SVET Committee Meeting

37th PARLIAMENT, 2nd SESSION

Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

EVIDENCE

CONTENTS

Wednesday, March 19, 2003

¹

1535

The Chair (Mr. Bob Wood (Nipissing, Lib.))

Prof. Evelyn Shapiro (Senior Scholar, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba)

¹

1540

¹

1545

The Chair

Mr. Roy Bailey (Souris—Moose Mountain, Canadian Alliance)

Prof. Evelyn Shapiro

¹

1550

Mr. Roy Bailey

Mr. John Williams

Mr. Louis Plamondon (Bas-Richelieu—Nicolet—Bécancour, BQ)

¹

1555

Prof. Evelyn Shapiro

Mr. Louis Plamondon

Prof. Evelyn Shapiro

Mr. Louis Plamondon

Prof. Evelyn Shapiro

º

1600

Mr. Louis Plamondon

The Chair

Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.)

Prof. Evelyn Shapiro

Mrs. Rose-Marie Ur

Prof. Evelyn Shapiro

Mrs. Rose-Marie Ur

Prof. Evelyn Shapiro

Mrs. Rose-Marie Ur

Prof. Evelyn Shapiro

Mrs. Rose-Marie Ur

Prof. Evelyn Shapiro

º

1605

Mrs. Rose-Marie Ur

The Chair

Mrs. Elsie Wayne (Saint John, PC)

Mr. Louis Plamondon

Mrs. Elsie Wayne

Prof. Evelyn Shapiro

Mrs. Elsie Wayne

º

1610

Prof. Evelyn Shapiro

º

1615

The Chair

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

Mrs. Elsie Wayne

Prof. Evelyn Shapiro

Mrs. Elsie Wayne

The Chair

Mr. Roy Bailey

º

1620

Prof. Evelyn Shapiro

Mr. Roy Bailey

Prof. Evelyn Shapiro

Mr. Roy Bailey

Prof. Evelyn Shapiro

Mr. Roy Bailey

Prof. Evelyn Shapiro

Mr. Roy Bailey

The Chair

Mr. Ivan Grose (Oshawa, Lib.)

Prof. Evelyn Shapiro

º

1625

The Chair

Mr. Ivan Grose

Prof. Evelyn Shapiro

Mr. Ivan Grose

Prof. Evelyn Shapiro

The Chair

Mrs. Elsie Wayne

Prof. Evelyn Shapiro

Mrs. Elsie Wayne

Prof. Evelyn Shapiro

Mrs. Elsie Wayne

The Chair

º

1630

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

º

1635

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

º

1640

The Chair

Prof. Evelyn Shapiro

The Chair

Mr. Ivan Grose

Prof. Evelyn Shapiro

Mr. Ivan Grose

Prof. Evelyn Shapiro

º

1645

Mr. Ivan Grose

Prof. Evelyn Shapiro

The Chair

Mr. Roy Bailey

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

º

1650

The Chair

Prof. Evelyn Shapiro

The Chair

Prof. Evelyn Shapiro

The Chair

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CANADA

Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

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NUMBER 004

l

2nd SESSION

l

37th PARLIAMENT

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EVIDENCE

Wednesday, March 19, 2003

[Recorded by Electronic Apparatus]

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[English]

    The Chair (Mr. Bob Wood (Nipissing, Lib.)): Order.

    We'd like to welcome a few people today. First of all, the students of the Forum for Young Canadians are in town this week. We invite you to our committee today as we study the effects of aging on the veterans.

    I also want to introduce our guest, Professor Evelyn Shapiro. Professor Shapiro is an internationally recognized scholar of public health policy, and she is also a member of the Gerontological Advisory Council.

    The council was established back in 1997. It's composed of about fourteen members, including academics and representatives of veterans groups who are leading authorities in the fields of aging, seniors, and also veterans issues. What they do is advise the Department of Veterans Affairs on policies, programs, services, and trends that have an impact on Canada's veterans.

    Professor Shapiro, it's a pleasure to welcome you here this afternoon. We know you made the trip in from Winnipeg today, and we know you have to be out of here by 5 o'clock because you have to catch a plane. If you have some introductory remarks, the floor is yours.

    Prof. Evelyn Shapiro (Senior Scholar, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba): I'll keep it very short, because from speaking to Diane Deschamps and exchanging correspondence, I had the feeling there were questions and so on that you wanted to discuss. I think I'd like to leave as much time as possible for those.

    I thought I would review for you the things that I think are very special DVA programs for seniors. In particular, I want to dwell for a few minutes on the VIP program, because I think it's really a very special program. It's special in several ways, and it relates to what you're doing. You may not see the relationship immediately because you've been looking at long-term care primarily in the facility area, but it's really important to understand, because that program is really related to helping people stay home.

    The first thing is that it was a very interesting time when it started. It has been a very special program for veterans, because nobody else had that program at the same time. It not only provided care at home, it effectively was what in the modern lingo is called a self-managed program, in the sense that individuals were assessed for what they needed, and they really got the funds to do it. They really were masters of whom they hired and what they did. It now has an official name in Canada, and a number of provinces have that kind of program. However, it was actually DVA that was a pioneer in this area and in experimenting with letting people decide where they're going to get the service and how they're going to use it.

    Also, it was interesting at the time when it came in, because at that time, the provinces, one after another, were beginning to develop home care programs. Consequently, VIP in some provinces was the only thing, and in some provinces it allowed veterans to have additional kinds of services not available in provincial programs, like aging in a place where you get yardwork done and so on, which is still not available anywhere. So I think it has been not only a pioneer program, it has really supplemented in some provinces. And in some provinces where there wasn't anything, it was the only thing around.

    What impressed me most with the staff especially was how willing they were. The Gerontological Advisory Committee hasn't been around very long, but what has been really quite extraordinary is how excited they've been to look at some of the advice they're being offered to see how they can fit it in, in terms of their own programs.

    So those are the three things I thought I'd point out, because there has been an openness and a real desire to do better. However, I do have some concerns, and I think some of them are directly related to DVA per se, and not necessarily the long-term care programs, although they do have a big effect.

    One is the fact that there are a lot of categories and they sometimes play against each other. For example, you have a category of veterans who are entitled to certain services because of their financial needs. This is really something important to remember as we begin to talk about some questions. It's important to remember that some veterans are not eligible for VIP. They're not eligible for such programs, yet such programs are the one thing that keeps them out of nursing homes. Since they're eligible for nursing homes when they absolutely need help, there's a pressure to move into a nursing home, which they may or may not need. They could manage at home, but they have to go into a nursing home. They have no other choice. So one of the things you need to think about is whether or not the categories act as a disincentive to using the cheapest service rather than the most expensive service.

