Proceedings of the Special Senate Committee on Aging
Issue 11 - Evidence, June 2, 2008 - Afternoon meeting
STE. ANNE, MANITOBA, Monday, June 2, 2008
The Special Senate Committee on Aging met this day at 1 p.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[English]
The Chair: Honourable senators, members of the public, I want to welcome you to the meeting of the Special Senate Committee on Aging. This committee is examining the implications of an aging society in Canada. We are here in Ste Anne this afternoon to hear from interested parties on the impacts of an aging society, and more specifically to hear their views on our second interim report tabled in the Senate on March 11. We look forward to this afternoon's testimony, as it will no doubt help us in our deliberations for our final report.
Appearing before us this afternoon, we have the pleasure to welcome Jim Wolfe, Manitoba Regional Director, Health Canada, and Dennis Sinclair, Program Manager, Indian & Metis Friendship Centre of Winnipeg.
We are also expecting Thelma Meade, Executive Director, Aboriginal Seniors Resource Centre of Winnipeg, but she has not joined us yet. I am going to start with the two presenters that we have, and then if Ms Meade is able to join us, then we will deal with her.
Mr. Wolfe, if you have an opening statement, let us begin with you.
Jim Wolfe, Regional Director, Manitoba, Health Canada: Good afternoon. I want to thank the committee for the opportunity to speak with you today, to inform you of our work in the Manitoba region.
Health Canada's First Nations Inuit Health Program funds the delivery of community-based health promotion and disease prevention in First Nations communities. Nurses employed by Health Canada provide primary healthcare services at 22 nursing stations in Manitoba. There are two federally run hospitals located in Peguis and Norway House. In Manitoba, there are 26 health offices, 10 health centres and four National Native Alcohol and Drug Abuse Treatment Centres.
Health Canada works closely with First Nations organizations including the Assembly of Manitoba Chiefs, Southern Chiefs Organization, Manitoba Keewatinook Ininew Okimowin, the tribal councils and First Nations communities to deliver our mandate. Together with First Nations organizations and communities, we carry out many activities aimed at helping people stay healthy, prevent chronic and contagious diseases.
In Manitoba, there are approximately 125,000 First Nations individuals located on and off reserve. Approximately half, or 51 per cent of the on-reserve population, lives in remote and isolated communities with no road access.
As of December 2007, about 10 per cent of the total First Nations population in Manitoba, or 12,000 individuals, were aged 55 or older. Approximately 6,500 live on reserve and 5,500 live off reserve.
Health Canada's First Nations and Inuit Health Program provides First Nations people living on or off-reserve with health benefits which are not insured by provincial healthcare, such as prescription drugs, eyeglasses dental care and medical transportation. In the Manitoba region, this program serves approximately 125,000 eligible First Nations and Inuit, of whom 9.4 per cent are 55 or older. In Manitoba, we provide approximately $170 million annually in benefits.
The Home and Community Care program is designed to involve First Nations and Inuit communities directly in planning, implementing, and delivering home and community care services. It provides: homecare nursing services; home support personal care services, a complement to INAC's assisted living program; short term in-house respite care; and access to medical equipment and supplies.
If these essential elements are in place and the community has sufficient resources to address other local home and community care service gaps, they are encouraged to do so. These may include such services as meal programs, adult day programs, foot care and home-based palliative care.
Our annual regional budget for home and community care for First Nations in the Manitoba region is approximately $16 million. In fiscal year 2006-07, approximately 67 per cent of First Nations clients accessing this program were 55 or older.
Regional staff works collaboratively with First Nations in examining ways to improve service delivery. Consultation with First Nations in Manitoba has shown that there is a need for better access to rehabilitative therapies as well as for day programs, long-term care facilities, palliative care, mental healthcare, and nutritional counselling. It has also shown a need for: greater flexibility in service plan delivery, that is, on the weekends and evenings; more education and training for workers; better discharge planning; increased regional capital funding; improved transportation options; and the resolution of jurisdictional issues.
As in other regions, attracting and retaining qualified home care professionals and workers is a challenge that is underscored in First Nations and Inuit communities by location, lack of professional support, and often part-time work.
Communities also receive Indian and Northern Affairs funding for their Assisted Living Program. Many communities have coordinated management of these federal home care programs. Additionally, communities would benefit from further coordination with provincially funded health services.
The challenge of coordinating federally and provincially funded health services on reserves is being addressed by Health Canada, in part, through its Aboriginal Health Transition Fund. This fund has a dual purpose. First, it aims to support the First Nations and Inuit communities in improving the integration of existing federally funded health systems within First Nations and Inuit communities with provincial and territorial health systems. Second, it assists provinces and territories in adapting their existing health services to better meet the needs of all Aboriginal peoples.
Health Canada has invested over $19 million in Manitoba projects to support coordination, integration and adaptation of health services with provincial health services.
Other integrated models for client care are being examined by the First Nations and Inuit Health Program in Manitoba Region. Many First nations clients admitted to hospitals in Winnipeg were being discharged without a formalized hospital care program assessment. In response to the lack of coordinated discharge planning, the Manitoba Home Care Program, in collaboration with the Winnipeg Regional Health Authority has established a formalized Home Care discharge planning process for clients returning to their home communities. This process has improved planning between hospital and community, resulting in improved client services and outcomes.
Health Canada will be collaborating with the remaining regional health authorities to improve communication and establish procedures.
At a national level, the Government of Canada and First Nations and Inuit Health organizations have undertaken research to gain better understanding of existing home and facility based continuing care services in First Nations and Inuit communities.
A National Joint Working Group is reviewing recommendations, developing a continuing care policy framework, and preparing an options analysis paper to support decision-making.
Health Canada will continue to help advance elder care through its program mandate in collaboration with other federal and provincial departments and our First Nations partners.
Thank you for inviting me to present to you today. I welcome any questions
Dennis Sinclair, Program Manager, Indian & Metis Friendship Centre of Winnipeg: Good day, my name is Dennis Sinclair. I am the program manager at the Indian & Metis Friendship Centre of Winnipeg. I do want to thank you for the invitation to speak today. What I can offer you is a look from the front lines.
We work directly with a lot of elders, Aboriginal elders in the community in Winnipeg, mostly from the inner city. We all know there are numerous problems and issues, in particular, health issues and economics.
In working with elders through various programs, we find a lot of the biggest concerns, aside from economics, are about literacy. Residential school systems have ravaged the Aboriginal community for many years, with effects we are still seeing today. Winnipeg's growing inner-city crime rate is, I think, very indicative of some of the trickle-down effect from this.
Let me tell you some of the problems that the elders have brought up. Transportation issues. You have a growing elderly population that cannot readily access different programs and different services for various mobility issues. There is a strong sense of isolation. For a lot of these folks, the biggest thing is to get to the Friendship Centre on a Thursday for lunch. You will have a group of 15 or 20 that regularly meet, and that is their day out, that is their fun day. But other than that, a lot of the time they are stuck indoors, especially during the winter months. This also leads to bullying and abuse.
Second, we have a growing problem with our youth, and neglect or disrespect towards elders. I know a lot of our community members are afraid to leave their houses. Never mind accessibility and mobility issues: just leaving their houses and walking down the street could be at times life threatening or a very scary proposition for them, due to the crime in the city. The area from which a lot of our clients come is the Lord Selkirk development area. Bullying and abuse can come from anywhere, including from family members. In a lot of instances, we find elders' children are forcing them into spending their money on the children's needs instead of their own, whether the income is from welfare cheques or old age, or pension cheques.
We are also finding an increasing number of elders actively participating in raising children. This leads causes a problem because of the gap in age. If you have someone over 65 plus raising a child who is 10 years and under, or a young teenager, the elder is having to work in a whole new world. Unfortunately, with technology and information readily available to children, a lot of the time, elders are not able to take a strong position. For whichever reason, many elders are scared of the new technologies and the Internet, and of accessing information in these ways.
A third issue that is raised is health and nutrition. Type two diabetes is a major problem in the Aboriginal community. We have an elder population that in general has lower literacy levels. Therefore, when they have papers to deal with, a lot of them will not understand what they are filling out, or what they need to do, or where they need to go. Again, this is what we have from those who come by the centre.
It is tough to get time to see a doctor if you have an elder who has a difficulty with mobility: there may be a Handi- Transit, but the overall process is very difficult. We can see those struggles when they come to the centre, and you hear them talking, and just sit and talk with them. If they miss an appointment for whatever reason, they cannot get back in for another month or two. It is very difficult, and there is a sense of ``who cares.'' You have a sense of defeat. When there is an obstacle, a lot the of time they will just sit back and take it on the chin. Because there are not a lot of services directly for those inner city folks.
Back to literacy. Any paperwork, even when it was filling out the residential schools reparations application forms, we would have them coming, and we would be doing the paperwork for them because they could not comprehend or identify the simple necessities. When they have to access government services or government funding, and they are given a lot of legalese, again, that sense of defeatism comes in. A lot of our Aboriginal community shy away, unless there is somebody there to help them.
Luckily, we are able to help. We have funding enough to be able to staff, to put this in place. But I know a lot of organizations have limited funding, so staff participation is limited in how they are able to help the elders in the community.
Really, aside from basic transportation, isolation, bullying or abuse, health and nutrition, and literacy issues, we just find a strong need to be heard. And that is what our elders that access our centre are really looking for.
Thank you very much. Again, any questions, I am open and available.
The Chair: Thank you, Mr. Sinclair. And now Ms Meade, who is of course representing Aboriginal Seniors Resource Centre of Winnipeg.
Thelma Meade, Executive Director, Aboriginal Seniors Resource Centre (Winnipeg): I am Thelma Meade and I am the director of the Aboriginal Seniors Resource Centre in Winnipeg, the first Aboriginal senior resource centre in Manitoba. We are very excited to be running it. It is not a very big place, but at this time it is doing quite an adequate job for our seniors of Winnipeg.
ASRC, Aboriginal Senior Resource Centre, is the only one in Manitoba and Winnipeg. We just completed a focus group in every area of the city, north end, west end, St. Boniface, hoping to find ways to expand the membership of our organization. The results show our membership is pretty happy with the programs. Any additional programs need additional staff and additional money, so that is where we are. We are very excited that we know which areas have a high number of Aboriginal people. We would like to get them to our centre, but one of the things that we are worried about is the impact of a large influx of people, so that we would not have the resources to serve them.
There is an increase in the number of Aboriginals moving to the city, because of lack of health services and hospitals, particularly in remote areas. Even as close as the southern area here, Pine Falls still has a hard time accommodating people. Just as in Winnipeg, they are faced with the problem of mobility, the ability to go back and forth to their medical appointments at these hospitals. Many of them live quite a distance away. If there are more Aboriginal seniors coming into Winnipeg, then we are going to need to expand and we are going to need a lot more funds to be able to provide assistance or provide the services to these people.
