Human Resources Committee on June 22nd, 2021

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 43 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 resume its study of the impact of COVID-19 on seniors.

I would like to welcome our witnesses to begin our discussion. Each will have five minutes of opening remarks, followed by questions.

We have with us today Mary Oko, the chair of the Family Council of Copernicus Lodge, and from the Canadian Network for the Prevention of Elder Abuse we have Kathy Majowski, board chair and registered nurse.

For the benefit of our witnesses, I'd like to make a couple of additional comments.

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

You may notice that in each round of questions, when the MPs start to get close to the end of their turn, I'll hold up one finger to indicate one minute left. Don't panic. You'll have a chance to finish your thought. A minute is actually quite a long time.

With that, we're going to start with Ms. Oko for five minutes.

Welcome to the committee. You have the floor.

[Mary Oko, Chair, Family Council of Copernicus Lodge, As an Individual]

Thank you, Mr. Chair.

Distinguished members of HUMA, thank you for allowing me to participate in the valuable work that this committee has been tasked to undertake.

As you know, I'm Mary Oko. I'm appearing before you today as a family member whose mom is currently at Copernicus Lodge, a long-term care home located in Toronto, Ontario. I'm also the chair of the Family Council, representing the families who have loved ones living in the home. My mom, Wanda Oko, is 95 years old, and has advanced dementia. I come before you to share how my mom and I were impacted by COVID and how I think we can make things better for our seniors moving forward.

I'll start by giving you some background.

During wave 1, my mom's home was fortunate not to have any COVID outbreaks.

During wave 2, my mom's home was hit pretty hard. Twenty-two residents died of COVID, and 100 of 200 residents and 85 of 300 staff were infected. Many residents are still suffering. Their health has declined; many who were once walking and independent now need walkers or wheelchairs or are bedridden. My mom is one such casualty. Before the lockdowns, she was walking; now she is bedridden, and during the lockdown she developed a stage 4 bedsore on her tailbone the size of a golf ball that will likely never heal. She didn't get COVID; however, she suffered due to the lockdown and other restrictions implemented under the guise of keeping residents safe.

Today I will share three concerns that have deeply affected me and my mom.

The first one is insufficient staff support for my mom. My mom has lived in long-term care for nine years. Because of poor supports provided, I felt compelled to hire, at my own expense, a care assistant who helped her with mental stimulation, exercise, feeding, and some outdoor excursions. In addition, I visited her twice per week to help with these and other activities, such as dressing and hygiene. Without this added support, my mom would not have continued walking or maintained mental engagement.

When COVID hit, my mom's care assistant and I were locked out of the home. When I was allowed back into the home in September 2020, my mom had declined because our extra care had not been available. She had stopped talking and she was less engaged. During the wave 2 lockdown, she received no access to exercise and was not able to leave her room. My mom is now bedridden and needs the assistance of a lift to move her from bed to wheelchair.

Assistance with feeding has always been an area where staff shortages are most obvious. Prior to COVID, my care assistant and I helped with my mom's feeding. During the wave 2 lockout, staff shortages and a lack of family support resulted in my mom eating poorly and a decline in her overall well-being.

As my second point, my role as a caregiver for my mom was not considered. Given there is a lack of staff to provide the level of care tailored for each resident, the staff always welcomed my help when I came to see my mom. They also valued that I could quickly identify issues that needed the attention of staff, or in some cases needed to be escalated to the doctor.

When COVID hit, I, like many families across Canada, was shut out. I was reduced to video meetings. At these meetings, my mom didn't acknowledge my presence, as she is better when I'm holding her hand and talking to her.

During wave 2, when families were once again locked out in the midst of our outbreak, as I mentioned earlier, my mom developed a serious bedsore. In pre-COVID lockdowns and restrictions, I could have had access to my mom and worked with the staff in addressing any issues she had. Families were not allowed to help when the home badly needed our support.

