Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 4 - Evidence - April 13, 2016
OTTAWA, Wednesday, April 13, 2016
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:21 p.m., to continue its study on the issue of dementia in our society.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I would like to start by asking each of my Senate colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, from Toronto, and Deputy Chair of the Committee.
Senator Merchant: Pana Merchant from Saskatchewan.
Senator Nancy Ruth: Nancy Ruth from Toronto, Ontario.
Senator Raine: Nancy Greene Raine from B.C.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: We are continuing our study on the issue of dementia in our society. I am pleased to welcome three different organizations to our meeting today. By agreement, I'm going to call them in the order they're listed on the agenda. Following the presentations, I will open the floor to colleagues for questions.
I will start with Dr. Suzanne Dupuis-Blanchard.
Dr. Suzanne Dupuis-Blanchard, Professor, President of the Canadian Association on Gerontology: Thank you, senators, for the opportunity to address the committee on the important issue of aging and dementia.
The Canadian Association on Gerontology is a national not-for-profit, multidisciplinary, scientific and educational association established to provide leadership in matters related to the aging population and with a mission to improve the lives of older Canadians through the creation and dissemination of knowledge in gerontological policy, practice, research and education.
In the fall of each year, the association holds an annual scientific and educational meeting where researchers, students and all stakeholders who work or have an interest in aging come together to share study results and exchange ideas on current issues in aging. Our membership is multidisciplinary and is composed of researchers, practitioners, key decision-makers and students. We also collaborate with different organizations related to aging, including, CIHR.
The federal government needs to take a leadership role to address aging and dementia, and time is of the essence. Although population aging is the success of our advancements in health and social care, the phenomenon will and has begun to present its challenges.
In Canada, the Atlantic Provinces are experiencing a higher proportion of adults over the age of 65 at a rate of 19 per cent in New Brunswick, with Nova Scotia, Prince Edward Island and Newfoundland trailing at 18 per cent. These provinces are on the brink of experiencing the challenges of maintaining the health of older adults while providing important care and services to optimize autonomy. For these reasons, the federal health transfers should reflect the age of the province's population.
Another eminent challenge of our aging population and dementia is human resources. In 2015, the Canadian Medical Association stated that Canada had 261 geriatricians. Despite their high rates of aging, none were found in P.E.I. or Newfoundland. In addition, only 2 per cent of internal medicine residents choose geriatrics as their first choice of practice. In nursing programs across Canada, some nursing students are graduating without any gerontology content or with minimal exposure to gerontology in their education; and few are motivated to have a career caring for older adults or their families, mostly because of negative stereotypes about aging. As a registered nurse and a professor in a school of nursing, I can attest to this reality.
To meet the needs of an aging population, all physicians, nurses, social workers, psychologists and other health professionals need to have the skills to care for older adults, in particular those with dementia, on the continuum of care from health promotion and prevention strategies to loss of independence.
We must set our gaze beyond these formal professions. The notion of aging at home has garnered much attention in the last few years despite its absence from the Canada Health Act. Research has shown that older adults aging in place mostly require services such as help with home maintenance, housekeeping, meal preparation and transportation.
Seniors with dementia require additional home care services. Home care workers providing these essential services are often overlooked but will become an indispensable asset for our aging population as we shift from institutional care to community care. Working conditions for home care and home service providers must be addressed. Our health and social system confers important responsibilities on these workers to prevent institutionalization. However, a recent study that my team and I conducted in the province of New Brunswick showed that home care workers are mostly women in their 50s being paid minimum wage, which in New Brunswick is $10.31 an hour; are not reimbursed for travel between their clients; and receive few hours of continued training. As a result, few young adults are interested in this type of work.
[Translation]
It is also important to recognize the needs of official language minority communities. The research clearly shows that, when seniors experience stress, health crises or cognitive impairment, such as dementia, they tend to use their mother tongue even if they were fluently bilingual their entire lives. Studies conducted in New Brunswick and Ontario revealed that French-speaking seniors receive comparatively more primary health care services in their language. This underscores the importance of training skilled workers who can provide proper health care to individuals in official language minority communities. Access to care in one of Canada's official languages is paramount. Equally important is that research in the field be encouraged and supported.
[English]
In addition to access to care for seniors in official language minority communities, older adults and care-givers in rural communities also face difficulties accessing services for dementia support. While the First Link program has known exceptional results since its launch, some rural communities have limited access, and a number of family physicians are not even aware that this program exists.
Other than the issues already presented, we must also address silos of care. Seniors and families with whom I interact frequently comment on the lack of coordination during transition periods and points of care. Although we believe that health and social care focus on distinct issues, for the optimal health of an aging population the structure of our system must facilitate communication and coordination of care and services between these two important elements of seniors care in dementia. Nowhere else is it more important to bridge health care with social services than for seniors.
As we embrace aging in the community, we need to consider the impact of loss of independence, including dementia, on two important elements. The first is the level of resources allocated for community services and care compared to institutional care. The second element is family care-givers. Care-givers are greatly undervalued. Family care-givers are either spouses who are also seniors themselves or adult children who juggle full-time work, family obligations and care or support for an aging parent. During certain points of care, care giving can be an intense experience with few resources to help alleviate this.
We need to address the many challenges faced by care-givers so that they may continue to provide important support to aging family members without suffering financial or job security issues. Care-givers are essential care providers who also need training and appropriate conditions to provide quality care.
The CAG believes that research on dementia ranging from prevention to living with dementia to a cure must be encouraged, along with continued research funding. The CAG and its members recognize the importance on research on all dimensions of dementia. We have presentations dedicated to it at our annual conference as a means of sharing knowledge to improve education and practice in this area. Our journal, the Canadian Journal on Aging, also publishes work related to dementia, but it is only a beginning and all stakeholders need to do more.
The CAG supports the need for a national strategy on dementia. With 1.4 million Canadians estimated to have dementia in 15 years, now is the time to develop a strategy. This strategy must include the following elements: address current and future working conditions, especially for home care workers, in order to recruit young people and encourage them to choose a career in aging; mandate minimum competencies in gerontology and dementia care for students in health and social-related disciplines, as well as other programs of study dealing with the public, and providing continued training is also essential; support aging in place for families with dementia by suppressing the silos of care, developing effective means of communications, and reviewing the Canada Health Act to include home care and long-term care; and encourage and support research on aging, especially on issues related to dementia, aging at home, frailty and official language minorities.
While health is a provincial entity, the federal government must have a leadership role in providing all Canadians with the best possible experience.
The Chair: I now turn to Dr. Veronique Boscart.
