Hansard Transcript 1989-Jan-09 | Legislative Assembly of Ontario

Miss Martel: Three months ago, the regional municipality of Sudbury requested funding from the Ministry of the Environment to help fluoridate existing water systems in the region. Several outlying communities do not have fluoride-treated water and the public health unit had evidence showing that young children in those communities had a higher incidence of tooth decay than children in the rest of the region.

Regional council originally approached the Ministry of Health for assistance with the fluoridation project. While the Ministry of Health agreed fluoridation was a safe and economical measure to reduce dental disease, regional council was advised to apply to the Ministry of the Environment for funding. That ministry has a 33 per cent grant available for projects that are designed to resolve health or environmental problems.

Given that dental disease is certainly a health problem, and given that the Ministry of Health referred the region to the Ministry of the Environment, the region believed its fluoridation project qualified for the 33 per cent grant. The Ministry of the Environment did not agree. The minister replied that he would not fund fluoridation equipment as a health matter. He gave no indication of what type of health matter his ministry would fund.

Surely the Minister of the Environment (Mr. Bradley) can do better than that, and surely both ministries should get their acts together on this matter. The Minister of the Environment should reconsider his decision and accept fluoridation as a project designed to resolve a health problem.

HIGHWAY CONSTRUCTION

Mr. Eves: It is my pleasure to rise today and inform the Legislative Assembly that this afternoon I will be introducing a petition with close to 4,000 signatures on it asking for the four-laning of Highway 69 from Waubaushene to Sudbury.

In attendance today are the mayor of Parry Sound, Mr. O’Halloran, and Mr. Wong, the mayor of Sudbury, as well as the past reeve of the township of Georgian Bay.

This is a very apolitical and nonpartisan approach to a very serious problem, and I understand that my colleagues the member for Muskoka-Georgian Bay (Mr. Black) and the member for Nickel Belt (Mr. Laughren) will also be rising to give statements on the same subject.

Just between Christmas and January 1 of this year, in a small stretch of 20 miles of Highway 69 between the communities of Mactier and Parry Sound, some seven people have been killed in traffic accidents. That is by no means unusual for this stretch of highway, which I believe is among the most dangerous in Ontario.

What we are seeking is a practical commitment from the government that over a certain period of time and a set timetable, it will indeed four-lane the highway through Parry Sound and on to Sudbury.

I believe that the resolutions of Parry Sound council and other municipalities are very reasonable and practical, calling for four-laning of the highway as far as Parry Sound by 1994. I believe it is one with a nonpartisan approach and an approach to improve not only the safety of Highway 69, which is part of the Trans-Canada Highway system, but the economy of northern Ontario as well.

Mr. Black: I do want to support the views expressed by my colleague the member for Parry Sound. I would like to point out that it is the first time he has been on the right side of an issue for many months and I congratulate him for that.

In all seriousness, I should point out to members of this House that the four-laning of Highway 69, and indeed of Highway 11, is an important issue. I would suggest that it is important in both cases for three different reasons. First of all, there is the safety factor involved. Those highways were originally designed for traffic at a time when the flow of traffic from southern Ontario to the north was much less that it is today. The rates of accidents on those highways are important ones that we must be aware of.

I would argue that the four-laning of Highway 69 is important also for the development of Muskoka, Georgian Bay and Parry Sound regions. Those are the primary resort and recreational areas in this province. Many people from southern Ontario will be increasingly moving to them for their recreational time.

Finally, as I have mentioned before, the linking of northern Ontario with the southern part of this province is a vital priority in the eyes of many people. So I support the member for Parry Sound, and the member from Sudbury who will speak later, in their efforts to have this highway four-laned as soon as possible.

Mr. Laughren: It is time that this government took some initiative to upgrade our highways. It has been told repeatedly by groups and individuals of the pressing need for expansion, repair and upgrading of our highways.

Highway 69, a major artery from southern to northern Ontario is still only a two-lane highway. It is not adequate either from a safety point of view or for the economic development of northern Ontario. In 1988, 23 people were killed in the 240 kilometres of two-lane highway between Waubaushene and Sudbury. That is up almost 200 per cent over the previous three years. Another 214 people were injured.

In a speech to the standing committee on resources development last week, the Minister of Transportation (Mr. Fulton) included among his major expansion programs Highway 69 from Waubaushene to Port Severn. That is approximately 10 kilometres; about five miles is all that is. The minister himself says that transportation is often cited as a major contributing factor to the relatively high cost of doing business in northern Ontario. “These costs are viewed as a barrier to economic development,” says the minister.

He says that the Ministry of Northern Development will design a larger highway capital construction program for long-term development. What is his priority? He tells us in his speech, “improving transportation infrastructure and service in and around the greater Toronto area is a major priority of my ministry.” It is time Highway 69 was four lanes.

HOSPITAL SERVICES

Mr. McLean: My statement is directed to the Minister of Health (Mrs. Caplan) and concerns a growing number of people in Ontario who do not want to end up being just one more statistic on her books.

I have a letter concerning Clifford Mears from the Orillia area, who was diagnosed as having severe angina. The earliest he could be scheduled for surgery was early January. That has since been delayed a number of times. Mr. Mears has since had a heart attack that has caused permanent damage and has led to the deterioration of Mr Mears’s quality of life.

I have a second letter -- these are both just last week -- from a Mrs. Beacock of Elmvale, who has been waiting since last November to have an aortic valve replaced in her heart. She was released from hospital late last year and told to wait for a call from the surgeon about when she could be expected to have her surgery. Mrs. Beacock is still waiting for that call.

The time is long overdue for the minister to get a better grip on her ministry because heart surgery delays like these I have mentioned here today place an enormous emotional stress on the patients waiting for the surgery, and for their families as well. It seems we cannot pick up a newspaper without reading about horror stories similar to those I have mentioned.

What are we supposed to tell people when they come to us and ask why their heart surgery has to be delayed time after time after time? Her ministry has declined to the point where major surgery is required to bring it back to health without further delay.

It appears that many of those heart surgery delays are a result of there not being enough hospital beds. If she had looked outside today, she would have seen a large group of homemakers who were protesting her government’s deafness for more funds to reduce the problem.

LONG-TERM PLANNING

Mr. Adams: The current boom in the economy of the province, including the unprecedented growth of Metropolitan Toronto, is creating stress in communities across Ontario. The government is responding to problems of housing, transportation, schooling and delivery of basic services to communities in and around Metro.

The scale of problems is directly proportional to the pace of development. Individuals, communities and governments are struggling with immense challenges which, properly handled, present great opportunities. Beyond Metro, the stresses are sometimes less obvious but are there nevertheless. Agricultural land and environmentally significant areas are being swallowed up or set aside for future development. Industries are trying to acquire prime development sites. The commuting distance to Metro is increasing, driving up home prices, increasing demand for rapid transit and generating more traffic on already congested highways.

I am concerned about the impact of Metro’s growth on the rest of the province. It is our duty, as provincial legislators, to ensure that the province as a whole benefits from these good times and is adequately prepared for challenges faced in the world economy. I urge that a high-profile inquiry be established to determine long-range planning strategies and goals for Ontario.

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LARK MANUFACTURING INC.

Mr. Reville: I want to bring to the attention of the Legislature today the plight of 140 mainly Chinese-speaking, mainly female workers who, until the end of September, had jobs in my riding at Lark Manufacturing at 345 Carlaw Avenue. These workers were laid off with five minutes’ notice. The company did not pay them back wages. They are owed between one and three weeks’ wages. They received no vacation pay and they received no severance pay.

A complaint has been registered with the employment standards branch, but to date that branch of the Ministry of Labour has done little that satisfies the workers that the government is really interested in helping them get money which they earned with their own hands, as they put it. I call upon the government to get cracking and help these workers.

VISITOR

Mr. Speaker: I know the members would want me to draw their attention to a visitor in the lower east gallery, a former member, Margaret Campbell. Welcome.

Hon. Mr. Peterson: A very proud mother of a member of the provincial parliament, you should add, Mr. Speaker, if I may.

Interjections.

Hon. Mr. Peterson: There is not much charity across this hall, Mr. Speaker, however.

STATEMENTS BY THE MINISTRY

EMPEROR HIROHITO

Hon. Mr. Peterson: On behalf of the government and the people of Ontario, I would like to extend my condolences to the people of Japan on the passing of His Imperial Majesty Emperor Hirohito.

The reign of Emperor Hirohito, which began on December 25, 1926, coincided with a period of tremendous change and growth for the Japanese nation. During the reign known as Showa, or the Era of Peace and Enlightenment, Japan emerged from the dark days of the Depression, and the tragic days of the Second World War, to develop as one of the world’s paramount industrial powers.

I know that the people of Japan felt the presence of the Emperor as a strong guiding force in their everyday lives, and they share a great sense of loss in his passing. I extend my sympathies to them in their hour of national mourning.

HOSPITAL SERVICES

Hon. Mrs. Caplan: I wish to bring members up to date on recent developments regarding the scheduling and cancellation of heart surgery at St. Michael’s Hospital.

An immediate independent investigation has been launched, under the Public Hospitals Act, into the scheduling of heart surgery at St. Michael’s. Vicki Kaminski, assistant executive director of nursing at Sudbury Memorial Hospital, and Dr. William Sibbald, co-ordinator of the critical care-trauma centre at Victoria Hospital in London, have been appointed as investigators by the province. Sister Elizabeth Davis, executive director of St. Clare’s Mercy Hospital in St. John’s, Newfoundland, has been appointed on the recommendation of the hospital. I have asked the investigators to report as soon as possible.

As indicated on Friday, the independent investigation will examine, among other matters, admission and scheduling procedures for cardiovascular surgery, methods of monitoring patients while on waiting lists for surgery and other factors which may influence the scheduling and admission process.

My ministry has recognized the need to assist hospitals meet the growing demand for cardiac care. Last June, for example, the ministry approved more than $21 million for the province-wide expansion of a program to treat and prevent heart disease.

Members should also know that funding requests by St. Michael’s last year for additional cardiovascular services were approved by the ministry, including $2.2 million for capital grants and $6.4 million in operating funds to meet the growing number of cardiac patients as well as additional beds required for critical care patients.

In keeping with its commitment to increase cardiac capacity by 200 cases per year, the hospital has informed us that it will open two more trauma beds this month and two more in February. St. Michael’s will also be adding about six critical care beds. At present, trauma patients must sometimes be put in beds which could be occupied by cardiac patients.

In light of the cases brought to our attention last week, we want to work with St. Michael’s to ensure that the scheduling and admissions procedures are as effective as possible.

