Proceedings of the Special Senate Committee on Aging
Issue 7 - Evidence, May 9, 2008 - Morning meeting
WELLAND, Ontario, Friday, May 9, 2008
The Special Senate Committee on Aging met this day at 9:05 a.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[Français]
The Chair: Good morning. We are delighted to be here in Welland, Ontario. We are examining in our committee the implications of aging and an aging society in Canada.
The range of complex issues, of course, is substantive and this is the first stop in our cross-Canada trip. We decided we would start in southern Ontario, and in this particular region, because we were informed that this region had a number of people who are considered seniors in this area.
We welcome this morning, from the Regional Municipality of the Niagara Community Services Department, Carol Rudel, Manager of Seniors Community Programs, and Dominic Ventresca, Director of Senior Services; from the Hamilton Niagara Haldimand Brant Community Care Access Centre, Tom Peirce, Senior Director, Strategic Planning and Integration; from the Niagara Health System, Wendy Robb, Health Program Director, Port Colborne Site.
From the Ontario Network for the Prevention of Elder Abuse, Maureen Etkin, Regional Consultant, Central West; Gail MacKenzie-High, Coordinator, Respite Companion Program.
Welcome to all of you this morning. I notice that Ms. Robb is not here, but Dominic Ventresca will begin with the first presentation.
Dominic Ventresca, Director of Senior Services, Regional Municipality of Niagara Community Services Department: Carol Rudel, the manager of Seniors Community Programs, who is with me today, and I have read with keen interest the Senate committee's second interim report. We are pleased to have this opportunity to provide you with illustrations of some of the issues that are pressing in our region, reinforcing some of the committee's proposed options, and also respectfully suggesting additional issues for the committee's consideration.
Our perspective is from professional involvement, if you will, working in this region for a combined 57 years and working with the Niagara Region Senior Services, which is a division of the municipality that oversees the 420,000 citizens in Niagara with 12 local area municipalities. As the chair said, we have a good number of seniors in this region, approximately 18 per cent, which is above the provincial and national averages, and one of the oldest census metropolitan areas in Canada.
I will give you a bit of context for the Niagara Region Senior Services. The municipality operates eight long-term care homes. We accommodate 957 residents. As well, we have a regional dementia centre, which is somewhat of a unique operation in Ontario, to address the needs of those with advanced dementia issues and also respite.
We also serve 400 to 500 individuals who live in the community through our ten adult day programs. We serve about 50 individuals through a supportive housing operation and probably another 2,500 individuals through programs such as our in-home respite program, our client intervention and assistance services, and also through caregiver education. In total, we employ about 1,100 staff and we engage over 900 volunteers who contribute to meeting the needs of our seniors through our programs.
We operate a small local continuum of care that bridges from community programs to long-term care programs and we expend approximately $54 million a year providing that care.
We recognize, though, that we cannot serve the entire region by ourselves and therefore have entered into numerous formal and informal partnerships with various others in the community to attempt to provide a more integrated approach to care for seniors.
To give you some examples, two of our long-term care homes are attached to hospitals in our region. Two of our long-term care homes have enabled community hospices to be constructed on our sites. We have a multi-agency and an inter-disciplinary admission, treatment and discharge team that assesses the needs for individuals with dementia to determine their eligibility for our dementia care centre that I referenced earlier, and also to assess perhaps alternative care if the centre is not the appropriate care for these individuals.
I mention as an aside that this evening, that team has been nominated for a geriatrics award in the south central region of Ontario.
The Niagara Region has also facilitated the construction of the Alzheimer Society's Family and Community Resource Centre on the site of one of our long-term care homes.
Finally, as an example, we are involved on the advisory committee of a unique program that has been initiated here in Niagara called the Home to Stay program, which is an attempt to provide multi-agency support on an immediate basis to people who are in emergency wards or on the cusp of being admitted to a hospital, or perhaps to prevent admission to a hospital.
A couple of examples of the type of collaboration we have engaged in, with a view to providing and enabling integrated care, we are both involved in numerous Local Health Integration Network initiatives, for example, on the alternative level of care issue, the aging at home issue and related strategies. We also belong to a local Hamilton Niagara Haldimand Brant geriatrics network and a community support services network, and I serve on the Board of the Ontario Association of Non-Profit Homes and Services for Seniors.
I have given you a little context as to the perspective from which we come and hopefully, have provided a little bit of, let us say, grounds for credibility as to the comments we make here.
As I mentioned earlier, Niagara being the census metropolitan area with one of the oldest demographics of seniors in Canada, we believe that Niagara serves as a microcosm or a living laboratory on what much of the rest of Canada will look like as the baby boomers reach their retirement age. Niagara should be looked at more carefully because we can learn from what is happening here and, as we develop solutions here, they can be used perhaps as a best practice or, at least, as a prototype for consideration across the country.
Briefly, some feedback on the interim report, beginning with a bit of information on the Niagara status relative to supports in the home, we will focus on all the various issues that you have raised on improved housing and transportation.
In Niagara, wait lists for subsidized housing are long and local transit is somewhat limited particularly because we have rural areas interspersed between our major small municipalities. We also have intermunicipal transit operated by the Niagara region, but it is limited in its initial phase to medical appointments only. Based on this pressing need for affordable housing in Niagara, we strongly reinforce the committee's proposed option 51 relating to the call for increasing the stock of affordable housing across the country.
As our local area planning data indicate, Niagara is critically short of affordable supportive housing, particularly in the southern communities of Niagara. This shortage has been viewed by many informed observers as a root cause for the inordinately long wait list for long-term care homes in Niagara. Approximately 1,500 people typically are on the list for admission to long-term care homes in the Niagara region where there are 32 long-care homes.
Also, many consider lack of affordable supportive housing options in Niagara as a root cause for the inordinately high number of patients in hospital who are awaiting placement to alternative levels of care. They are also considered the root cause for the inordinately high number of patient offload delays experienced by the Niagara's ambulance service where ambulances cannot transfer their patients to hospital because of overloaded emergency departments.
The lack of affordable supportive housing contributes to many health care system inefficiencies and the unnecessary expenditure of hundreds of thousands of dollars to work around the system's backlog. Accordingly, we reinforce your committee's proposed option 51 which increases the stock of affordable supportive housing and related options.
Second, Carol Rudel and I would like to make a point here around the issue of affordable and accessible transportation as being a key issue to supporting seniors in their own homes. Additional affordable and accessible transportation for other purposes would enable many more seniors to address various identified issues related to aging at home, such as active living and well-being, health promotion and prevention, and other dimensions that your report has covered.
Moving on to health care needs, we emphasize the need for improved service pathways and service navigation.
In support of the committee's focus on the pressing need for integration of the various support options available to seniors — the provision of the right service at the right time — additional emphasis is required on the alternative-level- of-care issue, long-term-care home wait lists and the care of individuals with extraordinary behavioural needs. Therefore, we reinforce your proposals 60, 64 and 68 related to national programs in various areas that support these initiatives.
Based on Niagara's experience with its hospital beds typically accommodating over 100 patients who should be in alternative facilities or in the community, with the long wait lists as I have mentioned, which are typically over 1,000, the lack of geriatric psychiatry and specialized behavioural support for hundreds of older adults, we respectfully suggest that the committee give additional consideration to proposed options related to improved balance of service choices in a continuum of care. The key word is "continuum'' of care that optimizes prompt and timely movement along the continuum. In this respect, we ask that consideration be given to the development of a national framework that identifies required care and service components for a continuum that promotes improved service pathways and improved system navigation.
Recognizing that the federal government has a limited role in the delivery of many of these services, we propose that the federal government can play the role of an enabler or a knowledge broker to help develop these frameworks to enable those who have jurisdictions, like the provincial and territorial governments, to use those frameworks to assist them in their mandates.
National guiding principles are required to underpin a publicly managed and funded continuum of care and service to address seniors' health care needs consistently across all jurisdictions, irrespective of the providers being non-profit or for-profit. The key is that there are components to a balanced continuum.
This framework may include components that are required in a continuum, including enablers for optimal self- management, personal support, professional services delivered in one's home, supportive housing and assisted living, community support services, long-term care, various hospital services, and hospice care. These examples of components can be promoted in a continuum in any community to provide the required service.
The framework can also have per capita ratios that can be based on local demographics so that there are minimum standards based on evidence and best practices to support the development of these per capita ratios. Also, the framework can include suggested practices for determination of components such as functional abilities, affordability, access, consumer choice and effective supports.
In terms of the federal role as enabler or knowledge broker, there can be a brokering of knowledge by promoting research, sharing best practices, improving public education, recommending national standards for care and service within a balanced continuum, and recommending integrated care practices with practical measures based on evidence and best practices.
To conclude, we suggest that additional consideration be given to the enhancement of affordable supportive housing; expansion of affordable and accessible transportation and inter-municipal transit; improvement in the balance of service choices and movement within a consistent continuum of care and service, including care for those with dementia; and the development of the role of a national enabler or knowledge broker.
We thank the committee for this opportunity to share these thoughts, and will be pleased to offer any further information through questions.
Tom Peirce, Senior Director, Strategic Planning and Integration, Hamilton Niagara Haldimand Brant Community Care Access Centre: Madam Chair and honourable members, I thank the members of the Special Senate Committee on Aging for the opportunity to provide commentary on the Second Interim Report.
As a quick note of background, the agency for which I work, the Hamilton Niagara Haldimand Brant Community Care Access Centre, HNHB CCAC, has a keen interest in the well-being of seniors. Last year, our organization provided services to one out of every nine citizens in our region aged 65 to 74; we provided services to one out of every four citizens aged 75 to 84; and we provided services to one out of every two citizens 85 or older. You can see we share your interest and commitment to seniors.
As a quick note of background, Community Care Access Centres were formed in 1997 as a combination of the old home care and placement programs. We provide information referral to a broad range of health and social services. We coordinate in-home or school-based care for eligible clients, and we coordinate placement in all long-term care or nursing homes in the HNHB area, whether these homes are privately- or publicly-owned such as those operated by the municipality of Niagara.
We are the only agency in the region whose catchment area matches exactly the area served by the Local Health Integration Network. CCACs were reformed in 2007 to match those geographic areas.
Our integration partnerships span the health sector from community agencies to all 11 hospital corporations in the area, family physicians and education and social service agencies.
One more introductory comment is that I commend you for your broad view of well-being by looking at a number of broader determinants of health such as income, education and housing.
All my comments are presented with the utmost respect for the work of the committee. Most of my comments focus on health-related issues. I generally provide the recommendation number in my comments. If I have comments related to other content, I identify the section involved.
My first comments relate to section 1.2, Defining Seniors. I suggest that the categorization of seniors cannot be contained into a three- or four-step continuum. Rather, it is a complex matrix that reflects various ages and various levels of wellness.
In section 2.1, Active Aging and Active Living, I want to emphasize the point you make related to transportation. This region, HNHB, has some areas that have municipal transit, transit for disabled persons and even GO or VIA transit. Other areas within the region have absolutely no public transit, and it is an issue.
Recommendations 1, 2 and 4 deal with volunteerism and, while laudable, the recommendations may be hard to measure or may create the potential for bureaucracy to implement such things as tax credits.
Recommendation 6 addresses tax credits for an expanded definition of eligible courses. Since the contention above is that lifelong learning promotes greater participation in learning in later years, the credits for the broader range of eligible courses should be for all adults, and not only seniors, to develop that habit.
