Proceedings of the Special Senate Committee on Aging
Issue 10 - Evidence, May 16, 2008 - Afternoon meeting
SHERBROOKE, Quebec, Friday, May 16, 2008
The Special Senate Committee on Aging met this day at 1:06 p.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[Translation]
The Chair: We have the pleasure today of welcoming Mr. William Murray, on behalf of the Conseil des aînés du Québec, Mr. Paul Rodrigue and Mr. Jacques Demers, from the Table régionale de concertation des aînés et des retraités de l'Estrie, and Mr. Gilles Beaulieu, from the University of the Third Age.
I welcome you on behalf of my colleagues.
William Murray, Research Officer, Conseil des aînés du Québec: Thank you, Madam Chair. I am very pleased to present to you the Conseil des aînés' position on aging, a position that is very general and very brief.
On behalf of the council, I would like to inform you that we are very pleased that the Senate has taken an interest in the general issue of aging. I believe that reflects the growing interest in our policies on this matter. We know very well that, here in Quebec, we have observed that the media are not that interested in aging, or are so in a more or less biased manner.
For example, we had the consultation of Ms. Blais, Quebec's minister for seniors, which was pushed aside by the Bouchard-Taylor commission on intercultural relations. Immigration is a very important issue, but, at the same time, aging will affect everyone in the same way as, and perhaps even more than, intercultural relations, which concern the urban and metropolitan centres in Quebec.
Aging concerns everyone, all of society, whether we are young or old. The senior population in Quebec will eventually be very large, which will have a significant impact on policies.
I would like to talk to you first about the role of the Conseil des aînés, which in fact is essentially governmental. It is to advise the Quebec government on aging and demographic change, but also on individual aging, how people can live in their communities and how they can age in good health, how to address these problems in cases of vulnerability or exclusion.
I am going to try to focus my presentation as much as possible on the second report tabled by the Senate committee, then address a series of issues in the context of the discussions. All the issues addressed in the Senate committee's second report concern, to the highest degree, the Conseil des aînés, which has issued opinions on those questions. I will therefore be very much open to discussing your main concerns with you.
As I have used the Internet version of the report, I may refer you to pages that are not those of the report that was distributed to me earlier. On page 5 of my version, so probably page 2 of your report, under the title ``Defining Seniors,'' the council has a role in conveying a positive image of aging among the Quebec population. That is one of the official mandates in the act and it defines the mandate of the Conseil des aînés.
When we act in the field, we try to act on the basis of positive images, relying on the fact that seniors are not systematically people who are losing their abilities. On the contrary, we know that seniors participate very significantly in society, both financially and socially, and we prefer to emphasize that point.
That is why, where reference is made, on page 2 of your version of the report, to aging as meaning the onset of functional or social problems, we feel that these are ageist assumptions underlying the definition, and we cannot support this type of definition of aging. We prefer a more traditional, chronological version of aging, while clarifying various problems, various aspects of life that change as the life cycle evolves.
There are definitely adjustment needs when people age, and that affects various aspects, which you mention in the report, and which I found very interesting. I thought this was an excellent summary of all the issues related to society's adjustment to what will be the major phenomenon of aging in the coming years.
The various aspects concerned are the funding of various programs, integration of services, the adjustment of health services in general, but also of community services, transportation services, support for family, that is caregivers. I am going to take them one by one and refer to the guidelines, which we can discuss later.
With respect to the funding of various programs, regardless of level of government, I believe that the report you have issued focuses more on the role of the federal government, and that is readily understood. I would like to state a guiding principle, which is that of the Conseil des aînés du Québec, when the time comes to discuss the funding of programs in the Province of Quebec. I believe that can apply to the way in which relations between the federal government, the provinces and territories are managed for the future.
Earlier I was listening to the testimony of this morning's speakers, first of all Mr. Hébert, who said we especially should not start establishing standards in the provincial or territorial health systems other than those that already exist and which are highly complex. That is what I understood from his speech. I am very familiar with his speech, but I believe this is an important point in the management of resources. It applies to health, but also in all fields.
Ms. Gravel told us about her experience in the field, which involves taking local needs and channelling them in order to generate not only financial wealth, but social and collective wealth as well. I believe this is a much more relevant approach than a general standards and objectives approach that is imposed on cities and towns and is not all that appropriate to the situation. If we want to talk about efficiency and effectiveness, if we want to be pragmatic, I believe we have to act on the basis of the cities and towns, first and foremost, and that is the council's position.
We are in favour of program funding. Having organizations in an attempt to decentralize as far as possible is also something the council has included among its orientations. That is the guideline I would like to discuss with you later with regard to funding for the systems as a whole.
The Senate Committee's report mentions certain aspects such as drug insurance, home care and gerontology training, all aspects in which it would perhaps be preferable, from the standpoint of the federation as a whole, to let the communities organize matters based on local needs.
It seems to me that the pragmatic approaches such as Ms. Gravel's non-profit organization, without being funded at the outset, have achieved positive results and a very significant impact. Why not support projects like that rather than establish general standards?
We do not have to duplicate programs as much as possible. Your report talks about integrating services in the health community. I have read a lot of reports on the subject. I was a professional in Quebec's health department for nearly six years, and that is my specialty, if you will. I have read a few reports by Senator Keon.
Integrating services is very effective in the health field. Integration developed as an organizational technique in the health field because the means were there to do so, because people understood first of all that this is a complex system, but a system that aims to achieve the same ends. When you aim to provide support for seniors more generally, I believe the same principle applies.
Acting locally, acting in a coordinated manner, but not just from a health or social services perspective: these are more silos that we are creating here. This means involving people who are linked to the transportation sector, who form community organizations; all these players can be active and act in a coordinated manner. We are talking about social adjustment here, not just about the adjustment of systems that are formally and commonly funded by our governments.
I believe this approach should be developed and scientifically documented first before it appears in the policies. I think that the aging study is a good opportunity to review certain governance methods in the provinces and territories, but also in the federal government, which, as I said earlier, I see more as a source of funding, but at the same time as something that can set clear objectives and, as Dr. Hébert said this morning, which could serve as a lever for the provinces, territories and regions in supporting certain policies that correspond to our values as Canadians.
In this service integration context, which I view more broadly, why not also promote the participation, the empowerment of our seniors as much as possible, and why not society as a whole? Your report was very clear-sighted in stating that people's involvement in volunteer work or in social participation, in the board sense here, begins at a younger age. If university students start getting involved in student associations, they will develop habits of social conscience and involvement that will continue as they age.
My final remarks concern federal transfers. This sometimes applies to certain provincial programs as well. We must ensure that funding continues. For example, there is no guarantee that the Canada health transfer will continue; it is only a 10-year agreement.
How do we go about ensuring that these social adjustment methods, which are developing through supplementary funding, can be maintained? When you change a social adjustment structure in the face of a phenomenon like aging, it is subsequently very hard to change it. It takes at least five to 10 years to adjust a system to a social phenomenon.
In the time it takes to fund a certain number of systems, the system is barely established, and if funding is stopped, everything has to start over from scratch. It is not logical or prudent for a government, whatever it may be, to operate in this way.
Paul Rodrigue, Treasurer, Table régionale de concertation des aînés et des retraités de l'Estrie: Madam Chair, I would like to thank you for coming to Sherbrooke to meet with us.
It would take about 10 to 12 minutes to read the brief that I have sent you. Since I was told not to take more than five minutes, I have condensed it.
We read with interest both draft reports that you have prepared. They contain enough material for hours of exchange and discussion. We will therefore limit ourselves to the essential, and we will leave the specialized groups to share their expertise in their respective fields.
First, we will discuss the ministère de la Famille et des Aînés, the Department of Seniors. The Table régionale de concertation des aînés de l'Estrie was one of the first to request the establishment of such a department in Ottawa. As for the Conférence des tables régionales, the regional steering committee conference, it sent a resolution calling for the establishment of a portfolio department at the federal and provincial levels.
One of the regional steering committee's concerns is the poverty and low incomes of elderly persons. We have undertaken some initiatives and supported all approaches aiming to improve the situations of vulnerable seniors. Statistics Canada has established $21,665 as Canada's poverty threshold. The Canada Pension Plan, the Guaranteed Income Supplement and the Quebec Pension Plan together add up to about $15,800. It is important for the total of these benefits to amount to at least the poverty threshold. It is vital that our elderly people no longer have to choose between food, medications, dental care and glasses.
In addition, special consideration should be given to widows aged 55 to 65 who have earned no income and are living in particularly precarious circumstances. I am sure you know of some in your circle.
It is incomprehensible that the Canadian government has not yet implemented automatic enrolment in the Guaranteed Income Supplement. This unfairness must be corrected for people who are entitled to, but have not claimed their benefits for one reason or another. We therefore insist on an automatic GIS enrolment and retroactive payments to those who are entitled to but have not yet received them.
