THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, May 15, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 5:01 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: My name is René Cormier, senator from New Brunswick, and I am currently the Chair of the Standing Senate Committee on Official Languages.
Before I begin, I would like to invite the members of the committee present today to introduce themselves, beginning on my left.
Senator Moncion: Senator Lucie Moncion from Ontario.
Senator Clement: Senator Bernadette Clement from Ontario.
Senator Mégie: Senator Marie-Françoise Mégie from Quebec.
Senator Dalphond: Pierre J. Dalphond from Quebec.
The Chair: Welcome, colleagues. I would also like to welcome our witnesses today and the viewers from across the country who are watching. I would like to point out that the lands from which we are meeting are part of the unceded traditional territory of the Algonquin Anishinaabe people.
Tonight we continue our study on minority language health services. For our first panel, we are pleased to welcome Stéphane Robichaud, Chief Executive Officer of the New Brunswick Health Council, in person. We have with us, via video conference, Barbara Losier, Executive Director of the Mouvement acadien des communautés en santé du Nouveau-Brunswick, as well as Dr. France Desrosiers, President and Chief Executive Officer of the Vitalité Health Network.
Good evening to the three of you and welcome to the meeting. We are ready to hear your opening statements and then we will have a question and answer period with the senators. I’ll start with Mr. Robichaud.
Stéphane Robichaud, Chief Executive Officer, New Brunswick Health Council: Mr. Chair, members of the Standing Senate Committee on Official Languages, good evening and thank you for this opportunity to contribute to your deliberations.
The New Brunswick Health Council is a provincial agency with a dual mandate to report publicly on the quality of health services and to develop and implement mechanisms for public input into improving the quality of health services.
The work of the New Brunswick Health Council must be done in an impartial manner with a citizen’s perspective. What is the state of health of the population? What is the quality of the services received? Regardless of individual characteristics, circumstances, geography, are resources being managed to provide the same quality of care to all? I have had the opportunity to listen to some of your previous sessions. Many clearly explained the risks associated with not receiving health services in one’s preferred language. Based on the lessons learned through the New Brunswick Health Council, the content of this statement will focus more on the barriers and opportunities for improving the quality of publicly funded health services. These improvements include, but are not limited to, access to services in the minority official language.
The most significant initial finding in fulfilling the mandate of the New Brunswick Health Council was the lack of generally accepted, geographically disaggregated data to assess the health status of the population, the quality of health services and the distribution of resources. This finding has been a major influence on the strategies adopted by the council from the outset. Indicator frameworks were developed in consultation with public health agencies, providing snapshots of population health and the quantity of health services.
The New Brunswick Health Council Act defines quality health services as measured by accessibility, equity, appropriateness, safety and effectiveness. For population health, a framework inspired by the State of Wisconsin has been adopted. This framework is based on the principle of the determinants of health, including measures related to quality and length of life. The categories of determinants and their weight in influencing population health status are health behaviours at 40%, socio‑economic factors at 40%, physical environment at 10%, and health services at 10%. Initially, the Health Council’s reports had a limited number of indicators and were limited to comparing New Brunswick to the national average. In the early years, the Health Council’s work benefited from exceptional collaboration with provincial organizations, which allowed for the identification and validation of several additional indicators from administrative data systems.
To fill some of the gaps, particularly in the area of patient experience, multi-year surveys were implemented across several health service sectors. In New Brunswick, this was the first time that surveys were administered in a standardized manner, providing data that could be disaggregated on a geographic and demographic basis. The survey questions identify whether citizens receive their services in their preferred official language, which provides a snapshot of the state of hospital care, home care and primary health care services.
I invite you to view the survey results on the council’s website at www.csnb.ca.
However, in terms of administrative data management in New Brunswick, it is still not possible to adequately disaggregate data on the basis of official language preference. Groups such as the Société Santé et Mieux-être en français du Nouveau-Brunswick (SSMEFNB) have been calling for this possibility since the work of the council began in 2008. This would allow for a better assessment of the relationship between official language preference and the quality of health services received. This is a particularly important issue for francophones living in the province’s English-speaking urban centres. Recent agreements between the federal government and the provinces and territories offer opportunities for improvement. The texts make reference to official languages and minority communities. In the coming years, particular attention should be paid to the accountability framework related to these agreements and its evolution. Clarifying the results expected from the investments and identifying performance measures will be important challenges.
However, with the support of effective governance, these agreements could contribute to improving the quality of health services, including access to services in the minority official language. Thank you for your attention.
The Chair: Thank you, Mr. Robichaud. I will now give the floor to Dr. Desrosiers.
Dr. France Desrosiers, President and Chief Executive Officer, Vitalité Health Network: I would like to take this opportunity to thank the Standing Senate Committee on Official Languages for its invitation. As President and CEO of Vitalité Health Network, I am pleased to share with you our experience as a francophone organization in a bilingual province where French is the minority language.
As you know, New Brunswick is the only officially bilingual province in Canada. Vitalité Health Network is the francophone regional health authority that covers the entire northern part of the province, as well as the southeast. It has 60 points of service, including 11 hospitals, nearly 8,000 employees, 600 physicians and 400 volunteers. In addition to being a pillar of the francophone and Acadian community, the network is an employer. It provides an environment where it is possible to work and develop professionally in French, but it also contributes to French-language training, as we are the primary clinical placement environment for all health professions in the province. In New Brunswick, francophones represent 32% of the total population and anglophones 68%. New Brunswick has one of the highest average ages of any province. Francophones have an even higher average age and therefore have a higher incidence of chronic disease and a greater need for health care and services.
In addition to demographic factors, the socio-economic profile of the francophone population also shows differences from anglophones, with lower levels of education and literacy, lower economic status, and less access to services, as francophones live primarily in rural areas.
Dr. Denis Prud’homme, a physician, researcher and rector of the Université de Moncton, is interested in the quality and safety of health services in minority language situations. At a symposium held last March on French-language health care, he presented the results of his analyses, which show that people who receive care in their mother tongue have better clinical outcomes than those who receive care in a language other than their mother tongue.
Yet in New Brunswick, according to the 2016 census, the rate of bilingualism is 72% for francophones and only 15% for anglophones. From a provincial perspective, it is also possible to conclude that francophones are at a disadvantage in this regard, as they are less likely to receive care in their mother tongue outside of Vitalité Health Network.
As for the challenges related to the shortage of health care professionals, the active francophone or bilingual workforce is not sufficient to meet the needs. Let me explain: At Vitalité Health Network, we rely mainly on the New Brunswick Community College and the Université de Moncton to train our health professionals. Considering that we are a bilingual province that must offer care in both official languages, and given the high proportion of bilingual students among francophones, our training institutions are therefore training professionals who are expected by both the anglophone and francophone health networks, not to mention many other types of positions requested by partners who also require bilingualism, such as the Extra-Mural Program or other federal points of service.
On the other hand, very few students from English-language post-secondary institutions choose Vitalité Health Network or our partners’ bilingual positions because of their low bilingualism rate.
Moreover, this reality is not taken into account in the allocation of post-secondary education spaces for francophones.
As for research needs, we believe that in order to fully understand the specific needs of francophone minority communities, particularly in the area of health, we must provide better support for francophone researchers in these environments, especially in New Brunswick. In general, the place of French in the Canadian research system is declining, with only 5% to 10% of applications to granting agencies in the health sciences written in French. In addition, French-speaking researchers who submit applications in French to the Canadian Institutes of Health Research are at a disadvantage. These applications are said to have a success rate of about 30%, compared to 37% for those submitted in English.
Finally, I also think that community involvement deserves some thought. Vitalité Health Network conducts a cyclical health needs assessment — for and with each of its 13 communities. Beyond this assessment, we want to support our communities in implementing initiatives that can meet the needs identified. This is the learning communities approach, which allows them to engage in a formal process, with the support of Vitalité Health Network, to implement initiatives that promote population health, while respecting the needs and linguistic and cultural particularities of the communities.
While Vitalité Health Network is a key player in safeguarding the French fact in our province, so are the communities, and I think we need to recognize this and incorporate them into our strategies.
I would like to say a word about the importance of the governance of regional health authorities. Although this is a provincial matter, I would like to emphasize the importance of maintaining two separate health authorities, one francophone and one anglophone, in order to preserve the French fact in New Brunswick. A few days ago, our government announced the creation of a new regional governance structure. After about a year of trusteeship, the new structure provides for the maintenance of a separate governance for each board; I believe that we must applaud this decision and ensure its continuity in order to respect the rights of the francophone and Acadian communities.
