NOVA SCOTIA HOUSE OF ASSEMBLY
Tuesday, July 5, 2016
Legislative Committees Office
Camp Hill Veterans’ Memorial Hospital
Printed and Published by Nova Scotia Hansard Reporting Services
VETERANS AFFAIRS COMMITTEE
Mr. Derek Mombourquette (Chairman)
Mr. David Wilton (Vice-Chairman)
Mr. Keith Irving
Ms. Patricia Arab
Mr. Ben Jessome
Hon. Alfie MacLeod
Mr. Eddie Orrell
Hon. David Wilson
Hon. Sterling Belliveau
[Mr. David Wilton was replaced by Mr. Brendan Maguire.]
[Mr. Keith Irving was replaced by Mr. Iain Rankin.]
[Ms. Patricia Arab was replaced by Mr. Joachim Stroink.]
Ms. Kim Langille
Legislative Committee Clerk
Mr. Gordon Hebb
Chief Legislative Counsel
Nova Scotia Health Authority
Ms. Lindsay Peach, Vice-President
Integrated Health Services - Community Support and Management
HALIFAX, TUESDAY, JULY 5, 2016
STANDING COMMITTEE ON VETERANS AFFAIRS
Mr. Derek Mombourquette
MR. CHAIRMAN: Good afternoon everyone. Welcome to the Standing Committee on Veterans Affairs. I’m Derek Mombourquette, the MLA for Sydney- Whitney Pier, and I’m the Chair of the committee. Today, we will be receiving a presentation regarding the Camp Hill Veterans' Memorial Hospital.
I want to remind those in attendance to please turn your phones to silent or vibrate. After we go through the presentation and get into questions, I just ask the presenter to let me recognize you before you answer, just for Hansard. We also have a number of items of committee business to deal with after the presentation today.
I’d like to ask members to introduce themselves before we move on to the presentation.
[The committee members introduced themselves.]
MR. CHAIRMAN: I’d like to introduce Ms. Lindsay Peach, who is the Vice-President of Integrated Health Services with the Nova Scotia Health Authority. I now pass the floor over to you for your presentation.
MS. LINDSAY PEACH: Thank you for the opportunity to join you today. For the Nova Scotia Health Authority, it’s certainly a privilege for us to be able to provide care and support to veterans, who have served our country so well.
On behalf of the Nova Scotia Health Authority, I’m pleased to be able to speak to you about one of the ways in which we provide that care through our long-term care services. As you know, we’re not able to speak on behalf of Veterans Affairs Canada. What I am able to share with you today, though, is the relationship that the Nova Scotia Health Authority currently has with Veterans Affairs Canada and more specifically how that applies to the Camp Hill Veterans' Memorial Building.
I understand that your interest relates to Camp Hill specifically, and I believe that that’s best understood within the broader context of services to veterans in Nova Scotia. To that end, I thought I’d begin with some context and perspective, followed by a general overview as to how veterans in Nova Scotia currently access long-term care services. From there, we’ll move into a discussion of the role of the Nova Scotia Health Authority specifically in providing long-term care to veterans and then move into a specific discussion related to Camp Hill, including the new agreement that was recently reached between Veterans Affairs Canada and the Nova Scotia Health Authority. Following that, I’m pleased to take any questions or have any discussion that you might want to have.
There’s several points in terms of context and perspective that I wanted to start by sharing with you today. The first point is that Veterans Affairs Canada, or VAC - and you’ll see that terminology used throughout the presentation - financially supports veterans in long-term care facilities throughout Nova Scotia. This includes contract beds in facilities like Camp Hill or the Northumberland Veterans Unit, or in community nursing homes in communities across the province. As I understand from Veterans Affairs Canada, there are currently 476 veterans in Nova Scotia receiving long-term care. Of those, 280 - or 59 per cent - currently receive that care in contract beds; and 196 - or 41 per cent - are receiving that care in community long-term care facilities across the province.
The second point that I wanted to mention is that Veterans Affairs Canada provides long-term care in the province through contract providers - there are four in total and of those, the Nova Scotia Health Authority is the largest. We have 94 per cent of the contract beds in the province.
The third point I wanted to mention is that the eligibility for services and programs offered by Veterans Affairs Canada is determined by them. As a service provider, we do not determine eligibility. As well, I wanted to note that provincial policies related to long-term care placement do not apply to the Veterans Affairs Canada contract beds, and I can get into that a little bit later.
The fourth point to mention is that we’re not able to speak to the policies of Veterans Affairs Canada or able to speak on their behalf. What I can speak to is the relationship that we have with them as one of the service providers and how those policies apply to us.
In terms of access to long-term care services for veterans in Nova Scotia, as I said, Veterans Affairs Canada determines the criteria and has a process in place to determine eligibility for long-term care. They provide financial support to individuals who require that service, whether it’s in a contract bed like at Camp Hill which we’ll be talking about today, or in a bed in a community-based facility across the province.
Factors Veterans Affairs Canada takes into consideration when they determine that eligibility include a veteran’s health care needs: if they are able to be supported in the community or if they require placement in a long-term care facility; what their service-related disability would be; what their income would be to determine any contributions that the veteran may make to the care; and the military service that the individual has had as well.
As I mentioned, once eligibility for long-term care has been determined by Veterans Affairs Canada, they do provide support for the veteran to access that service in one of two ways. The first way, and one that’s probably less frequently discussed, is community beds. These would be beds located in long-term care facilities and communities across the province that provide care to veterans as well as to community clients. As of last week, there are 196 veterans across the province receiving care in this way. Access to these beds is coordinated through the provincial single-entry access system, and for veterans who are receiving that care, Veterans Affairs Canada funds 100 per cent of the cost of care.
