Proceedings of the Subcommittee on
Veterans Affairs
Issue 4 - Evidence (Afternoon meeting)
CHARLOTTETOWN, Thursday, March 7, 2002
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 1:30 p.m. to examine and report on the health care provided to veterans of war and of peacekeeping missions; the implementation of the recommendations made in its previous reports on such matters; and the terms of service, post-discharge benefits and health care of members of the regular and reserve forces as well as members of the RCMP and of civilians who have served in close support of uniformed peacekeepers.
Senator Michael Meighen (Chairman) in the Chair.
[English]
The Chairman: We have not officially welcomed Ms LeMaistre who has the distinction of coming from the Gaspé, a distinction that we wish we could all share. Welcome, Ms LeMaistre. I would also welcome Mr. Mogan who we met in Halifax. I will turn the proceedings over to you, Mr. Murray.
Mr. Larry Murray, Deputy Minister, Department of Veterans Affairs Canada : Mr. Chairman, Mr. Bryon Guptill, who is with us this afternoon, could, perhaps, answer this morning's question by Senator Atkin's about the documentation relative to Aboriginal veterans.
The Chairman: That would be helpful.
Mr. Murray: The question concerned the composition of the documentation we have relative to Aboriginal veterans, how they compare with other veterans, and that sort of thing.
Senator Atkins: I was also interested in the health records.
Mr. Bryson Guptill, Executive Director, Aboriginal Veterans Policy, Department of Veterans Affairs Canada: I can address that question. When we were reviewing First Nations veterans files, we had no way of determining from our records, who was a First Nations veteran and who was not. For years, the challenge has been to determine who these veterans were. By working with the veterans' groups, we had an opportunity to determine from them and from their own records who had a First Nations background. From that information, we were then able to find their regimental numbers, their names, where they were from, and we then accessed the records. The records are kept with the records of all other veterans in the National Archives. We determined from the National Archives both their military services records and their health records, which are included with their military service records.
Some time ago, the First Nations veterans met with your committee to discuss their situation. Their military service records are fairly straightforward and they are similar to every other individual's military service record. However, when they came back from the war, the benefits they applied for determined their records.
If First Nations veterans returned to an Indian reservation, Indian agents dealt with them. If they applied for assistance under the veterans housing programs, or the Veterans Land Act programs, then the files we had were fairly sparse because the files for First Nations veterans who returned to reserves were passed on to the Department of Indian Affairs and Northern Development. It then became a matter of how the Indian agent dealt with the veteran on the reserve.
The situation on reserves is quite complex. What happened to the veterans on reserves depended largely on their experience with their Indian agent and that is where the records became more difficult to access.
Senator Wiebe: Were the First Nations veterans files from DND turned over to the Department of Indian Affairs?
Mr. Guptill: No, the DND records remain in the National Archives. All of their military service records and their health records, as they relate to their military service, are in the National Archives. However, if a veteran applied for assistance under the Veterans Land Act, the processing of his claim — that is, the details of his claim as it related to whether he built a house on the reserve, and all the invoices — was handled by the Department of Indian Affairs and by the Indian agent on reserve.
Senator Wiebe: The Department of Indian Affairs and not the Department of Veterans Affairs dealt with that.
Mr. Guptill: That is right.
Senator Wiebe: The benefits that would normally have been paid to a regular veteran would come from Veterans Affairs. Did Aboriginal veterans receive payments from the Department of Indian Affairs?
Mr. Guptill: The payments came from the Department of Veterans Affairs and were transferred to the Department of Indian Affairs for them to administer for the First Nations veterans who settled on reserves.
Senator Wiebe: Is there a record of that?
Mr. Guptill: Yes.
Senator Wiebe: Were they compensated at the same level?
Mr. Guptill: The eligibility for benefits was the same as for all other veterans. The difficulty in examining their cases, and what took us some two years to go through in detail, was determining what happened to them after they applied, and what happened in individual situations. From a records point of view, the story became very difficult because of the difficulty of finding from the 600-odd Indian reservations exactly how veterans were treated on the reserve by the Indian agent who handled all the documentation.
Senator Wiebe: I understood that, if a First Nations veterans wished to purchase land off the reserve, under the VLA, for example, he had no problems. The money was there from Veterans Affairs. The problem arose when trying to acquire property within the reserve. The act did not allow for an individual band member to own property on a reserve. It was for that reason many of the First Nations people opted, instead of taking the land, to use the money to purchase, say, a boat that would add to their income. Certain benefits, yes, First Nations veterans did receive, but a lot of it depended on the band administrator. While the First Nations veteran was serving, the allowance and the wages for the veteran's spouse and family were sent to the band administrator and, if he believed that the wife and mother were incapable of administering that money, it was put into general revenue. There is no doubt that there was abuse, and that the abuse was by the Indian agent.
I think that the joint recommendation is a good one, but I also think that government officials have to sit down and determine what level of compensation should be paid.
Senator Atkins: My impression was that they felt that, as veterans, they were not treated fairly, but that they now consider themselves as being treated on an equal basis. The chiefs seemed to express that point of view.
Senator Wiebe: I think the difficulty lies in how you assess compensation. From my personal perspective, the department has already set the guidelines, in that they made a determination in respect of the Merchant Navy. If the level of compensation to First Nations veterans is the same as that paid to Merchant Navy veterans, in effect, First Nations veterans will have received much more than Merchant Navy veterans because they received nothing until this award was made. The First Nations people are asking for over $400,000 and, to be honest, I do not think that is even being taken seriously. The decision now lies in the hands of the minister and the government. They must decide which direction to take. Is that a fair assessment of the matter?
Mr. Murray: That is exactly where it is. The government is sorting out what actually happens after Veterans Affairs transfers the benefit to the Department of Indian Affairs. The record is not clear in terms of what happens in relation to the documents after that. That is the challenge, and that is where the debate lies.
What did Aboriginal veterans on reservations actually receive? Nobody questions that the Department of Veterans Affairs made an appropriate transfer to the Department of Indian Affairs, but what happened after that is not clear in terms of documentation. That is where the record challenge lies.
Does that assist you?
Senator Wiebe: Yes. I was not aware that there was a transfer of files from the Department of Veterans Affairs to the Department of Indians Affairs and Northern Development. I would appreciate it if you would send any further information you have on that to our Chairman and that can be distributed to committee members.
Mr. Murray: Mr. Chairman, Mr. Darragh Mogan will deal with the post-traumatic stress disorder, and Ms Sue LeMaistre, who is the director of our Canadian Forces Veterans Affairs Canada project, will deal with that.
As light reading, we should like to provide you with a document which we have called Veterans Affairs Canada Corporate Canadian Forces (CF) Initiatives. It is hot off the press and outlines in great detail the initiatives that are currently underway relative to Canadian Forces veterans.
I will not spend much time going through the deck. We just wanted to highlight the changes in numbers in this client group. The line diagram shows what is happening to our total clients and what is happening to the Canadian Forces clientele. I would just like to underline that our predictions on the elderly veterans and on the survivors — not so much in relation to their specific healthcare needs but rather in relation to numbers — are fairly accurate.
