Interventions in Committee
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Kelley Bush
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Kelley Bush
2015-06-18 16:07
Good afternoon. My name is Kelley Bush, and I am the head of radon education and awareness under Health Canada's national radon program.
Thank you, Mr. Chair and members of the committee, for inviting me to be here today to discuss radon as a cause of lung cancer and to highlight the work of the Canadian – National Radon Proficiency Program.
Through the ongoing activities of this program, Health Canada is committed to informing Canadians about the health risk of radon, better understanding the methods and technologies available for reducing radon exposure, and giving Canadians the tools to take action to reduce their exposure.
Radon is a colourless, odourless radioactive gas that is formed naturally in the environment. It comes from the breakdown of uranium in soil and rock. When radon is released from the ground in outdoor air, it gets diluted and is not a concern. However, when radon enters an indoor space, such as a home, it can accumulate to high levels and become a serious health risk. Radon naturally breaks down into other radioactive substances called progeny. Radon gas and radon progeny in the air can be breathed into the lungs, where they break down further and emit alpha particles. These alpha particles release small bursts of energy, which are absorbed by the nearby lung tissue and lead to lung cell death or damage. When lung cells are damaged, they have the potential to result in cancer when they reproduce.
The lung cancer risk associated with radon is well recognized internationally. As noted by the World Health Organization, a recent study on indoor radon and lung cancer in North America, Europe, and Asia provided strong evidence that radon causes a substantial number of lung cancers in the general population. It's recognized around the world that radon is the second leading cause of lung cancer after smoking, and that smokers also exposed to high levels of radon have a significantly increased risk of developing lung cancer.
Based on the latest data from Health Canada, 16% of lung cancers are radon-induced, resulting in more than 3,200 deaths in Canada each year. To manage these risks, in 2007 the federal government in collaboration with provinces and territories lowered the federal guideline from 800 to 200 becquerels per cubic metre. Our guideline of 200 becquerels per cubic metre is amongst the lowest radon action levels internationally, and aligns with the World Health Organization's recommended range of 100 to 300 becquerels per cubic metre.
All homes and buildings have some level of radon. It's not a question of “if” you have radon in your house; you do. The only question is how much, and the only way to know is to test. Health Canada recommends that all homeowners test their home and that if the levels are high, above our Canadian guideline, you take action to reduce.
The national radon program was launched in 2007 to support the implementation of the new federal guideline. Funding for this program is provided under the Government of Canada's clean air regulatory agenda. Our national radon program budget is $30.5 million over five years.
Since its creation, the program has had direct and measurable impacts on increasing public awareness, increasing radon testing in homes and public buildings, and reducing radon exposure. This has been accomplished through research to characterize the radon problem in Canada, as well as through measures to protect Canadians by increasing their awareness and giving them tools to take action on radon.
The national radon program includes important research to characterize radon risk in Canada. Two large-scale, cross-Canada residential surveys have been completed, using long-term radon test kits in over 17,000 homes. The surveys have provided us with a much better understanding of radon levels across the country. This data is used by Health Canada and our stakeholder partners to further define radon risk, to effectively target radon outreach, to raise awareness, and to promote action. For example, Public Health Ontario used this data in its radon burden of illness study. The Province of British Columbia used the data to inform its 2014 changes to their provincial building codes, which made radon reduction codes more stringent in radon-prone areas based on the results of our cross-Canada surveys. The CBC used the data to develop a special health investigative report and interactive radon map.
The national radon program also conducts research on radon mitigation, including evaluating the effectiveness of mitigation methods, conducting mitigation action follow-up studies, and analyzing the effects of energy retrofits on radon levels in buildings. For example, in partnership with the National Research Council, the national radon program conducted research on the efficacy of common radon mitigation systems in our beautiful Canadian climatic conditions. It is also working with the Toronto Atmospheric Fund to incorporate radon testing in a study they're doing that looks at community housing retrofits and the impacts on indoor air quality.
This work supports the development of national codes and standards on radon mitigation. The national radon program led changes to the 2010 national building codes. We are currently working on the development of two national mitigation standards, one for existing homes and one for new construction.
