Justice Committee on May 10th, 2023

[Jodi Hall]

Thank you for the question.

As per the brief that we submitted, we believe that there is absolutely a need of enhancements to address elder abuse in Canada. We need to have it formally defined so that it's consistently considered across the country.

As well, elder abuse is much more than the physical aspect. We do need to consider social abuse, emotional abuse, financial abuse. These are challenging issues that are experienced not only in a particular setting but for all seniors across the country.

We certainly would support the introduction of elder abuse legislation in Canada that would thoroughly conduct consultations and engagement with critical stakeholders across the country, including police and many other organizations, to be able to address this growing challenge.

[Andréanne Larouche, Bloc, Shefford, QC]

In the report titled “Elder Abuse: Identifying the Issue and Combatting All Types of Abuse”, published in 2021, the committee's recommendation 4 asks “that the federal government identify and implement mechanisms to protect whistleblowers in long-term care”.

Do you believe that Bill C‑295 will help whistleblowers such as employees file complaints about elder abuse?

[Jodi Hall]

No, I don't believe that this bill will provide any type of enhancement for the accountability structures that are in place today at the provincial level.

We can also look to the Criminal Code as it exists right now. There are examples through legal precedent. I'm not a lawyer, but I can speak to what has been shared with me. We can point to the precedents that have been established through the Westray mine disaster and the ability to determine who the directing mind is when criminal charges are warranted. I would point to those as ways that accountability can be driven today.

[Andréanne Larouche, Bloc, Shefford, QC]

That's fine, thank you.

Earlier, my first question was mainly about types of abuse. I would now like to come back to the definition of a long-term care facility. Bill C‑295 proposes the following definition: “a residential facility, or part of a residential facility, the primary purpose of which is to provide long-term accommodation, meals, assistance and care to three or more adults who reside in the facility...”.

It does contain some key words. In your opinion, is it complete or should anything be added to it?

[Jodi Hall]

I think that it is an incredibly broad definition of a long-term care facility. It would encapsulate almost all types of long-term care organizations across the continuum of long-term care. It does not necessarily focus just on those organizations that care for older adults but on an entire range of community care organizations that provide extended care.

The definition is incredibly broad, and the committee would need to consider whether that is the intent.

[The Chair, Liberal, Randeep Sarai]

Thank you.

Next we'll go to Mr. Garrison for six minutes.

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

Thank you very much, Mr. Chair. I want to thank the witnesses for being with us today. I know that for many of them it was short notice to appear, so I appreciate their being here.

I want to start by saying that with all due respect to my colleagues on the committee and our witnesses, it seems to me that this bill did not arise out of the larger questions about care of seniors in this country or elder abuse; it arose out of a crisis during COVID, when we saw Canada having to send its military in to provide assistance in long-term care homes. Not to disparage or diminish any of those other concerns, I think it was pretty clear in our discussion with Dr. Fry at the last meeting that this is what she was really aiming at in this bill.

I think two things are clear about that. One is that workers in long-term care struggled heroically through the crisis to try to provide the necessary care, but despite that struggle, we ended up with one of the worst records among wealthy countries for deaths from COVID in our long-term care.

That leads us to the question of why that happened. It's been phrased or framed a couple of ways. Quite often, it's asked, “Why didn't workers do their jobs?” However, I think an alternative frame is, “Why were they not able to provide that care?”

I'd like to ask Ms. Silas to address that question. Why did we end up with such a poor record during COVID? Can you speak to the framing of that question?

[Linda Silas]

It's staffing, staffing, staffing. You know, if we want to put seniors at the middle of the equation and prevent neglect in elders' care, it will not be through the Criminal Code. Let's be honest.

We have to put respecting seniors' care on the top of our list, and that is respecting the workforce, who just love their seniors. It's probably one of the areas of nursing—and I say nursing broadly, because it includes personal care workers, volunteers and families—where there's a visceral love for what they do. They don't have the resources; they don't have the respect. Changing the Criminal Code is not going to change anything. It's really about putting seniors' care as a priority.

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

In the specific situation that arose during COVID, what would you, as a representative of nurses, say was the cause for death rates in the long-term care homes here being higher than in other countries?

[Linda Silas]

They worked behind the curtains all the time. Nobody was taking care of it.

As we said, in 2015 we came out with a report talking about the understaffing, the lack of training, the lack of personnel, etc., and no one was listening because it was a question of dollars and cents. It wasn't a question of how we took care of seniors. What we saw over the years was the profit margins going up, and we saw that during COVID. It was just an insult to all the health care workers that some for-profit homes were making a profit and giving money back to shareholders when.... We have to remember that most of the health care workers who passed away due to COVID came from the long-term care sector too, so it is about respect, about proper staffing and about giving our seniors, our elders, what they deserve in their last few years.

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

In comparing the record between the public and not-for-profit long-term care homes and the for-profit care homes, you've talked about the higher death rate and fewer staff per patient to start with. Can you expand a bit more on how that relates to the problems we're talking about?

[Linda Silas]

What we heard throughout the pandemic was that the for-profit homes were even more restrictive with regard to PPE, for example. That's when you saw the stories of PPE behind locked doors, because it was all addressed to an N95 respirator being a lot more expensive than a paper mask. Those are the areas where we saw.... Unions like SEIU did extended studies, and I encourage the committee to have them do a presentation comparing the for-profit to the not-for-profit.

