Veterans Affairs Committee on Dec. 6th, 2007

[The Chair, Conservative, Rob Anders]

Good morning, ladies and gentlemen. Welcome to yet another meeting of the Standing Committee on Veterans Affairs.

Today we're continuing to study the veterans health care review and the veterans independence program. Our witnesses this morning are Willie Lirette, president of the Fédération des aînées et aînés francophones du Canada, as well as Marc Ryan, who is the first vice-president, Ontario. Then from the International Federation on Ageing, we have Greg Shaw, who is the director, international and corporate relations.

The way it works generally, gentlemen, is that you have usually 20 minutes in entirety. However, I understand it's been set up so that there are 10 minutes each. So committee members will have a full 30 minutes of testimony this morning, if you so chose. And then after that, we have a pre-arranged roster of question asking between the various parties, and I will adjudicate that.

And the big question of course, gentlemen, is that I think we're generally all in favour of extension of the veterans independence program, but it's a question of how much.

So the floor is yours.

[Willie Lirette, President, Fédération des aînées et aînés francophones du Canada]

Thank you, Mr. Chairman. It is a pleasure for me to be here today. This is the first time I appear before a committee of the House of Commons and I expect it will be a great experience.

On behalf of the Fédération des aînées et aînés francophones du Canada, I would like to take this opportunity to thank you for appearing today before the Standing Committee on Veterans Affairs of the House of Commons. Further, I would like to congratulate you for taking the initiative in trying to improve the situation of veterans and seniors. The seniors' population will continue to grow significantly over the next 20 years. So it is important for the federal government to do what it can to improve the well-being of Canadian seniors.

The Fédération des aînées et aînés francophones du Canada is a non-profit organization whose membership is comprised of 12 francophone seniors associations representing over 3,300 members, including the Mouvement des Aînés du Québec and the Quebec Federation of Senior Citizens. We work closely with all our members to ensure that francophone seniors throughout Canada are able to access quality health care and services in their mother tongue.

We would also like to take the opportunity today to share with you our experience in the area of health care, and we hope that all our contributions will enlighten you and help you find new ways to improve the quality of health care and services available to veterans.

We would also like to point out that our area of expertise concerns first and foremost francophone seniors. We do not work with veterans in particular, but that may change over the coming years. However, it is fair to say that many veterans are members of our provincial associations and benefit from the services we provide.

In our experience, here are the main issues we have identified in the area of health care for francophone seniors living in a minority situation. First, if you look at the statistics, it can be said that, based on all the determinants of health, francophone seniors living in a minority situation are greatly disadvantaged compared to anglophone seniors. For example, data collected in Ontario reveal that 43% of francophone seniors are lower income, compared to 27% of anglophone seniors. Further, 36% of francophone seniors do not have a high school diploma, compared to 24% of anglophones. We do not have the figures for the other Canadian provinces, but we believe that the data would be similar elsewhere.

It is always very difficult for seniors to have access to services in French. According to a recent study conducted by Dr. Louise Bouchard and Valérie Bourbonnais of the University of Ottawa, 66.2% of francophone seniors living in Ontario do not speak their mother tongue with their family doctor. That's over half. Further, the study reveals that francophone seniors are more likely not to have a family physician than anglophones.

We have also learned from talking to people in their communities that seniors often face huge health challenges. It is extremely important for seniors in general to grow old at home, and even more so for francophone seniors. For instance, I recently had the opportunity to speak with a francophone senior from Manitoba who lives in a small, predominantly francophone, village several kilometres from Winnipeg. She explained just how afraid she was to have to sell her house for health reasons and to be forced to move into a nursing home, the closest one being about 100 kilometres away from her house. Even worse, it did not provide any services in French. That's when I realized just how vulnerable this francophone senior lady was to being uprooted from her community and ending up completely isolated from the francophone community.

In New Brunswick, when the time came to build a new home for veterans in Moncton, the responsibility for the project was given to the Régie régionale Beauséjour, namely the francophone regional board. As a result, the centre provides excellent services in both official languages. But that would not have happened if the home had been built in a place like Saint John or Fredericton. But since it was built in Moncton, which is bilingual, bilingual services automatically became a priority. But that's not the case elsewhere in the country.

