Status of Women Committee on Feb. 26th, 2019

[The Vice-Chair, Liberal, Pam Damoff]

Good morning.

Welcome to the 132nd meeting of the Standing Committee on the Status of Women. This meeting is in public.

Today, we'll continue with our study on the challenges faced by senior women, with a focus on factors contributing to their poverty and vulnerability.

We are pleased to welcome in the first hour, from the Hearing Health Alliance, Jean Holden, Advisory Board Member, and Valerie Spino, Advisory Board Member. Then from Pembina Active Living (55+), we have Robert Roehle, President, and Alanna Jones, Executive Director.

I'll now turn the floor over to the Hearing Health Alliance for an opening statement.

[Jean Holden, Advisory Board Member, Hearing Health Alliance of Canada]

Thank you very much, Pam.

My name is Jean Holden, and my colleague here is Valerie Spino. We represent the Hearing Health Alliance of Canada. We are representing a number of groups. We are representing consumers, hearing health care professionals, the hearing industry and foundations across Canada. On behalf of the Hearing Health Alliance of Canada, we thank the committee for inviting us to share our perspective about the important and often overlooked issue of hearing health.

In our meetings with some members of the House of Commons and Senate, some related personal experiences of how a mother or a grandmother cut off regular communication with family and friends, because of unmanaged hearing loss. This is like most people with hearing loss, who delay seven to 10 years before addressing their hearing challenges. Stigma, access to health care and the lack of understanding of the impact of unmanaged hearing loss in the public and the health care system contribute to this delay.

Hearing loss is one of the most prevalent chronic conditions affecting senior Canadians. Today, 78% of Canada's 4.8 million seniors have measurable hearing loss. By 2031, Statistics Canada projects that 5.1 million women will be seniors, so we can predict that almost four million senior women could have measurable hearing loss. This will have serious implications for the health of, and the health care services provided to, senior women.

Despite evidence-based research and statistics that show that hearing loss is widespread, with a serious impact on the health of Canadians, at a significant cost to government programs, hearing health remains a low public and health policy priority.

Women often experience gradual hearing loss as they enter their senior years. It's common for them to slowly withdraw from their social activities with family, friends and community, because it becomes embarrassing and stressful, and takes a lot of energy to cope in situations where they cannot participate and engage as before.

It is no surprise that unmanaged hearing loss is strongly linked to depression, anxiety and loss of self-esteem. Those who are socially isolated often reduce their exercise levels, contributing to other health conditions, such as high blood pressure, heart disease and diabetes. Research also strongly links unmanaged hearing loss in seniors with the onset of cognitive decline earlier, by two to seven years.

Most people are unaware that unmanaged hearing loss is significantly linked to the increase in risk of falls. The risk increases with the severity of hearing loss. Falls are the leading cause of injury-related hospitalizations among seniors. The most common injury is hip fracture, which occurs more often in women. It is very difficult for a senior woman to recover from a hip fracture. Many are admitted to costly long-term care facilities, and between 20% and 40% of seniors with a hip fracture die within one year.

For those with hearing loss, there is also a risk of reduced safety and security, with the inability to detect alarms, traffic and other audible threats in their daily living activities. It is clear that good communication is needed among doctors, other health care providers and patients, in order for patients to benefit from access to health care. Poor communication can cause mistakes in diagnoses—some of them are very serious—and mistakes made by patients when they fail to understand instructions from the health care provider.

I'm going to ask Val to continue. She will be speaking in French for our French-language members and then she will summarize our recommendations in English at the end.

[Valerie Spino, Advisory Board Member, Hearing Health Alliance of Canada]

The impact on health and costs resulting from unmanaged hearing loss have been well documented. Unmanaged hearing loss is too often linked to more hospital stays, higher rates of readmission and higher incidence of costly medical errors. This is the case for acute care admissions. We also know that isolation, depression, cognitive decline and falls are some of the top reasons for admission to long-term care facilities.

