Proceedings of the Special Senate Committee on Aging
Issue 10 - Evidence, May 16, 2008 - Morning meeting
SHERBROOKE, Quebec, Friday, May 16, 2008
The Special Senate Committee on Aging met this day at 9:01 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, ladies and gentlemen, members of the public, welcome to this meeting of the Special Senate Committee on Aging.
Our committee is examining the implications of an aging society in Canada. The complex consequences of aging have been a concern for governments for many years. However, these concerns are becoming more pressing as the number of seniors increases because of greater life expectancy and the aging of the post-war generation.
Since public programs and services for seniors are essential to their well-being, it incumbent upon us as parliamentarians to ensure that the needs of seniors are met.
We have come to Sherbrooke to hear from various stakeholders, who will talk about the implications of aging on our society and, in particular, they will tell us what they think about our second interim report which was tabled in the Senate on March 11 last. The report focused on active aging, elderly workers, retirement and income security, healthy aging, growing old in the place of one's choosing, and the regional distribution of health costs related to aging.
Sherbrooke is the fourth stop on our pan-Canadian travels and we are looking forward to hearing the testimony today, which, I am sure, will help us develop a complete list of recommendations for our final report.
For this morning's first round table, we have the pleasure of welcoming Dr. Réjean Hébert and Dr. Hélène Payette from the University of Sherbrooke, and Dr. Stephen Cunnane from the Centre for Aging Research.
[English]
Dr. Réjean Hébert, Dean of the Faculty of Medicine and Health Sciences, University of Sherbrooke, as an individual: Honourable senators, I would like to welcome you warmly to Sherbrooke. I am very proud that you made a stop here to hear about our work, the expertise of my colleagues on aging and what it can bring to your committee.
Sherbrooke is one of the largest research centres on aging in Canada, characterized by the multidisciplinary nature of the approach — Dr. Cunnane will probably speak more on that. In the research centre, we have people from the social research area and people from the biological area, as well as people interested in the organization of services.
[Translation]
I was the first scientific director of the Institute of Aging of the Canadian Institutes of Health Research (CIHR), and for the last five years I have been the Dean of the Faculty of Medicine and Health Sciences of the University of Sherbrooke.
Last fall, I also co-chaired a public consultation which the Government of Quebec created on the living conditions of seniors. The consultations led to a report which I am pleased to table with you. The report summarizes the testimony we received from 4,000 seniors whom we met in 27 towns, as well as 275 briefs which we received and analyzed. The report's conclusions are similar to the ones contained in your report and I believe they will contribute to your final report.
Allow me to give you a brief overview of our report, which contains three main ideas:
The first is supporting vulnerable seniors and their loved ones, which is a theme you have also addressed, and about which we affirm that the best way to meet the needs of an aging population is to consolidate our universal health care system, which represents the best way to meet the needs of the elderly. I would also invite you to state this clearly in your report, because a private system is not interested in looking after seniors, and any parallel system would drain resources away from the public system and reduce access to services by seniors. I believe we need to reaffirm this extremely important value for Canadians, namely that we maintain our public health care system.
We also emphasize the importance of seniors living at home. We heard this 4,000 times over and over again. Seniors want to remain at home and would like to receive services at home, and not have to go to an institution to be treated. Our health care systems need to change their approach in a significant way to provide home care services. The health care system has to be recentred around providing care for people in their homes, because people who have chronic illnesses and who need long-term care will become more and more common because of the aging of the population, and a hospital is not the place to treat them.
The system must be based on seniors living at home, which forces us to examine how treatment is provided in the home. This is a grey area in Canada today, because home care is not necessarily considered as being medically necessary.
The Canada Health Act goes back to the last century and did not foresee the importance of home care one day.
We therefore must clarify the status of home care under our public health care system. The Romanow Commission took a step in the right direction, but only addressed post-hospital home care or home care in particular situations, such as palliative care, for example. The concept of home care must be broadened and included in the Canada Health Act to cover long-term care, which includes mostly home care for the elderly and their loved ones.
This will require a major and massive investment in home care services. In Canada, between 4 and 5 per cent of health care expenditures are spent on home care, which is far too little. We need to make a major effort at investing better. Front line medical services must be improved, but also first line nursing services, which must be strong, because providing care in a person's home is much more complicated than doing so in a hospital, and so services must be integrated.
Sherbrooke is an area which has developed integrated services for the elderly. I had the pleasure of heading a research team called PRISMA (Programme de recherché sur l'intégration des services de maintien de l'autonomie), a research group which developed and implemented a model of integrated services which includes a single window, and consultation venues which bring together stakeholders from the public, private or volunteer sectors, and where they seek to agree on a basket of services to meet the needs of seniors. This system also involves case managers, computerized clinical record keeping, and an evaluation of common assessment tools.
PRISMA was implemented with success in this area, and a study has shown that an integrated system allows seniors to live independently for a longer time, decreases the number of trips to the emergency room, improves people's satisfaction and feeling of empowerment, and helps prevent additional costs while improving the efficiency of the system.
This system is currently being implemented in several other regions in Quebec, and I have had the pleasure of working with several regions in Ontario and British Columbia, and very soon I will be working with Nova Scotia, because several regions in that province are also interested in adopting this type of model for integrating services.
We must rethink funding. On page 48 of your report, you talked about registered chronic care savings plans, I am not sure that it is the right way to go. Rather, I think that funding services to help seniors remain independent should be paid out of the public health care system. I believe we must insist on maintaining a public health care system and provide an adequate level of services, rather than creating private funding instruments modeled on registered saving plans for this type of service.
We must also support caregivers, and you mention compassionate leave on page 49 of your report. I think the concept of compassionate leave should be broadened to also include long-term care provided by caregivers, because this is the type of care which they give to their elderly loved ones. We must therefore have compassionate leave over longer periods of time, and part-time leave, as well, so that the people who care for their elderly loved ones are not financially disadvantaged when they do so.
On page 37, you talk about gerontologists. It is hard to find doctors and nurses to work in gerontology. I think we have to value the care of the elderly. This means paying good salaries to doctors who specialize in treating the elderly. Gerontologists do not make as much money as do cardiologists, neurosurgeons or radiologists. I think this discourages students from thinking of a career in gerontology. The same goes for nurses.
We must value the care provided by nurses to the elderly by improving their working conditions and their salaries, so that these health care professionals feel the work they are doing is important, and we must provide them with the appropriate training.
People who work in intensive care, in surgery or hemodialysis receive very specialized training, but anyone can basically work in gerontology. In doing so, we deny the fact that certain skills and a certain outlook are absolutely essential and necessary when working with seniors. I believe we must insist on training in that regard.
The second element which came out of our consultations was to value seniors in our society, and to value the volunteer work they are engaged in, because they play a key role in this area. You mentioned the idea of a tax credit for volunteer work. I have certain reservations with regard to that idea.
First, tax credits are not the best way to reinforce social solidarity. Tax breaks were originally invented to help companies and they are not well-suited to strengthening social solidarity. Also, volunteering is, by definition, an activity which is done freely. However, any expenses relating to volunteering, such as the cost of gas for people who use their car, or the cost of meals if they need to eat out, should be tax deductible, as are certain expenses incurred in the course of one's job.
I think that if these types of measures are introduced to help people pay for their volunteer-related expenses, it would encourage volunteerism.
You also talked about progressive retirement. This is unavoidable. I believe we have to change the very idea we have of retirement. When I speak at a conference, I often say that, in 1872, Bismark decreed that people would retire at age 65 because at the time life expectancy was no higher than 57. When people received a pension at that time, it was in fact a survival benefit. If the same standard were applied today, retirement would only be at age 87.
So it is easy to see that the whole concept of retirement has to be rethought. We have to allow people to retire progressively. In Finland, for instance, it is advantageous for people to work past 60, because they receive additional holidays and benefits, and they are not penalized in terms of their pension and retirement benefits. We should apply that system here.
At the municipal level, you will hear about Age-Friendly Cities this afternoon. You mention this in your document. Marie Beaulieu, who has been very involved with the Sherbrooke experience, will share with you some of these extremely important aspects.
As far as financial security is concerned, only the federal government can automatically pay out the Guaranteed Income Supplement. As you know, there are 130,000 Canadians who are entitled to the Guaranteed Income Supplement, but who do not receive it, because they have not filled out their application, which is sometimes difficult for seniors to do. I believe that if the Guaranteed Income Supplement was paid out automatically, as is the GST rebate, it would greatly benefit seniors.
The Guaranteed Income Supplement provides an annual income of $13,400, which is insufficient, and which lies beneath the poverty threshold. I would invite you to recommend that the guaranteed supplement be increased.
Lastly, the third major theme which came out of our consultations was prevention, first with regard to stereotypes and the image we have of the elderly. You address this issue in your report, but I would like to point out that on page 2, you feed into those stereotypes, and I will quote the report.
At the end of the first paragraph, under the definition of seniors, you say: ``At the same time, old age is being defined by loss of independence or by ill health.''
I am sorry, but old age is not defined by a loss of independence. The loss of independence only applies to a small minority of seniors, and I would invite you to correct that statement in your report. On page 56, you also talk about the impact of the aging population, and the impression we get is that aging is happening at a catastrophic rate. Over one and a half pages, along with supporting data, the report says that the aging population will lead to a significant increase in health costs and will represent a burden to the economy.
It is true that three sentences follow that statement which paint another picture, because there is an alternative scenario which is also well supported. I would invite you to strike a balance between these two scenarios.
Some people believe that aging will have a catastrophic effect on society, but there are also very competent researchers who have shown that, to the contrary, the aging population does not represent a threat to our health care system. We cannot accuse Mr. Castonguay of seeing things through rose-coloured glasses, but even the Castonguay report has said that the aging of the population is not responsible for the annual increase of 1.3 per cent of health care expenditures.
I believe that your report must strike a balance between the two approaches and focus less on the catastrophic approach which, in my opinion, feeds into some of the most persistent stereotypes in our society.
You rightly talk about tax incentives for physical activity, and on page 17, you rightly state that tax incentives discriminate on the basis of age. Parents can deduct costs for their children's physical activities, but seniors cannot do so for themselves. I think that must change.
We have also highlighted the prevention of abuse and negligence. I would invite you to do the same. This includes suicide prevention and the prevention of addiction; addiction to medication and alcohol, which are well known, but also addiction to gambling, which is a growing problem. Casinos organize field trips for seniors, and I believe this is encouraging addiction to gambling.
I will conclude by saying that I am convinced that Canada and Quebec are ready to develop new policies on seniors and on aging, which will give us a new vision for the kind of society we want to live in.
