Human Resources Committee on Oct. 19th, 2017

[The Chair, Liberal, Bryan May]

Good afternoon, everybody, and welcome. It is a pleasure to be here.

Pursuant to Standing Order 108(2) and the motion adopted by the committee on Thursday, May 4, 2017, the committee is resuming its study of advancing inclusion and quality of life for Canadian seniors. Today is the first of three panels that will be held on the subject of inclusion, social determinants of health, and well-being.

We have an amazing panel with us today. First we have, coming to us from Vancouver, British Columbia, via videoconference, Dr. Margaret M. Cottle. Also appearing as an individual is Alison Phinney, a professor in the School of Nursing at the University of British Columbia, also by way of videoconference but coming to us from Winnipeg, Manitoba. Appearing here today we have, from the Canadian Centre for Policy Alternatives, Pat Armstrong; from the National Initiative for the Care of the Elderly, Raza Mirza; and from Réseau FADOQ, Danis Prud'homme and Caroline Bouchard.

Welcome. We will begin with opening statements, which will be kept to seven minutes. I will indicate when you have one minute left to wrap up.

We'll start with Margaret, coming from British Columbia. The next seven minutes are yours.

[Dr. Margaret M. Cottle, Palliative Care Physician, As an Individual]

Thank you very much.

My name is Dr. Margaret Cottle. I am a palliative care physician and a clinical assistant professor at the UBC Faculty of Medicine. For almost 30 years I have devoted my practice solely to the care of patients with serious illnesses and to their loved ones, especially—

[The Chair, Liberal, Bryan May]

I'm going to step in here. We're hearing a really loud crackle on this end. People are having a hard time hearing you.

While they work this out, I suggest that we move on to the next person. We'll see if we can figure this out and then come back to you. I apologize for it.

[Dr. Margaret M. Cottle]

Okay.

[The Chair, Liberal, Bryan May]

We'll now go on to Alison Phinney, who's also appearing via video conference.

The next seven minutes are yours.

[Dr. Alison Phinney, Professor, School of Nursing, University of British Columbia, As an Individual]

Thank you for the invitation to appear today.

As a nurse, my research has largely focused on vulnerable older people who are living in the community, especially those with dementia, but also more broadly, older people with physical impairments and social vulnerabilities. These are people who are isolated, maybe living apart from family, with a narrowing circle of support. Essentially these are people who find it difficult to get out of their homes, and when they do, they find there are fewer opportunities for engagement, for them to be connected with the larger community.

My research has explored the rather broad question of what is meaningful activity for this group, and more to the point, what can we do to support it? I'm going to briefly describe some of what we've seen through this research that might suggest some possible solutions.

I'm a community-engaged researcher. I'm really on the ground, so I'm not going to speak so much about top-down solutions but rather what I see happening from the bottom up.

Over the past several years we've seen ever-increasing numbers of small, community-based programs offering various kinds of group activity for older people and those living with dementia. These groups are diverse, they're often very innovative, and they exist largely outside the health care system. People are gathering in community centres, in church halls, and even in hotel meeting rooms. Our research has shown that these groups offer a range of health and social benefits, and against all odds, they seem to have staying power. They're really not disappearing.

In the interest of time, I'm just going to share two examples from some of the research we've been doing in B.C.

The first example is Paul's Club, a group for younger people with dementia, people between roughly 50 and 75 years of age. It's a social enterprise run on a volunteer basis. They have one part-time paid staff member. It was the brainchild of Nita and Michael Levy, a retired couple from Vancouver who wanted, really for very personal reasons, to do something for this particular population. They have over the past five years basically invented an approach that combines physical and social activity, all happening in the heart of the city. They have about 15 members who meet three full days a week.

These were people whose dementia had progressed to the point where they were no longer able to get out and about on their own. They were isolated at home but also unable to be left alone. Paul's Club has provided for them a new community of friends within the group, and it has them out walking in the neighbourhood every day where they are visible, active, and engaged with the broader community.

The second example I will share is Arts & Health: Healthy Aging Through the Arts, a program in which community centres across the city are offering weekly workshops for older people to work together for a year with a professional artist. It targets those who are identified as being at risk for isolation and marginalization. Our research showed that this program enabled these groups to make a real contribution to their community, bringing their artistic creations into public space and building social connections, while also improving members' physical and emotional health, but probably most importantly, what we saw was that it allowed them to build a real sense of belonging.

