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 for incontinence products imposed by the federal government is out of step with elders' needs — something Indigenous leaders and health advocates call "inhumane" and an "offensive" example of bureaucracy disadvantaging remote First Nations communities. 

The Nisichawayasihk Cree Nation personal care home discovered after signing onto a federal plan this year that Ottawa sets a limit on products such as disposable briefs and pads at five per resident each day.

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," Lusung said.

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.

The care home signed on to the federal government's non-insured health benefits program — which provides eligible First Nations and Inuit clients with coverage for a range of health benefits not otherwise covered — in March, making a switch from buying direct from a medical supply company.

The change was borne out of financial pressures, said Lusung, after the care home learned Indigenous Services Canada's First Nations and Inuit health branch covers nearly half of the costs of wound and ostomy dressings, incontinence products and more for some on-reserve long-term care facility residents. 

But the care home wasn't aware of the five per day limit until after it received an initial three-month shipment of supplies.

The average number of disposable briefs or pads NCN care home residents go through a day is more than double that, due to 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 department and Manitoba Health.

Goulet confirmed Indigenous Services sets "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 with this limit.... So the NCN personal care home is left footing the bill" for more, she said.

Levasseur said accessing federal non-insured health benefits can involve navigating a complex system that has suffered "consistent cutbacks" over the years in terms of which medications and products are 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 the care that they so desperately need and deserve," she said.

Indigenous Services contracts 7 Generations Medical Ltd. to supply participating care homes with the medical supplies they need.

The company specializes in providing home-care products to people aging in place in their homes, though it also has two or three First Nation-based personal care home clients in every province west of Quebec, including three in Manitoba, owner Kendall Smith told CBC News.

Smith said the daily cap set 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 changes can 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.

Lusung said 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 process have left the care home short on product, 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 NCN isn't happy, there is no contract obligating them to continue.

He also said the three main manufacturers of disposable pads and briefs in Canada say it isn't necessary to change someone using their incontinence products unless there's stool, because the products 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 based on 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 he leads, 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 barriers to accessing medication, eyewear, dental care, 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."

Lavallee said deficiencies related to cost-saving measures affect health outcomes and are a continuation of "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 the non-insured health benefit program for 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."