THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, December 4, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 4:59 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: I am René Cormier, a senator from New Brunswick and chair of this committee.
Before we begin, I would like to invite the members of the committee present today to introduce themselves, starting with the deputy chair, on my right.
Senator Poirier: Good evening. Rose-May Poirier from New Brunswick.
Senator Mégie: Marie-Françoise Mégie from Quebec.
Senator Moncion: Lucie Moncion from Ontario.
[English]
The Chair: Thank you, colleagues. I wish to welcome all of you and viewers who may be watching across the country. I would like to point out that I am taking part in this meeting from within the unceded, traditional territory of the Algonquin Anishinaabe nation.
[Translation]
This evening, we are continuing our study on matters relating to minority-language health services.
Before we introduce our witnesses, colleagues, a motion must be proposed to ensure that, if we don’t have a quorum, we can still proceed with the meeting.
Senator Mégie, would you like to move this motion?
Senator Mégie: I move:
That, notwithstanding usual practice, pursuant to rule 12-17, the committee be authorized to hold this afternoon’s meeting without a quorum if necessary for the purpose of receiving evidence, provided that two committee members are present.
The Chair: Thank you. Would it please you, honourable senators, to adopt the motion?
Hon. Senators: Yes.
The Chair: The motion is carried. Thank you very much, colleagues.
[English]
Welcome to our witnesses. For our first panel, we are pleased to welcome, by video conference, Kim Sawchuk, professor in the Department of Communication Studies at Concordia University and member of the Centre for Research and Expertise in Social Gerontology. Welcome, Ms. Sawchuk. We are also joined in person by James Janeiro, Director of Policy and Government Relations at the Canadian Centre for Caregiving Excellence. Good evening, and thank you for being with us.
Professor Sawchuk, we will now hear your opening remarks. The floor is yours.
Kim Sawchuk, Researcher, Centre for Research and Expertise in Social Gerontology, as an individual: Mr. chair and senators, thank you for being here to listen. My name is Kim Sawchuk. I am a professor, but I am also the director of engAGE: Centre for Research on Aging at Concordia University in Montréal. I am also an aging, anglophone woman living in Quebec.
Today, I am speaking to you on behalf of the Centre for Research and Expertise in Social Gerontology, or CREGÉS. CREGÉS facilitates knowledge sharing between academics and practitioners working in hospitals, long-term care facilities and community organizations. We bring together researchers, students, professionals and other collaborators to support aging by developing research on topics such as older adult mistreatment, diversity and palliative care; co-creating innovative practices; co-producing knowledge mobilization activities; and, training future researchers in gerontology. CREGÉS understands health and well-being from a holistic perspective. We consider how environments may allow us to flourish until we take our last breath or how these environments may hasten our end-of-life journey.
Unfortunately, for older English-speaking Quebeckers, there are growing fears of a set of interlocking policies that jeopardize their health, well-being and lives as contributing members to our society. As one recent interviewee stated:
. . . we feel as if we are under attack and we worry about staying in the province, about getting sick in this province — but we can’t afford to move . . . .
Nor do they want to because, “ . . . we are taxpayers and citizens who have contributed to the life of this place.”
You might ask if these sentiments are hyperbole. I am here to say that they are not.
The first point of attack, Bill 96 from 2021, which narrows who is considered an historic anglophone. The bill threatens to trump Quebec’s Act Respecting Health Services and Social Services, which states that health care must be adapted to support all patients regardless of language and culture.
Access regardless of language or culture is imperative. According to Quebec’s Institut national de santé publique du Québec, or INSPQ, patients who are not cared for in their mother tongues are more likely to receive an inappropriate prescription or not know how to take their medication; not understand their diagnosis; spend extra time in the emergency departments; be exposed to unintentional injuries or complications; or, be discharged from hospital without a follow-up appointment. They are also less likely to use mental health services that are available, be satisfied with their care, or show up to future appointments.
There are other threats to aging anglophones in Quebec from a holistic view of health and well-being. The demand to learn French within six months places added stress on those who do care work across formal and informal sectors — from workers in community organizations to grandparents who immigrate here to help with child care.
Finally, there is a problem with the retention of workers in the health sector in Quebec. This is related to a second point of attack. Colleagues in our medical schools and social service sectors worry that they will be unable to attract English-speaking students to these fields because of the doubling of tuition costs proposed for international and out-of-province students.
The third point of attack is the surprise amendment to Bill 15 that centralizes health services under a new health agency, Santé Quebec. Santé Québec will have the power to strip health institutions of their right to offer services in a language other than French if the numbers no longer justify it — that is, it is proposed in areas where minority communities have shrunk below 50%. How will they measure this 50%? What if an institution with the right to provide services other than French delivers 57% of its services in French? Does it lose its designation?
This is but the latest threat to the health and well-being of older anglophone Quebeckers, in particular those who belong to visible minorities in this province. When I informed an older adult — a long-time community volunteer — of your hearings, they told me to ask you, “Who is on our side?” This 80-year-old woman said, “I feel abandoned by my government.” When I asked if they meant the provincial government, she snorted, no. She feels abandoned by you, the federal government. They thought the Canada Health Act, and the Charter of Rights would be there to protect them. Now they are urging you to be champions of their right to a full range of services to enhance their health and well-being. This perspective aligns with the 1946 Constitution of the World Health Organization, which envisaged that, “ . . . the highest attainable standard of health is one of the fundamental rights of every human being . . . .”
Access to services in English in hospitals, community organizations and government agencies must ensure that we all live and die with dignity and joy, not with strife and worry. We old people are not vulnerable, but we are being made vulnerable by politicians playing political football with our lives. Do not let them.
Thank you.
The Chair: Thank you, Ms. Sawchuk, for your comments. Before we go to the questions and answers, Mr. Janeiro, welcome again. The floor is now yours for preliminary remarks. Then the question and answer period will follow.
[Translation]
James Janeiro, Director of Policy and Government Relations, Canadian Centre for Caregiving Excellence: Thank you and good evening, everyone.
[English]
Care crosses all stages of life, and our mandate at the Canadian Centre for Caregiving Excellence, or CCCE, covers all aspects of caregiving – from the needs of children with disabilities at one end of the age spectrum to elders at the end of life and everything in between. We are a pan-Canadian organization and as such seek to operate both nationally across the country and in every province and territory. Given that mandate, we are committed to understanding, supporting and representing caregivers from sea to sea to sea. This includes members of minority language groups in every part of our country.
One in four of us across Canada is a caregiver today, and at some point in their lives, half of all Canadians will become a caregiver. This bears a dramatic and unignorable impact on all aspects of life, including our economy, the workplace and even our political institutions. Caregivers are essential to every element of health care delivery. Caregivers provide three hours of unpaid, unsupported and often isolated care in the community for every hour of care provided through our health care systems.
My message today is clear: We are living through a crisis of care, and addressing this crisis is impossible without properly paid and supported care providers such as personal support workers. Over the summer, we commissioned the first national survey of caregivers and care providers. The findings are stark but, unfortunately, not surprising to anyone who has given or received care. I will give you few findings tonight.
Over three quarters of caregivers reported that they received no support over the previous twelve months. Over half tried to access services but failed. An overwhelming 91% of caregivers seek and need improved home care services, and 8 in 10 say the same about their need for high-quality, reliable respite services. One of the first projects that we funded was a study, led by L’Appui pour les proches aidants, or L’Appui, on the needs of francophone caregivers outside Quebec. L’Appui heard from organizations in every province and territory about how minority-language caregivers are being left behind by the systems designed to help them.
Respondents reported that they eagerly want to better serve francophone communities but lack the support or the funds to be able to do so effectively. Over two thirds of respondents reported that respite services are particularly important. Over 85% of organizations reported that they are not adequately meeting the need for respite services for francophone communities. A similarly large proportion of caregivers large proportion of caregivers reported a desperate need for respite services in our survey.
When asked why they are unable to meet these community needs, 90% of organizations supporting caregivers reported that their biggest problem was a lack of funds. This, in turn, translates to a crisis in staffing. Recruiting and retaining French-speaking care providers like personal support workers and direct support professionals is a necessary but insufficient condition to solving this crisis.
The Association francophone des aînées et aînés du Nouveau-Brunswick, noted in their brief to this committee that practically no effort has been made to recruit and retain French-speaking staff, who do not make much more than employees working at Tim Hortons or McDonald’s.
Fully 35% of care providers say that they have considered leaving the profession due to bad wages.
We are a nation of caregivers. All Canadians deserve to be able to access the services they need. This includes francophones outside Quebec, as well as anglophones in Quebec. Both sets of language minority caregivers face barriers in accessing what they need. Staff are essential. Without adequate and trained staff, the best-designed respite or home care program is just words on a page. Left unchecked, this crisis will only worsen as Canadians of all linguistic groups in every province and territory rapidly age.
Thank you. I look forward to your questions.
The Chair: Thank you for your comments. Before we go to questions and answers, I wish to ask members in the room to please refrain from leaning in too close to the microphone or remove your earpiece when doing. It will avoid any sound feedback that could negatively impact the committee staff in the room.
[Translation]
Colleagues, we will now open the floor to questions.
Senator Poirier: Thank you both for being here. My first question is for both witnesses. In your opinion, what are the biggest challenges facing the aging population, especially when it comes to accessing health care in the language of their choice? Is it money, the workforce or something else?
