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Record of Discussion – Care and Support Advisory Group

Thursday, April 6 – Friday, April 7, 2017
Lord Elgin Hotel – MacDonald Boardroom, Ottawa, ON

In Attendance

  • Kim Andrews, A/DG Service Delivery and Program Management (A/VAC Co-chair)
  • Mary Boutette, The Perley and Rideau Veterans’ Health Centre (Member Co-chair)
  • Carolyn Gasser, Royal Canadian Legion (via teleconference)
  • Major (Retired) Bruce Henwood (Member Co-chair)
  • Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces
  • Marie Andrée Malette, Caregivers Brigade
  • Percy Price, NATO Veterans Organization of Canada

Regrets

  • Dr. Alice Aiken, Dalhousie University
  • Sylvain Bouliane, VeteransCanada.ca
  • Candace Chartier, Canadian Alliance for Long Term Care
  • Debbie Eisan, Aboriginal Veterans Autochtones
  • Dr. Norah Keating, University of Alberta

Minister’s Office

  • Sherry Romanado, Parliamentary Secretary to the Minister of Veterans Affairs
  • Peter Cullen, Assistant to the Parliamentary Secretary
  • Dan Bourque, Stakeholder Relations

Veterans Affairs Canada

  • Karen Ellis, Associate Deputy Minister (presenter)
  • Kim Andrews, A/DG, Service Delivery Program Management (A/VAC Co-chair)
  • Sandie Williamson, A/Senior Director, Strategic & Enabling Initiatives, Service Delivery and Program Management
  • Shawn MacDougall, Senior Director, Strategic Policy Integration (presenter)
  • Madeleine Legros, Researchers, Health Professionals (Presenter)
  • Janice Burke, Director General, Team 2020 (Presenter)
  • Sonja Sheen, Manager, Team 2020 (Presenter)
  • Maryse Savoie, Director, Field Operations (Presenter)
  • Mary Nicholson, Director, Health Care and Rehabilitation Programs (Presenter)
  • Marie-Eve Chagnon, Senior Analyst, Stakeholder Engagement and Outreach

Observer

  • Timothy Zurakowski, Office of the Veterans Ombudsman (Observer)

Welcome and Overview of Agenda

Co-chairs Bruce Henwood, Mary Boutette and Kim Andrews welcomed the members. The Parliamentary Secretary introduced herself, thanked the group for its work to date and reminded members that Budget 2017 contains concrete action items that were developed from stakeholder groups like theirs, which represent veterans’ voices across Canada.

The co-chairs provided a brief overview of the work proposed for the months ahead and suggested a July 2017 meeting in Charlottetown, to receive further presentations on key themes and to develop recommendations for the Minister to be delivered in late August-early September. Recommendations will focus on the following items from the group’s mandate: the Veterans Health Care Regulations, Care and Support (services), and the Veteran Independence Program (VIP) (services).

The Record of Discussion from the December 9, 2016 teleconference was briefly reviewed. The group also discussed membership issues.

Budget 2017

The group supported Budget 2017’s Veterans’ Education and Training Benefit and agreed with elements supporting convergence and transition, as well as the Caregiver Recognition Benefit. However, members noted the Budget lacked mention of a Veteran ID card and details on financial security as well as the return to pensions for life.

Presentation: Veteran and Family Health Strategy

The presentation provided an overview of VAC’s current approach to health care programming and outlined the development of the Veteran and Family Health Strategy. The presenters sought the group’s views on the Strategy ahead of its completion in June 2017. The five-year strategy will outline priorities for Veteran and family health that will guide the development of policy options. The Strategy has drawn on a number of sources, including the Office of the Veterans Ombudsman (OVO), Parliamentary Committees and research papers from national health experts on the following topics:

  • Institutional Care / Long-Term Care
  • Home Care
  • Chronic Care
  • Palliative Care
  • Health of Veterans’ Families
  • Complementary / Alternative Care
  • Preventative Care
  • Spiritual Health

The presenters underlined the importance of considering the continuum of care and of providing appropriate support for caregivers. It was noted that fewer than 20% of Canada’s Veterans are currently VAC clients, which raised some concerns within the group. Members suggested that a Veteran ID card might be helpful for outreach and communication purposes. It was suggested VAC’s presentation on Veterans demographic be shared with the group.

Presentation: Contracting of Health Professionals

The presentation provided an overview of the collaboration among VAC, DND and RCMP to establish 4-year contracts with health-care providers that could be accessed by any of the three organizations. It will come into effect April 1, 2018 and will enable each Department to be more efficient.

A member observed that often the onus is on the Veteran to “pull” the services and that there should be more “pushing” of services towards VAC clients. The presenters noted that case managers now tend to do more of the pushing of services. A CAF member mentioned that departmental teams were being created to ensure a seamless transition for the Veterans and continuity in their care services.

Presentation: Journey Mapping

The presentation described the mapping of Veterans’ files to inspect methodology, identify concerns, and gather evidence of a typical journey as it relates to accessing services. The exercise followed over 400 cases as part of the Department’s Service Delivery Review. Early findings included:

  • Lack of follow-up across channels (phone, online, etc.)
  • Telephone tag and repeated calls
  • Veterans are often confused and overwhelmed
  • More reaching-out to Veterans is needed
  • “One-window” concept is required

Members expressed that the findings confirmed what they already knew and agreed that this was a useful exercise. It was suggested that VAC may want to consider using an algorithm to ask targeted questions to ensure more appropriate dispatching, akin to 911 services.

