Gaps in federal funding and authority expose many First Nations and Inuit Elders in Canada to inadequate long-term care, forcing them to leave their home communities, language and culture, documents show. 

The document obtained by Canada’s National Observer through an Access to Information and Privacy request shows that limited funding, unclear responsibilities and gaps between jurisdictional powers have created a significant shortfall in long-term care infrastructure.

While Indigenous Services Canada (ISC) runs the First Nations and Inuit Home and Community Care Program and the Assisted Living Program, the programs “do not completely meet the long-term care needs” of Indigenous communities, says the briefing note prepared for the minister. 

“These Elders are in their final golden days … but they [the system] plug and pull them from their homes, pull them from their loved ones, they pull them from their food that used to be their diet and they put them in homes and there’s some places where it’s hard for their family to see,” said Mark MacNeill, Indigenous law and policy expert and researcher on Inuit long-term health.

Many Inuit Elders are forced to leave their northern communities for distant southern care homes, MacNeill said, describing the situation as a “double whammy” for Elders who have already lived through the lasting impacts of residential schools and colonial policies and now face further cultural isolation and trauma in unfamiliar care environments far from their communities and support networks.

Sharlene Webkamigad, Anishnaabe-Kwe from Wiikwemkoong as well as an Indigenous health researcher and assistant professor at Laurentian University, said the relocation can be especially hard for those living with conditions such as dementia or Alzheimer’s disease or for Elders who revert to their first language later in life and cannot communicate easily in English. When older adults are placed in facilities where “they can’t speak any other language,” they may become “very closed off or not able to ask for what they need, just basic things,” she added.

Government documents show that current federal support ranges from in-home health services to per-diem funding for low-income individuals in long-term care, but ISC cannot fund the construction or full operation of care homes on reserve. 

To address this, the department drafted a Memorandum to Cabinet and a Budget 2025 proposal seeking authority for a “more comprehensive and holistic approach,” including infrastructure funding that does not currently exist. The department said it would not share the contents of that memo.

“Memoranda to Cabinet are subject to Cabinet Confidence and their contents cannot be shared,” Maryéva Métellus, spokesperson for ISC, told Canada’s National Observer in an email response.

Jurisdictional ambiguity

Webkamigad said the gaps in Indigenous long-term care stem partly from jurisdictional ambiguity. Under the Canada Health Act, long-term care is considered “extended healthcare” and mainly a provincial responsibility. This setup leaves federal obligations unclear, even as Indigenous health ties directly to treaties with Ottawa.

“In Canada, provinces are responsible for funding and licensing long-term care homes,” Métellus said. Construction and maintenance of care homes on reserves relies on partnerships with provinces, federal agencies and communities. Many existing facilities were funded through Canada Mortgage and Housing Corporation, provincial governments or local revenue. 

“ISC is passing the buck, also known as shirking its fiduciary duty. Health care is a jointly shared responsibility under the Constitution and even more importantly, our First Nations and Inuit relationship is in the first instance with our federal Government,” MacNeill said. 

MacNeill said Indigenous health services should be funded federally in the same manner as veterans’ hospitals.

Despite no infrastructure authorities for long term and continuing care currently in place, some communities have received one-time federal support. In January 2023, ISC provided $5 million through the Health Facilities program and $250,000 through the Lands and Economic Development program to fund architectural design for a care home in the Tyendinaga Mohawk Territory. But that was a one-time thing, the ministry said. “The funding through the Health Facilities Program was an exceptional circumstance using a funding stream that is no longer available,” Métellus said. 

Métellus added that the Grassy Narrows Mercury Care Home in Ontario is also being built as part of legal settlements with Ontario and Canada. 

Webkamigad said older adults remain central to cultural survival in several First Nations communities in Ontario and removing them from their homes affects the broader community.

“We can’t pass down our languages and our understandings of our lands and waters if the people who carry that knowledge are sent away to live out the rest of their lives somewhere else,” she said.

As a result, there is an urgent need for a “distinctions-based” culturally informed approach — meaning recognizing and respecting the unique rights, cultures and needs of First Nations, Inuit and Métis peoples individually, she said.

“We need to draw on the knowledge of those in the community and those older adults to start talking about what is even needed — long-term care facilities, intergenerational housing or close-knit community support,” she said. 

Métellus said that efforts to improve long-term care for First Nations and Inuit communities have been ongoing. In 2019, the government provided $8.5 million for Indigenous Services Canada to create a holistic care framework. Indigenous-led regional consultations were completed in 2022 and their findings helped guide joint policy discussions in 2023.

Métellus added that while budget 2025 does not specifically earmark funding for long-term care for First Nations or Inuit, it includes measures to support Indigenous communities more broadly, such as development of an Indigenous Housing Strategy.

The government document also notes that the absence of federal provision for long-term care on reserve has been raised repeatedly in human rights complaints.

Métellus acknowledged ongoing complaints before the Canadian Human Rights Commission and Tribunal alleging discrimination against First Nations adults with disabilities based on race, age and disability, but couldn’t provide further details. 

“As the matters are currently before the Commission and Tribunal, Indigenous Services Canada will not be commenting on the specifics of the cases to protect the integrity of the proceedings and the privacy of those involved,” Métellus said.

Sonal Gupta / Local Journalism Initiative / Canada’s National Observer.

---

You can support trusted and verified news content like this.

FIPA’s news monitor subscribers, donors and funders help make these available to everyone rather than behind a paywall. We appreciate every contribution because it makes a difference.

If you found this article interesting and useful, please consider contributing here.

---

Learn more about our News Monitoring here.