Veterans Affairs Committee on May 10th, 2007

[The Chair, Conservative, Rob Anders]

Good morning, ladies and gentlemen.

I hope it's muggy enough for everybody outside.

We are yet again pursuing the veterans independence program and the health care review. Today we have Norah Keating. She's not here with us, but I understand she's online now, and the technicians are getting that set up. She's with the Gerontological Advisory Council.

This is the second time I've had the experience of chairing a meeting in which somebody is coming in via teleconference.

[The Clerk of the Committee, Mr. Alexandre Roger]

She's there.

[The Chair, Conservative, Rob Anders]

Hello, Norah, are you there?

[Dr. Norah Keating, Member and long-term care and mental health specialist, Gerontological Advisory Council]

Yes, I am.

[The Chair, Conservative, Rob Anders]

Wonderful.

The way this works is that we are all seated around our table with bright, smiling faces, freshly scrubbed and ready to go.

What happens is that you have up to 20 minutes to give your thoughts on these matters. Then after that we have a predetermined party rotation, and the questions come up, and you handle them. It may last a while.

How does that sound?

[Dr. Norah Keating]

That sounds just fine.

[The Chair, Conservative, Rob Anders]

The floor is yours, then.

[Dr. Norah Keating]

Thank you, and thanks very much for inviting me to address the committee.

You will have heard from Dr. Victor Marshall, who chairs the Gerontological Advisory Committee, and from Mr. Brian Ferguson and Darragh Mogan from VAC, who have given you some background on the reasons why the advisory committee was invited to write the report Keeping the Promise: The Future of Health Benefits for Canada's War Veterans.

What I'd like to do is briefly address the main issues that they have covered, adding some additional comments based on the questions you asked of them. I have been able to look at those transcripts. I also will highlight issues in the report that we believe will be important in its successful implementation.

I have been a member of the Gerontological Advisory Committee of Veterans Affairs since its inception. My areas of expertise are in families and aging, in rural communities, and in long-term care. I must say that my expertise in mental health is mainly in the areas of how families provide care to older relatives with cognitive illnesses such as Alzheimer's disease, although my research team is now engaged in research on the impact of acquired disabilities on individuals and their families.

I co-direct an international research team for research on aging policies and practice and often consult with government departments and NGOs on social and health policy issues in aging. In my experience, the VAC Gerontological Advisory Committee is unusual, in that it is a standing committee of the department that brings together key stakeholders from the user groups, which are the veterans organizations, and the researchers in an ongoing dialogue with the department. It's actually a great mix of people with the on-the-ground experience of the veterans organizations as well as those with a national view of the issues.

Our mandate on this committee is to speak to the best ways to support health, wellness, and quality of life for war veterans and their families, from World War I—although I think we now have only one survivor—World War II, and Korea.

Keeping the Promise sets out a comprehensive, integrative health and social services system for these older veterans. I am an author of the report, along with Dr. Dorothy Pringle, who I think you're going to speak to in the next few days, and Dr. François Béland. The report was vetted by all members of council and endorsed by the veterans groups.

As you've heard, its main recommendations include combining existing VAC programs into a single program called veterans integrated services. I want to add that we think this integration is really essential. For one thing, the integration allows for a combination of the health, income security, and social connections that we know are key determinants of well-being in later life. Integrated services allow for much more ability to address the needs of a person and to take into account the context in which he lives. Supporting people in later life is not just about addressing physical frailty or providing a pension; it's about helping them to age well in the place where they live.

Integration is also important in that it allows for one point of entry into a set of services that cut across what commonly are stovepipes of health, social services, income, and housing, and to accommodate a range of people, from those who are living independently but could benefit from health promotion activities, to those who need nursing-home-level care. Older adults are incredibly diverse, and we can't forget that. I believe that this model is what the experts in aging see as ideal, and seeing it in practice would be a wonderful gift to Canada's veterans. Integration also drastically reduces the set of eligibility requirements that have become increasingly complex over 60 years of adding and tweaking programs to address the needs of an aging group of veterans, who in the 1940s needed educational programs and affordable housing for their growing families and now may need social connections and supportive housing.

The second principle, which is one I won't dwell on and which has been spoken about by the other presenters, is to base eligibility on needs rather than on the veteran's status. You've heard our phrase that represents this principle: a veteran is a veteran is a veteran.

I think there's unanimous agreement among the GAC, veterans groups, and department members that complex eligibility criteria serve no one well. I'd like to reiterate that this doesn't mean that all veterans would receive services under the proposed VIS, but all would be eligible if the need arose.

The third principle in the report I think also warrants some comment. Our recommendation is for an integrated program of services to veterans and their families. Now by families, the GAC is thinking primarily, though not necessarily exclusively, of older veterans and their spouses. Almost all the World War II and Korea veterans are men. For those with chronic health problems, their wives may have cared for them for many years, providing round-the-clock support and delaying nursing home placement. After the death of their husbands, services to these widows should continue.

