How elders from Nunavut end up in long-term care thousands of kilometres from home

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Peepeelee Arlooktoo does the best she can to care for her husband, Joe, at home, but it isn’t easy.

The elderly couple live together with two children and a grandchild in Kimmirut, an Arctic community of just more than 400 people a half-hour flight from Iqaluit, the capital of Nunavut.

Mr. Arlooktoo, 82, has diabetes and dementia. He has difficulty speaking. When he needs to bathe, his wife, who is 76 and in good health for her age, struggles to help him in and out of the tub. He can still feed himself, but she has to cut his food first.

Their home is a small, tidy space with purple curtains and an embroidered flower-covered cross hanging on the wall over an easy chair. Mr. Arlooktoo often uses a wheelchair to get around. At night, his wife lies awake, worried he’ll wander into the living room on his unsteady feet and fall.

“If he went down there,” Ms. Arlooktoo says in Inuktitut, “he would lose his dignity.”

Kimmirut, with its hilly terrain overlooking an inlet on the Arctic Ocean, is where Mr. Arlooktoo wants to grow old. He and his family know the people inside the single-storey homes scattered around the hamlet’s main unpaved road. They know the quiet rhythm of the place, which has a NorthMart, a Co-op store with a hotel, a small visitor’s centre and a century-old clapboard Anglican Church.

Most important, they know the land outside of Kimmirut, where Mr. Arlooktoo was born in an Inuit camp – a circumstance that is about as far-removed psychologically as it is physically from modern-day Ottawa.

The Arlooktoos are one of many Nunavut families torn between keeping their chronically ill elders at home with scant help, or moving them south, often for what remains of their lives.

The Government of Nunavut has for years transferred seniors who need round-the-clock care to a retirement home in Ottawa, a former hotel called Embassy West Senior Living that specializes in treating dementia patients. The transfers take place because Nunavut does not have enough long-term care beds overall, and because there is no secure ward for high-needs dementia patients anywhere in the territory.

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The people of Kimmirut and other Nunavut communities say that practice must end. Many Inuit are asking the territorial government to open at least a few elder-care beds in each of Nunavut’s 25 communities, all of which are accessible only by plane or boat.

Elders such as Joe Arlooktoo, once an accomplished carver and a member of the Northwest Territories legislature before Nunavut’s founding, should not have to leave the North to receive long-term care, they say. “It’s important for the kids and grandchildren and great grandchildren to know that he is their grandpa,” Ms. Arlooktoo says. “I want them to know where they come from.”

But long-term care beds don’t come cheap, particularly in the Arctic, where everything from supplies to food to staff wages tends to be more expensive than in the south.

The annual operating cost of a bed at one of Nunavut’s few existing long-term care homes can run as high as $325,000. Dispatching an elder to Embassy West – at an average cost to the territorial government of just under $200,000 a year – saves money.

Nearly 40 Nunavut elders live at Embassy West now, sequestered for the last few weeks in their rooms as the facility fought a COVID-19 outbreak.

Many of Embassy West’s residents are unilingual speakers of Inuit languages who are also part of a generation sent south for tuberculosis treatment in the mid-20th century, a painful chapter in Canadian history for which Prime Minister Justin Trudeau apologized in 2019.

“Sixty-five years later, they’re being sent out again,” says Manitok Thompson, a former Nunavut politician scarred by her own memories of being flown without her parents to a sanatorium in Manitoba. She remembers being spanked for crying, for speaking Inuktitut. She was seven.

Now Ms. Thompson lives in Ottawa, where she had been paying visits to the Inuit residents of Embassy West before the recent coronavirus outbreak began in late December. “The federal government [and] the Nunavut government have not been sensitive to them,” she says of the elders, “because they don’t speak English and they’re not aggressive enough to say, ‘I need help.’”

The plight of Nunavut’s seniors is emblematic of the struggles that all Nunavummiut face when they need the kind of rudimentary medical care that most Canadians take for granted.

Eighty-six per cent of Nunavummiut don’t have a regular health-care provider. Year-round doctors are scarce outside of Iqaluit. The territory, which struggles with high rates of suicide and addiction, doesn’t have a single permanent psychiatrist.

