Veterans Affairs Committee on Nov. 20th, 2007

[The Chair, Conservative, Rob Anders]

Good morning, ladies and gentlemen. Welcome to another meeting of our Standing Committee on Veterans Affairs.

While we're assembling and to give you a background on how this is going to work, I'll tell you that we're going to have a teleconference this morning with Darragh Mogan and Ken Miller.

I'll apprise everybody of how it's going to work. Witnesses generally have twenty minutes to use as they see fit to introduce themselves. You can split it as ten minutes apiece, or five and fifteen, or you can just have one person speak; it's whatever you want to do. Then we open it up to questions from members of the committee.

We are obviously in our study of the veterans independence program. Without further ado, I think I'll turn the floor over to our witnesses: Darragh Mogan, director general of the program and service policy division, and Ken Miller, director of the program policy directorate.

Good morning, gentlemen.

[Darragh Mogan, Director General, Program and Service Policy Division, Department of Veterans Affairs]

Good morning. Thank you very much for allowing us the time and for indulging our being on the end of the phone rather than there with you. Unfortunately, I'm unable to travel today.

I wanted to give a little focus to the opening--

[The Chair, Conservative, Rob Anders]

If you don't mind, I'm going to interrupt for a second, because the people who are doing the transcripts and the blues for the committee need to know which of you is speaking right now.

[Darragh Mogan]

I'm sorry; I'm Darragh Mogan.

[The Chair, Conservative, Rob Anders]

Thank you.

[Darragh Mogan]

When Brian Ferguson and I were appearing at the committee last May, we talked about the veterans health services review and the veterans independence program. What we didn't get to in the discussion of the continuum of care was the very important role long-term care now plays in that continuum and will certainly play in the future. Some 11,000 veterans receive long-term care under the auspices of Veterans Affairs. So with the indulgence of the chair and the committee again, my comments will focus on the long-term care aspect of that continuum and so will my opening remarks.

My first part of the opening remarks is to say I'm pleased to be here today--but actually I'm not there, and I apologize for that--in my capacity as director general of program and service policy.

Let me start by saying that Veterans Affairs has a long history of providing long-term care services and benefits to veterans. In 1919 Veterans Affairs began providing care, treatment, and rehabilitation for soldiers acutely injured during the First World War. Activity peaked at the end of the Second World War in 1946, when the department owned and operated 46 hospitals.

However, the environment soon began to change. By the 1950s, universal health care was becoming a reality, particularly in the late fifties. The foundation of the social safety net that has defined modern-day Canada was emerging. As First World War veterans aged, their long-term care became a priority. At the same time, in the early 1960s the provincial responsibility for heath care came to the forefront. In 1963 a cabinet decision, the Glassco commission decision, obliged VAC to transfer its hospitals to the provinces, which it did over the years, with the exception of Ste. Anne's Hospital in Montreal, the department's only remaining federal institution.

However, as part of the various transfer agreements outlining the transfer of these facilities, a fixed number of long-term care beds would remain available to the department on a contractual basis. These were called priority access or contract beds. Veterans have access to these beds in a network of facilities across the country. Today, VAC has close to 4,000 contract beds in 172 facilities at an average bed cost of $55,000 per year. Approximately 60 per cent of these contract beds are in 14 large transferred hospitals in urban areas. The average length of stay in a contract bed for a veteran is 2.6 years. Those eligible for contract beds include veteran pensioners, overseas service veterans, income-qualified veterans, and certain allied veterans.

To respond to the evolving needs, eligibility for long-term care benefits grew to allow veterans to access long-term care beds in community facilities. Today the department supports approximately 7,300 veterans in over 1,900 community facilities in addition to the veterans we support in our contract bed facilities. VAC pays for the uninsured cost of care, which in some provinces is the full cost of care, if long-term care is not an insured service. In other provinces the VAC portion is minimal, but the financial support from Veterans Affairs ensures that the cost of care to veterans is the same no matter where they stay.

