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Record of Discussion – Care and Support Advisory Group

Wednesday, July 26, 2017
Boardroom 1403, 14th floor, 66 Slater Street
Ottawa, Ontario
08:15-16:30 (EDT)

Thursday, July 27, 2017
The Perley and Rideau Veterans’ Health Centre
1750, Russel Road
Ottawa, Ontario
08:30-14:30 (EDT)

In Attendance

  • Dr. Alice Aiken, Dalhousie University (26 July)
  • Mary Boutette, The Perley and Rideau Veterans’ Health Centre (Co-chair)
  • Debbie Eisan, Aboriginal Veterans Autochtones
  • Carolyn Gasser, Royal Canadian Legion
  • Major (Retired) Bruce Henwood (Co-chair)
  • Marie Andrée Malette, Canadian Caregivers Brigade (27 July)
  • Percy L. Price, NATO Veterans Organization of Canada

Regrets

  • Sylvain Bouliane, Veterans Canada (.ca)
  • Candace Chartier, Canadian Alliance for Long-Term Care
  • Captain (Navy) Marie-France Langlois, Director, Casualty Support Management, Canadian Armed Forces
  • Dr. Norah Keating, University of Alberta

Minister’s Office

  • Ben Charland, Stakeholder Relations (mornings)
  • Daniel Bourque, (afternoons)

Veterans Affairs Canada

  • Libby Douglas, Director-General Service Delivery and Program Management and VAC Co-chair
  • Sandra Williamson, Director, Long Term Care and Disability Benefits (July 26)
  • Lynne McCloskey, A/Director, Long Term Care and Disability Benefits Directorate (presenter – via videoconference, July 26)
  • Beth Smith-Cooper, Senior Planning, Policy and Program Advisor, Directorate (presenter – via videoconference, July 26)
  • Kelly Carter, A/Manager, Policy Development, Policy Directorate (presenter – via teleconference, July 26)
  • Katherine Spencer-Ross, Director, Stakeholder Engagement and Outreach (morning July 26)
  • Janice Ployer, Senior Analyst, Stakeholder Engagement and Outreach

Observer

  • Amanda Jane, Office of the Veterans Ombudsman

Day 1: July 26

Welcome and Terms of Reference

Co-chairs Bruce Henwood, Mary Boutette and Libby Douglas welcomed the members.

As Advisory Group members had received copies of revised terms of reference (Terms of Reference – Care and Support Advisory Group - Veterans Affairs Canada) in advance of the meeting, all members present submitted their signed codes of conduct.

Presentation: Supporting Veterans in Long-term

An overview of the Veterans Affairs Canada Long-term Care (LTC) program was provided by Lynne McCloskey, Acting Director, Long Term Care and Disability Benefits. The presentation included background and historical context on the evolution of long term care, the authority and program eligibility, how it works, the current situation as well as some of the challenges.

The presenter explained that a means-test is applied to determine whether a Veteran is qualified based on level of income, as well as the amount of contribution an eligible Veteran is expected to make. World War II and Korean War service Veterans, Veterans with a 78% or greater level of disability, and Veterans with insufficient means do not contribute to the cost.

The presentation generated significant group discussion, including a concern that the complex eligibility criteria mean that some Veterans do not understand why they are ineligible when others are eligible. The group recommended that the long term care program be standardized based on need, and not based on when or where a Veteran served or was injured. Unless there is clear evidence that a Veteran’s needs are not related to service, VAC should presume that the needs are related to service.

As well, the group noted that better communication is essential as some Veterans may not understand the eligibility criteria. The group felt that some Veterans may be screening themselves out, without knowing that they may be eligible.

The group acknowledged the challenges of providing consistent care, given the individual agreements with provinces. The department confirmed that despite the multiple agreements, quality of care is always a priority.

The group also reminded the department that a Veteran’s spiritual and cultural needs are important when making improvements to services.

Presentation: Continuum of Care: The Journey from Home Care to Long Term Care

The Office of the Veterans Ombudsman (OVO) observer of the advisory group meetings presented on the findings of the OVO evaluation of support for Veterans across three settings: care at home, assisted living and long-term care.

