Human Resources Committee on Nov. 9th, 2017

[Lisa Sullivan]

Yes, that's not what I'm saying exists; I'm saying that's what I think we need, because that chronic population is going to be all of us. We're all living longer, and it will be seniors and supporting people wherever they are, whether that is in their home or—

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

We also have an issue with transformation in public attitude towards members of our community or families who are lesbian, gay, bi, transsexual, or two-spirited. There is a phenomenon of going back into the closet to fit into seniors programs, because all of a sudden, you're in a generation that maybe hasn't experienced the transformation.

[The Chair, Liberal, Bryan May]

We're going to have to come back.

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

I'm curious as to what policies you have in place and what policies you would suggest.

[The Chair, Liberal, Bryan May]

Be very brief, please.

[Lisa Sullivan]

That's really interesting. We do a lot of training with our staff and volunteers even on language around admission so that we're not asking people their gender, for example, or husband or wife. It's partly presenting yourself as an inclusive organization that I hope will break down those barriers.

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

If public money is there, that should be—

[The Chair, Liberal, Bryan May]

Sorry, Adam, I have to cut you off.

Rachel.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you, Chair, and thank you all so much for being here.

Before I start with my questions, I would like to ask you quickly to answer one question with a yes, no, or abstain. Do you believe the government should implement a national seniors strategy?

[Dr. Donald Shiner]

Yes.

[Nicola MacNaughton]

Yes.

[Janet Craik]

Yes.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Everybody said yes. Thank you so much for that.

Ms. Sullivan, thank you for being here today. I was a volunteer for hospice, so I really appreciate the work that you do, and I know how incredibly meaningful it can be for families when they're in such a lovely space and how important it is for the families as well who suddenly have access to being comfortable when somebody they love is dying. Thank you so much for your work.

In your strategic plan from 2016 to 2019, you definitely identified funding as a major challenge for your organization. How are you funded? You're talking about having to raise $2 million a year. Are you funded provincially or federally? Is there a wider gamut? How does that work?

[Lisa Sullivan]

Our funding is provincial. We're funded through the LHIN, our local health integration network, which is, as you know, our arm of the health ministry funding. We're funded differently for our community and our residential programs, but in total it works out to less than 60% of our costs, so the rest is fundraised. That's one of the reasons volunteers are critical to our services as well.

[Rachel Blaney, NDP, North Island—Powell River, BC]

I ran a non-profit organization for eight years, so I really understand the challenges of paying the administrative costs that are so imperative if you're going to do the work of raising money. It is an important thing to understand that the volunteers really add a profound service, but if we don't have the resources to hire the appropriate people to manage those volunteers and to administratively support fundraising, it can be a huge challenge.

[Lisa Sullivan]

Yes, exactly, and I would even add that most of our volunteers are seniors, depending on what the age cut-off is. It's very fulfilling work for seniors. They play a really key role, for sure, in the work we do.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Perfect.

The Conservative government stopped investing in Canadian Institutes of Health Research funding for palliative care in 2009, and then they disbanded the end-of-life care secretariat and stopped work on the national palliative and end-of-life care strategy. That's important, because we know that end-of-life care and having a strategy for that is so important.

Do you think an end-of-life care strategy should be part of a national seniors strategy, and how could additional research be beneficial for hospice and palliative care?

[Lisa Sullivan]

As I said earlier, I do see the end-of-life strategy as part of aging and seniors and how critical it is to stop fooling ourselves. Not only are we going to need more supports, but we all eventually will die, and it's very costly to die in a hospital. Nobody wants to die in a hospital, so end-of-life care has to be incorporated in that.

The other piece I'll quickly add, which I didn't mention and is the elephant in the room, is about medical assistance in dying. One of the things we've been advocating strongly for is that although that is a human right and it's legal for people, it's not part of the hospice care philosophy, and if we're making that available to people, we have to make quality hospice palliative care available to people, too. It's not an either-or, and that's always a concern when there is funding and strategies around medical assistance in dying.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you so much.

One of the things we know is that this is a huge savings to the taxpayer as well. I think the difference is $640 a day, which is very significant. How does it work? How do you coordinate this type of approach? There is no coordination around the system of end-of-life care despite the growing need, so how would this move forward, if it could?

[Lisa Sullivan]

I can only speak from the Ontario perspective. I think we actually have made some good strides in Ontario in the coordination of hospice palliative care. All the LHINs are required to have a coordinated regional palliative care program. It's not perfect, but at least everybody's talking together. In Ottawa particularly, we modelled a central referral and triage system so that anybody who is requiring hospice palliative care doesn't have to go to six different people to get six different services. We work with our home care and our LHIN. I think that's a good model. It needs more support, again, because I think the funding needs to be directed into the community.

I'll just clarify, too, that when I talk about hospice care, although we have residential hospice beds, hospice care can and should often be delivered at home. That really is poorly funded. There isn't the support to coordinate that care and support at home over a long trajectory.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you so much.

I'm going to move to Mr. Shiner.

I just have a couple of seconds, so I will come back to you in the next round.

I think you've done a really good job in your report identifying the challenges involved with aging in rural Canada. Can you give us some recommendations as to how the federal government can be a positive actor in reducing some of those barriers?

[Dr. Donald Shiner]

The most important action I've seen, from all my research, is that we need to encourage lifetime home building. I'd love to see it incorporated into the Canadian building codes. I know how difficult that is as a challenge, but we need to build homes for the future that people can live in with full accessibility, homes for life. If we don't start sometime, it means we're always building homes that are not very accessible.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now we'll go to MP Sangha, please.

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Thank you, Mr. Chair, and thank you to all the witnesses for participating here and giving valuable input.

We have heard everybody discussing caregiving for seniors, maybe long-term care or in their own homes. We have also talked about isolation and exclusion. Professor Adegun has talked about loneliness and seniors' empowerment and all those things.

My question is for the Canadian Association of Occupational Therapists.

What do you suggest to the committee for seniors who are not critically ill but are living in their own homes? Could you indicate four or five things to consider for better living in their homes?