National Defence Committee on Nov. 27th, 2020

[The Chair, Liberal, Karen McCrimmon]

Good afternoon, everyone.

I call this meeting to order.

Welcome to meeting number seven of the House of Commons Standing Committee on National Defence. Today's meeting is taking place in the hybrid format, pursuant to the House order of September 23, 2020. Proceedings will be made available via the House of Commons website. As you are aware, the webcast will always show the person speaking, rather than the entirety of the committee.

I wish to bring it to your attention that we have a total of six witnesses on the docket for today. I will prewarn you that I will be particularly strict when it comes to time issues and your allocation of time for questions. I think it's really important. All of these witnesses have something to contribute to our study, and I want to say thank you to them for joining us today.

I'll welcome our visitors with short bios. We have Carole Estabrooks, adjunct professor at the school of public health at the University of Alberta. She was chair of the Royal Society of Canada's working group on long-term care. Its members include other esteemed members we have heard from. The working group issued a policy briefing in June of 2020 that outlined the deficiencies in our long-term care sector and recommendations for action.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Chair, I have a point of order.

I am really sorry to start off the meeting this way and I know we don't have much time, but unfortunately I am not hearing the French interpretation. However, I did select the channel reserved for that purpose.

Am I the only one having this issue?

[The Chair, Liberal, Karen McCrimmon]

Okay.

Thank you very much.

[The Clerk]

Can you speak now?

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Yes, but I hear nothing.

[The Clerk]

It works that way.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Yes, I hear you now. Perfect.

Thank you.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Mr. Brunelle-Duceppe.

We'll continue.

Réjean Hébert is a professor in the school of public health at the Université de Montréal. He was a member of the chief science adviser's task force on long-term care, again, talking about recommendations for how we address the challenges of combatting COVID-19 in long-term care homes.

Then we have Mr. Richard Shimooka. He is a senior fellow with the Macdonald-Laurier Institute, and he writes extensively on the Canadian Armed Forces.

We have Madam Michelle van Beusekom, who is a co-founder of Protect People in Long-Term Care. It's an ad hoc citizen's group formed in April of 2020 to encourage decisive action to address COVID-19 in long-term care facilities.

Then we have two officials from the Department of National Defence, namely, Colonel Scott Malcolm, deputy surgeon general, and Major Karoline Martin. She was the commanding officer for the Canadian Armed Forces personnel deployed into long-term care homes.

Considering the number of witnesses before us today, I have asked them to try to limit their introductory remarks to five minutes. However, considering that some had already prepared 10-minute speaking notes or background documents, I would like to seek the members' agreement that the longer documents, once translated, will be provided by the witnesses to be appended to the evidence of this meeting.

[Some hon. members]

Agreed.

[The Chair, Liberal, Karen McCrimmon]

Thank you, everyone. I appreciate that very much.

With the administrative part of the meeting complete, we will begin with the opening remarks of Professor Estabrooks, please.

[Dr. Carole Estabrooks, Professor, University of Alberta, As an Individual]

Thank you very much.

In Canada, we are fortunate we have the capacity to call upon the Canadian Forces in crisis.

I'm thankful they stepped up to provide care in nursing homes during the first wave of the pandemic, going into unfamiliar and besieged care settings with little time to prepare. I'm grateful they stabilized parts of the long-term care system that had moved into deep crisis, preventing further suffering and unnecessary death. I am grateful they fulfilled their duty to report, and that those stark reports riveted the attention of Canadians and our leaders on the unfolding catastrophe.

In Canada, over 80% of total COVID deaths have been in long-term care, far outpacing any other country in the world. How could this happen? It could happen only by valuing older adults, and in particular older adults with dementia, less, and only by valuing nursing home care less than the care in hospitals and ICUs.