Nunavut has the fewest hospital beds per capita of any province or territory – one for every 1,100 residents, compared to a national average of one per 409. All of those beds are located in Iqaluit at Qikiqtani General, a 35-bed hospital with two operating rooms and no intensive-care unit.

Outside the capital, in 24 fly-in hamlets scattered across a frozen landscape spanning three time zones, nurses provide the basics at local health centres. But for most emergencies and higher-level care, Nunavut’s 39,000 residents, about 85 per cent of whom are Inuit, board a flight to Ottawa, Winnipeg, Yellowknife or Edmonton. Depending on the severity of their illness, they move into government-sponsored medical boarding homes or hotels in the south for weeks or months at a time.

If they are expectant mothers living anywhere other than Iqaluit, they move away for a month to give birth. If they are elders with advanced dementia, they move away forever.

Children play on a fence at the Kimmirut airport; Luggage and cargo on a small Twin Otter airplane travelling from Iqaluit to Kimmirut; The landscape between Iqaluit and Kimmirut, Nunavut.

In October, The Globe and Mail travelled to Kimmirut, Iqaluit and Pangnirtung, another community on Baffin Island, to speak with health-care providers, local and territorial officials, Inuit leaders and everyday Nunavummiut about what is and isn’t working in the health-care system of Canada’s youngest territory.

Despite immense challenges, the government of Nunavut has made progress on delivering more care inside the territory, some of it spurred by COVID-19 restrictions that made travelling for routine medical appointments especially onerous. To cite one encouraging example, breast cancer patients who used to fly south for a monthly infusion of a drug called Herceptin can now receive it within the territory.

But that type of modest progress has not extended to the Inuit elders who serve as a living bridge between the eastern Arctic’s past and present. To Natan Obed, the president of national Inuit organization Inuit Tapiriit Kanatami, the practice of sending Nunavut seniors thousands of kilometres away from their communities for long-term care “continues to be a huge failing.”

As of mid-January, 39 Nunavummiut lived at Embassy West in Ottawa. That’s significantly more than the seven Nunavut elders who were being cared for outside the territory in 2015, when the Government of Nunavut published a report warning that as the territory’s population grew and aged, more chronically ill seniors would have to move south if additional beds were not opened.

In 2014, there were believed to be fewer than 150 Nunavummiut over the age of 80. But the 2015 report predicted that number would quadruple over the following 20 years.

In the years since, not only has the Government of Nunavut opened no new beds, it has allowed two eight-bed assisted-living facilities in Baker Lake and Iqaluit to close. The facility in Baker Lake, a community of about 2,000 in the central Kivalliq region, shut its doors for good in 2018 primarily because of building code and structural issues, according to a past territorial health minister.

The Iqaluit closure is supposed to be temporary, but it has already dragged on for eight months, leaving the capital without a single assisted-living bed for seniors. The Government of Nunavut is promising to reopen the Iqaluit home as soon as the new Inuit-led operator finds qualified staff, a perpetual challenge in the Arctic, made worse by the pandemic.

The net result is that today Nunavut has about one-third fewer operational long-term care spaces for seniors than it did six years ago, when there were 51 beds spread across five communities. Now there are 36 beds divided among four communities: Gjoa Haven, Igloolik and Cambridge Bay, all of which have continuing care centres capable of handling high-needs patients, and Arviat, which has an assisted-living facility for patients who require less help but aren’t capable of living on their own. (The Arviat home battled a COVID-19 outbreak among staff this month.)

Igloolik

Cambridge Bay

Gjoa Haven

Baffin

Island

Kugluktuk

NUNAVUT

Iqaluit

Chesterfield Inlet

NORTHWEST

TERRITORIES

Rankin Inlet

Kimmirut

Arviat

Hudson

Bay

B.C.

ALTA.

SASK.

MAN.

NFLD.

ONT.

QUE.

