:
Good afternoon, everyone.
I call this meeting to order.
Welcome to meeting number seven of the House of Commons Standing Committee on National Defence. Today's meeting is taking place in the hybrid format, pursuant to the House order of September 23, 2020. Proceedings will be made available via the House of Commons website. As you are aware, the webcast will always show the person speaking, rather than the entirety of the committee.
I wish to bring it to your attention that we have a total of six witnesses on the docket for today. I will prewarn you that I will be particularly strict when it comes to time issues and your allocation of time for questions. I think it's really important. All of these witnesses have something to contribute to our study, and I want to say thank you to them for joining us today.
I'll welcome our visitors with short bios. We have Carole Estabrooks, adjunct professor at the school of public health at the University of Alberta. She was chair of the Royal Society of Canada's working group on long-term care. Its members include other esteemed members we have heard from. The working group issued a policy briefing in June of 2020 that outlined the deficiencies in our long-term care sector and recommendations for action.
:
Thank you very much, Mr. Brunelle-Duceppe.
[English]
We'll continue.
Réjean Hébert is a professor in the school of public health at the Université de Montréal. He was a member of the chief science adviser's task force on long-term care, again, talking about recommendations for how we address the challenges of combatting COVID-19 in long-term care homes.
Then we have Mr. Richard Shimooka. He is a senior fellow with the Macdonald-Laurier Institute, and he writes extensively on the Canadian Armed Forces.
We have Madam Michelle van Beusekom, who is a co-founder of Protect People in Long-Term Care. It's an ad hoc citizen's group formed in April of 2020 to encourage decisive action to address COVID-19 in long-term care facilities.
Then we have two officials from the Department of National Defence, namely, Colonel Scott Malcolm, deputy surgeon general, and Major Karoline Martin. She was the commanding officer for the Canadian Armed Forces personnel deployed into long-term care homes.
Considering the number of witnesses before us today, I have asked them to try to limit their introductory remarks to five minutes. However, considering that some had already prepared 10-minute speaking notes or background documents, I would like to seek the members' agreement that the longer documents, once translated, will be provided by the witnesses to be appended to the evidence of this meeting.
Some hon. members: Agreed.
[See appendix—Remarks by Carole Estabrooks]
[See appendix—Remarks by Réjean Hébert]
[See appendix—Remarks by Richard Shimooka]
[See appendix—Remarks by Michelle van Beusekom]
[See appendix—Remarks by Col Scott Malcolm]
The Chair: Thank you, everyone. I appreciate that very much.
With the administrative part of the meeting complete, we will begin with the opening remarks of Professor Estabrooks, please.
In Canada, we are fortunate we have the capacity to call upon the Canadian Forces in crisis.
I'm thankful they stepped up to provide care in nursing homes during the first wave of the pandemic, going into unfamiliar and besieged care settings with little time to prepare. I'm grateful they stabilized parts of the long-term care system that had moved into deep crisis, preventing further suffering and unnecessary death. I am grateful they fulfilled their duty to report, and that those stark reports riveted the attention of Canadians and our leaders on the unfolding catastrophe.
In Canada, over 80% of total COVID deaths have been in long-term care, far outpacing any other country in the world. How could this happen? It could happen only by valuing older adults, and in particular older adults with dementia, less, and only by valuing nursing home care less than the care in hospitals and ICUs.
We knew early in the pandemic that things in care homes were not good and could quickly become catastrophically worse, that attention and action favoured the young and the hospitals, and that decades of inattention, of managing on the thinnest of razor edges, had created these conditions. Still, when the military reports of COVID conditions in nursing homes came out, we gasped, we wept, and for some, a smouldering rage began. I regret that our men and women of the armed services had to step in, but I'm glad they did.
Our governments and our society have known, or should have known, what was happening. For example, the Royal Society of Canada report on COVID-19 and the future of long-term care identified over 150 media reports in the last 10 years about the state of nursing homes in this country. For over 50 years, reports of abuse, insufficient resources, neglect and so on in long-term care have been produced by governments, organizations, unions and the media. In the last three decades alone, over 80 Canadian reports have been produced at considerable cost and common themes have emerged, but little has been done. Every event was seen as an independent and siloed occurrence, and not part of systemic and long-standing problems.
At the heart of the long-term care and workforce challenges, in addition to ageism, is also undisguised sexism. Caring for the elderly in long-term care is considered “just women's work” that anybody can do. This is, of course, patently false. This is complex, demanding and skilled work. It is delivered by personal support workers of whom over 90% are older women and over 50% are immigrants. They are paid the poorest of any worker in the health system, often without benefits or the security of a full-time position, with poor preparation and little to no ongoing education. It's our modern-day workforce of the 17th-century Elizabethan poorhouse.
Before I end, I want to speak briefly to mental health among the military and civilian workers under COVID conditions. We know they are facing and will continue to face mental health challenges. In Italy, early estimates of moderate to severe anxiety and PTSD among long-term care workers approaches 50%. Mild symptoms approach 90%. These effects will linger for years and decades, but they will be less devastating if we act now to support the front-line workers and the older adults in care homes who have survived.
I am pleased to see support for the mental health and well-being of military personnel who were on a temporary assignment. We must turn now to the mental health and well-being of long-term care staff on permanent assignment, who have no such support.
In conclusion, I want to thank the standing committee for inviting me. The long-term care system into which we place our cherished loved ones has endured long-standing neglect because of undisguised discrimination toward the old and toward the women who do the honourable work of caregiving.
COVID-19 conditions in nursing homes have brought forth the deepest existential fear of many Canadians—the fear of dying alone. Just as Passchendaele has come to symbolize the senseless slaughter and unimaginable suffering of Canadians who served, COVID-19 in nursing homes has come to symbolize unnecessary death and senseless suffering among those who built Canadian society and who worked to make this one of the most desirable countries in the world in which to live.