Volunteer work in Canada has been valued at several billions of dollars. This volunteer work represents enormous savings for the country. A great deal of this work is done by seniors, the majority of whom are women. Many volunteers must spend from their own pockets in order to provide these services. And elderly volunteer workers certainly get tired easily. The value of this work should be recognized by implementing financial measures in support.
Because many seniors pay little or no taxes, fiscal measures are perhaps not the best solution in this case. We should consider financial compensation in the form of training for volunteers, reimbursement of expenses involved in doing volunteer work, and assistance to volunteer organizations.
How can we talk about volunteer work without mentioning the special challenges faced by family and neighbour caregivers? We would like to highlight three aspects that should be considered: first, training to enable helpers to adequately accomplish their tasks; second, relief services for helpers; and, third, long-term care.
The Regroupement des aînés will speak on these subjects. As for us, we insist that training be given to home helpers and homecare providers.
Social economy cooperatives and housekeeping services have neither the material nor the financial resources to provide their employees with adequate training. The quality of interventions therefore suffers, and by the same token, beneficiaries suffer as well. This can lead to cases of mistreatment and violence.
Home care is a major concern for us, as are abuse and violence. We are constantly working to support the development of prevention and intervention tools for vulnerable seniors, and we must remain constantly vigilant.
Funding for services remains a key problem for the majority of groups who are working with seniors. We are convinced that part of Ottawa's surplus could be used to support the essential work of these groups.
The committee is also concerned about housing and accommodation for elderly persons. We advocate a relaxing of the rules of the Canada Mortgage and Housing Corporation to make rents more affordable, especially for low-cost housing. It is vital for building code requirements to take into account the day-to-day realities of people who have lost their independence or who live alone. We should promote services such as common rooms, shared kitchens, shopping services, and common laundries in low-cost housing arrangements.
Transportation is vital for the autonomy of seniors, and it usually plays a determining role in enabling an elderly person to live at home. Adequate transportation structures that meet the needs of the elderly, in terms of physical structure, for example buses that adjust their height to the sidewalk, availability, frequency, safety and costs, are essential. Initiatives by adapted transport and rural transport groups should be funded to enable our seniors to remain independent. Communities must adapt to the aging of their citizens. Everyone benefits, both young and old.
From this perspective, the regional steering committee fervently hopes that any decisions that the government takes will consider the impact on an aging population. We are not just talking about today's seniors, but all citizens, who will one day be old. Today's decisions, like tomorrow's, must be made in consideration of the impact not only on current seniors, but also on generations to come.
To have and maintain good health, people need recreation and physical activities or sports. Incentive and facilitating measures should be put forward to encourage all citizens to be active, whether by tax credits and reimbursements for enrolling in activities, by setting up community centres to meet the needs of seniors in communities where there are none, or by adapting facilities to the needs of an aging clientele.
The Eastern Townships' regional steering committee for seniors has deliberately not brought up the subject of health care. We know that credible groups will do that. However, we are not unaware of the importance of this subject.
Sherbrooke is one of the rare towns to have a policy for hosting and integrating immigrants, and that is to its credit. However, we must not ignore the challenges of integrating aging immigrants. The inability to speak French and the prejudices surrounding so-called strangers are important barriers to integration.
Ways must be established to support and assist immigrant groups in order to facilitate their entry into seniors groups in our society, thereby preventing isolation. Services must be adapted to meet the needs of this particular clientele.
Age discrimination is a phenomenon that we have to address. We must ensure that seniors are considered full citizens in our society. We recommend the implementation of awareness programs.
Prejudice is usually the result of ignorance and perceived differences. The regional steering committee believes that the basic age criteria for service delivery create inconsistencies. People, whether old or young, experience different realities and should receive services according to their needs, not their age.
The retirement criteria and systems should be reviewed with the aim of preserving individual freedom of choice. A manpower shortage has been announced, and many people would like to keep on working. The CPP, GIS, employment insurance and QPP rules should be made more flexible to accommodate individual cases and individual needs. By harmonizing the taxation laws, workers could be encouraged to stay in their jobs as long as they want, without imposing penalties on their benefits.
We are very aware that aging populations do not live in the same manner and at the same rhythm in different countries. Your finding in point 84 is critical, that we must ``establish supplementary programs to compensate for unequal aging across the provinces.'' Quebec is the province where people age most rapidly. We must rethink the notion of equalization in order to restore equity to the growing needs of these citizens. The federal government's essential role is to develop the policy frameworks, laws and regulations for Canada's seniors.
You have an opportunity to recommend concrete actions aimed at improving quality of life for our seniors. We are counting on your expertise and openness to ensure that it is good to live and grow old in Canada and Quebec.
Gilles Beaulieu, Development Officer, University of the Third Age: Madam Chair, this is the first time I have had the privilege of speaking to a group of senators. I am moved. I was not ready to die yet!
Ms. Keli Hogan told me earlier that a few organizations had chosen to give evidence. We are very pleased that the University of Sherbrooke's University of the Third Age has been selected.
We have read your documentation, particularly the second interim report. You identify four broad themes. Questions 2, 4 and 5 are directly related to the concerns of the University of Sherbrooke's University of the Third Age. We will have a wish to make regarding question 4, which concerns income and retirement itself.
I will present the main points on the organization of the University of the Third Age, a few facts about our experience and some wishes or conditions for its maintenance.
You have a copy of the document that was translated into the second language, or the first, depending on your point of view.
The University of the Third Age of the University of Sherbrooke was founded in 1976, and we are the first senior citizen university in North America. So we have been around for more than 30 years. We are attached to the Faculty of Education of the University of Sherbrooke. We are members of the International Association of the Universities of the Third Age, a global organization that is unfortunately not that active, particularly in Europe.
The UTA's basic mission is to provide senior students, those 50 years of age and over — because we also have early retirees who come to our activities — with educational activities for the pleasure of learning throughout their lives, without any degree required or examinations. So it is really for pleasure.
One feature of the University of the Third Age is that we avoid all competition. If an activity is already offered by another organization in the community, such as computers or language courses, we do not offer those courses. We also supplement activities offered in the community. People may want to go a little further, so we can call on resource persons who can meet the needs.
The fundamental objectives of the UTA are to facilitate knowledge acquisition; combat isolation among seniors; promote the integration of seniors in cultural and social life; promote exchange; support individuals in their desire for accomplishment — as you can see, we are directly involved with a number of the committee's issues — and to provide society with a new wave of dynamic and responsible senior citizens. One point I might add is that all activities must be offered at the lowest possible cost.
The educational approach. As there is no homework or exams, these students are auditors, no degrees are required, activities take place during the day in the fall and winter sessions, and quality standards are specific to all types of training offered by the University of Sherbrooke.
The teaching arrangements are highly varied, based on needs, courses, seminars, lectures and workshops. Subjects include history, health, philosophy and politics, but non-partisan politics.
With respect to organizational principles, the University of the Third Age is based on the participation and involvement of volunteers, who are retired, and thus a partnership between UTA management and the 26 student associations across Quebec. So these are retirees, volunteers, who work to identify needs and organize activities in response to demand in their community. And all that is done by volunteers, who are thus unpaid.
The Faculty of Education provides administrative support for funding, the management of tuition fees and payment of resource persons. We pay resources persons $45 an hour, which barely covers their costs. Last year, we had some distinguished guests. For example, we had Roger Landry, former editor of La Presse; Alain Dubuc, an editorialist at La Presse; and Lorraine Pagé, former chair of the CEQ, to name only a few. And these people come for $45 an hour. That is one of the conditions.
The student associations are allowed greater independence in the organization of self-funded learning activities. This considerable independence falls within a framework, and there is nothing partisan about it, as was said earlier. We do not want subjects to be conflictual, such as anything concerning retirees, esotericism or sensitive topics; there are so many other subjects to study. We avoid anything that can be conflictual. That is not at all within our goals. We do not want to create tension; on the contrary, we want to release tension, and we want to enable people to develop.
The university's presence. Quebec has 17 administrative regions, and we are established in 10 of them. We are not in more regions because there are similar universities and we do not compete.
Across Quebec, there are 26 third age satellites, and thus 26 student associations. A number of satellites have decentralized activities, since there are vast regions, but 45 local sites.
Some 500 volunteers cooperate in the organization of local activities, and that number is growing. We have 12,000 annual enrolments, and that too is growing.
As can be anticipated, we support the issues and topics that the committee is examining, which are entirely legitimate: staying physically and mentally active in order to ensure well-being. A host of activities are offered and developed to maintain active neurons; so staying active is easy. We also offer activities such as folk dancing to enable people to stay physically active. There is also a cultural aspect.
