Health Committee on Oct. 24th, 2011

[The Chair, Conservative, Joy Smith]

I'll call the committee to order.

I want to welcome our witnesses. It's great to have you here today. As you know, we're studying the chronic diseases related to aging. And with our aging demographic in this country, I think it's a very timely presentation. So we very much welcome your input here.

From the Active Living Coalition for Older Adults, we have Patricia Clark, national executive director. Welcome. I'm so glad you're here.

From the Canadian Association of Retired Persons, we have Susan Eng, vice-president of advocacy. It's great to have you on our committee, Susan.

With her, we have Michael Nicin. Michael is a government relations and policy development officer. That's a long title, but an important one. Welcome, Michael.

From the Canadian Institutes of Health Research, we have Yves Joanette, scientific director, Institute of Aging. Welcome. I love your bow tie. You've given us a new level of decorum and whatever, here in this committee.

And we have, from the Fédération des aînées et aînés francophones du Canada, Jean-Luc Racine, executive director. Thank you so much. I have three older adult children who speak impeccable French; unfortunately, their mother still struggles with it. But welcome, and thank you very much.

We will begin with Patricia Clark from Active Living. There will be a ten-minute presentation, Patricia, and then we'll go into the Qs and As.

Go ahead. Thank you.

[Patricia Clark, National Executive Director, Active Living Coalition for Older Adults]

Thank you very much. Thank you for the opportunity to speak to you today on what we think is certainly a very important concern for older adults.

I'm here today speaking on behalf of the Active Living Coalition for Older Adults, also known as ALCOA. We have nothing to do with the aluminum company; there's some confusion over that one.

We are a national charitable organization. We were incorporated in 1999. We strive to promote a society in which all older Canadians are leading active lifestyles that contribute to their overall well-being. Our statistics show that approximately 60% of older Canadians are inactive. These inactive older adults are unable to realize the health benefits of active living.

ALCOA is in partnership with its member organizations that include 24 national organizations and 35 local or provincial organizations. Within each of their mandates they support and promote the importance of staying physically active. We encourage older Canadians to maintain and enhance their well-being and independence through a lifestyle that embraces physical activity and active living—hence the name Active Living Coalition.

We have several goals, but some of the goals that apply to this particular session relate to increasing public awareness of the benefits of active healthy living; supporting and encouraging older adults to embrace an active lifestyle by providing resources and social supports; and identifying, supporting, and sharing research priorities.

The membership of ALCOA is very strong from the research perspective. All of the resources and documents we produce are based on the current research and evidence of the day. This discussion today, as Joy Smith was saying, is so vital. As you may know, the statistics show that by 2016—less than five years from now—the number of individuals over the age of 65 will outnumber those under the age of 15. This has never happened before in the demographics in Canada.

We know that the population is aging. With this significant shift in the increase in the demographics of older adults, it is also essential that we shift our thinking to prevention. That's not to say that youth are not equally important and worth our time and energy, but the sheer volume of Canadians in this age group definitely demands significant attention.

All of ALCOA's research is based on the evidence of today. We have created several resources for both older adults and practitioners that relate to a variety of chronic diseases. I have included some of the documents we have produced in the package you have with you.

Many times I do presentations, and when I speak with older adults about chronic diseases I talk about them as the good-news and bad-news story. It's both good news and bad news, because the research shows that for many people, many of these chronic diseases are lifestyle diseases. The bad news is that people have acquired these lifestyle diseases because of the choices they have made. For whatever reason, they've made those choices, whether it's through lack of physical activity, food choices, or choosing to smoke. That's the bad news. The good news is that because these are lifestyle diseases, these and other diseases can be prevented or better managed if the older adult adopts a healthier lifestyle.

Specifically, these diseases include diabetes, cancer, heart disease, and strokes. The research reviews also show us that physical activity can help prevent the onset of or better manage diseases such as Alzheimer's, osteoporosis, and arthritis.

