Tuesday, October 4, 2016
Salon Krieghoff - Casino Hilton Lac-Leamy
3 Boulevard du Casino, Gatineau, Québec
0830 – 1630 (EDT)
In Attendance
- Sylvain Bouliane, Veterans Canada (.ca)
- Mary Boutette, The Perley and Rideau Veterans’ Health Centre
- Candace Chartier, Canadian Alliance for Long Term Care
- Debbie Eisan, Aboriginal Veterans Autochtones
- Carolyn Gasser, Royal Canadian Legion (Co-chair)
- Major (Retired) Bruce Henwood
- Dr. Norah Keating, University of Alberta
- Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces
- Patrick Murphy-Lavallée, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal
- Marie Andrée Malette, Caregivers Brigade
- Percy Price, NATO Veterans Organization of Canada
Regrets
- Dr. Alice Aiken, Dalhousie University
Veterans Affairs Canada
- Libby Douglas, Director General, Service Delivery Management (Veterans Affairs Canada (VAC) co-chair)
- Marie-Eve Chagnon, Senior Analyst, Stakeholder Engagement and Outreach
Observer
- Andrea Siew, Office of the Veterans Ombudsman
Welcome and Overview of Agenda
The co-chairs welcomed members and participants to the face-to-face meeting and provided an overview of the agenda. The objective of the meeting was to provide members with information on the VAC care and support programs to help them provide well-founded input to the Veterans Health Care Regulations, and particularly the Long Term Care Review. The meeting was opened with an Aboriginal Prayer and members were thanked for their willingness to incorporate the Seven Teachings of the Grandfathers into the Group’s principles.
The member co-chair reported on her participation in the Advisory Group co-chairs’ Meeting in mid-September, and the co-chairs’ meeting with the Minister of Veterans Affairs that followed. At both meetings she reported on the Care and Support Advisory Group’s progress to date.
The co-chairs’ meeting provided an opportunity for co-chairs to learn of the other groups’ areas of interest and focus, including areas of cross-over among the groups. For CASAG, these areas were at-home care, service excellence and mental health. The co-chair said that opportunities for sharing and collaboration among the advisory groups will be forthcoming.
The member co-chair also debriefed on the 2020 Health Accord Summit she had attended, at which the Canadian Medical Association (CMA) stated its stance on seniors, and offered to distribute her notes to Group members. The CMA proposes something akin to the Veterans Independence Program, but for all Canadians, so they can receive the help they need when they need it, yet stay in their homes if that is their wish. The CMA also supports help for caregivers.
The Record of Discussion of the previous CASAG meeting was approved by all members without changes.
A CASAG member who also sits on the Service Excellence Advisory Group reported on the last meeting of that group. He also noted that when it comes to long term care, there appear to be two classes of Veterans as some are eligible for support whether or not the need for care is related to a disability from military service.
The first of several presentations delivered over the day provided an overview of the Veterans Health Care Regulations (VHCR), and was followed by more in-depth explorations of the three components of the VHCR: Treatment Benefits, the Veterans Independence Program, and Long Term Care. Members were invited to ask questions and provide comments during each presentation, and were informed that their input and feedback was essential in helping the Department understand the Veteran and family experience, and identify emerging issues, particularly for the Long term Care Review.
The Current Regulations
Members learned that the current VHCR are somewhat outdated, gender-biased, and inflexible. The regulations were written in an era when it was assumed that a spouse would care for the Veteran without compensation. For example, a Veteran’s spouse would not be financially compensated for driving a Veteran to an appointment, while a neighbour would. A CASAG member also noted age-ism in the regulations; an injury suffered in service is assessed taking into consideration the age of the Veteran and what might be the effects of age-related “wear and tear” in the area of injury.
Cultural relevance
A member observed that there is no cultural sensitivity built into the regulations that might, for example, provide Aboriginal veterans with alternative forms of treatment such as sweat lodges and traditional Elder healing methods. In discussion about long term care, she noted that it can be traumatic and can compound problems for Aboriginal Veterans when they must leave their communities to occupy contract beds elsewhere. The Department also needs to understand that decisions about an Aboriginal Veteran member’s long term care is a community decision, not only the Veteran’s or the family’s.
