Veterans Affairs Committee on June 15th, 2006

[The Chair, Conservative, Rob Anders]

This is another meeting, yet again, of our veterans affairs committee. Today we have some more witnesses prepping us on the veterans independence program. We have Mr. Brian Ferguson, the assistant deputy minister of veterans services, and Mr. Ken Miller, director of the program policy directorate.

I leave it to you gentlemen witnesses to say what you have to say.

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

Thank you, Mr. Chair, and good afternoon, everyone. Bon après-midi. I would like to thank the members of this committee for the invitation to be here today to discuss the veterans independence program. I welcome this opportunity to provide you with an overview of this outstanding program and to share a brief history of how it evolved and a few lessons my department has learned as a result of providing for the health and home care needs of Canada's senior veterans.

One of our most successful and popular programs, the Veterans Independence Program, has been made available to more and more clients since its inception.

When the program was first introduced in 1981 as the aging veterans program, its sole focus was to help veterans remain independent in their own homes for long enough that long-term care facilities became available. VIP has since become the model for programs both in Canada and throughout the world. It was designed to help senior citizens live independent lives in their homes and their communities until long-term care becomes an absolute necessity. Its goal is achieving nothing less than healthy living within the community through such assistance as housekeeping, groundskeeping, and transportation, an emphasis that was all but unique in North America in 1981 when the program began.

It is modelled 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.

In addition, if any veteran client or primary caregiver feels they have a need that is not being met and for which they feel they should be eligible, we work directly with them to assist in arranging the additional care they require.

In total, approximately 97,000 Canadian veterans and primary caregivers receive VIP services today, at an approximate cost of $270 million, a fraction of the costs for providing the same number of clients with bed and long-term care facilities.

Currently we have 10,600 veterans in long-term care across the country. More importantly, it has allowed those Canadians who access VIP to remain in their homes, not only helping to maintain their independence but ensuring a high quality of life in their later years.

With your concurrence, I would like to review the slide deck that has been provided for your reference. My colleague, Mr. Ken Miller, director of program policy, and I would be pleased to answer any questions you may have on the subject.

If you're fine with that, Mr. Chair, I'll proceed with the slide presentation.

[The Chair, Conservative, Rob Anders]

Since I was engrossed in the signing of our report, yes.

[Brian Ferguson]

If we turn to the opening slide on the veterans independence program, I'll cover basically today.... I'll wait until the slides are distributed.

The second slide in your possession indicates the topics covered today. I won't read it to you; I'll simply go into the topics themselves.

I'll begin with the background. The VIP program was first introduced as the aging veterans program in 1981; that was the genesis of the program. It was renamed in the mid-1980s to the veterans independence program. The services received under the program are authorized under the veterans health care regulations.

In terms of purpose and philosophy, the VIP program exists to assist clients to remain healthy and independent in their own homes or communities. Services are based on clients' particular circumstances and health needs, so it's a needs-based program. It complements other federal, provincial, or municipal programs available. Clients must first access these other programs; we top up missing services when they are eligible for them.

The services provided consist of the following five elements: home care, which is the lion's share of the expenditure on an annual basis, with about $207 million; ambulatory health care, meaning health care to assist you in getting around in your environment; transportation; home adaptation; and the other big-cost item, nursing home care.

Home care itself includes access to nutrition services, such as meals on wheels; personal care, which includes assistance with bathing and dressing; professional health support, which includes nursing and occupational therapist support; grounds maintenance, which includes snow removal or lawn care; and housekeeping, which includes laundry, vacuuming, and meal preparation. As you can see, it is a full range of very practical assistance for maintaining independence in the home.

Ambulatory health care includes health assessment, diagnostic services, and social and recreational services under the supervision of a health professional. It also covers travel costs to access these services. If someone has to get out of the home to access these services, travel costs are covered.

Transportation services are there to help clients participate in social activities and to do shopping, banking, etc., when transportation is not otherwise available.

Home adaptations are there to provide access to enable clients to carry out basic everyday activities, such as food preparation, personal hygiene, and sleep.

Nursing home care is for clients who can no longer live at home. That's care in a facility in a client's community under the veterans independence program.

We are often asked who is eligible. Veterans who require VIP for their pension condition or condition for which they receive a disability award are eligible if they need the VIP to be able to maintain their independence.

Disability award recipients who are assessed at 48% or higher and who require VIP services for any health condition are eligible. That basically grants VIP on the assumption that 48% is a threshold high enough for them to need that assistance.

Also eligible are disability pensioners who are at risk due to frailty and who require VIP for any health condition.

