Human Resources Committee on June 1st, 2021

[The Chair, Liberal, Sean Casey]

I call the meeting to order.

Welcome to meeting number 37 of the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities.

Today's meeting is taking place in a hybrid format pursuant to the House order of January 25, 2021. The proceedings will be made available via the House of Commons website. The webcast will always show the person speaking, rather than the entirety of the committee.

Pursuant to Standing Order 108(2), and the motion adopted by the committee on Tuesday, February 2, 2021, the committee will proceed to its study of the impact of COVID‑19 on seniors.

I'd like to welcome our witnesses to begin our discussion with five minutes of opening remarks, followed by questions. Appearing today, as an individual, is Dr. Veronique Boscart, executive dean, School of Health and Life Sciences at Conestoga College; and from the Centre of Aging, we have Dr. Michelle Porter, professor and director at the University of Manitoba.

For the benefit of our witnesses, I will just make a couple of other comments.

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 you're not speaking, your mike should be on mute.

We're going to start with Dr. Boscart for five minutes, please.

Welcome to the committee. You have the floor.

[Dr. Veronique Boscart, Executive Dean, School of Health and Life Sciences, Conestoga College, As an Individual]

Thank you.

My name is Dr. Veronique Boscart. I'm going to start off by stating that I am a registered nurse. I've been a registered nurse in long-term care for over 25 years, and I've worked throughout the COVID‑19 pandemic on good and bad days.

I'm also in my second five-year term of the CIHR/Schlegel industrial research chair for colleges in seniors care, which means that I hold a national research chair focusing on workforce, staffing and training related to those caring for seniors in our country. Within that portfolio, I conduct pragmatic intervention research to really optimize life and care for seniors and their families both in long-term care as well as in retirement and home care.

I also hold the role of executive director at the Canadian Institute for Seniors Care. With that group, we develop tailored training for the future and existing workforce in seniors care. Most of our work is focused in Ontario.

Last, I'm the executive dean at the School of Health and Life Sciences at Conestoga. There we have focused our strategic mandates on optimizing education and training, as well as innovation in research for our health care providers. We are very committed to raising and bringing into place a generation of health care providers who can recognize and address the needs of our seniors and their care partners in our community.

I want to thank you for the opportunity to speak to you today on the needs of seniors in Canada.

As you're aware, seniors age 65-plus are the fastest-growing population and are more likely to have chronic complex conditions and they [Technical difficulty—Editor] support from a health care team [Technical difficulty—Editor] communities. The COVID‑19 pandemic really highlighted the gaps in our care system, so I think, unfortunately, Canada is the country with the highest mortality rate in long-term care homes. I can personally testify to the detrimental effect that has had not only on our country, but also on our workforce, our families, our loved ones and our communities. Now more than ever is a time to critically reassess the design and the way we provide our services for seniors, as well as how we are educating the future workforce on how we deliver current care practices to our seniors.

There are many reports available on that. I'm happy to provide more detailed information when answering your questions. There's never been a better time than now to really cause a change in our long-term care and health care systems.

I am more than delighted to contribute further, and I pass it back to the chair.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Boscart.

Next we are going to hear from Dr. Porter for five minutes, please.

Dr. Porter, you have the floor.

[Dr. Michelle Porter, Professor and Director, University of Manitoba, Centre on Aging]

Thank you for the invitation to speak today.

I am the director of the Centre on Aging at the University of Manitoba in Winnipeg. Our centre has existed since 1982 and is the focal point for research and knowledge mobilization on aging in Manitoba.

The first issue I would like to discuss is access to information and services specific to the pandemic. One example here includes the fact that most resources, information and booking systems, etc., have relied on web-based systems. Whether it was finding out about where testing locations were or when to get vaccinated, this information is typically provided as a website. In the short term, we need to ensure that access to information is available through the phone as well. Phone numbers need to be highly publicized, through COVID press conferences, for example. If you don't have access to the Internet, how do you find the phone numbers?

We applaud the federal government for providing funding to add a phone line to the Manitoba 211 services. This is a needed service in the short term.

In the long term, we need to find ways so that everyone has access to the Internet. This requires physical infrastructure. It also requires that everyone can afford the equipment and services, regardless of where they live and what their income is. Access to Internet is critical for long-term care as well. In many homes, Wi-Fi did not exist or was not sufficient, so including this in standards for long-term care would be important. Every resident room and common room in a long-term care home should have good Wi-Fi.

Another access issue that has been quite apparent is transportation. Age-friendly transportation and affordable resources are lacking in many locations, particularly intercommunity transportation. This has affected access to COVID testing and vaccinations. If aging in place is a goal for governments, then we have to ensure that communities are age friendly in terms of transportation.

One tragic story in Winnipeg occurred when a family had to pay for a stretcher service to bring their bed-bound father to a vaccination site. An age-friendly community would find ways to ensure that the environment can enable that person to live in a non-institutional setting and still receive services.

