Veterans Affairs Committee on Jan. 29th, 2008

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

In all honesty, would you say it's an incomplete survey?

[Mark Speechley]

Well, it's a selected sample.

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

I love that word.

Also, did you do a survey at all...? I know that one of the main principles or guiding lights of the veterans independence program is to allow veterans and their spouses to stay in their homes longer.

When I talk to doctors, I find that the falls occur when the veteran or his spouse has moved out of their house and into different surroundings and they are not familiar with the bedroom, the bathroom, the hallways, and sometimes they're not mentally adjusted properly to accept those new surroundings; thus things like falls happen. Did you do any correlation between falls at home or falls somewhere else, such as in a mall, or somewhere else, or falls in a new setting where they had been moved?

[Mark Speechley]

I wish I had. I had to keep the questionnaire short to get the response rate at 70%, so I just asked for the number of falls. We didn't make distinctions between where they were.

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

Okay.

I have one other point for you.

A lot of this, of course, has to do with what facilities are available in the provinces or territories. As my colleague Mr. Valley indicated, the rural parts of Canada have great difficulty in accessing services or assistance, or even in picking up the phone and not getting an answering machine when calling in that regard.

Has any of this work translated to the provinces and territories, where they could be encouraged to work with the federal government, who pays? My own personal view with regard to veterans is that it should be the federal government that pays for it, but there are always those challenges of who delivers the service. Veterans Affairs may pay, but somebody else delivers the service, and therein sometimes the baton doesn't get passed properly.

What analysis or recommendations can you give to this committee to see that this dialogue and communication is increased from he who pays to she who delivers so that the process can be smoother for veterans?

[Mark Speechley]

To use the example of the physician who called me and said he wasn't going to call the veteran back in for a reassessment because OHIP wouldn't pay, if Veterans Affairs would pay, then OHIP could bill Veterans Affairs. It's a simple example.

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

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Stoffer.

Now on to Mrs. Hinton with the Conservative Party, for seven minutes.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you very much.

It never ceases to amaze me that no matter how many years you sit on this committee you learn something new almost every meeting. I never realized, for example, that there was any kind of activity happening at a university that was specifically studying falls. That's news to me.

Those were very interesting comments that you've been making, and I've been busy trying to read all of your paperwork while I've been listening. There are a couple of things I'm going to put in front of you for some feedback.

It always becomes a question of who pays. Health care is a shared responsibility. Basically it's the province that provides it, and the federal level of government sends funding to the provinces. You're going to get a little differentiation, I suppose, from province to province, but there's probably a way for more than one level to work together.

I was also thinking about the delivery part of it. You were wondering how our veterans are going to find out about this. I think it's a bigger discussion than simply veterans; I think it should also include all elderly people.

There are a number of different ways we could do this integration of the province, the community, the federal level, and the physicians across the country. If a patient is in a physician's office and the physician tells them about some of these facilities or exercise programs that are available to them to prevent the fall, I think that would also be beneficial.

Something we always overlook—and we shouldn't, because they do a tremendous job in this country—is the veterans organizations. They may be the best educational source we could have for notifying veterans of these different programs that are in place.

In terms of the programs that are in place, again we have this wide variety. You can have things such as the Y, which I know works with seniors, whether they're veterans or not; seniors centres, where many veterans live; recreational departments in cities and communities; and groups that get together on their own.

As an example of a group of seniors getting together on their own, my community, the city of Kamloops, has a seniors group that goes to the larger malls in the city prior to their opening in the morning. As a group of seniors, they walk the whole mall with no one in their way and go up and down the stairs. They have a very good social part to this as well as the physical activity part of it.

There all kinds of different ways. My husband, who is not yet a senior—he would shoot me if I said he was—goes to something called a boot camp. I personally thought he was crazy when he and my daughter started going to this together, but the difference in his well-being and the way he feels since going to this boot camp has been tremendous. It's a group of exercises done in a group setting. He is the oldest member of his group, but he's benefiting from this tremendously.