The benefit of enabling veterans to access beds in community facilities is it does enable veterans to have choice in where they live, so some veterans would have a facility preference, for instance. It would also allow them to be as close to home as possible. Our Veterans Affairs Canada contract beds only exist in certain communities across the province, so allowing them to access long-term care in our community-based facilities provides them that option. It does also allow them to be collocated with a non-veteran spouse or another family member.
The second way that Veterans Affairs Canada provides support to veterans requiring long-term care is through contract beds, and that’s often the option that’s discussed. These would be designated beds located in facilities that provide priority access for eligible veterans, again, eligible veterans as determined by Veterans Affairs Canada. Right now, for contract beds, that would include World War II and Korean War veterans; there is another access point for Camp Hill, which I’ll discuss later. Access to these beds is coordinated by Veterans Affairs Canada, as is the eligibility for that. As of last week, there were 280 veterans receiving care in this way across the province.
Of the second category of ways that veterans can receive long-term care in the province, the contract beds, there are four providers in the province, as I had indicated, that provide this level of service: Nova Scotia Health Authority, with 314 beds; High-Crest Springhill nursing home in Springhill, with 10 beds; St. Anne Community and Nursing Care Centre in Arichat, with 5 beds; and Wynn Park Villa in Truro, with five beds.
More specifically, getting into the details of the role of the Nova Scotia Health Authority in providing those contract beds, of the 314 Veterans Affairs Canada contract beds that the Nova Scotia Health Authority operates, 175 are located at Camp Hill in Halifax; 31 of those are located at Taigh Na Mara in Glace Bay; 20 are at Harbour View Hospital in Sydney Mines; 5 are at St. Martha’s Regional Hospital in Antigonish; 20 are at the Northumberland Veterans Unit in Pictou; 23 at the Fishermen’s Memorial Hospital in Lunenburg; 25 at Soldiers’ Memorial Hospital in Middleton; and 15 at Veteran’s Place in Yarmouth.
As I’d indicated, we do have an occupancy rate in some of these facilities. Right now, these beds are about 85 per cent occupied across the province. I do have the occupancy by facility if you’re interested in knowing that. The total budget combined that we receive from Veterans Affairs Canada to operate those beds is $41.8 million. The per diem ranges from $249 to $397, depending on the facility.
Moving, then, into a specific discussion around Camp Hill - Camp Hill was formerly a veterans hospital. It was transferred to provincial jurisdiction in 1978, under the terms of the Camp Hill transfer agreement. Since that time, Veterans Affairs Canada has continued to serve as both a funder and as a collaborator. This agreement was updated in 1992, as a master agreement between the province, the Nova Scotia Health Authority - actually its predecessor organizations - and facilities to provide long-term care.
It’s important to note that Camp Hill is a long-term care residence for veterans. While we do provide nursing and medical care, for certain, for veterans, it is not a hospital. Camp Hill itself is comprised of 175 beds located across seven units that provide priority access to veterans in need of long-term care. They do provide us with an annual operating budget of $25.4 million - that was the budget for 2015-16 - and that translates into a per diem of $397 per day for those beds.
In addition to the nursing care that’s provided at Camp Hill, it’s important to note that the services there also provide a broad interdisciplinary team of support, including respiratory therapy, physiotherapy, occupational therapy, recreation therapy, social work, psychology, and spiritual care. It is a broad-based team support. The other thing I need to note is that Camp Hill also enjoys an amazing amount of support from local Legions, military organizations, veteran support organizations, and volunteers. It’s quite amazing to see the support and involvement of the local community in that facility.
Camp Hill is not licensed as a long-term care facility by the Department of Health and Wellness. However we do hold ourselves to the standards established by Accreditation Canada, the long-term care standards, so we are nationally accredited. The last survey would have been done in April 2014 as part of the Capital Health process at that time, and we received exemplary status from Accreditation Canada. We also do ongoing surveys of the veterans who are residing in the facility to determine their level of satisfaction and make adjustments as we need to.
The utilization of Camp Hill beds - this is the breakdown as of July 4th. Of the 175 beds at Camp Hill, 150 are occupied by veterans. We do have a number of beds at the facility that are occupied by patients who have temporarily relocated due to the Dartmouth General redevelopment. There is an agreement in place with Veterans Affairs Canada that allows us to use beds when they’re not needed by them for temporary purposes. We do have 12 beds that are unoccupied. The unoccupied beds are largely located on two of the seven units.
Given the number of sustained vacancies that we’ve had at Camp Hill, an opportunity was identified to explore ways in which the capacity could be used to meet the long-term care needs of other veterans. While we’ve seen a 43 per cent reduction in the wait-list for long-term care since April 2015, we do continue to experience wait-lists for long-term care in Nova Scotia, and that was having an impact on veterans’ access and care.
On June 24th of this year, Nova Scotia Health Authority and Veterans Affairs Canada reached a new agreement to expand access to Camp Hill for veterans requiring long-term care. Again, just like the contract beds, eligibility for this access is determined by Veterans Affairs Canada. Veterans that are eligible under the Veterans Health Care Regulations for care in a community facility other than a contract bed would be eligible for accessing care under this new agreement at Camp Hill.
