Mrs. Garon.
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.
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.
4:45 p.m.
Principal Investigator, Research Centre on Aging, University of Sherbrooke, As an Individual
I will answer in French.
Can you hear me?
4:45 p.m.
Principal Investigator, Research Centre on Aging, University of Sherbrooke, As an Individual
Okay.
A person's social participation is certainly reduced if they are in a wheelchair or in a confined environment.
4:50 p.m.
Conservative
The Chair Conservative Joy Smith
Excuse me. We just lost translation.
Do we have it now? Okay?
Go ahead. I'm sorry for the interruption.
4:50 p.m.
Principal Investigator, Research Centre on Aging, University of Sherbrooke, As an Individual
Social participation is certainly reduced if a person has poor mobility or is in a wheelchair. If someone is unable to go out, it's even worse.
However, in organizations or in Villes amies des aînés, or senior-friendly towns, there is a desire to try to reach these people. We are not talking about immediate or direct participation. We must use sentinel programs to target socially isolated people, give them access to services they never thought they could receive and put an end to their isolation in terms of human interaction.
All that does not happen right away. Time is needed for those people to regain a level of participation that would be closer to that of the rest of society.
There are some nice examples in the town of Granby, where there are a number of different stakeholders. There are firefighters, social workers and, especially, senior organizations that take advantage of the program you talked about earlier. I think that program should be better funded because the work being done in the field is really impressive. It is being done for and by seniors. So, there is a long way to go when it comes to funding, especially for this kind of program.
There are initiatives in the field that are also used to seek out isolated people and make them more socially involved. A lot of interdisciplinary and intersectoral cooperation is needed. Social workers in health care and firefighters are involved, among others. Some of them are referred to in fire halls as “seniors' firefighter friends”. That's a step in the right direction. You can really see that people are working on making things better.
Did I answer your question?
4:50 p.m.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
Yes.
To follow up on that question, when you talked about age-friendly cities, my question was, what does an age-friendly city look like? You've answered and you've given me some examples, but I imagine it would require organizations like yours to have strong relationships with the elected officials in municipalities to address some of those issues. Can you describe what you're doing at that level?
4:50 p.m.
Principal Investigator, Research Centre on Aging, University of Sherbrooke, As an Individual
I am a professor at the University of Sherbrooke, in the school of social work. I have been doing this research for three years.
Tomorrow, I am meeting with the administrators of Quebec's ten largest cities: Montreal, Trois-Rivières, Quebec City, and so on.
We will spend a whole day working with city representatives on how to increase seniors' social participation and how to make their cities more open to using arrangements they already have available, in particular. In fact, our towns are working with universal accessibility and social development policies. What needs to be done so that our seniors are seen not as consumers but as citizens?
4:50 p.m.
Conservative
4:50 p.m.
NDP
Anne Minh-Thu Quach NDP Beauharnois—Salaberry, QC
Thank you, Madam Chair.
I will follow up on what my colleague, Kelly Block, was saying. I will continue asking you questions, Ms. Garon.
I want to thank all the witnesses for joining us today. If there is time, I will have other questions for you.
Could you tell me what criteria a town needs to meet to become senior-friendly? Who sets those criteria? What about infrastructure costs? I don't know if you have the answers to these questions, but perhaps you will know more tomorrow. Do you promote intergenerational interaction? How should a city's environment be adapted? How much time is needed to implement all that? That's a whole bunch of questions for you.
4:50 p.m.
Principal Investigator, Research Centre on Aging, University of Sherbrooke, As an Individual
I would first like to get back to the fact that, in Quebec—I can talk about Quebec—the program is funded by the ministère de la Famille et des Aînés. Two million dollars are invested annually to help towns implement what I call “the model”. That model has already contributed to an increase in seniors' participation in in-house steering committees. We now sometimes hear from seniors in city councils, although we had never thought about hearing from those people before. We are working with them, not only because they are voters, but also because they have something to say about their towns.
The model makes that possible and is funded by the ministère de la Famille et des Aînés. MAMROT, the department in charge of municipal infrastructures, funds a $9-million program for small transformation and municipal infrastructure projects to increase accessibility for people in their towns. Sometimes, that may involve installing an elevator or rebuilding sidewalks that were poorly thought out in some places. That way, these programs are making it possible to rethink or rebuild those infrastructures. That's part of the answer to your questions.
Regarding recognition, the question you asked is very important. The model must be recognized by the World Health Organization. I think that now, in English Canada, work is being done with the Public Health Agency of Canada. Personally, as a researcher, I have been recognized by the World Health Organization from the beginning, and the models used have been adopted by that organization. We are also recognized by the ministère de la Famille et des Aînés du Québec. Criteria are currently being implemented, especially criteria on social participation based on the model. In fact, people need to participate from the outset, not only as consumers, but also as citizens. This model must be examined.
I am currently working with a research team on assessing the implementation and the impact on towns. We sometimes work on achievement indicators for those programs. Recently, I made a presentation on that topic in Ireland. I did not mention that in my presentation because it is more research-oriented. This is a very important issue, and I know that Manitoba has adopted a recognition policy to prevent non-participating towns from calling themselves “senior-friendly”. That way, each province would plan assessment procedures. However, we are all working together, with the Public Health Agency of Canada, on developing those recognition criteria.
Does that answer your questions?
4:55 p.m.
NDP
Anne Minh-Thu Quach NDP Beauharnois—Salaberry, QC
Yes, absolutely, thank you.
My second question is for Mr. Poston. It's about pharmacists.
Since people take more medication as they get older, and some medication is very expensive, does the Canadian Pharmacists Association possibly foresee using more generic drugs to give seniors access to more affordable medication? Is that something your are considering?
4:55 p.m.
