Disclosure

Privacy Impact Assessment (PIA) Addendum Summary (2017)

Government Institution

Veteran Affairs Canada

Government Official Responsible for the Privacy Impact Assessment

Kim Andrews
A/Director General, Program Management and Service Delivery

Head of the government institution / Delegate for section 10 of the Privacy Act

Crystal Garrett-Baird
Director, Privacy and Information Management

Name of Program or Activity of the Government Institution

My VAC Account – Interoperability for Benefit Applications

Description of Program or Activity:

The initial 2011 Privacy Impact Assessment (PIA) documented the risks and mitigation measures of implementing the My VAC Account (MVA). In 2013, the PIA was updated to assess the privacy impacts of the evolution of the portal.

Recently enhanced MVA functionality now allows for an electronic exchange of information between VAC and the Department of National Defense (DND). The electronic extraction of specified DND data elements will provide VAC with up-to-date, real-time service history and personal information about still-serving and recently released CAF members that is needed for the adjudication of benefits and services at VAC. The collection of service history and personal information from DND by VAC is not new but the electronic exchange of information between DND and VAC is a more efficient means of collecting only specific required data elements.

The focus of the 2017 PIA addendum is the automated exchange of information between VAC and the Department of National Defense (DND) through the MVA portal. The exchange is designed to enable two things:

• Data Matching

  An identity authentication process will confirm the service information of Veterans and still-serving members of the Canadian Armed Forces (CAF) who are applying for VAC benefits and services. This will be achieved through a data linkage and will verify a serving member’s or recently released Veteran’s service with the CAF.

• Data Extraction for Benefit Claims

  Electronic extraction of specified data elements (e.g. release date, release type, etc.) from DND will support a streamlined application process for members and Veterans who apply for VAC benefits and services.

  Risks identified though the Addendum have either been mitigated or addressed through mitigation plans.

Privacy Impact Assessment (PIA) Summary (2013)

Government Institution

Veteran Affairs Canada

Government Official Responsible for the Privacy Impact Assessment

John Walker
Director General
Service Delivery and Program Management Division

Head of the government institution / Delegate for section 10 of the Privacy Act

Shawn MacDougall
Director
ATIP Coordinator

Name of Program or Activity of the Government Institution

My VAC Account

Description of Program or Activity:

In 2011, as a commitment to client service, VAC introduced an online portal available to VAC Veterans. This portal, entitled, My VAC Account enabled individuals to view and update basic personal information (such as name and address), communicate with the department via secure messaging, complete certain applications online, access the status of some of their services and change their direct deposit information. This was only one additional point of access as individuals could still request information and make changes to their information in person or by calling the National Call Centre Network (NCCN).

In 2011, a Privacy Impact Assessment was completed that documented risks and mitigation measures. Since that point, there have been changes to My VAC Account and an updated PIA is required in order to ensure the risks identified in 2011 have been addressed, document the evolution of the portal and identify any risks that may have arisen due to the modifications.

In addition, this PIA will document the relationship and use of the My VAC Account technology by the Veterans Review and Appeal Board (VRAB) and representatives from the Royal Canadian Legion (RCL).

By December 31, 2015 VAC officials are anticipating that there will be 18,000 individuals accessing their information through their My VAC Account.

Description of the class of records and Personal Information Banks associated with the program or activity

Class of Records and Personal Information banks can be reviewed at: VAC's Info Source Chapter

Legal Authority for Program or Activity

It is important to note that My VAC Account is linked to multiple programs/services within VAC, each of which operates under their own legal authorities.

The legal authority derives from the Department of Veterans Affairs Act and from Section 4 of the Communications Policy of the Government of Canada.

Risk Area Identification & Categorization

The following section contains risks identified in the 2013 PIA. A risk scale has been included. The numbered risk scale is presented in ascending order: the first level represents the lowest level of potential risk for the risk area; the fourth level (4) represents the highest level of potential risk for the given risk area. Please refer to “Appendix C” of the TBS Directive on PIAs to learn more about the risk scale.

Where risks associated with the enhancements assessed in the 2017 addendum differ from the 2013 PIA, this difference is noted.

1. Type of Program or Activity
   • Administration of Programs / Activity and Services - Personal information is used to make decisions that directly affect the individual (i.e. determining eligibility for programs including authentication for accessing programs/services, administering program payments, overpayments, or support to clients, issuing or denial of permits/licenses, processing appeals, etc.).
   • Level of risk to privacy – 2
      
2. Type of Personal Information Involved and Context
   • Sensitive personal information, including detailed profiles, allegations or suspicions, bodily samples and/or the context surrounding the personal information is particularly sensitive. For example: the personal information by association indirectly reveals intimate details on the health, financial situation, religious or lifestyle choices of the individual and other individuals, such as relatives.
   • Level of risk to privacy – 4¹
      
3. Program or Activity Partners and Private Sector Involvement
   • Private sector organizations or international organizations or foreign governments
   • Level of risk to privacy – 1²
      
4. Duration of the Program or Activity
   • Long-term program - Existing program that has been modified or is established with no clear “sunset”.
   • Level of risk to privacy – 3
      
5. Program Population
   • The program affects certain individuals for external administrative purposes.
   • Level of risk to privacy – 3
      
6. Technology & Privacy

   1. Does the new or modified program or activity involve the implementation of a new electronic system, software or application program including collaborative software (or groupware) that is implemented to support the program or activity in terms of the creation, collection or handling of personal information?

