Health Committee on Dec. 7th, 2020

[Teri Mooring, President, British Columbia Teachers' Federation]

Thank you, Mr. Chair.

Thank you for the opportunity to speak with you today on the issue of safeguarding teachers' mental health through the second wave of COVID-19.

I'd like to begin by acknowledging that I am speaking to you from the traditional ancestral and unceded territory of the Coast Salish peoples, specifically the Squamish, Tsleil-Waututh and Musqueam nations.

I represent the 45,000 members of the British Columbia Teachers' Federation, all the public school teachers from kindergarten to grade 12 and adult educators. Our challenges and concerns are not unique. They are echoed by teachers from coast to coast to coast.

As a member of the Canadian Teachers' Federation, the BCTF, alongside other teachers' unions from across the country, acknowledge and appreciate the critical work of teachers and education workers across Canada, who continue to exemplify essential front-line service and professionalism during this critical and difficult time in our collective history.

While the mental health of teachers and indeed everyone in Canada has been dealt a serious blow by the coronavirus, these problems far predate the pandemic for Canadian teachers. Increasingly difficult working conditions have been straining teachers' mental health and resilience for decades. At the same time, we are also witnessing rising rates of mental health challenges among our students, and this is truly heartbreaking.

As public education budgets have declined in the past two decades, public expectations of our school systems have risen. As education is an essential part of long-term solutions to many of society's challenges, including the raising up of Canada's next generation of leaders and citizens, such expectations are understandable.

One of our favourite BCTF slogans is “Kids matter. Teachers care.” That really is at the heart of why we are called to the profession. Kids do matter enormously, and we do care deeply. Teachers and schools are only one element of what must be a collective social effort to support young people's diverse aspirations and needs. Strong and focused federal leadership, coordination and resources must be a part of this national endeavour.

When schools were closed in B.C. on March 17, teachers had less than two weeks to respond to the enormous challenge of transferring their classroom practices and skills to online remote learning. Adding to their stress was the knowledge of the toll the pandemic was taking on our most vulnerable students. The digital divide, food and housing insecurity, family violence, racism and other traumatic experiences limited or completely diminished some students' ability to truly access their education.

In B.C. we've returned to full in-class learning. Our research shows that the inadequate implementation of health and safety measures is taking a critical toll on teachers' physical and mental health. “I feel scared, isolated, lonely and very sad”, said one teacher in a BCTF survey conducted this fall. Another stated, “The stakes now are just so much here—I can't protect my kids from a potentially life-altering disease.” These are among the deeply concerning words expressed by teachers regarding their current mental state.

It's also important that we recognize gender inequality at play in a feminized profession. More than 70% of public school teachers in Canada identify as women. The emotional labour of caring for their students as well as their own children while also often providing eldercare for family members is an extra burden shouldered disproportionately by women teachers during this pandemic.

What actions can the federal government take to reduce teachers' distress and support them in their critical roles as front-line and essential professionals? Our members told us that consultation, communication and co-operation are key. Teachers feel less vulnerable to mental and physical risk when a critical majority within their school community understand and abide by health and safety protocols and when those protocols are deemed to be adequate.

I refer you, Mr. Chair, to the recommendations in our brief. They outline the ways the federal government may catalyze informed, constructive, transparent improvements and collaboration regarding teachers' mental health.

The $2 billion in federal funding provided to provinces and territories was appreciated and necessary to ensure basic school safety protections. Unfortunately, it wasn't enough to allow schools to reduce classroom density to facilitate physical distancing. There also need to be measures in place to ensure that federal funds are used to directly improve the safety of classrooms. More needs to be done when we are witnessing the COVID-19 cases in B.C. and many other jurisdictions continue to rise unchecked.

Another stressor for teachers is their economic stability. Teachers who have been exposed to the virus and are required to isolate use up their entire allotment of sick leave for the year. With many teachers already running out of sick leave, the federal benefit, as is, is inadequate, as it necessitates too large a reduction in pay for teachers who already live in one of the most expensive jurisdictions in Canada.

Additionally, for the most precarious workers, teachers teaching on call or replacement teachers, who can potentially work with hundreds of students across many schools every single week, there is no contractual sick leave. Teachers should not have to choose between their health and their ability to make a liveable income.

