Justice Committee on May 13th, 2021

[The Chair, Liberal, Iqra Khalid]

I'm sorry, Ms. Nowgesic. We missed the last part. Would you like to repeat that?

[Marilee Nowgesic]

Not a problem. It was about evacuating people from any further harm, so removing all parties.

[The Chair, Liberal, Iqra Khalid]

Yes. Thank you very much.

We'll now go to Monsieur Fortin.

Please go ahead for six minutes.

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

Thank you, Madam Chair.

Thanks to all the witnesses who are here today.

Elder abuse is a concern for us all, and I think it's appropriate that we hear the various points of view. With you, I'd like to pay special attention to first nations. Maybe it's just my imagination, but I always thought the first nations had a great deal of respect for their elders. That's what I've always felt. I'd like to hear what you have to say about that.

Do you think first nations elders are treated differently by their fellow citizens than in civil society in general?

Perhaps Ms. Nowgesic could answer.

[Marilee Nowgesic]

Thank you very much, Mr. Fortin.

I will try to look at what it is in regard to the first nations specifically.

In that community, we've been inundated via an exhausting list of external factors—drugs, loss of jobs, money, and under this current COVID environment, people being restricted once again to maintaining no other contact outside of their community. We're then seeing an increase in domestic violence. We're seeing child abuse. We're seeing people not having resources available.

First nations elders are held in esteem in a greater portion of the communities. However, because of whatever socio-economic conditions, mostly financial, the elder becomes a victim of constraint, limitation and restriction. It's those types of abuses. We've seen them. We've heard them. We heard what happened when the Indian residential school monies came out. That was why power of attorney documents came forward. But what didn't come forward after that? The identification and requirement for wills for these elders. Who does the money go to? Then we have people fighting in the community.

But for the most part, the elders, because of the wisdom, because of what they have obtained...and we're now moving into a new generation of elders who have a different level of ways of knowing. That will become part of what will be a policy, political and legislative structure as we move into the 21st century.

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

Thank you, Ms. Nowgesic.

Is the situation of first nations elders the same when they live on reserves as when they live in big cities?

[Marilee Nowgesic]

It is the same reality. I think it's even increased when they get to an off-reserve environment. Due to the societal values and factors that come into play, they become victims within what was supposed to be a safe space for them. Their ability to catch a bus, their ability to sit on the road and wait for that bus to come...and then somebody takes advantage of their frail mental state, says, “Oh. Hi, Auntie. I'm so-and-so. I'll take you for a ride”, then dumps off Auntie and steals her purse. What does Auntie do then? She doesn't know how to use a phone. She doesn't know what to do. That is the reality. That is what's still happening. Unfortunately, law enforcement is saying, “Oh well, it's out of our hands. Report it back to your chief.”

It's those kinds of complacent attitudes that frustrate the nurses even more because then it's, “What medications did you have? What were you placed with?” Then the nurse is inundated. We have to look at protecting our nurses because they are the front line for that trust and the traditional approach between western and traditional medicine.

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

What do you think could be done to provide better protection for elders living on reserves? First of all, can anything in fact done?

If not, should the solution come from band councils or from the federal government?

How do you view that?

[Marilee Nowgesic]

That's called the “dream list” for the elders. They would like to see elder lodges. We would like to see an elder lodge placed in every one of the 637 first nations communities across the country, all able to hire every kind of health care professional that they can within those facilities. It is a federal government responsibility because they have the facilities management and the infrastructure.

We need to hook them up with Internet. This is going to be a new generation, one that will be part of FaceTime, Facebook and any other technological advancements at their disposal.

Thank you.

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

I see.

I'm going to go quickly to Ms. Ferrier or Mr. Villeneuve.

How do you think the financial security of seniors across Canada could be improved?

[Miranda Ferrier]

I'm not sure if my colleague is still here. He might have been having some Internet problems, but I'll take it first. Thank you very much.

For their economic safety, we need to look at how we can provide them with the best care possible, the safest care possible, so that they can flourish where they are. I truly believe that we need to have better reporting systems, data collection systems, as was talked about earlier. We need to have education, and not just education of health care workers. I can tell you, as a personal support worker for 16 years, I had to source out my own education on elder abuse. The public is not aware of the signs and symptoms of elder abuse.

[The Chair, Liberal, Iqra Khalid]

Thanks very much.

Thank you, Mr. Fortin.

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

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

Thank you very much, Madam Chair. I too want to thank the witnesses for being with us, especially during National Nursing Week and also Indigenous Nurses Day. I want to thank them, obviously, for the work their members have done over the last 15 months, but also for the work I know they'll do when the rest of our society moves on from the immediate COVID crisis and the impacts are left to their members to deal with.

I want to start with a question, Ms. Nowgesic, about services and supports available to indigenous seniors who live off reserve. In my riding, more than half the indigenous population is urban and off reserve. Certainly, I've heard a great deal, especially during Covid, about the lack of services for those seniors.

