Federal plan's cap on coverage for incontinence care products 'inhumane' and 'offensive,' say chief, doctor

Staff at a northern Manitoba Cree Nation care home say a daily cap on coverage forincontinence products imposed by the federal government is out of step with elders' needs somethingIndigenous leaders and health advocates call "inhumane" and an "offensive" example of bureaucracy disadvantagingremote First Nations communities.

The Nisichawayasihk Cree Nationpersonal care homediscovered after signing onto a federal plan this year that Ottawa sets a limit on products such asdisposable briefs and pads at five per resident eachday.

Katrina Lusung, a nurse in the northern Manitoba community, said that's led to shortages that have staff driving an hour to Thompson to buy more off the shelves of a big box store.

"We're not going to let them sit on their incontinent products when they're visibly soiled or they're fully soaked.... These residents are like my family," Lusungsaid.

That's a challenge the care home is encountering "because of the inadequacy of the amount that they are providing ...which is obviously not enough," she said.

Thecare home signedon to the federal government'snon-insured health benefits program which provideseligible First Nations and Inuit clientswith coverage for a range of health benefitsnot otherwise coveredin March, making aswitch from buying directfrom a medical supply company.

The changewas borne out of financial pressures, said Lusung, after the care home learnedIndigenous Services Canada's First Nations and Inuit health branch covers nearly half of the costs of wound and ostomydressings, incontinence products and morefor some on-reserve long-term care facility residents.

But the care home wasn'taware of the five per daylimit until after it received aninitial three-month shipment of supplies.

The average number of disposable briefs or pads NCNcare home residents go through a day is more than double that, dueto a variety of conditions that may cause incontinence, said care home executive director Jessie Horodecki.

"They're saying each resident shouldn't need more than five incontinence products a day,"she said."We're here, we work with our residents, we see this every day. We need minimum 12 per resident every day."

Indigenous Services Canada spokesperson Jacinthe Goulet said the 24-bed NCN facility is jointly funded by the federal departmentand Manitoba Health.

Goulet confirmed Indigenous Servicessets "frequency and/or quantity limits on some products" based on"consultation with health professionals."

'Inhumane and unjust': chief

Nisichawayasihk Cree Nation Chief Angela Levasseur said the five per day limit "does not make any sense."

"It would be inhumane and unjust to leave our citizens withthislimit....So the NCN personal care home is left footing the bill" for more, shesaid.

Levasseur said accessingfederalnon-insured health benefits can involve navigatinga complex systemthat has suffered "consistent cutbacks" over the years in terms of whichmedications and productsare covered.

"It's coming to the point where it's really jeopardizing our ability to run our personal care home facility and to provide our elders with thecare that they so desperately need and deserve," she said.

Indigenous Services contracts7 Generations Medical Ltd. to supply participating care homes with the medical supplies they need.

The companyspecializes in providinghome-care products to people aging in place in their homes, though it also has two or three First Nation-based personal care homeclients in everyprovince west of Quebec,including three in Manitoba, owner Kendall Smith told CBC News.

Smith said the daily capset by the federal government is"quite generous"compared to some provincial programs in Canada and "isn't out of the realm of what's normal across the country."

He noted residents on prescribed diuretics or with conditions that may warrant more frequent changescan obtain more pads and briefs with a prescription from a doctor or nurse specializing in wound care and incontinence.

Goulet, the Indigenous Services spokesperson,said "everyone deserves to age in dignity" and advised clients with "unique needs" who need more incontinence products to reach out to the non-insured health program.

Lusungsaid staff in Nisichawayasihk must explain in requisition forms why each resident needs items such as incontinence-care products and how many per day, which they didn't have to do when dealing directly with a corporate supplier outside of the non-insured government program.

Sometimes delays in the approval processhave left the care home short onproduct, she said.

Smith said any perceived delays would be related to the prescription approval and review process by the federal government.

"They're very adamant you can't supply anything until you got the approval," said Smith."I do understand that it's unfortunate ...as it gets straightened out."

Smith said if NCNisn't happy, there is no contract obligating them to continue.

He also said the three main manufacturersof disposable pads and briefs in Canada say it isn't necessary to change someone using their incontinence products unless there's stool, because theproducts are designed to absorb urine in 30 seconds.

A 'care less' approach from province, feds: doctor

Dr. Barry Lavallee,chief executive officer of the health-care-focused organization Keewatinohk Inniniw Minoayawin Inc.,criticized the nature of the federal system arriving at caps for essential items basedon guidelines from manufacturers.

"I take offence to any company that's making money off of Indigenous people to suggest the number [limit].If we need 10 [products daily per patient], so be it."

A primary function of the Winnipeg-based organization heleads, which represents 70,000 First Nations people from 23 northern Manitoba communities,is to push for reforms to the health-care system administered by the federal government, said Lavallee.

He said First Nations also still face barriersto accessingmedication, eyewear, dentalcare, along with inadequate rehabilitative services and more.

"Both provincial and the federal systems have always had a 'care less' approach" when it comes to administration of First Nations, Lavalee said, "whether you're an elder or you're pregnant."

Lavalleesaid deficiencies related to cost-saving measures affect health outcomes and are a continuationof"persistent oppressions through the federal government to First Nations health."

He suggested the caps Nisichawayasihk has encountered are an example of what needs to change.

His organization hopes to take over and facilitate thenon-insured health benefit programfor the nations it represents and renegotiate costs with Ottawa, he said.

"Those bureaucracies, which are quite resistant, don't seem to change no matter what kind of government we have in place,"said Lavallee.

"Our negotiations as we go forward will be far higher than their current budget. That is a fact."