      Risk to privacy – No

   2. Does the new or modified program or activity require any modifications to IT legacy systems and / or services?

      Risk to privacy – Yes

   3. Enhanced identification methods - This includes biometric technology (i.e. facial recognition, gait analysis, iris scan, fingerprint analysis, voice print, radio frequency identification (RFID), etc…) as well as easy pass technology, new identification cards including magnetic stripe cards, “smart cards” (i.e. identification cards that are embedded with either an antenna or a contact pad that is connected to a microprocessor and a memory chip or only a memory chip with non-programmable logic).

      Risk to privacy – No

   4. Use of Surveillance - This includes surveillance technologies such as audio/video recording devices, thermal imaging, recognition devices, RFID, surreptitious surveillance / interception, computer aided monitoring including audit trails, satellite surveillance etc.

      Risk to privacy – No

   5. Use of automated personal information analysis, personal information matching and knowledge discovery techniques - For the purposes of the Directive on PIA, government institution are to identify those activities that involve the use of automated technology to analyze, create, compare, cull, identify or extract personal information elements. Such activities would include personal information matching, record linkage, personal information mining, personal information comparison, knowledge discovery, information filtering or analysis. Such activities involve some form of artificial intelligence and/or machine learning to uncover knowledge (intelligence), trends/patterns or to predict behavior.

      Risk to privacy – No³

7. Personal Information Transmission
   • The personal information is used in system that has connections to at least one other system.
   • Level of risk to privacy – 2⁴
      
8. Risk Impact to the Institution
   • Reputation harm, embarrassment, loss of credibility. Decrease confidence by the public, elected officials under the spotlight, institution strategic outcome compromised, government priority compromised, impact on the Government of Canada Outcome areas.
   • Level of risk to privacy – 4
      
9. Risk Impact to the Individual or Employee
   • Reputations harm, embarrassment
   • Level of risk to privacy – 2⁵
      

About the New Veterans Charter

On May 13, 2005, Bill C-45, the Canadian Forces Members and Veterans Re-establishment and Compensation Act (the New Veterans Charter), received Royal Assent. The New Veterans Charter represents the most sweeping change to Veterans' benefits and services in the past 60 years and keeps pace with the needs of releasing Canadian Forces members and their families, while still providing services and benefits to help traditional war-service Veterans live with dignity and independence.

This Privacy Impact Assessment (PIA) describes the Disability Award, Death Benefit and Detention Benefit program under the New Veterans Charter. This program is designed to recognize and compensate for the non-economic impacts that a service-related disability may have on Canadian Forces clients and their families. This program encourages wellness, facilitates the transition of Canadian Forces clients and their families from military to civilian life, and consists of four components:

• Disability Awards - A tax-free, lump-sum payment that recognizes and compensates Canadian Forces members and Veterans, and in some cases, surviving spouses/common-law partners and surviving dependant child(ren), for the non-economic effects of service-related disability, including pain and suffering, functional loss and the effects of permanent impairment on the lives of Canadian Forces members, and Veterans and their families.
• Death Benefits - A tax-free, lump-sum payment that recognizes and compensates a surviving spouse/common-law partner and/or surviving dependant child(ren) of a Canadian Forces member for the non-economic impacts of a sudden service-related death. These non-economic impacts include the member's loss of life, the resulting loss of guidance, care and companionship, and the impact of the member's death on the functioning of the household.
• Clothing Allowance - Paid monthly to individuals in receipt of a disability award who require specially-made apparel or have wear and tear of clothing in relation to the impairment for which a disability award has been granted.
• Detention Benefit - A tax-free, lump-sum payment which recognizes and compensates for the non-economic effects arising from the period of time the Canadian Forces member or Veteran was detained by an enemy, opposing force or criminal element; was engaged in evading capture; or escaped from such a power.

With application to any of the awards/benefits under this program, the client is required to submit documentation which may include: member's name, service number, date of release, service medical records, other medical/hospital reports, death certificate, detention information, Worker's Compensation information, and dependant information.

About the Privacy Impact Assessment

A Privacy Impact Assessment provides a framework to ensure that privacy is considered throughout the design or redesign of programs or services and identifies the extent to which proposals comply with all appropriate statutes. Assessments help managers and decision-makers avoid or mitigate privacy risks and promote fully informed policy, program and system design choices.

