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Calls for a Canadian national seniors’ strategy intensified in 2015 – everyone from the CMA to the IRPP held consultations across the country, identifying key issues and laying impressive groundwork for a future strategy. Lack of political will, however, holds us back – discussion of a national seniors’ strategy during the federal election was very limited, and it is still a political black box. An effective seniors’ strategy would provide a framework for all of the issues I have described – access, affordability and advance planning.

The long-term-care sector will be a critical partner for implementing, supporting and evaluating assisted-dying requests when the proposed legislation becomes law. Home-care workers and health-care providers in long-term-care facilities, alongside family members, are often the last to care for dying patients outside hospital settings. For many Canadians, long waiting lists to access limited long-term-care spaces are a significant barrier. Regional disparities in access, quality and affordability also exist, and multiple advocacy organizations have emphasized the need for national leadership on issues of elder abuse and neglect in long-term-care facilities.

A national senior’s strategy will be essential to improving seniors’ quality of life, supporting families and caregivers, and planning for Canada’s rapidly aging population. Canada currently has one geriatrician for every 15,000 Canadians, and there are significant gaps across the country in the quality, cost and access to care.

May 24, 2016 

ith Canada’s assisted-dying dying legislation currently before Parliament, it becomes increasingly urgent for the Liberal government to make substantive commitments to policies and programs that will support this sea change in the health-care system.

"This is not about rolling back contracts. This is about working together to find solutions as we go forward that reflect the fiscal circumstances that we're in," he said, noting the government is "staring down" a $7 billion revenue hole. AUPE President Guy Smith said the repeal of Bill 45 means "one of the most odious remnants of the (Alison) Redford era" will be gone. Smith said he made it clear to Prentice that front-line workers "are not the problem" and discussions on the negotiations framework and essential service legislation "have to happen in consort with each other."

HSAA President El i sabeth Ballermann said she was encouraged by the "sign of good faith" as the "punitive, mean-spirited legislation to repress labour unrest" was killed. She said HSAA is prepared to proceed in good faith. Prentice confirmed the government will repeal Bill 45 "immediately" during this spring session. It is expected that Prentice will call an early spring election shortly after the government presents its budget on March 26.

In recent weeks, the B.C. government has been under intense pressure from the fired workers and the family of PhD student Roderick MacIsaac, who killed himself after he was publicly dismissed in fall, 2012. The province has apologized for firing Mr. MacIsaac and has rehired or settled out of court with most of the employees. Lawsuits involving two others are ongoing. When the researchers were fired, the health minister at the time suggested there had been a massive privacy breach, which would be referred to the RCMP. But access-to-information documents have shown the province never gave the Mounties the evidence they required to start an investigation, and one was never conducted.

Mr. Chalke said the government would have to make it clear to those testifying that they must disclose all information or else change the law to give his office access to information protected by such agreements, as is enjoyed by the "more modern" office of the Representative for Children and Youth. "My concern about this issue is so significant that I would formally ask that the committee not refer this matter to my office unless it is accompanied by a recommendation to government for an urgent legislative amendment," he wrote.

Mr. Chalke's conditions for accepting the case also include a supplemental budget from the Finance Ministry so that no other investigations are displaced, as well as an unlimited amount of time to examine the firings. Mr. Chalke, a former assistant deputy minister of justice, began his term last week by contradicting predecessor Kim Carter's assertion that the Ombudsperson's office would be equipped to look into the health firings scandal. In her reply to his letter, Attorney-General Suzanne Anton sent a letter to the legislative committee Wednesday stating that many of Mr. Chalke's concerns would present challenges to any public inquiry into the matter.

She said the Ombudsperson could notify the legislative committee if his investigators were hamstrung by any confidentiality agreements and those concerns could be addressed by redacting names or any other information that would violate those agreements. George Heyman, an NDP MLA and member of the committee communicating with the Ombudsperson, said the Attorney-General's letter did not allay his concerns. "At first blush, it appears to be an attempt to very quickly brush off the concerns of the Ombudsperson," Mr. Heyman said Wednesday evening. Health Minister Terry Lake has repeatedly said a public inquiry would be too costly and slow. Mr. Lake declined an interview request Wednesday, but a spokesperson sent an e-mail saying the government "recognizes the public's desire to fully understand what took place in regard to this issue."

Kat Lanteigne, executive director for BloodWatch.org and writer of the play Tainted based on three-years of research about the tainted blood scandal, travelled to Alberta to help spread the message about concerns about private, donor-paid plasma collection. Lanteigne said these types of clinics had started to show up in Ontario in the last few years. "This is a big-pharma push," she said. "If they can build a clinic and get a licence from Health Canada then they can open without the province's permission." She said that the private sale and collection of blood and plasma introduces risk into the system. She also dispelled another myth that plasma is being imported into the country. She said that is not the case, as about 70 per cent of the drugs produced from plasma is what is being imported. When successful in the fight to get Ontario to legislate against private, donor-paid plasma collection at the end of 2014, and because Quebec has a similar law, Lanteigne said they made the mistake of thinking that because the largest provinces in Canada had done this, the rest of the provinces would follow suit.

