Proceedings of the Special Senate Committee on Aging
Issue 2 - Evidence, December 11, 2006
OTTAWA, Monday, December 11, 2006
The Special Senate Committee on Aging met this day at 12:37 p.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chairman) in the chair.
[English]
The Chairman: Good afternoon and welcome warmly to the meeting of the Special Senate Committee on Aging. This committee will examine the implications of an aging society in Canada. This afternoon, we have two panels. We will begin with the first, which is comprised of three groups: The Canadian Association for the Fifty-plus, CARP, represented by Judy Cutler, Director of Government Relations; the Royal Canadian Legion, with Jack Frost and Pierre Allard; and the International Federation on Ageing, represented by Jane Barratt.
We will begin with Ms. Cutler, who will present us with views from her organization.
Judy Cutler, Director of Government Relations, Canadian Association for the Fifty-plus, CARP: We have been waiting a long time for this committee and we are grateful for this opportunity. There is a curse that says, ``May you live in interesting times.'' Well, we are living in unprecedented times with the demographic shift that has been called an age quake at the UN. We at CARP prefer to describe it as age waves since the impact will evolve over time. Whatever we call it, the aging population will have a great impact on society because it is estimated that by 2030 one in four Canadians will be over 65 as the war babies and boomers join current seniors to create a strong cohort and a significant voice.
We have a choice as a society: Either to buy into the myths that seniors will drain the health and pension systems, for example, or to take advantage of the reality that seniors can contribute to society. Governments can play a positive role by developing policies and programs for an aging population by design rather than dealing with the fallout later by default and with crisis management. Clearly, mindsets have to be changed if we are to go beyond our obsession with defying aging and youth-oriented society. There is nothing wrong with looking and feeling good, but it should not preclude a dynamic and productive society for all ages. Social attitudes and marketing practices that are based on ageism create demographic silos where age groupings are pitted against each other in the workplace, in health care and in the media. This situation must change.
Moreover, the perspective that all members of any demographic sector are the same must change. In CARP's view, the way to make these changes happen is to give older Canadians the opportunities to be active, creative and thriving participants in society. What a mistake and waste to buy into ageist stereotypes and prejudices. For example, older people are not necessarily frail, slow or sick. Most are in good health and they are able to learn new information and skills, including technology.
In fact, seniors bring with them life experience, work expertise, commitment and passion for lifelong learning. This dynamic can and should be nurtured by making healthy and active living and aging a possibility for everyone. Most older Canadians look forward to retirement but there are those who want to, or need to, work. Matching their skills with the growing number of available jobs in a broad and creative manner is one way to go. I know from personal experience that skill sets in one field can be applied to another field. This application requires thinking outside the box rather than becoming weighed down with lower expectations on the part of employers and employees.
I will take the argument further. Some jobs can draw on non-professional experience such as the skills implicit in homemaking or a trade that has been a hobby, such as carpentry, cooking, artwork, et cetera. Of those who are frail, either physically or mentally, many are still capable of activity, even if at times limited. For example, they can work from home with modern means of technology and communication. If call centres for Canadian services can be located in India — and they are, as we know — then surely seniors can be meaningfully employed in their homes in a range of business sectors. There are still places in Canada where a big obstacle for seniors who want to or need to work is mandatory retirement, including in federally regulated industries. In our view, it is a human right for Canadians to have choice about when to retire based on ability and not on age.
Let me make it clear that the Canadian Association for the Fifty-plus is against both mandatory retirement and mandatory employment. We believe in the ``carrot'' of incentives rather than the ``stick'' of enforcement. When older workers are part of the labour force, the economy and government coffers benefit as well as the individual. Older workers not only pay taxes but also spend on goods and services, which stimulate productivity and economic growth. This point is an important justification not to clawback public pension income from those who are still working. We would like to see a band of supplementary income allowed for recipients of the Guaranteed Income Supplement without any negative impact on their GIS.
At CARP, we hear from many people for whom mandatory retirement means poverty, social isolation and the loss of meaningful activity, all of which can lead to physical and mental illnesses, thereby putting unnecessary stress on the health care system. The alternative contributes to independence and quality of life. However, even where mandatory retirement has ended, older workers still face the challenges of ageist employers who discriminate against those who are as young as 45 when it comes to hiring practices.
We recommend a federal-provincial-territorial national program to advance the value and inclusion of older workers in the workforce. Incentives are needed for employers to retain and hire older workers, such as funding or tax credits for training, retraining and upgrading. Access to Canada Pension Plan, CPP, at age 60 without having to leave work to apply is another example of what is needed to encourage older workers to stay in the workforce. On the other hand, we do not want to see the age of pension eligibility delayed for those who retire or those who continue to work. Let us not forget that we have a progressive tax system for those who receive both pension and salary.
There is also a new face of retirement. The traditional rocking chair image disappeared a while ago and those who retire tend to remain active physically, intellectually and spiritually. Opportunities for such activity must be more widely available, accessible and affordable, whether it is continuing education, exercise or even meditation.
Volunteerism is another avenue that is often undervalued as an important, relevant and significant activity. According to Statistics Canada, in 2003-04 an estimated 12 million Canadians provided volunteer services in a number of sectors to countless recipients. When we take into account the fact that 2 billion hours of service were provided, we can see that volunteerism ensures the provision of many essential services that would otherwise be unavailable, and which society could probably never afford. We need not only enhancement of the volunteer sector, with tax credits and even compensation for volunteers, but also financial support for a sound infrastructure for recruitment, screening, training, monitoring, evaluation and recognition. This support will clearly impact on the quality and the quantity of volunteers, and their contribution and participation in the community.
There is a whole world of possibilities if we bring the young and the elderly together to exchange, learn and share from each other in terms of skills, experiences and ideas. Such intergenerational initiatives such as mentoring, counselling, consulting and coaching can augment the knowledge of both the young and the elderly, creating a dynamic, robust and productive workforce, community and society. These activities can also go a long way in dispelling ageist views.
Personal and professional experience has made me and people at CARP concerned about the millions of caregivers, mostly women, across the country. Their role in home care cannot be ignored but neither can their plight. No other job demands commitment, 24 hour, 7 days a week, and in most cases without training or adequate support. Burnout is common but could be avoided with a national respite program that offers caregivers regular breaks from their demanding responsibilities. Such a program will also help to prevent premature, and more costly, institutionalization of those being cared for, and even the caregivers themselves. Moreover, caregivers and care recipients would benefit from a national home care program that includes chronic care and community nonmedical care with governmental transparency and accountability. As well, a national mental health strategy, as outlined in the Kirby-Keon report, would contribute to the health and quality of life of caregivers and care recipients, as I well know from looking after my brother who was schizophrenic.
It is unconscionable that Canada is the only G8 country without such a strategy to serve millions of people suffering from mental illnesses. We are concerned about the aging of the mentally ill, whose needs are specific, unique and ignored. For caregivers who continue to work, or leave work to do full-time caregiving, policies must be in place for flexible work hours and reasonable leaves of absence. For substantial leaves of absence, we would like to see a distinct Employment Insurance fund and eligibility for more than the current limited period of palliative end-of-life care. Also, the stop-out provision in CPP for new parents should be extended to all caregivers who leave work to provide elder care.
A huge challenge is what I call the re-entry phase of caregiving: After the caregiving, then what? We need to have a post-caregiving support system to help build or rebuild skills and confidence for a successful transition back into life and into the labour market. There are so many more issues to raise: poverty, pensions, environment, fraud and scams, affordable housing, elder abuse, et cetera. I hope some of these issues will be raised during our discussion here.
I will close with a quote by UN Secretary-General Kofi Annan, on the occasion of this year's International Day of Older Persons, who said:
...the whole world stands to gain from an empowered older generation, with the potential to make tremendous contributions to the development process and to the work of building more productive, peaceful and sustainable societies.
Jack Frost, Dominion President, The Royal Canadian Legion: Thank you for inviting the Legion to appear today.
The aging of the Canadian population is inevitable. This reality calls for mitigating measures in areas such as health promotion, home support services, affordable supportive housing, long-term care, palliative care, and lifelong learning.
The Royal Canadian Legion feels strongly that measures should be implemented immediately to deal with these dawning demographic challenges on which you have been briefed.
New policies must be implemented to meet the changing needs of seniors while preserving their ability to contribute to the productivity of Canadian society.
The Gerontological Advisory Council, GAC, of Veterans Affairs Canada, of which the Royal Canadian Legion is a member, has made recommendations regarding health benefits provided to veterans. One recommendation deals with a comprehensive health promotion program that preserves a vigorous intervention model for veterans with high-care needs. Such a dual approach would be logical for all Canadian seniors.
To quote from the GAC 2006 report, Keeping the Promise, services provided to veterans should include ``appropriate early intervention and health promotion services, more intensive home supports and a wider range of residential choices.''
This approach would benefit caregivers, including those who have not received benefits from the Veterans Independence Program, VIP, because they do not meet the current complex eligibility criteria.
The key objective of health promotion for seniors should be to help seniors maintain independence and productivity. With the VIP, Veterans Affairs Canada goes a long way toward doing exactly that. The Legion has long advocated for an extension of this successful program to the pre-1981 recipients, and eventually to all Canadian seniors.
A seniors' independence program based on need for all Canadian seniors would reduce the hospital expenditures for hospitalization and long-term care. The integration of health promotion and preventative health measures into medical programs, coupled with more affordable housing options, would reduce overall healthcare expenditures.
The Legion has operated has a housing program since the 1980s. Our housing program has been re-invigorated with the appointment of a consultant in 2000 for the Legion's Housing Centre for Excellence in Charlottetown. An employee from Veterans Affairs Canada second secondment to the Legion, David MacDonald has coached Legion branches in developing new housing projects for seniors and veterans, such as the Alexander Mackie Lodge in British Columbia.
The biggest challenge the Legion branches face in getting these projects going is meeting the mandatory equity requirements to qualify for insurance from the Canada Mortgage and Housing Corporation, CMHC.
The challenge is because of the more stringent insurance criteria CMHC is imposing for small corporations. These criteria result in increases in the loan-to-equity ratio for small projects. Unfortunately, a small equity gap of $150,000 on a $3 million project could be the only obstacle preventing a project from securing construction funding.
A simple solution is to set up a small revolving fund to provide gap financing. Repayment would be deferred for five years. These equity gap loans would be repayable with interest within five years. This program would become self- sustaining. We provided, as an enclosure, a more comprehensive description of this recommendation.
