Human Resources Committee on May 13th, 2021

[Laura Tamblyn Watts]

Thank you for your question, Mr. Lauzon.

We have taken some steps forward. However, as an example, the money given to domestic violence was $350 million off the bat, followed by another $157 million. When we compare that with the zero dollars for elder abuse and neglect, we see a stark difference between how government responses have been thinking about older people. Again, we think a federal seniors advocate would have supported government in understanding that resources around things like abuse and neglect were going to be critically important.

We do thank the government for its investments. We think the work with United Way was critically important in particular. Where the challenge has ever been with the new horizons for seniors program—I've been very involved with new horizons for more than 20 years—is that they tend to be one year only, with the rare exception of a few multi-year programs, and predominantly pilot-based, with a need to show sustainability. The new horizons for seniors program has been up for review many times. The review process is always the same. Make it more easy for renewable funding and not make it always a one-year program. Elevate that $25,000 to a more meaningful level, or at least allow three-year programming after $75,000, so communities can provide supports. We know that austerity is coming. We know that the first things that get cut are seniors programs. Certainly this is going to be a matter where we need to institutionalize support for seniors and not make just one-time payments.

The last thing I would offer is that it was excellent to see that $500 payment, and again a bit of a support next year as well, to support older people directly for elevated expenses that they have. If you compare that one-time support to ongoing monthly support for children and youth in need, women in need, and others such as CERB, we see that really the answer is more of a universal basic income answer rather than a one-time cost.

Older people have dramatically more expenses in terms of delivery, in terms of transportation, and in terms of different types of medical care during COVID-19. I think it would be helpful to think about how on an ongoing basis older people could be supported with the elevated costs caused by COVID-19.

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

Thank you for your response.

Both witnesses can answer my next question, starting with Ms. Ferrier.

Earlier, you explained why there was a difference and that the pension increase applied only as of age 75.

Do you agree with us that the key is to focus on the most vulnerable people?

We know that half of our seniors, starting at age 75, begin to suffer from a disability. Picture yourself at that age, suffering from a disability, when half of disability cases are considered severe. These people often can't even stay in the same place. In 57% of cases, these people are women. In four out of ten cases, these women are widows. Yet 50% of these people have an annual income of less than $30,000.

That's why a responsible government should take concrete steps to help seniors aged 75 and over.

Based on these statistics, would you say that the government is making a good decision by helping people aged 75 and over, rather than providing less support to everyone, or even providing support to people who are wealthy at the age of 65?

[Miranda Ferrier]

I agree with what the government did by only focusing on those who truly need the help. I think that's of great importance.

However, I'm concerned about those who may be just above the threshold of what the government entails as struggling from the age of 65 up. My only concern is what that threshold is going to be and how we can ensure that they're all taken care of at the end of the day.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lauzon.

That concludes this panel.

Ms. Tamblyn Watts and Ms. Ferrier, you may have heard at the start that I said this was meeting number 34. I don't think I have ever said this: You made my job easy today. Your answers were concise, but extremely well thought out and informative. We're off to a really good start on this study thanks to you.

Thank you so much for the work that you're doing in support of our seniors and those who care for them, and for your testimony here today. It is greatly appreciated.

[Laura Tamblyn Watts]

Thank you, everyone.

[The Chair, Liberal, Sean Casey]

Colleagues, we're going to suspend while we get ready for the second panel.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order.

Today's meeting is on our study of the impact of COVID-19 on seniors.

I have a few comments for the benefit of our witnesses. Before speaking, please wait until I recognize you by name. When you're ready to speak, you can click on your microphone icon to activate your mike.

Interpretation is available in this video conference. You have the choice, at the bottom of your screen, of floor, English or French. When speaking, please speak slowly and clearly. When not speaking, your mike should be on mute.

I would like now to offer you a warm welcome to the committee to continue our discussion. You will have five minutes for opening remarks followed by questions.

We have with us today, from Age-Well, Alex Mihailidis, scientific director; and from the National Institute on Ageing, Samir Sinha, director of health policy research.

We'll start with Mr. Mihailidis for five minutes.

Welcome to the committee, sir. You have the floor.

[Dr. Alex Mihailidis, Scientific Director, AGE-WELL]

Thank you, MP Casey and members of the committee.

