Veterans Affairs Committee on Sept. 26th, 2012

[The Chair, Conservative, Greg Kerr]

Thank you very much, Ms. Mathyssen. That's your five minutes, believe it or not.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

It goes so fast.

[The Chair, Conservative, Greg Kerr]

It does.

Mr. Hayes, for five minutes, please.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you very much, Mr. Chair.

It's a pleasure to be here and ask my first question at this committee.

It's interesting. I have four family members who left the military. None of them were case-managed.

This question is for Ms. Bastien. You made the statement that your case management practices are world class. I'm hoping you can elaborate on why you would make that statement and what constitutes “world class”.

[Charlotte Bastien]

We have a solid program. We do research. When I say research, we don't do research in case management, but we do research on best practices; we exchange best practices, and we keep up to date. We do have experts within the department who keep up to date worldwide on best practices and case management and ensure that we have a good learning program and a good competency program for our case managers, to support them in doing their job as case managers.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you.

Ms. Stewart, in your statement you mentioned that we're here today to talk about strengthening case management, which is in fact the truth, so it obviously assumes that there were weaknesses in the previous system. Here's what I want to know. What was the process you went through to identify those weaknesses? What were some of those weaknesses? How have those weaknesses been corrected?

[Charlotte Stewart]

Well, like any organization, you're going to evolve. You're going to change. In our organization, we have, over time, shifted from an organization focused primarily on war service veterans. We are now moving to having more Canadian Forces veterans than war service veterans.

In and of itself, that has created some change. The needs and expectations of the Canadian Forces veterans are different. That wouldn't point so much to weaknesses or deficiencies in the system. It would point, instead, to a system that needed to be modernized and updated to reflect those needs and demographics.

I think we're very cognizant now of the requirements of the Canadian Forces veterans, much more so than we were 10 and certainly 20 years ago. That's been a gradual shift.

How do we know? We have various means. First of all, we do client satisfaction surveys. That is an important tool, but it's not the only tool. Our own case managers told us very directly. In fact, they led reviews in the department to give us feedback on how things were looking from their perspective relative to their abilities and their own satisfaction in serving the newer veterans. They gave us excellent advice, guidance, and recommendations, which have been, actually, cornerstones of the program we have in place now. In addition to that, we get feedback from veterans organizations and the ombudsman. We accept and in fact encourage a variety of feedback. That has shaped our agenda, and will continue to do so, frankly, because it is a five-year action plan.

I can say that even since we first launched it about 24 months ago, it's changed. And we're always trying to do that to reflect best practices.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

How's my time, Mr. Chairman? Do I still have time for one more?

[The Chair, Conservative, Greg Kerr]

Sure. You're doing great.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you very much.

This is just a question about a tool that identifies risk factors in veterans. Please accept my apologies; I don't understand risk factors in veterans, so I'm hoping you can talk a little bit about what that means and how that tool identifies those.

[Charlotte Stewart]

Risk can mean different things.

When it comes to using these tools, what's important is that there are a number of factors that have to be looked at. There is not just one. Even the word “risk” in a risk assessment is actually a compilation of many different factors. For instance, you can have an individual who has a profound physical condition. When we look at him or her, our goal is to assess and support the person making the transition to civilian life in overcoming any impediments to that. So we're going to assess that individual's capability or risk of making that transition.

Within that, though, you might say that if the person has a profound physical issue, that's probably going to cause a transition problem. But in fact it does not in all cases. Here's an example. Someone who has a lot of family support, who is adapting well to that physical condition, and who perhaps had training in the military that is very adapted to civilian life, may present with low risk for transitioning to a successful civilian career or civilian life.

It's not a simple approach. Yet when you interview an individual, when you engage the person's family, when you develop, as a case manager, an understanding, as they do, of how to tease out information from the person and begin to do this assessment, these words take on a very important meaning. It really comes down to asking if this individual is at risk of not adapting. Is he or she at risk of something more severe? Mental health conditions can lead to more severe situations. It's very important that the professionals we have use these risk tools to identify a risk profile. We then develop our case plan based on that.

I hope that answers your question.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Yes, thank you very much for that comprehensive answer, and thank you, Mr. Chair.

[The Chair, Conservative, Greg Kerr]

Thank you, Mr. Hayes. Now we'll go to Mr. Lobb for five minutes, please.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks, Mr. Chair.

Just to Mr. Casey's points, as far as district offices or case managers go in his province, I hope as things progress he keeps the committee up to date with the level of service in his community and his province.

