Proceedings of the Special Senate Committee on Aging
Issue 9 - Evidence
OTTAWA, Monday, May 28, 2007
The Special Senate Committee on Aging met this day at 12:32 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 to the meeting of the Special Senate Committee on Aging. We visited the Elizabeth Bruyere Research Institute on May 18. I have asked staff to make a summary of that visit and, if members are agreed, I would ask that it become part of the record of the committee's proceedings.
Hon. Senators: Agreed.
The Chairman: Today's meeting will focus on vulnerable seniors. To help us understand the issues surrounding this important topic, we will hear from representatives of a variety of organizations. The first panel of witnesses is from the Alzheimer Society of Canada: Mr. Dale Goldhawk, Chairman of the Board; and Mr. Scott Dudgeon, Chief Executive Officer. The mission of the Alzheimer's Society of Canada is to identify, develop and facilitate national priorities that enable its members effectively to alleviate the personal and social consequences of Alzheimer's and related diseases, to promote research and to lead in a search for a cure.
As well, we will hear from Ms. Judith Wahl, Executive Director of the Advocacy Centre for the Elderly, a community-based legal clinic for low-income senior citizens. ACE is managed by a volunteer board of directors, at least half of whom are seniors, and is funded through Legal Aid Ontario and is the first legal aid clinic in Canada to specialize in the legal problems of seniors.
Finally, we will hear from Ms. Faith Malach, Executive Director of the Canadian Coalition for Seniors' Mental Health. The coalition's initiatives are based on the belief that mental illness is not a normal part of aging and that all seniors have the right and deserve to receive services and care that promote their mental health and respond to their mental illness needs.
Dale Goldhawk, Chairman of the Board, Alzheimer Society of Canada: I am the volunteer president of the Alzheimer Society of Canada and I thank you for your invitation to appear here today. I will begin by expressing my appreciation for the important work that this committee is undertaking on behalf of Canadians. We are pleased to be part of the ongoing deliberations of the committee. We would like to take the next few minutes to talk about the effects of Alzheimer's disease on an aging Canadian population.
By its very nature, the disease slowly destroys memory and reasoning, erodes independence and leads to the need for increased levels of caregiving and family support. It robs us of the very attributes that define us as autonomous, functioning people, eventually affecting all aspects of a person's life, including how they think, how they feel, how they act and how they react to their environment. Make no bones about it, this disease is a deadly condition. No one is cured of it and no one survives it, including my father.
Throughout its course, Alzheimer's disease puts individuals in a vulnerable state, leaving them at an increased risk of abuse, neglect and economic hardship. Alzheimer's disease attacks without prejudice in that it strikes rich and poor alike and claims victims from all walks of life. It affects more women than men, and most caregivers are women.
Seniors whom your committee has already deemed to be at risk, including older women, unattached seniors — of whom almost three quarters are women — and immigrant seniors become even more vulnerable following a diagnosis of Alzheimer's disease. Many people diagnosed with Alzheimer's disease are already struggling with other chronic conditions, such as diabetes, heart disease or hypertension, that complicate treatment and compromise further their economic and physical well-being. Almost all people with Down syndrome who survive into their 40s will develop Alzheimer's disease.
As your committee works further to define "senior," we at the Alzheimer Society of Canada, ASC, are always faced with this same issue. Alzheimer's disease does not strike down only those over the age of 65. With increased knowledge and awareness of the disease, people are being diagnosed as early as 50 years of age and certainly in their early 60s. The economic and health sector ramifications of this are nothing short of enormous.
What does all this mean to Canadians? What does it mean to the Government of Canada as it struggles to understand the changing landscape of this country's demographics? Mr. Dudgeon will provide the committee with more details.
Scott Dudgeon, Chief Executive Officer, Alzheimer Society of Canada: Approximately 450,000 Canadians over the age of 65 currently have Alzheimer's disease or related dementia, and the number of cases is expected to double within the next generation. A Canadian government study completed in 1995 estimated the total annual cost of Alzheimer's disease and related dementia to be $5.5 billion. While more recent estimates are unavailable, it is safe to assume that 12 years later the costs are considerably higher. As we look to the future, Alzheimer's disease and related dementias might prove to have the highest economic, social and health cost burden of all diseases in Canada. It is our belief that the Government of Canada must act now and sponsor the development of the Canadian dementia management strategy as proposed to them by the Alzheimer Society of Canada. Time is of the essence.
This strategy will draw upon the collaborative efforts of policy-makers, health care system managers, clinicians, researchers and health care providers. It will encompass those aspects that most directly impact the lives of those touched by Alzheimer's disease or related dementia.
Allow me to elaborate. Effective prevention can help to reduce the future epidemic of dementia and ultimately reduce the burden on the Canadian health care and social network systems. We need to define specific interventions that are designed to delay the onset of dementia or to mitigate the impact of dementia on people who have the disease.
There are several barriers to early diagnosis within the health care system and within society. Dementia often goes unrecognized by families and physicians or it is misdiagnosed. We need to develop interventions that will raise awareness of this disease and help physicians in diagnosing dementia.
With respect to improved treatment, access to effective medications is essential for those suffering from Alzheimer's disease. Some seniors are financially vulnerable and cannot afford the high cost of purchasing necessary drugs. Also, medications approved by Health Canada to treat Alzheimer's disease are not currently available in all provinces. We need to ensure that all Canadians have timely and equitable access to current and emerging treatments.
With regard to improved care, we need to look at approaches to be adopted by home care, community services and long-term care facilities to preserve function and maintain a good quality of life for people with dementia, including high quality end-of-life care. We need to improve care delivery by assisting health care workers with appropriate training and support interventions.
With respect to care for the caregivers, the leading cause of admissions to long-term care facilities for people with dementia is caregiver exhaustion and burnout. For many people with dementia, their primary caregiver is also their spouse, who in many cases is dealing with health problems of their own. We need to identify actions that will maintain the health of family caregivers and maintain their capacity to support people with dementia in the home setting.
Finally, with respect to research, more funding is needed in support of Canada's world-class researchers who are working to find a cure and to improve the quality of life for those with the disease. We need to generate more research dollars and concentrate on facilitating the translation of research and best-practice guidelines into sustainable improvements in clinical practice across Canada.
We believe that these six critical areas must be addressed through a Canadian dementia management strategy. It is more evident now than ever before that gaps exist in meeting the needs of people touched by Alzheimer's disease. The implications for future government policy initiatives need to be understood and addressed. We are asking this committee to acknowledge the gravest fears of aging Canadians by prevailing upon the Government of Canada to make dementia a national health care priority.
Judith A. Wahl, Executive Director, Advocacy Centre for the Elderly: Honourable senators, thank you for the opportunity to present here today on the issue of vulnerable adults. I am coming to this issue as a lawyer from a legal perspective. To put my remarks in context, I will explain the work of the Advocacy Centre for the Elderly and, particularly, our experience in representing and advising older adults.
The Advocacy Centre for the Elderly is a community legal clinic, and although we have been open since 1984, we are still the only legal service of its kind in all of Canada concentrating on elder law, although there is a growing demand and interest in elder law issues.
The range of legal services provided is broad. In direct legal service, we provide advice on individual problems and representation at all levels of courts and types of tribunals. The advice and representation is across a broad range of legal issues, although the greatest demand is for advice and advocacy on issues related to mental capacity problems from the senior's perspective; advocacy on health law issues; access and eligibility to home care and long-term care systems, the largest growing area of work; conflicts around discharge from hospital; mental health problems, particularly those related to access to home care; long-term care; and advice and representation on what we would broadly call elder abuse issues, which include abuse of power of attorney, fraud, misuse of authority, financial abuse, physical abuse and neglect.
The second part of our work is public legal education. We provide education services to the seniors population so that they can navigate through the systems. We have identified that many seniors do not have the information they need to get access to and prove eligibility for some of the services.
We do workshops and work collaboratively with others on education programs to improve the legal rights of seniors. For example, we have been involved in a great deal of collaborative work with police services in Ontario and with the Ontario Police College to improve the police response to crimes against seniors, including crimes that may occur in long-term care settings, and to develop improved approaches to investigation of particular senior-focused crimes, such as abuse of power of attorney.
We have also been part of the Alzheimer's initiatives in Ontario and, in particular, the development of educational materials and training programs on advance care planning and health care consent. That has been done in collaboration with the Alzheimer Society of Ontario, the Ontario College of Family Physicians and the Government of Ontario.
We also engage in a variety of law reform activities where we respond to legislation and policy that is presented, particularly in the provincial legislature. Some of the submissions we have done lately include submissions on long- term care, advance care planning and health care consent, elder abuse response, and retirement home regulation.
Clearly, not all seniors are vulnerable. Although I hope the stereotype will disappear, I know that to some degree it still continues. Older age alone does not make a person vulnerable. The common complaint we get from seniors contacting our office is that they are not being taken seriously, that others are taking control of their lives and taking away their rights to make their own decisions, testing their capacity and their competency when in fact they are totally competent.
We look at vulnerability in terms of developing responses that are not too intrusive. We do not support changes to the Criminal Code to make specialized offences in respect to elder abuse. The code is sufficient to respond to elder abuse. What we see in practice is the need to provide better responses from policing services and from the Crown attorneys to give them the time to approach these issues in comprehensive ways. Unfortunately, many of the issues related to elder abuse get dropped to the bottom rung, even within the police services. Unless you have an active service, like the one in Ottawa, elder abuse does not get the attention it needs.
What contributes to vulnerability? It is not the seniors themselves that I see as vulnerable. We see vulnerability because of a lack of accurate information about rights within health and social service systems. Despite legal frameworks, we see services and systems denying seniors' basic rights with respect to eligibility and access. The seniors may not have the information to advocate for themselves; likewise, the families of seniors who lack mental capacity may not have the information they need or access to appropriate legal or advocacy assistance.
For example, we deal daily with discharge issues from hospitals. Most hospitals across this country have illegal discharge policies, in my opinion. In Ontario, we see people being told they have to take the first available bed in any long-term care home wherever it is, even if it is a far distance from family and friends. In fact, the law supports a right of choice. There is a balancing in the law. Of course, people need to move out of the hospital when they no longer need acute care, but, at the same time, people's rights to choice have to be respected so that they get to the place where they will receive appropriate care with the supports they need. Our experience in this area is that where people are forced to go places that they do not want to go or that are not appropriate to meet their needs, they just recycle back into the hospital beds from which they were discharged. The law supports the right of choice, yet it is not observed.
We also see this in respect to health care consent and advance care planning. I am supportive of appropriate advance care planning, but some facilities require seniors to execute advance directives even if it is not their choice or make statements about DNR — do not resuscitate — when they do not want to. The facility does not want it in their way on their form. It does not reflect provincial law in any province, yet that type of pressure is put on seniors in those forums, and the seniors do not always have the knowledge to push back. Seniors are vulnerable because of lack of understanding by health and social service providers of seniors' rights within the systems, so we can end up with denial of those services or a determination that a person is ineligible for services. Recently, we have been advised of problems with seniors with past psychiatric histories not even being allowed to apply to particular long-term care homes.
