Veterans Affairs Committee on May 13th, 2010

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

You said “he may be”?

[Brenda MacCormack]

Again, it's based on level of disability.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

But he's lost his arm and three fingers.

[Brenda MacCormack]

Yes, and I would expect that this would progress. If he's unable to work, I would expect that his disability would be progressing over time. The permanent impairment allowance would be an allowance that's available for life. It has three grade levels, and the amounts payable range between $500 and $1,500 a month. This would be the only payment that would continue after age 65.

As well, he would then be able to avail himself of the general benefits that are available to the Canadian public. As I mentioned, the supplementary retirement benefit would be payable at age 65, which represents 2% of the gross earnings loss that he was eligible for over his....

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

The unfortunate part is that André would receive the 75% at the senior private's level, as you've indicated. But if he were going to spend 25 or 30 years in a career in the military, there's a high probability he could have become a sergeant, lieutenant, or captain. But there's no pro-rating of that, and that's what we've heard is the major flaw within this: it doesn't give indexing for the possible advancement that most people in the military achieve. So there's a snag there.

You've obviously heard and read a lot of the testimony from people who come before us—the Legion and other individuals. They have been, I'll put it mildly, extremely critical of the new Veterans Charter. You may not agree with everything they're saying, and maybe they have misconceived some things, but they can't all be wrong. I'd like you to tell us what cracks or crevices you notice in the new Veterans Charter. And have you had the opportunity to tell your superiors within DVA that these are the problems you're seeing?

Surely clients must be calling you and asking what's going on here. When you see these cracks—and obviously a lot of it is legislative changes, there's no question, which you obviously have no authority over—do you have the right to advise your superiors, ADMs, and deputy ministers, that this is a continuing problem and that we need to address it? Have you noticed any flaws yourself with the new Veterans Charter compared with the old system? If you did, have you had the opportunity to forward those concerns to Suzanne Tining or the minister himself or, for example, to your ADMs?

[Brenda MacCormack]

I would start by saying that absolutely I have the opportunity to raise concerns and do analysis and listen to what's being said and form my own opinion based on that analysis and communicate it. Of course, that work is currently ongoing.

As you know, we've had a number of reports tabled by special committees: the new Veterans Charter advisory group, the special needs advisory group. These groups are comprised of not only stakeholders, with representatives from the Legion and other veterans organizations, but also experts in the field of rehabilitation, disability management, and occupational therapy.

We've certainly been listening to them. My experience to date has been similar to what Monsieur Vincent was pointing out, in terms of whether we're doing enough for those who have catastrophic injuries. Does it make sense to give the same amount to those individuals, and are we giving them enough to support them over their lifetime? As you pointed out, if we're paying someone at the level of a senior private, is that enough to sustain them over their lifetime?

I think the answer is yes, I certainly have that opportunity, but I firmly believe that the package that is there is a good package. It has a firm foundation, it's based on the right principles, and it's heavily weighted in terms of the research base that supports it. That's not to say that there shouldn't be some building on it to address gaps, but that analysis is ongoing.

[Janice Burke]

In terms of our mental health clients, or clients who suffer from mental illness or PTSD, depression, or anxiety, I have to add--again, I've been working with the department for quite a number of years--I have seen the old system. I have seen our mental health clients struggle. I have seen them focus solely on compensation and I have seen a system like that really promotes illness.

What I'm seeing in the new Veterans Charter, in terms of the programs it offers, it offers hope to these individuals. I don't know if you can put a price tag on that, but it gets them to look positively at the future in terms of employment, which we could not do before with the old system. It also allows us to treat these people more holistically.

I don't know if you've seen the statistics, but we have over a thousand clients who have served in Afghanistan, who have mental health conditions, not necessarily related to Afghanistan but they've had multiple deployments. Fifty percent of these people are still serving. We have not seen anything, I don't think, compared to what we are going to be seeing coming to us in the future, perhaps after 2011.

I'm glad we have the new Veterans Charter programs in place to deal with that. If we did not, I don't know what we would be dealing with today.

[The Chair, Conservative, David Sweet]

Thank you very much, Madam Burke.

At the rate we're going, Mr. Stoffer, you'll probably have another round.

Now on to Mr. Lobb for seven minutes.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Ms. Burke, that's a good segue into the question I was going to ask you, so that was timely.

You have likely read or been briefed on most of the testimony that has been made on this study. There has been a tremendous focus on lump sum and the earning loss benefit and the pension and the debate about the who, what, where, when, why, and what was the best thing. Certainly Veterans Affairs is committed to a wellness model, and the thing I think we haven't hit on so much is the rehabilitation side, some of the significant costs incurred in providing rehabilitation.

