Veterans Affairs Committee on Dec. 4th, 2007

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

It was not evaluated following the legislation in 2003, so we have a study that started in 2001 and this is now 2007. In 2003 there was not an evaluation done. Do you know why not?

[David Pedlar]

Actually, a small-scale evaluation was done during the first two phases, but it wasn't as thorough an evaluation as we thought was necessary.

Part of the interest in doing a more sophisticated study came in part from the Gerontological Advisory Council, because they felt that not only was it important for Veterans Affairs, but it was also very helpful information that might have a greater impact outside Veterans Affairs in the broader health care community.

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

My concern is that we have something that has been going on for.... You're not going to get anything now for five years, from 2003 to 2008. I'm wondering why. Is there a good reason?

[David Pedlar]

We've collected different levels of evidence over time. Currently, though, the evidence is being used in the context of the health care review.

The OSV program is part of the bigger picture of the health care review. The kind of evidence that we're generating would be to enter different kinds of questions, such as whether the VIP program should be more comprehensive than it is now. Through this kind of study you can help answer that question. Another question would be whether there are greater opportunities for care substitution between home care and institutional care. These are the kinds of questions we can answer, nuance questions, through a study like this, so this kind of study is actually very important for our current priority, which is the veterans services health care review.

There are different levels of evidence in terms of the quality of studies. The better the evidence, the more impact the studies can have. This study will have very good evidence, so it can have a very strong impact at Veterans Affairs and potentially in other health care jurisdictions as well.

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

Thank you very much.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Shipley.

Now we are on to the Liberal Party of Canada for the second rotation, where each person will have five minutes.

Mr. St. Denis, for five minutes.

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

Thank you, Mr. Chair, and thank you to you two gentlemen for helping us out today.

I was quite intrigued when both of you mentioned the study that indicated a saving in the third year of $3,000, if I wrote this down correctly, in favour of those who had home care versus those who went without it, indicating what I think we all anecdotally realized, that it is less expensive and a happier situation when we can help seniors stay in their homes as long as they physically can.

Did I write that number down correctly? The advantage is to the taxpayer in that study, to put it crassly, or to society, by keeping our seniors at home?

[Marcus Hollander]

That is correct, and I think the difference was about $3,500 in the third year after the start of the study. There was really a natural experiment in British Columbia, where there was a policy of no longer providing housekeeping services to people who were at the lower level of care. A few of the health units, as we called them at the time, took that very seriously and reduced their rosters. Others did not, and so we had a natural experiment where we could look at two health regions where the cuts were made and not made.

When we broke down the data in that study, we found that on average, if you looked at the two groupings, the major increasing costs related to admissions to long-term care facilities—on a proportional basis, more people were admitted to a facility, thus increasing the costs—and the use of hospital services. So the people who no longer got those services basically found they might run into some problems, for whatever reasons, because of the lack of those services. The result was that they went to hospital more often and were more likely to be institutionalized in a long-term care facility.

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

Before I continue, I have a small related question. What would be the average number of hours of home care provided in the study?

[Marcus Hollander]

It would have been very modest. I can't remember the exact number of hours, but typically for a low-level care needs person, they might get something in the order of four to six hours a month. That is, somebody may come in, perhaps twice a month, to provide some basic care and home maintenance. So relatively, it was very low-cost provision of health care.

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

So again, to use your words, a very modest investment in home care leveraged a tremendous advantage in terms of the cost of institutionalizing someone and, of course, in terms of related visits to the hospital and emergency wards, because they didn't want to have somebody helping them at home.

[Marcus Hollander]

Right.

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

I think most of us would have guessed that was the case, but it's good now to have the studies confirming what we might have guessed was the case.

Is it because the dollars in question here were federal that the person was institutionalized or getting help at home? The funding envelope was the same in both cases. This, I imagine, led to the possibility of an experiment like this, because where we are unable to do these things, sadly, is where there are different jurisdictions involved. Get outside the veterans community to the population in general and we're then dealing with provincial dollars and federal dollars comingled, and it's harder to make that case.

Were there any provincial impediments to the experiment?

[Marcus Hollander]

First of all, it was basically a study that was done in British Columbia, so it would have related to the British Columbia continuing care system at that time. These would have been dollars within the provincial ministry of health. Obviously, with federal transfers, some of that money would be federal as well.

