Legislative Assembly of Ontario

[Report continued from volume A]

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LONG TERM CARE STATUTE LAW AMENDMENT ACT, 1992 / LOI DE 1992 MODIFIANT DES LOIS EN CE QUI CONCERNE LES SOINS DE LONGUE DURÉE

Resuming the adjourned debate on the motion for second reading of Bill 101, An Act to amend certain Acts concerning Long Term Care / Loi modifiant certaines lois en ce qui concerne les soins de longue durée.

The Acting Speaker (Mr Dennis Drainville): I believe when last this bill was before us, the honourable member for Mississauga South had the floor.

Interjections.

Mrs Margaret Marland (Mississauga South): It's going to be interesting to speak when everybody else is speaking. I think I'll just wait.

The Acting Speaker: To the honourable members, please, if you're leaving the chamber, the honourable member for Mississauga South is about to begin her remarks on this bill. Order, please.

Mrs Marland: Thank you for your help, Mr Speaker. When I finished my comments on second reading of Bill 101 the other evening at about two minutes before midnight, I was about to read something to the House which I think better than anything else expresses why I'm concerned that this bill has no reference in it to children.

The assumption, I think, as I said last Thursday evening, is that long-term care is a provision of service primarily to adults, to the aging population, to the frail elderly, and unfortunately, and in some cases tragically, the long-term care of children starts very early in their lives.

For that reason, I wish to read into the record a letter that was written by very special parents. It's an open letter they wrote because they wished to share with other parents, and I think particularly different levels of government, what their life is about with their child who has very special needs. The letter reads as follows:

"Today when I went to my mailbox I found a notice to Community Living Mississauga's clients re leisure cutbacks.

"I am left shaking my head and wondering how I will cope next summer with the possibility of little relief and no leisure programs for our daughter who is now eight years old.

"Up until our daughter was four and a half years old, her life and ours was fairly typical. She was fully functional and speaking in six- to eight-word sentences.

"She was born with tuberous sclerosis and we were well aware that she could 'grow into' problems associated with this disease, problems such as seizures, mental retardation and tumour growth in the major organs.

"In January of 1989, before her fifth birthday, our daughter suffered a grand mal seizure which took doctors over an hour to stop.

"She lay in a hospital bed for three weeks after, before she could even open her eyes. Because of the prolonged insult her brain had suffered, she lost all of her development including her speech. Eight weeks later, when she was discharged from hospital, she had the mental abilities of a newborn baby.

"My husband and I have worked constantly as well as relentlessly with her and a full three and half years later she has the mental abilities of an 18-month-old, and we have been told that this will probably be as good as it gets.

"As I said earlier, our daughter is eight years old, weighs approximately 85 pounds, has the mental abilities of an 18-month-old, relies totally and completely on my husband and myself for her needs, has poor seizure control, is not and never will be toilet trained, she is non-verbal and she is extremely active, requiring supervision 100% of the time.

"As dependent as she is, we have grown so much in love and as a family because of her. We are quite prepared to accept whatever comes and whatever is required. We love her to bits! She is the happiest child you could ever hope to meet and, fortunately for her, she will never come to understand her limitations. Again, our goal is to keep her as happy and productive as she can be.

"We are infuriated to read yet again about more funding cutbacks. Our lives for ever changed in that hour of our daughter's seizure. It was also no one's fault. We wonder why the very people who require assistance continually get the shaft and are somehow 'punished' by all these cutbacks.

"My husband and I are trying to manage and balance a very difficult and demanding lifestyle. I haven't even mentioned the endless array of doctors' appointments, assessment and tests that are part of our everyday lives.

"It is unfortunate that these cutbacks are made by people who probably would not be able to take a step in our shoes, let alone walk a mile in them. It is also unfortunate that the people who make these cost-saving decisions don't consider for a moment what effect their decisions have on already overstressed, overtired and overworked parents.

"I would like to make it perfectly clear that our daughter is very much a part of our family and will be as long as we are physically able to care for her. Part of the reason we are able to 'keep going' is because of our regular respite care and the leisure programs. We are very much in need of these programs to help us cope.

"Perhaps some of these decision-makers would like to spend a day in the life of our daughter. I would even put them up for the night so they could experience first hand the joys of getting up six and seven times a night to put her back into bed and monitor the length of her seizures.

"I would like them to come and see how active she is. My husband recently chained our console TV to the wall because she almost tipped it on herself. I would like them to watch her 100% of the time with barely enough time to go to the bathroom or have a hot cup of coffee or even a lukewarm dinner. I would like them to watch her seven days a week, for nine weeks during the summer holidays and maybe, just maybe, they would begin to see the value of these programs. At the very least, I would hope that they might see the reality of caring for a special child, and ours is certainly not the worst-case scenario.

"Without sounding vain, parents of special children should be commended for the job that we do! Instead of attacking the people and programs that make a difference in our lives, I think a long, hard look has to be taken at what is happening.

"We are truly annoyed at this latest notice. Whatever happens, we will find some way to cope. We have no other choice. Despite everything we have lived through, we still have much to be thankful for and it's just a shame that someone in the government can't wake up some morning and smell the coffee.

"We're two disheartened parents."

That's the end of the letter from which I was reading. I think this letter, in all its poignant comments, illustrates better than anything I can say what the situation is for these families who depend on respite programs at this point in their lives and, who knows, ultimately some form of long-term care for their loved ones.

When I get up and speak, the government members automatically assume I'm saying what I'm saying because I'm in the opposition. I can assure you that whether I was a backbencher in opposition or a backbencher on the government side of the House, I would still be standing up saying the same things.

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I guess I must be very naïve because I fail to understand how a government cannot prioritize in terms of human need. I guess I fail to understand, when you are sitting as a cabinet member around the cabinet table and all the different ministries are there asking the Treasurer for their individual funding and the importance of their program versus somebody else's program, why it's so difficult to say: "Well, look, folks, right now we're in a recession. Right now we're very short of money. We haven't had the revenues this past year" -- or two years or whatever -- "that we predicted, and you're not all going to get the same budget allocations that you're asking for or that you had last year. But we are going to start by looking after the people who need the most help first."

What would be so difficult about that? What person couldn't stand on a public platform as a politician, anywhere in this province -- and people have heard me say this before -- and say to a group of people at a public meeting, whether it's 10 people, 15 people, 500 or 5,000 people, "I'm sorry, we don't have money for that program because we have to have the money for this program in terms of human need"?

I've gotten into trouble before saying things about where I think there are examples of government wasting money, so I might as well get into trouble again.

I have said in the past year and a half that in spite of the French Language Services Act, I am appalled that this government has committed $16 million to bilingual signs on our Ontario highways at this time. If this was a perfect world and we weren't so desperately short of money in Ontario, then I think if the Minister of Transportation wished to implement that aspect of the French Language Services Act -- which is optional, by the way; it's not a requirement under the act, but an option that the minister has to interpret the act to make the provision of those bilingual highway signs -- I wouldn't object to it and I wouldn't talk about it, because I would feel that it was a program that was affordable and everything else had been looked after.

But when I think of a family such as the family whose letter I have just read, and hundreds of other families like them -- we saw some of those families about 10 days ago on the front lawn here at Queen's Park. In fact, we saw over 4,000 of those families, their friends, their relatives and their health care workers coming down here in a public demonstration to say to this Bob Rae socialist government, "Please have compassion on us."

This is the party that when it was in opposition, you would have thought had the sole licence to compassion. They were the party in opposition who claimed they were the only people who cared about people. Well, as the saying goes, something happened on the road to Damascus. Certainly, between sitting on this side of the House in opposition and walking whatever it is -- I guess maybe 14 feet -- across the floor of this House to sit on that side of the House on the government benches, this New Democratic Party did something for which I will never forgive it. In my opinion, they betrayed the people who thought they could count on them.

They have betrayed the people who thought they were a party that cared about the underdog, the individual who suffered in many, many different ways and many, many different forms. But the fact is that they don't. Their Agenda for People is full of promises. Their record in the past two years is full of broken promises. So while they had an agenda for the people in this province, their actual record is totally different.

When I think about these families, I can give you all kinds of examples of families like this that I'm personally aware of, the families who have children who when they turn 21 no longer have access to any kind of daytime program in the form of an educational program, so that when they're 21 they don't have the option of being picked up on a bus in the morning to go out for a program of stimulation and challenge and motivation by professionals. Those children now, when they turn 21, fall completely between the cracks and there is nothing available for them to do. With the shelter workshops now cut out, there's another option that has been reduced and eliminated.

These parents are an example. They're talking about their child who is eight years of age. I could come in and read similar letters from parents of all ages of children. I have letters from parents. I can tell you right away of one mother who's 67; she's a widow and she's looking after her 42-year-old developmentally disabled son. There is no help now available to these people. In a lot of these cases, they've never, ever asked the government to take their children and be wholly responsible for them.

This family isn't asking for that. This family is simply saying: "We need the summer program. We need the leisure program and the respite program." That's what they're saying. In this case, it's hard to forecast, but I'm sure that this little girl would not be able to go to a sheltered workshop in the future.

But many of the parents of children of varying abilities have been perfectly happy to look after those children at home as long as there were some intervals from time to time where they had the respite and the relief, as this mother says, from being up six or seven times a night to put this little eight-year-old girl back into bed and to monitor the length of her seizures. These people aren't saying: "Take my child. I can no longer look after him. I no longer want him at home." That isn't what these parents are saying.

Many of these parents -- and again I can think of three at the moment who happen to have sons who either are 21 or will be turning 21 next year and for them June 1993 means the end of their access to the school day program. Those parents, for 21 years, have looked after this child who can't walk, can't speak, is in diapers and needs constant care and supervision for every one of his needs. But those parents have never asked the government for a penny. They've never said, "I can't cope. You have to take my child and put my child in an institution," hospital or whatever facility was needed.

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No. They have said they want their children at home. They want to look after them at home, where they know what kind of care they are given, where they know those young people, and sometimes eventually of course middle-aged and older but still their children, are surrounded by a loving, caring environment because they are in their home and they know what their needs are and their wish is to meet them.

But what happens when a government makes cutbacks to organizations like the community living associations in this province? As far as I'm concerned, it demonstrates that that government has no heart at all.

When you look at the aging parents, as I mentioned the other night, who've looked after people with special needs all their lives and they are now becoming ill because of their age and they've been worn down by their responsibility, they are so frightened and so concerned about who will look after their children after they have gone, as they are physically becoming weaker and less able, week by week, to do the job themselves.

When you look at Bill 101 and we talk about long-term care, there are many, many areas of service that come under that title of long-term care, and many of those areas are areas for which there are no alternatives. There are no choices for the individuals who require that care.

My concern is that when this government thinks it's okay to cut back programs that are for our most frail and vulnerable people, then I really wonder how it can make decisions in the overall picture of provision of care for anyone.

I feel very strongly about the fact that this government today, as I've said many times, simply doesn't seem to be willing to prioritize. I would emphasize that I have not said this, but there are many people who have said to me, "Is it because in the overall scheme of things there are not as many of us in the overall population as voters as, say, their union friends who are voters, or larger groups, constituency groups, whose intimate need for survival isn't as great but there's more of them?" In the crass world of politics, what they're asking is, is it because there are more votes for them if they do something for these larger constituent groups and they're not as concerned about the few votes that fall under the category of these families in extreme need?

I don't choose to answer that question, because I feel it's up to the government to answer it. I'm not going to answer that question on their behalf, but I'm quite confident that the electorate will answer that question on behalf of the government at the next election, because a government that does not look after its most frail, vulnerable people, as far as I'm concerned, has to be the worst kind of government possible.

Some people will survive no matter what the economic climate, no matter how deep a recession, no matter how bad a depression. If you have your health, you are able to survive. If you have your health, you're able to look after your family members and help them to survive.

I'm a daughter of a family that immigrated here in 1930, and I can assure you that in those next nine years of the Depression of the 1930s that my parents were here, there were many times when my parents went hungry. Not my three brothers and I, because that's how parents work: They make sure their children are fed. But when I think back to the 1930s in Ontario, to the Great Depression, as we refer to it, and recall the accounts of what my mother and father did, I often wonder whether even I could do that today or whether our society has changed so much that none of us is willing to make sacrifices today -- except when we don't have any choice, of course.

My parents were hungry and they lived apart. My father was living in Toronto, in fact living at the YMCA, because he couldn't afford to live anywhere else doing the menial job he had. He was thrilled to have a job in Toronto. It was a concern for him, but it wasn't something they couldn't live with, that he had to leave his wife and four children in St Catharines on their own for the winter months.

When I think of what that kind of experience meant in my own family, it teaches me a lot. It teaches me the fact that if you are healthy physically and mentally, you can endure unknown amounts of change, you can always adapt. In that case, my family did adapt. In retrospect, I never heard my mother say that she suffered through the Depression; she just said they lived through it. Every time they had to do without something else they accepted it, but the point was that my family was blessed with health in those years. They weren't blessed with anything else except health and each other.

The people who need long-term care which is covered by Bill 101 are people for whom none of those options is a choice. Why should long-term care be planned around forcing people to make choices that may be totally inappropriate? I placed concerns on the record the other night that areas of this bill are not in reality looking at the options for some patients, some people requiring different levels of care in institutions.

It always sounds great to say: "We're going to bring everybody home. We're going to take everybody out of an institution." All I can say is that if that will work, that's great; but where it will not work, then it's not something where a government can arbitrarily say, "We're going to do this because it's best for everybody." It's got to be something that's realistic for the people who are involved. I really feel that if this government were planning long-term care reform, I would have expected that the first area it would look at is the people who are in that kind of care for the longest period of time. That's why I'm concerned about the fact that Bill 101 has not addressed the needs of children in any way at all.

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In closing, I simply say that if this government has any money to spend on making these changes -- because it's surely going to cost millions and millions of dollars to make the changes it is proposing, because it's going to have to set up this whole infrastructure in community-based resources -- if it has the money to do that, which is the goal it must have by introducing Bill 101 in the first place, then why in the meantime would it cut back funding to the community living associations, as an example, and its triministry funding, which were developing programs that looked after these people, the examples I've given, who fall between the cracks now because there are not programs in existence for them?

There's a lot more that can be said on Bill 101 and future planning for long-term care in this province, but we also have a government that believes in silencing the opposition, so we are limited in the amount of time we can speak, and I'm down to my last two seconds. For that reason and that reason only, I have to relinquish the floor.

Mr Larry O'Connor (Durham-York): Just a few comments to the previous speaker. I want to thank her for her participation. She raised a number of areas, and it's hard to recall everything from --

The Deputy Speaker (Mr Gilles E. Morin): Questions and comments.

Mr O'Connor: That's right. It's hard to recall some of the issues from last week, but I'll try to recall a few of them. One aspect of the long-term care facilities and homes for the aged was in terms of accessibility and accountability for funding. She said there was not any mention of the developmentally disabled as far as accountability is concerned. This also deals directly with the funding for adults with disabilities and the amendments that would permit the Ministry of Community and Social Services to proceed at some date with direct funding for the developmentally handicapped, in addition to the pilots being planned for the physically disabled. Other aspects of the relationship with the long-term care reform agenda for developmentally handicapped of course will be set out later on in January, with a policy statement to come out.

I would like to reiterate the fact that last week the minister did make an announcement of $133 million for the integrated homemaker services, which will be essential in ensuring that care for the residents of facilities will be able to take place in the community in which they live. I think that's a very important aspect of the long-term care, and I'm sure we'll get much further into this as debate proceeds.

The Deputy Speaker: Any further questions or comments?

Mrs Yvonne O'Neill (Ottawa-Rideau): I too would like to make comments about the statement of the member for Mississauga South. I think she has brought very poignantly to the floor of the House -- certainly in the reading of the letter in which she presented, the very personal case she brought to our attention -- that there is a great deal of concern in the community that deals with disabled people, particularly developmentally disabled people, regarding this whole long-term reform that's presented in Bill 101.

We have had, from the government member who has just spoken, "funding at some date," he said, and pilot projects that are planned. That's what's making people nervous. We don't have any real commitment. We've known this legislation was coming for almost two years, and the pilot projects that were supposed to have taken place so that the legislation could be implemented tout de suite have not happened. That's why people are worried, that's why people are concerned, that's why they have no faith in the hopes they had dreamed for.

Respite care is not mentioned. The $133 million that was mentioned last week by the minister -- I've looked all over in every document that's been presented, including the Hansard of her remarks we don't know how long that $133 million is guaranteed for. Is it base funding? Is it a one-time grant? What does it cover? It's just thrown into the wind, and people are to buy that as a great commitment. I'm sorry, but we don't.

The Deputy Speaker: Any further questions or comments? If not, the member for Mississauga South, you have two minutes to reply.

Mrs Marland: Community Living Mississauga capped or closed its waiting list almost a year ago now. In a city of half a million people, which the city of Mississauga is, and the region of Peel is almost three quarters of a million people now, you can imagine what a devastating effect that had on the clients of Community Living's programs.

The reason they closed the waiting list wasn't because there wasn't an increasing need; it was the fact that they think five years on a waiting list is inhumane. I think so too. For the member for Durham-York to stand up and say, "We are addressing disabled adults, handicapped adults" -- I think he used that word -- he obviously hasn't heard a word of what I've said because the point I've been concerned about and I'm expressing is that there's no mention of children in this long-term care legislation.

Frankly, policy statements and regulations and all this stuff that you're talking about, that you're promising for January, February, spring, goodness knows when, I'd like to know how you think that is helping those people who are on five-year waiting lists today. It's the same all over the province. I happen to know the figures in Community Living Mississauga.

What I want to say to you, as a representative of this Bob Rae socialist government, is that my dream and my vision for the future of this province is not five-year waitings lists that are closed because there is no money to fund these programs that are for vulnerable, frail people of all ages.

The Deputy Speaker: Are there any other members who wish to participate in this debate?

Mr Tony Rizzo (Oakwood): I'm delighted to have the opportunity to advise the House on the positive impact Bill 101 will have on elderly persons and their families.

Bill 101 will have a special significance for those Ontarians who may have found themselves in the difficult and stressful position of trying to find a suitable nursing home or home for the aged for an elderly family member.

Although some communities have volunteer placement coordinator services, as a general rule the family must identify potential homes to determine whether a bed is available and whether the home can meet the special needs of an elderly person.

At a time when emotions and physical strengths may be exhausted from having borne the burden of care at home for many months or even years, families must become experts in care levels, payment schemes and eligibility criteria.

Bill 101 will change all of this. The amendments will enable the minister to designate placement coordinators across the province who will be responsible for determining eligibility, identifying potential homes, assessing whether a home can meet individual needs and authorizing the admission. Placement coordinators will ensure that elderly persons have access to the home of their choice to every extent possible.

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In addition, the amendments will establish a uniform set of eligibility criteria and the mechanism through which consumers may appeal eligibility decisions. Homes will be permitted to accept only persons who have been found eligible and who have been authorized for admission by designated placement coordinators. Homes will be permitted to refuse to admit an eligible person only if the grounds for refusing admission are set out in the regulations under the act. The amendments create a power for a director under the act to order the placement coordinators to a home if the home demonstrates a pattern of refusing admissions that would be in violation of the regulations.

The establishment of a province-wide network of placement coordinators will enable the government to manage access to scarce long-term care facilities more effectively and to ensure that persons with the greatest needs are admitted to an appropriate home. Most significantly, elderly persons and their families will have the help they need to find a home that will provide the quality of care and service our senior citizens deserve.

But I want to add that we have to be very prudent in how we deal with the private sector institutions. Reading the proposed amendments to the Nursing Homes Act, I had the impression that placement coordinators will have in their hands not only the future of nursing home applicants but of the nursing homes as well. Placement coordinators will have the power not only to judge the eligibility of an applicant, but also to authorize the admission of the person to the nursing home.

In other amendments, placement coordinators receive immunity from damages. Furthermore, I haven't been able to find a section addressing the possibility of an appeal process initiated by the institution, whereas appeals initiated by applicants are going to be reviewed by the appeal board, operating under section 23 of the Health Insurance Act.

I see one major risk in this approach, that is, that we will create a new group of powerful mandarins. These public sector employees will have almost life-or-death power over private institutions. We even make sure that these employees will not be held accountable for their actions either by the courts -- which is right, I think, because not every matter should be dealt with in a court of justice -- or by an independent body.

We appreciate the private sector's contributions to long-term care in our province, but the time has come to introduce a system that is more user-friendly, more individualized and better able to give the patients what they really need. With this bill, this new system will allow us to accomplish the difficult goals of giving better accountability and better services at a reasonable cost to both clients and taxpayers at large.

Placement coordinators responsible for private institutions must have a role slightly different from their colleagues responsible for public or non-profit organizations. I do not believe that in the present form the interests of the private, for-profit organizations are as well protected as those of the public and non-profit organizations.

I hope Bill 101 will be amended, for more than one reason:

First, to give eligible applicants the right to enter a private, for-profit nursing home at his or her will if space is available. Placement coordinators' counselling will be welcome but not required -- at least, should be welcome but not required;

Second, to give institutions the right to appeal the decision of a placement coordinator in cases where they feel unfairly treated; and

Third, to set up an independent board of appeal whose members shouldn't be employees of either the government or the private sector.

My approach in selecting the board of appeal members would be to identify experts in this area who do not have a direct professional link with these services. Such a board would guarantee to everyone, including the general public, that the review process would be totally impartial. There are a number of professionals presently not directly involved in this sector who are competent enough to be members of such a board.

Bill 101 is only the first important step towards redirecting the entire long-term care system. I praise the minister's effort in achieving one of our government's major policy objectives; that is, to give people a greater opportunity to be independent and a greater chance to live in their homes or in the environment of their choice.

From now on, disabled people will have direct access to grants. Only a totally reliable and user-friendly system of public and private, profit and non-profit institutions will enable us to give users the freedom of choice they deserve, but these objectives will only be accomplished if we can guarantee that the taxpayers' money will be well spent.

The Deputy Speaker: Are there any questions or any comments?

Mrs O'Neill: I'm pleased that the member for Oakwood has brought forth to the floor of the Legislature two of the concerns that have been expressed to me over and over on Bill 101.

The role of the placement coordinator is indeed powerful. I think the member for Oakwood talked about a powerful mandarin, and that is true. We have nothing in this bill that talks about the qualifications of this powerful person.

There is no definition in the legislation that talks about the community that the placement coordinator will serve. We don't know whether that is to be the communities that we know as towns and villages or whether they're to take in surrounding areas, and how broad those surrounding areas are.

All of that is going to be left and we're going to take a leap of faith. I will speak more about that in my own remarks.

The other area that is extremely weak and nebulous in this piece of legislation is the appeal process. We are talking here about vulnerable people, and in many cases we are talking about people who have had a crisis thrust upon them by accident or by sudden illness or by old age, and all of a sudden they have no recourse except to finally end up in Divisional Court, according to Bill 101.

We are talking here about families that need some sensitivity, families that need to know they're going to be treated justly and fairly and that the process is as easy as it can be under the circumstances.

