THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
OTTAWA, Wednesday, June 10, 2020
The Standing Senate Committee on Social Affairs, Science and Technology met by videoconference this day at 11:30 a.m. [ET] to study the government’s response to the COVID-19 pandemic.
Senator Chantal Petitclerc (Chair) in the chair.
The Chair: Honourable senators, before we begin, I would like to remind you of a few items.
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Good morning, everyone. Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
I’m Senator Chantal Petitclerc from Quebec. I’m the chair of this committee. It’s our pleasure to be here this morning.
Before we give the floor to our witnesses, I would like to introduce the senators who are participating this morning in this meeting.
We’re pleased to be joined by Senator Munson, Senator Seidman, Senator Forest-Niesing, Senator Miville-Dechêne, Senator Pate, Senator Bovey, Senator LaBoucane-Benson, Senator Griffin, Senator Dasko, Senator Manning, Senator Campbell, Senator Mégie, Senator Omidvar, Senator Poirier, Senator Moodie, Senator Kutcher and Senator Martin.
On April 11, 2020, the Senate adopted a motion to authorize the committee to study the government’s response to the COVID-19 pandemic. Today is our fifth meeting.
Colleagues, the impact of COVID-19 on Canadian seniors has been devastating, with 80% of all COVID-19 related deaths in Canada being residents of long-term care facilities. Today, the committee will hear from witnesses representing long-term care facilities and seniors’ interests.
I’d now like to introduce our first witnesses for this morning. We’re joined by Jodi Hall, Chair of the Canadian Association for Long Term Care; Dr. Réjean Hébert, Professor and Geriatrician at the University of Montreal’s School of Public Health; and Carole Estabrooks, Adjunct Professor at the University of Alberta’s Faculty of Nursing.
We will begin with opening remarks from our witnesses. The floor is yours, Ms. Hall.
Jodi Hall, Chair, Canadian Association for Long Term Care: Members of the committee, I want to thank you for inviting me to appear before you today to discuss Canada’s long-term care sector and the work we have been doing to respond to COVID-19. I am the chair of the Canadian Association for Long Term Care, also known as CALTC. As the leading voice for quality long-term care in Canada, our members deliver publicly funded health-care services for seniors right across the country.
I want to start by acknowledging the seniors who have died as a result of the COVID-19 outbreaks. Our hearts are with their families. Certainly I know that you’ll join me in extending our sincerest condolences to them.
I also want to take this opportunity to thank all of the front-line workers who are continuing to provide very compassionate and skilled care to Canada’s seniors in this very trying circumstance.
It is important that we take the time to reflect, but I know that we will find that the impact of COVID-19 in long-term care homes could have been mitigated if governments had been proactive in supporting the sector prior to the outbreak.
Some of the challenges that I’ll be discussing today have been exacerbated by COVID-19, but really they represent systemic issues, and our members have been raising these challenges for many years.
I want to be clear. COVID-19 doesn’t care about the funding model of a home. All types of homes have been affected by this virus, and each has had a different experience. This has been an extraordinarily difficult and painful time for everyone involved, including the residents, their families, the frontline staff and for those who operate these homes.
Right now, our efforts as a nation should be focused on supporting long-term care homes in outbreak, so we can help them stabilize their situation.
Differences in experience with this virus are based on a range of factors. These factors include aging infrastructure, the staffing situation both pre-outbreak and during an outbreak, and how rapidly the homes have been able to access PPE and other supports.
In the early days of the pandemic, testing, cohorting and infection control measures were largely focused on seniors and caregivers who showed symptoms. Infection control experts and public health scientists now understand that asymptomatic carriers can also be highly contagious and the incubation period for the COVID-19 infection is far longer than other viruses. As a result, homes that were affected by the virus early seem to have been hit the hardest.
I also want to outline how care is provided in a home. Any and all care that is provided in a long-term care home — whether that care is provided by a doctor or nurse or other health care provider — is part of the provincial funding that is provided to these homes. Each province regulates the long-term care sector a bit differently, but generally, homes receive a funding envelope for care, programming and staffing. So if we use Ontario as an example, the government funds all long-term care homes with highly prescriptive expenditures, which are audited through an annual reconciliation process.
Every dollar for nursing and personal care, programs and food are earmarked for that area, and if dollars are not spent, they have to be returned to the province. In short, there is no profit on any of these funding envelopes.
I will now elaborate on the systemic problems relating to long-term care infrastructure.
Many older homes still have three- and four-bed wards and do not have private rooms, making it a challenge to implement cohorting and isolation measures. Older homes generally have narrower hallways and often only one dining room on the main floor, both of which make it difficult to keep residents spaced apart.
On April 11, the Public Health Agency of Canada released an interim guidance document on infection prevention and control measures for long-term care homes. Some of the guidelines, such as restrictions to certain work zones and the use of single rooms for certain types of care are almost impossible given the layout of some of these older facilities and homes. Any existing outbreak management plan in a long-term care home, including the isolation of symptomatic residents, is hindered by inadequate space and layout availability.
We are seeing how devastating these infrastructure challenges can be during an outbreak. We know that there are at least 400 long-term care homes across the country that require updating to modern design standards. We know in Ontario alone that 50% of long-term care homes require significant renovations or rebuilding in order to meet the current design standards.
The other systemic challenge facing the sector is the ongoing health and human resources crisis. Due to the five-minute time constraint, I urge you to review our most recent pre-budget document for an in-depth discussion on health and human resources. I will say that through the leadership of the federal government, there must be collaboration with the provinces, territories and the long-term care sector to develop and implement a pan-Canadian health and human resources strategy.
In closing, there are systemic challenges that the sector has been grappling with for years, and a lack of support has led to increased challenges during this pandemic. As we have asked before, and we ask again, that the federal government provide assistance to the sector to ensure that seniors have the housing and the care that they need, not just in a time of crisis but every day.
Thank you for your time and I’m certainly pleased to answer any of your questions.
The Chair: Thank you. We’ll turn the floor over to you, Dr. Hébert, for your opening remarks.
Dr. Réjean Hébert, Professor and Geriatrician, School of Public Health, University of Montreal, As an individual: Madam Chair, honourable senators, ladies and gentlemen, I want to begin by thanking you for inviting me to participate in this Senate committee. The COVID-19 crisis is the result of three decades of neglect with regard to the care provided to seniors, both in institutions and at home. I’ll start by talking about the crisis in residential facilities. However, I want to broaden the discussion to include all seniors who are losing their independence and who are also suffering from neglect in the health care and social services systems.
There’s a major crisis in residential facilities in Quebec, particularly in residential and long-term care centres, or CHSLDs. Over 3,000 people have died, or 8% of the people living in this type of institution. This significant disaster is the result of several factors. The first is the lack of medical and nursing supervision. This supervision would have made it possible to take care of people with multiple medical conditions and, above all, to deal with health crises such as the one that we experienced. Second, the significant shortage of staff and attendants, which has been really critical during the crisis, can certainly be attributed to a compensation issue. It can also be attributed to the lack of promotion of this profession. In addition to technical skills, the profession requires strong human qualities. We must also talk about the measures to prevent the spread of the disease, which haven’t always been ideal; the availability of equipment; and, above all, staffing stability. The movement of staff between facilities has been a significant factor in the spread of the disease. As the previous speaker pointed out, the physical facilities are also inadequate. There are still many multi-bedded rooms, shared bathrooms and facilities in need of major renovations.
Lastly, CHSLDs have lost their local management. In Quebec, CHSLDs are now integrated into superstructures that include hospitals, community centres, rehabilitation centres and several CHSLDs. The CHSLDs no longer have local management that can ensure the quality of the services in the facilities and that can also quickly address any issues that may arise. The situation in the CHSLDs is the tip of the iceberg. We have an issue in Canada. We’ve prioritized the institutional solution to meet the needs of seniors who are losing their independence. Our Canadian health care system is the source of this issue. The system was designed in the last century for a young population. The system covered mainly hospitals and, by extension, auxiliary hospitals, which have become our residential facilities.
We didn’t focus on home care. Canada allocates only 14% of public funding for long-term care to home care. This is the worst statistic among the OECD countries. Other countries such as France, for example, spend over half their budget on long-term home care. Denmark spends 73% of its budget on long-term home care. More money must be invested. However, there’s no guarantee that, when more money is invested, it will translate into home care services. I remain very doubtful about the major $6-billion investment announced in the 2017 Budget. Will the provinces, and especially the facilities, really prioritize this investment for home care? This remains an important issue. Facilities and provinces prioritize access to hospital services. Hospitals will continue to receive the lion’s share of health care spending.
The funding approach must be changed. Funding must be provided directly to the users, the recipients, rather than to the facilities. To that end, Japan and most countries in continental Europe have implemented public long-term care insurance, which allocates money to people based on their needs. I wanted to establish this type of insurance when I was Quebec’s health minister from 2012 to 2014. Unfortunately, the bill that we introduced died on the Order Paper because of the snap election. We must revisit this idea and implement in Canada the type of funding that makes it possible for people to continue living at home. Canada has several options. One option is to enact long-term care legislation, which would establish principles. The provinces that abide by these principles could receive federal transfers or a Canada home care benefit, a direct benefit that would help individuals pay for the services that they need.
In closing, the current crisis shows us that major issues must be resolved if we want to meet the needs of seniors who are losing their independence, particularly in residential institutions. However, we must also look beyond this crisis in institutions and reform the care provided to seniors who are losing their independence so that they can continue living at home, in their community, among friends and family, for as long as possible. Thank you.
The Chair: Thank you, Dr. Hébert.
Now we have opening remarks from Dr. Estabrooks.
Dr. Carole Estabrooks, Adjunct Professor, Faculty of Nursing, University of Alberta, as an individual: Good morning. I would like to thank the committee for inviting me to make remarks, and I would like to thank the previous speakers for their comments.
I’m a scientific director of a longitudinal applied research program that has been looking into issues of quality in nursing homes for about 15 years, mostly in the western or Atlantic provinces, with some activity in Central Canada. I’m going to focus exclusively on nursing homes.
A long-term care home or a nursing home is not a chronic hospital. It is a home, and for most of its inhabitants, it will be their last home. The older adults in these homes require both health and social care. They are old, half of them over the age of 85, frail, with many coexisting diseases. About 80% of them have dementia, itself an age-related, life-limiting disease. Their care has been and is increasingly complex and demanding.
Yet over half of Canadians surveyed say they would rather die than go to a nursing home. How is it that we have let it come to this in Canada, a high income, high quality-of-life nation? How have we let 85% of Canada’s COVID-19 deaths occur in nursing homes, the highest rate of any country in the world? Let us not in Canada be in the position that we will cry in the streets “bring out your dead” as we pass a nursing home.
That is what will occur if we do not immediately prepare for a possible second wave of COVID. We have thus far failed in our duty to care for our most vulnerable citizens, with particular savagery in some places in Canada. We should each of us stop and recall every day that we, in the worst of the first pandemic wave in some parts of Canada, left old people to die in their own excrement, without water, without food and without human contact. Old, vulnerable Canadians — someone’s parent or grandparent, husband or wife, brother or sister, friend or long-time companion.
This is everyone’s problem. This is not just a problem in Ontario and Quebec. Every one of the some 1,800 nursing homes in Canada is but one step away from an outbreak of COVID-19. Witness the tragedy unfolding in Campbellton, New Brunswick. One physician with COVID who gave it to one patient, who then went to work in a nursing home and gave it to three staff and 15 seniors, one of whom has died so far. One step away — that is all any nursing home in any province or territory is.
It is complacency and non-malevolent neglect. It is our attitudes toward the old and infirm. It is our attitudes toward the work of caregiving — the purview of women. It is our belief that anyone can care for an old person with dementia. It has got us precisely where we are today. It is our baffling belief that we could manage a system as complex as the long-term care sector without decent data. It is something more akin to using a Ouija board than an evidence-informed approach. This is in the 21st century.
However, blaming is not useful. The task now is to solve the immediate problems and then turn sharply to the medium- and longer-term problems or this will surely happen again. Not because we don’t know what to do. I can cite hundreds of reports literally gathering dust on shelves. I can cite thousands of research papers offering solutions to various of the challenges. I can personally cite you over 10,000 interviews my own team has done with direct care staff. They tell us they are under duress, inadequately prepared, that they miss and rush essential care because there’s not enough staff and not enough time.
What needs to happen? We must ensure every home in Canada is ready for the possibility of a second wave. We must continue to fix the worst of the workforce conditions: pay, benefits, working in multiple sites. We must ensure homes have the equipment and resources to test and trace all residents and staff, to screen all workers, visitors and families, to ensure all have proper PPE and training in infection control.
We must help women workers whose children are out of school, and whose own aging parents may need care, with innovative strategies for childcare and for respite. We must treat families like families, not visitors.
We must assess the impact of one-site work policies to make sure there are no unintended consequences. We must ensure competent management and leadership in all homes.
We must figure out how to deploy available workers if a home is crippled by staff who are themselves sick. We must have data. For heaven’s sake, we need to have good data so we can manage the system properly.
What does not need to happen?
Another commission, inquiry, report or study. We can read the 100 we have. They all point to the same solutions time after time. We must not favour acute care over long-term care. We must not engage in unrealistic thinking; that this will be easy and will not take resources. It is hard work and, of course, it will take resources, but it won’t bankrupt the country.
We cannot engage in endless acrimonious debates over federal and provincial jurisdictions.
Do any of us believe that the old person lying in their own excrement, thirsty, in pain, alone and afraid as they died, wondered whose jurisdiction it was to help? Thank you.
The Chair: I want to thank all our witnesses.
Let’s move to questions from senators. As you may guess, we have a lot of questions.
Just a quick reminder that each senator has five minutes for questions, and that includes the answers. If you wish to ask a question or answer a question, please use the “raise hand” function in Zoom. Once I have you on my list, the hand will be lowered.
When you are asking a question, please identify the person whom you wish to answer. It makes it a lot easier for me.
Today we will begin with questions from Senator Poirier, deputy chair of this committee, followed by Senator Griffin.
Senator Poirier: Thank you to all three witnesses and for all the information you have shared. We greatly appreciate you taking the time to be with us today.
My question is for the Canadian Association for Long Term Care, Ms. Hall. In a news release on June 4, you said Canada was not prepared for this pandemic. It’s been difficult to watch how our long-term care was hit.
In your opinion, was the advice and the guidelines given by the government and the Public Health Agency of Canada inadequate to respond to the pandemic?
Ms. Hall: Thank you. Referencing the experience of many of our members, what was often noted was the timeline was an issue — when information was given, when directives were put out, and when they had full access to PPE, and the ability to understand and implement those precautions. Very early on there was a disconnect that happened.
The other point that I’ll reference is that the reality of what was being advised simply wasn’t possible on the ground. When we talk about things like social distancing during meal time, for example, that can be extremely challenging, especially with the older infrastructure. So that created a mix of circumstances that were incredibly difficult.
From the beginning of the outbreak to what we look at now — our understanding of asymptomatic transmission, our understanding and the list of symptoms that we identify related to COVID — certainly our knowledge has grown significantly. Early on, those were all challenges that I think contributed to the outbreaks in these homes.
Senator Poirier: Thank you. My second question is also for you, Ms. Hall.
Dr. Theresa Tam said last week that an explosive wave of cases is a distinct possibility with a second wave. Has Dr. Tam and the government presented plans and adjustments for the second wave?
Ms. Hall: I know with each province there are also provincial directives being given. Everyone is continuing to focus on the cohorting plan, prevention steps and staff screening.
As time moves on, with the funding being often very limited for long-term care facilities, the burden of the responsibility for the resources that are needed to purchase the PPE — and we see many examples of overinflated pricing and price-gouging related to that — in addition to ongoing challenges with access, it has created a circumstance where everyone is doing absolutely their best.
I think everyone has a much stronger understanding today than back in early March, but these challenges are still there. I know there are steps being taken by the federal government as it relates to PPE supply in Canada, and certainly at the provincial level, planning is continuing right across the country, but there still are these unspoken challenges about the cohorting and making sure that we’ve done everything that we can.
As far as staffing numbers, that continues to be a challenge and something that will require much longer-term planning.
Senator Poirier: On April 8, the Public Health Agency of Canada released guidelines for infection prevention and control of COVID-19 in long-term care homes. That was almost a month after the outbreak started in Canada. In your opinion, should these guidelines have been part of the pandemic plan before the outbreak and not a month after? How long did it take to implement the screening guidelines?
Ms. Hall: Yes, it was a month, and that did create a delay in response. I think individual homes across the country, and provincially, organizations were certainly watching what was happening globally and were doing their best to kind of create a robust response for their own individual homes, exploring and trying to understand screening measures, but they were relying on the directives coming from public health nationally and provincially to make sure that they were following the trends that they were identifying and the timelines, so we would know when to put these certain measures in place.
There was a delay. If those guidelines or directives could have been given earlier, it would have allowed for more robust screening measures to be put in place much sooner.
Senator Poirier: Thank you.