Families
The current VHCR do not consider the central role played by families and this is being looked at carefully by the Department. For example, mental health issues affect whole families, not just the person suffering from the illness. One member noted that the regulations see families as “accoutrements” to the Veteran. For example, currently, when caregivers are fully involved, financial support is entirely in the name of Veteran. She suggested that different questions should be asked, such as whether the family caregiver should be given support. One member who cares for a Veteran suffering with PTSD and related problems added that the regulations are strict and focus on physical disability, without recognizing how seriously debilitating PTSD can be and the burden a Veteran with this condition can place on caregivers. It was proposed that the regulations must adapt to this reality.
In discussing the Family Caregiver Relief Benefit (FCRB), members also learned that it is associated with a Veteran's ability to carry out Activities of Daily Living and/or Instrumental Activities of Daily Living.
A VAC official indicated the Department does have a family strategy at this time, but there is a need to move strategically forward with a vision more focused on families. The member co-chair noted that this is why the Care and Support Advisory Group should connect with the Advisory Group on Families. As a start, CASAG will be getting a presentation on the Families Strategy.
The Relevance of Advisory Groups
This last comment sparked a conversation about the Advisory Groups, with one member saying she felt there are too many Advisory Groups and their structure should be looked at. On the other hand, collapsing Advisory Groups could lead to the splintering off of sub-groups. A member suggested that it could be helpful if some members who are better placed to sit in on other Groups could do so. The VAC co-chair said that this is a concern and it would have to be addressed, and staff of the Minister’s Office said that she would also take this point to the Minister’s office.
Medavie Blue Cross Cards
A member noted that the cards Veterans hold no longer state whether they are in Group A or Group B, categories that refer to health care benefits the Veteran can receive based on eligibility and the specific Programs of Choice (POCs).
Members learned that the classification was removed because the card is used not only for Veterans but also Canadian Armed Forces and RCMP Veterans. The card now has the number of the National Client Contact Centre, so Veterans can call to get more details. Several of the Veteran members have two cards. Their old card included all of the benefits and programs for which a veteran was eligible. There seemed to be consensus when a member stated that “the new card may be best for VAC but the old card is better for the Veteran.”
A suggestion was to send detailed information to Veterans or put it online. However, sending information to Veterans can pose problems, one being the “manila envelope” factor—an aversion that many Veterans have to government-issued envelopes. The VAC co-chair said that they would look at how the Department came to the decision, and whether they had spoken to any Veterans when the card was changed. She committed to coming back to the Group on the matter.
Throughout the day, comments, questions and suggestions by both members and presenters were about the importance of early, accurate and thorough communication and education about programs and services. What, how and when the Department communicates with the Veterans community is just as important as what VAC delivers. Veterans and family members should be told up front what they are entitled to, and proactively informed of other options available to them as they age or progress through changes. Another common refrain was the necessity to involve Veterans and Veteran stakeholder organizations in policy development or changes, and in decision-making. Programs must be developed from the point of view of Veterans, not the Department.
Regarding long term care, a member suggested that VAC should go back to looking at providing supports and services to Veterans that need them along their course of life. A Veteran might be very young at the point of injury and would require this sort of “long term care.” For this reason, the term “residential care” should be used in place of what VAC now refers to as long-term care. Another member noted, however, that the term “residential care” may not be viewed positively by Aboriginal/Indigenous communities. The importance of how care is actually delivered was also a common point raised. There is a need for transition supports, and an awareness that each Veteran has his/her own needs. The cultural component of care, and making a connection with the Veteran and his or her family at the beginning of their relationship with VAC (through front line workers or case managers) is significant because it makes the rest of the journey much smoother.
Next Steps
At the end of the day, members were thanked for their participation and informed that they would receive options for the potential date of their next teleconference.