DRUG ABUSE

Hon. Mr. Ward: Our government believes the schools of this province can and must share in the challenge of fighting drug abuse by our young people.

Educators, including teachers, principals and elected and administrative officials of school boards, must work in partnership with parents, communities, police and many others in our province to attack substance abuse.

Today I am announcing an important initiative designed to help educators do their part in this joint endeavour.

I am pleased to announce the appointment of Karl Kinzinger, director and secretary-treasurer of the North York Board of Education, as chairman of a ministry advisory committee to help school boards develop drug education and drug abuse policies.

Karl Kinzinger is a capable and appropriate choice for this important position. He has joined us today and is sitting in the members’ gallery. He brings to the chairmanship an extensive background in Ontario’s educational system, including 15 years as a teacher and principal in both rural and urban schools and 20 years in various administrative posts with the North York board, one of the largest in this province.

The creation and adoption of drug education and drug abuse policies by school boards was a recommendation in the report on the use of illegal drugs in Ontario by my colleague the member for Muskoka-Georgian Bay (Mr. Black).

The advisory committee’s role will be to ensure that there is consistency in the drug education policies school boards adopt. The committee will create a framework to provide boards with direction on what should be included in a drug education policy.

The committee is to present me with its report by the end of this year, and the policy framework is to be available to school boards by the spring of 1990.

It is my expectation that every Ontario school board will have a comprehensive drug education policy in place by September 1991.

In addition to the chairman, 10 major educational organizations, the Addiction Research Foundation and the Ontario Provincial Police will be invited to have representation on the committee along with Ministry of Education representatives.

The work of the committee is one of several steps my ministry is taking in a co-ordinated attack on drug and alcohol abuse in Ontario. It is an essential link in the province-wide partnership through which we must all help our children say a strong no to drug abuse.

RESPONSES

EMPEROR HIROHITO

Mr. B. Rae: On behalf of the New Democratic Party, I want to share in the comments made by the Premier (Mr. Peterson) on the passing of Emperor Hirohito.

I am sure, along with many others who have watched the events of the last few days and had a chance to reflect on the history of this century, it really is quite a dramatic series of changes in the relationship between Canada and Japan, and between Japan and the rest of the world, over which the Emperor has presided.

Of course, we send our prayers to his family and wish a healthy and happy reign to his successor, Emperor Akihito.

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HOSPITAL SERVICES

Mr. Reville: In response to the statement today by the Minister of Health (Mrs. Caplan), I want to start by saying it almost defies belief that the government should respond to the tragedies that have occurred, not just recently but ever since this minister took over that job, by launching an investigation into scheduling of heart surgery at St. Michael’s Hospital.

This is a classic case of blame the victim. There is more than one victim here: there are the people of Ontario and there are the institutions and medical professionals who are doing their best to provide those people with the care they need.

It does no good for this minister to recite again announcements that were made as long ago as June and from which we have seen little effect. It is astounding to me and I am sure to any member of this Legislature that the minister has failed to say again today what it is she intends to do about the critical and growing shortage of nurses in the province. It makes no sense at all to say that the matter is finished because we are going to put some money into creating beds. We can renovate all the wards we like, but until we solve the nursing crisis, nobody is going to be in those beds because there will be no care available for people who are recovering from surgery.

The medical profession has been very clear, particularly of recent days, in indicating that it too believes that the problems being observed in the scheduling of cardiac surgery are almost entirely related to the shortage of nurses. It appears that the government’s stinginess in terms of funding hospitals means that, in the interim, hospitals are unable to go to agencies to hire critical care nurses.

One of the responses the minister could make immediately is to consult with the hospitals, surgeons and nurses and discover just how much money it would take to ensure that at the moment, in the interim, money could be made available to hire nurses from agencies.

That, of course, will not solve the long-term problem. There is no mystery whatsoever about the nature of the problem and the steps that must be taken by this government and by this Minister of Health to solve the problem. Continuing to repeat that the nursing shortage is a cyclical problem is an insult to all those professionals who have advised the minister otherwise over and over again.

This matter is not at all news to the minister. I know people will not be satisfied with this kind of response. By all means, one can always look into procedures that are taken or not taken at particular hospitals, but this will not do at all. I think it is far past the time when the Minister of Health and this government must take immediate action to solve the nursing crisis before that profession, the largest profession in this province I might add, is wounded fatally.

EMPEROR HIROHITO

Mr. Brandt: I want to take this opportunity to join the Premier (Mr. Peterson) and the Leader of the Opposition (Mr. B. Rae) in expressing the sympathies of our party with respect to the recent passing of His Imperial Majesty Emperor Hirohito. This is certainly a very sad and difficult time for the people of Japan, who held their emperor in such high esteem.

I think all Canadians certainly share with the people of Japan the terrible loss of the emperor’s passing and the passing of an era in Japan which was a very difficult one for the people of that country, going back to the time of the Second World War, then to a more enlightened era under the past emperor when Japan became one of the largest economic powers in the world and one of Canada’s most important trading partners.

In this time of national mourning for the people of Japan, I want to take this opportunity to extend our heartfelt sympathy to all of those people in Japan and to the Japanese throughout the world who will certainly have this sad moment as a result of the passing of Emperor Hirohito.

HOSPITAL SERVICES

Mr. Eves: I would like to rise and respond to the statement made by the Minister of Health (Mrs. Caplan) in the Legislature this afternoon. It is a somewhat interesting statement, from this particular minister especially. I am reading here from the minister’s statement of June 9, 1988:

“In Toronto, the three heart surgery units will increase their ... case load ... to 3,100 almost immediately.” I do not know what “almost immediately” means to the Minister of Health, but we are exactly seven months later to the day this announcement was made on June 9, 1988. This is January 9, 1989. Hello. Is anybody over there? Is anybody listening? “Plans for a fourth unit at Sunnybrook Medical Centre will be accelerated. We expect it to be in operation by the end of the year.” That was 1988; this is 1989.

I would like to join with the comments my colleague the member for Riverdale (Mr. Reville) made about the nursing shortage. Both opposition parties have been talking about the nursing shortage in this Legislature for many months. The minister’s response has been everything from, “There is no nursing shortage,” to, “Yes, there is one, but it is cyclical”; “Yes, there is one, but don’t worry about it, because our nurses are the highest-paid anywhere in Canada”; “Yes there is one, but we’re going to graduate a record number of new graduates this year from nursing.”

So there is no problem, Minister. Where are the problems? Why are these people dying? Why are their problems not being addressed?

The minister told us there was a central registry system for cardiovascular surgery patients operational in the city of Toronto as a pilot project before the end of the year. Why did that not help Mr. Coleman? Why is it not helping these other patients and why is the minister sending an investigation team to St. Michael’s? It sort of smacks of the investigation team she sent in to Cambridge Memorial Hospital.

I do not know why the people over there will not take responsibility for the decisions they make that they have control over. If they get their act together, then they can talk to somebody else about getting their act together and maybe save some lives in the process.

DRUG ABUSE

Mr. Harris: I want to respond briefly to the statement by the Minister of Education (Mr. Ward) and say that we are pleased to see Karl Kinzinger, director of the North York Board of Education, as chairman of the committee. However, that is where our pleasure stops.

When Benji died and the Haywards came to us all, they said, “It’s too late for Benji, but we hope it isn’t too late for others.” They encouraged us all to press on faster and with more resolve.

The minister’s statement says a comprehensive drug education policy will be in place by September 1991. It is already in place in North York in 1988. Many are asking why it was not in place in many more boards in 1988. I do not think anybody can accept that it will not be in place in 1989, let alone by 1990, and the minister is saying he is going to wait for September 1991. I think that is unacceptable. I think it will be far too late for many more people, many more youths, many more students in 1989 and in 1990.

My only question to the minister is: Why the wait? We have unanimous consent that we must go in this direction. Why is he taking two years to bring forward something we are all --

Mr. Speaker: The member’s time has expired.

ORAL QUESTIONS

HOSPITAL SERVICES

Mr. B. Rae: I want to ask some questions of the Minister of Health about the crisis in surgery for heart patients and ask her some questions about the announcement she made in the House last June.

The minister announced a central registry pilot project for heart surgery patients which has not yet started. She also announced a major expansion of facilities for heart surgery which is not yet in place. She announced that Sunnybrook Medical Centre would have a new unit performing surgery by the end of 1988, and that has not happened. She announced that there would be additional surgery at the Toronto Hospital.

I can tell her that Toronto General Hospital is actually performing fewer heart surgeries than it was last year. At Mount Sinai Hospital, again, the change is not yet in place. At St. Michael’s Hospital, there are only two additional beds of the several announced by the minister.

How does the minister explain this incredibly dismal record in the implementation and follow-through of an announcement which got all kinds of publicity last June when the minister made it? Does the minister not feel that these broken promises are things she is responsible for and that it is not good enough for her to pass the buck and blame the institutions, that she has to take some responsibility for the fact that the things she said would happen have not happened?

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Hon. Mrs. Caplan: I would like to say to the Leader of the Opposition that the announcement that was made last June was the result of consultation with some of the leadership from Metropolitan Toronto and across the province in the provision of cardiac care. We discussed what was needed as far as expansion was concerned, not only for Toronto but also for other centres across the province, and what was a realistic implementation time frame.

I am as frustrated as he is that there have been delays in implementation. I was assured at the time that the time frame that was set out was reasonable and I am confident that we are making progress to implement. The funds are available, and it is a question now of having the partnership between the hospitals, the staffing and the ministry to make sure that the resources are in place.

Mr. B. Rae: The minister announced that these things would be done, that they would have an impact right away in reducing the waiting list and that they would have an impact right away on the surgery being performed in this city and in this province, and those announcements have not come true. They are another list of broken promises from this Liberal government.

I would like to ask the minister if she can explain why her government has not made one practical proposal dealing with the nursing crisis and the nursing shortage; why there has not been one specific intervention from her and from her government dealing with the fact that even once these capital improvements have been made, the beds have been set aside and the renovations have taken place, the hospitals simply do not have the staff to perform the surgery and to provide the care that is needed for patients before, during and after surgery.

Hon. Mrs. Caplan: In fact, the Leader of the Opposition is not correct in the last analysis. The registry which he talked about, while it had some delays in getting going, is up and running now. Toronto Western Hospital’s increased capacity is functioning and available now. There are additional beds, which I mentioned today in the statement, coming on stream at St. Mike’s. Sudbury has increased its capacity, and I understand the Hamilton capacity is increasing within just the next couple of weeks.

