Veterans Affairs Committee on May 11th, 2009

[Carlos Lourenso]

From the analysis we've undertaken and the research, I think the pressure comes in the new services that are evolving from the provinces. At a certain point in time we had very little, and then home care emerged. We had nursing homes and old folks homes with different types of titles. What we see now is this emerging piece in the middle--things that you've heard of, like retirement living, supportive housing, assisted living--and all of these different care modalities that are being developed by provinces and in other jurisdictional authorities.

Our challenge is to try to ensure that within the authorities we have at this given day, we're able to renew our policies so that veterans can continue to access the services that best meet their needs. If someone is well enough and chooses to stay at home, then we should be able to support them at home. If they can't stay at home anymore but they don't really need a nursing home, then our challenge is to be able to support them in that place that exists in the middle, in that supported living environment. The greatest challenge for us now is to find ways to be able to consistently apply a supportive policy framework for veterans across that continuum, seeing that this evolution of these middle programs differs across all of the different provinces.

[Greg Kerr, Conservative, West Nova, NS]

Good. Thank you very much.

I have a bit of time left here, and my colleagues will have some wonderful questions in a moment, but I really do want to home in on the contract versus the community beds and get a better understanding of exactly what a contract bed is and why it's losing favour, I guess, or becoming less desired, or whatever way it was that you put it. Can you tell us a bit more about where a contract bed would be, what it would be, and why it is not as much in favour today?

[Carlos Lourenso]

There are different types of contract beds. And it depends on the agreement we had with the province or the facility at the time the beds were transferred to the province.

In a place like your area, Soldiers Memorial Hospital is a facility that has 25 contract beds in it. Those contract beds are for veterans only; civilians can't get into those beds. We pay the full cost of those beds. The programming is essentially the same as the programs in the provinces.

As for other contract beds, if you go to B.C., the deal with B.C. was that when we transferred the facilities to them, they took the facilities. We have a number of beds that we have priority access to, contractually, and we don't pay any extra for those beds. So the province contributes to them, as they would for any other bed. The resident contributes. We ensure that the resident pays a standard $856 and we don't pay any more.

In some places in Atlantic Canada, the agreement was that we pay the full operating cost--Soldiers Memorial, Camp Hill, Taigh Na Mara, places like that which you might be familiar with. It's the same situation with some other big ones in Ontario--Sunnybrook, Perley Rideau here in Ottawa, and the Parkwood Hospital in London. Those are the big ones that we pay, and veterans have a priority access to those facilities. In some of them we offer specialized programming based on the needs of the veteran profile in that area.

[Greg Kerr, Conservative, West Nova, NS]

So for a veteran, it could be more costly for them individually to go into some of those contract homes.

[Carlos Lourenso]

No. The cost is always the same.

[Greg Kerr, Conservative, West Nova, NS]

So why are they losing favour with the veterans?

[Carlos Lourenso]

Generally speaking, most contract beds are located in large urban-centred facilities. People want to move to smaller facilities that are scattered across the country in their communities.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Kerr.

Thank you, Mr. Lourenso.

We'll go to the Liberal Party, and Madam Foote, for five minutes.

[Judy Foote, Liberal, Random—Burin—St. George's, NL]

Thank you for being here, for your presentation, and for your eagerness to take questions from those of us around the table.

I was listening with interest to you talk about your program that enables veterans to have renovations made to their homes as the need arises. At what point is the decision made that you will no longer make renovations so the veteran can stay in his or her home? Some of the things you referenced were changes to a washroom, or maybe a ramp into a home. At what point does it become too costly? For instance, would you put a bedroom downstairs? Is there a point where you would no longer make renovations and move that veteran into a long-term care facility?

[Carlos Lourenso]

I can speak to that from one perspective, and Colleen can speak from another.

