Status of Women Committee on Oct. 20th, 2011

[Josette Roussel]

Yes.

[Sana Hassainia, NDP, Verchères—Les Patriotes, QC]

Do you have any figures?

[Josette Roussel]

I can't give you any figures off the top of my head, but this takes place mainly when we train people who have to work in these environments. We train them both on the approach and on how to react in certain situations and how to report them. Yes, there is a need for training in both cases. You raise a very good point.

[Barb Mildon]

May I add to that very excellent response that what we would like you to focus on, what I ask you to look at, is the situations in which we have bylaws or requirements that registered nurses be on site in long-term care facilities for at least one shift a day or that they constitute a certain percentage of the staff. Help us to ensure that we have good staffing or that we have the professional presence of nurses to guide the kind of care and care design that is taking place.

The other thing we need to remember is that the long-term care sector is perhaps the most poorly resourced sector of our health care system. This plays a role in the number of staff and the preparation of staff that are brought to bear to care for our vulnerable elderly.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

You have four minutes left.

[Charmaine Borg, NDP, Terrebonne—Blainville, QC]

We all know that with an aging population, public and even private institutions are overcrowded. The elderly often have to be cared for by informal caregivers.

As a nurse, can you tell us whether informal caregivers are getting enough training to truly prepare them for this role?

I think it's an interesting dynamic. These people jump into this without really knowing what is waiting for them. They may not really know how to react in an abuse situation.

[Barb Mildon]

Let me begin and then invite Josette to respond.

This is why we need so very badly to have a well-resourced public health nursing system. It is proactive visits by public health nurses that can help caregivers cope with the very real strain of caring for vulnerable elderly in their homes. They can provide resources, they can link to day care centres, and they can promote the wellness of the seniors themselves so that they stay better able to cope in those environments. We need to look at proactive approaches. As for training themselves, that is another thing that public health nurses can do quite well.

I can only bring you the example of my own grandmother. Certainly we had family involvement, but she benefited greatly from regular visits from a public health nurse. Those public health nurse programs have been seriously eroded across our country. The kinds of proactive visits I'm talking about are primary targets for reduction when budgets are an issue.

So I believe it's a combination of both.

There are other strategies in place to also look at supporting our caregivers, most of whom are working in a volunteer capacity as caregivers while balancing many stresses in their day-to-day lives and who can use all the support we can give.

[Sana Hassainia, NDP, Verchères—Les Patriotes, QC]

Could you quickly give us some numbers on abuse in public organizations and in private organizations. You seem to favour public organizations, which would be more effective. Could you explain why you came to that conclusion?

[Barb Mildon]

I would be remiss if I were giving you the impression that I favour one or the other. They both have a very important place in our care system.

Private organizations have opportunities to influence their pricing and their admission criteria in ways that aren't in place in public organizations or among public providers. That's one key difference. If you have an ability to pay for service, you generally can influence a better or richer mix of staff, and perhaps a wider array of services. That's what I'm speaking to.

Long-term care settings that are public in nature, that are not for profit, receive all walks of life in terms of vulnerable elderly, so they perhaps don't have as much opportunity to influence the rich staff mix that's needed. I really shouldn't even use the words “rich staff mix”. I'm talking about a staff mix reflective of the continuum: registered nurses and registered or licensed practical nurses, as well as health care aids or personal support workers. That's really the difference I'm trying to alert you to.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

We'll now move to Roxanne James.

[Roxanne James, Conservative, Scarborough Centre, ON]

Thank you, Madam Chair.

Thank you to both of our witnesses. I'd like to welcome back Ms. Mildon, a familiar face at our committee.

I have a question related to our family violence initiative, FVI, and our long-term commitment from the government to address violence within relationships involving kinship: intimacy, trust, and dependency.

The Public Health Agency of Canada leads and coordinates this program on behalf of 15 different partner departments, agencies, and crown corporations. Can you explain to the committee the impacts of this coordinated approach through the federal government? Would you please expand or elaborate on that for the committee?

[Josette Roussel]

No. I don't have knowledge of this particular program. I can just comment on our experience with the PEACE project, which is really a Canadian approach and is showing that coordination is providing common language and common learning around the issue of elder abuse. We're seeing great benefits from that coordinated approach.

I cannot comment on the other program.

[Barb Mildon]

I regret that I, too, don't know it as well as I would like to, but what I do know from my experience as a home care nurse and also from nursing in general is that the kinds of tools that Josette has talked about and that I've talked about in reagrd to the PEACE program lend themselves beautifully to family violence interventions.

It's the emergency room nurses who may see the first signs of family violence. We need tools for them in order to alert them to what the family violence signs can be and what they can do to intervene. Home care nurses also see it in their settings. The family violence program, as I see it, has the greatest potential to do exactly as you've said, by going across the sectors: it is that seamless, integrated approach to elder abuse that will have the greatest effect.

I see this program as very pivotal to your deliberations.

[Roxanne James, Conservative, Scarborough Centre, ON]

Thank you for the answer.

I want to also acknowledge that we have talked in this committee about the programs through the government that have been quite successful. One is the federal elder abuse initiative. I believe it has been a program and money that was well invested. In addition, the new horizons program is continuing, and our commitment to invest further moneys into it has been well received right across Canada. Of course, there is our Speech from the Throne and the commitment to tougher sentencing against elder abuse.

I'm just wondering, outside the throne speech, about the different programs that are in place right now with which you are familiar. Which ones do you see as having been most successful? Where do you see the fruits of the labour and the investments and so forth? I wonder whether you can comment on that and on why you feel that such is the case.

