Wednesday 17 February 1993

Long Term Care Statute Law Amendment Act, 1993, Bill 101

Leamington Mennonite Home and Apartments

Jean Marie Drummond, administrator

Villa Maria Home for the Aged

John Malette, vice-chair elect, governing board

George Leaman, assistant executive director

Sandwich Community Health Centre Inc

Isabel Cimolino, executive director

Beth Piet, seniors' programmer

Windsor-Essex County Community Planning Council--Persons with Physical


Taras Rohatyn, executive director

Windsor and District Labour Council Labour Advisory Committee

Ken Brown, co-chair

Persons United for Self-Help (Windsor and Essex County)

Joan Cowie, president

Parkwood Manor

Robert Moreton, administrator

Judy Zieske, fund-raising development officer

Ontario Advisory Council on Disability Issues

Dr Shirley R. Van Hoof, chairman

Persons United for Self-Help (Southwestern Region)

Bonnie Quesenel, chairman

John Moran, board member and member, para transit advisory committee

Victorian Order of Nurses, Grey-Bruce Branch

Catherine Goetz-Perry, executive director

IC Funding Financial Corp

Donald Stevens, executive vice-president and chief operating officer

London Regional Psychological Association

Dr Edward Helmes, representative

Fairview Mennonite Home

Bob Weber, treasurer

Tim Kennel, administrator

Thames Valley Placement Coordination Service

June Payne, director

Royal Canadian Legion

Ed Neil, provincial service officer


*Chair / Président: Beer, Charles (York North/-Nord L)

*Acting Chair / Présidente suppléante: Fawcett, Joan M. (Northumberland L)

Vice-Chair / Vice-Président: Daigeler, Hans (Nepean L)

Drainville, Dennis (Victoria-Haliburton ND)

Martin, Tony (Sault Ste Marie ND)

Mathyssen, Irene (Middlesex ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Owens, Stephen (Scarborough Centre ND)

*White, Drummond (Durham Centre ND)

Wilson, Gary (Kingston and The Islands/Kingston et Les Îles ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

Witmer, Elizabeth (Waterloo North/-Nord PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Caplan, Elinor (Oriole L) for Mr Daigeler

Carter, Jenny (Peterborough ND) for Mrs Mathyssen

Hope, Randy R. (Chatham-Kent ND) for Mr Drainville

Jackson, Cameron (Burlington South/-Sud PC) for Mrs Witmer

Jamison, Norm (Norfolk ND) for Mr Gary Wilson

Lessard, Wayne (Windsor-Walkerville ND) for Mr Gary Wilson

O'Connor, Larry (Durham-York ND) for Mr Owens

Wessenger, Paul (Simcoe Centre ND) for Mr Martin

Also taking part / Autres participants et participantes:

Cunningham, Dianne (London North/-Nord PC)

Quirt, Geoffrey, acting executive director, joint long term care division, Ministry of Health and Ministry of Community and Social Services

Wessenger, Paul, parliamentary assistant to the Minister of Health

Clerk / Greffier: Arnott, Douglas

Staff / Personnel: Drummond, Alison, research officer,

Legislative Research Service

The committee met at 0904 in the Cleary International Centre, Windsor.


Consideration 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 Chair (Mrs Joan Fawcett): I would like to begin the hearings of the standing committee on social development. We are dealing with Bill 101, An Act to amend certain Acts concerning Long Term Care.


The Acting Chair: I'd like to welcome everybody here this morning, and because we would like to keep as tight to the schedule as possible, could we have the Leamington Mennonite Home and Apartments representatives come forward, please. Take your seats at the table and welcome, and maybe you could identify yourselves.

Mrs Jean Marie Drummond: I'm Jean Marie Drummond. I'm the administrator at the Leamington Mennonite Home and Apartments in Leamington.

The Acting Chair: Welcome. You may begin.

Mrs Drummond: Thank you. Welcome to the sun parlour. I know you didn't have to travel as far as I did on our county roads today.

I appreciate the opportunity to come before you to give my concerns as an administrator and the concerns of my board of management of our home and apartments regarding Bill 101. We fully support your bill, by the way. It's long overdue for change in the long-term care system.

I just want to give you a little bit of background about my home so you understand where we're coming from. Our home is a home for the aged. It was built in 1965 by four United Mennonite churches. The churches in the Mennonite community, which is a large community in the Leamington area, fully support and assist in the operation of our home. We have 72 beds and approximately 54% of our residents are of the United Mennonite religion and over 80% of our residents speak German. The administrator doesn't. Even though she's taking lessons, it's nicht gut.

Our meals, programs, services are all influenced by the German culture and the Mennonite religion. We have a very strong religious influence in our home, something that for many persons is the very reason they seek entry into our home. We also have a continuum of care, 54 apartments, 27 town houses and 43 condominiums, all for the elderly, all onsite, and many services go to them from our home.

We're a community. We encourage independence, which is right in line with what you're doing, and we assist them to stay in their own apartment/town house for as long as possible by helping them get the community services that are so badly needed and providing some of the services right from our home. It's a natural progression and many times, no matter how much community/home support we give, institutionalization will always be there. They will have to eventually come to our home.

One of the concerns we have is choice. Our home is very privileged, I think, in our county. We're known for our Christian influence and our very good nursing care, and when I ask people why they want to come to our home, that's why. So as you can see, I get many Mennonite and non-Mennonite applying. We're in very, very high demand and because of the unique linguistic characteristic of our home, the German-speaking community in the county, and indeed two counties -- Kent county -- seek to get into our home. Our community call it "our home."

We'd like to see the legislation strengthened in the aspect of choice, to be made a bit more explicit. My people are very frightened, as is our board, the whole Mennonite community and the four churches, that they will want to come into their home and they won't be able to get in, that they will be sent to another home.

There's a lot to leave at stake with PCS. I have met with them. I get along very well with them. We have an extremely good working relationship and we haven't run into problems, but this is too important for us to leave on an informal, friendly-type basis as far as getting people into our home and having their choice recognized is concerned.

Along the line of choice -- something I ran into just yesterday -- we need to look at couples. I have several on my list and I have one I'm working with now. In many cases, only one of the couple requires institutionalization. The remaining spouse, under the new legislation, probably will not fit the definition of "extended care," "continuing care," or "long-term care," whatever you want, to come into our home. The last thing I want to do is break up a 65-year-old marriage, and I have many of those.

I'm working with a 98-year-old to come into my home. He has to. His 96-year-old wife is quite healthy and can manage very well in an apartment and does not meet any of the current requirements to come into the home. I could bring her in as residential -- I'm still a home for the aged -- but under the new legislation, she wouldn't be able to come. I really think this needs to be addressed. I see a lot of it. The choice has to be available to them.


In working with the elderly and trying to keep them in their apartments, we notice that in many cases -- I see it a lot; perhaps it's the unique culture of my people -- they really can't cope with a lot of outsiders coming into their home. I've had many come to me and say: "That's it. I've got to come in." I've got six people coming in. I don't want them in. I arranged for VON support or whatever. No, they don't want it. They want to come into the home. They're done. They've made up their minds.

Again, we need some explicit wording on the choice, to make sure they have that choice. Maybe they don't want home care. They don't want to be in their home. They'd rather come to the home and get that holistic care under one roof. I see that a lot in my experience in our home.

Our second concern relates to admissions and choice, but again it's the home's choice. I've seen the draft grounds for refusal, three of them. I come from a long background of acute care and, believe me, those kinds of people on ventilators, epidural anaesthesia and with need for on-site surgery wouldn't even be on an acute floor. They would probably be in an ICU. That needs a lot of work.

The home needs to have some choice too. There's an awful lot of leeway currently in these draft standards that I have seen. There are many reasons why I believe a home can legitimately be able to refuse an admission. It's imperative, and we are doing it. We do our own pre-admission assessment. We have the papers from the VON, and they're right on, but you've got to look at that person, talk to him, talk to his family and see how the fit is going to be. This is an important fit, because we're not talking about a two-week stay with us or even a two-month one. It could work out to a three-year or longer stay, and that fit's very important.

There are many things about our home -- our physical environment, the way the home is laid out, indeed the very bed that is available -- that can affect whether or not a certain person, whether it be their problems or whatever, should indeed come into our home. I urge a very quick appeal process for the home should the opportunity occur that probably the person is not suitable for a particular home.

The one other concern my board and I have is the proposed system of inspections. Again, coming from acute care, I guess I'm not used to such rigorous inspection put right into legislation. I am very used to accountability, though, and I take that accountability and most of my peers in the homes as well take this accountability very seriously.

I tend to look at the accreditation system, and I would like the committee or whatever to look at your inspection proposals vis-à-vis this accreditation. It's almost a doubling of effort. I'd rather see you make accreditation mandatory than have another system piled on top of it. The standards set by accreditation would indeed ensure a very good level of quality of life and care to the people in our homes, and I only see superimposing a second system as producing a larger bureaucracy. My board call it red tape.

As I say, I do favour accountability, but I'm afraid of the duplication. It can be cumbersome and it can be costly, costly for our ministry and very costly to the homes as well. So I really would encourage you to look at that. There are other methods of ensuring accountability, and inspections need to be rethought.

Lastly, as an administrator, if I didn't hint at funding, the rest of them would probably hang me. I'd like to see there be a link between funding and quality of care. If we are obligated to provide a certain level of care, please ensure somehow, somewhere the funding is put in for us.

The greatest example I see now is that of staff education. It's been years since my staff have seen an IV, let alone feeding tubes that soon, we understand, will be commonplace in homes. We're not afraid of it but we have to plan ongoing, continuing education and that is a very costly venture, especially for a home like ours and other homes indeed. It will be costly. I know Bill 101 addresses staff education in a very minor way, but we'd like to see funding attached.

We are a non-profit, charitable home. We belong to the Ontario Association of Non-Profit Homes and Services for Seniors; I'm sure you've been bombarded by the OANHSS people. I encourage you to listen to their concerns, as they do speak for us and we do support them. That's all I have. I thank you very much for listening to me.

The Acting Chair: Thank you very much for your presentation. You've hit on a number of points, I'm sure they've sparked some questions and I hope you will stay to answer a few questions if the committee has some.

Mrs Drummond: That would be fine.

The Acting Chair: Thank you. Mr Wessenger first.

Mr Paul Wessenger (Simcoe Centre): Thank you very much for your presentation. With respect to the matter of consumer choice, I'd just like to assure you that it's certainly an underlying principle with respect to the whole question of health care reform, that consumer choice underlie that aspect. Certainly it's the intention with respect to this legislation that consumer choice be recognized in the whole process of placement. I mean, it's an underlying principle. I'd just like to assure you of that, and certainly we are looking to see if there is any way we can make it clearer.

With respect to the matter of the point you raise concerning staff education, certainly expenditures on staff education will be recognized as a legitimate expenditure with respect to the funding formula. I just wanted to assure you on that.

With respect to the question of inspection, I'd just like to ask you the first question. Under the existing system, do you have any problem with the way the compliance system works with respect to your home?

Mrs Drummond: We have the compliance system within the homes for the aged. I have no problem with that. I guess we don't have inspectors coming in and some of what I guess I see as red tape. I think it's very important that the local ministry office, the regional office and its program supervisors work very closely with the homes. That's very important. We've enjoyed that at our home, so I am very comfortable with that.

Mr Wessenger: Yes, because I understand the intention is to continue that process of working on a consultative approach to try to improve quality management.

Mrs Drummond: I would hope so. In reading some of the draft standards I had some doubts -- I guess the very words "inspection" and "inspectors" and I have visions of rafts of people. It's quite a bureaucracy to inspect.

Mr Wessenger: I think unfortunately sometimes legislation creates the wrong impressions.

Mrs Drummond: I would hope so. I'm comfortable with our consultative process that we have currently in the home.

Mr Wessenger: I'm assured that is certainly the way the process is going to continue as it is with respect to trying to work with the homes on a consultative --

Mrs Drummond: Good, thank you. That's very important.

Mr Wessenger: The last point is that I'm very pleased to hear you have this sort of situation of your seniors' apartments and your home for the aged on one -- because I think that's an excellent combination. I just want to ask you, have you considered perhaps applying for supportive housing with respect to your additional --

Mrs Drummond: Yes, I just started working last week with our area office to do some work on starting a needs assessment and getting the whole ball rolling for that.

Mr Wessenger: I think that would help with respect to your couple situation. If you had that supportive housing, it would allow greater flexibility in meeting --

Mrs Drummond: We would hope so. We're going for that. As I say, with our continuum again in the choice, it's very natural. If they've lived with us for 10 years, they don't want to go to another home; ours they're used to. They're spending much of their time there with our activities, our church services, so they expect the continuum. They don't even dream of going anywhere else and that's where the choice really comes in for my people on this continuum.


The Acting Chair: Mr Hope, just very quickly.

Mr Randy R. Hope (Chatham-Kent): I know in the Leamington-Wheatley area, around the Mennonite community itself, there are different cultural aspects and some are still stuck with the old traditional and some are moving in the more advanced. How are you coping with that as far as what you're trying to do?

Mrs Drummond: Most of my Mennonites are of the United Mennonite faith. The other group that is in our area is the Old Colony Mennonite, the Mexican Mennonite group. Coping with it is really no problem. They want to come to our home for the religious aspects, and really their religion is very different from the United Mennonite, and the language. Even though they speak Plattdeutsch, my staff understand it and quite a few of my Mennonite residents understand Low German versus High German. I have three in now, and maybe another four on my urgent list. There hasn't been a big push from that particular group at this time, and maybe there are some other ramifications that we aren't aware of with our experience.

Mr Hope: I was just curious because I've dealt with the community itself on that whole issue.

Mrs Drummond: Yes. It's mainly the German and the cultural. Our food is very similar to many of the dishes they are already familiar with.

Mrs Elinor Caplan (Oriole): Thank you for an excellent presentation. The themes of concerns that you have regarding choice, the lack of multicultural sensitivity in this piece of legislation and your concerns about the adversarial inspection model the bill contains are something that we've heard from a number of deputants.

You've heard some, I think, assuring words from the parliamentary assistant. While that's all well and good, I'd like to suggest that you can't take Hansard to court with you when you're dealing with legislation. Because Bill 101 will become a law and it will be interpreted ultimately within the courts if there are problems, hopefully we'll have amendments put forward by either the government or the opposition parties to deal with precisely the kinds of concerns that you have.

I'd like to ask you a couple of questions on the kinds of amendments you'd like to see to this legislation that would give you comfort that your concerns have been addressed. I guess one is on the area of choice. Would you like to see an amendment in this legislation that required in the admission criteria or the assessment process the multicultural sensitivity or religious requirements of the applicant?

Mrs Drummond: Definitely.

Mrs Caplan: The second was on the issue of couples, that it also, perhaps as part of the assessment criteria, look at the needs of families or couples to remain together.

Mrs Drummond: Definitely.

Mrs Caplan: On the accountability question, the inspection question, I've heard you say that you'd like to see an amendment that would make mandatory accreditation.

Mrs Drummond: I know that philosophy of accreditation is a voluntary thing and I'm very familiar with the accreditation system. But, yes, don't reinvent the wheel.

Mrs Caplan: Would it be an accreditation of both management and program?

Mrs Drummond: It should be, yes.

Mrs Caplan: As well you talked about -- perhaps you didn't; it might have been someone else. Rather than the inspection model with inspectors and that sort of labour-management adversarial kind of model, perhaps based on an outmoded ideology, the suggestion has been that you would make mandatory a kind of quality management or continuous improvement program in the statute.

Mrs Drummond: That, to me, is an expectation as an administrator. To me, the adversarial system of inspections is far outdated.

Mrs Caplan: You'd be comfortable with an amendment that required that kind of continuous improvement approach to quality built in by statute as a program requirement.

Mrs Drummond: Yes.

Mrs Caplan: Again, I hope we will see some of these things either brought forward by the government or accepted by the government as they are proposed by the opposition because, as I said, you can't take the Hansard to court on good intentions. Lawmaking is not about good intentions; it's about what the law actually will say. I appreciate your coming forward and I appreciate your advice.

Mrs Drummond: Thank you very much.

Mr Jim Wilson (Simcoe West): Thank you, Mrs Drummond, for an excellent presentation. I won't repeat what my colleagues have said in terms of summarizing some of the points you made. I just want to clarify. You've seen the draft manual with regard to the very limited circumstances in which a facility can refuse a placement. In layman's terms I would say, in looking at the four criteria, that they're just very medical, and you said in your presentation that in fact these people would belong in a hospital ward.

Mrs Drummond: Oh, definitely.

Mr Jim Wilson: I gather you're implying that the ministry is certainly aware that the grounds for refusal, as outlined in the draft manual, would effectively not give a right of refusal to the facilities. Would that be your opinion?

Mrs Drummond: That's what I would like to have, the right of refusal, some choice.

Mr Jim Wilson: On what grounds should we give a facility that right?

Mrs Drummond: Oh, boy, I could sit down and work on it with you. You have to be in the home, to understand the flavour of the home. As I say, even your physical environment -- homes are all built differently, the type of people you have in your home. There must be a fit. I would hate to see such a thing abused that you pick and choose for other means than proper good quality care for the person coming in. You should never take anybody in if you cannot give them the care they deserve to have. Then it's up to the administrator or whomever to prove why they can't do it. And, please, we are professionals. We are highly accountable for every bit of care given in our home. If, for instance, I felt I could not give the care, I would sit down with whomever it was and explain my reasons. I would hope they'd be agreed with. That's the kind of choice we need.

Mr Jim Wilson: So we have to try and ensure that the opinion and professional view of the administrator is taken into account through the placement service.

Mrs Drummond: Yes.

Mr Jim Wilson: Okay, that could be a little difficult to draft into legalese.

Mrs Drummond: I know. As I say, it's too important an issue to be black and white. I guess when I read it over and saw the exemptions I thought, what if my grandfather was still here -- and he was raised with a horse and buggy -- and two days right after the horse and buggy came the Concorde. When you look at it now what we're allowed to care for -- I mean, no oxygen or other things and all of a sudden we're going to get everything but. That's time warp.

Mr Jim Wilson: Yes, especially if you say the staff haven't had the opportunity for training for many years.

Mrs Drummond: No, they haven't.

Mr Jim Wilson: In fact I got a letter from a constituent of mine. The operator of her nursing home -- actually, no, the home had just been taken over by the municipality so it became a charitable home for the aged or a municipal home for the aged -- had made it very clear that staff will have to pay for their own training. At least that was what was expressed and I brought it to this committee at the first opportunity.

Mrs Drummond: Scary.

Mr Jim Wilson: It is scary and in the long run it'll be the residents that suffer in terms of not receiving quality of care, if you get more than the Hansard assurance that there will be some funding available to upgrade staff skills. Just as Mrs Caplan said, it's difficult to take Hansard to court although the court does look at the intention of legislation, but you'll spend a couple of years doing that.

Mrs Drummond: A lot of intentions lost, or what is paved with good intentions.

Mr Jim Wilson: The court also takes into consideration the credibility of the government giving those intentions. I just thought we'd get things lively this morning.

Mr Hope: Past practice must have proved it, right?

Mrs Drummond: I guess many things in your legislation are very explicit, but some of the other things are too valuable and too important to leave to informal systems or intentions. So if certain things are going to be explicit, I think other things really need to be developed.


Mr Jim Wilson: Just in summary, we share your concerns, because so much is left up to the regulations, and of course regulations are made behind closed doors and through the cabinet process.

Mrs Drummond: Yes.

Mr Jim Wilson: We'll take your concerns into account and try to introduce amendments to help you out.

Mrs Drummond: I appreciate it.

The Acting Chair: The staff would like to clarify something.

Mr Wessenger: I'd like to have some clarification because I think perhaps it may be an incorrect impression that I'm giving to you with respect to one item. I'll ask staff to clarify that.

Mr Geoffrey Quirt: On the issue of the reasons a facility could have to refuse admission, I think you referred to four examples of particular treatments that appear in the program manual. Those were four examples of procedures that would not happen in any nursing home or home for the aged in the province. The attempt was made to clarify the scope of the nursing program that should be available in nursing homes and homes for the aged. Those were four examples of things that we're not expecting would ever happen in a nursing home or home for the aged.

In terms of the scope of the nursing program that we had hoped to deliver, the rule of thumb or our guideline is that we'd like to see the same range of services available in a nursing home and a home for the aged that a visiting nurse now can do in a person's own home. That's our guideline.

Mrs Drummond: I'm sorry, Geoff. You're saying that our scope of practice of nursing in our homes will be the same as what they're able to give in the community?

Mr Quirt: Yes. Things like intravenous pain control, in-dwelling catheters or pressurized oxygen are all things that it is possible to deliver in people's own homes through good PCS.

Mrs Drummond: Good. I would expect too that there will be things that we can do in our home that they can't do in the community.

Mr Quirt: Yes. We'd be happy to see you do that, but I was simply pointing out that our expectation is not that all of a sudden nursing homes and homes for the aged become acute care hospitals. What we're trying to do is catch up to the progress that's taking place in nursing with the technology and so on, progress that our legislation and policy hasn't kept pace with.

The reasons that will be prescribed in regulation that a home can have for refusing an admission would be practical reasons similar to the reasons you've alluded to this morning. For example, if a resident were to need a particular service or therapy that the home staff were yet to be trained in or couldn't provide, that would be a legitimate reason why a home could refuse admission.

Another example might be that a resident had a cognitive impairment and needed a special environment, a secure environment perhaps, and the home wasn't prepared to provide that. It's certainly our hope, and I suspect your experience would bear this out, that our placement coordinators would not refer somebody who couldn't be appropriately cared for and that the placement coordinator would understand what the facility could provide.

Mrs Drummond: First, I would hope so. We're fortunate. We have a good PSC and I work well with them, but that may not be true in all cases. We can't use that experience. Again, with the examples, I'm sorry, but with my 20-some-odd years in acute care, the examples given are not to me appropriate because you would not find those things on an acute care floor of a hospital. Ventilators? The training required, that's an ICU nurse's job. You're talking epidural anaesthesia; again, a delegated medical act.

Those are examples that might be more appropriate in acute care legislation to say that these are the kinds of things the nurse won't see on the normal floor, let alone in our homes, which are still back in the ages of no oxygen, and catheters send people into orbit. Those are common nursing procedures. Again, it explains how outdated some of our current standards and things are, but as I say, let's not go from the horse and buggy to the Concorde, especially in legislation.

The Acting Chair: Mr Wilson and then Mrs Caplan. Very briefly, please, because we're over time now.

Mr Jim Wilson: I'm just wondering if Mr Quirt -- I appreciate his comments, but what if through the process of give and take in drafting the service agreements over the years, the government sort of notches up each time what services and level of care and medical procedures are to be done in that home? I think there's some suspicion out there that with the closure of hospital beds and people moving out of the hospital sector, they have to go somewhere and that, yes, at some point our homes may be required to give a level of care that's currently being done in the hospital and probably more appropriately should be done in a hospital setting. At the same time, the funding isn't adequately flowing to the nursing homes to keep up with Big Brother's expectations of what they should be doing.

I sort of see a cycle, a worry here in terms of you've got service agreements. If they're breached, you're in trouble. What if you can't meet your service agreements because the funding isn't assured?

Mr Wessenger: Do you want me to --

Mr Quirt: It's up to you.

Mr Wessenger: Perhaps I'll start out and let Geoff add. My perception would be that when you negotiate a service agreement, you're looking at the existing services that can be provided in an institution. It is a negotiated agreement between the ministry and the institution. Of course, in any negotiation, obviously the salient points are going to be raised by the institution about what services can be delivered and which ones can't. I'm just looking at it purely as a lawyer, from a legal point of view, and it would seem to me that since it is a negotiated agreement and the service requirements are set out in the schedules to the agreement, they're negotiable.

It would not make sense to impose on an institution a requirement to provide services it's not equipped to do. That's just general. I'll see if Geoff wants --

Mr Jim Wilson: Just to quickly add to that --

The Acting Chair: You asked for one question.

Mr Jim Wilson: What if the placement coordinator has people on his list who really need care that's currently being done in the hospital? Isn't that putting pressure on the homes that must accept these residents for levels of care that they perhaps can't provide? We know that the annual reviews are some time later, and the funding may not catch up, that sort of thing.

Mr Wessenger: I'll let staff just add to it.

Mr Quirt: I think you've raised a very good point there. Certainly, if placement coordinators have people on their list who require hospital care, that's the facility to which they should refer that resident.

We have a bit of problem in Ontario now, a bit of an embarrassing problem, in that sometimes placement coordinators have people on their list and they have two choices: If they need pressurized oxygen or catheter care, they can send the client to a hospital to get that service, or they can send the client home to his or her own bedroom. They can't send them to a nursing home and home for the aged. We've been criticized in Ontario for the fact that you can get more sophisticated nursing care in your living room than you can in any nursing home or home for the aged.

That's the problem we're trying to address by catching up to what's possible on a visitation basis in health care delivery in the community, so that each of our homes for the aged and nursing homes can meet that standard. The message we get back from qualified nurses in our nursing homes and homes for the aged is that they're quite able to do what their colleagues do in the community.

The Acting Chair: Ms Caplan, could you put your question, and then perhaps it can be answered so that we can get on with the next --

Mrs Caplan: Yes, one question, because it is supplementary to the discussion that we've been having: On your question of the reasons for refusal, would you be more comfortable if there was an amendment to this legislation that said the institutions or the nursing home, the long-term care facility, whatever, had the right to refuse admission on the grounds that they were not able to provide appropriate care, and then by regulation "appropriate care" could be defined, which would allow keeping up with new technologies and changes and so forth, but it would be very clear that you would then be able to make your case and that that would also then be able to be appealed?

Mrs Drummond: Yes, that right is very important, and I have no problem with an appeal process for that.

Mrs Caplan: So you'd like to see an amendment to the legislation along those lines?

Mrs Drummond: Yes.


The Acting Chair: I thank you very much. You've obviously sparked a lot of comments and questions and I thank you for your presentation.

Mrs Drummond: Thank you, and good luck.

Mrs Caplan: So will you do it?

Mr Wessenger: I think we all have to remember that we have to get our best legal advice.

Mr Hope: You must have had a lot of sleep last night, Elinor. You're right on the ball this morning.

Mr Jim Wilson: Could I just ask a point of clarification while we're waiting for the next presenter? I appreciate Mr Quirt's comments in clarifying for myself and the public what the intention is, but I guess my problem is, and it's more to the parliamentary assistant, that in my experience in my own area we're getting fewer RNs in the home; they're having to cut back. There is a ratio that's required, but I've an aunt who's the head of nursing in a particular home for the aged in my riding and she's having to supervise more and more aides, as it were. The problem is, I think, that the current trend, with fewer and fewer RNs in the home, flies in the face of what this legislation is trying to do. How is the government reconciling that?

The Acting Chair: I would like you to take that under consideration, please, and answer that at some other time.

Mrs Yvonne O'Neill (Ottawa-Rideau): That is a very important question. Let's not forget that.

Mr Jim Wilson: We're supposed to inquire about things. We are not robots.

The Acting Chair: I'm sure they will take it under consideration and provide an answer.

Mr Hope: We have a week of clause-by-clause.

Mr Jim Wilson: That is not what clause-by-clause is for.


The Acting Chair: The next group is the Villa Maria Home for the Aged representatives, if they would come forward, please. Welcome to the committee. I would ask you to make your presentation now. Identify yourselves, please, for Hansard.

Mr John Malette: Thank you very much. I wish to thank the committee for allowing me to make this presentation here this morning. We're all very busy --

Mr Wayne Lessard (Windsor-Walkerville): Would you introduce yourselves?

Mr Malette: That's in my report. I'm going to get to that shortly.

My name is John Malette and with me is Mr George Leaman, administrator of the Villa Maria Home for the Aged. I am at present the vice-chairperson elect for the Religious Hospitallers of St Joseph Health Centre of Windsor which includes Hotel-Dieu Hospital and Villa Maria Home for the Aged. I am also the vice-chairman of the long-term care committee of that board. I have served on the latter committee for four years now.

I first became interested in assisting at the Villa when some of my family members were admitted as residents. I offered my services four years ago, and fortunately for myself I became involved. I have no medical training to speak of. I am merely an interested and concerned citizen of this community and province.

Hotel Dieu Hospital in Windsor operates 57 chronic care beds. Villa Maria operates 129 beds, of which 57 are extended care and 63 residential care. Of the 63 residential care residents, 14 have extended care certificates. Our budget for Villa Maria is just over $3 million at present with the residents paying approximately 62% of these expenses.

The home has offered residential services for seniors since 1944 and from our present structure since 1956. Although we have attempted to modernize the design of this building, unfortunately it does not optimally serve the disabilities of today's frail elderly.

My brief presentation this morning will raise several points regarding Bill 101 under three main headings: (1) choice, (2) governance and (3) funding.

First, choice: We welcome the consistencies that will flow from a single placement coordination service. For some time now we have enjoyed this service under the capable leadership of the Victorian Order of Nurses. They control the master waiting list, but each of the facilities maintains its own list. In accordance with the new legislation, it does not appear that we will be permitted to do so post-Bill 101. The VON presently provides this excellent placement service for nursing homes, homes for the aged and rest homes within our community.

We currently have no details, but it would appear that the consumer may not be admitted to the facility of his or her first choice. Consequently, we wonder if the system can be developed and implemented where choice would carry a high weighting value on the criteria list. Also, if the placement officer recommends admission other than the client's first choice, could that decision be appealed?

We are a Roman Catholic-owned facility in a community that has a high proportion of members of that faith. Consequently, we therefore are a popular choice among seniors, and we anticipate that this will continue. We're asking you, can the element of choice be accommodated?

From a facility point of view, Bill 101 is not clear on an appeal process should we not agree with the placement decision. Under a case-mix index system, it is extremely important that we maintain a consistent mix of light-, medium- and heavy-care residents. Since the funding matches the CMI review only yearly, this mix becomes pivotal to our existence. We must be able to appeal decisions.

In regard to governance, Bill 101 makes very little reference to our boards. If some of the accountability principles from the accreditation process could be incorporated into Bill 101, the inspection format could be significantly minimized. A local community board, as is ours, has a built-in accountability factor through our bylaws and committee structure. In fact, we recently convened a board retreat and some of our attention focused on the issue of public accountability. We are going to address many of these issues in the months to come.

In the for-profit nursing homes, the same accountability could be accomplished with the use of community advisory councils. We also refer to the board's built-in ability to monitor quality assurance programs. At Villa Maria we have embarked on a formal, continuous quality improvement program with the health centre. Such programs are formally tracked by a quality assurance risk management committee of the board. Rather than have inspectors monitor this action, simply legislate it into the board's responsibilities. The villa will also be surveyed and receive accreditation from the Canadian Council on Health Facilities Accreditation.

The bureaucratic inspection system, in our estimation, carries a high dollar cost, which we feel should be spent on direct care. The whole concept of inspection, in our opinion, carries a negative connotation. Early in a section of the draft program and services manual, the writer states, "A service agreement benefits all three parties that have an interest in it, when both the provider and the government focus on the spirit and intent of the agreement." The writer then goes on to state what the provider may do, shall do, shall not do, will submit, will retain, shall adhere, will not assign, and when the provider does not, the government will impose sanctions. He then includes in the indemnification clause that, "The provider will indemnify and save harmless Ontario from all costs, losses, damages, judgements," and on and on.

It's our opinion that the province is forcing facilities such as ours to be fully accountable for our actions or lack thereof, but province fails to accept any responsibility. Yet they are the body that wrote the standards they cannot necessarily match with funding.