I feel very strongly that these issues have got to be brought forward in some form of an amendment, an amendment that is going to attend to the people's needs in this province.

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The Deputy Speaker: Any further questions or comments?

Mr O'Connor: I want to thank the member for Oakwood for his comments. I know that he talked very eloquently about the independence it will offer seniors, and I think that's an important aspect of it.

I know he's certainly concerned about a number of areas. I guess one of the areas he would be concerned about would be that some of the consumers do not have care givers who are willing to support the provision of care within their homes. However, where there is a willing care giver available in the home to support the provision of care provided under the health and personal support program, it is conceivable that a consumer would be cared for in the home.

Within the long-term initiative, it has been suggested that the consumers with heavy needs would be discharged back into their homes. We would have to recognize that facility placement for some consumers may continue to be the most appropriate alternative. He has talked about independence, and sometimes that's not possible. We will have to take a look at all the aspects.

He talked about the appeal boards, and I'm sure that we'll hear a lot of different opinions around the boards during the course of this debate. I look forward to hearing further discussion, and I thank the member for Oakwood for his fine contribution.

The Deputy Speaker: The member for York East.

Mr Gary Malkowski (York East): I'd like to participate in response to some of the comments by the member for Oakwood.

I'd like to say that I think he's been very clear when he talks about the concept of empowering people with disabilities and senior citizens to make sure that people get the appropriate services in terms of community services and support services by the people who take care of them in their homes. It's very, very important and must be very clear.

The member for Ottawa-Rideau talked a little about qualifications and criteria and the role of the placement coordinators. I appreciate that, but I'd like to reinforce and clarify that concern by remembering that as we look back at statements by the Minister of Health, Frances Lankin, who talked about placement coordinators and their responsibilities to ensure that senior citizens' requests are met and that the appropriate support services will be chosen by the placement coordinators to provide comfort and cooperation, I believe that's part of a major role of placement coordinator. The design of this is to provide empowerment and the concept of consumer participation in making sure they get what they want. That's part of the role of placement coordinator. I wanted to clarify that.

With Bill 101, the whole purpose, I believe, is to reduce tensions and conflicts between the placement coordinators and professional service providers and the consumer. I think this provides a clarity and as much information and resources as possible to senior citizens and disabled people to allow them to develop a clear understanding and idea of what their options are before they make a decision, to make sure that they have everything available to them and to make sure that everything works out as smoothly as possible, the goal being, of course, to reduce tension and to reduce concerns.

I just wanted to raise that and to clarify that this whole thing is to empower disabled people and senior citizens. It's very, very important. This process, the whole concept, like I said, is to empower, to give that to people who are now vulnerable.

I believe the member for Oakwood has been very clear and brought beautiful points in his speech. This is a real first for our senior citizens. This is good and it will be a good environment for our seniors.

The Deputy Speaker: Any further questions or comments?

Mrs Joan M. Fawcett (Northumberland): I'd just like to place a few thoughts on this, especially in the area of the placement coordinators.

The member certainly extolled the virtues and abilities of these people to make good judgements with the best interests of the clients in mind, but I'm just concerned. Will these people be placed in their own communities? We don't know what this region is going to contain and it would be sad if people were placed out of their communities, away from families and friends. I think this is a real concern of people who may have to be placed in a home for the aged or a facility of that kind.

Also, a concern placed to me was by the director for a home for the aged in my riding. She was saying that she has different levels of care in her facility, and should there be a vacancy in one particular area but the client who is going to be placed in her facility is not of that kind -- for instance, maybe she has a vacancy in a real chronic care area and yet the person isn't ready for that yet -- is she going to be forced to take this person and then disrupt the whole area in her home?

These are questions that are coming forward, and really the bill does not answer those and we haven't heard any answers. So I hope that very soon some of these things will be sorted out, because I know people are very worried about how the operation of this bill will take place.

The Deputy Speaker: The member for Oakwood, you have two minutes to reply.

Mr Rizzo: I'm pleased by the attitude of the opposition party regarding this bill, and there are many points where I agree with them. I think all these concerns will be addressed by the minister at a time before the first reading in the House.

The Deputy Speaker: Are there any other members who wish to participate in this debate? The member for Ottawa-Rideau.

Mrs O'Neill: I am pleased to participate in the debate on the Long Term Care Statute Law Amendment Act. This complex bill amends seven separate pieces of legislation, among them the Nursing Homes Act, the Charitable Institutions Act, the Homes for the Aged and Rest Homes Act, the Ministry of Community and Social Services Act, the Health Insurance Act and the Ministry of Health Act.

The minister, in her statement of November 26 when she presented this bill, announced that she was introducing "a new integrated long-term care health and social service system for seniors, their care givers, adults with physical disabilities and those who need health care services at home."

This statement is another in the long and growing list of feel-good announcements by this government which often turn out to be very short on details, very vague on time lines and misty at best in committing to financial funding. The details for the implementation framework are promised for next spring -- another time line I feel may not be realized. The changes to income-based subsidies and indeed the very costing of this program is still very far from being determined. In fact, we can't get any answers to that question of cost.

While the minister has the luxury of procrastinating on these very important issues surrounding this legislation, the district health councils are being asked to begin immediately, and I repeat immediately, to restructure their operations so that they are in line with this government's long-term care strategies. They are being requested to get busy with little real leadership or direction and with little real, and I emphasize real, commitment. While the minister postpones the release of the report and the implementation framework, the district health council partners are ordered to immediately begin an implementation of a yet-to-be-released framework.

This bill is most striking for what it does not say. A quick scan immediately reveals that there is no mention of plans or policies concerning municipal responsibilities, the role of rehabilitation institutions and those facilities, the provision of respite care, convalescent care, or laboratory or pharmaceutical services. I'm just scratching the surface. All that I have suggested above are important components of any responsible policy of long-term care, and I know that most Ontarians would agree with me.

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Nor in this long-awaited legislation do we see any reference to patient classification guidelines to identify residents who need complex multidisciplinary care. Facilities, whether they be homes for the aged, nursing homes or charitable institutions, have waited and waited for this announcement, and now they find that their list of questions is just growing and growing and growing. They all look in vain for a framework or even a mention of the components of one of the most complex transitions that they have ever been asked to face in this province, and they find almost none. They are asked to wait for the spring of 1993 -- or will it be summer? A member tonight said, "God alone knows when."

Many, many details of the concepts outlined in this legislation are left to be specified in regulation, requiring a very, very large leap of faith on the part of the government's health care partners, the health care professionals of this province and providers who are expected to implement this package. Vulnerable Ontarians whom this legislation is meant to serve and the families that support them are also asked to risk their journey into the future without a map.

I ask, will the minister alone determine the duties and qualifications of the placement coordinator? Who will draw up the details of the service agreements? What will be the eligibility criteria and procedures for admission and discharge? What is the frequency with which applications for admissions may be made? What are the criteria for determining bed capacities for specific levels of care? Who will provide the new definitions that there will be for extended care and nursing care?

Who will mandate what programs and goods are going to be available to residents? Who will determine the maximum amounts that may be charged for particular classes or levels of care, services, programs or goods? What will the staff-resident ratios be? What are the provisions for in-service training for staff? Who determines qualifications of personnel? What are the criteria for the quality assurance plans? Who will establish a complaints procedure for patients?

These questions are accountability issues. Service agreements, plans of care, quality assurance standards, and powers of inspection are all issues of accountability, and yet the answers to each and every one of the questions I have just enunciated are that they will be found in the regulations.

Regulations, I remind this House, are the exclusive prerogative of the government's executive council. Don't demand accountability in either the legislative forum or the general public. You and I, the people of Ontario, must just wait and see what the NDP government decides to do about each of these important issues that affect your life and mine and those of our families. I ask, will it be possible, with such important decisions resting with the minister and the cabinet, that the local district health councils' process will be real consultations about real local needs?

Madam Minister, do we really know your plans for the role of the district health councils? I say not. I remind that this government's record on consultation is anything but golden. In fact, the march of November 26 of some Ontario citizens -- those with the greatest need, I may add -- to Queen's Park indicated that, in many minds, the consultation process in this province at this moment is non-existent.

Another major concern of many is the role and responsibility of the designated placement coordinator. The member for Oakwood has just brought that to our attention. The person or persons who fill this position, we are told in section 5 of the bill, will be chosen by the minister.

The person chosen by the minister for this position will wield enormous power over the lives both of applicants for long-term care and their families and the people who operate and work in long-term care facilities, yet we see not even one mention or hint, in any document I have seen on this issue or in this legislation to this point, of qualifications; and neither do we find, as I said earlier today, the definition of "the community" that is mentioned in the legislation. What does "the community" mean? The community that will be served in the decisions of the placement coordinator is yet undetermined -- another accountability issue.

We on this side and, more importantly, the families seeking long-term care for their loved ones, are being asked to trust that whoever is designated to this powerful position of control over the delivery of long-term care in Ontario will have the appropriate qualifications, whatever they are, and appropriate background, whatever that is, with no such assurance given in this nebulous legislation.

I want to read from the bill about the placement coordinator role:

"Admissions to nursing homes, charitable homes for the aged and municipal homes will be controlled by placement coordinators designated by the minister. A placement coordinator will determine whether an applicant for admission is eligible for admission and will determine whether to authorize an applicant's admission to a particular home. All determinations by placement coordinators must be made in accordance with the regulations" -- those yet-to-be-determined regulations, I remind.

A fallout from this direction is that facilities will be mandated to accept anyone deemed by the placement coordinator to be admissible. The facility cannot refuse any admission -- I repeat, any admission -- deemed by the coordinator to be acceptable. Their only recourse and the only recourse of families who are refused placement is an appeal process that leaves many Ontarians very insecure.

I remind you and this House, Mr Speaker, that we are talking about families who are making difficult decisions, often for the first time, in difficult and strange circumstances: families in crisis, families undergoing major stress, families often full of fear and sometimes full of guilt. If placement is considered unsuitable or is refused, these families, these patients, must become entangled in a complex legal proceeding.

I urge the minister to remember and protect the relationship with health care professionals that patients have, providers of choice. Many patients often have a practitioner -- and I know the minister knows this -- who has been a care giver throughout most of their lifetime. I also remind the minister that a facility's inability to refuse an admission tends to test the history that has developed in this province along ethnic and religious traditions in the care of the aged on Ontario. This direction comes, I remind, from a government that claims to be socially and culturally sensitive, that claims to be the true champion of the vulnerable. This concern has been brought to me by many groups.

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I turn now to the issue of home care. The minister is quoted in the December 3 edition of the Toronto Sun as saying: "There will be someone who can come in and can help them take a bath, if that's what they need, or help them get their meals ready or perhaps do a little bit of light housekeeping in order to help that senior remain in their home with independence."

Those services are now available in communities, and it's not nearly as simple as the minister stated on December 3.

Hon Frances Lankin (Minister of Health): You don't know what you're talking about.

Mrs O'Neill: The minister is stating that I don't know what I'm talking about. I happen to have a father who has these services, and they're very limited services, and they're not warm and cosy and soft and cuddly, as the minister states. And it cannot be done on the ad hoc basis the minister talks about. If the minister knows so much about this issue, she knows that people at this time can have 60 hours per month, 15 hours per week or three hours per day.

Hon Ms Lankin: Right across the province, Yvonne?

Mrs O'Neill: In many locations of this province. If the minister would listen, instead of interfering, until her time arises to respond, she would know that what I'm saying is that this does not satisfy all needs of all people in home care. There's much more to home care than getting a little meal or a little housekeeping or a bath.

Madam Minister, your statement is extremely idealistic. It doesn't attend to real needs of real people, and it sets in motion a whole series of false hopes and impossible dreams. What exactly does the $133 million stand for that you announced last week? We can't find out over what period of time. We don't know whether it's folded into base budgets. We don't know all the communities it will attend to. You've named several. Do other communities have to stand by and wait?

Your idealism in this Bill 101 is unbelievable. The services you are outlining to the seniors, who really need them, are daily needs. They are continuous needs, week after week, year after year, and Bill 101 does not present to them the security they need.

Moneys for these purposes must be guaranteed in base budgets of the agencies that will administer the programs. Madam Minister, I'm sorry that I do not find that kind of definitive commitment to the seniors of Ontario in this legislation. My question to you is, how will Bill 101 change the services that are there now, and will they serve real needs?

This year, we've seen almost every municipality in this province freeze funding for their home care programs, and you suggest that by adding $133 million you're going to extend this program right across the province. You've stated that home care will be available in many communities that at this moment do not or cannot provide the service. I remind you, Madam Minister, $133 million is not a large amount of money.

My question remains: Are we really talking about more service or less service for seniors in Ontario with real needs? Placement coordinators and comprehensive multiservice agencies must be designed to really improve community services for the seniors and the disabled and must give them the opportunity to access the quality of life that is rightfully theirs.

I would like now to turn to the section of the bill that deals with the disabled, section 19 of the bill, which amends the Ministry of Community and Social Services Act to allow the minister to make grants in accordance with the regulations to or on behalf of persons who have a disability and who are at least 16 years of age to assist them in obtaining goods and services that they require as a result of their disability.

It's very curious that the minister is so enthusiastic in making this commitment when she hasn't even begun a pilot project in this province to examine how such a program would be administered. Without a pilot project, it's next to impossible to assess the process or guidelines for accessing these funds. It's impossible to determine what real resources will fill what real needs, the necessary components of the new contracts for service or regulation of services. I ask, how can we begin such a new initiative without specifics or without any real leadership? Where, I ask again, as I have throughout this entire bill, is the accountability?

What I believe we are left with in section 19 is another announced policy, policy direction which will be very slow in delivery. I think this is a shocking omission if this minister expects us to believe in her commitment to empowering disabled adults.

I get very nervous when the ministries of this government talk about major departures from the way we've been doing business, or a massive overhaul, or a major restructuring. It often means cutbacks, centralization, alternative approaches to service, reallocation, and new definitions for such crucial terms as "chronic" or "high-risk care."

All of that makes me and Ontarians right across this province very nervous. A question they continue to ask is: Can we trust that our real needs will be met, and when will we know the answer to that important question? This long-term care legislation must emphasize an enhancement of services to fill real needs, not a mumbo-jumbo of administrative red tape.

I finally ask, why does so much of the substance of this legislation remain to be determined? We've waited two years to hear this government's policy on long-term care and now we are being asked to wait until January for details, then spring for others, and the minister indicated next year for others. We are just told to wait and see, the details will follow. I urge the minister to send this bill to a legislative committee for public discussion.

In conclusion, I'm disappointed that although a long-term care policy is desperately needed in this province, we are again being given only platitudes and promises lacking in detail and commitment. What we need is a guarantee that there will be no gaps in patient services. What we really need, we need to know that the quality of care that this bill promises is provided to the seniors and disabled in this province.

The Deputy Speaker: Are there any questions or comments?

Hon Ms Lankin: I welcome the opportunity to move off second reading and refer this to committee and I think the member will have an opportunity -- I hope she's there and participates -- to have many of her questions answered. I think it is important that people have that opportunity to explore legitimate questions.

I would have to say, though, that the comments made by the member really show a profound lack of understanding of much of what is there. I have only two minutes so I won't be able to answer everything she put forward, but let me just say the announcement with respect to integrated homemaking made it very clear that it was 133.5 million new dollars. That's an addition to base budget.

If the member knows anything about integrated homemaking, that's not simply home care. Home care has to do with home nursing; integrated homemaking is a different program. I think the member should know that. Her government was around when it was introduced. She should also know that there are 17 areas of the province that do not have it at all presently and this is a major expansion. It is new money and it is new service. It is only one of the basket of services that have been identified in terms of long-term care.

Your comment about consultation just floors me. We were out and we met with over 70,000 individuals. We had a major consensus developed about the direction that needs to be taken and I think we're responding to that in a very positive way. I hope that the consultation response document and others will assure the member of that.

The legislation that is before her is not comprehensive long-term care; it is the changes that need to happen to the Nursing Homes Act, the Charitable Institutions Act, the Homes for the Aged and Rest Homes Act to bring about levels of care funding and the kind of accountability measures that she is talking about.

I think we have built in new accountability measures in terms of development of service agreements around individual residents that never existed before, guarantees that residents will be made informed of that, guarantees that those things and other financial documents will be posted in the homes. I mean, there is more accountability than we've ever had in the system. If we can improve on it with suggestions from the member, we'll certainly look at that.

With respect to individuals with disabilities, I point out to the member that you can't have pilot projects when the minister doesn't have the ability under legislation to flow the funds. The changes in this would allow the minister to flow those funds and we will establish the projects.

The Deputy Speaker: Your time has expired. Thank you.

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Mr Robert V. Callahan (Brampton South): I'd like to address one of the issues that my colleague touched on. I have never seen an act, in the eight years I've been in the Legislature, that had more regulations. I think the people of Ontario, particularly the seniors who deserve better, should be aware of the fact that regulations are done, as my colleague said, by the cabinet, by whatever the number of cabinet ministers they've got right now.

I tell the people in the government, all you backbenchers who care very dearly about our seniors, that you should care about them, because our seniors have paid, paid and paid and now are 80 and 90 years of age and are going to have to rely upon a cabinet to make regulations that could be changed every time Floyd Laughren or the Treasurer of the day decides that this is the way they are going to do it.

I think that's a totally unacceptable way to deal with seniors. These people have given long, hard years in earning and desire to have a decent accommodation when they become old and feeble. What you in fact have done is you've just simply told them, "Well, you've got to wait."

If you look through this act or any meaningful person looks through this act, they'll find that everything is done by the cabinet, those 12 or 13 people or 20 people who are in the cabinet, plus all those spin doctors down the hall, who are going to decide from time to time how to deal with senior citizens. I find that totally unacceptable, I find it totally irrational and I find it a piece of legislation that's not supportive of anybody in this House.

You're going to let your cabinet ministers and the Treasurer of the day decide what we should with our seniors? We already have difficulties. It's already been documented by my colleague in terms of trying to find places for these people. Minister, you're not doing anything for them. You're giving them a road map, which is nothing more than a road map to what I suggest is pure communism.

The Deputy Speaker: Any further questions or comments?

Mr Malkowski: I've listened very carefully to the comments from the member for Ottawa-Rideau and the member for Brampton South, and my goodness, I think they show clearly a very profound misunderstanding of this legislation. I believe both members have failed to understand the proposals, the amendments to Bill 101 and the concerns expressed.

The member for Ottawa-Rideau says that she's concerned. She talks about, where's the accountability, where's the definition and where is the responsibility? What does community mean? What does region mean, and process and regulation? But let me tell you the proposals under here are very clear and the guidelines talk about the importance -- the basic objective of the bill is to be more effective, quality assurance and also to enhance and empower the residents and the families, and government has a clear role in this.

To hear the member opposite talking about just pejorative criticisms, standing on her feet and criticizing without one word of recommendation, without one positive thing to say by the member for Ottawa-Rideau and also the member for Brampton South, that, I think, shows real irresponsibility. I don't accept that for one minute and I believe it's a real concern. I believe senior citizens deserve better.

The senior citizens of my riding certainly wouldn't appreciate that kind of pejorative criticism. Opposition members should be more clear and should find out more the facts to provide constructive criticisms and constructive recommendations to this bill. I would encourage the members opposite to make positive recommendations, to be more positive in their approach to long-term care reform, to be logical and to be with the community instead of trying to point out fictitious fallacies and misunderstandings that would just upset senior citizens.

I'm here to help clarify the misunderstandings and to challenge the opposition members to think carefully about what they have to say when it comes to long-term care reform. Let's work together on this for the quality of care that our senior citizens deserve for effective and quality control. Maybe the members opposite are scared of us, maybe they're scared of the kind of leadership we're showing. Maybe that's why they're being so pejorative in their criticisms.

The Deputy Speaker: Questions or comments?

Mrs Barbara Sullivan (Halton Centre): From another room I caught the remarks of my colleague and I want to stress that her comments were indeed positive. All the way through the discussion of long-term care reform, we are looking for movement ahead. We're not looking to stand still in one place, but more information is required and more decision-making notations are needed in order to make positive contributions to the discussion and the debate, so that we in the opposition can assist in formulating what is a rational approach to long-term care.

The member has discussed issues relating to personal choice. We are very concerned, as are many people whom we have spoken with, that Bill 101 will in fact limit personal choice, the choice of an individual to decide which home or which particular place he wants to enter, whether or not the placement coordinator says he is eligible for that particular place. I think the member spoke logically about the necessity of a personal choice to be very much on the table and for the minister to take into account, as the issues are discussed and the final determinations and the regulations surrounding the placement coordinator are put into place, what limits will be placed on the placement coordinator to override a person's own preferences and what protection a person will have with respect to making a personal choice about which home and in what geographic area he or she will want to live.

The Deputy Speaker: The member for Ottawa-Rideau, you have two minutes to reply.

Mrs O'Neill: I rise very discouraged. The minister has said she's willing to go out to public hearings. I brought forward questions that have been presented to me, and I've been shot down, told I don't know what I'm talking about, that I'm negative and that I don't really have any interest in the seniors of this province. This is the way they're going to enter the hearing process. I think many of the questions I presented tonight will be brought forward in the public hearings. We're being asked to take a giant leap of faith. Every single issue of accountability that I brought forward tonight is by regulation. I remind you that regulation does not give any direct accountability to anyone in this province, including the people who sit in this Legislature.

The minister refuses or will not tell us what the $133 million is for. Is it going to be folded in? We know that the home care programs and integrated homemaking programs in this province are all being frozen and cut back. If the agencies are not going to be guaranteed those as a part of a base budget, they are useless.

To be told that we must do it as it's presented, that this is all wonderful, is exactly what I said when I began: a warm, cosy feeling, again without very much commitment, without much guarantee, and certainly the consultation that's going to take place does not seem to be meaningful.

Interjections.

The Deputy Speaker: Order. There are 10 minutes available after the member for Simcoe --

Mr Callahan: I know what goes on.

Mr Robert Chiarelli (Ottawa West): In 1995 we will use your regulations. We will regulation you guys to death. Change the law because of your regulations.

Interjections

The Deputy Speaker: Order. Would you like me to ask you to leave the House, the member for Brampton South and the member for Ottawa West? It's okay if we start now?

Mr Allan K. McLean (Simcoe East): I'm pleased to enter into this debate with regard to Bill 101. The reason I'm doing it is I've been concerned with regard to health care, long-term care, the most vulnerable people in the province of Ontario, for many years. I've talked about it on many occasions, and I've made statements in this Legislature with regard to our seniors and with regard to the homes for the aged.

With this Long Term Care Statute Law Amendment Act, 1992, I thought it would be a good opportunity for me to be able to enlighten myself as well as learn more about this act that's being presented here. Having the opportunity to get up and to say a few words on it. The Minister of Health may not agree with them all and I respect that, but I hope she also respects what I have to say, because this is a learning process for us all. On a major bill such as this Bill 101, I'm sure there will be disagreement between parties with regard to it.

