Healthcare Reform in Canada for Dementia

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Healthcare Reform in Canada for Dementia & Long Term Illness
An understanding of the “lived experience” of “caregivers” of patients with dementia
requires a psychological profile of the caregivers after a substantial amount of time has been
spent caring for patients with a devastative terminal illness that is dementia. A conjunction of
understanding; as it concerns the nature of dementia and its effects and imprints on the human
condition as well as the parameters of knowledge that is required of the caregivers need to be
examined to be effectively establish this discourse. It is important to understand that often
Alzheimer’s disease is a pre-cursor to dementia and possibly is the causative factor in about 60-
70% of dementia cases; Dementia leads to loss of cognitive functions and deteriorates the ability
of the individual to perform mundane and normative human tasks while the symptoms of
memory loss continue to become worse over time (World Health Organization, 2015;
Alzheimer’s Association, 2016).
A definition of “Lived experience” for the purpose of this discourse can be termed as the
day to day activities of nurses with their patients and how these interactions have indelible
impacts on the lives for the nurses for the long run; and this is often explored using a
phenomenological hermeneutic method (Fackler, Chambers & Bourbonniere, 2015; Lindseth &
Norberg, 2004). The manner in which the current healthcare policies affecting the patient and
also the caregiver’s and family must be prorated and amended because there are numerous

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shortcomings and this discourse will further explore these shortcomings The next step in this
specific paradigm of Dementia and its effect on the Nurses and caregivers is to centralize the
discussion from a broad spectrum or worldview and centre the discussion specifically around
caregivers in North America and more specifically in Ontario, Canada. It has been reported in
predictive fashion that the threat of dementia is imminent for the older section of the population;
“the age standardized incidence of dementia in Canada has Running head: HEALTHCARE
REFORM DEMENTIA been estimated at 21.8 per thousand for females and 19.1 per thousand
for males” (Raina et al, 2004, p. 50). This prediction that the prevalence of dementia in the
Western world will only continue to thrive is very important because it means that resources
must be allocated and the stressful effects of caring for patients must eliminated or addressed
with efficacy.
It is often difficult for patients with dementia to communicate in an effective manner
whether through verbal means or non-verbal quirks and it can be difficult for the patients to
understand the nurses as well (Soderlund, Cronqvist, Norberg, Ternestedt & Hasebo, 2015). The
effects of caregiving are that it is very psychologically taxing and it takes a toll on the mental
state and possibly the overall elasticity of the mind as this is put in perspective in scholarly
views; “Objective aspects of dementia and/or patient-related variables are arguably not the only
predictors of caregiver QOL, and the subjective experiences of caregivers could be strong
predictive factors given that there is overwhelming evidence of negative psychological states
associated with caregiving” ( Takai, Takahashi, Iwamitsu, Oishi & Miyoka, 2011). Deriving
from the understanding of scholarship from varying sources cutting across the U.S., Canada and
Japan is that effects of Dementia being the psychological effects associated with disease are
more impactful on the health of the patient as well as the caregivers than any debilitating

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physical aspects that are resultant of ailment. The needs of patients with dementia are numerous
and unending and therefore there is a need for patience and a resolve in dealing with such
patients that is often draining and stressful for the nurses and as well the family of the patient.
The provision of services and care to patients with this terminal illness may have a lasting
impact on physical, emotional and psychological health of the caregiver; statistical information
in form of survey shows that 35% out of a sample of 221 caregivers reported some Running
head: HEALTHCARE REFORM DEMENTIA form of deterioration to their health as a direct
result of caring for a patient with dementia and this was further accented if the caregiver was
living in with the patient (Thompson & Roger, 2013, p. 224). It is important to understand the
pervasive nature of a carrier with an illness displacing their psychological turmoil and how this
can begin to unspool and encroach on the mental elasticity of the caregivers and family
members. Medical Implications of Dementia and field experience of caregivers The main
medical implications of Dementia affect the ability of the patient to effectively remember simple
tasks and the impairment of cognitive abilities as well as a distortive understanding of the
passing of time; while the primary responsibility of caregivers is being an agent of helping the
patient to achieve independence and the highest levels of functionality as it regards the physical,
intellectual and spiritual wellbeing of the patient (Hynninen, Saarnio & Isola, 2014;
Dimakopoulo, Sakka, Efthymiou & Karydaki, 2015).
An illnesses such as Alzheimer’s and dementia are very difficult and costly to treat
because they are terminal in nature therefore the usage of drugs to treat such ailments are
understandable. There are several side effects as it concerns these drugs and it is necessary to
understand that there are usually residual effects that result from the use these drugs. The side
effects of these drugs range from many physical symptoms (nausea, diarrhea, cardiac