We all talk about this magic pill. The magic pill we need to take to stay healthy is simply to adopt an active healthy lifestyle. Obviously this is a lot easier said than done, based on the statistics of older adults living with chronic diseases. In a recent survey done by the Victorian Order of Nurses, VON—they provide in-home care to elderly people across Canada—their report shows that their clientele have an average of not one, but 3.5 chronic diseases each. So they're not just dealing with diabetes; they may be dealing with hypertension, arthritis, and Alzheimer's--quite a plateful of issues.

ALCOA, along with many other research organizations, have conducted research to better understand the barriers for older adults to adopt a healthier lifestyle. What we have found, unfortunately, over ten years is that the barriers do not appear to have changed. These may or may not be new to you, but some of the barriers include things such as accessibility: the issue of transportation and being able to get to a class, the times that exercise classes might be offered. Is it safe for them to even get to a class or a community centre?

There is the fear of the program and whether they are going to hurt themselves. They are very afraid of falling or taking a class that is inappropriate for their level of ability. Is it suitable for them?

Cost is an issue, whether it's the transportation cost to get there or simply being able to afford to pay for the class. Another barrier is psycho-social support. This has to do with motivation and social interaction. This is very important because of all those other tangible barriers to accessibility. So if transportation, cost, and safety are removed from the equation, if an individual is not motivated to adopt a healthy lifestyle, removal of the barriers is really irrelevant because they won't want to go anyway.

Another key factor that really needs to be addressed first and foremost when we are considering prevention and management of chronic disease is the issue of mental health. From what the research shows, if you do not address mental health as the first concern, there is no need to address the other chronic diseases, because an individual with mental health concerns is not going to have very much interest in their other health concerns. So we need to look at mental health as the first and foremost issue when dealing with either prevention or management of chronic diseases.

In September 2006 a paper was produced for the federal, provincial, and territorial committee of officials for seniors, and it was called “Healthy Aging in Canada: A New Vision, A Vital Investment”. I want to take just a moment to read two paragraphs from this very large document, which I think are critical to our discussion.

Today, older Canadians are living longer and with fewer disabilities than the generations before them. At the same time, the majority of seniors have at least one chronic disease or condition. Our health care system primarily focuses on cure rather than health promotion and disease prevention. Redirecting attention to the latter is required in order to enable older people to maintain optimal health and quality of life. The evidence is clear. Older adults can live longer, healthier lives by staying socially connected, increasing their levels of physical activity, eating in a healthy way, taking steps to minimize their risks for falls and refraining from smoking. But there are real environmental, systemic and social barriers to adopting these healthy behaviours. Some relate to inequities as a result of gender, culture, ability, income, geography, ageism and living situations. These barriers and inequities need to be and can be addressed now. Through a combination of political will, public support and personal effort, healthy aging with dignity and vitality is within reach of all Canadians.

The document then goes on to discuss how we can achieve this new vision for healthy aging in Canada by addressing supportive environments, mutual aid, and self-care. It's one very important document that is reinforcing the need for older adults to remain physically active.

In addition to this report, more recently at the 66th session of the United Nations General Assembly, a resolution from the high-level meeting of the General Assembly on the prevention and control of communicable diseases was introduced and adopted on September 16, 2011. So it's really hot off the press a month ago. What is of significance to note is that physical-activity-related solutions are prominent throughout the UN resolution. Out of a very lengthy document, I've taken just a few statements to highlight this point.

They acknowledge the global burden and threat of non-communicable diseases and that it constitutes a major challenge. There is a profound concern that non-communicable diseases are among the leading cause of preventable morbidity and of related disability. We must reduce the risk factors and create health promotion environments. We must engage all sectors of society to generate effective responses for the prevention and control of non-communicable diseases. We must strengthen the capacity of individuals to make healthier choices. And most importantly, prevention must be the cornerstone of the global response to non-communicable diseases.

To inform and educate older adults is the first step to prevention and better management of chronic diseases. Addressing the determinants of health is also critical to develop policies that will provide equitable--

[The Chair, Conservative, Joy Smith]

Ms. Clark, you're over your time. I've given you quite a bit of extra time. Could you sum up now?

Thank you.

[Patricia Clark]

That's not a problem.