Under the new agreement, Veterans Affairs Canada will be responsible for determining the eligibility and assessing the needs of a new cohort of veterans. This is similar to our relationship with them regarding contract beds. We have also agreed that we would work together to ensure that veterans admitted under this new agreement will receive the same high standard of care currently offered at Camp Hill. While we are currently working out the details and the process to operationalize the agreement, we were able to accept the admission of our first resident on June 29th under this new agreement.
I think that concludes the formal part of the presentation. I’m now happy to take questions you might have.
MR. CHAIRMAN: Thank you. We’ll start with questions. Mr. Wilson.
HON. DAVID WILSON: Thank you for coming here today and for giving us an update. I understand your limitations on speaking on behalf of Veterans Affairs Canada, but of course, over the last number of months especially, there has been a lot of attention around vacancies at Camp Hill and the ability for veterans to gain access to those beds.
This new agreement, which I see was reached on June 24th - I know the criteria are with Veterans Health Care Regulations. Do you know what that is? Are you able to provide the committee that regulation? I think that would clear up some of the questions that many families out there have about access to it. If there’s a new agreement, and they’ve changed regulations, is the province able to provide that to the committee today or over the next few days?
MS. PEACH: My understanding from Veterans Affairs Canada - and again, I can’t speak for them - is that this new agreement that we have in place with them did not require a change in their health care regulations that I referenced. So admissions to Camp Hill would be under those regulations. They would be the best ones to provide those. They’re the criteria that they utilize for admissions both to the contract beds as well as these. It’s not something that we would have ready access to.
MR. DAVID WILSON: So the agreement really is that they’re going to use more beds at Camp Hill? I know the province has jurisdiction over the building, the facility. Is that what you’re saying here? There’s a lot of confusion out here. We’ve had a number of cases - Mr. Blindheim, I believe, is the first individual to gain access after what we can assume are changes to some policy that nobody knows about. Really, though, this is just an agreement with the province saying that, potentially, Veterans Affairs Canada will use more of the unoccupied beds at Camp Hill. Is that correct? Am I understanding it correctly?
MS. PEACH: Maybe if I could clarify. The Camp Hill building itself is a resource of the province, operated by the Nova Scotia Health Authority. The agreement that we have with Veterans Affairs is in place with us to be a contracted service provider of long-term care on Veterans Affairs Canada’s behalf, if you want to look at it that way.
This new agreement that we’ve reached with them is to enable them to utilize the 175 contract beds that are available at Camp Hill for a category of veterans other than World War I, World War II, and Korean War veterans, as determined by them. So it’s reaching that agreement that we agree to continue to provide that service to that new group of veterans that they identify, in keeping with the same standards that we would have for the other veterans at Camp Hill.
MR. DAVID WILSON: It’s interesting, though. I’ve been paying close attention to this, and I don’t know what that new criteria is - I don’t think Nova Scotians or Canadians know - so that’s the frustrating part. Hopefully you understand that.
But they didn’t request additional beds at Camp Hill - it’s still under the 175 that have been in agreement for a number of years now, right?
MS. PEACH: Yes, so it would be allowing them to use a category of those 175 for a different purpose, as they deem fit.
MR. CHAIRMAN: Thank you, Mr. Wilson. Mr. Orrell.
MR. EDDIE ORRELL: Thank you, Mr. Chairman, and thank you for your presentation.
I guess my question’s a pretty simple question. With all that has gone on with Mr. Blindheim’s access to Camp Hill’s veterans’ care - I know the Nova Scotia Health Authority operates Camp Hill, as it does all of their long-term care facilities and the hospital - besides the funding from Veterans Affairs Canada, what is the difference between the care that Mr. Blindheim would have gotten if he were in one of the province’s other facilities or in Camp Hill?
MS. PEACH: Because Camp Hill is a facility that is specifically designated to provide care and support to veterans, Veterans Affairs Canada does provide support for other members of a broader allied health team that would be different than other long-term care facilities across the province. So, looking at the unique needs of the veteran population and the care that we’re providing, there are some differences in what Veterans Affairs funds us to provide in terms of that interdisciplinary team, in comparison to other community residences. That would be the difference.
MR. ORRELL: I guess the logical question is, what differences in care would there be? Also, why couldn’t we as a province put Mr. Blindheim in care as a non-veteran until they straightened that away with what was going on with Veterans Affairs Canada? Obviously he needed the care. He needed to be in the care facility.
Putting all the other differences aside, if he needs the care, he’s going to get access to a care facility and then let both levels of government fight out who’s going to pay for it. To me, it was just ridiculous that this poor gentleman was sitting there and two levels of government were fighting over who was going to come and pay for it. Eventually, it’s the same taxpayer who pays for that care, so why didn’t the provincial government say, put him in one of our facilities and we’ll deal with that stuff later on? Is that something that was thought of or talked about? Is it something that happens or doesn’t happen? I guess that’s my question.
MS. PEACH: It’s difficult. We can’t speak to the specifics of cases.
MR. ORRELL: I understand that.
MS. PEACH: It’s difficult to be able to provide all of that context when presented with them in the media as well. I think what we’ve endeavoured to do is, when cases are identified, work with the family or the next of kin to make them aware of other supports that may be available to them. As I’d indicated, veterans can be placed in long-term care facilities across the province, which can sometimes allow for more immediate or more ready access close to home, and does allow for co-location with spouses.
That can take some time as well, but we certainly do try to reach out if they are existing clients of ours to make sure they’re aware of all the options that might be available to them, but recognizing that individuals have choice and so sometimes may prefer a particular placement over another.
MR. CHAIRMAN: Mr. Rankin.
