Veterans Affairs Committee on May 8th, 2007

[The Chair, Conservative, Rob Anders]

Good morning. This is yet another glorious meeting of the Standing Committee on Veterans Affairs.

This morning, pursuant to Standing Order 108(2), we are pursuing our study of the veterans independence program and the health care review.

We have, as witnesses this morning, Mr. Brian Ferguson, the assistant deputy minister of veterans services; and Darragh Mogan, the executive director of the service and program modernization task force.

I know at least one of you is incredibly familiar with the procedures here at the committee, but we usually allow our witnesses about 20 minutes. So it could be 10 minutes each, if you'd like, or it could be 19 minutes for one of you and one minute for the other, if you wish or see fit. And then you get a chance to hear all the questions our committee members have to put to you.

So, gentlemen, the floor is yours.

[Brian Ferguson, Assistant Deputy Minister, Veterans Services, Department of Veterans Affairs]

Merci. Thank you very much, Mr. Chair.

I will deliver our only remarks from the department this morning.

Thank you, Mr. Chairman.

I am pleased to be here today, in my capacity as Assistant Deputy Minister, Veterans Services Branch, to discuss the work currently underway within Veterans Affairs Canada on the Veterans Health Services Review.

Let me start by saying that Veterans Affairs Canada has a long history of modifying programs and services to better respond to the evolving needs of veterans. In the early to mid 1900s, veterans returning from World War I, World War II, and the Korean War were greeted with a suite of benefits and services to help them successfully reintegrate into civilian life. Since that time, eligibility for benefits and access to services have been extended to include a broader group of veterans. New programs have also been introduced, including one of our most successful and popular programs, the veterans independence program.

First introduced in 1981, VIP, as it has been known, is a national home care program providing services such as housekeeping, grounds maintenance, personal care, and nutrition services to help veterans remain independent in their homes. Its goal is achieving nothing less than healthy living within the community. It is modeled on a graduated health care approach that emphasizes early assistance to prevent clients from becoming unduly dependent on the long-term health care system, allowing them to live with dignity, security, and comfort in their own homes for as long as possible.

Today, approximately 98,000 veterans and primary caregivers—74,000 veterans and 24,000 caregivers—benefit from VIP services, at an approximate cost of $274 million a year. This is a fraction of the cost of providing these individuals and veterans with beds in long-term care facilities. More importantly, it has allowed them to remain in their homes, not only helping them to maintain their independence but ensuring a high quality of life in their later years.

Those who care for veterans, primarily widows, can continue to receive for a lifetime the same housekeeping and grounds maintenance services the veteran benefited from before death or being admitted to a long-term care facility. This recognizes the contributions that these caregivers made in caring for the veteran, often at a great sacrifice to their own health, and their continued need for support to remain in their homes, often in the very home they shared with the veteran.

In spite of the changes made over the years to try to better respond to the needs of war veterans and their primary caregivers, the reality is that further action is required if we are to make a difference in how these veterans live out their remaining years.

Over the years our programs have incrementally evolved to meet clients' changing needs. The result is that we are faced with complex eligibility rules and a system that leaves some veterans without the care they need when they need it and where they need it.

The goals of the veterans health services review are threefold. First, we are examining the changing health needs of our aging veterans to identify gaps and barriers in meeting service needs. Secondly, we are soliciting input on areas where significant improvements could be made. The feedback from this committee will be a critical input in this regard. Thirdly, we will be developing appropriate proposals for change, which our minister will take to government for consideration.

I want to emphasize that we are not in a position to provide you with the results of the review today, as we are fully engaged in the process of analysis and policy development. However, we are most anxious to hear from you about how to make the review a success.

I understand that Dr. Victor Marshall, who is the chair of the Gerontology Advisory Council, spoke to you last month about the council's work. The sum of Canada's most distinguished experts on aging, seniors, and veterans issues, including representatives from the major national veterans organizations, the council provides the department with advice on how best to support the health, wellness, and quality of life for our traditional war veterans from World War I, World II, and the Korean War.

Its report, Keeping the Promise: The Future of Health Benefits for Canada's War Veterans, advocates for veterans' access to health services on a needs basis rather than on the entitlement basis that exists today. It also recommends integrating VAC's current three health care programs—treatment benefits, the veterans independence program, and long-term care—into a veterans integrated services approach that provides a full continuum of care.

The critical importance of early intervention and health promotion is also emphasized. The council's report and recommendations are helping to guide the work of the veterans health services review.

Currently, the department is exploring how to provide more streamlined access to health services to more veterans. We want our veterans to age as well as possible and to receive the most appropriate care based on need. To get the best outcome, VAC is examining how appropriate health benefits could be targeted to clients based on assessed needs. We are taking a careful look at the appropriateness of disability pensions and low income as the only gateways to access our health care program. For example, and this is a possibility, eligibility could be based on a combination of military service and need. In simple terms, a veteran is a veteran is a veteran.