Senator Griffin: I have a question for Dr. Hébert. As you know, our mandate as a committee is to review the government’s response to the pandemic, so what would you say the Government of Canada has done well in its response, and then what would you say it has not done well?
Dr. Hébert: I think the Canadian government has done quite well — not as early as it should have been — in setting some guidelines for long-term care settings.
What would have been very important was providing equipment earlier to Canadians, and Canadian institutions, to prevent the spreading of the infection, but I think the Canadian government, like the provincial government, has not been prioritizing care for older people and for the handicapped over the last 30 years, and this perfect storm happened because there was not as much attention as we could have had for these vulnerable populations. I think that’s the major lesson we should learn from the actual crisis.
Senator Griffin: Thank you, that’s great. Dr. Estabrooks, could you answer that same question? In your opinion, what has the government done well, and where has it not performed as well as we could have wished?
Dr. Estabrooks: Yes, thank you. I think communication has not been perfect, but it’s been done particularly well in Canada relative to some other countries that we’re observing at the same time. I think we’ve maintained, for the most part, a sense of reasonable considered calm, and that is important in these situations.
I would first echo everything Dr. Hébert said in terms of it being difficult for some of us to answer the short-term question, meaning we know that we got here because of much deeper issues. One of the short-term things we could have done better was we favoured acute care over long-term care. I think that’s clear not only in Canada and the provinces, but everywhere. Although we couldn’t have predicted, we over-prepared in some provinces, if not many, for the surge, and we lagged behind in some of the preparations we were doing in long-term care, particularly around education, infection control and use of PPE, personal protective equipment.
It’s important to remember that 90% of the direct care in these homes is provided by unregulated workers who don’t get any ongoing education for the most part, and have minimal levels of education. So when acute care and others have gone into LTC sites, one of the things that we hear is that the education has to happen continuously, and over and over again, because some basic principles that you might expect in acute care just aren’t there, even though nursing homes do a pretty good job annually of managing influenza outbreaks, but the conditions are quite different. The residents and staff are mostly vaccinated, so the novelty of this virus has made it much more wicked.
Senator Griffin: Thank you.
The Chair: Before I continue with senators who have questions, I’d like Dr. Hébert to elaborate a bit on the question asked by my colleague, Senator Griffin.
As you know, I’m from Quebec. These days, Quebec newspapers are making many comparisons between British Columbia and Quebec. Obviously, the situation is quite shocking.
For example, in British Columbia — on March 21, if I’m not mistaken — staff were very quickly prohibited from moving between residences. In Quebec, this rule hasn’t been completely implemented yet. Given this reality where the provinces must make decisions, would the federal government have a slightly stronger role to play, if I may say so? Were the Public Health Agency of Canada’s guidelines given too late, or were they clear enough? How could this situation have been avoided in Quebec?
Dr. Hébert: Quebec’s situation is special for several reasons. In Quebec, we’re currently having a hard time as a result of two consecutive reforms that integrated facilities into superstructures, especially the latest reform in 2015. The CHSLDs and home care for seniors were sidelined in comparison with the hospital role of these superstructures. There’s an issue with prioritization and funding in long-term care facilities. There’s also the issue of human resources being directed to the hospital, which constitutes the priority for these superstructures. These basic conditions led to this crisis.
There’s very little medical supervision in CHSLDs. Doctors have been redirected to doctors’ offices to give every Quebecer a family doctor, according to the previous minister’s guidance. Doctors have abandoned their practice in CHSLDs. The same is true for nursing staff, which has decreased significantly. There’s a lack of professional supervision in long-term care facilities and a shortage of attendants. As a result, CHSLDs haven’t been prioritized. There isn’t more accommodation in Quebec compared to the other provinces. I did the work with Statistics Canada using the same criteria to compare the provinces with each other. The accommodation rate in Canada for seniors is 5.7%, and the rate in Quebec is 5.9%. There isn’t more accommodation in CHSLDs in Quebec. The issue in Quebec is that the quality of services in CHSLDs has declined in recent decades. This caused the infection to spread much more than in other places.
The other issue was obviously staffing stability. As you know, attendants in Quebec work in multiple establishments, since there’s one bargaining unit for all CHSLDs in these superstructures. As a result, the staff move around a great deal. This is very harmful to the quality of services. It also significantly affects the spread of infections, as we’ve seen with the current crisis.
Canada took an extremely active role in establishing principles for accessing the health care system through the Canada Health Act. However, this legislation was based mainly on doctors and hospitals. The legislation doesn’t really cover everything else. The federal government doesn’t have the legitimacy to impose national standards. A major issue is at stake in terms of Canada’s legislative and even constitutional framework. The Canadian government should have long-term care legislation that would enable it to establish national standards. That way, the Canadian government would have more legitimacy in the future to take the proper steps to help the provinces not only implement services, but also respond to crises such as the one that we experienced.
The Chair: Thank you for this response.
Senator Munson: Yes, thank you very much. I’m struck by the comments by Dr. Hébert. Other witnesses could join in on this. You talked about the tragedy of the handicapped and you talked about a long-term care act. I’m curious to know with these long-term care nursing homes, where 80% of the cases or deaths have occurred, how many of those 80% were persons with disabilities? In conjunction with a long-term care act, how do we build infrastructure and have people involved with expertise in dealing with those with disabilities? I think they are the forgotten people in this whole debate.
Dr. Hébert: Yes, I completely agree with you. I think we focused in the last century on hospital care, and we completely neglected long-term care because we were a young population. Now that Canada is aging very rapidly, we have to adapt our health care system to the aging of the population and the people with multiple conditions and disabilities.
The Canada Health Act is no longer appropriate to the aging of the population because it doesn’t encompass the long-term care in institutions and mostly at home.
In our public budget, 86% is devoted to institutions because institutions are considered part of the hospital care. That was the long-term care hospital. But there is nothing in the Canada Health Act about home care. If we want to support people with disabilities living in their own homes, we must have a funding system to allow these people to stay at home with the appropriate services, and we don’t have that. Those people are moving into the institutions that could respond to their needs.
Instead, we should let people live in their own homes and adjust the services, with public funding, to allow them to age in place. That’s the major lesson we should learn from this crisis.
The issue of long-term care is a continuum, coming from home care to the institution, and we should not forget it’s a continuum and we have to have a systemic approach to improve the services that are needed by people with disabilities in this country.
Senator Munson: You touched on something which is very sensitive. Today there are people who are living at home, for example, with cerebral palsy at the age of 25, with their parents, and both parents are working. That kind of home care was there. Post pandemic, we have a situation where, what kind of care will be there for the person who wants to stay and live at home, when the two parents still want to go out to work? A person with these kinds of disabilities has a fragile medical condition; their immune systems are susceptible to COVID. Who would come into the home post-pandemic? There are tens of thousands of cases across the country like this. I don’t know if others want to be part of this conversation, but we have to find solutions.
Dr. Hébert: I’m very concerned about that. The focus right now is on the institution, but from the debt angle, there are people with disabilities that are not receiving the appropriate services at the moment, and the priority is given to the institution. The human resources are moving to the institutions to support those institutions, but people with disabilities are left without any services at the moment, either from the public, the government or the social agencies that are responsible for giving some of the services for dealing with domestic tasks or personal care. That’s a major issue at the moment, and I’m concerned that those people are going to be obliged to go to the emergency room and be hospitalized, or will die in silence and indifference. It’s a silent drama that is happening at the moment in Canada, and no one is talking about those people at home who are left without the appropriate services. I fully agree with you.
Dr. Estabrooks: Thank you. I wanted to follow on Dr. Hébert’s comments about the continuum of care. There is a continuum, but there isn’t going to be an ability to eliminate the need for nursing homes. We certainly can keep people out of them much longer if we have proper community and home care supports, but because of the nature of the individuals in long-term care — 80% of them have dementia — at some point as dementia progresses, the needs that one has overwhelm the family and community, if you even have a family. It’s important that we recognize that institutional care is a part of this.
When we talk about long-term care homes — and this is why Dr. Hébert’s comments about the Canada Health Act are germane — we’re not talking about a chronic hospital. We are talking about somebody’s home. It’s health and social care, and we need to have a framework nationally that allows us to deliver appropriate care with adequate resources in that way. How do you live well with severe dementia — and you can — but how do you live the last part of your life well and how do you die well?
I think we’re aware that most Canadians have a strong sense of wanting to have some autonomy and the ability to control that, and right now that isn’t necessarily the case in many of our facilities.
Finally, people with disabilities are a challenge and a major issue in this sector, but it’s not just people with disabilities. The people in long-term care are like the people in Canada, and vulnerability and inequity play major roles in how well you do in long-term care. I would place poverty at the top of the list.
If you’re poor and you’re in a nursing home, you’ll likely be a woman and you won’t be able to buy vision care, hearing care and dental care, and all the uninsured services that we now have in these settings. It has become a very complex place, much different from how it was 10, 20 or 40 years ago when we began to build it. Thank you.
Senator Munson: Thank you.
Senator Seidman: Thank you to all of you for your presentations.
Ms. Hall, I will ask you about your submitted list of recommendations to the federal government, which is meant to address the upcoming budget. You submitted your recommendations in February and I believe you mentioned this in your presentation. One of your recommendations was to develop and implement a pan-Canadian health and human resources strategy to deal with the shortage of long-term care workers and you wrote:
A health human resources (HHR) strategy for the long-term care sector must focus on the right number mix, and geographic distribution of providers, as well as the appropriate setting for providers to deliver services.
I would be happy to hear you discuss your vision for this particular strategy, and I’d like to know if you have discussed this with the federal government.
And I do have a question for Dr. Hébert as well, if we can get to it. You’re a geriatrician and a former Minister of Health and Social Services in Quebec, and you have, in a very attractive way, talked about the move from acute care to community care and the need to move some of our services to community care, namely in home care.
I’m a great advocate for aging in place, and there has been a lot of talk about the lack of resources in the community to foster that. I’d like to know what role the federal government might play in moving some resources from acute care to home care.
Ms. Hall: Thank you very much. Yes, in regard to the submission that we made in our federal budget submission in February, and actually, if you look back over the last four years, that was part of a submission we have been making year after year after year, which is that there is a health human resource strategy developed for long-term care across Canada. For our members, this has been a long-standing matter. It’s one of our top priorities, which is why it is in this document, and I think that unfortunately, because of the effects of the COVID-19 outbreak, we see how serious this issue is.
Some of what we’re talking about is the support of the federal government for a very targeted immigration strategy, to help shore up other professionals that we have available to us. I think there is also serious work to be done to engage our young people across the country so that they understand what the career opportunities are.
There have been so many negative or incorrect headlines made about long-term care over the last few years that you certainly can understand why many young people may not necessarily choose senior care as a field of choice. So I think there is a tremendous amount of work that can be done to better portray the beauty of this sector. I know we’ve heard so much about the challenges but, equally, some of the most passionate, dedicated and intelligent people I have ever encountered are from this sector, and they’re not there because they weren’t good enough to go somewhere else. It’s because they chose to be there, yet that’s the messaging that doesn’t get out. There is a lot of effort and energy that can go into promoting what this sector really is all about.
Overall, for Canadians, we’ve done polling through the Canadian Association for Long-term Care and we know that long-term care and care facilities, care homes, do matter. I think that is something we need to do a better job engaging the public and promoting overall what it is that we do.
Dr. Hébert: I’ll speak to you in French, because I know that Senator Seidman understands French very well. We worked together on the Canadian longitudinal study on aging many years ago.
One of the Canadian government’s successes has been the implementation of our current health care system. As I said earlier, the system is based mainly on hospitals and medical care, and therefore on what’s medically necessary, as set out in the Canada Health Act.
If we want Canada to have the legitimacy to address long-term care, the country needs specific long-term care legislation that would establish principles similar to the Canada Health Act, but specific to long-term care, including home care and institutional care. As an alternative, Canada should use its spending power to create a Canada home care benefit similar to the Canada child benefit. This benefit would provide direct funding so that people with disabilities can access the services that they need. This benefit would be established based on an assessment of a patient’s disabilities.
In all provinces, workers use a tool to measure disabilities. In Quebec, this tool is called the functional autonomy measurement system, or SMAF. In the other provinces, the tool is called the resident assessment instrument, or RAI. We have a basis for determining people’s eligibility for this benefit and the amount provided. This made it possible to cover home and institutional care through specific funding. This would provide a way out of the current situation, where long-term care is lumped in with all the budgets of the facilities. These facilities focus much more on hospital care than on the care provided to seniors with disabilities or people with disabilities.
The Chair: Thank you for this response.
Senator Seidman: Is it correct that you’re on the long-term task force that was created by the Office of the Chief Science Officer, and if so I hope that you are putting forward some of these really exciting ideas on that task force.
Dr. Hébert: Yes, I’m part of this task force. I submitted proposals that were accepted in the part of the report that addresses longer-term issues for long-term care. I did this work in recent weeks.
The Chair: Thank you.
Dr. Estabrooks, you raised your hand to Senator Seidman’s question. Do you have something to add to that?
Dr. Estabrooks: Yes, just a point about home care and the broad continuum of care that happens before people end up in nursing homes. It’s not the same across all provinces, but in provinces that have had really successful aging in place or aging policies, one of the things that we’re seeing is that older adults come to nursing homes much later in the course of their illnesses, and their complexity is higher, their demands are higher, so the entire face of the patient-to-resident population in nursing homes is changing as we become more successful in the community.
To Ms. Hall’s comments, we haven’t even begun to keep up with the workforce requirements for that kind of a population. We don’t count care aides or PSWs accurately in this country, so it’s challenging to do workforce planning, let alone look at the ongoing training and educational requirements. Just to note that — [Technical difficulties] — nursing homes are — [Technical difficulties] — continuing care is complex, so when you push it in one place, even if you have success, there’s always a consequence elsewhere. This changing population in nursing homes is something we have to pay important attention to.
Senator Forest-Niesing: I will perhaps begin with a comment for Ms. Estabrooks. I appreciated your candour and I fully agree with your statement that we do not need another commission, inquiry, report or study because there are already many of them and because they all point to the same solutions. It’s time to act. I have a question that was asked by the colleagues before me, and it absolutely must be asked, about reports the military has given to the Ontario and Quebec governments on the poor conditions they observed when they were providing support to long-term care facilities. As we know, although the issues have been brought to light in a very striking way, they are not new and we know that negligence has existed for many years.
I am particularly interested in the problems observed from the point of view of all the witnesses in relation to differences between living conditions in private for-profit facilities and public not-for-profit facilities. I would also like to hear what role you believe the federal government should play in addressing these issues.
Dr. Estabrooks: The issue of privatization is complex. There’s a lot of controversy about it. My experience is that when I look at data about care quality, it isn’t always associated with the kind of ownership a nursing home has. In this province, we don’t see quality differences among the different ownership models. I think it’s because the provincial government here regulates direct hours quite aggressively, so you don’t get the kinds of differences you see in some jurisdictions.
I think we have to be careful when we talk about privatization in publicly administered homes. It’s complex. We have to look at it and manage it in a way that is thoughtful. That’s my comment on privatization.
I’ve lost track of what your second question was.
Dr. Hébert: Maybe I can answer and talk about the situation in Quebec with respect to privatization. There are two types of private facilities in Quebec, namely private CHSLDs under contract, which abide by exactly the same rules as in the public sector, that is, the same fees, the same base salary for staff and the same eligibility criteria for individuals. However, an unregulated private sector has developed, and that is cause for concern because fees and staff salaries are not controlled, and the quality of services is far less regulated than in private homes under contract.
In my opinion, there is no room in Canada for unregulated private-sector homes. I feel that, to ensure quality care for people, and above all, to keep them from being charged excessive fees, these settings must be under contract if we are to let the private sector be active in the field of care for the most disabled members of society.
Senator Forest-Niesing: Thank you. We could give Ms. Estabrooks the opportunity to respond...
Ms. Hall: Maybe what I would also add is when we talk about what is largely referenced as a nursing home type of care home, they are all regulated by the provincial governments, and they are regulated the same regardless of the corporate structure that’s in place. I think that’s what Dr. Estabrooks had referenced.
Individuals who we would consider to be the most frail would be in that provincial model of being in a highly regulated environment with a great deal of oversight. So there is no difference and, again, there is no profitability that is allowed on care provision itself.
Senator Forest-Niesing: I had a question for Ms. Hall on one of the recommendations her association is making with respect to hiring international students to address the acute needs and labour shortages in seniors’ residences. I think you mentioned this earlier: have you considered including newcomers to the country and making inquiries at the Immigration Department about possible measures to formalize the status for these newcomers more quickly, to attract them to this profession and to see it as a pathway to entering the country?
Ms. Hall: Some of the issues that we’ve specifically noted, for example, in the budget submission we had made, are around how the designated learning institution criteria is allotted to colleges that are offering, for example, personal support worker education. So if it’s a private college, they don’t necessarily need all of the criteria. Often, we see that many newcomers to Canada have completed that training and therefore don’t necessarily qualify for the post-graduation work permit. There are some very technical issues that we believe the federal government could assist with in mobilizing some of the newcomers to Canada who are interested in joining the workforce.