We knew early in the pandemic that things in care homes were not good and could quickly become catastrophically worse, that attention and action favoured the young and the hospitals, and that decades of inattention, of managing on the thinnest of razor edges, had created these conditions. Still, when the military reports of COVID conditions in nursing homes came out, we gasped, we wept, and for some, a smouldering rage began. I regret that our men and women of the armed services had to step in, but I'm glad they did.

Our governments and our society have known, or should have known, what was happening. For example, the Royal Society of Canada report on COVID-19 and the future of long-term care identified over 150 media reports in the last 10 years about the state of nursing homes in this country. For over 50 years, reports of abuse, insufficient resources, neglect and so on in long-term care have been produced by governments, organizations, unions and the media. In the last three decades alone, over 80 Canadian reports have been produced at considerable cost and common themes have emerged, but little has been done. Every event was seen as an independent and siloed occurrence, and not part of systemic and long-standing problems.

At the heart of the long-term care and workforce challenges, in addition to ageism, is also undisguised sexism. Caring for the elderly in long-term care is considered “just women's work” that anybody can do. This is, of course, patently false. This is complex, demanding and skilled work. It is delivered by personal support workers of whom over 90% are older women and over 50% are immigrants. They are paid the poorest of any worker in the health system, often without benefits or the security of a full-time position, with poor preparation and little to no ongoing education. It's our modern-day workforce of the 17th-century Elizabethan poorhouse.

Before I end, I want to speak briefly to mental health among the military and civilian workers under COVID conditions. We know they are facing and will continue to face mental health challenges. In Italy, early estimates of moderate to severe anxiety and PTSD among long-term care workers approaches 50%. Mild symptoms approach 90%. These effects will linger for years and decades, but they will be less devastating if we act now to support the front-line workers and the older adults in care homes who have survived.

I am pleased to see support for the mental health and well-being of military personnel who were on a temporary assignment. We must turn now to the mental health and well-being of long-term care staff on permanent assignment, who have no such support.

In conclusion, I want to thank the standing committee for inviting me. The long-term care system into which we place our cherished loved ones has endured long-standing neglect because of undisguised discrimination toward the old and toward the women who do the honourable work of caregiving.

COVID-19 conditions in nursing homes have brought forth the deepest existential fear of many Canadians—the fear of dying alone. Just as Passchendaele has come to symbolize the senseless slaughter and unimaginable suffering of Canadians who served, COVID-19 in nursing homes has come to symbolize unnecessary death and senseless suffering among those who built Canadian society and who worked to make this one of the most desirable countries in the world in which to live.

We do not need more commissions, inquiries or reports. What we need is a modern-day equivalent of a bold Marshall plan and its resources to accomplish a root and branch overhaul of the long-term care system. If we do nothing, then once the vaccines are administered, once COVID-19 has passed, once memories fade, once new priorities take centre stage, nursing homes will return to pre-COVID conditions until the next virus. It doesn't have to be this way.

Our oldest citizens can live serenely, enjoying the last stage of life in nursing homes where their carers have time to contribute to the quality of their lives and to provide high-quality care. We can choose which it will be.

Thank you.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Professor Estabrooks.

I now give the floor to Professor Hébert.

[Dr. Réjean Hébert, As an Individual]

Thank you, Madam Chair.

Good afternoon, ladies and gentlemen.

First, I'd like to thank the Standing Committee on National Defence for inviting me here. This is probably the only time it will happen in my career, given that this issue is pretty far removed from my usual concerns.

I'd like to begin by voicing my support for the comments my colleague Carole Estabrooks just made.

[The Clerk]

Pardon me, Mr. Hébert, could you hold the microphone while you speak? It would greatly facilitate interpretation.

Thank you.

[Dr. Réjean Hébert]

As I was saying, I support the comments that Ms. Estabrooks has just made. I completely agree with her analysis.

Since we have less time to address you, I'm going to focus instead on a number of facts that should outrage all Canadians.