Seniors may be vulnerable because systems are not adapting to changing needs and demands. We see an increase in persons with dementia in long-term care and we see the call for training, but the training does not get done. In fact, in Ontario, it has been integrated into the long-term care legislation, but the real question is whether we can implement it. We see the good policies coming out but not the supports for their implementation.
We also see people not receiving the home care services that they need, particularly those seniors who have mental health problems. The other day I was told bluntly by one of the home care services that they do not do mental health. People needing supports in the community might have to turn to living in an institution because they cannot get the services at home.
Seniors may be vulnerable because of the interpretation by providers of the limit on access to services. Two hours a week of assistance is not enough for a person who needs a small amount of daily care in order to keep them out of a long-term care home. Recently I have been dealing with a woman who has ongoing needs for personal support and nursing services. This has been confirmed by the home care services, but she has been told she will no longer receive the equipment to support the services — a hospital bed in the home and a commode. Ironically, one of the support services is telling her now that they will not be able to provide the service because it is unsafe for the workers. She is eligible but she cannot get the equipment because the service has a rule that they will pay for the equipment only for one month. She is a low-income woman and cannot pay for that rental herself, so will end up without the equipment and in a long- term care home.
How should these matters be addressed? I have more questions than answers. Should there be a national home care program that makes available not only medical and nursing services but also ongoing personal support services? So many people need a little every day that would keep them out of the long-term care homes, but that is not within the systems.
Do we need to train health professionals and social service providers in the legal framework in which they work? As a lawyer, I see the legal framework as helping to balance the rights within systems. However, we see that the training given to health professionals, even in palliative care, should include an element about the proper legal framework in their province in order to get the advantage of the balancing in the legislation.
How do we ensure seniors' access to accurate information about rights and access, eligibility, and how to navigate systems? I test out different information lines to see what kind of advice they give. I must say it is not always as thorough as it should be or it does not deal with the contentious issues like getting a review if you are denied a service.
Is there a need for advocacy and legal services for seniors across the country? At this time there is limited legal aid for civil matters across the country outside of Ontario, and Ontario has it only because of the network of community legal clinics. Even there it is limited.
There is a federal role in legal aid. Should this be expanded beyond funding for criminal matters and youth justice, which is where the funding is concentrated?
Lastly, in terms of response to elder abuse, should we be looking to approaches based on support and assistance to the senior, which would include access to social housing and home care, approaches that are not based on child protection models but rather that respect the rights of seniors as decision makers who need assistance when an abuse occurs?
Do we need increased and improved support to police services to investigate crimes against seniors and give them the tools with which they could do the work? I was talking to a police officer recently who said his service is supportive of him doing the investigations, but they do not have the videotaping equipment necessary to take statements from seniors. Right now with numerous cases coming through, if you do not have that video-taped statement you may not have the evidence when the matter comes to trial, and the matter will come to naught.
I will conclude there and wait for questions.
Faith Malach, Executive Director, Canadian Coalition for Seniors' Mental Health: When I told my family I was coming to Ottawa to see the senators they told me the Senators were playing in Anaheim on Monday, not in Ottawa, and I was going to the wrong place. The Senators helped to put Ottawa on the map, and I am here today to make sure that seniors' mental health is put on the map.
Honourable senators, I want to take the opportunity to thank you very much for your invitation to the Canadian Coalition for Seniors' Mental Health to present to you today on seniors' mental health in Canada. During my time I will briefly raise some of the most important key issues from the perspective of our coalition. We are a national organization made up of 850 individuals and approximately 85 organizations across Canada. The coalition's mission is to promote the mental health of seniors by connecting people, ideas and resources.
Our goals are the following: first, to ensure that seniors' mental health is recognized as a key Canadian health and wellness issue; second, to facilitate initiatives related to enhancing and promoting seniors' mental health resources; third, to ensure the growth and sustainability of the coalition.
The coalition has a volunteer steering committee made up of 13 national organizations. I am pleased to see Mr. Scott Dudgeon presenting here; he is one of our national steering committee members.
The most important message I can formulate today is that seniors suffer from a wide array of mental health issues and illnesses. Typically, when we think of health and aging we think of the physical illnesses — cancers, arthritis, stroke, heart diseases. Yet, in addition to these common physical illnesses, seniors also experience mental illnesses including mood, anxiety and psychotic disorders, in addition to emotional, behavioural and cognitive complications and a variety of brain diseases such as Alzheimer's disease, stroke and Parkinson's disease.
It is important to recognize that while many individuals experience mental health illnesses as they age, many have lived with mental illnesses their entire lives and enter their senior years with a mental illness. It is important to acknowledge those differences.
According to the Mood Disorders Society of Canada, the chance of having a mental illness in your lifetime is one in five. While mental illness is not a normal consequence of aging, the information and data related to seniors is quite alarming. For example, depression is the most common mental health problem for older adults, with a reported rate of 21 per cent. The group with the highest rate of hospitalization for anxiety disorders is those over age 65. Among older persons undergoing general surgery, the reported frequency of post-operative delirium is 10 per cent to 15 per cent. For cardiothoracic surgery, this number goes up to 25 per cent to 35 per cent, and for repair of a hip fracture it is 40 per cent to 50 per cent.
Suicide is another area of serious concern, as the incidence for suicide in Canada is highest among men over age 80. As illustrated by these numbers, seniors' mental health cannot be ignored.
The coalition is thrilled with the recent announcement of the Canadian Mental Health Commission. At the annual Canadian Institutes of Health Research, CIHR, meeting last week for the Institute of Neurosciences, Mental Health and Addiction, the Honourable Michael Kirby shared in his presentation that seniors would be a target group for the commission, and we are thrilled to hear that.
It is understood that one of the key goals of this new national group will be to combat stigma and discrimination. This is of particular importance to the coalition because seniors with mental health issues face what we refer to as double stigma or a double whammy, the stigma of aging and the stigma of mental health. In order to address this problem, there is a need for increased public education, raising awareness, and targeted anti-stigma and discrimination campaigns specific to seniors and mental health. Audiences must include the general public, the media, health-care practitioners, families, caregivers, administrators and policy-makers.
A third major issue is gaps in information. Until May of 2006, Canada had no national multidisciplinary guideline pertaining to seniors' mental health issues. With the support of funding from the Canadian government through the Public Health Agency of Canada, the coalition brought together experts from across the country to develop the first ever national guidelines in the area of depression, suicide, delirium and mental health issues in long-term care homes. Approximately 11,500 hard copies of guidelines were sent to hospitals, long-term care facilities and mental health teams across Canada, and 10,000 copies of these guidelines have been downloaded from our website. A supplement of the guidelines produced in the Canadian Journal of Geriatrics was sent to 10,000 physicians across Canada.
The creation of these guidelines has raised some important issues and challenges. First, there is a significant lack of evidence-based research in Canada on seniors' mental health issues. Second, there are tremendous disparities within and across provinces with regards to provision of care. This is specific to prevention, detection, screening, assessment, management and monitoring of mental illnesses in Canada with regard to seniors. Third, mental health care must be approached from a psychosocial and pharmacological perspective that includes the patient and the family. Fourth, access to mental health services and professionals across and within treatment sites, communities and provinces varies widely. Fifth, there is a serious need for training and education of health care practitioners on mental health and seniors. Finally, there is a lack of information about how to integrate guidelines into practice.
Since our guidelines were launched, dozens of organizations and individuals have begun to implement them, but this takes leadership, time and evaluation. Our coalitions has submitted a solicited request for proposal in January 2007 to the Public Health Agency of Canada, Division of Aging and Seniors, to facilitate seven large-scale, provincial pilot projects to implement the guidelines, but we have yet to receive approval for this project.
Another key issue that must be raised is the accessibility to mental health services. Many compounding variables must be considered and further investigated to comprehend and respond to this issue, including lack of mental health professionals, limitations in accessing communities mental health services, limitations in accessing services that would assist in maintaining seniors in healthy communities and in their own homes, lack of mental health services and programs available to seniors within long-term care homes, access to primary care physicians, and priority of physical health programs and policy over mental health programs. Many of these problems are systemic in nature and stem from lack of funding for community programs for mental health, lack of inclusion of mental health within training for health care practitioners, and the lack of funding for mental health professional services over physical health care programs.
A further issue that must be raised is that of caregivers. Providing tax credits and financial support for caregivers is simply not enough. The government must ensure that those caring for our seniors with mental health issues are provided with the necessary emotional support, education and respite. If our caregivers are not cared for, they are increasingly at risk for mental health issues themselves.
Many additional issues for discussion have not been raised, such as housing, chronic illness, addictions, emergency preparedness, medication issues, et cetera, but seniors' mental health is an enormous topic that encompasses all of the determinants of health, all health disciplines, and many professionals outside of the health care spectrum and across continuums. Whether one lives in a rural or an urban setting, the community or a long-term care setting, whether a senior is aged 65 or 99 years, they may be affected by a mental health issue.
In only five years, our coalition has created national guidelines. We have created a seniors' mental health research and knowledge exchange network. We have held two national conferences. We have presented to Senate committees such as yours. We have participated in advisory and advocacy groups. We have created momentum and energy to bring seniors' mental health into the spotlight. While we are exceptionally wealthy in spirit, knowledge and commitment from our stakeholders, we are exceptionally poor in funds. We have only one year left of funding. Our successful national facilitating body will come to a close. This will be a sad end to a group that has flourished and has moved forward the seniors' mental health agenda. Without operational and project funding support from all levels of government, the coalition will disband. Surely a national group with an operating budget of less than $200,000 annually that enhances the lives of seniors should be supported by government.
Our coalition has submitted a written document to the committee responding to the interim report, providing details on many Canadian seniors' mental health initiatives and providing additional recommendations on issues, but for the purpose of our oral submission, we make the following recommendations. One, the coalition strongly supports a recommendation for a national aging strategy with the recognition of seniors' mental health as a critical matter and as a priority public policy planning and service delivery issue. Two, acknowledge that mental illness must be considered equally as important as physical illness. Three, recognize that seniors must be provided with access to professionals, services and resources that ensure prevention, treatment and management of mental illness. Four, we recommend a national strategy to combat stigma and discrimination; that must be a priority. Five, dedicated funding for the Canadian Coalition for Seniors' Mental Health to facilitate strategic national initiatives that enhance and promote seniors' mental health care, resources and collaboration is a must.
The Chairman: Thank you very much. I must say that the day I was appointed to this Senate, a young boy asked if I could play hockey that well, so there is some confusion with respect to the role of senators.
My questions are to each and every one of you, but I will begin with Mr. Goldhawk and Mr. Dudgeon. You said something today that struck me for the first time, and that is that people with Alzheimer's disease also have all the other diseases associated with aging, and I think we tend to not think that way. We think that if someone has Alzheimer's, then they have Alzheimer's, without necessarily thinking that they may also have diabetes or have had a stroke or may also have heart problems. Do you have any accurate statistics on the multidisciplinary management of these people?
