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 second of three panels that will be held on the subject of housing and aging in place.
Welcome to all of our esteemed panellists. Welcome back, all of our committee members.
I have a couple of notes. We're going to get started right away with opening remarks of seven minutes. When you see me signal, it means you have one minute left. Don't panic. A minute is a long time. I usually try not to startle you when I do this, but I have had the occasion where I've caught people off guard, but don't panic. You have lots of time.
Also, this is a reminder that committee meetings are fully bilingual. Witnesses may be asked questions in either English or French.
To begin, we're going to introduce the panellists.
Appearing as individuals, we have Melissa De Boer and Andrea Dresselhuis. They are students of the school of nursing, Trinity Western University. Thank you for coming.
From the Canadian Home Care Association, we have Leighton McDonald, president of Closing the Gap Healthcare. Thank you, sir, for coming.
From Centre action générations des aînés de la Vallée-de-la-Lièvre, we have Michèle Osborne, executive director; and Julie Mercier, coordinator of activities.
From Elim Village, we have Ron Pike, executive director.
From FORREC, we have Steve Rhys, executive vice-president.
We're going to get started right away with Melissa De Boer and Andrea Dresselhuis.
The next seven minutes are yours.
Nurses are the eyes and ears of health care. We bear witness to the triumphs and suffering of seniors, as they make up much of the population we care for. Today we want to talk about three issues. First is housing as a social determinant of health. Second is wraparound home care that allows seniors to age well in place. Third is dying well.
Social determinants of health are those conditions in which people are born, grow, live, work, age, and die. We urge you to view housing as a social determinant of health, because unsuitable housing contributes to considerable differences in quality of life among Canadian seniors. Inadequate housing can lead to negative consequences, including the onset of disease and the worsening of chronic conditions.
Nurses assess home environments regularly for potential challenges faced by seniors, such as snowy sidewalks, unsafe lighting, unhygienic environments, or something as simple as stairs or clutter. However, our assessment goes beyond the physical structure to those things that transform a house into a home, allowing seniors to thrive and flourish in place.
Through the lens of housing as a social determinant of health, a nurse may also consider the location of one's home in terms of access to reliable, affordable, safe transportation not only to medical appointments, but to social outings and for access to their hobbies and interests.
Addressing housing for seniors then must, in policy, be multi-sectoral, considering how housing shapes all aspects of positive aging. The development of a seniors strategy has to practically assist, through provision for maintenance, upkeep, or renovations.
Volunteer driving programs and affordable public transportation will also support seniors to remain in their home. As Pat Armstrong highlighted in her presentation to this committee last month, social inclusion cannot happen if a senior is socially isolated in their residence.
We urge this committee to recognize housing to be a social determinant of health as a necessity to advancing inclusion and quality of life for seniors. This is an upstream approach, requiring a health-in-all-policies strategy to improve health outcomes and quality of life for seniors. An upstream approach will prove more cost-effective than paying downstream for the negative health consequences of poor housing and social isolation.
Good afternoon, and thank you very much for the opportunity to present to you today.
The Canadian Home Care Association is a national not-for-profit membership association dedicated to advancing excellence in home care through leadership, advocacy, awareness, and knowledge. Closing the Gap Healthcare, the company I work for, is a sustaining patron of the association and works closely with them in order to advance key priorities in home care.
Supporting older Canadians to live at home with dignity, independence, and quality of life is a priority for all home care programs across the country. To achieve this goal, our health and social care services and communities must support an environment where older people not only age in place but are also active and productive members of the community. Older Canadians want to remain in their homes and believe that home care is a critical part of making this happen.
Unfortunately, there's chronic underfunding and suboptimal capacity for the delivery of these important services across all jurisdictions. On average, provinces spend only 3% to 4% of their health care budgets on home care, even though this is proven to be more effective than acute care and is the preferred setting of care for seniors with a frailty.
Even with the federal government's commitment to investing $6 billion in home care in the next 10 years, publicly funded programs will remain challenged to provide these services with the increased demands of an aging population. However, there are a number of innovations taking place, and I think it's important to highlight some of these.
The first one I'd like to speak about is one that facilitates social connectedness among socially isolated seniors. The World Health Organization states, “Belonging to a social network of communication and mutual obligation makes people feel cared for, loved, esteemed and valued. This has a powerful protective effect on health.”
