Proceedings of the Special Senate Committee on Aging
Issue 11 - Evidence - June 11, 2007
OTTAWA, Monday, June 11, 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. Welcome to this meeting of the Special Senate Committee on Aging. As you know, this committee is examining the implications of an aging society in Canada. Our first panel today will focus on home care, continuing care and caregiving, which is an important perspective.
We will first hear from Dr. Janice M. Keefe, Professor in the Department of Family Studies in Gerontology at Mount Saint Vincent University in Halifax. In 2002, Dr. Keefe was selected as Canada Research Chair in Aging and Caregiving Policy and was awarded funding from the Canada Foundation for Innovation to develop the Maritime Data Centre for Aging Research and Policy Analysis. Recently she was appointed Director of the Nova Scotia Centre on Aging and the Lena Jodrey Chair in Gerontology. Prior to joining Mount Saint Vincent University, Dr. Keefe worked in public municipal home care. Her current research areas include informal caregiving, specifically work and elder care, financial compensation and assessment, human resource issues, rural aging and continuing care policy.
We will then hear from the Canadian Caregiver Coalition in the person of Ms. Palmier Stevenson-Young, President. The Canadian Caregiver Coalition is the national voice for the needs and interests of family caregivers.
[Translation]
The Canadian Caregiver Coalition is a bilingual, not-for-profit organization made up of caregivers, caregiver support groups, national stakeholder organizations and researchers.
[English]
The Canadian Caregiver Coalition provides leadership in identifying and responding to the needs of caregivers in Canada. Its mission is to join with caregivers, service providers, policy-makers and other stakeholders to identify and respond to the needs of caregivers in Canada.
Welcome both of you to the Senate of Canada.
Janice M. Keefe, Canada Research Chair in Aging and Caregiving Policy and Director, Nova Scotia Centre on Aging, Mount Saint Vincent University, as an individual: Thank you very much for inviting me to speak to your committee. It is my pleasure to be here.
I am interested in talking with you about some of the key factors that need to be considered in the aging of our population. I will focus primarily on the projected needs for chronic home care services — some of the research I have been doing with my colleagues. I will look at some of the issues around family and friends as part of that home care program and offer some policy solutions from some of our international work. We have been looking at 10 different countries and how they have been addressing the needs of older populations and of caregivers, in particular.
The demand for support services will only increase, given the projected needs of the population. That will put pressure on human resources. I want to talk to you about human resources in terms of family and friends. There are also the human resources of the paid home care worker, which I do not want to leave out of the equation.
The provincial/territorial home care programs are the obvious vehicle through which to try to support caregivers. That poses challenges for the federal government related to jurisdictional issues. However, I believe there are two ways in which the federal government can play. First, they can enhance the dialogue among the provinces and offer some policy solutions across provinces and territories, looking at what initiatives they are doing themselves. Second, they can provide incentives, some carrot sticks, to help provinces and territories provide support to caregivers.
Finally, I will talk about what we can learn from other countries' policies and how we might be able to use federal government vehicles to provide some direct payment to caregivers.
I will not spend much time on the demand. I know you have probably heard several experts talk to you about the aging of the population. I am sure you are getting tired of hearing that, but I will throw this tidbit out. In 1960, one in 20 of the elderly population was over the age of 85. I think it is that older group we really need to be thinking about, particularly when we are talking about home care services. We need to look at aging broadly when talking about other issues, but with home care, it is over the age of 80 or 85.
In 1960, one in 20 was over the age of 85. By the middle of this century, it will be one in five people, so we know there is a huge shift happening here. Because of the baby boomer bulge, we are trying to account for how many of those will be healthy people aging and what impact their decreased supply of children will have.
My colleagues and I completed a series of complex multi-simulations with Statistics Canada. I will not go into the detail but we can provide that. We looked at demand-supply scenarios — the supply of caregivers — and we found that in 2001, 15 per cent of women over the age of 65 did not have a surviving child. By 2051, 30 per cent will did not have a surviving child. The question is who will care for those individuals when they need support.
We also looked at demand; we looked at issues around disability and what will be the increase of disability in the future. We noted that by 2031, the number of older people who would be in need of assistance would more than double from 2001. Basically, our findings suggested that there would be both a relative and an absolute increase in the need for formal home care services.
We showed three different scenarios. I will not go into detail, but if we could increase the health of the population, this compression of morbidity would help us to delay the need for support for disabilities. Looking at improvements of the health of the population could have a major effect on the need for and use of services. Nevertheless, if things go as they may, the results point to a steady increase of human resources needed to care for our older population.
Who are these human resources? Some of them are privately paid and some are through public programs, but the vast majority of human resources that provide care to older people in the community are family and friends. In fact, 70 per cent of the total number of hours of service provided in the community is provided by family and friends. If we lose family and friends — think about no surviving children — we have a problem. We need to have those human resources to provide support.
In 2002, using the General Social Survey, the GSS, there was an estimate of one in five people over the age of 45 who provided care to an individual because of a long-term disability. That is 20 per cent of our population aged 45 and older who is providing care to someone.
When we talk about policy, all of those caregivers, while very important to the care receiver, would not necessarily be eligible for receipt of policies. As a quick personal example, I am the second youngest of a family of nine. Seven of my siblings live within 30 minutes of my 84-year-old mother. They are all considered caregivers by the GSS. You will not provide support or policy to all seven of them because five of them are boys and they do not do as much as the girls do. Therefore, you will target your support, which is all I am trying to say.
There will be a need for support for these caregivers. In Canada, there is no one-stop shopping for caregivers. There is no place where all people can go. The availability of support depends on where you live, how much money you have and for whom you are caring. If you are trying to access services through the provincial government, it depends on whether or not the care receiver is willing to receive that support or services.
Continuing care policies are under provincial jurisdictions. With the increased pressure from hospital and rising costs of health care, some of those provincial programs have focused more on acute home care programs and less on chronic care needs. This is a challenge for caregivers because people leave the hospital with complex needs. That affects not just the care delivered in the community but also the caregiver. It will increase their stress as well.
What can the federal government do? They can target resources to the provinces to help support chronic home care services and caregiver initiatives within that area. They can also provide leadership working with the provinces to develop a Canadian caregiver strategy.
Caregiving is a global issue. While the Government of Canada has yet to develop a strategy for supporting caregivers, other countries have taken a more active role in this vein. Australia, for instance, over a decade ago had in place the National Respite for Carers Program. The U.K. had a National Strategy for Carers in 1999. About two months ago, Gordon Brown announced an updated caregiver strategy looking to vision for the next 10 years.
I lead an international research project examining policies for caregivers in 10 countries: Australia, France, Germany, Israel, Netherlands, Norway, Sweden, United Kingdom, Canada and the United States. We have identified four types of policy supports available.
First is direct service to caregivers. This gives caregivers respite, support through the home care program, education, information, resources and counselling. Second is direct payment, where caregivers receive allowances, compensation or reimbursement for expenses. Third is labour policy, where we look at workplace policies, labour standards and Employment Insurance policies such as our compassionate care benefit. Fourth is indirect compensations — tax credits, pension credits, dropouts from pension, et cetera.
In an effort to make research more accessible, we developed fact sheets, which we provided to your researchers. They give a bird's eye view of the policies out there. We have completed more detailed analysis of this as well. I invite you to contact me for more detail.
I want to give you two examples, the U.K. and Australia. The caregiver allowance is not intended to replace labour market participation but rather provides a small sum of money to acknowledge the social value of caregiving or provides assistance for out-of-pocket expenses.
Australia is interesting. They have a caregiver allowance of about $100 Canadian every two weeks. This non-taxable allowance is provided to caregivers who give at least 20 hours of support. All caregivers providing at least 20 hours of care are eligible. It is really recognition, rather than income replacement. It provides the caregiver some support in terms of providing respite. Australia also have a caregiver payment, an income-tested program that supplements low-income caregivers.
The U.K. has a caregiver allowance available to caregivers of a disabled child or adult who is a relative or friend. There are certain eligibility criteria. The care receiver must be in receipt of disability benefits and the caregiver must provide at least 35 hours of care per week. There is no asset test, however, and they were eligible for about $108 every week in 2005. It is now about $200 to $400 a month.
There is also a direct payment. The U.K. is interesting because they built one policy and augmented it. We have a chance to build a good policy that has all of these different components. Their direct payment gives cash to the caregiver to buy services and support to meet their needs. It is a reimbursement for their particular needs.
Why should we support caregivers? They are the backbone of our home and continuing care system. Without them, imagine the long-term care facilities and assisted-living facilities we would have to build and imagine the wait lists for emergency rooms.
Caregivers experience high levels of stress. If we do not support them, we may end up with two users of our health care system.
Finally, it is cost effective. We recently published the policy implications of our projections in the journal Canadian Public Policy. We reviewed the public policy scenarios of the U.K. and Australia and identified the costs of those in Canada, given our thoughts on disability and projections.
Augmenting the policies of respite or introducing financial support for caregivers was estimated to be $1.1 billion for the financial support to $2.2 for respite services in 2001. That is a lot of money, and these are conservative estimates. We can give you the scenarios.
Over time, those costs would double because the disability of the population will double. For the financial compensation, equivalent to the Australia system of $100 every two weeks, the cost would double from $1.1 billion dollars in 2001 to $2.2 billion in 2031.