    The other thing I've been very concerned about is particularly the elderly caregivers of veterans, maybe because I'm a woman and maybe because I took care of a husband for many years until he died. I think you leave caregivers in the dark. Not only do you not pay very much attention to them, you also don't...here they have been providing for anywhere from ten to fifteen years, and now it's going to be twenty years for some veterans who are still alive. There has been a caregiver at home, and that's really what has allowed them to stay home. It wasn't only the services that they could purchase. They really could be home because there was somebody there. Their wives were usually a little younger, so they were better physically.

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    I think you now have a new rule, but it was even hard to get to there, whereas now at least the caregiver continues getting service for a year after their husband dies. For all the years they put in, I just don't think that's fair. Besides that, as their health is beginning to fail, it sometimes doesn't allow them to have services they may need.

    Also, there has been no recognition not only in terms of what subsequently happens to them, but also during the time they're caregivers. The program is geared to veterans. Caregivers don't necessarily have and haven't had access to the kinds of things caregivers sometimes have in other programs, such as help with understanding what to give and how to do the caregiving, all kinds of helpful literature, or whatever it is. In a sense, it's as if there is one person that you're looking after. You're doing very well in that regard, but I think there has to be a way in which caregivers have an opportunity to also do as well as they can. I think they could be doing better than they're doing if they were given that kind of help, and sometimes even relief in terms of being able to just take a rest. I think that's a second concern.

    And I think you're going to be surprised to hear the third concern, because I'm a great fan of the Romanow report. It's what is going to be happening now in home care. The latest announcement from the meeting between the federal and provincial governments was that they decided they're going to provide additional funds—because that's what the federal government will provide, and I'm assuming the provinces will continue to provide what they're giving, although I don't know that for sure—but it's all going to be in short-term care. Aside from mental health, it's going to be for post-hospital acute care and it's going to be for palliative care for people who need it for under sixty days. Neither of those are going to be helpful to the veterans who need long-term care.

    On top of that, there's a problem already in all the provincial home care programs. Because of the reduction in hospital use and the faster discharges, the acute care is using up a lot of the money initially also used by people who need long-term care. It used to be one pot, and it was used by both services. Now more money is going to go into the acute care and nothing else is going to be going into long-term care. Less is going to be available in the provinces for the kind of care provided to veterans on a provincial basis. In some provinces, you're basically really only topping up.

    You may now have to really begin to think about what that's going to cost you, because a lot of provinces have been cutting out services to those people who don't need medical services or need help on only one morning of the week or whatever. They're just cutting them out altogether because they don't have the money. Or they're not given the money. Let's put it that way. They don't have it because they're not given it.

    In a sense, we're getting more and more concentrated into replacing hospital beds, but that's not what the veterans of that age need. When you're talking about aging veterans, they may go into hospital in need of a couple of weeks of care, but that's not what's going to do it for them. Your costs have been kept down primarily because the provinces have been doing the major bulk of the home care delivery. Maybe not in the Maritimes to the same extent, but certainly in all the other provinces, they've been full-fledged programs that have been on for years. They've been really propping up the veterans, along with everybody else.

    So I just thought I'd mention these things.

    In talking to Diane, I unfortunately missed getting...it wasn't that she didn't send it, I think I just didn't really realize your study now was really concerned with long-term care. I was asking whether you're concerned with quality or whether you're concerned with the availability or the accessibility of long-term beds for veterans. I did want to mention that you really have to be very sensitive to the fact that beds are just beds. There's a whole territory of long-term care in which everything is interconnected. If you do something in one area, it affects another area, so you have to be very careful with what you do with that.

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    In my province, which is Manitoba, I started our province-wide home care program. I can tell you that 1,450 people were waiting for long-term care beds in Manitoba. Within three months, we sent all the workers out and said that if the people who were waiting wanted home care, they could be on home care. In no time at all, the number was down to 500. We no longer had 1,450 people waiting for beds.

    So if you have categories in which you only allow.... You had a pilot program, and it turned out to be exactly the same. In the pilot program, they told veterans to never mind the category for the moment, and asked them if they would rather be at home instead of going into a nursing home, because they had the veterans' names down for a nursing home. About half the list disappeared.

    So you have to think of the two pieces as being interconnected. They're not separate, except if you separate them by category, by who is eligible for what.

    That's all I thought I'd leave you with.

    The Chair: Your comments are interesting, and we certainly appreciate them. I know a lot of people agree with your facts, and it will be interesting to see how the questioning goes. I know my colleagues have a lot of interesting questions for you.

    We'll start off with Mr. Bailey, from the Canadian Alliance, for seven minutes.

    Mr. Roy Bailey (Souris—Moose Mountain, Canadian Alliance): Professor Shapiro, you come to us with a great deal of spirit, because you actually performed the duties in home care yourself. As my wife would say, trying to look after a man is in itself a meritorious achievement, for this there should be Victoria Crosses, and so on. From even the few times I have been sick, I understand I'm not a very good patient.

    I come from Saskatchewan, and I know of what you speak. I have been part and parcel of watching the home caregivers and how that field has expanded. You are very correct in saying that a veteran, or even an elderly person who is not a veteran, prefers to stay at home if they have the choice. The only one catch is that sometimes they prefer to stay at home too long—but not too many do.

    I think I mentioned this to my colleagues before, but if you couple together the VIP program with provincial home care in the DVA program, it means the stay at their own residence can be even longer, because the VIP program can include the yardwork, the snow shovelling, etc. So I'm looking forward to having this committee complete their trip, and we'll have a chance to talk about combining these two programs. Furthermore, it's a lot cheaper for the provinces. If they have to take over, they don't all have the medical facilities to provide care, and so on.

    The one point I want to pick up on, though, is that of a home caregiver who is the wife or a daughter of a vet. It seems to me that what they need—and you alluded to it—is some extra training, and I agree to that. But they also need some respite care, just a day off. In my communities, I have seen this and I have talked to them about it, mainly with the help. For the health of the caregivers, would you not agree to give to that one particular person a two-day break if lots of beds are available? Let's give that woman a weekend break. That's a very key point, because if the caregiver goes down, it's all over.

    Prof. Evelyn Shapiro: It's very interesting, because when you talk about respite, I had mentioned it incidentally, but there is a problem. In Manitoba, we do have respite beds in facilities, by the way. Some people do use them. Sometimes they have to go out of town for a wedding, but they can't go. When a daughter is getting married somewhere and so on, you can do that if you make arrangements. But respite is also provided in the home, and there are also day care programs that provide respite. There's a whole repertoire of things.

    What's interesting to me is that some provinces are very much ahead in this respect, and they make the assumption that it's available in other provinces when it's not. So in a sense, you have to really have a good look at the inventory within a province in terms of the availability, at how the program has evolved, and even at how old it is, because it takes a while for a program to mature and evolve.

    The provincial home care programs did something that veterans now need to think about. If they're prepared to loosen up the interplay, the issue isn't only caregivers. As you would know in Saskatchewan—and Manitoba was the first to have these, I hasten to say—the provinces all now have a single-entry program. You don't go just into home care, you go into a continuing care program or whatever it's called. The decision is made either at the beginning or somewhere along the way that the situation no longer is tenable at home, and then the person needs a nursing home. When you put people in a category that doesn't really allow that, that's where the problem is.