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A lot of people have indicated that this bill is flawed because it will have a profound financial impact on senior citizens while virtually ignoring people with disabilities, children and primary care givers, and lastly, because it is designed to eliminate private sector involvement. We look at what happened to day care in this province. We look at the private day care that has been provided for many years at a very reasonable cost now being changed to the public sector.

The number of those aged 65 or over will rise significantly from 1.132 million, 11.6% of the population in 1990, to 2.169 million, which is 16.5% of the population in the year 2015. The population aged 75 or over is expected to more than double from 452,000, 4.6% of the population in 1990, to 957,000, 7.3% of the population in the year 2015. It has been projected that the number of individuals aged 85 and over will increase 185% by the year 2015. Statistics also indicate that by the year 2006, Ontario will have approximately 1.5 million disabled people living in the province, an increase of about 36% over the current level.

Bill 101 is an example of the NDP government's willingness to impose user fees on vulnerable adults, those people who are struggling to survive on fixed incomes, in order to reform Ontario's health care system.

When this bill was introduced, the government confirmed its plan to charge seniors up to $300 a month more for nursing home care. The NDP government will raise $150 million from the user fee increase, something that was unacceptable to this administration when it was in opposition. Bill 94 got rid of those fees and now they're being reinstated by this present administration.

It is interesting to note that at the same time as this government's Health minister is paying for her long-term care proposals on the backs of Ontario's frail and elderly by raising nursing home user fees by $150 million, the same government's Municipal Affairs minister is giving away $150 million worth of housing on the Toronto Islands and driving the public sector out of providing day care, to the tune of $100 million.

I rose in the Legislature on October 27 to tell the Minister of Health about her government's shabby treatment of Ontario's vulnerable senior citizens who are unable to care for themselves. At that time, I told the minister that since September 1990, 20 nursing homes in Ontario have closed. The 94-bed Bestview Health Care Centre in Orillia has never had any new beds allocated by the provincial government since it first opened its doors. Bestview alone has a waiting list of over 100 vulnerable senior citizens waiting for beds. It has been indicated to me that other nursing homes in Orillia, as well as those in Penetanguishene and Elmvale, also have lengthy waiting lists.

I asked the minister what I was supposed to tell people like Nancy Crisp of Big Cedar Estates, who was in desperate need of a nursing home bed for her husband. So far, the only answer I have received from the minister is the introduction of Bill 101, which does nothing for vulnerable senior citizens except to raise their user fees to up to $300 per month.

The minister's treatment of vulnerable adults is deplorable. She does not seem to be concerned about sending out more health cards than there are people in Ontario. It was only about a week ago that I had a health card brought into my office that had just been mailed out to an individual who had been dead for two and a half years. I have no idea what's going on with regard to the scheme in the ministry of allocating these cards when people turn 65 without any application to indicate that it's needed. She doesn't appear to be too concerned about wasting more than $39 million on that scheme to reduce medicare fraud when the same scheme itself is open to abuse.

I would suggest that the time is long overdue for the Minister of Health to live up to her responsibilities. She should get her spending priorities in order so that vulnerable seniors in Ontario can have access to nursing home beds and receive the dignified care and treatment they so rightly deserve. I would suggest that it also goes for her colleague the Minister of Community and Social Services, whose cutbacks could very well mean the end of sheltered workshops, like ARC Industries in Orillia, Collingwood and Midland. Both the Minister of Health and the Minister of Community and Social Services have seriously misguided spending priorities that will leave vulnerable children and adults in an untenable position.

So I would urge the government to send this bill to public hearings -- I understand the minister has indicated that she will do that -- because I believe the minister has left out many components of long-term care, including palliative care, rehabilitation, regulation of retirement homes, support for primary care givers, and human resource management and training.

I'm also concerned that the funding allocations are extremely vague on this long-term care document. For example, Redirection of Long-Term Care and Support Services in Ontario never explains how much money is currently spent on long-term care. The document mentions that $647 million will be spent on long-term care by 1996-97, but it fails to explain if this is new money, and the total is never broken down. So we don't really know what the figures are.

Mr Chiarelli: On a point of order, Mr Speaker: Surely the member for Simcoe East is deserving of a government quorum. I don't believe there's a quorum in the House.

The Deputy Speaker: I'll check with the table. Is there a quorum?

Clerk Assistant and Clerk of Journals (Mr Alex D. McFedries): A quorum is not present, Speaker.

The Deputy Speaker ordered the bells rung.

Clerk Assistant and Clerk of Journals: A quorum is now present, Speaker.

The Deputy Speaker: A quorum is now present. The member for Simcoe East.

Mr McLean: There's also no mention of the breakdown of the current spending on long-term care, while the document claims that $200 million is to be allocated to institutions. It also maintains that $150 million of this funding is to be raised from consumers. So I guess that partially explains the increased user fees for senior citizens in nursing homes.

My party is extremely concerned about the future action against the private long-term care sector. We fought tooth and nail for the private child care sector, and you can count on us to do the same thing for the private long-term care sector, if the need arises.

It is rather ironic that this government goes to great lengths and expense to designate, proclaim and promote one month out of the year in recognition of our senior citizens. It is the same government that continues its discriminatory policy that requires senior citizens over the age of 70 to undergo automatic driver licence testing in the event of an accident, regardless of the circumstances.

It has been brought to my attention on more than occasion that if a senior over 70 is parked in a parking-lot and somebody hits his car, he has to go and have a driver's test after that accident happens. I've talked to the Minister of Transportation about that, and would hope that it would be changed. I can see that if it was the individual's fault that the accident happened he should have a test, but not when it's somebody else's fault. Clearly such testing should be restricted only to those charged with causing an accident or those who have displayed a lack of competence in operating a vehicle.

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This is the same government that penalized senior citizens on June 8 when it increased the costs of several civil court actions such as real estate and mortgage transactions, wills and estates, divorces and family law. At that time, I made a statement in this Legislature explaining those increased fees that were brought in. It's the same government that's penalizing senior citizens in a government ripoff that will see their nursing home fees increased, as I said, by up to $300 a month if Bill 101 is passed.

This legislation is by no means a complete response to reform of the long-term care system in Ontario. I expect the government will undoubtedly come under fire once seniors' organizations and organizations that provide long-term care services have an opportunity to study this legislation and realize that very little in the long-term care system has changed for the better.

Senior citizens fear that the closing of chronic care hospital beds will trap them in much the same way psychiatric patients were trapped when institutions were closed in the 1970s. They are demanding that closed chronic care beds be reopened.

I have indicated on many instances in this Legislature, with regard to the cost, that the Huronia Regional Centre in Orillia, which has been a facility for the mentally handicapped, is a large facility, that there's lots of room there and that you could have a homey setting for people who are in the hospitals in our chronic care beds. Get them out of the hospitals. Put them into a setting whereby it would be more compatible and thereby the people who look after them would be in a nicer setting.

On many occasions I have talked about the people in our nursing homes and homes for the aged. My indication is that this ministry, under the direction of Bill 101, wants to keep them in the homes as long as they can, which most people and I agree with. We should keep them in their homes as long as we can. But I don't think that we should keep them in the home and provide 24-hour care for those individuals. Wouldn't it be better to have them in a setting of some of the beautiful nursing homes that we have and homes for the aged that we have in the county of Simcoe, so to speak, whereby they can get out? They have a bus to take them out. There are places that we have to look at which are more appropriate than some of the cases we have.

Only this morning I had a call from a lady whose child who is handicapped. This single parent is having problems getting help through the Ministry of Community and Social Services. She has to have a special car seat for this child. This individual is not on mother's allowance, not on welfare, she is working, and I commend her for that. But this individual needs some help because she's a single parent for this child who is partially blind and needs a special car seat to take her to the hospital to see the doctor. It disturbed me when I got that phone call from that individual, because here we have a person who is working in the community, paying her own way, and she is having trouble getting somebody to help her with this special car seat. The dollar has got to be close, but I commend her for working and for paying her way. Comsoc, through the ministry office in Barrie, would not deal with the problem. My office has been in touch with community groups within the city, indicating that perhaps the Kiwanis Club or the Rotary Club could help this individual.

So in section 19 of this bill, where we're dealing with social services, I believe it is important that there be something there by which we could help individuals such as this who want to continue to work. This individual could very easily say, "I don't want to," and stay home and draw mother's allowance, but I commend that individual for continuing to work.

I want to touch briefly on district health councils. I was in this Legislature when they were first initiated, first formed. District health councils, in my estimation, were to get information from the community, to compile that information and to help the Minister of Health in terms of some of the decisions she would make with regard to long-term care.

I'm not so sure that process has worked very well, because I've watched and I've indicated where ministers of Health have made decisions based not on recommendations from those district health councils but on what the ministers felt was appropriate at the time. So I have to ask, are the district health councils there to serve as an excuse for a minister who wants not to do something, or are they there for a purpose?

When we look at some of the costs affiliated with the district health councils, the studies they're doing -- they're in phase 2 in the Simcoe County District Health Council. I think the work they do is important and I encourage them to continue to do the work. But I have a concern with regard to the ministry. Are they accepting those recommendations and is the Minister of Health looking at those recommendations through the consultation process?

I remember when the home care program was initiated. It wasn't that many years ago, but it has certainly turned out to be a great benefit to help many people stay in their own homes. I encourage the ministry to continue that program and to build upon that program, so people can stay in their own homes longer. The other side of that is our nursing homes and our homes for seniors, where they provide care that is badly needed.

The other aspect of the bill that concerns me a great deal is the aspect of regulation by cabinet, where cabinet can make decisions to change whatever it likes within that legislation.

The concerns that have been raised here with regard to Bill 101, I think are important. As I said earlier, the reason I wanted to speak on this bill was so that I could become more familiar with this legislation the government is putting through, because of the many people who are involved in it.

When we look at some of the satellite health care clinics we have in the province, at the health care clinic over at Wellesley and Bay, where you can walk in and immediately be treated, I often wonder if some of those health cards we have that are floating around are not ending up in the wrong hands.

I wanted to raise the responses of the interest groups to the long-term care paper. A number of groups are very sceptical of the government's consultation process. That's not what we're saying; this is what the interest groups' response has been. The response to the NDP consultation document has been overwhelmingly negative. A number of groups and individuals have expressed concern that persons with disabilities and children have been ignored in this report.

Three groups representing one million seniors formed a coalition to review the NDP long-term care paper. The group, Senior Citizens' Consumer Alliance for Long-Term Care Reform, released an extremely critical response to the NDP paper in early July. The senior citizens' consumer alliance fears that the closing of chronic care health beds will trap seniors in the same way psychiatric patients were trapped when institutions closed in the 1970s. They have asked that closed chronic care beds be reopened.

The Ontario Association of Non-profit Homes and Services for Seniors released a report in July which showed that more than 4,300 Ontarians are on waiting lists for long-term residential care. At the same time, as I said earlier in my remarks, six nursing homes have closed since 1987 because of deficits, which creates a huge burden on families who have to care for ailing residents and relatives.

The list goes on of what this group and the responses to the long-term care paper have brought before us.

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A number of groups have expressed concern that hospital services are being curtailed at a time when services are not yet available in the community. Almost everyone commenting on the long-term care paper has pointed out serious flaws with the proposed 40 service coordination agencies, and many believe that the service coordination agencies will duplicate existing services and set up another costly level of bureaucracy.

There's been some concern expressed that the government does not plan to increase the overall long-term care beds. Primary care givers are concerned that instead of being rewarded, the families who take care of their elders at home as long as possible could be penalized, because when they eventually need such facilities, there could be long waiting lists. The list goes on of the concerns that have been raised.

In responses to long-term care, the Ontario Nursing Home Association sees the new levels-of-care funding in place by 1993. The new accountability framework may make it that much more difficult for private sector survival. The private nursing home sector will not be impressed with the amendment to the Nursing Homes Act which allows the government to provide capital funding for non-profit nursing homes, and this could very well set the stage for the government to take over privately operated nursing homes.

Is that the aim of the government, to take over privately operated nursing homes? I hope not, but it would not surprise me if that were part of the overall response. The private sector is still reeling from the minister's speech to the senior citizens' consumer alliance in July 1992, which confirmed the NDP preference for not-for-profit service expansion. The private long-term care sector has watched the demise of the private care sector and is concerned it is next on the hit list.

The direct funding model will be extremely popular with persons with disabilities, as it will allow them to manage their own care.

There have been many concerns raised in the public consultation that has taken place across the province by people who are looking at the 17 new areas of the province and the current program, which services 21 areas of the province at the present time.

When we look at the overall assessment of this Bill 101, I'm pleased that I had the opportunity to be part of the discussion and to learn a little more about it, because the nursing homes, the homes for the aged and long-term care are going to be looked at in a very serious manner.

On many occasions, I have indicated that it costs about $350 to $400 a day -- and I may be low -- to keep an individual in a chronic care unit in the hospital. Why would it not be more appropriate to try to place that person in a nursing home? It would cost a lot less money and they would get better care.

I remember going to the hospital, not that long ago, to visit an individual who was in the chronic care unit. This individual was sitting in bed, and her window looked out upon the roof of part of the hospital. You could not see a tree, you couldn't see anything but sky and a roof. Psychologically, that individual was not very comfortable to be unable to see even a tree, or the sun, for that matter, because of the side of the hospital she was in.

I would urge the minister to look at cases such as that. I ask the minister, why is not more appropriate to provide more nursing home care and get people out of the chronic care units in our hospitals? I don't know why. I've been at this for a long time and nobody has given me an answer yet, and I want somebody to do it.

Is Bill 101 going to solve this problem? I don't think so. I think I know what the aim is. Part of it is to keep them in their homes longer. There isn't anybody here who doesn't agree with that. But it is a responsibility of the medical profession to make sure there is a cost analysis; that's got to be part of it. You can't keep somebody in a home and have three different shifts of people looking after that individual. You've got to have it so that person can enjoy life in the dignity of her own home, as well as having the health care that is needed, within reason.

Mr Speaker, I thank you for the opportunity to say a few words, and I hope the minister will have some of those answers for some of those very good questions I asked.

The Deputy Speaker: Are there any questions or comments?

Hon Ms Lankin: The member raises a number of very good questions and I appreciate the opportunity, although brief, to respond to a couple of them.

Particularly in the latter part of his statement he spoke about being unable to get a good answer as to why we have people in chronic care hospitals who perhaps could be taken care of in nursing homes or other locations, and why we couldn't do that, and would Bill 101 help us in any way? The answer is, yes, Bill 101 will help us.

The fact that we're moving to assessments of funding on the basis of levels-of-care requirements means that some of those homes that were reluctant to take heavier-care patients into their homes because the funding wasn't equitable for them will be able to do that. Also, some things that were considered heavy care, medical intervention of types, which by law and regulation could only be done in hospital settings, will now be able to be done with the appropriate training and support in homes for the aged or nursing homes, so in fact we will be able to move some of those people.

Similarly, the kind of supports we hope to put in place through the other announcements that will be involved in long-term care, which are not part of this legislation in front of us in terms of community supports, we hope will help keep more people independent and in their homes and not having to go to a facility because there's no other choice. We want to provide that issue of choice.

The issue you raise with respect to waiting lists in different parts of the province is obviously troublesome. We have a very bad distribution of the resources we do have. It's not that we believe we have insufficient numbers of nursing homes or homes for the aged beds, but we don't have them well distributed, and we hope through the process of locally led planning and regional planning that we will be able to do some of that redistribution as new beds come on or beds that have previously been awarded but haven't been built come to be built, that we can address those areas.

The other thing we hope is that through placement coordination -- and I agree with people who have raised concerns around issues of choice and concern for cultural sensitivity, and that will be built into this program -- we will be able to help the people who require the service the most get into a bed first, and that we will be able to manage waiting lists in a way where we don't have people's names on multiple lists and we're not sure how many people are actually waiting in any given area. We think we can have a better management system that will serve the people in your area of the province and across the province.

The Acting Speaker (Mr Dennis Drainville): Further questions and/or comments?

Mr Monte Kwinter (Wilson Heights): I want to congratulate the member for Simcoe East. I think he raised a lot of very important points, a lot of concerns that constituents in my riding have certainly expressed. I happen to represent a riding that has a fairly substantial number of seniors and people who are looking after seniors in their homes.

Some of the concerns I have with Bill 101 are the things it doesn't cover. It seems to me that as the population ages -- and the demographics show that we are an aging population -- there are going to be greater and greater demands on the system, particularly when it comes to long-term care.

My concern is that the government, in its zeal to cut costs and expenses to deal with the health care problem, may be making some of the wrong choices. I have a great deal of concern, and I hope this will go out to a public hearing and, more importantly, that the public hearings that are held are meaningful. It's sad, the number of public hearings I have attended over the time this government has been in power that are really nothing but shams. The decisions are taken, the decisions are made, they go through the motions of listening to groups just so they can say, "This has been the most extensive consultation ever."

There's an opportunity for people to speak, but unfortunately there doesn't seem to be an opportunity for anyone to listen. What happens is that the government, with its majority, comes in and says: "We've listened, we've responded, we've made some changes around the edges, but basically this is the decision. We are here, we have been given the right to make these decisions, and we're going to make them." It would seem to me this is something that really is going to create some problems, and I hope the minister will be responsive to those people who take the time to come and make worthwhile suggestions.

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The Acting Speaker: Further questions and/or comments?

Mr Paul Wessenger (Simcoe Centre): I'd like to respond to some of the comments from the member for Simcoe East, in particular his comments with respect to the change in the charging of fees to residents.

I'd like to point out to him that at the moment we do have a problem with respect to our homes for the aged; that we have persons who are in the capacity of residents of the homes for the aged and who pay the full cost of their care and their accommodation, while we have other people there in extended care beds who are treated differently. One of the purposes of this legislation is to ensure that this inequality in treatment is changed.

Second, I'd like to point out that we're changing the method of determining ability to pay. The question of accommodation fees will be based on ability to pay. Under the existing legislation, ability to pay is based on an asset test as well as an income test. That's going to be changed so there's purely an income test. We're also ensuring in the legislation that each senior would have $112 per month, I believe, as a personal needs allowance for discretionary spending. So I believe we're making major improvements with respect to the method by which residents pay.

Also, with respect to some of the general comments concerning long-term care, it sometimes seems to be an assumption that people are in either nursing homes or homes for the aged or chronic care hospitals or in their own homes. What we have to think about is that the community can deliver care not only to people in their own homes but to people in residential senior homes, which exist now; also, this government has been very supportive of supported housing units, which also provide another choice of supported living for our seniors.

I think the whole approach very much addresses the needs of seniors with respect to long-term care, and certainly this legislation is only a small part of it; that is, as an institutional role.

Mrs Sullivan: Once again commenting on the remarks of the member for Simcoe East, I had hoped that the minister, in her two-minute response, might have addressed the first issue raised by the member, which related to the funding of the initial steps of long-term care.

The member has rightly raised them as issues of concern to the facilities across the province. We know there has been a commitment that $200 million of the $647 million will be made available to long-term care facilities; that $150 million of that money will come from patients themselves as co-payment for the accommodation portion of their residence.

We have been told that the $56 million which is promised to nursing homes for January 1, 1993, will not be paid, and that was to accommodate the level of care funding; that homes are now being told, we understand, that they've already received some of that money and that a lot more, which is due and which has been promised, will not be paid. In fact, the homes will not receive the funding for which planning for patient care, for services and for staff within those homes has been under way since the minister made the announcement recently.

The member spoke with respect to regulations affecting the cost to taxpayers of providing services. We hope that in committee we will have an opportunity to review the issues of the income test which the government has chosen and to compare its viability versus an assets test and to explore the reasons for that choice.

We're also concerned with the issue of the right of a home not to charge or to charge above specified government limits, which will be disallowed under this bill. The member began to touch on it, and I hope that as we go through hearings this issue will come forward in greater depth.

The Acting Speaker: The honourable member has two minutes for a response.

Mr McLean: I want to thank the members for their comments with regard to the statement I made, about 25 minutes' worth, and they've raised some of the issues that I had. I want to thank the members for Halton Centre, Simcoe Centre and Wilson Heights and the minister for their comments.

I want to speak a little longer with regard to the 4,200 Ontarians on waiting lists for long-term residential care. That has been a great concern of mine for a long time. When we have had six homes for the aged close down since 1987, I'm wondering what we're going to do to find a placement for those people. For a long time, I have indicated in many statements in this House and in many different speeches the availability of the Huronia Regional Centre for a long-term care facility for many of those people who are in hospitals in chronic care wards. That facility is there; it is a beautiful setting. Many of our elderly people who are in hospitals on the chronic care floors would be served well if this government would look at that as a long-term care facility.

The member for Simcoe Centre talked about the homes for the aged and the ability to pay. I have to wonder, is this another form of user fee being applied, with regard to the ability to pay? I thought everybody was treated equally and fairly, not based on whether you could pay or whether you couldn't. When the member makes that statement, it leads me to believe that there are going to be user fees implemented within Bill 101, and I think I'd indicated other sections of the bill where I thought there would be user fees as part of it.

Ms Jenny Carter (Peterborough): I would like to outline for the honourable members how Bill 101 will ensure that funding provided to nursing homes and charitable or municipal homes for the aged is directed appropriately to resident care and services. Hopefully, this should answer some of the questions raised by the member for Ottawa-Rideau.

The amendments to the Nursing Homes Act, the Charitable Institutions Act and the Homes for the Aged and Rest Homes Act will require homes to be accountable to residents, their families and the government on behalf of the people of Ontario. These amendments will go a long way towards achieving fairness for all residents and the best possible value for money spent.

All homes will be required to enter into a service agreement with the province as a condition of receiving provincial funds. Becoming a party to a service agreement will also be a condition of a licence or approval to operate a nursing home or a charitable home for the aged. Municipalities have a statutory obligation to operate, and therefore having a service agreement cannot be made a condition of approval to operate in their case.

The service agreement will outline what care programs and services and accommodation are to be provided to residents and what measures the home must take to correct any deficiencies. The agreement will contain certain mandatory provisions, including a requirement that the home comply with the act, the regulations, the service agreement and the standards and criteria set out in the program manual.

Program supervisors and compliance advisers will use this service agreement, as well as the acts and regulations and the program manual, to monitor and evaluate the homes provision of the required programs and services. The home must provide a written agreement to each resident or the resident's representative, indicating what services are to be provided to the resident under the province's service agreement with the home.

In addition, the annual budget developed in partnership with the home will be incorporated into the signed agreement. The budget will specify the types and amounts of service that the home is to provide to residents in relation to three components: first, nursing and personal care, including nursing staff costs; second, programs and support services, including quality of life programs such as therapy services, spiritual care coordination and recreation and activation services; and third, accommodation, including costs associated with the operation of the building and items such as housekeeping, laundry and dietary services.

Homes also will be required to post the service agreement in the home, as well as certain financial statements, as required by the regulations, to ensure that staff, residents and their families are informed of what services are to be provided in the home in exchange for provincial funds.