The program began in 2006 as a collaboration initially between the city and the regional health authority. It's my understanding that the health funding has essentially disappeared over time, but the programs themselves have continued, and in fact they've grown, becoming much more deeply rooted in their local neighbourhoods.

This research is really offering examples of how these kinds of groups can improve physical and emotional health for seniors, but the strongest finding, consistently, is how it enhances their social inclusion.

I'm not the kind of researcher who's going to argue that it will reduce health care costs. That's not the work I do. But I do argue that these are the kinds of supports we want to have in Canada as we grow older. It's not only to support well-being and quality of life so we feel and do better as individuals, but that we want our society to be one that welcomes age and that allows space for older people to not only be well supported but to contribute as active social citizens.

As for “where next?”, the evidence is growing that these kinds of programs work, especially for the groups that are offering physical and creative activities for older people. These are becoming increasingly popular across Canada and internationally as well.

To some extent, it's now a matter of sorting out details—what kinds of programs work best for whom, and which particular approaches work best—but the big question remains, which is about how to create solutions that make these kinds of grassroots initiatives more broadly accessible. There are very real challenges, of course, and there's always the matter of funding. These groups tend to expend a lot of energy finding sufficient money to keep going, so what kinds of funding models might work better?

Also, reaching the target group isn't easy. Those who are isolated can be very hard to find. Even when we succeed, transportation is a really important issue. How do we bring people together, especially when they're outside urban centres? Transportation isn't just about making sure people get to the doctor's office. It's also about seniors getting out to attend meetings and to meet with friends and stay connected.

My final point is about the community capacity to provide these kinds of programs, which remains quite limited. Here, I'm talking about two things. There's capacity in terms of the knowledge and skills that are required to work with a population that can be quite complex, but also, and I would say more importantly, we need to build capacity in terms of our collective awareness and understanding around aging and, in particular, dementia. For too long, our awareness has been couched in fear of the so-called grey tsunami. Our work is showing that we really need to confront that problem of underlying ageism if we're truly to be an aging-inclusive society.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much.

For the next seven minutes we will hear from Ms. Pat Armstrong, a research associate from the Canadian Centre for Policy Alternatives.

[Dr. Pat Armstrong, Research Associate, Canadian Centre for Policy Alternatives]

I am also a professor at York University.

Thank you for inviting me here today, and for your attention to advancing inclusion and the quality of life for seniors. My presentation is based on my many years of research, which have made it clear that inclusion and quality of life are at least as important within health services as they are outside of them.

Today I want to focus on three main issues—namely, access to appropriate health services, the scope of home care, and the quality of long-term residential care.

I begin with health services. As I am sure you know, the 1964 Hall Royal Commission on Health Services concluded, on the basis of a thorough investigation of the evidence, that covering the full range of services was the only logical and money-saving way to coordinate care, ensure that people were receiving appropriate care, and eliminate both the expense and the delay of sorting the deserving from the undeserving. But the federal government decided it would start with hospitals, and then doctor care, before moving on to other services—an expansion that never happened.

The evidence gathered by the royal commission is still relevant today, and the need for universal, coordinated coverage of the full range of services is even more urgent with population aging. The growing numbers with chronic health issues need to be able to move smoothly among services and be treated within them by those who understand geriatric care.

We need a national initiative, similar to the Canada Health Act, to ensure universal, accessible, and comprehensive care, and to finally complete the project begun long ago. Our seniors, who struggled to bring us our most popular social program, deserve no less, and our search for equity requires it.

I now turn to my second issue. Care at home is claimed to be the first choice of everyone, and certainly this is what my friends say, but my friends are middle class and have pensions and a wide circle of family and other friends. The notion that everyone is best cared for at home ignores the fact that many people have no safe, healthy homes, and that many homes are not havens in a heartless world, as the feminists used to say.

Smaller families, more singles, and the need for children to move to find employment are among the factors that mean that many people have no family or friends near enough to provide care or companionship. The aging-in-place solution also ignores the fact that many people require skilled care that cannot easily be provided by partners and friends, who are themselves getting older, and it ignores the fact that many people live in places unsuitable for those very heavy care needs. I live in an old Victorian house that is full of stairs. You have to use three sets of stairs to get into it, and I can tell you that those lifts you see on TV won't fit on my stairwells.

Finally, care at home often means isolation at home, as we just heard, especially if the only accessible groceries are at Walmart, miles away, and the local bank has closed. Isolation is the opposite of inclusion.

