Thank you for the opportunity to share with you information about the policy analysis work that I and my colleague Dr. Janice Keefe, from Mount Saint Vincent University in Halifax, have been involved in.
This research focuses on one benefit of the employment insurance program, namely, the compassionate care benefit. Our review of this benefit was originally part of a larger program of research on financial initiatives intended to support family and friend caregivers of older adults.
In addition to policies such as the CCB, we have reviewed initiatives that provide direct cash payments and stipends, tax policy, and pension schemes. We recognize that the CCB is not limited to the older population, but based on our work, and for the purposes of this presentation, that is our focus.
As you are likely aware, the Canadian population is aging. While this is a success story, there comes with it the need to rethink how we as a society currently support our older population to ensure that we are well positioned to meet the needs of our older citizens and their families. At the same time, there is concern about Canada's labour force, with much attention in all sectors on recruitment and retention of employees. Part of this discussion should now be on how we can support employees to balance work and family care responsibilities.
In 2007, 2.7 million family and friend caregivers, aged 45 years and older, assisted a senior because of the senior's long-term health problems. Nearly six in ten of these middle-aged caregivers were women. Further, more than half of this group, or 1.5 million, provided assistance to a senior while also being employed.
Numerous studies have documented the costs and consequences of juggling caregiving and employment responsibilities on women's short- and long-term financial security, employment status, health, and well-being. And while these national data that I quote do not speak specifically to palliative care cases, I feel they provide a valuable context on the issue of work and elder care and the importance of this issue to working women.
As you know, the compassionate care benefit was implemented in 2004 as a means of addressing some of the employment impacts on Canadians who leave work to support gravely ill family members. From an HR policy context, it has the potential to retain employees who otherwise may have to leave the labour force during this difficult time in their lives, because it enables an employee who has a dying relative and who would be eligible for employment insurance benefits to take leave from the workplace for up to eight weeks and receive partial income replacement for up to six weeks.
So the CCB is a positive first step towards supporting employees. Our comparison work of similar policies in other jurisdictions, however, we feel, can inform and strengthen Canada's compassionate care benefit. In 2004-05, we conducted a systematic and in-depth review of family care leave policies in Sweden, Japan, Norway, the Netherlands, and California to understand the scope and specific parameters of these programs, and then we compared them to Canada's compassionate care benefit. These policies provided income support for employees on leave from the workplace, and the nature of the leave included critical or terminal illness.
It should be noted that every jurisdiction reported similar gender differences in the utilization rates of these programs, with women being the primary program users. Underlying reasons why women represent 70% to 80% of the users of this program are embedded in societal expectations and employment economics.
So what did we learn from this comparison? We learned a number of things, but I'll share with you a few specific findings related to eligibility criteria and the value of the benefit, as these are suggested to impact access to the benefit and the consequences of utilizing this benefit.
Regarding eligibility criteria, we found that there are usually criteria, which include employment, relationship, proximity, and definition of the illness, that have to be met for an employee to be eligible. However, these eligibility criteria varied across the jurisdictions we reviewed, some being more liberal than others, resulting in implications in terms of access and utility of the program.
For example, at the time of our research, for Canadians to access the CCB they must have met the general requirements for the EI program: 600 insured hours in the past 52 weeks. Japan, whose program is also embedded in a national employment insurance scheme, has similar qualifying employment criteria. Because Canada's and Japan's benefit is embedded in the country's employment insurance scheme, this limits accessibility to those whose labour force participation is regular and full-time. That is less likely to be women, and less likely if they are simultaneously managing family care responsibilities. These noted exclusions do not exist in Sweden, Norway, or California, where eligibility is extended to all workers, including part-time and self-employed, provided that they have contributed to a national social insurance program, as is the case in Sweden and Norway, or state disability insurance benefits, as is the case in California.
Other criteria include the relationship of the employee to the dying individual. After a change to Canada's CCB in 2006, eligibility was expanded to include extended family members such as siblings, aunts, uncles, and grandparents. This is consistent with the reality of Canada's changing family and the support networks of older adults, making the benefit accessible to a wider group of employees.
In addition, there is special provision for the employee to also receive the benefit if they are non-kin but considered to be family. Other jurisdictions have similar relationship criteria. In the case of Japan, the employee and relative have to co-reside. Sweden's leave is the most inclusive of all we reviewed. There, employees with a dying family member, friend, or neighbour are automatically eligible without any special provision.
With respect to defining illness, Canada's CCB definition of the term “gravely ill” is considered stringent and the process cumbersome in comparison to other jurisdictions. In Canada the employee's relative must be at risk of dying within 26 weeks and need a medical certificate to that effect signed by a physician. This can at times be difficult to assess, given the sometimes unpredictable nature of the dying process, thereby making it difficult for employees to know when to apply for the leave and when to take the leave itself.
California's policy does not include reference to death or dying. It uses “serious health condition”, which is defined as any illness, injury, or physical or mental condition that involves in-patient care in a hospital, hospice, or health care facility. So while the condition is serious, there does not need to be imminent death.
Similarly in Japan, for employees with a relative whose condition requires constant care for two weeks or more due to injury, sickness, or physical or mental disability, the definition does not include “death” or “dying”. At the same time, the Japanese policy may be considered more stringent than Canada's CCB because of the need for a Japanese employee to be providing constant care.
Likewise, Norway's policy identifies at-home care. While direct care is often being provided by family members, it is not required to access the benefit, nor is there a specific venue identified.
In comparison, Canada's policy may be used to support care in either a community or institutional setting. While the CCB is limiting by its “dying” criteria, the fact that it does not stipulate care itself or the venue is considered a strength of the policy as it can encompass the full spectrum of employees, from those who provide emotional support to those who actually perform physical care, regardless of living arrangements.
In addition to eligibility criteria, another important consideration in understanding the utility of a benefit such as CCB, especially for women, is the actual value of the benefit itself. This can include whether it is considered taxable income, continuation of fringe benefits, job protection, and the right to leave. At the time of our research, Canada's CCB provided the right to leave, job protection, and income replacement of 55% of an employee's regular income up to a weekly maximum of $413, following a two-week unpaid waiting period. Contributions to other social protection benefits such as EI and CPP are suspended during this leave.
Because gender inequities in wages persist, with women continuing to earn, on average, less than men, it makes economic sense for the female worker, rather than the male worker, to reduce her income, as it will be the least disadvantage for the overall household. Depending on one's salary and the importance of the employee's income to the household, being limited to $400 per week may prohibit them from accessing the leave, may result in employees drawing on savings to supplement their leave, or may place some families' financial security at risk.