These examples show how the government can meet the growing needs of seniors and veterans to secure affordable, supportive housing without imposing an additional drain on healthcare and long-term care funding.
It is an unavoidable reality that many seniors and veterans will require institutionalization in these facilities. It is clear the health promotion can delay this change. Seniors and veterans prefer to remain in their homes as long as is feasibly possible. For some, this preference may mean facing the final transition in the familiar surroundings of their residence, assuming appropriate palliative care can be provided.
Veterans Affairs Canada has a program for at-home palliative care, which should be investigated by federal and provincial health authorities as a potential model keeping in mind it is less costly to provide services in a home than in an institution.
We have advocated for national standards of long-term care. When seniors and veterans face the reality of transitioning to those facilities, there should be a well-defined level of care, which should be the same whether they reside in Newfoundland and Labrador or British Columbia. Seniors should be covered by a seniors' bill of rights to establish national standards of care, benefits and services.
The Legion recognizes lifelong learning for seniors is a necessity to ensure continuing prosperity and productivity of the nation. One element of lifelong learning resides in access to computers and information technology.
A founding member of the Canadian Seniors Partnership, the Legion has advocated for easier access to information for seniors. We recognize that access should be provided through an integrated portal to simplify the identification of services at federal, provincial and municipal levels of governments.
In the past, the Community Access Program funded by Industry Canada provided computers to seniors in Legion branches where seniors often congregate. This program was discontinued. It should be revisited and enlarged to provide computers in long-term care facilities for seniors and veterans.
The Legion advocates strongly for the following: A vigorous health promotion program for seniors coupled with an intervention program for seniors with high-care needs; more intensive home supports modelled on the successful Veterans Independence Program and palliative care programs; access for non-government organizations such as the Legion to a revolving equity fund to provide gap financing for affordable housing projects; national standards of care in long-term care facilities, and a national seniors' bill of rights; and access to information technology.
Jane Barratt, Secretary General, International Federation on Ageing: The International Federation on Ageing, IFA, is pleased to present its views to this committee today. It is a rare honour the federation takes seriously.
Never before in the history of this nation, and the world, would every one of us here today experience the impact of population aging, and the current demographic trends today and for the foreseeable future.
The IFA was established 30 years ago. Its headquarters has been in Montreal for the last 14 years.
We are proud to have Canadian members, government and non-government. Our mission is to understand aging policy and programs internationally so we can inform, educate and promote policies and practices to improve the quality of life of older people in Canada and all older people.
Our responsibilities include building, facilitating, and strengthening bridges between governments, non-government and the corporate sectors; strengthening non-government organizations in Canada and around the world so they can build a capacity to represent and support the older people they represent; and to improve the understanding of the effect and impact of government policies and programs on the lives of older people. Our programs include the analysis of aging policies from 30 countries, to better understand trends and ways the governments are dealing with many of these issues that we are dealing with today; a scan of legislation and other policies around the despicable elder abuse trend in this country and other countries; and a unique capacity-building program, which supports NGOs to understand better how to represent the people they serve.
We believe that with consolidated up-to-date policy and program-related information, the IFA is in a good position to support national, provincial and smaller bodies in their policy development. The IFA has general consultative status at the United Nations and its agencies, including the World Health Organization.
Substantive issues that are changing the lives of future generations today in every part of the world are unnervingly similar. The vexed question of how to prioritize them is equally challenging. These issues, which we have observed in Canada and many countries around the world, include pensions and benefits — the financial protection: how are older people going to live longer without financial support?
Some of our people in Canada are asset rich and cash poor. How do these people access health care that they want in the future? Other issues include discrimination — age discrimination in health and social care, employment, and accessing goods and services; and insufficient and inequitable access to continuing care ranging from in-home care to long-term care and sometimes specialist institutional care.
It is a myth that most older people will enter institutional care. One in seven people over the age of 75 in developed countries are likely to go into some institutional care. This means six out of seven older people will be in the community today.
Another issue is increased family caregiving. There is a strange paradox because we are experiencing urban migration; therefore the family-giver social network will not be here in the future. I do not want to see children being celebrated for their caregiving role in their family. That is not their role as they grow up in life, to be a primary caregiver. Let us not let that happen in Canada.
With regard to respite programs, family caregiving is a natural tendency for us all. Each one of us here today will either give or receive care at some time in our life, and the whole notion of respite needs to be addressed. It is imperative that all these and associated aging issues are viewed through the gender and cultural lens to give meaningful voice to these specific cohorts.
After canvassing the aging policies and programs for many different countries not unlike Canada and reflecting on the work of our NGO members who represent 50 million older people in the world, I ask myself the question: What is the single broadest policy intervention that could in some way impact on each of these substantive issues? The answer is ``healthy aging.'' My caveat to this term is that aging — growing old — is not a health issue, nor should we see it as a health issue in the future, but rather part of the life course approach. I have a belief that aging starts at birth and throughout the life course we experience changes in our life, and at times we need specialist services and care.
One may ask the question, is there a crisis in Canada in regard to older persons? We may respond to this question by asking again whether all older Canadians have the same access to goods and services across the country, the same choices, and even whether the life expectancy is the same for all cultures. If we cannot answer in the affirmative, then, yes, we have a crisis.
Let me now go back to the policy and programs of healthy aging and explain in broad terms why it is imperative that Canada make a long-term commitment to such a strategy. It is not a quick fix but relies on bi-partisan commitment and is at the essence of future generations. Healthy aging depends on a variety of influences or determinants that surround individuals, families and nations. At times we talk about older persons as a separate cohort. Older persons, like all of us here aging today, are part of a community.
Understanding the evidence behind these determinants — economic, health and social services, behavioural, social, personal and physical — helps us to design policies and programs. It takes courage from governments to recognize the long-term benefits that programs and strategies such as healthy aging can deliver in terms of its economic return; but they do.
We must also confront the complexities that national service standards and quality standards will inevitably deliver. However, Canada cannot be a nation where differences across provinces impact negatively on the health and well- being of our older citizens.
In Canada, the prevalence of chronic disease is increasing. In 2005, 91 per cent of seniors reported one or more chronic health conditions as diagnosed by a health professional, compared with 87 per cent in 2000-01. In 2005, the most frequent chronic conditions of seniors living in the households were: arthritis/rheumatism, almost 50 per cent; high blood pressure, 45 per cent; heart disease, 19 per cent; and diabetes, 15 per cent. These chronic conditions call for a healthy aging strategy.
In Canada, I am pleased to say that we can boast most impressive research and research institutions, thoroughly experienced and committed government offices and a non-government sector that works in partnership with and has a growing interest in the corporate sector. However, at times we are moving in the same direction but moving in parallel. It is time that we connect towards a common purpose.
Canada was one of almost 190 countries to sign onto the United Nations Madrid International Plan of Action on Ageing in 2002. We played an important role in developing that plan. The key priority areas are: older persons and development; advancing health and well-being; and ensuring an enabling environment.
Is it time to consider using this plan as a framework for the future: An important national planning tool that addresses inequities across the provinces and creates the vehicle for social change where older persons will know intuitively that they are one of the keys to healthy and vibrant communities?
In 1999, the IFA convened the fourth global conference in Montreal. At that time, we attracted 1,350 delegates and 50 ministers. From that meeting the Montreal Declaration of the Rights and Duties of Older Persons was born. Together with the United Nations Principles for Older Persons, both these charters remain relevant and should underpin our understanding of strategies in the future.
In 2008, IFA convenes its ninth global conference in Montreal, Canada. We will focus on some of the substantive issues I mentioned today: healthy aging, age discrimination and continuing care. Because IFA wants to add value to Canadians, we want to add value to the development of your policies.
At the same time, Expo Ageing Montreal will be convened for the first time. We will call on designers, architects and planners to come and talk with aging experts. It is the convergence of designing an environment that supports people as they age. It is an ambitious, timely and much needed event in Canada. No time is more urgent than now to improve the quality of life of older people.
The IFA is in a unique international position to gain valuable information on the efficacy of policies and practices, and to be a constant contributor to the lives of older Canadians. The federal government and several provincial jurisdictions are to be commended for their recognition and deep understanding of older persons' needs in the area of emergency preparedness, age-friendly cities and rural and remote communities. These are examples of long-term, responsive strategies. The future of older persons in Canada is our collective community responsibility; not only the responsibility of government. It is the responsibility of people here today in our communities. We are committed to working in partnership in all sectors towards effective and meaningful policies that create service equity and consistency towards a healthy older population now and in the future.
As Secretary-General of the IFA I acknowledge members of the Senate committee and thank you for the opportunity to share our perspective to your commitment.
The Chairman: Thank you very much, and thank you to the whole panel for your excellent presentations this afternoon.
Senator Mercer: I appreciate your appearance and your presentations. I have a number of questions.
Ms. Cutler, on page 7 of your presentation, you made reference to the fact that CARP would like to see a band of supplementary income allowed for GIS recipients without any negative impact. It sounds good, except that the GIS is designed to help people with the need for extra income.
If these seniors have the ability to earn supplementary income one way or the other, how does that affect those seniors who have no ability to do that and the GIS is a must for their survival? We are creating two levels of GIS recipients.
Ms. Cutler: Let me point out that people who receive GIS, even those receiving CPP, Old Age Security and GIS are still living below the cut-off line for poverty. They are not making a reasonable amount to ensure quality of life.
That, along with the fact that we have a shortage of younger workers to replace the retiring work force, is an incentive for people to return to the work force to improve their quality of life and also to contribute to the labour market.
We are not asking for a $50,000 paycheque, but there are people who receive GIS who cannot afford to visit their children in another city or to buy shoes. It is not as though those on GIS are doing well.
Senator Mercer: I appreciate that. You say that many of these people are below the poverty line. We have had difficulty in establishing a definition of what that line is. Many people tell us many different things. One of the accepted lines has been called into question. It is a bit of a moot point.
In the previous government, there was a minister responsible for seniors, and indeed, the minister had some special responsibility for caregivers as well.
Was government on the right track with that minister? Should we return to that? Should there be a minister responsible for seniors with spin-off responsibility for related groups such as caregivers of palliative care?
Ms. Cutler: Yes: We have always asked for a minister responsible for seniors but one with teeth, not as a token gesture.
We had a minister of state who was effective in getting things done. It was a good combination to have caregivers' families and seniors together. It was an appropriate merging of responsibility.
However, we do not see seniors on the radar screen at the moment. Even the Ontario Seniors' Secretariat does not seem active. We are hoping the seniors' council that was promised will be announced at some point in the near future.