On page 5, you list some values, and I would invite you to add another value which to my mind is fundamental, and that is the value of solidarity, which is extremely important for seniors and also for the way we look after our seniors. If we had a policy on aging, this would lead to a plan of action which would transcend federal, provincial and municipal governments, which would transcend the various departments and sectors of our society, and which would lead us to treat seniors the way they deserve to be treated in our society, thus allowing society to benefit from the wisdom, experience and knowledge of the elderly.
[English]
The Chair: I want to point out that we recently passed legislation that, while not perfect, will go a long way to meeting one of your objectives: People who now file income tax and qualify for Guaranteed Income Supplement, GIS, will get it automatically. They will not be required to fill out a separate form. That is new legislation that will be in effect very shortly. That is a good step forward.
Clearly, the whole issue of GIS is still with us, but I wanted to make that reference. I do not always agree with this government, as you can imagine, but on that aspect, I am in full agreement with the decision that they made.
[Translation]
Dr. Hélène Payette, Professor, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, as an individual: Madam Chair, I would like to thank the committee for welcoming me this morning. I think that Dr. Hébert has set the table very well for me to talk to you now about something that has been at the heart of my work for a number of years, which is nutrition and the food intake of older people.
I noted that there was only an extremely brief section on nutrition in the report, and yet we now know from research findings that are still quite recent, that people's dietary intake affects all aspects of aging and can have a major impact on the quality of that aging.
We all know how infancy and old age are the two most vulnerable stages of life, where the integrity of cognitive functions, the effectiveness of the immune system and muscle and bone health, among other things, are closely linked to living conditions, the quantity and quality of dietary intake and behavioural habits, such as exercise, which you address at length in your report.
We know how much care is taken in feeding our infants and children to ensure their life-long health. However, the importance of nutrition for seniors was largely neglected up until a few years ago, namely by a lack of research in the area.
We now know the key role nutrition plays in promoting quality of life; preventing frailty, disabilities and worsening chronic diseases; and, overall, delaying the aging process. What distinguishes the healthy centenarians we so admire is the quality of their nutrition and their level of activity and social participation.
Yet, despite certain actions, nutrition for seniors is still being overlooked in health measures and policies.
Recent research shows that, in Canada, there are still seniors at home suffering from protein-energy malnutrition, a syndrome observed in underdeveloped countries, and seniors losing up to 10 per cent of their weight after being hospitalized. This under-nutrition leads to a vicious circle of fatigue, recurrent infection, frailty and disability, which continues to worsen the nutritional deficit, one that is hard to reverse and that requires a long and sustained treatment.
Recent research shows that it takes twice the amount of calories to reverse under-nutrition in seniors compared to young people. Therefore, like in so many other areas, an ounce of prevention is worth a pound of cure.
I would like to make a few recommendations to the committee that could help our governments save significantly on care and services for people whose health and independence are compromised because they did not have daily access to a healthy and adequate diet to meet their needs.
In the report, the committee briefly summarizes the role of nutrition in promoting good health and the prevention of chronic conditions often found among seniors. I would like to begin by commenting on the only two options regarding nutrition.
First, option 35 is intended to introduce public information campaigns targeted at seniors and the general population to increase understanding of the negative impact of bad eating habits.
I find this recommendation somewhat negative and I think that much more positive recommendations can be made with regard to diet. Seniors are very receptive to public health messages and I think that things could be said in a more positive way rather than just telling people to avoid a poor diet.
I would also like to draw the committee's attention to these information campaigns.
Major changes can be observed during the aging process, and these changes oblige us to completely revisit our promotion and prevention approaches with regard to diet. Research on nutrition and aging is, ironically enough, still in the early stages. However, we already know that promotion and prevention strategies in the area of diet must be adapted to the specific features of this population, or else we will harm more than we will help.
For example, changes in the proportion and distribution of fat and muscle call for an adjustment in the criteria governing healthy weight that is applied to a younger adult population.
A recommendation stating that a healthy weight must be achieved at all costs and that excess weight should be avoided at all costs, characterized by criteria used for young adult populations, could harm many seniors by causing them to lose weight, which would affect their nutritional health.
Similarly, according to current knowledge, protein requirements for seniors are apparently even higher than those for young adults. So if the total consumption of food in a single day is reduced too much, the protein allowance will suffer as well. This lack of protein can be disastrous from many aspects given the importance of protein to our diet.
The aging process is a vulnerable stage of life during which the existence of chronic conditions may give rise to numerous dietary restrictions. It is thus important to conscientiously weigh the recommendations in our messages to ensure a positive balance between the advantages and the harmful effects. Here is an example. Studies have shown that fear of cholesterol unfortunately causes many seniors to completely exclude eggs from their diet, which is sometimes their only source of protein.
Other restrictions, such as a diet without salt, can cause people to considerably reduce their daily food allowances and thus worsen their chronic condition rather than improve it.
This means that public health messages cannot simply be based on knowledge acquired from young populations. They must be based on the most recent knowledge issuing from research.
Last, information campaigns must also target the adults who assist these seniors so that they have a better understanding of the needs and characteristics of diet and so that they can avoid a certain form of ageism that negatively impacts on the nutritional health of seniors. For example, the idea that the less an elderly person eats, and the thinner they are, the better.
We have examples of extreme thinness and nutritional deficiencies that greatly undermine the autonomy of these people.
As concerns option 36, I completely agree that a strategy to improve the oral health of seniors will certainly result in an improved diet and a better quality of life for these people. However, this is not the only factor that influences diet and nutritional health among seniors.
I would thus like to suggest a few additional options.
The committee's report very accurately points out the vulnerable financial situation of many seniors who live in their homes within the community. It should be recalled that the first budget item that suffers when people lack resources is food.
People need to first cover the costs of their housing, their medicine and their health care. There is often very little money left over to buy a sufficient quantity of healthy food. Today, unfortunately, many seniors use food banks in order to obtain the minimum amount of food necessary. You will agree with me that this is an unacceptable situation in a country of abundant resources such as ours.
We have to guarantee a decent level of income for all seniors so that they have enough to eat.
Furthermore, for seniors to be able to live at home, given that this is probably what the majority of people want, they must have access to enough adequate food, and this could entail the provision of supply, delivery and meal preparation services.
A national home care program, as proposed by the committee, would also have to include a nutritional screening program that could quickly identify those individuals at risk of becoming irreversibly undernourished without timely action.
Early intervention could prevent under-nutrition by focusing on individual risk factors such as oral health, as described in the report, and other individual or environmental factors. Often these individuals simply no longer have the ability to prepare their meals and they have no one to help them with meal preparation.
However, screening is useless if further measures are not taken and monitored on a regular basis in order to ensure follow-up and treatment for nutritional problems by specialists. Over the past few years, several guides, grids and tools have been developed and validated by Canadian researchers for the purposes of screening for nutritional risks. Unfortunately, these tools have not yet been integrated on the ground. One of the main reasons for this delay is the lack of nutrition professionals in community practices.
As in the case of doctors and nurses, more dieticians have to be trained and more positions for dieticians have to be opened up in communities in order to ensure the nutritional follow-up of individuals.
Finally, providing food is also a social act. Community organizations such as meals on wheels and community cafeterias meet several seniors' needs besides providing a supply of essential quality food, and they deserve to be supported.
I would like to briefly speak about those individuals who live in seniors' homes that are the living environment for several Canadian seniors. There are significant deficiencies in the quality and quantity of meals served in some of these homes.
The quality of food services provided in these homes should be a condition for their certification. In fact, as in the case of individuals, the part of the budget that is most often eroded in order to free up funds is often food. We have a public responsibility to ensure the well-being and health of our seniors, even in private living environments.
I would like to remind you that in these institutions, seniors constitute a captive and vulnerable clientele given how rare available spots are. Professional resources must also be allocated to this sector in order to ensure that the meals prepared in these homes meet food safety standards and meet the energy and nutritional requirements of the people living there.
I would like to conclude with a word on residential and long-term care centres, where I think people have forgotten that our sense of taste and smell are what guide our eating habits.
Recent studies have shown how the senses significantly affect our appetite and food intake. Long-term care centres are home to the people who reside there. We are not talking about a temporary stay at the hospital. However, the way food services are organized in those residences is modeled after the hospital environment, and meals are often prepared off-site.
Just imagine receiving a meal tray that has travelled a fair bit before being placed in front of you, with food that is lukewarm and has almost no aroma. That does not have a very stimulating effect on one's appetite.
Research has been conducted in a number of long-term health care facilities in Canada and Europe where small health care units were outfitted with their own kitchens and dining rooms. All of those studies have shown an improvement in residents' nutritional status, vitality and sociability. Food services develop not only people's nutritional health, but also their social well-being.
New facilities, such as those that have recently been built in Sherbrooke, have opted for this new kind of food service organization, particularly for people with dementia. This type of organizational concept should be adopted as the standard for all new buildings, refurbishments or expansions of existing long-term health care centres.
Allowing people who live in long-term care centres to have their meals in a stimulating and friendly setting satisfies an essential need, that is, to feed oneself with healthy foods.
[English]
The Chair: Thank you, Dr. Payette. It is very interesting that on Monday we were in Halifax at the Camp Hill Veteran's Memorial Hospital, where they prepare the food on site in two different kitchens on the same floor. You could smell the bacon all through. We all got hungry, so we relate very well to your presentation.
[Translation]
Dr. Stephen Cunnane, Director, Centre for Aging Research, as an individual: Madam Chair and members of the committee, good morning. I would like to avail myself of this bilingual setting to continue in my mother tongue, which is English, in order to communicate my message more accurately.
[English]
Thank you very much for this opportunity to present and for the efforts that you are going to across the country to understand the milieu of the aging population and what some of the priorities should be. I hope we can make a useful contribution to that process.
I am the director of the Research Centre on Aging, a position I have occupied for just a year. Dr. Hébert was the founder and director of the research centre until 2001, and Dr. Payette followed him. It is through them that this research centre has developed and has become known for the national and international plan, and I certainly hope to continue the work that they have started.
I have a document to leave with you; I have two copies of the annual report from last year. We are 37 researchers, and in a city such as Sherbrooke with 125,000 people, it is quite an accomplishment to get those people together in a single milieu. We are from five faculties, which comes back to the term ``multidisciplinary'' that Dr. Hébert used. We are trying, in a way, to do the A to Z of aging research. Twelve departments are involved with our researchers, and we are on three different sites physically, which imposes a certain logistical challenge at times even in a small city.
We are doing what I would call the engineering to the ethics of research on aging, and we have specialists who are capable of mounting research projects or developing collaborations on topics as diverse as the engineering aspects and some of the computerized assisted devices and so on to help the elderly, certainly those requiring rehabilitation, and the ethical issues that we have to deal with today.
It is not based strictly on medical aspects or services or on fundamental research at the cellular level. We are trying to move forward on all those levels.