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arrhythmia) to mental effects such as psychosis. These drugs can be used but it necessary to
minimize the side effects of such medications and also understand that current treatments of
diseases such Alzheimer is costly and it affects about 24 million people worldwide. Individuals
suffering from such ailments often need the help with everyday life and many cases of Dementia
are and outshoot of a person that was suffering from Alzheimer’s. There are numerous
challenges that are faced by the individuals that help people with these illnesses.
The Role of Reform and changing the narrative about mental illness Social Determinants
play a role in the understanding of illnesses such as dementia and the manner in which a patient
can be helped. Dementia and terminal illness is an excellent topic and case study for the manner
in which treatments and advancement in bio-medicine; and the role that the government has in
reviewing the laws about the usage of medicine and the impact on the medical support staff and
health-care practitioners. These is the direction in which the healthcare reform should have
specialized focus on individuals who need long term care because it is a sort of a silent epidemic.
The focus of this particular discourse was to take a look at the needed reforms from the
perspective of the patient and also the healthcare practitioners. The reason for this is that this
allows for a broad understanding on the way in which healthcare and the needed reforms are
conceptualized.
Mental illness rates for adults in ages of 70 and 89 extend to dementia but increases with
age as reflected by Alzheimer Society of Canada, 2010. It has been observed that older adults are
likely to live to chronic illness with comorbidities with mental illness. Canada Health Act (CHA)
aims at promoting, protecting and restoring mental as well as well-being for residents of Canada
(Gill, 2009). This facility is devised such that its residents can have access to health services with
or without barriers arising from financial or any other sources. CHA influences a number of

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health programs with definitive criteria’s being public administration, universality,
comprehensiveness, accessibility and portability of such services. Catering to mental health and
long term conditions includes involvement of allied health professionals within community
settings. Such services often needs to extend beyond Canada Health Act for providing viable
coverage in provinces. In cases of long-term conditions or dementia there is need for long-term
residential care or home care, ambulatory services but such services are exempt from the
program of the Canada Health Act (Cohen, 2007). Initial reforms in regards to such Act needs to
be made such as to include all residential care, home care, ambulatory services. The Act needs
to include all medical treatments that are deemed to be medically necessary such as to improvise
and impact health of general population who are experiencing either of conditions or
comorbidities.
Canada health services is primarily functioned by Federal funding. But such funding is
deemed to be reduced by $36 billion and to include 50-50 cost sharing to 18-82 percent cost
sharing. Such reduced contribution from Federal government can act as a deterrent to provide
support and health care treatments to citizens facing conditions related to Dementia, long term
disabilities. The Federal government with downloading responsibility to provinces there are
rising fears that lists of medically insured services will be affected (Sibley, 2011). There needs to
be brought amendments into being such that medically insured people are able to avail services
related to conditions as discussed above. As the country is faced with problems from rising
ageing population such consideration will help the government and its individuals plan a better
way.
Though policies of Federal and provincial governments needed to include mental health
policies and long term conditions for seniors, they have focused on children excluding seniors.

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Governments have rationalized that as major mental illness and long term conditions are faced in
childhood ( approximately 70% cases) focus needs to be on them rather on seniors (Iwashyna,
2010). The society does not value those who are ageing and are faced with long-term conditions
or dementia. Therefore, a major policy change in this regard will bring about fair and equitable
distribution of funds as well as other resource allocation. Risks of social inequality has risen
considerably due to accumulated disadvantage of such policy. Health reforms relative to
equitable distribution of policy benefits needs to be extended to all. The policy with reduced
focus on mental health and long term conditions has excluded a portion of a population along
with lifespan (Rochon, 2008). This depicts lower interests of the government to bring changes
and reforms in this segment of healthcare. Various seniors in government offices are of the view
that dementia or Alzheimer’s diseases are no mental illness. Therefore, for generating greater
awareness there needs to understanding related to dementia and Alzheimer’s regarding the way
they are viewed. Funding in fields of mental health was provided till the age of 65 and concerned
with grey area of psychogeriatric. Split between views for dementia and long term conditions
involved management as it included neurology, geriatrics. Further various mental health
community has regarded dementia as an unimportant issue, there are also division in regards to
mental health teams and senior teams (Witlox, 2010). For raising greater awareness and bringing
about changes management teams and mental health teams needs to work in a coordinated and
integrated manner. There needs to be integrated policy documents and service systems catering
to dementia and long term conditions.
Long-term care analysis in Canada is misleading as the country has differential set
of developmental history in each area territory or province. Long-term care reforms at a national
level might pose to be a significant challenges as data gathering units themselves had been able

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to successfully collect data for limited number of provinces. Though Canada Institute for Health
Information (CIHI) has aimed at standardization of information and health care facility pan-
Canada. Health care reforms needs to aim at installation and upkeep of facilities catering to
patients of dementia or long-term conditions on a national basis. Poor distribution of facilities
and infrastructure amongst hindered functioning of such facilities for catering to increasing
number of patients in the ageing population. Inequitable distribution of such facilities have led to
comparing 5% residents under age of 65 can be compared to a grain of salt.
Quebec has been omitted from various calculations and measurements that can depict its
facilities being set up to cater to patients (Wahlbeck, 2011). The leading challenge that has
deterred government or health care bodies in implementing reforms or setting up facilities or
gathering data is lack of common language. There are a variety of language spoken across the
country, which makes it difficult to apply similar norms or regulations or make any
demonstrations. Heath care reforms needs to ascertain either English or French is spoken at
facility centers. This will ensure steady communication amongst various professionals and also
across departments.
Health care systems across Canada needs to bring about changes in appropriation of costs
paid for patients for long-term conditions or dementia. Costs that needs to paid by patient parties
and government largely varies across various provinces and areas. In areas where there is
provincial importance given to dementia or long term conditions patients health recorded are
better and they get treatment. But in other provinces such cases are ignored grossly leading to
differential access to health care facilities.

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Bibliography
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