Health Committee on May 13th, 2020

[The Chair, Liberal, Ron McKinnon]

I now call this meeting to order.

Welcome to meeting 20 of the House of Commons Standing Committee on Health. Pursuant to the orders of reference of April 11 and 20, 2020, the committee is meeting for the purpose of receiving evidence concerning matters related to the government's response to the COVID-19 pandemic.

In order to facilitate the work of of our interpreters and to ensure an orderly meeting, I would like to outline a few rules to follow.

First, interpretation in this video conference will work very much like it does in a regular committee meeting. You have the choice, at the bottom of your screen, of floor, English or French. If you will be speaking in both official languages, please ensure that the interpretation is listed as the language you will speak in before you start speaking. For example, if you're going to speak English, please switch to the English feed and then speak, and if you are going to speak French, switch to the French feed, and so forth. This will allow better sound quality for interpretation.

Before speaking, please wait until I recognize you by name. Once questioning starts, the witnesses can speak as appropriate. When you are ready to speak, click on the microphone icon to activate your mike. Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. I remind you that all comments by members and witnesses should be addressed through the chair.

When speaking, please speak slowly and clearly. When you are not speaking, your mike should be on mute. If you have earbuds with a microphone, please hold the microphone near your mouth when you are speaking. Should any technical challenges arise, please advise the chair or clerk immediately and the technical team will work to resolve them.

Before we get started, could everyone click on their screen in the top right-hand corner and ensure they are on gallery view? With this view you should be able to see all the participants in a grid-like fashion. It will ensure that all video participants can see one another.

I would now like to welcome our witnesses.

We have, from the Canadian Association of Retired Persons, Ms. Marissa Lennox, chief policy officer; from the Council of Senior Citizens' Organizations of British Columbia, Ms. Gudrun Langolf, the immediate past president; from the Conseil pour la protection des malades, Paul Brunet, president; from the Office of the Seniors Advocate of British Columbia, Isobel Mackenzie, seniors advocate; from the Canadian Association for Long Term Care, Jodi Hall, chair; and as individual, Pat Armstrong, distinguished research professor of sociology, York University.

We will begin with the Canadian Association of Retired Persons and the Council of Senior Citizens' Organizations of British Columbia. I understand that they will share the slot, with five minutes each.

Please go ahead, Ms. Lennox, and I'll signal you at the halfway mark.

[Marissa Lennox, Chief Policy Officer, Canadian Association of Retired Persons]

I'd like to thank all of you for having me here.

Ms. Hall, it's so nice to see you again. We spoke together in front of the HUMA committee.

CARP is a national, not-for-profit, non-partisan organization with 320,000 members who come from every province and territory across Canada. It's important to distinguish that while a lot of our members are retired and enjoy above-average education and income, an overwhelming majority consistently support that CARP represents the interests of all older Canadians across Canada. We believe all older adults deserve to live in dignity and with respect, regardless of income level, family support and health challenges.

It is with the following areas of health care that COVID-19 has undermined these fundamental principles of aging well and revealed a lack of planning and preparation that would secure the health and well-being of seniors during a pandemic.

The first and most obvious area is long-term care. If COVID has revealed anything, it has revealed that we warehouse seniors who are frail and very ill in unsafe situations that are underfunded and understaffed, including those who often have little or no certified training. We expect individuals and/or their families to pay a significant part of the privilege to be in those facilities. We placed both residents and staff at immense risk by not prioritizing the availability of PPE in long-term care soon enough. Too often, health system planning stops at the budget line of what government funds. We think it's time we reconsidered this during a pandemic.

It is unconscionable that of 5,000 deaths in Canada so far from COVID-19, 82% were among a population we are duty-bound to protect, and we failed. This is not the responsibility of the federal government alone, but it is the duty of the federal government to make sure that it doesn't happen again. If we've learned anything, it's that we didn't have a real plan in place for seniors in long-term care in this kind of pandemic. This is despite having advance warnings from other countries, seeing previous crises of similar scale like SARS and MERS, and having experience with seasonal influenza that spreads in these settings and claims seniors' lives annually. These are our most vulnerable members of society. We can and we must do better.

