:
Good morning. This is yet another glorious meeting of the Standing Committee on Veterans Affairs.
This morning, pursuant to Standing Order 108(2), we are pursuing our study of the veterans independence program and the health care review.
We have, as witnesses this morning, Mr. Brian Ferguson, the assistant deputy minister of veterans services; and Darragh Mogan, the executive director of the service and program modernization task force.
I know at least one of you is incredibly familiar with the procedures here at the committee, but we usually allow our witnesses about 20 minutes. So it could be 10 minutes each, if you'd like, or it could be 19 minutes for one of you and one minute for the other, if you wish or see fit. And then you get a chance to hear all the questions our committee members have to put to you.
So, gentlemen, the floor is yours.
:
Merci. Thank you very much, Mr. Chair.
I will deliver our only remarks from the department this morning.
[Translation]
Thank you, Mr. Chairman.
I am pleased to be here today, in my capacity as Assistant Deputy Minister, Veterans Services Branch, to discuss the work currently underway within Veterans Affairs Canada on the Veterans Health Services Review.
[English]
Let me start by saying that Veterans Affairs Canada has a long history of modifying programs and services to better respond to the evolving needs of veterans. In the early to mid 1900s, veterans returning from World War I, World War II, and the Korean War were greeted with a suite of benefits and services to help them successfully reintegrate into civilian life. Since that time, eligibility for benefits and access to services have been extended to include a broader group of veterans. New programs have also been introduced, including one of our most successful and popular programs, the veterans independence program.
First introduced in 1981, VIP, as it has been known, is a national home care program providing services such as housekeeping, grounds maintenance, personal care, and nutrition services to help veterans remain independent in their homes. Its goal is achieving nothing less than healthy living within the community. It is modeled on a graduated health care approach that emphasizes early assistance to prevent clients from becoming unduly dependent on the long-term health care system, allowing them to live with dignity, security, and comfort in their own homes for as long as possible.
Today, approximately 98,000 veterans and primary caregivers—74,000 veterans and 24,000 caregivers—benefit from VIP services, at an approximate cost of $274 million a year. This is a fraction of the cost of providing these individuals and veterans with beds in long-term care facilities. More importantly, it has allowed them to remain in their homes, not only helping them to maintain their independence but ensuring a high quality of life in their later years.
Those who care for veterans, primarily widows, can continue to receive for a lifetime the same housekeeping and grounds maintenance services the veteran benefited from before death or being admitted to a long-term care facility. This recognizes the contributions that these caregivers made in caring for the veteran, often at a great sacrifice to their own health, and their continued need for support to remain in their homes, often in the very home they shared with the veteran.
In spite of the changes made over the years to try to better respond to the needs of war veterans and their primary caregivers, the reality is that further action is required if we are to make a difference in how these veterans live out their remaining years.
Over the years our programs have incrementally evolved to meet clients' changing needs. The result is that we are faced with complex eligibility rules and a system that leaves some veterans without the care they need when they need it and where they need it.
The goals of the veterans health services review are threefold. First, we are examining the changing health needs of our aging veterans to identify gaps and barriers in meeting service needs. Secondly, we are soliciting input on areas where significant improvements could be made. The feedback from this committee will be a critical input in this regard. Thirdly, we will be developing appropriate proposals for change, which our minister will take to government for consideration.
I want to emphasize that we are not in a position to provide you with the results of the review today, as we are fully engaged in the process of analysis and policy development. However, we are most anxious to hear from you about how to make the review a success.
I understand that Dr. Victor Marshall, who is the chair of the Gerontology Advisory Council, spoke to you last month about the council's work. The sum of Canada's most distinguished experts on aging, seniors, and veterans issues, including representatives from the major national veterans organizations, the council provides the department with advice on how best to support the health, wellness, and quality of life for our traditional war veterans from World War I, World II, and the Korean War.
Its report, Keeping the Promise: The Future of Health Benefits for Canada's War Veterans, advocates for veterans' access to health services on a needs basis rather than on the entitlement basis that exists today. It also recommends integrating VAC's current three health care programs—treatment benefits, the veterans independence program, and long-term care—into a veterans integrated services approach that provides a full continuum of care.
The critical importance of early intervention and health promotion is also emphasized. The council's report and recommendations are helping to guide the work of the veterans health services review.