In conclusion, experience shows that in so-called bilingual environments, English ends up being the language of operations, functioning and services. That said, Vitalité Health Network and the entire population would benefit from an increase in bilingualism in the province, both in terms of available human resources and business relations with other health partners in New Brunswick, to enable everyone to express themselves and function in the official language of their choice.
Although language is not a determinant of health, care in the mother tongue has a direct influence on patient health, as we have seen with Dr. Prud’homme’s research. As a linguistic minority, the francophone population has always made many compromises. Increased investment in minority language health care and services would not only contribute to the development of the francophone population —
The Chair: I’m going to ask you to wrap up, Dr. Desrosiers. I’m sorry.
Dr. Desrosiers: Yes, I was on the last page. I just wanted to say that this would contribute not only to the development of the francophone population, but also to its health.
I want to thank you for giving me this opportunity to share my thoughts.
The Chair: Thank you, Dr. Desrosiers.
Barbara Losier, Executive Director, Mouvement acadien des communautés en santé du Nouveau-Brunswick: Thank you, Mr. Chair.
Good evening, honourable senators. The Mouvement acadien des communautés en santé du Nouveau-Brunswick, or MACS‑NB, is a non-profit community organization. Let me thank you for the privilege of sharing our perspective on minority language health services with this committee.
We applaud your foresight in understanding the importance of this issue to all Acadian and francophone communities across the country.
For more than 20 years, our organization has been acting as a network to mobilize and support communities and local populations in New Brunswick’s Acadia in taking charge of their health and well-being, both individually and collectively. The MACS-NB brings together 166 communities, Healthy Schools organizations and associated groups. Through its multisectoral collaborations, our network has connections with nearly 200 groups, players and partners in the field of French-language health and wellness in New Brunswick, Canada and even internationally.
I would like to highlight the successful partnerships we have with the Vitalité Health Network and the New Brunswick Health Council.
I would also like to extend a warm greeting to Senator Cormier, who has been a long-time ally of the MACS-NB and a great cultural and artistic advocate in our communities.
The intervention lever favoured by our organization is the Healthy Communities — Healthy Schools model, which aspires to achieve community happiness by placing citizens at the heart of every action and every process.
You will understand that our vision of health is reflected in the aspirations of our communities. This vision includes the 12 determinants of health as recognized by the Public Health Agency of Canada, and is bolstered by strong citizen and community participation. It supports community capacity building and has a strong influence on public policy to achieve health equity; this vision highlights community and school vitality and promotes an ever-growing connection between the system and the community.
The MACS-NB is convinced that the Acadian and francophone community of New Brunswick says yes to the inclusion of linguistic clauses in health transfers; yes to the capture of the linguistic variable to support data on the health of our population; yes to the recognition of language and culture as inseparable components of the determinants of health; yes to the perspective of shaping health in a different way that will lead to vibrant health for the greatest number of people, and in French.
Even though New Brunswick is a supposedly bilingual province, the Acadian population still has great needs in terms of access to promote health services in French. The data show that this is the case even in regions where francophones are in the majority. We can speak here of primary health, mental health, population health and health in isolated rural areas.
It is clear that not everything can be solved from the system alone. The community is eager to be part of the solution as a full partner and is reluctant to be relegated to the passive role of patient. Let’s give communities the power and capacity to offer alternative solutions, as they are already doing across the country.
Studies such as that of the New Brunswick Health Council have shown that health services and care account for only 10% of the population’s health. As Mr. Robichaud said, 40% of health is based on socio-economic factors, 40% on behaviour and 10% on the physical environment.
However, at least 80% of the money allocated to health is concentrated on the first 10% of care and services.
It is more imperative than ever to act on the other 90%. Let’s support upstream action on the determinants of health by, for and with the communities, notably by setting aside a fund from the Public Health Agency for the promotion of the health of official language minority communities.
Let us also realize that Health Canada’s programs for the health of official language communities are currently focused on supporting health systems.
It is important to create a better balance by strengthening the capacities of communities and associations so that they can adequately support the system in improving access to services and be recognized as full-fledged stakeholders.
Supporting the vitality of minority communities remains one of the cornerstones of the Action Plan for Official Languages.
It is clear today that the current methods, which focus primarily on curative care rather than expanded health services, have led us straight into a corner and into upping the ante, even though all the efforts made are highly commendable.
Do we dare to do otherwise? Will we continue to focus on treating disease, or will we dare to work towards full health for our people?
Thank you for giving us a voice and for listening to us.
The Chair: We’ll now go to question period. I would remind you not to get too close to your mike when you speak so that our interpreters can hear, and especially to ensure that they are not adversely affected.
I’ll give the floor to Senator Moncion.
Senator Moncion: Welcome, Mr. Robichaud, and welcome to our online witnesses.
My first question is for you, Mr. Robichaud, and it has to do with disaggregated data.
At the beginning of your statement, you said that this could give a snapshot of the health of the population, but that you didn’t necessarily have a lot of information, and that the information you did have access to was not necessarily disaggregated.
Can you tell us what advantage the government might have in operating in this way, precisely by not accumulating this data, by not wanting to know and by burying its head in the sand?
Mr. Robichaud: It is difficult to take this question in that sense. I would just like to reinforce one point. When you come into the health sector and you haven’t been in the health sector your whole career, you find that our services are changing and you find ways of working without that disaggregated information. I don’t think it’s fair to put all the weight solely on the elected government. Our administrative structures have evolved with this reality over the years.
You know, when the council looked at this, it wasn’t so much that there was a lack of data as that the data we had were very disconnected. There were larger centres, which have more resources, and there may be some exercises that need to be done to understand the health of the population, for example. However, some areas of the province, where the institutions are smaller and people wear many hats, don’t necessarily have the resources to do that kind of work.
It’s really province-wide; I would say it’s not just politically, but organizationally and within the public service. In fact, I would add that one of the lessons I’ve learned myself along the way is that there is a public sector reality outside of health care as well. If you look at our social programs and the education system, the stakeholders have all said over the years that we have been working that they would benefit from having a better understanding or being better integrated, I should say, in the decision-making process, to better know the population that they serve.
Senator Moncion: Thank you.
This is curious, because we were studying Bill C-11 not so long ago, where we were dealing with algorithms that give a lot of information to a large number of companies that we do not know. In the health sector, it would be in our interest to have tools like these, because despite the fact that a lot of money is invested in health systems, we do not have access to all this data. We haven’t yet thought about investing in this area, which is often a shame, because it has negative effects, if you will, on the services we offer now.
Given this premise, is there any work being done in this regard?
Mr. Robichaud: I would like to build on the point you just made.
I think there is potential in the use of algorithms and new technologies in the work that is being done around data. However, when you think about these companies, you have to understand that why they use this data and how they use it is specific to their reality and their needs. Here’s what you can’t overlook on the public side... There is a saying in English: “garbage in, garbage out.” If we apply these technologies to our data, when the quality of the data itself is not necessarily what it should be —
There are two things I would bring to your attention. One is the importance of having geographically aggregated information. It’s true that the postal code is an important element when you look at the results. In fact, at the council, we realized that the provincial averages represent the reality of very few people, because there are many variables.
There is a second element, to build on the quality element. What is unique to the health sector is resources. We are very ill-equipped to understand our resources, the human resources, the physicians, the family physicians, for example, and the practice profiles. We don’t know how many we have or how their time is being used.
I’ll close with another example that struck me personally, given the nature of the work I do. At the beginning of the pandemic, when there were speeches about ventilators, I listened to the responses, but no one responded in our health systems, because we don’t know our resources well; basically, that’s the response. We couldn’t answer clearly, because we don’t keep track of our resources well; that’s one example. There is data on resources, but that’s one of the things that the council, when you look into it, always has to spend several months validating, because you can’t rely on the data that you have at first glance.
Going back to algorithms, if you just put that kind of information into tools like that, the quality will be affected by the fact that the data itself needs to be improved. It’s a chicken and egg situation: having spent decades working with this kind of data without doing it properly gives you the quality that you have. Conversely, if you put more effort into using the data better, the quality will improve over time.
Senator Mégie: Thank you to the witnesses for being here to share their experiences with us. My question is for Dr. Desrosiers.
I wanted to talk about research with you. When researchers apply to granting agencies, are there clauses in the forms that require publications to be produced in English or is the researcher free to choose?
Dr. Desrosiers: I think it would be worthwhile to validate this with researchers, but to my knowledge, it is not a requirement. They have the option of doing research in French or in English.