Senator Mercer: Mr. Frost, you made reference to the desire to have a seniors' bill of rights. Do we have a sample, template or model we could base that on from some other jurisdiction that would be useful to us as a place to begin the discussion?
Mr. Frost: I do not have one with me, but I would be pleased to provide what we see as a seniors' bill of rights, if you provide us the time to accomplish that.
Senator Mercer: That would be helpful and provide us with a concept of something we could develop. We do not need to rely exclusively on your recommendations. If you have a template or a sample, that would be helpful.
In your recommendation, one of them consists of access of NGOs such as the Legion to revolving equity funds to provide gap fund financing for affordable support of housing projects. I like the idea of non-governmental agencies such as the Legion and others being involved in providing housing. Obviously, this is not something new.
First, how did CMHC respond to this recommendation? How has Veterans Affairs Canada responded to this recommendation? You are in a special category of dealing with Veterans Affairs Canada as well as CMHC.
Pierre Allard, Director, Service Bureau, The Royal Canadian Legion: We have mailed in these two recommendations, which are part of a resolution we passed at our last convention. These letters were mailed out last month. We are expecting results from both agencies. We also hope to meet with CMHC to discuss more in depth this recommendation, which is important to us.
Senator Mercer: I encourage you, as you go through that process and receive a response from CMHC, to keep us in the loop to help us understand what is happening. We have had representations from CMHC already. As we have other witnesses, that will be helpful. What about Veterans Affairs Canada?
Mr. Frost: We have had informal discussions with Veterans Affairs Canada. They have been receptive to the idea as a matter of having it entrenched in policy and who would be responsible for what. We are still a ways from having a hard copy that I can provide to you, but they are looking at the idea favourably.
Senator Keon: Thank you very much for taking your time to come here and help us deal with this problem.
One thing I confronted in my occupation before becoming a full-time senator was, when people reached the age of retirement, frequently they had tremendous abilities. One would like to have hired them back in some capacity, but they would say they could not go back because it interfered with their pensions and it put them in a different tax category. It is financially negative to go back at say a fee of $25,000 a year.
How do you deal with that? Could you recommend something that would deal with that?
Ms. Cutler: As I stated in my presentation, we have a tax system where people pay taxes based on their income.
I am in the situation now where I recently turned 65. I am collecting my pension, OAS and CPP, and I am working. I do not have enough to retire, but it is putting me in another tax bracket. Therefore, I am paying a lot of taxes and trying to decide whether I should take a month off. What do I do? It is a real dilemma.
I think we need a comprehensive review of the pension system in light of today's reality. These programs and policies were developed at a time when people's lifestyles and work habits were less than today. When 65 was declared the age of retirement, most people did not even live that long. We need to look at retirement from a contemporary perspective in terms of needs, and not only of the individual but of society as a whole. If we have a shortage of workers, how are we improving the situation by making it not practical for people to continue working?
Mandatory employment is not the way to go in our view because people should have choice. However, instead of tinkering with changes here and there, we should look at the whole system in a holistic and integrated perspective.
I want to introduce Taylor Alexander, my colleague and a consultant at CARP.
Senator Keon: Can someone expand on this a little bit because I suspect you are at a point of losing some of your pension if you keep working, correct?
Ms. Cutler: Yes.
Senator Keon: Let us have an opinion, suggestions or something. Should the CPP be sacred so that when seniors go back into the work force, they are not killing themselves financially, where they need to make $20,000 for the $10,000 they are losing on the pension? Can you think of a suggestion?
Ms. Barratt: Perhaps we can look at it from a different perspective. First, there are the labour market shortages, which we know will occur, if not right now, in Canada. There are also the issues for a proportion of older people who, when they retire, are not part of the community because they are not viewed as productive and able. We have the sociological and community aspects and, from what Ms. Cutler expressed today, we have some inflexible systems that were born in an era much before what we are dealing with now. I agree the issue needs a separate comprehensive review, keeping in mind that we have inflexibility in terms of people not being able to be supported financially in their older age. One of the fears of older people is not having enough money. Yet, we have a system that is intransigent at the moment, and then we have the labour market shortage. This issue is a symptom of other changes going around it.
We are saying that this is how it is, but we are trying to deal with these other variables. We need to confront the inflexibility of the system, particularly based on some important social changes that are occurring in the demographics.
Senator Keon: Is there a need for a redesign of the pension system to fit in the professional lives of seniors so that they can go on working without suffering the penalty of a loss of one or the other pension?
Ms. Barratt: Certainly: Pension reform and design has been occurring in many other developed countries because of this issue. Other governments have tackled it because of what they are experiencing, similar to Canada.
Mr. Allard: As a note of caution, however, some people who were in the work force had a certain expectation of when they could retire and what package would be available. Anything that is framed in the future should preserve the rights of the people that were in the system today.
Mr. Frost: There is an old adage that a picture is worth a thousand words, but an experience is worth a thousand pictures. The country is losing a whole myriad of experience out there because people have met the mandatory retirement age and they must go off into the sunset. If those individuals want to continue to work, they should be allowed to do so.
As you said about the pension, the mandatory contributions to CPP and Employment Insurance should be deferred. Minor tweaking could be done that would be beneficial to allowing these seniors to continue to contribute to society.
[Translation]
Senator Chaput: You stated in your presentation that you would be recommending, among other things, that a federal-provincial-territorial program be implemented to promote the advantages of hiring older workers and of integrating them into the work force.
What type of federal-provincial program would you like to see in place? Would it take into consideration the three generations of seniors, if I can use that expression?
First, we have the baby boomers who are nearing retirement age and who may not necessarily want to retire, either because they are not financially prepared to do so, or because they want to continue working.
Next, we have the seniors who are already retired and who, in many cases, live below the poverty line or are socially isolated.
Finally, we have those in need of care. You mentioned informal caregivers and palliative care.
As I see it, there are three different clienteles, so to speak. Would the federal-provincial program be designed to address the needs of each client group? Would the program take into account persons nearing retirement and seek to encourage them to continue working so as to meet existing labour requirements in Canada? As we all know, many jobs cannot be filled.
Can you explain to me what kind of federal-provincial program you have in mind?
[Translation]
Senator Chaput: Yes. Are you referring to transferring skills from one field to another?
Ms. Cutler: Yes.
Senator Chaput: It is a possibility, but for now, the system does not allow this. Attitudes would have to change.
My next question is for Mr. Frost or Mr. Allard. At the close of your presentation, you mentioned a past Industry Canada program which involved distributing computers to different organizations, including the Royal Canadian Legion. You also talked about nursing homes for the elderly. When the program was still in operation, did you receive any computers to be donated to nursing homes? Would you like this program to be reinstated?
Mr. Allard: When the program was operational, some branches had received computers. Unfortunately, the Industry Canada program was not operational nationwide. Some provinces chose not to come on board. Computers were not donated to long-term care facilities. We would like to see the program expanded to include such facilities.
Senator Chaput: An idea came to my mind when you mentioned this program and I would like to know what you think about it. I can envision common rooms in nursing homes equipped with computers. I can see a sick grandmother able to keep in touch with her granddaughter in Australia. I can imagine different generations staying in touch with the help of computers.
Mr. Allard: Indeed, but computers could also be a useful tool in terms of providing information about the services and benefits available from various federal or provincial departments. The idea of a single portal was also suggested. Experiments are currently under way in Ontario. For example, seniors could, using a single portal, get answers to their questions about direct deposit of GST refunds, thus saving them the trouble of having to telephone different federal government agencies to obtain needed information.
[English]
Ms. Cutler: We need a program, but it must be at different levels of government because education is one part; pensions are another part; and training, retraining and upgrading are another part. When someone reaches a certain age, employers tend to think, ``They did this, so they cannot do that.'' I know from my own experience because I used to work in the arts and I am now working in advocacy. It was not easy to make the switch — not for me, but for the employers who could not make that leap. We need to provide incentives for employers to train and retrain, and be a bit more creative in terms of developing a work force. We need programs that bring young and old together in intergenerational kinds of activity such as education and training sharing.
We need pension reform to provide incentives for older people to come back or stay in the workforce; part time, temporary or whatever it takes. We must create a program that changes the mindset that when you reach a certain age you are out in the pasture. If employers feel that way and treat older workers that way, the workers themselves start believing it is true. When they are given opportunities to show that they can contribute, it is a fantastic thing.
There is a case that we know of where an older person was given a chance to volunteer and talked about his IQ improving. It was not improving; he was given a chance to expand his experience and to share his innate ability to contribute.
I am not sure if that answers the question. We must think outside the box and give people an opportunity to expand. As with children, this expansion should be a lifelong experience. People are not stuck in the niche that was created for them because they are at a different time of life.
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Senator Cordy: I would like to follow up on that one-stop shopping, because I have seen lists of government programs for seniors, and I think most of us would be challenged to find how to go from point A to point Z. How can we streamline government services particularly, but services overall for seniors? You suggested one-stop shopping. In Nova Scotia we have Access Nova Scotia where they can go and have many services delivered. Can you expand on that a little bit?
Mr. Frost: I have experienced this problem, and today if I want to research what is available for my parents, for example, it is a nightmare working through all the intricacies of knowing what is out there and available. If we had one-stop shopping, a single portal of entry, we would have federal, provincial and municipal programs that are available.
The biggest stop measure here seems to be the lack of cooperation between the federal and provincial governments. As Mr. Allard said, we have a program in Ontario that is successful only in one small community. We have talked to other communities to try and interest them to come on board. We were not unsuccessful, but trying to interest people in the benefits of one-stop shopping is difficult.
Senator Cordy: What is the community in which it is working well?
Mr. Frost: Brockville.
Ms. Barratt: I have had experience at the coal face with one-stop shops, and there are cautionary notes about how we update one-stop shops and determine what quality service is versus varying qualities of service. We also know that information is only good at the time we need it. How do we access that information at that time?
The other cautionary note is the language we use. The language across Canada is different in the terms we use: Long-term care, community care and in-home care are all different and mean different things to different people. That caution is not even going down the track of different cultures and what words mean in different cultures.
Therefore, while it is working successfully in a community, there is a good reason; because it is a small community. In a small community there is more ownership around this one-stop shop working. I have had experiences with one- stop shops on a national basis, and they fall short from this relationship that we have with one another, knowing where the services are and where a good service is. In theory, we need to look at it, and there are some cautionary notes around it.
Senator Cordy: Have you seen any national programs that are working well?
Ms. Barratt: I know of national programs that have a track record of about five or six years.