This brings us to category 3, funding. We recognize the government's current economic position, and we realize the implications for its citizens. We only hope that the government realizes our plight. For the past 10 years we have principally operated within our means, even when we at Villa Maria had a disproportionate number of extended care residents in our care, where we received only residential funding. We have enjoyed small surpluses and small deficits except in recent years, when there were significant arbitrated wage wars. We have attempted to adhere to the general budgeting guidelines imposed by our government. We are not extravagant but pay a competitive wage for our industry. Villa Maria tends to the needs of the whole person: social, emotional and spiritual as well as the basic nursing and nutritional needs.

The government must be constantly aware that with the emphasis on in-home support services, more pressure will be exerted on facility-based care for persons who are currently in chronic units. Unless there's a lot more money available to us than we think, the standards in the draft copy of the program and services manual seem unattainable. It calls for additional professional staff such as a social worker, registered dietitian, a licensed food supervisor daily, licensed occupational therapist or physical therapist, a staff educator and, in our case, a doubling of our current housekeeping staff. Until our case mix index is known, the nursing staff patterns are also unknown, but we fear that standard may be excessive as well.

Much to our surprise, the Workers' Compensation Board recently informed us unilaterally and without consultation that we will now be responsible for the premiums for students in training and possibly also volunteers.

Finally, capital funding that is fair to both the for-profit and the non-profit sectors must be clarified. A partial source should be a clearly defined preferred-accommodation clause inserted in the regulations.

In conclusion, ladies and gentlemen, we have an opportunity now to correct past funding inadequacies to the long-term care industry. Minister Lankin has expressed on numerous occasions, as have other MPPs and ministry staff, that we are designing a system to meet the care needs of the client. We strongly suggest that the standards you are establishing cannot be met with a per diem of $90. If you truly want the needs of the frail elderly met, you must reallocate additional resources to our industry. I can assure you of one thing: If the government provides funding to meet the actual costs of care, Villa Maria will commit to meeting the government's minimum standards and more. We can do it.

This concludes our presentation. I wish to thank the committee for its attentiveness and would be pleased to answer any questions you may have.

The Acting Chair: Thank you very much. We'll begin the questioning with Mrs O'Neill.

Mrs O'Neill: Thank you very much for a very practical brief. You've brought the details to the surface, and I think that's very helpful. The program service manual you've examined very closely. I find that very helpful. If you could go to the bottom of your page 3, could you say to us a little bit about how you think some of that wording could be improved? What would be more realistic? We've heard from other individuals, certainly, that the expectations that are created here in the community are not going to be able to be met with the supports, particularly the monetary supports, that seem to be accompanying this policy direction, so could you say a little bit more about how you could change some of that?

Mr Malette: Certainly Mr Leaman would like to answer that question.

Mr George Leaman: We agree with the intent, where we should use more professionals. We're just not convinced that the funding is matching those standards. I guess what we also fear is that after the province writes those standards, it will not accept any responsibility. We will be responsible for matching the service agreement and we don't know how we can do that with the standards written the way they are.

How they could be changed -- I must admit that we didn't sit down and try to rewrite the service agreement, but the "shall dos" and "shall not dos" are really imposing, to us.

The Acting Chair: Okay, Mrs Caplan, do you have --

Mrs Caplan: Yes, you heard the questions that I had of the previous presentation. Is there any comment that you'd want to make on the suggested amendments that I discussed in the area of both the ability of the long-term care facility to say it was not an appropriate placement, or an alternative approach to what we've heard as an outdated adversarial inspection mode and in its place an accreditation and a mandate to the board to ensure that there is a continuous improvement program within the institution? Do you have any comment on those proposals and on multicultural sensitivity?

Mr Leaman: I guess what we would like to see is an appeal process that is real, not vague. As far as the quality assurance, we have embarked, as we said in our remarks, on a formal program and tied into accreditation. I agree that if there's some legislation to force us to meet those accreditation standards, then that might be the easiest way of accomplishing so-called inspections.

Mr Malette: When we look at the continuous quality improvement program that we have, and as a board member and just as a member of the community here, I know that we examine those extensively at our monthly board meetings and we're provided with charts and information and surveys that have been circulated to people who have utilized our services, and we look very closely at those and they're monitored very closely.

It's developed into a sense of pride, I think, for our administrators and also for board members to see that higher levels are being attained and we can pinpoint precisely where there are inadequacies. If we see there are some specific inadequacies I, as a board member, can say, "Are there specific problems we're encountering here?" or "What can be done to correct these problems that are occurring?"

Mrs Caplan: What I've heard you say is that that is a much better approach and that mandating that as a board responsibility or as a responsibility of a long-term care facility would yield a better outcome or result than the old-fashioned adversarial inspection model.

Mr Malette: Personally, I feel strongly about that. There is a sense of pride to see, as I expressed, among board members and among administrators to attain high levels.

The Acting Chair: Thank you, Mrs Caplan. I think we have to move on. Mr Wilson.

Mr Jim Wilson: My thanks to both of you for appearing today and in particular, John, to you for volunteering your time. As vice-chair of the board, you are to be commended. It's a sign of good citizenship.

Mr Malette: Thank you very much.

Mr Jim Wilson: A couple of practical questions. One is, you talk about the additional bureaucratic hardships that could be imposed on the home and the cost of the envisioned inspection system. Can you give us some practical examples of where costs might increase to your home?

Mr Leaman: I'm not sure we're suggesting that the cost to the home would increase. It would be a cost to the system as a whole. All the dollars from that inspection process could be diverted into the homes for direct care.

Mr Malette: I think that was the thrust of our presentation in that regard. We're looking at some allocation of funds bureaucraticwise that would fall within the province's budget as opposed to our specific home and being contained within our home.

Mr Jim Wilson: None the less --

Mr Malette: We'd be soliciting moneys allocated to our home as opposed to having an inspector.

Mr Jim Wilson: So any time there's more bureaucracy, obviously there's less money for the actual care in the home.

Mr Malette: Basically, that was our feeling; that was an opinion we expressed.

Mr Jim Wilson: Along that same line, and this may be equally difficult to give a practical example of, but when you talk about the government forcing facilities to be more accountable but the way the legislation is worded it doesn't appear that the government wants to take any responsibility once it sets the standards, can you give us a better feel for what that might mean?


Mr Leaman: Again, going back to the previous presenter and also to Geoff where he talks about catheters and so on, that does carry a cost factor in professional staff. I guess our fear is that it's written in the standards and then not backed up with funding. We'd be more than happy to take care of people in those circumstances but it's got to be properly funded and it's not my feeling that $90 is going to cut it.

Mr Malette: As I was expressing earlier, as a community member, I feel that we are more or less partners and that there are responsibilities that fall on both sides of the partnership and that we would like to receive adequate funding.

In the past, at the villa we have had a number of extended care patients that we received residential funding for and there is a tremendous cost associated with having these people in our residence. Through our efficiencies and through the efforts of the sisters we were able to provide an excellent service, even though in my opinion we weren't receiving adequate compensation or funding from the province for these individuals.

Mr Jim Wilson: Just one quick question. I get the sense from your brief that you feel that with all the new rules coming in, the board's future role will be simply trying to keep up with all the points and shalls and shall-nots in the manual, and perhaps this will take away some of the flexibility and innovation that volunteer board members bring to their role. There must have been discussion along those lines among your board members. How do they feel about all this?

Mr Malette: Just to keep up with the ongoing changes and the developments as a board member is extremely difficult. The whole system seems to be evolving very rapidly and to be imposed upon us with additional requirements. It's a greater burden for us, but I know that as George has expressed as an administrator, he feels it will be quite difficult to adhere to a number of the requirements that are being imposed on us. I don't know if George has anything further to add to that.

Mr Leaman: No.

Mr Jim Wilson: Yes, we've heard that from various other groups.

The Acting Chair: Mr Lessard, you're the next questioner.

Mr Lessard: Thank you, Mr Malette. You indicated that you're the vice-chair elect?

Mr Malette: I believe so.

Mr Lessard: I want to wish you the best of luck as you continue your rise up the board at the Villa Maria, and thank you for taking the time to make the presentation here as well. I know that you also operate a small business as well as being a member of the board.

I wanted to address the concerns that you'd indicated about choice. The previous presenter mentioned that as well and the parliamentary assistant to the Minister of Health, Mr Wessenger, addressed some comments with respect to the weighting of choice. However, I wanted to ask you about the master waiting list and the good experience here in Windsor that we've heard from other people, about how the Victorian Order of Nurses is involved in that. Have there ever been any times that you're aware of that there have been any difficulties between the lists that the VON keeps and the ones that you might keep at the home?

Mr Malette: I'm not aware personally. The only exposure I've had to the Victorian Order of Nurses has been very positive. I know they are aware of many of the needs within the community and also many of the needs that exist within the homes and how the homes are managed here within our city.

Mr Lessard: I guess my question is: Do you think it's really going to be a disadvantage if in fact you aren't able to maintain your own list at the home?

Mr Leaman: No, not with our experience with the VON.

Mr Lessard: Okay, and I'd like to ask the parliamentary assistant whether he can confirm whether they would be able to maintain their own list when this legislation came into effect or not.

Mr Wessenger: No, the whole placement process is that the placement coordination system will assign the question of eligibility first of all and then determine the question of priority, although, as you indicated, consumer choice is very much a part and a basic principle of this system. I think maybe staff might like to add something too.

Mr Quirt: Yes. The placement coordinator would be required to keep a list for each facility because, as Mr Wessenger mentioned, the first job is to determine whether people are eligible through a process that involves making sure they're making an informed choice and know about what's possible in the community.

The second job is to find out which facility the resident prefers and the resident then could indicate a first choice or second choice, and the resident's name would appear on both lists for those two facilities. The placement coordinator's job is then to determine, of all the people who have expressed a particular preference, their first preference to get into that facility, which potential admission requires the service the most, and that's the person who would be referred to the facility. In other words, the placement coordinator has to keep a list specific to each facility because the people get to pick which facility they'd like to be considered for.

The Acting Chair: In the few minutes remaining to your party, would you like to continue?

Mr Wessenger: Yes. I'd just like to ask one question. I noted you're very critical of the inspection process, but what I'd just like to ask you is, do you feel that residents and families will feel assured that the standards of care are being safeguarded if we assigned by legislation the responsibility for ensuring good care without any government inspection process whatsoever? Is that what you're advocating?

Mr Malette: Absolutely. I'm quite confident that I feel very comfortable with our presentation and that the public can feel confident that we're adhering to the standards that are being suggested and imposed on us.

Mr Wessenger: I would suggest to you that families of residents expect the government to have a strong role in ensuring appropriate and safe standards of care and also to ensure the taxpayers' money is being used in the best way possible.

The Acting Chair: I thank you very much for your presentation, and we will take your remarks under consideration when we are deliberating. Thank you for appearing.

Mr Malette: Thank you very much.


The Acting Chair: The next group is the Sandwich Community Health Centre Inc. Welcome to the committee. I'd ask that you identify yourselves, please, and begin your presentation.

Ms Isabel Cimolino: Thank you. I'm Isabel Cimolino and I'm the executive director of the Sandwich Community Health Centre. With me is Beth Piet, our seniors programmer at the health centre.

Our presentation is taking a slightly different approach in that we are not an organization governed by legislative authority, so consequently the amendments in Bill 101, I think, are best left to those individuals so operating, but as a community health centre and one of an organization of community health centres within the province we do have some information to share with you, and indirectly, some of the contents of Bill 101 are addressed through that particular process.

What we wanted to share with you today was the results of a survey in which 24 community health centres in the province participated with respect to the role of CHCs, community health centres, within the long-term care system and, at the same time, have Beth speak to you about the experience at the Sandwich Community Health Centre.

What we did not include in the brief was a description of the Sandwich Community Health Centre and what we are. That information was made available to a Toronto office and is certainly there, should anyone wish to do that. Without further ado, I will address or highlight some of the contents in the brief that you have in front of you.

I do have one apology. We did have a little bit of problem with snow the other day and consequently the brief was typed by a young woman on placement from St Clair College who did not notice my bottom instruction, "Would you tell the computer to number the pages?" Consequently, the pages are not numbered and I do apologize for that. But the best-laid schemes, you know.

Mr Hope: As long as you don't go over 10, we're okay. Eh, Elinor?

Mrs Caplan: No. We have five fingers and five toes.


The Acting Chair: I think we'd like to listen to the presenters. Thank you.

Ms Cimolino: Community health centres are community-based organizations, and consequently the role that each plays within its community is different because it is based upon the community it serves. We all have different staffing and different budgets with which to work, but certainly our orientation is that we are responsive to community needs and issues. We collaborate with other agencies, and one of the things that we seem to do quite well is that we're proactive in helping communities gain the knowledge to make choices around issues which impact upon them, and one of the examples of that is the consultation around long-term care. At this point I would ask Beth to describe that experience to the committee.


Ms Beth Piet: Thank you. According to the 1986 census, the number of seniors 54 and better within the catchment area of the Sandwich Community Health Centre, which approximates the boundaries of Olde Sandwich Towne in the city of Windsor or census tracts 009/010, is 24.6% of our total population, compared with 21.8% for the city of Windsor. So we have a slightly higher number of seniors in our area.

When the community health centre opened in September 1989, I discovered there were five groups already of seniors meeting on a regular basis; two of those groups were tenants' associations and the other three were either church-based or social groups. I established a working relationship with these groups, exchanging information and ideas and establishing programs with them to meet their needs.

One thing that became clear was that these groups had little or no connection with each other and most had no knowledge that the others existed or what their purpose was. This was an incredible situation, given that the majority have strong ties with the town of Sandwich, either having been born and raised there or having lived their adult lives there. I subsequently contacted the leaders of the groups and invited them and one other group member to a meeting to discuss common issues and to decide whether meeting on a regular basis would be beneficial to them.

There was strong support at that first meeting to form this coalition of leaders. One lady even commented at the end of the meeting that no one had ever even invited them to sit around the same table and that she was very grateful.

The group has named itself the Olde Sandwich Towne Senior Advisory Council and we meet bimonthly. The groups share information. They've joined each other's groups. They plan outings together. They hosted last August, on one of the only sunny days we had, the first annual Sandwich seniors' picnic and a summer evening concert in our town gazebo. They actually picketed against increased bus fares in the city of Windsor and conceptualized and supported the opening of the Olde Sandwich Towne Seniors' Centre. This opened on January 8 and our seniors' centre is the third centre under the umbrella of the Greater Windsor Senior Citizens' Centres Association and is open on a trial basis one day a week for six months. The centre has been open five Fridays to date and has received overwhelming support from the seniors.

Another indication of the confidence of the seniors in our area in our health centre is that a $5,000 donation was given to the local Windsor Public Library board through myself from one of the seniors of Sandwich to be used in establishing a library in Olde Sandwich Towne. This lady didn't know how to go about donating the money and knew that we would be able to support her and go about it in the correct fashion.

The local seniors not only have been empowered to act as a group but have established a trust in the staff of the Sandwich Community Health Centre.

On two occasions, when an important issue has arisen where community input is critical, we have organized a town hall meeting. One such occasion was to discuss the feasibility of a seniors' centre in Olde Sandwich Towne; the other was a long-term care consultation meeting in March 1992. Some 39 seniors attended the town hall meeting.

At the meeting many familiar issues were identified. I'm sure you've heard all of them. Examples were inadequate care giver relief, fear of inadequate community-based services and fear of poor post-operative support in the home.

Perhaps the most unique issue raised was that the seniors in our catchment area stated that they want to maintain or expand their relationship with the Sandwich Community Health Centre. At that time the service coordination agency concept was being highlighted and they liked the concept, but they wanted to keep the relationship close with the health centre.

They told us that they've established a trust in the health centre. They receive safe -- and that word came up a few times -- personal care and they know when they contact us that their needs will be met either through us or on a referral basis because of our close relationship working with other agencies.

Ms Cimolino: Thank you, Beth. I will now go on with the rest of the highlights of the community health centre process of the 24 health centres.

CHCs generally agree with the intent of the LTC strategies. They have the potential to enhance and complement our present work in the community and they are consistent with our philosophy of care. They would strengthen existing support services, offer more accessible respite care for care givers, recognize and enhance both community development and health promotion work. However, there are always question marks raised when anything's going on. Of concern is that during the shift from institution to community care, there is some fear that some things simply won't be there, and resources is one of them.

As far as the general community is concerned, this survey recognized the following:

-- More resources for home support services and to offer practical assistance to seniors and the disabled. They give examples of housing, modification of homes, financial help, social support and so on. They are listed there and I certainly don't believe I necessarily have to read them all.

-- Encouragement and support should be provided to individual families and communities so they have options -- choice, whatever way you want to say it; it all means the same thing in the end -- and can make choices in order to take more control over what is happening to them and to their communities.

-- Echoed everywhere: more training for professionals and other agency workers to meet new demands and more complex health problems in the community. Also going along with that would be the requirement for public education and community development strategies targeting the physically and mentally disabled seniors, the families, volunteers and so on.

With respect to community health centres -- and that's what should be there instead of the "general community"; I guess we had another little gremlin in there -- this would depend on the community health centre itself and the role the community, along with the health centre, determined it should be doing in that particular community. So some of the things listed there are the demand for services, what can we do with resources already established and what the capacity of the centre actually is.

During the consultation process the following concerns were expressed:

Community-based services must be in place and adequate before the institutional downsizing actually occurs. They're mainly thinking of hospitals here. Before these things occur, we better be ready in the community and not face the problems encountered by the mental health individuals back in the 1960s and 1970s, where it was a wonderful idea, but there were problems. We just weren't ready and we want to be ready.

Some of things they're saying: There's already an apparent decrease in acute, chronic and respite care, but they don't seem to see alternative resources there. This is happening in some of the communities the community health centres are serving. They want to make sure the funds are reallocated into the community. If you're going to save money through closing a hospital, then hopefully that money will go back into the community for retraining of staff and for helping staff in the transition from institutional care in hospital, where the RNs may go from there to a senior citizens' home where these nursing things are required of them.

The rights of seniors and the disabled or families must be respected. We felt that in all of this LTC process the role of the consumer was unclear. We do not need a huge administrative structure that cannot be sensitive and responsive to the community. I don't think anybody wants any more bureaucracies with which to deal. They felt some sort of system could be devised to ensure that we do not have this massive structure with which to deal. They mention that they remember the lessons of the psychiatric deinstitutionalization, and we simply do not want to find ourselves in that same situation.

Funding as an issue was not necessarily addressed in the question, but underlying most of the responses, it became clear that funding certainly was an issue. Again, harping on financial support for government strategies, they must be there, they must be in place if this is indeed to be effective.


The CHCs, because of the way we function anyway, certainly stress the importance of planning as an effective way of managing finances, and collaboration between community agencies and other institutions, because there's absolutely no other way we can function without an institution. But we have to be able to do so in a cooperative way, collaboratively, and in some sort of partnership to ensure that the needs of the people we serve are in fact served.

Regardless of the type of system which emerges, there were some things that the community health centres saw as being extremely important for such a system. These are a system which is community-driven, with representation on planning and other committees from consumer and service providers; a system which is flexible, one central number perhaps to call for available services; a culturally and linguistically sensitive system; a system sensitive to each client's individual needs and choices, both from a social and medical perspective; a system with skilled workers in all aspects of service delivery, from entry into the system through assessment, planning for care, service delivery and special events or crises; a system that is accessible; a system that ensures that complaints can be aired and dealt with effectively; a system that facilitates collaboration, cooperation and communication between community agencies and institutions; a system that is geographically appropriate; and a system which provides quick response in crisis.

Attached to this is a photocopy of what the procedures for CHCs in the Ontario long-term care system were, and then broadly stating that they look at planning as an area in which we can be of assistance; assisting in the transition to community-based services; working with the long-term care system -- you're looking at opportunities for service provision and linkages between institutions and other community organizations, because we readily realize this is not something that can be done in isolation; looking at resolving issues; identifying community issues, trends and gaps in services; advocacy -- we all advocate for our clients and we can certainly see community health centres working along with other community agencies in there; linkages for clients, for community; health promotion; community development -- this is particularly something that community health centres undertake and appear to do very successfully; and the actual provision of services, a wide variety of services in our individual communities, depending on the needs of the community.

In conclusion, the community health centre philosophy of community participation and a broad view of health allows us to look at health issues from a unique perspective and to enter into productive partnerships within the community we serve. The makeup of each centre reflects these communities. As a shift to more community-based services occurs in Ontario, we see ourselves playing an integral role, continuing with present services, expanding others and developing new expertise to meet the changing demands. We are meeting this challenge through continued collaboration with other community agencies and institutions and as full members of the long-term care system.

One of the things with respect to the Sandwich Community Health Centre is a Chinese proverb which is a guiding principle in our health centre: "Tell me and I will forget, show me and I will remember, involve me and I will understand." Everything we do within that community health centre has to meet those kind of criteria, because otherwise community health centres will lose that marvellous aspect that they enjoy in a community which simply warms the cockles of this anthropology major's heart.

We have the structural analyses of things, we have functional analyses, but overlooking it is the ethnographic one. If you don't deliver to the community what the community needs, you may as well stop throwing good money away after bad and start over. I think this whole health care reform system process at the moment, of which this LTC is part, is the opportunity to design a system that'll carry us for years and years and years.

I sincerely believe it could be done by looking at what we're doing, changing what isn't working and ensuring that the dollars are there to strengthen those areas that have been identified, both in this brief and I'm sure everywhere you go: staff training, adequate supports in the community and so on and so forth.

I thank the committee for listening to us. I hope we maybe gave you a little bit of contrast to Bill 101 and, as I said, hopefully dealt indirectly, if not directly, with some of the contents of the legislation changes.

The Acting Chair: Thank you very kindly for your extensive brief, and we take your cautions very seriously. I'll begin the questioning with Mr Wilson.

Mr Jim Wilson: Thank you very much for your brief. It sounds to me like you've got your work cut out for you at the CHC, given all the things that you do and that you envision, hope to continue to do and to expand on under long-term care.

Specifically to Bill 101, have you reviewed the placement coordination service as envisioned in Bill 101 and have you given any thought as to how CHC might fit into that? The placement coordinator, more so than now, will be certainly the gatekeeper to the institutional system envisioned through this piece of legislation. I'm just wondering if you've given any thought to that.

Ms Cimolino: I wonder if Beth might wish to answer that. Because she is so much in the community dealing with seniors and other organizations, she might be able to address it better than I.

Ms Piet: PCS is an integral part. We work with them. I'm kind of a dichotomy because I work in the health promotion area but I also work closely with the clinical staff, and that is the group that deals with PCS most closely. In my past, working with the Alzheimer society, I worked with them almost daily, and it's very important to maintain what they do. As Jean Marie Drummond said, we have an excellent PCS here, so I hope we don't become blasé. I expect it to be that good everywhere.

Mr Jim Wilson: Is it in terms of, you get to know the individual senior very, very well --

Ms Piet: That's right.

Mr Jim Wilson: -- and can pass on specific information about the individual to the PCS?

Ms Piet: So you're asking how we work with PCS.

Mr Jim Wilson: I just want to make sure you're not somehow written out of the current system.

Ms Piet: No, no. I don't believe at all that we will be. Our role is that we would make referrals to PCS, and maybe more important, we explain what that is to the clients and the family, the care givers, because they don't know. They've never heard of PCS, most of them, and even if they have, they really don't listen or become that involved unless it directly affects them. So you repeat and you give them the reassurance and refer them to PCS.

In our case most of the time we don't hear again, because it's always taken care of by them. We work closely with them, they call us sometimes about information that can help with a family, and I would hope we can continue to work with them because our clients -- it's a small client base compared to a lot of people. The community trusts us and comes to us with everyday kinds of questions.

Mr Jim Wilson: Do you have a volunteer board structure? Is that how the CHC works?

Ms Piet: Yes.

Mr Jim Wilson: And you have a number of volunteers who help out in the centre?

Ms Cimolino: At the moment our primary volunteer work is done through our board members. We are currently working on a volunteer strategy to involve the community more, although in some of our programs we do enlist the help of people who pass through that particular system.

We're working to develop this more, but we're doing it with the community to ensure that we have volunteers in an area that the community's going to accept, because again, if we don't do that, then we will soon lose the trust of the community that we've worked so hard to build up.

Mr Jim Wilson: I appreciate hearing your comments on volunteers and that you're working towards that, because certainly, as we see more pieces of this long-term care reform come into place, I think we're going to see an increasing need for volunteers at CHCs. Someone's going to have to coordinate all those volunteers in the community, and it could be an area that you could specialize in.


Ms Piet: Could I add something? With the seniors' program, we don't have a formal volunteer system, but when working with the seniors, they come forward and volunteer with me. I can't tell you how many times they've done that. It's usually around a particular program or issue, and they're there. There are many I can call on at a moment's notice. Because they value what we do, they support us 100%.

The Acting Chair: Thank you, Mr Wilson. Now I have three questioners for the New Democratic Party, so I hope you will take that into consideration in your four minutes allotted. Mr Hope.

Mr Hope: Always short and sweet and to the point.

The Acting Chair: Certainly.

Mr Hope: I have two questions. Number one: Do you see the role of the community expanding when March comes around when the discussion paper is out there, and doing workshops and promoting and understanding -- I agree with the philosophy; if you understand and you are part of it, it's better to work with. Do you see your role expanding come March when the discussion paper is released?

The other area I want to talk about, because you talked about the issue of the buses and how they mobilized themselves -- I'm wondering if they're also going to look at that with the North American free trade agreement coming up and being part of that, as we see the federal government trying to erode our social programs through NAFTA and other ways. I'm wondering if you see them playing an active role in trying to destroy or kill NAFTA in itself, as another political motivation.

Mr Jim Wilson: What is the CHC's position on NAFTA?

Ms Cimolino: Our particular community health centre has been dealing with other issues and has not yet got to NAFTA. If the seniors feel this is impacting them and it means erosion in certain areas, then I'm sure many people will come forth.

I think I'll have to see some tangible results of that, unfortunately, and maybe that's leaving it too late. But I think -- seniors power -- seniors are willing to speak. They are excellent advocates on their own behalf. What they simply need is someone to help them along the way.

All I can say is that if they find something that is worthy of their attention, as they did, for instance, through the recent constitutional things -- they got together, wrote letters and that type of thing. So I would say yes, if the role is appropriate for our community, but we will be guided with the community, and that's the way we go. I don't always agree with them, but we work with them because they have said to us this is what they want.

Ms Jenny Carter (Peterborough): I think this was a very refreshing presentation, because of course we are by definition dealing more with the institutional side, but we have to remember that there's this very large component that will be part of the whole picture. Of course, there is something like $400 million that's earmarked to go into the sector. I'm not quite sure when that's going to start appearing, but I hope and believe that it is.

I want to ask you specifically about representation. You talked about representation on the boards and committees that are involved with this whole picture, and I understand that the district health council's going to have long-term care committees which will play a big part here. I'm just wondering what you think would be the ideal representation of the different elements.

Ms Cimolino: Representation on the long-term care system, do you mean?

Ms Carter: Well, as I said, there are going to be these committees, I believe, under the district health committees.

Ms Cimolino: As long as the people at the table are those individuals who are the service providers or recipients of services -- and sometimes that can be the same person -- as long as there is decent representation from the various constituents, which will vary from community to community depending on what's already in the community, as long that representation is there and the opportunity to expand to ensure representation, then I think we're journeying along the right road.

This committee may or may not know that there is a reconfiguration of health care in this city under the auspices of the district health council at the moment. Although the report isn't out, the process was various task forces which actually had all that kind of representation around them. As a cochair of one of these, I was absolutely amazed at the way the groups came together. The physicians, nurses, different hospital employees, various community-based organizations came together and worked very hard and made some very difficult recommendations, even though they would be directly affected, and possibly adversely.

I think as long as the opportunity is there, people are really marvellous in the way they then address the issue they have to do and can somehow step back from personal issues. All I can say is that we have to look at each community, see what is necessary there and ensure that the representation suits the community in which the committee is formed.

Mr Larry O'Connor (Durham-York): I have a question around the PCS and perhaps areas that don't have such integrated PCSs in place as we've seen here. It was pointed out to us in Thunder Bay that they've got a very good system. I'm not totally familiar with the network of CHCs. Do you believe there could be areas of the province that may have CHCs that could help facilitate or work with the government to help somebody develop that placement coordination?

Ms Cimolino: I think there's the opportunity there. When we were approved for funding, there were 18 CHCs. At the time the survey was conducted there were 38 operational CHCs. There are now 49 and possibly another six coming on stream, and they are emerging in areas not only of geographical areas we serve, but maybe linguistic groups like francophones; it could be rural, where it's much broader. So the answer is yes, in many areas there are CHCs that could form an integral part and perhaps even spearhead, depending on the community they're in and depending on what resources are already there.

Mrs O'Neill: I didn't realize you were growing as quickly as you are, according to those figures. Over the last two years I've worked with a community health centre very closely and I just want to say that I think your secrets of success are that you do truly reflect your communities, whether they be the professionals who serve or the people whom you serve. I think your secret also is that you respect the dignity of the individuals you serve. You're constantly in communication with them to see what more you can do for them, how you can do it differently. You're not afraid of being evaluated by the people you serve. I think you are a team of professionals and I think that's the other component that's a secret.

I would encourage you to continue to pursue the volunteer aspect of your work. I think there's a lot of talent there within the seniors themselves and within the people who normally support seniors. Sometimes, though, they need a little push or they need help. They feel the seniors have needs maybe they can't fulfil or they're even frightened of the elderly, and I think once they get their feet wet they sometimes get very sold, and some of these people are very young. Ms Caplan has some questions, I think.

Mrs Caplan: I know you were here for previous presenters and we've heard from the parliamentary assistant. Some of your comments about the government's approach to inspection and the bureaucratic concerns you have for large bureaucracies: Would you support, would you request or suggest, amendments that did the following things as an alternative: for example, an amendment that would require on a mandatory basis accreditation for all long-term care institutions. That's one.

Ms Cimolino: I think accreditation, if we're all working towards the same goal, is a good standardization aspect.

Mrs Caplan: Accreditation of both management and programming results?

Ms Cimolino: Yes.

Mrs Caplan: Second, a mandatory requirement that all long-term care institutions have a quality management program in place to accompany the accreditation requirement.

Ms Cimolino: Yes, if that is needed to support what is going on without overloading. We don't want too much imposed at the local level either. They have to be able to work.

Mrs Caplan: This would be instead of the external inspection with the severe restrictions that you have in place suggested in this legislation.

Ms Cimolino: There's always a place for self-regulation.

Mrs Caplan: Third, then, in order to make it work and empower the residents would be a mandatory residents' council in all long-term care institutions.

Ms Cimolino: I think their voices should be heard and listened to.

Mrs Caplan: The other amendment that we talked about was one when it came to choice, both for the long-term care institution, as well as for the individual client's needs, one that reflected the ability of the long-term care institution to provide appropriate care and to be able to reject on the grounds that they could not provide appropriate care, and second, for the client, the multicultural sensitivities, as well as the care requirement for the client. Would you support those kinds of amendments to the legislation?


Ms Cimolino: There has to be some sort of sensitivity to multiculturalism, linguistic and all the rest of it. It's very difficult. Quite frankly, I have no idea. You're sort of going to have to do it. There's definitely those areas in the province and within communities where to do otherwise -- I think we have to take into consideration and be realistic. For instance, we have to come up with a French-language services program. In our catchment area, 97% of our population is English-speaking and the other 3% don't speak French, yet we are devoting this energy, you know.

I'm just saying to be realistic, and there should be an opting out provision if it's not necessary in the community. We have to get back to the community, and that's why it's so hard to answer the questions that came from there. You're setting the basis here. It has to be in the community and I cannot say what is standard in every community.

Mrs Caplan: When you say there, you're pointing to the government?