Currently, the department is exploring how to provide more streamlined access to health services to more veterans. We want our veterans to age as well as possible and to receive the most appropriate care based on need. To get the best outcome, VAC is examining how appropriate health benefits could be targeted to clients based on assessed needs. We are taking a careful look at the appropriateness of disability pensions and low income as the only gateways to access our health care program. For example, and this is a possibility, eligibility could be based on a combination of military service and need. In simple terms, a veteran is a veteran is a veteran.
It is often difficult to relate current health problems to a specific event or a situation that occurred during military service 50 or more years ago. We also recognize there are latent, long-term health effects of military service that create need today. It makes sense to provide health benefits that allow our veterans to stay independent for as long as possible, wherever it is they choose to live. By doing this, VAC can delay and often prevent the need for long-term care. This means developing a program that is flexible, where the level and intensity of service could be increased depending on need, and that is what we are looking at.
The department is continuing to work closely with the Gerontological Advisory Council to develop tools to assess client care needs so that appropriate benefits can be targeted to meet specific needs. With their expertise and evidence-based health promotion, the council is also advising on the design of a healthy aging strategy so we can support veterans in maintaining or improving their quality of life.
We are looking into the types of support and assistance that will help veterans remain independent as long as possible, even with a chronic illness and disability. Ultimately the veterans health services review is about meeting the needs of those who have donned a uniform in service to our country. Knowing that the outcome of this work is critical to veterans and may also serve as a legacy for the care of seniors in Canada, we are devoting the time and effort necessary to make sure we get the best possible outcome. It is the logical next step in the department's evolution.
[Translation]
It is similar in scope and importance to the New Veterans Charter, which represented the most comprehensive transformation in Veterans' programs and services in 60 years. It has the potential to be an excellent foundation on which to respond to the health needs of younger Canadian Forces Veterans to come.
Thank you, Mr. Chairman. I would be pleased to respond to any questions that the Committee may have.
Thank you for coming this morning and appearing before us again.
You mentioned the changes Veterans Affairs goes through as it tries to adjust to new programs, new realities, new veterans, different issues. I'm sure you're aware of the fact that we face the front line of complaints. I've often wondered, when we see the veterans or their families come in through the doors and the complaints are there, how many are happy whom we don't know about--and I assume there are quite a few of them. We don't get to see those people, so thank you for the effort you're making.
I'm always wondering, and I'll keep going back to it ad nauseam, about delivering the services in the far-flung areas of the country. We notice on maps...and I can't remember right now who spoke to us and showed us the distances between offices and all the services that are provided. We know there are contract services out there in provincial hospitals and for all these other services.
Can you suggest to me how we're changing and how we're trying to...? Health care migrates to the larger centres. In my riding I don't have a large centre, and there are many instances like that right across Canada. As the services become more and more condensed in the larger areas, how do we provide services in those areas to make sure they have access to it?
:
That's an excellent question and a continuing challenge for us, as you can appreciate and have highlighted in your question.
We have a set-up across the country where we have 50 client service teams now that are established in localities that are designed to serve the vast majority of veterans.
In the instances where we have people living in rural areas, those client service teams are still responsible for the rural areas for which they provide services. Actually, we invest in our area counsellors to go out to visit those individuals in their communities.
We are also investing in what we call proactive screening. In other words, for the aging veterans who live at home, we attempt to call as many of those as we possibly can on an unsolicited basis each year to determine how they're doing in their home. If they're doing poorly, from the screening tool we have, that we use over the phone, we send a work item through our computer system directly to the line staff who live closest to them, and they go out to visit within a short period of time.
That system seems to work relatively well, but it doesn't solve completely the issue. We're continuing to look, for example, at provinces and others with innovative approaches, such as telehealth and those other mechanisms, which we are factoring in, by the way, into our veterans health services review, as elements we should consider in our policy development.
:
Thank you very, very much for coming here today.
I wanted to correct one thing, though. In your second paragraph, you say:
In the early to mid 1900s, Veterans returning from World War One, World War Two and the Korean War were greeted with a suite of benefits and services to help them successfully reintegrate into civilian society.