In Canada, in a study of seniors who were surveyed, those over 60 years of age, 43% reported feeling lonely, with 13% feeling chronically lonely, and 30% suffering from episodic loneliness. It's estimated that 1.3 million Canadian seniors suffer from chronic loneliness. Studies show that health deterioration is twice as high in those who have chronic loneliness than with those who do not. As health deteriorates, quality of life deteriorates, as does the increased burden on the health care system. Individuals who engage in meaningful social relationships are healthier, happier, and live longer. However, there are many in our society who are not able to have these social interactions due to a number of limitations.
There are innovative programs, such as one called Keeping Connected, which is offered by Closing the Gap Healthcare. It supports seniors, from a social health and well-being perspective, through planned telephone calls, anything from one to three times a week, with those calls lasting 20 to 30 minutes at a time, based on the assessment of the loneliness of that senior.
When comparing loneliness scores from intake to discharge on this program, findings indicate that Keeping Connected is effective in supporting lonely seniors. In the study that was done, findings included that 97% of these clients felt involved during the calls; 88% felt the companion understood them; 96% of clients looked forward to the calls; 73% felt companions made them feel less lonely; and 99% would recommend the service to other seniors. This is a truly low-cost, high-impact solution to social isolation.
Another one I'd like to raise is leveraging technology to meet the needs of seniors in their homes. With this chronic underfunding and the lack of capacity, we need to leverage technology. Technological advancements have created new options for care delivery, improving people's health, and at the same time improving efficiencies and reducing costs of care. Technology-enabled home care focuses on prevention, independence, and quality of life. For frail seniors with complex care needs, deployment of innovative technology-enabled home care solutions can mean the difference between being an active participant in their community or living their remaining years isolated or in institutional care.
The benefits of innovative technology-enabled home care solutions include better control of chronic illness through remote patient monitoring; improved safety in the home due to the ability for technology to alert caregivers and health care professionals of early signs of deterioration in health; enhanced self-care and person-centred care through the provision of education and active patient engagement; improved safety and medication management for people in their home, a challenge we know that elderly people have; and increased access to appropriate care in rural, remote, and hard-to-service areas, and we have lots of those in our country. Supporting the vital role of family caregivers is also an important part of this.
It's easy to envisage a future health system fully immersed in a range of technologies that support seniors care in the home. However, our collective challenge is how we attain this vision. In advancing the adoption of technology, we need a cohesive strategy, long-term investment, policy changes, and a structured change management process.
In closing, I would like to bring light to a vital part of the home care and health care system: family and friend caregivers.
Canada needs to do more to support caregivers, especially when their continued dedication and contribution are the reasons why so many older Canadians have been and will remain able to age in their places of choice for as long as possible.
A 2012 Statistics Canada study found that one in10 caregivers spends more than 30 hours a week providing care. That's equivalent to a full-time job. They contribute $25 billion in unpaid care every year to our health care system. As 50% of carers are between the ages of 45 and 65, their prime working years, there is a considerable cost to the economy as well, estimated to have been $1.3 billion in 2012.
Although caregiving can be rewarding, caregivers often compromise their health, incur out-of-pocket expenses, and face employment challenges in the absence of appropriate support. Canadians want governments to do more to help seniors and their family caregivers.
Five priority areas have been identified by caregivers and caregiver support groups across the country, and these are: one, safeguard the health and well-being of family caregivers through the funding of caregiver respite programs and other community-based services; two, minimize the financial burden placed on carers by improving awareness of the new Canada caregiver credit and amending this to make it a refundable tax credit; three, support caregiver access to information and resources by developing a national resource database that links with current jurisdictional initiatives; four, assist employers to provide supportive workplaces that recognize and respect caregivers' needs by funding an employer-for-caregivers consortium that would equip employers with information, tools, and resources; and, five, invest in research on caregiving as a foundation for evidence-informed decision-making.
While we have made advances in some of these areas, there is much more to be done to ensure caregivers are recognized, valued, and supported in their vital role.
Once again, Canadians believe that home, not a hospital or a long-term care facility, is the best place to recover from an illness or injury, manage long-term conditions, and live out one's final days. Our federal government can enable the meaningful change that will be needed to meet the growing and evolving needs of our aging population by playing a key leadership role on this issue of significant national importance.