We do not need more commissions, inquiries or reports. What we need is a modern-day equivalent of a bold Marshall plan and its resources to accomplish a root and branch overhaul of the long-term care system. If we do nothing, then once the vaccines are administered, once COVID-19 has passed, once memories fade, once new priorities take centre stage, nursing homes will return to pre-COVID conditions until the next virus. It doesn't have to be this way.
Our oldest citizens can live serenely, enjoying the last stage of life in nursing homes where their carers have time to contribute to the quality of their lives and to provide high-quality care. We can choose which it will be.
Thank you.
:
As I was saying, I support the comments that Ms. Estabrooks has just made. I completely agree with her analysis.
Since we have less time to address you, I'm going to focus instead on a number of facts that should outrage all Canadians.
In this first crisis, Quebec experienced true “age-icide”. I use that word deliberately, because that is really what it is all about, in my opinion. In Quebec, 10% of people living in a CHSLD died during the first wave. In Ontario it was 2.3% and in British Columbia it was 0.6%. Of all the European countries, only Spain has figures somewhat similar to ours. In that country, 5.3% of people living in long-term care facilities died from COVID-19. The death toll was twice that in Quebec.
Why did Quebec experience such a massacre? Several reasons can be cited. I will list some of them, so that what Quebec went through never happens again, in this province or elsewhere.
It became clear that in Quebec, living conditions in facilities like CHSLDs had been neglected over the past three decades. First, CHSLD management and governance have been completely “swallowed up” by much larger health care facilities. As early as 2003, the boards of directors and executive management of CHSLDs were eliminated, and CHSLDs were merged with hospitals and local community service centres in all Quebec communities. This first major reform in 2003 caused the CHSLDs to lose their own administrative entity.
New structural reforms came in 2015. This is when the integrated health and social services centres, or CISSS, were created. Rehabilitation centres and youth centres were integrated and establishments across an entire region were merged. In Quebec, we therefore ended up with very large groups with several missions: the hospital mission, of course which is still predominant; the frontline services mission; the CHSLD mission; the rehabilitation mission, and that of youth centres.
New Brunswick and Alberta also experienced a major merger of this kind that places the hospital at the centre of institutions and marginalizes the other missions of these huge complexes. We are therefore left with CHSLDs that no longer have their own management. Investigator Yves Benoit, who produced a report on the situation at CHSLD Sainte-Dorothée, says the following:
More than five reporting lines stand between the CEO of the Laval CISSS and the managing first responder (coordinator) of CHSLD Ste-Dorothée.
If you count the ministry, that makes six reporting lines. For example, it could take several days or even weeks to submit a problem to hospital management and get a response. A significant loss of agility was having an impact on how these facilities were managed.
Staffing shortages, especially of personal support workers, are the second major problem. Over the past few years, the work of PSWs has been devalued, not only due to inadequate pay, but also, I would argue, because the human element has been removed from what they do. Putting a time limit on each of their tasks has obscured the PSW's role, which is to provide residents with emotional support. The PSW's value lies therein. The quality of the work environment has deteriorated over the last five years, in the wake of the major reforms in 2015. Over half a billion dollars in excess wage insurance, overtime hours and the use of freelance labour show that things have deteriorated.
The third major issue is the deterioration of medical and nursing care. Physicians have been steered towards clinical practice. They have therefore abandoned CHSLD practice. Similarly, nurses have been steered towards hospitals, where greater needs arose. As a result, medical and nursing care in CHSLDs no longer made it possible to monitor patients properly and, above all, to treat them in the event of acute deterioration.
The fourth major reason is facilities are obsolete. Some facilities have multi-bed rooms, shared bathrooms, or ventilation and air conditioning problems, and some do not have a spare room to provide end-of-life care or isolation rooms for treating infections.
The pandemic has been mismanaged due to the focus on preparing hospitals to receive patients with the virus and massive transfers to CHSLDs of patients at the end of acute care. Priority was also given to hospitals in terms of infection prevention and control, resulting in a lack of both these in CHSLDs. Staff have been moving freely, and they still are, unfortunately. This has contributed to outbreaks and spreading the virus. Problems arose with availability of equipment, and priority was again given to hospitals. Visits by family caregivers, who provide residents not only with emotional support, but also with necessary, even essential, day-to-day care, were not permitted.
Designation of hot spots came late once outbreaks were under way, and staff could not get tested in those facilities. These oversights led to a major crisis. Imagine if it were 10% of children in schools, 10% of children in daycare centres, 10% of an indigenous community. People would be horrified, everyone would stage un rebellion. However, we had no “Old Age...” or “Old Lives Matter” movement for seniors in the first wave. I fully agree with Ms. Estabrooks that this pandemic brought thinly veiled ageism to the fore.
I'd like to thank the Canadian Armed Forces for coming to help limit the damage of this pandemic in our residential facilities.
Thank you, Madam Chair.
I'm a senior fellow at the Macdonald-Laurier Institute where my focus is international security and strategic and military studies.
In the past year, the COVID-19 pandemic has caused significant dislocations in the Canadian economy, politics and society. If you look into the international sphere, the pandemic has accelerated a number of long-standing trends and introduced several new challenges. Over the past decade, we have witnessed the fragmentation of political, economic and military arrangements that underpin a rules-based international order. The post-Cold War consensus has broken down and, driven in part by the growing conservativeness of national actors in international relations, Russia, China and Iran have rejected or worked to usurp this western-led order.
The fraying of the post-Cold War consensus has occurred among our close allies where populism and nationalism have emerged as powerful and disruptive forces. Their growth is variously blamed on historical lows in public trust of governing institutions, declining economic prospects and rapidly changing societies.
Manifestations include populist leaders such as Viktor Orbán in Hungary or Jair Bolsonaro in Brazil. One of the clearest indications of this emerging era of global power competition is evident in the military sphere. Over the past decade, a dramatic modernization effort has been undertaken by major military powers encompassing increases in funding, reorientations of force structures and the fielding of new capabilities. The breadth of these technological advances arguably sets the period apart from earlier eras, which will affect the fundamental nature of warfare, like with artificial intelligence.