One comment, in responding to the health-related recommendations, is the obvious fact that health is primarily the responsibility of the provinces but I wish you every success in identifying programs or initiatives that are so patently beneficial we will not need to spend time convincing authorities in various jurisdictions to adopt them.
Recommendation 36 speaks to dental care. I bring to your attention a seniors' dental program within this region. The name is Halton Oral Health Outreach, HOHO. It is an award-winning program whose goal is to coordinate dental services for the elderly and adults with special needs in Halton, the Burlington area. Seniors' oral health should be a focus for all seniors.
In recommendation 41, I respectfully suggest that telemedicine should be advanced as a mainstream modality to increase availability of certain services. Mr. Ventresca talked about the challenges with respect to geriatric psychiatry in the Niagara region. I think that telemedicine is an emerging technology that can be used to bring about greater access.
Section 4.4 addresses chronic diseases and I suggest that recommendations should be made to prioritize the manner in which we attempt to manage such conditions as diabetes, congestive heart failure and chronic obstructive pulmonary disorder, among others. Along with prevention, better chronic disease management will increase the quality of life for those with these conditions, and reduce the usage of active treatment modalities.
Recommendation 54 speaks to the issue of supportive housing. Again, to note the disparity of services within only this region, the area of Haldimand and Norfolk has no supportive housing units. This lack can lead to an inappropriate or premature use of nursing home beds. Again, Mr. Ventresca talked about the waiting lists for long- term care homes. In HNHB, we typically operate somewhere around 99 per cent to 100 per cent occupancy, so beds are in use which, if there were alternatives, might be freed up to address those wait lists.
I support any recommendation that helps identify and support the civic-based champions of new supportive housing initiatives.
Recommendation 60 addresses a national home care program. I heartily concur, with the understanding that we raise the bar and not identify the lowest common denominator.
Recommendation 64 touches on the issue of caregiver support. In Ontario, we have the capacity for respite care, but only so long as the maximum hours allowed by regulation for the patient has not been exceeded. There is tremendous merit in assigning a separate basket of services in the name of respite to the caregiver, as opposed to tying it to the maximum level of service allowed for a particular client.
Compassionate care is addressed in recommendation 65. This program is a wonderful one and the one additional recommendation I ask you to consider is waiving the two-week waiting period. Employment Insurance has a two-week waiting period and there is nothing compassionate about a leave that creates economic hardship.
Recommendation 69 speaks to the sharing of best practices. This recommendation obviously relies on the good will of those on the leading edge. I support it, but wish the committee well in creating the sense of altruism in the broader population.
In conclusion, I have attempted to limit my remarks to those areas in which I have at least some direct experience.
Again, I commend the committee for its efforts. I hope that many of these issues or recommendations can be viewed in a non-silo, non-territorial manner. Many issues can and should rise above jurisdictional or political party limitations.
I again thank you for the opportunity to present and to strengthen your work, hopefully.
Maureen Etkin, Regional Consultant, Central West, Ontario Network for the Prevention of Elder Abuse: Madam Chair, honourable members of the committee, welcome, and thank you for this opportunity to respond.
As a regional consultant, my remarks will reflect all of Ontario. I want to raise the profile of senior abuse as a critical issue for all seniors.
Between 2 per cent and 10 per cent of older adults will experience abuse at some point in their senior years. That percentage represents up to 370,000 seniors across Canada and 160,000 here in Ontario. Cognitively- or physically- impaired seniors will be abused at a rate two to three times higher. Injuries from abuse and neglect seriously impact a senior's health and independence.
Senior abuse has widespread health, social and economic implications related to many of the issues and barriers of active and healthy aging that were outlined in the committee's interim report.
If senior abuse can be integrated more closely with some of the other report recommendations, there will be opportunities for greater impacts and cost efficiencies.
One of the main causes of senior abuse is isolation. Many recommendations made in chapter 2 under Active Aging dealt with helping to reduce social isolation of seniors. Realizing that these recommendations also reduce the risk of senior abuse is helpful in program planning, especially with the transportation issues that were mentioned, or even planning educational workshops for seniors on preventing and protecting against abuse.
Research on competency is another huge area that impacts senior abuse. Diminished capacity is a risk factor for abuse. Currently, declaring someone incompetent is too often an all-or-nothing proposition. A senior may be able to decide where they wish to live, but may not be able to make decisions about managing their finances. This area is confusing for seniors and service providers. There is a definite need for more research into best practice in this area.
Financial abuse is the most commonly reported abuse. A Canadian study found an average loss of $20,000 per senior. Losing financial resources reduces a senior's choices of where and how to live, and can undermine quality of life. The senior may need to stay in an abusive setting because they lack the funds to move. Financial abuse also means the senior has much less left for the basics of housing, food and medication.
Although an abused senior is kept isolated from others, at some point, they will have contact with a government worker, perhaps in regard to pension or veteran benefits. This contact provides the government with an opportunity to inform and educate the senior on how to prevent and protect against abuse. As well, government workers can be trained to recognize signs and symptoms of abuse and how to help.
Several recommendations were made concerning interdisciplinary education. It is important to identify those groups most likely to interact with seniors, such as pharmacists, personal support workers, and even dental care workers. We have had people from the Halton program sitting on some of our networks.
We should work with these groups toward a national standardized curriculum on senior abuse.
Personal support workers are one of the largest groups to interact with seniors in their homes, and may be the only contact an abused senior has with the broader community.
Other recommendations that can be broadened to encompass senior abuse involve public education initiatives. Part of healthy and active aging is learning how to reduce the risks of abuse and knowing where to access help. Most abused seniors do not know where to go for help and there is little consistency in what services are available across Ontario. This is a critical issue to be addressed.
In some places, service may consist of volunteers who answer a helpline between the hours of 11 a.m. and 3 p.m. maybe three days a week, and that is all that is available.
In Ontario, no single organization has the mandate to deal with senior abuse. Many organizations do not look for it and they do not find it. Too often, abused seniors do not fit mandates for service. This area again is a critical one that needs better integration, consistency, and some standardization across the province and across the country.
Most abuse happens in the community where seniors reside. The options listed in Chapter 4 to address abuse and neglect are all focused on providers and caregivers. There needs to be an option that focuses on the senior. As part of an integrated model, seniors need to be able to access the supports to help them manage an abusive situation, whether that means leaving or remaining. Seniors need more opportunities to learn about how to prevent and protect themselves from all types of abuse, with an emphasis on financial abuse. Financial abuse is the most commonly reported abuse, and seniors feel less threatened about learning about it.
Chapter 4, option 37, states, "Develop supports for caregivers and promote education to prevent burnout.'' This option fits better in chapter 5, under "Options for Supporting Informal Caregivers.''
Feeling stressed and burned out does not automatically lead to abuse. The majority of caregivers who feel stressed on a daily basis do not abuse. Other factors must be present. Yes, we need to support caregivers who take on the burden of care, but not as an option under abuse.
Option 38 speaks to improved training. Again, this option needs to be broadened to include more than care providers. It should include government workers, landlords, pharmacists, bank tellers, and paramedics. Any front-line worker coming into contact with seniors should be trained to recognize the signs and symptoms of abuse and know what to do next.
In summary, my recommendations include: create a broader understanding of the causes of senior abuse and the associated risk factors so that senior abuse can be part of an integrated model on aging; examine the list of existing options throughout the report for opportunities to include senior abuse — I highlighted those in an appendix in my brief; broaden the training curricula of government workers and others to include abuse; add an option on education and intervention targeted to seniors; and create a better consistency of response for abused seniors across the province.
My colleague will present a brief case illustration.
Gail MacKenzie-High, Chair, Niagara Elder Abuse Prevention Network, Ontario Network for the Prevention of Elder Abuse: Thank you, Madam Chair, and honourable members of the committee. I thank you for the opportunity to respond to the Special Senate Committee on Aging Second Interim Report.
I am chair of the Niagara Elder Abuse Prevention Network. The following is drawn from my 22 years of experience in working with the senior population.
Given the estimates of older adults experiencing abuse at some point in their senior years, based on our current demographics, anywhere from 1,512 to 7,560 senior persons will experience abuse in this region alone.
I want to share with you a composite illustration of some of the situations that have occurred in the Niagara region throughout my years of experience, that will provide you with an image befitting the remarks of my colleague.
Rosa is a 79-year-old woman, suddenly widowed, less than a year, from her marriage of 55 years.
As a result of her husband's recent demise, her income, which was largely dependent upon his private pension, has been significantly reduced. Her home is in need of regular maintenance, a car is in need of repair although she does not drive, bills have been piling up, and Rosa is feeling overwhelmed. She has withdrawn socially from her previous activities due to financial worries and emotional exhaustion.
She does not want to move from her marital home. Her adult son has moved in with her six months ago in an effort to offset costs and assist with the maintenance of her home.
A community agency is called by neighbours, reporting that they often year the son yelling and swearing, threatening to have his mother placed "in a home.''
In meeting with Rosa, the agency staff observed that she appeared to have some difficulty with her memory, although it is unclear as to whether this difficulty is the result of cognitive decline, or a reactive depression related to the recent loss of her spouse and her current situation.
Rosa reveals that her son has a history of sporadic employment and that she now suspects that he may have a substance abuse issue and perhaps a gambling problem. He denies these problems and thus refuses any assistance or help in these areas. Rosa gives money to her son to buy groceries for her, but little food is found in the house when agency staff visit, and Rosa reports that no change ever comes back from those shopping trips.
Rather than finding herself in a position where her situation is improved, Rosa finds herself further financially burdened.
She has one other adult child, a daughter, but she lives at a distance in another province. The daughter contacts her mother by phone on a weekly basis and has expressed concern that what assets her parents had saved are quickly being depleted.
Rosa discloses to agency workers that her son is sometimes verbally abusive. When asked if she thinks her son would ever hit her, Rosa denies it, but states she is afraid of him, claiming that when he drinks, he "gets into a fury and he could explode.''
Rosa wants help but expresses fear that if she asks her son to leave, she will not be able to stay in her home, and fears her only choice will be long-term care placement. While agency staff attempt to explore options with her, she chooses to take no action at that time.
Weeks later, Rosa presents to hospital with a fractured wrist, and upon physical examination, the physician notices bruising that is inconsistent with her explanations of their cause. With careful probing by hospital staff, Rosa reveals that her son has been pushing her around, and the police are notified.
Further investigation reveals that her assets have indeed by now been depleted and she may not be able to remain living in her home for much longer.
While charges will be laid against the son, Rosa has lost her ability to age in the place of her choice. She has lost her ability to be involved in the activities of her choosing due to her financial losses, and she has lost her relationship with her son. We need to know that while it might not appear to others to have been a relationship of value, it is still her child. There may be feelings of guilt and remorse associated with this loss, in turn leading to diminished self-esteem.
Physically, her injuries may take longer to heal and she may find herself with limitations affecting her ability to manage some of the daily activities that the rest of us take for granted.
An able person who, only a year ago, believed that she had control of her choices, found herself in a position of having inadequate income, suffering loss of trust, and facing imminent financial loss.
So, what would we have wanted for Rosa? We would want Rosa to maintain her choices in her senior years, and that goal supports options 24, 25 and 28 around income security, and all of Chapter 5 on aging in the place of choice.