    I really wanted to make you very much aware of that, because it's much easier if you say where a person's stream is. No veteran should have to go into a nursing home if the local home care program, never mind DVA, thinks they can be managed at home if they have the help through DVA or wherever the resources are.

    In a way, it's true that you can go out and ask people if they would rather stay home or not if you give them home care. That's okay, because it's a good experiment to start with. But at some point, practically in every province now—certainly in nine out of the ten provinces—there is a procedure that does that or can do it for you. You don't even have to do it yourself. It's a question of wanting to cover the bases after it's already been done.

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    Mr. Roy Bailey: Just as another comment that is more of a cross-Canada comment, you're quite right that as the cost of delivering health services went up, the age of Canadians went up. With those two in combination, we had tremendous pressure for immediate acute care. Provinces took it on the nose politically for having the long line-ups and so on. Many of the provinces came in with home care, but they left out something in between, and that was the long-term care. I think we're addressing that now, Mr. Chairman, and I thank our guest for alluding to that, because it was a fact of life across Canada.

[Translation]

    Mr. John Williams: Mr. Plamondon, you have the floor for seven minutes.

    Mr. Louis Plamondon (Bas-Richelieu—Nicolet—Bécancour, BQ): Excuse me for being late, Madam. I was told that we would be sitting in room 362 of the East Block and I went there and realized that the committee had moved. This is why I am late.

    I did not have the pleasure of hearing all of your presentations, but I would like to hear your opinion about a program we have in Quebec and which could perhaps be applied to war veterans. This is a program for natural caregivers and beginning with this year's budget, it will be partly funded by the Quebec government. Natural caregivers are relatives of the person; they may be sons, daughters, women or men who consent to work only part-time so as to remain with an aging or sick family member to deliver the needed care rather than to place him in a home or a public institution.

    There are currently groups of such people in every part of Quebec, and these groups have formed a federation which obtained $60 million, I believe, from the Quebec government. I am not sure of the figure. Thus, these caregivers will be assisted to the tune of somewhere between 600 and $1,000 a year. Of course this is not a large amount, but it is a beginning and it will increase with time. Bit by bit, we are carrying on this experience which not only eases the burden on the public system, but also ensures more human service to patients, helps to keep them in their home environment, etc.

    There is often an attempt to put war veterans away somewhere. In fact, what they need is help at home, and this is what they are requesting. In some specific situations, they may need help from their own family which, in turn, needs help from the government. What is your opinion about this?

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[English]

    Prof. Evelyn Shapiro: It's very interesting, because Roy Romanow also made a suggestion that is slightly different. I don't know if you read the Romanow report vis-à-vis home care and caregivers. He took a wholly different tack. I don't know if it's being discussed between the provinces, but it doesn't have to be. It has to do with employment insurance, actually. It involves using employment insurance for payment of caregivers. That is, giving them some access like you would have with employment insurance. You'd have to read the section of the report.

    You're talking about a very elderly population now in terms of the veterans. We're talking now about it being very heavily centred around those 75 and over. If my memory is correct, the statistics on veterans are very interesting because a lot of them are married, more so than the general population of old men. They tend to be well because, aside from the fact that women in general are younger, more of them are married than men in the general population. So for many of them, there is someone at home with whom they're very much bound in.

    The issue for the wife, the spouse, primarily is not really the payment aspect of it, it really is more the relief aspect and the help aspect. So if you're asking if the spouse should be paid, that's one thing. For most of those women, though, I don't think the issue is money, the issue is really that they're wearing out. They're just wearing down. You're now talking about what we call, in English, informal caregivers. That is, family members, nieces, nephews, and wives. That's what you're talking about, right?

[Translation]

    Mr. Louis Plamondon: Yes, that is what I meant.

[English]

    Prof. Evelyn Shapiro: Yes, and I don't have any problem with the Quebec solution. I think it's terrific. But I'm not sure it fits the...we're talking about elderly spouses caring for elderly spouses. This is not a population that would otherwise be at work, do you know what I'm saying? These are people who give up jobs, give up promotions, and give up free time. The spouses give up free time but they're not giving up jobs, because they're not of that age.

[Translation]

    Mr. Louis Plamondon: I understand your point of view very well. Supposing that there is an elderly couple but there are also children, or perhaps a niece or someone else in the family who could come to help them two or three times a week. Now, those people cannot be paid because they have no official diploma, because they are not officially designated by the state, and because they do not belong to a system. This is what I mean by a natural caregiver. The care they provide is often much more appropriate, because of the family ties and the human relations. I do not know if this kind of help has been evaluated and how we could remunerate these persons. Could it be done simply through a tax credit or something of that nature?

[English]

    Prof. Evelyn Shapiro: You could do it more easily in the Department of Veterans Affairs than you could anywhere else, because you're already giving the veterans the money to purchase the service. If you were to say your wife wants to do the yardwork and that you would pay her instead of paying somebody by hire, that probably would solve the whole problem. I'm just not sure she's going to be able to go out and mow the lawn.

    What I'm really trying to say is that you already have a self-managed program. Don't forget that aside from what they get from the provincial home care program, the veterans get the dollars to buy the service. That's what we call a self-managed program. In effect, if you said to them that they could hire their wife, they could hire their niece, they could hire their nephew, or whomever, there wouldn't be a problem. I don't know if that's what you want to do, but it's certainly an option. You could say they can hire anybody in the family.

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[Translation]

    Mr. Louis Plamondon: Thank you very much.

[English]

    The Chair: Thank you very much, Monsieur Plamondon.

    We go to the government side, for seven minutes with Mrs. Ur.

    Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.): Thank you for your presentation. Your presentation rings true to what's happening in my life, because I am a caregiver as well as a politician. My husband had a massive stroke two years ago, and he is with a caregiver when I'm here. So I'm well aware of the relief aspect to some degree.

    You said that is probably one of the strongest points for the spouse of a caregiver. I think of the relief aspect, but also of the costing as well. As much as we would like to think family is all around you, families are spread out, families are busy. And it's long-term, it's not an acute situation, so no matter how dear you are to the person who needs the help, it's almost a little bit much to expect that kind of continuous help, so it's really important that we have the respite care too, perhaps. Those areas are available in Ontario in nursing homes, and for a nominal fee of about $35 a day or whatever.

    What I see sometimes with caregivers and whatnot is that, whether you go through Para-Med or an institution or something like that, the cost is too expensive for the average person—and I don't know if there would be sufficient funds under the VIP program to cover those kinds of expenses. So my one question to you is whether or not you find a difference of support, rural versus urban, with our veterans? Is there a longer waiting list in one part of the country versus the other? Have you found that out?

    Prof. Evelyn Shapiro: Are you talking about for a bed, for help at home, or both?

