I call the meeting to order.
Welcome to meeting 24 of the House of Commons Standing Committee on Health.
Pursuant to the order of reference of May 26, 2020, the committee will now continue its briefing on the Canadian response to the outbreak of the coronavirus.
Pursuant to the motion adopted by the House on May 26, 2020, the committee may continue to sit virtually until Monday, September 21, 2020, to consider matters related to the COVID-19 pandemic and other matters. In addition to receiving evidence, the committee may now also consider motions, which shall be decided by way of a recorded vote. Finally, the House has also authorized our committee to conduct some of our proceedings in camera specifically for the purpose of considering draft reports or the selection of witnesses.
In order to facilitate the work of our interpreters and ensure an orderly meeting, I'd like to outline a few rules to follow.
Interpretation in this video conference will work very much as it does in a regular committee meeting. You have the choice at the bottom of your screen of either “floor”, “English” or “French”. Please speak slowly and clearly, and hold your microphone in front of your mouth as directed during the sound check.
If you will be speaking in both official languages, please ensure that the interpretation is listed as the language you will speak before you start. For example, if you're going to speak English, please switch to the English feed and then speak. This allows for better sound quality for interpretation. Before speaking, please wait until I recognize you by name, except during questioning of the witnesses when the witnesses may respond appropriately as the questioner requires. When you're ready to speak, click on the microphone icon to activate your mike. Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. I would remind everyone that all comments by members and witnesses should be addressed through the chair. Should any technical challenges arise, please advise the chair or clerk immediately, and the technical team will work to resolve them.
I also draw your attention to the upper right-hand corner of your screen. There is a choice between “speaker view” and “gallery view” if you're on a PC. If you click to the “gallery view”, you'll be able to see all of the participants in a grid-like manner, and it will ensure that all video participants can see one another.
I'd now like to welcome our witnesses. Each witness will have 10 minutes for an opening statement followed by the usual rounds of questions by members.
From the Battered Women's Support Services, we have Angela Marie MacDougall, executive director. From the Canadian Red Cross, we have Conrad Sauvé, president and chief executive officer. From the Carnegie Community Action Project, we have Fiona York, project coordinator and administrator. From Ornge, we have Dr. Homer Tien, president and chief executive officer. From the Region of Peel, we have Nancy Polsinelli, interim chief administrative officer.
We will begin with Ms. MacDougall.
Good afternoon and thank you, honourable Chair, Madam Clerk, and all the members of the House of Commons Standing Committee on Health.
Battered Women's Support Services, BWSS, was formed in 1979. Our mission is to end gender-based violence by changing the historic underpinnings of discrimination against women through education, advocacy and support services to assist all women affected by gender-based violence as part of our aim to eliminate violence, and to work from an intersectional anti-oppression feminist and decolonizing perspective, which is one that promotes equity and liberation for all women.
Based in Vancouver, British Columbia, we are a non-partisan, incorporated, non-profit society and federally registered charity. We are governed by an independent board of directors, and we work in collaboration with similar organizations across Canada and internationally.
Over the past 17 years, BWSS has developed a unique expertise and intersectional approach to the complex and overlapping identities and factors of oppression, disadvantages that impact women and contribute to their subjugation and vulnerability to gender-based violence, including and not limited to domestic and sexualized violence.
We do this through direct service provision. In 2019, we responded to over 18,000 requests for service through our intake and crisis line, counselling, support groups, legal services and advocacy, employment, indigenous women's program, black women's program and Latin American women's program.
We also deliver skill-based training for professionals, systems and community groups, volunteers and other individuals. Training and educational workshops are grounded in sound theoretical frameworks that include trauma, socio-cultural and intersectional theory and practice.
Our advocacy reach includes legal, institutional and systemic advocacy to improve the status of women in Canada and the response to gender-based violence.
I speak today on behalf of Battered Women’s Support Services, where our volunteer and staff team continue to provide support services on the front line, supporting survivors of gender-based violence with crisis intervention, counselling and legal advocacy.
Like our counterparts across British Columbia and Canada, the women who access our services are navigating violence against women and gender-based violence including domestic and sexual violence, poverty, substandard and precarious housing, substance use and ill mental health, sex work and sexual exploitation, as well as compromised immune systems resulting from all of these factors.
The COVID-19 pandemic poses very specific challenges for women in our communities. Our services and programs are the vital community-based response positioned to make a difference. The work of our organizations includes alleviating isolation, as well as providing vital support services that increase women’s safety and keep women alive. Our support services span crisis, domestic and sexual violence intervention.
Last year I had the privilege of visiting China and through those contacts and networks we learned that quarantine was increasing the instances of domestic violence. In those cases, our Chinese counterparts cited the COVID-19 pandemic as the major contributing factor in 90% of the cases. This feedback from our Chinese counterparts in Beijing, Guangzhou, and Jinzhou was clear. It was important to ensure the continuation of services, expand or modify services and take every action available to advise women of services.
In early March, Battered Women’s Support Services thoughtfully and strongly considered these potential increased rates of violence and worked to get out in front of the problem. We recognize the importance of being nimble and creative, so our actions involved scaling up our direct service provision to 24 hours a day, seven days a week. We included email and text options as well as a toll-free number.