The scope of this PIA is limited to the particulars of the Disability Award, Death Benefit and Detention Benefit program under the New Veterans Charter. The PIA reflects the program status as it existed on October 6 2006, and identifies seven privacy-related issues, all considered to be low risk. To resolve these low-risk concerns, the following mitigation measures have been brought forward:

• Additional Awareness and Training
• Development of Information Management Accountability Framework
• Addition of Information Management responsibilities to work descriptions of Regional Directors General and Director General of the National Operations Division of Veterans Affairs
• Development of evaluation and performance measurement criteria
• Addition of Information Management components to the responsibilities of the Quality Management Program
• Update of program forms and the Treasury Board Secretariat Info Source publication to include the registered Personal Information Bank number
• Removal of the Social Insurance Number as an identifier in this program
• Potential for new Records Disposition Authorities for client records
• Consistent management of information through its lifecycle according to legislative and central agency requirements
• Updated Threat and Risk assessment following modifications of electronic records system.

Privacy-related issues have been mitigated.

ADDENDUM to the PIA – March 2017

In October 2011, payment options for the Disability Award were introduced. These options included lump sum, annual payments or a combination of these two.

In April 2017, the amount of the Disability Award and Death Benefit will increase and an additional payment as provided for under the Budget Implementation Act, 2016 (BIA 2016) will be implemented. This change represents a new use of information within the program.

Risks identified within the Addendum have been mitigated with recommended updates to the Personal Information Bank for Disability Awards (VAC PPU 603) and internal processes.

VAC is committed to continue monitoring and providing ongoing communications, training and awareness to management and staff concerning the protection of personal information.

Legal Authority

The additional payments will be administered in accordance with the transitional provisions set out in Part 4, of the Budget Implementation Act, 2016 (sections 107 and 108).

In relation to the Disability Awards program, personal information is collected pursuant to sections 45, 47, 48, 49, 50 and 80 of the Canadian Forces Members and Veterans Re-establishment Act.

Privacy Impact Assessment (PIA) summary

Government Institution

Veteran Affairs Canada

Government Official Responsible for the Privacy Impact Assessment

Mary Nicholson
Director, Health Care and Rehabilitation Programs

Head of the government institution / Delegate for section 10 of the Privacy Act

Crystal Garret-Baird
Director, Privacy and Information Management

Name of Program or Activity of the Government Institution

Caregiver Recognition Benefit

Description of Program or Activity

The following description of the program is based on the 2018-2019 Departmental Results Framework and the Veterans Affairs Canada Program Inventory.

Core Responsibility: 1 – Benefits, Services and Supports

Support the care and well-being of Veterans and their dependents or survivors through a range of benefits, services, research, partnerships, and advocacy.

Program Description: P10 – Caregiver Recognition Benefit

The Caregiver Recognition Benefit formally recognizes the contribution caregivers make to the health and well-being of seriously injured Veterans who require continuous care and supervision, due to their service-related physical and/or mental health condition(s). This benefit is paid directly to Veterans’ caregivers.

Description of the class of record and the Personal Information Bank

• Caregiver Recognition Benefit – Class of Record VAC MVA 892
• Caregiver Recognition Benefit – Personal Information Bank VAC PPU 702
• Classes of Records and Personal Information Banks can be reviewed at: VAC's Info Source Chapter

Legal Authority for Program or Activity

Personal information is collected pursuant to section 65.1 of the Veterans Well-being Act, as well as the associated Veterans Well-being Regulations.

The legal authority requires that the individual be in receipt of a VAC Disability Award and, as a result of the disability, requires ongoing care. In addition, the legal authority will require that the informal caregiver be at least 18 years of age and not be otherwise remunerated for his/her service.

Risk Area Identification & Categorization

The following section contains risks identified in the PIA for the new or modified program. A risk scale has been included. The numbered risk scale is presented in ascending order: the first level represents the lowest level of potential risk for the risk area; the fourth level (4) represents the highest level of potential risk for the given risk area. Please refer to “Appendix C” of the TBS Directive on PIAs to learn more about the risk scale.

1. Type of Program or Activity
   • Administration of Programs / Activity and Services
   • Level of risk to privacy – 2
2. Type of Personal Information Involved and Context
   • Social Insurance Number, medical, financial or other sensitive personal information and/or the context surrounding the personal information is sensitive. Personal information of minors or incompetent individuals or involving a representative acting on behalf of the individual.

     Level of risk to privacy – 3

3. Program or Activity Partners and Private Sector Involvement
   • Within the institution (amongst one or more programs within the same institution)

     Level of risk to privacy – 1

4. Duration of the Program or Activity
   • Long-term program.

     Level of risk to privacy – 3

5. Program Population
   • The program affects certain individuals for external administrative purposes.

     Level of risk to privacy – 3

6. Technology & Privacy
   1. Does the new or modified program or activity involve the implementation of a new electronic system, software or application program including collaborative software (or groupware) that is implemented to support the program or activity in terms of the creation, collection or handling of personal information?

      Risk to privacy - No

   2. Does the new or modified program or activity require any modifications to IT legacy systems and / or services?

      Risk to privacy - Yes

   3. Enhanced identification methods - This includes biometric technology (i.e. facial recognition, gait analysis, iris scan, fingerprint analysis, voice print, radio frequency identification (RFID), etc.) as well as easy pass technology, new identification cards including magnetic stripe cards, “smart cards” (i.e. identification cards that are embedded with either an antenna or a contact pad that is connected to a microprocessor and a memory chip or only a memory chip with non-programmable logic).