The second area is home care supports. CARP has long been examining the positive outcomes of other countries around the world who have met the challenges of long-term care with innovative solutions in leveraging home care options. Denmark, Norway and Finland are a few examples. In Canada it's reported that at least 20% of residents in long-term care could have their needs met at home.

That said, for those who are leveraging community-based home care supports with personal support aides, workers, and other in-home supports, several issues arose as a result of COVID-19. The first was the lack of PPE, which, along with the cross-utilization of personnel between retirement care homes and individuals requiring in-home support, contributed to a greater rate of community transmission in both settings. There was a clear lack of direction and guidance for caregivers and family supports, reinforcing the fact that in-home caregivers were not considered a part of the pandemic response.

The third issue I'd like to raise is the surgical backlogs. Many diagnostic, treatment and surgical activities have fallen victim to the focus on COVID-19. It includes a reluctance by Canadians to seek treatment for new non-COVID symptoms. This is not just a possibility; it is very much a reality today. CARP fears what this might mean for the health of our older populations who suffer from chronic conditions as well as such life-threatening disease conditions as cancer and cardiac care. Attention to this backlog, and conditions requiring such care, need to be prioritized.

If I have time, I'd like to draw your attention to two more things.

[The Chair, Liberal, Ron McKinnon]

You have a minute.

[Marissa Lennox]

Okay. I'll be quick.

The first area is protections for vaccine-preventable illnesses in older adults. As initial information suggested that COVID-19 was a precursor to an advanced pneumonia-type response, this has created serious concern within the older adult community. As PHAC previously reported, they anticipate that less than 10% of older adults are fully up to date on their vaccines. A follow-up survey of individuals shows that this number may actually be closer to 3%. Older adults do not have the same access to mass vaccination programs as those, for example, administered in schools to children.

Seniors, now more aware than ever, are hyperconcerned about other potential weakenings of their immune system, and want a fighting chance if they contract COVID-19. As CARP helps to communicate the importance of routine vaccination as an important part of the health care of an aging population, this also represents a great opportunity for the government to achieve maximum uptake on vaccines by older adults. This has been echoed by our 26 chapters across Canada in both rural and urban areas. CARP is looking for vaccines to be among the first inclusions in provincial or any potential national pharmacare formularies, with public funding and inclusion of the best-in-class vaccines to combat seasonal influenza, pneumonia and shingles in older adults.

[The Chair, Liberal, Ron McKinnon]

That's five minutes.

[Marissa Lennox]

Okay. I have one more sentence.

Especially as we prepare for a second wave of COVID-19, this will provide seniors with baseline protections.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to the Council of Senior Citizens Organizations of British Columbia.

Go ahead for five minutes, please.

[Gudrun Langolf, Past President, Council of Senior Citizens' Organizations of British Columbia]

We are part of the Council of Senior Citizens Organizations of B.C. We are the largest independent, volunteer-run and operated federation of seniors organizations in British Columbia. We have approximately 100,000 members and we come from all socio-economic backgrounds. We are very proud to be non-profit and to accept no commercial sponsorships, for example, donations from pharmaceutical companies or for-profit service providers.

As citizens and senior citizens, we are proud and extremely grateful that Canadians have responded to the call for action to reduce the transmission of the virus to others, and especially to vulnerable people like us, seniors. We thank you for all of your efforts in dealing with this unprecedented health crisis that caught many of us by surprise. The opportunity to let you know our thoughts and recommendations about long-term care in particular and seniors' health care in general is very welcome.

By the way, we appreciated your report on national pharmacare and are looking forward to some fruition from that.

Almost half of the COVID-19 related deaths in Canada have been of seniors living in institutions that masquerade as care homes. Appalling conditions that came dramatically to the public's attention existed for several shameful decades long before this pandemic. Much of public policy seems to be based on baked-in anti-age prejudice, much like racism or sexism. Combatting and eradicating discrimination based on age will take concentrated, systemic attention over time.