We dedicated the homepage of our website to COVID-19 and violence-specific information including safety plans; how to help a friend, neighbour or family member; and a listing of shelters and transitional housing in Canada and internationally. We continue to deploy a comprehensive communications plan utilizing social and mainstream media, advertising, blogs and email blasts.
We advocated as strongly as we could with municipal, provincial and federal governments for unrestricted funding for supplies, service modification and increased staffing levels. We sought engagement with provincial and federal health offices to deliver messaging through their platforms to advise victims of gender-based violence that their physical safety was more important than social distancing, and to seek out crisis line and text support.
We continue to utilize alternative measures to conduct outreach and follow up through remote networks, and we maintain our physical office for drop-ins and individual, in-person appointments.
Through these efforts, demand for our services increased upward of 300%. Calls fell into seven general themes: women who were out of abusive relationships and were experiencing increased post-trauma reactions and suicidality; women currently living with abusive partners who were looking for opportunities to ensure their safety and to understand their situation; co-workers of women who were living with abusive partners where work from home had impacted their ability to assist their co-workers as they had been previously; family members who wanted to know how they could assist their sister, mother, aunt, cousin, who they knew were in abusive relationships; neighbours who had a previous awareness or who had just become aware of a woman in their apartment building or community and were looking for options; professionals who wanted to consult on how they could support their clients under COVID-19; and children and youth who had witnessed their mother’s abuse their entire lives and were calling to discuss how they could plan for their safety, their mother’s safety and that of their siblings.
The contributing factors we have identified through our front-line work over the last three months have been economic insecurity and poverty-related stress; the very real impact of social isolation and quarantine; increased alcohol consumption and the consumption of other substances, licit and illicit; exposure to exploitative relationships; reduced health service availability and access to first responders; reduced contact with schools, neighbours, hairdressers, etc.; fear to seek help and/or leave the house; the inability to temporarily escape abusive relationships and partners; and exposure to ongoing violence, including violence in the community, such as sexual harassment from landlords. Women were profoundly impacted by the scaling back of services, as each service was navigating its own needs in terms of staffing and social distancing. There was also a profound lack of funding support at the front end of social distancing mandates.
In the past, women would contact their support service over the phone while they or their abusive partner was at work or otherwise out of the house. With the COVID-19 restrictions, women have fewer opportunities to leave the house and fewer opportunities to call a support service such as a shelter. Many shelters and transition houses are communal living areas, with shared kitchens, laundry and common areas, and in some cases shared rooms, and in most cases shared bathrooms. This kind of environment is not conducive to social distancing, and numerous women whom we have placed in transition houses have left, citing too much isolation during the lockdown. We have since engaged the private sector as we continue to work with transition houses, and have a floor of rooms in a Vancouver hotel, where we have housed and are housing 15 women and six children on a temporary basis.
Combined with the escalated COVID-19 home-quarantine measures, abusive partners are using isolation, coercion, threats, emotional abuse, economic abuse, abuse of children and companion animals, and their privilege to fully maximize their power and control and exert violence on their victims, with lethal effect.
In one month, we've experienced 11 killings of women. On April 1, a 41-year-old woman was murdered by her 35-year-old partner in Ontario. On April 1, a 33-year-old woman was killed by her domestic partner in Brockville, Ontario. On April 2, Tracey MacKenzie was killed by her partner in Hammonds Plains, Nova Scotia. On April 8, 61-year-old Tina Seminara was assaulted by her husband in Osoyoos, British Columbia, and died a week later from her injuries. On April 11, Julie Racette, a 33-year-old woman, was killed by her partner in Winnipeg, Manitoba.
On April 17, a woman was assaulted in Portapique, Nova Scotia, by her long-term common-law partner. She managed to escape and hid in the woods. The man proceeded to murder 22 people, the deadliest mass shooting in Canada's history. The same man intended to killing his ex-wife. Brittany Ann Meszaros, a 24-year-old, was killed by her common-law partner in Calgary on April 27. On May 1, Tina Tingley-McAleer, a 43-year-old woman who was called an amazing sister and great mom, was killed by her domestic partner in Hillsborough, New Brunswick. On May 4, Lois Paterson-Gartner, 55 years old, and her 13-year-old daughter and their family dog were found dead in a murder-suicide carried out by a man they lived with in rural Strathcona County, Alberta.
This number of killings represents a statistical spike in lethal misogynist violence. It is up to Canada to reinforce the community-based matrix of women- and gender-based violence services. For us, it doesn’t really matter whether we’re talking about pre-COVID-19 or now, with the lessening of social distancing measures. We continue to do the work, and we know that gender-based violence was already a pandemic. For every woman who is killed, we know from our front-line work that there are thousands more living in fear.
Good evening, Mr. Chair. Thank you for having me here.
My name is Conrad Sauvé. I'm the president and chief executive officer of the Canadian Red Cross. I'm honoured to be here today to update you on the important work, as outlined in the documents provided, that the Canadian Red Cross is carrying out across Canada to support individuals and communities and to help the municipal, provincial and federal governments respond to the COVID-19 pandemic.
