SVET Committee Meeting

37th PARLIAMENT, 2nd SESSION

Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

EVIDENCE

CONTENTS

Wednesday, May 28, 2003

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1530

The Chair (Mr. Bob Wood (Nipissing, Lib.))

Mr. Allan Parks (Dominion President, Royal Canadian Legion)

The Chair

Mr. Allan Parks

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1535

¹

1540

¹

1545

¹

1550

¹

1555

The Chair

Mr. Roy Bailey (Souris—Moose Mountain, Canadian Alliance)

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1600

Mr. Allan Parks

Mr. Roy Bailey

Mr. Allan Parks

Mr. Jim Margerum (Long Term Care Coordinator, Royal Canadian Legion)

Mr. Roy Bailey

The Chair

Mrs. Elsie Wayne (Saint John, PC)

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1605

Mr. Allan Parks

Mrs. Elsie Wayne

The Chair

Mr. Pierre Allard (Service Bureau Director, Royal Canadian Legion)

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1610

The Chair

Mr. Pierre Allard

The Chair

Mr. Jim Margerum

The Chair

Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.)

Mr. Allan Parks

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1615

Mrs. Rose-Marie Ur

Mr. Pierre Allard

Mrs. Rose-Marie Ur

Mr. Pierre Allard

Mrs. Rose-Marie Ur

Mr. Pierre Allard

Mrs. Rose-Marie Ur

Mr. Pierre Allard

Mrs. Rose-Marie Ur

Mr. Jim Margerum

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1620

Mrs. Rose-Marie Ur

The Chair

Mr. Carmen Provenzano (Sault Ste. Marie, Lib.)

Mr. Allan Parks

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1625

Mr. Carmen Provenzano

Mr. Allan Parks

The Chair

Mr. Pierre Allard

The Chair

Mr. Roy Bailey

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1630

Mr. Jim Margerum

The Chair

Mr. Allan Parks

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1635

The Chair

Mr. Allan Parks

Mr. Jim Margerum

The Chair

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1640

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

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1645

The Chair

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

The Chair

Mr. Jim Margerum

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1650

Mr. Pierre Allard

Mr. Roy Bailey

Mr. Pierre Allard

The Chair

Mr. Pierre Allard

The Chair

Mr. Pierre Allard

The Chair

Mr. Roy Bailey

Mr. Allan Parks

Mr. Roy Bailey

Mr. Allan Parks

Mr. Roy Bailey

Mr. Allan Parks

The Chair

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CANADA

Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

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NUMBER 006

l

2nd SESSION

l

37th PARLIAMENT

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EVIDENCE

Wednesday, May 28, 2003

[Recorded by Electronic Apparatus]

¹  (1530)  

[English]

    The Chair (Mr. Bob Wood (Nipissing, Lib.)): The Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs, in our ongoing study on long-term care, welcomes the Legion this afternoon.

    I'd like to introduce Allan Parks, the president. Maybe you can introduce the people you have with you, Mr. President.

    Mr. Allan Parks (Dominion President, Royal Canadian Legion): Thank you very much Comrade Chairman. I would like to first of all thank you very much for allowing us the opportunity to appear before you and make our presentation.

    With me today is Jim Margerum, the coordinator of our long-term care program at dominion command headquarters. We also have Pierre Allard, the director of our service bureau, who is also very involved in the long-term care aspect.

    These are my two specialists I've brought, so feel free to throw out any questions after. We hope they'll have the answers for you.

    The Chair: I'm sure they will.

    Okay, you're on.

    Mr. Allan Parks: Thank you very much, Mr. Chairman.

    First I will speak on long-term care theory and reality.

    The Legion appreciates the opportunity to appear before the SCONDVA Subcommittee on Veterans Affairs. The Legion is testifying today on behalf of veterans who have fallen victim to a complicated process of long-term care, which in theory is simple but in reality is not responsive to the veterans' needs within the spirit of the veterans charter. The Legion's object here is to see that war veterans with overseas service who are in need of long-term care actually receive this benefit. The charter provides for it.

    Assuring proper care was relatively simple when the majority of veterans homes were operated by Veterans Affairs Canada; however, as VAC entered into contractual agreements with the provincial authorities to transfer veterans facilities and their operation to provincial health authorities, things became more complicated.

    Ste. Anne's in Montreal is the last veterans hospital operated by VAC, and in many ways is a model for what was and what should be. In every veterans facility but Ste. Anne's, different contractual arrangements have allowed disparities to develop in services, funding levels, staffing levels, wait list management, and criteria for entry.

    While the Minister of Veterans Affairs remains responsible for veterans' care, the provincial health authorities, through legislation, policies, and practices, have so much discretion over how the care is delivered that more than 10 different standards have evolved for veterans' long-term care in Canada. The regulatory status of care programs varies from one jurisdiction to another. There are different arrangements for charges to clients. The range of professional services varies amongst provinces and territories, and between rural and urban areas.

    It is almost impossible to develop meaningful comparisons, as there is no common database or information system that would facilitate better comprehension of numerous policy variances dealing with access to services.

    In the area of actual care standards, VAC and the Legion have consulted on national standards for long-term care. Last year, VAC contracted with the Canadian Council for Health Care Accreditation to validate standards in 10 outcome areas for veterans care facilities across Canada. The Legion did receive an interim report that indicated progress was being made in the accreditation of contract facilities under the new standards. In addition, the Legion entered into a contract with VAC to interview annually approximately 4,000 veterans accommodated in about 1,500 of our smaller community facilities, and to provide feedback to the district offices.

    The Legion is satisfied with the progress we are making in care standards. Nevertheless, there is room for improvement in the practical application of these standards, for example, in providing more privacy and dignity to veterans who may suffer from dementia-type ailments or who may require palliative care. However, the Legion is also very concerned there are too many policy variables that restrict access to services for veterans.

    Fair and equitable access to veterans' beds is a separate major issue requiring attention. Wait lists, in theory, should provide an orderly means of allocating accommodation on a priority basis for a facility or a region. However, for veterans and their families, access to care facilities via the wait-list process is a source of frustration and a focus of system shortcomings. When one considers the intent of the legislation and policy “that the recognized obligation of the people and Government of Canada is to provide compensation to those members of the forces who have been disabled or who have died as a result of military service” one might ask why those who have served should ever have to wait,

    A number of other related questions arise. Should veterans and their families not know whether they are eligible for long-term care benefits through veterans affairs? Should those eligible have to fight a maze of bureaucracy in both Veterans Affairs and the provincial health authority to obtain a placement? After waiting, should those listed for 18 months have to accept a placement within 24 hours of notification or be dropped from the list? Should those not accepting an available bed offered in a location away from family or comrades be dropped from the wait list?

    If we look at each of these issues in turn we find there is generally much misinformation about who is eligible for long-term care. Many veterans or families don't realize that there are qualifications for various entitlements, and are properly turned away. On the other hand, we see instances where veterans who should be entitled are turned away from long-term care because their point of contact is not well enough informed to offer proper advice. We feel it is important to raise awareness of this health care benefit through an information campaign within veterans organizations, Veterans Affairs Canada, provincial health authorities, and the general public.

