Health Committee on May 13th, 2020

[Dr. Pat Armstrong]

In terms of the federal role, I think they need to put in money, but it needs to be money with conditions. I think it could be in a parallel piece of legislation to the Canada Health Act. I don't want to open the Canada Health Act. I think the Canada Health Act is a brilliant piece of legislation, because it sets out the principles while allowing each jurisdiction to adapt those principles within their own jurisdiction so that it gives us both.

The principles are somewhat different, I think, in terms of long-term care, and we have a different kind of labour force. I certainly think it needs to include a national labour force strategy, but that isn't the labour force that's addressed in the Canada Health Act. The principles talk about reasonable compensation, but they don't address some of the other issues that have been raised today and that have been raised over and over again. We have enough information and evidence now that we could set out those principles, especially if we consult the kinds of people we've been hearing should be consulted today.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you, Dr. Armstrong.

I'll try to get a question in here for Ms. Mackenzie.

A few weeks back, I read that B.C. had announced more supports for seniors and caregivers during COVID-19, in addition to the funding provided by the feds through the local United Way organizations and the new horizons for seniors program we announced in early April. Now that the provincial funding has been out there for about three weeks, maybe close to a month, I'm interested in your perspective. What are you hearing as to how this has benefited seniors and whether it has been difficult for them to access their support?

This could be something I could easily ask people from other provinces as well, in terms of provincial and federal measures, but in this case, with respect to the provincial measures, I'm curious as to what you're hearing on the ground.

[Isobel Mackenzie]

The funding that you're speaking of went to the bc211 program over the last seven weeks. That's where I was highlighting those sorts of services. What it showed us was that number one is to make it easy to get the service. That was the beauty of the 211 number. There are not a lot of digits to remember. Number two is to harness the energy and capacity of volunteers who want to help. That was a key part of the program. Get them connected with those seniors and respond quickly to things like “I need groceries”, “I need meals delivered”, “I'm getting lonely” or “I need somebody to talk to.” From the perspective of the issues created by COVID-19, I think that was an effective way. It got out there fast.

I give full credit to the B.C. provincial government for doing that and partnering with the United Way and bc211, which is interlinked with the United Way, a network across the country. I think the federal government signalled that as well with what they did. I think it can be highly effective. It certainly has connected a lot of seniors with services they needed, not medical services but important ones.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thank you.

[The Chair, Liberal, Ron McKinnon]

We now go to Mr. Thériault for six minutes, please.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for their insightful comments. We have to find solutions. My first question is for Mr. Brunet.

Your opening statement was very compelling. You're known for your anything but complacent attitude. It's a quality I appreciate.

On March 13, Quebec was the first to declare a public health emergency, when it had just 17 cases and no deaths. Two months later, the situation is this: the number of cases will surpass 40,000 by tomorrow and more than 3,220 people have died.

Most of the witnesses we've heard from—even some today—have told us that, early on, the weaknesses and vulnerabilities of the health care system exacerbated the rampant spread of the virus. They cited underfunding of the system as the main reason.

Many would prefer to standardize the rules from coast to coast to coast, but health care is the domain of the provinces and Quebec. You had reservations about nationalizing CHSLDs, saying you preferred that Quebec pass legislation requiring a minimum level of care and services in CHSLDs and retirement homes, whether private or public. I'd like you to elaborate on that.

Tell us, if you would, what the parameters or key pillars of that legislation should be.

[Paul G. Brunet]

Thank you.

You're right. Over the past 45 years, we've contributed to dozens of parliamentary committees, public consultations and, for the past 35 years, public inquiries, mainly in the area of long-term care. In terms of results, however, things haven't changed.

Long-term care is provided every single day. People need to know that these facilities offer a good standard of living. That means ensuring measures are tailored to the reality on the ground. After 25 years as a health care advocate and given what I've seen, I respectfully submit that it doesn't matter whether an institution is public or private, despite what all the scientific studies say.

I've seen miracles and horror stories in public and private institutions alike. The difference lies in the men and women who run the establishments and their ability to show leadership in bringing together residents, families, unions and health care professionals. When all of them are at the table, the difference is clear. The low number of complaints these establishments receive has shown me that it doesn't matter whether they are public or private; the men and women running them and their ability to work alongside staff are what really matter. That's the empirical evidence I've gathered after being in the field 25 years and seeing hundreds of cases.

