44th Parl. 1st Sess.
December 4, 2023 11:00AM
Mr. Speaker, I am pleased to rise to give some of my thoughts on Bill C-295, which was introduced by the member for Vancouver Centre. It is an act that would amend the Criminal Code on the subject of neglect of vulnerable adults.
I am very pleased to be speaking to this subject, especially on behalf of all vulnerable seniors in my riding, but also their families. Families, as we have seen over the last three years, also suffered through the subject matter we will be discussing as part of the bill.
It is a fact the chronic neglect and abuse of older adults living in long-term care facilities is a long-standing problem. This is something that slipped under the radar for many years before COVID so frighteningly put it to light and exposed what was there all along.
Bill C-295 would specifically amend the Criminal Code to create a specific offence for long-term care facilities, their owners and officers when they fail to provide necessaries of life to residents of facilities. We would finally, this Parliament, be putting into the Criminal Code a specific offence when the people who run these facilities fail to uphold their part of the bargain.
It would also allow the court to make an order prohibiting any owner or officer of such a facility from being, through employment or volunteering, in charge or in a position of trust or authority toward vulnerable adults. Again, there will be consequences for people who are in those trust positions, but it will also allow courts to consider as an aggravating factor for the purpose of sentencing the fact that an organization failed to perform the legal duty it owed to a vulnerable adult.
We could rightly question why it has taken so long to even consider putting these things into the Criminal Code, but here we are, and it is about time we moved forward with the bill.
I want to also recognize that the Standing Committee on Justice and Human Rights did its due consideration of the bill. During its review of the bill, 15 witnesses appeared before the committee, including the research chair on the mistreatment of older adults, from the University of Sherbrooke, the Canadian Network for the Prevention of Elder Abuse, Elder Abuse Prevention Ontario and the Canadian Federation of Nurses Unions. There were 15 witnesses in total over four meetings at that committee. The committee also had 26 briefs submitted to it as a part of its study.
Going to the committee report, I will direct members of the House to the fact that one of the big changes that was made was replacing the word “manager” with the word “officer” and specifically putting a new definition, so now the people who are covered by the word “officer” include the chair person of the board of directors, the president, vice-president, the secretary, the treasury, the comptroller, the general counsel and the general manager or managing director of a long-term care facility. Again, it goes after that top echelon of people who are responsible not only for the overall budget of a place but for how it directs its care levels, its staffing standards and the level of service that residents can expect at those facilities.
It is no secret that there has been a long history of neglect, and what the pandemic did was shine a very important light on that. However, it has often been called “hidden neglect” because many people who worked in the industry, worked at long-term care homes or even those who were responsible for reviewing their actions have known that unfortunately this has existed for quite some time.
It is also a fact that during the pandemic especially, there was a huge difference between the for-profit long-term care homes and the public or non-profit facilities. The for-profit facilities had a much worse patient outcome overall than not-for-profit homes in general.
In my home province of British Columbia, the Seniors Advocate recently reviewed the situation with for-profit long-term care homes. It has been noted that in British Columbia the cost of a publicly subsidized long-term care bed through a private operator has jumped 35% in the last five years. The Seniors Advocate found that not-for-profit facilities spent about 25% more per resident on direct care when compared with for-profit care.
When a review was conducted on the financial records from 2021 and 2022, it showed that long-term care facilities operated by for-profit companies delivered 500,000 fewer care hours than they were funded for by the province.
Again, it speaks to the larger theme, that when profit is introduced into the health care system, other considerations seem to make their way to the forefront rather than looking after the people for which the facility was designed.
I also want to point out that we are all very familiar with the time when the Canadian Armed Forces were deployed to some of the hardest hit long-term care homes, where they documented horrific accounts of inhumane treatment, abuse and substandard care.
According to the Canadian Armed Forces' reports, dozens of residents in two Ontario nursing homes died, not from COVID-19 but from dehydration and neglect.
I have looked at some of the short Coles Notes from those reports. I will read them out for the record: “conditions in two of the seniors homes...appeared to be nothing short of horrid and inhumane as ill-trained, burned-out and, in some cases, neglectful staff coped with the growing care needs of elderly residents”, residents faced “inadequate nutrition” because most of them were not getting three meals a day — and when they did, “underfeeding was reported.”; “Respecting the dignity of patients is not always a priority.”; Other patients were “left in beds soiled, in diapers, rather than being ambulated to the toilets.”; and “troops had to send a senior to hospital after the resident fractured a hip and was not cared for by staff.”
These are just some of the alarming things that came out from the Canadian Armed Forces that were deployed to those homes. Again, for the people who are familiar with long-term care homes in Canada, this was nothing new. All COVID-19 did was to serve to shed a light on that.