    Mrs. Rose-Marie Ur: For both.

    Prof. Evelyn Shapiro: If you're talking about things external to DVA, I don't think there is a problem in long-term care now. I know people are on a waiting list in Ontario, though, because they're effectively using up the acute care part and they're not getting any more money. In effect, there is a problem there.

    So in some provinces they're a problem, but in other provinces it depends on where you live. That doesn't necessarily mean rural versus urban, though. For example, in B.C., a study was done about a year ago. Most of the province has gone regional, and the regions decide how they're going to apportion the money. What has happened in a province like B.C., according to this recent study, is that some areas have started saying that if you only need a little help, they can't provide it because this is all long-term care. If you need a lot and that will keep you at home, that's fine. But if you need somebody to come in twice a week for three hours to help you manage, you can't get that. Other regions have decided not to do it that way.

    It's interesting, because in the two regions that decided to cut services, it actually ended up costing them more because people were hospitalized over and over again. In the two regions that decided not to do that, there was really a much lower cost within a three-year period than there was in the regions that cut services. So you can see from the regional programs that it's sometimes a bad efficiency and that you don't save any money by doing that.

    I think we have to be very careful. We're talking now about a program that is cumulative because it's long and it's over time. That means that, in a sense, you're doing it over many years. Very often, respite obviously becomes a very critical issue. I'm also concerned, as I said, with whether or not we owe these people after ten years or so. We owe them something for themselves afterwards. I always felt really badly about that. I have just really felt badly about the cutoff. That's just my personal feeling about it.

    Mrs. Rose-Marie Ur: Regarding the VIP service, presently when veterans receive that program, can it just be someone outside the family who is hired to do the windows or rake the lawn or whatever?

    Prof. Evelyn Shapiro: I think so, but I'm not sure about that. I think it's something you need to look into. I know most of the provinces have that kind of rule. If you're in self-managed care, you can't pay if it's a family member.

    Mrs. Rose-Marie Ur: That would be something interesting for the committee to look at, because surely there could be a—

    Prof. Evelyn Shapiro: I think it's really important to have a standard set.

    Mrs. Rose-Marie Ur: Exactly. A family member could perhaps have a set fee for whatever.

    Prof. Evelyn Shapiro: You'd have to work that out very carefully, because I know the big issue that occurred when we first started the program particularly in very small communities, was that almost everybody was related to everybody.

    The problem is how to differentiate between long-term care and short-term care, because families really don't have the cumulative experience. If somebody has some particular thing and then comes home and recovers in four weeks and the family helps out, it's a different kind of thing from them going on year after year.

    The second thing is that there is always the feeling that the family has a responsibility. Your family is your family, after all. There's love involved, there's closeness involved, and there is something that you owe each other. But there has always been this separation between what family members owe each other by virtue of being family, and what families need in the way of help aside from that. It has been an issue that I don't think has ever been fully resolved.

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    Mrs. Rose-Marie Ur: What you say is absolutely true, but in this day and age.... I think that was something we had many years ago. That's not to say our young people, our children, aren't that way, but society has changed in that respect. Children move away and tend not to be close to their mom and dad or to their grandparents or to be that accessible.

    On another point, you were saying there seems to be a lack of opportunity for caregivers to have the necessary information or to be shown how to administer proper procedures. I'm very fortunate to live near London, Ontario, where they have Parkwood Hospital. They have zillions of programs. They could keep you going day and night attending programs to help people administer caregiver processes. I think that's really important, and perhaps it's something we could look at throughout the country as well.

    I thank you for your presentation.

    Mr. Wood, I'm finished.

    The Chair: Mrs. Wayne, you have the floor for seven minutes.

    Mrs. Elsie Wayne (Saint John, PC): I want to welcome you here today, Professor Shapiro. I've been very much involved with the veterans for quite a few of the last ten years while I've been up on the Hill.

    Back in Saint John, New Brunswick, we had the Department of Veterans Affairs hospital, the DVA. You're probably aware they tore it down and built a very small one. That was very unfortunate, because as you know, all of our veterans are getting older, not younger, and we need more beds, not less beds. So it really broke my heart when that happened.

    My father-in-law is 95 years old, and he is in the veterans hospital in Saint John, New Brunswick. He never complains about anything. He couldn't stay at home. He owned his own home, but my mother-in-law passed away when she was only 75 years old, so he was by himself until his health deteriorated.

    I'm quite concerned about something. We were in Montreal and we were in Quebec to look at the hospitals there. We were in Toronto to look at the veterans hospital there, although they don't call it the veterans hospital anymore, which bothers me. Out west as well, as you know, they've found problems. I have to say I honestly believe in my heart and soul that the only hospital that still remains under the jurisdiction of the federal government is the one in Quebec.

    Mr. Louis Plamondon: Ste. Anne's.

    Mrs. Elsie Wayne: Yes, and it's a beautiful hospital. Their programs are wonderful. But all of our DVA hospitals should fall under the jurisdiction of the federal government. They should have remained there, because they were all veterans from coast to coast, Professor Shapiro. They were, and they are.

    Prof. Evelyn Shapiro: It's very... I don't want to interrupt you. I'm sorry.

    Mrs. Elsie Wayne: No, that's fine. But it really tugs at my heart. They have a difficult time trying to get the funding they require.

    At the one back home, they have added another section in the past two years, and it's for all those with Alzheimer's. But now we have a long list of veterans who need to be in the hospital, and there are not enough beds. We're going there, but when it comes to the programs that they have for them.... We used to have people who would come in and do programming for them. Well, because of the cutbacks, they had to take those programs out, so now we have a lot of volunteers coming in.

    I have to tell you that if you had been there on Monday and on the weekend, you'd have thought everybody who was in the hospital was Irish for St. Paddy's Day. The people who are there and who work there do a fabulous job.

    One lady gave me a letter, and she has been a part-time nurse for ten years. She would like to become a full-time nurse to get the benefits, the same as everyone else, but she hasn't been able to do that because of the lack of funding.

    I think our veterans should be a number one priority when it comes to funding, or we wouldn't even be sitting in this room today. We wouldn't be up here on the Hill if it wasn't for them, Professor. We have to remember that.

º  (1610)  

    Prof. Evelyn Shapiro: That's certainly true. I won't argue with that.

    Let me mention a couple of things, because some myths are floating around in this room that really are myths, they're really not reality. First, if you look across the provinces—and we've been doing two different studies looking first at a 13-year period, and then at the last 10 years—the trend for old people using nursing homes is way down. In the last 10 years, the numbers have gone down by 15% in Manitoba.

    In other words, given the choice, some people will still go in for a whole variety of reasons, but mainly because they don't have social supports and the care has gotten to be too heavy in the sense that they need 24-hour supervision.

    But the point is that the trend is a downward one, and most of the reason for the trend is that people who are the “younger older”.... The elderly are now divided into three ages. They call them the “young elderly”, the “middle-aged elderly”, and the “old elderly”, because you now have people living well into their 90s and 100s. The survival rate has just absolutely been extraordinary.