The program has developed an extensive outreach program to inform Canadians about the risk from radon and encourage action to reduce exposure. This outreach is conducted through multiple platforms targeting the general public, key stakeholder groups, as well as populations most at risk such as smokers and communities known to have high radon.
Many of the successes we've achieved so far under this program have been accomplished as a result of collaboration and partnership with a broad range of stakeholder partners. Our partners include provincial and municipal governments, non-governmental organizations, health professional organizations, the building industry, the real estate industry, and many more. By working with these stakeholders, the program is able to strengthen the credibility of the messages we're sending out and extend the reach and impact of our outreach efforts. We are very grateful for their ongoing engagement and support.
In November 2013 the New Brunswick Lung Association, the Ontario Lung Association, Summerhill Impact, and Health Canada launched the very first national radon action month. This annual national campaign is promoted through outreach events, website content, social media, public service announcements, and media exposure. It raises awareness about radon and encourages Canadians to take action. In 2014 the campaign grew in the number of stakeholders and organizations that participate in raising awareness. It also included the release of a public service announcement with television personality Mike Holmes, who encouraged all Canadians to test their home for radon.
To give Canadians access to the tools to take action, extensive guidance documents have been developed on radon measurement and mitigation. Heath Canada also supported the development of a Canadian national radon proficiency program, which is a certification program designed to establish guidelines for training professionals in radon services. This program ensures that quality measurement and mitigation services are available to Canadians.
The Ontario College of Family Physicians as well as McMaster University, with the support of Health Canada, have developed an accredited continuing medical education course on radon. This course is designed to help health professionals—a key stakeholder group—answer patients' questions about the health risks of radon and the need to test their homes and reduce their families' exposure.
The national radon program also includes outreach targeted to at-risk populations. For example, Erica already mentioned the three-point home safety checklist that we've supported in partnership with CPCHE. As well, to reach smokers, we have a fact sheet entitled “Radon—Another Reason to Quit”. This is sent out to doctors' offices across Canada to be distributed to patients. Since the distribution of those fact sheets began, the requests from doctors offices have increased quite significantly. It began with about 5,000 fact sheets ordered a month, and we're up to about 30,000 fact sheets ordered a month and delivered across Canada.
In recognition of the significant health risk posed by radon, Health Canada's national radon program continues to undertake a range of activities to increase public awareness of the risk from radon and to provide Canadians with the tools they need to take action. We are pleased to conduct this work in collaboration with many partners across the country.
Thank you for your attention. I look forward to any questions the committee members might have.
Sony Perron
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Sony Perron
2015-06-01 15:39
I would like to thank the committee chair and the rest of the committee members for the invitation to appear here today.
I, and other officials at Health Canada, have reviewed the Auditor General's 2015 Report, and we have paid a great deal of attention to his recommendations. We take the findings seriously and are addressing each of them through an action plan. This plan will continue to be refined and defined in collaboration with first nations. Indeed, as you know, we work in cooperation with first nations. This plan can therefore only be completed with an additional commitment by our first nations partners.
The health care system serving first nations is highly complex. Provincial health systems do not directly extend to first nations reserves. To support first nations, Health Canada provides the delivery of a range of effective, sustainable and culturally appropriate programs and services. We work with first nations to increase their control of health services and collaborate with provinces to increase access and promote system integration.
We also support programs that address first nations health priorities in the areas of mental health, chronic disease, maternal and child health, and health benefits providing coverage for prescription drugs, dental care, vision care, mental crisis intervention, and medical supplies and equipment.
Most of the community-based programs have been transferred in varying degrees to over 400 first nation communities. This number does not include British Columbia, where in 2013 Health Canada transferred its role in the design, management, and delivery of first nations health programming in British Columbia to the new First Nations Health Authority.
Health Canada provides funding to first nations to deliver clinical care in 27 remote and isolated communities, again, outside British Columbia. In an additional 53 remote and isolated first nation communities, Health Canada continues to deliver clinical care. The delivery model varies based on the specifics of each province and geographic conditions. The clinical care teams are located in nursing stations, along with community health workers delivering other programs.
Because of the importance of these services, it is imperative that Health Canada ensure that remote communities have access to clinical and client care, that nursing stations are staffed with registered nurses, and that nurses work in a safe environment, have access to physicians to support them, and have access to tools.
