Good afternoon, everybody, and welcome. It is a pleasure to be here.
Pursuant to Standing Order 108(2) and the motion adopted by the committee on Thursday, May 4, 2017, the committee is resuming its study of advancing inclusion and quality of life for Canadian seniors. Today is the first of three panels that will be held on the subject of inclusion, social determinants of health, and well-being.
We have an amazing panel with us today. First we have, coming to us from Vancouver, British Columbia, via videoconference, Dr. Margaret M. Cottle. Also appearing as an individual is Alison Phinney, a professor in the School of Nursing at the University of British Columbia, also by way of videoconference but coming to us from Winnipeg, Manitoba. Appearing here today we have, from the Canadian Centre for Policy Alternatives, Pat Armstrong; from the National Initiative for the Care of the Elderly, Raza Mirza; and from Réseau FADOQ, Danis Prud'homme and Caroline Bouchard.
Welcome. We will begin with opening statements, which will be kept to seven minutes. I will indicate when you have one minute left to wrap up.
We'll start with Margaret, coming from British Columbia. The next seven minutes are yours.
Thank you for the invitation to appear today.
As a nurse, my research has largely focused on vulnerable older people who are living in the community, especially those with dementia, but also more broadly, older people with physical impairments and social vulnerabilities. These are people who are isolated, maybe living apart from family, with a narrowing circle of support. Essentially these are people who find it difficult to get out of their homes, and when they do, they find there are fewer opportunities for engagement, for them to be connected with the larger community.
My research has explored the rather broad question of what is meaningful activity for this group, and more to the point, what can we do to support it? I'm going to briefly describe some of what we've seen through this research that might suggest some possible solutions.
I'm a community-engaged researcher. I'm really on the ground, so I'm not going to speak so much about top-down solutions but rather what I see happening from the bottom up.
Over the past several years we've seen ever-increasing numbers of small, community-based programs offering various kinds of group activity for older people and those living with dementia. These groups are diverse, they're often very innovative, and they exist largely outside the health care system. People are gathering in community centres, in church halls, and even in hotel meeting rooms. Our research has shown that these groups offer a range of health and social benefits, and against all odds, they seem to have staying power. They're really not disappearing.
In the interest of time, I'm just going to share two examples from some of the research we've been doing in B.C.
The first example is Paul's Club, a group for younger people with dementia, people between roughly 50 and 75 years of age. It's a social enterprise run on a volunteer basis. They have one part-time paid staff member. It was the brainchild of Nita and Michael Levy, a retired couple from Vancouver who wanted, really for very personal reasons, to do something for this particular population. They have over the past five years basically invented an approach that combines physical and social activity, all happening in the heart of the city. They have about 15 members who meet three full days a week.
These were people whose dementia had progressed to the point where they were no longer able to get out and about on their own. They were isolated at home but also unable to be left alone. Paul's Club has provided for them a new community of friends within the group, and it has them out walking in the neighbourhood every day where they are visible, active, and engaged with the broader community.
The second example I will share is Arts & Health: Healthy Aging Through the Arts, a program in which community centres across the city are offering weekly workshops for older people to work together for a year with a professional artist. It targets those who are identified as being at risk for isolation and marginalization. Our research showed that this program enabled these groups to make a real contribution to their community, bringing their artistic creations into public space and building social connections, while also improving members' physical and emotional health, but probably most importantly, what we saw was that it allowed them to build a real sense of belonging.
The program began in 2006 as a collaboration initially between the city and the regional health authority. It's my understanding that the health funding has essentially disappeared over time, but the programs themselves have continued, and in fact they've grown, becoming much more deeply rooted in their local neighbourhoods.
This research is really offering examples of how these kinds of groups can improve physical and emotional health for seniors, but the strongest finding, consistently, is how it enhances their social inclusion.
I'm not the kind of researcher who's going to argue that it will reduce health care costs. That's not the work I do. But I do argue that these are the kinds of supports we want to have in Canada as we grow older. It's not only to support well-being and quality of life so we feel and do better as individuals, but that we want our society to be one that welcomes age and that allows space for older people to not only be well supported but to contribute as active social citizens.
As for “where next?”, the evidence is growing that these kinds of programs work, especially for the groups that are offering physical and creative activities for older people. These are becoming increasingly popular across Canada and internationally as well.
To some extent, it's now a matter of sorting out details—what kinds of programs work best for whom, and which particular approaches work best—but the big question remains, which is about how to create solutions that make these kinds of grassroots initiatives more broadly accessible. There are very real challenges, of course, and there's always the matter of funding. These groups tend to expend a lot of energy finding sufficient money to keep going, so what kinds of funding models might work better?
