Proceedings of the Special Senate Committee on Aging
Issue 13 - Evidence, June 5, 2008 - Morning meeting
VICTORIA, BRITISH COLUMBIA, Thursday, June 5, 2008
The Special Senate Committee on Aging met this day at 9 a.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[English]
The Chair: Honourable senators, members of the public, welcome to this meeting of the Special Senate Committee on Aging. The committee is examining the implications of an aging society in Canada.
The complex issues related to aging have preoccupied governments for many years. They have become more prominent, however, as the number of seniors grows as a result of both a longer life expectancy and the aging of the baby boom generation. The public programs and services offered to seniors are essential to their well-being, and it is our duty as governments to ensure that there are no gaps in meeting those needs.
We are in Victoria today to hear from interested parties on the impact of an aging society and, more specifically, to hear their views on our second interim report, which was tabled in the Senate on March 11, 2008. The interim report focuses on active aging; older workers, retirement and income security; healthy aging; supports to aging in place of choice; and the regional distribution of health costs associated with aging.
This is the seventh and final stop of our cross-country travels. We look forward to today's testimony, which I am sure will help us to develop a comprehensive set of recommendations for our final report.
While all senators are welcome to recognize the B.C. Retired Teachers' Association, Senator Cordy and I have particular interest since we are both retired teachers.
Our first panel is the Council of Senior Citizens' Organizations of British Columbia, represented by Ms. Gudrun Langolf; and representing the B.C. Retired Teachers' Association, we have Mr. Cliff Boldt and Mr. Reg Miller.
Gudrun Langolf, Director, Council of Senior Citizens' Organizations of British Columbia: Thank you for the opportunity to appear before this committee. Unfortunately, Mr. Kube is indisposed and has asked me to stand in for him. Regrettably, his presentation is not available either, so you will have to make do with mine.
As I found out only last night that I would be here today, I may well be repeating a few of the things that are in your report. Please take that as a confirmation that those are important points.
Senator Mercer: We will.
Ms. Langolf: The Council of Senior Citizens' Organizations of British Columbia, COSCO, is an umbrella group of 75 seniors' organizations, which in turn represent approximately 80,000 British Columbians. We are rooted in the trade union movement as a result of retiring workers organizing to better retirement conditions for themselves and their cohorts. We have expanded to include seniors' faith and cultural groups, retirees from all walks of life and even some associations of manufactured-home owners who are retirees.
As your interim report reflects, seniors are hardly a homogeneous group, unless of course the only characteristic you look at is aging. There is no shortage of issues that face elders in our population in general. We are not the only country in the world that has to grapple with changing demographics.
You made some suggestions when we were asked to appear in front of you. I will not read them to you other than to say I have not been able to find many gaps in what people have provided to you so far. That is probably just myopia. What is missing is a recognition that there has to be a comprehensive social policy. It is vital to the health of our society as a whole, not just seniors.
The band-aid or repair service mode of dealing with these issues has negative consequences for our society. Many of the conditions citizens deal with later in life originate from conditions in our early years. One example is elder abuse. The antidote or vaccination against bullying has to start in quality day care and be followed through and reinforced with booster shots throughout life. Eliminating childhood poverty — our grandchildren's — may well be the first step in that direction. Helping children to develop into confident and assertive adults may prevent abuse not only in adulthood but also for elders.
Abuse, I believe, includes ageism. It seems that our society still tolerates humour that denigrates two groups: seniors and lawyers.
Physical fitness is another obvious example. Making it easy and habitual includes reserving green spaces, allotment gardens, parks, physical games throughout school years, adequate and safe bicycle routes — for the physically challenged or seniors, these should accommodate tricycles — hygiene stations with drinking water fountains and, very importantly, public toilet facilities, both rare commodities in our region. I know of individuals who will not take their diuretic medication for high blood pressure on the days that they travel or are away from home for fear of not having an accessible toilet. Nobody wants to talk about the fact that every one of us has to go pee. It just is not a sexy thing to talk about.
The other problem in our area is that there is no such thing as a comfort station in transit areas. If they exist, they are locked, for heaven's sake, and you have to try to find an attendant, who is usually nonexistent. It is a very small item, but it is a significant barrier for people to get out and about in their community. I do not think Vancouver or the Lower Mainland is unique in that, but I do not have any evidence for the others.
When I go on my bike rides, I have to design my route to include some of these health facilities. You cannot be spontaneous. In Vancouver and the Lower Mainland, we can count the public facilities on the fingers of one hand. Construction sites, Johnny-on-the-spots, and accommodating restaurants fill the void. This is not acceptable in a civil society and is a big barrier for people.
When the federal government does cost-sharing on big public transportation projects, they ought to include as a condition of giving that money — our money, actually; you know it is just another pocket — to include bathrooms and up-and-down escalators as well as other accessible ways of getting to and from stations. That ought to be the absolute minimum.
A third example is nutrition. Much of what bedevils us in our dotage may have its origin in an inadequate diet in early years. Eliminating childhood poverty and ensuring that gap families have adequate resources — money and accurate information about nutrition — provides a basic foundation for desirable health outcomes. Ensuring that seniors are able to purchase nutritious food is essential for our well-being. To that is attached food and water security. You cannot separate them out; they go hand in glove.
Agricultural land reserves and holistic, sustainable farming practices are essential for our health and the health of our economy, not just seniors. Ensuring that those engaged in farming are able to earn a decent living is part of that as well. Having access to clean water is still not universal in Canada, and much to our shame there are still too many communities that have to boil water they wish to consume. Rectifying these conditions would have a far-reaching, positive impact on the health of future generations as well as seniors. Seniors with compromised health living in these communities are at serious additional risk, as are other vulnerable individuals.
All the seniors I know are active, physically and mentally. Many of them are active in community institutions and facilities and help relatives and neighbours. I have heard that some seniors suffer in silence. Those are the ones we do not know. This may be because of the stiff-upper-lip conditioning or a paralyzing and perhaps irrational fear of being institutionalized against their will when they become incapacitated in some way or another.
Building age-friendly communities, the terminology of the day, will take more than lip service and will require the coordination and cooperation of municipalities and provinces. The federal government has to provide leadership and some core funding beyond the New Horizons for Seniors grants. They just will not do it.
In my neighbourhood, and this is a typical example, for over 30 years Marpole Place, a refurbished fire hall, provided an adult day centre for elders with a referral from the health authority. This was one of two on the west side of the city of Vancouver. Nine are located on the east side. It serviced about 40 to 50 vulnerable seniors and offered pickup-return service by van, a communal meal, arts, crafts, music, therapeutic services, social interactions, entertainment and outings, and much-required respite for those who care for those seniors, usually family members.
Without any consultation with the community, this service was relocated right across town to a brand new facility that provides what is now called ``campus of care.'' Ostensibly it was relocated because there was no new money to fund both. There was a waiting list on the east side, so they figured they would fix that problem. In order to fix one problem, they created another: a deficit of service to our most vulnerable, services that allowed 40 to 50 seniors to remain in their own homes. That happens with many of the things we try to do in society when the budget is not there. You fix one problem and you create a few others.
The competition by non-profit societies for scarce and ever-shrinking funds to enable them to provide much-needed neighbourhood support is unbelievable. Most spend fruitless hours writing applications for grants, hours they should be spending on direct programs and services. Every time I go to one of these group meetings, the people are talking about how much time is eaten up by grant writing. I think it is just torture by another name.
We need a federal housing strategy. Currently the building of residences is developer-driven. Whenever we advocate for a mix of housing that includes social housing within each project, someone is bound to raise the concern that it is too expensive and that we cannot and should not interfere with the free marketplace. We are the marketplace.
We will pay for the consequences of homelessness, not the developers. We will pay for the shoddy workmanship, or leaky condos, first in the high price of the units and then a few years down the line for remediation and, in some cases, even with tax dollars when municipalities have lost lawsuits in relation to that. It is adding insult to injury.
We want you to bring back the co-operative housing model. It was a huge mistake to eliminate it. The consequences are still reverberating around the communities.
When I served on a board of a society that helped groups develop co-operative housing, we were able to qualify bids. We happened to specify that only unionized builders' bids would be considered. To us that meant reputable companies that had a stable workforce, employed qualified trades and trained apprentices, and that they would be around when something went wrong.
In and around 1985, after I had left that sector, they were instructed that the bids could no longer be qualified that way and that they had to accept the lowest bidders, period. Enter numbered companies that dissolve after a project is finished. Lots of leaky buildings. You can see Vancouver is tarp city. It is outrageous.
One building project that I know of in 1985 cost $3 million to build 54 units — relatively reasonable, good quality, as far as we knew then. It cost $7 million to remediate. It is outrageous. It is money that we could have spent elsewhere.
This is only one example of an unintended consequence. While not always quite that dramatic, fixing something creates another, usually bigger, problem. Much of what we do as a society in the social realm is tinkering with stuff. That can have dire consequences. If we allowed drug companies to do that with new medicines, we would be in real trouble. Why are we reluctant to do the pilots and small projects that have relatively reasonable, measurable conditions and, if they are good programs, transfer them to a larger scale?
Recently in New Scientist I read about a program in prisons in the U.K. where they had random drug tests for inmates. They caught a whole bunch of people who were smoking weed. After a while they ended up with a whole bunch of addicts who were on heroin, and that was because it was not as detectable as weed. Here something that was relatively harmless — and I mean that advisedly — ended up being a much more harmful situation.
I am not suggesting we are doing that with seniors, with heroin. It is just an example of a well-meant, well-conceived idea, people trying it out. Things we try should be small experiments with measurable results and then applied, when they are effective, to the larger realm rather than throwing everyone into chaos or creating huge programs.
We think that some immediate actions are advisable and could alleviate some of the hardships for our seniors. As a minimum, we recommend increasing the Guaranteed Income Supplement beyond the cost-of-living increase to address rising food costs and housing and transportation costs.
We want to make sure there is secure funding for seniors' programs that focus on seniors helping seniors and build in enough support for administrative assistance. We want more support for health, literacy and prevention programs to be developed and delivered by seniors, again with administrative assistance if required.
We want the tax give-away stopped and the current surplus used to rebuild some of the programs. Axing the literacy program had dire consequences in small communities. What a hare-brained idea that was. It saved so little money and did so much harm. That is just one example.
We want public health care rebuilt and the erosion to private operators stopped. Include dental and extended health plans for services not covered by basic medical plans. It is important not to waste the recommendations of the Romanow commission.
Very important for those of us in the Lower Mainland is to eliminate the onerous 10-year waiting period for immigrant seniors to receive their pensions. It just is inhumane. It cannot be of humongous consequence money-wise to include them. We want you to help provide, fund, support and establish quality licensed day care centre spaces for both adults and children.
As I said earlier, I may have reiterated many of the comments and requests made by other presenters, but the six items I listed are our suggestions for a start while we all try to sort out the environmental and social policies.
The Chair: Thank you for your presentation. You are right, it is an uncomfortable discussion to talk about the fact that people need washrooms. As someone with a husband who has had prostate cancer for ten years, I know intimately exactly what you are talking about. Thank you for putting that on the record.
Cliff Boldt, Director, B.C. Retired Teachers' Association: I am here on behalf of the B.C. Retired Teachers' Association which I will be referring to as the BCRTA. Thank you for inviting us to attend and to present today. We are an organization of approximately 13,000 retired teachers and administrators from the public school system in British Columbia. We also have membership from the post-secondary institutions in the province as well.