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    Although the Legion can do little more than offer advice or intervene in attempts to cut through bureaucracy, we are frequently approached after a veteran or his family has reached the point of frustration. In Ontario, persons in need of care, including veterans, must first be screened and be wait-listed for appropriate accommodations by a Community Care Access Centre. Unless a veteran very clearly self-identifies and insists on a veteran's placement, he may never be referred to Veterans Affairs for a second screening and a second wait list for a veterans care facility, or a community bed at Veterans Affairs' expense.

    It has been our experience that once a veteran is placed, even temporarily, while awaiting a veteran's bed, the Community Care Access Centres bureaucracy does everything administratively possible to maintain the status quo and frustrate attempts for a veteran to be transferred with his comrades. In all provinces, the placement of veterans is simply subordinate to provincial health authorities.

    Even though it appears simple, the access process is actually very complex. For example, Ontario has 41 Community Care Access Centres, which maintain individual lists. There is no evident coordination among these 41 centres. To access a facility, a veteran must undergo a gerontological assessment, which can be done by a VON nurse, a VAC specialist, or a provincial health specialist. This assessment will confirm the degree of care required, based on a special level of care. Level 1 is adult residential care; level 2 is intermediate care; and level 3 is chronic care.

    Unfortunately, provinces and territories all have their own assessment models. For example, in Alberta nine regional health authorities are responsible for services delivered through hospitals, community health centres, continuing care facilities, public health programs, and home care. Again, even though it utilizes a simple point-of-entry system, there is no evident coordination among the nine RHAs.

    This was confirmed in a 1999 comprehensive study on healthy aging, which recommended that RHAs should work together to ensure coordinated access to services across regional boundaries. It is not evident that this recommendation has ever been fully implemented, as there continues to be some diversity in program delivery even within some jurisdictions, let alone across jurisdictions.

    Furthermore, the focus of service delivered is to continue to support an individual in his home. In other words, a recommendation for referral is always the last resort. More fundamentally, in all the reports and studies conducted by the Alberta government on aging, the word “veteran” does not appear once. This criticism could be equally applied to other provincial jurisdictions. In Ontario, priority for veterans is not properly recognized in the long-term-care legislation. The word “veteran” appears only twice.

    Recently, a Saskatoon family appealed to the minister in a letter seeking placement for a veteran, after apparently exhausting all other possibilities, including an appeal to the Saskatoon health board. The 90-year-old veteran survived Dieppe, to be later injured in France, and receives disability pension at 100% for “gunshot wound penetrating skull, with laceration of brain and resulting paralysis of the right arm and right leg”. He is also in receipt of attendance allowance and exceptional incapacity allowance. The family was complimentary in its letter about efforts by the Veterans Affairs counsellor to obtain any entitled benefits.

    One might think that this veteran's credentials and letter from the family physician recommending placement in a veterans facility, sooner rather than later, would carry the day at an appeal. However, the health board chairman apparently stated that the veteran's status afforded him no particular consideration, and having made an independent assessment, refused placement.

    This incident was just as frustrating to Veterans Affairs officials who attended the hearing but had no status to intervene. Essentially, the family wishes to know how a veteran could be hung out to dry. The Legion and others share the same family's interest in a response.

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    In another typical illustration of uncaring bureaucracy, we quote from a December 2002 e-mail from the daughter of an 81-year-old World War II, Korean and regular force veteran suffering Alzheimer's. After intensive dealings with Veterans Affairs and the Alberta health authorities, the daughter's reasons for turning to the Legion are obvious in her e-mail:

You can imagine my mother's horror when the phone rang at 8 a.m. telling her that Dad would be accepted at a local nursing home today and that she only had 24 hours in which to get him there. When she indicated that she did not wish this placement but would wait for a placement at Belcher, she was told that if she did not accept this one my father would be removed from any waiting list. At this point my mother lost control of her fragile emotions and contacted me at my teaching job.

I made phone calls to her health care worker and Veterans Affairs and was told this is indeed the new procedure since the Belcher has been taken over by Care West. I must let you know this is far from adequate for our veterans. My father has stated quite clearly that he only wishes to go to the Belcher, which was promised him years ago. He has stated, and I firmly believe it to be true, that he will stop taking his medications if he is forced into any other facility, as he feels he can retain his dignity at the Belcher but will only be a body elsewhere.

If something is not done to rectify this vast problem, I am sure I will be burying both parents in the near future. As of 4 p.m. today they have decided to refuse the bed, so Dad is now off the list. Mom has promised him that he will not leave home until he is accepted in the Belcher. She is not up to looking after him, and with a full-time job and three kids to look after, my time is limited as well. The Belcher is now been refusing to a veteran who gave over 35 years to protect this country. He says he would willingly go for long-term care at the Belcher tomorrow, as many of his friends are there already.

    It does not matter that common-sense Legion intervention helped overcome pedantic bureaucracy to obtain access for the veteran. The question is, why aren't the organizations and people who staff them client-centred, as advertised? Veterans Affairs should not be fettered by its own contract, but should be capable of tearing down obstacles, communicating effectively, intervening, and helping instead of obfuscating.

    The intervention came just in time, as this quotation from an April 2003 e-mail indicates.

I am writing this short note to inform you of the passing of my father. Dad was able to spend the last weeks of his life in the Colonel Belcher Long Term Care Facility, due to help from many. He loved the facility and was looking forward to moving to the new location. He met and touched the lives of many fine people during his short stay there. It has allowed my mother to face this end with courage and a sense of peace, as she was able to spend his last weeks as his wife rather than his care provider. Our family was able to enjoy his company without having to face the tragedies his illness brought on. I am glad I fought so hard to get him into Belcher. It was a fight worth fighting.

    We suggest that this type of situation is common, and of course by definition a bureaucracy is typically unyielding, unresponsive, and hard to reform. Here is the case of an 83-year-old World War II, RCAF veteran with post-war RCN service.

    A May 2003 e-mail offers further illustration, conveying a sense of déjà vu.

I am the wife of a veteran. He began to lose his sight some 10 year ago. We know very little of hospitals and health procedures, so I am quite stymied now that he has been in assessment for seven weeks--mainly depression leading to weakness--and now they want to send him to a nursing home and he would prefer the veterans hospital.

Can you give me any information as to applying for a place, and my husbands chances of getting into the Colonel Belcher here in Calgary?

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    Our Legion comrades are doing the best they can to intervene in such cases in Calgary and elsewhere across Canada. We don't have a complete picture of the scope of the problem, but we see enough cases to be convinced of the need for Veteran Affairs to be more proactive in advising eligible veterans of their long-term care entitlements and searching out those who are in need; taking control of the waiting list and cutting through associated bureaucracy; offering one-stop shopping for veterans and families, instead of leaving them to suffer the process of both the department and the provincial health authorities; offering a knowledgeable point of contact to communicate simply and clearly with veterans and their families on long-term care issues; and developing a clear, precise, and simple information source providing guidance for veterans, spouses, or family members on how to deal with the process.