My name is Alex Mihailidis, and I am the scientific director and CEO of the Age-Well networks of centres of excellence. I am also a professor at the University of Toronto, having specialized in the area of technology to support older adults for the past 20 years. Age-Well is Canada's technology and aging network.

During this pandemic, we have seen older adults and their caregivers stay resilient, like all Canadians, with the help of technology. All of us are wondering what the world will look like post-pandemic. We can say with certainty that technology will play a much larger role in the lives of older adults and caregivers. With the increase in the use of telehealth, it's not an exaggeration to say that technology is going to help transform the care that older Canadians receive. We anticipate this across all settings, hospital, community, home, and long-term care, where the pandemic has resulted in devastating consequences.

Are older adults receptive to technology? The answer is yes. A poll commissioned in July 2020 by Age-Well shows that COVID-19 has significantly increased the use of many technologies among older Canadians. The poll surveyed over 2,000 Canadians age 50-plus, who are representative of our country's provinces and territories, and used a mix of online and telephone surveys.

More than six out of 10 Canadians age 65-plus agree that technological advancements can help to lessen the impact of COVID-19 on their daily lives. The majority agree that technology can help them maintain relationships, reduce social isolation, pursue hobbies, manage all aspects of health, and stay safe, independent and active as they age.

These trends are driving a multi-trillion dollar age tech market internationally, and Canadians are no different. The majority of those age 50-plus, which includes the future generation of seniors, are willing to pay out of pocket for technology that allows them to stay at home as they age.

Many cutting-edge technologies that benefit older adults are in development, and some are on the market. At Age-Well, the backbone of Canada's age tech sector, research teams and start-ups have over 100 technology-based solutions in the pipeline or that are already making a difference in people's lives, including during the pandemic.

What is age tech? It is anything from glasses on your face, to smart home systems to support aging in place, to mobile health apps and platforms designed to enhance safety and quality of life for residents in long-term care.

I want to emphasize that the timeline for implementing such solutions has moved up dramatically because of COVID-19. People want these technologies now. Even after the pandemic passes, these innovations will be needed to enable people to live longer in their own homes and to ease the increasing pressures on the health care system.

Age-Well is actively working with long-term care providers, such as with the City of Toronto and elsewhere, to determine the technology needs and to implement solutions today.

Here are three ways in which we can accelerate the delivery timeline:

First, the Canadian government needs to increase investment in Canada's age tech start-ups, so that products get into people's hands sooner. Canada's gross domestic expenditures on research and development as a percentage of GDP declined almost 16% over the past 10 years, while other OECD countries grew by approximately 10%. We need to change the storyline in order to continue being an international leader in the age tech space.

Second, we need to accelerate actual access to broadband Internet, which is often a challenge in rural and indigenous communities. In our modern society and in a country like Canada, access needs to be considered a basic right. In long-term care and seniors residences, Wi-Fi must be available.

Finally, supporting clinicians to integrate apps and other new technology into their clinical practices is key for transforming Canada's health care systems. The federal government can play a role in this by earmarking funds for assistive technologies that help with low vision, hearing, cognition and social inclusion, which are critically important for seniors.

As a Canadian organization driving forward Canada's age tech sector, Age-Well will continue to work with key partners in industry, government and community groups to guide and increase the impact of homegrown innovations.

Seniors and caregivers, whose involvement is essential, will be with us every step of the way to ensure that emerging technologies are practical, and will be adopted now and post-pandemic.

Thank you very much for this opportunity to speak with you.

I welcome any questions from the committee.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Mihailidis.

Next we have Dr. Sinha for five minutes.

Welcome to the committee.

[Dr. Samir Sinha, Director, Health Policy Research, National Institute on Ageing]

Thanks, Mr. Casey, and members of the committee.

I'm Dr. Samir Sinha, and I'm the director of health policy research at the National Institute on Ageing.

The NIA is a Ryerson-based think tank focused on addressing the realities of Canada's aging population. Additionally, I serve as the director of geriatrics at Sinai Health and the University Health Network. I was recently appointed as a member of the federal government's National Seniors Council and invited to chair the Health Standards Organization technical committee that has been tasked with developing the new national long-term care services standard for Canada.

