Veterans Affairs Committee on Nov. 21st, 2022

[The Chair, Liberal, Emmanuel Dubourg]

I call the meeting to order.

Welcome to meeting number 26 of the Standing Committee on Veterans Affairs.

Pursuant to Standing Order 108(2) and the motion adopted on Monday, October 3, 2022, the committee is resuming its study on the impact of the new rehabilitation contract awarded by the Department of Veterans Affairs on the role of the case manager and quality of service delivery.

Today's meeting is taking place in a hybrid format, pursuant to the House order of Thursday, June 23, 2022.

To ensure an orderly meeting, I would like to outline a few rules for witnesses and members to follow.

If you are on the video conference, please click on the microphone icon to unmute yourself. When you are not speaking, your mike should be on mute. Interpretation services are available for this meeting. You have the choice of either floor, English or French.

As a reminder, all comments by members and witnesses should be addressed through the chair.

Pursuant to our routine motion regarding connectivity tests, I want to let the committee know that the witness went through the necessary testing before the meeting.

I would like to welcome our witnesses.

We have Ms. Angela Aultman, case manager and president, local union 90002, Union of Veterans' Affairs Employees; Amanda Logan, case manager and president, local union 60006, Union of Veterans' Affairs Employees; and Whitney McSheffery, case manager, Union of Veterans' Affairs Employees.

Yes, Mr. Richards.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I have a point of order.

I'll just say this briefly because I don't want to take time away from our witnesses. I think it's very important we hear from them. I wanted to make a quick comment as a point of order this morning.

We had received an amended notice for this meeting indicating committee business time in the last 15 minutes, during the time when we do have veterans. I guess it's been changed now and there's only one veteran, but we did have veterans scheduled.

It's concerning to me that any time we have witnesses scheduled and particularly when it's veterans.... They're given a very short period of time. To schedule that kind of committee business situation and cut into their time should only be done where it's absolutely necessary.

I would ask that you, as chair, commit to having a conversation with, at minimum, the vice-chairs of the committee and, ideally, the members of the steering committee in the future before making such a decision, to determine whether that is, in fact, a reasonable incursion on witness time.

I'll ask if you could commit to having those conversations in the future, prior to cutting into witness time.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Richards.

I understand your concern. As you know, it's extremely important for us, and I think for all members of the committee, to work for and listen to veterans.

At the same time, I have to tell you that you have elected a chair and we also have a clerk working with us. We are doing everything we can to have the committee functioning correctly.

Sometimes it's happened, as in this situation.... Right now we have one hour with three witnesses, and we were supposed to have two witnesses for the second hour. The clerk deals with those witnesses every day. One of them said at the last minute that she was sick and couldn't be present. Even this morning, the clerk got in contact with her again and she said that she was not available.

With the other one, there was a lot of discussion, and we are pleased that in the end he said that he was going to buy a headset and would be able to participate.

I saw that we had one hour with one veteran—one witness. Also, this is our last meeting on that study, so we have to give instructions to the analysts to do the report. It has to be in camera.

We also have the budgetary allocations.

The agenda is extremely tight. That's why the chair, in discussion with the clerk, came to that conclusion. Even during the weekend we discussed that. You have to be confident in the chair with the schedule.

[Churence Rogers, Liberal, Bonavista—Burin—Trinity, NL]

On a point of order, Mr. Chair, we do have a vote scheduled for one o'clock. We need 15 minutes to get back to our offices or to Parliament in order to do that. On what we see scheduled here, obviously, we need to finish 15 minutes early, before one o'clock, to vote.

[The Chair, Liberal, Emmanuel Dubourg]

Yes, Mr. Rogers. I think we can deal with that in the second hour, because the vote is around one o'clock. We need to have a unanimous decision on that, on what we're going to do about the vote.

We're ready to go. Are there any other interventions?

[Blake Richards, Conservative, Banff—Airdrie, AB]

Quickly, as a follow-up, Mr. Chair, I appreciate.... I've been in your position. I've chaired committees in the past myself. I understand what you're dealing with and what the moving parts are, and I know that decisions have to be made. I am indicating to you that I think what would be helpful as chair in situations like that is to have a communication with at minimum the vice-chairs, and ideally the members of the steering committee at least, just so we're aware of what is going on. Perhaps there can be alternative ways of dealing with things so that we don't cut into witness time.