In relation to the Canadian Forces veterans, we are not as confident of our projections. It depends obviously on decisions the government may make relative to future operations. It also depends on whether some of our outreach programs in the last while will have a greater impact than they might have had previously. There are some unknowns, and I suspect it will be another year or two before we are can be comfortable that our projections are reasonably accurate in that area.
Slide number seven is the ``Lessons Learned'' slide which will set the context as I whip through the response which I largely outlined in Halifax. These are lessons we learned from Canadian Forces veterans, Canadian Forces members and their families. They are also based on a number of studies. The Standing Committee on National Defence and Veterans Affairs did an extensive study, starting in 1997, that led to a report and ultimately a decision by the government in the form of an approved memorandum to cabinet on the quality of life of our Canadian Forces personnel. That study, those recommendations and the government response have driven much of our activity in this area.
A number of other studies were also done, and some are ongoing to this day, within the Canadian Forces. You may have heard of the McLellan report; the Sharpe commission on soil contamination in Croatia, which was a year or two ago; and the recent report by the ombudsman, André Marin on PTSD. We read those reports and, for the most part, they reflect our conclusions based on a variety of inputs. They seem to track one with the other largely.
Our department did a major study in three phases called ``The Review of Veterans Care Needs.'' The first two phases dealt with the needs of traditional veterans. Phase one specifically dealt with the needs of veterans in the community and that led to a number of enhancements such as the Veterans Independence Program. The second phase dealt with veterans in institutions. The results of that study, coupled with your own Senate report, ``Raising the Bar'', have largely driven many of the things that we will talk about later this afternoon concerning residential care strategies, long-term care and so on.
The third phase of that study was devoted to Canadian Forces veterans. A combination of all those studies led us to form a Canadian Forces VAC Steering Committee which is co-chaired by Brian Ferguson at the ADM level, and currently, Lieutenant General Couture who is the senior military officer responsible for military personnel. It also led to the Canadian Forces Veterans Affairs project, of which Sue is the head, and it also tries to deal with the day-to-day things that we can fix without changing legislation. We also have a continuum of the service project, which I will touch on in a few minutes, headed by Mr. Bob Atkinson. Unfortunately, he was unable to attend because his mother is quite ill in Seattle, Washington and he is out there.
I set that framework because I wanted to emphasize that there is a research basis to this. With more time we could go over that in greater detail. All of those inputs are, to some extent, summarized on the ``Lessons Learned'' page. We refer to a Canadian Forces member suffering from a disability or a Canadian Forces veteran, where the services were uncoordinated and fragmented. There was a lack of overall accountability between ourselves and the Forces, as well as other players, multiple providers. We also deal with the provisions for members who have problems as a result of service or non-service. In other words, in the event of a car accident on the weekend, serving members are covered under this insurance program. There is the involvement of ourselves, Veterans Affairs Canada, and there is certain involvement by other federal departments such as Human Resources Development Canada and, obviously, in a country in which health care is a provincial responsibility, the provinces are also involved.
For the veteran who may be suffering from fairly complex problems of one sort or another, they must find their way through a bureaucratic maze, with no coordinated point of entry. That kind of overview is to some extent what we have been trying tackle. From 1990, this department has had the mandate to respond to those needs so, since the late 1990's, we have set out to do that in a meaningful way, working extremely closely with the Canadian Forces, with veterans organizations and with some of the other stakeholders.
As to our process, some of it was purely a matter of communication, that is, making people aware. That became clear to me when I first came to the department. We have held a number of briefings with both the senior officer rank and the senior NCO rank across the Canadian Forces. Last year, our people at the district office level have also engaged in briefings with somewhere in the order of 20,000 serving members of the Canadian Forces. We have increased staff awareness, because dealing with a 39-year old suffering from PTSD with a number of family concerns, is different from dealing with an 80-year old who knows you very well and for whom you actually have programs that have evolved over the years to meet his needs.
I would touch on the third bullet on page 4. We have done a lot of work across the country. We have now been in every province except P.E.I. and Newfoundland. We have brought together, in one room, all the federal departments, departments like Health Canada, HRDC, the Public Service Commission, all the provincial players and, in some cases, municipal or regional players, and made them aware of the situation as we see it and as the Department of National Defence sees it. These meetings have been co-chaired. I usually kick them off and there is normally a senior military person in attendance. The aim of this whole process, and I think it has been quite successful, has been to try to establish across the country some of the kinds of networks that we already have for gerontological purposes. We know whom to work with when dealing with 80-year olds. Dealing with 39-year olds suffering from PTSD involves a different network of agencies and folks, and this process has gone some distance in helping us to do that.
One of the senators asked about our presence on bases. We now have full-time Veterans Affairs transition coordinators at seven bases. In fact, when we spoke to you in Halifax, I think it was five. We also have pension officers and area counsellors on most bases in the country for one to two days a week. They have an ongoing dialogue with members of the Forces.
The DND VAC Centre for the support of the injured and retired members has been underway in Ottawa since 1999. The assistance service, the help line that I referred to this morning, has been in place since this April. It is working quite well and it has health care professionals who connect people, who call for assistance, to our district office network across the country.
We are doing a lot work in trying to come to grips with mental health services, PTSD and other illnesses. Darragh will deal with that in his presentation.
We talked about the significance of the passage of Bill C-41. Again, we would convey our heartfelt thanks to the Senate for moving as quickly as you did. It has been very important for the reasons we discussed this morning. As I also mentioned, we now have the regulatory approval for health care support.
We did change our protocols for PTSD. Again, Darragh will touch on that.
We have a Veterans Affairs Canada Canadian Forces Advisory Council chaired by Dr. Peter Neary, who is the Head of Social Sciences at the University of Western Ontario; a mix of health care professionals and practitioners of one sort or another in areas like PSTD; experts on family and family issues; and we have representation from all the peacekeeping veterans organizations. I am happy to say, Mr. Chairman, that the traditional veterans organizations are now back at the table in the council as well. Their issues have been addressed and, if you wish, we can give you an update on that.
The Chairman: Could you clarify that for me?
Mr. Murray: They are back in both. The minister met with them in Halifax where there was a meeting with the new minister, which was scheduled for January 30. It was a very successful meeting, and the minister, Dr. Pagtakhan, had talked to all the leaders by phone beforehand, including the late Bill Barclay, before he passed away, for about an hour. We had a very successful meeting relative to the issues they had raised, and they are all back at the two councils. Mr. Chadderton still has some concerns relative to the ability of veterans organizations to table briefs at those advisory councils, but I believe that he has now spoken a few times on the phone to the minister and that he will be back as well. I think the issues they raised were more pertinent to the next session than this one, but the bottom line is that they are back, which we are very pleased about.
The Chairman: That is good.
Mr. Murray: The new definition of veterans was important. I went over that in Halifax, but if you have questions, I would be happy to come back to it.