The average stay in community care is 1.2 years, less than half that of a contract bed. The main reason for this--I speculate here--is that our largest group of veterans who are eligible for the priority access or contract beds are only eligible for this most expensive care option and tend to go there earlier and stay longer because of the absence of choice for them. I will speak more about this a little later.

Those eligible for a community bed include veteran pensioners, overseas service veterans waiting for contract beds, income-qualified veterans, lower-income Canada Service veterans, and certain allied veterans, as well as Canadian Forces veterans, reservists, and civilian pensioners, but only for the care of service-related disabilities.

Over the years, veterans have shown a marked preference for remaining at home as long as possible. Veterans Affairs' first national home care program--we like to think that it is very innovative, and I believe that it is--was introduced in 1981 to assist veterans in remaining in their own homes for as long as possible or in accessing community facilities closer to where they live. This highly successful veterans independence program provides services such as housekeeping, grounds maintenance, personal care, and nutrition services to help veterans remain independent in their own homes and communities. At the moment, approximately 73,000 veterans and 25,000 of their primary caregivers receive benefits from this program.

As a result of the increasing need among aging war service veterans for residential care, and faced with long wait-lists for access to some facilities in major centres, the department introduced two approaches to respond to this specific need. In 1999, using the VIP model, the overseas service veteran at home pilot project was introduced to allow eligible overseas veterans to access these services at home while they were waiting for contract beds to become available. Eight hundred and seventy veterans access this program. In 2000, we also enabled overseas service veterans to access care in community beds while they waited for contract beds to become available. Twenty-four hundred veterans now use this program.

Throughout its evolution, VAC has been committed to the quality of its long-term care program, which costs about $340 million annually. In response to a Senate report in 1999 called Raising the Bar: Creating a New Standard in Veterans Health Care, the residential care strategy was developed. In response to the needs of aging veterans and their families, the strategy emphasized specialized care for those with dementia. It includes VAC's ten national outcome standards of care, which were developed through significant consultation with external health professionals, gerontological experts, and provincial ministries of health.

Standards were developed for such areas as safety and security, food quality, personal care, and access to clinical services, among others. They were endorsed by the Veterans Affairs' Gerontological Advisory Council, the same council that provided the report forming the basis of the veterans' health services review. The Gerontological Advisory Council was represented by some of Canada's most distinguished experts on aging and seniors' and veterans' issues, and it included representatives from the six major veterans organizations. Our national outcome standards are the foundation upon which we have built our quality assurance in long-term care.

To help ensure quality care for veterans in these facilities, Veterans Affairs undertakes the following measures. It surveys veterans' satisfaction with contract or community beds through the completion of a client satisfaction questionnaire, often with the help of VAC or Royal Canadian Legion representatives or with input from the family when the condition veterans suffer from does not allow a direct contribution. Departmental staff follow up with the facility management on any identified issues, and if they are not dealt with in a timely manner, a facility review is completed.

During 2005-06, close to 3,300 veterans completed the survey with what we consider to be a remarkable 96% overall satisfaction rate, nationally.

Veterans Affairs has professional health care staff complete facility questionnaires to assess an institution's ability to provide for the care and needs of veteran residents. Again, any identified issues are followed up immediately.

Veterans Affairs has partnered with the Canadian Council on Health Services Accreditation and has seen the successful accreditation of most of its 4,000 contract beds.

As most veterans receive long- term care provincially, VAC remains committed to quality care by improving its oversight in residential care and strengthening the services provided by the department.

[Ken Miller, Director, Program Policy Directorate, Department of Veterans Affairs]

It's Ken Miller. I'm just going to take over from Mr. Mogan at this point, with the committee's agreement.