What would be the cost to the health care system if we do not do it? We undertook a policy road show across Canada and were asked to provide the implications of not supporting caregivers. Therefore, we looked at the possibility that without caregiver support, the care receiver would enter a long-term care facility just three months earlier. What would it cost the health care system if they entered a long-term care facility just three months earlier than they would have with caregiver support? We estimated that an additional three months multiplied by the number of people using the facilities would cost us, in 2001, $6.5 billion. While it was $1.1 billion to provide financial support, it was $6.5 billion to provide the long-term care facility for just three months in 2001. By 2031, the cost would be over $12 billion.
Do we invest in caregivers or do we invest in long-term care facilities? Caregivers are the essential part of the home and continuing care system. They are the invisible person working day after day with little or no recognition. There are a number of ways and policies that we could consider to help these caregivers. I think that caring for the elderly and community care policy should recognize both the needs of the care receiver but also the family providing that care.
Thank you for the opportunity to provide just a glimpse of our research into caring for the older population in Canada.
Palmier Stevenson-Young, President, Canadian Caregiver Coalition: It is my pleasure to be able to speak to you on behalf of those seniors who are caregivers and care receivers. As a caregiver for my father, a long-distance caregiver for my father-in-law and an old baby boomer, I have experienced some of the challenges facing seniors. Both of my dads are World War II veterans with overseas service who cannot receive any assistance from Veterans Affairs Canada, which is significant.
Canada's population is undergoing radical changes that will have a profound impact on our society. Baby boomers in Canada are facing the role of caregiver to a parent, other relative or elderly friend. At the same time, countless seniors face the dilemma of caring for a chronically ill spouse and/or disabled adult child. Caregiving is a cornerstone of our communities and health care system. With unpaid caregivers providing 70 per cent of necessary care to older, chronically ill and disabled Canadians, there is an urgent need for greater recognition and awareness of the diversity of the caregiving experience and understanding of the challenges associated with family/friend caregiving and the identification of strategies to support caregivers in their essential role.
Who are caregivers? Caregivers are Tom and Martha, a 75-year-old couple living with their 45-year-old son, Paul, who has schizophrenia. Paul is unable to care for himself without supervision. Tom and Martha are getting older and finding it more difficult to address Paul's needs. Paul is very fearful and rarely leaves the home. At times he refuses to take his medication because of the side effects. His parents have learned how to encourage him to bathe and address his personal care needs but it requires tremendous energy on their part. Because Paul does not have a specific physical disability in addition to schizophrenia, he is ineligible for help through a home care program. As a result, Tom and Martha spend countless hours every month searching for private home care assistance to provide respite and have had to resort to hiring anyone who answers their newspaper advertisements.
Tom and Martha are like many caregivers who fall outside the home and community care eligibility criteria. Persons with mental health disabilities are not eligible universally for services unless a physical condition limits their level of functioning. Thirty years ago their son Paul would have been placed in an institution. The development of new pharmaceutical treatments and the deinstitutionalization movement of the 1970s have had a profound impact on the treatment of mental illness. If something happens to either of his parents, Tom and Martha fear that the surviving spouse would not be able to cope with Paul by himself or herself. What will happen to Martha, Tom and Paul?
A caregiver is Claude, who is struggling to care for his wife, Marie, 83, who has Alzheimer's disease. Her condition and health have been deteriorating and she has progressed to the palliative stage. Claude has promised Marie to let her die at home. Claude is 87 and has several chronic conditions, including heart disease and arthritis. Throughout his caregiving, Claude has experienced a variety of levels of service. About five years ago, their home care service was cut from five to three hours per week for homemaking. Marie attended an adult day program to give Claude a break until she was unable to feed herself and go to the washroom unassisted. While Marie is getting care from the palliative care program, Claude is exhausted from the years of caregiving and his own failing health. Claude and Marie are typical of many frail seniors who have seen changes in home and community care over the years. The level of service changed due to home care funding cuts without taking into consideration both Claude's and Marie's needs. Changes in program and service levels must be based on a needs assessment of both the caregiver and the care recipient. What will happen to Marie if Claude becomes ill?
Caregivers are Norma, Kathleen and Jennifer. Norma, the mother, is an 85-year-old Irish Canadian living in Vancouver who suffers from osteoarthritis, has recently had a hip replacement with poor results and is, therefore, in pain. She is aware there might come a time when she can no longer care for her youngest daughter, Kathleen. Norma has trouble driving and has thus given up her car. She is unable to do heavy housework. Although she still cooks, she finds it difficult to do so because of her hip pain. She has mild memory problems in that she forgets names, leaves pots on the stove and is confused at times by complicated banking systems.
Kathleen, 50, Norma's youngest daughter, lives with her mother. Kathleen has a developmental disability and is mildly intellectually disabled. She volunteers in the community, takes public transit and relies on her mother to remind her when her appointments are and to supervise her money management. Kathleen does the household shopping under her mother's direction and does the heavy housework for her mother under her mother's direction. Jennifer, Norma's other daughter, is 55 years old, works full-time, is married with teenaged children and lives on Vancouver Island. Norma and Kathleen live in a self-owned two-level home with stairs. The main bedroom is on the second floor. There are steps up the front of the house and steps down the back of the house. Norma and Kathleen have lived there since Kathleen was born.
Kathleen attends a community workshop, where she volunteers twice a week. One of the leaders at the workshop notices that Kathleen has missed a few days, which is unusual for her, and that when she comes in, she seems less tidy and a bit more stressed than usual. The worker talks to her and Kathleen admits that her mother is having bad pain and things are difficult at home. The worker phones the health unit and makes a referral to a community care assessor, suggesting that Norma and Kathleen need help with homemaking, at the very least, and possibly more.
These three examples of seniors living in caregiving situations illustrate the complexity of the challenges faced by caregivers, care receivers and the health care, home care and community support systems. These examples also demonstrate that there is no typical profile of Canadian caregivers. They are as diverse and varied as the Canadian population is. We do know from recent Canadian caregiving statistics that approximately 60 per cent to 75 per cent are women, 35 per cent to 65 per cent have paid employment, 32 per cent are distant relatives or non-kin and 25 per cent to 45 per cent are seniors themselves. Caregivers are aging too.
As Dr. Keefe mentioned, Canada lags behind the U.K., Australia, Germany, Japan, the Netherlands and the U.S. which have developed supports for caregivers or have developed national caregiving strategies. Some progress has been made in supporting caregivers in Canada. The 2003 First Ministers' Accord on Health Care Renewal provides for short-term acute home care coverage, and the employment insurance compassionate care benefits provide income support and job protection for workers caring for gravely ill members in their final days. However, the latter program does not help senior caregivers. They are not employed.
To ensure that caregivers have choice, a voice and the support they need, they must be full participants in determining the policies and programs that are the integral components of a Canadian caregiver strategy. Some of the actions that would demonstrate a leadership role are to develop and sustain a communications strategy that informs Canadians about caregiving and that values and acknowledges caregivers in all their diversity; to enhance health and social services for the care recipient, the caregiver and their families; to provide remuneration to caregivers; to develop financial support programs; to provide grants, allowances, tax deductions and reimbursable tax credits to offset the costs of caregiving at home; to ensure that case management plans include assessment of caregiver needs; to provide information and education to support voluntary sector organizations that represent caregivers; to develop a clear picture of caregiving in Canada through data collection; and to develop a Canadian research agenda for caregiving including knowledge transfer mechanisms.
The Canadian government's role is to facilitate the development of a pan-Canadian strategy and strong leadership by working collaboratively with the provinces and territories. Doing so will ensure that caregivers like Tom and Martha, Claude, Norma, Kathleen and Jennifer, will be able to carry on their caregiving roles without sacrificing their own well-being. In order for a national caregivers strategy such as the one I just described to become a reality, the federal government must take an active role in this work and bring together policy-makers, stakeholders and family caregivers from across Canada to begin discussion and mover toward action. It is imperative that the federal government accept this critical role to ensure a strong support system for seniors today and tomorrow.
The Chairman: Thank you. Both of you have given us much food for thought.
Dr. Keefe, I liked the way the you indicated that there are four different policy areas that we have to pursue: direct care respite education, direct payment, labour policy standards and indirect supports. You talked about direct care and direct payment, but you did not go into much detail about labour policy and standards and indirect tax relief. Would you like to take the time to elaborate on those two areas?
Ms. Keefe: Yes, I would be happy to do that. As you know, in Canada we have the Employment Insurance program for the compassionate care benefit. One of the areas where we could improve that is labour policy. In our work, I have been looking at how five other countries deliver labour policies in this regard. Our policy, as you are likely aware, has been underutilized. It has not been used nearly as much as we had anticipated. That is because of the nature of the program. They have tried to expand the relationship, which is good. I do not know if it has been enacted in legislation but the government will broaden the definition of "terminally ill."
There are many challenges with our policy. Some of the countries that we examined allowed more flexibility in the utilization of the policy. For example, in Sweden they are eligible for 12 weeks of compassionate leave that can be taken over a period of time. It does not have to be a 12-week block. Imagine caring for someone who is terminally ill. You might want to be out two days per week and spend three days per week at your job. However, they were able to get compensation. In Sweden, of course, compensation was higher than in Canada; it was 80 per cent of their wage.
That flexibility in utilization is something to think about. California has an even better system than Canada, which was shocking to me when I was looking at their policies. They have a similar percentage of wages, but the maximum is about $800 Canadian per week, whereas our maximum in EI is about $450, so they have a much greater advantage.
In different countries, people do not necessarily use the labour force policies for the terminally ill. Some of the challenges are related to the need to get physician support to actually say that the person is dying now, because nobody wants to give up. One way to get around that is to be a little more flexible in providing leave for people who are caring for chronic-care older individuals as opposed to this idea — there is no good way of saying this — that they are supposed to die within a certain period of time. That is a real challenge.