I mentioned the continuum of service as the longer-term issue. In reality, as we have tried to come to grips with this, we are finding that the day-to-day work of the CF VAC project that Ms LeMaistre is part of is coming together. It is difficult to sort out what applies to here and now and what applies to the future, but the bottom line is that we are trying to reconfigure our programs and service to maximize independence and enhance well-being through access to required supports to prevent or minimize the occurrence of, or the severity of, a disability or illness. In other words, we are trying to turn back the clock, to an extent, to try to help these folks become fully functioning citizens as soon as possible. We are focusing on transition, rehabilitation, reintegration, and trying to come up with an approach to the benefits and the services to help this to happen. Some of that will require changes to legislation and so on, and so aspects of it will be longer term. However, it does seem to be coming together and we hope to be in a position to move this forward relatively soon. In fact, thanks to the SCONDVA report and the Quality of Life Initiative, we will probably be able to access some additional money without delays. It is looking very positive in that sense.
The only reason we tie it to the federal disability agenda is to indicate that that, in fact, is the model we are trying to use relative to disabled members or former members of the Canadian Forces, focusing on rehabilitation and reintegration.
I will now turn to Darragh who will deal with post-traumatic stress disorder. We did not spend much time on that.
Before I do that, however, I would underline that Dr. Pagtakhan, as the new minister, and as a physician himself, in his six weeks here, has focused on the health care needs of our aging veterans. He has had a positive dialogue with the major veterans' organizations. He is also cognizant of the needs of Canadian Forces veterans. He has specifically focused on the area of post-traumatic stress disorder and has asked us to do the same. He has some ideas on things which we as a department and which we as a country need to do in this area. I believe this is an area that will remain as a high priority during his time as the Minister of Veterans Affairs.
With that by way of background, I will ask Mr. Darragh Mogan to carry on.
Mr. Darragh Mogan, Director General, Program and Service Policy Division, Veterans Services, Department of Veterans Affairs Canada: I have a relatively short presentation, perhaps more to provoke discussion than anything else.
With respect to a definition of post-traumatic stress disorder, PTSD, in lay terms it can be described as a reaction to things that you cannot really control. This is not a clinical definition, but I think it conveys the idea.
This next slide will indicate how the numbers have changed in the last seven years with respect to PTSD. In 1995, we had 25 clients under the pension system; we have 1,500 in 2002. That is not to say that the incidence of PTSD has changed that much. It is just that VAC's understanding of it as an illness, as an injury, has increased over that period of time.
Today, 70 per cent of those who apply for disability pension get it on the first try. We made some changes to how we access and diagnose PTSD, making it easier for people to come forward. The military culture has been part of the problem. Post-traumatic stress disorder has been viewed as being a sign of weakness; hence, people hold it back. However, an ailment like that cannot be held back. It eventually manifests itself, in some form or another. The object of the exercise is to catch it early and make the person feel comfortable in doing that.
The concern, of course, is that it is difficult to diagnose. Community treatment and assessment options are limited for people with military post-traumatic stress disorder. While the problem is not large, it is a very public problem.
Our estimates are that 15 per cent to 20 per cent of individuals coming back from deployments will suffer some form of PTSD, given the frequency of deployments since the 1990s and their increasingly dangerous nature. That 15-per-cent to 20-per-cent estimate may be low. The most recent report by the military ombudsman, Mr. Marin, indicates that the problem is much larger than we had thought. Whether that is completely accurate is not clear yet, but PTSD is certainly a major problem for both National Defence and for Veterans Affairs.
PTSD does not go away when someone takes the uniform off. In fact, in most cases, post-traumatic stress disorder does not even show up when a military person has the uniform on, and that is a real challenge.
Nevertheless, PTSD became increasingly apparent as a result of the kind of deployments that have taken place in the 1990s — and Admiral Murray would know much more about these than I would. The nature of the engagement changed, in effect, where an individual was confronted with horrific experiences, not just peacekeeping. The terms of engagement did not allow the normal military reaction to come into play. As a result, we are seeing a greater incidence of these ailments, both in uniformed personnel and in people who have left.
As a result, the way in which we dealt with psychiatric disabilities in Veterans Affairs, both from a pension and health point of view, was overhauled completely. Previously, we needed a very specific diagnosis, not a syndrome like post-traumatic stress disorder, but depression, clinical depression, manic depressive psychosis — something very specific before we would act on it. We realized what that was doing. We were causing or sustaining pain and suffering in individuals, individual who were experiencing trouble coming forward, let alone coming forward with a very tidy diagnosis that we could use.
We made it wide open, saying that if an individual presents with these kind of psychiatric conditions, we will accept the diagnosis as PTSD and sort out exactly what it is later on, if it is not that. From the pension side, we will pension the disability rather than the specific diagnosis.
That explains why the numbers have grown from 25 in 1995 to around 1,500-1,600 today. We are catching more of these people, and we are able to help them sooner, which is less threatening for them.
We have a bilingual toll-free service available on a 24/7 basis. We are focusing on developing a peer-support network. We are working with PTSD sufferers in and outside the military. The peer-support group work something like AA, where it is led up to a certain point by individuals who are suffering from the disorder. However, also present are well-trained individuals, ready to refer circumstances they cannot handle. They are also equipped if get into trouble, because some of them will, and we just had that in Toronto. It seems to be very successful.
On very complex cases between National Defence and VAC — and some of them are very complex — we have national case conferencing with the best minds in DND. We work together on a file, with the individual's permission, to try to sort it out, as a means of becoming more learned in the area.
As a result of an Australian initiative, there is a booklet on PTSD. I do not have it here, but it is very interesting, both in terms of the people who suffer the disorder and those who look after them.
We recently set up a research directorate. Its primary focus right now is deployment-related heath, not just PTSD, but that remains a priority area.
The next slide is about the PTSD application process. I will summarize here. We could make this extremely complicated for the individual, and be justified in doing it, or extremely easy. This looks complicated. In effect, it is not. If someone comes in the door and is presenting with the problem and cannot establish that it is a disability related to PTSD, we will assume it is from the time they walk in the door in terms of treatment. We will not let the individual go untreated for this. We will allow the pension process to work out exactly what it is. The presumption is that if we cannot trace it for a specific psychiatric or psychological ailment, it is PTSD, and we will pension the disability as we see it and sort it out later. I think that is a fair summary.
Mr. Murray: Just two points I would like to add, to bring home something that Mr. Mogan said. Based on our research, the research of the Australians and I think the Americans, 15 per cent seems to be the figure associated with people returning with PTSD. Darragh used the 15 per cent figure. In addition to the 15 per cent, there is another 10 per cent to 13 per cent who are suffering from some other type of psychiatric affliction, for a total of about 28 per cent. Less than 2 per cent of our Canadian Forces veterans or clientele are pensioned for PTSD.
So when Mr. Mogan commented on whether Mr. Marin's report of 50 per cent was correct or not, we do not know, but we are asking. Our research people can look at where did that number came from.