Another area I want to raise is seniors working past 65. Seniors, particularly Aboriginal seniors, need to work past 65, if they have the skills and qualifications. I am a senior myself, and if I quit working right now, I would have difficulty in meeting my living costs because rent and food and gas and transportation are getting much more expensive than even two or three years ago. Aboriginal seniors have to be allowed to continue to work past 65 because the cost of everything is going up, but the OAS is not going up at all.
That is a difficulty. The cost of living is going up and the economy is strong, and yet there is nothing that will support seniors, particularly our Aboriginal senior women. Many of the women did not work for 25 years. Therefore, all they are going to rely on is their CPP, if they have any, and the OAS. That is such limited income to live on, it is almost scary.
Building healthy activity is also a concern. Seniors are living longer, including aboriginal seniors. That is why our ASRC resource centre needs to be supported.
Since the last time I talked about this, we have learned how programs could work well with Aboriginal seniors. Because when we first came to the Kekinan housing centre, I was a bit discouraged thinking, how am I going to get these seniors, the seniors within Winnipeg, out to do things and get them away from being shut-in the way they were. We had to get them away from thinking that their health was so bad, and they did not have skills so they could not contribute anything. The self-esteem, the self pride of our Aboriginal seniors was quite low.
Now we have a bit of money to work with, not much. We are only two and a half staff. We have managed to establish programs such as a sewing club, and arts and crafts, and story telling. Now we can see that from these programs we started since the last time I talked about support, that there is there is a big difference. Our Aboriginal seniors now feel like they are contributing, that they are doing something and are still valuable.
Story telling: We are going to write a book, and we are looking for funds from all over. We are going to write a book so we can retain and maintain the history of the Aboriginal seniors, Aboriginal people. Again, they can see a bit of light that they can still contribute and do something for Canada.
Families. I think I mentioned before that in our Aboriginal culture, we used to keep our elders at home. It was kind of scary to move Aboriginal seniors into a personal care home. Lack of money and support is forcing us into doing that, into letting the elders, the seniors go to homes. The homemaker program is minimal, just an hour or two a week. So there is very little medical support at home, even when medical support is needed. As well, a lot of Aboriginal people are working, the same as in the dominant society. They are working and they cannot afford to have someone take care of their elders and seniors at home.
So something we are also looking at is trying to get assisted living, maybe 30 units in the City of Winnipeg, to help our Aboriginal seniors. This would help because they cannot get the help and the meds and housekeeping and home care from the government. And homecare is not even worthwhile using, because I think it is so limited.
One of the things that I really want to work on, providing we get financial support is the history of our Aboriginal seniors. And so that they could have the continued feeling of contribution to our ``turtle island,'' our Canada, our country.
Another very important thing that I see for seniors is to get together and use their language. We just do not just have one language, we have the Cree, Inuit and, you know, Ojibway. I notice that even in our activity time, that the Ojibway will get in the corner and start talking their language, and they are still all together. The well-being of the Aboriginal seniors means retaining their culture and language, and to be contributors to Canada.
I guess another thing that we started to work on involves Partners for Careers. We are doing a program called Peer Helper Training Program. That is, getting together maybe 12 at a time, and talking about how they can go out in the community and work with the community with this training. It gives them the opportunity to work with people, let us say the schools, and maybe another health centre or even right within the centre.
This partnership with Partners for Careers of Winnipeg is really an opportunity for us, because they have provided the package and they go through teaching the empathy and how to work with people. Now they feel that they can still learn, not just sit there and have everybody doing things for them, but do things themselves.
Mr. Sinclair mentioned the residential schools and that is one of the major things today. We hear because we speak the languages — I speak two or three languages, and the outreach worker does work in both Cree and Ojibway. The southern part of the provincial is mainly Cree and Ojibway; we do have just a few Inuit and Dene.
We opened in 2004 and we would like to thank some of the funders for giving us the opportunity to work with seniors.
The seniors really enjoy activities such as going on the river boat and even to the IMAX. As I said, however, we did focus groups to see what our members want to do. Because sometimes when programs are top-down, they do not work. They have to come from the people themselves. As a director, I believe in that you have to work with the people and not pour in things from the top. It works well when they decide what they want.
So we stop, and the outreach worker usually does the workshop. We also bring in people to help with healing in the residential schools. It is not easy talking about residential schools. And I know when they are going to talk and when they are not going to talk about it.
Mr. Sinclair mentioned literacy. That is one of the things we are talking about doing. In fact, New Horizons gave us some funding and we purchased four computers and we are going to have computer training for seniors. I said no chat talking, no text messages. They are excited about it, and we are going to have classes and they are going to do the computer work.
We are excited about our book, because I think it will preserve some of the stories of long ago. We are asking them to talk about the way they lived, before cars and all that. How they made their own soap, how they made their own light, how they cleaned the wooden floors. I think with the support of our government, I think we can do it, and I know we can do it and we will do it. Thank you.
The Chair: Mr. Wolfe, in your presentation, you spoke about the fact that you had $170 million annually in benefits, which included everything from prescription drugs to medical transportation. When I last looked at the Nunavut budget, and that was some years ago, 70 per cent of their medical budget was actually spent on transportation. How much of your $170 million annually is spent on transportation?
Mr. Wolfe: Unfortunately, I do not have that figure with me. I can undertake to provide that to you. We have it, I just did not come prepared for that question.
The Chair: The only reason I ask that is because I know that a number of southerners are quite shocked, because they do not really think of transportation as being a core component of a healthcare budget. And yet, if you are dealing with remote communities, as you are with 51 per cent of all Aboriginal people on reserve in a remote community, medi- vacs tend to be rather expensive propositions. So this is as much to educate everybody, as anything else.
Mr. Sinclair, you made reference I would have to say to Old Age Security, and so did you, Ms. Meade. But neither one of you made reference to the Guaranteed Income Supplement. What we have learned so far crossing the country is that many seniors, particularly seniors who have lived much of their life in remote communities, have no idea they are even eligible for a Guaranteed Income Supplement. Is that your experience, Mr. Sinclair?
Mr. Sinclair: Absolutely. To tell you the truth, even though I'm on the front line, this is the first time I have heard of it. I would not think that our clients, our community members, would know about it. I am not sure which organizations would be the ones to tell them about it. If this information does not get filtered down to us as front-line workers, then I could not see how we could pass that on to the community members.
The Chair: Can I suggest that you go on the Government of Canada website, and go to Guaranteed Income Supplement and download the forms. Because I suspect that most of these 15 clients that you are having lunch with, or community members that you are having lunch with every Thursday, probably all qualify and none of them are getting it. Maybe you can help them fill out those application forms.
Mr. Sinclair: Absolutely.
The Chair: What about you, Ms Meade? Is your organization familiar with the GIS?
Ms Meade: Yes, we are familiar with the income supplement. Service Canada comes in, and we have done three workshops already, on topics such as the supplement, and the senior disability. Just the other day, I was at a meeting in the Filipino community, and they had the MP from Ottawa, the seniors critic there, and Judy Wasylycia-Leis.
A new thing that I will be bringing attention of to the seniors is the hidden disabilities that you can apply for, you know. We ran into one accidentally with one of the ladies that was in a wheelchair for 17 years or something, and the outreach worker was doing an advocacy for her. We discovered that she can apply for a certain disability benefit. I think she is being reimbursed for nine years. But, again, we ran into that accidentally.
Service Canada comes in and does workshops, or we get them to come in individually and talk to people. We know that, but that is because I am involved with the Age and Opportunity program, and I am a lot into these training programs that the Winnipeg Regional Health Authority is putting on for seniors.
The Chair: That is very interesting, because what we have learned, of course, is a number of things. First of all, the law has changed, and that is a good thing. Anyone who now files an income tax form and has indicated that their income was below a certain level will automatically get the Guaranteed Income Supplement. But before they always had to file a separate application form. So that is a positive change in the law. But I know a great number of Aboriginal people do not file income tax forms, so that is not going to help them in any way, shape or form.
The other issue, of course, is that some of them have not even applied appropriately for their Old Age Security. Quebec, by the way, has done a much better job than the rest of Canada. They have almost 100 per cent coverage of all their citizens. We know that there are significant gaps in the rest of Canada, and among those gaps are Aboriginal people.
Senator Mercer: We have been talking a lot on this committee about healthcare providers. Mr. Wolfe, you say Health Canada operates two hospitals in Manitoba, has 22 nursing stations, has 26 health offices, and has 10 Health Centres for Native Alcohol and Drug Abuse Program Centres. That is a lot of places. I assume that some of these cohabitate with each other, that they are not all separate entities. How many nurses, how many doctors would Health Canada employ in Manitoba?
Mr. Wolfe: Approximately 132 nurses. I do not have a specific figure for doctors, but we essentially receive physician services in three ways. One is through private service contracts for physicians in the far north, and there are approximately 15. I say approximately because those numbers change almost monthly. Then for the middle of the province, we contract with the Northern Medical Unit of the University of Manitoba, who provides physician services to the communities. An association called Amdocs, is a South African doctors' association, provides services to Cross Lake. I believe there are approximately five physicians there. I am not certain what any of NMU numbers are, but I can be more precise about that if you wish.
Senator Mercer: Both Mr. Sinclair and Ms Meade talked about some issues particularly around language. This morning we talked an awful lot about language, particularly about service being offered in the French language. Now we are talking about Cree and Ojibway. Do any of these physicians or nurses speak Cree or Ojibway?
Mr. Wolfe: I am not certain of the physicians, but I can tell you that a large number of our nurses do speak one Aboriginal language. That could be Cree or Ojibway or, I believe, Dene. Because upwards of 40 per cent — again, my figures are approximate, I can be much more precise — of our nurses are First Nations, so they do provide that kind of service.
Senator Mercer: Again, we have concentrated on the rural areas. What about in the urban centres such as Winnipeg? Are your services equally split across Manitoba or are they concentrated in the isolated regions?
Mr. Wolfe: Our mandate is for providing on-reserve services, so that is the area that I am responsible for. Our services are provided totally on reserve, with the exception, of course, of non-insured health benefits and, if clients are in the city, then they can access that as well.
Senator Mercer: Mr. Sinclair, we continue to hear about literacy being an issue in our Aboriginal community and amongst other seniors as well. It is not restricted to just the Aboriginal community. The current government has cut back on the funding for literacy programs. You might have access to other funding because of your situation. Has funding been made available to operate literacy programs perhaps at the friendship centre or in other centres in Winnipeg?
Mr. Sinclair: A lot of the time we have to hunt and pick for any funds. There are some, but we are talking minimal dollars. Let us say you go to FACT, Families and Communities Together. They will give you $5,000 to run a literacy program. Half the time this is just to get people out because you have to provide food. A lot of this money goes towards food. You are really ``nickel and diming'' to find monies available for any and all literacy programs.
Then you run into another obstacle. We work primarily in the inner city, the north end, the high risk area. We are able to bring these service to other areas of the city because we find these small amounts of dollars here and there. But you will get denied a lot of the time because you are suddenly in an overlapping of services. For us, we have the Friendship Centre, but we are located right next to Ma Mawi Wi, Ndinawe Youth Centre, Kekinan. And right across the street, Turtle Island. All of a sudden we are all competing for the same little pot of money and that pot dwindles even more. We are told, well, there is already something, there is an adult learning centre in your area, so you cannot access this minimal amount.
