:
When Brian Ferguson and I were appearing at the committee last May, we talked about the veterans health services review and the veterans independence program. What we didn't get to in the discussion of the continuum of care was the very important role long-term care now plays in that continuum and will certainly play in the future. Some 11,000 veterans receive long-term care under the auspices of Veterans Affairs. So with the indulgence of the chair and the committee again, my comments will focus on the long-term care aspect of that continuum and so will my opening remarks.
My first part of the opening remarks is to say I'm pleased to be here today--but actually I'm not there, and I apologize for that--in my capacity as director general of program and service policy.
Let me start by saying that Veterans Affairs has a long history of providing long-term care services and benefits to veterans. In 1919 Veterans Affairs began providing care, treatment, and rehabilitation for soldiers acutely injured during the First World War. Activity peaked at the end of the Second World War in 1946, when the department owned and operated 46 hospitals.
However, the environment soon began to change. By the 1950s, universal health care was becoming a reality, particularly in the late fifties. The foundation of the social safety net that has defined modern-day Canada was emerging. As First World War veterans aged, their long-term care became a priority. At the same time, in the early 1960s the provincial responsibility for heath care came to the forefront. In 1963 a cabinet decision, the Glassco commission decision, obliged VAC to transfer its hospitals to the provinces, which it did over the years, with the exception of Ste. Anne's Hospital in Montreal, the department's only remaining federal institution.
However, as part of the various transfer agreements outlining the transfer of these facilities, a fixed number of long-term care beds would remain available to the department on a contractual basis. These were called priority access or contract beds. Veterans have access to these beds in a network of facilities across the country. Today, VAC has close to 4,000 contract beds in 172 facilities at an average bed cost of $55,000 per year. Approximately 60 per cent of these contract beds are in 14 large transferred hospitals in urban areas. The average length of stay in a contract bed for a veteran is 2.6 years. Those eligible for contract beds include veteran pensioners, overseas service veterans, income-qualified veterans, and certain allied veterans.
To respond to the evolving needs, eligibility for long-term care benefits grew to allow veterans to access long-term care beds in community facilities. Today the department supports approximately 7,300 veterans in over 1,900 community facilities in addition to the veterans we support in our contract bed facilities. VAC pays for the uninsured cost of care, which in some provinces is the full cost of care, if long-term care is not an insured service. In other provinces the VAC portion is minimal, but the financial support from Veterans Affairs ensures that the cost of care to veterans is the same no matter where they stay.
The average stay in community care is 1.2 years, less than half that of a contract bed. The main reason for this--I speculate here--is that our largest group of veterans who are eligible for the priority access or contract beds are only eligible for this most expensive care option and tend to go there earlier and stay longer because of the absence of choice for them. I will speak more about this a little later.
Those eligible for a community bed include veteran pensioners, overseas service veterans waiting for contract beds, income-qualified veterans, lower-income Canada Service veterans, and certain allied veterans, as well as Canadian Forces veterans, reservists, and civilian pensioners, but only for the care of service-related disabilities.
Over the years, veterans have shown a marked preference for remaining at home as long as possible. Veterans Affairs' first national home care program--we like to think that it is very innovative, and I believe that it is--was introduced in 1981 to assist veterans in remaining in their own homes for as long as possible or in accessing community facilities closer to where they live. This highly successful veterans independence program provides services such as housekeeping, grounds maintenance, personal care, and nutrition services to help veterans remain independent in their own homes and communities. At the moment, approximately 73,000 veterans and 25,000 of their primary caregivers receive benefits from this program.
As a result of the increasing need among aging war service veterans for residential care, and faced with long wait-lists for access to some facilities in major centres, the department introduced two approaches to respond to this specific need. In 1999, using the VIP model, the overseas service veteran at home pilot project was introduced to allow eligible overseas veterans to access these services at home while they were waiting for contract beds to become available. Eight hundred and seventy veterans access this program. In 2000, we also enabled overseas service veterans to access care in community beds while they waited for contract beds to become available. Twenty-four hundred veterans now use this program.
Throughout its evolution, VAC has been committed to the quality of its long-term care program, which costs about $340 million annually. In response to a Senate report in 1999 called Raising the Bar: Creating a New Standard in Veterans Health Care, the residential care strategy was developed. In response to the needs of aging veterans and their families, the strategy emphasized specialized care for those with dementia. It includes VAC's ten national outcome standards of care, which were developed through significant consultation with external health professionals, gerontological experts, and provincial ministries of health.