However, whether it is 50 per cent or 28 per cent, less than 2 per cent of our Canadian Forces veterans are pensioned for PTSD, and that concerns us. Clearly, the military culture issue is there, or whatever the issue is.
We have recently initiated a clinic at Ste. Anne's Hospital, and hopefully this clinic is tied in with the five operational trauma and stress centres that DND has established across the country.
As I said, our minister, Rey Pagtakhan, has underlined the need for us to look at all that and probably do more in this area. Nevertheless, I wanted the committee to at least be aware of that.
Senator Wiebe: I am not a doctor, but I certainly agree with your definition of PTSD. I think it has been around for awhile. I think a lot of our veterans suffered PTSD following World Wars I and II. We just were not able to identify it as such, or we gave it another name.
There is no doubt that PTSD is difficult to diagnose. As Admiral Murray said, if someone says they have PTSD, you will presume that they do and treat them for it. There may be those who want to take advantage of that, but the fact that our figure is so much lower than that of the Americans and the Australians tells me that you are probably handling it very well.
Rather than treat the ailment, why not try to prevent it? Perhaps the responsibility should be on the shoulders of DND, rather than Veterans Affairs, to train individuals before sending them in as peacekeepers or troops into a stressful area. Some can handle that kind of stress, others cannot. I go back to my experience in Bosnia when I was visiting with the troops there. The terms of reference the first time our peacekeepers were deployed there was for them to watch, observe and report. They saw an atrocity unfolding. That is all they could do. They could not step in and do anything about it. It was when they were returning home that we really first started hearing about post-traumatic stress disorder.
When I was there, the rules of engagement had changed. They were now doing peacekeeping duties under NATO. If they saw an atrocity, they could move in and stop it. They could prevent the atrocity from happening, or they could apprehend the guilty individual.
In my discussions with the troops, they seemed to be relieved and very pleased about the fact that they were actually doing the job that they were sent there to do.
I know that I have asked in the past for studies on returning veterans from both theatres, but enough time has not elapsed to come up with anything concrete on it.
I think PTSD is a problem that we have always had, but we now recognize it. Perhaps there is something that DND can do in its training, to ensure that we minimize PTSD, by making sure that the right people are sent to the right areas.
Mr. Murray: I think it is fair to say that DND has done and is doing a lot of work in this. There is a lot more work going into pre-deployment briefings, mid-deployment interaction and return-deployment activities. The Australians are starting a project to track every soldier. On our research side, we are looking at various things.
There also is some question about some individuals being more prone to this than others and whether that can be determined, and then reinforcing the individual. I do not think anybody really knows that. I think the issue has been around for some time, in reading books of some of the returning veterans after World War II or whatever. Is this sense of helplessness part of it? It may well be.
We know for sure that recognition is part of it as well. In other words, if you are part of a million and a half returning folks who freed the world and the entire country recognizes that, acknowledges it, and shows tremendous support for what you have achieved, that is probably different than your being part of a small group of people who go off to war in Rwanda, watch 60,000 people be killed, and come back to peace, and nobody knows that you have even returned. I think the issue of recognition is very definitely part of it, the new veteran's definition, and that is what drove that.
I know DND is working hard. The involvement of the Prime Minister, the Governor General and others, ministers, in saying farewell and welcoming troops back is extremely important, in our take, relative to this kind of thing.
Mr. Mogan mentioned the OSISS project, the peer-support project. That project is also focused on the issues you raised around how we support people before they go and whether the cultural thing is part of it.
With the peer-support project, DND is hopeful, and we are hopeful, that, for someone suffering PTSD, talking to someone who has been there, indeed, someone who has suffered PTSD and who is now trained to be a peer-support worker, will help. We are hopeful that this approach will help.
Ms Sue LeMaistre, Acting Manager VAC-CF Project, Department of Veterans Affairs Canada: The peer support network has three components. The peer-support network is one; sensitizing DND staff and Canadian Forces generally on the matters is another; and the third is to try to engage in a more concrete and pointed way that whole issue of pre-and post-deployment.
Therefore, things are happening, and there are plans in the works for working on PTSD prevention in the coming months.
Senator Wiebe: Is PTSD curable or just manageable?
Mr. Mogan: Like most psychiatric disabilities, it is treatable. In time, with the right treatment, the current state of the research is that it will go away. I think the amplitude decreases. However, like these types of psychiatric disabilities, their disturbance is in the perception of what is real and what is not.
However, yes, with the right kind of treatment the disorder will fade; it will become less dominant in a person's life. Without treatment, it will not go away.
Mr. Murray: It depends on the individual. It also depends on when treatment is started. There is no question that the severity of PTSD increases without treatment. If an individual has been suffering from PTSD, is on a fourth deployment, then disappears somewhere and turns up after being out of the Canadian Forces for three years, the disorder is more difficult to treat. We want to start treatment as soon as possible. We know that early treatment is the most effective. We want to provide that support. However, I suspect that for some people the disorder will be manageable as opposed to curable. That would be my take on it.
Senator Atkins: Is there any connection between ADHD and PTSD?
Mr. Mogan: None that I am aware of. I will check the research on that.
Senator Atkins: There are a lot of similarities between the two. Although they detect ADHD at young ages, a lot of people get to adulthood without knowing they have the problem.
Mr. Mogan: Certainly, one of the symptomatologies would be the same, that is, the inability to focus and stay focused on a certain thing. My sense would be that the research is going to show what prompts that difference, that the symptom is quite different for someone.
By and in attempting to catch this early, we need to have these transition coordinators do increasingly what happened after WWII for exiting veterans — in other words, handed off from National Defence to Veterans Affairs and screened, in a way that you agree to, as all veterans after World War II did. We are trying to catch this early and in a non-threatening way. As we know, and as Admiral Murray knows, 15 per cent of Canadian Forces people are not receiving a pension for PSTD. We only have a small number. We are learning lessons with National Defence and we are working with their case managers to try to get a fairly smooth handoff for people who are experiencing all manner of disability, but particularly this one. I will look at the research and submit it if there is any.
The Chairman: In the ombudsman report, I think, to your credit, certainly you came out with a pretty glowing report, whereas I venture to say the Department of National Defence did not get quite as high marks for the treatment of this problem. Is the communication between the two of you good?
Mr. Murray: I would say that the communication is excellent. If there is a sense that we got differing levels, I would say that that is not fair. It is important that we are trying to make a research connection with the report, the time frame of when the report started relative to Corporal MacEachern's problem, and what has unfolded since then, things like this peer-support initiative. DND has made operational five trauma and support centres across the country. That is a major undertaking. A number of training initiatives have focused on the mission — that is, the country you are going to, et cetera — all of which is part of what Senator Wiebe was alluding to. I would say that both departments have been working very closely together on this thing.
Mr. Ferguson can comment on this, because he is on this committee with General Couture, and on this one we worked extremely closely.
