Human Resources Committee on March 31st, 2022

[The Chair (Mr. Robert Morrissey (Egmont, Lib.)), Liberal, Bobby Morrissey]

We'll call the meeting to order.

Welcome to meeting number 16 of the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities.

Our meeting today is taking place once again in a hybrid format pursuant to the House order of November 25. Members are attending in person and by using Zoom. Those attending in person must follow the health protocols that are currently in place.

To ensure an orderly meeting, I would like to make a few comments for the benefit of witnesses and members.

Before speaking, please wait until I recognize you by name. For those participating by video conference, please click on the microphone icon to activate your mike. For those in the room, your microphone will be controlled by the proceedings and verification officer. When you are not speaking, your mike should be on mute.

Members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. For those participating by video conference, you have the choice at the bottom of your screen of either the floor, English or French. For those in the room, you can use an earpiece and select the desired channel. If interpretation is lost, please advise me and we will stop the proceedings until it's corrected. As a reminder, all comments should be addressed through the chair.

Pursuant to Standing Order 108(2) and the motion adopted by the committee on Thursday, February 3, the committee will resume its study of labour shortages, working conditions and the care economy.

I would like to welcome our first group of witnesses to begin our discussions with five minutes of opening remarks, which will be followed by questions. I would ask the witnesses to please keep your opening comments within the five minutes. If you have additional information, you can always submit it to the committee, and it will be on the record.

Again, I would ask those participating to speak slowly for the benefit of our translation and interpretation services.

From the Atkinson Foundation, we have Armine Yalnizyan; from the Canadian Dental Association, Richard Holden, president, and Aaron Burry, acting chief executive officer; and from the Canadian Mental Health Association, Rebecca Shields, chief executive officer, York and South Simcoe branch.

We will start with the Atkinson Foundation for five minutes.

Madam Yalnizyan, you have the floor.

[Armine Yalnizyan, Atkinson Fellow on the Future of Workers, Atkinson Foundation]

Chair Morrissey, thank you so much.

Honoured members of the committee, I appreciate greatly the opportunity to speak to you today to address one of the most pressing public policy issues facing Canadians and the future quality of all of our lives—labour shortages and working conditions in the care economy.

I thank Bonita Zarrillo for tabling the motion to study the issue.

You may not know me. I'm an economist, past president of the Canadian Association for Business Economics, and business columnist for the Toronto Star. I'm also the Atkinson fellow on the future of workers, and I am indebted to the support of the Atkinson Foundation, which dedicates itself to advancing economic and social justice principles, as did Joseph Atkinson, journalist and business founder of one of Canada's most popular and historically influential newspapers, the Toronto Star.

He knew then, as you know today, that strong businesses are made stronger when their workers and their customers are not scrambling to cover their basic needs. That requires strong governments dedicated to ensuring that programs like health care, child care and elder care—which support the economy every bit as much as roads and bridges—are both in good repair and fit for purpose.

The care economy is often viewed as a derivative, a “nice to have” once the economy is functioning. It is not, and as the pandemic has made abundantly clear, it provides the foundation for all other economic activity. It happens to be an economic powerhouse in its own right, accounting for 12.6% of GDP. Did you know that's bigger than the auto and oil and gas sectors? It's actually unparalleled by any sector of the economy other than finance and real estate—and we know how well that goes.

Care for those who are too young, too old and too sick to work is always partly unpaid. It is always a labour of love, but paid care now accounts for one in five jobs in Canada. Though every job could be a great job in this sector, many jobs are unpaid and precarious. Maybe that's because it's female-dominated. Upwards of 90% of workers in most occupations within health and education are women, and the workforce is also disproportionately racialized.

Viewed as essential, these workers are essentially treated as disposable. Population aging means that this sector of the economy is destined to grow, so how it grows matters. Already, we are facing labour shortages in small towns and big cities alike, so how we address the shortages matters because it will shape our economy and our nation. We can make every job a good job, and we would transform all of society in the doing, or we can muddle through, mostly failing to solve the problems.

Right now, there is no more pressing labour market issue than how we prepare the care economy for the decades of population aging that lie ahead, making today's challenges pale in comparison.

In order to maximize our potential and minimize the impending challenges, we need a pan-Canadian strategy so that no province loses out. Your earlier questions to other witnesses on other days have presaged what that strategy might entail.