Collectively, these new technologies have increased the lethality and potential of ways to apply force. Many are vast improvements over existing systems or have no preceding analogue. The technological developments are not strictly limited to military kinetic issues. They also affect our political, economic and social systems such as with cyber-capability. Perhaps one of the most problematic aspects of this emerging military reality is the lack of norms around these new technologies, which may result in greater instability.
The COVID-19 pandemic has further undermined public trust in the governance structures of western states, a fact that is exacerbated by the disinformation campaigns conducted by foreign powers. This is evident in major protests and civil unrest surrounding public health measures and participation in the violent far-right and militias rising in several countries.
Moreover, states' emergency and economic responses to the pandemic have saddled many of them with large debt loads that will require decades of austerity measures to eliminate, thereby limiting their ability to address domestic and foreign challenges. These challenges are particularly key for developing states, which are less well equipped to handle economic and political consequences of the pandemic. They face a weakened global trade system and a growing risk of political fragmentation due to the same forces that are affecting developed states.
In the pandemic's aftermath, many states will adopt a strong domestic focus to rehabilitate their economies and societies. This is evident in Canada's southern neighbour. The incoming Biden administration has already highlighted the immediate need to focus on domestic issues upon entering office. In foreign affairs, the president-elect was clear. He believes that diplomacy is a primary foreign policy tool of the United States, and tends to work through alliances and international institutions. While his administration will likely provide greater leadership than his predecessor's, this means that Canada and other allies will need to shoulder an increasing burden for international security, despite facing the same economic and political challenges as the United States. At the same time, we will be less able to rely on multilateral institutions that have suffered significant legitimacy and credibility issues as a result of the pandemic.
The Canadian Armed Forces are likely to experience greater foreign demands in the coming years, as weak states succumb to centrifugal pressures created by the difficult economic and political environment, and fewer developed states wish to assist in stabilization efforts. The nature of these conflicts poses significant risks for the Canadian Armed Forces. The proliferation of new technologies and capabilities will greatly complicate Canada's ability to intervene as well. The conflict in Nagorno-Karabakh shows how relatively modest unmanned aerial vehicles can have decisive consequences on the battlefield. Particularly concerning is their low cost. Armenia and Azerbaijan are relatively modest economies that could easily afford these novel capabilities.
It is not just low-end conflicts that the Canadian Armed Forces must prepare for. We can observe that China has thus far weathered the pandemic in better condition than most other developed economies, posting a positive growth rate for the rest of this year. Meanwhile, the Russian Federation has continued to play a spoiler role internationally, despite suffering the pandemic's effects. Thus, the challenges of a great power conflict will likely become increasingly acute as the decade wears on.
To respond to these challenges, the Canadian Armed Forces must become increasingly nimble, and nowhere more so than in how it acquires and incorporates these new technologies. The 2017 defence policy white paper, “Strong, Secure, Engaged”, is far too rigid in this age of rapid technological development. Many of these systems require quick, iterative upgrades to maintain their fighting edge, which our government is not well organized to deliver.
The procurement system itself is severely hampered by an overly regulated oversight system that ensures project delays and cost overruns. These issues are exacerbated by the reality that successive governments have seen defence procurement as a vehicle to direct government money into domestic constituencies. This only causes further delays to procurements and eats into the defence budget. The temptation to further exploit defence procurement to these ends will be particularly acute given the clear economic challenges facing the country.
None of this suggests that Canada should act like a global policeman at the outbreak of violence; however, the trajectory of recent international relations, particularly after the pandemic, suggests that the world is becoming increasingly unstable, and that military force may be required to ensure this country's security and prosperity. Canadians must be clear-eyed to the challenges they face, and the country must possess the appropriate tools to address them.
Thank you.
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Thank you, Madam Chair and committee members, for the invitation to speak here today.
I'm a co-founder of Protect People in Long-Term Care, an ad hoc citizens' group that launched a petition on April 7 asking for emergency funding for LTCs, a national coordinated strategy and the implementation of shared standards. To date, our petition has garnered over 98,000 signatures from every province and territory in Canada.
I'm also speaking to you today as someone with a unique lived experience and perspective. Both of my parents live in Grace Manor, one of the five LTCs in Ontario that received military assistance in May.
I'd like to underscore that many of us with loved ones in LTCs saw this tragedy coming. We are intimately familiar with the systemic gaps and failures in this sector. When we saw what was unfolding in Spain and Italy in February, we quickly realized what was coming our way. Chronic understaffing is endemic in this sector. When families and volunteers were locked out on March 13 in many parts of the country, we knew that staff who were already overstretched would quickly become overwhelmed. Our anxiety rose as we learned that LTC staff were having to fight to get access to PPE. We watched in horror as outbreak after outbreak was announced, yet LTCs in many jurisdictions were not being prioritized by their public health authorities for access to testing to ensure the rapid assessment and cohorting of residents.
My parents' LTC in Brampton, Ontario, reported its first case of COVID on April 7. Each day the numbers rose, but they had to wait an agonizing eight days after that first positive case until their public health authority, which was following Ontario Ministry of Health directives, would finally give them access to testing for all residents.
By then it was far too late. In their LTC, with a population of 120 residents and 36 staff, there were 65 resident cases, including both of my parents, and 21 staff cases, which ultimately resulted in 12 deaths, including two staff.
With staff levels so depleted, those remaining were working up to 16 hours a day. The senior administration at Holland Christian Homes, the not-for-profit that runs Grace Manor, reached out to the Province of Ontario and the local health authority for help. They hoped to partner with the two local hospitals in Brampton and to receive redeployed medical staff from those hospitals. When that didn't happen, they asked—as a last resort in an increasingly desperate situation—to be considered for military assistance. On April 24, the Ontario government formally made the request for military assistance on behalf of five homes.