I was also listening when Mr. Valley was concerned about outlying areas. If you don't live in a city you don't have access to a Y, perhaps, and maybe don't have access to a large mall that you could use at no charge. I'm sure in some parts of Canada this is still the way it is.

But do you recall ever seeing one of the mobile van units that used to go around as libraries to smaller communities that didn't have the facility of a library? That might be something worth exploring as well: having a mobile unit that has these physical trainers, if you will, go into remote communities and produce these kinds of programs. In that event, maybe the veterans organizations in those communities could take over, once they had learned to do it.

I was listening, and these are just thoughts coming out of my head. I will leave the balance of the time for you to answer, and if there is any time left over I will pass it to my colleague, Mr. Shipley.

[Mark Speechley]

Thank you very much.

I forgot to mention the Royal Canadian Legion, which was absolutely essential in this project. The funding came from VAC and Health Canada, but the Royal Canadian Legion was our partner. They were extremely supportive. I should have mentioned it. Thank you for the opportunity to acknowledge them for their support.

I agree with you one hundred percent. There are all kinds of fall prevention and physical activity opportunities out there. But as Clara and I were talking about on the plane, for the younger older adults, who are basically no different from any of us, except they're a little older, the malls are fantastic, and they don't need supervision.

We're concerned about the frailer adults. I think there are well-meaning people in senior centres and church basements where exercise classes are offered, but if the person doesn't have proper training, one can actually do more damage than good. A person can get into trouble pretty quickly with cardiac problems or falls. The Centre for Activity and Aging is actually known for training physical activity instructors.

In terms of the remote areas, I don't have a solution. It's a big challenge, and I sympathize with you.

There is the home support exercise program, which can be done in your chair in Kenora as well as it can be done in your chair in downtown Toronto. Getting the videotape to Kenora isn't a problem. Having a person fly in to give the instruction isn't a problem, but someone has to pay for that plane ride.

I don't know the answer to getting supervised exercise classes to remote areas. We wrote a grant to try to do that with a mobile unit and it wasn't funded.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

I've changed my mind. Mr. Shipley is used to that, so he's going to let me have the rest of my time.

There were other things I read as I was listening to you. You were talking about muscle strengthening, which is obviously a benefit to anyone, no matter what age you are. You were talking about balance training. I would agree with my colleague that a lot of veterans suffer from balance problems because of injuries they've had during their service. If you have an inner ear problem, or you have a tendency to develop inner ear problems, you're going to have a balance problem.

The other thing that really wasn't mentioned—and this comes from my background prior to being an MP—is the medication. A lot of seniors are taking more than one medication for more than one problem, and that is true for veterans as well. Sometimes the integration of two medications can cause problems that might make a person lose their balance, or fall.

This goes back to what I was saying earlier. If we're going to have a solution to the problems of veterans or seniors falling, it's going to take cooperation from a number of bodies. It will not work unless one of those bodies happens to be the Canadian Medical Association. Physicians are in the best position to give advice to their patients who are seniors, whether or not they're veterans. That advice is usually heeded by seniors. If their daughter who happens to be an exercise guru were to tell them to do something, they may not heed that as quickly as if it came from a physician.

I think we have to have the province and the federal level onside with this. We have to have the physicians onside with it. We have to have a lot of people onside with it. We might even be able to find willing partners in insurance companies.

Thank you.

[Clara Fitzgerald]

I think what your question and comments speak to very eloquently is that a one-size-fits-all protocol for veterans is not a model that will work effectively for everybody.

To identify the risk factors that are reducing independence for these veterans, whether they're living in community-based care facilities in various communities throughout our country or they are older people who are primarily homebound, I think it's important to address the risk factors that potentially contribute to their dependency and create appropriate programs they could benefit from. If the falling is happening because of a hearing issue, then maybe that hearing issue needs to be addressed. That's not to say that the physical activity intervention won't still benefit that veteran; it certainly will. But we have to take a look at the primary causes that are causing dependency and chronic disease in veterans.

[Mark Speechley]

If I could, I'll speak very quickly to the medication problem. I agree that it is a major problem. We identified it as one of our risk factors. We notified family doctors that their patients were on eight medications and asked if they could please review them. In many cases, the doctors reviewed them, and the patients were still on eight medications.