We must maximize opportunities for seniors to be active members of society: involvement encourages this. Promoting people's vitality in old age and aging in the place of their choice: we have a new component that we are developing in this area. Earlier I told you that activities were offered at 45 sites, but now we are going beyond that. There are increasing number of residences for participating seniors. Where there is a sufficient number of individuals and we can secure self-funding, we also offer activities at seniors' residences, and this has become very successful. That, by and large, is what is going on at the University of the Third Age.
We would now like to state two facilitating conditions which could promote the vitality of retirees wishing to manage their own development. There is nothing new here. These are already identified on the lists of options proposed, but we are nevertheless emphasizing these points.
Valuing volunteer work: this can take the form of tax credits and the reimbursement of travel expenses, for example. These volunteers are not paid, but nevertheless incur personal expenses, and we should at least reimburse their expenses. That has already been identified.
Granting a tax credit for retiree training: we know that tax credits are currently granted when training is employment-related. Retirees no longer have jobs, and these tax credits are increasingly denied for retirees. If tax credits could be granted, that would be an additional incentive.
That, by and large, is what I wanted to present to you, and to tell you that the University of the Third Age of the University of Sherbrooke supports your efforts and is proud to tell you that your objectives are realistic and achievable, since, not to make any pretentious claims, we have been achieving them for some 30 years.
[English]
The Chair: Thank you all for wonderful presentations, which were very much focused on both our report and the need, in some cases, to broaden it and make it more inclusive, which is exactly why we are here to talk to you. Clearly, we heard some witnesses in the past and we wanted to come out to communities like yours to discuss these issues with people on the ground as opposed to the experts in the field.
Senator Mercer: Thank you, gentlemen, for being here this afternoon. We really do appreciate your participation and paid close attention to what you were saying.
I am curious. You said that the university has been operating for some time; I believe you said since 1976.
Do you know of similar universities in Canada or North America? Are there other universities like University of the Third Age?
Mr. Beaulieu: I am sorry but I do not know. In Québec, it takes different forms.
[Translation]
At the University of Montreal, the organization is a bit different. They present Les belles soirées, but people have to travel to the university. At the Université du Québec à Montréal, there was a new program called Générations, and people had to travel to that too. At Laval University, to our knowledge, there is no organization as such, but it is apparently being developed. At the Université du Québec à Trois-Rivières, activities have been introduced. The University of the Third Age at the University of Sherbrooke has been the leader for 30 years now.
[English]
Senator Mercer: We discovered today that the University of Sherbrooke is leading the way in many things, which is good.
You talked about a tax credit for the training of retirees, and you quickly point out that currently that type of credit is available only for job-related training. Give me an idea of how you would see this work because this idea intrigues me.
[Translation]
Mr. Beaulieu: When volunteers file expense reports, we reimburse kilometrage expenses. When they attend meetings, they often have to travel far, and when they have meetings that last the entire day, we reimburse lunch expenses.
The university has the information, and could issue a new TP4 or TPZ form; we have the accounting, we have the training, and we could tell you whom we have reimbursed and the amount of expenses incurred as part of their volunteer duties. At that point, those documents could be appended to the tax return and, we hope, honoured by the revenue department.
That is the suggestion we are making. And all that would be managed by the accounting department of the University of Sherbrooke. The University of the Third Age is a bit like a department within the Faculty of Education at the University of Sherbrooke. The Finance Department at the University of Sherbrooke could manage all that.
[English]
Senator Mercer: One of the ongoing concerns that I have expressed to the committee is that the recordkeeping that we propose for tax credits, either for volunteering or, in this case, the training of retirees, becomes the stumbling block of how it is done and how accurate it is. We do not want to put an administrative burden on the university, community group or charity that is involved. Do you see this as an issue?
Mr. Beaulieu: We already do it.
[Translation]
The only thing we do not do is issue receipts, but we already have all the accounting. We already know what amount we have reimbursed to such and such a person for kilometrage and meals. We already have the information in our systems. And I assume other structured organizations would have the same information.
In any case, that could give our volunteers a privilege and encourage them to get involved to a greater degree. Even if there were an associated cost, it would be worth it, because our volunteers invest a lot of their time and energy, and a number pay out of their pockets.
If we can at least offset the expenses associated with their volunteer work, that is the minimum we are asking.
Senator Chaput: Sir, at the university, you have basic resources, which means you have accounting services. Do you have any ties with a bigger university? How is it that you have these financial resources to pay people that a community group would not have?
Mr. Beaulieu: The University of the Third Age of the University of Sherbrooke is part of the University of Sherbrooke's education department. As a result, we have accounting services like any other faculty at the University of Sherbrooke. However, the rule is that every activity of the University of Sherbrooke's University of the Third Age must be self-funded. So what adult students have to pay to attend a series of talks of training is $65 or $70. Those amounts are used to pay: rent for the room when the room is not lent to us, the professor's salary, kilometrage and other material expenses required by the course, if photocopies have to be made and so on.
The rule is to keep expenses to a minimum to encourage people to come and take part in the activities. Forty-five dollars an hour for a resource person is not a lot, and we pay only for classroom time. We do not pay for preparation time.
I was a teacher all my life and we know that, for some content, the ratio of preparation hours to training hours can be 10 to one. We only pay for the one hour in which the service is provided. It is a choice that we make to pay teachers a minimum cost. That enables students to pay as little as possible for training.
Senator Chaput: Who does your accounting?
Mr. Beaulieu: There are three clerks at the University of the Third Age secretariat, and they manage the time sheets and issue payments.
[English]
Senator Keon: Mr. Rodrigue, you rightly pointed out something that the committee believes in very strongly, and that is the tremendous wealth of knowledge, expertise and energy that lies in retired people. We agree that we are not tapping into that wealth appropriately.
I want to raise a paradox, the flip side. Let us use airline pilots as an example. As we have encouraged people not to embrace mandatory retirement, to remove mandatory retirement, I think it can subject the public to avoidable risks.
The pilots at Air Canada retire at age 60, but do so because they have mandatory retirement through their pilots association, not from Air Canada. Many of those pilots continue to fly other commercial airlines. I am sure that these men and women are responsible and not flying if they feel they are not capable of doing so. Nonetheless, their peers at Air Canada felt they were not up to it and asked them to retire at this age. There are some things that we just cannot escape in old age, no matter whether we retain our looks, vitality or whatever, we lose cognitive ability, we lose fine motor skills, we lose other things, and we just have to accept that.
What I am really groping for and I have asked this question before, is what should be put in place of mandatory retirement to be sure that we are not putting the public at risk by allowing people continue to work in professions beyond an age where they really are not safe to be working? Do you have any ideas?
Mr. Rodrigue: You are talking about Air Canada and that is a good example, but I will give you another example. Consider a retired provincial police officer or a firefighter. They can retire early at 48 years or 50 years of age. They retire with a big pension and then what do they do? They work for another agency, a private agency, and they work there for probably $15 an hour. So, why work there for less? Why did the ex-officer or ex-firefighter not keep his or her job? This is our question.
If that person wants to work until age 55 or 60 years and is physically able to do it, why force him or her to take a pension? Keep the person at that job and do not let him go out work for nothing and take somebody else's job. When you hire those guys for $12 an hour or $15 an hour, you have a guy who could do that same job who is 35 years to 40 years old, who has a family, and who does not have the job because the retiree has an advantage on him because he has the experience.
Senator Keon: You are absolutely correct and your point is very well taken. That is why mandatory retirement has been removed in many circumstances. However, I do have this concern that there are areas where I feel it should not be removed. We are moving toward a blanket removal of mandatory retirement. I think the airline pilots are a good example because the Air Canada pilots have said they will not fly a commercial aircraft after 60 years of age, no matter how good we look, but many of their former pilots are now flying other commercial airlines. There is nothing in place with some of these airlines, mind you, I know some of them are asking for mandatory retirement at age 65, but some of them are not asking for mandatory retirement at all. They are leaving that up to the individual pilot.
I know that pilots have to undergo careful annual evaluations, medical evaluations and so forth. I also know that a person can be evaluated medically, look very good and drop dead the next day. It concerns me that we have this blanket removal.
What I am groping for is people with your tremendous expertise to come forth and offer some guidance about this issue, because I think right now, it is a hole in the social safety net.
Mr. Rodrigue: As I said in my brief, there are people who are 75 years of age and who are young physically and mentally, and another person at 50 years of age is very old. That is why we say do not go by the age of the person. When you say at 75 years of age that you are old, you are probably not old at 75n years, and the other one who is 50 years of age, he is old, and they say he is not old, he is only age 50. So you see, there is always something that does not balance there. You penalize that guy who is 50 years old because he is sick, and you penalize the other guy who is 70 years old and he could continue to work.
Those pilots from Air Canada, they are going to work as pilots for WestJet or BlueJet, you name it, but for much less than what they were making at Air Canada. The ex-Air Canada pilot is taking a job that another pilot could have, but he does not care; he has his pension from Air Canada plus what WestJet is paying him. Perhaps he works only 10- 20 hours per week.