For Grace Manor, that assistance was vital. Half of its staff was gone. The military presence gave remaining core staff the breathing room to recruit, bring in and train new staff and ensure that proper infection control protocols were firmly in place. Military personnel also provided much needed human contact for residents—many of them frail, vulnerable and confused—who, by this point, had been completely cut off from any in-person visits with their families for over a month. My father so appreciated his conversations with the military personnel from places like Nova Scotia and Petawawa. He told me yesterday that it was a good thing they came.
Why did this happen in the first place? Why was military assistance needed? How did it get so bad?
As we've heard today, it got this way after decades of political leaders ignoring dozens of reports that flagged a host of critical systemic issues, such as underfunding, chronic understaffing, poor labour practices, the lack of shared standards of care and training standards, deregulation, privatization and absence of accountability. We had plenty of warning. This catastrophic failure to protect our most vulnerable should not have happened.
Here we are today in the second wave. Over 12,000 people in Canada have lost their lives to COVID. Eighty per cent of all deaths in the first wave were of people living in long-term care—the worst record in all OECD countries. Dozens of long-term care facilities across Canada are once again in outbreak, yet the same struggles with access to testing and rapid cohorting that we saw in the spring continue.
Kat Cizek is one of my co-founders. Her dad lives in Toronto's Lakeside, an LTC currently in outbreak where COVID-positive residents have been left on the same floor as those who have not contracted the virus. Another co-founder—we're only four—is Kitra Cahana. She is seeing staff and resident infections skyrocket at the Maimonides facility in Montreal, where her father lives. Despite this alarming outbreak, the public health authority has not made testing mandatory for staff and visitors.
I don't have words to describe how excruciating it is to watch this again. Despite all we know, all we learned in the first wave and all the studies and policy recommendations, so little has been done to address the root problems that have caused this crisis. We should not be relying on the military for last-resort crisis management in a sector where the problems and the solutions are this well known. This is not a good use of military resources and training. I am sure it has compromised military operations and budgets in many ways to come to the aid of a sector where private operators have continued to reap handsome profits for their shareholders throughout this crisis.
We've begun to see reports of how Operation Laser has impacted the mental health of military personnel who were thrown into an acute-crisis situation in a unique environment that they didn't necessarily understand. Military medical staff are not long-term care specialists. Caring for high-needs elderly, over 80% of whom suffer some form of dementia, is a skilled activity, even if our society does not recognize it as such.
In the throne speech on September 23, the federal government made a commitment to national standards, yet almost 10 weeks later the details and a timeline have not been shared. It is so disheartening to see the jurisdictional bickering that is blocking the groundswell of grassroots support right across this country for national standards. It is imperative that all levels of government come together to fix this broken system.
I am so thankful that the military was there for my parents and for Grace Manor. I never want to see this happen again. This sector needs to be properly supported. The long-standing problems need to be addressed. We need concrete action on those national standards. The military has other work they should be doing. Speaking on behalf of the 98,000 who signed our petition, I hope we can count on you to help make that happen.
Thank you.
:
Yes, Madam Chair. Thank you.
Madam Chair and members of the Standing Committee on National Defence, it is a great honour and privilege to be here today, along with Major Karoline Martin. I thank you for the invitation to discuss elements of the Canadian Forces health services deployment into Ontario's long-term care facilities, supporting Canada's most vulnerable in the midst of the COVID-19 crisis.
As you heard in previous testimony, Operation Laser saw the deployment of hundreds of health services personnel. Nurses, medical technicians, medical assistants, physician assistants and dental personnel all came together to form composite teams known as augmented civilian care teams. As the director of health services operations, I was the architect behind the medical aspects of the plan that saw the augmented civilian care teams deploy into long-term care facilities in Ontario. Major Martin had the distinct pleasure to deploy as the officer commanding the augmented civilian care teams within Ontario.
From April to August, we deployed into seven long-term care facilities with the primary mission and goal of saving Canadian lives. Upon our arrival, we witnessed a sector in crisis. Our clinicians and Canadian Armed Forces personnel immediately mobilized and began to work tirelessly alongside our civilian health partners to stabilize the situation and support not only residents but also the organizations and clinicians we were deployed to support.
Although CAF personnel are not experts within the long-term care sector, we responded to the call during a critical moment in Canadian history. Clinical excellence, compassion and patient advocacy are the cornerstone ethical principles that all Canadian Armed Forces clinicians live by. As such, when concerns regarding the conditions and the standards of practice arose, we as Canadians, as clinicians and as soldiers had a clear duty to report our observations. I'd like to stress that our observations were only a snapshot in time that reflected the realities within the long-term care facilities in which we worked during the early stages of the COVID-19 crisis.
The CAF health services personnel who deployed on Operation Laser are a passionate and dedicated group of clinicians who will always advocate for patient and resident well-being and the provision of high-quality health care to Canadians. It is with this lens of systemic improvement that we graciously accept your questions and queries.
We thank you once again for this opportunity and look forward to your questions.
Thank you, Madam Chair.
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As I stated in my remarks, the nature of the technological development is quite broad. It's not just one or two areas like in previous eras. It's not just, let's say, ICBMs, intercontinental ballistic missiles, or it's not just greater communications. Basically in almost every area of military capability we are seeing some advancement.
That is, in part, driven by something that is generally called the broader technologies, such as AI, which are affecting how all capabilities are starting to operate together with greater connectivity between different military capabilities. You see a much greater focus on network capabilities as well as some very specific and unique capabilities that are narrow in focus, such as hypersonics, which is a significant area of growth in the last decade or so among the United States, China and Russia as well. Russia has recently just deployed several new types of hypersonic weapons on large missiles or carried by airplanes.
In that sense, there are quite a few areas that the Canadian Armed Forces must be aware of. As I said in my remarks, if we look at the Azerbaijan and Armenia conflict just recently, we see that UCAVs were a significant part of that conflict and that really did change what occurred and the outcome. Those capabilities range from very low-cost items that cost several hundred dollars, to extremely expensive, unique capabilities that have very wide effects.