CANADA

Gulf of

St. Lawrence

Ottawa

UNITED STATES

0

400

KM

Nunavut long-term care facilities

Location, number of beds and level of care

Location

Number of beds

Care level

Gjoa Haven

10

4

Igloolik

10

4

Cambridge Bay

8

4

Arviat

8

2-3

Iqaluit*

8

2-3

*Closed temporarily since May of 2021

Care levels

Level 2: Minimal support required; individual is independently mobile

Level 3: Individual with chronic health issues, dependent on aids

for mobility; requires significant daily support

Level 4: Complete assistance with mobility; limited ability

to communicate; requires moderate professional nursing care

Level 5: Significant medical and nursing support required;

diagnosed with a dementia-related illness

kelly grant and john sopinski/THE GLOBE AND MAIL,

SOURCE: TILEZEN; OPENSTREETMAP CONTRIBUTORS;

government of nunavut

Igloolik

Cambridge Bay

Gjoa Haven

Baffin

Island

Kugluktuk

NUNAVUT

Iqaluit

Chesterfield Inlet

NORTHWEST

TERRITORIES

Rankin Inlet

Kimmirut

Arviat

Hudson

Bay

B.C.

ALTA.

SASK.

MAN.

NFLD.

ONT.

QUE.

CANADA

Gulf of

St. Lawrence

Ottawa

UNITED STATES

0

400

KM

Nunavut long-term care facilities

Location, number of beds and level of care

Location

Number of beds

Care level

Gjoa Haven

10

4

Igloolik

10

4

Cambridge Bay

8

4

Arviat

8

2-3

Iqaluit*

8

2-3

*Closed temporarily since May of 2021

Care levels

Level 2: Minimal support required; individual is independently mobile

Level 3: Individual with chronic health issues; dependent on aids

for mobility; requires significant daily support

Level 4: Complete assistance with mobility; limited ability

to communicate; requires moderate professional nursing care

Level 5: Significant medical and nursing support required;

diagnosed with a dementia-related illness

kelly grant and john sopinski/THE GLOBE AND MAIL,

SOURCE: TILEZEN; OPENSTREETMAP CONTRIBUTORS;

government of nunavut

Igloolik

Cambridge Bay

Gjoa Haven

Baffin

Island

Kugluktuk

NUNAVUT

Iqaluit

Chesterfield Inlet

NORTHWEST

TERRITORIES

Rankin Inlet

Kimmirut

Arviat

Hudson

Bay

B.C.

ALTA.

SASK.

MAN.

NFLD.

ONT.

QUE.

CANADA

Gulf of

St. Lawrence

UNITED STATES

Ottawa

0

400

KM

Nunavut long-term care facilities

Location, number of beds and level of care

Care levels

Care level

Location

Number of beds

Level 2: Minimal support required; individual

is independently mobile

Gjoa Haven

10

4

Level 3: Individual with chronic health issues;

dependent on aids for mobility; requires

significant daily support

Igloolik

10

4

Cambridge Bay

8

4

Level 4: Complete assistance with mobility;

limited ability to communicate; requires

moderate professional nursing care

Arviat

8

2-3

Level 5: Significant medical and nursing

support required; diagnosed with a

dementia-related illness

Iqaluit*

8

2-3

*Closed temporarily since May of 2021

kelly grant and john sopinski/THE GLOBE AND MAIL, SOURCE: TILEZEN; OPENSTREETMAP

CONTRIBUTORS; government of nunavut

Political paralysis is partly to blame for the failure to build more beds faster. There are longstanding disagreements among the territory’s MLAs about where to build new long-term care homes, and how many to build.

Nunavut’s last government promised to open new, long-term care facilities in Cambridge Bay, Rankin Inlet and Iqaluit, the largest communities in each of Nunavut’s three regions. The first, a 24-bed facility in Rankin Inlet, is supposed to open in 2023.

However, that regional approach has met resistance. Nearly 22,000 people have signed an online petition, started by Ms. Thompson and an elders society in Iqaluit, calling for the construction of elders homes not just in regional hubs, but in every Nunavut community. The Nunavut Association of Municipalities and Lori Idlout of the NDP, the territory’s new federal member of Parliament, both back the movement as well.