Senator Mégie: Why do they deny them grants? If they apply in French and the granting agencies suspect that the publication will be in French, do they refuse?
Dr. Desrosiers: I don’t want to speak for other research partners, but we can see that fewer grant applications are accepted when they are submitted in French. We can imply or we can hypothesize that this is one of the reasons, but we would have to validate this hypothesis with the granting agencies.
Senator Mégie: Thank you. I have a question for the other members of the panel, if you could answer it.
One of the witnesses last week mentioned that noting the person’s language on their health insurance card would be a good start, or one of the avenues that would ensure that they are offered services in French.
What are your thoughts on this?
Ms. Losier: Thank you for the question, senator.
I would say that the Mouvement de la santé en français au Canada is very interested.
It has already had the experience, notably with Prince Edward Island, of including the language variable on the health insurance card.
Other provinces and territories are working on this. There are discussions with New Brunswick, but is the health card the only option? There are files that were created just recently, during the COVID-19 crisis in New Brunswick. There is now a file called MyHealthNB; it could be a possible solution. Many partners are on committees working on including the language variable in population health identification systems to make this happen.
There is work that was done in Prince Edward Island and I believe there is research in Manitoba as well, but I can’t speak for the other provinces. I know it has been done in Prince Edward Island. In fact, in New Brunswick, the New Brunswick Health Council, the Vitalité Health Network and our organization are all working within the committee created by the Société Santé et Mieux-être en français du Nouveau-Brunswick (SSMEFNB) to achieve this goal one day.
Senator Mégie: If this was done in Prince Edward Island, there must have been an impact study? Did the fact that it was done make a difference?
Ms. Losier: I would say yes, absolutely, it changed things. Today, the Acadian and francophone community has access to data and the Government of Prince Edward Island and Health PEI have access to real data on the needs and on the use of health services in French by francophones and francophiles in Prince Edward Island. Of course, you would need to ask the people of Prince Edward Island. I am aware of this because it has been studied and researched nationally to support the process in other provinces and territories. We could ask the people at the Réseau Santé en français Î.-P.-É., and they could tell us a lot more.
Senator Mégie: Perfect, thank you very much.
Senator Clement: Good evening, and thank you to all the witnesses. My first question is for Mr. Robichaud and Dr. Desrosiers, and it has to do with the issue of data collection. What interests me is the intersectionality between language and belonging to a minority group, for example. You’ve done disaggregated surveys, I believe. Did you capture that intersectionality? If so, how did you assess its impact?
Mr. Robichaud: If you take a look at the council’s website, you’ll see, when you search the data — it’s important to note here that these are our own surveys, so we control the questions we ask, which then allows us to disaggregate it. Newcomers and Indigenous people, anglophones and francophones: These are examples where we were able to disaggregate the data. People who identify as non-binary, for example, in our schools — that allowed us to better assess the big difference in anxiety, depression, and feelings of being overwhelmed, and it allowed us to have a better grasp of the reality. Now the challenge is to be able to do that on the administrative side as well.
What I would add in relation to the previous question is that the skill allows you to do a cross-check; if you look at people who have diabetes, for example, and you want to assess how well they are controlling it — we can look at areas like Saint John and see if being a member of a minority group gives us equitable results with the rest of the population. Using this identifier, we could do that.
Currently, hospitals ask what language clients prefer. As a province, we need to have a more standardized approach to data collection and how to do analyses like the ones I just mentioned to assess whether being in a double minority, as a francophone in Saint John, affects our health. I would even add that in New Brunswick, there are also anglophone minority groups in francophone areas, and that is also included in our data.
Senator Clement: How can we standardize all this? What is the solution?
Mr. Robichaud: We had a project a few years ago in connection with the work we are doing on the Indigenous population. In discussions with the department, we came to the conclusion that it is not necessarily a question of being simply anglophone or francophone, but that the health system must be able to better identify the sub-populations. The discussion evolved. Yes, mother tongue is a factor; also, for newcomers, it would be relevant to better capture this, especially with recent demographic trends. To that we can add the Indigenous population where there are higher rates of morbidity — like chronic disease, for example — than in the general population.
These are all things that could allow us to do better analyses, but it’s a matter of finding a consistent way to do it.
Right now, some hospitals ask this question all the time, but not necessarily all of them. Once we figure it out, we need to have a collaborative approach with all stakeholders to make sure that all interactions with the system are used to validate it. I’m not familiar with the P.E.I. example; confirmation occurs when the card is registered.
There are different ways of doing things. We are continuing our discussions with the department. I think we are very close to getting there, but it will take a sustained focus to find a solution.
Dr. Desrosiers: We can’t rely on our past or our present with respect to this data, because we are quite archaic in our approach. There is no data available for the subpopulations that we have access to that we can pull enough information from to act on. The vision with the new health plan is to have a connected system — and I echo Mr. Robichaud’s words — where the different partners, the board, the ministries, the health authorities and the private partners work together to share data and to properly organize data governance, which will allow us to be more consistent and have more reliable data to make informed decisions in the future.
Senator Dalphond: I would ask Dr. Desrosiers for a copy of Dr. Prud’homme’s report. You referred to a study and some results. Could you send it to the clerk of the committee?
Dr. Desrosiers: Absolutely.
Senator Dalphond: Mr. Robichaud, Ms. Losier referred to 12 determinants identified by Health Canada and you referred to determinants based on the Wisconsin system. Are these determinants the same?
Mr. Robichaud: It’s coming together. When the council began its work, we found around the table people who had experience as health professionals, health managers, people who work in the education, public policy and community sectors.
In fact, Ms. Losier was a founding member of the Health Council.
The model they were looking for was a way to organize indicators — hence the Wisconsin model. In the system, Health Canada determinants were used. We looked around the world. There was consistency — at least in the industrialized countries — on the concept of determinants. But it was in Wisconsin that we found a tool that allowed us to organize indicators to paint a picture with examples of measures that would be used as socio-economic factors: health behaviours, environmental factors and health services.
Senator Dalphond: For New Brunswick, there is an additional factor, which is the fact that there is a bilingual population, which is not the case in Wisconsin.
Mr. Robichaud: The language of services is captured in all our surveys. If it can be identified on the administrative side as well; the model does not need to change. In fact, this would answer the question: Are our francophones less healthy than our anglophones? I would say to you that we often have francophone communities that are healthier and have better results.
We cannot attribute this to specific things, but as a provincial organization, I can tell you that, in the activities of the group to which Ms. Losier belongs, we — as an organization that deals with the English and French communities — have taken note that the organization is different on the French and English sides. Ms. Losier’s group ensures a certain mobilization and sharing of experience and knowledge that is not seen in the same way on the anglophone side.
Senator Dalphond: My next question is for Dr. Desrosiers. We realize that data on certain individual characteristics, such as language, are not always collected in the same way.
When a patient comes to Vitalité Health Network, are they asked in which language they prefer to be served? If they answer that they don’t care, we don’t know if they are French- or English-speaking. How do you structure the data collection? I understand, for example, that there is no health insurance card that indicates language preference for services.
Dr. Desrosiers: The active offer is made up front when health care staff introduce themselves to the patient and ask if they prefer to be served in French or English. All of our guidelines are aligned with that. When we look at our largest hospital in Moncton, 50% of the clientele is English-speaking and 50% of the clientele is French-speaking. People are fairly accustomed to finding someone who speaks the patient’s preferred language, if the health care employee or professional is not able to respond in the patient’s preferred language.
Senator Dalphond: Do you write a note in their file? Do you write it at the beginning, in French or in English?
Dr. Desrosiers: At admission.
Senator Dalphond: Afterwards, if that person undergoes an operation, they are not asked what language they want to hear if they are in a coma. We know that they want services in French, for example.
Dr. Desrosiers: Yes. As soon as the patient is registered, regardless of the service, all patients register, whether it’s for the emergency room, selective services or outpatient services. That is part of the basic questions that patients are asked.
Senator Dalphond: Thank you.
Senator Mockler: I would be remiss if I did not apologize to you, honourable senators. I just learned that driving a car in the Montreal area is not like driving in Edmundston.
I want to address each one of you. All three of you play an important role in providing and improving health care in our region. I want to congratulate you for that.
I would like to formally acknowledge that this is the first time I have met Dr. Desrosiers, who has a very good reputation. I want to congratulate you on your leadership and dedication to improving the quality of health for the people of Acadia, the people of Brayons and the francophones of New Brunswick.
My questions relate to recruitment and accreditation.
Dr. Desrosiers, what are your strategies for recruiting personnel, particularly from francophone countries? Do you coordinate your own strategies or do you join forces with other boards or levels of government?
