Wednesday 26 October 1994

Long-Term Care Act, 1994, Bill 173, Mrs Grier / Loi de 1994 sur les soins de longue durée,

projet de loi 173, Mme Grier


Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair /Vice-Président: Eddy, Ron (Brant-Haldimand L)

*Acting Chair / Président suppléant: Curling, Alvin (Scarborough North/-Nord L)

*Carter, Jenny (Peterborough ND)

Cunningham, Dianne (London North/-Nord PC)

Hope, Randy R. (Chatham-Kent ND)

*Martin, Tony (Sault Ste Marie ND)

McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

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

Owens, Stephen (Scarborough Centre ND)

*Rizzo, Tony (Oakwood ND)

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

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Curling, Alvin (Scarborough North/-Nord L) for Mr McGuinty

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

Malkowski, Gary (York East/-Est ND) for Mr Hope

Sullivan, Barbara (Halton Centre L) for Mr Beer

Wessenger, Paul (Simcoe Centre ND) for Mr Owens

Also taking part / Autres participants et participantes:

Ministry of Health:

Wessenger, Paul, parliamentary assistant to the minister

Quirt, Geoff, acting executive director, long-term care division

Czukar, Gail, counsel, legal services branch

Clerk / Greffier: Arnott, Doug

Staff / Personnel: Filion, Sibylle, legislative counsel

The committee met at 1010 in room 151.


Consideration of Bill 173, An Act respecting LongTerm Care / Projet de loi 173, Loi concernant les soins de longue durée.

The Vice-Chair (Mr Ron Eddy): Good morning, ladies and gentlemen. Welcome to the social development committee, which is considering Bill 173, An Act respecting Long-Term Care, clause by clause.

Mrs Barbara Sullivan (Halton Centre): Mr Chairman, as a result of information that came to the committee yesterday from the first nations and meetings I had yesterday afternoon -- I believe government members will be discussing the issues with first nations people today at noon; I don't know when the third party will be meeting with them.

Mr Jim Wilson (Simcoe West): At noon.

Mrs Sullivan: At noon as well? We are drafting some amendments to put forward, one or two of which will affect section 2, which is the next section we're moving into. I'm going to ask that those sections be held open, rather than having votes on those sections, until we can have some discussion of the issues that are put forward.

My sense is that the minister has been negotiating and continues to negotiate with first nations with respect to specific agreements on long-term care delivery and that this bill does not accommodate any agreements that would be made. We should certainly at least have the discussion. I understand that it's late in the game for these to come forward, but I believe the council of chiefs has spent substantial time on it and that it merits having them put forward.

The Vice-Chair: So it would be in order to proceed with those amendments to section 2 that we have before us, I believe. Is that correct? Mr Wessenger, do you wish to comment on that matter?

Mr Paul Wessenger (Simcoe Centre): I think some of the amendments will have to be, by agreement, stood down; for instance, the ones relating to the first nations. I know there's a PC motion. I think we should leave section 2 ultimately open to allow for any possible amendments at the end, but we can deal with the amendments that are not relevant to first nations.

Mr Jim Wilson: For the record, we certainly agree with that. We had prepared a couple of PC motions on behalf of the first nations, but as meetings are pending, I would agree that we have all-party agreement to deal with those at an appropriate time.

The Vice-Chair: Is that agreed? Thank you.

We will now proceed with amendments to section 2. The first is a Liberal motion regarding subsection 2(1).

Mrs Sullivan: I move that the definition of "agency" in subsection 2(1) of the bill be amended by adding the following clause:

"(b.1) a corporation without share capital that is incorporated under part II of the Canada Corporations Act, and that is carried on without the purpose of gain for its members."

This amendment is a significant one in that it would enable the Red Cross in particular, and quite specifically, to be recognized as an agency and therefore subsequently to be recognized as an approved agency, items which cannot occur now under the terms of this bill.

Red Cross, because of its particular incorporation status, is left out of long-term care despite the fact that it has a lengthy and honourable history of providing home care and homemaking services throughout this province. We feel it's a real slap, first of all, at the kind of service the Red Cross has provided over the years for it not to be included, for it not to be able to be recognized as an agency or an approved agency, to be left out simply because of the method in which it's incorporated. It isn't enough, it seems to me, for the government to argue that the particular organizing structure of an organization which has a history of service and community involvement is such that it should be precluded from the activities it has carried on over a period of time.

There is an enormous volunteer component to Red Cross activities. The Red Cross is known as a fair employer for its own employees. The work they have done in homemaking and home care is exemplary, and in many cases it's the only service that's available in a community.

For the government to cut the Red Cross out of any involvement in service provision, particularly as an agency or as an approved agency, is something that is unconscionable and should not be accepted. I don't believe the people of Ontario ever foresaw that the Red Cross would be left out of an opportunity even, in certain circumstances, to become an MSA. Whether or not that would happen, it seems to me that it shouldn't be precluded at the beginning of the process, but rather should be contemplated as the plans in a community are being developed with the participation of people in the community.

Mr Jim Wilson: Members will note that the PC motion to follow is identical to this motion from the Liberal Party. Therefore, we are in agreement with the Liberal motion. However, this amendment alone does not get the Red Cross totally out of hot water. I just want to remind members of what the Red Cross told us in its submission in Hamilton on August 18, 1994, from the Canadian Red Cross Society. I have a couple of paragraphs I want to read to explain why incorporation is only one of the problems they have and prohibits the Red Cross from participating in the MSA structure as proposed by the government. On page 9 of their brief of August 18, it reads:

"The legislation, as it is currently drafted, precludes the Red Cross, its regions, branches or programs from becoming an MSA or providing services as part of an MSA. Notwithstanding, the Red Cross is committed to meeting the needs of vulnerable members of our communities, building on the range of services that we have developed over the last 75 years.

"The Ontario division of the Canadian Red Cross Society is not a distinct organization, but is a part of a nationally incorporated entity, the Canadian Red Cross Society, which in turn is part of the International Red Cross and Red Crescent Movement. The Red Cross has had a long history of effective and efficient service throughout the world.

"There cannot be more than one Red Cross in any country. We operate under the bylaws established by the society. These bylaws describe authority and organizational structures and set parameters for our operation. The society has only one board of governors. This board is ultimately responsible for the overall direction and operation of all aspects of the society. No agreement or arrangement may be entered into that will in any way diminish the authority of the society's board or impinge on the society's fundamental principles, particularly:

"Independence: The International Red Cross and Red Crescent Movement is independent. The national societies, while auxiliaries in the humanitarian service of their governments and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the movement."

Finally, they note on page 10 under the principle of unity:

"There can only be one Red Cross Society in any one country. It must be open to all. It must carry on its humanitarian work throughout its territory.

"The legislation requires that each MSA be incorporated under the Corporations Act, Ontario, or the Co-operative Corporations Act, Ontario. Each MSA must have its own board of governors selected in accordance with the act. These requirements are incompatible with the fundamental principles and corporate structure of the Canadian Red Cross Society."

That's the end of the quote from the brief. Essentially, in a nutshell, incorporation is one problem. The second problem is that the structure of the MSA boards would also preclude the Canadian Red Cross from becoming involved in the MSA structure, as will the 80-20 rule, which we'll be discussing in depth, I'm sure, in a few minutes.

Therefore, I would also ask members to note the PC motion for clause 2(1)(c.1) which also alters the definition of "agency" and gives a specific mention of the Canadian Red Cross in the same section that deals with municipalities and boards of health. That, in conjunction with the Liberal and PC motions dealing with incorporation, together should allow the Red Cross to participate in the MSA structure if the government proceeds with this legislation.


Mr Wessenger: We will not be supporting this amendment. It's an essential ingredient of the MSA that we have to ensure we have community-controlled boards, that they have consumer representation, that they represent both health and social service perspectives, and also that they represent the diversity of the community. With a federally incorporated agency, there's no way we could have the jurisdiction to ensure that a federally incorporated agency would carry out those perspectives.

Mrs Sullivan: I would like the parliamentary assistant not to read from his notes and to explain to us why he believes that a federally incorporated corporation such as the Red Cross, operating in Ontario, with volunteer committees in every community, does not represent the diversity of the community and is not consumer-controlled. Who does he think these people are and where does he think they come from? I'd like further response to this. That is just the most ludicrous rationale I've ever heard.

Mr Wessenger: If we're going to deal with the Red Cross, look at the Red Cross specifically, the Red Cross has a federal board, a Canadian board of directors. That Canadian board is not reflective of the diversity of an MSA in Simcoe county or an MSA in Renfrew county. There's no way the provincial government can ensure the community accountability of one federal board. And the Red Cross is a hierarchial structure; it doesn't have local incorporated branches.

Mrs Sullivan: You take taxes from federally incorporated corporations.

Mr Wessenger: It's governed from a highly structured situation.

The Vice-Chair: Please, one speaker at a time. Had you completed?

Mr Wessenger: Yes, I have completed.

Mrs Yvonne O'Neill (Ottawa-Rideau): I hope Mr Wessenger and the NDP government have the money to put where their mouth is, because to buy out the Red Cross is going to cost them $75 million, and then they're going to have all the severance cheques they're going to have for the Red Cross employees. That is the crassness of this.

The other aspect is that there are over 40 communities I have been in touch with, and there may be double that number, particularly in the north, that haven't got one other alternative but Red Cross for home care. All of a sudden, all those traditions, all those relationships with the existing physicians, psychiatrists, health care, community care workers, are going to be destroyed. This is going to be a very interesting exercise, to wipe out the operation of the Red Cross in home care in Ontario. I don't think it's going to be a very pretty sight.

Mr Wessenger: If I might respond to Mrs O'Neill, she might look at our amendments with respect to the continuation of employment and the employment opportunities for those agencies that don't continue. Certainly we are protecting the employees. Those people will eventually be doing the same thing in a multiservice agency as they are presently doing. So there are going to be no particular severance packages because that is provided for, that employment is offered to an individual with a service provider by the MSA. There'll be no right to severance pay.

Mrs O'Neill: Severance pay isn't going to save this operation, let me tell you. You're destroying a mission, you're destroying a tradition, you're destroying a group of people who have gained the trust of many, many people in this province. I don't think your severance package is going to restore that, and I do not believe Bill 173 creates employment. I'm sorry.

Ms Jenny Carter (Peterborough): I feel quite strongly about this and I certainly don't support this motion. I have heard I don't know how many presentations from the Red Cross, both in my own home area and elsewhere. We all know they have done good work, that they have pioneered the field, that they have provided services where there are no services.

But it is the Red Cross's own structure that makes it unable to work in with what we're planning here. They have, as Mr Wilson described in full, an internationally based structure. They are not designed to fit into a grass-roots organization in a local area.

Mrs Sullivan: Get out. Oh!

The Vice-Chair: Please.

Ms Carter: As far as I can see, there will be no barrier for those same well-trained, caring people to continue to work where they have been working. It will not cost, as far as I can see, any money whatsoever, because there will be successor rights. Those people will be able to move over into working as they have been working under the MSA that will be set up in their area.


The Vice-Chair: Please, can we have order. I cannot hear the speaker.

Ms Carter: I would point out also that patients have never had the choice of whether they would have a nurse who was Red Cross, VON, Saint Elizabeth, whatever. All these organizations have done a good job, but that good job comes basically down to the individual employee who is working with the client. Some are better than others, obviously, and that devotion and that training will still be available under a much more publicly accountable system than has been the case in the past.

Mr Gary Malkowski (York East): I would like to respond to comments that were made by the member for Halton Centre. To the comments about the structure of the Red Cross, I'd like to share that in my own constituency the local Red Cross in East York is very positive, very proactive. They're working with the groups, they're working at the local level and working cooperatively. The Red Cross people who work there have told me quite clearly that they are working quite well.

They're hearing that the provincial office is sending out direction and they're feeling it's conflicting with what they'd like to do locally, so what they need is the people at the local level to reflect what's happening locally. Red Cross has very good intentions in terms of people working in the north and having representatives there, and they do provide a service where there are gaps. But the Red Cross in my area is saying that they're working very well towards the implementation of an MSA, so my experience with the comments in my riding just don't jibe with the comments you're saying about the Red Cross in terms of what's happening locally. Maybe you're just listening to the comments from people at a provincial level and not listening to what's perhaps happening at a local level. I support what the parliamentary assistant said.


Mrs Sullivan: I find it quite shocking that the government is being so hidebound with respect to the structure of an organization that is incorporated under the laws of our country and, simply because it isn't incorporated under the laws of our province, says it can no longer be involved, can no longer take its place as an approved agency in any community in this province, simply because it is incorporated by our federal government, by our national government, rather than under a provincial statute. I think that's absolute madness.

The function of the organization, which can be completely separated from the structure of the organization, is one that we are all familiar with, where there has been a record of service in virtually every community in this province. To say that the structure of the organization has limited it in any way in terms of the quality of care, in terms of the service provided, in terms of the accountability for its funding -- and it certainly has received, and been open to receive, provincial moneys from time to time for necessary projects that are being undertaken in various communities -- why all of a sudden does it not qualify? The government says it's because it will not have the authority to deal with the issues that are associated with Red Cross because of its particular incorporation status. Absolute nonsense.

The rules and regulations that are included in this bill are strong, they are clear, they are going to be demanding of any agency that is allowed to become an agency under this bill. The minister has authority to provide strictures with respect to the types of service that are offered, to require agencies to perform certain things in a certain way, to demand quality control, to demand financial accountability, and in fact all of those powers are included in this bill.

Don't try to tell us that the government would not have authority to deal with a Red Cross if it became an agency at a local level. It's absolute nonsense and in fact it's misleading. The bill would give the minister complete authority in every sense of the word and in every way that any other agency in the province would have that accountability. Red Cross, as an agency, would be just as accountable as any old MSA set up anywhere else.

I think the argumentations that the government is putting forward are just way out of line. They really fly in the face of the history and experience of every part of this province. It's just madness.

Mr Jim Wilson: This bill contains, for dubious reasons, as provided by the government to date, a three-pronged attack on the Canadian Red Cross, Ontario division. Not only is incorporation a problem -- and the government's indicating now with this amendment that it is not prepared to budge on that -- but also the fact that the board structure, as envisioned in the act, creates a barrier for the Red Cross to continue to exist in Ontario under an MSA structure, and the third prong is the 80-20 rule, that is, limiting all those service providers outside of the MSA to only 20% of the market in the delivery of community services.

Currently, the parliamentary assistant, Mr Wessenger, will know, the Canadian Red Cross in Simcoe county, I believe, delivers about 97% of the homemaking services in our home area. That home area is for Mr Wessenger and me. The Red Cross serves 130,000 people across this province. These people are the needy, the frail and the vulnerable people of our society.

The Red Cross depends currently on about 10,000 volunteers, and, by the way, we've had no explanation from this government of how it will replace in terms of dollars and time those thousands and thousands of volunteers, many of whom will not, and have told us very clearly they will not, volunteer for the government or for a perceived government structure or arm of the government called a multiservice agency.

Ms Carter: Nobody volunteers for hospitals.

Mr Jim Wilson: The Red Cross has 6,000 staff, many of whom will be displaced. The Red Cross will not be able to exist if the 80-20 rule, if incorporation, if the structure and board of the MSA go forth as in the government bill.

Again, other than having this ideological bias and some sort of grass-roots flowery talk about representation on boards by local communities, Ms Carter and Mr Wessenger have just essentially charged the Red Cross as somehow not doing a good job in serving the hundreds and thousands --

Mr Wessenger: On a point of order, Mr Chair: He's making an incorrect allegation with respect to what I said.

Mr Jim Wilson: Let me rephrase then. What is your problem with the Canadian Red Cross given that, as Ms Sullivan has pointed out, it is incorporated under our federal government? Do you have a problem with the federal incorporation?

The people who work for the Red Cross in Simcoe county, Mr Wessenger, live in Simcoe county. They're are as grass-rootsy as you get. The people who volunteer are real people. They're real residents of Ontario. They're as grass-rootsy as they get. Maybe they're not your favourite NDP appointees whom you want to put on MSAs, but they're real people. They're breathing and living and volunteering and helping their neighbours and friends and the elderly and the frail.

To somehow say that this is wrong is the only interpretation I can take, that they're not accountable when they live in our communities, when they talk to their members of provincial Parliament regularly and are accountable with us to the people of Ontario. I want to know, again, why do you want to put Red Cross out of business, and all those volunteers? Why the three-pronged attack?

Will you budge on anything so the Red Cross can participate in your own model, which means either this amendment has to be supported for incorporation along with the change in the board structure, the membership of the board of MSAs, or, if you won't accept the first two, will you allow the PC motion which specifically allows the Red Cross along with boards of health and municipalities to become MSAs or, fourth, get rid of the 80-20 rule? In fact, if you got rid of the 80-20 rule, the Red Cross could continue, in Simcoe county and throughout the province, to provide services on a contractual basis with the MSAs and therefore you wouldn't have to tear down the Canadian Red Cross.

What are you prepared at all to give on any of those four points so the Red Cross can continue to exist? Because I tell you that people in Ontario are now starting to figure out what your social engineering is all about and they're getting quite angry. I think by the time this bill -- and I hope people who are watching today pick up the phone, pick up a pen and paper and write the Premier, write the Minister of Health, phone their MPPs' offices, particularly the NDP offices --

Mr Larry O'Connor (Durham-York): Point of order, Mr Chair.

Mr Jim Wilson: This better be a point of order.

The Vice-Chair: Mr O'Connor.

Mr O'Connor: Thank you, Mr Chair. I appreciate that and I'm sure my colleagues won't mind me raising a point of order considering that they did that on several occasions yesterday.

Mr Jim Wilson: It better be a point of order.

Mr O'Connor: I'm sure that they don't have a problem with that.

My understanding is that we are dealing with a clause before us, a motion placed by the Liberal member that refers to section 2 of the bill. This isn't about free air time for political announcements to be had. We've gone through a public hearing process and we are now dealing with a clause-by-clause discussion of the bill.

Mr Jim Wilson: I'd like to respond.

The Vice-Chair: Just a moment, please. I'll decide who's speaking next. Thank you. You do not have a point of order. Would you please continue, Mr Wilson.

Mr Jim Wilson: This isn't a free political announcement. This is going to cost a lot of people their volunteer positions --

Mr Cameron Jackson (Burlington South): Their jobs.

Mr Jim Wilson: -- their jobs and their services.

Mr O'Connor: In your simple mind.

Mr Jim Wilson: You know, what you're saying, and Ms Carter --

The Vice-Chair: Mr Wilson, will you address the Chair, please, and can we have one speaker only.

Mr Jim Wilson: Mr Chairman, what I'm hearing is that all of those representatives from the Canadian Red Cross who appeared before this committee during the public hearings, somehow it's in their minds --

Mr Jackson: Their simple minds, according to --

Mr Jim Wilson: -- in their simple minds and in their lawyers' minds and in all the advice they're getting --

Mr O'Connor: That's a simple mind speaking right now.

Mr Jim Wilson: -- and in the international board of the Red Cross and Red Crescent movement, it's in their simple minds that they won't continue to exist. That's a charge you cannot back up, because the facts are on the table. The facts are that you're wiping them out along with the VON, along with denominational services --


The Vice-Chair: Mr O'Connor, you'll have the opportunity to speak.

Mr Jim Wilson: -- along with members of the Catholic Health Association of Ontario and other denominations.

Mr Jackson: You're calling them all liars.

Mr Jim Wilson: They cannot exist when you limit the market under the 80-20 rule, when you don't allow them to incorporate, as they must incorporate to exist. Why can't you have them budge on some of these points to allow the Canadian Red Cross to exist in Ontario?

The Vice-Chair: Thank you, Mr Wilson.

Mr Jim Wilson: I'd like an answer.

The Vice-Chair: Ms O'Neill.

Mr Jim Wilson: I'd like an answer from the parliamentary assistant, please.

The Vice-Chair: Yes, he will be answering. Ms O'Neill is next and then Mr Wessenger.


Mrs O'Neill: In rejecting this motion, I think the only group of people in this province that is going to be helped is going to be lawyers. I really do think that in the actions that are going to be taken by this government against the Red Cross, there will certainly be many court challenges.

I really am having extreme difficulty with Mr Malkowski's presentation, or his intervention, I should say. We had 10 presentations from the Red Cross. We had them in Thunder Bay, we had them in Ottawa, we had them in Sault Ste Marie. In every case there was a common thread, that is true, but in every case there was a very local input of what it was going to do in that community, and particularly in the north the message was very clear. We're not just listening to the provincial association, I'm sorry, and I've met with most of those people.

There is a complete rejection of the fund-raising abilities of the Red Cross by rejecting this motion as well, and that goes right to the grass roots. If you want to talk about schools, most of us who went through the public and separate school systems of this province were introduced to the Red Cross first. They set up a trend in a person to become much more altruistic. They have an ability to give a focus and to give a perspective that is unique to them.

I just feel that this is another cutting of successes by this government. Whether it's successes in long-term care in this province, successes in child care or indeed successes in auto insurance, it's just all wiped out with one wide brush by pieces of legislation that are presented by this particular group of people.

The Vice-Chair: Mr Wessenger.

Mr Wessenger: I do appreciate the chance to respond, and I think maybe we'll try to have a little more calmness and maybe hopefully -- I'll try not to be inflammatory here, just to try to settle things down.

