Thank you very much for indulging me. It's much easier having some idea of who's who, where you're sitting, and that sort of thing. It helps a lot.
Again I would like to thank you for the opportunity to speak to the committee today. I hope to leave you with some recommendations, which I suspect you are already considering, and a sense of the long-term relationship that CNIB and the veterans of Canada have had.
The CNIB was founded in 1919, in particular to address the issue of war-blinded veterans coming home from World War I. Our original founder and executive director was Colonel Edwin Baker, who had been wounded by a sniper's bullet in France. He went through rehabilitation services in England at St Dunstan's and returned to Canada—he and many other young men—hale and hearty other than the fact that he could no longer see.
What was facing all of these folks in 1919 was going out on the street selling pencils, or being hidden in someone's basement. Blind people couldn't do anything. So it was institutionalization, homelessness, or something, but there was no good alternative. So the CNIB was founded partly to address that issue.
During the twenties and thirties in particular, the CNIB worked with Veterans Affairs Canada--the Department of Veterans at that point--to ensure that there were benefits in place for veterans.
Colonel Baker, as was described in his biography, made 30 trips to and from Ottawa, going to parliamentary committees to argue for an increase in war-blinded veterans' pensions. He was successful in 1926 at bringing it from $9 a month to $11 a month. In those days that was obviously an accomplishment.
In the 1930s, these young men were in their thirties and were also faced with the Depression. The CNIB helped to create employment across the country, as some of you will remember, by having kiosks, cigarette stands, and cafeterias. They created a plan that provided employment for people who were blind, including veterans. So that's where we started.
Today the CNIB is a much larger organization. We have 1,100 employees and 54 offices across the country. Although we still deal with veterans, we also deal with the larger population of Canadians with vision loss. We work on strategies to inform people of ways to prevent vision loss in old age by quitting smoking, eating green leafy vegetables--nobody ever wants to hear that, but it helps--etc. We also work with about 1,800 veterans across the country. Only 30 are left who were blinded in combat. The rest are people who have had age-related vision loss.
The CNIB provides a variety of services to help people maintain their independence or mitigate the emotional and social effects of vision loss. At this point our resources don't allow us to be long-term case managers of veterans who enter our system because they have vision loss. We struggle with even being able to inform them of all the benefits available. Persons with mild vision loss might enter our system and then develop a more severe vision loss later, but we don't know that, because they figure there's nothing to be done. This group is typically in their late seventies and eighties. They are frail, elderly people and often have other issues. That's the gap I will talk about later.
What do we do? Let me show you something to give you a practical example. We provide things like peer counselling and reassurance to people that they may have lost their sight but it's not going to be forever. We work with people and offer things like low-vision aids.
This is a rather large magnifier. It generally has batteries attached, a light, and that sort of thing. It looks a bit cumbersome, but it's a stronger magnifier than you're going to find at Wal-Mart or stores like that--this is five times. I'll pass this around.
So what's the big deal? Well, the big deal is that, by using this, somebody may be able to read his or her income tax form and fill it out. It may not be the most popular activity in the world, but it's essential. It's about independence, even if it's income tax. But it's also about reading price tags, reading the instructions on a pill bottle, and that sort of thing.
So along with that low-vision product, we provide the information and the support around common questions that people ask. Why are my eyes like this? What happened? Did I do something wrong? What can I expect?
We want to emphasize that Veterans Affairs Canada's health services for people with vision loss is a model for the rest of the world. I'm not just saying this to butter you up; it's true. Blind veterans of the United States and the European veterans associations have all looked to Canada in their development of vision health services for veterans. Nothing is perfect, but we're doing pretty darned well right now. I want to congratulate all of you sitting around this table who are monitoring, discussing, and reviewing what we can do better, because that's to our credit. We want to emphasize that although there are some gaps, generally speaking we have a pretty comprehensive program.