To conclude, COVID-19 has put into stark relief what happens when the mandates of austerity and efficiency meet a national crisis. B.C.'s public education system, like others across Canada, has endured deep cuts and chronic underfunding for decades.

This struggle is the backdrop to our current reality. It's also a primary reason Canada still enjoys an envied position as one of the best education jurisdictions in the world—our commitment to high levels of professionalism and expertise, and to equitable access to high-quality education for every student in every constituency, in every community.

Thank you again for the opportunity to share the experiences, perspectives and counsel of B.C.'s public school teachers.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Mooring.

We will now go to the Canadian Association for Long Term Care and Jason Lee, treasurer.

Please go ahead. You have seven minutes.

[Jason Lee, Treasurer, Canadian Association for Long Term Care]

Thank you, Mr. Chairman.

Members of the committee, I want to thank you for inviting CALTC to appear again before you today to discuss seniors living in long-term care and the supports that residents require to protect their mental health.

My name is Jason Lee and I'm here today as the treasurer of the Canadian Association for Long Term Care, also known as CALTC.

As the leading voice for quality long-term care in Canada, our members advocate on behalf of our residents at the federal level to ensure seniors can age and live with dignity.

Our conversation today is focused on mental health. This has no doubt been an extraordinarily difficult and painful time for everyone involved, including residents, their families, front-line staff and those who operate long-term care homes. In my limited time, I want to focus specifically on residents' mental health. If needed, I am happy to come back to the committee with more information on the effects of COVID-19 on mental health in families and staff.

Studies have shown that social isolation has a negative impact on health, especially in seniors, and that this increases the overall cost of our health care system. Moreover, social isolation in the senior population can even occur in care homes where there's an abundance of residents and staff. We know that those who are more connected with their families and friends lead longer, happier and healthier lives. COVID-19 has presented unique hurdles in residents' mental health, as physical isolation is required in outbreak situations.

Since the beginning of the pandemic, governments, public health officials and the long-term care and continuing care sectors have faced challenges that are not only unprecedented, but also ethically and emotionally complex. Perhaps the most significant has been the issue of family visits.

Family members or close companions are a vital part of the care team within long-term care and are crucial to the residents' experiences. When visitations were restricted earlier in the year, many residents experienced an impact on their overall quality of life, despite the best efforts of staff. While such restrictions were and still are necessary for keeping residents and staff safe, we also understand how important it is to be physically and emotionally close to those who are important to us, particularly as we age.

Staff in homes across the nation have been nimble, innovative and dedicated in trying to connect families with their loved ones with the use of phones, technology and other measures to protect their communications.

While directions for families and other visitors vary across the country, depending on the rate of COVID-19 in the community, many of the new approaches to connecting residents and their families during this turbulent time require new and updated technology, enhanced use of personal protective equipment, upgrades to home infrastructure and additional staff to ensure safe visits.

This is why CALTC called on the federal government in September for immediate and stable funding in the amount of $2.1 billion over two years to cover personal protective equipment, staffing and other costs associated with COVID-19. I would like to acknowledge and thank the federal government for investing the first $1 billion of that ask through the safe long-term care fund just last week.

However, mental health challenges in long-term care, like other challenges exposed through the coronavirus, are not unique to this moment. Further long-term care investments are required to support structural changes that bring the infrastructure and training that homes and staff need to provide the level and type of care seniors deserve.

Specifically, investments need to be made in the retrofitting and rebuilding of new long-term care homes to create environments that live up to modern design standards, especially with respect to residents living with Alzheimer's disease and other forms of dementia.

Additionally, a vital component of success in the provision of health care, from individual care plans to facility operations to government policy direction, depends on having the best information available that has been collected at the point of care. This is true for long-term care. Facility-level data that is comparable and shared across Canada can support policy-makers and health practitioners in improving the quality of care, and therefore the quality of life for long-term care residents.

Finally, it is time to modernize the Canada health transfer to include dedicated demographic top-up that reflects the increased costs of aging populations. We can only hope to appropriately address mental health for residents through the appropriate funding of all aspects of their home life and their care, and there is a role for the federal government in ensuring access to the appropriate mental health supports.