So the lack of home care services in French is a major challenge for all seniors, but especially for francophone seniors.

Seniors want to stay at home, but in order to do that, they need home care services.

The support, or rather the lack of support, for natural caregivers—which can also apply to veterans—has repercussions on the health of seniors. Because there is a shortage of services in French, francophone seniors often have to turn to an informal support network when they need home care, which points to the importance of having a solid support network for natural caregivers, but unfortunately this is not always the case.

The lack of francophone nursing homes for francophone seniors is also a huge concern for these people. Back home in New Brunswick, the situation of seniors who are stuck in regular hospital beds and who are not in nursing homes is a major problem. The same holds true for veterans in New Brunswick: there are not enough places to accommodate them.

To address these different types of problems, the Fédération des aînées et aînés francophones had to be creative and find new ways of reaching out to seniors, and to do it with very few resources. So to achieve this goal, we had to develop a strategy based on certain principles. Let me mention a few of them.

Seniors must be much more than simply "patients" within our system. We have to create strategies which involve seniors, which allow seniors to be consulted, and which allow them to contribute to finding solutions to certain social problems which will arise over the coming years.

For instance, we have created a community support program which trains senior volunteers who are leaders in their community, to help the most vulnerable seniors, or those who are in the poorest health, to help them find services in French. The project was very successful, but it was only funded over nine months. Although the program had to end, I believe that had it received the appropriate level of funding, it would have been extremely beneficial and would have saved the health care system a lot of money.

Next, it is important to focus on prevention and health promotion. In my province, for example, less than 1% of the total health care budget is spent on prevention. All of the money is spent on healing, and that's a major problem. Seniors don't want to wait to get sick before something is done. That is why we organize health forums in francophone communities. They are extremely successful and well-attended by many seniors. It is good for francophone seniors, who often feel isolated, to get out and participate in such events. It gives them the opportunity to exchange stories and put their own health care situation in context. These get-togethers are good for seniors' mental and physical health.

We must also take advantage of the know-how and experience of retirees. In that regard, the Fédération des aînées et aînés francophones du Canada is currently working with each provincial association, and with each territorial and provincial federation, to develop an intergenerational health care plan of action for each province and territory. We believe that implementing these plans of action will help prevent illness and improve the health of seniors. As an aside, the program has until now also taught grandchildren about growing old. So by becoming involved in activities to improve the health of other generations—grandchildren, young parents, and so on—seniors who involve themselves are much more inclined to take better care of themselves, and being in contact with other generations will only be good for their physical and mental health.

As for the specific situation of veterans and the health care services they receive, we believe that it is important for the federal government to look at models in which veterans and their families can contribute more within the system and express their opinions as to how to provide better services.

Let's compare that to a situation where parents are involved in their children's school. If parents are involved in the school, chances are that school services will improve because of the parents' feedback. Consequently, we believe that if veterans or seniors in general are involved in their area of health care, if they can be involved in the decision-making process, it will improve the system.

We need to get away from the traditional doctor-patient model to allow patients and their families to have a say in the health care choices they make. People are increasingly talking about personal choice in health care, and studies have shown that when patients have a greater say in the type of health care services they receive, they recover more quickly. Therefore, patients must be involved in the healing process.

We would have liked to speak at length about certain other initiatives, but we hope that we will have the opportunity to do so during the question and answer exchange.

In conclusion, I would like to thank the committee for having given us the opportunity today to talk about the needs of Canada's francophone seniors. I also believe that many of our needs are the same as those of anglophone seniors. We therefore hope that the different solutions we have proposed will help you to develop new models to improve the quality of health care to veterans and their families.

Furthermore, I would like to end by congratulating the federal government which, like some provincial governments today, has appointed certain ministers or senators specifically to look after the needs of seniors. We are very pleased that Senator Marjory LeBreton was appointed to this position and that we can now meet with senior-ranking government officials who are open to seniors' concerns.

