Wednesday 10 March 1993

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

Ontario Psychological Association

Dr Ruth Berman, executive director

Dr Mary Tierney, coordinator, long-term care initiative and member, legislation committee

Extendicare Family/Community Advisory Boards

Bill Hayward, representative

Catholic Children's Aid Society of Metropolitan Toronto

Ann Westlake, manager, long-term care

Benevolent Society Heidehof for the Care of the Aged

Thomas Pongray, board member

Gord Midgley, administrator

St Peter's Seniors' Comprehensive Health Organization

Dr Leila Ryan, chair, community steering committee

Susan Goble, project coordinator

Irene Das

Coleman Health Care Centre

Deborah Wall-Armstrong, president

Françoise Bouchard, administrator

St Joseph's Villa

Barbara Mahaffy, director of finance

Gerry Malcolmson, trustee and chair, public relations committee

Regional Municipality of York

Peter Crichton, commissioner of community services

Shawn D. Turner, administrator, homes for the aged program

Service Employees International Union

Judi Christou, assistant to the president

Lin Whittaker, nursing home coordinator, Local 220

Marcelle Goldenberg, director of research

Ontario Association of Developmental Service Workers

George Anand, president

Ontario Multifaith Council on Spiritual and Religious Care

Rev David Pfrimmer, representative


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

*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:

Carter, Jenny (Peterborough ND) for Mr White

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

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

Jamison, Norm (Norfolk ND) for Mr Martin

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

Sullivan, Barbara (Halton Centre L) for Mr Daigeler

Wessenger, Paul (Simcoe Centre ND) for Mrs Mathyssen

Also taking part / Autres participants et participantes:

Haeck, Christel (St Catharines-Brock ND)

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 1008 in committee room 1.


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 Chair (Mr Charles Beer): Good morning, ladies and gentlemen. We begin our hearings on Wednesday, March 10, Bill 101, An Act to amend certain Acts concerning Long Term Care.


The Chair: Our first witnesses this morning are representatives from the Ontario Psychological Association, and I would now invite them to come forward. Have a cup of coffee, some good old Toronto water. Please make yourselves comfortable and, once you're settled, if you would just introduce yourselves for Hansard and to the committee members and then please go ahead with your presentation. Again, welcome to the committee.

Dr Ruth Berman: Good morning. Mr Chairman and members of the committee, I'm Dr Ruth Berman, executive director of the Ontario Psychological Association, and with me is Dr Mary Tierney, head of geriatric psychology at the Sunnybrook Health Sciences Centre. Dr Tierney is a member of our legislation committee and coordinator of our long-term care initiative.

The Ontario Psychological Association is the voluntary organization representing the profession of psychology in Ontario. Our membership of approximately 1,400 includes psychologists, psychometrists and graduate students.

We are pleased to have the opportunity of expressing our views on Bill 101, the proposed amendments concerning long-term care. We have followed the debate on long-term care with great interest and have previously responded to the earlier government proposals outlined in the documents Strategies for Change: Comprehensive Reform of Ontario's Long-Term Care Services and Redirection of Long-Term Care and Support Services in Ontario. We are pleased to provide members of the committee with copies of these submissions for their information and we have given the clerk copies of our prior submissions for circulation.

The Chair: Thank you. We have both of those documents.

Dr Mary Tierney: In general, as psychologists, we would be in favour of any system which would provide the elderly and the physically disabled with greater control of and autonomy in their lives. We would support as a basic principle the concept that services must be directed at individual needs, in particular those that enhance and support an individual's independence, dignity and quality of life.

On the whole, we think it is a good idea to combine the acts that govern nursing homes and homes for the aged as well as to amend relevant aspects of the Ministry of Community and Social Services Act, the Health Insurance Act, the Ministry of Health Act and the Municipality of Metropolitan Toronto Act.

However, we have a number of specific comments regarding Bill 101 which we would like to raise with you today. First, we are pleased that the bill amends the Ministry of Community and Social Services Act and allows for grants for persons with disabilities to assist them in obtaining goods and services that they require as a result of their disability. However, there's no mention of the special needs of residents with mental health problems nor how their needs can be met.

Recent studies of Ontario facilities show that 75% of nursing homes and homes for the aged residents have some degree of cognitive impairment. Other studies of the same facilities show that 60% have mental problems resulting from Alzheimer's disease and other dementias, traumatic brain injury, developmental disorders, chronic substance abuse, depression, psychotic disorders and the like.

These individuals often require specialized services and facilities in order that their disorders are accurately diagnosed and appropriately treated. The bill provides no indication of who will screen or validate diagnoses of those with mental problems to determine what level of services the individual requires of a nursing facility.

Psychologists are one of the two professions authorized under the Regulated Health Professions Act to provide diagnoses of mental and neuropsychological disorders. Will there be provision in the regulations to include psychologists in this role? Psychologists are not covered by OHIP. Will this bill ensure that these services are available?

A related issue is that because of their disorders, these individuals may wander, be aggressive or destructive to self or others and exhibit other behavioural disturbances. In some instances, for example, for those at risk of wandering, locked units may be required. The issue of separate units in facilities for those with special needs has to be addressed in the bill. How will this issue be dealt with under the regulations?

A second major concern is in regard to the placement coordinators. As proposed in the bill, placement coordinators will control admissions to nursing homes, charitable homes for the aged and municipal homes. They will be designated by the minister. Who will these placement coordinators be and what will be their level of training? From whom will they seek information? What criteria will they use for decisions regarding admissions? To what extent will cultural, religious and linguistic needs of individuals be taken into account? Who employs these placement coordinators? It is a clear conflict of interest if it is the facility itself.

If the placement coordinator deems a person eligible, the facility must admit this person unless there are grounds for refusal of admission specified in the regulations. What are these grounds and who will determine whether they are applicable or not?

The Alberta classification tool is the tool that will be used to assess long-term care facilities for level of funding by determining the amount of nursing care required by the individual resident We trust this will not be used as an assessment or screening instrument, as it was not designed to be used in this manner and thus will not provide useful information. Furthermore, the tool does not assess the amount of care required of other members of the multidisciplinary team even in those facilities where such individuals are employed.

A third issue is in regard to the requirement specified in the bill that each resident of a nursing home, a charitable home for the aged or municipal home must be assessed and a plan of care developed to meet the requirements of that resident. Given that the majority of residents will have mental problems, who will develop and supervise the specialized care plans of these needy individuals? Psychologists can play a valuable role in this area.

Psychologists have recognized expertise in the development of behavioural intervention programs to deal with behaviour disturbances frequently associated with dementia and brain damage. Understanding the behavioural implications of neurological damage can assist the care givers in anticipating and interpreting many of the actions of the ones for whom they are caring. Psychologists can train care givers in long-term care facilities to work more effectively with their residents.

The provision of treatment for individuals once they have been admitted to a home under the new act remains of great concern to us. The purchase of services other than nursing appears to fall under "quality of life," a category of funding proposed for the operation of homes. At present, there are no psychologists on the staff of nursing homes or homes for the aged and relatively few within chronic care facilities. Psychologists can provide essential and unique services in the form of psychological assessment and diagnosis, behavioural management of wandering, aggression, depression, incontinence etc.

We understand that this envelope of funding is small and that an entire range of services will be competing for these limited funds, including, for example, special meals to meet the requirements of residents with religious restrictions. We are concerned that if there is no clear statement in this bill of a need for expert psychodiagnostic services and psychological care, these services will not be available to the residents of these facilities.

It should be noted that in the United States specialized diagnostic and treatment services of psychologists for nursing home residents with mental problems in medicare-certified facilities are governed under the pre-admission screening and annual resident review regulations of the Health Care Financing Administration. Similar regulations are required under the current act to make these essential services available.

These are a number of the issues, and there are others as well, related to long-term care which have been fully elaborated in our prior submissions. We are prepared to meet with the committee members for further discussion on these issues at any time and would be pleased to answer your questions at this time.

The Chair: Thank you very much for your submission and, as you indicated, the previous submissions from 1990 and 1992. We'll begin questioning.

Mr Paul Wessenger (Simcoe Centre): Thank you very much for your presentation. I'd just like to indicate to you, for clarification with respect to your comments with respect to the Alberta classification tool, and assure you that it will not be used as an assessment or screening instrument. Further, the plan of care for each resident is to be developed by a multidisciplinary team, of course in consultation with the resident and the resident's family. I just thought I'd give that clarification.

The Chair: Any comment on that?

Dr Tierney: The comment would be that you said the care plan will be developed by the multidisciplinary team. That would be determined by who's employed by the facility. Our concern is that psychologists are not currently employed by any nursing home or home for the aged, so we would not be included in the multidisciplinary team.

Mr Wessenger: Yes, I certainly appreciate the fact that your services are in many cases needed in this multidisciplinary team.


Mrs Joan M. Fawcett (Northumberland): Thank you for your presentation. Just following up on that, how widely are your services used in the homes or any of the long-term care facilities?

Dr Tierney: Well, probably within this province, the facilities that employ psychologists for geriatric residents are the chronic care hospitals.

Mrs Fawcett: And that's the only area there where you are presently --

Dr Tierney: There are no nursing homes or homes for the aged that actually employ on-staff psychologists. I can refer to examples where I've been employed by a resident or where another psychologist might be employed on a consultation basis, but certainly not on the staff or employed on any kind of regular basis.

Mrs Fawcett: And having done that, you can see the need for an expansion of your services. On the one part of your brief, you said that you're "concerned that if there is no clear statement in the bill of the need for expert psycho-diagnostic services and psychological care, these services will not be available to the residents of these facilities." This just all fits together, then. Is there anything further you would like to say on that or how you would like to see it included in the bill? As an amendment, or --

Dr Tierney: Or if it could be included within the regulations, it would specify which members of the team must be included for these kinds of diagnoses.

Mrs Fawcett: Yes. Well, that's a problem. We haven't seen the regulations yet. We know that so much is going to left there, and we're not just sure. But you would think, then, that the place for that would be in the regulations rather than in the bill itself?

Dr Tierney: Or if there could be some recognition, which we also discussed, of the different levels of care required for residents, because that's not mentioned within the bill.

Mrs Fawcett: Right. Thank you very much.

Mr Cameron Jackson (Burlington South): I'd like to build on your current relationship with chronic care hospitals. If you've been apprised of the ongoing dialogue before this committee, you'll be aware that the government has a plan to reclassify chronic care hospitals. We have heard first hand in Ottawa at the Perley, and there are six other hospitals that are currently under negotiations to downsize the level -- I'd better be careful -- not level of care, because they don't want to admit that, but it amounts to the same when you take highly skilled professional individuals and remove them from that setting. The theory is that we'll have the same level of service. I don't buy that, but that's the way the government, the NDP, are trying to convey it.

Are you involved in those discussions in terms of the staff dislocation, the reclassification of the beds? Because before this committee it has been very specifically and graphically explained to us that there will be fewer medical interventions, which I know include your services. So if there isn't a place for you in the continuum model there, then where is it? And if this is the only place and it's about to be diminished, you're really fighting for some participation in the process of extended care in Ontario. That's really where you're at, because you're losing ground.

Could you respond to some of that in detail in terms of how you've been involved at the Perley, as an example, or in a generic way with the government in its reclassification and downsizing of the chronic care hospitals in Ontario?

Dr Tierney: Well, at present there is not a psychologist at the Perley, so we have not been directly involved there. I could speak to my experiences at Sunnybrook, which are a bit unique because of the role of Veterans Affairs, which provides funding. Therefore, some of the chronic beds are not eligible, but they're certainly under review.

These changes are not just a concern of psychologists within chronic care facilities. They are also a concern of occupational therapists, physiotherapists, social workers, speech pathologists, many of the other professions which are employed primarily in chronic care facilities, because that's where the funding is. With the change in classification based on the Alberta classification tool, which is completed only by nursing -- it's not completed by the other members of the team which may have input as to level of care -- the individual will be possibly moved from a chronic care facility based on that information. You're right; we're all concerned about that.

Mr Jackson: But don't you as well embrace the notion that it has less to do with the movement of individuals as it does with the extraction of levels of service in those institutions? We have uncovered during these hearings that the Perley will no longer be a hospital. It cannot be called a hospital and it doesn't have the protections under the hospital act; it will be a long-term care facility and it falls within the ambit of this revised legislation.

So it's less the movement of the individual; their acute care needs are going to be there. Their acuity rate will still be there, but they won't have as many respirators. They won't have the physicians. They won't have what we call the life-sustaining interventions and the psychological interventions that are so important at that level. That's what this committee is coming to realize, as has been explained by Mr Quirt under cross-examination as to what the government's plan really is.

Ms Jenny Carter (Peterborough): First of all, a comment, and then a question. Of course, this is just a barebones act, as you might say, and we are missing the regulations that put the flesh on the bones and this has led to a lot of concerns that I hope in the long run will prove not to have been necessary.

Certainly, your concern about the placement coordination is something that we've heard a lot about but, on the other hand, we have had presentations from, for example, VON groups which are in fact performing that function in their own local areas already and it does seem to work very well. Certainly, the element of choice is very much at the top of the minds of these people and they don't see any reason why this would change as a result of Bill 101. So hopefully that's a problem that will turn out to be non-existent.

It seems evident that psychologists are already not playing as big a part as maybe you should in this whole picture and maybe this is something that we should look at much more closely. I was just wondering if you could fill in for us some of the details as to how earlier intervention by psychologists might lead to people not becoming such serious cases as they otherwise might and how this would save money further on down the line.

Dr Tierney: I'd be happy to do that. I think what we're addressing today is mainly the role of psychologists within the facilities. But, as you've mentioned, psychologists can play a role in the continuum and I think the whole problem is, you have to look at why people are institutionalized in our facilities in the first place. When you see the majority are for mental problems, are we really addressing those needs and have we put any emphasis there in either diagnosing or treating those problems? This is what I think is lacking.

It's just not there, because psychologists can in fact -- and often this is what is done. We see this at Sunnybrook all the time. The individual is admitted to a facility and he has not been diagnosed or he has been diagnosed with Alzheimer disease and there's probably about a 50% accuracy rate in this diagnosis. If there's no further workup of this individual, he is treated in that way and there's no chance for any kind of rehabilitation or improvement in function.

What psychologists can do is diagnose these individuals accurately and thoroughly in such a way that not only does it provide that accurate diagnosis but it's also the kind of diagnosis that can lead to treatment so that if a depression, for instance, has been missed, whereas the person has been labelled with Alzheimer or some dementia, the depression in fact can be treated and can be treated without medication. That individual then can go home.

But because these services are not available, individuals remain in our nursing homes and homes for the aged, misdiagnosed and not treated, and this is what I think is very expensive.

Ms Carter: So existing teams do not include psychologists as much as ideally they should?

Dr Tierney: Well, no, and that's the problem; only within. I think this is what was being alluded to earlier, really. As well, not all chronic care hospitals employ psychologists. Unless the individual's family employs a psychologist on a consultation basis, the individual within the facility doesn't have access to that service.


Mr Stephen Owens (Scarborough Centre): On a point of clarification.

The Chair: Yes.

Mr Owens: Mr Quirt, if, in the writing up of a care plan, it's indicated that the services of a psychologist are to be part of that care plan, and recognizing that psychologists are not an OHIP-covered service, what would be the responsibility of the facility or the resident to pay for the service? In terms of the enforcement of the contract between the resident and the facility, what would happen?

Mr Wessenger: I'll ask staff to reply to that one.

Mr Geoffrey Quirt: I'm Geoff Quirt, acting executive director of the long-term care division. If, in developing the care plan for a resident after the resident was deemed to be appropriate for admission to that facility, it was indicated that the resident could benefit from the services of a psychologist, the facility would have at its disposal the funding available and the quality-of-life funding component of the new funding formula to purchase specialized quality-of-life-related services, including specialized services like the services of a psychologist, an occupational therapist or physiotherapist.

I note, however, as has been pointed out, that the more appropriate point of involvement of a psychologist might be in the assessment stage when a multiservice agency or a placement coordination service was exploring the reasons why someone was considering moving to a facility and exploring community service alternatives and looking at the problems that were presented to the family and the client; that may have been probably an earlier and more important and more productive place to involve that specialist resource.

The Chair: Thank you very much for coming today. I believe we have also had psychologists from several other centres who have come forward, and I think certainly the message has been consistent. We appreciate your being here this morning.

Dr Berman: Thank you very much.

Dr Tierney: Thank you.


The Chair: I now call our next representative from the Family/Community Advisory Boards of Extendicare Guildwood, Extendicare Bayview, Extendicare Scarborough and Extendicare Park Road, if he would be good enough to come forward.

Mr Bill Hayward: I'm here.

The Chair: Welcome to the committee. If you would introduce yourself for Hansard and for the committee members, and then please go ahead. I think we have a copy of your submission in front of us.

Mr Hayward: Good morning, ladies and gentlemen. My name is Bill Hayward. On behalf of the Family/Community Advisory Boards and the several hundred elderly people who live at Extendicare Guildwood, Extendicare Bayview, Extendicare Scarborough and Extendicare Park Road in Oshawa, please accept our thanks for the opportunity to speak to you about Bill 101, An Act to amend certain Acts concerning Long Term Care.

The Chair: Just before you go forward, do members have a copy of this? I guess copies are being made. I'm sorry. There was one here. I guess they're making copies, but please go ahead, and we'll distribute them as soon as we get them.

Mr Hayward: Okay to proceed?

The Chair: Yes.

Mr Hayward: We're going to talk specifically about the impact of the proposed copayment increase that residents of nursing homes throughout Ontario will have to pay to continue living in their homes. At the outset, we wish to go on the record as fully and strongly supporting the 11 recommendations submitted to you by Mr Jim Lumsden, chair of the Council of Family/Community Advisory Boards in Ottawa, on February 24. We believe that your serious consideration and government's adoption of these constructive recommendations are prerequisite to ensuring equity and fairness to everyone: residents, staff, administrators and care givers, all those who will be affected by Bill 101.

In preparing to meet with you today, our members spent a lot of time trying to decide how to most effectively convey to you our concerns, and those of the elderly people we represent, about Bill 101. At first, we considered the facts-and-figures approach -- hard numbers, demographics, chronicity rates, province-by-province regulatory and cost comparisons, income levels, forecasts, projections -- the type of number-crunching and statistical gathering that all governments generate, or as increasingly seems to be the case, cause the public to generate in order to respond to what we believe is ill-planned, incomplete and unjustified legislation.

On balance, however, we figured that you'd get all the statistics you'd need from other presenters or from your own staff, so we decided to take a more human approach. After all, we can't afford to forget that it is human beings, not statistics, who suffer the consequences of poorly crafted legislation enacted by governments at all levels. With Bill 101, the people who will be affected are among the most vulnerable in our society and least able to suffer the consequences. In order to discuss Bill 101 on a human level, we believe it is essential for all of us here today to share the same perception, image, if you will, of the people we're talking about.

To do this, I'd like all of you here today to think about an elderly relative or friend, someone who's getting on in years but who still has most of his or her faculties, someone who's still able to maintain a degree of independence in terms of living alone, getting around, using the telephone, shopping -- generally speaking, able to take care of themselves.

Hold that picture and think about that individual, relative or friend three to five years down the road, perhaps the victim of a cruel and disabling stroke or struck down by heart disease, arthritis or Alzheimer's. Picture that person having to be fed and bathed, and picture yourself having to sit for hours in a hospital waiting room because of that person's most recent serious fall or burn or attack. Picture that same person with a healthy mind but a deteriorating and unresponsive body. Picture wheelchairs and picture walkers and picture canes, and picture, if you can, anxiety, confusion and, in some cases, severe isolation.

These are the images of many of the people who will be directly and immediately impacted by Bill 101, particularly the unbelievable resident copayment increase of up to 45%, depending on whether the rate goes up by $10.88 a day or $11.88 a day, the latter being the third level of increase to be announced since last fall and the latest amount that the government says these people will have to pay. We want you to recall these images of these people as we discuss elements of Bill 101 from a human perspective.

Before most of you is a copy of a letter written by Vera Nicholls. She's the former president of the residents' council and a three-year resident at Extendicare Guildwood. I say "former president" because Vera doesn't live there any more. She had to give up her bed at Guildwood because of a prolonged hospital stay brought on by a series of heart attacks, the last of which hit her after writing this letter. Vera wrote the letter so that it could be read at a meeting we held at Guildwood on December 20 to familiarize residents and their families with Bill 101. She didn't feel she'd be strong enough at the time to speak in person at the meeting.

If I can be permitted to digress for a moment, this was the same meeting to which we had formally invited Premier Rae and the former Minister of Health, Frances Lankin, and although we contacted them more than three weeks prior to the meeting, we didn't receive the courtesy of a reply or an acknowledgement. It was only after I made a series of 11th-hour phone calls within less than 24 hours of the meeting that we were able to confirm that a government representative would attend. Unfortunately, he was unfamiliar with the details of Bill 101, having himself been given very short notice and pressed into service in an instant.

For the record, I'd now like to read Vera's letter. It's dated December 10. As I say, Vera wrote it to be read at our December 20 meeting.

"As president of the residents' council of Guildwood Extendicare nursing home, I wish to express my anger concerning a proposal up before Queen's Park at this time to increase the residents' share of their accommodation for long-term nursing home care by $11 per day.

"I find this to be unacceptable entirely. It boggles the mind how anyone can possibly come up with a proposal of this kind. I am strongly against it. These people struggled years ago to keep their homes together under the most trying circumstances and went without so much in order to put a few dollars away for their old age. We have arrived, and we get hit with the fact that we must continue paying for the rest of our lives for care and comfort. We paid our dues long ago. We don't live in the lap of luxury now, but we do have the excellent care to which we are entitled.

"We earned our right to this care long ago. I am wondering what our families feel about this proposal. I hope you will speak up loud and clear and let your thoughts be known.

"Things have come to a pretty pass when our government has to reach into the pockets of the aged and infirm to bolster up a failing health care system. We shouldn't have to have this trauma hanging over our heads at our ages. It's disgusting, to say the least. It would seem they are trying their level best to make paupers out of all of us so we shall wind up on the ward with nothing. It's too bad our government can't govern where it's most needed and not stoop to battering residents of nursing homes.

"Please families, help us fight this.

"Sincerely, Vera Nicholls."

As I say, Vera wrote that for dissemination at a meeting we held with the families and residents.

Excuse me, Mr Wessenger. Did I say something that was humorous? I noticed that you were laughing.


The Chair: Please go ahead.

Mr Wessenger: Go ahead.

Mr Hayward: Thank you.

Vera's letter and her current homeless situation I think illustrate in human terms two major impacts of the pending legislation. Her words I think echo the anxiety, the frustration and the anger felt by nursing home residents and their families over this drastic hike planned in the resident copayment. We're certain that all nursing home residents in Ontario would express the same emotions if it weren't for the fact that the majority of them have cognitive or physical impairments which prevent them from being here to speak for themselves today.

Her situation is that she's in hospital, nobody knows for how long -- indefinitely -- with nowhere to go, and perhaps for the remainder of her life, depending on her health. We think this exemplifies the uncertain future shared by large numbers of ill, frail, elderly women and men now in hospital simply because adequate chronic care facilities just aren't available.

Continuing to reduce or freeze nursing home beds in Ontario -- and we understand this is part of the redirection in Bill 101 -- will certainly set the stage for a human care dilemma unprecedented in this province's history. It's estimated that the number of people over age 85 -- and that's just the high end of the aging explosion that will be fuelled with the eldering of the baby-boomers -- is expected to grow by nearly 120% during the next decade or so.

Similar to others who have appeared before you, we do not disagree with the government's intention for increased funding for expanded community-based and home support services. Clearly, it's a laudable goal for seniors to stay at home or with families as long as practical, but not at the expense of people like Vera or the thousands of other elderly who, through no fault of their own, will find themselves facing similar anguish and uncertainty in their foreseeable futures: people like our parents and our spouses and our relatives, and, since none of us can predict what low cards life will deal us in the future, maybe even you and maybe even me.

There's no doubt that despite the improved and extended home care, the demand for special accommodation in future is going to be there. The question is, ladies and gentlemen, will there be sufficient beds to meet the demand? In terms of timing, it's the government's intention to hike up the copayment immediately upon passage of Bill 101. Already, letters advising of the increase have been received by residents, just adding to their anxiety and to their apprehension, especially for those people who say they can't afford the 45% hit.

In response to these fears, which the opposition voiced during the debate of the bill, a debate which occurred, many of you here remember, late at night and with so few government members in attendance that a quorum count had to be called three different times -- perhaps it's an indication of the government's lack of receptivity to the opposition and to constructive criticism from the public -- here's what the government said. We quote the Honourable Frances Lankin, the then Minister of Health:

"Each person's charge will be based on the ability to pay as determined by a simple income test. If they are getting the federal guaranteed income supplement, GIC, they have limited ability to pay. If they cannot pay the full charge or per diem, the charge will be reduced or eliminated based on the amount of GIC they receive."

How do we reconcile that statement with the other government position that those residents whose annual income is $10,680 or more will be targets for the full increase? That $10,680 is probably less than most of us here spend for our cars. Think about having to live on that amount for a year, and then think about having to use even more of it or have more of it taken away from you for so-called improved services when, as of today, right now, we haven't been told, nor have the residents, what those improved services are. That's the nub.

