Veterans Affairs Committee on April 1st, 2008

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

Thank you.

[The Chair, Conservative, Rob Anders]

I don't normally do this, but I'd like to quickly interject on the question that Mr. Stoffer raised. And I just want some thought on this, not speeches per se.

At the end of the U.S. Civil War, the State of South Carolina spent 97% of its entire budget just paying for amputated limbs. So when we raise the question of legal liability for the services of people on behalf of their state or their country, we sometimes have to be mindful of the implications of that—for whatever that's worth, sir.

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

If I may interject, the reason for it is that I have asked before for the clerk to get the minutes of that public accounts meeting out to all of us. The senior military personnel said that this is an issue they would look at. They didn't reject it; they just said it's something they would look at.

[The Chair, Conservative, Rob Anders]

I understand it's urgent. It has implications above and beyond.

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

I know. That's why I said Defence.

[The Chair, Conservative, Rob Anders]

Okay. Now we're going to head over to the Conservative Party, and Mrs. Hinton, for seven minutes.

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

Thank you, Mr. Chair.

Thank you for coming, Helen, and thank you, Captain, for your service to your country. You've been tremendous moral support to your wife today, and I am sure she has been tremendous moral support to you as you've done your job for our country. It's nice to see.

I've been making a number of notes. I listened quite carefully to what you were saying. I certainly have heard from other witnesses regarding a manual or handbook. I think that's actually a very good idea, and it's something that as the veterans affairs committee, we could certainly put forward .

The other thing you mentioned that has to do with treatment of veterans, which is what we're really here about, is that you'd like to see an exclusion of travel time from the number of hours allotted for treatment. That seems like a reasonable thing as well, because if you're a therapist and you have to travel an hour and a half to get to that veteran, it shouldn't come off his occupational time. So that's something we could certainly have a good look at here.

You made some other comments today, though. Let's go back to the medical discharge, someone who is medically discharged from the military, because that person is truly a veteran. That person has been medically discharged, so now we have a problem that we have to help them with. And they're going to move—I'm using your example of the move to Manitoba.

Is there anything standing in the way of a veteran's gathering his medical treatment plan from his current therapist and asking the therapist for a recommendation to another therapist in the new community? Is there anything that prevents that from happening?

[Helen Gough]

No, but I believe the rapport needs to be built before that. There needs to be something before they get there. What's to say it's not going to fall through? What's to say there is no occupational therapist? When you have a mental illness, organization and motivation and those types of things that we take for granted don't necessarily happen. Also, there might be anger in the home. There may be stuff.... I'm sorry, I'm not speaking very eloquently. There might be issues that keep them from reaching out to services on their own.

That would be great. Have a nice little piece of paper with all their treatments and everything, walk in and hand it to an OT, hand it to a nurse. That would be great, but that step does not always happen.

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

We're talking about two different things here.

[Helen Gough]

Okay, sorry.

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

From my perspective, anyway.

You're talking about someone with a mental illness as a result of service, and I was talking about someone with a physical illness. So in the case of someone who is going through physical therapy of some description, I was wondering if there is anything standing in the way of their getting their medical information and a recommendation from their existing therapist to get one in a new community. That's where I was going with that one.

[Helen Gough]

Yes, that's possible. I think that's happening now. Whether or not there's consistency, I'm not sure. Whether they actually go there and get the therapy, I'm not sure.

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

Okay, but going back to what we're looking at in this committee, we're trying to make improvements to the veterans independence program and to veterans' health care in general. As an occupational therapist, can you elaborate on what kinds of services you do provide to our senior veterans?

That would be one question.

And do you believe that occupational therapists are provided with enough knowledge about Veterans Affairs Canada programs to be able to help veterans as they are treating them?

[Helen Gough]

I'm going to answer the second one first.

I started with Veterans Affairs in September, and I honestly can tell you that I had very little knowledge as a private practitioner to understand the system very well. And because I'm one of these crazy people, I went out and made a point of gathering as much information as possible. I feel that it's very convoluted. I really had to pull everything together, and I still don't know if I have it all.

I'm talking just about my little role as an OT and what I needed to do, so I don't even really understand the larger scope of it. I don't know what the rehab team does. I don't really know what nursing does, or the health care team. I can't speak to them. They're excellent. They're knowledgeable and they're accessible. That's definitely a kudo to the VIP program, because I have a direct line to them. But I really didn't feel that I had something that told me what was being offered.

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

So if you're going to work for Veterans Affairs Canada as an occupational therapist, you think there should be more information given to that person.

[Helen Gough]

Yes, policies, vendors lists, area counsellors' numbers.