Thank you very much for allowing me to share this with you. I'm happy to elaborate during question time.
The mission of the Centre action générations des aînés de la Vallée-de-la-Lièvre is to foster the well-being, autonomy, and vitality of seniors in Vallée-de-la-Lièvre, in the Outaouais region. All our services are designed to develop the full potential of seniors to remain in their own homes as long as possible, as they wish to do.
The organization's objectives are to prevent isolation and loneliness in seniors; to foster contact among seniors and retired persons; to encourage retired persons to devote their time to seniors; to utilize seniors' skills; to inform seniors about their rights; to emphasize the personal and collective responsibility of seniors; to change the community's perceptions of seniors; to facilitate cooperation among the various stakeholders who work with seniors; to support the civic participation of our seniors; and to help seniors stay in their own homes. In short, we are familiar with the needs of our seniors and know what is happening with them.
We also offer various services that enable us to reach out to seniors. The services are tailored to their needs. For example, we offer: transportation assistance for medical appointments; the Bouf' Mobile service, which delivers fresh or frozen meals to their homes; friendly visits and phone calls through our volunteer matching system; a tax clinic; a reference and information centre in both official languages; and help filling out various forms.
We also have a support group for seniors' family caregivers and local employment initiatives for vulnerable seniors, which we call ITMAV. We have two ITMAV officers in our offices.
We also offer various activities to help seniors maintain their autonomy and foster their vitality. These activities focus on prevention and the promotion of healthy lifestyle habits, including presentations and crafts workshops, cultural workshops, and discovery workshops. We also offer recreational and cultural workshops.
We support the development of seniors' potential by getting them involved in democratic life though community kitchens and a community garden. We support individuals in their natural environment by offering all these services and all these activities. As a result, we are often in the field and converse with seniors. Finally, we encourage them to be active in their community.
The area we serve extends from Val-des-Bois, in the north of the Outaouais, to Thurso, and includes Buckingham, Masson-Angers, Mayo, and Lochaber. We serve about 16 municipalities.
Since we know our clients well, we are in a position to make certain recommendations. Further, I would add that our organization has 1,000 members and 120 volunteers.
I will now give the floor to Ms. Michèle Osborne, who will tell you about our recommendations.
Hello. Thank you very much for the opportunity to be here with you today.
The region we serve includes both rural and urban areas. It includes many very isolated villages where there are few home services to help clients age in their homes. Our recommendations are designed to provide long-term funding for our mission, for organizations such as ours, and for other organizations that offer services to seniors to allow them to age in their own homes. I think all Canadian seniors want to stay in their own home for as long as possible. By offering transportation assistance, we help seniors get to the hospital and medical clinics at a low cost. These individuals also have trouble getting transportation to go shopping or for social outings.
Funding is needed for services that are effective, rather than constantly trying to innovate. Innovation is needed for seniors, but priority should be given to services that have been demonstrated to be effective in allowing seniors to age in their homes.
We recommend that funding applications for grant programs be simplified. Calls for proposals are often issued in the summer, with three or four weeks' notice. For community organizations such as ours, it is not easy to submit proposals. This also makes it difficult for other organizations to submit proposals.
Furthermore, our organization has to draft about eight major reports on results each year. It goes without saying that if we spend our time filling out forms, seniors do not receive as many services. We suggest therefore that the reporting requirements be reduced.
Additional support for family caregivers is also needed. Many seniors are able to live at home thanks to their family's support, and this must be recognized, financially, in particular.
We recommend adding social housing in urban and rural areas, and improving the effectiveness of public networks that provide services for seniors, specifically by tailoring them to their reality. For example, ATMs and bank counters have been closed in many small municipalities, so seniors do not have access to an ATM. That leaves them at a loss and they often find it a very impersonal process.
We recommend that seniors should have access to local health services in all municipalities to enable them to age in their homes. There are many villages where, unfortunately, there are no more family doctors, nurses or services offered by the health network. As a result, people have to go elsewhere to get those services, which means they cannot remain in their homes.
Grants should be offered to make seniors' housing universally accessible. Their living environment should be adapted as they age, for example through home visits.
