Health Committee on June 4th, 2019

[The Chair, Liberal, Bill Casey]

Welcome to meeting 150 of the Standing Committee on Health. I'm sorry that we're late. There's a little bit of chaos these days that we have to deal with. We'll proceed as quickly as we can.

We're going to open our testimony on violence faced by health care workers. Today, our guest from the Canadian Association for Long Term Care is Jennifer Lyle, liaison for the National Alliance for Safety and Health in Healthcare. Joining us from the Canadian Union of Public Employees is Jenna Brookfield, health and safety representative. From the Hospital Employees' Union, by teleconference from Burnaby, British Columbia, we have Georgina Hackett, director of occupational health and safety; and Alex Imperial, representative. From Liberty Defense is William Riker Jr., chief executive officer.

Welcome to you all. Each one of you has a 10 minute opening statement, and then we'll go to our question period.

We'll start with the Canadian Association for Long Term Care. You have 10 minutes.

[Jennifer Lyle, Liaison, National Alliance for Safety and Health in Healthcare, Canadian Association for Long Term Care]

Thank you.

My name is Jennifer Lyle. I am the CEO of SafeCare BC and one of the founding members of NASHH, the National Alliance for Safety and Health in Healthcare. I am here today on behalf of CALTC, the Canadian Association for Long Term Care, as the NASHH-CALTC liaison.

CALTC is a national organization composed of provincial associations and long-term care providers that publicly deliver health care services for seniors across Canada. It also represents care providers who deliver home support services and care for younger adults with disabilities.

The National Alliance for Safety and Health in Healthcare, NASHH, is a national-level collaboration of workplace health and safety associations that works with health care organizations and workers across Canada to promote safer, healthier workplaces.

Mr. Chair, honourable members, our continuing care sector is in a state of crisis. Our care providers are understaffed, under-resourced and under incredible pressure to provide quality care to an increasingly complex population. This set of factors creates a toxic mix that not only leads to burnout but also to workplace injuries.

Consider the numbers. Nationally, time lost claims due to violence in health and social services have increased by over 65% in the past 10 years. In B.C. alone, health and social services account for over 60% of all workplace violence claims among major industry groups, according to WorkSafeBC, and yet this sector amounts to only 11% of the total provincial workforce of this group.

Overall, violence is one of the leading causes of workplace injuries in B.C.'s continuing care sector, and B.C. is not unique. Across Canada we all face the same challenge: how to address the root causes of workplace violence in health care.

In order to address the root cause of an issue, you first need to identify and understand it, and that leads me back to my earlier remarks about being understaffed, under-resourced and under pressure.

To understand the pressure care providers are under, you need to understand how those relying on the continuing care sector have changed over the past decade and where we're headed. Today 62% of long-term care and 28% of home care clients have some form of dementia, a number that's expected to increase. By 2031, over 937,000 Canadians will have dementia. That's an increase of 66% from the present day.

In addition to the trends we see around dementia, we're also seeing an overall increase in complexity of the needs of those being cared for in a community setting as we continue to move away from an institutional model of care. This includes people with psychiatric disorders and addictions who may also now be facing dementia as they age. These things are all risk factors for violence.

Violence is not a foregone conclusion in any of these instances, but too often our system puts care providers at risk because of how care is being delivered. That brings me to my next point—being understaffed.

In a recent survey conducted by SafeCare BC of the continuing care sector, 95% of respondents indicated that their organization was short-staffed. You might wonder what staffing shortages have to do with violence; in that survey, we asked. We asked how staffing shortages impact care provider safety, and what they told us is that staffing shortages lead to rushing, to fatigue, to feeling like you don't have time to ask for help. All of these things put care providers at risk.

Not only that, but when you're working with vulnerable populations—for example, seniors with dementia—it's vital that you have the time to understand their needs and their triggers, yet it's this time that's in such short supply for our care providers because of chronic staffing shortages.

Not only that, but just as staffing shortages lead to workplace injuries, workplace injuries lead to staffing shortages. Take B.C. as an example. In 2018 the equivalent of nearly 650 full-time positions were lost because of workplace injury. Imagine an organization—or several organizations, for that matter—losing that number of full-time employees. Imagine the impact. That's the cost of workplace injuries.

