Proceedings of the Special Senate Committee on Aging
Issue 12 - Evidence, June 4, 2008 - Afternoon meeting
VANCOUVER, British Columbia, Wednesday, June 4, 2008
The Special Senate Committee on Aging met this day at 1:04 p.m. to examine and report upon the implications of an aging society in Canada.
Senator Sharon Carstairs (Chair) in the chair.
[English]
The Chair: Members of the public, welcome back to the meeting of the Special Senate Committee on Aging. This committee is examining the implications of an aging society in Canada. We are here in Vancouver this afternoon to hear from interested parties on the impacts of an aging society and more specifically to hear their views on our second interim report tabled in the Senate on March 11.
This afternoon, we have the pleasure to have before us Penny Bain, Secretary and Director, Board of Directors, BC Centre for Elder Advocacy and Support, and Charmaine Spencer, board member, Canadian Network for the Prevention Elder Abuse.
On behalf of my colleagues, I welcome you very much. We will begin with your opening remarks and then hopefully we can have some question and answer.
Penny Bain, Secretary and Director, Board of Directors, BC Centre for Elder Advocacy and Support: Thank you, Senator Carstairs. Just a note that the organization that I represent is just in the process of reconfiguring itself and we are now called the Centre for Elder Advocacy and Support, so I will be referring to us by that title. You will see that noted in my brief as well.
I will just speak for a few moments and my colleague Charmaine Spencer will be speak for a few moments and then we will both be here and available for questions from you.
First of all, I would just like to note that both Charmaine and I are here today to speak about the issue of abuse of older adults in Canada. My particular expertise is in British Columbia. Charmaine represents an organization that is a collaborative group looking at elder abuse from a Canadian perspective.
We are particularly concerned about the whole question of elder abuse. We have noted that the first brief or the most recent brief from your committee spoke about elder abuse briefly, starting on page 29, looking at the options to combat abuse and neglect. We would like to see that particular section greatly expanded in terms of its description of and indication of the scope and the impact of elder abuse. We would also like to see it become much more targeted and specific about what federal leadership could do to make various aspects of our current system of addressing issues such as elder abuse more effective.
My comments will be primarily in relation to the criminal justice system response. I recognize that the Criminal Code of Canada is a federal responsibility, but the administration of the criminal justice system is a provincial matter. I want to raise these particular issues with you in a B.C. context, to indicate how the whole question of elder abuse could be addressed from a leadership perspective. Not necessarily involving legislative change, but in terms of providing guidance and support for various provincial initiatives around the effective implementation of policies that arise out of the criminal justice system.
My colleague will be speaking to you about research and work that she has done in a broader perspective because we recognize that we all work on the issue of elder abuse and its prevention much more broadly than just in the criminal justice system context.
I do not want to read out things from our brief, which is in front of you, like the description of abuse of older adults found on pages 2-3. I just want to note that abuse is much broader than physical, sexual and emotional abuse which are aspects that might first come to mind.
A great deal of the abuse that we see in our program is financial abuse. One of the areas where older adults seem to be the most vulnerable and the most victimized seems to be in financial aspects of their life. A lot of work has been done in that area, but I will say that when we talk about financial abuse, we are talking for example about financial fraud using the telephone. There is a national organization sponsored by the RCMP called PhoneBusters that looks at this problem. Their statistics show that 90 per cent of the phone frauds in the country are targeted at older adults.
That is one type of predatory behaviour that we talk about when we talk about elder abuse, but we are also talking about a form of financial abuse of older adults which is family initiated. It is largely unmentioned and quite hidden in the same sense that family violence or child abuse has been hidden for a number of years.
I want to emphasize the financial abuse and the family aspect because it is one area where people often feel a bit uncomfortable, but the consequences of that type of abuse generate a lot of the phone calls and information-seeking that we have experienced through our organization. So just to highlight that.
Another subject that is often uncomfortable for the general public to speak about is the sexual abuse of older adults. That discomfort makes it difficult to address on the level of broad political policy.
We are also talking about older adults' rights as all Canadians' rights to privacy, to confidentiality. They are basic human rights in various contexts, but particularly in the healthcare sector, et cetera.
Finally, we are also talking about neglect, and because I am focusing on the criminal justice system, of course there are very high standards for establishing what is neglect. But just to keep in mind that the various forms of abuse incorporate neglect.
I think probably you can imagine why seniors have become targeted by predatory behaviour either by their families or by third parties who are trying to take financial advantage of them. All the concerns that we have about people with lesser abilities to protect themselves in our society apply also to older adults when they start to experience health and other problems. We know from general crime statistics that those with any sort of health frailty or disability have a much higher incidence of being targeted by predatory behaviour or by criminal conduct.
We know that living with abuse and neglect, and this is true for all age ranges but I am speaking particularly of older adults, has a huge impact on their personal health. It affects their self-confidence, their self-esteem. It can result in depression because in many cases, we are talking about an important relationship with the person who is perpetrating the abuse and neglect.
The stresses of living in these conditions and not having them adequately addressed by the government systems that are meant to respond to them results in a very serious health consequence. So it becomes cyclical. You can see that if someone is abused in one relationship and then moves on to another and is abused in that relationship, there is a downward spiral and declining ability to function in life and to care for oneself.
What our organization has been doing for the last 15 years is focused primarily from the senior's perspective, dealing either with actual victims or with those who are simply vulnerable. Trying to provide them with some legal information and response. This has been funded through the B.C. Law Foundation for a number of years.
We have a very able paralegal who answers about 1,600 calls a year. Some result in him representing the caller. Most of his work, though, consists of giving legal information over the phone to callers from all over British Columbia.
In addition to those legal information services, the organization also has developed training materials and carries out a number of training workshops for various professionals who are working in the area of elder abuse.
Part of the material was developed as a result of three years of funding from the National Crime Prevention Centre. That funding resulted in a very detailed information package. Research that went into the development of that package resulted in the recommendations that I am going to dwell on when I get to the specifics about the justice system.
We have just received funding from the BC Law Foundation to start a law clinic. We are now in the process of hiring a lawyer who will be able to represent older adults in asserting some of the legal remedies that they might not otherwise be able to assert because our provincial legal aid plan is quite limited in terms of legal supports for victims.
Certainly if an older adult is the alleged perpetrator of a crime, they can get standard Legal Aid. But if they are a victim of a crime, for example, financial abuse by a family member, and they cannot afford a lawyer, we will be one of the alternatives for them in the province to respond to that.
The primary focus of my comments from the centre's perspective is an appropriate role for the federal government in helping Canadians to live free from abuse and neglect. We have developed these recommendations based, as I mentioned, on some research that was funded by the National Crime Prevention Centre. Since then, the Crime Prevention Centre has changed its priorities and so the last time we applied for funding to continue some of this work, we were told, "No, we only fund projects relating to youth.'' That was last year. This year, they only fund prevention projects relating to substance abuse.
So I guess basically one of my messages is that there seems to be no recognition within the National Crime Prevention Centre that crime prevention needs to span all age groups. Not that the federal government is not funding other activities in this area, but that particular one was very supportive of us for a number of years.
I want to give you an example of a couple of calls that I myself dealt with. I am now retired, but I was the executive director of the centre and in that capacity was primarily a paralegal who answered all those information calls I told you about. But a few other calls came to me and I just wanted to give you some examples of typical calls.
Drug addiction can be a huge problem within the population and the calls that I received have been older adults who are being harassed and abused by drug-addicted adult children. In one particular scenario, I have suggested a grandson, but it could be a son. When a drug addict in the family knows that a senior has some financial resources, often that is senior can be the target of subtle pressure where there is difficulty within the family in distinguishing between natural gifts to grandchildren or to children, and coercion. Often it is quite clear that the line has been crossed and that the senior is in fear of their life if they do not in fact turn over all of their resources to this abuser. What is the appropriate criminal justice system response in those cases?
We often get calls from caregivers and particularly managers of facilities that provide care to seniors, just seeking some information. We do not represent those organizations or facilities. We only represent seniors themselves, but we do give information obviously to family members and to others.
One scenario that often is the first indication that financial abuse is being perpetrated by a family member is where, for example, the older adult is in the care facility and has given the power of attorney perhaps to an adult son. The son is now spending that parent's money for their own purposes even though the duty is to spend the money for the benefit of the person who granted the power of attorney. In this case, we will get a phone call from a facility's manager saying the father or grandfather's bills are not being paid, what can we do about this? What is underlying it is criminal behaviour, the misappropriation of the senior's funds.
In British Columbia, there is a complex network of Health Authority, Public Guardian and Trustee. We have victim service workers in the province. There are a number of agencies that could respond. We have a network that you will hear about in the brief from the Community Response Network Association. We have a system that has been mandated under provincial legislation to bring together community groups to respond to elder abuse.
There are a number of ways of responding to these kinds of situations in the healthcare system, the legal system and, if I can call it that, the social support system. But what I wanted to focus on was the appropriate response from the criminal justice system when there is clearly a criminal act and often it is absolutely clear that the conduct is not something that is has really been approved by the older adult? Of course, that becomes a gray area, as I say, when it is family relationships.
The criminal justice system of course is armed with its usual responses to crimes. What we found in the research we have done and the work we have carried out is that a number of those responses from the criminal justice system are not appropriate in cases of elder abuse. The responses that are the normal way of responding to, say, a robbery at a bank or a theft on the street or whatever, are not necessarily going to be the way to hold these perpetrators accountable. Basically, we need to stop them doing what they are doing and hopefully recover some of the funds.
We need to hold the perpetrator accountable and get some protective system in place so the abuse stops and the older adult becomes safer. Then finally, through civil remedies and some criminal remedies, if the funds have not completely gone to the cocaine dealer or whatever, we need to find ways of trying to recover some funds for the senior.
You might think it is straightforward: if it is a crime, it is a crime and the police can take care of it. But the problems come with the kinds of remedies that the criminal justice system is most comfortable with — arrest and detention, perhaps enforcing protection orders that are issued by the judge in the court, et cetera. When you start to try to overlay civil remedies like civil protection orders and civil suits for recovery of funds with the criminal justice system response, you get a lot of confusion.
In British Columbia, we get confusion because we have health authorities in the province mandated under provincial legislation to investigate circumstances relating to abuse and neglect, and their mandate often gets confused with the criminal justice system, the police response in a particular situation. So there are all these questions about protocols and procedures developed perhaps 20 years ago in relation to, for example, investigating child abuse. Cases involving the elderly are not being worked through the system with the same level of attention and sophistication.
The spotlight has not been shone on some of the complexities of trying to balance the criminal justice system response with healthcare and social work response in this area.
I realize I have spoken for a bit of time here, but if I could, can I just touch on some of the recommendations in the report just to highlight them?
The Chair: Yes.
Ms. Bain: I am now at page 7. I am aware the role of Crown prosecutors is always a touchy subject because the Crown is independent. At the moment, we have some inquests relating to family violence where there is a lot of toing and froing about whether or not the Crown can be asked to testify at the inquest about what principles they applied in making a decision about detention orders or not, et cetera. Anyway, this is about fraud, which is a provincial area of jurisdiction.
Federal leadership might be to indicate that, throughout the country, we should have some level of uniform accessibility of our criminal justice system response. To say that even though access to justice and the administration of justice is a provincial responsibility, from a federal perspective, we do not want to see vulnerable seniors left with an inappropriate response from the justice system because of some of these barriers.
Charging policies. There are some complexities around whether or not proceeding with a particular criminal charge is in the public interest. We would like to see is some policy statement broadly stated by all Crowns, all provincial governments across the country, that it is always in the public interest to prosecute a case in which a vulnerable adult has been seriously abused.
We have a policy in B.C. called the Violence Against Women in Relationships policy which has that type of statement embedded. It means that a vulnerable spouse, and it could be male, but it is primarily directed at women, has their vulnerability, dependency, the barriers they face in accessing the justice system, taken into account. We would like to see a similar kind of policy in place around elder abuse issues.
The role of the police. Often police officers will say to us that they are confused about their role. Under provincial legislation, they are usually to accompany the individual who has been mandated by provincial legislation to investigate something and keep the peace. They may also be uncovering evidence of a crime. They have a continuing responsibility for the enforcement of the Criminal Code of Canada, even though they have also got another hat on at the particular incident that relates to their role, a protective role where another provincial authority is taking a lead.
In British Columbia, that would be the Health Authority under our Adult Guardianship Part 3 legislation, or our Public Guardian and Trustee's office.
The police involvement in the prosecution of vulnerable adults. There seems to be confusion about their role, as a result of all sorts of pressures on individual police officers, within police departments, within philosophies of policing authorities at a provincial level, and on the RCMP. I think incidents need to be investigated in the same way that crimes are investigated, but while trying to balance and take into account police responsibilities under the provincial legislation.
We would like to see emphasis on respecting the complexity of these kinds of cases and the delicacy of the situation of the victim, the vulnerability of the victim, by ensuring that the investigations take place in the investigative branches, not just having a general officer who is asked to respond. We get so many calls from relatives trying to help older adults or older adults themselves, who are totally frustrated because they have told their story "to the police,'' and they just do not get any response. We do not think it is because the senior is not accurate in what they are saying. We think there is just a lot of misunderstanding and failure to communicate and failure to commit to the investigation of these cases.
Vancouver has a fraud squad with ten officers. However, this is a huge city with very sophisticated crime in the financial sector. All financial corporate crime as well as incidences of, say, abuse of power of attorney that results in a senior's savings being wiped out are investigated by those ten officers.