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Elder care was one of the most discussed issues in the territory’s fall election campaign, with new and returning candidates alike vowing to open more beds within Nunavut’s borders, even in the face of a massive infrastructure deficit highlighted by Iqaluit’s fuel-in-the water crisis. For two months in the fall, residents couldn’t drink their tap water, even if boiled. A new boil-water advisory was issued for Iqaluit this week.

When the territory’s 22 freshly elected MLAs met for their first sitting on Nov. 19, each presented a copy of the petition calling for complex care beds in every community in Nunavut.

Younger Nunavummiut signed the petition with an understanding of what is lost when their grandparents and great grandparents move away, says Aluki Kotierk, the president of Nunavut Tunngavik Inc., the organization that ensures the territorial and federal governments keep the promises made to Inuit in Nunavut’s founding agreement.

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While moving south is often devastating for elders, it’s equally hard on those left behind, most of whom can’t afford the thousands of dollars it can cost to fly to Ottawa. The Government of Nunavut pays for two trips a year for one relative at a time to visit elders at Embassy West, but that’s hardly sufficient for most Inuit families, which tend to be sprawling and multigenerational.

“Because so many Inuit live under the poverty line,” Ms. Kotierk says, “many of them will not see their elders again alive.”

The separation is enough to make elders such as 93-year-old Lizzie Ittinuar, who lives at Embassy West, declare they would rather move home, without adequate care, than endure the loneliness of old age in Ottawa.

Ms. Ittinuar, who as a young woman was sent from her home in Chesterfield Inlet to tuberculosis sanitoria in southern Manitoba, has told her eldest son, Peter Ittinuar, more than once that she is ready to leave Embassy West. She is among the Inuit elders at the home who tested positive for COVID-19 in January.

“She said, ‘Son, I’d like to be home and be able to see my grandchildren,’” Mr. Ittinuar says, “‘even if my life is going to be shorter.’”

Boats are reflected in the water of Hudson Strait in Kimmirut.

Kimmirut is located on the southern tip of Baffin Island, the land mass in the eastern Arctic that resembles an upside-down dog. Kimmirut, formerly known as Lake Harbour, is where the dog’s eye would be.

Most of the elders who live there today were born on the land. They grew up in outpost camps where tight-knit family groups moved with the seasons, harvesting ring seals and beluga whales, fishing for arctic char, trapping fox and hunting caribou where and when each species was most plentiful.

Some still travel by quad or snowmobile out to the cabins they keep on the rocky, windswept land outside the hamlet.

The Anglican Church set up a mission in Kimmirut in the 1800s and the Hudson’s Bay Company followed with a trading post in 1911. The hill that looms over the community bears a sign, spelled out in stones: HBC 1911 Lake Harbour.

The shift away from life on the land came in the 1950s and 60s as federal government policy, abetted by infectious disease and a rabies outbreak that decimated the sled dog population, disrupted the South Baffin Inuit’s semi-nomadic way of life, according to the Qikiqtani Truth Commission’s report on the history of Kimmirut.

The QTC’s research, which predated that of the national Truth and Reconciliation Commission, concluded that the Government of Canada enacted harmful colonial practices in the Baffin region between 1950 and 1975, including forcing Inuit families to relocate and killing their sled dogs. The federal government issued a sweeping apology in 2019.

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For the people of the Kimmirut area, the most consequential practice of the era was sending Inuit to southern tuberculosis sanitoria in the 1940s, 50s and 60s. The policy thinned the ranks of families living in the camps outside Kimmirut until those who remained had little choice but to acquiesce to the Crown and move to the year-round settlement.

Jeannie Padluq, who lives with her husband, Eliyah, down an undulating dirt road from the Arlooktoos, remembers wandering with her younger siblings from family to family in Kimmirut, seeking help. Her parents, stricken with TB, were taken south more than once in the 1950s on the C.D. Howe, an Arctic patrol and medical ship.

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Ms. Padluq is grateful her parents returned, unlike some others. Their names were George and Nellie – or E741 and E715, Ms. Padluq says through a translator. Those were the numbers federal officials inscribed on their leather tags. Ms. Padluq was E7301.

