Evidence of meeting #12 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was home.
A recording is available from Parliament.
Conservative
Executive Board Member, National Initiative for the Care of the Elderly
The tools are actually available on our website and distributed nationally, across the country. Right now we're tracking, and we've had probably half a million tools distributed, of which a significant percentage have been linked to depression, delirium, dementia, and that area.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
I also understand that your organization has an ethnicity and aging “theme team”. Why has your organization created this theme team, and what health-related issues are different when you have seniors from different ethnicities? Can you elaborate on that?
Executive Board Member, National Initiative for the Care of the Elderly
That is a relatively recent theme. Just for your information, we initially started with five theme teams--caregiving, for example, and elder abuse. About 18 months ago we were asked by a number of our members and people in the public to look at the concept of ethnicity, recognizing the diversity of this country.
Chinese Canadians make up one huge population group for us. It's not that the health care issues for Chinese people themselves may be different; how they respond to those strategies that may be different; how they interact with their neighbours, and the terms they use, may be different. So we're trying to get an enhanced sense of that specific cultural group, of how they would define the terms, how they would use the terms, what behaviours work for them or not, and how that differs from the larger Canadian context so that the information can go back into practice.
That applies to Chinese Canadians, but it also applies to those from India and from Ghana. It's just understanding the diversity of this country and putting it back into practice every time.
A common example is with some of our recent immigrants from Thailand. For the older adults, the word “cancer” does not exist in that vocabulary, but it's part of their health care reality. The word “depression” may not exist for older adults from Thailand, but the expressions for feeling blue and feeling sad do exist.
It's to give us as health care professionals a clue so that when you're working with a certain ethnocultural group, you really begin to understand the language, and the choices they make, and you can better enhance and support their health.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
Is there a list of ethnic groups that you guys are targeting in particular, and maybe a reason why?
Executive Board Member, National Initiative for the Care of the Elderly
The Chinese Canadian group was the first. The most important reason was because of its percentage in the population, of course. The second reason was that we have certain colleagues who have a strong interest in ethnocultural issues with Chinese Canadians. Since we simply cannot do everything, we'll start with that group, see what our progress gives us, and potentially expand.
The other area where multiculturalism does play a key role for us is in the issue of abuse and neglect of older adults and some of the cultural connotations coming through there. We've used Chinese Canadians there. We've used some first nations as well, and some Indochina and southeast Asia cultural groups.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
A lot of ethnic communities tend to keep their parents and the elderly with them, so basically they're staying with families, with their children, or grandchildren, and others. Are you looking at that? Is there any sort of information you have in that respect which may be different from others'?
Executive Board Member, National Initiative for the Care of the Elderly
It's not a key priority for us right now in terms of our theme teams, but it's a well-established fact within the research community in this country—and I would defer to my colleagues as well—that caregiving practices and the health status of older adults from a variety of ethnic backgrounds may change, in our view. But the research also shows us that when you immigrated to this country will impact your health status, whether you're a first generation or a second generation.
There is not extensive, but certainly strong evidence in this country about multicultural and immigrant needs.
As an aside, we do have an emerging study underway looking at health care status among immigrants who are first generation over the age of 65, what they are saying about their health, and how they utilize health care services. But it's just beginning. It's a huge area, but we're starting.
October 31st, 2011 / 4:25 p.m.
Conservative
Executive Director, Canadian Pharmacists Association
Could I just add something? One of the practical things that our members deal with on a regular basis is the young child who comes into the pharmacy with either their grandparent or perhaps an aging parent and essentially acts as the go-between in terms of translation. I think it's a big issue in terms of developing the right cultural sort of setting, the right language.
We have a lot of drug information materials that are translated into a whole range of languages, but often in practice the use of the child as the go-between is what many health care practitioners face.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
Thank you.
My next question is actually targeted towards the Canadian Pharmacists Association. Electronic health records have been discussed as a means of improving collaboration and the flow of information between health care professionals. What is your organization doing to help facilitate this? How might electronic health records be helpful in reducing the impact of chronic disease among aging Canadians?
Executive Director, Canadian Pharmacists Association
As a specific activity, we've been working with Canada Health Infoway.
As a national association, our big commitment is to the development of national standards to actually make sure that, rather than having to sort of reinvent the wheel in terms of the electronic health records done in every province, we try to establish pan-Canadian standards, which means the technology can be built in one way, if you like, to serve the whole country. Advocating for pan-Canadian standards has been one of our important activities.