Ms Cimolino: No, I'm not talking to the government side. They asked me specific questions and I wasn't able to answer them adequately, I think. But it's simply because we're so community-based and now is the time to lay the groundwork from which all things can spring. I certainly think we have to be realistic, and I cite that example of the French-language question. We do provide services in French, actually, but it's not a main issue with us and it's difficult for us to devote energy to it when there's so much energy needed to go in other places. I wish we could speak Spanish, because that's what we need at the moment.

The Acting Chair: I thank you very much for your presentation. You've certainly brought another view and we appreciate that.

Ms Cimolino: Thank you.

The Acting Chair: I hope you will keep in touch as we go through the rest of our hearings and deliberations.

Ms Cimolino: We will.


The Acting Chair: The next group is the Windsor-Essex County Community Planning Council -- Persons with Physical Disabilities, if the representative would come forward, thank you. Please identify yourself.

Mr Taras Rohatyn: Good morning. My name is Taras Rohatyn and I'm the executive director of the Association for Persons with Physical Disabilities of Windsor and Essex County. I'd like to welcome you to the banana belt, those who haven't been here in a while, and those who came from northern Ontario originally. This is just fairly standard for us, the snow.

I take this opportunity, Madam Chair and members of the standing committee, to present to this committee an abbreviated statement and position paper of the Windsor-Essex County Community Planning Council -- Persons with Physical Disabilities, of which I am the chairperson. The comments are very reflective of my employer at the APPD.

On a short overview of the council itself, on September 27, 1990, consumers with physical disabilities and service providers met, culminating approximately a year's work, with the creation of the community planning council. Membership to the council equally includes persons with physical disabilities and major service providers from Windsor and Essex county. Representatives from the provincial ministries, city and county governments and the United Way have committed to act as resource persons. Significant issues such as this long-term care redirection, accessible and alternative housing, employment opportunities, to name a few issues, have been brought forward for the council's deliberation. The planning council functions as a proactive forum, intending to ensure that the needs of persons with physical disabilities are not only met but that services are of the highest quality and standards in the province.

With the first reading of Bill 101 completed, in conjunction with Bill 43, the health professions act, with the passage of the Advocacy Act, ongoing discussions on employment equity, the creation of the Ontario Training and Adjustment Board and questions on supported employment, the position and the concerns of our community planning council taken during the consultation process must be reaffirmed to this standing committee on social development.

We've taken our approach in four or five different sections and would like to advise you of our comments.

Regarding the proposed new direction, it is generally agreed that the direction proposed in the original consultation documents and subsequent discussions of enhancing, expanding and emphasizing community and support services is not only appropriate but long overdue. However, in general context it was noted and affirmed that there must be an appropriate transition period, ensuring that community support services are in place prior to the contemplated shift from institutional care.

There are two items we wish to address under the heading of this new direction. The council firstly affirms its position and mandate that it is representative of individuals with physical disabilities regardless of their age. The council accepts the position of its children's services representatives, that children with physical disabilities, their care givers and their related programs must be included as an integral part of this redirection process, as their service needs are, for the most part, for their entire lifetime, a true long-term care need.

Comment from one of our consumers indicates: "There must be a distinction recognized by the government between seniors and those with physical disabilities and their care. Many seniors" -- not all but many -- "who are not overly active in the community look for comfortable remainder of life; those with disabilities, especially young adults, look for what they can achieve in life."

Council members stressed that distinctions do not arbitrarily occur in real life when a youth turns 18 or 21. Children with physical disabilities require the same support and programming as adults whether old or younger and cannot be relegated to other specialty legislation. Therefore, the arbitrary position suggested in Bill 101, 16 years of age or older, that long-term care is only for adults with physical disabilities is not accepted by our council.

One of our consumers indicated: "Seniors have more clout with government. We must make the government aware of issues regarding those with physical disabilities" and young adults.

The second general intent under this section indicates that although the majority of our council members were in favour of a decentralization of the system, there were significant concerns regarding the lead involvement and the potential influence of the local district health councils. It was the opinion of many of the council members that community intents and the spirit of involvement may be lost, as social service agencies and individuals with physical disabilities have historically been excluded from the decision-making process in medical model systems.

Regarding family care givers: The community council expresses relief and gratitude that discussions on the needs of family and care givers have finally been recognized, given that these individuals have been the mainstay and the key and integral source of support to persons with physical disabilities. It was agreed, and the council recommends, that more formalized funding for support services for family givers, specific training, education and support groups is necessary.

One of our consumers with disabilities indicates, "It is a good idea for support groups, but some situations, as in my being disabled, working and being a mother with an `able' infant child -- no one, especially in government, I think, understands this situation."

Council members further affirmed that respite services, in-home and onsite, must be expanded to accommodate care giver concerns. Respite services must be available to all with physical disabilities regardless of age. It was suggested that training and support also must be made available to family members to prepare them for the use of the respite service as this situation, the use of the respite alone, might be somewhat traumatic.

Our document further comments -- we don't have the time -- on the need for enhanced transportation, a potential tax incentive for care givers and expanded ADP or assistive devices program guidelines.

Regarding community support services, one of our consumers indicates, "Government is under the impression that one size fits all."

The council unanimously agrees that recognition must be made by all involved that there are significant differences and requirements for persons with physical disabilities and seniors, let alone children with physical disabilities. Members concur that the basic community services such as appropriate transportation, housing, education, employment, attendant and respite care and information and referral services are critical factors to a successful redirection. A concern was expressed that those services may not be in place prior to the evolution of the long-term care direction due to the situation, and future needs and services may be relegated to back burners for want of more recognizable and high-profile statistical services.

The majority of members agreed that generic eligibility criteria are not appropriate given the population groups addressed in this document and that consideration must be made to the significant differences between persons with physical disabilities, meaning young adults and seniors. A further concern of the council dealt with the direction of funding and the implications of fund-raising for program needs.

It was agreed that core services need and require 100% funding and cannot be reliant on community fund-raising to support basic service programming. Fund-raising should only be envisioned for purposes of capital and asset needs.


Regarding health and professional support services, consumers must have a direct say and opinion in what supports they are to receive. I've noted the fact that in Windsor/Essex county there is a significant shortage of professional workers and the council is concerned that levels of funding, given the difficult economic times, will not become available, thereby not being able to address this issue. It is reaffirmed that the support systems must be enhanced and in place during any transitional period.

A further concern was raised by a significant number of members regarding home services and the current variety of worker-level education and employment backgrounds. One comment suggested that with a community-based model, interpersonal skills will become as important as those skills that will be required to maintain an individual in his or her home.

A number of service-provider representatives raised concern over questions of liability and questioned whether appropriate mechanisms could ever be in place to prevent potential grand-scale problems of self-directed or self-funded care.

It was agreed that there must be significant increases in the availability of education and training courses, especially on a post-secondary level, for workers to support the long-term care objectives.

One significant concern expressed was the lack of direction by successive governments regarding attendant needs and vocational and employment pursuits by persons with physical disabilities. Not one ministry has addressed or seems prepared to address the issue that persons with severe physical disabilities will require attendant and personal supports in employment centres. The community planning council proposes that the long-term care division become the lead mechanism regarding this complete lack of coordinated services.

Regarding supportive housing, it is the position of the community council that individuals with physical disabilities do not want to be segregated or ghettoized, and must be allowed to have and to make choices by having a variety of options available to them. It is the impression of a significant number of members of this council that the current government directions lean towards non-profit housing as the only seeming alternative for persons with physical disabilities and for seniors. One consumer added that "Housing should be available according to an individual's preference."

The council agrees that there must be greater flexibility in the provision of support service programs for those living in their own choice of residence. The question again of choices and options for persons with physical disabilities is raised in this regard. A specific example is current unavailability of 24-hour personal service. Locally, such service provision is only available in a segregated setting. Other community programs are restricted to the number of hours available to a person on a monthly basis. Services in an individual personal residence, excepting respites, are not allowed over a 24-hour period. The consumer has two options: a segregated setting or an institution.

The council affirms the importance of supported service living units or SSLUs. Windsor, although never acknowledged, has been in the forefront of innovative SSLUs and transitional living programs since the early 1980s. The community councils suggest that the programming approaches of Windsor service providers be considered as an appropriate model for expansion of the service. The council further expects that significant funding will be attached not only to the expansion of the SSLUs but also to existing programming.

Regarding long-term care facilities, the council strongly recommends that the long-term care facilities have community representation involved at the board level to provide input to their policy-making structure. Reciprocally, however, it is important that the long-term care boards and staff be involved in the community's decision-making process. This council feels that it is extremely important that facility and community work as equal partners and not within isolated vacuums working for the same common goal.

Our council expresses little further opinion regarding issues involving funding, surplus retention and user fees. We again stress, however, that in order to enhance facility care, community respites, support services and day services must be in place and available prior to any formal facility implementation.

The last issue prior to the conclusion is service coordination. This significant question permeated council discussions regarding service coordination as there was a varied divergence of opinion on system, style, representation, structure and approach. It has now been suggested that the focal point of any long-term care system be placed in the hands of the district health councils on a local level.

Council members are concerned with this approach, given that historically community social service agencies and representative persons with physical disabilities have not been involved due to a very structured system of DHC member nomination.

Many of those currently involved in health councils come from medically oriented backgrounds and bring a health orientation with them. It was further suggested that issues regarding persons with physical disabilities may be diminished or disregarded. The potential management of the system through the DHCs, in the council's opinion, will prove to be a very difficult community chore. It was agreed that it will be a demanding task to find appropriate board representatives with little or no conflict of interest, given the concerns previously expressed.

Further concerns were expressed regarding any assessment procedure. It was agreed that any generic assessments could potentially exclude the needs of individuals with physical disabilities, whose stable conditions require a much different approach to their individual situation.

Given the aforementioned, and reiterating our perception of a health model orientation, the community council expresses great concern with the direction and proposal of utilizing the district health councils, and the focal point of long-term care.

We acknowledge and commend the recognition of the concept of individual choice in the proposed bill. However, in order to realize the suggested approach, consumers with physical disabilities and their service providers, knowledgeable in their field, must have equal representation in the process.

To conclude, the Community Planning Council -- Persons with Physical Disabilities expresses its excitement at a number of positive changes contemplated by government, and supports the general initiative, direction and many of the principles of the long-term care redirection.

The council, however, is very wary of legislation that contains little content, with policy decisions being made by way of minister-ministry regulations. The council further fears that specialized interest groups with non-community agendas will influence these regulations and that proper and due process of public opinion will not be allowed.

We reiterate, however, the importance that consumers with physical disabilities, and all significant others associated with them, must be allowed to be involved in our system and the decision-making process as equal participants and partners. Our submission recognizes the importance and strength of our community and we look forward to active involvement in the discussion and changes of our future.

We thank you for the time, and we respectfully submit the longer version of these comments.

The Acting Chair: Thank you very much.

Mr Wessenger: Thank you very much for your presentation. Just a point of clarification with respect to the planning process for long-term care: I don't know whether you're aware of the fact that the process will work through a subcommittee of the district health council. That subcommittee will have consumer representation on it as well as social service provider representation on it, so it's to be a much broader-based approach, the subcommittee approach, than having the DHC do it itself. I'm just wondering if that would allay some of your concerns, that the subcommittee will be a broad-based body that will do the planning, which will combine health and social services and consumers.

Mr Rohatyn: I appreciate. However, I think in structure and in formal organizational charts, subcommittees provide recommendations to a body which makes decisions and I think our intention, realizing that there will be broader representation, is at the board level itself where the actual decisions will be made. But I appreciate; I wasn't aware it was on a subcommittee basis.

Mr Wessenger: You indicated also that you seem to favour what I would call -- and let me classify this as a functional approach towards -- you're saying physically disabled children should be under the long-term care umbrella, which is what I would call sort of a functional approach. You'd definitely prefer that over sort of a client approach in the sense of -- for instance, one of the other alternatives, of course, with respect to the children who are physically disabled, is to look at the concept of trying to have a broad approach towards children's services in general. I know that's a contradictory concept, but I just want to confirm that you prefer the functional rather than the sort of broad-based approach towards children's services.


Mr Rohatyn: I think our approach is client-based. Yes, it is functional, but I think we look at the fact that when we deal with individuals with a physical disability and those who are born with it, it is in fact a lifelong approach. If you are looking at children and then all of a sudden the arbitrary age of 16, some services may be available up until 16, and it's the reality today that all of a sudden they're not available when you're 16 or 18 or 21. So we look at it, yes, as a functional approach but we also look at it as a client-centred approach.

Mr Wessenger: You also indicate in your brief that there should be differences between the young persons who are physically disabled and seniors. Are you implying there should be financial differences and, if so, would that mean that, upon attaining the age of 65, a person would get less financial support if he were disabled?

Mr Rohatyn: We did not approach finance at all on this. What we were looking at was in fact the individual at 21 or 22 with a very stable physical condition, hopefully, in this society, having another 50 or 60 years or 80 years of longevity but being able to work within community, being able to socialize within community.

Their approach to life is very much different than an individual who may be 80 or 85, still very active in the community but medically may be at a different point in time, socially may be at a different point in time and may be approaching life on a very different basis. We did not look at finances at all on this.

Mr Wessenger: Are you supportive of the direct funding model that's in the legislation with respect to grants to individuals so that they can purchase their own services?

Mr Rohatyn: There are a couple of issues that have been raised. If I could speak from a professional point of view, we've spoken on this issue with individuals, with consumers' clients, within the administrative portion at board level and the like on many occasions.

In the reality of today, with the laws we have in place, with the legislation that's coming, with employment equity and the like, there are specialists called human resource specialists who are out there and who are hired by associations, by lawyers, by judges and the like to handle these very specific issues: termination, wrongful dismissal, providing CPP and UIC benefits back and forth. Those are very significant issues when it comes to direct funding. Brokerage has been discussed, a person having dollars channelled through them where he can purchase services. It's a very large issue.

The concept itself of an individual being able to say, "I would like this person to work for me," I know that my association agrees with this council. The implementation, however, and the practical side of the vast amount of legislation that oversees hiring and firing, all of the potential problems that might be there I think have to be very strongly looked at, because there could be very significant implications to an individual having direct funding and direct purchase service.

Mr Wessenger: You would be supportive then of the pilot project approach to this?

Mr Rohatyn: That we would have to be. I think that will get us off the ground to see what the problems are.

Mr Wessenger: Fine. Thank you.

Mrs O'Neill: Thank you very much for stating very clearly the complexity of the direct funding model. I'm happy that you've done that. I'm also very happy that you have reiterated, and we have heard it from the disabled themselves, that generic assessments and eligibility determinations are very inappropriate. They just don't work with the disabled.

You've also pointed out another weakness in this bill, which I think has been pointed out to us by others even this morning, that it has as its basis, and through many perceptions, that it's a non-community agenda. Those are all things I think we have to work at with this particular piece of legislation. I'm happy that you brought forward the role of the family care giver, because we haven't heard a lot about that, and the respite care and the needs of the working disabled.

I'd like you to say a little bit more, and certainly Mr Wessenger's just almost invited you as well to talk a little bit more about what you think is the best way to go with children with disabilities up to 16, because the bridge, as you suggested, certainly between 16 and 21, is a very narrow bridge and doesn't seem to have very strong foundations even now, and with this legislation could be even more fragmented, in my mind.

Can you tell us what you think, from all of your experience, would be the best place to legislate for children with disabilities?

Mr Rohatyn: Thank you for the comments. I don't know that our council has gotten into such specific detail other than realizing that there are so many fragmentations, and this is not just today and it's not this government; it's been a successive process over the many years that this has occurred. There is a vast amount of legislation that impacts on a child, right from the Ministry of Education -- I'm not sure what the new ministries are themselves at the present moment -- through to Health, through to Community and Social Services, through to children's councils, through to this, through to that.

I think our perspective when we are dealing with long-term care, part of it being a social service side and part of it being a health care side, has to be directed within this realm of long-term legislation. The Ministry of Education or the educational process itself will deal with the education side, but there is an overlap at a point in time of personal care workers. The Ministry of Education will have different rules and regulations today versus what maybe the long-term care division and activities of daily living provide. There has to be a linkage; if not, some legislation that overrides that, to say that one worker is in fact the same, that they will be provided with the same standards, the same education and will in fact do the same work.

When it comes to other activities of daily living, being the social service side itself, respites are extremely poor in the amount of funding that is available to children at the present moment. The dollars are just not there for children with physical disabilities. The dollars are also not there for those adults with physical disabilities and those seniors with physical disabilities, and that could be a common linkage, that respite is respite, whether it's a 3-year-old and the parents need it very dramatically or whether it's an 80-year-old with a wife or husband with a disability who has to have a little bit of time off.

Those are just common threads that I think could probably be worked out, but we take this on a commonsense, common basis approach. It is one and the same, respite or things along that line. We didn't delve into it as specifically as maybe what you were looking for us to do.

Mrs O'Neill: I think that's been very helpful. Do you notice any changes in the attendant care programs in the immediate past? You certainly express some fears you see regarding attendant care. Would you like to say a little more about why you have those fears?

Mr Rohatyn: In our profession we provide an outreach attendant care service within Windsor and Essex county itself. One of the problems we've had is that we've been working under guidelines, nothing specific, and guidelines are just general comments that you can do this and can do that.

There's a question of activities of daily living and what really that does mean, and it is our impression that that will not be addressed. There will be no definition put to this. It's very difficult to define something and then have to work around that. I think that's also the practical side of it.

But what do activities of daily living mean? If it is that personal service to allow the individual to work within the community and be involved in the community, then that is far-reaching, because you in fact are dealing with ventilators at that point. You're dealing with what we call B&B, bowel and bladder. You're dealing with ileostomies and colostomies. You're dealing with personal care. You're also dealing with children -- as we indicated, one of the parents who is disabled but having children -- and that is a concern. Is there a crossing point? Is it the adult or is it this?

There is the employment setting. There are a lot of concerns, and if you have just a general set of guidelines to work within, ladies and gentlemen, it doesn't work. You are at that point having to prejudge these guidelines, sometimes making arbitrary decisions, which may be right or may be wrong, and in the long run you may not be right. But who loses? Not the association that's providing, not the worker who's providing, but the direct consumer, who may or may not have a voice involved in this.

Mrs O'Neill: Thank you for giving us the practical side.

Mr Jim Wilson: Thank you for your presentation. I too very much appreciate your comments concerning generic assessments. On page 8 in the section entitled "Long-Term Care Facilities," I gather you'd be in favour of mandatory residents' councils in those facilities.

Mr Rohatyn: The council has agreed that would be very necessary, yes.

Mr Jim Wilson: You go on at the end of that section to "stress that in order to enhance facility care, community respite, support services and day program services must be in place and available prior to formal facility implementation." I appreciate that comment, so that this government won't repeat the mistakes of the past. To what extent are things shaping up on the local level in terms of community services being put in place?

Mr Rohatyn: I think that everybody is sitting and waiting to see what happens with legislation -- I'll be very honest -- because part of that will facilitate movements in the community.

Specifically regarding individuals with physical disabilities and day programming, very little exists. That's been the reality because those individuals have not been paramount in any government's eyes, and this is part of the reason why we were making our statements.


Individuals with very, very severe physical disabilities who may not have the options available to them of employment, social interaction, social contact or community involvement because of physical barriers -- doorways and the like -- have nothing available. There are a lot of volunteer groups out there, but they get stressed and they may not have the professional capacities to work with those individuals.

I hate to put it to you, but the boob tube becomes a very important focal point of their lives -- that being television -- and sitting at home and then, of course, the stress on the care givers.

We are not by any means any different than the rest of the province. I think Windsor has taken a lot of very strong initiatives in this community, but that day program is very important, not only on the social side of it but also on the vocational and employment side of it.

Mr Jim Wilson: On page 7, at the bottom, you reiterate the view of the council that the non-profit housing scenario should be viewed as only one approach and that "our position is that a variety of options and choices must be available."

A couple of questions: One, do you think there's been too much emphasis on putting up non-profit housing to the exclusion of not considering other options? Two, will this direct grant that the minister may from time to time dole out -- as it's worded, money appropriated from the Legislature -- do you think that will help to ensure we're not ghettoizing people with disabilities into strictly the non-profit buildings?

Mr Rohatyn: I appreciate your reiterating the comment that we're looking for larger choices. I think everyone does. I think everyone should be looking either to own his own home or to move into an accessible apartment, into coop, non-profit or the like. One of the problems is that there isn't enough of it. There aren't enough accessible units, whether they be actual permanent, one-single-bedroom residences or apartments and the like. Mandatory legislation indicates 5% of all non-profit housing or all -- and a lot of private developers are moving into that. There's got to be more.

I run one of the SSLUs, independence-training apartment program, and at the present moment out of the 16 units where we train individuals we have six people who have been waiting for two years to move into accessible units -- two years. That is a long time to wait. The backlog of individuals wanting to go into training apartments is 9 and 10 and 12, and some people say, "Well, I can't wait any more."

Part of it does impact on an entire system. Hopefully, if the parameters of direct funding also include some assistance -- and I don't know whether there was even a practical suggestion at that point -- of allowing individuals to move into community at their own choice, that might be considered by this committee.

Mr Jim Wilson: We have heard evidence previously that part of the problem is -- you mentioned waiting lists to get into SSLUs, that's part of the problem. There are many people who are in SSLUs now who would very much like to get out and therefore free up space for others that may be appropriate to move in. To me it's unclear whether grants to individuals will allow -- whether there will be enough flexibility there to allow people to move into their own choice.

Mr Rohatyn: It was my understanding that the grants -- and again it's just maybe trying to read what is there or maybe reading more of what I want to see -- would be directed more towards the personal care side itself, the attendant care side or the respite side itself.

It is a much broader issue, not only with the individuals who are held up in the process of an SSLU moving out into community; it is also an issue of the personal care that is involved. If an association such as ours that services 50 people in an outreach attendant care program has a waiting list of 130 active individuals, and that is the reality of today, a person also requires attendant services stepping out into community and is only making applications, some priorities may be already existing and they may not be able to move.

That is a functional problem of the system itself, but it is much broader than just the physical structure of the building or maybe direct funding itself. It is a large encompassing issue.

Fortunately, and I'm being very frank here, we have had these discussions and are having these discussions on an ongoing basis locally in the community, part of it being council, part of these comments being directed to our friends in government.

The Acting Chair: I thank you very much for coming today.

Mr Rohatyn: Thank you very much. Good luck.


The Acting Chair: The next group is the labour advisory committee of the Essex County District Health Council. Would the representative come forward.

Mr Ken Brown: We're a labour advisory committee to the Essex County District Heath Council, but our committee is formulated through the Windsor and District Labour Council, if that clarifies it any.

The Acting Chair: Yes. Would you identify yourself, please, and then begin.

Mr Ken Brown: My name is Ken Brown and I'm the co-chair of the labour advisory committee.

The Windsor and District Labour Council represents approximately 32,000 working women and men belonging to 62 affiliated unions in this area. The labour advisory committee was formed last year in response to an invitation from the Essex County District Health Council. We are designated as an advisory group to the health council's steering committee established to oversee the health care reconfiguration project that is currently under way in this community.

The labour advisory committee has representatives from the Canadian Union of Operating Engineers and General Workers, the Canadian Union of Public Employees, the International Brotherhood of Electrical Workers, the Ontario Nurses' Association, the Ontario Public Service Employees Union and the Service Employees International Union, all of whom represent health care workers in Essex county and indeed across the province. We also have a representative from the Canadian Auto Workers to provide the voice of a consumer on our committee.

I've already identified myself. I'm the co-chair of that committee. On behalf of the labour council and all our committee members, I want to thank you for inviting us here today. We welcome the opportunity to present our views on this very important legislation.

Let me say at the outset that we agree that change is necessary and we generally support the goals as set out in the November 26, 1992, news release concerning the new legislation, those goals being: a fairer funding scheme for nursing homes, charitable homes for the aged and municipal homes for the aged; improved accountability to residents, their families, workers and government; consistent resident payment policy; simplified and streamlined access to long-term care facilities through placement coordinators; and direct payments to adults with disabilities who are able to buy and manage their own support services.

However, we do have some concerns about what we see as shortcomings. In the time allowed, I want to identify a few of those for you and talk a little bit about each of them.

With the restructuring that is planned for the entire health care system, we are very concerned about looking at long-term care in isolation from the whole health care reform. Due to budgetary restraints, some health care reorganization has been taking place already in communities across the province, and what it's meant is reduction of services and a layoff of employees in these health care institutions. In our view, if we continue in the present vein, essential services will be chipped away bit by bit and we'll never get them back. The planning then has to recognize and acknowledge the connection of all parts of the health care system. Long-term care is but one part of a comprehensive health care system and it is difficult to examine it in isolation.

If I lose my voice, I'm not choked up with emotion; it's simply a sore throat that I've been fighting for a couple of weeks.

It is our submission then that long-term care has to be looked at as part of the whole health care system of the province, and all planning has to be done and everything in place before further changes are made.

The proposed legislation would require service contracts with the crown in order to run a nursing home or a charitable home for the aged and also provides for admission criteria to be determined by placement coordinators. We don't have any difficulty with either of these, but I note that in both cases, the service contracts and the determinations of placement coordinators are to be done in accordance with the regulations. We were not provided with copies of the regulations in the package of material that we received. I'm told at this point those regulations have not yet been developed. It is difficult to comment on these areas without seeing the regulations that will make them work.

The proposed legislation also requires that quality assurance plans be developed and maintained and provides for inspectors to enter these homes and carry out inspections at all reasonable times. What it does not appear to do, however, and we think it should specifically do, is provide for whistle-blower protection, particularly for employees and/or residents. The employees and residents are certainly in the best position to be aware of violations, but they're also the most vulnerable people. They don't have strong protection so that they can feel free to point out potential violations without fear of recrimination, and we fear they will be reluctant to do so.


It is also our belief that inspections ought to be carried out with greater frequency than is our experience now, in the nursing home industry particularly, and without advance notice. It is all too easy to have everything in great shape for an inspection that you've been able to plan for for two or three weeks or a month.

We are very much concerned that the government has seemingly accepted the argument that quality services can be delivered cheaper and better by community agencies or private operators. However, Ontario's previous experience with the deinstitutionalization of ex-psychiatric patients in the 1970s was judged largely to be a failure. The motivation at that time was to reduce institutional care costs. Although the government promised community services would be developed to help former patients integrate into community life, many of these services were never established. Our concern is that in an effort to deal with shrinking health care resources, the institutional care budgets will be cut before putting the necessary systems in place so that people can be cared for adequately at the community level.

We also question one of the underlying premises of this reform in Ontario especially: that seniors are institutionalized at a disproportionately high rate compared to other jurisdictions. The Ontario Association of Non-Profit Homes and Services for Seniors says that Ontario government figures for 1992 show the institutional rate to be at 5.9%, which is on a par with or lower than other Canadian and international jurisdictions. In 1987, Ontario's rate was 6.1%, compared to British Columbia at 6.6%; Sweden, 7.3%; Quebec, 6.6%, Manitoba, 5.7% and the United Kingdom, 5%.

Deinstitutionalization will place additional responsibilities on families and friends for the elderly and people with disabilities. For a variety of reasons, persons needing services may prefer a setting such as a hospital or long-term care facility. Individual preference must be protected.

Shifting emphasis to community and home care will also have an adverse impact on women in that they will be responsible both for raising the children and caring for frail elders. Moving work to the community sector, which is traditionally lower paid, will result in women being pushed into these jobs just when collective bargaining and pay equity have begun to address these inequities in the institutional sector.

We further question the wisdom of reducing institutional beds in the context of the shifting demographics. In 1990, Ontarians over 65 comprised 11.7% of the population. By the year 2001, seniors will comprise more than 15% of the population. Between 1990 and 2011, the growth rates will be 59% for seniors, compared to 22% for the entire population. Those 85 and over constituted slightly more than 1% of the total population in 1990. Their numbers are expected to double by the year 2011 to 2% or 2.1%.

As well, we see the logic in expanding the role of hospitals in the provision of community-based health care. One way to ensure quality home care services is to provide them out of existing facilities. This could go a long way to eliminating duplication of costly administration services and maintaining public administration. There are also hospitals in the home programs in other parts of Ontario which provide home care services.

We believe the government should examine these models closely before attempting to move home care services to community agencies, many of which are commercial operators. Often the artificial dichotomy between institutional care and home care sends up a smokescreen which obscures the real issue; that is, how to reform institutions into more humane places to live.

We believe the five cornerstones of health care -- that it be publicly administered, comprehensive, universal, affordable and accessible -- are essential to long-term care as well. In the period between 1976 and 1989, while 7 out of 10 provinces were reducing the number of private nursing home beds, Ontario increased its percentage of private nursing home beds from 47% to 54%, making us by far the largest supporter of private sector nursing homes in the country. We are absolutely opposed to this direction.

What we really need is a conversion strategy to turn the profit nursing homes into publicly owned not-for-profit homes. In our view, the best way to provide decent nursing homes is to remove the profit motivation from their operations. It is our experience that the quality of care found in private nursing homes is generally inferior, as are the wages and working conditions of the employees who provide the care.

I said earlier that we recognize that change is necessary. We also recognize that with shrinking financial resources, largely due to the federal government's abandonment of the people of this province by continuing to reduce transfer payments and effectively refusing to pay its fair share for maintaining our health care system, we have to find ways to be more efficient in every respect of our health care delivery, including long-term care.

We believe there are a number of ways to create efficiency without cutting or otherwise adversely affecting the quality of care. Some of these are: Where possible, eliminate unnecessary and costly duplication of services; provide community care and outpatient care from existing facilities as opposed to expanding and fragmenting a network of community agencies and the administrative costs that would be associated with that; review the whole fee-for-services model used to compensate doctors and private labs.

On this last point, although this province placed a cap on doctors' incomes, the government's settlement with the Ontario Medical Association simply did not adequately address increased utilization. A Globe and Mail report last spring indicated that physician billings were up by 11% for the first three months of the 1991-92 fiscal year. Payments to doctors amount to only 16% of total health care expenditures. However, they are estimated to control approximately 80% of health care costs.

There are a number of studies that indicate that the current fee-for-service system encourages abuse and unnecessary treatment. We believe this fee-for-service approach to health care is a part of our system's current financial woes and must be re-examined.

Health policy experts say that studies conducted in the last few decades have shown that patients are subjected to tests, surgical procedures and prescription drugs which are not useful and frequently may be harmful. Such conclusions have been confirmed by a 1988 Report of the Ministry of Health's advisory Drug Quality and Therapeutics Committee, which reported that as many as 20% of senior citizens admitted to hospitals were as a result of adverse drug reaction and dosage mistakes.

These few items addressed here with respect to efficiencies and ways to save money are by no means exhaustive but certainly represent ways and means of saving substantial dollars without adversely affecting quality of care and service that we deliver.

Those are my remarks. I understand there may be some questions, and once again I thank you for your time and attention.

Mrs O'Neill: I just have one question. Certainly, we've heard several of these points before. The one we haven't heard before, however, is the whistle-blowing protection. I'd like you to say a little bit more about that. I'm pleased that you said employees and/or residents. Could you say a little bit more about how you think that could be achieved or what you think would be necessary to make sure we would have full knowledge if there was an infraction?

Mr Ken Brown: I think it's simply legislation that would specifically protect their rights to do that, similar to what you may have in the Labour Relations Act, that an employee -- this would have to be residents and employees -- can't be coerced, discriminated or recriminated against in any way for exercising their rights or bringing to the attention of the powers that be what they see as violations of the act or the service contract or any difficulties that may go on. It would simply be legislation that would clearly state that employees and residents have that right, that this right is protected under law, and that they are not going to face any reaction as a result of that kind of action or pointing anything out.