But I think we should recognize first of all that structures are means to achieve ends, and that when you look at the question of service delivery and how people receive that service, what's most important really to the people receiving the service is the people delivering it. That includes both the employees who do that and the volunteers who provide those services. It's certainly the intention to preserve that function and those people and those volunteers.

Whether you change a structure, changing a structure doesn't mean you're changing the people who provide the service. It doesn't mean that you're changing the way those people deliver that service. It doesn't mean that you change anything except the legal structure under which they're operating. I think we should all remember that.

It's certainly the intention for us to preserve and to retain those people delivering that service, to make sure they continue to deliver service in the same way and to make sure that these volunteers are doing the same thing as they're now doing, to value, to recognize how these volunteers work. So I think we should look at that, and then we look at structure.

Structure sometimes can be inhibiting or maybe inefficient in the way services can be delivered. If you're looking at what's the ideal way, we think, of delivering services in the community, it's having a community board, it's having a community representation, it's having that consumer representation on that board, and we think that's very important in a delivery system. We think that by making it more community-responsive, by preserving the same people, by encouraging the volunteers, we're going to have a better mechanism and delivery system.

Mrs Sullivan said it doesn't make any difference whether it's a federally incorporated corporation or a provincially incorporated. Unfortunately we have to recognize that legal differences do exist. In the case of a provincially incorporated body, we can define what must be in those bylaws. We can require the bylaws to be a certain way. We can control what provincial corporations do. We cannot control what a federal corporation can do.

The only way you could deal with a federally incorporated body, if you had one appointed as an MSA, would be to withdraw their approval as an MSA, and that would be the only action you could take, while there are many other courses of action you could take of a lesser extent with respect to a provincially incorporated. So it does make a difference whether it's federally incorporated or provincially incorporated.

Mr Malkowski: I'd like to respond to the comments from Ms O'Neill, the comments that she heard from the different chapters of the Red Cross, specifically in the north. But I think you really missed my point. Looking at the Ontario seniors' alliance, they raised concerns about the lack of consumer mechanism for participation in the Red Cross, in the VON and in hospitals. They were concerned about how they could have an improved mechanism for participation so that the agencies could respond. But we haven't heard any response to the concerns by the Ontario seniors' alliance group for their participation.

Maybe your office has been receiving a lot of feedback from them, but they haven't been mentioned. I think we want to try and find a balance of the different perspectives of Red Cross and the other consumer groups. That's what we're here to try and do, to find that balance between all presenters on how we can best establish a system where the implementation of the MSAs can represent locally. We heard from the other groups. Perhaps you could clarify for me, did you receive any feedback or any concerns from the Ontario seniors' alliance?

Mrs O'Neill: If I'm to answer, I received the same correspondence as anyone else on this committee. I've also met with this group, I think, on three occasions, maybe more. I have been at their press conferences. What I do find is that I never saw once where the seniors' alliance asked that the Red Cross be eliminated. I don't think they understand it.

If I may just add my explanation to Mr Malkowski, the Red Cross -- and I have spoken, as I say, to many of their groups and chapters; "branches" I think is the word it uses -- have not involved the consumers because they don't want to create undue stress and pressure on the people they serve. The consumers that have been involved have, however, been the consumers that are on their boards right now and that are on the boards of VON. My leader and I met with a group of those people last week in Ottawa.

We also know that there are consumers represented in the coalition of 22 organizations that are really concerned about Bill 173. So to say that consumers have not been involved or to say that consumers were never involved in long-term care in this province is just not true.

Ms Carter: I think what we're really talking about here is a question of governance, who's going to have the responsibility for running these services. We need to get it absolutely clear what is being said on both sides here because I think there's a little bit of fudging. Bringing in volunteers is irrelevant to that point when you're talking about them actually delivering services, because they're going to be able to continue to do that now.

I understand that what the opposition parties are putting forward here is a concept of a federated service, where the agencies keep their identity and where the system would in fact be run by providers. What we are bringing forward is a system where power goes in some degree at least to consumers and certainly to people in the local area. That is what this is all about.

That's why we had a big consultation, as you know. Something much more similar to a federated system was put forward originally. This was not approved by the --

Mr Jackson: By cabinet.

Ms Carter: -- literally thousands of people who were consulted.

Mr Jackson: By cabinet.

The Vice-Chair: Please, you will have --

Ms Carter: What we have come up with is a system where the governance is firmly based at the local level, firmly community- and consumer-oriented, and what you are really saying with the amendments that you want to bring in is that this is not the way to go, that we should not have largely consumer representation deciding how this system will be run.

Mrs Sullivan: That's a complete misrepresentation.

Ms Carter: The Red Cross is relevant here only because it is differently constituted to some of the other agencies, but as we all know, the plan is that they will all become more closely integrated, that the administration will be brought together and that this is where the savings and the integration that we've been asked to produce will come in.


If we accept this amendment, power does go to the federal level. It leaves the level that we are trying to bring it to, which is the grass-roots level. So when you express your concerns about grass-roots input, actually you are talking on both sides of your mouth because you're trying to remove power from the local level at the same time that you are saying you support it. I don't accept that.

I think consumers do have a voice here because they are the people who know what they need; they are the ones who know when the service is not meeting those needs. I think their input is absolutely basic and crucial, and if we hear that denigrated, then that is a real indication of where your proposals are coming from where you do not in fact want this to be a democratic, grass-roots, locally controlled means of delivering health care.

Mr Jim Wilson: My interpretation of what's happening and what this bill represents is, I admit, dramatically different than the NDP's. They talk about more grass roots, yet we've been told and "communities say," but the bill is so prescriptive, I don't know what's left for communities to say.

As I said yesterday, I think the new boards of the MSA, with all of their local people on them, don't have much to decide, though. There's not a lot of flexibility in terms of essentially the services they must provide and who will provide them, ie, a monopoly is created. You don't have, as Mrs Carter is suggesting, integration. You've got annihilation. There is nothing to integrate when you get rid of the Red Cross and VON and that.

I don't think, and I say this as politely as possible, the government either understands, or it certainly is not willing to acknowledge, what they're truly doing. We are told that because of particularly the 80-20 rule, there won't be enough business left out there for the Red Cross or the VON or Saint Elizabeth visiting nurses or Para-Med or Dolores Lawrence's group or many of those other private sector groups, any of the existing agencies, to continue to exist, because they won't have the critical masses, there won't be enough market share. They won't be able to provide the choice to consumers if the MSA structure and the 80-20 rule in particular go through, and all indications are so far that the government's going to go through.

So let's not talk nice, airy-fairy talk about integration. It's annihilation. They don't exist. You dissolve them and you make them into a monopoly. I don't know how the bill could be any clearer on that. I would venture to say well over 95% of the witnesses before this committee came forward and told us that's their interpretation of the act, and that will be the reality and it has been the reality in other jurisdictions where this sort of stuff has been tried at varying degrees.

Ms Carter spoke earlier about costs, and she denies there will be any new costs. I don't think, Ms Carter, the Red Cross is going to give the government its capital assets, its cars. I think those people, its employees that are displaced, are not going to walk away without severance packages. Your own bill refers, in the job security provision, that some of them will be hired, but if not, the Employment Standards Act kicks in and severance packages are given. So there's an anticipation of displacement there.

Ms Carter: But we're hiring more people. Remember that.

Mr Jim Wilson: That is cost. I don't think the VON's going to give you their fleet of cars, and if you remember, during the hearings we asked Mr Quirt, "Have you started to figure out how much it will cost to buy all those cars and capital assets of the VON?" So there are costs involved there with starting your new system.

You also spoke earlier about choice. Choice is annihilated.

Ms Carter: There never was.

Mr Jim Wilson: For some reason she says, and she says it again, there's no choice out there now. There are, by your own admission, hundreds of agencies to choose from. In my area alone, although the Red Cross, because of a coordinated effort, delivers most of the homemaking services, there certainly are choices. There are choices. If you don't like the Red Cross, you can go to another agency. You won't be able to do that when there's only one game in town, and that's the MSA. In fact, what you're doing is eliminating choice.

I would venture to say that the reason the Red Cross -- I know it to be a fact in my particular area -- happens to be delivering most of one particular type of basket of services, the homemaking services, is because they've made coordinated efforts with other agencies to say, "Look, we can do it best." I have never had a complaint from a consumer in 12 years in the business. I've never had a complaint about the VON or the Red Cross, I just haven't, and I read all of my mail and respond to it, and I answer my phone calls, and I'm in my riding all the time. I grew up there. My family's lived there 168 years. I've never had a complaint.

Mr O'Connor: You wouldn't listen to a consumer advocate. All you do is badmouth them.

Mr Jim Wilson: I don't know why you want to get rid of the Red Cross. I think you'd want to enter into, and what we're trying to propose here is, a partnership relationship, which is your Premier's own talk all the time. Yet you won't budge on this amendment, and by the sound of it, on the amendments coming up, to also allow the Red Cross to continue to exist. You won't budge on it.

Mr Wessenger says, in the most agnostic terms I've ever heard in my life, that changing a structure doesn't mean much except in legal terms. What about the mission statements, the principles I read to you about the Red Cross, the principles of the Catholic Health Association of Ontario groups, the principles of the Anglicans and the Jewish communities and the linguistic and cultural communities that deliver these services? They have principles and values and missions such that when you change their structure and annihilate their participation in the delivery of services, it's more than a simple legal exercise.

I find it offensive that you fail to understand, and we failed in our mission to try and make you understand, and the witnesses have clearly failed in their mission to try and make you understand, that the unique identity of these groups, the Canadian Red Cross and the VON and our denominational service deliverers and others, is what attracts different people and different types of volunteers to volunteer for those different organizations. It's the choice of whom you volunteer for. It's the fact that Meals on Wheels in my area of the province is 100% volunteer.

Why do you want to just absorb that into the MSA, where you're going to have to start paying people to coordinate the program? Yes, you may retain some volunteer Meals on Wheels people, but the ones I've talked to have said they'd quit; they're not going to go work for the MSA. There are other agencies they can go to, like the Heart and Stroke Foundation of Ontario, which won't be part of the MSA, which are not community based or these types of community services. There are hundreds of other agencies they can go to, and I tell you, as in Quebec, they'll walk away. They'll walk away.

Ms Carter: All these principled people are going to walk away?

Mr Jim Wilson: Because there's lots of choice of whom to volunteer for out there, lots of choice, and they've been attracted for various reasons to the Red Cross or VON. We heard all kinds of testimony about what attracts them to those various missions of those agencies. You're eliminating choice.

Ms Carter: The needs of the people they serve are going to attract them.

Mr Jim Wilson: Volunteers are very much threatened by this, and I don't know where you get off at all saying that these agencies that exist in our communities are somehow not grass roots. They're as grass roots and more aware, I would say, of the problems that they have to confront day to day on the front lines than you and I are as politicians. The nurses who work for the Red Cross, the homemaking staff of the Red Cross and their other employees are actually out there delivering services and dealing with our constituents face to face when we often talk to them on the phone. They're solving their problems.

I have never had a complaint and I can't say that about too many other things in society, because over the span of time that I've been in the business you're bound to have complaints about a lot of other things, but I've never had complaints. I've never had a senior say, "I'm not happy with the service I'm getting." In fact I've heard the opposite. My own grandmothers and family members have had the services of VON and Red Cross and homemaking services. Compliments have been many and frequent.

Where there are complaints, I assume the Red Cross must be responding to them, because they're not making them to my office and they didn't make them to George McCague's office, and, by God, people complain about all kinds of other things regularly. I'm sure my phone upstairs is constantly ringing, as it does all day, because my 1-800 lines are here at Queen's Park for my riding, so I'm in touch on an hourly basis with what's happening in the riding.


You just don't have the justification. You want to control this thing. If you're talking about community, grass-roots participation on boards, then, at the other side, who's talking out of which side of whose mouth? Mr Wessenger talks about, "We need to make sure they're incorporated provincially so we can have government central control of these organizations." I think your case fails. I think that with the exception of the consumer alliance that Mr Malkowski correctly points out has a wish to proceed with the MSAs as envisioned in the bill --

Ms Carter: Well over a million people.

Mr Jim Wilson: I'm not sure that's true. We could get into that debate on exactly how many people they do represent because I'm not aware of anyone in my riding who actually belongs to the consumer alliance, but there might be a few. But the ones I've talked to, if they do -- I've certainly talked to a number of very active people who may belong to the consumer alliance, and they tell me they don't want the Red Cross going out. That wasn't part of the deal of long-term care. They didn't know that's what they were asking for.

I agree with Mrs O'Neill. I think a lot of people are either naïve or are refusing to be believe that keeping these distinct identities, keeping choice in the system -- yes, better coordinated, yes, get those phone numbers in so that people can easily access the system and other methods of easily accessing the system, but don't tear down existing agencies when you've not made a good case that they are not delivering good service.

I think the truth out there lies in the fact that they're doing a good job, that the Red Cross has been around for 75 years for the very fact that it is doing an excellent job in our communities. You've not made a case for getting rid of them.

Mr Jackson: I would hope that the --


The Vice-Chair: I'm doing it in the order that people indicate they wish to speak. I would like to remind you, Mr O'Connor, that we had three NDP members speak in a row.

Mr O'Connor: I know. That's what I'm saying: Going in rotation will be fine with this caucus.

The Vice-Chair: Thank you. It shall be done. Mr Jackson.

Mr Jackson: Thank you, Mr Chairman. What I was going to say was that I've listened to this debate, which seems to be bogged down with the Red Cross when in fact the Red Cross isn't the only agency that should be applied to the concerns raised in this clause. When you consider that certain native bands are federated on a national basis and incorporated on a national basis, the government may be, either in a manipulative way or in a direct omission, eliminating certain groups that could be eligible. I think it's unfair.

I've listened patiently to Mr Wessenger and to the NDP members who keep harping on the Red Cross, but there are other organizations. There are certainly Islamic organizations and Muslim organizations that are so relatively new in Canada that they hold national non-profit corporate charters. I think that although legal counsel was directed to examine this, it was done purely from the perspective of the legal relationship, that the government wanted clarification and this committee wanted clarification. At no point did we really look at who we were eliminating or forcing outside the circle of services by denying this amendment which would allow for representation for those organizations that hold solely national charters. I think we're being foolish, whether it is for a linguistic, religious or even a very small group providing services for the handicapped that has only a national charter.

I want to set that aside and I want to come to the Red Cross because I could contribute to this debate with stories from my community about all sorts of volunteers. I have a couple of people who phoned me last night. They're so angry and they've asked me to read their names into Hansard as people who are quitting. They're not going to volunteer for this agency. They're going to move their compassion. They're going to move their commitment. They're going to move their donation of their gasoline and the 50-cent coffees they buy for their seniors when they take them to their doctors. They're going to move all of those. They're not going to abandon them, as Ms Carter has suggested in her interjection. As the several who phoned me have indicated, they're going to do work for Community Living. They're going to assist the handicapped people in this province who are being overlooked in this legislation. They're going to help a whole host of citizens.

I don't think anybody should be suggesting that volunteers will absolutely disappear into the woodwork. What they're going to do is leave this sector and move to another sector, and I want to give an analogy to the government members which I'm sure they will appreciate and accept with understanding.

You know, when Bob Rae got elected, he had, what, some 29%, 34% popularity in the polls. All these people supported them. They've invested their vote with him. He's now at 15% in the polls, and those 15% of people are not going to now not vote.

These were decent, honest, hardworking, principled people in the labour movement who've basically said, "I can't vote for Bob Rae in conscience any more because he's turned his back on us."

The volunteer sector is just like people who voted NDP all their life. They'll still vote, but there's been a break with the principles of how our society has been organized and operated, just as Bob Rae broke faith with the principles of a political party in this province that, quite frankly, had a very important role to play in this province. So volunteers won't disappear; they're just going to go somewhere else.

I want to address the final point on this amendment with respect to the Red Cross. What angers me is, I am not satisfied that the government isn't addressing another one of its agendas somewhere deeply embedded within the Ministry of Health. It is no secret that the Ministry of Health has been fighting with the Red Cross, the same organization we're dealing with, not on the issue of the services it's providing for seniors but on the issue of tainted blood.

This battle has been going on in this province and in this country, and it has not been a very pleasant battle between bureaucrats in Health ministries at the national and provincial levels and the unfortunate circumstances around the Red Cross, which is being assaulted on this issue. I cannot be convinced that this government isn't somehow making its point in the most dramatic, crass --

Ms Carter: That's an ugly word.

Mr Jackson: -- cruel and inappropriate way possible.

I'm telling you that I am convinced that there is sufficient evidence that the government is stonewalling the Red Cross because of the negotiations that have been going on about tainted blood.

Ms Carter: It's the Red Cross's own constitution that is the problem.

Mr Jackson: It is not the sole constitution, because you're ready to turn your back on all sorts of organizations with national charters that provide services. For some reason the Red Cross is being singled out, isolated, targeted and is about to be dismantled for a major portion of its services in this province.

You have got to explain it better than how Mr Wessenger has by reading simple paragraphs prepared by staff talking about process changes. We're talking about huge losses of resources, human resources, a commitment from an organization that's taken hundreds of years to be built up.

And I'll tell you, there's a moral issue here. The moral issue is that when no government was prepared to provide the direct services out of compassion and a desire to respond to needs in the community --


Mr Jackson: It doesn't matter what government it was. The fact is that the genesis of these services was when good, well-intended, open-hearted people came forward and said, "We'll fund-raise, we'll find the volunteers, we'll deliver the services to our senior citizens in this province," and the VON came forward, and the Catholic church and its agencies came forward, and all sorts of cultural groups came forward, and now we're going to say to them, "Now that we've used you to get the market opened up and to provide for the service, we're now going to discard you."

That is the issue here, and that is a moral question for a government that would do that to any group in society, and that's why the national component of the Corporations Act has got to be included in this legislation in order for a whole series of organizations that provide services that an MSA can acquire and that they can be part of and contribute, with their long history of service, to the planning and the integration and the success of the MSA models, which we want to support. We just are concerned that you are constantly taking people away from that table, not adding people to that table.


Mrs Sullivan: It seems to me that if one is making any attempt to ensure progressive change, one ought to create the maximum opportunities for involvement, to utilize the experience, good and bad, out of the history of the area where change is required, to take advantage of expertise, to take advantage of the commitment to excellence that has existed in previous services and to ensure that there's a welcoming mat open, to ensure that attempts to create progressive change are inclusive rather than exclusive.

It seems to me that what's happening here and what every person in Ontario should understand is that the Red Cross is being denied, by the New Democratic government in Ontario, the ability to participate over the long term in progressive change and to be part of that progressive change. The Red Cross is respected in every single local community, it's respected provincially and it's respected nationally. Its volunteers spring out of our communities, from community roots, they reflect the priorities in the community in the work that they do in local Red Cross decision-making and they serve local people.

Across Ontario, 130,000 people who are now receiving services from Red Cross will not receive services from Red Cross because Red Cross will not be allowed to be an agency. Red Cross will not be allowed to be recognized. In other words, the government is saying that the Red Cross services that have been provided have no value. Those 130,000 people will in fact be having to look elsewhere when they have been receiving help from human beings who happen to be employed by Red Cross today. They will have to look for help elsewhere. Just because those service providers work for Red Cross, they will be taken out of this new approach to long-term care.

For years and years and years the quality of service, the volunteer activity have been exemplary. Now, in one fell swoop, the history and the expertise and the service and the commitment to service are being wiped out because this government says the Red Cross in Ontario has no value.

I want to particularly dissociate myself from the remarks of Mr Jackson with respect to the tainted blood issue. I do not believe there is a link in those areas and in that decision-making. However, I do believe that the government is taking a major misstep, is misreading the values in our community and is taking a fundamental attack on the culture and fabric of our volunteer agencies in each part of Ontario. I regret that. Clearly, they're not going to budge. They've dug in their heels, and goodbye, Red Cross.

The Vice-Chair: Mr Wessenger has requested to speak out of order to comment.

Mr Wessenger: Just to make the point that they should be aware that there's nothing in the act that prohibits the Red Cross from being a service provider. I just wanted to make that clear on the record.

Mr Malkowski: I'd like to respond specifically to the PC members who were saying they hadn't heard one complaint to their office. I'm happy that the concerns of the Ontario seniors' alliance were recognized, but you said that not one person had a complaint. We were saying that the Ontario seniors' alliance was concerned about how its participation could happen. One of the comments was talking about the Red Cross and its mechanism. I asked if there is a formal mechanism for them to allow consumer participation and they responded by saying that they did have to work on that issue. But it was interesting.

As you have talked to the public this morning, perhaps I could talk to the public and say that if there were people who had concerns, they should perhaps be contacting Mr Jim Wilson's office. Then we can really hear if he is hearing all of the concerns.

Also, another comment was made by the member for Burlington South, Mr Jackson, saying that there was a connection with the tainted blood issue. I say those are not valid comments and there is no connection between this issue and that issue. I'm happy with the comments made by Barbara Sullivan in trying to dissociate herself from those comments and that there is no connection.

My final point is, I would like to remind you that the senior population, who are the consumers, deserve their voice to be heard on how they want best to see the system improved. I think the Common Sense Revolution tries to cut and to hurt the seniors and the vulnerable people and people with disabilities, and I think that is not a commonsense philosophy, because it is hurtful.

