Perley and Rideau Veteran's Health Care Centre
Veterans' Care
KEN POLE
© 2015 FrontLine Defence (Vol 12, No 4)

Much of the debate about Canadian Armed Forces (CAF) veterans of late is about those who have returned from recent combat and other missions across the globe, but there are still thousands of older veterans scattered across the country. Their average age is 89 and they remain part of a nationwide challenge as well as a national and international debt. In Ottawa, they are concentrated at the Perley and Rideau Veterans’ Health Centre, which reserves 250 of its 450 beds for World War II and Korean War veterans. Like similar institutions, the Perley Rideau is having to reassess its roles and responsibilities as the number of veterans from that era continues to dwindle.

The Perley and Rideau Veterans' Health Centre

According to the federal government’s main spending estimates for the current fiscal year, the overall number of veterans is estimated at approximately 697,400. They include some 98,200 World War II and Korean War veterans who rely on Veterans Affairs Canada (VAC) for support.

Nearly 91% or $3.2 billion of VAC’s budget represents payments to veterans, their families and other recipients. The overall $3.52 billion allocated for VAC in 2015-2016 is down 1.5% from last year but it’s up marginally in absolute terms from $3.51 billion in 2013-2014 as inflation offsets a dwindling demand.

The History

The Perley and Rideau Veterans’ Health Centre reflects a history which began just 30 years after Confederation, when the heirs to the late William Goodhue Perley, a lumber baron who served briefly as a federal politician, conveyed property for the care of persons needing long-term shelter and care.  

When that property was expropriated in 1912, a new Perley Home was built ­on Aylmer Avenue, and over the ensuing decades it was expanded, adding physiotherapy and orthopaedics to its services. In the meantime, the Rideau Veterans Home (RVH) was built by the federal government as a temporary residence for the rehabilitation of World War II veterans.  

In 1988, Veterans Affairs Canada invited the Perley Hospital to submit a plan to combine with the RVH and the Veterans Wing of the National Defence Medical Centre in a new 450-bed facility. Construction on Russell Road began in 1994 – with VAC covering 55%, the Ontario Ministry of Health (OMH) 30%, and the Regional Municipality of Ottawa Carleton 10%, and the balance covered by community fundraising.  

In 1995, the first residents moved in. Two years later, the OMH designated the new facility as a long-term care home. It was renamed Perley and Rideau Veterans’ Health Centre in 1999, and registered by the Canada Revenue Agency as a charity, which enabled the organization to solicit and receive donations, bequests, legacies and grants.  

Continuing to grow with the needs of residents, the campus-like facility underwent a major renovation and expansion (designed by award-winning Ottawa-based Edward J. Cuhaci and Associates Architects Inc., and MMMC Inc. Architects) in 2013.

The total budgeted this year for the Veterans Independence Program, which VAC says is “to assist in defraying costs of extended health care not covered by provincial health programs”, is $90.6 million. That’s down 6.8% from 2014-2015 and less than half the $184.06 million provided for the year before.

There is a continued shift in responsibility to the provinces and, for the Perley Rideau, it means a potential reduction in services at a time when its supporters say it should be an exemplar for the rest of the country. The facility is supported by the Perley and Rideau Veterans’ Health Centre Foundation, which supplements funding from VAC and the Ontario Ministry of Health and Long-Term Care to sustain services to residents, apartment tenants, and seniors in the  broader National Capital Region.

Veteran Reading in Library

The foundation’s executive director, Daniel Clapin, explains that “from a fund-raising perspective, we have all kinds of name-gift opportunities.” One generous $150,000 gift came from the Molson Foundation. “Andrew Molson (a member of the Molson Coors Brewing Company board) said, ‘well, you can call it Molson Foundation Activity Room if you think it’s beneficial to you, but it doesn’t matter to us. If you wish to honour an individual from your board, or a veteran, please do so’.”

That kind of altruism is an important element of the balance sheet here, as it is at similar institutions across the country. It cost $48.3 million to run Perley Rideau in 2014. The 2015 budget is still evolving but last year’s total included $8.5 million from VAC to offset meals and accommodation costs as well as subsidize socially-valuable programs such as arts, music, and wood shops, which are not often found in long-term care facilities and involve substantial effort by dedicated volunteers.