Registered nurses and nurse practitioners are predominantly the first point of contact in isolated communities and are highly educated and qualified individuals. To ensure that our nurses are prepared for the unique demands of working in remote stations, a mandatory training requirement has been defined and is now part of the national education policy.
I can report that we currently have an 88% compliance rate on Health Canada's nursing education model for controlled substances in first nations health facilities, while advanced cardiac life support is at 63%, trauma support is at 59%, pediatric advanced life support is at 64%, and immunization is at 61%. The overall compliance rate is at 46% as of the end of April 2015. We still have work to do, and we are doing it while ensuring that we have resources in place to backfill these important positions while incumbents are in training.
Health Canada is committed to ensuring that nurses working in remote first nations communities meet established public service requirements on top of these workers' already robust credentials.
Remote and isolated practice environments sometimes require nurses to respond immediately to life-threatening or emergency situations. Nurses therefore need appropriate mechanisms to perform these important duties.
Clinical practice guidelines assist nurses to address clinical care situations and provide instruction on whether and when consultation with a physician or a nurse practitioner is required. There are arrangements in place for all nursing stations to access physicians when physicians are not located in the community. We also continue to collaborate on region-specific solutions with provinces to advance access to health services and with regulatory bodies to support nurses practising within their scope of practice.
A key challenge is the need for more nurses. Health Canada has implemented a nurse recruitment and retention strategy, which involves a number of initiatives: a nursing recruitment marketing plan, a nursing development program, a student outreach program, and an onboarding program.
Since its February launch, we have received over 500 nursing applications, with 200 of these moving to the next level of screening. As well, the strategy aims to increase the number of nurse practitioners, which will provide greater stability in the clinical teams, assist in meeting training objectives, and enhance the level of services available at the community level.
Nurses and other community health professionals require facilities to conduct their work. Currently, we invest approximately $30 million annually for repairs, renovation, and construction of health facilities, plus an additional $44 million for maintenance and operations. The nursing stations are owned by first nations communities, and we collaborate with them to support their operation.
We work with first nations communities to ensure buildings are inspected and deficiencies are addressed. In response to the audit, we are implementing a more robust tracking system to capture this work. We will also enhance our process in order to use facility condition reports as a tool to better plan maintenance and renovation work with the owners.
In addition, to ensure new nursing stations are built to code, we have updated our requirements for attestations and have communicated the change to facility management staff. The audit rightly noted that the requirements, such as the station as defined currently, did not provide the necessary level of assurance.
Another area reported on was the management of medical transportation; medical transportation that provides coverage to support access to insured health services. Health Canada spends over $300 million on medical transportation per year, and approximately 60% of that is in remote and isolated communities. The main reasons for transportation are emergencies, at 24%, hospital services, at 10%, appointments with general practitioners, at 7%, and dental services, at 5%.
The program provides coverage for transportation to the nearest appropriate professional or facility that takes place when the needed service is not locally available. Our goal is to provide timely coverage for medical transportation to avoid an undue burden for clients and health care professionals. Decisions are based on a national program framework and are made with a solid understanding of the health services available and the transportation options at the regional level.
In response to the audit observations, the program has already modified and disseminated guidelines to resolve discrepancies observed between our practices and the medical transportation framework in terms of the level of documentation required.
Regarding the transportation of children who are not registered, Health Canada has a long practice of allowing coverage for a child up to one year of age to be covered for medical transportation under the registration number of their parents. Health Canada will continue its efforts with partners to inform parents and make available registration material in nursing stations and health centres.
Health Canada and the Assembly of First Nations are undertaking a joint review of the non-insured health benefits program, of which medical transportation is a component, and I am pleased to report that the work is well under way. It will identify strengths, weaknesses, including inefficiencies in administration, and recommendations for action.
Given that the geographic location, the size of the community, and the need to ensure cultural safety influence the range of programs and services funded or provided by Health Canada, comparing one community to the other is not always possible or the best approach. Community health planning, investing in the integration of services with provincial systems, and the development of community programs and capacity have proven to be more effective and more responsive to community needs over time.