I might add that when you go to Ottawa, or to any other province, you have to knock on 10 or 12 doors because everyone has a file involving seniors or veterans. We do not have the human or financial resources to do all of this. So at least one door is open for us here, in Ottawa, and we can show up to meet with Ms. LeBreton, whom in fact we already met with.

Once again, thank you. We would be pleased to answer any questions you may have. The brief time we have had to make this presentation was not enough to provide you with more substantial information such as statistics or research papers. But we can talk about that another time.

[The Chair, Conservative, Rob Anders]

Just to let you know, you've used up about twelve and a half minutes.

So the others may carry on, please.

[Marc Ryan, First Vice-President (Ontario), Fédération des aînées et aînés francophones du Canada]

I would just like to add to or go over a few ideas. My president spoke about New Brunswick. I would like to take the opportunity to speak about the Montfort Hospital, which serves veterans and National Defence. Once again, this is a bilingual institution which is able to provide services in both official languages.

Elsewhere in the country, another contribution should be underscored, that of the Société Santé en français. This association does outreach in minority language communities throughout Canada. It has proven its mettle in the past five years. I believe that currently, it is in the process of setting up health services in French throughout the country, in areas where this situation is precarious.

The absence of long-term residential care centres is truly a problem. It is an iceberg that is looming before us but that we have not yet hit. As the Ontario president of this association, I can assure you that elsewhere in the country, this is a problem that is going to become more serious and that will not be easy to resolve, because we're dealing with departments that deal with municipalities, housing in general and an entire range of support programs. So the problem is far from being resolved.

In addition, Mr. Lirette spoke about community accompaniment which, in minority language areas, is very important. Thanks to community accompaniment programs, we can often delay the institutionalization of people who are gradually losing their autonomy. The long-term care centres cost the health system a great of money. This being said however, it is still important to have these centres.

Finally, allow me to describe very briefly the health prevention days that we organize and for which we request funding so that we can organize others in all minority language areas. At the beginning of the day, we present the technical aspects of a given disease, for example, heart diseases or Alzheimer's. Then, there is always a nurse who takes people's blood pressure and blood samples. People are notified that this day will be taking place and we usually have some 100 to 250 people in attendance. This first part of the day is very technical. Then, we talk about nutrition. Later in the day, we invite either a policeman or a social services representative, to discuss abuse of seniors. Usually, the day ends with an entertainment type of presentation.

In closing, intergenerational programs are designed to reach out to isolated seniors. Francophones in minority language areas throughout the country have a pressing need for such programs.

I don't want to take any more time, thank you for your attention.

[Willie Lirette]

I would like to add that the aging population is a problem with a bright side. All governments, whether federal, provincial or territorial, have trouble realizing that in 20 years, we will be faced with a major problem in terms of replacing the labour force, because many seniors will no longer be on the labour market. The government seems to have trouble accepting the idea that it needs to prepare for this major influx of seniors into the population well ahead of time. I think that this population segment of seniors will reach 20% in a very short time. Once that happens, what services will be available?

I know that governments are elected for four or five years on average, and that often programs or projects are planned over this same time period. Governments seem to forget that problems can take on massive proportions in 15 or 20 years. As concerns this idea of planning programs ahead of time or helping governments deal with these situations, I have not yet heard an answer from elected officials, whether at the provincial or the federal level. This is a major issue, especially for the federal government. It must consider setting up something tangible that will help us in 10, 15 or 20 years because the problem will be very real at that time. We have not yet felt its full impact.

I am now ready to answer your questions.

[The Chair, Conservative, Rob Anders]

All right, thank you very much.

Now we're over to Mr. Shaw for 10 minutes, if he wishes.

[Greg Shaw, Director, International and Corporate Relations, International Federation on Ageing]

Thank you very much. It's a pleasure to be here today. It's my first time presenting to a committee in Canada. As people can probably hear from my accent, I'm not Canadian. I'm originally from Australia, but I've presented to certainly a few parliamentary committees in my time, when I was in Australia working with the Australian health department.