The recent book about Mulroney being On the Take, I think that's just a symbol of the work with the Tory government and the Tory philosophy, and I think that's terrible.

Mr Jackson: We're bringing up Karl Marx now.

Mr Wessenger: Mulroney and Karl Marx in the same category. That's interesting.

Mr Malkowski: I think that is just an example of Tory work and that's not an appropriate way to work. What we want to see here is people working to have an accountable, representative system where it isn't controlled.

Mrs Sullivan: On a point of order, Mr Chair: Could the member speak to the motion?

Mr Malkowski: I think it's time to hear the voice of Ontario seniors and allow the consumers who have their experience to be taken into consideration. I think we have to be accountable to get a balanced perspective from the service providers of Red Cross, VON, but also get the consumers' perspective in as well so that we satisfy the consumers. I think that's the message the seniors want us to hear from Ontario. I don't think we need to be fooled by the Tories' Common Sense Revolution and their work.

The Vice-Chair: Mrs O'Neill.

Mrs O'Neill: I had my comments in response to Mr Malkowski earlier, Mr Chair.

The Vice-Chair: I'd like to go to Mr O'Connor, but he wants me to follow rotation, so I guess I should go to --

Mr Jim Wilson: That was his request. I like the old system of put your bloody hand up.

The Vice-Chair: Mr O'Connor, you're next on the list.

Mr O'Connor: I guess the reality is that as we've gone through these committee hearings, we usually have followed rotation. I thought it might be easier in the matter of rotation to deal with it, but it's quite acceptable. I would like to deal with the clause.

The Vice-Chair: The Chair wishes to respond. I have recorded all the names and you'll find there's a good rotation except on occasion, mostly with the government party which has had several speakers in a row, but it's because they put their hands up. I have the proof here and I can give it to you if you wish after all this. Anyway, I'm sorry it's so long that you've had to wait to speak today.

Mr O'Connor: I do appreciate that, Mr Chair. I'm certainly not about to go back to Hansard and check the time of some of the speeches, because I don't think we need to do that. Thank you, Mr Chair.

I want to deal with the clause before us.

Mrs Sullivan: That would be a --

Mr O'Connor: Unfortunately, it's hard to do that over the heckles from my colleagues, because they haven't dealt with that. The matter before us today is clause-by-clause of Bill 173, and the fact of the matter is that the clause and motion before us deal with what they feel is something that's going to eliminate the Red Cross from the provision of services. That's their feeling. They've pointed out on several occasions that we heard from the Red Cross in Toronto, we heard from them in Thunder Bay and right across the province through our hearings, and in fact we did. I guess if there's maybe some criticism of some of the consumer groups out there that we didn't hear from, it's that they should have done the same thing. They should have come out again and again and said for the million people whom they represent across this country that they want to see this type of evolution take place.

Mrs Sullivan: Who does the Red Cross work for? Consumers.

Mr O'Connor: The point is, change is always a difficult thing. Change is something that isn't easy. You know, we have to at some point start to re-examine the mandates. I don't doubt for a moment that if long-term care is an essential role that the Red Cross wants to continue to play into the future that they aren't going to go back to Geneva and say, "We want to see an accountability mechanism in place to meet the demands of the consumers in Ontario." The consumers of Ontario said through a consultation process, "We want to have some local accountability." The Red Cross doesn't have that ability.


Mr Jim Wilson: Let's get rid of the UN in New York.

Mr O'Connor: The fact of the matter is that I don't believe --

Mr Jim Wilson: Let's get rid of the UN, make community boards --

The Vice-Chair: Please. Mr Wilson, I call you to order.

Mr Jim Wilson: Geneva, a neutral country, a city of the world --

The Vice-Chair: Mr O'Connor has the floor and we wish to hear him speak. Proceed, Mr O'Connor.

Mr O'Connor: Thank you, Mr Chair. The reality is that the consumers, the seniors in Ontario, don't have access to that wonderful organization through a policy process. They don't have a direct element that can go to the governing body. The makeup --

Mrs Sullivan: What are you talking about?


The Vice-Chair: Order.

Mr O'Connor: What we heard from the Red Cross was that they weren't able to be part of the process because it wasn't within their incorporation papers.

Mrs Sullivan: Because of your rule.

Mr O'Connor: I don't want to minimize the credibility of the Red Cross that my colleagues want to by saying that they aren't going to change and, as difficult as change is, re-examine the role that they do play in long-term care within our community. I believe that if they are going to continue, they will find that flexibility that is necessary, that will allow them to be more responsive to the consumers.

We heard a lot of concern about the volunteers, because in all of the long-term care delivery in our community there is a very strong network of volunteers. Not for one moment is there anyone on the government side who doesn't recognize the value of these volunteers. Not for one moment. In fact, I think it really does a disservice when you start painting with a broad stroke the elimination of all these volunteers that we're hearing being talked about. The fact of the matter is, the volunteers volunteer because they enjoy adding that value to the community. They play a very important, fundamental role in long-term care delivery in our communities, and nowhere in this legislation does that try to preclude that very important role of volunteers. In fact, we are going through a clause-by-clause process that I see a lot of strengthening going on, strengthening for the needs of those seniors, the consumers.

This was all about the consumers, and we heard from a ton of providers. There's no doubt about it. I guess a fallacy maybe could be pointed out that this is going to destroy everything. The reality is there's a lot of strengths out there. Let's build on those strengths. Let's take the strengths that are out there.

Mrs Sullivan: Instead of throwing them away.

Mr O'Connor: Let's take the community response, the consumers who want to see a change that's going to be more integrated. Let's be a little bit more inclusive and now include some disabled. Let's be more inclusive to all the community.

Now, if there are problems that my colleagues have because there are exclusive boards that my consumers, my seniors in my community, don't have access to --

Mr Jim Wilson: Name one.

Mr O'Connor: If they've got a problem with that, then -- you know, it's amazing when you think of the versions that are being put forward by the opposition: brokerage, confederation. They've got all kinds of wonderful names for it. If I was to consider for a minute the type of involvement that is necessary and try to amalgamate it into what they see, let's name -- how many different agencies are there here in Metropolitan Toronto? At least two dozen with home care delivery, with a budget of $100 million. Try to get a consumer representative board that is going to acknowledge all the services and do it in a brokerage or a federated model. Why, we would end up with a board the size of the Parliament here. We'd have to rent out the Legislative Assembly.

Mrs Sullivan: Actually, we'd have to have a whole bunch of consumers on it, wouldn't we?

Mr O'Connor: We would have to rent out a board the size of the Legislative Assembly to try to allow them a chance to have some input into the process. Where can you hear from the consumers in some huge bureaucracy like that? If there's something that the government heard --

Mrs Sullivan: You don't know what you're talking about.

Mr O'Connor: -- when we went out through a public consultation process, and we heard from 75,000 seniors, it was that they want it to be brought down closer to the community: "We want to have more community involvement." The seniors' alliance came here before us and said it's important the seniors have a voice in what is being played for them.

Mrs Sullivan: You're darned right. Nobody disagrees with that.

Mr O'Connor: They want to have a say in the service that's going to be provided from now and into the future. Yes, the changes that are included in this legislation are going to be around for a long time. Let's make no doubt about it. These are changes that are going to affect the long-term care delivery in this province for a long time, and no one can deny that there has been the need for this change.

We have said for over a decade -- the Tories heard it when they were in government, the Liberals heard it -- that there needs to be a change. Now, all of a sudden, as the changes are coming about and as we respond to the direct concerns brought to us by the consumers, they're saying: "It's too awkward for us. We don't know how to access this. We don't know whether we have the VON in our community. We don't know whether it's the Red Cross we're supposed to turn to." The doctor doesn't know whether they should be phoning the home care program run by a regional municipality. Excuse me, but they've moved out of a regional municipality. Now they're not even covered by that program any more. They don't know where to turn to.

They need to have something that's going to respond to the needs of the consumer right in their community, and what do we have? We have everyone saying there's really nothing wrong with the old program. We can continue on as long as we want and let's come up with a brokerage model that is going to pull together the board from the VON, the board from -- well, here in Toronto, there are over two dozen. We're going to end up with a board with over two dozen different service providers coming together. That's going to be more responsive? I don't think so. I don't think it is going to serve the consumers well to have that type of a model.

To go and try to put an exception through this clause that says, "Let's make exemptions for federal corporations because we'll have better access that way," I don't believe for a moment that this is going to happen.

I certainly wouldn't recommend to any of my colleagues that we support something like this, because I find this quite ludicrous. Unfortunately, what we have heard through this consultation is never enough from the consumers. When we do hear from a body that represents the consumers, over a million seniors, what do we hear? We heard: "They did a flawed study; we don't really like what you said," and then personally name the head of the presenters who came before us, and I found that quite repulsive.

Hopefully, we can keep to the high road here and deal with the facts before us. The facts before us are that there needs to be reform take place, and that's what this is about. This reform is one that is to be built upon the strengths, and while there have been solutions in the past, while there has been some networking starting to evolve, it certainly didn't start to evolve with the lack of legislation out there; it was because there was legislation under way. All of a sudden, groups come together, and I am encouraged by groups like CHATS that came before us from York region. I am encouraged that they are coming together to be part of that process.

I am sure that when we get to the end of this we're going to see a better long-term care delivery mechanism through the multiservice agencies. With that, I'll conclude my remarks.

Mr Jim Wilson: That was a very interesting set of remarks from Mr O'Connor. It's interesting that he somehow thinks it'll be awkward to get the two dozen or so agencies together in a partnership model, in a federated model, to help better coordinate the system in Metro Toronto.

In his example, the 200 would be an unwieldy board, but under this bill the government is creating 20 multiservice agency boards in Metro Toronto, each with, I don't know, 15 or 20 members. Let me see, that would be 20 times 20, 400 people now to run and coordinate services in Metro Toronto just at the board level.

Mr Jackson: Four thousand.

Mr Jim Wilson: No, it's 400. I did take university math, I recall.

Please think of your own arguments in that sense. It's a problem to get together 200 but, in the name of big government, bigger is better: "We need 400 to replace the two dozen because we can't trust those two dozen to continue to provide the 75 years of service they've been providing to the community." The NDP came along and in four short years they want to remake the province in their own image.


Mr Malkowski spoke about the Common Sense Revolution. Again, as I have to do from time to time in these committee hearings, I would remind him that health care is a top priority of the Mike Harris government, that we're the only party out there now promising and committing, and we've done the numbers to seal the health care budget and to make sure that any saving derived in the system --

Mrs Sullivan: On a point of order, Mr Chairman: Could the member speak to the point, please?

Mr Jim Wilson: I am speaking to Mr Malkowski's comments about the Common Sense Revolution, which he felt was pertinent, and it is pertinent to health care in the province.

I can't help it if the other parties are jealous of the fact that we brought out a commonsense policy that the people of Ontario agree with in overwhelming numbers, and that the NDP policy is to re-engineer the province in its own social image, as we see in this bill, and the Liberals are mute on health care policy with respect to how they will fund and how they will ensure that seniors have the services and that the people of Ontario will have health care services, the full spectrum of health care services, when they need those services.

People are extremely worried, and it's part of the debate here today, that with the monkeying around and the dollars you're going to be funnelling to administration and to takeover and to annihilation of community services, valuable dollars in the health care system are being absorbed into starting up this MSA process and money will not be available to provide the services to people when they need those services.

Mrs Sullivan: On a point of order, Mr Chairman: The amendment that's before the committee is to redefine an agency to include a corporation that's incorporated under federal laws and that has operated "without the purpose of gain." Perhaps the member could speak to that amendment.

Mr Jim Wilson: It is, you will know, in Robert's rules and Beauchesne and everybody else, quite appropriate to speak and respond to debate which has been raised surrounding the amendment on the table, which is what I am doing. It's perfectly within order, and I appreciate your recognizing that, Mr Chair, because you've in no way cut me off, which is your prerogative and yours alone.

I do want to read one thing about volunteers. It was provided by the three groups: the Red Cross Society, Ontario division, the St Elizabeth Visiting Nurses' Association of Ontario, and the Victorian Order of Nurses (Ontario). It's in response to the Price Waterhouse study that was sponsored by the Seniors Citizens' Consumer Alliance for Long-Term Care. The section is entitled "The Loss of Volunteers." It is extremely important. It is what we've been talking about here. It says:

"In looking at the long-term cost of the amalgamated MSA, Ontario can learn from the experience of other jurisdictions, such as Quebec, with their local community service centres," which I spoke about yesterday in debate.

"Regarding the CLSCs, the Quebec government task force report on health promotion, Objective: A Health Concept in Quebec, stated, `Furthermore, the government has often been reproached for killing the volunteer movement by systematically paying people in the community to do the work they formerly did without pay.' The report stated that charities previously providing service in Quebec have `progressively disappeared,' and the overall wage cost for services increased.

"VON has 5,000 volunteers and Red Cross has 10,000 volunteers in home support programs. The Human Services Alliance, which includes St Elizabeth's, has calculated a value of $10 million per year in volunteer support in time given for the archdiocese of Toronto alone."

The Human Services Alliance also includes such groups as St Joseph's Health Centre, Saint Michael's Halfway Homes, Villa Colombo, which we heard from, the Catholic Health Association of Ontario, children's aids, which we heard from, and Catholic Charities of the Archdiocese of Toronto, many of those who spoke to our committee, and it asked the question, "Has the government calculated the financial cost to the health care system if these volunteers and community members do not transfer their loyalty to the MSA from VON, Red Cross" -- which is pertinent to the motion -- "and Saint Elizabeth?"

To date, the legislative hearings have heard from any number of community provider groups expressing concern about the retention of volunteers with the shift to multiservice agencies; they have heard the same from volunteers. This loss will be a high-cost add-on to the system.

Again, the government, in dismissing this motion, in not supporting this motion -- and there is an identical motion to come up from the PC Party -- just ignores the arguments put forward by these agencies and by volunteers. We've tried to make our points in as forceful, emotional and factual a way as possible. Unfortunately, the government is not listening to these valued agencies in our society and is hell-bent on putting them out of business. I'm sure to the day they go to their graves they'll deny they did it, but I can tell you, you're doing it, you're putting them out of business. If you won't accept this series of amendments in section 2, then please reconsider the 80-20 rule, which, if you got rid of that, would help to alleviate a lot of the stress you're putting on the community service sector with this legislation.

The Vice-Chair: Ms Sullivan, did you wish to speak?

Mrs Sullivan: Yes. In conclusion, with respect to the amendment I have put forward, I think it goes without saying that our party is highly disappointed and deeply discouraged by the government's intransigence in not accepting and not recognizing the value and the expertise and the service which has been provided to people in Ontario for close to a century by Red Cross in home care and homemaking services.

This amendment would have ensured that Red Cross would have been part of a new long-term care system. What the government is saying is that Red Cross has no place, and we deeply, deeply regret that. I believe it's clear the government does not intend to change its view. I suppose the only thing I can say to people in Ontario who have been served by highly qualified volunteers and employees of Red Cross is that it's a loss to everyone in Ontario.

Mrs O'Neill: Except for lawyers.

Mr O'Connor: I want to address the point my colleague Mr Wilson raised. When he refers to the CLSCs from Quebec and the report done back in the 1980s, the reality is that those were boards that included professional groups in the process. This isn't the intention at all. Of course, here we've no intention of paying the MSA board members, and they are to be volunteers, which is a different principle. I guess that's the closest reaction he can come up with to that as a model. It's very loose in terms of trying to compare the two, because the two don't compare that well together. I just wanted to make that point.


The Vice-Chair: The Liberal motion to amend subsection 2(1) of the bill is before you.

Mrs Sullivan: Recorded vote.

The Vice-Chair: All in favour of the motion?


Curling, Jackson, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Malkowski, Martin, O'Connor, Rizzo, Wessenger.

The Vice-Chair: The motion is lost.

The next is a PC motion regarding the same matter.

Mr Jim Wilson: Mr Chairman, as the identical Liberal motion was defeated, I gather it would be redundant and probably out of order to pursue this motion.

The Vice-Chair: Yes. The next is a PC motion to amend subsection 2(1) of the bill.

Mr Jim Wilson: Is the one you're referring to the federated multiservice board, Mr Chairman? We have a couple.

The Vice-Chair: The Canadian Red Cross; to add (c.1).

Mr Jim Wilson: I move that the definition of "agency" in subsection 2(1) of the bill be amended by adding the following clause:

"(c.1) the Canadian Red Cross Society."

In discussions with legal counsel, it was felt that if the government were to reject the previous motions put forward by the Liberal Party and one by the PCs with respect to incorporation, and if the government won't modify some of its makeup of the board of the MSA, and if the government won't move on the 80-20 rule, which we're hearing it won't, perhaps the most direct and simplest way to ensure that the Red Cross is able to continue in existence in Ontario -- it will be in every other province, but it won't be in Ontario if this bill goes through -- to ensure that it can continue to do its good work, it was suggested and agreed to by myself, on behalf of my caucus colleagues, that we simply add the words "the Canadian Red Cross Society" to this section, which would allow it to become an agency as described under the act and, subsequently, possibly a multiservice agency as described under the act, as we can't get the government to move on its incorporation rules in clauses (a) and (b) of this section.

They do allow a municipality and a board of health under certain conditions to become MSAs. They will allow, as the wording of the bill is, "a council of a band" or "a first nation," as I think subsequent amendments will read in this section, to compete to become an MSA. However, we want to add also the Canadian Red Cross Society so that it can continue, so that it may in fact become an MSA.

If the government wants to achieve its objectives for this legislation, why tear down existing agencies? Why not in this case allow the Canadian Red Cross to prove to you that it can become an MSA? It's a big player in the system now in Ontario, which you know undeniably is the case. You can then on a government-to-Red-Cross basis negotiate perhaps some change in representation. If you want more consumers, if you want to make sure -- which is the case now, by the way: that people may participate, may volunteer, may go in and talk to the Canadian Red Cross any time.

But if you want to do that, you've got four years in this bill to get these MSAs up and running and delivering services. During that time, if you put the Canadian Red Cross in now, you can then go back and talk to it and you won't have put it out of the business in the meantime and you can work with it and maybe come up with some bylaw changes, if the Red Cross can do that, to help meet your definition of an MSA.

I think it's a reasonable approach. It puts them on equal footing with municipalities and boards of health. We will also, I hope people will note, in the later amendments deal with a bias against establishing municipalities and boards of health as MSAs; we will be asking that that clause be deleted. But for now we ask that the Canadian Red Cross be specifically mentioned in this part of the bill so that it will continue to exist in Ontario.

Mr Wessenger: I'd just like to point out that the Canadian Red Cross Society is a federally incorporated agency, and the same arguments we had in the previous resolution would apply. I suggest we should just vote on the motion.

Mr Tony Martin (Sault Ste Marie): I just want to put a couple of thoughts on the record in light of the discussion that's gone on for the last almost two hours. It won't be long.

For me, this bill is about integrating services. It's not about integrating agencies or anything else, it's about integrating services, it's about improving services, and it's about improving access to those improved services across the province. We're putting significantly more money into the system as we move in that direction.

We have some choices: We can either continue to prop up the existing agencies, which have done good work -- nobody is saying they haven't -- so that a whole pile of the new money going in goes to administration as opposed to the actual services to people that we want to see improved, or we can integrate the services and set up one administrative structure that is as cost-effective as we can make it so we can in fact do what I've said we're trying to do here.

There's the accusation that instead of doing this what we're in fact doing is a concerted effort to wipe out some charitable organizations in this province, and that's not the case. Change is difficult and it affects groups differently. Certainly, in this instance I don't think we're pretending for a minute that what we're doing here will not significantly affect some of the organizations out there in our communities that are held in great esteem by all of us, cause them to rethink their mandate and their mission and hopefully cause them to return to the reason for getting into this business in the first place, which was to serve people.

If, with a gathering of people in the community and some of the work we've done around the question of how we more effectively spend the new money in the interests of people in need of long-term care in this province, it is a new, more coordinated, integrated organization that spends more money in the trenches than it does in the offices of the organization, then that's where we're going.

Specifically, on the question of the Red Cross, certainly it has done good work in our communities and continues to do good work. I've sat in my office and talked with some representatives of that association over the last couple of months and struggled with them re this whole question. I shared with them, however, that my understanding of Red Cross, my first coming to know Red Cross, was certainly not under the banner of it delivering long-term care in my community; I came to know Red Cross because of the very valuable and important work it does in the area of blood and the very important and valuable work it does across the world in responding to crises and emergencies of various sorts. We watch television at night sometimes and see the Red Cross in some areas of our world where none of us would venture to go because of war and famine and things going on.

To suggest for a minute that the changes we are making in Ontario to our long-term care will result in the disappearance of Red Cross from the face of the earth or from the fabric of the social service or human service or health service delivery in this province is just not true. Yes, the Red Cross will be impacted seriously by what we do re this bill. However, I'm convinced, as a person who has parents who are now dependent on these services and as a person who will, in the not-too-distant future, depend on them himself, that this is in the best interests of the consumers, of those who are in need of long-term care and will continue to be in need of long-term care in this province.