Jeannie Padluq and Eliyah Padluq have company over for sweets and coffee at their home in Kimmirut; Sewing and preparing a sealskin fur.

That history is one reason Ms. Padluq, who, at 72, is still active enough to zoom up and down Kimmirut’s hills on her four-wheeler, shudders at the prospect of moving south for long-term care in the future. Another is the thought of being separated from her children and grandchildren. After visiting a friend at Embassy West six years ago, she couldn’t sleep, haunted by the thought of leaving her family behind.

In Kimmirut, Ms. Padluq’s family and culture are always close by. At lunchtime, relatives pile into her kitchen, which smells faintly of the seal skins drying in the next room. One granddaughter and her two boys burst in without knocking – nobody knocks in Kimmirut – as Ms. Padluq is about to pull sugar-coated rolls from the oven. She serves them with tea and coffee, arranged on a cherry-patterned plastic tablecloth.

At noon every day, children and teens pour out of Qaqqalik, the community’s K-12 school. The hamlet office, the Kimik Co-op, the visitors’ centre – everything shuts down for an hour in the middle of the day so families can eat together at home.

On an unseasonably warm day in October, with the temperature hovering around zero degrees and no snow in sight, some of those families were enjoying the blubber of a beluga whale caught the day before by one of Kimmirut’s best young hunters.

When a grey bucket of freshly harvested beluga is deposited at the home of Sandy Akavak, 80, he grabs a cutting board, slices off a thick slab of blubber, chops it into cubes and begins popping them into his mouth.

Ready access to country food, as Inuit call the game, fish and marine mammals they catch locally, is one of the benefits of growing old in Kimmirut.

An elder slices beluga whale meat at home in Kimmirut.

“Us Inuit, we’re used to the cold,” Mr. Akavak says through a translator. When he was growing up, his dad drove a dog-sled team for the RCMP. For Inuit who have to move to Embassy West, “they miss home. They want to be home.”

Mr. Akavak considers himself in good health for an octogenarian, even though he uses a walker to get around. He takes medication for high blood pressure and a heart condition. If, in time, he needs round-the-clock care, Mr. Akavak says, shrugging, he is resigned to moving south.

He’d rather stay in Kimmirut, but he is practical about what’s possible in his tiny community, with its rotating cast of health care workers from the south and an infrastructure deficit so profound that a dozen or more people sometimes share a two-bedroom housing unit.

Mr. Akavak’s granddaughter, Rosie Akavak, understands the infrastructure shortage in Kimmirut better than anyone. She is the community’s housing manager.

Scanning a computer screen in her office, she ticks off the numbers: there are dozens of families on waiting lists for homes in a community with limited housing stock. Still, Ms. Akavak holds out hope that one of Kimmirut’s few vacant buildings can some day be converted into a small home for elders like her grandfather. She collected signatures for Ms. Thompson’s petition.

In the meantime, all that is available in Kimmirut to elders such as Mr. Arlooktoo, who turned down a spot at Embassy West, is a modest amount of home care. A nurse runs Mr. Arlooktoo through exercises a few times a week, help for which his wife is grateful.

Seal skins are stretched on frames outside of a home in Kimmirut; Sandy Akavak stands next to a polar bear hide drying on his staircase; Caribou antlers strapped to the exterior of a home.

Last September, the community’s supervisor of health programs, a long-time northern nurse many in Kimmirut praise, arranged to send Mr. Arlooktoo to a health centre in Rankin Inlet for a few weeks to give his wife a break.

He returned cleaner and plumper, thanks to the professional care. “He was sleeping well and you could tell that he had a really good time,” Ms. Arlooktoo says. Unfortunately, the respite was temporary. The health centre in Rankin Inlet, which is located on the western shore of Hudson Bay about 1,200 kilometres west of Kimmirut, has a few beds with 24-hour nursing for uncomplicated patients, but they aren’t meant to be a substitute for permanent long-term care.

Ms. Arlooktoo acknowledges that it could be difficult to build and properly staff a long-term care home in a place as tiny as Kimmirut. The territory’s shortage of trained health-care professionals is one reason Nunavut’s last government rejected demands for an elders facility in every hamlet.