Of course, police departments have to have policies of practices for allocating their resources, but we found, for example, the Edmonton Police Department has a policy that takes into account the impact on the victim of the particular fraud when they are trying to decide whether or not they will investigate it. We would like to get the message across in a national way that these are very important cases for the individuals involved. It can be life and death, literally, even though it appears to be just about money. It is not the same as CIBC making a bad investment.
There have been commitments by various provincial governments to track, say, family violence cases or child abuse cases within their system, so that research can be done and a window can be opened and some light shone on this problem. None of that takes place in relation to abuse of older adults and so all of the cases are kind of lumped together and it is very hard to identify what is an elder abuse case when you're looking at research.
Many of these barriers I have been mentioning, like getting the police to investigate, knowing how to make a complaint, et cetera, result in many fewer crimes being acknowledged in the system than actually occur. Once there are there, however, it is very hard to identify them.
Expediting files involving vulnerable older adults through the court system. This is something that is tried with various kinds of cases in the court system, but not in this area.
Providing sufficient resources to the Crown. Again, that is a provincial issue, but essentially, the Crown being under-resourced makes some difference to them in terms of what kinds of cases they will actually approve for charges. There was one police officer in Canada who was specializing in researching power of attorney abuse cases, investigating them, coming up with detailed bank records, et cetera, in order to prove significant fraud. It is not rocket science, but it is complex. It requires a lot of resources. The only reason that officer was successful in getting convictions was because he was paired with a Crown who was also becoming experienced in these cases and had the time and the resources to prosecute. Cases can take a lot of time and a lot of court resources, so it is a temptation on the Crown's part just not to want to proceed unless there is an absolutely lock-down case.
Policing and other agencies. The work that needs to be done to make sure that officers know what their role is in relation to the various agencies that are mandated in their communities and that protocols are worked out to ensure ongoing training for police and the agencies that they need to work with.
Another big area of concern is protocols between banks and other financial institutions and reporting to police. Often, the banks will have very rigid, strict policies based on both federal and provincial legislation relating to privacy and confidentiality. So essentially, if the senior is being financially abused but has not given consent to release that information, the bank is very reluctant to go forward even though it is clear to them that a crime is taking place.
There are exemptions within both federal and provincial legislation that provide for institutions like banks being able to breach confidentiality in order to report a crime, but it is not always clear cut and often there are a lot of internal-to-the-bank procedural barriers to reporting. It would help if there were a federal initiative helping banks and financial institutions to develop appropriate protocols and responses, based on the understanding that they have a public duty and how that relates to the various criminal and provincial laws involved in being able to work more effectively with police.
I just go back to the example of this investigative police officer in Saskatchewan. What he did was have regular meetings with all the senior bank people in his community and let them know what the police were seeing in terms of trends around abuses against older adults. They would provide him with information about trends they were seeing, though not about specific cases. When a specific case did come up, the bank individual who realized, yes, this is a crime and I need to report it, knew who to go to. It just improved the communication.
There are a lot of non-profit organizations that are not directly governmental but which receive their funding as part of a government mandate around providing support or services to seniors. They themselves need to have protocols in place when they recognize that there is a need to report.
Similarly, in this province we are lucky because our provincial government does fund victim service workers in the province. They similarly need protocols and training around recognizing elder abuse and reporting, et cetera.
Restorative justice is a concept that is often looked to within the criminal justice system as an alternative to conflictual, adversarial proceedings. With restorative justice, some guidelines or awareness need to be placed on those that are managing that process to recognize the need for safety and protection for the victim of the "crime,'' just in the same way that vulnerability in spousal abuse cases or child abuse cases would be recognized.
We need to ensure that information is out there and the language is spoken in the community about all of these issues.
Develop more monitoring procedures particularly in relation to residential care settings, and I will leave it to Charmaine to speak about that.
All provinces have some sort of criminal injuries compensation. So a crime has taken place, not necessarily prosecuted and convicted, but the victim is entitled to apply for some compensation.
We need to take into account some of the additional needs that seniors have in order to be safe. These relate to the dependency concerns we have been talking about. So it might be that for the senior to be safe, not only do they need a cell phone that is speed dialed to 911 and an alarm on their door, but they also need some support services to come in and make sure that they are not having to go back to the abuser for basic healthcare.
Programs like Block Watch and other sort of crime prevention programs need to expand their thinking and take into account the needs of older adults. We need vigorous education for older adults about spotting frauds and how to prevent them.
Next Monday, I am giving a talk to 40 seniors that was organized by a local health authority about powers of attorneys and some of the strengths and pitfalls of powers of attorney and signing agreements related to healthcare, consent to healthcare or not, as the case may be. Older adults really need to understand that when they get to the point of being dependent on others to make decisions for them, what is involved in that and under what circumstances they can revoke that consent.
We have developed some small cards for police to carry around with them about signs of abuse. Helping to identify signs of abuse and where to report and what their responsibilities are under some provincial legislation.
Focusing on physicians, healthcare providers, et cetera, around education.
Finally, just to note that a lot of the fraud takes place in relation to misappropriating government pensions and that the Income Security Branch perhaps needs to do a bit more around educating their call centre staff, et cetera, to help them to spot some of the signs of abuse when a caller calls about that kind of problem.
Charmaine Spencer, Member of the Board, Canadian Network for the Prevention of Elder Abuse: Good afternoon. I am Charmaine Spencer. I am a gerontologist with Simon Fraser University, and I have been researching and working with community organizations on various aspects of abuse and neglect in later life since 1992. That includes having written close to a dozen major publications for government and community groups on various aspects of this multidimensional issue from a cross-Canada perspective.
I am also co-chair for the Canadian Network for the Prevention of Elder Abuse. CNPEA began 10 years ago as a volunteer and a national network of local, regional and provincial organizations, government representatives, service providers, academics, seniors and other interested persons whose focus is on effective abuse prevention, education and intervention.
CNPEA is the only national network in Canada whose focus is specifically on abuse and neglect. We have a regionally representative board of 19 anglophone and francophone members from across Canada who jointly bring over 160 years of experience on these issues. We are basically older than confederation.
Today, I am speaking primarily in my professional capacity more than my board capacity, but I do wear those two hats in this discussion. I wish to commend the Senate committee for the wide-ranging effort that they have made with this second interim report to identify the various options in the area of aging in Canada. The committee decided to limit its perspective to individual aging and supporting individual aging, but those broad trends and those cumulative effects across populations are equally important.
My comments today fall into three different categories: points that are raised within the interim report, gaps in the report and future government directions. As you have undoubtedly heard from other witnesses, abuse and neglect of older adults is multifaceted, so it is really hard to sort of pick on one part or another. It does not have simple answers, but there are answers out there and it occurs within community or institutional settings.
The interim report speaks to the importance of supporting volunteer efforts and the CNPEA certainly recognizes that. As a volunteer network, we have the skills, we have the knowledge, but we need the support of an infrastructure to aid us in our national work that crosses 13 jurisdictions and over 9.9 million square kilometres of our country. Right now, we are basically reaching our capacity in terms of what we can do through things such as in-kind contributions.
Secondly, the interim report speaks to abuse and neglect of older adults, largely in the context of care and care facilities. Thank you very much for actually touching upon that seriously under-recognized issue of abuse and neglect in care facilities.
A Way Forward is a national project which my colleagues from six universities and I just finished. We are looking at promising approaches to abuse prevention in care facilities. We found that fewer and fewer vulnerable seniors are actually eligible for licensed care facilities, and more and more are living in alternative environments such as assisted living, personal care homes, and in Quebec, the residence privée for aged persons.
In many parts of this country, there are few, if any, standards for these "lower care'' facilities. That leaves people who live there very vulnerable at least for the potential for neglect.
I know that the committee touches on these different kinds of housing support care options in its report. It is very important that these models are understood and carefully evaluated for the capacity to support aging and that we recognize both their strengths and their limitations.
In The Way Forward project, we also found a real patchwork in protections or oversight in terms of the licensed care facilities across the country. In the past five to ten years, there has been a growing concern being expressed within provincial and federal government departments, particularly provincial governments, industry, care providers associations, unions, and advocacy organizations, about the quality of care and the potential for abuse and neglect within the facilities.
There is a need for national standards in key areas in terms of oversight, abuse protection and reporting. The Criminal Code actually does have a little bit of a whistle blower piece to it, but it really has not been used in this area.
At the same time, I wish to underscore that abuse of seniors in the community is more like other forms of family violence than like caregiving or caregiver stress, which the interim report largely addresses. It can start earlier in life, carry into later life or it may develop in later life. We need a much better understanding of the risk factors and the protective factors in this area.
New Zealand, for example, is one country that has begun that process of actually looking at what are the protective factors. What are the things that we can do to help reduce the likelihood of abuse and neglect. So any future government family violence strategies and initiatives need to build on and reinforce our understanding and awareness of abuse across the lifespan.
These are intergenerational issues. As Penny has eloquently pointed out, among other things, this is a justice issue. In the earlier reports, we have identified that you do not need to have a special part of the Criminal Code to address the issue. At the same time, there are maybe one or two parts of the Criminal Code that could be updated. For example, section 331, which deals with theft by power of attorney, could be more responsive to financial abuse situations and be able to capture it in a better way and there is a broader need to understand this as a justice issue.
In terms of potential gaps within the report, it is extremely important to recognize and understand the interconnections among provincial and federal government policies, and how they affect the overall vulnerability of older adults and particularly the risk for abuse and neglect.
At a research level, we are beginning to understand the special risks for some populations. For example, ethnic minority seniors. Especially those who are sponsored immigrants. These include isolation, family dynamics, role reversal and language opportunities. The current 10-year federal requirement for sponsoring a relative may leave older sponsored immigrants in a highly dependent and vulnerable role. The requirement for sponsored wives was reduced from ten years down to three years for exactly that reason, because of that known vulnerability.
The existing policy ignores the substantial contribution that older immigrants have made to raising Canada's new citizens and their ongoing contributions to families when they come to Canada themselves. The problem at the federal level is compounded by provincial responses to social assistance applications by abused immigrants when the sponsorship has broken down.
The Senate committee has tended to look at aging policy as a separate and distinct issue, and that makes sense within its mandate. But at the same time, there are some limitations to the approach. Our employment insurance policies, affordable and adequate housing policies, mental health and substance abuse policies all affect younger and middle-aged adults, and these policies often determine whether they will be dependent on their aging parents when they have a need.
It is that dependence of adult children on their parents that is well recognized as a risk factor for abuse, including financial abuse, and that is one of the things that Penny was speaking to as well.
We find that the lack of affordable housing leaves low-income seniors vulnerable to inadequate housing, as well as things such as intimidation and other harm from both public and private housing providers. The threat of being evicted for speaking up about legitimate concerns about housing is far more comonplace than we have given credence to.
In terms of future government directions. In the past year, the federal government has identified abuse and neglect of older adults as an important issue and earmarked funds to address that. About $13 million over a three-year period, and that is an incredibly wonderful and important first effort. However, it is also extremely important that those funds be used to further our knowledge and improve practice in the area, and to support the work that is developing at a network level, whether that be a local, a regional or a national level.
At present, federal government efforts appear to be functioning in isolation from provincial efforts and even more importantly, without awareness of what has existed, what exists and what has gone on before at a community and professional level. That is an environment where it is really easy to duplicate effort, waste money and even more, frustrate key stakeholders within the community.
I would like to offer just a couple of illustrations of where this might crop up. In 2007, New Horizons called for abuse prevention proposals, but apparently was unaware that Quebec also had a project funding strategy for abuse prevention well underway at the same time. That created serious potential for duplication of funding for some projects: it also meant that well-deserving initiatives also went unsupported.
In the past month, the federal government issued a request for proposals looking to develop a generic training guide on abuse issues that could be used by national groups to train their membership. Basically, they are talking with people in terms of the police, social workers, legal and financial bodies as the target audiences.
It is important to know that generic guides actually have been created in the past at a provincial level and at a community level. A lot of it has actually been done with federal dollars and that they are being used at a provincial level in many jurisdictions. But the RFP failed to appreciate, is how the particular audiences that they are looking at, the police, the financial industry, the legal bodies, social workers, actually receive and deliver their training. At a regional and a national level, we know how that unfolds because we have been involved with it in the past. The other thing that happened with that is that it failed to appreciate the important jurisdictional differences in resources and laws. So although it is very wonderful to be talking about generic approaches and things along that line, there are a lot of important differences across the jurisdictions.
Fortunately, these types of oversights can be remedied fairly easily, for example, by having a national representative such as CNPEA on the elder abuse task force. We and the provincial networks and the other organizations that constitute our membership are well connected to the issues. We know the primary actors. We know what has gone on before. We know what is happening or not happening in the various jurisdictions.
So basically, in this area, good aging policy is always based on good information and we can help aid that process. Thank you.
The Chair: Thank you very much. Judging by your last couple of paragraphs, you think that they are trying to reinvent the wheel when the wheel is already moving down the road.
Ms. Spencer: That might be a fair comment, but that is my personal perspective.
The Chair: Thank you very much.
Senator Cordy: These presentations were excellent, by the way.
You spoke about sexual abuse of seniors and we do not hear a whole lot about that. You hear occasionally about a house invasion and a senior woman particularly living by herself may have been sexually abused. But it is not an issue that we are hearing a whole lot about.
Now, sexual abuse of — I will say women particularly, although I know it can happen to men as well — of younger women was kept in the closet, behind the curtain, whatever you want to say, for many, many years because women felt that it was their fault somehow. It was their fault that they were being sexually abused. Is that why we are not hearing about sexual abuse of seniors at this point?