We would want her to be able to identify the problem and to intervene before a crisis occurred, supporting option 38 on the training of human resource workers on senior needs.
We would want to prevent her financial loss, physical harm and emotional trauma, supporting option 39 around best practice guidelines.
In conclusion, I support the options identified in the report, while emphasizing the opportunity to expand upon many of them to include the prevention of senior abuse.
I respectfully recommend the expansion of options 37 through 40 to include education targeted toward the victims and potential victims, particularly the vulnerable and isolated seniors themselves.
I thank the committee for the invitation to present my remarks today, and for your consideration of our feedback on this second interim report.
Senator Cordy: Thank you very much and it is wonderful to be here. We enjoyed your scenery on our ride last night from the airport.
I am interested in the latest two comments about educating seniors in terms of elder abuse. First, I want to talk about how we educate seniors in terms of their rights and responsibilities. Educating and informing seniors is a concern. A high number of seniors in Canada do not receive their Canada Pension Plan because they are not aware of the fact that they must apply for it. The concern is, how do we educate them about receiving entitlements.
Have you found any programs that work in terms of educating seniors themselves on how to recognize, because they do not always recognize, that they are being abused? That is the first question.
Ms. Etkin: It is a challenge because people are afraid of the word "abuse.'' They do not want to admit it might happen, and there is that fear factor. So education is a challenge.
What I found to be useful when we have gone out to speak to seniors, in seniors' centres, going to where seniors are, is changing the wording a little bit to how to protect yourselves or how to prevent injury. Again, since financial abuse is so common, that topic is popular with seniors and with many people. If we use the topic, "protecting your finances,'' that way, we are able to bring in the other topics.
I think, as well, part of the education is not only for the senior, but for older adults, caregivers who provide care for the seniors. When we have worked with seniors where they are at, at senior centres taking part in programs and participating in senior fairs, that approach has been successful. The challenge, of course, is reaching those seniors who are not participating and who are more isolated.
Again, we have found it to be helpful to work with cultural groups. We have run programs where we have worked at providing the training to members of a particular diverse culture and then those members speak to their peers in their own language. Going to churches, temples and mosques is really finding out where seniors are.
In some of the diverse communities, the best place to reach seniors is through the grocery store and putting up pamphlets there.
I think there is no one particular approach. Again, I think the more we can integrate it into the activities that seniors are taking part in, the better. A growing number of seniors are becoming more computer literate. The Internet is a wonderful place as well to provide programming as long as it is senior-friendly.
Senator Cordy: You talked about training the public, and you gave examples of bank tellers, lawyers, physicians, pharmacists and landlords to recognize potential abuse so that the doctor in the hospital is not the only one noticing it. There are many people.
Should we have a national education program, and not necessarily call it "Look for abuse,'' but "Watch for your neighbour''?
Ms. Etkin: There are many successful programs, even one right here in Niagara called Niagara Gatekeepers. The Gatekeepers program has that premise of training and highlighting people out in the community to recognize abuse. Again, it can be expanded for all vulnerable seniors, so that we are looking at postal workers, and at people in the beauty salon.
There are examples. This program also exists in the States — probably Ms. MacKenzie-High can give you a little more information — where there is a heavy emphasis on training everybody who come into contact with seniors. If this was a national program, it would help to move it ahead and to increase the recognition factor.
Ms. MacKenzie-High: The Gatekeepers program started in the United States. It has been brought successfully to Niagara. I believe now they are looking at expanding on a provincial level, but absolutely, what we need is a national format of that program to ensure that the general public is trained in what to be aware of and what to report, where they can report it and where they can send people for help.
Also, the Ontario Network for the Prevention of Elder Abuse has created effective public service announcements that have been televised, that show demonstrations of abuse. I would like to see more of that work on a national level so that those people perhaps who cannot go to the public presentation will have an opportunity to say, that happened to me, and that might be abusive. Then, they have a number they can call.
We want to see it broadened on a national level.
Senator Cordy: My last question is for Mr. Ventresca.
I am interested in more information about your regional dementia centre. Is there a huge waiting list to access it, and how did it start?
I am also interested in your multi-agency team because that is a challenge, to have government departments working with one another, and how you brought government departments together.
Mr. Ventresca: The dementia centre was formulated after a number of community groups and consumer groups came together to recognize the need for two dimensions of dementia care. One is the respite side, where family caregivers care for their loved ones at home, but from time to time need support beyond, let us say, in-home respite, which Niagara region operates, or perhaps day programs which Niagara region operates.
We found that there was sometimes a need for overnight respite or several days of respite, so we created a place for eight. It is like a little bed-and-breakfast for eight people at a time who can come to live for overnight or for a few days. We also have a day program there, so that day, evening and night continuous respite can be offered to families, so that families can take a break from time to time or, if something comes up in the family caregiving dynamic where perhaps a spouse looks after a person with dementia at home and the spouse takes ill or whatever, we have this service in Niagara. It operates across the entire Niagara region. It is located in St. Catharines and it is attached to one of our long-term care homes.
The beauty of that service was that it was along with the other side, which is a 17-bed bungalow again, for those who have advanced dementia, who are perhaps already living in a long-term care home or who need placement and are having difficulty being placed. It provides an opportunity for folks to be assessed for a 90-day period prior to admission to another facility. If they already are in a facility and that facility is struggling to maintain them in their facility due to behavioural issues that go beyond the capacity of that long-term care home to manage, then the facility can seek a transfer to this centre. Staff members who are better trained than the average long-term care home staff, along with the psycho-geriatric resource consultants from the psychiatric hospital in Hamilton, can work along with us to assess what interventions may work best, and then have these folks go back to their original long-term care home in their own community.
The beauty of that approach was that it was formed through community activists who came together, and through the municipality and through an opportunity that came up through the Ministry of Health in Ontario, to rebuild some of our aging facilities. We capitalized them and skimmed these beds from the larger component of beds to be developed, and created the centre.
The notion of an interdisciplinary multi-agency assessment team came up because they were already involved in the planning, so we said, the Alzheimer Society, the hospital and the psycho-geriatric consultants who are working in the community often have common clients. Why not come together as a team to assess their needs and then make a joint decision?
Our staff chair that committee, but when the folks are at the table, they are not really working for their agency, they are working for the person who is being assessed at that time. That is the beauty of the approach, and that is why they were nominated for an award; for making practical, integrated health care happen, which is often talked about.
As you know, in Ontario there are 14 Local Health Integration Networks who encourage and enable this kind of approach. We did it here in Niagara based on the needs of the individuals and the community's will to serve them in an integrated way.
Waiting list I think was the other part of the question.
There is always more demand for service than there are resources to provide the service. In the area of complex dementia, the 17-bed unit is typically filled at all times and people apply that we cannot admit. That is why I said earlier in my remarks that we either assess their applicability or suitability to be placed in the T. Roy Adams Regional Centre for Dementia, named after a former mayor of St. Catharines and a long-term advocate for people's needs in Niagara. The Adams Centre either admits them or we provide alternative care in the event that we cannot, but yes, there usually is a waiting list.
On the respite side, it is more week to week and month to month, because the needs crop up as they are, but it operates at a high occupancy rate, although it is good to keep a few vacancies there to respond to the unforeseen needs that may arise from time to time.
Carol Rudel, Manager, Seniors Community Programs, Regional Municipality of Niagara Community Services Department: With regard to the respite centre, I want to describe some of the new features that I think are important if you consider a national respite program. It is important to consider respite in its broadest terms so that it is not restrictive in terms of its access.
The purpose of respite is to provide the caregiver with the necessary support at the time it is needed. If it becomes a complex program from an access point of view, then it becomes a burden on the broader health system.
If someone requires physician assessments prior to coming in or they require specific med pharmacy orders that require an individual from the community to continue to go back to various medical support services to access the centre, it becomes more cumbersome.
What we found with the Adams respite centre was a willingness in Niagara from a lot of community partners to take a look at the access protocols for a long-term-care funded respite bed, that being an overnight bed, which is offered through the Community Outreach and funded on the community side of things.
We realized that we needed to provide rapid response at a time that somebody needed it, and if access is too complex, then we cannot optimize the utilization of that program.
We introduced the adult day program into that location, recognizing that respite comes at any point within a 24- hour period. Somebody may need it for 24 hours, they may need it for 12 or they may need it for six. To establish a respite program, it is necessary to recognize that the need for respite does not fall within a defined period of time.
The Chair: Thank you very much. Before I turn to Senator Mercer and Senator Chaput, I need a motion, senators. Apparently, local television will come to the meeting. They have agreed to abide by our normal rules. Can I have approval that television cameras can set up? So agreed.
Senator Mercer: I found this discussion of elder abuse disturbing but also some of the suggestions that you made intriguing. I find the financial abuse in the case of Rosa, that you gave, interesting.
Yesterday, I attended a meeting of the Ontario Seniors' Secretariat Liaison Committee in Toronto, on behalf of the committee. One thing that was brought up by the francophone organization, La Fédération des aînés et jeunes retraités francophones de l'Ontario, FAFO, was that they had put together a new booklet on the ABCs of fraud.
When we have difficulty talking about the financial abuse that happens, and a good deal of it coming from family members, if we could find a way to somehow work it into the education of the community and of seniors themselves, it might be interesting if we could use some of the good work that has already been done by others.
I am curious, though. You talked about the need for cross-disciplinary education and to involve people in reporting or identifying elder abuse. We talked about pharmacists, doctors, nurses, dentists, Veterans Affairs Canada personnel, bank tellers, lawyers, postal workers, and probably others that I have missed. That is a long list of people.
How do we protect the privacy of both the senior and the reporter of a potential elder abuse, and also not put such an onus on reporters that they will not report because it will cause too much trouble for them to report what they have seen?
Ms. Etkin: I think we do not necessarily want to go with the reporting mentality. It is more that we want those people to recognize that this person may be abused and provide them with the option that help is available, and where they can find it, or, depending on the person, they may be able to offer some of those supports.
For example, for bank tellers, for financial managers, it is usually obvious that something is going on. Large amounts of money are missing, someone always accompanies the senior and the senior is forced to sign documents. There are simple things they can do at that level in terms of speaking with the senior alone and letting them know some of the dangers of a joint bank account. For example, if they add this person's name to the account, does the senior know that in five minutes that person can clear the account out? Most people are not aware of those things. Does the senior know their pension cheque can be deposited directly into the bank account, so that when their nephew shows up on May 1, because that is when the cheque comes, they do not need to worry about that cheque.
People can do a lot of practical things. I think part of the issue is that elder abuse is so hidden, so bank tellers and others do not think about it, because we do not see it on the media, we do not hear about it, and so it is not at the top of their list.
Senator Mercer: I want to continue with bank tellers and bank managers for a moment, because we all end up dealing with that common denominator in our lives, whether we are young or old.
Do we have programs to educate bank tellers to watch for abuse? I had a personal incidence in the family recently with my uncle, who was making some financial changes. When he contacted his lawyer, his son was with him. The lawyer pointedly removed the son from the room and said, is this what you really want to do? The lawyer determined that change was exactly what my uncle wanted to do, which was fine. However, bank tellers and bank managers are not social workers. They are not people who are normally trained to identify abuse.