The problem that comes there is, the Aboriginal community, I am sorry, is not going to go to a primarily white or non Aboriginal-run learning centre. If you do, you are missing culture; you are missing a language. You mentioned that a nurse is usually on staff somewhere that speaks a language. You named some, but Machif was not included in there. We find this with a lot of non-Aboriginal learning institutes, it is the same thing. They are able to bring some Aboriginal staff members on, but the Aboriginal community really enjoys and needs that sense of familiarity of culture, of a background as in, you know where I am coming from. That is what they really look for. If we have a learning facility or a learning centre in the area, we will not get money because they are already there. Our community members have difficulty accepting, admitting the fact that their literacy levels are lower, and then you have to go to almost an outside institution in order to do this. It is very difficult.
Senator Mercer: I would hope that someone will try to coordinate this. I know that in my visits to Winnipeg over the past several years, I did visit a school in the inner city with some people from the Winnipeg Community Foundation, which is one of the biggest and best community foundations in the country. That school was funded and it was geared very much towards the Aboriginal community, and they actually had elders in the classroom and the program was quite good. I guess it is an issue of coordination.
All three of you gave the presentation independently and you all used some words the same. Language was one word you used the same. Literacy, two people talked about literacy. But everybody talked about transportation.
You two talked about transportation needs. Mr. Wolfe talked about $170 million annually in benefits, which includes prescription drugs, eyeglasses, dental care and medical transportation.
Indeed, Ms Meade you mentioned transportation and dental care being an issue.
So Mr. Wolfe has $170 million in programs designed to be delivered mainly in remote communities, I acknowledge that. But the transportation issue is people being transported from their remote communities to a larger centre for treatment, et cetera.
So is there a coordination that happens between all of the people sitting at, not necessarily the individuals, but the organizations you represent, at the table? Is somebody coordinating this?
Mr. Wolfe: I can speak for Health Canada. Essentially, what we try to do is — and Senator Carstairs, your point is well taken — a large part of our expenditures are in medical transportation as well as in pharmacy. Medical transportation, in particular, requires a coordinated approach. The demands on the program are fierce, they are huge. And the program continues to grow because of the fact that is mentioned here by some of the guests, as well as the written material you have. Our people have to travel a large distance to the major tertiary care centre. So that does necessarily up our costs here. Our costs continue to grow approximately 13-14 per cent a year. Funding does not keep up with that. We do lots of reallocation and coordination of programs.
For example, I can give you an example of a community in Manitoba, in Fisher River. We ask the Northern Medical Unit doctor from the University of Manitoba to travel to the community to provide services to the elders, as opposed to bringing them all out at so many dollars apiece, even if this is less than medi-vac, of course. You are still having to travel a large distance. Whether it is to Winnipeg, to Dauphin for example in this case, or Gimli, it is still a two or three hour trip. Yes, we try to coordinate that with other travel.
There are many clients going to dialysis, not all are seniors, of course, and so we provide vans, often 12-seaters. You often see a plethora of people in there from dialysis clients to people going for mental health counselling, or for just regular doctors' or physicians' appointments.
Ms. Meade: I would like to make a comment about transportation. When I say transportation, the only little transportation that we do is to pick up seniors to come to the activity. We cannot do anything to transfer people to medical appointments or anything. Because, to begin with, when you move to the city, you cannot have access to that money; that is federal money, you cannot have that. If I am living there right now, if I am not working and I need transportation to the hospital, I would not be able to get it. Even though I am First Nation and I belong to a reserve — I am an urban reserve person you might say. I cannot access anything they have.
For the Aboriginal Senior Resource Centre, all we do in the area of transportation is use a van that was donated by Winnipeg Foundation. We pick up the ones that cannot come to the activities. That is the only thing we can do.
As far as medical, we have tried using these medical services to get one of the ladies to the Health Sciences Centre for dialysis. They say that is a federal government jurisdiction, they do not give us anything.
So we Aboriginal, urban, First Nations people have a difficult time in accessing any kind of money in the City of Winnipeg.
Mr. Sinclair: The question was asked, are we coordinated, and I have to say no. When press releases and announcements are made, that is what they are, we get a fax that comes across the fax machine that says Health Canada announced $1.7 million, $170 million, $500, whatever it is, for these services. Then we are left. Now you have got 25-50 agencies rushing to the Internet to find the information, to find out what is available, who is allowed, what the requirements are. Yes, maybe it should be left to our own devices to find it, but we are not coordinated. The press release goes out and then it is left for the actual agencies to find.
You did make mention of the Winnipeg Foundation. Yes, great, excellent resource, that I think every single Aboriginal organization has accessed at one point in time or another. You know, it would be great to have more than that. But when you do go to apply to that Winnipeg Foundation, and it is not to try to be greedy, but it does say, have you applied this year? They will grant you for one year. You might get a van, like you guys got the van, but you still may be left without money to run your program. We find that too. When the fiscal year comes up and we say, okay, let us analyze to see who applied for what at Winnipeg Foundation. And you have to talk with one of your coordinators, and you might say ``I cannot believe you got $1,000 for this. Because now we are going to have to look somewhere else.''
So the Winnipeg Foundation is great, but it is not the be-all and the end-all. There is not enough money to go around, which is I think obvious.
Senator Mercer: There is a frustration at the lack of coordination. I do not know whose fault it is, but we get everybody trying to do good work. There are only one or two sources of funding, so we have got to figure out how to coordinate it so that more people are getting better services and that people are providing money, whether it be the taxpayers through Health Canada or Indian Affairs, or people of the community of Winnipeg, the community foundation or whatever other charity. We have got to be able to find a way to maximize.
The Chair: I think, Senator Mercer, you would find that all three witnesses at the table today would share your frustration at the lack of coordination, whether it is Northern Health Unit, the Resource Centre, or the Indian and Métis Friendship Centre. Because there is little or no coordination and an awful lot of time is spent trying to break down barriers between these organizations with little or no success.
Mr. Sinclair: I think another problem is the fact that some organizations are smaller, and they will have two staff, two and a half staff, five staff. At the Indian and Métis Friendship Centre, aside from our drop-in workers, we have seven people on staff. It is going to be harder for us to find that money. I am not knocking them, but compare that to the Manitoba Metis Federation which has a dedicated core of 300 plus staff members, and gets a greater share. The Indian and Metis Friendship Centre was the first Friendship Centre in Canada. We are celebrating our 50th anniversary this year. It was begun directly because of the need of Aboriginals coming to the city in 1958. This is where we were established. Now, we were not able to grow to a staff of 200 or more, but we still servicing 70,000 plus people in the City of Winnipeg.
The City of Winnipeg has more Aboriginal population than Nunavut, Northwest Territories, and I believe it might be British Columbia combined. And that is just the City of Winnipeg. However, funding depends on how many people you have to go out there and find the money. I think that is where the problem really lies. You will have bigger organizations with more people able to access more money, whether they service the people or not. I think that is where some of the problems come from.
The Chair: I suspect it would be Yukon, not British Columbia.
Mr. Sinclair: Sorry, yes.
Senator Cordy: It just seems we are always in Canada discussing which jurisdiction is it. But when you look at health care and the federal government gives the money to the provinces, but ultimately the federal government is responsible for the health care for RCMP, military, Aboriginal First Nations and penal institutions, I find it amazing to hear these stories about lack of coordination. Because if any of these is going to get a coordinated effort, it should be the groups that I have just mentioned. It is not happening.
I have to go back to the issue of literacy because I used to be a teacher. You talked, Mr. Sinclair, about literacy being one of the major challenges that you are facing. If you cannot read when you are 17 and 18 and 19, unless you get help, you are not going to be able to read when you are 65 or 68 either. It certainly provides a lot of challenges. You talked about paperwork the people are unable to fill out. I know there are cutbacks within the past two years to literacy programs and programs that were not continued.
Ms. Meade, you talked about getting funding from New Horizons, which would be an unusual area to get it from, but nonetheless it worked. How are you going to go about dealing with literacy? Because, as I said, if you do not have literacy when you are younger and you do not learn, then it is going to be compounded. Because then you have got children and grandchildren and you cannot help them.
Mr. Sinclair: Well, I know for us at the centre, any literacy that we put on, it is informal, because we do not have the funds for it. But we do try to bridge that gap between the elders and their grandkids, or elders and children. Literacy is not just about reading, writing and arithmetic. It is overall comprehension of materials.
I recently completed a report on Aboriginal literacy in Manitoba, and that was sent out through the National Association of Friendship Centres. It is even simple things like, you have that can of evaporated milk that is on the shelf, and it is $2.19, but it has a blue label, that is what your mom bought and that is what herr mom bought, so that is what you buy. But right beside it is a can of evaporated milk for $1.58. It is just simple comprehension of everyday literacies, not necessarily the reading, writing, arithmetic.
How we attempt to bridge that is by giving basic literacy skills. Life skills, which also encompass literacy, in my estimation. But by bridging that with the elders being able to take what they have learned from us. Because I really think that we have to do what we can right now for the elder population. Let us also not forget that the Aboriginal population in Manitoba is growing 20 per cent faster than the non-Aboriginal population.
In 40 to 60 years, we are going to have a greater problem if we cannot educate our youth. I know this is a committee on the aging, but our youth are going to be aging. We are really trying to proactively address the needs and the issues that are going to happen in the future, while at the same time trying to address the problems that we face today.
How are we going to do it? I do not know. It seems like everyday you wake up and you try and find some new magic solution. I think every organization does that. How are we going to effectively institute change? It is through partnering, is one thing. We cannot rely on the government to be able to fund us for everything. We have to search out money again, we have to try to find it, and we have to fight each other for it.
We have two seniors groups here that are sitting right next to each other, that I have never met, but I think we have a lot of the same initiatives. We too get funding from New Horizons for our elders program. It is through partnering and in finding those organizations and people and dedicated staff that will be able to put in that extra, because we cannot rely on our funding. And unfortunately, it does have to come extra from the grunt workers, from us right on the front lines.
How do we fix it? I do not know. It has to be addressed or that culture is lost and is not being handed down to our children.
Senator Cordy: I hear frustration. I am sure all three of you feel it at times. But what are the challenges for finding out about government programs? It is finding out about the programs and it is accessing the programs. Senator Carstairs mentioned the Guaranteed Income Supplement earlier. If you do not know about it and if seniors do not know about it, how can they apply for it? We have even heard that there are a number of Canadians who are not applying for Canada Pension, and so they are doing without it. Although, in Quebec, they are doing a great job of communicating it. But what are the challenges of finding out about government programs and being able to access funding for them?
I remember being in Newfoundland and they said sometimes paperwork is involved. We understand that every organization has to be accountable, but sometimes the paperwork, they had to ask themselves, is it worth going through all this to get $5,000? They said you almost needed a full-time staff person just to become aware of programs and to fill out the application forms. Are you finding the same kinds of things?