Certainly at a pan-Canadian level, we do believe there is an opportunity for a focused Canadian strategy to create priorities for people at all levels of care provision — whether it’s a registered nurse or a licensed practical nurse level or personal support worker — that they have greater access to immigration opportunities within Canada. We’d very much welcome an opportunity to work with the federal government to better understand what the needs of the long-term care sector are, and how this could be a solution for us going forward.
The Chair: Thank you.
Senator Moodie: Thank you to the witnesses who have joined us today. I wanted to focus a little bit more on standards of care, if we could, and on the impact of deregulation in long-term care institutions over the past decade or so.
We know there has been some increase in deregulation, especially concerning things like annual inspections and so on. I’d like to ask you to comment on the role of deregulation in setting the stage for the outbreaks we have seen and the high death rates we have seen.
I’d also like to ask a little more about standards of care. Are there national standards of care for long-term care institutions? I’m sure there must be a body of work in this area that you could share with us.
The second part of that is, are institutions required to undergo accreditation for this, to have a closer look at their standards on a regular basis? Is this voluntary or is it mandatory?
The final question I’d like you to address is if there are delivery-of-care models that we should be looking at in other countries that would perhaps serve us better. We talked a lot about past problems, but I’d like to understand, in looking forward, what particular new information do we have that might shed some improvement on this sector.
I’d like to ask Dr. Estabrooks and Dr. Hébert to start. Thank you.
Dr. Estabrooks: Thank you very much. Nursing homes — and I’m speaking particularly about 24-hour residential long-term care homes — are an interesting mix of regulations.
There’s serious over-regulation of many things, and tremendous under-regulation on other things, before we even look at what the accountability processes are in terms of inspections.
So we heavily regulate against risk. Nursing homes are treated punitively if they have too many, for example, injuries and falls. If that is not done carefully, it results in kind of perverse activities, in that nursing homes begin to do things to restrict mobility to avoid falls. It’s not just the regulations; families often also tend to be quite risk-averse, and understandably.
Around individual freedoms, movements and rights, there can be over-regulation, but then there are all these places we don’t regulate at all. There are no national educational standards for front-line workers in nursing homes.
We have heard about the perfect storm and the tremendous complexity of care that is required by these residents. We have 90% of that care being delivered by people who are unregulated, meaning well and usually very committed to their work, with somewhere between eight weeks and eight months of education and no ongoing education. That’s a place where national standards and some oversight and regulation could be helpful. It won’t fix everything, but it’s a place to start.
As to inspections, it’s not clear to me why you would do an inspection by telephone or why you’d say, “We’re coming next Tuesday” if you’re going to do an inspection. I think there are some technical things that different jurisdictions can look at to shift that.
We also don’t have enough staff in long-term care facilities. You know what happens in a hospital when they’re being accredited. There’s a massive attempt to get ready for the accreditation. All forces are brought to bear. In a hospital, even though they might be tight, they have resources to bring to that. When you do that in a nursing home, you are pulling from people who are giving front-line care, or from regulated nurses, physiotherapists or occupational therapists, if you even have those allied health professionals.
I think the issue of regulation and standards is one of the areas where we could have federal frameworks that would help us. You should be able to move your mother from New Brunswick to Vancouver and have the same kinds of expectations you do in the acute care system, in terms of portability, accessibility and all those sorts of things. I think a framework that looks at the social and health care required in the continuing care sector, with a focus on long-term care, could be terribly helpful to us in Canada.
Dr. Hébert: I think accreditation is a key issue. With the structural reforms we have seen in Quebec, the creation of the big superstructures, Accreditation Canada is accrediting every superstructure, not each of the CHSLDs or nursing homes, and that’s a problem.
Accreditation Canada was developed for accrediting hospitals. We need to look more closely into accrediting nursing homes and setting standards for care, and for how many physicians you need to be able to provide care in a nursing home, in particular: how many nurses you should have on the floor for each shift; how many people for personal care; what are the conditions for the sharing of bathrooms, and all these issues that are important in day-to-day life, but more important during a crisis such as we face at the moment. The adaptation of accreditation organizations is critical, in my mind, to ensure we have standards and that people admitted to those institutions are treated properly.
When I was minister, I created a kind of unannounced inspection visit, where three people were going to nursing homes to check certain criteria. The report from these inspection visits was supposed to be posted on the internet in order to be transparent, but also with a plan to correct the problems that were identified. Unfortunately, this is no longer in place, but I think that type of unannounced visit is important to be able to see what the problems are in nursing homes.
Senator Manning: Thank you to our witnesses today. I have a couple of questions. My first is to Dr. Estabrooks.
I’m wondering about the sharing of information between provinces — the sharing of best practices, quality improvements that could be made, and what means are in place to create common standards, which you talked about a few moments ago — as we look to a national program for long-term care.
My next question is for Ms. Hall. There’s been a lot of discussion across the country over the past number of weeks in relation to personal protective equipment. What is the current status of the supply of PPE in long-term care homes?
Dr. Estabrooks: Thank you. There aren’t good mechanisms for sharing. One of the things we’ve been criticized for in Canada, regardless of the sector you’re looking at in the health arena, is being a country of pilot projects. We have a lot of small projects, some of them very promising, but scaling them doesn’t occur. We don’t communicate well among provinces. There are not even mechanisms.
We run a partnered program where we bring stakeholders, policy-makers, etc., to the table, and sometimes we can’t even get them there because they’re not permitted to travel. That’s how serious the issue can be.
As to promising practices, quite a bit of work has been done in Canada on promising practice. I’d like to start by saying that you don’t need a fancy nursing home built in 2018 to provide good care. There are horrible buildings in this country that are delivering high-quality care. A lot of that goes to the leadership and management, and we’re not supporting our leaders effectively. We need to know more about why they’re doing well. They have also tended to do well during COVID, so I think that’s important.
There are tremendously interesting models in other countries, and we’re not sharing that information well and we’re not sharing whether provinces are trying it out. For example, the dementia villages in the Netherlands or the green care farms in Europe, which are very promising; can they be scaled? Do they fit our culture and context?
The short answer is, no, we don’t have good mechanisms. But we have a lot of people. If we can get the mechanisms and processes right, everybody — from policy-makers to managers, leaders, associations and researchers — could begin to put this together if there were some framework.
Ms. Hall: Just to quickly make a statement about data sharing. As Dr. Estabrooks pointed out, there’s a tremendous amount of data provincially. Long-term care is highly regulated, but there is a challenge when we try to compare. So creating a national standard is something we have talked about extensively at the Canadian Association for Long Term Care. There are strategies to do this going forward. There’s a resident assessment instrument and other tools that can be used.
To go back to the specific question that was directed to me regarding PPE: The federal government has created a supply council to look at this issue in more depth, so we look forward to the outcomes of that for the homes on the ground, if I can express it that way. The cost of PPE is still a major question mark for everyone. Accessing the supplies, certainly in the short term, was one thing, but we need to consider that this is probably our long-term reality for some time, where we’ll need continuous access to personal protective equipment. Many of these organizations have very little resources, so it’s a serious question from that point of view.
As far as being able to procure PPE, whether it’s at the provincial government level or by the individual facility, the situation has gotten better. It has stabilized, but there are certainly long-term questions about what this will look like going forward and the overall sustainability of it. Whether we’re looking at products that could be recycled or reused, or whether we can have a centralized approach to procurement in order to control costs, those are critical issues going forward.
Senator Manning: I have a quick question for Dr. Hébert. In relation to the task force on long-term care, can you tell us how often you meet, and is there a report or recommendations in the future from your task force?
Dr. Hébert: Thank you for the question. We met via teleconference five times. The last one was a couple of weeks ago. We have been working with the first report on the immediate action that should be taken by Health Canada to establish standards to improve the situation and prevent a second wave. We’ve also worked on a second report for more mid- or long-term issues that should be addressed by Health Canada and the provinces about long-term care. But the committee is no longer meeting.
Senator Manning: Thank you.
The Chair: Thank you for that response.
Senator Mégie: Thanks to the witnesses for their very good comments. My first question is for Ms. Hall. The Canadian Association for Long Term Care had recommended the establishment of immigrant streams. I am coming back to my colleague Senator Forest-Niesing’s question, but I would like to address another factor with you. It is about the doctors, nurses and nursing assistants with foreign credentials who have been in Quebec and Canada for some time. When the major crisis came, all the provinces said, and everyone, especially in Quebec, cried out that we needed all hands on deck, that we needed people to come and help out in the CHSLDs. They were completely ignored. We are even turning to immigrants, but we are not turning to them. It is only because their skills have not yet been recognized.
Is there anything we can do? What could the federal government do to facilitate this? Do you have any ideas? The question is for Ms. Hall, but then I would also like to hear Dr. Hébert’s comments.
Ms. Hall: Thank you. I can say in that regard that certainly any individual who is here in Canada who has a credential would fall under the jurisdiction of the provincial regulatory licensing body. Whether that’s the College of Physicians and Surgeons, for example, in a particular province, or the individual registered nurses association, those organizations govern the regulatory criteria for their licensing.
If there is an opportunity for us to collaborate with those individuals and to find a way to engage them in the long-term care workforce, in a capacity where they could immediately begin, we would certainly be interested to work with all skilled people out there to come and work in our homes.
Dr. Hébert: First, I am happy to see my former colleague Marie-Françoise again.
Senator Mégie: Likewise.
Dr. Hébert: The issue of recognition for foreign physicians is extremely important. It has been discussed a great deal in Quebec over the past 20 years. I was dean of the faculty of medicine at the Université de Sherbrooke when a form of qualification upgrading was set up for foreign-trained doctors. The challenge is upgrading qualifications and securing the availability of internship locations to perform the upgrading. A lot of work has been done in Quebec to help foreign doctors acquire the skills that Quebecers and Canadians have a right to expect from all physicians. I do not feel the federal government has a role to play in this area, which is more of a provincial jurisdiction and is reserved for the bodies that set standards for medical practice.
I cannot comment on nursing. I know, however, that a lot of effort has been made to provide qualification upgrading for nurses and nursing assistants.
I believe that those who worked as personal support workers during this COVID-19 crisis should, at a minimum, be entitled to prior learning assessment for their contribution. In this regard, the federal government would have a role to play in ensuring that their status is settled, in terms of citizenship or permanent residence. They made a significant contribution to the management of the crisis. The least we can do is show them our appreciation for lending a hand in these difficult times.
Senator Mégie: Thank you, Dr. Hébert, and thank you, Ms. Hall. I have another question. I do not know which one of you can answer it. One point has not been addressed with respect to seniors. In addition to their vulnerability as seniors, some are also at the end of their lives. We have not talked about that. What struck me in Quebec is its community resources called palliative care homes — in other provinces, they are called hospices — where people have also had to suffer the effects of COVID-19. Families had to be prevented from visiting them, so many of them died alone. The system has been blamed for that.
Do you feel, after reflecting on this, if you have reflected on it, that there would be a way, in the event of another crisis, to avoid this humanitarian crisis, or this human crisis, in this small area? I know it may be smaller, but it still involved vulnerable, not to say very vulnerable, people.
Dr. Hébert: If you will allow me, I will attempt to provide an initial response. I think that, indeed, we went too far with restrictions on palliative care centres. We now know that it is possible to set up these places and provide personal protective equipment so that families can be with their loved ones in their final moments. In an effort to protect the general public from spread as much as possible, I believe we went too far, and public health authorities recognize it. With certain conditions, of course, we should allow families to be there in palliative care facilities, but also in CHSLDs, to be beside their loved one in their final moments. I believe it is inhumane not to do so and that the drawbacks of an excessively restrictive approach are far greater than the benefits.
Senator Mégie: Thank you.
The Chair: Dr. Estabrooks, Senator Mégie doesn’t have any more time, but I want to hear you on that because I think we were all disturbed hearing some of those stories.
Dr. Estabrooks: Yes. First of all, almost everyone in a nursing home is dying. This is their last stop, and that’s okay. We can make it a really good place. Over 90% of people will die there. The other 10%, a good proportion of them, will die often inappropriately transferred to an emergency room.
So palliative resources are critical and they’re in short supply in nursing homes. Just on the palliative services issue, we’ve got a long way to go, as we do on mental health services.
In terms of families, I would like to ask the senators if they think that in any hospital in this country, if a dying baby in a neonatal intensive care unit would have been permitted to die without its parent. I think what we’ve done is completely egregious and unacceptable. I know why we did it, but we didn’t let up fast enough. There is no reason a daughter can’t dress up in a hazmat suit just as well as a personal support worker can. We have to give them equipment and teach them how to use it, but when you’re old and dying in a nursing home and you have dementia, you need familiarity. You’re scared and it’s confusing. Now there are all these people walking around in masks and gowns. You can’t hear their voices well or see them well.
Families in nursing homes provide a lot of care because we rely more and more on families than unpaid workers to fill the gaps we’ve got. If any of you have had a parent or a sibling or a spouse in a nursing home, you know how much care families provide. To just say, you can’t come, is one of the biggest failures we have in the pandemic. Even if we did that in the beginning because we were confused and afraid, we could have let up much faster. That’s one of the issues going forward that we have to address. I know it creates some risks, but life isn’t without risk. We know enough now so we can manage it. On that issue we don’t really have a good record. Thank you.
The Chair: Thank you both for those answers.
Senator Dasko: Thank you to the witnesses for appearing today. I’ve learned a lot. I would like to start with a couple of questions for Ms. Hall. First of all, you represent private owners, do you not?
Ms. Hall: Yes. We represent a mix of public and private.
Senator Dasko: A mix, yes. Okay. You mentioned earlier that the formula for funding is very specific and the money coming from public dollars is very focused and there is no room for profit in there. Where does the profit come from if every dollar you say is allocated to food goes to food, and so on? Where does the profit come in the care homes then?
Ms. Hall: Sure. For those organizations that have this type of corporate structure — and I’m speaking in very general terms for a business concept — there are elements that are highly regulated and controlled. So if we talk about care, that is absolutely one of them, but then there’s actual infrastructure of the facility. So there could be fees for accommodations, for example. So that is separated out in that way. That is a particular piece.
But then you have to think about these corporations as very large companies that have multiple business holdings, and where their profit margins are gained can be in different parts of their corporate structure, as opposed to the actual kind of nursing home care provision itself.
Senator Dasko: Let’s say if you are contracting out the food service, there would be an opportunity for profit there, would there not?
Ms. Hall: There is slight variation across the provinces as to how the regulations work, but largely if there is a profit that is generated as a result of funding food, they have to be returned because they’re in protected envelopes. As far as the quality of the food, the menus of what’s being served for meals, those are also monitored and regulated and overseen by dieticians. I know that that’s often a thought, that those are areas that are skimped on, for example, to create profit margins, but that’s not an example of an area where profit can be generated.
Senator Dasko: So it’s in other areas then?
Ms. Hall: Yes.
Senator Dasko: Are the companies making profits in the long-term care facilities or is it just in the retirement homes?
Ms. Hall: It’s often in retirement homes. Again, I can’t speak to the specific business models of each of the organizations because they’re all structured differently and uniquely, but you also have to think about it even from a real estate point of view and where equity comes from, and how equity can be used to leverage funds for other types of developments that can be more profitable. So it’s part of an overall business concept.
Senator Dasko: Okay. Thank you. I have another question. I know I’ve got some time here.
A couple of you today and other experts in the field have talked about a greater federal role in this area. I just wanted to be a little more specific about this. If the federal government is going to get involved more, along the lines of the Canada Health Act, then what that actually would involve, as far as I understand, would be the federal government providing money in return for greater regulation. At the moment there is no regulation on the part of the federal government. This is a provincial area.
So presumably to improve the service, we are not actually looking for a common standard across the country. We are looking for a better standard across the country than what we are seeing now. So in return for the money, presumably there would be a much stronger regulatory framework that would cover, presumably, many areas of operation. So it’s not just the money, of course. Everyone wants the money, but it has to come with something.
So I want to be a little specific about whether you welcome this particular model.
Dr. Hébert, you’ve been very helpful in setting out a couple of different models there, but I want to ask Ms. Hall and Dr. Estabrooks specifically if you do favour this model as well? Is this what you are calling for, keeping in mind that the federal role would have to be much greater, I presume?
The Chair: Would you like to answer first, Dr. Hébert?
Dr. Hébert: I think the federal government has two options: either by having a law, having a bill passed to set up standards, principles, for inviting provinces to adhere to these principles. If they adhere, they are a part of funding that is coming from the federal government or allocating direct payment to people.
I think the first model is the model of the Canada Health Act, and it was very effective in order to set up those standards. You see in Quebec, for example, that the two last ministers of health have written to Quebec in order to correct the situation for the excess rate fees that were charged to people, and was in contravention to the Canada Health Act, and it was very effective. So even in the hospital context, it’s still very effective to have those principles.