Canada is unprepared for the challenges of hearing loss. Culturally, hearing loss is often written off as a normal part of aging and carries a stigma.

Screening for hearing loss is often not a part of an annual physical exam. Health care providers across the system are often unaware of the signs of hearing loss, the impact of unmanaged hearing loss and the importance of addressing the issue.

All this adds up to serious problems for senior women, and especially for women who have low incomes or who live in first nations communities. Most of the time, access to hearing health services isn't covered by the health care system, and these services aren't sufficiently available in northern, first nations and rural regions.

One of our goals at the Hearing Health Alliance of Canada is to have more women pay attention to their hearing health. There's a role for federal, provincial and territorial governments to collaborate with various communities of interest to adopt policies and actions to promote hearing health.

First, we all need to do much more to increase public awareness to prevent hearing loss, to identify and manage hearing loss and to destigmatize hearing loss.

Second, there is an urgent need to integrate hearing loss assessment, diagnosis, prevention and treatment into existing health programs and to facilitate collaboration among front-line health care providers to promote hearing health as part of overall health.

Third, governments must address existing models of government funding and tax benefits to provide equitable access to hearing health care and assistive devices.

There is no doubt that making hearing health a high public policy priority will provide immediate and long-term benefits in the form of significant savings to our health care system and increase the quality of life for our seniors, especially women.

We thank you for your attention and consideration.

[The Vice-Chair, Liberal, Pam Damoff]

Thank you very much for your presentation.

We'll now turn it over to the Pembina Active Living folks for their presentation.

[Robert Roehle, President, Pembina Active Living (55+)]

Thank you, Madam Chair.

I would like to begin by thanking this committee for inviting us, Pembina Active Living, to appear before you.

My name is Bob Roehle, and I'm the President of Pembina Active Living. Beside me is Alanna Jones. She's our long-term Executive Director.

As a senior and someone married to one, I don't need to be convinced of the importance of the issues and challenges faced by older people, particularly older women, issues like access to transportation, health services and medication, home care services, affordable housing, justice, widowhood and loneliness. These are all quality of life issues that should, in my opinion, be a right of Canadian citizenship. However, let me say up front that our experience and comments will focus more on the issue of social inclusion and connectedness.

My approach this morning will be to give you an overview of Pembina Active Living, who we are and what we do. Ms. Jones, who is the long-term, hands-on person in the organization, is prepared to elaborate in more detail.

Pembina Active Living came into being in 2009 as a result of a few community-minded seniors in south Winnipeg getting together to discuss needs of their peer group, folks like themselves who had retired and were living in their own homes, condos and apartments. They realized, from their own experience, that much of their social network and connectedness related to their careers and children, and these had come to an end, hence the need for an organization to bring these lost souls together with folks of their own generation and station in life.

Out of these discussions, Pembina Active Living was born. It has a simple mandate, to enhance the quality of older adults living in south Winnipeg. In 2013, PAL achieved charitable status from the Canada Revenue Agency, thus allowing it to issue charitable tax receipts to donors. As a word of explanation, Pembina Active Living is essentially a community club or a community centre for seniors.

With annual funding from the Winnipeg Regional Health Authority of approximately $40,000, plus membership fees of $20 per person and an ongoing fundraising campaign, PAL is able to retain the services of a part-time executive director and administrative assistant. This allows PAL to operate two and a half days per week out of less than adequate space in a local church. This is supplemented by renting space as necessary in local community centres. PAL's membership varies somewhat from year to year and within the year depending on the activities being offered. PAL's current membership is around 450 people. It has been as high as 500.

Without the assistance of over 100 volunteers contributing in excess of 6,000 hours of their time, PAL's $100,000 annual budget could not be stretched to do the things we currently do or offer the services we offer to seniors.

PAL is celebrating its 10th anniversary this year. While we are pleased with our accomplishments to date, we have much more to do. Besides the critical need for more operating funds, our other immediate challenges are as follows.