Beyond the numbers, there is the human toll. There is the care aid who is sexually assaulted by a home care client with dementia. There is the nurse who is punched in the jaw by a senior suffering from delirium. There is the personal support worker who doesn't know how she could possibly face going back to work. Finally, there is the senior whose care is impacted because the person they rely on, the person they have developed a relationship with, is no longer available to help because of workplace injury.

What can be done? One option is a renewed national health human resource strategy—one that incorporates a seniors care lens and a workplace safety lens, one that reflects the changing demographics of our society and the shift towards community-based care, and one that places both the physical and the psychological well-being of our care providers at its centre, because ultimately we're talking about people, people who are trying to do the very best they can with what they have.

That brings me to my last point: being under-resourced. This is a big topic, so for brevity's sake I'll focus on three key areas: infrastructure, education and data.

From an infrastructure perspective, research has proven the power of design, specifically dementia-friendly design. Dementia-friendly environments support the person with dementia and minimize the risk of responsive behaviours. Put simply, dementia-friendly environments are not only associated with better care, but they're also safer for the care providers.

However, we face significant challenges across the country. CALTC estimates that 40% of care homes need significant renovation. In B.C., the average age of a care home is 30 years. A lot has changed in 30 years. Our understanding of dementia and the power of smart design has increased significantly, and at the same time, seniors entering care homes have changed. Gone are the days when a senior would drive herself to the care home and unpack her own suitcase. The care homes in which these seniors live are no longer designed for their needs, and that absence of design affects both the quality of their lives and the safety of the care providers who support them.

The federal government has an opportunity to make an impact in this area. One opportunity is to build on the $6 billion in community health investments made in the Investing in Canada plan to include investment in care home infrastructure, because, make no mistake, these are not care facilities or hospitals: These are people's homes. Such investments could be used to incorporate the last three decades' worth of research and knowledge into retrofits and new builds that better support safe care.

Our care providers are also under-resourced when it comes to education. Presently there's no national standard on workplace safety core competencies for health care workers, and there's also significant variation between health care occupations as to what core competencies are required.

Part of our work at SafeCare BC has been focused on making inroads with this group for that very reason. Working in continuing care is a high-risk activity, and therefore all health care providers should be required to exhibit baseline workplace safety competencies prior to entering the field, yet we see that this is not the case.

Part of this stems from a lack of awareness, and therein lies opportunity. There is opportunity for a public-facing campaign to raise awareness of the issues of violence in health care and the tools and strategies available to mitigate it. There's also an opportunity to address the lack of standardization in education, such as by establishing a national task group to create guidelines on core competencies and workplace safety for care providers.

Finally, there's data. Data is how we make informed decisions. It's as much a resource as physical infrastructure, yet when it comes to national-level data, we struggle. There is no standardized national definition of “the health care industry”, and when it comes to workplace injury data, each province's workers' compensation board codes workplace injury data differently. That makes it difficult to do an apples-to-apples comparison of the data and identify national trends.

In this challenge lies opportunity again, such as taking a leadership role to create a national-level workplace safety data benchmark, as was done similarly in previous pan-Canadian projects such as the Canadian medication incident reporting and prevention system.

Understaffed, under-resourced and under pressure—there's no doubt that these are big challenges, but there is an opportunity for the federal government to drive positive change, and change we must. The future of the health care system depends on its people. If we don't take care of the care providers, who's going to take care of us and our loved ones when we need it?

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to the Canadian Union of Public Employees and Jenna Brookfield. You have 10 minutes.

[Jenna Brookfield, Health and Safety Representative, Canadian Union of Public Employees]

Good afternoon, and thank you for the opportunity to address your committee today.

I speak on behalf of the 680,000 members of the Canadian Union of Public Employees. Our members are on the front line of the health care system, and as such are personally dealing with the phenomenon of workplace violence. Of our members, 158,000 work in health care environments, including hospitals, public health, residential long-term care facilities, community health, home care and the Canadian Blood Services.

Our written submission contains many statistics that help illustrate the prevalence of violence in our health care system. I hope to spend my time here today highlighting the impact on our health care system and on the individual workers that Canadians count on in their times of greatest need.

