Thank you very much. It's a pleasure to be here today. It's my first time presenting to a committee in Canada. As people can probably hear from my accent, I'm not Canadian. I'm originally from Australia, but I've presented to certainly a few parliamentary committees in my time, when I was in Australia working with the Australian health department.
I'm the director with the International Federation on Ageing. The organization is 35 years old. It's been in Canada for 15 years. It is one of four premier NGOs that have general consultative status at the United Nations and deal specifically with issues on aging.
We generally focus not on disease-specific issues but really on the social issues around aging. We're a facilitator and bridge-builder between government, NGOs, and best practice, looking at what's happening from a country-by-country perspective in terms of programs and policies that support seniors.
It's certainly welcoming that this particular committee is looking at the issue around veterans, because the veterans issue is not only an issue in Canada but also in many other countries, and I can certainly give some perspectives from the Australian veterans care system during questions and answers. But what I want to focus on today is some aspects of the Gerontological Advisory Council report of November 2006 and some of the recommendations that this particular body was making, particularly when we talk about veterans and the demographic of veterans as it currently is today, and the tendency for governments to look at an illness model of care rather than looking at a wellness model of care.
The International Federation on Ageing certainly encourages governments and supports policies and programs that look at models that support wellness and interventions to actually reduce disease burden.
As Willie indicated, governments don't spend a lot of money on health prevention and health promotion, because the results that you see from those things are generally long-term and the health benefits aren't necessarily realized in the short terms of governments.
There isn't enough effort done in most countries around health and wellness programs. There are some aspects of the veterans home care programs here that have taken some leadership and worldwide recognition, such as Canada's falls prevention programs and early interventions around falls prevention, which certainly supports and benefits veterans.
The other issue that I think is of major concern is the support that carers receive, who are the people at home supporting the veterans who need some form of support. I think in the last 10 or 15 years there's been a greater emphasis on the support that home carers, or the spouses and families of seniors, provide and add to the cost savings of government. Programs that support specifically those carers certainly are encouraged, and I know there are some very good models, both within Canada and outside Canada, that really focus on how to support the carers of those veterans to maintain them to be independent, or for them to remain within the community or at home for longer.
In doing that, what governments certainly have recognized, and there's a great move away from residential care to more home-based community support programs.... The issues for seniors around those home-based community support programs are these: Where do I get information about those programs? Who do I make contact with, and are there single points of entry or single points of referral? Are there some consistencies from one province to another around those referrals, particularly to home care programs?
The issue of a one-stop shop, in terms of an assessment and referral component, is certainly an initiative that is welcome, and which the Gerontological Advisory Council has recommended. People only look for these services when there is a crisis and they don't know where to go, but if there's a one-stop referral assessment point that looks at the issues not only of the veteran but of the whole family and the infrastructure of the family, and they make the referrals to the appropriate services, it certainly puts the families and the veterans themselves at ease in terms of, if there is an issue, where they need to go.
We do have to recognize that people only access these services when there's a crisis, and when there's a crisis they need support and service tomorrow. So it's an issue of how to get information out about what services are available. The NGO community across Canada and returned service league organizations have a vital role to play in informing veterans about the range of services that are available, and not only to inform veterans about the range of services available but to start talking among themselves about the inequities of services across provinces in Canada. That's the same in many other countries where health jurisdictions are done at a provincial level.
In terms of what are some of the trends that are happening, if we look at veterans' home care programs—I'll give an example of Australia—what they're looking at is using multidisciplinary teams for assessment so you have a single point of entry for assessment. Those assessments are uniform and eligible right across the country. They also maintain an amount of money for packaged care services, so they can actually support families and the veterans with what they would call a community aged care package, or a veterans aged care package, which could buy in the range of services that a particular veteran might need to keep them at home for much longer. Certainly the emphasis is how we keep people as part of the community where they live and where they've contributed for as long as possible. The issue that was highlighted of people having to move to go into long-term care or other care facilities is not only an issue in Canada, but is also an issue everywhere, and it's an issue around the multiculturalism of senior populations in countries.
In terms of looking at the range of programs and services, there has to be an emphasis around health and wellness. It will certainly, in the long term, reduce the cost burden of governments in terms of the cost of care, or it will limit the cost of care to a much shorter period when you start looking at long-term care costs. If we look at world trends in developed countries, only about 4% to 5% of people who are over the age of 70 today will go into a long-term care institution. There are many people out in the community who will remain in the community, and only through an issue around health will there be cause for intervention and generally hospitalization.
If there aren't that many people going into residential care, why aren't they going into residential care? It really is because of the movement around developing community-based services that support the people to remain independent at home for a lot longer. It is also about developing programs and services that promote independence and health and wellness so as to reduce the disease burden in the longer term.
Case management is another issue that was discussed by the advisory council in its report, and it's a model that has been followed and adopted in a number of countries. The issue around case coordinators or case managers is the caseload that they end up having to take on. In the Australian system where we had case managers for a geographical area, the burden on those case managers was quite significant, and it was recognized very early in the piece that the particular program was underfunded, because case managers were trying to support 70 to 90 people on a weekly basis, which was just out of the realm of their particular possibilities.
I think the issue of uniform access, or access to services that doesn't necessarily discriminate, is an important one. If I'm a veteran and I'm living in Manitoba, I want to know that I can get the same level of access to services, whether it be health care services or services that can support me at home, that I can if I live in Prince Edward Island.
Nationally, that's an issue for the Canadian government to look at, and even the NGO sectors, to start talking about what the differences are. What are the services that I can get in Manitoba as opposed to Prince Edward Island, for argument's sake? I think those are issues that do need to come to the forefront.
Having a national veterans program certainly overcomes many of those issues, and having programs that are funded independently by the Department of Veterans Affairs goes to much more of a uniform model. But for other seniors, it's not necessarily uniform.
So I'd certainly like to commend this committee for looking at how they might support, review, and improve the quality of care for veterans. I'd be very pleased to respond to any questions or talk about some international perspectives.