At the very least, Ms. Arlooktoo says, there should be a home capable of caring for patients with dementia in Iqaluit, a half-hour away by Twin Otter plane. Kimmirut is closer to Nunavut’s capital than any other community.

Mr. Arlooktoo has family there, including his daughter, Saimataq Arlooktoo Karpik. She feels her father should be able to get the help he needs without having to move away from Nunavut, but his health “is not getting any better. It’s getting worse,” she says.

A neighbourhood in Iqaluit, which is a half-hour away from Kimmirut by Twin Otter plane.

On an overcast Saturday, Ms. Arlooktoo Karpik, 60, was among a group of female elders bobbing in a motorboat on Frobisher Bay, with her husband, Imoona Karpik, at the helm. As they waited for the tide to go out, she and her companions shared bannock and white-bread-wrapped hot dogs, which the expedition’s leader had barbecued on a nearby boat.

When the last of the water drained away, the women stepped out onto the bay’s mucky bottom and began digging for clams.

Iqaluit residents, including a group of elders and youth, harvest clams at Aupalajaaq.

“It’s very soothing for my health,” Quaraq Pitseolak, 63, said at the end of the day, her bucket full of clams the size of fists. “Being outdoors is medicine for me.”

The clam-digging outing was organized by Pairijiit Tigummiaqtikkut, a not-for-profit Inuit elders society that also operated the Iqaluit Elders Home until the government closed it in May. The eight-bed home was designed for seniors who are no longer capable of living alone, but who are in good enough shape to get by with a few hours of help a day.

Pairijiit Tigummiaqtikkut had been running the facility since the 1980s. But last year, the relationship between the society and the territorial government disintegrated after a clash over staffing and financial reporting requirements. The society and its long-serving lawyer, Anne Crawford, say they felt “belittled” by government officials who asked them, off-the-record, to fire their Inuit bookkeeping firm and an Inuk manager at the home.

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Nunavut’s then-health minister, Lorne Kusugak, told The Globe in a written statement that the Department of Health never ordered the society to change its ways. In his view, the society failed to file required documents, “even with countless attempts from my department to assist them,” he wrote.

Either way, the society decided in April not to renew its agreement to run the home, but promised to stay on until the government found a new operator.

Then, in early May, the pandemic intervened. Two workers at the home tested positive 10 days apart, forcing two shifts of workers into isolation. The home’s six residents were vaccinated and none caught the virus, but the overlapping isolation stints meant that for four days, the home wouldn’t have enough staff to care for the residents.

The society tried to find ways to keep the residents in Iqaluit, including putting them up in hotels for a few days and asking a nurse in isolation to monitor the distribution of medications virtually, according to a May 19 memo the society sent to some of Nunavut’s Inuit organizations.

But the government’s long-term care officials “seemed to only have one goal,” the memo reads, “which was to transfer the residents south.” Four of the residents consented to moving temporarily to Embassy West, while two refused and found places to stay elsewhere in Nunavut.

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With the facility empty, the government decided to turn a planned minor renovation into a major one, and the home has now been shuttered for more than eight months. (The Nunavut health department declined to answer questions about the falling out with Pairijiit Tigummiaqtikkut or its decision to temporarily shut the Iqaluit home in May. The health department would say only that it thanked the society for its work.)

The closure is having a spillover effect on Nunavut’s only hospital, says Francois de Wet, chief of staff for Qikiqtani General Hospital.

“It’s a huge ethical issue, but it’s also an operational issue for us,” he says. Frail seniors who in the past could have been cared for at the Iqaluit Elders Home now land in the hospital, contributing to overcrowding. “We end up having to transfer more acute patients to Ottawa – patients potentially that we could keep here – because of that lack of beds.”

Pat Angnakak, a former Iqaluit MLA, is among those who believed Nunavut’s capital should have opened a large long-term care home years ago. After hearing from a constituent who couldn’t get local help for a mother with dementia, she co-founded a not-for-profit, the Sailivik Society, whose purpose was to build and operate a home with more than 100 beds.

