Veterans Affairs Committee on Dec. 6th, 2007

[Willie Lirette]

There is no doubt that there is a difference between services offered in rural areas and those offered in cities. For example as concerns Moncton, where I come from, the rural population comes to Moncton to obtain services. New Brunswick's three major hospitals are located in Moncton, Saint John and Fredericton, the northern part of the province. I am sure that the same problem exists in Ontario, Alberta and Newfoundland and Labrador.

Another problem in rural regions is the lack of public transit. In cities, public transit exists. Based on the 2006 population statistics published by Statistics Canada, seniors and the population at large from rural regions tend to move to capitals or large cities. Services are more readily available there, especially treatment for cancer and other diseases.

In New Brunswick, there is a veterans' hospital, but it is located in Moncton. This means that veterans from the northern part of the province must move to Moncton and end their days there. The rural versus urban situation is a definite problem.

[Todd Russell, Liberal, Labrador, NL]

I'd like to hear Mr. Shaw on that.

[Greg Shaw]

It's not that. If you're in a rural or remote area you certainly are disadvantaged in terms of access to health care. It doesn't matter what country you live in. It's the same everywhere. It's a question of what services are available to get people to health care services and what services can be developed that are going to support people within their own community.

I think there are some good examples of very small community nursing posts and nursing stations that certainly do support small communities. In some rural settings, people have access to general health care more quickly than most people in cities have access to health care.

There are both disadvantages and advantages. If you're talking about specialist care, clearly specialist care is delivered in major urban settings. So there's got to be transport and support mechanisms to get people to those specialist care networks. I don't think any government can say we will have equal access to specialist health care, no matter where you live. No government can do that.

[The Chair, Conservative, Rob Anders]

We'll now go to the Bloc Québécois, to Monsieur Gaudet, for five minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chairman.

I am lucky because my mother turned 98 in October and I spoke to her last night at 10:00 p.m. She is in great shape. Mr. Perron was talking about this. Our father died at home and we would also like that to be the case for our mother. I think it's a matter of attitude, but it is quite probable that it will be different with the baby boomers. We tend to congratulate each other because nobody else congratulates us very often. So let's give ourselves a pat on the back.

Mr. Marcel Gagnon travelled across Quebec to study the situation of seniors and the Guaranteed Income Supplement, and I believe that other provinces were also involved. It was a good thing. In fact, one of our MPs, who is a priest, is also doing the same thing.

I wonder whether we should not also undertake a travelling study with regard to veterans. I don't know. We should perhaps launch a crusade to inform veterans of their rights. Last week, we met with someone who, for seven years, has tried to be recognized as a veteran. He served in the armed forces for 20 years. He fought in the war in Bosnia. In fact, he fought in several wars. So he has been trying for seven years, and he still has not been recognized as a veteran. This means he does not get a pension, and he also suffers from post-traumatic stress disorder.

This is what I'd like to know. In your opinion, how can we best help these people? As you said, it will probably be quite different for baby boomers. I get the impression that it's not the member of the Quebec Federation of Senior Citizens or of the Fédération des aînées et aînés francophones du Canada who are causing a problem. Rather, I think it's those people who are not members of these organizations.

I don't know what to do. A little earlier, you suggested a solution familiar to the government. I would like to find solutions. I think that we all know what the problems are. Now we need solutions.

I would like all three of you to respond.

[Willie Lirette]

It is not easy to find solutions. Research tells us what we need to do. I don't have this research with me now, however. Last week, I attended a conference on research into aging which was held in Ottawa. Every researcher said that seniors had serious nutrition and health problems. If I want our associations to work with veterans, I will have to contact them, which is something we have not necessarily done.

Many veterans are members of our associations. But they are simply regular members, and do not have the status of veterans. It's important to find out what it is that veterans want, who they are and what their problems are. I had the impression that the new veterans' hospital in my area had addressed that problem in the province. I don't know what the situation is elsewhere in Canada.