Also eligible are war veterans who qualify because of low income--income levels are established under the War Veterans Allowance Act--and who require VIP for any health condition. People sometimes are under the misperception that this is the way into the VIP--in other words, it's income tested. It's not income tested. It is another gateway into the program for those who have low income, but these other avenues are there as well.

Totally disabled non-pensioned prisoners of war who require VIP for any health condition are also eligible.

It continues with overseas service veterans who are eligible for long-term care, who are at home awaiting admission to a priority access bed, and who require VIP for any health condition. That requires just a bit of explanation. All of Canada's overseas war veterans are entitled to long-term care as a benefit, regardless of whether they were injured in the service of Canada. If there's any kind of a backlog when it comes time for them to access that care, they're eligible for VIP assistance at home to maintain their independence while they're waiting for the bed to become available.

Canada's service veterans who require VIP for any health condition are also eligible. Canada's service veterans are veterans who served in Canada during only World War I or World War II for a minimum of 365 days, who are over age 65, and who are income qualified.

Eligible as well are primary caregivers, including spouses or common-law partners, of any veteran who at any time since 1981 received housekeeping and/or grounds maintenance services at the time of death or admission to a long-term care facility.

In terms of numbers and costs, as of March of this year, we are providing VIP services to approximately 73,800 veterans and 24,000 primary caregivers. I should underscore that's eligibility for housekeeping and/or grounds maintenance services only. The total cost for VIP was $270 million last year.

The program has evolved a lot since it was first designed in 1981. Veterans' eligibility for the program was expanded in order to meet the changing needs of veterans and clients. Today there are over 15 eligible groups and subgroups, and, as you know, pressure continues to be exerted for further enhancements.

Highlights of the program's evolution are outlined on this slide. In 1981 the war service veterans pensioners were eligible. In 1984 the first extension was made to income-qualified war service veterans. In 1981 Canada service veterans for their pension conditions were added to the eligibility list. In 1990 special duty pensioners for their pension condition were added. In 2003 housekeeping and/or grounds maintenance for life was granted to survivors and primary caregivers of veterans who died on or after September 1, 1990. And most recently, in 2005, lifetime housekeeping and/or grounds maintenance services were granted to primary caregivers, including spouses and common-law partners of veterans, who received these services at the time of death or admission to a long-term care facility. So that took it back to the beginning of the program.

Quite a number of significant client groups are not currently eligible: 166,000 war service veterans, including 86,000 veterans who have overseas service but who receive no pension--they are eligible for long-term care but they're not eligible for VIP; 80,000 veterans who served primarily in Canada but have insufficient service time or do not satisfy income requirements--in other words, less than that 365 days to qualify as a Canada service veteran.

The estimated cost of providing VIP to these individuals who are excluded would be about $500 million annually. That would include the home care, the long-term care, community beds, and related treatment costs.

There are an estimated 237,000 survivors of veterans who have never had VIP services and therefore they would not be eligible. The estimated cost of providing VIP, the housekeeping and grounds maintenance only, would be $330 million a year. These figures are illustrative of the cost magnitudes that would be attached to increasing the eligibility.

Some other considerations. I mentioned that the overseas service veterans have eligibility for long-term care but don't have eligibility for VIP, except in one circumstance, and that's what we call our overseas service veteran at-home pilot, which was implemented in 2003 because we had wait lists in a few cities--Halifax, Vancouver, and Ottawa. It takes a long time to build facilities and beds for individuals at that stage of their lives, so a pilot was introduced to offer these overseas service veterans on the wait list for a long-term bed access to VIP home care and treatment benefits until a bed became available.

The results of a survey done after we introduced this program were that 155 of 170 veterans who participated in the pilot chose to stay at home rather than move to a facility when a bed became available, asking us to extend the pilot. Even though with these individuals the cost approximated $7,000 a year--higher than the average because of the conditions they were in--it's still a bargain compared to the $20,000-plus it costs to put somebody in a long-term care facility.

I would also like to highlight that we have a continuing care research project under way with Ontario. In September 2005 we launched, in collaboration with the Ontario Seniors' Secretariat, a project to evaluate the impacts of our OSV at-home pilot project and to compare the outcomes and costs of providing home care, supportive housing, and residential care to VIP clients in Ontario. This will be a full costing of all the costs associated with home care and VIP related to these programs and will provide a definitive baseline for people to assess the real numbers associated with this program. The project results will be used to make informed decisions on continuing care policies, with the goal of improving supportive services to veterans, seniors, and their families, as well as contributing, we hope, to national policy-making on continuing care issues. We're expecting the results of the study by June of next year.

I would like to conclude by simply reminding people that we have two toll-free numbers for information on all of our programs, including the VIP, and they are listed here on your slide deck in English and in French.

