Veterans Affairs Committee on Dec. 6th, 2007

[Greg Shaw]

There have probably been a number of research projects around the differences of how health care or home care is delivered, whether it's federally or provincially.

You're talking about municipalities having 20-year visions and federal governments having four-year visions. I think a lot of the visioning comes from the senior bureaucrats within government. There's no doubt about that. They're the long-term strategic thinkers and they generally help shape programs and services and relate with other provinces around what's going on. And the government either supports or doesn't support that agenda.

I think some of the difficulty is that new governments are elected and come into place and do want to change things, and they do change things marginally. They don't necessarily pick up on good practice that has happened elsewhere. And it's a challenge for government; there's no doubt about that.

For all parliamentarians I think there has to be a mechanism where people put aside their party relationships--provincial relationships, federal relationships--to actually talk about the common good of a target population or cohort, and that, in this particular case, is veterans. How do you come together to actually support cohesively the support of veterans so they receive the same level of service where they are? While there's probably been a number of reports that talk about the disparity and differences, I don't think probably much research has been done on how those things can actually come together.

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

I appreciate that.

My colleague has one quick question, and I have one more supplemental.

Looking at the veterans independence program that we have today, does either of you have any recommendations to put forth in terms of how we can improve the program or any additional services that should be added to the program? You mentioned a multidisciplinary, one-stop shopping perspective.

[Greg Shaw]

There are always ways that you could improve programs. Certainly for the veterans themselves, it's getting access to information easily. So a single-referral access point would certainly be beneficial for the veterans themselves.

Having a multidisciplinary team approach to assessment that actually looks at early intervention in terms of health promotion as well is certainly a key, right through to the geriatrician who can look at the geriatric health care needs of older people, but it would include a social worker. So a multidisciplinary assessment team certainly would help, so that people aren't being referred to multiple sources from time to time.

The other challenge, I think, is getting assessments accepted nationally. If my mom is going to move from Montreal to Toronto, she's going to have to go through a whole new assessment process; it doesn't matter what service she needs. So there's no portability of assessment processes or acceptability of what other people do, and I think, somehow, a single referral and assessment point with national acceptability would be a good thing for veterans.

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

That's a good point. We have that same problem with the trades. Trade barriers are one of the big stumbling blocks interprovincially in our own country.

[The Chair, Conservative, Rob Anders]

Just to let the committee know, we would be reverting over to the opposition, but the given member is not.... Bear with me. I don't think I'm officially allowed to refer to who's not here, but you know what I mean.

So now it goes back over to the Conservative Party and Mr. Sweet, and then it's followed up by the Bloc.

Mr. Sweet.

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

Thank you, Mr. Chairman. I have just two brief questions.

I regret that I wasn't here earlier to hear all your testimony, because certainly what I've heard right now has been very good.

Mr. Shaw, I understand that a question was asked earlier comparing Australia and Canada, but how many countries have you had experience in, in analyzing geriatric care globally? Lots?

[Greg Shaw]

Lots, yes.

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

Okay, good. That's all I wanted to know. As I said, I wasn't here earlier and didn't know your experience and credentials.

[Greg Shaw]

We've worked with research institutes all across the world in terms of issues around older people.

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

Okay.

I guess it's probably not fair to say that home care is emerging, but because of what appears to be some time it's taking to actually implement it, it's still an emerging practice. Where do we stand internationally, in terms of the other countries you've looked at, in getting on board with this idea that my colleague had mentioned earlier, that it makes very good sense morally, ethically, and financially to have more residential care for seniors?

[Greg Shaw]

It's hard to make direct comparisons country by country, because health care systems operate differently, but if I talk about some good models or good practices, the move is away from residential care. The move is for governments not to be involved in the delivery of residential care services. So you don't have nursing homes anymore that are owned and operated by government or provincial governments, in many countries, and that has been a move over 15 to 20 years, the reason being that it's difficult for a government to implement and measure itself against quality improvement or quality assurance principles, and it's very difficult for government to criticize itself.

Governments that have recognized that have looked at strengthening quality assurance systems within home care and long-term care, but the delivery of those systems is very much within the private sphere or the not-for-profit, non-government sphere. Governments are packaging services much more that look at making the services fit the basket of needs that the veteran has, rather than the veteran having to fit to the basket that the government has. So they're packaging care services to what they might call a community aged care package, in a number of countries, and those packages are worth about $12,000 or $13,000 a year, but those packages contain a whole range of services based on an assessment from a multidisciplinary assessment team. They're good things that certainly happen.

The move away to more residential settings of long-term care facilities, to make them more like home, certainly has been an emphasis for 10 years.

So those are a couple of comments.

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

I'll just zero in on one thing, because we had some previous witnesses whom I'd asked, and it wasn't part of the study they had done.