MR. IAIN RANKIN: Just following on the same line of questioning, I’m going to reference the other case that had some prominence - that would be Alan Sagar. I know he’s not yet ready, but the family is looking to plan ahead for obvious reasons. The last time they had any kind of recognition that they would get services was in 2013, and it took about eight months to get those services. As he’s in his 90s, I’m just wondering, does the Department of Health and Wellness actually get involved while he’s waiting to get some kind of recognition? Something could happen abruptly, and if the federal government’s going to take eight months again, what’s the role that the province plays in jumping in there and ensuring that he actually has a place to go?
MS. PEACH: Again, not being able to speak to the specific cases, it’s difficult for us, unless an individual is a client of ours or reaches out to continuing care, to offer that support. So we certainly encourage individuals to reach out to us if there’s other support that they think the continuing care system would be able to provide to them. It makes it easier for us to make those connections for them.
I think what we do try to do in cases like that is to identify what supports we can provide within the provincial system and certainly answer any of the questions they have around what supports Veterans Affairs may be able to provide for them, as well, to the extent that we’re able. In situations where individuals want to plan ahead for their care needs, I think that’s a valuable thing for individuals to be able to do, recognizing that there is a team behind them that looks at their current care needs and helps to try to project the future of what that could possibly look like.
MR. RANKIN: And you mentioned that the regulations hadn’t changed. Is there appetite within the federal government to change regulations? What would be the process there? Do they take information from military relations within provinces? Is there someone who could provide input from our perspective to give advice for possible regulation changes?
MS. PEACH: That would really be a question best asked of Veterans Affairs Canada, what their plans may be for the long-term review of those regulations.
MR. RANKIN: Okay, thanks.
MR. CHAIRMAN: Mr. MacLeod.
HON. ALFIE MACLEOD: Thank you, Mr. Chairman, and thank you, Lindsay, for your presentation. I guess the question really on a lot of people’s minds is, as of the change of regulations on June 24th where now the admission standards are different, if another situation came up similar to the one that took eight months to find a solution - are you aware if this can be avoided again? I guess what really bothers a lot of us, and I think everybody around this table, is the fact that it took that long to actually respond to the needs of a veteran who has served our country.
What I’m interested in, and I think everyone is interested in, is finding out whether or not the changes in the new agreement will keep this from happening again to somebody else.
MS. PEACH: The health care regulations haven’t changed. What has changed is the agreement that Veterans Affairs has with us. My understanding is the applicability of that agreement, if there is a veteran who meets the criteria that they’ve determined under the health care regulations, who requires care in a long-term care facility, whereas before the subset of that population that would be able to be supported at Veterans Affairs Canada contract beds, like at Camp Hill - that category has expanded. They would be able to respond in a situation like that. They determine the eligibility and they advise us when they do have a resident who is appropriate for care in a particular facility.
I understand that that is their intention: to be able to expand the access to deal with situations like that.
MR. MACLEOD: Basically, we’re hopeful, then - or would it be safe to say that the health authority’s hopeful - that such a situation wouldn’t take place again, understanding as much as you do about what VAC is offering for our veterans now?
MS. PEACH: That would be my understanding, that this would provide an option for care that may not have been in place previous to that. I think the other important element is that there are other options for care that can be explored as well, in community-based facilities, that sometimes individuals may not be as aware of, that we certainly need to ensure that we’re sharing with them. Obviously the priority we would have is that individuals get access to care when they need it, so we certainly would want to work with individuals in cases such as that one to ensure that they’re aware of the other options that might be available to them.
MR. MACLEOD: I guess the long-term goal of everybody here is to make sure that this eight-month period of time doesn’t pass again. So the Health Authority is willing to do as much as it can to make this happen as long as Veterans Affairs puts a name forward in a timely fashion. Is that a fair assessment of what’s taking place?
MS. PEACH: Unless the individual is already a client of ours, the first point of contact that we have is through Veterans Affairs Canada and their identification of their need. So absolutely I think this new agreement presents an option that we wouldn’t ordinarily have had. The other thing I would say for the Health Authority is, we can’t insist that an individual accept home care or long-term care. While we might make individuals aware of options that could be available to them in the community, it is a choice that they’re able to make whether or not they choose to accept that.
MR. CHAIRMAN: Mr. Stroink.
MR. JOACHIM STROINK: Listening to your conversation today and your presentation, it really brings light to how important the feds are in dealing with our veterans. We should be dedicated to our veterans; they have done a lot for this country. I guess that’s what I’m kind of asking - it seems like we have a very finite role in this, and the feds have a larger role. Can you just kind of walk us through in a tight format what that relationship is? How much influence do we have over the feds on this, especially when it comes to the home care piece of that discussion?
MS. PEACH: Veterans Affairs Canada would determine the eligibility in the programs and services that they offer to veterans. In some instances, they deliver that service themselves or through other contracted relationships that they might have with providers. In this particular instance, in relation to long-term care, we happen to be one of the contracted service providers that they utilize to provide long-term care. They’ve also entered into agreements with us to provide other supports to veterans, like the recently announced operational stress injury clinic. We do certainly provide that care on their behalf.
Our ability to enter into conversations - this recent agreement was an example. We certainly shared with them that we do have an opportunity in terms of the capacity that we have at Camp Hill. We also shared with them the current wait-list for long-term care placement in the province. While it’s improving, we do still have a wait-list for that service. So we have an opportunity to engage in those conversations with them, but ultimately, it’s Veterans Affairs Canada that determines the programs that they offer to veterans and the criteria and eligibility that are applied.
MR. STROINK: So for us trying to intervene in these things is a pretty moot point when they have so many regulations and guidelines set in place to take these veterans in. Is that a fair assessment?