We appreciate the opportunity to respond to your interim report. Taking a look at the way you have structured the report, you have really covered the waterfront in terms of the issues. Your interim report provides a very good road map for the federal, provincial and territorial governments to follow. I do not think there is a need to reinvent the wheel. The time is now for good public policy and programs to implement your recommendations.
The main priorities for our organization, and I think for seniors generally, relate to health, housing and income. Those are the three major areas and they figure quite prominently in the recommendations in your interim report.
Senator Carstairs, you mentioned in your opening remarks that the government's responsibility is to ensure there are no gaps in these services. We are hearing through our contacts with other provinces and here in British Columbia that public policy and programs are creating gaps in the services for seniors — big-time, we think.
A major theme in your report is the emphasis on health promotion and disease prevention, the need for adequate nutrition, appropriate physical activity — everybody talks about physical activity and not all of it is appropriate to all people — and good mental health. When disease or illness does strike, there are some costs involved. Pharmaceuticals, for example, can be prohibitive. Some seniors in British Columbia are having to choose between filling a prescription and paying to put food on the table or a roof over their head. Forcing choices like these on seniors is not conducive to promoting a healthy senior population.
You make reference to the cost of pharmaceuticals option 34. In references 4, 6, and 7 in our appendix, we direct your attention to the issues surrounding this and the fact that the cost of prescription drugs is not keeping pace with the income most seniors have. In the last 10 years, drugs have become the second largest cost in health care in Canada, second only to the cost of hospitals. That is not being recognized in government policy or government programs. You will be having round-table discussions with experts, and they will go into much more detail than I, but it is something that needs to be flagged. Suffice it to say that seniors are concerned with the reluctance of provincial governments to include more generic drugs in their formularies and that the federal government's approach to patent laws is a problem.
A current issue in the area of pharmaceuticals is Bill C-51. Should it pass the House, and I am hoping it will not, this is a good chance for you to give it a sober second look because of the significance it will have for seniors and others who depend on health food products. Bill C-51 would make it that much more difficult for seniors to obtain these products, and their costs will increase.
Another issue related to housing is the issue of home support and home care services. These have declined significantly in British Columbia in the last 10 to 15 years, creating increased pressure on families who are giving this care. We are pleased to see that you have addressed these in various recommendations, as adequate resources in this area can significantly enhance seniors' options for aging in place.
You make some sound recommendations in regard to housing generally. The debate over whether to pay for services for seniors is at an end, because the conclusion is that it is much cheaper to take care of seniors in their own home than it is to put them in a facility.
I am from the Comox Valley here on Vancouver Island. Approximately 35 per cent to 40 per cent of the acute care beds in our hospital are filled by seniors who are waiting for some place else to go, including death in some cases.
Aging in place is not a matter of a selfish desire; it is common sense. It will save provincial, federal and territorial governments money.
Over and over we hear of the benefits to society, to the community, of keeping seniors in their homes as long as possible. It is not good enough to have a homogeneous community; it is really important to have a mix of ages in your community, and keeping seniors in their homes will allow that.
One thing we have in B.C., which I think is unique in Canada, is that people over the age of 55 can defer their property taxes on their principal residence. I am taking part in that program and that has saved me about $1,700 a year, which I find is a good break.
This legislation was brought in by the provincial government about a generation ago, I think sometime in the 1970s. It helps in the sense that real estate prices are going nuts here on the Island and in Vancouver generally, and you are probably hearing about this all across the country. We have serious problems; in some communities in this province, seniors who want to downsize and move into something smaller, to go say from 3,000 square feet to maybe 1,300 or 1,500 square feet, is impossible, because the 1,300 to 1,500 square foot unit is not there, or if it is there it costs more than the sale of their family home. That creates a real problem. In some cases, they go into a facility.
Ms. Langolf mentioned the unintended consequences of the significant budget cuts that came out of the federal budget in 1994 and 1995. We are still feeling a major impact of those on various programs, including health care and infrastructure support for the provinces. These cuts, as well as the issue of prescriptions, need more discussion, and you will probably have this when you meet with your council of experts.
Your interim report also stressed the need for integration of services, and again Ms. Langolf referred to this. The whole integration of services, primarily at the school level, was really big in the 1970s and 1980s. Senator Carstairs will know about some of the community school projects in Winnipeg that were leaders in the province and in some cases still are.
We need integration of seniors' services, a one-stop-shopping concept. This issue has been addressed in many ways in various communities out of need; necessity has created the service. It is important for different agencies and service groups to sit down together to identify what the needs are and to see where they can provide integration of these services.
The lack of integration is due in part to turf wars among professionals. I am sure all of you have experienced or seen this in different ways in your own communities. A federal ministry of seniors would be a good operating model in order to cut through some of the existing duplication of services, whether you are speaking of veterans, for example, or health care being dealt with by different agencies. This again is a common-sense approach you are putting forward in some of your recommendations.
In discussing future policies and programs for seniors, you might want to make reference to the issue related to peak oil. This is the elephant in the room in many cases. If you have been to the grocery store recently, you will notice there has been a significant increase in the cost of your cart full of groceries that you take home. It would behoove the committee to take a look at some of the long-term consequences going 30 to 50 years into the future and consider what will happen with social policy generally and in relation to seniors in particular.
The cost of living is going to increase: housing, transportation, food services to seniors, both public and private. How will governments at all levels adapt? That is a question you cannot answer. However, if you initiate public debate, that would be helpful.
I want to raise one other area that has recently come to my attention. The U.S. government has published a document that details how health and other services will be rationed to seniors and the disabled in the event of a pandemic. They call it ``pandemic triage.'' I have attached in the appendix the relevant document and included the website. You and your staff can take a look at that in more detail later on.
This document represents a significant shift away from what we currently accept as social values and attitudes toward seniors and the disabled. It suddenly puts them on the periphery. That is a debate that you can initiate to get people talking about this. What will happen, in the case of the Island, if we have a major earthquake or pandemic?
I will conclude by advocating for a federal ministry for seniors. This would provide one source of support for seniors as opposed to having to go through a number of ministries to find out exactly where it is they need to get their services. This would also help ameliorate in part what we have seen in the past of either cuts in services or the reduction in resources for services that exist for seniors.
Ms. Langolf is hinting at targeted funding for seniors. I wonder whether the tax policy of the federal government in the last 10, 15 or 20 years and the devolution of powers to the provinces are creating a situation where the federal government is no longer able to influence or even direct where it wants things to go, especially in terms of seniors' services. That is another challenge I throw back into your court.
The Chair: Thank you for your presentation.
Before I turn to the other senators for questions, I thought that there was symbiosis between what Ms. Langolf said and Mr. Boldt's and Mr. Miller's and my profession. We see a situation in which schools are frequently closing, particularly schools in areas in which the population is aging and moving into a suburban area, and it seems to me it is time we used some of those buildings for other resources.
Ms. Langolf talked about day programs for adults. Could you not use three or four classrooms that are not being utilized for school kids for such a day program for seniors and also develop an intergenerational link between the remaining children in that school and the seniors that are in that school? We know there is frequently a wonderful bond between the first generation and the third generation. Sometimes the same bond does not exist with the second generation. Yet we do not seem to think outside of those boxes. Education buildings belong to the departments of education. Seniors buildings belong to the departments of seniors, if we happen to have one. We do not seem to move.
I would like to hear from you about using facilities in new ways as we are trying to develop new programs.
Ms. Langolf: We attended eco-density discussions at city hall in Vancouver. Everybody is thinking about how to use these facilities.
I am enthusiastic about using public buildings for a variety of uses. I am mindful that it is not a good idea to develop things for people in a prescriptive way that says you have to do something like this or like that. That is an invitation for it not to work. There has to be a different approach to developing community facilities. They may not always be schools; I was talking about an old fire hall earlier.
It is important to look at communities and what members of that community think is appropriate and what they can use and attract to those facilities. That is a longer process.
It seems to me politicians are more and more reluctant to engage in conversations because people come up with good ideas and they have to do away with their preconceived notions of what they want to do. It is a tough situation. I would not want to be a politician for anything in the world.
Your point is well-taken. We should be using these buildings for all sorts of reasons if they are available and spaces are available. We do know about the turf wars Mr. Boldt was talking about, and it has to do with the competition for scarce dollars. You are always in competition. It is unfortunate but reality.
Mr. Boldt: I did not dwell on it in my presentation, but it would be valuable for you to take a look at the division of powers within the federation. I am biased towards a strong central government. I am concerned that the power has shifted to the provinces. Is the federal government now competent, legally and constitutionally able to do what you are suggesting? Education and the disposal of school buildings is a provincial matter.
I often think of an armoured truck as an analogy. The federal government passes a budget and puts X number of dollars in for a seniors program, let us say. That armoured truck goes to the province, and the Ministry of Finance takes a bite because they have to administer this money. It goes to another ministry, and they take another bite. By the time the armoured truck gets to where it was supposed to go, there is not as much money on the truck as there was when it started out. That is the kind of issue you are in a position to analyze and discuss.
The Chair: You are correct that there has been a devolution of power. It seems to be what the provinces want. Like you, I happen to believe in a strong federation, and I think that view is shared by both senators at this table. However, the Conservative senators are not represented here today. Enough said on that.
Reg Miller, Member of the Advocacy Committee, B.C. Retired Teachers' Association: The coordination is the difficulty. At the provincial level, the government is putting it into the bailiwick of the school boards. The school boards need the money, so they are not willing to give the space away. It ends up being a difficulty for anyone who wants to make use of the facilities because of that.
From the standpoint of seniors, if we had both a provincial seniors ministry with someone looking after that and especially a federal ministry where there could be direction along those lines, it would really help. We do not have that direction right now; everybody is doing their own thing. School boards are doing their own thing. Here they are selling their property; the schools are now becoming condos. That is just adding to the difficulty for seniors, because they are not condos that seniors can afford. As Mr. Boldt mentioned, when you sell your home, you will not get as much as you need to buy an expensive condo in that development.
Coordination is needed at the federal level by a seniors ministry or at least a minister to direct, and it is also needed at the provincial level.
Mr. Boldt: This afternoon you will be hearing from Dr. Marilyn Bater from the Vancouver Island Health Authority, VIHA. It would be interesting to ask her about the role of VIHA in this area of integration of services; they are the bottom line, if you will, in British Columbia. What are they doing to integrate services to ensure there is no duplication?
The Chair: That is exactly why we are speaking with her.
Senator Mercer: Ms. Langolf, you suggested using the current surplus to fix some of the problems that you outlined. I have bad news for you. There is no surplus because of the tax cuts that have been made, the elimination of two points in the GST. I am sure you have invested your two points in the GST wisely and you will be a rich woman some day because of it. That has basically handcuffed this government and any future government.
That goes to your point, Mr. Boldt, about the shift in the devolution of power. This is a huge concern. We have not reached a crisis yet, but we are getting close to it. We are seeing a downturn in the economy every day, in all parts of the country. It is very frustrating.
A recent article in The Chronicle-Herald from Halifax, my hometown newspaper, quoted the architect of some of this, Mr. Flanagan, saying how it has finally worked and they have finally shifted. He was quite gleeful. I am disgusted by the whole thing.
I was interested in the provincial program you outlined, Mr. Boldt, of deferring local property taxes. Do you know what the takeup is? In the end, when you sell your property or your children sell your property after you are gone, the taxes then need to be paid retroactively. Is there interest on the taxes?
