Health Committee on May 5th, 2020

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair, and I thank all of our witnesses for giving us the opportunity to hear directly from them during this busy and difficult time.

I want to start by asking questions of the Canadian Manufacturers & Exporters.

In my riding of Newmarket—Aurora, Magna International is one of the many Canadian businesses that have recently answered the government's industry mobilization call to action to retool their manufacturing and to help in this fight against COVID-19.

Has your association received many questions about this call to action, and what types of businesses have been able to quickly retool their manufacturing lines in this short period of time?

[Mathew Wilson]

We've been working on this issue. Mr. Laskowski mentioned earlier the minister's advisory council on the pandemic responses from supply chains. At CME we've actually been working on a similar committee that predates this by years. We've been sitting on this committee and trying to provide information and advice to the government on how to stand up the manufacturing supply chain from the very early stages of this crisis. We've been working on understanding what the needs are of governments, of the health care system and of others, and then trying to help our members retool wherever possible.

A company like Magna that retools has the size, scope and capacity to be able to do those types of things. Bombardier has done similar things, as have Linamar, GE and GM. A lot of companies have done a lot of great things across the country.

The problem tends to be with smaller companies. The big companies don't know who makes the subcomponent parts, and are trying to connect to other companies, and so we would help a company like Magna. In the case of Magna, I'm not sure we did specifically, but in cases like that, we've helped companies similar to Magna try to find subsuppliers and some of the components that are necessary to make the finished products. Ventilators are complex components containing probably thousands of different pieces. That's where we play a role, behind the scenes, trying to connect together companies that make those products.

Companies from across the country have been involved in this. One of our member companies, Dynamic Air Shelters from Mount Pearl just outside of St. John's, is making shelters. There's Stanfield's in Nova Scotia which is making gowns. It used to make underwear, socks and things like that. Bombardier is making face shields, and we have hockey equipment manufacturers making them as well. A wide variety of companies have switched production.

I know that in Ontario there are at least 350 companies. There's a group called the Trillium Manufacturing Network that has tracked that. If Ontario has 350, across the country there have to be thousands of companies that have switched their production into making this type of equipment.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

What are your thoughts on the federal government's support of these manufacturers to date?

[Mathew Wilson]

The support, actually, has been fantastic. There are holes in some of the support programs, but very early on we called for things like the wage subsidy program because we saw the necessity of keeping people on the payroll rather than letting them go when there was a massive decline. Keeping them on the payroll allows them to switch production and make other things, but it also allows them to quickly restart as the economy restarts. Things like the wage subsidy, the loan guarantees, tax deferrals, anything that kept cash in the pockets of the companies, was essential, because the liquidity was everything.

Generally speaking, the partnership with the federal government has been outstanding. There are some problems with some of the programs, but generally speaking, it has been very good.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

I'm concerned about the way we address or protect ourselves against foreign supply chains and about our dependency on foreign supply chains. Do you have any thoughts on how we might take steps to protect ourselves against that reliance? One example that rings very well with me is the fact that there were some masks stopped at the border. How do we protect ourselves against that type of risk?

[Mathew Wilson]

Well, I guess it was a good thing that they were stopped and caught, right? We have regulatory standards for a reason. What I was worried about, actually, is that the regulatory standards would be loosened in times when people most needed protection and that these things would come into the country. That didn't happen, which was good.

This isn't about having our own domestic supply chain. I think the conversations going down this road are a bit dangerous. Canada long ago gave up the idea that we are our own unique economy. Starting with the Auto Pact back in the 1960s, we started integrating with other economies. It's been a huge advantage to our economy overall—all that trade that Mr. Laskowski was talking about—and that's because of trade.

I think the trick, though, is to make sure we understand where those supply chains are, who manufactures what and where the weakness and vulnerabilities are in the supply chains. That work really hasn't been done all that well, not at all. When you find the weaknesses, then you can identify them. There need to be duplicate supplies. You need to fill those holes by understanding those gaps, right? That really is the trick, and right now we don't understand that.

The other thing is that we didn't really do a good job following 9/11, when initial stores were created to augment PPE, for example, N95 masks. We originally had pandemic planning in place following 9/11 and SARS. Most of those stores were never maintained. That was actually the bigger problem. Governments didn't maintain the stores to keep them updated, and that was right across the country. It's more a provincial issue than a federal issue. That was a bigger problem, probably, than the foreign supply chains.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

I'd like to—

[The Chair, Liberal, Marcus Powlowski]

Thank you, Mr. Van Bynen.

Mr. Thériault, please go ahead for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair. I hope everyone can hear me. It's a bit difficult today.

I'd like to start by thanking all of the witnesses.

Your testimony has been enlightening and we will surely rely on your comments as we look for measures to ensure that this nightmare never happens again, especially in our long-term care homes, Ms. Vyce.

A common thread throughout the testimony we've heard so far is that the pandemic is a circumstantial issue, whereas the increased vulnerability of our health care systems is a structural and systemic one. Since the mid-1990s, successive federal governments have offloaded their deficits to the provinces and Quebec. Health transfers have slashed drastically.

When a pandemic like this one comes up, we're hit full-on by the vulnerability of our health care systems, and we can see the unacceptable contradictions experienced by those using the system.

How many of your members were sent into combat without any PPE, and how many of them have been infected to date? In Quebec, 80% to 87% of all deaths are connected to long-term care homes.

Do you have figures regarding your members?