In the models that you've discovered, are there some cost-benefits in those suites of services to having home visits by physicians, where now you have the apex of the professional services in actually being able to monitor precisely how long this person can stay at home and still be in good health and well served?

[Greg Shaw]

Multidisciplinary teams, which are established by governments or funded by governments, do the visits into individuals' own homes and meet with families and the individual care recipient to go through those assessment processes, and certainly that's beneficial.

More and more within the health care system, the general practitioner is not going to individuals' homes, particularly older peoples' homes anymore, so they're still having to go to a general practice in public hospitals or their local clinic. But if they're looking at development of services to support them as they age, they're referred by their GP or an independent, me or you, to an independent multidisciplinary assessment team that is, in a number of countries, funded either by provincial governments or by federal governments.

Australia has 56 multidisciplinary funded teams across Australia to do assessments around that issue, which is a federally controlled system.

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

Do the other witnesses have anything to say, Mr. Chair?

[The Chair, Conservative, Rob Anders]

If they wish.

[Willie Lirette]

There are different systems in each province.

In New Brunswick, for the past 30 years, we have had what we call home care services or the extramural program. It works well. This program provides care to patients once they leave the hospital, for as long as they need it. Services offered include physiotherapy, social services and all medical services required, except for services from a physician, who does not go to the patient's home. However physicians will go to long-term residential care centres. This is a service offered by the program. Naturally, the extramural program, because it offers care in the patient's home or in a nursing home, places less stress on the regular health care system, for example, on hospitals. Patients who, 10 years ago, had to spend two weeks in hospital now spend two days. This means that more beds are available.

However, there is a problem: some seniors are hospitalized while waiting for a space in a long-term care centre because they have lost their autonomy. This is a major problem that all provinces are currently experiencing. There are too many seniors taking up hospital beds that are thus not available for emergencies. This is a major problem in both hospitals in Moncton. Over 200 elderly people are awaiting spaces in long-term care centres, but there is simply not enough room.

Also, seniors are now in better health, living longer and have less need of services. There are only 2, 3 or 4% of all seniors in long-term care centres because they have lost their autonomy. All the rest are active in society, and the longer we can keep them active and independent, the less it will cost our health care system. This is a fact proven by research, once again.

[The Chair, Conservative, Rob Anders]

Now we go to the Bloc Québécois, and Monsieur Perron, for five minutes.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

First, sir, I would like to thank you for your testimony. I share your concerns about health care for seniors. Like you, I think that we have and we will have more seniors in society because people's longevity has greatly increased over the past 25 years.

I am a great believer in home care and I am aware that major efforts must be made in this regard, because natural caregivers lack assistance. There are not enough medical personnel to provide services in people's homes, there is a lack of funding, and there are many areas that must be worked on. Like you Mr. Lirette, I hope that the provincial, municipal and federal governments will start developing a long-term vision rather than focusing on the next election and working only to get re-elected. We need a long-term plan.

Those are my comments on what you've said. If I have forgotten something, feel free to comment.

[Willie Lirette]

I know that time is running out, but you referred to natural caregivers. Most of us here would not have the skills required if all of a sudden a member of our family, our spouse, for example, became incapacitated and we had to care for him or her. What we recommend—

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I would like to clarify something. What I mean by a natural caregiver is someone who cuts hair, mows the lawn and other things like that. There are also medical caregivers. That is another group.

[Willie Lirette]

Natural caregivers, for the most part, are spouses or other members of the family. We recommend a training program even before these things occur in a family. I don't think anyone is ready to provide such care or do all this work. For the past few years, we have been asking the governments for training programs for natural caregivers.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

I agree with you.

[The Chair, Conservative, Rob Anders]

We have a very short period of time left, and I'd like to try to get some other issues dealt with very quickly.

I thank our guests tremendously for their appearances today. I think your testimony has been very useful with regard to the questions we're addressing and the report we hope to put out shortly.

Please forgive us if we now turn toward some travel issues coming up for the committee.

Thank you very much for your appearance.

[Greg Shaw]

Thank you very much.

[The Chair, Conservative, Rob Anders]

Thank you.

Committee members, you just had the papers passed to you. All we're really looking for is approval by the committee so we can take this to the Liaison Committee.

We discussed this previously and passed a motion with regard to travelling to see some of these facilities across the country. It's broken up into three. Two of them are day trips.

The one for Quebec City requires we have a plane to make it there and back. So you have that, for about $30,000.

There's also one to travel to Petawawa, which should be a little bit easier in terms of ground transportation. And that's looking at just under $2,000.

Then we have the visits to Shearwater in Nova Scotia; Goose Bay in Newfoundland and Labrador; Comox, British Columbia; and Cold Lake, Alberta. That more lengthy and complicated trip is $134,000 and change.

If you wish, you may ask questions, or we can have a discussion about it. No? Fairly straightforward?

Mr. Sweet.