Justice Committee on May 11th, 2021

[Kathy Majowski]

Absolutely. Thank you.

In the community setting, we see in many cases that older adults do not want to report family or friends and do not want criminal proceedings. They are dependent on the perpetrator for something, whether it be to help them get groceries, for transportation to a doctor's appointment or for tasks that allow them to continue living comfortably in the community. They do care about the person who is helping them.

From the work I do, we've seen a lot of success when we assist to put more resources in place so that older adult is no longer dependent on the person who is abusing them. They are able to access resources in the community, whether it be volunteers, social services or health services. Particularly during COVID, we've seen a wonderful uptick in these services and supports, where they no longer have to be so dependent on the perpetrator. They can go back to being family members without that extra complication of one depending on the other.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Thank you, Ms. Majowski.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you, Monsieur Fortin.

We'll now go to Mr. Garrison for six minutes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair. Thank you to all the witnesses for being with us today.

I want to go back to Ms. Majowski, who talked about prevention.

Do you believe that strengthening the Criminal Code provisions that would hold private care operators responsible for failures of care that result in injury or death of long-term care residents would help in terms of providing an incentive to avoid elder abuse in those homes?

[Kathy Majowski]

I do. I do think there needs to be more accountability when it is discovered that private care providers, and even municipal care home providers, are not doing the job that our older adults deserve. There should be a level of accountability.

Speaking for Manitoba, there is oversight from our provincial government for the long-term care facilities. There are certain standards that the long-term care facilities need to uphold.

However, if a care facility in Manitoba does not meet those standards, that information has not been made public. It's not something that is shared. They are given chance after chance to rectify the situation. Sometimes they do for as long as the oversight committee is keeping an eye on things and then they no longer need to.

There are—one hundred per cent—concerns that the accountability is lacking in these care homes and for these care providers.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much.

On the question of staffing and staffing levels, it would seem to me that if institutions had been properly staffed during COVID, they wouldn't have fallen into crisis so early or so deeply. While Mr. Lake's testimony seems to treat staffing as something that falls from the sky, it would seem that before COVID there was a problem with inadequate staffing levels to provide adequate care. Is that your experience?

[Kathy Majowski]

Absolutely.

I can speak both professionally and personally. My grandmother is in one of the care homes that suffered a significant COVID outbreak, and we learned after the fact that they were staffed at pre-pandemic levels, even when there were outbreaks in other care homes in the city.

I have worked in care homes. The pre-pandemic levels are woefully inadequate. The amount of time that staff have to spend with each resident is broken down almost to the millisecond. They are given very little time. There's no time for any crisis or any variation from the routine, which makes staff very stressed. They're not able to perform the task they know they should be doing. This has been an ongoing issue, and I don't think that the staff need to fall from the sky, but I do feel there are long-term care facilities that are chronically understaffed and expect volunteers and family members are going to fill the gaps.

What we saw with COVID was, when the volunteers and family members were no longer able to access the homes, there was a significant crisis already. We should not have to depend on volunteers and family members to be able to care for our older adults properly.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

I will turn to Mr. Lake since I have cited him.

I'm curious about whether the BC Care Providers Association is working on establishing standards for itself as care providers and professionalizing its own organization. You've talked about B.C. care aides needing to be professionalized, but does your organization work to establish standards of care that your members will deliver when providing long-term care?

[Terry Lake]

All our members are contracted to the provincial government through health authorities, and they're very highly regulated. For instance, all inspection reports of long-term care are available on the health authority websites. We have patient care quality officers whom families can go to if they feel there's an issue about care in their family's nursing home.

On our independent living and home health side, we are starting an assurity program, which does have a level of care, a level of standards, that people have to meet. That's more on the independent living and private home health side, not the contracted long-term care side, because the regulations there—I can tell you, having been the minister—are very stringent.

In British Columbia we have probably the best organized system of care for seniors because we are so tied into regional health authorities for oversight. Whether you are a health authority home or a contracted provider, that same level of regulation and care and hours of care are legislated.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

What you're saying to us then as a committee, is that we shouldn't wait for the providers to raise standards of care. We will need to focus on regulations and perhaps national standards for health care, rather than wait for the providers to tackle these problems, that you're just going to wait with the current level of regulations.

[Terry Lake]

We have to remember that seniors care in Canada, in almost all cases, is publicly funded for their care component but not the hospitality component. Providers can only provide the level of care that governments are willing to invest in. When we talk about not being able to have staff or not being able to attract and retain staff, it's because Canada underinvests in seniors care by about 30%. Until and when we address that, we won't see improvements in raising the level of care through staffing.

[The Chair, Liberal, Iqra Khalid]

Thank you very much.

That concludes your time, Mr. Garrison.

We'll now go into our second round of questions, starting with Mr. Baldinelli for five minutes.

[Tony Baldinelli, Conservative, Niagara Falls, ON]

Thank you, Madam Chair.

I'd like to take this opportunity to thank all our witnesses for being with us today.

Ms. Hajek, thank you for being here. One of your comments resonates with me. It's the regrets, the things we do not do, and so it's important that we're doing this study and we're here today to look to all of you and your comments.

I was wondering if you have had a chance to review the recent long-term care report in Ontario that was released on April 30. If so, do you have any comments on that?

