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Record of Discussion – Care and Support Advisory Group Teleconference

Wednesday, June 5, 2019
Ottawa Marriott Hotel, 100 Kent Street, Ottawa, Ontario Boardroom - Cartier III

In attendance:

  • Mary Boutette, The Perley and Rideau Veterans’ Health Centre (Co-chair)
  • Major (Retired) Bruce Henwood (Co-chair)
  • Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces
  • Marie Andrée Malette, Canadian Caregivers Brigade

Regrets

  • Debbie Eisan, Aboriginal Veterans Autochtones
  • Sylvain Boulliane,VeteransCanada.ca
  • Percy L. Price, NATO Veterans Organization of Canada

Veterans Affairs Canada Officials

  • Sandra Williamson, A/Director General, Service Delivery and Program Management (Co-chair, Care and Support Advisory Group)
  • Christina Clorey, Senior Analyst, Stakeholder Engagement and Outreach

Presenters (teleconference)

  • Mary Nicholson, Director, Re-establishment, Financial Well-Being, and Business Intelligence
  • Beth Smith-Cooper, National Program Manager, Treatment Benefits
  • Alan MacKinnon, Treatment Benefits
  • Sylvie Thibodeau-Sealy, Director, Veteran Priority Programs Secretariat
  • Tabitha Stubbs, Veteran Service Team Manager, Field Operations Division
  • Jane Hicks, Director, Pension For Life Implementation
  • Fiona Jones, Manager Program Policy Directorate
  • Peter Brumwell, National Program Manager, Benefit Operations

Observers:

  • Laura Kelly, Office of the Veterans Ombudsman (Care and Support Advisory Group)

Opening Remarks

The VAC and member co-chairs welcomed the members. The meeting included round table introductions. The Care and Support Advisory Group last met formally as a group in August 2017. There has been attrition in the group and it was noted there is no quorum for today’s meeting. The member co-chairs highlighted the members of the Care and Support Advisory Group who have stepped down since the last meeting: Dr. Alice Aiken, Carolyn Gasser, Dr. Norah Keating, and Candace Chartier.

Advisory Group Work Plan Discussions

The group spent the bulk of the day discussing the items listed on the Advisory Group Work Plan for the Care and Support Advisory Group, as well as having presentations on several work plan items.

Veterans Survivors Fund: Marriage after 60

The Federal Budget committed 150 million dollars over 5 years to face the challenge of Veterans who marry after 60 – the work is taking place within Veterans Affairs Canada and the Canadian Armed Forces/Department of National Defence. It was explained that if a Veteran marries after 60, the spouse does not receive the superannuation benefit (retirement pension).

Questions were raised regarding what issues the Department is hoping to get input on. Members noted that they would need to see the policy to be able to provide guidance.

Case Management and Guided Support

Concerns were raised regarding the interface between the rehabilitation program and treatment benefits. For example, through rehabilitation a Veteran may have certain benefits, and when the Veteran moves to guided support they may lose these benefits.

It was expressed that there needs to be better transition between case management and guided support regarding goals, and better communication and expectation setting regarding the timeline for guided support services (e.g. guided support for one year post case management).

There was an interest in viewing the screening tool and risk assessment. It was noted that Service Excellence Advisory Group is working on this topic as well.

Further Refine Life Trajectory

It was noted the Veterans Affairs Canada Policy Division have the Care and Support Advisory Group report from 2017. The Office of the Veterans Ombudsman noted that their report has a number of similar themes.

Veterans Emergency Fund

The Director, Re-establishment, Financial Well-Being, and Business Intelligence delivered a presentation on the Veterans Emergency Fund.

The Veterans Emergency Fund has been in place for just over a year and has the potential to help Veterans across domains of wellbeing. The maximum grant amount per Veteran per year is $2500, however exceptions can reach $10,000. Further Gender Based Analysis Plus work will continue on the program through qualitative research.

Next steps for the program include honing the definition of “unexpected” and working on a new business process which follows an “if, then” model.

Discussion

  • Questions on the measurement and data collection of the program were raised, for example:
    • whether Veterans Affairs Canada is capturing repeat applications from Veterans and families;
    • whether Veterans Affairs Canada is measuring internal and external referrals to resources from the Veterans Emergency Fund;
    • who are the top organizations referring Veterans to the fund;
    • whether there is a breakdown of the “other” funding category (in terms of demographics and statistics);
    • whether there is an overrepresentation of current Veterans Affairs Canada clients versus new clients who apply to the fund; and
    • whether Veterans Emergency Fund data will be used to review the effectiveness of the other programs Veterans Affairs Canada offers.
  • A suggestion was raised regarding the idea having something similar to the Canadian Armed Forces CPAF loans. It was noted that the Veterans Emergency Fund is meant to provide rapid financial assistance, and having a loan program would change the program significantly.
  • Dental services were noted as a major area for applications to the Veterans Emergency Fund in the “Other” category. It was suggested that this category may warrant its own category in the fund. A member co-chair noted Veterans Affairs Canada could consider including the Pensioners Dental Service Program as a service that Veterans could opt into.
  • It was suggested that if the Public Opinion Research proposal for qualitative research on the Veterans Emergency Fund can be shared, the Care and Support Advisory Group could provide input on the questions proposed for this research.
  • Members requested the Veterans Emergency Fund definition of emergency and the criteria for the Fund.