It would be my estimation in this situation, for example, that we do have an in camera meeting to deal with a report on the 28th, which is a week from today, and we could have probably added those items to that agenda. That would have been a suggestion to deal with it.

I'm just saying that in the future I would ask that you commit to having a conversation with your colleagues prior to making decisions like that. That's all I'm asking.

[The Chair, Liberal, Emmanuel Dubourg]

Okay. That's great. I understand that.

As you can see, the clerk has already taken action on that this morning and has sent an email to you explaining why we're going to have only one witness for the second hour.

Mr. Desilets, did you have something to add?

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

I fully agree with the member. We should do everything in our power not to cut our witness time.

If I'm not mistaken, we were first told that the schedule would be changed and then told that one of the witnesses would not be appearing. That was the sequence of events, wasn't it? I just wanted to confirm that. We should make the most of the valuable time—

[The Chair, Liberal, Emmanuel Dubourg]

I understand perfectly. It's true that members were told about the change in schedule first, but further to the back-and-forth emails and discussions that took place, the clerk and I felt we needed to inform all of you at the same time if there wasn't time to discuss it with the vice-chairs. That's what the clerk did when she sent everyone the email explaining what happened. Rest assured that, going forward, we'll do a better job of communicating with you to ensure the committee runs smoothly.

Now, honourable members and ladies and gentlemen, let's proceed.

Ms. McScheffery, you'll be going first.

The floor is yours for five minutes. Go ahead, please, Ms. McSheffery.

[Whitney McSheffery, Case Manager, Union of Veterans' Affairs Employees, As an Individual]

Thank you. I'll be starting.

Mr. Chair and committee, thank you for inviting me here today to speak about this important issue impacting our Canadian veterans.

I began my career at Veterans Affairs Canada six and a half years ago with the belief that I would be able to positively contribute to and enhance the livelihoods and well-being of our Canadian veterans and their families. This position was a perfect fit, considering my education as a social worker. As well, I was the daughter of a veteran, experiencing my father being deployed and the struggles we faced as a family upon his retirement. Four years later, my older brother would deploy to Afghanistan, again in 2012, and most recently to Latvia. I am also the spouse of a U.S. Army veteran of the 101st Airborne, who deployed to the early invasions of Afghanistan and Iraq, and was injured in his last tour. I have personally witnessed how war changes our loved ones.

I am all too familiar with and extremely proud to be part of the lives of military families and military culture, but for many civilians, there exists an ignorance as to what the reality is truly like in re-establishing in civilian life after these experiences. Veterans' physical and mental health issues are often complex and multi-layered. Operational stress injuries, moral injury, chronic pain and psychosocial issues are just the tip of the iceberg.

My great concern with this rehabilitation contract is that privatizing these services will only serve to further isolate our veterans from their government and their community—and from the public service employees who have their best interests at heart, rather than a bottom line, a policy or a profit. Our veterans already face difficulties trying to relate to others who do not understand their experiences and the residual impacts those experiences have on their social integration, emotional support, self-esteem, identity, sense of coherence and trust. This contract will undoubtedly exacerbate these psychosocial challenges.

I cannot explain to you the helplessness I feel when my veterans ask me what this contract means for them and their re-establishment. I am unable to provide them with reassurance or comfort when I myself am faced with so many unknowns about what my work will look like and how much control I will have in ensuring that they get what they need. I cannot ensure that they won't have to build trust with yet another stranger, expose their vulnerabilities and retell the darkness they are living in.

I fear that for a long time the department's expectation of case managers has been to simply placate and manage veterans' anger and frustration. As a social worker as well as a public servant, I have the responsibility and an ethical obligation to respect the dignity and worth of the person, uphold integrity, and advocate for the importance of human relationships and social justice. The uncertainty of this contract prevents me from espousing these values and ethics, to the point that this year I chose not to keep my social work registration. I felt I was unable to uphold these values and ethics within my workplace.

I'm left with the feeling that the department is using this contract to further distance themselves from veterans and their families, and that it serves to abdicate their responsibility to uphold their very mission, mandate and values by minimizing the relationship with their case managers. Since March 2020, I have been unable to see my clients face to face. My office remains closed to the public. The department has ceased our ability to perform home visits with veterans and their families, which was a critical tool in building rapport and trust. Building rapport with clients by phone or virtual call is nearly impossible. These decisions do not honour the sacrifices of these dedicated heroes, and they certainly do not foster the trust, care, compassion or respect that they deserve.