Ms. Meade: I think that is one of our biggest struggles. I know we have access to Age and Opportunity, and we have access to the other senior organizations. But when there are only three, only two and a half staff, when do you have time to research out all the funding agencies and do all the paperwork?
New Horizons is a good organization. To apply, you have a package that thick to fill out. A year ago, they funded us for sewing machines. We had to work on a package that thick just to get $11,000. In return, when you finish that little project, you have to give back a package of reports that thick.
When there are only two people, and you have your daily work — you are doing activities and you are doing advocacy, and you are doing all the work, you know. That is the one thing. Another problem I see is that it is so difficult to get any monies for administration. You can get lots of little projects, but putting together a project that big is very hard. We are just lucky that Winnipeg Regional Health Authority is funding two positions. To get a position, to get funding for administration and overhead, is one of the difficult things we find. In order to be aware of all of these programs that are out there, to do all the proposals and all the research, it would take that one person to do that. With the limited number people working, it is difficult.
I myself just hear about them, and someone will email me. If someone emails me about a chance for funding, then you are taking a whole day just to put it together. North End Revitalization also gives out maybe $5,000 here and there. Even for that $5,000, you need a report that thick, you know. So that is one of the things that I find very difficult.
Our First Nation clients include Metis, Inuit, First Nation. To get any money from the federal government for First Nation people, or Manitoba Metis Federation, is like trying to build a bridge — it is very difficult. We sometimes write letters to the Assembly of Manitoba Chiefs saying, we have 21 First Nations clients, so can you donate this amount of money, we are going on a field trip. They will put in a penny in a bucket. It is difficult to get any money. We are not even attempting to help people for medical services and travel and all of that. We try to direct them to the tribal councils, because we would just never be able to reach anybody.
Senator Cordy: You said, quite rightly, that the best programs are the ones that come from the people who need the programs. Yet, Mr. Sinclair, you said the announcement of the program is when you find out about it, without any consultation, or with little consultation. I am just wondering how much consultation is there between the Aboriginal First Nations groups and the Government of Canada before programs are announced?
Mr. Wolfe, you talked about the National Joint Working Group for reviewing recommendations relating to health care. Who is on this joint working group, and is the communication just coming one way or is it a dialogue? Who is part of the group?
Mr. Wolfe: Typically, in terms of that one, we have Indian Affairs and Northern Development at the table, Health Canada is at the table, various provinces may be at the table. We also, at the national level, have input from the Assembly of First Nations Chiefs. That is typically how we get the advice and input in terms of the policy issues and studies of that nature.
Senator Cordy: Ms Meade, you have ideas that you think would be very workable. How do you communicate that to others, or is there anybody you can communicate it to? Right now you are sort of looking at programs that are in place and you are trying to make what you want to do fit into the program. If you want to do something that comes up as an idea from one of the elders that you are working with, how do you try and find a program that fits into what they need, or can you recommend new programming to start?
Ms. Meade: With our group, you mean?
Senator Cordy: Yes.
Ms. Meade: Well, because we are labelled, our name is Aboriginal Senior Resource Centre, it is very difficult to go to the politicians. The AMC and MMF, however, have big leaders, they have politicians. So we are way at the bottom here. We hope that we can hear there is some kind of funding and if our group wants to do that, then we apply. But it is not to say we would be the priority, because, as you know, the politicians are the biggest ones, the loud speakers. When they announce big monies, we will attend, but we never even get anywhere near, because the big politicians are there.
When you talk about Indian Affairs and Northern Development, well, even myself as a First Nation coming from a small community, I never even go to Indian Affairs because there is no use. Indian Affairs will say, you know, we look after that reserve first. But that is my reserve, you know. That is why a group of women fought for portability of treaty rights.
If there is portability of treaty rights, we should be able to access that money. The only money I have access to is my $5.00 once a year, you know, that I can go and get. That is the only money, as a First Nation woman, from a First Nation community. But other than that, you have to live on the reserve.
The Chair: Which, by the way, I think is a bit of a myth. I think that many in the non-Aboriginal community think all Aboriginal people, no matter where they live, have access to all these programs. Those of us who have worked know that that is not true, but that is I think the perception often among the general public, that you have access to all of these programs.
Senator Chaput: Mr. Wolfe, you are Regional Director of Health Canada's Manitoba region, and it applies to First Nations and Inuit Health, but the funding is only for services on reserves. Even if, with the best intentions in the world, you would like to help Ms. Meade in her centre, because she has needs in transportation, your programs and policies and whatever would not help you to do so. Am I correct?
Mr. Wolfe: For the most part. The only thing I would like to correct there, Senator, is that for non-insured health benefits like drugs and other services like that, off-reserve First Nations can access that. All the other programs are for on-reserve. That is the mandate.
Senator Chaput: Ms. Meade, you get some funding, I heard, from different programs or whatever. You end up filling applications, getting small sums of monies, and working with programs, and many times having to do much, very much paperwork. It is the same thing with Mr. Sinclair, I believe. You do not have access to any funding to enable the centres in Winnipeg as an example, to get together and work together and make sure that one knows what the other does. Did I understand correctly? Did I hear correctly? Because you did not get to meet Ms Meade before today, right?
Ms. Meade: No. I know the friendship centre. I go there; I have worked tables there. We use the friendship centre, for example, for the Folklorama, when we go and set up a table. We go there and negotiate for a free meal for the seniors there. They go there for functions. But as far as me and the organization, I always thought that organization is a friendship centre, a drop-in where you come and all of that. But I do work with Ma Mawi Wi Chi Itata Centre. I work with them. Like they do a star blanket training at our place because we have no money for that so they do that in the evening.
I partner with as many as I can. But I guess, in my eyes, I look at the friendship centre as a social program for everyone. I never see it as a senior centre.
Senator Chaput: I understand.
Ms. Meade: That is the reason why I do not, and I think Mr. Sinclair is new there because I knew all the staff before. In the area of recreation participation, socializing, we do go there. But as far as sitting down and say, well, let us look at our monies, we do not, we have not done that.
Senator Chaput: Either one of you, how many centres, if I may call them that way, are there in Winnipeg, centres that have to do with Aboriginal or First Nations, whether they are for youth or for elders? Are there quite a few?
Ms. Meade: I think each area has its own. East Kildonan has a drop-in centre, and the North End, and then St. Boniface has a little centre. But I do not know if they are all specifically for Aboriginal. I know East Kildonan has a little Aboriginal Resource Centre but that is for young people.
Senator Chaput: Do you want to answer that, too?
Mr. Sinclair: Yes. I could not give a number. But there are quite a few. Like right around the friendship centre in the immediate vicinity, we have five to 10, pretty evident. Like I say, there is Ma Mawa Wi, there is Ndinawe, there is a friendship centre, Rossbrook House. So there are a lot of avenues. What each one pertains to, I could not say. And that is just in our general area. But then if you are looking West Broadway, if you are looking the North End, the North End Co-op is a cooperative that operates in Gilbert Park, but they have an office over in Brooklyn, in Weston.
There are a lot of different things out there. You can get your name on a mailing list through the North End Renewal Corporation, or the Aboriginal Centre out on Higgins there, where they send out a book, you know, it is this big, and it has a list of all the different services.
Ms. Meade: But there are no seniors.
Mr. Sinclair: There are no seniors groups.
Senator Chaput: Ms. Meade, you talked a while ago about focus groups. So when you put into place a focus group of elders, because you want to discuss a certain issue, how do you reach those seniors?
Ms. Meade: Well, when we do a focus group, we usually put it in the Native newspapers, like Thunderbird Voice and Grassroads, and then we advertise in the areas. Usually we will do about 12 to 15 seniors in a focus group. We did one on Henderson at Good Neighbour Seniors. We work quite well with non-Aboriginal seniors centres, because Good Neighbours just let us have our focus group there. Because we are trying to reach seniors in different areas, because that is our mandate through Winnipeg Regional Health Authority.
I think at the beginning I said that is the way of promoting our centre, recruiting. But, again, you have to be careful not to have an influx of people because how are you going to help them with very few resources?
Senator Chaput: At the beginning of your presentation, Ms. Meade, I believe you said, and I agree with you, that Aboriginal seniors past 65 should have the right to work if they want to, or many times if they need to. According to the focus groups that you have held and the people that go to your centre, do you know the kind of work that these seniors over 65 would like to do, or are looking at, or are there any skills that they would need to be trained for? Do you have an idea, or have you done that work yet?
Ms. Meade: Well, the last time we did a focus group, we talked about the areas where Aboriginal seniors would be interested in doing things. Right now, at least in the City of Winnipeg, there are lots of requests for seniors to go and work at the schools, to help out at the schools with honorariums. Two of our ladies help out like that. One is 81 years old and is a counsellor at Yellow Quill College two days a week. The other is a counsellor at the Red River College Aboriginal student organization there two days a week to three days a week. Another one, who is 77, works for New Directions as the elder counsellor.
Those are the jobs that our people can do. Then do not forget that our age group, the 65 year old and up, right now, are mostly the people that were in residential schools. They do have skills. I would not want to be a teacher again, but I was a teacher. I am working after 65. But I think there should be an incentive for seniors to continue to work, because there are a lot of skills.
As I go to these meetings, preparing for the elder abuse conference, a lot of elders are sitting there. Mind you, they are not Aboriginals. I am the representative of the Aboriginals. But I see all the skills in there. That is why I say we can work after 65. In fact, I predict a lot of us are going to have to work until we can do work no more, because of the economy.
The Chair: Mr. Wolfe, I would just like to end this afternoon with respect to a comment that you made about the Aboriginal Health Transition Fund. What are the successes? You mentioned the need for coordination. I think we all recognize that that has been the area where work must be done. Have you achieved any successes here in Manitoba?
Mr. Wolfe: At this point, no. Most of the programs have now been running for just over a year, so it is too early to tell. We are hopeful. We have seen some initial success, I think, in addressing the fact that was raised here, in that the jurisdictions are talking to each other. We have all the partners at the table. Even though, as you well know, government is always hamstrung by stove-piping jurisdictional issues. We deal with that on an ongoing basis. Often, First Nations are caught in the middle of that, regardless of the issues, whether medical transportation or other.
So we do have those people at the table. We are trying to get a better understanding of how that might be, and do what we can, within our respective mandates, to move things ahead. Because there is always flexibility. There are things that we can do and I am hoping we will be able to do. Because I do certainly understand the frustrations. First Nations and as government would like to see a seamless continuum of care from on-reserve into urban centre but often our policies do not allow for a continuation of that after a certain amount of time. After that, other services should kick in but in many cases they do not, at least not quickly enough. So you do have these rifts between them.
In short, no, it is too early to tell. I am hoping that we will see good evaluations. We do an annual evaluation, but most of these projects are fairly long-term and that takes some time to take effect.
