Status of Women Committee on May 30th, 2017

[The Chair, Conservative, Marilyn Gladu]

Good morning, colleagues. We're happy to be back studying the economic security of women in Canada.

For our first panel this morning, we have Tamara Daly, who is an associate professor at York University and the director of the York University Centre for Aging Research and Education. Welcome.

By video conference, from Caregivers Nova Scotia, we have Angus Campbell, executive director; and Cindie Smith, caregiver support coordinator. Welcome to you, as well.

Joining us is Hélène Cornellier, from Quebec's Association féminine d'éducation et d'action sociale.

Welcome.

Each of our speakers will have seven minutes. We will begin with Tamara, for seven minutes.

[Dr. Tamara Daly, Associate Professor, School of Health Policy and Management, CIHR Research Chair in Gender, Work and Health, Director, York University Centre for Aging Research and Education, York University, As an Individual]

Madam Chair, I'm very honoured to be speaking to such an important committee. My specialization is care work for seniors, both in its paid and unpaid forms, and that's what I'll focus my comments on today.

The conversation about unpaid work is current and it's critical. What it isn't, however, is new. The quintessential Canadian book on gender and unpaid work, The Double Ghetto, was written nearly 40 years ago. It used Statistics Canada data to look at women's and men's segregated work inside and outside the home. A recent second printing highlights some of the gains women have made in educational attainment and labour force position. However, it scathingly reveals the persistent segregation all these years later, particularly when we consider care work.

The debate is increasingly showing up in popular media. For instance, following on the heels of Anne-Marie Slaughter's Atlantic Monthly piece, Melinda Gates used her 2016 annual letter to focus on unpaid work. She wrote:

Unpaid work is what it says it is: It’s work, not play, and you don’t get any money for doing it.... You can think of unpaid work as falling into three main categories: cooking, cleaning, and caring for children and the elderly. Who packs your lunch? Who fishes the sweaty socks out of your gym bag? Who hassles the nursing home to make sure your grandparents are getting what they need?

Child care is most often the focus of debates about unpaid work, while care for seniors is less visible. Care work for seniors in both its paid and unpaid forms can involve help with body care, dining assistance, and organizing, such as with medical appointments and finances, providing transport, and assisting with the home, such as cleaning and maintenance.

Importantly, family care work and private companion care provided in communal and publicly funded dwellings like nursing homes are less often discussed. My comments will highlight paid and unpaid care work and note when it is publicly funded or privately paid.

Care work is gendered, with women generally providing greater quantities and performing tasks that are more time-consuming and less flexible than care work than men provide. For instance, women provide more housekeeping, meal preparation, and personal as well as medical care. Men provide more transport and home maintenance such as snow shovelling.

According to a Statistics Canada, in 2012 there were 5.4 million Canadians who provided care work to a senior with a chronic health condition, a disability, or a problem related to aging.

The location where care work is provided is also an important consideration. More than two-thirds provided care work to a senior living in a private household. An additional 16% provided that care work to a senior who lived in a private household with them. Another 14% provided care work to a senior who was living in a care facility.

It is most often daughters and spouses who provide this work to women who live in residential settings. The 2016 census data show that about 70% of those who live in nursing homes as well as seniors residences are women.

Many Canadians are also providing substantial amounts of care work in terms of time. More than half of family or friends who lived with a senior provided more than 10 hours per week of care. Nearly one-quarter are doing more than 10 hours of care per week for a senior living in a nursing home where publicly paid care is available and provided.

We also cannot ignore the impact of providing care work. Strain on family relationships was reported by just over one-third of those helping seniors living in a care facility and about one-third of those who shared a home with a senior needing care. This compared with about one-fifth of those who provided care work to seniors living in a separate household and about one-quarter of those who help seniors living in supportive housing.

Women also experience greater negative impacts resulting from their care work, affecting areas as wide-ranging as their finances, their health, and their social lives.

The care needs of people with dementia are particularly important to consider. There are more than half a million people currently living with dementia in Canada, with estimates that this figure will nearly double by 2031. The unpaid care required to aid people living with dementia is an estimated 19.2 million hours per year. That's unpaid care, and a conservative replacement cost of this is $1.2 billion. Experts warn that care work time is also expected to double in accordance with the numbers of those living with the condition. A very large proportion of the costs of unpaid dementia care work is borne by families because the public system only covers a fraction of the total cost of dementia.