Veronique Boscart, President, Canadian Gerontological Nursing Association: Thank you for the opportunity to present today. Today I'm here representing the Canadian Gerontological Nursing Association, CGNA, and also the Registered Nurses' Association of Ontario, RNAO. The CGNA is a national organization representing gerontological nurses promoting practice at a national and international level. The RNAO is a professional association representing registered nurses, nursing students and nurse practitioners in Ontario. We've developed a joint submission for you with 12 recommendations that I will present in five key areas.
The first key area is health system resources. Dementia is a complex illness that requires responding to biomedical, psycho-social and ethical challenges. That multifaceted illness requires a multifaceted approach that includes various health and social services. It also requires health human resources equipped with the knowledge and skills to manage this chronic disease.
An ample supply, distribution and utilization of health care professionals, including RNs, nurse practitioners and unregulated care providers, really need to work together in teams. It is critical that they support the people living with dementia in a variety of settings. It should be one of the key elements included in the next health accord, along with enforcing the Canada Health Act with appropriate increased health funding, reinstating the Health Council of Canada, and expanding Medicare to include universal home care and Pharmacare without co-payments or user fees.
The second key area I want to highlight is education. It is imperative that registered nurses and nurse practitioners and all others, including unregulated care providers, have opportunities to enrich their knowledge, skills and competencies to care for people with dementia. This can happen through dedicated education in gerontology and chronic disease management. But efforts should also be made to really provide human and financial resources to support that uptake of this education into the practice setting, making sure that the evidence, which we know out there is sufficient, actually happens in the real setting.
CGNA has developed care competencies for nursing to practice in caring for seniors. RNAO has developed several nurse best practice guidelines that are translating evidence into practice setting. Unfortunately, some of these are not picked up by nursing schools or in practice settings. The work of these nurse practice guidelines and these competencies can make a really big difference. It is adopted throughout the world but not always in Canada.
It is also important that the Canadian health system aligns the knowledge and the skill of our health workforce with the needs of the people that live with dementia. There are some exciting efforts under way in Ontario and other jurisdictions to authorize RNs to prescribe medications. That would provide accessible and continuous care for persons experiencing dementia, unlike having to wait several weeks to find the right medication prescribed by the right care-giver.
The third key area I want to highlight is housing. If you truly want to foster living well with dementia, it means that we need to support people remaining within their own homes and communities as long as they can. That requires access to appropriate home and community supports and assistance for care partners or care providers. Well-organized home care services and sufficient and suitable day care programs are important staples of supporting aging at home and providing those care partners with the support they truly need.
When a person with dementia is unable to live at home because it might not be safe or the supports might not be in place, they might consider transitioning to a supportive care environment. In Canada, we should ensure that Canadians with dementia, regardless of their socio-economic status, have access to appropriate housing. It can be done by ensuring accessible housing strategies exist that can accommodate varying levels of need. We further urge the application of a health equity lens in government decision-making to better understand the sociocultural and economic factors that people with dementia and their care partners experience every day.
The fourth key area is care partners or care-givers. These are the people that do this every day: the family members, the friends, the neighbours and the volunteers. They are critical to support people living with dementia. Compared to care-givers of older adults who have retained their cognitive abilities, care partners of persons with dementia are more likely to experience chronic health issues, depression and social isolation. We urge the committee to recognize the value these people bring to people living with dementia and to ensure structured supports, including accessible day programs and respite care possibilities. We also call on you to support efforts that coordinate the information about services available to these care partners and people living with dementia through one organized system.
The final key area I would like to mention is the integration of health and social services. A shift is needed in Canadian health policy from a focus on individual sectors to a much broader, integrated model of health and social services — inter-professional primary care delivery that utilizes all teams of regulated health care professionals and unregulated care professionals to all practice together to provide the best care possible.
Furthermore, these things really enable providers to enter into a long-term therapeutic relationship. It is the same care provider providing the same information to the same families living with dementia. It really allows the one-access person. Constant access to a single point of contact for the care is very important when you have dementia. Primary care registered nurses are very ready to serve as the dedicated care coordinator in the system.
Dementia does not discriminate. It is the leading issue in everything I do as a nurse every day. It has impacted my family. Chances are it will touch you or somebody that you know in your life. We ought to do a better job of dementia care in Canada.
CGNA and RNAO are grateful that we have the opportunity to present to the Standing Senate Committee on Social Affairs, Science and Technology and possibly contribute to the work you are doing. We look forward to seeing these recommendations being integrated in your reports. We welcome any opportunity to further collaborate.
The Chair: Thank you very much. I will now turn to Dr. Marie-France Tourigny-Rivard, representing the Canadian Academy of Geriatric Psychiatry.
[Translation]
Dr. Marie-France Tourigny-Rivard, Geriatric Psychiatrist and Professor, Department of Psychiatry, Division of Geriatric Psychiatry, University of Ottawa, Canadian Academy of Geriatric Psychiatry: I will be making my presentation in English. For those who prefer, I would be happy to answer questions in French.
[English]
Thank you for inviting the Canadian Academy of Geriatric Psychiatry to contribute to this important study on dementia in our society. The CAGP is composed of nearly 300 geriatric psychiatrists who provide clinical care to thousands of persons affected by dementia every day in collaboration with primary care providers, mental health colleagues, geriatricians and other specialists. CAGP members are actively involved also in education of future physicians and specialists, as well as in research.
I'm a recently retired geriatric psychiatrist who helped develop mental health services for seniors of the Champlain region and the francophones of northeastern Ontario through the University of Ottawa geriatric psychiatry specialty program, which allowed our region to train and retain a critical number of geriatric psychiatrists.
I participated actively in Ontario's five-year dementia strategy — so you need to know that there were successful strategies in the past — from 2000 to 2005, a strategy that tried to address many of the issues that you have heard so far.
I also helped develop a document addressing the specific needs of long-term care residents called Building a Better System: Caring for Older Individuals with Aggressive Behaviours in Long-term Care Homes, serving as the basis for the Behavioral Supports Ontario program, which greatly enhanced mental health services for persons affected by dementia in this province.
Finally, I was Chair of the Seniors Advisory Committee of the Mental Health Commission of Canada, which your committee had recommended in 2006, and I remain a member of its current advisory council. As you may already know, the Mental Health Commission has developed our first Mental Health Strategy for Canada as well as Guidelines for Comprehensive Mental Health Services for Older Adults in Canada, a document that outlines in some detail the range of mental health services that we hope would be accessible in each province and each region for those who live with a mental illness or the psychiatric complications of dementia.
Like almost all Canadian families, my family has been affected by Alzheimer's disease. In preparing these remarks on human resources, I used both my personal and professional experiences to reflect on resources that are needed and those who care for them over the course of this very long illness.