Mr. Allard: The single portal needs to be designed carefully. If it is a single portal for seniors then you may need a larger type font and a simpler approach. Surely the single portal is easier than navigating the numerous stops that Mr. Frost refers to where one must phone four different numbers in a federal program for an answer. That is not logical.
Senator Cordy: You want a real person answering the phone, do you not?
Mr. Frost: That would be nice.
Ms. Barratt: Often the family looks for the services and navigates for the services. I am the baby-boomer but I am sourcing the services for my parents. It is a relationship we need to understand.
Ms. Cutler: I agree with what has been said, but we must go beyond the current silos of services. If the one-stop shopping is not the way, we must find another way. For example, for caregivers it is a nightmare to navigate the system and they hear things by chance if they are lucky. There is no integration amongst services. Often they must choose which one is more important and often they need both or more.
Senator Cordy: We have heard of silos within given levels of government and, as someone said earlier, trying to break down the silos between the levels of government is also a challenge.
I want to talk about home care initiatives that are working and those that are not working and whether you think we need a national home care strategy. The Legions have been promoting the VIP program. It started because there was no room for people in the hospital. Once people were on the VIP program, there was room in the hospital but they said, ``Thanks but no thanks; we prefer to stay in our homes.'' I think most seniors prefer that. From a financial perspective, it is much cheaper and it keeps people happier.
When we made our health care report, we looked at the home care program in New Brunswick. I had an opportunity to go to the Yukon and they had good seniors' programs there. Do you know of countries that have a national home care strategy that is working well?
Ms. Barratt: I was intimately involved with a national home care program that was equitable across the provinces. The program had national standards that were met through consensus with the provinces and had accreditation with the approved providers. Services ranged from community-aged care packages — packages of care that were worked out with the person receiving the care and their family in the home — right up to what were called ``EACH'' packages, or Extended Aged Care in the Home. Those packages were more detailed and had intensive nurse care. I am aware of and have been closely involved with national programs that have a track record of 15 years. They extended to rural and remote areas, the indigenous population and culturally specific programs called culturally and linguistically diverse — CALD — programs in different languages. I would be happy to share that with the committee at a later date.
The Chairman: What country are you referring to?
Ms. Barratt: My accent gives me away. It is Australia. I was intimately involved with delivering the program and creating it. I would be happy to share it with you.
Ms. Cutler: Taylor Alexander is an expert in this area so I will pass this question to him. We want to see a national home care program that includes chronic care — that is, one not limited to acute care — and community care and is not limited to medical care. At the moment, that is what we have and it is up to the discretion of provinces. We are seeing cutbacks everywhere.
Taylor Alexander, Consultant in Aging Policy and Continuing Care, Canadian Association for the Fifty-Plus, CARP: Every province and the territories have different home care programs all with different eligibility programs, different levels of care, different amounts of care, and so forth. The different programs create a patchwork quilt across the country. We have advocated for a national home care program with standards and with the provision of core services comparable from province to province, and so on.
Having said that, perhaps the weakest link in the chain of home care services across the country is the provision of home support services and the level of service that are provided primarily by non-professional or paraprofessional workers that provide most of the paid home care services in the country. This particular cadre of individuals are perhaps the lowest paid, work with the fewest benefits, often pay for their own training, in some provinces pay their own travel expenses, and so on. Yet these people are relied upon to provide the bulk of home care services. That is why my colleague mentioned, in terms of the provision of chronic home care, that these individuals provide the bulk of home care services. It is critical that this group of individuals be an integral component of a national home care program. When we think of home care, we tend to think of professional services but paraprofessionals are the bedrock of the home care programs. We strongly suggest that issue be given attention.
There is an urgent need for a national human resources strategy in home care across the country because the supply and distribution of home care workers varies tremendously across the country. Many provinces are recruiting from out of country to try to enlist home care workers in Canada. That supply and distribution is critical to an equitable provision of services across the country within the home care sector itself.
Senator Keon: I want to ask a supplemental question. What you describe would be wonderful if it could be constructed. However, I would like to take you to the payer for such a service. I assume the core services that you are talking about would be paid by the single payer, the same as in health care now. That is, 70 per cent of essential services are paid by the government as payer if the service is listed as essential. I suspect a large number of necessary services would not be defined as essential and would not be covered by the government payer. How do you suggest that these services be covered?
Mr. Alexander: Likely it is unfeasible to cover everything within home care on a single payer basis, but we must achieve some national consensus on our core basket services. Over and above that, I recommend that the home support worker level be considered part of that core provision of service — we at least need to come to consensus on that. There was federal-provincial-territorial consensus around funding for home care a few years ago and home care workers were included, but there is no consensus on standards of service, commonality of core services, and so on. Money was made available to the provinces and we do not know how that money has been drawn down, where it has been allocated, how it is being spent and so on. It would be useful to have that data.
Senator Murray: What money?
Mr. Alexander: The money that was provided for home care.
The Chairman: That was money first established in the 2003 Health Accord, and added to in 2004. I agree with our witness that at no point have they come up with the shared interpretation of how that money will be spent.
I can give you a specific example. One area on the table was the payment of drugs for palliative care patients. In some provinces such as British Columbia, if they have palliative care services in the home their drugs are covered. In many other provinces, drugs are not covered. Patients were returned to the hospital because in the hospital the drugs were covered. There was an attempt to come up with a basket of core services that would be funded. My understanding is that the provinces have received the money, but to date they have not come up with a shared interpretation of what that money will be spent for.
Mr. Allard: Not only are the care services not standardized or the services not standardized but the identification of individual care needs is not standardized. They could be assessed on a three-level scale if they are with the federal government or five or six-level scale if they are with another province. Surely we should standardize that aspect of it also.
Senator Murray: To follow up on Senator Keon's questions, when you speak about a national home care program are you speaking about a national or federal home care program?
Mr. Alexander: I am not implying that the federal government would deliver a national home care program or that it would be federally funded or administered, per se. Obviously the funding would be cost-shared with the provinces, and the federal government transfers money for those purposes. I am speaking of a national vision for a home care program on which people can agree on a common set of principles and standards.
Senator Murray: The question is, how is that to come about? I am speaking to the advocates now, and whether your advocacy extends to pushing the provinces on these issues. The chances of another ``medicare,'' in which the federal government sets out a Canada Health Act, puts the program on the table and says come in or not, are slim to none. You are familiar with the Social Union Framework Agreement, SUFA, signed by the Chrétien government with nine of the provinces and we have moved a distance since then. There is talk now of further guidelines, perhaps even constitutional amendment, relating to the use of federal spending power. None of the desirable things that you advocate will be impossible, or even necessarily more difficult or less effective when they come about. It is only that the process is and will be different.
Mr. Alexander: We are sensitive to that dynamic, and it has become increasingly difficult since SUFA to move those initiatives forward. However, in the case of home care it is not necessary to develop parallel legislation around a national home care program. These kinds of advancements can be made on an administrative basis within the existing framework. We have looked at that issue in some of our organizations already, and there are ways of moving ahead administratively on these kinds of initiatives without developing further legislation.
Senator Murray: To come back to the outstanding point you made about the patchwork, surely that situation is possible to resolve. Surely it is possible to move to some uniformity, some basic agreed standards, criteria and so on, but uniformity must be achieved cooperatively among the provinces and territories. I remember being told of interprovincial meetings of ministers responsible for senior citizens and that kind of thing, and there are meetings of health ministers and such all the time.
Are you aware of efforts in this area of home care to try to standardize or make more uniform what is now, as you say, a patchwork? If not, why not?
Ms. Cutler: That is a good question; that is our question. The last we heard, a basket of services was developed by the provinces, rejected by Ottawa and then vice versa. It seems not to be on the agenda anymore.
Senator Murray: That would be the basket of services eligible for federal funding. Much of these services surely are provided now by the provinces on their own nickel. Why, in this federation, would they not want to get together and come up with something more uniform?
Mr. Alexander: I think part of the hesitancy might be where the mean will be established. Will you bring everyone up to a certain level or everyone down to another level? There are pressures among the provinces and territories around that issue, and that can create difficulty.
Senator Murray: That is where the advocates come in, is it not? You will try to persuade them all to come up to the highest level.
Ms. Barratt: It is also about money. Let us be realistic. In the model that I am most aware of, there is some matched funding between the federal government and the provinces, and it is arrived at by an administrative process rather than legislation.
However, it is also important to consider that this strategy we are talking about then also impacts on family caregiving as well. It may take some of the load off there. It is about our social structure as well. It is an important strategy to put in place. We want some equity across the provinces to ensure that older people have services when they require them.
It is interesting that some of the core services in the core package you are talking about are things like changing dressings, shopping and some personal care. One would expect those services would not cost a lot of money, but would allow older persons to stay in their home; and that is what we want.
The Chairman: I have one question for Ms. Barratt. We spoke with respect to pensions and you indicated that you knew of some countries that had moved ahead with providing some pension reforms. Can you identify those countries for us so that we can have research done on them?
Ms. Barratt: The IFA convenes a meeting of senior government officials at the time of each of their biennial conferences. In Copenhagen in June 2006, in recognition of this very issue, we convened a meeting of 100 government officials. I am happy to send that report to the committee that encapsulates some of those discussions, and also identifies key people internationally who have worked in this area for a number of years.
The Chairman: Thank you to all our panellists for providing excellent information this afternoon.
Honourable senators, we now will hear another interesting panel. Lynn McDonald is the Scientific Director of the National Initiative for the Care of the Elderly, Sandra Hirst is the President of the Canadian Association on Gerontology, and Anne Martin-Matthews is the Scientific Director for the Aging Institute of the Canadian Institutes of Health Research. Please proceed.
Anne Martin-Matthews, Scientific Director, Institute on Aging, Canadian Institutes of Health Research: Thank you, and I thank the committee for the opportunity to speak today. Having looked through the materials of previous presenters, I know you have heard a great deal about the demographic shifts and their socio-economic and policy implications, so I will focus on three key points today. First, I will give you a brief overview of the Institute of Aging and our role in advancing research on aging. I will talk briefly about the strategic priorities of the institute and our approaches to public engagement with seniors to inform our research process. Then I will focus on what our partnerships and public engagement tell us about the issues that are most important to older Canadians across the country.