During my first month on the job, I was given 45 files, which steadily climbed to 62. When we expressed our grave concerns, not only for our own mental health but for the quality of the service to the veterans, management's only reply was that the work would always be there. Within a year, I began experiencing severe burnout and anxiety, to the point where I was waking at night with panic and with nightmares of my clients dying of suicide because I couldn't keep up.

Many times we were working not with a sole veteran but also with their spouse and children. We were managing families. This is a grave responsibility when you feel as though you're drowning. Life as a case manager is incredibly challenging, but it's also one of the most rewarding experiences I have had the honour of doing. The ratio of 30:1, let alone 25:1, has never been a reality for us. We have been told that this is an unrealistic expectation.

Being silenced, gaslit and invalidated by the department has been one of the most demoralizing experiences of my life, but I vehemently refuse to give up advocating for better service for our veterans and our heroes. That is why I am here today.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you so much for your statement.

Now I would like to invite Ms. Amanda Logan to speak for five minutes or less.

Go ahead, please.

[Amanda Logan, Case Manager and President, Local Union 60006, Union of Veterans' Affairs Employees, As an Individual]

Mr. Chair and committee members, my name is Amanda Logan and I'm a local president in New Brunswick. I've been a case manager for almost five years.

I was taught from a young age that it is important to be able to speak and interact with others, to get to know people, learn about them and understand them. My strength is my ability to connect with others. When I meet with a veteran, I genuinely enjoy getting to know them and taking the time to listen and ask questions. I am interested, and I want to help.

When people talk about their passions, I think this is mine. This is why I became a case manager. This trusting relationship or working alliance allows veterans to share their trauma, the challenges they deal with each day, their fears. This trust allows them to feel comfortable to voice what they need. Can you imagine being in that position, being vulnerable in this way? It is not an easy thing to do to share this information with a stranger, and it is even more challenging during a global pandemic when we are unable to see veterans in person.

This relationship is the foundation that a veteran's case plan is built on.

Right now we are under tremendous pressure to meet deadlines for the transition of case management services to the third party contractor. We are doing this at the same time as we are trying to help veterans and their families. Since June, we have asked questions about the implementation of the new contract, only to be told that this information is forthcoming—a time that has not yet come.

There has been no meaningful consultation with case managers. We've been instructed to adhere to the changes and to do it quickly. We have not been properly trained on this new rehabilitation contract. We have only been provided with an informational 52-step process and new acronyms.

It is very challenging to know what to share with our veterans to prepare them for these changes when we do not know ourselves. Our worth as case managers is no longer measured by our ability to connect with veterans and assess and develop their case plans with care, compassion and respect. Our worth today is measured by data, stats, ribbons, complexity levels and concluded files.

We often talk about high caseloads. The promise of managing 25 cases never happens. Let me be clear. This has a direct impact on our ability to meet our mission of providing exemplary client-centred services. With upwards of 40 files, our process becomes diluted. We are more susceptible to making mistakes. This has consequences for our health and well-being. Quite frankly, it keeps us up at night. We worry whether something has been missed and what kind of impact that could have on our veterans and their families.

I often hear from our veterans that they are coming to us after struggling on their own for so long. In the past, we have had the autonomy to develop that individualized plan. This allows us to put measures in place to ensure that our veterans feel safe so they can begin to heal. Case managers work at the veterans' pace, meeting them where they are, bridging the gap between our expectations and where they are coming from. We do this because they have been injured serving our country and their lives have been completely changed because of it.

I am afraid that in the future, this piece will be lost. I am afraid that veterans will be forced to adhere to rehabilitation plans that are guided by specific and hard timelines, and that their rehabilitation plan will be prescribed by a contract that was awarded through a tendering process, not developed from the veteran's physical and mental health needs. I am afraid that if they are not able to participate in the streamlined process, they will face cancellation of the program and file closure, a financially and emotionally devastating measure.

As case managers, we are worried about how all of this will affect our veterans. I am afraid that this new contract will reduce the role of a group of workers who are an experienced, well-trained group of professionals who want to serve our veterans and their families. We have knowledge, integrity and commitment to service. We take pride in our role as public servants. We can make effective decisions and are accountable for our work to our employer and, most importantly, to our veterans and their families. Just imagine how well we could do this work if we had appropriate resources and permanent funding in place.

As a final note, I want you to know that I love my job. I'm honoured to work with veterans and their families. I'm thankful for the organization and my colleagues. This is why I'm here today sharing my concerns on behalf of my union and my fellow case managers.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much for that, Ms. Logan.