First of all, I want to take a moment to acknowledge the 23,253 older Canadians, representing 95% of Canada's deaths thus far from COVID-19, as well as their families.

There's a growing public discourse on the role of governments to address the inadequacies of our supports for older Canadians during the pandemic, including the provision of long-term care, and growing calls for the federal government's greater leadership in these areas. While other countries have acted clearly and decisively to develop stronger systems of long-term care for seniors as they've aged, Canada didn't. This inaction cumulatively helped to sow the seeds of this tragedy we've been witnessing, where 62% of Canada's deaths to date from COVID-19 have occurred in LTC settings, the highest rate of any G20 country.

I publicly noted early on that while LTC homes were becoming the epicentres of Canada's pandemic, there was no national mechanism in place to track these outbreaks in a consistent way. Neither PHAC nor CIHI were doing this. Our NIA, thus, took on the task to systematically collect all the data related to resident and staff cases, and deaths at individual home levels across Canada. Had we not done that, the truth of what happened in long-term care might have remained obscured.

Our highly accurate record, developed with CIHI support, has become the basis of many important studies and analyses. However, my point here is that something important like this should not have been left to the goodwill of provinces or a university research centre, but should have been a clearly enabled function of the federal government's pandemic response. Moving forward, clear protocols and systems need to be in place in future to ensure we're never caught off guard like this again.

PHAC was helpful in coming up with some early guidance to help the provinces and territories look at more standard infection prevention and control measures, and the treatment of COVID-19 cases in long-term care settings. However, it's not clear why the agency could not have been enabled or supported to provide much needed guidance to the provinces and territories to navigate other important challenges, such as addressing the effects of social isolation and resident access to family members.

It was our NIA, on our own initiative, that decided to lead on the creation of national LTC guidance. First, the release of our spring 2020 “Iron Ring” guidance continues to serve as the evidence base around how the provinces and territories should respond to COVID-19 in congregate care settings. We've now updated that three times.

In July 2020, we released our “Finding the Right Balance” guidance document to support the reopening of Canadian long-term care homes to family caregivers and visitors. With the majority of LTC residents and staff being now vaccinated, the lack of guidance being issued, as the CDC has done in the United States, is forcing residents and families in homes across too many parts of the country to remain isolated from each other, producing serious physical and mental health consequences.

Again, the NIA is helping to develop new evidence-based guidance to enable our provinces and territories to safely reopen their homes, but it should be the official government bodies, like PHAC, leading this work.

I'm glad that the federal government is now providing much needed leadership with the creation of new national standards for long-term care. Enabling this with $3 billion will also be helpful to ensure the provision of a more consistent and higher standard of care across Canada. In being asked to chair the HSO's technical committee, I am thrilled to see an unprecedented level of public engagement in this work so far.

In the future, with our NIA research showing that at least 430,000 Canadians have current unmet home care needs, while more than 40,000 are on wait-lists for long-term care homes, even before the pandemic, we need to do more to support Canadians to age well and in their own homes for as long as possible. Our research shows that Canada spends 30% less than the average OECD country on the provision of long-term care, and close to 90% of our public LTC dollars are spent on institutionalizing people rather than caring for them in their own homes where they want to be.

Our NIA's “Pandemic Perspectives” report shows that virtually 100% of older Canadians want to do everything possible to remain in their own homes for as long as possible. Our “Bringing Long-Term Care Home” report shows that this could be done well and for lower costs for many people currently in our long-term care settings. Of course, people have the right to pay privately for their own home care services, but this is not an option for the majority of Canadians who don't have the financial resources to do so.

The recent commitment to increase OAS payments for Canadians 75 and older will enable some to better meet the growing costs associated with aging and aging in place, but we need to think bigger, as other countries have, perhaps by enabling the creation of a national long-term care insurance program or further improvements to the guaranteed income supplement program for lower-income older Canadians.

Where do we go from here? While it's good that most political leaders have agreed that long-term care is broken, we need to ensure that we pair our immediate actions with efforts to determine how best to fix and fund the long-term care system that all Canadians should look forward to as they age. In this regard, I am glad that our NIA has been helping to ensure that we can define the issues properly, ask the right questions and find the right answers and ways of implementing them as quickly as possible.