We need space. PAL needs a permanent home of its own, a dedicated office and storage space and a five-day per week drop-in centre with a canteen to serve coffee and perhaps a light meal at noon.

We need diversity. We must find better and more creative ways to reach out to our indigenous community, to new Canadians and to the rainbow community. A recently awarded and much appreciated New Horizons grant from the federal government of $25,500 should go a long way to helping us reach out to these other groups.

On social cohesion or connectedness, PAL must strive to become more holistic as a seniors centre, not just a place to take one-off inexpensive exercise programs.

Allow me to end my formal comments with a quote from an editorial in a recent issue of Maclean's magazine. It is referring to a study done by people at Brigham Young University, a psychologist by the name of Julianne Holt-Lunstad. It says:

“Current evidence indicates that heightened risk for mortality from a lack of social relationships is greater than that from obesity,” Holt-Lunstad’s study concluded.... Being lonely is comparable to smoking 15 cigarettes a day.... It’s also worse for your health than the...risks arising from alcohol consumption, physical inactivity or air pollution—all of which get much more official attention than loneliness.

Humans are social creatures, and avoiding the necessity of social contact can be devastating to our physical and mental health. I believe that applies equally to both young and old in our society. That's really where PAL is operating. It's trying to increase social inclusion among the older adults of south Winnipeg.

Thank you.

[Alanna Jones, Executive Director, Pembina Active Living (55+)]

Thank you, Bob.

Thank you to the committee for this opportunity.

I would like to acknowledge the federal government's commitment to seniors through its minister of seniors position, the national seniors strategy and the new horizons for seniors program.

As you know, senior centres are an important part of our communities. Through the promotion of healthy active aging, community involvement and social inclusion, senior centres provide valuable resources and opportunities to older adults all across Canada. Research on senior centres demonstrates that participation is associated with social, mental and physical benefits; and that by fostering the exchange of social support, senior centres protect older adults against the negative impacts associated with social isolation, making senior centres invaluable resources in the communities in which they operate. Given that older Canadians are now the fastest-growing segment of our population, with their numbers expected to double over the next two decades, the importance of our senior centres to the well-being of this demographic cannot be overstated.

Pembina Active Living (55+) is an non-profit, senior-serving organization in south Winnipeg. Our catchment area of Fort Garry comprises 11 communities, 77 square kilometres, and is home to 18,775 adults over the age of 55, or over 25% of the total population of our area.

PAL recognizes the diverse needs and challenges of older adults and is committed to the development of programming and opportunities that will enhance their lives. The well-being of older adults is one of our core values and we believe that active living and social inclusion can enhance physical and mental wellness. Research at the Canadian Centre for Activity and Aging found that fit people are half as likely to become dependent in later life. Health Canada's physical activity tips for older adults recommend two and a half hours of moderate to vigorous aerobic activity each week.

We address that at PAL through some of our weekly programs. We have 20 plus programs running through the communities, including older adult resistance and weight training, yogalates, line dance, seniors' yoga, zumba for seniors, cycling, bowling, a garden club and a lunch group. We have a movie group, a writing program that has published nine books, computer workshops, pickleball, three free annual community events, and a wellness, leisure and special interests speaker series that is free to all the community.

All this is great for those who can afford our programs, but for the many low-income older adults in our community, many of our programs and activities are out of reach financially. In addition, transportation to and from senior centres was the most common barrier to participation for older adults. These are two issues that, with our limited resources, we simply cannot address.

PAL has accomplished a lot in its 10 years with very few resources, and we have a lot to be proud of. At the same time, there is so much that we cannot do and many we cannot reach because we simply do not have the resources. We are at the limit of what we can do with a skeleton staff and a volunteer base who are already putting in approximately 500 hours a month.

In order to reach out to the thousands of older adults in our community, many facing social isolation and loneliness, we need support. We need stable annual operating funds, without which we will not be able to fulfill our mission. We believe that senior centres are perfectly poised in the community to address the various issues faced by older adults. The most impactful thing we believe the federal government can do is support senior centres through direct funding.