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Bill 101 will establish new requirements for more rigorous financial reporting and accountability based on a quarterly reconciliation process. Homes will receive funds on a monthly cash advance basis and will be required to submit proof that moneys have been spent in accordance with the terms and conditions of the service agreement. Most important, the province will be able to recover funds not spent appropriately through the quarterly reconciliation process.

Finally, the amendments will empower the province to reduce or withhold payments, place restrictions on or freeze admissions and suspend or revoke approval to operate if the home is in contravention of the service agreement, the act or regulations.

The amendments to the Nursing Homes Act, the Homes for the Aged and Rest Homes Act and the Charitable Institutions Act, as set out in Bill 101, will result in a consistent approach to accountability for all three types of homes and greater financial accountability for public funds.

I urge all members of the House to support this bill so that Ontarians can be assured that public funds will be spent on providing the care and services that elderly persons in nursing homes and homes for the aged need and deserve.

The Acting Speaker: Questions and/or comments?

Mr Callahan: I want to go back again to the issue that all of us in this House should certainly be concerned about, seniors and their care in the future, because many of us are fast approaching becoming seniors.

Hon Ms Lankin: We're getting there faster every day.

Mr Callahan: Faster than ever. I think the concern, as I expressed before and perhaps a little more vehemently, is the fact that this bill, and I've looked through it, deals in a very real sense by regulation. I think all of us have to be clear, and I think everybody watching this accountability session should be aware, that regulation has a nice name; it's by order of the Lieutenant Governor in Council. It's done by the cabinet, and the cabinet consists of whatever number of cabinet ministers are the government of the day. The backbenchers, and more often than not the backbenchers who represent the good people of this province, don't have one word to say about whether or not things change.

There are all sorts of things in here that can be changed. They can change the fees; they can change the services available. It can all be changed at the whim, really, of the guy or the woman who pulls the purse-strings of the treasury and says, "The treasury's having a tough year, so we're going to change it back." I think seniors deserve more than that. They deserve to have a fixed plan to be able to know, in the golden period of their lives, that they're not suddenly going to have the entire game plan changed on them by the people in cabinet.

I think the reason they elect people of this Legislature is to be able to have a say in how they're going to live and how they're going to live out the latter years of their lives. As members of the Legislature we should be aware of that. In fairness to the minister, maybe through the public hearings that will come about. But I certainly hope it will fill in the gaps and that it won't be simply, "That'll be done by regulation." Regulations are the silent laws of this province. They never come through this Legislature. They're never debated. They are at the whim of the people who are in power, be that the Liberals, Conservatives or NDP.

The Acting Speaker: Questions and/or comments?

Mrs O'Neill: A pattern has been developing tonight, and maybe the audience in Ontario will see it. When the members of this side speak, the minister rises to her feet and she talks in an arrogant, pedantic and condescending way about all our remarks. When a member of the government speaks, that does not happen. Maybe it's the apples on our desks today that have made that happen.

From the remarks of the member for Peterborough we have, "We hope we will put in place," "will outline," "it's all in the future." Everything the member for Peterborough talked about tonight is going to be guided by regulation. It's going to be part of this highway of broken promises this government has had.

The people in Ontario, including the taxi drivers who sometimes take me to the airport, talk about government auto insurance, the tuition fees that weren't to be. These are the things our people are judging you by. And all regulations: Personal choices are going to go out the window. We're going to have consistency right across this province; the care of the vulnerable is going to be consistent. Isn't that what we all want?

The Acting Speaker: Further questions and/or comments?

Hon Ms Lankin: I appreciate the comments of the member for Peterborough. I know she has long worked on these issues, and she has been an advocate within government ranks for us to move ahead with long-term care redirection. Of course, I know that all members of this House share an interest in this issue, that many people have within their constituency sizeable populations of seniors and nursing homes and chronic care beds and are worried about these services and are worried about the continuum of care being provided in a way that is accessible, that is culturally sensitive and that maintains quality of care.

The issues of hopes and desires that the member has raised are ones we hope we will be able to deliver on as we continue through these debates and answer questions in the process of public hearings, as well as addressing a number of the concerns that have been raised. I point out that in fact I have indicated in response to members opposite a genuine appreciation of their questions and have attempted to answer some of them. Where there have been members who put forward rhetoric and empty criticism, perhaps I've been critical of that as well.

Throughout the course of this, however, the kinds of legitimate concerns that have some foundation in reality when you look at the legislation are ones we will work with members opposite to try and deal with. If we can build more assurances and accountability into the legislation, versus regulation, then that is something I favour in the long run as well. With the kinds of desires the member for Peterborough has put forward and her commitment and the commitment of the members opposite, we'll be able to build a good piece of legislation which is but one part of what will be a comprehensive long-term care system.

The Acting Speaker: Questions and/or comments?

Mr O'Connor: I just wanted to make a couple of brief comments on some of the things the member for Peterborough has spoken on, and maybe even thank her for coming to my riding to speak to some of my constituents about long-term care. It's often quite easy to get involved with only what happens in the Legislature and not go out and meet people in other people's ridings. Being parliamentary assistant for the minister responsible for seniors' issues, she's really gotten quite involved with this; in fact, she's gone out of her way to come to the riding of Durham-York and meet with some folks in Cannington. We had a small meeting in a building, predominantly seniors, and talked about long-term care and how it will affect them.

She's very well versed, and she's shown that again tonight in her comments, because she's talked about the need for consultation. She's even gone beyond what her role is, I think, and made sure that other people would understand this. So I want to compliment her on her comments this evening and take this opportunity to thank her for coming into my riding.

The Acting Speaker: The honourable member for Peterborough has two minutes to make response.

Ms Carter: I thank the honourable member for Durham-York for his kind comments. He came to my riding and repaid me in kind, and that was much appreciated too.

With regard to the statement by the member for Mississauga West and his fear that this is all going to be done by regulation, I think it's worth pointing out here that we're looking at the outcome of one of the widest and most thorough consultations with the people of this province that has ever been carried out by an Ontario government. I believe 75,000 people were consulted in something like 3,000 meetings.

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As was pointed out by a member opposite, there were criticisms, but the final version of this legislation has taken account of a lot of the criticisms that were made, and I think the feeling out there is that we all want to get this new long-term care put through and under way in our province.

The member for Ottawa-Rideau insulted the minister by calling her irrelevant, which doesn't seem a very high road to take in arguing this Legislature.

Personal choice is exactly what we are going to get as a result of this legislation. The assessment of individuals who need long-term care is going to be much more personalized, their individual requirements and wishes are going to be taken into account much more than they have been in the past, and instead of going from one place to another being assessed at each one, it will be done all at one time and will be much less of a hassle and a nuisance to the people concerned.

The Acting Speaker: Further debate?

Mrs Fawcett: I welcome the opportunity to participate in the debate on long-term care. I would like to open by saying that the pressures for reform of the long-term care system in Ontario are definitely great. The changing demography of Ontario's population, consumer expectations and inadequate funding, coupled with the inappropriate use of resources, represent, I believe, the major pressures.

To maintain the status quo would mean a continuation of unmanaged access, of blocked acute care beds, of light-care clients in high-cost facilities, of the uneven distribution of services, of continued consumer confusion and a fragmented systems management structure. I think we were slowly going towards that in a chaotic way, in that nothing has been happening. We seem to have been ready to begin the long-term care reform two years ago -- well, almost two and a half years ago now -- and we have waited this long, so there are further gaps in necessary services to enable cutbacks to be made in hospitals and so on.

There is a lot of fear and there is a lot of anguish out there among those who really need long-term care, but the pressures are not new. In fact, if the NDP government had implemented instead of revisiting many of the issues, issues identified and agreed upon by the previous administration and the consumers, their families, friends, volunteers, care givers and professionals across this province, many seniors and physically disabled persons would now be benefiting from long-term care reform instead of anxiously awaiting it.

Perhaps the biggest concern I have with this government's attempts at the redirection of long-term care is its piecemeal approach. Every time they think they have found a piece to the puzzle, then the search is on to try to put it in place, but what concerns me is that they haven't got the whole picture in front of them, so they really don't know how or where the pieces fit.

Last week we had an announcement on nursing homes and homes for the aged. Well, these are certainly two institutional settings that play a major role in the delivery of long-term care services. Where do chronic care hospitals and rest and retirement homes fit in? Speaking of rest and retirement homes, there has been little or no mention of this kind of seniors' living. Many residents of rest and retirement homes have been asking that regulations be put in place to govern such things as maybe the monthly rate increases that occur and the support services that should be available at reasonable or no cost. Very often this is not the case for people living in these kinds of facilities, and those seniors really need the extra services as well. Possibly they should be given the ability to choose some of these kinds of services, because there does seem to be an inequity here.

Can the minister continue to cut hospital beds and staff and have no idea where the patients and care givers are to go? The answer to that seems to be that when the next piece of the puzzle falls into place, which is the chronic care role study expected in January 1993, then she'll let us know. In the meantime, though, seniors are suffering.

Another piece of this puzzle announced last week was the establishment of the placement coordination services, and of course we've heard quite a few references to this. We heard that there's going to be the establishment of a comprehensive multiservice agency and the continuation of the 135 bureaucrats involved in the Ministry of Health long-term care regional office who will facilitate and administer -- this is yet to be announced -- this funding and the programs.

It really does sound confusing, and I think it is rather confusing, as to just how all of this is eventually going to get coordinated. While the minister espouses the benefits of a continuum of care services, she continues to create layers upon layers of bureaucracy that will make the idea of one-stop access obsolete before it's initiated.

Indeed, many of the pieces of the puzzle the minister has discovered and announced have created more questions rather than alleviated concerns, and much of this can be attributed to the yet to be prescribed regulations, which will directly affect the way homes for the aged and nursing homes operate. A lot of mention has been placed here on the regulations, and I hasten to say that regulations will not be discussed in this Legislature. We will not have a chance to debate these regulations. They will just happen.

A few examples: Under the Charitable Homes Act, regulations that will be prescribed will be types of accommodation and care services; programs and goods to be offered to residents; requirements governing assessment and classification of residents; required bed capacities to be set aside for residents requiring certain care and service programs; maximum amounts that may be charged for particular classes or levels-of-care services programs; short stay accommodation that may be required in a facility; financial systems to reconcile funding mechanisms; methods of recovering excess payments; provisions for service agreements; filing requirements for financial statements, reports that must be posted and filed with the ministry; requirements for quality assurance plans, including development, implementation and revision and monitoring system; requirements for plans of care, including content and development, implementation and revision; and so many others that will just be brought forward and regulated. And that's only one segment.

Homes for the aged and rest homes: These regulations are going to prescribe types of accommodation, care and services; requirements governing assessment and classifications of those residents; required bed capacities to be set aside for residents requiring certain care; applications to placement coordinators re eligibility, and eligibility criteria; short stay accommodation may be required; maximum amounts that may be charged for particular classes or levels-of-care services and programs; again, their filing requirements and notices that have to be posted; and requirements for quality assurance plans and care.

Then we have a whole new set under the Nursing Homes Act regulations. All of these will be regulations: required bed capacity in these, and applications to placement coordinators re eligibility for entry, and the short stay accommodation, and maximum amounts that may be charged in these facilities. All of these are things that we won't be able to have a say in.

We have to wonder, just what are the details of all these regulations? What is the government really trying to hide here that we won't be able to see? Why won't they allow them to be revealed to public scrutiny? We really do have a number of concerns around this regulatory part of the bill.

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Now I'd like to examine some of the initiatives the minister announced and what they will mean. Last week the minister announced the establishment of the placement coordinators who will be making decisions on the eligibility and admission of patients to homes for the aged and nursing homes.

In talking with Carol Galloway, the director of Northumberland county's home for the aged, Carol had many concerns about this new placement coordinator. If she has an open chronic care bed in a facility, will she be forced to accept a palliative care patient for that bed? Will that bed remain open? Who will occupy it? Many other questions surround these placement coordinators, like who they will be and what qualifications and training they will have to make these important decisions. How are they linked with the other sectors of the long-term care continuum? Important questions, like who will pay for them and to whom will they be accountable?

The senior citizens' consumer alliance has suggested that the placement coordinators in fact are nothing more than brokers, that these brokers cannot stand alone but that the placement of patients in all institutions must be part of a fully coordinated continuum of long-term care services.

Another initiative the minister announced this week was the establishment of comprehensive multiservice agencies. While the idea is well received, I would suggest that the minister would want to stress the word "local" when discussing comprehensive multiservice agencies. Certainly many of the functions to be performed by these agencies are already being done by district health units.

In fact, the Haliburton, Kawartha, Pine Ridge District Health Unit board of health, in its response to the redirection of long-term care consultation paper, stated, on page 14, section 9, titled "Service Access and Coordination," said:

"We agree with the description of the current situation and the need for services that are better coordinated, integrated and matched to the needs of the people. However, as stated earlier, we do not agree with the proposal to establish 40 new agencies and governing boards to perform the agreed-upon functions. The establishment of these new agencies and boards, when structures are presently in place, is an unnecessary duplication leading to increased cost, funds which could otherwise be directed towards providing service to people.

"We submit that the functions described for service coordination agencies are at the present time being performed by home care administered through health units. These functions include assisting people to live independently; acting as a single point of access; assessing needs of the individual; providing information, advice and referral systems; helping consumers develop individualized service plans; purchasing services for consumers; and helping facility residents. Where expansions and improvements are indicated, they can be carried out within the present structure."

Will the minister be taking this into account when she begins to implement long-term care? Some areas are already doing what is being suggested and only need to expand in order to serve more people.

"Home care currently looks after the vast majority of the long-term care requirements. It would seem reasonable that if the present structure -- ie, the health unit home care program staff -- were expanded to meet the other remaining services, a much more efficient and economical system would result, rather than transferring the bulk of the services to a brand-new agency and setting up a new administrative structure under an inexperienced board."

The consultation paper makes the point that service coordination agencies should involve consumers and their families, and that the agencies be representative of their communities and receptive to their needs. We submit that present boards of health, with a mix of provincially and municipally appointed members, meet these requirements. Health units have experienced staff presently deployed and have an extensive administrative structure in place to deal with the payroll, bookkeeping and a multitude of other day-to-day operations.

There are certain administrative aspects of sponsoring this program which will be duplicated but not replaced by setting up the proposed new agency. These would include such administrative and overhead costs as illustrated from the following Haliburton, Kawartha and Pine Ridge District Health Unit data: leases and rent on physical facilities; home care share in all board of health facilities in 1991 was $210,267, which represented 40.92% of the total accommodation costs. These leases continued for several years in some locations on this previously agreed-to sharing formula between public health and home care. If home care physically goes elsewhere, someone will be responsible for fulfilling the terms of the existing leases and similar costs will be incurred in setting up home care operations as part of a service coordination agency in another location.

Senior management structure: The management structure within the health unit will remain as it presently exists with or without home care. The costs included here are salary, fringe benefits and related costs for the chief executive officer, director of administrative services, executive secretarial services, payroll administration services performed by the board of health, which in 1991 amounted to a cost of $95,679 to home care. These services would be far more costly to set up independently under a new structure while in no way reducing the present costs of the board of health. In fact, the costs to the board of health would go up because there would be no longer a recovery from the home care.

Overhead costs: There are certain economies of scale achieved through the sheer volume of activity in certain areas such as photocopiers, fax machines, telephone systems, computer equipment, software, printing facilities, payroll system, postage meters and the bulk acquisition strategies used for most of these services.

The health unit also enjoys the benefit of lower premiums on packages such as its malpractice, liability, contents and equipment, errors and omissions insurance and life, long-term disability and extended health insurance because of the volume of insurance purchased. Both types of coverage would be more costly to the board of health and the new agency if purchased separately. The cost to home care for 1991 for all these overhead cost items was $33,250, which represented 36.2% of the total cost to the health unit. Once again, if the program is removed, the cost remains to the board of health, but any new agency incurs a similar cost to set up these services.

The minister's announcement of a palliative care policy for Ontario is certainly long awaited, but I want to just read into the record the World Health Organization's description of what palliative care really means. It says it is the "active total care of patients at a time when their disease is no longer responsive to curative treatment and when control of pain and other symptoms of physiological, social and spiritual problems is paramount. The overall goal of palliative care is the highest possible quality of life for the patient and the family. Palliative care affirms life and regards dying as a normal process. It emphasizes relief from pain and other distressing symptoms, integrates physical, psychological and spiritual aspects of patient care and offers a support system to help the patient live as actively as possible till death and a support system to help the family cope during the patient's illness and in bereavement."

That's a tall order and I really think that in going into this area we have to be sure the support services are going to be there and really appeal to this kind of patient where it is a different focus. We have to make sure that comfort is the real key to this. Many decisions must be made around who is eligible for these kinds of services and the ways of delivering this kind of care.

There are three main ways of delivering this care that are talked about. There are free-standing units, which often are partly funded for supplies and then run in the main part by volunteers; there are hospital wings or sections, and here these are usually directed by doctors and medical staff; then there are the home care services that are provided for the dying person so that he or she can remain at home with those support services. There are many advantages to all three and, of course, some disadvantages. I think we really need to be careful here, when we are planning this, that we make the last months of life as comfortable as possible. I will certainly be waiting to see just how this unique kind of long-term care will take shape in the months ahead.

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I'd like to talk a little bit about education. Education of the consumer and the provider are of upmost importance if the reform of long-term care is to have any real effect. Seniors, as consumers, must be made aware of what is available to them and how they really are going to be able to access the system. There is absolutely no sense in reforming the long-term care system unless those included are aware of what it can mean to them.

As well, the training of service care providers is going to be essential to the delivery of services and the implementation of a new system. It is fine for the ministry to announce a new patient classification system in homes for the aged and nursing homes, but who is going to pay for the training of individuals whose job it will be to classify patients? In the case of homes for the aged, I would strongly suggest that another level of government does not have the moneys to meet a cost-shared arrangement and that the provincial government must be committed to fully funding the training. I know right now that the home for the aged in my riding had a chance to take some extra education, but the municipality was not willing to share this cost and so that education was lost.

We must not forget doctors in all of this. The doctor is often the first point of entry to extra services that the seniors require. Doctors also must make sure that they are aware and they must be made aware of the services that are available and how they can be accessed. As well, more emphasis must be placed on the training of doctors that geriatrics be stressed at both the family medicine and the specialty post-graduate level. Doctors are in the business of life giving and trying always to find some method of curing someone. Sometimes, and especially in the palliative care section, it's comfort that is needed here and not yet another new thing to try.

Where hospitals fit into the minister's puzzle of long-term care is a very good question. Her continued cutbacks and bed closures would indicate hospitals have an interesting place in her puzzle, and I hope they do have a place. Yet nearly all of those involved in long-term care believe that hospitals are an integral part of the continuum of long-term care. I would suggest that the need for chronic care beds will increase in spite of our best efforts to increase community-based and in-home services. Given that the projection that the 65-plus population will grow to 68% in the next 20 years, and that the 85-plus population will grow 161% in that same time frame, surely all the demands will not be met by community-based in-home services. There will always be patients who require the care only hospitals can provide.

The Senior Citizens' Consumer Alliance pointed this out when it suggested that it is essential that Ontario continue to maintain excellence within the hospital sector, even though the role of the hospital within a more balanced system may alter. They were concerned that chronic care beds are currently viewed as the end of the road in the reformed long-term care system and that there is a real danger that they could be transformed into providing only warehousing for these elderly people who can no longer be served in nursing homes or homes for the aged.

We hope that the government is not trying to return to a style of chronic care delivery which our province abandoned decades ago. Consumers utterly reject this approach or view of chronic care hospitals. Indeed, we see many very progressive chronic care hospitals across the province. These hospitals should be strengthened within the system on a regional basis.

What consumers want is a network or system of chronic care services within their community that can respond to their actual chronic care needs. I know that the consumers' alliance was pleased to learn during the public hearings that the Alberta classification system would not be applied to chronic care hospitals. However, in the light of the current crisis in the chronic care hospital system, which is forcing the closure of many chronic care beds, we're very, very concerned about the kind of funding formula government is proposing for this sector in the future.

We really want to stress that chronic care hospitals have an absolutely key role to play within the long-term care system as centres for excellence in geriatric care, particularly in providing short- and long-term care rehabilitation services, and also in providing complex care for chronic care patients who are also medically ill or unstable.

I think that chronic care hospitals should be represented on governments and management structures of the comprehensive multiservice organizations so that coordination and integration of institutional and community-based services actually take place.

Now I'd like to mention a few things about the profit versus non-profit. I think that in the delivery of services currently for these two areas, there is definitely room for both. We need both. We cannot at this stage eliminate the for-profit services that they can provide. I know when the ministry held its consultation in my area, there were 5,220 respondents and in a summary report of their findings, on page 15 of their report, it clearly stated, when talking about service coordination agency functions, "Purchase of service from for-profit and not-for-profit providers to enhance quality assurance and competitive pricing" is absolutely key. Right now, approximately 45.5% of homemaking services funded by the government are provided by the for-profit sector.

Mr Callahan: They're going to eliminate them.

Mrs Fawcett: Really, I hope that is not true, because they do such a good job.

Currently, 70% of all nursing home beds in the province are managed by the for-profit sector. That is approximately 21,000 beds in the system now being used by seniors in the for-profit sector. If there is a problem in one of those homes, fix the problem, don't cut it out. This "When in doubt, cut it out" syndrome has to be forgotten. Surely the intention of this government to reduce the private sector's role to 10% in two years is putting into jeopardy the entire reform of long-term care.

Should this happen, the quality and quantity of care will be seriously reduced, unable to meet the demand and leaving consumers without the availability of service. Consumers will lose their right to choose what kind of service they want and who they want to deliver it for them. There is room for both, and in fact without both, the system just won't work.

In closing, I would like to say that although we all recognize the need for reform of long-term care, and we have a good sense of what that reform should be, we must not in our eagerness disregard or discard those very important services already in place. To implement changes to the system, we must back these changes with financial commitment. You can't just put the puzzle together piece by piece without knowing what the whole picture looks like. People will fall through the cracks if you do. Seniors want a continuum of care delivered through a system that will emphasize community-based and in-home service while ensuring that individualized high-quality care remains available in institutions.

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The Acting Speaker: I thank the member for Northumberland for her participation in the debate. Questions and/or comments.

Mr Paul R. Johnson (Prince Edward-Lennox-South Hastings): I want to start by saying that some of the comments the member for Northumberland made have been echoed to me recently by some concerned people in my own rural riding of Prince Edward-Lennox-South Hastings. I think there is a feeling in rural Ontario that some of the decisions being made with regard to long-term care are being made in an urban area and aren't really dealing with the real-life situation, the real existing situation of long-term care in rural Ontario.

I listened very carefully to the member for Northumberland. Debbie Moynes, the director of community care for seniors for Prince Edward county, and Fred Murphy, retired doctor, came to see me just last Friday in my constituency office. They made an appointment to come and see me because they said they'd heard there was going to be a great reduction in the funds available for long-term care.