Mr. Brian Ferguson, Assistant Deputy Minister, Veterans Services, Department of Veterans Affairs Canada: In fact, senator, if you have a chance later to glance at this document, you will see that almost all of these initiatives are joint initiatives between ourselves and DND. On the particular issue of PTSD, they have played a leadership role in putting together on many of the bases these case coordinators, and we have gone along and matched their case coordinators. Those case coordinators are to help the still serving Canadian Forces individuals who are suffering from whatever illnesses, including post-traumatic stress disorder and others. They put these case coordinators on the bases to get a better handle on those problems.
We, working with them, put transition coordinators on the same bases so that we could begin to work upstream whenever they were applying for pensions from us so that the handoff could be seamless. DND has taken very much a lead position.
With respect to the OSISS, the peer-support group, it is a DND program and we are cooperating with them on that. I would just echo what the deputy minister has said. We have done some good things, we think, but DND has done a lot of good things and we are happy to be working with them.
Mr. Murray: I do not want to give the impression that I am criticizing or throwing rocks at the Marin report because I really am not. We are very interested in finding out where he got his 50 per cent number. In terms of the broader conclusions around the cultural issues and whether we need to do more, those sorts of things, we accept that. I just think that there has been a whole lot of activity since he started the work on that report. That is my only point.
The Chairman: As I understand it, you are required to report to DND a serving member of the Forces who seeks help for this condition. To me, the danger of that is that the news gets out and the person becomes ostracized. You have all that conflict between confidentiality and the requirement to report.
Mr. Murray: We touched on this one in Halifax, and I think I will ask Mr. Mogan to comment. It is broader than this issue, actually; to some extent, it is related to Bill C-41. Prior to Bill C-41, we did provide medical support to personnel who had been injured in special duty areas but not beyond that. With the arrival of Bill C-41, the numbers became quite large and it became a very serious concern around operational health and safety.
Your point is correct. There is no question, our area counsellors as well as ourselves are concerned, particularly given the cultural issue that is clearly there as recently as the Marin report. In this case, we had to make a decision, we made the only moral, ethical and legal decision we could. Nevertheless, it does create an issue in the minds of people for reasons I understand. If they come to us and that winds its way back to DND, then we are the same as DND in their mind, so why would they come to us for help. That is the issue that you are alluding to.
Mr. Mogan: Currently, if an individual who is suffering from anything comes to us to apply for a disability pension, which is normally the way it is done, we let them know right up front that if he or she does not want to apply for a disability pension we will not be sharing information. However, for the sake of operational safety and national defence itself, pilots, tanks, intelligence officers, whatever, we have an obligation — and we checked this out in our privacy law — to share that information and to make sure the individual knows beforehand. We had only a few complaints when we told people we would be sharing the information. In fact, we had some people in the military wondering why we had not been doing it all along; they recognize the problem of not sharing information. We know that this could create one more barrier for someone suffering from a psychological disability to come forward, so it is not a perfect world, but the object of the exercise behind this was to put ourselves in the position where we were supporting the will of the Government of Canada that the troops be safe, secure and operational, as opposed to double- and triple-doctoring and the base surgeon not knowing about it.
Mr. Murray: The issue here was the possibility of two doctors providing support to the same individual, an individual who might be a Herc pilot or a soldier, who should not have been rotating back in, responsible for a whole bunch of lives besides his or her own. Obviously, that is problematic.
At the same time this was unfolding, or prior to this, DND had tightened up its rules around how much information the doctors — it is very definitely the military doctor now who has the absolute right not to share the information with the chain of command if, in his or her mind, there is no risk. If the individual is about to deploy or is actively flying, probably some portion of it does have to be shared, and we are only sharing the information with the Canadian Forces medical system. The Canadian Forces medical system and the doctor on the base or at the unit then need to decide whether the information is relevant.
When we are dealing with clients, we have no idea whether, say, a pilot is running a recruiting centre or is actually flying an airplane. Hence, it was that kind of problem. DND has tightened up on this as well, so that this is going to medical authorities and they decide whether there is an operational implication.
The issue of the possibility of shared information ultimately being shared with the military chain of command is still there, but I do not see another option, actually.
Senator Wiebe: Unfortunately, one cannot put as much stock in what one reads in the newspaper as one used to be able to. During the Swissair disaster off the coast of Nova Scotia, I recall reports of possible PTSD problems with some of the people that were involved.
Is that so, and have you been involved with some of those who were actually there?
Mr. Murray: It is true actually. Some of the people were involved in fairly horrific operations of recovery, divers and others. I was in Fisheries at the time and many of the Coast Guard people as well were in. We deployed counsellors to the scene.
I think we do have some clients now out of the Forces; if not, I would be surprised. The Swissair event is not dissimilar to the events that are triggering these issues in Rwanda, Bosnia, and so on. It is the horror and the helplessness and all that kind of stuff.
Senator Wiebe: We do have first responders and Emergency Measures Organization people who probably on a smaller scale deal with exactly the same thing. Do they go through a different kind of training?
Mr. Murray: That is an interesting question. Mr. Mogan did make the point that the expertise on military post- traumatic stress disorder is extremely limited. In fact, the expertise in the country on PTSD in general is quite limited. Nevertheless, it is our understanding, and I think the understanding of the experts, that the kind of post-traumatic trauma that a rape victim, or a policeman or firefighter experiences is different that what we are dealing with on the basis of one six-month deployment or three six-month deployments back to back. It appears to be different.
We held a regional session in Saskatchewan. A number of reservists as well as RCMP were invited. Some RCMP have participated in peacekeeping missions. The three Mounties we spoke to said that there was a difference, that they found, in returning to the detachment, a lack of recognition and understanding from others. They say the ones who have done peacekeeping suffer the same kind of PTSD that the military sees, which appears to be different, at least in some respects, from the person who is trying to deal with the immediate horror.
I personally would have thought that a firefighter or a policeman over time would have some similarities, but I am not an expert, senator. They disorders apparently are different and the treatment to some extent is different.
Senator Wiebe: I think I have probably talked to a couple of those RCMP officers in Saskatchewan as well because I have heard similar stories from them.
Mr. Murray: They really added value to the session and we are now including them.
The Chairman: Before we go to our last briefing, I want to ask you for an update with respect to the Senate report entitled ``Raising the Bar: Creating a New Standard in Veterans Health Care'' — sometimes referred to as ``Crossing the Bar.'' I wonder whether you, Mr. Murray, or your officials could provide us with an update, as the last one was in October 2000. At that time, you had accomplished most of the objectives and fulfilled most of the recommendations, but maybe there has been some progress since and we would be interested in knowing.
Mr. Murray: We would be very pleased to provide an update to our October report, Mr. Chairman, on that Senate report.
The Chairman: We will now proceed to the next briefing.
Mr. Mogan: I will give you a brief introduction to the healthcare part of our business in Veterans Affairs, by turning your attention to the mission statement. The area we focus on in that mission statement is to promote their — that is, veterans and their dependents — well-being and self-sufficiency as participating members of their communities. This is very, very important in the home care area and in the residential care.