While we've been gradually increasing our responses to this and our responses to natural disasters here in Canada, it goes without saying that the size and scope of this response is unprecedented in our history. We have been responding from the first days of the outbreak by providing support to the Public Health Agency of Canada in helping some 1,200 Canadian travellers and crew members who were quarantined in Trenton and Cornwall in the early days, as well as providing psychosocial support in Japan for the more than 50 Canadians who were in 40 different hospitals in Japan.
It's important to note that we had the ability and the expertise to do this because we have been engaged internationally, thanks to the support of the Canadian government, in deploying both cholera and Ebola clinics in the last number of years. We reassigned our international health experts to help with the early stages of the response to the quarantine, in setting up, with the public health agencies, the appropriate protocols to ensure for our staff, our volunteers and those we helped that it could be done safely.
We are also in partnership with Global Affairs Canada in supporting the shipping and receiving of international donations and protective equipment.
The Red Cross is also continuing to provide assistance in a variety of ways to seniors or vulnerable people here in Canada.
In Toronto, for example, we distributed over 5,000 food hampers to seniors or vulnerable people who couldn't leave their homes.
In Ottawa, we launched a home support program and we visited almost 3,000 seniors to make sure that they had what they needed.
Together with Indigenous Services Canada, we created a virtual operations centre to provide mental health information, assistance, guidance and support to indigenous communities across the country.
For several weeks, the Red Cross has been providing support to seniors' centres in Montreal, particularly in the West Island. Our support is focused on three areas: personnel recruitment, which is a major concern; the training of personnel and volunteers who enter the facilities; and the deployment of personnel to different facilities to ensure that infection control measures are being properly monitored. We started with eight health care facilities and we're now at over 40. The demand keeps growing. With the Ontario government, we're even looking at the possibility of deploying similar teams in that province.
Our work with Employment and Social Development Canada is another very important part of our activities. From the start, we've been talking about the importance of providing training and protective equipment, not only in the various facilities, but also in the community.
We now have a support program that includes personal protective equipment for the community and training. The program targets about 5,000 organizations. We also have a funding program for non-profit organizations that don't have charitable status. This program has just been launched.
As you can see, there's a large-scale increase in our operations throughout the country, but just because we have COVID-19 doesn't mean there are no longer natural disasters. We're active, of course, in many places presently. Again, with flooding in Fort McMurray, we are there. Following the request of the Government of Nova Scotia, we're raising funds for the victims of the terrible tragedy that happened there, which we were talking about a little earlier.
These events are a reminder that there are factors we can plan for in our response, but there are also many risks we cannot plan for. I'm not going to get into all of the types of responses that the Red Cross has had, but when we're looking ahead, there are really three areas that we can continue to invest in regarding our response.
One is the focus on vulnerable populations, not just in institutions but in the community. We're doing work in Toronto and Ottawa, going door to door in some communities. We need to map out and understand where vulnerable people are, not just during these events but also on an ongoing basis. We are also doing friendly calls throughout the country, again to ensure that people are safe in these communities. We're seeing that the outreach, what we're doing around Ottawa for example, is essential.
In the case of COVID-19, we've deployed some of our [Technical difficulty—Editor] we have purchased. We have an expertise globally in this area. This has been funded by Global Affairs Canada, so we can do work internationally. We've deployed field hospitals in many parts of the world, from Nepal to the Philippines to Congo. As I mentioned earlier, we're managing Ebola clinics and cholera clinics as well.
It is the first time we've deployed this equipment in Canada. We've deployed part of our field hospital in Vancouver and Montreal, and we have been supporting communities in the north with mobile capacity. Obviously we need to again look at building up a stronger capacity for a national response as well. We're looking to work with the provinces on what the needs are moving forward.
We have been increasing our operations throughout the country. Again, we're dealing with a combined issue of the pandemic and natural disasters. This will require us to think about how to increase our base capacity and what new level of base capacity we must maintain to support municipal governments, provincial governments and the federal government with moving forward.
I'd be happy to answer questions.
This has added more homeless who used to shelter with friends and family. One estimate is as high as an additional 400 homeless due to no-guest policies. As well, shelters reduced capacity by up to 50%, meaning even more people in the street.
Privately owned SROs are often poorly maintained and have shared washrooms and kitchens, meaning that residents are in close contact and unable to safely self-isolate. Government funding provided meals and cleaning in only 11 SROs, which will be ending soon.
Peers and non-profit groups have been providing meals, supplies, information and support to people living in tents, on the street and in inadequate housing in the Downtown Eastside. Over 10,000 meals and hygiene kits have been provided by CCAP volunteer efforts.
Coming out of this crisis, housing needs to be radically rethought. The lack of housing is devastating and contributes to unsheltered deaths through exposure, violence, substance use and ill health. Now it is clearer than ever that housing is essential to support the most vulnerable.
A demand for hotels from the province and city was answered by the targeted evacuation of Oppenheimer Park tent city, bypassing those most in need and most at risk of COVID.
Taking into account the homeless population, the newly homeless, those in SROs and shelters, close to 9,000 hotel rooms would be needed; 262 were offered to Oppenheimer Park residents, with a reported 638 rooms being provided in total.
As borders closed, the illicit drug supply closed and drugs became even more lethal. Several overdose prevention sites, OPS, closed, and OPS use went down from 6,000 per week to 2,000 per week. Overdoses spiked in March, with eight deaths in one week in March. Safe supply measures have helped to address the crisis, but there is no confirmation that it will continue past the pandemic.
