Veterans Affairs Committee on Oct. 20th, 2009

[Brian Ferguson]

Darragh will answer.

[Darragh Mogan]

And I'll do it in English, sir, just to make sure that my answer is, as I understand it, accurate.

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

It's not a problem.

[Darragh Mogan]

There are two ways in which we provide health services to veterans.

One, when it's related to a war service disability, Veterans Affairs pays 100% of the cost, and it doesn't matter à travers le Canada, it doesn't matter where. The other is where the eligibility is based on income, through the war veterans allowance or the veterans independence program, and we pay what provinces do not insure. So in long-term care, it might be a different amount we pay in Saskatchewan from what it would be in Quebec, depending on how much coverage the individual has as a resident of the province. That's the basic policy foundation for the payment of health services.

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

Unless I am mistaken, in the case of veterans receiving long-term care at Ste. Anne's Hospital, all hours of care are covered by the Department of Veterans Affairs. However, if a veteran lives in Trois-Rivières or Nicolet, for example, since they are usually Quebec residents, long-term care is often provided by the provincial health department in return for a portion of the patient's pension.

Does the Department of Veterans Affairs cover a portion of the costs when the veteran receives services other than at Ste. Anne's Hospital?

[Darragh Mogan]

The relationship remains the same, whether the individual is in l'Hôpital Sainte-Anne or in a licensed community care facility. If the care is for the pension disability—war pension or service-connected pension disability—we pay 100% of the costs, and there's no assurance du Québec. If not and it's another eligibility, we will pay for up to a maximum of what, in the case of Quebec, Quebec does not pay for. Whether it's in Sainte-Anne's, where there is a $115 per day insurance paid every day for a veteran who is eligible for l'assurance-maladie du Québec, or in a licensed nursing home in Chicoutimi, it doesn't matter where, the same principle applies.

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

Are you talking about a drug plan?

[Darragh Mogan]

I am.

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

But if the patient is treated somewhere other than Ste. Anne's Hospital, whether it is in Trois-Rivières, Nicolet, Quebec City or some other place, all of the lodging costs, long-term care, are covered by the province. You are talking as much as $115, but if the patient is not staying at Ste. Anne's Hospital, the health care costs...

[Darragh Mogan]

If care is assured for someone resident of Quebec, it doesn't matter where they are; whether they're in Sainte-Anne's or in un foyer d'hébergement à Trois-Rivières, it won't matter. We'll pay what is not covered by the province. I think our accommodation and meals amount to $850 a day. To give you an example, say the level of support from the province was $1,000 a day and the cost of care was $2,000 a day, then Veterans Affairs would pay so that the cost of care to the individual was only $850 a day, which is our rate.

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

So that is the difference. That's fine. Okay.

[The Chair, Conservative, David Sweet]

Thank you, Mr. André.

Now Mr. Stoffer, for five minutes.

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

Thank you very much, Mr. Chairman.

Thank you gentlemen for coming today.

I have comments on just a couple of issues. First of all, I think the charter has improved the quality of life of veterans and their families; but as in everything, things need to change. One of the things I'd like to see—and this, of course, would require legislative change—is to see the RCMP fully incorporated into some sort of a charter, because right now, if RCMP veterans go to DVA for any assistance they require, they don't qualify for things like the VIP program, etc. So I think a discussion on their inclusion will eventually have to take place.

I also have here information on what the British do for their HM Armed Forces personnel. They've doubled the upfront payment to £570,000 for the most severe injuries or death. That's quadruple what we give. This is one of the things I'd like to see changed. I know we work side-by-side in Afghanistan. The guys are sitting there, thinking: well, if you go, your family gets this; if I go, my family gets that. So maybe it's something to look at in the future.

As well, what's most important is that this or any other lump sum payment does not affect eligibility for any other payment schemes they get. So there must be no deductions, no clawbacks, for example.

One of the problems we have is that the charter will move along and eventually will change to benefit the modern day veterans, yet we still have outlying problems from before. We still have many veterans who are getting the SISIP clawback deducted from their medical payments, or deducted from other payments. That's still a problem.

We have veterans who are still concerned about the marriage after 60 act. If they're married and remarry at 59 and live for 20 years and die, then their second spouse gets the pension. But if they marry at 60 and live 20 years and die, the second spouse gets nothing.

These are old hangover problems that our veterans are still dealing with.

Also, there is the issue with the amount of money a pensioner leaves when he dies. The spouse only gets 50%. That should be bumped up, because in many cases the spouses then dip right into the poverty world.

The Veterans Charter I think is doing an admirable job, but there's no question it needs to be improved.

I have three questions for you.

When military personnel leave the service because of either a physical or mental injury and go into the other public service for jobs, some of those people in those jobs are looking at these guys and thinking, hmmm, if you're not good enough for the military, what are you doing in here? So there needs to be more sensitivity training in the rest of the public service to let them know these men and women are coming from the military and that they should not be treated with kid gloves, but with understanding that they may be going through PTSD issues or some things of that nature. That's one question.

Two, there is the concern about the future of veterans when Sainte-Anne's gets privatized. Or, if it doesn't get privatized, what's going to happen to the thousands upon thousands of veterans who will need hospital care when World War II and Korean veterans pass on? What's going to happen to the modern day veteran in that regard?

