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Record of Discussion – Care and Support Advisory Group Teleconference

Wednesday, July 6, 2016
0830 – 1630 (EDT)
Pearson Boardroom, 8th floor, International Development Research Centre, 150 Kent Street, Ottawa, Ontario

In Attendance

  • Mary Boutette, The Perley and Rideau Veterans’ Health Centre
  • Libby Douglas, Director General, Service Delivery Management (VAC co-chair)
  • Debbie Eisan, Aboriginal Veterans Autochtones
  • Carolyn Gasser, Royal Canadian Legion
  • Major (Retired) Bruce Henwood
  • Dr. Norah Keating, University of Alberta
  • Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces
  • Marie Andrée Malette, Caregivers Brigade
  • Warrant Officer (Retired) Andrew McLean
  • Patrick Murphy-Lavallée, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
  • Percy Price (for Gordon Jenkins), NATO Veterans Organization of Canada
  • Andrea Siew, Office of the Veterans Ombudsman (Observer)

Regrets

  • Dr. Alice Aiken, Canadian Institute for Military & Veteran Health Research
  • Candace Chartier, Canadian Alliance for Long Term Care

Record of Discussion

The first in-person meeting of the Care and Support Advisory Group (hereafter the Group) opened at 9:00 a.m. The Veterans Affairs Canada (VAC) Co-chair welcomed the members and invited them to introduce themselves. Tending to business at hand, members agreed to a minor change to the agenda, the recording of the session for note-taking purposes only, and to take time to review the May 5, 2016 Record of Discussion (ROD).

Changes to the ROD were suggested and accepted, notably the first sentence under the heading “Nomination of a Care and Support Advisory Group Co-Chair” and a correction to an inaccuracy in one of the points under the “Issues” section.

The Director of Long Term Care and Disability Programs, gave an overview of long term care (LTC), highlighting the distinction between community beds and contract beds in hospitals and LTC facilities, and provided an update on the Nova Scotia LTC agreement. Speaking notes were requested, and it was agreed that they would be distributed to the Group.

The Nova Scotia agreement established the designation of 15 contract beds for Veterans only at Camp Hill. The Department has been building relationships and engaged in discussion with several provinces to replicate this agreement so that contract beds for Veterans are secured in LTC facilities across the country.

The issue of beds for Veterans sparked a discussion among members. Several felt that Veterans have not been given the care they deserve, and that the Government favours WWII and Korean Veterans in this regard, creating discrepancies and unequal treatment in LTC among the Veteran population. Members’ collective concerns on this subject was noted and acknowledged as a theme that “a Veteran is a Veteran.”

The Senior Director of Policy spoke to the Group about the research and issues that the Department is looking at vis-a-vis Veterans Health Care Regulations. He stated that they will be looking to the Group for their advice in this regard.

Some members working in Veterans’ health and long term care said that the reality is, and policies must reflect, that Veterans have “unique and special” needs in terms of rehabilitation, restorative care and mental health therapy. The clinical profile is different for Veterans, and not all facilities are responsive to their needs. The VAC Co-chair suggested that a full day should be devoted to this subject and that the Group would be consulted.

The next presentation, The Canadian Veteran Population, delivered by the VAC Director of Research via teleconference contained a wealth of material about the composition of the Veteran population (traditional to modern-day); the military-to-civilian transition, global well-being, and finally, research findings on the well-being of Veterans in Canada.

Members asked whether there is a research focus, or studies being done, on:

  • gender differences in the Veteran population;
  • various cohorts of Veterans (Balkan and Afghanistan); and
  • “minority” group Veterans such as Aboriginal and Lesbian Gay Bisexual Transgender Queer or Questioning (LGBTQ) Veterans.

A member said that while the mantra “A Veteran is a Veteran” is often heard, looking at data only from large groups can be problematic. She asked whether other research methodologies were being considered that could get at this enhanced information (from studies of smaller groups of Veterans) because it could be important to the Group in terms of understanding their issues of care and support.

The researchers acknowledged that more work needs to be done in the area of women Veterans but data accuracy is hampered by the low percentage of women in the reserve and in the regular forces. In the case of LGBTQ Veterans, it is an emerging area and work is being done in the USA on this group.

However, qualitative work is being done by the Department to understand these groups and issues in addition to large population methodologies. Additionally, the Treasury Board Secretariat is requiring Departments to develop policy based on research done through the lens of gender, cultures, urban versus rural populations etc.

A member advised that researchers must consider that in Aboriginal communities, cultural and spiritual contexts matter.

Members reviewed and suggested changes to the Group’s Terms of Reference (TOR). Members agreed to circulate the TOR with changes before the next meeting.

Members then had an opportunity to elect a co-chair among their members in camera. Carolyn Gasser was elected as the Group’s Co-Chair.

The afternoon session was facilitated. Members were asked to consider what they mean by “care and support”. Members offered various thoughts on what care and support would look like or involve:

  • Veteran-centric;
  • Holistic approach to care that is culturally, mentally, physically, and emotionally supportive;
  • Providing care at home is a priority. Home care to Long Term Care, but the gap in-between needs to be addressed;
  • Get out of crisis management;
  • Focus on seamless transition;
  • Get Veterans in the door more easily, not just because they need a hearing aid;
  • Build a new foundation. Look at tangibles (policies) and intangibles (people and their competencies);
  • Quality care and support: accessible, affordable, effective, efficient;
  • How we deliver is just as important as what we deliver;
  • Care and services that are respective and responsive to the wishes and needs of the person;
  • Care is more than a bag of services. The World Health Organization model is about the outcome of the intervention;
  • Doctors and physicians need to liaise with VAC;
  • Put a number of specialists on the person; and
  • Not a cookie-cutter approach.

Other issues arose: privacy laws that prevent a caregiver, even if a spouse, to be the voice of their loved one. A waiver is available to speak or gather information, but acting on behalf of another is more complex and this requires Power of Attorney.

The question what would you like to achieve:

  • Challenges around physical, mental and pain and the unique challenges that might bring in terms of the care and support needed. Not all needs of Veterans are the same; and
  • Give people and communities information about what is available, not just for Veterans, but for organizations that care about them.

How would this group address that as a goal?

  • Key word: communications;
  • More area counsellors to go in person to see the VIP Veteran. See the attendant - often in worse shape than the Veteran. Give a physical assessment of the Veteran;
  • Mandate letter: organize goals around “deliver a higher level of service and care”;
  • Hidden needs of Veterans;
  • Issues around particularly vulnerable groups;
  • Continuity of care;
  • What is the right model for case management;
  • Contribute to regulations based on need of Veteran and not where and when he/she served; and
  • Mental health hot line. (There is VAC Assistance but it is not a crisis line)

At the end of the meeting, members were advised that the Department would like their input on its review of LTC and that this consultation might happen in the Fall 2016. The VAC Co-chair stated that they would set milestones and link them to their mandate. The first short-term goal would be feeding into the LTC Review. Members requested information in advance to help them prepare.

The next meeting of the group would be via teleconference. Three options for dates and times would be sent out in the next few weeks, and a date chosen.

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