    The department has effectively contracted for 10 different veterans care systems across Canada. Therefore, in the same way it has responded to assure national standards for long-term care, we call upon Veterans Affairs to assure a national standard of access to long-term care for entitled veterans. Time is of the essence, as most war veterans have already reached their sunset years.

    In June 2002, the SCONDVA produced a report titled “Long Term Care for Veterans: The West Coast Crisis”. This report resulted in three major recommendations. These three recommendations and VAC's response to each follow.

    Recommendation one was that Veterans Affairs Canada immediately provide additional funding to ensure that the quality of long-term care provided to veterans at the Lodge at Broadmead, the George Derby Centre, and other health care centres in British Columbia is not adversely affected by any shortfalls in provincial and other funding.

    The VAC's response was the Government of Canada takes its responsibilities and commitments to veterans seriously. Canada has a proud history of recognizing and remembering the contributions of those who have served this country, in times of war and peace. Ensuring that quality long-term care is available to meet the health needs of veterans remains a priority for the Government of Canada. VAC is committed to working with its partners, in this case facilities in B.C., to ensure an appropriate resolution to the B.C. situation.

    On October 9 and 10, 2002, VAC representatives met with officials from both the Lodge at Broadmead and the George Derby Centre regarding funding to these facilities to offset the financial challenges brought on by the provincial changes in funding in B.C. and provide enhanced programming for veterans.

    The reality is that Broadmead provided an estimate of funding shortfall to VAC in September 2002. VAC did not respond until mid-March 2003, at which time $425,000 additional funding was provided. However, this money was allocated with only 14 days left in the fiscal year, making program delivery for 2002-03 a rather difficult challenge. To cope with the shortfall through the earlier part of the year, Broadmead had been forced to cut quality of care and reduce staff. The follow-on funding is also problematic.

    Recommendation two was that Veterans Affairs Canada become more involved in the control and management of the wait list for our veterans seeking access to long-term residential care facilities in B.C.

    VAC's response was that the Government of Canada is committed to ensuring that quality long-term care is available to meet the health needs of veterans. The government is committed to working with its partners, in this case health authorities in B.C., to ensure an appropriate resolution to the B.C. wait list situation.

    Discussions are currently underway with the regional health authorities in order to enable VAC to have increased control in the administration of individual facility wait lists for VAC's priority access beds (PABs). The intent is to have the name of any veteran who does not meet the provincial criteria forwarded to VAC, to ensure VAC is able to provide the necessary care requirements, either in the home, or in a private or community facility.

    The government would like to assure the public that the number of PABs is not going to be reduced. It is stipulated in VAC's current policy that in instances where an eligible veteran requires care but does not meet the provincial criteria, and therefore cannot be admitted to a provincially insured bed, VAC will pay up to the full cost of care in a private facility, or meet the veteran's needs through a provision of the veterans independence program, or VIP.

    The reality is that the wait list has been significantly reduced by basically redesigning the assignment process. Until April 2002 in British Columbia, the intake policy for wait listing was based on the chronological order of requests if a veteran met the basic entry criteria. As of April 2002, there is no longer a wait-list process per se. Access is on a needs basis. However, this does not take into account the fact that eligibility criteria have been raised substantially.

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    In addition, veterans are given 24 hours for a placement, generally inside a geographic area. For example, the island of Vancouver is a single health authority. This in effect means that a veteran residing in Victoria could be moved to Comox without regard for proximity to spouse, family, and friends.

    The reality is there are not sufficient beds in the Victoria area, a scenario that is aggravated by a reduction in the total number of beds. All of these elements must be factored in when referring to a veterans waiting list for Broadmead that has decreased from 375 to approximately 70, plus the reality that veterans are not treated on a priority basis.

    Recommendation three was that Veterans Affairs Canada undertake the renegotiation of the 1996 transfer agreement between the Government of Canada, the Government of the Province of B.C., and the George Derby Long-Term Care Society, and the agreements with other B.C. centres providing long-term health care to veterans, in light of the changes made by the government of B.C. in its funding and residential care access policies, effective April 15, 2002.

    VAC's response was that the government believes that if recommendations one and two were put in place, it would not be necessary to renegotiate any existing agreements. Renegotiations are not necessary, as the funding changes to major facilities in B.C.--recommendation one--are to be approved and finalized in fall 2002 under annual operating agreements. The wait listing of clients within facilities in B.C. will be properly managed by VAC's regional district--recommendation two. The government does not feel at this time that renegotiation would be beneficial or necessary. However, such renegotiations are an option if VAC's implementation response does not address the issues raised in recommendations one and two.

    The reality, notwithstanding VAC's response, is that recommendations one and two have not been fully addressed. The logical conclusion is that VAC should renegotiate the 1996 transfer agreement.

    As in most of the country, the wait list and access are the lightning rod for attention. In some parts of the country, the deplorable standard of accommodation is the focus. For example, an issue of concern in Newfoundland is privacy in long-term care facilities. Renovations were undertaken at the Caribou Memorial Veterans Pavilion in St. John's, Newfoundland in 1994. These renovations were mostly cosmetic in nature and included improved lighting, new furniture, etc. They did improve the quality of life of residents; however, they did not deal with major issues of privacy and dignity, as more than 60% of veterans were sharing rooms with one or more individuals.

    Today, with 75% of the residents suffering from dementia and significant associated behavioural problems, this overcrowding is no longer acceptable. Over the past years, it has been necessary to move the disturbed residents to the lounge area to ensure some level of privacy. This seems a rather strange practice, especially when one considers the lack of privacy and hygiene considerations, such as the lack of a sink in the lounge area. Residents with impairments should ideally be provided an element of privacy, for their benefit and the benefit of others.

    This is but another example of problems that have arisen by transferring federal facilities to provincial authorities that have not taken appropriate measures to deal with a changing clientele with more demanding needs.

    Our conclusion is there are no national standardized long-term care assessment mechanisms for providing veterans priority access to long-term care. Even though provinces and territories have a single point of access, the role of this single point of access varies in both range of services and methodology, from referral only, to referral and admission, to referral, admission, and follow-up. This methodology does not automatically include a VAC oversight.

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    There are still communications problems between VAC and veterans, and between VAC and provincial-territorial jurisdictions. Reliable information and informed advice are not always available, despite the proliferation of glossy pamphlets, obtuse documents, and the trendy Web-based data. There continues to be a lack of awareness of services. The first link and one-point contact for veterans should be with VAC. Access should be simplified, so that a frail veteran can make his way through the process without frustration.

    The veteran's charter promised to provide veterans nationally equitable health and nursing-home care. A veteran who has served his country to secure the freedom we enjoy and the values we hold so dear deserves the security of simple and easy access to long-term care.

    Thank you, Mr. Chair. As I said, my specialists are here with me and will gladly undertake to answer any of your questions.

    The Chair: Thank you very much, Mr. President, for a very comprehensive report on long-term care. I know that my colleagues probably have lots of questions, so we will certainly start right away with Mr. Bailey for seven minutes.