I'd like to give you a personal human example of just one person who is going to be disadvantaged by this increase. It's one of the reasons I'm here. Remember, as I said, to flash back to these images we talked about earlier.

My mother, who also lives at Guildwood, has a total annual income of $12,300. That's it, folks; no more. The Bill 101 copayment increase will immediately cause her monthly accommodation costs to jump by approximately $375, bringing her annual expenditure for room and board alone to $17,789. That's about $5,500 a year more than she brings in from her pension. You tell me how she will be able to afford such an outrageous increase just to have a roof over her head, to say nothing about being able to buy little things like toiletries or the odd blouse or dress, or anything else that helps her to maintain her individuality or her self-sufficiency and, perhaps most importantly, her self-esteem.

My friends, something is drastically wrong with the government's plans and priorities if my mother, and a sizeable portion of the other 46,000 or so elderly men and women living in nursing homes, must, as we said earlier, suffer the consequences of this bill and the copayment increase that's embodied in it.

I'm confident that those here with me today could tell you similar stories about their relatives currently living in nursing homes. Even if they didn't, you will make your recommendations in full knowledge of the potentially devastating effect this aspect of Bill 101 will have on their loved ones and on those of your constituents who undoubtedly face the same human dilemma if the copayment increase is rammed through based on the present timing and amounts.

Speaking of amounts, if the lion's share -- that's 75%, or $150-odd million -- of the government's announced $200-odd million to improve nursing homes and homes for the aged must come from existing residents -- and we don't believe it should -- then it's incumbent upon you to seriously consider Mr Lumsden's detailed proposals and recommendations, particularly as they relate to the proposed residents' copayment increase. I know he has been dealing with Mr Quirt quite extensively in correspondence for the last several months on the whole issue. For those among you who do prefer to make your decisions based on hard facts and figures, you'll find plenty of them in his report. Initiatives such as graduated annual increases tied to rent controls and the consumer price index have to be analysed and given every consideration. I think the operative word is "phase-in."

If, on the other hand, you're among those who do not fully accept that 75% of this money should be drained from residents of long-term health care facilities, then you only have to look to the most recent Auditor General's report on government spending to suggest other sources of funding. For example, I understand there's $140 million outstanding in the employers' share of OHIP fees, and there are undetermined hundreds of millions of dollars in unjustified and fraudulent welfare claims, to name just a couple. Hire a few more investigators, enforce existing laws and curtail the squandering of dollars to the undeserving. Redirect these funds to those who need the money most.

Stamp another nickel tax on to a pack of cigarettes or a bottle of booze and push some of those dollars into long-term health care. Most people will support the so-called sin taxes, but only if they're assured that the money raised is pumped directly into health care reform and not used to service the deficit or used for some other unrelated program.

Re-examine the allocation of dollars that are in the health system now. I'm told there's lots of money in the health system, and although the organization and distribution of those funds is probably a whole other issue, it's something we should be looking at.

Bill 101 seems to be the right thing to do, but in reality, Bill 101 appears to have been crafted in a vacuum. In fact, it gives rise to more questions than it answers. For example, it calls for level-of-care funding based on annual classification audits, a test of which was undertaken at considerable expense in nursing homes by the government last year. Where are the results? Where is the report? How will classification be carried out in future? Is the Alberta model -- and I heard the previous speaker mention it -- the best instrument to use in evaluating Ontario's needs, particularly given the differences in population, aging patterns, health delivery systems and so on that exist between the two provinces? What are the new and improved services nursing home residents will get for forking out $150 million more with Bill 101?

How will placement coordination work? What criteria will be used for placement? Geographic? Ethnic? Or will it simply be that you go where the bed is, because available bed space will become increasingly disproportionate to need given the bed reductions and closings under way now and in the future?


Where is the report on community consultation promised by government first for last year and then for January of this year? This is the report that the government is saying was the most exhaustive, comprehensive community consultation in the history of this province. It's being used to justify the passing of this bill, yet the report has not been given to the people who participated in the consultation to see what the justification is for everything embodied in Bill 101.

What else besides an extraordinary hunger for cash formed the basis of a 45% hit to our at-risk seniors? What influence have the public service unions had on the government's decision to penalize residents of private nursing homes, the majority of which provide equal if not higher levels of care in terms of quality, frequency and respect for the individual's dignity than most of the so-called not-for-profit institutions?

These and a whole host of other questions must be answered and, I think more importantly, asked by the opposition and the media in the future debate to come on this bill. Speaking of the opposition, we give full credit to the honourable member for Halton Centre, Barbara Sullivan, and the honourable member for Mississauga South, Margaret Marland, who did press for answers to these questions and others during the debate of this bill prior to second reading. Unfortunately, as I mentioned earlier, the debate took place during the late evening, somewhere between 10 o'clock and midnight, with virtually no government members available to answer them.

Ladies and gentlemen, you have the opportunity or, better stated, the obligation to evaluate all of the submissions presented to you. We again urge that you carefully consider the recommendations presented by Mr Lumsden and the council of family and community advisory boards. These recommendations make eminent sense and should be fully considered now before the bill becomes law.

As I said earlier, we're dealing with one of the most vulnerable and disadvantaged groups in our society -- I'm sure you've heard that since you started your hearings in spades -- but it's a group that all of us, everybody around this table, in rapidly increasing numbers will become part of sooner or later. In future, "should have dones" and "could have dones" will be too late and too little to address the human misery that will be born out of this bill as currently proposed. The time for improving it is now.

Thank you for listening and hopefully for acting.

The Chair: Thank you very much for a very full presentation. As you noted in your brief, we did have an excellent presentation as well from Mr Lumsden when we were in Ottawa. We'll start the questions with Mrs O'Neill.

Mrs Yvonne O'Neill (Ottawa-Rideau): Thank you for giving a personal touch. I think it's very important for each of us to place an individual in our minds who may be affected by Bill 101.

I think you are one of many, particularly in the last two weeks I would say, who have presented to us that the consultation, although expressed by the government as being extensive, has not been as meaningful as many had hoped. It did not see the things they had presented translated in Bill 101 and they are now beginning to understand that completely.

I too in my remarks have continued throughout the hearings to place before the committee my concern about the placement service and what the definition of "community" is in reference to placement service, whether that be neighbourhood, ethnic or religious.

I think you are right when you're suggesting that we are really attacking the most vulnerable, people who are making in this province $10,680, as one of your examples. This person also is subject to income tax in this province, which is not the case in other provinces. People don't know this. People don't realize the $150 million is likely going to come from most people. The average person's income is likely around $20,000. Is that the group we want to tackle in Bill 101 or other government legislation? I don't think so.

The term even of, "Well, this won't be touched," and the answer is, "Because there will still be the comfort allowance." I recently lost my father in January. I never talked to him about his own money as a comfort allowance. I think it's a degrading term. I'm sorry. Even people who have some dementia want to give gifts.

Mr Hayward: Sure they do.

Mrs O'Neill: They want to feel good about themselves.

I have really no questions for you other than that you have referred to the brief in Ottawa, which I think was an excellent brief. Have you got some highlights from that brief? There were many ideas presented. We're not going to get all of those included in any amendments or any regulations that we may suggest. Would you like to suggest something that you feel would zero in on your point that we could place as an amendment?

Mr Hayward: There were a few things. I don't know whether I should be the person who perhaps prioritizes them, but there are some things that came out of Jim's brief that are just so natural to do, something as simple as, on the inspections that are going to be called for in the new bill, that the inspections be done on a constructive and collegial basis rather than an "Aha, we caught you and you're going to pay for that" kind of thing.

That seems to be the attitude now and may be the attitude in the future. He's saying it should be, "We're all in this together. We're all trying to do the best for our elderly persons," as far as this bill applies to elderly persons, -- I realize that's only one part of the group affected -- something as simple as the inspections being done in a collegial way rather than in a confrontational way; standardizing all the regulations; everybody playing with the same deck of cards. If you're going to be criticized across the board, then you should benefit across the board as well in terms of government benefits.

The family/community advisory boards: This could almost be saying, "You're creating a niche for yourself in it," but making the creation of such boards mandatory. I can only speak for Guildwood. I can't speak for the representatives from the other three homes -- I don't know how long they've been in operation -- but until Guildwood's board was formed, the only mechanism in place for the residents was the residents council. Let's not kid ourselves; some of the people on this council are limited in terms of their capability of taking on an issue or an item to address.

Vera, the lady whose letter I read, was the president of the council. She sat on our committee and was a dynamo, a person whom we welcomed. We're so sad she's in the situation that she's in now. Please don't misunderstand. I'm not saying Vera's in the situation she's in now because of this legislation, I'm not prepared to go that far, but she was upset about it to the point that she did write the letter.

I think having a mechanism like a family/community advisory board mandatory so that there is that --

Mrs O'Neill: You're not the only person who's suggested that, you might be happy to know.

Mr Hayward: Yes. I know Jim had.

Mrs O'Neill: It has been suggested really almost across the province.

Mr Hayward: These are volunteer people. There's no time for them. I'm not being paid. I'm looking after my interests. I'll be quite upfront. I know I'm going to be hitting this age bracket fairly soon. I want to make sure there's something in place for me that I can handle and not the situation my mother has right now, for example.

Mr Jackson: Bill, thank you for your brief. You've covered an awful lot of ground here.

Mr Hayward: It's a shotgun approach.

Mr Jackson: A shotgun filled with the truth none the less. First of all, I wanted to thank you for putting on the whole issue of priority and prioritizing or whatever the buzzword is and that there is money out there. To put a figure on the welfare fraud, five weeks ago the auditor, who's just down the hall, confirmed that the figure is around 10% of payouts that are either fraudulent, unnecessary or inappropriate.

Mr Hayward:~There's the whole problem.

Mr Jackson: That's about $600 million that is spent by Ontario taxpayers unnecessarily on welfare. I just wanted to put a dollar figure on it for any of your future discussions. That came from our Provincial Auditor.

I also want to say to you that we have been concerned right from the day of the announcement of the NDP's love affair with user fees and coming up with this $150-million figure. We have asked for the financial workup and any impact studies, which is what you spoke to, the impact of that decision, and we've asked that of this government. Perhaps I could get a short answer, Mr Chairman. This has been a request that I made of the ministry when Mr Wilson made the announcement and a request through the committee process. Do we have those financial impact studies or the financial workups for how they arrived at this user fee increase?

Mr Wessenger: I'll ask ministry staff to reply to that.

Mr Quirt: A package of that material is being prepared for the committee, along with the other material the committee has recommended that we provide. Mr Lumsden, as a matter of fact, was mailed those calculations and that material at his request, I think probably about a month ago now.


Mr Hayward: I can't speak for Jim, but Jim says he has not received any of that information that justifies the rate of the hike or the source of the hike. He has not. I spoke to him last night.

Mr Jackson: Mr Chairman, Mr Quirt was present at a briefing that I participated in the day the minister stood in the House to make this announcement and that was my first question, where was your impact study and what were the implications? I had several questions on it. Mine is about a six-month standing request, the committee has a one-month standing request, and I'm delighted that Mr Lumsden may be the beneficiary of all this information ahead of the elected people in this province; none the less we're still waiting for that information.

If I may yield my last question in the short time to Mr Hayward, since you raised a dozen or so questions in your brief, would you like to raise a question directly with Mr Quirt and use that time, which I will yield to you if you'd like to raise a question for Mr Quirt or Mr Wessenger?

Mr Hayward: I think my question would just echo yours, Mr Jackson. We're looking for the data that justify the level of increase and the sourcing of the increase. Everything is being hung on this consultation report and on the classification audit that was done.

I know one was done in Guildwood. There were two nurses in there going around for a period of several days with little clipboards and pencils and watching how long it took to lift a resident's hand and how many had to be fed and the audit was done. But there's been no report since then. My question echoes yours. Where's the meat, so to speak; where's the beef?

Mr Wessenger: Thank you for your presentation. I'd just like to indicate with respect to the report I believe it's going to be out very shortly.

Mr Jackson: Mr Lumsden's already got it. Maybe we should call Mr Lumsden and have it from him.

Mr Wessenger: Perhaps I'll have staff clarify the report that will be out with respect to the classification system.

Mr Quirt: It appears that there are three reports being referred to. There's a request that was made by this committee on analysis that compared the calculations done by the Ontario Association of Non-Profit Homes and Services for Seniors with respect to copayment revenue generation with the provincial figures. That report's under preparation for the committee. It's a different report from the one requested by Mr Lumsden. Mr Lumsden received the analysis of the ability to pay of seniors over 80 years of age on the basis of individual OAS/GIS rates for the over-80 population in Ontario and the data on how $150 million was estimated.

The third report referred to is the report that provides the results of the patient classification survey, resident classification survey conducted last fall. That report is being prepared currently. It will be shared with members of our funding focus group towards the end of March and each facility in the province will receive a package that includes its individual results and a comparison of how its individual results relate to the average results for various categories of beds across the province, residential care in charitable homes and municipal homes and extended care in charitable homes and municipal homes and nursing homes.

The Chair: Perhaps I might as the Chair request that the information that was sent to Mr Hayward be shared with the committee as well.

Mr Quirt: The information was sent to Mr Lumsden in Ottawa and we'd be happy to provide a package of that information.

The Chair: I think it would just help if we could have that as well.

Mr Hayward: May I speak?

The Chair: Yes, go ahead.

Mr Hayward: I'm not familiar with the information that Mr Quirt said he sent to Jim. I do have a copy of a request to Mr Quirt from Jim, dated November 25, and I could read it, where he's asked for specific information related to what you were talking about, and I have a copy of your reply, dated December 14, to him, which, in my opinion -- and I could be the uneducated person here -- doesn't even touch on addressing what he asked in his reply. We could be talking about two different things, Mr Quirt. I'm not trying to put the light on you; I'm just saying that it doesn't jibe with what he asked and what he got back as an answer. If anybody wants to see these or read them, they're welcome to.

Mr Wessenger: Yes.

Mr Quirt: There was a subsequent request made by Mr Lumsden. There have been telephone conversations with him, at least three meetings.

Mr Hayward: He has even tried freedom of information, I understand, to get some of this information. He's been turned down under the FOI act to get this kind of information.

Mr Quirt: I wouldn't want to comment on his request there. I know the information he's asked from us has been provided to him without having to go through the freedom of information process and a package several inches thick went to him, I believe, in January or February.

Mr Hayward: I can't speak for Jim.

The Chair: If that information could be made available to the committee, then perhaps we can all determine what is there. Parliamentary assistant, you had another?

Mr Wessenger: Yes, I do have a question. Several groups have made presentations to this committee suggesting that assets of the individual residents should be considered in determining the obligation to make a copayment. I would like your comment on whether you think assets ought to be considered in an ability to pay.

Mr Hayward: I personally don't think they should be, but let's back up for a second. The government's position, as I understand it, is we're not going to be doing an assets test, if you will;, we're going to be doing a simple income test.

Income generated by interest from investments, savings or whatever, that's income. Is that considered income? Then it's very quickly apparent what the assets are, based on the amount of income interest or dividends that someone's being paid so it is, in effect, to some extent, an assets-based means test.

My opinion on whether a person, because he has some money he managed to put away, lifetime savings -- should it be considered in what that person has to pay or should that money be used for him to enjoy the rest of his life in comfort? I have to say it should be used for his to enjoy the rest of his life in some sort of comfort and normality.

The Chair: Thank you very much, Mr Hayward. I think we could go on for some time.

Mr Hayward: I'm sure we could.

The Chair: I regret, as the Chair, there are other witnesses, but we want to thank you again for your presentation and for being here this morning.

Mr Hayward: You're welcome, and also the boards at the other Extendicares.

The Chair: Right. Thank you all for coming this morning.


The Chair: I then call on our next witness from the Catholic Children's Aid Society, if you'd be good enough to come forward. Welcome to the committee. Perhaps you would be good enough to introduce yourself for Hansard and then please go ahead with your presentation. I believe we have a copy of your submission.

Ms Ann Westlake: Good morning. My name is Ann Westlake. I'm the manager of long-term care at the Catholic Children's Aid Society of Metropolitan Toronto. I welcome the opportunity to be here this morning. I've come to use my voice to speak on behalf of a group of individuals who can't speak for themselves, who can't be here and can't articulate their needs and I welcome the opportunity to do that on their behalf.

I want to speak to you about a group of, at present, some 180 individuals, young adults. All of them have a variety of life circumstances, but they share three things in common: They have all been in the care of a children's aid society in Metropolitan Toronto; they all have some degree of developmental disability; and they all have long-term needs.

I hope to be able to share with you today, in a simple way, a situation that has emerged over a very long period of time. The complexities of which and the feeder system that's contributed to this difficulty are quite complex, so I don't expect to be able to address it thoroughly, but hope I can leave you with an impression of how the situation has emerged and what it means for the people's lives that it affects.

As all of you know, people who have disabilities have traditionally been dealt with in our society through a process of institutionalization. They were segregated, set aside and it was a belief system of our society that, on behalf of these individuals, we were assisting them as well as their families if we were to provide them with specialized services, often set apart from the community.

Our thinking about that, the cost of institutionalization, began to change in the 1960s and 1970s until we came to determine that the cost of institutionalization in both economic and human terms was very, very high. What we saw emerge in our society was a system of community-based support services for families and individuals and as that began to happen, we began to return people to the community and we began to ask families to continue to provide care for their children with special needs.

Unfortunately, all families were not in a position to continue to do that -- the availability of services, the range of services, sometimes limited families' ability to provide that care -- and the options for those families became increasingly limited.

Eventually, in the case of some individuals, those families were forced to come to a children's aid society or at times were advised, at the birth of a child with special needs, to relinquish the care of that child to a children's aid society.


Children's aids traditionally have only two options in the provision of services to children who come into the care of child welfare. They can place a child in a foster home, or in the 1960s, 1970s and 1980s, we've had a range of children's group homes or boarding homes that we have had available to us to provide care to children.

I want to tell you a little bit about myself, to tell you why I'm here today and how this problem has evolved for me as a professional working in this field. In the late 1970s, I entered the field of child welfare and chose to work with children who had developmental disabilities. It was my great delight and my great privilege to do so. As part of my work, I found myself working with kids in foster homes and group homes, and it was my expectation that as those children grew up, they would move on into a system of support services that would help them live their lives as adults.

That was the case in the 1970s, but as the pressure for the available resources increased over time, it became more and more difficult to move children who became adults into a system of services that would support them through adulthood. I found myself, as a front-line worker, increasingly having difficulty finding those supports for the people I had served as children and who were moving into their adult years.

I moved on in my adult years and had a variety of other opportunities to do a range of work. I found, much to my surprise, several years after having made a job change, that children whom I had served were stuck in exactly the same circumstances they had been in when I had known them as 16- and 17-year-olds. They were living in either a foster home or a group home setting that was designed to provide care for children, and there was no future prospect of their having an appropriate home, an appropriate vocational opportunity that would serve them as adults.

That's what I'm here to talk to you about today. Those young adults are increasing in number as each day passes. They have come to the doors of the child welfare agency as children. Children's aid has a mandate to serve them to the age of 18 and, in some circumstances, 21, and past that age there is no one who will provide for their care. The crisis that emerged for child welfare approximately 10 years ago resulted in them doing some advocacy on behalf of these individuals. What that resulted in was a mechanism financially that allowed for these young adults to remain in their children's placement until such time when appropriate adult services could be provided. This problem was identified 10 years ago. Many of those individuals are still in the same circumstances.

The implications of this situation are great. First of all, in human costs, what we find is that there are children with special needs and adults with special needs being served in the same residential circumstances. It compromises the needs of both groups. Foster families that had anticipated seeing the children they had raised move into adulthood are left with the burden of providing care for adults in the absence of adult services.

There are no standards to regulate the quality of care that the adults are providing in children's services. At the other end of the continuum, the residential beds that are required for children are being utilized by adults, thus creating an ever-increasing clog in the system.

Most of the residences in which these young adults are placed are operated for profit and consequently an ever-growing sum of money is being spent each year on behalf of these individuals. Essentially, last year, it's my understanding that approximately $5 million in deficit funding was spent to maintain the status quo.

I've had an opportunity of late to speak to some of these young adults, some of whom I knew when they were children, some of whom I'm only getting to know now, and the ones who are able to talk to me are able to tell me that this isn't what they want their lives to be. They don't want to be living with children; they want to have jobs; they want to have opportunities; they want to have day programs; and they want to have a future. At the present time, the hope of their having a future appears to be quite limited. We've known about this situation for 10 years and for 10 years we've been unable to find a systemic solution to the problem.

I'm here today to make three recommendations and to ask you to consider them. The first is that in the drafting of any legislation on long-term care, please consider this specific group of young adults as individuals who should be considered in the drafting of that legislation. They do have lifelong needs. They have a human entitlement to be considered to have those needs met.

Secondly, as part of the multi-year plan, I think this is a group that could and should be designated as a special-interest group in the implementation of the second phase of the multi-year plan. The multi-year plan is coming to the end of, I think, the first seven-year phase, and consideration is being given to planning for the next phase of that legislation. This is a group that needs special consideration. I would suggest that as in the first phase, individuals within this group could be targeted on an annual basis to receive service so that we could begin to see some movement in the system.

Thirdly, I would ask that some consideration be given so that systemically we can begin to address this difficulty at the front door. Some of the reasons this situation has come to emerge is because of a limited number of support services in the community for families that have children with special needs. Families come to children's aid societies as a last resort often to receive help when they are in crisis, and until we begin to address that need at the front door we're going to see the numbers in this group continue to increase over time.

We anticipate that over the next five years, children with special needs who are becoming adults in the care of the children's aid society will number an additional 150 people. That will put us to a level of well over 300, and if we look at the cost implications and the human implications, they're very great. I would ask you to consider how something might be done now to begin to address this problem.

I'd be happy to answer any questions you might have.

The Chair: Thank you very much for your oral presentation, as well as the document that you've left with us. I know I benefited greatly from talking to you about this issue and I'm particularly pleased that you were able to come before the committee. We'll begin the questioning with Mr Wilson.

Mr Jim Wilson (Simcoe West): Thank you for your presentation. I think you raise a number of interesting and indeed challenging points. In an attempt to find a solution, I want you to comment on my recent experience with respect to children with special needs.

There's a nursing home in my riding near Stayner called SweetBriar Lodge Nursing Home, and 47 of its 50 residents are severely developmentally handicapped children and young adults. Many of them are children with special needs. The problem we're having is that the government has built some group homes, and the theory is that many of these children and young adults are to move into the group home setting also in the riding.

The problem we're having is that the funding isn't there for operating the group homes, although the bricks and mortar are up. Coupled with that, many families don't want their loved ones to leave the nursing home. I've been inundated with parents saying that every time some bureaucrat over in Barrie, who has never seen the resident, decides that someone has to move to a group home. In almost every case over the last two years, the parents and family have then come to me to say: "No, Joan's been there for 15 years. She wouldn't know the difference whether she's in the nursing home, which is familiar surroundings, or whether you move her." And having visited there, I think that's a fair assessment of many of the residents, in layman's terms, in crude terms, I admit.

Where do you think we should be going? You know, many of my administrators, whether they be in community living or administrators of nursing homes, very much feel that the government will, every once in a while now, shift someone from a nursing home to a group home just to keep the system lubricated. But the group homes are turning out to be so expensive. I think the cost of putting up the group homes in Stayner for eight residents was well over $300,000, and their staff ratios are tremendously high compared to the cuts that have had to take place in the nursing home sector.

To me, not having spent a lifetime working with this, but as Health critic and having spent a long time now touring around and seeing these institutions and visiting group homes, there's got to be a happy medium. There's got to be a solution there that I haven't quite figured out, so I'd appreciate your comments on that. That's atypical, I think, of what's going on in the province.


Ms Westlake: I'm not arrogant enough to believe I have the answer to a question like that, which is very enormous, but I can certainly offer you my comments.

Mr Jim Wilson: Anything would be a help.

Ms Westlake: It's a question that's defied the province of Ontario and indeed most of the country for some time. I think families with members who have such serious needs face a great deal of stress in trying to make decisions about the quality of their lives. We in our wisdom, 20, 30, 40 years ago, felt that institutionalization was the best way to serve people who had very complex needs. We decided 20 years later that that wasn't the way to serve people with complex needs, and I believe, now that money is in less supply than it was to provide services, that we're beginning to question again the tenets upon which we began to deinstitutionalize.

Families are afraid of change, in some instances, where a member of their family has appeared to be comfortable over a great period of time. I think it may be unsafe to assume that the individuals themselves wouldn't notice change and wouldn't know if they were in an institution or in the community. I don't feel I'm well enough informed to be able to make that assumption.

Mr Jim Wilson: Well, that's coming from the parents themselves.

Ms Westlake: Yes, I understand. I think what we need to look to is a range of services for people. I appreciate that the costs are escalating increasingly and I think we need to search for alternatives that lie somewhere between a standard of care in the community that may cost in excess of $300 or $350 a day for people with very complicated medical needs, to an institution where the quality of care, in some instances, is less than it ought to be. I don't know what the solution is.

Clearly, I know that the dollars that need to be designated for this group of individuals are high and need to compete with a lot of other groups who have needs that are as significant, though different. I just hope we don't reach a point where we begin again to look at institutions as the answer for people who have special needs. It's too easy. We've gone back and forth in our thinking, depending on the fiscal and economic pressures that exist. I think we need to be more creative than that and I think there are ways and means by which we can be more creative.