Mr Jim Wilson: I appreciate and respect the comments by Mr Martin from the government side. I don't agree with much of what has been put forward. I certainly want to make sure that people understand that, yes, Mr Martin is correct, the Red Cross will continue with its work in the area of blood, at least for now. Mr Jackson did make the point that there is some uncertainty in that regard, with the Krever inquiry going on now. However, I do not know what the outcome of that will be; none of us does.

But the Red Cross, along with the other agencies we've frequently mentioned, tell us, and I have no reason to doubt them, that they will be out of the business of providing homemaking services and these community services listed in the bill that they're currently providing, which range from a number of services.


I grant you, if they feel it's worthwhile to keep some staff around on that side of their ledger apart from the blood side to run an adult day program, because we know adult day programs for the purposes of funding and contracting are exempt from the 80-20 rule, they may want to still be in that business. But they're telling us they probably won't, because it's not worth their while to keep an administrative structure on that side to only deliver a very minute portion of the community services they're currently involved in, because that's what you're rendering them to. You're putting them out to pasture to compete with the existing agencies for a very small portion of the service sector.

If you want to talk about cost, it is not cost-effective then for Red Cross or VON or anyone else to stay in existence on that side of the ledger just to provide a minute portion of services. That's the point. Therefore, on a cost-effective basis, Red Cross and VON and that will dissolve those divisions, and that's what they've said very clearly. They cannot justify to their community-based boards, in the case of VON and that, those costs to simply provide such a small portion of the market.

Again, in my part of the province and Mr Wessenger's part of the province, Dan Waters's part of the province, Al McLean's part of the province, Simcoe county, 97% of homemaking services are delivered by the Red Cross. They will not be in business in Simcoe county after the MSA is formed, because you're expropriating those services and putting them under the MSA. They've made that very, very clear. To only be around to serve a very small portion doesn't make sense for them to keep administrative structures for that.

The other point I wanted to make on this is, Mr Wessenger said that for the same reasons of incorporation they can't support this amendment. However, I would say to him that what this section does is very clearly talk in two parts about a corporation under the Corporations Act, Ontario, and cooperatives. An MSA can be a cooperative model.

A municipality I don't think is incorporated federally, Mr Wessenger. I don't think a board of health is incorporated federally. Therefore, I'm trying with this motion to put the Canadian Red Cross on the same basis that in the future it may become an MSA on the same basis that a municipality or board of health may.

So you can't tell me that (a) and (b) have anything to do with what we're talking about now. You specifically had this definition of "agency" in the bill to provide for such things as the exceptions to those that aren't incorporated now under either part (a) or (b). So you have to list municipalities separately, you have to list boards of health separately, and I'm asking you now to list the Canadian Red Cross, because it is the group that has come forward and said, "Because of the structure here and the incorporation rules contained therein, we need a separate exemption if we're to continue and if we're to participate in your own MSA model."

I can see in Simcoe county, with the seven major players we have, Mr Wessenger, who are all non-profit, by the way, with the exception of a bit, 3% of the service provided by Para-Med and maybe one or two other private agencies, the agencies together, if allowed to cooperate together and allowed to form partnerships, may very well end up, with one of the big players like the Red Cross, wanting to be the MSA there.

Your bill would prohibit that. Your bill says, "No, we've got to reinvent the wheel totally," and I think that in the name of allowing communities this empowerment that Ms Carter and Mr O'Connor and everybody else seem to talk about but refuse to do anything about, just talk about it, we should allow the Red Cross in the future to become an MSA, and therefore it needs this exemption in the act under the definition of "agency."

The Vice-Chair: The parliamentary assistant wishes to clarify a matter.

Mr Wessenger: Yes, I'm just going to ask legal counsel to set out the legal aspects of this concerning the Red Cross.

Ms Gail Czukar: I just wanted to clarify that the reason the other agencies such as boards of health and municipalities are specifically listed is because they don't fit the definition of an organization that's incorporated under the Corporations Act or Co-operative Corporations Act. The Canadian Red Cross Society, as a federally incorporated body, cannot be an exception because it's still subject to federal corporations law, and as a matter of corporate law, provincial legislation which impinges on the corporation's corporateness and ability to control its own affairs doesn't apply to a federal corporation. So the provisions in our bill that would be consequences of particular kinds of breaches of the act simply wouldn't apply once the Red Cross, as a federal corporation, was an agency and was operating. So we would lose the accountability that we would like to have, in addition to the fact that we couldn't impose our governance requirements under section 11 and so on on the Red Cross because it is a federal corporation.

Mr Jim Wilson: In response to that, I will accept your legal argument of why you can't accept this amendment. What I don't accept is the lack of political will on behalf of this government to allow MSAs to adjust this bill in whatever way is recommended by legal counsel to ensure that the Red Cross can become part of the MSA structure. Now, do you have the will to allow that to happen or are you absolutely determined to drive the Red Cross out of any participation in the MSA structure that you're formulating?

Mr Wessenger: To answer that question, we are adamant with respect to the MSA structure having an integrated, functional system. As you may have recalled, there may be various methods of governance with respect to an MSA. There was a submission to this committee suggesting that the cooperative method could be used as a method to allow existing provider agencies to have a role in governance of an agency. That was a legally permitted model. But certainly as far as the functional integration of the system, that's not a negotiable issue as far as the government is concerned.

The Vice-Chair: I had one additional speaker.

Mr Jim Wilson: Briefly in response to that, Mr Chair --

The Vice-Chair: Mr Wilson.

Mr Jim Wilson: My belief is, where there's a will, there's a way. You've forthrightly said there is no will on behalf of the government to make adjustments for the Canadian Red Cross to participate in your MSA structure. And they've ruled out the cooperative model.

Mr Wessenger: That is the only potential model that was brought to our attention that could fit within the scheme of the act.

The Vice-Chair: We had one additional speaker: Mr Malkowski.

Mr Malkowski: I think it's important to understand when we're looking at the MSA structure that if they decide to perhaps purchase services from the Red Cross, this isn't prohibiting them from doing that. I mean, they are a valued service provider. It would be up to the structure of the MSA to define its needs depending on what the local community decides.

As well, what is important is accountability, and we have to be accountable to the local community. But I think we have to also listen carefully to the concerns raised, again, by the Ontario seniors' alliance. It's very important for them to have a formal mechanism of involvement to feel satisfied with the services, and perhaps the Canadian Red Cross could think about that in terms of when we look at the establishment of the MSAs.

Mr Wessenger: I'd just like to indicate that there is certainly a level of flexibility, and I'd like to make it clear that it's possible the Red Cross may continue to play some role with respect to the long-term care area. I wouldn't like to say, because each local community is planning its own proposals -- for instance, it may be that the Red Cross could play a role with respect to training, for instance, of homemakers.

Even though they wouldn't be involved in the administration of employing them, they could be involved, for instance, in some specialized services that they may develop and they may continue to play a role. That's going to be up to the Red Cross, what role they want to play, and up to the local communities how they see they can work with such agencies.

The same with VON or any existing agency; they can develop new mission statements that can still provide for them a role within the whole question of long-term care.

The Vice-Chair: Thank you. The PC motion to amend subsection 2(1) by adding clause (c.1).

Mr Jim Wilson: Recorded vote.

The Vice-Chair: Recorded vote. All those in favour of the motion?


Jackson, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Malkowski, Martin, O'Connor, Rizzo, Wessenger.

The Vice-Chair: Motion lost. The committee stands adjourned until 2 this afternoon.

The committee recessed from 1201 to 1414.

The Acting Chair (Mr Alvin Curling): We'll resume the clause-by-clause consideration of Bill 173. I think when we left off the PCs had an amendment before us.

Mr Jim Wilson: I move that subsection 2(1) of the bill be amended by adding the following definition:

"`federated multiservice board' means a board established under section 11."

I don't think it would be appropriate to belabour the debate at this point about a federated multiservice board, which is the federated model being put forward by the PC caucus, given that an earlier attempt to change a definition certainly failed and it was made very clear that -- sorry, am I on the wrong motion?

The Acting Chair: Yes, I was just thinking about that. Maybe in sequence it's the Liberal in regard to the case management. Would you want to move that, Mrs Sullivan?

Mrs Sullivan: I move that subsection 2(1) of the bill be amended by adding the following definition:

"`case management' includes,

"(a) the assessment of the needs of a person applying to receive community services and/or the evaluation and monitoring of the needs of persons receiving community services; and

"(b) the provision of community services directly to individuals and the coordinating of the provision of community services to the individual by health care professionals and other service providers."

The Acting Chair: You'll be speaking to that, Mrs Sullivan?

Mrs Sullivan: I'll be speaking on it as soon as I can find it. This amendment is one that came out of quite deep concerns through the entire hearing process with respect to how people are dealt with once they seek long-term care services.

It was very clear that in a scenario where we have an integrated and single-point access for either information about services available that a person would require with respect to the eligibility for services or with respect to the actual access to delivery of services, the professional services that were included in the bill related to nursing services, occupational therapy, physiotherapy, social work, speech-language pathology and dietetics, the very specialized nature of case management itself, which is involved in intake services, in assessment and coordination of service delivery, had been left out of the bill.

One of the things that we were concerned about and that people who appeared before the committee were concerned about was that without case management being recognized ultimately as a professional service, then indeed the person could be left without linkages into the system, without actual emphasis on coordination of services in an appropriate way, without full assurance that not only the social needs but also the clinical needs of the individual were met through an appropriate assessment and coordination of those services.

In consequence, in the bill we will be including, under subsection 2(7), case management as a professional service. The definition that we have included here of "case management" is the definition, slightly adapted, which is being used for case management in mental health reform. The work of the case manager in either this circumstance or in the mental health scenario is comparable. Indeed, the case management association put forward words that are also included in and reflected in this definition, and we feel that it pretty much sums up the role of a case manager.

The other issue that came very much to the fore was the concern about the risk intervention/crisis intervention situation. We heard some horrific tales. Frankly, after some of the tales that we heard I got some autopsy reports and looked at what the situation had been in those circumstances. They probably or possibly could have been avoided with the intervention of a case manager who would have been able to maintain ongoing contact with the individual about whom there was concern, rather than having a person here, a person there and so on.

We feel that this is an important amendment, that the recognition of case management is quite key to the assurance that people who are seeking care and services and information will be able to find them through an MSA in a logical way and with the expertise provided through a case management system.

I'm urging the government to accept this new definition of "case management," understanding that in 2(7) we're asking that case management also be included as a professional service.


Mr Wessenger: We have a problem with this amendment for two reasons. The first reason is that we don't believe the definition is accurate in that the provision of community services directly to individuals is, in our opinion, not part of case management services. So that's a problem with respect to how it's defined.

The second concern is that certain adults, particularly those with physical disabilities, take exception to the use of the term "case management," and we in effect have included all the functions of case management under section 20, and we feel that is adequate.

The reason of course for defining "case management" would be if you're going to refer to case management in later provisions of the act, as Ms Sullivan said, if you're going to list it as a professional service, and we don't think it should be listed as a professional service.

Mrs Sullivan: If I could respond to that, indeed the definition is accurate in that a case manager may ordinarily be a social worker or a nurse who, as part of the services that they would provide, may well do either the social work or the nursing services. To exclude that direct provision by a case manager is an incorrect definition of the work of a case manager.

I'm interested in the parliamentary assistant's concern with respect to some representatives of the disabled community who do not want case management. I believe that there is and ought to be provision that is accounted for, probably in Bill 101 and less so in this bill, that would enable the physically disabled to manage their own services in such a way that a case manager would not be required in every circumstance.

I also point out to you that nursing services would not be required in every long-term care situation; that occupational therapy services, physiotherapy services, social work services, speech-language pathology and dietetics would not be required in every circumstance for every client who comes to the MSA. Neither would case management or the full range of the work of a case manager necessarily be required for every individual who comes forward. None the less, just as that full range of services isn't required for everyone, those professional services are included in the bill. We believe that case management also ought to be included in the bill.

Mr Jim Wilson: I want to speak in support of this Liberal motion. Somewhat along the lines of Mr Wessenger's line of thought, I think it actually points to a need for a definition of "case management." Certainly we should be including the term "case management." There's also a PC motion for subsection 2(7) to include case management in that list of professional services. We think that's absolutely essential.

I think it would be very difficult to leave section 2, the entire section, without some mention of case management. Because there is some degree of diversity with respect to the definition of "case management," I think it's appropriate at this point that a clear -- and this is very well worded and clear -- definition of "case management" be included in the bill so that in subsection 2(7), hoping that you'll accept the PC and Liberal motions to include case management in the list of professional services, people know when reading the bill what exactly we mean by "case management."

I really didn't follow your first line of reasoning with respect to rejecting this idea. Perhaps you'd like to repeat it.

Mr Wessenger: The first aspect: Ms Sullivan said that case managers will in effect sometimes provide service, and I think that's a fair comment, that people who are presently in the role of case managers probably in the restructured MSA will in fact be providing services other than just case management. But if you look at the type of services, case management generally relates to assessing the needs of an individual, monitoring, evaluating, reassessing and deciding the appropriate mix of services that person should receive, in conjunction with working with individuals, obviously, and taking into account their wishes.

When you're defining services, you're confusing it by saying it includes provision of service, because that means that in effect case management includes everything under the whole act, because every service could be part of case management. I think that's too broad a definition, because that means anything from providing Meals on Wheels to providing occupational therapy. That's really my concern on the definition. I would think the definition was probably quite adequate if you took out the words "the provision of community services directly to individuals and." The rest of the definition probably is fairly accurate.

Mrs Sullivan: I'm prepared to make that amendment if the government's willing to accept the definition.

Mr Wessenger: I think the second position is we're advised that it hasn't been a policy to define it in the act or to refer to it in the act but to deal with it by setting out the function in section 20.

Mr Jim Wilson: That very aversion the ministry seems to have to case managers is outlined in the brief that was presented to this committee by the Ontario Home Care Case Managers' Association. I want to read from page 3 of that brief, where it says:

"Case management has been misunderstood and undervalued. The essential core functions, the skills, knowledge and experience of case managers continue to receive lipservice from the ministry. Ministry staff acknowledge the issue and assure case managers that the ministry acknowledges the vital service of this core element of the community delivery system, yet there remains a reluctance to identify case management in the legislation.

Key functions of case management are holistic assessment, service planning and coordination, resource management, reassessment, alternative planning for changing needs or discontinuation of service. These functions provided by present home care case managers ensure accountability and consistency, and reduced fragmentation and inappropriate service utilization."

I think that any parliamentary assistant to the Minister of Health would have a very difficult time wanting to continue with his argument that case management shouldn't be defined and indeed included in this bill when they're ready, able, willing and already helping you to achieve your goals in long-term care and should be very much part of the reform system. If you don't like the wording of the Liberal motion, Mrs Sullivan's already indicated that she's willing to show some degree of flexibility there. Do you have any other suggestions of why you don't like the wording, and we'll work with you on it.

Mr Wessenger: If I might just respond, I think the concern is often we have perceptions people have from the use of language. I think that's what we're dealing with here, a perception of the use of the phrase "case management."

As you know, we had a discussion at noon today with members of the first nations and language was very important to them with respect to how they were described in the bill. The same thing could be said for those people who are receiving services. It's the idea that people are receiving services. They don't want to think of themselves as a case or they don't want to think of themselves as being managed. That's the aspect that consumers find offensive, this idea that they are a case and they're going to be managed. It's a perception. They want to think that they're individuals participating in their own plan of service.

Mr Jim Wilson: This is a profession that has a title, whether you like it or not and whether those consumers who are making that argument like it or not. These people provide valuable services. They don't go around referring to their clients as cases, person to person. It would be much like our constituency cases. We've got them, but we call them by their names when we go to their homes and speak to them on the phone.

What you're doing here is simply recognizing a profession. You list other professions, like nursing and occupational therapy and physiotherapy, and to me it's important that case managers be recognized as a profession and be part of long-term care reform. And I don't think, because the name of their profession or their job title is case management, that they necessarily go into people's homes and call them cases in management.


Mr Wessenger: It is a question of perception, I agree with you, because the case managers are doing an excellent job of respecting people's wishes and getting them to be involved. But language sometimes has an impact, and it's the concern about the language rather than anything else that is the reason, respecting consumers' representations that they don't like to be thought of in that concept. That's the reason for rejecting the definition.

Mr Jim Wilson: A very interesting argument, not one I am particularly familiar with.

Mrs Sullivan: Or have contemplated or heard before.

Mr Jim Wilson: Yes. It may take me a moment to digest this one, because that would mean we should just have generic names for all professions, I suppose, in case somebody might get labelled something they don't want to be labelled.

I don't see it as a language issue, as you specify. I see it as the title of an existing profession that needs to be recognized in this round of reform or you're leaving in jeopardy their status and leaving in question, I think, how professional case managers are to be included in the MSA structure and in the services delivered by that structure. I see a real need for it in the act. I am open to hearing your language argument again, but I must admit at this point that I don't particularly understand it.

Mr O'Connor: I appreciate the opportunity to speak on this issue. It certainly is one we had some representation made to the committee on. I think the important thing here is that what we've tried to do through this entire process is recognize the involvement of consumers, the consumers' right to be involved in their own decision-making to ensure that they can in fact have some direct involvement in how their -- using generic words -- case might be managed. I don't think they see themselves as that, as Mr Wilson pointed out. But section 20 of the bill certainly does involve the consumer to the best degree possible in developing the plan that's referred to by the agency.

Case management as we know it today is something that's provided through the home care program and reflects that delivery model in not so much the same way that we see this evolution taking place, where the consumers have more control in the entire process. Section 20 of the bill certainly reflects everything that would be included in what would be called case management. I don't think adding the words "case management" in the fashion proposed by this Liberal motion adequately reflects the role the consumer is to play in this.

The reason all this change is happening is directly a result of the consultation that pointed to more consumer involvement. We've read articles in the paper about people who are being visited by nurses because they've been sent home, where they maybe prefer to have the homemaker who was there in the past.

Mrs Sullivan: With a case manager, that wouldn't have happened.

The Acting Chair: Let Mr O'Connor finish his comment.

Mr O'Connor: It's not to say that the individual is going to make a decision that will affect all the care they are going to get, but they're going to be involved in the process of developing their own plan of care. The important thing is that all the elements my colleagues are referring to in terms of case management are certainly well covered off in section 20 of the bill -- they're there in great detail -- and if they want to make suggestions, it may be more appropriate to deal with this issue in section 20. But the primary concern here is the fact that it's the consumer who wants to be involved in this process.

Mr Jackson: I suspect there are several reasons why the government is resisting some of these amendments, some of which emanate almost exclusively from the deputations that were before this committee for the last several months. One reason, a punitive sort of reason, is, "We don't want you to get credit for doing it." The second is that they probably don't want to do it because they don't believe in it, and a third reason is that they don't want to do it because they'll lose control. I suspect it's a combination of the last two, because this recommendation makes eminent sense.

Yesterday, we took most of the day to discuss how we were going to make this system more efficient, more powerful because we utilize the resources in a more effective way. There was one key phrase the government defeated yesterday that was put in both Ms Sullivan's and Mr Wilson's and my amendments, and that was the issue of coordination. That disturbed me, because I couldn't understand why the government was so scared of putting in the purpose section the word "coordination." Now, in our first opportunity to deal with something tangible about coordinating services, which is case management, we get the government running for cover.

One of the knocks put on this bill by several groups, especially some of the unions, who allegedly are good friends -- at least the last we checked they were still good friends -- with the government, was that it was deprofessionalizing this process, that it was utilizing an old collective bargaining trick: for the government to wrest management control by isolating and denying not the bargaining rights but some of the professional skills required to make the system work.

The analogy in my mind is with the teachers with specialist certificates. School boards try and say, "We want to hire any teacher we want." The teachers legitimately say: "We have a specialist certificate. We specialize in this. We've fought hard in collective bargaining." But the child who receives our services deserves the best teacher for that, who's qualified to do that job. When you're contract-stripping, you try and pull that away.

I think all that is being asked here is that we have a group of professional individuals who are integral to part of the process, which is to coordinate an individual's needs, which are both complex and multifaceted and change at different times during the course of their need for those services. If you understand anything about the aging population, you'll know that they change, that they're multifaceted and that they're complex. You can need certain supports in the home because you don't have access to chiropractic service, which then means you need someone else to do some other medical intervention in the home setting. All of them build on each other.

That's what case management is like, and that's why in Ontario, where we believe we have one of the best systems in North America, we achieve that, because we allow these professional groups, case managers -- and my colleague Mr Wilson has quoted extensively; there's no sense for me to re-read it into the report. But the Ontario Home Care Case Managers' Association, according to our researcher to this committee, has had extensive, broad-based support from all the various elements in the system.

If the government is determined to take this quality service away, we have the right to fight for that, because we believe it's that critical to the delivery of the service in an efficient manner.

I want to bring one section, if we're going to move forward to section 20 of the bill. I've listened carefully to what the government has had to say about the language. Mr Wessenger is a lawyer and therefore language has become the key issue for him, that he would like to argue its variances. Perhaps Mr O'Connor, with his background in collective bargaining, is starting to see the light about the concerns here that we are somehow deprofessionalizing and making less effective the system of long-term care reform as it relates to this motion, with case management being embodied as a service, with expectations, as a defined role within the act.