In closing, we cannot pretend that mental health care is somehow separate from other types of care received in homes, or even separate from other challenges the sector faces. It's easy to look at the current situation in long-term care homes across the country and say that long-term care is something to be avoided at all cost. It's easy to discuss and demonize long-term care homes as warehouses for the elderly. This, however, is not the long-term care that we as operators and staff know it to be.

There is not a home in this country that does not see itself as an extended family, one that includes its residents, their families, staff and the community in which they operate. Phrases such as “warehousing” are a real problem in mobilizing much-needed funding and support for the sector.

To truly address the systemic issues in long-term care and ensure that the effects of COVID-19 don't happen again, we need to stop discussing long-term care as a last resort for seniors and start thinking instead of how we can make the last years of someone's life vibrant and comfortable. How can we invest in long-term care homes, communities and wraparound seniors services to ensure that seniors who come into a care environment feel as though they are making a new home?

Thank you for this opportunity to speak to your committee.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Lee.

We'll go now to our questions and start with Mr. Maguire.

Mr. Maguire, go ahead, please. You have six minutes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

I want to thank particularly the witnesses who are here today for their presentations, which were very informative.

The issues are immense amongst all the different levels here, but I want to first approach it from the seniors' position. We looked at two-thirds of our youth being affected and a third of the seniors being affected, more by mental health issues, which is a smaller number but it's excruciating for those families who are in that position. Data has been mentioned by all of you as an important area. I wanted to focus a little bit on the additional stresses causing our mental health issues and contributing to some of the health issues and the staffing of our long-term care facilities.

Mr. Lee, I wonder if you could answer this first. Before the pandemic, recruitment and retainment of health care aides in facilities was under pressure and was already a challenge. Is there publicly available data to look at the turnover rate of health care aides in these long-term care facilities?

[Jason Lee]

That's a good question. Currently, we don't have a system in place across the country where data is collected at the source—in the homes—and gathered and shared in any way across the country so that we can easily answer that question. Anecdotally, the industry would look at turnover rates in the first year of employment in the area of 25% turnover, so it does have a high turnover rate. Again, I say that anecdotally, because the data system that I mentioned earlier does not exist. If we had such a system, your work as a policy-maker would certainly be easier.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Yes, thanks.

In long-term facilities, I know there seems to be a situation where there aren't enough full-time positions in some of those areas. Due to the pandemic, we have a lot of major problems here in trying to contain these outbreaks in the facilities, and now most provinces have said that the health care aides can't work in multiple facilities.

Moving forward, I wonder what concrete measures you would suggest or you can think of that the federal government should implement to encourage these long-term care facilities to offer more full-time positions, so that they don't have to work in multiple facilities. I know that the staff who are working there are very concerned about being the ones who might bring something into the homes.

[Jason Lee]

Absolutely, the last thing any staff member wants is to be the person who brought COVID-19 into their home. No matter how innocent it is, that's not what they want to see happen.

Specifically about the question of permanent full-time positions, the industry right now is in need of workers, and my experience has been that staff who are looking to work don't have any shortage of work available to them. Historically, we generally operate under collective agreements in the majority of these homes, and the number of full-time and part-time positions is normally written right into those collective agreements, some of which are 30 or 40 years old.

Certainly in our homes we offer a lot of full-time positions, but not all staff want that. A lot of staff are looking for a casual or part-time position because they have their own situations and they want that flexibility.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Yes, with families and that sort of thing, for sure....

One of the things that came up on the weekend.... A Harvard epidemiologist, Michael Mina, spoke out about the importance of rapid home tests and said that home testing could be a big game-changer. At-home rapid tests aren't available in Canada and haven't been approved in Canada yet.

I know staff members are pretty concerned about bringing COVID into their workplace, as I said, so to reduce the stress of employees in these situations, should the federal government be approving and distributing the rapid at-home tests to staff who work at these long-term facilities?

It may apply to other things like our school systems as well. I know that in Manitoba the premier has just indicated, Ms. Mooring, that they will have enough rapid tests for two tests a week for every teacher until the end of June.

