Mr. Chairman, members of the Standing Committee on Veterans Affairs, I am very pleased to be here today.
You have been briefed by Veterans Affairs Canada officials on the new veterans charter program and on the continuum of care in the context of veterans health care programs. We are somewhat surprised that these briefings did not include any reference to the recommendations in your committee's report, “Resetting the Bar for Veterans Health Care”. Nevertheless, allow us to comment on what you were told by VAC officials. We fully recognize that they also care for veterans but ultimately must operate “within their authorities”, as you are told repeatedly.
You were told that VAC has adopted a continuum of care with an integrated, seamless system of needs-based services along a life course. You were not told that VAC has not adopted recommendation 1 of your report “Resetting the Bar”, which was asking for a “redesigned veterans health care program” for “all surviving war service veterans from the Second World War and the Korean War” and all “Canadian Forces veterans”. The modern veterans still do not have access to long-term care and that is a gap in the new veterans charter.
You were not told that, according to recommendation 3 in your report, access would be based “on need rather than on the basis of veterans status”. Even though one may be tempted to think that the language used by the VAC officials could suggest that a needs-based approach has been adopted for the three components of health services—treatment benefits, long-term care, and the veterans independence program—the reality is that very complex criteria grids are still in place.
I invite you to look at our brief. You will see an example of what I'm talking about. There are four pages of Veterans Affairs Canada policy. If you turn to page 2 of those four pages, you will note that there are some indicators for the tables at pages 3 and 4. Those indicators mean that there's a simple symbology attached to the criteria grids.
For example, E means that you're eligible; E with a number means that the client is eligible if a qualifier applies; E with a semicolon between the qualifiers indicates that each qualifier stands alone; and E+ means that both qualifiers must be met. When you turn to pages 3 and 4, you will see what the criteria grid looks like. I would suggest that if somebody is calling NCCN, the national client contact network, and asking for information about his or her eligibility, the analyst who's answering the phone had better be well versed in this type of information or the wrong information might be provided.
Note that we are not advocating a complete elimination of eligibility criteria, but surely these criteria grids could be streamlined to three or four basic criteria.
Similarly, we are not advocating access to long-term care for all modern veterans. That might be unaffordable. However, access could be provided to modern veterans who served in special duty areas or special duty operations such as Afghanistan, and to medically released Canadian Forces personnel.
You were told that VAC must eliminate gaps between VIP--the veterans independence program--and long-term care. But VIP is not a panacea. Veterans may indeed choose to stay at home for longer periods. They may ultimately elect to go into community facilities at a time when they are truly frail. You were not told that their caregivers may suffer burnout; ultimately, they will be unable to look after their spouses as they themselves may require access to long-term care. As well, the longer one delays transition into long-term care, the bigger the needs will be. In some cases, institutionalization is the only choice.
You have been told by Veterans Affairs Canada that where there are vacancies in contract facilities all efforts are made to open up these beds to community clients. You were not told by Veterans Affairs that couples continue to be separated at the end of life, including some of these caregivers who have suffered burnout, as VAC contract beds are made available to community placements. No real priority is assigned to spouses in a standardized fashion across the country.
You were told by VAC that they now speak the language of the Gerontological Advisory Council report, “Keeping the Promise”. Even though you were told they have adopted the lingo, you were not told that they have not eliminated the barriers and have not implemented appropriate screening tools to identify high-needs veterans. Keep in mind its complex eligibility criteria grid.
You were told about joint Veterans Affairs Canada-Canadian Forces integrated support teams to look after the critically wounded soldiers returning from Afghanistan. This is indeed an excellent initiative, championed by the Chief of Military Personnel in the Canadian Forces, which will pay great dividends, and we applaud that. However, it is unfortunate that this concept was not implemented sooner.
Another reality is that the majority of these modern veterans have not yet transitioned to veteran status and are still under the care of the Canadian Forces. Even though these wounded warriors may have benefited from some elements of the new veterans charter, they have not yet tapped the full resources of the new veterans charter in the context of the family of programs available to them.
Furthermore, some may be eligible for a permanent impairment allowance but cannot collect this allowance until they retire, which seems grossly unfair, especially for the critically wounded. More challenging is that those who have been critically wounded in Afghanistan may not be provided with adequate financial resources until the current earnings loss benefits, ELB, criteria are resolved.