    Mr. Roy Bailey (Souris—Moose Mountain, Canadian Alliance): Thanks, Mr. Chair. You couldn't hit me at a better time, because I have had it up to here in the last month, not with Veterans Affairs, but rather with the absolute stupidity--maybe I should not use that strong a word--the misinformation within the medical association, no matter what province you're dealing with.

    Some of these incidents to which you drew our attention are very much on my mind. Right now I am waiting in my office for a call back from a minister. I don't want to talk to the deputy minister; I want to talk to the minister.

    Having said that, we have failed. By we I mean we collectively have failed. You mentioned a key phrase that is utmost. If we are going to correct this situation, it has to be in conjunction with Veterans Affairs, the Royal Canadian Legion, and so on. We need a massive information package out there. It must be delivered so it can be understood. We have people out there who don't even know what we're talking about when we talk about veterans. You can believe that or not, but that's absolutely true.

    I recently had a case myself in Regina. This was a 91-year-old Hong Kong veteran. We have a facility there that is designed...but they refused to place him in that facility, even though his wife, nephews, nieces and everybody else.... We finally won, but why should we have to go through all of that? Nobody on the Regina health board had a cotton-pickin' clue about veterans. Now that's not just in my province; that's in every province, because my letters come from every province.

    So my first question is this, Mr. Chair. Have you thought of any concrete way in which this committee, the government, and yourselves can bring forth an information package that will conk 'em and be read? Unless we have that, these problems you have are going to grow and grow. So what's your plan?

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    Mr. Allan Parks: I think both of our comrades sitting beside me are very involved in this. The other thing they have, which you mentioned, is some of the criteria you have to go through in a province and fill out, to try to get access to one of these long-term beds or long-term care. Never mind asking a frail veteran to fill one out; I sure wouldn't want to have to deal with it because I could never manage it.

    Mr. Roy Bailey: That's stupid.

    Mr. Allan Parks: Jim, maybe you could fill him in on some of the....

    Mr. Jim Margerum (Long Term Care Coordinator, Royal Canadian Legion): We do have a problem. I hate to pick on politicians, but I have to bring this item up. We have 10 provinces, and the problem is we have 10 different standards and 10 different attitudes from the provinces, in their wisdom in trying to extract more money from the federal government to pay for everything.

    In 1995 we wrote a letter to the then opposition leader, Mr. Harris, in Ontario. His commitment to us was that a Harris government would ensure that the special rights of veterans would be preserved and supported in the provision of long-term care services and facilities, and in the family. The lawyers for his party in Ontario would write wording that would protect the rights of veterans and make it a recognized fact, so they could easily get around a lot of these barriers. They promised us that. It is now May 2003, and we haven't had a single word changed.

    This wording here would guarantee, over and above the rights of provincial obligations to a resident of that province, the additional needs and care veterans should be receiving because of their service during the war and the trauma they went through. In effect, the provincial standard would hold for funding, and Veterans Affairs Canada or federal funding would be a top-up to ensure that those particular programs would be given. I believe the provincial politicians, primarily, have to get their acts together and work as a group if they genuinely and sincerely want to resolve the problems our veterans face.

    The biggest part of it, the tragedy, as indicated there, is the wife raised a family when the veteran went overseas for four years, then in the latter years, their sunset years, they decided the veteran had to go 60 miles away. The wife did not drive because she was probably 80 years old and had no way of getting there. There may have been no commercial transportation to the place. They were separated again in their greatest time of need.

    The provinces, the CCACs, and the other responsible provincial authorities are not doing their job. They don't talk to each other. Not only do I have 10 different provincial standards, but within the province each facility has different standards and each CCAC has different standards.

    So there's a lot of work to do, but if people genuinely want to do it, certainly with the experience of the Legion, other veteran organizations, and the federal and provincial authorities, it can be addressed--and the sooner the better.

    Mr. Roy Bailey: I just want to react to what Jim has said here. You're right about the 10 jurisdictions. Finally, after getting placement for what this Hong Kong vet deserved--and it was kind of a personal thing, I was so upset about it--I cooled off and walked down to the administration. I said to the administrator, “Do you have any priorities here for long-term care for vets”? She said, “Not to my knowledge”.

    Mr. Chairman, that's the point. We need a massive campaign and we need to work together with you people because it's going to get worse.

    Thank you. I've used up my time.

    The Chair: Mrs. Wayne for seven minutes.

    Mrs. Elsie Wayne (Saint John, PC): As you probably are aware, Mr. Parks, we just finished going across the nation, from B.C. right through to Newfoundland, looking at all the veterans hospitals. I certainly know that out in B.C. there were major concerns. I wasn't able to go to the one in B.C., but I heard about it from my colleagues when they came back.

    We were over in Newfoundland, and you're absolutely correct there. We were very concerned because we saw three veterans in one little room. There really wasn't room for them to even have their families come in, and they had one closet for all three veterans. We were quite shocked; we truly were.

    We haven't finished our report yet, but once it is given to us--as Mr. Wood, our chairman, will tell you--we do plan to go after the government on this. We found that in Ste. Anne's it was really quite different. There's no question about that.

    In my city of Saint John, as you know, they took down the DVA hospital and built Ridgewood. My father-in-law happens to be in there. He's 95 years old, and he's quite happy because they really look after him. He's in a wheelchair, and so on. They do have an Alzheimer's unit they've built.

    We have a long waiting list because a lot of our veterans are out in the regional hospital--that's our regular hospital--waiting to get in. It isn't until someone passes away that someone else can go in. We really have to expand.

    I think the biggest thing we have to try to get our government to understand is that with all of our veterans getting older every day, to turn it over to the provincial governments.... As you have stated, they are just part and parcel of the whole health care system in every province, with the exception of Ste. Anne's Hospital.

    I will give all my colleagues full marks because we don't play politics with this at all, Mr. Parks. We don't. We all work together to see what we can do. We will be going after what we feel is best for the different regions of Canada. What you have stated here is absolutely correct.

    I want to ask you one question. I've had a call and many letters from Mrs. Miller in Fredericton. Her husband was the chaplain out west. At the time, the government didn't send the chaplain overseas, and he didn't pick and choose where he was going to be, but now he is bedridden. I just got the letter this past week. I've been dealing with him, and he's been told that because he didn't go overseas he doesn't qualify to go into a veterans hospital. She simply can't look after him because she's in her eighties.

    I really don't know what's going to happen to Mr. Miller, but I wonder how you people feel about people like Mr. Miller. They didn't go overseas; they didn't pick and choose and make that decision themselves. The government of the day or the military of the day made that decision, so how do you feel they should be treated, Mr. Parks?

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    Mr. Allan Parks: As you know, the minister made an announcement in the House in the last couple of weeks that sort of hit seven of our priority resolutions. We sat down afterwards, and I had the opportunity to talk to a few people after these went through. We're very happy about the things that went through because we had fought for them for years. There was the allied veteran, as an example, and the widow.