Lastly, my mom and I, as her power of attorney, were not properly consulted in decisions that impact my mom. We consider Copernicus my mom's home and not just an institution. Since my mom has advanced dementia, I have always been involved in the discussions and decisions relating to the level of care provided to her. COVID changed this situation. Especially, during wave 2 my mom and I as her power of attorney were not included in some of the decisions that were being made that impacted her level of care.

As an example, on December 14, two residents tested positive for COVID on my mom's floor, and then nine, again mostly on my mom's floor. This led to a decision to confine over 200 residents to their rooms 24-7, many in areas where no active cases existed. This decision was made based on meetings held between Toronto Public Health, the Ministry of Long-Term Care, Unity Health—which is the hospital that's partnered with our home—and the Copernicus management team. Residents and families of residents being impacted by such decisions were not given a voice at these meetings.

Any other patient in our health care system is given the benefit of consultation in decisions that impact their health. During COVID, as it relates to COVID, no such consideration is given to seniors living in long-term care or to their power of attorney. Why is this considered acceptable?

How do we fix this? Here are my four suggestions.

First is national standards for long-term care. Comparing what was happening in my mom's home with other long-term care homes in Toronto or in other provinces, I note there is a lack of consistency in how our seniors are cared for in many areas, including staffing levels, COVID testing, and IPAC controls.

No senior should ever feel that they are discriminated against based on the city or town they live in, the province or territory or the type of home they choose to live in. We are all Canadians, and our seniors should be treated fairly and equitably from coast to coast to coast.

Second, never lock out families. Families serve an integral role in the level of care provided to our seniors. We know our loved ones, and we can and do work with the homes to provide the quality of care our loved ones need. Until adequate staffing levels are addressed and funded, it is essential that families not be denied the right to improve the quality of care and indeed the quality of palliative care for our loved ones who live in long-term care. My mom and our seniors will always need their family for love and support.

Third, raise the profile of family council. During COVID, the Family Council at Copernicus Lodge was a strong voice speaking for their residents. The Family Council pushed for the resumption of regular bathing and showering, demanded increases in mental stimulation and activities and so much more, but family council members are unpaid volunteers, and it is a real challenge to attract and retain members, especially when we are not listened to by well-paid management and health care agencies.

Lastly, a resident voice at the table is needed. In any discussions that impact the health and well-being of the residents, their voice and/or the voice of the power of attorney who represents the resident needs to be included.

I beg you to never silence my mom's voice.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Oko.

We're going to go to Ms. Majowski next. Welcome to the committee. You have the floor for five minutes.

[Kathy Majowski, Board Chair and Registered Nurse, Canadian Network for the Prevention of Elder Abuse]

Thank you, Mr. Chair, and thank you to Ms. Oko for sharing her experiences.

Good afternoon, everyone. I'd like to acknowledge that I'm speaking to you from Treaty No. 1 territory, the traditional territory of the Anishinabe, Inninewak, Oji-Cree, Dakota and Dene peoples, and from the heart of the Métis nation.

The Canadian Network for the Prevention of Elder Abuse is a national non-profit organization made up of individuals and organizations that care about older adults and the prevention of harm in later life.

Elder abuse has long been nicknamed “the silent pandemic”. It was rampant in our communities long before COVID. Like gender-based violence, it has flared under COVID and emerged as a shadow pandemic in 2020.

We all experienced the stress and impact of the pandemic. What helped many of us rise to the challenge every day was a supportive family or social group. For many older Canadians, these crucial bonds were obliterated by the pandemic. The necessity to stay home and socially distance whittled away opportunities for social interactions and access to core services.

During the first few months of the pandemic, we ran a survey to evaluate the immediate impact of COVID-19 on our members. We asked elder abuse prevention folks and senior service providers what they were experiencing and observing. When asked about the impact on the seniors they served, respondents listed “increase in elder abuse and domestic violence” as the number one issue, followed closely by “decreased access to services and supports” and “increase in social isolation”.