That was true for many veterans, but it wasn't true for aboriginal veterans. Many of them were left out. In fact, they went back to their units or reserves or wherever and really didn't get very much at all. So I would simply caution you on that, because if I were an aboriginal veteran who read it, I think I'd be a little perplexed by that.
You said something as well that I couldn't agree with more: “a Veteran is a Veteran is a Veteran”. I'd like to only add one thing to that and say: “a widow is a widow is a widow”.
I have repeated this many times. I have a letter that was written on June 28, 2005. It is signed by Stephen Harper, the Prime Minister of the country, and it says:
A Conservative government would immediately extend the Veterans Independence Program services to all widows of all Second World War and Korean War veterans regardless of when the Veteran passed away or how long they had been receiving the benefit prior to passing away.
I have another letter written by, at that time, the opposition critic, saying “until the Conservative Party forms government I am unable to change the regulations to extend V.I.P. benefits to all Veterans' widows”.
The Conservatives are now government--it's been that way for over 15 months--so my question quite clearly is, have you been given instruction to extend immediately the VIP program to all widows of veterans, regardless of time of death or if they applied?
:
The difficulty I have is that you indicate that this program, the VIP, actually saves money. So if a person served in World War II and in Korea--that's proven, he's a veteran--and if he has a widow, he passes on and he has a widow, what's the difficulty in extending the VIP to her right away? I don't understand what the difficulty is. If she's a widow and she's in her home and somebody passes away, I don't see what the difficulty is in extending the program. You have a two-tier system right now: some widows get it, some don't.
As you know, by the time we get this review in the fall, it will probably be next year before we see anything, and by that time, a fair number of these widows will have passed away. They're very frustrated, and so are we, because a letter from the Prime Minister, when he was in opposition, said they would do it immediately. To them, immediately means right now--not after a review, not after careful consideration, but right now.
I know this is a question more for the minister, but I can't tell you how frustrated I am that they're being delayed because of a review. A review was done in 1998--a health care review--and we're doing another one. These widows are getting older. They're getting frail. This system saves the government money. I don't understand why....
My question for you, though, on another aspect of health needs, is on hearing loss. I'm getting an awful lot of veterans in the Halifax area who have been turned down for hearing aids and/or a pension because they couldn't prove that the hearing loss was related to their service on board the ship or on battlefields. When they came home, they didn't go get a hearing test; they just went back to wherever they lived. Now, years later, of course, they have tinnitus or hearing problems.
Dr. David Lyon has said very clearly that there is a relationship between exposure to loud noise at that time and what's happening 60 years later. But they're repeatedly being turned down, over and over again.
I'm just wondering, how can we move that issue forward to help these guys?
:
Maybe, Mr. Stoffer, I'll try to give a little addition to the answer Brian gave to your first question. This is a very important one. I can't presume to make any political statements, and I wouldn't.
There are veterans who served Canada who are not eligible at the moment for the health services they need as much or perhaps even more than spouses. So it's not that one trades off against the other. We have a very complex eligibility system. After 60 years of adding patchworks, it's very difficult for people to navigate through it, even our own staff. What we don't want to do, even though there is an imperative to move quickly on this, is, in a rush, make some serious mistakes that we'll be back here having to be accountable for later on.
I don't detect any change in the commitment. I do sense that a comprehensive review of health services that will get away all the barriers to good health outcomes, including those for widows, is, in terms of veterans, at the top of the government's list of things they really want to do.
I guess all I can do, from a public service point of view, is say that it does take time. I can't account for every second of time that's lapsed between the time it was written and now. But what I can say is that I don't see a diminution in any commitment there. I do see the desire to make a comprehensive approach so that we don't add yet another patchwork eligibility issue.
Hearing loss is one of the major presenting conditions for pension eligibility. The benefit of the doubt is there. If someone doesn't have clearcut evidence that their service was a causative factor in their loss of hearing, if they're in a trade, a hard C trade or whatever, that's likely to produce hearing loss, benefit of the doubt means they will get their disability award or their disability pension.
If there are problems on an individual basis, we'll look at them for sure. I don't know that there's sort of a system-wide problem. Maybe you could provide more information and we'll respond to it.
There's a range of costs, depending on which option you take. The options are in general terms now, but I would say they range from a very low cost to...overall, because if you do a needs-based approach, you can actually assign a benefit that isn't as expensive as maybe an entitlement benefit because you're giving what they actually need, not what they might have been entitled to under the old system. On the other hand, you will get more people in the club, which would increase the cost at that end.
