Justice Committee on May 13th, 2021

[The Chair, Liberal, Iqra Khalid]

I call this meeting back to order.

Welcome to our witnesses for this afternoon's panel on our study on elder abuse.

Just for the benefit of witnesses who are just joining us now, I'd like you to take note of the interpretation icon that's at the bottom of your Zoom screen. Just select the language that you'd like to listen to. You can speak in French or English. When you are speaking, just ensure that you unmute yourself, speak slowly and clearly, and when you have finished speaking, make sure that you put yourself back on mute. Please wait until I recognize you before speaking.

With that, I'd like to welcome our witnesses. We have the Canadian Indigenous Nurses Association represented by Marilee Nowgesic, who's the chief executive officer. We also have the Canadians Nurses Association, represented by Michael Villeneuve, chief executive officer. We have Miranda Ferrier, who is the chief executive officer, Canadian Support Workers Association.

Welcome, and just before we get into it, I'd like to wish all of you a very happy National Nursing Week. On behalf of our committee, we really appreciate all of the great work that you do in keeping us safe and healthy. Thank you for your contributions.

We'll go ahead and start with the Canadian Indigenous Nurses Association for five minutes.

[Marilee Nowgesic, Chief Executive Officer, Canadian Indigenous Nurses Association]

Thank you, Ms. Khalid.

My name is Marilee Nowgesic. I am the chief executive officer for the Canadian Indigenous Nurses Association.

I am in the unceded Algonquin territory of the Anishinabe people. I am here in Ottawa. I am originally from Thunder Bay/Fort William First Nation, and I am an Eagle clan member of the Ojibway Nation.

I'd also like to recognize today is Indigenous Nurses Day, so I extend acknowledgement to all of the indigenous nurses across the country. We are the organization to represent your voice.

I would also like to give you a little bit of a backgrounder to CINA. CINA is the oldest indigenous organization in the country, celebrating this year 46 years. As well, we have at this point roughly 9,800 indigenous nurses across the country who have identified as being first nations, Inuit or Métis. We have concluded there are probably quite a lot more. Because of the unique identifier situation we face in Canada, many workers are apprehensive about identifying in the indigenous category for various reasons, one of which we will step into in June as we address the third round table on racism. However, today, I thank you for the opportunity to come and speak with you with regard to elder abuse in the indigenous population.

I would like to thank and recognize Mr. Virani for bringing forward the motion to the House to look at this very important issue in Canada.

Indigenous elder abuse in Canada is part of a recognized land issue. We need to, first of all, take a look at the definition issue of “elder”. Elders in Canada in the indigenous lens are those people who have been given insight and understanding, as well as communication skills, to pass on the collective wisdom of generations that have come before us. You have heard from many of our elders, first nations, Inuit or Métis, in your previous work within your constituencies. “Elder” is capitalized when used to indicate honour or a title, as opposed to “senior”, as identified in Health Canada's definition.

The global statistics are lacking and the abuse of elders is grossly under-reported worldwide. Several countries, including Canada, have carried out research to examine the issue over the past several decades. There is no way of knowing whether abuse and neglect is getting worse or better, especially in indigenous communities. Statistics on the abuse of our elders are scarce for the general Canadian population, and the information is less available for the indigenous elder population.

Having said that, the definition of “elder abuse” has also some contributing factors when looking at the categories of elder abuse: domestic elder abuse, institutional abuse or self-neglect. Because of these categories, we also look at types of elder abuse that are prevalent in our indigenous communities: physical, psychological and financial. The most egregious forms of this abuse was evident when we saw the settlements to our indigenous elders as part of the Indian residential school system allocations.

Defining “elder abuse” also looks at several other areas that we, in our indigenous nursing ways and knowledge, want to be able to identify. We want to look at abandonment; physical, psychological, financial and sexual abuse; neglect and spiritual abuse; and the contributing factors that lead to elder abuse, the demographics, the stress, the societal factors and those which also lead to our life expectancy. We know there are dependency rates and there is a lack of statistical sources that would allow us to really look at that view with regard to the indigenous population.