In this first crisis, Quebec experienced true “age-icide”. I use that word deliberately, because that is really what it is all about, in my opinion. In Quebec, 10% of people living in a CHSLD died during the first wave. In Ontario it was 2.3% and in British Columbia it was 0.6%. Of all the European countries, only Spain has figures somewhat similar to ours. In that country, 5.3% of people living in long-term care facilities died from COVID-19. The death toll was twice that in Quebec.

Why did Quebec experience such a massacre? Several reasons can be cited. I will list some of them, so that what Quebec went through never happens again, in this province or elsewhere.

It became clear that in Quebec, living conditions in facilities like CHSLDs had been neglected over the past three decades. First, CHSLD management and governance have been completely “swallowed up” by much larger health care facilities. As early as 2003, the boards of directors and executive management of CHSLDs were eliminated, and CHSLDs were merged with hospitals and local community service centres in all Quebec communities. This first major reform in 2003 caused the CHSLDs to lose their own administrative entity.

New structural reforms came in 2015. This is when the integrated health and social services centres, or CISSS, were created. Rehabilitation centres and youth centres were integrated and establishments across an entire region were merged. In Quebec, we therefore ended up with very large groups with several missions: the hospital mission, of course which is still predominant; the frontline services mission; the CHSLD mission; the rehabilitation mission, and that of youth centres.

New Brunswick and Alberta also experienced a major merger of this kind that places the hospital at the centre of institutions and marginalizes the other missions of these huge complexes. We are therefore left with CHSLDs that no longer have their own management. Investigator Yves Benoit, who produced a report on the situation at CHSLD Sainte-Dorothée, says the following: More than five reporting lines stand between the CEO of the Laval CISSS and the managing first responder (coordinator) of CHSLD Ste-Dorothée.

If you count the ministry, that makes six reporting lines. For example, it could take several days or even weeks to submit a problem to hospital management and get a response. A significant loss of agility was having an impact on how these facilities were managed.

Staffing shortages, especially of personal support workers, are the second major problem. Over the past few years, the work of PSWs has been devalued, not only due to inadequate pay, but also, I would argue, because the human element has been removed from what they do. Putting a time limit on each of their tasks has obscured the PSW's role, which is to provide residents with emotional support. The PSW's value lies therein. The quality of the work environment has deteriorated over the last five years, in the wake of the major reforms in 2015. Over half a billion dollars in excess wage insurance, overtime hours and the use of freelance labour show that things have deteriorated.

The third major issue is the deterioration of medical and nursing care. Physicians have been steered towards clinical practice. They have therefore abandoned CHSLD practice. Similarly, nurses have been steered towards hospitals, where greater needs arose. As a result, medical and nursing care in CHSLDs no longer made it possible to monitor patients properly and, above all, to treat them in the event of acute deterioration.

The fourth major reason is facilities are obsolete. Some facilities have multi-bed rooms, shared bathrooms, or ventilation and air conditioning problems, and some do not have a spare room to provide end-of-life care or isolation rooms for treating infections.

The pandemic has been mismanaged due to the focus on preparing hospitals to receive patients with the virus and massive transfers to CHSLDs of patients at the end of acute care. Priority was also given to hospitals in terms of infection prevention and control, resulting in a lack of both these in CHSLDs. Staff have been moving freely, and they still are, unfortunately. This has contributed to outbreaks and spreading the virus. Problems arose with availability of equipment, and priority was again given to hospitals. Visits by family caregivers, who provide residents not only with emotional support, but also with necessary, even essential, day-to-day care, were not permitted.

Designation of hot spots came late once outbreaks were under way, and staff could not get tested in those facilities. These oversights led to a major crisis. Imagine if it were 10% of children in schools, 10% of children in daycare centres, 10% of an indigenous community. People would be horrified, everyone would stage un rebellion. However, we had no “Old Age...” or “Old Lives Matter” movement for seniors in the first wave. I fully agree with Ms. Estabrooks that this pandemic brought thinly veiled ageism to the fore.