Mr Jim Wilson: Even a number of institutional administrators would agree that there has to be a mix and probably a better mix than what we've got now, and they want us to ensure that there's flexibility, that parents have some say in this, and the residents themselves, where capable.

Mr Randy R. Hope (Chatham-Kent): As you brought forward some of the issues about multi-year plan, phase 2, I guess we call it, and long-term care initiatives, the big concern of the ministries and also of those advocates, whether they're community living or family auxiliary, is, are we going to create another gap for people to fall through? Where does long-term care play? Where does multi-year plan, phase 2, come into the joint conversation?

What we're trying to do is make sure that the gaps are not there. Your concerns have been echoed to us in Ottawa, London, Windsor. You're absolutely right. Is somebody rethinking a whole policy? I don't think so. I guess the major goal is to downsize the institutions. We have some very large institutions out there. The direction of the government is to downsize them, complying with the multi-year plan.

The big question is -- and you raise a number of concerns of fiscal realities out there -- how do we manage the system? You've come up with a good answer. I was waiting to hear what your answer was when my colleague opposite was asking you what the solution is. I believe that's where it's going to take the partnership -- the family auxiliary, the community living group, the government and parents -- to sit down and have positive conversations on how we meet the ultimate goal.

I look at some of our centres which provide a number of activities and make residents part of them, everything from swimming to working with computers, and then I take a look at some of the nursing homes and I question the actual community living that's inside that institution, making them actively a part of it.

Those concerns you raise: You're absolutely right, and I've heard it consistently throughout these hearings. How do we put it in perspective and how do we clear it up? I believe, and I agree with you, that they ought to be part of the long-term care overall picture, hopefully when the discussion paper comes out this month, and then they ought to be more constructively involved in the phase 2 operation of the multi-year plan. Will we come up with an answer? Only if the partners put their heads together and we come up with positive ways.

Ms Westlake: I agree. I would suggest that there aren't easy formulas. People can be ghettoized in group homes that are smack dab in the middle of downtown Toronto as much as they can be in a 60- or 70-bed residence. It's a little more difficult to provide normal experiences, I think, in a setting for a large number of people that's set outside of a community, but it can happen. We do have to struggle with one another.

Mrs O'Neill: I thank you very much for coming. Others may not agree with me, but I think your presentation has been totally unique. We've had quite a bit of representation, and I'm very pleased, from the many parent groups of developmentally disabled young people in this age group of which you speak who prefer particularly the specialized developmentally disabled institutions that are now also very fragile in this whole devolution. There are a lot of things going on that make all kinds of people who are in your position, or families of or advocates for this particular group of people, very nervous and vulnerable, because actions do speak louder than words. I think of the special services at home program, which, as you know, has reached a crisis, particularly in the area of Kitchener-Waterloo, where families have actually given up their children.

Ms Westlake: Yes, to children's aids.

Mrs O'Neill: This is the most severe tragedy, to my mind.

Ms Westlake: So they've become part of this group to which I refer.

Mrs O'Neill: Exactly. The sheltered workshop cutbacks have caused a whole other set of confusion for the age group you've brought before us. I think you have brought forward, more clearly than anybody has at this level, and I've certainly spoken to many people individually -- I think the case studies are very helpful; although you didn't refer to them, they're attached to your brief -- that there are adults, many, many adults, in children's beds. This is a very severe problem that nobody seems to be addressing, and it's causing a total backup and it's also causing many family problems and in some cases marital breakdowns.

We know this whole problem is long term, and I hope the parliamentary assistant for Community and Social Services continues to speak as he just did, that this issue should be addressed. Unfortunately, as I say, not many people have come forward with your message.

I would ask you -- and I know it's impossible for you, but certainly much less possible for me -- to suggest where we could begin. Would it be in adding to the budget of special services at home? Would it be in day programs? Would it be in supporting foster parents? Where would you make your first step to show this group of what I consider significant but vulnerable members of our communities that there is going to be something done on their behalf, something positive? Is there any one area you could suggest that we could put some moneys into and show at least a good intention? That's my concern right now, and I get at least five letters a week from individuals involved in the situations you're talking about who feel: "The rug is gone. There's no hopefulness. We're stuck and we haven't got anywhere to turn. We have aged parents," or aged foster care or care workers.

Mr Hope: MCSS has Hope.

Ms Westlake: It's a very, very difficult question and a very great dilemma and clearly I don't have a solution. I'm here to talk specifically about the needs of this group of young people who are without families, who are without care providers, who are at the mercy of staff, who hopefully are dedicated to them and committed to them.

Mrs O'Neill: And I think on the most part are very dedicated.

Ms Westlake: I believe so as well.

If I may be permitted to make just a few comments relative to what you said. I think we need to be extraordinarily diligent in trying to determine where our limited dollars are best spent. In my opinion, we have a very great obligation to attempt to support families who are providing care to their children at home. I think the dollars that have been made available to special services at home have gone a long way to prevent children from having to leave their families.


The other end of the spectrum, the whole issue of the aging parent and an adult with special needs for whom they're providing care, is another issue. But I think we can hold off the time that comes when an individual needs to leave his home if we provide some supports at home.

I can give you a very poignant example from my own experience that'll suggest what I'm talking about. I think we have to look at the financial limits in the special services at home funding. We had a little boy in the care of our society who was originally from Toronto, and because he needed a very specialized resource, we needed to move him to a group home that was in eastern Ontario. His mother was very committed to him. He had very complex needs both developmentally and medically. He had to move to a group home that was north of Belleville, some great distance from Toronto. His mother was a single parent, she had another child. She wanted her son at home. She didn't have a vehicle; she got on the bus every other weekend at great expense to herself to go and see him. She didn't have the means to bring him back; sometimes we, as an agency, we're in a position to bring him back to Toronto.

What she needed was an additional $4,000 or $5,000 a year on top of the money she was able to receive from special services at home so that she could provide for his care. That would have meant an outlay of approximately $15,000 a year. We, as an agency, were purchasing care on behalf of that child in a very specialized and very good group home at the cost of about $55,000 a year. So the savings to the province of Ontario, if we had made available that funding to that mother, would have been approximately $40,000, not to mention the quality of life for both her and her child.

Mrs O'Neill: And the sibling.

Ms Westlake: Precisely.

Mrs O'Neill: Thank you for being so precise.

The Chair: Thank you very much for coming and speaking about a special group of people. We appreciate you taking the time to come this morning.

Ms Westlake: Thank you for the opportunity.


The Chair: I would now call on our last witnesses for this morning, from the Heidehof home for the aged, if they would be good enough to come forward.

The Acting Chair (Mrs Joan Fawcett): Just a quick change of chairs for a minute. Would you introduce yourselves and begin your presentation, please?

Mr Thomas Pongray: My name is Thomas Pongray, and I'm one of 12 directors of the benevolent society Heidehof in St Catharines. With me are Richard Meyer, Ferdinand Neheli and Gordon Midgley, the administrator.

I am here today on behalf of the board of Heidehof in the hope that this time you will listen to us and amend Bill 101, at least to the extent that it affects charitable homes.

In October 1991, the Ministry of Community and Social Services, the Ministry of Health and the Ministry of Citizenship jointly issued a paper entitled Redirection of Long-Term Care and Support Services in Ontario: A Public Consultation Paper. The ostensible purpose of this paper was to serve as a focus for discussion with regard to planned changes in funding and providing long-term care for senior citizens. There were proposals that we agreed with. However, one of the proposals that caused us alarm was the notion that access to homes for the aged would be regulated through a service coordination agency.

I believe that most boards of directors of charitable homes agree with us that the use of service coordination agencies to place individuals in homes for the aged would both reduce individual choice and the ability of charitable homes to maintain the particular culture and excellence in service that is the hallmark of most such homes. This is certainly true of Heidehof. But you did not listen to us, or perhaps the agency that was charged with conducting the consultation process did not have the mandate to make the changes that we requested.

I am here to tell you that Bill 101 will substantially reduce the ability of senior citizens to choose where they would like to spend their remaining years. The bill proposes the office of a regional placement coordinator. The individual, instead of applying to the institution of his or her choice, will be ground through the bureaucracy of a placement coordination office. I submit that it will be an entirely lucky coincidence if the individual ends up in the home of preference. I am absolutely convinced that, faced with the systems needs of a placement coordination office -- by "systems needs" I mean the needs of the office to perpetuate itself and to guarantee the employment of its officers -- the needs of the individual will have little sway, and this at a time when the individual is at a vulnerable age, probably more easily manipulated than at any other time in his or her life.

From the point of view of the institution there will also be no choice. We will not be able to admit residents who are attracted to our institution because of our ethnic or religious values or because of our reputation for excellence. The decision by the placement coordinator will be final. We will also have no choice but to admit individuals placed by the placement coordinator's office, regardless of whether that individual would be a good fit, from our perspective, of community and culture and regardless of whether or not we would think that we had the capability to service that individual adequately.

Please also note that the bill flies in the face of some of the very comments contained in the consultation paper. Under the heading "A Renewed Vision," the consultation paper speaks of "primacy of the individual and his or her right to dignity, security and self-determination." If you want primacy of the individual, give the individual the right to choose.

The consultation paper speaks of "promotion of racial equity and respect for cultural diversity." If you want cultural diversity, permit our home to control admissions.

The paper speaks of "importance of family and community values." If you want to achieve family and community values, and by this I assume we can include shared religious and ethnic values, then give the individual the choice as to which community will best fit his or her needs.

Heidehof is proud of its reputation for excellence and service to its residents. Heidehof was established in 1972 and expanded in 1975. The complex consists of both apartments for self-sustaining individuals as well as the home for the aged. Initially, the average age of a resident in the home was much lower than it is now, but over the years the average age of admission has increased, particularly as persons who transfer from the apartments transfer at an older and older age.

To give you a picture of the Heidehof home, please consider the following statistics. Of 48 admissions to the home between January 1991 and March 1, 1993: 24, or 50%, came from the Niagara region; 13, or 27%, came from outside the region; and 11, or 23%, came from our own apartment complex within Heidehof. Of the same 48 admissions: 34, or 71%, speak German as their preferred language; 6, or 12%, speak English as their preferred language; and 8, or 17%, speak other European languages as their preferred language.

Heidehof provides a wide range of services, from community support programs, independent apartment living, dependent apartment living, residential care beds and extended care beds, all within its premises located in the heart of St Catharines. As I have said before, Heidehof enjoys a reputation of excellence with regard to care of its residents, with regard to the maintenance of its physical facilities, with regard to its recreational facilities and even with regard to its foods. I believe you can verify all of this with officers of the Ministry of Community and Social Services.


I wish to refer you to what some of the families of former residents have said about Heidehof. We have a letter here from the family of Mrs Maria Barth, dated September 3, 1992:

"On behalf of the late Mrs Maria Barth, we, her family, would like to say thank you to each one of you.

"In the 10 years that our Oma Barth was with you, you have shown her genuine kindness and care and we know that she really considered herself to be zu Hause with you. This was never more obvious than when she took her fall at the beginning of August and was given the option to remain in the hospital or to go back to Heidehof and you; she said she wanted to go back home to you. Her decision at that time was and is a tribute to each one of you.

"Throughout her short illness you saw to it that she was as comfortable as possible in her shoulder brace by moving her regularly and you made sure that the doctor was notified when she was in distress, even insisting that she be taken to the hospital to receive oxygen to aid her breathing. We always hoped and trusted that she was in good hands with you; in the past few weeks you have more than proven this. You balance capability with a wonderful caring attitude, even singing hymns the night before she died. What a comfort that would have been to her.

"On the morning of our Oma's passing, you took extra care to ensure that everything was looked after. She looked so peaceful and at ease in her own bed that we felt she had only just fallen asleep. You gave her passing a great deal of dignity.

"Being able to be alone with Oma to say a final goodbye was very special. You gave her family and friends the privacy that we needed but you didn't stay too far away should we have had need of you. It was also comforting that every one of you who were able to pay your last respects that morning did so.

"Even our funeral director made us feel proud that Oma Barth had been with you. He said that you imparted so much dignity on the occasion and took such pains to arrange matters that he felt privileged to attend at the Heidehof.

"Thank you, each one of you. You are a wonderful team of nurses who we really could not have done without either within the past weeks or the past 10 years.

"Yours sincerely, the Solondz family and friends for Mrs Maria Barth, 1893-1992."

I have another short letter here from the family of Mrs Elizabeth Schwarz, dated December 8, 1992:

"Having observed with great admiration the excellent and attentive care given our mother, Mrs Elizabeth Schwarz, by all involved since she became a resident, we, as members of her family, feel compelled to express to each and every one our most sincere thanks and appreciation.... It is of great comfort to know our loved one is in the hands of such dedicated people."

Finally, from the Olesevich family on the passing of their mother:

"We would like to express our sincere thanks and appreciation for the wonderful care provided for our mother throughout the years and especially over the last while. Heidehof was her home for almost 10 years, and she always felt safe and comfortable there. Your kindness will always be remembered."

When Heidehof was opened in 1972, Bill Davis, then Premier of Ontario, said the following at the opening ceremonies:

"One of the priorities of our government is provision of adequate services and housing for senior citizens. We have, I think, made good progress in this area in recent years, but no matter how much a government may do, there is always scope for voluntary effort. Indeed, it is much more desirable that the community should initiate and administer as a local undertaking such projects as the Heidehof Home for the Aged. In this way, it becomes a vital and integral part of community life rather than an impersonal service administered from a distance by the anonymous arm of government."

Mr Davis said there is always scope for voluntary effort. We see Bill 101 as being nothing short of an attack on the validity of what we, the board, have tried to achieve at Heidehof in the last 20 years. The bill tells us that the job we have done for the past 20 years was not well done; an external government authority must be introduced to straighten us out; placement coordinators must be introduced to tell us who to admit. Inspectors with plenipotentiary powers and, please note, no liability whatever, will have free rein throughout our home to investigate, to question our staff, to remove records and, should we be found in breach of our service agreement, to cut off funding.

If we can no longer control admissions to our home, if we can no longer maintain the cultural distinctiveness of our home, if we are no longer in a position to continue to strive for excellence in our care, in our facilities and in our recreational programs, what reason is there for us directors to make the effort to manage our home? What incentive is there for our directors to donate their time, energies and money for fund-raising? What incentive is there for our hundreds of volunteers to donate their time to improve the quality of life for our residents?

By continuing with Bill 101 in its present form, you run the serious risk of losing much or all of the voluntary effort that for the last 20 years has made Heidehof what it is. I am sure that we are not alone in this and in fact I am sure that most charitable homes feel the same way we do.

What we ask you to do is to exempt at the very least charitable homes from the provisions of Bill 101 with regard to the appointment of placement coordinators and the appointment of inspectors. Both of these represent an unwarranted intrusion of the government into a system which runs very well right now. I believe that nothing can replace the dedication and enthusiasm of a volunteer board of directors and the wider community to which such a volunteer board has access.

If you truly wish to preserve the primacy of the individuals in this new system, allow the individuals to make the choice of where to go. If you truly believe that multiculturalism has validity in the new system, then preserve the right of charitable homes to control their admissions. If you believe that volunteer boards and volunteer workers make a significant contribution to the care of the aged, then permit our boards of directors to exercise responsibility as we have done for the last 20 years.

Thank you. We would be pleased to answer any questions.

The Acting Chair: Thank you for your presentation. We'll begin the questioning with Mr Wessenger.

Mr Wessenger: Thank you for your presentation. I'd just like to make a statement of clarification, because the concerns that you raise have been raised on many other occasions with respect to the question of consumer choice and also with respect to the question of cultural and spiritual and ethnic and linguistic concerns.

First of all, with respect to the whole question of the role of the placement coordinator, certainly the role of the placement coordinator is to enhance consumer choice, not to restrict it. It will enhance it in the sense that it will provide all the options available in all the facilities available -- the community care options, the supportive housing options -- and also it will not be limited geographically; it will be across the whole province. So certainly we see the placement coordinator as a great enhancement of consumer choice.

Secondly, when we have discussed the existing placement coordinators and how they work, we've heard that they have worked very well with respect to respecting cultural and ethnic and linguistic concerns. They always indicated to us when they appeared before us that they take these into account.

Consequently, because of all the misunderstandings, I'd like to indicate that the government will be recommending to the committee an amendment to the bill requiring placement coordinators to take into account the preferences of the applicant, with particular attention to cultural, spiritual, ethnic and linguistic considerations, before authorizing admission to a facility.

The proposed amendment will also make it a condition of authorization that the person consent to the admission -- now, this is not legally required, because a person has to consent to admission now under present law, but we're going to put it in to clarify that that's the case because there's a great deal of misunderstanding in that regard -- and that the facility agree to accept the person unless the facility does not have the appropriate physical facilities or trained staff to meet the person's needs.

So I just thought at this time I would put it on the record so that it would help clarify some of the misunderstandings that have occurred out there.

The Acting Chair: Thank you, Mr Wessenger. I think that's a welcome addition.

Do you have any comments on this?

Mr Pongray: Yes. We receive many of our applications from individuals, some from within our region and some from outside the region, and I still would have a concern as to how those applications are going to be handled. We receive these applications because we do have a reputation throughout Ontario and even beyond Ontario. Now, when somebody comes to us, how will the system make sure that there will still be that consideration? We will not be able to deal with the application, so what happens?

Mr Wessenger: I could try to answer that, but I think probably Mr Quirt could give you a more comprehensive answer to that so I will ask him to reply.


Mr Quirt: Take, for example, someone living in Kingston who had a particular interest in the cultural and spiritual environment your home provides. First of all, that person would be made aware of the option of application to your facility and that person in Kingston would have the choice of saying, "The Heidehof Home is the only home I'm interested in, so just submit my application there," or the person might say, "Here are the two homes and now that you've told me about them, I'd like to apply to" whichever.

What would happen then is that the placement coordinator, working with your facility in your area, would ask you to review the information concerning that resident and ask you to make an initial determination if you felt that you could adequately care for that particular prospective resident. Then the placement coordinator, working with your facility, would prioritize the needs of all those people from perhaps your local neighbourhood or from people around the province who have said that they wished to get into your facility.

It would be the placement coordinator's job to authorize admission to your facility for those people who, first of all, had expressed a particular interest in getting into your facility and, second, were in the greatest need of the services you provide.

Mr Gord Midgley: I'd just like to state for the record as well that the placement coordinator agency in Niagara region does not work for Heidehof, quite frankly. We may have 10 to 15 applications sent our way a year, of which I don't think we've accepted one, because they're not even the appropriate level of care for our home. I really think the placement coordinating agency at the present time doesn't know what Heidehof's about. They deem us to be a nursing home. We're not even a nursing home. I guess with that background I really challenge what's going to happen with the new system.

The Acting Chair: Ms Haeck, do you have a question?

Ms Christel Haeck (St Catharines-Brock): Yes. I wanted to thank Heidehof for coming. I've had a chance to tour the facility and I really invite some of the other people sitting around the room to have a look at Heidehof. It's a wonderful facility. I really can't explain it more than that. It is something that really and truly meets a whole range of needs for people in our community but obviously beyond.

For the information of my colleagues, we had a meeting within the government caucus with the Heidehof board about two weeks ago and indicated to them that we very strongly supported their position around the cultural aspects of their brief. Realizing that they in fact do support a community far beyond the Niagara Peninsula, we felt there are a number of other groups that came before us that were in a similar situation and we felt they brought forward some interesting and very important comments representing their communities.

I do echo their sentiments today and I appreciate the parliamentary assistant's comments. I hope we can address some of the concerns around placement coordination, because I realize that there are still a number of concerns out there. I appreciate the comments of the member from the ministry staff. I know there are still questions and I hope we can work those through for all concerned.

Mrs O'Neill: Gentlemen, you have brought before us what many others have and I think it has been very helpful to have the point made as often.

You did talk about the almost oppressive inspection that seems to be going to emanate from Bill 101, and one of my concerns is that it's built on a very confrontational model, even imposing sanctions, with not very many specifics about that. Could you say a little bit more about how you think things work now -- and you said you felt you had the support of the Ministry of Community and Social Services -- and how you see them going to be acted upon after Bill 101 is implemented?

Mr Midgley: At the present time we work with program supervisors with the Ministry of Community and Social Services and it's done in a very consultative process when they come into the building. It's really a shared responsibility, if you will, in trying to better life and quality of life for our seniors. What we see in the inspection process is almost the removal from that aspect, looking at what's happened in the nursing home sector, and it seems to me that the nursing home sector is being implanted, if you will, in this bill. That's totally unnecessary as far as I can see.

Mrs O'Neill: Okay. The other thing you brought forward was your fears about your governance and the strength or ability for yourselves to make decisions as you now do. Could you say a little bit about why you feel that will change drastically with Bill 101?

Mr Midgley: I think what's at issue is that prospective residents come to Heidehof. They know who we are before they even get into the process. They're coming to us and speaking in their German tongue. I don't know what'll happen in a placement coordination agency.

Mrs O'Neill: I'm talking about the governance, the board. You feel your board is threatened and the decisions your board will make regarding the management of the home, I guess, broader than placements, I think I'm talking about. I wonder why you feel your governance or your decision-making is so threatened in Bill 101.

Mr Pongray: At the present time we have a board of directors. Many of the members of the board have been there since the inception of Heidehof. I think it's pretty obvious to everyone who has been there that the decisions we've made over the years have been good decisions and, as Mr Midgley has mentioned, we have worked with the ministry. It is on more of a consultative basis; I think that the phrase "partners in care" has been used.

I believe under the new bill we'll no longer be partners in care; we'll just be a little appendage to the ministry that will basically mandate every little aspect of how the home is to be run. They will come in and supervise to make sure it has been done the way they mandated it and then will give us a report card to see how we're doing. Basically they'll also have control over the funding, so they'll have all the control of what is to happen. What does that leave to the board? I believe it doesn't leave very much responsibility for us.

Mrs O'Neill: You expressed it very well. I think many have brought before us that the strengths that are in places such as you, in communities such as yours, are not going to be built upon; they're going to be threatened. I think it's very important that we emphasize that the strengths that are there and the traditions and trust that have been built up are maintained. I thank you very much for emphasizing that so well this morning.

The Acting Chair: Mr Jackson.

Mr Jackson: Thomas, good to see you. Thank you. I received your personal letter. I've been on the road with this committee for some weeks now and have not been able to respond to it. However, I'm pleased that you were able to put on the public record the concerns on behalf of your residents.

First of all, we're somewhat pleased that the government has moved from, "We'll consider it," to announcing today that it'll bring forward an amendment. That's encouraging, since both opposition parties have indicated that, in the absence of that, we would be putting forward amendments. Our amendment might be different from the government's amendment, and that's the area I want to discuss with you.

First of all, let me say at the outset that I do not believe there is some sort of conspiracy to offend the mission statements of culturally based or faith-based residences for seniors. I don't believe there's a plan. However, when we consider the economics of today and we consider the framework in which the government's put this legislation, with no new expansion of beds as a cornerstone statement in this legislation, one can then see a situation where yes, a placement coordinator will be required to be culturally sensitive in the placement. However, the government has said that the primary issue and the primacy of this legislation are on a needs basis.

Clearly, the number of Ontario residents of your cultural background is not a growing number. There are lots of other seniors' groups that are growing in numbers rather quickly. So is it your concern that over the course of a decade, the cultural complexion of your service, program etc will change dramatically, because the government will say:"We just don't have applicants" or "We have applicants, but in our opinion as the placement coordinating agents, as the gatekeepers of the system, we're telling you that person's level-of-care need isn't high enough and therefore he can't go in there. We'll wait until he is an appropriate appointee and then we'll allow him to go in. But in the meantime, we've got these eight or nine other people waiting who live in the Niagara Peninsula and they must go into your facility."

Is that what you're concerned about, that the amendment I just heard doesn't change that? Perhaps the gentleman would like to comment.

Mr Pongray: To the extent that the population is changing and to the extent that we may have fewer people applying to us who are of an ethnic origin, German ethnic origin or other European origin, we're not concerned about that. That is a national phenomenon that will happen.

I think what we are concerned about is that the placement coordinator's office will have other priorities, such as you mentioned. I think it's inevitable when you have an office, such as the placement coordinator's office will be, that there will be a set of rules imposed on that, some self-imposed, some imposed externally, and they will follow those rules. Out of that will come decisions regarding the individual.

It is also customary for an office like that to put pressure on the individual and say to the individual, "Look, this is the best place for you to go." As a result of that, there will be placements which will not really reflect individual choice.

We also have the fear, as you mentioned, that we will have placements which we will be unable to accept, perhaps those who would want to come in, because we have filled up all the positions. There's also some of that, although I don't think that's our major fear.

Our major fear has more to do with this whole business of establishing a coordinator's office over which we have no control. We no longer have control over our admissions. It's bad from our perspective as an institution and we believe it's bad from the perspective of the individual.

Mr Jackson: Your previous brief, which I have a copy of, submitted by the Concerned Charitable Homes in the Niagara Region, is a very good brief which I recommend for further review by the committee. It sets out all the liabilities, which are growing, without any of the modest control you currently enjoy with your admissions.