Dr. Desrosiers: Thank you for the question.
We are still taking our first steps in international recruitment for Vitalité Health Network. Over the past year, we have been on five or six missions to countries in the Francophonie to do recruitment. To date, we have always been accompanied by partners who have already made their mark in international recruitment.
Among our most important partners, Opportunities New Brunswick has been very supportive. I would also note that the Université de Moncton is our second most important partner in our international recruitment initiatives.
Senator Mockler: What steps have you taken to recognize the credentials of individuals recruited from abroad? When I was in government in New Brunswick, it was always an international discussion. So for foreign credentials, what barriers does the federal government need to remove to facilitate recruitment and address the health workforce shortage?
Dr. Desrosiers: The answer is different depending on the type of health professional you want to discuss. If you’re talking about the nursing side or the nursing profession, it’s much more of an influencing power that we’ve used over the last year to make sure that the Nurses Association of New Brunswick, or NANB, moves forward to recognize foreign certification more quickly.
We immediately hired qualified newcomers who were registered nurses in their home countries. We hired them as orderlies, while lobbying within the provincial nursing association to speed up the recognition of prior learning. It’s a collaborative effort with that partner. Frankly, it’s working — for the first time in a long time — with NANB.
For physicians, it’s a little different. New Brunswick was one of the only provinces that didn’t have a program in place to assess the competencies of incoming physicians. We are building an approach with the College of Physicians and Surgeons of New Brunswick. Vitalité Health Network has been a pioneer in this area in recent years. We have participated in Canadian round tables to try to influence our province in this direction. This is bearing fruit: The program is under construction with the College of Physicians and Surgeons of New Brunswick.
Senator Mockler: I have one last question, Dr. Desrosiers: The FCFA recommends that the federal government recruit 12% of francophone immigrants outside Quebec by 2024. The figure we are given is 50,000 people who speak French. Do you believe that such targets would address the labour force challenges to ensure better quality health care in New Brunswick and Canada?
Dr. Desrosiers: I think that is definitely part of the solution. The solution is multifactorial. We need to talk about retention as well as recruitment. We need international recruitment. If you look at the demographic trends in our province, that won’t be enough. We need to think about different approaches.
Senator Mockler: Thank you.
The Chair: Before we go to the second round, I will ask some questions myself.
Ms. Losier, I must acknowledge, for the benefit of my colleagues, that I had the opportunity to work with you for many years before I came to the Senate. I want to say that before I ask you my questions.
You have made an important case for the recognition of community organizations in maintaining the health of citizens. How could the federal government better support your communities and community organizations? We know that the federal government has agreements with the provinces. We wonder if these agreements should include language clauses and if such clauses would allow you to obtain more funding. Can you give us a picture of what the federal government could do to better support you and your partner organizations in your work?
Ms. Losier: I would say that I suggested the first thing in our presentation. We suggested a program specifically for the promotion of the health of official language minority communities in Canada. A proposal has been made to the Minister of Health of Canada to that effect.
This is an ongoing discussion, but the biggest challenge is that health investments in Canada, at the provincial and territorial levels, are often focused on the treatment of illnesses, the purchase of state-of-the-art resources and equipment and the people who accompany our patients. This is very important. We don’t deny that, but there are very few programs that are specifically dedicated to working upstream on other health factors, which would ensure that people don’t all end up in the hospital. It would also prevent some of the heavy lifting in the health care system. There needs to be a greater investment in health promotion, disease prevention and community capacity building. Health promotion is something that the community can take to another level. Citizen mobilization is about supporting communities.
Language clauses attached to health transfers are fine, but until there is a program — there was a fantastic program — and I congratulate Senator Mockler, who was the Minister of Wellness for the New Brunswick government. The Department of Wellness no longer exists or has been split into other departments.
The reality is that systems of government and priorities are changing. Public Health New Brunswick has just been launched and will have a responsibility for wellness and the well-being of citizens.
I would say that there needs to be more investment upstream to support communities and associations. This will encourage people to take better care of themselves and avoid clogging our emergency rooms. We need to have a choice.
The Chair: Thank you.
We know that culture is considered a determinant of health. Language in itself is not a determinant of health. Several witnesses said that language should perhaps be included as a determinant of health. What are your thoughts on this?
If language were integrated, what kind of impact would that have on the federal government’s accountability to the communities you serve?
Ms. Losier: Language is inextricably linked to people’s culture and cultural identity. However, language is indeed not recognized as one of the 12 determinants of health. It has been included in culture. Excuse me, but I may be showing community sensitivity by saying that it is more beneficial to drown language in culture than to make it a determinant in itself.
If the Government of Canada and the Public Health Agency of Canada were to recognize language as a determinant of health, this could be a major step forward for official language minority communities in Canada.
At the moment, language is considered to be inextricably linked to the cultural determinant, and it is named in all the work that is being done.
The Chair: Thank you, Ms. Losier.
My question now is for Dr. Desrosiers.
You talked about the decision of the Government of New Brunswick to create two new boards of directors within Horizon Health Network and Vitalité Health Network. If I understand correctly, there is also a collaborative council that is being created for the two networks to talk to each other, according to the news that was announced.
You said earlier that bilingualism always turns into English in the end. How do you see this collaborative council working? In your opinion, will it really meet this need for collaboration between the two boards?
Dr. Desrosiers: We have not received the details of the mandate and operation of this committee.
In all honesty, in general, most of the meetings at the provincial level are conducted in English because most francophones are bilingual and most anglophones are not. Now, this is not to say that because we are bilingual, it is as easy to work, think and be alert and relevant in our conversations when we are not working in our first language.
This is a reality not only for this committee, but for all the provincial committees in which we participate. Despite the efforts of some departments that sometimes provide simultaneous translation services, it is far from an ideal situation in our province at this time.
At the provincial level, there is definitely a need to increase the alignment and coordination of the various health partners. In New Brunswick, the Department of Health and the Department of Social Development are two separate departments. If there is a lesson learned from the pandemic at this decision-making level, it is that there is a need. I wouldn’t necessarily say the need for collaboration, but more importantly the need for coordination focused on the needs of the patient. Coordination between the different partners — we’re not just talking about the two boards. We could be talking about the Health Council, the Department of Social Development, private and public partners who work in New Brunswick to provide our Extra-Mural Program and our ambulance service. There needs to be an alignment of priorities.
The Chair: My next question is on human resources. Bill C-13, on official languages, which has just been passed in the House of Commons and will soon be sent to the Senate, talks about a francophone immigration policy.
What challenges do you face in promoting and integrating human resources from abroad? How could a federal policy better support your human resources needs, particularly with respect to the recognition of diplomas? We talked earlier about credential equivalency.
What do you think the policy would need to be in order to really support you?
I would ask Mr. Robichaud to answer my question first. Then it will be Dr. Desrosiers’ turn.
Mr. Robichaud: The factor this brings to mind is that of properly defining language-based positions. Sometimes we run into obstacles. You’ll determine that a position needs to be bilingual, but because there are no candidates, they’re labelled as “equal proficiency” positions in the system, and then you end up hiring a unilingual person.
I think there are much clearer definitions and it would be important to follow up.
I hear too often that language is not a skill in the selection of some of these positions. That immediately brings to mind the element of definition and how funding should be tied to positions that will meet that definition. We practise more often than not — I see that we contravene the needs identified as “bilingual” because we end up saying they’re all skills. Yet, the language skill was not enough.
The Chair: Thank you.
Dr. Desrosiers, do you have a comment?
Dr. Desrosiers: Not on this point.
The Chair: Thank you very much.
We don’t have much time left. I would ask you to keep your questions short and your answers short.
Senator Moncion: I will ask my questions, but the answers can also be given in writing.
Between Vitalité Health Network and Horizon Health Network, are there budgetary disparities in the amount of money associated with either network? Are people from one network better paid than people from another network? We’ve seen that in other places quite often.
My second question is related to the exams that francophone graduates take. We have seen much lower pass rates for those who took the NCLEX exams compared to the exams students took in Quebec.
Has this new option had a positive impact on your network?
The Chair: Do you want to answer the question, Dr. Desrosiers?
Dr. Desrosiers: I can start, if you are in agreement.
With respect to equal pay, all salaries in New Brunswick are managed by Treasury Board; it is a provincial approach that is, in theory, fair. Are there audits to verify compliance with Treasury Board directives? That is another question. To my knowledge, there are no audits that are done in a general way to compare one network with another.