Mr. B. Rae: I did not hear an answer to my question about nursing at all. We can argue with the minister about what has been and what has not been done. If she is arguing that the commitments she made in June have been fulfilled, let her say it outside and try to convince the patients who have been waiting and who are waiting still and who know perfectly well that the promises this Liberal government made to them have not been kept.

The minister will know that the first recommendation of the special report on nursing manpower by Professor Noah Meltz, conducted on behalf of the Registered Nurses’ Association of Ontario, recommends that the Ontario Hospital Association and the Ontario Nurses’ Association adopt premium pay scales to attract registered nurses to difficult-to-staff units, and that includes cardiac care units.

The minister will also know that the ONA president has announced on the weekend that she is willing to reopen the collective agreement between the nurses and the hospital association to deal directly with the pay levels of nurses who are providing cardiac and critical and intensive care.

I want to ask the minister a very direct question: Is she prepared to sit down with the hospital association and find a way to fund the kinds of increases in pay that she knows perfectly well are going to be absolutely essential to attract, train and keep nurses at the bedside for heart patients?

Hon. Mrs. Caplan: As the Leader of the Opposition knows, there were a number of recommendations addressed in the studies which have been brought forward on nursing manpower which talk about the obligations of the employers, the hospitals and the employees, as well as educators and government. As he knows, I made a commitment to open the Public Hospitals Act to make sure that nurses participate fully and are recognized as important members of the health care team.

I was pleased that the Ontario Nurses’ Association announced that it would like to return to the negotiating table. Their negotiations are with the Ontario Hospital Association, and in fact I would support those new contract discussions. I would like to see such issues as differential pay for critical care nurses discussed. I know the collective agreement between the Ontario Nurses’ Association and the Ontario Hospital Association could be amended in some way to allow for the flexibility required to make sure that the needs of critical care, in downtown Toronto particularly, are being addressed.

HOME CARE

Mr. B. Rae: I have a question to the Minister of Community and Social Services. I wonder if the minister can tell us whether he agrees with a statement that was made by the interministerial committee report on homemaker services. The committee was set up in January 1987, two years ago, and it reported in July 1988. The report states, “... increasing homemakers’ wages is the single most important factor in ensuring the ongoing viability of the visiting homemaking system.”

I wonder if the minister can tell us whether he agrees with that and what he intends to do to deal with a situation where a visiting homemaker from Port Colborne to whom I was talking outside on the steps today, where neither the minister nor the Premier (Mr. Peterson) was prepared to come, told me she is making $5 an hour providing care for senior citizens at home. What is the minister going to do to increase her wage to a living wage?

Hon. Mr. Sweeney: In response to questions in the House last week with respect to the deficit situation, I said very clearly that one of the key issues was the wages being paid to the direct front-line homemakers and that any attempt to deal with the deficit situation by itself would not resolve the current problems. The homemakers’ wages are a very important component to the whole difficulty.

Mr. B. Rae: My question was: What is the minister going to do to deal with the most fundamental recommendation of that committee? That committee made a fundamental recommendation. What is the minister going to do to deal with the basic recommendation of that committee?

If he wants to keep people, if he wants to stop a turnover rate as high as 120 per cent and 130 per cent in some parts of this province, what is the minister going to do to make sure that people are paid a living wage, a wage that will allow them to stay there, that will treat them with dignity and will mean that people will not be leaving every three or four months, with people having to be trained and retrained? What is the minister going to do to implement that basic recommendation of his own --

Mr. Speaker: The question has been asked. Order.

Hon. Mr. Sweeney: The honourable member is aware of the fact that in the last two years my ministry alone, apart from the Ministry of Health, has put an additional $40 million into the homemaker programs of the province. At the same time, we realize the increase in the growth and the demand for that kind of service.

As a result of that, the Ministry of Health and the Ministry of Community and Social Services are jointly preparing a complete overview of community care programs versus institutional care programs. The honourable member will be well aware of the fact that at the present time the institutional care programs in both ministries take a very substantial share of our budget.

If we can figure out ways to shift money from that component of our two budgets into community care, then we are going to be able to resolve these issues, but we are going to be dealing directly with the issue of homemaker wages very shortly.

Mr. B. Rae: This government and its predecessor Tory government, which it is beginning to resemble more and more every day as I speak, have been studying this question of the relationship between institutional care and community care, between the ministries of Health and Community and Social Services, for more than a decade. There are reports piled up higher than my desk out here in the minister’s own bureaucracy on this relationship.

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The people who were demonstrating outside and who are leaving the profession in droves do not need another overview. What they need is an increase and a commitment from this government to fund community care at a level that will allow community care to grow in a realistic, sensible way. Every government in place has to face up to that reality. What is the minister going to do now to increase the pay of the people who were demonstrating outside?

Hon. Mr. Sweeney: Mr. Speaker, it becomes increasingly difficult to respond to these kinds of questions, because you will be well aware of the fact that this same opposition leader, his colleagues and the members of the third party over the last several months have been very strenuous in their questions to the Minister of Health (Mrs. Caplan) about putting increasing sums of money into the basic health program that exists now.

The member will be well aware of the fact that last year the total new taxes that were raised by this government were $1.3 billion. Of that, $1.2 billion -- in other words, every single cent of those new taxes, with the exception of $100 million -- went into the health programs to respond to the very kinds of questions that they have constantly been raising in this House.

What honourable members have to appreciate is that we cannot continue to pour those kinds of dollars into the institutional component of health and, at the same time, put additional dollars into communities. We have to find a way to balance those two kinds of service. That is what we are trying to do.

Mr. Brandt: My question is to the same minister and along the same lines as the question raised by the Leader of the Opposition (Mr. B. Rae).

The minister is aware of the fact that there was a demonstration, obviously, on the front steps of the Legislative Assembly today. There was some concern about neither the minister nor the Premier being in attendance to at least share with the group that was assembled, the homemakers of our province, their views as to what is going to happen with respect to the future of that program.

I think their concerns centre very specifically on the interministerial report which has been developed, starting some two years ago and made public about six months ago, relative to the changes that are going to be necessary in homemaker services. Can the minister share with the House what he intends to do with that report? Does he intend to implement the findings of that report and its recommendations? If so, when can we expect that the decision will be made by his ministry?

Hon. Mr. Sweeney: There were three essential recommendations in the report that the honourable member will be aware of. One has already been discussed, the direct wages paid to the homemakers. The second one with respect to the homemakers was training programs. The kind of care of the elderly and the disabled in the province today is of an increasingly serious and difficult nature. The third one was the rates paid directly to the agencies for the administration costs which they encounter in delivering those services, including, as the Red Cross brought to our attention, the travelling costs of its workers. All of those have been accepted by us as legitimate concerns and legitimate areas for consultation and solution. We are working on those right now.

As the honourable member said, the report was released publicly approximately six months ago. We have constantly been in touch with the various agencies across the province and with the municipalities, who are our funding partners. As the member knows, my ministry pays 80 per cent and the municipalities pay 20 per cent. We have been in touch with the Red Cross. We consulted with them last Friday as to what our intentions were in the immediate short term, as well as our long-term intentions. It is an ongoing process and we are dealing with it right now. All three of those issues must be dealt with.

Mr. Brandt: I would like to remind the minister that this is, in fact, a report prepared by his ministry in consultation with other ministries. It is not an outside consultant’s report but an internal government report with a series of recommendations by his own people. Second, it is in direct line with and supports the promise made by the Premier in the last election, and I recall those ads very well, when the Premier promised to expand the homemaker program right across this province into areas which are not at the present time receiving that particular type of service.

In order to help the people who have taken the time to come here today and to demonstrate at Queen’s Park, can the minister perhaps give them some indication of what he plans on doing with respect to issues like the inadequate wage levels that these people are receiving at the moment? Can he give us some indication of his time frame, when he intends to act on his report prepared by his ministry and others?

Hon. Mr. Sweeney: I do not think I suggested at any time that it was other than an interministerial report. On the basis of that, that is why we agree with the three main recommendations in the report. I am not in any way denying that.

At the same time, I have to remind the honourable member that the introduction of the integrated homemaker program by this government was picking up a program which his own government had attempted to introduce as far back as 1981 and it sat on the shelf from 1981 to 1985 with no action at all.

We are not suggesting that we have gone as far as we need to go or as far as we plan to go with the current program. We know what the needs are, but the difficulties that we are encountering are because, in fact, we are taking a proactive stance in this field. We are moving increasingly into the field. We are moving into the field with elderly persons’ centres. We are moving into the field with a whole range of home support services. We are moving into the field with Alzheimer’s services, and we have moved into the field with this new integrated homemaker program.

In total, this government is spending $373 million in a range of home support --

Mr. Speaker: Thank you.

Interjections.

Mr. Speaker: Order.

Mr. Brandt: That program has not used up the money that the minister provided for in his own budget, so he has underspent that program.

For weeks now we have been talking about picking up the operating deficits of the Red Cross and other of the not-for-profit agencies involved in delivering a homemaker service. As late as Thursday of last week, we talked about the need for that deficit to be picked up in order that those agencies could continue to operate.

Now we have an announcement over the weekend about the fact there was going to be a demonstration on Monday -- today -- here at Queen’s Park, and interestingly enough, right in the middle of those two time frames, the Thursday question and the Monday demonstration here, there was an interesting announcement made by the minister, after stonewalling this question week after week and day after day in this House, refusing to make a commitment.

Mr. Speaker: The question?

Mr. Brandt: All of a sudden, like manna from heaven, an announcement was made by the minister that the Red Cross would receive $1.1 million and that there would be $1.8 million in total to all of the homemaker agencies that required a covering of their deficit.

Mr. Speaker: Question?

Mr. Brandt: I ask the minister: What happened?

Hon. Mr. Sweeney: I would ask the honourable member to examine the answers to my questions from last week. I believe there were three different ones on three different occasions and on each one of those occasions I indicated very clearly that we were in the process of reviewing that request and that if we could find the necessary resources, we were prepared to allocate them.

I also indicated specifically, in response to a question from this honourable member, in response to another newspaper report in fact that we were not going to pay it: “No, I did not say that at all.” We said very, very clearly we were trying to find the resources; and second, we were trying to ascertain for ourselves whether or not agencies other than the Red Cross were involved in this particular concern and to what extent we could verify the deficits themselves.

All of those things were taking place during last week. Since it had not yet been resolved as of Thursday at 2:30, I could not respond to it. It was resolved later on Thursday and the announcement was made on Friday. We cannot be quicker than that.