    I'm saying we don't even talk about the 65-year- to 74-year-olds. In a sense, they're not even using hospitals very much, whereas before they were fairly consistent users of hospitals. That's much less the case now. It's really those 75 and over in hospitals, and for nursing homes it's those 85 and over. Most of the people going in are over 85 years of age. Obviously, though, you may need a ward for the demented, although you're lucky with veterans, because men don't become demented as often as women do. There's a bit of gender gap.

    But here's another myth. This other myth is the business that it's costing us more and more because people are getting older. I've now looked very carefully at all the studies, and what they're pointing out is that this is not what's happening at all. Even with the baby boomers coming up, by the way—just so you know—the additional cost as the baby boomers go in will be 1% a year, because they're not going to turn 85 all at once. In effect, you're going to have a 1% increase. What's really killing people nowadays is the cost of drugs and high-tech equipment. Those two things are using up an enormous amount of funds, because nobody wants to be without a new diddly-dad or whatever it is. That's where a lot of the money is going. And by the way, the elderly don't get much use out of those things, I must tell you.

    Your veterans aren't getting the benefit of all the money that's being poured in. What's being left out is long-term care. There's no question about it, both in terms of the home and in the community. And New Brunswick has always had a kind of odd home care program. It was a kind of hospital replacement, and then you had to meet social services requirements because you needed to have money. As long as you didn't have money, you were okay, but if you had money it was a problem. In effect, the veterans there really have benefited from the DVA programs more than those in other provinces have, because basically that has been the program. That's not as true in the west.

    So in effect, you're right. I think some beds may become necessary, but there is now a trend to do something quite different because of the trend downward in nursing homes. There's no point in building beds that people don't want to go into. They feel the future aged will want to do so even less.

    There's a trend toward really trying to put together something called assisted living. It doesn't mean the people will be there forever, but there is a way of bringing people together. We used to build senior citizens' housing. Veterans didn't have to use that primarily because they had help for things like yardwork and gardening. But because other people either didn't have very much money or couldn't do all those kinds of things as well, they felt it was necessary to move into senior citizens' housing. Whether it was high-class or subsidized, that became the trend.

    Nowadays, the trend is to really modify that concept and to move some of those—and we do it when we're building new buildings, because some of them are wearing out—by putting in help within the home for people who need help but who don't have a caregiver, and to then provide it on an ongoing basis. That's becoming the trend nowadays, rather than the nursing home.

º  (1615)  

    The Chair: I'm just going to take about a thirty-second break because I know our guests from the Forum for Young Canadians are leaving.

    We thank you for hanging in, and we hope you guys have a great week.

    Voices: Thank you.

    The Chair: Mr. Bailey will be starting off our second round.

    Prof. Evelyn Shapiro: Can I ask you something before you go on?

    The Chair: Absolutely. I thought you were finished, Professor.

    Prof. Evelyn Shapiro: It relates to something Mrs. Wayne said, but it was on another subject. I just wanted to say something else in relation to veterans hospitals.

    I think everybody is entitled to the very best care. I must say that it's not because I think less of veterans or more of veterans, but I think every hospital, every nursing home, and every home care program should be the best it can possibly be.

    I actually taught at Deer Lodge when it was still a veterans hospital. I'm not sure a lot of the veterans today would choose to go into a veterans facility specifically. In other words, it may be that the whole community in which that person lived was really made up of other veterans and there was a whole community of people who knew each other from pieces of it, because New Brunswick is not that big.

    When I worked there in the 1980s, it certainly became clear to me that the veterans who were there were really people who had not developed a community. They were basically more or less loners than they were socialized in the community. Most of the other veterans wanted to be either near where some of their families were or they wanted to be downtown, so the veterans hospital was not serving very many. They had an acute area that was serving them, and they had marvellous adult day care programs for veterans who were quite ready to come in, but not all of them were anxious to go in.

    Don't forget that there was no medicare and there was no hospital insurance at the time those were put up. You have to think in terms of the olden days. The veterans were privileged in those days in terms of getting services that weren't available to anybody else. Now there are people who have been veterans for years and years and they would not consider going into such a place because their friends are elsewhere in another place, in another long-term care facility. So that's something to think about.

    Mrs. Elsie Wayne: But there is a long list of veterans who want to be in there, because a different scenario exists now. The entertainment is there and all of the ones who are there are a family.

    Prof. Evelyn Shapiro: So you're saying it's a sort of culture.

    Mrs. Elsie Wayne: It's a family, yes.

    The Chair: Mr. Bailey, you have the floor for five minutes.

    Mr. Roy Bailey: My colleague Rose-Marie alluded to something, and I just want to say something in relation to it. On my own, I visited the Parkwood, in London. I was there with a friend. If I remember correctly—check me if I'm wrong—it was once a hospital and they turned it into a veterans hospital. But it's more than a veterans hospital. They have a program there that everybody should see. There's woodworking, there's...it's unbelievable, and they have three or four floors of it. It was the finest facility.

    And we didn't see it, by the way, colleagues. We should go down there one day.

    However, Professor Shapiro, I haven't found a veteran who doesn't really care that he—or she, because some are women as well—is with veterans as long as they're with people who are friends and who are their own age. I found this out, and I asked person after person in London if they would prefer to be separated, with the vets on one ward. They said, no, they had their friends, they were living together, and they were doing everything from weaving to woodwork to actually painting. It was a wonderful experience. In my opinion, that is the way of the next decade. The way of the next decade is that we won't have enough vets. The average age now is 82 or somewhere in there. Does anybody know the average age?

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    Prof. Evelyn Shapiro: It's about that.

    Mr. Roy Bailey: Okay, so you're going to have fewer vets. Therefore, in order to provide all the facilities, you're going to have to have combinations like what you have at Parkwood, in London. It's beautiful.

    I think we have to think about that, Mr. Chairman, as we complete our visitations.

    Prof. Evelyn Shapiro: I'm almost sure I visited it. It's a big building, and it also has all kinds of physiotherapy and occupational therapy programs and stuff. It also has adult day care in terms of people coming in from the outside, and it isn't only for veterans.

    Mr. Roy Bailey: And that's the way of the future, I think.

    Prof. Evelyn Shapiro: I didn't like their halls, that was the only thing. I thought the corridors were too dark. That's what I remember about it.

    Mr. Roy Bailey: I just wanted to make that comment, because I think that's what we have to think about in the future.

    Prof. Evelyn Shapiro: We're talking about programs here, we're not talking about buildings.

    Mr. Roy Bailey: That's right.

    That's all I have, Mr. Chair.

    The Chair: Mr. Grose, for five minutes.