It is often difficult to relate current health problems to a specific event or a situation that occurred during military service 50 or more years ago. We also recognize there are latent, long-term health effects of military service that create need today. It makes sense to provide health benefits that allow our veterans to stay independent for as long as possible, wherever it is they choose to live. By doing this, VAC can delay and often prevent the need for long-term care. This means developing a program that is flexible, where the level and intensity of service could be increased depending on need, and that is what we are looking at.

The department is continuing to work closely with the Gerontological Advisory Council to develop tools to assess client care needs so that appropriate benefits can be targeted to meet specific needs. With their expertise and evidence-based health promotion, the council is also advising on the design of a healthy aging strategy so we can support veterans in maintaining or improving their quality of life.

We are looking into the types of support and assistance that will help veterans remain independent as long as possible, even with a chronic illness and disability. Ultimately the veterans health services review is about meeting the needs of those who have donned a uniform in service to our country. Knowing that the outcome of this work is critical to veterans and may also serve as a legacy for the care of seniors in Canada, we are devoting the time and effort necessary to make sure we get the best possible outcome. It is the logical next step in the department's evolution.

It is similar in scope and importance to the New Veterans Charter, which represented the most comprehensive transformation in Veterans' programs and services in 60 years. It has the potential to be an excellent foundation on which to respond to the health needs of younger Canadian Forces Veterans to come.

Thank you, Mr. Chairman. I would be pleased to respond to any questions that the Committee may have.

[The Chair, Conservative, Rob Anders]

Well, thank you very much.

All right. Our first person up would be Mr. Valley, with the Liberals.

[Roger Valley, Liberal, Kenora, ON]

Thank you, Mr. Chair.

Thank you for coming this morning and appearing before us again.

You mentioned the changes Veterans Affairs goes through as it tries to adjust to new programs, new realities, new veterans, different issues. I'm sure you're aware of the fact that we face the front line of complaints. I've often wondered, when we see the veterans or their families come in through the doors and the complaints are there, how many are happy whom we don't know about--and I assume there are quite a few of them. We don't get to see those people, so thank you for the effort you're making.

I'm always wondering, and I'll keep going back to it ad nauseam, about delivering the services in the far-flung areas of the country. We notice on maps...and I can't remember right now who spoke to us and showed us the distances between offices and all the services that are provided. We know there are contract services out there in provincial hospitals and for all these other services.

Can you suggest to me how we're changing and how we're trying to...? Health care migrates to the larger centres. In my riding I don't have a large centre, and there are many instances like that right across Canada. As the services become more and more condensed in the larger areas, how do we provide services in those areas to make sure they have access to it?

[Brian Ferguson]

That's an excellent question and a continuing challenge for us, as you can appreciate and have highlighted in your question.

We have a set-up across the country where we have 50 client service teams now that are established in localities that are designed to serve the vast majority of veterans.

In the instances where we have people living in rural areas, those client service teams are still responsible for the rural areas for which they provide services. Actually, we invest in our area counsellors to go out to visit those individuals in their communities.

We are also investing in what we call proactive screening. In other words, for the aging veterans who live at home, we attempt to call as many of those as we possibly can on an unsolicited basis each year to determine how they're doing in their home. If they're doing poorly, from the screening tool we have, that we use over the phone, we send a work item through our computer system directly to the line staff who live closest to them, and they go out to visit within a short period of time.

That system seems to work relatively well, but it doesn't solve completely the issue. We're continuing to look, for example, at provinces and others with innovative approaches, such as telehealth and those other mechanisms, which we are factoring in, by the way, into our veterans health services review, as elements we should consider in our policy development.

[Roger Valley, Liberal, Kenora, ON]

You just mentioned that you actively contact the veterans. I don't have it--maybe it's my own fault--but is that list available to MPs like me who could actually touch base with some of the veterans in our ridings?

[Brian Ferguson]

We have some privacy issues there. We'd have to look into that, but I can get back to you on what we can do to help you in that regard. I know there are privacy issues. We cannot reveal names or people's conditions.

[Roger Valley, Liberal, Kenora, ON]

I'd like to contact them, but I can understand the privacy issues. So you're telling me that Veterans Affairs contacts every veteran.

[Brian Ferguson]

We attempt to contact every veteran. We don't have the resources to contact them all on an annual basis, but we're working to get there. We've made that a goal of the department. When you combine the people who come through the door looking for our services and those we call, a very high proportion of our veterans are reached.

[Roger Valley, Liberal, Kenora, ON]

Thank you for that.

You mentioned in your comments that you have three goals. You ask if we are soliciting input on areas where significant improvements could be made, and you say that feedback from this committee is important.