[Marta Hajek]

If I may, through the chair, I'd like to defer this question to our director of partnerships, Raeann.

[Raeann Rideout, Director of Provincial Partnerships and Outreach, Elder Abuse Prevention Ontario]

Thank you.

I haven't read the report entirely, but we do know there is the need for further training and education to the staff in identifying. Sometimes staff may not even recognize some of their actions may be considered abusive in nature in regard to that.

Again, I don't work directly within that long-term care sector, but with my colleague, Mr. Lake, we recognize the lack of staffing. We knew that some of those shortages were evident prior to COVID as well, and that it is a necessary need that we do need to implement in the future in terms of staffing.

Also, getting back to the national standards for long-term care, we need to integrate that training and education component. There needs to be the recognition of what the role and responsibility is in reporting when they do see significant issues happening to residents by other colleagues they're working with and that whistle-blower protection that I think other colleagues have mentioned in previous testimonials.

Thank you.

[Tony Baldinelli, Conservative, Niagara Falls, ON]

I'll follow up on that with regard to what other witnesses talked about, under the federal Criminal Code, the notions and requirements for whistle-blower protection and then criminal endangerment codes as well. Could I get your thoughts on that?

[Raeann Rideout]

I would refer to our colleagues who have the expertise and legal background in regard to the Criminal Code amendments.

I know Mr. Graham Webb made a recommendation around criminal endangerment, and I know it's something other colleagues have supported.

Again, Krista James, from the Canadian Centre for Elder Law indicated, in terms of looking at investigation or research, what best practices would work, and what other legislation is working across borders as well in terms of looking at best practices that we would implement in the future.

[Tony Baldinelli, Conservative, Niagara Falls, ON]

Excellent. Thank you.

It seems to be a consensus in some of the discussions here on the whole issue of staffing and the needs in that area. I know from the long-term care report that the province issued on April 30, from page 236 all the way to page 239 it talked about staffing and the requirements there. It talked about the regulation of PSWs.

I know the provincial government has committed $86 million, for example, to provide free tuition to PSW students so that it could bring on stream 8,000 new PSW workers.

If that were provided today, how long would it take before we would have those workers working in facilities?

[Terry Lake]

In British Columbia, and I think it's fairly similar across the country, it takes about eight months to be certified as a health care assistant. These programs are extremely important and the sooner we start them, the better.

We have a similar program in the province of British Columbia.

We simply don't have enough people living here in Canada to fill those roles. Already the provincial government has hit a plateau in entrance to a totally free, paid-for program, so we need to have immigrants take those roles. That's why we really need to work hard to bring people in to fill those gaps.

[Tony Baldinelli, Conservative, Niagara Falls, ON]

Thank you.

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Mr. Baldinelli.

We'll now go to Mr. Virani for five minutes.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Thank you very much, Madam Chair.

I'll be splitting my time with Mr. Sarai, so I'll keep it fairly brief.

I want to recognize, first of all, that this is National Nursing Week, so thank you to all of the nurses who are doing this extremely important care, particularly, Ms. Majowski. I know you are a registered nurse. I am married to one.

Second, I would just say thank you to all of you for the work you are doing and your commitment to this cause.

We're very seized of the issue of standards, which has come up repeatedly, and with the issue of funding to support those standards. That's why, as a government, between the fall economic statement and the current budget, we've committed about $4 billion in total to this sector alone.

What's important is that we also recognize that standards will, by necessity, still be breached.

I want to address this question particularly to Ms. Hajek, because I don't think she has weighed in on it yet, about this criminal component. We've heard from Mr. Lake on this and I've heard a little bit from Ms. Majowski about it.

One, do you feel, Ms. Hajek, that we need to improve the criminal standards for neglect of those who are in care? Two, if so, do you appreciate or endorse what was suggested by Mr. Webb at the last panel?

[Marta Hajek]

Thank you, Mr. Virani.

I would certainly endorse the position that many of my colleagues have taken. Again, we are in a crisis situation. There needs to be more accountability, and there need to be consequences for bad behaviour.

People who don't adhere to the rules and whatever existing standards are in place now have already demonstrated how, without consequences, this will just continue. It will be exacerbated beyond just what the COVID environment has provided for us. Yes, there need to be consequences and they need to be worked into the Criminal Code.

I have no legal expertise myself, but I hear horrible stories every single day. Our responsibility as a society is to look after one senior at a time and to make a difference in their quality of life.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Thank you very much, Ms. Hajek.

I'll turn my remaining time over to Mr. Sarai.

Thank you.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you, Mr. Virani.

My question is for Mr. Lake.

Mr. Lake, it's good to see you here. I've grown up around old folks homes all my life. My mother was a cook in one and my aunts were care aides and nurses aides. I used to get babysat for 45 minutes to an hour between my parents' shifts, so I knew a lot about it when I was in my younger years.

What I've heard from you is the concern that, one, there is a lack of funding and, two, there is a lack of care aides and other staffers. There is an acute shortage here.

Here's what I would like to know. When a private care facility doesn't have the staff, do they still maintain the same amount of patients or do they have to reduce the amount of patients to make sure the staff-to-patient ratio is maintained?