I just want to add that we did not specifically name women as the subject of our presentation, but our membership is 70% women.

All of these issues are directly impacting the senior women in our communities.

Thank you very much.

[The Vice-Chair, Liberal, Pam Damoff]

Thank you.

We're going to start with our first round of questions.

Bob Bratina, you have seven minutes.

[Bob Bratina, Hamilton East—Stoney Creek, Lib.]

Thank you.

This is a great topic.

On the question of hearing, first of all, one of the big issues with regard to hearing is the cost of hearing devices. There's a lot of confusion about what works. You see ads for things that are $29.95 that are just as good as a $5,000 device. Is there any advice you can give in that regard? Is there a way of determining good devices at proper prices?

[Valerie Spino]

I'll answer, since my day-to-day work involves bringing older people out of isolation and helping them return to their social lives. I'm an audioprosthetist. I spend my days answering these questions.

Yes, there's a range of hearing aid technology. A hearing aid is a computer. Take the example of two computers in an electronics store that look exactly the same. If you launch software such as Word while simultaneously surfing the Internet on one computer, it will be difficult to use, whereas you can launch all the software at the same time on the other computer, and it will work well.

A hearing aid contains a computer. A more sophisticated computer will manage sound better. It will certainly lead to a better understanding of speech and better audibility. The software in hearing aids can emphasize “s” and “f” sounds and contain a noise reducer. A range of technology exists.

It's often said that the best and most high-end hearing aids are the closest thing to normal hearing. All the available research and technology is used to manufacture high-end hearing aids. Basically, the latest technology is used to design a machine that most closely matches the human ear.

Unfortunately, not everyone can afford the Ferrari of hearing aids, or the largest and most efficient hearing aid. As a result, there are various forms of hearing aids.

Since I work in the field, I can see the difference between an entry-level hearing aid and a high-end hearing aid. The performance varies according to the quality of the hearing aid. Obviously, it's better to have an entry-level hearing aid than nothing at all. Science has understood for a very long time that it's better to have a hearing aid in each ear than a hearing aid in only one ear. At one time, glasses had only a single lens, but it was quickly understood that we use both eyes to see in three dimensions. It's the same principle for ears.

Yes, there are different qualities. In an ideal, utopian world, everyone would have high-end hearing aids. That would be best. However, unfortunately, that's not the reality. That said, certainly each increase in quality is a small improvement for the patient. We don't disapprove of the fact that there are hearing aids for all budgets because, unfortunately, not everyone can afford high-end hearing aids.

[Bob Bratina]

Jean.

[Jean Holden]

If you take a broader perspective and consider the value in return of preventing depression, isolation, loneliness, the kinds of challenges that we see with falls and early cognitive decline—if you take that into perspective—the investment in hearing health with hearing devices and a few follow-up visits is minuscule in comparison to what it costs the Canadian health care system with the results that may occur and do occur if people do not manage their hearing loss.

[Bob Bratina]

What do you recommend for people who feel it's time to think about a hearing device in getting information?

One way would be to go to one of the retail providers who may simply want to sell up; whereas the person may simply be wanting to get good information.

[Jean Holden]

The best solution is to discuss this with your physician, and/or go directly to an audiologist physician who would refer to a hearing instrument practitioner. These professionals are trained in helping individuals to understand their own situation and how it impacts their lives, and guiding them through the process of selection of solutions.

It's best to go to a professional who is trained in these behaviours. You don't really have access to go directly to a manufacturer in Canada. There are some direct-to-consumer devices that are starting to show up on the Internet that are claiming to be cheap solutions and so on. This has been a challenging debate in the industry, of course. It's more than just people in the industry trying to protect their services and technical device sales. It's really about being sure that consumers have the available devices that they need and that are safe for them.

There's a great debate in the FDA south of the border about these issues, and nothing has been passed there yet.

[Bob Bratina]

With regard to the prevention of hearing loss, the baby boomers were the first of the rock-and-roll generation who were warned that all of that loud rock-and-roll music was going to make them deaf.