Maybe I could get the two of you to comment on that, just on the home test kits.

[Jason Lee]

From the position of Canadian Association for Long Term Care, we're in favour of testing. We'd like to see more testing done. At times, there has been difficulty having access to the level of testing that we would like to have for our staff and residents in the community. Therefore, if this is a step towards more access and reliable testing, that would be a favourable step.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you.

Ms. Mooring.

[Teri Mooring]

I would concur that rapid testing for teachers and home testing would be helpful. We've had some issues in B.C. around the length of time it takes to get the results of a test, and during that time, of course, teachers need to remain off work. While that has improved, certainly access to rapid testing at home would also be helpful for teachers in terms of, as you say, reducing stress and ensuring that they're safe and that, if they have questions about their health, they can get a quick answer.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

We go now to Mr. Fisher.

Mr. Fisher, please go ahead. You have six minutes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Mr. Chair.

Thank you to all the witnesses. An awful lot of information was given to us today, and I thank you all for that.

I want to direct my first question to Dr. Kates.

Although it seems as though there's a light at the end of the tunnel now with multiple vaccine candidates under review, and we're hearing very good things about them, we know that Canadians are still struggling to cope with public health measures designed to keep them safe.

In August, after wave one, you were quoted in the Hamilton Spectator as saying:

I think people are generally feeling a lack of motivation, anxiety and stress and are looking to kind of break out, rather than move out smoothly.

Could you tell us what the specific challenges were that Canadians faced mentally as they looked to go back to old routines after coming out of that first wave? What can we learn from that as we look to our future post-COVID-19 second wave in Canada as we start to roll out the vaccines?

[Dr. Nick Kates]

It is a real challenge, because we are asking people to go again through something that.... When they went through it the first time, they thought that would be it and then they could move on. There's also fatigue, and people have to some extent exhausted some of the things they were doing early on when they were in lockdown or in isolation or needing to follow some of the distancing measures. There's a general feeling of frustration. There's a timelessness, a sense of “When is this going to end?”

We have relied on collective goodwill and a collective sense of shared responsibility for looking after each other, and I think it's going to be so important that we continue to reinforce that, continue to reinforce the messages that you're doing this not just for you, but for the people around you.

Again, we have to be careful that we don't oversell the arrival of the vaccine. It is going to take time. We don't know what the effects are going to be. We don't know what happens if people are vaccinated differentially in terms of the activities we're looking at. Therefore, we have to help people continue to reset their expectations, whether it be about immediate events or social or other activities that they were hoping to participate in, and at the same time really focus on some of the benefits that people have noticed from having time to focus on other things, focus maybe on simpler rewards, realizing that there are some things that we had built some of our expectations around that aren't as important as they are at the moment.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you very much, Dr. Kates.

My next question is for Mr. Lee—or is it Dr. Lee?

Based on some of the things you said in testimony, how important was the most recent announcement by Minister Carla Qualtrough of $23.2 million in funding for colleges and institutes in Canada to develop and implement an accelerated online program to train approximately 4,000 new personal support worker interns?

[Jason Lee]

Thank you.

I'm not a doctor and I don't play one on television, but it's a good question and it is a good announcement.

We see that funding as very helpful. We've talked about the need for more training and more staff. We'd like to see a national health human resource strategy that would incorporate training initiatives like that. What can we do through our immigration programs to bring more health care workers to Canada? How can we train them and make sure they're in the right sector and in the right provinces?

A more comprehensive strategy would be our request, but this is a very good piece of it. The one thing in that particular piece that we would have liked to see is an opportunity for not just the public institutions, but also the private training institutions to have access to that same program.

It's a good step in the right direction.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you, sir.

Mr. Chair, I'm going to give my last bit of time to Mr. Kelloway.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Fisher.

Mr. Kelloway, go ahead.

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

Thank you so much.

My question will be directed to Dr. Kates.

Dr. Kates, my constituents often face long wait times for mental health support. In saying that, though, I knew that my constituents would benefit from the Wellness Together app as it provided a direct line to important mental health resources at no cost.