We are a centre of excellence at the University of Sherbrooke, which means we have a certain recognition in the university milieu and certain benefits and obligations. However, I think we stand out in research done by the university. One of the priorities of the University of Sherbrooke is to support the research centre and research on aging in general.
We are a research centre of the Fonds de recherche en santé du Québec. Quebec has 19 of those centres, and that is also recognition at the provincial level that the area that we work in, aging research, is something that absolutely requires the attention and focus that can be provided by a research centre and the infrastructure funding from the province and the federal funding that we get, and various sorts of funding for the research projects themselves.
In a way, we are a model for the approach that is required to understand what healthy aging is about. It is a message that Dr. Payette was trying to leave with you. We have to focus on healthy aging. It is a message that Dr. Hébert was trying to leave as well. People want to age at home, and ideally they need to stay healthy in order to stay at home and to stay out of hospitals. Healthy aging is what the future of aging is about. We are working on those levels, the services required. It takes research. It is a young field.
Aging research, in fact, is a new field. We are celebrating our twentieth anniversary this year as a research centre, which started as a small group with three or four researchers led by Dr. Hébert in 1988. If you compare it to the work on cholesterol, for instance, that has been going on since the early 1950s, I would argue that we still do not know how to interpret elevated cholesterol, how to treat it or whether to treat it. Perhaps in young adults, we need to treat high LDL cholesterol and so on, but what about in the aging population? Is it important to treat cholesterol at 75 years of age or not? Most people at 75 years of age are on a statin. Can we really justify that these days or not? Therefore, it is a young field, and this is why research is quite important.
One of the main concerns or fears about getting old today, on a parallel perhaps with cancer, is Alzheimer's disease, cognitive decline, loss of memory. Everyone, particularly the baby boomers, fears that diagnosis; everyone fears it in a family member when one sees the classic example of, ``Where are my keys?''
What do we do about Alzheimer's disease? The incidence is rising rapidly. It does not matter what statistics you look at, we see that the incidence has increased dramatically over the past 20 years. Where are we going with this issue? Do we have any effective treatments today? If you look at the literature on this, most physicians treating Alzheimer's disease will tell you that it is too late. Once we have been able to diagnose the condition, it is too late. We need to take care of the people who have Alzheimer's disease, but we need to think, as well, about preventing it.
Alzheimer's disease is not a genetic disease. Genes are involved at some level, but the reason it is changing is because our lifestyle has been changing over the past 50 years. That is a factor that we can do something about. We will not eliminate Alzheimer's disease, but we can affect it. The same things that affect your risk of cancer, diabetes, a heart attack or a stroke are the things that affect your risk of Alzheimer's disease. It is not in a different category. The recommendations are not different for people to treat Alzheimer's disease or to prevent it. It is about the risk of diabetes.
Diabetes is the main problem facing healthy aging on all levels, all disease aspects related to cancer, heart disease and brain function in the elderly. Type 2 diabetes, or adult-onset diabetes, involves insulin no longer being effective in the body. This is a problem that starts in the twenties, thirties or forties. We have to change the attitudes of people starting at school-age children.
The attitudes start in children, in adolescents, in high schools, in the types of food that are available, in the amount of activity, in the number of physical education instructors in schools, in the number of pathways for cycling in cities, and so on. Ottawa is a beautiful city for that sort of thing, with the cycling paths and skating on the canal — although that only lasts two or three weeks. However, the concept of what type of exercise you do is in your head. It is not a question of buying an exercise machine for $2,000 and using it religiously for three weeks and then letting it gather dust. It is about walking to work, getting off the subway one stop before your building, and it is about doing this for life because it is about prevention.
We do not have all the answers, but we need to come in at different levels. We need to understand what is happening at the cellular level to develop new drugs. We have elderly people who need drug treatments, and we do not necessarily have the best ones yet. Therefore, there are definitely developments at the medical and pharmaceutical level.
There is also basic public health common sense around exercise, nutrition — as Dr, Payette was trying to explain — and the services to allow people to stay at home. A balance is needed between taking an approach to public health, improving our research and understanding of some of the fundamental aspects, respecting the need in the long term of people to stay healthy and basically keep them out of hospital as long as possible.
That is my message. Thank you very much for your time.
Senator Mercer: I would like to thank all three of you for coming. Dr. Hébert, you talked about home care. In our travels so far, home care has been the focus almost everywhere we have gone. We have visited a couple of locations. I am interested in your opinion as to which province in Canada today has the best home care program. We need a model, and if we are to make any recommendations in home care, we want to come in at the top level.
I know that in my province of Nova Scotia, we do not have the top model. I am not happy to admit it, but it is a fact. I am interested in knowing which one or two provinces we should be examining more closely.
Dr. Hébert: I am not sure there is one. I have travelled around Canada a lot over the last 20 years. I can say to you that no province could be looked at as a model for home care. It is a general problem in Canada probably because it was not considered as medically necessary care in the Canada Health Act. Therefore, it was neglected.
It is now time to focus on home care, as I said, because that is where the care is. At the moment, in every province in Canada, we have many examples of the misadaptation of hospitals to support long-term care because the emergency rooms are crowded; the beds in hospitals are occupied by people needing long-term care. The hospitals should no longer be the centre of the system.
We have to re-centre the system around the home with strong primary care services and strong home care, and a good integration of services also. It is very difficult to coordinate the care at home because many agencies and professionals are involved. That has to be better coordinated.
We need a model in Canada. The models and the literature of integrated care that we have at the moment come from the United States, which has a different health care system. For example, the model from the United States, the Program of All-inclusive Care for the Elderly, or PACE model, was replicated in Alberta as the Comprehensive Home Option of Integrated Care for the frail Elderly, or CHOICE model, in which an organization is taking care of a given population, is not a good fit for Canada.
A good model should integrate all the agencies in a given area, not be separate from the usual health care system. The model we developed here with the Program of Research to Integrate the Services for the Maintenance of Autonomy, PRISMA, is a systemic change that includes all the actors involved in the care of the elderly, with a single point of entry and a case manager who is responsible for evaluating the needs of the people and ensuring that they receive good service from the right agency at the right time.
The case manager is a key professional in such a model. We should not duplicate the different assessments of the elderly people; we should be sure that one assessment is common to all the agencies and that there is good communication between agencies. The electronic health record is a very strong instrument to foster such coordination. It works in a Canadian context. We know how to implement that. We know that there is no extra cost to implement such a system, but we should invest first in order to benefit second. That is the message. We cannot do that without investing to get the benefit from such coordination.
We need to consider home care as part of our health care system, as integrated into our health care system, and we need to invest in home care. If we invest in home care — and there is a lot of evidence on that — we will decrease the pressure on hospitals and long-term care institution, and improve the quality of life for people. That is what people want; they want to stay home; they want to get the services where they live, not the other way around.
That is a strong message, and I hope your report will insist on this issue, which is critical for the sustainability of our health care system.
Senator Mercer: I would suggest that that is probably where we will go, without predetermining that today.
Dr. Cunnane, I was impressed when you said that 37 researchers, 5 facilities and 12 departments are involved in several campuses. That is quite impressive, particularly for a community this size.
The University of Sherbrooke has a special relationship with medical schools with the University of Moncton, in New Brunswick.
Dr. Cunnane: Yes, they do.
Senator Mercer: I am curious; does this research centre have a special relationship with the University of Moncton as well? Are they involved in your research, and do they benefit from the quality of researches that you have in Sherbrooke?
Dr. Cunnane: The short answer is, no. At least that is what I thought; perhaps I need to be corrected. Obviously, I need to be corrected. I will turn it over to Dr. Payette.
Dr. Payette: I think there is no systematic organization or collaboration, but I have been an adjunct professor at the University of Moncton for many years. Other researchers from the research centre and from the University of Sherbrooke collaborated for a while and still do. There is a centre on aging at the University of Moncton, and we are dealing with people from the social department and the nutrition department. I supervised many students and still collaborate with them. I am a co-investigator on projects with the University of Moncton.
I think it is coming. Not a lot of research is done on aging at the University of Moncton other than by the social department, but I think we can progress and increase this collaboration eventually.
Dr. Hébert: You raise a very good point. We developed a campus in Moncton for 24 first-year students in medicine. I was there yesterday for my annual visit to meet with the students, the professors and the authority from the hospital, and it is going very well. We are in the second year now, so we have 48 students, and it is going very well. We are already involved in clerkships in New Brunswick and also in family medicine residency programs for 15 years now.
You have a good point. It is now time to extend this implication in research, and probably research on aging is a good way to start. Recently, the Government of New Brunswick announced the creation of an agency for research in the province, which will help to support research projects and research centres. I am sure the University of Sherbrooke will be very active in developing that in the province.
Senator Mercer: I want you to know that those of us from the Maritimes really appreciate the work that the University of Sherbrooke is doing with the University of Moncton. It is extremely important for us to have home- trained doctors who work in the French language because of the Acadian population in all three Maritime provinces. It will be very helpful as we produce the first graduates — and hopefully they will stay in Atlantic Canada.
This is the type of cooperation that schools should have in solving the great problems that we have across the country. I want to ensure that you know that it is very much appreciated.
Dr. Hébert: At the moment, the French students from Nova Scotia, PEI and Newfoundland are coming to Sherbrooke to get their medical training. We get three or four students every year, and we are in negotiating with the Government of New Brunswick at the moment to keep those students in the Moncton campus instead of bringing them to Sherbrooke. It will be a very good move to keep those students from Atlantic Canada in the Atlantic provinces for their training.
The Chair: In my discussions with Dr. Hébert earlier, I also learned that there are some francophones from Western Canada, Manitoba included, who are being trained at the University of Sherbrooke, and physicians are available to them so that they can do their medical training in French.
Senator Keon: The Canada Health Act was a great contribution to Canadian society, but the negative spin-off from the act is that it placed the single payer in the position, for a very long time, of only paying for services that doctors provided or hospitals provided. We are gradually getting a little beyond that.
However, I spent my professional life, 35 years, as the CEO of quite a large institution, and as a practising doctor. I knew, within a very short period of time, that we were doing things wrong. I tried to convince governments along the way to change without much success, but I think we are on the verge of it now.
As an aside, in the Senate now, I am concentrating on a study on the human life cycle called population health, which includes from parenting through maternal health, through early child development, and so on, to seniors. I do not believe we will be successful in implementing our ideas unless the ideas that all three of you were expressing this morning can come to pass, and that is, we have to build community infrastructure.
That is tough, because the hospital establishment is so powerful. When you start talking about community infrastructure, they jump on it and want to build, and they have these huge budgets. I know because I had access to over $100 million a year for years and years. You could do just about anything you wanted with that money, and this is a huge barrier.
I commend you for what you have done in coming together. The exciting thing about you guys here in Quebec is that you are ahead of the curve. My brother was a family physician, and he worked in the CLSCs, the local community service centres, when they first came out. I thought this was the most exciting development that I had seen in medicine, but somehow it just did not work out the way it should have. I do not know what went wrong, but it did not. It was a great idea to have this integration of social services and medicine at the community level.
If the gospel you are preaching this morning about allowing a senior to live a healthy life is to start planning in her teenage years for her senior years and to die happily in her own bed at 105 without having had cancer, heart disease, a stroke, type 2 diabetes and so forth, if that will come to pass, we have to somehow marshal the heart and mind to turn our concept of health 180 degrees; and that is my question to you.
How can we influence government to turn their thinking 180 degrees and to invest in community and home care and the rest of it, but to invest in the community where the ideas you are preaching can be implemented? I would like to hear from all three of you.
Dr. Hébert: That is a very good question.
I have seen, over the last 10 or 15 years, that the discourse around aging is now more frequently in the public arena than it was, and that is a very good thing. The baby boomers are aging, and it will be a very strong phenomenon because the baby boomers have been associated with social development in this country and for the development of all the health services from which we benefit. I am sure they will continue to request good services, access to services, home care, and so on.
I am confident that the new generation of older people will be more effective in convincing the politicians and the government that it is an important area.
The other phenomenon I see at the moment is that hospitals are realizing that if there is better community care and primary care, they will have less pressure, and it will benefit them. It will help the hospitals concentrate on their main purpose, which is acute care, technological care, and not be overwhelmed by people requesting primary care or long- term care.
This mindset from a CEO of a hospital will be very important because what I see here in Sherbrooke, for example, the CEO of the university hospital is very supportive of the development of primary care and community care in the area because she realizes that it is very important for the university hospital to focus on their primary objective.
Commissions such as yours and ours, are a very important exercise to stimulate and put this debate on the public scene. I commend you for that. I am very pleased that you are committed to that. We need to convince the politicians and government that that is the way we have to go.
Dr. Keon, as you know, it is similar to treating a fever with aspirin but not treating the infection. Investing in hospitals because they are overwhelmed with emergency care and the beds are occupied by long-term care is that same as treating a fever and not the infection. If we do not treat the cause of that by improving the community care and primary care, we will never solve the problem of hospitals. That is a major issue for the sustainability of our health care system.
Dr. Payette: Research is so important in this to provide evidence-based data to have a clear message on what is important, what are the problems, such as PRISMA or other longitudinal studies on population health. We are conducting a longitudinal study on nutrition and aging in Sherbrooke and Montreal. These studies, such as the Canadian Longitudinal Study on Aging, CLSA, which is almost in the field now, will provide evidence-based data and will also create awareness in the older population that we are interested in what they are doing.
I have seen that with the cohort that we have been following for four years. These people are very interested in learning about the opportunities that are there for them in health and in social services. This knowledge transfer that is created through the population health studies can help to mobilize the people in asking for better services and care.
Dr. Cunnane: I think you have posed the challenge of the century, in a sense, Dr. Keon. My perspective is aligned with those of Dr. Payette and Dr. Hébert.
We need to work in parallel; we need to do more research. It is similar to research on diabetes or cancer or any other major degenerative disease in that we can say that there is always new information that we need to learn before we act, but there are certain steps we can take right now.
My concept of that as applied to healthy aging is that maybe we could conceive of some model communities where we could do a pilot project on a community base. We probably need a population of 50,000 or 100,000 in order to do that. However, are we prepared to invest in a model to test the ideas that we have? We have enough information to react now. We do not have all the answers, but we will never have all the answers. We will continue to do research on improving services and access to home care, but why not invest in a national network of model communities where we are testing an idea?
It would be similar to environmental projects, if you will. We should not wait for the votes and the government to change the way we think — obviously, governments have to invest in something that is related to health care; it is a provincial mandate. We have the nuts and bolts of a model community, in Moncton perhaps, or Granby in Quebec. I do not have expertise on how to implement that sort of project, but I think we are at that stage. That is what I would propose.
Senator Keon: That is an extremely interesting concept. I have watched federal governments over the years, and they get very nervous about upsetting the provinces. Therefore, they say that health is the domain of the provinces. On the other hand, the provinces are facing bankruptcy through their health care systems, with some of them having close to half their budget consumed by the health care delivery systems. They do not have any flex. Nothing will happen there because they do not have the money. The federal government has the money.
The role of the federal government is the welfare of all Canadians in my opinion. Their responsibility is to provide the financing, the incentives and the organization for change. For example, we will never get out of this conundrum we are in now with all the money going to hospitals and medical professions instead of the broad brush and instead of community medical social service facilities that we need for healthy aging, such as home care and social work.
How can we, in our Senate committees, impress upon the federal government the need to step up to the plate and exercise their responsibility, their leadership in change in health in Canada? How can we encourage them to provide the funding that will allow for change, for healthy seniors living in their homes, et cetera, which implies a tremendous change in the infrastructure, as you all said?
Dr. Cunnane: I do not have a crystal ball, but I would like to make reference to one specific example of how change happened in a minority government, a change affecting the health of Canadians in a minority government situation about four or five years ago.
Paul Martin was the Prime Minister for a period of time, and the issue of trans fatty acids was very much on the radar of Canadians. If I recall correctly, the scenario was that an NDP member of Parliament from Manitoba, whose name escapes me, at some point used this as a leverage tool, I suppose, and the rules were changed about the content of trans fatty acids in the Canadian diet.
The science did not change overnight when that process got going. What changed? It was the opportunity to work and to negotiate within the parliamentary system that we have, and particularly in the context of a minority government.
We happen to be in that situation today, and maybe the cards are aligned differently. However, perhaps minority government situations are an opportunity to try to put pressure on a multi-party approach, which would not occur in a strong majority government situation where perhaps one would ignore some of those pressures from all sides.
People in our position have an obligation to lobby the government directly on Parliament Hill, the way we did for the brain drain of scientists over the years and the Canada Research Chairs Program, amongst others. It was a response to lobbying by scientists and professors, and that is what we have to do. That is part of our obligation.
Dr. Hébert: I am very disappointed these days, especially with the Government of Quebec, who has complained for a decade now about the fiscal imbalance and the expense being in the province and the revenues in the federal government. Over the last two years, the federal government decreased the goods and services tax, GST, by two percentage points, and the province did not take this opportunity to invest this fiscal revenue to improve the services for the population.
It is a scandal because it means $2.5 billion for this province. With $2.5 billion, you can substantially improve home care and health care services. However, they did not take this opportunity to correct the fiscal imbalance. Another example is the health transfer that some provinces use to decrease the tax instead of investing in health. That is a big issue.
I do not know, it may be a strange idea, but maybe we can label some of the health transfer to focus especially on home care in order to oblige the province to invest in what Canadians need in home care. It may be a strange idea, but I am sure your analysts could look at such an idea to see how it could be proposed in your document.
The Chair: It was very interesting that, prior to the signing of the 2004 Health Accord, all provinces, including the Quebec government, agreed to a national pharmacare program. In that case, it was the federal government that chose not to make the decision to have a national pharmacare program.
My own sense is that perhaps provinces do not want absolute control in the hands of the federal government, and that is fair; it is their field of constitutional implementation. Having said that, there are ways for the federal government to direct dollars from the federal coffers to provincial coffers for specific programming, home care being one of them.
[Translation]
Senator Chaput: I would first like to say that I greatly appreciated your presentations. I am a Franco-Manitoban, and we francophones have always looked to Quebec to see what Quebeckers were doing because, for us, you have always been on the cutting edge.
I know that the Collège universitaire in Saint-Boniface has a distance education program with Quebec in the health care sector.
If the focus in Canada were on health and the competencies of older people, based on that we could consider people's homes as the heart of the matter. If that were the case, if I understood correctly, we would have to clarify the Canada Health Act, which focuses on healing after a hospital stay.
If that were the case, and we clarified the act, we could make homecare a priority. If that were a recommendation, do you think the federal government should play a very active role in home care? What changes would we have to make and what would be the role of the federal government?
Dr. Hébert: I believe that the federal government would first have to include home care in the Canada Health Act. That would be a great stride forward. That would send a message to the provinces and territories that home care would have to be part of any health service coverage.
I do not believe it is the federal government's role to organize care, to provide care, to be instrumental in organizing services, rather it is the role of the provinces. However, tax transfers to the provinces should, in my opinion, identify home care as a specific funding area.
I believe all provinces are ready to do this. You could give the provinces an instrument, a tool to say: ``We cannot invest in this hospital, we have money to invest in home care.'' So, you would be giving the provinces a tool to justify what they do and counter the hold or control of hospitals. I think that may be an avenue to explore.
Senator Chaput: Would you conceive of a national standard?
Dr. Hébert: No, not a national standard. I am of the view that provinces should organize their own services. There can be national objectives or policy directions such as a focus on home care, and long-term care, but I do not believe there should be national standards. There are 13 different health care systems within Canada and I think that is an asset. While meeting national goals and the values inherent in a national direction, you should allow the provinces to adjust the distribution of services based on the way they organize their services.
Senator Chaput: I have a question for Ms. Payette. When it comes to home care, what would you think of having a nutritionist as a component, someone who is an expert, perhaps a mobile team, I do not know, someone who could teach families, schools, over the course of people's lives? Could that be incorporated within home care?
Dr. Payette: I think it is essential for that component to be included in home care. And that is what I was raising, how rarely we see nutrition professionals within the community, within community organizations. Even within our current CLSC system, nutritionist positions are very, very rare. These people are mainly assigned to work with small babies, children, pregnant women and if they have a few extra hours a week to spare, a bit with seniors.
So, I think we have to look into how important these services are and have regular follow-up, that nutrition be one part of the overall assessment of a person and his or her needs; there needs to be a very rigorous system in place to organize all of these services, including food services within a home care program.
On several occasions, I had the opportunity to note that access to food and the difficulty in preparing it were often reasons mentioned as to why people decided to change their lifestyle and move into a home. As far as I am concerned, it is absolutely shameful for this service, which is really quite simple, not to be offered when we have so many other services. We have meal delivery services. There could be meal preparation support services to help these people stay in their homes. I think this aspect is essential within a home care program.
You know, we do not really realize it when we have no disabilities and it is not really a problem for us, but we eat three times a day. We enjoy eating and having healthy food. We eat three times a day and go grocery shopping at least once a week.
All of these food-related activities can become a serious problem for people in a weakened state, when they have difficulty getting around in the wintertime when the sidewalks are too icy. This is an area of serious concern and rapidly becomes a problem for people in weakened states.
So, I see this as essential.
[English]
The Chair: As a quick addition to that, in your remarks, you made comments about guidelines. Do you think that Canada's Food Guide has to change in order to make special reference to people over the age of 65, or whatever?
Dr. Payette: I am glad you ask that question. I had it in my speech, but I thought I would not have time to talk about it.
Yes, of course. Actually, there are no real recommendations or guidelines specific to the aging person in the Canada Food Guide. As I said before, areas exist where the recommendations should be adjusted, or where a nuance should be added, and, in some cases, the recommendations should be completely changed.
For example, I was speaking about the optimal weight. Over the last ten years, we have observed, we are not sure why but it is a fact, that all the people who are in the overweight range of the body weight index criteria live longer or are in better health, and they cope better than the others. This always pleases people when I say that.
The strong message about obesity that we hear nowadays is correct; there is a problem with obesity. As people age, they are very receptive to public health messages. Very often people will restrict their diet to respond to this message because the recommendation says that this way they will avoid all these diseases. However, we have to be very prudent in the public health messages, and we definitely need to revise the food guidelines and adapt them to the aging person.
The last version of the Canada's Food Guide has some specific recommendations for the elderly, but it is not enough. The reason is that we do not know enough right now; we need more research to be clearer about the message. To give the wrong message to people would be very dangerous for the quality of life and health as well.
Dr. Cunnane: I agree with Dr. Payette. I think there is also a balance, however. We tend to ``overmedicalize'' disease processes and forget a little bit about the public health aspect. We need to send a message about nutrition and prevention and to improve the Canada Food Guide to make it applicable to all age groups. We have also created a bureaucracy around nutrition. Now, we have to look at the label to be sure of what we are eating. In fact, the healthiest foods are the ones without any labels.
There is the message about improving the food guide, but there is also the message that we have, at least in Quebec — and maybe it is national — about the 5-30 business: five fruits and vegetables and 30 minutes of exercise every day. Let us simplify what we can simplify, do better research and improve the guidelines, but let us not make the message too complex because people do not get it; we do not actually need to make it more complex.
Senator Cools: I would like to thank the three of you for coming before us. In so doing, I would like to thank you for your work as doctors in this field, this necessary and emerging field.
I would also like to take the opportunity to thank Dr. Keon. Dr. Keon is a very special human being and has devoted a great part of his life to the practice of medicine in a very specialized way. Many people do not know that he is equally devoted to being a good senator and brings to the Senate his great knowledge of this medical system. I just wanted to thank you for that, Dr. Keon.
I wonder if you could articulate a little more about nutrition elements, such as more protein for the aging population. You said that food in these institutional settings is the highest area of profit — I had no idea. I wonder if you could elaborate very quickly on that.
In addition, one of you talked about the increasing incidence of Alzheimer's disease and type 2 diabetes in today's communities.
Dr. Payette: I will start with proteins. The recommended intake of protein for adults is .8 gram per kilogram of body weight. However, research has shown that when you are feeding this amount of protein to elderly people, they will slowly use their muscle protein to have a sufficient amount of protein to build tissue and so on.
Many people do not even eat .8 gram of protein per kilogram of weight per day. That is not adjusted yet in the guidelines, but I hope it will be in the next few years as research builds and convinces people of the need to increase the recommendation for protein.
We have to be aware that as a person reduces the total intake, the amount of food the person eats, if the person does not eat enough calories, the person will use protein as a fuel. Protein should be devoted to building tissue; it is not to fuel. It becomes worse when the diet, as it is with many people, is low in calories because the amount of protein they get from that diet is used as fuel. Protein is not very often raised as a problem in our population because we have all the food needed to have enough protein, but it becomes a problem in the older groups.
As for the food in the residences, research that shows that the quality and the quantity of the food are not adequate. First, this is due to a belief that older people should not eat much; and, second, food is quite expensive, so the private residences that have to make a profit will use this budget item to decrease their costs.
It happens more often than we would like to see.
Dr. Cunnane: You asked about Alzheimer disease and type 2 diabetes. Is that in the context of an increase in diabetes?
Senator Cools: You are suggesting that the incidences are increasing. I wonder if you could tell us a bit more about that.
Dr. Cunnane: Alzheimer's disease is a complex disease, and I do not want to give you the impression that we have any instant solutions to it. The major non-genetic risk factor is adult-onset diabetes. It is something that did not exist in the Aboriginal North American population 50 years ago. Now, it is the biggest single problem in the Aboriginal population in Canada by far.
It is a lifestyle issue. We can have susceptibilities that are different genetically, and people from different origins do have different inborn risks. However, we are exposing those risks, and that is why it takes off in certain populations.
Type 2 diabetes is a style of life; it is a question of activity and food intake — being overweight and the level of physical activity. My personal perspective is that the physical activity is the part that could change the risk of diabetes more than changing what we eat. That is my perspective. Not everyone agrees with that, but we should definitely do something about physical activity for all sorts of reasons besides diabetes.
Therefore, if we have a problem with Alzheimer's disease and diabetes today, if we look ahead 20 or 30 years at the risk to our adolescents — and even our children now with obesity — we have a disaster on the horizon. It is a Titanic that needs its direction changed because the iceberg is not far away.
The Chair: An interesting study was done, as you know, in an Aboriginal community where they changed the diet of their people back to their earlier diet, which was filled with protein, oily fish and meat from the land, and all of a sudden, diabetes went down. It just adds to the debate.
Dr. Hébert: I want to raise one more quick point on palliative care. Palliative care is seen as care for people dying from cancer at a younger age. We should probably shift that to end-of-life care because older people usually die from cancer but also from dementia and cardiovascular disease. We should foster end-of-life care in the older population. I hope that the document will broaden the notion of palliative care in order to encourage older people to seek out those services when they are dying.
The Chair: Thank you, Dr. Hébert.
As you know, senators, palliative care is a pet cause of mine, but in addition, that is where I first met Dr. Hébert, and that is why we are in Sherbrooke today.
I want to thank Dr. Hébert, Dr. Payette and Dr. Cunnane for their wonderful presentations this morning. I know you will see your ideas reflected in our final report, which we hope to table on September 30 because October 1 is the International Day of Older Persons, and we thought that that would be an appropriate day for us to table this report in the Senate.
[Translation]
Honourable senators, we will now be moving to our second round table. It is a pleasure for us to welcome from the Association estrienne pour l'information et la formation aux aînées et aînés, Ms. Sylvie Morin and from Agence Continuum inc., Ms. Hélène Gravel.
Hélène Gravel, Chair, Agence Continuum inc.: Madam Chair, thank you very much for welcoming us here this morning. Agence Continuum is a private recruitment firm specializing in return to work for pre-retired and retired individuals.
The agency was born out of an obvious need: on one hand, the aging population, and on the other a shortage of labour; we also knew full well that our corporations were going to need qualified competent labour and we believe that the pool of pre-retired and retired individuals met these criteria very well.
At the same time, I must admit we have been operating for two years and have met with a number of retired people who spent their lives working in a variety of areas of activity. There is one constant, after people have retired for a year or two, and I am referring to people between 52 and 70, which is that they did have big retirement dreams. They thought they would travel, do certain things they had never done. After two years these people generally realize they face some boredom and their self-esteem has dropped considerably.
You cannot forget that these are people whose identity, over the course of their lives, revolved around what they did and not necessarily who they were. So, there is a great deal of distress among some of our candidates, who say: ``What am I going to do now for the rest of my life?''
As you know, life expectancy is increasing, by one year every four years, and this period of professional inactivity becomes an increasingly heavy burden to bear for them.
Increasingly, businesses are interested in rehiring people who are slightly older. They are incredible human resources, extremely competent, and tremendously reliable. If you were to compare them say to generation Y today, they are completely different. But make no mistake; it is much more difficult for us to find adequate employment for some people than it is for others.
What we have chosen to do is to think outside the box and innovate. We tried to assess needs and offer services which could be provided by these people. We offer two very simple services. First of all, we offer private chauffeur services. Clearly that would apply most often to male retirees that we also have women who may choose to combat boredom by helping people who need to get around, for instance, to go to see their doctors. So, we have retirees, drivers, and many retired police officers working for us. It is reassuring for our clients and very convenient for people who unfortunately do not have family members to take them to their appointments. Our driver services also cover getting to conventions and any type of business travel. We often drive professionals, like university professors, to the airport.
The other service is one we call nannies at home. We have a list of retired people, most of whom are women, who come and help out young families. We know that these families are exhausted, and we also want to increase the birthrate, so we wondered what we could do to give them a hand. Often the grandparents do not live close by. I must say that at the moment we do not have enough caregivers to meet the demand, which is exponential. Every day, we hear about great success stories, when we manage to find the perfect match. These are often older women who, unfortunately, are living below the poverty line. In any case, in this region, this has become a real problem. So we help out with young families by providing them with a responsible individual for 20 to 40 hours a week. In addition, we pay these people $10 an hour, and this helps them out tremendously.
I must tell you that the demand both for drivers and caregivers, which only accounts for a small part of what we do, is growing. I think that these services meet a real need that society is going to have to face up to. We will have to be more creative in trying to bring these two generations together — that is, young people, so as to encourage them to have more children, but also the older generation, by making them feel useful and enhancing their self-esteem.
We have other projects having to do with volunteerism. Last year, we introduced a program called Passing on the Passion. As you know, the school drop-out rate is about 34 per cent. We have a bank of retired professors from the University of Sherbrooke — and I must say that we did not make any money on this even though we are a private company — that come into high schools to encourage young people not to give up, and to pass on their passion for a particular subject.
Let me give you an example. I have a chemistry professor who goes and talks to a chemistry class and tells them that what gave him the guts to complete his education and to go a little further was this or that particular factor. So we are talking about life experience, not just academic concern. These people become models for the students. We try to spark the interest of these young people, because they really need some models.
So far, the success rate has been very good, and this mentorship program between volunteer professors and students is outstanding. The kids often are astounded that a university professor with a doctorate would take the trouble to sit down and talk with them as equals. That is something we hear quite often.
Once again, we are building the self-esteem of retired professors, who need to feel useful. But we are also building the self-esteem of these young people, which is something that is often forgotten.
The other project, the most recent one put forward by the agency, was not mentioned in the brief, because theoretically, it will be launched in September. This is a volunteer medical guidance clinic that uses the services of retired physicians. You know as well as I do that when we try to fill in some of the gaps, the problems with the health care network are everywhere. That is not true just in Quebec, but throughout Canada. Is there something that can be done to overcome the boredom experienced by some of our retired people and at the same time meet some of the other needs that exist in our society?
This is a medical clinic staffed by volunteer retired physicians. You should see what great resources we have and how generous people can be: these doctors are working voluntarily between 8 and 20 hours a week.
What are their reasons for doing this? First of all, they do not need money. That is the first point. They want to be part of a group, they miss their colleagues. These are people who worked very hard all their lives and they need to continue giving. The reason they went into medicine in the first place was to look after people, to have them get well. What they have been telling us is that they had so little time to sit down and talk to their patients in the last years, and now, if they feel like spending an hour with a patient, they can do so.
So we are trying to meet needs and at the same time take advantage of all this outstanding expertise and generosity of people in pre-retirement or retirement.
Sylvie Morin, Coordinator, Association estrienne pour l'information et la formation aux ainées et aînés: Good morning, Madam Chair. I am the coordinator of the Association estrienne pour l'information et la formation pour contrer les abus faits aux aînés (AEIFA). This is a community group that has been in place for the last 15 years here in the Eastern Townships. We are also a regional body, and we cover a huge area made up of 88 municipalities counting Sherbrooke and its seven MRCs (regional municipalities). We serve some 300,000 people.
In the last five years, we have carried out over one thousand interventions. Each of these interventions involves the interaction of four to five people. Where seniors are involved, the AEIFA has met with between 4,000 and 5,000 individuals in the last few years.
We are also on various round table groups and we provide training in schools.
We know there is hope. We try to raise the awareness of seniors and inform them to fight abuse, and we see that progress has been made. When seniors are better informed, they talk more about their situation.
The AEIFA meets with seniors to make them more aware of the problem. There are different types of meetings: we go to day centres for seniors, to their living rooms, and to retirement residences and seniors' clubs. In addition, we work directly with seniors at our office or in their homes.
According to our calculations, we have met with approximately 30,000 seniors in recent years.
We have also trained a number of volunteers so as to increase our efforts to fight abuse.
Since the beginning of 2008, we have been getting two or three calls on average a week from individuals who are looking for some help with problems having to do with abuse.
Most often, the family is involved. In other words, the son, the grandson, the daughter, the spouse, the brother or the sister. And the root of the problem very often has to do with money.
In addition, the AEIFA is involved with the schools to provide training about abuse. For example, we talk to seniors a great deal, but there are also the attendants, for example, the front-line workers in the day centres and in hospitals.
We consider this very important, because a study has shown that on average 15 to 18 per cent of future graduates were victims of abuse or violence themselves, and may also have various problems themselves. We often see people in high school equivalency programs. These are adult education programs for people who want to go back to school. If they pass the equivalency test, they do not have to go through Grades 7, 8 and 9.
Our organization has a different way of working with seniors. Why? Because it is important that seniors trust the people they are dealing with, and they need to feel that the information they will disclose will be taken seriously. It is essential that a senior is made to feel comfortable when the senior is on the point of disclosing something. Elderly people do not want to have the feeling they are wasting our time. They are always afraid that they are bothering us.
So it is very important to give them the time they need and not to hurry them along, and to respect the kind of help and support the elderly person is looking for. They are extremely afraid of the police and of legislation. We have to visit them regularly so they can begin to feel comfortable and ultimately contact an organization or a person on regular basis.
It is also important to point out that not saying anything strengthens the position of the abuser. Every time I speak to seniors in their residences, it is something I always strongly emphasize.
We have determined that it takes an average of between 10 and 15 hours to help and prepare seniors who need help. It makes a huge difference if elderly persons have the feeling they have outside support and can take control of their lives again.
As you can see, for the AEIFA, elder abuse is our greatest concern. When we read the report, we felt it did not address elder abuse enough, and so was not as good as it could have been.
In our opinion, the Canadian government, in its role as an umbrella organization, could develop better regulations, legislation, programs and policies focused on prevention, awareness, detection and, in particular, intervention, to root out elder abuse.
The New Horizons Program is, in our view, a good way of helping organizations which work with seniors, but the ideal would be to create an ongoing program which would support recognized organizations working in this sector to continue their fight against elder abuse and maintain the expertise they have acquired over the years.
This would allow organizations to save a lot of the time they would otherwise put into funding applications and help allay financial concerns with regard to the availability of funding for the next year.
[English]
The Chair: Ms. Gravel, I would like to know a bit more about this medical orientation clinic. I saw something about it on national television. I wondered if it was the same program because, I must admit, I did not pick up on the location. These are doctors who are neither giving prescriptions nor doing surgeries; all they are doing is essentially sitting down with patients to talk to them about their problems and who they should see or when they should see someone. Is that how this program works?
[Translation]
Ms. Gravel: We have been told that the biggest problem is referring each patient to the appropriate service in the interest of saving time, because sending them to the hospital emergency rooms is not always the best solution, but that is what usually happens.
In this case, I must admit that the project is constantly changing. What we decided to do, along with the Collège des médecins du Québec, is to only pay the premium for retired physicians, which authorizes them to write prescriptions. For example, if you need to see your doctor quickly, but can't, you can always get a prescription for a retired physician.
So what we are basically talking about is a referral service. The physician will make a diagnosis, that is an obligation, but the physician has been doing this for 30 or 40 years. However, minor surgery will not be carried out at the clinic. The first thing that will be done is to assess how serious a patient's case is.
So if you need to see a specialist, the advantage of using these physicians is that they are connected to a network. Here in the Eastern Townships, between 25 and 30 per cent of the population does not have a family doctor. The first mission of the clinic would be to help those people. But they are not there to replace anyone else. The purpose of this undertaking would be, on the one hand, to generally reduce backlog in the medical system, and on the other hand to help people, for whom it is often difficult — let's not deny it — to quickly meet with a doctor, someone who will take the time to listen to them.
Obviously, the concept of a medical orientation centre is based on two observations: I was appalled to hear doctors say they were ``bored,'' and second, family physicians were telling us: ``We see the same patient five or six times a year, and even if we tell the patient that everything is fine and under control, the patient wants to back simply to be reassured yet again.'' Lastly, retired physicians are people whom we could go and see in case of an emergency. It comes down to the fact that people need to speak with someone with medical expertise.
In case of an emergency, the volunteer physicians will be able to directly refer a patient who is in serious distress to a specialist within the network the volunteer physicians are still connected with. But it will often turn out that the doctor will tell the patient to ``take two aspirin, go home and get some rest,'' which will reduce emergency wait times, among other things.
[English]
The Chair: It reminds me of being in an emergency room, as a young mother, with a child with asthma, who could not breathe, and asking another mother why her child was there; she had a splinter in her finger. I wanted to take the child somewhere where the mother could not see, take the splinter out and send the kid home. I obviously could not as I was not a physician. However, it addresses a very urgent issue, which is that we do have hospitals triaging, and they frequently need to have someone to assess the seriousness of the problem and if a physician needs to be seen immediately.
As a supplement to that, in terms of your drivers' program, who pays for these drivers?
[Translation]
Ms. Gravel: The client. I have always maintained that the best solutions are often simple ones.
I would like to come back to something you said earlier on when you saw the woman with the child who had a splinter in a finger. Young mothers, for instance, get peace of mind from knowing that there is a doctor nearby in the neighbourhood. If you happen to meet the doctor and you have a concern, you will naturally ask him whether the problem is serious.
The volunteer orientation centre directs all these people to where they are needed the most. We need to use our imagination and never lose sight of the fact that, whatever happens in the next few years, there is a pool of extremely competent people who will be living longer and who will only ask to give back to society, if only to feel good about themselves. Sometimes they will need to be paid, and sometimes they will work on a volunteer basis.
Let me come back to the physicians. At one point, we asked them whether we should apply for a bigger grant so we could pay them. But they refused. How wonderful. Money is not the answer to everything.
We also determined that there was a need for more drivers. We are also encouraging people to carpool. For example, at the University of Sherbrooke, we encourage people to drive three to a car rather than each person taking their own car to get to the same meeting.
The client pays. There is a profit for the agency and drivers are paid $10 an hour.
The same holds true for caregivers. Families call us because they are looking for the right caregiver. It is not a big expense. I must admit that we do not make much money off of that service. Thankfully, though, we are also involved in other things. That is why our team likes to undertake small projects and they do so with a smile. It also represents a better use of our human resources.
It is important to determine where the needs are in our society and in our environment and how these competent people, who have exceptional skills and who may be a little bored, can help fill the void.
I admit that attitudes are always changing. I think that not only are we helping our community and improving the quality of life of people, but it also improves the quality of life of our seniors because they feel useful.
We always have to try to project ourselves into the future: how am I going to feel in 20 or 30 years? What is going to motivate me to get out of bed in the morning?
I think that this has an impact on people's general health. I spoke about this issue at great lengths with Mr. Hébert and it is obvious that our health is clearly better when we feel useful and when we want to get up in the morning.
[English]
The Chair: Ms. Morin, you made a statement, and I do not disagree with it because I think you are absolutely right, but I want you to go into a little more detail. You said that money was at the heart of the problem with respect to incidences of abuse. Would you elaborate on that for me?
[Translation]
Ms. Morin: When I meet with seniors, they often start to talk about the types of mistreatment and how it occurs. We know that now people have a life expectancy of 82.
With respect to one factor, we do understand seniors' attitudes towards inheritance. I often raise this issue in the workshops, I often talk about this infamous inheritance where people to some extent feel that they owe their children something. But as the children reach the age of 50 and 60, they start putting more and more pressure on these seniors in order to get their hands on their money.
A second factor that is just as important is when the son or daughter has gambling or financial problems and maintains a very regular relationship with a parent based on this need for money. We see horror stories involving parents who are 70 or 75 years of age with a child who has just about gone through all of the inheritance. This is often done under pressure.
That is truly the reason for the mistreatment. Often the elderly person does not even realize that he or she is being mistreated because, as far as he or she is concerned, as I explained earlier, the inheritance is part of the family, so it becomes complicated.
[English]
Senator Keon: Ms. Gravel, I thought your presentation was extremely interesting because it embraces the potential of private-public relationships and what they can do.
I was driven to the airport in a limousine by a senior woman, who told me that she does it because it compensates for her boredom. She does not need the money. She had enough money to buy the limousine, and she said that she gets paid enough to make her operation feasible. This woman devotes a great deal of her time driving people to and from one of the hospitals, and so forth, on a voluntary basis.
I just thought what a wonderful opportunity to harness all this wealth and human energy.
Is there any move toward some sort of networking? Large national organizations are not necessarily that good all the time. Good things usually happen at the community level.
Is there any sort of networking with your organization that can promote this type of wealth in human resources with seniors?
[Translation]
Ms. Gravel: At the outset, and I am repeating this, I run a private company. We recruit our labour at large.
We are already working with groups of retirees from the Sûreté du Québec throughout Quebec in order to provide a chauffeur service. The nanny service will soon be provided. I think that these are basic requirements just about everywhere.
We are really talking about corporate strategies. This is part of our medium-term objectives. The same thing applies when we talk about volunteer orientation centres, for which the company does not receive any money, and that is important. This is more my social side, which is quite highly developed.
Obviously, the telephones are ringing off the hook with people asking for volunteer medical clinics just about everywhere.
The answer to your question is yes, we do see an interest there, and I personally do as well.
Getting back to the chauffeur service, it is true that more and more people are going to be providing this service, either on a volunteer basis or for pay. However, I see another problem with that. Many people who are now working for me do so under the table, and I do not believe that as a society, we should be encouraging that. At any rate, that is not part of my personal value system. Now, this is a service that is organized and it is declared. It is important that this be mentioned as well.
I did not reinvent the wheel. There have always been chauffeurs. There will always be people who provide this service and who get paid under the table, and the same holds true for nannies. In both cases, these services are organized and declared, so I see another positive impact in this.
[English]
Senator Keon: Ms. Morin, it seems to me again that networking could be of tremendous benefit to the country in the type of thing that you are doing, that other people could benefit from you tremendously.
Do you think there is a need for some type of facilitation of networking? For example, through a knowledge exchange centre, which may be provincially located, or maybe cities could have a knowledge exchange centre that could network with other knowledge exchange centres so that the kind of information that you have available could be disseminated to other places.
Again, it seems that there is so much potential for doing good things in other areas with what you are doing.
Should we be advocating assistance to create a knowledge exchange across the country on a networking basis?
[Translation]
Ms. Morin: That is obvious to us because the organization was a precursor with regard to mistreatment. As I told you in the beginning, we have been around for 15 years and we know that this exists and we have developed an expertise with regard to intervention, information and awareness.
If there were other organizations similar to ours in other municipalities, organizations that would be set up and that would allow us to communicate and exchange information, this would clearly be extremely helpful; both for the organization and for all those who are not affected. Not everyone is going through the CLSC or through the hospitals.
For our part, I would say that we have succeeded in increasing interest through awareness and more information. The more work we do on the ground, the more we realize the importance of having an organization such as ours. Obviously, such an organization could work in other municipalities.
[English]
Senator Mercer: Ms. Gravel, your agency seems to me to be very unique in a field that will be growing, and I congratulate you for it.
We mainly talked about medical people and then about professors, drivers and babysitters.
Have you been able to identify and fill demands for other seniors who are retired or about to retire? Is the demand exclusively local to the Eastern Townships, or are there opportunities that are further afield, whether it be Montreal or Quebec City, or even outside of Quebec or outside of Canada?
[Translation]
Ms. Gravel: I must tell you that what we call generational help is a worthwhile enterprise throughout the country and not just in a specific region.
It is true that we are the first and only private recruiting agency to have a specialty niche market for pre-retirees and retirees. Initially, I was told that this would not work, that we would not be able to cover our costs. On the contrary. It is true that we have diversified our activities to some extent. What I have talked about here this morning relates to special projects.
I have the opportunity to sit on the advisory committee for employees aged 45 and up for the Government of Quebec. What we have noted, and what is unfortunate to see, and it is simply due to a lack of workers, is that our companies are turning increasingly to their current employees. They are trying to retain their current employees, but they are looking increasingly to slightly older employees to recruit workers. At present, and I experience this on a daily basis, we are having trouble recruiting workers in general.
So, a lot of work needed to be done to make our companies aware that it is highly worthwhile to have workers aged 55 and up for a number of years to come. Initially, unfortunately, our companies still believe that there are a lot of well-educated and well-trained young people available, and this is completely false.
Unfortunately, often before reacting, you have to have your back up against the wall. We are trying to make companies aware that they need to wake up now.
Today, we are placing engineers who retired two years ago and they are working in firms. We also place a lot of managers, which is greatly appreciated. These are people who for example worked their entire lives in management and who will work as consultants or managers for a company and as paid members of boards of administration, something we are asked for frequently, that is to fill positions within boards of administration with various retirees having exceptional experience.
You have all heard of Rona, which really was the first company to hire retirees. Obviously, this is one of our clients and we do business with them.
I will tell you that things have changed a great deal over the past two years, and now there is a demand in all sectors of activity. I do not need to tell you that retired nurses are being courted on bended knee in order to get them to come back into the system. It is a shame but that is how it is.
Now, we really see this in all activity sectors, but we still need to properly understand the conditions that those individuals will have. They no longer want to be subject to the pressure they experienced when they were young. They want to do things differently. They want to feel integrated into their new workplace. That is why everything related to human resources and the quality of life at work is important; we talk about this a lot in the area of health care, but we need to talk about it in all sectors of activity. This goes to the very heart of it, and this will enable us to properly integrate slightly older individuals in all sectors of activity.
Clearly, to me, the future of our country and our capacity to get through the next 20 years, during which we will experience a labour shortage, depends on generational help. Also, again, and I come back to this constantly, we cannot leave people who are healthy and who want to give, be they 55, 60, 65 or 70, at home. It is a matter of their self-esteem as well as of our collective health.
I think that, in the future, every and any initiative that the government can implement to encourage people who want to do so. . . in fact, often what is missing is that when we started our agency, people told us, ``I wanted to do something, but I did not know what.'' Obviously we are going to take the time to tell them ``What would really excite you for the next few years of your life?'' It is not necessarily something that they have done all their lives; it could be something completely different. I know people who were lawyers and who want to be painters. We are going to help them do that.
Among our nannies, we have former teachers and former nurses. They no longer want to do the same thing they used to do; they want to do something else. So, the link is easy to make throughout Canada. It is about finding a place that will allow the company, in other words the client, and individuals who want to give back to do so. And I think that really this should be done throughout the country, because this is the future, in our opinion, and those people want to give for many years to come.
[English]
Senator Mercer: The Canadian International Development Agency, CIDA, does work all over the world, and people from Quebec have been major participants because of our association with so many French-speaking countries around the world, through our relations with the francophonie.
Have you been able to work with CIDA perhaps in placing people with a particular expertise, who they might be looking for to go overseas and work in developing countries?
[Translation]
Ms. Gravel: Not with CIDA. What we are doing now, is that a number of our retired engineers who are working for private firms will go, for example, to Algeria. So, we do international placements, not publicly, but privately. Everything depends on changing people's mindsets. I was listening to you when you said that CIDA does this in various other countries, but there are countries which can serve as examples for us in this regard. I think that it is time to be forward looking within our own country, because we need these people here too.
[English]
Senator Mercer: Ms. Morin, the work you do is extremely important. We have talked about abuse in many other communities.
Have you been able to engage others in identifying abuse in the community? Sometimes, as you said, abuse goes unreported. Your term was their silence empowers the abuser, which I think is very true.
We have heard about other communities where people in the community have been engaged in identifying the abuse. Have you been able to do that, and have you had any training programs to help people in the community recognize elder abuse?
[Translation]
Ms. Morin: Yes, clearly that is our first element because when we talk about intervention, I would say that more than three quarters of our interventions are due to an initial screening.
How is the screening done? Somewhat as I mentioned earlier, by training volunteers. Each year, volunteers serve as multiplying agents, who are trained to be able to see and detect individuals who might be experiencing abuse.
Someone goes to the day centres every week. We meet with seniors, we talk to them and we give workshops of approximately an hour, but often they run over. Because of the relationship and trust that grows between an organization or individuals on the ground and seniors, it is quite common to get phone calls later and to meet with people to talk to them.
Another thing that encourages people to disclose this information is when we meet with seniors in group settings. Simply exchanging information will often lead to someone saying, ``Oh, yes, that is true, I am experiencing that too.'' And then a discussion will take place.
That is why it is important to work on the ground, to go and see them, and not just once. It requires a great deal of time and energy, but it is important.
[English]
Senator Mercer: We have heard elsewhere how important it is for people who interact with older Canadians to keep their antenna up to look for abuse. We heard that some of the banks have actually done some training with their staff.
Have you seen that in the banks and the caisses populaires in Quebec? Have they been mindful of their responsibility to notice unusual things happening in seniors' bank accounts that did not happen before, which could be potentially a sign of financial abuse?
[Translation]
Ms. Morin: When we talk about the Estrie region, there are seven MRCs. In each of the MRCs there was groundwork to be laid this year. Some of them have already created regional roundtables on abuse. These roundtables often comprise people from the credit unions and the police force. There are scheduled meetings. I can tell you that there has been progress. There are roundtables that were already organized this year, but there is still work to be done in the area of awareness.
As you mentioned, we get a lot of support from the credit unions, because these people are on the front lines and they are aware of money that continually goes missing. So, in our opinion, there is still work to be done in this area, in order to continue to cooperate and move forward.
I am saying that there is work to be done, but there has been a lot of work done already. Training the tables is not something that can be done in one day.
[English]
Senator Mercer: Ms. Morin, you indicated that you thought our report did not have enough emphasis on identification and prevention of abuse. I can assure you that, since we started our travel across the country, that has certainly moved up on our priority list because we have heard that this is an issue in every community.
Hopefully, when our final report comes out, you will be able to say that your comments and those of others have had an effect.
Senator Cools: Ms. Gravel, I understand — and I have never heard of such a thing — that your organization is a profit-making company that is essentially doing community work. Maybe this is very common. Could you tell me a little more about the organization, how you are able to turn a profit and if this is a growing tendency?
[Translation]
Ms. Gravel: I dare hope so, but perhaps I would say that I have had the opportunity, in the past few years, to have two jobs that are completely different, but that have enabled me to get to know both worlds well. First, I was director general of the Regroupement des organismes communautaires de l'Estrie and then afterwards the director general of the Sherbrooke Chamber of Commerce.
In my opinion, the creation of wealth and equitable services go hand in hand. We cannot work in isolation, we must work together.
I will tell you that our company is doing extremely well. We are turning a profit. I am not making money from the retiree, pre-retiree part. This represents approximately 5 per cent to 10 per cent of my sales figures. My accountant is telling me to set this aside, and my answer is no, because I believe in it. I believe in it as a businesswoman because it is an interesting business opportunity and it is somewhat visionary, so I think that it will be successful. I also believe in it because, as I said earlier — and the same goes for my team — we so enjoy our work, and we can quickly see the results of what we have accomplished.
At the beginning of my remarks I explained how this came about. It came about for two very clear reasons. This was a business opportunity. When you decide to go into business, your business idea has to be based on what is happening in the community: a lack of labour, aging of the population, available and skilled individuals. In my case, it was pretty easy to put two and two together.
Once the company was started, it led to the creation of several small projects, that have become bigger. I spoke earlier about the ``Transfer of Passion'' with retired teachers, and everything that we are doing with our retired doctors; however, the basic idea remains the same.
It is so simple when you think about it. Regardless of the sector these people have worked in, one must never forget that once they are called upon to help, whether they are paid for it because they need that, or whether they do so on a voluntary basis, because they also need that, everyone wins. Personally, I think this is the way of the future.
[English]
Senator Cools: It is very interesting, and I wish you continued success.
Ms. Morin, the subjects around domestic violence are subjects with which I am very well acquainted. I know a considerable amount about the phenomenon of intervening and bringing relief.
My question to you has to do with your strategies and interventions. How often do you intervene and solve the problems and grant relief? How often do you resort to the Criminal Code, to a criminal prosecution, which, with seniors, can be devastating?
I know of a case about three years ago where a few slaps were exchanged between two senior spouses. Some diligent policeman came in and got the prosecutions underway. Then, of course, both of them were very frantic at their ages. Fortunately, when they went before the judge, the judge scolded them as though they were two children. He told them that they were far too old for this, and then dismissed the charges. That was the end of that because the fear of God had been upon them.
I am curious about the nature of your interventions. Do you have any data on victims and perpetrators, on how often the spouses are against each other or other family members or other individuals?
Most important, how often do you resort to the mighty blunt hand of the Criminal Code?
These are conscious decisions that people who do this work have to make. When I was on the front lines, considerable years ago now, I was always reluctant to go to the Criminal Code provisions for prosecution, to laying that information, unless the situation was extremely serious.
I found in those days, my approach was a more successful approach, especially if you can open people up to talk to each other. Different workers have different approaches. I knew other workers to whom it did not matter how much a couple or the family was helped, as long as they got a prosecution; that is what they wanted. I am sure you know the damage that happens in those families for years after such a prosecution.
If you do not have any data, I understand, because quite often you just do not have time to collect the data in the front lines. I am curious as to whether you have such an approach.
[Translation]
Ms. Morin: I would like to give you an example of how we become involved in a situation of abuse; this is an incident that happened not very long ago. A 52-year old woman called and she was crying a lot and she said to me: ``I have betrayed my family. What I am doing makes no sense, all I want to do is commit suicide, and I want to kill my brother.'' That was what she said as soon as she called. Obviously my response was to gain that woman's trust and to embrace what she was experiencing, and to take note of what she was sharing with me. This was a situation involving brothers and sisters, and a brother within the family who was abusing his parents quite extensively. That is why this individual called. But this person did not want any involvement with the police; she did not want any legal procedures. At that time, I invited that individual to come and meet us and I assured her that there was no question of undertaking any procedures without consent within the family. This woman came to meet with me along with her sister, because she had told her that she had requested help. We met five or six times, and we met with the family. We did not become involved with the brother, nor with the parents, because that is not what they had requested. However, these individuals received tools and empowerment through our explanations and awareness-raising. I explained to her when she told me that she wanted to kill her brother because of what he was doing to her parents that it was the behaviour she wanted to kill and not what was happening. All of this made eminent sense, and throughout our meetings, we acquired tools, for example, the use of proxy.
I think that our involvement was successful because this individual called me recently to tell me how helpful it had been.
In the end, no, we did not use the process, but we do know how important this was for them within their family.
That might be the example I could give you in relation to your question.
[English]
Senator Cools: What you are saying is extremely important because when you look at these relationships, they are very intimate, very close and the individuals are very vulnerable, so one has to be extremely sensitive in how one manages it. You need to open them to understanding their own offensive behaviour, and also the interaction because quite often it is not him or her, rather it is them together. Therefore, I am very pleased and relieved that you have that approach because in my view that is by far the most successful, and the most effective.
I would like to say, Chair, I do not know if we have looked at this, but one of the foremost American scholars on physical abuse of elders is a woman named Dr. Susan Steinmetz. She comes out of the original group of Dr. Murray Straus' around the University of New Hampshire.
If, one of these days, we want to get a scholarly examination of this subject matter, we could think of Dr. Steinmetz, if she is still doing this type of scholarship.
From a professional involvement over the years, I know what you are speaking about. I remember one time we had a husband break down a couple of doors and literally come into the shelter. That did not faze me at all.
The next day, I phoned him, and he said, ``I have been expecting you to call. I have seen you on television.'' I said, ``Well, you must come over here and talk to me, because we have a few things to talk about, including the repair of this door.''
It was fascinating because the wife was concerned that I would bring down the heavy hand of a prosecution. It was a very touchy situation. He came and when he sat down to talk to me, he cried like a baby while he talked about his frustration. When that was all finished and he was ready to go, I reminded him about the door. He told me not to worry, that he would repair the door himself. He went out, bought a new door, bought paint and repaired it.
It is just a question of how we approach these problems. Often in these intimate affairs, people have very little insight into why they feel what they feel, and why they react the way they do.
I am encouraged by your approach. Thank you.
[Translation]
Senator Chaput: I am sorry, I was absent during your presentation. Perhaps you already answered my question.
Ms. Gravel, yours is a profit-making organization. Do you have access to aid or subsidies from any level of government, be it federal, provincial or municipal?
Ms. Gravel: Not at all. However, precisely because of the magnitude of our activities right now, I think I won't have any choice but to seek such help. Obviously, this is a niche that we want to continue to develop. These are services that we want to continue to develop.
There is no doubt that eventually, given that we have increasing demand from our candidates as well as from our clients, we will have to find ways and means, especially for the nanny service, because for other things, private enterprises are able to pay. If nothing else is done for young families who need assistance, it would be important to find some incentive, to do something that could help us continue to offer this service in the future, as well as all the others, notably the volunteer doctors. That is obvious.
Senator Chaput: Do you have a target clientele?
Ms. Gravel: The candidate clientele or the —
Senator Chaput: Of your services.
Ms. Gravel: The answer is no, in the sense that we were the only ones to position ourselves in the niche where we help pre-retirees and retirees find a job if they want one. The rest of our clients are from all kinds of sectors, both institutional and private enterprises.
I would like to add that the different levels of government could do something regarding the tax aspect. Several of our retirees have gone back to work and are penalized because their pension income is reduced. I think that in the future, we will have no choice but to address that more seriously.
Senator Chaput: You say we must address that issue; is there a recommendation that comes to mind as an example?
Ms. Gravel: I have nothing specific. What we do know particularly is that our retirees earn rather low wages all their lives and when they decide to go back to work because they need the money, in some cases there are penalized when they declare additional income, and yet often it is very minimal.
I cannot give you any exact percentages, but I think we have to help them so that they feel encouraged not only by companies who open their doors to them, but also by the government which, from a taxation standpoint, could find a way to ease their tax burden.
I think that we are coming to that indirectly. If we want to encourage people to go back to work, and I think we will have no choice but to do so, there will have to be these incentives because there are many who feel like going back to work, but who do not do so because they say it will cost them too much. That is all.
Senator Chaput: In your experience, what has been the biggest challenge in establishing and operating an enterprise like yours?
Ms. Gravel: Good question. You know, whenever something is new, I would say that there is always some part of — There is no resistance to change in this case because I would say that up to a point, people said that it was almost virtuous for a private company to conduct itself this way. But I am not that naïve. I know full well that this is a niche with a future, economically speaking as well.
So for a business woman like me, as I said, this is a niche that represents about 10 per cent of my sales, but that does increase month after month because on the one hand, the labour force shortage is growing, but on the other hand, and fortunately, companies feel increasingly that this is a high-quality work force and that we must either conserve it or hire it.
Senator Chaput: If you were to leave tomorrow morning, is there someone else who could do the same type of work? Would there be a succession?
Ms. Gravel: I spend my life trying to find a succession!
We discuss this a lot. I have the good fortune of having quite a broad window on what we do. I look at all these recruitment agencies and I see that more and more of them are saying ``Well, this might not be such a bad idea.'' They will be far more open to this.
There is one thing I must tell you. In the private sector, what people look for first and foremost is to make money quickly. When discussing my competitors in the recruitment sector, what our older candidates say to us is that they bring their CVs to a recruitment agency and are told ``It's too bad, but there is no room for you.'' With me, it's the reverse.
What we did was build this bank with exceptional expertise, as well as raise public awareness, and we told companies ``look how much qualified personnel we have.''
I would cite as an example secretaries who are over 50 years of age. We do a lot of outsourcing with those people. Outsourcing means that these remain my employees, I pay them, but I would say that I rent them to various clients. Secretaries over 50 have exceptionally good French. These are people who took the trouble to acquire computer skills and who because of their experience integrate easily into a new work place. So that is the greatest resource for our companies right now, and those people are in such great demand, you can't even imagine.
We are talking about secretaries, but we have to capitalize on all occupations and sectors of activity. I'm convinced that within two years, the skills that companies will want to get are those of people aged 50 and over.
Senator Chaput: In your case, you're completely independent right now because you have not fallen into the trap of getting government subsidies, if I can state it that way. You are completely independent.
Ms. Gravel: Absolutely.
Senator Chaput: But if at some point you were forced to go a bit further to continue to offer these services, for example by getting access to tax credits, would that be good for your company?
Ms. Gravel: Yes, definitely.
When you try something new, you're feeling your way around and you never know how people will respond to something new. In this case, we know full well that this is a growing phenomenon, and as the gentleman was saying earlier, I think that it would be a very good thing if this were to be done throughout the country, for all kinds of reasons, both economic and social. There is no doubt that at one point a private company that has given itself a social mission — and not all private companies have done so — realizes that if the service they provide makes sense, at some point they will need assistance to make sure it is ongoing.
Senator Chaput: I have a brief question for Ms. Morin.
You say that your association is engaged in informing and training senior citizens. In your experience, Madam, what is the most effective way to inform senior citizens? We know that as people grow older, the information that is most readily available to them is not necessarily the same information that is available to young people.
What is the most effective way to keep in touch with your clientele, in terms of informing them and preparing them for the future?
Ms. Morin: As I just mentioned, regarding information, it has to do with meeting people in person. People's presence is what really counts, and not only a one-time presence. We really must go at it again and again in order to make ourselves known to them. When we meet with groups, when people exchange ideas, when dialogue is encouraged, the things that people confide to the group are quire extraordinary. This is of the utmost importance. We did not stop at the residence level. Let us take pharmacies for one — many senior citizens are to be found in pharmacies at any given time.
We carried out a project for contacting our clientele of senior citizens. We spent two or three weekends distributing information and flyers to senior citizens.
This involves being present on the ground. The more senior citizens hear about us, the more efficient we get. We can also see this in the number of returned calls and other subsequent interventions.
Senator Chaput: How many people do you contact on a yearly basis?
Ms. Morin: On a yearly basis, strangely enough, it is like the tip of an iceberg. We realize that the more we talk about it, the more telephone calls we receive and the more people we reach. I could say that within a given year, we reached out to at least 4,000 or 5,000 persons in our region, through trade fairs and regional county municipalities. And that is simply our area.
[English]
The Chair: I want to thank Ms. Gravel and Ms. Morin for their presentation. You are both obviously providing an extremely important service to this community. We hope that by your example others will do the same in other communities across the country.
The committee adjourned.