I'll tell you, I don't trust any government to implement what's in the best interests of people if it's not in legislation. The single most important defence a citizen has is to take the law which we're passing and say, "Our services could be better developed in an MSA if we had case managers, if we could hire case managers, and if this government of Ontario would fund our MSAs so we can afford these good-quality professionals to do this service."


If you go to section 20 of the bill, it talks about how a citizen who is receiving services participates in the revisions to their plan. You can't have somebody who has limited experience with seniors or senior support services. You can't have someone who was maybe working as a lab technician at a local hospital but because they got laid off, according to this government's approach, got hired first to work in the MSA, and now this person's in charge of doing assessments and case management reviews. We can't do this hit and miss. I'm going to remind the members of the government that the way you're transferring people, with the last-fired, first-hired approach we're going to take to the conversion of many of these agencies, you're going to have a lot of unqualified people doing certain kinds of work.

There is protection in clause 20(2)(a) of the bill, which says this shall be done with an agency, arranged by an approved agency to review any given plan, that those services should be fully developed by a competent person and that that person should work closely with the person who needs the services and wants their plan revised. We're saying that the way it's written, the government can put anybody it wants in that position, and we don't think that's good enough.

This is not a language issue, it's a collective bargaining issue, quite frankly, from where I sit, because they don't want in this collective agreement the rules that will govern an MSA. They want to be able to say, "We don't want case managers." They may be a little bit more expensive, but the truth is, we'd rather have somebody who's been doing home care to now coordinate all these complicated, complex medical interventions and, as I say, the multifaceted multiplicity of services required by an individual when they want to revise their plan.

If you're not going to approach this from this point of view -- and I seriously doubt your regulations are going to cover it, because if your regulations are going to cover it, you've got nothing to fear from putting it in the language of the bill. It would be misleading in the extreme to say, "Don't worry, we'll put it in the regs." Clearly, you want nothing to do with professional case managers assisting the MSAs across this province, and I think that's wrong.

Mrs O'Neill: I really did think this was one of the amendments the government would consider positively, as I listened to the government members when the case managers across this province came before us as we conducted our hearings. I'm just incredulous about what the parliamentary assistant has said. I have never heard a weaker reason for not doing something than feeding into misunderstanding, and that's what this is.

I have explained to this committee before that I've had very personal experience in this area within the last two years. My father did not know anything about case management but he certainly benefited from the experience of a case manager. I will tell this government that it also likely saved you a lot of money in his care, simply because he had somebody who took an interest, who treated him as a whole person and who got the services he needed when he needed them and discontinued them when he didn't need them. He was treated with the greatest of respect and there was nothing about "managing" him. If anything, he had a fuller and better quality of life because he had a better case manager.

The case managers of this province obviously are now going to be wiped out, and I'd like to know from Mr Wessenger -- and you may laugh, you may laugh, but that's what they think.

Mr Wessenger: Well, if you'd make sensible statements, Ms O'Neill --

Mrs O'Neill: I want to know where they fit into the bill, I want to know how they're defined in the bill, and will there be a role for them in the MSA? Certainly now they don't. I've met with them in two cities in this province, in large numbers, and they don't feel they fit into Bill 173. If they do, maybe you can satisfy us all by telling us where.

Mr Wessenger: First of all, you should be aware that we have case managers now working in our system and case managers are not referred to anywhere in existing legislation -- no definition or description. The fact that we're moving to new legislation and not defining them, the same way, is not going to make any difference with respect to the role they play or the functions they fulfil, and there's certainly no indication that we will not have case managers continuing to do these as they are presently doing.

With respect to Mr Jackson's comment saying that MSAs will be forced to hire people who are not qualified, there's a provision right in the labour bill, subsection (5), that the successor employer is not required to offer positions to persons who are not qualified to perform the services required of them. Clearly, you're not going to have a lab technician doing the job of a case manager.

Mr Jackson: On a point of order, Mr Chairman: I did not say that. Mr Wessenger, I didn't say that. What I said was that if it's not in the bill, they won't be required to hire that level. That's an entirely different issue. If it's in the bill and they try not to hire them, they can't do it. It's a collective bargaining issue. If you're not mentioned in the bill, you don't have to hire that person. I'm sorry you missed my point. What you attributed to me is exactly the opposite to what I'm saying.

Mr Wessenger: There is a requirement in the bill under section 20 that an approved agency do all the functions of case management. What you don't do is define a class of employees as a case manager. That's true, you don't do that: You don't have case managers specifically referred to. But you do have the function clearly set out in section 20, and if an approved agency is going to perform that function, it clearly has to have people who have the qualifications of the present case managers in order to fulfil the function. The agency would be in breach of its obligations if it didn't have the people providing those services. But you don't have to define and list everybody's job description in legislation. I don't see that as necessary.

Mr Malkowski: I believe the motion is well intended. Obviously, it shows you're caring about the consumers, but I think it can be very patronizing in many ways. There are many disabled adults who feel that the idea of assessment is offensive. If you remember, in the SARC report the former minister of Comsoc recognized concerns that were raised by the disabled community about vocational rehab services. I believe the Liberal government raised the concern that people were talking about: how the VR councillor treated their clients. Many of the disabled clients identified a problem, and I think this is a very similar point being raised, that it can be very patronizing. When we deal with assessment and things, I think this kind of motion is not appropriate and that we need to respect the dignity of people with disabilities.

Section 20 clearly defines it without talking about assessment in a patronizing way, so I would support the comments of the PA for the Minister of Health. Perhaps people, if they're unclear on what I've been saying, can re-read the recommendations from SARC. I don't support this motion.


Mrs Sullivan: One of the things that's clear from the parliamentary assistant is that, in his view, because case management, while it exists now in certain circumstances in certain areas, isn't defined in any other legislation, therefore it isn't necessary to define it here. To my mind, that's a ludicrous statement.

We are saying that case management must and should be a mandatory service, that every multiservice agency should and must include case management as one of the services in the mandatory basket alongside other professional services such as nursing, occupational therapy etc.

The concern with respect to section 20 of this bill is that the functions that are listed here, while indeed they may be offered by a case manager in an integrated way, as they're laid out in section 20 are laid out in a linear fashion rather than an integrated fashion. The job of the case manager is to integrate, to coordinate, to ensure that evaluation and continuing monitoring is done alongside the patient, alongside the client, which is clearly included in the bill.

There is absolutely no question about there being any assault on the dignity of a client because a case manager is involved or because someone doesn't like their name. It happens to be the name of a profession. Some people might not like the name "doctor," I suppose.

Mr Jackson: "Politician."

Mrs Sullivan: Or "politician." That happens to be the name of the work they do. The work they do is to ensure the coordination of the services, working with the person to ensure that if there's any inclination or any suspicion that clinical requirements must be met, those clinical requirements are brought in only in the amount, at the right time, at the right place and in the right proportion to meet the needs of the individual. This is a person who works alongside the individual.

If you had been seriously considering the major complaint of people who were receiving services through the long-term care consultative process whenever it occurred, it was that one person was involved in this, one person was involved in that, no one knew where the case lay, no one knew what was in the records, the records were in different places.

The case manager is there to integrate those scenarios, to ensure that there is one person who works with the individual who's receiving the services, who follows that person, who ensures that the records are maintained, who ensures that the referrals are made and the follow-ups are done, that if there's any confusion, for instance, about the kind of drug that's being prescribed and how it ought to be taken, there's additional counselling associated with that. It's an integrative function. It is work. It's a professional piece of work.

If you look at section 20, indeed, many of the functions of the case manager are included in section 20. They're not presented in any way that would indicate that they have to be coordinated, that there has to be sensitivity to the needs of the client. Indeed, the coordination element is left out of this. That's the key role of the case manager. Your functions -- it's not there.

Mr O'Connor: Case management, the way you define it, is not there; that's why it should be part of the MSA. The MSA will pull together, for example, in Metro --

Mr Jim Wilson: Oh no.

Mrs Sullivan: Just a minute. You don't understand this whole issue. You do not understand this whole issue. This is a very important issue.


The Acting Chair: Order. Mrs Sullivan is on the floor.

Mrs Sullivan: It's very important. Section 20 does not define the role of a case manager. We believe very strongly that a case manager should be included as a professional service, that people will not have the appropriate services they have been asking for, and indeed demanding, for many, many years, since long-term care reform was first contemplated and the issues discussed.

This is one of the central questions and one of the central demands that consumers have been making. In my view, the government probably is leaving this particular issue out of the list because it doesn't want to pay for a service that it's intending to pretend that it's including but in fact isn't including. This is a money issue, and the government is saying, "We're not going to pay to give people the service that they want and that they've asked for."

Mr Jim Wilson: Very briefly, I just want to make it clear that the discussion on this side of the table has been quite accurate in terms of case management as a profession. It's also the name of the function that's carried out by professional case managers, social workers at times, nurses at times.

I remember visiting our VON in Simcoe county recently, the Collingwood branch, and meeting with the case managers. If one simply takes a half-hour with them, one is amazed at the amount of work they do and the amount of coordination they add to the system. As I said earlier, it's very difficult to understand in any way why you would want to shoot them out of the system now or, if that's not the intent, why there is such resistance from the government to wanting to include them, which is the attempt of this motion.

Secondly, with respect to Mr Malkowski's argument previously and yours, Mr Wessenger, about people's problem with the language, that they don't want to be treated as cases or managed as cases or whatever the argument was, I think in section 20 there are safeguards allowing and ensuring that a person has the absolute right to participate in their plan of service and the revision of the plan of service.

That's why that's all there, so that they can't be treated as cases by any of the professionals who are dealing with them and trying to provide services to them. In your own bill you've kind of inadvertently or purposely ensured those rights are in there, and we're supportive of those rights. Also in the bill of rights, if we ever get to it, there are provisions to ensure that people aren't treated as cases and as inanimate objects.

With that, I don't understand the government's resistance here. We are supportive of Ms Sullivan's motion, and I call the question, if I can do that after debating --

The Acting Chair: Before calling the question, Ms Carter hasn't spoken.

Mr Jim Wilson: Oh, then let her speak. Sorry.

Ms Carter: This is almost funny, it seems to me, because what you're doing on the other side of this debate is bringing forward the complaints that some presenters gave us, whether these complaints add up to a consistent picture or not. This morning we were hearing that the Red Cross either can't be integrated or doesn't want to be, and now we're being told that we're having insufficient integration.

Maybe I should point out that a large reason why we're doing this in the first place, why we're setting up multiservice agencies, is to achieve integration so that case managers can work more effectively in an integrated system. Whether you have case managers or not, if you've got different little things all over the place --

Mrs Sullivan: They don't have to have them. They left them out.

Ms Carter: But in effect they're not left out; they are certainly subsumed in section 20, because the description there of what is to be done, "the agency shall...assess the person's requirements...determine the person's eligibility...for each person who is determined to be eligible, develop a plan of service that sets out the amount of each service to be provided to the person," all this is obviously what a case manager does. So I can't quite see why we need to specify that a case manager does what is in fact case management.

Case managers, as has been said, exist now. They will continue to exist, only they will exist in a much more congenial situation for them, where they have much more ability to put together a unique plan for an individual with that individual's participation and consent. How can you at once argue that we should keep the divisions, the hard walls between the different agencies with their very clearly defined functions, and at the same time we should be getting those walls down and integrating? You can't have it both ways, and what we are doing here is integrating.

Finally, you can't spell everything out in the legislation because the more you try to do that, the more you list things and define things, the more you're going to leave something out. I don't think there is any doubt whatsoever that the case management function is very clearly part of what we're doing in this act.


Mrs O'Neill: I have to respond, if I may, to the parliamentary assistant's response to me and I have to ask him the question again, because he said "if," and I've read section 20 now. I see the words "assess," "determine eligibility," "review," "revise." There is nothing either in that or in the list of services that talks anything about coordination.

We were told yesterday and we've been told from the beginning that the purpose of the act is holistic; it's to treat the person with respect and dignity. How can you do that when we know that no matter what this government says about funding for multiservice agencies, there's not going to be unlimited funding?

These particular professions that are named in the act will no doubt be fulfilled because they will have to be; they're mandated. Any intent to integrate the services of the various professions is not in this act; it is only in words of the act. There is no directive here that will give an MSA any motivation to do what we're saying.

I'd like Mr Wessenger to tell us what he means by, "It's guaranteed in the act" or "Things won't change," because this morning I listened to lecture after lecture about how difficult the change is going to be but it's going to happen and people are going to have to get used to it. We don't see integration or those who do the integration now as part of this act, nor do they see themselves. The word "if" certainly scares me. Maybe again I will give Mr Wessenger the opportunity to tell me how they are going to fit into this system.

The Acting Chair: Mr Wessenger, do you have some comforting words for Mrs O'Neill?

Mr Wessenger: Certainly I understand the whole intention is to incorporate the existing case managers in the system, and they will continue to play the same role they're doing now, with the exception that I think there probably will be some other functions they'll be performing in addition. I would suggest probably that will evolve --


Mrs O'Neill: I would really like to hear this answer.

The Acting Chair: Order.

Mr Wessenger: That will probably evolve because of the fact that if you have an MSA, you have the case managers working for the same agency as your nursing services and your homemakers etc, there are obviously going to be some management functions and supervisory functions that will probably be, and this is just a --

Mrs O'Neill: This is Paul's opinion.

Mr Wessenger: This is looking at it as how things are likely to evolve, I would say. It will also be the individual agency that's going to determine what functions --

Mrs O'Neill: I'm sure that will be of interest to the case managers.

Mr Wessenger: If there are additional functions that case managers play, it will be certainly determined by that agency and by the board of that agency as to how it functions.

Mrs O'Neill: I hope the boards --

Mr Wessenger: I'm just saying that if I was sitting on a board of an MSA, I would certainly look at some restructured roles with respect to some of the people who are moving into that board. If I was in that position, I would be looking at this.

Mrs O'Neill: I just hope the DHCs and the MSAs will include case managers in their plans.

Mr Jim Wilson: Point of order here.

The Acting Chair: You had a point of order?

Mr Jim Wilson: The point of order is pertinent to the order. We're only on section 2 of the bill and we don't have a heck of a lot of time left. It's clear the government isn't going to vote in favour of this amendment, so let's get on with it.

The Acting Chair: That's not a point of order.

Mrs Sullivan: Just in conclusion before we vote, I want to say that, first of all, one of the key elements of long-term care reform is that it's multidisciplinary and that it integrates and brings together social services and health care services. The fact that there is inconsistency now across the province in the existence of case managers is a signal that there will continue to be inconsistency in the availability of case management when new MSAs are put together.

If there is no mandatory provision, I will guarantee you that in some parts of the province people will be better served because they will have a case management system than they will be in other parts of the province, and you can bet it'll be people in the north and the east and in rural areas who get the short end of the stick once again.

I suggest that we vote on this section.

Mr Wessenger: I'd just like to make a comment that we do listen occasionally to good suggestions, and certainly we're going to look at the suggestion about section 20, about seeing if we can do something about adding the word "coordination" into that section. I thought I would acknowledge that.

The Acting Chair: It seems to me there is no further discussion on this motion. Maybe I'll just call the vote now.

All in favour of the Liberal motion on subsection 2(1)?

Mr Jim Wilson: Recorded vote.

The Acting Chair: I hear they're asking for a recorded vote.


Eddy, Jackson, O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Acting Chair: All against?


Carter, Malkowski, Martin, O'Connor, Rizzo, Wessenger.

The Acting Chair: It's been lost.

We move to the next motion. I presume this one is the PC motion now.

Mr Jim Wilson: Which one would you like this time, Mr Chairman? Because I don't have any particular order of all my 2(1) motions.

The Acting Chair: Well, I hope that all the amendments coming in will be in sequence now anyhow. I'm at subsection 2(1) again, a PC motion.

Mr Jim Wilson: Okay, the one I have deals with federated --

The Acting Chair: Oh, I'm sorry, this is the government motion.

Mr Jim Wilson: This is our second false start, Mr Chairman.

Mr Wessenger: I move that the definition of "director" in subsection 2(1) of the bill be struck out.

The reason this is being done is that there was a lot of confusion created in presenters who thought we were going to be appointing directors of multiservice agencies. Of course that wasn't the way the bill read, but we're going to get rid of it just to avoid any of that confusion.

Mrs Sullivan: How is the minister going to appoint directors?

Mr Wessenger: I think they're going to be program -- no. I don't know. I may need the assistance of legal counsel to indicate how we're going to deal with that.

Ms Czukar: The minister has the power, of course, to appoint any of her employees as directors or program supervisors. That's an inherent power that she has. It was only with respect to the appointment of persons who are not employees of the ministry that it was needed in the bill, but there was no function assigned to directors appointed who were not employees. That was the reason we took it out.

Mr O'Connor: There was some confusion when we went through the hearing process. People felt that the appointment of director actually meant the director on the MSA itself, so like a board member. That's where that confusion came from as we went through the committee hearing process. It was never that intention at all. In a matter of trying to clarify it, that's why this section is being struck out, as has been pointed out by the parliamentary assistant.

Mr Jim Wilson: Just let me get this straight and tell me if I'm right or wrong. You're basically ditching section 4, because there's no need for it apparently, but in 51.1 -- and I can't find my 51.1 -- what does it do? It just gives regulatory authority? No, tell me what 51.1 does, the new one.

Ms Czukar: Section 51.1 gives the minister the power to appoint a person as a program supervisor because specific powers of program supervisors are set out in the act with respect to inspections and so on. The power under 51.1 includes the power to appoint persons other than employees; it could include an outsider. The reason that's there is to allow the minister to appoint someone independent to do an investigation in a particular case where they would need those kinds of inspection powers or that sort of thing.

I might just clarify that the reason that "director" was taken out also is that you would need it in the act, as we do for "program supervisor," only if you were going to assign specific powers or functions that couldn't otherwise be delegated by the minister.


Mr Jim Wilson: I was enthusiastic when I thought you were eliminating directors and program supervisors because we're always worried about the cost of administering these acts and enforcing them. Perhaps I could ask Mr Quirt: Program supervisors I assume are existing employees who will be given these new titles and powers under the act. You're not going to hire a whole army of bureaucrats.

Mr Geoff Quirt: That's correct. They're existing employees in our 14 area offices of the long-term care division.

The Acting Chair: We'll now commence the list. I presume that they have seen them in order to have a discussion. Maybe we'll just call the motion, then. All in favour of the government motion? Against? Carried.

The Vice-Chair: The next motion is a PC motion to subsection 2(1).

Mr Jim Wilson: I move that subsection 2(1) of the bill be amended by adding the following definition:

"`federated multiservice board' means a board established under section 11."

For reasons stated yesterday and earlier today, we're still pursuing our federated multiservice board, which would allow the maximum degree of flexibility at the local level and retain the current service provider agencies and allow them to get together in a cooperative partnership model to coordinate services without having to destroy those agencies, tear them down, as this bill does, and amalgamating them into a multiservice agency or monopolistic structure. We just don't agree with that aspect of this bill and therefore are attempting to change the makeup of the MSA through this amendment and others.

The Vice-Chair: Speakers? All in favour of the PC motion to amend? Opposed? The motion is lost.

PC motion subsection 2(1).

Mr Jim Wilson: This would have been a motion subsequent to the previous motion, but since it was defeated, I won't be introducing this motion.

Mr Wessenger: I think we'd better clarify: Is this the multiservice one re the definition of multiservice --

The Vice-Chair: We did the PC 2(1) which was "federated." Is that correct?

Mr Wessenger: Yes. That was defeated. Which one are you withdrawing, Jim?

Mr Jim Wilson: I'm withdrawing the one that would have struck out the definition of "multiservice agency."

Mr Wessenger: Okay, good.

Mr Jim Wilson: Obviously, we're going to have to keep it in there now that we didn't replace it with a federated board.

Mr Wessenger: Right.

Mr Jim Wilson: Against my better judgement, I might say.

The Vice-Chair: The next motion is a Liberal motion regarding subsection 2(1).

Mrs Sullivan: I move that subsection 2(1) of the bill be amended by adding the following definition:

"`long-term care facility' means a nursing home under the Nursing Homes Act, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act."

Once again, to ensure that we do have a seamless system of long-term care, a continuum, it's important that long-term care facilities be recognized in this bill, and they certainly are mentioned. This definition is identical to that which is included in Bill 101.

The Vice-Chair: Any speakers? Ready for the motion? Those in favour of the Liberal motion regarding subsection 2(1) of the bill? Am I too quick?

Mr Alvin Curling (Scarborough North): You've called the vote already?

The Vice-Chair: Recorded vote?

Mr Curling: No, did you call the vote?

The Vice-Chair: Yes, I'm calling it now.

Mr Curling: Rather speedy, Mr Chairman. Okay. Go for it.

The Vice-Chair: Thank you. Those in favour? Opposed? The motion is lost.

PC motion, 2(1), "multiservice agency" --

Mr Wessenger: That's been withdrawn.

The Vice-Chair: Government motion 2(1), "personal record."

Mr Wessenger: I move that clause (c) of the definition of "personal record" in subsection 2(1) of the bill be struck out and the following substituted:

"(c) is in the custody or under the control of the service provider."

This amendment clarifies the definition of "personal record" to include records which may be in the custody of a service provider as well as those under its control, because there may be some documents that are in the custody that would not be deemed by the holder under their control because of perhaps the nature in which the document was released to the person having custody.