So what does the future hold? You've heard now how over the past 90 years our programs have incrementally evolved to meet clients' changing needs. But the expansion of eligibility has resulted in numerous categories of veterans, each qualifying for long-term care based on different eligibility criteria and gaining access to different benefits, some of which are based on health need and others granted automatically. The result is that we're faced with complex eligibility rules and a system that leaves some veterans without the care they need when they need it and where they need it. It may also provide certain veterans who are fully functioning in their community with more benefits than needed.

We're also seeing a 20 percent vacancy in contract beds and an 81 percent increase in utilization of community beds since 1996. Many times community facilities are preferred over contract beds as they're closer to the veteran's home, closer to their family and community, and they provide the option for a spouse to live there as well when that's an appropriate level of care that's needed.

Veterans are demanding more choice in care options, and unfortunately the current criteria often limit the choice and the fit for the veteran. In spite of the changes made over the years to try to better respond to the long-term care needs of veterans and their primary care givers, the reality is that further action is required if we are to make a difference in how these veterans live out their remaining years.

We realize that the time to act is now. The average age of our frail elderly war veterans is 84 years old, with almost 2,000 passing away each month. We want our veterans to age as well as possible and to receive the most appropriate benefits and services at the right time and at the right place. What is needed is a long-term care program that offers choice in care settings, including greater access to the veterans independence program services and also to community-based assisted living options. Overall, we envision a program that is flexible, providing support and assistance across the full spectrum of need, in which the level and intensity of service could be increased depending on the need.

Ultimately, Veterans Affairs wants to meet the individual needs of veterans who have faithfully served our country. To that end, we will continue to work with provinces and long-term care facilities to respond to changing needs of veterans. Also, we will work with veterans organizations and stakeholders to maintain the principles of choice, quality, and accountability. Finally, we will move forward with the veterans health services review, which could address many of these issues.

With that, Mr. Chair, I'll turn back to my colleague Mr. Mogan to conclude our comments.

[Darragh Mogan]

In effect, committee members and Chair, that does conclude our comments. I think we're ready to take questions that members may have.

[The Chair, Conservative, Rob Anders]

All right. Thank you very much.

We have a rotation, and just so you know, it goes from party to party. We start off with the Liberals, with Mr. Valley for seven minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you, Mr. Mogan and Mr. Miller. Thank you for participating today. Even though you were unable to travel here, we'll be able to get the information and answer some of the questions we need answered.

My first question is whether you can just run through something again. I know you explained it briefly. The contract beds are in the hospitals that have been handed over in 14 large urban centres. That is in contrast to the community beds. Can you explain how the community beds are situated generally across Canada and the difference between the two? We understand one's in the urban centres, and the community beds are where?

[Darragh Mogan]

It's Darragh Mogan here, responding to the question. The community beds are in about 1,900 facilities across Canada. They're really where the veterans choose to go, and where they're licensed by the province for the most part. That's the kind of choice I think Ken Miller was talking about that veterans prefer. So they're located wherever it is there is a vacancy and the veteran wants to go and the provincial admission criteria are met.

[Roger Valley, Liberal, Kenora, ON]

I'll explain again. I represent Kenora riding. It has very small communities. Can you tell me that there would be community beds? We saw maps with the distribution of the beds right across Canada. I do not remember a lot of choice in my riding or in northern Ontario. I believe we're serviced by one of the large hospitals out of Winnipeg--

[Darragh Mogan]

Yes, that's Deer Lodge.

[Roger Valley, Liberal, Kenora, ON]

I don't know that we have any other access. Thunder Bay may, but the next access for a large facility is, I believe, over in Sudbury. So you're saying we would have contract beds in even the smallest of communities?

[Darragh Mogan]

No. What I'm saying, Mr. Valley, is we have about 4,000 contract beds and the inconvenience of those is that they're not located necessarily where the veterans are located all the time. So it would mean that someone from Kenora would have to go to Winnipeg, and there's a real down side to that in terms of one of the determinates of health, and that's social integration. You can't lose your family contact when you have to drive 250 or 300 miles to see somebody.