On October 23, 2020, CBC posted a story to its website. I will quote from a part of its investigation:
CBC Marketplace reviewed 10,000 inspection reports and found over 30,000 "written notices," or violations of the Long-Term Care Homes Act and Regulations (LTCHA), between 2015 and 2019 inclusive. The LTCHA sets out minimum safety standards that every care home in Ontario must meet.
Marketplace isolated 21 violation codes for some of the most serious or dangerous offences, including abuse, inadequate infection control, unsafe medication storage, inadequate hydration, and poor skin and wound care, among others. The analysis found that of the 632 homes in the Ontario database, 538 — or 85 per cent — were repeat offenders.
I also want to recognize that women represent 65% of patients in Canadian residential continuing care facilities. This is absolutely a gendered issue to which we need to pay close attention.
In addition, the vast majority of care providers in supportive care are women, with a significant portion of these individuals being newcomers or immigrants, especially among personal support workers. Women account for the majority of the workers among both immigrants, which was 86%, and non-immigrants, 87%.
My NDP caucus believes that the victims of negligence in Canada's long-term care facilities deserve justice. Part of the confidence and supply agreement that we have with the Liberal government is the tabling of a safe long-term care act to ensure that seniors are guaranteed the care they deserve, no matter where they live.
Although Bill C-295 is a step in the right direction, I do not believe it goes far enough in this regard. Rather than addressing this issue solely through a private members' bill, we expect that the government will follow through on this requirement and table legislation that puts these standards into more encompassing law, so that all Canadians, from coast to coast to coast, can not only ensure that their loved ones are getting the care that they deserve, but that our vulnerable seniors have the full force of law to ensure they are living with the dignity they deserve.
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Mr. Speaker, this morning, I am rising to speak to Bill C-295, an enactment that amends the Criminal Code to create an offence for long-term care facilities, their owners and their officers to fail to ensure necessaries of life are provided to residents of the facilities.
I have had a few opportunities to replace my colleague on the Standing Committee on Justice and Human Rights to study this bill a little more in my capacity as a former project manager responsible for raising awareness of elder abuse and intimidation.
To come back to the bill, it also “allows the court to make an order prohibiting the owners and the officers of such facilities from being, through employment or volunteering, in charge of or in a position of trust or authority towards vulnerable adults and to consider as an aggravating factor for the purpose of sentencing the fact that an organization failed to perform the legal duty that it owed to a vulnerable adult.”
The bill is perhaps a little opportunistic. It follows the abuse that occurred in seniors' residences during the pandemic. That is what it seeks to address, but the bill creates criminal offences in these cases. Liberal logic dictates that filling the Criminal Code with offences is a way of helping people.
I will explain the bill in a little more detail, along with progress made in Quebec and what remains to be done.
Bill C‑295 adds two definitions to the Criminal Code, long-term care facility and officer, with the goal of building criminal offences around them. I could list them. We seriously examined the bill. In particular my colleague from Rivière-du-Nord studied it in depth in committee. Upon reflection, the Bloc Québécois will vote in favour of the bill at third reading, because the Bloc proposed two amendments that were adopted.
The first sought to replace the definition of “manager” by that of “officer”. We discussed this a great deal in committee. The notion of “manager” that previously appeared in the bill was much too broad. In the previous definition, an official responsible for purchasing or a nursing team leader would have been affected by the bill. Many witnesses said this went much too far. As for the notion of “officer”, it is well defined in the bill. It covers directors and senior members of the board such as the president and the vice-president. In short, the amendment places the responsibility on people in charge of the centres and not on the workers, who are already struggling to keep the health care system going.
The other amendment ensures that the judge will take into consideration penalties under the legislation of Quebec and of the provinces. Some provinces, like Quebec, have laws against abuse that force health care facilities to have policies and a complaint process. The judge will take that into account in imposing a prohibition order.
The Bloc Québécois believes that it is relevant to determine whether including criminal negligence of seniors in long-term accommodation in the Criminal Code will help them get the care and services to which they are entitled.
Seniors have been the biggest victims of the COVID-19 pandemic. We recognize that. They were overrepresented in the number of deaths. They are also the ones who suffered and continue to suffer the most from the aftershocks of the virus through isolation, anxiety and financial hardship.
I want to point out that Quebec already has legislation on elder abuse and the abuse of any vulnerable adult. This legislation provides for fines and protects informants who report mistreatment. That is what I was working on at the time. Community organizations and the health care network worked together on this new law.