Our core business here is to promote independence, again, self-sufficiency, using whatever tools we have or using whatever tools the community offers. We call that our continuum-of-service commitment to veterans and their dependents. No matter who has the solution to the problem, we will try to find it with the client, whether we have the solution or somebody else has.
This slide shows expenditures. I will not go into them, although it is interesting that, for $193 million, we are able to care for about 5,000 veterans in institutions, but for almost $30 million less, in our home care program, which we will come to at the end, we are able to care for 65,000 veterans. One sounds like a bargain against the other, and I think it is.
I will now turn to our residential care strategy. From ``Raising the Bar'' and from our own work on the review of veterans care needs, a residential care strategy emerged to manage the overall long-term care needs of veterans, and it is to that that I am going to ask my colleague, the Director of Residential Care, to give you a synopsis of where we are on that.
Mr. John Walker, Director, Residential Care, Department of Veterans Affairs Canada: It is a pleasure in my mind to be here because we have made considerable progress since the last time I appeared before the committee and we are pleased to report on it.
As Mr. Mogan has alluded to, we did develop a residential care strategy — that is, the parameters within which the department will attempt to deliver the long-term care benefits to veterans for the foreseeable future. Essentially, there are two areas that needed to be addressed in this strategy: the supply of beds and the quality of care that is delivered within those beds. If those two issues are addressed to the extent that they need to be, we will have gone a long way towards achieving our mission.
There were challenges in terms of how to meet the health care needs of traditional veterans. The average age of a WWII veteran is 80; the average age for veterans in the institutions is 82 this year. It is burdensome for the caregiver, who is usually a spouse. As well, health care costs are an ever-increasing concern for the government.
In June 2000, then Minister Baker announced 2,600 new beds. The funding for those beds would be available for veterans on an as-needed basis. There are approximately 1,041 of those beds being utilized at last count. Of course, that is subject to change on a daily basis. Nevertheless, we still do have a considerable number of beds available for anyone who may need one, on an ongoing basis.
In terms of our overseas service veterans, who are generally not eligible for our Veterans Independence Program, if they have applied for a long-term care bed, one of our priority access beds, but there is no availability, we will enable them to stay at home longer through our Veterans Independence Program and our treatment program.
With regards to the strategy itself, the area of quality of care was certainly one where veterans organizations were quick to point out to us that we had not done the job that perhaps we had ought to. Hence, we have recently entered into an agreement with the Canadian Council on Health Services Accreditation whereby our priority access beds are to be accredited by the council and VAC's 10 outcome areas are to be incorporated in the accreditation process. These areas include safety and security, food, access to spiritual guidance, cleanliness, et cetera., will be incorporated into their process.
We have an annual questionnaire to monitor resident satisfaction based on 10 care outcome standards. Our counsellors help to administer this questionnaire to veterans in our facilities. We have found this to be really quite needed. In the past, once the veteran had gone into a facility, we just assumed that the care that he or she was being provided was adequate. In some cases, that was the case; in others, it was not.
At our larger facilities, our health professionals, nurses and doctors, answer a rigorous questionnaire, along with facility administration, to determine that their needs are being met.
In Ontario, we have established a position called the Director of Quality of Care for the Ontario Region. That individual is a Mr. John Conlin. He is a former district director in Ontario, a long-time Veterans Affairs employee. He is stationed at Sunnybrook itself. He is responsible, particularly at Sunnybrook, on a day-to-day basis, for addressing and resolving problems as quickly as possible.
I am pleased to report that that has worked quite well in the Ontario Region. Certainly, a comparison of Sunnybrook now with Sunnybrook four years ago would render a significant improvement by any standard.
Under special initiatives, we have best practices conferences, where we bring together representatives from our facilities to share best practices and problems solved. That was a direct recommendation from the Senate subcommittee, and it has worked very well. To the best of my knowledge, it is the only national conference where representatives from all the 10 provinces come together to discuss issues like that.
The Departmental Hospital at Sainte-Anne's is becoming a centre of excellence for cognitive impairment and psychological care, and it is being used as a resource by several of our priority access facilities.
We do have a dementia care initiative, an initiative whereby facilities request that they have what is called a facility assessment for their readiness to deal with people who have dementia. A lot of veterans suffer from dementia, in one form or another, upwards of 70 per cent, and we find that the staff training in several of our facilities is not what it should be. Through this initiative they are able to get enhanced training in that area.
In terms of capital improvements, there have been capital projects in the cities you see listed on this slide. Those have been well received. As well, $67 million was announced for renovations at Hôpital Sainte-Anne.
Senator Wiebe: Twenty-six hundred new beds — that sounds great.
Let me start off by saying that I think your home care initiative and your VIP program is just excellent. The majority of our seniors, whether they are veterans or not, like that kind of approach.
I think where Veterans Affairs is making a mistake is capital improvements in cooperation with the provinces and facilities enhanced. You are spending a lot of money in these areas. You are creating new beds in some of these facilities, but you are not getting one ounce of credit. The only time that the veteran or the general public reads about it is when a press release is sent out. If there is an official opening, someone from Veterans Affairs will be there to make a five-minute speech and help cut the ribbon. A little bit of press will follow the next day. The provinces continue to take the credit for every single inch of space that is in there. They will never mention Veterans Affairs. A lot of our veterans are sitting back and saying, ``The department is not doing anything for us.'' It goes back to Admiral Murray's comment about how important it is returning soldiers to have the Prime Minister meet some of them there, to be recognized. That is why it is so important to have a physical plant, to say, look, this is a veterans home care facility.
It may mean twisting arms with the provinces to have them change the name of the facility or to have some recognition on the outside of the facility that it is shared. I think this is the direction we should be going in, because this committee has heard representations from veterans associations that say what I have just said, that the Department of Veterans Affairs is not providing these kinds of facilities. I think that there is an area that the department should really look at.
The average age in our military is quite high; soon the demand is going to be there for those facilities.
If DND or VAC builds the facilities, and if there are spare beds, why not rent them to the provinces? That would give us visibility. However, the taxpayer is still paying the bill, whether VAC, the feds or the provinces build it. I think you people have to work out whichever is the best way.
My only suggestion is that when you are spending those kind of bucks, try to find a way in which the Department of Veterans Affairs can get credit for the beds they are making available.
Senator Atkins: Can you do a joint project with signage and that sort of thing and negotiate that with the provinces?
Mr. Mogan: We understand what you are saying, and there is no reason why we should keep our light under the bushel.
We have been focusing on the needs for structural changes to accommodate dementia care patients, like the Dorothy MacHam Unit in Sunnybrook in Toronto and others. We are focusing primarily on getting the job done. However, telling people that you are getting the job done is part of it; I can certainly understand that.
Mr. Murray: Are we doing things perfectly? No. However, there is much activity underway.
You are right about the traditional veterans: We have to come up with more effective ways to communicate what we are doing, because it is important for veterans to see that.
When we spoke with the minister, he said the same thing. We need to figure out how to communicate more effectively what is actually happening because it is part of the cure.