Almost 1,700 years ago, the Roman poet Juvenal famously asked, “Who watches the watchmen?”, a question that helped articulate the fears of a society concerned with the abuse of power and centralization of that power. If there were a Canadian equivalent to that question in 2019, it would be “Who cares for the caregivers?”

As a society, we have decided that health care is a priority and we've dedicated many resources to its provision, yet we have failed to tend to the needs of those who are on the front lines providing those essential services.

Employers have failed to take appropriate actions to address workplace violence. Provincial governments have failed to appropriately regulate and fund our health care workplaces to address these challenges. Our judicial system has failed to introduce accountability for those who assault our careworkers.

Who cares for the caregivers? Their families do, and so do the unions, but most importantly, the countless Canadians who look to them every day for help and support care deeply for our caregivers in this society. We need to make sure that they feel those in power care as well.

Violence in our health care system is reaching epidemic levels, and that is not just hyperbole. The statistics from workers' compensation boards in all Canadian jurisdictions attest to the fact that workers in long-term care settings alone report more incidents of violence than any other workplaces. A care worker in a long-term care setting is more likely to experience violence on any given day than a police officer or a prison guard.

I wish I could say that now is the time to act, but sadly, that moment passed long ago. Now is the time we can try to limit the damage and do what we can to protect those workers who care for us.

My role at CUPE brings me into contact with care workers every day when their workplace health and safety system fails to protect them and the judicial system fails to hold their assailants accountable and they turn to their unions for support. I am not able to provide the resources they need to be safe at work and I am not able to impose sanctions on those who have assaulted them, but I am able to advocate for them, and that is why I'm here today.

I am here to give voice to our members working in the home care sector who have been beaten and sexually assaulted because when this female-dominated workforce is sent into the homes of their clients, they have no control over their working environment and have no colleagues to turn to when things go wrong. I have met these people. Just last month, I spent an afternoon listening to one of our members who was sexually assaulted at work and didn't want to report it because the last time it happened, nothing happened, except that she had one less client the next day and four hours' less pay.

I'm here to speak on behalf of our members in long-term care workplaces across this country, those workers who strive to provide safety and dignity to a generation of Canadians who built much of what we all enjoy today. Unfortunately, these workplaces have changed dramatically in recent years.

What we used to refer to as “retirement homes” now house everybody who needs care but does not fit anywhere else within our health system. That includes people like a former bodybuilder who suffered a traumatic brain injury and is now unable to regulate and control his violent impulses. This is a real resident in a real long-term care facility. I have personally witnessed the aftermath of his assaults every time adequate staffing resources are not available when he needs care. The lucky ones only have bruises. Three workers over the last two years who have worked with this resident have had bones broken.

It is not just the young and physically vigorous residents who are a source of violence. Rates of cognitive impairments in the elderly are on the rise, and many, such as Alzheimer's or dementia, can compromise the residents' ability to regulate their own behaviour. Through no fault of their own, these residents have also become a frequent source of workplace violence. A lack of resources puts staff at these facilities at risk, as well as the other residents in care.

I'm here to advocate for our members in the acute care sector: the workers in hospitals who provide care to us in our moments of greatest need and all of those who keep these services running, including everyone from the dietary workers in the kitchen to the administrative workers and the environmental service workers who keep our hospitals sanitary and safe from pathogens and bacteria. They are all suffering from violence in their workplaces.

Our hospitals are difficult workplaces at the best of times, but when violence occurs, it makes this difficult work almost untenable. Employees in almost every other sector can pause work in dangerous situations by using the right to refuse unsafe work. This system has broken down in the acute care sector. Licensed staff are threatened that to pause care in any situation could be construed as abuse and cost them their licences and their livelihood. Others are compelled by their empathy to put themselves at risk because someone else is in need.

While other workplaces can bar people with a history of violent behaviour from entering, hospitals must accept everybody and find some way to provide care to anyone who is in need. Our members would be the first persons to advocate for the right of everyone in Canada to receive quality care. CUPE advocates for the right to be safe while providing that care.

The factors causing violence in our health care system are complex and multi-faceted. Researchers have identified four distinct types of workplace violence, and each one is truly a unique workplace hazard that requires a different approach to solve.