We will now hear from Angela Aultman for five minutes.

[Angela Aultman, Case Manager and President, Local Union 90002, Union of Veterans' Affairs Employees, As an Individual]

Thank you very much, Mr. Chair.

Thank you for the opportunity to speak today in support of my colleagues and my veterans.

I've been a case manager just shy of six years. Prior to coming to VAC, I was in a case management role with another federal government department. A key factor in in my decision to change departments was the opportunity to make a real impact in the lives of our esteemed veterans, as well as their promised commitment of a 25:1 caseload. A lower caseload was appealing, as I believed it would allow me to effectively invest my time and resources, and that I could develop strong and trusting alliances with the veterans I serve. This is something that can make all the difference in whether intervention is successful.

Within my first six months with VAC, my caseload was up to 48. It is currently sitting at 40. This means that it's harder to be as effective as I’d like to be and to give my veterans the time and attention they deserve. As a result, I'm skeptical of the reassurances that the new contract will not mean the loss of case management positions.

Case manager retention has been a problem with the department since before my time. At one point in 2018, I was one of two case managers in my office for a period of three months, as case managers left due to burnout. I have continued since this time to see good case managers doubt their skills and abilities and leave the department, noting that this is not what they signed up for—not because of how they interact with veterans, but because of the heavy administrative burden within the role and the prioritization of documentation over quality client contact.

Measures put in to provide support are temporary, and it's hard to balance our commitment to the work and service to our veterans. Term employees know that their position is not guaranteed and could be terminated at pretty much any time. That's a disservice to all case managers and to our veterans.

Coming back to the rehab contract, we anticipated a new provider for vocational-specific services, not the contracting out of the entire rehabilitation program. We were told we could shape what the contract would look like. We were told we would have meaningful consultation in the process. Even as part of the working group, this did not occur. Over the past 18 months, much of our information came from town halls that didn't allow any dialogue. They called it consultation, but it was presentation.

This contract has caused a lot of stress. We were pressured to close files, complete a six-page document outlining how to best work with the veteran, and complete complexity assessments. This meant more time with paperwork and less time with veterans, and I simply did not get the necessary training to effectively navigate this transition for myself or for my veterans.

On November 1, we finally got a question period. I was alarmed to learn that while veterans migrating to the new contractor can keep their providers, new applicants will have to use the contractor providers. Failure to do so means cancellation from the program for non-participation. This is a significant loss in veteran autonomy, which is a key point in re-establishment in civilian life. Providers with extensive veteran experience have voiced concerns about registering with the contractor, as it would mean lower pay. My concern is that veterans will not have access to local providers as a result.

In light of my experience with veterans, I need to say that my greatest concern is for our veterans navigating the onboarding process of the new rehabilitation program. We have yet to see the new computer system, and I have not been advised as to how to initiate the referral to the contractor in the first place. More importantly, I implore you to consider the newly released unwell veteran having to navigate these various systems and having to retell their story while struggling with complex needs and without resources.

Gone is our opportunity to stabilize these unwell veterans before referring them to a contractor. Under the new process, everything is happening in tandem. The veteran will undergo assessment with us, Veterans Affairs, and with the rehab service specialist. They'll do a case management plan with VAC and a rehab plan with the contractor, and all of this is prior to connection with providers.

It's my experience that when these kinds of veterans encounter this many challenges, they will disengage. The unwell veteran is whom we're going to lose and who will fall through the cracks. This is where lives are at stake, and this is what keeps me up at night.

I’d like to share a story. It's one that all case managers have experienced. A veteran comes to us seeking help via the rehabilitation program. They're focused on their physical condition—it could be their lower back or rotator cuff, for example—and are identifying this as their only concern. I recognize that there's more going on, because I’m engaging with this person. I suspect PTSD. The veteran is defensive about their mental health and denies any challenges or impacts, stating they're just there for that physical condition. Over the next six months, I utilize motivational interviewing and I connect with gentle conversations regarding mental health, at the end of which the veteran states, “I don’t trust psychologists, but I trust you, so I’m going to do the assessment.” This starts a path of healing that changes everything for that veteran and that veteran's family.

I can do this because I don't have a bottom line to answer to. We all have our success stories, and we carry these with us. A veteran once remarked to me, “Please don't ever stop doing this. I can tell this is more than a job for you. This is a calling and veterans need you.”