The only thing I can say is that, geographically, my riding of Huron—Bruce is significantly larger than Prince Edward Island, albeit the population is slightly less, and there are no district offices in my riding and no case managers live in my riding. I would argue that the one I do know lives in London and works out of London. The commute from London to Clinton is an hour, and certainly I've never had any complaints about the level of service in the four years I've been a member of Parliament.

It is possible, but I do encourage Mr. Casey to keep us up to date with how things are going where he is.

With a case manager providing service to a World War II veteran who's been analyzed, diagnosed, and needs some sort of hearing correction—let's call it a hearing aid—from the date he is deemed to be eligible for a hearing aid, my understanding is he would pay for the hearing aid himself and then be reimbursed by Veterans Affairs. I'm wondering how long it would take to receive the compensation for what he or his family has put out for the hearing aid.

[Charlotte Bastien]

It might not be a case manager; it might be another person in the district office dealing with that.

If the individual already has a hearing disability that's been recognized as linked to his or her service, when he goes to his provider to get the hearing aid, the provider would communicate with the department or a third-party provider and would get authorization. We would take care of the payment and the veteran would leave with his hearing aid. Or if it needs to be ordered, it would be paid for, and then when it's ready he would pick it up from his provider.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Generally speaking, with that scenario, what would be the approximate timeline from the date he was in till the date he received the money in his account?

[Charlotte Bastien]

No, he wouldn't have to pay out of pocket. We would pay the provider. The provider would contact us the day the veteran goes for the exam and gets fitted for the hearing aid or as he's seeing the veteran, and we would okay the provider to bill us, not the veteran. The veteran would leave with his hearing aid and would not be out of pocket. It would be the same day.

[Ben Lobb, Conservative, Huron—Bruce, ON]

There have been a lot of changes to case management service provided to our veterans. I've been on the committee since 2008, and it has been pretty well ever-changing since that time.

You're telling us today, me, other members of the committee, members of Parliament, the veterans ombudsman, that some great changes are being made. What tangible data can you deliver to us that's been mined to tell us what our level of service was before, what it is today, and the proof that what you're telling us is fact? I'm interested to know that.

[Charlotte Stewart]

We do manage our service standards and report monthly. Those are available on our website. For instance, we can attest to the fact that the time to adjudicate a disability award has decreased by 30%. The turnaround time to be accepted into the program for rehabilitation decisions—that's a key program of our front line case managers, and this is where the veteran can receive medical, psycho-social, or vocational assistance—has gone from four weeks to two weeks. Another recent improvement is around our telephone service, where we now have a strong grade of service and response rate around our calling. We do maintain those very actively.

As well, we are always reviewing areas where we can improve or develop service standards that show more current metrics. The ratio of case managers to case-managed clients is very important. That is now a very key indicator. As I mentioned, it's about 30:1, and this is measured monthly as well and reports are available to those who must deliver that service.

Those are some examples.

[The Chair, Conservative, Greg Kerr]

We're there, unless you had a really critical short one. No? Okay, thanks.

That ends the first round. Thank you very much. We'll move right into the second round, a four-minute round.

Mr. Stoffer, are you starting, or is it going to Madame Perreault?

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

Madame Perreault.

[The Chair, Conservative, Greg Kerr]

Madame Perreault, you're on.

[Manon Perreault, NDP, Montcalm, QC]

Thank you for joining us. I am sure that your job is very demanding.

I will not repeat everything my colleagues opposite have said when they thanked you. I want to make myself clear. When we talk about services for people with physical or mental health problems, I know that it is impossible for everything to be perfect, despite all your efforts. I am sure of that.

In committee, I thought that we would be trying to see how we can improve the service for veterans. I want to get this straight. When we talk about case management experts, we don't necessarily refer to your case managers. As a result, when a manager has a problem or is going through a difficult situation, they have to talk to your experts. Is that correct?

[Charlotte Bastien]

It depends. We have some case managers who are more skilled and more experienced. They might not need to consult with case management experts on complex issues.

But we can have case managers with less experience. Although they are very good and qualified, they may seek the advice and support of case management experts in the department or even health professionals, depending on the situation.

Once the goals in the case plan are identified, we look at treatment options. It is important to know what resources are available in the community to help the veterans achieve their case plan objectives.

As you said, things are not perfect. We have some very experienced and qualified case managers. Some are more experienced and some are younger. The young ones have less experience and they are learning. Those young people need to have the proper tools and support to be able to hone their skills and keep them up to date. It is a challenge that we are constantly working on. We need the expertise to be able to maintain and upgrade their skills.

[Manon Perreault, NDP, Montcalm, QC]

I fully understand. I am not questioning your service. On the contrary, I think that you are doing a great job.

Earlier you said there were 250 case managers. In very difficult situations, those people are going to consult experts. How many experts can assist those case managers?