Senator Wiebe: We need to get the provinces to designate a wing in their buildings to veterans, a veterans wing. These are just ideas, but somehow we have got to put the department front and centre in more places.
Senator Atkins: Is there an opportunity to get the Legion more involved in this area?
Mr. Murray: There probably is, actually. Among the things we have done recently is launch our own client base, which was supported by the Legion. We do work with them. However, we need to think more about communications than we have.
The Chairman: May I ask how and where is that distributed?
Mr. Murray: It is distributed to all agent branches across the country, to all clients. This is the second edition.
Mr. Ferguson: About 250,000 copies were sent out. This is only the second edition; this is the winter version. We launched our first one in the fall. Precisely for the reasons that you have articulated, we felt that we were not getting the message out to our existing client base. We have a lot of initiatives that we have not yet let the general public know about. This is one venue where we might get more of that message out.
Mr. Murray: It has been very strongly supported by veterans and veterans organizations. Thanks very much, senator. I think that is a very valid point.
The Chairman: Just before you do carry on, may I ask a question about common standards across the provinces — or are you hoping to escape that today?
Mr. Murray: We were really hoping to get that question.
The Chairman: Let me elaborate a little bit. I was contacted personally by Senator Rossiter from Prince Edward Island; she has an obvious interest in this matter. She sent to me a letter she received from the Kingston Branch President. In that letter, the president attached a letter that all Legions had received from the Dominion President, Mr. Barclay, before he passed away, dated September 21, 2001. In his letter, Mr. Barclay said, and I quote:
Veterans Affairs has now set the end of March 2002 —
That date is rapidly approaching.
— as a target date for implementation of common veterans care standards.
The letter continues:
Until Veterans Affairs Canada produces a realistic plan of action to attain national veterans care standards matching those that it has proved it can achieve at Ste. Anne's, I and the rest of the Dominion Executive will not meet with the Minister or his staff. It is for that reason that I have directed our representatives to cease participation in the Gerontology Advisory Council and the Veterans Affairs Canadian Forces Advisory Council until such time as this matter is resolved.
I think, Admiral Murray, that you gave us an answer to the last part that of the citation that I just read, that they have rejoined those two.
Mr. Murray: Correct, Mr. Chairman, and I can give you an answer.
The Chairman: Perhaps you can give me a response in terms of the action plan.
Mr. Murray: Certainly. That letter from Bill Barclay was a follow-up letter to a letter that was sent to the minister withdrawing from participation in all executive exchanges, and that happened to include the two advisory councils, until they got what they considered to be meaningful response from us on three issues — the quality-of-care issue, I think, being the most important. I think Mr. Barclay underlined that in that particular letter.
The other two issues were POW compensation and VIP support for widows.
On January 30, the minister, the Honourable Rey Pagtakhan, had a meeting with the leaders, and at that meeting the minister was able to indicate to the leaders that a contract had in fact been completed with the Canadian Council of Health Institute Accreditation on January 23, I think, and that the accreditation process was now unfolding. As the major priority access facilities come up for accreditation, they will now include the 10 outcome areas. There is a whole component, as well, of training for our staff, training for institute staff, and we have also asked veterans organizations and the Legion in particular to engage with us and become part of that process, and they are quite pleased with that. There is a fair amount of work begun to bring that to fruition.
Mr. Walker: About two weeks ago, I spent an afternoon with Mr. Jim Rycroft, Director of the Service Bureau for the Royal Canadian Legion, on this very issue. In the response that I wrote to that particular initiative, he wrote back to me that I had captured the essence of it and that they were ``happy'' with our response and the approach, which is very much a joint one as it is now, but they would have to wait until Mr. Parks came back into the country.
He was in the Caribbean, I believe, until this week. I am hopeful that they will respond to us.
I believe they are meeting with us next week. Hopefully we will have an initiative and an action plan signed off by both parties which will address those letters, many of which I have responded to since they were written.
That is the most up-to-date status I can give you.
The Chairman: Thank you. It sounds like the matter is moving ahead.
Mr. Walker: It is moving ahead. I would not go so far as to say that it is signed, sealed and delivered, but it is certainly in process.
The Chairman: Thank you very much. I will communicate that with Senator Rossiter. I guess we can move back to home care.
Mr. Mogan: I do not propose to go through all of these slides because I gather that you already have a lot of this information. Some would say Veterans Affairs' flagship program is the Veterans Independence Program, not because it is more important than others, but because it has broken ground that no other national program in this country has. For over 20 years, it has successfully provided a home care alternative to institutional admission that has proven to be probably 10 times cheaper and a lot more satisfying to its clients. It provides individuals with a choice of how they wish to be cared for and support for the caregiver, and it recognizes particularly the dignity of the home setting and that grounds keeping or housekeeping is almost as important as how healthy people are. I had something to do with the creation of that program, so it is more good luck than good management that it has turned out this way.
The veterans' organizations took a leap of faith some years ago in supporting this because they were very concerned, as the national council seems to be now, about an adequate supply of beds. Lord knows how many beds we would have had to establish for people if we had not offered them the home care choice. It is interesting that, having already given one legacy to Canada, veterans have now given another by opting into this Veterans Independence Program.
One of the unique features of the Veterans Independence Program is what is called ``self-managed care.'' Veterans Affairs makes a contribution, but individuals manage that against a care plan for which, in effect, they are accountable. It offers a range of services — housekeeping, grounds keeping, social transportation, personal care, meals, home adaptations, where needed, for special equipment, and ambulatory health care, where people can spend the day receiving therapy and then go home at night. The rates are cited here. The interesting thing about the concerns expressed by central agencies is that if you set a rate at $7,000-$8,000 for home care, everybody would go to $7,000 or $8,000 within an hour. It is 20 years later, and we are still on the average of $2,000. We find that if the Government of Canada makes an investment and assists individuals with a plan, they will take it the rest of the way. It is quite a remarkable lesson. I will not describe the rates here.
However, we sometimes have situations where people are so determined to stay at home, they run a very high clinical risk to themselves, and then you can get into some ethical considerations about how far do you go with the government's money. Generally, we go as far as we possibly can and very high-price situations are the exception. Fortunately, we have not had any real difficulties of that kind, and most people will accept much less of an investment as long as they are given the choice of staying at home.
More to the point, we have been running a pilot project on our priority access beds at the two or three sites where there are not enough. We provided these individuals, who were otherwise only eligible for expensive institutional care, with the VIP and treatment benefit program, if they had nothing else. In other words, they were just plain suffering and toughing it out with their spouse at home. Remarkably, we are increasingly finding that even though these people could have gone into a bed, when we knock on their door and tell them their bed is ready, they say that they would rather stay at home. I think that is probably the hallmark of success and it really means that the VIP program is meeting its objectives.
Senator Atkins: Are you having any difficulties with major centres cutting back on transportation?
