Status of Women Committee on Oct. 27th, 2020

[Jodi Hall]

I've unmuted. My apologies.

[Gudie Hutchings, Liberal, Long Range Mountains, NL]

Also, Madam Chair, could the witness put the microphone closer to her lips, please? It's difficult to hear her.

Thanks, Ms. Hall.

[Jodi Hall]

Okay. Hopefully, this will help you to hear a little better. My apologies for that.

In regard to health human resources, we are calling on the federal government for support in the development of a pan-Canadian health human resources strategy. This is an area that is the most consistent top-level issue for long-term care right across the country. We are facing a crisis as it comes to available staffing. I have noted several different types of examples for the support for immigration but also for enhanced efforts in regard to education and the promotion of careers within long-term care. Those are areas that we have immediately identified and could potentially offer support in.

For infrastructure, we have been noting this as a critical issue, with aging infrastructure in many jurisdictions across the country. We saw the full impact of that as it relates to COVID-19 and the spread of that virus. It was incredibly challenging for some homes that have very narrow hallways, small rooms and shared dining areas that made it incredibly difficult for the infection control practices to be fully implemented in the way that we knew public health intended. There is an incredible need for that to be addressed going forward.

On the side of data, it's very challenging to compare long-term care across the country because of the data void we have. There are many homes across the country that are using an interRAI resident assessment instrument, in which the data are submitted to the Canadian Institute for Health Information. That does allow for some comparable information, but we're also advocating for the addition of a management information system that would allow for more of the business type of information, such as the administration, the spending, the impact and where the money is going to be included, for us to be able to track that.

We acknowledge in our ask to the federal government that being able to adequately report on the impact of those investments and to better understand the care needs of residents and where investments need to go are critical, so we would ask for that added support.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Chair, there's no interpretation.

[The Chair, Conservative, Marilyn Gladu]

I have to go now to Ms. Sidhu.

I'll give everybody enough extra time to make up for the long answer.

Thank you.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Good morning, everyone.

I would like to begin by thanking the witnesses for their testimony. I'd also like to thank my colleagues across all parties for working together and agreeing to continue to study COVID-19 and how it impacts women. It is good that we are looking at how COVID-19 has impacted women in long-term care, as we all know just how hard long-term care homes across Canada have been hit by this virus.

My question is for Professor Armstrong. In my region of Peel, we have had over a total of 962 cases and 200 deaths among staff and residents in long-term care due to COVID-19. Without a doubt, this is a tragedy. I have been working, along with my colleagues, to advocate for a national standard in our long-term care homes, even though long-term care homes come under provincial jurisdiction, we all know. I know that between 2015 and 2019, our government increased long-term care funding to over 500 organizations, and the horizons for seniors program focused on the seniors as well, but there's a lot more that we need to do.

Professor Armstrong, you talked about a lack of special training, special skills and specialized care. What unique consideration should we give to women who live in these long-term care homes? We all know that we need more staff, as there's a shortage of staff as well. Can you elaborate on that?

[Dr. Pat Armstrong]

There have been studies by the World Health Organization, the OECD and the ILO. Just a year ago, we were warned that we were going to face a terrible crisis in recruiting and retention in long-term care unless we did something about the entire range of working conditions, including—and this relates specifically to what you were saying—a recognition of the skills involved in this work and the valuing of the labour force.

I interviewed a resource director in Norway who said that what surprised her most when she went to long-term care was how demanding the work is and how hard people work. That's been made invisible, including all of the extra work they do without pay in long-term care.

We must have minimum staffing. We must have decent wages. We must have as much full-time employment as possible and permanent part-time to fill the rest on the casual side. We must have people work in one place, as B.C. showed us. We must recruit more people, and we must to make sure that they have training that recognizes, as Carole said about what is required in this job.

The work is medical, and it's also social. It involves the full range of people who work in a long-term care home. We need all of those things at once. It's been layed out for us again and again. As the recent Ontario long-term care commission said, and as Carole also repeated, “We don't need more studies. We need action.” In parallel with the Canada Health Act, I think we need federal action that says, “You meet these conditions, and we'll give you money,” but you have to prove that you meet these conditions, the standards that the throne speech talked about.

[Sonia Sidhu, Liberal, Brampton South, ON]

I know that women are also much more likely than men to provide unpaid care to family and friends who live in these facilities. How can provincial governments address this gap in compensating the unpaid work of women who work in these homes and family members to support residents in long-term care? What role could the federal government play in this? You said that the federal government could play a role, but what role could it play, and how can provincial governments address this gap?

[Dr. Pat Armstrong]

There are two kinds of unpaid care—I didn't get to that in my talk. One of them is the unpaid care by the people who are otherwise paid for the work. They do a lot of it. They work through lunch, they take home people's cloths to wash, they shop for them, they do all kinds of things. That's the women who do that work. For most of the people Carole talked about who come in as family, “family” is usually a term we mean for women. How can we support them?

First of all, we can support them by making sure there are enough staff there to do the necessary work. That's why they do all this unpaid work; otherwise it doesn't get done. That's the first thing we have to do.