So I would hesitate to give you a cost figure at the moment because I think it would be misleading. But I can tell you that the costs would range from I think a very little, incremental cost, if any, to a significant cost. But it would be less than if you don't change the system. We've already identified that if we don't change the system, the options for government at large are going to be more expensive to accommodate needs.
I know that doesn't give you numbers, but I think it's the reality of where--
We did have an interesting discussion with witnesses the other day, with Mr. Marshall of the GAC. I think when we look at that, we can be assured that this committee wants to work with you to bring this study to fruition for the veterans. That's what we're here for.
In terms of acting and timing, we've actually done a number of things, right from the bill of rights to the ombudsman who is coming in place, and we're now looking at the health care and the extension of the services that we really want to look at.
In terms of the VAC, you say you take their advice because you believe they are the experts and they're brought together. I appreciate that, and I think most of us around this table would share that view after their presentation the other day. How will that be compiled? We're going to have to make some priorities, obviously, at the end of the day. Are you compiling, then, the programs they have, and will you come with options?
Thank you, gentlemen, for being here today.
Just a point of information for colleagues, who are probably aware that our committee meeting, as are all committee meetings, is broadcast on the web. After that meeting, I had a call from a brother of one of the nine soldiers who died on August 9, 1974, and he was appreciative of the work of the committee that day. So in cyberspace we are being heard.
On the notion of the overall review, ad hoc changes versus comprehensive changes, I think we appreciate that there's a time and a place for both. Ad hoc changes will sometimes provide for the patch that's needed to deal with an immediate concern, but every so often you have to step back and look at a comprehensive review. We appreciate the work of the department in that regard, and I hope what we do will be helpful. But it is a concern that, based on the five-year figure used for the charter, we might be facing more or less five years for this.
When did the clocks start on the department's review?
:
It's a very good question. Brian put forth the principle that a veteran is a veteran is a veteran. We didn't mean it only to a war veteran is a war veteran is a war veteran, because there are individuals, especially since 1990, who have had pretty harrowing service for this country.
The principles of a needs-based versus entitlement-based approach, according to the Gerontological Advisory Council and anyone we've consulted with, fit both groups. The new Veterans Charter was meant to provide services and benefits for immediate support for transition to civilian life of much younger veterans, and the health review is meant to finish that process off, as was done for the war veterans, by providing a needs-based approach when they need it.
Their average age is not 28 or 29; it's actually 56. There are 600,000 Canadian Forces veterans out there. There are 150,000 who are over age 65 and about 7,000 or 8,000 over age 85. So although the need is not great there, it's certainly there. The Canadian Forces veterans organizations, the three of them, which have been working with us on this, endorse—at least they do up to now—the findings of the Gerontological Advisory Council's report, Keeping the Promise, and they expect that the principle of a veteran is a veteran is a veteran will be addressed in the context of the review.
That's a long-winded answer, but yes, we're very much seized with the idea that this, to the extent we can do it, is a needs-based system that won't create new categories of veteran eligibility.
:
You've actually put your finger on one of the great difficulties of the current system, which is to be able to relate the current malady or illness back 50 years to the causal effect, a cause that determined that illness, which is why in the end we have a system that's based on collecting information that would make a connection between the disability and it being caused by service.
We go back into the archives and pull out all the relevant information, and our adjudicators will make an assessment based on that information as to whether there's anything on the record that might have indicated that the individual was injured or suffered some difficulty during military service that could be related back to the current illness.
That information is coupled with the medical reports that we pay for that are sought on behalf of the veteran to determine whether the medical doctor looking at the evidence would say that the condition could have been caused by that event that occurred 50 years ago.
Taking those two factors into consideration, our adjudicators will then determine whether they're eligible for the benefit. If they're eligible, there's a step taken to determine what is the degree of payment that would be made, and that degree of payment is determined through the level of disability that the individual has suffered.
That's the way the system works. It's very paper-heavy. It requires a lot of analysis and pulling information from files. We turn the system around as fast as we can. We average less than six months to get those types of decisions made, but they are difficult to make, quite frankly, given the lack of information. So we end up with individuals who can't pinpoint the particular evidence that they need to justify that, which is why this needs-based approach would do away with that.