With an early diagnosis of dementia, we have to plan for care and support services to maintain our loved ones at home for approximately six to ten years — it's a very long time — and accept that the majority of persons with dementia will require a move to a residential or long-term care setting for an additional two to six years, even if the best home support services can be put in place. I don't think that you've heard very much about long-term care so far.
In the first stages of the illness, family caregivers and family physicians usually provide most of the care. They, in turn, need access to community support services, including services that encourage socialization and promote healthy habits, as well as services that have typically been provided by Alzheimer societies across our country: education, peer support, family support and day programs for stimulation, socialization and respite.
In the first stages of the illness, they also need time-limited support from specialists, such as neurologists, geriatricians and geriatric psychiatrists, mostly to establish a diagnosis and determine if contributing or aggravating factors can be removed, such as medications that interfere with cognition or treatable illnesses such as depression. For example, geriatric psychiatrists often help determine whether anxiety or depression are the cause or the result of cognitive problems or can be treated successfully without worsening the dementia, as this will greatly improve the quality of life of the person with dementia and the quality of life of his or her caregiver.
In the middle to late stages of the illness, there is an increased need for respite and residential care services and a higher risk of hospitalization for delirium or caregiver burnout. Specialized teams — such as geriatric mental health outreach and community teams staffed with psychiatrists, mental health nurses and other health professionals — are needed to help develop person-centred treatment plans for the highly prevalent behavioral and psychological symptoms of dementia, called BPSD for short. Eighty to ninety per cent of persons with dementia will experience BPSD at some point during the course of their illness. This is huge. Behaviours are the major risk factors or predictors for both long-term care placement and caregiver distress.
Geriatric psychiatrists are experts in this part of dementia management and because of this have an important role in supporting family caregivers and increasing the capacity of staff from the community care homes to deal safely with those problems. This helps prevent visits and admissions to hospital.
I was asked to address issues surrounding resources. We will never have enough specialized human resources to directly and longitudinally provide care for all people affected by dementia in Canada. As you have heard already, we need to make sure that all existing and future health care providers have the capacity to provide good mental health care for persons affected by dementia. This includes family doctors and specialists, nurses, occupational therapists, social workers, personal support workers and physiotherapists who will undoubtedly have clients with dementia. In order to do so effectively, they need to have acquired sufficient knowledge and skills during their university or college degree but also need to be supported by interdisciplinary, specialized services in shared care or collaborative care arrangements during their years of practice in the community, long-term care or hospital setting.
Yes, there is a need for more training, and we need to make sure that the educational content of all university and college programs that prepare future health professionals include caring for persons with dementia in their curriculum. The Royal College of Physicians has recognized this need for specific training in geriatric psychiatry for all of its future psychiatrists, in addition to establishing 12 accredited training programs to develop the subspecialties.
Our first recommendation is, as part of a national dementia strategy, it will be important to have a mechanism to monitor whether colleges and universities are providing the kind of knowledge and training that is required by health professionals to care for persons with dementia.
We also need to have enough specialized mental health human resources — not just geriatric psychiatrists but also clinical nurse specialists, psychologists, social workers and occupational therapists — to fulfill the following roles: The role of having advanced knowledge and skills to provide exemplary care in the most challenging situations, and in doing so, participate in the development of new knowledge that can be transferred to other caregivers and providers. They also need to know how to provide support and ongoing education in the form of consultation, mentoring and shared care arrangements to increase the capacity of existing services offered by family physicians, psychiatrists, staff of long-term care homes, home care staff, et cetera.
Specific comments on how many —
The Chair: Doctor, I wonder if I could ask you to go directly to your summary. You have a detailed summary in this section, and I think we can understand that very clearly. I think your recommendations are important to get to next, if you wouldn't mind.
Dr. Tourigny-Rivard: Okay. The next recommendation is to increase the specialized geriatric mental health resources with a sufficient number of funded residency training positions in geriatric psychiatry. At the moment, even though the programs exist for training and we could be forming more geriatric psychiatrists, there is no protected funding for people to do their residency training.
In the context of a national strategy for mental health, the Mental Health Commission of Canada, in collaboration with Health Canada and the Canadian Institute for Health Information, should be tasked with a study that would provide a more specific human resources plan for the Mental Health Strategy, including a specific study that addresses the needs of its rapidly growing older population and foreseeable needs in regard to dementia care.
Our fourth recommendation is to expand and increase the availability of high-quality home care and long-term care. Just as a note, this needs to include mental health care elements.
Fifth, improve the quality of life of Canadians who currently reside in long-term care homes and those who will need long-term care in the future due to dementia.
In summary, information such as the Guidelines for Comprehensive Mental Health Services for Older Adults in Canada that were developed through the Mental Health Commission, the commission's Mental Health Strategy and some model services for dementia do exist. The challenge has been to convince health ministries to fund the range of mental health services that would help maintain a viable health system while also addressing the growth of its elderly population. We urge your committee to consider a recommendation to earmark some of the federal transfer payments in the upcoming health accord to address this issue of mental health human resources specifically.
The Chair: Thank you very much. I now turn to my colleagues.
Senator Eggleton: Thank you very much for your presentations. You've all talked about the human resource issue. I'd like to get this clarified because, Dr. Dupuis-Blanchard, you mentioned in your presentation that 261 geriatricians are in Canada at the moment, according to the Canadian Medical Association. None were found in P.E.I. and Newfoundland. In addition, 2 per cent of internal medicine residents choose geriatrics as their first choice of practice.
I recall this came up once before. I'm not sure it was the CMA, or whoever it was, who said that there had been a problem with the remuneration differential for people in this line of work, this line of medicine, and that things had improved. Maybe I'm mixing apples and oranges here. Maybe you could explain this a little bit more and what needs to be done to change this, because obviously with an aging population, the fact that only 2 per cent of internal medicine residents are interested in geriatrics is rather alarming.
Dr. Dupuis-Blanchard: It's very alarming, and we definitely need to address it. I'm not sure there's a magic recipe or anything like that to call upon.
With regard to the pay comment that you made, it is true that when we look at the salaries of different specialists, geriatricians are quite low on that list, having surgeons, orthopaedists and other specialties right up there, while geriatricians are quite low on that pay scale. I'm not sure how much of a factor that is. It certainly could be.
What's most worrisome is that the younger physicians are not interested or motivated to continue in this field. There are different reasons. If we look at research on the issue, we know that they prefer a very high, active field, where technology is quite involved. It's more attractive. It's more sexy than talking about aging.
Senator Eggleton: Than working with old people. Yes, okay.