I'm the director with the International Federation on Ageing. The organization is 35 years old. It's been in Canada for 15 years. It is one of four premier NGOs that have general consultative status at the United Nations and deal specifically with issues on aging.

We generally focus not on disease-specific issues but really on the social issues around aging. We're a facilitator and bridge-builder between government, NGOs, and best practice, looking at what's happening from a country-by-country perspective in terms of programs and policies that support seniors.

It's certainly welcoming that this particular committee is looking at the issue around veterans, because the veterans issue is not only an issue in Canada but also in many other countries, and I can certainly give some perspectives from the Australian veterans care system during questions and answers. But what I want to focus on today is some aspects of the Gerontological Advisory Council report of November 2006 and some of the recommendations that this particular body was making, particularly when we talk about veterans and the demographic of veterans as it currently is today, and the tendency for governments to look at an illness model of care rather than looking at a wellness model of care.

The International Federation on Ageing certainly encourages governments and supports policies and programs that look at models that support wellness and interventions to actually reduce disease burden.

As Willie indicated, governments don't spend a lot of money on health prevention and health promotion, because the results that you see from those things are generally long-term and the health benefits aren't necessarily realized in the short terms of governments.

There isn't enough effort done in most countries around health and wellness programs. There are some aspects of the veterans home care programs here that have taken some leadership and worldwide recognition, such as Canada's falls prevention programs and early interventions around falls prevention, which certainly supports and benefits veterans.

The other issue that I think is of major concern is the support that carers receive, who are the people at home supporting the veterans who need some form of support. I think in the last 10 or 15 years there's been a greater emphasis on the support that home carers, or the spouses and families of seniors, provide and add to the cost savings of government. Programs that support specifically those carers certainly are encouraged, and I know there are some very good models, both within Canada and outside Canada, that really focus on how to support the carers of those veterans to maintain them to be independent, or for them to remain within the community or at home for longer.

In doing that, what governments certainly have recognized, and there's a great move away from residential care to more home-based community support programs.... The issues for seniors around those home-based community support programs are these: Where do I get information about those programs? Who do I make contact with, and are there single points of entry or single points of referral? Are there some consistencies from one province to another around those referrals, particularly to home care programs?

The issue of a one-stop shop, in terms of an assessment and referral component, is certainly an initiative that is welcome, and which the Gerontological Advisory Council has recommended. People only look for these services when there is a crisis and they don't know where to go, but if there's a one-stop referral assessment point that looks at the issues not only of the veteran but of the whole family and the infrastructure of the family, and they make the referrals to the appropriate services, it certainly puts the families and the veterans themselves at ease in terms of, if there is an issue, where they need to go.

We do have to recognize that people only access these services when there's a crisis, and when there's a crisis they need support and service tomorrow. So it's an issue of how to get information out about what services are available. The NGO community across Canada and returned service league organizations have a vital role to play in informing veterans about the range of services that are available, and not only to inform veterans about the range of services available but to start talking among themselves about the inequities of services across provinces in Canada. That's the same in many other countries where health jurisdictions are done at a provincial level.

In terms of what are some of the trends that are happening, if we look at veterans' home care programs—I'll give an example of Australia—what they're looking at is using multidisciplinary teams for assessment so you have a single point of entry for assessment. Those assessments are uniform and eligible right across the country. They also maintain an amount of money for packaged care services, so they can actually support families and the veterans with what they would call a community aged care package, or a veterans aged care package, which could buy in the range of services that a particular veteran might need to keep them at home for much longer. Certainly the emphasis is how we keep people as part of the community where they live and where they've contributed for as long as possible. The issue that was highlighted of people having to move to go into long-term care or other care facilities is not only an issue in Canada, but is also an issue everywhere, and it's an issue around the multiculturalism of senior populations in countries.

In terms of looking at the range of programs and services, there has to be an emphasis around health and wellness. It will certainly, in the long term, reduce the cost burden of governments in terms of the cost of care, or it will limit the cost of care to a much shorter period when you start looking at long-term care costs. If we look at world trends in developed countries, only about 4% to 5% of people who are over the age of 70 today will go into a long-term care institution. There are many people out in the community who will remain in the community, and only through an issue around health will there be cause for intervention and generally hospitalization.