That's what I've experienced, what I've witnessed and what I think. Unlike others, I don't claim that it's based on scientific research.

[Luc Thériault, Bloc, Montcalm, QC]

I'm more interested in the bill. In an April 25 interview, you said you had put forward a bill. I'd like to know a bit about the framework and the way it could contribute to the solution, especially in Quebec.

[Paul G. Brunet]

We've actually been documenting everything for 20 years: how to run establishments, manage people, supervise staff and so on. Staffing comes up a lot, but supervision is really important. Henry Mintzberg, himself, says that people with little training need supervision in order to do their jobs. Staff members need encouragement, guidance and direction in carrying out their duties.

The idea behind the bill is to introduce a minimum level of care and services, which would be based on the type of establishment where people were admitted. No one could operate a public or private seniors' residence that provided care and services below the prescribed standard. They wouldn't be allowed to; it would be prohibited. What's more, the institution should be subject to oversight.

How many times have we told the government that it's delusional to think everything will be fine if the necessary oversight and checks aren't performed, no matter how many measures it implements in the health care system? People are granted licences to operate these public and private establishments, but terrible things happen and, in some cases, people who don't know what they're doing make their way in.

[Luc Thériault, Bloc, Montcalm, QC]

From the outset, the key has to be adequate funding. Every year that health transfers are cut from 6% to 3%, it results in a huge shortfall. The various networks try to make do with what they have.

The current pandemic is a public health crisis. It has to do with health. Places that provide care are seriously affected. For every $100 the federal government spent on programming to support the economy, it spent just 33¢ on health care to support our so-called guardian angels.

Right there, there's room for improvement.

[Paul G. Brunet]

Yes, certainly.

I recently had lunch with former Quebec premier Philippe Couillard. He told me that, after announcing a $20-million investment in his area for CLSCs, CHSLDs and home care services, he then went to a CLSC or a CHSLD and asked whether the money had arrived. He was told that a few thousand dollars had finally arrived on the ground. There's a great deal of bureaucracy, and this issue is even worse at the federal level, unfortunately. As a result of many issues, this money doesn't really benefit the employees on the ground.

Granby zoo employees earn $16 an hour when they first start working. We earn $12 an hour in a number of places. Could we at least be paid the same as the people who take care of animals? Sorry for sounding so silly, but we need to use some shocking examples to make the authorities think.

I understand your perspective, and we have the same issue in Quebec. However, at the federal level, things are even worse, because of the bureaucracy.

[Luc Thériault, Bloc, Montcalm, QC]

You're saying that we must inject money into front-line services rather than trying to set up programs across the country that will inevitably involve an administrative drain. In terms of monitoring, there are already many health department employees who aren't on the front lines and who must be paid.

[Paul G. Brunet]

Accreditation Canada conducts monitoring and provides accreditation to care facilities in Quebec and across Canada. However, these people won't eat what we're eating on the ground, won't smell what we're smelling and won't hear what we're hearing. Accreditation Canada doesn't do this.

In 2014, Liberal minister Dominique Vien established certifications for seniors' residences that met the standards. These residences were told that they would be accredited, but that if they failed to comply with the accreditation requirements afterwards, they would be deluding themselves. Lastly, in Quebec, we have departmental visits carried out by volunteers. As a result of former minister Barrette's reform, the opportunity to talk to people in the units has been greatly restricted.

Unfortunately, three things are used to monitor and check what's being done, and this is having very little effect. It's sad, but the system has been bureaucratized and not much has been done to improve the situation on the ground. If we don't eat what we serve people, the reason is that the product isn't good.

[Luc Thériault, Bloc, Montcalm, QC]

How do you think that we could—

[The Chair, Liberal, Ron McKinnon]

Mr. Thériault, I think you're done. I lost track of the time, but I think I gave you extra.

[Luc Thériault, Bloc, Montcalm, QC]

I found that quite nice, although unusual, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

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

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for being here.