Mr. Dudgeon: I do not off the top of my head, but there is some good literature on the co-morbid conditions. Obviously, one of the strongest risk factors for Alzheimer's is aging and, as people get older, they accumulate a variety of health issues. Once people have dementia, the management of those issues becomes quite a bit more complicated; however difficult a time you might have had with your heart disease or diabetes, once you are demented, compliance with medication is very difficult and just attending to the normal tasks of staying healthy becomes very difficult. The co-morbid conditions become that much more important than they were before the onset of dementia. I would be happy to find some literature that would support this, if that would be helpful to the committee.
The Chairman: It would be very helpful. It makes sense, if you think about it. If you have dementia, you will forget to take your injection for insulin, if you happen to be insulin dependant, or you will forget to take your arthritis medication if you have rheumatoid arthritis, and the condition of your rheumatoid arthritis may therefore complicate your condition of Alzheimer's disease.
Mr. Dudgeon: There is another feature to that with respect to the caregivers. The people who are looking after people with Alzheimer's disease do not look after themselves, and that is well-documented. The incidence of depression in people who are looking after family members with dementia is much higher than that in people looking after family members with other chronic conditions. There are other health conditions as well. They are just not taking very good care of themselves because their focus is on the person whose primary need is so urgent.
Mr. Goldhawk: In the case of my family, the health of the primary caregiver, my mother, suffered greatly. She went into this huge battle — the seven years it took for Alzheimer's disease to kill my father — in perfectly good health and ended it in very poor health and she died a few years after that. I always consider that to be part of the Alzheimer's death toll in our family.
Another aspect about a multiplicity of diseases is that I often think somehow Alzheimer's disease is put somewhere near the bottom and considered too frequently to be a benign disease where you just kind of forget who you are and what you are and where you have been in your past life. However, is really filled with a lot more agony and suffering than that forgetfulness theory would entail. There is all the early anxiety of the victim himself or herself wondering and worrying about why they are losing themselves to this disease. That is later replaced by the family worrying and wondering about what will happen to the loved one who has this terrible disease in which the person you knew and the person you loved, for all intents and purposes, has disappeared.
The Chairman: I think we have all shared family experiences like that. In 1980, my father, who was a stroke victim for 10 years complicated by diabetes, died in May and my mother died in December, primarily because she had worked herself to death looking after my father. We have all seen those caregiver problems.
Ms. Wahl, in your presentation you mentioned the law reform commission. Have they done work attempting to generate ways of approaching the law with respect to vulnerable seniors?
Ms. Wahl: Actually, I had not commented directly about the law reform commission. Now that it is gone, I wish it were back. In the past, they had done reports on aging. I can remember early reports about capacity way back when I first started my practice. I think it is an important element in the development of the law that we have that type of resource that looks at those issues in depth. Unfortunately, at this time it is not there.
The Chairman: You indicated that you did not think we needed specific changes in the law; we needed to have some work done to generate more engagement with the police or with other law agencies. When I heard your report, I was thinking of the whole issue of wife abuse, that at one point it was just a family thing that we did not interfere with. Is that the approach to elder abuse that is practised to some degree by our police — that this is within families and we do not want to venture there?
Ms. Wahl: We have to get over that attitude. It is the same with wife abuse. The law was already there, but it was not being applied. I draw exactly the same parallel to many of the abuses that we see with seniors. That is the peril.
Multiple things have happened. One is that we are not taking the abuse seriously because it is just seniors. Second, it takes time to do those investigations. The police services have such a huge workload with big crimes and other things going on, and elder abuse issues might be more difficult to investigate and take more effort. To communicate with someone who has a communication disability, or to go into a nursing home to meet with people to really check out whether the senior is capable and so on takes a lot of effort on the part of police services.
I have seen some police services doing it very effectively. Ottawa and Hamilton are two good examples. However, they also need the credibility within the policing systems. Many police services do have an elder abuse officer, but that person is more a community relations officer doing education in the community but not providing that investigation element. Very few police services dedicate the police to investigative services, or they do not give them the tools in order to do full investigations.
Dealing with elder abuse has been hampered by the attitude that the seniors who are victims of abuse are like children and therefore we should follow a child protection model. I do not support that model. I do endorse the parallel to wife assault. These are adults; how do we support adults in an appropriate way?
The Chairman: Ms. Malach, I want to talk to you about funding. By whom are you funded? If you are to be funded in the future, should you be funded perhaps by the new Canadian Mental Health Commission that has been established?
Ms. Malach: To date we have had a mix of funding. Our project support funding has come through the Public Health Agency of Canada, through the population health fund, to fund projects such as the guideline project. We have had minimal funding, in the range of $10,000, for workshops from the CIHR Institute of Aging and the CIHR Institute of Neurosciences, Mental Health and Addiction. We have also had minimal funding from pharmaceutical companies and from small private foundations. However, over the past two years, most of that has run out or funding calls have not been relevant to our coalition, so we found it particularly challenging either to fit into a funding call or to be supported by private foundations.
In response to your question about the commission, if it was appropriate, absolutely. It has been challenging to figure out what the commission will be funding, and it is hard to know where seniors will fit. Certainly, we would be very open and could find some very quick wins for the commission in areas of stigma and discrimination and knowledge transfer activities specific to seniors. We have the infrastructure and the commitment from our stakeholders to produce some quick work through our knowledge exchange network, where we have already set up an online knowledge exchange opportunity for people to share research and knowledge.
Our challenge is our current staffing and the resources to keep it going. If there was funding to contribute to that, we have the infrastructure already set up. We have had a research workshop in the past where we have gathered together seniors' mental health researchers to speak to them about what some of the barriers are, what the opportunities are for bringing people together and what they need. We have the momentum and commitment from people, but we need money to keep us afloat. We have the partnership with CIHR and the Institute of Aging and with the Division of Seniors. In some ways, it really comes down to the dollars — not large dollars, but just the flow of some funds and the commitment.
We found it very difficult going out and meeting with foundations, banks and pharmaceutical companies to raise interest in some of the competing projects. I found it interesting that you brought up the question of how we mix with other disease groups. We have recently started a new project with mental health, seniors and cancer, because we know that cancer is a disease that affects seniors. We are now linking with cancer groups to identify the specific needs of seniors around cancer and mental health. We have found some small funding in that area. We found that if we link with other groups and bring in seniors and mental health, that is a creative way to bring in funding but also bring in some of the important topics.
We have learned that we have to go outside the box in order to sustain ourselves. Looking toward some of the other disease groups has kept us afloat.
Senator Murray: Ms. Malach, you told us you bring together in excess of 800 individuals and more than 80 organizations. I presume that would include provincial partners. Am I right in saying that those provincial partners would receive funding from their provincial governments?
Ms. Malach: Yes. Many of those are individual organizations — hospital groups and community groups that provide services; they would receive funding from their own provinces to run services.
Senator Murray: You mentioned the lack of training and the lack of funding — I presume you mean public funding — for mental, as distinct from physical, health. Where those policies affect people directly is at the provincial level. What are you or your provincial partners doing on that issue? What do you think Parliament or the federal government can or should do about it?
Ms. Malach: One example of what we are doing is in Nova Scotia, where we have worked with government and community groups to set up a seniors' mental health network in Nova Scotia. We meet regularly with the provincial government, long-term care groups, some mental health community groups and many of interdisciplinary and caregiver groups to talk about provincial seniors' mental health services, local needs and their community and long- term care needs. They have determined their provincial priorities related to seniors' mental health in terms of training and education under provincial policies. This new network has sat down and talked about what they need as a province and as a network. From a national perspective, we are able to give them national guidelines and connect them with other programs and services. For the first time, they are able to talk about what is happening regionally, create plans for their recruitment and training issues, and determine locally and provincially what they need.
Senator Murray: I do not want to put words in your mouth, but do I conclude that, in your view, in terms of training, funding, et cetera, overall, mental health issues do not have a sufficiently high priority among the policy- makers who are running the provincial health systems. Is that fair?
Ms. Malach: I can give you one example. Looking at long-term care facilities, nurses are trained on wound care, diabetes, emergencies and prevention of falls but not on mental health care; it is not on the list. Even in new long-term care legislation, mental health is not on the list. Why that is so is a good question.
Senator Murray: I do not know whether it was you or Ms. Wahl, because I made my notes without identifying the person I am quoting, but perhaps both of you spoke about the considerable differences among provinces in a number of areas. Was it you, Ms. Wahl?
Ms. Wahl: Yes, I spoke to that.
Senator Murray: How do we address that? Read the line from your study, if you would. I did not take the comment down verbatim but it struck me when I heard it.
Ms. Malach: When we created our guidelines, one the major issues we have heard is that it is difficult for people to implement our recommendations because there is tremendous disparity between the provinces regarding the provision of care, prevention, detection, screening, assessment, management and monitoring of mental illness in seniors and training.
Senator Murray: What is left?
Ms. Malach: There is nothing left; that is all of it.
Senator Murray: One does not want to start pointing fingers, but are there best practices? Are one or two provinces manifestly ahead of all the other provinces in this respect?
Ms. Malach: I would say that Ontario and British Columbia are starting to do it well; I would not identify the provinces in total as doing it well, but certain areas within the provinces are, and that comes down to the leadership of certain people, areas and programs. Within Ontario, the P.I.E.C.E.S. program does it well and they are teaching it well.
Senator Murray: How do we address it, or do we address it? It is not a matter of the federal government bringing the hammer down because, as you know, that does not get us very far. What do we do and what do you do to keep the pressure on, to keep their feet to the fire?
Ms. Malach: In this specific case, with the guidelines we have formed an Ontario working group and have brought together some key leaders, specifically with the P.I.E.C.E.S. program and long-term care facilities and practitioners who have some influence within the retirement homes, long-term care facilities and the psychogeriatric resource consultants. They have looked specifically at the recommendations of the guidelines as well as at some of the recommendations that have come out of the Registered Nurses Association of Ontario guidelines, which are specific to nurses, to find ways to balance those guidelines with some of the training programs in Ontario to try to find a way to implement them into practice. Of course, questions remain: Who will teach them? How will they be integrated into some of these homes, and who will pay for it? We have now made a connection with the Ontario Seniors' Secretariat to look at whether there is money available and what it would look like in a practical way. Whether it is conferences or seminars to bring together psychogeriatric resource consultants to do an evaluation, at least we have had opportunities to bring them together and they have agreed to do so.
Senator Murray: I should not say that I am surprised that Ontario and British Columbia are doing it best, but it does surprise me that other provinces with a disproportionately high number of seniors in their population are not ahead of the others, which is what you are telling us.
Ms. Malach: They are not, no.
