Veterans Affairs Committee on Dec. 3rd, 2013

[Nathalie Pham, Manager, Client Service Team, Montreal Office, Department of Veterans Affairs]

Thank you for the question.

Veterans have access to case management services based on their needs. All veterans—regardless of their service, demographic profile and where they live—have access to those services based on their needs, which are assessed when they turn to the office for assistance.

Mr. Hillier talked earlier about the tools used to identify veterans' needs in relation to case management services. Over the past few years, we have invested a great deal of effort to ensure that the response was provided in the most timely fashion possible. Mr. Hillier said that the department has introduced intensity tools that measure the risks that prevent an individual from transitioning to civilian life. We use those tools to identify the needs in case management services.

[Manon Perreault, NDP, Montcalm, QC]

Are there any criteria that lead to a veteran's automatic acceptance, or is the assessment based on individual needs?

[Nathalie Pham]

The assessment is focused on the veteran's needs. No distinction is made among veterans when it comes to access to case management services. Access to those services depends on the needs of the veteran and their family.

[Manon Perreault, NDP, Montcalm, QC]

How can you determine when an individual is ready to stop using a case manager's services? Is that a decision you make with your service and the veteran, or can a veteran continue to receive those services even if you have decided they should stop?

[Nathalie Pham]

Case management is an engagement process with the client. We identify the needs and the objectives veterans and their families want to meet. Once the results have been achieved, the next step consists in “disengagement” because the individual no longer needs case management services.

It goes without saying that the veteran can decide to stop receiving case management services at any time. We stay in touch with them and provide them with services as long as needed.

[Manon Perreault, NDP, Montcalm, QC]

What happens if you determine that the veteran does not need that service, but they want to continue receiving it?

[Nathalie Pham]

A relationship is established between the case manager and the interdisciplinary team supporting the veteran. The decision, which is always based on the need, involves the veteran and the case manager. Case management services continue to be provided if they are necessary. That does not mean that the department distances itself from the veteran. Veterans have access to a range of services and to support from the department staff at all times.

[Manon Perreault, NDP, Montcalm, QC]

Okay.

You said earlier that a veteran can stop receiving services when they want.

If a veteran decided to stop receiving the services, but their loved ones knew perfectly well that this would not be the right thing for them, could they get in touch with you? Could that result in closer monitoring?

[Keith Hillier]

Certainly in the case management plan, we always encourage family members to participate. The veteran can bring who she or he wants: a friend, a buddy, a spouse. It's up to the veteran.

I want to be very clear. The reality is that our case managers do not provide clinical intervention. They are there to support and to work to develop the case plan. It is the veteran herself or himself who has to go to their medical treatments, whether it be for physical injuries or mental injuries. Certainly we would encourage the family to encourage the veteran to keep appointments and to use medication or treatments, whatever has been prescribed by the medical experts.

But at the end of the day, if a veteran refuses to participate in the medical plan, we really have no control over that, other than moral suasion, to try to work with the veteran and his family to say, “You really need to keep doing this, because if you want to get better this is what you need to do.” As a doctor said to me one time when I worked in Ottawa and I had a knee problem, “Keith, it isn't going to get any better on its own, so you better get some treatment.”

[The Vice-Chair, NDP, Peter Stoffer]

Amen. Thank you.

We now move on to Mr. Hawn, please, for five minutes.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you very much, Mr. Chair.

Thanks to our witnesses.

My niece is a case management supervisor in B.C., and I do appreciate how hard they work.

You mentioned that 40:1 is the national standard. Who set that standard and how does that compare with our allies, the U.S., Great Britain, and Australia?

[Keith Hillier]

Ms. Pellerin will start, and then I'll add, Mr. Chair.

[Anne-Marie Pellerin]

There are different models of case management. As Mr. Hillier has said, our case managers ensure that there's coordination of service. We don't provide the direct service. In terms of informing our case management practice across the country, we rely on the research and the best practices in the case management industry. For a population such as ours, the general standard is around 40 cases per case manager.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay. Does that compare with other veterans services in other countries?

[Anne-Marie Pellerin]

It would be similar, but in other countries the case management model is a little different than ours.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Fair enough.

I really want to talk about access. I don't think there's too much argument that, if you put them side by side, there are many more benefits and services and so on that are available under the new Veterans Charter than under the old Pension Act. The big challenge is access, actually getting those services to the veteran.

Mr. Hillier, you were around under the old Pension Act. I would suspect—well, I'll let you answer—that there were as many complaints about access under the Pension Act as there are under the new Veterans Charter. Is that a fair statement?

[Keith Hillier]

I think that's fair, yes.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

So access is not new.

[Keith Hillier]

Access is not new. What's new is that we're dealing with a new generation, not just as it relates to veterans. If I look at my family, my kids, they're from a different generation. They want it now. They want an answer this afternoon. In fact, sometimes that's possible. Sometimes when you get into serious cases, in order to make sure you get the best outcome for the veteran, you do need to involve a number of medical professionals to get their opinion. Sometimes, yes, you can have this, but it may not be the right answer because it actually could be contrary to the better health outcome.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Now, I'd like to challenge you a little bit, because so many times veterans apply for something, it's denied, and then they go through the veterans review and appeal process. Normally they go through at least.... Well, if it happens on the first appeal, I think that's probably a little bit rare. They eventually, if they need it, will get it, but they have to jump through so many hoops to get to that stage.

Is there anything we can do, thinking outside the box, to do that appeal process up front instead of making the veteran jump through all of these to finally get a yes? Sometimes the answer is no. Sometimes it has to be no.

[Keith Hillier]

Yes.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

But for a whole lot of guys and gals, if we got them the service up front and then maybe did some due diligence after that, we might have a lot happier group of folks out there.

[Keith Hillier]

I'll start off, Mr. Chair, by saying that at the first application, in the vicinity of 70% of veterans get a yes or a partial yes: their claim is accepted in full or in part.

I might want to point out that through the initiatives that have been announced by the minister and previous ministers, we've done a lot of work in the area of letter simplification, explaining to a veteran what we looked at, what evidence we looked at, and why we came to the conclusions we did.

There was also the recommendation that came from the veterans ombudsman. In his report of January 2013, he recommended that in cases where there appeared to be some missing information, we actually call the veteran before we render the final decision. We've been doing that. We're finding that in some cases, a no will turn into a yes—which is good.

There's also the fact that if a veteran, without having to go to the Veterans Review and Appeal Board, finds there is a piece of information that was missing or that they didn't have at the time, they can send that in to us and we will do a reassessment. It isn't necessary to go to the Veterans Review and Appeal Board. Then, of course, if the answer is no at the departmental level, they can go to VRAB.

I think the best advice I've given to veterans and veterans organizations, and when I've gone to Canadian Armed Forces bases and wings, is to make sure you get all your information up front. If you look at the statistics, you will find that the 70% probably grows to somewhere between 85% and 90%.

One of the things I keep telling people is that if you don't have the medical documentation—if the infamous CF 98, I think it's called, is not in your file—we do take witness statements. So if something happened, you can have witness statements, which we will accept in lieu of the documentation. I think keeping the information up front....

I also want to point out, Mr. Chair, that Veterans Affairs Canada has about 50 employees across Canada who are dedicated to helping people complete their applications for disability benefits.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Mr. Hillier, and thank you, Mr. Hawn.

We'll now move on to Mr. Lizon, please, for five minutes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

Thank you, everybody, for coming to the committee.

Mr. Chair, I would like to join my colleagues in wishing all the best to Mr. Hillier. I hope he will have many fruitful years ahead of him.