Lo and behold, there was an announcement and there wasn't a reduction in funds, so they came and said: "Thank you very much. I'm really glad to hear there's all this money. However, now that we're here we'd like to tell you we have some concerns with what's happening." They said: "We have a great system in Prince Edward county. It exists, it's based on a lot of volunteerism, a lot of people who help each other within the community." They were consulted about long-term care, but their fear is that they weren't listened to.

Interjection.

Mr Johnson: Not entirely; to some degree, maybe. This relates to what the member for Northumberland said: They said they were very concerned because they felt that although they had been involved in the long-term care discussions --

The Acting Speaker: Thank you. The member's time has expired.

Mr Callahan: I want to address one of the points my colleague made; I think it's very important. This legislation is a very significant mirror image to day care centres, in that we're going to eliminate over a period of time those centres making a profit. I have to read that, because you're talking about people who pay $100 a week now having it reduced to $37, if I'm not mistaken.

Minister, you should come out to my riding of Brampton South. We have a facility out there that has three buildings: Faith, Hope and Charity, interestingly enough. Seniors live in the apartment dwelling and then they move to a place where they need a little more care and finally into a chronic facility that's absolutely superb. I'm sure you're aware of it, and if you haven't visited it, you should. It's particularly significant because it deals with people of a particular community, the Dutch community. These people, instead of having the trauma of being dragged from the stage where they're able to look after themselves across the city to some place that's foreign to them, can simply move through these buildings in a very significant fashion. That's a profit corporation. They do have some licensed beds there.

But what I see happening in this legislation -- maybe not at the outset but over the long term -- is that there will be no choice. I think you're having exactly the same argument with the people in day care.

I think government only has one purpose. It's purpose is to protect people in areas where they're being dealt with badly by society, but you don't just step in and try to be everything to all people. You can't afford it. I think if my good friend the Treasurer, Mr Laughren, were here, he'd agree with me.

That's why I'm so concerned about regulation, because the rules are not set in stone; they're being made up as the game goes along and as the dollars either flow in or flow out. I think that's a very dangerous proposition.

The Acting Speaker: Further questions and/or comments.

Mr Malkowski: I listened carefully to the debate this evening and the contributions from the member for Northumberland, and I'm wondering if the concept in this discussion is disempowerment or empowerment. I'm just wondering where the member stands. We're talking here about the promotion of the concept of empowerment, but how can you have empowerment if you're not talking about that, if you're talking empowering professionals? There seems to be a bit of conflict there. I think it's very important that we support the concept of community-based long-term care reform. The whole point of this is to empower consumers to make the appropriate choices for them, of where they want to be in the community.

In the areas where you talked about balance of community-based and the role of health care providers, yes, it's important that we talk about options and that things need to be available. There has to be that important balance, but one area I would like you to address is, should consumers have full options? What do you say about that?

I visited one private health care institution in my own riding and there were people who approached me who told me that some residents pay over $3,000 a month, and these are senior citizens. Is that a fair system? Is that what the member opposite would say is a fair, balanced system? I would question that. I think the for-profit system is there for some, but I would like to see an empowerment for people who don't have that kind of money. We need to provide a fair, balanced system for everybody, for consumers, and to make sure that accountability really happens.

I think it's really important that health care reform accept the responsibilities and regulations based on a community-based empowering system, and that's the point this government is trying to address. I'm wondering if the member opposite is really talking about disempowerment or empowerment in the health care system and long-term care. Could you clarify that for me, please?

The Acting Speaker: Further questions and/or comments?

Mrs O'Neill: I'd like to congratulate the member for Northumberland, our critic for seniors. We certainly have had from our caucus tonight, in every comment and speech made, real fears that have been expressed to us, real needs that have been expressed to us by real people, real concerns that have been brought to us by real people. This government and this minister are saying "leaps of faith." This government is riddled with scandal, riddled with embarrassment and full of broken promises -- none of that can be denied, and the general public in this province knows -- and we're asked, "Are they really going to deliver what they say they are?"

Municipalities, the partners that are so important in all of this, are not even mentioned in this legislation and haven't even been mentioned tonight. It's really frightening what the member for Northumberland brought forward: the piecemeal approach, step by step, January, spring, next year, and perhaps the next government will finish it up.

Mrs Fawcett: I appreciate the comments from my colleagues and members opposite. I couldn't agree more in some respects with the member for Prince Edward-Lennox-South Hastings, as far as rural needs versus urban needs are concerned, but he sort of lost me in the translation. I have to say I have always been a strong proponent of the fact that the Metro tail shouldn't wag the dog always and that needs in rural Ontario are different. That's why I think it is so important.

If I could speak to the member for York East as well, while he talks about empowerment, I like to talk about choice, choice that is especially important in rural Ontario, as I would imagine it's important in the urban centres too, but rural people do not like to just be told, "Here is where we have a facility for you." I think they would rather say, "I would choose to go to this facility because it happens to be in my community, where my friends are." I think that is very important if we are going to make long-term care work in this province.

I look forward to putting forward those kinds of ideas when this bill goes to committee and we can really get down and find out just what the government has in mind, because right now there seem to be so many things that are left unsaid.

If I could very briefly mention the whole palliative care dilemma around AIDS victims, that is a whole new concept we have to think about too.

The Acting Speaker: Thank you. Further debate?

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Mrs Elizabeth Witmer (Waterloo North): Before I begin the discussion concerning the long-term care reform, I'd like to add my congratulations to the member for Northumberland. I thought she did an outstanding job in bringing forward the concerns of people in the province of Ontario.

I was particularly interested in some of her final comments regarding empowerment. I think that is a much abused and overused word. Certainly, from the input I've received in Waterloo North and from people I've spoken to, their desire is not empowerment; their desire is to have freedom of choice, the freedom of choice to choose where they spend their days.

Unfortunately, we have before us today another flawed, very ideologically based policy, this one on long-term care, which largely ignores people with disabilities, children, the primary care givers. Unfortunately, we have another piece of legislation that is aimed and designed to eliminate private sector involvement.

In this province, there is a role for both the public sector and the private sector. If we're going to continue to provide the social safety net we have been so proud of in this province, it's absolutely critical that the private sector continues to play an important and supportive role in the delivery of services to people in this province.

In our discussion on long-term care, we're referring here, of course, to the personal health and social services that are delivered over an extended period of time to people who are elderly, people who have disabilities, because as we know, it is time for this government to take action on long-term care because the population is aging and the population 65 and over is going to rise very significantly from the present time, when we have about 11.6% in that age bracket in 1990, to the year 2015 when about 16.5% of our population is going to be 65 and over. We also have to remember that the number of individuals aged 85 and over is going to increase by 185% by the year 2015.

We need to take into consideration what the needs of these individuals will be as their numbers increase. Not only is the number of elderly going to increase, but the number of people with disabilities is also expected to increase. Again, it is estimated that by the year 2006, we're going to have in this province 1.5 million disabled persons, an increase of about 36% from the current level. Also, estimates show us that about 40,000 adults are going to depend on others for some degree of assistance for their basic personal care.

That's why it's so very important that we act now to put in place a long-term care package that responds to the needs of seniors in this province and allows them the freedom of choice to make the decision about where they will go to receive that care.

Presently, seniors can be placed in four different kinds of residential settings depending on the level of care needed. We have the chronic care hospitals, which of course provide the highest level of care, we have the nursing homes, we have the homes for the aged, and we have the rest and the retirement homes. The latter, of course, accommodate the seniors who require very little or no nursing care.

As we know, the Ontario government has been planning to reform the long-term care system for quite a number of years. The Liberals released a blueprint and now the Rae government has produced a plan of action. But I'd like to go back to October 21, 1991, when the government first released its discussion paper Redirection of Long-Term Care and Support Services in Ontario. I was amazed at that time at the reaction from the families, the care givers and the seniors in my community. There was tremendous fear that the government would not be taking a direction that seemed to them to be appropriate. I'd like to take an opportunity now to share with you some of the comments I've received from seniors.

I had occasion to visit Parkwood Manor in the city of Waterloo. They wanted me to come and learn first hand about the issues and concerns surrounding the redirection of long-term care in the province. I was particularly pleased that this meeting included not only the staff and the residents but also the families. The two primary issues of concern that evening were funding and staffing. They wanted to make sure that both were adequate to respond to the greatly increased nursing care needs if we're going to continue to provide a high quality of care for our seniors. However, what was most important that evening for the care givers, the families and the seniors themselves was that they have the option of choice in the selection of care. I'd just like to share with you some of the individuals who spoke and some of their concerns.

The first one: "There needs to be a provision to provide a level of staffing that more adequately responds to the greatly increased nursing care needs of the last five years." Another one: "We are concerned about the role of the service coordinating agency, the preservation of a maximum standard of care and the option of the freedom of choice, the choice of choosing a group residence over home care or vice versa. We are concerned about the government's emphasis on deinstitutionalization." These are the concerns of the seniors, the families and the care givers concerning the selection and the freedom of choice.

Another one commented about the advantages of living in an institution. However, this individual wanted, in the selection of an institution, to be assured that she would be allowed privacy and independence. Again, it's back to the freedom of choice.

They also spoke to us that evening about the need to make the training of health care workers accessible to all those who wish to upgrade their skills and also the need for adequate funding to provide staffing to ensure the primacy of the individual and his or her right to dignity, security and self-determination. It is absolutely essential that in our discussion of long-term care reform we always remember the primacy of the individual, that individual's right to dignity, security and self-determination.

Just for your interest, I'd like to indicate that at Parkwood Manor the average age of residents has gone up between 1963, when it was 67, and 1991, and it's now 87 years old. So you can see that, as a result, that particular institution has new needs.

These, then, were some of the comments that were shared with me. I'd just like to add by reading to you the comments of one family whose mother had been in Parkwood Manor for the last two years. They indicate to me:

"We appreciate that it offers a continuum of care to satisfy her needs. We are glad that our mother can live in a place where she feels comfortable. It was more by good fortune than by design. We trust that the option of choice will always be available to all seniors in the future."

I'd also like to mention to you at this time that the seniors in Woolwich had a forum to discuss their future, and the seniors in Woolwich decided that they would like to see facilities in their community that would offer a combination of independent apartments and nursing care that would be available if and when needed. So certainly seniors in my riding and seniors throughout the province are very concerned about the issue of long-term care reform.

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The NDP has had a public consultation period. However, I have to tell you that just as in the case of Bill 40 and now in the case of 80, and of course OTAB, there's been a great deal of concern and there's been tremendous scepticism about the genuineness of the consultation. Are all the voices who have concerns being listened to? Is their input being incorporated into the policy? Someone may be listening, but there is concern that their viewpoints are not being taken into consideration in the drafting of the legislation.

People are concerned about the direction of long-term care reform, this fundamental restructuring of Ontario's long-term care system. They're concerned about the direction that the government is going. Our own Community and Social Services critic, Cam Jackson, has asked that the NDP reform funding arrangements with nursing homes and homes for the aged to ensure that individual needs can continue to be met.

Mr Jackson has also expressed concern with further bureaucratization of the long-term care system through the establishment of 40 very expensive service access agencies. This is a concern that I have heard repeatedly throughout the riding of Waterloo North. People are concerned about the duplication of these agencies and the cost. We have an excellent district health council in our community and they are concerned about the possible duplication of service when there's already a good service.

Our own Health critic, Mr Wilson, has expressed concern with the effects of the random hospital bed closures that are taking place everywhere throughout the province of Ontario with little regard to the need or to what is going to replace the hospital beds that are being closed.

What we have here is an NDP consultation paper, a document that really is a replica of the Liberal plan with very minor differences, and I'm not quite sure why we've spent so long in consultation because there certainly hasn't been much in the way of movement or improvement and it's disappointing that it's taken over a year to come forward with this proposal.

We are very concerned that the Rae government has left out many of the components of long-term care. Although some mention has been made recently of providing some palliative care, we're concerned because we haven't seen the entire package, and this is one area of care that is of great concern to people in this province. We're concerned about the lack of mention concerning rehabilitation, the regulation of retirement homes, the support for the primary care givers, human resource management and, of course, training. Again, the funding allocations are extremely vague and there's really not an explanation as to how the money is currently spent and how it's going to be spent in the future.

We are very concerned about the future NDP action as they again take on the private sector, this time not the child care sector but the long-term care sector. Unfortunately, during the discussions regarding the private child care sector many independent female operators have been driven out of the child care field and we've seen absolutely no additional child care spaces.

As I said before, there is a place in this province not only for the public sector but also for the private sector. It's extremely important that we continue to provide people with the options of choice and that we provide them with the best service available. If the private sector can provide those services, we need to continue to allow them to do the job that they've done so effectively up until now. We are concerned about the NDP action to drive out the private long-term care sector.

We are also concerned because the government appears to be poised to increase user fees for the residents in long-term facilities to unprecedented levels. Unfortunately, some of the money that is going to be generated is going to be generated through new accommodation fees on the backs of the senior citizens in this province. We don't have the details of the new funding arrangements, but certainly there is every indication that again our seniors are going to suffer through the imposition of user fees.

In June 1991, the Minister of Health promised to increase funding to institutions by $200 million. Ironically, $150 million of that promised funding is to be raised through user fees.

Another area of concern is the future role of the chronic care hospital, and again this is an issue of tremendous concern to the hospitals and individuals within not only my own community of Waterloo but the cities of Kitchener, and I've also heard from the Cambridge hospital as well. What is the future role of chronic care hospitals?

I'd like to just summarize some of the concerns relating to this long-term care paper. There is scepticism about the genuineness of the government's consultation process. Will they really incorporate the viewpoints of all the people in this province or only the viewpoints of the special-interest groups as they did in putting forward Bill 40?

Again, the response to the NDP consultation document has been overwhelmingly negative. There has repeatedly been concern expressed that people with disabilities and children have been ignored in this report. We know that three groups who represent one million seniors formed a coalition to review the NDP long-term care paper, and that group, the Senior Citizens' Consumer Alliance for Long-Term Care Reform, released an extremely critical response to the paper in early July. These people expressed fear that the closing of the chronic care hospital beds is going to trap them in the same way that psychiatric patients have been trapped when the institutions closed in the 1970s.

Is this what the government intends to do? Once the patients were released, there was nowhere for them to go other than back into the home, and many of them have ended up aimlessly wandering, sleeping in hostels, with inadequate shelter, inadequate support to meet their mental needs. There simply has not been any concern at all for these individuals who were put out of the institutions. The dollars and the care did not follow those individuals once they were released, and the appropriate funding and support services were never put into place.

I certainly hope that if this government intends to close the chronic care hospital beds, that there will be appropriate care and appropriate services provided to accommodate those individuals who would be otherwise accommodated in those chronic care hospital beds. In fact, the senior citizens' consumer alliance have asked that the closed chronic care beds be reopened.

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We know the Ontario Hospital Association is frustrated with the staying-at-home rhetoric which is often used by this government to justify its drastic downsizing of Ontario's hospitals. Again, although they talk about staying at home and although that needs to be a choice the individuals in this province can make, the government needs to provide alternative support and care for the individuals who stay at home, and it needs to be appropriate. The individuals need to have the choice.

Many people have expressed concern, as I've mentioned, that hospital services are being curtailed when the services are not yet available in the community, and we have no hint about the future government direction or policy concerning all of the services that are going to be available in the community to meet the needs. We've heard a few sketchy details. However, one of the gravest and most serious concerns individuals have had about the NDP long-term care reform initiative is with the very serious flaws in the proposed 40 service coordination agencies.

As I mentioned before, individuals in my own community have expressed concern that the 40 service coordinating agencies are going to duplicate existing services. Unfortunately, it appears we are going to have yet another costly level of bureaucracy, just as we set up today, when the government passed the Advocacy Act, Bill 74, a very expensive Advocacy Commission, another level of bureaucracy, which means we're going to have to hire advocates and we're going to have to hire all sorts of other bureaucrats. Is it going to improve the level of service? That's a question I ask and certainly it's a question individuals are asking throughout this province.

Another concern is that the government doesn't plan to increase the number of long-term care beds. The people who are looking after family members at home, the primary care givers in this province, are very concerned that because of the long-term care initiative being proposed, instead of being rewarded for keeping the family member at home, they're going to be penalized, because when they eventually do need facilities to take care of their family, there are going to be long waiting lists, and they're wondering how long that list is going to be.

We all know that sometimes, one day the senior can be functioning well at home with limited support, and within one week that individual unfortunately needs to be placed in a facility where there is more nursing care available. Unfortunately, we've recently been placed in that position ourselves, where a member of our family, in the period of one week, had to be removed from his home, where he was living independently, into a nursing home where he did need some specialized care. These people are concerned that when that care is needed, there is going to be a long waiting list and they're going to be put in a situation where they cannot provide the nursing care that is required.

Nursing homes and homes for the aged, of course, are not totally happy with the government's announcement. They certainly need a greater allocation to go to their residential facilities over the next few years.

It's unfortunate that not all of the groups and individuals have had an opportunity to respond to the legislation, because the legislation was only introduced on November 26, and several years ago. However, it's obvious that the new accountability framework is going to make it more difficult for private sector survival. It's obvious that the stage has been set for the NDP takeover of privately operated nursing homes. The private sector is still reeling from the Minister of Health's speech to the senior citizens' consumer alliance in July 1992 which confirmed the NDP preference for not-for-profit service expansion. They know they are next on the NDP hit list.

As this government makes decisions on behalf of people in this province based not on what is in the best interests or needs of the people in this province but rather based on the NDP ideology, I'm very concerned about that.

I would suggest that there are many concerns regarding the long-term care proposal. I trust the government will take into very serious consideration, and make many amendments that will take into consideration, the views of the people in this province. I would suggest to you that individuals in this province want a continuum of care that takes their individual differences into consideration but continues to allow them a personal choice.

The Acting Speaker: Questions and/or comments?

Hon Ms Lankin: I would like to begin by saying that I'm concerned the member opposite has perhaps some misunderstanding -- let me put it that way -- of some of the proposals we have put forward.

I think she correctly outlines a number of the positions we heard from communities during the very extensive consultation that was undertaken with respect to long-term care. Particularly, I'd like to address the point both she and the member for Northumberland raised with respect to issues of concern that communities had raised with respect to duplication of services and bureaucracy that may be caused by the establishment of service coordination agencies.

The member may remember that in the previous government's paper on long-term care, there was a proposal for a single access point, a service coordination agency. That proposal was in the document we sent out for consultation, and through extensive months of hearing from people we have come forward with an entirely different proposal with respect to moving away from a brokerage style of service to a case management style of service, and bringing together community services and governance structures for more efficient delivery of services and ending of duplication. In fact, it's very responsive to what was heard during the consultation and to what the seniors' alliance has come forward with.

I think there are a number of areas like that on which we could perhaps provide more information for the member that would be of assistance in terms of what we've actually decided.

With respect to the bill that's before us, of course it has nothing to do with those issues that were being talked about directly. The legislation before us -- I want to stress again for those people watching, because they might have a number of concerns with what they've heard because we're talking about a lot of other things -- is about funding and requirements of accountability in nursing homes and homes for the aged.

The Acting Speaker: Further questions and/or comments?

Mr Callahan: According to my calculations, I'm probably going to be signing off with the test pattern when I get a chance to speak, so I'd like to get up again and say that seniors, to me, are the most favourite people in the world. All I caution you about is that years ago the Conservative government, in what it considered to be a very humane fashion, eliminated all the institutions in this province and let these people out on the street and said it would provide services to accommodate those people. I don't know about your experience, but I've travelled around the city of Toronto and you find people out there who have mental disabilities who are sleeping in the streets, you have people who have alcohol problems who are sleeping in the streets, you have people who are homeless who are at food banks and are sleeping in the streets.

I guess my word of caution to you is that in dealing with the seniors, people who have worked and put in their fair share of responsibility and heavy effort in this community to try to help Ontario, please don't desert them.

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I see this as a bill that's highly under regulation as opposed to legislation. It's a situation where you may very well find that you're eliminating a lot of these things. I particularly see on the horizon that if we're going to eliminate any type of choice for seniors, it will be not-for-profit totally. If that's the case, and you don't have sufficient accommodations for these seniors and the people who are not providing for them in their own homes, where are these people going to go? Are they going to wind up just like the people with mental disabilities and so on who were left in the streets of Toronto and the streets of Ontario by the Ontario government of the day, the Conservatives, by eliminating institutions?

I just urge you that this bill has to be more specific. It has to be in a way and shape and form that will show us that seniors will be dealt with with the respect they deserve.

The Acting Speaker: Further questions and/or comments?

Mr Ted Arnott (Wellington): I'm pleased to rise in response to the member for Waterloo North's fine presentation this evening. I just want to add one thing that she mentioned in her member's statement this afternoon.

The special services at home program is a very important community-based program. It doesn't deal directly with this bill, but the fact that the government refuses to adequately fund the special services at home program -- in the member for Waterloo North's community as well as my own, as well as the member for Grey's, who has also raised this issue in the House -- indicates that there is not adequate community-based support services in the province at the present time.

If the government cannot maintain its support for our most vulnerable people, our families with disabled children, during a recession -- a difficult recession, I will give you -- how can we have any confidence whatsoever that there are going to be adequate community-based support services in place to compensate for what the government is doing with respect to its long-term care bill?

It's just incomprehensible to me that we could have any confidence whatsoever in that particular initiative. So I must question it and I must add that I doubt very much that anything we debate tonight is going to find any confidence in the communities out there. This is an important initiative we have tried to bring forward to the government's attention on numerous occasions. I myself have raised it three times in the House, and I just can't believe the government does not respond to it.

I would just leave it at that and perhaps ask the member for Waterloo North whether she herself has any confidence with respect to that program.

The Acting Speaker: Further questions and/or comments?

Mr Johnson: I hope it's appropriate for me to respond to the member for Waterloo North and in essence continue what I said previously. I was heckled a little and got a little dislocated and a little disjointed in what I was trying to say, because I wasn't sure what the members on the other side were heckling me about.

However, with regard to what the members opposite have said in terms of long-term care, I did have some concerned people in my office, and let me say this: All they really wanted to tell me so that I could bring it to the attention of this Legislature was the fact that they didn't want to see any duplication of services, they didn't want to see the government make any unnecessary expenditures, because they know that at this time it is very difficult for the government to find the resources to fund many programs. I didn't finish my previous statement with that, but that's what I was trying to say, and now that I've said that, I'll be very happy to sit down.

The Acting Speaker: The honourable member for Waterloo North has two minutes to respond.

Mrs Witmer: In response to my colleague the member for Wellington, I would just like to indicate that it's because of the government's treatment of the special services at home program and its lack of commitment and lack of compassion, really, that I really have no confidence whatsoever in its ability to provide long-term care that is going to be responsive to the needs of the individuals in this province. It's because of that.

Indeed, today I spoke about three mothers in my community who were forced to abandon their children to family and children's services because the number of hours of support they were receiving had been reduced and because they had no respite from the care of those children. I know of four other families in my community who are also considering the abandonment of their children because this government refuses -- refuses -- to provide the appropriate funding to support those families.