About the Institute of Aging and the Canadian Institutes of Health Research, some of you may well know, because this act passed through the Parliament and Senate of Canada in June 2000. The Canadian Institutes of Health Research, CIHR, evolved from the amalgamation of the Medical Research Council of Canada and the National Health Research and Development Program within Health Canada in June of 2000. We fund 10,000 researchers across the country in universities, teaching hospitals and centres. The funded research focuses on four key areas central to the health of Canadians: biomedical research, clinical research, research on health services and health policy, and research on the social, cultural, environmental and economic determinants of the health of the population. CIHR consists of 13 institutes. Many of the institutes are focused on specific diseases such as cancer, on functions such as nutrition, on health services or on special populations such as Aboriginal health or children.
I am the scientific director of the Institute of Aging. Our focus is on the age-related consequence of diseases for later life rather than on the diseases themselves. CIHR's investment in research on aging, you may be interested to know, has increased from $14 million five years ago to $63 million this past year. The fundamental goal of the Institute of Aging is the advancement of knowledge in the field of aging to improve the health and quality of life of older Canadians. This goal is important to emphasize because we are more than a funding agency. We do fund research, as do all the CIHR institutes, but we also set strategic priorities for research on aging. We work with partners to help us identify those priorities. My first message to you is that research that leads to an improvement in the health and quality of life of older Canadians is a priority of CIHR's Institute of Aging.
We cover five broad areas: healthy and successful aging, biomedical and biological mechanisms of aging, cognitive impairment, aging and the maintenance of functional autonomy, and health services and policies relating to older people. This research crosses the full spectrum of research. To give you a couple of examples, we fund research on such topics as gene expression on aging, respiratory infections in older people, management of osteoporosis, ethno-cultural diversity in long-term care facilities, and meaningful activity from the perspective of persons with dementia.
We also fund research on the link between research and action. We call that knowledge translation. We also fund research designed to enhance the commercial development of products designed to improve the quality of life in old age. One such product developed through this funding that will be on the market in January is a sole sensor, a balance- enhancing shoe insert designed to reduce the risk of falling in older people.
The key message is that the factors that will effect an improvement in the health and quality of life of older Canadians are multi-faceted, complex and go well beyond a focus on a single disease or function studied with a single research tool.
Let me give three examples of work we are doing in these areas. In terms of a focus on disease, we have the Cognitive Impairment in Aging Partnership. The acronym is a bit unfortunate — the CIA partnership. Beyond that, I will say that this partnership, which has brought together a dozen representatives from the voluntary, public and private sectors, was initiated by the Institute of Aging. Last year, we invested $18.7 million of research in this area. We focus on vascular health and dementia, biological mechanisms of Alzheimer's disease, and issues of care giving and dementia. I know you have heard from earlier presenters about the importance of focusing on caregivers.
Our mobility in aging strategic initiative is a more recent focus of the institute and it has a broader focus on function. You know as well from previous presentations that as life expectancy has advanced, the number of disability- free years experienced by older Canadians has not increased proportionally. The Institute of Aging invested significant funds, and will continue to do so over the next few years, into developing research teams working in partnership with the community to focus on the prevention of disability and aging.
We have completed a series of regional and national consultations and we have heard from groups about a whole range of issues to do with mobility and aging. We heard about everything from the timing of crosswalk signals at busy intersections frequented by seniors, to housing designs that limit mobility, to programs that help seniors adjust when they lose their licence.
The focus of our endeavours in research tools has been on the Canadian Longitudinal Study on Aging, CLSA. You have a brochure about the CLSA in the materials that I will leave behind. This ambitious study is planned to roll out in 2008, with the cooperation of Statistics Canada, and will track between 30,000 and 50,000 Canadians over the age of 40. It is unique in that it is starting earlier than any other world-wild longitudinal study of aging and it is the first study of its kind and magnitude in Canada. Much of what we know about aging is from snapshots and pictures taken at one point in time. The expectation is that as a result of the CLSA, health care providers and government policy makers will have knowledge of the processes and factors that affect health and aging to enable them to better identify ways to prevent disease and promote healthy aging.
My final point has to do with partnerships and public engagement. We know the issues are complex. We have felt that seniors themselves and not only the research community represent an important constituency of the Institute of Aging. To that end, we have engaged in a consultation with 350 representatives of seniors' organizations through five regional meetings and a national meeting held in Canada over the last few years. Senator Carstairs, I believe you attended the meeting here in Ottawa, the national meeting convened in May 2003 by my predecessor.
What we heard from those consultations are the most frequently noted issues, namely, the lack of age-appropriate health services. These issues include training in standards of practice for clinicians who work with older adults, universal access to age appropriate health service, and medication costs, use and overuse. I can speak more about this in our discussion later, but I will mention that the acute shortage of geriatrics specialists in Canada was a focus of the discussion with seniors there. I know my colleague Dr. McDonald of the National Initiative for the Care of the Elderly will speak about this later.
The housing care continuum was a crucial concern to the seniors we spoke with. Also, issues of preventing disease and disability, and promoting wellness were another area where they felt we needed to know more. They also felt that issues of isolation and mental health were broadly neglected in terms of areas of focus.
We have five regional reports of those meetings. They are available in English and French if your committee wants to see them. A synthesis document bringing together the findings of all five will be presented this year. We also engage with other partners at the federal and provincial level — and I can discuss that later — and with private sector partners. The age-friendly initiative of the World Health Organization, WHO, which you have heard of, is one such initiative.
I want to close by noting something that I hope your committee will take note of. Our institute works hard to bring young people into the field of aging in Canada. We undertake this work with federal partners such as Veterans Affairs Canada and the Alzheimer Society of Canada; with provincial funding agencies such as Fonds de recherche en santé du Québec, FRSQ, and through CIHR training initiatives. We know there will be a crying need in the years to come. We need more people dedicated to careers in geriatrics and gerontology, and to basic research on the biological aspects of aging, all with the goal of improving health services delivery to an aging and elderly population. Thank you for your time. I look forward to our discussion this afternoon.
Sandra P. Hirst, President, Canadian Association on Gerontology: I want to express my appreciation on behalf of the Canadian Association on Gerontology for the opportunity to address you today. The Canadian Association on Gerontology, CAG, is a national, multi-disciplinary, scientific and educational association established in 1971 to provide leadership with respect to the aging population. We are a member of the international association of gerontology and geriatrics. Our mission is to improve the lives of older Canadians through the creation and dissemination of knowledge in gerontological policy, practice, research and education. Within our membership are academics, practitioners, researchers and clinicians, many of whom work directly and indirectly with older adults and those important to them, in a range of settings.
Knowing your interest in long-term care issues, I want to draw your attention to three issues. First, there is the need to support ``aging in place.'' The vast majority of seniors wish to live in their own homes, although those homes are usually 30 years plus, two stories and too big. Aging in place is a preferred future, but it should not be defined by financial means, physical limitations or physical capabilities. Opportunities must be provided for all seniors to have access to services such as mowing the lawn, snow shovelling and grocery delivery that will support their ability within their own homes, and will support the choices they want to make. We support a national home care program to go to choice.
I want to make a side note here that the majority of seniors are healthy. The term ``health promotion'' we support and encourage, but healthy aging does not start at 65; it starts the day that one is born. The chronic condition does not start when one turns 65. It has its roots in the 30s and 40s.
Second, we need quality long-term-care facilities. We know there is an emergence of a range of options for older adults to help them stay in the community to age in place, but there will always remain a need for long-term-care facilities. The definition of ``long-term care'' varies across this country. This variation represents a challenge to those of us receiving care in them. My own bias is coming through there. We know that for older residents entering long-term care, the age of admission into these facilities is increasing into their 80s. We also know the complexity of health concerns these adults are facing, from tracheotomies to feeding tubes. We are asked to provide care to complex older adults who have a variety of needs. Older adults entering long-term care rarely present with one health issue. They have multiple concerns. In addition, they may experience flare-ups. A simple example is an older resident with Alzheimer's who spends three days scrubbing her cheeks. The staff fails to realize that she may have a toothache. They assume her increased aggression requires medication, yet that acute condition could be dealt with easily.
Perhaps the most vulnerable of our senior population is cared for primarily with uneducated staff at their bedside. That is deplorable. Also, staff in long-term care are primarily from ethnic backgrounds that are themselves challenged by their inability to communicate in either of our two official languages. I would like to reiterate: education, education, education.
We know, too, that families want to maintain contact and to provide care to their older family members but their involvement, regrettably, is not always welcome. From a facility perspective, there is no clear definition of long-term care nationally. Each province and territory employs different terms to describe the experience. The staffing requirements and legislation that governs these facilities differ across Canada.
We know that an older adult in Ontario may not be able to come into Alberta without a three-month waiting list. Yet their oldest son may live in Alberta and may wish to provide some support. Facilities are an issue for us. We know that there is no consistent standard of care nationally as to how we give physical, psychological and emotional care to older adults. As I said earlier, education is essential.
Third, we have a new subgroup of older adults emerging in this society and in long-term care in particular: older adults with intellectual and developmental disabilities. We have populations now in their 40s who are demonstrating Alzheimer's-like symptoms. By the time they reach 60, at least 50 per cent of individuals who have Down Syndrome will develop Alzheimer's-like symptoms.
Their families are aging: they are admitted to long-term care. Regardless of the setting in which care is delivered, this subgroup of our senior population will warrant our attention.
Prior to closing, I want to thank both Dr. Martin-Matthews and Dr. McDonald. We illustrate beautifully the concept of collaboration; moving research from the theory and academic setting into practice.
On behalf of the Canadian Association on Gerontology, I would like to express my appreciation again to be able to address you today.
Lynn McDonald, Scientific Director, National Initiative for the Care of the Elderly: We are pleased to be invited here today. We are the youngest kids on the block; we are not even a year old. We are the National Initiative for the Care of the Elderly, NICE. We are a national and international network of researchers and practitioners involved in the care of older adults through medicine, nursing and social work as the three primary professions. We also have many related professions of occupational therapists, physical therapists, psychologists and lawyers.
We are funded by the federal government through the Networks of Centres of Excellence New Initiative program, which we are truly thankful for. We are also funded most recently now through the International Research Development Centre, IRDC, which brings us 10 new partners from around the world: China, India, Germany and Australia, et cetera.
We have 100 members from the three major professions working together in teams of academics and practitioners. We have 25 partners in academia, business, and community institutions such as Baycrest Centre for Geriatric Care, a long-term care facility in Vancouver.
The overarching goal of our network is to provide quality care to older people. I will give a quick overview of NICE, why we exist and our recommendations. You have a brief in front of you.
The whole point of our network is the transfer of knowledge from research that Ms. Martin-Matthews funds into the end user's hands at the bedside so that treatment teams can provide the best possible care to older people. The network of members met and they picked 10 priorities for Canada. We are working our way through the list, because we have only so much money. We are starting with caregiving, dementia, and palliative care.