[English]
Mr. Janeiro: That’s a good question. The issue of funding and staffing are very much interrelated. It is no secret that wages in this sector, not only in the minority language communities but also across the sector and across the country, are quite pathetic, hovering near or around the minimum wage, while they do backbreaking, emotionally draining and difficult work.
The question of funding and human resources go hand in hand because, absent adequate funding to raise the wages and other workplace conditions and supports, like access to retirement savings plans, for example, or benefit packages, or transitions from part-time to full-time employment, or predictable schedules — all of which cost money — as well as higher wages, we end up with a workforce crisis, which is where we are now.
Without funds, we don’t get the workforce that we need and, without the workforce that we need, we are living through this crisis of care.
Senator Poirier: Thank you. Ms. Sawchuk, do you have comments you would like to add?
Ms. Sawchuk: I would concur with my colleague. One of the most important dimensions of this is how much we say and we pretend to value care and how poorly we pay people who actually do care work.
Also, from the research that I’ve done, there is the lack of distinctions and training for people who do respite work, and an acknowledgment of that what kind of work means and the lack of flexibility in terms of hours, in addition to poor wages and poor working conditions.
That’s it for my comments. I agree with everything else my colleague has said in response to your question.
Senator Poirier: I am from New Brunswick, and I was a member of the legislative assembly before. I know a bit about how the system worked in New Brunswick. I’m not sure if it is the same in every province, but most of the caregivers — unless it is a private one or an organization that’s out there — get funding from the provincial government. That’s negotiated for the salary and then the money goes to the organization. Out of that, they then pay the employees. Depending on the case, a financial analysis is also made with the individual needing the care to see if 100% of the care is paid for, or whatever percentage is shared. Many times, a percentage can be shared.
If I remember, back then — and this is quite a few years back, so I’m wondering if it is different; I’ve been here for a few years and it could have changed since then — once of the concerns, which was addressed to a certain point, was that when the government would give the money to the agency, it didn’t always flow down to help the health care worker. Sometimes, it was kept within the organization to have more administrative staff or something like that. Back then, the government would announce that they were going to increase the salary by 25 cents an hour, or something like that, but when it came down to it, the increase was maybe only five cents or 10 cents. That was addressed at a certain point, I remember, when they said they would give a certain amount and the government would say, “No. This amount is for the employee and it has to go there.”
Can you can talk a bit about that? Has it changed over the years that I’ve been here and I’m not aware? Is it better now than it was? I am not saying the organizations are not doing a fantastic job because I know they are. They are recruiting people and doing the best they can. In my immediate area, we have two or three and they work very well. I want to know if that situation is the same. Both of you can answer if you want.
Mr. Janeiro: Ms. Sawchuk, would you like to go first?
Ms. Sawchuk: You can go ahead. To be quite frank, my expertise is not care work in every single province. However, as a woman who lives as an anglophone in Quebec, with aging parents in Manitoba, one of the other problems in the informal sector is knowing how to help and be an advocate for your loved ones who live in another province because of the way our health system is fractured across the provinces. I will speak to that later. I will let Mr. Janeiro speak now.
Mr. Janeiro: Well said. You raise an excellent question. It is a combination of oversight and overhead. At the end of the day, these agencies exist for a reason, namely, to try to make the delivery of care more efficient, to ration resources as they are distributed, to train as well as to perform compliance efforts to make sure the staff doing the work on the ground are doing so in compliance with federal and provincial regulations on the work. That all costs money. Unfortunately, it is high. The cost is not zero. Particularly as an agency gets quite larger, it becomes more and more expensive — not on a per-head basis, on a per full-time equivalent, or FTE basis, but it gets more and more expensive to do that kind of administrative work on the ground.
There have been a couple of innovative models across the country for how to do more of what you are talking about, namely, turning a government announcement of an increase in wages of “X” dollars into an actual on-the-ground increase of “X” dollars in the hourly pay packets of the staff on the ground.
The province I am more familiar with is Ontario. During the pandemic, the government announced a temporary wage enhancement of $3.00 for both personal support workers and workers in the adult development services sector; that is, for staff supporting adults with intellectual disabilities in group homes in the community. It took a while to get going. It wasn’t the smoothest of processes to implement it on the ground, but there was an agreement between the government and the employers that the full amount would be translated down to the staff so that the government commitment of $3.00 turned into a $3.00 wage enhancement. Eventually, that was made permanent, as was this understanding that it wasn’t to be eaten up by administration fees but to be delivered on the ground to the staff.
I will say, though, that because of the difficulty of operating the supports during COVID, the government also augmented the administrative side, just to make sure that they were able to function as well as deliver this $3 without taking money off the top.
So really, I think it is a convoluted way of answering your question. If a government is determined to come up with a number and have that number be reflected in the pay packets, it is a question of oversight and providing a little extra support to make sure that it actually translates down to those wages.
Senator Poirier: We talked about the individual paying into it. We talked about the province paying into the organization. Where is the federal? Is it all through the transfers? What more can the federal government do? Are they doing enough? And if not, where do we start? What needs to be done, as far as you are concerned? Is it more transfer money or what?
Mr. Janeiro: Respectfully, I would say our federal government is not doing enough on this today. One thing we’ve been calling for at the Canadian Centre for Caregiving Excellence is the need for a national caregiving strategy to wrap our arms around all parts of this very large and complex issue that affects one in four Canadians today and eventually half of us.
Specifically on the question of home care, there are a couple of things that could be done. First, in the discussions with provinces around transfers, it is worth having the conversation around a dedicated pot of money that can be used to improve working conditions, including wages. There has been some talk of this. It hasn’t really translated quite yet into action on the ground, but there has been a commitment from the government to improve wages for personal support workers in particular. It just hasn’t quite translated into action yet.
The other side of this as well is the federal government has done some excellent work on long-term care standards. Now, it doesn’t cover everything within the realm of long-term care, but it was released about six months ago, I think, where some really good work was done on improving the quality of care. Unfortunately, that didn’t come with any money attached to it.
The policy work has been done, and now it’s a question of funding it. Also, I would go so far as to say extending those same sorts of interests in quality and level of service delivery to the home care sector as well, to care providers who are going from house to house, town to town, all across the country, delivering very similar services but in people’s homes.
The Chair: Do you have something to add, Ms. Sawchuk?
Ms. Sawchuk: I would like to add one small point. It is a question of wages but also a question of working conditions and the amount of work that has to be done in a particular amount of time and what amount of time is allotted for each dimension of a caregiving regime that one develops.
I think it is a really complicated question, as my colleague has pointed out. I agree with his analysis, but I also want to call attention to our goal here, which is to provide the best health-related quality of life for people, not just care for them before they fall apart or as they are falling apart, but to create the conditions so that we don’t fall apart in our final hours. That requires people having time to give the kind of care and service they need. Most of the care workers that I’ve talked to in my lifetime are people who do care and care greatly, but they get burnt out, not only because of the amount of money they have at their disposal because of the work they’ve chosen, but because of the conditions of their work and the demands for greater efficiencies in terms of the delivery of care.
I also want to say that this is a very important issue for women in our society. The majority of care workers at this point are women who have either done unpaid labour throughout their lives or take time to do this work. This affects their lives as they age. It affects our pensions because they are also indexed to the amount we earn throughout a lifetime. This is a real problem with a lot of reverberating effects along the chain of care.
The Chair: Thank you so much.
[Translation]
Senator Mégie, go ahead.
Senator Mégie: I thank the witnesses who are with us. My question is for Mr. Janeiro.
On November 8, Le Devoir published an article whose title loosely translates to “Canada is facing a crisis of family caregivers,” which cites the example of a woman who wanted to defend the language rights of her parents who were vulnerable people. She talked about travelling long distances to obtain specialized care.
Following up on the Canadian Caregiving Summit, in which you participated, do you agree that the principle of accessibility contained in the Canada Health Act must also cover equitable access for official language minority communities?
[English]
Mr. Janeiro: Thank you very much for your question, senator. Yes, absolutely, this question did come up a fair bit during our recent summit that was held here in Ottawa last month.
Canada is a large country. We have people all over the place, fairly sparsely populated once you get outside of the large cities. Particularly in those moments of very intense, especially end-of-life care, personal care or changing needs as one transitions from one part of their illness to another, in particular, I would say it’s not fair to expect that person and that family to have to transplant themselves out of the familiar and out of the community that they know well, where they have their networks and their connections, including a network of caregivers outside the family, like neighbours, friends and chosen family. It is fundamentally unfair to expect that those people be in that situation and have to transplant themselves from what they know to a larger urban centre to receive the care they need.
There is good work that can be done around delivery of these services in smaller communities and in the home. If not in the home, at least in a community health clinic rather than in a large hospital in a larger urban setting.
I would agree wholeheartedly that this right should extend and unfortunately does not yet extend to ensure Canadians are able to access what they need in their familiar environments, in the geography that they understand.
[Translation]
Senator Mégie: Thank you. My next question is for both witnesses and stems from your answer and what has been mentioned in some articles.
In order to keep caregivers at their loved one’s bedside, should a budget be considered? Since we’re talking about underpaid attendants, should there also be a budget for caregivers? We know that, up until now, caregivers have done volunteer work out of love and devotion. Could there be a way to compensate them?