The focus on care at home often ignores the conditions of work for those providing paid and unpaid care, at the same time as it fails to understand the skills as well as the risks involved for both patients and care providers. In other words, we cannot rely on care at home to provide for many of the current care needs. For those who can be cared for at home, we need to provide enough paid staff with appropriate skills, and create working conditions that ensure quality of life for those who provide, as well as for those who need, care.

Finally, I want to focus on long-term residential care. Very few people plan to go into long-term residential care, and most governments, as well as much of the population and many staff, see it as a last and worst resort. But no matter how much we focus on aging in place, we are all potential residents and have a vested interest in ensuring the quality of care there.

As a senior manager we interviewed in Ontario explained, “The average length of stay or living in the home is 18 months, and every day I say, ‘If you had only 18 months to 24 months of life left, what do you want it to be?’ And it's our job to make that the best it can be.” The job belongs not only to that manager and those staff, but to all of us. Our eight years of team research and studies of 27 care homes in six different countries have convinced us that the conditions of work are the conditions of care. You cannot have resident-focused care without creating the working conditions that allow for such care.

Right now in Canada, we too often fail to provide those conditions, which is one reason why those who provide direct care in these homes have the highest rates of absence due to illness and injury. Indeed, staff in care homes are more likely to get injured than police officers or firefighters.

If we are to focus on adding life to years rather than simply focusing on adding years to life, we need to understand the importance of not only having enough staff but also having enough staff with appropriate education and conditions that ensure continuity in staff. Higher turnover rates and reliance on casual, part-time, and agency staff increases the risk of injury while undermining the care relationships that prevent violence and provide quality of life for seniors, to name only some of the working conditions at issue. A significant body of research also indicates that ownership matters, and that the quality of care tends to be lower in for-profit homes.

In conclusion, I would add that the consequences of our current system are profoundly gendered. Women live longer than men, use the health system more, and have fewer economic resources, so the failure to provide care has a gendered impact. The impact is unequal among women as well. Women also provide the overwhelming majority of paid and unpaid care work, so poor conditions of work have the greatest impact on them. In home and residential care, a significant number of those women are from immigrant and racialized communities. We need a federal initiative to ensure universal access to the full range of health services delivered by non-profit organizations based on the same principles as the Canada Health Act. This also means a human resource strategy that ensures appropriate conditions of work. We need to do it now, before it's too late.

Thank you.

I'm sorry about my voice, I have a chronic issue in my throat.

[The Chair, Liberal, Bryan May]

There is no apology necessary. We've all been there.

Thank you very much.

We are now going to the National Initiative for the Care of the Elderly, to Mr. Raza Mirza, network manager.

You have seven minutes.

[Dr. Raza M. Mirza, Network Manager, National Initiative for the Care of the Elderly]

Thank you, Chair, and thank you to the committee for having me here today.

I'm both a senior research associate at the University of Toronto and the network manager for the National Initiative for the Care of the Elderly, also known as NICE. I'm here today in my capacity as the network manager to represent the board of directors and the scientific director of NICE, who was unable to join us today due to other commitments.

What NICE is here to suggest today is that the foundation for improving the overall quality of life and well-being for older adults, including those factors associated with community programming, social inclusivity, and social determinants of health, is by building capacity among older adults to become mainstream social citizens instead of being ghettoized through separate health and service systems. This foundation also requires new policy and practice responses based on well-funded research and evidence that captures the complex issues facing an aging population.

As an organization, NICE is an international centre for excellence, funded by the national centres of excellence, and is a not-for-profit charitable organization that was initiated in 2005. NICE is a knowledge transfer and exchange network that works to improve the care of older adults in Canada and abroad. We accomplish this by placing valid and reliable knowledge on aging into the hands of those who need it. This includes older adults, their family members, practitioners across disciplines—which includes nursing, social work, and law enforcement, as some of the examples of these disciplines—students, and policy-makers.

NICE accomplishes this work through a few different mechanisms. One mechanism is through research. Another is through the use of theme teams, where our teams are led by a researcher and a practitioner, who do work on different aspects of aging. NICE currently has 12 theme teams, which includes teams working on issues related to elder abuse, dementia care, mental health, dental care, caregiving, and financial literacy, to name a few. The third mechanism is making tools from evidence-based research that has never seen the light of day.