Those extras, which bring a quality of life often lacking in institutional care, could be in jeopardy as the Perley Rideau contemplates a future with substantially reduced, if any, extra federal funding. “We’re actually in the middle of negotiating next year’s budget; it’s always done around this time of year,” Chief Executive Officer Akos Hoffer tells FrontLine. “But next year’s budget won’t  be dramatically different; if anything, there would be inflationary increases and things like that. We’re not changing any of the programming dramatically, up or down, or anything like that, or staff levels.”

One solution to cuts to funding is to return Perley Rideau to its roots, providing chronic hospital care. “We were originally constructed and funded [by the province] as a chronic care hospital,” Hoffer explains. “What we’re looking at now is: our core business will remain long-term care but we have so many beds that the question is what is the best use of those beds for the health care system?

Veteran's Reading Room

“Already, 34 of our 450 beds are convalescent care; it’s a short-stay program, you’re coming out of hospital, say after a hip surgery, you need some time to recuperate before you go home or to rehab. Then you get to spend some time here. We can do that. For those in need of support before returning home, I think we can provide an excellent level of care and support.”

To that end, Perley Rideau is in discussions with The Ottawa Hospital and the Ontario Ministry of Health and Long-Term Care. “Right now, for example, we’re looking at repurposing a unit for what’s called sub-acute care: just coming out of the hospital, you’re not totally medically stable, but if we take care of you here, we have a very rehabilitative approach, that’s still our expectation and would still fall under the Long-Term Care Homes Act. You can designate units for a special approach like that. That’s what we’re going to be applying for in the near future.” Hoffer does not think that will lead to formal designation as a hospital again, at least for now. “I don’t think that, at this point anyway, that’s necessary to accomplish our goals,” he says.

“At the end of the day, long-term care will remain our core business and we will have a tangible commitment to veterans. “From the art on our walls, to the victories we commemorate and our legions of supporters, we will always have a strong connection to veterans. It’s an important part of who we are.  What we are exploring is growing our sub-acute care programs for all seniors – veterans and non-veterans alike.”

Hoffer doesn’t foresee Perley Rideau being subsumed into The Ottawa Hospital, which already has three main campuses in the city. “As much as we want to stick to our core competency of providing care for seniors, they want to stick more and more to their core competency of acute care: emergency medicine, surgery, all that sort of thing.” However, as TOH pushes toward more specialized care, the transition is hindered by having to accommodate patients who don’t need acute care anymore – at significantly higher cost to the province.

Veteran's enjoy an art class

In December 2012, Living Longer, Living Well, a report by Dr. Samir Sinha, director of geriatrics at Mount Sinai Hospital in Toronto, and provincial lead in Ontario’s Seniors Strategy, highlighted the challenge facing Ontario and, by inference, other provinces with significant numbers of seniors. Among other things, it acknowledged that seniors not only “helped to build our country and our province” but “continuously help shape our society by sharing their experience, knowledge, expertise, and wisdom.”

However, the report noted that while “they have been contributing to our economy longer than any other age group older adults in general – and those with complex issues in particular – drive health care costs. Although only 14.6% of Ontario’s population at the time, seniors accounted for nearly half of the province’s health care spending. “Left unaddressed, our demographic challenge could bankrupt the province,” it warned.

Part of the solution is the kind of support that enables seniors in general, and veterans in particular, to stay at home as long as practicable – an initiative Hoffer said the Perley Rideau is buying into. The historical focus has been on long-term care only for residents, but Sinha’s report urges a community-wide approach which would include hospital and other health providers.

“We think the ideas we’re presenting align with that strategy,” Hoffer says.

But there’s no avoiding that demographic curve, especially its impact on funding. “We’re okay for the near term, but as the veterans population goes down, and our veteran occupancy goes down, that will create a funding shortfall,” Hoffer replied when asked how Perley Rideau could function with fewer federal dollars.

A visit by members of the Canadian Armed Forces
A visit by members of the Canadian Armed Forces.

“This is where it gets a little complex; because we were originally constructed as a hospital, we will always have […] costs that are hospital-oriented. You can negotiate with the province to say ‘we’re unique and we need unique funding’ and we intend to do that. In parallel, we’re trying to solve the problem on our own. For example, if we repurposed 40 beds for sub-acute care, we have an opportunity to make sure the funding for that is adequate – it’s 40 less beds to worry about from a funding perspective and there are benefits for patients, residents and the health care system.”