Also, reaching the target group isn't easy. Those who are isolated can be very hard to find. Even when we succeed, transportation is a really important issue. How do we bring people together, especially when they're outside urban centres? Transportation isn't just about making sure people get to the doctor's office. It's also about seniors getting out to attend meetings and to meet with friends and stay connected.
My final point is about the community capacity to provide these kinds of programs, which remains quite limited. Here, I'm talking about two things. There's capacity in terms of the knowledge and skills that are required to work with a population that can be quite complex, but also, and I would say more importantly, we need to build capacity in terms of our collective awareness and understanding around aging and, in particular, dementia. For too long, our awareness has been couched in fear of the so-called grey tsunami. Our work is showing that we really need to confront that problem of underlying ageism if we're truly to be an aging-inclusive society.
I am also a professor at York University.
Thank you for inviting me here today, and for your attention to advancing inclusion and the quality of life for seniors. My presentation is based on my many years of research, which have made it clear that inclusion and quality of life are at least as important within health services as they are outside of them.
Today I want to focus on three main issues—namely, access to appropriate health services, the scope of home care, and the quality of long-term residential care.
I begin with health services. As I am sure you know, the 1964 Hall Royal Commission on Health Services concluded, on the basis of a thorough investigation of the evidence, that covering the full range of services was the only logical and money-saving way to coordinate care, ensure that people were receiving appropriate care, and eliminate both the expense and the delay of sorting the deserving from the undeserving. But the federal government decided it would start with hospitals, and then doctor care, before moving on to other services—an expansion that never happened.
The evidence gathered by the royal commission is still relevant today, and the need for universal, coordinated coverage of the full range of services is even more urgent with population aging. The growing numbers with chronic health issues need to be able to move smoothly among services and be treated within them by those who understand geriatric care.
We need a national initiative, similar to the Canada Health Act, to ensure universal, accessible, and comprehensive care, and to finally complete the project begun long ago. Our seniors, who struggled to bring us our most popular social program, deserve no less, and our search for equity requires it.
I now turn to my second issue. Care at home is claimed to be the first choice of everyone, and certainly this is what my friends say, but my friends are middle class and have pensions and a wide circle of family and other friends. The notion that everyone is best cared for at home ignores the fact that many people have no safe, healthy homes, and that many homes are not havens in a heartless world, as the feminists used to say.
Smaller families, more singles, and the need for children to move to find employment are among the factors that mean that many people have no family or friends near enough to provide care or companionship. The aging-in-place solution also ignores the fact that many people require skilled care that cannot easily be provided by partners and friends, who are themselves getting older, and it ignores the fact that many people live in places unsuitable for those very heavy care needs. I live in an old Victorian house that is full of stairs. You have to use three sets of stairs to get into it, and I can tell you that those lifts you see on TV won't fit on my stairwells.
Finally, care at home often means isolation at home, as we just heard, especially if the only accessible groceries are at Walmart, miles away, and the local bank has closed. Isolation is the opposite of inclusion.
The focus on care at home often ignores the conditions of work for those providing paid and unpaid care, at the same time as it fails to understand the skills as well as the risks involved for both patients and care providers. In other words, we cannot rely on care at home to provide for many of the current care needs. For those who can be cared for at home, we need to provide enough paid staff with appropriate skills, and create working conditions that ensure quality of life for those who provide, as well as for those who need, care.
Finally, I want to focus on long-term residential care. Very few people plan to go into long-term residential care, and most governments, as well as much of the population and many staff, see it as a last and worst resort. But no matter how much we focus on aging in place, we are all potential residents and have a vested interest in ensuring the quality of care there.
As a senior manager we interviewed in Ontario explained, “The average length of stay or living in the home is 18 months, and every day I say, ‘If you had only 18 months to 24 months of life left, what do you want it to be?’ And it's our job to make that the best it can be.” The job belongs not only to that manager and those staff, but to all of us. Our eight years of team research and studies of 27 care homes in six different countries have convinced us that the conditions of work are the conditions of care. You cannot have resident-focused care without creating the working conditions that allow for such care.
Right now in Canada, we too often fail to provide those conditions, which is one reason why those who provide direct care in these homes have the highest rates of absence due to illness and injury. Indeed, staff in care homes are more likely to get injured than police officers or firefighters.