Treatment Benefits

The National Program Manager, Treatment Benefits, delivered a presentation on Treatment Benefits, including an overview of treatment benefits, eligibility (actual and forecasted recipients), coverage (A and B coverage), and programs of choice (14 in total). She was joined by a member of the newly established Treatment Benefit Renewal team, who provided an overview of their work aimed at improving delivery of the program.

Discussion

General

  • Members noted that some of the key words do not work in searching the benefit grids on the Veterans Affairs Canada portal. A suggestion was made to do some communications outreach on the Medavie Client Portal and bolster My VAC Account.
  • A question was raised regarding when Veterans Affairs Canada can exceed the rates for benefits. The Veterans Affairs Canada co-chair noted that the standard is 20% or a $20 buffer for Programs of Choice 1 and 7. For example, if something is on the grid under $100, the buffer is $20 and over 100, it is 20%.
  • Communication of A or B line coverage was discussed as the benefit card no longer provides that information. It was noted that the disability letter and the Veterans Affairs Canada portal provides this information.

Prescriptions

  • Regarding Program of Choice 12 (Related Health Services), a suggestion was made to consider removing prescription requirements for certain health benefits (e.g. physiotherapy, massage therapy, etc.) to improve efficiency.
  • A suggestion was offered that certain over-the-counter medications should not require a prescription or that there could be a dollar limit for over-the-counter medications without a prescription.

Health Spending Account

  • The idea was raised about having a health spending account for Veterans to allow more flexibility on how to allocate resources. It would not be a transfer of funds but instead an extra account (e.g. $200-$500) that the Veteran could apply to health spending.
  • Alternatively, the idea of a “wellness fund” was also suggested which could pay for gym memberships, etc. It was questioned whether any changes in the Department in this regard would have to be cost neutral.

Over the Counter Medication

  • The Veterans Affairs Canada co-chair noted that they will review over the counter medications, specifically whether you need prescriptions for certain benefits and prescriptions where the drug identification number is not on the benefit grid.

Priority Areas

  • It was raised that Veterans Affairs Canada could look at Program of Choice categories and look into the most commonly denied claims, prioritize which Programs of Choice should be reviewed first, and identify problem areas that could be addressed quickly.
  • The VAC co-chair noted that they are continuing to look at improving the benefit grids and considering different models for treatment benefits. In addition to the Benefit Review Committee, the broader perspective of the Care and Support Advisory Group could be helpful in moving this work forward.

Veteran Homelessness

The Director, Veteran Priority Programs Secretariat and Stakeholder Engagement and Outreach delivered a presentation on Veteran Homelessness.

The Veterans Affairs Canada homelessness poster was discussed.

VAC is leading the development of an approach to preventing and ending Veteran homelessness in Canada using a whole-of-government approach to address current gaps and improve support to Veterans in crisis. This approach was developed in consultation with Employment and Social Development Canada, Department of National Defense/Canadian Armed Forces, and the Canadian Mortgage and Housing Corporation.

Veterans Affairs Canada’s approach includes four themes:

  1. Lead and Engage: Improving collaboration and leadership through all levels of government, including at local and regional levels.
  2. Find: Improving outreach and engagement and to identify and connect with homeless Veterans.
  3. Assist: Improving mechanisms to assist people who identify as homeless through housing, employment, and other support (e.g. Education and Training Benefit).
  4. Prevent: Preventing homelessness through optimizing well-being.

An example of a whole-of-government approach is the Back in Step video, which Veterans Affairs Canada created to help Royal Canadian Mounted Police identify homeless Veterans. Moving forward, Veterans Affairs Canada will continue to align and coordinate efforts across government and community to address homelessness.

