Human Resources Committee on Oct. 19th, 2017

[Dan Ruimy, Liberal, Pitt Meadows—Maple Ridge, BC]

How do we even tackle that?

[The Chair, Liberal, Bryan May]

Be very brief, please.

[Dr. Margaret M. Cottle]

Well, it's not a brief thing, but I would say we need to look at what's happening in other countries. Even in Quebec there are some wonderful models there that are based in homes. There are facilities that are doing a better job than we're doing just warehousing people. It's very hard for people to be cared for at home in the final stages, but we need to look around the world, find the things so that we don't reinvent the wheel, and then do those things that would be helpful in our settings.

[The Chair, Liberal, Bryan May]

Thanks.

Next we have MP Sangha. Maybe he could share some of his time with Mr. Ruimy.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you very much.

Thank you to all the expert witnesses giving input to the committee today.

To Mr. Mirza, we've been talking here about isolation and inclusion in the system. We've also been talking about the reasons that people become isolated, such as critical health conditions or other things. Everybody talks about providing better services to seniors. Every one of us knows that we will get to that stage. How would you recommend that social inclusivity, engagement, and healthy aging of Canadian seniors be addressed within the context of the national seniors strategy that we've been talking about?

[Dr. Raza M. Mirza]

I'll quickly go over some of the risk factors that we have from our own research at NICE. We looked at social isolation within the context of age-friendly communities. That is one of my overall suggestions, that we look at how to empower communities to support older adults who stay in their homes. We know that older adults want to age in place; we've heard this a lot. We know that older adults want to not go to long-term care if they can stay within their communities and stay in their own homes and remain engaged.

We know from the literature that an individual who is over 80 years old, who is living alone, who has a compromised health status, who doesn't have a child or a contact with family, who lacks access to transportation, and who has low income or is disabled will be at risk for being socially isolated.

One of the problems that we encountered in the research studies we conducted through NICE on age-friendly communities, and we've heard this from other witnesses as well, is the fact that individuals who are socially isolated are very difficult to identify. They're isolated; therefore, we can't reach them. Often the problem is that when we do reach socially isolated individuals, it's in a state of crisis, so you'll find them in the emergency department. The next problem is that you've identified someone who is socially isolated, you've assessed them for the risk factors and they're at risk of being isolated, so now where do you refer them within the community? What services do you provide to those individuals? Where can you send them?

Within the larger context of social isolation, one of the risk factors we've also uncovered as a result of our work is that little opportunity for engagement within the community is a big problem, but the larger problem that participants from our study also suggested was that it's not mutually rewarding. The programming and the community initiatives have to be mutually rewarding. The older adult has to feel that they're contributing something to the programming and to the community, that the programming is not just for them but that they're able to contribute something back. That's the way we should approach programming.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

There are two situations here. One is that those who are very critically ill need to go to long-term care. But there are the other seniors, those who can stay home and can be taken care of by the family members and by some experts from time to time. Those people who are taking care of them at home are doing it out of love and affection. That's what Dr. Cottle talked about, that we have to be compassionate, that communities have to be compassionate, but the government has to do something.

What steps do you think the government can take?

[Dr. Raza M. Mirza]

If we look at it in the bigger picture and the fact that age-friendly communities, compassionate communities, and what we're talking about doesn't happen in a vacuum, and if we have to support those individuals who are going to participate in these communities and provide care for their loved ones in their homes and keep them out of hospital and out of long-term care, there has to be some flexibility built into income supports for caregivers. Caregivers are often having to choose the loved one, as you mentioned, at the expense of their own professional development, their own professional growth.

Having flexible work schedules or an accommodated schedule around an illness or a critical illness is important. I know there's compassionate care and bereavement leave, but—

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Mirza, I have another short question.

[Dr. Raza M. Mirza]

Sure.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

For those who are seniors and who are, say, new immigrants who are not very good at conversing in English, or haven't had a good education in IT and using the system, is your organization, NICE, doing something to help them? What would you suggest that the government adopt in terms of a program to help those types of seniors?

[The Chair, Liberal, Bryan May]

You have 30 seconds.

[Dr. Raza M. Mirza]

I'll make it very brief.

There are three points I want to raise about immigrant communities. In our work at NICE, there are two groups of immigrants we're dealing with. There's a group of immigrants who came to Canada a long time ago, who've grown older in Canada; and there's a new group of immigrants who've come to Canada. Both of these groups are facing very similar challenges. Within the context of elder abuse, within the context of financial literacy, and also within the context of age-friendly communities, we do education and training and we conduct research to help facilitate, but it is on a very small scale. What I have been suggesting is that we need more education and more training, but we can't have that without the evidence and the research that goes behind it.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you very much.

[The Chair, Liberal, Bryan May]

Thank you very much.

MP Wong, please.

[Alice Wong, Conservative, Richmond Centre, BC]

Thank you, Mr. Chair.

Thank you very much to all the witnesses who took the time to respond to our questions.