The Canadian Forces are trying to adapt to this capability. I would argue that in many cases the priorities that were laid out, let's say in 2017, may not be as relevant as they are today. One of the best examples, referring back to Nagorno-Karabakh, is the development of new types of air defence systems. I'll give an example in the United States. I believe there are now six or seven ongoing air defence system projects that the U.S. Army is undertaking and implementing into service.
Canada has one program in the defence capability guide. It is the GBAD program, and it is identified for delivery, I believe, in 2026 or 2027. That means, for the next six or seven years, the Canadian Armed Forces will not have a dedicated air defence system to defend against threats that, as we just witnessed, have decisive effects in a conflict and are easily and cheaply available to many different countries.
Does that answer your question? Does that give you a perspective of where this squares up?
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Absolutely. If we look at the development and the rollout of vaccines internationally, as somebody who watches innovation and development of very high-end military capabilities, I'm utterly astounded. We are literally watching, in front of our eyes, a modern scientific miracle, where we have developed a vaccine from almost scratch in the space of a year and will have it basically rolled out and hopefully put into Canadians' hands or arms, or whatever, in just over a year. That's impressive.
One of the things in observing how government operates, especially during times of crisis, is that a lot of the rules, a lot of the straitjackets that are placed on policy implementation, are quickly removed in order to identify ways that we can be more efficient and quicker to do what's required. In terms of the military capability, I believe there has been quite a bit of process put into the system that has actually prevented the Canadian Armed Forces from getting the equipment they need.
If we're talking about GBAS specifically, I look at other countries that identified the problem of UAVs that provide great threat to their countries. They immediately purchased a system, put an interim system into operation and then looked at the long-term solution. However, in Canada, in a lot of cases, and we can look back to Afghanistan or other operations, I feel that we tend not to actually acquire the capabilities that we need until there's a crisis. At that time, it's the worst time. I'd probably ask some of the military members of this panel right now, if they did not have the capabilities needed, how quickly did they have to scramble to get some of them?
I think that's the case.
:
Thank you very much, Chair.
I'll start by thanking all the witnesses for being here. We have so many wonderful witnesses and I hope we have the time to really have a conversation with each of you and hear from all of you. Rest assured that we'll do our best to ask questions to all of you throughout today's meeting.
First off, in my community of Etobicoke Centre, we lost 42 residents to COVID-19 at the Eatonville Care Centre. This is one of the homes in which the Canadian Armed Forces initially served in Ontario. Therefore, Colonel Malcolm and Major Martin, on behalf of my community, I thank you for your work, for your service and for the service of the men and women who served under your command, for all the work you did and for caring for, and frankly, saving the lives of constituents in my community.
Also, thank you for preparing the report about what you discovered, the horrific conditions in long-term care homes in Ontario and in Quebec. As a result of your report, certainly in Ontario, the five MPs who represented the homes in which you served ended up, in late May, writing to and to Premier Ford asking for a number of things, including national standards to be put in place for long-term care. Of course, as was mentioned by Ms. van Beusekom, in the throne speech the government announced that it would be working with the provinces to establish national standards for long-term care.
Your report enabled awareness and transparency, which has led to advocacy, which has led to the government committing to national standards. When we get to those national standards and they are implemented, that will make a difference for seniors for generations to come, so for that, I'm deeply thankful to you and all the men and women who served under your command. Thank you.
My first few questions are for Ms. van Beusekom. Thank you for being here and for your testimony.
What do you believe needs to be done to address the horrific conditions, frankly, and the practices that were identified by the Canadian Armed Forces in long-term care?
I'm really focusing on the long term. I know there's a response that's needed immediately in the context of COVID-19, and I'm not trying to deprioritize that, but I'm curious about what you think needs to be done over the long term.
:
I think Carole Estabrooks has done a ton of work on this. I'm so thankful to all the people who have been working on these issues for decades.
The first one is staffing. As I said in my testimony, this sector has been chronically understaffed for decades. Family and volunteers were the glue that held it together. When they were forced to leave it fell apart. As I also said, it was not a surprise to us. In Ontario, the Registered Nurses' Association of Ontario and others have been advocating for a four-hour minimum of direct patient care per day. That's a really good beginning. We need the staffing levels to be increased. We need proper funding for this sector. We need proper training for PSWs. I was talking to the doctor at Grace Manor yesterday and he asked why Sheridan College and others don't have programs for PSWs in long-term care? It's specialized.
As we've heard in today's testimony, it is a specialized skill to care for older adults with complex needs. We need standards of care, and they need to be the same across the country. B.C. did great. Early in April they increased salaries for people who are chronically underpaid, which made it possible for them to work in just one home. They did really well in testing, but it's so uneven across the country. We really need those national standards. Start with adequate funding and with the staffing ratios. Other things can come in the medium and the longer term, but for now we need to support those core staff. The military came in and that was fantastic, but they don't have the relationships. The most important thing is the relationships with the residents. That's what the core staff have. We need to support those core staff who know the residents, who know what they need so they're not run off their feet.
This has been known for decades. We knew this before COVID. There's no excuse for why this isn't happening now.
:
I appreciate that very much.
I think I have a little less than a minute and a half remaining in this segment.
Ms. van Beusekom, I'll ask you this question but ask you to answer within about a minute or so, if you can. First of all I should say that was the one who recommended that we reach out to you. Thank you for coming today. I wanted to let you know that.
Ms. Sidhu advocated, and you have advocated tremendously, as have others in our caucus and elsewhere outside government, for national standards for long-term care. You alluded to that a moment ago. Can you speak to why those standards need to be established?
I'm so grateful to . When we launched our petition, we wrote to all kinds of federal and provincial ministers. We got a lot of responses. Member Sidhu was the one person who really engaged with me as a human, and I really appreciate that.