The Bloc Québécois believes that the federal government is acting within its purview with this bill, which would add tools for investigators. We therefore took the time to study the bill in committee to assess its usefulness. Beyond prosecuting managers who commit crimes or who could do so, it is important to ensure that seniors receive services that improve their quality of life. In this regard, the Bloc Québécois would like to emphasize the other important role the federal government should play in health care, and that is to increase transfers so as to cover 35% of system costs. The Bloc Québécois also wishes to reiterate that the sad events that happened in residential and long-term care facilities, or CHSLDs, are no excuse for the federal government to impose national standards on these facilities.
Of course, we saw the critical situation in CHSLDs, which ultimately forced the government of Quebec to ask for military assistance on April 22, 2020, following a failed call to mobilize citizens to help with staff shortages in care facilities. In May 2020, negotiations between the Legault and Liberal governments were particularly tense because the federal government refused to extend the military assistance in Quebec. In a way, the federal government used Quebec’s need for military assistance in the throne speech to announce its intention to impose Canadian standards in CHSLDs.
This was a way for the federal government to impose its requirements when faced with the provinces and Quebec joining forces and calling for a 35% increase in health care transfers. Quebec reiterates that demand. The government is back on the attack, supported by the NDP, trying to impose its standards. The Liberals are still clinging to this idea. In the 2021 electoral campaign, they promised $6 billion for long-term care in exchange for imposing their standards.
I could list many events in Quebec politics that show how concerned Quebec is with what is happening in residential and long-term care facilities. I will remind members that sections 91 and 92 of the Constitutional Act, 1867, define the division of powers between the federal government and the provinces. They specify that health is the exclusive jurisdiction of Quebec, except when it comes to the health of indigenous peoples, military hospitals, drug certification and quarantine. Let us keep this in mind, because it is important.
The Liberal Party of Canada and the NDP keep stubbornly trying to interfere in areas of provincial jurisdiction, especially health care, because it is so obviously important to people. The federalism they stand for, however, requires each level of government to operate within its areas of exclusive jurisdiction. We had this debate before the election. In 2021, the NDP introduced a motion to impose national standards on long-term care facilities. We had already spoken out against that back then. What we want is for the federal government to do its part, because of the staff shortage and, obviously, because we have to find ways to work on solving the many problems facing the health care system.
Thirdly, the Quebec government had to answer to the opposition in regard to its ministers’ decisions. As we know, the Quebec minister who was responsible for seniors and caregivers at the time moved a motion on December 2, 2020 denouncing the Liberals’ desire to impose Canadian standards on long-term care facilities, or CHSLDs. It was adopted in Quebec’s National Assembly. The Bloc Québécois supports the National Assembly of Quebec’s unanimous position and denounces the Liberals’ centralizing vision.
Since then, the Quebec ombudsman has released a report making recommendations to the government. A provincial plan for deploying emergency personnel, a protocol for deploying extra staff in exceptional circumstances, and a Quebec strategy to combat staff shortages are also in place, and our computer systems have been updated. In addition, Quebec’s department of health and social services presented a Quebec action plan to recognize the complexity of care and service provision in long-term care facilities. We also adopted legislative measures to define the guiding principles that must be followed regarding living environment quality and organization and established the procedure for applying them through regulatory means. In short, Quebec is taking action and already has ideas for fixing the situation. The federal government will not be able to any better, since it knows nothing about the situation on the ground in these particular hospitals.
We know that the Quebec government has presented its plan to reform the health care system. This plan includes a range of measures, including large-scale recruitment of workers, better access to data, the construction of new hospitals and more accountability for executives. In addition, the coroner is still investigating, and some people are calling for a public inquiry. In short, in every case, it is up to Quebeckers to take stock of the situation and fix their system; the federal government cannot just jump in and start doing the work Quebec is already doing.
As we know, these regulations are part of the Quebec Act respecting health services and social services. Most long-term care facilities, some 86%, are public, compared with only 46% in the rest of Canada. We said all this before, when we were debating national standards for long-term care facilities. Let us be clear, Quebec and the provinces have the expertise and experience needed to manage long-term care facilities. The federal government does not. For all of these reasons, Quebec opposed every one of these national standards.
If the federal government truly wants to help the provinces and Quebec emerge from the pandemic and provide better care to our seniors, it should stop being so paternalistic. It should forget about imposing federal nationwide standards that are not a good fit for a range of different social and institutional contexts. It should actually increase health transfers, which would enable Quebec and the provinces to attract and retain more health care workers.
At least, there have been some amendments to this bill that the Bloc Québécois agreed with. We heard the testimony and followed the committee's work very closely and rigorously. That is why we will be voting in favour of the bill, with a view to focusing on the Criminal Code, which is under federal jurisdiction.
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Mr. Speaker, I rise to speak to Bill C-295, an act to amend the Criminal Code on neglect of vulnerable adults.