We must look at the determinants of health, and I think there is no question that the research and evidence unequivocally confirms the urgency to address the disease prevention and management of older adults. And certainly ALCOA has a reach through our membership and through our partners. We can reach over one million older adults in Canada, and we would like to work with the government.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Ms. Eng.

[Susan Eng, Vice-President, Advocacy, Canadian Association of Retired Persons]

Thank you very much, and thank you on behalf of CARP, a national non-profit, non-partisan association of about 350,000 members across the country. We have 50 chapters now across the country. We advocate for public policy changes that improve the quality of life for all Canadians as we age. And health care, of course, for our members and for all Canadians, remains a top priority, but it matters more as we age.

Despite the fact that today's generation of older Canadians are living longer, healthier lives, the likelihood of developing chronic disease increases with age. The prevalence of chronic conditions that particularly affect older Canadians is in fact increasing. The impact of chronic disease on the health care system is expected to increase substantially. The population as a whole is aging, especially as the baby boom generation moves through the senior years.

The real cost drivers in the formal health care system are the escalating costs of treatments as well as of drugs, and also the increased usage by healthy as well as by chronically ill Canadians. But if nothing is changed now in how we deliver health care, the current system may indeed be unsustainable--not, as some would have it, because we are aging, but because of the way we are structured.

The Canadian health care system serves Canadians well for acute care but is not mandated to provide continuing care for those with chronic diseases for which medicine has no cure, by definition. That responsibility, which we would call quality-of-life care, falls to informal caregivers and the home care sector, which is at best a patchwork across the country. So CARP is calling for a three-part approach. First would be a comprehensive home care and caregiver support strategy to deal with people who are now taking on home care and caregiver responsibilities. Second, we have to ensure access to primary care and drug management. And finally, as has already been focused on, would be prevention and health promotion.

Home care was recognized as the next essential service in the Romanow report, which recommended that the massive home care transfers to the provinces be used to support medically necessary home care services and that the federal government provide direct support for informal family caregivers. Despite this and the billions of health transfer dollars since, there is not to this day a comprehensive home care and caregiver support strategy that applies nationally, and there should be.

An estimated 2.7 million Canadians provide the equivalent of $25 billion a year in caring for their loved ones at home. A quarter of those caregivers are seniors themselves. Women are more likely to be caregivers and are more likely to be the ones who have to leave the workforce in order to provide round-the-clock care.

Apart from some modest tax measures, albeit much improved by the recent federal budget, and compassionate leave, there really is no national policy addressing the needs of informal caregivers. Home care services are a provincial jurisdiction, and there are also no national standards of care or certification. Yet the vast majority of Canadians want to stay in their own homes as long as possible, even if they have medical challenges. Not only does this improve their health outcomes, but it keeps them among their family and friends, all of which adds to their quality of life.

This is good social and health policy, but it's also good fiscal policy. A well-integrated and successful home care strategy has the potential of diverting massive amounts of demand from the formal health care system. Home care is 40% to 75% less costly than institutional care.

Finally, not only is a comprehensive home care and caregiver support strategy good public policy, it also makes good political sense. CARP, as some of you might know, polls its members regularly. We have an online newsletter that reaches 85,000 e-mail addresses, and we poll them every two weeks. Some 2,000 to 5,000 members answer our polls, often in the course of a weekend, and we poll them on our various advocacy priorities. Consistently, they rank caregiver support and home care strategy as a top priority. They say that a party stand on caregiver support and home care would change how they would vote. They rated the campaign promises in the recent federal election for us and they especially appreciated the refundable tax credits that were proposed by the opposition. They did, of course, appreciate the increase in caregiver support in the budget, but they appreciated the comprehensive nature of some of the platforms, and they want the new government to improve on even their promise by adopting some of the other recommendations that were on offer.

Just this weekend, some 25,000 members gave us their views about how best to support family caregivers and to improve the availability and professional competence of home care workers. They recommend better pay and accreditation, and help with improving the work of home care workers and financial support for family caregivers, particularly those who are taking on full-time responsibilities.

