Health Committee on Nov. 28th, 2011

[Michael Nolan]

In terms of the calculation, I don't have a number for you today. However, one of the goals of community paramedic programs—paramedic services across the country, of course—is that we are attempting to offset increase in pressures.

Whether you look at the 40-year to 60-year cohort, or the 60 years and above cohort, we know that with the epidemic for health care need and the baby boomer population, we're having a very difficult time keeping up today. Our offsets are a start to attempt to flatten this tsunami, this wave, of age that's approaching us, as well as the exponential increases in call volume we've experienced over the last 10 years.

I'd be happy to provide the committee with exact dollar values in terms of the estimates of cost savings. But when you look at a single patient who is diverted from an emergency department as a result of not calling 911, receiving appropriate care in the home—prevention of a fall that results in a fractured hip—we know those cost savings are enormous to Canadians when you start to look at reductions of between 60% and 88% in terms of utilization.

We also know these folks are our highest risk group. They are our high flyers. They're the people we know bear down on the health care system at large.

[The Chair, Conservative, Joy Smith]

Mr. Nolan, before I forget—and I'll make up your time—this is a very important point that Dr. Carrie has brought up. If you could bring that estimation and give it to the clerk's office, we'll see that it's distributed to all members of this House.

[Michael Nolan]

Wonderful. Thank you, Madam Chair. I'd be happy to.

[Colin Carrie, Conservative, Oshawa, ON]

I have a couple of quick questions. Out of curiosity, how long does it take to educate a paramedic in Canada?

[Michael Nolan]

A primary care paramedic, which is the entry-to-practice level in Ontario, is two years. In much of Canada, it's one. Then, an advanced care paramedic requires an additional year.

There are significant cost savings from starting out to becoming a clinician...and of course the costs of paramedic salaries are less than many of the health care providers we have compared in terms of the skills and services they provide.

[Colin Carrie, Conservative, Oshawa, ON]

I was going to get nosey, but I'm not going to ask you how much you make per year.

What would the average paramedic cost the Ontario health care system per year?

[Michael Nolan]

It would be between $50,000 to $70,000 per year.

[Colin Carrie, Conservative, Oshawa, ON]

You mentioned the scope issues and expanding the scope. We've heard, basically from all the associations, that we should be utilizing the professionals we have out there within their full scope of practice. What do you find are the barriers to expanding your scope or to being utilized to the best of your abilities?

I was listening to Dr. Reichman, and he was saying that we have to be a little bit bold and look at innovation. The question he asked was whether they must be in acute-care beds. That was a great question. You know what? I'm going to ask you that question.

[Michael Nolan]

Great. Our goal is to keep people out of acute-care beds. Of course, much of Canada is rural and remote. Our health care system relies on people coming to services, not receiving services in their communities.

In the case of Long Island and Brier Island, for example, the paramedics do blood sampling and analysis in the community so that we can have just-in-time diagnostics so that a patient's treatment regime can be adjusted, for example.

On other diagnostics and services in Halifax, the paramedics who are going into nursing homes are now suturing patients in nursing homes. Instead of taking the person to the service, we're bringing the service to the patient. Really, paramedics do house calls every day, and the individual skills they require to serve Canadians best should not be hampered by regulation, for example. They should be finding the appropriate place and time to deliver the service.

[Colin Carrie, Conservative, Oshawa, ON]

That's one of the challenges.

I'm from Oshawa. I had a wellness clinic. I'm a chiropractor, and I work with medical doctors. I know that my colleague across the way is also a chiropractor. One of the things we always used to hear was that one day in an acute-care bed would pay for a year's worth of chiropractic care.

It just amazes me that it seems that we still can't direct people to the right professional at the right time.

Dr. Rosenberg, I'm quite pleased to see a geography professor here, because it seems that we have had a lot of health care professionals and the standard people, let's say, we would expect to have here.

I liked what you had to say. In your bio, you mentioned that you were planning to do more research on volunteerism. You also brought up the differences between small towns and urban areas. A lot of Canadians are in small towns. How does that relate to volunteerism? How can we use volunteers in a better way?