The other area for labour policy is labour standards. We can talk about workplace policies, but that is out of the public purview. However, if we talk about the Canadian Employment Standards Act and the provincial labour standards, we would be able to get somewhere on entitlements to paid leave days.
In terms of the indirect compensation, I deliberately did not mention tax credits because that seems to be Canadians' favourite way of trying to get something done. I am sure the tax people do not see it as an easy vehicle, but it is a vehicle that is under federal jurisdiction. There are many challenges related to its delayed system of care. In my field, we speak about the inverse care law: The people who need the care the most are the ones who do not know about it or do not have the accountants who can direct them to apply for it. There is a real challenge related to using the tax law for that. However, if it was a refundable tax credit, then it would be moving in the right direction. That certainly could be considered. Currently, it is non-refundable.
Other countries tie pension credits to the care allowance so they are able to use that policy vehicle of already having been assessed. This is where it becomes challenging for us, because there needs to be an assessment, which in those countries is usually by a provincial home care person who determines that there is a certain level of need. Then caregivers are eligible for an allowance, and attached to the allowance is that the state will pay their pension credits towards what we would call their CPP.
The Chairman: To ensure the record is clear, the six-week payment in the compassionate care program also does not have to be taken all at one time; it can be taken over a series of 26 weeks.
Ms. Keefe: Yes.
The Chairman: It has been provided for. The reason we did not go the route of the tax system was that people needed the money at a particular time, and there was no way within the tax system to provide them the money at that time. The defect, of course, is that the compassionate care program does not cover all those people who are not in the workforce, nor does it take care of anyone who is not eligible for EI at that particular time, even though they may be in the workforce.
Ms. Stevenson-Young, you said something that I suspect I should have been aware of but was not. You said that someone with a mental disability is not entitled to home care. Is that true straight across the country?
Ms. Stevenson-Young: I think the situation is changing. There was an agreement amongst the first ministers to start to provide home care over a certain period of time for people who have mental disabilities. In general, people who have a mental disability are not eligible for home care.
The Chairman: That is rather shocking, is it not?
Ms. Stevenson-Young: Yes. About two years ago I attended a conference on home care mental health and I was shocked that there was such a difference between having a physical and a mental disability.
The Chairman: I suspect Senators Cordy and Keon knew that, since they worked on the mental health study, but I did not know that.
Senator Keon: The other problem is the disparity between provinces.
Ms. Stevenson-Young, you pointed out that 70 per cent of the services that are currently being provided are voluntary.
Ms. Stevenson-Young: Yes.
Senator Keon: Dr. Keefe, you spoke about your four policy areas and how someone gets looked after, but I am wondering how many areas of Canada have some kind of navigator to assist a family in this minefield.
Ms. Stevenson-Young: That would be a wonderful opportunity, to have a navigator to help you through the system. Even if you are familiar with the system, it is very difficult to find your way through it. In Ontario, there are case managers with the community care access centres, but they do not really do the navigation. They will set you up with some services, if any are available, and then are you on your own to find supplemental services. The navigator for people who are caring for people with various chronic diseases or disabilities could be a position in regional health care authorities.
Senator Keon: I have some knowledge of how the community care access centres work in Ontario, but I do not know how they work in the other provinces. I keep advocating that we reorganize health in that we have community centres that provide primary care and social services so that we can add a dimension of reason to all of this.
Are the community access centres of Ontario better than those of most other places? I understand Quebec probably has the best, does it?
Ms. Keefe: Yes. I suppose it depends on whether you are talking about governance structures or about care delivery to individuals on the ground. As you suggested, there is a lot of disparity in how provinces organize their regions. Quebec has been identified in the past as being more broadly in tune with the needs of family and friend caregivers. There are certainly pockets of highlights in Quebec where they seem to have their health and social service centres, CSSS, integrated, and some of those centres provide a significant amount of caregiver support as well.
When we had the Minister of State for Families and Caregivers a few years ago, I was asked to speak about the system of support that exists for caregivers. There really is not a system. You go to home care to get services for your older person, but there is a myriad of not-for-profit organizations and volunteers. You might get transportation over here from your senior's club, but there is not one place for someone to go, like a navigator. While home care assessors are dedicated to their job and are wonderful in all of these places, it is not their mandate to be calling up the local volunteer organization to set up that friendly visiting for you.
I think your idea is a good one, and other countries have tried to do this as well around the respite care programs; they have a social system operations centre where caregivers can gain access to information and resources and have someone provide them with information on what is available to them. One of the greatest challenges is making the public aware of that information, and it is especially sad when you hear about people who could have benefited from the public service system but they did not know about it.
Senator Keon: Do you think that governments are just plain scared to address this because they feel there would be an escalation of manpower requirements? The more I look at the systems for mental health, population health, seniors, and so on, the more it seems to me that we have reached a point in all provinces of Canada where we cannot do without some major thrust and development of combined primary care and community social service centres. The community access centres are doing the best job they can, but they really do not serve that function.
Ms. Keefe: No. I totally agree about the need for that. There seems to be a fear of the woodwork effect, which is that if we provide these services or supports for caregivers, they will come out of the woodwork. Look at the EI program. They did not show up. Most people are not trying to work the system. There are probably a couple in every group, but in the main, people are not trying to work the system. We need to get over this idea that people will come out of the woodwork, and we need to provide caregivers with support before it is too late and they too end up in a long-term care facility.
We also need to understand the cost difference. You need to put resources into the preventative measures and the navigation and help people get a system of support to help the community. As Ms. Stevenson-Young was suggesting, you need to provide support for some of the volunteer organizations in the community and to provide support for caregivers and older people who live in those communities. That goes a long way to helping people stay there and not have to move to a facility. Some preventative measures have a long-term effect of keeping people healthier in our communities.
Senator Keon: I will talk more about this later, if the chairman will allow me to do so in the next round.
Senator Cordy: Ms. Keefe is an alumnus of Mount Saint Vincent University. It is good to have you here. You have done a lot of work in Nova Scotia.
I would like to get back to the communications strategy that we should use. You are correct; there are many programs for which people do not come out of the woodwork because they do not have time to find out about the program. Ms. Keefe, I think you made the comment that those who do not have to access the programs are probably those who are most aware of them.
How do we disseminate the information? In Nova Scotia there is a 1-800 number, but those numbers do not always work, because if you want this, you have to press 2; if you want that, you must press 7; and on it goes. How do we communicate to seniors and to caregivers? Caregivers who are employed outside the home in addition to being caregivers do not have an hour to sit leisurely and read the newspaper when they come home from work.
Ms. Stevenson-Young: As Senator Keon mentioned, it would help if there were a navigator in the system for people to use. As an example, Ontario currently has a pilot project called First Link. It deals only with Alzheimer's and dementia. The First Link coordinator meets with the family health teams and other doctors in a broad community in Southeastern Ontario. She will be given the names of the people who have been diagnosed with dementia. As coordinator, her job is to contact the person and ask if there is any help that they require now or any resources that they think they might need. If they say, "No. It is overwhelming. Leave me alone," then the coordinator will leave them alone and come back to them in a few weeks to ask again, "Is there any assistance that we can provide you? How can I help you find resources?" The coordinator continues to follow up with that person and their family, if their family wants to be involved.
Once the pilot program is over, I think it will be adopted across Ontario. It is in five centres in Ontario right now. It has proven to be effective in Ottawa, and I think it will prove to be effective across the province. A First Link coordinator, or navigator or some person like that could be used across the health care system to bring the system to the people rather than the people having to go to the system.
Regarding 1-800 numbers, my father, and I suspect other seniors, will not use those numbers. If the phone starts asking him to push a button, he hangs up. He says he does not have time to waste. He is 82. He does not have a lot of time left and he does not want to waste it pushing buttons. Having a navigator in place in the regional health authorities would help.
It is important to have services — public health, primary health, community services and acute care services — all connected together. It is time to start looking at the health system as a whole and start cutting across all these silos. We have to bring in housing and transportation as well. I live in a rural area. There is no bus service. If I want to get to a doctor or to a hospital, I must have a vehicle. If I am a senior who has had my licence taken away because I have been diagnosed with dementia or have heart problems, or whatever, then I cannot go anywhere unless someone comes to get me. That is not a good situation for any Canadian. This is in Southern Ontario, not in the remote areas of the country. I live 41 kilometres from the 401 and we live in a black hole. There is nothing. There is no cellphone service, no high speed Internet service and no bus service. There are no services available. The nearest village is 12 kilometres away. We need to start looking at cutting across jurisdictions and silos and bringing information and services together so that people can easily access what they need, without having to run the gamut of pushing buttons and calling someone else for help.
Ms. Keefe: I am not a communications expert. For the people on the ground, communications is an important component that needs to be there.
As a society, we need more recognition of caregivers in that broader vein. How do we get that? We need a vision or a caregiver strategy or something out there, up front, that we could turn to when we are looking into where we want to go, what our values are around caregivers for seniors, and what we are trying to achieve in this society of Canada. My goal would be that people in a community, whether it is a rural community or downtown Toronto, would recognize the caregivers out there. Maybe the caregivers would recognize themselves as caregivers, because that is part of the challenge: they are so busy just getting through the day that they are not looking for support to help them. How do we get that message out there of this broader need for a caregiver strategy and the need to value the work that women and men do in our society in helping older people to stay in their community for as long as possible? Are others helping as well but do not even recognize it?