In conducting the review, the OVO considered whether the right programs are in place and whether the programs are adequate and accessible. The OVO found inequities with the eligibility criteria for VIP and Long-term Care, inadequate monitoring of Veterans’ advancing health care needs, and inadequate support for Veterans who need more assistance than is available through the VIP. The OVO also found that the continuum of care available may differ not only by province, but by geographic area (i.e. urban vs. rural). As a result of its findings, the OVO has developed a number of recommendations for Veterans Affairs Canada. The final report will be available in October 2017.

The group discussed how the OVO findings and proposed recommendations related to the advisory group’s own assessment of gaps in care for Veterans. In particular, both the advisory group and the OVO felt that there is a gap in service between those needing supports to live independently at home and those needing access to long-term care facilities. The advisory group recognized that the level of services may differ from urban to rural areas, as specialty services offered through the provinces may not be available in rural and remote areas. Therefore, provision of care to Veterans living in rural and remote communities needs to be considered. Overall, the group felt that the OVO findings and recommendations are consistent with the recommendations being prepared by the advisory group.

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

In follow-up to the May 2017 Care and Support Advisory Group meeting, this presentation provided background on the Grant Development Tool (GDT) and its link with the Veterans Independence Program, an in-depth overview of the GDT, and changes resulting from the introduction of the GDT.

The Advisory Group members acknowledged that the provision of housekeeping and grounds maintenance services is important for allowing individuals to remain in their homes longer and maintain independence.

Presentation: Veteran and Family Health Strategy – Issue Diagnostique

The presentation provided the key findings of the Veteran and Family Strategy Issue Diagnostique. As part of the exercise, the department considered VAC’s role in Veterans’ health care historically, previous reviews and reports conducted by internal and external organizations and committees from 2000 to the present, research findings of eight national health experts, international approaches, emerging trends in health care, an analysis of the Canada/provincial/territorial health care context, and a robust internal and external engagement strategy.

Key findings of the diagnostique include:

  • Veterans have a higher prevalence of chronic physical health and mental health conditions than similarly aged Canadians, yet less than 20% of Canada’s Veterans receive services from the department.
  • Given provincial responsibility for the provision of health care to Canadians, there are inconsistencies in the way health care is delivered across the country.
  • Emerging trends in health care and in other countries’ departments of Veterans Affairs are moving toward more integrated models of care.
  • The current eligibilities for VAC programs are complex, time-consuming and illness-focused, and are a barrier to integration across the continuum of care.

These key findings are helping to frame options for improvements to health care for Veterans and their families. For example, less time spent on administrative matters concerning eligibility could lead to more resources available for assessing and meeting the needs of Veterans and their families. As well, a shift in focus from disability to wellness would result in more emphasis on the roles of prevention, promotion and ability.

Overall, the group expressed its support for the direction that VAC is heading with regard to health care for Veterans and their families. They noted that the simplification in eligibilities would be a better approach and would allow VAC to better address Veterans’ needs. A concern was raised about VIP eligibility for spouses: if a Veteran in receipt of VIP dies, the services can continue to the spouse, but if the Veteran dies with no VIP eligibility, the spouse is not eligible for VIP. The presenter agreed to review this concern further.

Closing Remarks and Roundtable

The member co-chairs provided a summary of the meeting and indicated their satisfaction with the discussion. All participating members agreed that the discussions were excellent, the presentations were very informative and that they are in a better position to refine their draft recommendations to the Minister.

Day 2: July 27

Advisory Group Discussion and Recommendations:

The group focused its time on its draft framework for a continuum of care and refining recommendations for the Minister. In addition, the group was given a tour of the Perley and Rideau Veterans’ Health Centre and had the opportunity to meet some of the residents.

Next Steps:

The member co-chairs will revise the Group’s recommendations to the Minister and circulate for group consensus.

The co-chairs agreed to a teleconference on August 1 with the Minister’s Office in follow-up to the meeting.

The VAC co-chair will forward materials on VAC services and benefits for circulation to the participants at the National Association of Friendship Centres Conference being held in November 2017.

The Stakeholder Engagement and Outreach group will work with the co-chairs to establish a date for a future meeting.

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