Veterans Affairs Committee on May 11th, 2009

[Carlos Lourenso]

Perhaps I can speak a little bit from my own experience in going out and undertaking assessments. That's a number of years ago now, and they seem to be getting greater and greater all the time.

All services that are allocated to veterans in terms of home care or groundskeeping, personal care, are allocated based on a health need. Many times people, in order to remain at home, actually need fewer services than we think they do. They need services with key activities of daily living and key functions within their house in order to remain independent, but people don't give up their independence. They want to continue doing those things that they can do. So although we have a maximum of $9,000, the reality is that, across the country, the average amount of VIP allocated is much less than that.

If they needed more, they would receive more. There is no limit around the $2,800. The limit is, obviously, almost three times that amount. But it really demonstrates that with some supports in critical areas, people are able to remain independent in their homes for a long period of time.

[Judy Sgro, Liberal, York West, ON]

I don't want to belabour the issue right now, but $8,000 doesn't pay for a lot of home care. I would suggest that they've got a spouse or a family member who's doing one heck of a lot of work and the $2,000 or $2,800 is paying for a limited amount of minimum services required.

But i want to move on to a couple of other areas there.

There's the issue that the eligibility criteria for access to departmental health programs seem to be much more reactive than proactive. What are you doing to try to change that?

[Colleen Soltermann]

With respect to the treatment benefits program?

[Judy Sgro, Liberal, York West, ON]

For all of the programs.

[Colleen Soltermann]

For all the programs. We have criteria that are in place to support veterans with the VIP and the long-term care, and the treatment benefits that we provide support that care in their homes or in the long-term care facility. If they are eligible for the VIP and the long-term care, the treatment benefits come along with it. Our war service veterans, for example, can have access to the treatment that they require to address any health need to the extent that the province doesn't provide that care.

So for the most part, our war veterans, once they're participating in the VIP and the long-term care, can have access to the treatment they need in order to support their health needs while they're at home or in long-term care.

[The Chair, Conservative, David Sweet]

Madam Soltermann, I'm sorry, and Madam Sgro, it's over eight minutes, actually.

[The Chair, Conservative, David Sweet]

Mr. André, you have seven minutes.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Hello everyone.

That is a good question, Ms. Sgro. I am going to continue in the same vein by asking other questions.

You offer home support services to veterans. I understand that priority is given to home care rather than care in institutions. It is less expensive. You offer several services: inhalation therapy, nursing care, housekeeping, assistance with bathing, etc.

In Quebec, in each region, there are CLSCs, local community service centres, where professionals such as inhalation therapists, nurses and social workers are employed. They offer a range of services. In Quebec, there are social economy cooperatives that offer housekeeping services and assistance with bathing to the public. There is a great deal of pressure exerted on the system, because the aging population needs these services.

How do you link these services? When you assess people who need home support services, for example, do you use the same grid to evaluate the number of service hours required as that used by the institutional network for the population as a whole?

Waiting lists are a problem that the health care system is often confronted with. When someone asks for assistance with bathing or home care, his or her name is placed on a waiting list, and it may take some time before the request is evaluated. Are the waiting lists longer or shorter than those for the existing institutional network? Is the program of service and resource allocation more or less generous? Do you evaluate customer satisfaction with regard to the services offered? Often, the existing network provides for only one bath for someone who might need three per week. Services are being cut, and the same is true for housekeeping services.

Is your budget adequate enough to allow you to offer these services to the clientele? It is a big question, but now the floor is yours.

[Carlos Lourenso]

Thank you for your question. It is a big question.

Perhaps I could begin by saying--and this might help to clarify part of the question from the previous member--that the VIP program is intended to top up provincial programs that are available for veterans and anyone else who is eligible. People access the programs locally, as anybody would, through an assessment by their local health authority or, in Quebec, through the CLSCs. After that assessment, they are allocated a certain number of hours or services by the CLSC or by the health authority where they live. After they are allocated those services, we will still take an assessment from Veterans Affairs and see if there are other services or benefits they weren't eligible for or that had hit a limit in the province, and we will augment the services they receive to ensure that the full scope of their needs are being met.

With respect to the question within your overall comments, if someone is on a wait-list for services from the CLSC or a health authority in another jurisdiction, they do not wait for our services. We will apply the VIP services to people while they're waiting for the provincial services. They will not go without. We don't have a wait-list for VIP. If you're eligible for VIP, you, like any other citizen in the province, will access your provincial home care services. When you do that, we will also assess you from a Veterans Affairs perspective and provide you with the additional services you may need, if you need them. If you're on a wait-list and there is an absence of services, we will apply our services at that point.

[Guy André, Bloc, Berthier—Maskinongé, QC]

You state that the services offered to veterans are the same as those normally offered to the general public, except that some of them could be offered through the Department of Veterans Affairs.

I will give you a concrete example. Let us say that I am incapacitated and living in my home. I need three baths per week, but after having completed an assessment and in order to take into account the service cuts, the CLSC provides me with only two. So I tell them that I need three. Do I go to Veterans Affairs to have access to my third bath? Does Veterans Affairs pay the CLSC or the cooperative so that I can have my third bath? Do you use the same assessment criteria for the hours and services?

[Carlos Lourenso]

In that situation, someone accesses the services they need from their local provider. So let's take your example. Two baths is their limit. We will send out our counsellor or a registered nurse to undertake an assessment of you. They agree that you need a third bath in that week, and we will implement the VIP program and offer you the support you need in order to access that additional service. And that additional service can come from a provider of your choice. And we will work with you together; our counsellors on the front end will work with you to determine where you want to receive that extra service. Is it from the same provider of the CLSC? It could be, or it could be from another provider. We don't pay them, we pay you.