As indicated earlier, Health Canada funds a number of community programs aimed at addressing specific needs and working as a complement to the clinical and client care program. These programs are funded to support community health needs and mostly managed by the communities themselves. In response to the audit, we will improve our support to community health planning to enhance integration of the community-based programs and clinical services where these services are delivered by Health Canada. We will also engage with the communities to review the current service delivery model and clinical care resource allocations.
The last area I would like to discuss is coordination among health system jurisdictions.
We work closely with partners to build health service delivery models that take into account community needs.
We have made significant progress with health service integration over the last 10 years. We see examples in various regions where there are more physicians' visits, provincial services are being extended on reserve, and there are more collaborative arrangements between community health services and regional health authorities. Co-management and trilateral tables exist in most regions to formally engage with provincial and first nations partners to advance common practices and resolve systemic issues. We will formally engage these tables in order to make progress on the important issues raised in the report.
Health Canada will continue to collaborate with our partners to develop and implement other models of first nations-led health systems across the country, as we have celebrated in B.C. We have presented an overview of our action plan, which requires further engagement and collaboration with first nation partners. We believe the next update will be more comprehensive as it will benefit from our partners' input.
In closing, we are working on a number of actions in response to the audit, and we will continue to do so.
I would note that I am accompanied today by three senior officials from Health Canada's first nations and Inuit health branch: Valerie Gideon, assistant deputy minister, regional operations; Robin Buckland, executive director, office of primary health care; and Scott Doidge, acting director general, non-insured health benefits.
We would be pleased to answer your questions. Thank you.
Sony Perron
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Sony Perron
2015-06-01 16:50
Thank you.
One of the things we have done for almost 15 years now is we have invested in health human resources not only to attract people from the south to working in first nation communities, but also to increase the number of aboriginal health workers. This has been an important investment for the branch. While most of them may not come to work in the first nations and Inuit health branch, in the end they may decide to go to work for the provinces or for the first nation communities themselves, which is great. Having more health workers who have an aboriginal background is one element of the strategy, because we do have employees who come from first nation communities working in first nation communities. We are really proud of that, because the cultural dimension of the health services is very important.
Something all of you are probably aware of is that we have a lot of people who, when they go to the south to visit a hospital or see a physician, are a bit nervous about that contact, because they are not used to it. We are trying to bring the cultural appropriateness of the service into the community, thinking that this will also create a more resilient and stable workforce there. It's very important to invest there.
In terms of better informing the nurses, if you have not done so, I invite all of you to go to the Health Canada website to see the video and information we have displayed there since February of this year in terms of what it is like to be a nurse in a first nation community. We do this to try to attract more workers to Health Canada, but we also use that to bring those people who prefer to work for first nation communities there. It's an aggressive marketing campaign to show what it is like to work there. There are also advantages for people who like to live closer to nature, work in small teams, and face challenges. There is value. We are also trying to amplify the positive side of this. There is not only the negative.
I think working in this environment might also bring a lot of satisfaction for the health worker. In fact, we see that when we meet with our staff who are in these locations, they are very dedicated, highly professional, and highly conscientious people, and they like their work. Some will go there for a while because.... The bad side of that—and we're trying to be very transparent with that—is that there is a lot of overtime. For people working in these communities, if there is someone who is sick at night and the nursing station is not open, they will go there and be on overtime. Sometimes there are really long shifts and it's really intense at times in the community. Some people are attracted to that. We are trying to profile this, as well.
Robin, I don't know if you want to add something about the onboarding or the training action we do to prepare nurses to go to work in the communities.
View Isabelle Morin Profile
Since we only have five minutes, my questions will be short.
Ms. Schroeder, I am very interested in the mental health of seniors. The numbers you gave us are very troubling. Many seniors tell me about the obstacles they are facing. You talked at length about shame, which we often hear about. It is not always easy for children to realize that their parents have mental health problems. They wonder how to meet with responders and how to help their parents.
Your approach is much more centred on cooperation. You mentioned a few practical examples. If you know of any model initiatives on awareness, prevention and reducing the stigma, could you tell us about them? What could we do? What are the model initiatives? What is the role of the Mental Health Commission of Canada in sharing these initiatives?