Standards were developed for such areas as safety and security, food quality, personal care, and access to clinical services, among others. They were endorsed by the Veterans Affairs' Gerontological Advisory Council, the same council that provided the report forming the basis of the veterans' health services review. The Gerontological Advisory Council was represented by some of Canada's most distinguished experts on aging and seniors' and veterans' issues, and it included representatives from the six major veterans organizations. Our national outcome standards are the foundation upon which we have built our quality assurance in long-term care.
To help ensure quality care for veterans in these facilities, Veterans Affairs undertakes the following measures. It surveys veterans' satisfaction with contract or community beds through the completion of a client satisfaction questionnaire, often with the help of VAC or Royal Canadian Legion representatives or with input from the family when the condition veterans suffer from does not allow a direct contribution. Departmental staff follow up with the facility management on any identified issues, and if they are not dealt with in a timely manner, a facility review is completed.
During 2005-06, close to 3,300 veterans completed the survey with what we consider to be a remarkable 96% overall satisfaction rate, nationally.
Veterans Affairs has professional health care staff complete facility questionnaires to assess an institution's ability to provide for the care and needs of veteran residents. Again, any identified issues are followed up immediately.
Veterans Affairs has partnered with the Canadian Council on Health Services Accreditation and has seen the successful accreditation of most of its 4,000 contract beds.
As most veterans receive long- term care provincially, VAC remains committed to quality care by improving its oversight in residential care and strengthening the services provided by the department.
:
It's Ken Miller. I'm just going to take over from Mr. Mogan at this point, with the committee's agreement.
So what does the future hold? You've heard now how over the past 90 years our programs have incrementally evolved to meet clients' changing needs. But the expansion of eligibility has resulted in numerous categories of veterans, each qualifying for long-term care based on different eligibility criteria and gaining access to different benefits, some of which are based on health need and others granted automatically. The result is that we're 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. It may also provide certain veterans who are fully functioning in their community with more benefits than needed.
We're also seeing a 20 percent vacancy in contract beds and an 81 percent increase in utilization of community beds since 1996. Many times community facilities are preferred over contract beds as they're closer to the veteran's home, closer to their family and community, and they provide the option for a spouse to live there as well when that's an appropriate level of care that's needed.
Veterans are demanding more choice in care options, and unfortunately the current criteria often limit the choice and the fit for the veteran. In spite of the changes made over the years to try to better respond to the long-term care needs of veterans and their primary care givers, the reality is that further action is required if we are to make a difference in how these veterans live out their remaining years.
We realize that the time to act is now. The average age of our frail elderly war veterans is 84 years old, with almost 2,000 passing away each month. We want our veterans to age as well as possible and to receive the most appropriate benefits and services at the right time and at the right place. What is needed is a long-term care program that offers choice in care settings, including greater access to the veterans independence program services and also to community-based assisted living options. Overall, we envision a program that is flexible, providing support and assistance across the full spectrum of need, in which the level and intensity of service could be increased depending on the need.
Ultimately, Veterans Affairs wants to meet the individual needs of veterans who have faithfully served our country. To that end, we will continue to work with provinces and long-term care facilities to respond to changing needs of veterans. Also, we will work with veterans organizations and stakeholders to maintain the principles of choice, quality, and accountability. Finally, we will move forward with the veterans health services review, which could address many of these issues.
With that, Mr. Chair, I'll turn back to my colleague Mr. Mogan to conclude our comments.
:
I hope I'm going to get my 52 seconds also.
[Translation]
Good morning, Mr. Mogan and Mr. Miller.
I have a lot of questions as a result of your presentation. For example, you say you have agreements with 14 major hospitals. Can we have the names of those major hospitals?
My second concern is that you say you have agreements with virtually every province because the provinces don't have the same systems. In Quebec, long-term care comes under a provincial program that covers virtually all of them. Are the costs incurred by our veterans who have access to this care entirely paid by Quebec? I'd like you to give me a snapshot of the Canadian system and provincial systems, and I'd like to know the percentage you pay in each of the provinces to occupy the beds.
A trivial question also comes to my mind. Are there still a lot of veterans overseas? I wonder how many of them have stayed there and have access to services.
Lastly, I'd like you to give me more details on what is my biggest concern. I'm talking about your eligibility rules, which virtually none of the veterans or their friends and family know. I'm also talking about the complexities that these people have to face in registering for the program.
Those are the questions I had to ask you.
In regard to agreements with provinces, there are some agreements with provinces but they are only used to normalize the relationship between the provinces and the federal government for the management of these contract beds. For instance, we have them in Ontario and in Manitoba. We don't have many contract beds in the province of Quebec, so there's no federal-provincial agreement there, but there are agreements with the facility. For instance, in Quebec City there are agreements with the facility there on the day-to-day operation of it, the admission criteria, who pays for what, and the relationship between admission of a veteran to one of these facilities and the civilian eligibility. Across the country, the care of veterans is very much a cooperative federal-provincial enterprise and we rarely, if ever, have any difficulties in that area, which is a very good thing.