If there aren't that many people going into residential care, why aren't they going into residential care? It really is because of the movement around developing community-based services that support the people to remain independent at home for a lot longer. It is also about developing programs and services that promote independence and health and wellness so as to reduce the disease burden in the longer term.

Case management is another issue that was discussed by the advisory council in its report, and it's a model that has been followed and adopted in a number of countries. The issue around case coordinators or case managers is the caseload that they end up having to take on. In the Australian system where we had case managers for a geographical area, the burden on those case managers was quite significant, and it was recognized very early in the piece that the particular program was underfunded, because case managers were trying to support 70 to 90 people on a weekly basis, which was just out of the realm of their particular possibilities.

I think the issue of uniform access, or access to services that doesn't necessarily discriminate, is an important one. If I'm a veteran and I'm living in Manitoba, I want to know that I can get the same level of access to services, whether it be health care services or services that can support me at home, that I can if I live in Prince Edward Island.

Nationally, that's an issue for the Canadian government to look at, and even the NGO sectors, to start talking about what the differences are. What are the services that I can get in Manitoba as opposed to Prince Edward Island, for argument's sake? I think those are issues that do need to come to the forefront.

Having a national veterans program certainly overcomes many of those issues, and having programs that are funded independently by the Department of Veterans Affairs goes to much more of a uniform model. But for other seniors, it's not necessarily uniform.

So I'd certainly like to commend this committee for looking at how they might support, review, and improve the quality of care for veterans. I'd be very pleased to respond to any questions or talk about some international perspectives.

[The Chair, Conservative, Rob Anders]

I am so impressed. That was 29 minutes and 48 seconds. Can you believe that? If only committee members could be as good with their time as our witnesses today. Well done, gentlemen.

We have party rotations here. First is the Liberal Party of Canada, and Mr. Valley, for seven minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you very much.

Thanks for coming in this morning.

I find it a bit ironic for us on this end of the table that we're talking about aging. We all aged quite a bit last night. We had our Christmas party and we're feeling a little older this morning.

I can definitely sympathize with some of Mr. Lirette's comments. I serve a riding that is very rural, very widespread, with very small communities. You talked mainly about the services you're trying to provide and languages and everything else, but I'm sure that even in northern Quebec and other places in Canada, not only in my own riding, we get to where there are no services. We almost take anything we can get. Personally, in my home community, we don't have enough doctors. We have three doctors. There are supposed to be 16 serving there.

With the challenges of serving people as they age and with all the complications that come when you don't have services and you have to travel, it gets tougher; and then when we put the veteran into the mix, with all the issues that they can have, it just gets harder and harder.

So I definitely sympathize with all your efforts, and we're lucky we have people like you who are trying to provide these services. That's one of the strengths of Canada, that there are groups that try to step forward and bring everybody together.

I have some questions for Mr. Shaw.

I shouldn't generalize, but one of the things we do hear from some of our veterans is that they don't feel well served by the Department of Veterans Affairs. They feel that there are gaps and flaws. In your experience, is that a similar thing for veterans around the world? Is it similar in Australia? Do they feel that they're well served? We have guests up from the United States once in a while, and they don't feel that they're well served by some of their veterans departments when it comes to health care. And of course, problems always compound as we age.

[Greg Shaw]

If you asked veterans anywhere, they would probably say they're not well served by the veterans affairs department within their own specific countries.

Primarily, it is around the disbursement of access to service and who delivers those services, because no one agency in any one country delivers the range of support needs and services, from basic maintenance and support that one would need, to health care needs. Those are delivered by a range of agencies and organizations, with little regard for single-point entry of access, single-point assessment, or comprehensive assessment. So even veterans within the Australian system certainly would be saying exactly what veterans here are saying, that they're not necessarily well served.

