Health Committee on Nov. 16th, 2011

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you very much, Madam Chair. Thank you to the witnesses for coming back for another round.

I wanted to address my questions to Ms. Wilson. It's good to see you.

We've heard from many witnesses during this study that seniors with chronic diseases often suffer from an additional disease of depression, or mental illness. I'm just wondering if we have any statistics or information on what sort of a problem we are dealing with there. What percentage of Canadian seniors are dealing with a mental illness?

[Kimberley Wilson, Executive Director, Canadian Coalition for Seniors' Mental Health]

Thanks for your question.

The data we have, sometimes we don't think is necessarily as accurate as we'd like it to be. A lot of the ways mental illness manifests in older adults aren't necessarily captured by some of the tools that we have. If you take depression, for example, some of our data show that in community dwellings samples the rates are similar across all ages, at 12% to 15%. We also think there are probably a lot of older adults who aren't being captured properly in those statistics.

However, if you look within long-term care, the numbers for depression go up significantly, with up to almost half of all residents in long-term care showing some symptoms of depression. Some surveys have shown between 80% to 90%.

I think probably what's most important know is that the numbers don't change as people age. In fact, we see an increase. If we're saying one in five Canadians lives with a mental illness, that would also be true for older adults with certain segments being at higher risk.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

What are some of the common precursors that have been identified amongst seniors who are dealing with depression? Is chronic disease one of them? What are some of the others?

[Kimberley Wilson]

Living with chronic disease is absolutely one of risk factors. In particular, that's one of the risk factors for suicide.

There are a lot of physical illnesses that people experience as they age, but we also see psychosocial factors, such as bereavement, with the loss of partners and friends, and the loss of independence and autonomy. A lot of these life transitions that are more common to later in life are what we see as some of the risk factors for depression, in addition to the biological risk factors that we all have at any age.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Right, and maybe you can refresh our memories about how your organization is reaching seniors who find themselves suffering from mental illness or depression.

[Kimberley Wilson]

Right now, we work primarily with health care providers to give them knowledge translation tools and some of the best evidence about the information we have in terms of assessment, treatment, prevention, and management. We work with the health care providers who we hope then change their practices.

We've also done some work directly with older adults by creating some user-friendly brochures educating people about what depression is and what other common mental illnesses are, to try to take away some of the stigma so that people feel comfortable going in to see their family physicians, identifying some of the symptoms they may have, and asking for help.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

In the system--provincial and federal--are we doing a good job of reaching seniors and letting them know that this is a danger they might face? And are we reaching out to their kids, who are often in charge of their care as they grow older? Are we doing a good enough job globally, I guess, of making seniors aware that this is something they may face and in trying to educate them on how they might mitigate those circumstances?

[Kimberley Wilson]

I think this is an area where we have a lot of opportunities to strengthen what we are already doing. There are certainly people who are champions across the country in local communities who do excellent work, but I don't think we're doing it well enough yet.

I think it's really important, too, to think about the two separate cohorts that we talk about: our current cohort of older adults who really grew up with a lot more of the stigma associated with mental illness than perhaps our next cohort may experience; and then the baby boomers, a very different generation, the one that we often talk about when we talk about this boom or tsunami that might be coming.

I think there are opportunities in the curriculum. Right now we know that medical students, for example, receive very little information about mental illness in general, and mental illness in late life in particular. Right now we don't have a lot of mechanisms to reach people who are currently in practice and to introduce them to some of the newer assessment tools, some of the risk factors, and the opportunities for treatment in late life.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Our government has invested significantly in mental health research, with $130 million previously, and has renewed that funding. Are you using any of the research that we have put into the mental health strategy? Is this something that you see benefiting Canadian seniors?

[Kimberley Wilson]

Yes, absolutely. I'm very privileged to be part of the Seniors Advisory Committee at the Mental Health Commission of Canada, so I'm very well aware and very proud of the work that has been happening at the Mental Health Commission.

Part of what we feel we've contributed, and which we hope to see change policy and practice, is our guidelines for comprehensive mental health services for older adults, which were funded by the Mental Health Commission and will inform part of the strategy moving forward. They will be released in 2012. So absolutely, but I think there are also opportunities to enhance that contribution as well.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mr. Strahl.

We'll now go on to Mr. Casey.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Madam Chair.

First of all, you will have to forgive me. Hedy Fry is the regular member of the committee for the Liberals. I am standing in because she's not in town today. I didn't have the benefit of any of your presentations, except the ones that were made today. I come at this, on more than one level, from a position of ignorance. My apologies in advance.

The committee I normally sit on is veterans affairs. I was somewhat pleased in hearing your presentation, Madame Laurent and Madame Mercier. There is a bit of an overlap. What I want to ask you about ties into this, given what you've had to say about palliative care and the concerns of the nursing profession in caring for the aged. You are probably aware that in the province of Quebec right now, there are extensive negotiations under way for the transfer of the Sainte-Anne-de-Bellevue Hospital from the federal to the provincial government. I would be most interested in your perspectives and your organization's perspectives on what both sides should be considering in those negotiations, and your views on the potential impact on your profession, on health care in your province, and on the patients.

[The Chair, Conservative, Joy Smith]

Go ahead, Mrs. Laurent.

[Régine Laurent]

Thank you.

I want to begin by saying that we are not involved in the negotiations. Therefore, I will give you my point of view based on the information we have. That information came from government officials.

We share the concerns of our colleagues from Sainte-Anne-de-Bellevue: specific clients need specific care. For instance, earlier, I was talking about seniors with specific needs. So, we think that in order to take care of veterans, certain particularities must also be taken into account.