I have been involved in an age-friendly rural cities initiative. It started off with the World Health Organization's Global Age-Friendly Cities Project, and then the Public Health Agency of Canada is looking at what makes smaller rural communities an age-friendly place to be. I am sure you have heard of it.
There was a discussion about a woman in a remote rural area in Nova Scotia who called five people to see if she could get a ride to the hospital, which was an hour and a half away. Her sister-in-law ended up driving three and a half hours from Halifax to take her to the hospital. Four people around the table said, "You should have called me." People are willing to help, but nobody is there to navigate or coordinate these needs. It is too bad.
Senator Cordy: A plan would be excellent, as would the recognition of caregivers, what they do and the support that they provide not only to the individuals they are caring for but also to society as a whole.
Your suggestion of being proactive is also good. People are often reticent to ask others for help. Sometimes we are also reticent. We are quick to say, "If you need anything, call," instead of knocking on the door and doing something.
I would like move to the topic of human resources in the field of home care. We know that those working in the field of home care often receive minimum wage or slightly above minimum wage. They require training to work in these low-paying jobs, and it costs them thousands of dollars to take the training. How will we retain people in the field of home care if we are not paying to train them and if we are paying them minimum wage? Are we doing any work to establish national standards for those involved in the field of home care work?
Ms. Keefe: That is another area near and dear to my heart. Home support workers, particularly the front-line workers, are invisible in our human resource strategies, as far as I can tell. We have strategies for physician care and for nursing care in the future. Those professions are vital and important to our Canadian health care system and our home care system, but who is doing the front-line stuff? Where are those people coming from? You are absolutely right. We talk about it almost as an extension of the family care that is provided, so there is an expectation that it is just women's work so it is not really valued. As an alumni of Mount Saint Vincent University, you would appreciate where I would be going with that, although I will not focus on that now.
There are differences across the provinces. The differences in the rates of pay for home support workers even between New Brunswick and Nova Scotia are astounding — $4 and $5 an hour — and the training is different. That amazes me. I do not know what is happening currently with national standards around training. I know that the provinces used to talk to each other through the provincial and territorial committees.
Retaining workers is a huge issue, because a study we did in Nova Scotia not too long ago showed that those front-line workers were getting quite old themselves. It is all relative here, but their average age was in the 50s. That is a significant issue as time goes on. I do not have any answers for that. Some provinces are actively recruiting workers.
There are differences across provinces in how home care services are delivered, whether through for-profit agencies or not-for-profit agencies, and in the standards associated with each. In Manitoba and Prince Edward Island, I believe home care workers are employees of the government system. There is huge variation.
I do not have any simple answers, only to say that I think you are right about the need to pay more attention to the human resource needs of the front-line workers and the home support workers particularly.
Ms. Stevenson-Young: They need to be included in the health human resources. When people talk about health human resources, they think of doctors, nurses and specialists. They do not talk about the front-line workers going into the home. In Ontario, the personal support workers have a training program, so they are all trained. The Alzheimer Society has tried to introduce dementia care training in every community college. Gradually, everyone who is working on the front lines will have that kind of training.
That training is through the community colleges, so that might be an area where some pressure could be brought to bear. I am not sure to whom community colleges report. I believe they are provincial, and if there is a federal jurisdiction there, perhaps you can put some moral suasion on community colleges to ensure they are training front-line workers. The salary ranges are important, too. If you are paying someone minimum wage, you will get minimum effort, except from those who are very dedicated.
Senator Cordy: Money is always a great persuader.
My last question has to do with a national strategy, if in fact we will have a national strategy developed by the provinces and territories in conjunction with the federal government.
How would we allow it to be a national strategy but, on the other hand, have flexibility? Usually with government programs, it has to be a square peg in a square hole, and if it is anything different, then it just does not happen. How would we get a national strategy with flexibility?
A few years ago, I was on the Prime Minister's Caucus Task Force on Seniors. One of the best places we found for home care was in the Yukon. They had a small seniors population, because people who moved to the Yukon many years ago would often retire in the South. Now, however, one of their challenges is that the seniors population in the Yukon is growing rapidly because many people are finding a lifestyle they love in the Yukon and with many of their children working there, the parents are coming to stay with them.
How do we go about creating programs across the country that will work for everyone?
Ms. Keefe: You start off with what you consider to be your basic values — for example, where you want to be in different periods of time. Most of the provinces have a respite care component in their home care program. They can learn from each other about different ways that they can support caregivers, whether through adult day centres, an enhanced respite program or the taxation measures that exist.
From my perspective, the need is for the wider range. With respect to flexibility, to me there is not one service to whom we should be saying, "You shall have X." For some caregivers, X does not work in their particular situation. There needs to be flexibility in order to be able to deliver that support. Many of the provinces have moved a little more towards self-managed care programs, which may provide some flexibility for families to be able to provide more flexible support services.
I do not have any magic solutions or requirements that every province has to provide X amount of care, but there should be some key components that they would agree to, like respite services or adult day care where it is reasonably feasible to do so or maybe support for a community-based system to enable caregivers to have access.
The public purse should not have to do it all. Communities might be quite willing to provide some of that through the not-for-profit and voluntary sectors, but there must be the encouragement to be able to do that. The U.S. system, which provided pockets of money for states to develop some caregiver support programs, is another model that might be considered in moving forward a strategy.
Ms. Stevenson-Young: The federal government could take the lead by providing an overarching framework for a strategy to work with leadership and to work collaboratively with the provincial and territorial governments to put in place the components that should be available to all people in Canada.
With regard to a communications strategy, it would be a Canadian-wide strategy to allow people to know that caregivers are providing a service to their communities. That could be done by having a "Caregiver Day" or "Caregiver Week." Many things can be done, and they can be done from the national level.
With regard to tax implications, we talked about the compassionate care benefit under the EI program. That applies only to people who are employed. The self-employed, people who are not eligible for EI, seniors and others who are not working are not covered by that. There must be another way of helping people in that situation, perhaps through the Canada Pension Plan. Since 1965, most people who have worked have paid into the Canada Pension Plan. Perhaps there should be something for senior caregivers under the old age pension system. There are many things that can be considered at the federal level. Providing support for families is a local issue. If there is encouragement from the federal level to the provincial level and the local level with the values and the basic components described, support for families at the local level should be the same everywhere in Canada.
The federal government should provide an overarching program and show leadership to the other levels of government in a Canadian care-giving strategy.
Senator Murray: Let us spend a minute on those people for whom the federal government has direct responsibility and to whom it delivers programs directly. We are told, for example, that Veterans Affairs Canada offers various home care services to clients. Ms. Stevenson-Young reflected on what appeared to be eligibility problems in respect of her own father and father-in-law.
First Nations and Inuit Health Branch at Health Canada works with First Nations and Inuit communities in developing home and community care services. Indian and Northern Affairs Canada provides an adult care program that assists First Nations people with functional limitations due to age, health problems or disabilities.
What do you know about those programs and what might be learned from them by provinces?
Ms. Keefe: I know less about the Inuit programs but am quite familiar with Veterans Affairs Canada programs, and they are what we in the business consider to be the Cadillac of home care for older people. They are very involved for those who are eligible, and I will give you a different perspective on this. I think we can learn a lot from the Veterans Affairs programs.
When people are eligible to receive those services, the services are comprehensive and flexible. They provide not only the acute home care services that you might get from a provincial government but also the gamut of home maintenance, yard work and support for activities that enable people to stay in their own homes.
In past years, they have put additional emphasis on reducing wait lists for long-term care facilities and providing enhanced home care services in order to delay institutionalization for a significant portion of their clientele.
That speaks to how successful and cost effective a home care program can be if it provides a range of supports rather than targeting specific things, such as assistance with bathing, for example. If you need assistance with bathing, you probably need help with housecleaning, grass cutting or snow removal so that you do not slip and fall and end up needing a hip replacement. All home care services will not be able to provide the gamut of services, but if we combine home care with a community development strategy, there is opportunity.
Senator Murray: By calling it the Cadillac of programs, are you suggesting that it would not be practicable or affordable for the wider population? You seem to be saying, at a minimum, that we could learn much from it and that while it could not be provided by one level of government or one government department, a government in collaboration with various community agencies and volunteer groups, et cetera, could provide the standard of service that Veterans Affairs provides.
Ms. Keefe: It is your latter statement that I am thinking of. It is the Cadillac compared to some of the provincial home care programs, which have been going toward an acute care model rather than toward providing chronic home care support services. In many provinces there is no more maintenance home care. It is only if you need personal care that you can access their home support services. You do not get housecleaning or other such supports.
The Veterans Affairs program is more comprehensive in what it provides to its clientele. We could look to that as a model of how to develop that support for all senior citizens. It may not all be delivered or paid for by the state, but it would be organized by the state.
Senator Murray: Here is your chance, Ms. Stevenson-Young, to fire a shot at Veterans Affairs Canada. Tell us how your father and father-in-law both managed to fall through the cracks.
Ms. Stevenson-Young: They do not have a wartime pension. Therefore, they are not eligible for any of the services Veterans Affairs provides, even though they both served overseas during World War II. My father is 82 and my father-in-law is 84. They both have health issues and my father-in-law is currently in the hospital in St. Catharines.
We cannot access any of the services provided for other veterans because neither of these men had a disability from World War II. For more recent veterans, post-traumatic stress disorder is considered a disability. I am sure that some men who fought in World War II have been suffering from post-traumatic stress disorder for 60 years.
I have spoken to people at Veterans Affairs in P.E.I. and have learned that consideration is being given to providing those services to all men and women who served overseas during the Second World War. They are dying off quickly, so it is not a huge population. There will not be hundreds of thousands of veterans coming forward for these services.