Ms. Bain: In British Columbia, a group of researchers looked at this particular issue a couple of years ago. Our legal information counsellor who answers that information line I was mentioning also finds similar dynamics.
We are partially talking about a generational issue around culture and expectations so that many women of an older generation learned that behaviour of keeping these dirty little secrets within the family or the community. Their primary concern was not to shame the family or not to shame their particular community and that often led to under- reporting and reluctance to access any outside assistance or help.
So those same dynamics that you spoke about with younger women are manifest many-fold, based on the stories and experience of women who have experienced sexual abuse, not just in their relationships but also in settings in which they are dependent on, if it is a woman, a male caregiver for meeting their needs.
So some scenarios that I have heard about. For example, there is something that I refer to and I think other healthcare providers refer to as a serial predator caregiver. So it will be perhaps a younger man who makes a point of joining seniors groups. Going to the bowling league. Going to the church group, et cetera. Doing this for the sole purpose of befriending an older lonely senior. Part of the motivation is to take financial advantage, but sometimes also sexual advantage of that senior.
It is not just partners in intimate relationships that are perpetrating sexual violence against older women. It's also what I call these serial predators. Amongst caregivers, you will hear stories that, well, a fellow cleaned out this particular woman and took advantage of this particular women. Then he moved on down the street to that one, and the next and the next. What does that say about our safety and protection services, that we are not able somehow to bring an end to that kind of serial behaviour?
I have thrown a lot into that answer, but there are education materials. There is a particularly strong video that was developed by the B.C. and Yukon Society of Transition Houses that highlights several examples of what we mean by sexual abuse of older adults, and it is a much more common scenario than the average member of the public would like to think.
Our information counsellor is male, but he is a particularly gentle soul and quite good at developing a trusting relationship with a particular client. It has to be over time because usually the client will first contact him about something that is not sexual abuse, but related. His experience is that eventually he learns that sexual abuse is another one of the underlying issues.
Ms. Spencer: Just to add a few other points, we see the sexual abuse issues come up in several different contexts. Within care facilities, certainly it has been identified there. As a matter of fact, some of the more notorious cases were actually heard from care facilities in Calgary and Edmonton. What you are talking about there is usually a predator, a staff person who preys on mentally incapable adults within the facility.
Within a facility, another type of situation that occurs — and Penny actually touched on this — is where a woman — usually a woman — has dementia, and her husband is seeking intimacy with her whether or not she wants it and whether or not she is able to recognize him as her husband. Staff often struggle with how to respond to these types of situations.
At a community level. Eight to ten years ago, Kingston Sexual Assault Centre actually did us up a really nice publication talking about sexual assault in older women that was geared both to their workers and to the older women and talking about the generational issues, the whole fear of being able to disclose and whether or not a person should have to disclose the harms that they have experienced both currently or in the past.
We also see this arising in terms of posttraumatic stress disorder. Psychologists are seeing it. Again, they are not necessarily using the words "abuse,'' "neglect,'' and "sexual abuse.'' They are talking about it in terms of older women's relationships usually with their spouse or their partner. So it is an issue that is surfacing.
Quebec Network for the Prevention of Elder Abuse, for example, RQCAA, actually chose sexual abuse as one of their key themes for this year. So at a network level, it is being recognized as one of the issues that needs to be addressed in the area.
Senator Cordy: Is there a lot of research on it? Quebec is taking it as being an issue, but is there a lot of research on sexual abuse?
Ms. Spencer: No, there is not. As a matter of fact, one of the things I did for Quebec was put together a little fact sheet that says this is what we currently know and there are a lot of gaps, but helping to sort of raise awareness of the issues. I mean, there are so many gaps in this area. I know. The whole area is pockmarked, so this is yet another one.
Senator Cordy: I want to move on now to the National Crime Prevention Centre. I just want to clarify this. They are no longer funding initiatives related to prevention of crime against seniors; is that correct?
Ms. Bain: The National Crime Prevention Centre went through a priority-setting process within the last 18 months, two years. I got caught because I was developing an application to the centre with the assistance of the regional staff. We got the whole application pulled together according to the priorities that had been in place. They funded crime prevention initiatives in a broad range of areas. But the letter I got in response when the application finally went in was: we no longer fund elder abuse crime prevention; our focus is on youth.
I was speaking to someone today in our provincial victim services, and she was saying that this year, the priority is substance abuse and we were speculating, well, what will the priority be next year? But the problem is of course that other initiatives, for example, the family violence initiative, which crosses 12 ministries within the federal government, has in the past said we are no longer going to be doing crime prevention, for example, in the area of elder abuse that relates to family violence, because the National Crime Prevention Centre is there to work on prevention of these kinds of crimes. Well, if they then drop that as one of their priorities, it means no one is working in the area.
At the moment, the message that has gotten to me as one of those seeking to know what is going on in the field is that the National Crime Prevention Centre is setting its priorities on an annual basis and at the moment, it does not include elder abuse.
Senator Cordy: So there is no long term planning, I guess.
Ms. Bain: I do not know what they are planning.
Senator Cordy: Out of this $13 million over three years that the government is touting, is there any money in that for programs related to prevention of crimes against seniors?
Ms. Spencer: The short answer is we do not know exactly how those funds are allocated or will be allocated. But basically, they will probably be spread among the various ministries and adapted to the priorities within the various federal ministries.
I have not seen and certainly have not heard of an overall plan for that money. It may very well exist, but certainly at a network level or a community level, it feels as if that information may be sitting in the various silos. So there has not been that kind of dialogue about the goals.
Senator Cordy: I was in my office last week and I picked up two wonderful looking brochures dealing with the federal program coming out for abuse against seniors. Was there any dialogue, to the best of your knowledge, with community groups or provincial governments in terms of what needs had to be met in terms of dealing with abuse of seniors?
Ms. Spencer: The short answer is no. To be fair, in a sense, we have been having these discussions with government over an extended period of time. However, within governments, people change, the individuals who are in positions of responsibility change. Plus, I think there is an overall challenge that even if we do talk, we may talk about education and have one understanding of what that means and the government may have a different kind of understanding about what that means.
It can be really easy to come up with "we need generic stuff,'' when actually maybe we need more sophisticated types of information that is geared to specialized practitioners, for example. That might be one of the things that may be important in this area that would again help to move our knowledge forward. To help move our practice forward.
Ms. Bain: Maybe just to expand on the question you have been putting to both Charmaine and me. We believe that there is a great deal of specialized expertise within this fairly small collection of researchers, academics and community organizations in the country. This issue is relatively new on the radar in the sense that it does not have the same level of support and services as, say, spousal assault or child abuse. That group is relatively small, but there is a great deal of expertise particularly residing in Charmaine's organization in terms of the individuals who are members of that network. We believe that the federal government, in developing some of these initiatives, could look to us for some insights that might help them to target funding policies, policy development, et cetera, more effectively.
So we are here and we are willing to share our expertise.
Ms. Spencer: At the same time, I think it is really important to say there have been some really important developments within government that are actually developing independently of that funding allocation. Human Resources and Social Development Canada, for example, put out RFPs for five background papers to work on their own midterm research policy plans and so those background papers are focusing on prevalence and incidence. Risk factors is one of them. One of them is focusing on theory in the area. Another is working on how well the family and violence perspective fits in around abuse and neglect issues for older adults. A fourth one is on best practices and a fifth one is dealing with the incidence and risk factors for abuse and neglect in institutional settings.
Those are actually background papers that government will be drawing upon. So one particular ministry seems to be able to draw upon to build its internal knowledge to develop its own midterm planning. I think that is to be applauded.
Another really wonderful initiative has been at the federal-provincial-territorial level, with the working group on senior safety and security, and the efforts. So that is with the ministries working together.
Now, the thing is for that FPT working group, it does not have representation from all the provinces. The representation is also on other important issues that affect other age groups as well as older adults. That working group for an extended period of time, has been really helping to move the issues forward, to build the understanding. Sometimes, though, there does not seem to be quite as coordinated an approach or as much open discussion between the various interested and affected parties as there could be and it is really one of the things we could be working on now to improve for the future.
Senator Cordy: Ms. Bain, you talked a lot about training individuals within the community. In addition to training seniors, we also have to help people within the community, you mentioned banks and concerns about privacy and how we get around that. You also talked about training for Income Security Branch that was dealing with CPP and OAS, so that they would keep their eyes and ears open for signs of financial abuse. How could you see that working?
Ms. Bain: When seniors call their telephone information service, one of the responses of the individuals who are staffing that service could be to ask a few more questions. If something raises an alert for them, to ask more questions and to try to connect that senior with their own internal processes, for example, for redirecting the mail to get the cheque out of the hands of the person who is misappropriating it. Strategies such as that are internal but there is also the possibility of increasing their responsiveness in relation to knowing the remedy — knowing how to get that senior who is being abused connected with the resources in their particular community. Because often, the supports that need to be in place go beyond just making sure the cheque actually gets to the senior it belongs to.
The whole purpose of training for service providers in the community, whether in a private financial institution or within a government agency, et cetera, is to make sure that they are aware of the signs and indicators, of what their responsibilities are within their own organization, of policies and protocols and about reporting to other organizations.
All institutions face barriers in terms of having communications flow effectively. Targeted training is often one of the long jam breakers that breaks that problem with communication. So it is really having a will to put these kinds of programs in place and there is certainly the expertise available to assist in presenting that kind of training.
Ms. Spencer: I think Ontario has an agreement in place with Service Canada to do some of that training with the Service Canada representatives. So we have some of these kinds of innovations being tried and being developed. We do not get to hear about them outside. It is only when we get to talk with each other across the country, we get a chance to really learn about and see what is being tried. What works well. What seems to fall flat on its face and why that might be the case. It really helps. Again, being able to facilitate that networking across the country is extremely important in this area. We have wonderful pockets of information across the country.
It is not helpful, however, to put all the information on a web site or scan everything into PDFs and stuff and assume that people will know where things are, how things work out and things along that line. It is a more complex process than that.
Senator Cordy: Unfortunately, we have heard where people are phoning Service Canada about their old age security. They are not receiving CPP to which they are entitled and the person on the other end of the phone has been told not to tell them that they are entitled to their CPP benefits, which is insanity in my humble opinion.
The Chair: What you are saying is that it is good to share best practices, but there has to be a dialogue about those best practices.
Ms. Spencer: Absolutely, yes.
Senator Mercer: Are not some of these things, things that should be discussed or should have been discussed by the Law Reform Commission?
Ms. Spencer: Well, let me see.
Ms. Bain: Sorry, Senator Mercer, could you clarify; are you referring to the B.C. Law Reform Commission?
Ms. Spencer: The former federal.
Ms. Bain: I know you have received a submission from Laura Watts who is the director of the Centre for Elder Law Studies in Canada, but she is also with the B.C. Law Reform Commission. So that is why I wanted to clarify. But yes, the Canadian Law Reform Commission could assist with some of these gaps.
As I think we were both trying to suggest, there is a lot below the surface of law reform when it comes to actually implementing, not even just at a policy or regulation level, but rather at how agencies and individuals with these mandates could help a senior become less vulnerable or access remedies within systems. Those protocols as to how people work together are a key part that underlies what the Law Reform Commission might be able to do.
Senator Mercer: I agree, and the Law Reform Commission is not necessarily the answer, but the Law Reform Commission was always on the leading edge making sure that we as legislators were catching up with what was happening in reality in the field.
Now, this $13 million that we have talked about, and we do not know what the priorities or the goals are to that. I suspect it has been announced several times though.
Ms. Spencer: It has not. The press releases spoke about it in the context of a national campaign. Thatt is one of the kinds of things that was suggested as a possibility.
One of the things that we brought to the government's attention was that provincial campaigns have existed in several jurisdictions. We are really happy to share that and there will be opportunities to build on that rather than trying to develop something that is new. Thinking about who you see as the target audience, what you see as the key messages, how you make sure you have got the community resources in place, when you have an awareness-building campaign.
It is not that we do not see it as important. We think it is extremely important, but it is only one part of a much bigger puzzle.
Senator Mercer: $13 million could do a lot of things if somebody only had some idea of what they wanted to do with it.
Ms. Spencer: I must applaud the government for moving on this. Around 1995, we had again some really wonderful opportunities that we were able to build on was through the family violence initiative. Abuse and neglect of older adults was one tiny, tiny piece of that whole part, but, boy, it sure helped to get people thinking. Building awareness and things along that line. So I am not going to put down anything that helps to build awareness. I am just asking for some thinking, first of all.
Senator Mercer: Right. The discussion about power of attorney that many people have. In my family, I have an 80 year-old mother. My sister has power of attorney and I know she is doing a good job. I am not a lawyer so it may become obvious as I talk about this. Does it make sense for older adults when giving power of attorneys to children to perhaps try to give it to two children as opposed to one and give some sort of check?
Ms. Bain: You raise an excellent issue because many adults, when they give a power of attorney to their adult child, are making a decision about how trustworthy, how dependable, how whatever, their children are. If there are a number of siblings to choose from, that can cause issues in the family. Or, it could be that the senior has made that decision and said, okay, this is the person that I trust the most or the two people. Then something happens not only to the senior but potentially as well to the person who has been granted the power of attorney. In other words, the person becomes less trustworthy because, say, their company is going bankrupt. They are under pressure. They feel entitled because they have this power of attorney and therefore the opportunity to access the funds of the senior and think, "Well, Mom would not mind because she would want my business to succeed,'' or, "My addiction is more important than anything and I cannot see the rest of the family's needs,'' et cetera.