HOSPITAL SERVICES

Mr. Eves: I have a question for the Minister of Health. In response to a number of questions that I and other members have asked regarding waiting lists for heart surgery, she said, “Our system is designed so that those in life-threatening situations receive priority.” She also said that if a patient requires immediate surgery, that treatment is readily available. Does the minister still stand by her previous commitment?

Hon. Mrs. Caplan: I think the member opposite will agree that in fact our system is designed so that those requiring emergency and urgent care receive that care first.

Mr. Eves: Let me tell the minister some facts about another constituent of mine, a Mr. Porter. Mr. Porter is 58 years old. He has had eight heart attacks in the past 18 years. He has been hospitalized for a week at a time in North Bay Civic Hospital eight times since April 1988. He needs triple-bypass surgery. He has an aneurysm in his left ventricle. He has been on oxygen daily since October. He is on nine or 10 different types of medication a day. He had bypass surgery in 1976 and has been on a waiting list in Ontario for cardiovascular surgery since August 1988.

Would the minister agree that this is a life-threatening and critical situation? Why has Mr. Porter been on the waiting list for five months?

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Hon. Mrs. Caplan: As the member knows, what we have been attempting to do, as in the announcement of last June, is to respond to a needed increase in capacity for cardiovascular care. I have said on numerous occasions that we rely on physicians to use their very best medical judgement in determining the priority of patient need and ensuring that those requiring urgent care get that care first.

I always advise patients, if they have concerns, to contact their physicians so that those appropriate medical judgements can be made. When the member asks me a question in the House for my medical judgement, I would tell him I am not a physician.

We recognize that there has been a very large increase in the number of people recommended for this surgery and we have moved to expand capacity across this province in the centres providing cardiac care. That is coming on stream. The registry is up and running. I believe that this will, along with the increases in capacity, help physicians to refer their patients to the most appropriate location for care.

Mr. Eves: Trying to pass the buck to the physicians, quite frankly, is not the answer to the problem. I do not believe a lot of the other supposed answers the minister has given us over the last several months are the answers to the problem either.

Let me just tell the minister about a few people under her system where everybody who gets immediate care gets it: Mr. Pitcher, 36 years old, father of three, died last March awaiting heart surgery. He had been on a waiting list at St. Michael’s Hospital for two months. Mr. Thornton, another constituent of mine, had his surgery postponed five times before it was made available last April. He had a heart attack on the table and died three days later. In July 1988, Gordon Montgomery, 59, of Sarnia, was put on an urgent waiting list at University Hospital in London. Mr. Montgomery finally received his operation in December 1988. He was one of the lucky ones. In early October 1988, Brendan McLean, 40 years old, was told that he needed heart surgery the next day --

Mr. Speaker: The question.

Mr. Eves: He was placed 16th on an emergency surgery waiting list. He died six days later. Richard Rutter, 64, of Kingston -- I can go through this whole list; I am not even halfway through it -- and we end up with Mr. Coleman a few short days ago.

Are Mr. Porter and the others like him out there going to go the same route as Mr. Coleman and some of these others?

Mr. Speaker: Minister?

Mr. Eves: Or is she going to do something to correct the problem, besides saying it is the physicians’ problem and they have to make the decision or these people are going to die?

Mr. Speaker: Order.

Mr. Eves: Is she going to do something as Minister of Health?

Mr. Speaker: Order. Will the member take his seat?

Mr. Eves: She told us she solved it in June --

Mr. Speaker: Order.

Mr. Eves: -- when obviously she did not. What is she going to do?

Mr. Speaker: The member for Parry Sound --

An hon. member: Throw him out.

Hon. Mrs. Caplan: In fact, I think we have made progress. In the past, the surgical capacity has increased. We are responding.

The member might find it interesting to know that Sudbury, which has additional critical care nurses available, will be sending some of its nurses to Toronto in February to help, so that the downtown Toronto critical care nursing situation can be alleviated somewhat. As well, there are additional critical care nurses in training right now, so that will be an assist.

I can say to the member that in fact there are, and have been for the last couple of years, in excess of 5,000 coronary artery bypass surgeries performed in Ontario. We expect next year that this will significantly increase. I can tell the member that as we monitor that and increase the capacity, I believe that we will work together co-operatively with the physicians and the hospitals to ensure that we can implement this so that the patients can receive the care they need as soon as possible.

AUTOMOBILE INSURANCE

Mr. D. S. Cooke: I have a question to the Minister of Financial Institutions in regards to the insurance companies of Ontario. He will be aware that last Friday another insurance company, Prudential, announced that it will not be offering new car insurance policies to the people of Ontario. The minister will also understand that this is the fourth or fifth company that has withdrawn from the market in Ontario in the last couple of months.

What is the minister prepared to do to stop this systematic withdrawal by the private insurance companies from offering insurance to car owners in this province? If he is not prepared to offer public auto insurance, what is he prepared to do to guarantee that car insurance purchasers at least have options in the private sector?

Hon. Mr. Elston: The honourable gentleman should be aware that there are a sizeable number of companies offering insurance coverage to the people of Ontario, and he might want to, as he gives examples of those withdrawing, give a list of the companies which are still offering service to the public. In fact, there is a very large number: 170 or so companies is the total at this current date. I stand to be corrected, but there is not much variation between that number and the actual number which make insurance coverage available to the people in the province.

Mr. D. S. Cooke: It is amazing to hear cabinet minister after cabinet minister say that everything is fine in Ontario. People are dying on the operating tables in this province and insurance companies are withdrawing from the market in Ontario and his only response to this whole thing is to say, “We’ll give them nine per cent increases on their rates last year” as this company is saying, “Either give us 35 to 40 per cent more or else we’ll stay out of the market.”

I am asking the minister what he is prepared to do to guarantee that those in Ontario, who are living under laws where it is compulsory to have car insurance, are going to have access to either reasonable rates in the private sector if he is not prepared to go the route of the public sector insurance, or if they are not prepared to do it, is the minister going to seriously consider public auto insurance in this province?

Hon. Mr. Elston: The honourable member is being outrageous. First of all, let me say this as an example of what happens to a company that says that it requires huge increases. There was an indication that Safeco was going to be needing, as a result of its testimony, a 53 per cent increase in its premium prices. That caused the people who were customers of Safeco to indicate that they wanted to change policies, which brought a rejoinder by the people at Safeco, who said, “We weren’t really saying we needed 53 per cent. Listen, do not change your coverage.”

What was asked of me by the member for Windsor-Riverside (Mr. D. S. Cooke) was, in fact, what am I going to do to make sure that there is a choice in the marketplace. I have said that in the marketplace in Ontario there are about 170-some companies offering coverage for automobile insurance.

What is also being done is that there is a public hearing so that the people in the province can be assured that the parts of the rate-making structure are put together fairly and that they will know exactly what the rate is made up of when premiums are assigned to them by their companies. I can tell the people of the province that the hearing process will continue and that it is a fair and open process, and that if private companies -- and this is an unusual situation for them -- want to get out of the business, then that is a private company’s decision. But I have never heard the New Democratic Party before, until now, saying, “Mr. Minister, please” --

Mr. Speaker: Thank you. Thank you.

Interjections.

Mr. Pouliot: You are talking out of both sides of your mouth. If you do not have an answer, say so. You do not have an answer. You did not have one last week; you do not have one this week.

Mr. Speaker: Order, the member for Lake Nipigon. Order. The member for Nipissing (Mr. Harris) is waiting to ask a question.

Mr. Pouliot: You will make the announcement when the election is called; you know that. You do not have the guts to get up and say it now.

Mr. Speaker: We will just wait, if the member for Lake Nipigon wants to waste time.

USE OF LOT LEVIES

Mr. Harris: I have a question for the Treasurer. At a meeting this weekend, school board officials from across the province were a little surprised to learn from Treasury officials that the only way lot levies would be acceptable to the government would be if the government share of education capital expenditure was reduced from 75 per cent to 60 per cent.

Trustees also felt that they were being blackmailed into a position that if they ever wanted more money or if anybody wanted more money for schools in this province: “You are not going to get it from the government. We are not going to live up to the former way of doing it. Even though the economy is expanding, we are not going to go that way. The only way you are going to get it is to support our lot levy proposal.”

I would ask the Treasurer if he shares the views of his officials that were expressed this weekend or is he beginning to feel, as I do, that some of his greedy Treasury officials think their only job in life is to figure out ways to wring out more money from the unwilling taxpayer?

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Hon. R. F. Nixon: The honourable member speaks with yearning tones of the former way of doing things. The former way of doing things was to support the capital needs for elementary and secondary education to the extent of about $78 million a year. That was flat-lined for many years. In the three years we have had the responsibility of the Treasury, this has increased to $300 million.

In order to assist in more long-range planning, rather than the year-to-year planning that was the regimen of the previous administration, I have indicated that the budget would have at least that amount in it for the next three years. We have indicated anything but parsimony. We have indicated that we want to spend as much money as is needed to meet the requirements of the community as they are presently understood.

Mr. Harris: In spite of the Treasurer’s election promises, he has cut the education operating share from the former way of doing it, at 48 per cent, to under 44 per cent now. Now he wants to cut the provincial capital share from 75 per cent to 60 per cent.

I want to get this straight; I want to be fair to him. As I understand it, what he is proposing is that a lot levy on new lots that will increase house prices, say, $5,000 to $10,000 -- pick a figure, whichever it ends up as -- would represent, say, one to two per cent of the housing total. But he will increase the housing affordability problem on all the homes because all homes will go up.

I want to understand what he is really proposing. He is proposing to increase the housing affordability problem on all homes by getting some revenue on to the municipality, which it will have to pay instead of the government, on only one or two per cent of the homes out there. I want to understand --

Mr. Speaker: Order. Thank you.

Mr. Harris: Is that what it is and does that make sense to him --

Mr. Speaker: Order. The question has been asked. Will the member take his seat.

Hon. R. F. Nixon: Mr. Speaker, I am sure that you, unlike the honourable member asking the question, have read the proposals in the policy paper, which as well as proposing lot levies as one of the alternatives, also refers to other alternatives.

We are proposing a special loan fund based on capital from the Canada pension plan for certain of the municipalities. We are also proposing an amendment to the appropriate legislation that would permit school boards to enter into agreements with developers whereby lot levies and other special funding would be unnecessary if the developers themselves were to undertake the cost of building schools up to the specifications.