    Mr. Ivan Grose (Oshawa, Lib.): I was interested when you said people are growing older. We have three old-age homes in my constituency, and I had the bright idea that we could get a list every month of the people who are over 75. Of course, we would do the 80s, the 90s, and the 100s, with the Queen and the Governor General and so on. It was a bright idea, and now I get a big pile of letters every week that I have to sign. But 100 is not an odd age now. At one point, I said, “Wait a minute, are all the people moving to Oshawa when they get to be 100?” Apparently they all lived in Oshawa.

    In the last batch I did, I had one for a four-year wedding anniversary. I said we didn't do four-year wedding anniversaries, but the bright young lady I have looking after these things said we do for people over 85. Two of them had been over 85 and had been married for four years.

    One thing that strikes me is that if an older person—they may or may not be a veteran, but let's lump them all together—falls and breaks a leg or something, does recuperate in an acute care hospital, and can go somewhere else because they don't require acute care, there are no convalescent hospital spaces. Old-age spaces are at a premium—you may have some left over in Manitoba, but we certainly don't in southern Ontario—so that person would be taking up an acute care bed. This seems like bad management to me, and I keep bringing it up time after time, every time we talk about health care. That acute care bed is expensive, whereas a convalescent bed or an old folks home is much cheaper.

    Incidentally, Elsie, you wouldn't want to see the veterans hospital they had in Toronto before they started using Sunnybrook. I remember it from when I was a very little boy, which was a long time ago, before the Second World War. My uncle was in there and my great uncle was in there, and it was a terrible place then. I think it has been torn down now. They built a condominium and made a lot of money.

    But I think it's better for veterans to be mixed up with people who are not veterans. If you have a room full of veterans who are over 85, they can talk about the old battles and so on, but I don't think that's a good idea in the long run. What do you think?

    Prof. Evelyn Shapiro: It depends a lot on where you lived and who you associated with. For the veteran who came back and who still is, for example, very associated with the Legion because his friends are there and that's where he goes to have a beer on Saturday night or whatever, and he has done that over the years, then by virtue of being a very involved member of the Legion, his friends are veterans. You would therefore want to find them in whatever nursing home you are going to be in. In New Brunswick, for example, in some of the small maritime communities, it may be that the Legion was the centre of all the social activities when they were younger, as well as now, when they're older. In a sense, then, those are their friends and those are the places they want to be.

    In larger cities, you're more anonymous. What happens is that you really become friends with a whole variety of other people. You don't necessarily only go to the Legion, or you may not go to the Legion at all. You really develop friendships in terms of your own social class or whatever, and you have a whole bunch of different kinds of social networks. For those people, being in a veterans hospital therefore doesn't carry any special weight unless it has particularly good programs. For example, Deer Lodge had adult programs, particularly for people who lived outside and came in for adult day care. People flocked to them from everywhere not because it was a veterans hospital, but because it was a damned good program. I think people wanted to come in and they did go in.

    Of course, maybe I have the wrong attitude, but my attitude is that you have to have very good programs, and, by golly, they help veterans and they help non-veterans. You shouldn't have bad places or bad programs.

º  (1625)  

    The Chair: You have another minute or so.

    Mr. Ivan Grose: I come from a reasonably large city that has, I think, the second-biggest Legion in Canada. As a matter of fact, the Legion built some senior citizens' housing right behind the Legion, and it has worked out very well.

    Prof. Evelyn Shapiro: Yes, they've done that in a lot of places.

    Mr. Ivan Grose: Not having been an inmate in a hospital for a long time—I hate hospitals—I was wondering what the best place for a veteran would be. At Sunnybrook, in Toronto, they have the veterans wing, which is virtually almost separate from the rest of the hospital.

    Prof. Evelyn Shapiro: It is virtually almost separate.

    The thing is, I'm concerned. One thing you've said really needs to be said very clearly to everybody. One of the things that's very clear to me is that when you have an old population, you have to have resources for rehabilitation. That doesn't only apply to a post-hospital stay. For example, it's true that if you break a hip, you need rehabilitation afterwards.

    But the fact is that, at Deer Lodge, one of the things I did learn is that people—in this case, veterans—as they get older, get rusty in terms of using themselves well. They may be not so good because one leg doesn't work too well anymore. The fact is that they can learn how to use whatever they have, but nobody is really doing the job of teaching them how to do it.

    There's no place in the provinces either. We have beds for a specific kind of purpose. Ontario has a bunch of rehab beds. They have them in chronic care hospitals, they have rehab wings, and so on. It's not that they don't have them, it's that when you have an elderly population, what you really don't need are programs designed for you to start doing occupational therapy or physiotherapy every day for an hour, because people can't take it at that age. What you need are longer-term rehab units that are basically geriatric rehabilitation units. They are really very hard to find, and in a sense, getting them back on their feet is really an important thing.

    The Chair: Mrs. Wayne.

    Mrs. Elsie Wayne: I just have one question, Professor Shapiro. You were speaking before about the spouses. I've been receiving quite a number of letters with regard to spouses. Certainly, as you know, they do have some help for one year, then there's no help at all after that.

    I don't understand how we could possibly think these spouses are going to be able to continue on. They're as old as their husbands. They're in their 80s, some in their 90s, and we're saying that for one year, we'll give them some assistance, then after that they get no assistance at all.

    Prof. Evelyn Shapiro: And not only that, sometimes it means that if they're 85 or 90 years old, they have been living because partly their husband has been getting the grounds help.

    Mrs. Elsie Wayne: That's exactly right.

    Prof. Evelyn Shapiro: In effect, they can't even continue living there, because they can't do that and they have no money to spend on it.

    It seems to me that there has to be some reasonable.... There's no question about it, both in terms of getting them a little help for themselves, but also in terms of the ordinary things you gave to veterans when the spouse is still there.

    I mentioned that at the beginning. I feel very strongly about it.

    Mrs. Elsie Wayne: So do I, and I think most of us at the table do, Professor.

    The Chair: I have a couple of questions, Professor Shapiro.

    In your opening comments, you talked about some concerns you had, especially with DVA. I think you said they have lots of categories that play against each other. Can you elaborate on that? I'm looking at whether or not we could get a handle on something so that we could maybe recommend that they lump some together so that we wouldn't have these disincentives.

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    Prof. Evelyn Shapiro: One I can offer you is a pilot project that really proved its worth. In that pilot project, for veterans eligible only because of their financial situation, they offered them the opportunity not to have to go into a nursing home if they needed a lot of help. They instead offered them the opportunity to get into the VIP program. That was done only as a pilot project to see what would happen, and I think the number of people wanting to go into a nursing home after that went down by either a third or a half.

    In effect, what I'm saying is that you're paying more for nursing home care when you don't have to pay for it, because these people are not eligible for the VIP program by virtue of the fact that they're a different kind of veteran. Somehow or other, I think it's cutting off your nose to spite your face. Not only is it not particularly good for the veteran, it doesn't make sense to me financially.