The other area that we've worked on, together with colleagues in medicine, in nursing, and with Health Infoway, is the developing of standards around the information that should be in a record and the information that needs to be exchanged across the continuum of care. Those are two examples of where we've worked on the issue.
Conservative
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much, Madam Chair.
I want to thank everyone for their excellent presentations. You've identified some of the core issues that we need to talk about. One of them is the issue of aging at home.
I was recently at the Baycrest conference in Toronto. They said that from their research, when you take a senior out of their surroundings.... Because their surroundings always help them remember: when they see a picture or something familiar, they keep their memory together. When you take them out of that and put them in a nursing home, all of those little markers that used to prompt their memory are gone. They become quite confused and disoriented and start to go downhill after that, so it isn't whether the quality of care of the nursing home is good or bad, it's that this is a major factor in moving people out of those surroundings.
You've talked a lot about home care, community care, long-term care models, and collaborative models, which I know the college of family practitioners is now speaking about: integrated models with multidisciplinary teams that are managing chronic illness in the community. But in order for that to happen.... I know that during the 2004 accord there was money put aside to do some of those projects, to see what worked and what didn't work. We now know that this kind of system works.
I would like to hear your comments on whether you see this being a huge piece in the 2014 accord. Would you like to see this change? How would you like to see it change?
On pharmacies, you've said that the cost of providing prescription drugs is exorbitant. There's the concept of looking at a pharmacare plan. Again, that was in the 2004 health accord. It is essential, for it to move forward, to look at how you can provide necessary medications for people who can't afford them anymore, especially as we become seniors.
Dr. Pringle, you floated a very interesting plan about a long-term care act and a long-term care insurance fund. I'd like to hear you elaborate on that a little more, because I think that is what we have to learn to do: to provide care outside of a hospital, as you say, in a facility that is appropriate and that gives the right kind of care, and by a person who is not necessarily a physician, because the Canada Health Act is physicians and hospitals.
One final question--
Conservative
The Chair Conservative Joy Smith
Okay, Dr. Fry. Would you like them to answer these questions before your final question?
Liberal
Hedy Fry Liberal Vancouver Centre, BC
No. I just want to throw out one final question to the pharmacists.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Okay.
Just quickly, you talked a little about e-prescribing. There are some things that I'm a little concerned in terms of e-prescribing. Who prescribes? How do you know you have the right prescriber? Also, can we hear a little about drug shortages? I'll leave you guys to it.
Conservative
Professor Emeritus, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, As an Individual
I'll take on the aging at home. I'll begin, and my colleagues can contribute.
I don't think there's any question that we lag in having good community support. We have some good models. SIPA and PRISMA, from Quebec, really demonstrate how we can keep people at home much longer using interdisciplinary teams with case managers who can move money around—who have that control to move money when somebody moves into a hospital—and who can then set up the services, very rich and intense services, for a short period of time to get them back out of hospital.
I know Ontario best in terms of that. We started off with a robust aging at home program that got eroded over the years. We don't have a federal act that addresses home care, and somehow the funds got transferred to meet our waiting times. They really got put into the acute care system, which is like a big sucking vacuum cleaner. It pulls in all the resources.
That's why we proposed what we did. We're not original in this. I think Neena Chappell, whom you might know, from the University of Victoria, and Marcus Hollander proposed what they call a continuing care act, a long-term care or continuing care act, in order to give continuing care, home care, and long-term care. If we have good continuing care, we can delay the need for nursing home care.
I don't mean to eliminate nursing homes. Probably Denmark has gone about as far as you can in that, because they have such a well-coordinated and intensive home care program. Before we're going to get that, we need federal leadership to establish this continuing care act. Then to complement it, it needs some funds.
Dr. Réjean Hébert, from the University of Sherbrooke, has recently written about the need to establish this long-term care insurance plan. It would serve community care and nursing home care and provide funding so that it can't be eroded by the demands of acute care. It would be tax funded, publicly funded.
What he proposes is a fund whereby provinces could set up their own schemes. That may include putting funds into the hands of family members or of older people requiring community long-term care so they can purchase their own. Or they can rely on a provider, who would be paid publicly, but that may very well be through a public or a private agency.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Could you send that to us, if it's in both languages, so we can have a look at it, please?