Veterans Affairs Committee on April 1st, 2008

[Helen Gough]

It does, pretty much. The health care team is very accommodating in giving me more hours if there's a more complex case. Without hesitation, they trust me and what I'm doing. If I say this veteran needs a little bit more time, he's having some cognitive limitations with power mobility, we can assign him a rehab assistant to train him on the new power device, for example, which is pretty complicated for someone who's 91 years old.

So we have flexibility, and it's excellent. I've never been declined more hours, but I don't believe the travel time, for example, should be considered therapy time.

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

So there's still a gap. Notwithstanding your good intentions in a given case, there are limitations.

Are you permitted to train a child of this veteran who lives nearby, a spouse, or a volunteer to take on some of the less technical work that you do, after you're finished? Because you get a budget allocation, either in hours or per veteran, are you allowed to train somebody to take over?

Let's say it's a literacy issue. They don't understand the forms they get in the mail. Are you allowed to—

[Helen Gough]

That wouldn't be my area. I know the area counsellors are good advocates for that type of thing, but that is a huge barrier I see with my veterans. They will ask me on a number of occasions to help them fill out their forms. They cannot see. I cannot call them on the phone. When I call them, they do not understand what I'm saying. Can you imagine me giving them a 1-800 number? That doesn't work.

But training someone else to do my job? Maybe I'm a control freak, but I wouldn't allow someone else to do that. I like going in. I like making sure I do my follow-up, making sure the equipment is installed correctly, that the easy-lift chair or the power device is still working. And then if there are any outstanding questions and my case is closed, the area counsellor can always follow up.

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

Could any of the work you do or some of the gaps that you see need to be filled that you can't do—because you're there and you're seeing these gaps—be solved in some instances with a video? Through the Internet, if they have access to broadband, webcams, and so on, is this a possibility? Or are we dealing with clientele—

[Helen Gough]

I see what you're saying. So you would be able to talk someone through a routine assessment?

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

There are certain medical programs through which seniors are checked on several times a day. They have to go to their computer and they have quick access.... Anyway, is there a potential—

[Helen Gough]

That's interesting. I had not thought of something like that, but that is definitely something I would look into to find out more about it.

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

The suggestion is yours.

[Helen Gough]

Maybe I'll put that down in the long brief I gave you. Do you need another page?

[The Chair, Conservative, Rob Anders]

Thank you.

To Mr. St. Denis, there's lots of space in here, so she should have plenty of opportunities to follow up with these solutions.

Now on to le Bloc Québécois avec Monsieur Bouchard pour cinq minutes.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chairman.

I would also like to thank our witnesses.

If I understood correctly, there are not enough therapists to look after veterans. This is a known situation. I also gathered that veterans do not always receive treatment which is appropriate for them. Is this an organizational problem or is it due to the lack of professionals available to treat veterans?

[Helen Gough]

I'm sorry, but are you asking if some veterans are receiving inappropriate therapy? That's how I understood it, sorry.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

In your presentation, you said that some people do not receive appropriate care. That's what I gathered from your presentation. Is this an organizational problem or is the lack of treatment due to the shortage of professionals?

[Helen Gough]

I believe it might be organizational.

My example is that I didn't know where I was.... No one followed me, so no one knew where I was, and no one knew where he was posted. We're posted to Kelowna, but his medical system, for him to go to get his teeth checked, is in Chilliwack, and his.... You know, some people don't have a veteran that.... By the way, when I use the word “veteran”, I mean people like my husband as well. So I'm using that word interchangeably. As I mentioned, there are different types of veterans, in my mind.

So I think it's an organizational problem. If we could track people on these frequent moves, these constantly changing situations these veterans are experiencing, and if they could be watched when they are suddenly released, as she mentioned—because they're in a unique position—then I believe they will get the right care.

I don't know if this is answering your question, but I do believe it's cultural too. I tried to find services on five occasions; I actually went to counsellors five different times. I'm telling you that I really believe that if they understood what the culture was like.... I actually had one counsellor tell me to quit school and to go home. I had another counsellor tell me that I was overreacting, because I broke down about the training of a military soldier who had been killed on a base. One of the counsellors told me she was horrified by the number of times a rocket attack hit my husband's base when I was on the phone with him and a communication lock-down was happening. Those are things I had to deal with. She was horrified, and she couldn't help me with them.

