cardiovascular disease, arthritis and functional/activity limitations. Currently there is a ratio of 1 bed per 99 individuals aged 55 and over for First Nations living in their communities compared to 1 bed per 22 individuals aged 65 and over in the general Canadian population (Assembly of First Nations, 2007).
On the other end of the scale, approximately 50% of the First Nations population is under the age of 25, compared to Canada’s median age of 37.5 years. Additionally, migration back to First Nation communities will increase the population already living in these communities to increase by 34%. This will impact on existing services and supports needed to provide culturally competent support to for population in rural and/or remote settings, including the demand for continuing care.
Addictions and mental health issues arising from cultural fragmentation can complicate the ability of First Nations individuals to provide appropriate care. As with the broader aging population elder abuse is also an ongoing concern. While statistics on the abuse of elders are scare for the general Canadian population, even less information is available for the Aboriginal elder population with respect to the incidence and prevalence rates of abuse that may be occurring in the Aboriginal community. Existing research on the issue of violence and First Nations people indicates higher rates in comparison to the general population in Canada (Dumont-Smith, 2002).
However, there are also strong family and community ties embedded within First Nations culture that support caregivers. In designing policy and programs to support these ties, it is important to recognize that Western conceptions of intervention may be different than First Nations ones, and that elements of First Nations culture cannot necessarily be ‘extracted’ to fit Western care models. This awareness and ability to support First Nations caregivers requires cultural competency. Cultural competence is defined as a set of “congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals that enables the system or professionals to work effectively in cross-cultural situations” (Cross et al., 1989). The Nova Scotia Department of Health has developed a guide on cultural competence for those working in the primary health care system.
The School of Nursing, University of Victoria, presents three free Distance Study Modules on Cultural Safety. The purpose of these modules is to reflect on Aboriginal peoples’ experience of colonization and racism as these relate to health and health care. The modules are designed for nurses, nursing students, and nursing instructors, as well as other health and human service workers, to explore the concept of cultural safety as it relates to nursing practice.
To access the modules, please click below: