Proceedings of the Special Senate Committee on Aging
Issue 11 - Evidence, June 2, 2008 - Morning meeting
STE. ANNE, MANITOBA, Monday, June 2, 2008
The Special Senate Committee on Aging met this day at 9:02 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, I would like to welcome you to this meeting of the Senate Special Committee on Aging.
Our committee is examining and reporting upon the implications of an aging society in Canada. The complex issues surrounding aging have concerned governments for many years. These issues have become all the more urgent as the number of elderly persons has increased, due to longer life expectancy and the aging of the post-war generation. As the programs and services targeting the elderly are essential to their well-being, it is incumbent upon us as parliamentarians to ensure their needs are fully met.
We have come to Ste. Anne to hear from various stakeholders about the implications of an aging society and, more specifically, to hear what they think about our second interim report tabled in the Senate on March 11. The report focuses on active aging, older workers, retirement and income security, healthy aging, aging in the place of one's choice, and the regional distribution of health care expenses associated with aging.
Ste. Anne is the fifth stopover in our Canada-wide tour and we are very much looking forward to hearing from today's witnesses who will, undoubtedly, help us develop a full range of recommendations for our final report.
For this morning's first round table, it is our pleasure to welcome Mr. Jean Balcaen from the Villa Youville; Mr. Aurèle Boisvert from Santé Sud-Est inc., Mr. Charles Gagné from the Centre Taché and Foyer Valade; and Ms. Annie Bédard from the Conseil communauté en santé du Manitoba. Thank you to all of you for having taken the time to meet with us today.
We will start with opening remarks and then move on to committee members' questions.
Jean Balcaen, President, Villa Youville: Madam Chair, as an individual, and on behalf of the organization I represent, I would like to welcome you to the Villa Youville. We are glad that you have chosen Ste. Anne as a meeting place and as a location in which to consult with the Manitoban community. It is quite appropriate, given the topic of today's presentations, that you chose to hold this hearing in a seniors' services centre. We hope you have a pleasant day with us.
To begin with, we would like to make a general comment about your committee's second interim report dated March 2008. This important collection of issues and options with respect to the aging population paints an accurate picture of the overall experience of seniors throughout the country. The picture painted by the report is very much in line with what our Manitoban seniors are experiencing. Clearly, the experiences are the same regardless of the province of residence. And that is why we would like to add our voice to your interim report and, in doing so, ratify its content, confirm the importance of the issues outlined therein, and support the proposed amendments that have been brought forward. We hope that the very existence of this text is but a prelude to an ongoing effort to ensure that there is cooperation between all stakeholders concerned by the issues facing Canada's seniors, so that together we ensure that these issues are addressed.
Chapter 5 of your interim report deals with aging in the place of one's choosing. And it is in this spirit that we would like to draw your attention this morning to the need to make Canada's linguistic duality a top priority when it comes to maintaining quality of life among our francophone seniors. In most instances, language is inseparable from the expression of the culture that it underpins. The two together form a whole.
Villa Youville, which came into existence 43 years ago, and of which I am president, has from its very inception looked after the interests of elderly francophones from the southeastern region, in particular, other regions of the province, and of about 20 per cent of francophone seniors from the Winnipeg urban area. Villa Youville was officially designated a francophone organization 15 years ago and has, since then, stood out by offering a whole array of services in both official languages. The fact that the Manitoban government has acknowledged our linguistic competency is but further confirmation of why Villa Youville opened its doors in the first place. Our predecessors recognized how important it is for the villa's clientele to be served in their own language and to live in a familiar environment. It is a recognized and accepted fact that being able to live in the language of one's choosing is an important part of one's quest for quality of life.
Oftentimes, when it comes time to move to a long-term health care institution, there can be a lot of sadness. Often the change of address is associated with isolation, and being plunged into an unknown world where one does not know anybody. For francophones, that often amounts to a complete uprooting, a new village, a new town, a different culture, an unfamiliar language, different religious practices, and so on. The language and cultural baggage associated with the new place of residence are the main contributing factors to a feeling of detachment and a loss of connection with one's original community.
The cultural and linguistic awareness that characterizes residences for francophones helps to offset the tension and stress associated with moving. At the Villa Youville, for example, when a senior arrives, although it is still a stressful experience, it is an opportunity to be part of a new community, and also to reconnect with former acquaintances and friends. When a new client is admitted, frequently he or she reconnects and there are hugs and kisses which are evidence of prior connections. Often people recognize each other as being former neighbours, business associates, second or third cousins or personalities who played a particular role in the Manitoban francophone community. These linguistic and cultural ties are virtually a guarantee that the client will be able to adapt to his or her new environment and integrate into the new community. In many cases, those seniors who previously lived in isolation in their homes reconnect with their community, as it were. They are reunited with people that they knew previously. They have a new social network, and quite quickly, their admission into a long-term care facility plays a role in helping them feel like they are an inherent part of a social network which they thought they had lost forever.
Another important aspect of the phenomenon that I just described is that seniors reconnect with their francophone community through the visitors that come to the facility. These visitors often come from the same areas and fill seniors in on what is going on outside their Villa Youville community. These visitors are in a sense a lifeline to the broader francophone community. Residents find out about common acquaintances, get up to date on who is doing what, and form an opinion on the municipal councils' projects. Overall, it is just as if the seniors were still in their village participating fully in its development and vitality. All that is different essentially is that the seniors are living at a new address.
The new friendships which are built between visitors and residents become just as important as those enjoyed in their prior lives. One only has to think of the friend of a prior acquaintance who invites her sister to visit one of our residents on a weekly basis, who has become a new friend as a result of the visits she pays to her mother in the villa.
In conclusion, language and culture clearly play a key role in an individual's general well-being. It is therefore very important to continue maintaining a level of health care that is respectful of the beneficiary's linguistic and cultural reality. Awareness of the importance of ongoing attention to cultural differences is closely linked to the quality of patient care.
In closing, we would like to thank you for having invited us to participate in this day devoted to sharing ideas and for having listened to our comments on aging. We applaud your undertaking of such an initiative and we congratulate you for your dedication to issues affecting our seniors.
Aurèle Boisvert, President, South Eastman Health: Madam Chair, good morning and welcome to Southeastern Manitoba. I am pleased to cover the salient points regarding aging in our region in my capacity as chairman of the board of South Eastman Health/Santé Sud-Est.
[English]
I would like to address three topics, namely, linguistic services, poverty and palliative care pertaining to our elderly.
[Translation]
According to the Public Health Agency of Canada, culture is one of 12 main health determinants. And when we talk about culture, we include language. The quality of health services a patient or a client receives depends a great deal on his ability to communicate in his own language. Communication is and will always be a key factor in an individual's health and community. And this is increasingly important in an aging population, as people tend to return to their mother tongue when they age.
According to research, poor communication between a client and a care provider may, among other things, increase the probability of a patient misunderstanding medical advice or the prescribed treatment and lead to a considerable decrease in the quality of service.
As a regional health office that is designated bilingual, we must provide our clients with services in both official languages, in English and in French. However, the reality is that we often face several challenges in offering the full spectrum of services in both English and French, due, among other things, to budgetary constraints.
At South Eastman Health, we need funds earmarked strictly for bilingualism in order to fulfil our linguistic mandate. It is no longer logical for us to be in competition with ourselves to allocate budgets to offering services in French to the detriment of quality or the quantity of health services that we offer.
In Southeastern Manitoba, if we are already facing difficulty offering services in mandatory languages, how much more difficult will it be to provide services in German, Ukrainian or Spanish, which is the first language for our growing unilingual immigrant population? For this aging unilingual population, it is also important to be able to communicate in their mother tongue in order to ensure follow-up in accordance with health care providers' directives.
[English]
The second issue I would like to bring to your attention relates to aging in poverty. In our region, few subsidized housing initiatives exist whereby a ceiling rent would make housing affordable for an aging population living on a pension.
However, where the ceiling for the rent does exist, adding the supportive housing cost to it often prevents our low- income pensioner client accessibility to such a service. With the low vacancy rate, it is even more difficult for our aging population to access affordable housing.
Furthermore, with the increasing costs of building material, contractors are finding it difficult to establish new affordable housing complexes accessible to our low-income pensioners. Because they need to recover the costs of the construction, it boils down to increased rent or sale prices.
It is the elderly who are in a bind as they cannot afford these increased costs for housing and supports. Our seniors already have to keep up with the cost of living on a very minimal pension. How can they keep pace with increased housing and living costs on so little income?
Our aging population deserves to age with dignity and have a quality of life that is affordable and within their means. Our parents and grandparents need to have access to affordable housing; they are more than deserving of it. They are more than entitled to have a place they call home — where they can have a balance at the financial, spiritual, emotional and intellectual level.
My final topic today speaks to palliative care services for the elderly. Though much has been accomplished federally, provincially and in our region, much more needs to be done. Based on a recent study by the Quality End-of- Life Care Coalition of Canada, QELCCC, less than 37 per cent of Canadians who are dying are receiving the type of care they require.
Many individuals who are nearing the end of their lives would prefer to die at home, surrounded by family and friends and supported by palliative care staff. Most individuals die in hospitals and personal care homes. Our challenge is to ensure that our staff are trained and supported to deliver quality end-of-life care.
Furthermore, that national study indicates that there can be wait times for these essential services. This is a serious issue, given that palliative care patients are in their final moments of life and should not have to wait for care.
Finally, we are seeing a significant percentage of dying Canadians never accessing palliative care services. In our region, it is reported that this can be due to fear, stigma and administrative barriers, such as physicians not completing referral forms. With a rapidly aging population and a rise in the number of individuals being diagnosed with advanced illnesses such as cancer, it is vital that all Canadians have access to the program, support and treatment that will provide them with comfort and dignity at end of life.
We need to develop the supports to ensure individuals who are dying have access to adequate end-of-life care whether they are dying at home, in hospital or in a personal care home. Our region includes rural areas, and geography and sparsely populated areas are an added challenge. Residents must travel for support. It was recently reported to us that some residents decline services, including palliative care radiation, as they cannot afford the gas for their car.
Our regional health authority is committed to achieving wellness and the best possible health partnering with individuals, families and communities. It is in partnership with government also that we can provide Canadians and our residents with the quality health services and quality of life that they need and deserve.
[Translation]
In conclusion, I want to thank you for having taken the time to hear me out this morning.
Charles Gagné, Director General, Centre Taché and Foyer Valade: Madam Chair, I am the Director General of the Centre Taché and Foyer Valade. I apologize, but I did not have an opportunity to prepare a written brief, so I will simply add on to what my two predecessors presented. Moreover, I must not only express my support for the presentations by Mr. Balcaen and Mr. Boisvert, but also say that it is certainly a reality that we are facing in Winnipeg in the type of services that we offer, by that I mean the importance of services for seniors and adapting to the requirements of the aging population in my two facilities. I am going to speak as Director General and share with you our reality, which sometimes keeps us awake at night, as our mandate is to deliver services to people who are very vulnerable.
Foyer Valade and the Centre Taché are two homes with a total of 464 beds. One of the homes is mandated by the province to serve the francophone community; the other home, Centre Taché, with 314 beds, serves the population of Winnipeg by offering bilingual services. So we are mainly serving francophones in Winnipeg.
In both of these facilities, we offer several services, including palliative care, long-term care, chronic care, and we have specialized units for people suffering from dementia or Alzheimer's. In one of our facilities, we also offer services to a population referred to as ``young adults'' which is essentially a population facing a shortage of long-term care service providers and a lack of other residences within the community that can meet their needs. They are not in our facility because they are seniors; they are there, essentially, because they need care and services.
There are two things and two interrelated aspects, the first being the quality of service, which can inevitably keep a director general awake at night on occasion. And if there is one thing that I would urge you to emphasize in your report — and I have only quickly read through it once — it is this: regardless of where the services are provided, the aging person, today or in the future, will demand an unprecedented quality of services, a quality of services that we have not yet seen. Bear in mind that this is, in fact, the first generation of aging people whom we are institutionalizing in what we call ``long-term care facilities.'' We do not yet know how we will have to adjust to the aging baby boomers. We know full well that what they will be looking for in long-term care and services will be very different from what our parents sought. We must ask ourselves if they will want the same level of services, as the baby boom generation influenced many policies and will continue to influence many policies. I hope that this report was not created simply to meet the needs of baby boomers, because we must bear in mind that it will be another 15 years before baby boomers are recognized as seniors. It is very likely that when the baby boomers hit 75, the definition of seniors will be different.
One aspect that concerns us at present, in addition to the quality of service level, is the shortage of manpower. Manpower has changed significantly in the field of health; we must devote a great deal of time to training, recruitment and retention of these workers. I do not think I am generalizing, but workers who are now in long-term care facilities, especially providing bedside services — and I am referring primarily to the non-professional manpower — are for the most part made up of immigrants who have recently arrived in Canada. In Winnipeg, we sometimes compare workers in homes to those of the textile industry 40 or 50 years ago. In Foyer Valade, as in Centre Taché, we are currently losing what I would call the homogeneous workforce which, 10 to 20 years ago, was mainly francophone, Franco- Manitoban, and well established in the community, and we are now seeing a diversified, multi-ethnic workforce which is not only bilingual, but which increasingly is not working for us simply because we are a bilingual centre, but because they are seeking a stimulating work environment.
So that is the challenge facing all care facilities and even all health service agencies. It will be a growing concern, if national labour force strategies are going to truly attempt to meet the needs of people who, in long-term care facilities, do not have the same media or political appeal as, for example, people requiring surgery for a knee or hip replacement or to correct a heart problem. Remember, an 85-year-old woman who breaks her hip in a home does not have the same appeal, in the health system or for the medical field, as a person who is 55 or 60 years old. But this perception will have to be completely overhauled, as there will be more and more of them. The quality of service and the workforce are two key aspects.
The third comment that I want to make — and in my view, this is not negotiable — is that older people who require services must live in a community that respects them. We must respect the fact that language and culture are of the utmost importance in the aging process. Take my mother, for example, who was never perfectly bilingual, but who could get by in English; now, she is living in one of my homes and no longer speaks English. So simply being served by a person who cannot communicate in her language adds to her anxiety at an absolutely astounding level — and I have witnessed it — and I had not imagined the repercussions on the quality and services offered and the sense of insecurity that provides an older person.
In addition to culture, an important factor for this community is spirituality. The baby boomer generation will realize that they are not immortal, that all aspects of spirituality, of confessionality, will take on a different dimension; I have no doubt that that will take on importance in the delivery of palliative care and in the organization of services around certain communities, as clients will be looking for certain services related to spirituality and to confessionality, and we will have to invent or develop them in order to adapt to the community as such.
I congratulate you for the report which provides an excellent analysis of the current and future situations. And if I have one last comment to make, it is that if we are not successful in meeting and adapting to the increasingly demanding needs of our aging clientele, we will see that the private sector will accentuate the gap between people who can afford this care and those who cannot. So I think that it is a long-term threat if we do not succeed, as a system, in offering quality service at all levels and to all potential aging clienteles who will be faced with these needs.
Annie Bédard, Executive Director, Conseil communauté en santé du Manitoba: Madam Chair, since my colleagues have clearly illustrated the situation, I will perhaps go back to some aspects concerning official languages.
Madam Chair, first of all, I would like to thank you for having invited the Conseil communauté en santé du Manitoba to present its comments on the report of your committee on aging in Canada. I would like to congratulate you for the quality of the work that you have done on such an important topic. The task that you have undertaken is huge, given the complexity of the situation and the wide range of options available to us.
You will also allow me to point out — I am certain, Madam Chair, that you will share my opinion — that you would find it difficult to find, anywhere else in the country, a better place than Ste. Anne for delving into the issue of aging and services that are tailored to suit this stage in our life, particularly when dealing with francophone community members in a minority situation. The community of Ste. Anne has always been a pioneer in this field. The Villa Youville, where you chose to hold your hearings, is an eloquent example of this; as you can see, the decor is magnificent and there are a variety of adapted housing options with health services close by. And we know that here, in the Villa Youville, the ability to communicate in the client's mother tongue is an important factor. Essentially, we are a community that has made health services for seniors an integral and vital part of its economy.
I am the director general of the Conseil communauté en santé du Manitoba, the CCS; Mr. Charles Gagné is the president but today he had to put on another hat and so I am filling in as the organization's spokesperson. The Conseil communauté en santé du Manitoba is one of 17 French-speaking health networks located in the provinces and territories where francophones are in a minority situation.
But before I go into greater detail about the organization I represent, I would like to, if I may, go back to a comment that you have already heard regarding your report, namely that it would be opportune for it to acknowledge more explicitly the requirements of official language communities in a minority situation. We have referred to this issue here, but I would nevertheless like to emphasize some points in order to explain why. Of course, some witnesses have said that the report is not sufficiently explicit in detailing the federal government's obligations with respect to official language communities and have suggested that your report should urge the federal government to assume its specific responsibilities to official language minority communities, as you have been invited to do for the First Nations, the Inuit, the veterans and inmates of federal penitentiaries. So today, as I said, I would like to provide you with further explanations as to the why underlining this recommendation, and finally, I would like to make a few suggestions as to how this could be accomplished in concrete terms.
As you know, today our linguistic duality is at the very heart of the Canadian identity. This fundamental characteristic of Canada was enshrined in the first Official Languages Act adopted in 1969 and, later on, in the Charter of Rights and Freedoms of 1982, as well as in the amended Official Languages Act of 1988 and in various Supreme Court rulings interpreting the language rights provided for in the Charter. According to the amended 1988 Act, section 41 states that — and here I am making an aside —:
The Government of Canada is committed to enhancing the vitality of the English and French linguistic minority communities in Canada and supporting and assisting their development; and fostering the full recognition and use of both English and French in Canadian society.
As you also know, an amendment was made to the Official Languages Act adopted in 2005 making this obligation ``judicable.'' This means that cases of non-compliance with this obligation to contribute to the development of official languages minority communities can be the subject of a court challenge. I am not a legal expert, but I have been told that this obligation on the part of the federal government to promote linguistic duality and to support the development of minority official languages communities is quasi-constitutional. On the basis of these legal aspects, the federal government has a specific obligation to ensure that any policies and programs developed with respect to aging bear in mind the realities of francophone communities in minority situations and ensure that these communities have real access to any programs that will be implemented. This fact deserves to be pointed out in your report, as others have mentioned earlier, and this is why we need your support and that of the committee to ensure that this quasi- constitutional obligation is not forgotten.
I can already hear you thinking and saying to yourself that aging often comes under provincial jurisdiction as it pertains to sectors such as health and social services, where the Government of Canada plays a relatively limited direct role. These are sectors where the provinces or territories have the primary responsibility and it is at this point that I would like to now talk to you about the organization I represent: the Conseil communauté en santé du Manitoba. As I said earlier, the CCS is one of 17 networks that belong to the Société santé en français; it was incorporated in 2004 and set up thanks to an initial investment made by Health Canada through Société santé en français. We very quickly received official recognition from the Government of Manitoba as the voice of the francophone community in the health and social services sectors. And today we can say that we are this bridge between the provincial and federal partners and the needs of the francophone community in Manitoba. We have launched and supported many initiatives designed to meet the needs of our seniors, using the lever of federal money which has facilitated the province's long- term commitment in projects that would probably not have been possible without a hand up from the federal government.
To illustrate what I am saying, I will give you an example — with a modest investment of $60,000 from the federal government, the developers of a community health centre in the rural community of Notre-Dame de Lourdes managed to develop a centre and set up a multidisciplinary team which in turn enabled them to mobilize the community around this project and raise nearly two million dollars, with an additional one million dollars coming from the provincial health department. Today, the population of this rural municipality — and we know that rural communities often find it more difficult to provide services to their aging population — has access to health promotion and disease-prevention programs as well as health care in its language.
I know that I do not need to convince you about the negative impact of language barriers in health service delivery, but if I may, I would like to quote very quickly from a presentation entitled The Impact of Language Barriers on Health Care, which was given by Dr. Alexander Green, an associate professor at Harvard Medical School, during the third meeting of Santé en français held in Ottawa in February 2007. One of the research papers he quoted from showed that in the American hispanophone population, nearly half of the respondents from a household where Spanish was the language used at home felt that they had difficulty communicating with their doctors. According to another study undertaken by the Wirthlin Worldwide Survey, nearly 20 per cent of the respondents said that they had refrained from seeking medical attention because their doctor did not speak their language, namely Spanish. Such research is important because it sheds light on language barriers and their impact on health services. Namely, people are less likely to seek medical attention, they are less likely to understand the care given, there is an increased risk of medical error, the quality of care provided is reduced, there is a greater likelihood of ethical issues and lower client satisfaction.
These are the primary consequences of linguistic barriers and it is for these reasons that we must ensure that official language communities have access to health care in their language, as we illustrated earlier with my colleagues. This fact is especially relevant for those population categories with precarious health and a command of English that is at times inadequate.
The CCS has just finished its first study on disabled francophones living in Manitoba, which of course includes elderly people with motor disabilities. One of the main conclusions of this study, apart from the fact that any disabled person needs services, is how crucially important access to services in French is for people to feel like full-fledged citizens. In addition to having a motor disability, if a person is also unable to receive treatment in French, this obviously has a huge impact on the quality of life and the health of that person. This leads to additional costs for the government and families.
To conclude this part, we would ask you to include in your report the notion that the Government of Canada is responsible for contributing to the development of minority official language communities. Although health care falls under provincial jurisdiction, it is important for the Government of Canada to take a leadership role in the area of official languages. We believe that the Santé en français networks, which operate in every province and territory, represent a model of cooperation between partners respectful of each other's jurisdictions. In fact, this was recognized in the recent report produced by Mr. Bernard Lord, who also pointed to the success of organizations which network and partner together, such as the Société santé en français. These organizations are a good model to follow.
Our organization has become a forum for discussion amongst all our partners who are interested in improving access to health care services and social services in French within Manitoba's francophone communities. This forum, which was created by the CCS, has helped to implement concrete initiatives, whose outcomes are measurable and which benefit our fellow francophone citizens, without sinking in the quagmire of jurisdictional battles. So instead of deploring the fact that your report does not address the issue of official languages, my intent today was to tell you why I think it is important that official languages be included in your final report, and to suggest how it can be integrated into areas of provincial jurisdiction.
The Conseil communauté en santé du Manitoba would like to thank the Special Senate Committee on Aging for having invited us to make a presentation today. We believe that the work you are doing is extremely important. I hope that our observations will be useful to you, and we hope and believe that the changes we have proposed will be taken into account.
The Chair: Thank you very much, Ms. Bédard.
[English]
Let me begin by explaining that this committee has, in fact, ended up going to more unusual destinations than where senate committees normally go. You will find that frequently senate committees hit the big spots such as Montreal and Toronto, and we chose not to go to either.
When I started to look at Manitoba as a site, Ste. Anne immediately came to mind. It certainly was supported by Senator Chaput. However, I think I actually put it on the list before she even decided. It was for the very reason that we heard today. I thought it was very important to hear from a francophone community, outside the province of Quebec, in that community, and that is why we are here in Ste. Anne.
I would like to ask you, Mr. Gagné, about a program at Centre Taché, which I always thought was a very special program and which you did not speak about today. A lot of our emphasis has been not just on those needing care but on the caregiver. I would like you to mention briefly the day hospital and the burden, I think, that that lifts from many caregivers who are lucky enough to be able to access for their loved one that particular unit of Taché Centre.
Mr. Gagné: We are only starting to discover how to go about linking institutional care with community care. At one point in the health system, we created a bit of a silo approach to what is in the community and what is in the institutions.
The adult day centre at Centre Taché, which is the largest in the province, serves approximately 300 elderly. It runs eight programs over five days; we run three evening programs geared toward people who live at homes or in their communities or in their residences and want to have one outing a week. They come to Centre Taché where they are provided with a good quality meal, some activity, exercise and social interaction. The program tends to do extremely well in keeping people autonomous.
Every morning when I walk to work, especially at minus 40 in January, I notice these fragile 80- or 85-year-old individuals coming off a vital transit bus with their walkers going to this adult day centre, and I realize how much we give them a reason to wake up in the morning. It is important because one of the aspects of aging is not having anything to get up for in the morning. At some point, the elderly need to have that reason, and the adult day centre provides that.
I am sorry to be emotional about it, but an area we sometimes fail at, I think, with long-term care is that we sometimes remove that reason for the elderly to even get up in the morning because of the institutional environment we are in, even within the homes we house them. We need to get much better around that. That is where the whole dimension of spiritual care comes in. Spiritual care, in the widest sense of the word, is how I apply it.
I want to mention the importance of respite. A part of respite is to provide the caregiver needed rest in order to give them further encouragement on caring for their loved ones. When people have to send their loved ones into a long-term care home, sometimes we wonder if it is harder on the person we are receiving in the home or the person left behind. In most cases, it is probably harder on the one left behind in terms of their ability to continue to live with that individual. This is where I think a place such as the Youville Centre is an extraordinary example. If we could replicate that elsewhere, it would be of extreme value to our system in terms of that continuity of care and that aging-in-place thinking; that would help.
Senator Mercer: You all touched on a theme that we have heard in many places across the country, particularly in places with linguistic minorities such as in Moncton, New Brunswick. We heard about it in Moncton and also in Sherbrooke, Quebec. It is an issue of the availability of medical professionals, doctors and nurses, who work in the French language and the training of those people. I am interested to know about the training of the doctors and nurses in the francophone community in Manitoba.
We have heard, for example the difficulty they have, in New Brunswick because up until recently no training has been available in Atlantic Canada for doctors in French. However, now through the University of Moncton, in cooperation with the University of Sherbrooke, they are in their second year of medical school at the University of Moncton. Therefore, they are addressing the issue.
It is a real problem that we are not educating enough people in the medical field, but it gets even more magnified when we look at the linguistic minorities in certain parts of the country. Perhaps someone can address that issue and tell me, what is happening in Manitoba and what is happening in the Franco-Manitoban community?
Mr. Boisvert: I teach at St. Boniface University College, which is the French sector of the University of Manitoba.
We have established an agreement with the University of Ottawa and the University of Sherbrooke to be able to send some of our students to those universities so that they can study medicine in French. This is, I think, a very good step in the right direction.
However, we should have more vacancies for those students for two reasons. First, when someone studies to become a doctor, they might decide to specialize. Fifty per cent of them do, I believe. Therefore, that means that maybe they will not come back to their community because of that specialty. Second, when we send our students to Ottawa and Sherbrooke, they are generally 21 or 22 years of age. If they find a partner who lives out there, there is no guarantee that they will come back; we have to be very careful. If they do, well, so much the better because maybe they will bring back another doctor or physician, but that is usually not the case. Therefore, we need to have more opportunities to send more of our students to those universities.
The University of Manitoba should have a quota to guarantee that we have bilingual physicians coming out of that school also. I think that should be one of their criteria. Certainly, competency and academic performance are very important criteria, but there are maybe 500, 600, 700 people applying to go into medicine. I was talking with a professor who was on the committee that chooses the students; he said that when they get down to about 200 students and they only take 100, they could take any one of those 200 and they would be good physicians. Therefore, maybe we should look more seriously at having some of our students who are bilingual having access; that should become a criterion. It is very important.
I know here in Saint-Anne, all of our physicians are francophones. We are so blessed with that; it is incredible. However, they could use another three doctors here. They have always insisted on recruiting francophone doctors or bilingual doctors, and their challenge is enormous.
Ms. Bédard: The challenge is also important with nurses too. We now have the opportunity to have the nursing program at the St. Boniface University College, but this program was installed recently. Again, it is about training enough nurses to fill the demand that we have with the different establishments and also regional health authorities, RHAs. Therefore, that is still a challenge.
Also, timing is a huge challenge. For example, when the program finishes and nurses look for jobs, sometimes there is a gap in timing between when those people are looking for jobs and when the establishment and the RHAs can hire them. We talk about creating a fund for those organizations and establishments so that they are able to hire when those students are available in the workforce. If they do not have jobs right away, they will go somewhere else; they will go to another establishment, and then we sometimes lose the nurses that we are training to be bilingual professionals.
Senator Mercer: Has a closer examination has been done of the University of Moncton program where the students are at the University of Sherbrooke but are studying at Moncton? I appreciate the relationship with the University of Ottawa as well. Has there been any study of perhaps trying to adapt the Moncton model to fit the St. Boniface University College?
Mr. Gagne: There may have been some willingness to study the model, but there is a particular challenge in Manitoba, to the extent that we already have a faculty of medicine. This was not the case in New Brunswick, which facilitated some of the inter-relationship between the University of Moncton and the University of Sherbrooke. Therefore, we always have to ensure that we not only partner with the University of Manitoba, but ensure that they are always on side from a community perspective, or even from a training facility perspective. My work also leads me to St. Boniface General Hospital, which is a teaching facility and is also affiliated with the University of Manitoba.
I think we have seen over the last four or five years, with the promotion of the Consortium national de formation en santé, the CNFS — sorry, I cannot translate that — much more openness at the university level to look at trans- provincial cooperation around how we train. Fortunately, universities are not of the silo mentality as much as they may have been in the past, in protecting their territory. The Sherbrooke-Moncton model has often been used as a case in point around how that can work. The relationship St. Boniface University College has with the University of Ottawa has a lot of potential to develop more opportunities for our francophones to learn, teach and study in French, while at the same time continue to not make it that University of Manitoba does not have an obligation to train people who will stay in Manitoba and ensure that within those training programs, that they do recognize a need for bilingual physicians. I would make the same case for the need for Aboriginal physicians. They do have that responsibility, I would argue, as well.
The Chair: This year they had 24,000 applications at McMaster University for their medical school. They had 14,000 at the University of Ottawa. It makes you realize that perhaps we should not only be establishing more francophone centres but also more medical schools.
[Translation]
Senator Chaput: I would like to begin by thanking all four witnesses. As a member of Manitoba's francophone community, and in my capacity as a senator who represents this community's tradition in Ottawa, it is always a pleasure for me to hear what you have to say, it makes me even prouder, and it makes my job even more enjoyable in the Senate. So thank you to the four of you.
I have a general question and it is not directed at any witness in particular. In the course of your presentations, you rightly spoke to the importance of cultural and linguistic awareness, of spirituality, and, increasingly, of the right for a person to choose to die at home. But certain services would have to be available for that to happen. For example, Mr. Gagné, you talked about day centres in urban areas. Is there a day centre here which provides this type of care for seniors, or something to that effect? I remember that at one point we were talking about the well-being of seniors. Is this in fact the reality? There is a centre here for francophones living in this region.
Mr. Balcaen: Yes, there is a day centre for seniors. About 75 to 80 people are using it at the moment. I know this is a very important service, because my neighbour, who is 95, uses it. And I have occasionally driven her there or picked her up from the centre and she has told me about everything that went on during the day in great detail. She has also told me how happy she was to get out of the house a little. She is 95 years old, she is very lucid and very physically active. I think one of the reasons for this is probably the day centre at Villa Youville.
Senator Chaput: Do you have a transportation service similar to the one at the Centre Taché, or do people who come to the centre have to find a ride themselves, from someone they know or from a volunteer?
Mr. Balcaen: There are drivers available who get their mileage paid to drive these individuals to the centre and pick them up afterwards.
Senator Chaput: My second question is about home care. I did not hear any comment about home care and its importance for seniors in helping them stay in their homes as long as possible. Could I have some comments on home care?
Mr. Boisvert: In our region, people who need home care are never turned down. Home care is very important in our region for reasons of compassion and respect, and dignity for people. It is also very important for very practical reasons, because, proportionally speaking, we have the lowest number of acute care beds in the province. We have fewer than two beds per 1,000 people in the region for acute care. Our objective is to keep people in our region at home as long as possible. In other words, that means keeping them out of hospital and out of our long-term care institutions. I think we have a very good home care program. That does not mean that we could not improve it, and in some cases older people will want to die at home. People providing home care services must get more training in palliative care. One of our challenges is to provide our team with this type of training.
Ms. Bédard: With respect to home care, which is your recommendation 60, I think, I would like to suggest a national program. I think this is extremely important. However, I would add that the training of bilingual people is also important as well as the whole issue of trust. When people come to our homes to provide home care, trust is obviously a very important feature. That is why it is so important to have services in French, services that meet the needs of these people for ethical reasons, but also to reduce the likelihood of misunderstanding when people are given instructions regarding their care.
Mr. Gagné: I support the points that have been mentioned. Your chapter on housing in your report is very good. However, at some point there will have to be some balance struck. Clearly, people can be kept in their homes if the government is prepared to cover the cost of home care. All the residents in our facility could stay at home with the right resources. It is just that from an economic point of view, this may not be the right solution in all cases.
Manitoba wants to establish something between home care and long-term care facilities. They would be called residences for semi-independent individuals or supportive housing. However, we think there will be a lot of problems with this idea. Even though we do see it as having a great deal of potential, people are aware of home care and they want it as a right. Those who are less aware of home care services may go into long-term care facilities prematurely. There could be middle ground, while people are still in the community, which would be known as supportive housing.
In our opinion, one of the problems is that there is not necessarily any coordination. One of the key points in your report is that it is difficult for the system to incorporate all these services and there is some fear on the part of this system about making older people aware of all the service options available to them. I am often surprised to find out from the people I deal with that they are not familiar with the services available to the aging population. Our health care providers are reluctant to provide this information because they are afraid that the demand for certain services will exceed the supply.
The baby boomer generation will cause us to provide more transparency in health care services than we have ever seen. They will be informed, they will be aware and they will make certain demands. The government will have to find the right economic balance so as to provide the best services to the community. I am not sure that doing more in all areas will allow us to meet needs better. The objective is to better coordinate the services we have, so that people can make choices and can be aware of the choices available to them at various stages of their life.
Senator Chaput: And where should this coordination come from, in your opinion, Mr. Gagné? Ultimately, we do need some coordination somewhere for all these services.
Mr. Gagné: First of all, this is of course a matter that comes under provincial jurisdiction and the so-called regional authorities are very much involved. The coordination could be done at that level. Nevertheless, the federal government has a huge role to play not only as regards equalization and tax incentives, but also in setting minimum national standards for services. For example, in Manitoba, there are standards for long-term care and for home care that are very different from those in place in New Brunswick. Do we want to see something in the system at the national level? There are tremendous disparities regarding various services. Or, do we want some standardization so as to influence provinces in their planning with the federal government as to how to coordinate all of this? In my opinion, this is no different from the major debate we had on health care regarding performance indicators and the establishment of health information institutions. I believe this is part of the same negotiations that will have to happen at some point regarding the service standards that elderly people deserve.
[English]
Mr. Boisvert: With respect to home care, the perception of the client receiving home care, and it is probably correct, is that it is a free service. When people are admitted to a personal care home, PCH, it is relatively a free service. They do have to pay a percentage of their revenue to stay there. Therefore, we have one extreme with home care and another with the PCH or the hospital, the free service. However, in between home care and the personal care home and the hospital, we have a situation where there is supportive housing and assisted living, which is not free, it is actually very expensive for the elderly.
This creates a problem. There is a monetary incentive to go directly from home care to a PCH, rather than to go into supportive housing or assisted living, where supportive housing and assisted living is much better quality care for some. That has to be addressed because we cannot expect someone who is paying affordable housing rental of, for example, $400 a month, to go into supportive housing or assisted living knowing that if they go into the nursing home, they probably will not pay any more than their rent. However, if they go into supportive housing, they have to pay $1,000, $1,500, $2,000 a month. They can not afford it. It is a big challenge.
The Chair: Those of you sitting at the table know that at one point, my emphasis was on provincial politics, and I remember when home care first began. I remember that home care was only for the elderly, not for post-surgical care and not to speed people out of the acute care hospital situation. It was, in fact, just for those that were nearing the end of their lives. Now, we have this whole switch that has happened. If one looks at the real dollars, there are fewer dollars left in home care for the elderly than there was in its original inception. The acute care hospitals have found this a very attractive proposition. They can cut down a surgical stay from five days to two days because that person can now get home care. That means the budget line has been pushed off to another department, if you will, and those acute care beds can open up, which are good things.
We, as a committee, have been looking at opening up the Canada Health Act and making the Canada Health Act, thereby requiring federal dollars, not just for hospitals and for physician coverage, but also for home care.
I would like to hear your reaction to that possibility?
Mr. Boisvert: I would totally support that move. Home care is probably what will totally sustain our health care in Canada. I cannot see how we can continue with the costs in health care. To me one of the answers is home care, because that is quite a good deal, as you mentioned. I think it makes our system much more efficient. It addresses what patients want, they want to go back home. I would really support that.
Mr. Gagné: I would support that. However, we have to ensure that those who are caring for their own and not needing home care are also rewarded through some type of tax incentive so that we have some fairness in the system.
I also think that as we subsidize services, there will come a time when we have to entertain limited choices in terms of what options individuals do have. That is how we will get some level of coordination and some more fairness in the system. I know of situations where some people get many more resources in home care than others, and it is just a question of who is more insistent on phoning the minister or not phoning the minister.
The Chair: The other issue that is a concern to the committee is that, as we have traversed the country, it is very clear that there is tremendous inequality in what is delivered from one province to another and, therefore, inequality for Canadians.
I just got a BlackBerry message this morning to say that my Winnipeg assistant is in fact leaving for Calgary where his mother is in a personal care home. He would much rather have his mother in Winnipeg in a personal care home, but there are all kinds of obstacles in the way of that happening. He happens to be an only child, with no other relatives. However, we do not have portability for that whole issue of home care, long-term care, whatever, and that is one of the reasons I think your committee is looking favourably at opening up the basket of services that this so-called Canada Health Act presently covers.
Senator Cordy: I would like to go back to the issue of labour shortages, because certainly when you look at the health care system overall — and I am including seniors in the health care system — there is a shortage. When you look at health care workers and workers dealing with seniors in our other official language, it is compounded.
I used to be on the Standing Senate Committee on National Security and Defence, and we heard from francophone families who would be transferred; one of the spouses would be transferred to a small community in Canada. They had a very difficult time to find a family doctor in the language of their choice. I like the way that you tied language and culture together. I have not, but it just makes common sense because it is more than just the language; it is also the cultural aspect of it.
We have talked a lot about doctors, particularly, and the need for more doctors. It is not only doctors who care for seniors but also paraprofessionals and personal health care workers.
What about these services for francophones? I am talking about Manitoba because we are looking at smaller communities — and that is why we did not go to Montreal. What about these health care workers dealing with seniors? Someone made mention that a lot of the service workers are in fact immigrants who have the language but not necessarily the culture. I wonder if you could expand on that.
Mr. Gagné: We are seeing a change in the demographics of our labour force, especially at the non-professional level, at least from my experience. We are making in-roads in terms of training professionals, even though we had a bit of a late start in Manitoba, with the advent of nursing programs at St. Boniface University College. A young graduate nurse would have a challenge working in a long-term care facility due to the inexperience that that person would bring, as the ratio is just simply not the same.
Even though nursing is a particular challenge, we find the current system has changed significantly with respect to certified health care workers, who, in our case, are now predominantly recent arrivals. The demand for those workers is huge. There is mobility for those workers. The training is not extensive; people can get certified and start working within a six-month period, depending on the school.
In our case, the Franco-Manitoban Society, which is our provincial association, has been lobbying both provincial and federal governments to increase our franco-immigration in Manitoba, and many of these people have chosen the health care field within which to work.
The challenge is that we are not equipped at the local level to do the intercultural integration that is required, and we sometimes lose that labour force due to the hot economy.
For example, my case in point is a recent hire who, three months into the job, figured he could make more money doing stuccoing for a construction company. We lost a health care worker to the construction industry simply because the demand was there, and they were willing to train and teach. That does become a bit of a challenge when the economy is very hot — the way it is now — in terms of employees. However, at the local level, and within each province, we have to become much better at the intercultural aspect. How do we ensure that new arrivals, new Canadians, have a sense of community and a sense of belonging and that their employment or career is within that community and not just a transient point. That will be key to our success.
It is a bit unfair. I think sometimes our elderly are vulnerable by virtue of the fact that there is a bit of a revolving door.
I was maybe a bit cynical in my comments when I said that it was a bit of a textile industry of the 1960s. It sometimes feels that way. We have people working for us who have significant language barriers, both in English and in French. Thankfully, the nurses and the nursing complement coordinate the units in the way that it works for the sake of our residents, but we do get increasingly more complaints from our residents in terms of the staff's ability to understand other languages.
That is new to us. It is not new in the larger centres, such as Montreal and Toronto, but it is definitely new to Winnipeg. It is probably coming into more rural communities because we cannot necessarily replace the existing workforce with people who were born and raised in that community; the numbers are not there.
Senator Cordy: This will be a challenge for us in future with health care in terms of servicing in languages other than our official languages.
It is a shame that child care workers and people working with seniors are paid at such low salaries that people are in and out of the jobs more frequently because they can get paid more money working in other fields.
I am sure that Manitoba is no different than other regions. I am from Nova Scotia, and the waiting times for seniors to get into seniors' housing are very long. Would that be true here as well?
Mr. Boisvert: It certainly is quite true. We have a long waiting list for the personal care homes, I believe. Therefore, people obtain their home care much longer, which certainly is a stress on the home-care process.
We have realized that if we can train our staff at the health care aid level, and even the licensed practical nurse, LPN, level, locally, many of them will stay in the region — and I know I am competing with Mr. Gagne here because he is from the urban area. However, it is quite a challenge to attract people to the rural areas. Therefore, we need to offer the course locally, within our region, for most of them to stay in our region. That will be one way of addressing some of the training.
Senator Cordy: I grew up in Cape Breton, Nova Scotia. I asked the CEO of the health care board how he recruits and retrains. He said, ``Well, when the doctors come for their residency to a rural area, we give them a great social life so that they will meet someone from the area and stick around.'' I think one of you made reference to that earlier also.
I am interested in the bilingual services, and one of you mentioned that you need funds specifically for bilingual services because it comes at a cost. A few of you also mentioned that health care is a provincial responsibility, but bilingualism is a federal policy. Therefore, how do we ensure that we get bilingual services?
Ms. Bédard, I think you made reference to the federal government having to play a leadership role when it comes to official languages. How do we ensure that the federal government, in fact, takes up on that responsibility because it is law in Canada?
Ms. Bédard: As I was mentioning before, there is the model of the Société santé en français with its entire network across Canada, and Health Canada who is there and can support those networking organizations working with the province. I do not know if you had a chance to see the plans of the Société santé en français, but the idea is to work with the province and our partners, such as the Southeast RHA here or with Mr. Gagné as well at Centre Taché or Foyer Valade, to find some strategy provincially to ensure that bilingual services are offered. The federal money is essential in terms of the development of francophone communities all across Canada. It is almost a constitutional aspect. Therefore, with the organizations that are networking with the province and other establishments offering the services, I think this type of networking is facilitating the ability to offer French services.
[Translation]
Senator Chaput: Ms. Bédard, did some of the money that you got for networking come from the Action Plan for Official Languages, which has not been renewed?
Ms. Bédard: No.
[English]
Senator Chaput: We talk about the official languages plan in the Senate.
Ms. Bédard: That is what I was mentioning before. In the report that Bernard Lord gave to the Government of Canada, he underlined this networking, how efficient it was and all the results, but now train has stopped. We do not know when the national action plan will be approved; we heard it will be approved soon. However, health and social services is a huge system, and building those partnerships takes a long time. Therefore, now, with not having a national action plan, it has really stopped the train in a sense, and it will take time to start again and reactivate the train.
It is a part of the national action plan and the federal money that was put in the action plan. It was only phase one, and now we are waiting to go to the next phase to ensure that there is some implantation of services.
The Chair: As we know, the Official Languages Commissioner was very critical last week in terms of his report of the failure to act.
I have a significant hearing deficit, which makes it difficult for me to understand people who have accents of any type. Is this a complicating issue? From my perspective, they may speak English very well, but I do not necessarily understand them because of the accent that they have. I can only assume that the same would be true of those who come from West Africa, for example. They may speak French fluently, but they will speak it with a different accent than perhaps your clients, Mr. Gagné, can deal with.
Mr. Gagne: Yes, it goes both ways; both in terms of the residents or some of our new immigrants not speaking the same dialect or the same type of French. With our residents not necessarily being familiar with that, us giving instructions or work orders or managing the work environment, and with the new immigrants having to understanding the cultural differences in how we do things, it is often a risk for them to carry it out in a safe manner.
I find it unfortunate, especially in long-term care, and I do know we do spend a lot of money training professionals. No private business could survive with the limited amount of dollars that we spend on staff development within our own facilities, whether it be language training, intercultural, or even client service type of approaches. We spend very little money because it is just not available.
When I talk about quality of service, the expectation of the client is in fact that they will be able to communicate clearly and understand what is happening. It is in those areas that the expectations of the client need to be paid attention to; sometimes we pay more attention to the system than what the client is looking for.
Mr. Boisvert: As we all know, our health care dollars are very limited. We can always do so much more. For the regional health authority, it is quite a challenge to place the health care dollar in competition with bilingual services. I think there is a fundamental problem there, and health is certainly a provincial responsibility. When it comes to language, there is a lot of federal responsibility, and I really believe that, within those regions that are bilingual, financing should be coming from the federal government to the regions to implement these extra costs. I applaud what has happened. The decision has been taken that this institution, for instance, is labelled as French, it is fantastic. It really speaks loudly about quality of service. However, we cannot always be told that the cost for that is in our budget. There is just too much competition in the region for all types of services, and it makes for a very unfortunate situation when we do that.
[Translation]
The Chair: Honourable senators, we will now hear from our second round table. It is our pleasure to welcome Thérèse Dorge and Gérald Curé from the Fédération des aînés franco-manitobains, and, appearing as an individual, Dr. Gérald Gobeil. I would like to thank all of you for taking the time to come to meet with us today. We will start with the opening statements, and then move into the question and answer period.
Thérèse Dorge, President, Fédération des aînés franco-manitobains Inc.: Madam Chair, I am the President of the Fédération des aînés franco-manitobains, FAFM. We work with a group of some 1,600 seniors throughout Manitoba. Our organization has been in place for about 30 years. In the last three or four years, there has been an increase in our membership, and I think that one of the reasons for that is because of the programs we can provide. We are a federation and an official mouthpiece representing the interests and demands of francophones aged 55 and over. With our partners, we work to improve the quality of life of our members and help facilitate the introduction of services in French. One of the objectives of the federation is the development of the francophone community in Manitoba.
My colleague Gérard Curé, who is the director of the federation, and myself, only received your report this morning. We found out that we were supposed to be here today on Wednesday of last week. If you have any questions, we would be pleased to answer them, and then we could give the committee an overview and also tell you what we think about some of the recommendations in your report.
Gérard Curé, Executive Director, Fédération des aînés franco-manitobains Inc.: Madam Chair, I have been the executive director of the federation since 2002. I have tried to bring a new vision to the FAFM. A great deal of our work is done in partnership with various committees, including the one from the Centre de santé St. Boniface, which is one of our main partners. We try to keep people active in all ways in their community. I think it is important to keep people in their community as long as possible. The reason is that we have found that when people leave their hometowns or their family setting to go to a different place, they decline very quickly. This shows how important it is to keep them in their homes as long as possible.
The problem at the moment is that there are no services in French for our aging population in small communities. I think we must really look at this in order to provide the best services and to keep people in their homes as long as possible. We want to keep people active, but we also want to be able to provide them with the services they need.
Dr. Gérald Gobeil, as an individual: I have been a doctor here in Ste. Anne since 1965, so on July 1, I will have been in practice for 43 years. I have had an outstanding experience with the doctors with whom I have worked. I would like to give you an overview of the development of medical services in our community since 1948.
Physicians have been available in Ste. Anne since 1948. The first one was Dr. Francis Patrick Doyle, whose efforts resulted in the construction of a hospital. In those days, women had to go to St. Boniface to have their babies, or else they had them at home, and this was not really that satisfactory. Since that time, the hospital has developed in stages and expanded to include delivery rooms and eventually an operating room. Soon we will have two operating rooms, because there are two surgeons who do consultations and surgeries one day a week each. Surgery was introduced in 1969 when Dr. Jos Boucher from Saint-Baptiste came to work with us. At the time, our anaesthetist was Dr. Lemoyne. Dr. Boucher could not continue doing operations in Maurice, because there was no other doctor there to assist him, and there was no anaesthetist either.
Today, the hospital has 20 beds, of which four are always taken by chronically ill patients waiting to be admitted into a residence. Since we opened, we have had 13 doctors on staff, two of whom have died, and one who is now retired; another doctor had to leave and two are female doctors. All of our doctors are bilingual, and this is a condition for any new doctor we hire. This is because our meetings are conducted in French, except when there are English- speakers among us.
Bilingual students work for us 9 months out of 12. We are a group held together by our religious convictions, our honesty, integrity, sincerity, and our desire to teach patients about prevention. We are also committed to helping every age group in society, from young people to seniors, with a particular emphasis on the elderly. We have 9 family physicians, 5 of whom work rotating 24-hour shifts, and one of whom does general anaesthesia. Two of our doctors come from Quebec and the others are from Manitoba. They are graduates from the universities of Sherbrooke, Montreal and Ottawa, and from the Faculty of Medicine of the University of Manitoba. It is important to us to provide a bilingual service in the area we live in, and we are working on developing as many hospital services as we can. The five doctors who are on call can deal with emergency situations involving people who have been in a car crash, who have had a heart attack or who need to give birth by caesarean section. We have a good relationship with several specialists working in Winnipeg and St. Boniface, and, if necessary, we can transfer a patient to a third hospital on short notice. We also provide service to four satellite clinics, namely in Sainte-Agathe, Lorette, Falcon Lake and La Broquerie, and we also provide treatment to patients living at the Villa Youville. We have so many patients that we could easily hire three additional doctors. So we do not have time to twiddle our thumbs at the office. By the way, 8,000 patients a year go through our emergency room.
In 1965, the Villa Youville — a residence for elderly and senile people — admitted its first residents, and it grew along with our clinic and the hospital. Since then, the facilities have been expanded, and the most recent expansion is the part we are in today. That gives you a brief overview of the development of medicine in our region of Ste. Anne and in the southeastern part of Manitoba.
But we do have problems, namely in psychiatry and in home care, either because there is not enough money to hire nurses or there are not enough nurses who specialize in these areas. We only have two psychiatrists who each spend one day per month providing psychiatric services. So if one of our residents needs psychiatric services, that person will often wait a month before seeing a psychiatrist. In extremely urgent situations, we have no choice but to send patients either to the hospital in Selkirk or to the health sciences centre of the Winnipeg General Hospital.
Whoever described retirement as being a golden age was smoking too much marijuana, in my opinion. That guy was dreaming in technicolour.
[English]
The Chair: I was delighted that you started your conversation with a reference to Dr. Pat Doyle. For those of my colleagues who remember Senator Molgat, Senator Molgat and Pat Doyle were, of course, the very best of friends. I met Dr. Doyle on many occasions in the company of Senator Molgat. It was good to hear the name referenced because when I was in politics in Manitoba, Pat Doyle's name was synonymous with Ste. Anne. I could not speak about Ste. Anne without speaking about Dr. Pat Doyle in the same sentence. It was wonderful to have that reference.
Dr. Gobeil, you specifically made reference to the lack home care services in this community, but you did not go into any detail. I would like you to go into that detail now, if you could.
Dr. Gobeil: I will give you an example. Last week, I had a patient who has bronchiectasis. That is a very serious illness. She has already had bilateral partial pneumonectomies. She has to have pustulization and percussion twice a day, and with that, we prevent her from being admitted to the hospital for longer periods of time. I asked that these services be done every day, on weekends as well. I had to concede that they could not fit in the program or the staff to be able to perform these services on weekends.
Where is the problem? The nurses tell me that they just have to give them hours, and they will work them. However, we are told from the person responsible for administrating this particular service that they cannot fit in enough nurses to do the rotation. I do not know where the problem really is because I hear different stories from both sides.
The Chair: It is interesting because we actually visited the hospital in Moncton that runs the Extra-Mural Program two weeks ago, which is how they deliver their home care services. It was quite amazing to see nurses, respirologists, respiratory technicians, physiotherapists, occupational therapists and palliative care services under one roof. Each patient had one file, but that file went to as many people as needed it. They were reaching out to a huge urban as well as rural community. It can clearly work if the dollars and resources are put in place, but it is a significant challenge for your committee because it is the area that we keep hearing most often needs to be addressed, and at this point in time has not been, pretty well nationwide.
Tell me about some of the programs, Mr. Curé, that you are offering and that you hope to offer to your francophone community.
[Translation]
Mr. Curé: One of our projects would be to help rural regions. We are a provincial organization with 18 affiliated clubs, of which 3 are located in urban areas and the other 15 in the countryside. By this I am referring to outlying regions, where there is a dearth of services. Sometimes it is hard just to get to Winnipeg from far away. So we would like to provide better services farther away, so people living in rural areas could at least have access to adequate services. We want to provide home care — everywhere. If you look at the activities we provide, they are mostly focused on helping people remain active and as healthy as possible. We offer courses on nutrition, exercise classes, and workshops to train community leaders, so they in turn can help people become more independent and remain healthy as long as possible, and to organize physical activities, such as walking or other types of activities. We held our annual general assembly last week and we talked about all these things. We offered courses on nutrition and courses on how to reduce stress; this approach worked in some communities, but it was a non-starter in others. We also offered a laugher yoga program, which was well received in some areas, but people did not sign up after the second year. Sometimes we do not have enough leaders and we have to find new ones. If we had a little more money, we could send people into the homes of seniors to give the training so that the seniors could live at home as long as possible. So there are all kinds of activities; we organize trips, we have the spring games, we have a summer festival which is part of the Festival du Voyageur. We do all these things to help seniors socialize, to entertain them and to create nice get-togethers for them.
[English]
Senator Cordy: Dr. Gobeil, you talked about psychiatrists and the access and partnerships that you have with Sainte-Boniface, I think, in Winnipeg. I would like to talk about the whole issue of mental health with seniors. It is great that seniors are living longer. However we know, of course, that the older people get, the higher the percentage of dementia in the senior population. What services are available to seniors suffering from any form of dementia, and how easy is it to access programs? What about respite for caregivers in that area?
[Translation]
Dr. Gobeil: That way, at our request, when we realize that a person is not acting normally, we can ask for a psychogeriatric assessment to determine at what level this person is functioning. For the residents living here in the home, we have Dr. Zacharias, a psychogeriatrician, who will gladly make a diagnosis, conduct an evaluation and make recommendations. When our office detects mental health problems with a resident, that person must be referred elsewhere. We usually refer the resident to a psychologist who prepares a report. If it is a serious case, the report is sent to the psychiatrist who visits Steinbach once a month. We have two psychiatrists who each come once a month; one of them treats younger people and the other adults. There are times when we would like to act immediately, but that is not easy to do because of the urgency of a situation, and we are far too often forced to admit a patient to Selkirk if his or her case is too serious, especially when a person is having suicidal thoughts, or something along those lines, and we cannot keep them here at the hospital because they can leave when they want to. But if we admit such a patient to a psychiatric hospital because there is a good reason to do so, the hospital has to keep the patient for at least 48 hours, assess the patient and then make a decision. But the problem is that there is always a stigma attached to being admitted into a psychiatric hospital, especially the one in Selkirk. In the town of Selkirk itself, when people see someone acting crazy, they usually say, ``That one escaped from Selkirk!''
Services are slowly improving, but I still find it is taking a lot of time. We had hoped to at least have a mental health centre in our region by now. I recently tried to refer a patient to the Eden Mental Health Centre in Winkler, and I spoke to the psychiatrist there, who told me, ``I am sorry, but your patient does not live in our area.'' So I tried to refer this patient elsewhere. There are limits to what can be done, because each facility has its patient quota and its own set of problems, and mental health facilities are always full.
[English]
The Chair: Does any centre in Manitoba — I cannot think of one — offer services in French to a person with mental problem?
[Translation]
Dr. Gobeil: Not that I am aware of, no.
[English]
Senator Cordy: What would happen to a senior in this complex living independently, but within Villa Youville, who started exhibiting signs of dementia? They would not be able to stay here, would they, or is there a wing here?
[Translation]
Dr. Gobeil: Yes, we provide different levels of care. We have patients who have deteriorated to the point where they do not know where they are, or who even become physically or verbally aggressive, and they are placed in a section which is under lock and key so that they cannot escape. However, some of those patients have managed to escape, although it was not easy. So we provide four levels of care, and the most difficult patients are those who do not know where they are, who they are or what day it is. Despite the care provided by Dr. Zacharias, who willingly gives us advice, shares his ideas with us, as well as his recommendations, the fact of the matter is that he speaks English. He does not speak French. But we do ultimately understand each other.
[English]
Senator Cordy: Studies have shown that depression among seniors is quite high, higher than the average person would like to believe. Much of that is due to isolation. We talk about isolation in rural areas, but a senior can also be isolated living in downtown Toronto. One of our previous panelists was talking about a day program that they have for seniors. He said that seniors ask themselves what reason they have to get up in the morning. That is a big issue for seniors. Is there a way for family doctors, for example, to diagnose possible depression among seniors when they come in for a visit?
[Translation]
Dr. Gobeil: Yes, we are trying to do that as much as possible. We have a so-called ``day care'' service here, right in the home, which is working quite well. Not everyone wants to use the service voluntarily and sometimes we need to encourage them and advise them a number of times before they agree to come. They are hesitant about coming to these meetings. I think it is tied in with the fear of becoming a patient or resident here. I think they are trying to deny the fact that they need the care or pretend that they can do without it.
If you took someone from our institution who seemed perfectly lucid and admitted him to hospital, I can guarantee you that he would become disoriented by the third day; things come back to normal after the person gets used to the health care team and the situation eventually improves, and then the person goes home. But there is no doubt that the longer you can keep people at home, the better it is for them because it is a familiar environment. That is when home care becomes very important, especially for people on the lowest incomes and who are most ill.
[English]
Senator Cordy: Is there a shortage of francophone health care workers dealing in the area of psychiatry, psychiatrists and psychiatric nurses?
[Translation]
Dr. Gobeil: Very few are bilingual. In fact, I know a few nurses who are bilingual, and our psychologist is bilingual, but that is all.
Ms. Dorge: I think that the committee should be aware of how traumatic it can be for many of our francophone seniors who live in our small francophone communities and are used to living their lives in French, when they find themselves hundreds of kilometres from home, from one day to the next, in a supervised residence with no services in French and no francophone environment at all. Experience has shown that, when there is political will, ways can be found to ensure that francophone seniors can be served in their language and in their residential environment. We hear a lot about home care and the shortage of caregivers. There also need to be incentives and increased awareness so that residences can offer these services.
We are trying to keep seniors from being isolated. But if they are taken to the casino one day and nothing else happens for a month, they are very much isolated in their little world, which leads to dementia and depression. The aim of our federation is to try to prevent that. We know that French is a minority language, but we still need to fight to obtain services in French for our francophone seniors.
[English]
The Chair: That is exactly why we are here in Ste. Anne this morning.
Senator Mercer: I will put my other hat on as a member of the Standing Senate Committee on Agricultural and Forestry. We are in the middle of completing a study on rural poverty. We have discovered — not that it was a big surprise — a lack of medical services in all parts of rural Canada, and the difficulty in attracting medical practitioners to rural Canada. However, it becomes magnified and much more critical in communities where minority languages are in effect, whether that is English language services in certain parts of Quebec or, more likely, French language services in Manitoba and parts of New Brunswick.
You indicated that you have had some interns coming here to work on their training. Have you been able to attract any of those young people back, and where did they come from? Are they Manitobans, or are they from elsewhere and are just completing their education and you likely will not see them again?
[Translation]
Dr. Gobeil: Our task as preceptors is to attract people who are able to work with us. There are a few from other provinces who are studying here in Winnipeg. Most are from Manitoba, and we see students from each of the four years of the medical program. Some of them are doing their residency in rural regions like ours. If we feel they are capable, we invite them to join our group to fill in the gaps.
[English]
Senator Mercer: Senator Cordy would have you believe that the answer is a good social life when they get here, which is not a bad idea.
You almost come to the conclusion that the universal health care is only universal to those people who live in big centres, near hospitals, and where the language that is spoken is their language. It is not universal to everyone, even those people who live in bigger centres if the language is different than their first language.
This morning we talked to others about the program of training doctors at the University of Moncton within their relationship with University of Sherbrooke. We understand that there is a relationship between the University of Manitoba and the University of Ottawa, and the University of Sherbrooke. Would it be more beneficial to francophones in Western Canada, and particularly Manitoba, if there was a program similar to the University of Moncton program? They are actually now in year two of their medical school training. They are taking their training at the University of Moncton but are actually students at the University of Sherbrooke, and the faculty of medicine at the University of Sherbrooke oversees the program in Moncton. Obviously, the objective is to train Franco-Canadians in Atlantic Canada and keep them in that region. Would that help solve some of your problems and hopefully bring more practitioners back to Franco-Manitoba?
[Translation]
Dr. Gobeil: I believe that there are enough students at the University of Manitoba who are bilingual and who already come from our region. The problem is that practising family medicine is not all that attractive an option for them, given the long hours of work involved. Many of them expect to work nine to five, when it is really the opposite that is the reality here. And others want to specialize, obviously. So we are lucky when we can find even one. If they were trained in a francophone university, perhaps things would change. However, maybe they would be tempted to stay where they receive their training and so would not necessarily come back to Manitoba.
[English]
Senator Mercer: If I understood you correctly earlier, you indicated that most of the doctors here have a maximum case load and are not accepting new patients; am I correct? What do those people in the region do if they do not have a doctor?
[Translation]
Dr. Gobeil: That is a very serious problem. And a study has just been completed on that. If I take one or two more patients than I am able to see right now, when I leave other doctors will have to take my extra patients. The more I have, the less able they will be to take them all on. But demand is growing. Where we need doctors is especially with older people, who are much more numerous than before and require more time in the office to examine them properly and make a good diagnosis. It is a real problem.
I do not know what happens to people who have no family doctor. I would personally be prepared to take on new patients anytime, but I have to think of the new doctors coming up, since when I leave, they will have to handle 2,000 patients more.
The same thing is happening in the neighbouring town of Steinbach; they have many more doctors than we do but they are not taking on any new patients. So it is becoming a problem. Patients who need medical care go to the emergency ward after hours and even during office hours, and they have to be given care. Eventually some of them get into the system, but we need to be very careful because if we want to provide adequate service we have to avoid patient overloads, I think.
[English]
Senator Mercer: Thank you, I appreciate that.
We had a brief discussion about the need for activities to keep people active and to try to get them to come to centres such as the Villa Youville, not as a place to live but as a place of activity. Are there other facilities besides the Villa Youville in the Franco-Manitoban community that are specifically designed to do just that, to attract older Franco- Manitobans to a centre, to create the activities that will get them both physically and mentally active, and to have the usual collective trips that people like to go on?
Ms. Dorge: I do not think there are other facilities. St. Boniface might have an area where they have day programs and so on. Programs are being created locally and we can either sponsor it or encourage it. We have no money to sponsor it financially, but we encourage them to meet so that seniors are not isolated from the others. Our main goal is to keep seniors together.
With respect to doctors and seniors, to doctors right now, it is a profession where a few years ago it was a vocation, and they were there 24 hours. I do not think we can find young doctors that are doing this now because they have their families and many other commitments to take care of.
People often come to us requesting that we find a French speaking doctor for them. Even though St. Boniface has some, they are few and far between. In Ste. Anne's, all of them are francophone, but people will not travel to Ste. Anne; some do, but others will not.
The Chair: It does not sound like a good idea for them to travel to Ste. Anne. Ste. Anne's doctors are having trouble looking after their own.
Ms Dorge: That is a problem.
The Chair: Dr. Gobeil, I would like to put a very frank question to you. We know that there are shortages of geriatricians and family physicians from one end of this country to the other. How much of that is related to the fact that our medical system, including the doctors' associations themselves, fail to recognize the value of family physicians and geriatricians in terms of their payment schedules?
Dr. Gobeil: Could you repeat that question, please?
The Chair: We know that if you are a specialist in internal medicine, you will get paid a lot more than if you are a family physician. We also know that if you are a specialist in cardiac surgery, you will get paid a great deal more than if you are a geriatrician looking after our seniors. How much is that causing shortages in family physicians and geriatricians?
[Translation]
Dr. Gobeil: I do not believe it is really a problem, since I personally feel that I receive adequate compensation. We receive less than we should, according to the assessment by the Manitoba Medical Association; it is essentially a certain percentage of what the association recommends. But things have improved over the years, and I am sure that a doctor who wants to work just eight hours a day can easily make a go of it financially in a place like this. It is a matter of persistence, and there is also an element of self-sacrifice. The care we give is not just restricted to office hours; sometimes we need to go beyond that and this is something we need to be prepared to do. In my view, the financial side should not be a problem.
A doctor in general practice in Winnipeg, however, can easily obtain investigations and — The problem as well is that, if you are in general practice, your patients that get sick after five o'clock will go to a walk-in clinic or even the hospital, where they end up waiting for so many hours that they leave without getting treatment. But the doctors do not have to worry because they know that their patients will eventually be treated. Our system here is such that we make sure that everyone who comes to the emergency is examined and treated and then sent to their regular doctor or to a specialist in Winnipeg. So we now have a specific contract whereby we receive a certain amount of money when we work in the emergency ward, whether we have 20 patients or only one: it makes no difference, since we are paid for being on call.
When I was younger, we were on call 24 hours a day, but we received no compensation for the hours we spent by the phone, getting to the hospital or at the patient's bedside. Things have improved a lot from that standpoint. So I do not really see the problem. It may be less attractive to practise in a rural area rather than in Winnipeg, to take our region as an example.
Senator Chaput: Doctor Gobeil, you have just said that it may be less attractive to practise here. I am thinking about people outside the region who are looking at what is going on in Ste. Anne in your clinic, where you have nine doctors in 2008. So you are doing something here in terms of recruitment in order to have so many doctors, some of them young and some of them a bit less young like you, but at least you have them and they are all bilingual. So why is it that those doctors have come to the clinic to work with you and for the people of this region? What is your recipe, do you think?
Dr. Gobeil: The recipe is, first, that we invite them to do internships to show them exactly how we do things. It is important to keep in mind that we have a cohesive group with the same approach to our work and the support of the other doctors we work with. All those things make for a homogeneous group, despite our personal differences. This is very important, since I am asked every day what will happen when I leave. I respond that we are not at that point yet and that they will cross that bridge when they come to it. That said, I can guarantee them that, because their files are here, the other doctors will take them on as patients and there will be new doctors.
I think that we offer working conditions that are actually pretty good. Years ago, I used to be on call 24 hours a day for a week at a time. Needless to say, I was absolutely exhausted by the end of the week. Now there are still difficult days for those who are on call, especially on long weekends where there are a lot of accidents. But at least doctors are on call for only 24 hours and then someone else takes over. There is a rotation for weekends. So people are not forced to stay home.
We try to treat everyone equally, be they francophone, anglophone, Ukrainian or anything else. I think we provide relatively comprehensive services. And then, there are people who come from Sainte-Agathe, Saint-Jean-Baptiste, Vita, Falcon Lake, Hadashville, Beauséjour, people from all those places, La Broquerie, everywhere, really, they come here and they know there is some continuity of service.
Senator Chaput: A very brief question for you, Dr. Gobeil, and then one for you madam. In terms of home care, given your experience as a doctor since the inception of home care, would you say there has been progress in the delivery of these services or a decline?
Dr. Gobeil: No, things are much better than they were at the start.
Senator Chaput: So, things are better?
Dr. Gobeil: Yes.
Senator Chaput: In terms of hours and various services, or coordination?
Dr. Gobeil: In terms of having enough people available to deliver these services.
Senator Chaput: Ms. Dorge or Mr. Curé, on the issue of volunteering, you must have had to recruit volunteers in order to offer all of these services and activities. So, how do you go about recruiting volunteers? Do you get help? Do volunteers recruit other volunteers, how does that work?
Ms. Dorge: Well, I believe that the volunteers are, really, ourselves and mainly Gérard. We have a volunteer pool. For instance, for the spring games in Sainte-Agathe, they found their own volunteers and it was fantastic, everything worked out well.
If we want volunteers for a nutrition project and they have to be paid, I think our federation will not make it.
And then last week, at our annual general meeting, we recognized approximately 40 volunteers who have worked throughout the year, either to organize a social event, or a golf tournament. So all of these things, in all organizations are done on a voluntary basis. We have radio show called Envol 91, every Monday morning from 9:00 to 10:00 a.m., it is a program which is specially geared to seniors.
Senator Chaput: Is it community radio?
Ms. Dorge: Community radio, hosted by volunteers, volunteers technicians, everything is done on a volunteer basis.
So as I was saying, we have a volunteer pool. They are mainly retired individuals who are waiting around and saying, ``What are we going to do today? We want to do something.'' And they are volunteers, they are retired, so they have the time.
Senator Chaput: Do you pay for their transportation, do you give them anything or is it 100 per cent volunteer work?
Ms. Dorge: I would say 99.9 per cent volunteer work. We pay for transportation if we hold a meeting, if it is not a meeting for volunteers, but a meeting of the provincial board. So in order for them to get to the meeting, that is approximately the only compensation they get, aside from dinner. Everything else is done on a volunteer basis.
Mr. Curé: If I may add just a word, we have 18 clubs that operate and out of these I would say that in most of them there are between 7 and 10 volunteers sitting on the executive. There is a club in each town and they are all volunteers, so there is no compensation. The only ones who receive compensation are those who sit on the provincial council.
We are working on a data base, but it is very difficult because so many people move and it is difficult to keep up to date. We started working on the project this year. We have found that it is harder to find volunteers among young retirees, rather than people who are aged 65 and over, because these people do not want to become isolated. Those who retire at age 55 and who have worked for many years do not want to be stuck doing volunteer work. That might happen 10 years later. So, yes, there is a lot of volunteerism.
[English]
The Chair: Thank you to all of you for appearing here this morning. The information has been extremely useful to us.
Senators, we would normally rise, but we have a special person in the audience that I will ask to come forward. We are in a very interesting facility here; I think you saw some of that as you walked through. However, we actually have the gentleman who made this happen. He happens to be the spouse of Senator Chaput. We will ask Mr. Louis Bernardin to come and join us to tell us a little bit about the facility in which we are holding our meetings today.
Please tell us a little bit about how this facility came into being and all the wonderful things that it does?
[Translation]
Mr. Louis Bernardin, Director, Villa Youville: Madam Chair, doctors can be a big problem, and it was one which I did not want to have. When you are in charge of administrating a hospital and a seniors' home, you are already dealing with so many issues that you do not want to also have problems with doctors and staff. I was offered a job in Churchill, but I turned it down because the biggest problem up there was that they could not find any doctors.
I would like to go over everything which has been said because I have lived through every situation. I would like to start with Mr. Woolen Noyes, who was responsible for applying the Elderly and Infirm Persons' Act, and who was the only person with a part-time secretary. We wanted to build a retirement home, but we did not know how to go about it. So we asked Mr. Woolen Noyes to come, in his wheelchair, from Winnipeg to explain to us how things are done. Then we, the members of the Knights of Columbus committee, asked him, ``What do we need?'' To make a long story short, he said: ``Only you and your community know what it is you need.'' So we took a step back and looked at the situation and decided to build 30 hostels, and attached to those, 35 motels; we call them motels, but they are actually single or double independent units.
I worked as a senior operator, a telegraph operator, with CNR, and when I was still working at the station, they put me in charge of administration at the hospital. After, they made me director of Villa Youville. I had no experience whatsoever since I was just starting in that line of work. So I took administration courses at the University of Saskatoon.
At the hostel, we had a large and very heavy front door. People began to ask questions. I was hiring people who had been approved by the nursing department to work at the hostel. So my hostel filled up, and I put seniors in the motels, in the independent living units, and I provided them with services such as meals and activities. Eventually the people living in the motels began working as volunteers with the people living in the hostel. But at one point, they did not realize that Villa Youville was an independent facility; it was ``elderly subsidized,'' but nevertheless independent. So a man and two women came to see me without really saying what they wanted, and they began discussing with me the services we were providing. But what they really wanted to know is what my qualifications were, what entitled me to make the decisions I was making with regard to transferring people from the hostel to the independent living units. When he came in, the man noted that the door was very heavy and hard to open. In the course of our conversation, it was when he asked the question that I realized why he had come, and it was because he wanted to tell me in a nice way: ``Mind your own business!'' Since the independent living units were at issue, I told the man: ``But you said so yourself when you came in, the first thing you told me was that it was a heavy door. So I said that the people who can push the door open go to the motels, and those who cannot open it go into nursing care.'' And there was nothing more they could say.
I greatly appreciate the fact that both committees have travelled across the country and addressed the issue of palliative care. But palliative care is something we normally do through the Grey Nuns. So there is really no point in my talking at length about palliative care, because those services are provided by the Grey Nuns. They are the ones who showed us what palliative care is all about, how it is administered and how to maintain that type of care.
I heard you talk about ``day care'' and ``caregivers and all that.'' We provide ``day care'' without anyone's approval simply because people need it. What we did was we brought people to the villa and integrated them into the villa's programs. The only problem we had was that they were treated so well here, and there was no one at home to look after them, that they did not want to go home again. We had a facility in Hadashville, which was more or less a private residence for Ukrainians, but in the summertime, the woman who ran that facility was so overworked that we took in the really serious cases, namely level 3 residents, and we kept them for two weeks. But the same thing happened with them; they did not want to go back. This was happening outside of the MHSE Manitoba Health Commission, and we were not allowed to operate that way.
I heard all kinds of things about home care. I agree with Dr. Gobeil, who said that home care services were just as good. I did not know that, but I know that in the 1980s, home care services were drastically cut back, and I thought that was terrible because it is the right way to go if you want to save money, quite simply, and to encourage people to stay in their homes as long as possible.
The level of care was also discussed. There are accreditation programs which dictate the standard of care in a given facility. There are also agreements across the country, which set benchmarks by which to measure and compare the services we provide to our patients.
Dementia is certainly a major problem in seniors' homes such as ours, especially at the beginning. For your information, the hostel is the first level of nursing care, but there are three other ones over and above that. Sometimes in the span of a few months, the condition of our residents deteriorated, and they went from a level 2 to a level 3, and then to a level 4, and we had to put hooks on the exit doors to prevent people from getting out at night. We had to secure the doors, especially in winter. We managed to catch some residents who had made their way outside; they had a bad habit, especially the men, or going outside to pee in the bushes. You know, we are dealing with a generation which was fairly poor. Where we grew up, not only were people poor, but they were not very educated, and so these are people who needed a lot of attention, much more attention than people would nowadays. I can imagine that future generations will be easier to look after.
Let me continue to talk about dementia; there was a woman, Ms. Mettai, who lived her whole life in Winnipeg, she was a francophone who had married an anglophone, and had lived her entire life in English. But when the time came to put her in a home, they looked for a francophone one, and we were the only one, which meant that they had to move her to Ste. Anne. The lady was very forgetful; you know, she had all the symptoms of dementia. She eventually came into some money, and so under the Public Cost Fee program, she saw a doctor who assessed her. This doctor declared that she was insane and unable to manage her own affairs. When I heard about this, my first reaction was that I was furious because they came in through the back door, assessed one of my residents without even informing me of the fact. But they had conveniently forgotten that I was running a private facility and that they had no right to do what they did. So I brought in a psychiatrist from St. Boniface, a francophone, who reversed the first doctor's diagnosis. This shows that language is extremely important. As you grow older, you really go back to the person you used to be.
[English]
That is a quick overview of the comments that were made here today.
[Translation]
I do not know if you have any questions. You know, that has been my experience throughout my entire life. And I hesitated, even today, to come before you, because —
[English]
There is another comment I would like to make. As a matter of fact, I am adding a room to our house so that we can look after one another when we get there. The last place that you want to be is in a nursing home.
The Chair: Yes, but it is important for those who must come to nursing homes that they have facilities such as this one where they feel comfortable in the language that is their first language, that the people that are treating them are treating them in a way which is respectful to that. Ste. Anne is very fortunate to have this facility, and we thank you, Mr. Bernardin, for being part of making that happen.
The committee adjourned.