More attention is required to attend to the diverse needs of diverse women. For instance, due to cultural challenges, most immigrant families provide care work in private homes, even when dementia is a factor, and they don't, therefore, place families in nursing homes. More attention is also required to look at unmet needs. Families are dispersed geographically. In addition, the family unit has changed over time, with fewer children available to provide care work.

According to Statistics Canada, nearly half a million Canadians required care for chronic health conditions but did not receive it. One-quarter of those with unmet needs were over the age of 65.

Paid care work is also a key consideration. It is a feminized occupation. Overall, 80% of the paid care workforce is composed of women, and women make up over 85% of paid care workers in nursing homes. There is a large proportion of women from diverse racialized and immigrant populations who provide care work to seniors in communal settings. Immigrant and racialized women are often streamed into this care work, especially when other women are unwilling to do the work.

Care work is also among the riskiest of workplaces. Our research shows that care workers in Canada are frequently exposed to high rates of illness, injury, and violence. Conditions in Canada are far worse than in the Nordic countries, for instance. About two-thirds of the nursing and residential workforce is unionized across Canada, but it ranges from a low of 40% in Newfoundland and Labrador to a high of 65.9% in British Columbia. Despite this, most of the work remains low paid, part-time, and lacking in benefits.

There is an insufficient amount of publicly funded care available in home care and residential settings. Our research in nursing homes shows that increasing numbers of families are paying out of pocket to hire private companions to provide one-on-one care in nursing homes. This is largely due to insufficient staffing levels afforded by publicly funded care. Importantly, this care work is precarious, often paid under the table, and lacking in employment standards.

As the care often completely overlaps with the roles of the care aides who are on staff, it is also risky for the residents, the paid staff, and families. Most facilities lack even basic rules about care work that is paid privately, including about basic but important issues such as ID badges, duties to report to staff, or compliance with vaccination or infection control procedures. This private payment also creates a huge economic burden on families.

To conclude, paid and unpaid care work is one of the most important issues affecting the everyday lives of women across this country. While many seniors require care work, an increasing number have needs that are unmet. Paid and unpaid care work comes with risks. Families and friends are bearing an increasing financial and physical burden to provide care. There is an insufficient amount of publicly available care, and this mostly affects seniors who are women. Families are paying privately to compensate for insufficient levels of publicly funded care in nursing homes.

Thank you very much for this opportunity to raise these points with you today.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we'll go to Caregivers Nova Scotia.

Cindie and Angus, you have seven minutes.

[Angus Campbell, Executive Director, Caregivers Nova Scotia]

Madam Chairperson and members of the committee, thank you for accepting our written submission on the impact of caregiving as it relates to women caregivers and for allowing us to make this presentation to the committee.

Whether through telephone or face-to-face conversations or in support groups, we are honoured that hundreds of unpaid caregivers have shared their personal stories with us. It is from those stories that our recommendations have been drawn, but perhaps the most important, overarching message we wish to convey is the need to address challenges experienced by caregivers as far upstream in their journey as possible, before they lose their health and their ability to be productive. It is far more efficient to prevent a break than to try to mend an item after it is broken.

[Cindie Smith, Caregiver Support Coordinator, Northern and Eastern Mainland Region, Caregivers Nova Scotia]

There are many positive and uplifting testimonials, and we celebrate the caregivers' resilience and achievement. However, the accounts of unmet needs as well as struggles to see the job through and regain one's health at the end are far more common.

It is important that we put a human face on these challenges, so we are going to share with you some of their stories.

Here is the first one. Pam had to leave work several years before retirement to care for her parents. Although her workplace was able to grant flexibility with her work hours to accommodate medical appointments and the times when she was needed for hands-on care, they declined to do so. Her father and mother died two years apart. Shortly afterwards, her husband was diagnosed with dementia and now needs round-the-clock monitoring. She has lost her most productive pension years. As her husband was self-employed, his only income is CPP and OAS. She has no children, and she is very worried about her financial future.

[Angus Campbell]

Our second caregiver is Alice, who is a retired nurse living on a pension. She gives care to her elderly mother, who had a brain stem stroke last year. Her mother is no longer able to live independently and has moved in with Alice. Alice's mother was on a feeding tube for some time, and the cost of the food was not covered. Alice reviewed her out-of-pocket expenses for the previous year, and they totalled approximately $16,000. These additional expenses, along with the added stresses of caregiving, have taken a huge toll. Alice was denied the Nova Scotia caregiver benefit because her mother did not have dementia, which is a qualifying factor.