      Risk to privacy – No

   4. Use of Surveillance - This includes surveillance technologies such as audio/video recording devices, thermal imaging, recognition devices, RFID, surreptitious surveillance / interception, computer aided monitoring including audit trails, satellite surveillance etc.

      Risk to privacy – Yes

   5. Use of automated personal information analysis, personal information matching and knowledge discovery techniques - For the purposes of the Directive on PIA, government institution are to identify those activities that involve the use of automated technology to analyze, create, compare, cull, identify or extract personal information elements. Such activities would include personal information matching, record linkage, personal information mining, personal information comparison, knowledge discovery, information filtering or analysis. Such activities involve some form of artificial intelligence and/or machine learning to uncover knowledge (intelligence), trends/patterns or to predict behavior.

      Risk to privacy – No

7. Personal Information Transmission
   • The personal information is used in a system that has connections to at least one other system.
     The personal information is transferred to a portable device or is printed.
     The personal information is transmitted using wireless technologies.

     Level of risk to privacy – 2, 3, 4

8. Risk Impact to the Individual or Employee
   • Inconvenience
   • Reputational harm, embarrassment
   • Financial harm
   • Level of risk to privacy – 1, 2 and 3
9. Risk Impact to the Institution
   • Managerial harm
   • Organizational harm
   • Financial harm
   • Reputational harm, embarrassment, loss of credibility.
   • Level of risk to privacy – 1, 2, 3 and 4

Privacy Impact Assessment (PIA) Summary

Government Institution

Veteran Affairs Canada (VAC)

Government Official Responsible for the Privacy Impact Assessment

Sandra Williamson
Director, Long-Term Care and Disability Benefits Program

Head of the government institution / Delegate for section 10 of the Privacy Act

Crystal Garrett-Baird
A/Director, Access to Information and Privacy

Name of Program or Activity of the Government Institution

Critical Injury Benefit

Description of Program or Activity

The Critical Injury Benefit (CIB) is a new benefit, effective July 1, 2015, which recognizes and compensates eligible Canadian Armed Forces members and Veterans who on or after April 1, 2006 experienced a sudden, single incident that caused a severe and traumatic injury or an acute disease immediately resulting in a severe impairment and interference in quality of life. This compensation recognizes and compensates for the time between the initial injury or incident and when the CAF member is medically stabilized.

The requirement for an application may be waived based on sufficient information currently within VAC’s data holdings. Individuals will be notified and will be requested to provide their acceptance of the CIB prior to the Department providing the benefit. Individuals may also complete an application form. Compensation is provided in the form of a lump sum payment.

Description of the class of record and the Personal Information Bank

• The Class of Record: Critical Injury Benefit (VAC MVA 890)
• Personal Information Bank: Critical Injury Benefit (VAC PPU 700)

Class of Record and Personal Information Bank can be viewed at: VAC’s Info Source Chapter

Legal Authority for Program or Activity

Sections 44.1, 44.2, 44.3 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act (CFMVRCA) and the associated sections under the Canadian Forces Members and Veterans Re-establishment and Compensation Regulations as amended. Section 80 of the CFMVRCA provides disclosure authority upon which government institutions and agencies can rely.

Risk Area Identification & Categorization

The following section contains risks identified in the PIA for the new or modified program. A risk scale has been included. The numbered risk scale is presented in ascending order: the first level (1) represents the lowest level of potential risk for the risk area; the fourth level (4) represents the highest level of potential risk for the given risk area. Please refer to “Appendix C” of the TBS Directive on PIAs to learn more about the risk scale.

1. Type of Program or Activity

   • Administration of Programs / Activity and Services

     Level of risk to privacy – 2

2. Type of Personal Information Involved and Context

   • Social Insurance Number, medical, financial or other sensitive personal information and/or the context surrounding the personal information is sensitive. Personal information of minors or incompetent individuals or involving a representative acting on behalf of the individual.

     Level of risk to privacy – 3

3. Program or Activity Partners and Private Sector Involvement

   • With other federal institutions.

     Level of risk to privacy – 2

4. Duration of the Program or Activity

   • Long-term program.

     Level of risk to privacy – 3

5. Program Population

   • The program affects certain individuals for external administrative purposes.

     Level of risk to privacy – 3

6. Technology & Privacy

   1. Does the new or modified program or activity involve the implementation of a new electronic system, software or application program including collaborative software (or groupware) that is implemented to support the program or activity in terms of the creation, collection or handling of personal information?

      Risk to privacy – No

   2. Does the new or modified program or activity require any modifications to IT legacy systems and / or services?

      Risk to privacy – Yes

   3. Enhanced identification methods - This includes biometric technology (i.e., facial recognition, gait analysis, iris scan, fingerprint analysis, voice print, radio frequency identification [RFID], etc.) as well as easy pass technology, new identification cards including magnetic stripe cards, “smart cards” (i.e., identification cards that are embedded with either an antenna or a contact pad that is connected to a microprocessor and a memory chip or only a memory chip with non-programmable logic).