Dr. Dupuis-Blanchard: We see the same thing with nurses as well. We've done a few studies in our university looking at that. It's the same thing; they want to be where it's quite active, high impact, working in emergency or intensive care units, where everything is moving and it's up to date. We don't seem to be doing a good job, for those of us who have chosen geriatrics, of convincing them and showing others how complex a field it is and that it is dynamic and up to date and we are doing these things. We need to promote it a lot more than what we've been doing.
Senator Eggleton: You mentioned young people. Later in their career, can people be convinced to go into this kind of health care?
Dr. Dupuis-Blanchard: We certainly see it in nurses. I know that Dr. Boscart can talk to this. For nurses, it is seen more as a late career specialty where you go and it's less demanding. They think it's less demanding, and you think that you can retire in this field. They get quite a surprise when they start working in geriatrics and understand that it's quite a high level of work and is quite demanding. It's not a place where you go just to retire. For geriatricians, it's a specialty, so it would definitely be different because then they would have to specialize.
In New Brunswick, I know there are certain family physicians that do see mostly aging patients. They don't call themselves geriatricians, of course, but they are recognized as having more of a caseload with seniors.
Senator Eggleton: I'd be interested in hearing about the nurses and also the geriatric psychiatrists and what you think we could do or the federal government could do, along with the provinces and territories, to get more people into this field.
Ms. Boscart: Thank you for that question. From a nursing perspective — but it's similar, I assume, in other fields — to truly provide good care to a person living with dementia, a very comprehensive assessment is required. As a clinical nurse specialist myself, or as a geriatrician, one cannot do this in 10 minutes in a family environment where one can accommodate one problem only. People living with dementia don't present like that. They have a dementia and they probably have some other underlying conditions. The time invested in doing a good job is a lot longer than what you would do with adults that don't have dementia. Therefore, you cannot see as many people with dementia as compared to practitioners who have workloads not related to dementia.
The interesting part around the interest in gerontology as a field to study and work is that it has evolved. I am from Europe, where there is a little bit of a different perspective around aging. Aging and care for seniors has traditionally been seen as a specialty here in Canada and in the United States; while if you look at the numbers, which you are by now very familiar with, it's not an option to be a specialist. When I work in the emergency department, most of my people are older. When I work in long-term care, all my people are older. In the community, up to 90 per cent of the people are older. So gerontology is not a specialty; it's a core component of the curriculum that one should learn.
When we did a national study comparing all curricula in social work, nursing and medicine, we see many practitioners graduating without any content in gerontology. All of them receive pediatric care, which is necessary, but 2 per cent of our practitioners will work within pediatrics, and luckily so, and 98 per cent of our graduating practitioners will work with an older population. Yet a large group of social work curricula do not have any competency in gerontology. So you might very well have nurses graduating the next month that would never hear about the difference between delirium, dementia and depression, which is a core component. At CGNA, we developed these competencies and have been trying very hard to integrate them within the nursing curriculum, but it has to happen across the board.
The other component that is not helping all of this is that within the faculty, teaching these health care professionals, we don't have experts teaching gerontology. There's kind of the assumption that it's woven within the curriculum, but that's not the case. If you don't have an expert that is passionate about the topic, that can tell the stories about what is happening on a day-to-day basis, that can provide the mentorship and the clinical guidance, then you will not turn around people in that field. That's important.
The third component is that despite all of this, we are at the lowest number of RNs in Canada right now. The number of RNs is decreasing in Canada overall, despite the fact that we know that if you have a registered nurse, you will have better outcomes for your patients, fewer transfers to the emergency department and a better quality of life.
The Chair: Dr. Tourigny-Rivard, you wanted to come in on the earlier part, so could you deal with both those issues now?
Dr. Tourigny-Rivard: I'd just like to comment on the issue of geriatricians and physicians. In some ways, in geriatric mental health, geriatric psychiatry, we've done better in terms of recruitment and having the interest of young people because we had a core component of geriatric psychiatry included in the training of all future psychiatrists sooner than the geriatricians. So that's one element.
The other element is the method of remuneration. For geriatric psychiatrists, the remuneration is when we have mixed remuneration that takes into account the time it takes to do a more comprehensive evaluation in a complex situation, then that is not a deterrent for us to recruit geriatric psychiatrists. What has been a deterrent, unfortunately, is the fact that with the Royal College subspecialization, we are now required to have a residency training year that is funded through the health system, so the provinces and the deans of the universities basically end up controlling how many positions will be dedicated to geriatric psychiatry subspecialty training. So if you don't have the funding or the willingness from the universities to protect positions for geriatric psychiatry training, then we have interested candidates who cannot get the training for that reason.
It has not been an issue in terms of being able to have people who are interested in this field, who want to do well. I think people quickly recognize through their mandatory training that this is a very rewarding field. It's never boring. It's always interesting and challenging, and you need to always be thinking on your feet. So that's not a problem. The problem really has been the funding and the dedicated positions.
Senator Stewart Olsen: Thank you for your presentations. They were very interesting. They're a little overwhelming because we're just starting. I know there are some places that have excellent programs. I'm from New Brunswick. I know that we have a huge need, and it's a need that I don't think we can take the time to put together the teams of specialists. It's more immediate than that.
Have you given some thought to perhaps having a rural education, afternoons or symposiums, or putting teams together and going to small communities, the church halls or public schools? In New Brunswick, we have nurse practitioners who run clinics. It could just deal with what you were saying, and that is you need a proper assessment. Many people deal with their elderly parents in New Brunswick at home and don't realize anything about the assessment. They don't know. They just do the best they can and hang it all together on how they can manage.
I would like your comments on some kind of education that would deal with rural areas, smaller areas, and maybe start from the other end of the spectrum, such as programs to help care people at the very basics. I'm not talking about higher up; I'm talking about what's needed right now.
I would love to hear your thoughts on that.
Dr. Dupuis-Blanchard: I know in New Brunswick there is a geriatrician assessment team that travels from Fredericton to a rural community, and it has received great success because of that. It has gone where the people are and where the need is. It could certainly be used as a model, but it hasn't. I can't answer to why, but I know it hasn't so far. We know that it exists, so the potential is certainly there to look at it and see what else could be done elsewhere in other provinces as well.
The uptake to get people assessed is that families are very reluctant to have their loved one assessed as well. It is very intrusive, with lots of questions, and there are also questions about the financial aspects when you do get that evaluation done. It covers all of your life aspects, which includes the financial needs, and I think a lot of people are reluctant and quite scared as well of getting that assessment, especially knowing that diagnosis and having that diagnosis confirmed.