Aside from that, a lot of seniors do not realize that when they go to their lawyer and have a power of attorney drawn, often it is drawn specifically to become effective only under certain circumstances. Sometimes those circumstances are, "I am going to Europe for six months. I want somebody to take care of my affairs. I am perfectly competent and capable, but I just happen to not be here.'' In many cases, however, powers of attorney are executed and it says clearly within the document that the intention is that they only become effective when the person who has granted the power of attorney becomes incapable of making decisions for themselves.
In the past there have been incidences in which the person to whom the power of attorney power has been granted has been able to exercise it, in other words, use it to access bank accounts, sell property, whatever, before that event has actually occurred. Of course, a lot of that is to do with communication, knowledge, opportunity, access and whether the older adult has kept total control of all of the documents that would be needed in order for that type of thing to happen.
There are many protections that could potentially be put in place, but many seniors do not understand that they can revoke the power of attorney at any time while they are still legally competent. It is only once they become not legally capable of making decisions about their financial affairs that they can no longer revoke or change that power of attorney.
There needs to be some education for people to whom the power of attorney is granted. They need to be told that these are your duties and responsibilities and they only take effect in these circumstances. Often that works fine in families and everything goes well. If someone is trying to take advantage of that situation, lawyers will often suggest that, as you say, there are two individuals who have to make decisions jointly. Alternatively, in this province, we have representation agreements which deal primarily with healthcare decision making and making an advanced directive about who would be the person to make decisions for you if you became physically unable to make decisions about your healthcare, but also some financial transactions. There is a proposed amendment to the provincial legislation to modify that, to make the power of attorney document the primary document for financial affairs and the Representation primarily for healthcare.
In any event, the Representation Agreement Act provides for monitors to officially be appointed to monitor the conduct of the person to whom the agreement has been given. So the representative knows that they are accountable to George the brother-in-law, or whoever who has been appointed the monitor to make sure that they are acting in the interests of the senior. A lot of it is about education.
I am not sure if Laura Watts gave you a presentation about what sort of law reform changes are happening. Across the country, provinces are making powers of attorney acts more uniform so that you can go from province to province and have the same laws apply.
Ms. Spencer: There have been some very good efforts at a public legal education level across provinces, but again, it is patchwork. It varies from province to province in terms of building people's level of awareness in down-to-earth language around things such as power of attorney. What people's responsibilities are. What the effects are. Wills. Other different types of important legal documents that can affect older adults.
It would be nice if we were able to have someone available across the jurisdictions. The other challenge is the capacity to distribute it to the people who are most in need of the information. That reflects the diversity of seniors throughout the country.
Ms. Bain: Those who are the most vulnerable to having their powers of attorney abused are often those who are in institutions and institutional care. So there needs to be ways in which observers, like people within the institution, can see there is some evidence that the person with the power of attorney is going off to Hawaii with no immediate benefit to the individual in the institution, et cetera. In other words, awareness and alerting systems to try to stop this kind of abuse of powers of attorney.
The Chair: What also is very apparent though is that, even within provincial jurisdictions, let alone between provinces, there are inadequacies.
Ms. Bain: Yes.
The Chair: For example, I could have an advanced directive in Ontario but if I collapse in the reception room of a personal care home, even it I may be a resident of that home, and the person immediately dials 911 and the ambulance service comes, they must, by law, resuscitate me even though sitting in that desk is a document saying: I will not be resuscitated.
I think what you are addressing here is that we have an awful lot of examples of where one hand is not speaking to the other hand, let alone trying to get my advanced directive from Ontario respected in British Columbia.
Ms. Bain: If you were to, heaven forbid, collapse here in British Columbia, your healthcare providers would be entitled under the Healthcare Consent Act of British Columbia in certain circumstances to provide medical care or not provide medical care, just depending on what their best advice is. Even though the people that accompany you to the hospital might be able to say, "We know that she has a representative who should be consulted in making these decisions.'' There are provisions in the Health Care Consent Act for emergency healthcare.
Ms. Spencer: As you can see, these again are some of the multiple dimensions of the issues in this area. It is really hard to think of it as a very discrete issue. It has so many different aspects to it.
Senator Mercer: Do you have any statistics on elder abuse and particularly on financial abuse? Do you have any concept as to how big this problem is?
Ms. Spencer: How big a problem? The work that I did back in 1995 here in British Columbia was focusing very specifically on financial abuse and whenever you hear one in 12 seniors is having experienced financial abuse, that came from the study that I. That was done with personal interviews with seniors from across the province.
It was not a gigantic study. This only involved 200 seniors, so you have to be careful whenever you hear some of the figures. On the positive side, it was done as personal interviews so we got talking in terms of financial decision making across the lifespan and looking at the different kinds of ways of relationships that people have. One of the things that was really important within that work was it basically threw out the whole myth of the only financially abused person is a 75 year-old woman who is a widow, who never wrote a cheque in her life. That happens. Yes, absolutely. It's not the only kind.
It is also the sailing captain whose wife took care of all the finances for all the 50 years that he was sailing. It is also the older man who immigrated from the Philippines, in whose culture women take care of the finances and guys do not, things along that line.
Our measurements in terms of financial abuse, our knowledge in terms of financial abuse is still marginal, I would say. There actually is a forum being held in Ottawa specifically around financial abuse, bringing together different key stakeholders to be talking about the different facets of the issues and the possible solutions. That is on June 19-20.
One of the things I was talking about earlier was that background paper on prevalence and incidence. My colleague Gloria Gutman and I happen to be the ones who are writing that one and one of the things that we were looking at is how is financial abuse measured across in different jurisdictions and things along that line. Statistics Canada, back in 1999, did a social survey that had some questions around different kinds of abuse and neglect, and financial abuse was one of them. I only remember a tiny percentage of cases of people saying that they had experienced financial abuse. When I looked at the questions, they were asking about things, well, has anybody forced you to change your will. The thing is you have to know what percentage of the population actually has a will in the first place. What percentage of the senior population has wills? It is not somebody who has low income. It is not somebody that has limited education. It is people who have higher education. So higher, more income, more property.
If you are going be looking at that, that might capture one part of the problem but it is not going to capture all the financial abuse that occurs in the context, for example, of somebody whose OAS that is being siphoned off. So trying to capture sort of the multiple facets even within that one particular type of abuse can be challenging.
We offer some recommendations about how that might actually build that knowledge for the future.
I do not have it here but next week, one of the students at our centre is defending her thesis and it is looking at financial abuse and it is actually based on the VCC's files. She reviewed the files over an extended period of time looking at sort of the incidence of financial abuse and the different kinds of dynamics and perhaps the factors that were associated with that. So I will be actually reading through her thesis on the weekend. I am the external examiner for that thesis. So we have little bits and pieces of information.
The Brunel Institute of Bioengineering of the United Kingdom has a financial abuse project. So there is an interest at an international level about some of these issues.
In the future, part of that information will be developing. But one of the things that we are recommending is to build within Canada our level of understanding about financial abuse and the particular risk factors for it.
Senator Mercer: In the study of rural poverty with which I have been involved, we heard a term used by a woman who lived in a very small community in the Northwest Territories. She referred to it as "mobbing.'' She described it as what happened when she was living in an abusive situation and when she reported the abusive situation, the community was so small that the abuser was related to or had some relationship with everybody else in the community so that suddenly, she was not only isolated from the abuser; she is isolated from the entire community.
Ms. Spencer: That is right.
Senator Mercer: In small communities such as northern communities and the small communities in different parts of British Columbia, is this also the case with seniors who report any one of the different forms of elder abuse?
Ms. Spencer: It certainly is the case in rural communities and it is one of the things that really holds people back.
We have written in the past about sort of the seven special dynamics for abuse within rural communities and, interestingly, what some abusers do is they actually move the person from a large community, like Vancouver, up to a very small community, basically to isolate them.
If you are living in a rural community, there are all sorts of different kinds of things. The fact that you do not have a bank in your community can be a big, big issue. To use an ATM, who are you dealing with here? You are dealing with the local gas station/grocery store combination. So it is your niece, your nephew, who is getting your groceries for you with your old age security cheque and you are not getting any groceries, but you are not getting anything else that is coming back from it.
Again, it is about understanding some of the issues within the context of the social environment, the geographic environment.
Ms. Bain: Maybe I could just add that recently, this issue has come up in the context — you are probably aware of the residential school settlements that are going to older residents. It's about the preliminary distribution of settlements. So essentially, many older First Nations people in small communities, exactly the scenario you described, are suddenly receiving large cheques. We are hearing stories from them and from their families, et cetera, that there are both cultural issues about the sharing of the wealth, so to speak, but also predatory behaviour. On the cultural side, there is some lack of clarity around respecting the older adults' right to make gifts as opposed to having those gifts taken without consulting the older adult.
As for predatory behaviour within the service providers in the community, that could be, for example, Money Marts opening up in communities where there are a lot of settlements coming, just so that they can take advantage of making the loans and earning the high rates of interest, and car dealers setting up special deals, et cetera, et cetera.
I mentioned earlier the PhoneBusters and the statistics that indicate the high number of the victims that are targeted in general are seniors. The same dynamic occurs in small communities when there is potential for financial abuse.
The Chair: I have just one question actually and it is built on a combination of what you said but also what was said by previous panels this morning, and that is around the idea of the sponsorship immigration area. You said that the spouse had been reduced to three, but we were told it had been reduced to five.
Ms. Spencer: I believe it was three. I may be mistaken, but I am pretty sure. The reason I say that is two of my colleagues and I actually wrote a chapter on ethnic minority seniors. We were talking about this specifically.
The Chair: It would make sense if it were reduced to three because three is the time at which you can become a Canadian citizen in your own right. I assume that you are recommending what they were certainly recommending this morning that it should be significantly reduced.
Ms. Spencer: Yes. One of the things from work that has been done in terms of sponsored abuse and wife abuse and sponsorship, is that it really created an incredibly dependent and vulnerable role for women. We know that from other research that it does create this. We have a fundamental change in terms of roles within families, within extended families, that really sets the stage for abuse and neglect.
In terms of practical situations, imagine any one of us here being able to project for the next ten years our ability to take care of somebody else. I know that I certainly could not do it. Even with the best of intentions, somebody that I really want to be able to care for. A sponsorship can break down for reasons beyond people's control.
The other thing is it is not just that ten-year rule. The other part is the intersection between the provincial policy and the federal policy and that has to go to the social assistance part. In British Columbia, the social assistance that is provided to a sponsored immigrant becomes a debt owed by the sponsor, and that debt extends even after the person, the sponsor dies. It is a ludicrous situation. It treats both the sponsors and the people who are sponsored as if they are nefarious individuals who are out to rip off the government. That is the underlying message.
The Chair: Quite frankly, I am not sure that it is constitutional because if you are eligible for Canadian citizenship at the end of three years, how can you still be considered a dependent? But I suspect that although you are eligible, many of these people cannot qualify because they would not be able to speak one of Canada's official languages. And that in itself makes them more dependent, so you have really got a bubbling situation.
I want to thank you both very much. This has been extremely informative and very useful to our preparations.
Senators, we are now going to receive our final panel today, although following this panel, we have four walk-ons and we will also be getting a tour of this particular facility. So your day will not end with this particular panel.
Appearing before us are Joe Gallagher, Senior Director, First Nations Health Council, and Lisa Mercure, Member of the Elders Council, the British Columbia Association of Aboriginal Friendship Centres.
We had the great privilege yesterday visiting Sagkeeng First Nations in Manitoba and visiting their long-term care facility, and although I have been there before, I think it was a bit of an eye-opener to the other senators. We also had the great fortune of hearing from the Manitoba Association of Aboriginal Friendship Centres. Just so that you know that some of the issues we have heard, but we want to hear from you in great detail because we want to make Aboriginal seniors a very important part of our committee presentation in September.
Mr. Gallagher, let us begin with you.
Joe Gallagher, Senior Director, First Nations Health Council: Briefly, the First Nations Health Council here in British Columbia represents the 203 First Nations in this province in the implementation of the tripartite health plan which has recently been signed between the First Nations leadership in B.C., the provincial government and the federal government. Premier Gordon Campbell signed off as well as the Federal Minister of Health, Tony Clement, and within that plan are a lot of the issues that I think are identified in the report. In our comments to you today, we will touch on some of those things.
One of the most important aspects of that health plan is to close the health gaps amongst First Nations people with other Canadians. A big part of that are issues relating to the social determinants of health and the current status of those determinants in relation to First Nations peoples in this country, particularly here in B.C.
I will go into some comments that we have around the report itself and try and give you some of our thoughts on it.
The report acknowledges a correlation between positive social relationships and mental and physical health; the lack of social relationships has also been identified as a risk factor for the development of health problems. For First Nations this is very true as racism, whether direct or indirect, enhances social isolation and chances of individuals accessing health and social service programs. It also leads to accessing other determinants of health such as education, housing and employment.
We talk about the situation that a lot of our people face, even in accessing basic health services. Depending on the situation where they live and the environment in which health services are being provided, a lot of our people are not accessing them at all. In particular with our elders, the challenges they face in engaging a system that is not responsive to who they are as cultural people is something that does not result in quality service being delivered or even being accessed.
The report also mentions age friendly rural and remote community guide. For First Nations communities, our on- reserve community development is funded by INAC, Indian and Northern Affairs Canada, and does not fit into the general population infrastructure through municipal bodies.
Sewage and water on reserve is commonly inadequate as is the housing so basic infrastructure is of most importance to First Nations leaders and planners. Special facilities, recreation areas and other planning for elders is not high on the priority list when resources are stretched, especially since First Nations populations are higher on the youth side than elders.