First, we need better wages and working conditions, which are possible because so much of the care economy is publicly funded. Second, we need more timely and targeted training, including “learning while earning” programs. Third, we need an alignment of federal skills development policies for our own citizens, with federal policies to attract newcomers. These newcomers are increasingly entering as temporary residents; not immigrants who stay and build communities, not just fill jobs. Fourth, we need more rapid credentialing of internationally trained professionals and more paths to permanence for those who enter as temporary foreign workers. On your very first day, you learned that the temporary foreign worker program accounts for only 0.4% of the labour force, but hundreds of thousands of other people enter as temporary residents under different programs and work as well.

Better use of technology is obviously another element. We can improve timely access to supports, more telehealth, better use of AI to complement human skills for faster diagnostics and better diagnostics, improved used of e-health records to improve wait times and detect trends more quickly. Finally, we need better monitoring of the ballooning of temporary agencies and on-demand apps, because they tend to produce cost overruns, and they tend to increase exploitation through scheduling. That means modernizing our labour laws to reduce the growing number of people who are misclassified as independent contractors and are not able to access any labour protections or rights.

We urgently need a national strategy for health human resources, and we urgently need standards for long-term care before the federal government dishes out another dollar, building on what we have learned through the early learning and child care bilateral agreements that have been signed over the past year.

I do wish you Godspeed on your efforts to help inform and guide our next steps.

I am happy to take your questions.

Thank you again.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Yalnizyan.

Now we will go to the Canadian Dental Association.

Who is going to speak on your behalf?

[Dr. Richard Holden, President, Canadian Dental Association]

I am, Chair. Thank you. I'm hoping you can hear me okay.

[The Chair, Liberal, Bobby Morrissey]

Please continue.

[Dr. Richard Holden]

I wish all members of the committee a good afternoon.

I'm speaking to you from to you from Charlottetown, on the unceded territory of the Abegweit Mi'kmaq first nation.

My wife and I have both practised dentistry in P.E.I. for over 30 years. I have been actively involved in organized dentistry for two decades. I currently represent CDA as president.

For 120 years CDA has represented dentists in every province and territory as the national voice of dentistry. We know that oral health is an essential component of overall health. Dentistry is an integral part of health care in Canada. There are more than 25,000 Canadian dentists. If one includes dental hygienists, dental assistants and others, the dental sector represents a workforce of roughly 100,000 workers.

The COVID-19 pandemic had an immense impact on access to dental care. Offices were shut down for months. Upon reopening, we had to put in place new and extensive infection prevention and control procedures to prevent the spread of infection. This included wearing enhanced PPE, renovating offices to better separate treatment areas and purchasing new air filtration equipment. These precautions were very effective, but have come with a significant price tag.

The post-pandemic reality has now created a further challenge, namely, hiring and retaining dental assistants. Dental assistants are the glue that hold dental offices together. It is a skilled profession, and eight provinces require licensing or registration. In fact, ESDC recently reclassified dental assisting as a skilled profession in the national occupational classification.

The last time you went to the dentist, the person who placed the rubber dams, took X-rays and walked you through your treatment plan or after-care instructions was likely a dental assistant. Crucially, they provide a necessary second set of hands to dentists during most dental procedures, from fillings to extractions to root canals.

Even before the pandemic, the number of dental assistants was an obstacle to meeting the oral health needs of Canadians. In 2019, 36% of dental offices had unfilled dental assistant positions. From 2010 to 2020, the ratio of new certified dental assistants to new dentists entering the workforce fell from over 3:1 to almost 1:1. The pandemic only exacerbated this shortage. Dentists need more formally trained licensed dental assistants to manage new health and safety guidelines, but attrition rates have worsened.

Dental offices, particularly during COVID, can be a stressful work environment, and dental assisting can be physically demanding. Furthermore, 99% of dental assistants in Canada are women, with an average age of 38. Many exit dental assisting for other professions due to, among other factors, workplace concerns such as stress and mental health, the desire for flexible hours, and, more recently, the appeal of working from home opportunities.

It is our goal to work collaboratively to address these issues that directly impact retention of dental assistants. We are hopeful that the federal government's commitments on child care will help reduce barriers to full participation of women and men in the workforce going forward.

The CDA recently partnered with the Canadian Dental Assistants Association to submit a project to ESDC's sectoral workforce solutions program. Our project, “building the professional dental assisting workforce of the future”, seeks to address the many factors impacting the attrition of dental assistants from their profession by providing mental health and wellness training for dental office staff, human resources training for dentists and office managers, and increased access to certified dental assisting programs through the development of an online-based curriculum, as well as by developing action plans addressing interprovincial labour mobility and better integration of immigrants into the dental workforce. I am happy to share further details with you, and would appreciate any support you may be able to lend.