I'm a case manager, and despite all the challenges that entails, I've been very proud to be a face of this government and proud to support our veterans. I'm humbled and honoured that veterans have allowed me to walk in darkness alongside them. I strongly believe that the veterans who have been injured in service to our country at the direction of our government deserve a government face in their healing and not a for-profit company.

To veterans everywhere, thank you for your service. Thank you for trusting us with your experiences, your stories and your rehabilitation. We continue to carry you with us.

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you so much.

To all three of you, thank you for your interventions. I can understand the way you feel.

Right now, I'm going to ask members to ask you questions so that you can continue with your testimony.

This is a round of six minutes each.

I would like to invite Mrs. Wagantall to take her six minutes, please.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you so much, Chair.

To each of you women, I want to say thank you. You are the voice of our veterans in this circumstance, and I deeply appreciate your bravery in coming and sharing your hearts today.

Briefly, I would like to ask the three of you about this. You talk of 40 to 60 files and the promise of 25. The Auditor General's report made it clear that VAC has not lived up to this promise, and certainly has not created the environment that needs to be there, which means more case managers like you, yet the decision has been made to change the whole process. It deeply concerns me.

We have $5.6 million over five years, with 25% of that going to profit a company, as you mentioned. On your response to the comments that this is being done because of the administrative burden you face, which would be lessened by bringing this about, I would like to know if that administrative burden would be lessened significantly if more case managers like you were hired, to the point where you were dealing with 25 cases.

If you could each just briefly comment, that would be wonderful.

Do I see Whitney?

[Whitney McSheffery]

Yes. I'll start.

Yes, certainly. Just the volume of work definitely impacts that. Also, the promise that our administrative burden will be lowered by this contract, I believe, is false, because in the one Q and A we got, back in August, it specifically stated that the contractor is not even able to do letters, which is what they initially sold us on to try to get our buy-in on this contract. They said, “You will be doing less letter writing in terms of the resources you're putting in for veterans.” In fact, that's not the case, because the contractor does not have the delegated authority of case managers.

That's just one part of the puzzle: volume, letters and things like that. There are lots of things that the department could be doing to lessen our administrative burden with administrative assistance, but they have chosen not to do that.

Thank you.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

That's perfect. Thank you so much.

Next is Amanda or Angela.

[Angela Aultman]

Yes, the administrative burden has been an issue for a very long time. What we were asking for—and have been for a long time—is a reduction of the administrative burden. I do believe that with 25:1 and a streamlining of some processes, particularly the elimination of duplication of documentation and those sorts of things, this would be more manageable at 25:1.

Initially, when I first started and was promised a 25:1, which didn't happen, part of the training was that for two weeks I had a caseload of 22. Then they jumped it up to 48 within two or three weeks. Even during that two-week period, I felt like I was more effective, more engaged and more accessible to the veterans.

In fact, one of the veterans complained to my manager following that rapid increase. They noticed that I wasn't as accessible as before. The direction to me from that was that I had made myself too accessible at the outset, because I was very invested. It wasn't that the caseload number was the problem; it was that I was too accessible at the outset. I do think that at 25:1 I could definitely be more effective in case management.

Thank you.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Angela. I do appreciate that.

Mr. Chair, how much time do I have left?

[The Chair, Liberal, Emmanuel Dubourg]

You have two more minutes.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Okay.

Amanda, maybe I'll get you to respond to this concern that I have.

I'm very connected, as many of us are, with rehabilitation service providers that exist. A lot of them have veteran programs, created by veterans, that are incredibly effective. I see the approach being taken here, which gives the impression that we shouldn't worry and that we'll have plenty of lead time, but we have a situation here in which people who've been making a significant difference through you are no longer going to be allowed to do what they are very passionate about.

What are your concerns about those individuals or organizations that will no longer be part of serving our veterans?

[Amanda Logan]

I think that's one significant point, but it's also about the impact it's going to have on the veteran. If and when the time comes that they will have to change a provider, that will be devastating to them. It's not going to have a positive result, and we have a tremendous number of providers registered with Medavie Blue Cross at this particular time.

I know Whitney can provide some information there too.

[Whitney McSheffery]

Yes. The promise of 9,000 providers is very small in comparison to the number of providers we have access to through the regular Medavie Blue Cross providers right now, many of whom decided not to register for this contract because the pay is lower and it takes them longer to get paid. The payment goes from VAC to the contractor and from the contractor to the provider.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Whitney, do you have a list you could provide to this committee of the current service providers?