[English]
Mr. Janeiro: Absolutely. This is another question that came up quite a bit at our summit. We looked abroad to examples around the world where they do exactly this. In the U.K., there is a carer’s benefit that provides not a lot but a little bit of extra money every month to people who provide over, I believe, 37‑and-a-half hours of care every week. Now, that’s a high barrier to cross. That’s basically a full-time job, and the remuneration provided by the National Health Service in the U.K. is not full‑time pay. The theory is to provide a little bit of money for people doing this caregiving work.
We also see it in Australia and in parts of Europe. Even here in Canada, in Nova Scotia, there is a carer’s benefit. I think it’s about $150 a month. Again, it is not a large amount of money, but the framework is there, wherein if you are providing care, odds are you are not working full time because the demands on you as a caregiver require that you work less, so let’s help you a little bit to pay your bills and put food on the table. The framework is there, the idea is there and we support it wholeheartedly.
[Translation]
Senator Mégie: Ms. Sawchuk, do you have anything to add?
[English]
Ms. Sawchuk: Yes, I totally agree, but I would also add that many people I know have retained full-time jobs while also trying to do this care work. It is also important to think about whether that is remuneration because you give up your employment or because you have to take time off your employment. We have to make it as easy as possible for people to also know that these services or these benefits, if they come into existence, do exist and to make sure people have access to them.
Too often, I’ve seen people, including myself, not understanding what it is they are entitled to. Again, this is where we make sure the services are available in French in the other provinces, which is absolutely fundamental. Making sure that they are accessible in English in Quebec is also extremely important. Again, there are issues around other minority language rights in this country in terms of the reception of care.
In Finland, if you have a linguistic population that’s at 8%, then, for example, you have the right to demand accessibility in terms of health care services. We need to think about these things.
[Translation]
Senator Mégie: Thank you. I’d like to ask one last question that may be for Ms. Sawchuk, who knows a lot about what’s going on in Quebec, but Mr. Janeiro could add a word, if he’d like. I worked in home care for seniors all my life before I was in the Senate, and there was a service employment paycheque for families, so they could organize to get help in the community, perhaps at a lower cost, but it was sometimes enough to get help in the evenings and during the night.
I don’t know if that still exists — you tell me, given your work with caregivers. Do you think it would be a good solution? Ms. Sawchuk, do you think that, in Quebec, this could help people who speak the same language as their loved ones stay with them? What do you think?
[English]
Ms. Sawchuk: I’m not quite sure of the system of which you are speaking, but I think what people want are options, because people live in different contexts. Some live in rural regions; some live in more urban settings. Some have connections to their communities that are strong, while others don’t. I don’t think people are even aware of what those options might be.
I do not know the program of which you speak, so I don’t want to offer any other comments on whether it’s a viable one, other than to say that the context of lives is that, as we all know, we need to have options for people to customize care to the needs and the cultures that they live in and that they have.
[Translation]
Senator Mégie: It’s precisely because of this — to personalize care and retain the choice of language and culture — that people turn to CLSCs, which can offer them this by providing them with a certain amount. Are you familiar with this, Mr. Janeiro?
[English]
Mr. Janeiro: Yes, this logic you see more, actually, in the disability space rather than in terms of seniors care across the country.
In Alberta, for example, there is a large, established program of doing exactly this. A family goes through an assessment process. They are given a budget, and then with that budget they are able to go out into the community and acquire the services that they need.
I’m sure for some of them, it’s a linguistic element. For others it’s, frankly, the flexibility to be able to hire an aunt or a cousin who is, perhaps, more familiar with the family, speaks the language, knows the culture and maybe has some time in their day or in their work schedule to be able to provide that, especially if there is a little bit of money to help. We see that more in the disability space, and I think that’s something that is very much worth exploring, particularly as, again, we see one in four Canadians is a caregiver today.
When half of us will be faced with these questions, it is a matter of, as my colleague said, flexibility and options and having different ways of solving these problems.
[Translation]
Senator Moncion: We heard in your comments that the federal government’s funding is sufficient.
Could you tell us about the demands you are making of the provincial governments? One of the challenges of working in seniors care is connecting with provincial governments, as they’re responsible for anything related to health. That’s my first question, for both Ms. Sawchuk and Mr. Janeiro. Then I’ll have other questions related to that, especially in terms of the privatization of certain sectors that affect seniors.
[English]
Mr. Janeiro: You are right to say that there is a large provincial component to this. In fact, most of the service delivery side of everything to do with care is, indeed, on the provincial side.
That behooves, though, I think, the federal government to apply both the spending power and the regulatory power and other things to try to improve the situation on the ground, even in the domain of the provincial governments. That’s the first thing I will say.
In terms of today, with the provincial governments, we see a patchwork of different approaches across the country in how we care for elders as well as how we care for people with disabilities, children, adults and so on. One of the benefits of being in the federation is that we can take an idea from one province and apply it to another.
I’ll give you one example. In Quebec, they are a little bit further ahead. I often say, actually, that Quebec is a generation ahead of the rest of Canada when it comes to this issue of caregiving, and one of the things that happens on the ground in Quebec is that primary care doctors, when they are in the consultation room with the family, when they are giving that diagnosis that will require some sort of care provision to come along with it, they are also taking note of whom is the caregiver, so it’s physically in the record. Who is the caregiver?
It’s not just a simple matter of who is the next of kin or who is the power of attorney, but, rather, who is the person who is the caregiver for that person, in order to ensure that they have a role to play, both in the interactions with the health care system, which, as you say, are very much within the provincial domain, but also since they are going to be on the ground anyway, they should play an active role in the day-to-day care experience of that person.
They should be able to call up the personal support worker, a foundation or the company that’s delivering services themselves without having to go through a power of attorney or through the person who needs care. They should have their own standing and their own right. Quebec has lessons to teach the rest of the country on that.
Alberta, as well, has this culture of, again, having the caregiver as part of that conversation in the health system. What we can learn from these provinces and others, we should take from that and apply it across the country. One of the things that we’re starting to push for, as we begin our provincial advocacy is to take the ideas and the things that are working across the country and start to scale this a bit more nationally.
Ms. Sawchuk: Yes, that may be the case, but on the ground I’m not seeing things quite as rosy in Quebec as my colleague has portrayed.
First, it assumes you can get access to the family doctor. We know there is a crisis of medical practitioners in this province.
The second thing is that a large number of older adults end up alone, so even if they do make it to see a doctor, who are they going to say is their primary or other caregiver? We know that because many people end up going to another province for work, especially in the anglophone community, there is a greater majority of older anglophone adults who end up living alone. That’s particularly acute once you hit the age of 85 when it is more likely that you are going to need that kind of care.
Thirdly, I just want to say, where is care? We’re talking about it as if it’s either in the family network, maybe the friends and kinship network, or it’s formally provided. I also work with a huge number of community organizations in Montréal that get some municipal funding, some get provincial funding, but many could use federal funding that before used to be for their core missions. Now, they have to apply for projects over and over again. Much of it is related to what we think of as care, making sure people have enough food, have transportation to their medical appointments, and have the kind of hygiene equipment they need at home. We know that social isolation is a major problem for older adults and giving them the opportunity to see each other. I think care providers are overlooked within what we think of as the care landscape. We have talked about respite workers, and we have talked about L’Appui pour les proches aidants.
In addition, what I think we have seen since the 1970s, when the federal government stopped giving funding to community organizations that was core funding, is people writing a lot of grants and not being able to sustain projects and programs that actually work to provide care to their communities and their people, because they have to be constantly innovating and writing project grants rather than fulfilling their core missions and mandate.
That’s a change that happened, I want to say, in the 1990s, and I think that could be addressed, and that’s something the federal government could do.
[Translation]
Senator Moncion: Thank you. Funding is always a battle between the federal and provincial governments. When it comes to official languages, there’s the envelope reserved for several projects. We’re talking about several billion dollars over five years. It’s a matter of seeing to what extent the sums transferred to the various provinces for French-language services outside Quebec and for services to anglophones in Quebec actually make it to the programs for which these sums were earmarked. Do you have any information or statistics regarding these amounts and the various projects?
Last week, I met with representatives of the Canadian seniors association, who are currently working on a policy they want to present to the federal government in 2025. They have the same concerns, such as family caregivers, funding and money. It’s still a battle between the federal and provincial governments. The provincial governments have privatized many elements, so even if the money goes to communities that need it, like official language minority communities, their rights aren’t necessarily respected.
What kind of information do you have on how much money goes from one place to another?
[English]
Mr. Janeiro: That’s an excellent question. I, unfortunately, don’t have that level of specificity at the moment of where those federal funds are being allocated in the communities. I can get back to you on that and do some research. It’s an excellent question.
I can say that it’s also a matter of prioritization. We have reached this moment in our national life where people are realizing that care and caregiving are large and looming crises. We say in our offices that caregiving is the next frontier of public policy in Canada. We take that very seriously because it affects so many people now and to come. This is not a new phenomenon, but the public conversation around this is a lot more amplified today than it was five or ten years ago.
As this public conversation and the needs around care change, evolve and become louder, we will see calls for our governments to prioritize the meager funding that goes to service organizations to meet the need that they are feeling at that moment, one of which is a great need around care. On the specific figures, I can get back to you, with some research there.
Senator Moncion: Thank you.
