Veterans Affairs Committee on Dec. 4th, 2007

[David Pedlar]

We define health care broadly to include various aspects of a client's well-being. Health care is defined generally, consistent with good models of care for the elderly. It focuses more broadly on a person's capacity to function in a home and in the community, and not narrowly on what might have been considered, traditionally, medical-type health care concerns. So health is defined broadly, as it should be, for older persons.

As to the issue around studies and deadlines, and one thing or another, I can assure you that the preliminary findings and earlier information that has been collected on the study is being used for planning purposes within the veterans health services review as it's available. We don't have to wait until spring 2008 to make the research findings useful. We make them useful immediately. That's partly done by making sure there's a close working relationship between the team in Veterans Affairs that's working on the veterans health services review and the research team led by Dr. Hollander. There has been ongoing direct interaction between the two, so that findings from one can be used as soon as they're available, even if they're preliminary.

So we're not waiting for anything. We're using what we have as we move along, and we're making good use of it.

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

Thank you.

When you give Mr. Sweet his answer regarding how many have gotten on and my question of how many have left the program, could you also give us a statistic, if you're able to find it, on how many people actually call up for VIP services and are denied.

I'll just give you one quick example of a woman, Chris Beattie of Halifax. Her husband died. He was a veteran. He actually applied for VIP before he died. He was accepted into the program, but he had, as she says, the audacity to die before the program was actually delivered to him, and thus she was denied any access to VIP services.

This is the type of frustration, sir, that we experience on a day-to-day basis. So I just wanted to give you that as an example.

Thank you.

[David Pedlar]

We appreciate that feedback.

[The Chair, Conservative, Rob Anders]

Thank you very much.

I almost wanted to respond to Mr. Stoffer's question. I appreciate the fact that he's asking questions that he asks in the House, which is good. I was hoping he would do that.

I'm just offering my thought on this. For some of these people in my community who are 80-some years old, shovelling the walk or doing these various things in icy conditions can definitely be a health hazard if they slip and break a hip or something like that. As well, there's the strain on their heart and various things.

We will now go to Mr. Cannan of the Conservative Party, for five minutes.

[Ron Cannan, Conservative, Kelowna—Lake Country, BC]

Thank you, Mr. Chair, and my thanks to the gentlemen for being with us this afternoon.

Most of the questions have been asked. I also agree with the whole issue of health care as quality of life. We have to incorporate that element.

I represent the constituency of Kelowna—Lake Country, in the interior of the Okanagan in British Columbia. To those who have been familiar with Victoria and UBC and studying gerontology and the whole philosophy of aging in place, we have the highest demographic of those 65 and older. That's about 16% of my population in Kelowna, and Victoria, of course, has the highest number of individuals over the age of 80. So we have some excellent research based out of B.C.

I know Minister Abbott, our health minister, and Premier Campbell have been using this philosophy of home care and assisted living versus institutionalization or hospitalization, both from an economic and also a quality of life point of view. I think we have a model there, and we have the research. And like my colleagues at the table, I have many constituents who have come forward looking for improvements to a program that we know is broken and needs to be fixed.

I would just ask you this, then, from a summation of all the discussions that we've had with prior witnesses. If this committee completed and put a bow around the witnesses' information that we've gathered to date and submitted a report before our Christmas break, would that help you to expedite this legislation coming forward in the new year?

[David Pedlar]

I can't really speak to legislative timetables, but I can tell you that information from your committee, of course, would be very helpful in terms of the work the health care review is undertaking, as well as the research study that we're undertaking.

As health policy is formulated, of course, we use various sources of information, and they all make an important contribution. For example, research and the study that we're undertaking would be one important piece of information, but another critical one would be the kind of advice that this committee would give.

I know this committee had the pleasure and the opportunity to speak to, really, a wide range of experts in recent months, as I did have an opportunity to read the proceedings of some of your past meetings. So I'm sure a report from your committee would be welcomed and could play an important role in the process.

[Ron Cannan, Conservative, Kelowna—Lake Country, BC]

Excellent. We talked about this briefly at the last committee meeting, and if we can get a consensus after the conference call is over, hopefully we can get that report completed. As a member of Parliament on the government side, I'll do my best to get the legislation enacted as soon as possible.