I'd like to thank the Canadian Armed Forces for coming to help limit the damage of this pandemic in our residential facilities.

Thank you, Madam Chair.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Professor Hébert.

Now we go to Mr. Richard Shimooka, please.

[Richard Shimooka, Senior Fellow, Macdonald-Laurier Institute, As an Individual]

Thank you for having me at this committee meeting. I really appreciate the opportunity.

My testimony and remarks today are heavily based on my recent report on the post-COVID defence and security environment. I'm a senior fellow at the Macdonald-Laurier Institute—

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

On a point of order, Madam Chair, we have French coming in over the English channel.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Plus, we have no French interpretation.

It's all right now. It's been fixed.

[Richard Shimooka]

Thank you.

I'm a senior fellow at the Macdonald-Laurier Institute where my focus is international security and strategic and military studies.

In the past year, the COVID-19 pandemic has caused significant dislocations in the Canadian economy, politics and society. If you look into the international sphere, the pandemic has accelerated a number of long-standing trends and introduced several new challenges. Over the past decade, we have witnessed the fragmentation of political, economic and military arrangements that underpin a rules-based international order. The post-Cold War consensus has broken down and, driven in part by the growing conservativeness of national actors in international relations, Russia, China and Iran have rejected or worked to usurp this western-led order.

The fraying of the post-Cold War consensus has occurred among our close allies where populism and nationalism have emerged as powerful and disruptive forces. Their growth is variously blamed on historical lows in public trust of governing institutions, declining economic prospects and rapidly changing societies.

Manifestations include populist leaders such as Viktor Orbán in Hungary or Jair Bolsonaro in Brazil. One of the clearest indications of this emerging era of global power competition is evident in the military sphere. Over the past decade, a dramatic modernization effort has been undertaken by major military powers encompassing increases in funding, reorientations of force structures and the fielding of new capabilities. The breadth of these technological advances arguably sets the period apart from earlier eras, which will affect the fundamental nature of warfare, like with artificial intelligence.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Chair, I have a point of order. I am sorry.

The interpreter is doing what she can, but sadly it is too hard to interpret what the witness is saying. Perhaps if he spoke more slowly, it might help our interpreter. She just told me that the sound is choppy and she is doing what she can, but if you want to help her do her job, maybe we could find a way.

[The Clerk]

Yes, Mr. Brunelle. We're looking into it.

Mr. Shimooka, if you could put your microphone a little bit closer to you, speak more directly into it and little bit more slowly, it might help.

[Richard Shimooka]

Okay. Thank you.

Collectively, these new technologies have increased the lethality and potential of ways to apply force. Many are vast improvements over existing systems or have no preceding analogue. The technological developments are not strictly limited to military kinetic issues. They also affect our political, economic and social systems such as with cyber-capability. Perhaps one of the most problematic aspects of this emerging military reality is the lack of norms around these new technologies, which may result in greater instability.

The COVID-19 pandemic has further undermined public trust in the governance structures of western states, a fact that is exacerbated by the disinformation campaigns conducted by foreign powers. This is evident in major protests and civil unrest surrounding public health measures and participation in the violent far-right and militias rising in several countries.

Moreover, states' emergency and economic responses to the pandemic have saddled many of them with large debt loads that will require decades of austerity measures to eliminate, thereby limiting their ability to address domestic and foreign challenges. These challenges are particularly key for developing states, which are less well equipped to handle economic and political consequences of the pandemic. They face a weakened global trade system and a growing risk of political fragmentation due to the same forces that are affecting developed states.