One of the beautiful things about the VIP is that it allows people to do self-managed care. They manage their own care as much as possible. So we would say to them that we will give them what they need to get their third bath a week and we will help them decide where they want to get it. When they get it, if they want to pay for it or receive a bill, we will work out whichever method is better for them, and they become the manager, or the boss, of their own affairs.

[The Chair, Conservative, David Sweet]

Merci beaucoup, monsieur André.

Mr. Stoffer, you have five minutes.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you, Mr. Chairman, and thank you, ladies and gentlemen, for coming today.

You're absolutely correct, sir, that those who receive the VIP program are ecstatic about it, but I'm concerned about the ones who apply and are turned down.

As you know, in 2005 the government-in-waiting promised that all widows of World War II and Korean War veterans would immediately receive the VIP service. So my first question for you is this. Are all widows or widowers of World War II and Korean War veterans receiving VIP?

[Carlos Lourenso]

We....

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

It's a yes or no answer, sir.

[Carlos Lourenso]

Could you repeat the question again?

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Are all widows and widowers of World War II and Korean War veterans receiving VIP services?

[Carlos Lourenso]

I don't think so.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you.

I have a gentleman in Halifax named Captain Earle Wagner, whose wife passed away last year. He applied for VIP but was told that he was too wealthy and too healthy to receive it. He lost his primary caregiver, his wife. He was told by DVA that because his wife had passed away they would provide him with the care, but that he would no longer be eligible for VIP service because of his income and his stability.

I have a widow in St. John's, Newfoundland, whose husband passed away. He was one of those World War II guys who never thought about applying for DVA or government services, because people just didn't do that. They didn't ask government for help. He passed away. She was told that she has to have a disability tax credit or have a low income in order to qualify for VIP, and she doesn't have either. She was told by the 1-866 number that if she could get a doctor to give her a disability form that she could use to claim a tax credit on her T4, then she would be eligible to apply for VIP.

Why would you good people, with all your good intentions, make an 82-year-old widow go through that process? All she wants is to be able to stay in her own home. I have dozens and dozens of examples of this nature—people who are turned down by VIP even though their husbands or spouses served in World War II or in Korea. It's frustrating for a member of Parliament to tell them no.

So I'm asking you, as an MP, even though most of these people aren't even my riding, what we can do to improve this situation so that these people can receive the VIP service. I don't think the government did this intentionally, but they have developed a two-tier widow and a two-tier veteran. Yet when they landed on Juno Beach, there was no two-tier system in place. When they landed in Korea, there was no two-tier system. They served their country. We owe them. I don't think we should be putting them through this rigmarole.

My last question has to do with payments that some have to make. If you get long-term service done, you pay $45 or whatever. You pay the contractor, and then you send the receipt to the insurance company and you get it back within 30 days. Some elderly veterans are forgetting to submit all the proper forms. In order to assist them, why doesn't the contractor just charge the government directly and bypass having the veteran do it?

[Carlos Lourenso]

I'll start with the spousal survivor question.

Government has made certain decisions, and government has decided where it wants to be on that question, the scope of the authorities. Our role is to implement those authorities to the best of our ability. We share the same passion to ensure that we can do that, and we implement those authorities the best we can. That's what we've done in the survivor situation.

[Colleen Soltermann]

With respect to the payment aspect of your question, what we've been able to do with our contractor, Medavie Blue Cross, is to have providers register with the provider. The person who's accessing the benefit, say the veterans independence program, won't be paying out of his own pocket if he's using a registered provider. Rather, the provider would be reimbursed by our contracted administrator. We've been able to work with Medavie to ensure that clients won't be out of pocket when they're using registered providers.

[The Chair, Conservative, David Sweet]

Mr. Kerr.

[Greg Kerr, Conservative, West Nova, NS]

I'd like to say thank you for joining us today and for providing us with a lot of information.

I want to make sure we're absolutely clear on this point—all veterans, if there were no veteran program, would be eligible for any other programs provided by their jurisdiction, by provinces, such as home care and the like. I think we should start with that: they are automatically eligible citizens of their particular jurisdiction. This is a top-up program, as I understand it. So what they're getting is over and above what other citizens within that jurisdiction would receive.

Could you comment on that first, just to make sure I'm reading it correctly? Is this a correct interpretation?

[Carlos Lourenso]

That's essentially correct. The VIP is used as a top-up program. We expect that provinces and health authorities would offer to veterans whatever services are available to any other citizen of the province or that health authority.

We do run into situations sometimes, in tight times, when provinces or sometimes health boards find that a particular person presents as a veteran, where they will deflect to Veterans Affairs first. Certainly the client would never be punished or penalized in any way for that.

But generally speaking, you are correct, sir.

[Greg Kerr, Conservative, West Nova, NS]

I think you heard the last questioner say that he's happy with the program. It's those who aren't covered by it or who aren't eligible. We'll get into that, because you very delicately handled that. It's more our responsibility as government, more so than on the delivery side.

On this, though, a terrific amount of review goes on within the VIP, with all the support programs. As you said, it's constantly changing, and you're dealing with a lot of organizations in that regard. Where do you see the greatest pressure coming from as a growth item? The aging is working against them. You said that time is working against them. Where do you see the greatest pressure coming for new program services through the whole of VAC--the VIP, particularly, but through the whole program? Where do you see that pressure coming from?