Mrs O'Neill: Do you see that as part of Bill 101 itself?

Mr Ken Brown: Yes. From what I see in the package of information I have, it certainly could be incorporated there. It would be an appropriate place.

Mrs O'Neill: Could you just comment on the role of residents' councils in respect to that same thing? We've had several comments that residents' councils do not have as high a profile in this legislation as they might.

Mr Ken Brown: That's something that from our approach we haven't really looked at, but that would certainly seem like a means of incorporating it from the residents' side, through the councils. We certainly don't have any difficulty with that, residents' councils' approaches to dealing with problems.

Mrs O'Neill: Thank you very much.


Mr Jim Wilson: Thank you, sir, for your presentation. There are a just few points that I probably don't agree with --

Mr Hope: Which ones are those?

Mr Jim Wilson: -- which I'm going to elaborate on. You mentioned a couple of points on page 7 that I do want to ask you about. One is that you mentioned that your preference would be that the government have a total conversion strategy to essentially move the private sector out of the delivery of nursing home services. Do you have any idea what the cost would be? Have the unions looked at the cost to the taxpayer for that sort of thing at all?

Mr Ken Brown: No, I don't have any direct knowledge of the costs. In terms of dollars, I don't doubt that they would be substantial, but I still believe that over a period of time it can be done and that it's an investment in health care that has to be made. I suppose, as we see it, it would be a priority of spending. But I've not seen any -- we suggested that before -- figures to say, "This would be the costs associated with that if it were done in any specific time period." So no, I don't have the figures.

Mr Jim Wilson: I guess what I don't understand about that approach is -- and it comes every time a union group makes a presentation -- is why, when the standards are the same for both the private sector and the public sector in delivering health care -- and particularly this bill moves to ensure that standards are the same -- there would be a preference to want to shift the private sector out of the delivery of care, if the consumer is going to get the same care and if now the same inspection services will be provided in both sectors.

Mr Ken Brown: My own personal sense of that would just be -- and you're getting that from union groups -- their experience over time in dealing with private operators. I don't want to tar them all with the same brush. There are some decent operators out there. But we run into far more difficulties with private operators in a variety of what we see as not having adequate nursing care, added stress on the workers to get the work done. There are some guidelines in place now in terms of nursing hours that have to be provided per patient bed in the homes, but enforcing that can become a difficulty.

I think the experience of the unions that have dealt with them is that where you have private operators who are looking to make money out of it, they will tend to cut corners where they can cut corners, sometimes at the expense of workers being asked to do more than they should have to do and the stress on them, of course, of wanting to do everything and being all things to all patients. The people who work in this industry tend to be dedicated folks. It's not a simple matter to say, "I'm just going to leave that patient and not clean him up or take care of him, because I don't have time." So they make the extra effort to get it done. Our experience with private operators suggests that even with regulations they will try -- some of them may attempt to cut corners.

Mr Jim Wilson: I appreciate your comments. For your information, the government did do a secret study on what it would cost to buy out the private sector in health care. Because it's never been released to this committee and I'm aware that it was done, I would ask the parliamentary assistant, through you, Chair, that the study be provided. I happen to have been told by some people in the bureaucracy, as part of whistle-blowing, that it was done and that the government, for financial reasons, had to rule out the possibility of taking over the private sector. I think it would be very helpful if that information were made public, so I'd ask you to pursue that.

The Acting Chair: I'll ask the parliamentary assistant to take that into consideration.

Mr Wessenger: I don't think I can give any commitments on this matter.

Mr Jim Wilson: I'll get it one way or the other. The second thing is -- and I'll make clear from the beginning, even though there'll be heckles from the other side, and I appreciate the heckles -- that the federal Conservative government is different from the Ontario PC Party. Having said that, in fact it's probably in our interests to see a different-striped government federally, if I ever want to be in cabinet provincially. It's the way the province works.

But having said that, I'm disturbed every time the unions do this, and I think you lose some credibility for those people who are aware of the figures. The federal government didn't cut transfer payments; it cut the rate of transfer payments, from about 8% to about 5%. So this government got 5% more for health care and education from the federal government last year than it did the year before. This year it'll get almost 5% more than it did the year before, yet it transferred 1% to its municipal partners.

I think the question unions should be asking is, "What happened to the 4% differential?" rather than this fed-bashing, which doesn't serve to justify the facts at all. I just leave that with you, because I've remained silent through all the other union presentations. The facts are that the rate of transfer was cut from what it traditionally had been, but the transfer payments were significantly more from the federal government to the provinces than what the provinces transferred to their own partners.

If I were in a union, political agendas aside, whatever government was in power, I'd pursue very forcefully the question of what it did with the money. You know what the problem in federal transfer payments is: The provinces have always resisted the feds auditing their books. They transfer money in lump sums for education and health care into a very large envelope, and the provinces don't necessarily spend all that money on education and health care. So I put that on the record as a challenge to unions to ensure that the Canadian public is given the facts.

Mr Ken Brown: I made the comment and didn't provide much data. I frankly thought that it was a given. I've seen a number of studies that tell us the federal government's overall share of health care is reduced from a 50-50 proposition to somewhere in a 30% range and that over the next 10 years its goal is to achieve a $0 contribution. So I really didn't do anything in terms of providing the figures. I guess I thought that was a given and everybody understood that.

The Acting Chair: I think we'll have to move on, please.

Mr Jim Wilson: I'll just put one more. The studies that do show that are studies of the actual cash transfers and the tax point transfers. On total, transfers are up; they're not cut. I think you get ministers who, for political reasons, start to concentrate only on cash transfers, which are being reduced over time. But tax credits to provinces are just as good as cash in many cases, and I think the public doesn't generally understand that.

Mr Hope: The $4.5 billion has nothing to do with it.

Ms Carter: Thank you, sir, for a very valuable presentation. I just wanted to single out two points; one's already been highlighted, and that's the question of whistle blowers. Certainly, as far as residents go, not so much where it might be a matter of labour disputes, I think the government has already taken steps to deal with that through our advocacy legislation, which does give vulnerable people the right to call in an advocate and explain any problems and difficulties they might be having. If, for example, an institution were not being well run and inmates were being neglected or not treated properly, the advocate would probably find that it was a systemic problem, because more than one person would be complaining, and the advocate would be empowered to follow that up to do something about it. Could I have your comments on that?

Mr Ken Brown: The one on the labour certainly is not in a labour dispute. I just say that if an employee happens to be aware of something that affects the operation of the home or affects residents more so than the employees, he should have protection to report that.

Ms Carter: He could ask a patient to in fact call that number for an advocate.

Mr Drummond White (Durham Centre): I first want to commend Mr Wilson for his attempt to apologize for his federal brothers, a virtually impossible task.

Mr Jim Wilson: I wasn't apologizing; I was simply stating facts.


Mr Jim Wilson: You're in government. You are obligated to give facts; you are obligated to give true facts.

The Acting Chair: If you would like to carry on this conversation outside, it would be most helpful.

Mr O'Connor: He's got the floor. Relax.

Mr White: I want to thank you for your presentation. There are a couple of points I wanted to pick up on.


Mr Jim Wilson: I am not playing games. Show me the bloody federal budget.

Mr White: The issue that you mentioned here about how Ontario has been in the past unique in all of Canada in moving more and more towards commercial nursing homes, private nursing homes and for-profit social services, there's a substantive figure that you give. Do we have any updated figures? Have those tendencies continued?

Mr Ken Brown: I just have what I've given you there. I'm sure there's something more available. That was what I had at my disposal for the time I had to prepare for this.


Mr White: Sure. I'm very concerned about this. If we know that this tendency, this trend, is continuing, that's certainly something that many of our public sector friends are concerned about. I certainly would hope that that's not the case.

I think that many unions that work for both private, for-profit corporations and public sector facilities, not-for-profit, community-based facilities have spoken about the experience of their workers, spoken about the importance of the not-for-profit sector, clearly indicating a bias, even though they represent people who work in both.

I want to pick up on the issue about inspection. You hear talk about inspection of facilities. You talk about the need for that inspection to occur on a regular basis.

The Acting Chair: Excuse me, Mr White, but your colleague the parliamentary assistant does want to put forward a question as well, and I would ask if you could just ask your question, so we can get on with things.

Mr White: I will. Thank you, Madam Chair.

I'm wondering if you could comment upon the need for inspection versus a compliance mechanism or a consultative mechanism.

Mr Ken Brown: As I say, I happened to be in a home for a meeting Monday of this week and there was a nursing home inspector there on the premises, but it was a scheduled kind of thing; I don't know, had been scheduled for a period of a couple of weeks. I guess if you're going to do it in that fashion, it may not be any use bothering inspecting them.

I think the regulations are there, the compliance has to be met, and that standard should be met all the time, not just when you have an inspection scheduled. The standards ought to be met at all times, so an inspector should be able to walk in the door and say, "I'm here for a tour," do the inspection and make the report without scheduling it ahead of time.

Our experience is that they are infrequent and that they are scheduled with a substantial amount of advance notice, so it kind of defeats the purpose, I suppose, in ensuring compliance. Obviously, if you know what your requirements are and you know that they are going to be coming in and having a look at you, you're going to make sure that everything is as it should be. But it should be like that all the time.

Mr Wessenger: Thank you very much for your presentation. I'd just like to make one little point about your statistics on page 5 about institutionalization. It may or may not affect your conclusion, but the figure of 5.9% would relate only to homes for the aged and nursing homes. It would not include chronic care hospital beds or those 30,000 people included in rest and retirement homes. So if you took that into account, did the comparison, you might find Ontario is higher in institutional care.

Then I have a question with respect to your suggestion for whistle-blowing legislation. First of all, I'd just like to indicate that right now the inspection process does work on a complaints process, which results in an inspection without any warning. It would also act with respect to an anonymous complaint. Also, as my colleague Ms Carter said, we have the advocacy process, which would also help with respect to dealing with those situations.

I just have some concern that if you had this type of legislation of whistle-blowing, it might be counterproductive to the whole concept of quality management, because quality management really relates on the question of a very cooperative, consultative role between the employees and the employer, and I think we all want to encourage quality management in the process. So I'd just like you to comment on that.

Mr Ken Brown: I guess I would compare that last analogy to the occupational health and safety laws, where there is certainly a joint responsibility on the part of employees and employers to carry out the requirements of that legislation. Yet workers are well protected under that legislation. If they do get into work refusals or whatever because of an unsafe condition where the joint efforts to take care of it fail, the protections are there. We have difficulties sometimes, but I don't see that as undermining the whole process of occupational health and safety being a joint responsibility.

Have a joint responsibility but allow protection for somebody who says, "Even with the joint responsibility, they're not in my view doing what they're are supposed to do here, and I want to go a step further to complain about that or to get it looked after." They should be able to do that and be provided with protections.

Mr Wessenger: If I can just comment, my only concern is that it would seem the best process would be for the employee, if there's a problem, to communicate directly with the people responsible for making the decision. Maybe there are some instances where that's not possible, but that certainly is the ideal circumstance.

Mr Ken Brown: I'm not suggesting it's an end run such that you don't try to work out those concerns.

Mr Wessenger: Certainly the end-run situation is very counterproductive.

Mr Ken Brown: I wouldn't disagree with that.

The Acting Chair: Thank you very much for your presentation.

Mr Ken Brown: Thank you once again for your time.


The Acting Chair: Now, patiently waiting is the representative from PUSH -- Windsor and Essex County. Could Ms Cowie come forward.

I'm sure the people who are in the audience will realize that we as a committee do try to get along, and hopefully it will not be necessary to order two buses to go to London.

Mr Jim Wilson: Just stick to the facts, Madam Chairman.

The Acting Chair: Welcome to the committee. I believe it is Joan Cowie.

Ms Joan Cowie: Yes, it is. You have to bear with me. I have a very, very sore throat.

The Acting Chair: Oh, dear. There does seem to be a mean bug going around.

Ms Cowie: I don't think the weather is helping.

The Acting Chair: Well, thank you for coming, and we await your presentation now.

Ms Cowie: Ladies and gentlemen of the committee, thank you for coming to Windsor. My name is Joanie Cowie, and some of you might recognize me. I was recently at Queen's Park addressing some of these issues on a more personal level. I have been a resident of Windsor and Essex county for my entire life. I'm 24 years old. I'm the president of PUSH -- Windsor and Essex County, Persons United for Self-Help.

PUSH has been in existence for 11 years in Toronto and all over Ontario. PUSH has been in existence for Windsor just less than six months. PUSH is a provincial-wide group divided into six regions, and Windsor is part of the southwest region. We are a consumer-direct, consumer-oriented, cross-disability group. We advocate for the rights of the disabled as well as ourselves. Some of these areas include: transportation, employment equity, consumer direction, respite care, attendant care and accessible housing.

By reading Bill 101, I noticed that it was very vague about people with disabilities. It was more focused on institutionalization than integration into the community. Bill 101 has chosen to give rights to the people in institutions such as nursing homes, but has forgotten anyone living independently in the society. Everyone has a right to live independently, and this is our goal.

With Bill 101, consumers have no rights to services. An agency can cut services to the consumer at any time with no notice. This has been done several times in just Windsor alone. There is no recourse for the consumers. All consumers should have their rights protected. The government is not looking at consumer-direct funding in a broader context but just as a small pilot project.

In some cases, when the parent who has children is disabled, an attendant from an agency can come into the home and serve and feed the parent but will not serve the same meal to young children who are of small ages, yet they can go into another consumer/client home and feed a dog. I think this is very inhumane.

Does this make sense to the taxpayer, wasting money on agencies that have criteria and mandates that are outdated and need to be changed? In the consumers' eyes, this is a step backwards instead of forward. People with disabilities are a minority, but if you look at the statistics of the disabled, are among the least respected when it comes to their rights.

We, the consumers, can function independently within society, and though we need arms of assistance, we need not to be a burden. People with disabilities can work. People with disabilities can get married. People with disabilities can have children. People with disabilities can make decisions for their own lives and be successful in those decisions. Most important, people with disabilities can vote.


The government must stop listening to the agencies' ideas and listen to the people. Most people with disabilities did not ask for their disability, and this does not make us ignorant of any of society's ways of thinking. We, the disabled community of Ontario, must start working with the government to help it understand why the long-term care reform is so important.

There is no legal protection for the disabled that covers long-term care. Under the current system, people with disabilities are protected by this law, and this leaves us very vulnerable. In most cases, agencies have good intentions in providing services, but who knows better what they need, when they need it or how it is to be done than the consumers themselves? Consumers should have maximum control over the services provided in their lives. Given the opportunity to direct their own services, consumers would have a say in their services. This would provide administration with "less headaches," and quality of work would hopefully improve.

Unfortunately, many service providers do not listen to their own consumers' complaints or ideas about the care they are receiving. Many service providers must listen to and have to rely on the family members to speak up so that their own voice, the consumer's voice, can be heard. This is very wrong. Just because you have a disability does not mean that you don't have a voice. What happens to the consumer who does not have a family or an advocate or a reliable friend? In a study done all over Ontario, the disabled are the most oppressed and depressed, particularly because of the lack of consumer input in their care.

Consumer direct funding is an issue that needs to be given a chance. I believe the government should not be wasting tax dollars on services that are not always provided or are not done properly. I am not saying there won't be any failures, but people with disabilities must be given a chance to learn from their mistakes.

There are many people living in SSLUs -- support service living units, which is 24-hour attendant care along with housing -- who are paying over and above a room that is smaller than an average jail cell. These people did not choose their disabilities and they do not deserve this inhumane type of living. These people deserve the utmost dignity in their care and in their housing.

Housing has become a large issue in the city of Windsor. Homelink is swamped with people who require accessible housing. Along with the housing comes attendant care, for which there is also a long waiting list. There are many apartment buildings that could be made accessible in the area, again, but where does the attendant care come from? "Attendant care" can be defined as personal hygiene, meal preparation, toileting, bathing and regular assistance with activities of daily living.

What about respite care for the families of people who are disabled? We have heard too often from supervisors, directors and executive directors that there is no funding. Why is this happening? If you live with or you are the main care giver for an individual who has a disability, a break is something you just don't have. My mother is a prime example. Is this fair? The disabled community wants to live independently but needs respite care to give family members a break. It also would give them a break from their family.

Agencies are getting funded for programs that are not always followed through and for meetings that are unnecessary. There is also a lack of recognition for consumer groups that have valuable input for these issues. Effective consumer planning would improve their care.

After a child turns 18, many doors are closed and society is supposed to take care of them. We must start to make changes for the children and the families of tomorrow who will be facing this terrible mess. It can be avoided if we start today.

I am asking you to review and consider Bill 101 in the context of legal rights concerning respite care, attendant care, housing and, most important, consumer input. Are you satisfied that the concerns are adequately addressed in Bill 101 and present legislation?

The Acting Chair: Thank you very much for coming and representing a group very admirably. I'm sure that there will be questions here, that we will want to find out a little more on what the consumer and you think.

Mr Jim Wilson: Thank you very much for your presentation.

Ms Cowie: I'm sorry I didn't have a copy.

Mr Jim Wilson: Oh, it was excellent.

Ms Cowie: We will get you a copy.

Mr Jim Wilson: I think most members made notes. We do have the Hansard also to fall back on, so we know you put a lot of work into it. Don't worry about retyping it on to pages or something.

I share your concern that with regard the direct grants envisioned in Bill 101 and changes to the Ministry of Community and Social Services Act, both grants to individuals and organizations, the word "may" appears in those clauses. It isn't the firmest commitment the government could make. My colleague Margaret Marland, who deals with disability issues as the critic for the Ontario PC Party, has said many times that she and the groups she meets with are very worried that perhaps expectations are being raised with this legislation and that the government may not be able to meet all those expectations.

What I wanted to find out -- and I've not asked this question, so don't mind if I take a moment -- from the parliamentary assistant -- Mr Hope isn't here, but, Chair, through you to whomever, what is the extent of the pilot project that's envisioned? Perhaps we could just have a quick overview of that, the dollars involved, the number of people served, is it geographically specific and any other details that might be available, because I don't think it's been totally fully outlined to the committee.

The Acting Chair: I'm checking here with the other parliamentary assistant to see whether or not we could address this.

Mr Wessenger: We could probably indicate in general terms, but the specifics are not yet worked out, Mr Wilson. Do you want to hear something in general response?

Mr Jim Wilson: Yes, except that all the groups representing disabled individuals have alluded to this pilot project, so I assume there's more meat on the bones than just generalities at this point.

Mr Wessenger: You'd like a status report, is that what you'd --

Mr Jim Wilson: Status and as much detail as possible.

Mrs Caplan: How about a statement of government policy?

Mr Wessenger: I am not in a position to make that on behalf of the ministry.

Mrs Caplan: That's an admission that the government either has no policy or doesn't --

Mr Wessenger: No, no. I'm not the parliamentary assistant for the --

Mr Jim Wilson: It worries me that we talk about this pilot project, which is bad enough in itself that it's only a pilot project and that you're raising expectations out there. You should be prepared at this point, since you've moved with legislation, to tell us at least what the pilot project is.

The Acting Chair: Mr Quirt?

Mr Quirt: The way in which the direct funding pilot project would be implemented is the subject of work being conducted now by a work group that includes representatives of people with physical disabilities and their organizations, so, in effect, rather than designing the thing ourselves we're involving consumer groups in its design. If memory serves me correctly, the committee has met three times. I'd be happy to ask my director of policy to do a summary of the work done to date by the committee and perhaps get a summary of the minutes of that committee or something that would give the committee a sense of what's been discussed to date.

Mr Jim Wilson: What is the government's commitment in terms of a time frame of getting this pilot project up and running?

Mr Quirt: My understanding is -- and I have not met with the committee -- is that they're aiming for a fall pilot and to start the funding in the fall of 1993. It may well be that better suggestions than that have come forward at that planning group and I'll be happy to report if they have.

Mr Jim Wilson: Has money already been set aside for the pilot project? If so, how much and what's the duration of the project?

Mr Quirt: The funding for the pilot project would come out of the commitment of $441 million to improve community services. The exact amount to be earmarked for the pilot project I don't think has been determined yet, because the pilot project hasn't been designed. It would be resourced adequately once people were comfortable with the design of it. We're hoping that we'll reach consensus with representatives of consumer groups on how that would be implemented.

Mr White: I think, as you've heard through that dialogue, which unfortunately didn't involve you directly --


Mr Jim Wilson: Just her life.

Mr White: -- we are now, with this legislation and with this government, moving forward in the area of attendant care. I think there are still important issues here, though. We've had a number of consumer groups here.

Ms Cowie: But they're different from PUSH.

Mr White: I know. What I'm saying is that I'm impressed that consumers in Windsor are active, involved, and what I'm wondering from PUSH is, are you represented? Do you have people on the district health council?

Ms Cowie: PUSH Ontario does but PUSH Windsor, no. Like I said, we just started less than six months ago. What I've noticed just in the few meetings we've had is the fear. People don't want to come forward with their stories. When I went up to Queen's Park, my knees were knocking but I had a story of abuse to tell. The government is funding this agency and the agency doesn't care.

Mr White: Did you make your views known to the local people on the health council or to your MPP, your experiences?

Ms Cowie: My MPP, George Dadamo, knows all about it and so does my MP, Steven Langdon.

Mr White: Have they made sure that action was taken about that agency?

Ms Cowie: Not directly towards the agency. They have tried numerous attempts. I had my service cut. I have a form of muscular dystrophy. I have Guillain-Barré syndrome, which is a slowly deteriorating disease. I'm also a single parent. I have two children aged five and half and three. It's not just my life that I'm concerned about; it's my two children's lives.

If attendant care givers can go into another person's home and feed a dog, why can't they serve the same meal to two children? They won't do that, so then I end up doing it. Then they'll go and they'll wash my plate but they won't wash their plates. Does that make sense, government money being spent that way? I don't think it makes sense, plus it's wasting my fixed-income dish soap, to put it honestly.

Mr White: I think those are the very practical kinds of reasons that we need to have these kinds of projects. You need to be in control of your life.

Ms Cowie: That's why consumer-direct funding is so important.

Mr White: I think it took a great of courage for you to talk about those very specific, very personal issues. I want to thank you particularly for coming out today.

Ms Cowie: Thank you.

Mrs O'Neill: I have a couple of questions for you, Joan. You talked about your group being full of fears.

Ms Cowie: Yes.

Mrs O'Neill: I presume they're beyond fears of just revealing your situations. What are your fears regarding the attendant care aspects of Bill 101 or attendant care as it exists now? Could you be specific?

Ms Cowie: We have no protection. They can cut off your rights in a minute. You have no choice of the people who come into your home. The people who come into your home affect who lives in that home. I live on my own with my two children. Each and every individual who comes into that house, I don't care what the executive director or the director or the supervisor says, they affect my children and they affect me. When you have 16 people coming in to service you, that's 16 people you are taking your clothes off in front of.

Thank God, since I went up to Queen's Park and talked about more personal issues than I've stated here, it has been cut down to five; but even with those five, there are still attendants who were taken off because they had become "friends." You can't just walk into a house, bathe somebody and not talk about the weather. You can't go in and talk about, "What are you doing in school right now, or how is your correspondence coming along?" It just happens.

Mrs O'Neill: So do you feel Bill 101 will help? Is that your belief at the moment?

Ms Cowie: If they take into consideration the attendant care and the respite care, yes.

Mrs O'Neill: I wondered if you had any comments on the bill, including disabled children, as one of our presenters already stated.

Ms Cowie: I'm concerned about the disabled children of tomorrow because I do not want them to go through anything that I have gone through.

Mrs O'Neill: So you would like to see them included in this bill?

Ms Cowie: Yes.

Mrs O'Neill: Thank you very much, Joan, for coming to Queen's Park and coming here today.

Ms Cowie: Thank you.

The Acting Chair: I thank you as well for coming. I hope Bill 101 will address all of your concerns and those of the people you are here representing today. I appreciate your time in coming and thank you very much. I thank all who have come before us today. We really appreciate the time you have taken. I guess that will be the end of our hearings here in Windsor. Hopefully we'll be back again some day. The committee stands adjourned until we get to London.

Ms Cowie forgot something.

Ms Cowie: I'm terribly sorry. I just want to add that when you do take into consideration attendant care, when attendant care givers are removed from the home -- when you have children who are able-bodied like my children, they have been affected tremendously because they feel that these attendant care givers that are friends hate them. I've had to reinforce with my five-and-a-half-year-old that, no, this person doesn't hate you, they've just been taken out of the house. This is why we need to be protected.

I have to hang a picture of one attendant care giver on the fridge so that my son won't break down because she can't come to our house any more. That's not fair and it's not fair for me to sit here as a mother and say, "I am disabled and I am sorry you have to go through all of this, having people come in the house, but it's not your fault that they left and it's not my fault either."

The Acting Chair: Thank you very much. I think that was very, very necessary to put on the record.

The committee recessed at 1208.


The committee resumed at 1810 in Centennial Hall, London.

The Chair (Mr Charles Beer): I'm not sure whether to say good afternoon or good evening, but I think it's after 6 o'clock so I'll just say good evening, ladies and gentlemen, welcome to the first set of hearings of the standing committee on social development in London. My name is Charles Beer and I am the Chair of the committee.

I wonder if I might ask -- and I see they have already decided to do that -- to move into the chairs in front of us. It may be easier to see and listen to all of the tremendously intelligent questions that are going to be asked tonight as well as the presentations. We're delighted to be here. We have a full schedule of hearings, both tonight and tomorrow.


The Chair: Without further ado, we'll call upon our first witness, the representatives from the Parkwood Manor home for the aged, if you'd be good enough to come forward and make yourselves comfortable. I think I should tell you that you're not supposed to touch any of the buttons on these machines. They tend to self-destruct or bite back, or both. You'll see the red light come on. If you would be good enough just to introduce yourselves, not only for the committee but for the purposes of Hansard, then please go ahead with your presentation. Welcome to the committee.

Mr Robert Moreton: Thank you. My name is Robert Moreton. I'm administrator of Parkwood Manor, a home for the aged in Waterloo. Judy Zieske, who is our development officer for our fund-raising arm, has come along with me this evening.

I'm appreciative of the opportunity to appear in front of you this evening and relieved to see that it isn't a standing committee, that indeed there is a place to sit. I would like to read from my presentation exactly as outlined. You may have a copy in front of you at this time.

The Honourable Frances Lankin, Minister of Health, said in the Legislative Assembly on December 7, 1992, in reference to Bill 101, "The legislation before us is about funding and requirements of accountability in nursing homes and homes for the aged."

It's primarily because of those two components that I come to you today as administrator of Parkwood Manor, a non-profit charitable home for the aged in Waterloo, on behalf of staff, residents, the board of directors and families.

I had the opportunity to serve for a three-month period, from January to March 1992, as a consultant for the Ministry of Community and Social Services, interpreting and answering questions to various stakeholder groups on the public consultation paper, Redirection of Long-Term Care and Support Services in Ontario. With some missionary zeal, I bravely touted to all my audiences the four basic principles of the redirection's renewed vision, which I'm sure by now have been held over your heads as Damoclean swords: primacy of the individual and his or her right to dignity, security and self-determination; promotion of racial equity and respect for cultural diversity; importance of family and community; and equitable access to appropriate services. After all these years and several evolutions of the consultative process, I was naïve enough to believe the gospel I was preaching, and the time lines, I had been led to understand, were in place for the introduction and implementation of legislation and guidelines.

Towards the end of 1992 we saw a copy of Bill 101 and the first draft of the Long-Term Care Facility Programs and Services Manual. Neither of these documents fulfils, by language or implication, the four basic principles. Perhaps by now you've heard this message frequently and may perceive it is unsubstantiated paranoia.

Parkwood Manor, like many charitable homes in the province, is running at a deficit. We have now budgeted a third such year, losing over $250,000 on a $1.5-million annual budget. With anticipated deficit funding of $90,000, our losses for the 1993-94 fiscal year would be reduced to $160,000.

Our home is non-unionized and staffed below current Ministry of Community and Social Services guidelines, although we pride ourselves on offering a high standard of care and a degree of warmth in caring that is no better anywhere.

We have previously had the opportunity to share with Elizabeth Witmer, MPP for Waterloo North, the feelings of residents, family members and staff concerning the redirection legislation. I quote some of their comments to give you a flavour of our home and our concerns.

The slanted print that you will see at the top of the next pages are excerpts from the comments of various staff, family members and others.

Merna and Bruce Chambers, family members, had this to say: "We are glad mother can live in a place where she feels comfortable with others of her own cultural and religious background. It was more by good fortune than by design, because we were not given a lot of choice. We trust that that option will be open to all seniors in the future.

"The placement coordination service which will be incorporated under the proposed service coordinating agency is of great value to the community, eliminating confusion for seniors and their families looking for services. Everyone's concern about long-term care reform is that it will not increase costs unreasonably. We wonder if the SCA will add an administrative layer in the delivery of services or even create a bottleneck in accessing services if its case load becomes too heavy.

"We applaud the level of service given at Parkwood, the home-like atmosphere and the dedication of staff. The consultation paper states that `The government will ensure a consistent standard of service and quality of care in all homes for the aged and nursing homes across Ontario.' We caution the government to be alert to the preservation of the maximum, not the minimum, standard of care and to carefully determine the degree of controls imposed that may affect time spent with the residents, staff morale and paperwork."

Parkwood's comments are in the bold print at the bottom of the page.

You will have heard "choice" mentioned hundreds of times. We fear that the all-powerful authority given to the service coordinating agency will restrict this.

We applaud the extension of existing placement coordination service networks. Waterloo is blessed with an excellent one.

Accountability measures in Bill 101 and the draft manual suggest more time spent on paperwork, to the detriment of resident care.

Eileen Baxter, another family member, comments, and I would just read the paragraphs that are bulleted:

"I hope the government, in its emphasis on deinstitutionalization, doesn't ignore institutional needs. As the numbers of elderly increase, a freeze on the number of beds in the province may not be practical. Money for support services in the home must be limited to a threshold which balances wise use of tax dollars and the needs of the senior citizens.

"For economy and security for family members and aged relatives, nothing can replace affordable 24-hour supervision and care that a place like Parkwood provides."

We acknowledge the importance of helping the elderly remain in the community for as long as possible. However, Bill 101 does not currently provide for admissions for basically social reasons.

We also agree that to be accountable to the taxpayer, the government will probably not be able to afford expanded community support, as suggested in the redirection paper.

Linda Bruder, one of our dietary aides, writes in her last paragraph:

"Other departments," meaning other than dietary and nursing, "including housekeeping and maintenance need additional staffing, but we are aware that this cannot be added without increasing our deficit. We hope that the government will carefully examine all components of care when it determines daily rates for facilities."

From this we have concluded and concur that graduated funding for nursing care provided is a noble aim. Our current per diem cost for extended care is $96.78; unionized municipal homes run much higher. Will we be able to staff according to need, which has been our concern for almost 10 years now?

Also, the fixed accommodation and program charges do not currently take into account service provision for heavier needs.

Connie Dimitroff, one of our registered nursing staff, contributed the following:

"A demonstration of the changing care needs is explained by the following two charts: The first shows the increase of care required by particular individuals. The second shows the results of studies done between 1988 and 1991. It's interesting to note that the acuity rating, or minutes of actual care, in 1986 was 3,592 minutes, jumping to 6,028.5 minutes in 1988 and to 9,502 minutes in 1991. In that period of time, staffing in the home increased by only a third. The simplest interpretation is that staff are working at least 50% harder than they were five years ago!


"Besides the increasing frailty and complexity of care needs of our residents, other factors have increased our workload. These include: increased paperwork; more psychogeriatric needs; greater turnover of residents, as they are admitted later in life and have shorter residency here.

