Introduction
Often naturally self-effacing, many Indigenous Elders frequently lead with, “I’m not an Elder, I’m just old” and then proceed to re-contextualize a long-held perspective of the listener or provide a new, revealing viewpoint that ties back to the fundamentals of close observation, sustainable practice, trial and error, or culturally-specific received wisdom. Whether Christian, Traditional or a mix, these Grandmothers and Grandfathers often have a keen desire to share the knowledge gained from a lifetime of joy, work, relations, trauma, grief, trying, listening, and watching to those seeking guidance. The importance of this knowledge transmission and its two-way impact on generational wellness cannot be overstated.
Prior to being labelled inefficient and shuttered in 2013, the Health Council of Canada had been taking a long-term, in-depth holistic view of the health disparities experienced by Indigenous peoples living in Canada, with a particular emphasis on seniors. Their report, “Canada’s most vulnerable: Improving health care for First Nations, Inuit, and Métis seniors” made apparent the realities facing a generation of Elders. The combination of poorer health generally, higher incidence of chronic disease, mental wellness issues due to colonization, and less access to care, has led to an outcome gulf between Indigenous seniors and their non-Indigenous peers.
Elder and Senior Care in Manitoba
In Manitoba, in response to the COVID-19 crisis and its disproportionate effect on residents of Long Term Care (LTC) homes, the Manitoba government created a Ministry of Seniors and Long Term Care in 2022 to bridge departments, Ministries, and jurisdictional silos seen as barriers to effective care delivery. After engagement with community networks and 10,000 residents the provincial government released Manitoba, A Great Place to Age: Provincial Seniors Strategy. Notably, engagement and consultations did not include significant consultation with Indigenous groups. The plan aims to value all Manitoban seniors with a place in settler society akin to one already held by Elders in Indigenous communities.
The strategy singles out ageism and its systematic reduction of the social value of the aged as something to be ameliorated through a re-valuation and celebration of growing old. It states Manitoba seniors should expect to:
“Feel that [they] can stay active with purpose, connected to [their] communities, with a deep sense of belonging and value. To count on [their] needs, culture, and preferences being understood and met when accessing care and services. To be supported in all aspects of aging including social, recreational, wellness, and health in [their] communities, close to home, through in-person or digital models. To feel recognized and supported for the crucial caregiving and support provided by friends and family that empowers Manitobans to grow older with independence, dignity, and respect.”
The central goal is, “to establish a more comprehensive, responsive system of programs and policies that provides the supports and services so seniors can live independently in their homes, have active lifestyles, and the ability to stay connected to their families and communities as long as possible.” In his opening message, the Honourable Minister continues that the goal was to “invest in and support seniors with services and supports that respect our unique needs regardless of where we live, our ethnic and cultural practices, or the languages we speak. We will work across governments and with service providers to design and deliver high-quality services together.”
The plan calls for increased and better multi-generational housing options for Manitobans, increased collaboration between senior-serving organizations, an amelioration of community safety, affordability, accessibility and inclusivity, and the development of “Villages” aimed at supporting connectedness through shared culture, increased social interaction, and a design that privileges intergenerational contact.
Effectively, the strategy encourages settler Manitobans to see older Manitobans the way Indigenous cultures view their Elders – particularly with the emphasis on models of inter-generational access. The strategy includes a key, if unspecified, focus on Indigenous Manitobans, with the Minister noting the plan will “continue to strengthen our relationships with First Nations, Inuit and Red River Métis people to take a distinctions-based approach to co-designing services and supports that address the unique needs of Indigenous seniors.”
While the provincial strategy advocates for an Indigenous-like, culturally-rich, village lifestyle model of care, it fails to note that it will continue to force rural Indigenous seniors – many of whom would rather live on-reserve – to relocate to urban areas to perhaps receive life-prolonging care. Additionally, intergenerational living is the norm in Indigenous life, often due to funding barriers and necessity. The Minister acknowledges what Indigenous seniors have known for generations: that it has always been jurisdictional issues that are the major barrier to implementing adequate, home-based or proximal care for older Indigenous people in the province but does not lay out a plan to remedy this injustice. The Canadian Medical Association points out that disharmony between branches of colonial governments have had real and lasting effects on the quality of life for Indigenous seniors, making them victims of poor coordination and communication.
Alarmingly, health equity is entirely absent in the Seniors Strategy. The intergenerational trauma of the Indian Residential School system and the accompanying long-term effects on the health of Indigenous seniors is not acknowledged. Also absent is the reality that Indigenous seniors are more than twice as likely to experience food insecurity, nearly three times more likely to be diagnosed with diabetes, and will likely die a decade before their non-Indigenous peers. The goal of the Seniors strategy may be to create systems that value, house, and provide the kind of social opportunities to older Manitobans in a manner familiar to Indigenous seniors – but the inequitable health outcomes between Indigenous and non-Indigenous seniors must also be addressed.
There is an opportunity for the Ministry of Seniors and Long-Term Care to commit to services and standards that truly apply to every older person whose home is in what is now the province of Manitoba. However, to truly advance reconciliation, the province must seek leadership from the Indigenous seniors whose people have called Manitoba home for millennia, yet remain the most vulnerable and politically excluded members of society. Indigenous seniors have vastly superior, time-tested models of aging that provide a means to realize the kind of social, family, and cultural inclusion the province seeks to make their Seniors strategy a success.
Indigenous Seniors in Canada: Widening Health Gaps
Canada-wide, the number of Indigenous seniors continues to grow at rate that exceeds non-Indigenous. Between 2016 and 2021, the percentage of those aged 65 plus rose from 7.3% to 9.2%. During the same time, the number of Indigenous people calling urban centres home has also grown as they continue to support their dependents, reach an end point in their frustration with Non-Insured Health Benefits (NIHB), grow weary of regular travel to seek care for chronic ailments, or simply because no appropriate housing is available.
The issue of Indigenous Elder Care is a particularly strong illustration of how interconnected the social determinants of health are. Solutions or models that ignore aspects of cultural safety, trauma, poverty, public health education, systemic inequities, outsized incidences of chronic disease, Traditional Knowledge, or the values that have guided Indigenous life in what is now Canada for millennia will be incomplete.