We would welcome the opportunity to work with you on the report of this study, and further, with the indigenous population.

Again, thank you for allowing me to come here with you today.

Meegwetch.

[The Chair, Liberal, Iqra Khalid]

Meegwetch, Ms. Nowgesic. I appreciate your testimony.

We'll now go to the Canadian Nurses Association for five minutes.

Please go ahead.

[Michael Villeneuve, Chief Executive Officer, Canadian Nurses Association]

Thank you, Madam Chair; and thanks to the members of the committee. Good afternoon.

I'd like to acknowledge that I am on the same land as Marilee, my good colleague. It is the unceded ancestral lands of the Algonquin Anishinabe peoples, and I am just so privileged to live here and speak from here today.

My name is Mike Villeneuve. I am the chief executive officer of the Canadian Nurses Association.

I am joined today and will share my time with Miranda Ferrier, who is the chief executive officer of the Canadian Support Workers Association.

As you have noted, it is a special week for nurses as we celebrate National Nursing Week and recognize the courage and commitment nurses have shown during the COVID-19 pandemic. I don't need to tell you that it's not quite the cake-and-parties nursing week that it sometimes is, but that's the reality we're living today.

I give a special acknowledgement to indigenous nurse colleagues as we celebrate national Indigenous Nurses Day today.

Turning to the subject at hand, CNA strongly believes that as a society we need to assume a stance of zero tolerance for elder abuse. It's an unacceptable reality that, as Canada's population ages, it will require more forceful interventions. As you know, a lot more of us are heading into that age curve.

As patient advocates, nurses have a responsibility to both prevent harm and provide early intervention to protect older adults. Through their time spent with patients and families across the entire continuum of care, nurses are well positioned to help identify and address elder abuse.

Rigorous practice guidelines and screening tools, training, and effective monitoring systems and structures to make health care workers feel safe in reporting abuse are just some examples of important elements that need to be put in place.

Nursing is a self-regulated, autonomous profession. A major condition of this privilege is to protect the public and the profession by having nurses adhere to strict professional codes of practice that are underpinned by dignity and respect for patients.

The care provided by nurses and personal support workers, PSWs, in long-term care is deeply integrated and we really can't talk about one without the other when it comes to older adults in long-term care, so I am happy to now turn over the rest of my time to my colleague, Miranda Ferrier.

Thank you very much.

[Miranda Ferrier, Chief Executive Officer, Canadian Support Workers Association, Canadian Nurses Association]

Thank you very much, Mike.

I am Miranda Ferrier. I am the CEO of the Canadian Support Workers Association. We represent approximately 67,000 support workers across Canada. It is an honour and a privilege to speak today on this very important topic.

I know it's National Nursing Week, but I want to take this opportunity to commemorate Canada's personal support workers who have continued to step up through our COVID-19 pandemic.

We are here to address the ongoing issue of elder abuse, examine the effectiveness of our current laws in fighting elder abuse, analyze ways of penalizing those who neglect seniors under their care, and look at how to combat elder abuse more effectively in the future.

We must first acknowledge one of the very many roots of the cause. Our personal support workers across our nation are unregulated; therefore, our elderly need necessary public protections implemented through government regulations. Regulations provide the industry with a stabilizing element and help professionalize and validate the status of the PSWs. A core mandate of the PSW is to protect older Canadians and seniors and it is surprising that this workforce remains unregulated.

Through the establishment of a regulatory model, it becomes clear that PSWs are formally recognized as equal members of their health care teams, but more specifically, regulation would provide our elders and the public with necessary protections. If adopted nationally, a regulatory model demonstrates clear public safety mechanisms for all Canadians, including seniors. Regulation also levels the playing field in long-term care and community care.

We are grateful that, for the first time ever, the Ontario government has announced that it will be implementing a regulatory body for personal support workers in the province. This is a first step forward to addressing this problem.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you very much. You still had about 40 seconds on the clock, but I do appreciate any extra time we can get.

We'll now go into our first round of questions, starting with Mr. Moore.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Madam Chair.