Ms. Sawchuk: I have no specific figures either. I’m not a person who studies the political economy of the care system. I do mostly qualitative research with people on the ground, asking them about the conditions of their lives and work.
However, what I could add is that I would like to reframe care, I suppose, not simply as a crisis, but as an opportunity that we can change the way we think about our politics, not to treat older people as a continual problem, but to treat aging as something that will happen to all of us if we’re so lucky as to not die when we’re 20. To me, reframing care not as just a problem for us, but as an opportunity for people to think about how to age together differently and live well together is maybe something else that I would advocate for.
Senator Moncion: I think that our provincial governments see aging as a business and business opportunities also, because they have started privatizing all the long-term care facilities and most of the retirement homes now belongs to entrepreneurs who are there to make money. So when we’re looking at health care for older people, there is also a general knowledge — and this is not research that I have done — of thinking that older people have money and that they can pay for all the services that can be provided to them. The conversation about aging for older people is extremely important because of these ways of thinking that are out there but are not accurate. Those are the biggest problems we have, and we see it more and more.
I am from Ontario, and I see it more often in Ontario where they are privatizing so many things that were under the government’s purview, whether it’s aging, youth or mental care. It’s going to private sectors, and they are making money on it. Again, in Ontario, they are even paying double the cost for operations because the public service cannot provide. So they are paying people outside of the system twice, double the cost, just to get these operations done.
If Ontario and other provinces are doing it and they are asking for more money from the federal government, this is where I find the lack of control over where this money is going. So there is a frustration here, as you can see. But I’m on your side.
Mr. Janeiro: We share that frustration. Our public health care system is our sacred endowment and sacred right as Canadians. We take it very seriously in this country, as we should. I will say as well that in not too long a period of time, I would have to go back and look at the specific data. Frankly, in the last five years or so, this problem of seniors’ poverty was on the decline for a very long time and we had effectively, in a way, solved this issue. Of course not for everybody, unfortunately, but the problem of systemic seniors poverty had been addressed through a variety of different policy initiatives over the years by successive federal, provincial and municipal governments, but we’re seeing those numbers rising again.
It’s not just inflation, though inflation is a large part of it. It’s also that we’re privileged to live in a time where seniors are living longer, their needs change, they are healthier for longer, but they may also be ill for longer. As their illness progresses, their needs get more expensive. As the system they had been relying on becomes more threadbare, where does that funding come from? It comes out of retirement savings and out of pocket and increasingly out of the pockets of their support networks. Caregivers are, on average, about $6,000 out of pocket every year because of their care responsibilities. Part of that is exactly this: Paying for services that we all expect will be there provided by our health care system, but unfortunately when the time comes it is not.
This issue of seniors’ poverty will only get worse unless we take some real concrete actions, both on the income side, like CPP, GIS, et cetera, but also on the reality that things that seniors consume should go back to being public, rather than private.
Ms. Sawchuk: Yes, I want to thank the senator for her remarks and say I really appreciate your perspective, but also to say there is quite often the promise that, oh, this will be fine if we introduce telehealth or AI or other technologies into the equation. My background is actually in media and communications studies, and one of the other places that I think we need to think about it in terms of these costs, not just in terms of the privatization of our care facilities, is the high cost of access by older adults to the internet for information. If more government services and telehealth opportunities are going to be there online, we know that we play some of the highest prices in the world, quite frankly, for access to data, for example.
Seniors are being hit, once you hit the age of retirement and you are living on a pension or a fixed income, you know this is also intersectional that it depends on your gender. We know that people of colour have earned less in terms of their overall wages throughout their lifetime and will have fewer savings. We have to think about care within this broader social context. We talk about the social determinants of health. This is what we mean.
I want to recommend a film, Stolen Time, by Helene Klodawsky, that has just been released by the National Film Board, or NFB. The film examines some of the implications of the privatization of care and how that’s also connected to public pension funds, sadly, and the lack of regulation and oversight of some of the privatization of these facilities.
This is a much longer conversation that we need to continue having and that people have to be more informed about, but it also has to be thought of in terms of the overall budget of an older person after retirement. I talk to people who are making choices between medication and keeping a cellphone.
The Chair: Thank you. I will ask some questions as well. We’re focusing tonight on linguistic minorities and what the federal government can do. A lot of things belong to the provinces, but I would be interested in focusing on what the federal government could do.
I’ll start with Mr. Janeiro. I was interested in your article that I read on healthydebate.ca, titled, “Canada’s diverse caregiving community in dire need of federal strategy.” Could you tell us a bit more about the content of that? What’s the content, and how can the federal government, of course, respond to that content concretely?
Mr. Janeiro: Thank you for your question.
We have been advocating for this for about a year and a half now, since our inception, the need for a national caregiving strategy, to enable our federal government to wrap their arms around this issue, put some parameters around it and draw the box, if you will, around what it means to be a caregiver, a care provider, and, to your specific question, what those federal inputs into this large and growing part of Canadian life can actually be. A few, I’ll draw for you tonight. So, the first is what we have been arguing, which is a fairly easy fix, fairly low-hanging fruit, if you’ll pardon the image, where we could just convert the existing Canada caregiver credit, which is a tax credit within our tax code today, and convert it from non‑refundable to refundable. Currently, the system as it’s designed doesn’t work for caregivers. Only about 8% of caregivers across the country actually access this tax credit because it’s quite difficult to access in the first place. And there is a government commitment, both in Minister Freeland’s mandate letter, page 7, third from the bottom, but also in the Liberal platform from the last campaign, to do this, to convert it from non-refundable to refundable, to the tune of about $1,300 a year. Now, that’s not a lot of money — I will concede right off the bat. It only works out to about $100 every month, but we like to think of it as, at least, the thin end of the wedge. If we build a system that starts to put a little bit of money into the pocket of caregivers, we can build on that over time. And if you are one of those 20% of caregivers who live on less than $20,000 a year already, even that extra $100 a month can be the difference between buying some extra groceries or not at the end of the month. That’s one.
There is also the disability tax credit, of course, which is another federal domain that lives within our tax code. That can be adjusted to make it easier to access and more responsive to the realities of disability that ebb and flow and change. This way maybe you don’t have to go through the re-diagnosis process as often, and make it a bit easier for the caregiver in the person’s life to access this fairly generous credit that exists. It’s all well and good for these programs to be there, but if the walls are too high to access them, they might as well not be there, frankly. So the tax side is one part of it.
Another side of it are the various “leaves” that exist within our Employment Insurance, or EI system. We do have a bereavement leave and a caregiving leave. They are also very hard to access and limited in their use. You can only use them once per EI cycle. So if you go through the process of availing yourself of one of these leaves, say, for somebody who is near the end of their life, you actually have to prove with a medical certificate that the person to whom you’ll be providing care is nearing the end of their life. If you avail yourself of it, but the person you are supporting rallies — as happens quite often, mercifully — you are not able to use that leave again until you have filled up your EI bank over the course of a few working months.
If that person needs your help, say, in three months rather than a year, you are not able to take that paid time off work, and even the income replacement that is there is only, I believe, to about 60%, which is insufficient, we would argue, if you are going to be in the muck, providing full-time care for someone.
One more example that I’ll put on the table for you outside of the tax code and the EI system is with regard to immigration. In our care economy — the paid side of this, the care providers — we see a lot of immigration from abroad coming into Canada to fill these jobs. We see a lot of temporary foreign workers and a lot of abuse of these workers, and frankly, a lot of nonsensical things happening within the sponsorship categories, where a person is brought over to deliver care. They are matched up, of course, by virtue of the system with a particular employer or household, and then that relationship ends; either the person that they are supporting dies, or it sours, or, again, there is abuse, and unfortunately, our system’s response is to send them back home and then encourage them to reapply. Now, that takes time and money. It takes effort and heartache. Why not have an easier system so that if somebody wants to be here from abroad to be a caregiver, maybe we should have some sort of clearinghouse process so that you don’t have to go home and reapply. You can reapply or reconnect while you are still in Canada. I could go on about this at some length. I apologize, but those are three areas that we can —
The Chair: I have to sell you that the Standing Senate Committee on Social Affairs, Science and Technology, also known as SOCI, just completed a study on workers, and that’s one of the recommendations that they have made. So I certainly agree with what you are saying.
Ms. Sawchuk, you spoke a lot about the issues in Quebec for the English community. We know that the federal government helps through these agreements. Do you think it would be relevant to add linguistic clauses in these agreements to ensure that the provinces — in your case, Quebec — would take into consideration the linguistic issue more precisely than what you are saying?
Ms. Sawchuk: I hope so. I think I would advocate for that. Again, I would have to be careful about that, because I would be afraid that if those provisions were put in, I’m not sure what the provincial government would do, and I would hate to see services then being denied on the basis of a kind of fight between two levels of government, if you understand what I am saying. So, I think there might be a danger in that strategy, although I think it’s a possibility.