    Basically, when we sat down and talked around the table this is exactly what we came up with. Right now, if there's a spot we're missing it's exactly the niche you just mentioned. In other words, in some circumstances, with some of the battles we've just won--I guess I can refer to Jim too--maybe we've been giving on the one hand when we should have been fighting on the other.

    So that's definitely something we have to work on and look at. I know exactly who you're talking about when you talk about Mr. Miller. So that will be one of our priorities to work on.

    Mrs. Elsie Wayne: Thank you.

    The Chair: Mr. Allard, do you want to add something to that?

    Mr. Pierre Allard (Service Bureau Director, Royal Canadian Legion): I just want to add, not necessarily to that question but to your question previously on what can we do practically. Presently, because VAC has divested itself of what I will call contract facilities and has passed them over to the provincial authorities, the access protocol is the problem. The access protocols in all the provinces don't ask questions about whether somebody is a veteran or not. He is supposed to self-identify.

    For example, I have the New Brunswick access protocol to assess whether or not an individual should seek long-term care. First of all, the definitions of where he stands in the assessment are not in line with the VAC assessment, which is a very simple one--we've alluded to it in this report. Nor is there anywhere in this assessment protocol to tick a little box that says “I'm a veteran”, so we can sort of try to get some of these benefits that are available through VAC.

    So in practical terms, I think VAC should somehow negotiate with the provincial authorities to include this little tick-off box that says, “I'm a veteran”. That would be the first simple step to go through. We see the same thing in all the other access protocols.

º  (1610)  

    The Chair: There's no--

    Mr. Pierre Allard: I haven't found it. By the same token, I've been asking questions about access protocols for various provincial authorities, and it's very difficult to find this information. So maybe that should be brought up-to-date. Maybe we can have some type of conference or study to find out what's in place, so we can understand the processes.

    There's another element that's a practical solution. When VAC divested itself of these facilities, it agreed to negotiate with these facilities on a tripartite basis. The reality is that the negotiations seem to take place on a dual-partite basis between VAC and the provincial authority. The facility is sort of left on the side looking in and trying to say “Well, what is it I'm going to offer?” or “What is it I can get from this process?” So maybe we have to convince VAC they have to follow a real tripartite process in the negotiations

    I certainly don't want to pick on VAC, because by the same token I think they are looking at the level of standardization of care. I think they've listened to some of our recommendations. They do come forward with some solutions in the fullness of time. In some of these instances they were sitting on the sidelines as dumbfounded as we were that these people could not get into these facilities.

    The Chair: Jim.

    Mr. Jim Margerum: If I may add in support of Pierre, the problem really is that the provincial authorities, along with their federal counterparts and the veterans organization, must get together and point out that this safeguarding of the language for veterans in the agreement should be there. It's a no-cost factor to the province because VAC tops it up, which is their responsibility.

    We're just asking for the provinces to live up to their obligations when they grab these facilities. In nearly every case they've built them a new facility. They took it over for $1--and where have the veterans gone?

    The Chair: Mrs. Ur.

    Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.): Thank you, Mr. Chair.

    I thank you for your presentation. In your opening remarks you stated that some Legion members don't have enough access to information on what is and isn't available to them. Is there some format the Legion uses at the present time to keep their members updated?

    For example, I'm from southwestern Ontario between Sarnia, London, and Chatham. I know I have 19 to 20 Legions in my riding, so I'm certainly blessed with a lot of them and I really appreciate working with them. We have people who come out from Veterans Affairs Canada and from the Legion to have meetings with people to let them know what the latest information is. Is that just something we're blessed with, or do other Legions have the same access?

    Mr. Allan Parks: You've answered the question for me. This is exactly what we do right across Canada. We have veterans service meetings, where we bring in all the volunteer service officers from all branches in the provinces. We have district and zone meetings, where the director of our service bureau will put on a seminar and try to bring them up to date on any new things that are happening, as well as lot of the old things a lot of us forget. They in turn, we hope, go back to their branches and try to bring that out at their branch meetings, so all members become aware.

    But being very truthful, from the dominion aspect of long-term care--Jim can vouch for me--it's been like pulling hens' teeth trying to get information from across Canada from different provinces on any problems they're having. We know they're having problems, but it just seems that unless you have a specialist in the area who knows the things to look for and how to assess, the local person does not pick up on it.

    So this is one of the advantages of this new survey we will be doing right across Canada in the smaller community care facilities. We'll have approximately 85 people trained across Canada to go out and do assessments in community care facilities. In doing those assessments, they may also be able to pick up on veterans in facilities who aren't being looked after by the Department of Veterans Affairs, for instance. So we'll be able to pass those names on, and things like that.

    These are the things we have worked out agreements on with the department at this point.

º  (1615)  

    Mrs. Rose-Marie Ur: As you indicted, you're having a lot of frustration in working with the CCACs. I'm well aware of that. I have the same thing, and my husband isn't a veteran. It is a very difficult establishment to try to work with, and in working with them for veterans I'm sure it's that much more frustrating.

    They send out people who are totally not versed in proper health etiquette. When you're living with a situation that needs attention and they send someone out who does not understand health care needs of individuals--I've sent more than one packing--it adds more frustration to the situation than benefits the situation.

    When the committee puts their recommendations together, maybe we could recommend that somewhere in placement in facilities there should be a checkpoint--that we should have a special status for our veterans, and they should have priority access. I think that's the least we can do on behalf of the veterans who have served so well for our country. I would certainly support a recommendation like that.

    Mr. Pierre Allard: Yes. There is priority access for veterans, but they have to identify that they're veterans, and that's the crux of the matter.

    Mrs. Rose-Marie Ur: But whose responsibility is that?

    Mr. Pierre Allard: That's the crux of the problem: whose responsibility is it?

    Mrs. Rose-Marie Ur: But can you not get your information out as well to the...? I don't know how many members there are. I'm not pointing out that someone's not doing it; I just want to find out how many people, not just one--

    Mr. Pierre Allard: I really think our Legion members are well informed. But veterans who are not necessarily Legion members may have never come to VAC because they're too proud, or whatever. They're approaching their sunset years and things are not quite the way they should be, and the caregiver is also frail. So what do they do at that point?

    Mrs. Rose-Marie Ur: Then we should educate the CCACs.

    Mr. Pierre Allard: If they go through this process in New Brunswick, they won't self-identify unless there's a little box to tick somewhere that says, “I think I qualify as a veteran”. I don't know how we get there. Maybe VAC has to sort of negotiate that process with the provincial authorities so they're better informed.

    Mrs. Rose-Marie Ur: I agree with that.

    Mr. Jim Margerum: The other problem is you have approximately 450,000 veterans remaining in Canada. Of those, 150,000 are on the books of VAC for benefits, or what have you. Where are the other 300,000? That's the question.

    They are not members of the Legion. There are some yardsticks our people use when we go out to facilities. If a group of men are approximately 80 years old, you can be guaranteed that four out of six of them have been in the service. If you look at the demographics of the population in 1939 as an example, four out of six people were in the service. You can ask the group; you'll find out.