Have we embarked, or maybe we should embark, on an education program through the banks and through the credit unions to say, here are warning signs to look for, and here are simple things you can do to help, by asking several questions of the people.
Ms. Etkin: There are programs already that some banks have gone ahead with; I think the Bank of Nova Scotia and the Royal Bank. The problem is, the program is not standardized across the province, and it is not in every branch. We are not trying to make them into social workers because we would target the education to their area of expertise, which is finances.
Most of the time, if we speak to the bank tellers, they knew something was going on, but they did not know what to do about it. There was no policy and no mention of it. They are leery about confidentiality. They do not understand the boundaries. I think there is a lot they could do that they would welcome.
As an example, my mother, who is 87 years old, lives alone in Winnipeg. I am a Winnipegger. When my father passed on, she had never handled the finances. She went to the bank. The bank had a long-standing relationship with my father and they were excellent. They had a separate area set up for seniors. They helped her. It was marvellous.
After five years, as you know, the bank tellers and everybody rotate. Those people, away they went. The next time I went to the bank with my mother, that relationship was gone. There was no more seniors' corner; there was no one there who knew my mom. She had to go in the regular line with the bank tellers and speak loudly, and she did not know what was going on. The person behind would have total input into all her financial stuff. Why did that happen? It was such a wonderful program.
Sometimes, it is dependent, I think, on who the bank manager is and whether the bank has a huge population of seniors in that branch, but there is no reason why it cannot be more standardized.
The Chair: If I can interject for a moment, it can also happen the other way around.
In my father-in-law's case, $72,000 was taken from his account by a teller.
Ms. Rudel: Here in Niagara at least, and this is where I think we need to expand to a national type of program, the Gatekeepers program is volunteer-driven and part of their mandate is to train and educate bank tellers and bank managers. I know there are fraudulent bank tellers as well, unfortunately, but we need to educate the honest ones what to look for and what to recognize.
We have designed an effective system here in Niagara, although we probably need more Gatekeepers volunteers to help us with that. The Gatekeepers organization has partnered, in fact, with the Community Care Access Centre to monitor what we call the Gatekeeper Line, so those bank tellers can then contact the CCAC Gatekeeper Line and volunteers take the basic information and forward it to the most appropriate agency.
If, for example, it is a scenario of potential financial abuse, the most likely scenario is that the CCAC would forward that information to one of the community workers with seniors' community programs for the region of Niagara, who would then go and investigate with that person. It may well become a police issue if it is a fraudulent act or a theft, but the community worker will walk with them through that process.
There is some support but even here in Niagara, we could use more bodies, and indeed, to expand the program on a national basis. Whether it is called Gatekeepers or something else, it is the direction to go.
Senator Mercer: You have anticipated my next question, which was exactly that. Perhaps, we should make a note of the Gatekeeper program because it might be under our heading of Best Practices. It is obviously one that we might want to steal from you. It is a good idea.
Ms. Etkin: Our organization also has already developed a curriculum that can be used for these various groups, so we would not need to start from scratch to develop these materials.
Senator Mercer: Is it possible to make that curriculum available to the committee?
Ms. Etkin: I believe we brought a copy for you, as well as the public service announcements that you can take a look at.
Senator Mercer: I thought it might be a good idea that the committee view the public service announcements at some point when we go back to Ottawa.
Mr. Peirce, as you moved through your report, your support and recommendations on our recommendations, you talked about telemedicine, about which we have not had a discussion on before.
Can you expand on what is happening in the region, how it is being used or how you would like to see it expanded?
Mr. Peirce: Telemedicine is an emerging field that has the capacity to expand the availability of services or the ease of delivery of services.
Three telemedicine networks in Ontario were merged in the last year to year and a half to form the Ontario Telemedicine Network. They have three priorities: administrative efficiencies to hold multi-site meetings; educational opportunities; and clinical efficiencies to provide, for instance, wound care off-site, where a camera is there, and a specialist can be in a specific site, see wounds from all over the province, and make recommendations on the treatments, et cetera.
That type of program has unlimited capacity to expand available limited resources.
A second program that is currently in a test phase in Ontario is a program with family health teams on using telehome care, instead of telemedicine, for chronic disease management. This care does not have the camera component but transmits data — vital signs, et cetera — for people with specific chronic disease conditions that are then monitored centrally.
If somebody has congestive heart failure and all of a sudden their weight goes up over a short period of time, that is identified and the caregiver says: do they need to take a Lasix; do they need a visit; or do they need to go to an emergency department.
Those sorts of modalities, especially in more rural and remote areas, have tremendous capability and are expanding.
For telemedicine, I will bow to the Maritimes. In New Brunswick, there is a post-cardiac program where people take a camera and equipment home to monitor post-heart condition and hospitalization stays, and it has had tremendous results.
It is an emerging technology that helps deal with the health human resource shortage.
Senator Mercer: I will put my other hat on. I have been involved in a study on rural poverty. One big problem we talked about there was the real problem of transportation in rural areas. Telemedicine might eliminate that seemingly necessary visit to the doctor that they cannot manage because they are elderly and they require assistance to go there.
Mr. Peirce: As a further example, with the Community Care Access Centre, many of our shorter stay clients are on- service with respect to post-surgical or other wound care issues. There are a limited number of wound care specialists in this province. With an expansion of telemedicine, if the wound care specialist can be centralized and work with a nurse who makes a visit, there is the capacity to use that expertise on a much broader basis.
Senator Mercer: Do we use nurse practitioners in that program as well as doctors?
Mr. Peirce: Yes, definitely: I am not sure if wound care specialists technically would be nurse practitioners, advanced care nurses or advanced practice nurses.
The Chair: Not so many years ago, I observed a pilot project in Prince Edward Island, which was an incredible monitoring system of patients in their home, where blood pressure, pulses and all that kind of thing could be taken routinely every day. The home care nurse called the patient. The patient was in front of their little machine and all that information was immediately relayed.
It seems to me that we have not made nearly the kind of advances that we should have made in the further promotion of that technology, but what about further promotion of health information on your health card?
The common complaint I receive from seniors is the continual amount of testing that they are required to go through when they go from one doctor to another doctor, to another doctor, when all that information could be encrypted and could go with the patient.
What is your attitude about that kind of innovative thinking, Mr. Peirce and Mr. Ventresca?
Mr. Peirce: I believe each of the 14 Local Health Integration Networks have what is called a new Integrated Health Services Plan, IHSP. Every one of them has, as one of their priorities, the advancement of the electronic health record. It is a high cost investment but it may be short-term pain for much longer-term gain. Accurate, timely information that reduces duplication of tests and misinformation being communicated has merit. I believe as much effort as is necessary should be put into it to advance it nationally.
Mr. Ventresca: I think Mr. Peirce has nailed that issue nicely there.
The only thing I could add is, from the perspective of long-term care home operators, where we have come together within the area of the Local Health Integration Network, LHIN, a group of 20-some-odd homes have expressed an interest in becoming involved in some of the LHIN initiatives to record or have the information available electronically and share it so that seniors tell their story once and not have to repeat it over and over again. More importantly or equally important is not to have the system repeat all those tests with all the expenses involved.
The issue we face is one of funding. It would have to be at a higher level at the provincial level to say that this will be —
The Chair: Federal —
Mr. Ventresca: I do not want to go into any areas of federal and provincial jurisdictional discussions, but if there was a national standard or framework for this kind of thing, possibly with funding to be distributed to the provinces and territories to initiate it, that would be wonderful.
From an operator's point of view, we would want to do that. I think our consumers would be interested. It is a matter of a strategy, with funding to accompany it, to make it happen.
The Chair: Before I turn the floor over to Senator Chaput, I will introduce a colleague from "the other place.'' We never refer to members of the House of Commons and the Senate chamber as "the members of the House of Commons'' or "members of the Senate.'' We refer to them as "the members from the other place.''
The member from the other place at the back of the room is John Maloney. Nice to see you, John.
John Maloney, Member of Parliament for Welland: Welcome to Welland.
Senator Chaput: My first question is for Mr. Ventresca.
In your conclusion, you talked about the role of a national enabler and knowledge broker. Interestingly enough, our committee had a witness who told us that health care needed much more planning at the national level. As a matter of fact, I think he even told us that we did not plan at a national level; that there was not much planning.
Does that comment tie in with one of your conclusions here, and would you care to expand more on what you meant by the role of a national enabler and knowledge broker?
Mr. Ventresca: The role of an enabler and knowledge broker is one where information can be brought together and shared with those who have the responsibility of implementing the care.
I am sensitive to the issue of federal and provincial roles. If provincial and territorial roles are to deliver health care, for example, except for the selected groups that the federal government has direct jurisdiction over, then how does one influence what other parties are accountable for without having that direct authority?
The idea is to provide, first of all, the means to draw the information together, funding those who may do the research, those who will assemble the information, and then perhaps pull people together at national conferences or things like that, and provide input into frameworks. That input can then be taken to those who have the jurisdiction of delivering health care to apply that, with perhaps national standards or national goals, if they are reported. For those who do not meet those standards or goals, there will be subtle pressures because, again, the issue is not having the authority over those who provide the service.
By having that framework and some infrastructure to support that framework and deliver the message and the information, hopefully those who have the responsibility for delivering that service will take the information and apply it.
Senator Chaput: You see that taking place through some kind of a national policy, a policy at the national level?
Mr. Ventresca: I am not familiar with all the federal mechanisms to achieve that delivery, but provide the role of whatever it would take, whether it is a policy accompanied by funding to enable that process. Some initiative at the federal level to make that process happen would be a step in the right direction.
Therefore, when we learn about the Gatekeepers, when we learn about the Adams centre, it is shared not only among those who happen to use it, but that information is shared with others. Others are shown some of the tips and secrets to achieving it, and what are some of the successes, and hopefully, others will pick it up and do it in their area.
Senator Chaput: Mr. Peirce, you talked about telemedicine. You answered a question from my colleague.
On the seniors' dental program, you said you had such a program here, right? Can you expand on what has been happening in that program?
Mr. Peirce: There is a program in Halton, centered out of the Burlington area, which is the far northwest of our region. It is the Halton Oral Health Outreach. It attempts to provide dental care to seniors or adults with certain disabilities who might not otherwise access dental care.
There are so many aspects of health where, if your feet are sore, your mobility is affected; if your mouth is sore, your nutrition may be affected. The program focuses on trying to provide adequate dental care to some vulnerable or at-risk populations.
It has been an award-winning program of the Canadian Dental Association and the Ontario Association of Community Care Access Centres. It is associated with the Community Care Access Centre, which identifies seniors who qualify for that program and need that program, and they make that referral.
Senator Chaput: Is it a cost-sharing program? Who initially pays for that service?
Mr. Peirce: It is an insured service. They obtain funding for those clients at-risk. One of the reasons they are at risk is because they may not be able to afford it. If they have ill-fitting dentures because of aging, they cannot afford a new set. They have identified funds so that these services can be provided.
Senator Chaput: Who are "they'' who have identified funds: the region, the province, the association?
Mr. Peirce: It is an entity onto itself that is volunteer-driven, and it goes after the various funding sources.
Senator Chaput: How do they identify those who need the service?