Senator Murray: There are many serving overseas again as we speak. I am glad to have given you the opportunity to make that point.
One of our notes points out that the Canada Health Act makes reference to home care under its definition of "extended health services" and, therefore, it is not an insured health service to which the five principles of the act apply.
That does not seem to be what you are asking to have done when you talk about the federal government providing "pockets of money" for provinces. Ms. Stevenson-Young spoke of an overarching framework for a national strategy.
Ms. Keefe: Is your question whether I am asking you to put it under the insured service of the Canada Health Act?
Senator Murray: Yes, exactly.
Ms. Keefe: We have had that debate in this country for a number of years. I am sure you are familiar with it. There are some challenges with doing that. You are putting me on the spot. That is an extremely good question. I am not sure what my answer is at the moment.
I suppose the challenge with making it an insured service is that with some of the services provided it is increasingly difficult to differentiate between those that we desire and those that we need. That is where it becomes a challenge to include it within the insured health care under the act.
Do I think we can provide support for initiatives that could help people to live in the community more without making it an insured service? Yes, I do. I think that is the route we should take. We could get into a longer discussion about that, but that is my answer at this point.
Senator Murray: To clarify a point that came up earlier, do I understand correctly that of the provinces, Quebec is farther ahead than the others in this field? Are there provinces that are farther ahead than others that can provide a model of best practices or best programs in this field?
Ms. Keefe: If you check every province across the country, you will get a different answer about that.
Senator Murray: I dare say, but give us an overview.
Ms. Keefe: Certainly Quebec was a leader in providing an integrated health and social services system that provided some support to caregivers in the past. There have been changes to the Quebec system in the last number of years, and I think my colleagues in Quebec would tell me that it is no longer the desired place.
Nova Scotia continues to have chronic home care as one of its leading supports around their home care program. They put energy into acute home care, and they are looking to develop a caregivers strategy. I do not want to leave them off the mark, and I am from there.
Manitoba used to be the place to provide home care services. British Columbia has gone into more the acute care substitution model and I have not evaluated how that looks for caregivers. There are some challenges I know from colleagues such as Marcus Hollander, who might challenge the route they have gone into acute home care rather than chronic home care.
I do not want to leave out the community care access centres. They are another model. There is a lot of discussion about whether the managed competition approach is the best way to deliver services. That is why the provinces always need to be talking with each other, and I am sure they do. There are aspects of every province that are beneficial and there are aspects that may be harmful or less beneficial to the client.
The Chairman: Dr. Keefe, can you refer me to the country that in fact provides pension credits to caregivers?
Ms. Keefe: Yes. The U.K. provides pension credits with their care allowance.
The Chairman: Thank you very much for that. Thank you both. This has been extremely helpful.
We will now hear from our second panel of the day, which will focus on provincial initiatives related to seniors in Prince Edward Island and Nova Scotia. You are not allowed to get into competition with one another, witnesses.
We will first hear from the Group of IX, in the person of Mr. Bernie LaRusic, who is the Vice Chairperson. The Group of IX is an independent organization dedicated to improving the well-being of Nova Scotia seniors. Its primary role is to strengthen the voice and presence of seniors in government decision-making bodies. The group fulfills that role by serving as an advisory body to the Nova Scotia Seniors' Secretariat, the government agency that influences and supports policy development across government on behalf of Nova Scotia seniors.
So that you do not feel that there is a bias here, Mr. LaRusic, Senator Cordy is from Nova Scotia and Senator Murray and I both grew up in Nova Scotia.
Senator Cordy: Mr. LaRusic and my father were friends.
The Chairman: We will then hear from Dr. Judy Lynn Richards, Assistant Professor, Department of Sociology and Anthropology, University of Prince Edward Island. I must note that my assistant is from Prince Edward Island.
Dr. Richards works with various actors in P.E.I., including the Seniors' Secretariat of the Government of P.E.I., to promote the need to plan for the challenges of population aging. The project partners have launched an initiative of a collaborative nature, intended to create a collaborative work plan listing specific actions for the short, medium and long term.
Bernie LaRusic, Vice Chairperson, Group of IX: Thank you very much for this opportunity. As the incoming chair of the Group of IX, the seniors' organization in Nova Scotia, it is my pleasure to tell you about my province's Strategy for Positive Aging in Nova Scotia — the first of its kind in Canada. The Nova Scotia Seniors' Secretariat created this comprehensive 200-page document — which we have distributed to senators — which proposes 190 societal changes and actions. The strategy is a 10- to 15-year planning guide to help all sectors create age-friendly communities and plan for Nova Scotia's rapidly aging population.
The Group of IX seniors' organization serves as an advisory group to the secretariat. We do not work with them on a day-to-day basis. However, we are briefed regularly on their key initiatives, the most significant being the strategy for positive aging. With the recommendation of this strategy in mind, I will briefly address your key questions.
With respect to defining seniors, as noted in both your interim report and the Nova Scotia strategy, the age of 65 as the traditional retirement age dates back to the late 1800s. Times have changed and so has life expectancy. Is there a need to raise the age of eligibility, as other countries have? The answer is not as easy as it may appear.
Anything the Government of Canada can do to increase labour force participation among older workers would be a step in the right direction, especially down in our province, where we are very short of people working. They are moving west, as I understand. However, as the National Advisory Council on Aging pointed out, simply raising the age of retirement would hurt many low-income workers who access CPP benefits when they are laid off or leave work due to poor health.
When considering pension eligibility issues, we need to remember that older workers are not a homogenous group. In order to respect this diversity, a more flexible approach to pension eligibility may be a practical solution. We believe the first step should be removal of financial disincentives.
Many Canadians are willing to extend their work life, but most occupational pension plans — including Canada Pension Plan — do not encourage a phased-in approach to retirement; nor do they easily facilitate earning partial pension credits or drawing partial pension benefits. Addressing disincentives such as these is key to retaining older workers, which clearly points to the need for pension reform.
With respect to diversity of seniors, the National Framework on Aging's policy guide directly addresses the issue of the diversity of the seniors population. As you are probably aware, the committee of federal, provincial and territorial ministers responsible for seniors is leading a redevelopment of the guide. The intention is to make it more user-friendly, which I am sure will increase its use. The framework is an excellent tool and its principles were endorsed by seniors and governments across Canada.
With respect to policy approaches, we agree that the life course perspective and active aging are important models for providing an integrated approach to policy-making. Nova Scotia's strategy for positive aging also recognizes the complexity of aging issues and the broad linkages that exist between them. Nova Scotia chose the term "positive aging," which reflects the life course perspective but also enables an emphasis on older adults' changing attitudes, ensuring the long-term sustainability of government programs, and promoting shared responsibility among individuals, families, communities and a wide range of sectors.
Although it is important to tackle large and widely connected issues, time is of the essence. While plans are being made for the long term, immediate action must be taken to address the most pressing needs, and priorities must be chosen.
Through the development of Nova Scotia's strategy, the following priorities emerged: retaining, recruiting and retraining older workers; and increasing the number of volunteers, with a focus on seniors helping seniors. Because the demand for long-term care is growing so quickly, the province cannot keep up, and current solutions not sustainable over the long term. Therefore, it is vitally important that governments focus on supporting independence in the home and community.
Current work in the secretariat involves, among other things, participating in an age-friendly initiative, which is highlighted on page 28 of your interim report, and an initiative to expand the number and variety of housing options available to low- and middle-income seniors. Frankly, Nova Scotia cannot afford to be paralyzed by planning. We do not have the luxury of time.
Because the provincial government cannot do everything that needs to be done, it is important to look at how governments at all levels support or discourage the involvement of other sectors. First and foremost, obstacles have to be identified and removed by changing legislation, bylaws and zoning that currently prohibit certain types of affordable housing.
Volunteer initiatives have to focus on attracting retiring baby boomers and matching resources that are sitting idle while needs go unmet. Governments must provide multi-year funding commitments. Volunteers get very discouraged when they work hard to build momentum, only to see their project discontinued after just one year.
No matter what we do to encourage people to work longer, it will not happen so long as there are financial penalties for doing so. In the interests of time, I will not provide a comprehensive answer to your fourth question, the federal government's role, but I will mention one area of interest to the Group of IX.
Nova Scotia is the co-lead of the forum of federal, provincial and territorial ministers responsible for seniors. That committee is working well and is a critical mechanism for addressing the needs of seniors in all jurisdictions, particularly in the areas of elder abuse, senior-friendly communities and social isolation. This year, the secretariat plans to work with its federal, provincial and territorial colleagues to encourage pension reform discussions, and will encourage other FPT tables, such as financial officers to address these same issues. Because aging issues are spread across levels of government, predominantly federal and provincial, it is critical that the FPT forum be further supported.
I understand the CEO of the Nova Scotia Seniors' Secretariat, Valerie White, will be speaking to you this fall. She will elaborate on the work of the forum and provide more details on provincial government initiatives and innovative ideas.
In closing I will be pleased to answer your questions, but when it comes to the work of the secretariat, the amount of detail I can provide may be limited. I would be happy to discuss the role of the Group of IX. Collectively, our group represents 70 per cent of the Nova Scotia seniors. We are well-informed about seniors' concerns, and because of our national affiliations and our strong relationship with the secretariat, we provide an important link between seniors and government.