So CARP recommends that the federal government take the lead in the upcoming negotiations for the new health accords to promote a nationally coordinated home care strategy that ensures national standards of care with stable and sufficient funding, and supports the work of informal caregivers. This support could be accomplished by establishing a new designated federal home care transfer, to guarantee a basic level of home care services to all Canadians wherever they live, explore the feasibility of long-term care insurance, develop and invest in programs that allow more Canadians to age at home, and build upon the recognition in this recent federal campaign of the value provided by informal caregivers by ensuring a three-part strategy. This strategy would ensure that there is targeted financial support, especially for caregivers who provide heavy care, provide workplace protection and work leave, and integrate caregiving with the formal health care system through training, support, information, and respite care.

Access to primary care, especially geriatric care, is a huge concern. In fact, about four million Canadians do not have access to a family doctor. We haven't looked at the numbers precisely, but many of those four million will be seniors. Less than half of seniors with chronic conditions report that their doctors actually review their medications with them or explain the potential side effects. So that is a level of care that is needed, and 6% of those with those chronic conditions particularly focused on aging, such as heart disease, high blood pressure, diabetes, and arthritis, reported not having a doctor at all.

Seniors with chronic conditions who take at least five medications are twice as likely to experience side effects as those taking fewer medications. And here's the kicker. There are approximately 200 geriatricians now practising in Canada, about a quarter of what is needed, according to an estimate by the Canadian Medical Association.

So CARP recommends that the federal government take the lead again in the upcoming health accords to promote universal access to comprehensive primary care by providing incentives for doctors, nurses, and nurse practitioners to practise in under-served communities, to improve drug assessments, to ensure the quality and safety and costs of drugs, especially those taken by seniors, and to promote the study and practice of geriatric medicine.

Prevention is something that has been covered so I won't get into it other than to say that we support the premise that according to the Center for Disease Control, 40% of chronic illnesses are preventable, even among seniors. So we encourage and support the recommendations there. We would add our own including a focus on healthy food strategies, vaccination, and healthy living.

I have one last word that I will leave you with. It is not contained in our formal submission, but I'd like you to listen to it. It comes from the Los Angeles Times just this morning.

What if a new medication for severely ill patients had no role in curing them but made them feel much better despite being sick? Let's say this elixir were found to decrease the pain and nausea of cancer patients, improve the sleep and energy of heart failure patients, prolong the lives of people with kidney failure, drive down health care expenditures and ease the burdens of caregivers. Those are the promises of a fledgling medical specialty called palliative care—not a new drug but a new way of treating patients who are living, often for years, with acute or chronic Illnesses that are life-threatening. If palliative care were a pill, government regulators would very likely approve it for the U.S. market. Federal health care insurance programs would quickly agree to pay physicians and hospitals for treating patients with the new therapy. And patients would make it a blockbuster drug in no time flat.

End-of-life care is part of the quality-of-life care continuum and remains an unmet need in the Canadian health care system.

Thank you for your focus on one of the most important challenges to our quality of life as we age, and for the opportunity to have input to your recommendations.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Eng.

We'll now go to the Canadian Institutes of Health Research. Yves Joanette, please.

[Dr. Yves Joanette, Scientific Director, Institute of Aging, Canadian Institutes of Health Research]

Madam Chair, members of the committee, thank you for inviting us to discuss the health care challenge of the growing number of cases of chronic diseases we are seeing in Canada today and, particularly, the link between chronic diseases and our aging population and the even larger aging population we'll have in the years to come.

Canada is an aging country and is already among the oldest in terms of its population.

Life expectancy at birth in Canada is about 81 years old now, a little bit less for males than for females. Our life expectancy in Canada is greater than in the United States by nearly two years. It's greater than in the United Kingdom by a year, more or less similar to Germany and France, but still nearly two years less than in Japan.

At 65 years old, our life expectancy is approximately another 20 years. The most dramatic change is seen among the oldest old. The real achievement, however, will be to transform all these extra years into healthy extra years.

This is not yet the case. The current figures indicate that the proportion of healthy life is about 86.3 and 88.8 respectively for women and men in their lives. Transforming longer life expectancy into healthy life expectancy is one of the contributions of Canadian researchers in the field of aging, supported through the Canadian Institutes of Health Research. In 2009-10 alone, the federal investment in research and aging was $122 million through the CIHR.

