Veterans Affairs Committee on May 10th, 2007

[The Chair, Conservative, Rob Anders]

Now on to Mr. Shipley with the Conservative Party for five minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you, Dr. Keating. It's great to have you join us in this matter this morning.

[Dr. Norah Keating]

Thank you.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I have just a couple of questions.

You mentioned earlier that senior, older vets...people are very diverse. Are they more or less than the new vets? Is there a difference? Is there a different expectation for the vets or older people?

[Dr. Norah Keating]

We don't have the expertise with younger veterans, so I can't speak to that issue specifically. Except that we do know that as people move along life's track they become different from one another, so that there is great diversity. Situations make a huge difference. Younger vets—

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Is there a different expectation, do you think, by senior older vets from what there is by seniors who are not vets?

[Dr. Norah Keating]

Do you mean a different expectation by veterans compared with other seniors?

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I mean older seniors--other seniors who are not vets--in terms of expectations of services and those sorts of things.

[Dr. Norah Keating]

One of the things that we see with this cohort of older adults is that they're probably, in general, not nearly as demanding as we expect the next generation--the baby-boom generation--to be, for services.

I can't say--I just don't know--whether veterans have expectations that are different from those of other seniors about services.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

We've had a fair bit of discussion around needs-based and entitlement-based services. I want to follow up.

One of the things I've found with seniors is that it isn't always about the money. For those who have the money, it's about the availability of the service. I don't know if you have a comment about that.

In fact, for many seniors, if they have the financial wherewithal, it is not that they feel they shouldn't--in fact, most of them feel that they should, because they've been blessed in this great country with a number of things. But one of the things they often don't have is the access, or the road map for how to get to the services they actually need. I don't know if you have any comments on that.

[Dr. Norah Keating]

I would say that in general, what people of all ages, and certainly older adults, wish to do is to be able to live their lives in the place where they'd like to be. For older adults who may need particular supports to do that, absolutely, it's a question of getting access to the people or the services that can help them to do that. If those are not available, then having a higher income may not help them at all to continue to be able to live their life in the way they'd like to.

So access to services and people and support can make a huge difference to older adults.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

One of the things you had also mentioned--and I don't have the exact wording--is that as people become older and become frail, it's easier if they move to an urban area rather than remain in the rural area. I don't know if I got the gist of that right.

I come from a rural area, as some of us do. I find that in the rural area where I come from, there's actually a tendency for more care in the home by extended family. That may not be the case. I'm just wondering if you have a comment on that.

[Dr. Norah Keating]

One of the things we know generally, in rural Canada, is that older adults who are quite frail and need high levels of care often go sooner into a nursing home than would those in urban areas, and that's primarily because they can't get the community services.

It is true, and certainly we've found in our own work, that the smaller the community, the more likely it is that people in the community will be helping out. Whether that's done out of virtue and community cohesiveness or out of sheer necessity is hard to know for sure. But there is a sense that rural communities are particularly cohesive and supportive to older adults. And in many cases, that's absolutely correct.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I have just a quick one.

One of the things we talk about and have a concern about in Canada, regardless of what age you are or whether you're a veteran, is the availability of specialists, the shortages in the medical profession, and being able to have the access. We say we can supply the service. One thing we don't want to do is to say that we're going to supply these services and then actually not be able to have the professional people there to do the work and to supply those services.

When you're doing your study--and I've read through some of it--is that a concern, and how do you want to deal with that?

[Dr. Norah Keating]

The medical system has been aware of the challenges of providing medical services, particularly specialist services, in rural Canada for some time. I don't have particular expertise in that whole area on how we're managing.

I know that there have been a number of experiments done in issues like tele-health, for example, but I really don't have the expertise to speak to that in much detail.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Okay.

Now over to Mr. St. Denis, for five minutes.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, Mr. Chair.

Maybe I could just pursue my earlier line of questioning on family and family supports. My colleague Mr. Perron had asked about the home renovations, refits to accommodate an aging parent. Depending on the province, there are various programs. The employment insurance program has been changed in the last couple of years to accommodate immediate family members who may be able to stay at home to support an ailing parent or other close family member. I think Mr. Stoffer asked about other countries, and I think Betty Hinton did as well.

If you could have your way and the resources to do it, are there obvious gaps, more likely systemic gaps, that you would immediately deal with and that would pay immediate dividends if the resources were put in place to deal with them?

[Dr. Norah Keating]

In terms of support to family members in particular?

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Yes, support of family, in support, then, of the aging or ill parent.

[Dr. Norah Keating]

Well, the main issues that we addressed in this report are determining what it is that would be the best support to that older person and his or her caregiver, in trying to craft those services to the needs of that particular older couple or parent with child caregiver.

For older spouses, very often the kinds of services or supports they need are a break from their caregiving. If you yourself are in your eighties and providing care on a 24-hour basis, you need something of a break. Services that provide support to caregivers who are younger would be the kinds of things you're talking about that would allow for job protection of an employed caregiver who needed to take some time off to provide extra services.

So I guess my main comment, and I think what comes through in the report, is that the idea would be that if you're looking at need, you take whatever is the repertoire of services available and craft a set of supports that best fits that older adult and his or her caregivers in the community where they happen to live. I know that's a fairly general comment, but that's certainly the principle.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

That's helpful.

A number of years ago the federal government opened or started discussions with the provinces and territories on a national home care plan. There have been conferences, and of course the idea is of a continuum of all ages of the medical needs in a home setting.

You just mentioned in your last response, if I understood you, that not every situation is the same as the next, and their needs would vary. In your thinking, is there a place for a national home care program? Obviously we're leaving aside funding concerns and the extent of such a program. But should we as a nation get more serious about that?

We do have gerontology in-home workers, but it's not regulated, as I understand it, and it's not overly organized. I'm just wondering if you could comment on national home care in this context.

[Dr. Norah Keating]

Let me give you an example of a pilot project that Veterans Affairs did in recent years that I think addresses this issue. They were concerned that there were a large number of veterans who were on waiting lists for nursing homes. The intervention project was to offer people a set of enhanced services at home or nursing home placement. The enhanced services at home were services like personal care, assistance with housekeeping, etc. The waiting list virtually disappeared.

People do, for the most part, given the choice, wish to be at home rather than in a nursing home setting. That means we need to think about the best way to provide the support that we can to people who are living at home. It's beyond the mandate of our committee to speak to the question of national home care programs. I believe that more and more older adults will be living at home or in settings that are outside of nursing homes. There will continue to be challenges in finding the best ways to support them.

[Brent St. Denis, Liberal, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, Dr. Keating.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now we've over to Mr. Sweet with the Conservative Party, for five minutes.