Mr. Boldt: This program is hugely successful. It is used more in the wealthier parts of cities like Vancouver.
I have an application at home on my desk. I fill in a form and take it to a provincial agency in Courtenay, and they issue me a statement that says that my taxes have been paid, for an annual administration fee of $15. I am currently paying about 3.5 per cent to 4 per cent interest on that money. When the title changes hands, if I give it to my kids, for example, then it is due and payable; or if my wife and I sell and we move into town, which is on our agenda, then they get the first bite out of the money that is paid.
I have been doing this about four years. I think I owe $4,500 or $5,000. It is a very simple and useful program. How rich do I want my kids to be when I die? I can use that money today.
Senator Mercer: How much does it cost the municipal governments who are foregoing the tax?
Mr. Boldt: I live in the Comox Valley Regional District. The provincial government cuts a cheque. If I defer $1,700, for example, a cheque for $1,700 goes to the regional district. The local governments do not miss out. That money goes to them.
Senator Mercer: The provincial government loses out.
Mr. Boldt: That is why the provincial government charges interest, to pay for the administration.
Senator Mercer: It is going directly to our aging in place?
Mr. Boldt: Yes, it is. It is a unique program in Canada. I think we are the only province that has it.
Senator Mercer: Like everything else in British Columbia, it is unique.
Mr. Boldt: We are also very humble here.
Ms. Langolf: The provincial government does not lose out. It is a deferred payment. Although I think they are crazy, there are many seniors who do not want to take part in the program because they are concerned about there being a tax bite when they want either to leave the property to their heirs or to sell it. Obviously there are different attitudes at play as well.
Senator Mercer: Bringing back the co-op housing program is interesting. There are two styles of co-op programs. There is the style I think you are referring to, which would be co-op housing in a condo-apartment, and there is the other style, which Senator Cordy and I are more used to in Nova Scotia, where single family dwellings are built under a co-op program. The investment of the homeowner was provided through sweat equity; they actually did some of the work in building the home, which meant that they could repair the home later on because, unlike me, they would know how to use a hammer.
Which program were you referring to?
Ms. Langolf: I was talking about the one done by the Canada Mortgage and Housing Corporation. It is my belief that one size does not fit all, that we have to have a large variety of dwellings and options for people, including seniors. Some people are comfortable in apartments. I heard from the housing coordinator, Judith Graves, that some of the folks who live in the Downtown Eastside need to be able to touch their walls when they stretch their hands to feel comfortable and safe.
We need to provide different mixes of housing. Bringing back a co-op housing program would be a good step in that direction.
Senator Mercer: Like Senator Carstairs, I appreciate your comments about the need for public washrooms. I am a man over a certain age and I appreciate the sentiment.
I also thought you hit on an interesting point. This is not the first time we have heard the words ``child care'' in this Special Senate Committee on Aging. Your comment that the elimination of elder abuse begins in the day care centre is quite a bold statement, and I agree with it.
How do we address that? We have thousands and thousands of child care centres across the country, and I know you are using ``child care centre'' in a symbolic sense, but it seems to me that there is an opportunity, with so many children are in child care of one form or another, that we should seize on that and talk about building respect for one another and one's elders as well as younger people and one's peers. Do you have a suggestion?
Ms. Langolf: Your questions may be better answered by my cohorts here. Certainly none of it happens overnight. Some of the abuse happens in day care centres as well, so it is not like they are the be-all and end-all. The people who go through training for these licences, in B.C. in particular that I know of, are taught about respect for children and how to engender and receive respect in return.
Our suggestion is for quality licensed care. Does that guarantee that everybody will not be a bully? I doubt it, but the chances are smaller.
Mr. Boldt: I have lived long enough to have seen the wheel go around again. What was happening in the 1940s in Saskatchewan where I was born and raised is suddenly happening again. Co-ops were big in the Prairies in the 1930s and 1940s.
The issue of child care and senior care is a need for professionals and government bureaucrats to sit down and talk with each other. It is not rocket science. What we are talking about doing can be done. Sometimes you need a kick in the rear from somebody, and I am suggesting that either the province or the federal government do this, in terms of directed or targeting funding, for example, or making it a condition of receiving the money.
In North Winnipeg, your current Minister of Finance got his start in the 1970s in the community school movement, and he piloted some very interesting programs. At Britannia Secondary School in Vancouver there was an interesting combination where different cultures and different ages came together.
This has all been done before. If you talk to Greg Selinger, he will tell you about this. He is a valuable resource.
I was involved with the community school movement here in B.C. Nobody is beating down my door to get my insight into this. The wheel is there. It is just a matter of someone somewhere saying, ``Get with the program, folks.''
Senator Cordy: I love your comments about a strong federal government because I feel passionately that if we do not all work together and have a strong foundation or strong central government, it will lead to the weakening of our country.
We have heard about aging in place over and over again. We know that it is a win-win situation. Seniors want to stay in their homes, and for governments it is much cheaper.
We did hear, although I forget where because the days are all starting to blur together, a recommendation that if seniors are to stay in their homes over a certain age, perhaps there should be a federal grant for them to make it more affordable. You have talked about a provincial program where your taxes can be deferred.
What do you think about a federal plan like that to give monthly, quarterly or yearly grants to seniors who are staying in their own homes to help with the mowing of lawns, repairs and the like? Those are the things that seniors staying in their homes are finding very challenging. They cannot necessarily do all the home repairs the way they could when they were in their twenties and thirties, so they are having to hire people to do it. Have you thought about that type of a grant system?
Ms. Langolf: I have not thought about such a grant system, but I think it is advisable to try it in a study in significant numbers to see whether or not it is a useful activity. It would not break the bank and would be an important indicator of whether or not that kind of a program is useful to the communities.
I do not think any one suggestion about how people get the resources to pay for the everyday living things is necessarily the answer. If you took 600 to 1,000 households and made them part of a program, you would have the ability to measure success or failure; you would have good indicators about whether or not that is useful.
The Chair: Interestingly, we have such a program. It is called the Veterans Independence Program. It came about because there was going to be a need to build acute care beds and long-term care personal beds for veterans across the country. It was decided to try the Veterans Independence Program in lieu of that, only to discover that the veterans were so happy living within their own communities that they did not need the acute care beds and the long-term care beds. We know that it works. We have done the experiment.
Mr. Miller: Simply having funding is not the answer. There has to be more to it than that.
In some cultures, the family stays together and works together and lives in the same place. We have gotten away from that. We tend to want to build facilities to put seniors in rather than having them stay and age in place. There needs to be both education and coordination so that it is possible to have different age groupings in the house. It is still possible now, but we do not encourage that. Too many seniors see only the alternative, which is to go into some kind of care facility as opposed to having a way that we could have family members or non-family members living in the same place.
As seniors age and space becomes available, we need to have both education and programs to help have others in the same facility. That would help with the situation for accommodation for younger people, which is a problem right now, and it also helps with the senior being able to stay in the home. It is not taxing the government from a monetary standpoint. It is a cultural and educational change that is necessary.
Incentives could be put in place by the government in order for that to occur. We do have the caregiver incentives now so that you can have somebody come in and give care, but that is in a business relationship rather than a family relationship. We need to look more at the family relationship so it does not cost as much money. It might also prevent abuse if we had more of the family situation.
From the care standpoint, we have day care for children. Now we need to get seniors out of the house and into programs. We need more community programs like a day care for seniors. There is nothing wrong with day care for seniors where they can go to programs. The community does provide such programs through recreation facilities, but we just do not have enough education and enough push to have seniors go out into the community and into these programs to get out from sitting in the house and wasting away.
Mr. Boldt: I am nervous about a grant. Historically, governments will provide a grant and then say, ``We have solved the problem.'' That may be one part of the program.
In options 24 to 33, you have interesting ways to provide income support for seniors. As Ms. Langolf has mentioned a number of times, one size does not fit all. When you meet with your panel of experts, I would like to see the issue of creativity raised for solving some of these problems with the integration of services.
For me, it is a process more than anything else. People, especially at the local level, are encouraged to talk, to share information and to put together programs. What works in the Comox Valley on Vancouver Island will not work in the east end of Vancouver or in North Winnipeg. The process is the critical thing.
In the 1970s and 1980s, when I was involved with this kind of thing, I found that as soon as you sat down around a table with a whole bunch of people, usually over cinnamon buns or the muffins that the senator is enjoying here, all of a sudden solutions start to pop out. When you break bread with people, solutions will rise to the fore.
Process is critical, if you can get the experts to talk about this and fit it into your final report.
Senator Cordy: Very well said. The point about one size does not fit all is very accurate. I think the idea of flexibility and consultation really does work. Top-down decisions are not always the best.
The idea of family works if family is around. I am from Nova Scotia. Unfortunately, so many of our young people have left to go to work in Alberta. In the rural areas, the seniors are left behind. Those who have not gone to Alberta are moving to Halifax, to the city. It sounds really good, but as Mr. Boldt has said, the same solutions do not work everywhere.
I will turn now to the pharmaceuticals. You said sometimes generic drugs are not available on a province's formulary. Should we have a national drug formulary so that the same drugs are available in Nova Scotia, Prince Edward Island and British Columbia?
Mr. Boldt: Absolutely.
Senator Cordy: That was easy. You nodded your head, so I assume everyone agrees with that.
As a retired school teacher, I cannot help but comment on literacy. You are right, the insides have been taken out of the literacy programs. You also made the comment that so many of these things you can talk about in relation to seniors but they are programs that start when people are very young. If you cannot read when you are age 16 or 22 or 32, then you will not be literate when you are age 62.
Ms. Langolf: Then you can make the news that you have learned to read when you are 95, as I saw the other day.
Senator Cordy: That would be because of a literacy program that has now been cut.
When you spoke of literacy, you also talked about seniors helping seniors. As we were travelling across the country, we heard the challenges of getting volunteers. Volunteers are getting older. Mr. Boldt made reference earlier to peak oil. The cost of being a volunteer is becoming cumbersome for some people. It is great if you have a good pension plan or if you have saved some money, but if you have not, then to be a volunteer surviving on OAS is almost impossible.
How are you dealing with challenges like that, costs to volunteers, and are you having any challenges getting volunteers in this community?
Ms. Langolf: We are used to hearing about the baby boom tsunami coming. I want to make sure people understand that old people are not a disaster; we are not a destructive force.
I am part of the baby boom. I have been retired now for five years. Every one I know is active in the community because they still have some energy. Other folks who have been there before are burning out. You are right: it is difficult to sustain volunteer energy.
We should not expect volunteers to provide services that really ought to be provided by folks who are being paid. There are things that are not appropriate for volunteers to do or that we should not be expecting to download.
There are no easy answers, as you probably know from what people have been telling you. Groups like COSCO put on programs provincially for trainers. Those are all done by volunteers. I suspect one of the reasons Mr. Kube could not be here today is because he is doing a lot. We are trying not to follow that example.
Programs by volunteers are very important because people can feel useful and productive in a way that they might not be able to in the workforce. You can pick and choose. Sometimes you cannot do that when you are working. Your boss may not appreciate it.
It was suggested that people get a credit for volunteering. I have a bit of a problem with that. We have not really discussed it as a group to a degree that I can say that that is something we would encourage. The difficulty with that is the whole business of charity and how one deals with charity. Is charity anonymous?