The national standards are so important. Long-term care should come under the Canada Health Act. The needs are complex. People are living to be a lot older. It's not just taking care of people; it's delivering complex medical needs. Canadians should have that same guarantee, that whether you live in Iqaluit, Igloolik, Dawson City, Vancouver, Winnipeg or Whitehorse, you get access to the same standards of care. That should be a principle of our country. Right now as we've heard, it's broken, it's uneven and it's untenable, but we do know how to fix it, thanks to the work of so many people.
:
Thank you, Madam Chair.
I'd also thank the witnesses who are with us. We're addressing issues that are quite significant. I'd like to extend special thanks to the two members of the Canadian Armed Forces.
I thank you for the help you provided in Quebec.
My first question is for Mr. Hébert.
Good afternoon, Mr. Hébert. Thank you for attending the meeting today.
I'm going to cut to the chase. For decades, federal health transfers to Quebec have been shrinking. It goes without saying that you're aware of this, given that you are a former health minister for that province.
Can you describe the impact of the federal government's backlog in administering health care in Quebec and the provinces as the result of declining health transfers? We must remember that when the legislation first came into force, transfers were at about 50%. Today, they are at about 22% or 23%.
:
Thank you very much, Mr. Brunelle-Duceppe.
Federal transfers have indeed gone down. What I found most worrisome is that, under the Conservative government, federal transfers were not always evenly distributed. Not only were transfers capped at a certain percentage of gross domestic product, but they were distributed on a per capita basis, regardless of age. Provinces with aging populations, such as Quebec and the Atlantic provinces, found themselves at a disadvantage. It was an equity issue that caused a lot of trouble in those provinces, which had to cope with a more significantly aging population.
What I find more disturbing is how negligently the provinces, particularly Quebec, use the funds. More of this money has gone to hospital services and physicians' salaries than institutional care, and the COVID crisis has made that abundantly clear. Home care has been particularly neglected.
Our Canadian system is really based on hospital care. The system was developed in the 1960s and 1970s when we had a young population, based on medically required hospital care. Now, with an aging population, we really need to look at long-term care, and it's much better to provide long-term care at home. In Quebec and Canada, home care has been neglected over the past 50 years. Compared to other OECD countries, we invest only 14% of public funding in long-term home care, unlike other countries like Denmark, which invests 73% of its budget in long-term home care. We have the lowest marks in the OECD class.
If we had further developed the home care component, we could have avoided some of the massacre we experienced in facilities. If they had had the choice, many people would have stayed at home rather than opting for the institutional solution. I believe things really need to change in Quebec and Canada in this regard.
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To me, this issue is that, even with more funding, there would not be more money for institutional and home-based care.
If the past is any guide, the provinces will need to reach an agreement with the federal government in order to set priorities other than hospitals and physician pay and to address the real issues that have been exposed by the COVID crisis, namely, providing high-quality care in institutions, with quality standards, and especially home care. Funding for home care cannot be given to institutions as is currently the case with hospitals. Users must be the focus of public funding decisions.
I believe we need to move toward what several other countries have done, which is long-term care insurance. When I was in the Quebec government, I proposed a form of this insurance. Unfortunately, I ran out of time to implement it. But I think it's essential if we want to provide high-quality care to people.
:
Thank you, Madam Chair.
I want to thank all of our witnesses for being here today and for the importance of their testimony.
I just want to start off by saying that I agree that this is an issue of ageism. It is absolutely appalling to me that we don't have a meaningful national seniors strategy in Canada. I think of all of the work that has happened in terms of workforce development and a plan to replace our aging population in the workforce, but there has not been a plan put together about how we're going to support seniors as they age in our country. I want to thank everybody for this important testimony.
I will go to you first, Ms. Estabrooks. You talked about the fact that we're not seeing the very important skilled workers in this sector being respected, especially with the appropriate pay. One of the things that I saw in my province of British Columbia as well as across Canada was that a lot of those care workers were working two or three jobs at two, three or four different long-term care facilities, and as soon as the pandemic happened, some of them lost their employment at other places and were trying to manage their everyday life just doing one part-time job. I'm wondering if you could talk about how that has an impact on the services to our seniors.
As many as 30% of PSWs and care aides were working more than one job pre-pandemic. About 70% of that group were working for financial reasons, and many of them couldn't make a decent wage. Wages in Canada pre-pandemic ranged from $12 an hour to about $22 or $24. You can't raise a family on $12 an hour. That condition was there although we didn't know it. Some of us knew it because we had samples from certain provinces that told us that, but we as a country really had no idea that this was going on.
The impact was that they were working multiple jobs and, specifically with regard to the pandemic, the more places you work and the more you travel, the more likely you are to spread the disease. It's not through any fault of your own; it's just the more traffic and the more exposure you have, the more it happens. We have put these “one work site” policies in place in many jurisdictions and they have helped, but they are fraught with unintended consequences.
For chains with perhaps 14 homes that are used to moving their staff around to cover shortages, which all of a sudden can't do that, we have seen some really catastrophic shortages and some loosening of the conditions around that policy to accommodate for that. However, the core issue is that if you don't pay a workforce that delivers 90% of the direct care a living wage and you don't make it possible for them to have full-time employment with sick benefits and vacation benefits, then you're going to have both a dispersion through different homes and issues with respect to workers' commitment to the organization they work for. There is a whole trickle-down effect.
I'm not suggesting that on a permanent basis we might want to put a one work site policy in place. The reason people are working more than one job shouldn't be that they can't make a living wage or get sick benefits.
:
Madam Chair, thanks for the opportunity to answer these questions. I'll cover the first one, and then we'll turn the floor to Major Martin, who will be able to speak to the lessons learned, bearing in mind that what we saw there was a snapshot in time, so she will share some of her observations from that moment.
With respect to how the provinces make a request, I will clarify that, as a health services member, it's outside my lane on how that specifically occurs. The process, very generally, occurs through the regional joint task forces, and I know that you've had some of the regional joint task force commanders speak in the past.