Programs and services for youth are in high demand due to high rates of mental health and addiction issues, which are leading to high rates of suicide and other things. So we end up in a situation where, in the whole range of priorities, sometimes our elders get forgotten because the priority is around housing for families. When you look at how we work together and the importance of the family structure, we have a great need of taking care of families in general. The elders' needs on top of that are usually a burden that is put upon communities and one that they cannot usually address very effectively. Yet it is one that is increasingly growing in importance as we lose more of our elders on a daily basis.
On page 12, the report mentions that people are more likely to take advantage of learning opportunities in their senior years if they have continued to participate in learning throughout their lives. So, again, for our people, it is not necessarily true. Experiences that result from residential school, high drop-out rates and inability to access education due to poverty and lack of resources provided by INAC for post-secondary education leave, a lot of our people not participating in education — a lifelong learning kind of process.
More work has to be done to ensure that our people are able to participate in lifelong learning in acontext that will meet their needs. Programming and design of programming, not only delivery of programming, needs to be something that is done through partnership with our First Nations, to ensure programs are delivered in a way where our community members can participate successfully and enhance their opportunities to participate further as life goes on.
Page 13, recommendation 9, talks about adapting New Horizons for seniors or Aboriginals. New Horizons provides grants up to $25,000 for community projects that promote ongoing involvement of seniors in communities to avoid the risk of social isolation. It is a good idea, but many of our communities were starting so far behind that it may not be of significant value to them. We are still in need of facilities, transportation and workers to make these kinds of things happen. So it may be more appropriate that these kinds of resources are used to enhance our elders' participation in other programs that exist in communities that require and would benefit from participation of our elders as part of that program.
A lot of it involves programming related to our young people, where a lot of our communities are wanting to bring forward that traditional perspective to those programs, and lot of times we are not able to find the resourcing to support those kinds of costs.
Recommendation 11 talks about: educate Canadians about the benefit of physical activity. It is a useful recommendation and through our tripartite health plan, we have an action item that talks about the First Nations Act Now initiative, which in the Province of British Columbia, we have the ActNow which is the provincial government's initiative to help British Columbia become the most healthiest, fit jurisdiction within the country by 2010. Within our tripartite health plan, we are now engaging in physical activity initiatives as well as other initiatives related to better nutrition that will hopefully promote similar types of benefits for First Nations people. In our initiative, we are looking at addressing, physical activity and nutrition throughout the whole life spectrum of our communities. So we are hoping to engage our seniors and elders in those activities.
Recommendation 12: eliminate barriers which limit active living. So we need to consider additional barriers as First Nations, with differences on and off reserve taken into consideration. Accessibility for community members is exacerbated when communities are remote and there are no facilities. Transportation is always a huge issue, as is poverty and so on which limit access for not only our elders, but for families and youth to engage in recreation and sport.
With that, we do have a strong notion of preventative promotional activities because as our communities age, we want to try to limit the number of people with severe chronic conditions by trying to encourage a healthier lifestyle choices at an earlier age. Our elders are a big part of that dialogue that has to happen.
Recommendation 13: facilitate the sharing of knowledge and best practices. So, again, a recommendation that we think is very good. Our ActNow initiative is a good example of trying to work toward a knowledge transfer, especially in the area of traditional recreational activities and the kinds of things that communities can do and share amongst themselves to support a more active and healthy lifestyle.
The report discusses housing for seniors and how owning their own homes can help with retirement. This does not really make sense in a lot of our communities. In an on-reserve situation, our elders do not own their own homes or if they do own their own homes, they are not in a situation where the home becomes a bankable asset. If they have any kind of title to land, it is through a certificate of possession which has very little monetary value for the elders unless they are able to transfer it to another band member, which is usually the only way you can transfer those kinds of assets. So it is something that does not really make sense for our people.
Page 27 states: When the determinants of health are positive throughout life, seniors spend more years as young-old and middle-old, and fewer years in the frail-old stages of life. Again, not true for First Nations due to the effects of residential school and poverty. First Nations have a lower life expectancy and determinants of health such as education, employment, housing, health are lower than in the general population.
We struggle with those very fundamental pieces of looking at how we are able to improve the health outcomes of our people, so that our elders do have a better quality of life at an older age.
Page 28 mentions a need for proper footwear for physical activity. Again, a challenge for First Nations elders because of poverty, because of the social determinants that they experience.
Recommendation 34: establish a national comprehensive publicly insured or privately insured prescription plan. For status First Nations, this is somewhat available through the non-insured health benefits program provided by Health Canada, but this program in itself is inadequate due to the cost containment and direction on policy derived at a national level without regional disparities recognized. It creates a situation where the non-insured program does not cover all necessary prescriptions and there are concerns regarding the use of generic drugs.
Recommendation number 35: introduce public information campaigns about nutrition targeted at seniors and the general population. We are looking to do this in our tripartite health plan. In particular, we focused on our First Nations ActNow initiative as well as the Aboriginal Diabetes initiative which is through the federal government. We are working in partnership with the federal government as part of the tripartite plan to try and address this issue.
Recommendation number 36: ensure that the dental care programs for First Nations veterans and inmates in federal facilities cover the cost of dentures. A good recommendation, but this does miss the point that because of poor dental care throughout life, many First Nations require dentures most of their life, and poor dental care is a good indicator of heart disease. Adding onto this recommendation that expanding the non-insured health benefit dental policies to ensure that proper care is provided through the life spectrum and should include orthodontics would be important.
We face many different challenges with this non-insured program in terms of dental care for First Nations people all across the lifespan. This program, as in the case of the prescription program, is driven at the national level by a need for cost containment. Policy direction has created a program that looks good on paper but in reality does not work to serve the needs of our people. So by the time our community members become elders, their dental history has long been a problem for them.
Section 4.3 refers to health, human resources, gerontological and geriatric specialization. Cultural competency is essential for health service providers working with First Nations. The competency should include understanding and working with those who attended residential school, language and cultural traditions and the importance of family in the life of the elder. And really looking at how these things are put together and recognizing that in British Columbia, for example, we have 203 First Nations and all of those communities are not the same.
We have to be able to respect the diversity of those communities and then when we have service providers that are working with elders from any particular community, they need to understand that environment and what that means otherwise it becomes, again, a service or an interaction that is not beneficial to the elder.
Recommendation number 45: apply the gold standard and palliative home care to veterans, First Nations, Inuit and federal inmates. The point needs to be made that First Nations need to lead this at the community level. Not deliver it at a national, regional governmental department. A lot of our elders do not want to leave home because of some of those other things that we talked about in terms of their interaction with the public health system. They are more comfortable at home and a lot of our communities want to be able to find ways to take care of our elders at home. That is more in line with the culture of our people and something that we have to find a way to address.
Page 33 starts the dialogue on mental health, mental illness and dementia. It is noted that others have lived with mental illness much of their lives. It should be noted to this committee that First Nations have mental wellness issues for most of their lives including depression, suicide attempts, addictions, posttraumatic stress disorder due to factors such as residential schools. They may have suffered physical, emotional and sexual abuse throughout their lives, and so it is of extreme importance that these kinds of issues are looked at and taken into account as to what they really do mean for First Nations people and communities. The impact of residential school is something that we can never underestimate because it is having a generational effect in our communities. The elders that are still with it today that have experienced that and the issues that have resulted from that that relate to their interaction with their families is something that we need to be very cognizant of.
Recommendation number 46: develop tools to facilitate the early diagnosis of mental health conditions. Again, it should be noted that tools need to be developed at the community level so that they include cultural practices, taking into account residential school experiences and the stigma that communities may have around certain mental illnesses. We think there has to be a better way of doing it and that there cannot be tools that are developed in isolation from First Nations communities and their input, depending on where those tools are being applied.
Recommendation number 47: remove the 3 per cent cap on non-insured health benefit services. This recommendation should include that policies derived from non-insured health benefits should be designed and implemented by First Nations. The non-insured health benefits program again with cost containment and direction and policy derived at a national level, is not all that it could be. Because the needs of First Nations in the area of health services have a greater tendency to be determined by federal programming on what is in the best interests of First Nations people.
I will use dental as an example. When I am hearing stories around dental services being denied because decisions are being made that the individual is incapable of taking care of their teeth anyway, so it is not a good expenditure of money to provide the service, those kinds of things are just not good practices. So the non-insured health benefit program is not only about the cap. In B.C., we already acknowledge that the program is underfunded in relation to the rest of the country. It is about how the services are being delivered, how the benefits are being provided and the fact that people get turned away and, in many cases, are asked to be able to provide payment in advance and get reimbursed by the non-insured program. There are not very many of our elders that can afford to pay for their glasses upfront or their dental work or any of these things, even if they can get them approved. So a big problem with that program.
Recommendation 48 talks about expanding eligible expenses under the non-insured health benefits program to include the cost of foot care. Shis should be broadened to allow for First Nations to identify other needs other than foot care. Priorities are being decided in places that are a long way from recognizing where the real needs are at the community level.
One of the things that we recognize in our health plan is that we really have to turn this around. The governments need to recognize the First Nations' role in governing their own health services and that it is the inclusion of First Nations community design and delivery of services that will really move us forward in the ability to address the health needs of our people. It is not the government continuing with its role of designer or deliverer of programs, but more of them becoming the governance partner and the funder of these initiatives, allowing the communities to direct services as required by all members of the First Nations community including our elders.
Page 37 has recommendations around housing. Another recommendation should be that INAC needs to provide adequate resources for housing on and off reserve, and that is a very fundamental need for our people and the impact of housing on the health of all of our families and our elders.
Recommendation number 55: increase the supply of affordable supportive housing for First Nations and Inuit seniors. This should be provided regardless of residence because we have a lot of our people who find the face different kinds of challenges when they move on and off reserve.
Recommendation number 69: sharing our best practices related to integrated care. Integrated care is happening across the country with minimal opportunity to share experiences across jurisdictions. This is even the case between government departments: Veteran Affairs Canada offers one of the leading models of integrated care in the country, in contrast to the care provided by the Government of Canada to the First Nations people. So we have to figure out this whole idea about how to facilitate information sharing in other areas.
One of the approaches that we are looking at here in British Columbia from our First Nations Leadership Council, which is all of our political First Nations organizations working together, is that we do need to break down the silos where we look at health as an issue; education as an issue; housing as an issue; economic development as an issue. All of those social determinants affect the health outcomes of First Nations people in this province, and what we are trying to do at that level is start breaking down those silos between the government departments.
One of the discussions this year with the Leadership Council that I was able to attend in Ottawa was with the deputy ministers' committee on social inclusion that is chaired by the Deputy Minister of Health. At that discussion with all the various departments being represented, we were able to talk about a bit of a different vision of how issues and care should be provided to First Nations communities and people in this province, one that I think was initially accepted with a lot of interest by the people around that table.
Now we need to challenge ourselves as to how we continue that dialogue at least at a high level, so that we can look across government jurisdictions and authorities to be able to have this dialogue. We need to put the community at the centre of the discussion, the interest of the people that we are trying to serve, and move this dialogue beyond that so that we are able then to learn from the different processes. We need to bring together a more of a holistic approach of addressing not only the health issues, but all the social determinants issues of First Nations people in British Columbia.
Recommendation number 72: increase the stock of adequate and affordable housing for First Nations and Inuit. Okay. "Regardless of residence'' should be added. It should also be recommended that the costs for First Nations health will increase over time due to the fact that the majority of our population is youth and chronic diseases such as diabetes are increasing steadily. Resources need to be adequate to address these issues now and later on as our population ages.
We have to consider that as First Nations are looking to address these issues, our governance of our health services is extremely important and that we need the support of the federal and provincial governments to recognize that we have to find a new way of doing things.
The preventative measures that we are looking for to put place are something that communities need to do to support the growing population of young people and the young families that we have. As we do that, the importance of the role of our elders in that is a big part of it because we are always taught that before we can go forward, we have to know where we have come from, and that is what the elders do. They bring that traditional knowledge to us and the fact that they have this traditional knowledge that is not readily recognized as valuable to the non-Aboriginal community is a real challenge in how we move forward in some of these kinds of areas.
For example, when we look at some of these preventative measures to support healthy active lifestyles for people, for us, a lot of it is things like getting back out on the land. Having people able to go out hunting and do different things like they did before. There are many challenges that are in place now that alienate our people from our lands. If we are able to accomplish some of those things, we start having a healthier lifestyle. One where we also are feeding ourselves with more of a traditional diet that is better for the people and the community, as opposed to what we are able to afford by going to the grocery store and dealing with the need to buy the less expensive foods which are the things like the chips and the things that do not cost a lot. Every time we are trying to buy vegetables and other things that are very difficult to get in a lot of our remote communities, they come with a very high cost.
So food security and those other things are a big part of this whole peace that need to support not only our elders and the rest of our community but, again, in ways that are driven by First Nations and their ability to govern their own matters.
Thank you very much for the opportunity to present to you today.
The Chair: Thank you for a very detailed brief to us.
Lisa Mercure, Elders Coordinator, BC Association of Aboriginal Friendship Centres: Hello, my friends.
[Ms. Mercure spoke in her native language.]
Thank you to the Coast Salish for allowing us to live and work and be here today in their local nation, their local territory. Lisa Mercure is my name. I come from Northern Alberta on my mother's side. We are actually Mikisew Cree status, but we are of Dene descent. I am a program administrator, and I work at the BC Association of Aboriginal Friendship Centres. I give you my thanks and respect.
I would like to thank the committee chair, the Senate, the committee members and the communities who have participated in giving input into the special Senate committee report on aging, Issues and Options for an Aging Population.