You also talked about housing, which I think is very important. I sometimes receive people at my office who tell me that they have trouble finding housing. This is a challenge first, because they are seniors and, second, because they have mental health problems. It is very difficult for them to find housing. Do you have solutions to suggest to us?
Bonnie Schroeder
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Bonnie Schroeder
2015-05-28 16:06
Merci. I'm going to respond in English.
You raised three points. You asked about family caregivers, collaborative initiatives, and housing. Let's start with caregivers.
We know that, in the recent Mental Health Commission data indicators report, it was reported that 16% of caregivers report distress caring for someone receiving publicly funded home care. We know that number jumps for people caring for someone with depression, end of life, dementia, and aggressive behaviours. It increases exponentially. I do think we need to talk about not only caring for a senior regarding mental health, but we need to also think about the mental health of family caregivers. I think it's very important, and I will get into more of that in the written brief.
That being said, we know there's the emotional toll. We also know working caregivers really are struggling to juggle both work and care, and we're pleased with the federal government, through the Employment and Social Development Canada, for bringing in the employers for caregivers plan and working with businesses to bring this to the forefront, recognizing cost to bottom line, recruitment, turnover, and the like. I think it is a very important population that we need to address.
You talked about collaborative initiatives we've developed. We have our guidelines around stigma, which I think is really key. We developed anti-stigma training for providers, including a video, with the support of the Mental Health Commission of Canada, and the video was recently released. I will highlight two initiatives in our network. The Canadian Mental Health Association in Ontario adapted and piloted and evaluated a community-based mental health promotion program called Living Life to the Full. It found significant clinical improvement in mood, well-being, and quality-of-life indicators for this program, and we think it shows some real promising practice to protect and promote the mental wellness of seniors.
The other one is the Fountain of Health program, in Nova Scotia, which looks at seniors' mental health promotion along five domains: mental health, physical activity, positive thinking, and I forget the other two, but it's a great community-based initiative. So those would be three.
With regard to housing, care in home is critical, I think, and sometimes seniors cannot live independently in their own home. Where do they need to go if they're living with both physical and mental health problems? Long-term care is, again, a struggle to get into, and the statistics that Dr. Cohen mentioned are key. We see a much higher acuity and complexity in long-term care. So what are other options? Assisted living, retirement homes, and home care are options to support seniors living independently in their own homes.
Robert Thibeau
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Robert Thibeau
2015-05-27 18:33
Good evening.
Once again, it's a great pleasure for me to appear in front of this committee to speak to you on behalf of the Aboriginal Veterans Autochtones and its partner organization the Congress of Aboriginal Peoples veterans, as well as the first nations veterans of Canada.
I've been asked by this committee to comment specifically on division 17 of part 3 of Bill C-59, which amends the Canadian Forces Members and Veterans Re-establishment and Compensation Act to:
(a) add a purpose statement to that Act; (b) improve the transition process of the Canadian Forces members and veterans to civilian life...; (c) establish the retirement income security benefit to provide eligible veterans and their survivors with a continued financial benefit after the age of 65 years; (d) establish the critical injury benefit to provide eligible Canadian Forces members and veterans with lump-sum compensation for severe, sudden and traumatic injuries or acute diseases that are service related, regardless of whether they result in a permanent disability; and (e) establish the family caregiver relief benefit to provide eligible veterans who require a high level on ongoing care from an informal caregiver with an annual grant to recognize that caregiver's support.
The Aboriginal Veterans Autochtones believes that this portion of Bill C-59 as it deals with veterans requires us to examine it more closely as to the substance of what will be contained in that bill and what that actually encompasses. We feel that there needs to be a substantive commitment and positive action to prove to veterans, the veterans community and their families that this government and this nation does care for those they have sent into harm's way.
I will now briefly acknowledge the details of division 17 of part 3 and offer our words on these.
Aboriginal Veterans Autochtones and its partners are in full agreement that this looks like a step in the right direction for the Government of Canada and Veterans Affairs Canada. Transitioning of Canadian Armed Forces members and veterans and the services that have been mentioned in broad terms must include a sound and effective communication plan. There cannot be any misunderstanding as to what services are available and the benefits prescribed through Veterans Affairs. Therefore, effective communication is the key.