In your view, are virtual platforms such as Wellness Together Canada the future for mental health services, as an effective means of providing support to individuals in need of mental health, especially now as we move toward the winter months?

[Dr. Nick Kates]

I would say, absolutely. One of the lessons that I hope we can take away as we move forward is the opportunity to rethink the way we organize and deliver mental health care.

I would say that two particular pieces are important. The first is to really stress, emphasize and support self-management by individuals of their own care. This is not original; it's something that is part of all care. I think the pandemic has taught us not only that this is a way of greatly expanding the reach of the mental health services, but that it's effective. We know that virtual care and online CBT can be as effective as face-to-face.

Providing resources and support, but in a targeted way because it's not one-size-fits-all.... Different populations, whether it be young adults or parents who are dealing with problems with their children, may need different kinds of resources and services.

The other way we can broaden the scope of the mental health system is to realize that there are many other people. One of our greatest untapped resources is health care providers who are not working to full scope. Another is families. I don't think we've taken advantage of not only the willingness, but the expertise of families to assist in the care of their loved ones, and similarly as supports for individuals.

If we can support families and also primary care providers, public health nurses, other community visiting nurses and people working in community agencies with simple stepped approaches.... We're not turning everybody into a mental health specialist, but we're saying that there are lots of things around lifestyle and dealing with stress and family relationships that anybody can be trained to deliver.

Let's rethink how we do that. Let's try to broaden the base of our mental health care system, so we can use more expensive and highly trained resources in a much more targeted way for those people who really need that expertise.

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

Those are fantastic points. Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We will continue now with Mr. Thériault.

Go ahead for six minutes, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Mr. Lee, in September, you wrote a press release entitled "30 Years of Chronic Underinvestment has Created a ‘Perfect Storm’ in Long-Term Care". Some of my colleagues may think I suggested the title to you, but I can assure them we haven't met until today.

Many people have come and told us that all the pandemic has done is reveal the weak links in the health system and shed light on the vulnerabilities that chronic underinvestment in recent decades has caused in it.

Before returning to that point, I would first like to discuss the mission of the long-term care centres, the CHSLDs, and the role of families, particularly during a pandemic. In discussing a long-term care centre, we're talking about both a care centre and a living centre.

The living centre part concerns families, first and foremost. Over the years, responsibility for patients has been transferred to their families. As for the care aspect, that's provided by professionals. Families have been excluded during the pandemic as a result of a lack of personal protective equipment. That wasn't desirable, but it had to be done. If my understanding is correct, today you're saying we have to find other ways to ensure this separation doesn't occur. We have more resources with which to secure the CHSLDs, and we also have communication infrastructure that precludes our ever having to sever this family connection, which is necessary for the mental health of the patients as they approach the end of their lives. Lord knows the mental health of patients is essential in keeping them in good health.

Is that in fact what you said? Could you tell us more about those resources? Do you think the contribution of families should absolutely be preserved in the event of another pandemic?

[Jason Lee]

Thank you very much for your questions. I'll do my best to answer them.

I'll start with your reference to the press release back in September. This press release drew attention to the fact that the Canadian Association for Long Term Care has identified a number of issues, chronic issues, in the system. We've been speaking with the federal government and other levels of government for years looking to have these addressed. The silver lining of this pandemic is that it has shone a light on the sector of long-term care. It has everyone now looking at it, seeing that we can do better, and anxious to know what these corrections should be—must be—to ensure that we don't end up in the same situation again in the future.

We've talked about the need for staffing and a national health human resource strategy. That would be an important step toward ensuring that we don't find ourselves in this situation again. There's also the infrastructure of our homes. Hundreds of homes across the country need to be either completely rebuilt or refurbished so that they are better designed for infection control. If a virus like this were to present itself again, we then would be better equipped in these homes to deal with it than we currently are.

Earlier, I mentioned data as something we need to collect and share and give to policy-makers like you so that you can make good decisions about the sector. This has been an extremely difficult time for everybody, families and residents, across the country, and we really don't want to repeat this. We see that there are ways to avoid going through the same scenario. If another virus like this one went through our country in five years' time, we should have the infrastructure, we should have the staffing and we should have the information in place so that we can avoid—