I go back to the statement I made earlier. We have seen the deinstitutionalization of individuals with psychiatric problems. We have seen children and teenagers, such as the children and teenagers I've talked about when I've talked about the special services at home, living at home with their families, which is a very appropriate placement that works well if you get the appropriate support and care, and this government is turning a blind eye. My colleague from Grey, my colleague from Wellington and I have raised this issue on numerous occasions during the past few months, and they refuse to give these people any more support. We now have three young people abandoned to family and children's services --

The Acting Speaker: Thank you. Further debate?

Mr O'Connor: I'm pleased to have this opportunity to speak here tonight and I'm going to try to highlight certain features of Bill 101 that'll assist in the quality of care and accountability for residents in nursing homes, charitable and municipal homes for the aged.

Bill 101 will introduce mandatory requirements for all homes that are intended to have a direct impact on the residents. I'm going to highlight some of them, as well as perhaps talk about some of the issues that affect the constituents in my riding, and seeing how long-term care has affected some of that.

I'm thinking right now of an example of a program in Sharon. They've got a home there; actually, it was my very first ribbon-cutting as an MPP. It is a home for people with many disabilities, not just one disability, so their care is complex. I had an opportunity to talk to some of the people who worked there; in fact, this weekend I'm going to their Christmas party. The people who live there now in this place called New Leaf in Sharon have spent their entire lives in institutions. They've come out of that and have gone into a nice country setting, a rural setting. They come there after being put away for a lifetime in an institution, and because they're in that whole community atmosphere, they've made great strides.

There are so many different elements to long-term care that we've got to take a look at all aspects of it. We can't close our mind to just one of them. That's one aspect I wanted to point out because I felt that for the people who work at New Leaf in Sharon and for the residents there, it's going to be a special Christmas, just as it was last year. They're celebrating their third Christmas in their new home and it's really important. I just wanted to touch on that.

On to the plan of care, which of course is an important part of the bill. All homes will be required to develop a plan of care for each resident admitted to the home. While most homes do this as a matter of professional practice, it is required by regulation. The amendments make the plans of care mandatory. The homes will be required to assess the residents' needs on an ongoing basis and to make the necessary adjustments for the plan of care. The amendments will also include explicit obligation for the homes to provide a care outline in the plan.

I think that's really important. It's kind of like when we were growing up and our parents laid everything out; they had a plan and they planned along the way. I think back to my mother. She worked in long-term care facilities for about 25 years, and she didn't just leave it as work she was paid for. She took that home with her. She made birthday cakes and brought them in for residents. She brought residents home; there was many a dinnertime when we were blessed by having somebody from her long-term care facility coming home and having evening dinner with us. Some of them had spent a long time without ever actually having a meal with their family. For us, we had that opportunity to fill in that space.

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As we move into long-term care, I really think we're not going to have as many people kept in institutions. We have to thank some of those people, like my mother, who went out of their way to make sure that for people who didn't have an alternative, there was opportunity for them to get out.

Second, the quality assurance plan: Every home will be required to develop and implement quality assurance plans for the home. The plan must set out a system of monitoring the quality of accommodation, care, services, programs and goods provided to the residents. Many of the homes will have quality management plans in place. However, the amendments will now make this mandatory. Of course, it's important that we ensure that there is going to be some way of monitoring this, and I think this is going to be a very positive aspect of the legislation.

These of course are as a result of some of the consultations that took place around the province. As the consultations were taking place, I had a lot of people come into my constituency office and say that they felt this round of consultation was far more reaching than any in the past, and that they felt they had a chance for some real good input. It certainly was extensive, when you consider that there were about 70,000 people involved in it. It certainly reflects it, when we take recognize the need for quality assurance plans and put in there that that's mandatory.

Enhanced information sharing: Bill 101 also includes a new requirement for the sharing of information with the residents, their families and their representatives. The homes will be required to give every resident a written notice outlining the accommodation, care, services, programs and goods the home will be required to provide under the act and this service agreement.

The resident has the right to request access and an explanation of his or her plan of care. That's really an important aspect, because quite often when a person is under care he doesn't even know he has the chance to ask that question, and I think it's very important that we allow them that right.

Procedures for a resident to make complaints regarding maintenance or the operation of a home, the conduct of the staff, the treatment or the care they're receiving and additional measures would be set out in the course of the regulations. I think back to an opportunity I had to go into a home in Stouffville and meet with some of the residents there. I found it very enlightening to talk to some of the residents. Some of them have been there quite a while, and it made me wonder why they were ever there, because with a little bit of help, they certainly didn't need to be there.

In fact, I know that the Lions up in Pefferlaw have a proposal in to the Ministry of Housing to add to a building they have there right now. York region has come on with some frail-elderly units. As I said earlier, it's a matter of putting together a whole plan so that there's a whole continuum.

They're taking a look in a small town in rural Ontario -- a village, I guess, really -- and they're recognizing there are some folks in their community who could be taken care of if they were put into some sort of residential setting; that they don't need to have full-time care but just a little help. Those frail-elderly units, at some point in time when the funding comes through for that, will offer that. I hope I'm around for the ribbon-cutting for that, because I think that offers a unique opportunity.

Another thing: The homes will be required to post, in the homes, a copy of the service agreement between the home and the province. Of course it's important, because these residents would like to see what the agreement is between the home and the province. Maybe we don't always give them the credit due, and they'll be allowed that opportunity. They'll be allowed copies of certain financial statements and other documents and information as required by the regulations.

In Bill 101 there will also be a strengthening of the authority of the inspectors to monitor and to evaluate the care and the services of the nursing home, charitable and municipal homes for the aged, in order to ensure that plans of care, the quality assurance plans I've spoken about, are developed and implemented, and that the information is shared with the residents and the family in accordance with the legislation.

I'll go back a few years, if you don't mind, to when I was a teenager living at home and the folks living right behind me had two boys. One was around my age and one was a few years younger, but they had muscular dystrophy. It was an awful burden for the family, they were a lot of work, and it came to the point where they couldn't manage. The eldest boy was put into a nursing home for a while. As time went on, the community health nurse came by, they took a look at the house, and with the help of the local firefighters, they brought in a lift to help lift my neighbour out of his wheelchair and put him in bed and to help the parents lift him and give him a bath at home.

It was just a little help from the community, the community health nurse going in there and recognizing that you can make some changes, not costing an awful lot of money, and make it easier for the family to take care of their son at home. He never lived to be a great age, but he certainly did enjoy his last few years at home with his family, and that's an extremely important aspect that we need to take a look at.

These amendments will not only assist the province in ensuring that the quality of care and service is achieved, but I believe that they'll contribute to bringing about a better quality of life for our elders in nursing homes and homes for the aged.

With that, I'd like to close. Far too often we get wrapped up in far too much rhetoric in this House. I hope I haven't added to the rhetoric. I hope I've added a personal note that maybe a few of us can take a look at and set aside some of that rhetoric, and look at how we're going to make some positive changes, changes that have been a long time coming.

I know I've attended a lot of meetings in my riding and met with people providing care. They do it because they enjoy it, they love it, they really enjoy working with the people. They enjoy having those little extra birthday parties. Folks like my mom, who comes home after a long day and will make sandwiches to bring to a Christmas party, for example, or maybe arrange to have a country and western singer or something come in and sing for them -- I think that's an important aspect that they don't get paid for it, but it certainly needs to be looked it. Perhaps if it's planned out a little better, it would make life for those residents that much better.

As we change and come up with better alternatives, we have to make sure we take a look at the whole spectrum and the whole picture. I'll end with that.

The Speaker (Hon David Warner): I thank the honourable member for Durham-York and invite questions and/or comments.

Mr Steven Offer (Mississauga North): In response to the statement by the member for Durham-York, I hope that during this debate the members of the government side listen very carefully to some of the comments made by members of the opposition. I think it goes without question that all members in each constituency care very much about this issue, that they have spoken as members and in other cases about the issue at hand and bring to this Legislature and bring to this debate a certain opinion, a certain comment, from people of their own constituencies.

I hope the members of the government side recognize that there is a concern out in the community that when one is moving from a system that was composed of both not-for-profit and for-profit services that to move to the not-for-profit sector exclusively within a very short period of time may very well have a significant impact on the provision of service in the community, one which will affect a great many people who need that particular service.

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I hope the members of the government recognize those concerns that are brought forward, especially in the area of nursing homes and how it may very well impact on the service provided, the proposed freeze on nursing homes, with the move from the not-for-profit and for-profit to just the not-for-profit sector.

I hope the members of the government take these comments to heart. They are made as a result of a great many comments, concerns and opinions heard by members of all sides to this very important issue.

The Speaker: Further questions and/or comments?

Mr Callahan: I want to join in again in this because this is a program watched intensely by seniors, and what we're discussing tonight is something that should be very clear for them. I think that's the problem with the legislation; the legislation is not clear and I think that causes grave concern for seniors.

There are for-profit operations around this province that are quite good, but the signal being sent out by this legislation, particularly since it relies to such a large degree on regulation as opposed to definitive measures in the act, is that you're going to scare these people off. It's just like the Minister of Labour's leaking of his Bill 40 before they implemented the bill. That scared off all sorts of investment in this province; it probably scared off a lot of jobs.

I don't want to scare off the people who are my favourite and who should be everybody's favourite in this House: people who are seniors. They're our grandfathers, our grandmothers. I used to always get a kick when I was practicing; clients would come into my office and say: "We don't want to put grandma or granddad in that particular seniors' home because it costs too much and it's going to eat up everything they have in terms of savings." My comment to them was, "It's their money, they earned it, let them enjoy it and don't expect to receive it when they die." I think that's the reason for-profit facilities are equally acceptable to not-for-profit.

There are those seniors who, for whatever reason -- because of pensions, because they've sold a house and made a significant amount of money out of it -- do want the dignity of living in a for-profit community. We have several excellent for-profit seniors' homes in my community, and I don't see that the NDP should run in the same direction they're going with day care. It's trying to give nobody a choice. It's either our way or the road. I don't think you should scare seniors that way. For God's sake, don't get the message out to the public that it's going to be nothing but not-for-profit, because it gives nobody a choice, particularly seniors.

The Speaker: Further questions and/or comments?

Mr Wessenger: I'd like to commend the member for Durham-York for bringing to the attention of the House the fact that this legislation not only deals with the aspect of level-of-care funding -- which I think corrects a long inequity with respect to the funding of beds and also helps to deal with the problem of disincentives to taking on heavier-load patients requiring more care -- but it's important that we have this type of funding, that we have some sort of accountability measures put into the legislation to ensure that service levels are maintained.

As my friend indicated, one of the aspects of ensuring that level of maintenance of care is the plan of care for each individual patient and the fact that that information must be posted available; secondly, the fact that the service agreement between the Ministry of Health and the institution again has to be posted and there is a the mechanism in the legislation so that if the institution does not live up to its requirements under the service agreements, it can be penalized by the withholding of subsidies.

I think it's a very good piece of legislation that attacks the problem of the inequalities of funding we now have in our system, as well as building in the accountability we need to ensure that the system works well.

The Speaker: With no other questions or comments, then the member for Durham-York has up to two minutes to respond.

Mr O'Connor: I know that sometimes you'll say a few words in this Legislature and wonder whether the members opposite are really paying attention to what you said. I talked about the plan of care, I talked about the good folks living up there in Sharon at the New Leaf residence and how having a plan of care has brought those people miles down the road from where they were when they lived in an institution. I talked about the enhancement of sharing information. I talked about the quality assurance plan.

It's sometimes disheartening. You stand up here and make some statements about how good a piece of legislation may or may not be. You don't have to agree with that, but then the members comment on what you've said and start talking about: "There's regulations and we don't know what they're going to mean. You haven't talked about the dollars going into community care, and maybe that's not going to happen."

We already know that's going to happen. The statement took place in the House, this very Legislature, and it's been said several times: $133.5 million going in. I don't know how many more times you've got to say it. Maybe we've got to repeat it a few more times: $133.5 million is going into integrated homemaker services.

I just hope the folks at home have a chance to listen. Maybe the government members aren't long on pontificating and saying how terrible everything is, because we just talk about the facts -- the plan of care, the enhancement of information sharing -- and maybe put it in a real aspect, because we talk about how real some of this is.

In closing, I just want to say that with $133.5 million for integrated homemaker services, I think we're well in the direction of improving health care within the community. For my neighbours in the neighbourhood where I grew up, the neighbour who lived right behind me, he would know that care being offered at home is far better and more valuable than the institutional care he was subjected to.

The Speaker: Further debate?

Mr Joseph Cordiano (Lawrence): I am very glad to have an opportunity to speak to this very important issue. I think this issue is one which is of great importance to all members of the House and affects all of us in each of our various ridings, to the extent that this issue really defines what the efforts of any government can be in ensuring that its most vulnerable citizens are given the kind of service, the dignity to continue their lives, the kind of protection, if you will, that is required for people who are most vulnerable.

Having said that, I think it's important to look at just what's being undertaken by this particular government. I'm very proud to be able to stand up and say that I was part of a government that was initiating this change in long-term care. The policies of the previous government were being put forward to rectify the many years that had previously elapsed without the proper system having been put in place to effect these changes which are of lasting consequence and very significant to our most vulnerable citizens.

Our Liberal administration would have gone a long way further than what is being proposed here, and it's fair to say that, because let's look at what this government intends to bring about in terms of its funding initiatives. Of course, ultimately that's what we're talking about: money or the lack of money to properly fund what is essential to bring about the kinds of changes that are required. I think it's important to look at just what the government is proposing to do in that regard.

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The plan calls for some $647 million to be spent over the next five years so that by 1996-97, this amount of money would have been spent. However -- and this is a big "however" and a big "but" -- that money, that amount of allocation, is not deemed on a yearly basis; plans call for it to be spent at the end of this period, so this amount of money can be and probably will be spent by this government, but certainly not in the initial stages of this plan. In effect, most of the spending could occur towards the end of this period, which really calls into question this entire strategy. Because as my colleagues and various critics who have commented on this proposal have clearly and rightfully indicated, people are beginning to fall between the cracks.

As we shift resources away from institutional care and into community-based care, people are beginning to feel the real brunt of the lack of effective management on the part of this government. I have a very difficult time trying to comprehend the cutbacks this government is undertaking at present which are going to affect the vulnerable among us. That is very unacceptable, and it really calls into question the priorities of this government.

It's not simply a case of saying, "We don't have enough money," and then the members opposite will ask for money and at the same time we'll say, "We shouldn't spend any more because we don't have any more." Well, that's what governance is all about: setting priorities.

When I sat on the select committee on health several years ago and in other parliamentary sessions, I remember very clearly the members of the NDP were very eloquent and passionate about what they felt with respect to the health care services being provided in this province. Yes, they were ideologically straitjacketed. I see indications in this bill that we will indeed see initiatives that will take us from what is now a mix of profit or for-profit institutions and non-profit institutions.

This seems to be something this government continues to be preoccupied with, as it undertakes a series of redirections, to use its language, in these very fundamental services which are crucial to all of the citizens of this province.

I just want to cover some of the territory with respect to payment policy the residents will face in these institutions. Currently, I have figures that indicate that 46,000 seniors pay $26 per day; 13,000 pay up to $100 per day. However, under the new system, the 13,000 now paying up to $100 per day will pay $37 per day; of the 46,000 currently paying $26 per day roughly half will now pay $37; one quarter will pay between $26 and $37; and one quarter will pay between zero and $26, due to low income.

So we have a system of payment based on, as this government has indicated, ability to pay, but they've reduced the amount that those who can really afford to pay will be paying under this new payment schedule, from $100 a day to $37 a day. That is indicative, is a telling story about what direction we're headed in with respect to long-term care facilities. The initiative here is to ultimately remove the for-profit institutions in this sector of services that are being provided in the health care field.

I say that is simply not acceptable to the people of this province, because it will begin to erode the kinds of services which are being provided and will completely do away with choice. Choice equals freedom, the freedom to decide what will happen to oneself in the future, particularly for seniors, at an age when these decisions become more difficult and when you're least able to tolerate circumstances or an environment which is completely alien to you. You want the greatest comfort level, which is not only important to you physiologically but also psychologically.

We know that those are important factors for seniors, who are probably at the most vulnerable time of their life, many of our seniors, and those who simply want the choice to live in an environment which fulfils their requirements, fulfils their needs, and are willing to pay for that.

This policy does not take into account an evaluation of assets. That will simply deny people choice when you remove that possibility. As my colleagues and others have pointed out, after a lifetime of building up a reservoir, a nest-egg, I suppose many of our seniors would like to use that in the best way possible in their later years, and we are by this policy eventually going to deny them that choice, which I think is a fundamental change. That isn't stated here, but we suspect and we are concerned that this in effect is what's going to take place in the elimination of the for-profit sector.

The government says it's going to reallocate in its funding initiative $37.6 million from the hospital budget. I'll get to that in a minute. Another $150 million will be revenue that's derived from residents' charges for accommodation in these facilities. Another $460 million will be new provincial funding over the period of this five years. In effect, we're going to see, as a result of these changes in resident payments, revenues which are derived from fees that are paid by the residents themselves. It's a significant amount of money, but at the same time a shifting of the burden, because you'll have a greater number of people paying a higher percentage with respect to the amount that's being paid in the middle group. This graduated scale increases payments to generate this $150 million in revenue.

Ultimately what you have is a shifting of the burden to those seniors perhaps in the middle-income range, as is inevitable with this government. Their taxation policy -- and this is very reflective of the kinds of increases that we've seen in their taxation policy -- is to shift more of the burden to middle- and lower-income people. That's what's going to take place with respect to this new payment policy.

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There are a number of initiatives which the government says differentiate its policy from the previous policy of the last government. I'm only going to touch on a few of these, but with respect to the changes in copayment, we had a government that basically felt uncomfortable with the notion of seniors and the disabled being charged for services which it felt should be based on other kinds of funding, which would have inevitably cost the Treasurer more money.

Of course, they came to the conclusion that there's probably nothing wrong with charging fees for services that were non-essential, and that was part of the policy that was commenced by the previous Liberal administration. Personal services such as shopping, cooking, cleaning and home maintenance would be areas in which copayment would take place.

Finally, this policy has seen the day, with respect to this new redirection of this administration's initiative, and we're going to see something along those lines. Of course, this government likes to look at it and say that people are only going to be paying according to their ability to pay and that it will be a balanced copayment policy. But at the same time, we hear the Minister of Health talking about charging user fees to seniors who now get prescription drugs free. I think that's incredible from a minister who is part of a New Democratic government.

You can have a kind of rationalization in policy with respect to that area and lead to changes which will be more cost-efficient, but I think we have to be very careful about the direction the minister is headed in that regard, because it always seems to be the case that the burden falls on middle-income or lower-income people. This government has talked a good game in the past about changing that, but we have yet to see some very firm examples of a new change in that direction. It's always the middle-income group, who happen to be the largest group, who are hit with the greatest increases, regardless of the rhetoric we've heard in the past.

I repeat: I sat on the select committee on health and heard the great passionate pleas on the part of New Democrats of yesteryear, when Liberals were in power, who wanted to move with respect to these policies and were very clear about their intentions. This government does not seem to be as clear as the rhetoric would have had you believe.

As has been pointed out by my colleagues, in this bill a great deal of the initiatives have been left to regulation. Of particular concern in that area is that for culturally based groups or religion-based groups who now want to put proposals before the government, the rules for that are not very clear at all. This administration has a distinct change in policy in that regard from the previous Liberal administration. We were very clear. We had encouraged these groups to come forward because we believed they had a real link to the community they were going to serve, that these institutions that were built around cultural or religious considerations, of a nature that were local, reflective of the local community aspirations and needs, were very important and essential parts of those local communities. They continue to be. I have very fine examples of those institutions in my riding. Villa Columbo is one of them. The Baycrest Centre, not in my riding but which borders on my riding, is another.

If this government's initiative is to move away from that, as we've heard and I think is now clear, then it's completely removing an initiative and a policy which seemed to work rather well in the past without giving us very good reasons about why this initiative was necessary. My concern is that we will no longer have those kinds of institutions which were reflective and sensitive to cultural needs, to religious needs, and that they will be a thing of the past.

That's a very big concern. My colleagues have expressed that. Members on this side, or at least in our party, would not like to see that occur, and I think the minister has to be careful in this regard.

I'm going to conclude my remarks by suggesting that long-term care reform needs to move forward, but I remind the government that the initiatives stated with respect to this policy need to be supported by the kind of funding which goes into these initiatives. That is absolutely essential. We're getting people who are falling between the cracks. In my closing remarks, I want to make mention of a case -- and I'm sure there are countless numbers of others who have come before all of us, but this is a very telling story of a mother who came to my office to plead with me for the government to help her.

Her son is an autistic child who has very great needs with respect to ensuring that he stabilizes. He's very unstable at present, he's suffered a great deal of trauma in surgery, and she needed to place him in a long-term care facility. The family was getting some respite care, but the situation was that she needed some special funding for transportation services, and that, she was told, simply was not there as a result of the cutbacks that were initiated by this government. The amount of money was quite small, and this mother had no place to turn. She's relying on her parents, who are elderly, for additional care for another child, and they provided some support.

But we're talking about the transitional stage here and I think that's what's essential, to provide central funding -- absolutely critical -- to these families in these types of situations. They're falling between the cracks, and if deinstitutionalization and taking people out of institutions means they're going to end up with no alternatives, as we're beginning to see now, where the squeeze is on for every dollar that's being spent, we've got to get a reprioritization of what's essential and what isn't.

We cannot allow -- and I believe this will be a testament to this government -- the most vulnerable among us to suffer that fate. It's simply not on. These are cases, and I am sure there are hundreds of them, which are beginning to emerge on a daily basis. I say to the government in power that that's simply not acceptable, not for this government, not for this party, not for any party in this Legislature.

The Speaker: I thank the honourable member for Lawrence for his contribution and invite questions and/or comments.

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Mr Gilles Bisson (Cochrane South): I'm not going to take too much time, but just remind the member of something. He started off his speech by talking about us on this side of the House, in government, being able to set priorities. Well, I don't know how a member from the Liberal Party can stand on the other side of the House and tell us about setting priorities. Rather than dealing with the downturn of the economy when it was happening in the province, when you on the other side of the House had a chance, you set your priorities. What you did is you hit a structural deficit and you called an election. And you stand in this House and talk to us about being able to set priorities? I think it takes a lot of nerve, quite frankly.

I don't often get mad, but I've been listening to this debate from the very beginning, and rather than dealing with the issues, what people basically try to do here is to play political games. If, rather than dealing with the political issues, you tried to deal with the question of what long-term care means for the province of Ontario and talked about finding ways to improve and enhance that legislation, I think you would find a lot more cooperation on this side of the House. Instead, you decide to sit here for political gain and go against the very principles your own government talked about when you guys were in government, because you had started this process as well.