      Risk to privacy – No

   4. Use of Surveillance - This includes surveillance technologies such as audio/video recording devices, thermal imaging, recognition devices, RFID, surreptitious surveillance/interception, computer aided monitoring including audit trails, satellite surveillance, etc.

      Risk to privacy – No

   5. Use of automated personal information analysis, personal information matching and knowledge discovery techniques - For the purposes of the Directive on PIA, government institutions are to identify those activities that involve the use of automated technology to analyze, create, compare, cull, identify or extract personal information elements. Such activities would include personal information matching, record linkage, personal information mining, personal information comparison, knowledge discovery, information filtering or analysis. Such activities involve some form of artificial intelligence and/or machine learning to uncover knowledge (intelligence), trends/patterns or to predict behavior.

      Risk to privacy – No

7. Personal Information Transmission
   • The personal information is used in a system that has connections to at least one other system.

   • The personal information is transferred to a portable device or is printed.

   • Level of risk to privacy – 2 & 3

8. Risk Impact to the Institution

   • Financial harm and reputational harm, embarrassment, loss of credibility.

     Level of risk to privacy – 3 & 4

9. Risk Impact to the Individual or Employee

   • Inconvenience, reputational harm and financial harm.

     Level of risk to privacy – 1, 2 & 3

Privacy Impact Assessments (PIAs) are used to identify potential privacy issues of new or redesigned federal government programs or services. PIAs examine how government departments protect personal information through its lifecycle of collection, use, disclosure, storage, and disposition.

For more information, see the Privacy Impact Assessment Fact Sheet on the Web site of the Office of the Privacy Commissioner of Canada

Annex A - Record of Veterans’ communications with VAC staff

Note: The information that follows is VAC’s current policy with respect to recording conversations between Veterans and case managers or Veteran Service Agents (VSA). As noted in the report, in 2023 the Department commits to engage with Veterans and stakeholders to gather feedback on recording calls.

1. Policy and procedures

VAC does not have a policy on recording phone interactions between Veterans and case managers or VSAs because it does not record such interactions due to the sensitive nature of their conversations. It is believed that recording interactions between Veterans and their case managers or VSAs could harm the building of a trusting relationship and prevent Veterans from sharing important information. It does not record phone interactions the same way, it does not record home visits, transition interviews and in-person services to all of its Veterans.

The only conversations with Veterans that VAC records are calls to its National Contact Centre Network (NCCN) as this is a common practice of call centers in order to monitor the quality of services. As well, these conversations are less sensitive since Veterans are mostly calling to receive information or be directed to other services.

2. Standard and procedure of notetaking and file-keeping

After an interaction with a Veterans has occurred, documentation must follow in their file. For the VSA’s role, the documentation would most often be found in CSDN through the screening tool or in client notes or GCcase. For Case Managers, the information would be documented in GCcase under the Veterans’ plan or in the case management assessment.

If Area Office staff need to follow-up in writing with the Veteran following a conversation, MyVAC Account can be used if the Veteran is registered, and they would use official decision letters if it is related to VAC program related decisions (letters would be available in CSDN and GCcase). These letters would be uploaded to MyVAC Account or mailed out if the Veteran is not registered with MyVAC Account.

Annex B - Directive: Role of the Veteran Service Team regarding Medical Assistance in Dying (MAiD)

Note: This guidance/directive was distributed to VAC’s frontline staff on 23 August 2022 and posted on the internal website. Subsequently, five Q&A sessions were held with staff to ensure the guidance was understood and to give staff an opportunity to ask questions.

Medical Assistance in Dying (MAiD) is a deeply complex and personal medical issue that is out of the jurisdiction of Veterans Affairs Canada staff.

MAiD is discussed and administered by a treating physician or a nurse practitioner directly to the Veteran or is prescribed to the Veteran for self-administration. A Veteran must be eligible for government-funded health insurance for MAiD, and this decision must be discussed and made directly with the Veteran’s physician or nurse practitioner. (See: Dying with Dignity Canada).

Veterans Affairs Canada (VAC) employees shall not provide advice or suggestions to Veterans on the issue of MAiD. If a Veteran is seeking advice or assistance with MAiD, the employee must refer the Veteran to their primary care provider.

Any mention of MAiD by a Veteran must be reported to the Area Director of the responsible area who will advise the Director General of Field Operations.

If a Veteran has chosen to pursue MAiD with their primary care provider and shares this information with a member of the Veteran Service Team (VST), VAC can support the Veteran in navigating VAC benefits and services available. Veterans may consider the following potential benefits and services, including but not limited to: VAC Assistance Service, Pastoral Outreach, Disability Benefits, Additional Pain and Suffering Compensation, Critical Injury Benefit, Veterans Independence Program (VIP), Allowances, War Veterans Allowance, Caregiver Recognition Benefit, and associated treatment benefits, if applicable. Support can include resource coordination and navigation such as connecting a Veteran and their family to community resources, mental health practitioners, grief counsellors, pastoral outreach or other local resources. The VST should never provide advice, suggestions, or options relating to the MAiD process itself, as this should only occur between the Veteran and their primary care provider.

