Human Resources Committee on June 1st, 2021

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Mackenzie.

We're going to proceed with those questions forthwith, beginning with Ms. Falk for six minutes, please.

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

Thank you so much, Chair.

I'd like to thank all of our witnesses for their contributions to this study and making time to come to our committee meeting today.

Seniors living in long-term care have been at the centre of the health crisis and we know that no senior has been immune to the challenges that have been brought on by this pandemic.

My first question is for the Coalition pour la dignité des aînés.

Your organization released 38 recommendations to ensure dignity in living for seniors. How has COVID impacted the priorities and needs of seniors? Would these recommendations have differed before the pandemic?

[Lise Lapointe, Member and President, Association des retraitées et retraités de l’éducation et des autres services publics du Québec, Coalition pour la dignité des aînés]

Can I answer the question?

[The Chair, Liberal, Sean Casey]

Yes, absolutely.

[Lise Lapointe]

The coalition focused more on short‑term and medium‑term solutions that would alleviate hardship for our seniors. It took a crisis of this nature to expose many of the shortcomings that already existed but that had hardly been addressed, despite extensive investigations and research into the challenges faced by our seniors.

Abuse is still happening. Some would say that it's organizational abuse. However, the current issue is much bigger than previously suspected. That's why the coalition quickly took steps to ensure that our seniors are given a little more consideration.

It was necessary to send in the army, which reported degrading and disagreeable situations. This gave us a true picture of the situation of seniors living in long‑term care facilities in particular, but also in seniors' residences. This is how we were able to elicit responses.

We're asking for better home support. The budgets never meet the needs of the people. Normally, there's a set amount of funding. However, after a while, there's nothing left. The needs that have come up in the past few months are barely or not being met. It's necessary to reinvest in home support.

It's important to consider that seniors play a role in society. Before, we rarely heard about seniors. They weren't necessarily mentioned in policies. The Quebec and federal governments didn't talk about the need to invest more in building repairs or in making sure that air‑conditioning systems worked properly during heat waves. These matters weren't part of the discussions or among the issues raised.

A number of issues already existed. However, unfortunately, the situation deteriorated during the pandemic. We hope that the federal and provincial governments will listen to our requests.

The Canadian provinces could also benefit from certain federal measures, given the fact that seniors have a role to play, and it must be a prominent role.

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

Thank you.

Ms. Mackenzie, I'm wondering if you want to add to that from your perspective. How have seniors' priorities and needs shifted through the pandemic?

[Isobel Mackenzie]

It's been over a year now, but in the beginning, as you will recall, there were shelter at home orders, so really it was about getting groceries, medications and meals to seniors. That sort of faded a bit, as what came to the forefront was what was happening in long-term care. That became a continued focus as family members continued to be separated from their loved ones for what will now be over a year. That shifted as well.

I do think the issues around the lack of supports in the community that were there before COVID certainly was revealed more starkly during COVID. I think that's a theme you'll probably hear quite frequently, that these are not problems created by COVID, but these were problems exposed by COVID.

Most of us knew of these problems. I would say for me what was new—or under-appreciated might be a better way of putting it—is the degree to which we heavily marginalize the role that family members play. We saw that in our approach to visits in long-term care. We really have a lot of introspection and soul-searching to do as a clinical community. Basically, we pushed families out of the way and said, “Let us do our job; you're a visitor.” Different provinces dealt with it differently over time.

This issue around home care and supporting seniors at home I think is going to become more pronounced because, although the desire was there before, as we experience COVID, there is going to be even greater desire for people to stay at home. We need more federal level, and I don't know if leadership is the right word, but enforced standards and expectations around what people receive in terms of help at home.

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

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Falk.

Mr. Housefather, you have the floor for six minutes.

[Anthony Housefather, Liberal, Mount Royal, QC]

Thank you, Mr. Chair.

I want to thank all the witnesses for their hard work to support our seniors. We're very grateful to them.

I am going to start with Ms. Mackenzie.

During the course of COVID, in my riding, I had numerous long-term care facilities where many, many people died. I had four facilities where over 50 people died. I watched facilities that were not only understaffed but underequipped in the sense that there were four people to a room where there should not be any more than one or two in today's society. I saw very well-meaning but underpaid and understaffed nurses and PABs. I saw families kicked out and caregivers who were meaningful and necessary to the patients kicked out. People died not only of COVID, but of neglect. It was a tragedy.

While this is within provincial jurisdiction, Ms. Mackenzie, you talked about enforceability of national standards and how they could be made meaningful. Could you talk a little more about whether or not you agree that national standards are important in this case and how they could be made meaningful and enforceable?

Thank you.

