Status of Women Committee on Feb. 26th, 2019

[The Chair]

We don't have unanimous consent so we can't use the PowerPoints. We can get them translated and provided to the committee though.

[The Vice-Chair, Liberal, Pam Damoff]

Our next witness is Lori Weeks, from Dalhousie University. She's a professor with the School of Nursing.

Also, we have Tania Dick, who is the Vancouver Island representative in British Columbia for the First Nations Health Council.

I think we'll start with the video conference first, just in case we lose the signal there.

It's over to you, Professor Weeks.

[Dr. Lori Weeks, Associate Professor, School of Nursing, Dalhousie University]

Thank you very much for inviting me to present to you today. I'm sorry that I couldn't be there in person. I'm very pleased that your group is focusing on the needs of older women. There are certainly a lot of issues and not a lot of focus on this group, so I really commend you on this work.

I was asked to talk about issues that contribute to women's poverty and vulnerability, and hopefully you'll have access to my slides at some point.

We have a lot of intersections due to the issues of ageism and sexism. That's really the focus of this, I think, and it's what I'm going to talk about today. In addition to women who are older, there are additional groups of women who face additional vulnerability.

I'm really pleased that you have a person who is going to talk about indigenous issues and aging, so I won't focus very much on that component. That's another issue that can affect vulnerability in later life.

We know that there's a great deal of diversity among older women. We have a lot of older women in Canada who belong to a visible minority group, and that can also have a great impact on their experiences in later life.

One of the main things that I wanted to first focus on is the anti-aging industry. We have a lot of overt discrimination against older women. If you're watching commercials or any kind of media, it doesn't take long to see commercials that really are talking about why older people, women especially, should not look old. I think we really need to look critically at that. We don't have commercials saying why it's bad to be a woman or bad to be a young person, but we have a lot of focus in our society about women not looking old.

I think that's something that we need to change and really talk about in terms of a very overt form of discrimination that needs to be addressed in our society. I wanted to make that point very clear first of all. I teach a course on women and aging, with a lot of wonderful discussion amongst the mostly younger women in my course who are already absorbing these messages about wanting to look young. I think we need to have a lot of social marketing and a lot of campaigns around, “Why is it that we're allowed to discriminate overtly against looking like an older woman in our society?”

I'm sure that you are well aware of the demographics of our aging population, but we don't focus as much on the fact that there are more older women than older men—in my slides, you'll eventually be able to see some of the statistics around that—especially as we get older. Among people who are in their sixties, there's not a lot of difference in terms of the proportion of men and women, but it steadily increases over time. For example, for people who are 100 and over, it's about 90% women at that point. It's a steady increase in the proportion of women.

For any kind of services and supports that are focused especially on our frail older adult population—I'm thinking about things like home care, community-based supports and residential-based long-term care facilities—these issues are disproportionately affecting older women. Any time we have waiting lists and we don't adequately fund these kinds of services, it's really disproportionately affecting older women.

Another important demographic point that I would like to make is that as women get older, they are much less likely to live in a couple relationship than men are. A lot of older men have a spouse. For women, because women live longer and women often have a male partner who is older, it ends up being a situation in later life where there are a lot more women who are not in a partner situation, don't have access to a spousal caregiver and are living alone.

In Canada, we have a very large proportion of our older adult population living alone, but especially our older female population. We know that there can be a lot of challenges related to social isolation. It has a major impact on physical and cognitive health. Any efforts to reduce social isolation amongst our older adult population, especially our population of older women, are very important.

I've been really interested and engaged in research on housing for older adults for many years now. For the last couple of years, I've been focused on housing that supports social engagement. There are some really interesting and innovative forms of housing. One of them is called co-housing. I'm not sure if it's something that many people in the room are familiar with.

There are some examples of co-housing in Canada. They are very rare on the east coast, where I'm from. They are more common in central and western Canada. They are a form of intentional community where people come together and choose to live in a community. The size can range. Often they are somewhere between 10 and 30 units.

In Canada, there are a lot of regulatory challenges to these kinds of communities developing, but they are very mutually supportive. People choose to live in community with other people where they own their own unit, which is often some kind of apartment, but they participate in looking after the needs of each other and looking after the needs of the community.

This form of housing can also promote health in many ways. There's also some evidence starting to show that it can increase the amount of time people can live in the community versus using higher levels of care.

Some work we're doing on co-housing in eastern Canada has been really interesting because the only real model that groups have in Canada is to use a condo kind of model in terms of organizing these communities. Not all older women have the financial ability to purchase a home. There's no funding in particular to support these communities. They are not really a form of affordable housing. They are simply at the cost of building housing today.