I see this now in one week on OTAB, a project that was started under the Liberal government, under the Premier's Council; the former Liberal government dealt with an initiative called OTAB. We got into debate here at second reading the other day, and what the Liberal caucus did I thought was deplorable. What they did instead was try to make political gains and talked against an idea that was their concept. You started it. It took this government's management and its ability to see things through to get these projects off the ground and to get them in place for the benefit of the province of Ontario.

So to sit here in the House and listen to the member opposite take the position he does is, I think, a little hard to take. When you talk about setting priorities, why don't you set your priorities straight? Stop playing politics and work for the people of this province.

The Speaker: Questions and/or comments?

Mr Offer: I feel compelled to make some comment, first to compliment the member for Lawrence on bringing forward some of the concerns he has had in his constituency, but also to comment on the very strange comments by the member of the government for Cochrane South.

I think that really does bespeak the problem. Here we have members of the opposition parties bringing forward some of the concerns which they have heard from their constituency offices. I believe the member for Lawrence spoke about a constituent who came in who had an autistic child and was trying, within the time allocated under the new rules of procedure, to explain to members of the government what that meant, not in terms of some ideological blinder but rather what it meant in real terms: what it meant to that mother, what it meant to the family, what it meant to the stress and strain on siblings.

The member for Cochrane South sees this as some sort of "we and they," some sort of ideological position, when members of the opposition attempt as best they can to bring forward some of the concerns which they have heard. I too have heard some of those concerns, and in the time permitted, I want to also bring forward some of those matters that I have heard in my constituency office.

We all recognize that this is an issue which is of incredible importance to all of our communities, of incredible importance in terms of the type of care which we want to give not only to those children who may be disadvantaged but also to our senior citizens. When members of the opposition attempt this as best they can in the time allocated, as the member for Lawrence has attempted to do here, they seem to be castigated, seem to be tarnished, seem to be brushed with some sort of political stripe. Well, the fact is that the member for Lawrence and other members -- and I speak specifically to the member for Cochrane South -- were bringing forward some important concerns of their constituents, some of which are felt by many constituents throughout the province.

The Speaker: The member for Beaches-Woodbine.

Hon Ms Lankin: I want to address a couple of the comments the member for Lawrence made in his contribution to the debate tonight.

First of all, I think it's important for us to assure the members of the public who are listening that in fact there is a commitment to substantial increases in expenditures in long-term care over the next number of years. The members spoke about the need for these kinds of reforms to be backed up with sufficient funding, particularly as we look at trying to build a community infrastructure for delivery of services. As we look at that shift from overreliance -- I think anyone objectively looking at the system would agree -- on the institutional sector, in order to make that shift to the community the resources have to be there.

Over the course of the next number of years, we will be adding up to an additional $647 million; that's above and beyond the base budget. I want to make this point to all the members in the House, because I've heard on a number of occasions this evening the question being asked: Is this new money, or is this somehow money that's already in the base? The base budget is about $2.2 billion for long-term care. These are new moneys in addition to that, so I want to assure people of that.

The member also raised concerns with respect to a family in his constituency and a vulnerable child who is unable to access required services. I think we all know that there will be continued demands on the most important resources we have in health and social services. The focus of long-term care is, and has been from the beginning, focused on the client groups of seniors and adults with disabilities. That's not to say that there aren't others who need services and that we need to do better in those areas, but that's not the client group we're talking about with this initiative.

Last, let me say that I think it is important, if we're going to touch on a number of areas in debate, that we give members of the public watching accurate information. The member for Lawrence did talk about the fact that there were now new user fees that had been imposed for seniors who are getting prescription drugs. That's just untrue, and I ask the member to correct that on the record.

The Speaker: Further questions and/or comments?

Mr Callahan: Obviously, the member for Lawrence got that information from somewhere. Perhaps now is the time to ask the question of the Minister of Health, will there be user fees for prescriptions for seniors? You're saying no, so I hope that will never happen, because if it does, you can be sure that at a quarter to 11 on whatever night we're sitting, I will remind you of that.

The critical issue here is one we should all be very concerned about, and I think we are: seniors. They're living out their golden years, they're able to look after themselves for a while, in-home care, then they move to facilities, and I think it's important that the facilities we develop be the best facilities possible.

I've read through the act -- I'm not sure all members have, but I've read through it -- and what concerns me is that a good deal of it is left to regulation. I'm hopeful that during the committee hearings that these facts are going to be clarified, and perhaps it's going to be made clearer for those people who are going to be most affected by this, the seniors. I'm hoping that will happen, because if it does, then perhaps the legislation is something I can look at and support. But at present, so much is left to regulation. When I get a chance to speak, if I do, I will refer to such things as definitions of nursing care, accommodation, basic accommodation, preferred accommodation, short-stay accommodation and so on. They are all done by regulation.

If there's one thing that comes down to us from English jurisprudence, it's the fact that laws should be clear. Otherwise, it becomes that the law is governed by the length of the chancellor's foot, and that's not proper. In any democratic society, that's not the way you operate.

So I'm hoping that the minister, through these hearings, will listen to the public and that these regulations will be eliminated and we'll get definitive clauses in here so people know what it's all about.

The Speaker: The member for Lawrence has up to two minutes to respond.

Mr Cordiano: First, I want to say to the member for Cochrane South that I can sympathize with the way he feels, because what I raise touches on a sensitive, sore point: It is difficult for someone to sit on that side of the House and deal with these initiatives that have been undertaken by this government and to hear the criticisms out there. It must be difficult for you, sitting in the back benches, not being able to take part in that decision-making process, and then having to go out and sell these difficult decisions. I know what it feels like, and I sympathize with the member for Cochrane South; perhaps not to the same extent as these members are feeling today. But it's a very difficult job to go out there and sell something you don't really believe in, and that's why I sympathize with the member for Cochrane South, because he doesn't really believe in his government's initiatives, nor do most of the members on that side of the House. That's why it's difficult.

Mr Bisson: On a point of order, Mr Speaker: I would bring to the Speaker's attention that the member is imputing motive on the part of my support of the legislation.

The Speaker: The member for Lawrence has the floor.

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Mr Cordiano: On another note to the Minister of Health, I want to say that I would welcome her standing in her place at any time, on every single day, to reassure the people of this province that we will not see some form of user fee for prescription drugs for seniors. The minister wasn't paying attention to me, but I said I would welcome her standing up each and every day to reassure us, because there's a great deal of uncertainty out there about --

Hon Bud Wildman (Minister of Natural Resources and Minister Responsible for Native Affairs): You're creating it.

Mr Cordiano: We're not creating it. I'm just voicing the opinions of others, and that's what we do in this House.

Interjections.

The Speaker: With certainty, we move to the member for Simcoe West.

Mr Jim Wilson (Simcoe West): I'm delighted to point out that the debate has livened up just in time for my usual lively speech -- as we get dull laughter from the government side. But I think at 10 minutes to 11 at night it's really not appropriate to give a speech full of rhetoric, as at any time it's not appropriate. I want to comment for a moment on the sparring that's taking place.

I know all members realize that Parliament is a substitute for war, but you're not to take that literally. It's a substitute that many other countries, in lieu of guerrilla warfare, I'm sure would prefer. In Afghanistan and other countries in the past, you shoot each other rather than have frank debates in Parliament. It's no coincidence, of course, that the distance between the aisles on the opposition side and the government side is the distance between two armed swordsmen. However, late at night I don't think it's all that beneficial to point fingers.

I want to start off on a positive-negative note by saying that with the introduction of Bill 101 and the announcements the Minister of Health has made over the last couple of weeks concerning long-term care, at least the NDP is moving on long-term care and therefore we have an opportunity to debate this.

Mr Callahan: Oh, oh. Here's the other shoe.

Mr Jim Wilson: The other shoe, as the member for Brampton South has just challenged me, is that the Liberal Party did spend a great number of years and several million dollars studying and restudying long-term care. We didn't see any movement during their time in office even though they did make significant movement in extending human services, I think perhaps too much so, to the point now that this NDP government finds itself having to cut back on some of those services, particularly in the Comsoc ministry, that were extended by the Liberal government, because nobody bothered to figure out how these services were going to be paid for over the long run. That is indeed a problem and it will be a problem for our government in two and a half years to address some of the services that I think have been extended far beyond both the government's and the public's ability to pay.

In the area of long-term care, particularly Bill 101 that we're debating this evening, I want to caution the government and say to the minister that one of the problems with this debate -- and I've listened very carefully all evening -- stems from a significant problem with the bill, and it's been pointed out by many members who have spoken. We have a bill that doesn't have much meat on the bones; we have a bill that leaves all of the essential question, in my opinion, to be decided by cabinet through regulation.

We had a Liberal member earlier, the member for Ottawa-Rideau, delineate for the House -- and I won't repeat it -- the two dozen areas the government has reserved for regulations, and they're important areas. I suggest, and the member for Brampton South did say it in his two-minute rebuttal a few minutes ago, that Bill 101 isn't a good law, as it came out of the starter's block, because it leaves so much up to cabinet. Yes, we have a cabinet form of government in Canada and in Ontario; yes, we reserve some regulatory powers to cabinet. But Bill 101, this Long Term Care Statute Law Amendment Act, I think is taking cabinet's prerogative to the extreme.

Hence, the type of debate we've had this evening leaves a lot of members stretching their imaginations to poke holes in the bill. While the minister may have in her mind what all the regulations are going to look like, I hope she doesn't at this point, because we very seriously want her to send this to public hearings, and I gather she's agreed to do that. But while the minister may have a clearer picture of what she intends in this legislation, it's difficult for opposition members, interest groups, seniors and the frail elderly to get a handle on what direction the government is going in terms of long-term care services, because what we have is a giant jigsaw puzzle. A lot of the important pieces are missing, and they're to be filled in behind closed cabinet doors through the regulatory process. I think that's unfortunate. I think the minister is a very capable minister of the crown, and she could have presented us with a bill that contained some greater details than what we've seen.

But I want to concentrate briefly on a couple of areas that have been of concern and continue to be of concern to me and my caucus colleagues in the Ontario PC Party.

Surrounding the issue of funding of long-term care, I take the minister at her word that the $247 million that's been committed over five years is new money on the base budget. But what shocked all members of this Legislature, certainly what shocked citizens of this province, particularly because it came from an NDP government, was the fact that of the $200 million the minister committed to the nursing home and homes for the aged sector on November 26 in a statement in this House -- that's $200 million of the $647 million total new commitment by the government in long-term care -- $150 million of that $200-million instalment is to be borne directly by seniors and the frail elderly and residents in nursing homes and homes for the aged, non-profit homes. I think that's quite a shock.

I know it came as a shock to my own family, where prior to the announcement in the House the homes were already starting to charge $10 a day more, and that leaves families to come up with $300 a month more. It's above what my grandmother's receiving in terms of Canada pension and Gains and GIS.

It does come as a shock, because the history of this sort of user fee -- and I will call it a user fee, even though the government will call it something else; it's entitled to do that, but it is a user fee. It's adding to the user fees that are already in the system and, yes, we put those fees in the system --

Hon Mr Wildman: I thought you were in favour of user fees.

Mr Jim Wilson: The Minister of Natural Resources says, "I thought you were in favour of user fees." It gives me an opportunity to clear the air on this, because my party and my leader, Mr Harris, the member for Nipissing, have taken a great deal of heat over the last couple of years in the editorial pages and in articles because we've had the gall, the honesty and the integrity to come forward and talk about user fees, rather than this back-door approach. The minister, in the announcement in the House on November 26, talks about $200 million as a major instalment towards long-term care reform. What she very carefully did not say is that these are user fees to be borne directly by the frail elderly of our province.

Bob Rae in opposition called such fees abhorrent; well, there's a long list of terms he used to use, and I get a synopsis of Hansard here. But it's come as a shock to the public that the NDP would introduce these fees without any discussion. That's the challenge that we have put out there to the government. Yes, it was contained in the redirection document. Yes, there are a few lines devoted to the fact, but it's disguised. I know I had --

Hon Mr Wildman: How long have we been discussing long-term care? My God. No discussion?

Mr Jim Wilson: We've not had a discussion in this Legislature, in the two years I've been here, about user fees, about these fees. What we've said as a party is: "Let's cut the bunk. Let's cut the rhetoric. Let's stop putting out announcements like the minister made on November 26, where you have to read between the lines and do analysis to find out who's actually paying three quarters of the $200 million that nursing homes are going to receive."

Everyone in this province, whether it's for an emergency ambulance ride or non-emergency use of an ambulance, is sent a bill by the ambulance company, the municipality or the hospital, whoever's operating the ambulance service, and there's no discussion of whether or not the person or the family sent the bill can afford to pay that.

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It's a user fee that the NDP government within its first few months of coming to office increased significantly, again through regulation -- no announcement, no public discussion -- and there are numerous user fees. In fact I could go into my usual speech about user fees, in which we list tens of user fees in various health care and community and social services sectors. What we challenge the government to do is to devote some time in this Legislature specifically to where user fees should be appropriately placed and who should bear the brunt of these user fees.

Now there's some hint of that in this legislation, and I hope we can get into it in committee in terms of the government moving towards an income test. As I understand this bill -- although again it's not clear in the bill itself, but as I understand it from the discussion around it -- low-income seniors will continue to pay the $37 a day that they're paying now as a result of the recent increases, and on a means test or an income test, seniors who can afford more will be asked to pay more.

I can tell you that I attended a number of the public meetings concerning long-term care and that issue was never discussed by the coordinators who were sent out by the various agencies to set up the public meetings. It wasn't discussed in a forthright manner, I can tell you, or there would have been some frank discussion from seniors, who I'm sure would have said, "How am I expected to pay this?"

Also, by doing an income test, and I know we'll get into this in committee and I welcome that debate, the first question that comes to my mind is, does that mean if I don't really have any income as a senior but I have tremendous assets -- I may own a $2-million home -- according to what I read in the legislation, I can still own that home, plonk myself, when the day comes, into a home for the aged or a non-profit nursing home or a private sector nursing home, if there are any still left, and yet I'll pay the low rate because it's not an asset test, it's simply an income test?

Coming from a socialist government, coming from any government, this is passing strange, and it's a question the minister knows very well members would raise. In a cursory view of this legislation, that question comes up immediately, yet we've not had the answers from the minister to date.

The Ontario Association of Non-Profit Homes and Services for Seniors feels that the government's $150-million estimate -- that's what the seniors themselves will pay -- is actually a low estimate and that the new user fees, and these are their own words, "will only net the province $64 million."

That's something else that really throws a wrench into the equation we're talking about in terms of, how can the government be so off? There has to be something here that if the government -- our own research indicates that, yes, you can get about $64 million, $65 million based on what we've heard so far from the government -- how does the government get $150 million of the $200 million from seniors? It's a question that's not been answered and it's a question, I think, that's reserved for regulations. In terms of maximum amounts to be charged to consumers, to seniors, they are to be spelled out in the regulations.

I think that's pretty unfair. I think my family and other families should know right now what we can expect to pay to have our frail elderly and loved ones who must live in institutions and who in fact may prefer to live in institutions -- we should be able to plan and we should know ahead of time in legislation what those fees are. When you don't put stuff in legislation, I think one of the problems here is there's a lack of trust of this government. There have been so many scandals and incidences and circumstances, as I heard the Minister of the Environment say on a cable show last night. She didn't call them "scandals" but "circumstances."

We've seen triministry funding cut. We've seen financial cuts and service cuts to our most vulnerable in society: developmentally handicapped children, adolescents and adults. Sheltered workshops like ARC Industries have been told to close their doors early next year; and special services at home. We've seen all kinds of cuts from this government. We didn't have any discussion about them other than ministers making announcements that cuts were upon us, and therefore the public is sceptical of leaving anything to this cabinet to decide behind closed doors.

Secondly, what you hear when you speak to seniors' organizations -- I do a lot of that in my role as Health critic, particularly in my own riding, and we probably all speak to seniors' groups at least once a week or every two weeks -- is that they can't understand how they're being asked to pay more when the government has closed, what? What are we up to now, Minister of Health? Is it 5,000 hospital beds that have been closed? I know we can debate how many layoffs there have been depending on whether you use OHA figures or whether you use registered nursing association figures, which are much higher. The layoffs are far higher than the 700 or 800 the Ontario Hospital Association and the Ministry of Health tell us.

Seniors see these cuts and they see cuts to the vulnerable people in our society, and they know the government has $53 million to spend. The question they ask is: "Why am I now being asked to pay more to be in the old-age home? This government has money. They don't seem to have any qualms about borrowing it, offshore or otherwise. They're going to spend $53 million. They didn't take a cut. The government didn't take a cut in its overall planned expenditures. They increased those over the year before." It raises the question of priorities and it raises a concern in seniors' minds. They ask, "Are we really important to this government?"

I think all the platitudes in the world coming from the government side don't answer that essential question. What seniors look at and our frail elderly look at are actions. They see cuts on the institutional side in terms of hospitals. We had the scare a year ago that chronic care hospitals would be closed. They assume that money is being saved when you close 5,000 beds. They say, "Where is that money going?" We know from the government's announcements that in the year 1996-97, I think it is, $36 million or $37 million of hospital budget money will be in community-based care. We don't know what money is being transferred in the meantime.

I want to just note a quote here from James Lumsden of the Council of Family/Community Advisory Boards Nursing Homes. He wrote in a letter to the editor last month that this increased copayment, this $150 million that seniors are going to have to pay themselves, should be phased in. He said this would be consistent with the government's plan to fund long-term care reform over a five-year period.

Mr Lumsden writes:

"Try to envisage that you have lived through the Great Depression of the 1930s and all the hardships that it imposed upon people. Envisage the values that those who lived through that period of material deprivation came away with. Now envisage that you are 85 years of age and you have just been told that your costs will increase by $300 per month or almost every spare dollar you receive. You would have to forgive the elderly if they thought the Great Depression had returned and they were no longer living in the alleged age of social enlightenment."

I think that sums up the concerns of seniors with respect to the new user fees that the government has introduced, and I'm sure we'll hear a lot more in committee about this.

Muriel Culshaw of Barrie writes: "This is $4,015 more per year. Where, may I ask, does Bob Rae think that the majority of seniors in these homes are going to find this kind of money?"

The second major area of concern that other members have discussed and that I want to touch on briefly pertaining to long-term care reform and this bill in particular -- because I find this area quite offensive, I find it ideologically driven and I find it nonsensical -- involves the thrust of Bill 101, which is to eliminate the private sector from the nursing home business in Ontario. It raises the question of whether this essential element of Bill 101 is really the NDP game plan.

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In day care we have the living example and the current example of the government spending, I don't know, the estimates are up to $100 million, $105 million over a fiscal year to simply drive the private sector, the profit sector, out of day care; not to create any new day care spaces -- there is another $30 million or some-odd million set aside for that -- but simply an ideologically driven decision of this government to boot out anyone who might be trying to make a profit in the day care field or, in this case, the nursing home field.

The Ontario Home Health Care Providers' Association is concerned that the NDP will drive it from the provision of home care under this so-called reform system of long-term care in Ontario. On several occasions the Minister of Health has expressed her government's "continued preference for not-for-profit service." At a ministry briefing last week, ministry officials reiterated the government's preference for not-for-profit and could give no assurances that the private sector would continue to play a prominent role in the delivery of home care services in Ontario.

I think the following statistic is extremely important for all members, particularly on the government side, to pay attention to: 45.5% of publicly funded homemaking services are provided by private agencies. Publicly funded services make up approximately half the commercial providers' business. Commercial agencies employ 20,000 workers which include nurses, health care aides, home support workers, occupational therapists and physiotherapists. The majority of these workers are women.

I don't want to get into the Peter North, John Piper and Carlton Masters suggestion that's contained in my briefing note, but suffice to say that the NDP's record to date, at least its recent record, in response to the concerns of women in Ontario is terrible. If driving the private sector out of nursing home care is going to put more women on the streets, in the unemployment lines and on the welfare rolls, then really I think all of the platitudes and the wonderful campaign slogans and the Agenda for People and all the stuff the NDP claimed to have stood for in the past is a bunch of bunk.

I raised this issue of the private home health care providers in the estimates committee and in the Legislature and, to date, I understand -- maybe the minister will want to correct me -- -she still refuses to meet with the Ontario Home Health Care Providers' Association. In fact I recall, Minister, very clearly that the way you dodged my question in the estimates committee some months ago was that you simply said right away, "I'll meet with them if that's necessary." They still want to meet with you.

Unfortunately, you've gone ahead and introduced legislation that very specifically says that: "The minister may provide capital funding for a nursing home if the licensee is a corporation without share capital governed by part III of the Corporations Act." Ie, it has to be --

Hon Ms Lankin: It has nothing to do with home health care providers.

Mr Jim Wilson: You can't build any new nursing homes unless you're going to be a non-profit nursing home. I think that's what it has a lot to do with it, Minister.

The point I think we should make in the area of for-profit agencies is something that I think the NDP misses. We have example after example of the government really not being able to provide services cheaper and more efficiently than the private sector.

We have a history in this country and in this province that clearly indicates the private sector must be an integral part of our health care system, of our social services, and to simply want to drive it out, to spend millions of dollars not creating any new services but replacing services that are being provided effectively and efficiently by the private sector with a so-called non-profit sector or not-for-profit sector just doesn't make any sense to me.

I think what you have to take into account is that nursing homes under this legislation will all have to meet service agreements; they'll all have to provide service agreements to the crown; they'll have to abide by those service agreements, whether they're in the private sector or the not-for-profit sector. The standards are going to be the same, or should be the same, for a resident of a private nursing home or a public non-profit home, yet for some reason the government has a problem with Mr and Mrs Jones, who own a nursing home. They have a problem because they see or hear the word "profit" in that equation and they think profit is a dirty word. They don't realize that many of these private operators aren't making a profit. Quite a few of them are in deficit positions.

But they can still make a profit and meet the standards set by the government, provide quality service. If they're not, you should send your inspectors in and ensure that they are. They can do all the things any government may require of them, just as the non-profit homes can do, and they can still make a profit for themselves and do it cheaper overall than the government sector can, the non-profit sector in my mind being an extension simply of the public sector. How we prove this to the government is going to be a challenge, I admit, because of its ideology. It's going to be a challenge during the committee hearings, but we will do our best to ensure that the private sector that's providing 45.5% -- as an example -- of home care services is not driven out of the delivery of those services, that nursing home private owners are not driven out of their homes and replaced by these so-called not-for-profit agencies or homes.

In a letter to the Premier dated November 27 from a registered nurse whose name is Rosalie Armbrust, Ms Armbrust writes:

"Your government appears to be ignoring mounting evidence that should warn it off its course. In day care, the government is driving commercial providers from the sector, investing millions of dollars but not creating any new spaces.

"With home care in Manitoba, that government is now asking commercial providers to re-enter the field because its own experience with a solely not-for-profit system has resulted in a system that is rigid, non-responsive and bureaucratic."

I think that sums up pretty well what I would have liked to say in the area of that.