What is known as type I workplace violence occurs through criminal acts. Legislative changes such as those proposed in Bill C-434 will help deter some of these events. I would implore the committee to not stop there and to also turn its attention to other forms of violence that plague our health care workplaces.

What the researchers refer to as type II workplace violence is caused when those whom the workplace provides services to become the source of violence. It is incredibly complex in a health care setting. This risk is increased by heavy workloads, staff shortages and a lack of adequately trained security professionals fully integrated in the care teams.

The federal government has the ability to help address these challenges through specific targeted funding as part of the Canada health transfer. Such targeted funding could be earmarked to increase staffing levels and ensure replacements for staff who are sick or injured to ensure that nobody works alone. We could expand health services so that specialized treatment facilities are available and patients are not kept in settings that don't meet their needs or that don't have the training and infrastructure to provide care safely.

Other recommendations on what targeted funding could achieve include the provision of comprehensive in-person training for all staff to better equip them to recognize the signs or conditions that might lead to violence, as well as training on how workers can de-escalate violence and protect themselves if attacked. We can provide front-line workers with personal alarms and ensure that other stationary alarms in the facilities are available and functional, which is not always the case.

Also, we can provide support for workers who have been injured and/or traumatized, such as counselling services, and allow adequate time away from work to recover from an incident. We can provide province-wide access to chart information to inform staff of previous behaviours in patients who have been transferred between facilities, because in many provinces this is not the case.

As well, we can increase the provision of one-to-one care. We can also provide therapeutic programs to reduce patient stress, fear, frustration, boredom and anger. We can increase security personnel with high levels of training and the capacity to intervene with violent individuals.

Our written submission highlights these and other specific recommendations on how the federal government can take practical steps to reduce the risk of violence in health care facilities.

I thank the committee for inviting us to speak today. We look forward to further opportunities to help care for the caregivers in our society.

[The Chair, Liberal, Bill Casey]

Thank you very much. We're certainly hearing your words.

Now we'll go to the Hospital Employees' Union by video conference for 10 minutes.

[Georgina Hackett, Director, Occupational Health and Safety, Hospital Employees' Union]

Thank you to the committee for this opportunity.

My name is Georgina Hackett. I'm the director of health and safety for the Hospital Employees' Union.

[Alex Imperial, Representative, Hospital Employees' Union]

My name is Alex Imperial from HEU.

HEU is the oldest health care union in British Columbia and represents 50,000 members working for public, non-profit and private employers. HEU members work in all areas of the health care system, providing both direct and non-direct care services: acute care hospitals, residential care facilities, community group homes, outpatient clinics, medical labs, community social services and first nation health agencies.

Workplace violence is a widespread problem in the health care industry. Violence affects workers in all occupations and settings across the sector. Our care aides frequently experience violence in the workplace, witness and respond to violent incidents and often face threats and intimidation. While physical injuries are of significant concern, the psychological toll of workplace trauma is an emerging issue for our members.

Health care workers now have the highest injury rate of any sector in the province. In long-term care, the injury rate is four times higher than the provincial average. In B.C., according to WCB statistics, health care assistants suffer more injuries than workers in any other occupation and have the highest rate of injuries from violence. They accounted for approximately 16,000 injuries with time lost from work in the past five years, 15% of which was related to violence.

We also know that in health care the compensated claims under-represent the problem. There are multiple independent systems that collect reports of violence from health care workers across B.C. Without a standard integrated system to collect and analyze data, it is impossible to truly estimate the incidents of violence. Lack of centralized information also challenges efforts to identify and address contributing factors for violence that are shared or driven by the system. Research supports our belief that, for a variety of reasons, under-reporting is widespread across the sector. A national strategy or approach for standardized data collection and reporting of violence is recommended.

Our members experience various forms of violence along a spectrum from verbal abuse and threats to physical and sexual assault from patients, residents, clients and even family members. Our members are slapped, kicked, punched, pushed, spat at and grabbed. They endure being yelled at and threatened. These forms of violence result in emotional, physical and financial hardship for our members and their families.

I'm going to give the committee an example of one care aide who was kicked in the face, which resulted in a broken jaw. The trauma resulted in PTSD and chronic pain. The member was off work for a year while on workers' compensation. She is now back at work but is earning less than what she was earning prior to the injury. She is now battling the WCB, which refuses to pay a fair permanent disability claim. Currently, she still experiences dizziness, pain and confusion.