The Chair: Well, it would be a good day when the huge elephant in the room, the one who is asking the question, ``is this provincial, federal or municipal,'' would leave and go away, and we just decide that Canadians are Canadians.
Senators, we have a great gathering for our final panel session this afternoon. Maria Krentz is Acting Administrator for the Menno Home for the Aged. Steinbach 55 Plus is represented by Pat Porter, President, and Dianna White, Executive Director. We have the Club d'Amitié represented by Paulette Sabot, Treasurer. We have the Rest Haven Nursing Home, represented by Tannis Nickel, Director of Nursing Services. From the South Eastman Health Region, we have Sylvia Nilsson-Barkman, Services to Seniors Program Specialist.
Thank you, and I think we will begin with Ms. Krentz.
Maria Krentz, Acting Administrator, Menno Home for the Aged: Good afternoon. I was not sure how to prepare. After reading the second interim report of the Senate committee, I have some comments in relation to aging in place.
As stated in the second interim report of the Special Senate Committee on Aging, allowing seniors to age in the place of their choice requires a myriad of services, including adequate and affordable housing options, long-term care, community support services, and home care. The implementation of the Aging in Place Policy in this region is driving the building of supportive and assisted living housing units and more long-term care facilities or beds. The pattern has been to move an elder from their home to independent living apartment units, to assisted living, to supportive housing, and eventually to personal care home or long-term care. This model translates into four to five moves at least for any senior or disabled person, which changes their physical and social support systems, challenges their adaptation abilities, and often results in further social isolation and loneliness. We even impose marital separation. As stated by a cognitively well centenarian, as another move was being imposed on her, it was not the place that she was being moved into that was the problem, but the number of moves. There is no maintenance of choice.
Within the long-term care continuum, anecdotal reports demonstrate that with each move, the elder's loss of cognitive and physical functioning is significant. I feel that we are applying 20th century solutions to a 21st century need, and I feel there must be a better way.
I believe that moving to institutionalized settings is counter to the principle of encouraging aging in place, even if they are located within the same home community. All levels are forms of institutionalization, but only the personal care home or long-term care includes some programming for a holistic approach to living and wellness at all stages, and this is somewhat individualized and monitored. In assisted and supportive housing and long-term care, many of the activities of daily living are attended to by paid staff, usually focusing on the physical and safety needs. This decreases the opportunity for physical and social activity and leads to dependence and loss of meaningful life activities, or a purpose for being. Data already demonstrates that a reduction in activity levels is associated with seniors who live in institutions or in isolation.
As identified by the interim report, people are living longer and healthier lives. Also there is a need to heed the warning not to overbuild, a critical element that may result in an over-abundance of physical structures, similar to the proliferation of hospitals. In this region, we are already experiencing a dip in the number of people awaiting placement and the length of time that they are waiting for a PCH bed.
The challenge today is not to physically relocate our elders, unless they choose to, but to mobilize resources to match their needs. The focus must remain on changing the service delivery and not only the environmental structures, such as assisted living and supportive housing. These systems do provide support to meet physiological needs, through nutrition/meals, housekeeping, laundry, et cetera. But, based on my personal experience, the expectation is for an individual to be motivated to access any of the social or recreational activities. Often, they sit in their little apartment alone.
Again, as stated in the interim report, studies have demonstrated a strong correlation between positive social relationships and mental and physical health, and that a lack of social relationships has also been identified as a risk factor for the development of health problems. Data supports that people in urban areas have increased social exclusion compared to those living in the rural communities. However, perhaps building these types of housing alternatives also approximates mini cities, irrespective of their location.
The power of being invited makes people feel wanted and increases participation. Reaching out can be at an individual or at a group community level. This approach is in concert with addressing the identified barriers, whereby an enabler can be in the form of a personal invitation to participate. This is effective in personal care homes whereby the recreation aides invite residents to participate in scheduled activities. If they happened to forget, they are reminded. But they always have a choice of attending or not attending.
Allocation of resources, fiscal and human, should focus on restructuring what exists instead of building more of the same. Seniors and disabled do require safe environments that support socialization, relationship building, education, and meeting all of the other determinants of health. With today's technology, we have the means to promote safety through improved vigilance and more timely responses. The restructuring must include professional and non- professional supports that promote healthy living and quality of life, minimizing displacements across the continuum of alternative housing, with the overarching goal being mobilization of resources to where the people live and not mobilizing the seniors to centralized services. We should never impose more than one move.
On page 43, your interim report talks about ``one-stop shopping.'' This analogy can be further reduced to just a one stop, similar to an all inclusive resort. An idealistic integration of housing, health, recreational, social and spiritual assets can be provided within a one-stop model. For example, as I age, my ability to independently meet personal holistic needs can no longer be achieved within my home setting. However, my husband remains relatively healthy and independent. There would only be one move, involving both of us. The integrated model would provide housing for both, with access to shared services, such as meals and laundry, whereby the level of support provided is flexible based on needs, developing a community within a community. It would be almost like a commune, which would definitely appeal to the hippies of my generation. Thus my husband would have the opportunity to stay by my side, prepare his own meals, et cetera, and assist in providing care to meet my needs and the needs of others. He likes to be helpful.
With continuous and flexible services, even with disabilities, we can actively contribute to our own health and that of others. A feeling of shared helping/caring amongst the residents would be nurtured. Every person would be supported to contribute and participate safely in meaningful life activities. Safety devices are installed in all suites, but only those needed for the safety of the specific individual would be activated, to avoid violating privacy. Recreational opportunities can include a pool, theatre, bowling, a park, et cetera. For couples, when one spouse is deceased, the other remains in the same place, supported and nurtured, based on his or her needs amongst people with whom he/she shares a relationship. This same community would function based on democratic process where representatives can even be elected to govern that community.
I also want to share a real example of commitment and needs between spouses. We have a resident who required admission to personal care related to a severe decline in cognitive abilities. It challenged and exhausted the husband's abilities to provide a safe environment for her. The wife is admitted, the husband is there everyday, assisting her in any way he possibly can, because, in his words, she is his wife and that is his promise to her. The children are concerned that he is severing connections with the outside world. He has joined our in-house choir, attends church services, participates in some recreational activities such as games, and enjoys the special programming that volunteers bring. Based on his experience as a greenhouse owner, he supervises the yard work, sharing his expertise. But everyday he has to come to the personal care home, and then he returns to an independent living housing apartment where he and his wife moved when they could no longer be supported in their own home.
In summary, building more independent living, assisted living, supportive housing, and long-term care units based on existing models, to me, violates the aging in place principle. It displaces the seniors repeatedly through the necessitated moves. A novel integrated approach that minimizes relocating of the seniors, but provides flexible human and physical resources would maximize the health of the aging population without generating future obsolete infrastructure.
The Chair: Thank you. I like that, mobilize the need, not mobilize the seniors. Well said.
Tannis Nickel, Director, Nursing Services, Rest Haven Nursing Home: Good afternoon. I am from Rest Haven Nursing Home. The Haven Group also includes other facilities, including Cedarwood Supportive Housing and WoodHaven Manor.
Our organization is owned by seven Evangelical Mennonite churches in the Steinbach area. We provide contract services for the personal care home to the South Eastman Region. The churches saw the needs of their elders and began the personal care home so that they could be looked after in the way that they found that they wanted. It began with the long-term care home, and then a supportive living home of 30 units was built, and then Woodhaven Manor, which has 86 suites, 20 are rent geared to income housing, and 66 are life-lease housing units.
The apartment complex is next to Rest Haven, which kind of adds to Maria's philosophy of aging in place as best as we can. Being juxtaposed in this way has certainly improved the lives of our residents and the families trying to make the best of the situation that we have. There is an opportunity for a husband to be living maybe in long-term care, and his wife perhaps to live independently in the manor. This is a move, but it is a simpler transition. This solves a bit of the transportation problem. However, once they are at the point that they have lost many of their facilities, they have to move from Woodhaven into a personal care home, which is not the best.
The residents at Woodhaven very often volunteer at Rest Haven, the personal care home, and they find a lot of support with that. So the volunteer program is very strong and the juxtaposition of the two facilities enables this. We have about 266 volunteers at Rest Haven Personal Care Home.
Other issues that come up with families that I work with are issues of housing options in the community. And again, they move from the home and a yard and working out of the home, and move to a smaller apartment due to health or need for more services. I am from the southeast region, Stuartburn, and in that area we still have many elders living in homes without running water and things like that. And actually, my grandmother had to move into a home because home care would not provide service because they had no running water. The running water was me and the 5-gallon pail.
The things when I often hear when a new resident moves in are issues relating to the physical structure of the house. We actually have one contractor who goes around and offers help to enlarge doorways and makes ramps, and things like that. And it is a huge help to some of the areas that do not have easy access. So the elderly resident can stay in their home a bit longer.
In reading the report, I found several issues that concern our residents in South Eastman, and the families and volunteers that work at Rest Haven. And it is reassuring to me that these issues are being looked at.
Thank you for the opportunity to speak here.
The Chair: Thank you.
And now from Ms Paulette Sabot.
[Translation]
Paulette Sabot, Treasurer, Club de l'Amitié: Madam Chair, I was asked to talk about our club in La Broquerie, which is called the Club de l'Amitié. So here is an overview of the main activities that take place in the course of a year in our little village. We have a physical activity program led by a very good coordinator every Tuesday morning. The third Thursday of every month, except for the summer, we put on a lunch, which we cook ourselves. And twice a year, we have a group outing to someplace, and then we go for lunch or supper. Last year we visited a recycling plant, Prairie Bio Energy, here in La Broquerie, and the Premier Peat Moss plant in Richer.
In October we go to St. Boniface to see the play for seniors, and again we take the opportunity to have lunch or supper out. We manage to fill seven or eight cars. That way, people who do not drive anymore or who do not like to drive to St. Boniface can still take part. This year there is even a group from our club in La Broquerie that is going to take part in the play.
At our lunch in March, we had a dozen students join us. It was a lunch to talk about the differences between life today and life 50 years ago, including activities, the cost of living, means of transportation and religion. The churches used to be too small and now they are too big.
At Christmas, we have the most special meal, a supper, attended by about 100 people. It is a Christmas treat, with turkey, meat pies and so on. And after supper a few members of the choir start to sing their Christmas carols.
In February, there are the Festival du Voyageur activities at the hotel in La Broquerie. Most of the members of the Club de l'Amitié go there for supper and, after supper, there is a musical evening with traditional songs and dancing.
In late April, we go to Sainte-Agathe for the spring games organized by the FAFM. There are cribbage, 500, whist and shuffleboard tournaments. Very interesting.
We also offer very low-cost lunches after funerals; we charge just enough to cover the cost of the food, which is prepared by the members of our club.
There is another volunteer service. If someone needs to go to the doctor's or do some errands, there are always drivers available for them. The club is also open afternoons. Some men meet to play billiards. As some people say, we do not want to get rusty in La Broquerie, so we keep busy.
[English]
The Chair: Thank you. And now from Sylvia Nilsson-Barkman, please?