Another long-term care issue is related to quality of life. Clearly, there is not enough recreation staff in long-term care. These workers, primarily women, who are key to residents' quality of life, are often only able to find part-time and low-paid positions. We need to ensure that we think beyond the health care aspects of long-term care and provide much more in terms of social care, because these places are people's homes, not hospitals.

Overall, we need to ensure that all workers in long-term care receive the training they need, as well as the respect that they deserve through proper compensation for their vital roles. As we build back, we need to focus on the care economy and ensure that women from all backgrounds are not left behind.

The final issue I would like to introduce is the consequence of sedentariness during the pandemic. Many older people have moved very little for many months. This has implications for risk of falling, health and physical function. Post pandemic, we will need to ensure that programming and services will be available to respond. For example, we know that an individualized approach is critical for falls prevention. However, in Winnipeg, we have lost universal access to adult outpatient therapies because these services are not part of the Canada Health Act. This means there is reliance on private health insurance or paying out of pocket.

Similarly, access to therapy service is not sufficient within long-term care either and residents have experienced a dramatic reduction in their physical activity. Of course, we cannot forget about all of the individuals who will need to recover from COVID. We need targeted federal funds for appropriate therapies and physical activity programming to allow individuals to recover their physical health.

I would like to end by saying that the Government of Canada endorsed the global strategy and action plan on aging and health of the World Health Organization. The year 2020 saw the official launch of the Decade of Healthy Ageing by the WHO. Canada needs to ensure that, coming out of this pandemic, we are ensuring that older people are able to achieve good health in age-friendly environments that are free from ageism.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

We're now going to rounds of questions, beginning with Ms. Falk, please, for six minutes.

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

Thank you so much, Chair.

I would like to thank both of our witnesses for their time today and for contributing their expertise to our study.

Special thanks to you, Dr. Boscart, for your continued commitment to care for our seniors on the front lines throughout this pandemic.

Tragically, long-term care has been the epicentre of the pandemic. While the problems in long-term care aren't new—we know they're not new—they have been highlighted and heightened during this health crisis. We know the delivery of quality of care for our seniors depends on a skilled workforce.

Dr. Boscart, in the report that you co-authored, “Restoring trust: COVID-19 and the future of long-term care in Canada”, it suggests that the priority in addressing long-term care should be to solve the workforce crisis. In fact, it says that if we do nothing else, we need to address staffing.

That report was released in the first wave of COVID, so it was a few waves ago. Would you say that it is still accurate to prioritize the workforce crisis in long-term care? Could you also share with this committee in more detail the existing challenges in the long-term care workforce?

[Dr. Veronique Boscart]

Yes, absolutely. Thank you, Ms. Falk, for that question.

First of all, I want to accept your thanks. It's a privilege for me to give care to our seniors, and it brings much happiness to me and many others. I see it as a great contribution to our country, to which I am an immigrant, and I feel very fortunate to be able to provide care to its elders.

From a long-term care perspective, indeed staffing is a major challenge, and it is not getting any better. Many nurses and personal support workers, or unregulated care providers and others, have gone through one or two COVID tests themselves—I was one of them—and a lot of us have become sick. In addition to that, a lot of us have not been able to carry on with double shifts and continuous work. Many of my colleagues have worked non-stop since the onset of COVID. At times that starts to weigh, so we are losing staff because they are burnt out.

In addition to that, we also know, and I think my colleague alluded to it, that we work with a workforce in long-term care that is mainly female. The majority of them are unregulated, and we know that those groups of people come from the cohorts or the environments that sometimes struggle with life. Many of them are immigrants. Many of them hold more than one job in order to pay the bills. They cannot take a full-time job in one long-term care home because there are no full-time jobs available. There is full-time work, but there are no full-time positions available.

As a result, they do not have sick leave or benefit plans, or a pension for that matter, and they have to take more than one position in order to meet the ends. [Technical difficulty—Editor] who really have to rush from one place to another and are not committed to one specific home. That leads to discontinuation of care, and that always affects the resident and the family negatively. That is one very big problem that we have.

In addition to that, moving into COVID, we also had serious shortages of staff in long-term care. [Technical difficulty—Editor] found that even if nursing homes were staffed to the best of their ability with all positions filled, we still would only give 60% of the care that is required to provide quality care. Canada has the lowest staffing recommendations across all of our western countries in mandatory staffing for long-term care homes.

As of today, in long-term care, we are short about 60% of registered nurses, 50% of registered practical nurses and about 20% of personal support workers. It is impossible to provide care if you do not have the people to provide the care. That's a very short, first main problem that I see happening in long-term care.

It's very difficult to attract my colleagues to long-term care, if I cannot guarantee full-time permanent jobs with a pension plan, sick leave or anything else, and where you will always work a double shift. It's very hard to do.

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

Dr. Porter, do you have anything that you would like to add to that as well?