It's because veterans affairs departments are generally trying to look at the health care needs and issues on a national perspective, because it's generally a federal responsibility within government. But in many cases, a lot of the services are delivered through provincial, state, and territory governments. So there are always some differences from province to province or state to state, and getting the national coordination is somewhat difficult.

So veterans, whether it be in Denmark, or in Australia, or in the U.S., would probably say similar things. But I think what Canada is doing in reviewing and looking at how to improve the access to health care and services is certainly going to support veterans as they age.

[Roger Valley, Liberal, Kenora, ON]

Thanks.

I should have mentioned that one of the issues I have in my riding is that there are huge language issues, but they're generally not French and English. I have Cree and Ojibwa, because 60% of my riding is first nations. I have one of the largest populations of first nations in Canada, so there are all those other things that mix in.

When you think that a veteran comes home, and he's been serving with the Canadian Forces wherever, he speaks English or French, or he has the ability to do both. The problem is quite often recognized by people who don't speak either language in my riding.

It is a problem. But how do we get the information out? You talked about bringing the information to the people. We're not allowed to. There are privacy laws in Canada. For us, as members of Parliament, we can't get a list of the veterans in our ridings. We deal with issues. We deal with the Legions and everything else. But to get that information out before we get to that one problem, which is, as you emphasized a couple of times.... It is only when a crisis happens. So how do we build those networks when we're not allowed access to information?

This is for anyone who would like to answer that part.

[Willie Lirette]

I'm not aware of that situation. But to emphasize more what you said before when you talked about services in the language of your choice, the Government of Canada and the Société Santé en français have a good program going on. There is the development of professionals, for example. And one example out of that is the medical school that we now have in Moncton, a French medical school, which will train people in all kinds of professions to serve the community.

This is a means that the government has implemented to help train professionals and then ensure the presence of French services throughout the country. This agreement will expire in the spring, if I remember correctly, and it will have to be renegotiated. This is where the government should be aware of the success of Société Santé en français throughout the country and that it must be renewed in order to answer the questions you asked earlier.

As for veterans, I have made an effort in the past few days to obtain more information, because we were not necessarily aware of their situation. I have been told that the red tape is considerable. These people get discouraged and professionals are required to fill out the applications and help them in their quest for services. I remember the work done by Ms. Bradshaw when she was an MP, to set up the Centre de santé des anciens combattants in Moncton. I think it took three or four years for a decision to be made, and the veterans were on the fifth floor of an old hospital. Now, the service is excellent, but too much time has to be spent on paperwork for the provincial and federal governments.

In New Brunswick, we too have what is called a new government. In January, it eliminated all income from its list of eligibility criteria for admission into a nursing home, even veterans' income. Before January 1, when a veteran was obliged to go into a long-term care centre, this took up all his income, and his wife remained poor. I was told yesterday before leaving that in New Brunswick, this problem has been partly solved. But I think that your committee will have to see how these veterans' wives are treated when their husbands are admitted into a long-term care centre. Do they become poor? If you look at all women who did not work outside the home and who raised large families, whether they be the wives of veterans, fishermen or farmers, those are the poor women in Canada.

We have just learned that over 200,000 people are entitled to the Guaranteed Income Supplement but do not receive it because they were not aware that they were entitled to it. This is why we are urging the government to give us the means to go door-to-door and to make people aware of these things. This takes human resources. To date, the provincial government has made efforts in the area of social services and we have added many names to these lists, but there are still some 200,000 people who are entitled to the GIS. We have no way of contacting them. It seems to me that in the federal government's data base, they must be somewhere and we should be able to determine their circumstances. All we have to do is find a technological means of giving them this supplement, without their having to hire a lawyer in order to claim their benefits. I just wanted to add that comment.

[The Chair, Conservative, Rob Anders]

Thank you very much.

And now we're going to the Bloc Québécois, Monsieur Perron, for seven minutes.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Good day, gentlemen. It is a pleasure to have francophones at the table, for once, so that we can talk a bit.

There is a consideration that touches me deeply. We talked about veterans of a certain age, but we mustn't forget our young veterans who are suffering from psychological trauma. However, I'm going to confine myself to so-called traditional veterans.