[Translation]
Jacques Demers, Secretary, Table régionale de concertation des aînés et des retraités de l'Estrie: I would like to clarify a few points. I am lucky enough to be Vice-President of the Conseil des aînés and a member of the provincial board of directors of the Fédération de l'âge d'or du Québec. The Conseil des aînés meets occasionally with all the national associations, two or three times a year.
From those meetings, two major concerns were raised this year, and one is the gradual retirement we just talked about. All national seniors organizations in Quebec agreed that promoting gradual retirement should be a priority in Quebec. One of the suggestions was to provide compensation in the form of a pension tailored to hours of work that may not constitute a full week. Individuals could work either the morning or the afternoon, to strike a balance between family and retirement, and especially to raise awareness among business executives who say that the older you get, the less productive you are.
I think it is still illogical to think that you are less productive because you are 70 years old. Look at the age of today's political leaders Some political leaders are 65, 68 or 70, and they are still very active.
We should also see about establishing a mentoring system. We should find ways for seniors to help younger people take up duties for which they are not ready because they have not been in the heat of the action and these seniors have. I think these would be very profitable exchanges.
The second subject, with your permission, and we have not talked about it to date, which is unanimously supported by the seniors of those 17 associations, is housing for seniors. In Quebec, we have established what is called certification for private residences, which means that the government retains a firm to check social sanitation criteria in each of the residences on a mandatory basis.
I can tell you that it is going very well, although very slowly. This mandatory certification is supposed to be done every two years, and approximately 12 per cent of the residences have been certified in 14 months. We are supposed to start the same process over in eight or nine months. That is for the matter of socio-medical criteria.
FADOQ was recognized barely one month ago to verify the quality of life in the private residences. This is a different program from the certification program. With volunteers and individuals who have been trained, and under the supervision of a person in each of Quebec's regions, we will go into each of the residences to assess the quality of life of seniors there. This second component requires that we conduct interviews and so on. We hope that the two programs will work well and that the certification of residences, which is mandatory, will go a little more quickly.
The Conseil des aînés ultimately goes far beyond research and takes an interest in the basic problems that we have in Quebec.
[English]
Senator Keon: Mr. Murray, you alluded to the problems of integration, having worked in the health department for six years. Interestingly, we were discussing this over lunch. I said I had been familiar with the difficulties for about 30 years. You are much younger than I am Mr. Murray.
In your recommendations, I believe you said that the federal government should try to expedite integration at the provincial levels and that the regions, of course, integrate that into whatever federal programs are coming also.
What you did not mention was the community level. I have been convinced for quite some time, and you alluded to reading some of my papers, that the place to integrate is at the community level, because it is possible. When you get higher, trying to integrate government departments and so forth, I think you get into at least, very frustrating stuff.
How would you respond to that comment?
[Translation]
Mr. Murray: I stated some general principles, but they should be clarified. Your question is an excellent opportunity for me to go a little further on this integration idea.
I was saying that the community environment was the centre of everything that we can call the integration of health services, community services, transportation services and everything related to aging, in fact everything that concerns a senior citizen as an initial base unit for us to develop our services and programs.
When you talk about the federal government's role, I do not believe I stated that should new federal programs should be created in that sense, on the contrary. Instead, I am saying that the federal government could support the provinces' general objectives so that they themselves can introduce various integrated services network models in their communities.
I especially emphasized the point that integrated services networks are not just health and social services networks, because the initial goal, and Dr. Hébert talked about that this morning, is indeed to ensure that the hospital network, in particular, is not clogged by people who have chronic health problems and that hospitals can focus on acute problems. That is why the hospital system was originally created.
We need resources. Resources can come in large part from the federal government, but I do not expect it to develop programs to integrate services. I believe it can provide encouragement with respect to objectives, to the extent they correspond to the values of the Canadian public, to implement various service integration programs. I believe that the Age-Friendly Cities programs are very promising in that respect. I believe there is an integration idea here that the federal government could support in various ways.
I am not an expert on governance and federal-provincial relations. I cannot state a position on the municipal system, but let us integrate services based on local needs, as local players commonly do, because they are the ones who know exactly the nature of the needs of their localities. That is the principle I am trying to state as clearly as possible.
This is not even an issue between federalism and sovereigntism, not at all. It is a strategic issue. How do we ensure that our resources are allocated in the most efficient and effective manner possible? To do that, we need evidence, we need proof, and I am not sure there is enough evidence at this time for general models to be introduced wall to wall across Canada, for example.
I believe it would be preferable to allow the municipalities and local health and transportation organizations, and issue tables in Quebec that have a very good initiative, to support projects. So try to decentralize the organization of services as far as possible, while allowing a coherent transfer of resources, and do not duplicate programs for the same purpose in moving from the federal to the local level.
[English]
Senator Keon: Obviously, you know your subject very well and I agree with everything you have said. The only point I was trying to draw out is that we are in a position where we have to start changing the way we think and put more emphasis on community. Since provincial governments are very, very strapped for funding the health care system and in funding the social services and education and so forth, they do not have the financial capital to make major changes. I think a period of time where the federal government could flow, perhaps with the sunset clause for a limited amount of time, some money to the communities to assist in the integration they are already doing. I think it is very effective at that level and you already confirmed that.
I was trying to get you to make that point, and I appreciate the point you were making.
Mr. Murray: I absolutely agree with you.
The Chair: On Tuesday afternoon, we were in Moncton and we visited what they call the Extra-Mural hospital, a hospital without walls. This hospital only delivers services in the patient's home. We saw nurses, occupational therapists, physiotherapists, respiratory technologists, pharmacists and palliative care workers all delivering into the community. They never go to the hospital. They deliver only in the community.
I was very impressed. It seemed to me that this was the best kind of integration of health care services. Obviously, there are other services that patients need, but these particular health care services are delivered so that people can remain in their homes as long as possible and can, if they are in hospital, return to their homes as quickly as possible after a surgery or after an acute episode, et cetera.
Those are the kinds of services that I believe can only be delivered at the community level. Those are services, which the federal government, in my view, has and should not have any involvement in other than the big one, which is the money. The federal government can extend the money to communities through the provinces from the federal purse, which is the largest financial purse in the country. With adequate funding the federal government can make that integration and coordination of services take place.
We are struggling as to how to write a document to impress upon the federal government that it has an obligation to provide the dollars in order to make this happen. Senator Keon, who was himself a physician and who headed the Ottawa Heart Institute for many, many years and who is certainly involved in the high-tech medical field, would be the first to tell you that we have to change the way we deliver health care in this country. We have to make it a community- friendly and, more important, a patient-friendly system of delivery of care.
[Translation]
Mr. Murray: I agree with what you said about managing these federal resources in order to support the communities. That is the same approach as I took earlier when I spoke with Dr. Keon.
One point I would like to add to your speech is the point concerning knowledge transfers, from which we would benefit greatly if it were pan-Canadian. My dream is a set of pilot projects that might enable us to develop projects, to adopt the most efficient and effective approaches for improving services in the community.
We have evidence that home support and service in the communities, as you call it, are distinctly more effective in solving chronic health problems and social problems that are often long term or that we could also, in a sense, characterize as chronic.
So why not head in that direction? I entirely agree with you, but, once again, let us improve our approach and start to develop genuine expertise in the management of integrated community services.
Mr. Rodrigue: Earlier, I talked about home care. This is a very great concern. We have tried in Quebec. We have closed our psychiatric hospitals, we have taken these people and put them on the street, and washed our hands of them. There are no financial resources, no help whatever, no one to supervise them. We must make sure they take their medication and so on. That flopped, and it has not yet been corrected.
The first thing to do is to start correcting that situation. That is the first thing we have to do in Quebec, correct that situation, follow these people right through to the end. This week we heard some psychiatrists who no longer want to work in the prisons and who said: ``Your time is up, your treatment is not finished, good bye, go home or onto the street, goodnight, friends. Two or three months later, you find him in a mess in the street or getting into trouble in his neighbourhood.''
Second, home care is all well and good. Releasing people from the hospitals as soon as possible is something we do here in Quebec. Ask people who need an operation; they do not spend a lot of time in hospital; they are immediately sent home and are not taken care of. Consider the example of the 82-year-old woman and her 85-year-old husband who has just had a leg amputated and who was sent home. The guy weighs 250 pounds, and his wife weighs 100 pounds. What care do they have? They have a nurse who will go there for half an hour, two or three times a week. What does she do? The man falls down, and she is required to call the police to help her pick him up. It is abnormal situations like this that we are experiencing. That is why we said earlier in the report that it will take funding in order to train volunteers. You cannot take care of someone who comes out of hospital if you are not a nurse or you do not have the least knowledge of what to do. You have to give the right pill at the right time. You have to change dressings. There are precautions to take. We will have to start by educating our people, and then we will talk about home care.
