Status of Women Committee on Oct. 20th, 2011

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

I'm sorry.

Ms. Freeman.

[Mylène Freeman, NDP, Argenteuil—Papineau—Mirabel, QC]

Thank you very much for being here.

I am actually looking at the policy brief from the Canadian Nurses Association, which is called “The Long-Term Care Environment: Improving Outcomes through Staffing Decisions”. It talks about this:

Fifty-four per cent of nurses working in [long-term care] report that there is not enough staff to get the work done. Staffing decisions therefore have an impact on patient outcomes.

This actually results in violence for nurses and for front-line workers as well. It also states:

The Canada Health Act does not cover [long-term care], and the provision of this type of care falls under the jurisdiction of provincial and territorial governments. In consequence, there is a range of approaches to funding, regulating and governing LTC throughout the country.

The position statement of the CNA states that your association believes that a publicly funded not-for-profit health care system is the most efficient and cost-effective way of providing access to health care services for all Canadians. You also say that you support the principles of the Canada Health Act, which are universality, comprehensiveness, portability, and accessibility.

In reference to this position, which I think is amazing, could you speak specifically about support for long-term care facilities and how this might be helpful against violence, both for nurses and for patients?

[Barb Mildon]

I'll start and then invite Josette, who has experience on the front lines in implementing some of this, to comment.

First of all, the kinds of tools that are coming from the projects we've talked about are directed specifically to health-care workers in the long-term care setting. It is these kinds of tools--but perhaps even more importantly, the opportunity to learn about the processes that prevent elder abuse--that are having the greatest effect.

By that, I mean that we generally tend to think that any of our front-line health care providers need to spend 100% of their on-duty time providing care. In actual fact, in this knowledge age we need to take them away from their care-providing duties for some small periods of time to give them this kind of education and these kinds of resources. These projects generally provide funding to enable us to do that. Those opportunities to get the education and share and reflect on their experiences are having a beneficial effect in our care settings.

There are other factors that we need to look at in terms of what helps care providers be assertive, or aggressive, if you will, in preventing elder abuse. One is also having a work environment that's conducive to being healthy. So not only will the specific tools around elder abuse help them, but there is the more general principle that CNA is promoting of a 70:30 mix of full-time to part-time or casual staff. We believe that this 70% mark of full-time nurses or care providers assures a continuity and understanding of those patients, and that translates into better care.

We believe that attention to work environment issues, such as a place where they can have a break, getting their breaks, looking after their musculoskeletal health through ceiling transfer lifts, and those kinds of things, all play into a healthy work environment. When you feel healthy at work, you give better care and have better outcomes.

You're quite right in saying that patient safety and staff safety and well-being go hand-in-hand. But I will not let my colleagues off the hook by saying there's any excuse to not provide the best care, regardless of one's setting. We know as nurses how to advocate and we work under a code of ethics that CNA provides and that teaches us and informs us about how to provide care.

[Josette Roussel]

In the PEACE project, we describe the awareness education curriculum. We didn't describe it in detail, but the awareness modules have an understanding of elder abuse as one component. They recognize elder abuse and have an understanding of the laws surrounding it and of intervention strategies. But the fifth component of that program is healthy work environments. Barb alluded to this going hand-in-hand; if you have a healthy work environment, you will have health, and the workers will provide better care.

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

Thank you.

We have time for one more question.

We'll go to Mr. Leung.

[Chungsen Leung, Conservative, Willowdale, ON]

Thank you, Madam Chair.

Thank you for an excellent presentation. It was quite comprehensive.

Here's what I would be interested in knowing. There are various departments for funding sources from the federal government, either through the minster responsible for seniors, or through Citizenship and Immigration, where some resettlement programs go into the education of seniors and their rights, and there are also some from our Ministry of Health. How could all of these be coordinated?

Or are they coordinated? It seems like they're going in scattered directions. I'd like to hear your comments on how this can be coordinated and delivered as more comprehensive aid or a form of elder abuse prevention.

Then, as a tangential question to that, we're in a pluralistic society. Besides the two official languages, there is a host of first nation languages, and in urban centres, 180 languages are spoken. Where do you get the skills to go in and do this? Seniors generally do not have very good linguistic skills in one of our official languages.

[Barb Mildon]

I believe you've asked two key questions. One is the integration question and the second is the education or outreach question.

On the integration question, I think you raise wonderful opportunities. It is true that when funding or programs are fragmented across several entities, whether that be in the health care system or the government funding system, I would suggest that their effect is diluted.

If there is an opportunity to somehow create a central point of seniors care and outreach seniors programming, call it what you will, that central point where all seniors-related effort is going through a single point, I think that may bring about a greater and more coordinated impact. That is something for your consideration. I certainly see that.

We've talked about silos that happen in our health care system. We have the acute care silo, where everything is funded globally in our hospitals, etc., but what happens during those transitions from hospital to home? There's a gap there. We often don't have the communications. We often don't have the transfer of information that enables us to then go from the hospital emergency room, from patient discharge, into the home, and have one seamless provision of care. That's a demonstration of where we have the gaps. Transitions invite gaps. I believe you're absolutely asking a good question, and there may be a remedy for that.

With regard to your excellent question, I'll take it down to a finite level of language skills. We certainly know that senior women in particular often have fewer opportunities to learn the language of the community they're living in. That's often the case. That adds to their sense of isolation. That adds to their inability to reach out for help, and it becomes a downward cycle.

Again, I want to sound like a broken record and say that it is services like public health nursing or services that go into homes--outreach services--that can identify these situations early, bring solutions, and connect those vulnerable seniors to services that will help them navigate. That I've seen in action over the years.

[Chungsen Leung, Conservative, Willowdale, ON]

I have one more question for the Canadian Nurses Association. Do you cut across all types of nursing, from the Victorian Order of Nurses to home care, home care assistance, the emergency room, the entire spectrum, so that no one falls outside of that nursing umbrella?

[Barb Mildon]

I'm so proud to say no. For registered nurses, no. Unfortunately, Quebec is not an official member of our organization, but we have many linkages with our Quebec registered nurse colleagues. I would further add that we have 43 associate and affiliate or emerging groups of nurses who are already RNA-CNA members but who also then choose to self-identify with a given specialty group. To look at me, I'm a member of the Community Health Nurses of Canada and, through that, certified. these nurses have the opportunity to develop their skills even further and receive a national credential for their knowledge. It is a comprehensive continuum.

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

Thank you.

I want to thank you for taking time to be with us today. I congratulate both of you on an excellent presentation.

[Ed Holder, Conservative, London West, ON]

Just before we adjourn, Madam Chair, could I ask, perhaps through you to the clerk...? We've had a couple of sets of presentations now. It would be helpful for the presenters to provide those to us at the time so we can follow along with them. There is a lot of statistical information that I know we'll be getting, and it might be helpful for us in both official languages. Can I direct the clerk to make that ask of those very nice people who do present in the future?

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

Your point is well taken.

[Barb Mildon]

Please, for today, if you would like to take one, my colleague will make them available.

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

Thank you.

The meeting is adjourned.