We decided we want to put the information in the hands of the people who need it as quickly as possible. We have developed pocket tools on capacity and consent. If someone does not know the law they pull it out, take a look, they have it there and they can work with family and older persons so everyone knows what is happening.
Our four theme teams are developing these tools as interdisciplinary teams. The tools will be used in a knowledge- transfer event. There will be at least six of them across the country. The event is to train community or an institutional team in the use of the tool, for them to go and use the tool, and then we will evaluate the tool. The people evaluating the tool are seniors and their families: Did the tool work and was it helpful?
NICE is a not-for-profit corporation housed at the University of Toronto at the Institute for Life Course and Aging, of which I am the director. Our board of directors includes seniors, their family members, and all the professions I am talking about in terms of researchers and practitioners.
We also have a student/mentor program. Ms. Martin-Matthews underlined the problem, and Ms. Hirst reinforced it — education is a huge issue in this country, and to attract younger people to gerontology and geriatric medicine is tough. We pay students to join us and we engage them in knowledge-transfer events with the treatment teams.
Why do we have our network? Why do we put it together? Our network is the poor man's version of the Hartford Foundation in the United States where they have invested over $30 million in each of medicine, nursing and social work. They know they have an age wave coming forward and that they must be prepared. They have been doing that since 1984 and they continue to do it to today.
Obviously you know about the demographic change in this country from earlier panels. The second point is, we have a serious lack of professionals in this country, and a serious lack of professional training and education in geriatric medicine, gerontological social work and gerontological nursing. As an example, in 2000-01 seven medical students went into geriatric medicine for the whole country.
A study was done of the baccalaureate programs of nursing in this country, and the conclusion was there is little core gerontological content in programs and few clinical programs available for students to practice in.
In terms of social work, I will give an example: There are only two gerontology programs at the master's of social work level. The University of Toronto started one last year. Eighty students applied to go into child welfare and 12 students applied to go into aging.
The context I am talking about is, we have a shortage. I am also trying to say our education is not interdisciplinary. Ms. Cutler spoke earlier today about silos. Our education occurs in silos. At NICE, we promote education with an interdisciplinary context.
Older people are unique and have unique characteristics — they are diagnosed, the symptoms are atypical, the interventions are not what you would think and they require more or less medication — my medical colleagues can speak to that better than I. The truth is, better care is developed and delivered through teams. There is a considerable amount of research, and I have put all the research into your briefs so that you can take a look at it. We need to start training in an interdisciplinary framework.
We have made eight recommendations. They all have to do education. We have indicated a rationale for our recommendations and the action required.
Our first recommendation is obvious. We need to increase the number of gerontological/geriatric specialists in this country: nurses, doctors, social workers, and psychologists, et cetera.
The second recommendation is, we must develop and build upon existing interdisciplinary centres or institutions of aging across this country.
The Social Sciences and Humanities Research Council, SSHRC, put in place and funded the development of centres on aging years ago. They have done a marvellous job in terms of research. With more emphasis now, we can build on that infrastructure and train people in interdisciplinary teams in those centres.
The third recommendation from NICE is that gerontology/geriatrics must be required as part of the core knowledge of any graduate degree in the health professions. We also believe that community-based providers and institutionally- based educators must come together and develop curricula.
Next, interdisciplinary geriatric education should be a core requirement for all health professionals. People who are already in the field deserve more continuing education. Language is an issue and we need to find ways to communicate how to provide the best care.
Recommendation 7 is that we must put funding into developing faculty, at least in the three main faculties, so we can get a cadre of professionals in this country who are committed to training our professionals.
Finally, we need to devote part of our research agenda to the needs of practitioners in health-based professions. We need to transfer that knowledge as quickly as possible into the hands of the people using that knowledge. I include older people themselves and their families.
The Chairman: Thank you. I would like to put one question to all of you before I turn it over to other senators. Why are we not attracting people into gerontology and geriatrics — nurses, social workers and obviously physicians?
Ms. Hirst: From a nursing perspective, we have students coming in at 18 and 19 years of age. They have preconceived ideas of what nursing is. It is emergency room, ER. It is intensive care unit, ICU. We do not educate them early enough in grade 1 and grade 2 to realize the richness, diversity and complexity of gerontological nursing practice. They come in with society's attitudes.
Ms. McDonald: There is an ageist attitude in this country. I dare say that gerontology/geriatric medicine is not sexy. These are old people who are chronically ill and you never make them better. Maintenance is all you can hope for. People have a negative view. They do not understand how exciting it is to work with older people. If I could reach those people and expose them to working with older people, they can get turned on. That is our experience.
The other issue is lack of money. Students need money. If we focused in on scholarships for gerontologists, we would make a huge difference. We cannot do that. I kept saying in my faculty, ``Give me money, and I will find you 30 gerontologists.'' I know that is right, because that is what the Americans did, and it paid off in spades.
Ms. Hirst: It is education of faculty as well. Being a faculty member, it is encouraging and supporting and working with my colleagues around curriculum development to realize that maternal-child is not the only way to deliver care.
Ms. Martin-Matthews: To reinforce what my colleagues have said, even if one is successful in recruiting students to the excitement of the field of gerontology, which we have all been in for over 30 years, there are often only one or two such students in a program. They lack that sense of critical mass and linking with others.
The Institute of Aging this year created something called the Summer Program in Aging, SPA. Come to the SPA for a week in June for a brain massage in aging. We selected about 60 to 70 students from across Canada and brought them together for one week. I am talking about all fields. The people in the lab need to understand that even if they have never met an older person, they are doing work that is relevant. They meet the students in social work. This was a grand experiment, one year, highly successful, and we intend to repeat it again. It is expensive, and we need to work with colleagues. That is one week in a whole year for 60 students. I met a student a few weeks ago who said, ``Going to something like that was the best thing I have ever done.'' We can capitalize on those types of things by bringing them together, but working in isolation or feeling like your friends or colleagues are doing more interesting or more life- saving kinds of programs is an issue for us.
Senator Keon: I am not that old. Maybe I could go back and become oriented in gerontology. I was thinking that there must be a tremendous labour pool out there of nurses and, to a lesser degree, doctors, because they do retire a bit older, especially those in private practice, but the academics all must retire at age 65 — not any more, but they did when I was practising. They all did. They very young and they retired as young 65-year-olds. Many nurses retired at 55 because of the great pension plans. I hate to admit it, but I encouraged them, as an administrative person, because I could hire two juniors for the price of one senior, and they would take their pension.
I was thinking as you were speaking that something that might be worth a look is to try to interest some of the older health professionals in physiotherapy, nursing and medicine in coming back into an orientation program and becoming involved. That may be something for you to think about at the institute.
Ms. Martin-Matthews: The Social Sciences and Humanities Research Council, which is a different funding council from the one I represent at CIHR, had a program of reorientation grants some years ago. They took people who were not necessarily retired but were in fields relevant to aging, and that was deemed a successful program. At CIHR, we tried to develop something like that a few years ago with what we called a mid-career award in aging. The idea was to take people who were already working in a related area and pluck them out for a year, immerse them in aging and see where they could go. It was expensive. We felt, as an institute by ourselves, in the context of CIHR's larger budget pressures and its elimination of a career program, we could not continue that. However, there is merit in looking at that as a possibility. Our focus was not, as you are describing, Senator Keon, so much post-retirement but taking people at that crucial juncture in mid-career and doing some reorientation.
Ms. Hirst: The average age of a registered nurse in this country is close to 50. We know we have a drastic national shortage, and we have tried to do work through the Canadian Gerontological Nursing Association to pull those nurses back in, but we are consistently told it is not worth it, and it is too hard. They are tired, and I am afraid that is a reality we are dealing with.
Ms. McDonald: I must run a cruel ship, but at the Institute for Life Course and Aging, I have about seven people who come in as older people — journalists, a physician and many different people — and work. They now want to join NICE and say, ``Anything I can do to help.'' I was hard on them and told them, ``Well, if you're going to sit here and use our space at U of T, apply for a grant.'' They all did, and most of them received grants. They are happy with themselves, and they are having a blast. It was an accident, a serendipitous development, but it is a good suggestion.
Senator Keon: I have a friend who is the same age as I am and who went to medical school with me. He told me this summer that he owns eight per cent of a seniors' residence, and it is already giving him a nice income. He said the major reason he invested there is he wants to go there with his wife when the time comes. I thought that was a great idea. Seniors have money, and there is this tremendous shortage of appropriate facilities, housing and in the various dimensions and so forth. Much of it is owned by the private sector. If someone could involve seniors in investing in themselves, they could make a tremendous contribution to their lack of housing and so forth, and they would add a great deal to the planning of the continuum.
Ms. Hirst: That is an excellent idea. I think it would make an informed choice where a senior could help design something that he or she would like to live in, as long as it is one of the choices available to a senior.
Ms. Martin-Matthews: I am thinking about the work done by Ms. McDonald on retirement and income. The number of older Canadians that fall below the poverty line has decreased in certain years. Despite that increasing wealth and the fact that fewer are falling below the poverty line, we still have large segments of the elderly population who would not fall into the category of which you speak. However, many do and many are entrepreneurial enough to see real opportunities. The real challenge will be to ensure that where those opportunities arise, they are distributed across the country in terms of where people live. There are great concentrations of older people in downtown Vancouver, Toronto and Montreal, but in rural areas the investment opportunities may not be obvious and it is more complex to deliver services. We have high concentrations and congregations of older people in those settings. That model will take us so far but we must look at a whole suite of service opportunities.
Senator Keon: We were talking earlier with the previous panel about this phenomenon of core services for seniors. If it could be defined, then hopefully government would pick up the core services. However, government will not cover everything. It is a real challenge to involve the insurance industry and try to avoid the phenomenon of people paying out of their pockets because we have heartbreaking examples of people who run out of money.
Maybe you have some ideas on how we might put such a suggestion together regarding core services for seniors, ancillary supplemental services that could be paid for through insurance, and so on.
About six weeks ago, I had the great honour and pleasure of representing the Minister of Health at a think-tank in Europe on how to fund the gaps in health. The gaps exist in every country in the world. A lot of insurance people were at a meeting recently. It became obvious that if they are to fund the gaps, they have to start early. It would have to be something like a whole life insurance policy that you can draw down when you become old but you pay for it when you are young. There will need to be real thought going into that. It will require tremendous thought from government, the private sector, the insurance sector and so on.