Where Veterans Affairs is asking a province to provide a service, we pay for the service. Where it's for the care of a pension disability, someone who has a war injury, we pay 100 percent of the cost, no matter what province it occurs in.
[Translation]
Mr. Perron noted that there were problems with eligibility and the rules governing eligibility. He was no doubt right.
[English]
Monsieur Perron was commenting on the complex eligibility rules, and from a public service point of view, we couldn't agree with you more. One of the goals of the health services review, which Mr. Ferguson and I spoke of last May, was to attempt to reduce if possible, and we think it is possible, these rules that have been built up over 60 years of adding eligibility each time there was a political interest in doing that, without reconciling all the different criteria that a veteran might have to meet. We feel it's more important to focus our administrative resources on our abilities in caring for veterans rather than managing rules, and I think there would be general agreement at the political level with that goal.
Monsieur Perron, I hope I've addressed some of the questions you raised.
:
Thank you, Mr. Chairman.
Welcome, Mr. Mogan and Mr. Miller. It's always a pleasure to talk to you.
I don't have a lot of questions. I'm going to pass to my colleagues, but I do have a couple of comments I'd like to make.
I was extremely happy to see that the contract beds are actually allowing veterans to stay and have their spouses nearby. That's something that's very important to quality of life.
Regarding another thing that Mr. Valley said earlier, and maybe I can help him in this period of goodwill here, I get my message out to my veterans through two mechanisms. One is the ten percenter and one is the householder. I've had a number of veterans who really didn't have any idea they were eligible for some of the things they're eligible for. Perhaps that's one of the reasons why we've added 12,000 brand-new veterans to the role.
Thank you very much for appearing today, and I'm going to pass to Mr. Shipley.
:
Thank you, Mr. Chairman.
This is Ken Boshcoff, Thunder Bay—Rainy River, and I'll ask my questions. Perhaps you can write them down and then respond back. They shouldn't take very long.
One, when we talk about contract beds, these are both chronic and long-term, I'm assuming, at an average of 2.6 years. Is this usually the final domicile for most of these veterans?
Two, would communities in northwestern Ontario, such as Fort Frances, Atikokan, Rainy River, and Emo, be eligible for provincial travel grants out of province to, say, Winnipeg, or does the VAC do this as part of their social integration of funding formula?
Three, we talked about a 20% vacancy growing in contract beds, and we're averaging 2,000 deaths a month. Does this budget transfer to the 81% increase in community beds? Would the number of veterans returning from Afghanistan and the Middle East and other theatres have a portion of this for both physical and mental treatment? Are there adequate dollars to address their new needs?
Four, we hear of many cases that make the news about people who are short weeks or months of eligibility. In view of the average age being 84, will there be any relaxation of these rules to accommodate some of these people who are short by days, weeks, or months?
Five, with regard to the uninsured costs, you identify that many provinces and territories may pay fully and others not. What is the spectrum--100% payment to zero, if that is the range?
Finally, I'd like a quick response on the timeframe for the veterans health services review. I thought that would be done already. When can we expect some finality on this?
Thank you.
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To add to that, we do and can provide for the cost of travel when the veteran actually has to travel a distance to get the appropriate level of care. If it isn't available in their community at the community facility or an institution that is close to them, then we will take them whatever distance is required to have them go to the right facility.
You asked a question as well about vacancy in contract beds. I think the focus of your question was basically about the flexibility we had in terms of moving budgetary amounts between funding community beds or funding contract beds, and also covering funding requirements for the beds for Canadian Forces veterans. You used the example of what veterans returning from Afghanistan may have. There is a fair bit of flexibility around that in terms of our budget and how we use it to provide for the treatment costs in those various care settings.
You had a question as well concerning eligibility, and you made reference to clients falling somewhat short of timeframe. The only case in point that comes to mind around that is in the case of Canada-service-only veterans who were individuals who served during the time period of the Second World War but never left Canada. There is a regulatory requirement that they would have served for 365 days in order to become eligible. We do from time to time see individuals who have served various lesser periods who don't have eligibility. That is something that potentially could change in the future, if there were a will to explore that.
