Thank you very much.
I am actually here representing NICE, the National Initiative for the Care of the Elderly, of which I am a member. I am a psychologist, and I work at a veterans care program in London, Ontario, at one of the large priority-access-bed facilities in Canada.
The National Initiative for the Care of the Elderly is an international network of researchers, practitioners, seniors, and students dedicated to improving the care of older adults in Canada and abroad. NICE is funded through a new initiative grant from the Networks of Centres of Excellence.
Our members represent a broad spectrum of disciplines and professions, including geriatric medicine, nursing, social work, gerontology, rehabilitation sciences, sociology, psychology, policy, and law. We promote and facilitate interdisciplinary collaboration between and among researchers and practitioners to improve the care of the aging population in Canada and elsewhere.
The overarching emphases of NICE are networking and knowledge transfer--that is, getting good research into practice.
NICE has three overarching goals. The first is to help close the gap between evidence-based research and actual practice. The second is to improve the training of existing practitioners and geriatric educational curricula, and to interest new students in specializing in geriatric care. The third is to effect positive policy changes for the care of older adults.
With that as the background of who it is I'm representing, I'd like to provide some comments from NICE for the committee.
NICE would like to compliment Veterans Affairs Canada on the thoughtful consideration of aging issues that is reflected in the work of the Gerontological Advisory Council's report, Keeping the Promise, and in the veterans health services review. To further this good work, there are three specific issues that NICE would like to bring to the committee's attention.
First, we note that several of the issues of concern to NICE--in particular, caregiving, dementia care, and end-of-life care--are easily identified in the work to date. NICE has also identified elder abuse and mental health as priority issues for improving the well-being of older adults.
Mental health is an underserved focus in health care for seniors. This is evidenced by its prioritization within the NICE thematic framework as well as by the coming together of the Canadian Coalition for Seniors' Mental Health--another organization that I am a member of and have been on the steering committee of--specifically to advocate for improvements in this aspect of care for older adults.
Mental health is a critical component in any broad-based health promotion strategy. It's well known that poor mental health has implications for the ability to access, assimilate, and derive benefit from interventions that aim to enhance, maintain, or restore independence, that aim to improve functional autonomy, and that promote quality of life.
So mental health problems and illnesses are not well served by home care programs in general. We hope that appropriate attention will be given to the promotion of mental health in any changes to the veterans independence program that result from the committee's deliberations.
Second, we applaud the committee's interest in making services under the veterans independence program available to a greater number of recipients. We agree that the services provided should be based on assessment of needs. We note that the evolution of needs across the lifespan is an important consideration. An effective and user-friendly monitoring process will be essential to ensure that the provision of services stays current and timely.
We suggest that the inclusion of older adults in the process of developing and implementing monitoring will be essential to its success. Routine monitoring that is triggered by the passage of time is important, but even more important is the realization that health status can change rapidly for seniors, especially for those with a more tenuous hold on their independence. The needs-based assessment protocols that are developed should encourage self-monitoring and user input in the face of significant change on an ongoing basis. We would suggest that expertise in knowledge transfer and networking should be accessed to develop creative, state-of-the-art approaches to shared care in this context.
Third, we agree with the goal of supporting a range of residential care options for seniors, and agree that efforts should be made to encourage and enable older adults to reside independently as long as possible.
We note, however, that there is a risk in conceptualizing long-term-care homes as the residences of last resort. This has the potential to exacerbate the stigma already associated with this residential care option. For many reasons, a substantial number of veterans and other older adults need full institutional care if they are to survive. It has been said that a society can be judged by how it cares for its most vulnerable members.
Communication and advertising about changes to the current system should not suggest that those veterans and families who do not need long-term-care placement are somehow more successful than those who do. We also note that it will be important to ensure that the new emphasis on health promotion and innovative service delivery is as valued for those who reside in long-term-care facilities as it is for those who remain in their communities.
Thank you for the opportunity to present these views to the committee.