In the pandemic's aftermath, many states will adopt a strong domestic focus to rehabilitate their economies and societies. This is evident in Canada's southern neighbour. The incoming Biden administration has already highlighted the immediate need to focus on domestic issues upon entering office. In foreign affairs, the president-elect was clear. He believes that diplomacy is a primary foreign policy tool of the United States, and tends to work through alliances and international institutions. While his administration will likely provide greater leadership than his predecessor's, this means that Canada and other allies will need to shoulder an increasing burden for international security, despite facing the same economic and political challenges as the United States. At the same time, we will be less able to rely on multilateral institutions that have suffered significant legitimacy and credibility issues as a result of the pandemic.

The Canadian Armed Forces are likely to experience greater foreign demands in the coming years, as weak states succumb to centrifugal pressures created by the difficult economic and political environment, and fewer developed states wish to assist in stabilization efforts. The nature of these conflicts poses significant risks for the Canadian Armed Forces. The proliferation of new technologies and capabilities will greatly complicate Canada's ability to intervene as well. The conflict in Nagorno-Karabakh shows how relatively modest unmanned aerial vehicles can have decisive consequences on the battlefield. Particularly concerning is their low cost. Armenia and Azerbaijan are relatively modest economies that could easily afford these novel capabilities.

It is not just low-end conflicts that the Canadian Armed Forces must prepare for. We can observe that China has thus far weathered the pandemic in better condition than most other developed economies, posting a positive growth rate for the rest of this year. Meanwhile, the Russian Federation has continued to play a spoiler role internationally, despite suffering the pandemic's effects. Thus, the challenges of a great power conflict will likely become increasingly acute as the decade wears on.

To respond to these challenges, the Canadian Armed Forces must become increasingly nimble, and nowhere more so than in how it acquires and incorporates these new technologies. The 2017 defence policy white paper, “Strong, Secure, Engaged”, is far too rigid in this age of rapid technological development. Many of these systems require quick, iterative upgrades to maintain their fighting edge, which our government is not well organized to deliver.

The procurement system itself is severely hampered by an overly regulated oversight system that ensures project delays and cost overruns. These issues are exacerbated by the reality that successive governments have seen defence procurement as a vehicle to direct government money into domestic constituencies. This only causes further delays to procurements and eats into the defence budget. The temptation to further exploit defence procurement to these ends will be particularly acute given the clear economic challenges facing the country.

None of this suggests that Canada should act like a global policeman at the outbreak of violence; however, the trajectory of recent international relations, particularly after the pandemic, suggests that the world is becoming increasingly unstable, and that military force may be required to ensure this country's security and prosperity. Canadians must be clear-eyed to the challenges they face, and the country must possess the appropriate tools to address them.

Thank you.

[The Chair, Liberal, Karen McCrimmon]

Thank you very much, Mr. Shimooka.

Now we'll have Madam van Beusekom speak.

[Michelle van Beusekom, Co-Founder, Protect People in Long-Term Care, As an Individual]

Thank you, Madam Chair and committee members, for the invitation to speak here today.

I'm a co-founder of Protect People in Long-Term Care, an ad hoc citizens' group that launched a petition on April 7 asking for emergency funding for LTCs, a national coordinated strategy and the implementation of shared standards. To date, our petition has garnered over 98,000 signatures from every province and territory in Canada.

I'm also speaking to you today as someone with a unique lived experience and perspective. Both of my parents live in Grace Manor, one of the five LTCs in Ontario that received military assistance in May.

I'd like to underscore that many of us with loved ones in LTCs saw this tragedy coming. We are intimately familiar with the systemic gaps and failures in this sector. When we saw what was unfolding in Spain and Italy in February, we quickly realized what was coming our way. Chronic understaffing is endemic in this sector. When families and volunteers were locked out on March 13 in many parts of the country, we knew that staff who were already overstretched would quickly become overwhelmed. Our anxiety rose as we learned that LTC staff were having to fight to get access to PPE. We watched in horror as outbreak after outbreak was announced, yet LTCs in many jurisdictions were not being prioritized by their public health authorities for access to testing to ensure the rapid assessment and cohorting of residents.