So what we also use is a supplement. That's where the majority of veterans are. About 7,400 of them are community beds, some of which would be in Kenora. Some of them would be in Dryden, if they're there. Some would be in Fort Frances, perhaps. So that's the way of overcoming the disadvantage for veterans, say, in Kenora with having to go to Deer Lodge.

[Roger Valley, Liberal, Kenora, ON]

You mentioned a figure of $55,000 as the average cost per year for some of the beds, and I don't mean to split hairs here, but some of these hospitals are extremely small. This would be enough to make sure that there was a bed available in a small community if a veteran desired it there. It does cover the cost of it, then?

[Darragh Mogan]

The $55,000 we're referring to is our average cost for our contract beds, not the beds they use in Kenora or Dryden or Sioux Lookout, perhaps, but our costs, on average, for the Deer Lodge site beds--the 4,000. The community care beds are partially financed by the provinces and we just provide a top-up to whatever charges are made to the veteran patient so it's the same cost outcome for the person in a bed in Kenora as it would be for the person in Deer Lodge.

[Roger Valley, Liberal, Kenora, ON]

Thank you, and thank you for your knowledge of my riding. Not many people know where the riding is, let alone can name some of those small towns that you name.

[Darragh Mogan]

Well, there you go.

[Roger Valley, Liberal, Kenora, ON]

In 2006 the Gerontological Advisory Council, which we've heard a lot of, and we've asked and had here as witnesses, mentioned that out of the some 200,000 war veterans, only 40% receive health care benefits.

[Darragh Mogan]

That's correct.

[Roger Valley, Liberal, Kenora, ON]

I was wondering before you explained some of the things you already explained this morning whether that was because a lot of them are in the outlying areas. Clearly on some of the programs you're initiating, some of the ones that have been in place, and some of the ones you're revising, could we expect that number to rise because you're reaching out to the different areas?

[Darragh Mogan]

Certainly as part of the veterans health services review that Mr. Ferguson and I discussed with you last May, the object of that would be to see if we could respond to the 60% of veterans who don't have an eligibility for any care from us, or if they do, they only have eligibility for the most expensive care, and that's that $55,000-a-year bed care. So yes, I think the object of the exercise would be a bit more responsive than we are to the 60% of veterans who are not now eligible.

[Roger Valley, Liberal, Kenora, ON]

Thank you. We look forward to a report some day that can show that number climbing with all your outreach.

You mentioned the outreach with some of your surveys, and 33,000 veterans completed surveys. If I'm looking at it correctly here, 96% had a high satisfaction rate. You mentioned some of the ways you do outreach through the Canadian Legion, through VAC, in rural Canada. Are those the only methods you have? I'm just wondering how else we can reach.... Because as members of Parliament, we're not allowed lists that tell us the veterans who live in our riding. I think it would be a good tool for me to use to make sure the services are provided for those veterans, but we're not allowed to have that. We do work through the legions. I'm a long-time legion member myself. We do everything we can to try to find our veterans, but it's very hard for us to do.

Do you have any suggestions on how we would contact these veterans? There's outreach by either politicians or by anyone else in the outlying rural areas.

[Darragh Mogan]

It's a good question, and it's a challenge for anyone, particularly elected members, to reach the people they want to reach; I understand that, especially with a large riding like yours. Really, general knowledge and general information that you're interested in veterans and interested in helping is the only way in which privacy law will permit you to function in that area. We have the same restrictions on us. If the individual knows that they're being supported by us and has accepted that we can use that information to outreach them, that's fine. But it's really only a general kind of outreach. Through legion branches, the legion branch service officers know an awful lot of people in their area. And if the individual veterans, or particularly their families, can be in touch with you as a member of Parliament, or any member of Parliament, to help them out, then they can give you the authority to contact us, and that's great. That's perfect.

From our own experience, when we talk about the number of people suffering from any illness who go into these institutions, it's really very important to have that kind of outreach that you can get through legion branches and through your own constituency work.