Senator Murray: Another thing strikes me. One understands that in terms of health priorities there will be some difference in emphasis among the provinces because conditions vary and the incidence of various diseases differs from one part of the country to another. However — someone will correct me if I am wrong — the kind of disparity among the provinces that you are speaking about with regard to mental health does not exist in most other important diseases or afflictions. I do not think that for heart disease or cancer or other illness there would be such a disparity.
You partly answered one question when you told us that Mr. Dudgeon is on your steering committee. Your written submissions, which I have not had an opportunity to read, list some of the other organizations represented on your steering committee. I presume you all know each other at this table and that you work together. You do not regard each other as competitors. Are you familiar with the proposal that the Alzheimer Society of Canada has before the government looking for $300,000 to develop a national strategy?
Ms. Malach: Yes.
Senator Murray: Do you support it?
Ms. Malach: Absolutely.
Senator Murray: I think it was worth putting that on the record.
Mr. Goldhawk or Mr. Dudgeon, would you talk a bit about research? I understand that the incidence of Alzheimer's disease will increase because the proportion of our population that has aged beyond 65 years will have increased, in absolute terms. However, are you telling us that Alzheimer's disease is on the increase? If so, why should that be?
Mr. Dudgeon: Absolutely. At the age of 65, your chances of getting Alzheimer's disease statistically are about one in 14, but 20 years later, at age 85, they become even odds.
Senator Murray: That has to do with demographics, does it not?
Mr. Dudgeon: That has to do with aging. As the proportion of Canada that is elderly increases, the incidence of Alzheimer's disease will increase.
Senator Murray: Is there a higher proportion of people between ages 65 and 85 or over 85 afflicted with Alzheimer's disease today than was the case some years back? Is that what is happening?
Mr. Dudgeon: No. That part has been fairly stable. For people at a given age, the risk of Alzheimer's disease has not changed much except for this: If you have diabetes, your chances of getting Alzheimer's increases.
Senator Murray: Do they know why that is so?
Mr. Dudgeon: I cannot get into the science of it, but they do know why it is so. The cardiovascular risks associated with diabetes, heart disease or stroke are shared by dementia, and it has to do with the creation of the material that accumulates in your brain as plaques and tangles, which gum up messages across your neurons. That has to do with the same risk factors.
What people might want to do to mitigate their risk for dementia is similar to what they would do to mitigate their risk of heart disease or stroke, along with a couple of other measures, such as staying socially active, keeping your mind engaged and protecting your head.
Senator Murray: Who is doing the research, who should be doing the research, and how much headway do you observe they are making?
Mr. Dudgeon: Canada is a world leader. Some of the best science regarding dementia is being done in Canada, particularly at the University of Toronto, McGill University and the University of British Columbia. Those are the three leading centres. The amount of work being done is outstanding, particularly when you take into account how ill- supported it is.
Senator Murray: I presume you mean financially.
Mr. Dudgeon: Yes.
Senator Murray: Who is financing the research at those universities?
Mr. Dudgeon: Mostly it is the Canadian Institutes of Health Research, principally the Institute of Aging, but also the Institute of Neurosciences, Mental Health and Addiction, and other institutions.
Senator Murray: Is it your position that they are not putting in enough funds or that there are others who are putting nothing in who should be contributing?
Mr. Dudgeon: A little of both. I was at an event in Washington where a bill was introduced in the Senate asking for the government to increase funding for Alzheimer's research from the current $600 million a year to $1 billion. Canada is one tenth of the population, so our investment should increase from $60 million to $100 million. CIHR spent $60 million over the last five years. If that were the only measure available, we would be under-invested by a large margin. Our organization is the second-largest funder of research outside the private sector.
Senator Murray: From your private sources, your appeals for funds and so forth?
Mr. Dudgeon: Yes. Our contribution is just short of $3 million a year. We are doing our best to raise the bar and support it as much as we can, but there is a lot of work before us.
Senator Murray: Are they making headway with the research?
Mr. Dudgeon: Absolutely, in all of the areas I mentioned. Most of what is known about prevention with respect to Alzheimer's disease is quite recent. It is within the last five years that we now understand, in fairly measurable terms, cardiovascular risks and the role of keeping one's mind engaged. In our dementia strategy, we are looking at bundling a certain range of activities together directed at preventing dementia in older people. The scientists I have spoken to estimate that if this were done at the level of a population, you could probably save two years of time. That is a lot of time. If you can delay onset of dementia by two years over a population, serious money would be saved by Canadian society.
Regarding treatment, in June we should be hearing some exciting news. One of the most exciting bits of news may come from Neurochem, a Canadian company, announcing potentially the first disease-modifying drug. Currently the drugs that are available deal only with symptoms. Early results suggest that the new drug could be a disease-modifying drug. That work is being done in Montreal. It is quite likely the most exciting thing going on in dementia right now.
Senator Murray: We will look forward to that. You are a national organization of provincial organizations, a federation, as it were. How much work are your provincial partners doing vis-à-vis the provincial governments and health systems, and to what effect?
Mr. Dudgeon: I wanted to jump in when you were talking about regional disparities. When I look at the situation in Canada, Ontario and B.C, as Ms. Malach has suggested, are probably the provinces where there is more support from the government for the work being done in the field. Ontario has a sophisticated and comprehensive dementia strategy, which has the Alzheimer Society of Ontario partnering with government in ensuring that community services are available. I think some of the successes in B.C. are attributable to the strength of the major health regions, Vancouver, the coast, and Vancouver Island in particular.
The rest of the country is struggling. It is a challenge for the Alzheimer societies in the Atlantic provinces to provide services to their clients and raise funds in support of research. It is pretty variable.
Senator Murray: How much advocacy are they doing? I grew up in the Atlantic provinces and still follow what is happening there. They have a disproportionate number of people who are old compared to the rest of the country. What advocacy efforts are your organizations making with the governments there?
Mr. Dudgeon: I would have to say not a lot. Almost all of the money raised in the Atlantic provinces is going to direct service delivery, providing support to people with Alzheimer's and to their families. The only two provincial societies that have staff dedicated to helping provincial governments understand the challenges are Ontario and British Columbia.
Senator Murray: Would you not think they would do more to put those provincial governments' feet to the fire?
Mr. Dudgeon: If they had the money, they would.
Senator Murray: They have the votes, not to put too fine a point on it.
Senator Chaput: Looking at the organizations that you represent, you have a coalition, an advocacy centre and a society. How does your seniors' mental health coalition network with other coalitions? We all know that mental health is not only for seniors. Is there a linkage with other coalitions?
Ms. Malach: Our national coalition has a representative steering committee. Part of my responsibility is to meet annually face to face with our national steering committee, where we set our strategic objectives for the year; as well, we have quarterly meetings. We have a conference every two years. There will be one in September of this year, to which we have invited 52 participants to share information on all sorts of issues. All provinces will be represented by people who will be speaking on care issues, research issues and best practices from across the country. This year's theme is on moving forward in research, care and sharing of information. We will have 16 half-day workshops specifically around guidelines and emergency preparedness. We will share information about anything the coalition has been involved in at a national or provincial level. We are hoping for 400 participants.
We have a website and a research knowledge network. We send out newsletters and eBlasts to all of our members. We have a members' forum where people can share information and post research questions, knowledge and information. We encourage two-way communication for people across the country to share and post information. There is a lot of traffic of calls and information that goes on so people can share and communicate with us.
Senator Chaput: Is that the case for you, too?
Ms. Wahl: With respect to legislation, we are primarily working in a provincial forum. Many of the issues have cross-provincial interest, and we want to stimulate the types of work we are doing in other provinces. We have actively made contact with national organizations. For example, I know that Dr. Lynn McDonald from the National Initiative for the Care of the Elderly presented to the committee. I am vice-chair of the NICE network. We saw a great advantage to connecting with the NICE network, which is federally supported. We look at how we do that knowledge exchange and take the research into practice. Dr. McDonald mentioned that they created tools with respect to consent capacity. I actually prepared that and am now it for each province, working with lawyers in each province.
I have made many connections with the Canadian Association on Gerontology to bring the legal issues to the forefront. The national Canadian Bar Association has an elder law section, which tries to promote the issues across the country. With policing and elder abuse, we have made connections with the Canadian Association of Chiefs of Police. Lastly, the federal, provincial and territorial ministers for seniors have a joint committee looking at elder abuse. I am assisting in the organization of the conference scheduled this fall in British Columbia to look at elder abuse issues across the national perspective.
The Chairman: Ms. Wahl, I was concerned with your reference about advance directives and do-not-resuscitate orders, because I have long been an advocate of both. You indicated that they are now being used in a somewhat perverse way. Would you like to elaborate on that?
Ms. Wahl: This is reflective of the pressures in the systems and a lack of real understanding of the education to complement the work being done. You have good policy and intent, but in practice it is not coming through.
For example, I advocate on behalf of many seniors in long-term care homes in Ontario. In practice, we see facilities requiring the use of their own forms rather than using something that the senior prepared after having thought about it and worked it out. The facility will say it is a condition of admission that you must use our form, or it is a condition of admission that you must sign a do-not-resuscitate order in order to move into place. I thought that was friendly. You are moving into the place and the first thing they ask is that kind of direction. That is an inappropriate use of what is a good tool.
An inappropriate use of what is a good practice is trying to get people's wishes and get their involvement. We have seen advance directives being used as consents when in fact they are an expression of wishes of what you want for future care. They are to guide decision making down the line if you are not able to participate.
I have done the research on provincial legislation on this point all across Canada. In all provinces, unless the directive is a consent — and those would be very few and far between — the health-care providers still must get the appropriate consents from what would be the family members or the appropriate substitutes. We see resistance in putting that into practice. We see training on the clinical side of palliative care, but not on the decision-making part. That is very important because people may choose who they want to be their substitutes in the future. We see the wrong substitutes being turned to. There has been a distortion of what is good practice.
Therefore, through the NICE network we are trying to create what I call the quick reference pocket tools so that people will go back to basics and use that advanced care planning and health care plan appropriately. We are trying to get that into the universities as part of the education.
I teach a course on law and aging at the University of Toronto in the faculty of social work. My students told me they had never been exposed to some of the things I am teaching them, and yet to me it is fundamental for social workers, doctors and nurses to have that understanding of that legal framework.
The same thing is happening through the Alzheimer's initiatives in Ontario; I am part of the physicians' education program where we educate physicians about consent to treatment and advanced care planning. Physicians who attend our courses consistently tell us they did not know the information we were giving them.
Getting the policies into good practice is often where the distance occurs.
The Chairman: Mr. Dudgeon, you made a comment about the connection between Down syndrome and Alzheimer's disease. Would you elaborate on that?
Mr. Dudgeon: What is known about that is pretty recent, largely because people with Down syndrome used to die at a younger age than they do today. Now that they are becoming older adults, it is clear that they are at risk of developing dementia, compounding an already horrible health situation. It is a fairly new phenomenon, largely because people with Down syndrome are surviving into older adulthood.
The Chairman: Is it a disproportionate number of them who develop dementia?