[Cindie Smith]

Our third caregiver is Cathy. She is 66 years old and one of 10 siblings. She's the only one who didn't marry and have children, so when it came time to care for their 90-year-old mother, it fell to her to move back to Nova Scotia to help. Because Cathy took on that duty, the rest of the family has abandoned their caregiving duties. She does not drive and lives in a rural area, so she must rely on unreliable public transportation to take her mother to a variety of medical appointments. Cathy has recently gone through a cancer diagnosis and treatment, and still, she's the only one who steps up. Now, two years later, she's feeling the stress not only physically but emotionally and financially as well. She struggles every day to do the best for her mom and for herself. She says, if not for her faith and sense of humour, she would be much worse off.

[Angus Campbell]

Our fourth caregiver is Denise, who was a career nurse and was looking forward to retirement with her husband, but his diagnosis of dementia derailed their plans. She cared for him at home through the journey of this horrible disease until his death. Eighteen months after he died, she went to see her doctor about how terrible she had felt for years. She was no longer willing to chalk it up to caregiver stress or the effects of grief. After some testing, she was diagnosed with her own long-standing chronic medical condition and struggles to retain her mental and physical health.

[Cindie Smith]

Our final story comes from a wonderfully insightful client, who I have named Flora. She is a reluctant caregiver, and we've had many conversations about the lack of options available to her. Through her frustration, she compares the current condition of caregiving in Canada to the generation of lost young men who served in World War I. Intending no disrespect to their service or sacrifices, she talks passionately about the generation of middle-age women who currently are lost to caregiving.

In that discussion, we drew contrasts between the two groups. Soldiers had volunteered or were conscripted, confident that they would receive the tools and skills they needed to be successful. They received a paycheque. It was an indicator of the value of their time and effort and a means of support for their otherwise lost income. They were trained in boot camp on what to expect in the field and how to protect themselves and each other. They were given guns, protective equipment, maps, and rations, and they were shown how to use them. The enemy was defined and could be identified by its uniform. They were taught how the enemy thinks and acts and how to stay a step ahead of it. They were given a platoon leader who would provide guidance and leadership, helping to keep them safe and battle ready. In an office far away, there was a strategist working on a plan of how to defeat the enemy and get the soldiers safely home. When that soldier returned, there were plans and programs and services in place to help him move back into his productive civilian life.

By contrast, the average caregiver is more often a conscript than a volunteer for the position and lacks the confidence in what she is undertaking. She receives no paycheque to indicate the value of her time or her lost income. She is not trained for the role, but there are both societal and self-imposed assumptions that she should know or will somehow learn how to do the job. Although reminded often by many well-intended people to take care of herself, she is not versed in the personal dangers of caregiving.

Although the enemy is a medical condition, there's often scant information offered to help her understand the characteristics of the illness or what to anticipate. Sometimes there's a secondary enemy disguised as an overburdened health care system, uncooperative family members, or a care recipient who is resistant to services. There's no leader to help her along the way. There are no strategists with an eye to the overall plan and big picture, and when her loved one dies, when she is physically, mentally, and financially broken, there are no services. There is no GI bill to offer transition back to her life, and no glory to come home to, only the sorrow of grief.

[Angus Campbell]

We thank you for your time.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we will go to Hélène Cornellier by teleconference.

Ms. Cornellier, you have seven minutes.

[Hélène Cornellier, Coordinator of Action Plan and Communications, Association féminine d'éducation et d'action sociale]

Good morning.

I wanted to say that, to stay within the time limits, I will not read the entire four-page brief I submitted. I will skip some paragraphs of the brief to stay within my seven minutes.

That was a comment for the interpreters.

On behalf of Afeas, the Association féminine d'éducation et d'action sociale, I want to thank the House of Commons Standing Committee on the Status of Women for inviting us to participate in the hearings related to its study on the economic security of women in Canada.

First, I will give you a brief overview of Afeas, and then I will talk about the two main areas that the government should focus on when implementing solutions to prevent Canadian women from being at an economic disadvantage their entire lives.

Afeas is a non-profit organization that was founded in 1966. It represents 8,034 Quebec women who work as volunteers in 225 local groups in 11 regions of Quebec.