First I'd just like to give you a short history lesson. I want to send a message: on Monday, I will turn 67. So please don't forget to wish me happy birthday on December 10.

In my youth, the paternal grandparents were traditionally entrusted to the care of the eldest son and the maternal grandparents were entrusted to the care of the eldest daughter. That was the rule of thumb in Quebec society at the time.

This Quebec tradition was handed down to me, because of my venerable age. My mother-in-law died in hospital, but after her husband died, she came to live in my home. I took care of her without any government assistance. That's the way I was brought up.

But things don't work that way any more. We take old people—that's what I call them and that's what I consider myself—and we put them just about anywhere. Efforts have been made to establish a system so that these people can remain in their homes as long as possible. I approve of this system 300%, but it needs to be improved because old people are happiest in familiar surroundings.

I would now like to provide a bit of technical information to Mr. Shaw. I think that Quebec's health and social affairs system is the most advanced of all the Canadian provinces. For example, where else in Canada can you obtain assistance to build or adapt a co-generational home? Such a thing exists in Quebec. Where else in Canada can you find a system similar to that of our local community service centres, the CLSCs, that exist in Quebec and that offer health care to people in their own homes?

An intergenerational situation is difficult because many people would like to care for their parents in their homes. We can help them physically, but when they need health care, we are unable to help them because we are not experts and that is where the CLSC comes in.

I think that health care should be developed at the provincial level, with a federal tax rebate for families who provide health care to their elderly relatives, including veterans. Elderly people need home care, but we need the tools to provide it, and I think they are lacking.

Mr. Lirette, the politics 101 course that you gave earlier is highly accurate. Governments and politicians rarely think beyond the next election. They pass legislation with a view to being re-elected, instead of looking forward like any self-respecting company and trying to see where this country and this society will be in 50 years.

It is important to stay on the right track even when seeking to bring about change.

Those are the comments I wanted to make. If you wish, you may make other comments, or agree or disagree with mine.

[Willie Lirette]

I wouldn't go so far as to say that your health care system is better than ours. Each system has its own areas of expertise. But I get the impression that we also have what you described, and that other provinces do as well.

According to the most recent statistics on the health of Canadians, or local health boards across the country, there are still major problems, such as wait times to see a specialist. In New Brunswick, we have something called extramural hospitals, and we are the only province to have this type of thing. It's an asset for us. Indeed, as soon as a patient is discharged from the hospital, the patient receives care at home until he or she is well again. This program has been around for 20 or 25 years, and it works very well.

The aging situation you described is a real problem, and governments must stop and take its full measure, because one day they will have to deal with it. And if no plans have been made, we will be stuck with a major problem on our hands.

[Marc Ryan]

Mr. Chairman, I might add that in Ontario we are creating a system based on LHINs, Local Health Integrated Networks. They will bring together related services in a system resembling Quebec's local community service centres, which you are familiar with.

That being said, the problem remains for your anglophones in Quebec and our francophones in Ontario, namely—

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I'm sorry.

[Marc Ryan]

I don't want to get into Quebec's situation. I did not want to give you—

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I'm sorry. In Quebec, sir, there are eight hospitals for anglophones; and there's only one francophone hospital in the rest of Canada!

[Marc Ryan]

That's correct, sir.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

In any Quebec hospital, you can receive services in English, which is not the case for the rest of Canada, dear friend.

[Marc Ryan]

I agree, I will not challenge that.

However, in Ontario, we have taken great inspiration from the Quebec model for our approach.

The francophone minority in Ontario has a small problem: in some areas of the province, the LHINs are comprised of community leaders, so what happens when there are only 1 or 2 francophones on a board of 15 members? Francophones might therefore have serious concerns about whether services will be provided equally in both languages.

That being said, there is an alternative solution which we mentioned during our previous discussion. The Société Santé en français has thought of ways to make services more readily available to the public.

This is true for Manitoba as well, up to a certain point, and elsewhere, such as in British Columbia.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

That has been in existence since the 1970s.

[Marc Ryan]

That's right.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

It's been 35 years, specifically since 1974.