On what we can and cannot do, we have different levels of approval for costs. Essentially, for us, the limit on what you can do to somebody's house is based on their health, safety, and security. We can build a ramp, and we have built a new bathroom on a main floor. There are a number of modifications--some of them quite significant--we have made to people's homes to allow them to live there for a subsequent number of years. From a cost-effective perspective, if you look at spending x number of dollars to create a bathroom on somebody's main floor and then look at the cost of institutionalization, it becomes a pretty good option.

We have different levels of approval, financially speaking. At a certain point it doesn't become cost-effective anymore, or you're trying to keep somebody at home and fundamentally jeopardizing their safety and security. They're not able to be at home anymore.

Would you like the details on the levels?

[Judy Foote, Liberal, Random—Burin—St. George's, NL]

Is that decision left to the veteran when it comes to their safety and the level of care they receive, or is it made by the Department of Veterans Affairs?

[Carlos Lourenso]

It's made by our health professionals. A core assessment is undertaken, usually through a registered nurse, and then there are branching assessments. In a case like that we would have physiotherapists, occupational therapists, registered nurses--any specialist required--fully assess the situation to ensure that an appropriate modification would assist the person to remain in their own home safely and securely for a period of time. In the VIP, we make the decisions in the end, but they are made in very close consultation with veterans, their families, and those most concerned about them.

[Judy Foote, Liberal, Random—Burin—St. George's, NL]

In a situation where a veteran wants to remain in his or her home, the spouse is still living, and it's been determined that it's in the veteran's best interest to stay in the home, what happens if the spouse becomes disabled? If it's determined that it's in the veteran's best interest from a psychological perspective to have him continue to live in the home, will you make renovations to accommodate the spouse?

[Carlos Lourenso]

We don't have the authority to provide benefits to the spouse. We have the authority to ensure that the veteran is able to remain secure and safe in the home, so services can be provided. If his spouse had been providing services to him in order to achieve those outcomes, we would be able to implement services that would substitute for those she had been providing. But we couldn't make renovations specific to her physical incapacity.

[Judy Foote, Liberal, Random—Burin—St. George's, NL]

For a veteran to access the VIP program, is it necessary for the veteran to be seen by a medical doctor?

[Carlos Lourenso]

No.

[Judy Foote, Liberal, Random—Burin—St. George's, NL]

Just explain to me how it works, then.

[Carlos Lourenso]

A veteran would make an application, a contact, to us. The process would involve, initially, a screening of sorts to determine service--they served in whatever capacity they served--and eligibility, and some other key factors. But essentially, the decision about VIP is, first of all, that they have the right service, either through their service disability pension, their income status, or their frailty level. There are a variety of different ways to get VIP. Then the decisions about VIP are made based on our assessments. Area counsellor assessments, which are essentially done by our social workers, and our nursing assessments are the main core assessments used to decide what services will be put in place. Sometimes there will be a medical doctor, if that's required.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Lourenso.

Thank you, Madam Foote.

Now we'll go on to Mr. McColeman for five minutes.

[Phil McColeman, Conservative, Brant, ON]

Thank you so much for your passion for your work, which is very obvious to all of us.

In 2008 our government expanded services, as was mentioned. How many of the survivors are now eligible for services? Do you have actual numbers of people who benefited as a result of that expansion?

[Carlos Lourenso]

I can tell you how many applications have been approved. It's 2,252 as of a week ago.

[Phil McColeman, Conservative, Brant, ON]

Okay, and do you have any sense of the number who are eligible?

[Carlos Lourenso]

We had potential uptake projections of around 12,000. We're sitting at that number now. We have close to 300 applications pending. We've also commenced a fairly aggressive outreach program to find where survivors are to see if we can increase those numbers. We don't really know where it will land in the end.

[Phil McColeman, Conservative, Brant, ON]

I'd just like some clarification, just to expand to the next step. Mr. Stoffer brings up the ideological argument that everybody should be covered, no matter the income level or whatever. He mentioned that you assess people individually and that there is an income test. Is that correct?

[Carlos Lourenso]

Do you mean survivors?