Mr. Chair and committee members, thank you for inviting the Canadian Federation of Nurses Unions to present to this committee. On behalf of close to 200,000 nurses who I represent, I'm very pleased to be here. As mentioned, my name is Linda Silas. I'm president of the federation and a registered nurse.
Congratulations for undertaking this important study, and congratulations especially to those presenting via Skype. It is quite hard to present to these committees.
As all of you know, in the last census, for the first time in history, the share of seniors in our population exceeded the share of children. What does it mean for society? We know that most seniors want to stay in their home as long as possible. That means that the demand on continuing care services within the community will continue to increase. You have all read the studies and you know that by 2026 it is expected that the number of seniors needing continuing care will increase by 71%.
Our Canadian health care system needs to recognize the new realities of the home, especially looking at hospitals without walls. From the front-line nurses' perspective, staying in one's home might present many challenges, both for the client and for the caregiver. Assessing all the necessary medical and social services while ensuring clients' safety can be difficult. Rather than recommending a home-first policy, CFNU is calling for a safe-at-home policy.
What are the elements of a safe-at-home policy? We tried to answer this just two weeks ago at the annual meeting of the provincial and territorial health ministers on this topic. We highlighted “Safety at Home”, a pan-Canadian home care safety study. The report identified many things in the home environment that put the safety of the clients, caregivers, and health care providers at risk. For example, initial assessments of the clients might be done, but they might not be reassessed in a timely manner, and the coordination of their care is also an issue. What emerged is that many of these home care challenges were overcome when one primary provider, usually a nurse, was given the job of having the complete picture of the client and family situation and coordinating timely care, communication, and teamwork. The role of the primary provider can be effectively performed by a nurse practitioner or registered nurse. Ultimately, system failures led to adverse events and increased use of our health care resources, such as increased use of hospital beds, as well as increased risk of disability and death.
CFNU recently conducted a poll to confirm some of the safety-at-home observations. That poll was conducted just this September. Nine out of 10 home care nurses surveyed said the acuity of clients at home has increased. Nurses reported that the main reason for the decline in the quality of care was an increase in the client population. Current staffing was reported as insufficient to do the job. About 90% of home care nurses said their workload has increased over the last three years. The majority who reported frequently work overtime, and despite this, necessary work is being omitted. About half of home care nurses said essential tasks, such as reassessing clients and families, are not being done. Around 50% said that the service coordination is also left undone from the previous month.
The message is clear: there is not enough staff, not enough training for both paid and unpaid caregivers, and not enough time in the day to provide essential home care services. These numbers are from one poll, but what we are talking about are real people, real seniors, and real families whose care is not met.
To add to the complexity of home care, most seniors are taking multiple medications. Nearly two-thirds of seniors take five or more prescription drugs. About 40% of them take a drug from the Beers list that is potentially inappropriate for use by seniors.
Last week, you heard from our colleagues at the Canadian Medical Association, when Canada's doctors presented before this committee. CFNU is also supportive of expanding discussions to include income security, affordable housing, and other related issues, but for now, as Canada's nurses, we believe we need to stay focused on the health services that the seniors of today and tomorrow need.
To reiterate CMA's presentation on October 26, we are also long-time supporters of a national pharmacare program. A national pharmacare program would allow for improving, monitoring, and evaluating prescribing practice. It would do so much to eliminate inappropriate prescribing to seniors. It would also help ensure that seniors would have equal access to the necessary and safe prescription.
CFNU's recommendations, which we have distributed to the committee members along with the backgrounder, are as follows. First is a safe-at-home policy; second, senior patient appropriate and timely nursing assessments and interventions supported by the full health care team; third, continuity of care provided by primary nurses to ensure timely and seamless access to care providers; fourth—and you've heard it from different presenters today—education and support for all members of the team, including unpaid caregivers; and fifth, a national pharmacare program.
I will be pleased to answer questions.
Thank you.