What we’ve seen over the last years is that the federal government is providing much more money for home care, for example, without setting standards.
When I was minister, we allocated 20% more budget for home care. A couple of years later when we monitored the services that the people received, the services deceased dramatically. So there was no effect of the 20% increase in the budget for home care. I’m quite sure that it’s going to be the same for the $6-billion injection of the federal government, because the provinces and the institutions are prioritizing hospital care and access to hospitals. So there will not be a direct effect on home care and even on nursing homes. Giving more money is not enough. You have to set standards or give money directly to people. Those are the two options the federal government has.
Senator Dasko: Exactly, Dr. Hébert.
Dr. Estabrooks: I want to underscore what Dr. Hébert has said. You’ve got to have accountability. It’s just irrational to think of sending money without accountability.
One of the early places we could do it, and this is something I believe the federal government has jurisdiction over to some degree, is data. We don’t have data. When I say data, I mean every nursing home in the country should be required to report on standardized quality of care measures, standardized quality of life measures and standardized measures about the state of the workforce.
We know that the state of the workforce is one of the main contributors to quality. If you don’t know whether your people are burned out, are healthy or have injuries, have reasonable levels of job satisfaction; those things are eminently doable, but they’re not being done right now.
I’ve just spent several weeks trying to put together a few simple tables, and I’m nearly pulling my hair out because once you get past the superficial data that Statistics Canada has, and some of the data that the Canadian Institute for Health Information has, you have to pick up the phone and start making calls, which is crazy in this country. We should be able to do better. I would argue that, yes, we require some federal framework. It has to have accountability built in. I would start with data and standards around education.
The Chair: Thank you.
Senator Campbell: I would like to thank the witnesses and tell Dr. Estabrooks that you touched my heart deeply.
I have a question to continue from Senator Manning for Dr. Hébert. Why is the task force is not meeting anymore?
Dr. Hébert: I don’t know. We’ve been working on two reports, and the job is done according to Health Canada. I cannot answer that question. I’m not the leader of this task force. You should ask the minister maybe.
Senator Campbell: I will do that, or I’m sure Senator Manning will do that.
It would seem to me that the word “Constitution” keeps coming up and that health care is a provincial jurisdiction. Perhaps it’s time for us to take long-term care away from the provinces and make it federal. Do you have any comments on that?
The thing that I noticed the most is that in British Columbia this happens, in Quebec this happens, and in Ontario this happens. The problems are all the same. The solutions are different. I wonder if it wouldn’t make sense that we pull them all together. I know the Constitution is something we don’t want to go near, but I fear that when the pandemic is over, we will go back to same old, same old.
Dr. Hébert: One of the big achievements of Canada was to set up the health care system, and health care is still the responsibility of provinces but with national standards and transfers.
I think we could have the same approach. Let the provinces manage the long-term care system but with national standards. I think it could be a role for Canada in the 21st century.
Senator Campbell: Do other witnesses have any comments on that?
Dr. Estabrooks: I don’t think we need to just give it all, not that we could anyway, to Ottawa. But it seems, as Dr. Hébert has just explained, that there is a workable approach and we could identify a set of core issues that the federal government would require accountability on, for the transfers to occur. That would still leave enormous latitude in the provinces. It may be too much right now, but there is tremendous latitude now, but some key core pieces are missing.
The people in the sector, in the industry, know this, but as a population, and I keep coming back to it, this isn’t just health care. This is health and social care. This is about your quality of life. When you get up in the morning, is there some reason to get out of bed? Do you have any purpose? Do you have any meaning? Does anyone touch you? Do you have any joy? That isn’t necessarily the purview of health. There are some health components to it.
I would argue that you can’t have good quality of life if you don’t have decent and good quality of care. You can’t sit with a four-inch pressure sore and have quality of life. But health takes care of that. We need social workers, pastoral workers, recreational therapists, intergenerational programming, animals, gardens and sunlight. Those things are social care, so I think we could build that in. Ronald Reagan used to talk about a shining beacon on a hill. Well, we could be a shining beacon internationally if we put our shoulders to the wheel. This is a wealthy country despite our current challenges.
Ms. Hall: There is no question that this is a shared responsibility that I often think has gotten kind of passed back and forth, because of the constitutional questions here, but as has been referenced by my colleagues earlier, we’re at a different point in time. I think we are going through an aging transition in Canada that is unlike anything that’s ever been experienced historically, so we do need to look at different concepts for the future.
The data part is critical. There are centralized approaches to data collection, but not everyone can afford the systems to do it. I’m speaking about the data that gets submitted to the Canadian Institute for Health Information, either in the form of a management information system or a resident assessment data set that gets submitted, and then there is a national comparator, but there is a lack of funding for everyone to be able to participate in that.
With the leadership of the federal government, working with the provinces and with the homes on things like data, better understanding our workforce needs and finding a way to address the systemic issues — because introducing a national standard in itself doesn’t necessarily mean that the systemic issues are going to be resolved. Whatever those challenges are going forward, I think it will require all of us to collaborate, and it’s not just simply changing the constitutional components of who gets to control it.
Senator Campbell: Dr. Hébert, what is the formal name of that task force?
Dr. Hébert: It’s a task force on long-term care issues with COVID-19.
The Chair: We will find the precise name for you, if needed, Senator Campbell.
Senator Campbell: Thank you, chair.
Senator Omidvar: Thank you to our witnesses. I have been educated and moved immensely by your testimony. I have a 92-year-old mother who lives with me and frankly, at this point, I will do everything to keep her away from long-term care homes from what I read.
My question follows up on Senator Campbell’s question about the role of the federal government in the long-term care construct. I’ll ask the question a little differently, and maybe I will still get the same answer.
An increasing number of voices have put forward the position that long-term care should be brought under medicare. In fact, a CBC journalist called it, very colourfully, that leaving out long-term care from medicare was the original sin. Dr. Hébert, do you think that senior citizens in long-term care homes would have been better served and better protected if long-term care institutions were under the jurisdiction of the federal government, leaving aside the federal-provincial dog fight that would ensue with this?
Do you think they would be better off today and tomorrow?
Dr. Hébert: I don’t think so. Part of the problem in Quebec is the nursing homes no longer have their own administrative board and management team. It’s a big superstructure that is managing and governing every single nursing home in the organization.
Nursing homes have to be managed and governed locally. It’s quite important. Whether it is provincial or federal responsibility, if it’s not managed locally, you cannot ensure that every single nursing home will get the quality standards to be able to react to an eventual crisis.
I think that’s a critical issue. The local management and governance of those institutions are very important. If the federal government had been the overarching institution, I don’t think it would have been better. I’m convinced it’s not the overall political and big picture that is the case at the moment — it’s how those institutions are governed and managed.
Senator Omidvar: Thank you, doctor.
My next question is for Ms. Hall. Again, I’m going to stick with a question asked by my colleague, Senator Mégie, around the latent pool of talent that is underutilized in Canada in the person of internationally educated health care professions.
I know there is a cohort of these who have taken all the examinations and met all the standards to enter into their profession, and all they are lacking to take the final step is a supervised internship. There is a proposal being developed, with federal funding, that would create these internships in long-term care homes with the supervision of hospital-located professionals, physicians, that the long-term care institute is partnering with. In this way, I can see everyone wins. The immigrant wins because he or she gets through the final step before licensing. The long-term care home wins. The taxpayer wins. Most importantly, the senior citizen wins because there is a medical professional on site.
Do you have a response to this proposal, Ms. Hall, and Dr. Hébert if you like?
Ms. Hall: I’m not aware of this proposal, but it sounds incredibly interesting. Understanding the needs of our sector, I’m sure there would be a positive response from long-term care to support a strategy like this. I think this is a wonderful example of the types of things that could be examined under a pan-Canadian health care strategy.
I touched on a few things earlier, but also adding in this piece around education and opportunities to better leverage the human resources that we have available in Canada right now is incredibly important, and one that we would be interested to know more about.
Dr. Hébert: Having part of the training in nursing homes would be interesting for all medical students, and it’s not happening at the moment. In Canada, the training for geriatric medicine is not strong enough for the medical students trained in this country. I think it would be very interesting to have part of the training in nursing homes and in institutions.
For physicians trained abroad, the problem is when you get a licence as a physician, you don’t get a licence to practise medicine in nursing homes. You get a licence to practise medicine overall. Receiving training only in nursing homes doesn’t ensure competency to treat patients outside nursing homes. That’s the problem with your proposition. Nursing homes should be part of the training for physicians but not be the only training of physicians trained abroad.
Senator Omidvar: Ms. Hall, you spoke about the pressing infrastructure needs in long-term care facilities. The government has billions of dollars in the Canada Infrastructure Bank. Do you believe that now is the time to undertake complete retrofitting of long-term care homes through the instrument of the Infrastructure Bank as opposed to other envelopes of money that may be harder to access?
Ms. Hall: Absolutely. We have asked these questions and it seems there is a lot of misunderstanding. For example, when dollars were released for housing, some thought we were included in that, and then some thought we were included in the infrastructure piece. We are excluded from both. So we have fallen into a crack where we’re more closely associated with hospitals.
Absolutely, the opportunity is there. Across the country my colleagues have shovel-ready projects ready to go, as was the headline that was used before.
Senator Omidvar: I would dust them off and put them back on the table.
The Chair: We are slowly running out of time, but I want to make sure that the last two questions of the committee members are answered.
I realize other senators have more questions. I would ask you to forward those questions in writing to our clerk. We will make sure that we get these answers.
For now, we have the last questions from Senator Kutcher and then Senator Martin.
Senator Kutcher: Thank you, everyone. I want to note that family caregivers are partners in care, not just only at the end of life but in the continuation of life as well.
Are you in favour of there being a mandatory accreditation of all long-term care facilities, perhaps by Accreditation Canada? Are you in favour of personal support workers becoming a regulated profession with all the components that entails?
Dr. Hébert: The answers are yes and yes.
Senator Kutcher: Perfect.
Dr. Hébert: Yes, for the accreditation, but there should be norms specific to the nursing homes for accreditation of those types of facilities.
Senator Kutcher: I agree completely.
Dr. Hébert: Norms adapted to nursing homes.
Second, I think personal care workers should be regulated by a licensing body to ensure the quality of the services they provide.
I’m very pleased to see you again, Stan.
Senator Kutcher: It’s lovely to see you too.
Ms. Hall: I’ll jump in with a response as well with regard to the mandatory accreditation. Accountability structures are not something we’re opposed to, but making sure that whatever is introduced is something that creates real change and not just an exercise to prepare for accreditation. For example, making sure there is evidence that that is a path which creates the type of change, and supports that type of reform that we’re looking for.
As far as the PSW regulation, having some standardization and education is a very positive move. I think what we have to be mindful of is that through these efforts that we don’t create more barriers to having people come to be employed in the workforce, especially right now where we’re at a crisis state for staffing.
So if there is a way that allows people to enter into the long-term care workforce, with maybe more of an apprenticeship type of concept, as opposed to someone fully credentialed and going through the regulatory process. I think it would be helpful for us to explore a range of concepts as to how that could be achieved.
Senator Kutcher: Frankly, Ms. Hall, I can’t see anyone saying, “I don’t want to be a doctor or a nurse because I have to become a member of a regulated profession.”
Ms. Hall: No, no.
Senator Kutcher: Dr. Estabrooks, could I ask you the last question?
The National Institute on Aging 2019 report devotes about 25% of its content to discussing innovative and in some cases successful interventions across the whole spectrum of long-term care. Yet there is no place in Canada that I know of that is driven by the federal government. There are organizations that work to ensure that things that work very well and are scaled up across the country. Is there a role for the federal government in this kind of process?
Dr. Estabrooks: I haven’t thought about that deeply before. Yes, I think there is. It is clear that in Canada we have to do something to stop running these siloed, fractured places. Even if they’re successful, it’s not that helpful to us as a country if it’s only successful in Cape Breton or northern Saskatchewan. There are some wonderful programs around memory care in northern Saskatchewan, but they’re not being scaled. I can name some right across the country.
So yes, there is a role there. That’s probably one of the places where we can get the most bang for the buck in terms of accountability. We have to be able to stop things if they don’t work. We have to evaluate them. The way regions do it now is, here’s a really good idea and here’s $8 million, let’s do it. Three years later, you often can’t find a trace or thread of that activity. If we can get that organized in some way, people will cooperate with that, because everybody I run into wants to make the system better.
The Chair: Thank you.
Senator Martin: Thank you. I agree that this has been so informative and very moving. Thank you to all the witnesses.
What I learned today is there’s some very important language that we must all use in talking about long-term care, whether we say it’s a resident in a home and it’s about the continuum of life. Words like institution and facility make it feel very different. My mother is in long-term care. She’s young, she’s only 83, but she’s been in care for about eight years because of her dementia. I feel very fortunate with the home care my mother has received.
Having said that, I feel there have been some unfair generalizations about what has happened. I’m in British Columbia and I, as a family member, have been very satisfied with the compassionate care my mother has received. I do believe education on all sides is very important in this issue.
One thing I hadn’t heard throughout this session is the ethno-cultural needs of some of the residents. I’m in Vancouver, so fortunately my mother gets rice for three meals a day, which is important. Those considerations must be discussed when we talk about improvements we want to make to the care homes. I work very closely with a private facility, and they are exceptional as well. Regarding these unfair generalizations; I hope we educate all Canadians on this issue.
Ms. Hall, I’m wondering, in your discussions with the federal government — Dr.Tam, other national officials — if British Columbia is one of the provinces that can ease these restrictions for families, because they work with care workers. They are like our extended family. I’m just worried about the second wave; there is talk of a third wave. How do we move towards easing these restrictions? Can you give me some sense of hope, as a family member, that we will move forward bringing families into these homes again? That will be critical to caring for our seniors, our most vulnerable. Thank you.
Ms. Hall: I know there are many active conversations that are happening. Everyone across the board recognizes the critical role that families play in the lives of residents and making sure that we’re not creating more harm as it relates to social isolation and loneliness as a result of trying to physically protect them.
There is a debate, if I’m being honest, as to the physical protection piece, and then the benefits that come from supporting and engaging families. I know there are two schools of thought that are actively having these conversations. If there was some further direction about how families can safely engage in a facility, especially if there are COVID-positive residents residing there, it will go a long way to help support. If that’s something that the Public Health Agency of Canada can provide some technical direction on, I think it would be incredibly helpful. I don’t think there’s any debate about the importance of the family or the need to bring them in; it’s just how do we safely do it so everyone’s health and safety concern is respected as much as possible.
The Chair: Thank you for this. Dr. Estabrooks, did you want to have a last word on that before we have to go?
Dr. Estabrooks: I just wanted to comment on the diversity. There’s cultural and racial diversity. There’s diversity around gender status. We have a growing community of LGBTQ people in nursing homes who are not recognized and not always treated very well. We have people with intellectual disabilities. Two thirds of people in nursing homes are women. Two thirds of those with dementia are women. We’ve heard 95% of the paid care providers are women; 75% of unpaid care providers are women. Women residents in these homes are often of a lower socio-economic status. There’s a tremendous colourful multicultural group of older adults moving increasingly into this sector that reflects the Canadian mosaic.
We have to put cultural sensitivity on the line here. They are being cared for by highly racialized staff who don’t have a voice, nor do the residents often have a voice. So anything we can do to not continue to whitewash this resident population or the caregivers is going to be really important to quality of life and better care in this country. Thank you.
The Chair: Thank you very much for these answers. Witnesses, if you have something that you feel you forgot or you want to add, please do not hesitate to send it to the committee in writing.
I want to thank you so much for your very helpful, thought-provoking and inspiring testimony. Your assistance with our study is highly appreciated.
Dear colleagues, we will continue our study of our government’s response to the COVID-19 pandemic without further delay. Our witnesses this afternoon are as follows: Marissa Lennox, Chief Policy Officer at the Canadian Association of Retired Persons; Laura Tamblyn Watts, President and CEO of CanAge; and Dr. Roger Wong, Clinical Professor of Geriatric Medicine in the Department of Medicine at the University of British Columbia.
We will begin with opening remarks from Ms. Lennox. She will be followed by Ms. Tamblyn Watts and then Dr. Wong. Ms. Lennox, please go ahead.
Marissa Lennox, Chief Policy Officer, Canadian Association of Retired Persons: Thank you very much for the invitation to present before you today.
CARP is a not-for-profit, non-partisan organization with 300,000 members in every province and territory in Canada. While most of our members are retired and enjoy above average education and income, an overwhelming majority consistently support that CARP represents the interests of all older Canadians across Canada. We fight to ensure that all older adults can live in dignity and with respect, regardless of income level, family support and health challenges.
COVID-19 has undermined the fundamental principles of aging well, and revealed a lack of planning and preparation that would secure the health and well-being of seniors during a pandemic. Since the onset of COVID-19, we at CARP have done everything in our power to provide credible and reliable information to older adult populations on our website, through our call centre, via email distribution and through programming. We’ve also conducted various surveys and town halls to better understand our members’ needs and concerns.