Your fifth question was around uninsured costs and what the range is. There is a considerable range across the country. It typically tends to be higher cost to Veterans Affairs in the east, and lower cost in the west. However, from a veteran's point of view, it's a wash, because veterans who are receiving care pay what we call an accommodation and meals rate. That is calculated on the same basis for clients regardless of where they live. It's a little over the $800 a month range, and that covers the cost of accommodation and meals, obviously things they would pay for if they were living in their own private accommodation rather than in a facility. The way it works is, regardless of the level of provincial insurance that provides for the beds, from a veteran's perspective it equalizes at the end of the day.
The last question was around timeframe in relation to the veterans health services review. Mr. Mogan will respond to that.
Mr. Mogan, you mentioned a couple of times that you spoke to us in May. I went back to my notes, and there's a big note--I'm not sure if it's to you or to myself, so I'll have to ask you again. If I asked this question in May, you'll have to forgive me.
We talked about the health care review that you're doing and we're doing, and how much involvement there is with the veterans themselves. Are the general public of Canada or the veterans aware that this is going on?
You mentioned something, and again, I'll use your words. It's kind of profound, but changes have been made whenever there is a political will for it. That's unfortunate, but that's probably the reality we live in.
How much are the public of Canada or the veterans aware that we're doing a health care review? We have many people who give us comments if they are neighbours of a veteran and they see a veteran suffering. The veteran himself may not comment, but maybe the neighbour would.
Have we ever done any general advertisements? Have we done any outreach anywhere in Canada, such as your newspapers, letting them know this is going on? You may have responded positively in May. I don't remember. As I said, this might be a note to myself.
Do you have any thoughts?
:
The smart way for me to answer is to say it is a note to yourself, but it's not. You're quite correct.
The government had a choice to make on this one, and the choice we made was to ask the Gerontological Advisory Council--and they worked nearly for a year on this--to solicit views from the best and brightest in this country and internationally on what would make the most sense, given the complex eligibility rules we had, the fact that we aren't able to help 60% of war veterans, the fact that there are Canadian Forces veterans out there who need help when they're younger and older, and the fact there are primary caregivers who need help. We asked them to have a look at what we do and to give us advice.
The six major veterans organizations are on the Gerontological Advisory Council, but that isn't necessarily to restrict their advocacy; it is to ensure that they have the advantage of the best and brightest in this country on the questions that we asked. Their report is in the public domain. It's on our website. We submitted it to you, we'll submit it to anybody who wants to see it, and we solicit comments on that. We're getting quite a few.
I think the veterans community knows that we're doing it. We've had a process of talking to provinces about the policy basis for this--not to share views, because with a large cohort of baby boomers coming through, the lessons we've now learned about proper care of the elderly will pay dividends later on. Although we didn't seek a broad consultation mandate on this, in effect we've had all the benefits of a broad consultation mandate without the time necessary to get a specific mandate in that area. I'm quite confident we got pretty broad-based input, Mr. Valley, into our deliberations.
What we are waiting for, and with enthusiasm, is a report from the standing committee.
Good afternoon, gentlemen.
My name is Ron Cannan. I'm the member of Parliament for Kelowna—Lake Country in beautiful British Columbia. It's in the Okanagan Valley.
Just for your information, we have an aging population. We have the highest demographic in the census of metropolitan areas of people 65 and over--it's almost 16% of the population--and a good portion of those, of course, are veterans. We all want the best for our veterans and I'm looking forward to this holistic overhaul of the veterans health services review when it's completed.
Just following up on my colleague Mr. Sweet's questioning, I'm dealing with some of my constituents who wanted the veterans independence program so they could stay in their own homes, but they are not eligible; but, as you indicated, they would be eligible to go into the long-term care program, which is costing Veterans Affairs about $340 million a year. Do you have any idea how many individuals would be eligible to go on the VIP program and not for this long-term care program, and the potential cost savings for the government?
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This is not about witnesses, although I'm getting a feeling throughout the room, and it's certainly something I feel very strongly about. I'd like to run it past the committee to see if anybody would also like to consider it.
We did have a bit of a session on post-traumatic stress syndrome. I know that everyone of us in this room is very interested in what we learned and what we heard. I'd like to see the review we have already undertaken completed as soon as possible so we can move forward and make improvements to the veterans independence program through the health care review.
I'm wondering if there's an appetite in this room, in light of some of the things that have happened and in light of some of the things that have been said today, to look into the aspect of suicide. My understanding, from the few questions I've asked today, is that we don't track them as a country. Canada has never tracked how many suicides happen as a result of military deployment, etc. I know it is tracked in the United States, and the numbers are frightening.
I would like to know if there is a will in this room to go down that road after we finish the health care review so we can move our current traditional veterans ahead. Get this done and out of the way, and then have a good hard look at what's happening with our modern-day veterans and the kinds of things they're facing.