MS. PEACH: Intervening in particular client situations - I think we have two roles. One, to make them aware of a particular client situation if they’re not already aware, although most often they are because they’ve been involved. The second, I think, is to ensure that they’re aware of the other options that we’re able to provide that individual to meet their needs within the provincial system.
MR. STROINK: So understanding how deep this relationship goes in this situation, what kind of impact would there be to the Nova Scotia health care system if Veterans Affairs Canada all of a sudden said, we’re not interested in paying for all these beds? How would that impact us?
MS. PEACH: Certainly right now, the financial contribution that they make to us to operate those beds is not insignificant. It’s $41 million across the province for the Nova Scotia Health Authority to operate those beds on their behalf. In addition to that, connected to it would be infrastructure and staff and all of the supports that we have in place around those beds that we provide, and also, the individuals that we’re currently caring for within those facilities. So we would certainly want that to be part of a planned conversation if that was a decision that Veterans Affairs Canada wanted to make so that we’re able to plan and adjust as we need to.
MR. CHAIRMAN: Mr. Wilson.
MR. DAVID WILSON: This kind of follows well with the comments just made. The province does have a major role to play, I believe, in advocating for appropriate services for veterans because when a decision is made on the federal level to allow someone into Camp Hill, it frees up funds on a provincial level to care for residents who might need that. If they deny those patients, then that responsibility falls on the provincial government through home care, long-term care, whatever services.
We do have a huge role to play, and I hope your department, the minister, and the Premier recognize that we can’t sit idly by and allow the federal government to renege on their responsibility when it comes to providing services to veterans. It goes back almost to 2012 when the former Harper Government indicated that they may potentially get out of the business of providing care in long-term care facilities for veterans. I know no defined answer or change has taken place yet, but who knows? You indicated it’s $41.1 million just in the contract beds, and that’s facilities all over the province. If the federal government pulls out, that funding is going to be gone. We’ll have to recoup that, and that will put immense pressure on our budget provincially.
Is the funding allocated when the bed is in use both for the contract and for the - at Camp Hill, for example, are the funds allocated just when that bed is in use, or is it for the total number that we have, the 476?
MS. PEACH: Veterans Affairs Canada actually has a mixed model for the contract beds. For the beds, as part of the Nova Scotia Health Authority, we receive an annual operating budget to operate on their behalf, and we receive that set budget regardless of occupancy. There is some reconciliation that they do with us at the end of the year, and that would be the same for the long-term care facility in Springhill which is not ours but which they have a contract with. Two of the facilities, St. Anne Community and Nursing Care Centre and Wynn Park Villa, are based on an agreement where they provide a per diem when the bed is utilized by a veteran. It is a mixed model that they have in Nova Scotia.
MR. DAVID WILSON: In those facilities, for example, are we able to gain access as a province to those beds when they’re not utilized? From what I recall, they have to stay vacant if there’s no veterans in that region of the province. Is that correct?
MS. PEACH: My understanding for those beds is that they would remain vacant if not required by Veterans Affairs Canada. I can’t speak for them because we don’t operate those particular facilities where the rate is on a per diem basis. For the Nova Scotia Health Authority, I know we do have an agreement with them that allows us to use the beds when they’re not in use by Veterans Affairs Canada. In those cases, we pay the per diem, and it is on a transitional or temporary basis. As I said, we have used them for some of the development work that has happened, and we’ve used them when we’ve needed space to accommodate renovations and things like that. But again, it’s when not required by Veterans Affairs Canada.
MR. DAVID WILSON: If you could provide us that breakdown that you mentioned, which ones are utilized and stuff, that would be appreciated.
Over the last six months, I’ll say, has there been any discussion within your department and with the minister’s office on mitigation of potential increasing costs, for example? What is going on? I think there’s a strong need for the province to advocate to the federal government to say, listen, you need to live up to your commitment to our veterans. There’s a number of issues of the current veterans who can gain access to Camp Hill, as we know from the media recently.
There’s our current-day veterans. Look at the U.S. for example. I think they do a better job of supporting current-day veterans who were in Iraq or in Afghanistan. In Canada, that’s a discussion I think we need to push forward with, and provinces need to push that so that the federal government can make a decision to say how we deal with the increase in veteran care that we’re going to see in 20 or 30 years. There are veterans today who are in their late 20s, so they don’t need nursing homes now; they don’t need home care now.
Is there any discussion on a provincial level to say, listen, federal government, you need to live up to commitments that you’ve made to military personnel? What has transpired? Has the Premier been involved in any discussion that you’re aware of with your department to be a strong advocate to wake the federal government up, to say, let’s change how we’re doing things? We need to address a pending pressure on provincial services like home care and long-term care with a new wave of current-day veterans, as most people would call them.
MS. PEACH: I can’t speak on behalf of the department or the province in terms of conversations that might have happened with the federal government in relation to the care of veterans. What I can say though as a service provider - which the Nova Scotia Health Authority would be - we’ve certainly had some discussion with them around transition as their needs change. The unpredictability of the demands and needs of veterans is part of the challenge, trying to anticipate what the needs may be looking into the future.
From a process perspective, as a service provider, we have annual conversations with Veterans Affairs Canada as it relates to our budget. We have those conversations directly with Veterans Affairs Canada, as they’re contracting with us to provide that service. We certainly let them know if there are any pressures that we’ve identified.