Sex workers are another group that is disproportionately impacted by COVID-19. Sex workers have been pushed into more unsafe situations, unable to work at home due to no-guest policies and left without an income.
Lack of communication and Internet contributes to lack of safety and health-related information. Community centres, libraries and daytime drop-in spaces all closed, eliminating access points for information, phones, charging phones, Wi-Fi and Internet, and pushing people into the street. On one side of one block at Hastings and Main streets 167 people were counted. These enforced crowded conditions contribute to lack of social distancing and inability to follow health directives.
Community groups have called to open the streets to pedestrians to give those displaced from other spaces somewhere to go, and to close a portion of Hastings Street to non-emergency vehicular traffic. Once again these displacements from public spaces, services, housing, shelters and parks displace the most vulnerable and, disproportionately, the indigenous and those affected by trauma, poverty and colonialism.
Over-policing has been the response to the crowded conditions outdoors. Overuse and misuse of policing is a way to respond and control a community facing a pandemic and unprecedented closures and lack of supports, once again stigmatizing and pathologizing those most in need.
The lack of indoor and daytime services has also led to a massive failure of sanitation and washrooms. Handwashing stations and porta-potties were placed on Hastings Street and a few other locations. These inadequate facilities led to two deaths in two weeks, including an infant found passed away in a porta-potty.
Many peers found themselves out of work when facilities and services shut down. Community members subsist on punitively small incomes and the small amounts received from peer work are essential supplements.
Food security was immediately, and continues to be, one of the major concerns during the pandemic, with so many daytime facilities and resources closed. Community members and groups responded with donations, in-kind donations and support for meal distribution programs.
The issues of housing, food security, washrooms and handwashing were nowhere more apparent than the tent city at Oppenheimer Park. There were over 200 tents and 250 people in Oppenheimer Park until May. The provincial announcement on April 25 was welcome news that hotels would be leveraged to safely house those who are homeless, but didn't go nearly far enough and clearly targeted the eyesore of very visible homelessness in Oppenheimer Park.
Once again, hotel units and SROs were stockpiled for those in the park and bypassed others far more in need and at risk.
The hotels offered did not address community needs or respond to community input. Restrictive guest policies, no pets or partners and punitive and restrictive rules have made then inaccessible to many vulnerable people.
A new tent city has been established in the federally owned parking lot at CRAB Park nearby in the Downtown Eastside, with 40 community members who were unhoused or inadequately housed after Oppenheimer Park, or the many others who are homeless. Park bylaws in Vancouver have lagged behind the provincial requirements that camping be allowed overnight, and street sweeps displace those sleeping in the street on a daily basis. For many, there is simply nowhere to go.
My recommendations are as follows.
Call on the federal government to have a national plan and to work with all levels of government to immediately house the homeless by securing empty hotel rooms to house the homeless and the under-housed. Secure the hotels now and turn them into permanent housing.
House the most vulnerable, not just the most visible. Follow the examples of other cities by triaging and housing those with the highest risk factors, those who are over 65 years old and with underlying health conditions.
Have an open and honest sit-down dialogue about any plan to house first peoples in urban environments and about what plan is coming to provide homes for on-reserve families with all the basics, including drinking water.
Make homes available for the 2,000 plus sidewalk-dwelling persons, especially during this coronavirus, and secure federal funds to open the Balmoral and Regent hotel rooms, which would give downtown residents a home in a known service-providing community.
The national housing strategy only suggests reducing homelessness by 50% over 20 years. Instead, we need a federal commitment for the prevention and elimination of homelessness, with expanded federal investment in community-based homelessness responses.
We recommend the construction of over 300,000 new permanent shelter-rate housing units and enhanced rental supports for low-income Canadians.
We recommend the meaningful implementation of the right to housing. Immediately purchase or build 3,000 homes that are shelter-rate homes.
Develop and fund an aggressive acquisition strategy and work in partnership with provincial, municipal and non-profit sectors to purchase properties and assets for shelter-rate permanent housing now.
Prevent those with deep pockets from sweeping up assets and protect against predatory purchasing of properties.
Make reconciliation a reality through respectful engagement with indigenous peoples and no pipelines on unceded territories and by following the recommendations of Red Women Rising, the UN Declaration on the Rights of Indigenous Peoples, and the Truth and Reconciliation Commission.
Given that urban indigenous people are overrepresented among the homeless population, the federal government needs a national strategy addressing urban indigenous, one that is led by indigenous people for indigenous people.
Don't further displace indigenous people from unceded land by moving people encamped on federal lands or spaces. Let the homeless—mostly indigenous people—stay at CRAB Park, where they are safely encamped now but are facing an injunction that will displace them into streets and alleys that are more dangerous.
Enact the national protocol on tent encampments written by former UN rapporteur on adequate housing, Leilani Farha.
Invest in the guidance and direction of peers to ensure the efficacy and appropriateness of any response to homelessness.
Work with provinces and territories to provide adequate supplies of personal protective equipment to peers and front-line workers.
Finally, ensure access to real safe supply. The opioid crisis remains the biggest health and safety threat in the Downtown Eastside.
Thank you very much for your attention.