How do you go about getting feedback from the rural areas? We'll do our job at the committee, but how do you go to places like Red Lake or Sioux Lookout, where there might be only one, two, or three veterans? I'm using my riding as an example. How do you get into those remote sites to find out?

[Brian Ferguson]

Darragh, do you want to answer that question?

[Darragh Mogan, Executive Director, Service and Program Modernization Task Force, Department of Veterans Affairs]

Thank you very much.

There are a couple of ways. We have a pretty close working relationship with the Royal Canadian Legion. It has about 1,400 branches across the country. The last time I checked they weren't too shy about letting us know what they're hearing on the ground. Our counsellors travel to places like Sioux Lookout and occasionally Red Lake, and if they hear things they let us know. They too don't seem to be very shy about informing us.

So I think the veterans' network is pretty good; it's not ideal. To some extent computer technology is helping us, but I don't think it has matured to the stage where we have an absolute guarantee that the same sort of information is coming in from Red Lake as from central Toronto. That's not a reasonable thing to tell you.

But I think it's pretty good, and our deployed counselling staff is key to that. The fact that veterans organizations through our long-term care program are engaged in doing quality assurance across the country really helps us too, because they aren't restricted to the urban areas when they go out to look at quality assurance in long-term care.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

So if I ran advertisements in the paper about the process we're in, asking for input from the veterans in my riding, I could pass that on to you.

[Darragh Mogan]

I think it's fair to say we'd really welcome that.

[Roger Valley, Liberal, Kenora, ON]

Okay. I think that's something I'll do.

You mentioned the report Keeping the Promise, on the future of health benefits--I think it's from veterans integrated services. We just had that discussion with the individual. I was happy to know that we'd worked on it; I wasn't particularly happy to know that it hadn't been brought to my attention. The report has been out for quite some time. So you're telling us that you're working with that and you're actively involved with the Gerontological Advisory Council.

We didn't get that impression when we spoke to him. Maybe I'm being a bit unfair, but I got the impression that he made the report and they have more work to do. I didn't realize they were working closely with Veterans Affairs. The impression I got, rightly or wrongly, was that they had made the report and hadn't heard back. Can you correct me on that? Do I have the wrong impression?

[Brian Ferguson]

Certainly they are continuing to work with us. In fact, after the issuance of the report we had a special meeting with them in Charlottetown. Darragh could give some further details on that.

We are continuing to work with them. They've been very active over the years as an advisory council to the department. In fact, we run a lot of our key policy changes through that group to get the best advice we can. Certainly they've been very active on this file with us.

Darragh, do you have anything to add?

[Darragh Mogan]

We've had three meetings now with the Gerontological Advisory Council since the release. We have two more meetings planned. One is on the assessment service we might use through the health review, and the other is on what form a health promotion program may take. So if Dr. Marshall left the impression somehow that the liaison wasn't active, it might have been true for a little while, but it's certainly not true now. I think he'd be very firm on that.

[Roger Valley, Liberal, Kenora, ON]

I don't mean to put words in his mouth, so I won't do that. Maybe it was my incorrect impression.

[Darragh Mogan]

I don't know whether it was, but for the record, it's safe to say they've been functioning as an advisory group for us for 10 years. He said in his remarks--and I think it's true--that we do the vast majority of what they recommend. Why wouldn't we? They're the best and brightest in the country in that area. The veterans organizations are on that council, and they are not shy when it comes to making their points of view known.

[The Chair, Conservative, Rob Anders]

Thank you.

Next is Monsieur Gaudet with the Bloc for seven minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chairman.

Good morning, gentlemen.

Have you reached any agreements with the provinces concerning services to veterans?

[Brian Ferguson]

In general terms--and Darragh had comments on this--the department operates by topping up the services that are given to Canadians by the provinces. So if a province provides services to its citizens up to a certain level and those individuals, because they're veterans, are entitled to more than that because of our responsibilities, we will pay the province to provide those additional services. That has been a long-standing working arrangement right across Canada for many years. In essence, that's sort of the way we've been working. It's been practice and policy for years and years.

Darragh, do you want to add to that?

[Darragh Mogan]

We do have agreements with virtually all the provinces concerning the provision of health services for veterans.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you. You have 50 task forces for the country as a whole. It seems to me that's not a lot, considering the size of the territory. Do you intend to increase that strength or leave it as is?

[Brian Ferguson]

We established those client service teams based on our assessment of the need in areas across Canada. So each client service team is located in a geographic area of Canada where it can serve roughly 4,300 clients. We have increased the number of client service teams over the last year from 48 to 50, in recognition of a growing workload. We also analyze the workload of each team on a continuous basis, so if demand is going down in one area, we seek to move resources to another area where demand is going up. So we keep a constant watch on that.

Our feeling at the moment is that that's a pretty good size of operation for what is required out there. But we keep on top of it, and if we find any areas that are lacking, we have a look at them within our overall structure.