In very broad terms, the requests are coordinated from a request from the province itself based on the assessments done by the provincial emergency operations centres in discussions with the regional joint task force commanders. Then a request is sent up through the Minister of Public Safety that comes across to the Minister of National Defence. Based on the requests of the chief of the defence staff, we'll have a look at the availability of forces. Speaking specifically to health services, they would come to the surgeon general to reply as to whether we have forces available to meet those requirements. We would provide the response back to the chief of the defence staff, and then the planning staff would look at our overall ability to respond to that need.
Turning to your second question, I'll turn the floor to Major Martin to speak to the lessons observed in her time working in the long-term care facilities in Ontario.
:
Thank you for the question.
A few themes arose out of the report on our observations, certainly echoing what has been said by other witnesses. Staffing was a huge concern. When we arrived, many of the facilities had as little as 20% staffing, irrespective of what their nursing ratios were pre-pandemic. That made a huge impact on the outcomes of patients.
Second was infection prevention and control and really having that situational awareness of who was positive and who was negative. There were delays with having the results. Sometimes there was a lag of a week or up to 10 days, so by the time you got your results, you no longer had a good situational awareness of where the outbreak was. Also, the IPAC stream has centralized and/or standardized IPAC protocols. We within the CAF had a central IPAC member who provided us that advice, but IPAC was very different among each of the facilities in terms of donning, doffing, what the standard was for PPE, etc.
Finally, there's training. I think when you are looking at a degradation within the health status of a large population, having individuals who are trained in that acute care is paramount.
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For our troops deploying to Latvia, and for all of our troops deploying, measures are being taken to ensure that our members are not bringing disease into the country nor impacting those being deployed. Those folks are being quarantined in advance of their departure.
We have also been conducting operational testing on our members being deployed overseas to ensure that they are not, as we've termed it, “asymptomatic”, which means being infected with COVID-19 but not demonstrating any symptoms.
Then, of course, the Canadian Armed Forces has led the way in implementing very robust public health measures, including physical distancing, the use of masks, diligent handwashing and also strong recommendations for folks to have the influenza vaccine prior to their deployment, just to eliminate one other type of infection that could impact operations.
:
Thank you very much for the question.
Over half of the PSW workforce are immigrants. Over half of the people who are immigrants don't speak English as a first language and sometimes don't speak English well enough to understand it readily in a conversational way. It's a highly racialized workforce. We pay almost no attention to that. We don't collect that data. I have that data because we've been working for over 15 years with a longitudinal group in the west. We asked them what language they speak and where they come from, so we have that data.
When I talk to colleagues in Ontario and Quebec, it's even higher. It's not the same in some regions of B.C., and in the Maritimes it's a little bit different. It depends on the ecosystem that you're in. That is part of the reason they are so poorly compensated. They're women. They're poorly educated. They're not given any continuing education. They're not regulated, which means there aren't even criminal background checks, and we don't count them accurately in the country. What we have done is create this workforce that's largely unregulated, and we've deprofessionalized it.
In Germany, they legislated that 50% of the front-line workforce has to be regulated nursing staff, RNs. In Belgium, it's even higher, almost 65%. That's similar in other jurisdictions. Here, the regulated workforce is less than 15%, and that has been a financial decision, coupled with the belief that you don't need complex, competent skilled care for these individuals.
We can provide that care with a high proportion of unregulated staff, but we have to give them proper education. We have to give them continuing education, and we have to support them. We have to address what kinds of issues it creates if we have a highly racialized workforce in terms of the discrimination they feel. We know that COVID had a disproportionate impact on racialized groups, and we know that in some jurisdictions that was manifest in what happened in the workforce, in the nursing homes that had a particularly high proportion of people from other ethnic groups.
Poverty plays a role. The fact that they're women plays a role. All of these things come together and stack up, until you get a workforce that's quite vulnerable. On top of that, they're pretty much voiceless. They're not unlike the residents who don't have a voice; we don't give them much voice. They're at the bottom of a hierarchy, and they're not included often in a lot of decision-making, but they care. This is the thing that astonishes me through all of that. The average care aide or PSW in this country builds relationships with residents and cares and wants to do good work. We aren't even acknowledging....
That's the first step. Then we have look at what it means if a workforce is predominantly female and you have COVID and they close the schools and there's no child care. That's a problem. If you're a woman and you have children and the schools are closed and you're caring for aging parents, that's a challenge, so we have issues and we don't value caregiving. We don't value it for children, and we don't value it for the elderly. There's a very big convergence of these compounding issues of disparity and inequality in this workforce.
Thank you very much, Dr. Hébert.
We'll make sure your position is known.
My next question is for Maj Martin.
Good afternoon, Maj Martin.
Several important courses, such as career development courses, have been cancelled or offered with a limited number of candidates. This means that there are fewer trained soldiers, NCOs and officers who, in turn, could have trained other candidates. The COVID-19 pandemic really hurt everyone, especially in this area.
Would you be able to tell us what impact these delays are having on the preparedness of our forces?
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I'll have to speak to that in my current role as deputy surgeon general.
Back in March during the first wave, in an effort to respect the public health measures put in place by each of the provinces, the Canadian Armed Forces took a very disciplined role to cease operations in moving and training candidates from across the country so as to avoid becoming a vector. It certainly did slow down our training operations at that time.
We continue now respecting.... With the new information we have about the virus and adhering to public health measures, we will be restarting the training machine as of this fall. While we do have some catch-up to do, we have a plan in place to move that along.
In terms of our current preparedness for wave two, we stand ready to assist as requested by the Government of Canada.
:
Thank you, Madam Chair, and thank you, James Bezan.
I want to take an opportunity to thank all the witnesses who are here with us today and certainly to thank all the military men and women for what they've done during this crisis.