The solution is to see what is being done at the local level and to trust people. Our association has a network of 300,000 people, including the Quebec Federation of Senior Citizens. We could really help seniors and I believe we can do a better job than government. We have good projects, but once they're over, we don't have the means to carry on. When we have a nine-month project and we study a situation, such as elder abuse or transportation problems, once the project is over, there is no follow-up. We find solutions, but we cannot apply them. I'm talking about small, short-term projects which do not necessarily meet the needs of seniors at the local level.

The problem is that the government studies the issues, develops projects, and once the projects are over, it washes its hands of them.

[Roger Gaudet, Bloc, Montcalm, QC]

Mr. Ryan.

[Marc Ryan]

Mr. Gaudet, I would like to add the following. If you and I, together with the seniors' organizations in your riding, used electoral lists to find out exactly where neglected seniors are living, we could put together a group to meet with them. I think that's the solution. I would not want to indoctrinate them politically—

[Roger Gaudet, Bloc, Montcalm, QC]

No.

[Marc Ryan]

All I want is to see if they have needs and to define these needs. It's what I would call screening. But when you try to do screening, there can be problems with the Privacy Act. In my view, it is easiest for our small community organizations to reach these people, in their homes, rather than with a purely federal program.

[Roger Gaudet, Bloc, Montcalm, QC]

And you, Mr. Shaw?

I'm interested in hearing Mr. Shaw's response to this. Since he works for an international organization, I would like to hear his solutions.

[Greg Shaw]

There is a mechanism to track veterans. You're not always going to get feedback or access to veterans.

I'll make a point. My father was a Second World War veteran. He never belonged to any returned service league association, but he was known as a veteran because he held a gold card in Australia, so we knew—all the veterans in Australia.

Generally there are ways to get information to inform government about issues and needs of veterans. I look at the network of returned service league associations that exists worldwide, and there must be returned service league organizations across Canada that can come together to inform government of the issues of veterans, whether it be concerning what specifically government is looking for or something else.

Within the Australian sector, we consulted heavily with the NGOs supporting veterans about the issues and health care needs and the programs needing to be developed to support their ongoing needs. That was an ongoing review process. The minister for veterans had an advisory council that reported back to the minister on the needs of aging veterans.

[The Chair, Conservative, Rob Anders]

Thank you very much.

Mr. Hawn has been incredibly gracious in standing in for Mr. Sweet for this meeting. He came over with me from the House of Commons. Of course he's very much involved with the national defence committee on a regular basis, and what have you.

Subbing for Mr. Sweet, it is now his chance to ask a question, with the committee's consent.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you very much, Mr. Chair, and thank you all for being here.

As a veteran, I want to make a quick comment on the clawback thing, and then I have a couple of specific questions for Mr. Shaw.

There is no clawback. What has happened is that when veterans retire, they go from one source of retirement pension, which is under the Canadian Forces Superannuation Act, plus the bridge benefit, until they hit age 65. They now get it from two sources: the Canadian Forces Superannuation Act plus the Canada Pension Plan.

The Canada Pension Plan is designed to replace the bridge benefit. The amount of Canada pension somebody gets will depend on what they've done from the time they retired at, in my case, age 47 until reaching age 65. If somebody has done very little to qualify for CPP over that period of fifteen to eighteen years, then the CPP they get is going to be smaller.

It's not a clawback. Both programs are working exactly as designed; we're getting exactly what we paid for from both.

We can go back and argue with the design, if we wish, and that's fair, and going forward that may be something somebody might want to look at. But the personal contributions people would have to make in the military would go up very substantially, and they would probably not be happy with that.

It's an emotional issue, and I understand that, but the facts around it are not well appreciated by a lot of veterans. I get people pinning it on me, as a veteran and now a member of Parliament, and asking, “Why aren't you supporting it?” Well, guys, go back and look at it; it's working exactly as it was designed. Argue with the design if you want, but we're getting what we paid for.

That said, Mr. Shaw, you have some good experience, obviously on the Australian side and on the Canadian side now, with exposure to both systems. Can you give us a couple of examples of strengths and weaknesses within the Australian system and the Canadian system, with a view to things we might look at and should be considering here?