The Vice-Chair: If no one wishes to speak to the --

Mr Curling: I just wanted to say to Mr Wessenger that the cooperation of the opposition to some of the government motions is just so cooperative, that other word, and I hope that on some of the motions put forward by the Liberals we get the same cooperation by the government. Those are my comments.

Mrs Sullivan: Not so far.

Mr Curling: Not so far.

Mr Wessenger: A few.

Mr Curling: Oh, we got a few, sometimes inadvertently.

The Vice-Chair: No further speakers? I'll put the motion. All in favour of the government --

Mr Jim Wilson: Just a quick question, which I thought Mr Wessenger might have included in his explanatory remarks. Just for the record, this is consistent with other legislation, and was this just an oversight first time around?

Mr Wessenger: Counsel has got a more legalistic aspect.

Ms Czukar: In fact, this amendment was requested by the people from Management Board who administer the freedom of information legislation. They suggested this in order to be consistent with the definition in other legislation. Also, in subsection 2(2) where we define "personal record," it's clear that it includes assessments and information that might come from others so that it is within the custody of the record holder, and again it's to make it clear that anything that's within the custody or under the control is included.

The Vice-Chair: All in favour of the government motion? Carried.

Government motion, 2(1), "program supervisor."

Mr Wessenger: I move that the definition of "program supervisor" in subsection 2(1) of the bill be amended by striking out "subsection 4(2)" in the second and third lines and substituting "section 51.1."

This relates to the later amendment providing for the program supervisors being appointed under section 51.1.

The Vice-Chair: No one wishes to speak to the motion? We'll put the motion. Those in favour of --

Mrs Sullivan: I have a question here. Subsection 51(1) is with respect to the Public Vehicles Act.

Mr Wessenger: It's 51.1. It's a new one.

Mrs Sullivan: Okay, I'm sorry. I apologize.

Mr Wessenger: It's a new provision.

Mrs Sullivan: But we haven't passed that one yet, so can we pass this one until the other one is passed? The 51.1 hasn't been presented as an amendment yet.

Mr Wessenger: I suppose, though, we have already -- I shouldn't say that -- probably passed some definitions that we would --

Interjection: No.

Mr Wessenger: No, we haven't. Okay, so it should be stood down, then, technically.

Mrs Sullivan: We can't take the vote until later.

Mr Curling: Is just another way of convenience, striking it out and then we'll read 51.1, and then we ask --

Mr Wessenger: We can do this at the same time as we -- after we do 51.

Mr Curling: Okay.

The Vice-Chair: The motion is stood down.

Government motion 2(2).


Mr Wessenger: I move that subsection 2(2) of the bill be amended by adding "in the custody or" before "under" in the sixth line.

This again relates to the "personal record" definition, and I think probably the same explanation that was given by legal counsel would apply here.

The Vice-Chair: Discussion? All in favour of the government motion? Opposed? Carried.

Liberal motion re paragraph 3 of subsection 2(4).

Mrs Sullivan: I move that paragraph 3 of subsection 2(4) of the bill be struck out and the following substituted:

"Care giver support services, including respite care."

I may withdraw this because I think that the government has fixed the respite care and we've passed that one already, haven't we? I thought we had.

Mr Wessenger: It's going to come up again in subsection 12(1.1). That's to add a requirement to provide services for the purposes of palliative and respite care. It was felt that was the appropriate place it should be dealt with.

Mrs Sullivan: All right. I will withdraw this because I believe that it's covered in government amendments.

The Vice-Chair: Liberal motion withdrawn.

Next is PC motion paragraph 3 of subsection 2(4).

Mr Jim Wilson: For the reasoning just stated by Mrs Sullivan, we'll also withdraw this amendment.

The Vice-Chair: Withdrawn.

PC motion regarding subsection 2(7) of the bill.

Mr Jim Wilson: I move that subsection 2(7) of the bill be struck out and the following substituted:

"Professional services

"(7) For the purpose of this act, the following are professional services:

"1. Case management and nursing services.

"2. Medical services.

"3. Psychological, psychiatric and counselling services.

"4. Occupational therapy services.

"5. Physiotherapy services.

"6. Social work services.

"7. Speech-language pathology services.

"8. Dietetics services.

"9. Training a person to provide any of the services referred to in paragraphs 1 to 8.

"10. Providing prescribed equipment, supplies or other goods.

"11. Services prescribed as professional services."

It's an attempt to repair, I think, the government's bill in terms of ensuring that a whole range of professional services are included.

Again, we have case management, which I think we've debated at length already this afternoon.

We felt it important to include medical services in the list of professional services because a few physicians appeared before our committee -- and the Ontario Medical Association, as well as individual physicians, family physicians, those who deal with the frail elderly -- indicating that they weren't sure how they fit into this act and felt that it was, in fact, sort of an anti-doctor act to leave them out of the reform of long-term care, because there's no mention of the medical profession. So, in a general term, it was suggested by our advisers that "medical services" was perhaps appropriate.

"Psychological, psychiatric and counselling services": again back to the arguments we were making yesterday about the fact that mental health seems to be left out of this stage of reform. The people who are involved in the discussions surrounding mental health reform in this province, I can tell you, ladies and gentlemen, are extremely frustrated. They feel they're spinning their wheels out there and not seeing any action, and this is an attempt to ensure that those professional services, anyway, are included in this act.

Since our previous amendments that dealt with trying to include mental health in this phase of long-term care reform and ensuring that multiservice agencies had some responsibility, and district health councils some responsibility, for planning in this stage of long-term care reform for mental health services, and also our previous amendments to deal with those discharged as a result of the closures of psychiatric beds that are currently occurring once again in this province, we tried to ensure that the MSAs would have some legal responsibility for the care and maintenance of those individuals. That failed.

Also, occupational therapy was in the bill. Social work services were in the bill originally. Just bear with me. Essentially, those are the new additions that I've highlighted, and I think some of the debate has preceded the introduction of this amendment and I need not repeat it at this time.

Mr Wessenger: We won't be supporting this amendment for various reasons. We've already had discussion on the case management aspect, but aside from that I think there's a problem combining case management and nursing services together. It suggests that only a nurse could provide case management services; there are many other professions that do so. It should be noted that these are mandatory services to provide, not optional. The other thing is that I think we'd be moving a little too fast for even the opposition critics to integrate the whole medical system into the long-term care system. So that's the major one.

Mr Jackson: I think that's an unfair, throwaway statement rather glibly put by the parliamentary assistant. He was present when we did the health professions review act. What we're basically saying is that this legislation is far too silent on key and critical professional services which senior citizens have grown accustomed to using in this province. So for him to just glibly use an expression that we don't have time for the opposition members to integrate all these professions, if that's a valid statement, then I suspect that on behalf of all senior citizens we have every right to be fighting to make sure that you don't throw them out of the legislation. So, frankly, that's the reason for this.

This was referred to early in the process. We made indications that this section was wanting for further clarification of certain key, critical professional services, and several have been mentioned by my colleague. The one that concerns me extensively as well is the chiropractic services. The way you've written this, the minister gets to pick and choose which professions at his or her pleasure, and it does not protect certain services which are currently received by seniors in this province. So I take exception to the throwaway phrase by the parliamentary assistant.

Mr Wessenger: I think the point is missed that services will continue to be provided but they aren't to be required, mandated, to be provided through an MSA. It may be in some instances you'll have the development of comprehensive health organizations which will be providing more of the range of services, but to mandate that every long-term care MSA develop into a comprehensive health organization would make the goal of a long-term care delivery system impossible to effect.

If you look at what's being added here, these are mandatory services, not the question of options. There's obviously the case that an individual MSA can decide if it wishes to provide some level of, for instance, psychological services as an option. If they want to request of the minister to do that, that would certainly be optional, but what we're providing here is a mandatory basket of services to be provided.

Mr Jim Wilson: They're mandatory when we deal with the clause that says they're mandatory, which we haven't got to yet. I thought of that, and therefore when we get to mandatory services I agree that integrating the whole medical system -- and I think you put that very well; the long-term care system is a difficult one. But given that your minister, Ruth Grier, has a real, I think, favouritism for community health centres in this province and that sort of model, where physicians are very much part of and are on the staff of and are paid for under a different model than the fee-for-service model, I wanted to make sure the physicians, if a multiservice agency in some areas of the province -- I'm taking you on your word there will be some flexibility left out there for local communities -- if CHCs or community health organizations are the local MSA, I just want to make sure physicians aren't thrown out of the mix. How do you provide for that?


I can actually see in our part of the province there are some communities, as you know, that want CHCs. Wasaga Beach is one, for example. At some point they're going to have to be part of the mix. At some point I think the issue of physicians in the fee-for-service model in this province will be negotiated with government again, probably in the next few years. It does come up periodically. I was really concerned when physicians said: "How do we fit into this? How come we're not mentioned at all in this legislation in terms of professional services?"

Mr Wessenger: I think with the amendments that were made in the purpose clauses the other day, it's a clear indication of an obligation on the MSA to coordinate and to cooperate with respect to other health providers, and other health providers of course include other health professionals. So certainly the basis is there for that type of referral and cooperation and coordination.

Mr Jim Wilson: What about psychological, psychiatric and counselling services? We're not saying in this section that these people have to be hired on staff permanently with the MSA. This is a section listing professional services that are available as part of the basket of community services. They may be contracted by the MSA, which I assume could happen for physicians. It certainly happens for psychologists and psychiatrists and counsellors. Why can't we list them here in terms of making sure?

Again, going back to our discussion about physical and mental health, we seem to always be leaving out mental health in long-term care reform. Why aren't we listing them? For goodness' sake, we list occupational therapy and nursing and physiotherapy. They're as important as psychological and psychiatric and counselling services.

Mr Wessenger: With the exception of services prescribed as professional services, I think everything else that is listed will be mandated to be provided through the multiservice agency. Since that's the scheme of the act, the specific services mentioned presently in this section are those that are required to be provided through the MSA. It would change the scheme of the act to list those professions that are not mandated.

Mr Jim Wilson: No, that's not right. Paragraph 12(1)4 says, "The professional services referred to in paragraphs 1 to 8 of subsection 2(7)" are the mandatory services. Well, Mr Wessenger, there's no reason why we can't change those couple of little digits in section 12 to rejig, if you want to put a lower pecking order in terms of mandatory services. I don't see the harm in listing them here in 2(7) and then later in 12, saying "but they're not necessarily part of the mandatory services."

I don't think I heard physicians come forward and say, "We want to be necessarily a mandatory service." They said, "We just want mention in the bill so that we know the government's at least still thinking of us out there with respect to long-term care reform."

My preference by the way, though, would be that psychological, psychiatric and counselling services be included in section 12 as the mandatory services. It's a two-part thing. Right now it's, "Let's list services that we want MSAs to be providing, both mandatorily and otherwise trying to provide to communities," and "Section 12 nail down exactly those that must be provided before the agency can become an MSA or that they must be ready to provide in order to be an MSA."

Mr Wessenger: The whole intention of specifically listing was to relate to the mandatory provision. You know, if one starts to list every health profession in the schedule, it becomes somewhat meaningless. If you're going to mention one health profession, you ought to really mention them all, every one of them, and then you'd have a list that didn't make sense, and for no particular purpose other than perhaps it would confuse, because really what we're looking at is, what is the obligation of the MSA to provide? Item 9, "services prescribed as professional services," is really to permit an MSA the flexibility of providing some optional services, or us to add a mandatory service.

Mr Jim Wilson: I suppose, then, if you didn't want this argument to come up, you shouldn't have section 12. You should have just listed professional services that are mandatory in this section and then after that section put "services prescribed as professional services," which is the exception you leave out of paragraph 12(1)4.

What you've done here, of course -- and I understand what you've done, but what you've done with the groups, and it was clear when the witnesses were coming forward from some groups, is you've raised an expectation here, I think. When they don't see their profession listed, they feel they're left out, and I have to agree with them. You do feel left out. So I guess it's just a bit of a difference here with the way the act was done. There's probably some legal reason why it had to be done that way, but I'm not quite sure that would hold in this case, because you could have done this whole section a little differently.

But I'm still quite concerned. Could you just specifically answer my concerns about mental health services here, counselling and psychological and psychiatric services, which I think should be mandatory services. They're as important as anything you've got listed here.

Mr Wessenger: Well, those services can be provided under referral.

The Vice-Chair: Mr O'Connor?

Mr O'Connor: Actually, this dialogue that has just taken place covered it off fairly well. I was just going to point out that my understanding in looking at this section of the legislation was that it was left with some flexibility for the community to define some services into the future that may be needed. If those needs are recognized, then the MSA itself will come forward with that as a recommendation and the MSA would then provide those services. But I think the dialogue that Mr Wessenger and Mr Wilson have had has actually cleared that up for me quite well.

Mr Jim Wilson: Could I just make one comment on that? I agree with what Mr O'Connor has said, except that communities don't have -- you did use the qualifier, I think, "with approval," and you're correct. I just want to stress that, because the minister has final say on what will be delivered by the MSA in terms of new mandatory services or new mandatory professional services delivered by the MSA or provided by the MSA.

Mr O'Connor: That are mandatory, right.

Mr Jim Wilson: So let's not leave the impression out there to people that communities that really need psychiatry services as part of the basket of services, or psychological services or counselling, can just decide for themselves. They're going to have to go back to Queen's Park and ask for permission to have those as mandatory services as part of their MSA.

My preference would be that we just deal with that now and have it a goal to strive for for MSAs in their development, rather than an add-on afterwards as an afterthought that, oh, mental health services are somehow important in this province. I think you should be putting them in now and you should be encouraging MSAs to include them in the basket of services now so that it's not an add-on down the road in some disjointed way that isn't dealt with by Parliament.

Mr Jackson: I want to underscore my colleague's comments, because the reason we put forward this amendment is because this is the one chance we have to help define the levels of service. Let's not delude ourselves with any other understanding than the fact that we are now determining what are your baseline services and expectations for this program.

I don't know what experiences you've all had, but I've certainly had some very terrible experiences with the deficiencies of mental health support services for my frail elderly and many of the geriatric and psychogeriatric cases that are in my community. If what we're saying now by not supporting this amendment is that they're outside of the basic basket of services -- don't forget, we're talking an envelope system. A certain amount of money is shipped out of Queen's Park and sent to a community and given to an MSA. The MSA looks at the legislation and says, "Here's what we are required to do and, if there's some money left over, here's what we'd like to do." The government might say, "You can provide additional service," or it could say, "If you can find the money, you can provide additional service."


In the cases that are the most difficult, right now the psychogeriatric cases that are coming to my attention, it's very brutal. I mean, we chemically straitjacket these individuals. We put them in restraints. If you've ever gone into a hospital and seen what's being done to these people, they're not getting the services they require. It's frightening that as the number of psychogeriatric beds are reduced in our hospitals -- I'll tell you what they're doing to them. It happened to my Scoutmaster and he died this way.

He was dumped off to a psychiatric facility and he was in with some of the most severe cases and the elderly. I couldn't go and visit him past one visit. It was so devastating to see the kinds of conditions that a senior gets put into because there aren't the kinds of support programs and the additional counselling and psychiatric support services available to caring family members in a home setting.

I can't help but think that this is the time we have now to make sure that we do a better job in that area instead of saying, "I know we haven't been doing a great job in the past, but these are tough times and we're not going to be able to do a better job." That's exactly what we're doing here. By eliminating from the mental health perspective alone, the implications for our seniors who require these services -- if you've ever experienced what they're going to end up getting in this province, you wouldn't do this to a pet, let alone to a family member.

I'm telling you that for us to fight for this amendment, we do it with some conviction based on some very terrible experiences that our caucus members have shared with us. To leave it as happenchance that the minister of the day will have sufficient sensitivity or can win enough arguments in cabinet to squeeze out enough money in my view is a huge disservice and flies in the face of every direct appeal we heard before this committee over the course of this summer's hearings.

The Vice-Chair: Thank you. We will now vote on the PC motion regarding subsection 2(7).

Mr Jackson: We'd like a recorded vote.

The Vice-Chair: All in favour?


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Malkowski, Martin, O'Connor, O'Neill (Ottawa-Rideau), Rizzo, Sullivan, Wessenger.

The Vice-Chair: Motion lost. You had an alternative motion, a PC motion, alternate 2.

Mr Jackson: I move that subsection 2(7) of the bill be struck out and the following substituted:

"Professional services

"(7) For the purpose of this act, the following are professional services:

"1. Health care services.

"2. Social work services.

"3. Providing prescribed equipment, supplies or other goods.

"4. Services prescribed as professional services.

"Health care services

"(8) For the purposes of subsection (7), `health care services' includes any service provided by a member of a health profession as defined in the Regulated Health Professions Act, 1991."

Mr Jim Wilson: Could I just comment, Mr Chairman?

The Vice-Chair: Did Mr Jackson wish to comment further?

Mr Jackson: I'll comment in a moment. Let my colleague start.

Mr Jim Wilson: I'd just like to lead the comment on this. I know Mr Jackson has a particular interest in this amendment, but it is a somewhat generally worded amendment as opposed to the previous PC amendment that was defeated for this section in terms of its trying to be all-encompassing without being exclusionary. I think it's an approach that should be welcomed by the government because, as I think Ms Carter or somebody said earlier -- I'm sorry if I've got the wrong person -- when you try and list everybody, you end up leaving some people out.

So this bill uses the language of the act, the government's own language, in terms of calling them health care services, social work services and then has the other language that's already in the section with respect to providing prescribed equipment and services prescribed as professional services.

It also makes sure, with the caveat on subsection 2(8), that health care services are those services that are provided by any and all of the 23, I think it is we have now, regulated health professions. That way you've included everyone, not excluded anyone and you can make an adjustment to section 12 with respect to mandatory services.

Now I know it changes the government's model a little bit, but it also, I think, prevents turf wars and fights and who can do what and it gives maximum flexibility to your MSAs to do what's right for their communities and to get the health professional, the social work professional and others, the best person to do the job, to provide the service, without tying their hands or handcuffing their hands, as I think the current wording in the legislation does.

This way they can go out and ensure that when it comes to professional services that have to be provided by that MSA, give them some time. They'll figure out those services and who's best to provide them for their area, and they can come back to government and say, "These are our mandatory services with respect to this section under `professional services.'"

I think it's a good task that could be given to MSAs as they're developing, and of course you're not going to give them full approval to become an MSA until you're satisfied anyway as a government that they're able to provide the services they have lined up and they're the proper services for that area. If you're trying to give them flexibility and you're trying to include all of our health care professions and the hidden agenda is not to leave out the physicians or somebody else that you're maybe having a hard time with from time to time, in your own eyes, then I think you should support this legislation.

I know Mr Jackson wants to talk about chiropractic services under this act.

Mr Jackson: As has been noted by my colleague, we're concerned that this bill as it's currently drafted and the direction the government chooses not to expand in its definitions will restrict health professionals and their services to very specific services and it will exclude far too many groups.

I guess what we envisage for our MSA model is something for which the vision is found in the Premier's Council on Health, Well-being and Social Justice, which talks about a wellness perspective and looking at efficiencies. When you specifically put chiropractic and other services on the outside of the circle, you deny MSAs the opportunity to examine, with their program delivery, some pretty important innovations.

The reason chiropractic comes to mind is because we've had certain reviews done in Ontario. The Manga study, which was a tripartite study on chiropractic services, showed that managing lower back pain for senior citizens in Ontario can be done more efficiently, more cost-effectively, with a greater degree of comfort and mobility for the average senior citizen than any other modality. For that reason, we would want an MSA to say, "Look, we think there's a series of our senior citizens who might need less home care if we can increase their mobility and their activation factors simply by giving them these additional and periodic chiropractic interventions."

According to the MSA model now, the MSA, with a large number of seniors trying to manage lower back pain, would have to say, "Well, you're immobilized, so now what we're going to have to do is we're going to have to bring in this support service to go help you get your groceries, we're going to have to bring in this support service to help you vacuum your home, we're going to have to get modified elevating devices and devices in your home because you can't manage lower back pain."


The evidence is overwhelming, yet knowing that, we're going to structure a bill which puts this option completely on the outside. Now, I can understand; it's typical of any government that wants to maintain control. For all that's being said about this sort of local autonomy -- yes, we're creating a local autonomy, but, let's face it, we're controlling outcomes at Queen's Park.

In my view, if you're still going to give them a finite number of dollars at any given MSA, the trick is to let them have legislation that will allow them the flexibility to utilize the services not only of chiropractic but optometry services, chiropody and other services that are all included in the large list of services which we don't feel -- we agree with the parliamentary assistant -- need to be enumerated. We know who they are. We're simply saying, don't put them on the outside of the legislation, at the whim or the mood of the Minister of Health of the day, but put them inside the legislation, as we have suggested in this recommendation. This recommendation, as a motion, was crafted with considerable support from organizations that see the delivery of health services in long-term care from a team approach, and they would like these professionals involved.

Quite frankly, it simplifies the legislation. It makes it more flexible for where we believe the real power and authority should rest with the long-term care, and that's at the local level with the MSA, and not to have a highly centralized Minister of Health determining and imposing certain of these restrictions on the local MSA.