No seniors we know are looking forward to going into care. That's because there is a real reluctance to go into a warehouse to wait for the inevitable end, and everyone has heard a bad story or many more. In an unprecedented effort to consult with seniors in care, our British Columbia seniors advocate interviewed as many residents as possible. A large number of the interviewees were somewhat reluctant to voice specific complaints beyond the ones about regimented time, lack of showers and that sort of thing. As well, and very telling to us, was that a huge proportion of them confessed that they really did not want to be in there. The reports are available online, by the way, so I won't go into parsing the data.

Mistreatment and neglect of seniors represents a violation of the basic human right to security of the person. Allowing that discrimination to exist and flourish is a result of chronic underfunding of health care of seniors and other vulnerable people in Canada; accelerating privatization and commodification of seniors care; non-existent or ineffective government oversight of international investments in seniors care; no consistent, enforced national standards for care; and a lack of nationally coherent, shared vocabulary describing services provided or offered to seniors.

We call for the complete reform of long-term care provisions in Canada and for independent seniors’ organizations like ours to be consulted in the process. Our recommendations are as follows:

One, that the federal government immediately begin transformational reform of long-term care laws, regulations, practices, and funding levels. Two, that the federal government initiate a national inquiry into the ongoing privatization of seniors health care. Three, that seniors health care in long-term care as well as allied care facilities become part of the Canada Health Act. Four, that government ban international investment in private long-term care homes, and phase out private ownership of long-term care homes. Five, that federal and provincial governments ban the contracting out of essential services that protect the health and safety of seniors. Six, that national principles and standards be grounded in national and international human rights legislation and be developed specifically to protect the human rights of seniors in long-term care in Canada. Seven, that accountability and enforcement measures be developed based on national reporting systems for regular monitoring of the provision of seniors care, and that a Canadian seniors advocate be appointed to monitor the implementation of these changes and to report directly to government.

It is clear that no one with the power to make any changes listened to seniors themselves until now. If they did, there is no evidence that things have changed. The fact that almost half of all the deaths from COVID-19 in Canada are of institutionalized seniors is a wake-up call for Canadians.

[The Chair, Liberal, Ron McKinnon]

Could you wrap up, please?

[Gudrun Langolf]

Okay.

The conditions are not news. I’ve provided my speaker’s notes to the committee, and I urge you to look at those for the final comments.

Thank you very much.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Langolf.

We go now to the Conseil pour la protection des malades.

Mr. Brunet, please go ahead. You have 10 minutes.

[Paul G. Brunet, President, Conseil pour la protection des malades]

Good afternoon. My name is Paul Brunet, and I am the president of the Conseil pour la protection des malades, or CPM, which is now in its 46th year. The CPM is an independent not-for-profit charity and has submitted hundreds of briefs to Quebec's National Assembly and a few to House of Commons committees, as well. Our last brief was submitted in 2015, during the medical isotope crisis.

From the documents and information obtained, our analysis shows—

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, I'm not hearing any interpretation. I'm sorry. I'm on the appropriate interpretation channel, English, but I'm not hearing any interpretation.

[The Chair, Liberal, Ron McKinnon]

Perhaps you could toggle it to French, and then back to English, and see if that makes a difference.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, I'll try.

It's okay now.

[The Chair, Liberal, Ron McKinnon]

Okay, we're good to go.

Sorry, Mr. Brunet. Please carry on.

[Paul G. Brunet]

From the documents and information obtained, our analysis shows that the public health emergency in Quebec, which the Quebec government declared on March 13, 2020—nearly two months after the World Health Organization, or WHO, issued its first warning—did not include screening or testing in residential and long-term care centres, or CHSLDs, retirement homes or private seniors' homes.

However, by then, the WHO had already issued four warnings and Quebec's minister of health and social services had received a confidential memo on the concerns regarding seniors, not to mention the dozens of news reports around the world, including several in France and the United States, warning about the risks related to seniors and retirement homes.

The same documents and information obtained reveal that, prior to March 13, 2020, the health minister's own chief of staff, Mr. Valois, stated that, although preparations were beginning slowly, it wasn't an all-out effort to prepare for battle at that time.