We therefore recommend financial support to businesses that want to install lighting for seniors and improve accessibility for persons using a walker.
Financial support could also be make available to recreational organizations. Seniors do need to get out of the house and enjoy recreational activities.
We also recommend financial support for affordable transportation initiatives, as well as support programs to help seniors who have been subject to intimidation and ageism.
Thank you very much.
Good afternoon. Thank you for the opportunity to present at today's session, and thank you for the meaningful and vital work you're initiating through this committee.
I'm honoured to be here today representing an incredible group of residents, staff, and stakeholders who have played a variety of roles in creating a great senior living community called Elim Village. My hope is that by sharing our story with all of you today, we can inspire thinking, positive dialogue, and most importantly, action in other communities in order to advance inclusion and quality of life for Canadian seniors.
The Elim story begins in the early 1990s, when a small Bible study group got together. One of the couples in this group shared a challenging personal circumstance, in which they were required to place their parents into separate care facilities due to differing care needs. You can imagine the heartbreak when, after 50 years together, they were separated in the last stages of their lives. As a group they were moved by this story and began to envision a place where, despite differing care needs, spouses and friends would never have to worry about being separated again. They envisioned a community that had a variety of housing options, was professionally managed, was enriched with amenities, and allowed residents to celebrate life's joys and meet life's challenges together.
This story inspired the creation of the Elim Foundation, which began working within the community to raise the required funds to move the project forward. In the end, a total of 64 investors raised $1.5 million in equity, enough to put the vision in motion. Over the course of the last 15 years, the initial $1.5 million investment has grown to over $170 million in real estate assets and two senior living campuses. Our main campus, located on 25 beautifully maintained acres in Surrey, B.C., is home to over 650 residents and provides meaningful work to over 400 staff and volunteers. Our housing inventory provides our residents with flexibility and choice by offering a wide range of sizes, styles, and designs, including duplexes, condominium-style apartments, and private individual units for those requiring residential care.
On site we have both private and publicly funded units integrated within the community. The majority of our 250 independent units are private life leases and operate similarly to a strata with a monthly maintenance fee. Our foundation has also purchased five independent units, which they rent out to individuals who may not have the financial means to purchase a life lease.
Within our 109 assisted and supported living units, 50% are private, with the remainder being subsidized by BC Housing and Fraser Health. The majority of our 193 residential care units are publicly funded through the Fraser Health Authority, with a small private pay inventory set aside.
Our second project, located in Chilliwack, B.C., occupies nine acres and is in the initial stages of development.
At its core, the story of Elim Village is a real life example of the power of community. It's through community and the associated congregation of people and assets that we have created a number of advantages.
Through community we have raised investments to initiate and support the acquisition of land and building projects.
Through community we have been able to offer a wide range of housing and care options that reduce the physical and emotional impact of transition and change on older adults. In fact, we've had over 200 housing transitions, and we've been able to keep over 80 spouses together on the same property with differing care needs.
Through community we've added on-site amenities including a 400-seat auditorium, a small bistro, community gathering spaces, walking trails, a doctor's office, and a pharmacy.
Through community we have attracted other individuals and organizations like the Fraser Health Authority, which has been a key partner in integrating care services throughout the village.
Through community we have been able to make wellness a priority. Our programming supports this in a variety of ways, from concerts to wellness fairs and education, from fitness classes to dementia-specific programs. An important area of wellness is also found in spiritual care through the pastoral care program, where we increasingly deal with residents, families, and staff with end of life issues, including grief and loss.
Through community we have also been to engage a group of capable and caring staff members who serve the residents by listening to their concerns, answering questions, providing guidance and support, advocating for their interests, and even coming in to change the occasional light or fix a toilet.
Finally, through community we've been able to create a home for residents where they feel valued, supported, and secure. Similar schedules, interests, and shared experiences and histories allow them to engage and interact with one another on a daily basis, serving to combat the feelings and issues associated with isolation and loneliness.
While we are thankful for our situation and optimistic about the opportunities ahead, we recognize that we are among the fortunate few in our field. Our size, scale, and not-for-profit status have provided us with some financial margin to strategically invest in the community. The relatively recent addition of our residential care has given us service contracts with better than average care hours, and the fact that much of our infrastructure has been constructed during a period of low interest rates has provided us with beneficial financing.