The CIHR president, Dr. Alain Beaudet, appeared before you earlier this month and outlined CIHR's strategic plan. I'll remind you that this plan includes a commitment to concentrate efforts in five specific health research priority areas, including the priority areas to promote health and reduce the burden of chronic disease and mental illness, as was said.

CIHR has identified a series of so-called signature initiatives--that's how we call them--that are linked to the five commitment priority areas, many of which relate to chronic diseases and aging. These are large targeted research programs that will leverage several-fold resources from partners in the public and private sectors. They include, for example, inflammation and chronic disease, community-based primary health care--as we heard, it's a challenge--as well as the international collaborative research strategy on Alzheimer's disease.

Above and beyond the CIHR signature initiatives, there's a unique research platform that is supported by CIHR and the government that will contribute to the better understanding of chronic disease and aging. The Canadian longitudinal study on aging, or CLSA, will follow a cohort of Canadians aged 45 and older over the next 25 years. CLSA will advance aging research in Canada and enable researchers to move beyond providing a snapshot of the adult Canadian population towards observing and understanding the evolution of diseases, psychological attributes, function, disabilities, and psychosocial processes that frequently accompany the trajectory of aging. To date a total of $38 million in federal investment in the study is matched by $15 million from the provinces and other partners.

This demographic change has induced profound modifications of the types and patterns of diseases that Canadians have to live with. One of the main characteristics of this change is the increase in the proportion of chronic diseases such as, as we heard, diabetes or pulmonary conditions. Why is it so? Mainly because more acute diseases--infectious diseases, for instance--occurring younger in life have been largely controlled.

The result is that very few seniors in this country do not live with a chronic disease. Over two-thirds of seniors live with one or more chronic diseases. We heard some other figures earlier. If in most cases these conditions are controlled by medication or other health solutions, such as little bit of lifestyle change, it will have a major impact on the health of the aging population.

Let me share with you two dimensions of this new challenge for which research supported by CIHR is ongoing, to provide the necessary knowledge to help you in your decisions. These two dimensions illustrate the complex dynamics between chronic disease and aging. The first has to do with the fact that the presence of chronic disease induces an overall condition of frailty in the elderly, which is highly associated with the loss of autonomy, and which, in turn, can favour the appearance of other health conditions. Frail seniors, as many as 20% of Canadian seniors, are at greater risk for acute and chronic diseases, disability, and death.

Being unable to measure frailty in seniors delays our efforts to prevent these outcomes. A CIHR-funded researcher, Dr. Kenneth Rockwood of Dalhousie University, has developed and tested the seven-point clinical frailty scale as an easy-to-use predictive tool to estimate frailty in seniors. That's only an example.

At the same time, we're beginning to understand as well that some barely detectable chronic health conditions could play a major role in the series of physiological events that can cause other diseases. For example, research is beginning to reveal the role that low-level chronic inflammations could have in the cascade of events that induce Alzheimer's disease.

Again, due to the effort of Canadian basic researchers, whether the process by which our body accumulates amyloid deposits, which is the basis of Alzheimer's disease, could be initiated and sustained by the presence of chronic low-grade inflammation is the subject of a lot of research.

CIHR has a road-map signature initiative that will bring together researchers to build on significant Canadian strengths recognized throughout the world, with the global objective of bridging the silos between research groups working in particular on the chronic disease area, so as to recognize in advance the common pathways and interventions.

The second agent I mentioned of the chronic disease and aging dynamic challenge has to do with the way health services are provided and how health professionals are trained. Health professionals and the health system have largely been constructed on the basis of the acute disease model, as was said before. Of course we still need specialized professionals and acute hospitals to take care of those with acute conditions, but we need to complement this model with professionals who will be able to understand the complexities of the interactions between different chronic conditions. We certainly need a health system that will adapt to better care for those chronic diseases.