Mr. Mogan: I do not know about transportation itself, but unfortunately, when health budgets get cut back, the less obvious, less institutionally based services tend to go first. Thus, long-term home care, like the VIP, tends to get cut more than acute care. It would not surprise me, although I have not seen it, if transportation support services, which are usually run by the voluntary sector, not by government, would feel the effects if they depended on government subsidies.
Senator Atkins: I do not remember where, but I heard that there were cutbacks.
Mr. Mogan: I have not heard of any, but it would not surprise me. I think it is important for you to know that, if for whatever reason there is a cutback, the veteran does not pay the difference. Veterans Affairs will fill in with a national standard of payment for housekeeping, grounds keeping and personal care.
Senator Atkins: I guess people notice the time lag between when they call and when they are picked up.
Mr. Mogan: Yes, that could be so in the transportation area. Although, if there were a cutback, say, in a regional health authority, and it can happen, we will know very quickly from the clients, within minutes.
The Chairman: Did you deal, Mr. Mogan, with the intermediate nursing home care?
Mr. Mogan: No, not as such, although that is certainly one of the benefits we offer.
The Chairman: I happen to know of a case of a woman who was in the air force and is now in a community nursing home. I know her family is finding the expenses rather steep, but she is 89 years old and not able to look after herself. I do not think that they have applied for any assistance. Is that the sort of thing being described here?
Mr. Mogan: Yes, that is exactly what we are talking about. We can take the individual's name and look into it. There are eligibility rules, as you can imagine, but people in these beds — and we have about 3,500, 3,600 clientele in the community nursing homes — wherever they are, never pay more than the lowest provincial rate for board and lodging and receive more generous personal care and a living allowance for the person at home. If there are people out there who need that service and are eligible, we will get to them right away.
The Chairman: What care and services do you provide?
Mr. Mogan: Well, it is nursing home care, level II, intermediate level II to level III. It varies, but if you think of your standard image of a nursing home, that is the kind of care offered here.
Mr. Murray: We mentioned the 2,600 new beds. That gives us increased flexibility. For example, an overseas veteran in North Bay is entitled to a long-term care bed but does not want to go to the Perley Rideau in Ottawa because his family is in North Bay. His priority access bed, one of those 2,600, might be in a long-term care facility in North Bay, and then the bed next door could be a community bed. In other words, it is really an eligibility issue and a payment issue. Most of these 2,600 beds are in the same kind of facility as the community beds. There is a cap on the priority access beds but not on the community beds.
In other words, if we needed 5,000 community beds, assuming we could find them in the particular province or regional health authority, there is no cap on the number that we can access under the VIP program as long as there is a need. That is one of the issues in the bed debate that we have with some veterans' organizations, that there is no cap in this area, and in many cases, certainly with the additional 2,600, we are effectively talking about the same beds. It is just that the veterans occupying them are perhaps there under different criteria.
The Chairman: If the bed is provided or allocated by you, that is one thing. If someone would rather stay in North Bay than go to Sunnybrook, and there is a facility in North Bay that can provide the bed, eligibility is not a question. Now, there might be a question of cost. It might be that Sunnybrook costs ``X'' dollars and the North Bay facility, for whatever reason, costs ``X-plus'' dollars. Could that happen?
Mr. Walker: It would likely be the other way around — cheaper.
The Chairman: Can you conceive of a situation where the bed in the local community would cost more, and therefore you would pay only up to a certain level?
Mr. Mogan: That scenario is certainly possible. Under transfer agreements from 1964 and the Glassco commission, we have authority for about 6,700 priority access beds. The problem is with people who are not disability pensioners or low income. That group of relatively higher income, non-disabled individuals only have access to these relatively expensive priority access beds through the Veterans Independence Program. The other group of veterans has access to not only the priority access beds, but also these cheaper community beds that are dispersed. Of those 6,700 priority access beds for overseas veterans who were not disabled or low income, 2,600 of them were not occupied. To deal with a shortage of priority access beds, we treated these 2,600 as if they were VIP beds and allowed the individuals who needed them to use them. It gave veterans ineligible for other priority access beds the opportunity to stay at home.
The Chairman: Ineligible for what reason?
Mr. Mogan: By reason of only being eligible for these priority access beds.
The Chairman: Because of their income level?
Mr. Mogan: Either because they have no war-related disability or they have relatively high incomes.
Mr. Murray: An overseas veteran who may never have come through the door of a Veterans Affairs office, who has only received recognition through a commemoration program or whatever, and has adequate income, so therefore does not otherwise qualify, is nevertheless entitled to a long-term care bed, defined as a priority access bed — previously the 4,310 beds in the major facilities that used to be veterans hospitals, such as Camp Hill, Sunnybrook and so on. There is a combined challenge there when there are perhaps not enough beds in some of these facilities and people from North Bay would rather stay in North Bay. We decided that if the government had a legislated responsibility to give you an institutional bed that costs four, five, six times more than VIP and could not, so you were on a waiting list, that we have a responsibility to give you something, in this case, VIP home care. In many cases, those people are now saying that they will stay at home, which is one reason why some of our waiting lists are increasing. Someone in Tatamagouche, Nova Scotia who was not on a waiting list before, on becoming aware of this, decides, correctly and wisely, to get on that waiting list for Camp Hill, even though the individual does not necessarily want to go to there. There has to be a need, of course, and the veteran can get in on this pilot project now because we expanded it beyond the three locations. When the VIP program no longer works and the overseas veteran does not want to be in Halifax in Camp Hill, a priority access bed that might look very similar to a community bed could be available in Tatamagouche. The vet in the next bed might well be on the VIP community bed program.
Mr. Walker: Just by way of illustration, the wait list for the Perley in Ottawa is certainly one of the longest in the country. We had 17 empty beds this January and February and we had to call 50 veterans on that waiting list to fill them.
Senator Atkins: And you attribute that to the VIP?
Mr. Walker: Yes.
The Chairman: That is a nice problem for you to have, is it not?
Mr. Walker: It sure is.
Mr. Murray: Some of us would like to close the loop through legislation soon.
The Chairman: Thank you very much. We found it informative and interesting and we appreciate all the work that so many put into to making our day so productive. We commend you for your initiative and your flexibility. I am glad to hear that a number of issues that veterans' organizations have been concerned about and have communicated to us seem to be moving, at differing paces, towards solutions that will please everybody. As Senator Wiebe said, you undoubtedly deserve a lot more credit for what you are doing than you are getting.
Mr. Murray: I would like to underline what I said last night, that it really is important to the staff that you took the time to come here. I am particularly grateful for the walkabout this morning. Any time you are somewhere where we have a district office or a regional head office, I think you would find it extremely useful to do a walk through, meet some of the area counsellors and pension officers and see how that actually functions. We have used your report, together with the review of veterans' care needs, to drive the agenda on long-term care.
The Chairman: A list of those district offices would be very helpful, and I am sure Senator Phillips, in particular, would be very pleased to hear your comments.
Mr. Murray: Senator Phillips is a member of the Gerontological Advisory Council, so he is all over us all the time.
The committee adjourned.