    We go to church seniors clubs and places like that to get records. We take our old files out of the Legion if people haven't renewed because they got sick, or what have you. We review them and phone people. As a quick example, VAC said in the Ottawa area they had 140 people on the list. Guess what? We found 568 by going around to the facilities on our own, just as a sample to show that they're there. These are the people who are not aware of it.

    When you're talking with the spouses who are around 80 years old, they're intimidated by the bureaucracy and some of the stuff. A very simple form has to be developed, but the people also have to work together, especially the CCACs. The point of contact, as you pointed out, has to be clearly identified, so if a person looks like they may have been in the service, you ask them and you identify. Then you follow through with the normal procedure on what they're eligible for.

º  (1620)  

    Mrs. Rose-Marie Ur: Maybe there's an opportunity, through the householders of 301 members of Parliament, to disseminate information on this very important matter.

    Thank you.

    The Chair: That's a great idea, Rose-Marie.

    Carmen, do you have a few questions?

    Mr. Carmen Provenzano (Sault Ste. Marie, Lib.): Mr. Chair, I want to thank the Legion members for this presentation. In particular, I'm glad the Legion said in its presentation that it's happy with the progress that's been made on standards in long-term care, because I think that's important. We're all striving to achieve that ultimate ideal.

    This committee--I think pretty well all of the members here--was able to travel from one end of the country to the other to look at long-term care facilities and programs for veterans. You know, gentlemen, that they vary in each of the provinces. But after having the experience of going to facilities in every province and seeing facilities of just about every type, you come away with the valid impression that the facilities that are devoted to the care of veterans are, to one degree or another, a cut above what's available to the general population.

    The model I thought was so fantastic was in Saskatoon, Saskatchewan. I saw how the program operated to really create a wonderful life for someone in a long-term care facility. That's the standard we should be aiming for. Certainly Ste. Anne's is a facility of a different type, and you'd be hard-pressed to fault that institution.

    So the bottom line is that Canada treats its veterans much better than the general population. Having said that though, I think you have a committee here that is very receptive to the kinds of representations you're making, so whatever we can recommend to improve the quality of that care, we'd like to do. But I just feel we need to get that on the record. If what I'm saying isn't correct I wish someone would speak up. But when I travelled across the country, I didn't find any argument with the statement that veterans were treated better than the general population, in whatever province they happened to be receiving long-term care.

    Mr. Allan Parks: I'd like to respond to your question. As you said, by all means we give kudos to the Department of Veterans Affairs. We have fought long and hard to get the quality of care we feel the veterans should have from coast to coast. We feel we've made real inroads.

    The latest program we're doing with them is the survey. We'll be able to get out to those small mom-and-pop operations where we have veterans who the department is paying for but our counsellors can't get to because there aren't enough. So we'll be able to cover this, go through those 1,500 establishments, and hopefully bring back to the department any deficiencies we see there. As I said, I give the department kudos for that. They've worked with us and it's come a long way.

    There are still certain areas, mind you, where it's not where it should be, just like you said, but in other areas it's great. We always use Ste. Anne's as the model, and we say if they all could be set up that way.... That is the model; there's no question in my mind.

º  (1625)  

    Mr. Carmen Provenzano: Go to Saskatoon.

    Mr. Allan Parks: I'll have to visit that one.

    I just want to mention that our big concern now is standardizing access. Just as we've been saying, on all these forms and assessment sheets, everywhere we go and in every document we get, there's very little reference there for the person to let them know they're a veteran. Maybe we could get that standardized to some degree, where the individual walking in doesn't have to say, “I'm a veteran”. These people are very proud, as you know, and they're not going to say that, unless they're down and out or think they have to. That's the last thing they would say.

    But if there were something to twig the person doing the interview to ask, “By the way, are you a veteran?”--just a box they could tick off--that would open the door. They'd know he was a veteran and they'd know about all the other things that were available to him. We're trying to get that access standardized from coast to coast so we can get that implemented.

    Thank you very much. I agree with you 100% that the standard has come up really well.

    The Chair: Pierre.

    Mr. Pierre Allard: I just want to add that there still are, however, some disparities. I would suggest that Newfoundland possibly has some way to go.

    In addition to that, I agree with you when you say the level of care provided to veterans is possibly a notch above that for other residents. By the same token, in those facilities where we have veterans the level of care for all the people who reside there has increased, because they get the benefit of the increased funding. So there are two sides to that story.

    The Chair: Mr. Bailey.

    Mr. Roy Bailey: I have three points. First of all, once the veteran is identified there's no reason why the information required in any one of the provinces couldn't be on a standardized form. I think that's possible.

    Jim mentioned another point that comes up, and I run across this all the time in the letters that come in. I mentioned the 91-year-old Hong Kong veteran who was injured; you could see the injury. It was a war injury, yet he had not associated with the Royal Canadian Legion, so he had never asked for or received any benefits. The person looking after him was a niece, but that's nobody's problem. It's a problem, but you can't point any fingers in that case, outside of the fact I think people would respond to some type of survey being done. In some way, we have to get this information.

    Just in closing, Bill C-31 is on the agenda for this afternoon. I don't know whether we're going to get time to debate it further or not. Do you know the bill I'm referring to? It's a very positive bill, and I think some people will copy it. I've had lots of requests from professional firemen, professional policemen, and so on, particularly with a designated service area. There's nothing wrong with that at all.

    There's one thing I'm completely sold on. When I took this bill to my caucus--and I'm sure it's true for others--once I explained what the bill was all about I had unanimity. Everybody's going to support it.

    Just in closing, we still have 450,000 veterans out there, so indirectly, through the spouses and offspring, we still have a million people affected by Veterans Affairs. If it's the same in other caucuses as in my caucus, most colleagues are much younger and it's hard to get them motivated. It's a challenge for us all.

    Is there some way for these 450,000...? We know we have to be able to identify them. When they come to me I ask if they are veterans, but unless they offer that information, I don't know.

º  (1630)  

    Mr. Jim Margerum: I think we're going to do something in your area that we've had success with before. My colleague looks after Parkwood Hospital, which is a veterans contract facility, and we're going to have an intensive advertising campaign in every kind of news media--for churches, for seniors, for the local newspapers--to extensively cover the area and try to identify them. We've been very successful doing this in the Ottawa area. It needs a little infusion of funds and direction and concentration by levels of governments to assist us in doing the same thing. I bet you it will clear up 80% to 90% of identification problems.

    In answer to your question on the facilities, some of the mom-and-pop operations are great--greater than our contract facilities. As a quick example, my niece works up in northern Alberta at a facility in an area where there's a certain ethnic group. They have certain meals they like, and one of the cooks there is from the same ethnic group. She makes up these specialties at home and brings them in, all on her own. They treat the people...and when they go away and come back, they're glad to get back to that facility.

    But we have other areas where I suggest there's cherry-picking going on. Now what I mean by that, very clearly, is they have costs for staffing and they can handle certain levels of care. So if they have three people and one needs a heck of a lot of care, and one needs a fair bit of care, the one that needs the least amount of care is the one they're going to select to go in.