We are trying to put forward an array of alternatives that will mean the taxpayers of the province, in spending the $300 million a year -- who knows, it may he more in the future and we expect it might very well be -- are going to get the kind of quality school building the community has demanded, and really deserved, so that the quality of education is going to be able to improve under the leadership given by my colleague the minister.

LITERACY PROGRAMS

Mr. Faubert: My question is to the Minister of Skills Development. The minister will be aware of the survey that was commissioned by Southam Inc., which indicated that 24 per cent of Ontario adults are functionally illiterate. I am sure the minister knows that this means 1.2 million people in this province lack the equivalent of a grade 9 education, denying them the ability to participate fully in many day-to-day activities that most in our society take for granted.

There has been an increased focus on illiteracy from both the provincial and federal orders of government, and we have all been informed about the increased funds the minister’s ministry has provided to the community literacy groups this year, for which I congratulate him and his ministry. Can the minister assure this House that this funding is sufficient to meet the challenge of adequately addressing and eliminating illiteracy in Ontario?

Hon. Mr. Curling: I welcome the question from the honourable member. In response to the last part of his question, whether I feel these are adequate funds to meet the challenge of illiteracy in this province, I would say no. But I hasten to say that this ministry and this government have been able to get various people in the community, such as the labour unions, businesses and other governments, to pay attention to this very serious situation we have here in Ontario. As a matter of fact, it is more than Ontario; it is widespread. Adult illiteracy is at a rate of about 24 per cent.

This year this government, through my ministry, has spent $40 million in regard to the literacy program. Other ministries have spent an additional $10 million towards fighting illiteracy. Further, we have been able to fund 20 francophone groups in the province and a further 24 native literacy programs. Again, I say this is not sufficient in itself to eradicate illiteracy.

Mr. Faubert: The minister will be aware of the $110-million literacy announcement made by the Prime Minister last September. This has created a federal-provincial partnership to alleviate the problem of illiteracy. Is this new federal partnership on literacy encouraging news for the minister’s provincial planning in this field?

Mr. Runciman: Who wrote that for you?

Hon. Mr. Curling: I again welcome that question. I can hear the member from the third party asking who wrote that question. I am glad the third party is paying attention. The federal government itself has put $110 million towards literacy to be spread over five years, and in a comparative way, the provincial government has put $100 million in over two years.

I am encouraged the federal government is now paying attention and I welcome that amount of money. I hope, though, that in the future more money will be put into this very, very serious problem we have in combating illiteracy. The year 1990 is the International Year of Literacy, and I seek the support of my party and all my colleagues on the opposite side. I seek the support of the federal government in not only looking at $110 million for five years, but also in arresting the problem of illiteracy in this country and this province.

COURT SYSTEM

Mr. Hampton: My question is for the Attorney General. Last week, at the annual opening of the courts, the Chief Justice of the province stated that 282 accused criminals walked free from Ontario courts because of unreasonable delays in the prosecution of their cases. He further stated that the Attorney General’s intransigence in dealing with the problem of the shortage of judges is bringing the administration of justice in Ontario into disrepute.

What is the Attorney General going to do about this serious situation, or does he still insist, as he did a few short weeks ago, that it is not a serious situation?

Hon. Mr. Scott: I think it is important to have the situation in perspective. Court is conducted every day in Ontario in hundreds of courtrooms at 240 locations and it is presided over by 450 judges, which is one of the highest ratios of judges to population in the western world.

Thousands of cases are dealt with in Ontario every week, and as the Chief Justice’s own figures revealed last week, court lists on the civil and criminal side are in order in almost all those courtrooms all across Ontario. We have six problem areas, six problem municipalities, in the provincial court (criminal division) and one in the district court. They are all in the bedroom municipalities adjacent to Metropolitan Toronto.

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As I said last Friday to the loud applause of the Leader of the Opposition (Mr. B. Rae), who was present, the chief judge and I have grappled with this problem and have set up, as I announced to the House the other day, a number of projects to deal with it. I am confident that with good management, which is a co-operative exercise between an independent bench and the government, this situation can be addressed.

Mr. Hampton: It never ceases to amaze me that the Attorney General always tries to miss the question. The question was not about how many judges we have in total in Ontario. It was about the provincial court (criminal division), where 282 accused criminals walked free last year. Furthermore, even where he has put in his trial co-ordinator system in Ottawa, it has only reduced the backlog from 14 months to 12 months. Is that what he calls progress?

Finally, he says it only involves the bedroom suburbs of Toronto. Sixty per cent of the people in Ontario live in Metro Toronto or the surrounding suburbs. Sixty per cent of the people in Ontario are not getting the kind of justice they deserve. What is he going to do?

Mr. Speaker: That is two questions.

Hon. Mr. Scott: I am as troubled as I was on Friday by the expression “accused criminals.” The persons who are referred to were acquitted by the court and I am not prepared to determine, in the face of that acquittal, that they were criminals. We have had some difficulty grappling with the Chief Justice’s figures. It is not apparent where they came from and I am not able to give an assessment of them.

Mr. B. Rae: He does not know what he is talking about? Come on.

Hon. Mr. Scott: No, I did not say that at all. I did not say that for a minute and would not dare say it. What I do want to emphasize to the honourable member is that something like 10 million separate charges are laid in Ontario every year and dealt with. We have a justice system, as the judges recognized on Friday, of which we can be very proud. What we have to do to make it operate efficiently is to manage it co-operatively. This Attorney General does not decide whether courts sit in the summer or at night, or begin at nine o’clock or 10 o’clock. Those decisions are made, as they should be, by an independent judiciary.

As Chief Judge Hayes and I have concluded, this resolution, this approach to co-operative management, is important. It is being undertaken with considerable success in the six areas mentioned --

Mr. Speaker: Thank you. New question.

AUTOMOBILE INSURANCE

Mr. Runciman: I have a question for the Minister of Financial Institutions. As he knows, the Ontario Automobile Insurance Board hearings are slated to wrap up this Friday. He has been giving us the impression that he is being kept well informed on the happenings at the board. I assume Mr. Kruger is keeping in close touch with him or his officials. I wonder if he can give us a rough idea of how many presentations have been made to the board and how many of those are from outside the Metropolitan Toronto area.

I do not know if the minister was able to hear that, Mr. Speaker.

Mr. Speaker: Order.

Hon. Mr. Elston: I will give the exact number of presentations to the honourable member tomorrow. I will get an up-to-date tally for him and advise him personally.

Mr. Runciman: We attempted to obtain the information earlier, especially in respect to the people from outside the area, but the reality is that the board will be wrapping up its hearings this Friday without having set one foot outside of Metropolitan Toronto. If they truly cared about public input, if they truly cared about the different regions of this province, they would ease up on their Metro Toronto focus.

Instead, we get a lot of back-slapping in this Legislature from their own members saying what a wonderful job they are doing in eastern Ontario and what a wonderful job they are doing in northern Ontario. The reality is that they do not want to hear the views of the people of Ottawa, the people of Windsor or the people of Thunder Bay. All they apparently care about in this case, as in so many others, is Metropolitan Toronto. How can the minister justify not extending the hearings to give all concerned Ontarians a meaningful opportunity to comment?

Hon. Mr. Elston: The board hearings have been going on for some time now, as the honourable gentleman has indicated, and in fact the material that has been put in front of the board members has canvassed a series of issues, all dealing with items that are especially relevant to all of the people of Ontario; that is, the rates to be considered or the methodology by which rates are to be put in place for auto insurance premiums in Ontario.

The board’s mandate, as it was established, was to consider in a very open and public way what rates, or in this case, ranges of rates ought to be put in place so that there is fairness in that marketplace. I can tell the honourable gentleman that their mandate extends not just to Metro Toronto, but in fact it reflects right across Ontario. I think it is very plain to all of us here in the Legislative Assembly, as individual members and as insurance purchasers ourselves, that their mandate is important to everybody in every part of the province.

Their study reflects the insurance in every part of the province. Their requirements are to examine in detail those components that make up the rate-setting structure. They will consider everything that is required to be considered from right across the province.

I can tell the honourable gentleman that he, like --

Mr. Speaker: Order. New question, the member for Mississauga West.

CHILD CARE

Mr. Mahoney: My question is to the Minister of Community and Social Services. In the past several months, a number of grants for new day care centres have been awarded in my riding: a grant to the West Park Day Care Centre Inc., a nonprofit centre located in an industrial park, a grant to Sheridan College which runs a nonprofit workplace centre in the Mississauga Civic Centre, and a grant to the Mississauga Young Men’s Christian Association, which will open a child care centre in its complex currently under construction in the city centre area of Mississauga.

These grants are greatly appreciated, but I would like to ask the minister what he and his ministry are doing to ensure, specifically, that more workplace day care centres will be available to the families of Ontario.

Hon. Mr. Sweeney: The total number of workplace day care centres in the province today is approximately 50, and about 12 of those are directly operated by various ministries of government scattered across the province.

To facilitate workplace day care centres, we are doing two things. First, we provide a $55,000 startup grant to any employer who wants to start a workplace day care centre as part of his place of employment or in association with other employers. Second, we have set up an advisory council at each of our area offices scattered around the province to provide assistance and advice to potential employers on the basis of the interpretation of the legislation, the steps they have to go through to get a licence, the design of the program they ought to offer to meet their employees’ needs, and finally, the kind of funding we have learned from other experiences is required.

Given the number we have there now and given the services we are offering, there is no good reason why an employer who wants this service cannot get it.

Mr. Mahoney: I support the concept of workplace day care, but in today’s society, with both single mothers, and in fact single fathers out there and many people having dual career marriages involved, there seems to be a strong need for day care centres that are flexible enough not only to be in the workplace but also to respond to the demands of shift work and/or flextime.

How is the minister working with the day care community not only to ensure that day care is affordable and readily available in the workplace, but also to ensure that it is accessible to all parents who need the service at the specific times when they need it?

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Hon. Mr. Sweeney: Built into our new directions for day care in Ontario were two or three initiatives that I think respond to the particular question.

The first one is the establishment and funding of community development groups in various areas across the province. This is a group of volunteers, in most cases parents who need the service, who come together and assess the needs of their community with respect to issues like shift work, weekend work and things like that. They advise the local suppliers of day care as to what that need is. For example, in the Ottawa area there is a day care centre that operates 24 hours a day because in that particular community they decided they needed that kind of service.

The second thing we have done is to build a flexible services program into our total program. Initially, we supplied about $10 million for that. In this current budget year, we have added almost $3 million to that. That has resulted in about 290 projects serving well over 4,000 children. So I think we are recognizing those needs and beginning to meet those needs.