That said, like many other providers, we're concerned about a number of trends we are experiencing. We are increasingly challenged to do more with less, as care needs within assisted living in residential care continue to rise while staffing levels remain the same. Expectations with respect to quality of life are increasing, and dare I say they'll be higher with the baby boomers, yet we have little time and resources available to enhance areas like dining, food quality, and wellness services.
Finally, compliance requirements in all areas, from by-laws to building codes to workplace safety and standards related to clinical best practice, continue to rise. In isolation, these are positive things. However, in combination, they place service providers in challenging positions.
In order to ensure that the older adults of our country are appropriately supported and cared for, we need to be strategic with our use of time, energy, and resources. To this end, I would like to leave you with recommendations from the BC Care Providers Association, put forward in the January 2017 publication “Strengthening Seniors Care: A Made-in-BC Roadmap”, which I believe has application to the national conversation as well.
They are encouraging taking a four-pillar approach to strengthening seniors care in Canada. Pillar one is to encourage continued investment in infrastructure to ensure that the care we provide is supported and not hindered by buildings in which we work every day. Pillar two is to provide for appropriate hours of care and the necessary human resources and training to support it. Pillar three includes focusing on quality of life as much as quality of care. Both go hand in hand, and they must be put on the same playing field. Last, pillar four is to make strategic investments in innovation. We need to better use technology and ensure that proven pilot projects are supported and scaled in order to benefit more seniors.
Thank you to the committee for inviting our firm. I feel like we are at the opposite end of the spectrum, and the table was set very nicely to lead this up to where we are. We are not experts on seniors' living. We are not experts on health care. We are experts on life experiences: how we enjoy them on a day-to-day basis and how we apply what we've learned in the entertainment industry to resort living, as well as, now, to seniors' community living.
I'll leave the expertise to the people who deserve the expertise. We are at the design end of the spectrum, where we are trying to create environments for places where people want to live the rest of their years, post-career.
The opportunity came to us as a project in Florida. There was a community being built, but the entrepreneurial spirit of the owners who were developing it had a question that they were struggling with: If we provide the best care, and if we provide the best housing type, what is the environment in which people want to live? When they have a choice, where will they want to live? If they decide they are going to move more than 15 kilometres from where they raised their family and have their friends, Florida is that big jump. The big question for them was, why would people come here?
If we could pull that issue apart, aside from the distance they had to move when they relocated, the question is, what was the choice they were really making? They were looking for a place where they could live the next 20 to 30 years of their life, with new family and friends, building a new society around what their next few years were going to be like.
The key question here is, what are we trying to achieve? I have only two examples to point to for you right now, but I'll tell you that since these issues came up through discussions in the last two or three months, and the media caught on to this, people from the retirement home industry—many of you here are involved in that—and from the development industry have been asking how these two things come together.
We don't know how that's going to influence what your committee is considering. We don't have a clue. What we are doing is sharing with you a very real discussion that's going on. People want a choice. The boomers, right now, are driving that. That wave started in the early 1990s. We saw what was happening in Arizona, California, and then moving into Florida. The boomers are now at the peak of that wave, maybe a little past the peak, and they are driving the question of choice. They are choosing earlier. They want to choose earlier, because they don't want to move somewhere in the end stage of their lives, when they really need care. They want to start earlier and start a new life, and be sure that where they move to has the rest of the things, those essential ingredients that you have all been talking about.
They want to age in place, with their new friends, and of course they also want their family to be able to join them whenever they please. Isolation becomes an issue. They don't want to feel like they are in a community where the seniors live behind a wall, and the rest of us are driving on the streets nearby. That's a key ingredient when we design these communities. It's a community that is inclusive.
I'll talk about the two examples that I want to cite. One is where we really learned and tested our craft on this subject matter. That was at The Villages in Florida. When I met them, they had 12,000 residents, mostly in trailers, park side model trailers. They now have 120,000 residents living in three distinct communities, each one with its own set of services and commercial areas to support their everyday living.
There are 216 golf holes on 34 golf courses. There are community centres, a hospital, numerous memory care centres, and numerous assisted and full-care health care facilities. We had nothing to do with any of that.