It is unfortunate that our elder today, a national senator and founding Elders Council member for the BC Association of Aboriginal Friendship Centres is not feeling well and sends her regrets. I will be standing in for her today and highlight some of the areas addressed in our Aboriginal communities through the friendship centres that I am connected with.
I just wanted to give you a bit of an update on the B.C. friendship centres, and a bit of background and history. In 1972, 11 communities formed a collective association of friendship centres to provide communication support to the growing friendship centre movement.
From 1972 to 1975, the Pacific Association of Communication in Indian Friendship Centres or PACIFC was founded. A lot of the labour force and the programs and services were developed to meet the needs of our urban Aboriginal community. Today, our friendship centres are in 24 communities in B.C.
Today, as Aboriginal people, we need new ideas and concepts to be able to respond to the different challenges and take advantage of different opportunities where we can see something that may meet the needs of our community.
The B.C. association executive has included meaningful participation for youth by including voting positions on the board of directors for Aboriginal youth, and by allowing them to participate on the executive committee.
Recently, the B.C. association executive included an elders advisor and in June 2005, we developed an Elders Council. It was founded by three members: George Cook from the Victoria friendship centres; Basil Morissette out of the Kamloops area; and Marjorie White who is based out of Vancouver. The three of them have been meeting at our B.C. friendship centres. They are starting to listen in on their conversations and starting to document the issues and concerns they see within our communities.
The National Association of Friendship Centres has developed a committee of senators that meets prior to board meetings and acts as an advisory committee. That committee includes our elder, Ms. White.
The friendship centres have grown to be one very successful organization in British Columbia. In the past 10 years, we have increased our community staffing from 400 full-time employees to 850 full-time employees. Over the past ten years, we have seen our membership increase from 21 to 24 centres and many other communities are starting to express interest.
We are the single largest non-governmental social service providing agency in the province, the second largest being the YMCAs. Over this period, many individuals have benefitted from the social programs and services that we provide.
As part of our friendship centres, we also include 200 voluntary board members and that membership group volunteers over 16,000 hours of volunteer time for our communities.
We believe that we are starting to fulfil our mission statement by providing direct services now to over 1,300 Aboriginal and non-Aboriginal people every day. Last year, we administered and offered 372 different programs to urban Aboriginal people and those who walk through our doors.
The current reality for elders in our urban communities and in B.C. friendship centres is that change had a sudden impact. We have heard about the strength and support that our friendship centres have given to our community and we are starting to see that the challenges are really immense.
We have situations where we have to respond to cold weather with strategies to support the homeless that are in our community. Some communities are experiencing an increase of teen suicides. In these extreme situations, the friendship centres are requiring a sound infrastructure to cope with the gaps in community services.
All Aboriginal organizations experience a high rate of staff turnover, mainly with the front-line workers who experience the most stressing situations. Staff are working to the maximum, and are often not adequate to meet the demand for additional culturally relevant programs.
We honour the gifts of all who pass through our doors. Because our elders teach a a holistic philosophy, we seek a balance among all aspects of life: physical, mental, spiritual or emotional. To support growth in that, our organizations need to incorporate that holistic model and be able to include the guidance of our elders.
The friendship centre movement was founded with a code of ethics which they follow to this day. The code is something our elders developed and it is still relevant.
One of the requests that I received today from my elders group was to bring up the anticipated June 11 apology by the Prime Minister on behalf of the Government of Canada for the residential school experience. Our elders were given a one-time payment of $12,000 plus $3,000 for every year that they attended residential schools; there was a separate payment for the abuses that our elders suffered.
One of the highlights has been a promised truth and reconciliation commission whose chief commissioner has been chosen. It will have the power to subpoena documents, and, we hope, will be able to find the sites of mass burials. The commission will be holding hearings within B.C. communities.
The apology is scheduled for June 11. I hope this will be an opportunity for all our Aboriginal communities to come together, share in a meal, participate in different activities and celebrate our survivors.
The elders around the table recently shared some of their experiences at the residential schools. Our Elders Council meetings include all elders in attendance at our quarterly meetings. They wanted to recognize that the experiences affect them to this day. One of the elders has said that an apology is a very honourable thing to do to another person. It is like admitting a wrongdoing. She felt that she was there because of her faith in the Creator. She was a student and she survived because of that faith. Today, she is healthy, but she said that she would appreciate the support and be able to support all the survivors in her communities.
It affects all our Aboriginal communities. In one instance, another elder said the Aboriginal people lost their language: this one elder was punished for speaking his language and that happened to everyone. They lost that language and their children also never learned their language. They greatest damage was to our culture — who we were.
It has become apparent in our communities where language and culture are very important and it is a way that we identify ourselves. So I introduced myself in my own language, to try to capture that and remember the values of the elders that taught me, and to remember that language is a basis of our being as people. When we understand where we come from, we will be able to be more grounded and understand through the teachings how to be holistic and understand how we can keep moving forward.
Our land is our greatest resource. Although friendship centres are not participants in the treaty process, they do experience the disconnect where people move from the reserve systems into urban Aboriginal areas, rural or remote, and are not connected to elders. We know about the difficult in trying to come together and, as an Aboriginal community, being able to recapture their language, their culture.
There is a cultural foundation in British Columbia and there are initiatives where there is language programming available. The challenge is that our people are still migrants to this day and some of them are not connected to anybody that can help teach them the language and culture and guide them through that process.
It is really clear to me that our Aboriginal organizations in total need an elders coordinator in each of those organizations to support and develop programming that meets the cultural needs of our elders in the friendship centres.
Another initiative that I wanted to speak to you about is the First Citizens Fund in B.C. The First Citizens Fund is a perpetual fund in B.C. used to promote social and economic development initiatives for Aboriginal communities. So out of that fund there is an elders transportation fund that provides partial funding for transportation costs related to heritage, cultural and educational workshops and conferences. Applicants can be individual Aboriginal elders or a recognized Aboriginal organization on behalf of elders. That fund currently only provides twenty-five $1,000 bursaries, so it is clearly insufficient to meet the needs.
In British Columbia, we are really fortunate to have an annual elders conference. Last year it brought together over 4,000 elders, support workers and organizations. We had 44 organizations apply to the fund with a total request for $315,630 to support 489 elders who wanted to attend five different cultural activities in BC I believe that we should be supporting those kinds of initiatives.
One of the biggest barriers for our elders is transportation and being able to gather and commute back to their home communities and territories to be able to visit with their families.
I also wanted to give you a bit of a background on the Elders Council. In June 2005, the Elders Council's terms of reference were accepted. Its purpose was to provide advice and guidance to the B.C. Association of Aboriginal Friendship Centres board of directors and all its subcommittees. They provide advice and guidance on matters referred by the Elders Council, by the Provincial Board of Directors Committee and member friendship centres. They share their knowledge and wisdom within the council so that individual elders can bring that knowledge and wisdom back to their friendship centres and share information and resources.
In that Elders Council, we were able to start helping our elders to start applying for funding for different resources. It is really apparent that there are not enough language and cultural programs. We did receive a grant through the New Horizons. I believe that model should be also within our Aboriginal organizations, administered for and by Aboriginal people, and that the advisory committee reviewing proposals and activities should include our elders.
Within that project, $25,000 is received to begin to help our elders to self-identify. We developed an Elders Council brochure and posters so it was visible within our communities. We developed examples on how friendship centres involve elders on advisory boards and board director positions. We were also able to start to connect our elders with our youth and we are finding that that is a really successful model — intergenerational support.
The youth and elders decided to develop a workshop at the youth conference in March, where we brought together over 1,000 Aboriginal youth. The workshop was initially called "How To Support Elders Councils in B.C.,'' and our elders changed it to say, "How Our Youth Can Support Elders.'' It is beginning to be clear that networking and intergenerational support is a model that will work in our communities to start rapid rebuilding of our language and culture and integrate programming and services. That would be a model for all of our Aboriginal organizations.
Mr. Gallagher brought up the issue of food security and I would say that that is relevant across all of our Aboriginal communities. One of the issues would be around the traditional way of gathering food, which is being lost in our urban communities. We want to be able to ensure that traditional food is accessible for our elders. Some communities were able to do food fishing for their families. This year, for the first time I have heard in a long time, there was not enough fish stock to be able to provide food for their communities and, therefore, our elders went without.
We already heard about the disparity and the Aboriginal statistics on health are hugely disproportionate. There is a huge gap in life expectancy rates.
Our elders want to be able to gather and eat traditional foods. It is a way of life, and it is being lost and it needs to be shared with our youth. So it would be important to have additional resources to encourage our elders to travel back to their home communities or start to work with our youth on how to do that.
It has been a real privilege to work with our Elders Council as my advisors and teachers over these last years. One of their sayings is: "Share a meal, share your knowledge and share your culture.''
The Chair: Thank you very much.
Mr. Gallagher and Ms. Mercure, before I turn to the others, I would like to address the issue of jurisdictional disputes. We certainly heard this in spades when we visited Sagkeeng yesterday, but we have heard it in other venues as well.
I would like to hear from you, Mr. Gallagher, as to how you think this tripartite council, which sounds like a very good idea, will help to address some of these. Take just this basic example: if INAC is limiting healthcare increases to 3 per cent a year for on reserves when we know that the healthcare budgets in provinces are frequently going up anywhere from 3.5 per cent to 7 per cent a year, how are we going to resolve that jurisdictional dispute?
We also heard, for example, that on reserve, they were supposed to look after levels 1-3 of care for chronic needs patients and the province to look after level 4, but that the province does not look after level 4. If you could give us some idea of how your model would handle some of this jurisdictional disarray.
Mr. Gallagher: With our tripartite health plan, a number of things are happening and the jurisdictional dispute is one of those things that we have to try and move beyond. One of the early recognitions from the provincial Ministry of Health is that health services are provided by the province are for British Columbians regardless of address. That recognition is extremely important.
The health system is so large, we have huge challenges in communication between the federal system and the provincial system. People have been operating in isolation from each other for such a long time. So part of our work with the tripartite health plan is that we have a tripartite oversight committee, which includes senior members from the federal, provincial and First Nations leadership. It looks at issues overall and tries to find ways of breaking down some of these communication barriers.
Part of that for us in British Columbia is that as a Health Council, we are starting to have dialogue with every CEO of every health authority in this province, and there are five that serve regionally in this province. Through that dialogue, we bring our federal partners to the table and we start looking at some of the issues that are problems because of jurisdictional disputes. We need to have a clear agenda on where the priorities must be, based on regional issues, so we can identify which ones we need to try and address first.
Sometimes things are as simple as people just needing to know that something needed to happen. We have examples of that with home and community care issues; of communities that were needing home and community care and were not able to access it from the regional health authority. Discussion with the people responsible for Aboriginal health in that area reminded the people within the regional health authority that that is their responsibility.
Sometimes it is as simple as that. Other times it will not be as easy. We really are working towards creating a framework to identify specific issues that relate to jurisdictional disputes that are priorities within each region of the province and looking to finds ways to tackle them.
The other piece is that our planning processes have now become tripartite planning. We talk about the challenge in front of us to learn how to work in a tripartite way. It really is a challenge because the governments, for whatever reasons, speak different languages and choose not to acknowledge the capacities or the assets of the other. In particular, they sometimes so not acknowledge the assets of First Nations communities and their capacity to have a role in the delivery of health services. So we are looking at doing that.
The other thing in British Columbia that we are looking at a new governance structure to govern First Nations health services in this province. This will, at least from a federal perspective as we move forward, put things into the control of First Nations in terms of delivery of services that is now being delivered regionally by First Nations Inuit Health.
I think that with that also comes a discussion with the provincial government about how we work together with them to accomplish similar objectives. We need to put health services resources and capacities into a place where we can talk about the health needs of our Aboriginal First Nations people without worrying about whether it is a provincial or a federal service provider.
Work is now at an early stage that I hope will go a long way to remove the jurisdictional disputes and put on the table a common understanding that we are trying to address issues related to the health of First Nations people. Both governments have acknowledged that in small areas where we are successful, it is because we are agreeing on the issue we are trying to address and are not coming at it from our own perspectives. So we are trying to create that sort of common environment of working together which we are calling working in a tripartite manner.
I offer that as just some initial thoughts to your comments.
The Chair: You said I think, and I do not want to misquote you, that the province recognized that Aboriginal people living in British Columbia on reserve or off reserve were in fact British Columbian citizens.
Mr. Gallagher: That is right, yes.
The Chair: That in itself is a huge change.
Mr. Gallagher: Yes, it is. We have to put action to that. Although we can get the Premier to say it, we need every health authority service provider to recognize it and live up to those words. From there, it is also delivering that service in a culturally safe way.
The Chair: Maybe we can get him to do it at a First Nations meeting in Ottawa and he can challenge all the other Premiers to take exactly the same attitude.
Mr. Gallagher: I think that would be a good idea.
Senator Cordy: You talked about dental care and I think that you said it looks good on paper and I think as a non- First Nations person, I would assume that dental care is provided to anybody. But you have told us stories of people being turned away, of people being told, "Well, you do not take care of your teeth anyway, so what is the use?'' Is this a national policy? How are these decisions made? Because my assumption is that it would be something that is offered historically to First Nations people.
Mr. Gallagher: It does flow from national policy: cost-saving measures are part of the public agenda.
Senator Cordy: Not giving service I guess is a cost-saving measure, but it does not make sense.
Mr. Gallagher: Those kinds of things are driving how they deliver the program. In British Columbia, we start from a point of where we are underfunded in the first place relative to other provinces, and we are trying to address that in our discussions under the tripartite health plan.