Has that showed up in the longitudinal—

[Jean Holden]

Absolutely, 100%, it has. It's not just when you're in your middle years and as a teenager now with the MP3 devices and so on. As you age, if you have that noise-induced hearing loss, it exacerbates normal aging-related hearing loss. That's a huge challenge.

Again, we need public awareness. We need families to understand the issues related to seniors and hearing loss. We find that if—and this is studied by the psychologists—a family takes interest in their senior with hearing loss issues, that is the most significant factor to the uptake and the use of hearing devices.

[Bob Bratina]

I want to apologize because I was a rock-and-roll disc jockey. Sorry about that.

[Jean Holden]

We all listened to it.

[The Vice-Chair, Liberal, Pam Damoff]

Thank you very much.

Rachael Harder, you have seven minutes.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you for taking the time to be with us today to share from your experience in working with seniors in Canada.

My questions are primarily going to go to Pembina Active Living.

Mr. Roehle, I'm intrigued by what you're talking about with regard to the centre and the services that you offer. I know that in my hometown of Lethbridge, Alberta, I've witnessed the same. We have two thriving senior centres within my community, and I watch as seniors go there. They find meaningful relationships. They find access to different exercise routines, sports and other meaningful activities such as crafts, technology, and learning how to use computers and other sources of IT as well.

Can you further comment on why these centres are so important, particularly with regard to prevention? I've heard it said that there's a lot of preventative care that actually takes place by giving access to these types of centres, but it takes place in a way that we might not traditionally term as preventative care. Maybe it doesn't fit within the scope of a doctor's office, but nevertheless, it does certainly serve seniors in a very meaningful capacity.

[Robert Roehle]

I think all of the evidence suggests that if you keep people active, particularly seniors, they spend less time in hospitals, doctors' offices and care homes.

The economics in favour of keeping people active are overwhelmingly in favour of spending public money that way. I don't know how it is in other places in Canada, but in Winnipeg, for example, the community clubs are funded by the city. However, historically, their role and their target audience is kids—hockey, soccer and all of those kinds of things.

Of course, families are smaller. We have a different range of children now with a lot of new Canadians, so they all have different demands. The other reality is that seniors are now a big cohort in society. In fact, I think I saw numbers that showed that seniors over 65 account for more people—I don't know if that's in Manitoba or in Canada—than kids under 15 do. I think the community centres have to start recognizing that and governments have to start recognizing that because the economics in favour of keeping people healthy and active are quite overwhelming.

[Rachael Thomas, Conservative, Lethbridge, AB]

Are either of you able to comment on elder abuse and what you have observed there anecdotally? What you would recommend in terms of responding to this problem?

[Alanna Jones]

I can't personally speak to it. However, I do know that we have a resource coordinator in our community, funded also through the WRHA, who provides referrals related to elder abuse, and there are elder abuse suites in Winnipeg, available upon referral. That position, the resource coordinator, is closely linked to us. We make referrals back and forth, but we haven't directly received any of those calls. I personally haven't even heard any stories, but I do know that it's happening and that there are resources available.

[Rachael Thomas, Conservative, Lethbridge, AB]

If an individual is facing a form of abuse, in your community where would they most likely go to disclose that? If not at your centre, then where would it be?

[Alanna Jones]

They would go to the Fort Garry Seniors Resource Council. It is a separate seniors resource. They do referrals for things like elder abuse, home maintenance, doctor finding and resources. In lots of neighbourhoods in Winnipeg we have the resource coordinator connected to the seniors centre.

In our case, we don't have a centre. We don't have a facility. I work from home. We don't have somewhere that seniors can go yet; we're working on it.

In other communities, they have that resource finder right in the centre so that the services are coordinated. We don't have that in our catchment yet.

[Rachael Thomas, Conservative, Lethbridge, AB]

Are there particular challenges that you observe women facing at a level that is more prevalent than for men?