Again, I’m here representing, in a sense, the people that I know who are English-language speakers in Quebec. I myself do speak French, but I also grew up in Manitoba with family members who did not speak either French or English. I know many people here who are struggling to learn both languages, but are doing it. So I just think it is a question of how we make sure that whatever is in place, we’re not playing political football with people’s lives, and understanding that better health outcomes are tied to being able to speak in your own language. We know that at the end of life sometimes — and I have witnessed this with my own father that he sometimes reverted to his first language, Ukrainian. This happens. If people have dementia or other kinds of cognitive issues, they may have spoken French or English as a second language, but suddenly they may lose that ability, or if they are in a health crisis, they may not have that ability. I think we need to ensure the right to have a proper diagnosis, understand what treatment course has been given, be able to follow the instructions of a medical practitioner, be able to make follow-up appointments and understand how to access an online system. This is dependent on education and language ability. So how do we make it as easy as possible for them to be able to basically get the care they need during their lives and toward the end of their lives, and work from a place of compassion rather than punishment? We know what happened in Quebec with Joyce Echaquan. We know what happened in 2008 with another gentleman who was unable to access services in English. Death, and in the other case, poor health outcomes.
The Chair: You spoke about health determinants —
Ms. Sawchuk: Social determinants of health.
The Chair: Do you think that language should be included as a —
Ms. Sawchuk: Yes. Absolutely.
The Chair: What would be the effect of that for you?
Ms. Sawchuk: I don’t know. I think it would at least put it on the table and make people know, because right now, if it’s not made a category alongside other things like education, then it’s not considered seriously as having the impact that it has when you are in a hospital setting, a long-term care home or you are in another kind of organization looking for services.
If you can’t communicate, and people aren’t helping you to communicate, or trying not to communicate with you, you are not going to have good health outcomes. We know there is a relationship.
The Chair: Thank you so much. We are almost at the end of our session.
Senator Poirier: I’m going to change my mind on what I was going to ask, and I will follow up on what you have been questioning on.
Thank you both for the discussion tonight. It was very knowledgeable. It was very interesting. But I want to go back to the study we’re doing right now, as relating to health care for seniors in a minority situation. I just want to know if you agree with me that most of what we heard tonight does not affect just seniors in minority-language situations. I think this discussion has gone far beyond that. This discussion we’re having affects maybe all seniors, whether or not they are in a minority-language situation. I was trying to pinpoint exactly what the key thing would be that’s different for a senior in a minority situation. I know in some areas it could be the lack of manpower available in a certain language to be able to offer that service. But if we’re talking about caregivers in general, the salaries and the funding, do you agree with me that we’re affecting all seniors here and not just the ones in a minority situation?
Mr. Janeiro: Absolutely, this is a crisis for everyone, regardless of where you live and what language you speak, also outside of English and French. My own family background is Portuguese. I have spent most of my life being a translator to my grandparents as they have gone to hospitals, appointments and other things. The findings that we saw in our survey and our colleagues at L’Appui pour les proches aidants in Quebec saw in their survey — that I’ve lived and continue to live every day — is that accessing service is very hard as a baseline. When you add something on top of that, it makes it that much more difficult to access those services.
Caregiving is difficult. If you are a linguistic minority situation, it is just one more barrier to accessing an already broken system.
The Chair: Ms. Sawchuk, do you have a comment?
Ms. Sawchuk: No. I would just say that this is the case. The data shows that language minority speakers living either inside or outside Quebec, as my colleague said, face additional barriers and challenges in ensuring that they get, not only the care they need but also the right kinds of treatments they may need in different settings. It matters a great deal.
Yes, there is a crisis of care in the country, and there is an opportunity for care, but one also needs to understand that we live in a multilingual, multicultural society with two predominant languages. But what we want is for people to live a better quality of life until they take their dying breath. How can we enable that, rather than just worrying about what language a form is in? People should not have to be thinking about that as they are trying to enjoy their last days with their loved ones.
The Chair: Thank you, Mr. Janeiro and Ms. Sawchuk, for this very interesting conversation. I am sure it will help us with our report.
[Translation]
Ladies and gentlemen, we’d like to welcome our next witnesses. Thank you again and good night, Ms. Sawchuk and Mr. Janeiro.
[English]
For our second panel this evening, we are pleased to welcome Dr. Peter Tanuseputro, Investigator, Bruyère Research Institute and Public Health and Preventive Medicine physician.
[Translation]
We also welcome Jacinthe Savard, full professor at the University of Ottawa’s School of Rehabilitation Sciences, and Nora Spinks, chair of the National Seniors Council.
[English]
Good evening and thank you for being with us. We will now hear your opening remarks. Dr. Tanuseputro, the floor is yours.
Dr. Peter Tanuseputro, Investigator, Bruyère Research Institute and Public Health and Preventive Medicine physician, as an individual: Thank you, honourable senators and the Senate Standing Senate Committee on Official Languages for having me tonight. My name is Peter Tanuseputro. I am a practising family doctor just east of here in Orleans, and I am an associate professor in a division of palliative care. I do palliative care. I do home visits for my dying patients. I am also an investigator at Bruyère Research Institute.
Today I am going to talk about one of the studies in our team’s research that looks at routinely collected data to look at the health care delivery and health care outcomes for people of linguistic minorities.
Our study asked a very simple question: What happens to our patients who are hospitalized when they do not speak the same language as their doctors? The patient comes in, is admitted to The Ottawa Hospital, what happens if they cannot speak the same language as their doctor? Our study was published in CMAG, the journal of the Canadian Medical Association, and it was one of the top read papers last year, receiving 350 million media impressions, just to give you the idea that people care about this topic.
When we talk about minorities in health care, or minorities in general, we think about visible minorities, people like myself, who are obviously a visible minority. In health care, we often do not think about linguistic minorities, which is what I see in my practice and in our medical research community as well.
Our study was conducted out of L’Institut du Savoir Montfort, which some of you may know is an institute that is dedicated to improving the health care services that are delivered to francophones. Our study looked at allophones, who are individuals who don’t speak English or French in Ontario. It is important to know that one in three Ontarians don’t have English or French as their mother tongue, which includes my family and me. We emigrated here in 1986 from a small village in Indonesia. None of us knew a single word of English. I remember in Grade 3, when I came over, they were trying to teach me English and French at the same time, and they gave up on French. They said, just learn English right now and we’ll teach you French later; so my apologies if my French is not great.
What did our study do? We studied 189,000 Ontarians between 2010 and 2018 who were hospitalized. These were frail Ontarians — older adults who are frail. Again, we asked what happens to them when they are hospitalized and their doctor does not speak the same language as they do. We broke them down into allophones, francophones and anglophones. We found that 44% of francophones did not speak the same language as their doctor; and, 44% of francophones in Ontario who were hospitalized had a doctor who did not speak French. For allophones, only 2% of people had a doctor who could speak the same language as the patient. So when an Italian or Mandarin-speaking patient came in, only 2% of the time did their doctor speak the same language as they do.
The main outcomes we looked at was death — a fairly simple outcome — and also something we call “hospital harms.” Hospital harms are bad things that happen to you that are potentially avoidable, things like surgical infections, falls and medication errors. If there were better communication, perhaps those things could be avoided. We found that francophones who were treated by French-speaking doctors had 36% lower odds of these bad things happening, these harms, when they were treated by a francophone physician. For allophones, it was even more striking, with a 74% higher chance of bad things happening. For death, the most black-and-white outcome we have, francophones who were treated by a French-speaking physician had 24% lower odds of dying — not just bad things, but dying. For allophones, it was 54% lower odds of death.
In medicine, if you could find a pill that reduces a person’s odds of dying in the hospital by 24% or 54%, it would literally be one of the most groundbreaking findings you could ever make in this century. It would be an incredible pill. We know what that pill is. That pill is ensuring that we do all the things we need to do to make sure our health care practitioners speak the same language as our patients. It is things like slowing down and finding someone who can speak the same language, like going out and looking for interpreter services and finding the time to do that.
What’s really interesting is that our study found that when you provide language-concordant service, the length of stay went down as well, with 7% fewer days for francophones who were treated by francophone physicians and 23% fewer days for allophones who were treated by someone who spoke the same language as they do. It makes sense not only from the patient perspective, but from the health care perspective as well. You save money, and you really help patients achieve their best outcomes.
To conclude, we are doing other studies as well, and we are finding similar results in primary care. I am a family doctor, and there are similar results in terms of emergency room visits and hospitalizations. Now we are delving into things like mental health services and end-of-life services, things that make a big difference when it comes to good communication. We are obviously a very diverse country. The people who are sick in our hospitals are some of the most vulnerable people in our society. I think we have a duty to provide good care for these vulnerable populations, including care that is language concordant. Thank you.
[Translation]
Jacinthe Savard, Full Professor, School of Rehabilitation Sciences, University of Ottawa, as an individual: Thank you for giving me the opportunity to share my concerns regarding health care services in a minority language. As you probably know, francophones living in minority communities in Canada have a high rate of bilingualism. According to the 2021 census, the rate was 85%. Quite often, these people come to the hospital and can speak in English. However, people tell us, “When I’m sick, I’m not bilingual.” This shows the importance of access to French-language health care services in all Canadian provinces and territories. This is assuming that both official languages share equal importance across the country and that all Canadians deserve access to the same health care without facing any barriers.
For example, a francophone health care worker who provides health care services in both French and English described a stressful situation. She couldn’t respond in English to simple questions asked by a paramedic while her husband was having a heart attack. Her brain would only function in French.
I have another example. A francophone engineer who worked in English for his entire career in aviation told us that he misunderstood the English instructions provided by his cardiologist.