[Barb Mildon]

That is a wonderful question, and very comprehensive, and I really want to do it justice. If I may take the liberty, I will say that we will respond to these questions in writing as well afterwards, where we can be much more comprehensive.

All of these projects and programs that have been funded make a difference in going forward. The difference they make is that they lay down the evidence of what works. We saw that from your earlier presenters. We see that with the new horizons program, of which I've brought you an example.

Now what we need to do is integrate into an entire whole what we've learned from each of these disparate or separate programs. If funding were to be made available on a “next” basis, I would be looking for programs that bring these learnings into an integrated approach to elder abuse across sectors and settings and that provide demonstrated evidence that there is cross-sectoral collaboration and implementation of the programs.

We say in research that descriptive research is where you begin. Descriptive research gives you the evidence that you need, but then the next step is implementing that research. I think the greatest benefit of the projects that have been done is that of giving a voice to those who understand the issues and demonstrating that certain interventions make a difference. Now it is a concerted whole.

I believe that earlier in your deliberations you talked about despair over the definitions being different across provinces, territories, and indeed the world, and the presenters spoke of their work to achieve consensus on a definition. It's the same approach when you look at a program of interventions to prevent elder abuse.

I hope that's somewhat helpful. I promise you a more comprehensive answer.

[Roxanne James, Conservative, Scarborough Centre, ON]

Thank you very much.

I would like to touch base on one more issue. Previously, one of the witnesses mentioned that when we think of abuse against women, we always assume that it's a younger woman. Again, we sometimes isolate that to a certain age bracket.

I thought I heard you mention something about suicide rates. That is another topic in which, when we think of people who commit suicide, we're always thinking of a younger generation. We don't really associate it with someone in their sixties or seventies.

I'm not sure whether I heard you correctly, but could you talk about whether this is happening within the elder community? How often is it occurring? Also, is it actually tied to, or can you see links back to, elder abuse?

[Barb Mildon]

I'll answer the easiest questions first.

First of all, yes, it is a reality in our seniors communities and in our seniors population. There is a rising incidence of seniors committing suicide. The reasons they commit suicide are probably as diverse as those for any age group in our population. We can speculate that loneliness, poverty, and despair create the situations in which people would choose to end their lives. I can tell you with certainty that it is rising, that we are concerned, and that we need to address it.

In terms of the more specific numbers, I would have to get back to you on the statistics, but I certainly know that's happening. As you may have heard me mention in my earlier presentation, my day-to-day world is mental health. We are definitely seeing this as a national concern.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

Thank you.

Ms. Sgro has gone, so we'll move to Ms. Bateman for five minutes.

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

Thank you, Madam Chair.

Thank you both so very much for being here. It's very important to have this discussion.

As I'm sure you're aware, the government has taken unprecedented action to address the issue of supporting seniors positively and to combat elder abuse in all its forms. I'm fascinated to hear you speak to a number of the issues, and from the health care perspective.

I have two questions. We have invested a significant amount in an awareness program. There have been print, radio, and television advertisements. Could you speak to the effectiveness of that program, systemically, in your world of care? Also, perhaps you could tell us what else is needed on that piece.

[Barb Mildon]

Thank you for the question.

I'm so pleased with the question because I have seen the TV ads. In particular, I'll speak to those. There is one most profoundly affecting ad in which there's a gentleman who is with an elderly woman. He takes money forcibly from her. She offers him some; he takes the whole wallet. It's a most profoundly moving situation, and it is part of that awareness campaign.

First of all, I believe this campaign is truly having an effect. It is visible. It is eloquent. It certainly depicts the wrong behaviours and, therefore, the right behaviours.

I think what we need to do more, and next, is continue with the tools we need. That particular vignette shows a neighbour peering out of their window. The curtain is drawn aside a little and the neighbour is peering. What do we tell the neighbour to do when they see that? Do they phone the police? Do they phone public health? Do they go knocking on the door? What do they do? We need to make tangible advice and resources available to that neighbour who's peering and concerned.

Of course, I will also go back to this notion of an outreach program to those isolated elderly. Where could that woman go, knowing that she's not safe at home? Do we have a network of women's shelters she could turn to? Could she walk into the local police station, and would she be comfortable doing so? What resources are there for that woman who clearly knows in her heart that she's being abused? That would be my first answer.

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

Thank you for that.

We've had a number of witnesses at this committee. The other day we had Health Canada representatives and the Public Health Agency. How does the Public Health Agency, which has been empowered with this program to some extent, work with your association of nurses? Again, how could we do it better or how could they do it better?

[Barb Mildon]

I must tell you that I am profoundly grateful to the Public Health Agency of Canada. They partnered, for example, with the Community Health Nurses of Canada. That is one of CNA's affiliate and associate groups of nurses.

Through that partnership, they made it possible for the Community Health Nurses of Canada to create new competencies and a new certification program that gave them the skills and knowledge they needed to be the best they can be in their field. Knowledge of elder care, which underpins an understanding of elder abuse, is definitely an outcome of that partnership. What they're doing wonderfully is that they're partnering and they're seeing the benefit that each group of health providers can bring to many issues in public health.

I think the other thing they do wonderfully well are their reports, which are quite profound, quite comprehensive, and very much accessible. I would suggest that they are doing all the right things now with the study they have brought together, which I understand they have presented to you.

I can't speak more on a concrete basis to a day-to-day intervention, because I suppose in some ways we're waiting for the outcomes of the current projects. I do know that they are putting the right resources in place, they are making the right partnerships, and they are truly putting that federal funding, from my perspective as a nurse and as a community health nurse, to good use.

Again, I would be happy to answer that better when we go away and make some...[Inaudible--Editor].

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

Do I have...?

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

No.

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

No? Okay. Merci.