Senator Stewart Olsen: That's interesting. It's not so much the assessment, and I like that idea, but I'm thinking of small information sessions that even would say, here's the number of the flying assessment squad to come to our community, and then you can set up things, but I think we have to go more to the ground. That's just me, because I think people don't know what they're getting into when they start to care for someone like this, and it becomes more and more onerous until it's just overwhelming everyone.
Dr. Dupuis-Blanchard: I believe it comes to post-diagnosis support. It's one thing to get the diagnosis. It's one thing to be in a doctor's office and to get that diagnosis confirmed, but then what happens afterwards? How do we connect these people to the support that they need, especially if they're in a rural community? I know from my experience in New Brunswick, almost half of our province is rural.
Senator Stewart Olsen: Very rural.
Dr. Dupuis-Blanchard: And that's what happens. People come to the centres, either Moncton or Fredericton, and they see the geriatrician, they go back into their community, but then they get isolated in their communities because they're not really connected.
I know the First Link program has done some very good work, but when we look at certain rural areas it's still not up and coming. Recently I was at a meeting where there were physicians around the table where I was sitting and they had never heard of it, and these physicians were practicing in rural areas in New Brunswick. I thought if they're not aware, how can they connect their families and their patients to this program? There is a lot of communication that's lacking, I think.
Dr. Tourigny-Rivard: The last 10 years of my practice, I have worked entirely in rural communities; so there were physically located nurses that were part of the geriatric mental health team and the geriatric psychiatrists who would go and work with them on a regular basis, both in person and also through telehealth.
That team worked with about 50 primary care physicians, or family health teams, depending. Basically they helped build the capacity of that rural community by providing support, consultation and learning. How do people learn after they're in practice? They learn from having a problem, getting a consultation on that problem and being told how to do it and being able to succeed at doing it well. All of my recommendations would go to the primary care physicians, and we would support the person and the family during the time of implementation of the recommendations so that it would be a success. Then, if things didn't go according to plan, I could see the person again.
My involvement was relatively minimal, but it was there. It was there with some regularity so that you can build a relationship with the health care providers that are in those rural communities.
The same happened in northern Ontario, providing outreach services to Timmins in Ontario. You need to have the consistency, you need to have the locally based nursing staff, and then you need to have the expertise who is available through the locally based persons, and also the kind of physicians or specialists who will really see it as their role to support the primary care sector in general, be it long-term care, be it family physicians' offices.
Senator Merchant: Thank you all three. You said that women were primarily the caregivers, and here you are, three women appearing before us right now. I thought this was very interesting.
This weekend I was at a conference and I spoke with a couple of women, members of Parliament from one of the Nordic countries. I believe maybe it was Sweden. They had come to Canada and they said to me that what impressed them most about Canada was that they had visited — and I believe it was in Ottawa — care homes and they were very impressed with the way that we were looking after the elderly.
I had always thought, living in Canada, that people preferred to stay in their own home and that we should support them to stay at home as long as possible. But they said no, that was not working in the Nordic countries because people were very isolated and this added to all the difficulties that we were having.
I think maybe you are European.
Ms. Boscart: Yes.
Senator Merchant: I'm just wondering, because I was convinced people should stay at home as long as possible and we should try and support them, but because we have so few gerontologists, so few people involved in this area, is it may be better to try and group people together? Would one gerontologist be able to visit them by their bedside or in their room rather than making all these visits to individuals at home? I was surprised because I was sold on having people stay at home.
Ms. Boscart: Right now in Canada we have about 90 per cent of people with dementia living at home, supported through family care partners. For the majority, that's what they want to do, but we heard from our colleague here that the last couple of years in the dementia trajectory it's very difficult to do this at home.
Unfortunately, for long-term care homes, there are extremely long waiting lists. Quite often people go on a waiting list because the care is not manageable at home anymore, but they never make it into the home. There is kind of a back and forth to the acute care setting, back to home, back to the acute care setting. They don't live under ideal circumstances, and their quality of life is rather low.
We do know that with the changing numbers, our demands on the long-term care system will increase drastically. There is already great pressure. Long-term care is a very expensive alternative to providing good care at home.
For some people, long-term care might be a good option because there is not enough support at home. For others, it really is not their choice. That is, obviously, an individual choice to make.
Because of the long waiting lists and because of the high numbers that we have, what we see now when people do enter long-term care is that they really are at the end of their life. Where we used to have in Canada a length of stay of about five years, what I now see in our long-term care homes is six months. By the time you truly receive somebody in long-term care, things are not good.
Obviously there is a personal choice, but the support systems are a very wise investment, because we cannot support 100 per cent of people with dementia in long-term care environments.
Dr. Tourigny-Rivard: I disagree, because currently the average length of stay in long-term care homes in Ontario is a little over two years. This is shorter than it used to be, appropriately so.
Because there's been so much emphasis on keeping people at home, wanting to delay admissions to long-term care, we have neglected that sector, and now people won't really want to go because it is so impoverished. There are not the staffing levels, and there are not the environments that are needed to decrease the occurrence of behavioural problems. There has not been an upgrade of the long-term care homes to allow you to have such a basic thing as a private room. There are some homes in Quebec that don't have air-conditioning. There are really sad situations.
That's partly because, as human beings, we don't want to think of ourselves as going to a long-term care home. We don't want to think about that.
I will tell you that my advanced directive to my daughter is that I want to go into a long-term care home before the care becomes so difficult that my loved ones will get sick from looking after me. That will be part of my advanced care directives. I certainly hope that there would be enough good long-term care facilities so I would have a spot before it is too late.
The stress on families — I mean, we have lived it. The stress on families is tremendous. The long-term care environments are far better at providing care than hospitals. The very worst place I could land, if I have dementia, is a hospital while awaiting placement. It is the very worst environment. Not because the staff doesn't want to do a good job, it's just they're not built to respond to the needs. The environment is totally wrong. The acuity in the hospital system is such that there's no time to look after someone who has needs that are not urgent. You have a heart-attack victim next to someone who has dementia, and guess who is going to get the attention. Rightfully, the person with the heart attack.
So hospitals are terrible environments. We need to help them, but we particularly need to plan for enough long-term care homes and to plan for alternatives. I would be happy to go into a retirement home where some services are available. When I'm at that stage in my illness where I can't do the cooking safely or I can't look after the finances safely, that's provided for me. But if I need a lot of personal care, then I would like to be in a long-term care home.
The Chair: Before I turn to Dr. Dupuis-Blanchard, with regard to your comment, I think we were told at a recent meeting that approximately 15 per cent of people in hospitals are actually waiting for a long-term care home.
Dr. Tourigny-Rivard: Yes.
Dr. Dupuis-Blanchard: It is higher than that in New Brunswick, actually, much higher.