Knowing Heidehof as a residence which offers a range of opportunities for families -- it will allow for married couples to live either together or separate within the same institution -- again, this legislation doesn't acknowledge or provide for that. Again, it's a warm and fuzzy statement or it may be in regulations that to the best of our ability, we'll attempt to do that.

Do you not feel that the government's amendment should recognize that seniors have the right to live with their family members? A continuum of care program, such as the one offered at Heidehof, should have the protection in legislation which will say, "We may be taking the husband at one level care, but also the wife wishes to be resident in some type of accommodation within the facility," and that they come as a team, as a family, as a couple, and are not to be divided by the impersonal placement coordinator who says, "Look, we're not looking at her needs, we're looking only at his needs." His and her needs are together. That should be in legislation. Do you feel that should also be included in the strengthening of this halfway approach of the government to meeting your needs?

Mr Pongray: Absolutely. I would agree with that. Moreover, in our institution, we have independent apartments and we make admissions from those apartments into the home for the aged. One wonders how this will be affected by the new legislation. Will we no longer be able to admit those people because somebody else has come in between? Right now, we have a complete facility where somebody can be there. They can come in and be there with independent living and then gradually progress as they get older and be looked after. What happens now?

Mr Jackson: Thomas, that is part of why I suggested the government's amendment. The amendment that comes from the Progressive Conservative Party will not necessarily be the same, but ours will attempt to address that issue, to ensure that those facilities, those homes such as yours that provide that continuum of access are preserved in legislation so that you are protected. Thank you very much for your presentation.

The Acting Chair: Thank you very much for coming. The committee will resume at 2 o'clock. The committee does now stand adjourned until 2 o'clock this afternoon.

The committee recessed at 1204.


The committee resumed at 1406.

The Chair: Good afternoon, ladies and gentlemen. Welcome to Wednesday afternoon. This is the meeting of the standing committee on social development to review Bill 101, An Act to amend certain Acts concerning Long Term Care.


The Chair: Our first presenters this afternoon will be the representatives from St Peter's Seniors' Comprehensive Health Organization feasibility study. If they would be kind enough to come forward. Make yourselves comfortable.

Dr Leila Ryan: To the flashing red light?

The Chair: They all flash. It's handled by powers that are greater than ours. I have to keep reminding people not to touch them; all sorts kinds of incredible things may happen.

Dr Ryan: You notice how amenable we are to flashing red lights.

The Chair: We want to welcome you to the committee. If you'd be good enough to introduce yourselves for Hansard and for the committee members and then please go ahead with your presentation.

Dr Ryan: Thank you very much. Good afternoon. My name is Leila Ryan and I'm the chair of the community steering committee for the seniors' comprehensive health organization in Hamilton. With me is Sue Goble, who is the SCHO project coordinator.

I'm very pleased to be here today. For us certainly it's an opportunity to provide what we consider to be very important input into the amendments on certain acts concerning long-term care.

You have our brief in front of you, so I really don't want to repeat that. What I'd like to do is divide some fairly informal remarks into four sections. First of all, I'd like to give you a little background on our CHO site. I'd like to talk to you a little bit about a very important issue, and that is continuum of care, and then outline for you what we see to be five key problems with Bill 101, and then to conclude with some recommendations that we would like to make to you.

Before I begin on the more formal part, let me tell you a little bit about St Peter's Seniors' Comprehensive Health Organization, more commonly known as the CHO, because I'm not going to be through in 10 minutes if I don't shorten it.

Our project is one of six sites that are around the province that are investigating the CHO model. These sites have been at work for some time and have joined together in the Comprehensive Health Organization Network of Ontario, which I believe you heard from yesterday.

In the very broadest terms, CHOs take responsibility for the delivery of services for a locally defined population. This population becomes the members of the CHO. CHOs will work in partnership in the community with physicians, with acute care hospitals, with chronic hospitals, nursing homes, homes for the aged, in-home services and community services.

In 1988, which is almost five years ago now, St Peter's Hospital, which is a geriatric chronic care hospital, redeveloped its mission to focus on the senior population. Very briefly, what we did is direct our attention away from bricks and mortar and concentrate on how care was delivered instead of where care was delivered. The kind of initiatives that we took at that time were very much in keeping with the recommendations reported in the Evans, Spasoff and Podborski reports.

Armed with the knowledge of the changing health care scene and arising from its own mission, the board approved the submission of a proposal to the Ministry of Health in September 1988 seeking approval to undertake a feasibility study for a seniors' comprehensive health organization. What that meant is that our population would be defined according to age; ie, the over-65 group. We are fairly liberal in our definition of "senior."

The Chair: That was 1988?

Dr Ryan: That was in 1988.


Dr Ryan: I forgot the forum in which I was speaking. I'll be very careful in future.

In order to move this process forward, a steering committee was established with good, solid representation from consumers, community, provider groups, institutional and medical groups, the university, the district health council and of course St Peter's Hospital. This steering committee reviewed and revised the original proposal, approval for the feasibility study was granted in the fall of 1990 and the study was formally begun in January 1991 under the direction of the steering committee. During that time, ongoing consultation was held with consumers, physicians and other providers within the community.

As well, seniors in our community have talked about their issues and concerns about the currently fragmented system, the gaps in services, and some have acknowledged that they felt that the CHO system was a way to tie all the pieces together in a way that would be beneficial to them. The over-55 age group particularly is attracted by the possibility of this notion of one-step shopping for health care. That is one umbrella organization, a CHO, which knows all about their care needs. What is additionally attractive to this age group is the opportunity to participate in the decision-making process, the kinds of decisions that surround their health and social care needs. As well, potential partners are excited about this type of organization because they see this as being efficient, effective and an innovative way to deliver care.

Certainly, for our community the community participants see that this is a way of increasing the quality of care and, as well, increasing the flexibility in the way that care is delivered.

Probably most strongly, we and our community see that the CHO is a very rational way to provide the continuum of care for our citizens. We see this issue of continuum a very major one. In the light of that, I'd like to call to your attention some remarks to this committee that the Honourable Frances Lankin made in February this year:

"What we are attempting to do is understand that there really is a continuum of care that is required, and while we have pieces of it in Ontario now, we don't have good linkages and we don't have the sense of the continuum, that people can enter and exit various points of the system at appropriate times to get the care that they require at any particular point in time."

We in the St Peter's CHO agree totally with the minister's comments. There is a compelling need for a well-coordinated approach, community by community, to help improve upon that continuum of care for people.

While the former minister has previously made a commitment to the continuum of care as embodied in the CHO system, this proposed legislation will seriously undermine a CHO's ability to provide or purchase services. Bill 101 in its current form will present real barriers to achieving a continuum of care both now and in the future. In this instance, it appears that the government has chosen a regulatory approach which is in sharp contrast to the way both the hospitals and homes for the aged are currently governed and regulated. In short, the legislation appears to put one segment of the continuum under a completely different set of rules than the others.

While we agree with the minister's five stated policy objectives for Bill 101, we are concerned with the approach that government has adopted to achieve these objectives.

I'd now like to move to the key problems we see in Bill 101.

The first concern that we have is the shift from an insurance model to a contractual one. By placing long-term care facilities into a contractual agreement, this means there will no longer be a universal, accessible approach to health care in these facilities.

This bill also appears to remove all government responsibility to fund homes equally in order to provide the same level of service to everyone across the province. Each year, the service agreement must be renewed and the government will have no obligation under the act to fund the level of care required by residents or to continue to fund programs if they choose to change the agreement. There also appears to be no arbitration or appeal mechanism in the service agreement.

We believe government must be held accountable to maintain equitable and consistent services in all long-term care facilities throughout the province.

Our second concern has to do with increased expectation regarding levels of care without the necessary resources to back up those expectations. The proposed classification system is only being used to allocate funds for nursing and personal care services. The new funding formula will not enable long-term care facilities to deliver the various levels of care as promised by government.

The requirement for a care plan is set out in the legislation. However, there does not appear to be any flexibility should the resources not be available to provide the services outlined in the care plan.

In addition, it appears also that an overemphasis on paperwork may well reduce the amount of care that can be provided to residents.

Our third concern has to do with the placement coordinator role. The government needs to explain how this position fits in with its overall plan to provide better coordination of service delivery, both in-home and in facilities. If, however, the placement coordinator is to be the new gatekeeper, this service must be available 24 hours a day, seven days a week, as many, if not the majority, of these decisions may well be made on evenings and on weekends.

More consumer choice must be written into the legislation than is presently there with respect to ethnic, linguistic, geographic and religious preferences.

We also recommend that no new level of bureaucracy be created for this position and that existing resources be used for the placement and coordination function.

Our fourth concern has to do with the inspection role and the potential adversarial situation that this may set up. We identify that the amendments which cover the area of inspection are clearly designed for a worst-case scenario, putting in place very broad powers that would result in inconsistent and really potentially quite unfair application of the sanctions and the inspection process. Accreditation, peer review and continuous quality improvement programs have in other circumstances all been deemed more effective ways to monitor and evaluate. Draconian measures tend to produce the lowest common denominator of result. Participatory mechanisms have been demonstrated to produce much better results. Accreditation, peer review and quality improvement programs, in our mind, are much more effective ways to monitor and evaluate care. As an example, CHOs are accountable for ensuring their operations and services are effective through formal quality assurance management programs.


Our fifth concern has to do with the need for long-term care facilities to determine their own roles. These facilities must have the right to define their own admission criteria in consultation with the community, and they must be able to refuse an applicant based on a home's resources, both human and physical, and its ability to meet care needs. Facilities must have an appeal mechanism to challenge placement recommendations, and that mechanism must be a timely and efficient process.

In summary, our major concern is that these amendments to the legislation have set up a restrictive set of rules and regulations to deal with long-term care direction which are not at all in keeping with the philosophy of efficient and coordinated care.

In light of all of this, we have four recommendations, the first of which deals with governance. We recommend that the government adopt the same philosophical approach to the governance of long-term care facilities as it does to the rest of the institutional sector in the health care system. Currently, hospitals and homes for the aged are governed by voluntary boards of directors who ultimately bear responsibility to the government and to the community for the overall fiscal integrity and management of their organizations.

At present, chronic care hospitals and nursing homes have set up community advisory boards made up of consumers, families, interested citizens and providers. St Peter's CHO will have a similar governance structure, which we believe will not only improve the quality of decision-making, but will foster increased responsibility of its members for their own health. In short, our position is that a role in governance is the best teaching tool to help citizens in this responsibility for their own health.

We believe that the new long-term care institutions should maintain similar governance structures to those currently in place in acute and chronic care hospitals and homes for the aged. Only this approach supports the continuum of care concept for the consumer.

In terms of peer review and accreditation, we fully support the concept of accountability. Accreditation, peer review and continuous quality improvement programs, as I said before, have all been deemed effective ways to monitor and evaluate care. For example, again in the CHO system, CHOs are accountable for ensuring that their operations and services are effective through formal quality assurance management programs.

In terms of equity and funding, it is time to distribute funds equitably between nursing homes and homes for the aged. However, flexibility must be given to these facilities to enable them to use their resources as effectively as possible.

We also believe that where existing placement coordinators or agencies are currently doing a good job, a new structure should not be put in place. Placement coordinators should work with all the players, home care, acute, chronic and long-term care, to establish specific admission criteria that cover the range of needs in the community.

Not all levels of care will be available in all facilities, and it is important that placement be made in accordance with patients' needs. St Peter's hospital, for example, has established a number of specialty care programs which provide care to patients based on their primary reason for admission to the hospital. People who were admitted, for example, with respiratory problems, will be placed together in one program; those who have heart disease will be placed together in another. These programs allow for more specialized care of patients, since program team members are experienced in dealing with the specific health problems, and these programs benefit both the hospital, in terms of efficiency, and patients, in terms of care.

In the CHO system, to ensure that the widest possible spectrum of services is covered, the CHO must provide a full range of vertically integrated services to its members and, as such, will be able to match the consumer need with the appropriate inpatient, outpatient or home service. These services can be directly provided by the CHO, or the CHO may arrange for existing community providers to give the care.

My final remarks are coming up right now.

Since 1988, St Peter's CHO project and other CHO communities throughout the province have devoted thousands upon thousands of volunteer hours researching the efficiency, validity and appropriateness of the CHO model to meet the needs of our people. The government has previously confirmed that the CHO health care delivery method is one that matches the philosophy and ideals of the government.

Given that this is the first in a series of legislative amendments to address long-term care, our concern is that Bill 101 as it is now written flies in the face of the government's previously stated commitments to long-term care redirection and to the CHO model. In developing a reformed long-term care system, there must be a properly structured, well-coordinated, integrated system of community and facility services which can provide the range of choice and enhance the quality of life and independence of the elderly and the disabled. We believe it is possible to redirect long-term care services to meet these principles across the variety of facilities and in-home services, while at the same time retaining the strength and the diversity of the system.

Bill 101 is the forerunner of long-term care legislation and, as such, major changes must be made to this bill to ensure that the philosophical approach used to govern long-term care facilities does not present a major barrier to providing the continuum of care for the health care consumers of today and tomorrow.

Thank you very much for the opportunity to provide our comments today. This consultation process has allowed time for us to focus on the major points of concern in the proposed An Act to amend certain Acts concerning Long Term Care in Ontario. Thank you, Mr Chairman.

The Chair: Thank you very much for coming. As you're I think aware, we had the Ontario-wide group here, and being, I think, also aware that the Rainy River organization presented before us in Thunder Bay, it probably has been for some of us an excellent crash course in CHOs and how they function. I particularly appreciate the descriptive material at the end. Finally, St Peter's reputation comes before it, so we're delighted that you were able to come here today. We'll get into questions and begin with Mrs Sullivan.

Mrs Barbara Sullivan (Halton Centre): I've discussed many of these issues onsite at St Peter's and have always been thoroughly impressed with the work that has been done at the hospital when it was totally a chronic care facility and with the kinds of initiatives that are being taken in looking at the CHO.

I want to ask a question that might be a little bit bizarre, but I think it's important with relation to this bill. If St Peter's were an operating CHO facility, providing the continuum of care that is now being looked at, where would you fit with Bill 101?

Dr Ryan: I'll give that to Sue.

Mrs Susan Goble: The CHO model has to bring under its umbrella all of the pieces within the requirements for its members. In terms of the application of Bill 101 as it is presently being written, it would disrupt the momentum of that continuum because of some of the restraints that are being suggested in the rules and regulatory issues that are described. I think we would have some difficulty with the flow, if you will, of people, and in terms of having a fit within the governance model itself for the CHO, because the governance issues will be quite varied within the different elements that are part of the CHO.

By way of example, the acute care, the chronic hospital, the homes for the aged pieces, as they currently function, have the governance model. If Bill 101 comes in and some of those pieces which are now the homes for the aged piece have a very different requirement, it will probably disrupt and cause some degree of concern for how we might be able to smoothly participate with all of the providers being part of the CHO.


Mrs Sullivan: One of the reasons for placing that question is that we find it difficult that this particular piece of legislation has been put before us before the entire long-term care policy document is there and before the chronic care role study is available. As a consequence, we are looking at one piece in isolation.

We know that, by example, the Perley is moving in one direction in Ottawa. You are moving in a quite different direction with an enormous amount of community input. Yet we are finding that this bill is set in isolation without appropriate linkages that are readily seen or readily available and you may in fact have to go through a completely different process again even after your study is completed and if there's action to be taken.

Dr Ryan: In terms of the Perley, the differences there are that the Perley has opted to be a long-term care facility, which puts it in a totally other ball park. It is a complication, certainly.

Mr Jim Wilson: Thank you very much for your presentation. I too, along with Mr Jackson, visited St Peter's hospital last year and learned a great deal and was very much impressed. I'm also impressed to learn of your seniors' comprehensive health organization initiative.

I want to follow on what Mrs Sullivan's just been at, because I think we write the same notes down from time to time.

Mrs Sullivan: No, he just reads mine.

Mr Jim Wilson: Mine says: "How does CHO fit into this legislation?" I have a little hard time reading that way. None the less, she raised a very good point in terms of how this whole process is becoming rather overwhelming, I think, for legislators because we are doing this in a vacuum. We're having to spend early mornings and late evenings meeting with groups, trying to fit our own pieces together to try and figure out where the government's going because we get very little help from the parliamentary assistant or from government members on this committee. I'm not sure they really know where the ministry is going. I talked with the deputy and he's concentrating on hospitals these days, so I'm not sure Mr Decter's really figuring out exactly where long-term care is going.

I want to ask you the question again about CHOs and how you feel they fit in. I understand from your response that you feel if Bill 101 goes ahead, it could complicate the mix out there. On the other hand I can see the government, when it's their turn, saying, "CHOs really complement what we're doing". It probably depends on how you view it and if we knew where the system was going, then we'd know exactly how to view it properly. I want you to just expand on your thoughts and the complications that may arise.

Secondly, you deal with a different branch of the ministry, I assume, than the institutional side that developed this institutional legislation. Have you had an opportunity to discuss your concerns with the ministry or the bureaucrats to ensure they understand that you shouldn't be left out of the whole plan?

Mrs Goble: By way of opening, I will say that the CHO projects throughout the province looking at CHO modelling communities are dealing with the CHO program which is placed within the community health branch within the Ministry of Health, so our primary liaison is with the CHO program within the Ministry of Health.

Having said that, every CHO project -- and as we said to you on Monday, there are six of them -- has a ministry working group which is put together on behalf of that particular CHO project, which is to bring together the members of the different branches within the ministry who have jurisdiction or direct influence with the particular CHO community. So they do vary in each different community, depending on what is the complexity and makeup of the existing services in the community. Through those forms there is an opportunity to address some of these concerns.

Again, though, at the local level, we have an opportunity through the discussions with our consumers and with our providers to determine some of the issues that come before CHOs, so this again affords us the chance at the local level through the district health council, through the provider meetings, through the consumer meetings, through those groups coming together such as around a steering committee forum, that you can have a chance to address this. There are a number of ways we can mutually talk about this.

Mr Jim Wilson: Let's just throw something at you here. In terms of what I know of CHOs -- and I'm supportive of that direction -- in terms of your comments with regard to how there might be a disruption in the continuum of care, given this new placement coordination, agency or otherwise, that's going in place, would a CHO expand to be the placement coordinators? You're dealing with the seniors' population anyway. Have you give any thought to that, rather than our starting a new bureaucracy in areas of the province where they don't have placement coordinators now? Would that fit into the ethos of the CHO at all? Could it?

Dr Ryan: I think we already said that where there are effective placement organizations in place, they should remain that way.

Mr Jim Wilson: But where there aren't? For instance, in my area of the province, we don't have this stuff, and I'm an hour away from Toronto. They don't have it in Metro.

Mrs Goble: I guess it also speaks to something we were asked the other day with regard to long-term care. In some communities, particularly the more isolated rural communities, where a CHO will almost geographically encompass the population, that may be a good example of where you could expand upon it to be the provider and the overseer and the administrator, if you will, of the PCS function and long-term care.

Mr Jim Wilson: I can see that being helpful, because you have a personal relationship with the seniors you service, so you know the CHO will when it's up and running.

Mr Owens: I think Mrs Sullivan started us on a very interesting road, and I don't think her questions were bizarre at all. In terms of the CHO concept, I had the pleasure of touring the CHO in the Sault in January and was quite excited by the community-based care that's being delivered under that system.

In terms of my understanding of how a CHO functions, the CHO receives funding on a per-member basis. In your brief, in terms of the placement coordination -- and you reference it in other parts of your brief -- you say that if the service is not available that person will have to go outside the CHO for service. My understanding is that, for instance, a person could receive $1,000 worth of care at your CHO during the month of January. If that person has to go outside for care and another OHIP billing is generated outside of your facility, do you lose that funding for that individual for that particular month?

Mrs Goble: I'll respond to your question. In the capitation model for the CHO, you're quite right that the CHO will receive a per-member amount each month. If the CHO is unable to provide a particular service to its member or the member falls ill while he is outside of the geographic location of that CHO, the CHO is then responsible for picking up the costs of care that was required by the individual. On a negation basis, the CHO is billed back what was spent on that care wherever it took place. The CHO doesn't lose its money for that person, but there is a cost recovery process in place so that, in other words, whoever did provide the care is not billing the government as well as the CHO, having received the amount per month for the individual.

Mr Owens: So in terms of Mr Wilson's point with respect to CHOs acting as a placement coordination system, would there have to be a member/non-member type of function, or would it be your expectation that everyone would become enrolled in your CHO, for instance, in terms of the placement coordination? I'm just trying to get a sense of how that would work in terms of maintaining the funding integrity of your organization.

Mrs Goble: The CHO is a situation where people have a right to become a member or not to become a member. If the placement coordination situation were going to be expanded upon, I think -- and I have not had a discussion with the CHO program as to how this might come about -- it certainly would have to be dealt with differently, on maybe a program basis or some other model, if you were to pick up that particular administrative responsibility for membership other than your CHO members.


Mr Owens: In terms of your comments with respect to inspections and accreditation, we've spent some time hearing about the proposed legislation. I get really uncomfortable about relying on accreditation and internal responsibility systems as being the sole measure of quality of care. Coming out of a health care institution where I worked for 10 years, two of which were spent with the Royal College of Physicians and Surgeon of Canada, I have an understanding of the accreditation process and what happens during that process. I don't think we need to legislate standards of excellence. I think that for managers, whether it's of a CHO or nursing homes or long-term care residences, that should be the norm.

I guess the uncomfortable feeling I'm getting, and nobody has actually come out and said it, is that there seems to be a feeling that inspectors may be doing case finding when they go and look at these homes. My experience with groups like Concerned Friends is that inspectors won't have to do case finding, because there are already enough issues within the community as it is.

I'm wondering if you have any further thoughts on that and what kinds of things you would like to see built into the legislation, if you're saying that the current language is too strenuous. How would we maintain the integrity and protect the safety of, in most cases, society's most vulnerable people within these residences?

Dr Ryan: Probably both Sue and I would like to respond to that, but my first response would be that an appropriate governance model is probably the best route to ensuring the protection. Without that kind of participatory governance model, I don't think any regulation is going to be appropriate or will work really effectively: community advisory boards, good community participation and appropriate community participation. I don't think that means everybody has to sit at every table, but mechanisms that really promote the involvement and the sense that the community's voice is heard and that both families' and clients' needs are responded to I think are far better ways of protecting them than a draconian inspection system.

The Chair: I'm sorry, Mr Owens, but I'm going to have to bring our question and answer to a close. It's the lot of the Chair to try to keep at least reasonably close to time.

I want to thank you for coming today, for your presentation and for responding to our questions. I think I should also thank you for helping us to establish that, whatever else Ms Sullivan may be, she is not bizarre.

Mr Hope: It's a matter of opinion, though.

The Chair: Oh, oh, I've opened something up here. I apologize. Thank you again for coming. I will resist the temptation to make those comments in future.

Mrs Sullivan: Mr Chairman, if I may, I think the issues that are surrounding St Peter's and the other chronic care facilities in association with Bill 101 do require some additional clarification from the parliamentary assistant and ministry officials. By example, the Perley, a chronic care facility, among others, I understand has entered into an agreement with the ministry that it will accept $185 per day per patient for providing chronic care, without the role study being available. St Peter's, which offers chronic care services, is left in a kind of limbo situation, because it will also be offering, as part of its continuum of care, nursing home services. There is a gap here that I think should be explained.

The Chair: Would you be looking for a written description of how those institutions are to function in their relationship with the ministry?

Mrs Sullivan: That would be useful. I think it might also be useful, if there is an opportunity, to ask some questions.

The Chair: If you want to leave that with the Chair, perhaps through the subcommittee we can work out the best way of doing that.

Mrs Sullivan: Thank you.


The Chair: I next call Mrs Irene Das. Welcome to the committee. Would you be good enough to identify yourself for Hansard and for the committee and then please go ahead with your presentation? We have 15 minutes.

Mrs Irene Das: I recognize Mr Wessenger from the hospital thing that was similar to this.

Mr Wessenger: The hospital act.

Mr Jim Wilson: He's trying to forget those hearings.

Mrs Sullivan: Now, they were bizarre.

Mr Owens: You're so negative.

The Chair: Order, people.

Mrs Das: My name is Irene Das. I'm an RN with about 30 years' experience in nursing, and for the past eight years or so I have been working in a large nursing home.

Generally, I'm very pleased with the overall direction of Bill 101, dealing with charitable, municipal and private nursing homes. In particular, I appreciate the coordination and streamlining of long-term care with regard to funding, accountability and admissions process.

However, I have the opposite view to my predecessor here: I think some of the provisions do not go far enough. I hope my submissions to the standing committee on social development on Bill 101 will highlight and provide an in-depth look at the needs at residents and staff in these facilities.

As an RN, I will focus on nursing care needs primarily, as that is the reason why these people are in nursing homes. Otherwise, they could as well be in a hotel or room-and-board facilities or anything like that. It's because they do need nursing care.

Of course, to start off with meat and potatoes, the funding: It must be outlined in the act itself, I feel, that sufficient funding for nursing care will be provided and that it will be without charge to the residents. I have a list here of the current charges that people are charged in nursing homes and what the costs are.