Social isolation is a serious public health risk, with life-threatening consequences. It can be as damaging to health as smoking 15 cigarettes a day. It incurs negative health behaviours and decreased mental health, and it's also a risk factor for elder abuse, neglect and self-neglect. An isolated older adult may lack access to necessities, be more vulnerable to scammers and be trapped at home with their abuser, with no access to supports.

Almost 65% of our survey respondents reported the impact of COVID-19 on their programs and operations as “high”, with 83% reporting a disruption of services to clients and 46% reporting an increased demand for services. This was the perfect storm: increasingly isolated older adults in greater need of support services that were highly disrupted by the pandemic. Social distancing became a double-edged sword.

We all know what followed. Older adults living at home reported higher rates of isolation and mental health struggles. The Seniors Safety Line in Ontario reported a 250% increase in calls about elder abuse, and meanwhile, in some long-term care homes, residents endured appalling abuse and neglect.

The past year was a stress test that exposed the weaknesses in our system. Older Canadians have borne the brunt of this pandemic through deaths, isolation and decreased safety and quality of life, and they're not willing to be sacrificed and ignored anymore.

Around 90% of older Canadians live at home, and most of us hope to age in place. For this to happen safely, we need to be addressing abuse and neglect in our communities.

Our recommendations include improved training and education programs across sectors by providing adequate care for older adults in their homes and communities. We need to be focused not only on making sure that there are enough human resources to complete the assigned tasks; but older adults should also have a network of supports and community services that work well together and are trained and educated in recognizing and preventing ageism and elder abuse and are familiar with the local, regional and national resources available. The training needs to be trauma- and violence-informed, with an equity orientation to act as a bridge across sectors and mandates for a more inclusive and collaborative approach to prevention and response.

We also recommend encouraging the development of age-friendly communities and ensuring that this effort has an elder abuse prevention lens.

We know that personal support workers, also known as health care aides, have the most consistent and frequent contact with older adults receiving support in their homes and have inconsistent levels of education, training and oversight. Regulation of this role would increase protection for the public by stipulating professional responsibilities and would implement at least minimum standards for entry to the practice, as well as put processes in place for responding to complaints. Regulation would also increase safety by verifying qualifications and competencies for safe practice via a public registry and by providing information on complaints, similar to other regulatory bodies.

A key element would be minimum educational requirements and standardization of educational programs, including for trauma-informed care; dementia care; and elder abuse awareness, prevention and response, including information about the reporting process if there is suspicion of elder abuse. This would also foster safety and stability for these professionals, who are often women from racialized communities who are themselves more vulnerable.

We recommend providing sustained and appropriate funding for the elder abuse and neglect response sector on a par with domestic violence funding. In particular, we recommend providing dedicated support and funding to the CNPEA to ensure that there is a national organization dedicated to elder abuse prevention and awareness that will foster the exchange of reliable information among stakeholders and service providers across Canada.

Finally, we would recommend establishing a federal office of seniors advocate. It should provide systemic oversight and leadership on issues related to the current needs of Canadian seniors, as well as provide insight, analysis and direction to the government on the future needs of our aging population. Elder abuse and neglect awareness and response should be a key and ongoing mandate of this office.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Majowski.

We're going to start now with rounds of questions, beginning with Mrs. 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 contributions to our study today as we look to better support Canada's seniors as we navigate beyond this pandemic.

We know that the COVID-19 pandemic has underscored and exacerbated shortcomings in our long-term care homes. Unfortunately, it is our seniors who have paid the highest price for these shortcomings. Regardless of where they live, every senior has the right to age in dignity. Every level of government has a responsibility to take action.

Ms. Mary Oko, I want to thank you for your vulnerability and your willingness to advocate on behalf of your mother and, ultimately, all seniors.

I don't want to see an “Ottawa knows best” approach when it comes to national standards. Ms. Oko, I'm wondering how important you would think or believe it would be to not only have the provinces and territories at the table when it comes to discussion of national standards, but also to have frontline workers, seniors advocates and caregiving organizations.

[Mary Oko]

I feel that it has to be a collaborative approach. You need to have many people at the table, and definitely frontline workers.