If we are to focus on adding life to years rather than simply focusing on adding years to life, we need to understand the importance of not only having enough staff but also having enough staff with appropriate education and conditions that ensure continuity in staff. Higher turnover rates and reliance on casual, part-time, and agency staff increases the risk of injury while undermining the care relationships that prevent violence and provide quality of life for seniors, to name only some of the working conditions at issue. A significant body of research also indicates that ownership matters, and that the quality of care tends to be lower in for-profit homes.
In conclusion, I would add that the consequences of our current system are profoundly gendered. Women live longer than men, use the health system more, and have fewer economic resources, so the failure to provide care has a gendered impact. The impact is unequal among women as well. Women also provide the overwhelming majority of paid and unpaid care work, so poor conditions of work have the greatest impact on them. In home and residential care, a significant number of those women are from immigrant and racialized communities. We need a federal initiative to ensure universal access to the full range of health services delivered by non-profit organizations based on the same principles as the Canada Health Act. This also means a human resource strategy that ensures appropriate conditions of work. We need to do it now, before it's too late.
I'm sorry about my voice, I have a chronic issue in my throat.
Thank you, Chair, and thank you to the committee for having me here today.
I'm both a senior research associate at the University of Toronto and the network manager for the National Initiative for the Care of the Elderly, also known as NICE. I'm here today in my capacity as the network manager to represent the board of directors and the scientific director of NICE, who was unable to join us today due to other commitments.
What NICE is here to suggest today is that the foundation for improving the overall quality of life and well-being for older adults, including those factors associated with community programming, social inclusivity, and social determinants of health, is by building capacity among older adults to become mainstream social citizens instead of being ghettoized through separate health and service systems. This foundation also requires new policy and practice responses based on well-funded research and evidence that captures the complex issues facing an aging population.
As an organization, NICE is an international centre for excellence, funded by the national centres of excellence, and is a not-for-profit charitable organization that was initiated in 2005. NICE is a knowledge transfer and exchange network that works to improve the care of older adults in Canada and abroad. We accomplish this by placing valid and reliable knowledge on aging into the hands of those who need it. This includes older adults, their family members, practitioners across disciplines—which includes nursing, social work, and law enforcement, as some of the examples of these disciplines—students, and policy-makers.
NICE accomplishes this work through a few different mechanisms. One mechanism is through research. Another is through the use of theme teams, where our teams are led by a researcher and a practitioner, who do work on different aspects of aging. NICE currently has 12 theme teams, which includes teams working on issues related to elder abuse, dementia care, mental health, dental care, caregiving, and financial literacy, to name a few. The third mechanism is making tools from evidence-based research that has never seen the light of day.
NICE is fortunate to have a very large membership, with close to 4,000 members worldwide and official representation from 14 different countries. We continue to find ways to build up our membership to facilitate access to knowledge on aging around the country and the world. Our international arm, ICCE, the International Collaboration for the Care of the Elderly, gives Canada a world footprint in aging, but benefits us through returns on knowledge about aging and diversity. Our network is an important resource for many, as current professionals are not always up to date. The knowledge base in gerontology and geriatrics remains thin, and attracting new students to the field is still a challenge.
NICE has conducted research regionally, nationally, and internationally. This has provided us with important insights and lessons. As a result, the work we have undertaken at NICE has been evidence-based, and as a result we have developed over 200 tools in various languages to help improve the care of the elderly. These tools have been developed from the research we have conducted—I will speak specifically about this research today—and we focus on those insights that can provide us with the opportunity to work with older adults and improve the overall quality of life and well-being for seniors.
From the NICE perspective, it is crucial that decisions are made with older adults and not for older adults, that one of the ways to do this is to fund more gerontological research that partners in a meaningful way with older adults in Canada, and that we make sure we translate this knowledge to action through evidence-based changes to policy and practice.
We achieved a historic milestone in Canada last year, with Canadian older adults outnumbering their counterparts for the first time in our nation's history. This milestone was met with hope and optimism as older adults, in general, are living longer, are healthier, and are wealthier. However, we at NICE have also met this milestone with renewed efforts in our research, our training, and education programming to further improve the quality of life for more older adults.
When we look beyond the general experiences of older adults in our country, and the average older Canadian, we get a better view of the most vulnerable populations needing support. Our research has specifically focused on those populations, and includes victims of elder abuse; older members of the aboriginal community; those who are socially isolated, and often from diverse and rural communities; grandparents who are parenting again in later life; older adults who may not be financially literate; those living in poverty, mainly older women; those vulnerable to grey divorce or financial abuse and exploitation; and those who are unable to access quality end-of-life care with respect to hospice and palliative care.
As a dimension of unequal social citizenship, older adults are frequently subject to ageism, which is manifest in many subtle ways through discrimination in the workplace, transportation, the denial of the right to quality care, and ghettoized housing and services.