I also feel that, apart from the sufficient staffing levels, a proper mix in staffing is required, as that is very important. Otherwise, if you just withhold funding because people are not getting adequate care, the thing is just going to get worse, and those who suffer will be the residents and the staff, particularly the RNs, because they are accountable under the College of Nurses of Ontario. No matter what, even if there are detrimental circumstances beyond their control, they are held accountable and liable. Therefore, the home and the whole management must be made to accept responsibility by a system of accountability. I don't know how that works. I don't have enough experience in that area and I haven't thought about it enough, but maybe other people have the skill.

With regard to care plans, I think there should be the following changes made, or I have a few suggestions anyway: It should outline that it at least contains medical services, nursing services, nutritional services, rehabilitation, recreation, social work, pastoral services, and others can be added when needed or when they arise.

I feel that the resident and the family should be involved in the planning of care when at all possible. If there's nobody there or they are not capable of making decisions, then it's a different story. But the same thing is true for quality assurance, and I think you also should have all these things on quality assurance, plus, if you are inspecting accommodation, monitor safety, maintenance and cleanliness, pest control, these sorts of things. These are just very down-to-earth things.

Clear policies and procedures in these homes must be established regarding care plans and quality assurance plans, otherwise how are you going be able to inspect it and follow up on it? As far as quality assurance, I think it is not enough that we just base it on accreditation and peer review. For example, the College of Nurses has a thing called individual employee performance appraisals and they can be quite biased too.


I think there has to be a continuum so that management is appraised. They have to continuously try to do their best and the staff as well. Otherwise, what you're going to get is that the people at the lower rung of the ladder who have no control over the situation are going to be blamed for everything. Homes like that quite frequently are run very poorly. I guess they don't have highly paid executives running them.

Mr Owens: Most homes do.

Mrs Das: They do?

What happens is that they start witch-hunting and then they fire a few people who they feel caused the problem. Then they look good at the next inspection and they try afresh the same game, and when there are major problems happening, the same thing happens. This went on for eight years that I know of, until we got very capable people. For the past few years we've had very capable people running the home, but I don't want to say anything about the owner. That's a different story.

I'm going to repeat myself a little bit here about what the people from St Peter's said. I also feel that care plans and quality assurance plans alone are not going to do the trick, because if they're just going to add paperwork, they're going to take particularly the RNs away from the residents. They will have less control of the situation than they had before, because so much time is expended. People take these papers home and work on them and everything. It's just a bad situation.

Of course, we know there are many reasons why elderly people live longer and that they are sicker and have a lot of problems, physical, mental and so on. These people generally don't get much better, but at some point they start to decline. In addition, the uprooting from their homes leads to a lot of problems initially until they have settled into these homes. All of this can lead to a lot of frustration, unhappiness and disturbed behaviour in the elderly. Of course, that also takes a lot of care just to settle them down. So generally, the people we see nowadays in nursing homes require far more care than 10 or 15 years ago.

I have here a copy of a survey the ministry was sending around to ask the staff nurses what the staffing levels are at the present -- I don't know if you're aware of it -- and what we think should be done and the acuity levels of the different residents. I think they have five or six points you can grade them at. So I'm very pleased with that. However, I think we really got very, very little time. Also, it's such a hushed-up situation where you really have to be scared that your employer doesn't find out about it and that you don't get fired or something. I'll give you my own example in private. At present I have no job.

Employers naturally try to cut costs and as a result we see highly skilled RNs replaced with more junior ones and RNAs and so on. Then what happens is that the RNs can't keep track any more of what's going on with the residents. Since they coordinate everything, all the needs of the residents -- dietary, elimination, activity, whatever -- they can easily miss something that's happening to a resident and it gets out of control. So I think if you cut highly skilled nursing care and replace it with unskilled or lower-skilled levels or less experienced nurses, ultimately you're going to have higher costs. I'll give you some examples. If the problems get out of hand and they're not detected in the early stages, the residents can become really sick and then they end up going to hospital or becoming very ill, and all of that is costly. It can even lead to death. It can go so rapidly with the elderly, but it's also costly to the government and the taxpayer, and that will also come out in my examples, because frequent needless use of ambulances, paramedics, hospital emergency services and so on are far more expensive than preventive nursing care, anywhere, even in the nursing home or in the homes of these residents.

I don't know if I shall upset your stomach with some of these examples, but you have them written. For example, a resident could have a cold or congestive heart failure, and eventually these symptoms are very similar, but you really have to know a lot about these types of things. So the residents start declining and get worse and worse and worse, and quite often the frail elderly just crash. Their whole system just gives in, and quite often literally they just fall on to the floor, because they sit on a chair or wherever they are, and they can sustain a hip fracture, head injury or anything. Then 911 is called and the resident goes into a hospital. When they come back, most frequently they never regain their previous independence and they end up in a wheelchair. They require so much care.

The same happens with other very common things, like bladder infections and bowel problems. They're simple things, but you have to know how to prevent these sorts of things, and of course we do more complex nursing care as well. I have it in the written report.

In summary, what I think needs to happen is that you find a way, you who are the experts, of writing this legislation in such a way that we have three things: good systems in place to check and organize the situation, their enforcement and adequate funding.

In closing, I'd just like to say that I have a special love and concern for the frail senior citizens and I hope the government will make it possible to give better care and make these people feel valued and wanted in their last days.

I want to thank you, Mr Beer, and everyone on the committee, for having me here. I hope I was of some use to you, even though it might have been boring.

The Chair: Thank you. At committee we know that various organizations are going to come forward and we're glad they do. I think we always hope we will get more individual citizens who have an interest in the subject at issue who will come forward and provide us with their experience, so we're delighted you came. We're a little tight on time, but I'm going to allow one question from each caucus, beginning with Mr Wilson.

Mr Jim Wilson: Thank you, ma'am, for coming forward and showing the courage to come forward and share your experience with our committee. I suggest that, if your employer wrongfully dismissed you because you have shown the conviction of your beliefs, you work with your local member of provincial Parliament to seek justice there. We have the toughest laws in the world with regard to that.

Mrs Das: The nurses' union is involved. It is hard to prove.

Mr Jim Wilson: It is hard to prove, but your MPP should be pretty good at it.

Mr Hope: The legislation's not here to protect the worker of that nature.

Mr Jim Wilson: Well, I deal with this. Are we having a cross-debate here, Mr Hope? That's the responsibility of the MPP. If you can't do your responsibility, don't bother putting it on the record.

Mr Hope: No, no, don't mislead somebody. You're misleading an individual.


The Chair: Order, please. Mr Wilson has the floor.

Mr Jim Wilson: Sorry, I didn't think that was all that contentious. I just thought it was part of an MPP's daily routine to deal with such matters.

Mr Hope: Don't mislead her.

The Chair: Please.

Mr Jim Wilson: I want to get a feel for what your experience has been and the lay of the land out there now in terms of, you talk about the reduction in RNs that's been taking place.

Mrs Das: Reduction in all staff levels. At the moment, some nursing homes have been cutting health care aide and RNA hours as well, which affects us indirectly, but it affects the residents very directly. I think private homes are trying to get the government to cough up some more money for them.

Mr Jim Wilson: That's what I was going to ask. Is it just that the owners of these homes want to cut staff or is it that they're budget cuts, because it's happening in the charitable home and homes for the aged sector.


Mrs Das: I don't know exactly, but I've heard something about their trying to -- they did it once before in October, when there was a big demonstration and everything. They were cutting health care aide hours and other staff hours in order to blackmail the government or something like that. I'm not too sure of that. This is the rumour.

Mr Jim Wilson: Is that what nurses believe? Is that the scuttlebutt on the street?

Mrs Das: Most of them have no idea, but I've heard rumours.

Mr Owens: I am pleased that you're here today. It gives the committee an opportunity to speak to somebody who has the experience from the floor. I'm pleased to hear that ONA is working through your grievance; I assume it's ONA.

In terms of some of the issues that I've dealt with in my own riding, with RNs coming to see me about some of the stuff going on in nursing homes in my riding --

Mrs Das: You see, I was too loyal and I always gave the management time to correct whatever problems there may have been, and they have been very good. This whole thing -- my own case -- came out of the blue.

Mr Owens: This is the point I was going to make. Not one of those individuals has ever stated that she is complaining about the hours or the amount of money she's paid. Every time they've come to see me about something, it's been about care of the residents in the home. Again, you hit the nail on the head. In terms of the previous presentation and my discomfort around quality assurance and accreditation, the bottom line is that it's the front-line staff who get nailed with things. Once the inspector comes through, there's very little accountability for management practices and the failure to implement proper practices.

Mrs Das: Can I say something? I think I'm misreading it, but it's in there. I feel that the required staffing level should be posted in the home so that the staff know it and the residents and their families know it.

Mr Owens: That's right.

Mrs Das: That type of thing, something in that direction.

Mr Owens: I know that ONA has attempted to launch some professional responsibility grievances, because it feels that strongly about the quality of care residents are receiving. As a matter of fact, the Canadian Union of Public Employees presented a brief to us the other day. I'm not sure if this is going to make you happy or bolster your case, but it did an analysis of form 7's submitted to the Ministry of Health. They looked at the issues around the expenditures on continence care products, medical and nursing supplies, raw food costs, dietary supplies and services, housekeeping supplies and services and laundry and linen supplies and services. On an average per diem basis, the brief says the non-profit nursing homes spent 37.3% more than for-profits on these resident care items in 1990, and in 1991 the non-profit homes spent a full 42.2% more on these products and services.

Mrs Sullivan: What about raw food costs?

Mr Owens: You asked a question about where the money is going. There's a pretty clear indication about where the money is not going.

Mrs Sullivan: The bottom line is the difference of wet and dry diapers, cloth versus paper.

The Chair: Order, please. Let the witness answer the question. Please go ahead.

Mrs Das: What was the question exactly, in a nutshell? I got lost.

Mr Owens: There was so much howling and whining coming from the other side, I wasn't able to finish my question. You asked the question about where is this money going, and I think that my question is, more importantly, where is this money not going?

Mrs Das: Exactly. I think somehow it would be good to have of safeguards so that there is accountability at least in the areas that affect nursing care. Of course, I'm also concerned about the food and all these things. That's very important.

Mr Owens: Curare for Jim Wilson.

Mrs O'Neill: I just wanted you to go to one of your own statements, if you would. You've talked about the quality assurance plans, you've talked about posting the staffing levels and you've talked about assurances and worries you have. Then, on the other hand, you say that the quality of care will diminish and you'll have added paperwork.

How do you see Bill 101, or whatever we want to call quality assurance, being enforced? At the same time, what I see here are some accountability mechanisms not being in place. Do you want to say a little bit about how you see Bill 101?

Mrs Das: Yes. I think things like that should be in standard form with a lot of things pre-printed and then you just add your comments so that you don't have to rewrite all these stories. For example, if you have a care plan, you should have down, you know, different things: skin, this, that and the other, whatever can go wrong.

Mrs O'Neill: What makes you think it's going to be so different?

Mrs Das: We have some types of care plans now that are far simpler than they used to be in the past, at least parts of them. I think some things should be worked out in that area. Because I worked in the community as well, when I used to go with the VON, and I got down to a system which I made myself, and we had a form as well. I kept saying: "Okay. I'll ask these, these and these questions, and in order to get through these questions faster, I will rephrase them so that people just have to say yes or no or whatever." I think something like that should be done.

I'm a big believer in these forms being as pre-digested as possible so that you don't spend time writing pages and pages of stuff. These days, the classifications already have a system that has number 1, 2, 3 and 4. I didn't do classifications very much because I worked nights, but I went to the education on it and I have the material at home. If something is pre-printed and pre-organized, it makes it easier, but then, of course, still you need enough staff. You can't have all of this in order to excuse yourself so you will look nice because all your quality assurance plans and everything are in place. The girls might have taken it home to work on it, but then they don't have any time for the residents and they are run down. Something like that helps you.

The Chair: Thank you very much. I regret that our time has come to a close, but I again want to thank you very much for coming before the committee and for providing us with your presentation and also the examples you set out in you brief. Thank you again.

Mrs Das: I have a few questions too, but I don't want to keep you.

The Chair: I am awfully sorry.

Mrs Das: They will probably be answered eventually.

The Chair: If there are any other things, please feel free to send them through the Chair.

Mr Jim Wilson: Could I just ask the witness for a copy of the list. You have a list of charges to residents in nursing homes?

Mrs Das: Yes.

Mr Jim Wilson: Could you give that to the clerk, and he can provide that.

The Chair: We could make a copy of that certainly.

Mrs Das: The ministry put that out.


The Chair: I will now call the representatives from the Coleman Health Care Centre. As they come forward, I remind honourable members that we are running a little bit late. If questions could be sharp and succinct, the Chair would be most pleased.

Mrs O'Neill: We were promised a document draft too yesterday. Is it going to be forthcoming in the next while? I mean, tomorrow is Thursday.

The Chair: It is being sent to our offices, and I will check, as we sit here, whether it has arrived. It was being sent directly to our offices, and we'll check that out and see where it is.

Mrs O'Neill: Thank you.

The Chair: Welcome to the committee. If you would be good enough to introduce yourselves, then please go ahead with your presentation. We have a copy of your brief in front of us.

Mrs Deborah Wall-Armstrong: My name is Deborah Wall-Armstrong. I'm the owner-representative for the Coleman Health Care Centre in Barrie. With me today is the home's administrator, Françoise Bouchard; she's also our former director of care. We are one of 290 members of the Ontario Nursing Home Association. Those homes, with their 28,000 residents, represent over half of the long-term care facility residents in Ontario.

As a front-line provider in long-term care, the Coleman Health Care Centre is pleased to see the government moving ahead with legislation to more equitably fund long-term care facilities such as nursing homes, homes for the aged and the chronic care hospitals in the province. It is of some concern to us that the timing is somewhat slowed down, given the fact that nursing homes have been in a funding crisis situation now for several years.


Our particular home is a 110-bed nursing home facility located in the city of Barrie. Our residents consist of 56 homes for special care residents and 54 extended care residents, and we employ an average of 105 to 110 employees in the facility. We've been operating at our present location since 1981, and the home has a reputation for quality care. It has been given a three-year accreditation reflective of that quality care despite ongoing difficulties in managing two distinctly different populations within the home. We're also considered a teaching facility associated with Georgian College in Barrie.

We're painfully aware in the last several years of our own individual financial struggling, that if we have any hope of trying to maintain the kind of quality care that we have been providing, long-term care reform has to come in. Historically, our home, as a member of the Ontario Nursing Home Association, has backed seniors in seeking fairness for funding in the long-term care area and in ending illogical and discriminatory funding practices in the provision of that care.

We believe that this bill, when passed, would help to end what I had called the Russian roulette for seniors who find themselves, more by happenstance than by planning, placed in long-term care facilities that can be funded as much as 50% below another facility in their own area for the same levels of care.

I am also aware that the Ontario Nursing Home Association has presented a brief to you and has outlined several key recommendations. I've listed those in our paper, but in our short time today we can't hope to cover again and indicate all of those issues. But we do want to express our wholehearted support of them. What we want to do today is to highlight, through our own experience, the concerns in the placement coordination function envisaged in the act.

Our facility has a dual population, currently, of developmentally delayed adults along with extended care or senior population. We have for years had to deal with the difficulties of two very different groups. We often refer to it as caring for twins with different needs. As groups they don't lend themselves to significant integration, and until we finally achieved a three-year accreditation in 1986, we had been told previously by surveyors that it would be impossible for us, with our dual population, to meet standards necessary for the three-year accreditation in the quality of the environment in our home.

With considerable effort, staff commitment and cost, we have met the challenge. But doing that exercise and having done that, we recognize that at the present time it's becoming harder and harder for us to continue to sustain that. We have had to actually implement a definitive mission statement focusing on evolving our home into a homogeneous environment for all the residents in order for us to continue to provide on a long-term basis, we feel, quality care.

It's against the backdrop of that experience that we wish to comment on the bill's establishment of a placement coordinator and the lack of an appeal mechanism to challenge placement recommendations for facilities. Mrs Bouchard is going to outline some of our main concerns.

Mrs Françoise Bouchard: When a vacancy becomes available and candidates are considered for admission, our primary focus is the 109 residents already in our care, the capabilities of the staff in our employ and our physical plant.

The majority of our admissions come via the discharge planning officers in our community hospital. We acknowledge the fact that the discharge planners are under a lot of pressure to place the candidate anywhere they can. Their focus is not the 109 existing residents in our facility but the one candidate they have to place.

We are concerned that in Bill 101, the placement people will similarly be under pressure to place the candidate, without any counterbalancing pressure to ensure a good fit with the current facility residents and staff. An appeal process for facilities that allows them to object to placements would provide some of that counterbalancing pressure. The appeal process should recognize that facilities must be given the right to match potential residents with its own mission, services and programs to ensure quality care and quality of life for each of its residents.

We are also concerned that further movement after initial placement be looked at. Consider this scenario: The facility admits a resident whose profile does not indicate any behavioural challenges. Shortly after admission, the resident becomes both physically and verbally abusive towards residents and staff. Within a short time, it becomes obvious that the facility will be unable to meet the care needs of this resident. Also, the quality of life for the other residents and staff has become seriously jeopardized. In this situation -- and I assure you it is not an uncommon scenario -- will the placement coordinator be required, in a timely and efficient manner, to review such a placement that became inappropriate?

For the majority of our residents, this will be their last home. We continually strive to provide all residents with an environment that will enable them to maximize their potential and be the best they can be. In order to achieve this, we must have a mechanism to challenge placement recommendations without the fear of sanctions being imposed.

I believe the Ontario Nursing Home Association presentation indicated to you one of the shortfalls, we feel, that will take place with economic sanctions is its impact initially on residents and staff, and it should only be used as a final resort.

Mrs Wall-Armstrong: In summation, we also wanted to indicate that we have concern that the bill leaves too many issues to regulations. I think that may be part of the problem with the process at times. It provides considerable power to government and its inspectors without requiring corresponding measure of accountability. The bill holds facilities accountable for providing all residents' needs without ensuring that funding will be provided to make this possible. Our historic experience in the nursing home sector has been that this is a sure-fire formula for failure, and we do not want this reform to fail before it gets started.

The seniors' lawsuit backed by the Ontario Nursing Home Association members showed that there has been a discrepancy and an unfairness in funding for more than a decade. The residents in our nursing homes have waited too long for the discrimination to end. A resident's average stay in a nursing home is usually just a little over three years. Many residents, based on that statistic, who were in nursing homes when the government started the process to long-term care reform will not be alive to see it implemented even if it goes forward this year. We need and must have long-term care reform carried out in a swift, logical and caring fashion or we all will inherit as future residents of those same facilities our mistakes and their resulting misery.

Thank you for inviting us today, and if there are any questions --

The Chair: Thank you for coming for your presentation. We'll move right to questions. We'll begin with the member from Barrie, Mr Wessenger.

Mr Wessenger: Thank you very much for your presentation. I certainly know you're doing an excellent job of meeting the challenge of operating a dual-purpose facility. I know that is a challenge for you and I note your mission statement of eventually moving to a single-purpose facility, I think, which is probably the best in the long run if and when it's achievable.

Mrs Wall-Armstrong: I think it's also consistent with other government policy in regard to the placement for developmentally disabled.

Mr Wessenger: Yes. I note your comments too with respect to providing more clarity in the legislation and not in the regulations. I just thought I'd indicate that today I indicated to another group that there will be an amendment to the legislation to specifically put in the grounds for refusal to accept a resident. Those grounds, in general terms, will be where the facility doesn't have the physical structure or the staff appropriate for the resident. That has certainly been recognized, and we appreciate it being brought to our attention. Also, some of the other concerns we certainly hope to try to address. I would like to thank you again.

Mrs Sullivan: I'm interested in the issues you raise with respect to the requirement of the nursing home to accept a resident and the power of the placement coordinator in that. Under the current regulations, regulation 43 says:

"Where the physical or mental condition of a person is such that, in the opinion of his or her physician or the director, the person cannot be properly cared for in a nursing home, the person shall not be admitted to a nursing home or remain as a resident."

Regulation 56 says:

"Every resident shall be given nursing care in accordance with his or her needs, and the care shall be given under the supervision of a registered nurse" and so on.


I think these are key issues, particularly when we're talking about developing a plan of care. The plan of care is envisaged to be done once a year, which the current regulations provide for, but the funding is done on a per-bed basis. If the plan of care, now that you will have to accept people whose acuity is greater -- indeed, where the manual indicates that procedures for oxygen therapy, intravenous therapy and in-dwelling catheter care may not be required of a home, under the new rules they will be required. How are you going to deal with this in terms of funding if once again you're only dealing with a plan of care once a year, when the acuity of the resident is such that you may not be able to provide those services?

Mrs Wall-Armstrong: I think from a practical standpoint, initially we had been given indications that if somebody needed an IV or had an in-dwelling catheter and we did not have staff, we wouldn't be forced to accept them until our staff had had training. But how long that will be or whether -- that's the only comment that's been made to us on it, but currently we probably don't have staff that would be trained in those aspects yet. A lot of the RNs in the nursing home haven't had that training or, if they've had it, it's been quite a while since they've had it and they would need upgrading in that training. So there is an issue. It would be an ongoing issue in terms of education for them.

We are on an ongoing basis updating plans, even though they may only indicate a requirement of once a year. I think that's why we pointed it out. People don't remain static for a year at a time. There needs to be a process, because even right now we have difficulty, when we have a resident who is not suitable for a nursing home, in finding other placement. Even though the legislation may say they're not to remain in a nursing home, if there isn't another proper placement for them to go to, they still remain.

Mrs Sullivan: That's right. This is an issue that we're very concerned with, and I expect we will be bringing forward an amendment that will make it clear in the legislation that if a home is unable to deal with the care needs of the patient, whether because of staff training or physical accommodation elements and so on, that will be taken into account. I think it has to be spelled out in the legislation and not just in a manual or in regs.

Mrs Wall-Armstrong: I think so too. One of the reasons we stressed the need for an appeal process for the home is that we recognize, from watching placement coordinators right now in other facilities, how much pressure is on them to put that person in a placement. I don't see, without the balance of an appeal process by the facility, which is looking at its own specific environment and its own residents, where there can be protection for its existing residents against that pressure. There is a lot of pressure out there for placement people to put them in.

We have a very good relationship with the hospital. We know they're under constant pressure on placement. They know what our criteria are, but on a regular basis we are asked to accept people they know full well we're not capable of accepting. They're under that much pressure that, "Well, we've got to try." We're concerned that without some balance, the concerns of our existing residents won't be met. There won't be anybody to stand up for them and say: "No, this doesn't suit. You can't have somebody coming in here who's going to be disturbing all these people who are currently here."

The Chair: Mr Wilson.

Mr Jim Wilson: Thank you very much. As the member whose riding abuts Barrie, I'm very often in Barrie and I know of the good work you do at the health care centre.

Very quickly, we just discussed again the points you raised concerning pre-admission and inappropriate placements, but you also raise a very good point on page 3 of your brief: What happens if a placement becomes inappropriate after they're in the home? Given that most of this is left up to regulations and we don't know the answer to that, I'll ask the parliamentary assistant to clarify that matter. Is there an appeal or a mechanism to be put in place that would allow a facility to review an inappropriate placement?

Mr Wessenger: I will ask ministry staff to indicate the procedure through the placement coordination.

Mr Quirt: There currently is a provision in the bill that allows facilities to reject an applicant based on the reasons defined in regulations. As Mr Wessenger said this morning, he would be prepared to move an amendment to the bill that would provide a couple of examples, the example of a facility having a right to refuse an admission if there was no one in the facility with the appropriate training to meet the particular care requirements of a resident or if the facility was not designed appropriately to accommodate the resident.

Mr Jim Wilson: I'm aware of those, but my reading of the English language indicates that that's a pre-admission rejection; the person isn't physically in the home. This is reading the form from the placement coordinator, and the home has an opportunity at that point. What if someone becomes inappropriate after placement? Is there a procedure in place?

Mr Quirt: There's no procedure in place now, other than that the facility is required to seek out an appropriate alternative accommodation for that resident and to make application, involving the family and the resident's physician, to a more appropriate care setting, perhaps a private hospital.

Mr Jim Wilson: So under the new system, the facility would have to go back to the placement coordinator and ask to be --

Mr Quirt: Under the new system, the facility would indicate to the placement coordinator that the resident's condition has changed, the resident now requires a service that it's unable to provide, and ask the placement coordinator to seek out a more appropriate placement.

In the case of a quick change in the needs of the resident, an emergency situation, the physician would be able to admit that resident to hospital, and that often happens now. For example, if a resident requires a particular treatment that's not available in the nursing home, then the staff at the facility and the physician would make arrangements for that transfer in an emergency situation.

Mr Jim Wilson: Do the witnesses want to comment on that at all?

Mrs Bouchard: It has been our experience several times in the 11 years I've been with the facility that when a resident is admitted, for whatever reason, we're not given a complete profile, or that following admission, again for a variety of reasons, the resident is unable to adjust to the environment, and we've tried to seek help to have this person appropriately placed.

In one particular incident where the resident was physically abusive towards both staff and residents, it took 18 months to try and work something out and get some kind of assistance and be able to prove -- not to the family because the family was very empathetic with our situation, very distraught -- that in fact this person was not appropriately placed and was jeopardizing not only all the other residents but all of our staff. But it took 18 months.