Instead, as part of one of her first decisions, the new federal Liberal Health Minister approved CPR opening a clinic in Saskatchewan. Lanteigne says the Saskatchewan government, led by Premier Brad Wall, then approved the private, donor-paid plasma collection business to open in Saskatoon, "in between a pawn shop and a pay-day loan company." "This collection facility is a blood broker. They are literally a middle man Ñ a source to get profits. "We're asking the provinces and territories to pass voluntary blood donation acts which adds blood and plasma to their existing human tissue acts ..." Lanteigne explained. There is a lot of information on the BloodWatch.org website about the issue, including an informative timeline. The organization also has a Heart Watch rating system. Alberta currently has three hearts and Lanteigne would like to see that increase to five. "Saskatchewan has broken our hearts," she adds.

Kim Storebo, CUPE Local 46 president who works with Canadian Blood Services (CBS), also spoke at the event. She said CUPE supports a public, voluntary-based blood system in Canada, adding CBS needs to increase the number of its own plasma collection sites. The organization has been slowly closing locations since 2012. "There is no evidence the collection of plasma from paid donors will create self-sufficiency," she said. "Under no circumstances should there be payment of blood plasma donors with cash or cash-in-kind equivalents." The union wants to see blood and plasma collection remain the sole responsibility of Canadian Blood Services and for the organization to expand its plasma collection and its work hours and ensure stable and consistent hours for its employees. As part of the wrap-up of the Alberta tour officials with FOM, BloodWatch.org and CUPE presented an online SumOfUs petition with more than 15,000 signatures to provincial health minister Sarah Hoffman asking for all provincial governments to "implement legislation that ensures no for-profit, donor-paid blood plasma collection clinics are allowed to operate in Canada." Azocar assured those at the meetings that Friends of Medicare would continue to lobby the Alberta government this fall and next spring during the Legislature sittings.

Health Minister Leo Glavine said Thursday that the government decided to impose a framework that will identify which unions will represent nurses, technologists, administrative and support workers after negotiations with the unions broke down over the summer. On Friday he appeared to back away from that statement, albeit slightly. "The legislation doesn't specifically say what union people will be in," said Glavine. "It outlines a process that will enable to get to a streamline position." Some of the workers who attended the rally were clear that they want to stay with the unions that represent them now. Lynn Stanton, a Halifax nurse who works at the Victoria General Hospital's intensive care unit, called the government's move "shoddy."

"In our union we fought long and hard for the benefits that we have gotten," she said. "I've put in over 28 years there and I want to stay where I've been." The government has repeatedly butted heads with labour since sweeping to power nearly a year ago. Earlier this month it was named in a court challenge that aims to overturn essential services legislation that ended a strike by 2,400 nurses in Halifax in April. Following the rally Friday, Clarke said the unions will discuss their options over the coming days, including the possibility of further legal action.

Last week, CUPE Saskatchewan sent a letter to Health Minister Jane Philpott requesting her to review the provincial legislation to determine if it violates the Canada Health Act and, if it does, that she instruct the Saskatchewan government to comply with the act.

Philpott was not available for an interview Monday, but emailed the Regina Leader-Post the following statement: "Our Government will work in close collaboration with our provincial and territorial partners to build constructive relationships. Our priority is to ensure all Canadians have access to health care."

CUPE Saskatchewan president Tom Graham says the union consulted with lawyer Steven Shrybman and it is his opinion that Bill 179 violates the Canada Health Act. "Health care needs to be provided on need, not the ability to pay," Graham said. "We think there are solutions that can be done within the system that don't require people to dig into their pockets to get an MRI."

CUPE sent the letter to Philpott days after the Saskatchewan Medical Association (SMA) raised concerns that the provincial government's decision to allow people to pay privately for MRIs was "a hasty policy." In a letter to physicians, SMA president Dr. Mark Brown said the organization opposed the move and told Health Minister Dustin Duncan that at the end of October. Brown said the legislation allowing people to pay privately for MRIs runs contrary to the fundamental principle of medicare.

(Bill 179) is privatizing our health-care system as far as we're concerned ... It's a slippery slope," Graham said Monday. "We already pay for health care in this province and in this country and now we're being asked to pay twice if you want it faster." Private MRIs in Alberta have not reduced wait times, he said.

"Their wait times are worse than ours and in Quebec, it's the same thing, " Graham said. "We're really quite concerned about it and we'd like the federal government to basically direct the government here to follow the Canada Health Act." In past interviews, Duncan has said people leave the province for MRIs now. The legislation is a way to level the playing field and provide some benefits for the public system.

I think they need to put the resources in where they are needed," Graham said. "It's a matter of getting MRI machines and technicians and scheduling it - it's as simple as that. I don't know why we have to get into these elaborate, complex schemes ... We should be enhancing our system, not taking it apart."