The needs-based approach would say, okay, an aging veteran who has served in service would not have to relate that particular request for a disability benefit, which they could still apply for under a changed system, but would not have to achieve success in order to get other treatment benefits—the VIP program and other benefits that would be required.
:
Thank you, Mr. Chairman.
To follow up a little, I'm glad to hear that, in terms of cooperation with the provinces, that act of the federal government does top up and meet those needs.
At the end of my last question, Mr. Ferguson, you were talking about the needs assessment. Actually that was sort of my next question, and I'm glad you stepped into it.
One of the things you'd mentioned earlier--and we see it quite honestly time and time again--is that the applications become so complex that not only do the applicants not understand them, but neither do the staff people. The elevation of frustration tends to get pretty high when we cannot get consistent answers back from an applicant. You talk to different people and you get different answers.
I'm hoping that part of our discussion and your review, when you look at the needs assessment criteria...that they are clear and understandable, and not just to the applicant. Obviously now we'll have an ombudsman who will be there in part to help, but there always needs to be a consistent and understandable message coming from the staff. I guess that's not so much a question as it is a comment of mine, but you can make a comment on it. We see it in many departments from time to time.
:
Sometimes given the responses I hear that some veterans get, it would be good to know this is being checked to make sure that the people actually understand how to relate to veterans.
On that note, by the way, I do like your point that “a Veteran is a Veteran is a Veteran”. I wonder, when we say traditional veterans and modern-day veterans, whether we sometimes inadvertently create a class structure. I'm careful, though, to say that I know it's not intentional. Anyway, I like that terminology of yours much more.
I seldom would ever speak for the whole committee, but I think everybody was impressed by the Gerontological Advisory Council report, when we had the opportunity to question the council about it. I just have to say that the more of that report you actually incorporate into your services, the more pleased we'll be than ever.
I also want to say that all of us get lots of calls. I have two military bases in my riding and I certainly like to get the calls, but the calls not only have our staff busy, they're also heart-wrenching in most cases. I just wanted to say to you very directly, but empathetically as well, because I understand the amount of work you have to do, that if your work right now—and I'm certain it is—is going to mean less administration and that we're going to have a program that's sustainable and one that's going to meet the needs out there and be timely, then I'm all for it, but just make sure you don't waste even a day ensuring we can deliver that and encapsulate as many of the needs of our veterans, of every degree, we can.
I was quite concerned when we heard from the advisory council that some provinces are actually now refusing basic care to veterans and are asking Veterans Affairs.... That was what they said at the time when we questioned them. I don't know if you looked at the blues on that.
Is that the case?
I won't presume on the intentions of Dr. Marshall. Outside the Canada Health Act, in long-term care—which is not insured under the Canada Health Act, as such—there is variation in what provinces offer. Some offer more, some offer less, some offer different things. The goal of Veterans Affairs is to even that out, where we have to, especially in the area outside the Canada Health Act.
I don't know of any circumstance where veterans, just because they're veterans, are being disentitled or disenfranchised for anything that's offered by a province under the Canada Health Act. That I can say, categorically.
I do know that where Dr. Marshall and the Gerontological Advisory Council have advised creating a veterans integrated services program, there are going to be some provinces that offer a lot more than others, which has as much to do with the available provincial wealth I think as anything else.
But I don't think, from my experience, there is a province in this country that targets veterans for disentitlement. I really don't think that's so, and I don't think that's what Dr. Marshall meant.
:
There are two aspects to a response. One is that we are well connected to a number of countries and we work continuously with them. In fact, the U.S., the U.K., New Zealand, Australia, and Canada have formed what is called the Senior International Forum. It's been operating for a number of years. We share information on best practices with each other on a continuing basis. In fact, I would say without hesitation that we cherry-picked from those countries many of the ideas that are in the new Veterans Charter. We will continue to work with them to look at ideas for improvement of our health services as part of the health services review.
We have instituted our own monitoring systems as well, though. As Darragh mentioned earlier, in our long-term care facilities, we monitor using a standard tool that is designed around 10 outcome areas that we insist be met for our veterans in these institutions. Our results are well up in the 90% range in terms of satisfaction at the moment.