Then when it came time to arrange something, they wanted to talk a swap. We weren't interested in talking about a swap. We wanted to make sure that this person's care needs would be appropriately met and at the same time that we could carry on with our lives and look after the people the way we should be.

Mr Wessenger: I believe staff would like to add further clarification.

Mr Quirt: Clearly, there is a problem in trying to find an appropriate alternative placement for a resident who moves into a facility and whose behaviour changes and presents a danger to himself or herself or staff or others.

Mrs Bouchard: It's almost like we need a probationary period, whether three months or six months, like we do for employment, where, say, in six months you review this person and how the adjustment has gone and whether in fact that person is a good fit and if we can meet their care needs.

Mr Quirt: In half the province, currently, staff and the facility would be left to their own devices to find an appropriate alternative placement. With the advent of a placement coordination system province-wide, there would be someone else to help with that difficult problem of finding either the resources to help the facility cope with the problem or a more appropriate placement.

I would also add that under the proposed placement process, once an applicant has expressed a preference for a particular facility and has made application to that facility, we would expect the facility to do a preliminary review of that applicant's situation and indicate whether you felt at that point in time you could adequately care for the resident.

Then it may take three or four months for that person's turn to come up for admission to the facility of their choice, and at that second point, the facility would also have the opportunity to review the resident's situation to see if things had changed and to reassess whether it felt it could appropriately care for the resident.

The Chair: Thank you. I'm afraid we're running very late and I'm going to have to play heavy here and end this particular part of the afternoon's proceedings, but I want to thank you very much for coming before the committee. You have obviously raised a number of issues and questions of interest to the members. We thank you for coming from Barrie this afternoon.

Mrs Bouchard: Thank you.

The Chair: Merci beaucoup.


Mrs Sullivan: Mr Chairman, could we have a clarification from the ministry representatives, who have now indicated that there is an additional role for the placement coordinator on transfer: finding other appropriate services for the resident which are associated beyond placement of the resident in another facility. Where is that written down?

The Chair: Can we be fairly brief about this? I'll ask Mr Quirt to comment.

Mr Quirt: Placement coordination services, in their current role, are aware of other consultative resources that may be available to assess the appropriate requirements of a resident. For example, the regional geriatric program in Metro would of course receive referrals from a placement coordinator. Under the mature system proposed in the redirection, the placement coordination function would be with the multiservice agency, which would not only organize placement but would have the resources in-house to support people in the community and in a facility setting.


The Chair: I would now like to call the representatives from St Joseph's Villa. I remind members of the committee that we are now running a half-hour late, if we could keep that in mind as we proceed. Welcome to the committee. If you would be good enough to introduce yourselves, please proceed with your presentation.

Mrs Barbara Mahaffy: Thank you very much. I'm Barbara Mahaffy, director of finance at St Joseph's Villa. With me this afternoon is Gerry Malcolmson. Mr Malcolmson is a member of the board of trustees at St Joseph's Villa and is also chair of the board's public relations committee.

We certainly appreciate the opportunity to appear before the standing committee this afternoon. The major purpose of our presentation is to encourage the standing committee and the government to move forward without any further delays to implement this long overdue and important piece of legislation.

While in our presentation we will comment on some significant areas of concern and on some recommended changes, I cannot overemphasize the urgency to the seniors in our facility, the seniors in the Hamilton-Wentworth community and their families, that the inequities in the current legislation and current funding system be corrected.

St Joseph's Villa is a 370-bed charitable home for the aged located in the town of Dundas. The catchment area for both seniors and their families who currently use our services covers the following geographical areas: Hamilton-Wentworth region, portions of Brant county and portions of the regional municipality of Halton. These seniors and their families come from the following ridings: Wentworth North, Wentworth East, Brantford, Brant-Haldimand, Hamilton Centre, Hamilton East, Hamilton Mountain, Hamilton West, Halton, Burlington and Oakville South.

In addition to our home for the aged, we currently assist seniors to remain in the community through the provision of the SJV Senior Centre, which provides services to 103 seniors through a six-days-a-week seniors' day centre. The St Joseph's Villa respite care program is a six-bed service through which we provide a much-needed break for family members or spouses who are caring for frail elderly family members in their home.

St Joseph's Villa is the largest freestanding charitable home for the aged in the province. For the past eight years the seniors in our facility have been disadvantaged as a result of significant inequities in the current legislation and funding system. As a long-term care facility in the province of Ontario, we have the highest number of residents qualifying for and receiving care which the province has refused to fund. Since 1985 a succession of ministers of Community and Social Services has used the excuse of a new reformed or redirected system on funding long-term care as a reason for not correcting the significant underservicing to our residents in comparison to the residents in other parts of province of Ontario.

We believe it is time to get on with the new legislation. In addition, we believe it is crucial, in light of the lengthy delays in introducing the current legislation, that our facility receive redress for the significant deficits we have incurred in providing care to those seniors who most need it. We have appreciated the strong indication of support from all the members of the Hamilton caucus of the NDP, as well as the strong indications of support from local members of both the Conservative and Liberal caucuses, in encouraging government to correct this serious inequity.

While we have need for immediate and retroactive redress, we believe the passage of Bill 101 will be a significant step towards equalizing funding to all seniors in long-term care facilities across the province of Ontario. We believe it is crucial for seniors in facilities to have the opportunity to start with this level playing field.

We would like to spend the next few minutes laying out some concerns we have with the legislation in its current form and provide some suggestions in terms of how the legislation can be improved. The major areas we would like to cover are: (1)governance and quality care; (2)seniors' right to choice; and (3) adequate and equitable funding to meet government-prescribed standards.

The first area of issue is governance and quality care. The board of trustees of St Joseph's Villa strongly concurs with those who have drafted Bill 101 in their efforts to ensure that high-quality service to seniors is the top priority. The Sisters of St Joseph of Hamilton, as owners of our facility, insist that a high quality of service be provided to all our residents, with a special emphasis being placed on the needs of the poor and the marginalized in our society. With this in mind, both our sisters and board have taken their governance responsibilities and their accountabilities to the local community very seriously.

I am certain that Mr Beer will recall, from his time as Minister of Community and Social Services, having received over 250 letters requesting his support to maintain the high quality of care which St Joseph's Villa provided at that time and continues to this day to provide. Those letters came primarily from the seniors being served by the villa and from their family members. In addition, all of the provincial, municipal, regional and federal elected officials in our catchment area have communicated their support for St Joseph's Villa to Mr Beer, to his two predecessors as Minister of Community and Social Services and to each of his successors in office.

During the period since 1985, to our knowledge, no minister responsible for the provision of long-term care has received one complaint, either verbally or in writing, relating to the quality of care provided to seniors or the services provided in support of families by our facility.

As a charitable home for the aged, we do not believe we are unique in terms of the level of community support and appreciation for the quality of care we provide. We also believe this has not happened merely by accident, but our positive reputation within the community has been earned by our board's responsiveness to the needs and concerns of our local community.

We are extremely concerned that the emphasis placed on inspections, sanctions and standards in the new legislation will simply be the addition of a new level of bureaucracy that duplicates a function which is currently being well done, not only by our board of trustees but by similar boards in homes for the aged across the province of Ontario. We would encourage your committee to take a further look at the strengths in the current system and build on those strengths rather than creating an unnecessary additional cost to the taxpayers of Ontario.

Our second area of focus is seniors' right to choice. It is crucial in terms of access to long-term care facilities that seniors continue to have the right and privilege to select what for many of them will be their final place of residence. We are concerned that Bill 101 in its current state reduces consumer choice and reduces the control that seniors have to make decisions that significantly impact on an important part of their lives.

In Bill 101, consumer choice is reduced when no right of appeal is guaranteed to the senior; when the right to reside in a home that can provide services that are religiously sensitive to their needs is not maintained; when the right to reside with a spouse is taken away because that spouse cannot meet rigid eligibility criteria; when a senior has to wait until the decision to access facility placement is forced upon them, rather than having the opportunity to preplan for this important move, and when seniors and their families are forced to try all other community alternatives when their stated preference is facility placement.


We support a major role for placement coordination services and placement coordinators in assessing the needs of seniors. We have had an extremely successful relationship and partnership with the Hamilton-Wentworth Placement Coordination Service and look forward to the benefits which can be provided to seniors by facilities and placement services working in a cooperative manner. We, however, do not believe that cooperation can be legislated.

The role of the placement coordinator needs to take into consideration the desires of seniors, the needs of seniors and the ability and capacity of facilities to respond to both those needs and desires.

Finally, we are concerned about adequate and equitable funding to meet government-prescribed standards. We commend the province's initiative to ensure that standards are in place for the consistent provision of care to residents in all facilities across the province. In this area, we would simply request that the province ensure that resources are adequate to meet the care needs of seniors who access facilities that are funded by the government.

Bill 101 appears to take a major step to correct some inequities which go back over 20 years. While we would prefer perfect legislation, we find that the redistribution of available resources as identified in Bill 101 takes a major step in the right direction. We would ask the committee to push one step farther in this right direction and ensure that the resources are not only equitably divided, but that in addition they are adequately provided.

In conclusion, the redirection, the reform, the updating, the restructuring and the reconfiguration of long-term care in the province of Ontario have been discussed, have been consulted upon, have been responded to, have been put aside and have been laid over long enough.

The taxpayers in the province of Ontario have elected you to represent their interests. They have elected you to be decision-makers on their behalf. I would encourage you to take that responsibility seriously on behalf of the seniors in the province of Ontario. The time for action is now. I would urge your committee to act promptly and to put the new and appropriate legislation in place.

Thank you for your kind attention. We'd be glad to answer any questions you might have.

The Chair: Thank you very much. It's always interesting to be reminded of one's actions or, perhaps more appropriately, one's inactions. But we're glad that you're here and that we all have another shot at it. We'll begin the questioning with Ms Sullivan.

Mrs Sullivan: Thank you. As a matter of fact, I think I've written letters to Mr Beer, to Mr Sweeney before him, to Ms Akande, to Ms Boyd and to just about everybody else about St Joseph's Villa.

There are two points you've raised here that have not been raised before, because many of the other points you have brought to us have had some discussion. One of them is the question of preplanning for facility placement in times of strong physical need. We have just gone through the process of the Substitute Decisions Act and the Consent to Treatment Act. A major part of the thrust of that legislation is that one should be able to participate in advance in making one's decisions about what would happen to one later on, even if someone else had to carry that out.

I wonder what portion of your residents would have been in a preplanning situation, where they have looked at your facility and clearly it meets their religious needs, but they must have determined on their own or with their families that it would meet health care needs as well.

Mrs Mahaffy: I would say that by and large, about 70% to 80% of the seniors who come into the villa have gone through some kind of preplanning. Certainly, we get a number of emergency and quick placements within the facility, but many of them have lived in the community for most of their lives and have had placement in the villa, whether it's for religious reasons or social reasons or specific to a special type of care that we provide, as a desire through the later years of their life and have gone to the placement coordination service well before they were ready for placement to ensure that they were on our waiting list when the need arose.

Mrs Sullivan: That was my next question, how did that evolve through the use of the placement coordination system? That was also done in advance?

Mrs Mahaffy: Yes, we have many residents who've been on our waiting lists for two and three years who are not necessarily ready when we contact them to come in at that time, but their name then comes up again on the list.

Mrs Sullivan: To the parliamentary assistant, is that preplanning contemplated as part of the role of the placement coordinator?

Mr Wessenger: Perhaps I'd better ask ministry staff, because my own indication would be no, it's not really part of it. But I'll ask staff just to confirm that's the case.

Mr Quirt: Any prospective resident can apply to be considered for eligibility for a long-term care facility at any point in time. They can also reapply within a prescribed period of time and they can reapply if their needs change. So if someone was to apply and was deemed eligible, they would then in that process indicate which facility they would want to be considered for and then they would go on that list and would have every right to say, "No, I'm not ready to go in yet; would you please leave my name on the list?" when they were called and their turn came up.

I think that's probably the process that would happen currently at St Joseph's Villa, that when someone's name came up, they would be asked if they are ready for admission. If they said, "No, not yet," then they would stay on the list, and that would be the same system under the new system.

Mrs Sullivan: You said they'd have to reapply. Now they don't have to. Now they stay on the list?

Mr Quirt: Once they were determined as eligible, they would go on the list and they would stay on the list until their name came up at a time when they were willing to move in.

Mrs Mahaffy: I guess our concern is that the requirements for determining eligibility are much stricter --

Mrs Sullivan: Exactly.

Mrs Mahaffy: -- under the new legislation and that their name won't actually get to the list because they're not quite at that level of need yet, and then they go back to the bottom of the list.

Mr Jim Wilson: I'm not really personally familiar with the difficulties you've had at St Joseph's Villa, so perhaps in a nutshell you could tell me. Was it nursing care and the level of nursing care that you've been providing and you haven't been compensated rightly for it?

Mrs Mahaffy: We have 179 extended care beds, and in a nursing review that was done in 1988 by the ministry, an extra 99 residents were identified as needing the extended care level of service. We're providing that amount of nursing care to those residents, but we're not being funded to do that.

Mr Jim Wilson: That's kind of what I thought your answer was, and it just seems to me strange to be so supportive of a bill that delists extended care as an insured service and replaces it with levels-of-care funding with no guarantee that you'll actually get appropriate amounts of dollars.

Mr Gerry Malcolmson: Right now we're anxious to get ahead, so we figure if we get the bill moving we'll get some reply. Right now we're getting no action. At least the bill will give us some direction. Presently we're in limbo and we don't have an answer for that problem, so we're hoping that the bill will cure part of that so that we can go forward.

Mrs Mahaffy: One of the things the bill does is to recognize that you have a mix of residents receiving different levels of care and doesn't pre-determine how many people you can provide an extended level of care to. One of the dangers, having identified that you have many levels of care and that you have to provide services up to that level, is to make sure that those levels of care are adequately funded to provide care at the level the residents require.

Mr Jim Wilson: I appreciate your frustration and I appreciate your position. Let me just say for the record you're in for a rude awakening, I think -- again.

Ms Carter: I'd like to thank you for your very positive comments about the bill, and I think you've put your finger on the reason why this legislation is so urgent and why this particular piece of the whole picture of long-term care that we're dealing with had to come quickly. We have been criticized for bringing this in when other parts are not in place and people don't know what they're going to be, but obviously there was a problem with fairness of funding for institutions and that has to be dealt with quickly. I think that is the real picture there.


The point that adequate funds must be available is one that has been raised and I think that's well taken. Retroactive redress: I don't speak for the ministry here, but I know that funding is very short and I would have thought that was something we would like to do but is unlikely.

I think it's great that you have a seniors' day centre as well as your actual residential facilities, and that you already have a respite care program, beds set aside for that, which seems to fit in very well with the kind of picture that we're looking at overall.

You did raise the question again that we've heard a lot as to whether the placement coordinator would be able to take the desires of the seniors themselves and the ability and capacity of the facilities to respond to those needs, whether those would be taken into account. Mr Wessenger did tell us this morning that there will be an amendment to the bill, so maybe I can just put that on the record once more to state that the coordinator would take the preferences of the client into account, such things as ethnicity and so on; and also that facilities must have the staff and the equipment necessary to look after that person before that person would be assigned to them.

So I hope that does at least solve some of the problems that you have with the bill. I don't know whether you want to comment on that.

Mrs Mahaffy: Yes. I think certainly facilities have to be able to handle who comes to them. I think facilities have, by and large, been very flexible about doing their best to handle the residents that come to them. I think it's very important that we recognize that seniors need to have the right to choose and that we need not take that almost final right away from them, so that their final years are lived with dignity in the kind of environment that they would choose. They have chosen their environments up until this stage of their life, and I think, within our capacity to provide service, we ought to recognize that need on their behalf.

Ms Carter: I think that always has been the intention but it wasn't explicit in the bill. That has obviously been a great omission which is going to be rectified.

The Chair: Thank you very much for coming before the committee. I hope that, should you ever have to come to another committee, all of these concerns that have been expressed will by then have been met.

Mrs Mahaffy: And we won't mention our history again.

The Chair: History is always with us, but we are appreciative of your coming before us. Thank you very much again.

Mrs Mahaffy: Thank you very much.


The Chair: I now call upon the representatives from the regional municipality of York, the community services department. The Chair would remind members that we've been privileged this week to have several representations from York region and delighted again to see those who are with us. Peter, if I could ask you to introduce yourself and the delegation and then please go forward with your presentation.

Mr Peter Crichton: Thank you, Mr Chairman. My name is Peter Crichton. I'm the commissioner of community services, which includes the responsibility for the seniors' programs within the regional municipality of York. I have with me today Shawn Turner, who is the administrator of our homes for the aged program and very directly involved in the impact of this particular bill.

The Chair: Welcome. Please go ahead.

Mr Crichton: I'm pleased to have the opportunity to make this presentation and address the standing committee on social development regarding Bill 101.

The region of York is supportive of many of the province's overall objectives for reforming the long-term care system, including the stated goals of the Long Term Care Statute Law Amendment Act. The region has identified a number of areas of concern regarding the proposed amendments and wishes to present these to the committee and requests that certain assurances be provided by the province and that consideration be given to constructive recommendations made by the region to address these issues.

First, admission criteria: The revised admission criteria proposed under the new legislation will require the delivery of a wide range of medical procedures and treatments that are currently excluded and/or restricted under the Homes for the Aged and Rest Homes Act. This will result in higher care costs that over time will necessitate an adjustment in staffing complements requiring more skilled registered nursing and rehabilitation staff to provide this more complex care.

The region of York is therefore requesting a commitment from the government that it will provide adequate funding for: staff training and skills upgrading, heavier and more complex levels of care and staffing costs associated with the necessary realignment and intensification in staffing complements.

The second area of concern that we would like to bring to your attention is the funding system itself. The stated goal of this amendment to the legislation is to create a fairer funding scheme for all long-term care facilities. Based on our present understanding of the proposed funding formula, this goal will not be achieved, as it does not adequately recognize or account for legitimate variances in operating costs such as those associated with salary and benefit cost differentials among homes for the aged; unionized versus non-unionized environments; regional cost differences; pay equity; facility size, age and efficiency; increased laundry and dietary costs related to heavier care residents and economies of scale variables.

Accordingly, the region of York is seeking assurances from the government that the per diem compensation provided to facilities will recognize and fund these operating cost differentials. In addition, the region of York is seeking assurances that the per diem ranges for nursing and personal care will be established on the basis of the residents' actual care requirements and not on an artificial ceiling that is based on a predetermined, fixed global budget.

Failure to acknowledge these concerns and modify the funding system will penalize employers that have fully implemented pay equity plans, will penalize employers that are unionized and have higher wage and benefit costs and indirectly it will also penalize residents with heavy and complex care requirements.

The third area of concern is that of placement coordination. The region of York is supportive of the concept and potential benefits to the client of a centralized access system and placement coordinator for long-term care services. The region is, however, requesting that the government clarify the accountability of the placement coordinator and is recommending that a structure be established and implemented that will provide for a strong level of accountability to both the citizenry and long-term care providers in the local community.

The region of York is also requesting assurances from the government that the regulations governing the placement coordinator and admissions to long-term care facilities will include provisions for consideration of existing facility staffing levels when recommending placement, ability of the facility to appropriately care for the client, the right of facilities to appeal consumer eligibility and a formal facility appeal process.

The fourth area of concern that we'd like to bring to your attention is the area dealing with the resident copayment policy. Bill 101 proposes to amend the accommodation payment policy. Under the new policy, residents will be asked to contribute to their accommodation costs only. The amount that has been proposed is $38 a day. The province has indicated that this will result in an additional $150 million of new resident revenue, which is to facilitate funding of the reformed long-term care system.

The region of York has conducted an analysis of the actual amount of increased revenue that it would receive based on this revised resident copayment scheme. These calculations were based on the actual income levels and ability of the existing residents to pay the increased accommodation fee. This review indicated that the region's actual average resident copayment would in reality only be increased to an average of $29 per day as opposed to $38 per day. This represents a shortfall in potential revenue to the region of approximately $3,000 per resident, or $600,000 on an annual basis, not an insignificant amount. Of course, if one multiplies that over all homes, then you have quite a significant shortfall in anticipated revenues, something I don't think we want to underemphasize today. Accordingly, the region is requesting that the province recognize this differential in revenue and make a commitment that it will fund or provide the means to manage the shortfall.


The fifth and final area of concern is that of systems planning and management. Although not directly part of Bill 101, the announcements from the minister indicated that district health councils will be asked to restructure their planning capabilities and assure the lead role in planning long-term care in their respective communities.

The region of York is concerned that this realignment does not provide for substantive and direct accountability to the local community, since district health council members are appointed by the province and not elected by the local citizenry. The region of York is therefore requesting that the government reconsider its proposed position regarding planning and management for the long-term care system.

The region of York is recommending that accountability of this function be strengthened and enhanced at the local level by establishing a requirement that this planning activity be coordinated through, and that plans be approved by, the regional municipal councils.

In all areas of human services planning, the region believes municipalities should be given the responsibility for designing the local system and managing that system within provincial policies and priorities.

In closing, the region of York is grateful for this opportunity to comment on the legislation at this stage and to participate in the development of Ontario's long-term care system. The regional municipality of York is offering its continued support and welcomes the opportunity of providing further comment and assistance to the province as it proceeds with the reform initiatives. Thank you very much.

The Chair: Thank you very much for your presentation, and I note for Hansard the position paper from the community services and health committee that you have also left with us. We'll move right to questions.

Mr Jackson: Peter, thank you for your presentation. I'm on page 8 of your presentation and your concern about the separateness or the separation from regional municipal councils in this process. I guess this is the second time in a month that I've heard from York region about this process. I understand that with the review of day care planning and implementation, they've bypassed your council and your committee and gone directly to a community-based committee. I am, quite frankly, shocked and appalled, but I guess this is becoming a trend in York region and this government. That actually is going on now. They've bypassed your council. It's the only council that I'm aware of in Ontario where the government's done this.

Mr Crichton: Through you, Mr Chairman, in the region of York our council is concerned about the seeming proliferation of special-purpose bodies, not to the complete exclusion of the municipal process but certainly where the municipality is not adequately represented. It's the feeling of our regional council that we do have a duly elected process at the local level where there is direct accountability. They are on record as wanting to take a much more proactive role in what they call system architecture and system management at the local level, recognizing the responsibility of the province to set overall policy and priorities.

Mr Jackson: Yesterday we had with us the chair for the Niagara region. I posed several questions to him vis-à-vis the process of disentanglement and the fact that, in a peripheral way, the social services' partial contribution at the municipal level is part of the disentanglement process; it should be part of the disentanglement process. Yet here we have legislation which clearly speaks to your contribution at the municipal level, your lack of say and control in that process, and yet disentanglement discussions seem to be going on somewhere in this province separate and distinct from the activities of this community and the direct involvement of municipalities.

You've begged the question of how you're going to deal with a shortfall when the province sets all the rules, sets all the guidelines, sets all the rates and you're left with your rhetorical question, "How are we going to deal with the shortfall?" when we all know that you're just going to have to turn to council and say, "This is the shortfall." Is that a fair -- let me just say that that was a concern that the regional chairman for Niagara shared with us as well. Although you don't hold an elected position, you are very much here on behalf of your council.

Mr Crichton: We are here, as you can see from our council minute, at the direction of council and are reflecting council's position on this matter. Council is concerned that in many of these disentangling exercises the municipality will be left with the fiscal responsibility but without an appropriate say in the, as I said, system architecture and design. The region of York has its own concerns around the first phase of disentanglement, which we have made available to the process that's going on now, the shortfall between the tradeoff of roads and welfare, and there is quite a significant shortfall in the region of York. But we are also concerned about what we don't know about yet, which is the other stages of disentanglement, where we begin to include the other parts of the human services piece: namely, long-term care, child care, certain health concerns and so on and so forth. We don't know the whole piece yet and we remain concerned.

Mr Jackson: I appreciate that. Perhaps Mr Wessenger might respond directly to the question. What is it that we're going to be telling the region about its shortfall of about $600,000? Are we to reduce service, are we to reduce beds or are we to just come up with the money locally? Perhaps in his time he might be able to respond. I think it's one of the most important questions raised in the brief.

Mr Wessenger: I think I'm going to have staff comment on their figures on page 7. I'll ask staff to indicate whether that is accurate.

Mr Quirt: The province has made a commitment to homes for the aged, primarily municipal homes for the aged, but also a small number of charitables that we anticipate are now spending more in the operation of their facilities than they'll be entitled to under the new funding formula. The commitment is that our level of support, the support provided by residents and the province together, will not be reduced and those facilities will be, in effect, red-circled. In other words, the existing level of support they receive will be maintained and there will not be a resulting increase in the contribution that municipalities now make to the operation of homes for the aged, which on average is, if memory serves me correctly, about 15%.

With respect to the shortfall in resident revenue, it is the intention of the province to make up 100% of the difference between what residents are able to pay based on their income and the $38 fee that will be asked of residents who are not in receipt of the guaranteed income supplement.

The Chair: Comment or further question on that?

Mr Crichton: At this point we were not aware of that commitment on the part of the province. We welcome it. Right now our share is approximately 18% rather than 15%.