I’d like to share with you areas of common concern, which we’ve heard from CARP members over the past three months. Apart from the obvious human consequence, many have been severely impacted by an increase in the cost of living. This includes grocery premiums and delivery fees; increases in prescription dispensing fees; increased transportation costs for taxis where transit was unavailable or as a measure of protection; and cessation of free or discounted community services, including volunteer tax-preparation programs and food banks, which initially closed down to adhere to physical distancing restrictions. We’ve heard stories of CARP members forced to trade off everyday necessities because of these added costs.
In addition, stock market volatility, together with significant and worrying fluctuations in the value of seniors’ portfolios, has caused many to feel anxious and insecure about their ability to afford retirement. This problem is compounded by existing mandatory RRIF withdrawal rules that rob people of the flexibility to make adjustments and to control their own finances. The emotional wear and tear is particularly evident in a population that includes so many people on fixed incomes.
While we understood that the government’s initial economic response was to quickly address income replacement, it took several weeks to announce a financial relief program for seniors. OAS and GIS recipients were, indeed, relieved to learn of the one-time top-up, but many expressed that it should be recurring, considering that seniors will be the last to be released from physical distancing restrictions.
One final point on this topic: We have indeed been flooded with calls and emails from members expressing frustration with the length of time it is taking to deliver on both pre-election promises, as well as the one-time increase to OAS and GIS. Announcements claimed that these funds were to be expedited, but in actuality, the funds have been slow to disburse compared to other programs, and it will take a full eight weeks from announcement to disbursement. In contrast, the student CESB program took only 24 days from announcement to application, and payments arrived in student accounts in three short business days.
I would also like to speak to a second, more urgent piece around how we provide care for older adults, particularly in congregate settings like long-term care.
By now, we have all seen the military reports from Ontario and Quebec nursing homes, which detailed a blatant disregard for the human condition, including, “Aggressiveness when changing incontinence pads, forceful feeding by staff causing choking, patients observed crying for help with no response from staff, cockroaches, rotten food, patients left in soiled diapers. . .”
These findings are also consistent with stories we’ve heard from our own members in homes not inspected by the CAF. We’ve heard stories of residents going several weeks with only two meals per day and reports that quarantines were not effective or even acted upon, with both COVID negative and positive residents continuing to share rooms and bathrooms. One woman called to share that her brother was seen dressed in someone else’s clothing and had a full beard — an indication he’d not been shaved in weeks.
If COVID-19 has revealed anything, it has revealed the following: We warehouse frail and often very ill seniors in unsafe situations, which are underfunded, understaffed, and staff often have little or no certified training. We expect individuals and/or their families to pay a significant amount for what is really expected to be a privilege to be in those facilities.
It is unconscionable that of over 7,800 deaths in Canada so far from COVID-19, 82% were from a population whom we are duty-bound to protect, and we failed. While this is not the responsibility of the federal government alone, it is the duty of the federal government to make sure it doesn’t happen again.
It is clear now that we did not have a real plan in place for seniors in long-term care in this pandemic in spite of having advance warning from other countries and seeing previous crises of similar scale like SARS and MERS.
I’d like to conclude with just one final thought. As we reflect on Canada’s response to COVID-19, we must also look ahead. In the next 15 years, the number of people over 75 will increase by more than 80%, to 5.5 million.
If long-term care is broken today, what will it look like tomorrow? We must invest in innovative solutions to modernize long-term institutional care and, just as important, find ways to support home care for those who are able to age comfortably at home, in order to meet the needs of an aging population.
We can, and we must, do better. Thank you.
The Chair: Thank you.
Laura Tamblyn Watts, President and Chief Executive Officer, CanAge: Good afternoon, senators. Thank you for the opportunity to address you today on the pressing issues facing Canadian seniors and those most pressing during the COVID-19 pandemic.
My name is Laura Tamblyn Watts and I am president and CEO of CanAge. CanAge is Canada’s national seniors’ advocacy organization. We are a non-partisan, federally incorporated not-for-profit that works to bring forth the voice of Canadian seniors and works across the country in a pan-Canadian and expert way, to work collaboratively with stakeholders to advance the rights and well-being of Canadians as we age.
We work to support older Canadians to live vibrant and connected lives. In the time of COVID-19, however, this has been far from our reality. We will focus on three key areas and provide recommendations to the Senate committee in each category. The three substantive areas we propose to make our submissions are, first, elder abuse and neglect; second, long-term care reform; and third, social inclusion.
Many senators will know that one in five older Canadian adults will experience abuse and neglect. Physical, financial, emotional, sexual and institutional neglect are the most common forms. In fact, on Monday, we celebrate the 15th anniversary of the Canadian-founded World Elder Abuse Awareness Day, which is a United Nations recognized day. And I’m sorry to say that abuse and neglect in Canada has never been worse.
The one in five statistic is pre-COVID. Since mid-March, agencies that are responding to abuse and neglect across this country are experiencing what appears to be about a tenfold increase in calls. For example, Elder Abuse Prevention Ontario, a charitable not-for-profit organization that responds to elder abuse neglect issues in this province, used to get approximately 800 calls per month about abuse and neglect. Since mid-March, they receive about 800 calls every three days. This increase is also supported by evidence from police across the country, the Canadian Anti-Fraud Centre and organizations like CanAge. We are inundated daily with concerns about abuse and neglect, and not only about concerns in long-term care but overwhelmingly for the 92% of Canadian seniors who live in the community.
This government invested $50 million very early on, in March, to address the pressing issue of domestic violence at a time of self-isolation. And while the Minister for Seniors has a very specific mandate about addressing abuse and neglect in her mandate letter, almost nothing has been done in this regard. Our recommendations are as follows:
One, designate a similar amount of emergency funding to combat the spike in increased concern for elder abuse and neglect in the time of COVID, analogous to what was given to prevent and respond to domestic violence.
Two, as currently there is no easy place to report elder abuse and neglect, fund a national elder abuse and neglect toll-free line — it’s just a phone line — which would be answered by staff who could then support Canadians by connecting them to local responders. The national anti-fraud centre line could be expanded by its mandate, or a separate line could be added very easily.
The second substantive area I would like to echo from my colleague is long-term care, and we would like to provide some practical solutions. The national tragedy which has been unfolding in our long-term care system can no longer be denied, although the issues are well-known. And of course, we are challenged by our division of powers. We offer the following three recommendations:
First, establish a federal-provincial-territorial, national long-term care working group that will include seniors and caregiver organizations. Often, older adults and caregivers are excluded from conversations that are in fact about them.
Two, study the Australian model of long-term care. They also have a similar federation and a division between their federal and state authorities, yet the Australian model has worked extremely well during this time of COVID-19. We should consider creating a national, arm’s-length Canadian long-term care home regulator, analogous to the Australian version, which could oversee licensing, quality standards, and has the ability to suspend licences and issue fines. This model would be agreed upon across the federal-provincial-territorial bodies and would be attached to our third recommendation: to allow for federal transfers of designated funds, in coordination with the national regulator, to the provinces for delivery of services. Those funds would be designated and have reporting structures attached to them so they would not end up in general treasury.
My third substantive area is around social inclusion. We are now sharing the same experience for the first time. Indeed, everyone over the age of 70 has been put in self-isolation. We have all felt some impact of social exclusion and how hard that is, but it’s worse for many older people. In 2018, a Statistics Canada report found that 20% of Canadian seniors did not have a single person to reach out to — not one. And we know that social exclusion is a concern for both physical and mental well-being. Also, the World Health Organization found that ageism is the most prevalent form of discrimination in the world, and we would like to recommend three key substantive issues to address these.
First, this government give intentional focus on community-based programming for seniors as a way to provide upstream supports and services to older Canadians. We know that connecting people in their community is a way to encourage social inclusion and prevent loneliness.
Two, create an office of the seniors’ advocate at the federal level to consistently address issues faced by older people as our population ages, and to bring the federal government in line with the majority of provinces in this country, as well as comparator countries.
And three, embrace a national initiative for combatting ageism.
We would like to touch briefly on three other pieces as I conclude. We are pinning our hopes on a national COVID vaccine, but we need to reform our vaccine development, purchasing, distribution and approval systems in order to make sure that we get a COVID vaccine out, prioritizing people who need it most. That means we also need to make sure we get the vaccines already functional that we are not distributing equally, including our high-dose flu, shingles and pneumonia vaccines.
We need to fix the system and make sure the vaccines we already have get distributed to key people, safe and well. We also agree that we need to get rid of mandatory RRIF withdrawals, and we recommend that we prevent greater negative impact for people who have to cash in RRSPs early because of COVID-19 economic concerns, by giving tax relief.
And last, we know that insolvencies and bankruptcies are on the horizon, and we would like to suggest to this committee that we prioritize pension protection for pensioners who have paid in their whole lives, so that we don’t lose the pensions and create greater poverty for seniors. Thank you.
Dr. Roger Wong, Clinical Professor of Geriatric Medicine, Department of Medicine, University of British Columbia, as an individual: Good afternoon, Madam Chair, and good afternoon, senators. Thank you for inviting me to the Standing Senate Committee on Social Affairs, Science and Technology.
I am honoured to speak with you regarding the protection and support of older Canadians amid the COVID-19 pandemic.
I am the executive associate dean in the Faculty of Medicine at the University of British Columbia, a geriatrics doctor, a clinical professor of geriatric medicine, as well as the 13th president of the Canadian Geriatrics Society.
Older adults are vulnerable to developing infections, including COVID-19. In part, that is because the immune system function in seniors may not be working as well. Many seniors live with long-standing health conditions such as diabetes, heart disease and lung disease.
As I wrote in my recent op-ed in The Globe and Mail, in many ways, our life’s work is culminating now in real time with each new development of COVID-19. Everyone wants to help. From front-line health care workers, who risk infection caring for those in need, including our seniors, to our neighbours and friends who leave groceries on front steps, ringing the doorbell right before they walk away. That collective desire to help to alleviate stress and suffering is one reason to remain hopeful, even as the number of COVID cases and tragic deaths increase.
I believe that all of us must do everything we can to protect and support our most vulnerable, including older adults.
Government agencies, including Health Canada and the Public Health Agency of Canada, have repeatedly reminded us of the importance of physical distancing, such as visiting our older loved ones virtually, rather than in person during the pandemic. However, we must remember that physical distancing does not mean social isolation. We know that loneliness and isolation can have negative impacts on physical and mental health, especially for seniors.
We must interact with older adults regularly, perhaps at this point through computer technology, social media, or if they prefer, by telephone. The accessibility of virtual technology may present barriers for some older Canadians, such as those who reside in rural or remote geographic areas, because they may have limited internet network coverage, or those who cannot afford it due to socio-economic reasons.
For seniors, connecting with compassion is important at all times, but especially during the pandemic. It is even more crucial for those who live with dementia, such as Alzheimer’s disease, because they may not understand what is going on. It is imperative that we increase the support for family caregivers and people who have dementia. I believe the Government of Canada is well positioned to champion the development of national best practices in supporting vulnerable seniors and their households, and to provide the resources for sustainable implementation.
This includes how Canada responds to the situation unfolding, in particular, at long-term care homes across the country. Older adults living in long-term care are highly vulnerable, relatively voiceless and without strong advocacy.
As of June 1 of this year, 6,007 Canadians residing in long-term care homes have died as a result of COVID-19, accounting for 82% of the 7,326 deaths reported here in Canada.
We must protect seniors where they live. Recently, the Chief Science Advisor of Canada convened a task force on long-term care, of which I am a member. Our government and health leaders must set the tone now by emphasizing a humanistic and compassionate approach to ensure that we fully address the ongoing needs of older adults in long-term care. Practically, this would mean dedicating societal priority, strategic attention and appropriate resources towards long-term care in Canada, such as through the creation of a Canada long-term care strategy that is informed by continuous learning from a national health data system.
We all have observed that COVID-19 has unmasked a fragmented continuum of seniors’ care in Canada, which is compounded by the heterogeneous operational models involved in public and private sectors, making it difficult to provide older Canadians with equal and consistent access to the necessary services based on their care needs as they age. We must take action now to identify immediate and ongoing solutions to resolve these national systemic issues. This should, for instance, include a national dialogue to explore how long-term care can be covered within the Canada Health Act.
COVID-19 has also revealed that long-term care sector resources are not at the levels needed to enable the quality of health and social care required, both at regular times and at times of a pandemic. We must develop national strategies to ensure adequate and sustainable staffing in long-term care so that workers with the right mix of skills can focus working at a single site without crossing sites at a given time. This would require national guidelines to address compensation inequity and sick leave policies that allow symptomatic staff to stay home.
Nationally accredited and continuous professional development programs are also needed to refresh long-term care skills, including infection prevention and control. In addition, I believe that a national emphasis in Canada on increased health professional training — especially in areas of geriatric medicine, geriatric psychiatry, care of the elderly, palliative care, family medicine, internal medicine, and psychiatry — preferably done in a collaborative learning format, can bridge the existing service gaps across Canada in delivering the best possible care for older adults.
To mitigate the challenges in the long-term-care sector, I believe that Canada should also implement a number of additional systemic solutions, including the national supply-chain management of personal protective equipment, or PPE, with priority provision to the long-term care sector, as well as deploying a national approach to fast track COVID-19 diagnostic testing for both seniors and staff in long-term care.
I’m trying to share with you today that all of us must take collective action now in addressing these cross-sectorial and systemic issues affecting older adults, which are unmasked by COVID-19. I believe that a coordinated and strategic approach, led by the Government of Canada and with full engagement of the provinces and territories, can make the much-needed difference for older Canadians and their loved ones. The time to act is now. Thank you very much.
The Chair: Thank you, Dr. Wong. We will proceed with questions from senators. Just a quick reminder to use the raise-hand function in Zoom if you want to ask a question or answer a question. When you do ask a question, please identify whom you wish to answer the question.
Senator Poirier: Thank you to the witnesses for being here and for your excellent presentations.
My first question is for the Canadian Association of Retired Persons, Ms. Lennox. I come from a rural area in New Brunswick. Seniors in the rural areas have been hit differently than many seniors in urban areas, specifically in everyday things that we don’t sometimes think about, for example, banking needs. Right now, our local banks have closed down because of COVID-19. For seniors, a lot of them over 80 years old, we are realizing they don’t use credit cards or debit. They’re still into the cash system. Going to a debit machine is not something they would do; nor is online banking.
Quite a few who reached out to me were surprised by the lack of services. They would have to drive over an hour to access services in the city. There is no bus or taxi service in rural New Brunswick. There are many issues happening there, different than if you were living in the city of Ottawa, where there would be multiple branches and things like that.
In your opinion, what actions, if any, can the federal government take to better support seniors in rural and remote areas, who don’t have access to services in the same way as others?
Ms. Lennox: Thank you for your question. I think I caught part of it.
We have chapters in Nova Scotia and New Brunswick, and we’ve heard similar concerns raised. Part of the issue is that there aren’t a lot of services available for people in rural communities. This goes back to what I was talking about in my introduction around an increase in the cost of living associated with COVID, and a number of programs that have shut down as a result of COVID-19. These are things that have had a direct impact on seniors.
I think there’s a misconception that seniors haven’t been impacted by COVID-19. In fact, many have been directly impacted. As you say, many banks and tax preparation services have shut down, which people relied on, particularly at this time. Seniors have lost access to a number of food banks as well. It has been a real struggle. We’ve certainly heard similar stories from our own members, that they’ve struggled.
Senator Poirier: In your opinion, has the government put in place the needed programs and financial aid to ensure that our low-income seniors, in both remote and urban areas, are protected from the second wave that everybody is saying will probably come?
Ms. Lennox: No. I think the second wave is a real concern for a lot of our members. Many are concerned that, with the second wave, we could see a number of programs similarly either not reopen or shut down again.
Many of our members were welcoming of the OAS and GIS top-up but felt it should be recurring. Many felt they would be the last to be released from physical distancing restrictions. So I think more can certainly be done.
Senator Poirier: Do you feel that the government should have a little bit more say in what should and should not be shut down, or what is essential and not essential?
Ms. Lennox: I think the government has a role to play in working collaboratively with the provinces to come to that determination.
Senator Poirier: I have a question for CanAge. In a recent article you said that seniors are facing financial insecurity. The government’s response is a one-time payment, and two months after its announcement, people are still waiting for it. The Prime Minister said the economy is frozen, yet he moves ever so slowly to help seniors in this frozen economy that he’s talking about.
After the one-time payment that is given in July, do you feel that low-income seniors can continue to survive with no further financial aid from the federal government? My question is to CanAge, Ms. Tamblyn Watts.
Ms. Tamblyn Watts: The answer is no, older adults are not adequately supported. A one-time payment is welcome, but they’ve been waiting for an OAS top-up as well, and that has not yet been coming. We know that older people, and particularly rural older people, who may already be experiencing intersectional poverty and marginalization, are the hardest hit. The second wave is not going to come as a theory; it is already going to be a key issue.