Hoffer acknowledged that post-Korean War veterans, a demographic bubble originating in subsequent deployments abroad for Canadian regular and reserve personnel, could be an opportunity. “We’d love to be able to meet their needs – we can, but there’s no mandate at this time.

Veterans Affairs doesn’t have a ‘designated bed’ approach for post-Korean War veterans.   At this point, if you’re, say, an Afghanistan vet and you need long-term care, you would access a general long-term care bed like any other member of the community.”

The “priority access” beds for World War II and Korean War, and the 200 other long-term care beds all receive provincial base funding. “If we don’t have a veteran going into a bed, we would put a non-veteran in that bed. In a year from now, if we have 10 fewer veterans here, we don’t close the beds; we still get provincial funding. The issue is that we lose funding from Veterans Affairs and provincial funding does not cover our structural costs.” That, he adds, “forces us to look at what we want to be in the future” and “ties with our long range strategy and our vision.”

It remains to be seen how the vision for veterans services at Perley Rideau will evolve, but of its current 450 beds, 250 are “priority access” for veterans, which preserves a heritage dating to the late 1800s. The commitment to serving veterans is evident through interactions with staff.

In addition to long-term care, Perley Rideau offers 40 short-stay care beds for convalescent and respite care, 139 apartments, and a guest house for seniors with early-to-mid-stage dementia. There are also assisted living services for seniors who live outside its village, and a day program for those with mild dementia. On-site services at the village include a dental hygienist, a hearing clinic, pharmacy, physiotherapy, dermatologist and Alzheimer Society support.

Robert and Therese Hanley
Robert and Therese Hanley

The village comprises five buildings, three of which (Rideau, Ottawa and Gatineau) provide long-term care. Studio, one and two-bedroom apartments in the other two buildings offer a variety of care options. Two-thirds of the apartments are offered at market rent, the rest below. Residents can choose from 29 one-bedroom, 5 two-bedroom and 20 two-bedroom-plus-den units in Commissionaires Ottawa Place, or from 41 one bed room units and 4 two-bedroom units in another building (simply called “B” for now).

There are four commons of 10 studio apartments, each sharing a kitchen/dining area where meals are prepared and served through the assisted living program. The apartments are designed for seniors and veterans who can live independently, who require help with everyday tasks, or who are in the early-to-middle stages of dementia. At least 20% and up to 30% of all apartments are reserved for CAF veterans, while the rest are available to veterans or non-military seniors on a first-come basis.

Given their varied backgrounds, it would be misleading to describe a “typical” resident, but one couple, Bob and Terri Hanley, have sort of become a “poster pair” for the Centre, often featured as spokespersons and in promotional material. However, their arrival at Perley Rideau was fairly typical.

“I applied here five years ago,” he told FrontLine shortly after celebrating his 95th birthday. “There’s a very good system here. Anybody who’s in the service knows about this place – at least we did.” After he had been hospitalized a couple of times, his doctor suggested “a home” where care was readily available.

Bob was a Saskatchewan farm boy raised in Harris, “about 75 kilometres west southwest of Saskatoon on the way to Calgary”. Having always done “mechanical stuff” on the farm, he went off to a youth technical training program in Saskatoon and while learning aircraft mechanics, heard radio reports of British Prime Minister Neville Chamberlain’s abortive attempts to appease Adolph Hitler.

Six months of basic training in Toronto was followed by more technical college and then a posting to Alberta where he maintained aircraft for the Commonwealth Air Training Plan.

When the Royal Air Force began running short of technicians to support its Supermarine Spitfires, Hanley was shipped “across the pond” in January 1942. He and the other Canadians worked on various U.K. air bases as preparations for the Allied invasion of Europe matured and then he and two others were commissioned as engineering officers in January 1943.

Hanley was with the first fighter squadrons into Normandy after D-Day in 1944. He crossed The Channel in a Douglas DC-3 Dakota. “I never saw a sight like it in my life,” he said. “From England to Normandy, I don’t think you could’ve put another boat in there. It was absolutely full!” Hanley and his crewmates didn’t get very far in the first month. He spent a lot of time in a slit trench as Bofors anti-aircraft guns hammered at German attackers. “I think they used every single one all night,” he said, demonstrating how he used to move his helmet around to protect different parts of his body. “Shrapnel was falling like rain.”