Thank you to our witnesses. I wish you all a happy National Nursing Week, as our chair has already said. As well, happy Indigenous Nurses Day.

We want to commend the work of nurses throughout the country and indeed throughout the world. Over this past year, the extra strain of COVID—

[Stéphane Lauzon, Liberal, Argenteuil—La Petite-Nation, QC]

I'm sorry, Mr. Moore.

Madam Chair, we don't have translation because I think one of the witnesses has an open mike. The mike could be in the House of Commons in Ottawa.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Lauzon.

Can I please ask Mr. Clerk to just check in to see if all [Technical difficulty—Editor]?

[The Clerk of the Committee, Mr. Marc-Olivier Girard]

[Technical difficulty—Editor].

[The Chair, Liberal, Iqra Khalid]

[Technical difficulty—Editor].

[Rob Moore, Conservative, Fundy Royal, NB]

[Technical difficulty—Editor].

[Michael Villeneuve]

[Technical difficulty—Editor].

[Marilee Nowgesic]

[Technical difficulty—Editor].

[Rob Moore, Conservative, Fundy Royal, NB]

[Technical difficulty—Editor].

[Michael Villeneuve]

[Technical difficulty—Editor].

[The Chair, Liberal, Iqra Khalid]

[Technical difficulty—Editor].

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

[Technical difficulty—Editor].

[Michael Villeneuve]

Not being a legal expert, I won't venture too far into this, but I will say that there are a number of safeguards in the Criminal Code as we see it and understand it. We believe that strengthening and enforcing those at both the individual practitioner and the organizational level would go a long way to help the cause.

I'm not expert enough, Madam Chair, to suggest whether or not there need to be additions to the Criminal Code. The conditions that are there seem to be enough to safeguard if they're properly deployed.

I'll stop there, so I don't just wander.

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

Ms. Nowgesic.

[Marilee Nowgesic]

If the current socio-economic conditions aren't addressed for the indigenous population, the violence against all members of that indigenous community, especially the most vulnerable—elders and children—will continue at its present rate and will increase. Therefore, addressing the Criminal Code—which impacts the ability of the national indigenous policing services, the Royal Canadian Mounted Police, law enforcement and the legislation for indigenous nurses—will provide that opportunity for better reporting systems, incident management, patient safety and quality and improvement.

Data collection comes from the first nations, because we have the First Nations Information Governance Centre structure. In order to facilitate the raw data that will help in looking at treatments, programs, services, licensure and mobility of our indigenous nurses, we have to look at those pieces of policy, legislation and regulatory affairs that govern indigenous health care providers across the country.

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

Thank you for that.

I want to bring you into the conversation, Ms. Ferrier. This next question is about the nature of who needs to be the focus of any potential Criminal Code changes. We have heard a little bit about this over the course of the previous days. It's this idea of whether it should be the individual PSWs or nurses who are potentially criminally liable or whether the nexus of a strengthened offence should be more focused on the people who are managing institutions, directing institutions, etc.

I presume that I might know the answer, but I want to hear your perspectives, Ms. Ferrier, Ms. Nowgesic and then Mr. Villeneuve.

[Miranda Ferrier]

I've been asked this question many times before. It's something that we as an association federally and provincially have looked into, because nowhere across our nation is it the same.

I'll give you the example of Ontario, where I reside. In Cambridge, where I live, there really is no senior abuse unit for police. This is an issue we've come across many times, with personal support workers in community care becoming POAs, powers of attorney, for people and taking advantage of situations. Some police forces find that a civil matter, not a criminal matter. We need to look at it as a whole.

I think it depends on where they work, whether it be nurses or PSWs or whether the individual would be the one responsible or charged for whatever it is. I think the operators of long-term care homes or management should also be held accountable, depending on where they work.

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

I have only 30 seconds left. Could I have a brief answer from Ms. Nowgesic and Mr. Villeneuve on that point, please?

[Marilee Nowgesic]

If a report is going to be identified in the indigenous community at that level, then we have to think of a safe space for them to quickly go to. Once it's reported, how do we evacuate that nurse, the person, the people involved [Technical difficulty—Editor].