Judy Lynn Richards, Assistant Professor, Department of Sociology and Anthropology, University of Prince Edward Island, as an individual: Honourable senators, thank you for your invitation to be here today. I am here on behalf of our project steering committee to share information about our project, Planning for Prince Edward Island's Aging Population. Our work is supported by a grant from the Public Health Agency of Canada.
I am also here today as a demographer and as a gerontologist with population aging as my area of interest. To be clear, over 200 years of lowering fertility and mortality rates has led Canada to its ensuing aged population. In just four years' time, the first boomers will become 65 years old. Twenty years hence, the number of Canadian seniors will double from 4.4 million to 8.5 million.
These changes will create major challenges in every aspect of society: health care, labour force, social services, families and communities, to name only a few. It is important to remember that these challenges will also impact on the current senior population.
The way our project members see it, we have two choices: We could do nothing or we could plan to help to manage the change. In 2005, a policy analyst from the P.E.I. Ministry of Social Services and Seniors, a retired professor in social work, the executive director of the Seniors United Network and I obtained the grant from the Public Health Agency of Canada to effect policy change related to polices that create health inequities for seniors around the determinants of health. The goal of the project is to use collaborative efforts to educate Island seniors and engage them in policy development to help inform policy-makers and politicians about how to reduce these inequities. We soon realized that our collaborative planning efforts needed the support of decision-makers, the politicians. Our planning table now includes seniors, seniors' organizations, politicians, policy officials, the private sector, service delivery people and academics. We have been working together for two years to develop an action plan of healthy policies. The success of this plan lies in the premises that collaboration that stresses the importance of understanding one another's perspectives, language and meaning is vital and that a caring society is everyone's responsibility.
In phase 1, we held eight workshops across the Island to impart the need for this level of understanding. In addition to including representatives from the Island's many seniors' organizations, we asked these representatives to invite seniors from their communities who did not normally participate in local groups or politics. To work in collaboration to gain a common ground in the workshops, we asked the attendees, including the Premier, the Minister of Health, the local member of Parliament, and representatives from multiple political parties, to adopt the persona of a senior and to identify the challenges he or she may face in the context of an aging population. We asked the seniors to play the part of politicians and policy-makers to make decisions about what was needed to manage an aging population.
All involved had to examine their values and how these impact on others. Our latest planning and conference sessions involved about 60 individuals with two advisers from the executive council and two newly elected MLAs, in spite of an election two weeks ago.
The conferences were geared towards provincially and locally focused solutions aimed at three areas: senior-friendly communities, aging in place, and safety and security. I will now present a list of several examples and concrete solutions that came out of those collaborations. These can be reframed as recommendations to this special committee at the federal level.
First, standard building codes for universal housing designs that do not restrict seniors from everyday living, such as using your own bathroom despite having a walker, could be achieved through legislative changes. Second, travelling pharmacies, stores and medical clinics for rural and remote areas could be supported by transfer payments to the provinces; these would be targeted solutions aimed solely at managing an aging population in under-serviced areas. Third, a tax credit for volunteers, especially those who provide transportation to seniors, could be done through legislative changes to tax credit laws and would help keep seniors aging in place; one need only look to the current compassionate care leave program for a prime example of how this might work. Fourth, legislative changes that will move seniors above the poverty level could be made in the form of recommendations about the levels of, and the criteria for, receiving CPP, OAS, and GIS. Fifth, curriculum on ageism and issues of aging could be integrated into training for service providers in health and social service programs across the nation. Finally, increased accessibility in public buildings such as retail stores could be achieved through tax incentives for those who ensure accessibility.
We have a list of many more recommendations. We had about ten pages from our conferences, which we would gladly share. Many can also be translated into recommendations at the federal level.
The process we undertook had its own challenges. True collaboration, upon which we have insisted, takes much time and effort. We have had to manage personnel and political changes, which impaired our progress from time to time. The level of commitment required is extraordinary. As the time involved increases, the possibility of continuing with the process may diminish.
Nevertheless, overall we have managed to persevere. We now have a commitment from the Seniors' Secretariat, which is also involved in the process, to wait until after our public consultations, which we are planning for fall 2007, before they begin to put final touches on their policy platform related to seniors. This policy platform, with the inclusion of the information that we have gathered, will reflect the collaborative voice of seniors and others. We view this kind of leadership from the secretariat as important recognition of the collaborative process and its potential for success.
Most important, we leave you with two messages: first, our collaborative process will increase our chances to achieve a successful outcome; and second, we would like to invite you to be a part of our process. We ask that you help to share our work with other jurisdictions and all levels of government departments, who will face the same challenges. Thank you.
Senator Cordy: You both mentioned volunteers and their importance in looking at the whole issue of seniors and in helping seniors. Certainly, our previous witnesses noted that importance from a community perspective. We have heard before the pros and cons of the idea of a tax credit for volunteers. One of the pros is that volunteers would get the money back but one of the cons is that seniors do not have a great deal of flexibility in their income, so people would have to wait a long time to use the tax credit to get some of the money back.
First, would both of you comment on how we can get more people involved as volunteers. Second, would you explain further how the tax credit would work and whether there are other ways to get volunteers involved.
Mr. LaRusic: I am not completely familiar with how a tax credit for volunteers would work. Based on the material I have received, I endorse it as a method to try to assist all volunteers, whom we are beginning to lose, to continue their volunteer work, keeping in mind that these volunteers are aging, too.
I will give you two examples that happened in Nova Scotia. The first is a safe driving program for seniors. Under this program, the provincial government would pay $40 for seniors to register in a safe driving course. My organization, which has many government employees who were motor vehicle inspectors and directors, designed a course for seniors, got it approved and we put it on. However, the problem is that it is extremely difficult to get seniors to take the course, even at no cost to them. The course is only six hours — three hours per day for two days — and it will not cost the seniors a cent, yet getting seniors to take the course is a challenge.
Senator Murray: Why is that?
Mr. LaRusic: I have no idea. One rationale is that seniors are concerned that it would reflect on their licences. We have said many times that it has nothing to do with their licences but once such an idea has surfaced, it becomes belief and it is difficult to dispel the myth. If that were the only reason, we could mount an education program on it.
We do not have a registration fee but we could put a registration fee on the course and donate the receipts to palliative care. We know Cape Bretoners like to give money to others in need. We could show that they can get something for nothing if they come and give their registration fee to something worthwhile. We might increase the registration by doing that.
The idea behind senior safe drivers is that everyone says seniors are bad drivers. I can safely say that I am about the oldest guy in this room.
Senator Murray: You can no doubt say that you are an excellent driver.
Mr. LaRusic: Yes, I taught driver education for 15 years. How do you get volunteers to come forward? I know you volunteer. I have not taken your dossier but I am positive there is a volunteer in there. When I retired, I said I would not work again because I did not want to do a job where I have to be somewhere by someone else's definition. I want to do what I want to do when I want to do it, so I volunteer. How do you get volunteers to come? I do not know.
Another program developed by our association is a seniors handyman program for helping seniors. Many people in Cape Breton are jacks of all trades. I was married for more than 51 years and I know how to do house repairs. We help seniors fix running taps, toilets, install light fixtures and hang curtains. We do smaller house repairs, not roofing or larger plumbing and electrical jobs. We do this work at no cost. If we have to put in a sink for someone they might have to call a plumber but it can be difficult to find a good plumber to do residential work.
Asking seniors to come forward to volunteer does not seem to be the big attraction that it was at one time. We are losing them, although I forget how many. I believe that we have lost about 30,000 senior volunteers in the last ten years or less in Nova Scotia. The number of volunteers is going down as the need goes up. If tax incentive of some description can bring up the number of volunteers, I would be happy to support it. We give out awards and things of that nature but that is still not doing the job we want it to do.
I have difficulty attracting volunteers to the variety of things that I am involved with, let alone the other aspect of people caring for people around their homes. The area of caregiving was discussed earlier. I had an aunt with Alzheimer's disease, and in one month 28 different caregivers went into the house. That is stressful, not only on the person who has the disease but on the other caregiver in the house because he has to make these caregivers aware of the needs of the individual. How do we get caregiving straightened out so that there can be less turnover of caregiver staff?
Some of it is related to funding and the costs of paying these caregivers, whose schedules are wicked. I would never want to work as a caregiver, given the schedule they have. They come and visit my sister and I cannot believe what good cooks they all are. They are beautiful people and they can prepare meals. I cannot understand how they can do it so well, so often and so continually at the salary they are being paid.
I am very fortunate in that I receive a decent pension and I can volunteer my time. These people are not looking at anything like that — to be able to live their latter years with the dignity we spoke of. Like many others, they will be suffering.
I hope the committee can look at solving some of these problems we are talking about at the Group of IX. As the incoming chairman, I will be promoting the issues of caregiving and getting out as much information as possible. The other thing is how we can attract more volunteers by making it palatable, if not payable, to come forward.
Senator Keon: There is a broader problem here, is there not? Not only volunteers for seniors but volunteers in general are struggling, are not they?
Mr. LaRusic: Very much.
Senator Keon: The numbers of volunteers for a whole variety of services are really going down.
Mr. LaRusic: Everyone that I have talked to in any organization has found it difficult; the Golden K, the Lions Club, the Victorian Order of Nurses. They are all experiencing this.
Why it is happening, I do not know. Everyone has reasons for why it is happening. It is not what it used to be. I can tell you it is very annoying and frustrating that we cannot get people to come forward to volunteer. It is not a life commitment, but what happens is when you get into some of these organizations there is nobody coming behind you, and instead of a couple of months it turns into a couple of years. After that there is nobody there. It becomes another add-on. That is all right for some people, but many have other things to do and did not intend to make that type of a commitment. When they back out there is nobody to replace them.