Discussion

  • Homelessness was noted as a new item for the Care and Support Advisory Group and members wanted to ensure that the right people are at the table on the Advisory Group (i.e., service providers, people with lived experience).
  • It was highlighted that the Veteran and Family Well-Being Fund has provided funding to a number of organizations serving homelessness populations, e.g. Old Brewery Mission, RESPECT, VETS Canada.
  • The homelessness poster may imply that you need a phone. The idea of having business cards with the same information as the posters was offered as an additional source of information. A suggestion was made to add a bar code image to the homelessness poster so that people can scan it with their phones.
  • A request was made regarding the rates of homelessness among Veterans versus the Canadian General Population. Stakeholder Engagement and Outreach to send out Employment and Skills Development Canada’s Point in Time Count which counts how many Veterans self-identify as homeless.
  • Veterans Affairs Canada is not a central funding partner when it comes to housing initiatives. In terms of actual housing, that mandate falls within other federal government departments (e.g. Employment and Social Development Canada and the Canadian Mortgage and Housing Corporation).

Plenary Session

Pension For Life

The Senior Director, Pension for Life Implementation delivered a presentation on Pension for Life. Achievements highlighted included transferring over 80,000 clients and sending out over 190,000 letters. Moving forward, VAC will continue to work on functionality issues and enhanced training for staff.

Discussion

  • A member questioned why the letters sent out to Veterans were stock letters as opposed to individualized letters (e.g. “if you are receiving this benefit” as opposed to “as you are in receipt of this benefit”). It was noted that in this case, VAC focused on the importance of communicating changes to Veterans’ payment information early. If VAC had taken additional time to further customize the letters, Veterans would have received their first monthly Pension For Life payment before they received the letter explaining the change in benefits.
  • A question was raised on where Veterans Affairs Canada sources the base wages for pension income. The Canadian Forces Superannuation information will come from either the Canadian Armed Forces or the Veteran, depending on the case. When a Veteran notes that the amount Veterans Affairs Canada is using for the Canadian Forces Superannuation is out of date, the Veteran is requested to send proof of the correct amount.

Guided Support

An Area Director, Field Operations Division, delivered a presentation on Guided Support. Guided support provides services to VAC clients with a moderate level of need as part of the continuum of care model. Guided support was implemented on December 17, 2018 nationally with six face-to-face training opportunities.

Currently 951 Veterans are assigned to guided support. There are two streams: 1) Veterans who are followed through guided support for one year after case management; and 2) Veterans who have a high level of service need for a defined period of time (e.g. Long Term Care). Full reporting capacity is not available at this time to determine if Veterans are in Stream 1 or Stream 2 of Guided Support however anecdotally we know that most are Stream 1.

It was noted that at this time, guided support is not offered for out of country operations.

Discussion

  • There was a question regarding the difference between the criteria for case management and the criteria for guided support. It was suggested that the role of the Veteran Service Agent should be explained and put online.
  • A member raised the importance of informing clients of the 90-day guided support follow-up and the one year guided support follow-up standards post disengagement from case management, as well as the difference in authorities between Case Managers and Veteran Service Agents.
  • There were questions raised regarding whether Veteran Service Agents will create a plan or a checklist regarding the Veteran’s goals for 30 days, 3 months, etc. It was noted that the Veteran Service Agents will use a risk assessment in the screening tool but the intent is not to set goals. There was interest expressed from the Service Excellent Advisory Group members in viewing a copy of the risk assessment tool.
  • It was noted that the ratio of Veteran Service Agents to clients was 16 to 30 during the guided support pilot, and it was clarified that Veteran Service Agents do not need the same qualifications as Case Managers.

Women Veterans’ Forum

The Director, Veteran Priority Programs Secretariat and Stakeholder Engagement and Outreach, delivered an update on the Women Veterans’ Forum held in Charlottetown on May 23, 2019.

The forum had three objectives:

  1. Develop ideas and potential solutions to policy and program challenges facing women Veterans and their families;
  2. Present existing research on Canadian women Veterans and discuss directions for future research; and
  3. Promote collaboration and build strong networks among women Veterans and stakeholder groups.

Some of the findings of the event included the need for increased communication, increased Gender Based Analysis Plus research, better transition support for women Veterans, and improved research on healthcare for women Veterans, among others areas.

The next steps coming out of the forum include developing a work plan that has short, medium and long term goals for the Department, e.g. improving Veterans Affairs Canada’s website to address issues specific to women Veterans.

Discussion

  • It was noted that a report summarizing the forum will be distributed shortly.
  • A member noted that there are gaps in terms in entitlement and benefit grids regarding modern women Veterans, as well as gaps in the research. It was highlighted that the new Statistics Canada question on the Census may provide more data.
  • A point was raised regarding the importance of clarifying roles and responsibilities between the Canadian Armed Forces, Veterans Affairs Canada and the community when it comes to serving women Veterans.
  • The VAC co-chair noted the importance of ensuring that Veterans Affairs Canada puts forth a concerted effort to produce concrete and measurable actions that are within the mandate of the Department and sustainable over time.

Closing Remarks

The meeting concluded with a roundtable where members were thanked for their input and participation. It was noted that a Record of Discussion will be provided.

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