As for looking after high-needs veterans, you were not told that Veterans Affairs Canada is facing challenges in case management. VAC's internal evaluation of a pilot project of the Halifax rehabilitation case management reveals significant problems with “case plans not conforming to the principles of case management”. Problems have been identified with respect to “fragmented directional guidance, unclear boundaries for case management, confusion surrounding roles and responsibilities...inappropriate approach to case management...and a focus on benefit delivery rather than case management”. Those are not my words. Those are the words of Veterans Affairs Canada.
More than anecdotally, this description of the problems in the Halifax district appears to be consistent across the country.
You were told that adding eligibility for Canadian Forces veterans for long-term care is a political decision that will have to be considered in time, while, over time, our plan is to specialize the care and services offered in contract beds we now have for the older veterans. In that context, it may be that larger contract facilities are the only ones that have the capacity to look after high-needs residents, including critically wounded warriors returning from Afghanistan.
You were not told that if decisions are not made in a timely fashion to increase eligibility for modern veterans, the significant investment made by VAC in some specialized contract facilities might be at risk. In that context, you may wish to look more closely at what is happening at Ste. Anne's.
For example, after the transition to provincial authorities, will veterans still have access to the same number of priority access beds as exists currently, relying on normal attrition to eventually reduce demand, as has been done in all the larger priority access bed facilities in the country? What will happen to the day program currently serving the needs of veterans who are not yet ready for institutionalization? What will happen to the national centre for post-traumatic stress that is housed at Ste. Anne's? These are important questions.
You were told by VAC officials that the government made a commitment to invest $900 million into the new veterans charter programs over the first five years of the program. You were not told that by VAC's own accounting they have exaggerated the financial resources required, which seems to be a trend in all VAC program forecasts.
You were told by VAC officials that it may not be adequate to “ask a family of four to survive on 75 per cent of a private's salary for two years while a private is going through rehabilitation”, but that it is “better than what there was pre-charter”. You were not told that the reality, pre- and post-charter, is that the private would in most instances, if medically released, really be receiving the same two years of benefits, not from Veterans Affairs, but from SISIP, while any disability pension payments would be offset from SISIP benefits, an unfair policy that persists to this day.
You were not told that after SISIP rehabilitation, the private could be eligible, under the Pension Act, for a non-taxable disability pension for life, which would be greater than his guaranteed 75% salary taxable at the time of release under the earnings loss benefits. Keep in mind that a Pension Act payment is a payment, a disbursement, while an earnings loss benefit is a “guarantee of”, which has deductions attached. You were not told that, under the Pension Act, monthly disability pensions, non-taxable, would be the same whether you were a private or a colonel.
Since the new veterans charter received royal assent in May 2005 and was implemented in April 2006, VAC feels that the expectations created by VAC with central agencies upon program approval were “highly unrealistic”, and again, those are their words. We would suggest that these were not expectations; rather, they were a commitment that under a living charter concept the issue of lump-sum disability awards versus disability pensions would be reviewed within two years of program implementation and gaps would be addressed.
These gaps are known. They exist in the following areas: need for improved family support services; need for provision of adequate financial security; and need for improved rehabilitation services. All these needs are further amplified in the New Veterans Charter Advisory Group report that was released on October 1.
Unfortunately, the reality is that we now have two classes of modern disabled soldiers, most of whom are still serving in the Canadian Forces, while the CF appears reluctant to release them until we are out of Afghanistan or at least until the Canadian Forces has resolved the issues of return to work, accommodation, and/or universality of service. In practice, this means that still-serving wounded soldiers are receiving either disability awards post-2006 or disability pensions pre-2006, and that frustration among the ranks is growing to a boiling point as they are comparing the financial benefits in both programs.
It is becoming obvious that some are less than enamoured with the new veterans charter benefits. It is also becoming evident that critically wounded veterans may not be provided adequate financial security under the new veterans charter.
The Legion cares for those who serve and those who have served. They and their families need our support. A living charter has to be more than words. If the required urgent corrective actions and improvements to the new veterans charter are not implemented, we will come to the logical conclusion that the foundations of the new veterans charter are built on sand.
Thank you.