This is also tied in of course with the other comments we made. It's not only the $38 or the $29 copayment, but the increased costs due to the complexity of care that will be demanded. We are already having difficulty keeping up with the level of care required by our existing residents without these added treatments and programs, particularly in municipal homes for the aged where we are getting, I believe, a higher proportion of special needs residents. I mean, beyond the sort of traditional residential care and your basic extended care, we're getting people with very heavy care needs.


The Chair: Mrs Sullivan, did you want to ask something on this specifically?

Mrs Sullivan: Yes, I wanted a clarification. With respect to the resident fees, we've had a very clear statement that the province will make up 100% of the difference. However, the director has indicated that, while municipal homes won't receive less when the transfers are made, he did not indicate that those funds will be frozen until there's an equivalency between the municipal and charitable homes costs and nursing home costs. I think that has to be very much on the table and very much a concern of municipal councillors.

Mr Larry O'Connor (Durham-York): We certainly do hear from York region, in this committee, some different concerns,and seeing such a good representation from York region, I'm delighted to see that the care and the human services element in York region is a concern not only to council but to district health council, which came before us, and the placement coordination service that came before us as well.

Again on page 8 of your brief you talked about the district health council and some concern about accountability. I know we have regional council representation on the district health council; just this week they're taking a look at establishing the subcommittee that will take a look at this concern of long-term care and the planning aspect of it. Did you know about the meeting Monday night put on by the district health council and was somebody from council there to represent the concerns of York region and your department?

Mr Crichton: We do have representation on the district health council and my understanding is that representation was there from the region. I think the issue here -- the region of York, as I understand it, has been very supportive of the formation of the district health council in the region. The council has been very supportive but, at the same time, I think the council is looking sort of beyond that. At the moment, I think for those of you from the region of York -- Mr Chairman, Mr O'Connor -- you recognize that we are embarked on a process now of developing a regional official plan and, I believe, at the same time the regional council is examining its role in a number of matters and is beginning to express an opinion that its role goes beyond water, sewer and roads and that it has a much more direct role -- also a bigger role to play -- in the whole human services piece. I think they're beginning to express that, to formulate that, so I think you will see them testing the water, as we move through this piece over the next year or two.

As we expect to grow -- our population projections look at almost a doubling of the population over the next 30 years -- we have to start paying attention to some of the bigger issues you need to attend to in community building, and I think that's what we're doing. It's not only an increase in population; we're building a different kind of community, a more livable and sustainable community.

Mr O'Connor: I know that going through that process -- it certainly is an exciting process we're going through right now in trying to develop that official plan and I applaud the region for trying to take a look at the human elements as well. I hope they don't overlook some of the other community aspects, that we do have support in the community; for example, the community services council which offers some areas of expertise that I would think the region would want to take a look at in concern and bring them along with it and the district health council, of course. I'm sure York wouldn't overlook that. I know that the members who represent York in the Legislature have all been quite supportive of the district health council and I'm sure we're all looking quite forward to seeing the regional plan actually come into being at some point in the relative near future.

Mr Crichton: The members of council do not want to exclude the district health council or any other body within the community, but rather bring those bodies into the democratically elected process that has been set up within the region of York.

The Chair: If I might put on my other hat briefly, I'd like to follow up actually on some of the questions in terms of the regional planning function and, really, in the sense of strategic planning around long-term care and the district health council community services council. I think you are quite right in underlining, in the last few years in particular, a greater interest expressed by council to be more involved in a number of those decisions in that planning.

I realize that because the district health council is itself quite a new entity, and that you're working with them and looking at a number of issues, and I realize this is partly speculation, but in terms of the role of regional council and its relationship to what are two provincially appointed bodies, ie, the district health council and the community services council, as you look at a framework or a way of putting that together, how do you see that operating, that in the case of I suppose broadly speaking social planning and health planning that those bodies would present those plans before regional council, that this would become part of the process, whether it was long-term care or child care or what have you? Or would it be regional council and through its committee system that would have the primary function, initially, in developing those plans? Have you thought that one through at all?

Mr Crichton: In discussions to date with members of committee and members of council, it certainly hasn't been to the exclusion of any of these other bodies or any of these other processes that exist within the community, and the questions that are being asked today are, how do we link ourselves with those other processes to ensure that it's not just committee or it's not just staff coming up with planning, but how do we incorporate processes that exist or the works of bodies that exist in the community -- exist today or should exist -- how do we put them together in a meaningful kind of process whereby decisions that affect people at the local level can be made appropriately by council?

I don't hear council saying, "We've been elected to make the decisions, so therefore leave us alone for three years," but rather, "How do we begin to link up with the community processes that exist and build ones that are not there but should be there so that we can build a better community and a more appropriate one, a more relevant one?"

The Chair: One other question that maybe, Shawn, you might be interested in sharing your thoughts with us on this. The placement coordination function, in terms of the way that works currently in the region, do you see this as a model that in effect could be taken over and used, or are there some particular things that you think need to be altered in the way that system currently works?

Mr O'Connor: I might just add to that, they have pointed to some concerns around existing facility staff levels and concerns around placement, and maybe they've had some problems and they might want to point that out, if that's the case.

Mr Shawn Turner: In fact, at present, we haven't had those problems because the existing legislation allows us to review referrals and make a determination at the home level, whether or not we have the appropriate capacity to care for the client being referred to us.

Our concern would be with the new placement coordination service, that at that time, based on our understanding of the present funding or the proposed funding, we would not have a capacity to retain the same degree of social work that we presently have in our system, and that we would then be relying more heavily on the placement coordination service to do a more full and thorough assessment.

The type of assessment we currently receive from the placement coordination services I think we would deem to be inadequate, and certainly we do find the necessity to conduct a more complete assessment with our own staff. We would hope that in the reformed placement coordination system, they would have adequate staffing to perform thorough, complete assessments of the clients being referred to the facilities.

The Chair: I have to put my other hat back on now and move us along. Larry and I would be happy to stay here and just talk about York region, but that wouldn't be fair to the other parts of the province. I want to thank you both very much for coming this afternoon and for your presentation and recommendations.

Mr Crichton: Thank you very much, Mr Chairman and members of the committee.



The Chair: I then call upon on our next presenter, the representatives of the Service Employees International Union, if they would be good enough to come forward. Welcome to the committee. Once you're settled, would you introduce yourselves for Hansard. For the committee members, we have a copy of your submission in front of us.

Ms Judi Christou: My name is Judi Christou. I'm here representing the international vice-president of Service Employees International Union. With me are Marcelle Goldenberg, director of research, and Lin Whittaker, nursing home coordinator for Local 220 in the London area. We welcome this opportunity to present our views to the standing committee on social development concerning Bill 101.

This union represents approximately 45,000 workers across the province. Of these, 11,000 are employed in nursing homes, municipal and charitable homes for the aged. We also represent over 27,000 members employed in 93 hospitals. Some 85% of our members are women and many are visible minorities, particularly in the urban areas.

It goes without saying then that we are intensely and primarily concerned about the proposed long-term care reform and its impact on our members. We made a submission last year to the Minister of Health regarding the public consultation paper in which we stated that our members, as workers, have a substantial amount to lose and very little to gain from the proposed reforms.

This union is also concerned about the long-term care reform because we represent 45,000 consumers of health care, many of whom are in the unique position of participating on the front lines of the system and believe they have something significant to contribute to reform.

We feel that we are being asked to comment on Bill 101 in isolation, without knowing the policy directions resulting from the long-term care consultation and the details of the implementation framework. Indeed, we would be much more comfortable critiquing the bill if we knew how the government sees chronic care and acute care hospitals fitting into the picture.

We are also waiting for the chronic care role study that's supposed to be issued early this year. On the one hand, we are assured that workers displaced from the institutional care setting will be absorbed by community care while, on the other hand, workers who are currently being laid off from the hospitals have nowhere to go. For these reasons, we feel the need to reiterate some of the scepticism expressed in our submission on the original paper.

The shift in emphasis from institutional care to community care implies that there is something inherently wrong with institutional care and that community care is somehow superior. We submit that there is a need for both types of care as long as it is quality care, and that the government should remain flexible as to what that balance should be. If it is felt that institutional care is somehow failing the client, then institute reforms by all means, but we don't agree that this sector should be downsized or any thought of future expansion dismissed. We say this for a number of reasons.

The 1990 auditor's report documented long waiting lists and significant delays in the placement of patients in nursing homes and homes for the aged, presumably because there was a shortage of beds.

Then there's the question of the demographics, which I'm sure you are very familiar with by now. We are just concerned that if there are no institutional care beds for people who are cognitively impaired, will community care be able to provide the 24-hour supervision for each and every one of them?

Also, community care puts enormous emphasis on care givers, and most of the care givers are women. Today, for the most part women are in the workforce and/or looking after children. To expect them now to shoulder the burden of caring for infirm relatives is unjustifiable. Therefore, the practicality of this solutions as it is presented eludes us, unless of course the government assumes that community care will be a lot cheaper.

We stated earlier in our submission that we represent the front-line workers in health care, workers who are predominantly women and visible minorities. Just when collective bargaining, pay equity, labour law reform and the potential of employment equity are acting in concert to eliminate long-standing disparities, the government decides to transfer this work to the community sector that has traditionally been lower-paid and unorganized.

Currently this union represents four units of homemakers, or community care workers if you prefer. Two of those units are currently on strike and have been on strike for about a week and a half. They are actually paid more like $4 to $5 less than institutional care workers and they get little or no benefits.

The consultation paper stressed the importance of job security and decent wages for our members, but after decades of being scapegoats for government and employers, we remain sceptical.

Within that frame of reference, we will make a few remarks on Bill 101.

Residents, workers and taxpayers have for years called for greater accountability in the health care sector. This can only be accomplished if the system is opened up to allow for the participation and scrutiny of stakeholders. This is true too of the hospital sector, where we're seeing a little bit of progress, such as the implementation of hospital operating guidelines and staff planning committees which provide for the participation of unions and other groups. We believe Bill 101 should also be reflective of these democratic principles, specifically with regard to the service agreement, quality assurance, plan of care and inspections.

We do not know what the form and content of the service agreements will be as this is left up to regulation. However, we see certain similarities between this and the social contract proposed as part of the Public Hospitals Act review. We firmly believe that, like the social contract, the service agreement should be negotiated with the participants of the system, mainly the community, the residents and the workers. Similarly, the quality assurance plan should involve everyone at the workplace on a day-to-day basis and not simply be a reactive approach to incidents or individual performance.

Regarding the plan of care, the bill provides that the requirements of each resident be assessed on an ongoing basis; however, it does not say who is to do the assessing. We would assume that at least a doctor would assess the resident and, hopefully, the registered nurse assigned to the resident. Bill 101 makes no mention of the residents themselves or their families, but we believe they'd be an integral part of the plan of care. Similarly, staff such as the registered nursing assistant, health care aide, activity aide, who are primarily our members, could also provide valuable insight into a patient's needs as they are the ones who work with the resident on a day-to-day basis and provide the hands-on nursing care.

The inspection system has been a constant source of criticism in the past. Inspections, if they were held at all, were often scheduled far in advance, enabling a home to bring its requirements up to standard on a temporary basis. For this reason, we believe that inspections should not be scheduled in advance and that inspectors should speak to the workers in the facility and vice versa. However, this will only be effective if strong language appears in the acts protecting workers from reprisals of any kind from the employer or any other bodies. It is simply common sense to allow workers in the residence to report on conditions in the home without fear of reprisal.

Bill 101 requires the facility to post copies of those financial statements, reports and returns filed with the minister in accordance with the regulations. Therefore, we are unaware of the scope of the data to be made available to us. Regardless, we are here to ask for full and unrestricted financial disclosure, particularly with regard to the for-profit facilities.

Unions have, to be sure, a specific need for this kind of data. For the most part, every contract in the health care sector proceeds to interest arbitration. Almost without fail, the management will plead poverty or inability to pay year after year. Some arbitrators have rejected this argument, as jurisprudence would suggest they do, but others do not.

Recently we faced such an argument and the employer tabled a form 7 in support, which reveals very little about the financial state of the home. In order to respond to this argument, we requested financial data, some of which are documented on page 10 of the brief. This is just an indication of the kind of data that are available and also how money can be manipulated and hidden from view.

This union and many other groups have pursued full disclosure before the Public Hospitals Act review and we are hopeful that the review will result in mandatory disclosure provisions. Recently we received an arbitration award which required the hospitals to provide staff planning committees with pertinent financial and staffing information. This is only a beginning, but we believe the public institutions can no longer conduct their business in secret. If you want accountability, you have to have disclosure.


We have a couple of comments about funding. In reading the original discussion paper, we assume that the residents will not have to pay for nursing and personal care services. The bill is not as clear, however, and states that charges for various classes of services, goods and programs shall not be in excess of amounts determined by regulation. We hope the original intent, as stated in the paper, will be reflected in the bill or the regulations and that no residents will have to pay for their own care.

As a union, we take the argument one step further. The government must fund an appropriate level of care without expecting health care workers to subsidize that level of care by means of substandard wages and benefits. In our view, they have done so for many years and are continually expected to do so. In spite of the goodwill statements in the consultation paper regarding job security and working conditions for our members, we see no indication that the present situation is going to change. We think the homemakers' strikes are symptomatic of this.

The bill gives no indication of what criteria are going to determine who will be admitted to these facilities and who will not. This is going to be dealt with in the regulations. The bill also gives no indication, as would be expected, as to what happens to those people who do not meet the criteria. Presumably they would need community care, and we are hopeful it will be available for them.

In conclusion then, I think we're all in agreement that reform is badly needed in the health care system, but we maintain that it must be done on the basis of the whole system and not on a piece-by-piece basis. It must also be done on a fair and equitable basis. This union will do everything necessary to see that it is not done at the expense of our members.

There are still so many questions we have about community care that have yet to be answered: Where is it? Who is going to do it? What are they going to be paid? Will they be organized? What about the homeless? What about the cognitively impaired? There are still so many questions about this bill primarily because the essential elements are left up to the regulations, which we have yet to see.

Thank you for listening to our presentation. If you have any questions, we'd be happy to try to answer them.

The Chair: Thank you very much. I've just recognized that there is more in your presentation than you read. I was concerned at the beginning that we wouldn't perhaps get it all in. I just want to note that there are other elements. We appreciate that and will have an opportunity to look at them, but it also means we have time for questions. We'll begin with Mr Owens.

Mr Owens: I just want to begin by thanking you for your presentation. In my former life I was the president of CUPE Local 2001, Toronto General Hospital. I have some intimate knowledge about what it's like to bargain a collective agreement with a health care provider. While on the one hand they beat their breast and talk about compassion and excellence, on the other hand they try and push people into the corners and do everything they can to save pennies.

You make some really interesting comments. I want to go first to page 13. You talk about admissions. What has been your experience around admissions in terms of the patient mix or resident mix you are currently dealing with? Have you been exposed to inappropriate admissions, perhaps a person who, for instance, may be developmentally handicapped but also has psychiatric difficulties, or have you had difficulties with not being told that a resident or patient is potentially aggressive?

Ms Lin Whittaker: I coordinate the nursing homes in London, so we're talking about 20-odd nursing homes. Over the last few years we've found that the type of resident patient certainly has changed in terms of more care being given. One of the problems we have, and continue to have, is that our members are not informed of any difficult, for lack of a better word, residents, if there are violence and psychiatric problems. We try and ask for information so we can know how to deal with them, if we're given any guidelines, and that has not been forthcoming.

This year our local union, as our sister local did, has language in collective bargaining to try and get at that, to have disclosure on residents so we can assist them, help ourselves and not put ourselves in a situation that could be potentially dangerous to health and safety. To date, we've had no support for that. It's sort of that, with all due respect, it's none of our business.

Mr Owens: Interesting. In terms of inspections, accreditation and quality assurance, as worker representatives -- and presumably at some point you worked on the shop floor yourselves; I certainly know people who currently are employed there -- what's your experience around quality assurance? Is it real? How is it done?

Ms Whittaker: Are we talking about the inspections?

Mr Owens: Inspections? Absolutely.

Ms Whittaker: They have no value at all. It's known. We always know when there's going to be a pending inspection because all of a sudden the food comes out, the towels are replaced, the toilet paper's there, the Attends, the diapers. So we know. As soon as the inspection's over, then those things disappear. It's frustrating. I've seen our members bring food to residents because they view these residents as their family. It's not a relationship where there's no feeling. We think the present system is a farce. It gives lipservice to what it's supposed to do.

Mr Owens: We've heard presentations from residences, both secular and non-secular, saying that our language with respect to inspections is coercive, draconian, that it's going to promote confrontation. Have you had a chance to review the language that we're proposing under Bill 101? Do you see it as a means to begin to address the issues? If it does, I'd certainly like to hear about that. If it doesn't, where would you like to see the changes made?

Ms Christou: I don't think there's strong language in the act protecting the workers from reprisals from the employer. That's got to be there.

Mr Owens: The whistle-blowing protection.

Ms Christou: Yes, exactly.

Mr Owens: Would you like to expand a little bit on that?

Ms Whittaker: Yes. I don't know how personal you want us to get. In the last few weeks, we have had information pickets; our members are not able to strike. We're concerned that the Ontario Nursing Home Association has been telling its member organizations that there's a 0% increase. We've seen a lot of cutbacks.

Mr Owens: Fearmongering?

Ms Whittaker: Yes. We understand what they're doing. They're trying to justify the layoffs. We've got to the point where our understanding is that the nursing homes are still funded on the current level and care has been cut back. We've seen reduction in care staff, shifts being changed. Health care workers have been reduced, and we've been picketing. We've sent copies of our letter to the nursing home inspection branch; we've sent copies down to the ministry.

It's not unusual, when we have our regular union-management meetings, for that to be on the agenda, that somehow we would not be viewed as being chastised for having the nerve to contact the nursing home inspection branch to talk about the reduced care. But that's a separate issue. We start off the grievance procedure if people are suspended or disciplined for that, and that happens; that's real.

Mr Owens: So workers end up suffering in terms of doing what they view as their duty to their patients or their residents?

Ms Whittaker: Yes. I think somehow there's a power imbalance, that somehow that role is not expected of us.

Mr Owens: You're simply there to be clones.

Ms Whittaker: We give the front-line care, but we shouldn't care about the residents. We are their families.

Mr Owens: We know that's not true. You're there to care.

Mrs Sullivan: Just before I ask my question, may I remind members of the committee and those in the audience that this government had intended to bring in whistle-blowing legislation, as I recall, and so far it hasn't hit the floor of the Legislature.

However, I want to turn to the issue you raised on page 11 with respect to the arbitration award you received recently, requiring hospitals to provide staff planning committees with financial information. Is the information that you will now receive that which you have listed on page 10, or what did you ask for and what were you granted?


Ms Marcelle Goldenberg: The arbitration award we received requires that the hospital, and specifically if it's making changes from a human resources point of view, table with the union all pertinent information and have full disclosure. We would then request from an individual hospital the information we think we would need to be able to make an assessment in that particular situation.

What you see on page 10 is our list of what we believe would be the disclosure required in an arbitration setting for a nursing home, to make an assessment whether or not it has a valid ability-to-pay argument. This was a partial list, and also in consultation with some accountants, to give us an indication of what we would need to know to get a complete financial picture, because in most situations, either in a bargaining session or an interest arbitration session, we would find that the information in Form 7 does not disclose all the information.

For example, many nursing homes will mortgage. It will be highly leveraged and therefore will have a lot of mortgage payments to make, at very high interest rates. That doesn't really give us a true indication of the viability of that particular home. It may be that they made a financial decision to mortgage the home at 90% instead of perhaps offering a mortgage or having a mortgage at 50% of the value of the home.

We would really like to know in terms of what information they have so that we can make an assessment. In some cases, when they do that, especially in a limited partnership, we find that they're able to make the financial picture look very poor but the actual picture is not as poor as it looks.

Mrs Sullivan: I want to go back to the issue with respect to the real estate. Are you aware that there are many banks in Ontario that are ready to foreclose on nursing home mortgages?

Ms Goldenberg: We know there are 14 nursing homes out of 227 in this province that are currently in receivership, and that is different than being in bankruptcy. We have looked on some occasions at the finances of those 14, since some of them are SEIU homes, and some of the information we have looked at seems to indicate that some of the management of those facilities have been involved in questionable financial practices that we think are quite separate from the operation of that particular home.

Mrs Sullivan: And who made that analysis?

Ms Goldenberg: From the information we have from either our accountants or union staff having the ability to look at some of the information.

Mrs Sullivan: When you are saying questionable financial practices, are you indicating that there is something that has been illegal occurring?

Ms Goldenberg: No, I'm saying that there are some practices that have been committed or practised by those particular homes which have nothing to do with the operation of the homes, decisions that those owners have made regarding their particular home.

For example, they may have made a decision to mortgage that facility at 90%. They may have made a decision to flip the home and have it sold four times in four years, each time increasing the real estate value of the home but not necessarily -- and all of these are financial decisions that don't have anything to do with the day-to-day operations of the home. Do you see how we separate those two issues when they're out there to make a profit?

Mrs Sullivan: Yes, but on the other hand, the ministry funding is separate from those capital issues and therefore your operational funding, which pays the workers, is quite separate from those capital details.

Ms Goldenberg: No, not in the nursing homes. In the nursing homes you get the per diem. Each nursing home receives a per diem, and of the per diem it is to pay the workers, pay for the food costs and provide for all the operations. I don't believe that the capital funding is separate. There's a profit motive in the nursing homes, and obviously that is a problem.

Mrs Sullivan: How do you explain, then, that the summary of the for-profit nursing homes as well as the not-for-profit nursing homes from the Form 7s indicates that the for-profit nursing homes are losing approximately $2 per bed per day and the not-for-profit nursing homes are losing approximately $4 per bed per day? Both of the sectors are in deep trouble.

Ms Goldenberg: Both of the sectors need more funding; there is no question about that. What we're saying is that if you look closely at some of the for-profit homes, you will find that some of their practices contribute more to their financial picture than others.

The Chair: On that, I'm afraid I'm going to have to bring this to a close. I want to thank you for coming today and for your presentation and answering our questions.


The Chair: Could I next call upon the representative of the Ontario Association of Developmental Service Workers. Welcome to the committee. Would you be good enough to introduce yourself, and then please go ahead with your presentation.

Mr George Anand: Thank you, Mr Chair. My name is George Anand. I am the president of the Ontario Association of Developmental Service Workers. We welcome the opportunity afforded to a young and growing association like ours to present our viewpoints.

We feel this legislation is coming on the tails of three other legislations that we have just seen: substitute decision-making, consent to health and advocacy. As we look at those three legislations, one of the questions we have been asking is what kind of impact all those three legislations are going to have on the delivery of services and the impact those legislations are going to have on the direct service care workers while they are performing their jobs and responsibilities under Bill 101.

We like the principles behind Bill 101 that we understand are definitely to curb abuse, reduce duplication of service, look for better coordination and provide more empowerment to the consumers and the service providers, and we do appreciate the bill as it talks about taking into account the cultural sensitivities. But when looking at this bill, we also looked at the fact that this bill talks about providing empowerment to two groups: to the old-aged and to the physically disabled. One question we have asked is how those people who are developmentally disabled or those who have psychiatric disabilities, these particular two groups, are going to be affected under the provisions of Bill 101.

We are a growing association. At the time we started, we basically got together with the direct-care workers who have been working in the area of the developmentally handicapped and decided that we needed a professional association for the people who work as direct-care workers in the area of the developmentally handicapped. But since that time, we are in the process of opening our membership to the people who are working in the area of psychiatric disabilities and to those who are working with the old-age population. As we open our membership, we do realize that there may be more perceived differences rather than real ones in terms of the jobs, in terms of the skills, in terms of the training that's required by those individuals who are working in direct care in the field of developmental disabilities, psychiatric disabilities or old age.


Considering that framework, we also looked at some of the questions that had been raised in the consultation paper. It talks about the issue of accountability. For example, on page 25 it definitely talks about what process could be used to handle complaints and concerns of people receiving health, personal care and support at home. Then on page 23 there's a reference that new provincial training guidelines will be developed for health care aides who work in long-term care facilities and for workers providing personal care and support to seniors and people with disabilities in their homes. Then it talks about workers being trained to do a variety of tasks. Then it also talks about what kind of training or upgrading the workers should have.

Looking at all this, from our point of view we definitely feel that an association like ours should be given more authority to regulate itself. So with that kind of having a self-regulatory function within our association for direct-care workers, we feel that under certain provincial guidelines that are provided, those are some of the questions that had been raised in the consultation paper on accountability, on the training aspects and how our members need to govern themselves under different pieces of legislation: consent, advocacy, substitute decision-making and the other legislation. We are already in the process of striking a committee so that our committee members could go and start passing information to our members on these different legislation: what kind of impact it's going to have on their functions, on their responsibilities, on their duties. So having that kind of authority to regulate ourselves, perhaps we can take care of some of the questions that are being raised around those issues of accountability and on training guidelines etc.

We looked at the Globe and Mail. They were talking about people who are psychiatrically disabled -- on March 6 it says, "The Garbage Bag Evictions."

"Discharged psychiatric patients are in a terrible bind. They may be unhappy living in homes with poor care, but they are even more fearful of having no home at all."