What are the effects of violence in the workplace on our members?

The first is the loss of income. Even if they qualify for workers' compensation or LTD, it will not make them whole, as the WCB will pay only 90% of net; and for LTD, in most cases, will pay only 70%.

Second, they are never the same. Sometimes injuries result in permanent physical and psychological disabilities. Access to treatment can be an issue. They will suffer through pain, anxiety, depression and fear for the rest of their lives, and WCB and LTD will be financially responsible only up to age 65.

Third, violence results in the social isolation of members who are unable to return to their pre-injury job—more so if members are unable to go back to any kind of work at all. We note that some of our members have limited skills and experience to adapt to another occupation. The satisfaction and the connection provided by work and co-workers is gone, the future is uncertain and members need to reinvent their lives to manage, sometimes without success.

Fourth, violence impacts our members' families, which end up providing support both financially and emotionally. In some cases, the effects of the injuries due to violence result in relationship breakdown. Life is disrupted not only for the victim of violence, but also for the family and loved ones.

[Georgina Hackett]

The causes of violence in the workplace are complex and shaped by factors across our social, health care and organizational systems when all of these are brought together in the context of care. Solutions require collaborative systems-based approaches involving organizations at all levels of government. For the purpose of this presentation, I will focus on residential care; however, these issues are also experienced in our acute care and community care settings.

Our members report working chronically understaffed and facing crushing workloads to provide the quality care their residents deserve. Working quickly through care routines, with limited flexibility for providing basics such as baths or helping a resident to the toilet, are examples of factors that contribute to the potential for aggressive behaviour and violent incidents.

Our members also see a reduction in the resources to provide their residents with social, cultural and recreational activities, such as music and outings, which would support a meaningful quality of life and alleviate challenging behaviours arising out of confusion, isolation, frustration and boredom.

Our members also note that family members who are frustrated with care delivery or staffing changes due to shortages can also contribute to the potential for violence. They report having to manage the distress of family members who are frustrated, angry and exhausted when they're unable to continue caregiving on their own, encounter challenges accessing home and health care supports and fear having to accept the first available bed in a facility apart from their partner, family support system and their established social communities.

The B.C. seniors advocate reports that almost 85% of the residential care facilities in British Columbia are understaffed compared to the guidelines that have been put in place by the province. Residential home and community care services must expand to meet the growing needs of Canadian seniors and their families. Increasing staffing of both direct and support staff to meet or exceed the minimum staffing guidelines is critical. Residents in long-term care are increasingly frail, and their needs are rising. Ensuring that staffing guidelines keep pace with those needs is essential.

Investment in building infrastructure, violence prevention programs and education is also required. Our members talk about the physical environment being poorly suited to the care needs of residents today and point to a connection between design and violence risks. They talk about their residents needing safe and secure environments that eliminate barriers to mobility, look more familiar than institutional, increase engagement and reduce confusion and disorientation. They also identify the importance of staff safety features, such as clear lines of sight, spaces with multiple exits and the equipment to reliably call for help in emergency situations.

In our members' experience, better strategies are necessary to ensure violence alerts and effective behavioural care plans are implemented and shared across the system, comprehensive risk assessments are done, and “code white” teams are well trained. In addition, they also highlight a need for comprehensive violence prevention education that is available in multiple languages, is specific to their residents' care needs, such as dementia care and mental health, and includes support for practical application, such as peer coaching.

Our members have the right to work in a safe workplace. It's imperative that strong action be taken to establish and maintain safe and healthy workplaces that support a high quality of care.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to Liberty Defense Holdings, with William Riker, Jr.

[William Riker Jr., Chief Executive Officer, Liberty Defense Holdings Ltd]

Chairman Casey and members of the committee, thank you for inviting me here today to discuss this very important topic.

My name's Bill Riker and I've spent the last 37 years of my career leading global defence, aerospace and security companies in the implementation of their programs, products and services. This has included roles in general management, business development, product development and engineering and operations. I'm currently the CEO of Vancouver-based Liberty Defense Holdings Ltd., a publicly traded company listed on the Toronto Venture Exchange under the symbol SCAN. We are developing a weapons-detection technology called HEXWAVE that uses active 3-D imaging and artificial intelligence to detect threats in high-volume foot-traffic areas and other urban security environments.