If older adults are not treated like all other citizens, they're often socially excluded within their own communities. NICE is firmly committed to the perspective that older adults are indeed adult citizens and have the right to be responsible for themselves.
Social citizenship for older adults has been identified as a priority topic in Canada by the Standing Senate Committee on Social Affairs, Science and Technology, Employment and Social Development Canada, the National Seniors Council, and the Ontario seniors strategy, to name a few. Social citizenship, broadly defined, suggests equality of status in society and the right to membership of a community, the right to economic welfare and security. When we link this to quality of life and the social determinants of health applied to an aging population, the importance of social citizenship becomes even clearer. Although the research on the implications of differing rights and opportunities and social citizenship is very thin and limited, research has shown that approximately one in four older adults in Canada desire greater social involvement within their communities. Social inclusion was identified as a priority topic for social determinants of well-being.
Social isolation has also been flagged as a major health and social problem in older adults, and is not a normal part of aging. In particular, persons from diverse ethnic backgrounds may be at higher risk for social isolation, since they may be recent immigrants and may not be fluent in English. Social isolation is a complex issue, and may be a result of physical and social environments that are not built to support older persons and may be age-unfriendly.
To conclude, NICE is committed to the development of evidence-based knowledge supported by designated funding for research with older vulnerable populations, and for better training of gerontological geriatric students, policy-makers, and practitioners. Most critically, the straightforward education of older persons themselves sends the message that they can become active citizens, and are expected to be active citizens, contributing to Canadian society.
Again, we at NICE would like to emphasize the importance of research in gerontology and geriatrics that may better inform the directions we take in developing a national seniors strategy that matches the realities of a new generation of older adults in Canada.
Thank you very much.
Thank you, Mr. Chairman.
I'll be making my presentation in French, although you do have copies of my presentation in English and French as well as the full briefing.
Members of the Standing Committee on Human Resources, Skills and Social Development, and the Status of Persons with Disabilities, hello.
I am honoured to represent the Réseau FADOQ today as part of these special consultations which we sincerely hope will lead to the development of a national strategy on aging in Canada.
Allow me first to introduce you to our organization. Founded 47 years ago, the Réseau FADOQ is the largest seniors’ organization in the country, with nearly 500,000 active members aged 50 and over.
The Réseau FADOQ is the undisputed leader among organizations defending the rights of seniors in Québec, seizing any opportunity to speak out and advance our main cause: to obtain an adequate quality of life for all seniors. The Réseau is also a strong advocate for active aging, as we offer a wide range of sports, recreational and cultural activities that get more than 70,000 seniors a week moving. In addition, there are nearly 1,500 discounts and privileges available with a FADOQ membership card, which help seniors maximize their purchasing power at a time when many of them are increasingly impoverished.
The Réseau FADOQ doesn’t hesitate to use the enormous power of influence conferred by our impressive number of members in the service of critical issues. The gains obtained by the Réseau in recent years are significant. Whether working alone or in collaboration with partners, they include: the abolition of accessory health care fees, automatic enrolment in the Guaranteed Income Supplement, and the reinstatement at age 65 of eligibility for the provincial age amount tax credit, to name just a few.
For some years now, the Réseau has been calling for the development of an aging policy in Québec, because we believe that coordination and the introduction of a holistic vision of aging are the cornerstones of real improvements in the quality of seniors’ lives. In addition, for the past five years, the Réseau has represented Canadian seniors' organizations at the UN in the Open-Ended Working Group on Aging, which is striving to create a comprehensive and integrated international, global instrument for the promotion and protection of the rights and dignity of the elderly.
It is therefore only natural for the Réseau FADOQ to applaud the consultations that are taking place now, which will lay the foundations of a strategy on aging for the entire country. The policy that will emerge for seniors’ quality of life is crucial, not only for seniors, but for the future of the country. We firmly believe that such an instrument is the only way to adequately address the demographic challenges that are already underway, and increasing at record speed.
It goes without saying that we offer our full collaboration in this essential process, for which we have high hopes, because it will provide a common and unique direction and be conducive to action. Indeed, what is the purpose of cooperating and sharing our different expertise, if at the end of the day we do not follow up with concrete action? We must put knowledge into action; otherwise, the exercise will be in vain and seniors will pay a high price.
I come now to the main recommendations contained in this brief, resulting from nearly five decades of work entirely devoted to all facets of seniors’ quality of life.
First, the Réseau FADOQ recommends the creation of a seniors’ secretariat under the Federal Executive Council. We also suggest that all current and future public policies be looked at through a “seniors’ lens.” And we would welcome an upgrade of the National Seniors Council, so that it might become a locus of collaboration for organizations such as ours.