The VST can support the survivor and dependents with potential VAC services and support available to them, including the VAC Assistance Service, Disability Benefits in Respect of Death for Survivors and Dependent Children, Veterans Independence Program (VIP), Funeral and Burial Assistance, or Educational Assistance for Children, and the Hope Program.

The VST member supporting a Veteran who has chosen to pursue MAiD with their primary care provider is strongly encouraged to consult with:

• a Standards Training and Evaluation Officer (STEO) for assistance in navigating the benefits and services available to the Veteran and their family, and/or;
• a Case Management Practice Consultant (CMPC) for support or debrief when they are having a conversation with a Veteran and their family surrounding this sensitive topic.

Additional guidelines and business processes that may assist the VST in supporting a Veteran who has chosen to pursue MAiD with their primary care provider include: Guidelines for Caring Carefully, Guidelines for Engaging Families and Mental Health Resources Available to Veterans’ Family Member.

Annex C – Presentation deck: Role of the VST regarding Medical Assistance in Dying (MAiD)

Q & A Session
August, 2022

What is MAiD?

Medical assistance in dying is the name of Canada’s assisted dying legislation.

It refers to the administering of medications by a physician or nurse practitioner that – at the person’s request – causes their death;

Or the prescribing of medications by a physician or nurse practitioner that a person can take to cause their own death.

MAiD / AMM

Medical Assistance in Dying (MAiD) is a deeply complex and personal medical issue that is out of the jurisdiction of Veterans Affairs Canada staff.

Dying with Dignity Canada

VAC Role

Medical Assistance in Dying

Employees:

Shall not provide advice or suggestions to Veterans on the issue of MAiD.

Must refer the Veteran to their primary care provider.

Must report any mention of MAiD to the Area Director of the responsible area who will advise the Director General of Field Operations.

Can support the Veteran in navigating VAC benefits and services available if the Veteran has chosen to pursue MAiD with their primary care provider.

Consultation

The VST member supporting a Veteran who has chosen to pursue MAiD with their primary care provider is strongly encouraged to consult with:

• a STEO for assistance in navigating the benefits and services available to the Veteran and their family and/or; 
• a CMPC for support or debrief when they are having a conversation with Veteran and their family surrounding this sensitive topic.

Guidelines and Business Processes

Guidelines for Caring Carefully

Guidelines for Engaging Families

Mental Health Resources Available to Veterans’ Family Member

Questions

Annex D - Questions & answers on MAiD directive

The following Questions and Answers are not intended to deepen your understanding regarding Medical Assistance in Dying but rather clarifies impact to Veterans Affairs Canada employees as it relates to your role and responsibilities.

Question 1: What is Medical Assistance in Dying (MAiD)?

Answer 1: Medical Assistance in Dying is seeking an approved assisted death where the requestor is well-informed throughout the process and includes safeguards in place to ensure they are informed and know their options and truly, voluntarily seek approval for this remedy. The requestor retains until the very last moment, the right to change their mind on proceeding with MAiD. MAiD can be received by:

• the administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death; or
• the prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request, so that they may self-administer the substance and in doing so cause their own death.

MAiD legislation is the removal of such acts as criminal acts for which prosecution would occur.

Question 2: What should I do if a Veteran does not have a primary care provider such as a physician or nurse practitioner and has questions about MAiD?

Answer 2: If a Veteran does not have a primary care provider, the Veteran Service Team (VST) member can support the Veteran in connecting with their local health authority who can assist them in obtaining a primary care provider to have their questions answered. As indicated in the Directive, it is not the responsibility of the VST (or any VAC employee) to provide advice, guidance or suggestions to Veterans relating to a client’s considering or seeking MAiD.

Question 3: What should I do if a Veteran is considering or has chosen MAiD and would like to understand the impact to their VAC benefits and services?

Answer 3: Veterans who explore the possibility of MAiD may approach VAC to learn the potential impact on their benefits. They may also wish to learn how this could impact VAC benefits for their families. VAC continues to offer support to Veterans in understanding the impact on their benefits and services when are considering or have chosen to pursue MAiD. Case specific objective information can be provided to the client by the VST member about VAC benefits, services and programs. Please refer to the Condolence and Benefit Information Letter Process for additional information on various scenarios and consultation with a Standards Training and Evaluation Officer (STEO) is encouraged as each situation should be examined on case-by-case basis.

Question 4: A Veteran I am working with is expressing interest in pursuing MAiD and is also experiencing thoughts of suicide. What should I do?

Answer 4: The MAiD process, including procedural safeguards to ensure there is informed consent for the person pursuing MAiD is clearly outlined in the Criminal Code of Canada and under its supporting regulations. If you are concerned the Veteran who has expressed interest in pursuing MAiD may also be experiencing thoughts of suicide, please refer to the Suicide Awareness and Intervention Protocol and you may consult with your manager and a Subject Matter Expert (SME) such as Mental Health Officer (MHO) to support you with this protocol.