Our recommendations mainly have to do with how benefits are distributed, how health services are accessed by veterans. Therein lies the crux of the difficulty. Let me start by saying with absolutely no reflection on this committee—and I assure you I mean this sincerely—that the slowness of review of benefit grids or the ability to add products or new services to what is currently available, that review process, and the red tape that surrounds it, can sometimes can be very daunting and frustrating for all persons involved. I am not speaking in the larger political context, but rather of the process at Veterans Affairs, and I understand that this slowness can occur despite the best intentions of some of the most hardworking, competent, and dedicated bureaucrats.
So our first recommendation is the streamlining of the review of benefit grids. It's not good to make elderly people wait six, eight, or ten months for a new product or a change in a regulation that allows for more than one magnifier in a lifetime. These things are being resolved. We work very closely with program and policy folks at Veterans Affairs. Again, there's no lack of will, but there is some streamlining that could take place. We hope that this streamlining will result from your review and ongoing work.
With respect to our second recommendation, CNIB wholeheartedly endorses the report presented a year ago—to this committee, I believe—by the Gerontological Advisory Council, Veterans Affairs Canada.It was entitled “Keeping the Promise: The Future of Health Benefits for Canada's War Veterans”. This report says it far better than I'm going to be able to do today. It contains recommendations that would really improve the delivery of services for veterans, not only veterans with vision loss but all of them. Our second recommendation is to highlight one of the recommendations from that report, and that is to have case managers assigned to high-needs veterans. We would call somebody with vision loss a high-needs veteran.
So why? Why does this have to occur? In our case, for somebody with vision loss, there's a variety of obstacles: reading information, reading the manuals, reading just what the benefit grid allows. That sort of thing becomes a challenge. The other thing that becomes a challenge is the current set-up, in which a third party, Blue Cross, has a conflicting role in the awarding of benefits.
Blue Cross is the ultimate arbitrator of whether someone is eligible for a benefit, but they are also the body that is the appeal or the dispute resolution mechanism. So they have two roles. They're gatekeeping, which is essential because we need accountability. We are talking about taxpayers' dollars. Blue Cross is gatekeeping on the one hand and, on the other hand, resolving disputes, where perhaps someone believes they're eligible for something else and Blue Cross is going to arbitrate whether they are or they aren't. Blue Cross is a third party, audit type of mechanism that doesn't know the individual, that doesn't know the individual's situation, that doesn't know the nuances of the situation in the way of a case manager—even it were a Blue Cross case manager.
It doesn't matter who does it: Veterans Affairs, CNIB could do it for our clients, or Blue Cross could do it themselves. The recommendation is for a case manager who is able to assess the situation at the beginning and to be available as the situation might change. An example of a change is the person with vision loss. There may not be a problem with the veteran but with their spouse, who has been doing the reading or doing the driving and who may develop Alzheimer's. So that becomes a secondary issue. If a case manager is involved, they will know that in a situation like there is a benefit that already exists for additional help with housekeeping, etc.
It's very difficult to have someone in their late eighties trying to do that type of dispute resolution by themselves. Again, CNIB helps at this point, when we can, but we are not always able to, and we're not phoning people and proactively going out to try to help them.
So that is our second recommendation.
Our third recommendation is to again endorse what the report has already said from the Gerontological Advisory Council. All veterans who have served in the armed forces should be eligible for health services based on their health needs rather than their status. It becomes complicated whether someone served in this theatre, etc. As you all know, I'm not going to tell you what you already know about eligibility requirements and levels of service availability right now depending on types of service. It would enormously simplify some of the red tape if we just went to a veteran who has served in the armed forces, perhaps served in a theatre of war or perhaps not, but that would be a discussion for another day, and that person then becomes eligible for the available benefits.
Those are the three recommendations we have: streamline the red tape around determining new benefits, adding to a benefit grid or taking something off, which is also possible; second, a case management system, monitored or administered either by Veterans Affairs Canada themselves--in our case, CNIB with our clients--or by Blue Cross, it doesn't matter who, as long as there is some process in place; and last, that we eliminate the levels of eligibility for services.
Bernard, do you have anything to add?