NICE is fortunate to have a very large membership, with close to 4,000 members worldwide and official representation from 14 different countries. We continue to find ways to build up our membership to facilitate access to knowledge on aging around the country and the world. Our international arm, ICCE, the International Collaboration for the Care of the Elderly, gives Canada a world footprint in aging, but benefits us through returns on knowledge about aging and diversity. Our network is an important resource for many, as current professionals are not always up to date. The knowledge base in gerontology and geriatrics remains thin, and attracting new students to the field is still a challenge.

NICE has conducted research regionally, nationally, and internationally. This has provided us with important insights and lessons. As a result, the work we have undertaken at NICE has been evidence-based, and as a result we have developed over 200 tools in various languages to help improve the care of the elderly. These tools have been developed from the research we have conducted—I will speak specifically about this research today—and we focus on those insights that can provide us with the opportunity to work with older adults and improve the overall quality of life and well-being for seniors.

From the NICE perspective, it is crucial that decisions are made with older adults and not for older adults, that one of the ways to do this is to fund more gerontological research that partners in a meaningful way with older adults in Canada, and that we make sure we translate this knowledge to action through evidence-based changes to policy and practice.

We achieved a historic milestone in Canada last year, with Canadian older adults outnumbering their counterparts for the first time in our nation's history. This milestone was met with hope and optimism as older adults, in general, are living longer, are healthier, and are wealthier. However, we at NICE have also met this milestone with renewed efforts in our research, our training, and education programming to further improve the quality of life for more older adults.

When we look beyond the general experiences of older adults in our country, and the average older Canadian, we get a better view of the most vulnerable populations needing support. Our research has specifically focused on those populations, and includes victims of elder abuse; older members of the aboriginal community; those who are socially isolated, and often from diverse and rural communities; grandparents who are parenting again in later life; older adults who may not be financially literate; those living in poverty, mainly older women; those vulnerable to grey divorce or financial abuse and exploitation; and those who are unable to access quality end-of-life care with respect to hospice and palliative care.

As a dimension of unequal social citizenship, older adults are frequently subject to ageism, which is manifest in many subtle ways through discrimination in the workplace, transportation, the denial of the right to quality care, and ghettoized housing and services.

If older adults are not treated like all other citizens, they're often socially excluded within their own communities. NICE is firmly committed to the perspective that older adults are indeed adult citizens and have the right to be responsible for themselves.

Social citizenship for older adults has been identified as a priority topic in Canada by the Standing Senate Committee on Social Affairs, Science and Technology, Employment and Social Development Canada, the National Seniors Council, and the Ontario seniors strategy, to name a few. Social citizenship, broadly defined, suggests equality of status in society and the right to membership of a community, the right to economic welfare and security. When we link this to quality of life and the social determinants of health applied to an aging population, the importance of social citizenship becomes even clearer. Although the research on the implications of differing rights and opportunities and social citizenship is very thin and limited, research has shown that approximately one in four older adults in Canada desire greater social involvement within their communities. Social inclusion was identified as a priority topic for social determinants of well-being.

Social isolation has also been flagged as a major health and social problem in older adults, and is not a normal part of aging. In particular, persons from diverse ethnic backgrounds may be at higher risk for social isolation, since they may be recent immigrants and may not be fluent in English. Social isolation is a complex issue, and may be a result of physical and social environments that are not built to support older persons and may be age-unfriendly.

To conclude, NICE is committed to the development of evidence-based knowledge supported by designated funding for research with older vulnerable populations, and for better training of gerontological geriatric students, policy-makers, and practitioners. Most critically, the straightforward education of older persons themselves sends the message that they can become active citizens, and are expected to be active citizens, contributing to Canadian society.

Again, we at NICE would like to emphasize the importance of research in gerontology and geriatrics that may better inform the directions we take in developing a national seniors strategy that matches the realities of a new generation of older adults in Canada.

Thank you very much.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now we're going to go to FADOQ.

Danis Prud'homme, the next seven minutes are yours.

[Danis Prud'homme, Chief Executive Officer, Réseau FADOQ]

Thank you, Mr. Chairman.

I'll be making my presentation in French, although you do have copies of my presentation in English and French as well as the full briefing.

Members of the Standing Committee on Human Resources, Skills and Social Development, and the Status of Persons with Disabilities, hello.

I am honoured to represent the Réseau FADOQ today as part of these special consultations which we sincerely hope will lead to the development of a national strategy on aging in Canada.