I agree with the comments that have been made. I just wanted to add that it is true that seniors want to age in place and want to age at home as long as possible. With dementia, what happens is that there's no planning. The families don't want to think about it. They don't want to think about the future, and they just leave it from day to day. Well, days become months and years, and all of a sudden they're faced with a crisis situation.
The services in the community are not always available. I believe you referred to physicians making home visits and things like that. That's not happening. We're not seeing that. That could certainly make a difference, and even using nurse practitioners to their full potential, and RNs and other professionals as well.
People with dementia live at home as long as possible. It is the services. What I'm facing in New Brunswick is also the language issue as well, to have access to services in the language of choice, be it French or English.
Senator Seidman: Thank you very much. I really wanted to ask you about the health accord. You have all referred to it, and I'm trying to sift through the commonalties, understanding well the jurisdictional issues in the health field. However, I want to ask a question now to Dr. Tourigny-Rivard because of the point you just made about long-term care.
I myself haven't done enough research on this; however, I do know that Quebec very recently, before a change in government, had expressed a desire to create a long-term care planning fund and insurance models. The idea was to try to help Quebecers recognize the importance of planning for long-term care needs and to develop in the tax system and the insurance industry a way that people could save and create a personal fund for long-term care. This kind of fell off the papers when government changed, but as a federal legislator, I wouldn't mind having a response on that from you.
Dr. Tourigny-Rivard: I will have to give you a personal response on this. Certainly for me, I wouldn't mind paying taxes that would go directly to that if I would be sure that it would go to that and not to something else like an acute hospital.
Senator Seidman: I'm talking about a personal fund now if there was some tax advantage like there is for RRSPs and other things. You could set up some personal fund for long-term care planning and contribute to that personally on an annual basis and have some kind of tax reward system built into that.
Dr. Tourigny-Rivard: But then I would have to have assurance that the long-term care will be available.
Senator Seidman: Yes, of course.
Dr. Tourigny-Rivard: And quality long-term care available. How would you do that? How would you enforce that?
I think the government would be happy to collect my money, but they have not been so prompt at putting it in renovating facilities or staffing at a level that is needed to provide good care and for people to actually be proud of their work.
Senator Seidman: Sure. And that demands a rethink of the way the health system currently works.
I would just move from that back to the health accord for a moment and try to look at the commonalties that we have heard from you today and that we have heard from previous witnesses. I will list three of them and request your feedback or your response to that.
I think it was you, Dr. Dupuis-Blanchard, who mentioned in your presentation transfer payments based on demographics. I know that's a very common request from the provinces these days, and some are in favour and some are not so in favour. The next item is a redirection of budgets from the acute care system to primary care. The third is a national body tasked with assessing health human resource needs around elder care.
To me, they're related to the health accord and they're all things where the federal government could have some input. Could I have your viewpoints on that?
Dr. Dupuis-Blanchard: On the transfer payments, for me, coming from New Brunswick — this is maybe not the voice of the CAG — and sitting as a co-chair of a new council on aging looking to develop a strategy in New Brunswick and being told that we have to do with what we have and that there are no new monies available to develop the strategy or to plan for future needs, that invites me to speak to the reality. We're the province with the highest proportion of seniors in Canada. We're not a very rich province, which is fine, and we can certainly innovate and do all these nice things, but with no additional transfer payments coming from the federal government, it will be very difficult for us to face.
From doing presentations and meeting colleagues from elsewhere in Canada, I know people say they're going to look to the Atlantic Provinces as leaders because we will be facing aging populations sooner than they will. They want us to do these nice things and test out the market so that the rest of them can find the winning solution. How can we do that with no additional funds? I know there are other ways through taxes and all of that, but it also comes down to looking at those transfer payments.
As for redirections of budgets, the other thing is that we definitely have to come from that mindset that when hospitals were built, they were to answer to acute care. We're now using these acute care institutions for long-term care; but they weren't built for that. They weren't meant to have seniors living there for a year waiting for placement in nursing homes. We have shifted from the 1970s when we started publicly funding hospitals to looking towards the community and home care. We can't fully do that until funds are also allocated. I say to my colleagues all the time that we have beautiful documents that talk about the importance of home care and the social determinants of health and all these beautiful things, but we have no funds to go along with these documents and these initiatives so we can prove that they are adequate and we can do something. We can address this.
That shift is very difficult. In our latest provincial budget, there was talk of closing certain smaller hospitals or even emergency rooms. They had to retract those statements because of the way people were reacting. The government was going to transfer those monies to community health centres in the same areas, but that transfer is difficult. It is also difficult for people to let go of what they know as institutional care and go towards community care. The redirection of budgets is going to be essential for us to be able to address the needs of the aging population because the care is going to have to be in the communities.
I don't believe we can build new nursing homes to address all of what we're going to face, and even with dementia as well.
Ms. Boscart: Those are excellent statements. I want to add that when we look across the world, the highest performers in health care systems are the ones where primary care is leading for the delivery and organization of health care. Those are the high performers. We know where they are. It is primary-care based. Unfortunately, we don't have that in Canada.
To build on a previous comment, we know the long-term care is an expensive option but often a necessary option. Many of our seniors are on waiting lists for retirement. We have little legislation, prices are outrageous and services are not always optimal. I heard, probably at the same conference last weekend, that retirements and retirement organizations are the fastest-growing business in Canada. That's very scary because in my emergency department, I see people from retirement homes because there are no standardized assessments, no coverage by physicians, no clinical nurse specialists, and no RNs available because that mandate is not there, which leads to interesting things.
The last thing I want to point out is from an economic perspective. Canada uses about 3.5 per cent of its public expenditure on home care, which makes us the lowest of all members across the world in home care investment.
I'll close that with a quote from Henry Ford, who said:
If I had asked people what they wanted, they would have said faster horses.
That's not what they needed. They needed drastic change. We need to look very differently at this problem.
Senator Seidman: The third item was a national body tasked with assessing health human resource needs around elder care — a national body.
Dr. Dupuis-Blanchard: Definitely.
Dr. Tourigny-Rivard: I'm not sure what I can add to what has been said other than I'm not suggesting that long-term care is where we should go entirely. It is a complex issue. You need a range of services. You also need the investments ahead of the closure of hospital beds. We have had that experience in mental health. In order to close beds in provincial psychiatric hospitals, you need to have the community resources in place first before that occurs. Where it didn't quite occur, there were worse problems.
Senator Raine: I would like you to comment on the concept of campus of care. I have a little experience with that, and it seems like a good way to go. If we look forward and say we need to build more facilities, do you think this is a way to have public-private partnerships to make the value of the taxpayers' investment go further by inviting private investment? Are these campus-of-care facilities doing the job? Is that a good model?