An issue previously brought forward to this committee by the Aboriginal Veterans Autochtones was this very issue of effective communication to rural and remote communities of aboriginals, including first nations, Métis, and the Inuit. We must consider veterans living in remote areas and develop ways to remove barriers due to location and possibly a lack of technology and to improve outreach to those veterans.
The retirement income security benefit and its establishment cannot be commented on fully at this time as we require to see the content of the proposal. We can only hope that whatever will be proposed will be acceptable to meet the needs of those veterans and families requiring this assistance and that we will not struggle later on to obtain the services for veterans or survivors.
The establishment of the critical injury benefit is another positive step forward to respond to the needs of those who suffer severe and/or traumatic injuries related to their service. Again, we must ensure that the content of this will meet the needs of the affected veterans.
During a recent trip that I took with 28 veterans of the Italian campaign—heros of Canada—I heard horrific stories of battles fought, friends lost, and pain endured. I was humbled to be included with these individuals. The stories I heard were stories that had never been talked about. They were stories of tragic events, happy occasions, and remembrance of good old friends. It certainly gave me a better understanding and an appreciation of the need to ensure that veterans are properly looked after due to their personal contributions, their personal sacrifices, and their abilities to move forward.
I was informed by some of these outstanding veterans of suicides of friends, of alcohol abuse, and of family problems suffered by returning veterans.
I also heard of how some were able to tackle the demons and to become successful in whatever they decided to do. There are two comments that stand out in my mind that were shared by these veterans with me.
The first one is that we had a number of aboriginals who were in our units. They were all good soldiers and we lost more than a few of them. It is too bad they were not looked after when they returned home.
Two, if it was not for the Afghanistan veterans, we veterans would not have gotten the benefits that were denied to us long ago. We can certainly see the similarities between what earlier veterans had gone through in the past and what our current veterans are going through today. Today's veterans have also suffered deeply, both physically and mentally, from recent conflicts.
Today's veterans are forced to rely on the dedicated and steadfast efforts of caregivers who in some cases are spouses, who gave up careers, took a reduction in income, and faced financial hardships, and which for some, led to a strain on relationships and a breakdown in relationships. These caregivers ensure the best of care is given. They are the ones who assist the injured while leading to the ultimate survival of the heros. No one could ever take for granted these what I term front-line defenders of our injured.
Compensation to caregivers who sacrifice everything in order to provide much in the therapeutic recovery of our veterans should not be undermined, and they must be recognized for their selfless contributions. If there is a need to continue support beyond age 65, then this should never be questioned, as we are talking about individuals who have given a great deal of themselves for the freedoms enjoyed by other Canadians.
We must also remember that as a country, Canada has sent these soldiers, sailors, air men and women to places of turmoil, conflict, and outright horror. That being the case, we should never accept the shirking of the responsibility we have for looking after injured Canadian Forces members and veterans.
In closing, I echo the comments made by both the Veterans Ombudsman and the Royal Canadian Legion. The new Veterans Charter and the enhanced Veterans Charter are considered living documents. This means that as a living document it requires review and adjustment in order for it to meet the needs of its recipients. As I have stated before, the new Veterans Charter was introduced in the House and all parties accepted it, as did the Canadian Armed Forces and a vast majority of the veterans groups. The new Veterans Charter has a number of issues and problems, but it is the job of our politicians to look to and listen to organizations that are providing good advice and offering solutions to the problems associated with veterans.
ADA stands behind the Royal Canadian Legion and the ombudsman for their tireless efforts to move forward on behalf of all veterans. ADA has always taken the stance that we will support only those organizations or groups that are for positive movement forward on veterans issues.
A final thought from one of my partner organizations is that veterans should probably be the labour force at Veterans Affairs Canada and also appointees to the Veterans Review and Appeal Board.
On behalf of myself, my partner organizations, and all Canadian veterans, I offer sincere thanks for allowing me to attend this committee.
Joseph Burke
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Joseph Burke
2015-05-27 18:46
We approve of the wording amendments for the earnings loss benefit in clause 208, and the addition (c). We also applaud the extension of the earnings loss benefit past the age of 65.