They realized that when they brought people to live in a new community, they were going to want to stay. They made sure that they were given that opportunity to stay and to not have to leave unless they chose to. That was 22 years ago.
The second project is in Hamilton. I was telling Ron that it was like sending a message out into space to see if there's other life. Twenty-two years ago we wondered if what we were doing in Florida resonated with anybody. Twenty-three years later, I got a call from a guy in Hamilton who was asking me exactly the same question they asked us in Florida: “I'm wondering what a community for seniors would look like if Disney designed it. What would that feel like?” He said, “I imagine it would feel like a resort.” I said, “Okay, now you have to go down and see what...”.
We can't take all the credit, honestly, but that way of thinking has permeated the discussion on what boomers and others are trying to do, or on the decisions they're trying to make.
The project in Hamilton is 144 acres. There's a charity housing project already there, which is not sustainable, so as those people age in place and leave the community, they are being replaced with new residents, boomers who are buying or renting property, and who expect to live in an environment similar to the one I just described—Canadian-style and in Hamilton, somewhat urban, not suburban.
I welcome you to ask any questions. Pictures would have been a lot better, but I'd be pleased to answer any questions you may have.
Thank you very much, Mr. Chair.
Thank you to all the witnesses who came from different parts of our nation to share with us their expertise and excellent recommendations.
I hear again and again about the need to support the informal family caregivers. Statistics show there is a growing demand for family members or even friends to look after seniors.
CARP, a very hard-working, non-profit organization for seniors issues, stated that an estimated $25 billion, or 80%, of care, is provided annually by eight million informal, unpaid caregivers. They are making urgent calls for action to reduce the devastating emotional impact on caregivers, nearly half of whom experience stress or depression. Our job is not only to look after seniors but also to look after those who take care of them.
We have seniors homes and nurses who are well trained to take care of the seniors in their own institutions; however, when we talk about aging in place and about how seniors prefer to stay in their homes, this is a great issue. Then, of course, on our side, we are proposing actions that the government should start working on to support Canadians who are balancing caregiving and working.
My first question is directed to Mr. McDonald from Closing the Gap Healthcare.
You mentioned supporting informal family caregivers. Can you explain more on that?
We have a support group for seniors' family caregivers. We are subsidized by L'Appui, an organization that supports seniors' family caregivers. L'Appui offers support workshops for family caregivers; they are held every three weeks and last two hours each. A psychologist is present to help seniors' family caregivers talk about their problems, get information, and talk about their feelings. These workshops also provide tools to help them deal with stress or distress.
That is one thing we do. We also celebrate National Caregiver Week. On Thursday, November 9, we will be giving a presentation, together with the Société Alzheimer de l'Outaouais québécois, on dealing with refusal from a patient with a cognitive deficit, such as Alzheimer's, in order to help family caregivers communicate with the persons they are helping who have a cognitive deficit.
In our next grant application—we said there are a lot of reporting requirements and this is one of them—, we will ask for at least one more support group to help seniors' caregivers. Our group currently has 16 registered members, although we normally accept 12. Given that demand is so high, that public services have unfortunately been eliminated, and that a family caregiver group at our CLSC has been cancelled, we are trying to make up for that.
We have increased the number people accepted per group to 16, and there are currently 4 more people on the waiting list. Unfortunately, we cannot provide the service to these people, although they do need it.
Does that answer your question?
Our environment is very inclusive, but it is still difficult for certain individuals who are in a minority. It is difficult for seniors who are in a minority. A senior who has a good support network, a family, can find the services they need.
We work a lot with vulnerable people, those with low income who have trouble reading and writing and who, in many cases, have unfortunately been on social assistance all their lives. At 65, they did not apply for the Quebec pension plan so we help them fill out those forms. This is a very disadvantaged client group.
As part of one of our initiatives, local social workers travel around and reach out to the informal network of seniors in order to find these individuals. They contact the mechanic, the parish priest, their hairdresser, and the grocer. As soon we are aware of a vulnerable and isolated person, we try to establish trust with that person to identify their needs and direct them to the appropriate resources. It is an incredible service. Our organization has two local social workers. Every year, they locate between 100 and 150 seniors who are not familiar with the network.
It is easier for a person who has support, especially from their family. It is much more difficult for those who are isolated, alone, and especially for members of a minority. Being part of a minority is very difficult.