Mr. Peirce: They promote it. As I said, in this region, we deal with one out of every two people over the age of 85 and one out of every four over the age of 75. One of the roles as case managers is in taking referral. When we deal with someone, we try to identify the broadest basket of services possible for those for which we have direct responsibility like in-home nursing or personal support therapies. We also have knowledge of nutrition programs, meal programs and other social and health services. We identify for these people where they should go, or we help them connect to those services so they have that broadest basket of services possible for their specific needs.
If somebody is diagnosed with Alzheimer's, we will refer them to the Alzheimer Society for their support programs and their spousal support program, again so that we let them know as many services as are out there, and try and promote them so they use them appropriately.
Senator Chaput: I had questions about senior abuse, but they have been answered. I want to tell you ladies to keep up the good work, because the issue is a critical one.
The Chair: That comment will bring to a conclusion this particular panel. I extend my heartiest thanks to all of you. You have contributed to our information base as we go forward, and I am sure you will see some of the ideas you have presented, if not all, reflected in our final report which, by the way, we hope to table on September 30.
Senators, we now have with us, from the Alzheimer Society of the Niagara Region, Marge Dempsey, the Acting Chief Executive Officer; from the Ontario Home Care Association we have Susan D. VanderBent, who is the Executive Director; from the Hamilton Council on Aging, we have Denise O'Connor, who is the Executive Director, and Carolyn Rosenthal, who is the Chair of the Board of Directors; and from the Community Support Services of Niagara, we have Wendy Walker, who is the Executive Director, Patricia Tooley, who is the Program Manager, and Pat Frank, who is Chair of the Board of Directors.
Welcome to all of you. Let me begin with the first group, which is the Alzheimer Society of the Niagara Region.
Marge Dempsey, Acting Chief Executive Officer, Alzheimer Society of Niagara Region: I am delighted to be here. Thank you so much for this opportunity.
I will focus on the dementia perspective because as an organization, we serve all people in the Niagara region who experiencing dementia of any kind and I think that, as a country, we need to recognize that Alzheimer's disease is not the only problem out there.
This population, as you are fully aware, is growing enormously and will continue to grow until we find cures.
My presentation is from the perspective of people with dementia, which we see as a huge issue at the moment; that is, people with dementia who are out in the community living alone.
As you are probably aware by this time, I was not able to hear the initial speakers this morning. Niagara has a high population of elderly, the highest in Canada now; 17.4 per cent of our population is over the age of 65, so we are now number one in Canada. We were partners with Victoria and have now exceeded them.
What we also know though is that 8 per cent of all those over the age of 65 have a dementing illness of some kind. In the Niagara region, that percentage translates to about 7,300 people currently.
What we also know in our community is that 29 per cent of our seniors live alone. That is all our seniors. We have a population in Niagara of about 14,500 people who live alone in the community who are over the age of 65. That percentage of seniors living alone also translates to our population. People with dementia in the community here, if we look at it percentage-wise, we have about 1,100 seniors with dementia living in their own homes, on their own, at any given time. That situation is not unique to our community. That is something we face across the country, where people in the community are living on their own and who are experiencing significant changes in their cognitive abilities and their ability to function on their own. Because of that situation, this issue becomes huge for us as a community at large.
Currently, in our own population, about 28 per cent of those we serve who are living alone have no local family, and about 18 per cent have no family whatsoever. These people have no caregivers. This issue is also huge, because who is there to assist them appropriately in meeting their own needs when they are no longer able to do that on their own?
The dilemma is, when we look at this population, that as their cognitive changes increase, they no longer recognize that they have any problems. Therein lies the big difficulty, because what they do then is they refuse services because they do not think they need anything and that refusal leaves them failing. People with dementia who are on their own, because they do not have anyone to direct or to cue them, have what we call excess disability. They are more disabled than they would be by virtue of the disease, the damage of the disease, in and of itself. They are more impaired because they have nobody to support them, direct them or cue them.
This situation leads to people who are unable to meet their own needs in terms of remembering to take their medication, remembering or even knowing how to prepare their own meals, when they are at risk and those sorts of things. This lack of support leads to early admission to long-term care.
These populations need care way beyond what ordinarily would be the case if they had community supports, and if they had family members who lived with them and were able to support them effectively.
Our goal, as an organization, is to have this issue recognized. I think that it is not only our population who is cognitively impaired. While dementia is certainly an issue, people over 65 who live alone in the community have problems in and of themselves. It is an issue that we need to deal with as a community, as a nation, to ensure that this population will be adequately served and adequately resourced.
For persons with cognitive impairment who do not recognize their own risk and their own needs, we need to find innovative ways to assist them. The difficulty lies in the fact that we have a system that operates on certain mandates. If they refuse services then they will not receive services, whether they require them, because people have the right to risk.
We have to find ways to overcome the dilemmas that arise because they do not understand their own issues. We must be more innovative in how we try to serve them appropriately to keep them in their homes, which is what they want anyway because the next problem arises when we try to move them into care because they are at risk and they refuse to go. That is the worst-case scenario.
You heard about the Gatekeepers program earlier. One thing that happens is that these people are identified in the community as being at risk, often by the bank teller, the gas company or whomever, and the people who identify them want them to be assisted. Then our hands are tied because they refuse to go and obtain the help they need. They are still there, and people say, why do you not do something; you have to do something. We recognize that, but the process is a difficult one.
Ultimately, as I bring this issue to your attention, I hope that we can start to look at it, not only at the community level, but at the federal level, the national level, and the provincial level, in recognizing that we need to find ways to serve them appropriately. We need to ensure that individuals who want to remain independent, as they all do, are given the best opportunities to do that in the most effective ways to support them. To do that with this population, we have to be innovative.
The Chair: Before I move to the next presentation, I want to review some of the stats that you gave us. When you said that 29 per cent of seniors live alone, is that of all seniors?
Ms. Dempsey: That is all seniors in Niagara. Our current status is that 29 per cent of Niagara's seniors live alone.
The Chair: Twenty-eight per cent of all Niagara seniors have no local family?
Ms. Dempsey: That is our client population.
The Chair: I wanted to make sure. Thank you very much.
Susan VanderBent, Executive Director, Ontario Home Care Association: Good morning. Thank you for inviting us to come and present before you.
The Ontario Home Care Association, OHCA, is an organization of home health and social care service providers. Association members deliver nursing care, home support services, personal care, physiotherapy, occupational therapy, social work, dietetics, speech language therapy and medical equipment and supplies in the home.
Ontario Home Care Association members are contracted by all three levels of government, the Community Care Access Centres in Ontario, insurance companies, institutions, corporations and private individuals. OHCA members are accredited through the Canadian Council on Health Services Accreditation or the International Organization for Standardization, ISO.
The OHCA endorses the principles of the Canada Health Act and the Canadian health care system, which delivers a range of essential care services available to all residents in Canada on the basis of need, not ability to pay.
Home care is not part of the Canada Health Act, as I am sure you all know. Accordingly, policies, services and definitions vary between provinces and territories in Canada.
In Ontario, our publicly funded home care system falls under the jurisdiction of the Ontario Ministry of Health and Long-Term Care, which provides stewardship of our health care system in Ontario. Local health services are planned and funded by our Local Health Integration Networks.
Accountable to the LHINs are the CCACs, which provide access to the government-funded home care and community services and long-term care homes. That is our Ontario system, which I am sure you know.
Eligibility for publicly funded home care is determined through the CCACs, and care is delivered by service provider agencies that have been chosen through a process of competition. Service providers in Ontario can be privately owned or not-for-profit organizations.
As is the case elsewhere in Canada, OHCA estimates that the majority of home care is still given to loved ones by their families and other concerned unpaid caregivers.
I will provide some stats about the Ontario system that may be of interest to you. In 2005-06, 649,244 clients received home care services funded by CCACs. That is an awful lot of people. On any given day, approximately 185,000 Ontarians receive services through CCACs. In 2005-06, 25,766,724 visits and hours of care were delivered in Ontario; 67 per cent of that care was for personal support and homemaking, so the bulk of the care is personal support and homemaking. Nursing care, such as load management or infusion therapy, represents approximately 27 per cent of the care. Therapies such as occupational therapy, physiotherapy and dietetics, represent about 6 per cent of the care that is given. The elderly, those over 65, represented 58.5 per cent of admissions in 2005-06. Finally, 88 per cent of Ontarians surveyed in a Polara poll in 2006 indicate a preference for home care for themselves and the wish to live independently in their own home.
I will make some general comments about our aging society and then go directly to the options that we felt able to comment on.
Ontario's growing active senior population, we believe, is a testament to our progressive health care system and to our success as a society. We see this growth of our seniors as a good thing.
Our seniors play an invaluable role in our society and they contribute to the social fabric of communities.
One of the greatest health care priorities facing us right now is the need to respond to changing societal norms regarding seniors' expectations to live and age independently at home. How can we achieve that expectation?
While seniors of the future are predicted to be the healthiest in history, it is also known that the likelihood of developing chronic disease increases with age and can compromise independence. Therefore, we believe a strong home- care system is necessary to support seniors.
Most, if not all, people wish to remain independent during their older years. However, growing numbers of community-dwelling seniors are at risk for loss of independence, as Ms. Dempsey has told us, because they need more help than is currently available in the health care system to age at home. A clearly identifiable trigger point for imminent loss of independence is when a family decides, often for safety reasons, that a person must look at application for a long-term care facility.
This activity is often initiated by individuals who are on the fringe. I think Ms. Dempsey described that situation well. They are on the fringe. They need a little more help than is currently necessary or offered within the community system. They do not require the full scope of facility services, but they are on that fringe. It is at that point where we believe enhanced and focused services delivered in the home would make a major difference in the quality of life for the senior person and for their loved ones.
I will turn now to our recommendations and then finish up. We wanted to make comments on options 60 through to 69.
Our conclusion is that we are fortunate to live in a prosperous country where citizens can enjoy a high quality of life as they age. We recognize there are a number of opportunities to create an environment where seniors can live at home for as long as possible. To create that environment, there needs to be a willingness to change existing practices, and we need rigorous evaluation of new programs that are designed to keep people in the home.
In response to the Special Senate Committee on Aging Second Interim Report, OHCA provides recommendation on the home care section. Here are our summarized recommendations.
We believe that a national home care program is something that potentially can reduce or restrain the basket of services currently offered in existing provincial home care programs. Therefore, we, as well as the Canadian Home Care Association, are not in favour of a national home care program.
We began discussions about a national program after the Romanow report, and looked at the Health Transition Fund. We found such a variation between provinces in their home care programs that, in particular, Ontario's program, which is good compared to others, would have had to have been reduced to create a national program. This reduction would be difficult for Ontario and some of the discussions then were halted as a result.
To look at something like that, we need to take into account that existing services and programs are in place, and maybe those services and programs would have to be the bar that we start from.
I give you that recommendation and the rationale behind it.
We recommend that home care be expanded to be more actively engaged in activities that address prevention and proactive management of people diagnosed with chronic diseases. We need to go upstream. We need to start addressing some of the issues that people have early in diagnosis of a chronic illness.
The health-care system of the 21st century will be to look after people with a chronic illness during the trajectory of that illness. We are far beyond episodic care nowadays.
We believe that a tax exempt savings plan or registered chronic care savings plan be adopted so that basic services to support activities of daily living can be purchased by families. We need to start helping people think about planning for their older years because we are keeping people healthier and longer in their home, and we are grateful for that situation. As a result, they live longer and they have more challenges.