Allow me first to introduce you to our organization. Founded 47 years ago, the Réseau FADOQ is the largest seniors’ organization in the country, with nearly 500,000 active members aged 50 and over.

The Réseau FADOQ is the undisputed leader among organizations defending the rights of seniors in Québec, seizing any opportunity to speak out and advance our main cause: to obtain an adequate quality of life for all seniors. The Réseau is also a strong advocate for active aging, as we offer a wide range of sports, recreational and cultural activities that get more than 70,000 seniors a week moving. In addition, there are nearly 1,500 discounts and privileges available with a FADOQ membership card, which help seniors maximize their purchasing power at a time when many of them are increasingly impoverished.

The Réseau FADOQ doesn’t hesitate to use the enormous power of influence conferred by our impressive number of members in the service of critical issues. The gains obtained by the Réseau in recent years are significant. Whether working alone or in collaboration with partners, they include: the abolition of accessory health care fees, automatic enrolment in the Guaranteed Income Supplement, and the reinstatement at age 65 of eligibility for the provincial age amount tax credit, to name just a few.

For some years now, the Réseau has been calling for the development of an aging policy in Québec, because we believe that coordination and the introduction of a holistic vision of aging are the cornerstones of real improvements in the quality of seniors’ lives. In addition, for the past five years, the Réseau has represented Canadian seniors' organizations at the UN in the Open-Ended Working Group on Aging, which is striving to create a comprehensive and integrated international, global instrument for the promotion and protection of the rights and dignity of the elderly.

It is therefore only natural for the Réseau FADOQ to applaud the consultations that are taking place now, which will lay the foundations of a strategy on aging for the entire country. The policy that will emerge for seniors’ quality of life is crucial, not only for seniors, but for the future of the country. We firmly believe that such an instrument is the only way to adequately address the demographic challenges that are already underway, and increasing at record speed.

It goes without saying that we offer our full collaboration in this essential process, for which we have high hopes, because it will provide a common and unique direction and be conducive to action. Indeed, what is the purpose of cooperating and sharing our different expertise, if at the end of the day we do not follow up with concrete action? We must put knowledge into action; otherwise, the exercise will be in vain and seniors will pay a high price.

I come now to the main recommendations contained in this brief, resulting from nearly five decades of work entirely devoted to all facets of seniors’ quality of life.

First, the Réseau FADOQ recommends the creation of a seniors’ secretariat under the Federal Executive Council. We also suggest that all current and future public policies be looked at through a “seniors’ lens.” And we would welcome an upgrade of the National Seniors Council, so that it might become a locus of collaboration for organizations such as ours.

In terms of income, it is clear that the management and administration of the GIS must be reviewed and that this benefit must be improved. As for employers, the government must commit to raising awareness of their role in intergenerational equity and the financial health of future retirees, and encourage them to offer supplemental pension plans.

With regard to housing, the Réseau FADOQ believes that the Canadian government must showcase innovation and be a strong proponent of universal accessibility standards for all new construction financed with public funds, so that communities can evolve according to demographic needs. In addition, the Canadian government must lead by example in encouraging businesses to maintain local services.

Moving on to the central theme of health, I should mention the urgent shift towards better home care. The federal government needs to provide leadership on this issue and mobilize the provinces. To this end, one essential route is to provide better health transfers exclusively dedicated to home care and services.

In addition, we believe that the Canadian government should enshrine, in the Canada Health Act, a plan to provide minimum and equitable access to home care and services for all Canadians.

With respect to the Canadian health care system, it is essential to ensure its universality. With regard to measures directly related to health, the Réseau FADOQ suggests that the federal government be inspired by the National Health Plan presented by the Canadian Medical Association, including the framework specific to the rise of dementia currently faced by society.

Another request is the establishment of a national drug program, which would ensure equity among Canadians. In the same spirit of equity, as well as to better support seniors experiencing loss of autonomy, we hope that health transfers will take population aging into account and be paid out according to the proportion of seniors in the populations of each province and territory.

We can’t talk about the health of seniors without addressing the almost inhuman experiences of some family caregivers, whose numbers are expected to grow rapidly. On their behalf, we demand more substantial compensatory measures and a guarantee of employment for family caregivers in urgent situations.

Finally, we would like to remind you that adequate intervention is based on a situational analysis that is as accurate as possible. In this regard, it is important that future censuses allow seniors living in private seniors' residences to complete their own questionnaires, rather than making it the responsibility of the residence’s management.