    The Chair: We've talked about veterans basically in larger centres this afternoon. What about home care? I think you made a statement that it was underfunded, undervalued, and maybe overstressed. If it's possible, how would you describe the situation faced by veterans living in the rural areas, who need home care to stay at home, and who are far away? Do you have any knowledge of that?

    Prof. Evelyn Shapiro: Two studies have been done, in which there are consistent statements. I hear this all the time. One was done by a fellow in Ontario, Peter Coyt. What he found is that it isn't necessarily an urban and rural difference, there are just areas of Ontario where more people seem to be somehow getting better access and service than those in other parts of the province. He doesn't know why; he's just working with numbers. But the fact is that it isn't only rural–urban.

    In Alberta, there has been a study that does indicate that rural people don't really have access as good as the many services available in urban areas. In Manitoba, we just completed a study looking at things in terms of how many people are eligible for and actually get home care, and access right across the province was almost identical. If you lived in some rural community, the same percentage of people were coming into the home care program.

    So I suspect that it depends, province by province. It's very hard to give you an official answer. Rural people always feel underserved. I can tell you that's always the case. Those of us in the west always talk about the golden triangle, which is Toronto–Montreal–Ottawa, right? The thing is that we have these terrible feelings against... I come from Montreal, but I new I was a westerner when I began to hate the golden triangle. I think the same thing is true of rural–urban. Rural people always feel they're missing out, and they are because you have a greater variety of services in an urban area, so you have more choices. But that doesn't mean you aren't getting equivalent value in terms of services. So I don't know, but those are the three studies that I know of and can share with you.

    The Chair: When you think of the number of veterans in Canada who need full-time nursing care, do you think it's going to peak at any one time in the next five, ten, or fifteen years, or whatever?

    Prof. Evelyn Shapiro: First of all, let's be very clear when we talk about nursing care. That's really important, because people who are demented do not necessarily need a lot of nursing care, they need a lot of watching. For that, you don't necessarily need a nurse, you need somebody who's going to watch, be careful, and make sure they're okay.

    You're talking about care, so let's use the general term “care”. According to what the numbers seem to indicate, the older you are, the faster you die. Do you know what I mean? When you start dying, you die faster. If you're well until you're 101, for example, you go very fast when you start going.

    On the other hand, as they're aging, you have a lot more people with more chronic conditions. Some of the conditions are debilitating. Some of them make you dysfunctional. Some make you demented. Those people aren't really functional at all. So if you're well until you're old, you're pretty lucky in terms of how fast you go.

    There's no question that you're going to have more chronicity, but it starts at a later age. What they're talking about is very clear. What the academics are talking about is compressed morbidity. That is, you are well for a longer period of time, so when you start really getting into trouble later on, the time is compressed before you die. That's the latest idea that people are coming up with.

º  (1635)  

    The Chair: What requirements do you see for the future generation of vets? We also have to look at that, too, because of the Gulf War, because of Afghanistan, and because of all the different peacekeeping missions that Canada takes part in. Is Canada ready for them, do you think?

    Prof. Evelyn Shapiro: They're going to present a whole bunch of different problems, because they've had different experiences. Don't forget, it's not the same as when people went away for four years and they fought and they saw a lot of deaths. In the First World War, for one, there were so many deaths. The people then came back, but they had all shared a common experience in the way they lived and so on.

    I just read their paper, and I've also spoken to the chair of the advisory committee of the younger veterans. My feeling is that their experiences seem to be different. They're having different cultural experiences in terms of each country. It seems to be taking a toll psychologically, even more obviously than physically. I don't know what the reason is, but they're going to have the same problems. They may even have more of them if, for example, these various stress disorders lead to more divorces and so on. They're more likely going to be alone, and once they're alone, they have a bigger problem. There's no question about it. They won't have somebody not only to take care of them, but to support them emotionally. So I'm very concerned about them.

    And I also don't see the same kind of gathering of the thing that helps you keep up your morale, which is that the population is behind you. It seems to be diffuse here and diffuse there. I don't think people in Canada are unhappy with the army people, with the navy, or whatever, but I don't think there is a concentrated enthusiasm for people when they go and when they come back. Their families welcome them back, but I don't see the great towns and villages and parades and stuff when people are coming back in a major way. I just don't see that kind of welcome.

    The Chair: In a lot of cases, I think we're also tapping into reserves and regular forces. In a lot of cases, when they come back, they have nobody to tell their story to, just as you were saying.

    Prof. Evelyn Shapiro: Absolutely, but it's more than that. The people who came back from the Second World War—which is the one I know, because my contemporaries were the ones who went to fight—there were all kinds of special things. There were educational funds and many other things, and they were welcomed like heroes. Everybody thought they were heroes.

    I don't see anybody today saying, “You're heroes,” but I think it means a lot in terms of subsequently making your way through life. So I'm very concerned about them, because I don't think they're getting that kind of support. But maybe I'm wrong.

    The Chair: No, I think you're right.

    Just as another question, do you think the Gerontological Advisory Council is working? I know it had some hiccups along the way a couple of years ago, but it seems to be back on track. What's your opinion of that council?

    Prof. Evelyn Shapiro: Well, let me tell you.

    It wasn't the case so much in the middle, but at the beginning it was a case of them not being sure what they were doing here. But the only hiccup they actually had subsequently... after about the third meeting, we really got our act together, or maybe it was Veterans Affairs that got their act together, because they weren't exactly sure. They thought it might be a good idea, but they really weren't sure whether you eat it with a spoon or a fork, and they weren't really sure how to use it.

    After the third meeting, things went well. There was a period during which some of the veterans' organizations were very angry about the government having nothing to do with the advisory committee, and they refused to come or didn't want to come for a while, and they boycotted the meetings. But I think that has now been pulled together.

    One of the things the advisory council has done has been seen in the last two or three pilots the veterans have taken. The kinds of changes they've made have really come as a result of the Gerontological Advisory Committee, and I feel very much that we've really made a dent. I think we've made things better. Of course, if we hadn't gotten a welcoming and receptive group....

    I think they think we're terrific because we not only urge them to do things, but also because they get some help from their colleagues and because we tell them about some things they really should be doing. They then say the advisory committee thought this was a good idea, and I think it gives them some support. So I think it has really done a lot of good.

    I must tell you, though, that I just picked up Salute, the Veterans Affairs weekly, and I got a little concerned, because I think sometimes we could be going overboard. I see there's a new program. It's a telehealth program—and I don't know whether you read this. Much as I'm a softie, I'm a great believer in not spending money unless I really think it's a good idea. In Salute, it says that the telehealth program is going to take blood pressure or whatever, and it's going to do this by telephone, so you have to have equipment in the person's home and so on. I think the veterans are going to love it because it's machinery, people pay attention to you, and you can phone up and speak to a nurse at the other end.

    I've done a review of five pilots that have been tried with telehealth. Their goal was to reduce both hospital and nursing home use, but primarily hospital use and emergency room use. But it didn't do a thing for any of them. The idea was fine. Everybody loved it and they thought it was terrific. The people who provided it thought it was terrific, and the people who got it thought it was terrific. But whether it actually did anything, I don't know.