Three, we have 220,000 clients at DVA and 750,000 to 800,000 retired RCMP and military personnel, meaning that two-thirds of the people who have served aren't your clients. What are you doing, especially in Veterans Week, to get the message of the charter out to everybody in Canada to say if you're a veteran or the spouse of a veteran, we may be able to help you? Not just through the Internet or through the legions, what are you doing to get that message out there through the newspapers and television and radio to let them know these benefits are out there for them? This type of message went out, by the way, to all of the British papers, so every single person there would have seen it.

Thank you.

[Brian Ferguson]

Thank you very much for your comments and your kind words about the charter and the concerns you've raised.

Before we close, I would like Darragh to talk a bit about the British payment, because we've done a comprehensive analysis of it with an apples-to-apples comparison with our charter, which might be helpful to the committee.

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

Sure.

[Brian Ferguson]

Your point on sensitivity training is well taken. We haven't encountered that problem, but I can understand your concern that it could be a factor, that people might be saying what you mentioned. To be honest, I haven't heard anywhere else that it's an issue, but we are working with DND very closely, so I will follow up on your remarks to see if it's something of concern.

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

I could give you some private examples.

[Brian Ferguson]

Could you do that, sir? That would be very helpful.

Secondly, with respect to Sainte-Anne's, there's one clarification to make: we are not considering privatizing Sainte-Anne's, if that's the terminology used.

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

Sorry--transferring to Quebec.

[Brian Ferguson]

Okay just to clarify.

Thirdly, in terms of the need for long-term-care beds, our indication is that Canada has a lot of capacity in this area, which veterans are accessing, and we see utilizing the Canadian social safety network with the kinds of programs we have.

Darragh, perhaps you could elaborate on that point and then talk a bit about the British experience.

[Darragh Mogan]

When Veterans Affairs, in 1946, acquired a lot of this large hospital capacity, there wasn't anything out there in the community at all. With the coming in of medicare, social safety nets, established programs, financing of things that all parties support over the years, there are now 220,000 to 235,000 long-term-care beds. In terms of making a selection about where they're going to go when they need long-term care, home would be the best place to go if they can do it, of course, but if they need to go into an institution, as it were--to use a pun, given this committee--they'll vote with their feet. They'll go into the community eight to nine times out of ten. We have a lot of experience to show that. We feel the Canadian Forces veterans are probably like the traditional veterans: if you give them the choice to go into the community, that's where they'll probably go.

Second, we would need a parliamentary change. We need a significant regulatory change to re-establish for Canadian Forces veterans what the traditional veterans had. We have to remember, there was no choice back in 1946 for traditional veterans.

Mr. Stoffer, you raise the British experience. I notice that Mr. Allard is here from the Royal Canadian Legion, so he's had a look at the paper we've prepared on this and made some corrections to it. Generally, what has happened is the British went to a lump sum system the year before the new Veterans Charter came in. The tariff doubled it to £500,000 to £560,000. My son lives in England, and I know that the price of a gallon of gas there is almost two and a quarter times what it is here. He paid $800,000 for a small home where he lives in northern England--and it's a very small home. So the cost of living is a little different.

Secondly, if you look at the top four tariffs that the Ministry of Defence has, for the most severely disabled, there may have been one or two awards. There have been none at the top tariff yet, despite the fact that their military is three times as large as ours and they've had bigger deployments since 1990.

I have great respect for what the Ministry of Defence in Britain does. The job placement program we adopted holus-bolus, and I think it has the elements of success. I think the apples-to-apples comparison suggests that in terms, at least, of the amount of the disability award, things are not quite what they would seem with that direct dollar-per-pound comparison.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Mogan and Mr. Stoffer.

Now Mr. Storseth for seven minutes.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

Thank you very much, Mr. Chairman.

Gentlemen, thank you for coming in today.

I'll piggyback on Mr. Stoffer's point. The sensitivity training for the public service may be one thing, but I think a lot of these men and women in my area end up going into the private sector. I think what we need is better education on this for the Canadian public in general, particularly for things like PTSD and some of the things that some of our guys are going through when they come back. Oftentimes this is diagnosed years after they come back from Afghanistan, so it is something we need to see throughout our society as a whole, and not just in the public service.

I'd like to ask you, first of all, what tools you've used to evaluate the success of the new charter.

[Brian Ferguson]

One of the biggest tools is the program evaluation that's coming forward. It will be the most comprehensive review of the charter, in terms of a formal evaluation in the three phases we talked about. Even before the launching of the evaluation, we've had feedback mechanisms that have been in place. For example, the new Veterans Charter advisory group, which has issued its report, has been reviewing the charter for some time now and has been identifying areas that they think need to be improved and areas that are working well. We have the special needs advisory group, which is a group of severely disabled veterans who provide direct input to us on a regular basis. We have a lot of interactions from our staff, obviously. The feedback that we get on a daily operational basis is very important to us as well. The cases that come across the desk are learning experiences for us in the department. So we have a variety of mechanisms.

I don't know if I've missed anything there, Darragh.

[Brian Storseth, Conservative, Westlock—St. Paul, AB]

As far as these advisory groups, can you give me an example of who they're made up of?