I wonder if you could just tell the committee a little more about the wide variety and a bit about the costs involved, and the case of Ron, in your briefing package, who receives a modest amount, but who would receive a tremendous amount of services on the side.

[Janice Burke]

I would leave it to Brenda to talk about the costs associated with rehabilitation, but in terms of the mental health supports for our clients, with the new Veterans Charter, obviously the rehabilitation piece is key, because that's what provides the holistic approach to treating their conditions. Before, we would focus on that psychiatric condition. We are seeing clients in our system now with a combination of chronic pain, addictions, and psychological disorders. The new Veterans Charter, the rehabilitation piece, allows us to treat that holistically, whereas before we would not have. If you're talking mental health, I don't know what the program is costing us, but we also have our operational stress injury clinics across the country that can now do more than ever. We did have them prior to the new Veterans Charter, but because of the new Veterans Charter these clinics can now expand and do more than they ever could for these clients who have mental health conditions.

We have a host of other programs. We've got over 2,000 service providers who specialize in mental health registered across the country. We have over 200 clinical care managers who provide the daily contact with their clients with mental health issues. We have our peer support program across the country, volunteers who provide social support and peer support to our clients. We haven't costed all the components, but I can tell you, from my perspective, we now have a system that deals with the majority of the determinants of health, which we did not have before, and I think that's what makes these programs more advantageous for clients with mental health conditions.

In terms of costs....

[Brenda MacCormack]

We have provided some information in the deck regarding costs, which looks at expenditures of $12.8 million over the time period the benefits have been in place. When you're looking at those costs, it's important to understand these are new costs, over and above treatment that would have been provided in the old scheme.

I want to touch a bit on the difference in the nature of the treatment that was and is available. In the previous scheme we were able to provide medical treatment--physiotherapy, and those kinds of benefits--to an individual who had a disability pension. But we were only able to do that after they were in receipt of a disability pension, which sometimes meant they were waiting for six months or a year to get a pension that would enable the treatment. It was a benefit-driven type of system, where if they asked for the treatment and the doctor said they could have it, they would get it.

The way the system works now is much more proactive in terms of looking at what the person's needs are. The case manager is always involved with someone who is in rehabilitation. There is a multi-disciplinary group treating the client that the case manager liaises with. We're not just bound to treat the pensionable condition--for example, if someone has other types of health conditions that are creating barriers and that are interacting with the primary condition, we'll treat that as well. In the case of André, for example, if he is experiencing some depressive symptoms, some coping symptoms, we can help with that. We're not just going to provide him with what he needs for the amputation.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Another comment I've heard is that it is sometimes a little cumbersome, and the veterans aren't quite happy with how long it takes to begin receiving services. On the delivery side, I'm wondering if you could tell the committee what initiatives you have to cut red tape to be able to deliver the services in a quicker manner to the veterans.

[Jane Hicks]

Certainly. There has been quite a bit lately. One of the initiatives in the past month is that we have increased authority to the case manager so they can make decisions immediately. They don't have to rely on their client service team managers or other authorities. We've delegated authorities within the regions so they can make decisions in a more timely fashion.

We are trying to ensure that people are trained and up to speed and comfortable with some of the cases we see, as they are very complex. We are making sure they have the resources in place to assist them with these cases. In some of the offices across the country we have access to clinical care managers who can provide assistance to the case managers. We have regional rehabilitation officers. There's an increased access to resources. There have been improvements in resources, and certainly the caseloads.

There's work under way in the district offices to enhance the capacity of our case managers so their caseloads are lower than what they had been previously in order to give them more time to make decisions.

[The Chair, Conservative, David Sweet]

Thank you, Madam Hicks and Mr. Lobb.

We will now go on to Madam Sgro, for five minutes.

[Judy Sgro, Liberal, York West, ON]

Thank you very much for coming this morning.

As always, everyone coming before us represents the department extremely well. I think your care and compassion always comes across. Yet it continues to concern many of us about what I think is the department's desire to satisfy the needs and so on. We continue to hear of other problems. What we are trying to do here is find ways to correct those problems.

When we look at Antonio's situation, or Ron's, or any of the others, you think, how could anybody complain about this? They get a lump sum and then they get these monthly benefits. Why should anyone be complaining? Yet there are still lots of issues.

Before the charter, what would any of these cases have received as a lump sum payment compared to what any of them receive today? If you look at Antonio, and he gets $260,000, what would that lump sum payment have been before the charter for that kind of injury of loss of limbs?