My parents' LTC in Brampton, Ontario, reported its first case of COVID on April 7. Each day the numbers rose, but they had to wait an agonizing eight days after that first positive case until their public health authority, which was following Ontario Ministry of Health directives, would finally give them access to testing for all residents.

By then it was far too late. In their LTC, with a population of 120 residents and 36 staff, there were 65 resident cases, including both of my parents, and 21 staff cases, which ultimately resulted in 12 deaths, including two staff.

With staff levels so depleted, those remaining were working up to 16 hours a day. The senior administration at Holland Christian Homes, the not-for-profit that runs Grace Manor, reached out to the Province of Ontario and the local health authority for help. They hoped to partner with the two local hospitals in Brampton and to receive redeployed medical staff from those hospitals. When that didn't happen, they asked—as a last resort in an increasingly desperate situation—to be considered for military assistance. On April 24, the Ontario government formally made the request for military assistance on behalf of five homes.

For Grace Manor, that assistance was vital. Half of its staff was gone. The military presence gave remaining core staff the breathing room to recruit, bring in and train new staff and ensure that proper infection control protocols were firmly in place. Military personnel also provided much needed human contact for residents—many of them frail, vulnerable and confused—who, by this point, had been completely cut off from any in-person visits with their families for over a month. My father so appreciated his conversations with the military personnel from places like Nova Scotia and Petawawa. He told me yesterday that it was a good thing they came.

Why did this happen in the first place? Why was military assistance needed? How did it get so bad?

As we've heard today, it got this way after decades of political leaders ignoring dozens of reports that flagged a host of critical systemic issues, such as underfunding, chronic understaffing, poor labour practices, the lack of shared standards of care and training standards, deregulation, privatization and absence of accountability. We had plenty of warning. This catastrophic failure to protect our most vulnerable should not have happened.

Here we are today in the second wave. Over 12,000 people in Canada have lost their lives to COVID. Eighty per cent of all deaths in the first wave were of people living in long-term care—the worst record in all OECD countries. Dozens of long-term care facilities across Canada are once again in outbreak, yet the same struggles with access to testing and rapid cohorting that we saw in the spring continue.

Kat Cizek is one of my co-founders. Her dad lives in Toronto's Lakeside, an LTC currently in outbreak where COVID-positive residents have been left on the same floor as those who have not contracted the virus. Another co-founder—we're only four—is Kitra Cahana. She is seeing staff and resident infections skyrocket at the Maimonides facility in Montreal, where her father lives. Despite this alarming outbreak, the public health authority has not made testing mandatory for staff and visitors.

I don't have words to describe how excruciating it is to watch this again. Despite all we know, all we learned in the first wave and all the studies and policy recommendations, so little has been done to address the root problems that have caused this crisis. We should not be relying on the military for last-resort crisis management in a sector where the problems and the solutions are this well known. This is not a good use of military resources and training. I am sure it has compromised military operations and budgets in many ways to come to the aid of a sector where private operators have continued to reap handsome profits for their shareholders throughout this crisis.

We've begun to see reports of how Operation Laser has impacted the mental health of military personnel who were thrown into an acute-crisis situation in a unique environment that they didn't necessarily understand. Military medical staff are not long-term care specialists. Caring for high-needs elderly, over 80% of whom suffer some form of dementia, is a skilled activity, even if our society does not recognize it as such.

In the throne speech on September 23, the federal government made a commitment to national standards, yet almost 10 weeks later the details and a timeline have not been shared. It is so disheartening to see the jurisdictional bickering that is blocking the groundswell of grassroots support right across this country for national standards. It is imperative that all levels of government come together to fix this broken system.

I am so thankful that the military was there for my parents and for Grace Manor. I never want to see this happen again. This sector needs to be properly supported. The long-standing problems need to be addressed. We need concrete action on those national standards. The military has other work they should be doing. Speaking on behalf of the 98,000 who signed our petition, I hope we can count on you to help make that happen.

Thank you.