Sylvia Nilsson-Barkman, Services to Seniors Program Specialist, South Eastman Health: I have prepared a little differently. There were basically four issues that I thought I would bring forward. I have more of a regional perspective in that I serve the region.
When I think about ``rural,'' I think about it differently than some people. There is rural-urban, like Steinbach, there is rural-rural like Ste. Anne, and there is rural-remote. And it is the rural-remote that I will allude to in a couple of the situations that I am bringing forward. Because it seems like the smaller you get, the greater the challenge, and we certainly have some challenges.
I work with an organization called the Eastman Senior Citizens Council, which is made up of representatives from 21 senior clubs and the multi-purpose senior centre. And they have identified the greatest need as transportation. They have been voicing their concern to various people. And I think, again, the more rural you get, the more of a challenge transportation becomes as well.
In our region we have three communities that have handi-van services. That is not very much. This is a whole region with only three communities that have handi-van. The other services are provided through volunteer drivers that are recruited through community and tenant resource programs in the region. And the difficulty they face is finding volunteers who can take people with disabilities. If someone is in a wheelchair, or if they are not very safe transferring, then really they need a handi-van. And the volunteer driving program is not maybe something that best serves them.
Handi-vans are not very viable because they are extremely expensive once you get outside a more urban area. Dianna White and Pat Porter are sitting here, and they will say they are even expensive in Steinbach which I consider to be urban-rural.
I guess part of the problem is that in order for a community to purchase a handi-van, they have to raise a considerable amount of money, because the program that intergovernmental services offers only provides a portion of the capital cost for a handi-van and part of the operating costs. The costs are really put down onto the people that are using the services. That cost becomes really quite prohibitive for some people.
I will just give you some real figures. If one were to take the handi-van to see a specialist, let us say, because specialists are usually in Winnipeg, it would cost $94. To that, you can add another $26 for waiting for one hour and if you wait for more than one hour, another $26. So that is $120 just to go and see a doctor in Winnipeg.
Now, if I were to take our most remote area, in the Rural Municipality of Piney, the cost would be over $200 if that person had a handi-van. Now, they do not have handi-vans, they only have volunteer drivers, so the amount is a bit less. Of course, that does not suit everybody's need if their physical needs are greater than a volunteer driver can provide. So it is extremely expensive to rural people to use some of these services.
We are also experiencing a decline in the number of volunteer drivers that can actually drive people into the City of Winnipeg to see specialists. We find most of our volunteers are seniors themselves, and some of them are older seniors. The younger seniors are having a great time in life. They are not always volunteering, they are not always going to the Club de l'Amité, right? They might volunteer some, I am not saying they are doing nothing. But a lot of them are older seniors. They do not feel comfortable driving in the city, it is very frightening for them to drive there. Or they might have a disability that prevents them from weaving in and out of traffic and handling that. So that is a great need.
The rising cost of gasoline is causing problems. All of these programs are now looking at raising their fees. So instead of a volunteer driver charging $45 plus parking and a few other little expenses to drive from Steinbach to Winnipeg, if it is a volunteer and not a handi-van, that will increase shortly as well. Because somehow, someone has to pay those additional costs.
That is a tremendous concern. I do know that seniors can use medical transportation as a tax deduction. But if you look at the ones that are really struggling, it is the ones that are on basic pensions, and those tax deductions just do not help you at that level. It would be really nice if there was some type of subsidy that would help seniors who really need this service to use it.
In the more remote areas, it would be really nice if we could have smaller vans that would be cheaper to drive. If there were some program through government that would help subsidize that, I think that might be an answer. Maybe there could be better coordination between some of the communities in sharing resources.
The community of Sainte-Anne-La Broquerie right now is doing a handi-van survey, because they know there are a lot of people that need the service, but they are already starting to hear that the cost of using the handi-van will be prohibitive. So that is one of the issues.
Housing was another one. Again, I just wanted to point out that, again, when you go to rural-remote areas, it is very difficult to work with housing. It seems like these areas just do not fit into the box. There are these boxes out there, and you have to meet all their criteria. And one of the criteria, of course, is raising a good portion of the money yourself and then maybe getting an affordable housing grant.
When you look at a community like the Rural Municipality of Piney, who really need housing, the average income is around $26,000. The average home value is around $53,000, and the money is just not there to go and raise $2 million to build 15 housing units. It is a tremendous struggle.
One thing that we have found when we communicate with Manitoba Housing is that remote areas are not considered in the same way as northern communities, so they cannot be given a little preferential treatment, or there is no understanding that it is more difficult to raise funds in those areas.
There is a new program called Homeworks and that leads to the same conversation: you are not northern, or you are not this or that. But I guess it is something that they will still try and pursue.
The health status in the Rural Municipality of Piney, for example, is really affected by the lack of resources. In my brief, I mentioned just a few things. The thing that we found is that the small remote communities are really cozy, you know, they are really nice places. People feel comfortable and their neighbours help them, and it is a wonderful place to be. And they will live at risk rather than move from them. If we cannot put the resources in there, it becomes a struggle for the healthcare system to meet their needs properly. We see when we finally do get them to a point where they have to come into hospital, their hospital stays are far longer than they are for the normal population. I have a few statistics in here, I know you are receiving this report, I probably do not need to read them. The crude death rate, again, much higher. Basically, this is our poorest and our sickest area, and it is very difficult to meet their needs.
We came up with a wonderful model where we would have a primary healthcare centre, which already exists in Sprague. To that we wanted to add a 12-bed personal care home and an 8-bed supportive housing unit. The supportive housing unit would be a special unit that could become personal care home beds, or could become supportive housing, whatever the need was, and to that the community would add 15 elderly person housing units. We would utilize the staff out of the primary healthcare centre for doctor support, for doing a lot of healthy living teaching. We really thought it is a wonderful model and we are still struggling to get there. But it is a struggle because the money just is not out there in these very remote areas.
On healthy living, I loved your document and how you talked about healthy living, it was just very, very exciting. I think that is really where we need to go to keep people healthy longer. I am really glad Dianna White is here, because they are doing some great things in our region, as have some of the community resource counsels. What we are finding, however, is that we do not have the materials and we do not have the funding to subsidize the extra staff time you need to deliver this. So you have probably heard all this before, but it is really true.
We have found a really neat product that was called Living It Up. I do not know if you have heard of it, but it is a nutrition and exercise program for seniors. There are six modules that were developed by a nutrition student in Winnipeg. And with very little training, we were able to train lay people who work with these resource councils to deliver these modules. Seniors are just coming in droves to them, because you learn a lot, but you have a lot of fun with it too. And now Partners Seeking Solutions has come out with a drug and alcohol package that has modules, so we grabbed that up. The RCMP have Police Academy, and that is on personal safety.
We are starting to get our hands on these materials. We can use people who are not really professionals, but who with enough training and support can reach out to seniors in such a way that seniors want to participate. There is really a great demand for this information, and we would really like to be able to support these community groups that run these councils to deliver these services.
At this point, the Regional Health Authority is not adding any dollars because we do not have any dollars to add to do those things, but that would be wonderful to go in that direction.
The central district of our region has a great need. The RHA has developed a long-term care strategy. We find that in our central district, which is basically Steinbach and the Regional Municipality of Hanover, we have a large number of seniors, and the waiting list for personal care homes is extremely long. We have had up to 130 people on our waiting list in our region. That is not all for the central district, but most of it is for the central district. We have only 160 care home beds in that area. Over the last 30 years, the number of personal care home beds in South Eastman region has not changed, but our population has certainly changed. We have seven personal care homes with 334 beds, and there is a real need for this, and especially within the central district. I just wanted to raise that issue.
Dianna White, Executive Director, Steinbach 55 Plus: I am Dianna White and I am the Executive Director of Steinbach 55 Plus. We are located in Steinbach, and just recently, four years ago, purchased a large centre, just over 15,000 square feet. Our mission is to promote healthy active living to seniors, encompassing all the elements, the social, the emotional, the mental and the physical well-being. In order to do that, we have programming activities and services, and also volunteer opportunities, to help people remain independent in their community and to keep contributing to the community in which they live.
We fall under the guidance of Ms Nilsson-Barkman, in the support services to seniors management area, and do receive some funding from the Regional Health Authority. However, the senior centre itself that actually promotes the healthy active living is required to raise 70 per cent of its budget through means other than a grant from the Regional Health Authority. So much of our time and effort does go into fundraising in order to keep the programs running.
We have a community resource coordinator that works out of the centre, as well as two meals programs, one in Steinbach and one in Grunthal. We also run a two day a week adult day program for the frail elderly, and that is a partnership with homecare continuing care. It is a busy place at Steinbach 55 Plus.
While I affirm the needs that Ms Nilsson-Barkman has addressed, we are definitely very much aware of them, we are the only senior centre in all of South Eastman region. Our doors are open to all the seniors in South Eastman. But our primary area of service wwould be Steinbach and probably the Regional Municipality of Hanover, maybe reaching into Ste. Anne and La Broquerie just a little bit. But it is very limited and it is, again, a matter of transportation and distance. We do welcome all of the seniors in our region to come and participate and be involved.
Interestingly enough, in early April I was invited to a rural working group for older adults, which was held in Winnipeg, and the issues that you identify in your report are the same issues that came out of that one day session. And they were the issues of transportation, long-term care, nutrition and health, and healthy living. Affordable housing, of course, is huge.
At our centre we have identified one other issue that is of great concern to the seniors, and that is the issue of the doctors in our community. Right now, according to the statistics that we are able to just pull off their website, we have 20 doctors that practice out of two clinics, and then we also have three or four few doctors who work out of the Bethesda Hospital right in our area.
Recently, we learned that four doctors are leaving the community. The doctors we have at present, the 20 that are there, are all not taking new patients because they are fully booked. We now have, more specific to our concerns, an aging population who have bought into the healthy active living plan, but are still needing the doctor, and will need the doctor more as they grow older if they do not already. And the numbers of the doctors are diminishing.
There was an estimate done last week there could possibly be as many as 5,000 residents of Steinbach and immediate area without access to a family doctor. So imagine what that will do once these doctors leave, even to the Bethesda Hospital emergency department. And costs are higher for them to come in there.
That is a concern that has been identified at Steinbach 55 Plus. Imagine yourself being 75 years old, maybe being a diabetic or having high blood pressure, and going to your doctor every three months to get it checked and get a new prescription, and suddenly you are told that your doctor is leaving and nobody else is taking new patients. That is an issue that we have identified at 55 Plus.
Senator Mercer: Ms. Krentz, you have challenged us with a couple of very important things. You talked about one move as opposed to the four to five minimum moves that were happening. This is difficult to plan, as you can appreciate, as you have described. There are only a few centres that we have seen so far where this happens. One centre in my hometown that does have all of the levels of care, right up to and including palliative care. But that would mean the person might move into a stand-alone apartment, them and their spouse. As they progress, they would have to move within the complex, but within basically the same complex of four buildings attached to each other with common services in the middle. Does that work, or do you still think that it is the one move that is needed?