Since its inception, Afeas has been striving toward gender equality in every sphere of society. That is the organization's main goal, and as a result, it works on various issues affecting women in Quebec and Canada such as: gender equality, including women's ability to access democratic institutions at all levels; the financial security of women throughout their career and after they retire through the recognition of the unpaid work women do within the family as mothers and caregivers; access to education and training, pay equity, non-traditional jobs, and measures to support a work-school-life balance; access to safe living environments and measures to address violence against women and girls.

Afeas believes that both the paid and unpaid work of Canadian women must be taken into account in order to ensure their economic security.

Since its inception in 1966, Afeas has been considering what impact the lack of recognition for women's work has on our society. In 1968, Afeas presented the information it collected on homemakers to the Bird Commission.

One of its first campaigns sought recognition for the contributions women make to family businesses run by their husbands. In 1974, Afeas succeeded.

Other campaigns followed, and progress was made toward improving the living conditions of women in Quebec and Canada.

Some 35 years later, on April 1, 2001, Afeas created Invisible Work Day. As part of this annual campaign, which is held the first Tuesday in April, Afeas educates the public and decision-makers about the social and economic value of invisible work. Afeas believes that, if the contributions that women make within the family and community—which are essential to our society—were recognized, then social and financial measures could be implemented that would prevent women from living in poverty.

On April 1, 2010, at the request of Afeas, MP Nicole Demers moved the motion to make the first Tuesday in April National Unpaid Work Day. Although this motion was adopted, no action has yet been taken to implement it.

Here are a few recommendations concerning unpaid or invisible work.

First, the Government of Canada should make the first Tuesday in April National Unpaid Work Day, add it to the calendar of national days and acknowledge it every year.

Second, Statistics Canada should assess and calculate the value of unpaid work in Canada to show how important it is to the gross domestic product using the 2015 General Social Survey on Time Use. This calculation has not been done for 25 years, since 1992.

We also recommend that Statistics Canada make sure that the question regarding household activities is included in the 2021 long-form census, so that the people responding to it would be aware of how much of that type of work they do every day.

In addition, we recommend that the federal government ensure that all laws, policies and programs undergo gender-based analysis in order to determine how they will affect women, particularly their economic security.

Moreover, we recommend that the Government of Canada adopt a policy on work-life-school balance that applies to all spheres of society, including public institutions and private businesses under federal jurisdiction.

Next, we recommend that the Government of Canada work with the provinces and territories to create a family insurance plan that would cover mothers or fathers when a child is born or adopted, as well as caregivers when they have to take time off work to care for a loved one who is sick, has a disability, or is losing his or her autonomy.

We also recommend that the federal government work with the provinces and territories to create a national child care program to give women access to affordable child care and allow them to return to the labour market, if they so desire.

When it comes to the last two measures, every province and territory must have the option of opting out of this program, under the appropriate agreements, as was the case in Quebec when the Quebec parental insurance plan was implemented in 2006. Similarly, since Quebec has its own child care program, it does not need a national program.

We also recommend that the Canadian government provide retirement benefit credits equivalent to 60% of the average industrial wage for the period an individual spent caring for a young child or a loved one, if that person does not have any employment income.

Finally, we recommend that the federal government turn non-refundable tax credits for stay-at-home mothers and caregivers into refundable tax credits.

I would now like to talk about paid work.

There was a major influx of Canadian women into the labour force in the late 1960s. At that time, employers considered these women's contributions to the family as complementary to those of their husbands and, therefore, paid them less.

Still today, women generally continue to earn less than men, even for the same work. This lack of pay equity affects many women and has an impact on their economic security throughout their lives. They are negatively affected when they claim benefits, such as maternity, parental or retirement benefits.

In its brief, Afeas gives you a few recommendations on paid work.

[The Chair, Conservative, Marilyn Gladu]

Thank you very much.

We will now go to questions, starting with Mr. Fraser.

You have seven minutes.

[Sean Fraser, Liberal, Central Nova, NS]

Thank you very much.

I'll begin with our witnesses who are here from back home in Nova Scotia. It's good to see you by video conference.

One of the reasons I want to start with you is I'm familiar with the demographic problem, in particular, that Atlantic Canada is facing. We have more seniors per capita out east than any other province or region in Canada. If it hasn't already exploded, there's a ticking time bomb taking place with a need to enhance caregiver services, particularly for our seniors.