There is a nurse in Montreal or Quebec City who works in the street. He goes from house to house, at his own expense — he is not paid — to change dressings and provide care for people. There is a doctor in Montreal providing private service. He goes to people's houses. You call him, like in my grandfather's time, and he goes to your house. We need people like them, but the reality is quite different. They are closed up in offices and I think they waste an enormous amount of time.
I was in Florida this winter, and my wife had to go to the clinic. When you get there, a nurse takes your blood pressure and temperature. You do not need a doctor to do that. So when the doctor arrives to see you, he already has your file. He knows everything. He has not wasted half an hour. He takes five minutes, gives you a prescription and bye bye.
We will have to review that as well. They say they want nurses here to start performing medical procedures, but nurses are overworked. I have nothing against a nurse who does a little medical work, but she will not be on the floor; she will be somewhere else in the hospital.
The third point is that there is too much paperwork. Doctors, nurses and all workers spend three-quarters of their time completing reports. You cannot make me believe we need that much. Let people practise medicine, what they were trained to do, not do paperwork.
In Quebec, they have promised shorter waiting times, but it is worse than ever. We will have to start over from scratch.
[English]
Senator Mercer: Mr. Rodrigue, in your presentation, you drew our attention to something we have heard before, and you did it in a dramatic way in talking about Statistics Canada's figure of the poverty threshold being $21,665 and that the GIS along with the CPP and the Quebec Pension Plan comes to $15,800. You do not have to say a lot more than that to understand the problem.
I want to hear your opinion on a guaranteed annual income.
I should mention to you that this morning, Senator Carstairs mentioned to someone else the automatic enrolment in the GIS. I never give this government credit for anything, but I will give it credit for starting to correct that problem.
Quebec has such a terrific record on this issue, because nobody gets past this in Quebec, which is good, and now the federal government is going to enrol people automatically who qualify for the GIS without them ever filling out a form. So that problem is solved.
I want to go back to the gap between the $21,665 and the $15,800. Do you think we need to be looking at a guaranteed annual income as opposed to what we have now?
Mr. Rodrigue: Whether you are 25 years of age or 75 years of age, it is always the money. Like they say in English, money talks. You are telling people, if you earn under $22,000 a year, you are going to have trouble or you are in trouble, but we will give you just $15,000, okay? So, try to make up for the other missing $5,000. If they are sick or ailing, they cannot make up for that $5,000, but they are going to pay the same price as you and me for the butter and the milk. They are going to pay the rent at the same time.
That is why we have to take care of those people because if we are here today, we can lift our hat to those people. We have to think of the people who are coming after us too, and do not forget, we are going to be there in a few years. So, what we are doing today, we are doing for them but we are doing for us, and we have to think of doing it for the others who are going to come in 10 years and 20 years from now.
We have to think ahead, not just for tomorrow, for those studies, because we will probably be in need or somebody in our family could probably be in need in 15 years. We do not know what can happen.
What pisses me off, excuse me, is the money, the federal and Quebec governments always say, we spend, we spend, but they never say ``on gaspille,'' ``we throw the money away.'' When you see the Auditor General's report, it is reported for two days in the newspapers, on television, and after, it is goodbye. So when she makes a report and she says that such department, it is not going well there, too many expenses, why do not they come to the House of Commons every year and bring the paper to see if they have corrected the problem or not. This is what should be done. That would have more teeth and that would solve many problems.
The Chair: On that note, I want to thank Mr. Murray, Mr. Rodrigue, Mr. Demers and Mr. Beaulieu.
[Translation]
Senators, let us now go to our last panel.
We are pleased to welcome Ms. Marie Beaulieu, Professor, Social Service, University of Sherbrooke. Welcome.
Marie Beaulieu, Professor, Social Service, University of Sherbrooke, as an individual: Madam Chair, it is a pleasure to be here with you today.
I must say I read the document you sent me with a great deal of interest and understood that the invitation you had sent me more particularly concerned the Age-Friendly Cities program of the World Health Organization.
With your permission, since I am your only presenter, I am going to take two brief glances at two other subjects that you address in your report and that I think are very important.
The first point I would like to go back to is the entire issue of training in the gerontology sector and in the field of aging more generally. Then I am going to talk to you about a research topic on which I have been working for 20 years, which is really central to my work, and that is elder abuse. You talk about it in your report.
Obviously, I will keep this new Age-Friendly Cities program for desert, since this is an international movement in which Canada is playing a leadership role.
As regards training programs in gerontology and in the aging field, we have, here at the University of Sherbrooke, a masters degree in gerontology, which has been offered for about 20 years now, and we also have a doctorate in gerontology, which has been available for five years now. This is the only doctorate in gerontology in the world, which is taught in French, and all our scientific articles are based on the international literature. We work a lot with English- language literature, and we receive an enormous number of foreign students.
I am talking to you about this because it is a fundamental concern for me, the one you do not lose sight of, when you deal with aging, when you address three components, that is to say all the more biological or health aspects, and you often hear about that, but also the psychological and social aspects.
I think it is important to prepare the next generation of researchers because, in the aging field, although investments have been made in research in the past 20 years, we realize that the field has long been a poor cousin; there were fewer issues, fewer topics. Since we have been doing a lot of research, we have realized that the knowledge is nevertheless arriving at a very fast rate.
I would not want to talk to you just about research training. I am also attached to the school of social service at the University of Sherbrooke, and, in the past two years, we have developed a major in gerontology in the master of social service degree program. I am telling you about that because that is really a very important observation.
Young social workers in training, it must be said in all honesty, are generally more interested in childhood and the family. These are the most attractive subjects. At the same time, let us be realistic: the clientele of future social workers will consist mostly of seniors.
I am always struck, even a bit shocked, to realize that, in most of the major social work schools in the country, the senior care course is not even compulsory; it is an elective. I think it is a fundamental error if we do not present our future social workers with an attractive, well prepared curriculum, because they will wind up working with seniors without having any idea of what is normal aging and what is pathological aging.
You will agree with me that, in general, and you talk about this in your report, people have a rather negative idea of aging. There is an entire section on ageism which I enjoyed. It is as though, from the outset, being older means being sick, which means being costly for the health and social service system. These are obviously things that I fight every day, among other things by doing much more to promote social participation by seniors, to the extent they can do so, until the end of their lives.
I talked to you about social workers because that is what I know. However, I am in touch with professors at the nursing school. I am also in touch with people in medicine, occupational therapy and physical therapy. In fact, the greatest concern for me In telling you about training is preparing not only the next generation of researchers, but also our future case workers, those who will be working with us, working with seniors from a broad and stereotype-free knowledge base. We have some major challenges ahead of us.
I will now stop talking about the training component, but, if you want to go back to it, I can obviously talk to you more about our specific training content.
The second point I wanted to talk to you about was the entire issue of elder abuse. This afternoon, I brought two documents, of which I tabled three copies that will be distributed to you. As you are no doubt aware, we had an extensive public consultation on the living conditions of seniors in Quebec, consultations which were conducted last summer and fall and during which I had the pleasure to submit two briefs, one on abuse and the other on Age-Friendly Cities.
I am pleased to submit those two briefs to you as well, noting that my thinking has evolved in the past six months, but not enough to say that these documents have become obsolete.
Elder abuse is a theme that I think is fundamental. We have been talking about it for about 30 years, but we now realize that, in social policy and orientation terms, and I would even say in terms of action, we still have a lot of work to do. In fact, it is only since 2002 that we have been able to say that we have a common definition of abuse, a definition that was adopted at an international convention held in Toronto.
This definition gives us a common basis on which researchers, but especially seniors, workers, members of the families and social and public policy planners can agree and say that we are talking about the same thing.
If we were to make an initial recommendation, it would be that we should ensure that we have a common vocabulary. It is not obvious for everyone what abuse, violence and negligence are.
The issue of senior abuse, for me, is the third type of family violence, and the least well documented. Allow me to explain. We are very advanced in our knowledge of violence against children and we have established a certain number of resources and social responses to the problem.
We have also made a lot of progress in the past 20 to 30 years on spousal abuse, and, here again, we have established policies and action plans. We have not made spousal abuse a specific crime, but we have organized matters so that the Criminal Code is enforced in cases where it is indeed necessary, whereas, for children, as you know, we have tended toward youth protection laws.
The third area is elder abuse, and this is a field that I think is distinctly more complex because it can occur in seniors' residences, but there was also this entire issue of senior abuse in an institutional context. Just as, in child abuse, we know it is generally the parents who are the abusers, so we know, in spousal abuse, that it is generally the spouse who will be violent.