We also run periodically through a common measurement tool, an independent assessment of the client satisfaction with us. We use that to try to improve where we see areas of deficits or whatever needs to be improved upon.
But I'll go back to your original question. Yes, we are looking with these countries. To pick one country that provides an exemplary service I think would be difficult, but everybody has strengths and weaknesses in different areas. We're trying to, again, use the same approach here.
Darragh, is there anything you'd like to add?
:
Thank you again, Mr. Chairman.
I will just put a concluding aspect to my VIP crusade, as we say...still working with the widows and the veterans. They can only go by what they're being told, and what they were told by the now is that it would be immediately. The letter doesn't say there would be a review. It doesn't say we'd look at it. It doesn't say we would consciously think about it and we'll get back to you. It says immediately, and that's all I can go on.
If it sounds impatient, then it is, but the fact is these widows are getting older. They don't have much time. We'll lose about 40,000 Second World War and Korean War veterans this year. They'll leave behind...two-thirds of those will be widows, and most of them will not be eligible for VIP, and that is unacceptable in my term.
So I just put that one to rest right now. I know that's not for you, but if you can take it back to whomever and tell them to get their butt in gear on this one, it will be greatly appreciated, because it saves money. It saves money. The longer we wait, the more it costs us. If you do it for anything, do it for fiscal responsibility than for anything else.
My concern is Louise Richards. You probably saw her article in The Hill Times this week. I'm just wondering if you have an ability to respond to that, regarding her access to care at the Perley.
Also, we're getting a fair number of calls from across the country. There was one, a Harvey Friesen, which you're probably aware of, with asbestos. He was paid posthumously $100,000 for that. We're getting more and more people coming up, suffering from the effects of asbestosis, from their exposure to the ships and various buildings and plants they worked at during the forties and fifties, and that's coming back to haunt them now.
I'm just wondering what the department is doing in order to ascertain their concerns, to give the benefit of the doubt, to ensure that these aged civilians and veterans are able to be cared for as soon as possible.
We're aware of Ms. Richard's letter, her response to the minister's letter. I can't comment on the specifics, and you know I won't do that. What I can say is the issue was about the convalescent care beds at the Rideau-Perley centre and about whether veterans could have access to those beds, because they are on the civilian side of the hospital, and whether they could have access on a priority basis. The answer is, they are not part of the 250 priority access beds at the Rideau-Perley, but--and there's a big “but” here--if individuals, through a rehabilitation plan or for care of their war service-related injury, need convalescent care in the Rideau-Perley, in the Hotel Dieu Hospital in Kingston, in Nova Scotia somewhere--wherever they need it--we can pay for that and we will.
The reason we haven't had a reserve of convalescent beds there is because it tends to isolate the location of where this care can be received, and the downside of that is probably greater than the upside. The downside is it's only available to people in certain areas where we have these reserves of beds, and for the others, they have to move and leave their families to go to them. So if you can purchase the equivalent care somewhere in the community nearby for a war-related disability, it makes more policy sense. Our experience is that four out of five veterans would rather stay closer to home than they would to move a long way away.
I think that's probably the kind of policy...but we certainly understand Ms. Richard's concern there, and I don't know that the minister ever made a commitment that those were priority access beds, but they are available. If they need it, we can purchase the care.
I have a fairly short question. I'd like to follow up with something my colleague, Mr. Valley, was pursuing. It was some evidence we heard from a physician with the military in relation to post-traumatic stress disorder, part of the overall health review.
If I understood correctly, less than 10 years ago, after many complaints by former military and studies by the then defence and veterans affairs committee, it was ultimately decided by the government that something should be done for injuries at work, much as you see in the civilian world with provincial compensation programs. So an attempt was made more or less to mirror that for our military—none of us, I'm sure, would disagree with that notion—and at the same time, by providing military personnel with access to disability benefits while they're still in the service, to encourage them to come forward rather than to hide injuries for fear of being let go. So there were certainly a lot of positive benefits there.
I think the point of the testimony was that with that came a lot of extra demand on the medical resources of the military. Whereas they wouldn't have been concerned about the paperwork and the processing of a disability-type claim on top of the regular medical services to the military, they now had the two. I think the issue, then, was human resources in the medical field to deal with this.
Is your review going to deal, among many other questions, with that particular question?