I wonder if I could follow up on the question you asked my colleague. In the area of rural banking, we need to explore the notions of open banking; banking through Canada Post; increased use of direct deposits and automatic payments; and, above all, as we move forward in the next two years, to explore automatic tax implications. We know that older people are having problems preparing their taxes, yet tax preparation is the gateway to benefits. We should be looking to align with other OECD countries by having an opt-out of automatic tax preparation as opposed to putting the onus on people who may be increasingly in need and marginalized to do their own taxes.
Senator Poirier: Thank you very much.
Senator Griffin: Thank you to the panellists for your presentations. I have one question for Dr. Wong.
As you know, the job of our committee is to review the government’s response to the COVID-19 crisis. What do you think the government has done well in this response, and what has it not done well?
Dr. Wong: Thank you, Senator Griffin, for the question. This is a very strange period of time. This is an unprecedented time facing not only Canada but many countries and jurisdictions in the world.
In terms of the reaction and the responses of the Government of Canada so far, in particular when it comes to seniors, I would say there are a number of areas that are quite well done in terms of trying to share relevant public health information as it applies to seniors. We heard about the importance of physical distancing, for example. What does that mean for seniors, their families and loved ones? I think the work done through public health — namely, through Health Canada and the Public Health Agency of Canada — has gone quite well in terms of information sharing. Clearly, when we look at some of the most vulnerable seniors, including those who reside in long-term care, we see there are many areas that can present further opportunity for improvement, hence the reason for my commentary.
Two categories of issues have been unmasked by COVID-19. One category requires immediate action and response when it comes to physically protecting seniors, including those in long-term care, but also addressing their mental health needs — my comment that physical distancing does not mean social isolation.
There is a second category of deeper-rooted systemic issues. These are issues that have been around for some time, including, for example, regulatory mechanisms and standard-setting for long-term care homes. Even though there is a division of labour between the federal, provincial and territorial governments, there is an opportunity for the federal government, along with its leadership, to set benchmarks. This will be crucial.
There are some real nuggets and areas where the Government of Canada can devote priority attention and resources to address the issue. I think the key, the root of all this, is priority setting. For seniors and older adults and their loved ones, if the priority is indeed to focus on those areas, then the rest of the actions and resources that will ensure implementation is sustainable will come. It all comes from the priority setting.
Senator Griffin: Are you saying that the government has not done a good job in setting priorities, or that you simply want it to be better?
Dr. Wong: I would say that priority setting is an evolving concept. During regular times, when we have said that we view seniors’ care as an important priority, that’s good. It’s always good.
But when it comes to a crisis such as during COVID-19, and with the observations, in terms of some of the opportunities that we haven’t realized, it tells us that we need to re-prioritize and put even more emphasis on what we say we’re going to do.
Senator Griffin: Thank you.
Senator Forest-Niesing: Thanks to the witnesses for your testimony and for enlightening us on these issues that concern us so much.
My question is complementary to Senator Griffin’s and is specifically focused on what Dr. Wong identified as one of the many priorities, the attention that needs to be paid to broadening mental health services.
Before the crisis, but especially since the beginning of the pandemic, it was and is quite understandable to anticipate a certain level of anxiety among the elderly due to isolation and the consequences it has on mental health, whether we are talking about seniors living in long-term care facilities or those living in communities.
Can you tell us how much priority should be given to seniors’ mental health needs? I will ask Dr. Wong first, but I would also like to hear from our other witnesses.
Dr. Wong: Thank you, senator. This is a question which is very close and dear to my heart. I would try to be brief in my answer, but I want to share with senators an actual example that is happening here in British Columbia.
In order to reach out to seniors living in long-term care and to combat loneliness and social isolation during COVID-19, because of the result of physical distancing, we have launched an initiative, an innovation, called Connecting with Compassion. It is part of the Edwin S.H. Leong Healthy Aging Program at UBC, whereby we use computer tablet devices reaching out to seniors living in long-term care homes and connecting them with their loved ones, but more importantly, providing tailored programming of two types. The first type is connecting them with music. School of Music students at UBC have performed for free for these seniors, and we actually use these musical pieces as a conduit to connecting the seniors with their loved ones and so on.
We also recognize that many seniors don’t have families or loved ones, so they are alone, which is why we launched a second component, which is called the “Big Grandkids” program, similar to Big Sisters and Big Brothers, connecting seniors who do not have families and loved ones with students at the university. We have already launched this program in a couple of care homes in British Columbia. This is a province-wide initiative, and it provides an excellent opportunity to address the mental health issues, not just for seniors, but also for students who are affected as a result of COVID-19.
I think that is an exemplar of what I think can be scaled up nationally across Canada, and it is deeply rooted with grassroots movements of local communities to make it sustainable. Thank you.
Senator Forest-Niesing: Those are wonderful initiatives.
The Chair: Ms. Lennox, did you want to comment on that, and Ms. Tamblyn Watts?
Ms. Lennox: We’ve heard about wonderful programs similar to what Dr. Wong has mentioned. Another thing that we’ve heard is a lot of programs leverage the use of animals, through video technology, to engage with seniors in long-term care homes.
It’s a problem. I can speak personally. I know people who have feared for the mental health of their loved one in a facility and haven’t been able to reach them or have access to them. Others have taken them out of the homes as a result, so I do think more needs to be done in the way of leveraging technology to continue, particularly during a pandemic.
One thing that many provinces haven’t done is allowed family caregivers to go into long-term care homes to meet with their family. At a time when we had so many care workers going in and out of these homes — and I know now that they’re restricted — when family members were being isolated at home and were being told they couldn’t go in to see their family member or loved one, it had an impact upon them. I would encourage provinces to lift that restriction so family caregivers can get into these homes and see their family and loved ones.
Ms. Tamblyn Watts: Thank you very much. At CanAge we’ve been creating programs and connecting with some of the work at UBC, and CanAge has partnered with United Way for the Healthy Aging program, and delivering services to the program called Better at Home. That’s been a priority to ensure that we include social inclusion and mental well-being.
CanAge has also partnered with the University of Toronto and the National Initiative for Care of the Elderly to create a program entirely staffed by masters of social work students and practising social workers, to allow not just for people to call in for mental health checks and well-being checks at a more advanced level than just friendly neighbourhood programs, but it also provides a horizontal strategy for other programs that are doing friendly visitor checks, but have identified that mental health and well-being are real concerns. This is called the TALK 2 NICE program, and I am happy to provide the senators with more information on the program that we’ve created.
We’ve also worked with universities to change their advancement programs where they’re typically asking for money and support, and in fact, in wrapping community around that. In that program Queen’s University partnered with CanAge to do friendly visits and social isolation checks as well as alumni development, two to three times a week. This is a trusted resource because they’re already part of a community — again, working to see that we’ve identified mental health and well-being red flags, and then they would be transferred over to that more advanced TALK 2 NICE area.
What I would just like to partner with and focus on here is why we said social inclusion is such a key priority, and why we need to have a national seniors’ advocate, and why our investments need to happen at the community level. We know that communities connect with seniors, and seniors connect with communities, and what we need to see from the government is investment to support that.
Senator Forest-Niesing: Thank you for all that wonderful work.
Has my time run out?
The Chair: Unfortunately, it has.
Senator Forest-Niesing: In that case, I will be back in the second round of questions. Thank you.
Senator Moodie: Thank you to our witnesses today. My questions centre around data.
All of you have made many recommendations that could be solutions to counter the many failings that our seniors have lived during this pandemic. My focus is on data and on the forgotten seniors who are vulnerable amongst us.
Dr. Wong, I’d like to start with you. Could you comment on the impact on seniors who live in poverty, who are disabled, who are women, who are black here in Canada — who may not really have the luxury of worrying about their portfolios or cashing in their RRSPs, but whose lives have been devastated by COVID-19? Has the government been collecting this important data, and was it made available to you in your work with the task force? That is the first question directed mainly to Dr. Wong.
Second, could you comment on the overrepresented number of racialized women working as PSWs? Do we know how many of these women — who are black or non-white workers — have died while caring for others during this pandemic?
Dr. Wong: Thank you, senator. Perhaps I can begin by saying that I am completely in agreement with you that we must learn from data. One of the difficulties here, when we look at the pan-Canadian setting, is that there is a very heterogeneous availability of data.
Even when data is collected, whether that is made available to the various teams, whether in government or outside of government, to have access in a timely way. A real-time access to data is essential, in particular when facing something like COVID-19, which is so rapidly evolving. That is not the current status in Canada. That is something we must learn from and go from here. We need to address systemic issues which are based on learning from data, because otherwise it becomes opinions. Opinions are important but opinions must also be validated and supported by data, which allows opportunity for continuous quality improvements. If your original assumptions or hypotheses need to be fine-tuned, then data will help you drive that.
That said, to answer your question, within the task force there is some data available. I underline the word some, but there clearly can be more that should be available in addressing specific needs. I entirely agree that COVID-19 has unmasked a number of systemic challenges, including those seniors who are living either in poverty or who are disadvantaged, therefore having other social determinants of health rendering them to be more vulnerable. In fully addressing the needs of all seniors, we must remember not only the medical pieces of determinants of health, but the social determinants of health.
I also agree that the same argument would apply to supporting our long-term care staff and workers in the country. Let’s face it, in many of the conversations I had with colleagues who work either as PSWs or as other staff in long-term care homes, they are running off their feet. Everybody is trying to do everything they can, but somehow their hands are tied because of some of these systemic issues. Henceforth in my statement, I made reference to having national strategies and approaches that would address a continuous and steady, sustainable supply of health human resources, including our front-line workers to long-term care.
Senator Moodie: Thank you, Dr. Wong. I want to allow Ms. Tamblyn Watts and Ms. Lennox the chance to give us a sense of the profile of the membership of their organizations, in terms of disabled women and black individuals. Give us a sense of who you represent, please.
Ms. Lennox: While the majority of our members skew more educated and more affluent, I would say in terms of actual members that are part of a minority group, it would probably be a lot smaller than our own demographic, in the membership that CARP has.
Having said that, while the actual membership base of CARP tends to skew more affluent and more educated, we consistently hear from our members that they would like us to represent the interests of all Canadians across the country. For example, this month we’re actually launching a series on inclusion for Pride Month and for some of the demonstrations we’ve seen occur in the United States as well. We will be rolling that out on a weekly basis.
Ms. Tamblyn Watts: Thank you for the question, senator. CanAge works on a coalition basis. So we have a very intersectional approach and we proactively work in cooperation and coalition with groups that are historically marginalized.
On top of that, I also wanted to share with you a bit about the question you posed about who are the personal support workers and what data do we have about that.
Senator, aging and care of aging is gendered, and care of aging is especially racialized. I’ll just use some data from a province. I happen to be in Ontario at the moment. Personal support workers are about 92% women, and a significant over-representation of poor women who are recent immigrants in precarious work, who also have immigration status concerns and who work to support multigenerational families.
Senator, our personal support workers in many provinces are significantly underpaid and their work is also causing further poverty because they’re having to make choices about care and care giving. So these are systemic issues that CanAge is seized on and we work very strongly in a coalition basis with our marginalized communities. Thank you for the question.
Senator Moodie: Thank you.
Senator Seidman: Thank you very much for your contribution to our study of the impact of COVID-19.
I can’t resist continuing the conversation about data. I think I’m going to go back to Dr. Wong, if I may.
In fact, in your presentation, you talked about systemic issues and you did say we need a national health data system. So I’d like to explore that a little more of that with you if I can. At the end of your response to Senator Moodie, you were beginning to talk about national standards as well.
We have heard a lot about LTC data management systems and the importance of having a national management system. So if you could help us understand. Obviously these are things that have to be considered in a report about the government’s response to COVID-19 and what recommendations we can make going forward. So I would be really happy to hear what you could tell us further about these two issues. Thank you.
Dr. Wong: Thank you, senator. What I’m going to say in terms of this reference to a national health data system, it is an opportunity for us to put in a way that the data can actually drive some of the decision-making, rather than a simple tick box exercise. I’m not trying to be too negative about current systems that might be in place which involve a lot of quality assurance, but when it comes to quality improvements, opportunities must arise from this data collection that allows for improvement more than a little tick box.
Let me share with you some on-the-ground experience when you talk to practitioners and staff in long-term care, for example, that being a significant pressure point in mastering COVID-19. The notion of someone coming in with a clipboard and a little tick box sheet of paper can be very overwhelming and scary for staff who are already working and running off their feet, and say, what do you mean I need to meet these 10 little extra boxes? That is not the system that I’m making reference to.
When I talk about a national health data system, I’m talking about, for example, things that are already happening in Europe. So, for example, when I look at Britain, and I look at the National Health Service in the U.K., it has some pressure points. I’m not trying to say we want to replicate those pressure points, but one of the new directions when it comes to big data — and we talk about data size and data analytics — how do you capture real-time data that is going to be available to, not just practitioners, but also folks who are helping to make decisions when it comes to resource allocation, policy devision and so on, so that they actually have this data to work as a premise. That currently is not available. Even when data is collected, it is stored magically in this big black box that somehow is almost next to impossible for people to have access in a ready way.
Senator Seidman: You also talked about national standards. Again, this is something that requires federal government regulation or some such thing. If you could please elaborate on that, that would be good. Thank you.
Dr. Wong: Thank you, Senator Seidman. Full disclosure, I’m a medical and health educator. In the UBC medical school, I am the senior education dean. The way I look at it is, it would be nice and important for our federal government to take on a leadership position at a national level to set the benchmarking. The word accreditation comes to mind; that is about setting those standards nationally so that it can be implemented at the provincial and territorial level. There is a precedent in doing this. This is exactly how most, if not all of the health professional programs, training programs work in Canada. There is a national accreditation body setting the standards, and then individual provinces, territories, schools, colleges, etc., implement, and is a regular exercise of continuous quality improvement. That is the analogy that I would use, and is what we need for long-term care.
Senator Seidman: That would be right across the board for all the particular classifications, positions, a lot of descriptions of different kinds of jobs in long-term care. So you’re saying right across the board?
Dr. Wong: Correct. To expand on that answer, recognizing that heterogeneity in the public-private sector involvement in the country, these standards would have to apply across the board because otherwise there’s a risk of creating a second-class or third-class type of arrangement.
Senator Seidman: The real question I wanted to ask Dr. Wong has to do with this expert task force on long-term care. When I asked him this morning, Dr. Réjean Hébert said he too has been on this task force but there has been very little public information available on it. I’m wondering if you can help us understand the official mandate, who is part of it, what is the time frame and when do you hope to finish your report?
Dr. Wong: The task force of the Government of Canada is convened by the Chief Science Advisor, Dr. Mona Nemer, from Ottawa and it involves an expert panel from across the country. Most of the initial work has been completed. We have submitted our report to the government, and my understanding is it’s sitting within the federal government. We clearly agree that key messaging from the reports should be shared and communicated effectively. We are currently waiting for the government to take the next steps.
Senator Seidman: Thank you very much. I think my time is up.
The Chair: Yes. Thank you for these questions and answers.
Senator Mégie: My question is for all three guests. COVID-19 is said to have had a major impact on CHSLDs, that is, long-term care centres. This morning, the committee heard from a guest who strongly suggested that every effort be made to promote home care through a long-term care insurance program. What is your position on prioritizing home care? I would like to hear the views of all three guests on it.
Ms. Tamblyn Watts: Thank you for the question, senator. I can’t agree enough; 92% of all Canadian seniors will always live in the community with 8% in long-term care settings. We know that older people wish to live and age in place, and we know a focus on long-term care strategy must take a systems approach. That means to make sure that we are providing emotion-focused, systemic and quality care in all environments, and home care is a key priority to that. I know that Dr. Wong is smiling because we’ve had many conversations about that before, haven’t we, Dr. Wong?
When we think about it, we must think from a health and housing continuum. Home care is significantly underfunded and not prioritized, and it needs to be part of a health and housing strategy.
The Chair: Thank you. Dr. Wong, do you want to continue?
Dr. Wong: Absolutely. Thank you very much, senator, for the question.
We need to be mindful that when we talk about providing the best possible care for seniors and older adults, it is a continuum of care, underlining the word continuum. Continuum means, on a population basis, there are individuals such as Ms. Tamblyn Watts just mentioned, who will be residing in a community, requiring home care all the way to requiring assisted living, supportive housing and long-term care.
We also have to remember that any individual older adult may at times be moving along the continuum, to requiring different needs.
The essential component in terms of providing the best possible care for that person at a given time is the direction we should take. Therefore, home care being part of the continuum clearly plays a very important role in supporting seniors. I do agree aging in place is not just a statement, but a best practice that we aim for.
Are we there yet in Canada? I would say we have seen good examples of best practices in some parts of the country but there’s a lot of variability. Therefore, we need to do a lot more work to ensure it is across the board.
The Chair: Ms. Lennox, do you have something to add to that?
Ms. Lennox: Thank you for your question. I couldn’t agree more with my colleagues. When we’ve surveyed our own members, an overwhelming majority believe they would like to live their days at home and don’t anticipate moving into a long-term care facility. When we think about the continuum of care, obviously home care has to be a big component of that.