I would like to think about whether there are any ways to support innovations in housing, especially housing that promotes community, social engagement and connection, but there are a lot of financial and regulatory barriers to these kinds of things.

I will turn now to economic issues. Again, we don't focus enough on this, but there's a very large income gap between older men and older women, for various lifelong reasons, where a lot of older women today have spent a lot of time in very important, but often unpaid, labour.

Many older adults, and especially older women, arrive in later life where they only have access to old age security and the guaranteed income supplement for their income. We have a very large number of low-income older women in Canada.

There are a few challenges with some of the financial programs that we have available. It is good that we live in a country where we do have income support programs for older adults. Of course, this is a wonderful thing, but the maximum monthly payment for old age security today is around $600 a month, and the person needs to be a Canadian citizen or a legal resident for at least 10 years after turning 18. This does preclude some older adults, especially older immigrants to our country, from gaining access even to very basic amounts of money in later life.

The guaranteed income supplement for those who have very low income is almost $900 a month. For many older women that is the amount of money they have to survive on between the old age security and guaranteed income supplement.

I've also read some research showing that some people have challenges in accessing some of these forms of financial support, especially the guaranteed income supplement. I think we need to take a look at whether there is enough education around how to access these kinds of financial support programs in later life.

There's also a new Canada caregiver credit, which is a wonderful thing to have in our country. However, for people who are providing support to a spouse, a partner or another dependent person in their life, such as a child or a parent, again, this is a program that would—

[The Vice-Chair, Liberal, Pam Damoff]

Dr. Weeks, that's actually your time. Perhaps if you have other information to share, you can bring it up during questions.

I'm going to turn the floor over to Tania Dick for your presentation. Thank you.

[Tania Dick, Vancouver Island Representative, British Columbia, First Nations Health Council]

Good morning. Thanks for having me.

First, I'd like to acknowledge the Algonquin nation, whose traditional and unceded territory we are gathered upon today.

I was pretty excited to be invited to come and speak about senior care, because it is a broad issue, across the country, that we really need to deal with. More particularly, I was excited to look at it through the indigenous lens as well.

I am a registered nurse. It's wonderful to see Dr. Weeks, and hear her. Thank you for that.

I represent the First Nations Health Council, an advocacy group in British Columbia. We now fall under the First Nations Health Authority. We took over from Health Canada, which stops at the Alberta-B.C. border, and have created a community-driven, nation-based program. We are in the transformation stage around that.

Senior care is a big issue for us. We find in our communities that the majority of our elders, particularly over 50—we broke it in two different sections—end up leaving the communities, and rely on provincial services and acute care settings for their primary health care—all of their health care demands. In our communities, we only get physicians who fly in every two weeks, or once a month. The acuteness of their issues demands that they be moved to cities or towns where they are closer to access to those services. They no longer fall, per se, under Indian health or the First Nations Health Authority, and have to rely on the provincial health system. What we do federally— big-picture, umbrella-like—really impacts the indigenous community as well, through the provincial programs.

In B.C., in 2013 we assumed all of the programs and services from Health Canada, and the first nations and Inuit health branch, Pacific region. Our vision was to transform the health and well-being of B.C. first nations and aboriginal people by dramatically changing health care for the better. We have the opportunity, through the new organization, to work with surrounding provincial stakeholders. Bringing all of our data together really allows us to see what's working, or not working, and where the gaps are, which is really helpful. For quite while, we've been kind of stand-alone with Health Canada, so that makes a big difference. That relational piece among all of the stakeholders, provincially, is so important for closing those gaps. That has been a really exciting process as well.

Particularly for the analysis for today, we studied access to health care and medications, including data on chronic conditions, using the health system matrix for B.C. first nations senior women, broken out into two age categories: 50 to 64, and over 65. This was done in recognition that first nations communities themselves determine when a member has become an elder. The ages vary across B.C.

Some of the key trends we found preparing for today include a really increased reliance of first nations females aged 50 and over on accessing primary care in a hospital setting, particularly emergency departments. In 2014-15, first nations females between the ages of 50 and 64 were just over two times more likely than other resident females in B.C. to use the emergency department for basic primary care.

First nations women aged 50 to 64 have decreased access to primary care outside of hospitals. As I mentioned earlier, it depends on how we purchase services, and how isolated and remote the communities are. It's a general trend, across the board, for most communities purchasing those services, and having access to continual, consistent, adequate and safe primary health care for communities, particularly for our elders....