Question 5: As a VAC employee, I am feeling impacted by a conversation with a Veteran who is exploring or has chosen to pursue MAiD. What supports are available to me?

Answer 5: It is important that you feel supported when a Veteran you are working with has decided to pursue MAiD with their primary care provider. You are encouraged to consult with your Case Management Practice Consultant (CMPC), or your manager for support in navigating this situation. Guidelines for Caring Carefully provides helpful strategies and information for you relating to self-care, navigating work-induced stress and others. In addition, the Employee Assistance Program (EAP) provides the support of a confidential counsellor for all VAC employees.

Question 6: What is the role of VAC Health Professionals with respect to MAiD?

Answer 6: Canada’s MAiD legislation is part of the Criminal Code of Canada and is outside of the jurisdiction of VAC. VAC has no role in the assessment of Veterans for the purpose of MAiD. Veterans should contact their primary care provider, or their local or regional health authority if they wish to learn more about and/or pursue MAiD.

Question 7: A Veteran I am working with has pursued MAiD with their primary care provider. Do I follow the Suicide Notification Process?

Answer 7: According to Veterans Affairs Canada, if a Veteran pursues MAiD with their primary care provider, they are not considered to have completed suicide. Please follow the Condolence and Benefit Information Letter Process.

Question 8: What and how do I document a discussion of MAiD with a Veteran?

Answer 8: If a client has brought up the topic of MAiD to a Veteran Service Team member, you should document the facts of the conversation as you would for any other Veteran contact. Please see Service Delivery Documentation Guidelines - Training for more information on documentation.

Question 9: What and how should I report information when I have had a discussion of MAiD with a Veteran?

Answer 9: The Veteran Service Team member should report that a discussion of MAiD occurred with a Veteran directly to their manager and the date of the discussion. Identifiers such as name or file number are not required. The information will be provided to the Area Director and subsequently to the Director General of Field Operations.

Question 10: Why am I reporting to management information regarding discussions of MAiD with a Veteran?

Answer 10: Reporting information regarding discussions of MAiD allows the Department to understand trends and explore possible training needs and for you to be supported following these discussions with Veterans.

Question 11: Where can we direct media inquiries on the topic of MAiD?

Answer 11: If a VAC employee receives a media inquiry, they are to follow the following operational process: General Public or Media Inquiries. VAC employees are not to comment on the media inquiry, and are to provide the caller with the general inquiries phone number (613-992-7468).

The Department places the highest priority on ensuring that Veterans and their families have the support and services they need when and where they need them. This includes ensuring that encounters with VAC staff are conducted in a respectful and compassionate way. The distress this situation has caused to those involved and the Veteran community as a whole cannot be underestimated. The Department deeply regrets what transpired and takes very seriously issues related to MAiD and Veterans’ well-being. The steps taken through this investigation and the changes being implemented will serve to maintain the trust of the Veteran community.

Through its comprehensive investigation, the Department has confirmed the four cases isolated to a single employee who is no longer with the Department. Each additional allegation that has been brought forward to date has also been thoroughly investigated and confirmed to be unfounded. The Department remains open to hearing from Veterans and stakeholders and encourages anyone with information to come forward. VAC will continue talking with Veterans and employees about this issue and will follow up on any new information or requests that it receives. Any Veteran who is not comfortable bringing an issue forward to the Department should contact the Office of the Veterans’ Ombud.

VAC staff are the Department’s greatest asset. The Department is concerned that these incidents, isolated to one employee, may cause Veterans to hesitate in reaching out to the Department. Veterans Affairs Canada staff remain committed to ensuring a continued, high standard of service and care for Veterans and their families. The new and strengthened quality assurance processes put in place, combined with increased staff training and guidance, will help to prevent this type of situation from happening again. The Department will do everything in its power to maintain Veterans’ trust in Veterans Affairs Canada.

Although they were isolated to just one employee, the Department understands the seriousness of these incidents and wants Veterans to trust that VAC employees are available to support their needs in a respectful and compassionate manner. While early actions have been taken to ensure this type of incident does not happen again, further actions aimed at maintaining Veterans’ trust will be taken.

Moving forward, the Department will:

• Strengthen and deliver mandatory and clear employee training and materials on MAiD for new and existing frontline staff
• Establish enhanced reporting procedures immediately that will ensure that significant incidents are raised to the Assistant Deputy Minister and Deputy Minister levels more quickly where appropriate.
• Increase Monitoring for Issues and Trends
• Conduct a Review of the Escalation Process — to be led by the Department’s Audit and Evaluation Division
• Consult with Veterans and stakeholders on recording telephone conversations with case managers and Veteran service agents

Strengthen and deliver mandatory employee training on MAiD

• Prior to this incident, there was no specific guidance on MAiD included in VAC’s training materials because it was understood that Veterans should only discuss MAiD considerations with their primary care provider. Explicit guidance around MAiD and how to have conversations about MAiD is now included in VAC’s training program for new and existing employees. Going forward, training on MAiD will be mandatory and it will reinforce that providing advice on MAiD is not a VAC service and will provide information on the available programs and services offered to support the health and well-being of Veterans.
• VAC has created training specialized for all employees who provide direct, front-line support to Veterans. Work is underway to standardize training for all front-line employees and ensure staff have access to consistent information. The Department is committed to ensuring staff has the tools and training they need to do their jobs. It will be looking at how it can learn from this situation with a focus on ensuring Veterans receive the best possible support from VAC.