[Isobel Mackenzie]

I do think we need national standards, but as I said, the standards mean nothing if there is not enforcement and monitoring of those standards, so how is that meaningful? They have to be measurable, and there need to be consequences for noncompliance. Whether that is achieved by the mechanism the federal government already uses in health transfers—surgical wait-lists have to be managed a certain way, and provinces are not allowed to extra bill—would lead to financial penalties in the transfer payments from the federal government.

Those are levers that are available for the federal government to use that could push the provinces to demand better accountability from their care homes, whether they're operating them publicly or whether they've contracted with a private operator to operate them. I can't understate the importance of openness and transparency. The public wants this. They will drive this, and if it is known who's meeting standards and who's not, and where the money is going, I think the federal government will have the support of its citizenry.

[Anthony Housefather, Liberal, Mount Royal, QC]

Thank you, Ms. Mackenzie.

Ms. Lapointe or another witness from the coalition can answer my questions.

I understand that, in Quebec, the issue of federal standards is more sensitive, even though we're working with the province. However, as a member of Parliament from Quebec, I believe that national standards are necessary in this area. I have two questions.

Does your organization agree with the national standards, even if they aren't included in the 38 priorities?

Is the $90 million in funding for home support, as promised in the federal budget, a good step when it comes to your priority of keeping seniors at home for as long as possible?

[Rose-Mary Thonney]

Can I ask Mr. Lynch to respond?

[Pierre Lynch, Member and President, Association québécoise de défense des droits des personnes retraitées et préretraitées, Coalition pour la dignité des aînés]

Of course.

We've had a hospital‑centric health care system for a very long time. It has also long been predicted that more than 20% of the population will be over the age of 65 at some point. The demand for services and care will become quite different. Right now, a generation of seniors, the baby boomers, the people aged 75 and over, have suffered and died as a result of the pandemic in our long‑term care facilities. This wouldn't have happened if we had been prepared.

We may have standards across Canada, not just in Quebec, but they mean nothing if no one implements them.

I often visit long‑term care facilities because I know people who live in them. I can see that the department visits only every three years. In a public long‑term care facility, the visits are more frequent. In a private long‑term care facility, where the CISSS or organizations often rent places given the lack of space in public long‑term care facilities, the visits are every five years. We may have very strict standards. However, if no one enforces them, the standards won't work.

Certainly, the lesson from the pandemic's first wave is that our long‑term care services needed to be just as ready as our acute care services. This wasn't the case in terms of equipment, preparedness, training and the emergency response.

I witnessed the Canadian Armed Forces enter a seniors' residence here in Laval, where I live. At one point, among the 60 or so employees who work in that residence, 40 were sick with COVID‑19. It took specialists such as members of the Canadian Armed Forces to go in and get things under control.

We aren't prepared to deal with pandemics. Moreover, this won't be the last pandemic. It's the first, and it's a good warning. We must be better prepared and more proactive.

We're at the vaccination stage. One major issue in Canada is that we rely too much on foreign countries for our expanded immunization program, our vaccines and our biotechnology development. We need to reconsider how we build our industries in Canada and encourage pharmaceutical companies to come back here.

I don't know whether you're aware of this, but right now, we depend on the vaccines that enter the country. If there isn't any vaccine, we don't vaccinate anyone. At the end of the day, I believe that this is about preparedness and thinking outside the box much more than in a traditional manner. Unfortunately, our health care systems are used to thinking inside rather than outside the box.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Lynch and Mr. Housefather.

I'll now give the floor to Ms. Chabot for six minutes.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I also want to thank Ms. Mackenzie.

I want to acknowledge in particular the Coalition pour la dignité des aînés. In Quebec, the six member groups of this coalition are making a big difference in the lives of our seniors, and their influence extends beyond the people whom they represent.

Thank you for being here.

My first question is for the coalition representatives who want to answer it.

You quite clearly stated what steps the federal government must take with regard to the increase in the old age security pension and the guaranteed income supplement. People must be able to access these benefits at the age of 65, because they already have needs at that age. The Bloc Québécois agrees with this idea.

However, in addition to these enhancements, what concrete and direct steps can we take to improve the financial situation of seniors? Do you have any other examples to share?

[Pierre Lynch]

I would like to respond on behalf of the coalition a second time.

Of course, we weren't at all pleased about the lack of consideration given to providing this increase to seniors aged 65 to 75, who need it as much as the others.

A new financial allocation could also be created to improve the living conditions of people with the lowest incomes. Some countries provide insurance for seniors, which may be called different things. As a result of this type of top‑up program, people with an income of $18,000 could have a decent net income ranging from $24,000 to $32,000, depending on their city. The situation must be worse in Vancouver and Toronto than it is here. However, I can tell you that the cost of rent has risen dramatically in recent times and that this has negatively affected seniors in many ways. This would be a good first measure to implement.