Here in Ontario, we have a very strong registered nurses association that's been a very strong advocate and proponent for the quality of care that residents should be having. Individuals like that and advocacy groups should also be at the table, and also there should definitely be representation from the residents and from the families of those who cannot speak for themselves.

I agree that what I'm proposing in terms of national standards does touch upon what Kathy was referring to. My idea is that regardless of the type of home a senior chooses to live in, long-term care is just one option of many. There should be consistency across the country. It's been very frustrating for me and for many families—I have friends in other parts of Canada, and we compare notes—how disparate the quality of care is for our seniors. It was almost as though we were in 13 different countries instead of one country.

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

I do want to take note of your remarks.

You made mention of families and how important it is to not shut them out. From my background and experience of having worked in a medical facility, when it comes to people who are being hospitalized, I know how important it is to not fall into that institutionalization lull. It's something that you referred to when you spoke of your mother not having that constant stimulation every day.

I think what's so important is how much our families do in the caregiving role. It's not just that they're actively doing things, but they're also advocating. Family members and close friends—the ones who go and visit loved ones—are the biggest advocates and sometimes the loudest voices. I wanted to note that I think those activities are really important and valid to mention.

With regard to staffing, in my role as shadow minister for seniors, I've heard a lot of testimony on staffing shortages. In your experience, how have staffing shortages impacted the quality of care that you've seen, specifically for seniors in long-term care homes?

[Mary Oko]

The biggest example is the fact that my mom has a stage 4 bedsore. When it happened, it was in the three weeks while the families were being locked out. The home and the various people at the table knew that we had a shortage of nurses, specifically of registered nurses, so it wasn't like 200 people were in their rooms and we miraculously had a huge contingent of extra staff to help provide that level of care for each of these residents. They had to make do with the staffing levels that they had, even with the use of agency staff. The problem with having agency staff is that they don't know the residents very well.

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

There's a rapport with that, right, when you have that relationship? You know what they like, what they don't like and how to communicate, and that goes a long way.

[Mary Oko]

A lot of my advocacy is not to attack the staff. The staff have done the best that they can, but they're in a no-win situation. The funding levels and staffing ratios are completely inadequate to provide the level of care that our seniors need, especially in long-term care, where the average age of seniors is 80. Many of them have dementia, and they need specific types of care.

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

This is where I'm also leery. I know the government has talked about bringing in new penalties for caregivers. This is what I'm not okay with, because if we have residents who live in a home and there isn't the capacity—there are staffing shortages—I don't think it's okay to penalize somebody because they physically cannot do the workload. There clearly is a staffing issue.

I also wanted to make a note about mental health. Could you share at all, in your experience, how seniors you've witnessed have been impacted? How has their mental health being impacted, living in long-term care throughout this pandemic?

[Mary Oko]

Again, my mom was engaged and she was talking. She's not talking now. With many of the other residents, it was disheartening to watch those who were mobile and conversable. They are now less so than they were. They now need assistance with feeding. They need to be engaged, or they can't engage and you try to talk to them and they're confused, because they were also getting mixed messages.

During the lockdown, in my mom's home many of the residents were kept in their rooms 24-7. Even the ones who tried to get out of their rooms were constantly being told not to and being pushed back into their rooms. Once things started stabilizing and the residents were allowed to go out, they were petrified. They stayed in their rooms, and the staff would turn around and say, “Well, the residents don't want to come out.” They had been trained not to come out. They had so many negative messages that now they stayed in their rooms, but that just increases their isolation and their decline.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Oko, and Ms. Falk.

Next we have Ms. Young for six minutes.

[Kate Young, Liberal, London West, ON]

Thank you very much to both of our witnesses today. That was gripping testimony, especially from Ms. Oko, hearing about her experiences with her mother and what she had gone through.

My father died in a long-term care facility eight years ago, before COVID. Knowing the challenges that he faced in a long-term care facility, even that long ago—things have only gotten worse and worse through COVID—I really do feel for you, and can't imagine what it must have been like.