Ms. Boscart: Yes. There's a beginning initiative in some places in Ontario. Some organizations build a continuum of care where there might be retirement assisted living, supported living and moving into long-term care. This not only creates the continuation of care but also addresses a real big issue between a couple where one might be doing quite well and the other one is not doing so well. It is devastating for one person to move into long-term care and the other to stay home. They have to give up their life together. It addresses some of that, but it definitely looks at it from a financial perspective.
A second component is gaining a lot of interest: within long-term care, making these long-term care organizations hubs of excellence for care. It is an opportunity maybe from a rural perspective. Why could people that live in the community not come to these long-term care homes that might be small but they have kitchens and RNs available, although not enough, to do some assessments? There might be some respite care available. We have traditionally seen long-term care as care at a very high level. People move in, and we provide care. We can open long-term care up and be a hub for the community to support care for seniors. Even having access to a meal every day would be a huge advantage for some people in the community that live with dementia. A long-term care environment can provide that, given the right supports are in place.
Dr. Dupuis-Blanchard: In New Brunswick, we did a survey of 65 nursing homes and long-term care facilities looking at their perception of what they would think of opening up their doors and providing services to the communities. Looking at the distribution of long-term care homes, they're in rural areas and mostly anglophone and francophone. It seemed to be an answer to a lot of the problems we were facing; and 100 per cent them were in favour of modifying their role to play a larger role in the community, in particular offering meals and services such as housekeeping. They would become really the hub of the community for senior care and for socialization. They offer it already, so why can't it be extended into the community as well, with the proper resources, of course.
Senator Raine: Some of the people who are looking for a way to go at the end of their lives have resources in their home and could transfer those resources into their rent, if you like. I've certainly seen where you have a couple, and the partner who has dementia is very well looked after by a greater community who's supporting and socializing, and the husband or wife has an opportunity to have a life. It seems to work very well. The one I'm familiar with has the residential care side for people who need full care, so they never have to move. They're staying on the same campus.
What I'm interested in is how do we find a way to use public and private funds so that the greater collective can be affordable to those who need to be supported by the public taxpayer and where you want to be for those who want to spend their own money?
Ms. Boscart: We have examples of those already in Ontario. I'm happy to provide that information.
The Chair: That would be very good. Please send that through to the clerk.
I want to follow up on some of the things my colleagues have been asking, but I want to start with a more general question. In your testimony and other testimony, there are either direct or indirect references to a national strategy with regard to this issue. Actually, some are broader and cover the wider range of aging, but let's stick to the issue of a national strategy on dementia.
The issue that we've got in Canada, of course, is the Balkanization into provinces with direct responsibility and a federal government dealing largely with taxation issues and the dispensing of those funds. In your thinking about these various issues, have you thought about what kind of an organization, an existing organization or a new concept for an organization, would take charge or be directed by the national government to work with the provinces to develop a national strategy? We aren't really good at national strategies in health care. Have you got any immediate ideas? If not, after you leave here, would you think about it, and if an idea comes to you, forward that through to the clerk?
The thing that is obvious is that we can easily identify all these aspects that are required, but unless there is a coordinating plan to deliver it, it will not happen or it will happen by random access, which is how much of our health care happens now. I don't want you to theorize at the moment. Do any of you have an immediate example of who you would identify or what type of organization you think needs to be set up to develop a national strategy on behalf of the nation? If not, I'll leave it to you to think about and to get back to us.
Now, another issue that has been dealt with in your testimony here today and raised by the committee members is the issue of long-term care homes. In some of our background literature and generally referred to in some testimony, we see examples of long-term facilities that have developed a community environment in which dementia patients would go — that is, the need for socialization and the need for feeling part of a safe community. Do you have any specific comment or examples of what you would consider to be really good? What good examples have you seen of specific delivery of long-term health facilities?
Dr. Dupuis-Blanchard: None in Canada, from what I remember reading, but I remember reading about this community that I believe was in the U.K.. It was almost like a gated community. I almost hate to refer to it as that, but that's what it was. People with dementia would live in this gated, large community. If they decided they wanted to try to ride a bike or walk, there were no restrictions. It was a very open concept of living your life as you would like without having people tell you, "No, you can't do that'' or "You're very limited.'' It was very open. I remember reading an article about that, and it really marked me because I thought what a wonderful way to live your life, even with dementia; you are really not restricted.
The Chair: Just hearing about it is good, but if it pops into your head, you will submit that later?
Dr. Dupuis-Blanchard: Yes, I will forward it.
The Chair: Are there any other comments?
Ms. Boscart: There's an organization in Ontario, although they're expanding, called Schlegel Villages. They're a continuum of care, and they have taken a different approach. They are changing the culture in aging, but they are not working with different layers; they're working with cross-functional teams where they promote a different approach where people with dementia are part of a village. They try to promote meaningful activities, aspirations in life while being in a quality of life.
The Chair: They are part of a generally aging community?
Ms. Boscart: Yes. They also create walkable villages that are set up in such a concept that there are apartment buildings, a store and a pharmacist. It goes way beyond long-term care or retirement.
The one aspect I'm involved in is that we've created schools for personal support workers and nurses within these environments so we can train them to understand what care for seniors looks like, and care providers in the community, many people who are older themselves with disabilities, can come for a class on how to transfer their husband, who is 85 years old, if they don't have a lift in their home.
We're trying to combine the learning through a changing in the culture of aging by integrating that. This is happening on a small scale right now, but it really indicates that societal beliefs around aging have to change because there is a big stigma involved with aging as well.
Dr. Tourigny-Rivard: My only comment is that there are many examples across the country of good things that are done with regard to dementia care, but some of these need to be implemented across the different provinces. What we almost need is a report card for the different provinces in regard to this.
Now, when we are dealing with health, we deal with Accreditation Canada in terms of checking if the level of care provided is adequate. Maybe we need accreditation for the range of services that are needed for good dementia care, so from home care to residential care, et cetera.
The Chair: Once again, that notes the need for a national strategy of some sort. In fact, what we continuously hear is that we're a country of pilot projects. We have no rational way of transferring outstanding examples from one jurisdiction to another.
Senator Seidman: If I might go back to the discussion about health human resources, I think you all referred to the challenges in recruiting in medical fields and the allied medical specialties, such as social work, nursing, I presume physiotherapy, occupational therapy, all the professions that are critical in dealing with aging and dementia.
We did have the VP of the Canadian Geriatrics Society here at our last meeting, and he talked about the shortage in recruitment in the field of geriatrics. My understanding is that this is not the case in the U.K., where in fact it's one of the largest of the internal medicine specialties. Of course, they did come out very recently with their plan for 2020, which is a huge initiative.