With respect to the budget, this is an excellent question, because there is no clear formula for the distribution of budgets in New Brunswick. If there is one, I don’t know it and I’ve been asking the question for a long time. In fact, what would a fair budget be? Would it be based on the percentage of francophone and anglophone populations? Should it be adjusted to recognize the rurality of francophones? Should we know the health needs of francophones on average?
Vitalité Health Network must help train not only francophones in the province, but also the bilingual health professionals who are hired by the two health authorities and other health partners. So an equitable formula, I think, is not just saying 68% or 32% of the population. I think that’s something that needs to be thought through.
In terms of the NCLEX exam for our registered nurses, there has been a great improvement in terms of the translation of the exams and the tools. As far as I know, currently the pass rate for francophones is similar to that of anglophones, or at least improving in that direction.
I think it would be interesting to verify these rates, because we don’t necessarily have all the data on the number of francophones who have taken the exam in English, because they feel more comfortable taking it in English, and on their success rate. We do not have the data to form a complete opinion on that.
Senator Mégie: My question goes back several years. I was aware of a project called Franco Doc, which was mapping health care professionals in universities to try to match them by setting. At the time, I was with Médecins francophones du Canada and they came looking for us to serve as mentors for these academics.
Does this program still exist? Did it have the impact you expected in the community? Did it go well, or did the program disappear?
Mr. Robichaud: I don’t know.
Dr. Desrosiers: I’m not aware of that program, at least for the health system. What I can tell you is that we are in the process of setting up a mentoring program with the support of our retired nurses to welcome and accompany newly arrived nurses.
Ms. Losier: I remember the Franco Doc program and I would like to reassure Senator Mégie that this program is continuing, and it is a program of the Société Santé en français. We will be able to send you information and an update because today, the program is aimed at a broader group than just physicians. There have been benefits, absolutely. Thank you for contributing to that.
The Chair: Thank you for sending that information.
Senator Clement: I have a question for Ms. Losier. I am very interested in the partnerships that you have established, especially with the municipalities. We always talk about health, federal and provincial, but my experience in Cornwall is that cities are also using their budgets to address gaps in health care services for their communities. Can you comment or tell us about the partnerships you have developed with municipalities in particular?
Ms. Losier: There is a major municipal governance reform underway in New Brunswick. Indeed, municipalities are partners of choice, and I think Dr. Desrosiers would agree. The strength of municipalities and communities is to ensure retention and welcome. We need to have livable neighbourhoods and municipalities, places where health professionals want to settle.
I have a little anecdote. I remember people in the Lamèque community being asked how they recruit and retain their health professionals, and they would say, “We bring them here for an internship and then we marry them.” The role of municipalities is very important.
Senator Clement: Thank you.
Senator Mockler: To follow up on Senator Moncion’s question, Dr. Desrosiers, if nurses in New Brunswick used the Quebec exam instead of the NCLEX, would that make retention easier? Would we have more people moving to New Brunswick?
Dr. Desrosiers: This is one of the issues that has progressed over the past year. Our nurses now have access to this exam. They can choose to take the Quebec exam. What could facilitate access to the exam is to do it from their province, without having to travel to Quebec to take the exam. We have already taken a step in this direction and the success rate is quite high.
The Chair: Thank you. Dr. Desrosiers, Ms. Losier and Mr. Robichaud, thank you very much for your contribution to this important study. We’ll suspend for a few moments while we welcome our next witnesses.
For our second panel of witnesses this evening, we are pleased to welcome, from the Fédération des aînées et aînés francophones du Canada, Jean-Luc Racine, Director General, and by video conference, from the Association francophone des aînés du Nouveau-Brunswick, Marcel Larocque, President, accompanied by Jules Chiasson, Executive Director. Finally, from Carrefour 50+ of British Columbia, we have Joanne Dumas, President, and Stéphane Lapierre, Executive Director.
Good evening and welcome to the meeting. We are now ready to hear your presentations, which will be followed by a question and answer period. Mr. Racine, since you are here, we will start with you. The floor is yours.
Jean-Luc Racine, Director General, Fédération des aînées et aînés francophones du Canada: First of all, I would like to point out that Ms. Solange Haché was supposed to speak, but since she is having connection problems, I will do it for her.
Mr. Chair, honourable senators, as director general of the Fédération des aînés francophones du Canada, I thank you for inviting us and two of our member associations to appear before you today.
Our organization has been working for many years to promote the health needs of francophone seniors and, in particular, to promote the importance of providing French-language services in this area.
When you are elderly, ill and in a vulnerable situation, the last thing you want to do is to ask for services in French. You don’t have the strength or courage to make such requests. This does not mean that you do not want or need these services. On the contrary, seniors want French-language health services.
A recent study in Saskatchewan showed that 70% of francophone seniors who responded to a survey identified access to French-language health services as an important issue. Many francophone seniors in a minority setting told us how unfortunate and deplorable they find the lack of French-language services, particularly in terms of home care services and long-term care residences.
With respect to home care and support services, seniors tell us that it is virtually impossible to obtain services in French in the vast majority of regions across the country. When services are available, they are often cut off without notice or offered only in English. This is also the case in senior care residences, where French-language services are often neglected and even totally absent.
Over the years, we have met with young retirees who have shared with us their traumatic experience with the placement of their older relatives. One retiree told us: “My mother managed to live in French in her community all her life, but in her last years, everything was done in English. She couldn’t die in French.”
Yet it is possible to do things differently. In Prince Edward Island, there have been successes in strengthening the ties between nursing home residents and the community by providing funding to community groups for activities between local seniors and those in nursing homes. English-speaking stakeholders even said of one French-speaking resident, “We thought the resident was nonverbal, meaning she couldn’t express herself, but seeing her interact with members of the French-speaking community, we realized it was a language issue.”
As a person with cognitive problems gets older, a person who was fluent in English will revert to his or her native language. When you’re sick, it’s harder to be bilingual. It is important to be able to offer services in French; it can sometimes be a matter of life and death. When you are sick, you have to be able to understand and be understood in order to avoid misunderstandings that could lead to complications.
When dealing with an elderly, sick and vulnerable person, it is important to find a way to provide services in their native language. This is not a matter of public policy, or official languages, or even obligation; rather, it is a matter of providing good health care for all citizens. The federal government must play a leadership role with the provincial and territorial governments so that we can all work together to establish a better offer of health services for francophone seniors in minority situations.
First, language clauses must be included in the Canada Health Transfer and clearly stipulate the amounts to be allocated or the targets to be reached for the delivery of services to francophones in minority communities.
Second, there is a need for more strategic and sustained funding, and the federal government must ensure that provincial and territorial governments allow us to be more innovative and creative in the delivery of services to francophones.
Third, we need to support the provision of French-language home care and services. Fourth, initiatives such as those in Prince Edward Island must be encouraged to further engage community groups in visiting and organizing activities with francophone seniors in residences.
Finally, special attention must be given to seniors who are often doubly in the minority, namely LGBTQ2E+ and racialized people. Many seniors from the LGBTQ community told us how difficult it is to obtain more specialized services in French.
There would be many more situations to share with you, but we hope to have a chance to talk about them during the discussion. I see that our president, Ms. Haché, is now online. She will be able to answer many of your questions.
The Chair: Thank you, Mr. Racine, and welcome, Ms. Haché. You will be able to speak during the question period.
I will now give the floor to Joanne Dumas and Stéphane Lapierre, respectively President and Executive Director of Carrefour 50+ of British Columbia.
The floor is yours.
Joanne Dumas, President, Carrefour 50+ of British Columbia: Mr. Chair, members of the committee, thank you for the invitation to appear before your committee. It is truly appreciated.
We represent Carrefour 50+ of British Columbia, which brings together all the francophone associations that provide services to francophones and francophiles aged 50 and over, here in British Columbia.
Like the rest of Canada, the proportion of people aged 50 and over in our province continues to grow, from 1,882,000 in 2016 to 2,056,000 in 2021. This is an increase of 8.48% over this period, making our province the second largest province, after Ontario and excluding Quebec, with the largest number of people aged 50 and over. Of the 74,640 francophones living in a linguistic minority situation in our province, 32,355 are 50 years of age or older, which places us in third place, again excluding Quebec. It is important to note that British Columbia is still the only Canadian province that does not have a French-language services policy recognized by the provincial government.
This is quite sad.
Over the years, there have been many examples of signage, particularly in the area of health and public services, that was in several languages other than English, but excluded French. We have seen this in hospitals, medical clinics and donor clinics, as well as in libraries. We understand that we live in a unilingual English-speaking province, and we respect the right of citizens who speak other languages to have signage in their first language. However, as French is one of Canada’s two official languages, we feel it is essential that it be included in multilingual signage when languages other than English are used.
