Health Committee on June 4th, 2019

[Len Webber, Conservative, Calgary Confederation, AB]

Okay.

Mr. Chair, I know I have to share my time. How much time is left?

[The Chair, Liberal, Bill Casey]

Two minutes and 15 seconds.

[Len Webber, Conservative, Calgary Confederation, AB]

Oh, boy.

Okay, Ben.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks.

I won't hear any more critiques about equalization from an Alberta MP with that time allocation.

[Voices]

Oh, oh!

[Ben Lobb, Conservative, Huron—Bruce, ON]

My question is for you, Mr. Riker. Dr. Eyolfson was an emergency room doctor for many years in Winnipeg, I think in downtown Winnipeg. Let's say a distraught person came walking in with a switchblade because they weren't happy with the care they received the night before. Would your system detect that, and what could it do to prevent a doctor or nurse from getting injured?

[William Riker Jr.]

A key factor here in the intervention and capture or identification of a weapon before someone comes into a facility is really acknowledging what the spectrum of potential weapons could be. You have to be able to understand what they could be, such as metallic or non-metallic. A switchblade would be an example of a clearly metallic weapon.

The bigger concern is where we are seeing a lot of trends going right now, and that's to ceramic or composite-type weapons. There's the advent of the additive manufacturing gun. That's coming into play now. It's sad to say, but that's the reality. Perhaps of special concern is any kind of explosive or that type of substance coming in. It doesn't take an awful lot.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Your system would detect it, and then what would it do—lock the doors? What could it possibly do?

[William Riker Jr.]

In the detection sequence, first is the identification of a potential threatening item on a person or not, because part of the system here is that it will allow non-threatening weapons or articles to go into the facility. But if it does identify an issue, then there's an alert to the security guards, or it can also physically interact with the lock-out system of the doors. It can essentially lock the doors before the person gets into the facility.

When you look at the hospital configuration right now, you essentially have the four A's established out there. The fact that this system can be deployed on the outside of the building or on the pathway enables you to get that early detection, prevent the entry from occurring, and go ahead and give the security organizations or teams time to respond.

[The Chair, Liberal, Bill Casey]

I'm sorry, but your time's up, Mr. Lobb. You can blame Mr. Webber.

Now we go to Ms. Kwan.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you to all the witnesses for their presentations.

I want to first acknowledge and say thank you to the health care workers in our system from CUPE, HEU, and also the Canadian Association for Long Term Care, and to those who are not around this table. You do tremendous work in our community each and every day. It's fair enough to say that every worker deserves to go to a safe work environment, and this is what we're talking about.

I think all of the presenters talked about a standardized level of care that is needed across the country. Related to that is a standardized level of safety and how we implement that from the federal government's side. How do we go about ensuring that all the provinces have the mechanisms in place for, for example, staffing ratios?

I'll start with you, Ms. Lyle, and then go to Ms. Brookfield and then I'll come to the folks on the screen.

If you can, just list some examples of where you think the federal government should take action in bringing in a national strategy. Data collection was one thing I heard about. Are there other items that you think are a priority that the federal government needs to act on?

[Jennifer Lyle]

Yes. I'll go back to my earlier remarks about the health human resource strategy. If I remember correctly, the last strategy was originally authored in 2004. We're 2019 now. I would say that 15 years down the road we've seen again that shift towards the community-based care. We've also seen a rising level of awareness around not just the physical safety of staff—it was mentioned a few times in the other presentations—but also the psychological well-being of staff. I think one thing is to look at that national health human resource strategy and to revise and reinvigorate it with those aspects in mind, again taking into account the physical and psychological well-being of the care providers, relating the intersection between workplace safety and health human resources. Finally, the strategy needs to be revised with an eye to the fact that we deliver care in a community-based setting now more than ever. That's the model we're heading forward with, so I would say that would certainly be one, in addition to the data piece.

There's one last piece I would throw out there for consideration. A lot of the stuff we struggle with has to do with lack of awareness. We need to look at the opportunities for public-facing campaigns on the risks of violence in health care, and not just the risks but also the strategies and the opportunities that we can take advantage of to mitigate that risk. I think that is potentially an area where the federal government can take a role as well.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much.

Ms. Brookfield.

[Jenna Brookfield]

Jennifer made some wonderful points on the human resource side of things. There's one point I would add: We need to have a national strategy on getting people into these professions and retaining them there as well.

The retention is a really key point today. I've seen efforts in multiple provinces to recruit, but we're losing them on the retention side, and we do that for all of the reasons we've discussed here today. We're not making it a very welcoming work environment in terms of both the physical and psychological strains of the job and the lack of support that people feel, not just from their employers, but from the society as a whole. That's one point that I really wanted to get across. A lot of care workers feel like they're toiling in obscurity.

They are doing something that we terribly need them to do. I imagine that everyone in this room has had or has someone we love in a hospital—if not ourselves—or in a long-term care facility. We think a lot about them and their needs, but we need to focus on who cares for the caregivers in our society. There does need to be a strategy on recruiting and retaining people by developing a culture of valuing the health care worker.

That is part of a recruitment strategy, but it also comes to the second point, which is outside of the human resources side of things: how we actually fund and run the facilities. We do need more standardization across this country. I know that very clearly there's a division of powers between the federal and the provincial governments; however, the federal government provides the bulk of the financial resources that keep our health system up and running.