Paramedic Lisa Jennings says she was in a psychiatric ward, having contemplated suicide the night before, when she decided to start a grassroots movement for emergency workers suffering from post-traumatic stress disorder. 

Psychiatrist Jitender Sareen says he hopes that recent legislation adopted by some provinces will help first responders with PTSD to get access to treatment and other services quickly. (University of Manitoba)

This Senate has already sent a report back to the Commons, saying the Liberal bill should be amended to allow advance directives from those who wish assistance in dying and are still able to let their wishes be known.When the bill comes back to the Senate, independent Liberal James Cowan will push for an amendment broadening restrictions on eligibility.

The B.C. Civil Liberties Association says every provincial medical regulator has issued “detailed, comprehensive” guidelines for doctors under the high court ruling. Doctors’ conscientious objection rights are protected and, under provincial guidelines, two doctors are required to confirm the patient’s eligibility and consent.The real danger may lie in future court challenges — if assisted deaths are allowed under the Supreme Court wording that would be denied under the federal legislation, the government will have a problem.We shouldn’t be here after 16 months. Canadians deserved better. They deserve a better law.

CUPE submission on NS health care legislation

Nova Scotia Government & General Employees Union president Joan Jessome, who represents the majority of Capital Health nurses, said Glavine is attempting to hide the fallout of legislation.

Many nurses are leaving because they weren’t given a say about their representation under the new provincial health authority, not because of propaganda, said Jessome. “They’re fed up.”

An arbitrator’s decision Friday will all but certainly place all nurses with the Nova Scotia Nurses’ Union.

NDP health critic Dave Wilson said Glavine should acknowledge that some of the Liberals’ moves since coming to power are hurting health care. More focus should be placed on workplace concerns and staffing levels rather than union reorganization, he said.

Glavine said steps continue to address shortages, including adding seats at nursing schools and a proposal at Dalhousie University to condence the nursing program from four years to three.

But Saskatchewan's Health Minister Dustin Duncan seems to believe that a novel feature in their "model" will make it palatable: MRI providers will be required to provide a "public" MRI for each private MRI sold. There is great fog around this stipulation. MRI clinics in Alberta and British Columbia provide a menu of services, just like an auto repair shop. Of course, it is difficult to identify prices for Canadian MRIs because their websites, while advertising "competitive" prices, ask you to contact them. The United States is more "competitive." For example, Ohio law requires hospitals to publish their prices. The website for medcentral.org lists more than 40 items in its MRI price list.

Here is my question: If a Saskatchewan MRI provider does a foot scan for a private patient, does it then have to do a foot scan for a public patient? How will this be monitored? Also, when does the public patient get her foot scan? If a paying patient is standing in the door, does the MRI provider say, "Sorry, you have to wait till we provide the public foot scan that we owe?" How is this monitored? Does the government pay for the patient from the public list? If so, at what price?

Is this simply a revenue guarantee in disguise? Undoubtedly Bill 179 provides for wide ministerial discretion. Can we bank on the minister being discreet? This model is bizarre. If the provincial government is seeking ways to provide more MRIs without having to incur the upfront capital costs and to remove the operating costs from its budget, then just negotiate MRI fees in the physician fee schedule, as currently occurs with other imaging services.

However, it might quickly become obvious that the private modality cannot compete with cost effective public provision. Glen Beck is emeritus professor of health economics at the University of Saskatchewan.

Quebec is the first province to pass such legislation, arguing it is an extension of end-of-life care and thus a health issue, which falls under provincial jurisdiction. The injunction sought by the Quebec-based Coalition of Physicians for Social Justice and Lisa D'Amico, a handicapped woman, was related to a Supreme Court ruling last February that struck down the prohibition on physician-assisted dying.

But McKenna argued nurses in the long-term sector have gone into rooms where a homicide has occurred, and those in emergency rooms constantly deal with victims of violence and horrible accidents.

"You shouldn't exclude particular workers because they might not be the first one to step their foot into a vehicle accident setting," she said. The legislation would mean first responders could access Workplace Safety and Insurance Board (WSIB) benefits far more easily than they can now.

The presumptive legislation, if it passes third reading as expected, is slated to be proclaimed into law Wednesday. It had been long sought and has now been widely lauded by first responders.

In a statement issued on behalf of 8,000 Ontario paramedics, the Canadian Union of Public Employees (CUPE) said the bill will help lessen the stigma associated with PTSD and help first responders get treatment "before it's too late."

"Research shows that because of frequent exposure to traumatic situations, paramedics and other first responders are at least twice as likely to suffer PTSD than the general population," the CUPE statement says.

Craig MacBride, spokesman for Labour Minister Kevin Flynn, said the government is committed to workplace safety for nurses, creating a leadership table on violence in health care and also amending the Occupational Health and Safety Act to help prevent workplace violence and harassment.

It's also important to remember that nurses, like all Ontario workers, are covered for PTSD through the WSIB. Bill 163 simply creates a more responsive process for those who are most likely to face traumatic experiences on a regular basis," MacBride said.