The other point that you raised is in relation to the new veterans and the services they may be needing. I think that’s where you see us entering into new relationships with Veterans Affairs Canada more in relation to mental health and addictions and the supports that we’re able to provide. The new partnership that they’ve asked us to take on in relation to operational stress injuries is a really good example of that. Whereas before our relationship with them would have been focused predominantly on long-term care needs, and it still is, we’re also moving into those other conversations of support where we can be a provider of that service on their behalf, which I think just represents those changing needs and how we all need to change and adjust to the population.
MR. CHAIRMAN: Next we have Mr. Orrell.
MR. ORRELL: I guess with the number of Second World War veterans declining rapidly, there’s talk that there are going to be some changes to the criteria for admissions to Camp Hill. While the federal government is conducting its review, is there anything that’s been put in place in the meantime for assistance or to help veterans who are now wishing to gain access to Camp Hill while that review is going on?
MS. PEACH: There is not a specific review under way that I’m aware of. Veterans Affairs Canada may be doing their own review, and I suspect we’ll be having conversations about their regulations. But in terms of what services are provided, my understanding from Veterans Affairs Canada is veterans who have an identified need for long-term care would go through the process of being assessed by Veterans Affairs Canada. If they meet the eligibility as determined by them for Camp Hill and they have that need, they would then be in contact with us to determine what availability we have to provide that care to the veteran.
MR. ORRELL: If someone needs access to care but was deemed by Veterans Affairs Canada not to meet that criteria, they would still enter the province’s facilities for long-term care?
MS. PEACH: That’s a good point of clarification. What would be helpful is if they reached out to continuing care in the province to look at what supports we might be able to provide. I would assume that if an individual doesn’t meet the care needs to be provided with care in a Veterans Affairs Canada contract bed, it may be too early for them to explore admission to long-term care, but there may be other supports that might be available as well.
MR. ORRELL: I’m just trying to wrap my head around this. A veteran needs care, Veterans Affairs Canada is going to take the time to provide that care. I would like to see this committee maybe write the Minister of Health and Wellness and/or the Veterans Affairs Minister, who is the Premier, to ask him to allow these veterans who are either in need of care by assessment knowing they need care before they can get approved by Veterans Affairs Canada to allow them to use the services at Camp Hill because we’re going to provide that service anyway.
I guess I would move a motion to write the Minister of Health and Wellness and the Premier to allow those veterans to use the veterans’ services at Camp Hill and for us to support that until Veterans Affairs Canada decides if they’re going to support it or not support it because we’re going to end up supporting it anyway. Why put a veteran through all that like Mr. Blindheim went through, when they’re going to need care anyway? It’s going to be funded by the province or the feds. I would move that motion if I could, Mr. Chairman.
MR. CHAIRMAN: Ms. Peach, do you want to comment on that first?
MS. PEACH: Maybe just a point of clarification. My understanding is that the new agreement that we have with Veterans Affairs Canada around access to Camp Hill will alleviate some of that. I think it’s important to make sure that we have an opportunity - we’re two weeks into that new agreement with them - to test out how that works in terms of providing access to veterans.
My hope is that it does provide access to a category of veterans that we would have been challenged to provide that support to and that this will provide some of that solution. We’re certainly willing to work with Veterans Affairs Canada to evaluate that need on a go-forward basis. I think right now we don’t even have a sense of what the demand for that new capacity might be. But I suspect we’ll get a better understanding of that soon, as Veterans Affairs Canada is identifying veterans who are at the point where they require that level of support and care.
MR. CHAIRMAN: We have a motion on the floor. Can you repeat the wording of that motion?
MR. ORRELL: Just that we write a letter to the Minister of Health and Wellness and/or the Premier, who’s the minister for veterans affairs, to allow the veterans who are trying to access this service at Camp Hill to be considered for the service if the need is there, regardless of if Veterans Affairs Canada is going to fund it early or not. If they’re going without this service until we decide, they’re sitting at home and getting home care and they’re getting everything else that goes with it, so we’re still spending the money on the veteran - better off if they were in a long-term care facility like Camp Hill.
MR. CHAIRMAN: We have to deal with the motion, of course, but can we defer until after we finish the presentation? Are you okay with that?
MR. ORRELL: Yes, that’s fine.
MR. CHAIRMAN: We’ll deal with that after we conclude the questions.
MR. BRENDAN MAGUIRE: Thanks for coming today. I just wanted you to clarify it a little bit. You just said, allow access to a category of veterans that may not have had access. Can you elaborate on that?
MS. PEACH: Sure. The eligibility criteria that Veterans Affairs Canada would have used to determine veterans who were appropriate for care at Camp Hill was a set of eligibility criteria that they had very specific to contract beds. There were other veterans who they supported in community-based facilities across the province. My understanding of their approach in this new agreement is that there would be that category of veterans who in the past might have been able to access a community bed, who now would be able to access a contract bed under this new agreement at Camp Hill.
MR. MAGUIRE: Which veterans would those be?
MS. PEACH: That would be for Veterans Affairs Canada to determine.
MR. CHAIRMAN: The last round, to Mr. Wilson.
MR. DAVID WILSON: I would be remiss not to mention a couple of the veterans who have been trying to gain access. Of course, one name was mentioned already, Mr. Alan Sagar. But there had also been Mr. Donald Osborne and Mr. John Smith, who hopefully can find some comfort in the change or this new agreement that has been signed with the federal government on the use of the beds at Camp Hill.
I note that there are 13 beds, I believe, that are being used with the move from Dartmouth General over to Camp Hill. We don’t have to pay the federal government for the use of those beds? We just utilize the beds that were designated to be used by veterans, is that correct? There’s no cost, per se, to the federal government to use the beds that were designated as veterans beds?