"A levels-of-care funding is welcomed, but it must address all the components of care. We hope that the resident classification system which we will determine the home's funding will be fair and foolproof.

"We have a strong concern that in its emphasis on deinstitutionalization, the government has not adequately planned to channel enough funding into homes for the aged and nursing homes, which still remain the option of choice for many and offer the greater security and highest quality of life at the most reasonable cost."

We feel the imposition of intrusive inspections, violating trust, autonomy and undermining morale will add an even greater burden to staff. We have no evidence from what we have read that staffing ratios will improve.

The following two pages are the charts referred to in the previous page, the first one showing, from right to left, the increases in care requirements for a number of our residents. You can see it almost doubling in some cases.

The following table, which you need to look at by turning your page, refers to progression of acuity ratings from 1988 to 1991. Referred to in the second column is our resident status -- you can see we are a small home -- the amount of nursing care given and the amount of nursing hours that were available at the time. The last three columns indicate the decreasing number of people requiring under 90 minutes of care, and the last column, the increasing number of those over 180.

Ethel Saunders, one of our Parkwood residents, is very dear to our hearts. We consider her our poet in residence. I think to close the representation of folks from our home, it is appropriate if I read something she has written.

"At first it is just a room and we put up with it as we did perhaps with a rented house. But gradually we bring in a few things from our former home -- a special chair, our TV or radio, an afghan for the bed. But that's not all we bring; we bring the aura, that invisible radiation from the body that we can sense in others, if we but listen to it, of content, happiness, or the opposite, of misery or sorrow, etc. So we go into our room every day and, depending on the luggage we bring, that intangible something spreads out and fills what was once just a room; a rented house becomes ours, our special place, our home.

"It doesn't really matter whether the building is big or small, it's what we bring to it that counts, whether we have a house, an apartment or a room. We make it home by our very thoughts. A well-loved article, a picture or a special piece of furniture will reflect back into your aura and into the room, and it in turn can be sensed by others when entering, and they will be apt to say, `My, what a cosy room,' or `a lovely room,' and you know it is home."

Ethel puts her finger on the nub of our concerns around the intangibles that make a house a home which no legislation can measure or guarantee. In support of this, I quote the following position paper on Choices and Alternatives, printed by our provincial association in September 1991:

"Home is an attitude: Policy makers like to suggest that seniors would prefer to remain in their own homes at all costs. But what really is the preference of seniors? Is it where they live or is it assurance that his/her lifestyle, independence and dignity will be preserved? That is, when a senior states, `I want to remain in my own home,' it could mean, `I like my own familiar things around me, I am afraid of change and I want to be able to control my own life, eat the food I like to eat, wear the clothes I want to wear and continue with my physical routine.'

"Institutionalization can be attitude as opposed to the actual physical move. Living in a facility does not preclude the ability of a senior to live his own lifestyle. The facility is able to review the needs, values and preferences of individuals and work with them in determination of services and programs that best meet these needs. An evaluation is necessary to determine whether the quality of services and lifestyle of the senior is richer living alone in his or her home receiving packages of services or living in a facility with a family environment, psychosocial supports and health care. Government policy and funding must support quality of life for seniors, regardless of where they choose to make their home.

Quality of life is dependent on many factors, not simply the provision of physical care. Government must acknowledge that a tolerance threshold for community-based services exists for the family unit. There is a service level at which both the care givers and the care recipient benefit from facility-based care.

Bill 101 goes a long way in bringing together long-term care under one legislative umbrella, in creating a more user-friendly and equitable system. The system overhaul is long overdue. We support the bill and urge its swift passage incorporating the changes in wording to the Charitable Institutions Act as suggested by the Ontario Association of Non-Profit Homes and Services for Seniors in its February brief to the committee.

Some of these changes were ones that allow participation in placement decision-making by the home, resident and family as well as the service coordinating agency; that will permit appeals by the charitable home regarding admissions; that will take into account existing physical characteristics of facilities; that will protect the climate of partnership that has existed between homes and the Ministry of Community and Social Services and discourage an adversarial and inspectoral system.

In closing, I would like to thank the committee again for the opportunity to appear before you. I feel somewhat that this issue is similar to what the secondary schools are going through with their destreaming at the moment, where there opponents are complaining of poor timing and lack of working detail; that is, the curricular and finding frustrations.

Our concerns are probably the same as many you've heard. We need to know funding levels at the earliest opportunity. There are other things we question, such as an income-based user fee, which we can see will only cost the government more money. We're unsure whether married couples will be able to live in the same institution if one is well and the other is not. We applaud what I heard from Mr Quirt last week concerning capital funding, that the aim will be to direct it at priority of need. We are pleased to hear this.

In closing, thank you again. Please help us as soon as you can.

The Chair: Thank you very much for your presentation, and in particular the poetry of Ethel Saunders. I think that sets it all out in a very fine fashion. We have a number of questions and we'll begin with Mrs Caplan.

Mrs Caplan: Over the last days of hearings we've heard a number of concerns very similar to yours, and some of the suggestions that have been made vary slightly from the recommendations of any particular group. One of the ones that I would like to ask your opinion on would be an amendment on the issue of admission that permitted any long-term care institution to deny admission on the basis of the fact that appropriate care would not be available in that institution and then have an appeal process if that wasn't satisfactory and also then allow, by regulation, to look at what was meant by appropriateness of care. That would take into account the physical characteristics as well as the availability of staffing or the multicultural nature. Those could all be spelled out by regulation. Could you respond to what you think that kind of amendment might do for this legislation?


Mr Moreton: I can see it would be a very favourable amendment. We are fortunate with our placement coordination service in Waterloo, where we have a very collaborative relationship with them and they understand our difficulties. I guess our fear is that perhaps with the change of personnel they might use their rights within the bill as a club, and we might not have such a happy relationship.

Mrs Caplan: So you would want enabling legislation that would foster and support those kinds of ongoing relationships.

Mr Moreton: In order that the home would have the opportunity to participate in the decision as much as the placement coordination service agency.

Mrs Caplan: The other recommendation that we've heard from a number of presenters is that rather than the adversarial inspection system that exists in the bill today, there would be another alternative, one that mandated accreditation, perhaps by the health care facilities accreditation association, both accreditation for management and programming on the basis of their standards that are set and also a mandate for some kind of a quality management program to be developed within the institution. Then the accountability back would be how that program functioned and what the result might be as determined by the accreditors. Would that solve your concern around adversarial inspectors?

Mr Moreton: The bill and the draft manual do specify that a quality assurance program should be in place, so I assume that will remain, and I don't quarrel with that. We are not an accredited home. I have always felt that we are providing everything that accreditation would demonstrate, and for us it hasn't been an economical thing to do because the money we would spend on accreditation would cancel out the little bit of increase we'd get in subsidy.

On this subject, I can only repeat what a Ministry of Health representative said at the meeting at the Marriott Hotel last week on this question, that perhaps accreditation was not the tool that would work out the best since it was focused on policy rather than on demonstrated quality; in other words, the feeling that you could have a lovely shelf of policy and procedure manuals and yet not be following any of them and be tested in what you had in writing rather than the atmosphere end of what was actually happening. As we have not been accredited, I can't speak to the truthfulness of that, but I thought it was an interesting comment.

Mrs Caplan: What would your suggestions be, then?

The Chair: Last question.

Mrs Caplan: Last question? What kind of a replacement would you have instead of the adversarial inspectoral system that is proposed in this bill? What would your suggestion be to ensure that accountability of quality of care and good management of the facility?

Mr Moreton: I'm not asking for a withdrawal of any sort of compliance officer, inspector or whatever you call the policeman. I think the main thrust from homes for the aged that I sense, and feel myself, hearing things in the nursing home sector, is that we feel it is a demoralizing process they go through; if it can be just a softer approach, again, a more collaborative working together. I think a lot of the wording of the act has got to reflect that. We can still work the same way we always have. We will cooperate as we do with the health inspector, but nobody shakes in their boots when she walks in the door. That's just the sense we have now, and I guess that's why I referred to paranoia in my opening remarks, because I'm sure you've had a sense of that from many speakers.

Mr Jim Wilson: Thank you very much, Mr Moreton, for really an excellent presentation. It's very useful to the committee since you were involved in the process and helped sell the process in its initial stages. It's quite courageous of you to appear before the committee and share your points of view with us. Elizabeth Witmer did speak with both Cam and I about the home. A question that was left in her mind, or that she left in my mind, was, because you're not accredited now and given your funding shortfall and your deficit position, just in general terms to come up to the standards that may be required under the new service agreement arrangement, what type of hardship is that going to place on your home? Given that you probably have in the back of your mind some idea what the government's new rates are going to be and the availability of funding? I want to know what kind of hardship that may place on your residence and on your home.

Mr Moreton: I can't predict at the moment because I do not know any of the dollar figures, which we've been pressing for. We hope that at the February 24 meeting we will actually hear some numbers. We budgeted for a 12-month period, from April 1993 to March 1994, taking the worst possible scenario but feeling that we may very well have to roll with that. I really can't give you an answer until I know the deadlines for compliance, what grandfathering of certain things there will be. I'll have to know more of the rules before I can give you an answer.

In a general sense, if it robs staff of direct resident care time and we can't afford to pay for it, obviously it's going to have an immediate effect on the care of the residents, but I wouldn't hazard a guess whether it is.

Mr Jim Wilson: That's fair. We find that with a number of homes, because all of the information isn't available yet from the ministry.

I want to go back to a point that you made under Eileen Baxter's comments, and it's point number one, where you obviously are very familiar with the draft manual and its eligibility criteria. You make a very good point here, because it's a point that's often made in my own riding, that admissions likely won't be allowed, as you word it, for "basically social reasons."

The committee is aware of the experience I had when the government was going around talking about long-term care redirection and we held an evening in a particular municipal home for the aged and I had a couple of ladies come up to me afterwards and express the fear that in fact they may have to move out of the home because they wouldn't necessarily qualify under what was being talked about.

I said: "Well, no. Don't worry about it. We'll straighten it out." She said: "Thank God. I've peeled enough potatoes." She was damned if she was going to go back and be the labourer for the family on the farm. She was having a great time in Simcoe Manor in Beeton. She happens to be a cousin of mine, so I don't feel bad using her as an example. Can you give us your thoughts on that?

Mr Moreton: I can't quote the figures of waiting lists throughout the province for homes for the aged and nursing homes, but for Parkwood again, to be specific, we have 20 on our extended care waiting list and 20 on our residential waiting list, and with a turnover of only 12 to 15 residents a year, those folks are going to have to wait.

I am concerned about the eligibility criteria if someone who has been on the waiting list for a period of time is bumped by someone who is determined to be a greater priority by the SCA. If those priorities will be basically heavy or physical care and take precedence as emergency admissions, I can't see the person who needs -- their loneliness, their desire for company, unable to manage, kind of borderline -- ever having a chance to come in. That's my fear.

Mr Jim Wilson: Do you see the SCA or the placement coordinator's role as perhaps intentionally choking admission to the homes? I appreciate your early comments when you said this legislation doesn't appear to fulfil the promises made and the language used to sell redirection and long-term care reform earlier on, and I get the distinct suspicion that what we're setting up is a way to choke admissions so that people will be forced to stay in their homes and find other alternatives, rather than go into nursing homes or homes for the aged.

Mr Moreton: This is my sense from what is spelled out. Again, to me it depends on the staffing of the SCA and how flexible it can be, but obviously the strict interpretation would be very harsh for some people.

Mr Jim Wilson: I'm just about finished, Mr Chair. The government will tell you that its intention is otherwise, but I won't believe it until we see some changing of the wording of this legislation and of the policy manual. I hope your association and you yourself will keep fighting along those lines.

Ms Judy Zieske: May I make a comment?

The Chair: Please go ahead.

Ms Zieske: My mother is on the waiting list for Parkwood Manor, and probably if this goes through she'll not be able to get in because her need is mostly social; from a small social surrounding, only child -- I do not give a large social support, being a single parent -- and probably she will not get in for that very reason.

The Chair: Mr O'Connor.

Mr O'Connor: Maybe I could just pick up right from where you left off. It's a good point. I realize that in drafting legislation quite often it's in legalese or some other language that isn't really easy to read. So when you talk about the intentions, and of course the redirection paper, the consultation paper went around, you wonder where that got left out. I think we'd like to try to put that back in there somehow.

Is it your feeling that a centralized placement coordination would then limit the choices of your mother? Here's your mother needing to get into some sort of housing that's going to supply her needs, and currently you would have to put her on a waiting list. Is there only the one, or would you have her on a waiting for maybe two or three or would you put her on a waiting list with the placement coordination service and state your choices? What would be the best, do you think?

Ms Zieske: She has stated the three choices that she has requested. Her primary choice is to come to Parkwood because I work there and I could be a better support for her. Being a single parent, I cannot be the support of what is expected, and not having a lot of brothers and sisters, I'm her sole support. I have a great fear that when she gets more isolated due to not necessarily significant health problems but through blindness and some other things, she will not go to Parkwood or to any other home because she will not qualify. She will not be ill or have strong enough medical needs to go.


Mr O'Connor: One thing we did hear was that people may perhaps go there with their spouse into a setting that's going to take care of two needs at once. What happens if one of the spouses dies? I don't believe there would be the intention that we would be sending that other person back to find a room in a rooming house or anything like that.

Perhaps we should get some clarification from the ministry people, because if that's the case, then I think we've a serious problem on our hands. If I could, through the parliamentary assistant --

The Chair: Yes. The parliamentary assistant has a couple of points that he wanted to make. I'll allow that and then I'm afraid we'll have to move on.

Mr Wessenger: Let me just say that the point of clarification that the other parliamentary assistant raised is the one I wanted to have staff clarify, so I think that works out very well, if I could do that.

Mr Quirt: Geoff Quirt, acting executive director of the long-term care division.

You've raised a very good point about the eligibility criteria and the way the description of those criteria in the first draft of the manual reads. I think the point you've raised is that often someone's requirement for assistance with the physical activities of daily living may not be a major factor in determining whether admission to a facility is appropriate. As you would well know, there are many people who require a great deal of assistance with the activities of daily living who get that assistance from family and friends who would never consider putting their name on a list for admission to a long-term care facility.

So in determining whether someone can be adequately served in the community, in determining eligibility, many more factors other than their physical limitations have to be taken into account: their family circumstances, if they are isolated, lonely and afraid of being alone in the community. That can be a major factor in determining whether they can be cared for adequately in the community.

Part of the process in determining eligibility is also to make sure that clients make informed choices once they understand what's available to them in a community setting, and also that they know what options they have vis-à-vis facility placement. I think you'll see that language and that intention more clearly spelled out in subsequent drafts of the program manual.

I'd remind you as well that the manual is not a static thing. We have asked for the assistance of both provider associations and consumer groups to work on a regular review committee on that manual to make sure it reflects to the greatest extent possible a consensus about how services can best be delivered in the facilities.

The Chair: Thank you very much for coming before the committee, particularly with the inclement weather and coming as you do through what is normally the worst of it. We appreciate your presentation.

If the committee would bear with the Chair, I want to just note a couple of changes which I'd like to make in our schedule. I would like to thank the representatives of the Victorian Order of Nurses, who are here but who have agreed to the following.

You'll see on your schedule the presenter at 9 o'clock for the Ontario Advisory Council on Disability Issues, who requested if possible to come earlier. I would like to meet that request and invite her to come forward. I would also note, while she does so, that there are representatives as well here this evening from PUSH, Persons United for Self-Help, who were to be on the schedule -- at least the one we had, but I think there has been some confusion -- tomorrow at 6. They are here, and I would like to allow them to go forward as well. So if we can do that, I think that would facilitate everyone, and again, with thanks to the Victorian Order of Nurses for allowing that.


The Chair: We'll proceed, then, to our next witness. Professor Van Hoof, if you would be good enough to introduce yourself to the committee and for Hansard, and then please go ahead with your presentation.

Dr Shirley R. Van Hoof: Thank you very much. I'm Dr Shirley Van Hoof. I am chairman of the Ontario Advisory Council on Disability Issues.

On behalf of the Ontario advisory council, I appreciate the opportunity to speak to you today. In general, council supports the redirection of long-term care and welcomes the shift in focus from institutional care to supporting people in their own homes.

The Ontario Advisory Council on Disability Issues was established in 1975 to advise the government of Ontario on matters of concern to persons with disabilities. Council provides its advice to the Minister of Citizenship, the Honourable Elaine Ziemba, who in turn brings those concerns to the attention of the government. Council members come from different parts of the province, different backgrounds, and have different disabilities or advocate for persons with a disability. Currently, there are 14 members on council.

I will begin with some general comments and then focus on such specific issues as community supports and direct individualized funding.

Council believes that the Ministry of Health can achieve significant savings while providing services that are universal, consumer-controlled and community-based.

Council supports the principles of the Premier's Council on Health, Wellbeing and Social Justice. However, certain issues need to be addressed in order to meet the needs of persons with disabilities.

During their education, health care professionals must be made aware of the right of persons with disabilities to be self-managers and self-decision-makers. They must be made aware of the abilities of persons with disabilities, the importance of independent living, and the importance of an holistic approach to health care, including networking with community services and resources.

Basic care must respond to an individual's needs, including the provision of interpreters, guides or translators.

Health care must not be apportioned according to the person's ability to return to gainful employment.

Psychiatric issues have been ignored or sidestepped too long. Attitudinal differences between medical and psychiatric conditions must be investigated and eliminated. Community supports for persons with a psychiatric disability are at least as important as for those with a physical disability.

Council strongly recommends that community supports be increased now for persons with disabilities who have chosen not to live in institutions. I plead with this government not to abandon persons with disabilities and the elderly in this reform of long-term care, as has been the case for the deinstitutionalization of persons with psychiatric disabilities. Beginning in the 1960s, many psychiatric hospitals in Canada were closed, but the promised community supports never materialized. Many of these same people can be seen living on our streets today.

I am terribly concerned that the reform of long-term care is now showing signs of repeating these mistakes. Council has heard that the home care hours available per month have been cut back, while recovery time in hospital has been shortened. Thus, people who are being discharged from hospital are indeed not sent to hospital when significant support and care are needed. It is irresponsible to begin withdrawing services from institutions, either acute or chronic, before equivalent support services are available in the community.


Council knows of a 21-year-old who had to be admitted to a nursing home as the care giver's back had been injured while transferring the person. Home care was not able to supply the hours needed to assist this young person to arise in the morning and retire in the evening each day. The cost of just a few days in a nursing home would easily pay for home care for the full month. The problem in this case is that the dollars come from different pockets. I think the government knows what that means. It's that one pocket often doesn't know what the other one is doing or one hand doesn't know what the other one is doing.

Council believes that direct individualized funding gives choice, flexibility and control. Direct individualized funding gives the person with a disability as close to normal choices as possible. They would get to choose who assists them, when they get assistance, where they are assisted, with what they are assisted and why they are assisted.

Now, these are normal choices that everybody gets to make, but when you live within a supported living unit or have an assistant under another program, you don't get to make those choices. You get who comes through your door to help you into bed at night or get you up in the morning. You don't have a choice.

With direct individualized funding comes the right to hire and train their own attendant, take their attendant with them to work, visiting, on vacation or wherever they need assistance. Their responsibilities would be to manage their scheduling, finances, employees and personal affairs in the most appropriate manner.

It has come to the attention of council that renewals of orders in council can come as often as every six months. One mother stated that it was devastating to continually have to say the depressing truth about her son's poor outlook for the future and list his many disabilities so often. With lifelong disabilities, frequent reassessment is unreasonable. I think you have to realize that many disabilities are lifelong, improvement is not expected and often deterioration is what the future holds. Continually having to be reassessed and renew your application is very difficult, because you often have to say very bad and depressing things about yourself or your child. I think that if you can come to some reasonable agreement about when these renewals should come up, timing is a big thing.

Council believes all persons who need assistance should be eligible for direct individualized funding. They could choose direct management of the assistance or an advocate to assist them or take over full management for them. Those who do not wish to use this new support system can continue on their own present system.

Council believes that direct individualized funding would give persons who need assistance more control over their lives. Family relationships would be normalized to be interdependent, not dependent as so often happens now. Persons could live where they wanted, as their assistant would not be tied to their residence, which is now usually the case. Work, recreation and vacation could all be enjoyed as the attendant would be present if the person chose.

Council believes that with the assistance of attendants persons are empowered to plan and participate in life fully. Although the recipient is appreciative of the help, he no longer needs to feel beholden to friends and relatives for continual help. Persons can feel that they can do things themselves. There is nothing like the new-found freedom of inviting guests for dinner and not having to ask them to assist in preparing the meal.

In summary, the Ontario Advisory Council on Disability Issues continues to support in principle social legislation brought forward by this government. Our support for long-term care reform remains and we look forward to continuing to work with you.

Long-term care is an issue of vital importance to persons with disabilities in this province. It is imperative that the momentum of this reform be sustained. While I recognize that recent changes to cabinet have resulted in new ministers of Health and Community and Social Services, this restructuring must not be allowed to impede the progress of this reform. Persons with disabilities and the elderly of this province have been waiting patiently for almost a decade for some fundamental changes to the system.

Council strongly recommends that community support services be strengthened and funding increased dramatically, that institutionalization of the elderly and persons with disabilities be an option accessed by their discretion when necessary for their continued care. Referring to the person before me, I think it has to be the discretion of the person involved, whether they enter an institution or remain within their own home.

Council also strongly recommends that amendments to current legislation proceed quickly to allow universal availability of the direct funding option for attendant services.

I thank you for hearing me today and if there are any questions I'd be pleased to answer.

The Chair: Thank you very much, Dr Van Hoof, for your presentation and we'll move right to questions.

Mr Cameron Jackson (Burlington South): Thank you, doctor, for an excellent brief.

I wanted to go directly to the amendments in the Ministry of Community and Social Services Act. I'm dismayed by the reference to funding that "may" flow from time to time, and words which I'm sure you find unusual, that may be "appropriated by the Legislature," which is rather a unique phrase in law. Generally a program is entrenched in law, but this says the disabled "may" have access to funding if the funds are specifically allocated by the Legislature. That's very unusual in legislation. I'd like to get more of a focused response to you on how much confidence you have in the way that is currently worded.

Dr Van Hoof: We've been very, very unsettled by the lack of progress. As you know, Mr Charles Beer is here today. He promised us 500 positions of individualized funding back three or four years ago, and it really is disheartening that we've had to wait this long. Now we are at a point where they're saying this is going to be a pilot project, with no numbers: they don't tell us how many numbers will be available.

Orders in council have been in use since 1977 and it has proved very good. It seems to work and I just don't understand why it has to be a pilot project; why we can't go ahead with the funding, because we know it saves money. You don't pay for bricks and mortar when a person's in his own home. If you're in an institution you're paying for bricks and mortar; you're paying for light and heat; you're paying for all kinds of things that, if people live in their own home, they pay for themselves, and all the government is paying for is someone to come in and help them for a certain number of hours a day. I think not only is it good for the government, it's good for the people, because they have their things around them; they have their people; they follow their normal routine.

I think it's a win-win situation. I would like to see the funding entrenched and it not be a pilot project but a startup program. You may have to start slow. I like the 500 number; that's what we lobbied for at that time, so you get your feet under you, I think, and get to know the system a little bit better.

Mr Jackson: Doctor, I'm sorry to interrupt you. My colleague asked the question the other day and the response we got was that they had no information with respect to any pilots -- no numbers of spaces, no dollars allocated -- and we have to accept that as fact, from this government.

What is of concern to me is that, separate and distinct from long-term care, we have a document which indicates that the Ministry of Community and Social Services has to make a $1-billion-plus cut to its budget over the course of the next three years. This legislation speaks to the differently abled community, raises expectations, but absolutely nowhere can we see one ray of light that there's going to be some kind of response with the program. I don't wish to sound negative: I'm trying to be deadly practical here, pragmatic, but all the evidence out there is that this is not a priority in the context of this legislation for this government, and we're not seeing it mentioned anywhere. The $1-billion-odd cuts to Comsoc must just have the differently abled community shuddering.

I know my colleague wishes to comment, if there's time.


Dr Van Hoof: I'm afraid it does make us very nervous. The only thing that we can hopefully depend upon is, if they're trying to save money, we think this does save money. We think it does help out. As I say, I think it's a win-win situation. If I can only appeal to their wallets, I would say that this is a good program.

Mr Jim Wilson: Thank you, doctor, for your comments.

You also looked at the fact that you felt that while the direction and the intent of reform in the long-term care system is good, perhaps the government put the cart before the horse. We've had 5,300 hospital beds closed since this government came to office; 2,800 ONA nurses laid off -- we're not sure of all the other figures that belong to other unions and the non-unionized -- VONs laid off throughout the province, including Waterloo, which is going through a tremendously trying situation with public health nurses; we've seen eastern Ontario VONs laid off. Would your strongest recommendation be something to the effect that there should be a moratorium on any further layoffs and hospital bed closures until the government actually gets community-based services up and running?

Dr Van Hoof: Certainly. Two years ago, we made a presentation to them asking that they not move at all on institutional downsizing until the community supports were there. They promised that would not happen. They promised that they would have the community services up and running, there'd be no sweat, because they knew it was a better program. It hasn't happened.

I fear that we're going to be back in the situation that the psychiatric patients are in. It's been shown that hospital beds are down, that they are not admitting patients to hospital as they were when they need support systems. They are counting on the community services to absorb them, and they aren't able to. So we're in a very difficult situation and it's going on as we speak.

Mr Jim Wilson: And in spite of this bill, it's projected to get worse with the Comsoc cuts.

The Chair: I'm afraid we'll have to move on to Mr Hope. Just for the record, that announcement was in the spring of 1990.

Dr Van Hoof: The spring of 1990, so that's three years.

Mr Hope: Mr Jackson used the words "a ray of light," and I'd like to use the phrase, "ray of hope," because I believe the opportunity is here to make progressive change, and I think this change in the act is one that's very much needed.

We heard a presentation this morning about a young lady with two children, and the attendant care would only take care of her and not her two children. I think if we look at this legislation -- everybody's fearful of legislation, because we never know what the lawyers have come up with in developing the wording -- I guess it's the intent of the government.

There are a couple of questions I have to ask you. Through this process, I've heard a number of things and I've been trying to understand where they're coming from. Some people are asking for the attendant care aspect to be somewhat regulated. I heard you use the word "training," training your own staff or training your own individuals.

Dr Van Hoof: Yes.

Mr Hope: I'm hearing people saying, "No, there has to be a training mechanism for these individuals to meet certain criteria before they can become..." and I just wanted your viewpoints on that.

Dr Van Hoof: I really don't like that. I would like them to be trained perhaps in first aid, perhaps in lifting techniques, perhaps in ways not to drop me or anyone else, those kinds of things -- safety issues -- but don't train them how to give me a bath or how to dress me or whatever, because that is a very personal thing, and I know how I would like things done. It has to be the consumer's wishes that are brought to the fore.

So often in hospitals, things as mundane as taking urine samples -- being a doctor, being in a hospital is a very scary things. You see a nurse come in and take the urine sample out of the urine bag that's been there for four days. You know it's got to be growing something and you say: "Please, that's not how you take a urine sample. I've been doing this for three years and this is how I always do it, and blah, blah." So of course they put you on antibiotics because your urine bag's infected.

What happens in the home is going to be the same thing. If you train them in community college, they're going to come into your home and say, "This is how you wish someone; you start with the face and you down the arms etc," instead of listening to how the persons want things done and how they want their home arranged. Already my housekeeper comes in and says: "Wouldn't the lamp be better at the back of the table? It doesn't look right at the front of the table." Well, I can't reach it if you put it at the back of the table, and then I have to have someone even turn my lights off and on.

It's important that the consumers be in control, that the consumers basically train their helpers to do things their way, the way they want them. It's my house; it's my body. I would like my helper to do things my way. With the regimented training they will get in the community college, they're going to come in thinking they know best how to help me, and I don't think they do. I think, as I said, the lifting techniques or whatever would be fine to keep them safe and me safe, but don't train them in all these other things that are better done left to the consumers or their advocates. If it's a child, the parent will know how best to handle so-and-so, and if you do it a certain way, it's going to upset the child or the person. Routine is a thing that I think is hard to break, and if a child has been raised that you do things in a certain order or a certain way and a helper comes in and wants it done differently, then it's going to be very hard on the child to make that change.

I think the consumer has to be in control of this thing. You're going to waste a lot of dollars training people to do things and then they're going to want to run the show. The consumer has to be in control. Don't waste your money on training them.

Mr White: If I understand correctly, at the moment, in order to receive attendant care that's consumer-driven, consumer-directed that you are in control of and that maintains dignity in your life, that requires an order in council.

Dr Van Hoof: Yes.

Mr White: So it's something above and beyond the law as it presently exists.

Dr Van Hoof: Yes.

Mr White: Now, with the amendments that we're presently looking at, it will now be possible, under law, to do that --

Dr Van Hoof: Yes, it'll be --

Mr White: -- with the approval of an area office or the minister's office or whatever.

Mr Jackson: Maybe.

Mr Jim Wilson: If you're in the pilot project.

Mr Jackson: Maybe.

Mr White: Is that correct?

Dr Van Hoof: That's what we're hoping for. I'm hearing maybes and such. I know we have been promised, as well as politicians can promise us, that this is going to be a fact, you know, and I really hope that it does come to be because it'll be cost-saving for the province, it'll be dignity-saving for us, it'll put us in control of our lives. I listed the differences it's going to make to us. It'll give us a freedom that you take for granted, that everyone takes for granted. When you go somewhere you can do whatever you need to do; you can go to the washroom when you're at work.

But right now, if I have attendant care where I live, I can't take my attendant to work so I basically can't go to the washroom at work unless they supply me with an attendant. It becomes very problematic with leaving my house. I can't go out for dinner or whatever because I can't take my attendant with me. But if I pay them, then I schedule them for how I need them and I tell them what I need done, where I need it done etc.

Mr White: And with this happening --

The Chair: I'm sorry, Mr White; your time's up and we still have another set of questions. We're running out of time. Mr Wessenger.

Mr Wessenger: Thank you very much for your presentation, Dr Van Hoof. Contrary to what Mr Jackson said, the language in this legislation is normal legislation and is all questions, really, involving programs. It's the political will that's relevant, not the wording in the legislation.

Mr Jackson: I wasn't questioning that.


Mr Wessenger: I'd like to just ask ministry staff to clarify with respect to the whole question of the pilot project aspect.

Mr Quirt: Yes, I'd like to clarify that the funding for the direct funding pilot is available to us from the commitment of $441 million to invest in community services in long-term care, and in developing the pilot we really had two choices. We could have designed a pilot program and said, "This is how it's going to work and this is how much money we're going to spend in this many sites with this many people and these are the types of things you can do with the money." We chose not to do that and we're working with a group of people who represent consumer interests, consumers of services, who are people with disabilities, and we've met three times with them. We'll continue to meet with them to design the pilot collaboratively, as opposed to government designing it in isolation.

Dr Van Hoof: Excuse me. Is that the Attendant Care Accident Coalition you're meeting with?

Mr Quirt: They are represented on the group we are meeting with, to the best of my understanding, and as I mentioned to the committee this morning, we'll be developing a short report on the progress to date of those meetings to design the pilot and provide it through the parliamentary assistant to the standing committee on social development. We'd be happy to provide you with an update of our work towards designing the pilot project that we hope would be implemented this fall.

Dr Van Hoof: I'd appreciate that.

Mrs O'Neill: Thank you so much for coming, Doctor. You have revealed a lot about your own personal difficulties. I know that's not always easy and I thank you for that.