Sailivik attracted the support of Inuit organizations, MLAs and the City of Iqaluit, which set aside a parcel of land for the project. In 2017, Sailivik submitted a detailed business plan to the Government of Nunavut. “And that was it. Never a response,” Ms. Angnakak says.

Nunavut’s Health Department maintains Sailivik’s proposal was unsolicited and that officials did, in fact, meet with Ms. Angnakak. But she says that even after she became the territory’s health minister, she never got a straight answer from public servants about why the plan was rejected.

Ms. Angnakak, who ran unsuccessfully for the federal Liberals in last summer’s election, is a non-Inuk who grew up in the territory and speaks fluent Inuktitut. She is the daughter of Mike Gardener, an Anglican minister who settled with his wife Margaret in Kimmirut in the 1950s. The pair fell in love with the eastern Arctic and went on to build a life there.

When Ms. Gardener developed dementia, the couple reluctantly sold their Iqaluit home and moved to Embassy West together. “There was just no other way,” Ms. Angnakak said. “It really broke us as a family.”

On Oct. 12, Ms. Gardener died at Embassy West.

Kimmirut is home to roughly 400 residents. Seal and whale harvesting are common, and the residents live a more traditional Inuit life than in Iqaluit.

“There were a lot of tears,” Mr. Adjun’s eldest daughter, Barb, says.

Most cried because they knew they would never again see the father and grandfather who had delighted their community with his fiddling and graced stages across the country playing songs from his three albums. The flight to Ottawa would be too expensive for all but those fortunate enough to snag one of the two annual trips per resident to Embassy West.

Colin Adjun was famous across the Arctic as the Fiddler of the North.Courtesy of Barb Adjun

Mr. Adjun’s home community of Kugluktuk, formerly known as Coppermine, is as far from Canada’s capital as it is possible to be without leaving Nunavut. The hamlet sits 1,500 kilometres north of Edmonton, above the Arctic Circle. The sheer distance would make family visits to Mr. Adjun rare, contributing to his loneliness at Embassy West, Ms. Adjun says.

Monica Ell-Kanayuk, who lives in Iqaluit, is able to visit her mother at Embassy West more often.

But Ms. Ell-Kanayuk’s mother, who is in her mid-80s, aches from a similar homesickness. She agreed to leave her home in Iqaluit primarily because of mobility issues. She could no longer climb the many steps to her house, which sits on elevated piles, like most structures built on the permafrost.

Ms. Ell-Kanayuk’s mother chafed against settling in at Embassy West. She refused to hang pictures or put out personal belongings. “It’s broken her spirit,” Ms. Ell-Kanayuk says.

However, Ms. Ell-Kanayuk, a former MLA and minister of health for Nunavut, was quick to add that the problem wasn’t Embassy West itself or the care it provides. “It’s a facility that I’m thankful for – thankful that it’s been taking people from the North. The problem is we don’t have the facilities here.”

Sharon Goldman, Embassy West’s owner, and Selma Basic, the home’s director of operations, say they’ve made every effort to welcome and support their Nunavut residents. They told The Globe in an interview last fall that the home has Inuktitut signage, three Inuktitut-speaking translators on staff and serves a daily lunch of country food provided by Kivalliq Arctic Foods, a company based in Rankin Inlet.

As well, Nunavut’s health department says an Inuit cultural consultant worked with Embassy West to create a gathering space in the home for Inuit residents, where drumming, sewing, storytelling and social teas take place when public-health rules allow it.

Despite those efforts, some residents and their families have told Ms. Thompson, the petition organizer, and other media that, with so many Inuit and relatively few Inuktitut speakers on site, language barriers persist.

One incident last year illustrated just how powerless residents can feel.

In August, Lizzie Ittinuar spoke to the CBC North program Igalaaq, granting an on-camera interview in her room without the knowledge of Embassy West’s managers.