[Dr. Mark Rosenberg]

Certainly my colleagues here on the panel probably could offer as many examples as I can. The work we have been doing on volunteers I think is both a good news story and a bad news story. The good news story is that, particularly in the older population, older persons are perhaps the most dedicated volunteers for the other older people in their communities. Particularly in small town settings and in rural communities, they are also very vulnerable.

Often, when the older persons who are volunteers start to have their own health issues, the volunteer system starts to break down. I think what we're facing in a lot of our small towns and rural areas, and we do a lot of research in small towns and rural areas, is the fragility of these systems. They tend to work just the way they work in the larger urban areas, but they tend to be much more fragile, because the numbers are small. When the key people can no longer volunteer or when they burn out, which is one of the other findings we've had, those volunteer systems break down.

That's why you're also seeing how difficult it is for the volunteer sector to step in, in these communities, where the private sector isn't prepared.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Rosenberg.

I want to welcome Mr. Eyking to the committee. You're next, Mr. Eyking.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

Thank you, Chair.

This is my first time on the health committee, and I'm glad I'm here at this time, when your esteemed witnesses are doing quite the job of telling us what challenges we face in the health care system. I'm from small-town rural Canada. You see it with your neighbours, the challenges they're facing. Many times the so-called children, adult children, don't live in the community anymore, and many times the seniors are taken out of the home because there's nobody there to take care of them. You mentioned this, that it's two or three years sometimes that they're in the hospital.

Mr. Nolan, you talked about Brier Island and how they're dealing in creative ways by helping on-site. I think we have to have some more incentives out there. The Australians are doing a lot more to keep rural health care workers in rural communities, whether it's helping them with their loans or giving incentives to doctors, and I think that's one way. The other thing that's been thrown around is that if you stay home with a sick one, you could get EI coverage. If you look at the net return you're going to get—if you can keep a senior or somebody sick in a rural community in their own home, it saves thousands of dollars, and really, it's EI for one year to help that person.

I'd like to hear more about incentives, what government can do to keep people in their homes. I had a gentleman next door who was 85 years old. He was still able, but he had to have a health care nurse come. He was going to stay in his home until he died, and he did, but they'd haul him out because his driveway wasn't clear—little things like that. If somebody had cleaned his driveway, somebody could've been in checking on him. You just wonder sometimes. We don't have creative ways of keeping people in their homes in a rural community.

Should we be doing more on that, getting more services in rural Canada and helping people who are going to stay home, maybe with their mom and dad, or even a sick child that has cancer? How can we help them out more?

[The Chair, Conservative, Joy Smith]

Who would like to take that?

Mr. Nolan.

[Michael Nolan]

I'd be happy to speak to that, Madam Chairman. Thank you.

On the individual side, the Deep River program is a great example of where often the paramedics are called the oldest child. As you say, they've moved away. They've stepped in as the lightkeeper, if you will, in the community. They're doing home visits. They're holding their hand when they need their hand held. We're putting in home monitoring devices and connecting people to the appropriate services.

As the EMS Chiefs of Canada we've been working with this government to have the paramedics included in the loan debt forgiveness program so that we can increase the number of advanced care paramedics in rural communities in Canada. Advanced care paramedics on the emergency side can intubate you, can put a pacemaker on you, and so on, but on the primary health care side, they can also come into your home and rehydrate you with an IV. They can provide you with antibiotic care so that you're not being shuffled back and forth a couple of times a day should you have sepsis or a significant infection.

We'd like to increase our presence and the services we're providing in the community, and we'd like this federal government to assist us in doing that. But I think as well we provide an opportunity through chronic disease self-management, working with the individual and the family so that they have the appropriate answers when it comes time to care for their loved one, because ultimately that's what we all want to do in terms of taking care of our parents.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

My second question deals with the aboriginal community. It's the fastest-growing community in Canada. When you talk about resources we're going to need—we're going to need more nurses, more doctors—you'd think if that's the fastest-growing community we could hopefully draw from that community to have trained people. But the sad reality is that it's the most unhealthy community we have in our country. I have the largest aboriginal community in Atlantic Canada. It's just terrible. I know the truck drivers who bring in tractor-trailer loads of Pepsi and cola; two litres of pop is cheaper than a litre of milk.

You see these things and you see the health problems, and you see such a great potential we could have with the aboriginal community. How are you going to break the cycle of the unhealthy native community we have, and how can we encourage them to be part of our solution to a shortage of people power?