But thinking about families also means assessing the needs of these couples while both are alive. For example, it's important to assess the capacity of an older spouse to keep a veteran at home and to support her if the decision is to do so. We're thinking, as well, of other situations, such as those in which the veteran is a caregiver to his wife. Current programs in the department that focus on veterans as clients wouldn't allow for things like the home adaptations needed to accommodate the spouse of the veteran who uses a wheelchair, respite for the veteran who is the caregiver, or management of home care services to provide personal care to the veteran's wife. Family needs are central to this new view of veterans services.

The final point I'd like to emphasis is that VAC is providing services to veterans in all parts of the country. Veterans live in a wide variety of communities with very different resources. Even rural communities, an issue that's come up in your previous discussion, differ greatly, ranging from having, for example, about 1% of people in the community over age 65 to more than 40%. And they differ greatly in the services they provide and their supportiveness to older adults.

This is one of the reasons why we believe that front line staff who will implement the veterans integrated services must have the authority and flexibility to shift and allocate resources to meet veterans' health and social needs and take into account the setting in which the older adult lives.

That concludes my opening comments.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Mr. Valley would like to lead off from the Liberal Party for seven minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you, Dr. Keating.

I'm guessing that you're out in Alberta right now.

[Dr. Norah Keating]

I am.

[Roger Valley, Liberal, Kenora, ON]

Good.

First of all, thank you, and through you to all your members, for all the good work, really volunteer work, you do on this committee. We appreciate it.

I should know this, but I don't have that document with me, Keeping the Promise. You've been a member of the committee since its inception. So how long has that been?

[Dr. Norah Keating]

It's been about ten years.

[Roger Valley, Liberal, Kenora, ON]

Well, thank you for that service.

I hate it when you answer my question. Your last comment answered the questions I had ready. You mentioned at the very start that part of your expertise is in rural involvement. And you just answered part of my question by talking about the differences in rural Canada between rural Alberta, rural southern Ontario, and rural northern Ontario and Quebec. There's a total difference in what “rural” means.

[Dr. Norah Keating]

Yes.

[Roger Valley, Liberal, Kenora, ON]

I'm not sure of the term, but when you're deciding or thinking about what you're going to do or how you want to serve these areas, how do you gain that experience?

[Dr. Norah Keating]

Well, my research group has just finished a three-year program of research on older adults in rural communities. So we have a lot of background information, particularly on rural communities in Canada, which helped us develop the report, Keeping the Promise, and which we're using to advise the department.

That knowledge is something we've gained over the last number of years, really, specifically to help Veterans Affairs think about how to do this, how to support veterans who are living in rural Canada. It turns out that rural Canada is older, in general, than urban Canada and is aging more quickly. So it's an important question.

[Roger Valley, Liberal, Kenora, ON]

So you do have the experience, and I'm not questioning that. I'm just trying to cover issues for my riding.

You mentioned that we've raised this before. It probably was through me, because in our parties down here and in our discussions, there's a totally different understanding of what rural Canada is. When you say southern Ontario, you think of it as farming communities and everything else, but where I live it's isolated reserves.

[Dr. Norah Keating]

Right.

[Roger Valley, Liberal, Kenora, ON]

And I have 21 fly-ins, for which the only access is by air. Is there someone else on the committee, or is that where you gain your experience? I'm just trying to find out exactly where the information came from.

[Dr. Norah Keating]

I'm the main one on the committee who has research experience that I've been using to feed into the department. Of course, for many years the department has been providing services to veterans all over the country. So they have the on-the-ground experience. I think the main thing we've learned from the work we've done is that these communities are diverse, and you've identified that well. Even in rural Canada there isn't one solution for how best to serve people.

We do know that generally in rural Canada, frail older adults end up in nursing homes sooner than those in urban Canada do, because there aren't the other services available to support them at home.

[Roger Valley, Liberal, Kenora, ON]

Thank you. And that's exactly what we see: with the pressure in the last decade or so on health care, we're seeing fewer and fewer services provided out in those areas. Of course, we understand when we live in these small communities that we're not going to have the level of service that the larger centres do, but we've seen the squeeze on health care. We've seen the removal of physicians, of psychiatric services. There's not necessarily a total removal, but they're physically removed. They're basically dealt with through technology in a lot of ways. So how we cover that base is always a concern, and I continue to raise that whenever I have the chance.

You mentioned that you have contract workers or you have services as reasonably close as possible to the actual individual?

[Dr. Norah Keating]

I'm not an expert on the on-the-ground services that the department provides, but certainly they do provide services to their veterans across the country, and I think they, too, see the challenges in providing these services to rural communities, particularly those at a great distance from service centres, acute care hospitals, etc.

[Roger Valley, Liberal, Kenora, ON]

In my riding--my home town is about halfway between Winnipeg and Thunder Bay--just finding out what services and service providers are available has been a challenge, because they switch off from one location to another. There's a large base close to Winnipeg. Sometimes they have service, and sometimes it comes from Thunder Bay. So even as the member of Parliament, it's hard for me to keep track of who's doing what and where they're doing it.

[Dr. Norah Keating]

Yes. And I think one of the things in this report that I would underline is that one of the things the front-line worker working with the veteran would be doing is navigating through all of these services. It is a huge challenge for anybody to find out what those services are. It is certainly an immense challenge if you're a caregiver to somebody who's frail and you're trying to wend your way.

So I think that could be one service the department could do more on, which would be tremendously important to people.