No better example can be put about why we're putting forward this amendment than the one with respect to chiropractic services. The evidence is overwhelming that we can increase the independence of our seniors and reduce marginally the dependence on a whole range of services that come to bear on a senior citizen who has been debilitated by lower back pain and other complications which chiropractic can respond to in an effective, healing and progressive way.

I just appeal to the members not to reject this out of hand when the evidence is so clear and the nurses' professions have expressed interest in these kinds of relationships with these professions because of the results evidenced in the Manga report and others.

Mr Jim Wilson: Maybe members from the north haven't figured this out, but with the current model, if you have a shortage of occupational therapists or physiotherapists -- I don't even need the north. Let's try Alliston, Ontario, let's try Simcoe county, where we have a shortage of those two professions. How are we supposed to start up an MSA? To get a multiservice agency going, you have to provide those services in a mandatory fashion, according to this restrictive list.

Maybe it would be appropriate to have other professionals. In the north, for example, you've always been innovative with nurses in terms of the variety of things they've been asked to do that aren't necessarily strictly what we in the south would consider a normal nursing job.

Therefore, our amendment would give you that complete range of flexibility to get your MSA up and going and tell Queen's Park, for a change, who the professionals are and what mix of professionals are best to provide the services, in this section and in other sections, that are required. We're just trying to give some flexibility to the act.

For example, leaving chiropractic services out right now is not a good idea at all; therefore you shouldn't restrict yourself. You may actually be hurting consumers, or in some areas of the province you're going to be unable to get your MSAs up and going. I don't know how you're going to solve the OT and PT problem in my county, for example.

We've got two in Orillia hospital that I know of, none available for the homes, no money available for it right now. The Ministry of Community and Social Services took all those in-home services out, with respect to PT and OT.

I don't know where you pick those out of the sky that they should be mandatory. I'm particularly thinking of children's services. Community and Social Services has gotten rid of those professionals because there just isn't any money, and they're now all driving from Cookstown and Alliston up to Orillia. They're trying to come up with different models of service delivery, but one assumes at some point that's all going to be part of the MSA's responsibility.

I think you're missing an opportunity here to expand your vision and not restrict communities and allow them to look at the whole list of health professionals and allow them to provide the services. That's my last plea on this section.

Mr Wessenger: It was interesting to hear this discussion, because I think it does outline a philosophical difference with respect to how we see the services being provided by MSAs, aside from their structure. That is the fact that certainly from the government perspective we feel the necessity of providing a minimum level of basket of services across the province by all MSAs.

That's the purpose of the legislation, to provide that minimum level of basket of services and to provide the flexibility in what optional services may be offered by the MSA above that. I know that what the third party is indicating is that it wants a smaller basket of mandatory services and more flexibility. We feel it's necessary to have this minimum level of basket of services in order to provide a consistent minimum level throughout the whole province.

Mr Jim Wilson: I agreed with everything Mr Wessenger said in the latter part of his remarks, except that we have not argued for a smaller number of mandatory services. I don't recall arguing that. In fact, we're expanding it in this section by including all health care services.

Mr Jackson: You were knocking us 10 minutes ago for expanding it. Don't you understand what you're doing here?

Mr Jim Wilson: If anything, we're giving you a brand-new horizon to pick from here.

Mr Wessenger: I'm sorry I misunderstood you. I was interpreting it to mean, when you suggested that some areas might not have the resources, that they might prefer to use other health professionals in providing services. I thought that was the option you were advocating, but if you're advocating more services, I think that puts any government or the taxpayer in an impossible situation. If all health services are mandatory, all social work services are mandatory for everybody in the long-term care system, this system would take up a massive amount of the health budget.

Mr Jim Wilson: That's a very liberal interpretation of what I'm saying. Obviously, you can't have all health services. We're trying to say to let communities -- we have other amendments, which we probably won't even bother putting in now because they'll be redundant if this one gets defeated, but those would allow communities to decide what that mix can be. I don't know, in some communities where you don't have these mandatory professionals now, where are you going to pull them out of midair in order to get your MSA up and running?

Mr Wessenger: Mr Jackson said they should be mandatory. Are you saying all these things should be mandatory?

Mr Jim Wilson: He also talked about flexibility, as I did. Mandatory once the local communities tell you their mix of professionals now, what they can achieve in the next four years to get professionals they need. Rather than saying 1 to 10 are mandatory, of these services, be really daring and have a clause that says communities will determine the professional services that are mandatory. You're going to give them a certain amount of funding anyway, and there will be limitations there.

Mr Wessenger: Then my first interpretation was correct in the sense that --

Mr Jim Wilson: I agree we're dramatically changing your model.

Mr Wessenger: -- you're advocating a funding envelope approach but allowing each MSA to determine what should be in that basket of services --

Mr Jim Wilson: Essentially, that's it.

Mr Wessenger: -- which means you'd have varying services available throughout the province. Okay, I understand.


Mr Jim Wilson: I'm trying to help you get these MSAs started, because in some areas you may not have all these mandatory services. I'm assuming you've studied the province and you feel you can get MSAs with these services in every area. But in some areas I've travelled, I can tell you, there's a shortage of some of these services now, and therefore you may actually find yourself coming back and saying, "We need more flexibility in order to even get an MSA up and running, because the professional services we're supposed to be providing under legislation aren't quite available in that area yet." It may delay you getting an MSA up and running.

The Vice-Chair: Thank you. The PC motion re subsection 2(7) of the bill and adding (8) --

Mr Jim Wilson: Can I have a recorded vote.

The Vice-Chair: A recorded vote. All in favour of the motion?


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Malkowski, Martin, O'Connor, O'Neill (Ottawa-Rideau), Sullivan, Wessenger.

The Vice-Chair: The motion is lost.

A Liberal motion, paragraph 1 of subsection 2(7).

Mrs Sullivan: Mr Chairman, I'm not going to put that motion forward, as it's been defeated in a previous motion.

The Vice-Chair: Withdrawn.

Mrs Sullivan: I believe the next would be a motion that reads:

I move that paragraph 7 of subsection 2(7) of the bill be amended by adding "subject to any limitation contained in the Regulated Health Professions Act, 1991" at the end.

The reason for putting this motion forward is that we know that much of home care, particularly many of the services that would otherwise, probably in an institutional or facility setting, be handled by nurses and other professionals, is now going to be in the home setting, frequently provided by informal care givers, whether they're family members, neighbours or other individuals who will be carrying a large part of the direct care-giving services.

One of the things that's interesting is that in the mandatory basket of professional services, professional services include training to any individual so they would carry out those professional services such as nursing or occupational therapy or physiotherapy or social work or speech-language pathology or dietetics. Of those, all but social work services are regulated under the RHPA, and there are rules with respect to the way delegation can be done and training can be done etc under that act.

What we're concerned about is that those rules are followed, that there is an understanding that the RHPA provisions have precedence. We have deliberately used the words "subject to any limitation contained in the RHPA" because of course social work is not included in the RHPA and therefore, because there's no limitation in the RHPA, wouldn't be subject to that.

We certainly want to be certain that if there is training being done in nursing care it is done appropriate to the professional standards and according to the act under which it can be done, or in occupational therapy or in physiotherapy or in speech-language pathology. Once again, if you look at speech-language pathology, for the frail senior much of that work isn't associated with speech training, unless there's a stroke situation, but it may well be in terms of swallowing and so on where there can be training provided, but once again it should be done by the professional and according to the law and the regulations.

We're also, I suppose, putting forward in this a concern that the generic worker, improperly trained or trained not according to the regulations, may be highly problematic in the quality of care that's delivered to an individual who is receiving home care or care in an alternative setting.

I think this is an important amendment. It's a safeguard, and we recommend it to members of the committee. If the government is not going to support this, I think the government has to come forward with some explanation of why it would not support this.

The Vice-Chair: Any comment from the parliamentary assistant?

Mr Wessenger: The comment I would make is that I must admit I don't really understand what new effectiveness it would provide. I have difficulty understanding why it would add anything to the existing law, because at present services that are required to be provided by a regulated health professional have to be provided by a regulated health professional, and there's nothing in this act that changes that.

Mrs Sullivan: Yes, it does: "Training a person to provide any" --

Mr Wessenger: Maybe the mover would like to explain how adding it to 7 is going to add anything. I don't understand why it's added to 7, to be quite frank. Maybe the mover could explain how it is going to be effective.

Mrs Sullivan: The person who is being trained will be providing those services which a regulated health professional otherwise would provide. The training must be provided in accordance with the regulations and with the law of the RHPA, and it should be very clear under this act, because this act doesn't allow for that. This act says, "Train anybody to provide any of the professional services that are listed above." There's no limitation on that.

Mr Wessenger: If you train an unqualified person, just because they've received training wouldn't give them the right to provide the service.

Mrs Sullivan: You require them: "Training a person to provide" those services.

Mr Wessenger: But they couldn't provide the service unless they're a regulated health professional. That's why I have my difficulty.

Mrs Sullivan: Then why have you got 7 in in the first place?

Mr Wessenger: I don't know whether legal counsel could assist in that regard.

Ms Czukar: My understanding of why the training section is in that category is to allow assistants or others to whom those things can be delegated under the Regulated Health Professions Act, within the meaning of that statute, to be properly trained to do those delegated acts. It does allow for that to happen, and you don't need to say in this statute "subject to the Regulated Health Professions Act," because that would govern any of those acts that are going to be delegated by any health profession that's regulated under that act anyway.

Mr Jim Wilson: That certainly was my understanding also, that the RHPA is cast in stone and supersedes anything. This doesn't in any way take from or add to the RHPA in this regard.

I also thought it meant -- I might be stretching things a bit, but we heard a lot from nurses about the different type of nursing required in the community base, and that with MSAs there may have to be some adjustment with the type of nursing or the way they deliver nursing services in the community versus those that might be coming out of the institution. I thought this allowed that flexibility, to make sure MSAs brought those people up to training rather than displace those people.

But I do understand Mrs Sullivan's literal interpretation of 7. It does sound a bit scary unless you keep in mind that --

Mrs Sullivan: It is scary.

Mr Jim Wilson: -- as far as I can tell, there's nothing in here to threaten the RHPA. Therefore, I find myself in agreement with the parliamentary assistant on this amendment.


Mrs O'Neill: It's really quite passing strange, because the people of Ontario are going to have to interpret this act in all corners of the province. We have the ability at the moment to ask legal counsel her interpretation of 7. The interpretation she gave is exactly the amendment we want to place in. I cannot understand why we don't want to be as clear as possible in this act. Let's face it, the Regulated Health Professions Act is relatively new in this province. There are still people coming and trying to understand that act, let alone taking the rider here, "Well, everybody really knows that's what we mean." I think that's what I heard her say. So why can't we put it in, just to clarify that the training of the person, in all these acts, and there are a lot of procedures here that we're talking about, will be subject to the limitations, so that again fears will be allayed, people will know their position, know our intent?

The Vice-Chair: Anyone further? The mover is not present. We can't put the motion, can we?

Interjection: Yes, you can.

The Vice-Chair: Municipally you can't.

Mrs O'Neill: Stand this down until Mrs Sullivan comes back, if you like, for the vote.

The Vice-Chair: Can we do that? We can't proceed with another motion; that's the problem.

Mrs O'Neill: If we stand it down for the vote, can we not?

The Vice-Chair: Agreed that it be stood down?

Mrs O'Neill: For the vote until Mrs Sullivan returns.

The Vice-Chair: Thank you. The next motion is a PC motion re paragraphs 7.1, 7.2 and 7.3 of subsection 2(4).

Mr Jackson: We're here.

Hon Mr Wilson: I move that subsection 2(4) of the bill be amended by adding the following paragraphs:

"7.1 Services to prevent, identify and address elder abuse.

"7.2 Services for persons with dementia or with chronic psychotic illnesses, including the provision of supportive housing for such persons.

"7.3 Services for families and care givers of persons with dementia or with chronic psychotic illnesses."

By adding these services into the basket of services to be provided in this act, we are following on the recommendations of such groups as the Alzheimer society, various mental health agencies and associations that presented to this committee and spoke to us in meetings outside of this committee, particularly the mental health association, the Association of Ontario Physicians and Dentists in Public Service, the Ontario Advisory Council for Disability Issues -- I can't read my own writing -- which Mr Jackson may want to speak to. It's 7.1 that says, "Services to prevent, identify and address elder abuse," and I know he's had a great deal of experience with respect to elder abuse.

We think specifically that these services have to be included in the basket of services or they're going to be left out. The government's gone so far in this section as to be prescriptive with respect to other professional services that must be provided. We think they haven't gone far enough, and hence we're attempting once again here to add some more mandatory services.

I want to just quote for the committee in emphasizing the need for 7.2, which talks about services for persons with dementia. In the Alzheimer Ontario brief to this committee of August 1994, they write:

"A person with Alzheimer disease must depend on a care giver who can expect the individual to change personality, often becoming aggressive, to wander from home without warning and to lose all decision-making ability. In later stages, care must be given on a 24-hour-a-day basis.

"Family care givers must be prepared to provide eyes, ears, hands and minds for people they love who are irrevocably and steadily deteriorating; people who may not be able to speak coherently, to think, to recognize family members, themselves, other people, places or things; who cannot make judgements or control their own bodies.

"The impact of this exhausting responsibility on family members is magnified by the daily trauma of seeing a spouse, parent or relative become a needy stranger."

They go on to suggest that because of the toll it takes not only on the individual suffering with Alzheimer's but on the family and care givers, it simply must be a mandatory service and not left, in this case, to the whims of the local MSA.

I know that the government has attempted in other amendments to ensure that support services for care givers are there in terms of respite care. In this case we're asking that services for people with dementia and people with chronic psychotic illnesses actually be included, and we also draw in supportive housing. There are enough studies around this place to indicate that you must include that as a mandatory service for these people, and 7.3 of course deals with, again, the families and care givers in a mandatory way. Your other amendments that try to deal with care givers and families and respite care aren't mandatory. They're nice and flowery and wonderful and they're sort of rights and responsibilities, but they're not mandatory.

This is the section we're dealing with now, in 2(7), that to me deals with the actual teeth and the actual services that must be provided and funded by the government, although funding's questionable and we'll have some amendments to deal with guarantees on that at some point. But Mr Jackson may want to say something about elder abuse.

The Vice-Chair: Mr Parliamentary Assistant wished to comment, Mr Jackson.

Mr Wessenger: We will not be supporting this amendment because many of the services listed are covered elsewhere. If we start with 7.1, "Services to prevent, identify and address elder abuse," that was one of the basic purposes of the Advocacy Act. So that's how we see that being delivered in that area.

With respect to 7.2, it is true that the long-term care system does deal with some persons -- particularly it deals with people with Alzheimer's, but the aspect with respect to supportive housing, that's a separate program and not part of the long-term care funding. Well, it is part of long-term care funding, but it's not part of the multiservice agency funding.

With respect to 7.3, we already have under that clause care giver support services, and I would suggest that would cover the respite, with respect to care givers, of persons with dementia and chronic psychotic illnesses.

Mr Jackson: I'm perplexed in the extreme to hear the parliamentary assistant suggest that somehow we don't have to concern ourselves about elder abuse because there is an Advocacy Commission and a separate piece of legislation floating around in the bowels of this building somewhere.

Whether you think the Advocacy Commission's going to work or not, it shouldn't be an opinion from us politically. I want to advise the members of this committee that while we've been cloistered in this room today, the room adjacent to us was a press conference from not only the service providers but also the clients, the vulnerable in this province, who have been roundly condemning the Advocacy Act for its structure and its content and they have resolutely suggested that this piece of legislation is not the panacea the government has suggested it is.

I remind the parliamentary assistant that his government cut $52.5 million of front-line psychiatric services, which is why my Scoutmaster, Bill Orchard, was subjected to the dehumanizing experience that he went through until he died of Alzheimer's. Just to test this point, Parliamentary Assistant, I know you've been stonewalling the issues of psychiatric support services around chronic psychotic illnesses, dementia and so on. I'm going to ask that these three issues be separated for purposes of a vote.

I cannot in my imagination believe that your government and your Minister of Citizenship are going to sit by idly and watch you vote against the recommendation that we should even have the audacity to consider elder abuse programs and support services for seniors receiving extended care in the community.


I can't believe that you've been the parliamentary assistant to the Minister of Health for so many years now -- four years, is it? -- and it's escaped you how the elements of abuse are occurring when people are isolated. We have limited cases of institutional abuse because you've got eight people in the room and 12 different professionals popping in on you every day.

When people are isolated in their homes, that's where the growing cohort of elder abuse is occurring in this province. It isn't occurring in a hospital bed. They put chemical straitjackets on our seniors, they put physical restraints on them, there's that form of abuse, but there's a whole broader definition of abuse going on in the privacy of people's homes -- read "in their communities."

Look at what we offer in this legislation. I want to ask the parliamentary assistant to go to the next paragraph. He's suggesting that we don't need a reference to elder abuse in this bill, but if we go to the next section on homemaking services, my God, the government of Bob Rae makes sure that doing laundry and ironing is fixed in this legislation. That's how important ironing is. But elder abuse?

Your own minister has said it's a growing problem. The police have identified it as a priority in struggling with the social contract and reduced revenues to deal with this problem. Now you're going to put a whole series of additional professionals and non-professionals into people's homes, into the privacy of their homes, to provide services, and they're a government agency to boot, and you're going to say, "By the way, our government thinks that elder abuse programs will be covered by the Advocacy Commission."

Again, Parliamentary Assistant, you're also a lawyer. You would have read the Advocacy Act. You'd realize that once a case of elder abuse is identified, then you bring in the advocate. Then the advocate says, "You have the right to say no to this program." They already have the right to say no. We're talking about working with people where we've got suspected cases of abuse and building that into the program. I can't imagine you don't understand how elder abuse programs operate in this province, that you feel that threatened by this simple part of the amendment.

It's clear for financial reasons, you're stonewalling mental health services for seniors. That's clear. You've done it four or five times today. But this is the first time elder abuse has come up and we're still waiting for something concrete out of your government. Here we get one little example of a case where we can entrench it as something that a senior citizen can expect in their basket of services and you're saying, "We don't think it's necessary because we've got an Advocacy Commission down the street that may or may not be up and running in the next two and a half years."

Mr Chairman, I want to formally request that we divide this motion, and I hope you'll support that request, that we vote on paragraph 7.1, "Services to prevent, identify and address elder abuse," as a separate vote, and separate them. We can do 7.2 and 7.3 as one vote if that's more convenient. And I'm going to request a recorded vote.

I want to remind the members of the government, a lot's being said about, "Jane Leitch doesn't agree with you and she agrees with us." Well, I'm telling you, Jane Leitch and all the thousands of senior citizens in this province agree that this clause should be included, and you are going to turn your back on it. I'd like to call the question, Mr Chairman.

The Vice-Chair: Mrs O'Neill.

Mr Jackson: I called the question, Mr Chairman.

The Vice-Chair: Your first request to split the motion -- it's one motion, so we will deal with the motion in one vote.

Mr Jackson: That's your ruling?

The Vice-Chair: Yes. Mrs O'Neill, did you wish to speak?

Mrs O'Neill: We are going to be voting on the three sections together, is that what you've just ruled?

The Vice-Chair: Yes.

Mrs O'Neill: All right. I will then not need to speak at this point.

The Vice-Chair: Any other speakers? If not, the PC motion, paragraphs 7.1, 7.2 and 7.3 of subsection 2(4). A recorded vote you called for, I believe, is that correct? All in favour of the PC motion?


Jackson, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, O'Connor, O'Neill (Ottawa-Rideau), Martin, Rizzo, Sullivan, Wessenger.

The Vice-Chair: Motion lost.

Before proceeding with the next Liberal motion, could we return and call up for a vote Liberal motion re paragraph 2(7)7, which had been stood down previously. Those in favour of the Liberal motion at this time? Opposed? Motion lost.

Liberal motion, subsection 2(7) of the bill, adding 10.

Mrs Sullivan: I move that subsection 2(7) of the bill be amended by adding the following paragraph:

"10. Psychiatric, psychological or counselling services provided to persons with dementia or with chronic psychotic illnesses while the person is at the same time receiving community services."

This particular section is included because of the high prevalence of dual diagnoses, particularly in the elderly population although not limited to the elderly population, where one of the diagnoses may be a physical illness or impairment and another may be a mental or psychological or psychiatric impairment, where the need for services under the mandatory basket may well not be included or recognized.

We have been throughout these hearings, as you know, very concerned that mental health reform is occurring in one silo and that long-term care reform is occurring in another silo, and in a community service situation, in a scenario where an individual is outside of a facility or an institution where there are fairly routine mental health services, the assurance that those services will be available and will be provided to the individual is certainly lacking for long-term care services.

We felt, along with the extremely effective intervention from the doctors and dentists in public service and from organizations such as the Alzheimer Association, that the linkages had to be established, had to be obvious and, for those people who are receiving community services with dual diagnoses or even a single diagnosis, there had to be appropriate safeguards and assurances that these services would be in place and available through the same service centre that their other services are available from.