Really what the province did was make a determination that it wanted to invest funds in the people who needed higher levels of care and make that kind of a transfer. That was the policy choice.

Fortunately, the University of British Columbia has been working actively for a number of years with the Ministry of Health in British Columbia, and they have a very good database of administrative data, all confidential, and so on, but nevertheless, that was the data set that we were able to use, and it has data on home care services, residential, drugs, physicians, and hospitals. One can, on an anonymous basis, look at what the consequences are if there are certain changes in policy, and we were able to do that.

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

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. St. Denis.

Now we'll go to the Bloc Québécois, and Monsieur Gaudet, for five minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I have some simple questions to ask you, gentlemen. Have the studies that have been done been conducted in order to find problems or to find solutions to those problems?

[Marcus Hollander]

I think typically what would happen is that one would do studies on issues of relevance for future decision-making. They would be an input into policy formulation, so you may not be fully aware of a particular circumstance. If you do good targeted research, you can get relevant information about that, and depending on what that is, it may point out certain policy choices.

With regard to the kind of research we've done and are doing in this project, we are looking at levels of satisfaction as well as cost. This is not simply a cost study; we are also looking at contributions made by caregivers and the satisfaction with services.

What we find is that for people with similar levels of care need, home care is typically—not always, but on average—a lower-cost alternative. So in fact people usually prefer to remain at home. What this evidence would say is that if people prefer to remain at home, if they can get an equivalent level of care to meet their needs that they're satisfied with, then that might be an option for policy-makers to consider in terms of making greater investments in home care rather than in residential care.

That said, one must continue to recognize the importance of residential care for people who need that kind of service. So typically one would hope that the kind of data that is collected would in fact lead to improvements and solutions.

[David Pedlar]

I agree with Marcus' comments. In a nutshell, the goals of the study were really twofold. One was to take a really sophisticated look at the veterans independence program, one that hadn't been taken to date, in order to assist us with formulating our policy, especially in the context of the veterans health services review, which is a very serious undertaking.

Secondly, there has been ongoing interest in the veterans independence program in other jurisdictions in Canada, and outside Canada as well. If you want to transfer information about best practices, the best way to do it is in a high-quality research study, which this is.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you. I'll come back to that later, if I have the time.

My second question concerns home care. Is your first priority health or maintenance? I know this is very important. It's all well and good to say that it's less costly, but our veterans have given us our freedom. Health care is as important as having a beautiful lawn and all kinds of things outside the house. I think that what's important is on the inside, and that's the veteran and his family.

So I'd like to know what you mean by “health care”. I'm not telling you that maintenance isn't important. It shouldn't look bad. But health care is very important, for me at least.

[David Pedlar]

I talked earlier about the concept of comprehensiveness. That means you need a range of options to address the wide range of needs that veterans present with. Where veterans require higher-intensity care that could involve health care and more professional care, we want to make sure that's available to them. Where they may require non-professional supports, we want to ensure that those are available as well.

I think the discussion around housekeeping was more from a national policy perspective. While Veterans Affairs provides housekeeping and considers all the components of its program important, there has been a trend away from housekeeping services and towards professional care services.

Veterans Affairs' and the veterans independence program experience is that comprehensiveness really matters, and that housekeeping really matters as well, as do other components of the continuum of care, such as ones that would involve more professional health care providers. It's all important, and it's important that a program is capable of addressing a wide range of needs.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Now we'll go to the Conservative Party of Canada, and Mr. Sweet, for five minutes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, Mr. Chairman.

Thank you, Dr. Pedlar and Dr. Hollander, for your good work.

It's my understanding that in the past year 12,000 new clients have been initiated into the veterans independence program. First, could you tell me if that's correct? Second, how did that come about? Was that through the phone solicitation that we heard had happened? What gate did they come through?

[David Pedlar]

Unfortunately I don't have the direct answer to that question. I can get it for you. I don't work on the data in day-to-day program delivery.

I know a large number of clients came on, over the last few years, with the extension of services to primary caregivers, but I'm not exactly sure what the breakdown of new clients would be. That information is available, though.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You had mentioned in your opening remarks that there are 100,000 across Canada on VIP right now. If you extended the VIP to all the people who could use that, who need that, what would the caseload be?