Dr. Shaarika Sarasija is a postdoctoral fellow with the Faculty of Medicine at the University of Ottawa. A neuroscientist with over 17 years of research experience, Dr. Sarasija’s work has been published in various high-impact journals and presented at regional and international conferences. She has been the recipient of numerous awards during her career, including a CIHR
postdoctoral fellowship award in 2021. Her research has focused on the mechanism behind the development of Alzheimer’s disease with a focus on the impact of calcium signaling, metabolism, and oxidative stress on neurodegeneration. Currently, she is spearheading a project that strives to understand the mechanism responsible for the prevalence of Alzheimer’s disease in women. Dr. Sarasija believes that her scientific training and acumen can be used most effectively in public service and plans to work
in science and health policy development.

As a researcher studying the pathogenesis of Alzheimer’s disease, dementia is a topic that is rarely out of my mind. However, the human toll of the disease came more into focus when I began volunteering with the Dementia Society of Ottawa and Renfrew County (DSORC). I am part of their “Make a Connection, Take a Break” program aimed at providing meaningful social interactions for persons living with dementia (PLWDs)and respite for their caregivers. Unfortunately, this program is usually limited to about one hour of engagement per week. Given increased life expectancy, a concurrent increase in PLWDs is inevitable. Therefore, it is critical to form a system to prevent caregiver burnout. Most students enrolling in programs in health sciences already volunteer to receive patient care experience. Therefore, I believe an internship program where students provide respite care can offset the physical, mental, and economical burden on primary caregivers of PLWDs.

In 2019, the Public Health Agency of Canada (PHAC) published Canada’s first national dementia strategy in which it called attention to that about 432,000 Canadians are currently living with dementia and that this number is poised to grow dramatically with a growing and aging population [1]. Dementia can be defined as a chronic and progressive condition that affects brain function resulting in symptoms affecting mood, personality, language skills, and/or cognitive decline. While dementia associated with Alzheimer’s disease is the most common form, it can also be brought on by other neurodegenerative diseases like Lewy body, frontotemporal, or vascular dementias, or due to traumatic brain injuries. Progressive decline in persons living with dementia (PLWD) could adversely affect even their ability to perform basic daily tasks required for normal living like bathing or getting dressed. Recent studies have shown that the global cases of dementia may triple by 2050 [2]. Therefore, it is imperative that action be taken to reduce the dramatic toll dementia is set to unleash on Canadian society.

In “A Dementia Strategy for Canada: Together We Aspire”, the PHAC identified three major national objectives: First, set into place measures to prevent dementia; second, advance therapeutic strategies and find a cure; and third, improve the quality of life of PLWDs and their caregivers. As part of the third objective, the dementia strategy pledges to focus on “Improving support for family/friend caregivers, including through access to resources and supports” [1]. PLWDs rarely live alone, and their caregivers tend to be primarily family members, with children accounting for 58% and spouses 32% of caregivers, with friends or neighbors making up the rest. They ensure that the daily essential needs of PLWDs are met and commonly are a PLWD’s sole source of social interaction or emotional support. There is a higher likelihood for caregivers for people living with dementia to experience distress (45%) compared to caregivers of other seniors (25%). They are also 60% more likely to report distress if the person receiving their care displays verbal or physical aggression. This is not surprising given that caregivers for PLWD work on average 26 hours per week, which is significantly higher than the 17 hours per week provided by caregivers
for seniors without dementia. This can adversely affect not just their emotional well-being but employment status and financial well-being [3]-[4]. Caregivers also face out-of-pocket expenses for home modifications, transportation, rehabilitation services, and medications for PLWDs which the CIHI estimated to be $1.4billions in 2016, with it rising to $2.4 billions by 2031. Federal tax measures are available to alleviate the toll caregiving expenses may have, as are tax credits and financial support at the provincial level. Newfoundland and Labrador have policies that allow the PLWD to pay their caregiver. The Nova Scotia Caregiver Benefit provides financial support to caregivers of high-need, low-income adults, while the Manitoba Primary Caregiver Tax Credit provides a refundable credit. However, some of these currently benefit only caregivers with taxable income and could be difficult to access [5]. There are also local
support groups, adult day programs, and regional dementia societies like chapters of The Alzheimer’s Society of Canada and the Alzheimer’s Association, aimed at assisting caregivers. Veterans Affairs Canada also provides day programs for PWLDs [1]; however, these are meant to complement or supplement programs available in the community or provided by the provincial or territorial health plan. While useful, the need to provide further respite to caregivers remains critical and unmet. The establishment of an internship program asking those planning to pursue educational degrees to enter Canada’s regulated health professions to step up could address this need.

While many non-profit organizations do exceptional work in finding volunteers to provide respite care to PLWDs, it is unfortunately not enough to fully address the challenges associated with providing consistent care to them. There is an urgent need for this crisis to be addressed as the numbers of PLWDs are set to multiply over the coming decades [1]-[2] and caregivers of PLWDs tend to report heightened levels of emotional and financial stress when compared to caregivers of other seniors [3]-[4]. Here, I propose the introduction of a voluntary, financially incentivized internship program, urging students planning to enter a regulated health profession in Canada, to step to provide respite care to PLWDs. Health professions across Canada are governed at the provincial or territorial level through public legislations. While there is variability across the provinces in the number of health professions that are regulated, each province has enacted independent versions of an act regulating health professions in their jurisdiction (Tables 1-10; [1]-[21]). Based on these acts, self-governing, autonomous institutions (normally referred to as colleges – not to be confused with post-secondary educational institutions) have been established for individual health professions. These colleges are responsible for setting out the eligibility criteria for licensure approval (required for practicing said profession in each province), registering/licensing of health professionals under their purview, and if necessary, addressing complaints against them. In the Northwest Territories and Nunavut, health professionals register with the Office of the Registrar responsible for Professional Licensing within the Department of Health and Social Services for their license (Table:11-12, [22]-[23]). In Yukon, profession-specific, registrars appointed by the Minister carry out this function (Table:13, [24]). Students in these regulated health professions receive years of anatomy, physiology, and patient care training, and more importantly, are encouraged to develop the empathy required to provide respite care to PLWDs. It is also worth noting that most students interested in health professions already volunteer at medical clinics, hospitals, long-term care homes, and hospices for patient-care experience prior to enrolling in educational degrees required for their health profession of choice. Therefore, regulatory bodies for the various health professions, with financial and logistical support from their corresponding provincial governments could institute an internship program where students would provide respite care for PLWDs. The numbers of hours of respite care experience provided by students could be adjusted depending on the need for respite care in a particular province; this need in the community could be ascertained by collaborating with local dementia societies, support groups, and practicing medical professionals. These societies, groups and professionals could also provide insight into the level of care required by each PLWD, ranging from just requiring some additional social interaction versus needing more intensive life-sustaining support. The timeframe to acquire this experience can be set to start a year before the student’s enrollment in the educational program required for their health profession. This will allow the students of health professions multiple years to accrue the required hours of experience and for their assignment to be staggered to persons living with more advanced dementia as their healthcare training progresses. Given that this internship program has the potential to cause financial, time, and emotional stress on the health professionals-intraining, it could be incentivized with discounted licensing fees, tax-breaks on future income (for a predetermined number of years), and free psychological counselling as needed. With this program, permanent caregivers would receive support and respite, while students planning to enter various regulated health professions will receive additional first-hand experience in patient care. Please refer to the attached PowerPoint for the tables identified in the proposal.