We believe a national respite program framework should be established so that there is consistency to approach across the country but still opportunity for local flexibility as required by individual provincial and territorial contexts.
We recommend the federal government develop incentives for employers to create employment practices that are supportive of family caregivers. The formal home-care program does not provide the majority of care. Loved ones do that job, and we believe they always will.
We believe a forum should be created to enable more sharing of integration practices across the country. I have brought papers for the Special Senate Committee on Aging that were written about integration practices, and some key quality processes that every organization and every system of health care should look at as people transition through the entire continuum of care, from acute care through to home care, within the home care system and perhaps even into long-term care.
These key quality processes can help us establish benchmarks.
We believe that the mandate and funding for home care in Ontario needs to be expanded to achieve better integration with our system partners.
We believe that financial support, including Canada Pension Plan dropout provisions for family caregivers, be studied further, with an aim to ensuring appropriate and meaningful financial support for family caregivers.
Carolyn Rosenthal, Chair, Board of Directors, Hamilton Council on Aging: The Hamilton Council on Aging is a new organization that seeks to educate and advocate for improved aging experiences for older adults through a collaborative network of individuals and organizations.
We share both your vision of an inclusive Canada where seniors are engaged, active and healthy, and the values that you have identified as crucial to achieving this vision. In this spirit, we have three main points to make in response to your report. I will start by summarizing them and then elaborate.
First, we appreciate the comprehensiveness of your report and the excellent options your committee has generated. We strongly encourage you to adopt the World Health Organization Age-Friendly Cities model as a policy framework that supports and enables healthy, active aging.
Second, we recommend that transportation be given greater emphasis in your report.
Third, we want to share some of our experiences in working to address two of the key issues for older people in Hamilton, poverty reduction and social inclusion among seniors from some of the newer immigrant communities, and recommend that your report devote more attention to older immigrants and cultural diversity.
Let me begin with Age-Friendly Cities.
We fully share your enthusiasm for the WHO model of Age-Friendly Cities. We would be thrilled to see the Senate of Canada champion the Age-Friendly Cities cause. We think the model is an excellent one for maximizing the potential for healthy, active aging, positive aging, for individuals, and a good model for preparing our communities to support the large populations of older adults that we will experience in the coming years.
However, it will take a lot of support to help cities implement this model, and having the Senate as a national champion will help ensure that we move forward in making our cities age friendly.
The Hamilton Council on Aging has been excited about the Age-Friendly Cities model for some time. We are currently awaiting a decision on a grant application for funding that would enable us to move this vision forward in our city.
If we are funded, we will be the first large city in Canada to try to implement this model.
The Hamilton Council on Aging sees itself as serving as a catalyst by engaging a broad range of community partners in this initiative, and that is the way we have worked to date.
In developing our proposal, we were greatly encouraged by the excitement and support we found in our community. Among the various groups and organizations we met with, all felt strongly that our community is right for this initiative.
We know people are excited about this model and about the potential to implement it in Hamilton. We know too, from our participation in a meeting a week or two ago in Toronto, that the provinces are onboard for this. What we need is support in implementing this model.
It is not only money that is needed, although money is required, at least initially, but we need to mobilize the will of people in our community so that we can change the way we do things and create environments that support positive, healthy aging. We must do things differently.
Turning to transportation, one aspect of Age-Friendly Cities that we felt could be given more prominence in your report is transportation. It is a key issue for seniors in Hamilton, as elsewhere, especially people on low incomes. Transportation is closely tied to access to health services, social inclusion and active aging. Specific issues vary from one community to another, and among urban, suburban and rural areas.
We need a policy framework and funding for local creative solutions, and we can anticipate that access to transportation will continue to grow in importance as the price of gas rises, as seniors must give up their cars and as our suburban population ages.
We recommend two things.
First, we urge the federal government to assist municipalities in expanding public transit and to dedicate funding for upgrades to ensure that transportation is wheelchair accessible.
Second, we urge the federal government to adopt a basic tax credit of up to $2,000 for transportation that could reimburse 75 per cent of receipted transportation costs, both for seniors over 75 and for anyone with documented disabilities. This tax credit would help seniors and the disabled achieve participation and independence by removing the barriers caused by inadequate access to transportation to programs or even to medical appointments.
Third, I will talk a bit about two projects that our council is currently engaged in that are helping us move towards the Age-Friendly Cities vision, and that address two particular problems among our older population.
The first project seeks to reduce poverty among Hamilton's older adults by finding individuals who are eligible for benefits such as the Guaranteed Income Supplement, GIS, and who are not currently accessing them. I note that Hamilton has a higher percentage of older adults living in poverty than the national average. We take a neighbourhood-based approach, working with community agencies to locate these people, and we have trained a team of volunteers to help them fill out the necessary forms. We estimate there are about 4,000 older adults in Hamilton who are not accessing benefits, such as GIS, for which they are eligible.
We are pleased to see that the Senate committee advocates changes to policies on financial entitlements and to the federal-provincial fiscal framework. These changes recognize the additional costs the provinces will incur in dealing with aging populations.
A second project of ours is concerned with helping older adults from diverse ethnocultural communities access community services. We have reached out to Somali, Chinese, Punjabi and Sudanese communities, and will add others as this project progresses. We are nearing the end of year one and we have funding for another year.
We have recruited community agencies to partner with us in an effort to build on relationships with these communities and to link them to service agencies. The broader purpose of the program is to reduce individual social isolation and to promote social inclusion across cultures.
Ethnocultural diversity, particularly with respect to older immigrants, is a feature of most, if not all, of Canada's larger cities, and certainly of Hamilton. An Age-Friendly City approach must include recognition of this diversity and strategies for ensuring that members of diverse communities can experience a high quality of life in their later years. In that vein, we urge that your report give more emphasis to older immigrants and ethnocultural diversity.
To conclude, we applaud you on your report and again urge you to provide national leadership in the Age-Friendly Cities initiative. We feel that model provides a framework for achieving the broad goal of helping Canadians age well.
Wendy Walker, Executive Director, Community Support Services of Niagara: Thank you very much for the opportunity to respond to some of the issues that you have listed in your report.
Community Support Services of Niagara, CSSN, is a registered non-profit agency providing volunteer-based services to seniors and adults with disabilities. The mission of our agency is to support our clients so that they can live independently in their own home and in their community.
Our volunteer services include meal delivery, which is Meals on Wheels; social and congregate dining; and transportation — we have a volunteer transportation service. I endorse Ms. Rosenthal's remark that there needs to be more transportation services throughout, particularly, our area. We provide a visiting social and safety program. We also provide service arrangement and coordination of reasonably priced home maintenance and repair services, and we are starting a new home-making service this year.
We are partnered with the Community Care Access Centres to provide a home-to- stay initiative, where people receive transportation home from the hospital when family and friends are unavailable, and assistance in settling in their own home. We shop for groceries for those who have been in hospital for a period of time, and we drop off prescriptions, if that is something that the person needs. The CCAC, of course, arranges for the personal care or nursing care that the person requires to remain at home.
Volunteers are essential to the provision of our services. Our volunteer base has decreased gradually as our volunteers age, and some of them are even becoming clients, and few community members are stepping forward to take their place.
Agencies that rely on the services of volunteers to provide their services need to provide a worthwhile and meaningful experience for the volunteer to maintain their volunteer group.
In the volunteering sector, we have been advocating for tax credits for volunteerism for a while. We are pleased to see that it is option 1 of your report. A tax credit will recognize the valuable contribution of time made by our volunteers.
Volunteers on average donate between 50 and 100 hours of service annually. Volunteers provide services. They also sit on our boards of directors, our advisory councils and various committees, and they provide feedback from the community as to the kinds of services that are being provided and any gaps in services that are recognized.
Last year, hours of service by CSSN volunteers equalled 40,084 hours. This total represented a 10-per-cent increase over the previous year. Even though we have just under 500 volunteers throughout Niagara, and our volunteer numbers are decreasing slightly, our volunteers are volunteering more. They are stepping up to the plate and taking on more volunteer activities.
We have a database that accurately tracks any charitable donations and then we report these donations annually to the Canada Revenue Agency. The database also tracks individual volunteer hours of service. The total volunteer hours are reported to the Ontario Ministry of Health and Long-Term Care. We also track student volunteer hours, which are reported to the school so that the students receive credit for their volunteer contribution.
Recognition in the form of a tax credit would be welcomed by volunteers. It would recognize in a tangible way their contribution of time, and may be an incentive to recruit new volunteers.
I often think it is easy to sit down and write out a donation cheque for $100, and pass it on to the agency of choice, but there is no recognition of coming to the agency every week or biweekly and devoting two hours of time delivering meals, other than the internal recognition that we provide for our volunteers.
In Niagara, we are establishing a committee with the support of the LIHN and also the support of Marge Dempsey, to build closer ties with our local schools, colleges and universities to promote volunteerism. We recognize that people who start volunteering early in life, if they have had a good experience, usually will continue volunteering as an adult.
In that respect, we strongly support options 1 to 5 in your report that reflect on volunteers.
As mentioned previously, caregivers are another group that we want to talk about. I have listed option 37 and options 63 to 67.
Caregivers, as mentioned earlier, provide the majority of care to seniors living at home. They need to be supported in the form of readily available respite, education and assistance to help them understand and respond to the seniors' needs. Caregivers need support for their own personal needs.
We feel that, with appropriate supports in place, caregiver help and well-being can be maintained and the senior can continue to be cared for at home.
I want to talk briefly about another option that directly relates to our agency, the seniors that we provide service to, which is option 24, to make the Old Age Security and Guaranteed Income Supplement benefits non-taxable.
Seniors with limited resources need financial assistance to live independently at home. Many community services have a user fee, for example, the cost of the meal in the Meals on Wheels service. CSSN, our agency, provides subsidies from the donated funds. However, seniors on low income still experience financial hardships and often are not able to access the necessary services. We find that seniors choose the meals because they are not able to cook for themselves and they are not able to afford the home maintenance service to look after their home.
Option 38 is to improve training of workers providing the services to seniors.
Option 39 is to share best practices for the prevention of elder abuse.
Option 41 is, "Support capacity building projects for training in geriatrics and gerontology.'' Limited supports are available in Niagara, including the timely diagnosis and treatment of dementias. I think Ms. Dempsey referred to that issue as well.
Option 51 is to increase the availability of affordable supportive housing. Again, there are limited supportive housing options in Niagara. This housing is truly a benefit for seniors who are not able to perform all the activities of daily living. They have the assistance of staff to provide a certain level of help so they can maintain their independence.
Options 60 and 61 are to introduce a National Home Care Program. I think there needs to be some standardization across the country, certainly not to the detriment of existing programs that are in place. We see periodically where people come from other communities and other provinces that the services in Ontario and the other province are not the same. They are looking for the basic services.
Option 68 is the better integration of care between acute, long-term care and community. It is a necessity to ensure that seniors can live as independently as possible.
I think we have responded to the issues and options that directly impact the clients that we serve, the volunteers that provide our services and the community support services that we offer.
We feel that the information that is contained in your report is both timely and insightful, and we are supportive.
Again, thank you for the opportunity to participate.
The Chair: Ms. VanderBent, I want to talk about your position on national home care. It was never our intention that we go to the lowest possible denominator. It was our position that we go to the highest possible basket of services available.