Establish enhanced reporting procedures and strengthen processes

This incident has highlighted the need for VAC to review its quality assurance (QA) framework across the full spectrum of services delivered to Veterans and their families. VAC is committed to exploring QA from a broader service delivery to Veterans lens. With service points across the country, VAC is continually working to improve service to Veterans and further steps will be taken to strengthen its existing QA processes with a goal to:

• Ensure the quality of service is exceptional at every step of the process and follows the standards of practice, policy, directives, guidelines and business processes as intended, and
• Allow employee performance concerns to be addressed as they occur and provide frontline staff with regular feedback on the quality of their work.
• Identify opportunities to improve how VAC delivers services to Veterans, former RCMP members and their families.

Through the investigation, the reporting process for alerting all levels of management about significant incidents in a timely manner was identified as a weakness. A new business process has been developed that will help to ensure when Veterans raise MAiD with front-line staff, employees are to advise their supervisors and Area Director so it can be escalated to senior management. If a Veteran raises MAiD, employees are directed to raise it with their manager. The manager and area director now escalate it to the Director General of Field Operations. If further investigation reveals any inappropriate action, the incident would then be raised to the Assistant Deputy Minister Service Delivery and the Deputy Minister. Front-line staff have received training on this new business process to ensure it is understood and fully implemented. This process will be examined as part of the Audit and Evaluation Division’s review to identify ways to make it as efficient and effective as possible.

During fiscal year-end performance management discussions, managers will engage front-line staff in discussions about MAiD to determine if they have any related training needs or questions about the new guidance on MAiD and to identify further opportunities for improvement. Starting on April 1, 2023, area directors will have a new commitment added to their Performance Management Agreements requiring them to conduct increased QA monitoring of files, phone calls and secure messages.

Increase monitoring for issues and trends

VAC’s existing QA efforts will also be further enhanced to include specific monitoring around how frontline employees are handling discussions about MAiD, as well as any other emerging issues. Since November 2022, additional resources have focused on increasing monitoring and oversight.

• Calls to the NCCN are recorded and managers regularly review these recordings for quality assurance and training purposes. Managers are now reviewing more calls for each analyst — more than doubling the volume of calls being monitored. Reviewing more calls will help to identify staff learning needs and it will also help the Department to quickly identify service delivery trends and emerging issues.
• Secure messages received from Veterans via MyVAC Account will continue to be regularly reviewed. For new staff working on secure messages, managers will review their first 30 secure messages. On an ongoing basis, 7 messages per month will be reviewed for each staff member responding to secure messages. This represents 2% of messages being reviewed which is the accepted industry standard. When applicable, staff use pre-written response templates to ensure standardized service and quality.
• Increased review of call recordings and file reviews will allow management to identify issues at the individual level and correct it with the employee. If trends are identified broader training might be required to help address any gaps. Management will discuss these trends at the regular Field Operations Management Committee meetings.

In addition to strengthening QA efforts, VAC will continue to regularly survey Veterans to gauge satisfaction and areas of concern. For example, the NCCN measures their level of satisfaction with the service received by offering the option of completing a survey after the call. Feedback from these surveys and other program-specific surveys will enable VAC to identify further opportunities to improve service to Veterans and their families.

2023 escalation process review by Departmental Audit and Evaluation Division

The Department’s Audit and Evaluation Division will conduct an independent and objective review of the escalation process. This will include the processes and procedures in place in the Service Delivery Branch for the identification, reporting and following up on sensitive/significant incidents raised by Veterans (or brought to the attention of VAC). This review is expected to commence in April 2023, and opportunities for improvement identified in the review will be fully implemented.

Consultation with Veterans & stakeholders on recording telephone conversations

Currently, the only calls VAC records are those to the National Contact Centre Network (NCCN). Since this incident came to light, it has been suggested that calls between Veterans and the VAC employees who serve them should be recorded. Others have raised privacy concerns about recording conversations and how it could damage the building of a trusting relationship between the Veteran and VAC employees serving them. Recording conversations would be a significant shift in practice for VAC, however the Department is open to hearing from Veterans on this approach.

In 2023, the Department will use a variety of channels to engage with Veterans and stakeholders to get their feedback on recording calls between a Veteran and their case manager or their Veteran service agent. Through a consultation process, VAC will assess the impact it could have on Veterans, determine how it could be beneficial for Veterans, and hear any other concerns Veterans may have. In addition to meeting with Veterans’ organizations, the Department will use its Let’s Talk Veterans online consultation tool to take the pulse of opinions on the recording of calls. The Department is also reviewing other federal and provincial government departments’ policies related to recording conversations with clients. All input gathered will help to refine a proposed way forward in improving service to Veterans. Veterans can rest assured that no changes will be made until after a full and thorough consultation process has taken place.