Considering some of the other population groups that we may be going through, we definitely feel that the psychiatrically disabled and those who are developmentally disabled should be given the same opportunity as those given to the physically disabled. When the physically disabled have more empowerment, they can take the funds, they can see what particular service they want and what kind of services and in what manner the funds should be spent, so the same opportunity, the same empowerment, should be given to the other groups as well.

The Chair: Thank you very much for your presentation. Just before beginning the questions, could you just tell us when your association was founded and approximately how many members you have in the association, roughly?

Mr Anand: We started this association at the end of 1986. At the time we started, we circulated a petition among the institutions to see whether there was any interest to form an association for direct-care workers who are working with the developmentally handicapped. We got 400 signatures on the petition. As a result of that petition, we formed a steering committee to come up with the guidelines on the basis on which this association could be formed.

As we moved along, at this particular time, last year itself, we became an incorporated body. We are incorporated with the Ministry of Consumer and Commercial Relations. Our present membership is 125, but we have formed different chapters. Our resource, again, is the people who are working. We have a lot of items on our agenda, but in terms of our resources we are very, very limited because we are a few people who, besides our own jobs, have been carrying on the burden of this association. But we are definitely in the process of looking for more resources, at tapping some other kinds of funding sources.

The Chair: Thank you. Ms O'Neill.

Mrs O'Neill: Could I just continue a little further along on the Chairman's questioning? Could you tell us a little bit about what kind of professions your association represents? You said the people you work with are the psychiatrically and developmentally handicapped. Could you tell us a little bit more about what kind of work you do with them and what kind of professions your association encompasses?

Mr Anand: The members, at the time we started, are providing the direct-care services to the developmentally handicapped. That is in terms of personal care and supports. So our members come from the institutions, from the community, those who are working in the group homes, plus we have members from the teaching institutions, from the community colleges, like the student members, and two of the instructors there in the community colleges are our board members.

So the way we started was in terms of direct-care workers who are providing personal supports and care to the developmentally handicapped, but as we moved along, we also felt that at this particular time there was no professional association that existed at this particular stage for health care workers who work directly either with the psychiatrically disabled or with the old-age population. Considering that, last time in our executive we decided to open our membership to the direct-care workers who are working with the other two population groups, with the psychiatrically disabled and with the old-aged as well. This is the decision that we have taken and this is the direction that we are moving towards.


Ms Carter: The developmentally disabled and those with psychiatric disabilities, I guess, are not actually dealt with in Bill 101, but on the other hand they are closely connected issues and obviously are going to have to be dealt with at some point.

You referred to the articles in the Globe and Mail and, of course, Peterborough, where I come from, is part of that picture. Certainly in my own riding that link between the requirements of the groups you deal with and the other groups has become very plain. One of the things that is talked about in that article is the fact that a certain home which largely has elderly residents had a component of people who have been discharged from psychiatric institutions, and the owners of the home gave notice to those people that they had to leave by a certain date. Of course, this caused an uproar in the community and everybody's well aware that there is a gap in suitable accommodation for those people.

Also, we have a similar problem with the psychiatrically disabled who have a drop-in centre which is very valuable to them and they're in danger of losing that too. We even had a letter in the local paper very recently signed by, I think, three residents of the seniors' home that is concerned in all this, saying that these people had been very disruptive, wandering around the hallways asking them for money, handouts and this kind of thing and they really felt they shouldn't be subjected to this kind of problem. I'm just wondering what, in the light of all this, you feel about the Lightman report which of course addresses the kind of lodging that a lot of these people find themselves in, and what you think some of the solutions might be.

Mr Anand: From our perspective we feel that the solution is definitely in terms of how to empower first of all the direct-care worker who will be the first contact person, who will be the first contact with the psychiatrically disabled. So if there's more training, if there's more skill, and if there's more knowledge, the direct-care worker who's coming into contact -- and that direct-care worker also needs to abide by certain standards that we are in the process of setting up as an association. Then, of course, somewhere down the line we definitely would like to see ourselves as a regulated body too so we can monitor that our members are fulfilling or living up to those kinds of certain standards. So by empowering the direct-care worker, that definitely would go a long way in terms of providing a quality service to the individuals you have just referred to.

At this particular time we are seeing that the problems are a lack of uniformity, lack of consistency in terms of standards, and we don't feel there are any expectations on direct-care workers that they have to meet or that they have to abide by certain standards, so they have to be monitored in a certain way.

Ms Carter: You're really saying that standards of this kind would be an extra safeguard for the people living in these institutions, in addition to the right to appeal to an advocate and other safeguards; this is another approach. Thank you.

The Chair: Thank you. I regret again that time is pressing on, but I would like to thank you very much, Mr Anand, for coming in and making your presentation and also for providing us with information on your association.


The Chair: If I could then call upon the representatives from the Ontario Multifaith Council on Spiritual and Religious Care. I don't know if the clerk has done this by design, expecting we would need spiritual care at the end of the day, Reverend Pfrimmer.

Rev David Pfrimmer: I could also preach, probably for about 45 minutes, but I'll spare you that.

The Chair: We want to thank you very much for coming today. Also, I know that you have been with us a good part of the afternoon. We are running a bit late, but we really do appreciate your coming. We have a copy of your presentation in front of us. If you'd be good enough to introduce yourself and your colleagues for Hansard, then please go ahead.

Rev Mr Pfrimmer: My name is David Pfrimmer. I work with the Lutheran office on public policy. I chair the research and development committee. With me are the chairperson of the Ontario Multifaith Council on Spiritual and Religious Care, the Reverend Karen Bach, who works with the Presbyterian Church in Canada, and the past chair, Imam Yakub Khan, who is with the Toronto and area region Islamic community.

We're also pleased that you're willing to hear our presentation after a long afternoon and day, I'm sure. We've circulated to you. I'll briefly share some remarks and then if you want to have some questions, we can do it that way.

I want to say that the members of the Ontario Multifaith Council on Spiritual and Religious Care applaud the government's willingness to reconsider and improve the care provided to seniors and disabled adults of our communities across the province. How we care for those who are in need is fundamentally a reflection of the values that shape and sustain our communities.

The major concern of OMCSRC, as it's affectionately referred to, is the uncertain commitment to meeting the religious and spiritual needs of seniors and disabled adults. OMCSRC believes that there needs to be a declared recognition of the importance of the integral provision of spiritual and religious care in any long-term care considerations, for three reasons. I'll briefly highlight those in my remarks: first, the effective strengthening and meeting of the needs of seniors and disabled adults; second, a fuller understanding of the nature of community; and third, government's recognition in law, charters and codes of the importance of religion in the lives of its citizens.

I will briefly elaborate on these three areas to support our call for inclusion of a commitment to provide spiritual and religious care to seniors and disabled adults.

First, it's been documented in various studies that among the elderly, particularly those 75 years and older, there's a strong connection between faith and wellbeing. While growth in spirituality is a lifelong task, the senior years of a person's life are often a reflective time in which he reviews the meaning of his life. This can be a time of tremendous doubts and uncertainty. It can be a time to wrestle with questions of life and death. It is a time of evaluation to deal with the unresolved issues and experiences of life. It is also a time to draw comfort, hope and peace from participation in prayer, meditation, worship and in the life of the faith community.

Dealing with these ultimate questions of meaning, purpose and the impending future are opportunities for spiritual growth. The provision of holistic care, which includes spiritual and religious care, recognizes this need in seniors and disabled adults. It helps society also by tapping the wisdom they can contribute.

Second, faith groups have long been aware that there are fuller dimensions and deeper understandings of the reality of community. Community is a pattern of personal relationships, economic, social and political relationships, and natural relationships which are sustained and given life by our ability to transcend ourselves and see their complexity and meaning. This pattern of relationships is vital to our wellbeing. Long-term care must be based on a vision of health that seeks to maintain the wholeness of this pattern of relationships and uses them as a resource for the provision of care.

In addition, this requires the participation of communities in making decisions that affect them, respect for the care given by families, and recognition of the needs of communities themselves. OMCSRC would hope that the new legislation does not become so centralized in one local regional office or council that there is a loss of the flexibility and responsiveness to respond to the uniqueness and diversity of the various communities.

Third, governments in Canada have recognized the importance of religion in the lives of its people. In the Constitution Act, the government of Canada recognizes the supremacy of God. Canada has been signatory to a variety of international charters, such as the United Nations Universal Declaration on Human Rights, which proclaims that, "Everyone has a right to freedom of thought, conscience and religion," which includes the right "to manifest his/her religion or belief in teaching, practice, worship and observance.


The Canadian Charter of Rights and Freedoms guarantees fundamental freedom of conscience and religion. The Ontario Human Rights Code reaffirms this freedom. Specific provincial acts such as the Homes for the Aged and Rest Homes Act state, "An administrator shall ensure that there are adequate and regular opportunities in the homes for residents who so desire to participate in religious services."

This is even more broadly stated in the Charitable Institutions Act:

"The fundamental principle to be applied in the interpretation of this act and the regulations is that a nursing home is primarily the home of its residents and as such it is to be operated in such a way that the physical, psychological, social, cultural and spiritual needs of each of its residents are adequately met and that its residents are given the opportunity to contribute, in accordance with their ability, to the physical, psychological, social, cultural and spiritual needs of others."

Governments in Canada have committed themselves not only to ensure these rights in a general way, but also to enable people, particularly those under their care, to exercise those rights. The provision of spiritual and religious care is a means to honouring these obligations.

For these reasons, OMCSRC makes the following recommendations:

(a)that a stated commitment to the provision of spiritual and religious care be included in the development of new legislation, possibly in describing the quality assurance plan, and

(b)that the provision of spiritual and religious care be included and promoted as an intrinsic component of long-term care in the design of support services.

In conclusion, the religious community has long had a particular concern about the care for seniors and disabled adults, as well as for members of other vulnerable populations. In Ontario, we are fortunate to have a formal partnership between the faith groups and the government, as well as among the various faith groups themselves. This reality is not celebrated enough and has not always received the public attention it deserves.

The Ontario multifaith council is willing to work towards the delivery of improved long-term care by ensuring compassionate and sensitive spiritual and religious care that respects the religious rights of seniors and disabled adults while affirming their dignity as persons and recognizing the program needs for trained, community-supported and service delivery that conforms to agreed-to public and multifaith standards.

I might just draw your attention to the fact that we've appended to our presentation a discussion paper that was prepared for the long-term care consultation which has a longer list of recommendations, some of which may relate to the work of this committee, some of which may more appropriately relate to those who are developing the regulations in the long-term care manual. We'd also like to share those with you for your information.

I want to thank you again for the opportunity to make this presentation to you.

The Chair: Thank you very much. From the brief introductory note that OMCSRC was established in 1993, I would suspect you are probably the youngest organization to come before us, although certainly not in terms of what you do. I was not aware that had happened, so congratulations.

Rev Mr Pfrimmer: Yes. There was a new organization formed. Prior to that, it was the Ontario Provincial Interfaith Committee on Chaplaincy. So some of us have been around for a while.

The Chair: Obviously, an exciting development and I know we all wish you well. We'll begin our questions with Mr Jackson.

Mr Jackson: On that note, it's good, as a perennial social development committee member, to welcome David back. I've had occasion to receive briefs with both his monikers over the last eight years.

David, let me say at the outset that there isn't a word in your brief which I and probably all committee members wouldn't agree with you on. However, having said that, I want to move to a practical dilemma which this committee is facing. We have heard at length from single-faith-based facilities, and this presents a unique challenge, because since I have been in dialogue with legal counsel, they have shared with me and in our discussions have ascertained that for all intents and purposes, the protections and access to one's religious faith and the ability to practise it, to be able to celebrate it in your home, meaning the institution, will be protected.

However, if you read further, it also states that you have to provide that for everyone. Prior to your arrival today, I stated for the record that in no way do I think there's any great conspiracy to play with this concept. I do believe that on the basis of need, people will be asked to be placed or encouraged to be placed or told they must be placed when they are not of the same faith or cultural background or there are language difficulties, even, in terms of their placement.

Having said all that, what the law says is that the minute that, we'll say, a Catholic institution receives a Muslim, as an example, the Muslim has a right in law to say, "I believe that my religious needs should also be met in this environment and that an effort should be made."

We know that there are two models for a response to this. One is the one that occurs in the school boards, which is, in the interests of the minority, there will be no religious instruction. That is an argument in law and in public policy, which has an effect. The alternative, of course, is that you provide the services to all.

No one's put his mind around this, but we've been sitting here listening to it and we've been discussing it and you present yourselves as a rather unique presentation representing multifaith, so I want to ask you the question: What guidance can you give us? As public policy, it could move in either direction, as you well know, because if it isn't in law a protection for a child in a school, is it any less a law of protection for an adult?

Rev Mr Pfrimmer: I think there's two dimensions to your question. Let me start with the first one. There's first the right to have access to your own faith group and faith community, and I think you're pointing out in one case that is certainly something that's guaranteed.

Moving to the more public dimension, how you provide services to a multifaith constituency, I think Ontario is somewhat unique in that. I think it's been since the 1970s, 1972, when we started this process. One of the things that's interesting is that the faith groups came together and said, "How do we make sure that people have access to that and how do we provide and facilitate that access?" That's in a sense what many of our chaplaincy programs are about, to ensure that those who may have no faith community who need some services can avail themselves of it.

But secondly, for those, for example, who have a particular faith tradition who want to relate to that tradition and that service may not be there because there's not a large community in that part of the province or whatever, one of the commitments is that we will make sure they get access to those kinds of people they need, whether it's a priest or a rabbi or an imam or whoever. So in some sense there's a facilitation role that can be provided.

I'm not sure if that gets exactly at your question. It doesn't.

Mr Jackson: No, and I'm sorry, David, not at all. In Ontario we have embraced the notion that seniors and their faith should be one and the same, and we have moved in a direction of exclusivity, not inclusivity. Therefore, religious faiths, whether they're language-based as well or culturally based as well, but essentially these are religious-based institutions, have been allowed to meet the needs of the citizens, and in 99% of the cases their admissions are for persons of the same faith, and they go for that reason.

What I was suggesting to you is that in Ontario in the next decade, for reasons that come from the bill and the practicality of life in Ontario, it would appear that we may have to say to those institutions, "You must receive 10% or 20% of your residents who do not share that faith." I don't want to march you off on a branch here where we talk about the board of directors now saying, "Well, why should we contribute?" Those are all the statements we've heard and received up to this point.

What I'm basically asking to you is, according to the law, the law will ultimately fall on the line that it's not that your access to your faith is protected in a nursing home or a home for the aged, but that you can no longer practise exclusively in one capacity, in one faith. That is a legal response and I don't wish to quote at length all the court cases, but I cite for you the most contemporary example, which is the removal of prayer in our schools. I don't wish to debate that; I'm just simply saying that has, as its genesis, a point in law which flows from our Human Rights Code.


I'm sorry to be giving you such a challenging question, but you're the first individual in my six weeks on this committee to whom I've felt comfortable in posing it as a question, because it is a significant policy question which no one, as yet, has dealt with. But it essentially could occur as a ruling from the courts and/or a ruling from an interpretation. This is causing unnecessary and undue uncertainty out there.

But it begs the question, can exclusive faith communities that provide support for seniors continue in that capacity, or what will be the ultimate response to that? You may not have the answer and may wish to just meditate on that and get back to the committee, and that would be helpful. But I would feel better if I was able to share my concern with somebody for the record, because I see people out there worried about this. We're trying to get a finger on it, but when I talk to the lawyers, they tell me this is a very real concern.

Rev Mr Pfrimmer: We did have some discussion about that. If you look in the discussion paper, I think on page 6 there's probably a longer section; I may not be able to put my finger on it right away. But one of the concerns is obviously that if you have a faith group which has an institution that originated to provide care for people from the community as they reach their senior years, how do you not undermine the momentum and motivation that creates? Quite frankly, the public gains a lot by the kind of volunteer work and charitable giving that often supports those institutions in less direct ways.

So we've had some discussions about that briefly. I can't give you the final answer, but I can say this: One of the things the committee needs to be very careful of is that it may end up with a two-track approach to some of these situations. This is a personal observation, but I have not, in my experience, heard anybody say that they want to exclude folks from those facilities. In other words, if someone comes forward who needs care, at least most of the religious traditions are very open to that. Where the problem would occur is if it becomes so rigid -- and I think that was referred to in my comments here -- that another outside body is making those decisions of who gets in and who gets out, without any consideration of the community character of those institutions. Then you're going to run into major problems; it's going to be counterproductive.

The point would be, then, that there has to be maybe a bit of a two-track approach to this overall, that one has to respect the character and uniqueness of those institutions, realizing that they probably will be open to accepting people, because obviously bed spaces are at a premium.

Mr Jackson: I wish we had more time. I appreciate the indulgence of the Chair. I would like to talk to you after this is over because I want to pose a couple more questions to you privately, if I may. Thank you very much.

The Chair: Thank you. I think it is an important area.

Mr O'Connor: I want to thank you for coming and making your presentation. As Mr Jackson's been saying, we have heard from different people in the faith community who actually have their own home that they've established and have a community that they direct their service at and quite well. As you say, there's a whole network of volunteers that does evolve around that. It's not the intention to take away from that. You've certainly given us an opportunity here to take a look at where you see we might be able to bring this into the legislation, recognizing people's rights.

I know that in the church I go to, on Sundays at our service we have a minister of the eucharist who leaves the church and goes to the nursing home or home for the aged to bring that into the home that the person's living in. Most homes for the aged or nursing homes, if they're approached to take a look at the spiritual care that is required for the residents, in most cases try to accommodate, regardless of whether or not it's one of the religions that perhaps developed the care facility.

So I guess I really don't have a question for you; I just want to thank you. Maybe where you've stated we can put this might not be the appropriate place -- because we've had some good discussion in this committee about the quality assurance plan -- to put in a statement recognizing the needs that you pointed out to us; maybe it's some other spot. So I just want to thank you for that suggestion, and you certainly pointed out a need to us. If you have any comments --

Rev Mr Pfrimmer: Just one, and I suppose we're not firm on putting it in the quality assurance part of the legislation. I guess what we are concerned about is that it's stated somewhere, because if it's not stated, what tends to happen is it becomes a little bit haphazard. It also becomes vulnerable to a lot of very diverse interpretations which are not always in the best interests of the people within the institutions. I think what we're trying to do is offer a suggestion but also offer some help in terms of that in Ontario we have the mechanism, in fact, to ensure that this is done in some affordable and mutually respectful way. I think that's a clear point. So if there is someplace else that it could be inserted, that would be very helpful, and then as the regulations are worked out, I think some of those dimensions can be put in. We have in fact sent materials off to those who are tentatively looking at some of those issues now.

Mrs O'Neill: Rev Pfrimmer, have you been part of the advisory committees at all, or have you just made your presentations to these legislative committees on these hearings?

Rev Mr Pfrimmer: The advisory committees in terms of?

Mrs O'Neill: There've been a whole lot. As you know, there are statements made by the government that this has been the most heavily consulted piece of legislation in the history of Ontario, much of which I have exception with. Have you been part of that consultation at all?

Rev Mr Pfrimmer: Yes. We've been part of the consultation. To my knowledge, there were a couple of advisory committees, one on palliative care I think, that we've also made some interventions on as well. So we have been part of the consultation although we've been a little bit uncomfortable with how the material after we present it comes out. I suppose our discomfort comes in the sense that people treat it almost like every other service, and I guess our point here is that it has to be distinctive in some sense.

The same thing happens with volunteers often in institutions. We have people who are volunteers in an institution, who come in to provide a kind of service from their community or faith group, and end up being treated just like all the other volunteers who do different kinds of things. In fact, many of them end up in other capacities, and we're just saying that there needs to be a recognition of the distinctiveness of these two dimensions.

Mrs O'Neill: I'd like to read into the record, if I may, a couple of things from your previous brief, because you didn't have a chance to do that today. I think you made a very strong recommendation, which I totally agree with. "A stated commitment to the provision of spiritual and religious care be included in the development of new policy documents" was presented by you today. But you in the past, in a previous presentation, had said, "The distinct religious and cultural identity of long-term care institutions owned and operated by faith groups be recognized." That statement, although not said in those exact words, has been presented to us by many people across this province even as late as today.

The word "spiritual" was used in this committee today, and I'm very happy actually, by the parliamentary assistant. The word "spiritual" hasn't been around much in these discussions, and I think you've noticed that.

The other thing from the past that I'd like to put on the record that you have brought forward, "That spiritual and religious needs be part of the client assessment process and that the new standards of care include the provision of spiritual and religious care," and "That spiritual and religious needs be part of the client assessment process."

I think you know as well as I that in the social planning councils of this province there have been many very significant inputs by the religious of the communities where social planning councils have been successful, and those have been ongoing for 20 to 25 years.

I think the same role should be played by the placement coordinator. You in your brief and I in my comments for a long time have talked about, what do we mean by "community"? I don't know what we mean by "community." I still don't after sitting on this committee since day one. A faith community is one, and you're very much part of the general community whether it be neighbourhood, whether it be linguistic, whether it be cultural. All of those things are left to be decided. I still hope that we can somehow guarantee the placement coordinator, whether it's one person or a group of people, is not going to work in a vacuum, because many of the placement coordination agencies that are existing in the province right now, as you know and I know, have got advisory boards and/or a board of governance of some kind, and that's where I think you will need to fit in.

I wanted to ask you if you've seen the draft document, the Long Term Care Facility Programs and Services Manual, draft 1 or draft 2. Have you seen that?


Rev Mr Pfrimmer: We saw draft 1, and I think I sent, in a letter to the chairperson of the committee, a list of our detailed response to all the various dimensions of that.

Mrs O'Neill: I think you should see draft 2. I hope it's available to you today. If not, we have received it as of today.

Rev Mr Pfrimmer: I see it coming.

Mrs O'Neill: I feel very strongly that you will want to have input into it. I am quite disappointed that the words concerning faith are still lacking, because we have had this from every faith, and your group is so representative of all faiths that I decided to make these comments. You might be happy to know that you're not the first group of religious that ended our day, because in Kingston we had the chaplains end our day and, as you know, they have a very strong organization of pastoral care. Many of us on that committee that day expressed how important pastoral care has been to us as families and to our relatives who have been facing some very difficult decisions as they grow older.

So I thank you. I'm pleased the day has ended this way. I think you need to keep speaking very clearly. I find your comments very clear and I have no questions other than the ones I posed.

Rev Mr Pfrimmer: I think, basically, I want to thank you for that, because certainly that was our concern with draft 1, for example, of the document, that it had been purged of religious language. I think a lot of people think freedom of religion is really -- I mean, it has become almost freedom from religion rather than freedom of religion, and I think we need to look at that.

We are very fortunate in this province to have a level of cooperation among the various faith communities in this that is really exemplary in terms of North America and, I would suspect, many other countries as well. I think that's a resource that's available and a partnership that has been established formally that can be utilized.

In terms of your comments about the notion of community, I think we need to move to a more sophisticated notion of what community is. People are part of multiple communities. I think that would be our point. The sort of nuclear community where everybody does everything together and all the relationships are cut and dried no longer exists, but that's not something to be frightened of. That's probably something to feel fortunate for, recognizing that it introduces new dynamics that may be a challenge but certainly ones that we can work with in a creative way. So thank you very much for your remarks.

The Chair: Thank you. The parliamentary assistant wishes to just note something from the manual.

Mr Wessenger: I would just like to note from page 8 of the manual. It states: "Residents shall be supported and assisted in maintaining their preferred spiritual and religious observances, practices and affiliations both within the facility and in the community."

The Chair: Thank you. If I might, on behalf of the committee, I thank you for coming and for speaking so strongly to the spiritual aspect not just of seniors' lives but all lives.

In the last number of years in my own area, Rev Albert Revell worked in putting together a book for laypeople working with seniors in institutions and in the community which we circulated to all members of the Legislature. What we found and what I was struck by was the number of responses that I then received from members of all parties indicating that people had been asking: "Is there something for laypeople who, when they're working with seniors in institutions and in the community, are finding that need is there and not knowing quite how to respond to it?"

I just think that whole question, and certainly the point that Mr Jackson was making, is that it's an issue, that spiritual and religious side of lives, where we almost don't seem to want to really talk about it. As you say, it almost becomes freedom from. I've heard it expressed as a marginalization of the religious or the spiritual part of our lives. In some ways, seniors drive that point home more dramatically as we work, whether it's with our parents, other loved ones or people whom we meet in institutional settings. I just think you've raised a number of issues and that we as legislators, regardless of political party but as legislators, must try to find other ways of recognizing that that's a valid part of our lives. We thank you very much for coming.

Rev Mr Pfrimmer: If I might just say for the other members of the committee that we have two resources that are in the works. One is a multifaith packet that gives a bit of a summary of the various dimensions, the various faith groups that participate in the multifaith council. You may like to get a copy of that. I know the provincial coordinator's office for chaplaincy services has those.

We are also in the process of developing a policy manual which will be useful not just for chaplains serving institutions and government programs, but also looks at ways of building bridges between the faith communities, how to utilize those resources, particularly in institutions where they may not require a full-time chaplain or there may be a community-based program. You may want to keep your eyes open for those two resources as a kind of helpful thing to detail some of the ways in which we do it in a formal way in this province. Thank you very much.

The Chair: Again, thank you very much. With that, the committee stands adjourned until 10 o'clock tomorrow morning.

The committee adjourned at 1736.