Executive Director, Canadian Pharmacists Association
Yes, in fact, for most provincial drug plans that cover the aging population across Canada, pharmacists are required to dispense a generic drug if it's available, even if it's prescribed as a brand name, unless the physician writes “no substitution” on it. We see the extensive use of generic drugs in Canada. Obviously, a critical value is that they reduce the overall cost of prescriptions.
4:55 p.m.
Conservative
October 31st, 2011 / 4:55 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
Thank you, Chair.
Thank you for all the commentary so far.
I recently had both of my grandparents in seniors residences. One of them was afflicted with Alzheimer's. I know that it is certainly pressed.... One thing that surprised me was the limited capacity that existed. I know that every province is different, but for a lot of the long-term care facilities, if you're non-urgent, you'll be on a waiting list of four or five years, as is the case in my community.
I realize that this is a provincial jurisdiction, but what concerns do you have about the lack of capacity, given the fact that we have an aging population? I think the Alzheimer Society's Rising Tide report suggests that it's going to get monumentally worse. What advice would you have for us as federal politicians, given the fact that a lot of this is regulated by individual provinces? Where can we help? Where are our opportunities?
5 p.m.
Executive Director, Canadian Pharmacists Association
I can start.
I think we have a tremendous opportunity with the 2014 health accord or the renewal of health care transfers in 2014, however we want to describe that. I think there is a real opportunity for the federal government to provide leadership on a whole host of issues: home care, pharmacare, continuing care.
I think a feature of the 2003 health accord, the idea of tying the money to key priorities, has to be looked at seriously. I think the federal government has a critical role in providing leadership and I think a critical thing to consider—and I know it's administratively challenging and difficult to do—is tying money to some specific priorities that will meet pan-Canadian standards, whether they relate to pharmacare, home care, or long-term care.
The interesting thing with regard to long-term care is that greater investment in long-term care is essential to shortening wait times in emergency rooms. The problem of getting access to emergency rooms is created by not being able to move patients out of emergency rooms and admit them quickly enough, because the beds are full of people who should be in long-term care.
I think there is a real responsibility for leadership by the federal government to tie money to some specific priorities.
5 p.m.
Professor, Faculty of Nursing, University of Alberta; Canada Research Chair in Knowledge Translation, As an Individual
We would agree that the accord and the guidance that might come with that would provide stimulus for some of the actions we need to take.
The issue you speak to about waiting times is another version of the wait-time issue we have in the country. The last place we want frail, older adults is in acute care. It's a dangerous place for a frail, older adult. One of the things we need to do is figure out how to keep them in their homes or in their residences or receiving primary care in the community, more so than in acute care, and when we send them to acute care, we want them to stay there as short a time as possible. If they fracture a hip, they need to get in and out.
The issue of the wait times—the wait for long-term care—is actually quite complex. It's not as simple as an A and B relationship: that if we build more nursing home beds, we will shorten emergency room crowding problems. It's not quite that straightforward. This individual moves through the system and touches a lot of parts of the system, so it's going to take a coordinated effort.
We know that seniors are particularly vulnerable at points of transition. The nursing home-emergency department transition, for example, is a very important transition that we need to look at. Any guidance we get that provides stimulus from activities that happen as the accords work through will help us, I think, with things like residential and continuing care acts that will provide a framework within which we can look at tying funds to key performance areas.
5 p.m.
Conservative
5 p.m.
Executive Board Member, National Initiative for the Care of the Elderly
One of my concerns is what's called a “first bed policy” at a nursing home: an older adult in acute care may be transferred to the first available bed. That means that it may be 30 or 40 kilometres or miles away from where their family is. Although we want to reduce the acute care waiting list and free up beds in acute care, the suggestion for the first bed policy really needs to be looked at and examined, because it contributes to increased confusion and delays family relationships being maintained.
I'm sure Dr. Estabrooks would agree.
5 p.m.
Professor, Faculty of Nursing, University of Alberta; Canada Research Chair in Knowledge Translation, As an Individual
It's a serious issue.
5 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
I know that one of the comments the CMA made as well was on the cost of acute care beds. I think they said that being in a hospital bed costs 10 times as much as being in a long-term care bed.
I have just another general question--
5 p.m.
Conservative
The Chair Conservative Joy Smith
Mr. Brown, I am so sorry. I have been trying to get your attention. Your time is up. My apologies.
Dr. Sellah.
5 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Thank you, Madam Chair. I want to thank the witnesses for coming to provide us with some clarification. To start, I have a question for Dr. Pringle.
In one of your articles, you talk about the need for better cooperation among health professionals.
Could you explain to the committee what you have in mind and how that would help prevent and treat chronic diseases?
5 p.m.
Professor Emeritus, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, As an Individual
When I was talking about medical professionals, I was really talking about health professionals, not just physicians. We know we get better care when it's team care: where we have the opportunity to have the best prepared person for a particular area—it kind of goes back to scope of practice—who can be called upon from the team to deliver the care. It's really about that need to work in teams.
Frankly, with regard to the complexity of the care required by older people, and particularly those with dementia, they usually don't just have dementia. They have dementia, heart disease, diabetes, and arthritis. It's that complex care. It's more than what we can expect any one health professional to manage well. You need the team, and you need to have that team working well together with the resident, when that's possible, and with the family, always, in terms of assessing, making decisions, and then enacting that care.
That's the intent. We have to move from single providers. A problem in many nursing homes is that there is no team. We have very few registered nurses, some practical nurses, and then, mainly, health care aides. There may be a bit of help from physicians, who may visit weekly. Sometimes there is a bit of physiotherapy time and a bit of recreational therapy.
But frankly, given the numbers and the need, we don't have enough other professionals participating in teams to provide the best daily life and the best outcomes for the residents.