MS. PEACH: When we use the capacity that’s unneeded by Veterans Affairs Canada on a temporary basis, we are required to contribute toward the per diem that ordinarily would have been paid by Veterans Affairs Canada. That case - the very specific case in relation to Dartmouth General - is related to a unit closure to allow redevelopment to happen at that site. So we would be contributing to the cost of care for those individuals.
MR. DAVID WILSON: Just for clarification, that doesn’t go to the federal government. That just goes to pay for the individuals and to provide the care - correct?
MS. PEACH: I wouldn’t be able to speak to the details of the specifics of the financial transaction. The easiest way to put it would be that if there were a section of beds that we were utilizing for another purpose for the course of the year, we wouldn’t receive funding from Veterans Affairs Canada for those beds because they weren’t available to veterans.
MR. DAVID WILSON: I would hope we don’t send any money to the federal government. I mean, if they’re denying access and there are beds unoccupied and we’re using them - I hope that’s not what’s happening.
My last question is on wait times for long-term care beds designated for Veterans Affairs. Are those wait times and that list held solely with the federal government, or does the province work with them in one of the communities - the contract beds, for example - and say, okay, there’s a bed coming up? Is it solely the federal government’s jurisdiction, or does the province play a role in any kind of wait time?
So the question is, is there a wait time? And who oversees controlling that and trying to make sure that those veterans get access?
MS. PEACH: My understanding, because we do have vacant capacity across the province - overall, I would say there isn’t a wait time, or not a substantial wait time. We do have areas of the province and contract beds that are fully occupied, and I understand that there is a bit of a wait-list for service in that community.
The wait-list is maintained by Veterans Affairs Canada, and the eligibility on that wait-list is determined by them. They also determine that assessment for placement into the facility based on need, not necessarily based on chronological order. The way the process works is, when we have a vacancy in a contract bed, we notify Veterans Affairs of that vacancy and then they notify us of the veteran who matches the need for that bed, and then we proceed with the admission process.
MR. CHAIRMAN: Thank you, Mr. Wilson. We’ll finish off with Mr. MacLeod.
MR. MACLEOD: Just a point of clarification - I just want to be sure I understand this. According to your presentation, there are 150 beds at Camp Hill; 13 of them are now being utilized by Dartmouth General and 12 of them are unoccupied. That means there are 25 beds that are not being utilized. You do not get any funding for those 25 beds if they’re not utilized. Is that correct?
MS. PEACH: Just to clarify - and I appreciate that it is complex - there are 175 contract beds at Camp Hill; 150 of those are currently occupied by veterans, 13 are being utilized temporarily for individuals from Dartmouth General, and 12 are vacant.
Traditionally, historically, we’ve continued to received funding from Veterans Affairs regardless of whether the beds have been occupied by a veteran or not. It’s based on an annual budget, with the exception of the two facilities that aren’t Nova Scotia Health Authority facilities, which receive a per diem from Veterans Affairs. So they only receive the funding if they’re occupied by a veteran.
In the case of Camp Hill, where we’re utilizing a significant number of those beds for the temporary care of individuals for a longer period of time, there would be an adjustment to the budget acknowledging the fact that they wouldn’t be available to veterans during that period of time. Does that help?
MR. MACLEOD: Yes, I think that’s where we were trying to get before.
Right now, because there are 12 unoccupied beds, no veteran would be impacted by the fact that 13 of the beds are being used by Dartmouth General. Is that correct?
MS. PEACH: Right. We certainly have conversations with Veterans Affairs if we are planning to utilize any of those beds for purposes other than Veterans Affairs’ needs. They give us a sense of what veterans might be in the community who would be nearing placement options, and certainly if we were in a position where we had no vacant capacity and a veteran was identified as needing that care, then we would work to make that capacity available.
MR. MACLEOD: So at the end of the day, the veteran comes first.
MS. PEACH. Yes.
MR. CHAIRMAN: Thank you, Mr. MacLeod, and to the committee members, thank you for all your questions today. I’ll leave a few minutes for you to make some closing comments, Ms. Peach.
MS. PEACH: Again, I just wanted to take the opportunity to thank you for giving me the opportunity to come today. As I said, it’s an honour and a privilege to be able to provide this support - and again, not just in relation to long-term care but also the other supports we provide, for instance through the Operational Stress Injury Clinic.
I did want to take the opportunity to publicly thank the many staff, physicians, and volunteers we have who provide care and support to veterans each and every day. They find ways to honour the veterans in the care and support they provide to us in what they do each and every day. So I did want to take the opportunity to thank them for that.
MR. CHAIRMAN: Thank you for being with us today, and thank you for all of the information that you’ve provided to the committee members.
We’ll take a short recess and then we’ll come back to do committee business. We are now in recess for the next five or so minutes.
[2:50 p.m. The committee recessed.]
[3:03 p.m. The committee reconvened.]
MR. CHAIRMAN: Order, please. I call the meeting back to order. Before we move on to the other agenda items, of course, we have a motion that we have to deal with on the floor from Mr. Orrell.
I’m going to try the wording on this again: to write to the Minister of Health and Wellness and the Premier to allow veterans in need of care to access Camp Hill while awaiting approval from Veterans Affairs Canada. Is that correct, Mr. Orrell?
I’m going to open the committee to discussion. We’ll start with Mr. Rankin.
MR. RANKIN: I would take the advice of the witness and not presuppose the outcome of the agreement that was made in the review that they’re looking at, the regulation changes.