According to Dr. Howard Bergman, the Canadian leader in this area, the shift from mainly acute disease to mainly chronic disease means that first we have to increase our emphasis on primary care. Attaining this goal could be helped by the availability of new technologies and information systems allowing all the community health providers to have access to the information regarding the chronic condition of a given individual. Secondly, it also means that our health system should definitely evolve from being institution-based to being a network of health care. We need research on this, including hospitals and nursing homes, but also assisted living, community hospitals, physicians' offices, and so on, research currently being supported by CIHR.

Thirdly, it means as well that health services to individuals with chronic diseases will require physicians who will be better trained to cope with highly complex and intricate health conditions. These physicians will work more and more with the other health professionals to support individuals with chronic conditions to diminish the possible deleterious impact of these conditions on overall frailty—not to mention the impact of the declaration of other diseases like Alzheimer's disease, which I mentioned earlier.

This challenge has to be addressed, because currently seniors with chronic diseases are responsible for an important proportion of our health care. The decisions we have to make about adapting our health services to the elderly with chronic conditions have to rely on evidence coming from research on health services. This is why CIHR is also supporting this type of research, as well as basic clinical and social research. The Institute of Aging has already identified this topic as a priority, and is launching a special program that will support health services and systems for an aging population, a priority for research on aging identified by the seniors themselves across the country through the regional seniors workshop that we hosted some years ago.

We're convinced that research on health systems will provide evidence and knowledge that will help you with the difficult decisions about our health system.

I cannot discuss the interactions between chronic diseases and aging today without addressing the matter of prevention, as we saw.

[The Chair, Conservative, Joy Smith]

Is there a translation problem? You don't have the translation?

Is it better now?

Can you try again?

[Dr. Yves Joanette]

I want to speak briefly about the prevention of these chronic conditions. If it's true that we need to continue the research to understand the impact of chronic diseases on the general condition of fragility and the manifestation of certain diseases, we also need to continue to do research into how our health care system can adapt to this situation. We also need to continue research efforts to reduce the source of chronic diseases, as we heard earlier.

[The Chair, Conservative, Joy Smith]

Can you wrap up now? You've gone quite a bit over time.

[Dr. Yves Joanette]

Yes.

On behalf of the Canadian research community on aging, I would like to offer our appreciation for the support the government is providing to sustain the research I've been referring to in my speech. We are ready to move forward in order to provide the objective and demonstrated evidence at all levels to provide you with the evidence you need to make the choices that will make Canada a respected and inspiring world leader in this area.

Thank you so much.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We're now going to

…the Fédération des aînées et aînés francophones du Canada.

I'm sorry, my French is not as good as I'd like it to be.

[Jean-Luc Racine, Executive Director, Fédération des aînées et aînés francophones du Canada]

That's very good. Well done.

I will give my presentation in French. I hope the interpretation is working properly.

On behalf of the president, Mr. Michel Vézina, a resident of Saskatchewan, I would like to thank you this afternoon for your invitation. We are very pleased to present our testimony before the committee.

The Fédération des aînées et aînés francophones du Canada has close to 300,000 members. These people pay dues. We are actually a federation of federations. Our member federations include 12 federations of francophone seniors from all provinces and territories in Canada, except Nunavut. Of the 300,000 seniors who are members, approximately 30,000 live in what we call minority communities. So they live outside Quebec. For example, 13,000 members live in Ontario, 2,000 live in Alberta and close to 2,000 live in Manitoba. So there are a lot of francophones living in minority situations.

I want to talk to you today about treating chronic diseases. The angle I will take on the matter will be a little different from the other presentations that you've listened to, although they were very good and they contained good components. I would like to stress the importance of serving the francophone population.

This is a role and responsibility of the federal government under the Official Languages Act. Part VII of the act requires the government to meet the needs of francophones in minority situations. I think we need to give credit where credit is due. The investment of funds through Health Canada into the two organizations, the Société Santé en français and the Consortium national de formation en santé, for us, marks a unique opportunity to make advances, breakthroughs, to ensure that francophones can receive services in French. But these resources are still limited and the challenges are enormous, especially when it comes to treating chronic diseases.

So today I'd like to talk to you about specific cases, and mainly about the importance of serving the francophone community. Right now, there is a lot of pressure from hospitals with respect to treating chronic diseases. As soon as someone is identified as having a chronic disease, people try to free up the hospital bed and place the person elsewhere as soon as possible. Very often, it is to the detriment of francophones. I'll give you some concrete examples.