Research shows that vocabulary is contextual. If we can talk about our work in English, it doesn’t mean that we can discuss our health issues in that language. Fatigue, anxiety and pain can decrease our cognitive capacity and our ability to use a second language. We already feel anxious when faced with a medical condition. This anxiety increases when the appointment must take place in our second language. We’re faced with a vicious cycle. The need to use a second language increases the existing anxiety caused by the medical appointment. This in turn affects our ability to communicate.
According to research, around 20% of francophones in minority communities fail to consult a health care provider for fear that they won’t be understood or that they won’t make themselves understood. Some francophones choose to wait longer for services in French. As a result of these delays, their health issues could become worse. Others will travel to obtain services in French in another area or province. Some will decide to access private services at a cost. Others will choose to accept services in English.
What do people who seek health care in English have to say? A number of them describe the language discrepancies that they face with health care providers — and the studies were carried out with doctors — as unsettling and uncomfortable. This makes it harder to establish a relationship of trust with a health care provider. Some people report that they must prepare for the appointment by translating what they want to say beforehand. This doesn’t necessarily make it easy to react spontaneously during discussions with the health care provider.
A number of them report that they have difficulty speaking, that they forget to ask certain questions or that they don’t understand the information provided. Some even pretend to understand, to avoid irritating the anglophone worker or admitting that they aren’t perfectly bilingual. These communication difficulties can affect compliance with treatment, if the treatment isn’t properly understood, or can delay the diagnostic process.
As you can see, access to health care services in the official language of our choice is a matter of quality and safety.
I was asked to talk about how the federal government could improve the situation. I have a few ideas.
Of course, health care is a provincial responsibility. The federal government can’t create new health care services on its own. However, I’ve come up with six ideas. I won’t list them in order of importance. I’ll share them in the order in which they came to mind.
The federal government could help to better identify the places and providers capable of providing health care services in French.
French-speaking health care providers are found in every province. However, often neither the francophones seeking services nor the health care providers know where to find these services. A first step would be to create a list of the providers who can deliver services in French and the conditions for accessing their services. The federal government has the resources to carry out this type of survey. For instance, Statistics Canada often conducts surveys outside the scope of censuses. This could be a first step. French-language health care service navigators could be part of the solution. Provinces could also be encouraged to better identify people who might need French-language services. For example, identifying a person’s preferred language on their health card could help match people who need care in French with care providers who speak French.
My second idea concerns how the government could educate all health care stakeholders about the quality and safety issues faced by people whose first language isn’t English. In our studies, we found a real need for education. A number of managers told us that they didn’t see the need for French-language health care services, since francophones are all bilingual. They don’t seem to realize that being bilingual enough to hold a social conversation isn’t the same as being bilingual enough to talk about health. Moreover, while 85% of people identify themselves as bilingual, 15% of francophones outside Quebec do not.
The federal government has tools to raise awareness and access to advertising resources. It also has relationships with a number of national organizations, such as the Canadian College of Health Leaders, the Canadian Medical Association or other national associations of health care professionals. This awareness of the need for French-language services should lead to greater cooperation among the various health care organizations. It will never be feasible to provide health care services in French everywhere, in all institutions and in all provinces. It’s necessary to establish referral or collaborative structures to better guide francophones towards the services available in French. It’s time to eliminate the barriers that prevent francophones from accessing French-language services in areas right next door.
Another idea would be to help bilingual health care professionals maintain their skills in their second language. A number of them took immersion courses in high school, but then did their professional training in English. It would be useful to help them maintain their skills in French.
My fourth idea is to provide subsidies or tax credits to people who need to access private health care or travel long distances to receive services in their own language. To make a difference, these subsidies or tax credits must be well advertised in francophone minority communities.
The fifth idea is that the federal government must continue to fund Health Canada’s Official Language Community Development Bureau, along with the Consortium national de formation en santé and the Société Santé en français. The Société Santé en français is working hard to improve French-language health care services through its 16 French-language health networks. I don’t know how much more power can be given to these organizations, since health is a provincial responsibility. When French-language health network players have better access to health care decision makers in their province, they can certainly expand on their ideas for improving French-language services. These French-language health network players have better access to decision makers in their province when the provinces have French-language health services legislation. This isn’t the case in provinces where the legislation doesn’t exist.
Lastly, the Canadian Institutes of Health Research should require that the health services research that it funds look at language issues. It has a similar requirement for studies to take gender and sex differences into account. The research should also seek to include francophones in minority communities. Colleagues from English-speaking universities who want to include francophones in their studies often look for people from Quebec.
The Chair: I have to stop you. However, I think that you covered everything.
Ms. Savard: I was finished.
The Chair: Good. Thank you. We’ll no doubt have the opportunity to expand on some of your ideas during the round of questions.
[English]
Ms. Spinks, the floor is yours.
Nora Spinks, Chair, National Seniors Council: Thank you for the opportunity to speak with you this evening. Today I am speaking with you with my hat on as the chair of the National Seniors Council. The National Seniors Council was created in 2007 to advise the Government of Canada through the Ministers of Health and Seniors on matters related to health, well-being and quality of life. The council is made up of up to 12 people with very diverse backgrounds from right across the country. We include the perspective of organizations that serve the needs of seniors, experts in the field, academics, former elected officials, et cetera; and we work on a number of different topics and categories, trends, issues, issues of importance or of interest to seniors or their caregivers in Canada.
Some of the most recent ones have been aging at home, elder abuse, low-income seniors, volunteerism, positive and active aging, labour force participation of people over 65, intergenerational relations, social isolation and social engagement, financial crimes and harms against seniors, seniors’ housing, as well as issues emerging from COVID-19; and, of course, you can’t be talking about seniors without talking about ageism. We’ve developed a seniors’ lens to put every public policy through, similar to the gender bias lens that is being used.
According to a 2020 survey of the National Institute on Aging and the Canadian Medical Association, during COVID-19, 85% of Canadians and 96% of Canadians aged 65 and over reported they would want nothing to do with long-term care facilities and would do everything they could to avoid going into long-term care or having a loved one go into long-term care.
On October 6, 2022, the Minister of Seniors and the Minister of Health announced that the National Seniors Council would serve as an expert panel examining the measures, potentially including an aging-at-home benefit that could further help seniors age at home.
We have identified four areas of concern and focus: availability of services, accessibility of services, affordability and accountability. Of course, availability and accessibility very much include access to services in English or French.
We also looked at equity-deserving older persons and how they are disproportionately disadvantaged and may not see the intended impact of supports for their well-being and quality of life as they age in place.
Members of official minority communities have been really clear in our consultations in direct connection to aging in place. As part of this engagement, we heard from over 12,000 people across the country. Eighty-seven per cent of the surveys were responded to in English and 13% in French, but from both languages it was really clear that people needed and wanted, and in a lot of cases expected, to be able to receive care and services in their official language.
Six per cent of the respondents chose having services and supports in a preferred language as one of their top three issues, so it superseded finance and housing and other things, so that was important. Also, another 3.5% of respondents chose having services and supports in language other than English and French as one of their top three, which leads us back to the previous panel where you were asking about all seniors and language being so important.
We conducted round tables and interviews, and social connections and social isolation were top of mind. You can’t open up any newspaper or any academic journal without seeing social isolation and social connectedness being absolutely key, and of course, language and access to services and supports to reduce social isolation is absolutely critical for health and well-being. Social connection is now seen as more important than stopping smoking.
We’ve done a lot of work. We understand that the issues of social isolation and aging at home require a great deal of support. You heard from Mr. Janeiro earlier today about the importance of caregivers and the support circle around those caregivers being critically important in their official languages.
Services are not always culturally safe, appropriate or available, and we know barriers could lead to many negative outcomes, and you have heard some of them here. In particular, my former colleague on the National Seniors Council, Ms. Suzanne Dupuis-Blanchard, said it’s really important that services be available in those official languages, particularly in the community.
In closing, the report from the Office of the Commissioner of Official Languages entitled, Enjoying Your Senior Years in Your Own Language, Culture and Community: Federal support from key institutions and a portrait of English-speaking seniors in Quebec, calls to attention the observations made by the Special Senate Committee on Aging that seniors from official language minorities may be at greater risk of social isolation and ultimately be forced to move into assisted living or long-term care facilities without the services. You just heard wonderful data on that.
The National Seniors Council has been looking at aging in place. In order for that to be successful, having access to those community-based supports and having those services available in their official language is critically important, and equally so when they transition to long-term care facilities.
Thank you.
The Chair: Thank you to our three witnesses for your comments.
We will begin the question period with Senator Poirier.
[Translation]
Senator Poirier: I want to thank the three of you for being here. My question is for the three witnesses. You can all answer or choose who wants to answer.
In the Action Plan for Official Languages 2023-2028, up to $98.2 million has been allocated over five years, and I quote:
. . . in direct support for the vitality of official language minority communities in the form of an expanded offering of essential services . . . such as . . .health care for aging individuals . . .
Have you received or are you currently receiving funding from the federal government?
Ms. Savard: I can answer that question. I received some funding to set up a program. It was part of the Action Plan for Official Languages. The money was transferred from Health Canada to the Société Santé en français, which put out a call for proposals. We received money to set up an innovative fall prevention program. We used an exercise program conducted over video conference to reach francophones in remote areas and match them with health care professionals in major centres. So yes, I’ve received funding for this.
Senator Poirier: Did it help?