Prior to joining Liberty Defense in August 2018, I served in senior leadership positions with Smiths Detection, a leader in technology for weapons detection, including chemical, radiological, nuclear and explosive threats for the global security market in aviation, military, critical infrastructure and ports and borders. While at Smiths, I became acutely aware of the evolving threat to our communities from violent mass attacks and the need for the means to proactively intervene before they escalate.

I will tell you a little bit about my background. I'm also an Engineering graduate of the United States Military Academy at West Point and I served in the U.S. Army for over 20 years. While serving in Europe, the Middle East and Asia, I became aware of how rapidly violence can escalate and its impact on people's lives. The work that I do now is focused on preventing civilian casualties in places that should be safe and free from fear.

I understand that this committee is focused on identifying ways to improve the security of the health care sector, but the root of the problem is a much larger one affecting not only health care facilities but also schools, places of worship and many other public places. Much has been done over the past 20 years to harden facilities like airports, but there are still many soft targets, such as hospitals, that remain vulnerable to attack.

Our company's mission is to help protect communities and to preserve peace of mind through superior security detection solutions. Our product, HEXWAVE, will be capable of providing accurate, high throughput screening to identify threats. It can be installed covertly or overtly and uses 3-D imaging and artificial intelligence to detect threats in real time. These include both metallic and non-metallic items, in indoor and outdoor environments, in a variety of weather and extreme temperature conditions. The intent of the system is to provide improved situational awareness on a wider perimeter to enable greater response time for security teams.

The technology behind HEXWAVE was developed by the Massachusetts Institute of Technology Lincoln Laboratory in Boston, Massachusetts. We are now in the process of commercializing the technology for deployment in urban security environments starting in the second half of 2020. With regard to hospitals, the challenge is complex, and while there is no single silver bullet solution to counter mass public attacks, the path to preventing such tragedies that have occurred begins with acknowledging the crisis and the variables that contribute to threat events and actively working across government and industry interests to deploy an integrated multisystem approach.

This all starts with awareness. If there's one thing I've learned throughout my nearly four decades in this industry, it's that we don't realize just how dear true peace of mind is until it's taken away.

In October 2014, a mentally ill patient stabbed a nurse multiple times in the head and neck at the Brockville Mental Health Centre in Ontario leaving her seriously injured. Between October 2016 and October 2018, there were 175 violent incidents reported at the Grace Hospital and 444 at the Health Sciences Centre according to data from the Winnipeg Regional Health Authority.

According to Statistics Canada, 34% of nurses have reported being physically assaulted by a patient, and more than 800 health care workers in Ontario have had to miss work due to violence on the job over the past year.

In British Columbia, where our corporate headquarters is located, claims related to acts of workplace violence have been steadily increasing over the past six years, and assaults on nurses, including aides and health care assistants, accounted for more than 40% of all violence-related injuries according to WorkSafeBC.

Violence is the fourth-highest cause of injury within health care. Across all industries, nurses, aides, orderlies and patient service associates suffer the most injuries from violence, according to the Saskatchewan Workers' Compensation Board.

Incidents like these are becoming more common across the health care spectrum in Canada, including in acute care, long-term care and community care. When you consider that this activity is happening in the places where we go to heal, and that these facilities are where we and our loved ones are at our most vulnerable in every sense of the word, these are places where we should feel safe and where peace of mind is most necessary.

Now, it is an unfortunate yet undisputed truth that places such as hospitals, schools, houses of worship and malls are becoming targets. These are places where the public congregates, and they are becoming increasingly susceptible to potential violent events.

This is why I believe we need to change the way we protect these places and to take proactive measures, including embracing new technologies to assist in both detecting and deterring threats at the earliest opportunity, and understanding the limitations of current technologies; maximizing the time security teams and victims have to react by ensuring proactive detection, preferably outside of the soft target or facility; and, last, focusing on widening the threat detection range by implementing a layered approach to provide situational awareness to security teams.

The ultimate goal is to have a proactive rather than reactive strategy of prevention, so that an attack can be intercepted before it occurs. I'm not implying that detection is the only area that needs attention. Certainly not, especially in trying to address these issues, but it is, however, an important part of the equation.