The issue is highly complex in the case of elder abuse because, at home, people may find themselves in couple situations in which there is continuing spousal abuse, but also occasional abuse, and this very much struck me in some of my research work. Suddenly there will appear forms of violence of negligence that were not previously part of the couple's situation. In those instances, it is important to understand what has happened.
We did a follow-up of actual cases over one year, and we were able to determine that, when abuse becomes established between a couple and was not previously there, it is generally related much more to a loss of independence in one of the two partners, and the other one does not really know how to deal with the situation.
This leads us, among other things, to issues of home support for people who are losing their independence and good preparation so that caregivers are in fact able to play their role well.
I was telling you about couples. There are also adult children or grandchildren who can abuse seniors, and we also see the entire phenomenon of proximity, that is of people who are abused by those in their circle. It may be the neighbour who does the shopping, who goes and buys a quart of milk with a $20 bill and comes back with the quart of milk, but does not give back the change. I am giving you a trivial example, but there are dramatic cases involving seniors who are literally dispossessed of their property and finances by those close to them.
In an institution, there are two components that must be looked at. When we look across Canada, we can really equip ourselves from the various health orientations. These are all the more organizational issues, that is to say what is an acceptable institutional environment, and how we can ensure that there is a certain degree of quality control. When we say that, we have to look at organizational policies and schedules, among other things.
The example I often give, which is a shocking example for me, is the fact that every shift is responsible for serving a meal, which means that night employees will be responsible for breakfast, day employees for lunch and evening employees for supper.
What really shocks me is realizing that night employees, who finish at 7:30 or 8:00 a.m., will start waking up seniors at 5:00 or 5:30 a.m. in order to have the time to dress them, feed them and put away the trays before the day employees arrive. In those cases, I do not think it is the workers who are at fault, but rather our management practices and practices for organizing those environments where we have long boasted that our institutional environments are living environments, but you sometimes wonder to what extent they are real living environments.
In institutions, there is also the entire problem that must be looked at of a staff that is poorly trained and poorly supervised. A lot of people who work in our institutions have never been trained in gerontology or geriatrics, even people who do not even have reception centre attendant training in which they learn a certain amount of information.
It is as though we are less concerned about the professionalism or quality of the training of this personnel than, for example, that of the staff of day care centres, where we are distinctly stricter about people's profile and knowledge. I think we have some basic work to do in this area.
I could say a lot more about that. What it would be important for me to do when we take a pan-Canadian perspective is to emphasize the importance of being able to equip ourselves and to support ourselves. We currently have a network, called the Canadian Network for Prevention of Elder Abuse, CNPEA, which is doing an extraordinary job. People will always say that it is under-funded and asks too much of volunteers. I think we must support this kind of initiative and also continue supporting various research projects to gain a better understanding of what is being done, but especially to increasingly promote innovative intervention practices in which we learn what works and what does not work in order to provide assistance and support to seniors.
I will also say that we have developed intervention tools over the years. I have developed an intervention tool with which I train social workers so that they can conduct effective clinical follow-up. I have a doctor colleague from Montreal who has developed a screening tool for use in a doctor's office. There is a privileged relationship between the physician and an elderly person because an elderly person will generally see a doctor four to six times a year; so there is a relationship of trust in which the physician has a role to play. Clearly the physician will never conduct a follow-up because it is psychosocial support workers who do it.
So this brings us back, and I will conclude my remarks on abuse with this, to the importance of supporting integrated service networks in which there is interprofessional collaboration, but especially in which seniors are well provided with care and support and are not forgotten along the way. Ultimately, there is nothing worse than doing a screening and having nothing to offer. It is just agonizing for everyone.
I now come to my third subject, Age-Friendly Cities. This is an extraordinary project because it enables us to look at seniors where they live, from the perspective of improving their living conditions.
There are three major themes to Age-Friendly Cities: first, aging in good health while remaining active, and the notion of activity will change with the abilities of each person; second, this entire notion of participation, and thus the social integration of seniors; third, which concerns me, is this notion of security. For people to be healthy and to participate, they must feel secure.
A global guide to Age-Friendly Cities was published on October 1 last, and that is why we say that it is completely new. To prepare this global guide, field research was conducted in 33 cities around the world, and fortunately my colleague Suzanne Garon and I did the field research here in Sherbrooke. So Sherbrooke is one of the 33 pilot cities in the world, which is very pleasant. There were also three other Canadian cities.
I have tabled the brief that Suzanne and I submitted. I am going to refer to the major factors that I think are fundamentally important.
The first is that it is important to look at where people live in terms of the pivot of their human activity, but also the entire notion of progress. We have often associated the issue of aging more significantly with the developed countries, and the Age-Friendly Cities project has made us realize that accelerated aging is a phenomenon around the world and even in the developing countries.
What counts here is that cities be adapted to the needs of seniors so that we can meet the challenge of demographic aging together. The program initially focused on the major cities, on the basis that the major cities have the human, economic and social resources necessary to make innovative changes so that seniors can age well there.
We also said that major cities are also focal points because, as they age, people can very often tend to move closer to services, and thus to the major centres.
What characterizes us in Canada is that, although we are entirely reconciled with the Age-Friendly Cities approach to large cities, the money has been given to much smaller cities. When you look at a city like Saanich, for example, or Portage-La-Prairie, or a city like Sherbrooke, with 150,000 inhabitants, and you compare the results with, for example, Tokyo, London or Shanghai, you realize that we were in cities that were not very comparable in demographic terms.
However, the value of this project is precisely the way in which the eight topics were addressed. The findings from one city to another are exactly the same.
Age-Friendly Cities in fact are concerned with the eight major dimensions of seniors' lives.
Let us start with outdoor spaces and buildings. Here we are thinking of urban design and development and the possibility for seniors to have access to that. In terms of outdoor spaces, one thinks, among other things, of our Canadian winters and of the opportunity for seniors to be able to move around in winter on clear sidewalks. Some municipalities do not have sidewalks.
A number of examples emerged concerning buildings. One of the examples given here in Sherbrooke, and which emerged elsewhere, was access in certain places where doors are often very heavy, and where a draft or airlock forms where people have trouble entering. So we need a city where all our spaces are more accessible.
The second topic is transportation. To participate socially, people have to be able to move around. Of course, a number of elderly persons can still use a motor vehicle, but, for others, circumstances may arise at some point in which they lose their driver's licences, as a result of which we must be concerned about transportation for them. It would be important for our public transit to accommodate seniors so that they are not always associated with para-transit. It is a little unrealistic to think that all seniors need para-transit. There are alternatives.
In Sherbrooke, the transportation issue has raised a lot of questions that you will find in our report and that you will explain. A few months before we conducted our survey, there was a major change in the public transit structure and people could no longer find their way. So they were unable to move around, to know where and when they could transfer in order to go elsewhere.
The third topic is housing, that is the entire question of having suitable and adequate housing for seniors in which they feel secure.
The fourth topic is respect and social inclusion. Here we are back to your ageism issue, which is fundamental.
The fifth topic is social participation, that is recognizing that seniors are contributors to the development of our society.
The sixth topic concerns communication and information. Seniors are emphatic: ``Speak to us in a language that is clear, with big letters.'' You will not be surprised to hear all the criticisms they made of the voicemail boxes you get stuck in when you call virtually everywhere, and I am convinced that we all get very irritated when we come up against that, and it is often worse for seniors who, among other things, have vision problems or a certain dexterity problem.
The seventh topic is civic participation and employment. How can seniors, who want to stay employed, be or not be integrated?
The last topic, but not the least, is the entire notion of community support, the support given to those who are most in danger of losing their independence, and access to health services.
I was listening to the previous testimony when I realized that health is a horizontal issue; there are a lot of concerns about having a family doctor, having access to services, being able to move around in order to get services, and so on.
[English]
Senator Mercer: First, we have to say that we are impressed with the quality of the faculty at the University of Sherbrooke. We heard about the University of Sherbrooke when we were in Moncton, New Brunswick.
You said that you had developed an intervention tool and I would like you to tell me a little more about it.
[Translation]
Ms. Beaulieu: The tool is called ENMAIN, an abbreviation for enjeu, intervention, maltraitance and aînés, so there is a bit of a play on words there. It has just been translated into and validated in English and is called INHAND. It is a tool that enables psychosocial workers to assist seniors very clearly in their abuse situation.
I developed the tool following extensive work. I realized, among other things, that the greatest challenge for workers when they work in elder abuse cases is to balance their approach; if they respect the elderly person's independence, and thus that person's self-determination and sometimes respect their independence. This can even mean that, when the person tells me, ``I am telling you, but I do not want you to do anything,'' in that context, the worker can accept the senior's word and say: ``I am not someone who listens, and, for the moment, I am waiting for him or her to ask me to do something,'' as opposed to the other issue, which is the whole issue of protection.