LANDLORDS’ RESTRICTIONS ON PETS

Mr. Philip: I have a question for the Attorney General. On October 14 and December 14, the Toronto Humane Society sent representations, including a brief, to the Attorney General. In that brief they pointed out that as a result of pet exclusion clauses inserted by landlords, some 17 per cent of the animals they euthanize are the direct result of people having to give up their animals because of these pet exclusion clauses. This is some 10,000 animals euthanized, including the animals of senior citizens, disabled people and so forth.

Since the minister has not seen fit to even acknowledge receipt of the brief, let alone respond to it, I wonder if he would tell the House what action he intends to take. Does he intend to amend the Landlord and Tenant Act to prohibit these exclusion clauses?

Hon. Mr. Scott: The problem is presented because people who have pets which they want to keep, then sign leases that have a provision in them that they cannot keep pets on the premises they are renting. Those people must decide sooner or later whether they wish to keep pets or not. If they do wish to keep pets, they should see to it that they do not sign leases in which the landlord extracts a promise on behalf of tenants, for their own benefit and the benefit of their neighbours, that they will not keep pets. That, of course, is in the end, the solution to the problem.

Mr. Philip: If I understand the minister’s position clearly, what he is saying to all those senior citizens and disabled people is that they must choose between having their pet euthanized or having a roof over their head.

Hon. Mr. Scott: No, no, no.

Mr. Philip: That is precisely what he is saying. Where are these people going to move to?

Would the minister not agree that under the Landlord and Tenant Act, at the present time --

Hon. Mr. Scott: What do you do in your buildings, Ed?

Mr. Philip: I do not know why the minister is so upset. I sent him a Christmas gift. It was to help him in his worship services over the Christmas holidays. It was a mirror.

Why would the minister not agree to take the exclusion clauses out of the present leases, since landlords have other recourses to deal with those people who do not act responsibly as pet owners?

Hon. Mr. Scott: It has been perfectly clear that if tenants sign leases that do not have “no pet” clauses in them, there is no court that will evict them from the premises or, indeed, order their pets to be removed unless a pet is committing a nuisance for other tenants. If on the other hand tenants, for whatever reason, go ahead and sign leases that say, “You cannot have pets in this building,” they cannot be surprised if the landlord, in his interest and that of the other tenants, insists on the performance of that lease according to its terms.

That is the present situation. Tenants in the province have to decide whether they wish to live in buildings that do not permit pets or whether they are content to live in buildings that do permit pets.

CONTAMINATED SOIL

Mrs. Marland: My question is for the Minister of the Environment. The minister is aware of a very serious problem that we have in my riding involving lead-contaminated soil in the area of the former Exide Electronics plant and the existing Tonolli Canada plant. He also is aware that during the estimates of his ministry meeting on Thursday, November 24, I did ask him what the plans were for his ministry to meet the commitment it had made to the people in that community that the soil cleanup of the lead-contaminated soil would in fact start in the spring of 1989 and be completed by the fall of 1989. At that time, there was the response that it had to be a tripartite commitment between the municipality, the company and the ministry to pay the cost.

Mr. Speaker: Question?

Mrs. Marland: My question is: Since the city of Mississauga has passed a resolution saying it will not pay for this and has referred the matter to the regional municipality of Peel, and since the regional chairman, Frank Bean, is still waiting to hear from the ministry five months later --

Mr. Speaker: Order. I am sure the minister will find a question somewhere there.

Hon. Mr. Bradley: I was willing to let her go on with further information, because it is very useful.

The member will recall our discussions during the consideration of the spending estimates of the Ministry of the Environment in this matter, and I want to tell her that there have been conversations that have taken place between the Ministry of the Environment and the city of Mississauga at the present time at officials’ level where there was a discussion of the manner in which the city of Mississauga might participate, or the regional municipality of Peel.

Members may recall the example here in Toronto, where the city very quickly and voluntarily said that it would be pleased to participate in that particular kind of cleanup. As a result, we worked quickly with the Ministry of the Environment, working with the city of Toronto and the people in the neighbourhood, to ensure that an expeditious cleanup of the properties did take place.

Those discussions have been undertaken by people within the Ministry of the Environment discussing it with the mayor’s office, and I am hopeful that we will see the kind of progress the member is seeking.

Mr. Speaker: Thank you. I am sure the member will find some answer there to ask a supplementary about.

Mrs. Marland: I think what the minister has to address is the fact that his staff are not meeting with the municipal officials, nor with the mayor’s office. It has been referred out of the mayor’s office to the region of Peel.

What we need to know, what the people in the community want to know, is: Regardless of the financial commitments by whomever, when is this soil cleanup going to start and when is the ministry going to deal with the region of Peel? It has nothing to do with the city of Mississauga any longer.

Hon. Mr. Bradley: The member would know that, just as in the case of the city of Toronto, I guess the city of Toronto could have said it had nothing to do with it and simply say that Metro should deal with it. Instead, it decided that it would be a partner in this.

In the situation in Mississauga, they may have felt that the regional municipality of Peel was the more appropriate organization to deal with this, and I think there may be a way in which the regional municipality of Peel in fact can participate and that is the nub of the discussions that have been taking place by representatives of the Ministry of the Environment and the mayor’s office.

If my recollection is correct, this took place before Christmas, and obviously what has happened is that an approach has been now made, I believe by the city of Mississauga, to the regional municipality of Peel.

As would the member and the residents in the area, I hope to have this matter dealt with at the earliest opportunity.

PETITIONS

HIGHWAY CONSTRUCTION

Mr. Eves: As I indicated during members’ statements, I have a petition here signed by some 3,746 residents of Ontario. It reads:

“To the Honourable the Lieutenant Governor and the Legislative Assembly of Ontario:

“We, the undersigned, beg leave to petition the parliament of Ontario as follows:

“To have Highway 69 widened to four full lanes from Highway 400 extension to Sudbury.”

As I indicated, this petition has been signed by almost 4,000 residents of Ontario. I must congratulate Mayor Roy O’Halloran of the town of Parry Sound for introducing the initiative to get these petitions signed, and the people who are in attendance here today from Sudbury and Georgian Bay township, as well.

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HOME CARE

Mr. Brandt: I have a petition for the Lieutenant Governor in Council and the Legislative Assembly of Ontario, signed by 38 persons from the Hamilton area, which reads in part as follows:

“We are well informed as to the services provided by homemakers to the frail, elderly, infirm, palliative and disabled persons in this community and across the province. We appeal to you to recognize the value and continued need for the services of homemakers who maintain clients in their home environment. Homemakers are not the Cinderellas of society. They are, in many cases, the primary care givers. We urge you to elevate their status and make funds available so that the homemakers can continue to perform this invaluable service to society. We feel homemakers must be given the benefits received by other health care givers, such as pension plan, sick pay, etc. and a decent hourly wage.”

AUTOMOBILE INSURANCE

Mr. Adams: I have a petition from a number of residents of the general Peterborough area.

“We, the undersigned, wish to protest strongly the proposed increase in auto insurance. This increase may not seem large to you, but to us, whether seniors or working parents, this hike is atrocious and totally unnecessary. Please give this your strong consideration.”

REPORT BY COMMITTEE

STANDING COMMITTEE ON SOCIAL DEVELOPMENT

Mr. Neumann from the standing committee on social development reported the following resolution:

That supply in the following amount and to defray the expenses of the Ministry of Skills Development be granted to Her Majesty for the fiscal year ending March 31, 1989:

Skills development program, $406,299,500.

INTRODUCTION OF BILLS

STRATHROY MIDDLESEX GENERAL HOSPITAL ACT

Mr. Reycraft moved first reading of Bill Pr80, An Act respecting Strathroy Middlesex General Hospital.

Motion agreed to.

THE SISTERS OF SOCIAL SERVICE ACT

Ms. Collins moved first reading of Bill Pr61, An Act respecting The Sisters of Social Service.

Motion agreed to.

MOTION TO SET ASIDE ORDINARY BUSINESS

Mr. Speaker: Just before orders of the day, last Thursday afternoon, I received two applications for debate under standing order 37 to discuss a matter of urgent public importance. The first notice was filed by the member for London North (Mrs. Cunningham) and the second was filed by the Leader of the Opposition (Mr. B. Rae).

As members know, according to this standing order, only one motion can be entertained during a sitting. Therefore, as the first motion was received in my office at 2:32 p.m. and the second at 3 p.m., I feel it only fair that I recognize the member for London North to move that motion.

Mr. D. S. Cooke: What’s fair about that?

Mrs. Cunningham: The member is smiling; he must think it is fair.

Mrs. Cunningham moved that pursuant to standing order 37(a), the ordinary business of the House be set aside to discuss a matter of urgent public importance, that being the funding crisis for home care services in Ontario and, in particular, the imminent termination of the homemaker program offered by the Ontario Red Cross because of the present government’s mismanagement, total lack of leadership and absence of planning for the future with regard to this matter, which will lead to the loss of home care services in many communities, particularly in rural Ontario, resulting in a great deal of uncertainty for seniors and disabled people who are threatened with the prospect of losing their independence.

Mr. Speaker: Members have heard the motion, pursuant to standing order 37(a), by the member for London North. As I indicated earlier, this motion was received in time and therefore I have to consider an order.

I will listen to the member for up to five minutes, giving reasons why this House should debate this matter. I will also listen to two representatives from the other parties for up to five minutes.

Mrs. Cunningham: There are many reasons why this House should enter into an emergency debate on a very important service that has been offered for literally decades in Ontario, and that is the Red Cross homemaker service.

In the last provincial election campaign, the Liberals promised the people of Ontario that, if elected, they would move to shift the health care focus of the province from an institutional to a community-based approach. Expectations were raised and waiting lists increased.

Two years later, we witness increased frustration of health care providers unable to adequately meet the demand of the public and the growing discouragement of those in need of homemaker services that would allow them to remain in their homes rather than face unwanted institutionalization.

Specifically, the people of Ontario were promised by the Liberals in September 1987 that 28 centres providing homemaker service would be up and running in the next year. At that time, 18 centres were in place; and two years later, there are still only 18 centres providing homemaker services in this province. A recent glance at the estimates briefing report for the Ministry of Community and Social Services showed that for the next fiscal year, the government has capped homemaker centres at 18. These centres were to form the foundation for community-based health care services in Ontario. Many are now on the verge of collapsing.

We are in a state of crisis, and I think it is worth a debate in this House so that the citizens across this province will understand why we are concerned in opposition and what the Liberal government is going to do about it.