In terms of income, it is clear that the management and administration of the GIS must be reviewed and that this benefit must be improved. As for employers, the government must commit to raising awareness of their role in intergenerational equity and the financial health of future retirees, and encourage them to offer supplemental pension plans.
With regard to housing, the Réseau FADOQ believes that the Canadian government must showcase innovation and be a strong proponent of universal accessibility standards for all new construction financed with public funds, so that communities can evolve according to demographic needs. In addition, the Canadian government must lead by example in encouraging businesses to maintain local services.
Moving on to the central theme of health, I should mention the urgent shift towards better home care. The federal government needs to provide leadership on this issue and mobilize the provinces. To this end, one essential route is to provide better health transfers exclusively dedicated to home care and services.
In addition, we believe that the Canadian government should enshrine, in the Canada Health Act, a plan to provide minimum and equitable access to home care and services for all Canadians.
With respect to the Canadian health care system, it is essential to ensure its universality. With regard to measures directly related to health, the Réseau FADOQ suggests that the federal government be inspired by the National Health Plan presented by the Canadian Medical Association, including the framework specific to the rise of dementia currently faced by society.
Another request is the establishment of a national drug program, which would ensure equity among Canadians. In the same spirit of equity, as well as to better support seniors experiencing loss of autonomy, we hope that health transfers will take population aging into account and be paid out according to the proportion of seniors in the populations of each province and territory.
We can’t talk about the health of seniors without addressing the almost inhuman experiences of some family caregivers, whose numbers are expected to grow rapidly. On their behalf, we demand more substantial compensatory measures and a guarantee of employment for family caregivers in urgent situations.
Finally, we would like to remind you that adequate intervention is based on a situational analysis that is as accurate as possible. In this regard, it is important that future censuses allow seniors living in private seniors' residences to complete their own questionnaires, rather than making it the responsibility of the residence’s management.
In conclusion, let me assure you of the Réseau FADOQ’s full collaboration in the development of a national strategy on aging in Canada. Our expertise is at your service and we will closely monitor what is most essential to this process: the deployment of real actions that will improve seniors’ quality of life, today and tomorrow, throughout the country.
I'm sorry to have missed many of the other presentations. They were very interesting, and I'm very grateful to be part of the conversation.
My name is Dr. Margaret Cottle. I am a palliative care physician and a clinical assistant professor at the UBC Faculty of Medicine. For almost 30 years I have devoted my practice solely to the care of patients with serious illnesses and to their loved ones, especially in home care settings. I have many years of first-hand experience with patients and families who are enduring exclusion and a diminished quality of life mainly due to the lack of will in our society to provide the necessary resources. I find this distressing, since we seem to find the funds for multi-million dollar contracts for sport and entertainment celebrities.
Canada is a signatory to the United Nations' Universal Declaration of Human Rights. The preamble begins:
||Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,
Article 25.1 states:
||Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
At present, we in Canada fall far short of this very basic standard.
Loneliness, isolation, and vulnerability have been front and centre in my practice. A patient I will refer to as Joe is found in his home dehydrated, delirious, and combative. The open wound caused by his facial cancer is crawling with maggots. In the middle of a large, affluent city, he has no one to care for him. Even when family members are able to help, they are often stretched past the breaking point both physically and emotionally, and they face financial hardships and repercussions in their workplaces. We are scandalously tight-fisted, and do not provide enough sustainable support to the families who do this crucial work more cost-effectively and with deeper love than anyone hired to do so.
Frail senior citizens have many concerns in common with people in the disability community. Dr. Carol J. Gill of the Department of Disability and Human Development at the University of Illinois at Chicago, herself a polio survivor with significant motor and respiratory disabilities, has interesting insights into vulnerability. I commend to you for your review her two excellent articles. Although written for different contexts, they are extremely pertinent to our discussion. She points out that vulnerability is socially constructed rather then inherent in our physical or cognitive conditions. Her example is as follows:
||All my life I've been told that I can't get into my neighbourhood restaurant because my legs won't take me up stairs. Now I know it's because the restaurant owner won't build a ramp.
She also notes that needing help is a “socially created indignity”.
||It is the way people with disabilities are treated and regarded socially that leads anyone to feel ashamed if they need help to use a toilet. It is the stigma of disability that strikes fear into the heart of individuals who can no longer live independently or appear “normal”. It is the economics and social arrangements of disability that transform ill people into family burdens or nursing home inmates.
||The public generally equates disability with suffering. Because I have physical limitations, need help from others, and use devices such as a wheelchair and ventilator, many observers perceive me as a sufferer. I do not draw the same conclusion. Ironically, their prejudgments cause me more suffering than my impairments do. Having suffering incorrectly attributed to us when we are simply living our lives differently is a quintessential disability experience.
