Veterans Affairs Committee on May 31st, 2007

[Dr. Dorothy Pringle]

It is not likely to be a registered nurse. We need the registered nurses mainly for the care coordination and the hands-on care.

We saw this person as being probably a graduate of a program like physical education and health. There's a lot of health promotion in those programs, and there are a lot of those programs across the country. They may be a community college graduate with a diploma in a health promotion area.

They won't necessarily all have exactly the same background. They may be a graduate of Guelph's program in gerontology, for example, but they would need to learn the job. For those who have a less strong background in health promotion per se, that would be an area they would have to develop more expertise in.

That would be part of Veterans Affairs' job, to get all of these people up to speed on the areas of expertise required for this position. But we don't see nurses, physiotherapists, or social workers filling those early intervention specialist roles.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay, but this would have to be somebody with quite sophisticated capabilities. They would have to be a full-rounded resource for the veteran.

[Dr. Dorothy Pringle]

Absolutely.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

I don't want to get too much into operations, but I'd like to get a picture, as a member of this committee, about how you're envisioning this, because it sounds as though you're a management specialist.

Do you see a kind of a phone bank of people with some interpersonal skills who would contact the veterans, and once they would find a veteran who required the services, they would then hand them off to an early intervention specialist?

[Dr. Dorothy Pringle]

That could happen. Let me say that there may be veterans who are currently in the VIP program, for example, in which there's a caregiver, and who should be part of an activity program or a nutrition program, etc. The area care coordinator would refer that person to the early intervention specialist. That could be a way of getting in.

It could be through a phone call from a veteran who phones Veterans Affairs because they read about this in one of the MPs' newsletters or they may get Salute!, which is the Veterans Affairs newspaper, and read, “Please contact us. We're interested in helping you improve your health.” They make a phone call to find out what that's about.

They would be screened in terms of whether or not they need health services per se. If the screening indicated that they would need that, they would immediately be referred then to the care coordinator in their area.

If from the screening it doesn't look as though they require services, then they would be referred to an early intervention specialist and another assessment, a much more in-depth assessment, is done then, on the phone initially, and then in the home, if that's shown to be necessary.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Great.

By the way, was I being too presumptive? I presumed you were a doctor--physician--with management skills, because you said you were helping them put into place the measures that would be required to make the programs work to keep a promise. Is that your expertise--management?

[Dr. Dorothy Pringle]

I'm a nurse, not a physician. I have done a lot of work in administration. I've held a lot of administrative positions.

As a council, we're making recommendations for what Veterans Affairs needs to have in place—the people resources, the communication lines, the screening tools, etc.—to make what we recommended in Keeping the Promise operational.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay. I was on a fishing trip a little bit. I just wanted to know if you had the management expertise and what challenges you saw right now in moving ahead with these new initiatives, based on what you've seen so far in the interaction with the management at Veterans Affairs Canada.

[Dr. Dorothy Pringle]

I think the biggest challenges are recruiting and training the early intervention specialists. That's huge.

Second is reshaping the role of the area coordinator and adding more into that pool to move them to being more interventionist as care coordinators. That role has already expanded from what it was 10, 15 years ago, or even five years ago. We see pushing that further. There's a lot more involvement of the caregiver, so that area coordinator needs to be able to assess not only the veteran but also the caregiver and the family situation.

I think the biggest challenges are getting the right people in place and then getting them trained to the level required to fulfill what we're promising in Keeping the Promise.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

The very fast-selling management book, Good to Great, says that's always the biggest challenge, getting the right people on the bus.

Thank you very much.

[The Chair, Conservative, Rob Anders]

Thank you very much, Mr. Sweet.

Mr. Shipley.

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

Thank you. I have a couple of questions just to wrap up.

You mentioned you appreciate the veterans' support. I think that's important, not just for the political side, but I think it's important that the veterans know they have a support group like yours that is working for them. I think actually we need to take that a step beyond. You're dealing mostly in terms of a Gerontological Advisory Committee; that indicates the age group. I think now we're talking about expansion into the new vets. These issues you're dealing with are the same issues they're going to be dealing with at some point in time.

I'm just wondering, when we talk about some of the issues that veterans have to deal with when they come back, if there's a difference...? We have civilians and the RCMP who go through these traumatic diseases or experiences. Maybe it's the trauma that brings on the disease, or the injury. Post-traumatic stress, as we call it, is one of those.

Do you believe there's a difference between the individual who is in the public and has not been involved with the armed forces and those who have been involved with the armed forces in terms of some of the treatment they may need?

[Dr. Dorothy Pringle]

Yes. We're learning that now. That is what I'm going to refer to as the deployment research, which showed that you don't have to have a physical injury in order to have long-term effects of military service. Simply being in military service and being deployed has the potential to have negative health consequences over a very long time.