With the public health director, Dr. Horacio Arruda, on vacation in Morocco for a few days in late February, and even the premier, Mr. Legault, on vacation until March 8, it would seem that, in Quebec at least, COVID-19 was not considered a national emergency requiring that senior patients be identified, tested, isolated and treated.

At least, that is what the lack of screening, isolation and treatment measures recommended by the WHO since the beginning of February, particularly with respect to seniors in CHSLDs and retirement homes, suggests.

It was only three months later, on April 7, 2020, after four WHO warnings and a private memo to the health minister on the hundreds of news reports around the world, that the Quebec government finally decided to do something about seniors in CHSLDs and retirement homes. In Quebec, 81% of COVID-19 fatalities were residents of CHSLDs or private retirement homes.

On April 7, the Quebec government issued a news release in which Premier François Legault stated that his priority was to protect seniors. On April 10, 2020, as though they had been living under a rock, Mr. Legault's staff learned that COVID-19 was spreading like wildfire among seniors in CHSLDs and retirement homes. That was nearly three months after the WHO's first warning, the last of which came on March 1.

Moreover, “Early reports suggest that illness severity is associated with age...and co-morbid disease.” This is from the March 1, 2020.

In our view, the Government of Canada and the authorities responsible for the administration and health and safety of Quebec's CHSLDs, in particular, failed shockingly in their duty to prepare for health crises like COVID-19. They delayed introducing measures to test and treat the residents and staff of CHSLDs, as the WHO had been recommending since February 5 and March 1, 2020.

It is our position that they have violated the basic rights of thousands of Canadians and Quebeckers, people who were entitled to the right to life, including the right to receive life-saving care, to have bedsores treated, to be properly nourished, to be able to drink when thirsty and to be hydrated. Emergency doctors in Quebec told us that patients were hospitalized, not because of COVID-19, but because of dehydration and malnutrition.

These are people who had the right to integrity of the person, the right not to be housed with infected people, and when severely disabled, the right not to be lifted or changed by often well-intentioned but incompetent staff or volunteers. They had the right to dignity, the right to be treated like a human being, the right not to be left wearing a soiled diaper for days, the right to have assistance to use the toilet, the right not to be abandoned and the right not to die alone without dignity.

The authorities responsible for Quebec's CHSLDs were not prepared for COVID-19, despite recommendations by the Public Health Agency of Canada and the public health protection branch within Quebec's ministry of health and social services dating back to 2013.

How could the Canadian and Quebec governments have left seniors in these conditions and not responded sooner to the WHO's warnings and the information coming out of a number of countries around the world?

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Brunet.

We go now to the Office of the Seniors Advocate of British Columbia. Ms. Mackenzie, please go ahead. You have 10 minutes.

[Isobel Mackenzie, Seniors Advocate, Office of the Seniors Advocate of British Columbia]

Thank you. Good afternoon and thank you for inviting me to give my thoughts and observations on our initial response to the COVID-19 pandemic—

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, sorry—

[Isobel Mackenzie]

—as it relates to seniors. I'm hearing an echo in the background.

[Luc Thériault, Bloc, Montcalm, QC]

There's a problem, the same one I raised before the meeting began. The interpretation wasn't working properly the entire time the previous witness was speaking. For the sake of expediency, I put up with it, but I can't do it for the next three hours. The problem has to be fixed. It's happening not just with one interpreter, but with most of them. A microphone keeps going on and off in my ear as I listen to the interpreters. It has to be fixed. I bring it up at every meeting. I don't want to sound grumbly this afternoon, since it's such a nice sunny day here, but I can't take it anymore.

[Isobel Mackenzie]

Did I perhaps not have my interpretation button correct?

[The Chair, Liberal, Ron McKinnon]

I'm not sure that it's a problem with you. I think it may be something wrong in the interpretation booth.

I would ask the clerk if that's something we can address right away and whether we should suspend. Let's suspend for a couple of minutes and see if we can sort this out.

[The Chair, Liberal, Ron McKinnon]

We're resuming the meeting now.

Please go ahead, Ms. Mackenzie.