Evidence of meeting #67 for Human Resources, Skills and Social Development and the Status of Persons with Disabilities in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was home.
A recording is available from Parliament.
Research Associate, Canadian Centre for Policy Alternatives
It depends. So I guess that's an abstention.
NDP
Network Manager, National Initiative for the Care of the Elderly
It's a yes for me.
Rachel Blaney NDP North Island—Powell River, BC
Thank you so much.
Pat, in previous discussions we've heard witnesses talk about national standards for senior care providers. Do you think we should have minimum direct care staffing, things such as hours per resident per day?
Research Associate, Canadian Centre for Policy Alternatives
Yes, absolutely. The problem with minimums, of course, is that they often become the maximum, but without at least a minimum, people aren't getting enough care.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Yes. Thank you.
The other thing we've heard a lot about is just staffing for long-term care. Training and a lack of qualified people have been the top two concerns shared with me. Could you share your thoughts on that, and also give your opinion about working conditions as a major factor, with a few examples of how to make working conditions better and how that would make a difference?
Research Associate, Canadian Centre for Policy Alternatives
I can tell you one difference it would make. Our project has Nordic countries in it, as well as Canada, and a number of years ago we did a survey that we're now repeating on people who work in long-term residential care and home care. One of the things we asked about was violence. The levels of violence experienced by the Canadians who are providing care are reported to be much higher than those in the Nordic countries. The major difference is staffing levels. I think that's the fundamental condition.
The other condition, and this goes back to what we've heard from other people, is that continuity in care providers is absolutely critical to care, to the kind of care we heard about from Dr. Cottle, about knowing the person. You can't do that with casual staff. You can't do that with agency staff. You can't do that with people who don't know if they are going to have a job tomorrow. You have to do it by having as much full-time and regular staff as possible.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Yes. You said that really well, that the amount of care, and the good care, is really based on the working conditions of the people. I think that's really important.
You also mentioned your concern about for-profit long-term and home care. Could you tell me a little about what those concerns are? And could national standards be part of a solution to some of those concerns?
Research Associate, Canadian Centre for Policy Alternatives
A host of research has been done, in part by Margaret McGregor and Charlene Harrington, both of whom are part of our research team, and by people here at Bruyère who have looked at hospital transfers, for instance. You're much more likely to have transfers from nursing homes to the hospital from for-profits than from not-for-profits. The verified complaints are much higher. The injury rates are higher. We have a whole host of indicators that suggest that the quality of care and the quality of the working conditions are different.
Now, it's a pattern; it's not exclusive. Certainly there are some good for-profit ones, just as there are some bad not-for-profit ones, but it's a significant pattern. There's a significant body of research indicating that you're better off in a non-profit home. In Ontario the wait-list for non-profit homes is way, way longer than for the for-profit homes, because people hear their reputation and look at the indicators.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Can you talk a bit more broadly about how a national seniors strategy could promote care as a relationship?
Research Associate, Canadian Centre for Policy Alternatives
It's partly what I was trying to stress with this committee, that it's about human resources. Human resources has to pay attention to the conditions of work. We are relying increasingly on people from other countries to come to Canada to do this work. It's harder and harder to attract people within Canada to do the work, in part because it's insecure. It's precarious. In-home care is lower paid than in long-term care, and long-term care is lower paid than in hospital care. The work is heavier.
We need a strategy about training, but we also need to have the conditions so that people can use their training. We hear this all the time from people in long-term care, that they go home at night and cry because they could see what should have been done but couldn't do it. They just didn't have the time. So unless we have enough staff, and unless, to go back to the prior question, they have the kind of training they need...but the training's no good if you haven't the capacity to use the skills you have.
NDP
Rachel Blaney NDP North Island—Powell River, BC
We've heard that accessibility of the training is also a huge concern.
NDP
Rachel Blaney NDP North Island—Powell River, BC
It's not across the country in a fair way, and that adds to it as well. I think it goes back to the value of seniors—I have seven seconds left, Chair—and how we care for them.
Liberal
Dan Ruimy Liberal Pitt Meadows—Maple Ridge, BC
Thank you all very much for coming today and presenting.
Clearly, we have some challenges ahead of us. As a first-time member of Parliament, first-time politician, a question ran through my mind: what have we been doing over the last 20 or 30 years to get us to this point?
There are so many different directions to go in, but I want to focus first on this. When we talk about care, we have the haves and the have-nots. I'll give you two stories. One, I'll say, is actually my father. We can't afford to put him in a home and pay for it, because that's $5,000 a month. So he's in a government organization, which is brutal, absolutely horrible. I have a friend whose father is going into...for the same thing. There's an opportunity, because they can afford $5,000 a month. That facility is miles ahead of where the government facility is.
I see this across the country. I see this in my riding. We have a great assisted-living facility, but you have to pay $5,000 a month. I don't know where you're going to get the money from. My concern is that if you can afford care, great, but what about the people who can't afford care?
Dr. Cottle and Ms. Armstrong, the things you're both talking about are great. It's all about compassion. It's all about home care. It's all about families. It's about love. But we need to be able to transfer that into actionables. That's where I want to focus.
Perhaps I can start with you, Pat. What are the actionable pieces that we need to do starting now, moving forward? It's not going to happen overnight—we know that—but we need actionables.
Research Associate, Canadian Centre for Policy Alternatives
First of all, I've been in a lot of really good non-profit homes, or homes that are publicly subsidized. In Canada we have an incredible provincial range. One of the papers out of our project, actually, is on the variation in the fees charged provincially and territorially in Canada, and whether they are means-tested. There's an extraordinary range just there. If we had some standards on that, it would help.
Everybody charges accommodation fees in the publicly subsidized homes. I think we do have some examples of working...but it needs more money. As I was saying before, what we hear about most in long-term care is staffing, food, and clothes, or laundry. Those are absolutely critical. In some provinces we're giving people three or four dollars a day to feed people in long-term care. Well, it's no wonder it tastes.... We've tasted them in every place, and I have to say we couldn't identify some of it.
We need more money but we need standards, and we don't need more regulation. I know that might sound surprising from me, but our response has been to add more and more regulations, which means they have to do more and more documentation, which takes more and more time away from providing care. We need to have more people providing the care rather than filling out forms about the care they didn't provide.
Palliative Care Physician, As an Individual
I certainly endorse everything Pat just said. I also agree; by talking about home care, I'm certainly not denigrating long-term care. We really need it. I have done palliative care in long-term care homes, and they are not all created equal. I had one where I had to get the gardener to let me in, and I couldn't find a nurse on two floors.
So it's desperate, what's happening. I think what government could do is not make more regulations but have some national standards. We need people who can get to know their patients. More people will come and work in that setting—because seniors are wonderful to work with—if it isn't so heart-wrenching when they get there.
In B.C. we just had a big court case and now in the schools they have to have a certain number of students. Okay, let's do that for our seniors too. Let's say you have to have a certain staffing ratio. You have to have a certain percentage of full-time staff so that the residents get used to the people who are there. That's what they really need, that relationship. The people who are working there will stay there if they can provide the loving care they're trained to provide for the people they're caring for. They're not going home in tears. They can do those things that they can see will make a big difference.
Liberal
Dan Ruimy Liberal Pitt Meadows—Maple Ridge, BC
I have very little time left, Dr. Cottle, but perhaps you can just quickly address dementia. Certainly there are mild cases, but once it goes full-blown they become a danger to themselves, and they can become a danger to the people around them.