Current funds announced by the government to meet stated deficits will merely act as a temporary and precarious bandage. It is not meeting the demands.

The estimates briefing report also showed that despite the Liberal government’s promises, it underspent this fiscal year’s estimated budget for integrated homemaker programs by $5 million. We wonder about the true commitment on behalf of this government to a very important program, one that should have a vision and a plan for the province.

This debate is called to discuss the Liberal government’s failure to adequately address the needs of Ontario seniors and disabled and maintain its commitment to a community-oriented health care system.

This lack of planning and leadership is also accompanied by flagrant mismanagement on the part of the government, further eroding the future viability of community-based health care services in this province. Homemaker programs have not been adequately administered, but the fault lies with the government itself, not the program providers.

A government interministerial report on integrated homemaker services found that the government failed to adequately administer and manage these programs. This report was released some eight months ago, and as yet the government has failed to move on any of the recommendations which are crucial to the future viability of homemaker services.

Many of the recommendations are for the establishment of a rate-setting process. This is a management process, one that this government is responsible for. Currently, the rate reviews for programs are a sloppy process with no formal structure in place. The Liberal government has not required budgets to be submitted for review -- if one could imagine such a step -- and has failed to approve increases to budgets which are above the level of inflation. With no review, how can the government adequately assess the needs of the programs and future demands? We would very much invite the government this afternoon to tell us about its processes, whether they are working and whether it too is concerned about them.

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The interministerial report further states that when a budget is submitted little attention is paid to the needs of the client -- the people who were here, to support programs for the people who are paying the taxes in this particular province. The special demands of service delivery are not adequately addressed or the real costs to the organization in providing the homemaker services.

The Liberal government has failed to look at the true cost of delivering these services. That is the responsibility of the government, not the service provider. It is our responsibility to check out programs, to make sure they are working and to fund them accordingly. That is the role of government. While accusing the Canadian Red Cross Society of poor administration, the honourable minister fails to understand what components make up the administrative cost. The Red Cross, because of the insufficient number of service providers employed, is now sending staff out to three different locations a day.

Mr. Allen: The homemaker services of Ontario were in crisis two years ago and at that time the government bailed them out, covered their deficits and established an interministerial committee to bring in a report examining the circumstances of the homemaking services in Ontario and in the meantime undertook to establish integrated homemaker services.

There was a crisis two years ago; now we have another bailout. Nothing has been done to follow up the report that was finished a year ago and circulated to all the homemaking services in Ontario. Good feedback came to the minister. The minister in fact has known for two years what the proportions of this problem are.

The fact that nothing has been done to address the fundamental issues raised by the interministerial report constitutes the crisis today. The fact that the minister responded to the deficits once more is an indication that a crisis not only exists and continues to exist but has really not been touched. The interministerial report said flat out that the central issue for the provision of homemaker services today was the provision of adequate wages somewhat above the average of $5.60 per hour that homemakers make.

In order to maintain workers in the field to keep the service operational so that the clients of the service -- whom we all recognize as being very needy with respect to the service -- would in fact be served, what the minister has done and what the government did on Friday afternoon to bail out the Red Cross and several of the other homemaking services does nothing to address that question.

The problem for the clients has been the revolving door of service that has smitten homemaker service after homemaker service across the province, as retirement rates from the service have grown 20 per cent in some places right through to about 120 per cent in another, meaning that continuity of delivery has been impossible, the satisfaction that clients receive from being attended by someone they know is gone and homemaker services have to feed training dollars after training dollars to retrain new homemakers in their service.

In order to try to make ends meet, those agencies have tried to spread their homemakers more thinly, but that has meant more travel and therefore more travel costs, which the minister does not cover and which are only covered by some of the homemaker agencies. Indeed, there are homemaker agencies out there that do not cover the travel costs, and the individual homemaker has to cover those costs. There have been escalating costs of that kind in terms of compensation and in terms of long-distance telephone communication, which is necessary in order to keep people in the field in operation, that are quite outside the control of the agencies.

By simply covering the deficit, the minister and the government are in fact not addressing any of those issues. They are simply addressing, if you like, the status quo antebellum, the state of affairs before the real war broke out this afternoon when we met 500 homemakers on the front steps of this Legislature, a most unusual event.

When 500 homemakers, who normally do not kick up their heels in protest, finally resort to the desperate expedient of coming to the front steps of this place to tell us how serious their situation is, they are the best people to tell us whether there is a crisis. Any words in embellishment of any of their arguments on the part of myself or the member who just spoke do not paint, in any respect, the colourful case they can give us.

They tell us about the time they have spent on the job. They tell us about the training they have undertaken. They tell us about the care they give to the persons they serve. They tell us about the extreme dependence of those persons and how much they need that care. They also tell us how much they save the government, and it is extraordinary what the difference is.

Therefore, it seems to me that even on the basis of financing alone there is a crisis, because money is being spent which should not be being spent and which the government could be relieved of by providing economical and straightforward home care service as necessary.

Hon. Mr. Conway: I want, on behalf of the government, to speak to the motion standing in the name of the honourable member for London North, who it appears has had a very busy weekend, what with her drafting of emergency motions and her widely reported sermon in the Stratford Central United Church yesterday.

I just want to say to the honourable member and to her colleagues on the opposition benches that it seems to us in the government that the steps taken last week by the Minister of Community and Social Services (Mr. Sweeney) on behalf of this government indicate the willingness of the Peterson government to continue to address the very real needs and concerns which have been identified by the Red Cross and by others in the community.

I suppose, as the government moved last week to address the specific issue that was of concern to the Red Cross, we could presumably argue that this debate ought not to take place. But I recognize the interest of the honourable members opposite to press the government on the additional issues which have to be considered and addressed, and I welcome, quite frankly, the opportunity to spend an afternoon in this Legislature to welcome those from the homemaker community who I know are in the area today, watching perhaps, after the very interesting speeches made by the member for Sarnia (Mr. Brandt) and the member for York South earlier today, and tell them that we as a government do not see there is any lack of leadership. Quite to the contrary.

Our colleague the Minister of Community and Social Services has over the last three years and some months moved, I think with expedition and with effect, to address many if not all of the concerns in the community. I would be the first to say, and I know my friend the member for Kitchener-Wilmot (Mr. Sweeney) will agree with me, that of course more remains to be done. When we have addressed all the needs in the community in this and other matters, then we will know we have been transported to another place.

I say to my friend the member for London North when she says that there is a lack of leadership, that there is a crisis, that is not a view I share. I appreciate her concern. I point to the very considerable improvements this government has made over the last number of years. I want to speak personally for a moment, because the motion standing in the name of the member for London North draws our particular attention to the situation in rural Ontario.

I say to my friends the member for London North and the member for Hamilton West (Mr. Allen) that I represent one of the most rural constituencies in this province and I can say without fear of contradiction that over the last number of years, because of the kind of leadership the government has shown and the minister has exhibited, the conditions in rural Ontario have improved significantly.

Throughout the course of my Christmas visits in the Ottawa Valley, the Red Cross came to see me to indicate that it wanted the deficit question addressed. I told them then what the minister has indicated throughout the piece, that while we were very anxious to work with those who provide the homemaker services, including the Red Cross, to look at the deficit question, we were willing to admit that there were a variety of other issues that had to be addressed at the same time.

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To be sure, the opposition points out that the answer is simply to increase the funding. As the Minister of Community and Social Services will point out shortly, we have made significant improvements in the enrichment of homemaker services over the last number of years. When the government committed millions of dollars just some months ago to the integrated homemaker program, that was new funding for a new program. I believe -- and the minister can correct me -- that this year we will be spending something in the neighbourhood of $40 million for that relatively new program.

Of course, the demand that we have identified has been very significant indeed, and we intend to work with the very valuable providers of the homemaker services. I would be the first to say that, in my communities, the Red Cross plays an enormously important role in the provision of these homemaker services. They are not the exclusive delivery agent, but we recognize the enormous contribution they have made, and we intend, as a government, to continue to work with those providers.

I want to say on behalf of rural Ontario and on behalf of this government that under the leadership of the Premier (Mr. Peterson) and the member for Kitchener-Wilmot, we believe our record is good and our commitment is strong, and we consider the prospect for future advancement to be very positive indeed. We do not share the view that there is a crisis or, certainly, that there is any lack of leadership.

Mr. Speaker: We have now dealt with the motion of the member for London North under standing order 37(a), (b) and (c). We come to 37(d), and it appears from the comments made that members wish the debate to proceed. However, according to the standing order, I must put the question. Shall the debate proceed?

Agreed to.

Mr. Speaker: I remind all members who wish to participate that they may take up to 10 minutes. The debate will continue until we have run out of speakers or the clock strikes six. The member for London North, for up to 10 minutes.

HOME CARE

Mrs. Cunningham: I found the government House leader’s statements most interesting. I suggest his statement that many if not all of the concerns about the needs of the community have been or are very closely being met by this government is most interesting.

Certainly, one of the real needs of the community of the province of Ontario has a lot to do with taking care of people who are not able to care for themselves. We have been told over the last few months that the cost of health care in this province is out of control and spiralling. The government has also told the hospitals and people in charge of the delivery of medical services that they had better be very careful with their budgets. At the same time, we have seen waiting lists for different surgeries and for hospital beds on the rise -- long lists.

We have been told that community-based health care services are what this government will support. At the same time, we see in the nursing homes and homes for the aged long lists of people waiting to be admitted. We also see long lists of people waiting for some kind of respite care in this province. These are very expensive services and they are services that the people of our province are deeply in need of.

I think one of the most efficient ways of delivering service to our citizens is through a homemaker program. Therefore, we do agree with the government that it is a very important priority; it is one that is certainly fiscally the most responsible. I would think, for the citizens who would want to remain in their homes as long as they can, whether they be disabled, ill, elderly or just tired of being able to take care of themselves because of failing health and age, they would want to be home; and we should be supporting that.

Homemaker services for the elderly in rural Ontario will be especially seriously jeopardized if the province refuses to cover the Red Cross Society’s $1.1-million homemaking deficit. That was the criticism last week. I would suggest that this was the one that the government chose to listen to. In fact, they did. They met that deficit.

In doing so, they were just partially addressing the real needs of the Red Cross and of other homemaking providers across this province. The real problem, I think, for this government is to put forth a policy that it believes in, that makes good sense and that it can support, a policy that the people of the province understand.

It was this government that promised during the election of September 1987 that it would be supporting increased homemaking services. It established an interministerial committee to look at the need and to look at the kinds of expectations that would have to be met on behalf of the public, the service providers and certainly the clients.