In this family photo of Lizzie Ittinuar from the mid 1990s, she stands outside her sewing cabin in Rankin Inlet, wearing a parka she made. Now 93, she keeps busy sewing in her room at Embassy West Senior Living in Ottawa, thousands of kilometres away from home.Courtesy of family

The segment was critical of the home, and after it aired, Embassy West staff for a time barred Mr. Ittinuar and his nieces from visiting Ms. Ittinuar in her room. They were redirected to a common room where staff could keep an eye on them, according to Mr. Ittinuar.

He soon learned why: The home’s director had complained to Ontario’s privacy commissioner, the Government of Nunavut’s health department and others that the CBC had violated Ms. Ittinuar’s privacy, saying she couldn’t agree to be interviewed because she is under what’s known as a guardianship order.

When Erin George, Nunavut’s Public Guardian and Trustee, caught wind of the dispute, she contacted Embassy West and the Government of Nunavut to say that wasn’t true. Denying Ms. Ittinuar the opportunity to speak to media – and to visit with her son – would be “a severe infringement of her rights,” Ms. George wrote to one territorial official. “There is a long history of government agencies restricting Indigenous people from contact with their families, and we cannot condone policies that perpetuate this.”

After Ms. George weighed in, Embassy West allowed private visits to resume, Mr. Ittinuar says. But he called it “just unconscionable and vindictive” for Embassy West to temporarily circumscribe visits for a woman who is already thousands of kilometres away from home.

Both Ms. Basic of Embassy West and Nunavut’s health department said they couldn’t comment on an individual resident’s case.

The Government of Nunavut paid just over $6.3-million to Embassy West in 2020-2021, or nearly $16,000 per client per month. That figure is up substantially from about $7,300 in 2016, according to a written answer provided to the legislative assembly in June. The 2015 continuing care report cited a range of $3,900 to $5,900 per month for each out-of-territory long-term care resident. (Asked to explain the increase, the Health Department would say only that, “The monthly cost is all inclusive and is based on the resident’s assessed care needs.”)

In spite of the rising price tag, transferring Inuit elders to Embassy West is still cheaper than caring for them in Nunavut. The annual operating cost of a bed at one of Nunavut’s three continuing care homes ranges from $241,900 a year in Igloolik to $325,625 per year in Cambridge Bay. The equivalent figure at Embassy West is $196,363, according to a separate written response in November of 2020. (Beds at Nunavut’s assisted-living facilities, which provide less care, cost $187,500 a year.)

John Main, Nunavut’s new health minister, says the territory needs more money from the federal government to end the practice of sending elders south. “Developing these services and meeting these needs in Nunavut, I believe, is absolutely a part of reconciliation,” he says.

Federal transfers already make up about 80 per cent of the Government of Nunavut’s revenue. A spokesman for the federal Minister of Health’s office says Ottawa is working toward providing more funding for long-term care in Nunavut through a Safe Long-Term Care Fund announced in the fall of 2020 and a 2021 budget commitment of $3-billion over five years, “to support provinces and territories in ensuring standards for long-term care are applied, and permanent changes can be made.”

In the meantime, Inuit elders like Colin Adjun, the fiddler of the Arctic, spend their final days separated from their extended families, their culture, and their home. Before he died in Ottawa at the age of 77, Mr. Adjun told another of his daughters over and over that he wanted to go home. His body was transported back to Kugluktuk about a week after his death.

“He’s gone now. He’s buried. We’re okay,” Barb Adjun says, “but we will continue to fight for the elders in our Nunavut territory.”

Open this photo in gallery:

With reports from Chen Wang and Rick Cash. Video editing by Deborah Biac.

The Globe and Mail’s health reporter Kelly Grant is taking an in-depth look at health care in Nunavut and the challenges its residents face accessing it. Over the course of 2022, she’ll examine why the territory’s residents have some of the worst health outcomes in the country and what changes are needed to deliver better care.

Ms. Grant is working with photographer Pat Kane. Based in Yellowknife, Mr. Kane takes a documentary approach to his stories that focus on Northern Canada. Mr. Kane identifies as mixed Indigenous/settler and is a proud Algonquin Anishinaabe member of Timiskaming First Nation in Quebec.

If you have information to help inform The Globe’s reporting on Nunavut, please e-mail kgrant@globeandmail.com