Good day. I want to thank you for the opportunity to address the Standing Committee on Health today for the briefing on the Canadian response to the outbreak of the coronavirus.
My name is Homer Tien. I'm the president and CEO of Ornge, the provider of air ambulance and critical care transport services to the province of Ontario. I assumed my role in January 2020 after serving as the organization's chief medical officer for five years. I'm a surgeon by training, and I was previously medical director for trauma at Toronto Sunnybrook Health Sciences Centre where I still maintain a practice as a trauma surgeon.
I also spent 25 years in the Canadian Armed Forces and retired from the forces as a colonel in 2015 after deploying multiple times to front-line field hospitals in the former Yugoslavia and Afghanistan.
I'm here representing the more than 600 people who are part of the team at Ornge. We're the largest air medical and critical care transport organization in Canada, and we conduct approximately 20,000 patient-related transports per year.
Ornge is an integral part of Ontario's health care system, which is based on a hub-and-spoke model of care. In this model, patients are transported from smaller facilities in rural and remote communities to larger hospitals to receive a higher level of care. To preserve capacity for the next patient, these same patients are then repatriated back to their home hospital when it is appropriate and safe to do so.
More than 90% of our work is devoted to this type of inter-facility transport. To carry out our mission, we have a mix of helicopters, fixed-wing aircraft and land ambulances staffed by highly skilled paramedics and pilots. They are supported by aircraft maintenance engineers, communication officers, physicians and administrative staff.
Our operations are based in 11 communities across Ontario with our head office in Mississauga.
Today I would like to share with you the details of our operational response to COVID-19 and provide the committee with some ideas for consideration.
Caring for a patient effectively and safely in a mobile environment is challenging. It's about safely and efficiently getting the right patient to the right place with the right assets and crew at the right time. In the case of air transport, we even need a bit of luck with the weather.
COVID-19 has added entirely new complications to this mix. You need to optimize staffing to create search capacity. You need to re-evaluate your personal protective equipment needs in order to reduce risk to staff and patients. If you think about it, we're operating within the confined space of an aircraft or a land ambulance, a little box, while that patient is coughing or being mechanically ventilated within a couple of inches of the paramedic.
As COVID-19 first began to unfold, our organization had three basic objectives—protecting our staff, maintaining service delivery, and planning for a surge. These objectives have informed every decision and every action we have taken.
As of May 15, Ornge has transported 531 patients with either a confirmed or suspected COVID-19 diagnosis. Nearly half of these were transported by our critical care land ambulances, about 30% on our fixed-wing aircraft, and about 20% in our helicopters. These were all terribly sick patients. Nearly half of these patients were intubated and being mechanically ventilated. I'm pleased to report that to date no Ornge staff members have tested positive for COVID-19.
I would like to spend some time on one particular aspect of our operation. Ornge is the agency responsible for transporting stretcher-bound patients in and out of rural and remote indigenous communities in the north, many of which are accessible only by air. Our air ambulance crews respond regularly to approximately 30 nursing stations across northern Ontario performing more than 2,500 transports annually from these communities.
If one of these communities suddenly found itself with a number of severe cases of COVID-19, the local health care resources would likely become overwhelmed quickly. This situation would lead to a sudden and immediate demand for air medical transport, and in order to protect the other people in the community, those exposed would need to be tested. Those tests would need to be processed quickly at labs in larger centres, but with commercial carriers ceasing or scaling back operations, this becomes much more challenging.
Planning for these scenarios has been a central focus at Ornge since the crisis began. Ornge is a tool for health equity, particularly for rural communities and remote indigenous communities. We realize that we need to be creative, innovative and thoughtful about how we use our capabilities in order to provide the needed access to care.
Since mid-April, Ornge has been coordinating weekly logistical flights to transport samples from northern communities to the labs in the south for processing. To date, more than 2,000 COVID-19 testing samples have been transported via Ornge contracted aircraft. This has dramatically increased the speed of processing results, which we all know is critically important to preventing the spread of COVID. In addition, there's been considerable interest in reducing unnecessary travel to hospitals, particularly to those in the south.
For the past two years, Ornge, with its partners, has been supplying point-of-care lab tests to remote indigenous communities in the northwest. This has allowed members of these communities to access the appropriate diagnostic care in their communities and avoid unnecessary transport to southern hospitals, where they could be exposed to infection. As well, there's tremendous interest in telemedicine across the entire health care sector for the same reason. We've already been offering virtual consultations to northwest nursing stations in partnership with Thunder Bay hospital.
Last month, Ornge began providing additional telemedicine support to the rest of Ontario in partnership with CritiCall Ontario, a provincial bed-finding agency. Under this arrangement, any physician in any Ontario hospital can reach out to an Ornge emergency medicine physician, ICU physician or pediatrician to receive assistance in managing a patient, 24-7. This service is not specific to COVID and can be used for patients with general, acute and other critical care needs.
We're also working with some of our system partners to look at novel technological solutions. Specifically, we're exploring remotely piloted aircraft systems, or drone technologies, for the purpose of improving health equity for northern communities. This could involve the delivering of critical medical supplies to nursing stations and the shipping of medical lab samples to health centres.