In our society, it is bizarre that people can give hundreds and thousands of dollars and get tax receipts for that, while others work their fingers to the bone and get nothing. How do you deal with that? I do not have an answer for it. However, recognizing it and discussing it is very important. Perhaps a combination of things, including making some services available free of charge to people who volunteer rather than a grant or money.
Senator Cordy: It is easier to write a cheque than to volunteer 20 hours a week.
Ms. Langolf: Some people do not have the time because they are so busy making that money. That happens, too.
Senator Cordy: We need both.
Ms. Langolf: In our organization, we have people who have relatively good resources and those who are terribly poor.
Mr. Miller: That is where the credit could come in to help people because of the rising gas costs and all the rest of it.
As an educator, I come back to the fact that we need to ask seniors to help seniors. There needs to be a simple asking process, and we need to educate people that helping someone else helps yourself. The volunteering process can be very beneficial for seniors in many different ways, but they need to be asked sometimes.
If not, an incentive like a credit for volunteering time could be useful. I do not look at it as payment but as a recognition of the time. It is not like you will pay for the volunteerism, but you will give them recognition. Maybe not a credit; there may be some other way you can have the recognition. A lot of it comes down to education and simply asking.
Mr. Boldt: If every volunteer in the Comox Valley stayed home tomorrow, the Comox Valley would grind to a halt. What would happen then?
Volunteerism is saving government money. If you take it from that perspective, then you might appeal to those interested in the bottom line, those who want to reduce the size of government as much as possible.
With peak oil in the Comox Valley at $1.35 a litre, Meals on Wheels, for example, is having a very hard time getting drivers because the drivers do not have deep pockets and they are putting on 40, 50 or 60 kilometres in one run in one day. That is a problem.
Considering volunteerism from the point of view of the economy and the economic savings to society and government from having a strong volunteer program, let us look at ways to support volunteer programs.
Mr. Miller: I have to tell Mr. Boldt that the price of gas went up by 7 cents since he left yesterday; it is $1.46.
Mr. Boldt: On July 1 we get to pay another 2.5 per cent on a carbon tax. I am getting a $100 cheque from Mr. Campbell at the end of this month. I am dying to get that and spend it. That is a political shot. My apologies.
Senator Cordy: We made a few, too.
Ms. Langolf, you talked about the writing of grants. We have heard this over and over again. Agencies have to be accountable. We all understand that. However, it should not be that everybody is trying to put one over on the government.
How do we simplify things so it does not take a staff person two full days of the week to write a grant proposal? We heard somebody say that 50 per cent of their time is spent looking for grants that are available, because it is difficult to access what is out there, and then filling out the application forms, which we have heard are quite thick.
Ms. Langolf: There are times when I despair about the industries that grow up around things that are being instituted. You have the industry of fundraising, you have the industry of age, of seniors, you have all kinds of industries around poor people. I do not know how you can dismantle those, but I think they hinder the programming or services that need to be provided. It is time that government got back into the direct business rather than downloading it all on to societies, all these private groups that start out well-intentioned.
The other day I was talking to somebody in a seniors' group in New Westminster. I asked how many people are working in their office now, and the response was 10 people: they have grown from 1 to 10.
After a while you need to spend more time on the care and feeding of the organization, and it takes away from what you wanted to do. People are not doing this because they are nasty. It is just a natural phenomenon.
It is important for governments to get back into the direct provision of services. Right now they put on courses on how to apply for funding, for heaven's sakes. That is not helpful. That takes another day out of my week. It does not work. It does not help me. It does not help the community.
It is a double-edged sword. Yes, we want that money; yes, we need that money. Otherwise, we cannot do what the community would like to do. It is time for governments to get back in directly. It just does not work otherwise; it is inefficient.
It is like building campuses of care, for example, where they have adult day centres, assisted living and long-term care, and the one where you kick the bucket, palliative care, all four under one roof. You do not have to move very far; you can just go down the road and there they are. However, they have downloaded the inefficiencies. We all have to drive there now, including the workers and the families that visit the seniors. These facilities are usually not in the community; they are at the edge of town. If you go out on the highway here, you will see Delta View Habilitation Centre, which is a compound for people who are old and have Alzheimer's. It is difficult.
It is easy for us to think that when we consolidate things they really are much better. Governments have to get back into providing some of these services. Otherwise, we are inefficient with the way we spend our time, and it takes away from the programs.
We hear over and over again from the politicians that the cupboards are bare. I think that is the terminology they use. It depends on your priorities.
Mr. Miller: I agree that there needs to be government involvement. I mentioned before that we need a minister and a ministry for seniors to coordinate this so that there are not so many different programs and you have to make application to all of them.
The idea that you need to hire a professional grant-application writer to submit grant applications for you is causing the problem; you almost have to get a grant to hire somebody to do the grant to help you get the grant. By the time you go through the process, you have used up quite a bit of money. You are in competition, so you want to do that. That is what is happening now with the little industries: people are setting themselves up as grant applicators, and of course they want money to do that.
The process is evolving the wrong way. Instead of less money and time spent applying for the grants, more time and more money are required to get the grants in the first place.
Senator Mercer: Senator Carstairs said I am not a teacher, but I have been a fundraiser all my life and that was my profession before I came to the Senate. When I became a fundraiser back in the 1970s, I did it all. I did whatever needed to be done. I am a certified fundraiser.
Now there are groups of people who are grant writers. That is what has happened to the profession. Some people specialize in that and others specialize in planned giving. The business has become much more sophisticated.
I go back to something Ms. Langolf mentioned in her presentation, that to fix one problem the government usually creates another. I made a note to myself that that is what governments do. The issue is how do we take this opportunity. Senator Cordy was speaking of integration. How do we get this integration going?
We continue to look for good examples. We have found some across the country, which we will be writing into our report on best practices. Are there any other examples of where this does work? It has to work at some point.
Ms. Langolf: I do not have any other brilliant examples of how that might work. It is important for us to set up some pilots. That is essential. We need to risk failing as well as succeeding. We could be getting people together from the provincial and municipal governments.
With respect to the Vancouver Gateway Program, my MLA, Stephen Owen, worked with three levels of government. It seems to work for some projects. There is no reason we cannot put our heads together and find a project or two where we can see how integration can happen and what kinds of things we might want to integrate.
I hesitate to talk about experts because I think seniors are experts. That is no disrespect to people who are in professions, but generally speaking there is a lack of looking at things comprehensively. People look at the piecemeal stuff, which is understandable because that is their area of specialty. We lose the sense of the overall and how it all works together.
I would like to see more seniors here, although some of us probably qualify. Unfortunately, I have not looked at all of the submissions.
We should try those pilot projects. We can. We have the imagination. I do not have one right at my fingertips for you, but I would be willing to put my nose to the grindstone for it.
The Chair: Mr. Boldt, I know you want to get into this, but I want to ask you a question and then you can add whatever you want to that.
We have not touched this morning on the concept of flexible retirement, which has always interested me. September 1 to June 30 you are a teacher and then you retire and you are no longer a teacher. I am of the view that many teachers who retire might be burnt out but would not mind doing a less heavy teaching load, maybe 30 per cent or 40 per cent. They have real skills they could offer the next generation of teachers coming along. There is not nearly enough sharing of teaching skills from one generation to the next. It is very difficult to do when you are working full time and managing full-time classes or running schools on a full-time basis.
I would like to hear from you and Mr. Miller on the experiences you have had with retired teachers and whether some of them would have preferred to retire in a more gradual rather than an all-or-nothing way.
Mr. Boldt: When I talked about retirement 14 years ago, I talked about it in terms of a career change. I did not use the ``R'' word. I had had my fill of the classroom and working with teachers. I went on to other things and did other things.
What you are suggesting makes a lot of sense. It is happening more in the private sector than it is in the public sector. There is something to be learned there. That is one way of looking at it.
Many people define themselves by the work they did up to the date of retirement, and those people have a lot of trouble with retirement. A lot of retired teachers have gone on to other things. One friend of mine, for example, got involved with making compost bins and now he has become a consultant on recycling and the gardening related to that. He would not dream of going back into the school because he is busy doing this.
Again, flexibility matters. No one size fits all. That suggestion needs exploration. It will have to do with communication, talking with people and, as Ms. Langolf said, identifying niches and areas where something has to be done.
Mr. Miller: It is surprising you bring that up because that is what I did. I went through a flexible program myself and I have encouraged others to do so. I know a large number of teachers in British Columbia who have done that.
There are two ways of doing it. One is to go on a reduced load while you are still teaching. In most districts, you just have to ask for that. The difficulty is that when you do a reduced load, you are not guaranteed to go back on a full- time load. You are guaranteed for the particular load you are on, and you may not be able to go back into a full-time position if you want to. Once you take a reduced assignment, that is the assignment you are on until you decide to retire fully.
The other way it is to actually retire and then to go back substitute teaching, being a teacher on call. That is a preferred way because then you really do have the flexibility. I did it for 10 years after I retired.
I am still on the teachers on call list. This year I have done one day, so it was very flexible. Last year I did five days. The year before that, they could not find anybody to take the job, even though they advertised all across Canada; so for three years I had a contract as well as being retired. You can retire as a teacher and then go back and take contracts on in all districts, but you cannot always get on the teachers on call list. There was a problem because many districts had a policy that once you retire, you cannot teach. I took it to arbitration with the school district and now districts can no longer do that. They cannot have a policy that says that teachers who retire cannot go back and teach on an on- call basis. Teachers can ease out of it in that way.
As Mr. Boldt said, many teachers either want a break and then do something different or retire without doing anything or ease out of it because they identify themselves as teachers. I was one who identified myself as a teacher even though I am involved in 10 other companies. Still, I am a teacher. Teachers can be flexible. There are ways of easing out of it in a flexible way.
The Chair: It varies from division to division within the country. I have a niece who was told she had to go up to 100 per cent teaching even though she wanted to remain at 60 per cent in order to be a child care provider for her own children the other 40 per cent of the time. It was an all-or-nothing scenario.
We have to look at that, not only for education but for a wide variety of occupations, and we are concerned about how that will impact on the pension. In some pension situations, your best five years are your last five years of employment. If it is your best five years no matter when you took them, then your pension is protected. If it is the last five years, then you cannot go on a flexible arrangement or go part-time without significantly harming the pension.
Ms. Langolf: One of the more difficult aspects of flexible work arrangements is that employers believe that they will be incurring more costs. Now that the workforce is shrinking somewhat and we have to import workers, the incentive to become more flexible about working arrangements will be forced upon them.
I used to work for a trade union before I retired, and I can assure you that we tried very hard to get flexible working arrangements, including working at home, with limited success. Not everybody is in the fortunate position of teachers. Many clerical workers have not yet achieved pay equity. For them to retire flexibly is probably a non-starter.
Mr. Boldt: One final comment in regard to regulation. Very often a government body will create a regulation to which there are unintended consequences. Your niece's position of going from 60 per cent to 100 per cent is an unintended consequence. Regulation tends to breed rigidity.
The Chair: Thank you for your comments. It was extremely useful to our deliberations to have you here this morning. On behalf of the other senators, I want to express to you our deep appreciation.
Honourable senators, we will now proceed with our second panel. Appearing before us on behalf of the Family Caregivers' Network Society is Ms. Barbara MacLean; representing the British Columbia Seniors Living Association is Ms. Seona Stephen; from the Saanich Peninsula Health Association is Ms. Lyne England; and representing the Vancouver Island Health Authority is Dr. Michael Cooper, accompanied by Dr. Marianne McLennan. Welcome to all of you this morning.