Also when we surveyed our members, a quarter of them receiving home care services have actually had to purchase additional private home care services in order to actually meet their needs at home, to prevent moving into a congregate setting.
Denmark is often cited as an example of a model that works really well. Thirty years ago, it made significant investments in health care on the home care level and it hasn’t had to build a new conventional nursing home in 20 years. It is often cited as an example.
I know Ms. Tamblyn Watts also mentioned Australia as a model we should be looking to as well, but when we think about home care, one of the things we also need to think about, beyond investing, is modernizing our approach to home care, so at-home infusion services, pharmacy services, physicians, hearing, vision services, which today only happen in congregate settings. I think that would go a long way to meeting the needs of people aging in place.
Senator Mégie: I just have one request for Ms. Tamblyn Watts. Could she please send us her organization’s community program in writing?
The Chair: That is a good idea. We will make sure we follow up. Thank you very much in advance.
Ms. Tamblyn Watts: I’d be delighted to. Thank you, senator.
The Chair: Thank you. On my list for questions I have Senator Omidvar. Did you have a question?
Senator Omidvar: Yes, I did. I have a question for each of our panellists. Thank you so much for being with us today. My first question is for Ms. Lennox and it’s about money.
We generally recognize that Canada has a somewhat robust — it’s not perfect — social safety net for senior citizens made up of CPP, OAS, GIS, etc., but their own savings also play into their livelihoods.
I’d like to ask you what percentage of senior citizens have RRIFs. Would they recommend that senior citizens with RRIFs be able to withdraw funds based on their lives and their context and their need, as opposed to being mandated to doing so on an annual basis? Because the way I look at it, the taxman will come one way or another, either when you withdraw the funds or when the funds are inherited by someone else.
Ms. Lennox: Thank you for the question, senator. I’d have to get back to you on the percentage of seniors, rather, who own RRIFs. RRSPs convert to RRIFs at some point.
Senator Omidvar: Let’s just assume that all RRIFs are owned by senior citizens.
Ms. Lennox: I’ll have to get back to you on the percentage of Canadians. I will do that research unless Ms. Tamblyn Watts or Dr. Wong has that knowledge on hand.
What I can say is that when we have surveyed our members, an overwhelming majority have said that they would like to be in control of their retirement savings. That’s where RRIFs come in.
As you know, at age 71 an RRSP will convert to a RRIF unless you choose to withdraw all of your funds at that time, and within a year there’s a schedule you have to meet in order to start drawing down.
There is an option to transfer in kind. If you had $100,000 in mutual funds, you could move 5% over to a different investment vehicle. Many seniors are unaware that option is available to them, and there are often costs associated with transferring, and also with moving with dollars into an additional investment vehicle.
To answer your question bluntly, absolutely, the taxman will get their dollars eventually; it’s just a matter of time. That’s something that we’ve advocated for some time, the need to re-examine or, frankly, completely eliminate mandatory RRIF withdrawals, so seniors have complete control over their retirement savings, particularly during COVID-19 when we’ve seen so much volatility in the market. People don’t want to be rejigging their portfolios right now.
So while we welcomed the government’s response, early days, when they announced that they would reduce the minimum withdrawal rate by 25%, one, this wasn’t retroactive, so many people had already drawn down on their RRIFs in January or February; two, again, people would like to be in control of their retirement savings and would like to leave it in their RRIF so it can continue to ride through the pandemic.
Senator Omidvar: Thank you. My next question is for Ms. Tamblyn Watts. You referenced the work of elder abuse. I would like to ask you a question about the helping sector, the many not-for-profits and charities who serve senior citizens in these times of COVID and beyond. Just as elder abuse is seeing a real spike in services, I’m pretty sure others are too, by migrating to technology, etc., although I don’t know how you deliver Meals on Wheels. You probably can.
We also know that the sector has been horrendously impacted, with billions of dollars of losses of revenue and also minimum layoffs of roughly 118,000 people in the sector. Just when we need these organizations the most, they are suffering and in dire straits. Could you comment on the call for a stabilization fund by Imagine Canada to support organizations such as yours and others serving senior citizens, not just to survive the crisis but to participate in the recovery?
Ms. Tamblyn Watts: Thank you for the question, senator. The not-for-profit and charitable sector has never been needed as much as it is right now. As the senator has said, it is in crisis. Donations are down, volunteers are not allowed to participate in volunteering because, overwhelmingly, 72% of all volunteers in Canada are senior citizens themselves. So we’re seeing a huge systemic impact at the time we need the sector the most.
I do want to acknowledge the $350 million fund provided by this government, which was a needed step, but was divided into three cohort sectors. That was important to support Red Cross community funds and the United Way in supporting local at-home programs. Having said that, that does not help the general sector at a time they need most. CanAge is extremely supportive of the submissions of Imagine Canada and aligns with them in their request to assist the sector, because it is the amplifying and leverage that we know the Canadian government needs at this time.
Senator Omidvar: Thank you. If I have time, a quick question for Dr. Wong.
I would like you to comment on a news piece that has just come out on CBC that 83% of COVID-related deaths in long-term care homes happened in privately run long-term care homes, even though the rate of infection in private versus not-for-profit remains the same. What is your observation and advice to us on this report?
Dr. Wong: I think the long-term care sector, given its complexity of involving both the public and private sectors, requires immediate and tailored solutions in addressing, at a national level, that kind of benchmarking and standard-setting I spoke about earlier on.
These standards must be enacted upon in both the public and private sectors. I think what we’re seeing here is an unmasking of systemic issues. We have to remember that not all institutions that are run either publicly or privately are the same. There is a huge amount of heterogeneity. Therefore, in implementing the national standards that will hopefully be set by the Government of Canada, we also need to take the tailored approach from jurisdiction to jurisdiction in addressing the most impacted need right now, right away, to save and keep the well-being of older Canadians.
Senator Omidvar: Thank you all.
The Chair: Senator Kutcher, do you have a question?
Senator Kutcher: I have a whole bunch of questions, but I can only ask two.
Thank you very much to all the presenters. It’s wonderful to have you with us and to hear your words of wisdom.
The first question I’m going to ask on behalf of my friend and colleague, Senator Wanda Bernard. This is her question. I’m going to have to read it so I get it correct. Then I want to ask one of my own.
“In Nova Scotia, a high proportion of deaths have been African Nova Scotians at Northwood facility. In the GTA, there have been many deaths of racialized personal care staff. How are these issues being addressed specifically regarding the particular vulnerability of racialized Canadians in these facilities, for both residents and staff?”
Ms. Tamblyn Watts: Thank you for the question, senator. That is a near and dear question to my heart. As a proud member of Sandy Cove, Nova Scotia, a community of 67 people, the issue is incredibly important when we’re thinking about our rural and remote communities.
We don’t know what we don’t count. Overwhelmingly, the question of data has been throughout our discussions on long-term care. There has been not only just a lack of data about how racialized Canadians are affected by aging, as well as aging in long-term care, but aging generally. There has been an active resistance in some cases to collecting this needed data, which, in our respectful view at CanAge, senators, is part of the systemic problem we have on race in this country. So we are strongly advocating that we ensure we get the data collected that we need. We do know that overwhelmingly racialized Canadians are bearing the brunt of many of the effects of COVID-19, both in terms of seniors as well as the general population.
Senator Kutcher: Thank you for that.
Ms. Lennox quite correctly pointed out earlier that in Denmark and Canada there are vast differences in home care aspects of long-term care. In fact, the last I’ve seen is Denmark spends about 65% of its long-term care budget on home care; in Canada, it is roughly 13%. That’s a huge ideological difference and a huge difference in approach. However, there have been some attempts made recently to remedy that. In 2017 in the federal budget, $6 billion was allocated to home care.
What has been the return on that investment? Where did the money go and what did it achieve?
Ms. Lennox: The truth is, I don’t know. I don’t think it has necessarily gone to front-line care. It certainly doesn’t feel that way when so many are struggling to access home care right now.
I think we need to re-examine our funding model for long-term care, both institutional and long-term medical home care. One of the ways we do this is either bringing it under the Canada Health Act, as Dr. Wong mentioned, or to create a separate piece of legislation that would do a similar thing. It would really allow the federal government and the provinces to work together to come up with a proper funding structure to make sure we’re meeting the needs of people where they want to be met.
The Chair: Thank you. Did you have another question, Senator Kutcher? You have one minute.
Senator Kutcher: Time on my hands. In 2018, the Ontario Personal Support Workers Association published a study of 13,000 workers in long-term care facilities, and 79% of them said they were professionally unhappy. I’ve never seen those kinds of numbers in professional surveys. The top three things they said were short-staffed, inadequate pay and an unsafe work environment.
Three other studies done around that same time from the Canadian Federation of Nurses Unions, the Ontario Home Care Association and Manitoba Nurses Union all found the same thing. What the heck is going on?
The Chair: Who wants to answer that very good question?
Dr. Wong: I will try to clear up a very complex issue. That said, it does resonate with what I’m recommending in my opening statement, about the need of taking a national, holistic and systemic approach. When you’re talking about work satisfaction, workplace safety, the well-being of our staff and workers — whether it is personal support workers, nurses, doctors or any other in the long-term care sector — we must remember there are drivers such as compensation equity issues or lack thereof, sick leave policies and a whole host of what are considered non-traditional medical reasons contributing to that. That is why I think some of the findings that you have shared, senator, are already available to us in terms of knowing what is going on.
The question is, I don’t think we need to study this yet again. The question is, how do we identify solutions that are going to be sustainable in implementing, and also across the board, because we have seen a lot of health inequity across different communities in Canada.
An example we heard about, we alluded to again for seniors who live, for example, in areas of low socio-economic status, as well as seniors living in rural and remote Canada. I think we need to arrive at immediate and ongoing solutions.
The Chair: Thank you. Ms. Tamblyn Watts, I’ve seen you nodding. I have a feeling you want to add a few words to that so I’ll let you go.
Ms. Tamblyn Watts: Thank you very much, Madam Chair. Just very briefly, the recipe for why personal support workers are having these types of results is well known. Let me take a moment to say what they are anyway. They have quite low pay. In many cases they do not have guaranteed shifts. They have to travel between many locations in order to make ends meet. Pensions and benefits are not generally available to them. They get paid less money the farther they work from a hospital. They could get paid twice as much money in a hospital, often with better pensions and benefits. The moment that an acute care job comes up, long-term and home care personal support workers will leave that for the better job.
They do not have the requirements they’ve been asking for across this country, which is to establish their own professional college to allow for standards and practices in professional education. The personal support workers know what the recipe is.
The last piece I would add is, neither the built environment nor the dementia controls are available in many cases. As a result, personal support workers are often having to do a two-person transfer with only one person. They’re injuring themselves in the process and are often getting hit or assaulted because of behavioural responses, because we have a lack of behavioural response services in every long-term care home, which would be a key recommendation of CanAge.
The issues are well known, and I would also like to pull on the theme of the day: These are gendered issues and racialized issues.
The Chair: Thank you for that answer.
Senator Manning: Thank you to our witnesses. So many questions and so little time.
As a follow-up to Senator Kutcher, here in Newfoundland and Labrador there are some concerns with staffing shortages for personal support workers. Is this prevalent across the country? Are there any plans to try to address the shortage? I know you’ve hit on some of the issues why people may be moving away, but I want to see if the shortage is prevalent across the country.
My second question, to whoever may want to answer it: one of the largest issues we found during the COVID-19 experience with long-term care, which has been touched on several times today, is the fact that people couldn’t visit their loved ones even if they were dying, extremely sick, whatever the case may be. I’m just wondering about the possibility of a second wave of COVID-19 this fall. Are there any plans that anybody is aware of that are being put in place to address what I felt was a failure in the system, to have a loved one near someone when they’re passing away? Thank you.
The Chair: Who wants to take on that question first? Ms. Tamblyn Watts, I will volunteer you again.
Ms. Tamblyn Watts: Thank you. I will be brief because I’m sure my colleagues also have things to say. I know this is an area of great interest to Dr. Wong as well.
The staffing shortages question, senator, is profound and it’s across the country. It’s endemic. Part of the reasons we have staffing shortages is two-fold: The conditions are poor, and all the associated concerns I spoke with Senator Kutcher about make it a job that people don’t want to do. If they do get that job, it’s often one of the first jobs they do as a newcomer, and then will leave the minute something more stable, pays better with better shifts, is available.
We can solve some of the staffing shortages. I would indicate that Quebec has taken some dramatic steps in terms of trying to increase staffing by promising about a $50,000 wage and increases. What I would offer is, making conditions more palatable is one piece of it, but making sure they have the training, standards and skills is as important. To do that, we could be promoting across the sector — not just personal support workers, but across the aging sectors — educational sponsorships, grants and promotions. We need to develop an entire sector in geriatric care from personal support workers up to geriatricians like Dr. Wong.
To the question about a second wave, there’s no question; the answer is yes. We at CanAge are part of development with folks across the country on what is called an essential caregivers program. We know we will be living with COVID, not battling against COVID. There are best practices that we are espousing and working with key partners, and I’m happy to share that with senators as we’re developing that program. That provides personal protective equipment, extra training and supports, and allows at least one person to be designated an essential caregiver so we never, ever have this happen again.
Dr. Wong: Thank you very much. I just want to echo comments from Ms. Tamblyn Watts. In terms of answering Senator Manning’s question, yes, this is prevalent across the country. All the different jurisdictions that I’ve spoken to, they all echo. The public and private sectors both echo, so this is clearly prevalent, and for all the good reasons Laura has already alluded to, so I won’t repeat that.
To your second question, I will say that we have to remember, in Canada, each province and territory, in terms of public health advice, they provide guidance in terms of any visitation restriction when it comes to family members and loved ones going into long-term care. We must remind all of us, including our public health colleagues, that family — primary caregiving — is an essential activity. When we talk about having essential people going in, it is not limited to the workers and the staff and the doctors and nurses and the PSWs who go in. It includes families and loved ones, because all of us have been saddened when we hear stories during COVID-19 of someone dying alone, when a person living with Alzheimer’s disease or dementia is not able to feed because normally family members would be there feeding them. These are very disheartening lessons learned.
I think there is a solution. One of the solutions we have heard is, how do we support designated members of families and loved ones so they can still visit as an essential component of caregiving from the family, but in a safe and effective way?
Ms. Lennox: I really couldn’t agree more with my colleagues with respect to the role that caregivers play. I, myself, was a caregiver to two grandparents up until fairly recently. They were both in different respective long-term care facilities. I remember the joy that it brought them when I or my mother would go to visit them. It was so essential to their care and well-being.
I would also stress, too, that we need to remember 80% of people living in long-term care facilities have some form of cognitive impairment that plays a role in the impact on them of being isolated. When you lose that familiarity, it can be extremely devastating for someone, particularly someone who suffers from Alzheimer’s or dementia, and does not recognize who is surrounding them. They may only remember that one family member who comes to visit them every day.
Senator Dasko: Thank you to our witnesses today. It has been very interesting and very informative.
First a quick question to Ms. Lennox. You mentioned that your members were very unhappy about election promises not delivered. Could you tell us what those are that they’re unhappy about?
Ms. Lennox: Specifically it’s with respect to the election promise to increase OAS by 10% for people 75 and older, and the CPP survivor benefit by 25%. Many had hoped that they would see the benefit of that by now. It’s unclear whether the government will even move forward with it. In conversations I’ve had, I haven’t been told one way or another that they won’t be. While we appreciate that COVID-19 happened, many are still hoping that the government will move forward on that promise.
Senator Dasko: Yes. Thank you. Some of the other senators have asked some of the questions I was planning to ask. I hope you don’t mind, Dr. Wong, if I take yet another stab at this national data system, because I’m a data person and I’m going to keep drilling away at this. After both Senator Moodie and Senator Seidman asked you some questions, I will ask yet more.
As you know, the federal government has thrown money into CIHI and other efforts to try to do exactly what I believe is needed. We very much desire and need a data system that will collect data uniformly, and also will fill in the gaps of data. For example, the race-based measures are just one piece of it. We need to have socio-economic measures, etc.
Do you have any bright ideas, or whatever it may be, about how we can actually do this? As opposed to sort of expressing our great desire for this to happen. We’ve had the desire; we’ve had money thrown at it. Bad word, I know, but money has been allocated to these excellent efforts. Yet we seem to come up empty-handed years later.
Tell me what, if anything, can be done to make this happen.
Dr. Wong: Thank you, Senator Dasko. We need to understand some of the root causes of the phenomenon we are talking about now. Resources have been invested in data collection, through CIHI, for example, and yet we are saying that there are gaps in terms of data that we can learn from, in real time, in particular in addressing seniors’ health issues, including long-term care.
I think one of the root causes has to do with the focus or the priority or the attention when these data systems are being built. Historically, most if not all the data systems are built on an acute-care or hospital-medicine model. It is very heavily driven by metrics that actually may make sense in an acute-care setting, hospital setting, but doesn’t make much sense when it comes to the continuum of seniors’ care, such as in long-term care. That includes some of the examples that we speak about, whether it is on the socio-determinants of health or some other underlying socio-economic factors.
