and supplies are covered, and within categories only approved models of equipment from approved vendors are covered, and vendors may not charge more than specified prices established by the government. Nursing homes and home care Home care is an "extended" service, and is therefore not an insured service under the Canada Health Act. Home care is not considered to be a medically necessary service, like hospital and physician services, and provincial and territorial governments are under no obligation to provide home care services. In their 2009 report on home care in Canada, the Canadian Healthcare Association (CHA ) said that there was an increase in chronic disease rates as Canada's population aged. Home care is generally considered to be a lower cost alternative at a time when governments are concerned about the cost of healthcare and is generally the preferred option for seniors. One in four caregivers provide care related to aging. A 2016 study published in the Journal of Canadian Studies said that with an increasing elder population, in Canada, the supply of home care aids (HCA)s was not meeting the demand required to provide adequate nursing home care and home care in an increasingly complex care system. Home care aids face intense job precarity, inadequate staffing levels as well as increasingly complex needs including different types of routinized, assembly-lines types of work, and cost-cutting on equipment and supplies. They also work in situations where there are more occupational hazards, which can include aggressive pets, environmental tobacco smoke, oxygen equipment, unsafe neighborhoods, and pests. As the role of home care aids evolves, so does the need for more training and instruction. Nurses and HCAs are expected to think critically and execute real-time, and make evidence-based care decisions. Indigenous peoples The largest group the federal government is directly responsible for is First Nations. Native peoples are a federal responsibility and the federal government guarantees complete coverage of their health needs. For the last twenty years and despite health care being a guaranteed right for First Nations due to the many treaties the government of Canada signed for access to First Nations lands and resources, the amount of coverage provided by the Federal government's Non-Insured Health Benefits program has diminished drastically for optometry, dentistry, and medicines. Status First Nations individuals qualify for a set number of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye