Proceedings of the Special Senate Committee on Aging
Issue 9 - Evidence, May 13, 2008 - Morning meeting
MONCTON, NEW BRUNSWICK, Tuesday, May 13, 2008
The Special Senate Committee on Aging met this day at 9 a.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[Translation]
The Chair: Honourable senators, members of the public, welcome to this meeting of the Special Senate Committee on Aging. The committee is examining the implications of an aging society in Canada. The range of complex issues relating to aging have preoccupied governments for many years. They have become more prominent, however, as the number of seniors grows as the result of both a longer life expectancy and the aging of the baby boom generation. The public programs and services offered to seniors are essential to their well-being and it is our duty as governments to ensure there are no gaps in meeting their needs.
[English]
We are here in Moncton today to hear from interested parties on the impacts of an aging society, and more specifically to hear their views on our second interim report, which was tabled in the Senate on March 11. The interim report focuses on active aging, older workers, retirement and income security, healthy aging, supports to aging in place of choice and the regional distribution of health costs associated with aging. This is our third stop of our cross-country Canada tour, and we look forward to today's testimony, which, I am sure will help us develop a comprehensive set of recommendations for our final report.
On our first panel this morning is the New Brunswick Senior Citizens' Federation, represented by Ralph Smith, President; the Coalition for Seniors and Nursing Home Residents' Rights, represented by Cecile Cassista, Executive Director and Hector Cormier, President, who I understand will make the presentation; and the Association acadienne et francophone des aînées et aînés du Nouveau-Brunswick, represented by Jean-Luc Bélanger, Chair.
Welcome, to all of you this morning, excuse my French. We work on it in Ottawa, but we need to live in Acadia in order to make it really happen. We will begin with Mr. Smith.
Ralph Smith, President, New Brunswick Senior Citizens' Federation: I do not have any formal presentation to make this morning. I wanted to sit in and get some feedback from the committee, so I will reserve my comments for later, if that is acceptable.
The Chair: That is just fine.
Let us move on then to Mr. Cormier.
[Translation]
Hector Cormier, President, Coalition for Nursing Home Residents' Rights of New Brunswick: Madam Chair, following a careful reading of the second interim report on aging, I see that the Senate is doing very serious work. If all political institutions in the country were to do likewise, maybe we would see results more in keeping with the desires and needs of the population. However, that assumes vision rather than empty electoral promises.
[English]
It is interesting to note how you have come to fuse together so much material in so few words meaning so much under six issue-specific chapters, such as a definition of old age; active aging and ageism; older workers, retirement and income security; healthy aging; aging in place of choice; and regional distribution of health costs.
[Translation]
Although in its brief, the Coalition for Seniors and Nursing Home Residents' Rights has only commented on the needs for affordable housing and barrier-free codes to accommodate aging at home and on the need to include in the Canada Health Act a national home care program with standards comparable from province to province, funded by public funds, we are of the opinion that such public consultations with individuals, organizations and experts is the proper means to initiate a profound reflexion on the matter of aging. The consultations provide an opportunity to analyze the issues and options, to hold information sessions in order to create awareness among people on the issue, to create action plans and to make proper representations to elected members and governments.
[English]
We are not without knowing that a final report from this Senate committee will bring forth other elements to the content. We hope that it will stress the fact that each Canadian, whether young or old, is the first in charge of his or her own health rather than leaving this responsibility in the sole hands of health professionals. Is it utopian to think that professionals, especially doctors, through their organizations or training schools, will one day want to give a new meaning to the profession; one that would make it so that the individual would be perceived as a whole, a discipline that would recognize the influence of mind over body, a medical profession that would comfort and reassure rather than, or before, relying on the whole gamut of cold technology where individuals are considered as numbers only to return and be told to start all over again and to submit to other tests?
[Translation]
Aging has its own set of problems: the fear of growing old and being dependent on others, the loss of faculties, abuse, abandonment, negligence and isolation. Seniors often have to deal with problems pertaining not only to their children, but also to their grandchildren and even their great grandchildren. All this brings with it varying degrees of stress, which is the cause of many problems — some doctors estimate that 80 to 85 per cent of problems are psychosomatic in nature. And yet people are medicated, not to say overmedicated and subjected to a battery of tests. When it might be preferable to see a psychologist, a psychiatrist, a psychotherapist, a reflexologist, a massage therapist. Perhaps they should be told to watch their diet, to get more involved in social and physical activities or maybe to have some temporary respite. It is true that our minds are constantly being bombarded by all kinds of advertising that sings the praises of newly discovered magic pills. Television even teaches us how to influence our doctors as to what medication they should prescribe. Maybe this aspect could also appear in the final report. Doctors could be invited to explain what the real processes of recovery are. It is also important for the serenity of seniors that caregivers, family members and friends not treat them like children.
[English]
Norman Cousins in his book called Head First: The Biology of Hope and the Healing Power of the Human Spirit says that a very small effort to better the rapport between the patient and his doctor can result in significant progress in the state of the sick. He further adds that certain doctors have a tendency to give priority to technology over the direct exam of the patient. In fact, the confidence in sophisticated and costly means of medical exams could very well be the major problem of modern medicine. A sick person who spends more time with analysis apparels than with his doctor could very well be deprived of one of the main elements in an efficient treatment, that is trust and reassurance that only a well-advised human being can inspire.
This is even truer when the person is of the age where health is the main priority.
[Translation]
The work of this Senate committee and its findings must be distributed widely to inform people and become a reference to inform them and help in making demands and preparing action plans.
Jean-Luc Bélanger, President, Association acadienne et francophone des aînées et aînés du Nouveau-Brunswick: Madam Chair, the Association canadienne et francophone des aînées et aînés du Nouveau-Brunswick would like to thank you for giving it an opportunity to present our views and concerns about the report on population aging in Canada.
Our association's main function is to bring together Acadian and francophone seniors to promote their rights and interests and to promote their full development in their own languages and culture.
Our provincial association is on the board of the Fédération des aînées et des aînés francophones du Canada (Federation of francophone seniors in Canada). This federation has been in place for five years. A number of recommendations regarding francophone minorities in this brief are the same as those made by the federation. Like the national federation, we are very impressed by the quantity and quality of government recommendations in your report having to do with matters related to aging. We found that it contained a great deal of interesting material.
We would like to start by congratulating the Special Senate Committee on Aging which has shown courage in a number of the recommendations it made in its second interim report entitled: An aging population: issues and options. The committee has a good grasp of the issues related to the aging Canadian population and some of its proposed solutions are most interesting. That is why we want to begin by expressing our appreciation for the work you have done.
However, we would like to point out that the report makes no direct reference to the official language minority groups in this country — both anglophone and francophone. There are anglophone minority communities in Quebec as well as the francophone minority communities elsewhere. Under section 41 of the Official Languages Act the Government of Canada is required to show commitment to enhancing the vitality of francophone minority communities in Canada and to assist in their development. We believe it is essential that the Canadian government make more of an effort to ensure that francophone seniors living in minorities be recognized as part of the strategy to deal with the issues and challenges related to aging in Canada.
I will comment now on the recommendations in the report that we see as positive, but that require some adaptations to ensure that federal government takes into account its obligations as regards the official languages. We agree with recommendations 1 to 5 regarding support for volunteerism.
As mentioned by the federation and by our association, we believe that the future of minority francophone communities depends to a large extent on the contribution made by the volunteers and by the role that seniors and retired people can play. Minority francophone communities are aging. Given that young people in a number of these communities leave to work elsewhere, the aging population in rural communities is increasing quickly. As a result, it is important that seniors and retired people show the leadership required to ensure that their language and culture are passed on and to promote the vitality of these communities.
We are in complete agreement with recommendation 9, which is to adapt the New Horizons Program for seniors for aboriginals.
However, the New Horizons Program for Seniors is not well adapted to the reality of francophone Seniors in minority communities. Data collected by the Fédération des aînées et des aînés francophones du Canada show that francophone seniors in minority communities have not always received their fair share as concerns the funding of this program. The criteria established by the program discourage groups of francophone seniors, and many of them feel that the program does not sufficiently meet their needs, for example, in terms of multi-year funding, funding for salaries and certain sectors of the program that do not favour francophones. That is why we recommend the addition of a new resolution that reads as follows: ``Adapt the New Horizons Program for seniors to the needs of minority- language communities.''
We support recommendation number 41, which deals with capacity-building projects. This is essential, and we feel that the solutions to the problems being experienced by seniors can be found in the communities. Therefore, capacity- building projects for training in geriatrics and gerontology is important.
We feel that this recommendation is very interesting. However, we would greatly appreciate that the training of those working in geriatrics and gerontology be adapted so that they can offer services in the language of the minority. We know that with the Health Canada program Santé en français, certain minority communities had trouble receiving health services in French, depending on the sectors or specializations.
We have seen for ourselves, on certain occasions, the lack of French-language services in the area of health care. This has sometimes resulted in flawed diagnoses and placed seniors in vulnerable situations without being able to have access to services in their language.
We feel that a recommendation should be added to the report to emphasize the importance of training health professionals to serve seniors in minority communities in Canada.
Pages 34 and 43 of the report deal with the federal government's responsibility towards certain groups, including veterans, first nations, Inuit and federal offenders. We feel that the report does well to underline this responsibility. However, under the Official Languages Act, the report does not mention francophones or anglophones in minority communities as a group that comes under federal jurisdiction. We would greatly appreciate it if the committee agreed to consider adding seniors in minority communities as one of the groups under federal jurisdiction.
Recommendation 54 underscores the importance of increasing the stock of affordable housing, and recommendation 55 mentions the specific needs of first nations and Inuit seniors. We agree with these recommendations, but we find it unfortunate that the report does not place sufficient emphasis on adapting strategies to ensure the provision of adequate services in French to seniors in minority communities.
I would like to share with you the comments of an elderly lady. She said, ``It makes me very sad to see in our small francophone communities seniors who, when they get sick, must move into supervised homes hundreds of kilometres away from their home where there are often no French-language services available. Often, we lose track of them and do not receive any news of them for months. Sometimes the only news we hear is when we read their obituary in the newspaper. I find it shameful that people should treat seniors this way.''
This woman experienced this situation. I think that the committee should be aware of the trauma that this can create for many of our francophone seniors living in small communities. It has been shown that where there is political will, there is a way to ensure that francophone seniors can be served in their mother tongue in seniors' homes. There must be more incentives and more awareness-raising to ensure that homes offer such services.
Lastly, we would like to express our agreements with recommendation number 60, which suggests the introduction of a national home care program. We feel that it is essential that this national program take the reality and the needs of seniors into account, including the possibility of communicating directly in their mother tongue.
Thank you for having allowed us to share our thoughts on the subject of population aging. The Association des aînées et aînés francophones du Nouveau-Brunswick is confident that the proposed changes will be accepted, for the sake of the well-being of all linguistic minorities in this country.
The Chair: Thank you very much, Mr. Bélanger.
[English]
Both you and Mr. Cormier have articulated exactly the reasons why I felt it was necessary to come to Moncton, and also to Sainte-Anne, which is a small francophone community, outside of Winnipeg. We will be going to Sherbrooke as well.
You can have some comfort in knowing that a lot of your recommendations today will find their way. It is so easy to forget the minority communities, and we need to hear the input from them to put us back on track. Therefore, I really do appreciate what you have said today. It cast me back, and Ms. Cassista will remember this, when we were dealing with the Montfort Hospital in Ottawa, and members of the senate community did not necessarily understand why Manitoban senators would be engaged in a fight for a hospital in Ottawa. We sent our residents from the St. Boniface General Hospital, in Winnipeg, to be trained at the Montfort Hospital in Ottawa so that they could work in French. Therefore, when they returned to St. Boniface General Hospital, they would be able to work with the population in both official languages. It seemed a strange kind of mix, but it was a very important thing for us that the Montfort Hospital kept its vitality because of the training of physicians for St. Boniface General Hospital. There we are in this wonderful country of ours having to ensure that we meld services appropriately.
Mr. Cormier, you would have been quite delighted yesterday at the presentation of three doctors, two of them were gerontologists and one was a family physician. They were talking about exactly what you were speaking about today, that we have to change the delivery of the health care system, that we need to make it more accountable to the very patients that it is supposed to serve. It was good to have that reinforced this morning, as well.
Senator Mercer: Mr. Cormier, your first recommendation is that the building code standards be very free to accommodate aging in place. A nice statement, I think we all agree with that. However, can you tell me what you see as maybe the two or three major issues about the building code that are missing today that should be added in the future?
[Translation]
Mr. Cormier: Since I am the new chair of the coalition, I will ask the executive director to comment on this topic. She has held her position since 2004, and she will explain to you more clearly what we mean by it.
[English]
Cecile Cassista, Executive Director, Coalition for Seniors and Nursing Home Residents' Rights: I would be pleased to answer the question with respect to the housing. We have found in our research and study in New Brunswick, in the Maritimes, that the aging population are having to move from the rural areas or move out of their homes because they no longer can live in them with the barriers of not being able to go up the stairs or live on the first floor, and not having safety bars in their homes. The survey results show that they have either migrated to the cities or purchased a mobile home to place on their property because they do not want to leave their property; they have lived there for some 30 years and want to stay. We have found also that the building codes are continuing to allow these huge homes to be built with two or three levels and without 36 inch doors — they do not meet the needs of the seniors so that they can age in place. Seniors have told us that they want to live at home as long they can. That is certainly not the situation in the Atlantic provinces. I hope that I was able to enlighten you in that area.
Senator Mercer: That is fine. We all recognize and have heard some of that before about issues using stairs and the inability to live on the first floor because the washrooms are upstairs in many older homes. I think it is probably one of the communities that is invisible with respect to their being an issue with the width of doors until you spend some time with the seniors — yesterday we saw more wheelchairs in Halifax than we have seen in a long time.
Ms. Cassista: In terms of modifying and repairing their homes, extracting the dollars for that is extremely difficult for seniors. Many of them do not know about the programs. Although the money comes from Ottawa, it is administered by the province, and it is a very difficult process for seniors to go through. Therefore, as you travel, you will see, predominantly in the rural areas of the province, that these homes do need to be repaired and that seniors are living in these conditions.
Senator Mercer: Mr. Bélanger, you are right in everything that you have brought to our attention. We do not specifically make mention of minority rights, but we have spent a good deal of time talking about it. We have not put pen to paper not only on English language rights in Quebec but also the even more difficult problem of the rights of new Canadians who speak a language other than English or French. We are told that close to 50 per cent of the population now coming to Canada, the older new Canadians, speak a first language other than English or French, which complicates the problem. We will re-adjust that in our next break.
You mentioned New Horizons for Seniors Program not servicing the francophone community — I was a little surprised at that. I know my colleagues in the Senate and the House of Commons who come from those parts of the country with large francophone populations are very supportive of the New Horizons for Seniors Program, and I am surprised to hear that you think that the government is not doing a good job with that program.
[Translation]
Mr. Bélanger: Perhaps we should explain what the New Horizons Program for seniors is. In each province, there is a committee that selects the projects, and sometimes there is lack of francophone representation to educate the people on these committees. Even though the New Horizons program has simplified its forms, you should remember that many seniors are illiterate. This is an important factor that influences the number of applications in certain regions. Our research shows that the New Horizons Program for Seniors has fewer results in certain francophone regions as compared to the population as a whole. Perhaps the program is not sufficiently advertised or seniors need more help filling out the forms. The seniors of tomorrow should, in theory, have higher levels of education, with computer science and technology, and thus be better prepared. Not all seniors have access to the Internet or different means of communication. The New Horizons program could certainly be improved in order to better support seniors in this regard. Initially, there were significant areas where francophones were not receiving their fair share. Improvements were made by some provinces, but it should be pointed out to program authorities and to the Department of Human Resources and Social Development Canada that there are still areas where they must be careful, especially as concerns appointing the members of the committees. The committees do what they can, but sometimes there is no francophone representative who can help them learn about francophone communities. So it is sometimes difficult, depending on how they obtain their information, to understand the scope or the relevance of the project they are presenting. Sometimes, the project is refused because certain elements are lacking or, for one reason or another, public servants do not help the applicants throughout the process. These factors require improvement. However, it is an excellent program that has enhanced equipment for seniors, looked into elder abuse and the addition of other programs. However, we must ensure that minorities are served as well, and that they receive their fair share.
[English]
Senator Mercer: We Canadians pride ourselves on our linguistic duality. We also look at New Brunswick as our only official bilingual province. We know that the services offered across the province are not adequate in general; however, I am interested to know whether it becomes even more difficult when we analyze it on a language basis. Are there fewer spaces — of course it would have to be done on a population ratio basis — for francophones as opposed to anglophones in New Brunswick, and how does that relate to the staffing of facilities? I am picking up that you have some major problems in that area in that staff are unilingual or unable to communicate with the seniors in New Brunswick.
[Translation]
Mr. Bélanger: New Brunswick is supposedly the only bilingual province in Canada, but in reality that is not always the case for francophones. If you look at the public service in New Brunswick, there are still sectors in which francophones cannot obtain services in French. There have been many improvements and it is important to point these out, but just because a province is called bilingual or just because the city of Moncton says it is bilingual, does not mean that all services are available in French. Anglophones can obtain services in their language because most of the francophones working in the service sector are bilingual. That does not mean that anglophones do not provide good service, it is simply that services in all sectors are not automatically provided in French despite the fact that New Brunswick was declared bilingual. There has been some progress, but there still remains a lot to do. New Brunswick's program can still serve as an example for the other provinces, however there still remains obstacles in some sectors when it comes to being served in French.
[English]
Senator Cordy: Thank you so much for your presentations this morning. They have been excellent.
Mr. Cormier, as the chair said, you would have been delighted to hear the presentation by the three doctors in Halifax yesterday. You mentioned medication, and we used to hear about over-medication of seniors a number of years ago. However, I have not heard that for awhile, so I am not sure if that was part of your reference. You said that sometimes medication is used when perhaps it should be a psychologist or a nutritionist, for example, which lead into your whole discussion that hands-on is far more important than medication or technology. I wonder if you would just expand on that a little bit for us.
The Chair: Senator Cordy, I would like to bring Mr. Smith into this as well. We will begin with Mr. Cormier.
[Translation]
Mr. Cormier: When seniors consult doctors for heart problems, they may end up needing medication. However, if they are victims of abuse, if they have concerns about the future, what they need is perhaps a psychologist. There are people who retire from their work and who have a difficult time adjusting to retirement. It may not be medication that they need. Taking medication can truly become a vicious circle. That is why I was saying that some seniors perhaps need a different kind of treatment.
I am a retired teacher and I sit on a committee that often meets with group insurance company representatives. We have been told that if teachers had access to psychologists, to reflexologists, they could avoid spending money on medication that costs an arm and a leg. However, I believe that in general, and the doctors tell us this, that people rarely leave a doctor's office without a prescription. On the other hand, there is a mentality amongst people that there must be a magic pill that one can use that will solve problems that are often psychological or emotional, from one day to the next.
[English]
Mr. Smith: There is no question that some over-medication still exists; we hear it from our group. It really depends on the physician; some physicians are prescription-happy. However, it is an area that can be addressed, and it is more of a problem in the older senior groups than it is in the younger senior groups.
With respect to the New Horizons for Seniors Program, this program is well-received in the province of New Brunswick. The suggestion was made that the applications need to be simplified, and there is no question that that needs to be done. The forms, over the last number of programs, have been complicated for some of our senior groups, and that needs to be addressed. In addition with the New Horizons for Seniors Program, often the lead time between the announcement of the program and the closing date of the program is much too short; it does not give our organizations or the individual seniors clubs in the province sufficient time to do their research to make a professional application.
[Translation]
Mr. Bélanger: Obviously people need more time to fill in forms. I would just like to follow up on Senator Cordy's question and on Mr. Cormier's comments regarding medication. There is another point that was not mentioned in the report but that others will raise, and that is the issue of prevention, education and health awareness. Goverments should be investing more in prevention and providing support to organizations that work on the ground on a daily basis. Seniors have been in the New Horizons program but there should also be access to other programs. I think that the solution to many problems lies within communities. Community action is the life and substance of communities. Communities and organizations could be accomplishing much more than all the senior officials or systems. However, they lack the tools, and the financial and human resources to do these things. If there were several programs available to seniors' groups who work on the ground, that would help our seniors remain independent for a longer period of time, it would help them preserve the quality of life, and to remain close to their homes or their families for as long as possible. Obviously there will be those who will need certain treatments, medication, surgery, and so on. We are not disregarding that, but one of the association's priorities is to work hard and to raise people's awareness. The program has been improved in New Brunswick but less than 1 per cent is invested in prevention. That means that 99 per cent is invested in treatment. The government tells us that we are being listened to but we are still waiting for results. It is essential that the government, be it provincial or federal, invest in prevention and seniors' health promotion, that it give them the tools, the workshops, the forums and the information sessions so that they can take charge of their health and ensure that they stay physically, mentally, and emotionally healthy for as long as possible, and that they maintain the best quality of life amongst their families for as long as possible.
Mr. Cormier: Following Mr. Smith's testimony, he may be surprised to learn that an actuarial study was undertaken by the Fédération des enseignants du Nouveau-Brunswick, which provides group insurance plans for active and retired teachers, which showed that the most costly people in terms of insurance or medication are those individuals who retire at the age of 65 years. I was highly surprised that an actuarial study demonstrated this, that it is later that medication costs less. When the question was asked, we were told that when people leave their workplace, they are exhausted and it takes a certain number of years before they become used to retirement, to another lifestyle and another type of activity. So, a few months ago, they increased the contributions of individuals who retire at 65 years old and they considerably decreased the contributions of those individuals aged 65 years and over. Therefore, there is perhaps another myth that says that when you age, you leave things behind, these things are no longer important. Perhaps it is that people focus on the essentials, they worry less about some things, perhaps that is the explanation. I do not know if Mr. Smith was surprised by this, but that is what the actuarial studies showed.
[English]
Senator Cordy: That surprises me too, as a former teacher, that there would be more drug costs between the ages of 55 and 65. However, when you explain it, we can understand the challenge. Retirement is supposed to be one of life's major changes.
Your comments on health promotion are excellent. Seniors have been telling us in presentations that they want to be able to stay in their homes for longer. With respect to the lead time for applications for programs, a program for people with disabilities was announced that had a 30-day time period from the time the application came out to when it had to be submitted. Ironically enough, the finance minister's riding was the only one where a group had the application form ready, so that gave rise to me asking the question as to when they actually knew about the application forms coming out. You made an excellent point about the need for a longer lead time.
Mr. Bélanger, you gave us some excellent ideas, and we will look over our report and make some additions to it. Can you tell me about the human resources in terms of francophones, particularly in New Brunswick? When I was on another committee a few years ago, we came to New Brunswick and were told that military personnel transferring into some rural areas in smaller provinces had challenges finding a doctor who could speak to them in French. Is there a concern about the number of francophone health care professionals, and what could we do to increase those numbers, if in fact that is a problem?
[Translation]
Mr. Bélanger: Obviously, there have to be incentives, but there also have to be programs. The program, Santé en français, as well as the provincial organizations in francophone areas, are looking at all of Santé en français' services with professionals. It takes incentives to attract health professionals to francophone areas. It is difficult, constant work, especially in rural areas and in some francophone minority communities in New Brunswick. Take, for example, the Miramichi region, Saint-Jean and Fredericton, where there are francophone community schools in minority areas. There is currently a very positive process happening with the government with a view to establishing health centres or health clinics in French within these community centres. We are awaiting the outcome of a new agreement with the federal government in order to continue our Santé en français program for another five-year period. But there remains work to be done in this area. In communities with francophone minorities, they are succeeding in attracting francophone doctors who will provide services in French, and nurses, but there still remains work to be done in that area. In minority communities such as Saint-Jean, Fredericton, and Miramichi, it is more difficult. In New Brunswick, there are certain specialized services that are only available in anglophone hospitals. We hear many complaints about the lack of services in French. Sometimes patients manage to receive these services in French, but through simultaneous interpretation. That is not particularly helpful in emergency situations. The communities of Saint-Jean and Fredericton are working hard in order to attract francophone doctors to their clinics, to serve the francophone population.
The province is making an additional effort, but there still remains work to be done, that is certain. The University of Moncton has a medical school and it is the first francophone medical school in the Maritimes. It is under the umbrella of the medical school at Sherbrooke University. The French medical program is in its second year and it is our hope that students coming from Nova Scotia, Prince Edward Island and even Newfoundland will go back to their communities after their studies. There are also incentives whose purpose is to help retain these resources. There has been progress, but there still remains work to be done, that is certain. Francophones in some areas still do not have complete access to services in French.
[English]
Senator Cools: Good morning to all of you. It is a pleasure to have you come before us. One of the reasons that, as I am sure you know, we are travelling is precisely to make this sort of contact and to have a very close association with people where they live, in their own communities.
You are Acadians, Maritime French Canadians — particularly in New Brunswick — and a very unique group of people. Unfortunately, you are not well-known to most Canadians, who know very little of your experiences. Therefore, I hope that many of the comments and recommendations that you make will be featured in our report so as to inform the rest of Canada of your existence.
I know this may sound a little curious to some of you, but when I first came to Canada, which was in 1957 — a long time ago — I had never heard of Acadians. There are always Acadian senators in the Senate; a number of positions must go to Acadian senators. The first real Acadian senator I met was Senator Robichaud, who, as you know, was the former Premier of New Brunswick.
The Chair: You are referring to the first Senator Robichaud, as opposed to the second Senator Robichaud.
Senator Cools: Sorry, I am talking about the former senator, yes. We now have a current Senator Robichaud. Senator Louis Robichaud passed away; he was Premier of New Brunswick at one time, and had a personal tragedy — he lost a son.
The Chair: I think they know him as Saint Louis.
Senator Cools: We are talking today about aging, and you are raising a lot of very deep subjects; I would like to answer a few of your comments. Aging happens to everyone, if you are privileged to live so long. I recently heard of a problem of a particular aging person whose doctor was aging too. I am just wondering if you have any experiences with this. As doctors tend to be a little bit older than their patients, this senior patient found himself without the doctor who had looked after him all his life, who knew his whole life's history and his whole medical history. This doctor was retiring, leaving this individual at a very critical time in his life without a doctor.
This particular doctor was very sensitive to the situation and was trying to place his patients with another doctor that he trusted. It occurred to me that this must be a common problem where senior citizens, Canadians, find themselves having to go through the experience of acquainting themselves with a new doctor, having that doctor learn their whole history at a time in their lives when change and adaptation becomes increasingly difficult. It is very important that doctors begin to understand that they may have an aging population to look after and that that becomes the doctor's responsibility to try to place these patients with a doctor who is not too old to look after those people. I am just wondering if you have experienced this or know seniors who have had this experience because it is one of those unspoken issues that may be more common than we think.
Ms. Cassista: I have done a fair amount of work in the northern part of the provinces where we have a shortage of doctors and have aging doctors who have left, retired, for whatever reason. In the northern part of the province as well as in the cities, you will find that it is very difficult for seniors to get accustomed to a new doctor. They have refused to go because they now have a new, young doctor with whom they must work. I have found in my research that that is happening quite often. In my own personal experience with my own mother, she had not gone to a doctor for nine years because her doctor retired, and she did not feel comfortable. There are others examples of that, so it is happening.
Senator Cools: I am just wondering, if we could mention it — I do not know if it is even important enough — in the report. When I speak to seniors who are moving to Ottawa, moving to cities, I tell them to look for a younger doctor who can see them through old age; if they are 50 years old, find a 40-year-old doctor, not a 60-year-old doctor.
Mr. Smith: That is already happening, as Ms. Cassista said. If we look at New Brunswick and the percentage of older doctors who are retiring in the next five to ten years, it is very high. That will exacerbate this situation where the patient has been dealing with one doctor for years, 20 to 40 years in some cases, and will have to look for another physician to handle their needs.
Senator Cools: I have encountered cases such as yours, where because the doctors retire, the seniors or the elderly no longer bother to go to the doctor. We will think about that.
[Translation]
Mr. Cormier: It is not always a pleasant experience to visit the doctor today. You sit down in a cold room and male patients are asked to take their shirts off, and they freeze until someone comes to take their blood pressure. Then, after 20 minutes, a doctor will tell you: ``I am sending you for a rectoscopy,'' when in fact all you wanted to tell the doctor is that you feel tired. It is very important for an elderly person to be treated by someone who understands the process of aging, how difficult it is for the elderly to adapt, and someone who knows how to really listen and pinpoint what the real problems are. I think that most of the time, elderly patients do not really say what is bothering them. They are often too nervous to do so.
[English]
Senator Cools: I think that is fair to say. Perhaps all of this can be subsumed in a way under the title of ``doctor- patient relationships,'' or something similar. Maybe we could include a small section on it in the report.
In your communities in this part of the country, are your doctors responding to these new needs that are emerging — meaning a huge aging population — and is the profession adapting and studying gerontology and geriatric processes more? Yesterday we had some doctors present, and they said that the study of gerontology and geriatric medicine is not sexy enough and it does not seem to be that profitable. I think one of the doctors said that he thinks that if all doctors studied geriatrics it would be a better world or something to that effect. However, are your francophone doctors responding in that way? Are they looking to study geriatric medicine a bit more?
[Translation]
Mr. Bélanger: At the new school of medicine of the University of Moncton, young doctors are educated about the treatment of elderly francophone patients. The university even has a program called ``Grouille rouille,'' which basically means ``use it or lose it.'' This is a program targeted at that the aging members of our society. The school of medicine's program is geared towards the many different needs of the citizens of Moncton. People are really aware of the aging population, but I could not tell you whether doctors of a certain age are engaged in awareness activities; I do not have any statistics. Perhaps the medical society or the medical staff could enlighten us. But there is one thing we can do in the area of prevention, and that is to promote physical activity. If physicians worked hand in hand with various other organizations to make people aware of this fact, it would improve the situation. We have to go beyond prescribing medication and encourage physical, recreational and cultural activities, and also activities focused on a person's well- being. I think there is hope, since medical planning is much more engaged in these areas than it was before, especially in the field of family medicine. There has been progress.
Mr. Cormier: Are we adapting to the aging population? I believe so, but it is only the beginning. I sit on a committee at the Moncton Hospital whose members go into the community to meet with people with the goal of finding better ways to treat seniors. If you have time, I would strongly recommend you read Head First, The Biology of Hope, or the French version, which is entitled Le role du moral dans la guérison, La biologie de l'espoir, by Norman Cousins. The author believes that most people who visit a doctor do so seeking reassurance about something.
I am 71 years old and I am much less interested in material things. I have a certain level of income, and I do not need any more money, what I care about is my health. When you grow older, you become more aware of your mortality, and when you go see a doctor, you need to be reassured. You want to hear the doctor tell you ``You just have the flu and it will be gone in a couple of weeks, go home and rest, perhaps you are doing too much, perhaps you are undertaking too much,'' but often that is not what the doctor does. He sends you out to do a test, and so I get the impression that doctors do not trust their own instincts. It seems that when I was young, doctors provided more reassurance. But now, they immediately send you to undergo tests in a hospital, where wait times are endless.
I absolutely believe that general practitioners who take training courses should learn more about geriatrics and how to treat their elderly patients. I cannot insist enough on the importance of reassuring the elderly; physicians need to assess the medication which is being taken and ask their patients to bring their pills with them in order to see whether three quarters of them are really necessary. I am convinced that people must learn to take responsibility for their own health when they are young. Too often, that responsibility is put on the shoulders of health care professionals. Some medical school graduates will claim that this fact is the greatest failure of the modern world.
[English]
Senator Cools: You have said a lot, and I would like to respond to all of it, but we do not have the time. I will re-read your comments again. You said that human beings need to be reassured. You come back to the essential element that as people grow older, they become aware that they are running out of time, so there is a psychological experience that accompanies every ailment they might have. Therefore, it is twofold: The body is aging and pathologies are creeping in, but at the same time that human being is having a very profound and very deep psychological experience. This has been talked about before in this committee, and it is something that we have to crystallize into words. Therefore, I understand that.
I know universities are offering courses, but that is mostly for medical students who are going through university. When I put my question, I was trying to ascertain whether or not, on the ground here in your communities, those doctors in the field are responding and attempting to obtain that critical knowledge.
Mr. Smith: Further to your question, our seniors federation is in the process of setting up a research committee that will look at the impact of the aging over the next five to ten years, and we hope to go out into the community to do a lot of this research and utilize the professional people, too.
The Chair: We heard yesterday from these three physicians who, first, tried to disabuse us of the notion that seniors will live longer and that they will be better off financially. I think it is true. I think that economists would say that those of us who are seniors now — and with the exception of these two over here, who have not quite reached that level; the other two of us have — will probably be the better-off generation. Our children and future generations may not have as much money, unless we can leave them a lot.
They also said that with the rates of obesity, of galloping diabetes and that type of lifestyle that prevention programs become absolutely essential. We know what all government budgets are like. I have been in the provincial government in Manitoba for eight years and to try to get money for prevention for young offenders, for young kids on the streets, for health care needs is next to impossible because the parliamentarian sits in the legislature considering what he or she will get dinged on: the person who did not get emergency care, the person who did not get a doctor when they needed it. Therefore, there is this natural gravitation by those elected politicians to the immediate need not to something that, first, is not measurable, and, second, if it was measurable, would not for 10 or 15 or 30 years. We live in the now not in the future.
Do you have any ideas on how we can affect that change? We know it is essential. If we are to have healthy, active seniors who volunteer, then we know that we need to put that in place beforehand. They need to volunteer as young persons to develop that whole attitude. If they are to be healthy, they do not get healthy at 80 years of age, they have to have maintained a healthy attitude; they begin to get fit as kids in school not as an 80-year-old.
I was a little depressed when my daughter, who is a teacher like you, Mr. Cormier, and like I was, told me several years ago that her fourth grader had to sit down after walking two blocks. She simply did not have the energy or the fitness to continue after two blocks. How can we change that attitude?
[Translation]
Mr. Cormier: The difference between the House of Commons and the Senate is that you are appointed, and I believe this is a good thing as long as the Senate does not become a partisan institution.
Members of the House of Commons and in our legislative assemblies are elected. They have to chase after votes, and sometimes they even manage to get a hospital built in an area where one is really not needed — I will refrain from naming such places in New Brunswick — and where existing institutions located nearby were perfectly appropriate and able to meet the needs of the population. However, it is good to talk about prevention, as you said, and prevention can be measured, but perhaps not as accurately as the opening of a large building with a ribbon-cutting ceremony.
A moment ago, you were talking about Senator Louis J. Robichaud and the fact that he created a system of equal opportunities for all. He sent at least one commissioner, I believe it was Commissioner Alexandre Boudreau, to Sweden or Finland, and this commissioner and his colleagues concluded that the province should have administrative commissions like the ones in the Scandinavian countries in, at the very least, the areas of education and health care. But it is the only which the Robichaud government did not include in its reforms. Why not? Because it would have taken away from politicians the power to authorize the building of hospitals and schools, and other such institutions, because the commission, which would have been comprised of all kinds of experts, would have studied an area's demographics, for instance, to assess areas which needed a hospital or a school. I surprise myself in regretting the fact that New Brunswick did not choose that type of political system in which politicians would have assessed a situation and adopted the appropriate budgets. However, Madam Chair, I believe that we will now be spending a lot more time trying to fix short-term needs rather than looking at adopting long-term policies.
[English]
The Chair: I like to refer to it as the ``edifice complex.''
[Translation]
Mr. Bélanger: Indeed, Madam Chair, you raised an important issue. Of course a government wants to get re-elected every four years. But when you talk about prevention, you are talking about the long term. And as far as raising awareness is concerned, you have to reach all generations. You need to raise awareness among seniors, but also among our children and grandchildren with regard to aging. We have to change people's perceptions of seniors; people perceive us as being a generation which has had everything, and because we are getting older, people think we are responsible for the cutbacks in the area of health care. People do not look at all the good we have done and they forget that seniors have contributed and are still contributing as citizens who pay their taxes, who have raised families, who have worked and who are engaged in volunteering.
We, the seniors, must also work to see how we can change, improve or influence the policies adopted by our children, and our grandchildren. We are not paying enough attention to this aspect. We must continue doing this work and we must make a priority of seniors' issues. At the same time, I believe that we must be aware of what is happening in society, because we do not know how our children, our grandchildren will take advantage of social programs or pension plans and so forth. There are fewer people working and more people in retirement, which means that many factors can come into play.
I believe that we, as seniors, can contribute to building bridges between generations. There are not enough projects, there are not enough bridges. This is another factor. It is important for us to improve the way in which future generations understand the current conditions of senior citizens. There are voters, they will also be representatives later on and all this will count in the long term. I think that trying to find a short-term silver bullet solution is very difficult.
I think that we must work on a long-term basis, we must continue educating our people, and we must continue discussing prevention. The New Horizons for Seniors Program provide small projects that give us access to funds. However, this is not enough. I mean that when we have a project for one year and when we cannot continue it the following year, we have to ask for a new project. If we can make a difference in three years, it could become an independent project. However, we cannot do that. Government programs, whether they are provincial and federal, are all the same. They all lack continuity, despite the positive results of some projects. It is difficult for us to carry on certain projects. If we want to continue getting help, we must always align with what the governments want, and not with our needs. This is what makes a difference in many sectors.
I am aware of the fact that awareness-raising and prevention issues are not easy to deal with. This is because political parties or politicians want immediate and tangible results.
The University of Moncton has reopened its Centre de recherche du vieillissement en français for the Atlantic provinces. Recently, we met some representatives of Santé en français in the Atlantic region, and the importance of research was emphasized. We often have insufficient data and not enough serious in-depth studies regarding elders and francophone minorities. In some sectors, we do not have enough data to fill out the project application forms.
For instance, when dealing with poverty, we can get certain statistics, up to a certain point. We can see what percentage of elders received the Income Supplement because they are living under the poverty threshold. This is another sector that has not been dealt with. Actually, in our society, there is still widespread poverty among elders, especially women.
In New Brunswick, a study was done a few years ago that showed that 56 per cent of francophone women aged over 65 and living alone, were living under the poverty threshold. Quality food costs money and we know that this is an important component for a person's health. When they go to the grocery store, their small income forces them to make choices and all too often, housing expenses have priority over food.
In New Brunswick, there is a different factor, something our association has also looked at, the property tax assessments. We managed to get information for some cities in Quebec. Many seniors would like to continue living at home as long as possible, but on a fixed income or without an income supplement, that becomes very difficult. Real estate development that is growing in some cities or even along some coastlines is making some seniors feel forced to sell their houses. And even where?? resale value goes up, that does not help them. Every year, they have to pay a certain amount of tax, and the assessment goes up by $200 to $300 each year.
In cooperation with the associations, we are proposing that the government absorb those costs, then recoup the difference in tax due each year once the house is sold. In Quebec, the City of Candiac offers that option. Residents can choose that option. The option, or program, has a great deal of potential, and makes it possible for our seniors to remain independent and to keep their homes.
This committee's report is extremely interesting, and we hope that the government will make the necessary efforts to implement its recommendations. That will not happen automatically, of course.
[English]
The Chair: Mr. Smith, I read your brief and would like to address the issues of people living in nursing homes in terms of whether we need some type of — I do not like calling them patients — client bill of rights when they go into a long term care facility.
Mr. Smith: Yes, there should be some sort of patient bill of rights to protect the rights of those people going into homes. It does not exist presently, but there is always the possibility of abuse. Therefore, it is very important.
The Chair: At one point if you had to put your loved one into a long-term personal care facility, often a member of the family was close by who could monitor the care and visit on a regular basis. That is becoming less possible as the country has become more mobile. The situation most recently in Newfoundland is that you have people living in the outports still, but they are all very old. Their young people are out in Fort McMurray earning incomes. This is changing a little bit, but it is still dominant in this part of the country — and I have to admit my bias; although I come from Manitoba now, I was born and raised in Nova Scotia, and my mother's name was Martelle, so that should make you people feel more comfortable. The reality is that I am very concerned about the patient, or the client, who does not have an advocate. What happens in that case?
Mr. Smith: You are quite right in the sense that because of the mobility of the population is having an effect. If you go back 30 or 40 years, the family was there to support the elderly person. Now they are sort of left on their own, and they become very isolated. It affects not only their physical well-being but also their mental well-being, and it is an area that needs to be addressed.
Ms. Cassista: This is one of my areas of expertise; I work a lot with folks in the nursing homes. That is why seniors want to remain in their home as long as they can. Unfortunately in New Brunswick, we have 62 nursing homes with approximately 4,000 beds that care for level three and up. However, we also have special-care homes. These are mostly homes that people opened up to seniors in 1997 when the post-mortem was put on beds. When I came to New Brunswick four and a half years ago, I found in my research that, for the most part, they were not licensed. Many unlicensed special-care homes still exist.
That has been the thrust of our coalition in making recommendations to the government, and we were actually part of the stakeholders that developed the long-term care strategy. However, it is short; it does not have an actual plan, so we have a long way to go. In the four and a half years that I have been here, along with the coalition, we have made some progress in terms of long-term care for seniors. We were at the bottom of the list. We had the liquid asset that was being gouged by seniors when they went into nursing homes. That has been done away with now, and it is based on income.
Nursing homes, for the most part, are short staffed, and there is a high turnover of staff because of inadequate wages and training. Those people that are in residence — we call them residents, not clients or patients — in nursing homes are there because they are frail or ill, and they cannot live at home any longer. We do not have 24-hour care in New Brunswick for people to live in their homes. There is a shortfall of that. In New Brunswick, the government contracts out home care services to agencies and to the Red Cross at $13.64 an hour, so the staff are only getting about $8 or $9 an hour and are working 15 to 20 hours a week. Thus, we have a retention and training problem in this province. Many seniors in nursing homes do not have loved ones to care for them. I experienced that last year when my own mother, for a very short period, lived in a nursing home. Other residents shared the room with her, and their family members were nowhere to be found. I then became an advocate for those people because their food was cold, the room was dirty and so on, and that still exists in this province. We tell the government, and this government wants to continue to do the investigation themselves. Therefore, we support the ombudsman's recommendation that all complaints and investigations should be done through his office. That is one of the issues that we continue to advocate, and we believe that the bill of rights should be similar to Ontario's bill of rights. We have a long way to go in New Brunswick with long-term care.
[Translation]
Mr. Cormier: Madam Chair, I would like to say how frustrated I am about the scope of this issue. If the province was last on the list, or close to that, it would still be seventh — in spite of all the improvements made to the program in the past year or two. People were being bled white, not only residents of seniors' residences, who were being asked to pay $54,000 to $75,000 a year, but also their parents and spouses when the residents themselves did not have a high enough income. Many people ended up at a level of poverty they would never have experienced if they did not have seniors requiring the care that the residences provide. For example, one of our members, whose husband was a university professor, had to pay all of her pension and part of her personal income. She had opened a small business in Fredericton, but had to shut it down because she went bankrupt. At present, she is over 65 and is now teaching in China for $800 a month to cover all the expenses engendered by the ridiculous costs levied on residents. Doing this to people who have aged and who have built this province is a terrible thing. What is even more dreadful is that New Brunswick had appointed a council of seniors, whose chair said that we could not ask the government to improve conditions because it would cost too much. Fortunately, the government fired her and her entire council, and appointed a minister responsible in the council's place. The province even has a number of seniors' organizations, and what is very frustrating is that they said the government did not have the means to improve conditions. So as long as seniors' organizations do not pull together, we will never get anywhere. That is one of the reasons for which the coalition was established in 2004, and for which it will stay. The coalition's 54 member organizations monitor the government closely, and act as a watchdog. We are going to continue to do that work.
Mr. Bélanger: During last year's consultations on social development for seniors, another issue was raised: that of greater seniors' involvement on the evaluation committee. In Quebec, there is a program called ``Rose.'' I do not recall the name of the other program under which seniors assessed care centres, and other seniors were able to apply the knowledge from their once-practised professions in various areas, ranging from construction to medicine. The government gives these groups a subsidy, commissions are struck, and these commissions, rather than the public servants, are responsible for evaluation. I am not saying that departmental officials do not do their jobs, and I give them the benefit of the doubt — but I believe that a senior who has expertise in any one of a wide range of areas could do a very good evaluation and make recommendations. Quebec has such a program but I believe that the government withdrew it from the FADOQ. It appears that the government is in negotiations with the FADOQ once again because they have done an excellent job. The evaluation was carried out by seniors, for seniors, and dealt with what happens in care centres and old-age homes. In New Brunswick, the issue has been discussed, but there was never any response.
[English]
Senator Mercer: The University of Moncton has a medical school now, and sometimes I think we forget that; I am from Halifax, so I am not that far away, and I should remember. How long has the school been functioning? How many students are enrolled? How many graduates have they produced, and do we know where the students come from who are being educated there? You may not have the knowledge for these questions.
[Translation]
Mr. Bélanger: The school is in its second or third year. It is a new school of medicine at the University of Moncton, and is under the supervision of the University of Sherbrooke because the University of Moncton does not have all of the necessary elements. We hope that over the years, they will be able to accumulate the necessary tools. This means that students are graduates of the University of Sherbrooke, but the school is based in Atlantic Canada, which is where most students, approximately 30 who return each year, originate. There are perhaps a few students from Quebec, but to my knowledge, there are not many. The idea was to train doctors in the Atlantic region so that they remain there to practise their profession.
Earlier, we spoke extensively about linguistic minorities. I would like to point out that in New Brunswick, harmony between anglophones and francophones has improved significantly over the years. There is better understanding between these two cultures, these two languages. We have achieved a lot of progress because anglophone and francophone groups make up the coalition. When there are common issues to discuss with the government, we all work together. Therefore, there is a certain level of harmony. The role of our association is really to defend rights and interests, because bilingual organizations do not defend linguistic or cultural rights. I respect this. This is exactly why we were formed in 2000. Seniors had no one representing nor defending their rights and interests.
I would also like to point out the disappointment felt by francophones with respect to the abolition of immersion programs in New Brunswick. The government recently made cutbacks, and following a school system evaluation, decided to abolish the early immersion program that starts in kindergarten and lasts until grade 6. People find this deplorable because the program made anglophones more aware of the cause of francophones in New Brunswick.
That study did not evaluate the impact of abolishing the program. Early French immersion fosters better understanding of the francophonie in New Brunswick from the perspective of parents as well as children. There has been progress and improvement in New Brunswick. There is a much higher level of harmony, that we hope will continue and improve and serve as an example for the rest of Canada. And why not?
[English]
Mr. Smith: To answer the question on the medical school, I think this is the second year for the University of Moncton. There is a plan in place to institute an anglophone medical training facility in Saint John, New Brunswick, and this will be affiliated with Dalhousie. My understanding is that the government hopes to have this up and running within the next two years.
In closing, we have a question for the committee. We think the report is an excellent report. However, most of our services for seniors in New Brunswick are provided by the provincial government. Is there a plan in place, on the completion of this report to pull the provinces into your recommendations, and just how do you visualise this happening?
The Chair: We have tried to meet with the provinces. Yesterday we met with the department of finance from the Province of Nova Scotia, for example. Clearly, our mandate is primarily federal, how we can make the federal government understand its greater responsibility to an aging society in Canada. Some of the recommendations, hopefully, will provide additional funding for the provinces, who can then direct those dollars to the seniors. It is not our intention to try to direct services at the federal level. We do not think that will work, that the closer a government is to the people, the more likely those services will be delivered in ways that are responsive to the needs of those people. However, we do recognize that it is the federal government these days who has the bulk of the dollars.
If we were to have, for example, a national home care program, a national prescription program and additional benefits for seniors; if we were even to ensure that all seniors collected all the federal money that they, in fact, are in entitled to — because we know there are seniors who are not collecting the Canada Pension Plan and that there are seniors who are entitled to the Guaranteed Income Supplement that are not receiving it — if we could even make those types of changes, then it would make it easier, we believe, for the provincial governments to deliver the essential services required for the seniors of this country. That is the thrust of where we are coming from. We hope that we can table our final report on September 30. Maybe it will be grist for the next election campaign.
I want to thank Mr. Smith, Mr. Cormier, Mr. Bélanger and Ms. Cassista for their presentations this morning.
Senators, we have two groups of witness joining us now: Dennis Driscoll, Chair of the Veterans and Seniors Committee with the Royal Canadian Legion, New Brunswick Command; from the First Nations and Inuit Health Branch we have Debra Keays-White, Regional Director of the Atlantic Region; Wade Were, Acting Senior Advisor of Policy and Strategic Planning; and Peter McGregor, Special Advisor, Home and Community Care. Welcome to all of you, and we will begin with Mr. Driscoll.
Dennis Driscoll, Chair, Veterans and Seniors Committee, The Royal Canadian Legion, New Brunswick Command: It is with great interest that myself and members of the New Brunswick command perused your report. I did outline in writing a few summary talking points. The first one is the identification of seniors. Throughout the report, seniors are identified as individual groups, such as ethnic, geographical, employment related or condition of health. Seniors are seniors and should be simply age-defined with a base being determined if required. This refers to silo groups, and as long as that type of thinking is there, national policies, long term strategies and so on are very difficult to implement.
With respect to one voice for all, a national committee on ongoing seniors' service issues should be developed with a strategy to ensure that all seniors in Canada receive the same services. Again, this was approached a number of years ago. I sat on the committee of the Royal Canadian Legion, Demeaning Command. We put a variety of groups together and tried to come up with the same ideas. At that time, it was not workable; I still believe that it is workable in the long term, although, it will require a lot of direction.
On addiction and seniors, identification of seniors for financial benefit through government programs that operate casinos, lotteries, liquor control boards impacts a percentage of the senior population in a negative manner. Seniors should be removed from this target audience. I believe we have all seen the big casino blurb that comes on television and invariably shows a bus of seniors or an ethnic group that is trying to raise money, and it is identified that way. This is becoming more of a problem; it is a hidden problem for seniors. Typically, ``Nanny'' goes to bingo, and before you know it, she is spending $400 a week for bingo. Therefore, even though she has resources, the resources become depleted, and it creates different problems.
The issue of securities and seniors has really come to light in the last little while. A panel or some form of recourse should be implemented to deal with investments that have questionably depleted the capital. Many cases are currently documented, and there is no recourse at the present time — it is investor beware only. We hear many stories throughout the Royal Canadian Legion where there is a type of affinity investment being done. Someone will come in to an organization, to a sports group with an investment strategy and all of the sudden the whole group goes for that investment strategy and the capital is depleted leaving seniors with nothing. They are the first target. There does not seem to be any recourse in these cases.
Atlantic Canada right now is heading into an economic boom. Many parts of Canada have seen economic growth leading to higher property taxes, food costs, et cetera, and the list grows. The first line of impact in many cases is the senior population. Offset taxation for homeowners could keep seniors in their homes longer. An arrears account could be implemented with the value paid upon disposition of the property. I listened with interest as the previous speakers identified those types of issues.
You have already gathered a massive amount of information, and you are to be commended for that. These were simply areas that were prominent when reading the second interim report and that we would like to discuss with you. I thank you very much for your time Madame Chair.
The Chair: Thank you very much. Amongst your points were issues that we have not targeted, so I appreciate that very much.
[Translation]
Debra Keays-White, Regional Director, First Nations and Inuit Health Branch, Atlantic Region, Health Canada: Madam Chair, I want to thank the committee for the opportunity to inform you of our work in the Atlantic region and to share with you some of the challenges that we and our First Nation and Inuit clients experience.
Together with First Nations and Inuit organizations and communities, our office carries out many activities aimed at helping people stay healthy and preventing chronic and contagious diseases. Most of our efforts may be considered ``upstream'' and largely focus on the younger residents of reserves and Inuit communities.
The federal government provides these health services on the basis of policy and historical practice and supports the provincial and territorial government to provide health services to all Canadians including aboriginal people.
[English]
In the Atlantic region, there are 33 First Nations and 5 Inuit communities geographically dispersed across our four provinces. Communities range in size from about 50 to over 3,000 residents. Most communities have less than 500 residents. There are 23,000 community residents in total in the Atlantic region, and the Atlantic region's budget for managing First Nations and Inuit health programming is approximately $90 million.
We offer a wide range of community and public programs, which largely focus on children and youth, mental health and addictions, chronic disease and injury prevention, communicable disease control and environmental health.
Health Canada also manages the Non-Insured Health Benefits Program. In the Atlantic region, this program serves approximately 40,000 eligible First Nations and Inuit of which 14 per cent are 55 years of age or older. In the Atlantic region, we spend approximately $32 million in benefits, which include prescription drugs, eyeglasses, dental care, medical transportation, and others of importance to seniors and younger clients.
In terms of primary care, the Atlantic region has a limited role. We have an oral health program and a home and community care program. Primary care is generally the responsibility of the four provincial governments.
Our programs are generally delivered by First Nations and Inuit communities or organizations that have a high degree of autonomy and flexibility in how they manage their Health Canada program funding and how they deliver services. The Labrador Inuit operate under a self-government arrangement, while many First Nations operate under transferred authorities.
The Home and Community Care Program is our program that primarily focuses on the elderly. Last year, 56 per cent of the 1,243 First Nations and Inuit clients accessing this program were 55 years of age or older.
Our annual regional budget for home and community care for First Nations is approximately $5 million or 6 per cent of our regional budget. The communities' home care budgets range in size from $13,000 to $544,000. Due to small populations, more than a third of communities receive less than $55,000 annually.
The Home and Community Care Program is designed to involve First Nations and Inuit communities directly in planning, implementing and delivering home and community care services.
The Home and Community Care Program is comprised of essential service elements, such as home care nursing services; home support personal care services, which are a complement to the Indian and Northern Affairs Canada's Assisted Living Program; short-term in-home respite care; and access to medical supplies and equipment.
If these essential elements are in place and the community has sufficient resources to address other local home and community care service gaps, they are encouraged to do so. These may include such services as meal programs, adult day programs and home based palliative care. However, few have the means to offer these services.
Many communities are challenged to deliver the essential home care services for a variety of reasons, including the isolated and remote location of many of the communities and the small size of the program at a community level that does not allow for economies of scale. To a lesser extent, many of these challenges are also experienced by the provincial system in providing services in rural areas.
We work collaboratively with Atlantic First Nations in examining ways to identify priorities on home care and other programs. Consultation with Atlantic First Nations on home care programs suggests the need for better access to rehabilitative therapies, day programs, long-term care facilities, palliative care, mental health care, and nutritional counselling; greater flexibility in service plan delivery to allow for service care delivery on weekends and evenings; more education and training for the workers; better discharge planning; transportation options; and the resolution of jurisdictional issues.
Small communities with small budgets tell us that operating and staffing a home care program is a huge challenge when only a handful of patients require care. Further, their limited available resources can be exhausted very quickly if one or two residents have intense needs.
Attracting and retaining qualified home care professionals and workers is a universal challenge that is underscored in First Nations and Inuit communities by location, lack of professional support, rates of pay and the fact that the work is often part-time.
Communities also receive Indian and Northern Affairs Canada funding under the Assisted Living Program. Many communities have coordinated the management of these federal home care programs. Additionally, communities would benefit from further coordination with provincially funded services.
In Labrador Inuit communities, federal funding supports home care services to land claim beneficiaries while provincially funded services are delivered to other residents in these small remote communities. The Nunatsiavut Government wants to negotiate with the province on how they can share the cost of the delivery of a single program.
The challenge of coordinating federally and provincially funded health services on reserves is being addressed by Health Canada in part through its Aboriginal Health Transition Fund. This fund has a dual purpose. First, it aims to support First Nations and Inuit communities in improving the integration of existing federally funded systems within First Nations and Inuit communities with provincial and territorial health systems. Second, it assists provinces and territories in adapting their existing health services to better meet the needs of all Aboriginal peoples.
Through this fund in the Atlantic region, we have invested over $6.5 million in projects to First Nations and Inuit communities and provinces to support coordination, integration and adaptation of health services with provincial health services.
One project of particular interest to this committee involves a partnership between Nova Scotia First Nations and the Continuing Care branch of the provincial Department of Health.
As part of this project, a hospital-to-reserve home care discharge planning model will be implemented across the province. As well, an assessment of needs and capacity will be completed with home care services on reserves to inform the development of a provincial First Nations home care framework. Finally, the project partners are committed to establishing an ongoing tripartite policy forum for continuing care.
We believe that these measures will advance coordination and the development of a continuum of continuing care for First Nations in Nova Scotia, and be of interest to other jurisdictions.
The Atlantic First Nations chiefs have identified ``elder care'' as a high priority health issue to be addressed this year. The chiefs want to see a strategy that identifies local support options to keep elders in the community for as long as possible and a strategy that addresses cultural competency, quality care and access for those who are admitted to long- term care facilities off-reserve. Health Canada and First Nations are partnering on the development of a strategy in this area.
Services that are culturally appropriate is an important factor in program delivery. For First Nations elders, admission to a supportive housing or long-term care facility requires relocation far from their home and culture. There are no long-term care residential options in First Nations communities, and our clients tell us that the off-reserve facilities are not culturally safe. Currently, the number of First Nations elders in Atlantic Canada who choose this option is negligible. We must work with provincial governments to ensure that their ideals are respected.
At a national level, the Government of Canada and First Nations and Inuit organizations have undertaken research to gain a better understanding of existing home and facility-based continuing care services in First Nations and Inuit communities.
A joint working group is in the process of reviewing the research-based recommendations, developing a continuing care policy framework and preparing a policy analysis paper to support decision making in regard to improvements in continuing care services for First Nations and Inuit communities.
To close, Health Canada will continue to help advance elder care through its program mandate but also through collaboration with other federal and provincial departments and our First Nations partners.
Thank you for inviting me to present to you today. I welcome any questions.
The Chair: I thank you very much for your presentation.
I come from Manitoba. I have visited nearly all of the First Nations communities in my province. I have not been to Shamattawa, but I have been to Pukatawagan, I have also been to Norway House, Oxford House and Grand Rapids. I have been to a number of them, and I seriously question the flexibility of the programs that are delivered. I would like to give some specific examples. I was at Oxford House where the federal government decided that, yes, they could have a blanket warmer at a cost of $1,000, and then two weeks after the delivery of the blanket warmer, decided, no, they did not qualify for the blanket warmer. The patient at Oxford House, by regulation, can remain in that community, in the nursing station, for one hour. Realistically, we know they are often there longer than that. However, if they need to be there longer than an hour, transportation must be arranged for Thompson, Manitoba. Therefore, to have warm blankets to put on that patient to transfer that patient to Thompson in a Manitoba winter, which in that area can go to minus 40, seemed to me a pretty basic piece of equipment. I also saw the lack of flexibility, for example, in rusted out autoclaves in the same nursing station. I saw drugs held in a room in which mold was growing all over the ceiling and the walls.
I clearly came back and spoke to the Minister of Health at the time. I was also a minister at that time, and I was less than impressed with the delivery of this so-called ``flexible'' health care.
You are not responsible for that, and I do not want you to feel that I am dumping on you. W have got to do better. We have got to start delivering services that are in some way comparable to the services that we are delivering to non- Aboriginal people in this country, and we are not there yet. How will we get there?
Ms. Keays-White: I can appreciate your effort to make it to all of those communities because Manitoba does have a tremendous number of remote communities. I was in Thompson myself last week, actually, but, thank goodness it was not winter, and I know how cold it can get. As a nurse, I can appreciate the importance of having warm blankets. I know how welcome they were when I was a patient in a warm hospital. Therefore, I sympathize with you when you are describing some of these situations. Although, as you say, I cannot be responsible for them, I, too, would like to be part of the solution. It is reasonable to say that disparities exist across this country. I cannot speak for Manitoba at all. I hope we do not have situations in Atlantic Canada as you have described, but I must admit I cannot promise you that we do not.
How do we tackle it? It will take a team effort, there is no question. We are doing our part in Atlantic Canada by partnering with our First Nations bodies, our First Nations organizations. We work very much in concert. We have what is called a co-management approach here. Most of our communities are in one method of transfer or another, so we are doing what we can to, first, empower the First Nations communities as much as possible, giving them as much control and influence over how they deliver the resources that they have. As far as the amount of resources, we are doing what we can to increase that, and we advocate for them at the national tables. As you know, it is pretty well the only decision-making power I have to bring more money in. However, we also do pass on any increases that we get directly to our First Nations communities so that they can utilize any increased resources that they have.
We have talked to our First Nation chiefs over the past few years and asked them to identify their top priorities so that we could take any discretionary resources and discretionary efforts that we had at our disposal to focus on the major issues for them. The fist two issues that they identified were addictions and mental health and the third one was elder care and care of their seniors. The most resounding message that we hear from them is that they feel compelled and morally and culturally obligated to keep their elders at home as long as they can, and they do not find the available options for longer-term care palatable. They do not feel that they are culturally appropriate.
Therefore, we have sought provincial partners and are working with Northern and Indian Affairs Canada, INAC, as well to at least be an advocate. If we cannot do more to increase the money, then we can at least see what we can do to lever the available resources to try to improve coordination of the available services and to build on what the disparate groups might be providing. Our efforts through this Aboriginal Health Transition Fund to attract a provincial government to the table to meet with us and the communities so that they can hear from the communities about their issues is a really big first step for us. We are not working in silos anymore; we are actually looking at what we can offer to the communities and what the communities and the province can offer, and bringing INAC to that table to see how flexible they might be with what they have available to try to improve it.
I cannot address the financial piece, as you know, but, we are trying to at least coordinate the amounts and the resources that we do have to make it a more coordinated and integrated service delivery model. I believe what we are doing in Nova Scotia will inspire the other provinces because the chiefs work in the four Atlantic provinces together through the Atlantic Policy Congress of First Nation Chiefs. With all the communication across provincial boundaries, I am hoping that this will inspire the others.
The Chair: Thank you, and I am pleased to see those steps taking place.
Let me give you an example of communication breakdown. I am on the Sandy Bay Reserve. It is about 25 kilometres from Portage la Prairie. A young child has been taken to the Portage la Prairie Hospital. She has been diagnosed as being in need of a nebulizer. She spends an additional five days in hospital at enormous cost because of a total breakdown in communication between the provincial government and the federal government as to who will to pay for the nebulizer. Does that type of situation happen here, and how do you resolve it?
Ms. Keays-White: I am pleased to be able to say that I am not aware of anything such as that happening here. We have, in general, very good relations between the provincial governments and our staff. I will not say that issues do not exist where people want more resources, and maybe have a good case for more than we can pay for. However, in the six years that I have been here, I am not aware of an impasse between provincial and federal governments. Generally, we have been able to get them resolved.
The Chair: Mr. Driscoll, when we put in video lottery terminals, VLTs, in Manitoba, I happened to run into a Ukrainian priest at the airport. I had known him from Winnipeg, but he had moved to Dauphin. He said much of what you said today, that the babas — the Ukrainian name for grandmother — all of a sudden were playing the video lottery terminals and were no longer at home. With two working parents, a grandmother used to be the one who was there for the kids when they came home from school. In a similar situation at the Sheraton Hotel Halifax, which became the Casino Nova Scotia Hotel, I received a note under my door that said breakfast would not be served in the rooms the following morning unless we pre-ordered because seniors were being invited for a free breakfast and given a $5 coupon to visit the casino following breakfast. Those are my two examples of what I thought were targeting of seniors. Would you like to elaborate on those?
Mr. Driscoll: Currently, as you may be aware, Magnetic Hill, here in Moncton, has just been awarded a casino. This has been very controversial ever since its inception. The Royal Canadian Legion has taken part, as many other groups have, for the sheer matter of finances. However, we are becoming an addicted economy. All forms of government and organizations require revenue, and unless these revenue streams or sources are coming from other types of events, the choices are limited. The other types of events are no longer available. To ask a young girl who has worked 60 hours in a week, while trying to raise her two children, to bake pies to sell for a charity or any given organization is pretty unrealistic. Because of the fast pace that everyone lives and so on, we are noticing a lack of volunteers, which you have already identified. We were looking at some form of taxation break for volunteer hours. The whole system revolves like a wheel; it just goes on and on.
On this specific point of gaming, the New Brunswick government enjoyed a $133-million profit share through VLTs last year. A $90-million investment is going into Moncton. We have not seen the forecast-generated revenues yet; they are kept in a secret file folder somewhere. Many factors have impacted this year. When you look at other decisions that are based on health care, such as the smoking restriction, that has had massive economic impact on both sides of the fence; we are still down on the hospitality industry probably about 30 per cent across the board. People no longer go out and sit for an hour or two after dinner as they used to when they could smoke with another bottle of wine; they just do not do that sort of thing. They tend to eat, get out and go to someone's home.
The illegal contraband market, of course, has grown substantially. We are getting cigarettes from all over the country as other illegal things happen. This goes back to the senior issue in that many people store these items in ``Mama's'' house, and she winds up being charged, and so on. It is possible; other countries have enjoyed forms of gaming quite successfully. However, in Canada, I do not know; I just do not know where it is all heading; there is no end to it. If the casino here in New Brunswick is a go and is successful — excuse me, Senator, but Nova Scotia has not been really successful at it yet — it will be the wave of the future. In which case, things need to be put in place to identify the problems with this.
How do we protect the 75-year-old woman who has just lost her husband and has no companion now? She wants to do something, and the advertisements are telling her, ``There is a bus tour, Nanny, so go for the weekend.'' Six months later the woman is broke; she has spent her revenue, and nobody knows how this has happened. Again, she becomes a burden on the system. We have dealt with it for a number of years as I have said, through our own organization's fault. We have people come in who put all the their money, their veteran's pension in the VLT, and then the next day need the Poppy Fund to pay their oil bill. They will make applications as veterans who are in distress and require food, shelter or lodging, which we provide without question; it is a real cycle. We do not have the answer to how to get of it yet.
The Chair: Thank you. The last time I looked, $450 million of Manitoba's revenues were from gambling.
Senator Cordy: I am also from Nova Scotia, and you are right in that they are actually laying people off at the casinos. Seniors are often preyed upon financially sometimes by their family members, unfortunately, but also by charitable organizations. Families discover that their parents are spending substantial amounts of money through telemarketing phone calls that they are getting. Have you looked into that as an issue at all?
Mr. Driscoll: Yes, senator, we have. One of the major issues that that brings to the forefront is that a number of years ago a veteran was the target for the younger female population. A young woman that maybe was not financially sound or was looking down the road to her future would befriend an older gentleman who was a veteran, who had the resources and the income. The wedding bells would ring him being short-lived for this world, and she would maintain that lifestyle from that point on. Provisions have been implemented such as if you are married after the age of 61, there is no transference of a pension. That was a great help, although a segment of the population were very upset by it because there is a 59-year-old guy out there who wants to marry a 30-year-old woman and wants to provide for her — you cannot please all. That was very controversial, but it has worked; it has solved the problem for the long term, so we do not see too much of that anymore.
This end of the country has yet to see that great wave of telemarketers that British Columbia and the higher populated areas, such as Toronto, have seen. We are just at the tip of the iceberg for that. We hear the odd story that comes through our organization. Much of it is about paying upfront for a discount in the long-term use of any given item. If the people who are affected by this come out of their shells, there are resources for them to go to. However, we find most people now are living in little capsule, they will not come to people and ask the questions anymore. We have lost the communication skills and will continue to lose them as long as people stay at home. Many scholars say that 10 years from now the social skills of the youth will be questionable after spending so much time on a computer and dealing with the electronics that are out there. They will not have the necessary social skills to be able to defend themselves.
Senator Cordy: Sometimes I think the seniors are embarrassed to tell their family that they have lost their money or that they have given it away.
You touched upon the issue of isolation of seniors, which we have heard a lot. You could be isolated in a rural area because in Atlantic Canada, being a Nova Scotian, I know a number of our young people are heading out West to earn income. Therefore, you do not have family members around, but you could also be isolated living in downtown Moncton or downtown Halifax. You said that it is scary when you look at the future because younger people are now tending to play video games and interact with computers, which is a lower type of activity. Is there something that we should be doing to deal with isolation of seniors?
Mr. Driscoll: Again, it is about finding that answer. If you are looking at an individual group or an individual area, it seems easier to address than global issues. Globally, it has to happen through the media resources that we have now, through committees such as this. When the report goes back and is adopted by government, and when it gets filtered out through the system, it has to stay untouched. It cannot come to all of the provinces and the provincial bodies be allowed to tear it all apart to suit their own needs, which is what happens now and has historically.
Therefore, each province now has a different structure for seniors. If the money that will eventually fund all these things one way or another is at the national level, then maybe the simple answer is to have a directive that dictates the flow of the monies. They cannot be touched for anything else. Transfer payments are a very touchy subject when it comes to provincial governments. To turn around and just come up with the answers is very difficult. We have tried brainstorming, different types of committees, seniors' groups and even younger people's input as to what they wanted to see when they become seniors; it just goes around and around. We find ourselves talking about the same issues five years later, with no action.
Senator Cordy: Provincial governments really do not like it when the money comes with strings attached.
Mr. Driscoll: They do not, and that is a major downfall of the entire system. It is the downfall of the entire health care system. A major problem is that the money does not come with instructions on where it has to be spent. It should be specified without a choice, and if not, it must be returned.
Senator Cordy: I agree with that.
Mr. Driscoll: Thank you, senator.
Senator Cordy: I am interested in the palliative care, the community care program that you have for First Nations and Inuit in Atlantic Canada. How do you meet the needs of the people? Do they contact you, or do you contact them? Do you work with hospitals and doctors? How do you know when someone is in need of community care?
Ms. Keays-White: In Atlantic Canada, almost all of the home and community care is delivered in the community by the community. The linkage would be between a local home and community care nurse in a given community and the hospital. Ideally, there would be smooth communication, planning in advance of the discharge. However, in the real world that does not happen for everyone. I know that because I have been on both ends of the system: I have been a hospital nurse and a home community care nurse, so I know that the communication is not as good as it should be in any case.
We have learned that there are difficulties in communication on reserves with local hospitals, so that is one of the two major thrusts of this project that I was talking about, the Aboriginal Health Transition Fund. A sort of a demonstration site in Cape Breton has made an effort to increase, or improve, the linkage between the nurses on- reserve and in the hospital, and that has worked well for them. They are looking at how they can enhance that communication and demonstrate to other communities and encourage that to happen throughout the province. The breakdown in communication occurs everywhere, but this is one area that we are focusing on and trying to show improvements.
Senator Cordy: Is it mainly then for people who have been hospitalized and are coming home?
Ms. Keays-White: Yes, discharge planning from hospital.
Senator Cordy: What about someone who has needs because of a physical or mental disability, how do you tie into them?
Ms. Keays-White: We have home care services available to people who have not necessarily been in hospital. The doctor would communicate directly with the home community care nurse in the community, who would be able to provide services — limited services, mind you, because as I said, the resources available are really quite limited. The chiefs are frustrated as one or two high-demand clients can exhaust an annual budget fairly quickly. It is really varied.
I talked a little bit about hiring a part-time nurse. However, it is hard to find a qualified person, and that person may want to work full time when we may have only part-time dollars to offer. For a number of months, there might be very little work to do, and then there could be a peak because a very ill person or two very ill people are discharged or need palliative care and so on. Therefore, there is a variation on demand and problem in some communities when you have high-demand clients. Chronic care clients, as you say, someone who has a long-term care problem can also eat up the budget very quickly.
Senator Cordy: You said that the chiefs have set one of the priorities as elder care and, of course, have been looking at addictions, mental health and mental illness as well. If you have addictions early in life, you may continue to have them as you become a senior. You also said that, with community care, if there is money left over in the community care pot that you may be able to offer meals, housekeeping services, et cetera. We have heard also, not just from you, the challenges of getting long-term care for First Nations and Inuit peoples. If you were to provide meals and home care services, people would be able to stay in their homes longer. Therefore, how do you reconcile all of these factors? You are trying to keep people in their homes longer, but if you do not have the finances to provide services that in the long term would be less costly because they are staying in their homes, how do you work around that?
Ms. Keays-White: We are hopeful that the research that was undertaken over the past number of years and that the national joint working group, consisting of Health Canada, INAC, Assembly of First Nations and Inuit Tapiriit Kanatami, are working to put together some policy options that will address that, very broadly speaking. At a national level, it is being addressed, and we are hopeful that there will be long-term solutions available to enable us to enhance the services. In the shorter term, we are working as closely as we can in Atlantic Canada with INAC, our federal colleagues who have responsibilities for the basic part, most of the meal programs, et cetera. However, we provide some funding flexibility to allow communities, if they have additional dollars, to spend them in the same way they would with the INAC program, to enhance the services available there. With the resources that we have, the best effort that we are making is to try to be as flexible as we can in collaborating with our federal and provincial partners to ensure that the available resources are well-utilized. We are hopeful that additional resources will be available at the end of this study.
Senator Cordy: At this time in Atlantic Canada no long-term facilities exist for First Nations and Inuit people, is that correct?
Ms. Keays-White: Not on-reserve, no, and no dedicated First Nations facilities exist off-reserve either.
Senator Cordy: Do you have a plan, or long-term plan, in place? It is challenging because some of the reserves are very small, populations are very small. Sydney, Cape Breton, has some larger reserves, so you could see Membertou, for example, perhaps having their own facility, but then some very small reserves might only have 40 or 50 people. That would create challenges; yet, you have the other dilemma of whether you take someone from a small reserve and move them to Membertou, again as an example, out of their community, which is also not a positive situation because they do not have family members around. Do you have a long-term plan in place for how you see these types of situations happening?
Ms. Keays-White: As you mentioned, probably Eskasoni is the only community that has a population of over 3,000, and even at that, it would be difficult to find justification to build a long-term facility on-reserve. It is just too small; the population does not warrant it. We have started working more closely with the provincial government in Nova Scotia because they are renewing their long-term care program. They are building more facilities there, and this Aboriginal Health Transition Fund project has given us the opportunity to really bring them to the table and to have some solid planning with them. We have suggested — and they have been open to it — that if they are building or renovating any seniors' homes close to a reserve, they work with us and the communities to try to make them more culturally appropriate, such as designating a certain number of beds for First Nations clients and ensuring the décor is appropriate and staff, if possible, are First Nations staff; or, if not, at least culturally trained people who can bring that cultural sensitivity. We have made that effort over the past year as the Nova Scotia government has renewed and infused more money in their long-term care program.
Senator Cordy: Are there currently incentives in place for the First Nations and Inuit people to become health care professionals? I have heard that the numbers are very low.
Ms. Keays-White: The numbers are very low, and it an issue that we have been grappling with for a number of years. I mentioned that I flew through Thompson. I was only there for about an hour last week on my way back from Rankin Inlet. I am part of a national steering committee for the Aboriginal Health Human Resources Initiative. A major objective of that initiative is to try to increase the numbers of Aboriginal people in health professions of all types, not only nursing and medicine but any health-related profession. Therefore, bursaries and scholarships are now available. Another aspect of that is to look at existing health care professionals and increase their cultural awareness and cultural sensitivity. Those are the two major thrusts of that initiative. It is in year three of a five-year initiative. The first year was really just about getting it off the ground, but now it has started to show some growth and uptake. We will not be able to say that we have doubled the number of nursing students by next year. However, one of our objectives is to try to double the number of aboriginal nursing students enrolled in programs.
Senator Mercer: Thank you to both groups for being here. I would like to think that we were smart enough to plan this, but it was probably by accident that we have two different groups here. One group of people that we treat so badly and another group of people who we like to think we treat very well. The contrast is rather stark, how we treat veterans and how we treat aboriginal people, and probably the only good thing is that aboriginal veterans have the advantage to cross over the line.
The Chair: In the past, that has not worked either.
Senator Mercer: Not all the time. I appreciate that.
I wanted to go to Mr. Driscoll's discussion about gambling. We were in Welland, Ontario the other day where we visited the Rose City Seniors' Activity Centre — actually a beautiful place in Welland. We were there for hearings such as this. They gave us a copy of their monthly newsletter. After our meeting, I mentioned off record to the director that they have five fabulous trips planned for the month of May, three of them to casinos: the Tropicana Atlantic City Casino and Resort, in Atlantic City; Fall's View Casino, in Niagara Falls; and Fort Erie Racetrack and Slots, in Fort Erie. If you do not understand the problem, I guess that is it there. The legion itself, though, is a participant in this. The legion my mother goes to every week has a couple of VLTs. Fortunately, she does not play the slots; she is there to have a good time and dance. Is the legion addressing this on a regional or national basis because there is a growing dependence by groups such as the legion?
Mr. Driscoll: We have put on local educational events. We have looked at our staff and made them aware of the cycle, which I explained before, of the person who spends all their money and then comes back in the door. We do try to get that message out. We are partners with Addictions Services, all across Canada, but especially here in Atlantic Canada we have partnered with them on responsible gaming. Some legions actually have a limit so that if someone comes in, they put their $20 in the machine and once that is gone, they do not go back to the machine. We have a time limit of play on the machine as opposed to going into a commercial venture where you could sit for five or six hours. In all honesty, this is not widely adopted; it happens in little pockets in little communities where they know the people and know who can afford what. That does not lessen the fact that, yes, we are still endeavouring to try to set an example. The Royal Canadian Legion considers itself a leader in community-based events and programs. Again, we just have not come up with the answers.
Senator Mercer: A bill has been before the Senate, twice — maybe even three times — proposed by our colleague, Senator Lapointe, from Quebec. The thrust of the bill is to limit the locations; not to ban video lottery terminals but to limit the locations to gambling houses, if you will, racetracks and casinos, taking them out of the corner stores. When I travel by car through New Brunswick, I have stopped at places where I was surprised, in this province, to see video lottery terminals. That has changed a bit, but still, it is surprising to see your corner store with a lottery terminal. Do you think it would help if we limited the number of locations? Now that would, of course, affect you directly because it would mean that the local legion could not have one.
Mr. Driscoll: Senator, it has already been implemented. We are reducing the number of machines in the province to 2,000 currently under the existing formula. The basic rule is that any area accessible to anyone under 19 years of age will have their machines withdrawn. If the machines were in a bowling alley, that bowling alley operator would have that decision to make. If he wants to keep his machines, he has to impose an age limit of 19 or older and give up his youth bowling. If he figures that he could make a go of his business, then that becomes his option. However, he would have to give up his machines.
Right now in this province, probably the average income is $500 a week from a machine. The maximum number of machines per license is five, so it is a substantial amount of money to a private operator in the run of a year. It pays for their heat and lights. Private businesses counter that, of course, by saying that they will have to shut their doors if they do not have the machines. That decision has already been made. That is one of the base rules coming in. In addition to the casino here in Moncton, there will be, I believe, about 20 licenses granted throughout the province, to a maximum of 25 machines, which will further reduce the numbers. I believe the final implementation will be by 2015, so it is about seven years for the total implementation.
Senator Mercer: With respect to Senator Cordy's comment on the discussion on telemarketing, two years ago, Parliament passed the do-not-call legislation by which people can remove their name from the list. If we ever get the Canadian Radio-television Telecommunications Commission, CRTC, to do their job of enforcing the law instead of trying to make law, which is ongoing, that would be a big help to get seniors names off the list by just giving them a simple method of making a phone call to remove their name. I bring that up more for information.
Ms. Keays-White, I was interested in your statement about one project of particular interest to this committee that involves a partnership between Nova Scotia First Nations and the Continuing Care Branch of the provincial Department of Health.
When will it be implemented? Will a study be made of this program to see if it works, and if so, will the study be made public so that other areas can benefit from this?
Ms. Keays-White: Yes, it is the same project that I was just describing to Senator Cordy around the discharge planning in Cape Breton. The funding was only recently approved, so it is just now in the planning stages. However, the success in Cape Breton will try to be replicated throughout Nova Scotia to have better discharge planning in all First Nations communities in coordination with the provincial government. We expect, over the next few years, to be able to show enough of a success rate that, as I mentioned earlier, I believe the New Brunswick chiefs will sit up and take notice, and I am optimistic that perhaps it will have a spill-over effect in all our four provinces.
Senator Mercer: You also said that small communities with small budgets tell you that operating and staffing a home care program is a huge challenge when only a handful of patients require it and that their limited available resources can be exhausted very quickly if one or two residents have intense needs. What happens in these cases?
Ms. Keays-White: The chiefs generally will borrow from other sources of funds because they respect their elders enough to ensure that they get the services, but that runs a deficit in another area. They absorb what they can; I do not know a single chief who has let an elder suffer more than necessary. It becomes a problem in that sometimes they will have a surplus because they will have no one. They can have no one who requires services for a number of years, or very few people, and then they have one or two residents that require a lot of care, and that runs a deficit, so they have to find the resources elsewhere.
Senator Mercer: Mr. Driscoll, in your presentation, you talked about the need for a one-voice-for-all national committee of ongoing seniors' issues with a strategy to ensure that all seniors in Canada receive the same services. We really like this idea. Currently, the legion is interacting with tens of thousands, if not hundreds of thousands of seniors on a regular basis. Is there an effort through your various branches to ensure that the seniors who are coming to the legion, in its various incarnations, are accessing the Canada Pension Plan, or if they qualify for the Guaranteed Income Supplement, that they are actually getting it? Other than the province of Quebec, we know that a lot people are not getting the benefits to which they are entitled.
Mr. Driscoll: Each branch is assigned a trained service officer. We carry out our own training programs four times a year to anyone that is appointed to that position by a particular branch. The training ensures that that service officer knows what is available to the senior, what category they fall in, to assist with necessary paperwork and to facilitate that application in whatever manner they can. This is an extension of the Veterans Affairs program that goes out globally. That is being done straight across the country.
With respect to the national committee, I am referring to a national committee with one voice for all, rather than this type of a hearing that comes to us after the fact; we do not know when these things will happen. Sometimes the provincial government's interest in it will spike. They will hold many hearings of which we have all had sit through and listen, and then we do not hear anything for three years. Come election time, a change in the government or someone with a particular interest that has gotten a new profile with government, it will spike up again. However, there is no resolve to anything. I agree with all of the points raised by the presenter on behalf of First Nations. However, if we had a national committee, we could establish some base services for Inuit, for whomever. With the new immigration policies that the Canadian government is looking at, what will we do 15 years from now? Will we try to satisfy everyone's ethnic origin, or will we address seniors' issues as individuals? They are seniors, and there is room for cultural diversity within any type of facility, we believe. However, to do it on a piecemeal basis, it seems that everyone is on a different playing field.
The senator mentioned veterans, and we have enjoyed probably the best seniors' programs that are available in this country, bar none. I am the first one to applaud the people who have gone on before us to make those things happen. We do through Veterans Affairs; however, again, Veterans Affairs is a different block of money. It does not apply to all Canadians. Maybe there should be a level playing field for all Canadians, and that is your right as a Canadian. Therefore, that is what the legion message is attempting to say.
Senator Mercer: At a hearing a week ago in Ottawa, the suggestion was made that certain programs from Veterans Affairs, particularly the Veterans Independence Program, or VIP program, be made available to all Canadians. It would be a terrific way to take a program that has worked extremely well in the veterans' community and give it to the rest of the community.
Mr. Driscoll: We advocate that that is the ideal model for all things to follow. The health issues that are across the board know no boundaries; they are not determined by race, colour or anything else. If you are to be struck down with a terminal illness, it will happen regardless; if it is a debilitating illness, it will be the same, and therefore the services should be the same. The implementation of and the access to those services should be simple, straightforward and should be available to all Canadians.
The Chair: Before I turn to Senator Cools I have some very quick questions from our researcher for Ms. Keays- White. Do any of the Atlantic provinces provide home care in First Nations communities either because they are either contacted by the province or through the provincial program?
Ms. Keays-White: There is a real variation with the four provinces. Each has different levels of services. New Brunswick, for example, provides the same program that they have for all New Brunswickers, on-reserve as well. One of the issues that we have is to ensure better communication so that we know who is doing what, and where. However, in New Brunswick they do provide some short-term hospital-type care in the home. In Nova Scotia they do not. There are variations; it is really province by province. We try to ensure that we do our best to adapt to whatever the provincial government is able and willing to pay for. We have a real potpourri of services across the region.
The Chair: How does the per capita funding for home care and palliative care in First Nations communities compare to the per capita funding for the general population? We know, for example, from the Wendy report that the amount of money for social services in Aboriginal communities is significantly less per capita than it is for the non-Aboriginal community. Have you done any comparisons vis-à-vis the funding for home care or palliative care between what the provinces would have for funding and what the aboriginal community would have for funding?
Ms. Keays-White: I am afraid I do not know.
The Chair: We know that provincial budgets for home care services have increased over the past few years across the country. Has there been a similar increase in funding for home care under your branch?
Ms. Keays-White: I am hopeful that that is what will come from the research that has been done and the options that have been proposed.
The Chair: It has not come yet?
Ms. Keays-White: No, it has not come yet.
Senator Cools: I would just like to get some new information if possible. As I was listening to the witnesses, I had this strange sense that for every problem government solves, it creates 20 new ones. I had that sinking feeling as we were talking about the seductions of elderly people to gamble. Ms. Keays-White, in your presentation, you talked about addictions and mental health in First Nations people. Perhaps you could enlighten me about the individuals who have addiction problems. Can you give us an idea of the nature of the addictions? How many of those are seniors, and of those seniors, how many find themselves running afoul of the Criminal Code and find themselves incarcerated? Quite often, there is a relationship between addiction and crime.
Mr. Driscoll, do you have any data on the types of situations that you described, basically senior veterans being preyed upon by younger culprits, in other words, victims of crime? Do you have any knowledge of seniors as perpetrators of crime?
Ms. Keays-White, you may be ready to respond.
Ms. Keays-White: Thank you for the question. I hope that I can answer at least some of that. As far as the nature of addictions, the information that we have is mainly anecdotal; it is what we have learned in talking with our communities. The major problem, I think it is fair to say, continues to be alcohol. Alcohol abuse is prevalent in Atlantic Canada and on-reserve as well. It is fair to say, as well, though, that both non-prescription and prescription drug abuse is relatively high in Atlantic Canada on First Nations reserves. The aspect of addictions that was raised repeatedly by the chiefs, when they raised this as a high priority, was the misuse of prescription drugs. That may be, I will not say unique to Atlantic Canada, but it certainly has been identified as a major issue in Atlantic Canada. What percentage of those abusing drugs are elderly versus young would be hard to say. The focus has been on young people, yet when we learn of overdoses, it can be middle-aged people as well.
You do not hear a lot about addictions in seniors, but you do hear some. I know that there are problems with older people who are suffering from addictions to prescription drugs, in particular. However, we do not have any data on that, so I cannot tell you what the extent of the problem is; only that the chiefs believe it is a problem, and it is something that they are wanting us to help them work on.
I also cannot help but tie addictions to gambling because they are related, and one that has not been mentioned so far is bingo. A lot of bingo happens in our rural communities and on First Nations reserves as well. It has not been identified by our chiefs and by the communities as an issue, but deep down we believe it is probably all tied together. I am afraid I cannot answer your question on how many are aging.
Senator Cools: How many run afoul of the Criminal Code?
Ms. Keays-White: I do not know that. I cannot tell you how many seniors specifically run afoul of the law, but I would suspect that addictions in the incarcerated population is very high. We know that there is an overrepresentation of First Nations and Inuit people in our jails and prisons. I would suspect that a very high number of those in the facilities do suffer from addictions as well.
Senator Cools: I was just curious to see if you had any data because there are particular points when the need arises for health services during incarceration and it is not even clear who is really in charge of those problems. There are vast areas where the relationships are really quite grey and unclear. I was just wondering if you had some data.
Ms. Keays-White: Unfortunately we do not have a lot of data. Very little research is done in this area. I know from a previous job, where I was working with hepatitis C, we were aware of particularly high injection drug use rates. A study was done eight to ten years ago that showed hepatitis C rates in incarcerated populations were extremely high and of that, the gross proportion of them were First Nations and Inuit as well.
Senator Cools: I do not know the current status, but some senators may know that within the Correctional Service of Canada there was a time in history where they used to reserve certain prisons for older inmates. It used to be thought that you should not put the young, strong, bucks in with the older, aging inmates. I remember around 1980 or 1984, I think, Joyceville, near Kingston, was the institution for inmates who were 50 years and older. In those days, the Collins Bay institution was for the very young and strong group of lads. As you were presenting your evidence, some of these questions just came to mind. We know that Aboriginal peoples have huge problems with addiction, but the solutions are still eluding us.
Ms. Keays-White: One more initiative would be that very recently, within the past couple of months, we had a presentation by Correctional Service of Canada, in an effort to try to increase the partnerships that we have federally, at least. They have shown interest in working with Health Canada's First Nations and Inuit Health Branch. Therefore, I do think that there is room for improvement and growth there.
Senator Cools: That will be good.
Mr. Driscoll: Our victims of crime normally come to us through our organizational meetings and so on. Some of them have been perpetrated by our own organization, on our own organization. Some of the areas that seniors invariably get involved in include car sales, credit card rates and sale of leisure property. A senior is going into a nursing home, and someone knows they own a little cottage out by the lake and tells them that they have got a purchase of lands for community benefit. That is one of the big come-ons. They will go to the elderly person and say, ``Well, if you turn that block of land over, we can have a nice treed community for the kids and a playground.'' However, that is the furthest thing from the developer's mind. They will say anything in order to get that sale through. Those situations actually happen, and we hear the horror stories about it.
Roll-over investments are another major issue. Seniors are told that if, for example, they invest $500,000 with Company A, they will be paid 15 per cent annual interest on their $500,000. They call their kids or their grandkids and tell them that they can get 15 per cent interest, and everyone says, ``Oh, grandma, that is a great idea. Turn around and invest your money.'' They do get their 15 per cent, quarterly or whatever; the cheques do come in the mail. However, they do not tell the seniors that the capital that keeps getting re-invested is depleted. Therefore, at the end of a two-year time period, they have collected their 15 per cent, quarterly, but when they go to get their $500,000, it is no longer there. Only $50,000 is left. All the broker has to say is, ``I have lived up to my responsibility; I have paid you your 15 per cent. We lost that money investing it in the ``Hibernia Oil Fields,'' or whatever when, in actual fact, it is depletion of the account. W-FIVE has just done two major news releases on it this year. Both instances happened, I believe, in the British Columbia or Alberta area. Again, it is a wave that is hitting seniors all across Canada. Atlantic Canada always seems to be the last on people's lists because of our population. Those are some of the issues that have come to light, which we thought were noteworthy enough to bring it to this committee.
In addition, there is no recourse for the senior or for anyone to go back up through the system. It is legal; it is buyer beware. It comes down to the education that the seniors need to have. We, as an organization, have put on a variety of information sessions about security issues. We warn people not to give out their phone numbers or social insurance numbers. One of the most amazing exercises that we used to do was to go to a convention where there would be 300 or 400 people sitting in a row and put a piece of paper in front of each person and ask them to write down their name, address, phone number, social insurance number. Every one of them, invariably, would do it and hand it in. This highlighted how unscrupulous people take could take advantage of unsuspecting people. Many things have helped; for example, the Privacy Act and not allowing organizations to retain information has helped because now there is no release of information. Up until a couple of years ago, anyone could find out my military history through our organization. They could find out where I served, when I served and when I came back from overseas. There were no restrictions. However, now if someone was to call and ask about my military history, with this Privacy Act, we are not allowed to retain our own documentation, so that has put that to rest. I hope that answered some of your questions not raised more questions.
Senator Cools: Yes, it does answer my questions. I was wondering if anyone was collecting any data. The stories are endless. For example, at a particular retirement home — not a nursing home but the intermediate stage — this nice old lady had a taxi driver who used to drive her to the liquor store once a week to buy a bottle of wine, or whatever it was. He discovered that she had pools of cash. She used to go to the bank and come back with cash. He began asking her for a little bit of money, $25, $100 and so on, and she just gave it to him. Then he got better and bolder, and one day she went into the bank to withdraw $10,000. Of course, she had a smart son who had wanted her to have freedom with money, but he had put a limitation on it because he had suspected that something such as this could happen. The bank manager came out to question her, and when she told him that the taxi driver wanted $10,000, the bank manager went outside and swiftly got the taxi driver's name and information preventing a terrible crime. I would not call it extortion but certainly larceny. I hear similar stories often. I also hear stories about elder abuse.
I have received many phone calls from individuals who are assisting or caring for family members, and they go through a lot of abuse. ``Abuse'' has such a wide definition. I wish we could divide it up into different denominations. The issues are huge, and, as you say, we frequently come back to anecdotal statements. The situation you described, Mr. Driscoll, with the younger woman who was attempting to marry a fortune, or seduce a fortune, is far more common with both genders than we think. People tend to think it is females to males, but it is across the board. I have heard of an instance where a family had to work to intervene in a particular case, which was not easy to do. We hear all these anecdotes, but I imagine many of these situations elude enumeration and elude being recorded. It would be nice if, at least by the consciousness we will create, more of this data would be collected so that we can have an idea as to when a criminal offence is an isolated event or when it is a pattern. I am told that there are individual deviants who make it a practice to extract monies from seniors. Prisons used to use the expression ``Granny fraud'' where deviants would rob old people because they were weak and fragile and, quite often, did not know any better. We will have to be able to put our hands on some data, or we could just relate some anecdotes, I suppose.
Mr. Driscoll: I did not mention trustee violations, which is a problem with people who become trustees. Also, I can appreciate your request for documentation. As the Royal Canadian Legion, we do not even have access to servicemen who are hospitalized. We are not allowed to receive any documentation under the current legislation. Therefore, if 10 injured soldiers were to come back from an operational theatre tomorrow and be hospitalized here, the local legion would not know about that unless they are informed by their family or themselves. We have approached Ottawa in regard to that and asked for that exception to be given to the Royal Canadian Legion so that we can conduct our service work.
Senator Cools: It is all very interesting, and it is a huge issue that is getting bigger everyday.
The Chair: Exactly, thank you.
I started Ms. Keays-White off with a huge question, and I will unfortunately end with a huge question. You were talking about the home community care budgets, and I think you said that they were from $13,000 to $545,000 depending on the size of the on-reserve community. Has there been any discussion in your branch, and higher up, about getting away from per capita funding and moving toward needs-based funding? Even if it is a community of 50 people, if there is one elder who needs intense interaction, that will use up the $13,000 plus. I think of Northern Manitoba communities where there are children with intense disabilities; they can use up huge chunks of the funding, and, if those children were living off-reserve, it would not be based on per capita. Have there been any discussions at all?
Ms. Keays-White: I am not aware of any. I was just looking to Mr. McGregor, our consultant; he has been working with the national group who is looking at that. I am afraid I cannot answer your question. However, I would be happy to move it up to the national table and put it forward as a suggestion.
The Chair: You may find it in our recommendations, quite frankly, because I just do not think in many of these communities that a per capita cost makes any sense. It assumes that you will be dealing with an average, and if you deal with very small numbers, there is no average; and if you have an on-reserve community in which, perhaps, as many as a third of the children are born with fetal alcohol syndrome and fetal alcohol effects, FAS-FAE — and that is possible in Northern Manitoba — then there goes your average in a very short period of time.
I want to thank all of you very much for your presentations and you, in particular, Ms. Keays-White, I know I put you on the spot and recognize that my frustrations are probably also your frustrations almost every day of your working life. Thank you very much.
The committee adjourned.