Policy and Political Action

Policy & Political Action

Presentation to the Standing Senate Committee on Social Affairs, Science and Technology

The need to prevent and manage dementia in Canada is critical. In 2011, 747,000 Canadians lived with Alzheimer’s disease and other dementias (ADRD). This amounted to 14.9 per cent of Canadians 65 and older (Alzheimer Society, 2012). By 2031, the number of Canadians living with dementia will increase to 1.4 million (Alzheimer Society, 2012). Dementia does not discriminate. It impacts people of all socioeconomic classes, genders, ethnicities, and is not just a disease of older persons. For example, roughly 1 in 1000 people under the age of 65 develop dementia (Alzheimer Society Canada, 2015). The impact of dementia can be felt at all levels of our society. The significant stigma associated with dementia
creates further barriers to the access and delivery of high quality care and services. An urgent focus on living well with dementia is needed.

The Canadian Gerontological Nursing Association (CGNA) is the national organization representing gerontological nurses and promotes gerontological nursing practice across national and international boundaries. In 2010, the CGNA developed care competencies for gerontological nursing, including competencies to provide care for seniors with dementia.

The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses (RN), nurse practitioners (NP) and nursing students in Ontario. RNAO has extensive expertise in the area of dementia care. In particular, RNAO developed two clinical practice guidelines that are widely used.

  • Screening for Delirium, Dementia and Depression in the Older Adult (RNAO, 2003)
  • Caregiving Strategies for Older Adults with Delirium, Dementia and Depression (RNAO, 2004)
  • Person-and Family-Centred Care (RNAO, 2015A)

CGNA and RNAO are pleased to deliver a joint submission and appreciate the opportunity to inform the Standing Senate Committee on Social Affairs, Science and Technology as it reviews and reports on dementia in Canada. This submission will provide background and recommendations on five key areas related to dementia care in Canada: health system resources, education and training of health professionals, housing, care partners, and the integration of health and social services.

Recommendation 1: The federal government collaborate with the provinces/territories to negotiate a new multi-year Health Accord that:

  • Enforces the principles and spirit of the Canada Health Act;
  • Increases federal-provincial/territorial funding;
  • Advances interprofessional primary care with RNs, NPs, and all other health professionals working to full scope;
  • Reinstates the Health Council of Canada; and
  • Expands Medicare to include all medically necessary areas, starting with universal home care and pharmacare without co-payments or user-fees.

Recommendation 2: Support efforts to advance a timely diagnostic process for persons experiencing dementia, including the full utilization of RNs and NPs and access to specialized assessment services.

Recommendation 3: Ensure the appropriate supply, distribution and utilization of RNs and NPs in Canada to effectively support persons living with dementia, including specialized roles such as geriatric emergency management (GEM) nurses, psychogeratric specialists, and clinical nurse specialists in gerontology and/or mental health.

Recommendation 4: All RNs must complete mandatory gerontology and chronic disease management training in entry-to-practice curriculum including clinical experience with geriatrics.

Recommendation 5: Support efforts to enable independent RN prescribing in Ontario and use this as a framework for expansion across the country.

Recommendation 6: All unregulated care providers complete mandatory geriatric and CDM training that includes:

  • Communication and documentation skills;
  • Collaboration and team work;
  • Effective management of responsive behaviours; and
  • Person and family centred care and services.

Recommendation 7: Provide human and financial resources to support uptake in practice and education, of the most current and relevant evidence to ensure the highest quality, evidence-based care for Canadians with dementia.

Recommendation 8: Ensure that all Canadians with dementia, regardless of their socioeconomic status, have access to appropriate housing. This can be done by ensuring that accessible housing models exist that accommodate various levels of care needs and abilities, and resembles living at home.

Recommendation 9: Apply a health equity lens in government decision-making to better understand the sociocultural and economic factors that persons with dementia and their care partners’ experience.

Recommendation 10: Recognize and value the integral role of care partners for persons experiencing dementia and ensure structured support exist, including accessible day programs and respite care.

Recommendation 11: Support efforts that co-ordinate information about local services and programs under one body. Features of the services and programs should be clearly communicated to the public (i.e. provision of meal, length of session, age requirements, etc.).

Recommendation 12: Advance federal initiatives to support provinces/territories to make interprofessional primary care teams the foundation of their health system. Locate and embed care co-ordination and dedicated care co-ordination RN roles within primary care.

In conclusion, CGNA and RNAO are grateful the Standing Senate Committee on Social Affairs, Science and Technology for the opportunity to contribute to your work. We look forward to seeing our recommendations integrated into your final report. Please contact us should you need any further information regarding our submission.

Get the full submission with references below.

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