Ms. Savard: Yes, it helps. The thing about these projects is that they’re simply projects. Once the money runs out, we need to maintain this type of service. We worked closely with community organizations. These organizations pay greater attention to preventive care, as opposed to hospitals, which focus more on acute or curative care.
Community organizations don’t always have the resources to maintain the programs in place. This particular program provides 10 exercise sessions and information on fall prevention. It isn’t very expensive. It costs $2,000 or $3,000 per location or per session provided. However, organizations don’t always have that money available. They must apply for grants each year to maintain a program, since they receive funding only on a per‑project basis. As one speaker said earlier, therein lies the problem.
Senator Poirier: I’ll now turn to the other two witnesses to discuss the budget.
You brought up — and I included it in my questions — your program, Marche vers le Futur, or walk towards the future, which focuses on preventing falls.
Ms. Savard: Yes, that’s the program.
Senator Poirier: Do you have any plans for similar programs in the future? Do you think that this type of program could help anglophone or francophone seniors in minority communities across Canada?
Ms. Savard: I don’t have any plans for other types of programs. However, the use of video conferencing for fall prevention programs is a definite possibility. We proved it with our project. If people have other ideas, it could be done again.
Senator Poirier: Thank you. I’ll go back to my first question for the other two witnesses. I want to know whether they have any comments or whether they’ve received any funding.
[English]
Dr. Tanuseputro: Obviously, we need systematic change. In health care, in my mind, some of the solutions we can enact do not have to be terribly expensive. What needs to be done to change culture, I think that’s what we should be thinking about.
I talked about a study about people being hospitalized. Any of us can enter a hospital at Queensway Carleton or, if you are from Toronto, at Sunnybrook. You go to the emergency department; do they ask you what language do you speak? No, not really.
If you don’t speak English, is there a way for you, as a patient, someone who is acutely ill, to be able to access services for translation; is that option given to you? No. Are those solutions readily available out there in terms of technology and cost that are feasible? Yes.
There is a joke in the academic community that Canada has a string of pilot programs: Pilot program, pilot program, pilot program. We need to move beyond that.
Some of the solutions out there are not just about creating programs, but it’s about changing the culture and making it mandatory for individuals, providing health care, for example, to be asking individuals and, if that individual says not English, not French — or if they say French but not English — to offer them translation services. Does that ever get done? No. It doesn’t get done in my primary care office. It doesn’t get done in the emergency room. It doesn’t get done in The Royal, or the CAMH, the mental health hospitals. Why is it not being done?
Senator Poirier: My question was on the Action Plan for Official Languages 2023–2028 and the amount of money of $98.2 million over five years for [Technical difficulty]. Did you receive funding for that, or not?
Dr. Tanuseputro: No, we did not.
Senator Poirier: Ms. Spinks, please.
Ms. Spinks: It’s not something that we, at the National Seniors Council has directly looked at, in terms of that particular fund. It is something that we have been watching very closely. The National Seniors Council has representatives from Quebec, New Brunswick and Manitoba who are representing minority language in both languages.
I agree that, when these kinds of resources are made available to the community, it’s really easy to get excited with the shiny new object that’s available and forget that there is some really good work that has been done that should continue to get done. Everybody has to change their direction to what the shiny thing is of this period, and we forget.
It’s very often that somebody will come to me and talk about these brand new project that’s just been funded. I can make a phone call to five or six different people across the country and, between us, we can find an example of projects that might have been tried somewhere else in the country 5, 10 or 20 years ago because it’s pilot, pilot, pilot; project, project, project.
We have really robust tools now to evaluate programs and services that are funded by federal dollars. We need to find a way to roll that up and continue to fund those that work well, and for those that work well, find a way to scale them, or to transfer that knowledge to other parts of the country.
Senator Poirier: On that note, is there somebody that looks at all these pilot projects and decides, okay, this one here, we tried it at different places and it works fantastically, or this is one we need to meet with the minister and we need to say this is one that has to become permanent? Is there any work like that being done?
Ms. Spinks: I would love to be able to say yes, but in my experience the reality is it is that unless it is — hey, did you hear about it; or, what do you know — very much through professional networks. Years ago, there used to be structures, whose sole purpose was to do the coordination, facilitation, cross-pollination and facilitate collaboration. Those bodies used to be funded. They are no longer funded.
Senator Poirier: That would be a great recommendation for us, though, would it not?
Ms. Spinks: I think it would be an extraordinarily good recommendation to make.
It’s not just those that are happening now; it’s getting people who have been part of delivering those services for decades who might now be seniors themselves. I remember a story about a guy in Alberta at the beginning of COVID. He was in the hospital, and they were struggling with a shortage of PPE. He said, “Well, there is a warehouse full of PPE.” He had retired. His idea of stockpiling PPE had retired with him. They found the warehouse. They found the material — it had since expired — but there was no way to track, trace and support that after he had retired.
So there are lots of past learning and current learning. There is a lot of information about what works, and there are many seniors who will share their experiences.
Senator Poirier: Thank you.
[Translation]
Senator Mégie: I want to thank the witnesses for joining us this evening. You all spoke about language barriers for people in minority communities. Does the lack of services in their mother tongue prevent our seniors from seeking home care? They might think that, since no one can take care of them, they would rather stay at home. At that point, their situation could become worse. Have you found in your research that language barriers prevent them from seeking home care?
Ms. Savard: Yes. Some research shows that people turn down certain types of care, such as a bath, when they don’t receive it in their own language. With regard to research currently under way, a woman told us that her mother is offered two baths a week, but that she turns them down. This means that the woman has to bathe her. She turned down the baths because she didn’t want to receive this type of intimate care from someone whom she didn’t understand and to whom she couldn’t convey her pain. The caregiver had to give the baths.
In the senior’s mind, this issue won’t necessarily prevent her from staying at home, because her daughter bathes her. However, if her daughter becomes worn out, it may put an end to home care.
The seniors figure that they don’t have access to home care in French, but that they won’t receive any care in French in a residence either.
In my opinion, this issue won’t determine whether they choose to receive care. In both cases, the care will be mostly in English. It can — and certainly does — play a role in caregiver burnout.
Senator Mégie: Would anyone else like to comment?
[English]
Dr. Tanuseputro: That’s a great question.
I’m going to share a quick anecdote about one of my patients who was Chinese. He was dying, and I was visiting him in his house. He had lung cancer. He started developing dementia, and he was unable to care for himself. His wife was completely distressed and could not care for him. He obviously needed to go into long-term care, for example. He told me, “I refuse, because, one, they can’t understand me. I speak Chinese. Two, they don’t serve rice, and I eat rice for breakfast, dinner and lunch. Rice is in every meal, and I know they are not going to serve me rice.” For long-term care, it’s been brought up a couple times. It’s not only language but also cultural.
The funniest thing is that we don’t make accommodations to ensure that people who — because there are ethnic-specific homes. There are homes for Italians, Greeks and Chinese. Fifty per cent of those beds go to people who do not speak those languages because of this selection process we have doesn’t weigh that too strongly.
So absolutely: People refuse to get care and refuse to go where they should go. In return, not only does the patient suffer but the caregiver suffers. Unfortunately, 70% of people with dementia end up in long-term care before they die, and 70% of people in long-term care have dementia. There is a point where you need that extra support and you cannot be at home. That’s what I always tell my patients. Regardless, it’s definitely a barrier.
Ms. Spinks: We have to take into consideration the fact that a lot of care, interpretation or translation that happens is done by very young children. We don’t spend enough time in supporting young caregivers. We don’t even do a good job of recognizing them in this country. Certainly, the federal government doesn’t fund programs and services to the degree that they need.
I was recently with a friend. She was waiting for a cancer test to be done. Beside me was a little boy who was maybe 6 or 7 years of age. He was working on his device. His grandmother was going in for testing, and he was the only interpreter there was. He had big responsibility, and he took it very seriously, but he was the only one that could translate between his grandmother’s language and the health care community.
That is just another example of young caregivers and also the significance of language, both minority languages and those other than official languages.
[Translation]
Senator Mégie: I heard all three of you repeatedly refer to pilot projects. At the National Seniors Council, could you connect any of your research? I know that, in Quebec, a great deal of gerontology research is in the works. This may also be the case in other provinces. Is there a way of connecting this research, to avoid having to keep reinventing the wheel? Have you thought about this?
Ms. Savard: We certainly do have connections thanks to professional conferences and Société Santé en français. Initiatives, programs and success stories are shared, but not always by the managers who make decisions in the health care system. In fact, if the money isn’t there, managers don’t always focus on prevention first. Curative care is very expensive, and there are all kinds of other barriers. Société Santé en français has some really good ideas about what works and what doesn’t in French-language health care, but doesn’t have the power to dictate to a province that things should be done a certain way; that’s up to the province. What’s more, they don’t always have access to the decision makers. In Prince Edward Island, the person responsible for the French Health Network is also a French-language services advisor to the Department of Health. However, that’s a rarity in the provinces.
In Ontario, some French health networks that are also French-language service planning entities had the ear of the Local Health Integration Networks, or LHINs. However, now that they have been reformed and there are no longer any LHINs, it’s unclear how much room Ontario’s health agencies will make for French-language service planning entities.
For a program to become permanent, it would need a little more support from the provinces, and the organizations working for French-language services don’t necessarily have the ear of these people. In British Columbia and Alberta, don’t even think about it: French-language health networks don’t have access to the Ministry of Health, for whom French-language services are not a priority.