Ms Krentz: As I mentioned, idealistically, I want only one move, and I am not sure how to make it happen. I have dreamt of it for a long, long time. There are a lot of models out there. One of the things that occurred to me as I was driving here today, one area that I do not think anybody has ever alluded to or touched upon, is sexuality in the elderly. People still have needs, not necessarily sexual, but the need to be cared for by your spouse if you still have one, in that kind of close relationship. But we still displace them, even if it is within that type of a complex.
I do not have a solution, only a dream. That is why I brought it here, I thought I might as well challenge everybody. It is a dream that I have, and it is about mobilizing resources. If you can actually build this model, and I do not have anything concrete, you can use each other, the people that live there, to support other people there. I know there are a lot of models like you are describing, Senator Mercer, but I will go beyond that. I just do not know how to get there. It is a dream, but I think if we do not shoot for the dream, we will keep redoing the same things over and over again. And even people going from one part of a complex to the other, there is a significant change, especially in people with dementia. The cognitive abilities really, really decrease.
Senator Mercer: It is a dream that you have, but I must say it is probably not a dream you alone have. There are quite a few people who share that dream as well.
Ms Nilsson-Barkman, you talked about seniors who are willing to live at risk rather than move. Could you give us a little more, put a little meat on those bones for us?
Ms. Nilsson-Barkman: Our home care program did a review a few years ago when we were looking at developing this model in the Rural Municipality of Piney. They found that they had people that they should be panelling for nursing home, that they were struggling to care for, that were still living at home. They were living beyond what home care was really designed to be providing, but they just would not leave. They would rather stay there in their home community, knowing that they were at risk. It is a very difficult thing for care providers to deal with as well, where their care was surpassing that which a home care worker would feel comfortable providing.
Senator Mercer: It is also particularly a problem in rural-remote areas in very small communities.
Ms. Nilsson-Barkman: They have lived there all their lives; they have chosen to live that kind of a lifestyle. It is a very special place. When I talk to these people, like I can understand how they feel. I would not choose it for myself. They will feel quite displaced if they are removed to a larger centre. The only alternative would probably be to come to Steinbach. That is big for these people. For you and I, it would not be.
Senator Mercer: The issue for all of you, the issue of housing in its various forms is consistent. I think you said that the number of housing units has remained the same?
Ms. Nilsson-Barkman: The number of personal care home beds in the region has remained the same for the past 30 years. We did have some nursing homes that were replaced with nice new ones, but exactly the same number of beds.
Senator Mercer: At the same time, the population is aging.
Ms. Nilsson-Barkman: Yes. I guess another challenge that I see with what Ms Krentz is saying is that, when you take an average senior and put them into a place, they do not want to be with people that are not normal. That becomes a little bit of a difficulty if you want to age in place. Let us say you move into seniors housing, you can make that assisted living by adding meal programs and various supports, and then maybe you can even push it a bit further with block care through home care. But if everybody gets too ill, then it is not a normal healthy environment for some people, so then you lose this whole thing of this one move. It is a great idea, but do not know either how you do it. You can only do it, you can only push it to a certain point. Could you accept two moves?
Ms. Krentz: Only one.
Senator Mercer: It would be nice if we could negotiate, but we do not even have the facility to do the two moves yet.
I did not hear as much with this panel as we did with other panels was the discussion of transportation. Some of you did mention transportation to medical appointments. We were talking mainly in the last panel about Aboriginal people in rural remote areas, as well as urban areas. Is the volunteer base of volunteer groups who are providing the transportation, is that enough? Is that fulfilling the need, or are there people not getting medical services because there are not volunteers prepared to help?
Ms Nilsson-Barkman: We have some people where it is very difficult to transport them with volunteers. Then it is usually the family that ends up dealing with that, and it is home care that deals with it. I am kind of pre home care in the work that I have. So that would have been a great question for home care, because somehow those people need to see a specialist, or need to see a doctor. I am not sure who is doing it, but it is not Services to Seniors that take those special people. If they are not considered safe, it is just too high a risk for Services to Seniors to get a volunteer driver to do it.
Senator Mercer: There is also the question, from the volunteer's point of view, of insurance. Are they properly insured to be providing this kind of service?
Ms. Nilsson-Barkman: We have extended our High Rock Insurance to community and tenant resource programs within our region through the Regional Health Authority. We have written all of these programs that are part of Services to Seniors into our policy. We have not had one claim yet.
Senator Mercer: Knock on wood.
Ms Nilsson-Barkman: I am going to retire in a few months and I am just hoping I am going to make it, because something can just so easily happen.
Senator Mercer: We do live in Canada, we have winter and strange weather conditions.
Ms Nickel: Just a comment on transportation. I live in Stuartburn. It is pretty rural remote I would say. Just as an example, my husband does not drive in Winnipeg, because he has been in Stuartburn, and just has not had a need to go to Winnipeg all that often. He will drive to the mall somewhere close by. But when our child had a fractured leg and, you know, when mom is normally the one holding them on the way to the specialist, I was the one driving, because he just does not drive in Winnipeg.
So we, as a community, provide a support system to those people that do not. I take days off to take other people to Winnipeg. People coordinate their appointments and try to get on the same side.
As for home care, a lot of times they do end up taking handi-van. A lot of times actually what I have seen, and I know that it probably is not the best scenario — I worked in Vita Hospital for a while — we admitted people into the hospital and they went by ambulance.
Ms. Nilsson-Barkman: I am aware of that too.
Ms. Nickel: That is the alternative that they have.
Senator Mercer: Not a very efficient way to run a healthcare system, though, is it?
Ms. Krentz: I work in Grunthal, which is part of the Rural Municipality of Hanover, part of the Steinbach area. We do not have any health care services provided within the Grunthal area, which serves about a thousand people right immediately there, other than the personal care home. We are trying to support some of the people that just need regular blood work and so we have lab workers coming to the personal care home. We are trying to extend that service to the community and yet there is really not this infrastructure support. So there is a real need even from Grunthal, which is not very far from Steinbach, let alone from very remote areas for the transportation needs. It is huge.
Senator Mercer: Has there been discussion of two other types of delivery of healthcare, tele-health and the extensive use of nurse practitioners? Is that part of the solution to the problem?
Ms. Krentz: I would love to address the nurse practitioner. I believe that would help a lot to ease some of the primary healthcare issues, at least with the management of chronic diseases and so on in remote areas. I do believe that will help.
There is more than just the nurse out there that can help that aspect. As has been stated by Ms. White, we have experienced a physician shortage. At the personal care home, we struggled for about eight months without a physician addressing some of our resident care needs. It is really, really huge, but we just do not have enough. There is one nurse practitioner right now that I am aware of that is practicing in Bethesda Hospital, in the emergency department. I know the Regional Health Authority is planning to hire more, but it is just brand new still here. But I do see that as a viable option. Unfortunately, I am a nurse, and as a nurse I do not feel that nurses should replace doctors. Even though I am totally pro the nurse practitioner program, I do not want nurses to be used in this way, just because we have a doctor shortage. I believe in promoting nursing per se as a profession, as a discipline. Therefore, where is our role in the future, where is our role? It is not just because there is a doctor shortage at the present time that we should be promoting nursing taking leadership in that area.
The Chair: I am going to build a little bit on Senator Mercer's question and your responses to that, and that is this whole question of risk. We have spoken to a lot of professionals in elder law. Of course, they would assert that if I want to live at risk, that is my choice, and that nobody should step on my particular rights as a citizen and say, you are not allowed to live at risk. What would your comments be about that, Ms. Nilsson-Barkman?
Ms Nilsson-Barkman: When we were looking at personal care home beds for this remote area, I did not talk to the seniors themselves, I talked to the home care workers. They felt that some of those people would move if there was a facility within their own community, with their own neighbours moving into this facility. However, they would just rather be at risk than move away from the community, and if they die there, they die there. They are at home there.
The Chair: Unfortunately, when you live in rural areas, and certainly rural remote areas, you could in fact build say an eight bed personal care unit, or maybe a 15-bed personal care unit. Then you might well have a situation in which very large number of the clients within that personal care bed suffer from severe dementia. Other people do not want to be in that environment, because they do not want to be with these people who — and I think one of you said it — are not normal. They are still normal and they do not want to be with people that they perceive as normal.
When we visited the Northwood Manor, which was the centre that Senator Mercer addressed, they have seven or eight floors. Some of those floors can be designated for Alzheimer's or dementia patients, but then they have normal floors, if you will. That becomes a very difficult issue, I would suggest to you, when you get into a situation in which you have very few beds, and in which we know in the future, maybe dementia and Alzheimer's are going to be very huge issues. Particularly, if we have a population that, instead of the average age being 82 or 83, the average age perhaps becomes 85 or 86. We know that dementia levels start increasing very rapidly over that particular point in time. What would you comment on that?
Ms Nilsson-Barkman: I guess when we were looking at this model for the Rural Municipality of Piney, we knew that we had to create some critical mass. We needed to have things that would build on each other, because standing alone, a 12-bed personal care home is not viable. You need a 20-bed unit, to staff it properly so that it is financially sound. We thought if we could take out eight of those beds and make a special unit that can swing either way, we could remove it from the area where the personal care home part is, where the people that would have more dementia, or have more difficulty with dementia would be, and we would have this swing unit in the middle. Then those people could perhaps participate in some activities with the more normal ones on the other side, and wrap that around with the services that the primary health care centre offers. It is not an ideal situation. There still is some of that element of normality. But to make a viable product, we felt that we needed all of those components and that we would try to divide them appropriately.
Ms Nickel: I think that some of it has to do with your sense of community as well. These people are from that area. We accept panelled residents from basically all over South Eastman. Some people want to come to Steinbach, for example because their children live in Steinbach. Now there would be some that I can see that would want to stay in Piney, that want to stay in Vita, because their children are there.
Mind you, if they go into that setting and are normal, they are with their neighbour that they were neighbours with 20 years ago, who they probably had to help 10 years ago, and now they themselves are in a situation where they need services. Some people may not want to be in with somebody who is not as able as they are. However, I think they are looking at how they can help in that situation, or what they can provide for somebody else in that situation. Because of that sense of community, I think people are very forgiving in that situation.
So I see it both ways. I see it as a hindrance in a sense. Rest Haven is two separate floors, but we are not separated by any kind of dementia or non dementia. You see it very often, that they form a very close bond with who they are living with, and act appropriately. They can steer this person away from the door if they have to. They can help give this person their spoon if they need to. It becomes a very close knit home.
The Chair: I noticed when I was talking about living at risk, Ms. Porter, you were nodding your head. Would you like to make a contribution?
Pat Porter, President, Steinbach 55 Plus: Well, I think as you get older, yes, you probably do choose to live at risk. For example, I have lived in my own home for 32 years. I am not at risk yet, but you do not know when the time comes. Whether I will choose to stay there on my own or not, that is another question. Of course, home care would be available in Steinbach.