I saw our colleagues were asking that their current organization of health care be taken into account, and I agree with that. They say—and I believe them—that their organization is appropriate for patients with specific needs. They are worried that the way their health care is organized will change once they merge with the Centre de santé et de services sociaux de l'Ouest-de-l'Île, and I am also worried about that. That is why they asked that a separate board of directors be maintained for Ste. Anne's Hospital.

To my knowledge, the Government of Quebec has not consented to their request for a separate board of directors. However, we will give them all the support we can so that the current health-care structure, which meets veterans' needs, stays in place. We don't believe that being part of a health-care and social services centre means that everything should always be standardized, be it for veterans or other clients.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you.

I know that there is another hospital in the province—perhaps a few other hospitals—whose organization is not administered by regional directors. For instance, Shriners Hospital is one such model. If you could advise the federal government, would you say that it's important to insist on a separate organization only for that hospital?

[Régine Laurent]

I fully understand your concerns, and I share them. As far as I understand, unless the pressures are strong enough, they are asking for a separate board of directors for Ste. Anne's Hospital. I think that would be the best way to guarantee that the organization of health care remains unchanged.

However, it seems that the Government of Quebec wants to stick to its vision by not authorizing a separate board of directors. However, I think they can rely on us. We are ready to help and support them in achieving their goal.

You are right, there are other institutions in Quebec that do not operate like the others. One example from the other extreme is Shriners Hospital. It operates in a different way. I think that different client bases must be handled differently.

We will support them in their fight to keep the current health-care structure. As for the separate board of directors, I don't think the Government of Quebec will allow it.

[Sean Casey, Liberal, Charlottetown, PE]

Is it true that the regional organization is currently experiencing financial difficulties?

[Régine Laurent]

In my humble opinion, the financial difficulties are just an excuse. To my knowledge, administering health care at Ste. Anne's Hospital does not cost any more than it does at Shriners Hospital or the McGill University Health Centre. Health care is structured, and money is set aside to meet the needs.

Oh, I understand, you are asking about the Agence de la santé et des services sociaux de Montréal, Montreal's health and social services agency. That agency receives money from the health department for the whole region. Normally, it is responsible for health care in the whole region. Therefore, there should normally be no reduction in the health care currently provided to veterans at Sainte-Anne-de-Bellevue.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Laurent.

Now we'll go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

And thank you for all the testimony so far.

I recall from a previous year, Mr. Turnbull, that you were telling us about how to keep costs under control in the health care system. You talked about a hospital bed being about 10 times the price of a long-term care bed. That's why it's interesting to talk about home care. With the pressures on hospitals and on long-term care in Canada, home care becomes something that is obviously very important for us to improve to enable more seniors to stay in their homes.

Do you know of any examples of what's being done internationally that Canada could look at? Can you think of concrete steps we could take within our federal jurisdiction to make it easier for seniors to live in their own homes for longer?

[Dr. Jeffrey Turnbull, Member, Board of Directors, Associated Medical Services Inc.]

There are several important initiatives we could look at internationally, in particular in Scandinavia. We have to understand that the issue we're facing is that of building a chronic disease management system around our acute care facilities. We have a very good acute care system, but we haven't built or accommodated an aging population that has chronic diseases. So we have to build the system around this.

Other jurisdictions, in Scandinavia and elsewhere, have been able to respond to that challenge. They provide services, as we've heard, using different approaches, such as team-based care outside of the hospital, including home-based care. They are moving care out into the community, with a patient-centred focus, so that you're not using the hospital. For example, there are health care units within community centres, in a nursing home, or a long-term care facility, all providing a centre of care within those facilities as opposed to having to use hospitals as the default for a failing chronic disease management system. So there are many opportunities for us to work differently.

But I have to say that this is a wholesale change in the way we practise medicine. Our ability to adapt will depict and predict how successful health care will be in the future. Our current model, no matter how we try to massage or adjust it, will never be able to accommodate the demands of an aging chronic disease management system. So we need to think of making substantive changes, not modest ones.

On your last point as to the role the federal government could play, I think it could play an enormous and very helpful role in looking at a long-term, home-based care strategy right across this country. You could use elements of the transfer payments system to facilitate change, change that we know is dramatically needed, through some form of an innovation fund. That change would spur a new generation of health services delivery and provide the necessary care for our seniors.

[Patrick Brown, Conservative, Barrie, ON]

I think of my grandfather, who lived in his home until the last year of his life. One of the things which enabled that was his access to community care. There were regular visits to assist him with living independently.

A few weeks ago in Barrie, I was talking to a community access nurse who mentioned that they were actually cutting back and, therefore, wouldn't be able to reach as many patients. I was surprised by that, because I imagine that's a very valuable service.

Is having that type of service something you believe is integral to keeping seniors in their homes?

[Dr. Jeffrey Turnbull]

It is absolutely. All too often we hear that same story about community care access, getting providers out to the home with the necessary support systems, whether informal caregivers...and giving them support; getting pharmaceuticals for management of chronic disease; and getting providers, doctors, and nurses visiting in the home setting. That is much cheaper, but unfortunately the way we structure health care at the moment, it has to come from the acute care sector.

As you know, I'm the chief of staff of the fourth-largest hospital in the country, and our budget is over $1 billion. Yet today we spent about $60,000--that's in one day at one hospital--for care that could be provided much better out in the community. We must have systems in place that will allow us to move these institutional dollars into home care dollars. If we're going to be successful in the future, we have to do that. We cannot use our acute care sector as a default for a failing chronic disease management system.

[Patrick Brown, Conservative, Barrie, ON]

Okay, thank you.