[The Chair, Conservative, Joy Smith]

Mr. Rosenberg, would you like to take that one?

[Dr. Mark Rosenberg]

I'll make a couple of brief comments.

As one of my colleagues here alluded to—I think it was Dr. Reichman—the issue of obesity in this country or the issue of poor diets I think is not unique to the aboriginal population. I think it really is a crisis across all groups. In truth, I think both researchers and governments and communities need to come up with a much more coherent and successful strategy if we're going to change health behaviours.

The other issue is the fact that there is a very significant body of literature at the population health level that tells us that at a general level, as people's economic prosperity rises, their health improves. So in some respects, with the aboriginal populations, it's a health question; it becomes a question of economic and social well-being and policies to ensure that the aboriginal populations' economic and social prosperity rises. As that rises, some of the health problems we see now will not necessarily disappear, but the older aboriginal population will increasingly look like the non-aboriginal population with respect to their health.

[Mark Eyking, Liberal, Sydney—Victoria, NS]

Can I ask one more?

[The Chair, Conservative, Joy Smith]

I'm so sorry, Mr. Eyking, your time is up, but they were very good questions. Thank you.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

Thank you for the interesting comments so far. It pleases me to see Baycrest here. Obviously, you have a great reputation with everything you do with Alzheimer's and dementia. My riding is in Barrie, Ontario, so I hear a lot about Baycrest. We also happen to have a bunch of the hockey players that play in your Alzheimer's tournament who happen to reside in Barrie.

I want to know if there is anything in your Baycrest model that you think we should be adopting in communities across Canada. In Barrie, where there are day programs for patients who have dementia and other Alzheimer-related challenges, they are very helpful, I suspect, in delaying onset, but there is obviously not enough space and they're difficult to get into. Are there programs you offer at Baycrest that go beyond the typical day programs you have in senior residences in small towns?

[Dr. William Reichman]

What people with dementia need is both support for the patient as well as, vitally, support for the caregiver. Programs like dementia day care provide support for both. The patient is involved in an engaged environment, their health is looked after, they are with other people, and they are with staff who understand their special needs. But the caregiver, during this time that a patient is in a dementia day care program, is also getting respite, so they can go and attend to their own needs and to maintain their household. Dementia day care is a very, very valuable service, and it can be expanded, so there needs to be more capacity in communities across the nation for dementia day care.

But we can also leverage technology. For example, there are caregivers who don't have the wherewithal to take their loved one to a dementia day care program, who perhaps can't even afford a dementia day care program and would really rather be supported better at home caring for the person who has the affliction. So what we're doing is leveraging technology. For example, if you're a caregiver and you need support, you don't have to go to a meeting somewhere to get the support and you don't have to have a human being come to your home. Through web-based technologies, you can participate in caregiver support groups; you can get immediate access to a professional who can tell you how to manage a difficult problem you're having at home. And this is a very inexpensive leverageable solution, using technology.

The other thing is that one of the great burdens for families caring for somebody who has Alzheimer's and other aspects of dementia is when that patient is no longer themselves, when they start to behave in a way that betrays that they're no longer the husband in the way he was before. These behavioural problems are what often is the tipping point to then seek nursing home placement. What we can do now, and what Baycrest and others are doing across Canada, is send professionals into the household to make an appraisal of what these disturbed behaviours are and to help the caregiver be able to manage them more effectively.

As well, there are some patients whose behaviour is so terribly disturbed they can't be effectively managed at home, so there are special care units now in Ontario, a few—and this is being piloted in other parts of Canada—where the patient gets admitted to a special care unit for a time-limited stay, the behaviour gets managed, the caregiver gets trained, and the patient goes back home.

There's a whole array of these different kinds of programs that have been piloted here in Canada, as well as across North America, western Europe, and elsewhere.

[Patrick Brown, Conservative, Barrie, ON]

I know you do some research at Baycrest as well.

[Dr. William Reichman]

Yes, we do quite a lot.

[Patrick Brown, Conservative, Barrie, ON]

One thing we heard during our neurological disorder subcommittee was that physical and mental activity helps delay onset. It was sort of pointed out to us in a broader concept, not specific studies. Has your research reconfirmed that theory that physical activity is very helpful in delaying onset?