Second, we have to provide the kind of training and protections for those family members who do that unpaid work and who want to do it as an option. I think that by setting decent staffing levels and training and infection control, the federal government could help all of those who are doing unpaid work.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for Ms. Estabrooks.

I know that some provinces have emphasized policies around aging in place or aging at home for seniors. I wonder if you can explain what impact this has on residents who are in long-term care homes today, especially female residents. Has this resulted in increased chronic disease, such as diabetes? Can you explain that?

[Dr. Carole Estabrooks]

One of the primary effects of successful aging-in-place programs here in Alberta is that we've had a very aggressive aging-in-place set of policies as early as 2006 to 2008 to keep people in their homes, in the community, or in alternative living, to keep people out of long-term care as long as possible. That's been quite successful.

One of the challenges with that is that it's meant that the women, primarily, who go to long-term care in a nursing home go very much later in the trajectory of their life, their dementia and their other chronic conditions. It's not that it has increased the chronic conditions themselves, but as you get older and closer to death, within the last year or two of your life, if you have advancing dementia, in particular, your needs become much more demanding—“acute” is not the right word in long-term care—with a heavier workload. Moreover, they're more complex. They're not just complex medically, requiring the management of symptoms, which we don't always do very well in long-term care, but socially as well. There are now longitudinal data that show us unacceptable levels of symptom burden in the last year of life in many places, and their social needs are more complex because as your dementia gets to those stages, you have difficulty communicating.

Things like a pandemic where you're isolated are catastrophic for a person with dementia, both in the community and especially in the nursing home. Even if you have staff coming in, they're dressed in masks and clothing, so they can't hear well, they can't see their faces, and they're afraid. These people that we see in many jurisdictions—

[The Chair, Conservative, Marilyn Gladu]

I'm sorry to cut you off, but that's the amount of time you have, Ms. Sidhu.

We'll continue with Madame Larouche.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you.

I want to thank the witnesses for coming to the committee today.

I'm both the status of women critic and the critic for seniors. So you can understand that I'm particularly interested in the issue that you're addressing today. Clearly, the COVID-19 pandemic has had a serious impact on senior women.

I first want to make one thing clear. There has been a great deal of talk today about national standards. However, health comes under the jurisdiction of Quebec and the provinces. This principle is essential for us. Quebec and the provinces have asked that this jurisdiction be respected. The issue is mainly financial. There's a lack of money to ensure better wages for health care providers and support staff.

The labour shortage issue was also discussed. Some areas of jurisdiction can be addressed. In terms of the labour shortage, there was the situation of the guardian angels and their immigration status. It was acknowledged that some residences lacked personal protective equipment. The federal government could have taken action in these areas.

The financial aspect wasn't discussed. I'd like to hear your views on the importance of proper funding for the health care system. This would ensure that the staff who work with seniors receive better wages and that they have the proper protective equipment.

[Dr. Carole Estabrooks]

In terms of federal-provincial jurisdiction, there's absolutely a need for additional resources, particularly in the workforce. To think that we ought to transfer substantial resources without ensuring that across the country we have some reasonable, at least minimum, standards around education and care hours, care quality and the quality of life of residents, seems perhaps to fall short of what we ought to be doing.

Many of us believe that we need to have a co-operative federal, provincial and territorial effort that neither tramples on people's jurisdictional rights nor falls short of demanding that certain standards be met before transfers are made.

I'll open with that and see what the others have to say.

[Dr. Pat Armstrong]

I want to say two things. One is that how much we spend, which I understood to be part of the question, is a matter of values, as the Romanow report made clear. We haven't sufficiently valued this labour force or those people who need this care. I think it's time we did value them. The federal government has an important role to play and, as Carole said, shouldn't just give away the money, because it doesn't necessarily go there.

The other thing that I think is really important to remember, and what I was coming to, is that there is a care economy. Putting money into this sector would be an economic stimulus. The money doesn't go into a pit somewhere. It goes to people who then spend the money. If we're talking about infrastructure and stimulating the economy, the care economy, as the U.K. Women's Budget Group makes clear, is a very sensible way to go.

[Jodi Hall]

I completely agree when it comes to the jurisdictional question between the federal and provincial governments. For us, this has become a time when we need to look at this as a shared responsibility. I think the transition of the age of our population across Canada can't be borne by the provinces alone. For us, that is a critical consideration in terms of how the provinces and federal government work together.

For national standards, we absolutely will work with the federal government. As I noted before, we strongly support the implementation of the use of data to be able to understand what standards are needed and how they can be looked at in different jurisdictions.

We do have a very specific financial ask that we've put forward as part of our federal budget submission, which is $2.1 billion, specifically targeting needs around COVID over the next two years. We believe that is required to stabilize the situation in long-term care. It's for immediate repairs and infrastructure. It's for staffing and looking at issues around wages and recruitment incentivization. It's of course for purchasing PPE.