You talked about wanting to raise the profile of families and this idea of having a family council for people to listen to the concerns of residents.

Do you think that should be regulated as a part of long-term care standards? Is that needed, or is that something that the families of residents themselves have to really push for?

[Mary Oko]

In response to that question, I feel it needs to be regulated. In Ontario, it is part of the Long-Term Care Homes Act. However, in B.C.—I have friends in B.C.—there is no such act and there is no such thing as a family council. What families have had to do, my friends included, is come together and create their own quasi-family council groups through Facebook. Families were connecting to provide support and share resources.

Even in Ontario, where it's regulated, the idea of a family council is not always respected within ever single home. There are some homes that work very well with a family council, and then there are some homes that do not want to work with a family council. They feel that they don't understand it. They feel that it's just extra work. They feel that they're doing what they need to do to take care of the residents.

Again, the majority of the residents who are in long-term care have some form of dementia or cognitive disability. Even though many of the homes have a residents council, they cannot effectively communicate on behalf of themselves, because they're in fear that if they speak out too negatively, there will be ramifications imposed against them.

I have families within my own family council that are afraid to speak out because they feel that the quality of care their loved one will be getting will decline.

[Kate Young, Liberal, London West, ON]

Thank you very much, Ms. Oko.

Hopefully, you are very pleased that our government recently launched a consultation to define seniors abuse so that they can understand it properly and come up with better legislation.

I will go to Ms. Majowski for a moment.

Of course we know that seniors can experience elder abuse in any facility—in long-term care facilities, hospitals, while they're shopping, even in their own home. In your opinion, what steps can be taken to improve the reporting of abuse of seniors?

[Kathy Majowski]

Thank you very much for the question.

Reporting is a very tricky conversation. We do want to keep in mind that, first of all, 91% of our older adults live in the community, so they are being supported in the community. In the abuse that they experience, in many cases we know that the perpetrators are people who are close to them, whether it be a neighbour, a friend, a family member who's providing some sort of caregiving role, or is even [Technical difficulty—Editor] the person, so reporting is a very delicate conversation. I would say it's on par with domestic violence reporting.

Sometimes when health workers, social services workers or community services workers take on the responsibility of mandatory reporting, we're actually going against what the older adult would want. There are many reasons that they don't want to report. It may be that they don't want their family member to get in trouble, to experience legal ramifications for the behaviour. Sometimes it's because they do feel some guilt. We look at it as a bit of a harm reduction scenario where putting additional supports into place can take off some of the strain or reduce their need to depend on the abuser. In many cases, that can improve the situation.

It is important to consider [Technical difficulty—Editor] talk about reporting. Older adults are just as capable as younger adults to decide what's best for their lives, and they may have different ideas of what kind of behaviour is acceptable. We need to meet them where they're at and understand that we might have really wonderful ideas on how we can significantly improve the situation for them, but if it's not something that the person wants, then it's really going to contradict quality of life and happiness, safety and security. Elder abuse prevention is a very convoluted and nuanced conversation, particularly when we're talking about people who are living in the community.

For long-term care, for example, the conversation is much different. It is a much more structured environment. There definitely are ways that the reporting can be made a little bit more standardized. It's different across the country, unfortunately. Provinces and territories all have different models, so families and staff should be aware what resources are available for their facility, but in the community it's a much more complicated conversation.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Young.

[Kate Young, Liberal, London West, ON]

Thank you very much. You answered my next question, so I appreciate that.

[The Chair, Liberal, Sean Casey]

Ms. Chabot, you have the floor for six minutes.

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

Thank you, Mr. Chair.

I thank the witnesses.

The Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities is conducting this study on the realities experienced by seniors during the worst of the pandemic. However, some of the issues were already there, long before we began our work. We can discuss the living conditions of our seniors in a comprehensive way, from a financial, social or health perspective.