From a surge planning perspective, we're tapping into our most valuable resource, our people. Ornge has solicited paramedic volunteers to form a COVID-19 Ornge surge response team. There are 46 Ornge paramedics from across the province who have volunteered. They can be dropped off at any facility in the province to help with airway management and mechanical ventilation prior to transport. The team's deployment kit has the equipment and medications to be able to function independently, and includes the fully equipped airway management bag, a portable mechanical ventilator, monitors, medications and infusion pumps.
None of this could happen without the tireless dedication of our staff, which is why they need whatever support we can provide them during this stressful period. Whenever one of our crews transports a patient with a confirmed case of COVID-19, upon completion of that transport, we automatically put them on an operational pause. The crew is taken off-line temporarily in order to facilitate a debrief and a check on their personal needs and anxiety levels. In doing so, we're hoping to take care of their mental well-being as well as their physical well-being.
The Canadian health care system is one of the best in the world. Unfortunately, disasters like the COVID-19 pandemic reveal that our rural and remote communities are more vulnerable to disruptions in care pathways then our more urban communities. Air ambulance and critical care transport services are nimble, operationally focused organizations. We have the ability to innovate and adapt quickly to unconventional problems that affect access to care and health equity. I'd ask leaders and health care organizations to just ask us if they have a problem, and we will find a way to help.
Thank you to the committee members for inviting me to speak. I look forward to your questions and discussions later.
Thank you, Mr. Chair, for the opportunity to present to the Standing Committee on Health. And good afternoon to members of the committee.
My name is Nancy Polsinelli, and I am the interim CAO for the Region of Peel, which I will refer to in my presentation as “the region”. The region is an upper-tier municipal government providing services across the geographic area of Peel in Ontario. Peel is made up of our partner communities Brampton, Caledon and Mississauga. Peel is home to approximately 1.5 million people and over 175,000 businesses. The region delivers health, human services and public works across Peel.
COVID has brought unprecedented economic, social and health impacts for all Canadians, including those living and working in Peel. The social impacts are highest among the most vulnerable and marginalized in our community, as you heard from the witnesses this evening. This can be the result of social isolation, inadequate housing, loss of jobs or food insecurity. As I am sure this committee has previously heard, these social determinants impact personal health.
One of the most challenging social determinants of health in a pandemic is homelessness. Approximately 4,000 homeless people live in Brampton, Caledon and Mississauga, based on a point-in-time survey done by the region in 2018, so it's already outdated.
When the crisis began, homeless residents in shelters were offered hotels to encourage physical distancing. We acted quickly on that. About 50% of homeless residents now reside in hotels across Peel.
We rapidly scaled up testing at the sites where the region and its partners were offering services, with the region's paramedics assisting. The region's public health staff ensured shelters and other services were operating safely. An isolation program provides shelter for those who have risk factors for COVID-19 exposure or have been tested but who can't self-isolate. Those who test positive are provided with a secure, safe place for recovery and support.
Let me share one person's story; it shows how interconnected challenges can be in a pandemic. For the sake of privacy, I'm changing the name, but this is a true story. Donovan is 20 years old and he is definitely a front-line hero. He works as a cleaner in one of the 28 long-term care homes located in Peel. The region itself operates five municipal long-term care homes, but Donovan does not work in one of our homes. Although Donovan works full time, he finds it difficult to afford housing in Peel, where nearly 70% of low-income households live in unaffordable housing. While supporting the comfort and care of seniors in a home that is facing chronic COVID outbreaks, Donovan himself was going to sleep at night in a local shelter for young people.
Unfortunately, he tested positive for COVID-19. Donovan was immediately connected to our recovery program for the homeless where he can have the proper care, space and peace of mind to recover. Of course, Donovan had contact with other shelter staff; 13 of this staff are now in temporary self-isolation hotel spaces for essential workers. But this is not the end of Donovan's story.
The region's recovery program provides more than a self-isolation space. Once someone like Donovan is introduced to our program, all of their immediate acute-care needs are met. Donovan will see a physician, a nurse practitioner, and have access to 24-7 nursing care on site. The region will also provide additional health and social services support to provide a path to long-term housing, health and well-being. It truly is a wraparound service. For example, Donovan may be connected to primary care that he can continue using after isolation.
As we meet immediate needs in the COVID crisis, we are also addressing other health issues and seeking permanent housing for homeless clients. To do this, the region mobilized non-profits, community agencies, the region's paramedics and public health experts and health care providers.
COVID has called on communities to partner and collaborate on a whole new level. Another example of this collaboration is the Region of Peel's community response table. The response table addresses a broad range of needs, such as poverty, food insecurity, isolation, domestic violence, racism and mental health.
In the early weeks of the crisis, the region sent a survey to community agencies. We wanted to know what was keeping them up at night. The survey found, among other things, that 57% of those surveyed were facing immediate program closures. Like other organizations, not-for-profits needed support to adapt to the crisis so they could support the community.
The region's council approved over $1 million in funding to provide one-time grants to Peel community agencies that support the most vulnerable. In addition to financial support, the community response table helps providers find strength in numbers. It's made up of people from the region's human and health services departments, representatives from our partner communities and leaders from over 90 community agencies across Peel. The virtual table meets twice per week and it has self-organized even further to create task groups that address family violence, the needs of seniors and youth, and systemic discrimination.