Mr. Dudgeon: Far in excess of the population at large. They seem to have a particular risk of getting dementia.
The Chairman: Is that at a younger age?
Mr. Dudgeon: Younger than most people get dementia, yes.
Mr. Goldhawk: If you were to ask doctors who know about all the genome theories and therapies, they would say it is a chromosomal link between Alzheimer's disease and Down syndrome that causes that almost inevitably if you get old enough.
The Chairman: We have all raised the issue of caregivers and we know the stress on them of looking after people with mental illnesses and the range of dementia. What are the solutions? Do any of you have recommendations that could be made within the tax system, the support system, which could ease the burden on caregivers in Canada?
Mr. Dudgeon: I have a few. Last week I was in Ottawa to attend the opening of the bungalow associated with the Perley and Rideau Veterans' Health Centre. It is respite beds for people with Alzheimer's. Respite beds are probably the best single approach to giving caregivers a bit of relief and helping them stay in the game. If we can keep caregivers in the business of looking out for family members, then everyone benefits. The more we can do to support them in the community the better, whether that is through tax credits to help with the economic burden of caring for somebody, providing respite beds or providing education.
Some research indicates that caregiver education directed at the spouses of people with Alzheimer's delays nursing home admission by a year and a half. That is a tremendous savings to the system and it keeps a family intact that much longer. Caregiver education, providing supports through connection with a local Alzheimer's society and things of that sort are tremendously helpful and we ought to be encouraging them through government action. That is why in our strategy, which we are hoping to have supported by the federal government, support for caregivers is a real cornerstone. Without that, the rest does not work.
Ms. Malach: I would support those points. First is education, because the caregivers experience the double stigma of aging and mental health. There is great stigma associated with having a spouse who is faced with a mental illness. If they are educated, the mental illness is in fact a disease; it is normal, it can be treated, there are options for treatment, there are doctors and solutions and they can be helped. That education piece is important. There are supports out there. That is imperative.
Second, we need to support caregivers to keep people at home, whether through respite beds or community support services, supports for recreation or for someone to come into the home and help with basic tasks that may not be health-related, such as laundry, cooking, and other supports that are outside the box beyond the medications and bathing and those treatment supports that we assume caregivers are providing. We are often too focused on the medical and physical things, and we need to look at some of those other social determinants of health, the basic things.
We often hear that veteran care provides great supports to keep their veterans at home. We do not need people to go into long-term care facilities. We can keep them at home by providing basic care that extend to caregivers. We cannot assume that senior caregivers can do all those services. If we provide caregivers with the basic supports that offer them respite — laundry, cooking, shopping, mowing the lawn, shovelling the snow — so that they can further give care to their spouses, parents and seniors, that will allow people to stay at home longer. Mr. Dudgeon listed some of the basic solutions.
The Chairman: I am surprised neither of you mentioned the luxury of time alone for the caregiver, time they can spend for themselves away from the burden of their care.
Ms. Wahl, did you have anything to add?
Ms. Wahl: I would be echoing the same thoughts. In my presentation, I made the point that it involves looking at the way we see services and how we determine what is offered through a service. With respect to home care, people think of the softer services that I think are so necessary. We hear that again and again.
Another example is transportation service. Most paratransit services will not allow a person with Alzheimer's on with their caregiver if they are mobile. Unless the person has a physical disability, they are excluded, yet that is exactly the transportation they need because they cannot do the driving.
The necessary education is not only on providing care. We repeatedly see in our practice people wanting information on how systems work. We wrote a manual on long-term care law.
In the hotel room last night, I was checking my email, and one of my clients whose parent just passed away thanked us for the manual that has a detailed explanation of how long-term care services work and how to advocate. Caregivers also act as advocates. It is not just the eligibility, what you get and how you apply and what forms you fill out, but how to navigate through the system and what you do when things go wrong or when you hit a barrier. People need that education and information, and often that provides a relief for them, because they know what to do, what to expect and what the limits are on different things.
We have to look outside the box on some of these services. Home care is not just physical. It needs to be provided with social supports.
Senator Murray: No one at this table pretends to have any particular influence on these matters with the government, but for the record, I should ask the Alzheimer's people to tell us when they made the application for the $300,000 to develop the strategy, to what agency or department of the government they made it, whether they have heard about their application and what their expectations are with regard to it.
Mr. Dudgeon: We were directed by the minister's office to talk to people in the Public Health Agency of Canada, and we have been speaking to them at some length. We do not yet have the money.
It is pretty clear that everyone we have spoken to recognizes the importance of this and sees it as a practical way forward. They just have not identified the funding source. Obviously, one of the things we will be doing is talking to enough politicians, because priorities can change and perhaps the money will be allocated that way.
Any support that we might be able to get from this committee would be much appreciated.
Senator Murray: Have they turned you down?
Mr. Dudgeon: No. In fact, we have been invited to brainstorm about different approaches that might be taken. In the meantime, we have scientists across the country poised to work with us on moving forward on this strategy.
The Chairman: I want to thank all of you very much for sharing your information. It has been extremely valuable for our committee.
We will now hear from our second panel on the topic of vulnerable seniors. We will begin with Ms. Anna Chiappa, Executive Director from the Canadian Ethnocultural Council. CEC is a non-profit, non-partisan coalition of national ethnocultural umbrella organizations, which, in turn, represent a cross-section of ethnocultural groups across Canada working towards the preservation, enhancement and sharing of the cultural heritage of Canadians.
[Translation]
Then we will hear Jean-Luc Racine, Executive Director of the Fédération des aînées et aînés francophones du Canada. The federation, which represents 2 million francophone seniors across Canada, has a mission to defend the rights and interests of francophone seniors in Canada and to advocate for their needs so that they are able to thrive in their language and culture.
[English]
Live from Vancouver by videoconference, we will hear from the Canadian Network for the Prevention of Elder Abuse in the persons of Alison Leaney, chair of the board, and Charmaine Spencer, a member of the board, who will answer questions with Ms. Leaney. The network is dedicated to the prevention of abuse of older people in Canada. It is a non-profit, non-governmental organization that seeks to increase the ability of Canadian society to recognize and prevent mistreatment of seniors so that all adults can be free of abuse, neglect and exploitation in later life.
Anna Chiappa, Executive Director, Canadian Ethnocultural Council: Thank you very much for inviting the Canadian Ethnocultural Council to be here today. Briefly, to elaborate on the introduction, the CEC promotes the understanding of the multicultural reality of Canada as defined in the Canadian Charter of Rights and Freedoms and the Canadian Multiculturalism Act.
Over the years, we have worked with local, national and regional organizations, government departments and other sectors to carry out programs with project funding from Canadian Heritage, Health Canada, the Public Health Agency of Canada, Elections Canada and Industry Canada. The CEC won the Share Award, which was given to us by the Institute on Aging at the University of Pennsylvania for work on improving health and well-being of elders of diverse backgrounds. Health is a major concern of many CEC projects, especially in recent years. We have conducted studies and developed resources aimed at helping populations, especially ethnic seniors, to receive culturally appropriate health care and information. We derive our expertise on aging in Canada through our member organizations, through some of the work we have done, particularly around misuse of drugs by ethnocultural seniors, diabetes in older adults for Hispanic, Black and Asian populations and culturally appropriate best practices for healthy aging.
We have to acknowledge the help of Health Canada and the Public Health Agency of Canada for those projects, which have given us an opportunity to network with many organizations across the country. I want to make it clear that we do not represent ethnic and immigrant seniors but, by virtue of the fact we have worked with a number of these communities, we can offer some input into this process.
We believe the vast diversity of Canadian seniors with different linguistic, racial, ethnic and religious backgrounds can be vulnerable to injustices by institutions, agencies and, unfortunately, in some cases, even their own families.
In the introduction of the interim report of Special Senate Committee on Aging, the concluding paragraph states:
The Committee views the aging population as an opportunity — an opportunity to rethink how we balance work, family, and leisure throughout the life-course and an opportunity to re-examine the way we view and value the experiences of seniors. We have before us a great challenge, but one filled with possibility.
We fully endorse this approach to aging, knowing that a fuller understand of aging ethnocultural communities can be a rich source of information.
While a number of pressing needs of immigrant seniors were included in the interim report, the report lacks a demonstrated understanding of the richness of the social interactions, informal volunteering, self-help supports, associations, economic contributions and additions to the richness of Canadian society that ethnocultural seniors make.
The first interim report of the Special Senate Committee on Aging referred to demographic data based on the 1996 census, I believe. My reason for being here today is to bring the committee up to date with more recent information from the Statistics Canada report released in February 2007, using 2001 census information.
What is this diversity of ethnocultural and immigrant seniors? The best way to answer this is to refer to the recent profile by Statistics Canada, A Portrait of Seniors in Canada. One chapter in this report is dedicated to this theme. It defines immigrants as individuals who were not born in Canada, and/or did not have Canadian citizenship at birth. It distinguishes between Canadian-born seniors, long-term immigrant seniors, those who came after 1961; mid-term immigrants; and more recent immigrant seniors, those who came to Canada in 1981 or after, aged 55 to 64.
I would like to state for the record that the label "immigrant senior" does not reflect adequately the ethnocultural or racial component of seniors. Indeed, some would take offence to this label, especially those who have been here in Canada for many years, even decades, and those who have Canadian citizenship. When does one stop being an immigrant in Canada? Instead, we should be looking at the diversity of the seniors based on their ethnocultural, racial, linguistic and religious variables. Having said that, I will continue with the definition used by Statistics Canada out of necessity to help us understand a diversity of ethnocultural seniors.
In Canada, the ethnocultural population of immigrant seniors represents a considerably large group. In 2001, some 29 per cent of individuals aged 65 to 74 and 28 per cent of those aged 75 to 84 were immigrants, meaning they were not born in Canada and did not have Canadian citizenship at birth. By comparison, immigrants accounted for about 17 per cent of the non-senior population in 2001.
The report by Statistics Canada states the following facts. A relatively large share of seniors is immigrants but most are long-term immigrants. On a year-to-year basis, seniors account for a small share of new immigrants, that is, new arrivals. It was just under 2.3 per cent in 2004. The countries of origin of immigrants are changing. These changes are just beginning to be reflected in the characteristics of immigrants aged 65 and older.
Like immigrants in general, the vast majority of immigrant seniors live in Ontario, British Columbia and Quebec. It must be noted that in 2001, there were roughly 1 million individuals aged 65 plus who were immigrants, or 29 per cent of the individuals aged 64 or more in Canada. That is a significant proportion of the senior population in Canada. There are more 65-plus immigrant men than women. This is a distinct difference from the mainstream population, where there are more senior women than men.
As noted previously, as with the general ethnocultural population, immigrant seniors are predominantly located in Ontario, British Columbia and Quebec. Moreover, they are more likely to reside in large urban areas now than they were 20 years ago. Specifically, in 2001, 80 per cent of the immigrant seniors were living in one of Canada's 27 metropolitan areas, compared to 69 per cent in 1981. In contrast, only 53 per cent of Canadian-born seniors lived in large metropolitan areas in 2001, an increase from 48 per cent in 1981.