I encourage this committee and the House of Commons health committee, which is also studying health care human resources, to consider these workforce concerns when making recommendations to government. Focusing solely on the HR needs and challenges of Canada's public health system could have a deleterious effect on health care delivered in private settings, such as dental offices. Increasing recruitment into some professions, or mandating wages for others, can intensify shortages for the rest.

I will conclude by commenting on last week's commitment by the federal government to provide greater access to dental care for low-income families. CDA supports all efforts to improve the oral health of Canadians and increase access to dental care. We have long recommended federal investment to stabilize and enhance provincial and territorial programs that provide care to those Canadians who lack access to dental care. These programs are chronically underfunded, and are almost exclusively financed by provincial and territorial governments.

Such an approach would provide better and faster access to care to the people who need it most, using existing infrastructure, as opposed to a large-scale new federal dental care program administered in Ottawa. This would also minimize disruptions for those who already have access to dental care, whether through existing programs or employer provided benefits.

We look forward to collaborating closely with the federal government going forward on better addressing the oral health needs of Canadians.

I want to thank you for this opportunity, and I'm happy, along with Dr. Aaron Burry, our interim CEO at CDA, to answer any questions you may have.

Thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Dr. Holden.

We'll now go to the Canadian Mental Health Association.

Ms. Shields, you have the floor for five minutes.

[Rebecca Shields, Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association]

Hello. I'm the chief executive officer for the Canadian Mental Health Association, serving York Region and South Simcoe.

We are across 11 provinces and territories in our divisions, with 75 branches serving over 330 communities across Canada, and we are one of the largest clinical providers in all of Ontario.

I don't think it's a shock to anyone if I tell you that the mental health demands of Canadians have increased at alarming rates due to the pandemic, and that a strong, robust community sector is required in order to sustain the mental health of all Canadians in the entire workforce.

The pressures that we are facing warrant a massive increase in investment and smart increases in investment. Pandemic polling conducted by CMHA Ontario reveal alarming statistics. About 57% of Ontarians are lonelier compared with when the pandemic began, and nearly 80% believe that we will have a mental crisis once the pandemic is over.

Substance abuse is increasing, and wait-lists are higher than ever. As my colleagues have mentioned, it is disproportionately affecting women, particularly women with young children at home, who are under both financial pressures and the pressures of child care. However, with men, we are seeing rising rates of substance abuse, both with alcohol and cannabis, and this is a major concern as services are not readily in place.

It is of no surprise that we see demand in services at an all-time high, and higher complexity of care requiring longer service times before we can achieve recovery.

Approximately 80% of all mental health care is provided by community organizations, such as mine, and perhaps the demands on the community sector are not fully appreciated when we talk so much about the hospital sector and long-term care. However, without a robust community sector, there will be more problems faced, because we both focus on prevention, early intervention and ongoing recovery and treatment. However, we have not received base increases in over 15 years, and we are so inadequately funded. Although we may have grown by new services, existing services haven't increased.

We are not competitive with our hospital partners, and we are certainly—with increasing policies to support other industries—again falling behind. Our admin costs remain at 10%, which makes us unable to keep up with leadership and tech capacity, and yet we want a data-driven culture where we can actually get the data and analyze it with the business intelligence required to ensure that we're providing quality outcomes to our community.

At CMHA, we know that crisis services have jumped over 60%, and yet our critical care nursing shortage is at an all-time high, just like everybody else's.

Even before the pandemic, some of our branches were under water. Although we have seen some increases in programs in certain areas across Canada, certainly others are falling behind. I want to give a local example. Locally, my nurses are paid 66% of what is earned by hospital nurses and long-term care nurses. You can imagine, despite the burnout, we require these nurses in order to maintain good care for our homelessness population, for our vulnerable population, and now increasingly for the services we provide to newcomers and refugees.

I want to explain why that is so important. You can imagine, with the crisis in Ukraine, CMHA has yet again been asked to step up. We serviced over 292 newcomers and refugees last year. Of that number, 89% of the people demonstrated improved outcomes from depression, and 85% of the people improved outcomes from anxiety, which allowed for safer transitions and resettlements. This is huge, because we want people to resettle quickly, and it's up to the community sector to respond quickly to these urgent needs of our population.

The other issue that is faced by the health human resources crisis is the demand of other health care workers. CMHAs across Canada have developed programs, such as the BounceBack program, with a specific emphasis on managing stress and burnout. However, we can see that the stresses of the pandemic are continuing in all health care sectors and we're seeing an overall attrition in health care resources.

Critical investments are needed to deal with this stress and burnout, and programs to provide respite and relief for staff, so that they too can have their vacations. We've been working overtime to provide ongoing care, without any increase in funding to meet these needs.