[Dr. Michelle Porter]

I would say that the situation is quite similar in Manitoba to what has been described in Ontario.

This issue of part-time work, not being paid well, is clearly not going to entice individuals to come to these positions, particularly not after everything we've seen during the pandemic. Long-term care facilities have been kind of left on their own to fend for themselves and their residents.

A lot more needs to be done in this regard, in terms of ensuring that we have sufficient funding levels to provide the compensation. This is clearly identified in the WHO report. This is an issue across all of long-term care, and also would apply to home care as well. People are just not being paid well enough for the important work that they do.

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

What would either of you say is the greatest barrier to recruitment, then? Out of everything that was said or listed, what would be the greatest barrier to that recruitment and retention of staff?

[The Chair, Liberal, Sean Casey]

Answer very briefly, please.

[Dr. Veronique Boscart]

Pay.

[The Chair, Liberal, Sean Casey]

That was very succinct. Thank you.

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

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Falk.

Next we're going to Ms. Young, please, for six minutes.

[Kate Young, Liberal, London West, ON]

Thank you very much, Mr. Chair.

Thank you to our witnesses for being here today. That is a very interesting discussion, of course, about the challenge of retaining nurses.

Sixteen per cent of nurses have said that they'll leave their jobs in the next year, and only one-quarter took time off to look after themselves. I think this speaks to the obvious issue that we have.

You mentioned the excessive shift work that many nurses are taking.

Dr. Boscart, do you have any indication of whether that would be more acute in private versus non-profit homes?

[Dr. Veronique Boscart]

The answer is probably not. My colleague Dr. Andrew Costa conducted a study to look at care levels and to look at some of the different quality aspects of care in private and not-for-profit nursing homes, and found that it's very similar. It's very difficult to attract staff to these environments, and the ones you have often feel that they're not well prepared; hence, the challenge we have in our educational system to prepare nurses better for what is to come and then provide them with strong orientation so they remain on the job.

[Kate Young, Liberal, London West, ON]

Thus, it's not only pay; it's teaching. It's making sure that they have the skills that they need.

[Dr. Veronique Boscart]

Yes. Looking across Canada when we do a scan of all nurses—and this is very specific for the bachelor of nursing for registered nurses—we have looked at the content in their curriculum, and I am very happy to see there is still maternal-child education in there and trying to teach nurses how to help moms to breastfeed, which is absolutely necessary.

Ninety per cent of the people in our hospitals and nursing homes are over 85, so they receive additional care. Gerontology is not a mandatory component in our nursing curriculum in Canada, nor is it a specialism or something that people get paid for if they have an additional certification.

I know my colleague Dr. Porter has been a long-standing advocate at the Canadian Association of Gerontology to look at really enhancing the skills of [Technical difficulty—Editor], so if we do not prepare specialists, how do we provide excellent care?

[Kate Young, Liberal, London West, ON]

Dr. Porter, could you comment on that?

[Dr. Michelle Porter]

Just to add to what's been said about the lack of gerontology or geriatric education, I think you will see that this exists in other professions as well, even though they might end up serving primarily an older audience. Even pharmacy programs and rehab programs, many programs out there do not necessarily have that specific training for older people. I think this committee has already heard about the lack of geriatricians in this country compared to pediatricians.

It certainly is an issue. It is challenging, I would say, at the university level when young students are coming in. They're not necessarily anticipating that they're going to work with older people, and that's across all health care professions, but certainly most are going to end up working with older people. We really need to ensure that there are positions out there for people and that they're well paid, as we've already discussed, and that we ensure that gets put into the curriculum of various health care programs, that it's in case studies and some of the interprofessional education that goes on so that teams of health care professionals are able to appropriately serve older people in the community.

[Kate Young, Liberal, London West, ON]

You also, Dr. Porter, mentioned transportation. You said that if aging in place is our goal—and a lot of people now are questioning whether they'd ever want to end up in a long-term care facility—age-friendly communities are important.

What would you think we should do, as a federal government, to further that goal?

[Dr. Michelle Porter]

Well, the federal government is overseeing the age-friendly communities initiative across the country, although, of course, there's a large provincial jurisdiction over many of the services, which includes transportation. I'm not exactly sure what the role of the federal government is, and this is one of the issues that [Technical difficulty—Editor] involved in transportation, which includes municipalities. Municipalities really need support in providing these services, whether they're rural or urban communities. It is not a great scenario and we see stories in the paper where people are not able to get to vaccination sites, which is the main health care issue right now.

We're doing some projects right now in Manitoba. We did get some funding for them, but it all came about a bit too late. I think in general, within health care, there's a concept that someone will set up the appointments and hope that somehow people will figure out how to get to them. However, we've heard over and over again, when we've done consultations across the province, that transportation is a huge barrier for people when getting services, in particular with health care, and in being able to engage in their communities.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Young.

[Kate Young, Liberal, London West, ON]

Thank you very much.