Again, she writes:
||We are, in fact, much more frightened by the doctors who are out to help us but who see our lives as burdensome and who know little about options that make life with disability valuable. We know that the misplaced pity and pessimism of such doctors is reinforced by the medical institutions surrounding them, the policies that guide them, the health care funding system that rewards them for holding costs down, and the prevailing culture that influences their thinking about disability.
She also says the following:
||It is difficult for most people to believe that life with an extensive disability can be anything but suffering, and that suffering can be anything but dehumanizing. Perhaps, along with tolerance for imperfection, the public spirit has lost some of that down-to-earth courage in the face of human difficulties that carried previous generations through very hard times. I have also noticed how narrow the public imagination has become about what makes life valuable—so unimaginatively narrow that it cannot seem to encompass those two realities—disability and full humanity—simultaneously.
Here's one final quote from Dr. Gill:
||Anyone at any age can benefit from measures to enhance her/his self-determination, including dignified professional assistance at home, respectful responses to one’s everyday preferences, companionship or privacy as desired, and reassurance that the changes of aging and illness do not reduce one’s humanity and worth.
My conclusion is this. Every person deserves to be respected and cared for not “as if” she or he were a member of the human family, but precisely because he or she “is already” a full member of the human family. I hope that we will dream big dreams, that we can envision a Canada where love and community support are extended to every member of the human family; where all our citizens enjoy freedom, justice, and peace; that every life will be acknowledged as one worth living; and that we count it a privilege, not a burden, to care for each other, even when it is difficult. Government programs cannot change hearts, but they can foster compassionate communities and facilitate systems of care that will support those who bring love into the lives of every citizen. I sincerely hope that you will find creative solutions that can be implemented without delay. The need is profound and urgent.
Thank you to the witnesses for their excellent presentations.
We have limits in time to hear from you, and I'm sure you have a lot more to share with us than the seven minutes and answering some questions will allow you. Could you each ensure that you have provided us a written brief along with your recommendations, which we would translate? The purpose of today is to hear your testimony. We'll be creating a report with recommendations to the government. If you have specific recommendations, it would really help to condense what you are recommending that the government include.
The focus is on whether we need a national seniors strategy. Do we need to have a recommendation of leadership in all the different levels of government? We heard some comments on that. Does the federal government, in providing leadership, need to have a minister for seniors? We heard about the secretariat. It sounds very interesting. Do we recommend that each province have a person who is in the lead so that we have a point person in every level of government? From the last witness we heard that the need is profound and urgent. We have a very quickly aging population, and it's not consistent across Canada. Some areas have a very large senior population.
I will start off with you, Dr. Cottle. Your examples were profound and actually gut-wrenching that we are not taking care of our senior population already. We heard that there is limited involvement in geriatrics. You are a physician in palliative care. There are not that many. In my riding of Langley, there is one palliative care doctor with a population of around 140,000 people. It's a great place to retire. I don't know statistically the percentage right now, but I'm guessing probably about one in four or one in five is a senior. Even around this table, you probably have one in four who is a senior. I'm a senior.
Thank you all very much for coming today and presenting.
Clearly, we have some challenges ahead of us. As a first-time member of Parliament, first-time politician, a question ran through my mind: what have we been doing over the last 20 or 30 years to get us to this point?
There are so many different directions to go in, but I want to focus first on this. When we talk about care, we have the haves and the have-nots. I'll give you two stories. One, I'll say, is actually my father. We can't afford to put him in a home and pay for it, because that's $5,000 a month. So he's in a government organization, which is brutal, absolutely horrible. I have a friend whose father is going into...for the same thing. There's an opportunity, because they can afford $5,000 a month. That facility is miles ahead of where the government facility is.
I see this across the country. I see this in my riding. We have a great assisted-living facility, but you have to pay $5,000 a month. I don't know where you're going to get the money from. My concern is that if you can afford care, great, but what about the people who can't afford care?
Dr. Cottle and Ms. Armstrong, the things you're both talking about are great. It's all about compassion. It's all about home care. It's all about families. It's about love. But we need to be able to transfer that into actionables. That's where I want to focus.
Perhaps I can start with you, Pat. What are the actionable pieces that we need to do starting now, moving forward? It's not going to happen overnight—we know that—but we need actionables.
