Veterans Affairs Committee on March 4th, 2008

[The Chair, Conservative, Rob Anders]

My goodness. Thank you very much.

We'll go over to Mr. St. Denis, with the Liberal Party of Canada, for five minutes.

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

Thank you, Mr. Chair.

Thank you, Dr. Gutman, for being here. It's very interesting.

I was late because I was visiting with a delegation from the Canadian Medical Association. They're doing a lobby day today on the doctor shortage. I'm not sure if my colleagues have met with the delegations as well.

You mentioned the importance of training more geriatricians. One of the interesting points they raised was that many students going through post-secondary incur student debt. According to the figures they provided, the average medical student leaves medical school with $158,000 of debt.

So when you're looking at becoming a family physician or specializing, for the average person, cashflow becomes an issue. When choosing a field, if you have the intellectual capacity and opportunity, you may choose a field in which the income stream would be higher, allowing you to deal more effectively with the debt.

I'm going to guess that maybe geriatricians aren't on the high-income end. You mentioned income. We're humans, and taking care of our families and having a certain lifestyle are important for most people. So their suggestion was that we have to somehow weight the debt load as a sort of national priority, or do something with the cashflow so that medical students are making choices of a sub-profession based on their interests, their special loves, and the needs of the marketplace, as opposed to their own cashflow needs.

I'm wondering if you have any comments on general levels of compensation for geriatricians--because I'm sure there's a shortage--vis-à-vis professionals in other fields of medicine.

[Gloria Gutman]

I would think we should be thinking about offering some incentives and some bonuses to those people who go into geriatrics, because this is a service that we need.

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

Okay, fair enough.

In another vein, a witness who appeared a few meetings ago mentioned age-friendly communities. And of course there would necessarily be an important health and medical aspect to age-friendly communities. I don't recall that they mentioned where, but they mentioned there were some pilot communities that, with Health Canada's assistance, had sort of developed some models of age-friendly communities. Do you know anything about those?

[Gloria Gutman]

Yes, I do. That's a World Health Organization project that was done in conjunction with the Public Health Agency of Canada.

A guideline document that talks about how to make your cities more age-friendly has been produced. That came about from talking with seniors in 33 cities around the world. That is available on the WHO website.

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

Okay. Thank you. That's very helpful.

It's something about which we were trying to get more information. I happen to represent a large rural riding, but one of our communities, Elliot Lake in particular, has attracted thousands of early--and is there such a thing as a middle-aged retiree, like in their sixties--and some older retirees to northern Ontario because of the modest cost of housing and clean air and so on. It is creating some unique challenges and opportunities for--

[Roger Valley, Liberal, Kenora, ON]

And it's a Liberal environment.

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

Yes, clean air. So thank you for that reference.

I'll conclude with one of the points you made. You talked about the application of senior-friendly technology and the integration of that technology in such a way that you didn't have one device for the lifeline hanging around your neck for when you fall, and another one over here for the lights. You mentioned the things they had developed for the first lunar landing.

It would seem that we have, within our grasp, fairly inexpensive options that we could integrate into one simple clutter-free, trouble-free device for seniors. Am I right in assuming that we need to integrate these things so that they control lights and contain something to answer a door monitor, if, for instance, someone says “Hello, it's your neighbour, Mary Smith”, and so they can lock the doors or unlock the doors, or turn on the computer so you could access, maybe through a video conference, a professional?

There must be ways to make it very simple. I know it would be helpful to me, and I'm not yet a senior.

[Gloria Gutman]

The integration is a little trickier than what meets the eye. I've been asking exactly the same questions as you have for probably the last ten years, since we developed the Dr. Tong Louie living laboratory.

The idea was that yes, there's too much independent technology and not enough where all the information comes in to one place. It is possible to do. There are some software engineers, biomedical engineers who are working on those products, but they still have a ways to go. Again, the idea is that if they can solve that problem and make the device that will do a whole bunch of things at once, all of us are going to want to buy it.

