Human Resources Committee on Nov. 9th, 2017

[Janet Craik]

Can we wait? We cannot wait. If we want sustainable health care options, we need to smash the status quo. I think the opportunity at the federal government is that when you get the federal, provincial, and territorial health ministers in a room, you put these important topics on the agenda.

As I said, the health care system right now is oriented to helping those whose health is declining, whereas we know that the evidence is very strong that preventative measures can save money and improve health and quality of life. I think it's about getting it on the agenda now, and looking at how best to spend the money that is already there. We can spend it more efficiently, absolutely.

[Lisa Sullivan]

While I would agree—I support what you say, Janet—I think where I'm coming from is that obviously those people who are at end of life.... The reality, to put it frankly, is that the older you get, the more chance you have of dying. I'm sure you all know that. It's not something we can pretend isn't going to happen. The preventative piece, I think, is very clear, but we have a population that's living much longer with these chronic illnesses. They will need more supports as they move into their end-of-life process.

I think it is a paradigm shift to get government at all levels to think about how we support people living with these chronic illnesses as they age and how we take it out of acute care hospitals. Acute care hospitals are wonderful when you have an acute illness, but they're no place to be when you're dealing with a chronic illness or when you're at end of life.

We know that 75% of people would prefer to die at home, and “home” could be the retirement home or the long-term care home or the home they've lived in. We need to think about shifting those funds away from acute—trying to fix it—and into supporting people to live and die in their own home.

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

So it's critical that we deal with this now.

[Lisa Sullivan]

Absolutely.

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

Okay.

Mr. Shiner, thank you so much. We honour your service as a Canadian veteran. Sitting off to your right is my office chief of staff. She was with the Israeli military. Thank you for your service.

I'm probably out of time.

[The Chair, Liberal, Bryan May]

You have one minute.

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

Okay.

The savings are tremendous if we take people out of acute care and get them into hospice care. Do we have enough occupational therapists? You'll save us money. Do we have enough to do the assessment and make sure that people can age in place? You're critical. Do we have enough occupational therapists?

[Janet Craik]

Right now we're a workforce of about 16,000 across Canada. The employment rate is high at 93%. We do have some shortages as far the workforce is concerned. Fortunately, B.C., your province, is one place where we don't have the demand. The B.C. occupational therapy workforce requires input from those trained out of province. It has the largest percentage of out-of-province trained therapists. Ontario is another province that relies on a big influx of occupational therapists. Saskatchewan is another region where the percentage of occupational therapists serving the community is very small. The pressure has been on the government since 1966 to get an occupational therapy school in Regina.

So there are some workforce issues. Globally we are a strong workforce as well. We can rely on internationally educated occupational therapists.

You mentioned acute care. We are failing seniors if they land in acute care. I think we have to look at hospice models and community-based programs. Once they're in acute care.... It's not the place for them.

[The Chair, Liberal, Bryan May]

Thank you very much.

Mr. Ruimy, please.

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

Thank you very much. I'll be sharing my time with the parliamentary secretary, Adam Vaughan.

We've been hearing the same themes with all of our witnesses: isolation, loneliness, community, housing, and that sort of thing.

Mr. Shiner, again, thank you for your service, sir. The Yom Kippur War was quite an event.

You brought in a stat that I hadn't heard yet, that 93% of seniors don't plan to age in home. Is that correct?

[Dr. Donald Shiner]

They don't plan to ever leave their home. They have no plan. They deny it.

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

They have no plan to leave their home. Okay. So how do we as a government change that mindset? It is a mindset.

[Dr. Donald Shiner]

Yes. We need an education program.

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

Give me two or three things, for example, a policy change, that you think the federal government could do to encourage that. Let's face it, if you're not planning for this, if you're not planning for retirement, if you're not planning for anything, then you're not moving anywhere.

[Dr. Donald Shiner]

It's magical thinking. We exist in a world of magical thinking. We believe we are never going to grow old and get sick; therefore, we don't prepare for that future.

We need to undertake education. Those under 70 need to do their home construction incorporating lifetime home standards. Around 60 or 70 is pretty well when you stop building new homes. At 60- or 70-plus, you renovate. We need to make sure those renovations are done right, economically and efficiently.

The third group that needs education is Canadian home builders. They need to understand that we have evidence from England and New Zealand, where the lifetime standards are very entrenched, that it costs approximately $1,400 to incorporate the design changes at the time of building the home—$1,400, and you have a lifetime home.

Just think of the young child who breaks a leg at hockey or soccer and comes home in a wheelchair. They have to be carried up the front steps. They have to be carried up to their bedroom. They have to be assisted in the bathroom. If your grandmother is getting out of the tub and falls towards the bathroom door, and the door opens inward, it would require the emergency response crew to break it down while your grandmother is lying there naked on the floor. Why is the door built to open inward? It's not in the building code.

We do things without thought. We need to educate people so they think about this and prepare to take responsibility themselves.

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

Thank you.

I'm going to pass my time to Mr. Vaughan.

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Thank you. I have a couple of questions.

You say there is an emerging market, a clear need and clear cost savings and therefore profit. Why hasn't the private market responded, then? Why would some suggest that we rely on the private market to provide this housing, if the private market is not responding?

[Dr. Donald Shiner]

Some builders are trying to respond. There is a stigma about aging, and there is a perception that a lifetime home looks like some place that you would retire to, with grab bars and other things. I have a very good friend who heads HomesRenewed, the American program on aging in place. He is a carpenter, and he says that the best solution to aging in place is a two-by-four, a hammer, and some nails at the time you are building the bathroom, in the right place. It costs pennies.

It's just that kind of thinking that we don't have.

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Universal design.... If the government, for the first time in well over a decade, is now going to step in and start building new public housing, would you support thresholds around universal design to accommodate an aging population, as well as people with disabilities?

[Dr. Donald Shiner]

It has to be, for visitability—we can call it “visitability”—for lifetime home standards, and for accessibility. They are all the same ball of wax. Of course, any public building should incorporate those standards.

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

You mentioned that 93% of people believe they are going to age in place comfortably and stay in their homes, but that is a tricky number because they are not living in homes that work. Just having the housing is not enough; the adaptability of the housing is the critical component of it.

[Dr. Donald Shiner]

When I say 93% of Canadians.... As they approach older age, they don't think about aging in place. They believe they are going to be healthy enough and well enough, so they don't make any preparations. They don't think about it until the emergency—the broken hip or the accident. We need to help educate them so they think about taking responsibility themselves for getting things ready ahead of time.

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Lisa Sullivan, you talked about hospice care, but hospice care for people who are homeless and people with psychiatric needs or addiction issues is often just beyond their reach. Does your facility provide that segment of the population with hospice care? If it does, what are the assistances that are available to you?

[Lisa Sullivan]

We are really fortunate in the city of Ottawa. Hospice Care Ottawa does not have a particular target of street-involved population, but we have another partner in the community called the Ottawa Mission. Their entire focus is the street and homeless population. What we find with the street and homeless population for end of life is that it comes back to this notion that we look not just at the last couple of weeks of life, but at chronic illness. Those on the street dealing with chronic illness are going to have a lot more complications. The mission has a number of beds but also provides service on the street for people.

[Adam Vaughan, Liberal, Spadina—Fort York, ON]

Would you support a move that may not be directed specifically at seniors, a move toward supportive housing for people with chronic conditions as a way of managing hospice care at the end of life?