I'll quickly go over some of the risk factors that we have from our own research at NICE. We looked at social isolation within the context of age-friendly communities. That is one of my overall suggestions, that we look at how to empower communities to support older adults who stay in their homes. We know that older adults want to age in place; we've heard this a lot. We know that older adults want to not go to long-term care if they can stay within their communities and stay in their own homes and remain engaged.
We know from the literature that an individual who is over 80 years old, who is living alone, who has a compromised health status, who doesn't have a child or a contact with family, who lacks access to transportation, and who has low income or is disabled will be at risk for being socially isolated.
One of the problems that we encountered in the research studies we conducted through NICE on age-friendly communities, and we've heard this from other witnesses as well, is the fact that individuals who are socially isolated are very difficult to identify. They're isolated; therefore, we can't reach them. Often the problem is that when we do reach socially isolated individuals, it's in a state of crisis, so you'll find them in the emergency department. The next problem is that you've identified someone who is socially isolated, you've assessed them for the risk factors and they're at risk of being isolated, so now where do you refer them within the community? What services do you provide to those individuals? Where can you send them?
Within the larger context of social isolation, one of the risk factors we've also uncovered as a result of our work is that little opportunity for engagement within the community is a big problem, but the larger problem that participants from our study also suggested was that it's not mutually rewarding. The programming and the community initiatives have to be mutually rewarding. The older adult has to feel that they're contributing something to the programming and to the community, that the programming is not just for them but that they're able to contribute something back. That's the way we should approach programming.
Thank you very much to all the witnesses who took the time to respond to our questions.
First of all, I want to contextualize my question. I'd like to remind this committee that the previous government made seniors a top priority. I was honoured to have served as Minister of State for Seniors for five years. I have also had the honour of working together with NICE, and then with the long-term funding...and they've done an excellent job as well. In the previous government we were able to really look at issues of care, worker support, and taking care of the caretakers. What is unfortunate is that the current government does not prioritize seniors and their caretakers enough to continue our hard work on the file through a dedicated ministry.
I believe it was Danis who mentioned that you need a secretariat to really focus on seniors and then coordinate everything. You also need somebody who actually gives directions to the secretariat. I'd also like to say that, yes, some of the policies have been able to pass from the 41st session of Parliament to the 42nd—for example, the new horizons for seniors program. That is good funding for all the community groups that are helping to fight against elder abuse and helping, especially, seniors in isolation.
My question is this. Do you believe there is enough to address the dire financial straits many caregivers find themselves in? I know that our friends across also mentioned that about family caregivers. In some of my observations, some of them are also working at the same time.
I'd like to see if maybe Mr. Mirza could shed some light on that.
The group of caregivers that we think about are women. That's the first thing I'll tell you, and the literature will support that. The research we do at NICE will support that it is often a very gendered issue.
I want to focus for just one second on a group that we work with very heavily, which is grandparents raising grandchildren. They have stayed off the radar for a very long time, but we have conducted two national research studies with grandparents raising grandchildren. I can tell you about the situation for those caregivers. We don't often see that group as caregivers, we see it as a family responsibility when something has gone on, and it's an issue of family dynamics. Their financial situation is very dire. I can tell you that most of the participants in our study, 75% of them, were making between $15,000 and $50,000, and their legal fees for the year were way more than that. As a group of caregivers, that's very problematic.
I think we have to start to look at caregivers in separate groups. Dementia caregivers have different responsibilities and roles. Caregivers who are working with older adults who are in institutions are faced with different challenges and responsibilities. Caregivers for parents who are new immigrants who have language barriers also have very different challenges and roles. We have to start to unpack some of the ideas we hold with regard to caregivers and start to look at them as separate groups requiring very specific, targeted supports. I don't think the current support system is helping everybody out to the maximum level they can. We do work with vulnerable populations, and oftentimes they are heavily represented by caregivers who are women.
I'll tell you one last point, and then we can move on to someone else. Caregiving actually leads to a lot of family strife. Within the context of age-friendly communities, one of the things we recognized is that for those who are socially isolated, oftentimes it is as a result of family dynamics issues. It comes because of caregiving responsibilities sometimes. So if we can help support caregivers, we can empower and strengthen our communities and also take better care of our older citizens.
That is a million-dollar question.
I would say that the situation in many places in the world should be studied. In Nordic countries, there is complete home support. The way they go about it, the budget they provide, and the various methods they use are determined in partnership with governments or family caregivers, but also with social economy enterprises and the community. A family caregiver cannot do everything alone, and neither can the government.