The final topic in the last two and a half minutes is service coordination agencies. The government is hell-bent on setting up these 40 service coordination agencies. I guess the discussion we want to have -- and I plan on inviting quite a few members of public health boards to appear before the committee and try to convince the government that it shouldn't be setting up new bureaucracies, it shouldn't be setting up -- I'm sorry?

Hon Mr Wildman: Not.

Hon Evelyn Gigantes (Minister of Housing): Not.

Mr Jim Wilson: I'll allow a little humour to come in here, Mr Speaker. I know they're getting antsy because I'm going on longer than I planned.

But the point is that I keep being told by the Simcoe county public health unit, for instance, that anything these agencies are to do, they can do and can do better and there won't be duplication. If they would just be allowed to expand their mandate, or in fact fulfil the mandate some of them have, they could do a lot of the things Bill 101 envisions for service coordination agencies and there wouldn't be need to set up more bureaucracy. If you want coordination, if you're worried about a conflict of interest between those who deliver the services and others, you can work that out within the existing system.

I think there are still a lot of questions out there from public health units, where they exist in the province, about what their role is going to be, and they have a lot of questions concerning why the government wants to put them out of the business they're in now and replace it with a whole new layer of bureaucracy.

I think there are a lot of good concerns there that haven't been addressed. We've raised them in the past and we haven't received concrete answers from the government. We keep getting superficial answers. We don't see the answers in Bill 10l that we're debating this evening. We were hoping; there was a lot of hope; there was a lot of buildup to the introduction of this legislation. There has been an awful pile of speeches and a lot of paper floated around this place regarding long-term care. Unfortunately, Bill 101 falls short of the mark.

I'll conclude my remarks by simply saying that I hope the government, in the round of public hearings that I believe is to come, will truly listen to the concerns and will put some more meat on the bones of this particular legislation, because to leave it all up to the cabinet, I think, just won't cut in this day and age, and the trust level of the public in this government I don't think will allow it to move ahead with long-term care the way it wants unless we see it in this specific bill.

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The Speaker: I thank the honourable member for Simcoe West for his contribution to the debate. I invite questions and/or comments. The member for Beaches-Woodbine.

Hon Ms Lankin: May I say to the member for Simcoe West that I appreciate his comments on the bill and the questions and concerns he has raised. I think he would have always enjoyed to have an opportunity to have raised something and say: "Minister, will you fix this? Will you respond to it? Will you listen?" I'm going to do it. He asks us not to set up 40 service coordination agencies. Tonight, here in this debate, I'm going to say to you that we will not do that.

Hon Ms Gigantes: Not.

Hon Mr Wildman: Not.

Hon Ms Lankin: There's a little bit of humour in this.

In fact, I think unfortunately the research that has been provided for the speakers on the Conservative benches has been a little bit out of date, because consistently they have stood up and they have talked about this very point.

I say to the member that no, we didn't just change the name. If you look at the seniors' alliance and its response to the consultation and its demands for a different kind of coordination of service in bringing together agencies, moving away from brokerage to case management, that's in fact what we're doing.

With respect to the issue of what seniors pay for, I hope the member will look carefully at this, because there are currently seniors in the system who are paying $90 a day. It's an extraordinary amount, and they will be brought down to a maximum amount being paid of $37 a day. That's very reasonable when you think if it's going to be based on income. You spoke about a member of your family who received Gains. Any senior receiving Gains would only be paying something in the range of $24 to $26 a day. So really, it is geared to the income the senior has.

If I could indicate, currently seniors are also paying copayments, user fees, whatever, out there on nursing services and personal care services, and we're eliminating that. The only thing they will pay for is accommodation costs, and I think most people think it is reasonable that you pay for accommodation. You would in your own home; you do in the nursing home.

There are a number of other points I would like to respond to, but I'll have the opportunity to do that directly with the member and during committee hearings.

The Speaker: Further questions and/or comments. The member for Wellington.

Mr Arnott: I'm very pleased to rise to commend my colleague the member for Simcoe West for his fine presentation at this late hour. I would just like to add a few comments to the debate.

I've listened to the Minister of Health and her response. I thought it would be a cold day in Hades when you'd see an NDP government bringing in user fees and talking about increases -- it doesn't matter what sort of care -- for senior citizens. It's unbelievable. User fees are what it is, and we find the government will refuse, and consistently refuses, to address them and call them what they really are.

In my particular election campaign in 1990 I remember reading the press releases that came from our party leader's office. When he was asked about user fees, he was honest about it. He said, "Yes, we'll have to look at user fees, because the health care system at present is underfunded." Of course, we find that the NDP government has maintained user fees during the course of the last couple of years, and we find and we suspect that there will be continued user fee increases in the coming years.

I would just like to add that comment to the debate and, once again, I would like to commend the member for Simcoe West for his fine participation this evening.

The Speaker: Further questions and/or comments.

Hon Mr Wildman: We've heard all we can take.

The Speaker: Be that as it may, questions or comments? No. The member for Simcoe West then has up to two minutes for his response.

Mr Jim Wilson: I appreciate the minister setting the record straight. She's not setting up a service coordination agency; she's now setting up multiservice organizations. Sleight of hand, I'd say.

The NDP claims it is making the user fee system in nursing homes more fair, and that most seniors will pay less. If most seniors are going to pay less, then how does the government get a net increase in new money from seniors of $150 million over the term of the plan? How does that equate? I don't know.

I also want to say that, really, these user fees -- it's hypocritical of this party, the government, to be doing this. That's more our point, because I recall in the campaign, and I know the Liberal members will recall, that especially in the last couple of weeks of the campaign in 1990, the NDP party around this province, at least in ridings that I'm aware of, dropped pamphlets into our seniors' apartment buildings saying that Mike Harris was going to increase user fees on seniors and take away their medicare and do this, that and the other thing -- all things that we had no intention of doing. We were trying to be honest about the debate about user fees. And these people now introduce $150 million in user fees and have the gall to say that somehow that's fairer to seniors, with no discussion with seniors at all. I find this reeks of hypocrisy, and if you ever try to run a campaign with halos in this area again, no one's ever going to believe you. No one's ever going to believe you. Your credibility with the seniors community is shot.

The Speaker: Further debate? The member for Mississauga North.

Mr Offer: I'm pleased to join in this debate on what, without question, I think all members will recognize as a very important area.

As I've indicated some of the times when I've had the opportunity of responding in the two-minute speeches, I think it's an area which does affect all members in this Legislature, certainly, and not only as MPPs. I would hazard a guess that there are many members who have friends or family with either seniors who require care or indeed children and just individuals who are mentally challenged in some way. So this is a matter not just of being an MPP and not just of bringing the thoughts and opinions of their constituents to this floor, but in many ways of a much more personal nature.

Having said that, I do believe that all members of this Legislature, and specifically the government side, will listen to the comments of members opposite, because it comes not just from their role as an MPP -- members of the government will quickly cast those comments as "opposition" -- but in fact carries with it a certain experience where one has relatives and friends who may fall within this particular piece of legislation.

For me, I bring my thoughts to this floor as a result of discussions I have had with constituents and certainly with an organization in my riding called Community Living Mississauga. I believe there are a number of members in this Legislature who have had some discussions with organizations such as Community Living Mississauga, if not Community Living Mississauga itself -- the work that it has done for the community in the past number of years and the work that it hopes to do in the future.

Of course, a bill of this kind is very important to an organization such as Community Living Mississauga, which is an organization that, and I read from their pamphlet, "actively promotes the full acceptance and participation of people with intellectual handicaps." It was established in 1955 by a group of parents who wanted their children to remain at home in their community rather than live in an institution.

Here, more than 30 years later, we see in many ways the principles of Community Living Mississauga being carried out throughout the province. I know that there are a number of organizations such as Community Living Mississauga, which have worked for many, many years to do that. So I speak not just from their perspective but really from the opportunity that I've had of speaking with them, as well as the opportunity of speaking with parents and others who truly have a rare human interest in this area.

I must say to the Minister of Health, as she is in the Legislature on this particular bill, that at first instance I do have a concern with the legislation. I speak not so much of the substance of the legislation, but rather to an issue other members have brought forward, and that is to the immense areas that are covered by regulation.

I think we all recognize, as members of the Legislature, that pieces of legislation, of necessity, carry with them the regulatory mechanisms. I know there are people who are probably watching TV and saying: "What is that regulatory mechanism? What is it the member is speaking about?"

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I think we recognize that each piece of legislation requires regulations to give it some flesh on the bone. But I think there is a certain line that one crosses where the regulations are not just the flesh on the bone but rather attempt to be the bone itself, the framework itself. I believe, personally, that's a mistake. I believe that when you cross that line, you leave to regulation what should be addressed in legislation.

I think this bill could really address some of the regulatory aspects in legislative form. We know that is important. Firstly, it's important because it gives a certain sense of security or certainty as to what the legislation is and what the legislation hopes to be and how the legislation will attempt to meet its goals. Secondly, it makes it imperative that if there is to be any change to this area it will be done, and must be done, by amendments such as we have here. What does that mean but rather a sense of accountability?

I don't mean to be critical, but the fact is that I think we all have a role as members, and that is to debate pieces of legislation that come before the Legislature, to give our thoughts and opinions and those of our constituents to pieces of legislation. When it's done by regulation, we don't have that opportunity. It's done by a stroke of the pen through cabinet. I don't believe that is helpful to many organizations which really do depend on that sense of accountability, the sense of public participation in any changes to legislation.

I've gone through the legislation and I must say I was taken aback by some of the intense areas that are going to be addressed through regulation. I would certainly hope that the minister and the ministry staff would look at the real possibility of moving some of that regulatory area into legislation and have it in a way that all members can comment in a real fashion. There is just hardly any comment that can be made, except in principle, to the issue of regulation.

The next areas that I want to discuss -- I want to leave some time for my colleague the member for Brampton South -- are a couple of areas which concern me and concern some of the constituents in my riding. We will know that there is an issue of respite care. We know that parents particularly need regular periods of relief from the daily challenges of being parents, but for parents with children who are physically or mentally challenged, this is an absolute necessity.

I don't want to spend too much time in the area, not because I don't want to but because I just don't have that time in this debate. But I think we have to recognize that many of us -- I guess, certainly from my perspective -- many parents have said that there is an absolute need for an increase in the respite care service that is currently being provided. I have not seen this in the long-term care in Bill 101. That bothers me, I must say, because I think it's an absolute and necessary component.

I think we've heard, in some of the debate from members, that parents of children who are under some disability have been visited by parents who require this sense of respite care, of relief, of help, and it has not been forthcoming and in fact is being cut back. This causes a great stress and strain, as we all will know, in the families. We know this will cause difficulties in the family as to coping, meeting the particular challenges that have to be met, not just from parents but from brothers and sisters. So I indicate that this is an area that concerns me and an area I believe is lacking in this legislation.

Another area which has, again, been spoken to by other members, but I want to also bring this forward, is this issue of profit and non-profit or not-for-profit service. It is the goal, I understand, in this legislation that the for-profit is going to be reduced dramatically within a very short period of time. Some may say, "Well, that sounds pretty good." I don't believe so and it's not because I criticize one side or the other; I don't believe that's where the debate rests.

I believe we all want there to be a certain level of care in either sector, whether it's profit or not-for-profit, and if we can, through legislation, make certain that level of care is there, one sector is not better than the other. I believe that both sides can exist, that both can meet the needs of the people of the province. If it be the choice of individuals that they wish to take part in a profit service, then so be it. I believe this will help those who don't have that choice and will allow a certain freeing up of others to avail themselves of services in the not-for-profit sector.

I think our attention should be drawn to whether there is an adequate level of care. That should be always the driving force, in my opinion, of legislators. It should not be to drive one sector out, but rather to make certain that if both are to exist they must provide a minimum, acceptable, satisfactory level of care.

Hon Mr Wildman: This is the same argument that was made about medicare in the 1960s.

Mr Offer: The Minister of Natural Resources interjects, saying this was an argument made in the 1960s. The minister will be aware that in fact it's an argument that's been made in the 1990s. It's an argument that's been made not only in this area, but with respect to day care spaces. The question we have is, are we going to permit choice? Are we going to make certain that in this area there is a minimum, acceptable, satisfactory level of care? That is, to me, the role of legislators, and for us to say we are going to eliminate one side when we know full well in this Legislature, in this day, that there will not be the takeup in the not-for-profit, that there will be an impact, without any question, as a result of a move of this kind, then we must ask ourselves, is this the proper approach to take? I do not believe it is and so I have concerns about that area.

2340

I certainly do have concerns about this legislation as to how it affects our seniors population. Much has been said in that area. I certainly do agree with many of the comments made by my colleagues, but notwithstanding, I believe it is an area we must specifically address. We all recognize that the demographics of our population are that more people are getting older, that there are going to be more people over the age of 65 in a very short period of time than ever before.

That is going to continue, and as a result there are going to be new challenges to many different areas of service in this province. This will be one of them and we have to make certain that the framework is there to meet not only the challenges of today, of December 1992, but also of the next century. I believe that is something we have an opportunity of forming in its framework. If we don't do that, we miss an important opportunity and, I believe, set back some of the goals and hopes and aspirations of many in the area of long-term care.

There is another area I want to touch upon, and it is an area which is not in the bill. I've read the bill a couple of times and I'm not absolutely certain why. This is in the area of transportation.

For me it's an important area, because as we move to allow people to be part of their community for their whole lives, as we make our buildings and our shopping centres and what not accessible, we must think about how we get those who may be physically challenged to those buildings and malls which we have made accessible, whether it's access to the areas or the washroom facilities. I think there is a lot that can be done in the area of transportation.

I have received telephone calls. I've received many comments and concerns about young people who have some sort of physical disability who are going to school who are very much dependent upon when they can be picked up, and there is not a great certainty as to the pickup. There is an attempt to be certain as to the pickup, but sometimes that fails.

We hope and strive that individuals who are physically challenged will go shopping, will go to the malls, will go to work, will go to school, and we have and continue to build accessible facilities, but now we are left with the fact of how we get the individuals from their homes to those facilities with a certain degree of certainty. I believe that is an important aspect of this whole area, and it's one I have not seen.

There may be others who say, "It really isn't part of this legislation." To that, I say I disagree. I think it is part of this legislation. It is an important area. I think we cannot carve out transportation from one area, because it is an important aspect in the area of long-term care. People will be responsible, in an increasing way, for their own affairs, and they will be able to meet their own challenges and demands.

We want to put those structures in place to allow that to happen, and I believe there will be a great deal of discussion over those particular areas. But one of those areas is in the area of transportation, and for me that is one which has been brought to my attention by constituents who require the use of vehicles for those with certain physical disabilities. I believe that a piece of legislation should come to grips with that particular need. It may very well be a question of dollars. I think there is the need for the government to come to meet the challenges those dollars require.

There has been a fair discussion in the Legislature, I believe, in this area this evening, and one of the things I can't leave without making comment on is that for some, they look upon this area as some sort of political exercise. We've heard some comments about that during the evening, and I believe that to be very wrong. I think we are here expressing our opinions. I believe our opinions are in large measure based on some of the comments we've heard either through constituents or in my area through groups such as Community Living Mississauga.

They have done a remarkable job for our community over many years and they hope to be able to continue that. They recognize the challenges that families have to meet and they recognize their own challenges. They express to me the concerns about respite care specifically as well as others. They recognize that there is a need to allow families to have relief. That is an absolute necessity. It is necessary for the parents and it is necessary for the brothers and sisters, and they are concerned that those types of services are on the wane. For them and for others in other communities, they look upon that as a large challenge.

Just last week there was a day when many people from associations such as Community Living came to this Legislature, not just the associations but also some of the parents and some of the children, and I don't believe there was a member here who was not moved by some of the concerns.

But I also recognize that this is not just a matter of an MPP; it is a matter where many members know of these issues either at first hand or through family and friends, and they take that extra sense into a debate such as this.

I have indicated my concerns about this legislation. I have indicated my concerns that so much of this legislation is left to regulation. I believe it has passed that line, that it has gone beyond what is most permissible by regulation and is attempting in certain areas, in crucial areas, to do by regulation what it will not do by legislation.

That, to me, is a serious error because it takes away the rights of all, not just within this Legislature but groups such as Community Living, to comment on any changes. So I stress to the minister that they should be relooking at the areas that have been addressed in the regulatory area and see if that can be moved over.

I stress once more the concern I have had, as well as others, that there is a striking need for an increase in the area of respite care, and I recognize it is not just the Minister of Health but also the Minister of Community and Social Services who has carriage in that matter. We know this has a very large effect on families in each particular riding.

I stress thirdly the area of not discounting the importance of the for-profit sector, and it's not because it is for-profit but rather because it is a sector which does provide the service, and certainly does so in a way which I believe easily meets the needs of the people it serves in a way that the not-for-profit does also. It's not a question of whether one is better or another; that's not the issue. The issue is service, the issue is choice and, if both systems can live in one province, then so be it. I believe the citizens of the province are better off for it.

I recognize that my time in this debate is coming to an end, but I do stress to the ministers here are some of the concerns I have, not only with the areas that the bill does address but in a way with the areas that the bill does not address, areas such as transportation, respite care, matters which I think just transcend one particular ministry but rather are ones which are common to all.

I certainly do expect that this is going to be an important debate. I believe it's a debate which is important to all members and I believe it is one which the public hearing process must address. The areas just must be addressed through the public hearing process. Certainly groups such as Community Living Mississauga, I believe, will have invaluable contributions to make in order to address what I see as some of the concerns with the legislation which I have attempted to delineate in the short time available this evening.

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The Speaker: I thank the honourable member for Mississauga North for his contribution to the debate and invite questions and/or comments. Further debate?

Hon Marion Boyd (Minister of Community and Social Services): As one of the three ministers responsible for the long-term care legislation, I'm very pleased to have an opportunity to speak tonight to some of the issues that have been raised by our colleagues across the floor around Bill 101.

I'm pleased that both the Minister of Health and the Minister of Citizenship have been here to hear the debate tonight and to be aware of some of the concerns that our colleagues have, because I certainly agree with the Minister of Health that we expect the debate in front of committee to be a very fruitful one and one in which we can deal with many of the issues that have been raised in a forum that includes some of the very parties that the opposition members have expressed such concern about in this chamber.

There are a number of specific issues that I wish to address tonight about Bill 101 because, as the members opposite keep reminding us, everything is not in this bill. But then everything was not intended to be in this bill. This bill has some very specific direction, and it is a direction around the kind of funding options, the kind of funding formula that will prevail in terms of long-term care in nursing homes, in charitable homes for the aged, in municipal homes.

One other piece that is very important to me as Minister of Community and Social Services is the part of the bill that enables us to flow funding to individuals or to others, including agencies, on behalf of those who wish to live independently and who wish to purchase their own services.

Members opposite have indicated that, although we had certainly indicated our willingness to offer pilot projects that would enable this kind of independent care regime to apply, in fact we have not come forward with those pilot projects. There's a very good reason for that. We did not have the legislative authority to do so. The part of the bill that I am so excited about in this aspect is that we will be enabled under the changes to the Ministry of Community and Social Services Act to flow funds to individuals so that they are able to provide their own decision-making about their care, to purchase their own care in a way that is appropriate to them.

Many of the members opposite have talked about their own constituents who have talked to them about their concerns about this bill. I think all of us in this chamber have had constituents who have had an abiding interest in the issues of long-term care. I certainly have, and I have four constituents in particular -- Peter, Tannis, Bonnie and Steve -- who come to see me regularly in their wheelchairs and lobby me vigorously around having independent care.

These are very able people who require certain services in order to maintain themselves within the community, and they are very clear about the very important empowerment that's involved in this legislation. As I stand and speak to you tonight about it, their faces are very clear in my mind and their voices are very loud in my ear, as they have often been in terms of their legitimate demands for this kind of permissive legislation.

One of the exciting things we have seen in the developments over the past year has been programs like the attendant care outreach program and the special services at home program, which has been mentioned several times by members opposite, programs that have developed to meet those special needs of families and individuals within the community to enable them to live more independently.

These have been extraordinary successful programs. They have proven to even the most sceptical that there are ways in which we can provide care that were not dreamed of years ago, when we thought the only way we could care appropriately for people was to shut them up in institutions far away from their community, their family, their friends, their pets. We have come a long way since that time.

We have been led in that by the many courageous people who have varying forms of disabilities, who have reached their senior years and who have demonstrated to us that they can maintain their wellness and their vigour within the community in a much more successful way than they could when they were, may I say, incarcerated, in some cases, in facilities.

Some of the members opposite have claimed that this government has not listened to those people. They have claimed that in fact what we have brought forward is what was in our original consultation paper around the redirection of long-term care, and it is true that there are many aspects that are similar to the consultation paper. But after meeting with over 3,000 different groups, about 75,000 people, we certainly heard very strongly the need to change some of those directions to meet the real needs within the community, and we have done so.

I think it's important for us to put on the record very clearly that we have been so greatly assisted by the clarity of those who have varying forms of physical disabilities about why their needs differ from seniors and how they wish to be treated, what their priorities are in the redirection of long-term care; and similarly for seniors, whose interests are maintaining wellness, maintaining their position within the community and still having the security of knowing that if the time should come when they are no longer able or willing to live within the community in their own homes, there will be a place for them. We have listened to them.

What we are attempting to do in our long-term care redirection is to meet all those needs. But we're not meeting all those needs in Bill 101. We're only taking the first steps in terms of reaching the level-of-care funding that we promised would be a major beginning base for this new way of providing services; that we would be looking at those mechanisms and beginning there, so that indeed we can make more equitable the provision of that type of care.

We will have the ability now to start pilot projects to enable people to have individualized care, and we will be able to use the experience we all gain through those pilot projects to be sure that we can design programs in such a way as to maintain the safety and the security of individuals while we are enabling them to care for themselves in a very effective way.

One of the major complaints that my friends across the way have had is that this bill does not cover all people, and that's true. The direction of long-term care has very specifically been, ever since it came up in the previous government's lifetime, directed at the needs of seniors and the physically disabled. Quite specifically excluded from consideration under the previous government were the needs of the developmentally challenged, because they had a program of their own called the Multi-Year Plan.

I happen to agree with much that has been said by our opposition friends about the necessity to fold in the care of the developmentally challenged with the long-term care program in time, and there is no question but that there are enabling factors within this legislation that will lead us to that point in the fullness of time. But in the meantime it's important for us to move as carefully and as slowly as we can to ensure that we are creating for seniors and for the physically challenged what they expected out of this legislation.

Those who are developmentally challenged and their families and their friends are very specific about not wanting any possibility of moving their care back into the medical system. In the 1970s that was a move away from medicalization and a real view that in fact being developmentally challenged was not a medical issue at all.

You're getting anxious, Mr Speaker.

The Speaker: No. Indeed, I was quite enjoying the speech, but I wondered if this might be an appropriate place to break your remarks as it is 12 of the clock.

Hon Mrs Boyd: As long as I can complete when we resume debate.

The Speaker: I think your place will be held. It being 12 of the clock, this House stands adjourned until 1:30 of the clock later today.

The House adjourned at 0002.