[Marilee Nowgesic]

That becomes the jurisdictional issue—and, again, we're trying to get it to stop—between the health care provider having certain powers available to them and...why is there no indigenous health care access centre within those areas? Why is there no outreach being defined for that?

That's something we need to address. It is one of those socio-economic and societal factors that the federal government along with their provincial and territorial partners need to provide some recognition of.

Just because they moved off the reserve for a better quality of life, or for whatever reasons, that's their choice, it shouldn't lessen the availability of what they have coming to them as far as benefits and services are concerned. We have them come forward to participate in ceremony, then their old age security is clawed back, and so on, and so forth. It's an exhausting cycle. You can imagine what it's like for a senior who doesn't understand why these...are being placed on them.

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

Thank you very much.

We have heard testimony, and we have heard certainly in the media, of long-term care operators who have said the problem and the crisis during COVID was a lack of staff, and a lack of skilled staff. I have described that as acting as if the staffing problem fell from the sky when we know it existed before.

I want to go to Ms. Ferrier to talk about the lack of standards for staffing in long-term care homes and the pushing of work that often requires higher skill levels down to personal support workers.

[Miranda Ferrier]

That's completely in my wheelhouse to speak about.

Yes, COVID really brought the issue of staffing to the forefront, which I for one am very thankful for. The issue of short-staffing in long-term care facilities has been going back at least two decades slowly, and it has just been getting worse.

What we're seeing now in long-term care facilities, especially through COVID, is number one, the personal support workers are the ones who do the bulk of the work. What I mean by bulk is the bulk of the physical work. We're the ones who perform all their personal care. We help them with their mobility. We help feed them, dress them, toilet them, shower them. We are their main communication throughout the day.

Of course, the nurses are just as important, and we work as a very solid team in that environment, but what you have are two personal support workers, let's say, to a floor of 28 residents all with varying degrees of mental and physical issues. Some might take five minutes to help get ready, and some take 30 minutes to help get ready. Nurses have up to 60 to 80, if not more, people to distribute medications to in one shift.

It's a really impossible situation in long-term care facilities, and until there's an actual standard, maybe even a standard of a ratio, for long-term care facilities.... That's what we would hope to see come down from the federal government, a set ratio in long-term care. So there would be x number of residents per PSW in long-term care homes, and the same with x number of residents per nurse in long-term care homes.

Here in Ontario I sit on a long-term care champion table in regard to the long-term care staffing crisis we have been having, and the conversations are all around staffing and ratio issues.

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

Would you think establishing national standards either within the Canada Health Act or in separate legislation would help with the situation across the country?

[Miranda Ferrier]

Absolutely. I have thought that for years. Even if we start with something as simple as one personal support worker to eight residents, that's still too big for the record because of the varying mental health and physical issues, but if we just start with 1:8, then we will start to see a decrease in bed sores, in behaviours. We would see less burnout of the frontline staff because then there would be guaranteed only eight people they have to care for. Right now we're seeing one PSW to 18 to 20 residents, and that's in an evening shift. Overnights it's one PSW to 35 to 45 residents.

We need to see change, and I think it needs to happen from this part down.

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

And as we're the justice committee, we have been looking at possible changes to the Criminal Code. What I think we've seen is a tendency to blame personal support workers when there are cases of neglect rather than to blame the system that doesn't allow them to provide quality care.

I know that's a leading question, but I would like to hear from you on that.

[Miranda Ferrier]

I have nothing to add to that or change. I want to be perfectly honest. It's the truth. Because we're an unregulated profession, we're the easy go-to for blame. They can throw us under the bus, and our college is not going to get upset.

Yes. I totally agree, and that needs to change. It's not fair.

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

Thank you.

[The Chair, Liberal, Iqra Khalid]

We'll go into our second round with Mr. Lewis for five minutes.

[Chris Lewis, Conservative, Essex, ON]

Thank you very much, Madam Chair.

Thanks to all the witnesses, once again, for fantastic testimony.

My daughter works at a long-term care home, so I very much can appreciate each and every one of you. Also, I own an outfitting business in the far north.

Ms. Nowgesic, probably all of my questions will be directed to you. I will tell you that when you said in your testimony about elder with a capital “e”, that really resonated with me. I will keep my story short.

I will only use the first name, and I will not give the reserve name. However, I have visited many reserves myself.

I will tell you that Irene—I call her Grandma—is the most amazing person, and she has taught me so much from far northern Ontario on the Attawapiskat River. I have spoken to her at length over the last four or five years, and she's suffering dearly right now because she's stuck in Thunder Bay, and she can't go back to the reserve because of COVID.

As opposed to perhaps physical abuse of seniors, perhaps we could switch it and talk about the mental health issue that those elders off reserve right now are going through.

My first question is this: Is that a fair statement? A follow-up would be this: What can the government do to give nurses an opportunity to help both on reserve and off reserve?

[Marilee Nowgesic]

Thank you, Mr. Lewis.

Let's just say [Technical difficulty—Editor].

[The Chair, Liberal, Iqra Khalid]

[Technical difficulty—Editor].