Barbara MacLean, Executive Director, Family Caregivers' Network Society: On behalf of the Family Caregivers' Network Society, I would like to thank you for all the work that you have been doing across Canada. It cannot be easy, always doing the road show.
As an opening remark, I would like to congratulate the committee on their second report, which was incredibly inclusive given the range of issues across Canada.
Our organization represents family caregivers, and those are the unpaid moms, dads, sisters and brothers who do 80 per cent of the care at home within our health care sector.
I will reference a number of areas in the report. Chapter 4 on healthy aging and options to combat abuse and neglect ties tightly to the realm of family caregiving. Option 37, to develop supports for caregivers and to promote education to prevent burnout, specifically says:
Respite care services and support programs that help caregivers deal with the challenges they face can contribute to preserving the health and well-being of the caregiver, improving the care offered, and delay institutional placement or instances of abuse.
That emphasizes the trend that when we have overburdened and overworked family members and friends, bad things do happen. It is quite significant that it rests here as an identifier. One of the predictors of abuse is lack of adequate supports.
With our aging population, the number and quality of home support services that exist is a huge concern. In our scope locally, our organization reaches up to almost 40,000 people. That is in the local capital regional district alone. We are one of the few organizations in Canada providing a breadth of services. I am offering only a handful. Through core funding from the Vancouver Island Health Authority — they provide just over half of our funding — we exist as an organization to support families.
When you are looking at abuse, you are looking at all of the issues that are pertinent. It is not a very good picture that we are one of a handful of organizations across Canada. We receive phone calls from across Canada, yet our service area is the capital regional district. Although we are one of the few, we are hoping that that number can grow.
Chapter 4 also references respite care and support programs, and I would like to highlight that over the last decade the research and feedback indicate that respite is the number one tool that will create a difference. Respite is the number one thing that gives people relief from their caregiving duties. It is the number one thing identified that will help stop a cycle of abuse from even beginning.
Regarding section 4.5 in your report on hospice, palliative and end-of-life care, an outstanding amount of research and work has been done over the last 10 to 15 years, and I wanted to highlight that the recommendations within 4.5 are excellent. We support them fully.
Regarding Chapter 5, ``Aging in Place of Choice,'' what does that shift toward staying at home longer mean? It means families are doing more and more. We are seeing increased family support work and decreased ability to have home support services in place. That is a real concern.
Option 63, to provide information to caregivers, is critical. One of the key obstacles across Canada is that most people do not say, ``Hey, I am a family caregiver.'' There is no identifier or label that we conjure up and say, ``Because I am caring for my aging parent or my spouse, I am one of those people called a family caregiver.'' One of the battles we are facing across Canada is an identity crisis. There are services, information and support, and yet people do not know how to find them because they are not identifying themselves as family caregivers.
Since we began 19 years ago, we have been trying to increase awareness that we exist. We can do more with the resources we have, yet we lack communication and information about the service. That is true for all organizations across Canada.
Option 64 is to create a national respite program. If respite is the number one thing that will support caregivers, we need to pull together from a national perspective and create something called ``the ties that bind,'' a linkage, a policy, so that people are not dabbling around in their own communities at a loss for what else exists. We need to pull together and create a national respite program. We support that recommendation wholeheartedly.
Option 65 is to make changes to the compassionate care benefit. We know that it has been a good start over the last few years, but it is not enough. It is simply not enough to cover the needs of somebody taking time off work to care for somebody who is chronically ill and not just dying within the allotted time frame. That is a huge concern.
Option 66 is to provide financial support to caregivers. I will talk about that in my next area.
Option 67, to introduce a Canada Pension Plan, CPP, drop-out provision for caregivers, is excellent. I will also refer to that next.
Given that so much of your report covers things that relate to family caregivers, I will focus only on a few key things there from our perspective.
In Chapter 5, option 66 talks about financial support to caregivers being one critical area:
It has been suggested that the federal government could convene an expert panel on the financial security of caregivers.
That is great. We would like to go a step further: Please do not limit the expert panel to only financial security issues. We strongly support striking a federal expert advisory panel that could encompass a full range of issues related to family caregiving.
Many of the issues, including home support, home care, abuse, Canada Labour Code, all fall under one neatly packaged area and could easily be dealt with by a panel as a whole instead of being reducing to financial issues only. We look at the need to address issues like the impact on Canadian labour markets and productivity, to identify areas that require further data or policy development by provincial and federal governments. But we need the glue; we need the federal expert panel to get the ball rolling.
The expert panel could also look at changes to existing federal programs. For example, let us look at the CPP drop- out provisions for caregivers — similar to the child-rearing drop-out provision — so that they could continue their contributions when they drop out; and when they re-enter the labour force, they have not lost ground.
We might want to add that it is a huge gender issue, because women are the ones losing out phenomenally on a secure future and a secure retirement because they drop out. Eighty per cent of the people most severely affected financially in Canada are women, still, in 2008.
The panel could look at the establishment of a registered caregiving savings plan. It could look at amendments to the Canada Labour Code to include provisions for workers temporarily leaving employment in order to care for a person with disability needs. It could look at an innovation fund to support the development of different caregiving practices that reflect different communities. We have learned that the cookie-cutter, one-stop-shopping approach does not work for every community, and we cannot approach it that way. Innovation funds have been shown to provide the impetus for people to think differently about how to work together, not just prescriptively.
The expert panel could also put family caregiving on the map. We have learned that Canada has no national glue; we do not have a national policy, or even really a national agenda. We are not so proud about that. We lag far behind the United Kingdom and Australia in that respect. I have to say that as a representative at national conferences, it is a little embarrassing that a great country like Canada is not on the map in that respect.
Finally, provide the opportunity to include both private and public sector and volunteer sector representatives in an expert panel. Many people have spent several years in the caregiving sector. The sector is relatively unknown and unrecognized, but there is a depth of knowledge that you could pull together, and you would have more than enough people saying ``I will help'' when it comes to an expert advisory panel. Thank you.
Seona Stephen, Vice President, BC Seniors Living Association: Thank you for the opportunity to respond to your second interim report.
We have done much the same as Ms. MacLean. We have taken some highlights and then we would like to respond.
In option 56 you ask whether the federal government should play a role in the communication of best practices in regulation and whether different jurisdictions get together so that they do not need to reinvent the wheel in developing a regulatory framework for supportive housing. We actually disagree with the regulating of supportive housing.
When I talk about supportive housing, it does get confusing. We are talking about independent living. ``Supportive independent'' is how we talk about it in British Columbia.
We disagree with the regulating of supportive and independent living because we are based on a hospitality model of best practices, not a medical model. Assisted living in British Columbia is already regulated, as I am sure you well know, by the registrar of British Columbia, specifically dealing with health and safety issues.
The report mentioned that some assisted living facilities were providing levels of care beyond basic support. In British Columbia, that is well-addressed by the Assisted Living Registrar.
The British Columbia Seniors Living Association, BCSLA, is fairly new. We are just starting our fifth year. Our goal is to act as a resource for our members to prevent reinventing the wheel. We support best practices.
As outlined in our briefing note that you received earlier, you will see three of the main issues: the billing, the notice period, and the dispute resolution. In British Columbia we are working together with an industry-wide committee. It is just wonderful to see everybody around the table, and we will address this so that everybody is feeling comfortable and we need not necessarily go to the government-regulated model.
Option 41 is about increasing the number of geriatric and gerontology training programs. We strongly support the need for additional gerontologists. They truly understand the complex health care needs, particularly relating to falls and medication. We find that our general practitioners do not have the same depth of knowledge that these specialists have. The specialists provide outstanding service in the acute care hospitals, particularly in the geriatric rehabilitation programs that we have here in Victoria.
The sad thing is that there is a movement afoot to remove the gerontologists from geriatric rehabilitation programs. Hopefully Dr. Cooper can comment, because we would like clarification on that. Our industry affectionately calls these programs ``the geriatric jump-start programs'' because that is truly what they do. The geriatric rehabilitation programs do an outstanding job of preparing patients for discharge either to the family home or to the retirement communities.
Problem arise when seniors return home and the appropriate follow-up therapies are either nonexistent or difficult to access, or there is a requirement that the individual senior pays.
We would recommend that the gerontologists should be the clinical and administrative leaders in these geriatric programs. We stress the importance of a seamless continuum of service to seniors in order to capitalize on the progress made during the rehabilitation stage. This will prevent readmission. If we do not have the supports in the community, the seniors go back into the hospital, which is a cost to the health care system.
Another item is healthy diets for seniors. There are some excellent programs controlled by the community available to seniors, such as the Meals on Wheels program. I presume that Meals on Wheels would be governed by a dietician or Canada's Food Guide so that the seniors would be getting well-balanced meals.
Within the retirement communities, best practices are once again used. A dietician is always consulted when we are developing our five-week rotations, which are seasonal — spring, summer, autumn, winter. We work with Canada's Food Guide.
British Columbia has also come up with Healthy Eating for Seniors, an outstanding booklet that anybody can have and that we are using. It contains lots of information. I work with my chefs to make sure that we incorporate their really good ideas. There are some supports out there.
Certainly in independent and assisted living and even in the long-term care facilities, we do involve dieticians. I think we would be hard-pressed to say those seniors are not getting well-balanced diets.
Option 57 is to facilitate access to information about housing options across the country. Truly that is a concern. I would say probably the majority of us have websites well-established. In the last five years, probably a third of my inquiries have been coming through the website from across Canada. Our company is doing something good, because I am certainly getting lots of inquiries.
I am sure you are familiar with The Care Guide. It is in all jurisdictions across Canada. It outlines all the places available. It is free to seniors. Perhaps my particular retirement residence is not appropriate for some seniors. I would share this with them so that they are not lost. I would make some recommendations to them. I am sure you are aware that these items are available.
Senators from Ontario will be familiar with the Ontario Retirement Communities Association, ORCA, which has a 1-800 number that seniors can phone to get information. They are a well-established organization that we model after in British Columbia. We are exploring the thought that we, as an association, could have the 1-800 number that seniors in British Columbia could phone for advice.
Some communities in the province have established a seniors' hotline and reference centre staffed by individual seniors in the local community. How powerful is that? They are sharing their information with seniors. Sidney is a particularly good example of that.
Section 5.1 of your report is on housing. You state that 93 per cent of seniors ``live in private homes, and have a strong preference for staying in their own homes.''
Since I moved from acute care into retirement living, I have been fascinated by this. Within six months I do an interview with each resident that comes through my doors. I would say that I am not sure that that number is correct. What I hear from the seniors and from many of my colleagues in the association is that seniors often find that they are so overwhelmed by the thought of moving and the fear of losing control of decision making that they choose what they consider to be the easier, less daunting option, which is to remain in their home. This can create an environment of social isolation. It is also a loss of an opportunity for some seniors to live in a community, such as a retirement residence, where they could become more active, more connected and less reliant on community care.
Family relationships that were previously centered on caregiving, which Ms. MacLean mentioned, can be reinvented to a relationship of mother-daughter instead of mother-caregiver, for example.
We would like to see enhanced information and accessibility to community professionals that specialize in relocating seniors. Many seniors just do not know where to go. There are some excellent companies coming up. Some company officials have been nurses in the past so they have a caring sensitivity to that and they can actually take the resident through downsizing to moving into a retirement residence with as little disruption as possible.