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

That's fair. That's actually a very helpful comment.

In one of the other comments you made earlier, you said something about knowing in advance that a person is going to be released. You know months in advance in the military that you're going to be released. I agree with you on that. You would know that you were going to be released from the military in advance. But with a military injury that happens while the now-veteran, then-serving member is in a war zone or on peacekeeping, or whatever it happens to be, there isn't any way to know in advance that the person is going to be injured.

That was just a point, when you were talking about advance notice. It's going to be very hard to touch all those bases.

I didn't get an answer from you on the first one. As an occupational therapist, can you give us an idea of what you do for the veterans?

[Helen Gough]

I'm given an excellent occupational therapy assessment through the Internet, through the web-based Internet, from Veterans Affairs. The assessment form they provide us is absolutely excellent. It covers all areas of everyday life and is very client centred.

I just want to comment that, specifically on the Veterans Affairs assessment, it asks, what are the veteran's wishes and what is their perception of the problem? That's an excellent question to be on there, because it really allows me to start right from scratch with the veteran.

So I walk in and introduce myself, and they usually see me as a little girl and they have trouble taking me seriously for about 10 minutes. After we get over that, I go through their health concerns. I do a physical assessment, I do a mobility assessment, I do a power mobility assessment if that's what they're looking for, and I do a home safety assessment to decrease falls. Those are the types of self-care stuff that I'm looking at.

Occupational therapists, however, can do more than that. That's a very traditional role, a very prescriptive role, but we can do more than that.

I just received a referral for the first time to do pain management with a gentleman who is a veteran, who I believe is in his early eighties. That is something that not very many occupational therapists and the physician get to do. It's something we are able to do, but typically in the VIP program we don't get the opportunity.

I feel that occupational therapists can be used with veterans, senior veterans, in a leisure mandate as well. A lot of these veterans are restless. They lose their spouse. They're sitting at home. They don't sleep, because their bodies don't move. They don't sleep, because they're worried. They're used to bringing their wife to the hospital all the time and they had this role, but they don't do it anymore. So occupational therapists also look at leisure areas and recreation, and I think that should be expanded upon.

We also look at environmental barriers. A lot of these veterans would love to leave their house. I give them a scooter, power mobility, and they love it. But then they can't get to the Legion, because the Legion doesn't have a ramp that goes up.

Well, the cool thing about occupational therapists is that if we had the boundaries to open it up for us to assess the community where this veteran wants to go, we'd be able to allow them to access these recreation places. Then we can provide our recommendations, give them to Veterans Affairs, and hopefully they can be an advocate for their own people and say, “Hey community, hey MP, this is what we need changed in our community to make it more accessible.”

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

If we could bottle your enthusiasm and sell it, we'd all be rich. Thank you very much.

[The Chair, Conservative, Rob Anders]

That's true.

Now we'll go on to what we call our second round. You've taken care of all the parties now, so in the second round everybody just gets five minutes rather than seven.

We'll go again to the official opposition, the Liberal Party of Canada, and Mr. St. Denis, for five minutes.

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

Thank you, Mr. Chair.

And thank you both for being here today.

I think what might be throwing some of us off in terms of trying to understand the very good work that you and others in your field do is the words “occupational therapy”, because I think we think of it in a different context.

If you had to choose another name or words to describe what you do vis-à-vis veterans, still being occupational therapists, how would you describe yourselves? We've heard about the buddy system, assigning another, maybe younger, healthier veteran to work with an older, not-so-healthy veteran, to kind of be a guide through the system. It seems to me you're professional helpers.

How would you describe yourself, not using the words “occupational therapist”? That's a technical designation.

[Helen Gough]

Right now I have a very traditional role. As an occupational therapist, I work with safety in terms of breaking down barriers, more environmental barriers, so they're safe in their homes. They live there as long as possible, and they love Veterans Affairs because of that, but I'm thinking there's more to it, as I was mentioning. So unfortunately I'm a safety officer right now, but I think it's more than that—if that makes any sense.

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

When you start out with your training, is it more general than what you are being called upon to do vis-à-vis veterans?

[Helen Gough]

Absolutely. I'm excited to do more. I feel I have more training to let me do more than what I'm doing.

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

So where's the limitation? It would seem to me that leaving aside the issue of how much it would cost to have occupational therapists right across the land--and in an ideal world that would be great, to use your words--there is the limitation from the Veterans Affairs side that says you're assigned to a veteran, Mr. Smith, and you're limited to so many hours or so many visits, that this is all you can do. Is that what it comes down to?