More recent immigrants are more likely to be living in large urban areas. In 2001, 19 out of 20 immigrant seniors who had been in Canada for 10 years or less were living in metropolitan areas. In contrast, this was the case for only 74 per cent of those who arrived before 1961.
According to the 2001 census, only 4 per cent of immigrant seniors who arrived in Canada before 1961 reported that they could not speak either English or French, but the numbers change rapidly after that date. Of those who came to Canada in 1961 to 1970, 12 per cent do not speak English or French. In 1991 to 2001, 50 per cent of immigrant seniors who arrived in Canada were unable to speak English or French.
Regarding the racial profile, in 2001, almost one quarter of immigrant seniors belonged to visible minority groups. The proportion in 1981 was 6.8 per cent. More recent immigrants are much more likely to be visible minorities. Among immigrant seniors who landed in Canada in 1991, 75 per cent belonged to visible minorities.
With respect to income, according to the 2003 Canadian Community Health Survey, 26 per cent of immigrant seniors were in the lowest income quartile compared to 15 per cent of non-immigrant seniors.
With respect to retirement, in the Statistics Canada 2002 General Social Survey, near retirees were asked: "Do you feel you are adequately prepared financially for your retirement?" Twenty-nine per cent of Canadian-born near retirees believed that their financial preparations were inadequate. This was the case for 45 per cent who had immigrated to Canada since 1980.
Many recent immigrants are less likely to have insurance for prescription medication and are more likely to be in low-income categories. For example, in 2003, 48 per cent of recent immigrants aged 55 to 64 were covered by insurance for prescription medications. In contrast, 82 per cent of the Canadian-born population had insurance.
Another aspect is the support for families. Sixty-three per cent of immigrant seniors rated their sense of belonging to their family as very strong. However, this relationship can also make them vulnerable in terms of requiring they live with families because of low economic status.
In conclusion, the Statistics Canada report provides an overall picture of ethnocultural immigrant seniors. This segment of the population is becoming increasingly visible and more linguistically complex. They speak less English and French than previous immigrant populations. They are more likely to be living in metropolitan areas, especially Toronto and Vancouver. Although they are more educated, they will be less financially prepared to retire and more dependent on family.
While these are sweeping generalizations, I want to make the point that there needs to be quite a bit of research, coordination, and community involvement. In his report, Professor Durst expresses frustration at attempting to find information on immigrant seniors, and we concur with this. Having worked in the area for 10 years, I know there are very few organizations and little involvement in pulling information together. This is one grey area that has fallen between the cracks.
We would like to put forward some recommendations. Members of ethnocultural communities with whom the Canadian Ethnocultural Council is involved have indicated to us quite clearly that they wish to take part in improving the health of their community members because they see it as a way of contributing to the betterment of Canada as a whole. While we appreciate the work done by agencies like the National Advisory Council on Aging, we believe there must be a coordinated approach with the federal government in order to take the lead in bringing together community agencies and organizations from different levels of government, including municipalities, to address this issue. The multiculturalism program has taken a strong lead in bringing stakeholders together to address vulnerable issues impacting on ethnocultural seniors.
There is not one organization whose mandate is centred on research on ethnocultural seniors. Such a centre should be a clearing house for information, consultation and evaluation and a centre for education and outreach, in partnership with ethnocultural groups. There must be opportunity for those who are currently working with organizations to provide services to ethnocultural seniors, with opportunities to share, build knowledge and evaluate programs. Stable operational funding to community organizations that serve ethnocultural seniors has to be provided. Support must be given to families and communities to help care for their seniors. Intergenerational programs must be a component of this. While we seek to have an approach that focuses on ethnocultural seniors, they must also be represented in all communities and boards that have programs, services and policies dealing with seniors in general.
Educational campaigns to fight ageism, along with racism and discrimination, must be developed in cooperation with community organizations. As the senior population becomes even more racially and linguistically diverse, cultural competency has to be developed and strengthened in agencies serving and dealing with seniors.
Finally, I cannot stress enough the need to work with ethnocultural organizations, immigrant settlement agencies and community groups so that they have the support to do their outreach and offer programs in positive and caring social networks.
[Translation]
Jean-Luc Racine, Executive Director, Fédération des aînées et des aînés francophones du Canada: On behalf of the president of the Fédération des aînés francophones du Canada, Willie Lirette, I would like to take this opportunity to thank the members of the committee for having invited us to appear today. We appreciate it very much. Unfortunately, our president could not be here today for the presentation. So I am his delegate.
The Fédération des aînés francophones du Canada is a not-for-profit organization whose members include 12 associations of francophone seniors in Canada. There are about nine associations of francophone seniors in nine provinces in Canada. Only Newfoundland and Labrador and the Northwest Territories do not have an association of francophone seniors. In all, we represent 303,000 seniors. Also among our ranks is the Fédération de l'âge d'or du Québec, FADOQ, which has a membership of close to 280,000 francophone seniors.
I would like to focus my presentation on three of the four questions raised, while showing the vulnerable aspect of francophone seniors, particularly in minority situations.
Your first question was to find out whether the government should change the program eligibility age. We assume here that this would be an upward change. We think that, where francophone seniors in Canada are concerned, we should show more caution about this question. You will recall that in the report you published there are actually 16 per cent of seniors living alone who are below the poverty line. So there are still some very vulnerable people.
Furthermore, we think that people, especially the baby-boomers who are getting older, have not had a chance to benefit from private pension programs and to save enough money so that they can have a comfortable retirement at the age of 65.
We think that perhaps it is not the best solution to raise the age of eligibility for programs. I think that in recent years the government has put in place some measures enabling it to recover old age pension benefits from people with middle or high incomes.
I think that the current threshold is $62,000; beyond that the government begins to recover funds from Canada's old age pension plan.
If the government is really seeking to save money on government programs for seniors, we think that there are already measures in place to recover certain transfers of funds, to wit the $62,000 cut-off.
We think that seeking to raise the age of eligibility for the retirement program would further penalize people with low incomes because this would delay their eligibility for this program. In our opinion, that is not the right path to pursue.
As far as diversity is concerned, the members of the federation would like to stress the importance of recognizing the right to develop different strategies in the light of seniors' needs and particularities. To show the importance of adjusting such strategies to needs, I would like to refer to two situations in order to give you some very concrete examples. Senator Chaput may be more familiar with the first situation.
I met a senior in Manitoba who told me that she was living in a small village near Winnipeg. She lives in her francophone community, but she knows that one day she will lose her independence and have to sell her house. She knows that she will have to go into a nursing home located many kilometres from where she lives now, in a community that she does not know and, above all, in a home where there will not be any services in French.
I saw how dramatic this lady's situation was and also how vulnerable she was because, in being transferred to another nursing home, she is leaving her community, she is being uprooted, and finally her state of health will become vulnerable.
Here is another rather comical situation. The father of a lady from eastern Ontario went to see the doctor in Hawkesbury. The doctor gave him some instructions in English. He answered, "Yes, yes, yes," and his daughter told me that he did not even speak English. He did not understand English, but was too embarrassed to tell the doctor.
We know lots of cases of seniors who do not understand what their doctor is telling them. These people end up in a vulnerable situation. What we must realize is that in at least seven provinces in Canada, francophone seniors, those aged 50 or more, account for more than 5 per cent of the population. There are seven provinces in Canada where francophone seniors represent over 5 per cent of the population. So if these people do not receive adequate services in French, they will become much more vulnerable with regard to social services and their own general state of health.
I know that the government has already made attempts to offer health services and social services, and to support francophone communities in minority situations. We think that the government should continue in the same vein and support francophone seniors.
The third question is about which policy approaches to take. After consultation with seniors, we recommend that the government adopt policies that do not make seniors patients of the system, do not make them passive within the system. On the contrary, we recommend that they be questioned, consulted and above all that they be part of the solution for meeting the various challenges in the coming years.
We know that for francophone seniors in minority situations, services in French are not always available and I think that Senator Chaput is aware of the situation. The federation has put in place a mentorship program, in which seniors help other seniors to navigate the health system better. I have known seniors who waited six months for a call from a specialist and who, once they saw the specialist, were told, "I am sorry, but you have three months to live."
If other seniors could have advised them and told them not to wait for the specialist and to go to emergency, the situation would have been different. The mentorship program was designed to resolve this kind of problem. We had nine months' funding and, after the nine months, the project could not continue, even though we had 80 volunteers.
Often the government only funds projects for short periods and we have a hard time maintaining continuity in the programs. I think that, if we want to create an impact on the aging of the population, we will have to come up with much more solid long-term policies.
Finally, I would like to talk to you about another program we have worked on. Seniors tell us they want to go on working and we think that the government should implement policies that enable seniors and young retirees to remain part of the labour market.
We want to be volunteers and we also want to equip ourselves so that we can remain on the labour market. At present employers are not always very receptive to the idea of taking retirees and people of a certain age and having them join the labour market again. We think that it is important to do so, but unfortunately there are not really any solid programs that make this possible.
I could have continued talking about other measures, but I know that time is running out. Maybe we will have a chance to talk more in future discussions. Thank you for inviting us; we appreciate it very much.
[English]
Alison Leaney, Chair of the Board, Canadian Network for the Prevention of Elder Abuse: Thank you for the opportunity to meet with you. I will be following the slide package that I forwarded earlier today, because this is a big topic and seven minutes go very quickly. To provide some background, I will be speaking about the Canadian Network for the Prevention of Elder Abuse, CNPEA, as well as about senior abuse in Canada, challenges and innovations in this field and some recommendations at the federal level.
The Canadian Network for the Prevention of Elder Abuse has a volunteer board of 15 participants. With me is Charmaine Spencer, one of my colleagues on the board. We have representation across the country in all jurisdictions except New Brunswick and Nunavut, although we have had representation from Nunavut. We strive to be representative of the country geographically as well as in many other ways.
The purpose of the Canadian Network for the Prevention of Elder Abuse is to raise awareness and understanding of the complexity of abuse of older adults and to promote the development of appropriate resources and services for seniors who are abused or may be at risk of being abused. It is estimated that between 4 per cent and 10 per cent of people in Canada will experience some form of abuse or neglect in later life, which equates to some 165,000 to 413,000 seniors in Canada. Although we are of course concerned about seniors who are defrauded and scammed by strangers, by and large many of us are better able to deal with those situations, so the comments in our presentation focus on people who are abused by people in positions of trust who are well known to the senior, such as other family members.
There are, as I am sure you are aware, many different forms of abuse. They include financial, physical, sexual, emotional, neglect and violation of rights. Abuse of seniors can happen anywhere, whether in a community or institutional setting, and, as many of the other speakers have mentioned today, it crosses all socioeconomic and ethnocultural lines.
It is true that twice as many women come to the attention of various public agency authorities as men; however, fewer than one in five situations of abuse actually come to the attention of any public agency, and fewer still come to the attention of a public agency operating in the criminal justice system.