Our previous concern was that the earnings loss benefit be set at 100% of previous military net income. It is retained in the act at 75%, which represents a loss of 25% of income for the veteran. It is our opinion that this retention of 75% of previous military net income does not meet the test of fairness. We have concerns that the spousal benefit, with the retention of the 75% of previous military net income, will also not meet the test of fairness for survivors.
We applaud the powers given to the minister to waive application if it is deemed that a disability exists in proposed section 40.5.
I will turn now to critical injury benefit, disability award, a death benefit clothing allowance, and a detention benefit.
Regarding critical injury benefit, in proposed subsection 44.1(1), our interpretation of “or developed an acute disease” means physiological diseases. We request that the committee support an amendment to the proposed subsection to change the wording to read “or developed a physiological disease or psychological disorder”, thus using proper medical terminology.
We applaud the family caregiver relief provision in proposed subsection 65.1(1). However, we are appalled that there were no provisions in the bill for a caregivers monthly benefit. In our previous submission to this committee, we suggested a monthly benefit of a minimum of $1,600 net income after taxes, and CPP deduction compensation for all their caregiving activities in the daily care for their disabled veteran.
We are further extremely disappointed that there is no provision for a child support benefit. In our previous submission to the committee, we suggested a child support benefit based on the Ontario courts schedule as an example of the support needed per child.
View Sylvain Chicoine Profile
Thank you, Mr. Chair.
I'd also like to thank the witnesses for joining us this evening and answering our questions.
Ms. Migneault, we understand that you are a bit disappointed with the amount of the caregiver relief benefit. A question came to mind. Would you have preferred to have the benefit included in the veterans independence program, which you do not qualify for either? It's meant for activities such as housekeeping and yard maintenance, in order to give caregivers a break.
If the benefit had been included in the veterans independence program, would it have been helpful to you, given that you also have fairly young children at home?
Jenifer Migneault
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Jenifer Migneault
2015-05-27 19:02
The measure would have actually enabled me to keep working longer. One of the problems I encountered was case managers telling me that I was there to do the work and take over. That's the argument they would use to deny my husband services.
That said, another problem is the form that the benefit has been given. Something I would like everyone to understand is that, in the context of my relationship and family reality, my fatigue needs to be taken into account. I can't be separated from my position as a member of a couple. There are no if's, and's or but's about it; I am well when my husband is well.
Jenifer Migneault
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Jenifer Migneault
2015-05-27 19:05
Initiatives already exist, such as Wounded Warriors Canada and Can Praxis. It's necessary to address—
caregiver fatigue as a couple, as a family, and with also an input of education—just tools that I will bring back home to make a difference. Don't forget that PTSD is a process; we cannot solve this overnight.
Jenifer Migneault
View Jenifer Migneault Profile
Jenifer Migneault
2015-05-27 19:08
It would be as needed.
I know I look devastated. Honestly I am, but I was much worse five, six, seven years ago. It's a process. So if I needed it, honestly, for two weeks a year until I didn't need it as much, why not?
You must provide us with the help that we need when we need it, not when the system decides that this is the number of sessions we can have, for instance, with a psychologist.
Debbie Lowther
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Debbie Lowther
2015-05-26 18:53
Well, thank you, first of all, for asking VETS Canada to attend this evening and asking me to speak on behalf of the organization.
VETS Canada is an organization whose mission is to assist homeless, at-risk, and in-crisis veterans of the military and the RCMP. My husband, who is a veteran, and I founded the organization in 2010 after he stumbled across a veteran whom he had served with who was homeless in Halifax.
During the past five years we've had the privilege of helping over 500 veterans across the country. We've expanded from Halifax right to the west coast. In June of last year we were awarded a contract with Veterans Affairs as service providers in the field of outreach to homeless, at-risk, and in-crisis veterans. In the past five years, as I said, we've had the opportunity and the privilege to assist over 500 veterans.
One thing we've noticed is that every veteran's story is different. Every veteran's set of circumstances is different. There's no cookie-cutter solution to helping any one of them. One common denominator we see in our work is that the men and women we've assisted have not made a successful transition from their life of service to their civilian life.