My grandfather is a 96-year-old veteran who has actually received great in-home care, from which my family has benefited, because of certain programming that we have for veterans. There are many seniors, particularly those living in poverty in my community, who don't have access to a similar level of benefits.

Could you comment on how the federal government could best fund in-home care programs for seniors who aren't necessarily veterans to make sure they have access to quality care in their homes as well?

[Angus Campbell]

Mr. Fraser, thank you for that question.

Right now in Nova Scotia, as you are probably aware, we do have some provincial benefits that are unique to our province. We are the only province that offers a caregiver benefit of $400 a month to low-income people and a supplementary care program of $500 per month for people to look after somebody with dementia. Those things are unique to Nova Scotia.

How we can support seniors or caregivers is exactly one thing we have mentioned in our recommendation. We could possibly take a look at the savings to our health care system. We know that people want to stay at home as long as possible, and the health care system is saving from that, so why can we not redirect some of that funding to help keep these people at home?

[Cindie Smith]

If I may add, I believe currently there is a guaranteed basic income pilot project going on in three communities in Ontario. The guaranteed income is $17,000 a year. Given average costs in Nova Scotia of long-term care per month and alternate level of care, ALC, beds in hospitals, providing that caregiver with a $17,000 guaranteed basic income, allowing her or him to step away from work, is a savings of almost 50% of the institutionalized cost.

[Sean Fraser, Liberal, Central Nova, NS]

Certainly. Is that institutionalized cost the cost of care in a nursing home or hospital care?

[Cindie Smith]

That's both long-term care and ALC units in hospitals.

[Sean Fraser, Liberal, Central Nova, NS]

As a follow-up, one of the things that our family has experienced, and I know many others have as well, is trying to find a person who can offer the kind of quality care even if you do have the resources to pay for it. Is there a sufficient number of people qualified to provide care across Canada, or in Nova Scotia if that's your expertise? If not, how can we make sure we have the skilled workforce to meet the needs of our aging population?

[Cindie Smith]

In our opinion, no, there are not enough skilled persons to do that. Again I'll refer you to the recommendations we made in our written report, in particular recommendation 3.

A few years ago in Nova Scotia there was a non-repayable bursary for those individuals who wished to study continuing care assistance to provide exactly that service. That bursary has disappeared. Reintroducing that would, I'm sure, be enormously helpful, and in particular looking at those caregivers who have completed their role as a caregiver. That is an untapped pool of talent from which we can draw these people back into the workforce using their new skill set, augmented with some training.

[Sean Fraser, Liberal, Central Nova, NS]

I can't remember which of the witnesses—it may have been you, Dr. Daly—commented on the importance of transportation. No, I believe it was Caregivers Nova Scotia again, but this question is for whomever would like to tackle it. The example was there might not be access to reliable public transit in rural communities to allow a caregiver to travel to where they need to go, or potentially take the person to whom they're giving care to where they need to go in an affordable way. Could you comment on the importance of public transit, particularly in smaller communities, for seniors, individuals living in poverty or with disabilities, and what the federal government could do to help improve this situation for the caregiver?

[Cindie Smith]

There are challenges with living in rural areas, in particular, when the caregiver has reached a point in their life when they're no longer able to hop in the car and go to where the services are provided. In some communities there are services like mobile blood collection, that sort of thing, but not nearly enough, though. Of course, health care centres are in more populated areas. Given the geography of our province, a great deal of distance needs to be covered by some families, and it is a great stressor to them.

[Sean Fraser, Liberal, Central Nova, NS]

My question is for Ms. Cornellier.

You talked about the need to provide training and education for family caregivers.

What education and training programs could be introduced to turn the role of family caregivers into paid work opportunities?

[Hélène Cornellier]

For Afeas, it is not a matter of transforming caregivers—we actually don't refer to them as “family” caregivers, since the role is a social one—into orderlies. We feel that caregivers—who are usually either family members, neighbours, colleagues or friends—must be supported through financial measures and home support programs provided by their province's health institutions.

We think that those local health institutions or community organizations must include orderlies who can provide, usually at home, support to individuals who need care, such as seniors who have completely lost their autonomy because they suffered a stroke, people with cancer, people who need a bath, and so on.

So far, our position is very clear: we do not want caregivers to—

[The Chair, Conservative, Marilyn Gladu]

Unfortunately, the time is up. Thank you very much.

We will go now to Karen Vecchio, for seven minutes.