First of all, I want to contextualize my question. I'd like to remind this committee that the previous government made seniors a top priority. I was honoured to have served as Minister of State for Seniors for five years. I have also had the honour of working together with NICE, and then with the long-term funding...and they've done an excellent job as well. In the previous government we were able to really look at issues of care, worker support, and taking care of the caretakers. What is unfortunate is that the current government does not prioritize seniors and their caretakers enough to continue our hard work on the file through a dedicated ministry.

I believe it was Danis who mentioned that you need a secretariat to really focus on seniors and then coordinate everything. You also need somebody who actually gives directions to the secretariat. I'd also like to say that, yes, some of the policies have been able to pass from the 41st session of Parliament to the 42nd—for example, the new horizons for seniors program. That is good funding for all the community groups that are helping to fight against elder abuse and helping, especially, seniors in isolation.

My question is this. Do you believe there is enough to address the dire financial straits many caregivers find themselves in? I know that our friends across also mentioned that about family caregivers. In some of my observations, some of them are also working at the same time.

I'd like to see if maybe Mr. Mirza could shed some light on that.

[Dr. Raza M. Mirza]

The group of caregivers that we think about are women. That's the first thing I'll tell you, and the literature will support that. The research we do at NICE will support that it is often a very gendered issue.

I want to focus for just one second on a group that we work with very heavily, which is grandparents raising grandchildren. They have stayed off the radar for a very long time, but we have conducted two national research studies with grandparents raising grandchildren. I can tell you about the situation for those caregivers. We don't often see that group as caregivers, we see it as a family responsibility when something has gone on, and it's an issue of family dynamics. Their financial situation is very dire. I can tell you that most of the participants in our study, 75% of them, were making between $15,000 and $50,000, and their legal fees for the year were way more than that. As a group of caregivers, that's very problematic.

I think we have to start to look at caregivers in separate groups. Dementia caregivers have different responsibilities and roles. Caregivers who are working with older adults who are in institutions are faced with different challenges and responsibilities. Caregivers for parents who are new immigrants who have language barriers also have very different challenges and roles. We have to start to unpack some of the ideas we hold with regard to caregivers and start to look at them as separate groups requiring very specific, targeted supports. I don't think the current support system is helping everybody out to the maximum level they can. We do work with vulnerable populations, and oftentimes they are heavily represented by caregivers who are women.

I'll tell you one last point, and then we can move on to someone else. Caregiving actually leads to a lot of family strife. Within the context of age-friendly communities, one of the things we recognized is that for those who are socially isolated, oftentimes it is as a result of family dynamics issues. It comes because of caregiving responsibilities sometimes. So if we can help support caregivers, we can empower and strengthen our communities and also take better care of our older citizens.

[Alice Wong, Conservative, Richmond Centre, BC]

Can I ask the same question of you, Dr. Cottle, my fellow British Columbian?

[Dr. Margaret M. Cottle]

Are we giving enough money to the caregivers?

[Alice Wong, Conservative, Richmond Centre, BC]

To help the family members who are working and also looking after their parents and grandparents.

[Dr. Margaret M. Cottle]

It's a very big issue. I think one of the things the federal government could do would be to give some tax incentives to people who are doing these kinds of things.

Our first witness talked about the informal community programs and how they can be supportive. Giving money to those types of programs will get you much more bang for your buck. In my opinion, we need to have our whole society engaged in caring for seniors, where, as I said in my brief, each person “is” part of our human family, not “as if” they're part of our human family. We all need to see this as our responsibility to care for each other, funding some of these grassroots programs that will be unique and helpful within the situations where they are. What you'll have in Weyburn, Saskatchewan, will be very different from what someone will need in the west end here in Vancouver. We need to support those community groups, through the seniors lens, who can give us, using lots of volunteers, really good value for the dollars we invest.

[The Chair, Liberal, Bryan May]

Thank you very much for that.

MP Fortier, you have six minutes.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Thank you very much. Your presentations were very interesting and very informative.

I have a number of questions, but above all I want to understand better.

I will begin with Mr. Prud'homme.

Your expertise in this area is really outstanding. If there were a better practice or model that we should examine more closely and invest in, or a strategy that we as the federal government could focus on, what would you suggest to us today?

[Danis Prud'homme]

That is a million-dollar question.

I would say that the situation in many places in the world should be studied. In Nordic countries, there is complete home support. The way they go about it, the budget they provide, and the various methods they use are determined in partnership with governments or family caregivers, but also with social economy enterprises and the community. A family caregiver cannot do everything alone, and neither can the government.

There are other examples from around the world. As to the social participation of communities, there are places where residences are built with day care centres alongside seniors' housing, that is, intergenerational housing, but on a larger scale. This is all about inclusion, keeping people active. In terms of isolation, as someone said, keeping seniors in their homes is one thing, but if there is no public or community transit in age-friendly municipalities, or AFM, if there are no services that seniors can use, and they are not considered when changes are made, such as if pedestrian walkways are not long enough, they will become isolated, even if they have home support.

It is a very complex issue.

[Mona Fortier, Liberal, Ottawa—Vanier, ON]

Thank you.

Madam Armstrong, following your presentation, I was trying to identify a solution or best practice that you think we should look at. If you could share that with us more precisely, it would be appreciated.