As was articulately outlined by Judith Wahl, most seniors who are abused are very mentally capable and mostly what they need is access to support, assistance and information to make informed decisions about their options. The few seniors who are mentally incapable are extremely vulnerable, as we have heard from our colleagues from the ethnocultural, francophone, Alzheimer's and mental health associations.
In terms of challenges in the field and some of the solutions implied or imbedded in the recommendations, there are three areas of challenge that I want to focus on. First, there is a huge under-recognition of abuse of seniors in Canada. I would say that this field is 20 years behind where we were when we were trying to raise awareness about violence against women and, before that, how to prevent and respond to abuse of children. As I mentioned, fewer than one in five situations of abuse of seniors come to the attention of any agency and there are many complicated reasons for that.
The second area of challenge has to do with the complexity of the issue. As I mentioned, there are many types of abuse, and what might be an appropriate intervention for someone experiencing financial abuse might be quite different from one where someone has experienced a sexual assault. How long the abuse has been occurring is another dimension. Many situations are domestic violence grown old, while others may be a new relationship where things are just beginning to be out of control.
Other factors that impact how best to deal with situations of abuse or neglect include how isolated the senior is and whether they are a man or a woman. Men and women tend to experience different types of abuse. We have also heard reference to the impact of different languages, culture, physical ability and disability. Our public policies also impact seniors and how their situations of abuse might be addressed. Our policies do not always mesh, and as a result people fall through the cracks.
Third, while there are pockets of huge promise where people are doing very important things, there is a lack of appropriate resources and services throughout the country. We all know about the differences between the North and the South, urban and rural, and if we happen to be someone who does not speak English as a first language and we speak French or an Aboriginal language we are particularly challenged.
Some of my colleagues mentioned this afternoon that in the area of abuse and neglect there is a challenge in maintaining service providers who actually know how to intervene in these situations in a respectful way that is empowering to seniors. Many of these situations are extremely dangerous for seniors.
In terms of innovations, there are a number of intervention programs that are more intervention or intervening with individual seniors that I believe are very promising. Some include integrated criminal justice system responses, and Judith Wahl did mention some of those having dedicated police involved in these situations so they build up experience in dealing with these situations, and there are dedicated Crown attorneys and courts.
There are also a number of safe house, safe home initiatives and, as Ms. Wahl also mentioned, the Advocacy Centre for the Elderly is an important and great example to the rest of us in Canada about what seniors need in terms of legal advocacy across the country. There are also some jurisdictions, like my own and the Yukon, that have designated key responders to respond. It is their job to respond to reports of abuse and neglect. That is one of the challenges in this area, but for many of us it is like we are all responsible or whose job is it, so that is a challenge. However, there are many promising programs and I have mentioned only a few.
The other thing that is incredibly promising across the country is that there has been a huge amount of community capacity building at the local level through the development of community response networks. At the regional level, many jurisdictions are in the process of trying to develop regional networks across the country in many jurisdictions, and the Canadian Network for the Prevention of Elder Abuse has continued to try to be a link between people throughout the country.
Our network, until recently, had never received any funding. We did just receive a first contract with the Public Health Agency of Canada to endeavour to begin to identify some promising approaches for addressing and preventing abuse of seniors across Canada. We have been supervising that project completely voluntarily.
We have a number of recommendations for the federal level of government. We know that many of the things we are describing are within the purview of provincial jurisdictions, but that is a whole other matter. Therefore, I have nine recommendations. One is that we need to promote and facilitate research in many key areas related to abuse and neglect of seniors. We need to look at the root causes. We need to be able to evaluate the programs that we feel may be promising. Many have not been evaluated or in fact many are barely funded to operate. There are huge areas where research is needed.
Second, we need to review and address policies. I have given examples of where there are difficult impacts for seniors. For instance, the issue of privacy in the banking industry is interfering in financial abuse investigations. There is a lack of affordable housing, which puts seniors at greater risk. We have people who have been sponsored to come to Canada by the person who is now abusing them. Of course, we also have the interplay between mental health and addiction and so often it is hard to figure out how to proceed there.
The third recommendation is around the need to support network and capacity building across Canada at all levels, the community level, the provincial-territorial level and the national level. The CNPEA wants to be able to do a lot to support the knowledge transfer related to promising approaches across the country, but we have only volunteer resources to do that.
Fourth, we would like to see the work of the National Clearinghouse on Family Violence be continued and strengthened. I have just discovered there is something called the Woodbridge model that actually allows a clearing house to do more things to keep track of what research might be needed.
A fifth recommendation is to support awareness-raising opportunities such as World Elder Abuse Awareness Day, and I would like to acknowledge the work of the federal-provincial-territorial working group on seniors' safety that has taken a leadership role in that regard, as well as in looking at the criminal justice issues we have happening. There will be a forum held in Vancouver this fall.
Sixth, we need to strengthen inter-ministry and intergovernmental collaboration. Many people are trying to do that but because of the complexity of the situations that seniors find themselves in, it is hard to get all the right people together at the right time between levels of government and across government.
Seven, we need to work with Aboriginal communities to lessen the negative impacts of money that may be going into Aboriginal communities. As the opt-out period for the residential school settlement process goes by, a number of people will be receiving significant sums of monies, some of them not just for being students but also for having been abused in those settings. People are very concerned about the re-victimization of elders.
The eighth point is to sign the 2000 Hague Convention on the International Protection of Adults. There was a senior abducted from Nova Scotia and taken to the U.K. If Canada had signed that agreement, there might have been more that could have been done in that situation.
Lastly, building on some of the comments of our colleagues, we are also interested in seeing that there be support for the development of a national strategy to both address and prevent abuse of seniors, because we all have to deal with the ageism, racism, sexism and so on, as our other colleagues mentioned. We would be interested in ways to piggy back on other national strategies that are under development so that we are not reinventing the wheel, because we have a lot in common, and then we can fill in what is missing.
The Chairman: Thank you very much. I am confused about your eighth recommendation because I have never heard of the Hague Convention on the International Protection of Adults, and I do not think anyone else has amongst the senators here, so tell us about it.
Charmaine Spencer, Member of the Board, Canadian Network for the Prevention of Elder Abuse: The Hague Convention was first initiated in 1999, and it is, as you identified, an under-recognized convention. It provides for collaboration, or working agreements, between different country governments to deal with situations where mentally incapable individuals may have been aided or forced out of the country. Usually, the types of situations that we are talking about involve a person who has dementia and has been taken out of the country by a family member who lives in another country. It is an opportunity for the various countries to collaborate to return the person to their country of residence.
In the particular Nova Scotia case, the gentlemen spouse of a woman who has dementia had legal power of attorney and everything for her. His relatives in the U.K. believed that she needed to be cared for in a different kind of way. They got her to agree to go on a plane and took her over to the U.K. Since then, he has had significant difficulties in returning her to Canada. The U.K. and Germany are the only two signatories to that convention. If Canada had signed on to that international agreement, there would have been more opportunities to be able to help this particular person bring his wife back to the country.
The Chairman: I knew of the Nova Scotia case; I just did not know there was an international convention.
In terms of the ethnocultural groups — I would like to hear from the francophone presenter as well — what do you believe are the biggest barriers to seniors living in those communities, particularly seniors who are unilingual living in another language, for example, an Italian who speaks only Italian living in Montreal, or a francophone who speaks only French living in Notre-Dame-de-Lourdes in Manitoba or some other community? What are their biggest challenges as seniors?
Ms. Chiappa: I can only speak to the work we have done with our communities in the area of health and information on health. We have found that in some cases they rely on families. They rely to a certain degree on the community, but access to health information is one of the areas.
Another area of concern is the fact that, more and more, people are required to use technology. Whether it is the Internet or the phone systems or just getting information, it is very difficult and becomes increasingly complex for many of us who may be challenged in that way, but for those communities in particular. Communicating with families and communicating with their grandchildren intergenerationally is also an important issue.
For new immigrants who came to Canada in the 55 to 65 age group, their income is less than that of the previous generation even though they may be more educated. They have had more difficulty getting employment and accumulating the financial stability and adding to, for example, Canada pension plans and so forth. That will have a significant impact in the future.
[Translation]
Mr. Racine: The question of access to services in French is not negligible and the problem concerns francophone seniors in particular in Manitoba, Saskatchewan and Alberta. Professionals take it for granted that these people know how to express themselves in English and that therefore it is appropriate to offer services in English. We do not see an active offer.
But seniors, when they are sick, tell us they want to be served in French. In a vulnerable situation, these people are not able to demand services in French. Their vulnerability is then all the more pronounced. What is important is not necessarily the demand for services but the active offer. This is no doubt our biggest challenge when it comes to francophone seniors in minority situations.
[English]
The Chairman: It is interesting because one of my challenges as an educator in Manitoba was to convince English- speaking Manitobans that there were people in Manitoba who spoke only French. They did not believe it because they did not come across any who did not speak English. I also dealt with the problem of people being in Quebec who said, "They can speak English. Why would they not speak English to me?" and I was trying to explain that there were, in fact, 4 million people in the province of Quebec who did not speak any English. However, in Western Canada, I have to say that they simply do not believe that, but we know it is a fact.
Senator Murray: Ms. Leaney, I do not think I fully understood what you were telling us in your recommendation about working with Aboriginal communities to lessen the impact of the residential school settlements. I missed that. What were you getting at there?
Ms. Leaney: The recommendation is designed to acknowledge that many communities need support for ongoing capacity building to prevent abuse and neglect of seniors and elders. Certainly, that is true in Aboriginal or First Nations communities as well. The current opportunity to do that very deliberately is being created by the process of the class action related to Indian residential school survivors, where people will be able to apply to indicate they are survivors of the residential school systems and then further to pursue a claim if they were also abused.
I have been learning here in B.C. that because there could potentially be, within the next six months or less, fairly significant amounts of money coming to First Nations communities, people are worried about elders who receive monies having it taken from them. We are thinking about what we can do in support to maximize the positive impact of those funds, which are supposed to be a positive thing, to raise community awareness and support capacity building to prevent financial abuse.
Senator Murray: I do not know whether I should or could pursue that. I think you have explained as fully as it can be explained. We will see as time goes on how this works out. I hope you are right, that it is possible to avoid these people, who have already suffered abuse in their youth, being doubly abused because there has been a settlement and they have received some money for it. I suppose there are opportunistic people in every society and that must be guarded against.
When you talk about the need to review policies on immigration sponsorship, the situation you described is one in which an older person who was sponsored by someone in Canada ends up being abused by the person who sponsored him or her. I presume that those sponsorships would typically have come by way of family reunification provisions of our law and the sponsor would have had a right to sponsor the immigrant. What do you think ought to be considered or done by way of policies in this field?
Ms. Spencer: Basically, under the sponsorship rule, the sponsor is responsible for the individual for a 10-year period. That is a significant difference compared to the three-year rule for other family members, for example, your spouse. The sponsor is then responsible for all of the individual's needs.