The next step would be to improve the medical expense tax credits. Seniors are currently the main recipients of health care and they take many drugs. The eligibility threshold should be lowered from 3% to 1.5% for people aged 65 and over. This would provide some relief to the people most in need by ensuring a fairly significant reimbursement.

A number of companies have individual pension plans. Sometimes, for whatever reason, companies go bankrupt or become insolvent. A guarantee fund should be established to ensure that seniors can recover a portion of their pension fund in the event that the company where they worked uses the money for its own survival instead of treating the money as the former employees' retirement fund.

These are the three main measures that I have in mind.

Everyone would need a fairly significant increase in their old age security pension within a short time frame of two to three years. That way, the income of seniors could be increased from $18,000 to $24,000 quite quickly. This is necessary to ensure that these people can have enough money, not only to pay their rent, but to live decently.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you.

My next question concerns health. The whole issue of home support is a hot topic in Quebec. Even before the pandemic, people were asking for proper home support so that they could stay at home.

That said, we shouldn't throw the baby out with the bathwater, should we? Our public facilities house the people who need more care. These facilities will always be needed.

In terms of home support, how could the federal government provide tangible assistance to the provinces?

[Lise Lapointe]

Let me respond and also add to Mr. Lynch's response.

Yes, seniors have a standard of living that normally is not acceptable. Many people have complained about the measure announced by the federal government saying that it is discriminatory. Why shouldn't a person under the age of 75 be entitled to the same amount and a substantial increase in their pension income called the old age pension? We get calls from people who complain and are unhappy with the situation. So that needs to be addressed.

Our seniors don't invest in tax havens, that's for sure. It's also a fact that when they receive additional money, they can afford certain activities that they normally can't afford. This generates economic spinoffs, often at the local level. So you can understand that receiving a little bit more money from the federal government would actually allow them to afford cultural activities, transportation, or a little treat in the week or in the month, something that they normally don't get.

With respect to home care, yes, there is progress to be made. For example, to encourage home care, there could be a grant for the renovation of housing that seniors occupy. Of course, there is a program to help people with disabilities or deteriorating physical health adapt their homes to their situation. However, the forms are so complicated to fill out and the wait is so long that people often have to live two or three years in a house that is not adapted to their needs. So they will choose to go to a private seniors' residence or to a residential and long-term care centre, or CHSLD. So that's another measure that the federal government could improve.

On the other hand, on the municipal side, there should also be agreements so that seniors have access to free transportation. This would make it easier for them to get to doctors' appointments and other appointments without the need for a caregiver or companion.

These are some examples of measures that would not cost astronomical amounts of money, but could make life easier for seniors.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Lapointe.

Next we have Ms. Gazan, please, for six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you.

My first question is for the Coalition pour la dignité des aînés.

That is where my French will end, because I'm just learning French.

You spoke a lot about financial insecurity among seniors.

One of the things that I tried to champion after being elected was motion 46, for a guaranteed livable income for all, in addition to current and future income supports. One of my focuses, and I guess inspirations, is on much of what you said, that many seniors in Canada live in poverty and current benefits or guaranteed incomes are inadequate and sink seniors into poverty.

Do you believe that a guaranteed livable income—not survival, but livable income—in addition to current and future government programs of support are necessary to ensure that seniors can live in dignity in this country?

I will let one of you answer that.

[Rose-Mary Thonney]

Mr. Lynch, can you answer?

[Pierre Lynch]

Yes, of course.

Yes, such a program could make up for the lack of income, especially for the most vulnerable. About 33% of people currently live on the guaranteed income supplement, or GIS. At some point, they need supplemental income. Recently, my organization did a survey of its members. We found that among our 25,000 members, there were 4,500 caregivers. Do you see the connection?

That means that in our community, almost one in five people support another senior as a caregiver. There are costs associated with that, so they definitely need some supplemental income. Even though inflation is not very high, there is still a 1% to 2% loss in purchasing power from year to year. Unfortunately, the indexed increase in public and even private plans does not make up for this.

So this kind of program could be useful. For that matter, any program that raises the minimum income level for the most vulnerable seniors would be welcome.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Yes, I agree. I think we also need to start talking about the high cost of poverty. When you don't look after seniors by providing things like pharmacare and a good income, it impacts health and it costs in public health. I think there are a lot of cost savings to caring for people and making sure people can live with dignity.

You've written a lot about problems associated with Quebec's public long-term care centres, specifically highlighting the long wait-lists that force many seniors into private long-term care centres where there are lower standards across the board. From the working conditions to salaries, you listed a number of required changes to make sure seniors don't have to age in fear of insecurity and lack of care.

Can you tell us about what improvements to the working conditions of senior care are necessary? As the government develops national standards for long-term care, what standards would you like to see included?

Rose-Mary or Lise.

[Rose-Mary Thonney]

I will yield the floor to Ms. Lapointe.