The pandemic has called for us to locally develop solutions through innovation and partnerships. Beyond the immediate crisis, the community response table can be a continuing force for positive change in Peel through the recovery and beyond.
As the communities across Canada have found, seniors in long-term care are among the most vulnerable in the pandemic. As I mentioned, the region operates five long-term care homes, and there are 23 additional homes within Peel. To address the needs of these vulnerable residents, we also participate, as a region, in an integrated response table. This includes Ontario health partners, local hospitals, and the region's own public health, long-term care and paramedic services. This work features a rapid-response testing strategy in long-term care homes, in at-risk retirement homes, in shelters and in group homes. They have done over 8,400 tests for residents and staff beyond the amount the homes themselves have tested.
COVID-19 is also amplifying system pressures for mental health and addictions services. In the pandemic, many programs have been put on hold. Wait-lists are growing. This is unsustainable over the longer term. There is, and will be, a human and community cost. Before the pandemic, the region had created a community safety and well-being action table. It's this group that is helping to coordinate community partners as we mitigate mental health crisis situations and strengthen system navigation with local services.
In closing, municipalities like the region are on the front lines working to protect our residents, including the vulnerable. Every day we see opportunities to do more. We're committed to working with our provincial and federal partners to ensure a strong crisis response and gradual, careful recovery.
The pandemic is an unprecedented crisis that called for new forms of partnership. I'm proud to say that the region has done that work.
I hope that the members of this committee will see that the partnerships that municipalities have developed to help the vulnerable during the crisis should be maintained and even expanded. There is opportunity here. As senior governments seek to target human needs, it's these networks that can help to ensure that investments reach the most in need and support strong community recovery. There is great value and opportunity in having the federal government investing strategically with municipalities.
I want to thank you for your time today. We look forward to working with you to support Peel's diverse and growing community.
Thank you for the question. Through the chair, I'm going to separate the question in two and speak first to what I think are the underlying causes of these issues. Then I will certainly provide some comment on your question about the private homes with respect to municipal homes.
The first question is a very important one because, if anything, COVID-19 has exposed various issues in long-term care. When we look at the issues, certainly we will hear about things like staffing ratios, funding and increased complexity of resident needs, which are part of an ongoing discussion about change in long-term care. These are very important, and they're absolutely necessary. However, I want to dive a little deeper, because there are also cultural issues that are at the core of how we approach long-term care. These, I'd like to highlight a little more for the committee.
For a variety of reasons, long-term care has become inherently task based. Our staff rush to bathing, to feeding and to documenting. It's one resident after another, on a very strict schedule, with very little time for anything further. The issue is that when we approach long-term care like a set of tasks—a checklist, if you will—we make the needs of the person who's living in that home secondary to the completing the task. In many cases, it becomes fear-based care by the staff member and not the emotional-based care these seniors deserve.
Here are some thoughts about solutions. We hear a lot about person-centred care; it gets tossed around all the time. But at the core, it does offer solutions, so while we're looking at funding, we also need to look at creating a culture that enables staff to understand and meet the needs of unique people, the people living in the home, for their physical and emotional well-being. This is what helps to improve well-being, and it certainly avoids problems before they arise.
One example I'll give is that of a person living with dementia. We know that people with dementia sometimes wander or pace endlessly. This is an issue, both during the outbreak, because wandering can put them at risk of exposure, and in general, because they can become exhausted and it's a detriment to their own health in increasing their risk of falling.
A task-based approach looks at the wandering as a problem. The wandering becomes the problem. A person may recommend to put this individual on an anti-psychotic medication, or to restrain them, or to allow them to keep on walking all day.
A person-centred approach looks at wandering as the symptom and tries to understand why the person is wandering. We're not fixing the wandering. We're trying to understand why the person is wandering.
Through our work at the Region of Peel, we've implemented the innovative butterfly model of care for dementia care. For people who wander, what we've realized is that they wander because they need something. They're looking for something. They're looking for engagement, affection, security or love. They're also wandering because we put them in environments with long corridors that look endless to them, and they just keep walking. By understanding how we can support them through activity and conversation, we are creating a home environment, a safe one.
To close this, I'm going to suggest that when we enable true person-centred care, it isn't easy. It's not about the surface. It's actually about getting deep into the way we work and the way we think as the staff in those long-term care homes.
Some things need to be considered. We certainly need better staffing ratios so that staff have time to spend getting to know who is in their care, meeting with them, holding their hand and sitting with them. We need regulations that are less focused on documenting the completion of tasks and more focused on measuring the emotional care and well-being of those individuals. We need training programs and the funding to undertake them so that staff can have a better understanding of complex conditions like dementia and how to understand and meet individual needs.
I would say that I absolutely agree a hundred per cent that there needs to be immediate, very aggressive and very assertive action around housing. Since the seventies, there's been a real dire shortage of housing and social housing being built and a shortage of funding to the CMHC from the federal government. That's resulted in this really dire lack of housing, affordable housing and especially shelter-grade housing, which is what's really needed. There needs to be a real focus on returning to those levels and building housing for people who are homeless right now and also for people who are under-housed. That needs to be done in a very definite and assertive way immediately.