I want to make one quick point. I know that we're short of time, we're worried and it's Friday. One concern is that I think the study and what I'm on this committee for was originally the pandemic and the Canadian Armed Forces. I know we're getting into other discussions that I know are fantastic, but because we're short of time, maybe we could narrow it down to how it's really truly affecting our forces.
My question is for Mr. Shimooka. I'll begin by saying that we had the opportunity on Monday of having his distinguished colleague here, Dr. Leuprecht. He testified before this committee that in his opinion 25% of our active armed forces were dedicated to “domestic operations”, like we saw here in Operation Laser, and that the Canadian Armed Forces response to the COVID pandemic is an ineffective use of military resources and will definitely begin to harm our readiness for international responsibilities.
I wonder if you agree or don't agree with this assessment that Canada perhaps should look at standing up and funding a dedicated section of the Canadian Armed Forces for exclusive domestic operations.
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I would couch my answer by saying that I think that's not precisely a question for me. I think that's a question for, I guess, the body politic in determining what the roles are that the government wants to do for Canadians. If I look at different militaries internationally.... Let's take the Coast Guard or the protection of sovereignty. Canada uses its navy in a fashion that is probably more extensive than countries that have more robust coast guard capabilities—like Japan or something like that.
Relating that back to pandemics and aid to the civil power missions, like in this case, I think it is a reasonable ask, so long as there is planning and resources allocated that are commensurate to the task. Too often, I think, governments will saddle the Canadian military with a task and, as the fine representatives of the Canadian military here will show, they will do it to their utmost capability and ability, but the resources aren't applied and given to that mission. That's not just with the aid to the civil power. That's with a lot of different areas.
I would say my view is that I think that could be a legitimate use of the Canadian military. It just needs to be resourced properly and it must be clear that it is one of the tasks they must fulfill at the time.
Thank you to all the witnesses.
I don't have a lot of questions because your testimony and your written input is so comprehensive. Thank you for the passion with which you are protecting people who cannot really protect themselves. Some of you in the military, and others, have put yourselves at risk. I really appreciate the efforts of all the witnesses and those who have done that.
I'd also like to congratulate Major-General Fortin, who is going to head up vaccine logistics and operations for the military, which the announced today.
Just as a reminder, in all the recent previous years, each year there has been an increase in transfers to the provinces and territories for health care. I particularly thank Professor Hébert for mentioning that we made a record contribution for the first time on home care recently. I think everyone here would agree that is very important, especially considering recent events.
My questions are for Major Martin. As you know, a high priority for everyone on the committee is increasing the importance of women in the military. My two questions for Major Martin are along that line.
First of all, I'm delighted you've been given such a senior and important role. That's fantastic. From all reports, you've done a wonderful job.
Have you noticed any special needs—I know Mr. Robillard asked this question as well—for the women in the long-term care homes, either as patients or as workers? Are there special needs they have, recommendations specific to women, or is there any discrimination similar to the ageism that was discussed earlier, but specific to women?
Are there any comments on that from your experience in your management role in this situation, Major Martin?
:
Thank you, Madam Chair.
I want to thank our witnesses for appearing. I want to thank Colonel Malcolm and Major Martin, our military members who are with us.
Major Martin, I particularly thank you for your testimony at the Ontario long-term care commission. I think it was brutally honest. It really gave everyone a clear picture of the unfortunate events that unfolded and that you and your team were sent in to clean up.
To start, I have a couple of quick questions for you, Colonel Malcolm. If we were in an operation like Afghanistan and had so many of our medical personnel deployed in managing role 3 hospitals in forward-operating bases, would we have been able to handle the domestic response that was required during the first wave of COVID-19?
:
Thank you, Madam Chair. I would like to ask my first question to Professor Estabrooks.
Professor, it's good to see you again. I have about five minutes, so I'm going to try to split my time between you and Mr. Hébert, if possible. If we could keep it within two minutes, I'd be grateful, just so that I have a chance to ask him a question as well.
Professor, do you believe that it is important, in light of what the Canadian Armed Forces discovered and revealed as far as some of the practices and conditions in our long-term care homes are concerned, that national standards for long-term care be established? If so, why?
:
Thank you very much for the question.
I agree because, in every other field of medicine, we have standards, either Canadian or international, for treating diabetes, Alzheimer's disease, obesity and heart disease. These standards must be based on the best scientific evidence available and, because Canada's provinces have relatively similar health care systems, it makes sense to bring the provinces together to benefit from their respective experiences and expertise.
It's also worth noting that Quebec's health services are accredited by Accreditation Canada, which also have national standards and has applied these standards in Quebec for decades. So, it's normal to rely on not only Canadian standards, but also international standards, to ensure Quebec and Canada have the highest possible standards in the world when caring for elderly people in institutions.
:
Thank you very much, Madam Chair.
One thing I'm very pleased to see today is the discussion of long-term measures for long-term care that might help prevent the future need for the Canadian Forces to use their resources to provide this assistance.
I was particularly pleased to hear Mr. Hébert talking about the need to move from a hospital focus to a home care focus, and Professor Estabrooks and Ms. van Beusekom talking about the need to recognize and appreciate care as an important service in terms of accreditation of staff, training of staff, living wages and all those kinds of things.
I know we're nearing the end of our time. My last question is about short-term measures. I think I'll ask Ms. van Beusekom first.
Do you believe the measures taken before the Canadian Forces departed from the long-term care homes were adequate to guarantee the health and safety of patients in those homes in Ontario?
:
Thank you for the question.
No, I don't think the measures were adequate. In my view, the biggest issue was testing, which I spoke about. Long-term care should be given priority for testing. As soon as there is a confirmed case, everyone should be tested so that this population can be appropriately cohorted, negative with negative and positive with positive. If that can't be done, you take the positive people out of the location. That was a problem in the spring, and it's still a problem now.
It's testing and it's the cohorting. Those basic things that allow the teams on site to manage the outbreak are not systematically in place, and they're still not in place in Ontario.