There are serious situations in which we must intervene. There are cases where emergency hospitalization is required; there are cases where we have to consider evaluating the individual's ability or inability in order eventually to put a protection plan in place, particularly when there are cognitive losses.
My tool indexes three intervention models in light of the two values that I have just given you: the first, how ideally to assist the elderly person through all kinds of stages, and, second, how, at times, to accept that that person does not want you to intervene, but to continue providing reinforcement and to listen, hoping that that person will shift more toward intervention; third, on the other hand, in which case we are justified in taking more drastic measures, including, for example, calling the police, emergency hospitalization, and so on.
With this tool, I am training workers in Quebec's health and social services network. I have already trained a number of groups. My tool has been indexed by a pan-Canadian network that you may have heard of, which is called the NICE Network, for National Initiative for the Care of the Elderly, under the direction of Lynn MacDonald of the University of Toronto.
In that network, they have translated my tool into English and we are now going to start introducing it in other parts of Canada.
[English]
Senator Mercer: I want to discuss age-friendly cities project. My colleagues have heard me say that there politics are involved in this project. If we are going to move the agenda forward on age-friendly cities, we are going to have to change the terminology, because the reality of it is that the people making the decisions are not necessarily people who live in cities. Some of us have learned it the hard way that the word ``cities'' is problematic, so we start to talk in terms of age-friendly communities.
You talk about Saanich and you talk about Sherbrooke. Sherbrooke is a city. If Saanich is a city, it is a pretty small one. I do not know how we start to change it. I know internationally, it comes out of an age-friendly city discussion, but in Canada, it is the community side.
When the previous government introduced the cities agenda, the transfer of gas tax to the cities, it became a big internal problem because many of our colleagues were not from cities and they said we could not exclude them. So it is terminology.
I do not know how we do that, and I would like to hear your advice on that.
Someone made this suggestion earlier today that it might be possible to find a few locations across the country, whether big, small and medium size, in which we try to implement the age-friendly concept?
Do we designate those cities so that we can say to the rest of Canadians that here is what we have done in Sherbrooke; here is what we have done in Lunenburg; here is what we have done in Saanich? Should we designate the cities to show Canadians what does and what does not work?
Someone has to do this first. Someone has to make the mistakes that are going to be made so that other communities do not make them.
Do you think that is a feasible proposition?
[Translation]
Ms. Beaulieu: I love your question. The first answer is a little more political; you are absolutely right. In Canada, municipal powers are quite limited, whereas that is not the case in other countries. When I look at my colleagues in France, in the French municipalities, there is an elected representative responsible for senior citizens who makes old age policies for his own city.
I think they have gone for a concept in which they say, let us look at where people live. They mainly live in cities; so they adopted that term. Canada very quickly got away from that, even though we have kept the term.
There was also Health Canada's investment in a study in what they called ``remote and rural communities.'' So we have agreed to say that we have to look at where seniors live, and when they do not live in the cities, we also have to concern ourselves with that.
I would be completely comfortable with the idea of eventually changing the theme. I would just have to think of a term we could adopt, but I am nevertheless very much in favour of the idea of ``community'' because it is embracing.
The idea of introducing the program in a certain number of cities, which we could call ``pilot'' cities, to see how it works — I am pleased to announce to you that we are doing that in Quebec. Quebec's Secrétariat aux aînés has just invested $2.5 million to introduce the program in seven different communities in Quebec. This is a research action and evaluative research project that will last five years.
There are seven pilot cities, and my colleague Suzanne Garon and I, who conducted the initial study, were hired to supervise research on it.
So we are trying the initiative, and I must tell you that there are not just big cities; in any case, there are no cities that big in Quebec, apart from a few. So there are really cities of very different sizes. In one region, we took a number of small villages that work together, and we called that an Age-Friendly Region, rather than an Age-Friendly City.
This is completely new. The project started on April 1. We are in the initial stages, but there is such an intention and will to move forward that this is considered to be an interesting program.
We will definitely make mistakes and we will definitely do good things, and our role as researchers will be to conduct comparative analyses in order to derive more comprehensive knowledge.
[English]
Senator Mercer: I like the choice of ``community'' or ``region,'' it really does not matter that much to me as long as it is not ``city.''
You say that the pilot project happening in Quebec is in seven communities. It just started in April?
Ms. Beaulieu: It did.
Senator Mercer: My next question was to ask how things were going. It is obviously much too early now.
It is $2.5 million?
Ms. Beaulieu: Yes, $2.5 million over five years, and there is seed money in the communities for them to develop activities, and also research money for us to evaluate what is going on.
Senator Mercer: So we will have to wait five years to see the result.
Ms. Beaulieu: No, not exactly. At the end of the first year, we will have first data and we will be able to compare and give out some results.
Senator Mercer: I would ask that you keep us in mind as you distribute the results because even though we will have reported by then, our interest will not have waned.
Senator Keon: I want to bring you back to the senior abuse issue. Being pragmatic, let me use the example of a senior couple who are fundamentally financially and socially sort of dependent on each other, because of the way the system works, and there is some abuse there that has to be dealt with. It probably means removing them from their relationship.
What really does interest me is not what can be done, I would like you to tell me that, but it is what cannot be done, what things are missing in the social infrastructure that would allow you to go in and solve that problem?
[Translation]
Ms. Beaulieu: You take the specific example of a couple. For a long time, we thought we had to apply spousal abuse policies to the different couples, regardless of the age of the partners. We realized that, for the moment, that does not work. That is one of the things that should not be done.
Among other things, when you take, for example, an abused elderly woman to an institution for women victims of spousal abuse, elderly women do not see why they are there because the women there are often much younger women with young children; they are thus in another phase of their lives. The approach we will often take with them, which is an excellent approach, is an empowerment approach, the idea being for them to take back control of their lives and eventually to get out of the relationship.
We realize, among elderly people, that people very rarely want to terminate the relationship, particularly when there has been spousal abuse for a long time. If the people have been in that situation for 50 or 60 years, we cannot come in and say that the solution is to work toward a break-up of the relationship.
At that point, there is a whole supervision and mediation effort in which we have to work with a caseworker who is forced to get a grasp of the situation and, among other things, lead each of the partners to express more clearly what he and she are experiencing, in an attempt to find solutions, but solutions with which both are comfortable.
I would say that the difficulty that caseworkers say they most often encounter, and this is one of our infrastructure problems, is: ``I do not always feel equipped; I do not exactly know; I do not clearly understand the dynamics of elderly couples, but, when I make an effort, I know it will take me a lot of time.''
In general, the entire public social services network asks caseworkers to intervene quickly to a certain degree; so it expects them to open files, but also to close them, so that files do not always stay open. Caseworkers tell us that, in our structures, ``e are asked to intervene, but we are not given the time or the resources to do it right.''
I think the message that must be sent is that intervention in these cases is a complex matter and that, as a result of the complexity of the cases, it takes time and a certain expertise. And in each of the institutions — I am still talking about the public system, but that still interests the community system — we should have a better trained specialist who can either take on the case or at least coach, encourage or guide the other caseworkers. And that is lacking. So that would already be a step we could take.
[English]
Senator Keon: You are confirming then that there is not the infrastructure in place right now to deal with that.
[Translation]
Ms. Beaulieu: We definitely do not have all the necessary infrastructure; I confirm that for you.
[English]
The Chair: Thank you very much. You have confirmed some evidence we heard earlier with respect to the treatment of physical abuse, if you will. However, I am concerned about the other kinds of abuse that occur within the senior dynamic, the abuse which takes place in the long-term care facility, the abuse which takes place within the home.
You addressed that very briefly when you indicated that the dependent person is frustrated because he or she is no longer dependent and the caregiver, male or female, who has absolutely no training to deal with this person who, quite frankly, requires that training to deal with this person.
I watched this with my own family, with my father who was a stroke victim. In that case, my mother had been trained as a nurse, so she had the expertise in terms of his physical care. But I remember my father saying to me one day, with great sadness: ``Vivian is no longer my wife, she is my nurse.''
I would like you to comment on that situation.
[Translation]
Ms. Beaulieu: You are touching on a problem that many still refuse to consider, and I am pleased you're bringing it up. I am going to answer you with an anecdote that illustrates it clearly.
There is a filmmaker here in Quebec by the name of Gilles Carle, who suffers from very advanced Parkinson's, and who is very dependent, and who has been married for many years now to an actress much younger than he. And contrary to all the prejudices that one may hear, they are a very happy and very close couple. Mr. Carle is in a state of very considerable dependence and Ms. Sainte-Marie, who is his wife, speaks on behalf of all natural caregivers and regularly talks about everything it means to take care of a spouse. She has told, and that very much moved me, how at one point she allowed employees to come to the house to give him a bath, to dress him, and to perform a number of more instrumental tasks, because she said: ``from the moment I only did that, I was not longer Gilles Carle's spouse; I became only his caregiver; and there was no longer any room for what united us, that is to say being above all a couple.''