Senator Chaput: Madam Chair, I do not have any questions because Senator Mercer has stolen them all. As he was asking his questions, I had to strike down my notes. I have really enjoyed all your presentations and what you have told us today. Many things we have been told before, maybe in other ways, but there is a link, and the challenges that you are going through here are challenges that we are going through, I believe, across Canada.
Senator Cordy: We are still going to Vancouver and to Victoria, but we have been to the East Coast, Central Canada and now to what is really Central Canada, not Ontario. We are hearing the same types of things that we have heard when we had sittings in Ottawa, and when we travelled part way across the country.
I would like to go back to the transportation issue again, because we have really, or I certainly have struggled with this. What is the solution? We have talked about giving bus passes to seniors, which works in an urban area, and it works for seniors who are not handicapped. Somebody referred today to the tax benefit if you buy a bus pass and it is the same thing: that works if you make enough money to pay taxes, if you live in an urban area, and if you do not have a disability and you can use public transit. That really is for the use of very few seniors. But the challenges start to come in rural areas.
I am from Nova Scotia, so we have got Halifax, which is a city, and we have got Sydney and Cape Breton, the industrial area, which is a city, but it is very much a rural province. The challenges are there: you are read the paper every so often and you find that the bus from Halifax to Yarmouth is being cancelled, or the bus that went from Halifax to the Annapolis Valley is being cancelled. The challenge might be that the bus goes at 8 o'clock in the morning from Windsor to Halifax but does not return until the next day. So you have got a hotel bill. I know we have bandied it about even this afternoon.
What solutions do you have that we could recommend? Because what we would like to do is make recommendations in our paper and our report. It is a challenge to find something that is workable for the majority. I am not sure that you can find the one size fits all, because we have talked about urban versus rural. We have talked about volunteers, they are diminishing because we have got seniors helping seniors, with the cost of gas. These are all challenges that we are looking at. You have the solution?
Ms Krentz: I do not have the solution, but many, many dreams.
In the South Eastman community health assessment, they really looked at many, many aspects that they addressed, and one of them was transportation. And when you look at their children taking people, as Ms Nickel was saying, because there are no alternatives, it also impacts the economy of this area.
In the Regional Municipality of Hanover, again, our economy, or the income that people have, is below the provincial average. When you look at people taking time off work, a lot of the people that work, say at Loewen Windows, do not have a paid day off just because you are ill or you are taking somebody ill to go to the hospital. The cost of transportation becomes huge, but it also impacts on the person who has to take time off.
I live between Steinbach and Grunthal. Grunthal is a small community, as I mentioned before. In Grunthal, the community spirit is incredible. The relationship there, the community coming together, it is very faith based, and the church plays a huge role in the cohesiveness of the community. therefore, there is a lot of community spirit and support that way. We do have a handi-van, that is it, there is nothing else. Unless you need the handi-van or you need an ambulance, there is no alternative to than friends, family, volunteers. The community spirit is there, so that comes forward and that supports people, but there is no alternative. If you want a taxi, you have to get a taxi from Steinbach. It is 27 kilometres one way.
Ms Nickel: We have nothing; we have a horse.
Ms Krentz: So I dream a lot, but I have no solutions.
Ms Nilsson-Barkman: Grey Goose Bus Lines.
Ms. Nickel: No, there is no bus line out to Vita, and that is actually how the hospital used to get their blood services, and now we have to have volunteers to get the blood, if we need blood for that area.
I like Ms Nilsson-Barkman's small van idea. I think that is something retrofitted so you can access wheelchairs. We have a neighbour that my husband actually has just refused to take to the hospital because he is 300 pounds and my husband cannot help him in the vehicle anymore. So it is the handi-van. And for the Vita handi-van to come pick him up just to take him to Vita Hospital was going to cost around $80, and they just cannot afford something like that in this area.
A small van, of course, would be a little bit more economical. Because the thing is, there is not the volume. I know at Rest Haven we have our own handi-van, but it is not viable. We actually support Steinbach handi-van as much as we can, because it is actually cheaper for us to send our residents with Steinbach handi-van than it is to use our own handi- van.
In town, the handi-vans are there, but for the rural area, it is basically volunteer. Some alternative needs to be arranged because more people from my generation are working long distances. You cannot drive away, you know, and decide to come home and take people. I know that I take a lot of my neighbours to a lot of places, but I cannot do it alone, and neither can all the volunteers that are there.
Senator Cordy: And the challenge is with children too. In Nova Scotia, the rural areas, many of the young people are moving to Halifax or moving to Alberta. Family members in years gone by would have picked up a lot of this, but that is just not necessarily the case.
I am interested too in Steinbach 55 and the Club de l'Amitié, and we have heard and you sort of know it. People who were involved in the community when they were younger are likely going to be the people who are involved in the community as volunteers when they get to be senior citizens. In the same way, people who were active when they were younger are going to be the people who go to the friendship centres, or go to, in Halifax I think it was called Club 55 rather than Steinbach 55 Plus.
Do you have any type of an outreach program? Because certainly we have heard about isolation with seniors. For some of the reasons that I have mentioned earlier, families are not living in the area anymore, and we can have isolation in the city. Particularly in rural areas, if family members are not around, how do you reach out to seniors so that they become active within the community?
Ms Nickel: In the southeast, there are a number of different little, I guess they are not official senior centres, but they are groups, like the town hall where they have bingo on a certain night or things like that. They provide their own little support. I know Tolstoy has, Roseau River has, little towns like that have. I do not know if there are more areas like that. I know Piney has a bit of an active area where they make moccasins in the winter time, crafts groups, things like that in the Sprague area.
Ms White: Most of the senior clubs in South Eastman region belong to Eastman Senior Citizens Council, and there is a small fee of $20 a year that you pay. They provide some collective events where people can get together and enjoy each other's company, but also receive information and network between the clubs.
The clubs are a little different in that they usually have a board or a committee, whereas the senior centre has staff and is governed by a board. Our board of directors is a 12-member board. And we are responsible as a board to the membership and to the Regional Health Authority, to make sure that the funds we get are being used to provide the services that they are purchasing from us.
For advertising, we choose to use the local newspaper, so that there is always information about programs and activities, and to make a place welcoming. One of the ways that many people choose to get involved, even at the senior centre, is through volunteerism. If they are new to the community and they know that they can come in and contribute something, and then they become involved, and as they move along as they need services, they would be very familiar with the steps that are there. We sort of see ourselves as one stop shopping for a senior while they are living in the community. When they are healthy, they can choose to volunteer, participate in healthy active living. We have a computer lab, so volunteers are in there to help people learn the computer. Then we have fitness classes, Tai Chi, mall walking activities. We just had a long-term care workshop at the centre last week that was open to the community and many people came out and attended.
We try to offer all of those, and hope that people will become involved and will become informed. The local newspaper is gracious to us in that they allow us to have a column and we can advertise these things. Our local radio station does their part in giving us promotion and advertising, often at no cost, or minimum cost. That is how we hope to create awareness.
Our community resource coordinator does have a friendly visiting program, and family members can call for mom and dad and say, you know, mom and dad are lonely, or dad is lonely and would love to have someone come and see them. Our resource coordinator then matches them up with someone who has volunteered to do friendly visiting. For the friendly visitor, a volunteer application is put in place, there is a confidentiality check done, there is a police check done to ensure they are suitable to go into seniors' homes and will not have any issues there. So that is one that is popular.
She also has the transportation program which is used very much but, like the rest of them, is not always adequate. It becomes a particular issue when people become less mobile. It is one thing, even when they call the handi-van, the handi-van priority is for medical care and medical issues. If you are in a wheelchair and you want to go shopping, you may not be able to go shopping because the handi-van's first priority is health and medical. Those kinds of things come on the second level of importance. That is an issue as well. I do not know if that answers your question.
Senator Cordy: Yes.
The Chair: It has been a dilemma, I think, for a number of years, particularly in Manitoba. I mean, 65 per cent of our people live in the City of Winnipeg, so Winnipeg has always sucked up a certain number of services, because there is the sense of we deserve, we have the majority of people that just live in this one urban centre. Has anybody ever given serious discussion, in any of the health regions, to the idea that transportation from communities like this should be free to Winnipeg?
Ms Nickel: Not that I have heard.
Ms Krentz: There has actually been one change in relation to ambulance services, and that happened very recently. I believe it was like just over a year ago in the fall. I used to work at Bethesda Hospital emergency room. So let us say you came in, you had a motor vehicle accident and we sent you to Winnipeg, and you stayed there, you were admitted there, because we cannot offer you the services here in Steinbach. If you stayed in Winnipeg at the Health Sciences or St. Boniface, the patient actually got charged for the ambulance service.
Now, in the same scenario, if we send you to Winnipeg for a CT scan and you came back to Bethesda, it was absorbed by the hospital. Now, that changed just recently. That has been changed, through Manitoba Health for transportation by ambulance. So now when it is medically necessary, irrespective whether you come back or not, and it is signed off by a physician, it is no cost to the person. That is a huge saving. Because people used to end up with all sorts of extra billing. You have just been traumatized because you have been in a motor vehicle accident, we cannot provide you with the services and then you get the bill, because we cannot provide you with the services here, locally. That to me was huge. Manitoba Health has responded accordingly.
From a personal care home perspective, Manitoba Health is responding to the need of attracting professional people to personal care homes in relation to nursing services, especially. They put more money in that basket. We have just gone through all these processes here regionally, where we put forth what our nursing hours should be. The goal is to provide 3.6 hours of direct care for each resident in a personal care home. It is making it more attractive. Because until now, the stigma about work in a personal care home was that you were no longer a real nurse, or you were not as glamorous. I mean you work in a personal care home, you are at the end of your career. There is less stigma attached to where you work and so on. So there is a little bit of progress in relation to that. As far as people in the community, that is still a challenge.
The Chair: The issue is clear. I mean, we all know that the vast majority of medical specialists are in fact located in Winnipeg. I mean, they are not, even with the greatest respect to Steinbach, they are not for the most part located in Steinbach, and they are not located in Ste. Anne, and they are not located in La Broquerie, they are located in Winnipeg. Winnipegers never give two thoughts to this. They get on the bus or perhaps they take a cab, or they do whatever, and they go to see the specialist, they get back in the cab, they get back on the bus, they get back in their own personal vehicle, and they go back home. But it has never been that for people who live in remote areas.
Ms Nilsson-Barkman: I do not think people mind paying something, because they choose to live here and they know that. It is the amount they are having to pay. It is just unreal to think that you will pay $120 if you have to take a handi-van from Steinbach to Winnipeg kind of thing.
Ms Krentz: So what is your suggestion? How do we go about lobbying our government?
The Chair: I want to thank all of you very much for your presentations this afternoon. It was very helpful to hear from all of you, because you are experiencing it. Now this is why we are travelling. We have heard much of this evidence in Ottawa, but it is by people who have read or researched or done the digging, but they have not lived it. What we have heard from you this afternoon is you are experiencing it on a day-to-day basis, and that makes it very helpful. And we thank you very much.
The committee adjourned.