There are other examples from around the world. As to the social participation of communities, there are places where residences are built with day care centres alongside seniors' housing, that is, intergenerational housing, but on a larger scale. This is all about inclusion, keeping people active. In terms of isolation, as someone said, keeping seniors in their homes is one thing, but if there is no public or community transit in age-friendly municipalities, or AFM, if there are no services that seniors can use, and they are not considered when changes are made, such as if pedestrian walkways are not long enough, they will become isolated, even if they have home support.
It is a very complex issue.
In these committees, sometimes we tend to be partisan, and we tend to say, “This is what we did; this is what they're not doing.”
I really appreciate being here today. This isn't the committee I normally sit on, but I think I can speak with some experience, because I've done a lot of work within my own community in terms of our women's shelter. I know that one of the most prevalent demographics in recent years in terms of those who are using our women's shelter is widowed seniors, females, who are now being housed in our women's shelter.
This is going to be more of a statement than a question, if that's okay with the committee. I very much appreciated the testimony of the witnesses who are here today, both on the phone and in person.
I would like to tell you a little about my family. My mom worked for a very long time in long-term care as well as home care. She is all of about five foot nothing, and she spoke quite a bit about the violence she encountered at the hands of some of her patients. She also spoke, over that time, about being all alone and having to restrain somebody who was much larger than she was. She first injured her back because of a violent outburst of a patient who didn't mean her harm but didn't know what he was doing at the time. She subsequently talked about, and does to this day, how she wishes she were still doing what she was doing, but she was unable to continue because of the lack of resources, whether it was in Alberta or in British Columbia, where she finished her career. She also talked about the fact that there was no lifting mechanism in the rooms, how sometimes she would have to physically try to move a patient who was much larger than she was, and how that impacted her physically.
If she were here today, she would talk to you, emotionally, about something that hasn't been mentioned today. She would talk to you about going into a first nations community to help a first nations senior.
I believe it was Ms. Phinney or Dr. Cottle who mentioned that sometimes home care isn't the best care for our seniors—not necessarily because of bad intentions but because they don't have the capacity to care for the seniors the way they really should be cared for.
I remember one where my mom told me that she went in to deal with this gentleman. It was on a Monday. The last she had seen him was on a Friday. She said her heart broke, as the gentleman was still sitting in the same spot he was sitting in on the Friday. He had not been moved. He was still sitting in the clothes and the undergarments and the sanitary products that she had put him in on Friday. The rash and the pain that this gentleman was in, and the frustration for being left there, looking out a window—that broke my mom's heart.
Now I'm going to talk to you about my brother, who really is my hero. He's battled cancer twice. He is a senior care aide in a long-term facility in the Okanagan, and he works with the union, representing those who are in those facilities in the Okanagan. He tells me about the pain that the care aides go through, because they want to do better. They are in this profession because they want to help.
Mr. Chair, you can tell me if I'm going too long. This is more of a grandstand than it is anything else.
As I mentioned to my colleague, I really applaud the group that is around the table here. I don't think this is a time for partisan politics. I think we need to move forward. I can tell you quite confidently that when you're speaking to those who are in this profession, they want to help, but they don't have the resources. They haven't been given the resources. Far too often they are faced with overtime. They're tired. There is emotional stress on them. They care for these people, and they see their charges suffering because not enough resources have been given to help care for them.
I applaud you for looking at this, but I challenge you to come up with something that is manageable and that will have an impact, because we need this. Whether it is in Nova Scotia or British Columbia, we have seniors who are suffering. Every government is well intentioned, but we can do better and we must do better. I can tell you from examples that I know all too well.
I want to talk to Ms. Cottle and Ms. Armstrong, if I have a second.
I think one of the things that we are starting to do actually here in Canada is to combine hospitals and long-term care and assisted living, creating a community of those facilities. Rather than closing all our tiny hospitals and closing all of those things in small communities, we can combine all of the services to make them one real service.
I grew up in a tiny town in northern Ontario, and I've seen it work there. It's working in some of the Nordic countries. We were in a place in northern Sweden—we go in for over a week with a team of 14 people to look at these places—and their nursing home is physically part of the town swimming pool and the town recreation program. It's all one great big community. The cinema is there. By integrating all of the services, I think that we could do that in some of the small rural communities in a way that would keep them there.
The other problem for people in rural areas, which we heard about earlier, is the question of transportation. Of course, it's magnified for people in rural communities, which is something we need to look at as well.
I think step number one is combining services and keeping the hospitals. If you're old, you can't live in some place that is 60 miles away from a hospital, especially in Canada, given our weather, so you need to have those kinds of services there. We could do that by combining them rather than eliminating them.