Beyond that, there absolutely is a discussion required to address these long-standing systemic challenges. We know it's required for the future of long-term care.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you. However, Quebec and the provinces are working together to ask for an increase in funding, which has been drastically cut in recent years. Almost $10 billion has been lost. The Canada health transfer has accounted for 50% of the costs. We're now asking that the transfer be increased by 35%. Quebec and the provinces want the necessary money to reinvest the funding in their seniors.

This money could fund home care programs and home adaptations so that seniors can remain in their homes longer. Ms. Armstrong, I want to hear you speak about invisible work and the need to acknowledge the work of family caregivers. You spoke about the economic stimulus and about how people can participate in it. People could be given better wages or family caregivers could be given refundable tax credits.

We should acknowledge the importance of invisible work. This would enable us to develop better policies, and thereby encourage and acknowledge everything that these people do to keep seniors at home. What do you think about this?

[Dr. Pat Armstrong]

I think our strategy has to begin by recognizing the difficulties of doing that work. We have a current project that is looking at the move into long-term care. We have interviewed so many women who have reached a breaking point in terms of trying to provide care for someone at home. Certainly we need more care. Certainly we need to have better physical environments. We need to have what many people are talking about in terms of the “15-minute neighbourhood”. We have to think big, I think, in terms of the notion of home care.

We have to understand that staying at home is good for many people, but many people don't have a home. Many people, especially women, have a home that is abusive—physically, mentally, socially. While we need to support care at home, we also need to understand the intensive labour that goes into it. We have to provide alternatives for that as well as supports for that, which I think is the case in terms of long-term care. Certainly we need home care, but we also have to think of what that requires in terms of the extensive labour done by women.

[The Chair, Conservative, Marilyn Gladu]

That's very good, and that's your time.

We'll go now to Ms. Mathyssen.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Madam Chair.

I thank all of the witnesses for sharing their expertise with us today.

I think one of the key problems I see stemming from this—and, Ms. Armstrong, you talked about this, as I think all of the witnesses did—is the value of people. When we talk about one of the major problems within long-term care, it's the fact that it's majorly for profit. When we see the expiration of medications and the lack of adequate staffing and staff not being provided the proper PPE because it costs too much, and so on, ultimately we're talking about profit being at the centre of it.

One of the things we propose is that long-term care ultimately be pulled into the Canada Health Act, that the profit side be taken out and funding be tied to strong national standards—ensuring that those national standards of course mean something when you provide staff with the time they need to provide that high level of care.

Ms. Armstrong, I know you talked about the right to care and linking that with something as strong as the Canada Health Act. No matter how much money you have, no matter where you are, you have that right to care—but all of the witnesses will talk about that, I'm sure.

[Dr. Pat Armstrong]

I agree that public money should be going to public care and not to for-profit care, but I think we should also be clear that nothing in the Canada Health Act prohibits for-profit delivery. It only requires public administration by a not-for-profit agency. If we're looking to the Canada Health Act for protection against public money going into for-profit care, then I don't think that's the place to go.

I do think our strategy ought to be raising the standards and making sure that those standards are met and enforced and based on verified data. We've talked a lot about data, but those data have to be verified. We have to make sure—and this came out in the report by the seniors advocate in B.C.— there's a very strong emphasis on verified data, because she argued, convincingly I think, that the data, especially around staffing, for instance, was not verified. I think we should be raising the standards to an extent that there isn't room for profit.

One other thing: it's a pattern. Not all for-profits are terrible, not all municipal homes are wonderful. We're talking about patterns, as we always are in any health or social service.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Are there others? No? Okay.

In addition to that, in terms of that value of people, it comes down to the workers and respect for workers. We've heard a lot from those in early childhood education, and the idea that care and that role of care is done by women, but not valued because the majority are women. That gendered aspect doesn't provide them with the respect, the professionalism, that ultimately those professions require. I'd like to share a little about that. There was also a mention of ILO conventions. I believe there's been an ILO convention on the recognition of unpaid work for about 10 years now and that passage of that by the Canadian government could help.

[Dr. Pat Armstrong]

I'll go ahead, although Carole had her hand up.

I think that passage of that could help, but like other legislation, it will only help if we have an implementation strategy. We have a lot of legislation on the human right to care, for instance, that we've adopted, but haven't really done anything about. If we're going to adopt it, I think it has to come with a series of strategies, not just to recognize it. Health care workers don't want to be heroes. They want to have decent pay and decent supports, rather than just being called heroes. We have to do more about unpaid care than call them heroes and wonderful, loving people. A labour of love is still labour, and it still requires supports.

[The Chair, Conservative, Marilyn Gladu]

I think Ms. Hall wants to speak next.

[Jodi Hall]

Thank you.

I wanted to make an additional comment in regard to the question regarding for-profits in care. I just want to simply highlight that there are significant provincial standards and budgets that are set.

Funding that goes to all homes, including private organizations, is received in protected envelopes for things like staffing, food and care supplies, and items of that nature. If the money is not fully spent, it does have to be returned to the provincial government. That is something that is overseen at the provincial level.

COVID certainly affected all types of care homes—municipal, public and private—and that impact was not exclusive to any one type of organizational model.