In most sponsorship relationships that is a very positive relationship and the reunification is a good policy. Unfortunately, in some families the sponsorship actually starts to break down. There are reversals within the families, and the relatives may be expected to be taking care of all the family caregiving and so on, and they do not have the language of the main culture and are very vulnerable to exploitation.
If that sponsorship relationship breaks down, either the person may not be eligible for social assistance or the person becomes eligible for social assistance but then that provincial social assistance becomes a debt that the sponsor has to pay. That creates an even more vulnerable situation for the person who has been sponsored. In effect, the way the rules are set creates increased vulnerability for older relatives under the current sponsorship role. We did not always have the 10-year rule.
Senator Murray: I do not understand the policy as well as I should. Does the right to family unification apply to children and parents essentially?
Ms. Spencer: Yes.
Senator Murray: What we are talking about in others who are sponsored would be uncles or aunts or other relatives, or even non-relatives. Is that right?
Ms. Spencer: If you are a sponsored individual it is a 10-year rule. The thing is an individual family can really honestly believe that they will be able to engage in that sponsorship for that period of time but they may not realize the full responsibility. Plus, for many immigrants, their own economic situation, as we discussed earlier, is often precarious, so the potential for conflict within the family is quite heightened within these circumstances.
Senator Murray: What kinds of changes in policy ought to be considered in this review you are recommending?
Ms. Spencer: Prior to a few years ago there was no agreement between the federal and provincial governments that basically the social assistance would become a debt of the sponsor. That has not always been the situation. That change in policy and that arrangement by which social assistance now becomes a debt of the sponsor is one of the factors that leads to vulnerability in these kinds of situations.
Also, under sponsorship, the sponsored individual is not eligible for bus passes or things that can actually promote their independence within the community to help lessen some of the burden on families. Those tend to be at a provincial level, but there is also the aspect of operating within the broad framework of the sponsored-immigrant policy at the federal level. It is the interaction between the provincial and the federal policies.
Senator Murray: Ms. Chiappa, what do you know about this issue?
Ms. Chiappa: I cannot speak to it specifically. Immigrant settlement agencies would be more directly knowledgeable about this area.
Older adults coming to Canada in more recent years and not having any access to support is a major issue, and those people are vulnerable. They are sponsored to come here in some cases to help with family to look after children. As I mentioned before, the family is very important, but at the same time it might leave them vulnerable and they may not have the financial means to be able to deal with that. I agree it is an issue that should be looked at because as the population ages we will have more individuals in this particular situation. It would be wonderful if we could take another look at that whole issue.
[Translation]
Senator Murray: In the two cases you described for us, actual situations, and for the one involving that woman in Manitoba who may have to move into an anglophone nursing home, are you telling us that there is not a francophone nursing home in the Winnipeg or St. Boniface region?
Mr. Racine: Unfortunately I have not studied the actual situation, but what she told me and what the people with her seemed to be saying was that, indeed, there were not many alternatives for them, to be really in a home where there were services in French. But I could not describe it to you in precise terms. These people, you understand, are getting old; they look around in the community, they study their options, and what they seemed to be telling me was that there really were not any options for them and that it was hard.
Senator Murray: As for that man in Hawkesbury who went to a unilingual anglophone doctor —
Mr. Racine: It was an emergency.
Senator Murray: There are francophone or at least bilingual doctors in the region.
Mr. Racine: You would be surprised. Sometimes, in francophone institutions, there is such a shortage of personnel. I have already been to the Montfort Hospital, where a doctor spoke to me in English.
Senator Murray: You are the executive director of the federation. You told us that you have partners in nine of the ten provinces. Could you let us know about your efforts at the provincial level as opposed to the time and effort you put in here, at the federal level.
Mr. Racine: It is our partners who put in those efforts.
Senator Murray: You are a sort of federation?
Mr. Racine: Exactly. Still, there is work that takes place at the provincial level. It is not always easy. I know that in Manitoba a nice relationship is being built up between the Fédération des aînés francophones du Manitoba and the provincial government. This is also the situation in Ontario. There are some fine initiatives and increasingly the provincial governments are beginning to tune in to the needs of francophone seniors, even the francophone communities in general, a sort of collaboration that we did not see a few years ago.
Senator Murray: I ask you this question because I wonder what you expect from us, from the government, the federal Parliament, versus the provinces, which it must be admitted are responsible for this.
Mr. Racine: I think that the federal government must continue to play a leadership role. I do not think that it should stand back where francophone communities or anglophone communities in minority situations in Quebec are concerned. On the contrary, it should continue to be a leader to get the provinces to work in this direction. If there is not any leadership on the part of the federal government, I think that the provinces will not be as motivated to work with the francophone communities. We need federal leadership and, for us, that is very important.
Senator Murray: I do not want to ask you what is called, in the courts, a leading question, but do you find that we are standing back at the federal level?
Mr. Racine: We often get mixed messages. For example, on one hand, we saw the Prime Minister make an outstanding speech at Embrun. But, on the other, it is certain that getting rid of the Court Challenges Program affects a lot of the francophone communities.
Senator Murray: Seniors in particular?
Mr. Racine: Seniors in particular. There is some leadership, but there is room for improvement. Even the federal government is involved with seniors. Health is a provincial jurisdiction, but I can give you as an example the New Horizons Program, which is federal. We have statistics showing that the francophone communities do not always receive their fair share of the funding granted. There are still some improvements to be made.
We are trying to establish a link with the people from Human Resources and Social Development Canada, but it is still hard, it is not always easy. The federal government still has some work to do with regard to seniors, but there has also been some progress made.
We were very pleased that representatives of francophone communities in minority situations were appointed to the National Seniors Council.
I am giving you a few examples to show you what the situation looks like.
Senator Chaput: Thank you, everyone. My first question is for Mr. Racine. You are a federation, you have a board of directors composed of volunteers who come from various provinces. Quebec is also on your board of directors. You have representatives in Quebec. It is totally different from the other francophone federations in Canada, isn't it?
Mr. Racine: Exactly.
Senator Chaput: How is that Quebec is part of your federation?
Mr. Racine: As I mentioned at the beginning, our federation represents above all the needs and interests of francophone seniors in minority situations. But exceptionally the Fédération de l'âge d'or du Québec, which has 285,000 members, sits on our board and is a full member.
A very nice relationship has developed with the Fédération de l'âge d'or du Québec, FADOQ. We work together. The FADOQ has been a key player in supporting us in certain actions and in certain provinces. It is a fine collaboration that has lasted for about three years and that we are very proud of.
Senator Chaput: In terms of leadership from the federal government, did I understand correctly, during your presentation, that seniors would like to go on working and to be involved? So the system should change in that regard so as to enable them to do so?
Mr. Racine: Exactly. Research has been done in Ontario. The report talks about it too. It talks about a shortage of labour in the coming years. No one was talking about that a few years ago.
We should put in place some incentives to enable retirement-age workers to remain on the labour market, motivate them to stay, or to get young retirees to return to the labour market.
A study was done, and it is remarkable, because actually employers are now aware of the shortage of labour that is coming. And for us, services in French are a major issue. We want to continue to be able to offer services in French. So we need workers who can offer services in both official languages.
It is important to work on this file and put in place measures that will encourage seniors to keep their jobs. At present, to my knowledge, there are not really any programs. There is one to encourage seniors in rural environments, those aged 50 or more, but I think this program should be extended to allow more young retirees and older workers to continue working.
[English]
Senator Chaput: Did I hear correctly? I wrote down that a large percentage of the ethnocultural seniors who come to Canada do not speak English or French. Is it over 50 per cent?
Ms. Chiappa: That is right. The report given to us by Statistics Canada, A Portrait of Seniors in Canada, indicates that.
Senator Chaput: Those seniors come to Canada and do not speak English or French. Would they be staying with their children, who do speak one or the other language?
Ms. Chiappa: That is right. Those are the individuals we were talking about who are sponsored by families and who come for various reasons.
Senator Chaput: The children would speak one or the other language, but the seniors would not.
Mr. Racine talked about a mentorship program. If I understood, it was the elderly helping other elderly people and it had to do with the language issue. A francophone who does not speak English is helped by one who does speak English; was that the case?
[Translation]
Mr. Racine: What you raise may prove to be right but not in all cases. It was more about seniors helping one another.
[English]
Senator Chaput: I was wondering if that kind of program could help the elderly.
Ms. Chiappa: There are many options. Communities and families need assistance. The difference, in our estimation, is that there has been little leadership on ethnocultural seniors and ethnocultural communities in terms of programs and services run federally. We are not sure where we are going, to be frank. The multiculturalism program has been reduced dramatically and is not filling that gap. As I said with regard to recommendations, it should be considered. There should be leadership at the federal level to bring agencies and communities together that are working with ethnocultural seniors to look at all of these issues and to share information and develop some strategies. Unless I am missing something, I think there is a gap there.
Senator Chaput: Ms. Leaney, you represent the Canadian Network for the Prevention of Elder Abuse. Your board consists of volunteers. Do they come from different provinces? How do you go about networking with them?
Ms. Leaney: Our board consists of about 15 individuals from all across Canada. As I mentioned, the only jurisdictions from which we do not have board member representation at this time are New Brunswick and Nunavut, although we did, until recently, have a Nunavut member.
The board members are a very gifted group of people with diverse experience. Many of them are seniors' advocates and/or they work for government in their provinces and territories on the issues of abuse or neglect. As well, some of them play a leadership role in their province or territory in terms of responding to cases. They are social workers, nurses or physicians, or they may bring a particular gift in terms of community development or community capacity building. There are also people who bring a very strong academic focus.
Our members beyond the board are individuals — anyone in Canada who so chooses can become a member of the Canadian Network for the Prevention of Elder Abuse — and we also have members that are organizations.
Because we have been primarily without resources and have been reliant on various in-kind supports, most of the people on our board have never met and never seen each other, which is a challenge. It is only in the last two years or so that we have had access even to teleconferencing to talk together about where the organization should be headed.
We also have had to deal with some internal structural issues. We did not have bylaws that permitted us to meet by electronic means. While we want to expand massively the network so that we have many more members, because people really want to get connected to us, we did not do that initially because we were worried about being able to have a legal annual general meeting.
We have had some internal processes like that to address. Since we have addressed those and have just entered into this first contract arrangement with the Public Health Agency of Canada, the Family Violence Prevention Unit, for which we are very grateful, that will expand our network exponentially. We held a series of six or seven teleconferences on different aspects of addressing abuse and neglect of seniors, or preventing it, and people were starving to get connected and hear what other people are doing, because that is how we learn what works and what does not work.
The Chairman: I want to thank all of the members of the panels today for their presentations. This has broadened our knowledge of issues particularly relating to abuse but also to ethnocultural issues and our francophone population. All of these issues are important for us to hear about so that we can draft a report that reflects the needs of all seniors in Canada.
The committee adjourned.