[Brenda MacCormack]

In the previous scheme, it was not a lump sum payment that was paid; it would have been a monthly disability pension. In some cases there would have been specific kinds of allowances, depending on the nature of disability. From that perspective we didn't have large lump sum payments, except in cases where there was some retroactivity and we needed to catch up on the payment. That would be the time we would grant a lump sum. The other time would be when they were small amounts of money. Those were the only lump sums that would be given.

[Judy Sgro, Liberal, York West, ON]

Pre-charter, Antonio would have received exactly what he's receiving now, more or less, $2,000 or whatever the number is per month.

[Brenda MacCormack]

No, pre-charter he's not.... We're looking at the comparisons, and this goes back to Mr. Stoffer's question. The comparison here is of what he would receive now under the new Veterans Charter with what he would have received as a financial stream under the legacy disability pension system, if you're just looking at the financial pieces.

[Judy Sgro, Liberal, York West, ON]

But we did not have a lump sum payment previously.

[Brenda MacCormack]

No. That is correct.

What the new Veterans Charter essentially does is set up an entirely new rehabilitation support scheme. As part of setting up all these rehabilitation supports and approaching the question in such a different capacity, you have to think about the compensation scheme that goes along with it. When you are thinking about disability management principles, there is a basic premise that you can't pay people more money to stay at home than to go to work. You have to strike the balance with providing enough of a financial benefits stream that people can live with dignity and be supported, or in cases where they can go back to work, that they have an incentive to go back to work. Trying to strike that balance is pretty important.

All of the wellness programs are there, and then the financial stream is twofold. One is the lump sum—the disability award, which is recognizing some of the non-economic impacts of disability; it's quality-of-life factors, those kinds of components. Then there's the second set of benefits, which includes the earnings loss benefit, a permanent impairment allowance, the supplementary retirement benefit. That is the ongoing, monthly financial stream, which continues to be available. What is different is that it's based on their salary and is payable to them while they're participating in the rehabilitation program, or if they are unable to work, is payable to them until age 65.

[Judy Sgro, Liberal, York West, ON]

But there is no escalating clause in it, given the fact they are not moving forward. How many of the vets ever ultimately achieve employment?

[Brenda MacCormack]

It's early days. We have probably close to 3,500 clients currently in the program. We've had about 500 complete the program. So it is early to be looking at what kinds of outcomes we're achieving, but we have some early information that is telling us that a large percentage of people, when they complete the program, are getting employment.

I want to also point out that rehabilitation is not just about getting people jobs. It's also about improving their capacity to function in their family units, in their community, and if possible in their jobs. We will over time have better information about what kinds of outcomes we're achieving. We give people surveys when they enter the program, when they leave the program, and then two years out. We're looking at areas such as what their health status is when they're coming in, what their employment status is, what kind of financial resources they have, how they are integrated into their community, and whether they feel recognized for their service. Those are all pieces that we'll be measuring over time to look at what the impact has been, but we're certainly seeing, in early days, that we're having significantly positive impacts on mental health in particular. We have a number of individual cases that I've personally seen in which the kinds of outcomes we have been able to achieve are extraordinary—people with mental health conditions, which Janice spoke so eloquently about, who did not have hope in the past and now have it. They have the opportunity.

It's hard to measure the value of that opportunity. If you're giving the right services by the right people at the right point in time, you can have a tremendous impact on someone's life. This is the piece that is maybe not being talked about enough. It's not necessarily well understood, and we haven't seen as many public results as we will see in the future.

If Janice....

[Janice Burke]

Let me add to that. As Brenda indicated earlier, about one-third of the folks in the rehabilitation program have been released for longer than eight years. When you consider that 50% of them have mental health conditions—in fact, up to 75% of them are struggling with mental health, though they may not have full-blown mental illness—we're dealing with a group of veterans who did not have the benefit of early intervention. Because of that, we're dealing with a lot of addictions and chronic pain types of disorder, on top of the psychological conditions.

It is a very complex group of clients we are dealing with in the rehabilitation program. Had we had the opportunity to get that earlier intervention, I think you would probably be seeing different results or perhaps shorter periods of time in the rehab program. This is important to consider and to understand. These are not veterans just released from the service who have had the benefit of early intervention that we're seeing now, in defence. These are folks who have been out for a number of years and are coming back, and they are seeing hope. They are seeing light at the end of the tunnel. That's why these programs are so important to support.

[The Chair, Conservative, David Sweet]

Thank you, Madam Burke and Madam Sgro.

Now we go on to Mr. McColeman for five minutes.

[Phil McColeman, Conservative, Brant, ON]

I thank you as well for being here and for clarifying certain areas.

There has been a number batted around in this committee from various people, that case managers have been involved in as many as 800 or 900 cases at a time. Is this a manageable number? How often do interactions occur with those veterans for someone who's managing that number? I guess the ultimate question is, are more staff needed?