I always make this statement: As soon as I take on any responsibility, like chair of the Group of IX — which is a fantastic organization — I am already looking for my replacement. I am president of the retirees' association. I can tell you I have found my replacement. It took three years, but I found someone willing to take that on and do what should be done in carrying it forward. Not to do what I did, but to have the initiative, intensity and will to keep it moving. It is an organization that is doing good things for people.
Senator Murray: It says in your Strategy for Positive Aging in Nova Scotia document that Nova Scotia has the highest percentage of seniors in Atlantic Canada and the second highest in Canada.
Seniors are the fastest growing segment of Nova Scotia's population.
Although the total population of Nova Scotia is expected to grow by only 3 percent between 2005 and 2026, the seniors' population is projected to grow by 80 percent.
Seniors will comprise 25 percent of Nova Scotia's population by 2026.
A few pages after those statistics, the document talks about volunteers providing support to home care clients. Who are they? They tend to be older, an average age of 64; they are mostly women, 78 per cent; they are retired, 70 per cent; they have less formal education — 40 per cent with university degrees compared to 70 per cent of average community volunteers. There is your target population, is it not?
Mr. LaRusic: Exactly, yes.
Senator Murray: Why can Nova Scotia not get geared up to attract the required number of volunteers? We know the age group they come from and that age group is increasing considerably in Nova Scotia. That is your target.
Mr. LaRusic: Definitely understood; we have a target. What is the incentive that will get them to volunteer? Not all provincial government employees in Nova Scotia belong to our association. I will run across colleagues that I have worked with and ask, "How come you are not a member?" They will respond with, "What have you done for me?" As anyone sitting at this table and in this room knows, nothing moves slower than working with government. If I hold up our new health care booklet that took five years to put together as an example of what we have done, they say, "Is that all you did?" Well, you just try to get in to see a deputy minister or a minister about something like this; you are put aside.
One thing you must be prepared for is staying in the game. If you can stay in the game, you may come out successfully. That is a philosophy I learned at the knee of Senator Phalen. We were in the same union together. The person who succeeded him, Greg Blanchard, stayed in the game. He is not a senator. We must get people who want to get into the game. For some reason, most people say, "I enjoy doing what I am doing," and whatever that is, it does not seem to be volunteering. It seems like they have an impression that volunteering will be a locked-in commitment and they do not want to get locked into anything.
Senator Murray: Is the situation much different on the Island, Ms. Richards?
Ms. Richards: I am not that familiar with the volunteer sector on Prince Edward Island. I do know that many of the people I am involved with in the projects I am working on volunteer. We see each other at the same meetings and the same community efforts. They are always saying things to me like, "When will I get to clean my house, because I am so busy volunteering?" It is kind of the same thing.
I do not have any magic answers for recruiting volunteers, but maybe it would be useful to have some brainstorming sessions around how to do it. I am drawing on my experience with the P.E.I. Active project. On the Island we have much concern about obesity, especially in kids. How will we get P.E.I. individuals to become active? Do we have any money? No, we do not have any money. What will we do?
We had major brainstorming sessions around how to get Islanders active. With the little bit of money we were able to secure, we now have public announcements about getting active. We have launched a challenge to Islanders, people in different groups, to get active. It is starting to work. It came with some time and effort and brainstorming sessions. I am wondering if that would be useful as well in getting Nova Scotians out to volunteer.
As Dr. Keefe said earlier, people want to help but may not know where to go. We need direction for them about how to do it or what different organizations may need volunteers and what would be expected of them. Once they know it is a few hours a week or even a month or whatever it might be, then people may start to do the calculations in their heads and consider volunteering.
Senator Murray: Are your demographics on Prince Edward Island comparable to those of Nova Scotia?
Ms. Richards: Yes. We will be about 23 per cent over age 65 by 2020 and 28 per cent by 2030.
The Chairman: Dr. Richards, I would like to ask you some questions about the six principles that you laid down. First, you talked about standard building codes. As you know, there are provincial building codes and there are federal building codes. I do not know if we will have much influence over provincial building codes, but we might well have influence over federal codes. Do you think that that would be a useful start?
Ms. Richards: Absolutely.
The Chairman: The federal government could set standards, for example, that doors should be a certain width.
Ms. Richards: Absolutely. I have done a fair bit of volunteering with seniors over the years, and there is nothing more disheartening than seeing someone who has been living in the same place for so long and is now at the point where they need a walker. They are still independent and can get around and cook and clean, et cetera, but they end up giving things up, such as their house, because they cannot get into the bathroom and they cannot afford $5,000 worth of renovations to get the bathroom renovated. As soon as you leave the walker at the bathroom door, there is the possibility of slipping and falling. What will you grab onto in the middle of the bathroom in order to get to the other side? These are very practical considerations.
There should be standard building codes so that people do not have to worry about whether or not at some point in their life they will have to put the walker aside to be able to enter their bathroom and then eventually have to give up their house because the bathroom is too slippery.
Both Ms. Keefe and Ms. Stevenson-Young mentioned premature institutionalization. That is what we want to avoid. The cost of that to the government is incredibly high.
The Chairman: I was interested in your wish list for travelling pharmacies and clinics. All I could remember were the travelling bookmobiles when I was a child. I would be at Grand Lake during the summer, and all of a sudden the travelling bookmobile would come. We would get our books for the week and bring them back. Is that the kind of thing you envisage with a nurse practitioner, maybe a doctor, and a pharmacy on board?
Ms. Richards: Yes. My husband lived in a retirement home for a year and he said that there were one or two retail stores that used to come with clothes for seniors that were easy to get in and out of and had Velcro closures instead of buttons. That is another example.
When I was a gerontology student with Anne Martin-Matthews, she had me read something that came from Manitoba about a travelling doctors' van equipped for travel to rural and remote areas.
The Chairman: I was under the impression that most public and private buildings are accessible. What issues with accessibility are you finding?
Ms. Richards: Accessing bathrooms can be an issue. You enter the bathroom and have to wind your way through to the accessible stall at the other end. A building might be marked accessible but have no ramp and might have a two- or three-inch step to get over in order to get into the building. As well, the circumference for wheelchair turnarounds is limited in many cases.
Senator Keon: A lot of this was done for people with disabilities, without any thought to the needs of seniors.
Ms. Richards: Yes. There is an initiative by the federal Office for Disability Issues to learn from people who have had disabilities and have dealt with issues all their lives. We have done consultations with them about aging into disabilities or aging with disabilities and what we can learn from people who have had disabilities all their lives about the issues they have had to deal with and whether that knowledge transfers. In some cases it does not transfer, or it may transfer differently to seniors who are aging into disabilities.
Senator Keon: This is an interesting subject. The commercial enterprises that are building particularly the luxury accommodations for seniors I think are covering those issues quite well. However, there is an issue for seniors who are moving into the facilities that were built 25 or 30 years ago.
Ms. Richards: Yes, that is right.
Senator Keon: There must be some way of addressing that issue.
Ms. Richards: A senior and I were discussing this after the conference. She was talking about enforcement. You can have all the standard building codes, but if you are three inches off on the door, will somebody come and say, "Wait a minute. Before you put the final casing around the door, is it wide enough?"
The Chairman: I will give you a family example. When my father-in-law was in his 80s, every time we went to visit we put away the scatter rugs and every time we went back, the rugs would be on the floors again because he would insist that the housekeeper put them down again. I finally gave them away so the housekeeper could not do that. We discovered there were myriad things. In the 20 years between when my father, who had been a stroke victim, died in 1980 and when my father-in-law died in 2001, there were enormous changes in the new aids available — such as stand poles, lifts out of beds, new types of baths — but many of them are very expensive. That was fine in our case because we could afford to purchase them and to provide them.
However, what kind of funding is out there to help seniors who do not have that kind of access? For example, you might need a grab pole installed in the bathroom from floor to ceiling to provide stability. It might cost $89.95, but you do not have that much money because you are living at your limit already. Is there any funding in either of your provinces that will make that kind of assistance available?
Mr. LaRusic: Yes. On page 190 of the strategy book, under the heading "Home Improvement Grants and Loans" there is a list of eligible programs for assistance to fix up the home. The Parent Apartment Program grants up to $25,000; the Access-A-Home Program grants up to $3,000; and the Emergency Repair Program grants up to $6,000. These are in rural areas.
Last winter I was called in by a lady who wanted to get handrails put in the bathroom. I checked it out and determined where they could be anchored well. I think the bar she wanted was $18. There was no problem with the cost. I said, "Let me know when you want to put it in." Two days later she called me up and said, "I cannot put it in because I have to put snow tires on." I called her back and said, "That is great, but are you sure?" She said "No, I cannot afford both of them." I said, "I will see if I can find one. There is always someone you know who has a spare part somewhere." I found one. It was not shiny and brand new, but it was serviceable and could do the job.
The thing that really annoyed me is that this lady knew better than not to have a bar up there. She was a former registered nurse who had been retired for about 15 years and she was still pretty spry. She was going up and down the stairs. Her bathroom was on the second floor, so she had no problem negotiating stairs, but you can slip so easily in the bathroom. That hand bar should be mandatory in every bathroom.
You were talking about things that should be in the code. Handrails in the bathroom should automatically be in there. Most people have to use a bathroom. Somewhere along the line, if things go well, you will be very happy that this was something that had to be put in all houses so that when you go to them, it is there for you. These are small things.
Ms. Richards: It should also be in a convenient location. If you have to reach across like this to get into the tub, you are already slipping.