[Amanda Vyce]

I'll go back to the question posed earlier by Mr. Doherty. He was asking a similar question regarding the number of members who have lacked sufficient or proper access to needed PPE in long-term care homes. The survey conducted in Manitoba included both long-term care and home care workers. That survey was conducted in early April.

The Public Health Agency of Canada released its guidance policy on infection prevention and control on April 11. It would be interesting for us to survey our members to determine more accurately if access to PPE for our members increased following the release of those guidelines, which mandated that homes should be providing workers in the sector with adequate and proper PPE. At this point in time, unfortunately I'm not able to provide an exact figure on the number of workers who continued to lack proper access to PPE, but I certainly agree that this data would be very helpful for us in determining how we can prevent a situation like this from happening again.

One issue that we do know of, which has also has been very prominent, is that even in homes where staff have been provided with a limited amount of PPE, many staff members have indicated they are not receiving proper training on how to use the PPE or they may not have been properly fitted for an N95 respirator.

[Luc Thériault, Bloc, Montcalm, QC]

Let's talk about training.

There was a call for volunteers to help employees and workers at long-term care homes. I don't know if you heard about this, but apparently people were showing up and had to immediately become trained workers. They were assigned to duties identical to those of workers with years of experience.

Have you heard about problems with a lack of training for volunteers? Do you think that removing families and caregivers from long-term care homes is something we should do again next time?

[Amanda Vyce]

In response to your first question with respect to training, I believe that in Quebec, and definitely in Ontario, the government issued an order that allowed long-term care homes to essentially hire people off the street to fill staffing gaps in homes across the province. At this point in time, I don't know how many people have been hired through these avenues. These folks have been hired off the street with no previous experience or training related to work in the long-term care sector.

When the order was issued, our alarm bells were ringing very loudly. This is extremely concerning because the work of care aides is highly skilled. You're working with a population where many individuals have dementia. They can't communicate effectively what their needs are. You have individuals who have difficulty swallowing and need assistance with feeding. You need to know how to transfer individuals from a bed or wheelchair into a bathtub using a mechanical lift or from a chair into a bed or vice versa. These are highly skilled tasks, and the thought that someone could be hired off the street or simply volunteer their services, as altruistic and well-intended as they may be.... The risk to quality of care to patients is very high and very alarming.

With respect—

[The Chair, Liberal, Marcus Powlowski]

Please wrap up quickly.

[Amanda Vyce]

With respect to the second question, which is related to whether families should be removing their loved ones from a long-term care home, for most people this is not a realistic option, because they don't have the skills required to provide the necessary care for their family member.

[The Chair, Liberal, Marcus Powlowski]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, before you start my time, would you please clarify whether Ms. Black is available to answer questions?

[The Chair, Liberal, Marcus Powlowski]

Ms. Black has a new headset, I understand. We can always try.

Please go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. I'll address my first question, then, to Ms. Vyce.

You commented, Ms. Vyce, that the benchmark quality for long-term care is 4.1 hours of hands-on care per resident per day. If I understand your testimony correctly, no provinces or territories are meeting that standard. Am I correct in that?

[Amanda Vyce]

That is correct. Some provinces have no legislation regarding standardized hours of care. Some provinces, including your own province of B.C., have a guideline that homes can aspire to. Other homes do have a legislated minimum requirement, which ranges from 1.9 to 3.8 hours across Canada, but no province is meeting the recommended standard of 4.1 hours.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm wondering if you have the current average number of hours of hands-on care that is being delivered. Do you have an estimate of that?

[Amanda Vyce]

This question is actually extremely difficult to answer. The answer would vary by province.

One of the reasons it is so difficult to answer is that some provinces will calculate hours of care based on funded hours of care. Other provinces will calculate hours of care and include in that calculation the time that is not related to directly worked hands-on care. The time may include staff vacation time or paid leave, so it doesn't reflect work hours.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you give us a ballpark idea of what percentage of workers in long-term care facilities in Canada would be working under a collective agreement?

[Amanda Vyce]

That is a very good question. I do not have an answer to that question, but I will be happy to look it up and send it to you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

You painted, quite frankly, a shocking picture, which I think is one that Canadians have recently become more aware of. The idea of picturing our parents, grandparents and great-grandparents, seniors in homes, who are skipping their weekly bath.... That these folks are being left in soiled clothing for hours and not getting the attention they need I think is really appalling.

I know that recently the federal government published some non-binding guidelines to reduce the spread of infections in these facilities. Can you basically describe those and let us know if you feel they're adequate and should be made permanent?

[Amanda Vyce]

There are two parts to that question.

When the federal government's PHAC guidelines were released, I gave them a quick review. Most of the key guidelines that were recommended were measures that all provinces essentially had already undertaken, and this included limiting access by visitors to facilities and ensuring that PPE was available in homes. During any kind of outbreak, those are typical measures that a long-term care home would implement. They are things that will need to continue should a situation like this arise again, most certainly.

The other thing that some provinces have done—B.C., Alberta, Manitoba, Saskatchewan, Ontario and Newfoundland—is that they have implemented single work site orders. This limits workers in the long-term care sector to employment in only one long-term care home.

There are some employee groups that are excluded from these measures, and that would include some agency workers. This means that agency workers can still move between multiple sites, and also, hospital workers can. Some hospital workers are being redeployed to work in the long-term care sector. They can work a shift one day in the hospital, return to a long-term care home the next day, and then return to the hospital the next day. We're not—