    I was supposed to do a synthesis of all the experiments that had been going on in home care that had been funded by the federal government, and there wasn't one that was successful. And it's not that I said they were not successful. They showed that they didn't change anything in terms of hospital or emergency room use.

    If you want to do something as a pilot and test it out to see if it does something... in Salute, it says it's supposed to be a safe, reliable, and efficient approach. Well, I don't know what “efficient” means. Efficient in comparison to what?

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    The Chair: Not a lot of people around here do, either.

    Prof. Evelyn Shapiro: Well, “efficient” or “cost-effective” relates to a comparison between A and B. It has no sort of theoretical framework. Certainly, I don't see that it may not be safe and reliable, because somebody is going to be at both ends. But I'm not sure what it's going to do. Maybe I was waiting for the next meeting—which I think is in June—to say we maybe ought to set some goals and see if they're met, whatever the goals are supposed to be. But it worries me a bit.

    The Chair: Are there any more questions of Professor Shapiro?

    Mr. Ivan Grose: Yes, Mr. Chair.

    If I might. I've been here almost ten years, and I think you're the first witness I've ever heard who didn't like spending money.

    Prof. Evelyn Shapiro: Oh, I love spending money on the right things. The thing is that, to me, that's what I think you see when we talk about quality. It's a very big concern of mine. I've done studies, other people are in the process of doing studies, and there have been a lot of American studies—I think I'm the only one who did a Canadian study—comparing quality of care in nursing homes between for-profit and not-for-profit, for example. It makes a big difference. It has made a big difference in the States. It has certainly made a difference in Manitoba. People in B.C. are now looking for funding for a similar study.

    To me, quality is critical. It isn't the question of whether you're profit or non-profit, you just want the quality to be damn good. I think veterans should have the quality and everybody else should have the quality. To me, quality is worth paying for, and it has to be the right kind.

    Mr. Ivan Grose: Something does strike me as rather odd, too, when a veteran dies. Maybe he's 90 years old and maybe his wife is 85 and she has been looking after him in one way or another for 30 years. When he dies, we should pension her off because she worked for nothing for 30 years. If they were getting the VIP service, obviously it was because she couldn't mow the lawn. I know, I've heard the arguments about how much money it's going to cost. But it does seem rather strange to me that we don't look at them as a couple.

    Prof. Evelyn Shapiro: You're going to have to do that with the younger veterans, because some women are bearing an enormous burden, and not only physically, but also emotionally. They're really a wholly different group, and they're not going to stand around and wait. They're going to either leave or whatever it is, and there's going to be nobody.

º  (1645)  

    Mr. Ivan Grose: That's where I was going with this.

    Prof. Evelyn Shapiro: You have to begin to consider the fact that it isn't a question of paying them only money, it's a question of really paying attention. I think that's true. And it's not that I suggest that they don't get the money, because I think it's wrong, really, for somebody to have to just move out of the house one year after their husband dies and they were getting money for housekeeping. I don't know what it is, but there has to be a better way. But I don't think everything has to involve more money, by the way, I really don't.

    The Chair: Mr. Bailey.

    Mr. Roy Bailey: I just have a comment, having looked after parents on both sides. Each province has different categorizations of caregiving available. In my province, it's level I, II, III, or IV. If I look back over the last 25 or more years, the biggest mistake I've seen—and these aren't just in debts, but in my own kinfolk—was somebody placing them in a level at which they didn't belong. If you put a level II into a level IV environment, you're spelling a word that starts with “d”, “death”. I'm very concerned about that, because I've had to intervene several times. Have you seen that happen?

    Prof. Evelyn Shapiro: Families have to intervene. The fact is that there have to be people who are interested enough—both family and friends and so on—and who do have to look after quality. The thing is, sometimes homes make it such that, for example, they all have to eat dinner at four o'clock in the afternoon because that's good for the staff.

    People have to be prepared to really monitor as a group, because those people have families who are afraid to say anything because they feel it will fall on their relative who is there. They're very worried about complaining, so there does need to be a watchdog. That's what the provinces are supposed to be doing. They're supposed to be monitoring, because they know. And then there are complaints and appeals and those kinds of things, so that you can let people know. I think most provinces are relatively good at looking after it if somebody phones and says there's a mishmash here, people are in the wrong place, and they're with people they shouldn't be with. But not enough people take the....

    One group in Ontario used to go around doing that. I can't remember what they were called, but they had a name. They actually used to go into nursing homes and make noise if they didn't think the care was adequate, if people were placed wrongly, if it didn't smell right, or whatever.

    The Chair: Hopefully that's what we're trying to do with the veterans.

    Prof. Evelyn Shapiro: Exactly, and I think that's really important. I do think there needs to be a watchdog on the quality. And it doesn't only apply to veterans hospitals. If you have any kind of place where a fair number of veterans are concentrated, if you know they're mostly in this facility or wherever, then I think it's something you need to pay attention to.

    The Chair: Is everybody satisfied that we had...?

    I know you have to catch a plane very shortly. I want to thank you for being an excellent witness. You've been very informative, and I think I speak for everyone on the committee when I say this afternoon has really been a pleasure in terms of tapping into your tremendous knowledge of the veterans population and also of aging in general. You've brought a lot to the committee this afternoon, and we're very appreciative of it. Thank you for coming.

    Prof. Evelyn Shapiro: You're welcome, but I have to get the last word.

º  (1650)  

    The Chair: I'm used to women getting the last word in on me, so go for it.

    Prof. Evelyn Shapiro: It's because of something mentioned on this side that I just wanted to always say.

    I had just started the home care program when the office got a phone call from a man who wanted to see a worker. She went up to see him, and it turned out he was 101 years old. He was a small, wiry chap who was living alone, buying his own groceries, and doing his own housekeeping. He was doing everything himself. She said to him, “You know, it's very nice to see you and I'm glad I met you, but do you need anything?” He said, “No, I don't need anything, but, you see, I'm 101. My daughter, who's 79, who I've always been in touch with, and who came to visit and so on, has been really quite ill and may not really recover all that much. We talk on the phone, but she hasn't been over to see me. So I thought to myself that somebody else should know I'm here, so I decided to call you just so you know I'm here.”

    She said, “Well, would you like someone to phone you on a daily or weekly basis just to check up?” He said, “No, my daughter does that. I just want somebody to know I'm here”. She said, “Okay, why don't you also know that I'm here. I'll leave you my card, and if you feel you need something, phone me.” He said, “That's exactly what I wanted,” and he was just really happy as a lark.

    So you talk about people and when you talk about the growing number of elderly centenarians, it's just amazing to me how many there are. It's just fantastic. Every second day, there's a 100th birthday.

    The Chair: Thanks again.

    Prof. Evelyn Shapiro: It's been a pleasure.

    The Chair: The committee is adjourned.