Evidence of meeting #21 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was education.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Judy Morrow  Board Member, Canadian Association of Practical Nurse Educators
Barbara Mildon  President, Canadian Nurses Association
Cynthia Baker  Executive Director, Canadian Association of Schools of Nursing
Paul Fisher  Chairperson, Canadian Council for Practical Nurse Regulators
Anne Coghlan  President, Canadian Council of Registered Nurse Regulators
Josette Roussel  Senior Nurse Advisor, Professional Practice, Canadian Nurses Association

10 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

I think of support for students in the north in terms of nursing education, because they will stay in their communities, but there are lots of barriers to their success in educational programs. So programs supporting students, not just the recruitment of students in the north into northern programs, but retention of students, programs to support their retention in the program so that they graduate, they graduate well, and they go out to work in their communities, would be, in my mind, an approach to this issue.

10:05 a.m.

Conservative

Eve Adams Conservative Mississauga—Brampton South, ON

Thank you.

Mr. Fisher, do you have anything to add to that? I don't mean to put you on the spot.

I have just one final question, then. Is there anything that you would recommend the federal government do in order to clarify scopes of practice?

Ms. Morrow, you're nodding your head.

10:05 a.m.

Conservative

The Chair Conservative Ben Lobb

Ms. Morrow, if you could respond as briefly as possible, that would be appreciated. Thank you.

10:05 a.m.

Board Member, Canadian Association of Practical Nurse Educators

Judy Morrow

Certainly, no problem.

Along with what has been said here this morning, I believe that we need to identify what scope of practice means, first of all. Maybe we need to go back to the definition of what scope of practice is before we move forward and identify what each different nurse within the nursing family does within that scope of practice. I think we have a bit of groundwork to do first, and then I believe that we need to move forward. What's happening out there, from what I'm seeing, is that there's a scope of employment, and then there's a scope of practice, and the two tend to collide, so we need to go back to the basics.

10:05 a.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much.

Mr. Morin is going to ask questions for five minutes.

April 8th, 2014 / 10:05 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you very much, Mr. Chair.

I will continue with what my colleagues, Ms. Davies and Ms. Adams, were saying about home care.

As experts, you said that the population is aging. Older people in particular want to have more services at home. Dr. Mildon mentioned that pilot projects seemed to have good results. It was said that in order to ensure that there are national standards, a committee could be created and the federal government could take the lead. That could help the provinces meet their own specific needs.

Do all the provinces and territories have this need and do they have the will to move forward in order to improve home care services? My question is for anyone who would like to answer.

My second question is the following.

In concrete terms, what more could we do at the federal level to help the provinces and territories enhance the home care services they provide? In my own riding, public services are unable to meet the need. The number of seniors who are turning to the private sector is increasing because they really want home care.

Can you answer these two questions?

10:05 a.m.

Senior Nurse Advisor, Professional Practice, Canadian Nurses Association

Josette Roussel

I will answer the question in French and then my colleague will add her comments.

In the work and the research we have done with our colleagues, we have found that people across Canada want to find models or best practices that will lead to positive change without making major investments. These models can be at the team level. We have to examine the needs of different populations.

We can give you a number of examples in our written submission. They are not necessarily models based on specialty nurse practitioners. They may be models where registered nurses and other team members provide community services. As you mentioned, mostly seniors need these services.

In some communities, some nurses do not work to their optimal scope of practice. Our members have told us that their skills are underutilized. Only 40% of nurses' community health skills are utilized. That is what our research has indicated. We are trying to make changes to certain models of practice. That is my answer to your first question.

As for what could help, I believe that there are many examples we could share with the provinces and territories in order to improve home care.

I will let my colleague add her comments on this subject.

10:10 a.m.

President, Canadian Nurses Association

Dr. Barbara Mildon

Thank you very much for the question.

I will quickly add in the interest of time that I think you're speaking much to the history of the evolution of home care in Canada, which of course is not covered under the Canada Health Act, so that has always rendered home care very vulnerable to individual interpretation, but also to funding envelopes. I agree with you 100%. We are seeing situations where once the funding envelope is gone for a certain service, people go on a waiting list and they simply don't get the service.

I do know efforts were made in more recent years to come up with a federal agreed-upon basket of home care services across the country. Perhaps we need to revisit those activities. Other than that, again, it is up to the whims, really, of funding in the various jurisdictions.

10:10 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Do I have more time, Mr. Chair?

10:10 a.m.

Conservative

The Chair Conservative Ben Lobb

You have 10 seconds, so use it wisely.

10:10 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Or not.

10:10 a.m.