In conclusion, let me assure you of the Réseau FADOQ’s full collaboration in the development of a national strategy on aging in Canada. Our expertise is at your service and we will closely monitor what is most essential to this process: the deployment of real actions that will improve seniors’ quality of life, today and tomorrow, throughout the country.

[The Chair, Liberal, Bryan May]

That's fantastic. Thank you very much.

And now—our fingers are crossed—I believe we have Dr. Cottle not on video conference but on phone conference.

Can you hear me?

[Dr. Margaret M. Cottle]

Yes. Can you hear me?

[The Chair, Liberal, Bryan May]

We can, and it's crystal clear.

[Dr. Margaret M. Cottle]

Okay.

I won't be able to see you indicate when my seven minutes are up, but I did time my presentation twice. I'm just going to read the whole thing and you will have to bear with me.

[The Chair, Liberal, Bryan May]

We'll allow you to do that. Thank you very much for your patience. I'm glad we'll be able to hear from you.

[Dr. Margaret M. Cottle]

Thank you.

I'm sorry to have missed many of the other presentations. They were very interesting, and I'm very grateful to be part of the conversation.

My name is Dr. Margaret Cottle. I am a palliative care physician and a clinical assistant professor at the UBC Faculty of Medicine. For almost 30 years I have devoted my practice solely to the care of patients with serious illnesses and to their loved ones, especially in home care settings. I have many years of first-hand experience with patients and families who are enduring exclusion and a diminished quality of life mainly due to the lack of will in our society to provide the necessary resources. I find this distressing, since we seem to find the funds for multi-million dollar contracts for sport and entertainment celebrities.

Canada is a signatory to the United Nations' Universal Declaration of Human Rights. The preamble begins:

Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Article 25.1 states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

At present, we in Canada fall far short of this very basic standard.

Loneliness, isolation, and vulnerability have been front and centre in my practice. A patient I will refer to as Joe is found in his home dehydrated, delirious, and combative. The open wound caused by his facial cancer is crawling with maggots. In the middle of a large, affluent city, he has no one to care for him. Even when family members are able to help, they are often stretched past the breaking point both physically and emotionally, and they face financial hardships and repercussions in their workplaces. We are scandalously tight-fisted, and do not provide enough sustainable support to the families who do this crucial work more cost-effectively and with deeper love than anyone hired to do so.

Frail senior citizens have many concerns in common with people in the disability community. Dr. Carol J. Gill of the Department of Disability and Human Development at the University of Illinois at Chicago, herself a polio survivor with significant motor and respiratory disabilities, has interesting insights into vulnerability. I commend to you for your review her two excellent articles. Although written for different contexts, they are extremely pertinent to our discussion. She points out that vulnerability is socially constructed rather then inherent in our physical or cognitive conditions. Her example is as follows:

All my life I've been told that I can't get into my neighbourhood restaurant because my legs won't take me up stairs. Now I know it's because the restaurant owner won't build a ramp.

She also notes that needing help is a “socially created indignity”.

She continues:

It is the way people with disabilities are treated and regarded socially that leads anyone to feel ashamed if they need help to use a toilet. It is the stigma of disability that strikes fear into the heart of individuals who can no longer live independently or appear “normal”. It is the economics and social arrangements of disability that transform ill people into family burdens or nursing home inmates.

She writes:

The public generally equates disability with suffering. Because I have physical limitations, need help from others, and use devices such as a wheelchair and ventilator, many observers perceive me as a sufferer. I do not draw the same conclusion. Ironically, their prejudgments cause me more suffering than my impairments do. Having suffering incorrectly attributed to us when we are simply living our lives differently is a quintessential disability experience.

Again, she writes:

We are, in fact, much more frightened by the doctors who are out to help us but who see our lives as burdensome and who know little about options that make life with disability valuable. We know that the misplaced pity and pessimism of such doctors is reinforced by the medical institutions surrounding them, the policies that guide them, the health care funding system that rewards them for holding costs down, and the prevailing culture that influences their thinking about disability.

She also says the following:

It is difficult for most people to believe that life with an extensive disability can be anything but suffering, and that suffering can be anything but dehumanizing. Perhaps, along with tolerance for imperfection, the public spirit has lost some of that down-to-earth courage in the face of human difficulties that carried previous generations through very hard times. I have also noticed how narrow the public imagination has become about what makes life valuable—so unimaginatively narrow that it cannot seem to encompass those two realities—disability and full humanity—simultaneously.