Mr. LaRusic: You can talk to people who do emergency repairs, or you can go to the people who supply these things and they will give you an overview of the best place to attach it for people who need them. You then go in with the owner of the bathroom and hold the bar where they move around in the bathroom. We may be able to put it there or not. If not, it is adjusted.
The Chairman: It is great that Nova Scotia has a tax rebate program, but often the person needs to have something done then and they do not have the money then. They cannot wait until for a tax rebate six months, eight months or a year later. It is the same thing we talked about earlier with respect to tax credit programs. They are wonderful programs and I support them thoroughly. However, when we looked at the compassionate care program, the first thing we looked at was the tax system. Everyone paid taxes and we thought that was the place to go, but it was not the place to go because the people most in need could not wait for the rebate sometime in the future. They needed the support right then and there.
Has anyone given any thought to some kind of flexible financing that we could put in place so that people can get the money to get the job done when they need it done and then pay it back later, when they get their rebate?
Ms. Richards: In Prince Edward Island, we have a renovation program as well. Part of the problem with that program is that it is not advertised. Senator Keon was talking about the government being afraid and I think that that is what has happened there.
It is a good idea to have something flexible like that. When my husband and I get prescriptions, we pay for them and then go to the Blue Cross office and they reimburse us almost right away. An office that provided that kind of service might bring more flexibility.
Mr. LaRusic: I was thinking about continuing care. You dial a 1-800 number, someone comes in and assesses your needs. It would be great if they could assess your needs for things like hand rails at the same time and if you met the criteria, you could get the work done and then wait for the money to come. If that were done by the government, in all probability I could go to any supplier in Sydney and get whatever I needed to fix up someone's house.
That would be a tremendous help. I do not know how would be paid for, though. I do not know if you would have to reach in your pocket right away and pay for it, but it would help if someone could say, "That is stamp approved. Submit the bill and we will do it." We are looking at government here to say, "You met the criteria. We will pay the bill. Get the work done." That would improve the situation where someone says they do not have the money but they cannot wait too long for the hand rails or whatever.
It might be up to continuing care to do, because they come in and do an assessment of your needs, for example, if you need someone to clean your house or cook for you. If you need handrails and bars, it is not that difficult to tick that off as well.
The Chairman: Dr. Richards, my final question deals with the senior who simply will not admit that he or she needs these things. I was stubborn enough so my senior got them although he did not particularly need them, much like me. It was not a big problem. He had these things put in his house for him. How do you deal with that?
Ms. Richards: I think sitting down and talking to people is one way to do it. If we give seniors a chance to admit their limitations, they will. Many of the seniors I have known over the years do not want to admit their limitations. They want to say, "That television is just not working very well anymore."
Certainly there are times when you have to go in and do things, but I prefer working together, talking about the situation, and explaining to them the seriousness of some of the possible safety issues. With my mother-in-law we could say, "Do you know there is this or that out there that could help you?" The next thing you know, we hear from my sister-in-law that she has told her, "Maybe I should be getting one of these things." She may not say it to me at that moment, because that is admitting defeat, but she mentions it to my sister-in-law who then passes it along to me. We then know she got the message.
It is like anything. If someone were to tell me, "You have to change this," I am the first one to say, "You want me to do what?" I would probably do the exact opposite. We have to know that other people are the same. For some people, the ability to make decisions is one of the few things they have left or have control over. It is very important to keep that at the forefront.
The Chairman: Sometimes just saying, "Let us try it for a month," helps.
Ms. Richards: Yes. That is a perfect solution.
The Chairman: You then find within two weeks they are using it every day.
Ms. Richards: Yes, and then they tell their friends.
Mr. LaRusic: With respect to the senior safe driving program, we do not say, "We are giving you a driving test," but "If you would like an assessment, we will take you out to do so." No senior wants to give up their driver's licence. Trying to come to that decision with them when their ability to drive is diminished and allowing them to understand is very important. We have great people who are retired that have done this for years. They love nothing better than going out with a senior driver and informing them that their driving skills are not what they should be and that they should consider giving up their licence up because they would not want to injure somebody's grandchild.
It seems that when you start talking about grandchildren, you are on the right track. If you talk about hitting somebody, the response is, "They will hit me before I hit them." A non-offensive approach is needed, and then sometimes they feel it is at least partly their idea to move in that direction. It is not easy.
Ms. Richards: In between making an absolute change and where you were, there are modifications that people may live more easily.
Senator Cordy: As you both referenced, the whole definition of "senior" has changed over the years. When we look at developing programs for successful aging, we are working with a myriad of groups. We are working with the federal government, the provinces, municipalities, families, volunteer organizations and private organizations. How do we get everybody together?
Mr. LaRusic, you said that your particular agency, which is actually composed of a number of groups, serves as an advisor to the provincial government. How do we get all groups involved so that everybody can have a voice in developing programs, strategies or plans so that we are doing what is best?
Mr. LaRusic: I think you are on the right track with the phases you are doing here. This is very similar to what we did in Nova Scotia. We put a lot of information together by bureaucrats. I strongly suggest that what you are doing does not become a bureaucratic thing.
After we put together our discussion paper, we went to seniors' groups across the province, to 33 different locations across the province, and we engaged seniors in discussions on what they thought they needed. It is one thing for me to talk about the generalities of what seniors need. Fortunately, at this time, my wife and I are healthy trouts. To me, I can understand it, but I have not experienced not being able to do something physically. I am not good at walking. My knees are not that good. Other than that, I can do most things.
Going out and talking to these organizations and seniors' groups or inviting the senior population in to tell them we are looking at doing this and asking if they would like to tell us something was key. I believe very strongly that if you involve seniors in the development of the policy, you will not be on thin ice. You will be on solid ice because you are talking to the people for whom you are trying to do something. It is okay for me to speak on their behalf, and this speaks on their behalf, but we went out to get it from them, to have them involved in the process.
I doubt if you would hear anything different than what you will hear from talking to the professionals and the bureaucrats involved in this over the years. Those seniors have had a part in it. The important thing is to involve them.
Ms. Richards: Inviting people to be part of the discussions around how we can move forward and how we can work together is very important.
I have been involved with the Policy Research Initiative's strategies to plan for population changes that are coming. They do not focus only on population aging but on all population changes. There I have met individuals from other provinces who are working in different government departments. I ask them whether they are doing anything about population aging. They say, "Well, we have had a couple of meetings," or, "We got together with another department." I ask them whether they did anything else, knowing what we are doing in Prince Edward Island. Their answer is, "Well, no."
Leadership will be key to getting people moving and getting people interested in talking to each other and finding out what they need in their provinces or jurisdictions — just picking up the phone and calling people.
Our group started when we were at a workshop with Dr. Martin-Matthews. She was going across the country doing consultations. I met a lady there from the Ministry of Social Services and Seniors who was the policy analyst I mentioned in my presentation. We did not know that we were working up the street from each other. I asked her what they were doing about population aging. She said they are doing this and that and mentioned a couple of things they are doing. I told her we should really be doing something. She agreed, and then we agreed to meet regularly. That is how our group started, and then we applied for a grant.
There are other strategies we would like to address once this grant is over. The key thing is asking people to attend.
I would like to see us get together and have a conference to raise awareness of the need for planning for population aging and what we will all be faced with, especially in Atlantic Canada where we have few resources and the infrastructure is not as great as perhaps it is in Ontario, Quebec and some of the other provinces. It is not only seniors who are affected by the aging population. The labour force will have to deal with this. As well, communities and ministries of education will have to deal with allotments for funding from the government. This is a societal thing. We all need to be on board.
I think picking up the phone and calling people and somebody taking the initiative to promote a conference or a major meeting, as the Policy Research Initiative has, is needed. Something that focuses on population aging would be a good idea and would raise the profile a bit.
Senator Cordy: Are there discussions between various volunteer agencies in the communities or in the provinces? As you said, the provinces are not that large. I remember hearing a few years ago when I was doing another study on aging that in some communities you might have 10 agencies that want to do Meals on Wheels, and yet the great need in the community is transportation, such as taking people to doctor's appointments or church or what have you.
Is there any discussion within volunteer groups so that we are not having gaps in meeting the needs of seniors within a community, so that not all agencies or volunteer organizations are doing the same types of things? We know that with the reduction of volunteers, which appears to be a trend, we have to use our volunteers in the best way possible.
Ms. Richards: That is an excellent idea. If it is all right with you, Senator Cordy, I will take that back to the secretariat in P.E.I. as a suggestion. One person on the secretariat looks after ensuring that we have a nice distribution of things and not everybody is focusing on the same thing.
Mr. LaRusic: The different senior groups talk about how they will accommodate things. Down in the valley area, because it is rural and they do not have good transportation, that is one of the things they focus on. Somebody else is looking after the Meals on Wheels and is doing very well. They have worked towards the transportation end, trying to get people moving around. Senator Murray would likely be familiar with this: If anyone is coming from Cape Breton, you will let the whole family know because there is likely someone else who has to come up from Cape Breton to go to a doctor's appointment or you have to bring back someone. That network that is there. However, it has not been expanded.
As for some of the ideas that are talked about, ideas are no good without legs. Someone has to take ownership of the idea and grab onto it, and trying to allocate who should be targeted to take it on requires selling someone the idea of taking on a project. I believe it can be done. Many people out there want to contribute, but Meals on Wheels is not the thing they want to do. Having a selection of opportunities to become involved, either in an organization or as an individual, is a great idea.
The Chairman: Thank you both very much. It has been a very interesting afternoon.
The committee adjourned.