Dr. Armstrong, you recently co-authored a report entitled “Re-imagining Long-term Residential Care in the Covid-19 Crisis”. It recommended stopping privatization and ensuring non-profit ownership of long-term care facilities.

Can you outline for us why you made those recommendations?

[Dr. Pat Armstrong]

I think there's research indicating patterns. Of course, there are some good for-profit homes. There are some bad municipal homes even, or not-for-profit homes, but the pattern is clear that there tends to be lower staffing in for-profit. There tends to be more reliance on part-time and casual employees in for-profit. There are patterns of more ulcers, more transfers to hospitals and more falls. There is a whole host of patterns that are much more common in for-profit homes than in non-profit homes.

I should be clear that we said “non-profit”. That isn't talking about the government taking over all the homes. I'm talking about taking the profit out of care. I don't see any reason to put the money into profit when we're not particularly getting a benefit out of it, and in fact it may be the reverse. Why isn't that money going to care? It's—

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Mackenzie, I'll turn to you on the same subject. You put out a February 20 report that found that the province's for-profit long-term-care home operators, while making profits, are shortchanging seniors of more than 200,000 funded care hours per year. Your report found that non-profit operators spent $10,000 more per resident per year than for-profit operators and delivered 80,000 additional hours of care beyond what they were funded to provide. It also found that, under the current funding scheme, for-profit operators spent far less on care aides and other front-line staff than their not-for-profit counterparts.

Would you also endorse Dr. Armstrong's view that we should be putting more money into the non-profit sector as opposed to the for-profit private ones?

[Isobel Mackenzie]

I think what the report demonstrated was that we don't have the proper financial incentives or oversight. You could argue, Mr. Davies, that, if we get it aligned, then being a for-profit operator will be of marginal value.

I can't speak for Ontario. I know Jodi was talking about the way money is managed. That's not the way it's done here in British Columbia. We give a lump sum payment to a contracted provider, and we come up with that lump sum by saying you should spend this much on this, that and the next thing. They do provide statements that say, “Here is what we spent on this, that and the next thing”, and we look at that, but we don't do anything with it.

The classic example is around wages. In British Columbia, all care-home operators are funded to provide industry-standard wage levels, so they are provided enough to pay care aides at the industry standard. Whatever they pay them less than that, they get to keep. That's the problem.

There are things we could do quickly, and what we could remedy quickly is certainly the money we're giving you to pay wages for—we call them care aides in British Columbia—personal support workers, whatever. You have to pay that, and if you don't pay it, you have to give it back. What we pay you for the nurse, you have to pay, and if you don't, you have to give it back. We take away the incentive, and by that we take away the profit. We take away the motive for making a profit.

There was a very clear pattern. As Pat said, it's a pattern, which means there are exceptions to the pattern, so yes, there will be good performers or, as the economists would say, good actors, in the private field, and there will be bad actors in the not-for-profits.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm sorry, I have limited time, so just quickly, Ms. Mackenzie, you're obviously British Columbia's seniors advocate. I note that Canada does not have a federal or national seniors advocate. Would that be something you'd recommend the federal government to establish?

[Isobel Mackenzie]

They can certainly look at it. I think the challenge here that's been identified is a number of these issues are provincial, so what is the role of the federal government around this? Prescriptiveness is going to be limited, but leadership is going to be able to be there. The federal government does give money to provinces and can put strings on that money, so those are levers. They are public policy levers available to the federal government, even within the confines of the Constitution and the BNA Act.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. You anticipated where I was going to go, so I'll go back to you, Dr. Armstrong.

There is this question of what the federal role is. Some of us are calling for binding national standards with respect to minimum standards of care, ratios, etc. You've indicated that one particular model is a piece of legislation analogous to the Canada Health Act, but not the Canada Health Act, I understand. What's your view on what the federal government should do in terms of long-term care?

[Dr. Pat Armstrong]

We set that out in the report, I think, to some extent. It certainly should establish the conditions of work, which would include things like staffing, wages and benefits. Obviously, you don't set out the specifics, but you set out the standards and how you have to, for example, keep to the industry standards in those areas. Minimum staffing levels are absolutely critical and so is some notion about the appropriateness of the staffing levels, even if those are minimum. I always worry that the minimums will become maximums. I think that—