Mr. Charbonneau: Dr. Wong, could we get you to move closer to the mic and slow down for the interpretation.
Dr. Wong: Sure. When we talk about trying to have investment realized, when it comes to the data system, it will be important to have deliverables earmarked which are actually relevant to the long-term care system and to seniors’ health, not just a routine add-on to a system which historically has worked well, but mainly in an acute-care setting.
Senator Dasko: Yes. I wonder if you have any ideas of how we can actually get this to happen. These are data that we need. I agree and that’s exactly what I’m saying, but somehow we’ve not been able to move that into action. There are various reasons. The provinces perhaps don’t want to compare themselves to each other in terms of various metrics. There are silos. There are all kinds of motivations that they may have that will supersede the actual need for data. Can I conclude that we’re still going to be struggling with this?
Dr. Wong: The solution does not necessarily rest with the technological aspect alone in terms of data. I think it rests with the non-technological factors, such as what you’ve described. Very briefly, I can share that this is the same observation we see whenever we look at data in other sectors, be it in education or business and so on. We can actually try to collaborate and learn from the other sectors when we talk about health-specific data.
Senator Dasko: Yes, for sure. I don’t think it’s a technology problem. I agree it’s another problem. We’ll all see collectively what we can do to try to move that along.
Ms. Lennox and Ms. Tamblyn Watts, in terms of the priorities and the best way to deal with the issues we’ve discussed in terms of long-term care, a number of people are supporting what might be termed the model on which the Canada Health Act is based.
Ms. Tamblyn Watts, you mentioned Australia as perhaps a model that we might use. You also mentioned federal transfers plus regulation and how that might be important for dealing with the situation here.
Are you both actually calling for a model that is similar to the Canada Health Act, in which the federal government would put forward and give money, and then would require stringent standards and regulations to try to promote change in the long-term care system?
Dr. Wong, you’ve already talked about this, but I wanted to ask the other two witnesses their thoughts about that very specifically. Is this something we should do? Is this something that is a practical solution? Will this happen?
Ms. Lennox: So we have to go back and recall why we got into publicly funded health care to begin with. It’s to lower the barrier to access to health services that a Canadian needs, irrespective of their ability to pay for it.
The Canada Health Act is a great piece of legislation. It defines what is medically necessary as acute care provided in a hospital or care provided through physician-based services. But when you reflect on the kind of care that is being provided in long-term care homes, that isn’t the long-term care of the 1960s and 1970s housing model. People were able to drive up in their cars and get out with their suitcases and so on and so forth. Today the needs are very high. In so many ways, what is being provided in long-term care is really an extension of what is being provided in hospitals.
One of the ways you can do this is change what qualifies as medically necessary under the Canada Health Act to include the highest level of long-term institutional care in every province.
This is one way in which you can do that, and I would suggest that then the federal government would revisit its funding model to reflect this new additional responsibility under the Canada Health Act, and then what you could do is, the highest standards currently available across the country could form the minimum standard going forward.
The other tool you can use is to create a separate piece of legislation, similar to the Canada Health Act, but specific to long-term institutional care and long-term medical home care. Either way, the federal government would be in a position to work with provincial and territorial governments as well as other stakeholders, to work collaboratively on standards of care that Canadians can expect in these environments, and ultimately the goal is to raise standards radically in long-term care. I do believe fundamentally that is the way you do it.
Ms. Tamblyn Watts: Thank you for the question, senator. It is at the heart one of the most fundamental issues, and if we could go back in time and put it under the Canada Health Act, I would.
Now we are in a difficult position. We have about 50% of all long-term care home beds — although they are in the homes of people — provided by for-profit, and the funding models we have across the country put it into different pockets of funding, so the transfers go for certain services and then any additional monies that can be taken out in terms of dividend is squeezed in other ways.
We all know there are many places where long-term care is done well privately and where long-term care is done poorly in a not-for-profit system. We are well into it. We must ask the question and start the dialogue, but I am also a realist. With 50% of all long-term care home beds already currently done, we would have to think about nationalizing them, so we should start the conversation, we should look to the Australian model, which does have a mix. We should ensure that we have national standards and then that piece about the regulation, the licensing and the ability to fine. That, at least, can provide a measure of control to support federal transfers to the provinces and territories and to the long-term care beds.
It’s a difficult question to ask and functionally there is no magic wand that we can wave that will undo the system that we’ve created.
The Chair: Thank you for this.
Senator Munson: Thank you to the witnesses this afternoon. The first question is to Dr. Wong. I was struck, doctor, by three things that you said.
. . . Loneliness and isolation can have negative impacts on physical and mental health, especially for seniors.
For seniors, connecting with compassion is important at all times, but especially during the pandemic.
We must protect seniors where they live.
I’ve been talking with Senator Bovey about the Arctic and the North, and it struck me that we must protect seniors where they live. In this day and age, northern seniors, First Nations, Inuit and Innu — how can they be treated as families if they’re routinely sent away from their families now for end of life? The federal government has a responsibility at least in this area. We hear the arguments about federal-provincial jurisdictions. Well, here it’s federal. And you talked about connecting with compassion. How are we connecting with compassion? How can we do better for our residents in the North than we’ve done thus far?
Dr. Wong: This is a topic which is dear to my heart. When I talk about the potential negative impacts of social isolation and loneliness, there are actually good data to support the fact that the equivalent of that social isolation could be something like smoking 15 cigarettes a day, shaving off the life expectancy by an average of eight years. That comes from a comparison of different studies, so it’s a huge impact.
I totally agree that there are particular seniors who are more vulnerable. What you’re describing about those in the Arctic and the North is a good example of some of the underlying issues that occurred before COVID-19, but the impact is now exaggerated as a result of COVID-19. We all need to take a step towards connecting with a compassion approach. It is that driver, that root of compassion, trying to make sure that all decisions made are actually premised on that.
It does translate into different programming needs arising from the grassroots, from local communities, but also addressing systemic practices such as what you described before, when people are routinely being sent to different geographic areas, that creates extra barriers and difficulties. The question therefore becomes how can we reduce that risk by looking at practices that existed way before COVID-19?
Senator Munson: If home care is so important in the South it has to be equally important in the North. It may cost more but it doesn’t matter what it costs. It has to be what it is. We have to understand and respect that.
Dr. Wong: I totally agree. In fact, there is a precedent in terms of this particular line of reasoning. When we think about providing health and supportive care services to everybody, but including seniors in rural and remote Canada, we know the measurement is not only going to be the incremental costs of delivering, but it’s also the opportunity cost of having better health status, and therefore well-being of these seniors as a result of the services provided. Therefore, if we prioritize, and I hope we do, this is important for all seniors, no matter if they live in the North or the South, then the solutions and the programs and the offerings must follow accordingly.
Senator Munson: Thank you very much. I have one other question to the other two witnesses. I don’t know if this question was already asked of the Canadian Association for Long Term Care, but they had a point of view about relieving staffing shortages by setting up dedicated immigration streams for long-term workers. I want to get your point of view on how the government could establish a dedicated immigration stream and how much a stream would address the shortages.
Ms. Tamblyn Watts: Thank you for the question. We do have a shortage of workers and one of the ways we can address it is by looking at immigration in that priority area. Certainly, we have the ability to establish key expertise or priorities. We do that across immigration. Previously, for home care, we were supported by the live-in caregiver program many years ago. That went away under the Harper government. But we know where there is opportunity to support immigration and we can clearly elucidate where standards would be met, it is certainly an area that we can do more in that regard.
If I could also just jump on the question about Nunavut and the North. I’m happy to say that CanAge has been trying to partner with HelpAge Canada and the United Way and have a proposal into the federal government right now to address the issue of capacity building, both in Nunavut and Nunavik, and in some of the northern areas as well to develop a social services sector. We’re very hopeful that that proposal will get some attention.
I’m happy to provide that proposal to you, senator, if you would like to know more about capacity building in the home care sector in the North.
Senator Munson: I think we would all appreciate it very much.
Ms. Lennox: In relation to the immigration stream, it’s a good idea. It’s one part of the strategy to acquire talent, but ultimately we also need to be looking at ways in which we can retain talent in this space because we know there is such high turnover and such chronic shortages.
Senator Munson: Thank you very much.
Senator Bovey: Thank you, witnesses. I’d like to thank Senator Munson for raising the issues in the North and the discussion that has just happened. It is 40% of our land mass and I think so often those of us in the South tend to forget it.
I also want to thank Dr. Wong for his comments on the work with music and the arts regarding our seniors, and the intergenerational connections. I, indeed, have been involved in some of these music programs across the country. I actually started a public gallery in a hospital some 13 years ago, with the social determinants of health in mind.
As we talk about a continuum of care and the isolation from COVID-19, tell me how you think we can have the arts take a stronger place in solving some of the psychological loneliness, when we know the positive outcomes. What do we need to do? Because it’s very patchwork across the country right now.
Dr. Wong: Thank you, Senator Bovey. If I may start, and I invite my colleagues to chime in as well.
Absolutely essential. I think the fine arts is a nice conduit, a solution for us to try to engage seniors and their loved ones — not just during the pandemic but even when the pandemic moves into a “new normal” state. One thing for sure is that new normal state may not look like what it used to.
If the senators are interested, I’m happy to share. There’s a website story that UBC Faculty of Medicine published on how we deploy the fine arts, and talking about the music program Connecting with Compassion. I can share the link.
But there is another piece, namely, how do we get the information out to seniors so that they know this is available? This requires a communication strategy.
What I have also done, working with my colleagues at UBC Faculty of Medicine, is to develop an e-magazine called Pathways, which addresses seniors’ health issues. This includes resources available to seniors and their loved ones during COVID-19. Again, if senators are interested, I’m happy to send the link.
These resources have been deployed internationally. I’ve shared them with Australia, New Zealand, England, Ireland and many other jurisdictions around the world. Two solutions will be to have programmatic approaches to support and empower our musicians and other artists, but at the same time, get the information out to seniors and their families so that they know this is available.
The Chair: Thank you Dr. Wong. We would welcome you sending the links.
Briefly, Ms. Tamblyn Watts and Ms. Lennox.
Ms. Tamblyn Watts: Building on great work that Dr. Wong has indicated, I also think there is a pragmatic approach. We would like to see Heritage Canada put into some of its programming specific requirements for social inclusion of seniors as a lens for part of its funding. We feel this would be a practical way to ensure that the funded arts, which we must and should support, are accessible to all people.
Ms. Lennox: If I may comment briefly. This is not my area of expertise, so I defer to my two colleagues on this. However, if I can say from personal experience how important music is, particularly for people with cognitive impairment. I witnessed my grandmother decline, and she got to a point where she didn’t even recognize me, but she could continue to recite all the words of her favourite musicians. I would offer that as something that you should consider, because it’s incredibly important to people, particularly those in long-term care.
Senator Bovey: I would be interested in those studies. A number of us across the country are working really hard on this, and I think connecting the dots is important. If there is anything I can do, let me know.
Senator Pate: Thank you to all our witnesses, especially for the work you do on an ongoing basis. As a daughter of a mom who is in long-term care, whom I haven’t had an opportunity to see for three months, who is now on food supplements, who doesn’t get the music, who has infections, all the information you raised is important.
I want to come back to questions that were raised earlier and that you responded to. When asked about the story that came out today around the rate of deaths in for-profits, it struck me that my first paid work, at the age of 14, was working in a for-profit long-term care facility where there were clear demographics in terms of who was hired, who was there and who was privileged. I was hired at 14 and fired at 16, because then they had to pay minimum wage.
I’m curious about the statistics, if you have them, the disaggregated data — in terms of gender, race, ability and class, in terms of both the patients or residents of long-term care facilities — by for-profit and not-for-profit, as well as the workers. I know the workers in my mom’s home are wonderfully caring people. This is not in any way a criticism of them. However, many of them were working two or three jobs before the pandemic, and now only working one. They don’t have benefits. At one time they would have had 10 patients to take care of and now have 50.
I’m interested in those demographics, as well as whether there has been any particular focus on Call for Justice 7.4 of the Inquiry into Missing and Murdered Indigenous Women and Girls, which talked about the need for a specific focus for Indigenous folks on elder care and the like. I’m interested in those, and if you have any other key recommendations that you haven’t had an opportunity to share with us, if you could share those as well.
Ms. Tamblyn Watts: They’re not easy questions to answer, but I’m happy to have a go at some of them. In particular, there is a recent National Institute on Ageing study, which I can forward to the Senate, which does have good information about aspects of demography. You’re hearing me couch this term because I have not seen excellent studies done with disaggregated data in the way we would want, up to Campbell- or Cochrane-style evidence-based data. What I have seen are some studies that say some things, and more homogeneous data. For instance, some of the CIHR studies will break out a particular experience in British Columbia or in the North.
Senator, what you have captured is a key gap in our evidence. I would also suggest that part of what we need to do is make sure we fill these gaps. Aging studies are consistently underfunded in comparison to other areas of study. We have lots of data to show how underfunded our data analysis and studies across the social and health sciences are. I can provide you with some of that data, and I know Dr. Wong will have some data as well.
The other piece I wanted to share, in terms of the for-profit and not-for-profit sectors. I think this is a perfect example. It’s easy to say we know that lots of deaths occur in for-profits and fewer deaths occur in not-for-profits and therefore it must be the profit model. It may be the profit model, senator, but we need to have deeper information. How many people are staying in each room? Are they wards of four? Are the people in those homes getting the types of infectious disease control they need? What is the prevalence of donning and doffing in long-term care?
There are many more aspects other than the funding model. Having said that, it is critically important that we address where these shortages come from, because the single most difficult thing we’re seeing is staff cutting. We are also constantly hearing — and these are not recent experiences — about people hiding incontinence products in the ceiling, about people having to jimmy open locks on products for their own personal health and well-being that should be available to them. Anecdotally, we see that more in the for-profit homes than not-for-profit homes, but what you’re seeing is the lack of clear data that we have.
In terms of the North and the missing and murdered Indigenous women, I would offer that there is an opportunity to invest in home care and capacity support, but we have not done what we need to, senator.
Dr. Wong: If I may quickly add to the excellent response from Ms. Tamblyn Watts. Senator, your question illustrates that the gap in data that we’ve been talking about so much requires a deliberate way of doing the metrics that actually makes sense.
Your questions exemplify that we do not have that system in place now, that none of us can give you that bona fide data that you are looking for — that direct question that is done in a dedicated and thoughtful way. It’s not because of people not trying and not interested in doing it; it’s that the system is not built that way.
I think your question is an excellent example of where we need to drive this conversation. I remember the question from a couple of other senators about data. This is the example. You start from the answers, you try to look for mapping backwards. You try to figure out how to arrive at the answers.
Ms. Tamblyn Watts: Another reason why we need a federal seniors’ advocate, so we are constantly driving this conversation and it’s not left up to committees.
The Chair: Thank you very much. Ms. Lennox, if you have something to add, we can listen to you.
Ms. Lennox: I have seen numerous studies from around the world that compare for-profit to not-for-profit. Generally, what these studies show is there tends to be a trend that for-profit performs poorer, whether that’s higher rates of bed ulcers, higher hospitalization transfers, higher mortality rates, and now this study that came out here recently in Canada. You can see why that might be the case because of the increased pressure to turn a profit. One of the biggest budget line items is staffing, and in the absence of clear ratios or hours per resident, this is often the first thing that gets cut. Budgets for food are also pretty deplorable.
Having said that, there are examples of for-profit homes that have performed quite well. While the ownership model could be a challenge, a more fundamental challenge is around the underfunding of this system. I would just offer that.
The Chair: Thank you, Senator Pate, for raising those questions.
To our witnesses, please, if you have those studies and data, don’t hesitate to send them our way. We always appreciate it.
I want to thank our witnesses for the valuable time that they took to answer our questions. It is appreciated and very helpful to our study.
Honourable colleagues, I do need to keep you with me for a few more minutes. We have some housekeeping items for your consideration. As you may remember during the past meetings, some senators were not able to ask all their questions to the witnesses. Some of these questions were sent to the witnesses by the clerk. We have received some answers that were shared with all committee members.
I ask for a senator to move the following motion: That the document follow-up questions to the Canadian Support Workers Association and to Unifor be filed as an exhibit.
Senator Manning: So moved.
The Chair: Thank you. Senator Manning moves the motion.
Senator Moodie: I second that.
The Chair: All those in favour, please raise your hand in response and please keep your hand raised for 10 seconds.
All those opposed? All those who abstain? The motion is agreed.
Is it agreed, honourable senators, that we now proceed in camera to discuss future business? Again, all those in favour please raise your hand in response, and please keep your hand raised for 10 seconds. All those opposed? All those who abstain?
It is agreed. We will just wait a few minutes until the clerk advises that the committee is in camera.
Once again, many thanks to our witnesses. It is very much appreciated.