Thank you again for the opportunity to appear before this committee today. I'm happy to answer any questions you may have.

[The Chair, Liberal, Bill Casey]

Thanks very much to all of you for your opening remarks.

Now we're going to go to our seven-minute round of questions. We'll start with Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thanks to all of you for being here.

My question is for William Riker.

The committee witnesses who appeared before you highlighted the importance of having a robust security protocol surveillance system. You've stated that violence is the fourth-highest cause of injuries in health care and that we need to take a proactive approach. What kind of proactive approach should we take?

[William Riker Jr.]

Well, this is a multi-faceted challenge we we are facing. First of all, it's about understanding and accepting the fact that there is the potential for violence in health care settings, especially because of the magnitude of the emotion and activity that's going on there, and especially when you have a cadre of workers who are so dedicated to their patients—they want to help.

In addition to that awareness, then, is understanding what the potential threats are. Right now, our facilities are very open, and clearly we don't want to have a militaristic sort of protection environment, but there has to be something different from what there is now, just because of the prevalence of weapons and how they're proliferating across our society.

A proactive approach very much means to deploy detection systems early at entrances for pre-screening and then having a final screen for actually going into a facility, thereby enabling facilities to isolate any types of incidents. Also, it enables the proper training for guards and staff to be able to respond effectively within a very brief period of time. For example, if there were a shooting or if there were someone who came in with a knife, they would essentially be prevented from entering the facility, so that when emotions are running high, and an event could potentially escalate, that weapon is not present in the facility.

[Sonia Sidhu, Liberal, Brampton South, ON]

What kind of training do you think should be provided?

[William Riker Jr.]

Well, the training could very much be multi-faceted, from the perspective that it's clearly, first of all, about awareness and conducting the screening activity all the way through to when an event does occur. How do you isolate people and close the patients and other staff into rooms so that they don't have to try to intercede themselves? At the same time, you try to talk people down out of an incident or, if you have to, you can intervene physically and do that in an effective way and not make more problems than there could potentially be by brandishing weapons and escalating to a subsequent shooting event.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for the Canadian Association for Long Term Care.

Jennifer, you talked about “dementia-friendly environments”. Can you explain that?

[Jennifer Lyle]

Sure. When we think about the design of a care home or a care environment, what we're talking about is how the built environment is shaped. I'll give an example pulling from your hallway. It's nice and clean and has great lines. It's awful for somebody with dementia. The surfaces are hard; there's lots of reflection and glare, and there's not a lot of contrast between the walls and the floor. If you put somebody who has a cognitive impairment in that environment, they will become disoriented. They may not know where they are. They'll have trouble finding their way out. I'm a grown adult and I'm going to have to look at my way-finding cues to find my way out. That's how design can look when it's not supportive.

When we talk about dementia-friendly, what we mean is engineering the built environment such that it supports somebody who has difficulty hearing, who may have difficulty with vision or who has difficulty with information processing because their brain has changed, so that they can navigate that environment and interact with it successfully.

A great example of that in care homes is that in the new designs, you don't have dead-end hallways. If somebody has dementia and hits a dead end and they're trying to get out the door, that can lead really quickly to a feeling of angst, anxiety, stress, or anger, so what you see in the newer care homes now are circular hallways so people can have a continuous path instead of hitting a dead end. That's just one example of many, but you can see in that example how that translates directly to the safety of the care providers because they're not dealing with somebody who's upset or angry because they found that dead-end exit.

[Sonia Sidhu, Liberal, Brampton South, ON]

The committee has heard from witnesses about workplace factors, including staffing levels, wait times for health care services, overcrowding and a weak security protocol. How can we address those factors?

[Jennifer Lyle]

This is a really big subject, so I'll try to distill it down.

Let's take staffing shortages as an example. Again, I go back to our survey results. When we were looking at how staffing shortages impact workplace safety, we heard very clearly from people that they're rushing to get the task done. I think you actually heard from a number of people about the time pressure they feel that they are under when they're working in that chronically short-staffed situation.