When I hear you mention that, I say to myself, yes, you are headed in the same direction as Ms. Sainte-Marie's remarks, and I think that brings us back to how important it is to provide home support infrastructure that really meets the needs of the people who are caregivers.
Dr. Hébert, whom you met this morning, must have told you that, based on the studies he has conducted, the public system currently barely meets 10 per cent of the needs of caregivers and the people who need help. That means that 90 per cent of needs are not being met, things for which you rely on relatives to an enormous degree, and, if these relatives are not given support, that for me is an infernal spiral that is really taking us down to the deeps.
I am not telling you that these situations will necessarily always result in abuse, but certain forms of negligence can occur in these circumstances, and at that point the caregivers should not be blamed either. When you have exhausted, poorly supported caregivers, these are things that can happen. That does not explain all situations, but it explains some situations, and that is very sad.
[English]
The Chair: It is interesting because at first, we did have the VON coming in to care for him and to give him help, but my mother did not think it was being done properly. She had been trained in the old school. So she took over his physiotherapy, she took over his speech therapy, she took over everything.
My father died in May 1980. My mother died in December of the same year. She died of exhaustion. I think that is all too often the story of the delivery of care by one partner to another partner. She was only 73 years old. She had a weak heart, and that just contributed to the weak heart.
When we make a recommendation for a national home care program, which I hope we will be able to make, is that going to help to facilitate some of this training, some of this relief to home care workers?
[Translation]
Ms. Beaulieu: I think that any investment in home support programs is welcome.
When you go back to the specific situation of your mother, what I am hearing as well, and what I think is important, is that informal caregivers must feel they are partners in the decisions that are made and in the manner in which services are provided. Your mother probably never had the opportunity to speak or take part in the decisions, and it was easier for her at one point to say, ``reject the services and I am doing it,'' rather than feel part of a team that, as long as possible, wanted good things for her husband.
So that leads us back again to the matter of training for our caseworkers. Offering services is not everything. We have to offer them and know how to become partners with people. And we can never emphasize this too much in the training of our caseworkers. This is the whole relationship dynamic and the ability to enter into dialogue with people.
[English]
The Chair: Thank you, senators, and thank you, Mme Beaulieu. This has been a wonderful intervention, and I am very pleased you gave us the figure of 10 per cent, because Dr. Hébert did not give it to us this morning. The fact that you put that on the record is extremely important for our deliberations.
[Translation]
Ms. Beaulieu: It was a great pleasure for me, and good luck in your work.
[English]
The Chair: Honourable colleagues, we will begin what we call our town hall meeting.
We would first like to welcome to the microphone Monique Joyal-Painchaud, who has been very patient all day. She has been sitting and listening.
[Translation]
Monique Joyal-Painchaud, as an individual: Madam Chair, I would like to talk about Recommendation 66 on natural caregivers. I knew a family in which there was the relative, a 92-year-old man, and his wife. At one point, they needed help. It was the son who left his home to come and help his father, who was forced to sell his house to pay court costs. In the end, he spent all the money from the house and was not even in the same place either.
If he had received a salary like someone who works in a hospital or in an institution, he would have had a salary every week, which would have enabled him to keep his head above water without exhausting all his money and winding up out of luck at one point.
Proposals have been made for natural caregivers, but if we pay someone in an institution, the caregiver could also have a salary because it is more than 40 hours a week, and it is seven days a week. I think they should have a salary during the entire period when they are caregivers, perhaps not $20 or $30 an hour, but at least $8 to $10 an hour for a 40-hour week.
That is what I wanted to say. Otherwise, they are generous, but they wind up in tough conditions.
[English]
The Chair: Thank you very much for a very necessary addition to what we have been hearing. We need to hear personal stories like yours.
We would now like to welcome to the microphone Gilles Grenier.
[Translation]
Gilles Grenier, as an individual: Over the lunch hour, I read about Quebecers' drug costs in the Journal de Montréal; they spend about $832 a year on drugs, and most drugs have serious side effects.
I have a friend who has scoliosis in her spinal column. She worked with a couple who had Alzheimer's. It is strange, but the couple had the disease at the same time. She worked a number of hours and wanted to show that she was able to work, but what happened is that, when she left, she could no longer wear the same clothing. The doctor said her scoliosis had shifted about 55 degrees. I provided her with what she needed, but she had to see an orthopedic specialist at Sacré-Cœur Hospital in Montreal, a Dr. Morin. In the end, she tried an anti-inflammatory because she had serious pain and could not sleep at night. During the day, a lack of sleep at night affects the nervous system. He prescribed her anti-inflammatory after anti-inflammatory, and she still had pain. Even in her left arm, it was as though it was paralyzing. She picked up dishes and almost dropped them. Her name is France, and I told her, ``while you are at it, France, you might as well take 94-proof alcohol.'' You know, the old people took it. They did not care about anti- inflammatories. That is what my father took. He never went to the hospital, he never went to see doctors, and yet he died at 83 years of age, and my mother died when she was 87. My grandfather was a farmer and, to do a day's work, drank a glass of gin in the morning, and that gave him some pep. It worked, and he was virtually never in the hospital. It was only at the age of 83 that he was forced to go to the hospital.
I told my friend to go and see Dr. Clark, who used to be on Dufferin Street, and he worked at Sherbrooke Hospital. He was a very good family doctor, and he was her family doctor. He prescribed her some Revitolus (ph), in vials to be taken orally. One is black, which is animal glands, and another is 1,000 mg of vitamin C. You take that in the morning before breakfast with a little water. I added two or three drops of holy water. I know how to make holy water. Revitolus was prescribed for people who had had an operation, to make them stronger, so they could get out of hospital sooner. It really braces you. I started taking it myself, and you would think it gives you a more harmonious voice, and I feel stronger too. A little more and people would take me for Hercules, the god of musculature: ``Back off, Hercules is coming through.''
In any case, whatever may happen, I think you have to reduce the cost of drugs and prevent side effects as much as possible. If people have too much pain, a good shot of 94-proof alcohol, not to get drunk, and you ultimately forget a lot of pain with that.
[English]
The Chair: Thank you, Mr. Grenier.
Is there anybody else who would like to come forward?
[Translation]
André Fréchette, as an individual: I am a member of the Sherbrooke Community Association, which works for people 50 years of age and over. We manage an activity centre, a centre that organizes physical, cultural and educational activities. We also have the meals on wheels component, which delivers 325 meals a day in greater Sherbrooke. We say Sherbrooke is big, with a population of 150,000. Every day at noon, five days a week, we deliver between 325 and 350 meals.
When I received your document, your interim report, I was very interested in the first option, which was to grant a tax credit for volunteers. I have been a volunteer for eight years. I was lucky to be able to take a very good early retirement, but a lot of my co-workers are drivers and use their own cars to deliver meals. With the cost of gasoline, the people involved in this volunteer activity receive compensation of about $7 to $8 to drive 30 to 40 km to make deliveries. So that is very little, and that means we have a lot of trouble finding volunteers, even if we pay them a little compensation.
This would be important because we realize that the baby boomers, the people who had the privilege of having good jobs, once they retire, have a lot of other projects to do, personal projects, work on their homes, travel, new sports they want to master. So a tax credit would be very important.
Another of your options is very important, the one in which you talk about natural caregivers.
Before coming here today, for example, between 10:30 a.m. and noon, I delivered exactly 30 meals. What saddens me is to see that people are alone. The seniors we deliver lunches to are not miserable, but what is unfortunate is to see that it is not one of their children who comes to deliver their meal; it is a stranger.
There is one case, a 40-year-old man who comes and has lunch with his mother every day. He does not have the time to prepare a meal for her. He brings his own lunch, and he eats with his mother. I arrive and I give his mother the hot meal. I find it sad that this guy cannot get a tax credit to come and prepare his mother's meal himself, or just be there to receive it and not be penalized for his job.
Today I had a student from the University of Sherbrooke, a Senegalese, whom I was introducing to volunteer work, and that student from Senegal told me: ``Mr. Fréchette, I find it extremely sad to see the situation you have shown me today, 30 elderly persons at home alone at lunch time. In my country, we are poor, but we would not see that.'' That is the conclusion of someone who looks at us from the outside.
So, yes, a tax credit for volunteers, for the people who want to be volunteers, and not to have to be out of pocket, because some cannot afford to pay for gasoline, to pay for their travel, and a tax credit as well for natural caregivers so it is not strangers, so that it is people who are related. Being served a meal by a stranger is different. We can be as polite and nice as we can, but that is not like a son or a daughter bringing the food. That was my message. Thank you very much, and good luck to the committee.
[English]
The Chair: Thank you very much for that presentation.
That concludes our meetings in Sherbrooke.
The committee adjourned.