Health Committee on May 13th, 2020

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Armstrong, could I just interrupt and guide you to one particular aspect? I'm curious about your views on the Canada Health Act, which has five principles, including universal access and public administration. Would you take those concepts and advise that they be applied in terms of long-term care?

[Dr. Pat Armstrong]

Yes. If we understand access, as it says in the Canada Health Act, there's a broader definition of access of not simply financial, although financial is there, but it also includes actually having the facilities there. We haven't pursued that a lot.

Yes, I would certainly include access, and perhaps uniform terms and conditions, and comprehensive, which is interesting. It's the only place in the Canada Health Act where they get detailed and talk about what should be included. There's a charge for accommodation in every jurisdiction in Canada, so we exclude the food, and in some places the laundry, and we include some of those things that we talked about in terms of a plan in Quebec, because I would argue that food and laundry are absolutely critical to care.

We have to talk about what would be included in those services as well.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

That ends round one. We'll now start round two, with Mr. Jeneroux.

Mr. Jeneroux, please go ahead. You have five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thank you to the witnesses for being here today.

I want to talk a bit about some of what Ms. Mackenzie and Ms. Lennox touched on with regard to the degree to which investments will be impacted in the senior and retired population. Obviously the government has come forward with a $300 credit, if you will, but I still get a number of emails on that long-term impact, what it would really mean for these individuals.

Ms. Lennox, since it has been about two hours since your initial presentation, maybe I'll allow you to kick us off and talk about some of that, and then I'll ask Ms. Mackenzie to also provide some feedback.

Maybe we'll start with Ms. Mackenzie, since it looks as though Ms. Lennox might not be there.

[Isobel Mackenzie]

Okay. Let me know when her microphone unmutes and I'll stop talking.

That is the other shoe that really hasn't dropped yet. We don't know what the impact is going to be until we see what's really going to happen to the markets over time. You can't really tell now. It's going to be a year from now.

When we look at where seniors are getting their income, among seniors who have income in addition to their basic government pensions, a lot of them are getting dividend income, so what's the impact of that? What is going to be the impact on some private pension plans? Are they going to reduce the pensions because their investments have made them unable to make those payouts? We don't know that yet, but I think we have to remember that this is still coming. You've heard me talk a lot about poverty amongst seniors, but there's also a group of middle-class seniors, and we need them to have an income because they're also paying for a lot of their health care needs.

I agree with Pat. The Canada Health Act is great, and has some challenges.

A lot of health services that probably no one on this Zoom call even thinks about because we can do them all ourselves become health services for people in the community and they have to pay people to help them. They need money to do that, so we can't forget that piece of it. Certainly initiatives around reducing the withdrawal amounts for RRIFs are all helpful for now, and we'll have to wait and see what happens to the markets.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Is there anything specific, then?

[The Chair, Liberal, Ron McKinnon]

Excuse me, Matt.

Ms. Lennox has been asked to drop and rejoin, so if you want to ask her a question, we'll suspend for a minute or two and let that happen.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

If it's okay, we can keep going. We don't have to—

[The Chair, Liberal, Ron McKinnon]

That's fair enough; as you please.

Go ahead.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Ms. Mackenzie, is there any work being done in terms of what that looks like, what the ask will be to help protect these seniors?

I think of the ones who have emailed me. This wasn't part of their plan for retirement.

I'm trying to find what that ask will be. It's fair to say we'll look at what the markets do, but if there's an ask in place, I'd love for us to be able to consider that also as this committee continues.

[Isobel Mackenzie]

I think the ask would be to look at the overall economic impact on a group of people who have now lost the ability to in any way change the trajectory of their income. They have retired. They can't add to their savings any longer. They are drawing on their savings.

This is not the finance committee, but I don't know what markets are going to look like in a year from now. They might completely recover. You've heard this: Is it a V-, U- or L-shaped recovery? Those provide very different outcomes and degree of impact.

Making sure that people don't make rash decisions right now is important, and look at measures that allow people to not have to cash in, if they aren't required to, because markets are exceptionally low. Also, allowing for some capacity of capital withdrawals to shore up some expenses during this time might also be helpful. I think there's another side to this, and we'll see what it looks like and where we're at when the markets settle.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Jeneroux.

We'll go now to Dr. Powlowski for five minutes, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you.

I read somewhere someone describing a busy neighbourhood bar—although I miss such things—in terms of a place for transmission of communicable disease as being something akin to a wet market in China. There are different kinds of chronic care homes, and I would guess that, depending on the type of home, some have had more problems than others. Probably some homes, in terms of spread of infectious diseases, might also be akin to a wet market in China.

I think Ms. Hall outlined some of those things: a lot of homes where there are four people to a room, narrow halls and one cafeteria. I might add a few other things, such as lower-income residents, more seniors who are more elderly with more chronic care homes, as well as fewer staff, and those are the ones where coronavirus has hit and really spread like wildfire. Am I right or wrong in saying that?

Ms. Hall, maybe I could ask you.