There are countless examples of where the federal government funds things that are constitutionally under provincial jurisdiction and does provide benchmarks or earmarked funding for certain priorities. We could have a national standard for the level of care that's appropriate in an acute care setting, in a home care setting or in a long-term care setting. That could be based on the number of care hours that a client receives. That also could be based on the population size and the needs of those individual provinces.

I think we need to look both at the human resource side and at the facilities themselves, because our recruitment and retention strategy is not going to work unless we're actually making efforts to improve the working conditions across our health care sector.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much, Ms. Brookfield.

We'll go to the video conferencing with the HEU representatives. I don't know who's going to take this one on.

Is it Ms. Hackett?

[Georgina Hackett]

Yes.

To build on some of the things we've already talked about around data collection, reporting and ensuring that we are working towards understanding what the whole picture looks like, the data that we've reported out and discussed today is largely related to compensated claims. We know that there's a lot more information out there in the system that would help to inform how the system impacts violence in the workplace.

Some of that might lead to better nationwide strategies around providing people with social supports and family supports, as well as accessing and navigating the system, all of which contribute to the stressors that family members and patients are experiencing.

Another opportunity is that of creating national standards around the built environment specific to facilities by looking at those standards and expanding them or improving them around dementia care to make them dementia friendly.

Last, we would also support the ideas that have already been mentioned around human resources recruitment and retention. Those are challenges that we consistently see in British Columbia as well.

[The Chair, Liberal, Bill Casey]

Now we'll go to Mr. Ouellette.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Thank you very much for coming, everyone.

I want to talk a bit more about dementia and dementia-friendly environments, which you talked about, Jennifer. How much research has actually been done on how the physical layout impacts whether there is violence by patients who have dementia and on improving safety? Is there a lot of research on that?

[Jennifer Lyle]

It's a bit of a tricky one. To answer your question on research into how the built environment impacts the behaviour of folks with dementia, that's been done. There's a growing body of it out there that's currently available and looks at the intersection between behaviour and the built environment.

Where it gets a bit trickier—and I think you've actually hit on a weakness that we see across the board—is that there's a lack of research that makes that second leap, looking towards the tie-back with built environment and the actual hard data on workplace injury rates. We can make a secondary leap by saying that fewer responsive behaviours equal fewer incidents of violence, but actually making that direct leap is a bit tricky.

I would say that we can have the same problem when we run into the research looking at models of care. There's a growing body of research that looks at how different models of care impact the quality of the client or patient experience, but how that impacts the workplace safety of the care providers is often a component that's missing. This is actually a piece that we recently went into provincially—just because the body of research is a bit thin on that side—in looking at whether or not the person-centred care model, which is associated with stronger quality of care outcomes for dementia care clients, actually translates into fewer incidents of violence.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

However, a lot of the old facilities, for instance, have very long corridors, and there's a little nerve centre down at the far end, which means it is very difficult sometimes in these long-term care facilities to get help. Is that a model that is encouraged, or is that just because the layout has just been like that and we haven't really built anything different?

[Jennifer Lyle]

It's definitely the latter; it's more a historical precedent. If you look at the best practices right now, there are some great organizations in B.C. that have incorporated good design. You don't see those long dead-end hallways. You don't see walking paths that terminate at a door. You do see things like visual way-finding cues like memento boxes outside of people's rooms. You see doors painted different colours so a resident knows which room is theirs. You see walking paths. You see access to activities that you can do spontaneously to combat issues of boredom.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

How much of this information is shared with all health care providers in these long-term care facilities? I've been in a number in Winnipeg Centre and I didn't see coloured doors. I saw everything had white walls and maybe a kind of greenish hue on the doors. How much of this information about best practices is shared among health care facilities?

[Jennifer Lyle]

I can't necessarily speak to all of the provinces. I know that in B.C. a number of initiatives are under way. Creating dementia-friendly care homes is one initiative. It's part of a partnership between B.C. Care, SFU, and I'm forgetting another partner in there, who are looking at that specific translation. That is under way. I think the big challenge people run into is that at the end of the day, infrastructure upgrades cost money and care homes more often than not struggle with that funding. Again I point to the investing in Canada plan, under which it was great to see the investments in the community care piece, but there wasn't anything for care home infrastructure. Again, to put it in crass terms, if you don't have the dollars to make those changes, it's really hard to make it happen.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Thank you very much.

Mr. Riker, I have a few questions for you. You talked a little bit about safety. It was kind of interesting. I haven't heard that conversation very much around this table very much. I was just wondering if you could talk a little bit more about the use of technology not on the outside, perhaps, but even with patients. For instance, is it possible to be able to predict a behaviour of people with dementia in various situations, to monitor blood pressure in real time and to say, oh, something's coming, and maybe we should change what we're doing in this environment in order to keep a reaction lower. Is that possible?

[William Riker Jr.]

Yes, you actually have a great point there. There is a breadth of technology available out there for identifying and predicting behaviours. It spans the range from facial recognition to identify certain persons of interest all the way through to seeing behavioural changes—and then from a causality perspective saying, okay, someone is clearly upset, and what's the potential that that person will escalate to another level of violence or anger? That is something that can be be worked into a facility's security or communication system. From an ease-of-use potential opportunity, here is the training that would be proposed, and then of course there would be any kind of alert badges or indicators that staff could have to ask for help when they see something occurring.