The not-for-profit and the municipality-run or the religious-run are really based on community and are looking out for the care of seniors, compared to the for-profit, which of course says what they are. As I said in my statement, these studies showed a higher level of deaths there.

You're right, MP Garrison, that we had the worst experience of any developed country in the world, and that was due to our long-term care, which is why everyone is studying it now.

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

In your presentation, you talked about the fact that many people who are captured by this definition of “manager” in this bill don't have any decision-making power or any control over critical decisions on hiring or training. Can you talk a bit more about what that means in practical terms?

[Linda Silas]

Yes. I'm sure Ms. Hall could explain to you every province's laws, but in most provincial laws for long-term care, there has to be an RN, a registered nurse, assigned on a 24-hour basis. However, sometimes that registered nurse is the director of nursing, and he or she is at home in the middle of the night. Then it's the registered nurse who's on the unit, a licensed practical nurse, or sometimes just personal care workers with somebody on call.

Again, when we're talking about the Criminal Code—and Ms. Hall mentioned the Westray act—it's really to see who makes the final decision, and we guarantee you, the committee, that it is not the nurse or the personal care worker on the ward or in the long-term care facility. Often, it's not even the director of nursing in that facility or the director. It is either the shareholders or the board of directors, depending. The bill as proposed now is really flawed because it's talking about managers who direct the day-to-day activities, but they don't really direct the day-to-day activities, so we have to find out who directs them.

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

Thank you.

[The Chair, Liberal, Randeep Sarai]

Thank you.

Thank you, Mr. Garrison.

We'll now go to our next round for five minutes. That begins with Mr. Van Popta.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for being here and for giving us your very important expert evidence on an important issue.

Before I go on, I am going to address this to the chair. I was looking forward to the next panel of department officials, because I had some important technical questions about numbers of convictions, what's wrong with the existing legislation and what this bill could improve. I understand they're not coming.

I am particularly troubled, because we're getting competing evidence from our witnesses today. It's very valuable evidence—thank you for that—but one witness is saying that we need to broaden the definition of “manager” and another is saying we need to narrow it down, so we really do need expert help, and I am disturbed we're not going to be seeing that today.

We have these important witnesses in front of us, so I am going to ask them some questions.

Ms. Silas said in her evidence that she is advocating a narrower definition of “manager”. She said it shouldn't include lower-level workers, like the scheduler and the purchasing agent, and maybe not even the director of nursing, but it should be focused only on the person making financial decisions. She also said in her testimony that the history of the neglect of seniors is worse in for-profit homes than in not-for-profit homes.

My question is to both Jodi Hall and Terry Lake. Is that your experience in your fields and with your associations?

[Terry Lake]

I am happy to go first if you like, Jodi.

Certainly in British Columbia, where we have one-third government-owned and operated, one-third for-profit and one-third not-for-profit, there was no discernible difference in the incidence of mortality in care homes based on the ownership type.

I would take some issue there. I think it's a distraction, because we spend a lot of time talking about this issue rather than about how we can make seniors' care better. If you look at Quebec, for instance, where the Canadian Armed Forces personnel went in and saw some terrible situations, you see that 80% of long-term care is government-owned, operated and funded in the province of Quebec.

We point to Ontario's situation, where there just happens to be a large proportion of for-profit providers, and those for-profit providers have homes that have not had investment through the government investing in new facilities for a long time.

Studies in the U.S. show that ownership is not a significant factor. It is the age of the home and the size of the home that determine the difference in mortality.

I would even caution the committee about comments about Canada doing poorly versus similar countries. The Institute for Research on Public Policy published a paper in the last few months that showed the mortality rate in Canadian long-term care was about 26 per 1,000, which was actually better than about two-thirds of similar countries around the world.

We had 80% of our deaths in long-term care because our death rate in the community was so much lower than other countries, so you have to be careful about the data you're using to draw conclusions. As I said, I think it's a distraction because, as Ms. Silos has said, the key to improving care for Canadians in long-term home care is to invest, and we simply need to do that to make sure we have appropriate staffing.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Good. Thank you.

I am hoping Jodi Hall can respond to that as well.

[Jodi Hall]

Yes, and I completely agree with the comments that Terry has laid out. Every type of long-term care home in Canada was impacted by COVID-19. There were no exceptions to that.

We know that those experiences were largely shaped by the age of the infrastructure and the home's ability to implement infection prevention and control protocols, as well as the square footage that was available where residents lived together, as well as the number of staff available, especially during those early days.

Access to PPE and education for staff were limited, but it was largely due to PPE not being available globally. If you recall that time, which can feel very far away, it was an incredible challenge to be able to access the PPE that was required and to have the funding to be able to purchase it.

The other thing—

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

I'm going to stop you there because I'm almost out of time and I would like to give Ms. Silas an opportunity to respond.

Is that okay, Chair? Can I have 30 seconds, maybe?

[The Chair, Liberal, Randeep Sarai]

I'll give you 15 seconds.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Thank you.

[Linda Silas]

Ms. Hall is probably very right on the access to PPE, because, again, we've never put seniors' care as a priority in this country. Compared to an ICU, they were at the back of the bus to get any PPE, so I do agree there.

I don't have the references. This was a last-minute thing, but in our brief, we will send the references on comparing the for-profit versus the community and not-for-profit long-term care, both on the deaths and on injuries to health care workers. I commit to that.

[The Chair, Liberal, Randeep Sarai]

Thank you.

Now we'll go to Mr. Zuberi for five minutes.