We would also like to indicate that veterans or survivors who are currently receiving back benefits may be assessed on the need for VIP services as part of a regular follow-up by the department.

We have been attempting within the available resources to conduct what we call proactive screening. We will phone veterans of a certain age and maybe in a certain risk category to ask how things are going. Through that screening exercise, if our analysts at the end of the phone line feel there's an issue that may need to be resolved, we'll send out what we call a work item to our district office. Within 24 hours, somebody gets out to see those individuals and to see what kinds of situations they may be in. In many cases, it would lead to other services being added or the VIP program being instituted.

Mr. Chair, that concludes my brief overview of the VIP program.

Both Ken and I are here to answer any questions or to attempt to respond to any comments you may have.

[The Chair, Conservative, Rob Anders]

No problem. I take it that Mr. Miller is not going to add anything at this point.

The first seven minutes go to our Liberal colleagues.

Mr. Cuzner, you seem to be giving me a head nod, so fair enough.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Thank you Mr. Chairman.

Gentlemen, thank you very much for the presentation.

I'll base my comments on someone who's not unfamiliar to you two gentlemen, and that's Joyce Carter. I certainly know that Mrs. Hinton had an opportunity to speak with her on a number of occasions, and I know Mr. Stoffer has. She has been a tremendous advocate for the VIP program through writing monthly letters and making contacts with elected officials.

I reference her because in October, prior to the election call, she had received a letter from the then leader of the official opposition stating that benefits for the VIP program would be extended to all Second World War veterans and Korean War veterans, regardless of any of the past criteria.

Could you indicate to me what would have to take place within the program? What processes would have to evolve? Could you give me the genesis of trying to bring that through to fruition should that change be made? Could you give me some insight on how that would evolve?

[Brian Ferguson]

If I understand the thrust of your question, it would be on how we assess the need for change in the program and proceed with that. It's a timely question.

This morning we in fact had a meeting with the minister on this very subject. Upon his arrival in the department, he asked us to proceed with a comprehensive health care review, looking to improve our services, where we can, particularly to senior veterans and other clients. This morning he reiterated in his direction to the department that we need to ensure the review is comprehensive and achieves the best combination of value for money and service. The review is under way, and it will look at all of the various competing demands on the program.

One of the things he's asked us to ensure is that we do not have a piecemeal approach. We need to take a comprehensive look at the opportunities for improved service and, when looking at the pressures that are on the program, to examine the issues of eligibility and need. We're not to make ad hoc decisions that would be piecemeal in nature, and we're to come back to the minister with a comprehensive health care review for his consideration. This review will look at the issues of the VIP, long-term care, and other health problems.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

The VIP would be one aspect of that in the assessment.

[Brian Ferguson]

That's correct.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

As presented, if the VIP were to be extended, I think I read somewhere that the value would be in the vicinity of about $500 million if those services were properly extended under the VIP program.

[Brian Ferguson]

For the client group of caregivers and spouses, it would be about $330 million, if the program were only extended for the housekeeping and groundskeeping elements of it. The $500 million figure was to extend it to those veterans who currently do not have access to the program, such as the overseas services veterans and others.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

It's currently at $273 million now?

[Brian Ferguson]

It's $270 million, as of last year, in terms of what was being spent on it.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

With this review--and I know you wouldn't want to prejudge a review--with that intent, even under a new program and after the review, there would have to be a substantial injection of new cash within the department to cover those services, if that were to be the decision taken by the minister and by cabinet.

[Brian Ferguson]

Yes. I think that's a fair comment, Mr. Cuzner.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Could you give us a critical path and how you see this review evolving?

[Brian Ferguson]

The timeline we have in mind is getting back to the minister in the late fall with the analysis that he's asked us to conduct. After that it would be in the hands of the normal processes of government. Probably it would be sometime in the spring when we would be in a position to consider what the outcome of it might be. That's a guess off the top of my head; I wouldn't want you to take it as a definitive timeline.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

So it's very much in the initial stages and--

[Brian Ferguson]

It's a complex subject and will require a lot of analysis in terms of issues such as the mix of services that get the best payoff for VIP, the cross-impact of those on long-term care costs, and that sort of thing. It's a trade-off expenditure, and it's actually quite a valuable one.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

What do you mean by that?

[Brian Ferguson]

I mean in the sense that the money you invest in VIP really does avoid costs in long-term care, but you have to make the case; you have to be able to show that the numbers are real and credible. There haven't been that many definitive studies, which is why this study in Ontario is really going to help us in that regard.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

It's case by case, is it, to assess whether or not there is best bang for the buck?

[Brian Ferguson]

When it comes to actually applying it, yes, it would be.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Okay.

[The Chair, Conservative, Rob Anders]

You have maybe 40 seconds left.