In this new governing structure, the First Nations cannot take on something that is already broken and underfunded. It has to be at a fresh starting point with appropriate levels of funding. I will give you an example of how the national funding is an issue. It relates to funding and the payment of dentists. The nationally set rate of payment is 85 per cent, I believe, of the fee schedule. You are asking dentists in the province to take on patients at an 85 per cent payment when they have a full slate of appointments without trying to take on First Nations clients.
Because of the transient nature of our population, a lot of people always looking for a new dentist are coming to the city and trying to find a dentist. Dentists already have full practices of people that will pay 100 per cent. So our people get denied service. They cannot find dentists to provide the services at the rate set nationally.
The other sort of national initiatives around cost savings is that certain procedures have to be approved in advance. The remoteness of our communities means people have to pay money and take time to travel to a dental office. When they get there, if they find they need a root canal, they need an approval for that and the dentist will not provide the service until he has the approval, at 85 per cent anyway. So the person who just travelled from their community has to go home and go back later.
The reason the dentist will not just do it is because sometimes when the application for approval does go forward, it will get denied. So the dentist then has provided the services and has to either eat the cost or try to get the patient to cover it.
The other thing is that dentists are now balance billing, so that if they are getting 85 per cent of the payment and they have First Nations clients, they will bill the client the remaining 15 per cent and sometimes they do not have the resources to pay.
Our young children need a lot of work on the preventative side of things, and in these kinds of situations, they just do not get addressed. So the dental profession and the First Nations community are not connecting well.
We are trying to work as a Health Council meeting with the Dental Association here in British Columbia to look at that program and talk about how to make it work better. We want to put forward some kinds of recommendations of very specific kinds of things we hope to incorporate, if we are able to negotiate for the governance of those services on behalf of all First Nations in this province.
There are things that are moving forward, but the way the program is run makes it a difficult challenge. It is inaccessible to a lot of our people. Dental care is one of the hot topics whenever we sit and talk with chiefs about health services. That and transportation costs, patient transportation. Because of where our people are located and the access to services, all of those things are covered as part of non-insured services and they are not working as well as they should.
Senator Cordy: I have to say, I find it very frustrating. Yesterday and today have been eye-openers for me and I thought I knew a lot about the issues. But yesterday, to go to the Aboriginal community in Manitoba and to find out that healthcare workers working on the reserve are being paid less than those working off the reserve and that they have gotten one raise of 3 per cent in ten years.
Mr. Gallagher: Yes.
Senator Cordy: So they are doing it as a labour of love. To find out that dental care, which I assumed was being paid for by the federal government, is lacking tremendously and for those who are getting it, the dentists are getting paid 85 per cent. You can understand dentists with full practices.
Anyway, I am finding it very frustrating to look at these things and then to proclaim that we are doing great things in healthcare for Aboriginal people is such a fallacy.
I would like to talk also about the issue of mental health and mental illness. You both made reference to residential schools and I know you said that the apology will go a long way and that the Truth and Reconciliation Commission will go a long way. We have really hurt the culture of the Aboriginal people for the generation who went, but also their children who have not been able to get what their parents lost. How is that being dealt with within the First Nations peoples?
Mr. Gallagher: The apology that Lisa was mentioning, the bringing of people together, and a lot of the things that are being planned for June 11, are intended to try and do some of that. We hope it will be a good thing and we hope that the apology is sincere and received well. We worry if it does not come across that way.
I hate to be cynical about it, but as we said on these other issues, this government has not been too responsive. We look back to where we came from here in B.C. with our Leadership Council signing the Transformative Change Accord in November of 2005 with Prime Minister Martin. Then a couple of months later, the new government arrived. The Prime Minister would not go anywhere near the accord and they denounced that agreement. It linked all of those things; health, education, housing and infrastructure, economic development and reconciliation of rights and title. So that repudiation went to the notion of the honour of the Crown and whether or not there is honour there.
From a First Nations perspective, we get concerned. If we are bringing our people together, let us hope it is a good day. The question is if it is not, how do we respond to the negative reactions to the announcement?
In listening to Lisa, I really appreciated how she started her presentation and what she said about the people in residential school and where she is coming from in terms of using her language.
It is interesting to me is because I am a member of a First Nation here in British Columbia. I am Coast Salish. My community is Sliammon. It is 100 miles north of here. My dad went to a residential school and he was beaten for speaking his language, so he did not teach me the language. So I am an example of the missing generation. Over the years of my work in my community, my elders saw fit to give me a Sliammon name. I am very careful when I use it. Coming to this committee, my first response was not to use it here. When I am talking to my own people, I am more free with using it. That is only in terms of my own comfort with using it, based on what my dad had experienced and what he had taught me about it, and that it was not a positive thing for a long time. We are turning that around slowly in my community.
It was very enlightening to hear Lisa talk about why she does it and why she uses it, and I am very respectful of that and appreciative of that and her acknowledgement of the Coast Salish territory.
The situations that exist around the residential schools are so strong that we really have to be able to understand them at a very localized level: we cannot have broad-sweeping discussions. I have friends from home who are a couple of years older than I and even younger than I am that went to residential school. I listen to them about how they are working through things in their lives. Then I look at my life and my dad went and my mom went, but I did not go. I went to a public school in Powell River, and we had different experiences as a result.
It is understanding what they are trying to go through and understanding how it affected my family and my life and what I pass onto my son. So it is really kind of interesting how we are trying to find solutions for it. In the area of mental health and wellness, a big part of this is turning it around. A lot of our people tell us when we talk about mental health issues that we have to come from a wellness perspective and start building on the strengths we still have, not be looking at things from the illness perspective. Because we are just trying to survive its treatment system and it is not working for us.
To look at promotion and prevention and building the resiliency of our young people means incorporating culture and language and the things that are important and essential to who we are as people. That includes our connection to the land and resources and territories. A big part of it is that we are trying to turn around and get back to those things that are of value to us as people and find who we are. Again, in British Columbia, with 203 Indian bands, we have a number of nations that are very different from one another, but share a lot of commonalities in terms of their spiritual perspectives, and so on.
Ms. Mercure: You were talking about the residential school apology and mental health. One of the greatest areas that will be helpful is for our Aboriginal communities to be able to come together as one on June 11, and to be able to support our elders and all of those that have been affected by residential school, which means every one of those Aboriginal people.
The intergenerational effect is affecting us at all different levels in terms of losing the cultural knowledge. Most of our communities are based around the idea that everybody has a gift and a role in that community. Whether it is the language holder or the fire keeper in the Big House. everybody has a role in our community. I think some elders do not know what it means to be an elder and have been lost for a really long time.
So to be able to support those who have not been a part of their cultural community and to support those elders who want something that is culturally relevant in their Aboriginal organizations, both on reserve and off reserve, all of our communities need to come together as one.
It is going to be a time of healing for all of our communities, I think.
Senator Cordy: My last question is related to this also and you have made mention that you have lost so much culture and history. I am just wondering at the elders conference and with the Elders Council, is there any movement or any work being done on recording the history and the culture? Because there is not a lot available for people to look at either within or out of the Aboriginal community and a lot of stories have been handed down verbally, but not in books.
Ms. Mercure: I think that would be my rationale for more elder cultural-type programming and I think that would naturally evolve into recording the stories.
We are at a place right now where we need learn our languages correctly, our languages in B.C. especially. A third of all the Aboriginal languages in Canada are held in B.C. because it was a traverse place thousands of years ago. So it is important for us to have language and cultural programs developed by Aboriginal people for Aboriginal people, inclusive of all Aboriginal groups. We need that right away.
There is a urgent sense in our communities that our languages are at risk. Therefore our culture is at risk. It is trying to bring that awareness into the mainstream community and that it be in support of those non-government organizations and other communities to understand where we are today.
There were some initiatives, through the cultural foundation, to would start to gather and record language being spoken. There is an online program supported through the First Citizens Fund, as well, but it is not enough. They have to prioritize the projects. How do you prioritize one community's language over another?
Mr. Gallagher: I just wanted to comment on that. One of the important aspects of our language is our link to the land. I had the opportunity to work in my own community in relation to our treaty negotiation. One of the first things we did was discover that when you talk about your territory and people's relationship to the land and explore that history, what you get are family names, our traditional names, and how they are linked to the various locations in the territory and the things people did.
So bringing back and strengthening our ties to our language has really linked that whole area of how we connect to our territories. It then gets into the whole social fabric of the people. Which families lived in which part of the territories, their lifestyle, the resources they controlled and managed and shared. All of that is spoken about in our language. Our laws and our teachings come from that. It is a very rich exercise which is extremely dependent on our elders because they are the ones that have most of that knowledge.
I remember our activities in recording our elders. With respect to the history of my community, we are really sort of working to recover, revive, renew, rediscover a lot of those things and redefine what it means to be a Sliammon First Nations person. So it was quite exciting that we were able to do that.
What was even more valuable was we found we captured a great deal information from people that are no longer with us and we need to be able to do more of that. We were having these elders events and taking our elders back out onto the land to places they have not been for a long time. Having these memories come out from them was wonderful.
We have to be able to support more things like that. They should be acknowledged for what they are and they should not have to be part of something else. You should have the ability to do it because it is the right thing to do.
Senator Mercer: Thank you both for being here. I continue to learn so much on this trip. Perhaps the sincerity of the apology would be enhanced if he would embrace and acknowledge the Kelowna Accord, but I do not think we are going to see that, unfortunately. That may be too political a comment, but that is all right. I am amongst friends.
I want to talk about diabetes for a moment. Do you have any idea of the percentage of First Nations people in British Columbia who have diabetes? Secondly, with respect to the friendship centres, in the 24 communities where you have friendship centres, are you providing services there that are directly related to diabetes education and training to help people manage their diabetes?
Mr. Gallagher: The first question was about the number of people with diabetes. The information that we work from here is part of the Public Health Officer's report on Aboriginal health, and he has a new report coming out, I guess, in the months ahead this year. The statistics that we work with there are not always the best because lots of people get missed. There are lots of inaccuracies. So they acknowledge this data is not strong. So one of the things we need to do in our tripartite plan is try and address health data, as well as other data related to the social determinants of health.
The best way that that is going to happen is for the First Nations to be the owners and generators of that data. Right now, it is a combination of federal and provincial data. I think the number that came out, and Michelle is looking and might help correct me, is that our rates of diabetes are 40 per cent higher than the non-Aboriginal population. That is the kind of statistical information that I have heard.
The Chair: That translates to about 55 or 60 per cent of the adult population.
Senator Mercer: Amazing.
Ms. Mercure: You talked about the friendship centres and the programs that they offer within our friendship centres' local communities. We are not a local service provider but our 24 communities are. Under the health programming, there are 94 types of programs, which is 18.9 per cent of our overall programming.
They cover a broad range, including specifically around diabetes. For example, the Aboriginal health clinic in the Tillicum Lelum Health Centre in Nanaimo would offer community programming for people to come in and ask for things like diabetes foot clinics and to be able to speak to nutritionists and to work with the new programming that came out that is "Honour your health challenge.'' It is not a new program, but people are using the resources from that to help raise awareness in our communities about health living, healthy eating.
Senator Mercer: Mr. Gallagher, you mentioned the 203 First Nations in British Columbia. That is a large number and it is obvious not all of them are getting quality healthcare. Not all of them have doctors. Are there a large number of nurse practitioners filling in the gap and is there any use of Telehealth to assist in delivering some healthcare?
Mr. Gallagher: One of the major problems we have in B.C. is a nursing shortage. In the northern health authority region just last Friday, they were saying the average retention of nurses in the north is six months, but it is costing them a year's salary to try to bring each new nurse into the system. So it is a huge challenge for us here even beyond the doctors that are not available.
One of the action items in the tripartite health plan we are working on is to create and implement a fully integrated clinical Telehealth network for First Nations in B.C. It is a great action item with huge challenges in front of it because connectivity in this province is a huge problem. We have, as an example, more communities that do not have connectivity in this province that some provinces have First Nations communities. So we have some big challenges in front of us in this whole area of connectivity.
With Telehealth, at some point you are trying to get an industrial grade of connectivity to do a lot of the things you would like to do through that kind of technology. So the challenge in front of us is great.
The provincial government has stressed its commitments around connecting B.C. The federal government is lagging behind, but are making efforts to come up with their share of the money. Health Canada has come up with money to support the federal side of it because of the health plan. We are waiting for other federal agencies like Indian and Northern Affairs to put up their share,.
So those kinds of things are being talked about and we are developing a centre of excellence in health to help us move in this area so that we can be effective. A fair bit of work is going into this as an option for communities in terms of provision of health services.
Senator Mercer: At the centre we visited yesterday in Manitoba, one of the things that impressed me was the fact that all of the nurses there were not necessarily from the community, but all of them were Aboriginal. Is there a program in British Columbia to help to specifically reach out to young Aboriginal people to get them to consider nursing as a career since there is great need in the community?
Mr. Gallagher: There are a number of initiatives going on around that. One of the indicators in our health plan is around health human resources and the number of Aboriginal health service providers in the system. There are different initiatives. The federal government, for example, has an Aboriginal health human resource initiative where our Health Council is working with them to engage post-secondary institutions to develop better programming that is more accessible for First Nations people and Aboriginal people to enter in health professions. Nursing is one of those areas that is targeted.
There are other initiatives being moved forward by different First Nations health organizations, as an example, to attract more nurses and more programming in these areas. There is still a need to do more. It is one of the action items in our 10-year health human resource strategy. We need to incorporate not only nursing, but other health professions into it.