When you're working with somebody who has a cognitive impairment, sometimes you need to stop. You need to pause. You need to take time, but if you're in a situation in which you feel you don't have that time or you don't have somebody you can call in to support you in a certain situation, you could potentially be proceeding with an unsafe situation. Effectively, we set you up to fail right from the get-go as a care provider. That's the piece around staffing shortages.

I also don't want to lose sight of the fact that it's a vicious circle. We talk about workplace staffing shortages creating injuries. I mentioned earlier in my remarks that 650 full-time equivalents had been lost. That was the number of work days lost last year in B.C. just because of workplace injuries. Again, it's the vicious cycle that we get into with regard to that. I think the staffing piece is critical.

The education piece is also critical. You heard from several other presenters about the importance of having education on how to approach a situation and how to de-escalate it if it gets to that. That, absolutely, is a core part of what we do at SafeCare BC. But I also think, to go back to my earlier remarks, that having that education available to people before they hit their first practicum is absolutely critical, because by the time you walk in the front door, if you haven't had that education already from the get-go, you're already behind the eight ball.

[The Chair, Liberal, Bill Casey]

Now we go to Mr. Webber.

I understand that you're going to split your time with Mr. Lobb. Does he know that?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Yes, he does.

[Len Webber, Conservative, Calgary Confederation, AB]

I didn't know that, but I guess the Chair did. I'll be quick then. Thank you, Mr. Chair.

Thank you, everyone, for being here today.

I have the Canadian Union of Public Employees submission here, so I'm going to pick on you, Jenna Brookfield.

Your submission indicates that you're the largest union in Canada with 680,000 members across the country, and that of that, 158,000 are health care members. You have a list of recommendations here. One is that the federal government can prevent violence by providing new targeted funding in certain areas. One area is increased staffing levels—which was mentioned here today by a number of our witnesses—to ensure that no one works alone.

With 158,000 health care workers in the union, if staffing levels were increased, what do you picture that number as then being? What number would be a good, sufficient number to increase to from 158,000?

[Jenna Brookfield]

I think that number has to start with the needs of our patients, residents and clients who are in the health care system. I don't think anyone knows of an arbitrary number that we could impose Canada-wide across the system that would fix all of the issues.

The challenge is that the funding that's in place currently doesn't have any bottom built in for staffing levels. Some provinces establish, for example, the number of hours of care that a resident receives in a day. That varies greatly across the country. We have a lack of standardization. It makes it very difficult to make an apples-to-apples comparison from one province to another. I think the staffing levels need to be assessed on a facility-by-facility basis, particularly with an eye to the needs of the residents, clients and patients who are within that facility. Arguably, there will be those in our system who need more care than others. That depends on their age, how ambulatory they are and the medications they're on.

Current legislative frameworks province by province do establish some thresholds for, just as an example, how many registered staff need to be present. That does start to create a bit of a framework for how many people are actually in the facility, but when it comes down to the number of care aides, for example, who are in a facility, there is no standard anywhere in this country other than the number of hours of service that a resident receives. Because of the way we're allocating the existing staff, we're at times increasing the risk by having people working alone. Simply reallocating existing time resources, with an eye to the needs of the facility and the residents, could help to ensure that the workers and residents are safer before we even put another person into the system.

[Len Webber, Conservative, Calgary Confederation, AB]

I see. Great. Thank you.

You also mentioned that the system should replace workers who call in sick. How common is it that they're not replaced? It surprises me.

[Jenna Brookfield]

It surprised me too when I came to work for CUPE, but it is a shocking reality across the health system. The practices do differ from one province to another. One factor that influences this is the way in which the licensing of facilities works by provincial health departments. Often the licensing approval is based off the scheduled shifts, not the actual hours worked. The facilities are funded for a base level of care provided in terms of the number of hours.

We've seen many instances of where sick calls have not seen the worker replaced, or even where employers have put policies in place saying they will not replace the first one or two sick calls on a specific unit. Ostensibly, when they do that, they believe they're offsetting the overtime costs they incur in other places, but the end result is that we very regularly have people working short-staffed in care facilities. There's no effort being made to replace them. Too, it's not always a matter of the employer being unwilling to do it. The availability of staff in the sector is also a problem. The recruiting strategies that we have are not sufficient to provide enough people into our system to make sure that the facilities have enough people on their casual and part-time list to pick up the slack when facilities are short.