Much of what we need to do has been well known for years. Luckily it isn't rocket science, but it will take political will and a federal, provincial and territorial coordination of efforts. We thus recommend that the federal government fully support the work ahead that will enable the creation of new national long-term care standards and help its provinces and territories in addressing these issues once and for all.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Sinha.

We will now proceed to our rounds of questions.

We'll begin with Ms. Falk, please, for six minutes.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Thank you, Chair.

Thank you to both our witnesses for coming today and contributing to this committee study.

With an aging population, we need to ensure there is a better continuum of housing and care needs for seniors in Canada. There seems to be a consensus among older adults and seniors that they would prefer to age in place and live independently as long as possible.

I noted that in the National Institute on Ageing report released last fall, “Pandemic Perspectives”, a significant number of Canadians indicated that COVID-19 changed their opinion on whether they would arrange for themselves a nursing or retirement home. Given what we know, this change of perspective isn't surprising to many of us.

I'm interested to hear your perspective, Dr. Sinha. You yourself said early in the pandemic that if your mother were in long-term care, you would have pulled her out. Do you think that change in perspective is permanent? In addition to improving the standard of care in long-term care homes, which we know will not be an easy task, what do governments need to do to prioritize to respond to that change in perspective?

[Dr. Samir Sinha]

Thank you very much for that question, Ms. Falk.

The report we put out last fall really spoke about that shifting perspective, where 60% of Canadians said they were reconsidering whether they or a loved one would want to live in a retirement or long-term care home in the future. We followed up that report with another survey in partnership with the CMA. It basically showed that virtually 90% or more of Canadians, and especially close to 100% as they age, now will do everything possible to avoid going into a long-term care home.

Over this pandemic, I think those views have been solidified more than ever. I think the challenge is that now most Canadians are well aware of the shortcomings. They are really looking for change in the sector before they begin to trust it again.

These perspectives are real, and we have to understand them, but I think they can also galvanize an opportunity to not only improve the way we provide long-term care but also think about the value proposition of being able to provide more supports and services to help older Canadians age in the place of their choice, which is often their home. As I mentioned in my opening statement, close to 90% of our publicly funded long-term care dollars are spent on institutionalizing people, whereas if you look at Denmark, for example, they're actually spending two-thirds of their publicly funded long-term care dollars to support people in their own homes. It can often be done cheaper and without worrying about massive infrastructure costs. It can be done in a much more flexible way that can meet people where they're at and when they need it most.

I think there's an opportunity here to re-examine how we provide that care and what the federal government's role can be in something that for now has also always been purely a provincial and territorial jurisdiction. Our federal government currently, in the recent health report, is spending $6 billion to increase the provision of home and community care, and now $3 billion in new dollars on top of $1 billion recently, to try to improve the provision of long-term care across Canada as well.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

I think, too, it is so important that seniors have autonomy. In the past it's just been “this is where you go; this is just how the continuum of life goes”, and I think it's so important that different levels of government, where applicable, do what they can so that seniors can still have autonomy and choices in life.

Alex from Age-Well, I'm wondering if you have anything to add to that. What role could the age tech sector play in helping seniors live independently?

[Dr. Alex Mihailidis]

Thank you very much for that question.

I fully concur with Dr. Sinha's remarks around people wanting to remain in their own homes. Even in our own survey related to that, we found that during the pandemic, only 40% of those who responded to our surveys said they felt comfortable aging in Canada. That number dropped from approximately 60% before the pandemic.

Technology can play significant roles in keeping the autonomy of older people in their homes and communities. For example, we found that the number of older people who are now using social media to reach out to their friends, family and social circles has risen to approximately one-third of those who were surveyed.

We're seeing an increase in the number of older people who are using online tools for even online shopping. We even saw an increase in online dating among seniors with the pandemic as well.

We're starting to see these tools make their way into everyday use.

The one thing to consider, as well, is that it's a new demographic of older people that's coming very quickly with the baby boomers, where technology is mostly already integrated into their daily lives. This expectation is going to continue as they age.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Thank you.

Dr. Sinha, I have one quick question for you.

Given your background in geriatrics, I'm wondering what the solution is for addressing the shortages in geriatrics and also in palliative care. We do know, with the debate on medical assistance in dying in the House not long ago, members of Parliament noted the inadequate manpower that is in those [Technical difficulty—Editor].