Many of the residents I deal with in Victoria have no family. They may have the money to move into a private facility, but they do not have the wherewithal to deal with it. We need more communication on that.
The other thing is to connect families to support groups in their community, like the Family Caregivers' Network Society. The health authorities must be cognizant of the pressure they place on family members to augment the community care in the homes. We hear that a lot.
I will not discuss the briefing note because we are going to the table on Friday in Vancouver to start the discussion around these issues.
Dr. Marianne McLennan, Director, Seniors, End of Life and Spiritual Health, Vancouver Island Health Authority: We gave you some handouts and tried to make them succinct. I would echo many of the things that have already been said.
The health authority is challenged by the pressures and the requests for service. I will point out that half of our population is in the little southern tip of the map I provided you. The rest of our population is spread out remotely and rurally and difficult to service. That is a challenge, as is the challenge of aging, as everyone is aware. We have given you a snapshot of our context.
The prevalence of chronic conditions in the population of seniors, gaps in care and the fact the workforce is declining and we are having difficulty selecting and finding appropriate people to do the work are all pressures that point to the need for having ongoing innovation and excellence. What we have done in the past will not serve us in the future.
I have shared with you some planning models that have been developed in B.C. You may be aware of them. They put the person in the centre of our thinking on how we are going to approach health care planning. The thinking focuses on that person's journey through life in terms of staying healthy. We see things provincially that are supporting that, like ActNow BC.
It also considers the times when we have acute issues that come back that we need to get better at addressing. How do we build confidence in people's ability to get recovery? How do we give them competency and make sure they are able to make reasonable decisions? How do we connect them in their communities to support them on an ongoing basis?
The chronic disease issues and the disability issues require us to consider the whole person and what the seniors' values and goals are, and we have to optimize their independence in managing those challenges. Of course, we need to consider what it is like to cope with the end of life, and we want to help them plan in advance, think about what is important and valuable to them, and prepare for a good death.
When we take that to the level of action, to look at how we will actually approach it, we consider those aspects of the person and we think about the things that he or she can do in that phase of life, what the professional and informal caregivers need to know and do, what the agency or our organization as a regional health authority has a responsibility to do, and what is the greater social policy that we have both provincially and federally and have a responsibility to address.
I want to share with you the fact that the Vancouver Island Health Authority does have as a strategic priority the development of a seniors' centre of excellence. Partly that is a vision; it is also a strategy. We see ourselves as a virtual network of stakeholders, and you are hearing from many of them today about their interest, the resources they bring and the activities we can share to address these challenges.
We see ourselves as using geographical hubs. You heard that not all our communities will need the same kinds of approaches, and we need to be flexible in how we will orchestrate and meet those needs in our various geographies.
We will be looking at our interactive actions, what we actually do in the basic functions of caregiving and what education is required by our professionals, by the families, by the communities and by the future health care providers.
I would really like to stress the research requirement. As I said before, we know we cannot meet our challenges using the same strategies. We need to know what works. We need to have evidence to apply our new ways of addressing these issues, and those policy issues are another piece.
We have a partnership with the Centre on Aging at the University of Victoria. We are both generating new findings as well as making sure we get those findings into our practice. Partnership with the researchers is critical.
Dr. Michael Cooper, Division Head of Geriatric Psychiatry, Vancouver Island Health Authority: My focus is on the geriatric psychiatry side of things. We are looking at a number of priority issues and are working closely with the geriatric medicine side that Dr. McLennan represents.
Frailty is one of our key defining conditions. The frail elders are those who come to our attention. Falls prevention, medication issues, and chronic disease management are the key medical issues, and then there are a number of significant psychosocial issues around decision making. As Ms. Stephen mentioned, social isolation is another key area.
Let me talk for a minute about the mental health issues. I was looking at section 4.6 in the interim report and thought a little more data might be helpful in that area.
The population health model is helpful in understanding and approaching the problem. I rely heavily on a federal government website that provides the Population Health Template. A lot of work has been done over the past 10 or 15 years on that model.
A useful way of starting with that model is to break down the population we serve in the mental health field into four sub-populations, each of which has unique key health determinants, unique needs, and unique plans that have to be developed. The first group is the individuals with dementia. The second group is people who have had lifelong mental disorders who then develop age-related issues, such as the start of dementia and the development of complex comorbid medical problems. The third group is individuals who develop mental illnesses, most commonly depression, in later years. The second most common one is a group of paranoid disorders that can be quite challenging to manage. The fourth group is older adults with addiction issues. With the current cohort of seniors, those are primarily alcohol- related issues, but there is also prescription drug abuse; we have a lot of concerns around overuse of tranquilizer medications — the benzodiazepines or Valium-type tranquilizers. I will talk about each of these four groups.
More than any other of the four groups, the dementia group will challenge our society the most. The city of Victoria gives us a bit of a snapshot of what Canada will be like because we have a higher percentage of the elderly currently in our population, and I can tell you that in Victoria and throughout Vancouver Island our resources are being strained to the limit by this population group.
We know that as people get older the prevalence of dementia increases, and the unfortunate reality is that by the time people reach 85, most will have dementia. That figure is not likely to change until we have a cure for dementia. We can only hope that that cure is around the corner, because without it, it is hard to imagine how our society will cope with the aging population and the boomer generation once they hit age 85.
We know that 1 in 13 Canadians over age 65 have dementia. There is a high preponderance of psychiatric complications among that population. Probably 80 per cent to 90 per cent of people with dementia will develop psychiatric complications, and ultimately dementia is a disorder characterized by psychiatric problems. We need to look at how to plan for that.
We need to look at a range of options. Certainly having innovative programs that can provide prompt and timely assessment is key. We are looking at a number of exciting initiatives for Vancouver Island. We think reaching out to the family physicians and developing a shared care model will greatly help to address that early assessment piece. Dr. McLennan will talk about our Integrated Health Network for At-Risk Seniors project in a moment. That will be a showcase model of how we can approach that.
We are developing increased liaison and consultation with our key partners in home care programs and residential care programs. All of the geriatric psychiatrists on Vancouver Island visit all of the nursing homes across the Island in order to identify problems before they become a crisis in the residential care facilities. At the same time we are trying to deal with a growing number of individuals in the community who present similar challenges.
Through our mental health program in Victoria we have developed the capacity to respond on an urgent basis. We have developed a centralized intake process that I think will provide a model in terms of being a single point of contact to try to make manoeuvring through this sometimes confusing system of care a little bit easier both for seniors and for all of the health professionals out there.
We are also very proud of the program we have developed for the most severe population. With the closing down of the provincial mental health facility, Riverview Hospital, we have developed services on Vancouver Island to replace what was previously offered, and we have done it in a distributed fashion so that we have as a hub the in-patient programs located in Victoria and then satellite residential facilities located in Victoria, Ladysmith, and Campbell River. The last two opened just this year and are proving to be valued additions to the services. Individuals who previously would have been sent across to Vancouver for long periods of time can now reside closer to home and get the care that they need in a complex way. We have linked all four of these units in a dynamic, integrated way to ensure maximum utilization.
We are also very proud of our addictions program. In Victoria we have VISTA, the Victoria Innovative Seniors' Treatment Approach, which has been in existence for I believe about 15 years. It is modelled after some of the best programs in the world, and it follows an outreach model.
When it comes to meeting the needs of frail elderly with addiction issues, I would emphasize that an outreach model is the standard of care. This group is hard to engage in treatment programs. They do not fit into the usual kinds of adult addiction programs, and being able to offer them a specialized approach, going into their homes, their residences or nursing homes and addressing their needs has been very effective.
We are also very excited about future developments for Greater Victoria with the development of a new in-patient unit. This patient care centre will replace some of the aging facilities at Royal Jubilee Hospital providing medical and surgical treatment. It will also house their geriatric psychiatry unit, and it will follow the principle of an elder-friendly hospital. I believe it may be among the first in Canada to do so. It will be exciting to be a part of that.
Dr. McLennan: In North Island, we are also trying a blended team of geripsychiatry and seniors health, using the same team of individuals with those two specialties. We are finding that we are able to increase the primary health care capacity of family physicians and the families to manage challenging cases, and we are seeing less acute care admissions as a result.
I will highlight one or two more key innovative things we are doing. One is a system we put in place in South Island to connect our in-patient unit and expand our outpatient unit so that we have a whole system of care for our seniors who have the most complex medical issues. There is some information in there about what we needed to rethink and the assumptions we changed to put the service in place. Our results indicate that we saved probably about 18 bed-days annually with a resource injection into that strategy.
We also do not have a wait list for our geriatric unit. We can actually get people in within a day or two. This rethinking of how we deliver care and having the comprehensive system in place are critical for moving ahead with the challenges we are facing.
Dr. Cooper mentioned the Integrated Health Network for At-Risk Seniors project that we are working on. This is a health innovation demonstrated project, and I will highlight the fact that we do need seed money. We must try new things and evaluate them strongly to know if they will make a difference. This is an example.
We have 15 networked physician offices. We have a model, which I have given you in the handout, that connects each of those physicians with a home care nurse. Usually home care nurses are geographically assigned to their cases. In this case, the nurse and the physician share the same caseload regardless of where people live, and that communication, planning and working together is powerful. We are using that in our model.
We are also adding additional disciplines, like nutritionists and pharmacists, to that physician's office and to those families to support them. They will be linked to that comprehensive geriatric unit, so if they need an in-patient unit or surgery, for example, we will have that transition of information and knowledge about this person's ability to be managed in the home.
The evaluation has 30 performance indicators, and one thing they will be looking at is a return on the investment of resources that have been put into this from a decreased acute care utilization perspective. We are really excited about that.
The strategy is around improving and increasing the capacity of the resources already in the community to do more and better work with our seniors with more knowledge and to have good access and quick access for those issues where a specialist is needed.
I will not go through the medication management work that we have been doing, but we are part of the Safer Healthcare Now! initiative, part of the national work that is going on. We have developed locally a tool in home care for some of the medication reconciliation and the review process and assessing risk, and that work is being shared with that national group. We are seeing that this is a huge issue in the community, and I think we heard the other day some local results of some emergency department visits and the problems we are having with medication, so it is a really important area.
The last thing I will highlight is a couple of opportunities I think we need to explore. One is that we need to work in partnerships with municipalities and First Nations and other community groups because we really need to think about what it is like to have an age-friendly community. We are fostering some work there.
You heard about the physical design issues in our new hospital tower here in South Island at the Royal Jubilee. I think we need to make sure those building adjustments and needs are happening across the board. We are looking at technology as a way to deal with getting service closer to where people live and using in the best way our professionals who may be in South Island for patients in the North Island. We are looking at video conferencing and telephone transition support groups, and we are looking at innovative education approaches to keep our staff up to date on the latest information.
B.C. is doing some great work on collaborative provincial planning, which you may already have heard about. We have four provincial dementia projects on board this year as well as projects on stroke, and we are doing some work in the end-of-life area.
I would like to make two comments in conclusion. Our seniors' health strategy is evolving. We have started a seniors' forum in both South Island and Central Island to create a learning network that bridges between health and the community and our health authority leaders so that we can start to understand the issues and start to work in partnership. That will be key for us. We know we need to have creative solutions. We are getting some early experience about the aging population demands, and we are trying to be creative in our approach to meeting those demands.
Lyne England, Chair, Saanich Peninsula Health Association: Honourable senators and distinguished panel members, thank you for the opportunity to speak here today about this very important topic of aging.