With increased movement at retirement age to the warmer climate of Western Canada, one phenomenon is now better known and documented: A learned language is forgotten in various situations. Take the example of an exogamous couple for whom one person’s first language is French, but who, for various reasons, communicate in English. The French-speaking person can be said to be fluent in English. On the other hand, many medical or neurocognitive situations can cause a person to forget their learned language in favour of their mother tongue, in this case French. It is then very difficult for them to express their needs, or their misfortunes, in the language of the majority. As an example, here are two relevant articles: Alzheimer’s disease, forgetting a learned language —
The Chair: I’m sorry, Ms. Dumas, we have to interrupt you. There is a reception problem. Unfortunately, we can’t hear your statement.
Ms. Dumas: Could Mr. Lapierre complete the remarks? There was only one paragraph left.
The Chair: Please go ahead.
Stéphane Lapierre, Executive Director, Carrefour 50+ of British Columbia: Ms. Dumas mentioned that we have attached two relevant articles to the document that relate to what we are saying to you today.
There is a residence in Maillardville, a suburb of Vancouver, the Foyer Maillard, which has been in existence since 1969. For 47 years, priority of residence was given to people who spoke French, so that they could age in their native language. Since its reconstruction and reopening in 2016, although there are still French-speaking staff members, there are almost no French-speaking residents, and now there are no spaces reserved for this clientele, even though the centre, like many others, benefits from funds from federal health transfers.
So, with all these examples, we want to emphasize the great importance of imposing language clauses in federal health transfers to the provinces and territories, as is done in the area of education. French-language health care is a very important issue for francophone seniors living in a linguistic minority situation such as ours, throughout Canada.
Thank you.
The Chair: Thank you both for your presentation. We will now hear from Marcel Larocque, President, and Jules Chiasson, Executive Director of the Association francophone des aînés du Nouveau-Brunswick.
The floor is yours.
Marcel Larocque, President, Association francophone des aînés du Nouveau-Brunswick: Thank you for welcoming us. It is very interesting to be here. I am hearing some great things and I will try to add some different information.
We have sent you the documentation so that we can focus on the main issues. The main issue for the Association francophone des aînés du Nouveau-Brunswick is language. Even though New Brunswick is the only officially bilingual province, it is still too often the case that people cannot receive services in their mother tongue. This is why we are focusing on this important issue.
To illustrate this, my presentation will be divided into three parts: caring, the different roles regarding official languages in New Brunswick and what the federal government can do to support us in this matter.
As you know, our seniors are experiencing several problematic situations regarding services in their primary language. It has been said that there is an urgent need to act on many health issues, especially when it comes to language.
Almost two years ago, on June 15, 2021, we held a round table discussion on World Elder Abuse Awareness Day.
After that round table, a standing committee was formed and met about 40 times in 2021-22. The committee was made up of former ministers of all political stripes, senior government officials, people from the health care community, and well‑educated people who could follow up regularly. As a result of that first year of major consultations, on June 15, 2022, we released a report entitled Aging with Indifference and Indignity in New Brunswick, which you have received. I won’t give you the highlights. I just want to tell you that it is easy to read, it is 20 pages long and it has only six recommendations. It may take about 20 minutes to read at most. Throughout the underlying report, you will see what the language challenges are. I would caution you that this is not bedside reading, even though the report is not long, as there are some horror scenarios involving our seniors in New Brunswick. Unfortunately, I believe this is widespread across the country.
At the same time, the Association francophone des aînés du Nouveau-Brunswick conducted a review of the Official Languages Act. We submitted a brief, as did the entire Acadian and francophone association community. The judges, Ms. Yvette Finn and Mr. John McClaughlin, received our recommendations. Without going into detail, I will list the three main ones.
We asked that services offered to the public in nursing homes established under the Nursing Homes Act be provided in both official languages in all health regions of the province, in order to meet the needs of both official language communities in the province. As you can see, we are not just looking out for francophones; we want all New Brunswickers to be able to obtain health services in their language.
We have also asked that, for the purposes of delivering health care in the province, all health care institutions, facilities and programs under the jurisdiction of the Department of Health or the regional health authorities established under the Regional Health Authorities Act ensure that all services to the public are available at all times in both official languages of the province. As I mentioned earlier, in New Brunswick, a bilingual province, even in regions with a large francophone population, it is not always possible to have services in the language of one’s choice. I can confirm this for my Acadian Peninsula and for other regions of New Brunswick. Finally, we have asked that the definition of “nursing home” be included in the new version of the Official Languages Act, because there is nothing in this regard.
It has been mentioned several times this evening that as you get older, you go back to your mother tongue. So it is extremely urgent. What can the federal government do? We are asking the federal government to add a language clause to all federal health transfers in order to improve French-language services for francophone minority communities; we are also asking that a language clause be added to the transfers for elder care, so that francophone seniors in minority communities can benefit from care and support services in French in nursing homes and at home; we are also asking that the federal government contribute generously to francophone post-secondary institutions to ensure better retention and recruitment of staff in nursing homes and home support services; and finally, we are asking for support for research to find solutions that promote access to care and support services for seniors in the language of their choice.
Thank you again. Too often, unfortunately, we have to fight with the courts to have our rights respected, but together we can do it. Thank you for your time.
The Chair: Thank you to all the witnesses for your opening statements. We’ll proceed with the question period. First of all, Senator Moncion.
Senator Moncion: We often hear — and this is a common denominator — about the issue of language clauses. We know that, for Bill C-13, the government did not see fit to formally include language clauses in the documents.
Do you have any suggestions as to how this should be done, given that there may be other possibilities within the legislation that could open up this loophole and make it possible to achieve this objective?
Mr. Racine: I will invite my president to answer that question.
Solange Haché, President, Fédération des aînées et aînés francophones du Canada: Thank you very much. Excuse me, I had the wrong link, so I had trouble connecting.
Certainly, the issue of health transfers is a very important subject and a major concern for our federation. When we talk about health, it is certainly one of the sectors that is essential to the development of our communities.
We know that the Canada Health Act does not provide for any commitment to make changes in this regard. We know from experience that, in certain areas of the Canadian francophonie where there have been language clauses, with very specific, clear targets attached to specific amounts, this has produced certain results. This is exactly what the federation has been asking for for a long time: very specific clauses regarding health transfers. At this point, we can say that it is simply wishful thinking on the part of governments. There are very few commitments. It is very unclear what this priority is. We know that when there are no language clauses, practically nothing is allocated to our communities.
Are there any suggestions? Perhaps my colleague could answer more precisely, but I must say that the issue of health transfers, with very specific amounts and very specific language clauses, is a major priority on the national level.
Mr. Racine: Of course, we would have liked to see more teeth in the language clauses in Bill C-13. It is mentioned in the bill. There is a commitment to consult the communities to determine whether clauses should be included. I believe that health is paramount. We will accept it, but we will continue, and it will be up to the Senate to assert the importance of having such clauses in health agreements. That would be the least we could do. We need them. Ms. Haché described what we need. We need robust clauses, a little more than clauses with teeth. That is what we need in health agreements.
Senator Moncion: My next question is for the representatives of Carrefour 50+ of British Columbia. Ms. Dumas, you said that in 2016, the francophone population of British Columbia was 1,882,000, and that in 2021, it was 2,056,000. The total population of British Columbia is currently 5,071,000 people. This is almost half the population. If you add another 500,000 francophones, this means that almost half of the population in British Columbia will be French-speaking. This was a figure I did not have. I find it quite extraordinary, and I still find it completely absurd that you have so much difficulty obtaining services from the government. I don’t know if there is a question around that.
Ms. Dumas: Certainly, it is a challenge. We have problems with all the envelopes. Even with education, we have seen in recent years the amount of money that has had to be spent to take advantage of our rights in education; it has cost millions of dollars for the cause. You can appreciate that trying to promote health care has not become a priority overnight, believe me.
Look at the example of Foyer Maillard, a home established by a community, with land donated by the community, by francophones and for francophones.
As soon as it had to be rebuilt, because the building was tired, the money transfers came from the local health authority, and since it is money that comes from the province, the services and rights that we had acquired in the past — because we did our own thing — were lost. In fact, we have money from the province, and for them, it is not a province that is considered bilingual, as you know. There is not even a position or policy towards the francophonie in British Columbia.