    It's hard to prove and it's hard to find it, but I think if you talk to VAC people or others they'll admit there's cherry-picking. So that's one of the concerns we have with the facility. We're not saying they don't provide the care. As was alluded to, when there are veterans in the facility the general level of care goes up, because the VAC is generous with funding to assist veterans there.

    The Chair: Mr. Parks, on trying to get the message out, you obviously have liaison, which I'm privileged to know. You get together with the army and navy vets, Cliff Chadderton's groups, and the merchant navy and merchant marines on a periodic basis. Does this come up? Are they as sympathetic as the Legion about getting the word out for those vets, or is the Legion way ahead of these people and you can't convince these people to also help out?

    Mr. Allan Parks: We work hand in hand with both groups you've mentioned and the merchant navy. Unfortunately, they're not set up to the same degree we are. The concern of the NCVA, for instance, is the amputees. The army and navy unfortunately don't have a national base across Canada where they have sub-executive DEC meetings three or four times a year. They have their annual meeting where they get together, but other than that they just have their provincial convention. So it's very hard

    I've talked to both Cliff and Bob, and we are working together on this now for the same thing. In fact, on the last items the minister just approved, all the groups worked very closely together and stuck together. I guess that's how we managed to accomplish a lot more than we normally do. We're trying to break up that “divide and conquer” part, and if we stick together we can get a lot further. But I agree with you.

    There's one other important thing you brought up, and I think Jim will remember it. Probably 20 years ago in the Royal Canadian Legion we had an operation called Operation Service. We went out from our national headquarters here, through the service bureau, and contacted every one of our 1,600 branches across Canada to put on what we called Operation Service. They formed a committee in their branch and went out and solicited their whole community--did a door-to-door campaign. They knocked on doors and asked if any veterans lived there.

    That was probably one of the most successful programs we did back then. We were looking to help out benefit-wise, so possibly we could resurrect that again. We were identifying veterans and were able to bring that information out. Maybe we'd get a better handle on that too and be able to give advice on long-term care, and so on.

    So I'll certainly take that back to our veterans service committee and see if we can do something like that again.

º  (1635)  

    The Chair: Have you ever approached the minister with these ideas? I understand you people get together every once in a while to chat about what's happening with veterans. Have you ever brought this up to the minister face-to-face? I think some of the things we're chatting about are under the provincial umbrella of health care. From his level, would he not have to try to put the box there for veterans, or whatever, and get it changed? Wouldn't that be at his level?

    Mr. Allan Parks: We have had several meetings, although not that many with the new minister. But prior to that I had many meetings, and it was almost impossible to get anything done because with all the complaints we had everybody said it was just Ontario. That's when we found out we were having problems at the other commands. The other provinces weren't reporting back to us. We didn't have a specialist in the community, like Jim Margerum, who knew long-term care, the agreements, and all of that.

    Now that we've made Jim coordinator at our dominion level, we have long-term care people in most of the provinces across Canada that he's able to talk to and go back and forth with. Jim has had several meetings with the department, not necessarily with the minister, but with the deputy and the ADM. Maybe Jim can give you a little update on that.

    Mr. Jim Margerum: Every two months we have a teleconference with the ADM, Brian Ferguson; John Walker, who's the director of long-term care; usually Darragh Mogan; and the RDG in Ontario. I should mention that this is in Ontario. We discuss current problems and that.

    On advertising or seeking out these 300,000 veterans, I broached that subject a number of times at the bureaucratic level at the lower end, and it's never gone further. Perhaps it's a good suggestion you made that we go directly to the minister. We have the volunteers; we have the network across Canada. We need a coordinated effort using the same song sheet. The only real cost factor is advertising, because I think you're aware of what it costs to put an ad in the different papers. The branch looks after the volunteers. We go out in cars through the area.

    It can happen. We need to get the people together and get the authority, which would be Veterans Affairs Canada, so they can help us. I feel safe in saying that within six months from the start of a program we'd have over 80% of the veterans identified.

    The biggest problem we have is urgency. Right now, after a veteran goes into a facility they live on average for about a year. It used to be three and a half years, but now we're down to months. If we don't do something of this nature we're going to be guilty of failing our veterans--the ones who were not identified, who went through it, and have not been given the benefits they justly deserve and earned.

    So your suggestion to ask the minister to direct the staff to support such a program is a good one. It can be worked with churches and everybody because they're all winners, especially the provinces, due to the cost factor. We are looking after our obligations to look after our veterans.

    The Chair: On those community access beds--if anybody wants to hop in with some questions, by all means do so--I think at a Legion convention in Halifax in 2001 the minister went down and said we were freeing up 2,000 beds.

    What happened to those 2,000 beds? Are they being utilized across the country? Do you have any idea what happened to them, or did they just disappear and nobody's using them?

º  (1640)  

    Mr. Jim Margerum: With all due respect, the beds were freed up because they did not need a whole lot of parliamentary legislation to get the money back into the system. They had what they called acute care bed service for veterans when they first came home from overseas, and 2,600 beds were dormant. They weren't being used so money wasn't being spent. But the legislation and provisions were there.

    They recategorized the beds for long-term care, and that allowed them to operate and open the beds. Rather than build new facilities, which is time consuming and wouldn't do the job because by the time they were built our veterans would be gone, they have moved them into community facilities. There have been additions to smaller facilities in the community to create more rooms, and the veterans have been put into these facilities. It's very much a benefit because the spouse and the family are closer to their loved one.

    The care in most of these cases is good. They do police them. On the beds that were given, they said they would open them up to Canadian veterans who served overseas. They have a priority list, and unfortunately the priority list is so far down they don't resurrect it for them. So we have a lot of people who are complaining that they can't get into these facilities.

    We have a little bit of a problem with some of the facilities that don't cooperate. Again, there's cherry-picking. They don't want people who require heavy care. They want those who require simple care, or they want somebody who's diapered and in bed all day--to be blunt--and requires very little care.

    So we have some problems. I give the department and the minister of the day, Mr. Baker, full credit for what they've put out there; however, implementing it and having it operate fully is yet to be achieved.

    The Chair: Do you think it will ever be achieved?

    Mr. Jim Margerum: It can be done if people want to do it.

    The Chair: Would that take care of some of your problems?

    Mr. Jim Margerum: It would take care of a lot of the problems.

    The Chair: Are 2,000 enough?

    Mr. Jim Margerum: I disagree with VAC. They don't think I'm right. My argument is that as your age goes up your needs go up--such as Alzheimer's, dementia, and heavy care. They suggest I'm wrong and these aren't going up, but I strongly suggest they look at all their colleagues, friends, and family who are 80 years old. What are their needs?

    They conveniently say they have enough beds, when we raise the issue that there aren't enough beds in the area. But how do you argue with somebody who's been waiting two years to get into a facility? The beds that are empty.... They say they have a surplus of beds, but that's because the level of care has gone up, and some of those beds are at the low-entry level.

    We're telling them they have to add staff and give them training to accommodate those with a higher level of care, so they're not waiting a year or 18 months to get in. We're not asking for more beds; we're asking them to utilize the existing beds in a proper fashion.