I am interested in hearing you talk a bit about how this continuum of services, first, could be described; second, the core services defined; and, third, the supplemental services could be paid for. That is asking a lot of you without preparation, but it is not important that you are not prepared. You are all experts: tell us what you think.
Ms. Hirst: Regarding core services, another layer here is that our older adults are changing. We know that older adults are primarily females — that is evident. They experience financial changes and education changes. We are planning for a senior population now, and in 10 years the population is different. I suspect that some of those core services may have changed by then. Certain basic services such as housing, food, shelter, companionship are core. How you define them? I am not sure how to answer that, but they are fundamental to every individual, regardless of age. There is transportation, choice, companionship and freedom. We will not have freedom from disease and chronic conditions, but we need the ability to manage and work within the constraints that condition may give us to give quality of life, which I think is an over used term.
Ms. Martin-Matthews: The point about two or more generations over the age of 65 is really important. One of my favourite slides that I like to show when I meet with the public — and, I showed it when I met with the deputy ministers last year — is one depicting a man who is about 80 or 85 years old. He is standing in a garden in front of a lovely house in the U.K. That is our image of a typical older person. Spinning in from the side is his son, standing there with his arm around his father. The son is Mick Jagger. Mick Jagger is 63 years old. He is iconic for a certain generation but the point is made. It makes the point that when we think about planning for the future, we must remember that scene is the older person of the next generation. We are planning not only for Mick's dad but also for Mick himself. We must keep that point in mind, namely that aging is not all necessarily health and disability; it is related to active living, wellness promotion and disease prevention. That must be part of the way that we see the environment in which people will live as they age.
Often, there is an issue of psychology here. A lot of the work that the Institute of Aging has funded lately related to mobility has to do with driving and driving cessation. When people come to the point where they are no longer able to drive, they see that as the end of being independent and mobile. There is a real issue here. We must say to people, ``You can still get out. You can hire a taxi. Look at what your car costs, all those payments, and insuring and fuelling it, versus not having that expense and what any one taxi ride would cost.'' A real education needs to go on there. We do not necessarily need to replace the ability to drive with a publicly funded service. People will putting out less money if they take taxis. There is a certain kind of education, for example, engaging with the private sector of taxi drivers to have certain kinds of service at off-peak times, or to go set distances. In addition, we must recognize that not everyone has a car. We must look at the range of publicly funded transportation services and not necessarily add to them but make them more accessible.
A whole range of public-private partnerships can be brought to bear, as you describe, but a lot of education of the population is needed at the same time.
Ms. Hirst: There is a transportation system in the U.K. where an older person can pay a neighbour. It is an association that is funded through local grants and through taxpayers' money, but the older person may pay the cost for gas. That service raises insurance issues, but it is strictly voluntary. It shows one example of meeting the transportation needs of older adults that we are not considering in this country yet.
The Chairman: We had a colleague who came to speak to me about his mother. She would not use taxis because they were much too expensive. He did not know what to do. I said, ``Buy a whole bunch of taxi coupons. Put them on her front table and tell her that they are already paid for.'' It worked. All of a sudden it was not her money and she was happy.
My question has to do with education. When I was minister responsible for palliative care one of the issues was how we train physicians to become interested in palliative care — exactly the question in which you are engaged. We were able to find $1.25 million to fund curriculum in palliative care. It has now become a core curriculum and not a student will graduate from medical school in 2008 that will not have core training palliative care. Do we need the same thing in gerontology? I gather from Dr. McDonald's vigorous nodding of her head in the affirmative that the panel members are saying yes.
Ms. McDonald: We have to do so. We must say, ``This matters. Here is the money. Get on with it.'' It worked with palliative care and it will work with aging. I know it will work.
Ms. Martin-Matthews: I hope that during its deliberations the committee will talk to the gerontological nurses and the Canadian Geriatrics Society. When we talk to those groups they speak to the real issues relating to the Royal College of Physicians and Surgeons of Canada, which sets the regulations. A powerful message, in addition to the resourcing issue, is imperative.
Ms. Hirst: I can speak for the gerontological nurses because I serve on their executive. Education is core and it must be evidence-based. We cannot work on the same traditions that we have been trained under for 50 years. Education must go back to evidence and research guiding our practice. It must go back to education of what a social worker does and what a psychologist does so that we work in partnership. That is the value of the network.
The Chairman: There has always been a natural affiliation between children and their grandparents. You could build an initiative around trying to attract young nursing students on the basis of their grandparents. They could be trained to help those people that they are so fond of, in particular at a time when they might not be so fond of their parents.
Ms. Hirst: There are some intergenerational programs, one in Winnipeg and one in Calgary. Consistently, we hear from students that it depends on how much they like their grandmothers.
The Chairman: They probably like their grandmothers more than they like their mothers, if that is their attitude.
Senator Mercer: I am curious about the line of questioning taken by Senator Carstairs. I suggest not only do we need to have mandatory training for medical and nursing students but we also may need to bring training down to the high school level. At that point, perhaps, Senator Carstairs' last comment on people's relationships with their grandparents will kick in nicely and allow them to think about it. One primary group of people who will be caregivers are those young people for their parents, at least for a period of time. Many of us provide care for our parents at some time. I like the story about Mick Jagger's dad but I am more concerned about the fishermen's dad and the cleaning person's dad. I do not think I will hold a tag day for Mick Jagger's dad.
In your presentation, you mentioned national standards. The committee is developing themes as we hear testimony from more witnesses before the committee. One of them speaks to national standards and what they are. I ask for the view of all three witnesses on where we should begin in that regard. Do you have a list of where to begin, what to add or subtract next, and how to refine, change or in some way retool that list?
Ms. Hirst: From a national standards perspective there are two immediate thoughts, but standards are not restricted to those only. Education is the place to begin. It is a provincial issue but certain national association groups work with Ms. McDonald, for example.? There are core content areas that every single professional faculty should be exposed to. Palliative care is the perfect example. If faculties could move into gerontological nursing, I would be first at the door. Also, education must begin before junior high school. The second area that comes to mind is long-term care because that definition varies across the country. How many staff do we have? How is it funded? How are decisions made about going into those facilities?
Ms. McDonald: We need to educate people on aging as part of the life course perspective starting in grade school by having children involved in volunteer activities. We did that in Winnipeg and it was a great success. Children need to learn about aging and that it is a positive event.
In terms of standards, Bill 140 in Ontario, the LTC homes act, will set standards, in particular on elder abuse, which is absolutely not allowed. The bill proposes protocol to be followed when elder abuse occurs in the care of seniors. Everyone in Ontario is pleased with that. We had a forum on this issue and some standards are being put into place but we need to do the work at the university level. We have licensing bodies for doctors, nurses, social workers, psychologists and occupational therapists, et cetera. In those fields, research is a core requirement to licensing. Why is it not a core requirement in gerontology? That is one area that we often forget. We need to lobby to put that requirement on the agenda.
Ms. Martin-Matthews: My colleagues have raised important points with respect to training professionals, which is at the heart of your question. There is another issue on education. I came in at the end of your discussion earlier with the panel on home care. Not all delivery of services to older people is done by people with professional accreditation. We know that in Canada we have approximately 32,000 individuals, primarily, but not exclusively, women, who provide the kind of home care that we call ``home support'' in bathing, feeding, toileting and dressing. These people have little training, for the most part. They are paid on a per-visit basis to a home, with no recognition of the travel time to and from, et cetera. In considering the education aspects, we need to respect how important it is in relation to professionals.
Over the next 10 to 15 years, we will need an additional 32,000 home support workers to meet that future need. Yet, we are not recruiting in those fields. The minute people have sufficient training, they go to work for long-term care facilities, where they have continuity of payment. They know what job they will do from day to day. The way in which the delivery of home support services is structured, they cannot know what job they will do each day or where it will be done. I want to plead for recognition of that full continuum of workforce that we need in respect of our aging population.
Ms. McDonald: Personal care workers are hired by families, nursing homes and long-term care institutions outside of any profession. They are hired off the street to come in and watch over mother or dad to make sure they are fed, go to the washroom, et cetera. In some institutions, a family will have three of those people because they cannot be there to watch the quality of care that the person receives. Their food tray might be in front of them but they cannot always feed themselves. The people brought in to assist are paid under the table, are not paid minimum wage, are hidden much of the time, and likely belong to the cadre that you are speaking of that require a great deal of education.
Senator Mercer: One interest level for young people in particular in caring for aging members of society is through volunteer groups. I come from that sector and, when one visits a long-term care facility, they always see groups of young people visiting, whether to sing Christmas carols or to help decorate for a particular festivity. Do you see value in expanding the use of volunteers, not only in the basic care of seniors but also in increasing the quality of life of seniors, as opposed to actual physical health and well-being of care?
Ms. Hirst: The evidence supports that intergenerational visiting has value, and I would be the first to advocate for that.
My concern would be the preparation of the student to realize that a senior in a care facility only reflects that percentage of the older population. Sometimes students receive restricted visions unless they are exposed to the wealth and variety of seniors. That visit must be accompanied by education and evaluation, and sometime ethnic matching too, with the mother language coming through.
Senator Mercer: You have all talked about the fact that so few people are going into the field. Fairly soon we will rely on immigration to replace our workforce. We do so extensively now, but it will become even more pronounced in the future.
Now we have introduced not only new people to the workforce but people with different perspectives, coming from other places. In this room, we all have families that come from someplace else, unless we are native Canadians.
How do we prepare for that? As new groups of people come to the country, their parents and they themselves are aging. They will be the people recruited into some of these jobs. How do we prepare them to deal with the standards and culture of the people who are in need of their services?
Ms. Martin-Matthews: That is an interesting question, because there is the issue of their professional training. We are also talking about acculturation and adaptation, an awareness of the dominant norms and values of the society.
In Canada, we largely recruit a skilled labour force, but we still do not recognize the skill set of members of that labour force. For instance, when I conduct research in British Columbia with women who are employed at the lowest end of remuneration in the care system — the basic body work of feeding, toilet work and dressing — they are often learning about the culture when they are in someone's bathroom in a private home context. They have not been trained for that in terms of the curricula in the community colleges. Researchers are working with the community colleges to add components such as you described to the training of workers.
Moreover, many of these individuals come from the Philippines. They have training in nursing in the Philippines, but they come to Canada and their credentials are not recognized in this context.
We have two jobs to do. We need to find a standard, a mechanism for recognizing the credentials of our immigrants. When I come to Ottawa, many times I am in a taxicab driven by someone who is an engineer from Lebanon or a physician from somewhere else in the Middle East.