So, everything that has to be dealt with in British Columbia when dealing with the francophonie is always a big challenge, even if there are agreements with the federal government, such as in the education sector.
Mr. Lapierre: If you would allow me to provide additional information — senator, thank you for your question.
The numbers that you stated, 1 million and 2 million, that is the total population of the province; that includes all the people who are 50 years and older. Of that number, there are 32,355 who are 50 years of age and over who have declared French or French and English as their first language.
This puts us at about 74,640, or roughly 1.6% of the population. That’s the problem for us: We are not considered numerous enough, but according to our way of seeing things, we still represent one of the two official languages. So, when we talk about posters that are displayed in several languages in different environments, and that there are sometimes up to 12 languages on a poster, but that French is absent from this list, we find this absurd in terms of the official languages of our country.
I wanted to clarify the numbers; it’s partly the whole population versus the francophone portion.
The Chair: Thank you to the witnesses for their answers.
Senator Mégie: I welcome all of you as witnesses who are here to enlighten us for our study, and I thank you.
You have surely heard and read about the 2023-28 Action Plan for Official Languages. Do you know if the funding announced will be sufficient to help your organizations?
Ms. Dumas: When the minister toured Canada in French, it was unanimous. Everyone said that there were needs well beyond a 40% increase; however, with the new agreement, we will not go beyond 25%. There is still a shortfall to be able to function well and to do so in a professional and adequate manner.
I can say that yes, there is 25% more, but it is really below what was needed. When you consider that there hasn’t been a real increase in over 14 years, it was necessary to do something for Canada, both in the provinces and in the territories.
Mr. Larocque: If I may add something to complete, the federal money, bravo, we applauded it, there are some good amounts in there. Is it enough? No, it will never be enough.
I must add that in some provinces, like mine, New Brunswick, when transfers are made to the province, it is another struggle for us to get what is due to us. Often, it becomes very difficult to ensure that the money goes to the right place and that it is properly distributed; this doubles the complications.
Mr. Racine: In terms of health, the action plan provides for $92 million to encourage the provinces to offer more services in French, particularly — and this is mentioned — through an action plan for care and services for seniors.
For the moment, it is very difficult to know how all this will work. We’re waiting for more information, but we’re hoping that it might be new initiatives. What we understand for the moment is that it would come under federal-provincial agreements. That remains to be seen and that is our interpretation; it is still early to really measure the full scope of the health action plan and its impact on francophone seniors.
Senator Mégie: Since each of you manages programs, for example, if there was a lack of money, is it possible to implement the plan by looking at all the existing programs with a francophone lens, to be able to meet the needs of your seniors and their caregivers? Would that be a possibility?
Mr. Lapierre: Thank you for the question, senator.
I should just mention that we already make requests that reflect the reality of what we are asked to provide in our communities. However, we are mainly governed by the regional offices of Canadian Heritage. They often tell us in the last few years: “Ask for the amount of money you consider essential to the services you want to offer to your target clientele.”
However, we never get any additional money. It’s as if the envelopes are all predefined. There was a time in our province when it was called “the pie.” There was an amount of money in an envelope and you knew in advance who was going to get how much every year, or every two- or three-year cycle.
As Ms. Dumas mentioned, that didn’t change for almost 15 years. There was an adjustment three or four years ago. That helped a lot, but it was a catch-up from the previous 15 years when there was no increase. Now there is a planned increase, but it is a maximum of 25%. Maybe we will only have 5%, or maybe we will have 10% or 25%.
However, there are also organizations that will receive new funding in areas targeted by the action plan. So, we do not know how this will be distributed across the country as we speak.
Senator Mégie: Thank you very much.
Jules Chiasson, Executive Director, Association francophone des aînés du Nouveau-Brunswick: I would like to add something to what Mr. Lapierre said. In New Brunswick, a good part of our funding is allocated to projects that are not just funded by Canadian Heritage or because of the linguistic situation of the community.
Of course, we have the New Horizons projects, and there are also projects from other departments that provide some funding to our projects.
As for the funds set aside for the language community by Canadian Heritage, they could indeed be increased.
To answer the question that was asked earlier about health and how funding could be improved, Bill C-13 does not really answer the question about the fact that the funds are intended exclusively for linguistic communities, because they go through fund transfers.
Treasury Board might be the only body that could make regulations to ensure that those transfers are really for official language minority communities.
The Chair: Just to clarify, basically, you’re saying that under the regulations, Treasury Board could be more specific about how the funds are transferred and how they serve the populations that you serve yourself?
Mr. Chiasson: Yes, it could finally ensure that the transfers to the provinces are really intended to help official language minority communities. If the bill doesn’t do that, Treasury Board could still make regulations that could do that.
The Chair: Before I give the floor to Senator Clement, I have a follow-up question to Senator Mégie’s.
Of the programs that are funded by the Action Plan for Official Languages, are there any programs that are not permanent that you think should be permanent? Are there any programs that are funded by the Action Plan for Official Languages that you think should be permanent programs? Who would like to answer that question, if you have any information on that?
Mr. Racine: Are you asking about the health elements in the action plan or the action plan in general?
The Chair: The elements that would support the associations and the actions that you are taking in the health area, yes.
Mr. Racine: In the action plan, many health-related programs are being renewed.
Some envelopes will be renewed, but many of our initiatives — we just found out, because we thought it was funding, but we have a program more focused on the social dimension — we thought it was a permanent program, but we just found out it wasn’t. It’s often through the action plan that you learn these things.
For us, it is a question of having as much permanence as possible in the funds granted, and that is not always easy. That’s what we hope for. Unfortunately, in the new plan, even the $92 million I was talking about earlier is one-time funding for the next five years; there’s no commitment to renewal. We are very concerned about that. It will give us some momentum, but that’s as far as we’ll go.
The Chair: Thank you, Mr. Racine.
Mr. Lapierre: I would like to mention that even with respect to Canadian Heritage programming funds, we are not told from one time to the next that these are guaranteed amounts. When you talked about permanence, we can’t think that these programming funds are permanent either. You always have to prove yourself from one time to the next.
I understand that some agencies perform better than others, certainly, and some need to be revised — I would dare say we have a sword of Damocles hanging over our heads at times.
The Chair: Thank you for that answer.
Senator Clement: Good evening, and thank you all for your testimony, for your careers and the work that you do. Thank you also for the answers you have given with respect to the language clauses. Your comments tonight are very important.
I am interested in intersectionality. Mr. Racine, you say that one can be a double or triple minority; that is easier to say. Do you do the data collection? What work needs to be done to assess the impact of being a double or triple minority, let’s say being francophone, Black and older and having access to health services?
Mr. Racine: There are certain factors, especially in the case of newly arrived Black communities. It’s not easy to navigate the health care system, especially when you don’t speak English. Often, many of the newcomers who arrive in our communities can manage in French, but it is more difficult in English. This is quite a challenge and, as we know that more and more immigrants will arrive here, we will have to be more and more attentive to these needs. When you go to see a doctor and you don’t speak English, or hardly at all, it’s hard to know what’s going on, especially since you’re not very used to it.
There’s the whole cultural element to it, so it’s not easy. I’ve heard from people in the LGBTQ communities that in terms of services, it’s difficult, and when you go to the nursing homes, you have to go back into “the closet.” That’s the reality, because people who have a different identity are not easily accepted; you have to go back into the closet. It’s very difficult and painful.
Not only do they not have services in French, but they also have to go back into the closet. It’s not very interesting. This is a phenomenon that we don’t just see in our communities, we see it in Quebec. Dany Turcotte is working on this. So, it is important.
Senator Clement: What do you do with these stories? What needs to be done to...
Mr. Racine: We need more sensitivity in the communities. We do a lot of that. When I came to the federation, we didn’t talk about LGBTQ people; now we are talking about it more and more among the elders. What’s interesting is that doctors have told us that the trans people who come to see us are very much in their 20s and in the other group, people in their 60s. There is a growing need in this area.
We need to be innovative in the models or the type of services offered. The federal government must help us to be much more innovative in our approaches and perspectives to reach francophone clients, especially doubly isolated francophones. I think there are many things that can be done, but the federal government must show leadership, not just in terms of transferring funds, but also in terms of having a discussion with the provinces to take them much further. Often, the unfortunate thing about health care is that we tend to reproduce the models of the majority, and we want francophones to be able to offer services in a vast territory using the same model as anglophones.
However, there is evidence that sometimes we can be innovative. I have seen communities propose new solutions and often, anglophones envy us when they see how creative and innovative we can be. The government still needs to allow us to show leadership in this area, get the provinces to think differently and fund initiatives that it would not necessarily fund on the English side. That is where we need to go; I think that is the future for francophones.