I have read with interest other presenters' comments as your Senate committee has travelled across this great land of ours. I am heartened by some of the new perspectives and possible solutions that have been brought forward for consideration. Some of the possible options are enticing. Perhaps these suggestions will stimulate more dialogue that will lead to implemented solutions.
Roy Romanow concluded our health care system is ``as sustainable as we want it to be.'' However, we continue to hear voices pushing for reform and increased privatization despite challenges from many quarters. There are many learned people who contend that as long as the economy continues to grow, our health care system is in fact sustainable.
We appreciate that as the aging population increases, their needs and wants will put an even greater demand on the resources available. We all know that. I hear this at various committees I participate in and at visits to many long-term care facilities.
As a registered nurse, teacher and personal care provider for family members, I have witnessed the demise of dignity in long-term care facilities. For this reason, we must consider the situation all residents in long-term care facilities are currently facing, for unless the challenges of today can be managed, how can we possibly hope to manage in the future?
Since federal transfer payments were decreased in 1995, we have witnessed a correlation in the decline of care provision. This is not news. It is a fact that funding and staff shortages affect standards of care.
If there is adequate, consistent funding, there should be consistent staffing, which should also lead to consistent care. Residents should be activated regularly, repositioned and changed as frequently as required. Residents should be assistively fed in a calm, relaxed manner and responded to when they call for assistance in a timely and respectful manner. Residents should also be appropriately placed.
However, we do not witness this consistent quality care provision. Instead, we see and hear the residents' despair, the families' frustration, and the low staff morale.
Health care providers at all levels in Victoria are commended for doing their best under very difficult circumstances. Negotiated contracts have not been honoured, many registered nurses have been replaced by licensed practical nurses, and health care workers are choosing to work on a casual basis because of untenable workloads in long-term care. For these and many other reasons, all people working within the health care field should be saluted for their dedication, flexibility, compassion and caring for those they tend to daily.
We know residents entering long-term care are more fragile, with increased acuity of complex care needs, and we also know that we all strive for success and we should all be able to age successfully and fully to our potential wherever we are on the age scale or medical scale in residential care. This requires that residents' autonomy in long-term care be encouraged, not discouraged. It means aging holistically on all levels. It means nurturing residents as the unique individuals that are. It means continuity and comprehensive provision of care, not the minimum provision of care.
The new model of care implemented by the Vancouver Island Health Authority touts standardization of care, but we know uniformity provides continuity only if it is consistent, and that is not what occurs.
Before this model was introduced, long-term care facilities were chronically short-staffed. Now that the new model of care has been implemented, that has not changed. Further, one size does not fit all when we are speaking of individuals with different needs.
What can be done to improve aging in facilities aside from bringing staff levels up to an acceptable staff-to-resident ratio?
Reinstatement of the transfer payments by the federal government to acceptable levels would be a start. Then resources should be allocated for specific outcomes. There must be clear protocols put in place with follow-up and standards of care that are monitored.
Whistle-blower protection should be put in place for residents, friends, family members and staff, for until the pervasive fear of retribution in long-term care is eliminated, these people are unlikely to speak out.
Further, there should be accountability and more transparency in health care, and every facility should have a family council in place to advocate for those in care.
We know that wrapping up a solid solution to health care is not an easy task. One cannot wrap every individual in the same sized package with the same amount of string to hold it together. It simply will not work.
We sincerely hope the results of hearings such as this will lead to more comprehensive and equitable funding for the residents who call long-term care their home.
The Chair: Thank you.
Dr. McLennan, you said that you had some seed funding. Is that on a temporary basis or on a permanent basis? Can you explain how you are able to move to this integrated care model?
Dr. McLennan: Last year the province had some health innovation funding. It was a competitive process. Some of the funding was for one year, which made it very challenging to put together the service to be able to demonstrate the effects. We were better-positioned in South Island where we had more comprehensive geriatric services to work with and we were able to show that we saved a lot of in-patient bed-days. We do not yet have our budget this year, but we have hope that that will be solid funding going forward.
In our Nanaimo area, at the centre of the island, we had no services to build on, so we really just got started. We hope we will be able to lay the foundation there to grow.
Part of what we need to do is evaluate and be clear about how all our resources are being used and be able to shift them internally. Some of this work will happen that way.
The primary integrated network that I spoke about is a three-year project, so there is a lot more rigour going forward in that.
There is probably not enough research. Many components will not get that high-level indicator measurement where we could concentrate on learning. For example, we are doing work in the residential care area with the family physicians to make sure that they are supported in end-of-life and good care. From that work, we will learn a lot about what is needed and required. It is hard to make a difference with short-term funding. Long-term funding is needed.
The Chair: When you mention health innovation funding, I assume you are talking about federal dollars.
Dr. McLennan: Those are provincial dollars. I believe the national dollars are gone, and that is a shame.
The Chair: Dr. Cooper, you mentioned the fact that geriatric psychiatrists visit all nursing homes and long-term care facilities in order to provide assistance. Does that include First Nations facilities here on the Island?
Dr. Cooper: I moved to Vancouver Island a couple of years ago from the Okanagan, so I have not been to all the facilities on Vancouver Island. I believe there are some First Nations-oriented facilities in Port Alberni, and indeed our geriatric psychiatrist does go out to those facilities in Port Alberni. There may be others up Island that I am not aware of.
Dr. McLennan: They do outreach to people up Island, so it would be wherever they are.
The Chair: Earlier this week our committee visited a facility in rural Manitoba, in Ste. Anne, which was beautifully developed. The plant facility was really quite magnificent. The next morning we went to visit a similar long-term care facility, this time on a First Nations community, and I have to tell you that the contrast in terms of physical plant was pretty dramatic.
First of all, let me say very openly that we saw the same kind of care being given to all patients, but quite frankly the physical facility was just totally unacceptable at Sagkeeng First Nation. They do not have visits from geriatric psychiatrists, and they are still playing a game of who has jurisdiction over this particular area.
Your premier has clearly made the statement that all people of British Columbia are citizens of British Columbia whether they are Aboriginal or non-Aboriginal. In my view, that statement needs to be made by nine other premiers in this country.
Senator Mercer: Dr. Cooper, with respect to the new facility, you said that it was an elder-friendly hospital. Can you give me a snapshot of what is different about this facility as opposed to another facility I might visit?
Dr. Cooper: I am involved in planning our geriatric psychiatry unit, which will be half of one floor of this building. It is gratifying to know that all of the units will take elder-friendly considerations into the planning process. As to exactly what that looks like, I cannot give you a clear answer. However, I am getting a nudge from my colleague, so I will let Dr. McLennan give you a better picture.
Dr. McLennan: We are building on some research that was done by Belinda Parke at the University of Victoria. A complete manual has been developed based on that research about what it means to be elder-friendly, everything from the type of paint, the type of wall coverings, the railings. Rather than create a unit that is elder-friendly, the whole hospital will be built and designed and considered in terms of what elderly people need in visual cueing and other kinds of cueing to make them safe.
Ms. MacLean: I understand that there is also a component of elder-friendly that has to do with approach, philosophy and staff training. It is not just physical plant. Physical plant obviously has minimum standards, such as the lettering and font size of particular things like washroom labelling for the visually impaired. People as they are aging do not see so well.
Another component is the approach that teams take to work together in an integrated manner to treat somebody who might have a cognitive impairment at that late stage or a visual or auditory impairment. They might include family members in the planning model. An inclusive model involves planning well together as teams of professionals and community supports.
Dr. McLennan: That is a good point. I would note that a huge need across this country is education of our health care professionals about elder issues. We tend to want to move seniors off medical units because they are older, but that is the population. We are trying to work with nursing schools and other disciplines to get that message out there, and we are trying to work with our staff. That is a huge requirement for the health care system.
Senator Mercer: Dr. McLennan, you stated that there is no waiting list in the geriatric unit. That sort of shocked me. I am from Halifax. I have had occasion to talk to a lot of people. Waiting is what they do.
Dr. McLennan: I wish I could tell you we do not have a waiting list in the outpatient area we have opened.
We try very hard to get those urgent cases there first, and we are able to get immediate access to our diagnostic and testing area; they get the same level of service in the outpatient clinic that they would get in an emergency department so that doctors can make a good medical determination of what is going on.
We have had people who would have been in for a good week's length of stay managed during the day in that service.
Senator Mercer: How have you managed to do that? Are your patient-to-staff ratios different than what we will find elsewhere? Has British Columbia invested more in this field, or is the hospital in Victoria just lucky?
Dr. McLennan: No, the hospital in Victoria is as challenged as any hospital in the country. I am only talking about my one geriatric rehabilitation specialty, geriatrician-managed program. By having a comprehensive set of services, being able to move people from an acute unit directly into this intensive outpatient area for a short period of time while they get their rehabilitation and some education and support, we have been able to make a tremendous difference in our flow of patients. It is critical.
Elderly people should have a hard look at their need for hospitalization. We know they lose 5 per cent of their muscle strength every day they are in bed. You can imagine, if they are sitting in an emergency room and then in a bed for a week because somebody does not have time to get them up, they are in trouble.
We have a geriatric team that can visit any acute care unit and make sure there is an elder-friendly plan in place. We have an aide that can go and do the activities with that senior so that they are not waiting for the unit staff to do it. We have been able to target and provide some service based on those needs wherever they are in our hospital system in South Island.
Senator Mercer: It would seem to me that these measures fall under the category of best practices. We are very interested in that. As you notice, in our report we talked about best practices. We will steal some of your ideas.
Dr. McLennan: I hope so. We need new ideas.
Senator Mercer: Imitation is flattery, as you know.
Ms. England: I have heard that report from you previously, Dr. McLennan, and it is wonderful that you do have that continuum of care for those people from acute care.
However, the muscle mass loss, the 5 per cent, becomes even more acute and critical when you do not have enough staff in long-term care to ambulate and mobilize these residents or even to turn them as required.
Senator Mercer: Ms. MacLean, you made a suggestion of a Registered Caregivers Savings Plan. I wrote it down but I did not understand it. What do you visualize in that?
Ms. MacLean: When people opt out of employment, guess what they also do? They are not contributing to their RSP plan and they do not have a vehicle with which to do it. Perhaps their employer, who was matching, no longer does that.
Imagine all of the ways that you actually plan for your future. I do not know that it is done anywhere else. For example, the U.K. and Australia have some pretty neat innovations, but the financial piece in terms of contributing is not there either. This would be a first-in-the-world approach; you will have to make it up. How might that look and under what policy provision would that work? It is simply a labelled retirement vehicle that is specialized so that caregivers are able to do it. I am no expert in that area.
Senator Mercer: I guess I am having difficulty. If a caregiver has opted out of whatever their other occupation is, how do they contribute to this? Or are you talking about perhaps having this plan early in life in anticipation of being a caregiver?
Ms. MacLean: No. Most people will say that this does not concern them now. They will not buy into that idea. Most of us respond when it becomes a looming issue in front of us. At what age do we start contributing anyway?
It would perhaps be a way to avoid having somebody cash in their RRSPs in order to care for a person. It could be a matching scenario through the government when we are looking at those people who are most at risk of financial instability and then going into another social service system. That is the trend: lack of contribution to your RSP, dropping out of the workforce, not contributing to your future or planning for it very well financially. Those are the people on social assistance.
Senator Mercer: They are perpetuating the problem.