Here's one final quote from Dr. Gill:

Anyone at any age can benefit from measures to enhance her/his self-determination, including dignified professional assistance at home, respectful responses to one’s everyday preferences, companionship or privacy as desired, and reassurance that the changes of aging and illness do not reduce one’s humanity and worth.

My conclusion is this. Every person deserves to be respected and cared for not “as if” she or he were a member of the human family, but precisely because he or she “is already” a full member of the human family. I hope that we will dream big dreams, that we can envision a Canada where love and community support are extended to every member of the human family; where all our citizens enjoy freedom, justice, and peace; that every life will be acknowledged as one worth living; and that we count it a privilege, not a burden, to care for each other, even when it is difficult. Government programs cannot change hearts, but they can foster compassionate communities and facilitate systems of care that will support those who bring love into the lives of every citizen. I sincerely hope that you will find creative solutions that can be implemented without delay. The need is profound and urgent.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you, Dr. Cottle, and well said. I'm very pleased that we were able to hear your words, if not see you deliver them.

Before we get into the first round of questions, I have just a little bit of housekeeping. We are expecting bells at about 5:15, and we will have to wrap up at that point. We also have some committee business to conduct. I'm going to suggest that we will likely have time to get through the two rounds of questions, but we'll shoot to break for committee business at five o'clock.

I'd like to welcome and thank MP Doherty for joining us here today.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you.

[The Chair, Liberal, Bryan May]

Our first batter up is MP Warawa.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Thank you, Chair.

Thank you to the witnesses for their excellent presentations.

We have limits in time to hear from you, and I'm sure you have a lot more to share with us than the seven minutes and answering some questions will allow you. Could you each ensure that you have provided us a written brief along with your recommendations, which we would translate? The purpose of today is to hear your testimony. We'll be creating a report with recommendations to the government. If you have specific recommendations, it would really help to condense what you are recommending that the government include.

The focus is on whether we need a national seniors strategy. Do we need to have a recommendation of leadership in all the different levels of government? We heard some comments on that. Does the federal government, in providing leadership, need to have a minister for seniors? We heard about the secretariat. It sounds very interesting. Do we recommend that each province have a person who is in the lead so that we have a point person in every level of government? From the last witness we heard that the need is profound and urgent. We have a very quickly aging population, and it's not consistent across Canada. Some areas have a very large senior population.

I will start off with you, Dr. Cottle. Your examples were profound and actually gut-wrenching that we are not taking care of our senior population already. We heard that there is limited involvement in geriatrics. You are a physician in palliative care. There are not that many. In my riding of Langley, there is one palliative care doctor with a population of around 140,000 people. It's a great place to retire. I don't know statistically the percentage right now, but I'm guessing probably about one in four or one in five is a senior. Even around this table, you probably have one in four who is a senior. I'm a senior.

[Alice Wong, Conservative, Richmond Centre, BC]

I'm a senior.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

My good friend Monsieur Robillard is a senior. Maybe even a half of us qualify for that discount.

How do we, in a very short period of time and in a coordinated and effective way, meet the needs of seniors? From the examples we heard from you, Dr. Cottle, we're already not doing it. What is the low-hanging fruit that we can quickly enact so that we can start moving in the right direction? At this point, I see we're not prepared and it's already not happening. Could you comment on that, please?

[Dr. Margaret M. Cottle]

I suppose if I had that answer, I could rule the world. One thing that's been very interesting to me is that I have heard—it would be something for the committee to look into—that in the country of Denmark, they have not opened any new hospitals and have closed some long-term beds. They have put their money and their resources into home care.

I know that home care is not for everyone. I was very interested in the things one of the other witnesses was talking about, that it isn't for everyone. But is for a lot of people. Many people are not getting home care because they aren't supported. They can't get time off from work that's significant enough. There have been some recent changes in the EI laws and regulations, but it's not enough for someone who is dealing with caring for a parent with dementia, for example, which may take five or 10 years to do so.

We have great resources with our families. I have been taking care of people at home for 30 years. The families are more committed on the whole—it's not universal, but on the whole—and more loving toward the patients and their loved ones than anybody you can hire from the outside. They also tend to understand the person and what the needs are. But they need help. They need to have some outside help to come in and give them a break. They need help with their work.

To be honest, I think supporting the people who are already doing the work, and making sure they don't burn out such that the loved one ends up in a nursing home or dumped in an emergency room, would be certainly a good place to start.