People need to realize those things. I really believe they need to understand that these are things I deal with; for 10 months, these things were constantly happening. So I think there are special circumstances that clinicians need to understand about who we are as military spouses, which I speak as right now. So if people had been tracking me....

So it's an organizational problem, and it's also just cultural.

Hopefully that answers your question, sir.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

I have another question for you. You have been involved with the military and you currently work as an occupational therapist. Do you believe that the current culture within the armed forces leads members who are physically or psychologically injured to quit the military?

I have an additional question. Should CF members who have been physically or psychologically affected be encouraged to do something else within the armed forces? In fact, this might be a better kind of therapy. Further, if these people were integrated into the regular forces, it would reduce the number of veterans.

[Helen Gough]

Occupational therapists have the ability to assess the functional ability of a person. You can be certified in functional capacity evaluation, which looks at different components, psychological and physical, of people who are injured psychologically or physically. Once you break that down, you can find out what their capacity is, whether that be physically lifting and moving or whether that be how much of an attention span they have to read a book or be on the computer. Occupational therapists can provide this to soldiers--and they do right now, as third parties--to find out what it is they can do.

If soldiers have decided that enough is enough and that they need to get out, that they can't handle the military, then there is the VAC rehabilitation program. I don't have the specifics on that program, because I'm not involved in it. If they've decided that they want to stay, it is possible that occupational therapists can assist with finding an occupation within the Canadian Forces that is meaningful to them and that they and their families feel is safe and secure and fits their physical needs. If they have an amputation, maybe we can assist them and bring them up to a level so they are able to....

We also have to keep in mind the mandate of soldier readiness. They have to be prepared to go into combat. What that means I don't know, but of course I'm an enthusiastic person, and I think we could probably get them to that level. But we have to keep in mind that they need to be combat-ready. If they're not, then they put other people at....

[The Chair, Conservative, Rob Anders]

You can go on as long as you want.

[Helen Gough]

You don't want to give me that.

I think there are places in the military for them, if they find that meaningful. We can't just provide them with some desk job that they're not going to be happy with.

[The Chair, Conservative, Rob Anders]

Thank you.

You got good value for money there. You had five minutes but went to eight. That's pretty good.

Now we're going back to the Conservative Party of Canada. We'll have Mr. Shipley for five minutes.

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

Thank you, Helen, for coming, and your husband also, for what you are doing.

You mentioned being enthusiastic, which is a bit of fresh air but is also a bit of an understatement with respect to what you must apply to your patients, to the people you meet. You need to know that even though we have professional training, the attitude and enthusiasm an individual brings into the home counts so much. I would say to you that you would be a great therapist to have in anyone's home to help, aside from the professional part of it.

[Helen Gough]

Thank you.

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

I'm trying to understand the overlap between an occupational therapist and a physiotherapist.

[Helen Gough]

Do you want to know the difference?

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

Yes. Where is the overlap, or is there one? I think there is. First, I'm trying to understand what the difference might be. Second, what are the benefits of some of those overlaps in terms of the integration that we may have? Right now we have occupational therapists for veterans, but not for the Canadian Forces in our corps of defence. I'm trying to understand a little about the overlap between the two, if you can help me.

[Helen Gough]

Occupational therapists can look at and bridge the psychological and physical limitations of a person. They do quite a bit. Physiotherapists and occupational therapists overlap slightly. They can overlap quite a bit on the physical component. But what we're able to bring to the table is the concept of taking in—it's a fluffy word—the holistic view of a person, including the family. They look at the psychosocial aspects and the cognitive and mental disabilities people have.

Physiotherapists are specialized, and they're excellent. They have been part of the Canadian Forces since, I believe, 2000. They've served in Bosnia, helping soldiers. I think there was a pilot project done with that. They also provide ergonomics in the workforce. I'd like to know a little more about that and where that goes, because I know that occupational therapists also provide that service quite frequently.