I wanted to ask you, as chair of the Ontario Advisory Council on Disability Issues, we see nothing in the legislation about children with disabilities. Has that been part of your discussion at all on your advisory council?

Dr Van Hoof: Yes. This year children have been our focus, and we have family profiles of 10 families that emphasize the problems they have had in getting services. Through orders in council, families do have funding for attendants to go in and provide assistance to the families during the day. They also have a program for respite care. So they do have programs through orders in council, and as I stated in my brief, I would like to see anyone who needs assistance to be eligible for the direct individualized funding, whether it goes directly to the person or to someone who cares for him or her, such as parents, or whether it's through someone who I decide should manage my funding, because not all people can manage the funding. If I would like to appoint someone to help me or to manage it completely, that's who I think -- I think everyone who needs assistance should be eligible for this direct funding.

Mrs O'Neill: So you're speaking on behalf of the children or their advocates as well in the direct funding mode.

Dr Van Hoof: Yes. I don't have authority to speak for children because we don't have children on the advisory council, but certainly their presentation to us indicated that this would be beneficial to them.

Mrs O'Neill: Okay. I just wanted to ask you, "Council strongly recommends," and your first statement says, "Community support services be strengthened and funding increased dramatically." You know what the condition of the provincial budget is.

Dr Van Hoof: Yes, I do.

Mrs O'Neill: I know you've stated that it would be more cost-effective. Do you really think this is going to happen out of Bill 101? I'd like you to say a little more about how you think that can happen in 1993 in Ontario.

Dr Van Hoof: I think if they take a look at dollars going to be saved by providing care at home -- I stated the problem with the 21-year-old who had to go into a nursing home because his care giver hurt her back. If you can keep that person at home, you're going to save thousands and thousands of dollars by providing -- all you're going to be paying for is -- they probably need three hours in the morning and three hours in the evening and perhaps, I don't know, two hours some other time. You're not paying for the institutional rate that you're going to have to pay for day after day after day for that person in the nursing home, and you're not going to have to pay for other care for him because of the setting he's in. A 21-year-old in a nursing home is not a good place to be, because the care is not geared for that age group at all. They may need psychological counselling; they may need all kinds of things afterwards, you know. So the costs are great for putting that person in a nursing home, and I think if the government can ever stop thinking about pockets and think about the overall cost to the government --

I have to digress a bit. It reminds me of persons being transferred between hospitals for tests or whatever. The person is sent by ambulance. The cost is $181 to transfer, even if it's two blocks, for that ambulance to take them. A lot of these people can be put into wheelchairs and put in an accessible taxi for $20, but it comes out of a different pocket. The person at the hospital just signs a chit for that ambulance to come and go. If they take him by taxi, there's money or some kind of different mechanism that person has to pay for. Because it's easier to sign the chit for the ambulance, that person's sent by ambulance. That happens all over the province and costs megabucks to this government.

We've lobbied about this as well. Get your heads straight that the bottom line is the money. You're going to save $150, probably, every time you transfer a patient by sending him by accessible taxi. The same goes for the money you're going to save by keeping that person at home rather than putting him in a nursing home. It happens to elderly couples where usually the female is the nurse and provides nursing care to the disabled husband. If for some reason she cannot do that and he goes into a nursing home, even for a week, you could have paid for a helper to go in and help that family maintain the person in the home. Usually, if that person goes into a nursing home, it's weeks or months before he gets back into his residence. During that time this government has spent money. I know it comes out of a different pocket, but it's still your money and my money that pays for that.

Mrs O'Neill: Thank you so much for your personal and professional contribution tonight.

Dr Van Hoof: Thank you for hearing me.

The Chair: I'm sorry to have to end the questioning, Doctor, but we want to thank you for coming. If I can just briefly wear an old hat, I agree with you completely about the orders in council. I think one of the things that I recall most as minister that I just kept thinking about a system that badly needed overhaul was why were we dealing with a number of these issues through orders in council. We really have to find another way. I think that's the principle there. Let us share with you the hope that it's really going to become something very meaningful. Thank you again for coming.

Dr Van Hoof: Thank you very much.


The Chair: I would like to call for the representatives from Persons United for Self-Help. Just for those who are keeping a scorecard, following PUSH it will be the Victorian Order of Nurses, Grey-Bruce, then I. C. Funding and the London Regional Psychological Association, all of which I believe are with us. Again, I want to thank everyone for allowing PUSH to come forward at this point in time so that it can make its presentation.

Welcome to the committee. If I had known, Bonnie, that you were going to be here, I'd have brought my "Flying on My Own" sweatshirt. It's good to see you. If both of you would introduce yourselves for the committee and Hansard, then please go ahead with your presentation.

Ms Bonnie Quesenel: My name is Bonnie Quesenel. I'm the chairman of Persons United for Self-Help in the southwestern region. This entails from Windsor right to Tobermory. The gentleman with me is John Moran, who sits on the board of PUSH and is an active member on the para transit advisory committee.

My presentation is going to be more or less on the act to amend for attendant care for direct funding. I want to thank you very much for this opportunity to speak to you tonight. I appreciate it.

Good evening. I'm here today on behalf of a group of consumers across the province who have lobbied for over seven years in support of self-directed attendant services for people with physical disabilities. Our most visible contribution to date was a conference held at Woodeden in May 1990 for consumers, family members, service providers, ministry policy analysts and political representatives. The purpose of the conference was to shape the expansion and enrichment of attendant services within a changing social, economic and political environment in Ontario. A more specific goal was to create options and new models for attendant services in Ontario and to propose a five-year implementation plan for our model.


The conference was a success. The CBC taped the proceedings and produced a half-hour program outlining our achievements over the three days. Charles Beer, then Minister of Community and Social Services, applauded our efforts and told us in his keynote address that policymakers were listening and responsive to our proposals.

We had ample reason to suppose that this was indeed the case when, 10 days after our farewell luncheon, Mr Beer announced the creation of a direct funding pilot project for 500 individuals across the province. In addition, he declared the government's intent to enhance supported living options and fund approximately 1,000 new spaces in attendant care outreach.

Alas, summer came and winter and spring followed in their natural order without any follow-up on these very public commitments. We initially suspected our abilities to communicate our message clearly and effectively. However, as this stack of documents to my left shows, we and our allies have been clear and consistent in articulating our message over the years. Our message has remained unchanged over three changes of the political guard. Let's take a look, and then I'll summarize our position.

Independent Living: The Time is Now was produced by the Ontario Advisory Council for Disabled Persons in 1987. Independence and Control: Today's Dream, Tomorrow's Reality was produced by the Centre for Research and Education in Human Services in 1988. Helping to Shape the Future is a document resulting from a conference on attendant services in 1988. Self-Directed Attendant Services: Toward a Consumer Oriented Policy and Perspective on Personal Supportive Services was published in 1990. Flying on My Own is the result of our conference of May 1990.

Audrey King, a consumer and lobbyist of long standing, set the stage with an address from which I now quote briefly:

"Behind the Ontario government's long-term care reform are various assumptions which seriously threaten the notion of autonomy and independence. These are as follows:

"Adults whose disability requires attendant support are `dependent' and therefore need to be `looked after.'

"Only the `experts,' those schooled and skilled in health and community services, really know what is needed and who is qualified to decide and deliver this.

"Needs arising from physical disability are the same for everyone, regardless of age, cognition or circumstance, and therefore can be most affordable, accessible and appropriately addressed through a single assessment and service delivery mode."

Our proposals were guided by the following philosophical statements and resulting principles:

Whereas it is recognized that citizens with physical disabilities have the same rights and freedoms and responsibilities as other citizens; and

Whereas full participation in society is an essential means of exercising rights and responsibilities; and

Whereas exercising choices and control in one's life is fundamental to full participation,

Therefore, we hold to the following principles:

Self-directed attendant services are an essential support to some citizens, to enable full participation in society.

The enhancement of full participation of the citizen with a physical disability in society must be inherent in the design and operation of self-directed attendant services.

Recognizing there is a variety of individual capabilities, citizens with physical disabilities have that right to exercise the highest level of choice and control over said services, including the administration of resources.

Recognizing individual lifestyles, citizens with physical disabilities have the right to exercise choice and control over all aspects of self-directed attendant care services.

Self-directed attendant services are a reasonable accommodation which enables the citizen with a physical disability to meet his or her basic human needs and rights, and therefore should be provided free of cost to the consumer with a physical disability.

Self-directed attendant services are distinct from other services such as health care and welfare in that the consumer is the centre of expertise for his or her own services.

Individuals who perform attendant services are engaged in valued and essential activities and should be compensated accordingly.

The level of resources for self-directed attendant services must be sufficient to support full participation in society, as determined by the citizen with a physical disability.

Recognizing the citizen's right to freedom of movement, attendant services, as service to individual persons, must be free from ties to specific physical locations and must be fully portable.

Our action plan contained goals that were progressive over a one-, three- and five-year period. We addressed direct individualized funding, the issue of flexibility in various service types -- for example, outreach and support service living units, or SSLUs -- and the issue of portability in outreach and SSLUs.

We have proposed the establishment and progressive increase of the direct individualized funding option for consumers who choose to manage their supports. We propose that this option be continuously evaluated by ministry representatives and consumers to ensure both consumer satisfaction and cost-effectiveness, and that independent living centres be funded to act as resources for consumers in this process.

With regard to the issue of flexibility, we proposed that the current guidelines be amended to expand outreach hours of availability to 24 hours per day and to provide hours of service based on individual need, removing the three-hour-per-day maximum. We recommended that an inclusive process be developed whereby SSLU budgets would be calculated on a basis of individual needs. We asked that individuals, rather than programs, determine funding levels.

With regard to the issue of portability in outreach and SSLUs, we proposed a gradual expansion of attendant services for individual consumers outside the home. Such an expansion would respect the needs, the right and the responsibilities of individuals to participate fully in the socioeconomic structure of our society. We want to learn, work and travel. In short, we want to contribute, but find ourselves at this point needlessly restricted by outdated funding mechanisms.

I conclude now by again referring to the stack of documents to my right. Each of these reflects a coherent philosophy, resultant principles and action implications. Our message has been clear and our message has been consistent: We're against medicalized, professionalized care. We're for rights, responsibility and contribution. Let's begin direct funding now, before it's too late.

The Chair: Thank you very much for your presentation. I remember very well that meeting at Woodeden. There was a remarkable sense among all the people who were there that spring in 1990, and I'm sure it does look like a long time ago.

We'll begin the questions with Ms Carter.

Ms Carter: My remarks will be directed to the previous presenter as well. There was some mention of changes in the government and so on, and I would like to mention that I am parliamentary assistant to Elaine Ziemba, the Minister of Citizenship, who has indeed stayed in place. I think the kind of thing that you're saying is very much part of our concern and I don't see any discrepancy between our philosophy and what is being put forward here.

As you probably know, my colleague is Gary Malkowski, who is of course deaf and functions through interpreters. He's a very strong advocate for the point of view of disabled people, obviously.

We have already passed Bills 74, 108 and 109. They went through in December of last year. The object of those bills was empowerment for vulnerable people, and I think that is laying a foundation already for the kind of thing we want to achieve, that people's wishes can be respected. So this idea of individual responsibility and having your wishes carried out is really the cornerstone of our policy, and of course Bill 101 does include direct funding for attendant services. That is in there. That is part of it.


I just wanted to mention and ask for your comments on other things that the government is doing; one is that we're bringing forward job equity legislation. I don't know whether you're familiar with that. There are four designated groups that employers must employ in proportion to their representation in the population, and of course people with disabilities is one of those groups. So I think that would help to achieve the kind of total picture you're asking for. Do you have any comments on that?

Ms Quesenel: Most definitely. We're quite pleased about having that. There are some reservations, only to the extent that we are worried that employers may want to fill their quota, so to speak, and people really want to be hired for their abilities, not their disabilities.

Ms Carter: Absolutely. Part of the philosophy that leads us to this is that you do employ the best person for the job, and of course a person with a disability can be the best person for a job where their disability is not relevant, where it's the rest of the person that's applied.

Ms Quesenel: Most definitely.

Ms Carter: I think that's the philosophy we're putting forward. Also, of course, we have the Jobs Ontario Training fund, which is taking people who are currently on welfare or whatever and helping them to train with specific employers. There are even child care spaces dedicated to that so that somebody who has a family is not excluded.

The Chair: Question please, Ms Carter?

Ms Carter: Of course, another component in this whole picture is suitable housing, and I think we are moving forward on providing suitable housing.

The Chair: Thank you. Sorry, we have a number of people who want to ask questions, so we're going to have to move on.

Mrs Caplan: On a point of order: I thought in her speech, the parliamentary assistant --

The Chair: No, Mrs Caplan.

Mrs Caplan: No, I can't do this?

The Chair: I think we'll just move on and be of good cheer tonight.

Mr Hope: Thank you for the presentation. You bring about the reports from PUSH; Dick Santos, who used to be my executive assistant in the Ministry of Community and Social Services, brought the reports as soon as I hired him on to make sure that it was one of the initiatives that we do.

Ms Quesenel: Good.

Mr Hope: But with that, you talked about the supportive services, living units, and I want a question around the non-profit housing aspect that's going on and the units that are being designated disabled units. Is that being helpful?

Ms Quesenel: Oh, most definitely. But while that is well suited for many people, there are a lot of people who are in their own homes and apartments now who, like the person before me, if given proper moneys, could have their own care right in their place and wouldn't have to move.

Mr Hope: What I was doing was just going over your one-, three- and five-year periods for direct individual funding, outreach and support services. So most of these will be obtained in what we're trying to do with this act?

Mrs Caplan: It's already there free, Randy.

Ms Quesenel: Yes.

Mr Hope: I know, Elinor, we missed the point when you called it.

Mrs Caplan: My frustration is just bubbling over listening to the rhetoric from my colleagues in government. It's now two and a half years since you've been in government. You could have moved ahead if this was a priority for you, and it's terribly frustrating for me to listen to this kind of rhetoric.

I was also appalled this morning, frankly, and I think the parliamentary assistant for Ms Ziemba owes an apology to the people who have been coming before us, because of the language she used this morning when talking to someone about those who use the facilities in this province. Rather than referring to clients or residents or patients or consumers, she called them inmates. It seems to me that is a gross lack of sensitivity and it is worthy of an apology at hearings of this nature. When you reminded me just now about your position with the minister, it's just -- I've been upset about it all day. As consumers, you have come to this committee, I think, with a plan that -- I don't see anything funny about it, Mr Hope.

Mr Hope: You intimidate, let me tell you.

The Chair: Order. Can we just direct our questions to the witnesses, please.

Mrs Caplan: Yes.

Mr Hope: It's a good thing you were the Minister of Health.

The Chair: Order, please.

Mrs Caplan: The point that you've made in your excellent presentation today is your concerns that the legislation as it stands right now takes away from the consumer the opportunity to control, to risk if they wish and perhaps remedicalizes. Can you give us some advice or specific amendments to this legislation that would achieve what you're hoping for and what you have been waiting for for so long? Is there any specific section of the legislation that is particularly offensive as it relates to independent living?

Ms Quesenel: That we don't have to wait for three readings; get right to it.

Mrs Caplan: Given the wording in the legislation, the point that I'm making -- I don't know that it's possible. We've been waiting for three years, and with the Legislature not even in session, I don't know that that's possible. Although they could have gone ahead with their pilot without the legislative framework over the last two-and-a-half years if they had wanted to, because the precedents of order in council are there and available. So I understand that.

But you did mention very specifically in your presentation the concern that you have that what is being proposed is not going to achieve the goals that you've established. Is there some wording in the bill that you've noticed which is offensive to your organization, or are you satisfied with it and just want to see it go ahead?

Ms Quesenel: We just want to see it go ahead.

Mrs Caplan: Fine. Thank you.

The Chair: I'd now call on our next questioner. Welcome to the committee, the member for London North, Ms Cunningham, who's joined us.

Mrs Dianne Cunningham (London North): Thank you. I was just about to say the same to everybody else. Actually, this is London Centre, but these days I represent all of London, so welcome to the great riding of London.

The Chair: And with that non-partisan beginning, Ms Cunningham will now ask you questions.

Mrs Cunningham: Having said that, I would also like all of you to know that the two people before the committee this evening are probably two of the best-versed, probably two of the hardest-working people on behalf of the community that they represent. I've always been proud to have their assistance in the work that I've done because I can tell you that I have to go to them for good advice. So we're really pleased to have you here, Bonnie and John. I know you do so much, but this is very special.

I'm going to ask a question with regard to what's been happening, at least since I've been at Queen's Park in the last five years. I'm very aware, as are my colleagues, of the reports that have been written with regard to independent living. I'm as frustrated, I think, as everybody in the room, except that I don't have the power to do anything. So I'm looking across the table right now, because we don't always have to wait for legislation to do some of the things that are necessary. You've got your chance, so we'll be watching; I mean it. I can remember what the government members said over the last five or six years when they were in opposition with regard to independent living.

I'm looking at section 19, John. You probably won't have this one off by heart, but if you don't mind, I want to look at it.

Mr Chairman, I don't have the act, so I'm going to have to go by memory. But one of the concerns that's been brought to my attention by the groups in London is that they talk about goods and services in section 19. Perhaps, Paul, you could speak to this as well.

One of the great concerns that the community has is that it chooses its own attendant care givers. It's been something that has been put forward in probably six or seven documents that have been produced by independent and government studies over the last five years, and I know them well because it was new to me and Mr Beer, you know them as well.

Will this section, in your view, take care of that concern. Number one, you get to pick your own care giver, or whatever -- however you want to put the word -- does goods and services take care of that and in fact, do you then think that the whole process of grants for persons with a disability will take care of that concern? Is that what you read into the legislation -- and anybody else who wants to respond to that -- because that was the intent as it was put to me; is it going to meet our needs?


Mr John Moran: It will be people who will be provided by paragraph 19(11)1.

Mrs Cunningham: Is that the way you read it? Are you confident that's what it means?

Mr Moran: Goods and services to me is not necessarily -- services might imply an individual but not necessarily.

Mrs Cunningham: Could you offer some suggestions for wording that would make it more clear?

Mr Moran: Probably something like support services, which is fairly general and would imply possibly technology and possibly an individual or perhaps a range of individuals. Some people are going to require assistance 24 hours a day, and that's why the support-service living unit exists.

Mrs Cunningham: And support services could be defined somewhere in the legislation, then?

Mr Moran: And as broadly as possible and applied as broadly as possible at this point. As my chair said a few moments ago, it is tied to the home and to services directly related to living at home and not related to work, recreational or vacation time which I think all of us enjoy. That certainly does limit, even for a disabled person who was working a full-time job -- the cost of an additional individual taken on a trip means that many people, given the option to go on a trip which may well be to an accessible location organized by a group where disabled participants are encouraged, are still going to find that the costs are beyond their means.

Mrs Cunningham: What about the word "may."

The Chair: One more question because we have --

Mrs Cunningham: I'll let my colleague ask.

The Chair: Go ahead with yours. I'm saying you'll have one --

Mrs Cunningham: Will my colleague have a chance?

The Chair: -- and then Mr Jackson and then the parliamentary assistant has a comment.

Mrs Cunningham: I'm waiting for the PA to respond.

The Chair: I think Mr Jackson's comment relates to yours.

Mrs Cunningham: At the end is fine. Okay. Well, it's permissive legislation, Bonnie, and I think we had a discussion with another group a couple of weeks ago who came into my office and said they preferred to see the word "shall" in there as opposed to "may." John or Bonnie, if you can get on --

Mr Moran: "Shall" or "will" depending on the grammar of the day.

Mrs Cunningham: Won't this be a great celebration if we ever see this happen?

Ms Quesenel: Most definitely.

Mrs Cunningham: Thank you.

Mr Jackson: Very briefly, John, to demonstrate our concern that the government doesn't need this clause in order to bring in the program, and everybody agrees and understands that: The Minister of Health, I think, made four funding announcements to date on long-term care that pre-empt this legislation and yet your program was not mentioned. Is that part of the concern you have, that you're not in the first four items of funding where there were enhancements, where moneys were being allocated, that nowhere were you mentioned at all?

Mr Moran: I believe I read in one of the announcements, either November 26 or December 2 -- and I'll be fair: those are the only two announcements I've seen from the former minister -- that information regarding direct funding, as the acting executive director said, was being proceeded with but there was certainly nothing in there about specific numbers or implementation and methodology.

One of the concerns I have is that the individual who is taking direct funding is going to be so burdened down with paperwork that he'll be spending all of his time filling out forms and not be able to have a life because of the paperwork. I hope that when direct funding comes, there will be an option so that an individual might purchase from an organization the administrative support to do the necessary paperwork, particularly from an organization which has been doing it for a number of years, knows the legislation and the regulation and can do the work somewhat more speedily than somebody who's just learning the regulatory ropes.

Mr Wessenger: I must say first of all that Mr Jackson and I generally differ on interpretation of most things. I would prefer to rely on legal counsel, who indicate that legislation is necessary to establish a pilot project, although, as an indication, an order in council can work for an individual.

Mr Moran: It certainly has, Mr Wessenger.

Mr Wessenger: But with respect to the --

Mr Jackson: That is a crock and you know it. Who told you that?

Mr Wessenger: With respect to the other item, Mr Jackson, if you just keep quiet --

The Chair: Order, please.

Mrs Caplan: Where's your legislative --

The Chair: Order, please.


The Chair: Order, please. The Chair has the floor. I want to be very clear. We are here to listen to the witnesses. Let's just remember that. We'll have plenty of time to debate.


The Chair: Order. I want to just make clear we are here to listen to the witnesses answer questions. We can have our debate later.

Mr White: I have a point to clarify with respect to --

The Chair: I would just ask everyone in their language to please direct their comments to the witnesses, not to other members.

Mr Wessenger: With respect to the matter of the definition of goods and services, that is the broadest language you can possibly use in the legislation, so that gives the widest scope with respect to authorizing expenditures by the person with the disability. If you wish to have the language narrowed, certainly we would be very interested to hear your views on that, but the reason why that language is used is because it gave the broadest scope, the broadest powers with respect to --

The Chair: Thank you. Would you like to respond to that?

Mr Moran: Only that it's an interesting view and that I'll take it under advisement. We may consult with ARCH, the Advocacy Resource Centre for the Handicapped. They may be able to come up with their definition of those particular words as compared with other words which might be in section 19.1.

The Chair: I would say that if, upon reflection, there's something further to that point that you'd like to bring to our attention, please feel free to send a note to the clerk and we'll circulate that.

Mr Moran: Thank you, Mr Chair.

The Chair: I want to thank you both for coming before the committee for your presentation and particularly for the spirit of your remarks.



The Chair: If I could now call on the representatives from the Victorian Order of Nurses, as you make your way to the table, may I thank you for putting your presentation off until we had heard from the two previous groups. We appreciate it. We also recognize that, coming from Grey-Bruce, you may have had to fight your way through snow and various impediments. Welcome to the committee. If you'd be good enough just to state your name, then please go ahead.

Mrs Catherine Goetz-Perry: My name is Catherine Goetz-Perry. I'm the executive director of the Grey-Bruce Victorian Order of Nurses. I would like to preface my brief by stating that I would like to thank you for the opportunity to speak to the standing committee. My presentation is threefold: first, presenting general comments from the VON's perspective as to the long-term care redirection and movement in that vein; second, specific comments on Bill 101 from a provincial VON perspective; third, I would like to give you a flavour of what is occurring in the great white north, or part of it, and the impact that locally Bill 101 may have on a community's services.

VON has a vision of long-term care that consumers requiring long-term care services to promote their health and wellbeing will have a choice of needed services delivered in their preferred location by their preferred provider within available resources. VON recognizes that the growth in health care has been exorbitant and must be capped. However, a provincial strategic plan should be developed with funding allocation based on strategic priorities. The government should look at where the growth is and stage its funding allocation accordingly.

Funding community-based long-term care as an alternative to inappropriate use of acute care resources and institutionalization is a step in the right direction, but the government should ensure that there is a viable funding base in the community to sustain the proposed shift. This can be achieved by financing an increase in long-term care by staged reallocation of the existing health care budget.

To support community-based care, certain core programs should be in place. We suggest integrated homemaker expansion, respite care for care givers and in-home palliation as some examples.

In the area of planning, VON supports the government's direction to be as inclusive as possible when discussing the needs of the disabled and recommends that the needs of the physically challenged, children and adults with chronic disease and high-risk elderly be given equal consideration. Planning responsibilities should be clearly defined, with the recognition that the farther away decisions are made, the more things get lost. The real authority should be closer to the people and the consumer. Planning provincially, regionally and locally with clearly defined responsibilities will improve efficiency. The lead role for local planning should be assigned to expanded DHCs with enhanced social service representation.

In the area of allocation of resources, at this point in time the government has been considering the question of devolution of the responsibility for health and social services to local agencies. This is a follow-up to the recommendations of the Premier's Council that recognized the need to have a more flexible and responsive health and social service system in Ontario.

VON would support a government initiative to pilot the devolution concept with long-term care. The envelopes devolved to the local authorities should be inclusive of the long-term care budget, specifically including in-home services, community-based and facility services. This will allow for the flow of funds between the community and the institution as it is in the best interest of the local community, and it may also allow for rationalization of service delivery.

In terms of the flow of funds through bodies to agencies directly for delivering services, VON recommends that no one funding model be attached to the terms of reference for devolution. Rather, there should be flexibility of payment modes available to allow for the most cost-effective alternative given the nature of the service. For example, in terms of the physically challenged, direct payment to consumers whereby they purchase their own service might be more effective than direct funding to agencies. Long-term care clients with multiple-level needs may require a capitation program. VON, in bringing this forward, is attempting to identify that no one funding model best serves the needs of all clients, service providers and the government's need to contain cost yet ensure quality.

In order to ensure that the citizens of Ontario have reasonable access to service, it will be incumbent upon the province to ensure that core services are in place for each community. From the VON perspective, such core services and long-term care should include both in-home community- and facility-based care. Second, the province has a responsibility to ensure appropriate standards of care and delivery are met across the province.

I will leave my general comments at that and refer you, please, to page 9. VON views the amendments included in Bill 101 as movement forward, an incremental improvement in empowering the consumer, which allows for direct funding grants to the physically disabled; starts to standardize legislation for long-term care facilities, but does not replace separate legislation and does not address chronic care beds; ensures consumer access to key information regarding facility services, care, accommodation and consumer knowledge of care plan; and allows for appeal process regarding eligibility for service.

VON supports these incremental improvements and recommends that these changes be expanded to include similar requirements for chronic care beds and requirements for residents' councils in all long-term care facilities.

VON recommends that consumers have a choice of whether to receive needed services in a facility or a community setting within an envelope of available resources, in short, to ensure the consumer has a choice of service location.

VON recommends that if the consumers require and they or their surrogate decision-maker choose facility care, they have the choice of what facility to enter rather than having the decision solely made by a placement coordination service.

While supporting the incremental changes proposed to protect and increase the involvement of the consumer in their care, VON believes that the tone of the amendments is incremental and not comprehensive and thus not empowering. It would be most unfortunate if this happened. Therefore, VON recommends that Bill 101 amendments be delayed until the publication and public debate on the government's long-term care are complete.

The government is moving ahead on Bill 101, and the message that's sent is that it's still more interested in institutional care rather than developing community care options. Today, in Ontario, the resources allocated to institutional care, specifically chronic beds, extended beds, residential beds, far exceed the resources allocated community in-home services. By proceeding with legislative changes for facilities before developing and publicly debating the policy framework for long-term care redirection, the government is reinforcing the status quo institutional bias.

The legislation promotes fiscal accountability by a control on resource utilization rather than on measures for resource outcome. Examples include controlling the number and types of beds, as well as associated costs and a further list.

By moving ahead with facility legislation outside of the long-term care policy framework, and prior to local district health council planning, the government is not supporting its own direction for a strategic, policy-based approach to the health care system based on consultation. The legislation allows the government to designate the number of beds to require certain types and capacity of beds for certain levels of care, service, programs etc, but does not reference these requirements in terms of any planning process provincially, regionally or locally.

VON recommends that the legislation be deferred again until a policy framework is released and debated, and that district health councils planning for a long-term care be referenced in the legislation in terms of the designation of numbers and types of facility beds.

Bill 101 appears to ensure the continuation of a centralized funding of extended care beds, given the absence of reference to chronic care beds and the separate funding of these beds. VON strongly recommends that the government move away from centralized, fragmented funding to district funding authorities with a long-term care envelope that includes community-based, in-home and facility service provision. Only then will we see a significant redirection in long-term care from institutional to community-based care and the development of flexible, cost-effective services reflecting the community need and priorities.


Although funding of long-term care beds is not addressed in the legislation, from government discussion VON understands that the level of care funding will be introduced in regulations.

At a time when the government is considering the need for flexible funding and service delivery models, specifically capitation, case mix-equity blend with global budgeting, the government should consider the possibility of multiple funding options for long-term care facility beds. However, VON does agree that the current funding model of per diem funding is a disincentive to caring for residents with complex needs.

The new model should also have fiscal incentives for rehabilitation and discharge.

VON suggests that the development of comprehensive multiservice agencies by VON and other community agencies funded by capitation may significantly reduce the bed requirements by providing more comprehensive and potentially more cost-effective options in the home.

Prior to expending facility services, other community-based options should be considered; specifically, by having the funding envelope locally administered, more flexibility will be possible.

Finally, VON also supports a provincial role in long-term care facility planning by the development of provincial standards and requirements for care programs, including care facilities and access to a review of community programmatic decisions.

In the area of placement coordination VON recommends that the devolved long-term care management board or agency should house the placement coordination service. Since the board would fund all services, it's logical for that location.

VON supports the concept of expanding placement coordination province-wide or a key component of home care redirection. VON currently administers eight placement coordination services, so we have knowledge.

VON has concerns about the lack of consumer control over the location of sources in the expanded role of placement coordination and recommends compelling the coordinators to ascertain and provide the consumer's choice of service location.

Now I'd like to address some of the local environment in Grey and Bruce counties to give you a flavour for the impact in a rural area of the province.

Grey and Bruce counties have a population of over 141,000, and over 72,000 households dispersed over 3,400 square miles. The area only has one city over 20,000 in population. Over 15% of the population in the two counties is over 65, and there's been an 18% increase in that population since 1986.

The Grey-Bruce District Health Council has played a pivotal role in health planning in the district for several years -- we're fortunate -- and is well into its planning role for implementation of announced long-term care initiatives and outcomes of Bill 101.

There has been an agency by the name of the Home and Community Support Services Agency established in 1992 under the regional long-term care board and our local district health council with responsibilities for COMSOC-funded volunteer programs supporting the elderly and disabled adults, including Meals on Wheels and volunteer services.

Work has started on preparing a regional plan for palliative care services, investigating needs for respite care and adult day care and restructuring hospital roles and responsibilities.

The Grey-Bruce District Health Council and the Ministry of Health have known for some time that the allocation and the existing number of long-term care beds in Grey and Bruce far exceed the provincial average and ministry recommendations.

In 1989 the Ministry of Health did a review of two hospital building projects in our area for the Meaford General Hospital and Bruce Peninsula Health Services. At that time recognition was given that in total, out of those two hospitals, which are both under-80-bed hospitals, that 30 beds in total -- chronic care -- could be eliminated if community support services were available.

Grey and Bruce have no placement coordination service but have over 11 hospitals servicing the area. The Grey-Bruce home care program administers the acute and chronic home care program and the integrated homemaking program in our area. The client case load for the home care program has increased over 14% in the last two years. There's also been a dramatic shift in case load within the acute and chronic programs. Two years ago the distribution was approximately 20% acute clients and 80% chronic. In 1992, year to date, it has now shifted to 45% acute and 55% chronic.