The incentives have to be there. We need to talk to our funding agencies to answer to CIHR, to the Institute on Aging, and suggest to them that they should be maybe having a few special competitions on the technology development side of things for assistive products. Traditionally it has been more difficult to get research funding for that area. There are groups around the world that are working on it, but the funding has been limited.

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

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now over to the Bloc Québécois. Monsieur Gaudet, vous disposez de cinq minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chair. Your French is improving, which is very good. Congratulations.

Good afternoon, Madam Gutman. My mother is 98 years old and she is living at home with my sister who will be 70. Sometimes, we wonder whether it is my sister who's looking after my mother or my mother who's looking after my sister. We are a large family: we were 12 children, 10 of which are still alive. We greatly value our family and we greatly care about it.

What I find elsewhere is that there seems to be a lack of caregivers. We do not want older people to be institutionalized in long-term care homes. However, it seems to me that we do not have enough personnel for home care. I would like to know your opinion about that. Why are governments saying that they do not have enough money? For me, that is one issue.

[Gloria Gutman]

It's a problem around the world that has been caused by the drop in the birth rates. Around the world young people are having far fewer children than they used to have. So there is a much smaller supply of family to provide for older people. If anything, that says to us that there needs to be investment, there needs to be development of the home support industry. If we don't have a daughter, a son, or grandchildren to look after us, then we hope there will be a supply of paid labour to look after us.

Much of the home care around the world is being provided by immigrants. In the Pacific Rim countries Filipino nurses have played a major role in support of older people. We certainly want to make sure that people who are coming into the country and who are engaging in this kind of work have the right kind of training and the right kind of personality. In general, we have been blessed by some very good immigrant workers who have come in and taken on the role.

We need to think about the quality of home care. We began to look at the quality of hospital care, but there has been less attention paid to the quality of home care. Some research has been done in that area on how to monitor home care and how to ensure there is a sufficient amount of supervision. Training is one thing; the second is the degree of supervision and oversight. Whether the government is paying for the service for those who cannot afford it or the individual is purchasing it in the marketplace, we still need to make sure there is sufficient oversight and regulation that the service is provided at a proper level of quality.

[Roger Gaudet, Bloc, Montcalm, QC]

I agree with what you are saying. However, when you say that there are not enough children, I agree with you, but the son or daughter who has only one living parent, the mother or the father... Admittedly, some do not have any children.

It seems to me that our governments, both provincial and federal and even municipal, are not giving any help to families, be it some social benefits, tax credits, or municipal taxes exemptions.

Whether it is in hospitals or in long-term care centres, there is no love for the people. The attendant comes in in the morning and he has only 10 minutes to wash a client before moving to the next one. There is no love such as there would be if they were living in a house where people take the required time to care for them. It seems to me that our governments should perhaps give more help.

[Gloria Gutman]

We need to make sure policies are in place to encourage those family members who are capable, who are loving, and who are wanting to give service to be able to do so and not at such a high cost that they resent doing it.

For example, there are people who would like to stay home and look after their parents, but if they don't work in the marketplace...you know, they need two incomes for the family to survive. So we have to make it possible for family members to be able to be paid, and there are some programs that will in fact enable that. It has to be family that is somewhat removed—it can't be your daughter or your son—but it may be possible to employ a nephew or some other family member. Particularly in rural communities where there aren't outside workers, we maybe need to think about those kinds of things.

You want to be able to put safeguards in place so you don't have people who are taking on the job to exploit an older person, but rather, where they do have the skills and they are the only ones around to support them, to make it possible for them to do so without ending up in the poor house.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you very much, Madam.

Thank you Mr. Chair.

[The Chair, Conservative, Rob Anders]

Thank you.

Now over to Mr. Shipley for five minutes .

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

Thank you, Ms. Gutman, for coming. It's actually been very interesting.

You made a comment earlier about individuals who often are institutionalized, whether that's into hospital or the homes where they actually rely totally on other services, and lose their independence not necessarily because they want to, but it just happens. I think because of that, clearly, we've tried to and want to put things in place for independence, hence the VIP.