Senator Clement: So there is a blockage with the provinces?
Mr. Racine: Yes. Often, the provinces do not know. They know what to do for the majority, but for francophones, they are a bit ambivalent. We see this sometimes. With the federal government, we need to show leadership, have discussions and build on innovative models. I could name several, and if I am asked questions along these lines, I can answer them.
The Chair: Thank you. If you want the federal government to be more supportive of innovation and creativity, how would that be done? With specific programs? How do you imagine it, in concrete terms?
Mr. Racine: We just received funding for the Aging in Place Challenge program. We will probably sign an agreement. In short, it’s a first. It’s the first time we’ve gone into the communities to offer home support services with volunteers for francophone seniors. It’s a first step, but I think it will lead us to new ways of offering services. Right now it’s volunteer services, but they are thinking about how to provide home care.
If in 2019 I had come to you and said that the majority of medical consultations in Canada would be done via video conferencing, you would have said, “Come on, is that possible?” Yet we have lived it. The pandemic has shown us that we can take completely different approaches and models. They’re promoting home-based services; does that mean it’s going to be a doctor going from house to house, or is it going to be a doctor in the office providing services online? Instead, we would like to see a person or health support worker walking around with an iPad visiting patients. Instead of a professional, it could be people who help deliver those services; it could also be a whole care team of francophones who deliver online services to different people who are in their homes.
The Chair: Thank you, Mr. Racine, that makes the possible proposals clearer.
Senator Mockler: I want to add my comment to the witnesses who are here tonight. I would like to begin with a question for the three witnesses on new technologies.
In your opinion, do new technologies represent an opportunity for francophone seniors to receive health care in the language of their choice across the country?
Mr. Larocque: I will try to answer quickly. The short answer is yes, but we are not there yet. We have two categories of seniors in our population: people who are very comfortable with technology and people who are not comfortable at all. There is some learning and education to be done.
On the other hand, as Mr. Racine said, the pandemic has allowed us to do a lot of things remotely. Tonight, for example, we are talking to each other from across the country and we are having a serious and meaningful conversation. We need to develop this aspect.
We also have to realize that there are a lot of communities where something as simple as high-speed Internet is not available. We need to look at those things, but yes, it’s something that needs to be worked on.
I can do anything with my cell phone and people can receive services. It is not necessary to go to a hospital, where it is sometimes more dangerous for our health, if we can do it from home.
Ms. Dumas: During the pandemic, there was a project that Mr. Lapierre set up with the Red Cross to equip about 120 seniors with tablets. They then gave training to those who needed it, to better help them use this tool on a daily basis.
I can tell you that we have benefited a lot and that our seniors have really benefited. It broke the isolation, first of all, during the pandemic. They also learned things they didn’t know. They know where to go to get the information they need, both in terms of health and other areas.
I think it’s important to create these kinds of programs, like the one the Red Cross has created. It was really a win-win for us; it was very positive.
Senator Mockler: I will put my next question to the Association francophone des aînés du Nouveau-Brunswick. In a brief published in 2021, you talked about a lack of understanding on the issue of health care delivery. I quote:
Many administrators, service providers and health care professionals are not aware of the risks to francophone senior patients of not being able to communicate with them in their language. It is often assumed that French-speaking seniors can easily understand what is said to them in English, but this is not always the case.
In your opinion, is this too often the reality for francophone seniors in New Brunswick? What needs to be done with health care institutions to ensure that they respect the rights of francophone seniors in all regions of New Brunswick?
Mr. Larocque: That is a good question, Senator Mockler. I have had the opportunity to live in three different regions of New Brunswick: more francophone, more bilingual, more anglophone. In all cases, the answer is the same. Accessing services in French, even in francophone regions, can be a challenge. There must be political will and a will on the ground. We can’t just have easy answers and say that New Brunswickers are bilingual and that they will understand. This is not true. As we get older, this is a faculty that disappears.
You have to work harder and harder to make sure that... Sometimes seniors are seen as a burden, because it is expensive to take care of them. When they are well and living in their own homes, they contribute to different degrees to society. It is necessary for governments to invest in the senior population. Providing services in French in a province where one third of the population is francophone, one would think that it would be easy and yet it is not.
Yes, there is a shortage, there are recruitment and retention of personnel to be done, but when you are playing with people’s health, it must become a priority. It’s a humanitarian issue, much more than an economic one.
Mr. Chiasson: I will add something. Even in terms of services in nursing homes... For example, one of our board members who lives in Fredericton was forced to put her mother in a Moncton facility so that she could have services in French. She has to drive two hours to visit her and two hours back home. French-language services should be available in Fredericton itself.
Over the past few years, more and more English-speaking employees have been hired in French-speaking nursing homes because there is a labour shortage. It has been noted that some francophone homes require an interpreter to provide these services in French. This has become critical recently.
With respect to home support services, there is also a real problem with receiving services in French, but it is sometimes just as difficult to receive services in certain communities.
We noticed this last week. We met with a person who offers training to nursing home attendants, but also to hospital attendants. She told us that Vitalité Network pays for training for hospital attendants and gives a $10,000 bonus for these attendants to offer their services for two years, whereas for nursing home attendants, this is not done. They don’t get a bonus and their training is not paid for. So we have a lot of difficulty recruiting.
In terms of retention, the Special Care Home Association told us that turnover was over 40% in long-term care homes and that it got worse during the pandemic.
Senator Mockler: I think we have a common denominator, and that is the improvement of French-language health services. Yesterday, I was in a home and I had the opportunity to speak with people who were receiving services and those who were providing them. I would like to hear your thoughts on this: As far as caregivers are concerned, if they were more present and if we opened the door to them, whether in special care homes or in residences for the elderly, would this be a step in the right direction?
Mr. Chiasson: Briefly, we have had a project for two years and we have a research relay with the Université de Moncton. Indeed, caregivers are not supported in any way by any province or by the federal government. There is no support to ensure that caregivers can continue to help parents.
We learned in a report that was published a few years ago that caregivers contribute 28.5 million hours of work per year. If we were to pay them minimum wage, this would represent over $300 million.
I have a little anecdote about help for attendants in long-term care homes: We were told during the pandemic that the clients of a residence were complaining about the quality of the food. There was a lady and 12 other people from the community who offered their services to help a long-term care home because there was a labour shortage. The home refused the services saying that it was not allowed by the province.
Mr. Racine: I think it is in the best interest of the communities for community members to be able to enter the nursing homes. We see that it improves the health of seniors. For example, in Fort Smith, there is an amazing lady who comes into the classrooms; she shows the young people how to do a craft and then invites them to go into the residences and show the seniors how to do the craft.
It has a huge impact in the community. In the Yukon, they are very strong as well. They have a team of volunteers who meet with the francophone residents. We had to intervene at times, because the English-speaking workers did not understand what was going on. We volunteers were the ones who were able to clarify the situation to improve the lot of these people.
Senator Moncion: I have a big question about the erosion of services in relation to the privatization of long-term care and retirement residences, and the impact of the legislation that was passed in Ontario in the fall for patients in hospitals who do not have a place in a retirement residence. In effect, they’re being placed anywhere there’s a space, regardless of language or distance. Can you talk about that quickly?
Mr. Racine: My online colleagues are in a good position to talk about the situation in New Brunswick.
Mr. Larocque: As we speak, Bill-31 has been passed in New Brunswick. It gives the Department of Social Development full latitude to send medically discharged senior patients wherever it wants if there is no room in nearby homes near the families. Yet families can help their loved ones get served in their language. Indeed, the department can place people anywhere. That is a short answer, but unfortunately that is what is done in New Brunswick.
Mr. Racine: What is being done in Ontario right now is outrageous. I think they are isolating seniors from their families. When you go to a residence, you want to stay close to your community, and the fact that governments are isolating people and taking them wherever they please is unacceptable. I know that the Fédération des aînés et des retraités francophones de l’Ontario is working very hard on this issue.
The Chair: Ms. Haché, Ms. Dumas, Mr. Larocque, Mr. Chiasson, Mr. Lapierre and Mr. Racine, thank you for your comments and your answers to questions. I want to thank you, on behalf of my colleagues, for the work you do on behalf of and for aging people in this country. We have heard such unfortunate stories tonight that we will have to work tirelessly to improve their lot. A lot of that has to do with your organizations. Thank you, once again, for your contribution to the study we are conducting. On behalf of my colleagues and I, I wish you a good day.
(The committee adjourned.)