[Greg Shaw]

Certainly I can talk about some strengths—and weaknesses.

The Australian system is a national health care program. The entire health care program is nationally administered and delivered through the state or territory governments, but it really is controlled at the federal level. The aged care system in Australia is also a federal system and is controlled and delivered federally. Veterans services is exactly the same.

The advantage is that you get consistency. You have a national health care system; you have a national pharmacare system. People have access to the same level of services, and regarding the costs of those services, it doesn't matter where you live.

But there are some disadvantages, areas where the Canadian system has advantage over the Australian. The Canadian system of delivering health care offers greater opportunities for innovation and development of best practice, because governments provincially can step outside of things that are happening in other provinces and develop their own programs.

While it's an advantage, what I don't see is that the good practices that occur are being translated to other provinces. Is anyone here from British Columbia? B.C. has a very good program for seniors called ActNow BC. I've spoken to people in six or seven different provinces and asked if they knew anything about ActNow BC. They have never heard of it, yet it's a very good program.

That's my point. You have a great system here that encourages innovation and good practice, but you don't share it; we don't learn from it. In Australia, we hinder innovation, because it's a totally federal system.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you for that.

This is a pretty specific thing. It's a situation I was not dealing with, but that was around just last week. We talked about access and making information available and about checklists for where you get service, and so on. One thing I would throw out as a suggestion and to get your comment on is the idea of a checklist at death for veterans—not for the veterans themselves, but for the veterans' spouses.

I was in a situation last week in which a close friend of mine had passed away from cancer, and his wife was dealing with it. She had three people assisting her, three fellow veterans. One was a former chief of the air force and the two others were very senior officers in the air force. They had a real challenge in piecing together all of the things that a widow in that situation, who is obviously under stress, needs to deal with in terms of all the benefits and everything that's there.

It would seem to me that Veterans Affairs Canada should have a one-stop checklist—we talk about one-stop shopping—with all the things you need to do or all the agencies you need to contact. Some of them aren't within DND. Some of them are within DND, but there's the Canada Pension Plan and a whole bunch of different things.

Has anybody contemplated a checklist upon the death of the veteran to help the survivor?

[Greg Shaw]

In a number of countries where they've developed single access points for veterans with information on services, they would generally have that information available for widows. One of the issues in many countries is that once the veteran dies the widow is quite generally entitled to all the benefits, pensions, and so on from the deceased spouse. It's a minefield for those people to go through, in terms of wanting to know.

In countries that have developed a central point of referral, quite often it's for information or counselling lying within the departments of veterans affairs, and that's where it occurs.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

It doesn't occur here, and I think that's something we should look at.

[The Chair, Conservative, Rob Anders]

Fair enough. Thank you very much.

Now we'll go back over to the Liberal Party, to Mr. St. Denis. for five minutes.

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

Thank you, Mr. Chair.

Thank you, gentlemen, for helping us out today.

The comments that Mr. Shaw made in the most recent conversation with Mr. Hawn contained a very important point, that being the lack of a system or a regime to share best practices. That's unfortunate, because delays in adopting best practices potentially hurt the people who.... They are lost opportunities.

In the last meeting we had a witness from the Gerontological Advisory Council, and there was a researcher with the department. They talked about some pilot projects that involved tracking a group of veterans and in some cases their spouses. I think it included B.C. These people were on track to get older and go to a nursing home without any home care, whether it was just shovelling a driveway or helping with the grass or cleaning a house. We don't automatically associate these things with health, but I think most of us certainly would agree that they are health-related. If you're not strong, you can't cut the grass. If you can't cut the grass, it's less possible for you to stay at home. It can be a vicious cycle. They also tracked a cohort of veterans, in some cases with spouses, who did have home care. They did an analysis. This is a crass measure of success, but they used monetary cost. What was the cost to the country of one group versus the other, on average? They found that on average, those who got home care cost the system less.

Now, add to that the quality of life, of being able to stay in your home longer--even until your final hours, if possible--versus having to live in a home. Those are difficult to measure, but they are certainly benefits.