A great deal of effort and rigorous training goes into preparing the men and women to serve their country, and we feel it would be wonderful if they were given the same amount of training and preparedness on the other end, when their career is coming to an end, particularly for those who are being medically released, as it is unexpected.
The reason we're here today is to discuss division 17 of Bill C-59. It's the opinion of VETS Canada that the retirement income security benefit, the critical injury benefit, and the caregiver's benefit are all positive first steps. We do support that they be passed; however, we have some concerns about whether or not they will be the end of the road. It's our hope and our wish that they remain just that, first steps. There is a lot of improvement there.
We feel that the retirement income security benefit could be higher than the 70%. We would like to see the critical injury benefit be more inclusive of those men and women who suffer with OSIs, as these injuries, generally, do not immediately present themselves.
Something that would be nice to see included in the caregiver's benefit would be training for caregivers—and I'll take off my VETS Canada hat and put on my caregiver hat for a moment. My husband had PTSD, and when I was his caregiver—and I still at times am his caregiver—I didn't know if I was doing the right thing. Caregivers need training. They could be doing more harm than good, so it would be nice to see training for caregivers included in that caregivers benefit. Along with the amount of the benefit itself, it would be nice to see it revert to something a little closer to the attendance allowance.
In summary, as I said, VETS Canada does support the passage of Bill C-59, but it is our hope that it remains just first steps and that there's room for improvement. We like to say: Is it better than what was on the table yesterday? Yes. Is there room for improvement? Yes.
Thank you.
Perry Gray
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Perry Gray
2015-05-26 19:51
Thank you, Mr. Chair and committee members.
Like many public announcements, these new programs seem to offer more financial support for the veterans community. Closer examination of each one can raise a host of potential problems.
The one question that this committee can ask VAC about any new financial policy is, how generous will VAC be? VAC has a reputation for being as stingy as Ebenezer Scrooge or Scrooge McDuck. As of 2014, only 227 clients had received 100% of the new Veterans Charter lump sum, out of 46,760 recipients. The CIB lump sum of $70,000 will be offered on a limited basis and, like the NVC lump sum, is based on a percentage calculated by assessing the severity of disabilities. Initial estimates suggest that hundreds rather than thousands will receive CIB.
The FCRB is expected to provide relief to approximately 350 spouses or caregivers by 2020. Why is this estimated number of caregivers so small? I would think that many primary caregivers would like to take a break, considering the fact that many of them did not expect to have to work for 24 hours a day, seven days a week, because of veterans' disabilities. In fact, the FCRB could reduce the number of divorces caused by caregiver burnout.
The RISB may benefit about 261 clients over the first five years of the program. In my opinion, the RISB also has a poorly justified limit. In addition, it will be 70% of pre-65 income. There are two concerns that I shall highlight. Why is there any decrease in a veteran's financial support because of a change in age? Is it assumed that veterans need less support after the age of 65? Based on the studies of VAC's own Gerontological Advisory Council, veterans are able to enjoy long life but only if they have good support.
In 2006, Greg Thompson, the incumbent minister, provided information on the veterans independence program for this very committee. He stated that 86,000 war service veterans did not receive VIP. He did not offer an explanation about why they did not receive support and added that providing them with VIP might never happen. He did acknowledge that that home care is better than institutional care, and the council also acknowledged that veterans were likely to live longer if they remained in their own homes.
VAC is also aware that most of the health care given to Canadians occurs when we are babies and then in the last months of our lives. This suggests to me that, rather than less money, veterans will need more money to maintain an independent lifestyle, which will likely include support during activities that elderly and disabled people find difficult or impossible.
It should also be noted that the age of 65 will stop being a benchmark by 2023 for old age security. Will VAC also raise the age of eligibility for the RISB? I think that using age as a factor contradicts the spirit of Canadian human rights. Pension Act benefits are awarded in recognition of the sacrifices made by veterans, as are other benefits provided by VAC. Decreasing these based on age is discrimination. Nobody improves with age, unlike wine.
In summary, these three programs are expected to benefit a very small number of the estimated 205,000 clients and their families. The RISB may also result in financial hardships at a time in life when clients may need to pay for more support. Why is VAC developing programs if only a few will benefit?
Thus, VAC seems to be advertising a lot but delivering only a little.
Thank you.
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