Grey-Bruce home care contracts with two community agencies for homemaking services under the home care program and the integrated homemaking program, three community nursing services -- two for-profit and one not-for-profit -- and three oxygen therapy companies. Home care itself supplies therapy services. Client assignment to homemaking and nursing service is done on a random basis, with no choice offered to the client. Clients requiring multiple services may have more than four agencies involved in their care.

VON Grey-Bruce has recently completed a research study with partial funding from the Trillium Foundation on respite care, focusing on the needs of the care giver. We had a response that one in five households had someone receiving care in the home, or a 19.6% prevalence rate. There have been no prevalence studies done on care givers within the province of Ontario.

The problems of care receivers tended to be chronic, permanent or terminal; 46% of those care givers indicated they receive no assistance from their family or outside agencies, so close to 50% were doing it on their own. A third indicated that they would benefit from some help, assistance or training. The type of help, assistance and training they recommended was for independence in the area of education for themselves and relief. Three quarters of the care givers were female, married, with an average age of 51; 40% of those women worked outside the home, and two thirds of the care receivers were female, with an average age of 69.

Based on our local situation, VON Grey-Bruce recommends that consumers have a choice whether to receive needed services in a facility or a community setting within an envelope of available resources. Based on the Grey-Bruce experience, it's evident that excess resources have been allocated to institutional care, and reallocation of resources to community and in-home services to meet the demand has not yet occurred. Therefore, VON Grey-Bruce endorses the recommendation that Bill 101 be delayed until the publication of the government's long-term care redirection policy frameworks, in the hope that funding will be available in developing community care options. Implementation of Bill 101 may help perpetuate the local situation of excess long-term care beds and not address the need for rationalization and reallocation.

By moving ahead with facility legislation with implementation, the government in fact will hinder the what has appeared to be successful comprehensive planning undertaken by our local district health council. The Grey-Bruce District Health Council is preparing to address institutional care requirements under the umbrella of the long-term care policy framework, not separate and distinct from it. VON Grey-Bruce recommends that the implementation of the legislation be delayed and referenced under the district health council's plans for long-term care.

VON Grey-Bruce is taking steps to provide comprehensive, multiple services because of private client demand. Presently, we're providing comprehensive nursing services, including high tech and palliative and supportive care. We are now introducing home health support and homemaking services. In fact, tomorrow I am doing a presentation to the local home care program, asking to contract for homemaking services.


We endorse the development of comprehensive multiple-service agencies and delivery of such services to clients to reduce fragmentation experienced under the present local home care system. VON Grey-Bruce recommends that the government consider flexible funding options for long-term care facility beds and for residents in the communities with complex needs, and that the funding options be responsive to the client choice.

VON Grey-Bruce endorses and supports the expansion of integrated homemaking programs province-wide as a key component in long-term care redirection based on the local benefits we have realized from the program.

We support the local need for expanded placement coordination. That service should be housed under the long-term care management board.

No provisions are made under Bill 101 or other long-term care initiatives announced to date for flexible respite care and for care giver support. Based on outcomes of VON Grey-Bruce's research, VON recommends provision be made for these services and that funding be flexible and linked to service site and consumer choice.

The Chair: Thank you very much for a very full brief. I know you weren't able to read all of it, but we have it in front of us.

I would just like to note to members that we'll be able to have one person per caucus and one question. I'm mindful that it's still snowing outside. I also understand the London symphony is about to strike up, although the clerk informs me they are not going to be doing the 1812 Overture.

So with that we'll begin with either Ms Fawcett or Ms O'Neill.

Mr Jackson: The Rite of Spring by Tchaikovsky would be a help.

Mrs Joan M. Fawcett (Northumberland): Thank you for that very well thought out and comprehensive brief. There are just so many questions that you have answered, actually, in this brief. Grey-Bruce reminds me of the riding of Northumberland in a lot of ways in that you, I believe, have quite a rural component to your riding.

Mrs Goetz-Perry: Our population distribution is about 13% urban within Owen Sound and 86% rural.

Mrs Fawcett: And are you noticing large gaps in the services that you are able to provide to the rural community?

Mrs Goetz-Perry: Actually, I believe that services are fairly well integrated to serve the clients. VON is the only community agency that services all of the two counties. We are seeing fragmentation in pockets such as the Bruce Peninsula and south Grey.

Mrs Fawcett: And do you see it maybe escalating if the services are not going to be funded to get ready for --

Mrs Goetz-Perry: If there's no funding reallocation to community services, our home care program will have to cap services available to our clients. As stated in my brief, we have seen a 14% growth within those programs when only 4% per year had been predicted based on budget.

Mr Jim Wilson: Thank you very much for your presentation. It's indeed very comprehensive and one of the more thoughtful and detailed presentations that we've had to date at the committee.

One question, in two parts --

The Chair: Very subtle.

Mr Jim Wilson: -- just on behalf of the VON, though. I represent Collingwood. I'm also the PC Health critic, so I'm very much aware of what's going on in the province and particularly in our part of the province next to Grey-Bruce there. There is no placement coordinating service agency operating in your two counties. Is there any guarantee from the government that the VON will be taking up with the intention to expand the PCS? Will the VON be doing that?

Secondly, along the same lines, has there been any discussion with VON in terms of your agency being a multiservice agency as envisioned under Bill 101?

Mrs Goetz-Perry: I think what VON provincially is waiting for is to find out how the comprehensive multiservice agencies are actually going to function, whether they will be the funding and the service delivery agency or if the comprehensive multiservice agencies will be solely service delivery, with funding coming under a long-term care funding board.

Mr Jim Wilson: Without a commitment in writing -- I mean, there are a lot of presenters who are worried that we're just setting up another whole layer of bureaucracy that may duplicate the efforts being done by the VON and a number of other groups.

Mrs Goetz-Perry: I don't want to presuppose that VON will take on that role. I believe the government's intent with home care programs has begun to address the issue of coordinated services through a case management approach. However, not allowing consumer choice or allowing funding to be flexible such that rather than individual service, multiple service be funded, fragmentation has occurred at least to clients within Grey and Bruce.

Mr Wessenger: I again would like to compliment you on your very comprehensive brief. You've raised so many points that it's impossible to respond to them all.

First of all, I'd just like to explore your comments with respect to the question of funding. You indicated that you wanted to hear funding announcements. Well, I'm somewhat confused by that, because the government has, in effect, announced the $441 million into the community to allocate it among community support, in-home services and support of housing. It's true that the specific allocations among those various categories haven't yet been finally determined, but certainly that announcement is out there. Could you elaborate what you meant when you said, about the funding --

Mrs Goetz-Perry: I guess what I'm focusing on is that the reallocation of funding occur to support the services as they're needed. It has not happened at our local level. We have long-term care beds sitting empty. There's only about a 50% occupancy rate in long-term care beds in Grey and Bruce counties. The district health council has estimated that we have approximately 150 more long-term care beds than we require, yet they continue to be funded in part with obvious increased demand in the community, so I believe personally that we're not meeting the needs of all clients.

Mr Wessenger: What you're really looking for is to what extent community services will be enhanced? Is that more --

Mrs Goetz-Perry: No. I'm looking at to what extent the reallocation will actually occur.

Mr Wessenger: In that area.

Mrs Goetz-Perry: Of the funds announced.

Mr Wessenger: I might also ask you, with respect to the role of a placement coordinating agency -- I assume you want to see that that is the policy intention, that it brings all choices to the consumer, the community choice as well as the institution.

Mrs Goetz-Perry: If you'll refer back to my brief, what we perceive is that the placement coordination service, under the umbrella of whatever management service is set up to distribute funding, make information available to consumers about what options are available within the possible funding envelope and then help to direct those to the appropriate level of care.

Specifically, there are clients with complex needs who can be cared for in the community. A case in point: We just recently lost a client who had several venous-access devices, he was on continuous peritoneal dialysis and he was also disabled. He came back to us from the United States as a terminal client with AIDS. The care he required was intense. On a per-day basis, he required four hours of RN care and then some support care and support to his family. But that care was less expensive than what would have been required if he had been cared for in an institution, and his care would have had to be provided in a hospital, not a long-term care setting, and likely in an intensive care unit.

The Chair: Thank you again for coming to the committee this evening. I hope you'll have a safe ride home.



The Chair: If I might then call on the representative from IC Funding Financial Corp. The clerk is just circulating your brief. Thank you for understanding the somewhat later time of starting. Welcome to the committee, and if you'd be good enough to introduce yourself.

Mr Donald Stevens: Mr Beer and members of the committee, thank you very much for inviting me. I am Donald Stevens. I represent no group; I bring forth no lobby. I'm a businessman whose job it is to assist long-term care facilities in raising capital dollars for their mortgages. With the introduction of the new funding motto, you've both created new challenges and created new concerns in my business. I thought I'd come forward to bring four ideas or four concerns forward for your consideration. They are technical and perhaps much more involved with regulations than they are with policy, but I have no opportunity to talk to the technocrats, so I bring it before you, and you may wish to take it down to them.

The points in front of you are sort of in point form, and I'll just highlight them very quickly. First of all is the concept of the envelopes of funding that go to long-term care facilities. While I, from past knowledge, understand the desire and do support the concept of having the envelopes the way they are, the ultimate concern of the mortgage or capital lenders is that the entire funds available for repaying mortgages must now come out of the accommodation envelope, and the concern there is that the envelope must be of adequate size to provide adequate funds to repay the principal and interest and cover the debt service that's required in the mortgage. So when the minister and her staff have to put together the dollars assigned to that envelope, it's very important that adequate dollars be put into that to allow the lenders to continue to lend money to both homes for the aged and nursing homes.

CMHC, the Canadian body that does NHA mortgage insurance, also has very rigid requirements before it will insure a mortgage, and its needs must be met or it will not approve any insurance for mortgages. Again, I draw that to the attention of the people who put together the funding so that this can be considered when dollars are allocated.

The second concern about the envelopes is the implied liability of the operation, that if there is an overexpenditure in any one of the two first envelopes, that shortfall will not be made up by the government. I would like to bring in front of you that there will probably be a demand or a commitment by the lenders that the shortfall will also not be made up from the accommodation envelope, because by doing that you'll endanger the mortgagor from fulfilling his needs. So while you may write legislation about who picks up the shortfall, be aware that the people putting up the capital may also write their regulations.

I guess it's also important that I've just become involved with helping non-profit homes for the aged raise capital dollars, since it's becoming apparent that -- and as a matter of fact I understand that Mr Rae has recently called for better cooperation between the private and public sectors in --

Mr Jackson: That was in Manitoba.

Mr Stevens: Manitoba. Yes, okay.

Mrs Cunningham: And in France.

Mr Stevens: China was also good. The need there of course is to remember that the cost per bed that they've traditionally lived with has been twice what it's cost to build nursing home beds, and by bringing the two funding models together, which I think is a terrific idea, it's very hard for a funding model to recognize the capital cost of $100,000 per bed within the same funding model as a $50,000-per-bed situation. So I suspect that very shortly, when the models are announced and the dollars are announced, there is going to be a fallout that's going to have to be reckoned with sooner or later.

I've given you a couple of examples in my presentation of the type of dollars required to satisfy mortgage lenders; they're technical and can be passed along.

A couple of very brief last points: There seems to be, in the implementation stage, a desire by the technocrats to have audited financial information on both the care plans and the finances done to one fixed date, perhaps December 31 of each year. This is raising some real concerns in the audit part of our industry, because then you'd have all the auditors doing the audit at the very same time and all of the staff of the ministry receiving all their audit reports at the same time. You may want to consider having that date set whenever, because I've been assured by people who do audits that it can well be handled and you can receive the assurance required that the money was spent as committed, in the right places at the right time, without having to have the reports for all 500 institutions filed on the same day.

Again, I thank you for letting me come here and I want to stress that personally I think it's a strong idea that capital dollars for our long-term care industry be raised from the private sector. They can be induced to provide the loans required to help fund the mortgages for both sectors, but in doing so they have to see fiscal responsibility on behalf of the ownership of the facilities. Thank you very much.

The Chair: Thank you very much. I think this is the first presentation we've had fully from this particular perspective. We very much appreciate your coming before the committee. We'll begin our questioning with Mr Wilson.

Mr Jim Wilson: Thank you very much, sir, for your presentation. It is a new perspective that the committee's not considered to this point. We have talked a lot about the government's penchant for wanting to get rid of the private sector when it comes to the delivery of long-term care health care and we've talked a fair bit and had some pretty heated discussions today about the fact that the government won't release its report. It did a secret report indicating how much it would cost it to buy out the nursing home sector. Thank God for a few whistle blowers down at Queen's Park. We were able to find that out.

What they discovered is that it's going to cost them a lot of money. They can't afford to buy the capital, let alone anything else. Hence, they've backed down, even though what they'll do now, over a number of years, as they've done in day care, is simply drive the private sector out by giving a preference for services to the non-profit sector. The plan's pretty clear. We expect, though, that in the next two years, while they're still the government, they can't do too much damage and we'll do what we can to straighten things out if we form the next government.

I wanted to talk to you about capital, because you talked about it being necessary from the private sector for both not-for-profit and profit homes. The government's been coming up with some creative ways to borrow money and to raise capital with the new crown corporations. They haven't introduced one for this sector yet, but maybe that's next in line. I gather you wouldn't be here if you didn't think Bill 101 was of some threat to potential investors. The one line that catches me says: "If capital is to be raised from the private sector, one way the committee may want to consider is to recommend changing the existing imposed rules for 55% basic ward accommodation. By allowing additional preferred accommodations, homes will be able to raise additional capital dollars, thus making the projects possible." Now, it would be my reading of Bill 101 that we're going in the opposite direction to that. Do you have any comments on that?

Mr Stevens: No, I first of all don't feel that Bill 101 is a threat. What's more of a threat is the lack of decision and the stale, you know, just sitting out here. It was promised to the industry to be implemented January 1 and it hasn't been, and there is no commitment that I'm aware of now of implementation, so the lending industry has just stopped lending.

Mr Jim Wilson: This is the implementation of the new funding formula?

Mr Stevens: That's right. It's stopped. It doesn't know whether it can lend or not. It doesn't know what formula to lend on. It doesn't know what the budgets are. It can't handle applications.

Bill 101 is very ambiguous on how it wants to handle preferred accommodation and puts itself in a tremendous quandary, because in essence the commitment of the minister, as I heard it, as a simple businessman, I guess, was that she was going to make a level playing field between both profit and non-profit providers of service. Up to now homes for the aged have had a different way of charging for preferred accommodation than nursing homes have had and have certainly had a different way of charging for services than our hospitals have had over the years.

It was in the mid-1980s when hospitals caught on with a way of adjusting their losses or deficit or underfunding, whatever they want to call it, by increasing the costs and the number of preferred accommodation rooms dramatically. Perhaps that's helped a great deal. Certainly it's cost me a lot more money on my private health insurance because of trying to fund it, but it's helped that. I don't see a lot of money coming into Ontario to help pay for new services in anything going out there, and one way it can allow for the industry to be rebuilt -- again, both private and public systems -- is to allow a higher percentage of preferred accommodation. That puts money into the system that allows it to make things happen.

Mr Jim Wilson: Are investors worried? We've had some groups come to us saying that of the $208 million of new money supposedly being allocated to this sector, $150 million of that is to come through increased user fees for accommodation. Now, have you seen work-ups from some groups that have come forward and said that there was no way the government can raise $150 million through increased user fees, that it's a bit of a pipe dream? If I were an investor, with the worries and the uncertainty that's out there now, that would make me even doubly uncertain, given there may even be a shortfall in that envelope.


Mr Stevens: My understanding is there's going to be a $10-per-resident-day increase in the residents' share of long-term care stay. As a former chairman of a health council, and spending far too many hours sitting around rooms like this talking about it, frankly I thought that nursing home care was the cheapest place in the world to live. In essence, if you want to live in a ward room in a nursing home, it costs you nothing. You don't have to buy your food, you don't have to buy anything; you just live there for free.

Perhaps we have people there who shouldn't be there simply because it's too damn cheap. I also understand -- I haven't really looked into it too deeply -- that there is some method in place that those who really can't afford the increase can be cared for by some means test. It is unique that the Ministry of Health will be dealing with a means test, because I thought that was absolutely something it never did.

Mr Jim Wilson: It's only on the campaign trail.

Mr Stevens: In essence, the real competition will be that people who now have to pay $10 a day more for nursing home care may well choose to go into private retirement homes where their rates will now be more competitive and where perhaps you don't have to be in a room beside a psychogeriatric patient. Consequently, we're telling my friends in the private retirement home business that perhaps their business might get better, and this may save the government money because you may have fewer people living in your facilities.

The Chair: Mr Jackson, do you have a supplementary?

Mr Jackson: Yes, thank you. Don, good to see you again.

Isn't the major problem we have that there are three elements to long-term care reform and this is only one small part of it, these hearings and this bill that's before us? There's uncertainty about the funding formula. In dealing with lenders you have to basically go forward and say: "Well, show me something from the government that says this is how the formula will work. Show me that they will recognize these as expenses and that we'll be able to -- "

This committee has heard there are several nursing homes that are currently in receivership. I know the number was close to 40 that were on the verge of receivership in this province when the minister made her statement about the amended formula. That situation hasn't changed, so we are potentially talking about thousands of residents in Ontario who are in nursing homes that have this financial uncertainty still around them. They are not aware of it. The average resident is oblivious to all this, but in fact the government isn't, and we still haven't got the information.

Isn't that really in a nutshell our problem at the moment, that we don't have a formula, we don't have regulations and we certainly don't have the actual legislation? We see the rules of the game, the penalties for non-compliance, but we don't see to what extent you'll be able to keep your facilities open.

Mr Stevens: Yes. The crisis is not the philosophy behind it all, but just, "Give us the rules and let the industry go out there and run with it." Again, it's not just the problem with the for-profit, privately owned nursing homes, but definitely as big a problem with the homes for the aged, the church-run operations. They frankly just don't know how to do their corporate planning, how to raise their dollars or allocate their funds.

Mr Jackson: Homes for the aged can get their money through the municipal tax base, that is an option, but not charitable homes for the aged. Municipally run homes for the aged have the option to go to the municipal taxpayer, and that door is open in this legislation.

Mr Stevens: I just wonder if our city fathers are quite prepared for the tremendous shortfall that's about to hit them with this philosophy of paying $90 a day for care they were receiving at $135 a day yesterday. As a taxpayer, I really wonder.

Mrs Caplan: My question really is for the parliamentary assistant.

I want to thank you for an excellent brief. On page 1, at the bottom, you say, "If the government is expecting the capital dollars to be raised from private sources..." I think that's a question we should have answered, because obviously the private sector needs to have some certainty about what government policy is going to be if it's going to be able to respond. We have an anomaly at the present time where the Ministry of Health does not provide capital dollars to nursing homes whereas the Ministry of Community and Social Services does provide capital dollars to homes for the aged. So I would ask the parliamentary assistant if he would clarify his government's policy on the role of the private sector in raising funds for long-term care facilities.

Mr Wessenger: I think with respect to the private sector raising money, at the moment I would agree that there's a problem, until the level-of-care funding is in, to determine whether the private sector finds it financially beneficial to purchase existing homes or perhaps to build new ones. However, certainly the policy of the government is clear. The existing policy is to provide only capital funding for the non-profit sector, and I believe 50% funding is the ratio for both municipal homes for the aged and charitable homes.

The comment I would make is it's interesting that I've had discussions with some private home operators who are considering building new facilities. I think that's an interesting reflection, that obviously some members of the private sector feel the level-of-care funding will solve the financial difficulties.

Mr Jackson: A point of order, Mr Chairman. That is so misleading, that statement. When nursing homes are buying licences and they're buying beds and they're taking small units and amalgamating, that is the growth from the private sector.

The Chair: Mr Jackson --

Mr Jackson: You show me one private developer who's going to build a nursing home unless he has bought licences from small places --

The Chair: There will be time, Mr Jackson, to carry on this debate. Let the parliamentary assistant complete his remarks. You'll have plenty of opportunity.

Mr Jackson: That is completely misleading, to suggest that this augurs well, that the private sector thinks this is great legislation.

Mr O'Connor: He is misleading the witness. Throw him out, Mr Chairman.

Mr Wessenger: I think the policy is very clear. I've stated what the policy is with respect to the government, and that's it.

The Chair: I want to thank you very much for your presentation.

Mrs Caplan: I have one question.

The Chair: No, I'm sorry.

Mrs Caplan: I just have one question.

The Chair: Okay, would you ask your question.

Mrs Caplan: Does the answer that was just given by the parliamentary assistant give you any comfort as to the clarity of government policy?

Mr Stevens: No.

Mrs Caplan: Thank you.

Mr Stevens: The concept, of course, is that many of our clients are faced with the legal position of being told by the government that they have until midsummer of 1993 -- that's about three and a half or four months away -- to have in place solid plans of major rebuilds of their homes or else they may lose their licences, which is losing their business, which is losing everything.

In essence, the government has had no response to that, no direction. Many of them are saying: "You know, we cannot go forward with proposals because we don't know what mix of preferreds to put in our buildings. We don't know what programs to provide. We don't know what staffing to provide. We don't know anything." And this is a 1984, 1985 process from the Honourable Keith Norton all the way through Mrs Caplan's time, right through the process of having to rebuild our facilities.

But they need capital dollars. It's not going to happen unless they can raise funds, and I can't find them the funds if I can't give the mortgage lenders the rules to play by. My favourite thing is called the golden rule: The man who has the gold makes the rules. In this respect, with all due respect to all parliamentarians, it's not your gold; it's the money lenders' gold. They're not going to put it up unless they are certain it's going to be paid back to them.

Mr Wessenger: Might I respond?

The Chair: One final comment.

Mr Wessenger: Yes, just one response. As you may indicate, this cutoff date was originally set in 1988. The only thing I can advise you is that the situation is under review presently.


The Chair: Mr Stevens, I want to thank you for your presentation. As you can see, it has sparked a fair bit of discussion, but I think the points that you raise are ones the committee will want to reflect upon. So thank you very much for coming this evening.

Mr Stevens: Thank you very much.



The Chair: I now call on the representatives of the London Regional Psychological Association, if you would be good enough to come forward. I believe there are representatives here. Sorry, here we are. I was looking through a wall there. Your presence may be at just the right moment. Welcome to the committee. As you can see, the members are very alive this evening.

Mr Hope: Cut them off the coffee.

The Chair: We appreciate your presence. If you would be good enough to introduce yourself to the committee and for Hansard, then please go ahead with your presentation.

Dr Edward Helmes: My name's Edward Helmes. I'd like to thank the committee for the opportunity to make a few comments here on behalf of the regional psychological association. We have about 80 full members in our group. That represents about 60% of the practising psychologists in the area.

I think in general we would be very much in favour of any attempts to improve services for elderly and disabled individuals in the community, so we feel that this entire process of redirecting in long-term care has many opportunities for improving things for delivering services to these groups. Tonight I think I'll limit my comments to the changes that are proposed as far as Bill 101 goes, just to limit some of the possibilities for discussion.

One feature of the act that we note is that it does not make provisions for providing services to other disabled individuals, notably the ones with the serious mental disorders, the ones with developmental handicaps and the people with acquired brain injuries. These conditions often leave individuals severely disabled, and we would hope that at some point equivalent services could be made available to those individuals as well.

We'd also note that this entire process is one that is going to involve substantial change for not only individuals who might receive care but also for those who are providing services for the disabled. To the extent that the service providers are feeling they are operating in circumstances of uncertainty in going through this process, they're going to feel under increased stress, and this can only have negative consequences for the individuals who are receiving care from these individuals. As a result, we would recommend, or hope, that the introduction of any changes to legislation, particularly where it would involve substantial changes to the means by which services are provided, would do so in a way that introduces change gradually and provides people with some advance notice of what the changes are going to be.

We particularly note that this isn't the only piece of legislation that's going to be affecting people in this area. With the recent passage of the Advocacy Act, the Substitute Decisions Act and the Consent to Treatment Act, providing care for disabled individuals is going to become much more complex and is going to involve many more interested parties being involved in many decisions that are made for disabled individuals, and these are all happening within a relatively short period of time, which makes the whole process more complex.

One of the things that we do know that can influence the amount of stress individuals feel as they go through some process of change is the amount of control they have over that situation. I think many people at the moment feel that they don't have very much control at all. Anything that can be done to increase that control, even to increase the amount of information people have over the timing of the introduction of changes, makes the whole process less stressful.

That's one of the reasons why we think it would help to have pilot projects where new sets of regulations proposed can be piloted and tested before they're introduced on a wholesale basis across the province so that the bugs in the system, so to speak, could be worked out ahead of time. It would make the whole process less disruptive.

Another point that we'd like to make concerns the placement coordinators. These individuals would have substantially greater powers than do the existing placement coordination services. The act is notably silent on who these coordinators will be, what kind of training they might have or what kind of qualifications they might have. This in itself isn't bad, but at the same time there are no guidelines given for how these coordinators are to act, what factors they should take into consideration in making their decisions. If these are not set in place ahead of time, then the operation of capricious and arbitrary decisions is invited and greater inequities in the operations of these agencies will develop very quickly.

One would hope that at least the regulations would have some guidance in these matters, but I think in many cases the issues are made easier if the legislation in fact says something to provide guidance. In this regard, I think we would also endorse previous comments that were made that the preferences of the ultimate consumer of the services should have a fairly large effect upon the decisions of the coordinators.

Another issue that isn't addressed is whether the decisions of the coordinators are prescriptive for the nursing homes in the area. In other words, if a coordinator says that a certain individual is to be accepted by the nursing home, does the nursing home have the right to refuse that recommendation? And if they do, is there some process of appeal for all of this? As far as our reading can tell, the act doesn't address these issues.

Of course, coming from the psychological association, the final point I'd like to make concerns the role of psychologists within this whole process. Many of the individuals who are currently resident within institutions and many individuals who are currently residing in the community have a variety of serious mental disorders. These disorders are frequently among the most common reasons for admission to nursing homes and homes for the aged. Psychologists are among the few professionals that have experience in diagnosing and treating these disorders. We think that the coordinators' decisions about admission to homes should be at least informed decisions. It's our profession that's one of the few that is qualified to provide the detailed kinds of objective tests that are often the best means of determining these types of disorders, so we feel we have a definite role to play in all of this.

At the same time, our profession has developed many treatment methods for many of the disorders that older people have to suffer with, and for the conditions that often most seriously disrupt their relationships with care givers: wandering, insomnia, incontinence and all too frequently the types of aggressive acts that can be the last straw for a care giver. By providing management techniques we feel that, with proper training for the care givers, these problems often can be dealt with in the community.

But, at the same time, we don't see any opportunity for psychologists to provide these services within the terms of long-term care reform. There might be possibilities for this to be done, but with the draft preliminary funding systems that have been discussed to date, we really don't see that there's a strong likelihood of increased psychological services for older and disabled individuals being made available in this act.

Virtually every health care profession outside of medicine and nursing is all lumped together in a single category, that I think most operators of homes would see as the one that's most flexible and most subject to the problem of rating when funds in the other categories run short. With that type of arrangement, I don't think we can realistically predict that there would be the possibility for increased services under the terms of the current act.

I think that point covers most of the points I wish to make, if anyone has any questions.

The Chair: Thank you. There are a number of questions, for those who are here. I know everyone's a little worried about the heat that is going up. The clerk is desperately finding a way to turn it off. All I can say is that until we do, please keep your seatbelts fastened. Mr White.


Mr White: Thank you, Dr Helmes. I want to pick up on a bit of extrapolation from your presentation. There are a number of points I would like to talk about. However, I won't have the time.

What I want to concentrate on is the issue of the informed decision: the informed decision on the part of the placement coordinator, the person who is making a decision which is in the best interests of the client, the family and the institutions, and who has the greatest range of knowledge based on a range of professions, whether that's psychology, social work, medicine or nursing, and the informed decision on the part of the client. We see in the act that clients now have powers, powers to appeal decisions, powers that they need to be informed of decisions and of levels of care, and there's been some question put forth beforehand. What's the point of informing this person, or will informing that person be just a whitewash, because after all, they may not be entirely competent? Their reception of that information may not be an informed acceptance. They may need to have a support person with them, family member, advocate, as Mrs Carter would indicate, whatever.

Aside from specifically writing into the legislation that psychosocial issues, neuropsychological issues etc would be considered, how do you see that informed decision being actualized?

Dr Helmes: Well, I think one important part of that would be if consumers have made known to them what factors influenced the decision. At the moment, the act simply leaves that completely open. Will there be some weighting given to financial factors? What degree of physical impairment might be needed? What kind of mental impairment, if any? Or simply, can you apply if you feel like you want to live in a nursing home? Where are the boundaries to all of this? At the moment, nobody knows and a consumer can't make an informed decision unless he has some knowledge of what the rules of the game are. I think, at this point, nobody really knows.

My understanding of the current placement coordination services is that they have a much easier sort of game. They simply match vacancies in the nursing homes with the number of applicants and, to the best extent possible, they take the consumer's preference into account. But with the increasing limits that are being placed on the operations of the whole system, it's pretty clear that that may not be entirely possible in the future, and if it's not, what are the rules going to be? If you're going to have rules, it's only fair to let everybody know what they are and have them written out so that everything is on the table.

Mr White: Are you suggesting in regulation or in legislation that the informed decision be articulated?

Dr Helmes: Yes.

The Chair: Thank you. Mrs Fawcett.

Mrs Fawcett: Briefly, thank you for your presentation. It's around your fourth point involving the placement coordinators and how you people can become involved in the decisions: I wonder if you could just compare how you become involved now, and can you see a way that this could be ensured in Bill 101, so that your valuable input would be taken?

Dr Helmes: At the moment our involvement in it is not as common as I think we would like, and it's very haphazard because it very much depends upon where somebody lives and in some ways where their physician has privileges, because most psychologists at the moment are employed in hospitals. There are very few working in nursing homes and there are even fewer who concentrate on providing services to older individuals in the community, largely because we aren't funded under OHIP. So individuals in the community who want psychological services have to find a means of paying for them unless they can access them through a hospital, and with the demands within hospitals, there are quite strong limits upon what can be done there.

Mrs Cunningham: We could spend the whole night talking about accessibility for psychologists, but we won't do it this time. We'll do it another time.

It's my understanding, Mr Chairman, that this is the first psychologist whom we've had before the committee. Is that so?

The Chair: I believe that's so.

Mrs Cunningham: I was very interested, because what you've been presenting with regard to the changes in legislation that we've been part of in the last couple of years, all the changes to the Advocacy Act which we looked at, you know, over 100 amendments, and as we take a look at some of the directions that have nothing to do with legislation and everything to do with cutting services -- for instance in this city, we've had cuts to our sheltered workshop, which is something that is of great service to our disabled community. I suppose, given the previous presenter -- and I'd like you to respond to this, the Grey-Bruce. I think you were here when Catherine made her presentation and talked about the implementation of the legislation being delayed and referred under the district health council's plans for long-term care. What kind of advice would you give the government, given the wealth of opportunities that you have in your field with regard to the services that are here now, understanding what they're trying to do here and, I think, your participation in some of the hearings that were held?

Dr Helmes: I think one part of that is that to some extent I think it's the fault of our profession in that we haven't been making our services that widely available to the public, but at the same time, I don't think there's anybody who's lacking business. You know, whatever demand is there is sufficient at the moment.

But the district health councils, I think, are not always as aware of the services that psychologists can provide as they might otherwise be, and to the extent that we can make our services more known to them, I think it would help.

I'm not sure entirely what the relationship between the ministry and the health councils actually is, because from what I've seen, the health councils are in a very awkward position in that they're charged with planning and coordination but they really have essentially no power to enforce their plans or to direct their coordination.