There's been all this research over and over through the years about how housing reduces other costs in terms of the justice system, the health care system and for so many other costs that are impacted, and how it actually would be more effective to build the housing. Despite all of that over the years, and all of the evidence about how people are impacted by homelessness, it's probably been harder to see the impact than it is currently. During this pandemic, everything is heightened and everything has sped up, and you see it much more clearly.
Just in these few months, it has become so much more obvious and so much more apparent that housing is health care and that it's really needed. Not only are we seeing that people are impacted around the pandemic and the health issues with COVID-19, but all of those connected harms that relate to the shutdown and the way we're responding to the pandemic are also impacting people. Those are the things that I touched on, like the fact there's nowhere for people to go outside and people are being displaced and there's a lack of sanitation. All of those other impacts are related to housing as well, and we see this being really heightened by the current pandemic.
Certainly, there needs to be a real change in how we think about housing and homelessness. With the hotels, what has been offered so far was really targeted and was more of an evacuation than really addressing health issues. When hotels were offered to people in Oppenheimer Park, it was certainly a targeting. That wasn't given to those most in need. We saw younger able-bodied men in Oppenheimer Park being offered hotels—
To start with your second question, early days were the immediate response. We all know about the Canadians caught on the cruise ships who needed to be brought home and be treated in the most humane way possible at the same time as being quarantined. We provided immediate assistance as well as for those in Japan. We're talking about direct operations.
I think the key when we talk about surge capacity is that the Red Cross, as you say, is present everywhere and everybody congratulates us for that, but what you don't see is the amount of training we do to make sure that people, volunteers and pre-positioned materials are ready. We've been talking the last few years about increasing that base capacity to deal with natural disasters. I think we've helped some 260,000 Canadians displaced by fires, floods and so on in the last four years. Now we have an additional component, a pandemic, which requires a little more specialized surge and a little more capacity in terms of infection....
We want to take stock with public authorities on the expectation for the Red Cross to support them at the municipal, provincial and national levels. Then, we want to look at how we increase that base capacity and what kind of equipment we need to restock. I am talking about equipment and about our partnership in supporting provincial health authorities: what has worked, what is needed for a second wave and what is helpful. As a first reaction, we tend to throw everything we have at something. After that, we can say what exactly we need to restock.
I was talking about the north in terms of the 80-bed full hospitals We've deployed parts of those. Again, this expertise was developed on the international side. We are very strong, and this expertise was used efficiently in Canada. When we look at the north, we look at smaller mobile capacity, and we got a lot of requests from first nations communities to deploy equipment and support them.
We're taking stock of the fact that we have to stop treating these surge events as exceptional. We need a standing capacity that's a little more elevated to support all these needs.
We've actually set up a virtual assistance program.
I'm going to go back a little bit to what my colleague from Ornge was talking about, as well. We have a modular capacity—so a small capacity—to deploy not full field hospitals but a smaller capacity. We've been getting a lot of requests around providing additional equipment as well so that communities that are isolated can set up quarantine structures. That's not medical stuff; it's basic blankets, cots, and so on.
I think one of the biggest areas we're looking at is training and advice. There was a big concern, of course, at the beginning of COVID. We got a lot of requests to deploy full equipment in case something were to happen. Where we're getting a lot of questions is around deploying expertise, people who have experience in helping the communities set up, accompanying the community in terms of how to set up properly, and providing ongoing training. Ongoing training is a big area.
To refer to a previous question for all organizations, we have purchased, with the support of the federal government, some PPE for community-based organizations—and first nations fall into that, as well—in the form of kits that will be available for the next few months. We have enough kits for 5,000 organizations, and we want to increase that quite a bit.
We've set up a 24-hour call centre for first nations communities in five different languages to answer, basically, all the requests and to direct people to the right place for all the types of supports. There's a lot of effort in terms of training, ongoing training and building local capacity. In any situation, such as an emergency, the first response happens locally. We need to send in specialized teams after that, but it's first about how we can build local capacity.
It is certainly a very unfortunate situation. I have every confidence that when individuals go to work in long-term care their expectation, their need, is to support residents. I think that what is happening, unfortunately—and you see some similarities in Ontario—is the inability to get the work done in this COVID environment.
What COVID has taught us is that there are staffing issues. If we do not have the staff, then we cannot provide the right care to our residents or those who are living in the homes. If we do not have the funding, then we cannot train our staff to be prepared for a COVID pandemic such as what we've experienced.
I do believe that, through the province and through the federal government, there will be improvements. This is a systemic issue. It is not an issue that has just arisen today. It's a systemic issue. I believe that, through the federal government, there should be a component of long-term care as a national act, so that there is more oversight.
I have to say that I also believe that while we go in and improve the situation in this emergency, there are also long-term improvements that must be made. I'll go back to emotional care. It is not necessarily about making things more “command and control” through legislation, but about ensuring that legislation also involves emotional care, a different type of expectation for our staff in long-term care and one so that they too will thrive, one where staff will enjoy coming to work and supporting those residents they care for.
Those are some of the things. It is about staffing. It is about funding. It is about getting the feds to support, but certainly it is long-standing, and a lot of work needs to be done that is not—I'm going to say it again before I get closed—about the command and control. It is about how we support our residents and our staff in an emotional-based culture.