Veteran's reading the newspaper in their room

By the time the war ended, Canadians had helped to build a series of airstrips all the way to Hamburg, each supporting three squadrons of 16 aircraft. Working seven days a week “from daylight to dark, we rotated through bases as the Allies moved up.” It often meant scrounging for food to supplement military rations. Even more unpleasant was the task of finding downed Allied aircraft on the battlefield.

Hanley said he never lost hope that he would live through it, other than his first nights in that trench not far from Juno Beach. When he returned to Canada in July 1945, he quickly found that there was little prospect of a livelihood back on the farm. So he moved to Calgary, where he began working for Canadian Pacific Airlines and Edmonton-based Northwest Industries.

However, he joined the RCAF Reserves, where his commanding officer suggested that he might want to re-enlist as an officer. Although offered a job in Winnipeg by the federal Department of Transport, he opted for the RCAF. He retired as a Major in 1969 after a career which included oversight of maintenance at several key bases, including Ottawa Uplands, Trenton, and Bagotville.

Hanley then spent nine years at Treasury Board in Ottawa where, after his first wife died, he was introduced to Terri and they married in 1971. After a time in Florida, they returned to Canada, settling in rural Ingleside before returning to an apartment in Ottawa. There evidently was no consideration of anywhere but Perley Rideau, and the Hanleys were one of the first arrivals under the new regime.

Hanley then spent nine years at Treasury Board in Ottawa where, after his first wife died, he was introduced to Terri and they married in 1971. After a time in Florida, they returned to Canada, settling in rural Ingleside before returning to an apartment in Ottawa. There evidently was no consideration of anywhere but Perley Rideau for the Hanleys, who were one of the first arrivals under the new regime.

Now that the apartments are fully leased,  Perley Rideau is focused on  the quality of the care and services it offers while sorting through its best options to provide a bright future for its residents. Hoffer agrees that continued VAC support will be crucial. “We’re working out what the funding formula will look like as we have fewer and fewer beds.”


Seniors: Health Canada Challenge

The challenges facing Canada’s military veterans and financially-constrained governments are part of a greater looming issue. Statistics Canada’s latest population estimate, extrapolated from the 2011 census, indicates that of a 2014 national total of 35.5 million, 5.7% were 65 or older. In a major report published last May, the agency predicted that figure will jump to between 23-25% in 2036, and between 24-28% in 2061. “The increase in the proportion of seniors would be especially rapid in the next 25 years,” it stated.

The Conference Board of Canada has also warned that services for seniors are becoming more important to provide – and more challenging to deliver – as the population ages. “Seniors are more frequent users of […] health care systems and related social services, which puts additional strain on funding,” the think-tank stated in a report, Understanding Health and Social Services for Seniors in Canada, which was partly funded by the Canadian Medical Association. Its authors point out that, as demand for services grows, revenues are expected to shrink and, worrisome, the trend “should accelerate as the very large cohort of baby boomers moves into retirement.” Although not considered to be insurmountable, they said that ensuring system readiness and viability requires foresight by all stakeholders. “Effective, well-designed services and programs are essential for Canada’s future.”

The prevalence of dementia “stands out as a particularly important issue. In 2011, almost 750,000 Canadians were living with dementia, and this is set to double by 2031 if nothing changes.” Many other countries have prepared national dementia strategies to coordinate an effective response to these challenges. This is where Health Canada could take a leadership role, but the report says Canada “has been slow” in taking such a step.

“Alberta stands out among its peers for its coverage of seniors’ care, which includes dental and vision care. However, in all jurisdictions, including Alberta, these services are typically uncoordinated and seniors usually have to pay user fees or have their incomes tested to qualify for some or most services. […] Variations in financial support across Canada represent a significant inequity in access to care,” reads the report.

“With the expected growth in demand in all areas of seniors care, appropriate funding to match capacity with demand is essential. Notably, we observed that even though experts were unanimous in their support for expanding home care, which is a less expensive setting for nursing and convalescence than hospitals, there has not been an increased allocation of funds to this sector over the last decade (as a proportion of overall health care expenditures)” the authors wrote.

“The complex and interconnected challenges facing seniors and seniors care in Canada will require national action from federal, provincial, and territorial governments, as well as other key stakeholders and communities. Only by working together and in sync, will Canada be able to improve health care services for seniors, enhance the quality of life of seniors and their families, and reduce […] unfair health disparities.”

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Ken Pole is a Contributing Editor for FrontLine Defence magazine.
© FrontLine Defence 2015

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