[Jodi Hall]

Yes, those are absolutely factors. As I had outlined earlier in terms of the overall condition of the infrastructure in homes, especially older facilities, they were designed for a different generation, a different type of individual who required care. When we look to who we are caring for today, these are people with much more complex conditions than when these homes would have been built 20 to 30 years ago. The room configuration, the overall design and layout of the building, does put people closer together. When we think about things such as isolation and cohort planning, those become very significant factors in the overall prevention efforts against COVID.

We also have to remember that from the beginning of this outbreak to where we are today, we have learned a tremendous amount, especially as it relates to asymptomatic transmission. When we look at the homes that have experienced the most significant outbreaks, that was a critical factor as well, as staff introduced that into the homes and didn't realize the extent of their illness.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Ms. Hall, I want to continue on with you, since you work with chronic care homes in general.

On April 13, I think the Public Health Agency of Canada came out with recommendations as to safety standards, public health measures to protect the elderly in chronic care homes. Quebec declared a state of emergency on March 13. Certainly it was mid to late March when we started to really implement those social distancing programs.

Before the Public Health Agency of Canada came out with those standards on April 13, what was in place? Did the provinces have safety measures, and were they being implemented in the homes before April 13?

[Jodi Hall]

I think that everyone became extremely aware of the situation in early March. In individual care homes and certainly with colleagues of mine across the country, the discussions were very active and robust as we worked to see what was happening internationally and were starting to see the cases pop up in our own country.

There have been many examples in case studies that we were taking a look at and trying to share amongst ourselves as to the strategies that were needed going forward. We also looked to the provincial governments which were starting to take action. That happened at different rates in different provinces, and that included when access to additional PPE and additional guidance from the provincial public health departments were made available, so there was a bit of a range of time. Early access to appropriate personal protective equipment, better information, key information about asymptomatic transmission, in particular, as the symptom list began to grow were all factors for us.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Okay. I want to get one more quick question in.

I think you said that when it came to the worst homes, you couldn't implement the recommendations by the Public Health Agency of Canada to protect the elderly in chronic care homes. Did I hear you right? It was things like requiring isolation when all rooms contained up to four people. Did I hear correctly that some of these recommendations were unrealistic and couldn't be implemented in some homes?

[Jodi Hall]

That's correct. Our point was that there was a disconnect between some of the recommendations that were being made when you compared that to the reality on the ground and what could actually be operationalized.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Now, did Public Health—

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to Dr. Kitchen.

Dr. Kitchen, go ahead for five minutes, please.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you everybody for being here and for your presentations. It's greatly appreciated.

It was so nice to hear many of you talk about breaking things down with respect to long-term care. I think a lot of Canadians are missing that fact. They lump everything together when they don't understand all the factors. I think, Dr. Armstrong, you said it really clearly when you talked about appropriate training with regard to nursing, cleaning, laundry, diets, volunteers, support staff, families. Those things have to be looked at, so I appreciate that.

Ms. Mackenzie, you mentioned the outpouring of support we've had for seniors because of this crisis. I think it's fantastic that we see that.

I'm wondering if you're hearing that families are also stepping up to help out besides the volunteers who are helping out for other people. Are families stepping up? Do you anticipate that help being there when this crisis is over?

[Isobel Mackenzie]

I hope it's there. The short answer is that families are absolutely stepping up. We saw that initially. My office hears from folks all the time about their sons, their daughters, their grandchildren making sure they get the meals, etc. That is the silver lining in all of this. When the chips are down, Canadians have shown overwhelmingly they really care about their seniors. We have to build on that and leverage that now to get the needed improvements that a number of people have spoken about.

I think that we will sustain this. In long-term care certainly we've seen families express both their understanding of why they can't visit and their frustration that they can't visit. I think that's also reassuring in the sense that there are a lot of family members out there visiting their loved ones in care homes. We also hear about how they visit other people in the care homes who don't have family members living in the same city.

I am hoping that we will sustain this when we are through this pandemic. The phrase I use is “my grandmother, my mother, myself”. People can see that they do not want that for their loved ones, they don't want that for themselves, and that if the will is there, the change will happen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you for that.

Ms. Hall, you talked about two things that you left us with. One was infrastructure and the other was health and human resources and how challenging that is, in particular when we're dealing with multiple complex situations as we see with seniors. When I did my practice, basically the average lifespan for a male was 78 and for females it was 80, and now we see it is much longer. Now we're seeing issues of dementia. We're seeing Alzheimer's, anxiety, bipolar issues happening more and more as we age.

You covered a lot about the training for people to actually deal with that when you talked about the tight regulations needed to make certain that they're being followed, and they are being followed. I'm just wondering if I could hear your comments. Last week the Minister of Employment, Workforce Development and Disability Inclusion stated that, with respect to providing assistance in long-term care homes during the pandemic, “We may create...some kind of training so that people who aren't in these jobs now—maybe people who are at home and unemployed—can take a shortened version of this training and be able to perform the less complicated tasks that are required at these homes”.

I'm wondering how you see that impacting on all of those aspects that you talked about.