We can address some of those shortages with a recognition of their credentials, reaching an appropriate threshold of performance and expertise, and doing that in conjunction with helping immigrants appreciate and understand the dominant norms and values of Canadian society.
Ms. Hirst: Another possibility is culture-specific facilities. Across this country there are a number of those, for example, Toronto Baycrest Centre, which is structured for the Jewish community. There are a number of Chinese facilities as well. We should consider recruitment of ethnic groups specific to that facility and then develop and support their acculturation to the larger Canadian context. We have a number of good facilities.
The Chairman: Before I turn this over to Senator Cordy, I have a question based on something you raised, Ms. Hirst, and that was with respect to the changing conditions in long-term care facilities. I know they differ in definition, but they also differ in what has happened, it seems to me, in the last 20 years.
At one point, we had four levels of care within that long-term care facility. Now we have two levels of care, because the ones and the twos, and even some of the threes, now live successfully in the community. The long-term care facility has become a much more intense site of the delivery of complex care.
Have we changed the staffing levels in those places appropriate to the fact that they now deal with patients with much more complex needs, or do we still expect those same nurses, nursing aides and nursing assistants to provide the care when in fact the burden is so much higher?
Ms. Hirst: I suggest we have cut back. Where we had registered nurses, for example, we are now using licensed practical nurses, LPNs, or registered psychiatric nurses. Where we had LPNs, we are now using nurse's aides, because of funding.
Ms. McDonald: That is the case in Ontario.
Ms. Hirst: Alberta, B.C. and Saskatchewan have also cut back. That is deplorable.
Ms. McDonald: The care is more complex and people are not trained in complex care. That new area is developing before our eyes.
The Chairman: Is that one reason for burnout?
Ms. Hirst: It is bound to be. It is also a reason for the abuse and neglect that is prevalent in our facilities. I deliberately tried to avoid the use of the phrases, ``elder abuse'' and ``age abuse.'' We are not giving good quality care. We are not giving the kind of care that I want to give when I go into a nursing home, because I am rushing from patient to patient. I want more time to give better quality care and I want to be able to listen better. I think I listen pretty well, but my patient load is high.
Senator Cordy: On my cab ride in from the airport today I had a discussion with the cab driver, who is an electrical engineer from India and who has been in Ottawa for 18 months. It happens so often that as soon as somebody finds out we are going to Parliament Hill, we are asked to deal with the issue of credentials. It is a shame, when we have such well-qualified people in our country, that we do not use them to their capacity, especially since we have shortages in so many areas.
Ms. Martin-Matthews spoke about knowledge transfer, and Ms. McDonald spoke about the same idea, using different terminology: the idea of taking research and putting it into action.
Are we sharing best practices across the country with people working in the field of gerontology, or is everyone working in isolation?
Ms. Martin-Matthews: The answer is yes and no. If I compare the situation to when I came into this field 30 years ago, we are now much more aware. I have seen a real change, in the last decade or the last five years in particular, of recognizing that in certain crucial areas we know what we need to know.
What we need to do now is to ensure that the people who work in clinical and policy settings are aware of that. There is much more emphasis on that kind of accountability when we fund research today than was the case when I started in this field 30 years ago.
We have programs, for example, which are called Canadian alliances for health research, where before a project is even funded, researchers work in partnership with a group in the community. This is one of the initial programs that CIHR started.
If we fund researchers in Alzheimer's, many times the researchers work with a local Alzheimer's society or facility and to ensure their partnership not just in terms of how they deliver the answer to the research they are doing, but in terms of how they frame the question. What is the question? That is not just something that is dreamed up. I do not mean this pejoratively, but it does not come from the research community alone but in partnership with researchers.
That having been said, we have a long way to go. I attended a meeting in Winnipeg early in October. We were talking with a group of physiotherapists and occupational therapists about issues of mobility and aging. They were talking about how they simply do not have the time structured into their day, the way their facility operates, to cull the academic literature to find out the latest thinking about a certain procedure. We talked about ways that we might take interns or people who are newly trained, who spend a lot of their time learning about current research, and have them as resources in some of the practice settings.
We have a long way to go in terms of thinking what the best ways of effecting knowledge transfer are. We have a new Vice-president of Knowledge Translation at CIHR who is working with us around that best practices issue. We all think we know what we are talking about when we use these words — knowledge exchange and knowledge translation. We all mean largely the same thing, but we do not know the best practices for linking the research community and the practice community. However, I have more optimism around that than I did.
Ms. McDonald: One thing we are doing at NICE is we have different models for transferring knowledge across the country, and we will evaluate which ones work the best and the fastest. That is what we are trying to do. We keep applying for research grants to continue to do this and we have been successful.
We will try to find out what works in what type of area. We think rural will be different from a major city, and that ethnic diversity will make a difference. We need to look at many models. We have culled literature all around the world about knowledge transfer to find out the best practices.
In the U.K., they want to develop knowledge brokers as a profession. At first, I said ``What?'' Then I thought, this idea is not bad because there is so much knowledge out there. Ms. Martin-Matthews is right; we have a lot of knowledge but we need to pick what is the best knowledge. There is the Cochrane Collaboration, which you will know about, and the Campbell Collaboration, which sets standards for good, evidence-based practice. How do you know this piece of research is good? I know our network is based on those two bodies. We make our decisions based on those standards, and I think more and more people do.
Senator Cordy: It is almost a Catch-22 — you are short of people in that field and you are trying to share information.
Ms. McDonald, you transfer knowledge to those who need it. Is that those who need it in providing services, seniors who need the service or both?
Ms. McDonald: We only have so much money, so we started with the three professions; that is what we are talking about. For example, we have a virtual newsletter that goes out every two weeks. It takes three top, brand-new articles, judges them according to the research standards I spoke of, writes them in English or French in one paragraph — this is new, this is what is happening. People read that and receive brand-new knowledge in the field.
We direct our work at people in the field, but we have brought in older adults to say, this is a bunch of rubbish, this works and this does not work. They are independent from us and we are saying, go for it and let us know. Again, we are hit- and-miss across the country with who wants to belong and who cares enough to belong. I say to people, if you will not do any work, do not join our network because we work.
Senator Cordy: Your evaluation is done by people who are outside of your group.
Ms. McDonald: Yes.
Senator Cordy: I want to change the topic to the issue of seniors who suffer from poor mental health. Within the population as a whole, one in five Canadians will suffer from poor mental health at some time. We have heard from so many witnesses that it is challenging to deliver services to seniors overall. How challenging is it for a senior suffering from a mental illness? For example, Ms. Hirst spoke about the senior who kept rubbing her cheek.
Ms. Hirst: One that comes to mind is Ms. McDonald's work on homelessness.
Ms. McDonald: We did a study — ``In from the Streets'' — in Toronto of older homeless people. First, we looked at people who are on the streets, 50 years of age and over. Then we looked at people housed in alternative housing to find out how they finally got there.
Most of these folks had mental health issues and received no treatment until they were in some form of housing. Alternative housing usually means there is some type of service attached, either on-site or brought in.
These people lived on the streets; and we have shown — using the OHIP data before and after they were housed — that both their physical and mental health improved once they were housed. They needed the service. When they were on the street, they did not receive that service; and that is about as low as you can go in this country, in my view.
If you have gerontopsychiatrists come in, they will tell you the situation. They are rare people. There are not many of them, so how does someone with severe depression see someone if that person is starting to have Alzheimer's disease?
Ms. Hirst: There is a cultural issue here too. In certain cultural groups, we know mental health is a term that is not accepted or used; it is totally avoided and hidden. Ethnic diversity in mental health services is an issue. We know older seniors from diverse backgrounds do not access the health services they need.
Ms. McDonald: Dr. Rosemary Myers conducted a study in Toronto on ethnic seniors who could not access services for their mental health problems. It is substantial. I do not know how long it takes.
Ms. Martin-Matthews: Those issues are all crucial — along with the issue of stigma that is attached and the lack of attention to services that may be needed.
Another interesting angle is that while there are many problems, there are also some successes. One of my favourite examples of success, where research led to action, is when the government funded the Health Transition Fund through Health Canada in the mid- to late-1990s, with synthesis documents developed in 2001. I wrote the one on seniors' health. There were also documents on home care and mental health, et cetera.
One recommendation that came out of the Health Transition Fund, which funded demonstration projects across the country, related to the integration of pharmacists and physicians — bringing the pharmacist and the physician into collaboration, or five physicians if someone has five of them, to make sure everyone receives a profile of the medications, et cetera that a given individual is using. The demonstration projects in that area were highly successful.
I am encouraged to see experiments in this area around the country — I do not know if this is in all provinces, but certainly my own province of British Columbia and Newfoundland and Labrador have experiments going on. The minute a person is discharged from hospital or has another crisis in terms of their health care, the physician is brought in to do a review on the full range of medication. Sometimes, the depression, confusion and delirium are all related to the complex of pharmaceutical products that people are taking. We have much to learn about how these products interact in the body of a 91-year-old person, for example.
It is important to recognize that some intervention that are evidence-based have proven to be highly successful and hold some promise. Even though they do not address all the issues that my colleagues have identified, there are success stories and we can build on that.
Ms. McDonald: I want to talk about another incredible success story. This poster was made by older homeless people and it says ``political action.'' We have three points on the poster that we are sending to members of Parliament and members of legislative assemblies. We provide the stamps, but they designed the poster themselves. About 15 of them met with us for a year and when it was finished, they came back to us and said that it made them feel so good that they wanted to do something more. They formed a speakers' bureau, and they go out and speak about what it was like to be homeless, and the stigma of having a mental health problem. Now they have housing and support and they are doing well. They now have a meaningful activity.
Senator Murray: You do not need a stamp to send it to MPs or MLAs, by the way.
Ms. McDonald: We did in Ontario.
The Chairman: You do for MPPs in Ontario, but you do not for MPs and senators.
Thank you, honourable senators and, more importantly, thank you, honourable witnesses. This session this afternoon has been terrific. We appreciate that you have given us your time and knowledge.
Honourable senators, last week you will note that there was an announcement of a meeting to take place in February on seniors and emergency preparedness. You will all receive an email. We do have the resources necessary. If any of you are interested in attending that conference, I want them to send you the details of when it is. I know it is in Winnipeg in February, but beyond that, I do not know.
Ms. Hirst: It is from February 6 to 9.
The Chairman: Our witnesses know and that takes a little burden off. Please let us know if one or more of you would like to attend.
The committee adjourned.