We need to have particular funding to focus on diversity, equity and inclusion. I spoke of a newcomer well-being program, but we continue to have to respond to the diverse needs of Canada.

In summary, I'd like to thank this committee for listening. I have a lot more to say and will answer a lot more questions.

To be brief, we have not had any base funding increase. The demands are at an all-time high for all of our health care partners. We need an integrated health care system where community is funded as equally and as effectively as our acute hospitals, or else we're going to continue to exacerbate the problems that exist, where people's first encounter with mental health services is in the hospital when it should be in community or with their primary care provider.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Shields.

We'll now open the floor for questions, beginning with Madame Gladu for six minutes.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair, and thank you to all of our witnesses.

I'm going to start today with Richard Holden.

You talked about the shortage of dental assistants to service the needs of the existing burden on the dental care system. In light of the NDP-Liberal plan to make a national dental care program, which would add people who aren't covered today, do you have the adequate resources to do that plan, and if not, how are we going to get them?

[Dr. Richard Holden]

That's a great question. I think I'll start by saying that, depending on how the plan comes out, we feel that we're treating three-quarters of the Canadian population now fairly adequately. It's that 25% to 30% who are suffering.

We feel that dentists and assistants can step up. The dentist-to-population ratios are still adequate. There are certainly geographic issues that sometimes can come into play. We know that with dentistry in the sixties, seventies and eighties, certainly there were higher demands on dentists and the office staff to perform. I think that we would step up, certainly to get access for more of those vulnerable populations to get into dental chairs. I think it's something that the dental profession would do what they can to do it.

It is a challenge. We feel that we need to do something about the workforce, but at the same time, I think we could probably do that.

I have my colleague Dr. Burry, who is our CDA interim CEO.

Aaron, did you want to add anything to that?

[Dr. Aaron Burry, Acting Chief Executive Officer, Canadian Dental Association]

I think you've outlined it well, in that dentists have historically stepped up during this period. We also would make sure that with anybody coming to see us who is in need, we would look after them.

I think this would also reduce some of the demand on the hospital care system as this moves forward and into the place.... I can speak to that as a dentist. I can often solve something in half an hour to 45 minutes that an emergency room just can't do anything about.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

That's very good. Thank you.

I have a question for Ms. Shields.

I saw that CMHA did a study with UBC that said 41% of people in Canada have reported a decline in their mental health since the onset of the pandemic. That is what you said.

Do we know what the impact of this greater number of mental health problems was on employment? I would expect that people might have missed work. Do we have any quantitative measures about that?

[Rebecca Shields]

I don't have any quantitative measures to give you that are accurate statistics, but I can give you anecdotal information. We know that the rates of sick leave across the country are going up. Much of the sick leave, long-term disability and short-term disability, is related to mental health issues as the leading cause of disability.

The correlation is high, as people are really facing burnout. In particular what we're seeing is a huge burnout in the health care human resources sector as well. We're seeing that nursing people are retiring. They call it “the great move-on”, as people cannot keep up the pace they've been keeping up and yet are being demanded to do so. It is a crisis, because we know that the stress and uncertainty take its toll.

Again, it's disproportionately affecting women, particularly women in households with young children. Those women in particular are two times more likely to report depression and 1.5 times more likely to report generalized anxiety. That has an impact on them, but it also has an impact on their whole families.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Absolutely.

The other thing I want to talk about is that we've seen the increase in addictions. Certainly it's been my passion since I was the shadow health minister to try to call for long-term recovery, so that people can get an exit ramp to get off of addiction. We already didn't have enough of that.

Could you give us an idea of what you think the federal government could do to help fill that gap?

[Rebecca Shields]

I'm so glad you asked that question.

There are a couple of really key things. I really believe we need a public health awareness campaign around moderate use of alcohol and cannabis in particular.

Since the pandemic, we have seen, particularly with men, a 39% rise in risky cannabis use and 28% rise in problematic risky alcohol use. With women it's 18% and 35% respectively. This is from the Canadian Centre for Substance Use and Addiction and the Mental Health Commission of Canada.

We're seeing people use more. Of course as they use more over a longer period of time, it becomes harder to treat, so we need early education and intervention. We absolutely need programs that are easy to access. We need the federal government to fund more detox and more crisis services so we can get people into care.

I agree with you that for some folks we need long-term care and long residential programs. We also need to focus in on withdrawal management and ongoing integrated services.

Thank you.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Excellent.

I think I'm out of time. I'm sorry because I still had more questions for the next witness. I'll leave it there.

Thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Gladu. You had 10 seconds, but it's gone.

Mr. Van Bynen, you have the floor for six minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

I do want to thank all of our witnesses for contributing to our discoveries today and especially you, Rebecca, for all the great work you're doing in our community.

I only have three minutes because I'm sharing my time, so I'll unpack my questions right away. I'll let you respond to the ones you would see as a priority.

First of all, we've heard about the difficulties in funding and we understand what those implications are. Beyond that, can you outline what challenges you are facing in maintaining and attracting staff, particularly during the pandemic?

The second question would be this: How does your organization currently overcome those challenges? What would you recommend be considered as part of the longer-term solution in terms of having staff available?

[Rebecca Shields]

Thank you for that question.

We certainly have had challenges because we have not had base funding increases. Of course we're very worried about a provincial Bill 124, which limits our ability at this time to provide competitive wages to attract new talent. We can't always rely on more money and better compensation, so what do we focus in on?

We certainly focus in on a talent and culture strategy that really focuses on being a supportive, fun, engaged and purpose-driven work environment. I think that's why everybody comes into the care community. Whether you're a dentist or a mental health worker or you're working in an acute care or long-term care centre, we all want to make a difference.

However, we also want to feel that we're recognized as important and as having some value in the profession. Recently, all of the health care providers in Ontario's central region put together a statement of solidarity and support against the attacks we have been facing from people who are against masking and other public health measures. The type of abuse our sectors face has been terrible, so standing in solidarity, protecting our health care workers and being the first in line to stand up with them is part of strategy.

Certainly we would absolutely benefit from more funding to equalize wages and to be able to attract talent. At the same time, I know why my staff do this. They want to make a difference and they want to know that the services are available for their clients. It is their success that fills their heart. What we really need is to be able to do that in partnership and have services available.

Thank you.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

Could you also elaborate on the mental health challenges that are facing workers today, including the health care workers, mental health and addiction workers, and specifically the team you manage and organize?

[Rebecca Shields]

I think it's broken down into the rising complexity of care. Honestly, we are seeing exacerbated symptoms because people who may have been been treated earlier have waited longer. People are presenting with much more complex, deeper issues around substance abuse and misuse and larger degrees of homelessness and not being adequately housed. They are fearful of coming in, perhaps because of pandemic issues, and we're trying to reach them virtually, which is not enough.

Sometimes virtual services can work for mild to moderate depression or anxiety, but when you're dealing with complex care issues, you need to see them in person to be able to assess them fully.

We've had challenges among our staff who are feeling that there's moral distress and that they can't meet the needs of all Canadians or the people whom they serve. That's very heartbreaking for people. They come into this profession to make a difference, and when they see the wait-list growing and they see the complexity, it can be disheartening.

In our homelessness programs, we've also had significant challenges with housing affordability. In the region of York, affordable housing doesn't exist. Even with rent supplements, ODSP and other benefits, we still cannot find safe and affordable housing. Again, this is a moral distress, and a strong housing strategy that creates affordable and supportive housing for each and every Canadian is essential for us to take care of the most complex individuals. Our staff are burnt out, but our staff work tirelessly to try to address these issues.

Thank you.

[The Chair, Liberal, Bobby Morrissey]

Madame Ferrada, you have not quite two minutes.

[Soraya Martinez Ferrada, Liberal, Hochelaga, QC]

Thank you, Mr. Chair.

Thank you, Ms. Shields. My question is for you.

I have less than two minutes left. You've already touched on some solutions that would provide better recognition for the community sector. You said you wanted to feel "recognized" as important in relation to the support the community sector provides the health care system, especially with regard to mental health. Could you come back to that?

You tabled a report on March 1 in which you discussed some solutions. In the last minute and a half that we have left, I would like you to give us a concise answer on this subject. You could even send your report to the committee.

[Rebecca Shields]

The report spoke to a robust community mental health and addiction care sector where we provide early, easy access to Canadians. We support access, and we support navigation and referral that is integrated with our other health care partners.

We have to look at this in terms of a robust child mental health care sector where we're looking at families and early intervention. Most mental illness issues commence at the ages of 12 to 17. We have to invest a lot more services in youth, and it has been youth who have been overly impacted by the pandemic with their schooling. We really feel there's a need to invest in young people, particularly youth, to work with our school partners and to work in collaboration with all of the services that surround youth.

We also have to look at seniors' mental health and deal with loneliness and isolation issues because, again, chronic loneliness is one of the major factors that affects overall health costs and well-being for each individual. I'm happy to share the report with this committee post this meeting. I will send it in for your reference.

Thank you.