In Dr. Campbell's work in Australia, he did a clinical trial in which he actually reduced psychotropic medication--tranquilizers and barbiturates. He had a huge reduction over one year, and that was a successful trial. Unfortunately, at the end of one year, they were right back where they started. It's a really tough thing.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now we're on to what's known as the five-minute round, so everybody gets five minutes. There is no seven-minute business.

Now we're over to the Liberal Party. We'll have Mr. St. Denis for five minutes.

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

Thank you, Mr. Chair.

Thank you, Ms. Fitzgerald and Mr. Speechley, for your help today.

First, if I could ask Ms. Fitzgerald, you made reference to an example of a veteran who came to see you. It had something to do with there being no cost. I don't need to know anything confidential, but what were the services you were able to provide? I'm not sure that you mentioned that.

[Clara Fitzgerald]

The service he was seeking was to take part in a chronic obstructive lung disease exercise program. The veteran had chronic obstructive pulmonary disease. The program was not led by a physiotherapist. The program was led by a kinesiologist and other allied health professionals. The programs funded and recognized by the VIP are ones that are led by physiotherapists or are medically supervised. We had to make the case that the program being delivered was evidence-based. We were fortunate, being a national centre that does its own research and that benefits from the research others do, that we were able to make the case.

The question would be whether a similar veteran in another community who was trying to access a similar program would be declined because it was a health promotion initiative and not necessarily a rehab initiative led by a physiotherapist.

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

Thank you for that clarification.

I'll continue. Presumably, other sorts of--I'm not calling that non-traditional--non-central remedies, including non-traditional medicines, like acupuncture, would have a difficult time being covered under VIP. For the record, that may be something we want to pursue.

I'd like to talk about the gateway concept. Based on the evidence I've heard, if I could fix one thing only, it would be access by the veteran and being carried through the system--the continuity. It almost seems like you have to assign an expediter, a helper, an ombudsman--

[Clara Fitzgerald]

A health navigator.

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

Yes, you need a travelling companion for every veteran to walk him through the system. Not only are there the general limitations of age, but you may have added to that literacy issues, and the list goes on.

In fact, this example you gave is part of that. There's discontinuity for everybody else. In the example you gave, you were able to help that veteran.

I'm just wondering if either or both of you could talk a little bit about the continuity issue. We could have the best programs in the world and the most devoted and dedicated program officers and officials and professional care personnel, but if we can't get them from A to B to C efficiently and on a timely basis, we miss the benefit. I'm wondering if you could talk about that a little bit, if you have thoughts on it.

[Mark Speechley]

That was my reading of what the VIS program was designed to do, and that's why I was so positive when I saw that. I would just like to see it evaluated. It's easy to say we want to have continuity of care, but if you get caseloads that are too large, or if you don't have a rapport between the case manager and the veteran, then these things aren't going to work.

[Clara Fitzgerald]

As well, you can make the recommendation, but then if the person is not following through on the service, you can't evaluate that service as not being appropriate; it's that they never took part in the program. They didn't take the medicine or whatever the case might be.

Something to consider, which I just thought about as you were asking your question, is perhaps something like a travelling journal. The person is in the know on their health status, and as they navigate the system, the journal is on the journey with the veteran. That way we're better able to track the programs and services that have actually been attended by the veteran. That is something perhaps to consider--something that travels with the person--because it is impossible for all of the various health care providers to be in the know on what's going on with this person, and when you're reinventing the wheel, it's very difficult to do. If there were something like a travelling journal that follows a person, that might be--

[Mark Speechley]

We did that with hip fracture patients, and it worked great.

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

Yes--a bureaucracy positioning system, which could literally say where Mr. Smith is this week in the system.

[The Chair, Conservative, Rob Anders]

There you have it.

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

Mr. Chairman, as a point of information, Mr. Speechley has referred to VIS, and I just want to make sure there isn't a program I don't know about. Is it a different program, or are we referring to VIP? I just want to clarify that.