Ms. Oko, unfortunately, many seniors in residences are experiencing a situation like yours and your mother's. The same thing happened in some Quebec facilities. I would not lump all public seniors' care facilities together, because we also saw some good examples and good practices during the pandemic. However, the pandemic snuck up on us, and every province took steps to deal with it, to the best of their abilities. At times, it was painful for seniors, their loved ones and their families.

They had to take action to protect seniors, including preventing their loved ones from visiting them, and you're absolutely right that isolation had a variety of effects. Thank you for your testimony, even though it was difficult. I feel it reflects the glaring testimonies of people across Canada, depending on the network.

On the other hand, I have to say with all due respect that I'm skeptical of one solution that you seem to be putting forward, which is national standards that would come from Ottawa to regulate what's done in each province. I could tell you about the countless standards that we have in Quebec for our institutions and the organization of health care. These are choices we have made, particularly with respect to the number of attendants per patient. I don't believe that can be governed by a national policy that would apply uniformly. I have a very hard time believing that it will fix the situation.

However, you mentioned something that we believe is important. You talked about underfunding with respect to personnel. So it's the underfunding [Technical difficulty] of the provinces, which have the skills to organize health care, because it's a provincial jurisdiction. So Ottawa has to contribute. The Ontario and Quebec governments had one request for the federal government: significantly increase health transfers so that the federal share of funding for expenditures meets the needs of the provinces so they can deliver services.

How do you feel about the position of the Ontario and Quebec governments and others? Does Ottawa need to make a bigger contribution?

[Mary Oko]

When I made the suggestion about national standards for long-term care, my point was not that Ottawa would be dictating the quality of standards that would be imposed for each of the provinces. What I feel is that, yes, the federal government has an obligation to provide funding to each of the provinces, but they should also be working with each of the provinces, and why not use the best of what has worked in each of the provinces for the benefit of all Canadians who are living across Canada?

To your point, it is very different. As an example, right now I can go to see my mom, but I need to take a PCR test weekly, and I've had to do this since August. I'm fully vaccinated; my mom is fully vaccinated. In addition to the PCR test, I also have to do a rapid test, and then, once I'm in the home, I have to wear a surgical mask and a face shield. In Quebec, based on friends I've spoken to, there is no need to do a PCR test and there's no need to do a rapid test. All they have to do is wear full PPE. In B.C., they don't have to do a rapid test or a PCR test, and the only thing they have to wear is a surgical mask. Why is there a difference?

I'm at a point where, throughout this pandemic, if I could, I would have moved my mom from province to province depending on what was going on and working best for those seniors at that time. Why should I be in that situation? Why should families be put in that situation? We care, we love our loved one, we want them to have the best quality of care, and I feel that the provinces cannot expect to have a blank cheque providing funding to them without any kind of strings attached.

Each of you represent our various provinces, and I feel that each of you working as leaders can work with our provinces to try to find a solution that will be equitable and fair for all of our seniors across the country.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Oko.

Thank you, Ms. Chabot.

Next is Ms. Gazan, please, for six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much, Chair.

I'd like to start out by commending Madame Oko for her strength and sharing the story about caring about her parents. I also looked after my parents when they were both sick many years ago and I know the toll it takes in trying to make sure that your parents have care that allows them to live in dignity. Thank you so much for sharing your story.

Madame Majowski, thank you as well for your tremendous knowledge and work. My first question is to you.

For years, advocates in the disability community, including seniors, have advocated for better supports for disabled persons so that they can live with dignity. Unfortunately, in my opinion, I don't think the rights of disabled persons were a priority for this government or previous governments before the pandemic or during the pandemic.

Today, the day before the House rises and we're adjourning for summer—we have a potential election in the fall—finally this government introduced legislation to create a Canada disability benefit, known as Bill C-35, something that I hope sees the light of day, but I'm not very hopeful. To me, this piece of legislation should have been a top priority if we look at some of the statistics that we've witnessed during the pandemic.

I'm wondering if you can speak about how both persons with disabilities and disabled seniors in particular have been disproportionately impacted during the pandemic.