You'll recall, about a year and a half ago, a situation that made headlines in the newspapers. The mother of Ms. Lavoie, of Toronto, had Alzheimer's. When a person has this disease, often one of the first faculties to go is the use of the second language. So these people find themselves in a home that provides treatment for chronic diseases. But Ms. Lavoie could not be placed in a home offering services in French. In fact, Toronto has only 17 beds for francophones. At the time, three quarters of the beds were occupied by non-francophones, by anglophones. Ms. Lavoie was required to place her mother in Welland. Surely you know Toronto. Welland is about an hour away by car, when there isn't traffic in Toronto, which is very rare. To visit her mother, who was being treated for chronic diseases, it took her at least two hours of travel time.

Try to imagine the situation and what is involved in placing a person who has lost their second language in a home. It's as if you were placing your mother or father in a home where they only speak Mandarin. It would not be very comforting. This woman experienced the same thing. We are often confronted with cases where seniors are placed in homes that do not offer services in French.

I also want to point out to the committee that when people are sick and vulnerable, they want to receive services in their own language. When people are sick, they want to be sick in French. This is often what we have to face.

When you are vulnerable, you want to be comforted, not fight. When you are in a hospital bed, that isn't the time to fight for your rights. I'll give you another very concrete example to show you how difficult it is.

I'm going to give you the example of my grandfather. Six years ago, my grandfather went to see the doctor. He lives in eastern Ontario, in a community where the population is about 80% francophone. The doctor never asked him if he spoke English. The doctor described his situation to him and told him what to do. Do you know how my grandfather reacted? He said: yes, yes yes. My grandfather doesn't speak English and doesn't understand English. But he was too intimidated and too vulnerable to tell the doctor.

Many years ago, my grandfather and I travelled to western Canada together. I was 12 years old at the time. I would go with him to restaurants so that he could order a hot dog. Imagine. If he had trouble ordering a hot dog in English, understanding the doctors instructions in English would have been a challenge for him.

I could tell you about similar situations. I'll give you an example. I did a national tour of our francophone communities three or four years ago. I was very surprised. I met with francophone seniors who were offended. Their parents had lived their entire lives in French. When the last moments of their lives came, they couldn't be given services in French in the chronic or long-term care homes.

These people wanted to fight. This is why they were in groups for francophone seniors. They fought for that. I met with at least two or three people like that over the course of these encounters.

All that to say that it's important to have chronic care services in French. That's the message I want to pass on.

To conclude, I would like to point out that what's important is the equality of both official languages in Canada. All Canadians need to be able to get services of their choice in both languages. For us, it's essential. Although health care is a provincial responsibility, the federal government has to play an active leadership role in this matter. The provinces are open to it, but the federal government must be very active.

The other important thing is to think in terms of the active offer. It is wishful to think that people are going to demand their services. You can't wait or be passive. Especially when people are in a vulnerable situation, you need to be very active in offering services.

There is another thing to look at. The service criteria is essential. The language of service is essential. I think we need to be proactive and must be able to offer it. It's very important.

The last thing that I would stress is this. When the federal government and all the provinces want to offer services, it is important to continue working with the francophone communities. I think we can help you and support you in that respect. We would be enormously pleased to continue to work toward this.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go into our Q and A time. We'll have seven-minute rounds, beginning with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you, Madam Chair.

First of all, to the witnesses who are here today, thank you so much for coming. I feel that you all presented articulate and well-informed presentations. This, to me, is an indication of how critical an issue this is—chronic care as it affects older Canadians. We expect the CIHR to have great research, and you always do, but for all the organizations that are here, your depth of knowledge about the issue is a good indication of how important it is for your members and those whom you serve.

I've been struck by the commonality of the priorities that people are focused on, not just at this meeting, but at previous meetings we've had as well, whether it's on prevention and health promotion, or whether it's on chronic disease and how we're not really tending to it, because there's been so much focus on acute care.