COVID-19 brought to light issues in the long-term care industry. Canadians did not, and will not, accept the conditions that were on display during the height of the COVID-19 pandemic in long-term care facilities. This bill was initiated in that global atmosphere, with the primary objective of better protecting vulnerable people living in these facilities. Seniors and persons with disabilities in long-term care deserve safe, quality health care.
Bill C-295 is one method of delivering this care. My colleague, the member for Vancouver Centre, who sponsored this bill, is proposing changes to the Criminal Code in three ways. First, this bill proposes to amend section 215 of the Criminal Code, which criminalizes the failure to provide the necessities of life for a dependent. The bill would give owners and officers of long-term care facilities a duty to residents that is similar to parents' duty to their children; it would criminalize failure to ensure that the necessities of life, such as food, lodging and care, are provided to residents.
Second, this amendment would be supplemented by a prohibition order against persons convicted of this new offence. This order is an accessory to the sentence that may be imposed. It is discretionary and would allow the court to prohibit, for a period of time that it determines, the convicted person from seeking, obtaining or continuing any employment, even voluntary employment, that would place that person in a position of authority towards a vulnerable adult.
The third and final change proposed by this bill is the addition of an aggravating factor at the sentencing stage, requiring the court to consider a heavier sentence for organizations that fail to meet their legal obligations to a vulnerable adult.
This bill was studied last spring by the Standing Committee on Justice and Human Rights. I would like to focus my remarks on the work done by this committee and the results obtained.
Various witnesses were heard, several briefs were submitted and the majority shared the same concern, that the term “manager”, which was initially proposed in the bill, could result in the inclusion of frontline workers in this new offence. Given the critical shortage of staff in care facilities, according to the Canadian Association for Long Term Care, the proposed measure could “have a devastating impact on recruitment and retention by unintentionally creating undue risk and hardship for front-line staff. This will exacerbate an already emergency situation in many [group] homes” and facilities. LTC providers across the country provide an invaluable service to seniors and persons with disabilities.
Justice committee members from all parties welcomed amendments to this bill to carefully identify owners and officers as the responsible decision-makers, who are accountable for mismanagement. They are the ones holding senior management positions, such as those of CEO or chairperson.
The objective of the bill is laudable, but it should not interfere with the already precarious operation of LTC facilities. Officers are the individuals who make the key decisions on the care offered, the staff in place and the budget allocated to equipment, to name a few examples.
For vulnerable persons, their inability to care for themselves makes them completely dependent on the care provided by these people, who have committed to helping them by making these decisions with their best interests in mind. However, neither owners nor officers provide direct care to their residents; rather, they oversee the facility's operations, make key management decisions and ensure that the staff under their direction have all the tools they need to carry out their duties. Owners and officers who take all reasonable precautions and care in the performance of their duties would not be affected by this change in federal law.
With this amendment, the bill would specifically place responsibility on owners and officers of long-term care facilities who fail to ensure the necessities of life are provided to residents of the facility they manage, if this would result in causing or risking permanent harm to the health of the residents in their care.
Vulnerable adults in long-term care facilities depend on the good care of frontline workers and also on the thoughtful decisions of the management team. Frontline workers such as personal support workers, who provide direct care to LTC residents, would not be affected by this change in federal law. Sufficient staffing levels and adequate functional equipment, to name a few examples, come down to management decisions that can have an impact on the health of long-term care facility residents. Owners and officers therefore have a central role to play in the health of the adults entrusted to their care.
I am grateful for the work of the committee members who adopted the amendment to make the maximum sentence four years in this case, similar to the offence under section 161 of the Criminal Code, which deals with orders prohibiting persons convicted of offences against minors from working around them. The committee worked collaboratively to advance the cause of vulnerable people in long-term care facilities, and I remain convinced that we can continue to work in the same direction. Our seniors deserve better.
The current state of the bill is, in my opinion, improved and more in line with the principles of criminal law. We have all heard the difficult stories of people trapped in long-term care facilities at the very start of the COVID-19 pandemic, in many cases without food or water. The individuals at the helm of these facilities must be dissuaded from making decisions that risk jeopardizing the health of their residents. The bill would send a clear message: Vulnerable adults in long-term care facilities can rely on third parties to provide them with a decent life, and there is no justification for compromising their health and dignity. We remain committed to working with the provinces, the territories and the long-term care sector to ensure that seniors and persons with disabilities live and thrive with the highest standard of care.
I would like to conclude by saying that I am confident that Bill C-295 will be passed quickly by this chamber so it can be studied by the other place. The revised version would more specifically place the responsibility on the people whom, as a society, we trust to make sound decisions with respect to the care of our seniors so they can live out their final years in peace. Canadians should have access to safe and quality health care at all stages of their life.
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