Conservative

The Chair Conservative Ben Lobb

Okay. Thanks very much.

Next up, would Mr. Wilks like to go, or Mr. Young?

10:10 a.m.

Conservative

David Wilks Conservative Kootenay—Columbia, BC

Mr. Young.

10:10 a.m.

Conservative

The Chair Conservative Ben Lobb

Mr. Young.

10:10 a.m.

Conservative

Terence Young Conservative Oakville, ON

Thank you very much to all of you for being here today.

I was thinking about what Cynthia Baker said about long-term care and the aging population. For 13 years I've been serving on the board of a not-for-profit seniors residence in Toronto. We have three towers and 300 residents. We provide supportive care up to a certain level, but our average age is 89. Really we're almost like a nursing home for ambulatory seniors. In fact we had a birthday party in August for 14 ladies who are all over 100 years old. So it's not just the baby boom; it's the aging population. People are living a lot longer.

I want to relate a personal story, because it's perfectly relevant. My mother, in a not-for-profit seniors residence, last year had a heart attack and went to hospital. When she was ready to come out, she was what they call—you would all know this—a two-person transfer. It took two personal support workers to get her from the bed to a wheelchair and back. They couldn't accommodate her unless she paid for her own nursing care. Now, they haven't built any long-term care beds in Ontario. They say, “No, no, we're providing care in the home.”

They told me that my mother needed 16 hours of care a day. I talked to the CCAC, and they said they'd give her three. I said, “No, you have this wrong; she needs 16.” They said they'd give her three.

I got some advice from different people and I called back and negotiated. It was like a house deal, or a car deal. I said, “Well, if you pay from 8 a.m. until noon, my mother will pay the rest.” The person called me back and said she asked her manager, who said yes to that.

Luckily my mother was able to pay for that until she got into a long-term care facility, but the wave is coming, in Toronto in particular. For seniors who have a house in Toronto, they can afford it. Their houses are worth from $600,000 to $800,000, and over $1 million, so they can afford to pay for their care. It would have been $12,000 a month for my mother, at $25 an hour. But there are many who can't afford it, and no one wants to talk about it. We need to really optimize care for seniors who need different levels of care.

What should nurses be able to do, and then what should personal support workers be able to do in these facilities, in supportive housing and in long-term care facilities? What should doctors be doing? Who should be doing what? This is your chance to get on the record all those things you've been thinking about.

The second part of the question is for Barbara Mildon and then anybody else who wants to comment on it.

Is turf protection a problem in caring for patients, and in particular seniors? If it's a problem, please take this opportunity to identify it.

I'd like to start with Cynthia Baker.

10:15 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

That's a great question: what should everybody be doing? That's part of my thinking in terms of frameworks. I don't think it's clear at all. I think that's where we need to have a conversation across the country with all kinds of groups, all kinds of stakeholders, defining what the....

I mean, there is legislation about scopes of practice, etc., but all of this is relatively new. I don't think it's clear, and I think we need to work it out. I think that's the first step, in my mind, towards when we get that worked out, then how do we educate and align the education in terms of what everybody should be doing?

I don't know whether my colleagues would agree, but I don't think it's that clear. Things will overlap, but I do think we need to work it out. I think we need to align education, because I think this is really what the health care needs will be in 2020.

10:15 a.m.

Conservative

Terence Young Conservative Oakville, ON

Do you have any ideas on how to start working it out?

10:15 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

Yes. I would set up a national task force, with stakeholders representing the nurse practitioner education and regulation, registered nurse regulation and education, the Canadian association of schools of...the Canadian Nurses Association, other professions, physicians, other stakeholders in the group—

10:15 a.m.

Conservative

Terence Young Conservative Oakville, ON

So we just lock them in a room and tell them to work it out, or—

10:15 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

No, I'd set that up and give them a two-year mandate—

10:15 a.m.

Conservative

Terence Young Conservative Oakville, ON

Two years.

10:15 a.m.

Executive Director, Canadian Association of Schools of Nursing

Dr. Cynthia Baker

—to conduct focus groups, surveys, and work, with national forums bringing it together and synthesizing this information, developing and coming out with the kinds of clarification....

If I understand correctly, that's what the physicians are currently doing, but they're looking more at generalist versus specialization, this type of thing.

10:15 a.m.

Conservative

Terence Young Conservative Oakville, ON

I'd like to ask Barbara Mildon the same question, please.

10:15 a.m.

President, Canadian Nurses Association

Dr. Barbara Mildon

Thank you.

I'll speak first—

10:15 a.m.

Conservative

The Chair Conservative Ben Lobb

Ms. Mildon, we're up against the time, so very briefly, please.