When we analyzed the prescription drug piece, we looked at 56,000 first nations members, through the health benefits program, particularly female clients. Some of the highlights are as follows: first nations women 50 years of age or older are significantly more likely than the general female population in B.C. to have prescriptions for hypertension—

[The Vice-Chair, Liberal, Pam Damoff]

Could we pause for a moment? The bells are ringing, so there is a vote.

I need to ask the committee for unanimous consent for the committee to continue to sit, so that we can finish hearing Ms. Dick's presentation.

Rachael, are you all right with that?

[Rachael Thomas, Conservative, Lethbridge, AB]

Yes.

[The Vice-Chair, Liberal, Pam Damoff]

Okay. Go ahead.

[Tania Dick]

I feel like I don't want to talk about that. Statistics and data show we've been the sickest people in the country for generations. So really that's kind of repeating that message and that story. It's about what we do and how we go about tackling that and changing that through the transformation of those systems that provide those services for us.

One of the biggest things we talked about and that came out of going through the data was mental health and wellness. We could only collect the data through the physicians service lens—their visits, hospitalizations for mental health and substance use. But when we talk a little bit to our nurses.... We have access to some of the nurses in our communities, and this was profound for me. I actually talked to my mom. She was a nurse too. She is 74 now and my dad is 68. So, we're talking about my parents when we talk about this issue. They are the seniors in the community today. They are the first survivors of the residential school. That is really ground zero of the whole mental health trauma-informed piece that we hear about. The approach and the delivery of service have to ensure that we get to those people at a level where they are going to be able to respond to that and live the healthiest life they possibly can. Mainstream systems are not working for our indigenous people with the lack of trauma-informed care. I think this intersection is a really great opportunity for the TRC recommendations that have been rolling out and for the health system to really get on board and jump on that train and work through it and for our seniors. It triggered for me that, as I begin to look at losing my parents as they move through their lifespan, that that really was the first flow-through of residential school survivors, and that's huge.

Some of the recommendations we came up with through the data points highlight, of course, the need for more access to better quality of health services, particularly primary care.

Increased attachment to general practitioners can facilitate better access to tertiary care and other important services for improving health and wellness for first nations senior women. The following provides a summary of recommendations through these shared resources and the stakeholders we talked to in B.C. before arriving here today.

One is to improve home and community care programs to accommodate clients discharged from hospital, many of whom require continuing care at home. My mom is a prime example. She has had bilateral hip replacements and ended up losing the apparatus completely. She is wheelchair-bound and requires a lot of home care. We had to move her out of the village. She is now off reserve and doesn't have access to or does not qualify for Indian health services anymore. She is a little too far from the health authority for provincial services to come in, so she gets limited access to those services. There really has to be a collaboration between the federal and provincial services to actually capture these individuals when they come out of those kinds of acute-care settings. Our labs and X-rays end at three o'clock when the technician leaves and jumps on the ferry and goes away. So we have to put them in an ambulance and drive them two hours and a ferry ride away. Quite often the procedure is done, the test is done, and they are discharged and left at the door. These are 72-year-old people who don't have an escort, don't have a wallet and are in a hospital gown. That type of thing happens on a regular basis in our communities.

Next is to increase population health promotion and programming at individual, community and population levels to reduce rates of chronic conditions among first nations. At the first nations health authority level, we are really tackling that at a community-driven nation base level, but it really has to be reflected in the provincial level as well, and we have to find ways to collaborate on that because the majority of our people are off reserve and outside of those programs.

Improving primary health care access for first nations is absolutely vital. We also have to prioritize mental health and wellness including substance use and needs.

The biggest thing for me is to increase cultural safety and humility within the health system through adequate training, through constant revisiting. It's a culture that I personally have been a big part of and it's like running into a brick wall every day. We have to tackle it together, because it's going to directly impact the health status of indigenous people regardless of whether they live on reserve or off reserve.

I think that's it.

[The Vice-Chair, Liberal, Pam Damoff]

By the time the votes are finished, we won't have time to come back, so we'll have to adjourn. Would the committee like us to invite the witnesses back to answer questions? Yes. Okay. We will leave that with the clerk to arrange. I am sorry to have cut your time short. They were both excellent presentations.

Just before we adjourn, I want to let the committee know that our next meeting, on Thursday, will be televised. We have the Association québécoise de défense des droits des personnes retraitées et préretraitées. We have le Réseau FADOQ, the Canadian Association of Retired Persons, and Catherine Twinn and Madeleine Bélanger who are appearing as individuals.

With that, I will say thank you to our witnesses. We will see you again.

The meeting is adjourned.