My question is about trying to pursue the challenge of providing the kind of education that is necessary, recruiting people to become these professionals, but to also become the kind of professionals that provide the kind of services that are so necessary to having successful programs for the elderly, for elder care, for dementia patients. What suggestions can you make? What can we do to encourage proper recruitment and the proper attention in education programs?
Dr. Dupuis-Blanchard: The answer is mandating different programs to have content in gerontology. We enter professions at a very young age, usually straight from high school. We don't necessarily go into nursing or medicine with a very specific field in mind. Sometimes we do and we change. We need to be exposed to it when we're young and in that education program, and we need to be exposed to different facets of it.
I can speak as a nurse. A lot of our students think that it's only about seeing their patients in the hospital very sick or in nursing homes. They seldom see them in the community or have a positive experience. They're afraid of dementia because they're not exposed to it. They're afraid of the aggression, but then they realize that's not always the case. It needs to be part of the basic education program. Maybe we even have to look at younger people and high schools. Do we talk about population aging? Do we talk about what it means to age? Shift the way society views aging as well.
Fundamentally, it has to come down to their training programs. Once you're exposed to it, you can make a choice. I know it is no guarantee, but it's a first start. It's not only the health professionals. Seniors will be banking and doing all kinds of things. They will need lawyers. A lot of those professions are not at all exposed to what it means to age.
Dr. Tourigny-Rivard: Added to the mandated content, you need to have an inspiring teacher. It also helps to have exposure to seniors who are able to provide a positive image. Maybe they've had problems but are also able to demonstrate how they are living well with those problems. That is part of the stigma strategy, for example, recommended for mental health problems. Make sure that you include people who are able to talk about their challenges and demonstrate how they've responded to those challenges well. You need these additional two ingredients.
I'm not too sure how you recruit inspiring teachers in universities in particular. I'm hoping that the professors at the universities would actually have a clinical practice in the elderly. If you're doing it all on the theoretical perspective, you're not going to be teaching the right things, and your students will be able to tell right away if you're teaching them what is actually the lived experience out there.
The Chair: With the lack of mandatory retirement, you may have lots of examples in your universities that are giving true meaning to the idea of aging.
Senator Raine: We all know what Michael J. Fox has done for Parkinson's, and there is Glen Campbell and his film on Alzheimer's. Those are fantastic examples of education just because of the circumstances. The more those kinds of things happen, the better.
Dr. Tourigny-Rivard: That needs to be included in the teaching in the universities. How often do universities actually bring people with lived experience to their classes?
Ms. Boscart: The other thing to keep people in the field is to pay them decently. RNs and RPNs receive less money if they work in home care or long-term care compared to acute care. It does not make sense. With the same experience as an RN, I make less money per hour when I work in acute care compared to my shifts in long-term care. That's not a good way to keep people there.
Most home care organizations are not under one organization, so they have different pay rates. Some of them don't pay for sick days. None of them pay for travel between different care locations. Those unregulated care providers are at an absolute disadvantage to provide the best possible care. It's ludicrous to do that kind of job. I've done it myself, and you make about $30 per hour.
The Chair: I want to come to two other interrelated aspects that came up during the discussion, the idea of transfer payments and the Health Accord. The Health Accord and home care for aging is a major issue, and there's going to be clear discussion around that as we move in that direction on a new Health Accord.
The issue of transfer payments historically has not proven to be the solution. Even when a specific transfer is identified, it doesn't always wind up when it gets to the province in the area in which it's needed. All we have to do is look at the specific earmark in the previous 10 years of monies for reducing wait times and how that dissipated into the environment. Around 90 per cent went to increased salaries for dealing with other issues.
This is going to come up. You have the expertise and have raised these issues. We really need to have you in the field thinking about how to influence the way in which any changes in the Health Accord would be done that could get over the constitutional divide and ensure that if there is a specific category added to the Health Accord and funding earmarked for that, that it actually gets out there in terms of the application.
Once again, you have expanded with real examples on the situation here in Canada and your experience with examples abroad. If you think of any other examples with specific details or a specific reference, that's great. If you simply say, "I recall that I was at a conference and there was a discussion of something that was occurring in country X. I can't find any specific detail on it, but I found it an interesting example,'' just get that to our clerk and our researchers will attempt to tie it down.
What we are increasingly seeing in this study is that this is a subject that the world has suddenly become seized with. Even though dementia has been with us for a very long, we do not have a lot of examples where countries have pursued this in a dedicated manner with great outcomes at the moment. Anything at all that occurs to you that you can forward to us, please do.
Dr. Tourigny-Rivard: I have an example. When I'm presenting on the Mental Health Commission's materials, the one example that people who work for the ministries of health provincially always pay attention to is the fact that we did a little study looking at long-term care homes that had the services of a geriatric psychiatrist on a regular basis, a geriatric psychiatrist alone, and then a number of homes that had a geriatric psychiatrist with a nurse providing the liaison, consultation and so on. The admission rate for the homes where there was the same geriatric psychiatrist but alone was three times as high as the admission rate for the homes where there was this nurse-psychiatrist team working with the teams in long-term care homes, so providing the support and education to the nurses, the personal support workers and the physicians who work in long-term care homes. They pay attention to that.
Maybe we need to do a better job in Canada at doing some research on service delivery and demonstrate the cost- effectiveness of some of the things that we know because they've been put in place with demonstration projects. We need to evaluate a little bit better how this is saving governments money so that they can agree to invest it up front, and then you can reduce other things. Maybe that can be done through the national research.
The Chair: Related to your observation, there is the section in your testimony that I asked you to go over because it's a detailed issue with regard to staffing in this area, and that related to it. I noted that, but I appreciate your additional comment here as well.
Dr. Tourigny-Rivard: There's a lot of information in the Guidelines for Comprehensive Mental Health Services for Older Adults in Canada. Some of these examples are in this document. It's available on the website of the Mental Health Commission of Canada.
There's also a very good document called National Guidelines for a Comprehensive Service System to Support Family Caregivers of Adults with Mental Health Problems and Illnesses.
Senator Stewart Olsen: Is that also on the website?
Dr. Tourigny-Rivard: It's all on the same website, as well as the mental health strategy.
The Chair: You will forward those links to us?
Dr. Tourigny-Rivard: Yes.
The Chair: It has been extremely helpful to us today. I want to thank you for your openness, experience and for advising us. I want to thank my colleagues again for their questions that help us get you to respond to areas that we very much appreciate.
With that, I declare the meeting adjourned.
(The committee adjourned.)