Senator Mégie: Mr. Chair, can we ask Dr. Tanuseputro to send us the article through the clerk that he mentioned earlier about the discrepancies between the language spoken by the patient and the language spoken by their physician?
The Chair: Absolutely. Time is flying by, but we still have some left.
I’d like us to think about how the federal government can take action. I invite the witnesses to keep this in mind in terms of how the federal government can take action on the questions that will be asked.
[English]
Senator Moncion: You talked about changing culture, education of elders and the significance of language. These are areas where I think we need to work as well. On education of elders, one of the problems that we have is it’s very difficult for older people to change their mind. We are talking about someone who has dementia, who is at home and he doesn’t want to go anywhere because he eats rice three times a day, so there is a cultural problem.
One of the things that we have to do with elders now is to start speaking to them about life-changing events that bring them to be candidates not for home care, but for institutional care. I understand that the institutional care is not always the best, but you have a situation where you have family members who are caught in a very tight place because they feel they have the responsibility toward the aging parent and the aging parent is stubborn and doesn’t want to go anywhere else but stay at home. At some point it’s irreconcilable. It brings the kids to endure this and trying to do the best they can, or make a difficult decision for the parent who doesn’t want to go into long-term care. I want to hear you on education for elders on aging, preparing people for aging and for lifestyle changes. Do we do any of that?
Dr. Tanuseputro: I’m mindful of the chair’s prerogative of talking about what the federal government can do. You are absolutely right. When I have a patient who obviously just was diagnosed with dementia, the first thing I talk about with them is that this is going to be a journey, and this journey more often than not, 70% of the time, will be you being in a long-term care home, not even private retirement homes for those who can afford it.
It’s about changing norms, obviously, but also making it easier for adults, especially older adults, especially those who are in linguistic minorities to achieve that transition. So, if I fly on Air Canada, I might have an option to choose to eat rice for my meal. Why is that not an option when we are “forcing” someone to go into long-term care? It’s a simple enough request that I think some of these things can be done.
But absolutely, the reason why I brought up that 70% of people in long-term care have dementia, and 70% of people with dementia end up in long-term care is exactly that. A lot of people just have no choice, and it’s not up to the caregivers. It’s just impossible, honestly. A lot of people do not have caregivers that can be with you 24-7.
I don’t have an answer to that except that perhaps is there a role for the federal government in terms of promoting programs that provide education about what happens to individuals as they age? What are the needs and what is an actual progression?
It’s really sad when someone sees going into long-term care as a bad thing. I understand that not a lot of people want to be there, but it’s the reality that you need 24-7 care eventually if you have something like dementia or something progressive.
We’re talking about linguistic minorities. To ease that transition, providing services, providing culturally and linguistically appropriate care, it’s basic dignity that we can provide to these individuals. The $98 million is a lot of money, and it doesn’t take a lot of money to provide that choice for individuals.
[Translation]
Ms. Savard: I worked as an occupational therapist in long‑term care centres and seniors’ day centres. In Quebec, the day centres were run by the long-term care centres: For the elderly, coming to the day centre was a way of preparing for accommodation in a long-term care centre. I don’t know if that’s still the case. I know that in Ontario, day centres are not necessarily run by long-term care facilities. In my experience, if you try to educate people about what it’s like to age when they aren’t aging, they often don’t listen.
Senator Moncion: It depends if you have been a caregiver to someone, most of us have been a caregiver for one parent or both.
Ms. Savard: Yes, maybe a little more. With respect to our fall prevention programs, several have shown interest, but others say they are not yet at risk of falling. And yet, our program is designed for people before they are at risk of falling, but sometimes, people wait until they get there before they listen.
Senator Moncion: That’s great.
Senator Clement: Good evening. Thank you for your extremely helpful testimonials. I will ask my questions and let you answer afterwards.
My first question is for Ms. Savard. You stated that your studies have shown that there’s a difference between Quebecers and francophones living outside Quebec. I’d like to know more about this difference and distinction, and also how that changed your studies.
[English]
For the other two witnesses, I’m interested in intersectionality. You referred, Ms. Spinks, to cultural appropriateness. How do you define that?
Doctor, you said for the 24% lower odds of dying, if that were a pill, then everybody would want to manufacture, sell and take that pill. How do we take that message and move it into reality? How does a busy family doctor incorporate pay for interpretation in his or her practice? And so those are the questions for both of you.
[Translation]
Ms. Savard, I’d like to know how you made that distinction and why it matters.
Ms. Savard: I think the two groups have similar needs when it comes to health care; the difference lies in access to care for francophones living in minority situations.
When you include only Quebecers because you want to include francophones in the study, you’re including people who have access to services in their language. Since we’re including English speakers from English-speaking provinces, we don’t see the language barriers. That’s why I mentioned that minority francophones should be included in health services studies, so that others working for French-language services are made aware of the needs of minority francophones.
Senator Clement: That’s not already being done?
Ms. Savard: It’s not already being done, and that’s why I said in my opening remarks that the federal government could easily raise awareness on the impact of language barriers, because raising awareness isn’t a provincial jurisdiction that governments won’t want to hear about.
I think we still really need to raise awareness of language barriers. I see it with managers we interview when we are doing research.
Of course, in Ontario a lot more work has been done with the French Health Network of Northern Ontario; a lot of training’s been provided. However, that isn’t the case everywhere; there are still people who don’t understand and who think that francophones are all bilingual, or believe that as soon as you speak English to say hello, you’ll be able to understand everything. I went to Riverside Hospital and after the nurse said my name and I said yes, she told me she didn’t speak French. Then she started talking to me very, very quickly in English. I understand English, but not when it’s spoken that fast; it’s like they don’t realize it.
As part of our research, we train future health care professionals; I teach occupational therapy. With colleagues in nutrition, nursing and medicine, we stimulate the active offering of services in French, and we show students, future health care professionals and future physicians what they need to ask people, which is if they would prefer to speak French or English, and what they can do if they themselves don’t speak French. We need to raise awareness of this.
Senator Clement: Thank you.
[English]
Dr. Tanuseputro: It is an excellent question. Again, I am a family doctor. There is not enough time in 15 minutes to get translation services. The Canadian Institutes of Health Research, or CIHR, supports a lot of dollars in research. One of the avenues that can help, I think, is more and continual support for something called implementation science. I don’t know if you have heard of it. Implementation science talks about doing research not only for the sake of research. A large part of the criteria is using an intervention, like from a pilot study or something else that has been proven to be effective and then focusing on the scale-up. Therefore, it’s not just about proving that X causes Y, it’s about solutions, implementing solutions and learning from that implementation. It’s something called a Learning Health System, or LHS. CIHR is trying to support implementation science.
I’ve never seen one geared toward language or culturally appropriate care. Perhaps that’s something we can do — support the scale-up of interventions that we know work that can be evaluated, and then have a plan for a scale-up. If you dangle money in front of researchers with criteria, they will follow whatever criteria you put them in. If you focus on scale-up, you will scale up.
I have another very quick comment — we don’t have much time. We have amazing technology nowadays, right? There are things like AI — the return of AI — to be able to provide translation services on the spot. We are nowhere close to achieving those in health care. But if you dangle that carrot in front of researchers and the academic community to come up with solutions to incorporate technology and new innovative methods, and not just incorporate but scale up and have a plan for scaling up, I think you will have a good chance of success.
The Chair: Ms. Spinks, you have the last answer of the evening.
Ms. Spinks: I get to close off the comments. Let me pick up and support my colleagues on the panel here. I think technology is critically important, but we need to balance high tech with high touch. There is a big concern that too much technology will diminish the care that people actually receive.
I do agree that we need to support our medical community, the practitioners and any allied health care professionals so they can do their work and do it well. They got into these professions to help people. We need to do that.
From the federal government’s perspective, there are a couple of things. Some you have already heard about. One of them is a publicly funded long-term care insurance program. The research is very clear about the benefits of that for the next generation — today’s 30-year-olds and 40-year-olds — when they approach this age and stage. Another is leveraging things like the United Nations Decade of Healthy Ageing 2021-2030. Worldwide, we are moving collectively, sharing knowledge and information. To pick up on the idea of implementation science, it now takes 14 to 17 years to get research to practice. Implementation science is trying to shrink this to two to three years. The federal government spends a lot of money on research, the tri-council and CIHR, and to be able to harness and leverage that collective intellectual energy to get that faster to the health care professionals and to seniors in this country would be ideal.
My last comment is really about this army of seniors that you have at your disposal. If there is some way that we could find to recognize the contribution that seniors make in caring for others to do the translation. It is much easier to get somebody to come and provide translation in French or English in the emergency department if they could count that on their taxes and get recognition for that — to be able to cost that in some way and get that contribution recognized. One of the levers that the federal government has is the tax system.
Mr. Janeiro told you a lot about some of the other simple things, but I think some of these bigger ones are well within our grasp.
Again, thank you so much for bringing this very important topic to public discourse.
The Chair: Ms. Spinks, Ms. Savard and Dr. Tanuseputro, thank you so much for your contribution to the committee.
[Translation]
We’re grateful for your involvement and commitment. Esteemed colleagues, thank you very much. We will conclude the meeting with these final answers. Have a good evening.
(The committee adjourned.)