The Chair: I want to thank you both very much for this presentation. It was excellent and I would have to say, Mr. Gallagher, that I would be extremely honoured if you would allow us to use your First Nations name in our publication.
Mr. Gallagher: Okay.
The Chair: You will have to give it to us.
Mr. Gallagher: It is Kwunahmen.
The Chair: Do you have one as well, Ms. Mercure?
Ms. Mercure: No. In December, we have a thing called "family reunification.'' So in December I was connected to people. I only knew my nuclear family. So I have recently gotten to know that I have cousins, that I have an uncle and in one of those families they have ten brothers and sisters and 17 cousins, so I am really happy to say it is starting a process.
The Chair: That is wonderful. I am glad you have discovered your family, Ms. Mercure. It is extremely important, and I will just relate a very fun story to you. When my husband asked me to marry him, he suggested that we should have a very small family wedding. I suggested to him that I could not have a very small family wedding. He said, "Well, why not?'' I said that I have 150 first cousins. He said, "Nobody has 150 first cousins,'' and I said, "Well, if your mother is one of 18 and your father is one of ten, you have 150 first cousins.'' So I am glad that you are finding out about your cousins.
Ladies and gentlemen, could I invite Gregg Schiller, Bonnie O'Sullivan, Joanne Tayler and Steve Ellis to come and join us. The way in which we do this is that each individual is able to present for five minutes. There are no questions from the committee because of a pressure of time.
I understand, Mr. Schiller, that you represent the British Columbia Seniors Advocacy Network and would you like to start, please.
Gregg Schiller, Coordinator, BC Seniors Advocacy Network, as an individual: Thank you.
Thank you for the opportunity to speak to you today. I work here as a coordinator of the B.C. Seniors Advocacy Network. It is an amazing network of over 87 volunteers who are all seniors from all over the province of British Columbia. They provide advocacy services to seniors facing critical and complex issues. Our volunteer seniors have been screened and received intensive training to be educated about the various laws affecting seniors, and their entitlements and rights.
The majority of calls received by our B.C. Seniors Advocacy Network are around the issue of abuse and neglect of seniors living in residential care facilities. Some of the issues related to this topic include retribution and intimidation by staff and managers of facilities towards family members who speak up about their concerns for their loved ones in care. Family members have been threatened with having their visits cut if they speak up about their concerns. Maintaining access to family members is a basic right that needs to be protected, to avoid isolation of seniors. Nutritional abuse occurs when operators of care facilities try to save money on the backs of seniors by providing them with razor-thin sandwiches or providing meat dishes to vegetarian clients and not respecting their choices.
These are some of the stories that have been brought to our attention numerous times, and we have intervened to resolve the situation for the betterment of the seniors in care.
Again, the right to eat healthy, nutritious meals is a basic right that all Canadians deserve no matter where they live or how cognizant they are of their environment.
Neglect of seniors in care includes things such as not changing or cleaning seniors who may be incontinent or ensuring they sit upright when they have a feeding tube.
Other similar types of situations occur when staff ratios are way below what is needed. The lack of staff is a chronic problem in all residential care facilities.
Emotional and physical abuse occurs too when there is a lack of staff to provide the one-on-one supports that seniors require or when staff burn out or when there is stress amongst the staff members. Again, better training and more staff can help address this issue.
Other issues faced by the B.C. Seniors Advocacy Network include finding affordable or appropriate housing for seniors, especially in our Olympic City of Vancouver where housing prices are increasing to exclusive prices out of reach of most ordinary citizens.
Seniors are also calling us about living below the poverty line. We see an increasing number of seniors living on the streets and begging for money, along with the youth. This is not safe for seniors nor respectful for them to be forced to be in that position in life.
Another issue of importance to seniors is having the option to age at home with home supports. Unfortunately, that option is not always available because of a lack of funding and programs to allow this option to flourish.
Luckily, our B.C. Seniors Advocacy Network has been available to those seniors who call us who know about our services, so we can provide the supports they need and deserve. Without our help, many seniors would be languishing in residential care facilities or not receiving their entitlements and benefits. We help them to apply and get that financial assistance for them.
It is our hope that the B.C. Seniors Advocacy Network can be a model for the rest of Canada to build upon with a national network of skilled and dedicated seniors to provide appropriate advocacy services to seniors. Guaranteed long-term funding commitments from federal and other levels of government to support our Seniors Advocacy Network as well as a national network would be greatly appreciated, since we go from grant to grant to grant, short term. A long-term commitment for funding for our volunteer advocacy services would be a great benefit to all seniors.
I hope that the Senate committee can recommend providing financial support to volunteer seniors' advocates and, in particular, to our network here and eventually to help us build a truly national network of seniors' advocates across Canada as many seniors are increasingly falling into the category of issues that I have raised with you today.
I look forward to reading your final report and am open to answering questions you may have. Thank you for your time and I wish you all in promoting your excellent recommendations for the betterment of seniors across our wonderful country. Thank you.
The Chair: Thank you and thank you for the work that you do.
Ms. O'Sullivan?
Bonnie O'Sullivan, Social Coordinator, 411 Seniors Centre Society, as an individual: Thank you for letting me speak here today. My name is Bonnie O'Sullivan. I am the events and activities coordinator here at the 411 Seniors Centre.
Today I would like to speak to you about issues regarding lesbian, gay, transgender, transsexual, bisexual and queer elders. Here at the 411 Seniors Centre, we have a specific focus on inclusivity and, as such, we have an LGTB committee here which oversees a variety of programs and activities catered towards LGTB seniors.
LGTB seniors are an invisible minority in today's society and less often suffer from isolation and discrimination both inside the LGTB community and in the community as a whole.
When talking to LGTB seniors, it is important to remember that while our society as whole has changed to a large extent in terms of law and rights for LGTB people and in terms of becoming more inclusive, LGTB seniors as a group have suffered great oppression and have been forced into the fringes of society. Thus, as a group, they are much more likely to suffer from extreme isolation and much less likely to seek out support and help in times of need. Their previous experiences have often created a foundation of mistrust and a tangible, unshakeable understanding of oppression.
LGTB seniors face challenges both in the community as a whole and in the greater LGTB community. In addition, LGTB seniors have a specific set of needs and issues which should be addressed separate from the needs and issues of the general LGTB community. Thus, it is incredibly important to provide specific and direct services to LGTB seniors.
Within the LGTB community, events tend to be geared towards younger generations, and while I believe the community is very open to accepting LGTB elders, it is sometimes difficult to bridge the gaps between the two groups.
Currently, in Vancouver, there are a variety of different non-profit and government-sponsored program and initiatives which provide events for LGTB elders. The existing community is very strong and willing to actively participate in community-building exercises and education.
I think the greatest gaps in the current support systems for LGTB elders are two. Firstly, there is a need to access isolated LGTB elders who are either unaware of the services available or are hesitant to come up to their peers. I think it is paramount to educate LGTB elders about the services available to them. There is a need to reach out to LGTB seniors and create safe, inclusive, welcoming environments where they are comfortable enough to engage and share their experiences. In addition, there is a pressing need for outreach to LGTB seniors who are unable to attend current programs and activities, either because they are homebound or because their experience of discrimination creates a barrier in accessing current services.
The second gap is in recording and understanding the histories of the LGTB community. LGTB seniors are pioneers in the fight for human rights in this country, and their experiences and histories have an intrinsic value. I think it is very important to document and archive those histories and the emergence of lives that have changed the landscape of human rights in this country.
I believe that this country has systemically discriminated against LGTB people. I also believe that we have a lot to be proud of in terms of the giant leaps that we have taken to create equal rights for LGTB people. I think that it is something that Canadians should be proud of and that should be recorded so that we can share it with future generations.
I hope that the Senate committee can recommend providing financial support to initiatives for LGTB seniors, specifically those projects which focus on advocacy, outreach, education, archiving historical information and bridging generational gaps in the LGTB community. I believe it is to the benefit both of LGTB seniors and the country as a whole to understand where we came from and the great changes that have transpired in terms of LGTB rights in this country.
I look forward to reading your final report. Thank you for your time and thank you as a committee both for giving me the opportunity to speak here and for creating this forum to discuss issues that are so relevant and important in this country.
The Chair: Thank you for reminding us that we have made strides, but there is still more work to be done.
We will hear from Joanne Taylor next. She is with the Nidus Personal Planning Resource Centre and Registry.
Joanne Taylor, Executive Director, Nidus Personal Planning Resource Centre and Registry, as an individual: Yes. We believe in long names. Trying to be descriptive.
Thank you, honourable Senators, for this opportunity. I am Executive Director of the Nidus Personal Planning Resource Centre and Registry, formerly the Representation Agreement Resource Centre and Nidus Registry, so we have some history.
I would like to first bring greetings from our president who would have whipped down here if she could. She is Patricia Fulton, some of you may know her; the wife of the late Davie Fulton. Pat is a strong advocate for seniors issues and has provided wonderful leadership to our organization.
Under the umbrella of personal planning are a number of legal tools, but the concept is about planning, hopefully in advance of a serious illness or accident, when you might need help managing your affairs or making decisions. You will hear different terms such as advanced care planning or planning for incapacity. We are using the term "personal planning'' as somewhat of a generic term.
We grew our organization, a non-profit charitable organization group out of grassroots law reform effort and VCC. Many of the members of that organization who I know you heard from earlier were part of that law reform too, and people took different areas to develop and focus on. I believe we are the only community-based resource in Canada for the public, devoted to personal planning.
We help people learn about what opportunities they have to plan and what legal tools they can use, not just the technical part, but also the practical side of it. How do you exercise your authority? Really, you are an advocate on behalf of someone else. We do work closely with many of the organizations here at 411 to make sure that we are reaching out to the general community and bringing that information to everyone.
I am aware of the Senate report on quality end-of-life care and Senator Carstairs' follow-up report in 2005. It is still not there and I echo that here in 2008. I know that it highlighted advanced planning, but I would like to just add a couple points to this.
One is that in our experience, it is not all about end of life and, in fact, we do not want to wait until end of life to engage in this important activity. The Ministry of Health here in B.C. reports that 90 per cent of British Columbians die following a chronic illness or condition. There are many decisions that people might need help with along that journey. We want people to be communicating their wishes and preferences. So if someone should have to step up and act on their behalf, they can do so with full knowledge.
We have something very special called the Representation Agreement. We think other provinces might like to learn about and adopt our tool. We also have enduring power of attorney and those are tools that people can use to authorize somebody to act on their behalf, but there is all that other work that needs to go on.
One of the other points I wanted to make is that I think that there is some tension, perhaps, or area for discussion, around the medical professions' views on whether treatment, resuscitation is futile or not, and the patient's values and self-determination and how do we talk about that. We have, I think, a lot of information from people on that that we would like to share and we would like to encourage that discussion.
Then, and I think it has come up with the previous speakers, there is the situation of people who do not have someone to act on their behalf, and that is an issue for seniors. I think in ways we maybe never imagined. I hope this area, because I believe this is a growing field given the demographics, does not become an industry because I think it is important that the community is involved. Particularly, for people who do not have anyone, that is the community development that we need to do
We have a project in partnership with the B.C. Seniors Advocacy Network to get out into the communities and talk about these issues and to see how we can assist people to develop personal networks, for use of a term, so that they have someone that could stand in for them if they cannot speak for themselves and to honour their wishes.
So those are just a few of the brief points and I do appreciate the opportunity and look forward to reading more of your report. Thank you from our president, Patricia Fulton, and myself.
The Chair: Thank you very much and of course you have highlighted a very significant ethical issue, the discussions which are going on between the doctors who, on the one hand, say that they have taken an oath to do no harm, and pressures from families who of course want every single medical step taken, whether in fact it seems to be of value or not of value. That is a discussion we have not even started in this country yet, so thank you for raising it.
Last, but certainly not least, we have Steve Ellis, who does not represent any organization but certainly represents himself. Welcome to the table.
Steve Ellis, as an individual: Thank you. I appreciate the opportunity to talk about something that I think goes to the four pillars that you have here. Actually, five, sorry. This is beginning to sound like Monty Python, is it not? Dignity, independence, participation, fairness and security, and about a particular practice that I saw at a hospice. That is using antipsychotic drugs on people who do not need them simply to take them down several levels and reduce the workload in the building.
This is a reprehensible practice, I think, and most people do not know it even goes on. I did not know anything about it until a very good friend of mine essentially had her personality taken away from her for the last few months of her life while she was in a hospice.
As senators, you can bring a voice to this issue and you can make sure that this sort of indignity is not committed to other people. I am a one-issue guy on this one. This is the use of antipsychotic drugs to essentially take away their personalities to make them just a vegetable on a bed. It is obviously driven by financial pressures within organizations like that, but I do not think that this sort of a violation of their rights can be tolerated and you have the voice to make sure that it does not happen.
The Chair: I want to thank you for that and of course you have identified an issue. I am appalled that it is taking place in a hospice. I know that it takes place in long-term care homes. I was hoping that hospices were different, but thank you for identifying it for us.
This takes me, with my other hat, which was of course my palliative care hat and I can assure you, Mr. Ellis, that I will investigate the occurrence of that within the hospice network within Canada.
Mr. Ellis: You can probably identify it by the drugs people start to get when they go into these places and if they are given an antipsychotic, like Haloperidol or something, it takes some time for it to take effect. So their family do not really notices perhaps and it is just an appalling, appalling practice. And as a non-family member, I had no control.
The Chair: Thank you for that and I can assure you that this committee may not follow it up because it is kind of outside of our realm, but I will personally follow it up.
The committee adjourned.