I think that research influenced us greatly in terms of moving off this eligibility criteria as the entry to services in Veterans Affairs and moving to a needs base, so that if you were in the military, you may have been discharged in good health, but there's no way of knowing what the long-term consequences of that military service are.

So 30, 40 years later, as an aged person, you need to have access to and the benefits of services from Veterans Affairs.

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

The message has been very strong from a number of witnesses—actually, just what you're saying—about moving to a needs base rather than an eligibility base, just because it should be based on needs, not on eligibility, and I think too for the protection of the system and the protection of all the people who are involved with it.

One of the things you mentioned and that we've heard, though different terms have been used, is to get through the red tape, basically—the “navigation” of it has been one of the words. Clearly in some way we need to simplify the process and start to get rid of some of the bureaucracy there just for the sake of having the bureaucracy and of the paper load.

In some other industries, in manufacturing and what we've done in businesses, we've said we want to cut some of this paper by 20%. I'm convinced that this is likely one of those areas we should focus on: getting rid of some of the paperwork for these people.

One of the things, too, that has been implemented and that we didn't have but will have coming on very shortly is the ombudsman. It doesn't matter how good the system is; there are always people who fall through the cracks or need assistance to get to where they want to go. I'm hopeful that this ombudsman will be very helpful in having an independent view and being of assistance.

Can you give me a comment on how beneficial that will be?

[Dr. Dorothy Pringle]

I would agree with you that, first of all, a needs base should help us eliminate a lot of the paperwork and the red tape. I know you've talked about this previously.

I think the ombudsperson will be useful. I'm not sure it's possible to make a perfect system or to have any system work perfectly or in the right way for everybody, so you have to have something in place that allows people to say when the system hasn't worked for them. I think having an ombudsperson in place is a good way of identifying where the issues are.

Certainly now I'm familiar with the ombudsperson's role in hospitals. You may think you're in good shape in the hospital, but this person is beginning to hear the same story from several individuals; that helps you to know you have a problem in this area.

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

Can I just have one more quick question? I don't mean to cut you off, but I'm running out of time here.

One of the things we're concerned about, and everyone is, is the availability of professional services—and we know it's across Canada—doctors, specialists working in the public sector within our community, and also working with our veterans through Veterans Affairs. Do you see this as a need that's likely going to happen? Do you see that doing it brings complications?

[Dr. Dorothy Pringle]

If I'm understanding the question, I think it is likely that a lot of the direct care staffing is going to be outside of the Veterans Affairs system, that there will be contracts with people rather than direct care staff added to Veterans Affairs. That's probably true for physicians as well.

We have not talked about this at all on the council or with Veterans Affairs, but there may be some areas, and these would be in the more rural and more remote areas, where in fact there needs to be a Veterans Affairs base team. We need multi-disciplinary teams, for which maybe Veterans Affairs has to hire individuals directly in order to get them into those locations, because they're not available otherwise.

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

Okay, thank you.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Shipley.

Mr. Stoffer, we're going to go back to you for five minutes.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I have just one quick question for you, Madam.

I already see sort of a problem that may exist. When you indicate that there may be people who are contracted to Veterans Affairs to go out and do assessments on veterans or their spouses, the reality is that most things are based on a fiscal budget: what can we afford; how much money does the department have to do the work it is asked to do? You have a person go in and give an analysis or a review of veterans and their family, their situation, and what they consider they need. But sometimes the analyst's view of what the veteran needs may be completely different from what the veteran thinks he needs. So who has the final determination of what a veteran actually needs?

A veteran may say, “I need this, this, this, this, and this.” The person who does the interview or the analysis of it may say, “No, in our opinion, we think you need this, this, and this.” Who's the final arbitrator on that one? Does the benefit of the doubt go to the veteran, or does it go to the department, which ends up paying for this?

[Dr. Dorothy Pringle]

I think, to the extent possible, you try to reach common ground on that. That's one of your jobs as somebody who's doing assessments, to seek the view of the individual veteran and the caregiver of what their needs are. Frankly, in our experience there, in many cases they're likely to underestimate what they need, so they have to be persuaded that in fact they do need assistance with homemaking and so on. Then you need to give them your professional view, based on assessment of what they need. So you bring both of those together.

I think the final arbitrator would be Veterans Affairs. It would not be the contracted person in that home. That person would bring both views: the family strongly believes and cannot be persuaded otherwise that this is what they require; my professional view is that this is what they need, and we were not able to resolve these differences. That would then go to the Veterans Affairs team, and they may then have a meeting. It may be that you need to have a meeting with this family around trying to work this out.

I think we've heard earlier that the benefit of the doubt should go to the veteran.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Stoffer.

Mr. Valley.

[Roger Valley, Liberal, Kenora, ON]

Thank you, Doctor. I believe you're the third witness we've had from this group, your Gerontological Advisory Council.

[Dr. Dorothy Pringle]

That's right.