One of the things you talk about, and we have had a big issue with, obviously, is getting professionals. We've tried to do a lot in our budget, and in fact we've increased post-secondary education by 40% to try to entice people to get further education past secondary school. In saying that, when we look for professional services and home care services, quite honestly there is another element to it, that likely those services are rather non-professional but essential. I wonder if I could get your thoughts on it, because we hear a lot about what the government needs to do. Could I get some thoughts about what we can do to have people help people?

There are organizations—and I was at one last night, actually, called NeighbourLink—where there is an outreach to community by the young and the old to help people. I'm wondering if you have suggestions or thoughts on how we could expand those types of services, rather than always just forking government dollars out to hire people, when we actually have a growing demographic of aged people who are retired but healthy, who actually want to be doing something.

[Gloria Gutman]

For those seniors who do want to engage in helping other seniors, there are a number of vehicles. There are seniors centres and some programs that are run through seniors centres. There are some service and demonstration programs that have been done around the country, intergenerational programs and so on. I would agree with you that yes, we could and should expand on some of those programs to take advantage of those seniors who are able and willing.

Part of the problem is the stereotyping, that we tend to think about seniors as being old and frail. But there are lots who are not old and frail. I think the change in our policies about mandatory retirement may help to change some of the attitudes, to recognize that seniors can and do wish to contribute and to continue to do so.

Some people want to continue working in the paid labour force. There are others who are happy to be in voluntary roles. You have to get the right fit and get people matched up in the right program.

It's interesting that right now in British Columbia, where we have the Olympics coming, VANOC has partnered with the ministry that deals with seniors and has been doing the active ageing program to talk about how we can get seniors to be volunteers for the Olympic movement. The first question that we asked: Which seniors? Of course, those who have been athletic all their lives are going to be the ones who will most likely be chosen to fill these positions. But are there spinoff benefits that we can get from associating things like the Olympics, which are high-profile and very positive kinds of images, to feed back into the community so that other people will get on the bandwagon and use that as a vehicle for expanding the areas in which people volunteer?

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

I will go on to a different topic, if I still have time.

You were talking about safe and familiar environments. I know my colleague has brought this up in terms of the design of buildings and what have you, because there are certain provincial codes. There's a limited number who go into hospital; there are more who actually go into retirement homes, seniors homes, where they're still active, before they hit a nursing home.

Do you have much input or are you asked about things designed--going beyond provincial codes--that would encourage activity, encourage those to have access to equipment that is good for them to be using?

[Gloria Gutman]

We do get asked about that. It tends to be the for-profit developer who is the one who asks those questions, mainly because on the non-profit side, while they would like to do some of these things, the first thing that gets cut when it's budget time is anything that is above the basic building code, unfortunately.

The other question that you always want to ask is whether this design option or this equipment has actually been tested with real people. There are all kinds of high-end assisted living facilities in the States that have these fancy equipment rooms and all kinds of products--exercise machines and so on--that the kids think are great, but that the old people don't really use. You want to make sure you're investing in the kinds of equipment or products that will be used and will meet the needs of older people.

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

I think I'm about out of time.

Thank you.

[The Chair, Conservative, Rob Anders]

We have a space here that you can come back to.

Now we have Mr. Valley, from the Liberal Party, for five minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

I have one quick question. I want to thank Ms. Hinton for the advice on my mother-in-law. I just want to make sure everyone knows that I want my mother-in-law safe and healthy so she spends most of her time at her own home.

You mentioned the institute for the aging, research funding. Does Veterans Affairs fund studies on aging veterans to see if their needs are different? We know that some of the problems veterans have come from their hearing loss. So they have special circumstances. I'm wondering if Veterans Affairs does any funding for those institutes.

[Gloria Gutman]

I think it has partnered with the institutes on some projects. This is another area you might want to explore a bit further. I can't give you dollar values or tell you about specific funding programs, but certainly that's a vehicle. You want to find out the special needs and see whether they are being met.