[Dr. Samir Sinha]

That's an excellent question.

[The Chair, Liberal, Sean Casey]

Please be brief, if you can, Doctor. Thank you.

[Dr. Samir Sinha]

Yes.

Currently we have more older Canadians than younger Canadians, but we have nine times as many pediatricians as we do geriatricians. There are only 305 registered geriatricians in the country. Again, when we talk about palliative care specialists, there are not as many as there need to be. This is where we're calling for a national human resource strategy, or at least targeted investments.

The federal government, for example, could lead to try to promote training. We have more people applying for training positions than there are currently funded, and that's not helping us reach the critical mass we need to meet the needs of an aging population.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

Ms. Young, you have six minutes, please.

[Kate Young, Liberal, London West, ON]

Thank you very much, and thank you to our witnesses today.

Mr. Mihailidis, I want to first comment that my father, who passed away eight years ago, was so engaged with technology. He had his own Facebook page. He used it to communicate with his younger relatives in Scotland and Vancouver. He really took to it. I think there is a sense that older people shy away from it, but I think that's a fallacy in many cases.

I want to talk to you about getting young people engaged in and thinking about this next generation, how they can get into jobs that would support our aging population and what you think the federal government could do to encourage that.

[Dr. Alex Mihailidis]

That's a great question, Ms. Young. Thank you very much.

I love to hear those kinds of stories, like the one about your father. I hear similar stories everywhere I go. It's wonderful to hear and see the uptake.

You're right. It is a complete myth. The number one consumer group using smart phones in terms of increasing sales are those over 65. Technology is becoming more pervasive.

In terms of getting young people involved, actually, we're not seeing an issue. We're seeing an issue in trying to accommodate the number of young people who wish to get involved in this area.

That's what Age-Well has been doing. Age-Well has a very extensive training program, where we train current masters, Ph.D.s and undergraduate students in the area of age tech. In our first seven years as a network, we have put over 1,000 trainees through that program.

Many of them are not academics anymore. Many of them are doing their own start-up companies. Many of them are working in industry. Many of them are working in policy in government. Age-Well, alone, in the first six years has supported 46 start-up companies in this area, many of which are actually starting to make a little bit of money, which is always wonderful to see.

This is where we need to support things. We need to support the age tech sector to continue to grow. We need to encourage these young Canadians who are coming out of areas such as computer science and artificial intelligence. We are presenting really challenging and interesting problems for them to solve, and that's really what hooks them.

We need the support for our start-ups in the area of age tech, but also the support of well-established industries and companies that realize their number one consumer will become older as well, to help them make that transition into the area to learn about the age tech sector and, more importantly, to learn about seniors themselves.

[Kate Young, Liberal, London West, ON]

Thank you so much.

Dr. Sinha, I've been encouraging my residents to visit longtermcarestandards.ca to share their input on the topic of long-term care standards. As the chair of the technical committee, how will you use this type of information that you'll be getting to come up with ideas for long-term care standards?

[Dr. Samir Sinha]

This is an important question. It is an important task ahead. My colleague here is also the chair of the sister committee, if you will, which is the CSA committee that will be helping to develop the complementary set of standards. We're both working closely together as chairs and our committees will be working closely together.

One of the key goals that we both set out as chairs is to have deep public engagement. For example, many times when committees like this exist where the work is done, people are not aware of how they can get engaged. Many people have a lot of things to say.

Close to 4,000 people have already completed the initial survey that we put out. This is everything about what they want long-term care to look like and what issues are important to them. We have asked people to comment on the themes on a very broad basis, just so we can start hearing what matters most to Canadians, so that we do come up with standards that actually reflect what Canadians currently want and need and what they think is currently lacking.

This is only a start. We are also planning as chairs to lead the development of town halls and round tables and really do deep public engagement. The public will have an opportunity to do what we call a public review of our draft standards in January 2022, so that we can get more feedback. At the end of the day, when this feedback comes in, we want our committees to see what Canadians want and need.

That's why we're really looking forward to all the input we can get, so that when these standards come out, people can say that they are the standards that they respect and that they want. The standards then can become more broad-based in their use across the country, whether it be for accreditation, funding, enforcement, inspections or even new legislation.

That's what we're hoping to get from the feedback that we're soliciting right now.