Presentation: Service Delivery Review

The Veterans Affairs Canada Associate Deputy Minister made a presentation on the Service Delivery Review, a mandated exercise to identify opportunities for greater efficiencies and effectiveness in VAC’s service delivery model and to assess the performance measurement capabilities. An important part of that work was to close the seam between VAC and the CAF, and to support the transition of military members from the CAF. A total of 31 recommendations, requiring more than 91 actions, aim to:

  • Align program policy and corporate functions
  • Invest in business tools, technology and training
  • Develop a more integrated, simplified and user-friendly model
  • Strengthen external communications, information sharing and outreach

Other recommendations include simplification of the MY VAC sign-in process, improved digital strategy and e-services and continued review of service delivery.

The Associate Deputy Minister agreed with Advisory Group members that in the current Veteran experience it is the client who does the heavy-lifting. The Department is reviewing service delivery to change this experience and provide a three-tiered approach to Veterans’ needs by targeting three groups: case-managed clientele; self-directed clients; and the group between that may require guided support.

A member noted that Veterans should be given the benefit of the doubt and this would improve the service relationship. The Associate Deputy Minister indicated the review would be an evergreen exercise, with an ongoing opportunity for feedback which was welcomed by the membership.

Presentation: Guided Support Proposal

This presentation provided a deeper focus on the guided support pilot project for the three streams of clients: those with complex needs who require the support of a case manager, those with simple and occasional needs who can self-manage, and those with moderate needs, who require assistance to navigate VAC’s systems and processes. The main objective is for Veterans and their families to feel valued, respected, and satisfied with services. The service-level is based on the needs expressed by Veterans.

There are 3 components to the Guided Support Proposal:

  • Guided support from Veteran Service Agents (VSA), where the VSA is fully responsible and acts as the primary point of contact for a Veteran and family. VSAs are able to do home visits.
  • Guided support post-disengagement (when agreed-upon case management objectives are met) is a very delicate and slow process; it is planned far in advance and entails follow-up calls by VSAs every 3 months.
  • Guided support through the National Contact Centre Network (NCCN) is a reach-out initiative, where a Veteran receives an application package and a follow-up call approximately 2 weeks after the Veteran’s initial application to see if the individual has questions, or needs help in filling out the forms.

It was confirmed that VSAs have some decisional powers such as reducing delays and dealing with certain situations. Members pointed out that the Royal Canadian Legion also offers support to fill out VAC forms.

The presenters confirmed that feedback received from the pilot has been positive, from the 40 Veterans and their families and that 10 participants were in post-disengagement (objectives were met).

Presentation: Joint CAF/VAC Seamless Transition Task Force

Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces, and Care and Support Advisory Group member, made a presentation on transition services, the goal of which is to ensure that all releasing members of the CAF and their families feel supported and have the knowledge and ability to access the range of services available to them through their transition from military to post-service life. The continuum of transition services is based on a national network of more than 130 organizations and individuals, including case managers, veterans service agents, disability benefit officers, and health care professionals, where CAF and VAC must collaborate together to ensure a smooth transition. Both departments are working to simplify the process and ensure that when a member releases, services (such as pension) are already in place. The group is working on streamlining the bureaucratic process of transition, for example there are currently 50 memoranda of understanding between the departments.

Members agreed that a Veteran ID cards should be part of the transition service discussion. Members also noted that raising awareness of VAC services should start during basic training. The group expressed interest in following the convergence efforts between both departments, notably to address the overlap and gaps that currently exist for CAF members released from the military, and to simplify benefits to ensure that Veterans will have a streamlined, client-centric process that is easier to navigate, gets Veterans their services quicker and helps them transition to civilian life.

Presentation: Veterans Independence Program (VIP) Grant Determination Tool Brief

The grant determination tool was introduced because of the need to use a transparent tool to determine reimbursement for grounds keeping and home maintenance. It seeks to remove discretion in an effort to be fair and consistent. It varies based on needs, hours and types of services being paid and varies by region.

Members commented on questions in the VIP form and noted that the economic regions did not factor in rural versus urban centres. The group asked to receive more in-depth information on the program, the rates and the questions in the form. Members indicated they would formulate recommendations related to the VIP form questions. A member recommended that VAC establish a “handy-man grant” to keep seniors in their homes longer.

There was consensus among Advisory Group members and presenters that the VIP model, in Canada and elsewhere, is successful for the Veteran population, acknowledging there is always room for improvement.

Closing Remarks

The co-chairs thanked members for their participation during a very full meeting. The group plans to finesse its forward agenda in July and draft recommendations for the Minister in August or September 2017.

Items for next meeting

  1. Status Update: Veterans Health Care Regulations Review including updates on:
    1. Treatment benefits
    2. VIP
    3. Long Term Care
  2. OVO brief on Long Term Care
  3. VIP Grant Determination Tool brief – more in depth look at rates and form
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