Thank you, Mr. Chair, and my thanks to the witnesses.

[The Chair, Conservative, Rob Anders]

Thank you.

I don't have anybody else on the speaking list.

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

I have a short intervention, Mr. Chair.

[The Chair, Conservative, Rob Anders]

Mr. Brent St. Denis, for the Liberal Party.

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

I wanted to ask this, gentlemen. Going back to the fascinating study comparing a group that didn't get VIP and was eventually institutionalized, or put into homes, I guess, more appropriately, to a group that had home care and was able to avoid being put into a home, in the measurement that we've been given today—and the measurement most easy to make is a financial one—is any measurement of the quality of life possible? Some day I'll face that music, or my family will on my behalf, I suppose. From talking to many seniors, I would imagine they are happier when they can stay home, if they don't have to go to a nursing home.

Is there any way to measure the quality of life benefit of being able to stay at home and what that means in terms of longevity, to measure the indirect benefit to your health that comes with just being in your familiar surroundings with a spouse if your spouse is still alive, or with your family and your community? Is there any measurement of that quality of life?

[David Pedlar]

The answer to that is yes, but I think I'll hand it over to Marcus to explain to you exactly how we're measuring those kinds of questions in the study.

[Marcus Hollander]

There are quality of life scales that we've used in the past. There are strengths and weaknesses to each of them. But certainly if we look at the outcomes in studies, some of the things one typically looks at are the satisfaction people have with services—both the clients and the caregivers—and the quality of life of the individual.

What one typically finds is that both satisfaction and qualify of life are comparable, and sometimes better, for people living in the community. It varies a bit from study to study and whether you're looking at one or the other of those factors, but generally that seems to be the pattern of findings.

The other part of your question really relates to something that would be done more in a longitudinal study, where you would look at people over time and perhaps look at time to institutionalization and so on when you do comparisons. There has been limited research in that area, as far as I'm aware, at this point in time. But it's certainly an important area.

Longitudinal studies are a bit more difficult, particularly if you're using the outcome measures that we're talking about, because you want to do that over time. Their levels of satisfaction may change over time, and so on.

These are not studies that are easy to do, but certainly it's an important point that you make, and certainly one would want to see satisfaction and outcome included as outcomes. If you're doing cost-effectiveness, you need to look at both the outcomes and the cost.

[David Pedlar]

If I could add to Marcus's comment, on the second question around the health impacts, while a more complex strategy is required in order to really measure that effectively, you can ask people about it in a cross-sectional study, in the kind of study we're doing. Although it's not as strong a measure, it's also helpful to get that kind of information just by asking people hypothetically about what some of the effects are of being able to stay at home longer.

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

Thank you, Mr. Chair.

Thank you to the witnesses.

[The Chair, Conservative, Rob Anders]

Thank you.

Once again I have exhausted the questioners list. At this stage we're not wrapped up, though, because there are a couple of things I think some members wish to raise.

I'd like to thank our two witnesses, Mr. Hollander and Mr. Pedlar. Thank you very much. After we let you gentlemen go, we will be discussing the issue of the report, and hopefully that does help you. So thank you very much for appearing today.

And I apologize to the committee members and everybody else with regard to the snowing-in factor, but you were accommodating to be able to do this via teleconference.

[David Pedlar]

Thank you. It was my pleasure.

[Marcus Hollander]

Thank you very much.

[The Chair, Conservative, Rob Anders]

Thank you.

[Some hon. members]

Hear, hear!

[The Chair, Conservative, Rob Anders]

For our committee members, I wanted to mention that I talked to Michel. He says that Tuesday next week is probably not likely, but maybe Thursday, just before we go to break. We may be able to have something to talk to and debate, or what not, with regard to a report on the issue. It's short timing, really, given that we're not going to have that much time before the break, but we'll do the best we can.

And I think Mr. Shipley's leaning over to talk--

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

No, Mr. Chairman, you've just summarized. I think it is likely. We've heard a lot of discussion today about studies and not getting the length of time, and I think everyone here wants to move ahead. So if our researcher can put together at least that draft report for us to have and discuss before the break, that would be wonderful, and much appreciated also by our vets.

[The Chair, Conservative, Rob Anders]

Thank you.

Is there any other discussion on the subject? No? Okay.

This meeting is adjourned.