I am sure you are well aware that in some parts of the country, and I think of my home province of Nova Scotia, for example, there is a limited nature of home care services, not the least of which is because the provincial budgetary envelope, if you will, has not been large enough to subsume more of the home care services.
If we look at the arrangements that were drafted by the previous government with respect to child care, I think they addressed that issue, because they allowed for the flexibility of building on the program that presently existed. In other words, any monies that came from the federal government were not to replace what was presently offered, but to increase what presently existed.
If we were to come up with a design like that, would you have a greater comfort level?
Ms. VanderBent: Absolutely; I was at a lot of the tables following the Romanow report, looking at palliative care, for instance, and national standards for palliative care. We continued to run into this roadblock, which was that we could not define the basic basket of services. What we felt was basic, others felt was a Cadillac program and unaffordable.
I know that since the Romanow report, the federal government earmarked money to come to the provinces to expand our home and community care system, which is driving the changes that we see in Ontario. I cannot speak highly enough about the fact that the federal government has driven those changes and has helped us to expand all our services in the home and community care system.
I would be absolutely supportive, so would our association, but it will be a challenge to decide what is the basic basket of services that people need, and then to weave those services into all the different models and ways of delivering care that we have across this big country.
The Chair: What I liked most about the child care arrangements was that they were individualized. It was a national program, but the arrangements did not even attempt to compare Manitoba with New Brunswick. It said to Manitoba: This is the system you have in place; we will sign an agreement with you to give you additional dollars to build on that system.
That approach, to me, left that kind of flexibility. We talk about the need for federal flexibility and it seems to me that approach would be ideal. I think that was why Quebec joined because, as you know, they are always independent and always wanting to ensure that their services are sacrosanct and they are not compared to anybody else's services. If we did not explain that in our model, it was our lack of accuracy.
I am satisfied now that it is not the national nature that you object to, but ensuring that nobody will have less than they presently have.
Ms. VanderBent: Exactly.
Senator Cordy: Ms. Rosenthal, I am interested in your neighbourhood approach to contacting seniors about their entitlements. I am currently working on a speech for the Senate on the number of seniors in Canada who do not receive Canada Pension or the Guaranteed Income Supplement. If they do not receive Canada Pension, they do not receive the GIS. The problem is that seniors are not aware of their rights.
You have contacted seniors in a smaller community and it is working. How can we contact them at a national level to ensure that Canadians receive what they are entitled to?
Poverty has been reduced among seniors because of GIS, but the poverty levels of single women, particularly, are continuing to stay high.
Can you go over what you do in a little more detail, and is there any way that approach can be used across the country?
Ms. Rosenthal: We are about six or seven months into this project.
Our social planning and research council helped us with research to locate or identify the communities and neighbourhoods in Hamilton that have the highest percentage of low-income seniors. We then targeted specific neighbourhoods. It is a neighbourhood-based approach.
Community development is new to me. I come from an academic background.
I heard someone say that the Age-Friendly Cities model ultimately is one neighbourhood at a time. That model is the opposite end of what you are talking about when you see it from the federal picture.
Our initial strategy was to work with the Canada Revenue Agency and to go to tax clinics. Of course, the problem is that most seniors who come out to those clinics are somewhat aware of these issues. What we will do in our second phase is to use those clinics as a way of helping seniors who receive benefits access other kinds of subsidies that are available to seniors that they do not know about. For these federal benefits, the big ones, we are working through community agencies and neighbourhood associations to try to identify what we term "hard to reach'' seniors. These people are the ones who are isolated.
Often the two projects, the Entitlements Project and the Ethnocultural Diversity Project, overlap because some of these isolated seniors have language barriers and so on.
The best I can tell you at the moment is that working with local associations and neighbourhood groups, including faith-based organizations in some communities, has been helpful in leading us to individuals. However, the process is really turning over one stone at a time. It is a painstaking process.
We have trained a group of volunteers. I think that is key. I was interested in Ms. Walker's comments on volunteers. We are worried about how to maintain these volunteers over time because they are an extremely valuable resource and we are trying to come up with funding for a volunteer coordinator that will be permanent.
I do not know if this is helpful to you.
Senator Cordy: Yes.
Denise O'Connor, Executive Director, Hamilton Council on Aging: We have a community development person who is trained in community development and who has established relationships with a number of the ethnocultural communities. His relationships have helped us make headway into these communities and build those relationships.
Often, people from some communities are afraid of authority. They do not have positive experiences with government; governments are scary people. By building trust through the communities, the point is to build on existing trust relationships, but the approach must be community, it must be local. There is no other way. It is not about public relations, it is about making one-on-one contact. Governments can put out brochures but if people do not read them and they do not trust them, then they will not pay attention.
It is about those individual relationships.
Ms. Dempsey: I want to speak to that also because we find this issue often in this population of individuals who live alone.
Again, that issue crosses not only our cognitively-impaired population but also seniors in general who live alone. Perhaps they are immigrants who do not speak English well and, as you said, they are frightened of the concept of government involvement.
One thing that we have done, and that I think would be a useful strategy across the board, is for agencies that are involved in any way in any senior environment, to ask, as one of the questions that is part of their information- gathering, "Are you aware of all the resources that may be available to you financially?''
By asking that question, they are not asking the seniors for their income, they are not asking them about the money they are receiving, but they are offering the seniors something, some information. That approach seems to be more acceptable.
It should be part of the criteria, because many people are not only not receiving the money they are entitled to, they are not even filing their income tax. These issues are real.
Senator Cordy: We have heard some dreadful stories before our committee.
Ms. Dempsey: Yes, it is true. For years, people are not receiving the money they need to survive even.
Senator Cordy: One thing that I learned from a witness before the committee was that in Canada, the federal government, if seniors have not been receiving CPP or GIS, then they have an 11-month retroactivity. In Quebec, they have five years. The lack of take-up in Quebec is next to zero, whereas the lack of take-up in Canada overall, I forget what it is, but it is substantial.
That might also be one thing that we can look at. Somebody mentioned we can have all the brochures in the world, but we are not reaching all the seniors. If we can alleviate poverty among seniors, that goes a long way.
Ms. Walker, we think a tax break for volunteers is a great idea, and you do too. You made an excellent representation on that issue.
Your organization keeps good track of the volunteer hours that people are working. Not every organization is able to that because they do not have the volunteers to do it.
How can we keep it simple, if we have a tax rebate for volunteers? Government has a great desire to overcomplicate things so that people will say; you know what, it is not worth spending ten hours filling out these forms to receive $150 back.
Do you have a recommendation on how to keep it simple? We understand that the government must be accountable but, on the other hand, how do we not overcomplicate it?
Ms. Walker: That question is an excellent one. I was thinking of that problem as well. We provide donor receipts for people who give monetary contributions. Can we do that with volunteers? If we provide a donor receipt and the volunteer volunteers at several different agencies, they would have a donor receipt from each agency.
I want to say $1 an hour would be nice, but it probably will not work out in that respect. Some determination would need to be made of what an hour of volunteer's time is worth as a tax credit.
Senator Cordy: Even at the end of the year, the volunteer could receive a donor receipt in terms of the number of hours and then the amount could be determined later.
Ms. Walker: Yes, that is the suggestion. I do not know.
Senator Cordy: I think your comment is so accurate that it is much easier to write out a cheque than to volunteer every week.
Ms. Walker: It is much easier.
Senator Cordy: My next question is for Ms. Dempsey.
In my father's family, three have died in their early 60s. Those who have lived to be 75 or older have all exhibited signs of dementia, so I want to make sure that there are good plans in place if I should live to be that old.
I was on a committee that studied mental health and mental illness, and one of the things we looked at was dementia.
One thing you talked about was the right to risk. We grappled with that right as a committee; when somebody refuses to take medication or, as you said, refuses to leave their home for safety reasons.
Have you found a way that works well with that right? With the other committee that I was on, we struggled with this issue and we heard conflicting evidence from both sides, from people who said we cannot ever force somebody to take a medication against their will, and others who said, we must, for the safety of the individual.
Ms. Dempsey: Herein lies the huge ethical dilemma.
I am an old nurse, so I remember when the system was paternalistic and they did not tell people anything, they just did it. I worked in the days when placebos were given without consent. We cannot do that sort of thing any longer, nor should we. I was never in favour of that sort of thing.
Persuading people to take things under false pretences is not what we consider appropriate any longer.
However, I think that the critical piece is capacity. I think it is no problem for people to be at risk if they have the capacity to understand their risk. If they know that they are doing something that is high risk behaviour, or that they are putting themselves at risk to do it, and they fully understand and appreciate the consequences of that behaviour, then absolutely, they have that right to risk.
If they are a person who no longer understands and appreciates their own risk and that their risk is beyond what they, as a person, what we call their "then'' self, their previous self, would have considered a risk that they would ever have taken, or a means of behaviour or activity that would never have been appropriate to who they saw themselves as a cognitively-well person, and now as a cogitatively impaired person, they are doing those things, then that changes the situation.
I think that when a person no longer has the capacity to understand and appreciate their own risk and would never have put themselves in that position previously, then we can legitimately step in and say we will preserve that person as who they were. We can then engage in trying to assist them in being the person they were, even though they are no longer able to do that on their own.
If a person who willingly would have taken medication to ensure that their blood pressure was okay, that their heart was in good working order or perhaps even a drug to keep them feeling well mentally, as a previous person prior to their illness, then we should ensure that they can still do that even though they no longer understand they need to do that. I say we then find means of ensuring that can happen in perhaps a different way.
If they are taking a medication, we can find a way for them to take it. If the medication is to assist them perhaps for the dementia, we can tell them that it is a blood pressure pill, which they would be more willing to take, even though we are lying to them now because they are no longer capable. I would never suggest something like this for a cognitively well, capable person.
The same is true for providing them with services in their home, and that is what I said earlier, finding ways to be innovative and assist them. They do not think they need any help, so the help is not for them. They are doing something for somebody else, for example, by providing respite in the home of someone who has no support. It is not because they need help, but the approach is, "I have this friend who is lonely and they would love to be able to visit somebody.'' So it is for the other, as opposed to for themselves.
These are ways that you would never use for a cognitively well person, for a capable person, but for somebody who is not capable, I think we must. Therein lies the dilemma of our new system of autonomy. We have moved from paternalism to autonomy, and that is good, but it is also not so good for those who are no longer capable of expressing their own autonomy. It is a dilemma.
I do not know if that was the answer you were seeking.
The Chair: I think we are all struggling with that problem: When do I have a right to say I do not want services?
We know full well that there are older persons who have no cognitive impairment. They may have serious physical impairments so they are in a long-term care home. They do not want to be there, and there is no reason cognitively that they should be there. Do we say, fine, they can go into the community, even though we know their physical safety will be at risk?
It is a difficult issue and difficult on families who often want their family members placed in a long-term-care personal situation because they are concerned about either their mental or their physical safety. There we are on the horns, I suggest, of a dilemma.
Senator Mercer: You have raised a couple of interesting things with us today around the continued discussion of transportation. This issue continues to come up. I am also on a committee that recently completed a study on rural poverty where transportation is a major issue.
I will contradict myself a bit with respect to the study on rural poverty. It seems to me that one of the issues here in urban centres where there is public transport, one of our solutions to several problems — an environmental problem, a transportation problem for seniors and a usage problem for public transit — is that maybe we should think about linking part of the GIS benefits to a transit pass.