Ms. Eng, you're correct, the Romanow report did spell out, as the next big priority, the whole issue of home care, and the broader issue of long-term care as well. It dealt extensively with home care, whether it's through the formal system or through supporting families, and it also dealt with access to comprehensive primary care.

Hearing you today, I feel that we have this wealth of information, of research, of experience that's coming from all across the country, and yet we seem to be almost stalled as to where we're going. We've come from the 2004 health accord and we're now moving to the 2014 health accord. As you're addressing these issues for your members, the people whom you serve, when you talk about federal leadership that's required, what are three things that you want to see happen?

Some people have said that we need to have a first ministers conference just on health care that gets us working towards the negotiation of a new accord. But if we're to deal with this issue of chronic disease and we haven't made sufficient progress, despite all of this information, then I think we need to spell out what we mean by federal leadership. One thing might be a transfer involving home care, which is what Mr. Romanow recommended. We've talked a lot about the lack of affordability of drugs. We've talked about the need for comprehensive primary care. Maybe we need to be enhancing community health centres and the federal government should be taking the lead in that. There are any number of things. But I would like to hear you spell out the priorities for federal leadership to get us towards that 2014 accord.

I would ask this of any of the presenters.

[The Chair, Conservative, Joy Smith]

Ms. Eng.

[Susan Eng]

Thank you very much. I could say all of the above; indeed, all of those points are extremely relevant.

We have talked with our membership. We are engaging with them all the time, and we do focus on the fact that lots of work has been done around the country in a patchwork. There are all kinds of pilot projects that are taking place, but what is needed is a comprehensive set of strategies that can only come with a national conversation.

The health accord presents the opportunity for the federal government to set aside money to actually fund these initiatives, but a condition of having that money transferred to the provinces is to set certain national standards, certain national priorities, and to ensure there's accountability for the money being spent. In observing and reviewing the work that has been done according to the existing accords, we find the accountability is lacking.

While there may be projects that are happening—we know a few of them are very promising—we're not certain the knowledge is being shared. A lot of good work and a lot of serious money has been spent, so I think the federal role, and there is definitely a federal role, is to set the large framework. The coordination, the strategy, the accountability is implicitly a federal role.

The provinces, of course, have to deliver. Even in the latest elections this fall, all of them addressed many of these issues in a patchwork. They all had pieces of the puzzle, but none of them had the whole. The single most important message for us is that there be an overall framework.

The second piece, and I want to re-emphasize this because it's important from the point of view of fiscal management, is home care was identified as the next essential service to respond to an impending challenge, which is valid all by itself. But we feel that it's also important because it has the opportunity of restructuring the health care budget for the future. We're worried about its sustainability. We're hearing arguments for private pay, etc., and yet we're not looking at restructuring our actual delivery of those health care dollars and using them more appropriately. The opportunity arises with home care and caregiver support to actually divert a massive amount of demand, and therefore the opportunity to also put our fiscal books in balance.

Those would be our major recommendations for the federal role.

[Libby Davies, NDP, Vancouver East, BC]

Ms. Clark, do you have similar priorities? I mean, how do you look at home care? You could almost see it as prevention, as well, in terms of keeping seniors at home—healthy, active and so on—rather than in an institution. I wonder if you share that as a priority.

[Patricia Clark]

Certainly the idea of being able to live in your home as long as possible is what we do push: to remain as independent as long as possible and to have the choice to determine where you want to live and not be forced to live somewhere. The opportunity of being able to stay at home with home care is certainly very important from that perspective. So yes, we would support that, by all means.

We know from the evidence that the one person all older adults will always believe is their doctor; they always go to their doctor for their information to start with. We know that in the medical system now they don't get many hours of prevention within their medical—

[The Chair, Conservative, Joy Smith]

Ms. Clark, I'm trying to signal that you're over time.

[Patricia Clark]

Oh, I'm sorry; I didn't see you.

[The Chair, Conservative, Joy Smith]

Thank you. Please finish off.

[Patricia Clark]

Okay. What I would like to say is I think it would be very helpful if doctors were better informed, to have a system where they could refer so they're not looking at treatment all the time but prevention.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Williamson.