    The Chair: How does funding for those beds work? You talked about cherry-picking. I should know this, but if Veterans Affairs pays x amount of dollars, doesn't the hospital still get the money regardless of whether it's a low-end bed or a high-end bed? There's still compensation for the hospital to take care of these individuals, is there not?

    Mr. Jim Margerum: Veterans pay $743 a month maximum. If they were disabled or wounded they pay zero and the VAC picks up the full amount. The province has to pay a certain amount for beds--there are entry limits and levels--and VAC tops it up.

    A person sometimes falls through the cracks if they don't quite meet a criteria. For six months of the year one lady was paying $1,800 a month for her husband at Perley-Rideau Veterans facility, as an example. On July 1 the magic thing happened; she only had to pay $743, which Veterans Affairs Canada paid. She was paying $1,100 out of her pocket, and she never got the money back.

    There are little technicalities. They're reading the technicalities right so you can't fault VAC. But if a guy's a veteran on July 1, why wasn't he a veteran on January 1? We do have problems with the funding.

º  (1645)  

    The Chair: From Veterans Affairs?

    Mr. Jim Margerum: Yes, there are some problems there. I think they have to look at the way they're doing it because they've changed the way they handle the care of veterans. They're looking to keep them in the community, which we fully support, as long as they're able to be looked after with supplementary care, without saddling the spouse with all the heavy care. They're doing very well in a lot of areas, but unfortunately some of it is provincial care, and the provinces have cut it back.

    They've cut the staffing. A quick example is staffing at the Lodge at Broadmead. The staff all got a raise last year. Pierre and I were out there. The province agreed to let them pay 10%--whatever it was--but the province said they would only pay 70% of the increase in their budget and they had to find the other 30%. So guess where they found it? VAC said, “Well how much do you need?” They signed the cheque and put it in. They will not open the tripartite contracts or agreements because they're frustrated with contracts. If they open it up it's open to everything so it's a new ball game--let's make up a new deal. That's some of the problem.

    This is not in direct criticism of VAC; this is reality. VAC has dedicated staff who are trying to do it, but unfortunately they're caught with their counterparts in the provinces who aren't quite agreeable. We're caught with some of the facilities, as you saw in Ontario--$125 million bankruptcy for 10 facilities in which we had 122 veterans. They closed down a lot of them.

    We run into these problems with some of the operators. They certainly need to do a heck of a lot more screening on them, and that's a provincial matter. But VAC have to place their veterans so they'll often take a place that maybe shouldn't be used, but they have no choice.

    The Chair: Do you think VAC really saves money by keeping veterans at home longer? Granted they stay in the home a long time, but when they finally have to go to the hospital, whether they're suffering from dementia or whatever, it takes a lot more money to look after them. So is this not a wash, or whatever? How do you feel about that?

    Mr. Jim Margerum: It's a fact. We've wanted what we call floating beds in the community. That means if a veteran needs a bed and they put him in a mom-and-pop long-term care facility or nursing home, VAC floats the administrative support and the money for that bed. They don't build a new bed or wait in line for another one.

    The cost of keeping someone in a facility right now is at the low end of about $45,000 in a nursing home, and about $68,000 to $114,000 for long-term chronic care, per year, per person. If you keep them at home, the cost is about $45 or $46, depending on the support system they provide that person. So it could be anywhere from about $35 to $65 for support per month.

    There is a direct saving. The problem is the distribution of funding within the government department. I think that's where we have an argument with Veterans Affairs Canada. The money is probably there in most cases, with a little bit of top-up or adjustment once they've set the plan in motion, but the distribution of money could be better.

    The Chair: Have you brought that up with them?

    Does anybody else any questions, or am I the only guy asking?

    Pierre, do you want to add anything to that? No.

    This is something I just thought about. Do you think that Veterans Affairs could use an ombudsman?

    Mr. Jim Margerum: Yes. I'll tell you what happened and how it works. Nearly every government department in the province has an ombudsman. Veterans Affairs did not want to hear the word “ombudsman”, so they gave us, as a pilot project in Ontario, a director of quality care, because of the firing and the issues at Sunnybrook.

    Essentially that person is an ombudsman, and they're doing an outstanding job. They've really changed that place within four months. There's a dedicated doctor in the facility responsible for long-term care, John Conlin from Veterans Affairs, and Dave Gordon with the Ontario provincial command. They put together the wherewithal to solve problems. The duties of John Conlin are those of an ombudsman, so it speaks for itself. For some reason they don't like the word “ombudsman”. Change the word but do the job.

º  (1650)  

    Mr. Pierre Allard: Maybe rather than “ombudsman” we could call them a “quality of care coordinator” or something else.

    Mr. Roy Bailey: Just “care coordinator”.

    Mr. Pierre Allard: I don't think we'd necessarily favour an ombudsman à la Canadian Forces ombudsman, with a large staff to do research and analysis. We need somebody who can intervene on a case-by-case basis to solve immediate problems.

    The Chair: Without losing his job doing it.

    Mr. Pierre Allard: Yes. For example, John Conlin, who's a VAC employee, is doing a fine job.

    The Chair: I know all about John. He is doing a fine job, but he also thinks outside the box. Here's guy who commandeered a car, painted it up, and went through the streets of Toronto looking for veterans in need who were living on the street. He picked them up, and got into a lot of trouble with Veterans Affairs because he was using this old car.

    Mr. Pierre Allard: We commend his actions.

    The Chair: So do I. John Conlin happens to be a friend of mine. His wife, Shirley, used to work for me, so that's why I know all about what John does. But he is a very aggressive guy, and he's very well versed in Veterans Affairs. He does a lot of good stuff that other people should be doing but don't think about.

    Mr. Roy Bailey: I just want to say before we close that the gentleman from the Royal Canadian Legion was recognized in the House today for coordinating the Juno Beach project, and he got really good applause.

    I want to personally do the same thing. This was a project headed by the Legion, and I hope some day to get a whole list of those involved--not necessarily by name. This was a cross-country project that included individuals, small businesses, big businesses, corporations, and so on. I think it's a tribute to the leadership of the Legion, because when I look at some of the late contributions made by some of our provinces, it was a little bit shameful. I'll tell them that too. I don't think the federal government broke any billboards and advertised either.

    This is going to be a great thing. For my grandchildren and their grandchildren, this centre is going to sit there with as much military value and close proximity to Vimy, and so on. So I want to congratulate the Legion. They've done a great job.

    Mr. Allan Parks: Thanks very much. But I just want to make sure it goes on the record that it actually wasn't the Legion that spearheaded this; it was the Juno committee that got together and--

    Mr. Roy Bailey: They were mostly from the Legion.

    Mr. Allan Parks: Yes, most of them are Legion members. We went right across the country in all our branches and certainly supported them 100%.

    Mr. Roy Bailey: Every branch, yes.

    Mr. Allan Parks: We worked with all the merchants as well, so it was well done.

    The Chair: Do you have any questions of the witnesses? No.

    Thank you very much, gentlemen, and thank you for the comprehensive report. It was excellent.

    The meeting is adjourned.