Just within London, the various attempts of the hospitals to coordinate their services have gone from here to there and traced their steps backwards more often than they have forward. So I think everybody would like the health councils to do more, but until such point as the ministry decides to grant them some additional powers, which would be a very unusual step for the ministry to take, I don't know what actually could be done.

Mrs Cunningham: Well, there's a lot.

The Chair: Excuse me, just a brief supplementary. We really are --

Mrs Cunningham: Okay. I'll just make a statement then, because I think that the great frustration that we're getting, certainly here in London and southwest Ontario, is that this is not reflective of what the public asked for during the hearings. It's not concise enough and there's no backup plan. There's no outline of regulations. Nobody really knows how it's going to work, and therefore they're not quite certain how to advise the government. Maybe they're going to have to take a breath and come forward with some kind of structure that people can relate to.

The Chair: Thank you very much for coming before the committee this evening. We appreciate it.



The Chair: I now call the representatives of the Fairview Mennonite Home. As the representatives are coming forward, if I could just remind members of the committee that we have three presentations left, including the Fairview Mennonite Home, if we could keep our questions short and to the point.

Gentlemen, thank you for waiting. We appreciate your patience. If you'd be good enough, introduce yourselves to the committee and for Hansard and then please proceed with your presentation.

Mr Bob Weber: Thank you. With me is Tim Kennel, the administrator of Fairview Mennonite Home. My name is Bob Weber and I am the volunteer board member and treasurer of Fairview Mennonite Home, a charitable home for the aged.

Fairview Mennonite Home was established in 1943 out of concern by the Mennonite Church to provide care for older persons. That concern was for the members of the Mennonite Church as well as members living in the community. The Mennonite Church continues to support the organization through representation on our board, the auxiliary and through its financial gifts.

Our home is an 84-bed home for the aged. We have two apartment buildings providing 172 housing units. We have 16 cottage units and an elderly persons centre, providing support to several hundred community persons. We are currently caring for 57 extended care seniors and 27 residential care seniors with an average age of 88 years. We have 240 seniors living in our apartments and cottages with an average age of 81 years.

Fairview is a continuum-of-care facility, providing supportive housing in our apartments and cottages through to heavy extended care in our home. We believe in and we support a continuum of care approach, as we have demonstrated that seniors resident in our apartments have remained independent longer by utilizing the supports available through other programs.

Seniors living in our apartments have entered Fairview Mennonite Home with the expectation that care will be provided for them in our home when it is required. In the past we've had many couples live here. As their health has deteriorated, one person of the two would move to the home where their care needs could be met, while their spouse continued to live in the attached apartments where they could have continuous support.

We believe this ongoing relationship is threatened. We're concerned that Bill 101 could prevent persons living in our apartments and cottages from gaining access to the long-term care facilities when required. Access to these facilities will be determined by placement coordination services which are mandated under the act to give priority to the most urgent cases on their waiting list.

We believe that placement coordination services should have information on all homes in their catchment area. They should be a support to seniors and provide a consultative service regarding placement. They should not, however, dictate a placement that is contrary to the choice of the senior. Seniors, because of religious preference or custom, may request a specific facility, and that request needs to be supported.

We believe our organization has a unique understanding of the needs of the supporting church constituency. It is important that these seniors be able to access a facility that addresses their spiritual needs in addition to their care needs. There must be a choice: resident's choice for facility; facility's choice for the resident.

We are owned and operated by a supporting group of 26 Mennonite churches, mostly located in the Waterloo region. As noted earlier, these churches do support through their representation on the board, auxiliary and through their financial gifts.

We're currently in the process of securing architects to design a new home to specifically meet the care needs of our residents. To proceed with our plan we must raise 50% of the cost of the new facility in order to obtain the remaining 50% from government funding. Our current plans are to raise our portion of the funds from church constituents or, in other words, the private sector.

We are concerned that if we cannot assure these people access to Fairview when the need arises, we will not be able to obtain the financial support of the constituents to carry out our mission. We're sure that most of you are aware what this would mean to funding in charitable homes.

The current donations from the private sector are an important part of the overall funding of the homes for the aged, especially Fairview's. If these donations are put in jeopardy by the lack of choice, placement through PCS without consultation or appeal, there would be increased pressure on the provincial government to supply these funds.

We have grave concerns for the quality of life of our residents. We've been advised that long-term care facilities will be expected to provide heavier levels of care to increasingly frail seniors. Our concern is that the expectation to provide care will not be matched by commitment from this government of sufficient funds to provide the care required.

As part of our continuum-of-care philosophy, Fairview operates an elderly persons centre, which serves hundreds of community seniors in addition to persons living in our apartments. Our centre programs are specifically designed to promote independence to assist people in retaining and regaining their maximum physical and mental functioning.

If municipalities and the province withdraw their funding, our centre would not be able to function. We are concerned with what happens to those people who are retaining their independence through the use of the preventive programs in our centre. We are also concerned for families who are managing to care for an elderly loved one because of programs like ours.

We too believe in community-based health care. The elderly persons centre clearly supports seniors living independently in the community.

In summary, we have concerns with our ability to continue providing ongoing supportive care from independent living through the end stages of life if we do not have greater involvement in the admission process. We are concerned that our supporting church constituency will not be given sufficient consideration for placement in Fairview when they require facility-based care. We are concerned that private funding will be jeopardized if choice is removed and access restricted through PCS. We are concerned that funding be adequate to meet the heavier care need expected for persons living in long-term care facilities. Finally, we are concerned that seniors centres may have their funding withdrawn and about the major impact this will have on preventive community-based health care. Thank you.

The Chair: Thank you very much. Just before going to questions, could I perhaps just ask one, briefly. When you refer to cottages, could you just tell me what that means relative to an apartment?

Mr Weber: Tim, I'll let you explain that, please.

Mr Tim Kennel: We have 16 semidetached cottage units which are essentially apartment units, bungalow-style cottage or apartment units with a basement, and provide for independent living as well.

The Chair: I just wanted to be clear. I thought that's what it was but I wanted to be clear. Ms O'Neill.

Mrs O'Neill: I'd like to ask a two-parter, if I may.

The Chair: That's one question.

Mrs O'Neill: Yes. First of all, you seem to have a whole lot of fears built in. They seems to be centred on the role of the placement coordinator and eligibility criteria, if I'm reading them correctly, although you haven't said a lot about either of those things. Could you tell me how you feel the bill could be changed to allay some of those fears, and how the bill makes you feel that you will not be able to continue the preventive programs in your centre?


Mr Weber: The first part of the question, if we are reading Bill 101 correctly, gives the home absolutely no choice as to whom they admit and gives placement coordination services full authority to commit residents to our home.

It's very hard, as we heard from our last person, to decide need levels, we feel. Being a continuum-of-care facility, we can usually fill our beds -- it's not just a matter of filling them -- but the people sit on a waiting list in our apartments waiting to get into the home for the aged where care can be taken.

Not to be misled, we are not strictly Mennonite residents. We did do a study, and at the current time the home for the aged is less than 50% Mennonite residents; just slightly under, mind you. The apartments are just slightly over. So we do support the community and our Mennonite residents.

We think the powers of placement coordination, getting back to your question, should be in a consultative role, not a mandatory role. There has to be in consultation with the homes, with our administrators, with our admission staff who understand our facility. We think placement coordination could be a good information-collection area for residents to get information on what is available.

Mrs O'Neill: Thank you. You're sounding very much like our very first presenter this morning in Windsor.

Mr Jackson: I come from the community of Burlington and we had the unpleasant experience four years ago of a nursing home which was closing and the licence being returned and 160 residents -- not to give you the lengthy story, but what I learned in my workings with Ron Sapsford at the Ministry of Health in the nursing homes branch --

Mrs Caplan: You harassed the minister.

Mr Jackson: -- and I harassed the minister at the time, and she reminded me of that. However, what I learned was a couple of things, but the thing that struck me is, they had a facility similar to yours. That's the first commonality. Typically, the women were more ambulatory in the residential section and their husbands were in the nursing home section, and that's generally the rule.

We were being told that the ministry would allow overbedding, and we were looking at placements for these spouses in Cambridge, in Brantford, in Oshawa. Beds were found in Bancroft.

This is not a function of this bill. This bill is going to make that process a lot more organized and less a ministry function and more a local placement coordination function. Let's say a nursing home collapses. The bank says, "Look, we're turning the licence back" -- you know how the process works -- and now we have to dissipate 100 known residents. That's my biggest fear. You've been tested as a facility for facilities that are in difficulty and you've had to take some of the residents etc.

You don't have a negative brief; you have a very cautious brief with a lot of fears being expressed. But is that one of the things that perhaps disturbs you the most, that the charitable homes will be the ones that will be the front lines to take the residents who are leaving, for whatever reason, the regular private nursing homes which are collapsing? You will have no choice. These people come from outside your own region, let alone don't fit your mix, as they say.

Mr Weber: I don't know how you feel, but --

Mr Kennel: I think our concern is mostly with people who currently reside within the geographical community of Cambridge or who reside within our apartment and cottage complexes. As their spouse's health need deteriorates, they will be placed elsewhere in the community and then the continual support that the spouse living in the apartment or cottage can give disappears.

Mr Jackson: I wish I had a supplementary, but I know the Chairman won't allow it. I wish we had more time with you gentlemen. Thank you very much for your brief.

The Chair: Thank you. Mr Wessenger, with his one question.

Mr Wessenger: Thank you very much for your presentation. I certainly am pleased to hear that you have such a continuum of care in your facility. I think that's the ideal situation when you have that continuum of care.

I'd just like to assure you, before I ask my question, that consumer choice is very much an essential part of this whole question of placement coordination. Also, the social context is certainly going to be in the criteria with respect to the question of placement of residents. I certainly agree with you in the particular instance, in the spousal instance, certainly that's an aspect that should have very high priority in determining a placement.

But I'd just like to ask you a question, probably two questions, if I can get away with a supplemental. The first is, do you believe that within the social context, within the framework of consumer choice, priority really should be based on those having the greatest need?

Mr Weber: I'm not sure how one can decide that. My colleague beside me might. I can talk personally, because I had a father with Alzheimer's who was admitted, and I don't think it took a whole lot of people to figure out his need at the time he went in. The family is usually one that quickly decides need. We were very, very pleased there was a place like Fairview that could anticipate our needs and was there within days of when we needed it. That's not always available.

I also have aunts and uncles who have gone through Fairview, some still there -- the aunts and uncles are gone -- starting in the apartment, the uncles moving over. In fact my dad and my uncle were in the same room, with the wives in the facility, in a comfortable environment that we've created for these people. Being religious, it probably doesn't qualify as being cultural as the definition goes, and we're concerned with that, but it is an environment that people feel comfortable in and we go through our lives. I think it's important at that stage in our life that we're in an environment that we're comfortable with. I think that is extremely important.

So need to go with that? I can't define need; I'm sorry.

Mr Wessenger: Just one quick one: Are you satisfied with the way the placement coordinating agency works now within your area?

Mr Weber: In our area the placement coordination, as I understand, Tim, works excellently, on a consultative basis.

Mr Jackson: But they are not forced to take residents from outside the region, correct? No, that's true.

The Chair: I want to thank you very much for coming to the committee today and providing us with the comments in your brief.

Mr Weber: Thank you for your time.



The Chair: I now call on the representatives from the Thames Valley Placement Coordination Service. We're just handing out your brief as you take your seat. If you would be good enough to introduce yourself for the committee and for Hansard.


The Chair: Order, please. Please go ahead.

Mrs June Payne: Thank you. I think I'm either the last or the second-to-last presenter and I want to assure you that the brief you're getting is fairly long but I'm going to speak to only four pages of it.

My name is June Payne. I'm the director of the Thames Valley Placement Coordination Service. I really asked to speak to you today because I represent a very large PCS with very strong community input and you might want to ask questions of me. Certainly listening to the presentations that I've heard tonight, there are some very real worries about the PCS functions. I'm also the first president of the PCS association and I'm currently past president of that, so I have an overview, I think, of the PCSs across the province.

The Thames Valley Placement Coordination Service operates in Middlesex, Elgin and Oxford counties, with offices in London, St Thomas and Woodstock. Administered by the Victorian Order of Nurses, Middlesex-Elgin branch, the PCS has a PCS committee made up of 12 sector representatives from the community. These people guide and direct the service.

Although it's centrally administered, the PCS really functions on a day-to-day basis as if it were three separate PCSs. This division of functions occurred over time as the PCS sought to be responsive to the needs of its local areas. The three counties are very different and contain a mix of rural areas, small towns and larger urban centres. We serve a population of more than 500,000 people over a huge geographical land mass.

I thought you'd be interested to know that included in our catchment area are three large acute care teaching hospitals; six community hospitals, all of which have acute and chronic care beds; two public chronic care hospitals, including a Canada-wide veterans' care centre; two private chronic care hospitals; two large regional psychiatric hospitals; the Oxford Regional Centre; more than 60 nursing homes, homes for the aged and residential homes; three home care programs; and many other home and community support services. In fact, we interact on a regular basis with 91 facilities and services.

The PCS committee is very interested in these hearings and is very supportive of the response given by the Association of Placement Coordination Services of Ontario. I know you got that response on Monday in Thunder Bay from Wendy Kirkpatrick and I'm sure you're delighted I'm not going to repeat that information. We also wanted to say, though, that the PCS locally is also fully in support of the major policy goals that were outlined on the first day of hearings by the Honourable Frances Lankin.

Equitable access is a principle with which everyone will agree. It's a lot like motherhood. But it's also a principle that's much harder to implement, especially when the need is great in one's own family. The PCSs base their practice on the principles of dignity and integrity of the individual; reasonable and competent access to information about alternatives in care; informed consumer choice; equitable access to services and facilities for clients and their families within appropriate limits -- and what that means is that if someone wants to go to a chronic care hospital but really requires 45 minutes worth of care, then obviously the chronic care hospital is not an appropriate choice -- sensitivity to cultural, religious, ethnic and language issues in so far as this is possible; competent, experienced and academically well-prepared staff; and no vested interest in the service outcome.

We believe people doing placement coordination service functions must be fair. But it's also fair to say to you that we found that the key overriding principle that really takes precedence over everything else is that it is not enough to be fair; it must be seen to be fair.

Our PCS believes there are a number of principles that are vital to the implementation of Bill 101. We would like to see a statement of principles addressed, if not in the legislation, then in the regulations which will guide the placement coordination functions. We believe that if one gets the principles and the vision of a service delivery model right, then the rest of the implementation will fall into place relatively easily.

PCSs, as voluntary services, are adept at negotiation within their communities. If we really couldn't negotiate collaboration and cooperation, we couldn't get anything done, because we've never been mandated. We hope there will be room for local models and responses to Bill 101 since we believe there should be local variation to meet local needs.

This PCS supports fully a comprehensive, multiservice, single-access model, but cautions that the placement coordination function should be independent of in-home services functions.

We would also suggest that placement coordinators should not be connected in any way with a particular facility, and we would suggest that priority for placement, when it's outlined in the regulations, should have some flexibility in practice. We would caution against always giving priority to those in hospitals since those may very well penalize people waiting in the community.

We ask that flexibility be built into the regulations to enable facilities to have a voice in their acceptance of clients. We think it's eminently reasonable that access to all facilities, including chronic care -- we would also like to include the retirement home sector -- be through the placement coordinators, but we also think there must be some negotiation room to enable facilities to serve particular clientele according to their mandates. In other words, common sense and cooperation should prevail.

We believe that an appeal mechanism is appropriate. We ask that it be fair, humane and speedy. If there are competent people in the multiservice agency and adequate resources, then appeals should be relatively few.

If any of you have ever gone through the placement process with relatives of your own, you will know that it is probably one of the hardest things that happens in a person's life, to come to the point where they are sufficiently dependent that they can no longer live alone.

I'm grateful for the opportunity to speak to you. For your interest, there are two documents appended to this paper. One is a list of the Thames Valley PCS committee members, so that you can see the range of people who make policy for the service in this area. The second is the February 1992 response to the Redirection of Long-Term Care and Support Services in Ontario document, which really outlines our philosophical stance.

The Chair: Thank you very much for your presentation and the attachments. Those will be very valuable. As you noted, Mrs Kirkpatrick did speak to us in Thunder Bay and I think we were all struck not only by her own presentation but by the comments of everyone in that area in terms of how well they felt the system worked there. So we were interested to see that you were going to be with us tonight. We'll move right to questions with Mr Wilson.

Mr Jim Wilson: I really liked your presentation. I think it's to the point and, yes, we've had a lot of evidence before the committee indicating that placement coordination services, where they exist, are working well. One of the reasons they're working well, I gather, is because they have flexibility, and you emphasized that in your brief this evening.

Having read the draft policy manual that accompanies this legislation, it appeared to me in reading the eligibility criteria that there isn't any flexibility there. It's primarily need, and in layman's terms, I would say it's medical need that is driving the placement. You mentioned that perhaps there should be a set of principles. Would you like to see an addendum in that policy manual that's a set of principles in which, in light of the principles, these bullet points should be interpreted?

Mrs Payne: Yes.

Mr Jim Wilson: Have you had discussions with the ministry along those lines to try to put some flexibility into the manual?

Mrs Payne: We meet roughly every two months with the in-home services branch of the ministry and we meet with a number of the people who are setting policy. We have consistently, throughout our history, really been very strong on principles because, again, we think if you get the principles correct, the rest of it will follow.


Mr Jim Wilson: If I could just finish that, because another thing that concerns me -- and it comes from my own experience in my area of the province, because we have some exceptionally good homes; I'm sure every area does -- there is a bit of social placement going on, where people want to live in the home and may not meet the medical criteria outlined in the manual -- may not meet the need that's required. Have you got any comments on that?

Mrs Payne: I think essentially what we're dealing with here is equitable access to scarce resources that are government-funded. At that point, the government is saying there should be some criteria for entering publicly funded and there should be criteria based on need of the person. We certainly think there should be flexibility to allow for couples who have been married 50 or 65 years to live in the same facility, because they often have to apply for involuntary separation. There should be some flexibility like that. But by and large, in a publicly funded facility, when resources are very scarce and getting scarcer, I think people should really require the services that facility offers.

There is a very wide range of facilities available at the residential level. The criterion outlined in the residential care association is up to 45 minutes of care a day. Those facilities will often put in associated nursing services at a cost. None of that comes out of the public sector, though. We feel there will be provision for some type of care for those who can afford to use that level at the residential one. The majority cannot afford to do that and we think they should not then be penalized in the way they can access the publicly funded services or partially publicly funded services, such as homes for the aged and nursing homes.

Mr Hope: It's always nice to get the PCSs up here, because we hear a lot of bad stuff about you. A lot of people are fearful.

Mrs Payne: They certainly are.

Mr Hope: I was listening to the questioning and some of your comments about the involuntary separation. That shouldn't even be a part of our vocabulary, because it's very hard for people of that age to even consider the separation. The word "separation" sticks out more to most seniors than anything.

When I was going through your presentation, I wanted to ask you a question. I've been hearing it through the presentations. With these powers bestowed upon you to a community -- and I notice you represent a large rural area also -- do you see yourself as an individual taking away the human element of things and placing people? I'm getting this fatal picture of a placement coordinator who is not going to have any understanding of facilities and understanding of clients and it just seems like you're just going to start planting people all over. I just wanted to ask you that question.

Mrs Payne: There's certainly a huge fear and it's particularly prevalent around the Toronto area, which has never had a placement coordination service. My hope would be that the PCSs would be both sufficiently valued and sufficiently funded, that they could attract the very best front-line people. The way they'll operate will depend on how good the coordinators are and, secondly, how good the administration is.

Mr Hope: The other part I have is dealing -- you wanted separation from the in-home services. How would you link those two? You also made reference to retirement homes. Do you believe there ought to be a legislative body around to regulate that industry?

Mrs Payne: Yes. I believe there should be more regulation than there is. I know from the Ernie Lightman report that this is not a view he shares, that all applications should go through the PCSs. We think people, when they enter the long-term care system, minimally should come to the PCS for information about how the system works. The way it works now is such that the more care that is required, the less it costs. We think it's terribly important for people to be informed about cost, about choice, about alternatives.

It's also terribly important not to solve a problem too quickly, because almost everyone who comes to us -- and we see about 2,400 families a year -- thinks they're in crisis and they need placement tomorrow. If you can help them sort that out and reframe their fear and their distress, you can very often be looking at a very different solution within a week.

The Chair: Thank you. Ms Caplan?

Mr Hope: I didn't get an answer to the in-home one.

Mrs Caplan: We've been hearing on this committee nothing but praise for existing placement coordination services. It's sort of been framed in this way. The presenters who came forward in Thunder Bay and then again in Windsor and here and in other communities have said, "We may be unique but our placement coordination service works really well, and if that could just stay under this new legislation we would be quite satisfied." So the fear that we're hearing, as I think you've rightly said in your response to Mr Hope, is not for what's working well today in communities; it's the fear that this legislation is going to change those things.

The other thing we've heard has been concern about the flexibility and that this legislation is very intrusive and very prescriptive, and that one of the fears is that this formula will lead to negative change in the community.

I wanted to make sure that was clear and on the record because we've heard only praise in the places where we've been so far about the existing placement coordination services, and I wanted to share that with you.

I would have more comfort, and I think it is possible to do it -- on page 3 of your brief you've outlined, I think, principles that could give comfort as well as clarity to the legislation, and it is very appropriate for statements of principle to be enshrined in legislation. I would ask you whether it would give you comfort, rather than putting a statement of these principles in the regulation or in the policy manual, if you think it might be helpful if a section of the legislation that related to admission criteria, or in framing regulation, that the following principles would guide the policy development?

Mrs Payne: I think it would be very helpful to do that. I really do. One of the reasons I gave you the paper that was the response to the Redirection is that we've divided that into the seven principles of social justice, goals, choices, process, funding, planning and stewardship, and we think that this particular paper has been used as a model by one of the local hospitals for its response. We think you can't go wrong if you follow those principles.

Mrs Caplan: Thank you very much. I want to congratulate you on an excellent presentation. I think you've come up with some very good ideas of how the legislation can be improved to eliminate the fear and to add the flexibility, and I like the commonsense approach that you've taken to it.

One other point, if there is a minute, Mr Chairman --

The Chair: Thirty seconds.

Mrs Caplan: -- and that is the concern that facilities have. One of the amendments that I hope the government will consider, and we're planning to put forward if they don't, would allow the facilities to deny admission on the basis that they did not believe the care was appropriate for that client, and then you would have an appeal mechanism, or the same appeal could take place for them again to give that kind of comfort. Would you support that kind of an amendment that would encourage choice?

Mrs Payne: We would certainly hope that the facility would not be in a position of having to refuse. We negotiate every day to get people into care, but it depends on their client mix, how many people are off on workers' compensation because they've been assaulted, how many heavy care people we've given them in the last month, and they say to us, "We need to take someone who's lighter care." There is some give and take that is realistic. We would not expect them to consistently refuse people who appropriately met the level of care they provided, and we think that's reasonable, but oh my goodness, yes.

I understand it has been expressed in the Toronto area that they're just scared silly that you're going to have, say, a whole group of Mandarin-speaking Chinese people in the Jewish home for the aged. Well, that wouldn't happen. We would certainly work very hard at trying to find the appropriate facility, and we often do nudge facilities to take somebody who is heavy or unlovable or has a difficult family.

The Chair: Everybody on this committee is very lovable.

Mr Hope: I got a place to go, but I'll be lucky if I make it past 60.

The Chair: We won't get into debating how lovable or unlovable any honourable member is. I do want to thank you very much for coming forward. One of the questions that occurred to me was in terms of how many PCSs there were in the province. I understand from ministry staff there are about 23 and they cover approximately half the province. It might be useful for committee members if I could ask, through the parliamentary assistant, if we could have a list of those PCSs -- indeed, maybe we have them and I just haven't seen them -- and what areas they cover, because I think it is significant that both here and in Thunder Bay, in those two instances in particular --

Mr O'Connor: Windsor too.

Mr Hope: And Chatham.

The Chair: -- and Windsor as well -- I wasn't there this morning -- in the meetings in Windsor that we've heard a lot about how the existing PCSs work. I think it would be helpful for us to look at that and to look at the kind of criteria you set out as we go about our business. Thank you very much for coming this evening.



The Chair: I would now like to call on the representative from the Royal Canadian Legion and to thank him very much for having a great deal of patience, through to the final presentation, to be with us. We appreciate your coming. I don't know if you are aware, but colleagues of yours were with us in Toronto a couple of weeks ago as well. We always welcome a presentation by the Legion, and if you would be good to introduce yourself to the committee for Hansard and then please proceed.

Mr Ed Neil: Thank you, Mr Chairman. My name is Ed Neil and I'm a provincial service officer with the provincial command of the Royal Canadian Legion. There has been a presentation made already, and I think what I have here is pretty well a reiteration of that. But I would like to say a few things and possibly outline or highlight what's in here.

Something they didn't say and that I think they made you well aware of is what the Royal Canadian Legion does both in the country and in the province. The reason I end up being here is that we have five offices in the province. They're called provincial service bureau offices, and our job is to look after veterans' welfare. So I am indeed concerned with veterans' welfare, and this bill certainly is along that line.

Just to express the concerns regarding long-term care, a guarantee on priority access beds for veterans: Bill 101 does not include any guarantees with respect to priority-access beds. We have been advised by Ministry of Health officials that the long-term care reform will not violate the right of veterans to the priority-access beds provided for in the transfer agreements for Sunnybrook, Westminster and Rideau Veterans Home. This alleviates some of our concerns, but we are requesting that this guarantee be included in the text of Bill 101.

I believe the main thing that the Legion is concerned with is that veterans be included in Bill 101. They talk about closed beds at Sunnybrook, and the coordinated placement service organization remains concerned that the right of veterans to be recognized and receive all levels of care authorized by the veterans care regulation might be jeopardized by Bill 101. The veterans health care regulations provide for residential and nursing home care, and partial funding of this care is provided under the veterans independence programs, Veterans Affairs Canada, for certain eligible veterans. We want to ensure that the admission policy will continue to provide for social admissions and necessary adult residential care for veterans.

The last thing I want to point out is budget restraints. The Legion is concerned that additional budget restraint may result in further erosion to veterans' care in Ontario. We would like to establish a commitment by this government to ensure that this special group will be protected from future restraint measures. A Sunnybrook K wing situation cannot happen again.

Finally, as I said, the main concern is that veterans be mentioned in the bill.

Lastly, I have one suggestion, and this is strictly sort of an ad hoc suggestion. It refers to the bill itself. It is respectfully recommended that to the first paragraph immediately following explanatory note number 18, line 4, you add these words, "After 16 years old and those war veterans and ex-service personnel in receipt of health care benefits in Ontario from Veterans Affairs Canada."

That pretty well concludes what I had to say tonight. As I mentioned, I knew that you had heard from our people prior to this evening and I didn't want to take up a lot of your time, but I do thank you very much for listening.

The Chair: Thank you. We certainly will note that you have reiterated the presentation that was made in Toronto and that those views obviously also express points of view you would have raised. We appreciate the further comments, and particularly the specific ad hoc recommendation. It's always nice to have an ad hoc recommendation at the end of the day.

We'll begin our questioning with Mr Jackson.

Mr Jim Wilson: Mr Wilson.

The Chair: I'm sorry; Mr Wilson.

Mr Jackson: Even though I'm a member of Branch 60, I'll yield to my colleague.

Mr Jim Wilson: Now, are you sure you got that on the record, Cam?

I'll just let you know that on behalf of my party, the Ontario PC Party, after the presentation we had about the concerns expressed by the Royal Canadian Legion, I wrote to Legion Command indicating our willingness to introduce amendments to ensure priority access and to help along the lines of social admissions. You'll note this evening that I've been asking a lot of questions about social admissions, and I know it's important to veterans. We will do the best we can. If the government doesn't move on its own accord, we will certainly be prepared to introduce amendments in legislation to ensure that veterans are recognized.

Chair, I don't really have a question, but you might find this answer to my inquiry interesting. Correct me, members, if I'm wrong, but I think at the time we did ask for the government to give us an assurance or an explanation that any agreements that may be in existence with Veterans Affairs Canada are not in any way undermined or negated as a result of the introduction of this legislation. To date, I haven't got a response back concerning that.

Mr Wessenger: I will ask staff actually to indicate the situation in that regard.

Mr Quirt: I just wanted to clear up that the priority access arrangements at Sunnybrook Hospital in Toronto and the Westminster facility here in London are priority access arrangements for chronic care services, and neither of those facilities will be regulated by Bill 101. Clearly, what I understand to be the issue of closure of some priority access beds at Sunnybrook is still an issue for the Ministry of Health to be concerned with, but it's not an issue directly affected by this particular piece of legislation. The Rideau Veterans Home in Ottawa currently is funded by the federal government, and so the Rideau Veterans Home is not subject to the provisions of Bill 101 either.

It is possible, however, that if the Perley redevelopment continues as planned now, the long-term care facility that results in several years' time when that building is completed, a couple of years' time we suspect, that the priority access issue will apply with the new Perley long-term care facility, which would either be subject to Bill 101 or subject to what we hope will be a more comprehensive piece of legislation to follow. The transfer agreement between the province, the federal government and the Perley Hospital contains reference to continued priority access to a designated number of beds in that facility on behalf of the veterans.

Mr Jim Wilson: Just two short comments to Mr Quirt. You can understand the Legion's concerns, though, because we're dealing really with an area where we don't have a lot of information because we don't know the future of chronic care beds in the province. We don't have the chronic care role study.

Mrs Caplan: And long-term care.

Mr Jim Wilson: And we don't know the whole picture on long-term care, as Mrs Caplan is correct in pointing out. So there is a worry there. Secondly, on the local scene, what about the future of Westminster's chronic care beds and its veterans facility?

Mr Quirt: I am not familiar with any plans to reduce the number of chronic care beds in Westminster hospital or to diminish the supply of the beds that are affected by the priority access arrangement for veterans. There may well be, and I'm not familiar with them, but I would be happy to check to see if the Ministry of Health is aware of any discussion in that regard and provide an answer to the committee specifically. It would be very difficult for me to speculate on the future of individual chronic care hospitals down the road and the decisions that their boards of directors might make, and clearly the facilities to which veterans have priority access now are not affected, as I mentioned earlier, by Bill 101 because they're neither a home for the aged nor a nursing home.

Mrs Fawcett: I think that information is well taken and should be of some comfort, but I can assure you we are all aware of the tremendous work that the Legion does and continues to do. Some of the statistics and figures that were presented to us in Toronto as to all of the good works that are being done across the province should not remain unnoticed at all. We will continue to make sure that all of the concerns you have will continually be put in front of the government for it to include in the bill if and when it ever does particularly affect what you build in the future.

The Chair: Thank you very much for coming before the committee. We appreciate it.

Mr O'Connor: On a point of order, Mr Chair: I just thought it might be in order to bring greetings from Branch 141 while we're here.


The Chair: Anyone else have any more greetings? Actually the Chair welcomes that because it ends our evening's proceedings on such a note of harmony. There were moments earlier when I wasn't so sure of that. Mr Neil, thank you very much for coming.

Committee members, before we adjourn, just a note: I think we begin here at 9 o'clock tomorrow morning. I should tell you that the 6 o'clock and 6:15 presentations listed tomorrow have both been changed. The 6 pm tomorrow came tonight and the 6:15 has withdrawn, so our last presentation will be at 5:30. I think if we all work with dispatch tomorrow, we should be able to have a harmonious and effective day.

With that, the committee stands adjourned until 9 o'clock tomorrow morning in this place.

The committee adjourned at 2153.