The reason I say this is, my son has gone back to school and part of the tuition at the university is a transit pass. He does not use it a lot, but he has that pass and can hop on the bus any time he wants. It seems to me that this pass would be a logical thing. We spend millions and millions of dollars helping cities and municipalities build good infrastructure for public transit.
If we were to provide a pass, do you think that seniors, GIS recipients, would use it? There is no sense in building it if they will not come.
Ms. O'Connor: Yes, focus groups have been held in Hamilton on transportation and our Access Program, the program that links the community services with ethnocultural communities.
We have been told that if people had a bus ticket, they would go to the YMCA, so the "Y'' supplies bus tickets. Logically, it would clear up the barrier of spending a couple of dollars to go somewhere on the bus. As cities build more public transit, of course, it will be even easier.
That solution is great for people who are still mobile. Part of the recommendation we made on the tax credit is to address the people who cannot take public transit any longer.
Senator Mercer: That is exactly where I was going. You have solved my problem with my other report, that maybe we can provide a generous tax credit for people who are GIS recipients and do not have access to public transit.
Ms. O'Connor: I think 75 is an age that is arbitrary for people without a recognized disability. I am not sure we want to test people as to whether they are mobile or not. I thought age 75 was the higher probability; that a tax credit would be of value because perhaps they would be able to hop on the bus easily.
Senator Mercer: Ms. VanderBent, you are concerned about bringing the level of services to Ontarians down to levels of services of some of the other provinces. Senator Carstairs is absolutely right; Ontario offers the Cadillac service in the country.
I am a practical example of that level of service. I had a health issue last year. It happened to me in Ontario, so I had to access Ontario health care, and I received terrific service with respect to medical care, by showing my Nova Scotia health card. Because of the reciprocal agreement between the provinces, I had the same access to the health care services as any Ontario resident would have, and it was wonderful. However, I required home care for about a month and a half afterward. Since there is no reciprocal agreement between Nova Scotia and Ontario, guess who paid? I was required to pay. I have an insurance program because of my employment that covered a good deal of that cost, but it was a hindrance.
I kept thinking to myself as I was going through that experience — and I could do a lot of the work myself and I have a supportive spouse — what about someone who does not have that ability; someone who is older than me in a situation where they cannot access that level of service.
How do we prevent those people from falling through the cracks that are sitting at home and have the need for infusions every day? They need to have a nurse there at a certain stage to dress wounds. Perhaps they need a physiotherapist come to their home to help increase their mobility.
One of the biggest travesties in health care in the country is when the provinces removed physiotherapy as something that was covered. They treat the patient right up to the front door of the hospital and that is it, because the patient is not cured unless they have physiotherapy; at least I do not think so.
How do we solve this problem?
Ms. VanderBent: As I said in my remarks, clearly we have a health care system that is transforming now from an episodic system to a system where we are looking after people for longer periods of time, with more chronic illnesses. We are providing more surgeries that I think are life-enhancing, like hip and knee surgeries, lots of orthopedic surgeries, and that sort of thing, where we need that wrap-around care and we need greater levels of care in the home.
Years ago, I was the Director of Social Work at St. Joseph's in Hamilton. We would have someone in after a big hip surgery for maybe 10, 12 or 15 days sometimes, depending on the patient's age and stage. Now, the person is out quickly, perhaps in two, three or four days. If they are really elderly, maybe five.
It has changed dramatically, and the expectations of the community to absorb that kind of care are huge. We need nursing care, we need physiotherapy, we need community supports and we need personal support.
The person needs that kind of care, and if they do not have a family member, they can deteriorate rapidly.
We absolutely need to make sure we do not see any deterioration of a basic standard of care, because the health care system is driving so fast to new technologies that will allow us to do amazing things in a hospital, but we cannot forget that the majority of the time spent recovering is generally in the home and in the community. We need all the supports to support a person, particularly when they are ill and they could have other multiple health problems to cope with.
So, I agree. You were fortunate that you had insurance to support you through our home care program here in Ontario. Many people do not. If the home care runs out, then they do not have the home care. That is when we see the person on the fringe and the family says, mom cannot manage anymore; we are worried about her; I am frightened she will fall.
I receive calls like that every day at work from people, saying, what can we do? Our publicly-funded system is a major foundation of care.
Senator Mercer: I am a recent expert on knee surgery. Major knee surgery takes about four to five days from the day of the operation to the time they are out of the hospital, unless, of course, they screw it up like I did.
It seems to me that there is too much focus on the curing as opposed to the caring aspect.
I want to go to the issue of diversity that was mentioned.
I was interested in what you talked about, the Hamilton Council on Aging. I wanted to relate this fact to you. I think it would pertain particularly to a metropolitan city like Hamilton.
The percentage of immigrant seniors that speak neither official language has risen over time from 4 per cent who arrived before 1961 to 50 per cent who arrived between 1991 and 2001.
For those of us who do not understand the problem, 50 per cent of our seniors speak languages other than English or French, and we continue to produce materials in English and French. We must do that, but we, in government, need to find a way to help agencies translate materials into Punjabi, Mandarin, Italian, Hungarian or whatever language might be needed in the community.
Has there been any help for you, Ms. Rosenthal, to translate those materials?
Ms. Rosenthal: In a word, no.
Senator Mercer: I knew the answer.
Ms. Rosenthal: For the new immigrant groups that you refer to, part of our challenge is that these groups are not from Western Europe or even Eastern Europe. They are from areas of the world that have been relatively unknown to many of us, to many people in the service professions. There are not only language differences, but cultural differences.
Sensitizing all of us and people who are working in the community with these groups — cultural sensitivity — is an important issue. We are making efforts to disseminate what we learn through workshops and so on. We are planning to do that as we go along.
However, it is not only translating. We need advice on whether we are stepping over a boundary that will put people off. These issues that we need to deal with are challenging.
Senator Mercer: You are absolutely right that there are cultural and religious boundaries that we may step over inadvertently in our attempt to serve people. However, do you agree though it would be easier for people in those communities to respond if at least the material we have was in the language of their choice or the language they understand, so we can deal with the cultural boundaries?
This country continues to change, because people insist on coming here to enjoy this country, and that is what makes the place so great.
Ms. Rosenthal: We need to translate things. I think for translation, we need someone who understands the language, so hopefully we can build in a consultation about whether something needs a minor change in some way to be successful in that particular case.
Yes, access to funds for translation is important.
Senator Mercer: Perhaps, we could have centralized translation provided on a regional or provincial basis so that, say you wanted something translated into Punjabi, somebody would translate it into Punjabi but at the same time, perhaps vet it for cultural nuances that we might not be aware of.
Ms. Rosenthal: One challenge in dealing with these new communities is that, because they are new, they often are not highly organized the way the more established communities are, for example, the Ukrainian community or the Italians in Ontario.
I think it is a terrific idea to have somewhere to go for help with these things.
Senator Mercer: We have heard a number of times on this committee that the number of new Canadians who come here and do not understand our public pension system and then, as they work through their working lives, do not take care of themselves financially as many other Canadians do, by contributing to retirement savings plans, et cetera, and private pension funds. We have gone from the health issue to the financial issue, which leads to health issues.
Ms. Walker, you talked about the volunteer aspect. You talked about the declining number of volunteers. I have worked in the volunteer sector all my life.
We talked about the tax credit for volunteers. Number one, I think a volunteer hour is worth a hell of a lot more than a dollar an hour.
As a person who has run a few charities in my day and tried to measure the volunteer input that we had, and it has been absolutely terrific, I do not know how, as the manager of that charity, I could put a value on the contribution and then gauge the number of hours that you may have donated, that Ms. Tooley may have donated, or that Mr. Frank donated.
How do you qualify and quantify? My real problem is that as soon as the government becomes involved, it will be screwed up. So we must keep it simple. How do we do that? How do we make it simple enough that it allows the charity to encourage more volunteers and allows the volunteer to receive that recognition that the volunteer rightly deserves?
Ms. Walker: That is a good question. In the volunteer sector, they are looking at approximately $16 as the rate for a volunteer hour of service. That may have increased because this number is from previous years.
I do not know how it can be prorated for a tax credit, but I am sure there are lots of people in the volunteer sector who could make recommendations. I would be pleased to talk to some of my colleagues and bring back a comment on that particular issue.
Senator Mercer: I appreciate that. You can forward it to us through the clerk. I am anxious to have that kind of feedback because the problem is huge.
Senator Chaput: My questions will be brief.
My first question is a supplementary question to the issue that Senator Mercer has discussed with you. It is in regard to the volunteers and how we can come up with something that will show that we appreciate volunteers, and to encourage them to do even more volunteer work or have new ones.
One possibility is an income tax receipt for hours done. This approach is complicated; it will not be easy to measure or to manage. Another possibility, and I want to know your ideas on this suggestion, is a reimbursement of expenses in that volunteers receive monies to pay for transportation and meals, or a per diem for their volunteer work, an amount of money per day that is not taxable. The approach is the opposite to a tax receipt.
What do you think, Ms. Walker?
Ms. Walker: That is an interesting idea. We already provide a certain reimbursement. For our Meals-on-Wheels drivers to deliver meals in this Welland community, we give them $6.50 for their delivery of ten client meals. We provide reimbursement mileage for our volunteers who offer transportation to medical appointments and social activities that the seniors go to.
We have an annual volunteer appreciation dinner, but a taxable per diem rate might be an interesting concept.
Senator Chaput: Are there any comments on that idea from any of the other presenters?
Patricia Tooley, Program Manager, Community Support Services of Niagara: I also think the idea is a good one. One concern we have for transportation, for example, is that the reimbursement that we provide for our volunteer drivers is the amount that the client is charged for the transportation. We look at the issue seriously, balancing a fair reimbursement for our volunteers' mileage against the cost for the client, the ability for the client to pay. Every increase must be looked at.
Senator Mercer, you made a comment on a bus pass and I think a pass is an excellent idea. One thing that we find here in the Welland office, which has bus service although part of our areas do not, is that many of our clients will use our service in the winter because it is difficult for them to go to a bus stop over ice or snow, but as soon as the good weather comes again, then they stop using our service. Our agency allows people to go on and off that way. That saves the client money, but it also frees up a volunteer driver to provide transportation for someone that cannot use the bus. It would make an excellent combination.
Senator Chaput: I have one last brief question regarding volunteers. I believe one of our witnesses said that at one of our meetings — but we have had so many comments regarding volunteers — that lower-income persons tend to volunteer less because they do not have the means to go to the place. They do not have the means to do the things they would like to because they do not have money to buy clothes and that type of thing.
Have you ever seen such a situation? I am not sure if that is true.
Ms. Walker: I can agree with that statement because it costs volunteers money to volunteer. They drive to clients' homes, visit with the client, then drive back home. They come into the office to deliver meals. They receive a small stipend for the travel, but there is still a lot of travel involved. Our board of directors comes in and they do not put any mileage in at all.
Senator Chaput: They end up disbursing money too when they are a volunteer, over and above the time that they contribute.
Ms. Walker: That is right. Volunteer agencies do not have the money to reimburse volunteers for all their expenditures.
The Chair: Thank you all for joining us today. It was informative, As I told the previous panel, I hope you will see some, if not all, your ideas reflected in our final report in September.
The committee adjourned.