From either of our two delegations here, or both, is it your view that the study represents, anecdotally, the truth? It comes back to best practices, because we should be adopting this generally--not only for veterans but generally. Does it make sense to help people to stay at home longer, not only for quality of life but for cost?

[Willie Lirette]

All the research indicates that what you have said is true. The more the government helps us to promote health, for instance through a physical fitness program...

We have a program called "Grouille ou Rouille", 'Move or Rust", which has been in existence for 30 years without receiving any government funding. In southeastern New Brunswick, 700 people participate in this program. We have just convinced our new government just how important this program is for maintaining good health.

All the research supports what you said. The longer seniors are active and independent, the less it costs the health care system. This is a fact that is supported by research throughout the country. However, there still is not enough money in this type of health promotion.

I mentioned earlier in my presentation that in my province less than 1% of the total health care budget is spent on health promotion. The rest goes towards finding cures.

We have many exercise and health promotion programs, and forums on health. Health Canada has supported us greatly in this area. However, it seems that the federal and provincial governments do not realize that health promotion is important.

Recently, there was talk about giving us a program on elder abuse, but there was not enough money for us to develop a good national program which would mirror the one we have.

Yes, it's true, and research proves it. I can produce other research if you want showing that home care reduces the cost of health care, and this is important to seniors who wish to live independently as long as possible.

[Marc Ryan]

Every study shows this, and any investment the government makes in home care is done because it's much cheaper.

The longer we can keep someone at home, the better it is in terms of cost. There's no doubt about it.

There is a checklist, which is yay long. There are just so many services--I've gone through this exercise with my own parents--as to cutting nails, taking baths, and all of these things as we age that we can do less and less. With a number of things, we approach a time when it's beyond home care.

That's when spaces in a long-term care facility... We need a home for these people. It's a very relevant issue. This is just the tip of the iceberg: soon there will be a great number of people who cannot be cared for any more by their natural caregivers. What's more, there are no spaces. Waiting lists are already very long.

[Greg Shaw]

What is shown through the provision of home care services is that traditionally when people were looking at moving to nursing homes or long-term care facilities, 15 to 20 years ago, they were seen as accommodation options. Mom can't cope at home anymore, because Dad's gone; it's too much work, so she needs to be in a nursing home. And that was the only option. So the average length of stay of a nursing home resident 15 years ago was probably five to 10 years.

If you talk about the average length of stay of a nursing home resident today, I'm not sure what the statistics are for Canada, but in Australia it's less than two years. When I started in the health department, it was five years. So you can actually measure the success of your home intervention programs by the decline in the average length of stay in a nursing home.

It would be great if the average length of stay in a nursing home was under a year, because we know that people are being supported at home for much longer, with only very short-term interventions in a very unfamiliar setting in long-term care.

[The Chair, Conservative, Rob Anders]

Thank you.

Now we're moving over to the Conservative Party. And Mr. Cannan, I just want to say thank you very much for having accommodated Mr. Hawn.

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

Oh, it's a pleasure. We're all a good group here working together to improve the quality of care for veterans. I think for all that's our goal. I appreciate our witnesses being here today for our meeting to see how we can move that agenda forward as soon as possible.

Mr. Shaw alluded to it, and I'm very familiar with the ActNow BC program, as I come from British Columbia and represent the area of Kelowna--Lake Country, which has demographics of the highest senior population in Canada, according to the CMA.

Looking at it from a veteran's perspective, we talk about improving quality of care--the old ounce of prevention, pound of cure. There's reference to some reports of quantifying, and I know that it's very difficult. I spent nine years in local government, and coming to the federal government...we don't do long-term planning. In local government there's usually a 20-year plan, and in federal government, as you alluded to, you don't look at the long-term perspective.

One of the challenges is the partisan nature, and it doesn't matter which party is in government. I think it's always a realistic perspective of provincial and federal politics. How do you see that being overcome? Do you have some quantifiable studies where you can actually show the figures? We know from a common sense and logical perspective that it is, but have you been able to do any studies over a time period of 10 to 20 years to actually quantify that research information?