I would support a similar type of motion that asks for an update a month or two from now. As you said, it has only been two weeks, and we don’t know the full details of what came out of that. I certainly don’t want to let the federal government off the hook and make the province pay for services right away. It’s federal jurisdiction to pay for these veterans. They deserve it, but I do want to see the outcome of the agreement come through, and I don’t think anyone wants to jeopardize the outcome of that.
So I’m not going to support this particular motion, but if there’s a similar one that prompts some kind of an update on what transpired from that agreement, then I would support that.
MR. CHAIRMAN: Thank you, Mr. Rankin.
Mr. Orrell, on the motion.
MR. ORRELL: The intent is not to let the federal government off the hook. It’s the fact that if a person needs nursing home care and they’re a veteran, they’re going to get the care from the province regardless, that they’re going to be put into one of the province’s care facilities. At least if they were in the veterans hospital and had their assessment done, the people in the hospital could advocate on behalf of the veteran to stay there. The assessment would be done and it would determine if the person required the services of a veteran or not, which would, in my opinion, put more pressure on the federal government to come in with that funding.
We’re going to support the senior, even if he’s not a veteran - the senior may need it, they’re going to go to a nursing home anyway. There’s a cost to that. The same cost would be incurred if they get the services of Camp Hill hospital, but they would get their assessment and they would get the required services until the federal government decided. But the people who did the assessment and determined if they did need it or not could then put pressure on the federal government, which would alleviate the pressure on the provincial government, because then they wouldn’t be in a care facility that the government’s paying for.
MR. CHAIRMAN: Thank you, Mr. Orrell. Mr. Wilson.
MR. DAVID WILSON: Mr. Chairman, I’ll support this motion. On the premise of the timeline that we’ve seen the federal government act over the last year or two, it’s unbelievable to see a 94-year-old veteran fight to get access to services for a year or more.
I know there are a number of veterans out there pending review and pending assessment. The provincial government is receiving money for those empty beds. Why don’t we use them?
So I do support that motion, and I hope our colleagues would also.
MR. CHAIRMAN: Thank you, Mr. Wilson.
We have a motion on the floor. I’ll now call for the vote.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is defeated.
We will move on to the rest of the business of the agenda. Before I move on to the next item on the agenda, which is correspondence, I do want to recognize something that took place in the last sitting of the Legislature. There are a number of members here on the committee who were part of that process, and of course, that’s the Registry of Motor Vehicles changes that helped our military drivers transition into the private sector. I do want to thank and congratulate the committee.
One of the best functions of this committee is that we work well together to do what we can to support veterans, and because of that work and because of that motion that came out of this committee, that certification was passed. So on the record, I just want to thank the committee members who were involved in that important discussion and, of course, the representatives who were in front of the committee to push that on behalf of the veterans of the community.
I think it’s important to recognize that that started at this committee and that was passed. That’s going to be a big help for some of our veterans as they transition into private life.
We will now move on to correspondence. We have a number of pieces of correspondence. The first one is from Tourism Nova Scotia, in regard to the response to the letter from February 11th. I just want to put that on the record, that we did receive correspondence from that.
Then we have the information requested from the March 10th meeting for the Military Employment Transition Program. We received that correspondence.
We had an invitation regarding Enemy in the Ranks: Systemic Racism in the Canadian Forces discussion. That is also included in your package.
We also have correspondence from the Department of Health and Wellness, the information requested from the October 22nd meeting.
Then we have the Military Employment Transition Program. That was the conference that was held last month.
Finally, we have correspondence from the Honourable Alfie MacLeod and a response from myself as the Chair.
That is the correspondence that I have on file. Are there any questions or comments on that?
MR. MACLEOD: Just in reference to our exchange of information, I would like to make a motion that the committee ask for a report from the Health Authority in three months’ time on how the current process is working in engagement for the veterans. I think it’s fair to give it a chance, but I also think it’s important to do a follow-up and find out if the system is indeed working. If not, it may be something that we want to revisit.
My motion would be that - and again, it can be in letter form. It doesn’t have to be a witness coming back. But I think there should be a follow-up where in at least three months’ time we get a report on how the new system is working with the new agreement that was put in place on June 24th.
MR. CHAIRMAN: We have a motion on the floor. Is there any discussion on the motion? Seeing none, I’ll call for the vote.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is carried. Thank you, Mr. MacLeod.
We have one more piece of business here that I want to deal with, so just bear with me here for a second.
As you’re aware, we did have one presenter that we’ve been trying to reach out to for the last year, the Injured Soldiers Network, to come and present in front of this committee. They were approved in the last agenda-setting, and much credit to the Clerk, who over that period of time has tried very hard to have the Injured Soldiers Network present. We have still not received confirmation that they will come and appear before the committee, but we do have a recommendation to have someone present in their absence.
Who we’re looking at is the Canadian Institute for Military and Veteran Health Research. “The health and well-being of Canadian military personnel, Veterans and their families is maximized through world-class research resulting in evidence-informed practices, policies and programs.” Instead of having the Injured Soldiers’ Network present, in that slot we would bring in the Canadian Institute for Military and Veteran Health Research.
Is the committee in favour of that change? Can I have a motion on that?
MR. MAGUIRE: I’ll so move.
MR. CHAIRMAN: Moved by Mr. Maguire.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is carried.
The next meeting date will be September 20, 2016. We have Dr. Maya Eichler on veterans research on September 20, 2016.
That concludes our business. We are adjourned. Thank you all for your participation.
[The committee adjourned at 3:12 p.m.]