Ms. MacLean: The policy development folks who have far greater knowledge than we do about those areas could look into it. How could it happen? Whose responsibility could it be? Whose shared responsibility? Could people be coached to not let go of that? Maybe the impetus is an awareness of what will happen to you if you do not have planning in place. Those financial issues are not even discussed.
Senator Cordy: Dr. Cooper, I was interested in your comments about addiction issues. When I hear about seniors with addictions, prescription drugs is what I think of.
When you said that the number one addiction was alcohol, I should not have been surprised, because I was on Senator Kirby's committee on mental health and mental illness. When we talk about addictions, we hear about the hard drugs, but the reality is that it is alcohol. Still, it did surprise me because I had not heard of alcoholism being a major addiction among seniors.
Have you done any research on alcoholism among seniors? Have they carried alcoholism with them through their life, or is it comorbidity, where the seniors have another illness but are dealing with it through alcohol? Are they self- medicating with alcohol because they have either a physical illness or touches of dementia?
Dr. Cooper: Looking at our statistics, the majority of cases coming to our VISTA program are alcohol-related. A much smaller percentage have the tranquilizer problem.
We are not doing research. I work mostly in the mental health side of things; I do not do the addictions side.
You are right: it is complex and there are multiple determinants. Alcoholism in the elderly is not a single entity by any means.
The biggest chunk I see, which I think the public is largely unaware of, is brain damage due to alcohol. A small but significant percentage of people drink for many years. Some people can drink for many years and not get brain damage, but a certain percentage get Korsakoff's syndrome. If you asked the general public what Korsakoff's syndrome is, you would get a blank stare. People are unaware of the huge impact it has.
Korsakoff's syndrome is incompatible with living independently because it affects short-term memory and frontal lobe function, that part of the brain function that gives us judgment and the capacity to solve problems. These people are in the community. They wind up in our emergency rooms in acute care; they go through alcohol withdrawal, and then they wind up going to nursing homes. I do not have statistics off the top of my head on that one.
In other groups, we are looking for depression as an underlying common cause, some people with chronic anxiety disorders who are using alcohol. Clearly, programs like VISTA play a key role in trying to address the many psychiatric and social determinants, including grief and loneliness, that might trigger alcohol problems in seniors. There is a large underinvestment in this area, but I do think our VISTA program could serve as a model throughout the country.
Senator Cordy: Ms. Stephen, do you see that in the work that you do?
Ms. Stephen: Yes, I do. One of our challenges is that these people come into retirement living and we actually do not know. Sometimes it is triggered by the death of a spouse.
The beauty of Victoria is that there is an avenue. Even in the private retirement assisted living or in the independent living that I operate, we can actually access one of the programs that Dr. Cooper looks after. Dr. Cooper and his colleagues do come in.
Our goal in retirement and assisted living is to maintain seniors in their home regardless of whether they have mental health issues. My experience from some quite challenging cases, and I still have them in independent living, is that these seniors work well in routines.
I am a nurse, not a geriatric specialist, but I am learning from the gerontologists the key alert signs, and then if I need intervention, I can access the health authority and get support coming in. It is often just a matter of adjusting medication. I learned how to deal with them in a counselling fashion and then we get over the hurdle.
In the independent living in B.C. I certainly get a lot of support, which I have never experienced in any other province I have worked in. That is why I am so supportive. I get more support from gerontologists than I do from general practitioners.
The Chair: I am a little confused with your definitions. You seem to distinguish clearly between supportive housing, which you define as independent, and assisted living. In many of the places I am familiar with, for example in Ottawa, the two are combined in the same building.
Ms. Stephen: We can be combined in the same building, but we are very clear in our definitions.
I do not know whether you have talked to the Assisted Living Registrar in British Columbia. I noticed she was not on the witness list, and I think she is a key person. We in the industry are clear, but I do not think the public is clear. As one involved in independent and supportive living, I know well the level that I can go to. After that, when residents come in, if they are not appropriate for independent living, they need to go to assisted living. We have many facilities.
The association widened our membership to include assisted living because many places are being built with assisted living on the ground floor and independent and supportive on the other floors. You have to be very clear or you will end up with the comment you had in your report saying that many places are doing more than assisted living; they are almost into the complex care.
In British Columbia we have very clear definitions, which we had to get because all of a sudden the Assisted Living Registrar descended on us. None of us in the industry knew that was going to happen. Our association has worked closely with the registrar to be clear. Our job is to go out and educate our members.
I also work as a peer reviewer for the registrar. If facilities are having some difficulties, then she will delegate authority to me to go in, review the situation and come back with recommendations.
For me, it is very clear delineation.
The Chair: I am glad it is clear for you because I am not sure it is clear for many other people.
What concerns me is your statement that you do not feel that you need to be regulated. When somebody comes to me and says, ``We do not need to be regulated,'' I must say that my ears go up.
Ms. Stephen: I understand that. I am not talking about assisted living or complex care, I am talking about independent support where the people are cognitively intact. They can make their own decisions. All we do is support optional meal service, housekeeping once a week and laundry service once a week. Other than that, they live totally independently. Many of them are volunteers in the community. Some of them even have part-time jobs. I am talking only about the hospitality model of independence. We already have regulation in assisted living in the health and safety here in B.C.
I have just come back from the ORCA conference in Ontario. When I heard about what is going on there, I thought, wow, this is really complicated. Our definition is much cleaner. We are up against a hurdle. This government, and we have met with the minister, is wanting us to explore this because this government does not want more regulation and more government interference, but we have to protect our seniors.
Senator Cordy: I will get back to the addiction issues. I am wondering about your outreach service for adults with addictions and how that works and who makes the decision that they will get the outreach services. Do you get referrals from family members? Does the person come to you? If the person does not want help, you are banging your head against the wall.
Dr. Cooper: Referrals come from all of those sources plus many from family physicians and many from the home and community care programs where a home care nurse might identify a problem. Indeed, many of the patients or clients are quite reluctant to be engaged in the process.
One difference with the outreach model is that our team will persist in their efforts to engage that person, within certain limitations obviously, but they are very skilled at engaging these people, working with families where families are available. In many cases these seniors are quite isolated, and that becomes a difficulty. It is, again, a strength of our program.
Senator Cordy: You also recognize, as you said earlier, the possibility of comorbidity, so all of those things are taken into account.
Dr. Cooper: Yes.
Senator Cordy: Ms. England, I am interested in your comment about dealing with abuse of seniors and the need for whistle-blower legislation. We heard about abuse yesterday in Vancouver and also from other people across the country and when we were in Ottawa. We have heard of situations where family members go in to complain or to raise an issue and they are told, ``If you keep complaining, your mother or father or sister will be removed from the home.''
How do you feel whistle-blower protection would solve the problem? On paper, it sounds terrific. In reality, how would it work?
Ms. England: It is sad to hear that you have heard this elsewhere, although I know it is prevalent across Canada and in other countries as well.
The fear that people experience not speaking up allows this to continue. If people do speak up, there is a certain amount of protection there. It is incumbent upon us to make everyone in long-term care feel comfortable enough to speak up if a wrong is being done. Whether it be a social or emotional issue or a physical issue, we must know about it before we can make it right.
Senator Cordy: There is financial abuse, also.
Ms. England: Financial as well, yes.
I would like to comment on Dr. Cooper's program. I know that alcohol abuse and drug abuse occur in long-term care settings, and I would be very interested to know how quickly his team can access those problems in long-term care. Oftentimes inappropriate placements come into long-term care with these very problems, and I see it taking many, many weeks, with staff that are ill-qualified to deal with these specific issues having to cope with that along with all of the other pressures they are under.
Ms. Stephen: Could I make a comment on the whistle-blowing statement? Many of our organizations have such a policy. I do not know whether the Vancouver Island Health Authority has that, but certainly my organizations and many of my member associations do have whistle-blower policies in place to allow staff to come forward if there is an issue and not be penalized for it. That is a proactive measure.
The Chair: The reality is that while those provisions may exist, we know that whistle-blowing does not happen. It is not just with the care of the elderly. You can have it with the care of a child in a child care centre or even in a school, where parents are reluctant to complain because perhaps the teacher or the child care worker will take that out on the child who is vulnerable.
The same thing happens with seniors, and the fear is that if I complain about my mom's care, they will not take it out on me: they will listen politely but then take it out on my mother after I leave.
I think that is the issue Ms. England was trying to address. By having some form of legislation, then you put in some protection for those individuals that is not presently there, although there may be goodwill in terms of policy to have it there.
I will end with a question to all of you. Most, if not all of you, have read our report. If you were in our shoes and had to make one overall, overarching recommendation, what would it be?
Ms. MacLean: Can we have a top 10?
The Chair: Yes, you can. What would you want in the top 10? That is probably easier.
Ms. MacLean: Certainly we need a national framework that encompasses seniors' issues, something that a federal body stands behind where these issues can come together in a collaborative and cross-functional way. That does not exist. We have great pockets; we do not have a glue.
For example, our request would be to have a federal expert advisory panel on caregiving. I will even concede a federal expert advisory panel on all things to do with the aging population, and that would encompass that piece for us if nothing else happened. One function would be to give national scope to some of the issues that are not quite so prevalent and that people are not talking about. It would shine a light on them and they would become something that we can all work on together.
Ms. Stephen: I tend to go in the same direction. Our association does support the non-regulatory model, but I have learned from this that the definitions are not clear. I have a document that British Columbia is working on — I will send it to the clerk just for interest's sake — because there is a way that we can do it and still protect our seniors.
Again, I want to be very clear, I am not talking about the licensed care; I am not talking about the people who come under the Vancouver Island Health Authority.
In looking at gerontology and the programs that the doctors have talked about, we need to enable support into these retirement residences, where we can keep seniors in their homes without putting them into an acute care sector.
Dr. Cooper: Having national benchmarks that would set a standard for all areas of Canada to strive towards and to bring Canada up to the same standard of care that is being achieved in many other countries, especially Scandinavian countries, the U.K., and Australia. I believe Canada is currently falling behind in many areas where standards are available. We are especially falling behind in the area of our complex care residential facilities, and we need to invest considerably more in providing a full range of residential care facilities for that population of seniors that is the most vulnerable and the most complex medically and also has the highest rate of mental health issues.
Dr. McLennan: We need to support some knowledge networks between research and practice, and we actually need to challenge some of our assumptions. We have been challenging assumptions around seniors' abilities as opposed to their medical problems. We need new frames for looking at things, so we need a way to have evidence, informed practice, and practice-informed research that is tightly linked.
Ms. England: I would like to see an independent watchdog for seniors in place; legislated whistle-blower protection, which I have already mentioned; appropriate staff ratios; and family councils in each and every facility that would liaise effectively with the Vancouver Island Health Authority.
Dr. Cooper, I stand behind what you said about the standards.
Professor Ruggeri, the economics professor from the University of New Brunswick, presented an intriguing and provocative idea: his proportional-based transfer of money to provinces that have faster-growing aging populations than those that do not, it being a transitory thing.
Ms. MacLean: I will definitely get back to the committee on the registered caregiving savings plan. I will do a little homework with my colleagues and give you some more information on that.
The Chair: Excellent. I will end with a quote that Ms. England provided because it is extremely important for the work that we are doing. It is by Martin Luther King, Jr.: ``Our lives begin to end the day we become silent about things that matter.''
With that, I would like to thank each and every one of you.
The committee adjourned.