As I've indicated, in our view this issue is not limited to the elderly population. It does include young people, many of whom have undergone a traumatic scenario where perhaps a car accident or a devastating or catastrophic illness will require counselling and other mental health care to assist them. The middle-aged who are in a longer-term impairment situation may also need services such as this. What we're saying is that there should be an opportunity for a multidisciplinary, coordinated approach to that provision of services, that the MSA should be able to link the need or the identification of the need and ensure the availability of those services in an integrated, comprehensive way. We believe that this should be included in the mandatory basket.

The limiting factor in this amendment, as you know, is that the MSA would be responsible for the provision of those services to individuals who are at the same time receiving other community services which have been identified. In other words, this is not a total population situation. The MSA will not become responsible for the needs of the entire population but only for those who are receiving services through the long-term care service system.

Once again, I think that the information and the concern that was placed before the committee during the hearing process and throughout the process of mental health reform is compelling, and I urge you to accept this amendment.

Mr Jim Wilson: I just wonder what's going on here in terms of the commitment of the Liberal caucus to this amendment, because they've just voted against three different PC amendments that dealt with the whole continuum of health care services. I didn't hear any comments supporting even parts of our motions. They voted against the elder abuse provisions, the services for persons with dementia or chronic psychotic illnesses, services for families and care givers of persons with dementia and chronic psychotic illnesses and they voted against psychological, psychiatric and counselling services in our other amendment without even any verbal support.

Mrs Sullivan: On a point of order, Mr Chair: The member distorts the position that we have been taking throughout the entire public hearings --

Mr Jim Wilson: You can't have it both ways, Mrs Sullivan.

Mrs Sullivan: -- and indeed selectively picks from some badly crafted motions that he's put before the committee to disparage our legitimate and very deep concern in this area.

The Vice-Chair: That's not a point of order. Proceed, please, Mr Wilson.

Mr Jim Wilson: It was an interesting point, though. I enjoyed it. The record will clearly show that you voted against these.

Mrs Sullivan: You're darned right. They were bad ones.

Mr Jim Wilson: Oh, they were bad ones.

The Vice-Chair: Please proceed, Mr Wilson.

Mr Jim Wilson: Let's elevate the debate here. I will support your wonderfully worded motion here, even though it is not wonderfully worded. But the problem is, if you don't support us on these things because you find a problem with a word or two, how in the world are we ever going to get the government to come around? The track record in the last couple of days has been pretty bad in having the government come around to any of this.

I do want to point out that the Canadian Mental Health Association in its presentation to this committee mentioned specifically that the Ontario division of the CMHA said it was particularly concerned that those with a psychiatric disability are not specifically mentioned in the description of those who will be served by long-term care facilities. They went on to talk about the tremendous need to consider elderly persons, in their case, with a mental illness who require psychogeriatric and other long-term care support services. They presented us with staggering figures.

This particular figure is from a 1993 Ministry of Health study that said approximately 27% of those in provincial psychiatric hospitals are individuals over 65 who have a psychiatric problem. From the Mental Health/Long-Term Care Interface Working Group in 1994 a statistic was thrown at us that said that an analysis of the prevalence of mental health problems among the elderly in all hospitals and long-term care facilities has shown that up to 50% have at least one psychiatric problem. That's the facilities side.

The next deals with similar problems on the community side. As they age, individuals develop cognitive disorders which are more common in the elderly. For example, the incidence of dementia in Canadians over the age of 65 is estimated to be 8%, while the estimate increases to 34.5% of those over 85 years of age. Approximately -- and here's the important part -- 30% to 40% of Canadian seniors in long-term care facilities have a moderately severe dementing illness and up to twice as many people with dementia live in the community, so a staggering number of people require this protection, this inclusion of mandatory services in the act. We are supportive of it and we are consistent in our support of these services.

Mr Wessenger: We will not be supporting this motion, because the effect of it would be additional funding would have to be provided because it's additional cost to the MSA. There's additional service being added. That's the first aspect.

I wouldn't disagree that services should be available, but there's the question of who provides those services and which system provides it. It is our position that the community mental health should provide these services and it should be funded and delivered through that process.

Mrs O'Neill: As most of the providers, and certainly now some of the recipients who have gone through care know, this bill is really all about bucks. It's really all about limiting services and, if necessary, being put on a waiting list.

I'm having a lot of trouble with this, and I hope the parliamentary assistant will respond further, because we had a very extended discussion on case management. We were told that services weren't really going to change and that somebody would be doing it -- we're not really sure who -- and then we will refer to section 20 of the act. We were told the whole person would be treated through section 20.

Yet when we present this amendment, which again treats the person as a whole person, even to the case of records, which definitely are referred to in this act, we're told: "No, the person's going to have all these needs that have been outlined in the section of the act, whether it be ironing or whether it be personal hygiene, but if there's anything wrong with their mental abilities, folks, they've got to go somewhere else. They just have to go somewhere else, and we may or may not talk to the other people. We may refer them." I think that's the most I've been able to get out of this government about this matter.

This is very disconcerting: psychiatric, psychological or counselling services, while the person is in and at the same time receiving community services, no doubt through the MSA. How can we have any confidence that mental health will ever be attended to by an MSA board or through an MSA agency? I really have not got any guarantees, the people of Ontario don't, and what we're hearing is, "There isn't much money for mental health, folks." Maybe that's why we're dragging our feet on the reform.

Mr Jim Wilson: At least, in a sort of ironic way, I'm pleased to hear the parliamentary assistant admit the truth on this, because it seemed to me the last couple of days we dodged everything but the funding question, and to at least come forward and admit there isn't money is something we can understand. But I still don't think that should preclude you, because there is money in the mental health sector. It should be given a higher priority in your ministry. I could name a few programs you could drop.

The fact of the matter is there isn't money right now, but you do have mental health reform going on. Your own discussion papers talk about MSAs. I think it would be very wrong, as Ms O'Neill has said, to leave it out right now. I don't know whether you realize it or not, because maybe you don't get to talk to all the groups we get to talk to, but there's mass confusion going on in mental health reform right now. They don't know where they fit into this picture. They feel like, as I said before, they're spinning their wheels, and your MSAs aren't going to be popping up overnight anyway. There's a time frame in here that allows them time to get up and running and to have these services ready.

I think you should be proactive. You should be trying to advance that mental health agenda and programs and including them in some way in this legislation so that you partly fill that big need out there with respect to health care reform when people say to us constantly, "Well, we have no idea what the overall picture is in health care in this province." At least here you could help solve part of that puzzle by making sure mental health is part of the MSA structure.


Surely over the next four years your government or the next government is going to come to some conclusions with respect to mental health reform. You have to, because you can't keep having these people going to meetings every night and spinning their wheels. I would put them in now and start to redirect the funding that's going to be absolutely critical, because right now is when you're closing the psychiatric beds. Right now. You've got to get this legislation, because Parliament's a little jammed up, if you haven't noticed, and it's going to be hard for the next government, which will want to, I think, undo some of the things of the current government, to find the time to go back to Parliament and do these things.

I know you have regulatory authority in this bill, or will have, to add services, but I think as part of the planning puzzle right now you should be putting these services in, you should be talking about mental health services, and then that would send a signal to your own 12,000 bureaucrats that this is a priority in your ministry: Funding's got to be found, other programs have to be dropped, and money has to go to mental health services in the community. You box yourself nicely and purposely or else you can't get your MSAs going up.

I think that would be a way to advance this agenda and you should be supporting that and championing mental health, because communities need these services now and there may not be time, or parliamentary time, next year to be revisiting these acts.

Mr Wessenger: I'd just like to respond. I think certainly the member raises the whole question of mental health reform, and if we look back on closing institutions and the psychiatric hospitals, that started way back in 1970. One of the problems back then, everybody admits, was the fact that there was not the investment in community mental health.

I think definitely our government recognizes the fact we have to make an investment in community mental health, and I can assure the member it is the intention of the government to make that investment in community mental health and to not leave people in the lurch as psychiatric beds close. It will not require legislation in order to do that; it will merely require policy directions with respect to funding decisions.

I'm optimistic that we're going to have the mental health services in the community more than provided so that we will be able to provide some of these services through the referral system to community mental health in order that people can receive the services they need. It's not a question of whether they get the service or not; it's a question really of how the two systems mesh together. There certainly is a need to mesh the two of them, to coordinate the two of them together, and there certainly is a need for investment in community mental health. I recognize that.

Mr O'Connor: I appreciate this opportunity to speak on the importance of mental health reform. As I said yesterday in this very committee room, I know how strong my fellow colleagues are in advocating for mental health reform to continue. We will, as a government, address mental health reform in an appropriate fashion. It will be dealt with.

We recognize the need for programs to take place at a community level in mental health reform. It's not something that is included in detail in this bill because this bill is to deal with long-term care reform. I recognize that there are some areas where the two will cover off from each other, but we don't want to have the MSA out there providing all the mental health services that need to, in some cases, be created in communities, because there are a lot of communities where there certainly are some deficiencies.

This government is, I know, very committed to mental health reform. The document that was put out by the Ministry of Health isn't merely a document that says, "We're going to do it some day, whenever we get around to it." There's actually a lot of work continuing to take place on that very important issue, and I find it rather passing strange that we end up getting sidelined by the discussion about who's going to move forward on what reform and when. The reality is that the long-term care reform is something that is before us right now and it's something that we are dealing with, and hopefully we can try to zero in on exactly the legislation that's before us and through the clauses as we go through this clause-by-clause process.


The Vice-Chair: Order, please.

Mr O'Connor: Thank you for this opportunity to speak over the heckling of my colleagues opposite.

Mr Jim Wilson: One final point is that you've already dismissed three PC motions trying to deal with these things, two specifically. Don't let this one slip by you. If you're not happy as parliamentarians over there, and there are enough of you right now with some freedom, if you exercise it, to tell your own government that you want mental health in here, pass this amendment and over the next four years MSAs will have to integrate and mental health reform will have to advance to the point where something actually gets done.

If you're not happy as parliamentarians right now, this is your opportunity. Put your hands up, vote along with this amendment, get it into the legislation, send a very powerful message to your own government, to the Ministry of Health and to the other ministries involved that you want action on this. That would be a very positive thing to do. You could do it on behalf of your constituents.

I'm tired of NDPers -- and you've been doing it for 20 years -- telling me how important this stuff is. You've been in government four years and nothing has happened. You've set up more feel-good committees about empowering consumers and all this sort of nonsense, hiring an army of advocates. The bottom line is the services and you've got an opportunity right now to show some backbone, some leadership and actually lead your government in a policy direction that needs more attention and action.

Mr Martin: Are you suggesting we raise the deficit?

Mr Jim Wilson: I'm suggesting --

The Vice-Chair: Thank you for your comments. Any other speaker? If not, the Liberal motion amending subsection 2(7).

Mrs Sullivan: Recorded vote.

The Vice-Chair: All in favour?


O'Neill (Ottawa-Rideau), Sullivan, Wilson (Simcoe West).

The Vice-Chair: Opposed?


Carter, Martin, O'Connor, Rizzo, Wessenger.

The Vice-Chair: Motion lost.

A Liberal motion amending section 2 of the bill by adding (8) and (9).

Mrs Sullivan: I move that section 2 of the bill be amended by adding the following subsection:

"Performance of professional services

"(8) A professional service mentioned in subsection (7) that involves the performance of a controlled act described in subsection 27(2) of the Regulated Health Professions Act, 1991, shall only be performed by a member of a health profession in accordance with that act and the applicable health profession act.


"(9) For the purposes of subsection (8), `health profession act' means a health profession act as defined in section 1 of the Regulated Health Professions Act, 1991."

We've had comparable debate on another section. It's clear that we feel strongly that the professional services must be provided only by professionals.

Mr O'Connor: I agree with the intent behind this motion but don't want to undermine all the hard work that went into the Regulated Health Professions Act. That's a standalone piece that was very important. It went through a long consultative process and I don't believe that it's necessary to add this at this point. The Regulated Health Professions Act went through extensive consultation and defined exactly what were the regulated health professions. I don't think we need to add this all to this legislation.

Mr Jim Wilson: Unless I'm reading this wrong, it doesn't make any sense to me. What the Liberal motion says is, "A professional service mentioned in subsection 6(1)" -- 6(1) is personal hygiene --

The Vice-Chair: It was changed to 7 and corrected, apparently.

Mr Jim Wilson: Oh, I'm sorry. It makes perfect sense and I won't be supporting it because I think it's redundant.


The Vice-Chair: Any other speaker on the motion? If not, those in favour of the Liberal motion regarding section 2 of the bill by adding subsection 2(8) and subsection 2(9)? All in favour? Opposed? The motion is lost.

There were several motions, I understand, regarding section 2 that were stood down. We'll continue with section 3, then. The first is a government motion regarding paragraph 1 of subsection 3(1).

Mr Wessenger: I move that paragraph 1 of subsection 3(1) of the bill be struck out and the following substituted:

"1. A person receiving a community service has the right to be dealt with by the service provider in a courteous and respectful manner and to be free from mental, physical and financial abuse by the service provider."

This basically adds financial abuse, and I believe there are other motions by the opposition in the same manner, so we should be fairly unanimous on this one.

Mr Jim Wilson: Yes, I think that the parliamentary assistant is somewhat correct. I'll certainly be supporting this motion. I wouldn't give blanket approval, though. A couple of the financial mentionings coming up deal with not just financial abuse. So I'm certainly supportive of this, although I don't rule out that some of the other amendments might help to clarify this one. But given that we're at this one right now, I think we'll have to support it.

Mrs O'Neill: The parliamentary assistant just said that this is going to attend to financial abuse. We talked earlier today, and I feel very strongly, about people being treated in a condescending manner. I wonder why the words "has the right to be treated" have been changed to "has the right to be dealt with." There is a difference. "Dealt with" is, again, you're making the decisions about the person's competence or whatever; "treated" requires much more equality in the relationship.

Mr Wessenger: I'll ask legal counsel to explain that.

Ms Czukar: We changed the word "treated" to "dealt with" in I believe it's three of these sections in order to deal with some concerns expressed by some groups that the word "treated" might be interpreted in a narrow medical treatment sense, and we wanted to make it clear that we were including social services as well and to be less restrictive in that way.

Mrs O'Neill: I thought that would be the answer, but I don't like it.

Mrs Sullivan: We'll be supporting this amendment, and we believe that it covers some of the issues not only of elder abuse but abuse of people of all ages who are accessing the long-term care system, including financial abuse. You will recall that during the public hearings it was one of my concerns and the concern of some agencies that the bill-paying provisions that are included in the community service basket could open themselves to abuse. We like this addition.

The Vice-Chair: Any other speakers? If not, government motion, paragraph 1, subsection 3(1), all in favour? Carried unanimously.

The next is a PC motion, paragraph 1 of subsection 3(1). As was mentioned, this is similar.

Mr Jim Wilson: Yes. Since it is very similar, it's redundant and will be withdrawn.

The Vice-Chair: Thank you. Government motion, paragraph 2 of subsection 3(1).

Mr Wessenger: I move that paragraph 2 of subsection 3(1) of the bill be struck out and the following substituted:

"2. A person receiving a community service has the right to be dealt with by the service provider in a manner that respects the person's dignity and privacy and that promotes the person's autonomy."

This just changes the word "treated" to "dealt with." As well, "community service" is changed to "a community service." It's again very technical legal language.

The Vice-Chair: Any speakers? If not, all in favour of the government motion? Opposed? Carried.

Government motion regarding paragraph 3 of subsection 3(1), and there's a replacement. Is that correct?

Mr Wessenger: I move that paragraph 3 of subsection 3(1) of the bill be struck out and the following substituted:

"3. A person receiving a community service has the right to be dealt with by the service provider in a manner that recognizes the person's individuality and that takes into account the person's needs and preferences, including preferences based on ethnic, spiritual, linguistic, familial and cultural factors."

This amendment has minor changes. The word "treated" is changed to "dealt with" and "community service" is changed to "a community service." It's again very technical.

Mrs Sullivan: I'm not certain that these are all technical. I think there is a substantial change here in that what the government has done is to add the words that the individual "has the right to be dealt with by the service provider in a manner that recognizes the person's individuality" and so on.

There must be some reason that "service provider" has been included. You have to go back, of course, and look at the definition of "service provider," which may or may not include an MSA. I don't understand why the limitation has been put to "service provider" rather than, for instance, the person who answers the phone at the MSA or the person to whom the individual is referred. I don't get it. I don't understand why there's only one class of individuals who have to treat a person "in a manner that recognizes the person's individuality."

Mr Wessenger: I'm going to ask legal counsel to explain, but it should be noted that an MSA would be under the category of a service provider.

Mrs Sullivan: Well, is it?

Ms Czukar: Yes. "Service provider" is the most all-encompassing definition under the bill. It includes approved agencies and multiservice agencies as well as all other service providers. The reason for inserting the words "by the service provider" in these sections is because 3(1) opens with saying, "A service provider shall ensure that," so the obligation in the bill of rights is on the service provider.

The way that it was written previously we were concerned on closer reading after the hearings might be too broad, that the service provider would be put in the position of being required to ensure certain rights being respected when they would have no control over the situation. So, in these cases, we've said that it's the ways in which the service provider is dealing with the person that we believe the service provider can be obligated to behave with respect to.


Mr Jim Wilson: Since I have a very similar amendment to put forward next, I was wondering if the government would be friendly to amending its amendment as follows. That would be that after "recognizes the person's individuality and" we delete "that takes into account" and instead use the language of my amendment that says "that is sensitive to and responds to" the person's needs and preferences, including preferences based on ethnic, spiritual -- I think it's better than simply leaving it that the requirement under the bill of rights is to take "into account."

I'm far more comfortable with the language "that is sensitive to and responds to," particularly the word "responds," which to me connotes more action than simply taking into account, because the government's been taking into account a number of our amendments over the last two days and we've had very little action with respect to support.

Mr Wessenger: I think we have some concern with the language in your proposed amendment. I think we have difficulties with the aspect of "responds to" and also had some difficulties with respect to --

Mr Jim Wilson: "That is sensitive to and responds to," and in your language, "the person's needs and preferences, including preferences based on ethnic" etc.

Mr Wessenger: Just say "is sensitive to and responds to."

Mr Jim Wilson: Rather than "that takes into account."

Mr Wessenger: Right. That's what you're suggesting. If legal counsel says it's all right, then that's fine with me.

Mr Jim Wilson: Okay. Well, let's do that. Do I need to move a motion in that regard or can the parliamentary assistant amend his?


Mr Jim Wilson: Mr Chairman, I move an amendment.

Mr Wessenger: I'll get legal counsel's --

The Vice-Chair: We'll replace the motion by changing, in the second --

Mr Jim Wilson: No, I'd like to move an amendment. I move that the government's amendment amending paragraph 3(1)3 of the bill be amended by striking out "that takes into account" after "and" in the third line and substituting "that is sensitive to and responds to."

The Vice-Chair: Discussion on the amendment? No discussion.

All in favour of the amendment to this motion presented by Mr Wilson? Thank you. Carried.

Now the government motion, as amended. Discussion? Ms O'Neill, you had your name down.

Mrs O'Neill: I think I'll pass.

The Vice-Chair: Thank you. Anyone else?

The government motion to paragraph -- yes, Ms Sullivan?

Mrs Sullivan: I have one other question of the parliamentary assistant. I would like an explanation of why regional differences were taken out of the original drafting.

Mr Wessenger: I'll ask legal counsel to explain that one.

Ms Czukar: The wording here was changed to "needs and preferences," the person's needs and preferences. The former wording was more general with respect to differences. Now that we've related it specifically to personal needs and preferences, it seemed that regional differences weren't really relevant in the same way, and so we've used the same language that we've used in Bill 101 and other places where we've been talking about personal needs and preferences. Actually, those factors relate only to preferences.

Mrs Sullivan: Are preferences with respect to regional issues or geography included elsewhere? Have you added them back? It's a singularly important issue with respect to people who will be of course seeking care in their community and who want an interlinking service within their community.

Ms Czukar: I guess the issues of where people will receive services from within the MSA areas are dealt with further on in the bill in sections 11 and following with respect to MSA. I think the term "regional differences" in paragraph 3 of the bill of rights, as it was written before, was probably referring more to the issue of where people came from when it said "respects regional differences," rather than personal preference kinds of issues. So I think it was also vague there.

The Vice-Chair: Anything further? If not, government motion re paragraph 3(1)3, as amended. All in favour? Opposed? Carried.

It's now after 5 o'clock. Is there any other business that needs to be mentioned before we adjourn the meeting?

Mrs Sullivan: I'd like a clarification from the clerk. Since we have one more day of hearings on this bill and several dozen amendments to proceed with. I'd like a clarification on the process if we do not complete the entire clause-by-clause and if there would be consideration of seeking additional time from the House leaders to complete the entire clause-by-clause when the House resumes early next week.

Clerk of the Committee (Mr Doug Arnott): The bill remains referred to the committee when the House resumes. The committee normally meets Monday and Tuesday afternoons and the committee could decide at the conclusion of tomorrow or through its subcommittee, if it was preferred, how the committee would be proceeding with clause-by-clause consideration. The Chair of the committee had previously asked for a subcommittee meeting on Tuesday afternoon to consider the committee's future business.

Mrs Sullivan: Thank you very much. I appreciate that.

The Vice-Chair: Anything else? If not, the meeting is adjourned to 10 am tomorrow morning, same location.

The committee adjourned at 1707.