They looked at many recommendations. We are very pleased to take the time to thank the people who had input to the committee in the establishment and the writing, finally, of the Report of the Interministerial Committee on Visiting Homemaker Services.

I would suggest that it has been almost a year that the government has looked at the recommendations of that report. Meeting the deficit was just the beginning. Taking a look at the kinds of recommendations and problems in service delivery, the challenge to this government is the other part of the picture and the one that the Progressive Conservative Party is equally concerned about -- not just throwing money, not simply increasing funding, as the government House leader suggested, and not just providing new funding for a new program.

If this program were to continue being delivered the way it is now in Ontario, it simply could not survive. We know that one of the greatest challenges in delivering this program is having people to provide the service. We have many, many dedicated providers of a home care service working across our province. They start out with wonderful expectations, they start out with wonderful energies and wonderful hopes of being able to help other people. The real problem is that we cannot keep them.

We ask them to work long hours. We pay them rotten wages. We ask them sometimes to travel long distances. We pay them mileage. We do not pay them for the total time it takes to drive to locations very far away. We accuse them of having great administrative costs. Sometimes, in some of the service areas that we have been in contact with -- sometimes they have contacted us -- they advise us that perhaps two people are responsible for overseeing the work of some 67 homemakers.

I would suggest that administratively, in the true sense of the word, this particular service is extremely efficient. What we are looking at is a total lack of understanding around the high cost of transportation, around the high cost of training and keeping people in the job and around the very low cost to our government with very low wages.

We should be looking seriously at this report where there are a number of recommendations around training, some seven, and where there are a number of recommendations around wages, about 10. On one that I spoke on earlier this afternoon, the rate-setting process recommendations, we are looking at some seven. Finally, we are looking at recommendations that have to do with rate structures.

This particular service has been studied to death. What this government is extremely famous for is soliciting reports, soliciting input, asking for people’s advice, saying that it will be an open government, that it will ask the public and the citizens to participate in the democratic process, and then turning a deaf ear and doing nothing.

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I personally have the greatest admiration for the minister. I think his real problems lie in persuading some of his colleagues that if the government is going to make promises and is going to meet the needs of the people in Ontario, especially around homemaking, thereby allowing people to remain in their homes, it is going to have to start listening.

One would never criticize for one moment this particular report. As a matter of fact, it is the government’s own report. We have the Ontario Association of Visiting Homemaker Services helping us along, the Canadian Red Cross Society helping us along, the Visiting Homemakers Association (Toronto) giving good advice, the Ontario Municipal Social Services Association giving good advice, the Ontario association of home care associates giving every good piece of information it can give us, and individuals and groups such as the Community Concern Associates Ltd.

We could go and on. The government could not get better advice. Sooner or later, it has to bite the bullet and say: “We are not going to increase the number of hospital beds. We are not making more room for the elderly and people in need in homes for the aged and municipal homes. We are not going to increase hospital costs by having people in respite care in hospitals if it is not the most efficient way of providing a service.”

The only other viable way is to support a program that has been in existence for some 65 years. I think the government should be ashamed of itself for not showing leadership and saying: “This is our plan. This is what we are going to support.” Surely we do not always have to wait for threats of emergency debates, threats of marches on Queen’s Park, threats all the time of someone or other calling a press conference to get some action from this government.

Mr. Speaker, I thank you for the time. I hope the government members are listening. I am sure the minister will take the advice he receives this afternoon seriously.

Mr. B. Rae: I want to participate in this debate because this is an issue that has concerned me and members of my party for some time, perhaps particularly because there are so many members in the House who were not here during the Tory government and perhaps will not be as aware as the minister certainly is of the fact that there are many issues. Some were here for about three weeks while we had a Tory government, but that was an unreal period.

Mr. Reycraft: That was enough.

Mr. B. Rae: That was enough, but that was a slightly bizarre time.

I am talking about the long debates we have had in this House, going back at least a decade, on this question of homemaker services, and also, if I may say so directly to the minister, on this question of the relationship between his ministry and the Ministry of Health, in dealing with not only the question of homemaker services but also the question of service and care for the elderly generally.

I am aware of several studies that have been done internally on the relationship between the Ministry of Health and the Ministry of Community and Social Services. I think one of the really frustrating things, which one cannot get at in any detail in question period because of the nature of the beast, is the length of time it has taken this government to come to terms with some of the real institutional problems in the delivery of service and with some of the absurdities, the administrative complexity of this service that is being provided and the cost that imposes on all the agencies.

If I can just mention one example, it is not widely known, but it should be, that the Red Cross has to negotiate well over 200 separate contracts and separate rates with separate municipalities and areas in providing for home care on an annual basis. It makes absolutely no sense for there to be so many incredibly diverse rates, ways of doing things, ways of administering these contracts.

It would be far better and far simpler and would make so much more sense if there was one central contract, if you will, between the government of Ontario and the agencies providing for homemaker services and if the per diem rates and the per hour rates that were paid were negotiated on an across-the-board basis.

The leader of the third party said it was the question he asked on Thursday that caused the minister to come up with the money on Friday. I suppose I could claim it was the press conference I held on Friday morning that caused the minister to do his thing on Friday afternoon. Whenever I hear of those claims, I am always reminded of the person who thinks he caused the beginning of the hockey game because he joined in the singing of the national anthem.

I have no idea what caused the minister to change his mind or what battles took place within the government over the last week about whether to provide funding for these deficits. What I do know is that as I sat and watched questions from my colleague the member for Hamilton West and others during the last week, I could not figure out what the Liberal Party was gaining from failing to deliver on something for the Red Cross. I was asking my colleagues: “Where is the political advantage in being seen to be stingy with the Red Cross of Ontario? Is there something that’s gone on here that I don’t understand?”

I still cannot figure it out, but what I think needs to be said and emphasized is that there is a profound structural problem with the delivery of home care and with the delivery of care at home generally. I think the explanation has to be that home care has been the weak poor cousin of the social service-health care system. That is the essential problem. The essential structural problem we are dealing with is that health care and the social service component of health care, and that is really what this is, has always been seen as essentially an institutional system. Anything that takes place apart from that has been very much an add-on and very much a weaker sister in the system.

That problem was true when I got here in 1982. One of the first things we did in my party was to start a task force looking at care for the elderly across the province. It was an education for me as a member of that task force -- my colleague the member for Windsor-Riverside (Mr. D. S. Cooke) was also a member of the task force -- as we travelled across the province and listened to the problems endemic to Tory Ontario, as it then was, in the delivery of care at home.

We found there was no central piece of legislation that covered overall care at home. There was legislation on home care, legislation on visiting homemakers, but nothing on all those people who needed care and were not getting care. Now this government has improvised and created what it calls the integrated homemaker program, which was a build-on to what the Tories were already doing when Frank Drea and Larry Grossman were the Minister of Community and Social Services and the Minister of Health respectively.

I think it must be said that we really have not seen the administrative, the power change in the system of delivering care at home that needs to accompany the kinds of policy changes that are being talked about in the interministerial report. The interministerial report talks about wages, working conditions and training, and it also talks about the administration of the service. In each one of those areas this government simply has not moved.

The minister will say, as I know he will, “Look, when I took over in 1985 there was no money in the integrated homemaker program. Now, there is” -- well, there was supposed to be $43 million but there is only $40 million because we had the Treasurer’s (Mr. R. F. Nixon) cutback of September. “That money is there and it is new money.” He will also say, and if he will not I will say it for him, “The home care program in 1985 was spending a little over $150 million and now it is spending upwards of $285 million.”

So it is obviously an area that has expanded, but it has expanded because the demand for the service has expanded. It has not expanded because the quality of delivery of the service has improved dramatically.

One of the ironies of the minister’s announcement on Friday is that the announcement will not increase the wages of a single homemaker in this province, because what is it designed to do? The announcement on Friday is designed simply to cover the operating shortfall that is built into the budget of the Red Cross of Ontario for this past year.

In talking it over with the Red Cross people on Friday morning before our press conference, it became very clear that as much as they might like to see a higher wage structure, they are simply not in a position to do it. All they are doing is passing on the money they get from the government, as well, of course, as providing supervisory and administrative help for those people. That, again, is a bone of contention between the Red Cross and the minister because of the things he and others have said about the efficiency of the administrative overhead and the supervisory costs involved in delivering the service.

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My approach would be this: If the government is going to have a Minister without Portfolio responsible for senior citizens’ affairs, it should give the minister for seniors something to do. It should give the minister for seniors a line responsibility. It should let the minister for seniors take responsibility for nursing homes, for homes for the aged, for the delivery of home care and give that ministry the budget to deliver services for seniors at home and in the community in a comprehensive way, instead, if I may say so, of having these turf wars between the Ministry of Health and the Ministry of Community and Social Services carry on indefinitely and homemaker services provided at such a minimal, poor and inadequate level when it comes to people in the community.

My colleague the member for Windsor-Riverside was saying he had a call from somebody in his constituency who was saying that he had homemaker services for a year and that during that year he had 12 different homemakers. A homemaker is somebody who comes into your home, somebody who has a relationship with you. It is impossible to run a fair service and a good service if you have turnover levels that high, and it is impossible to stop turnover that high until we start building in a wage structure, a reward structure, a recognition structure for those people that is worthy of the name.

It is the problem we have in hospitals, the problem we have in nursing homes, the problem we have in care at home. Unless we pay enough and unless we take the service as seriously as we take care in institutions, in hospitals, it will continue to live from year to year, from hand to mouth and will continue to deny seniors and others the care they need at home. After all, if they do not get it at home, they are going to have to go to an institution.

Mrs. Marland: In rising today to speak in this emergency debate about the funding crisis for home care services in Ontario, and in particular the imminent termination of the homemaker program offered by the Red Cross because of this government’s mismanagement, total lack of leadership and absence of planning for the future with regard to this matter, which will lead to the loss of home care services in many communities --

The Deputy Speaker: Order, please.

Hon. Mr. Sweeney: My apologies to the member for Mississauga South, but I believe I stood but was not recognized. It is the Speaker’s decision to choose.

The Deputy Speaker: I am sorry. I did not see you. I am being told it was the Liberals’ turn to speak, was it not?

Hon. Mr. Sweeney: I believe the understanding is that we would make the normal rotation. Thank you, Mr. Speaker.

As our House leader has indicated, we also welcome the opportunity to participate in this debate. I believe the emergency nature of the debate that was suggested last week has been temporarily resolved, but I have no quarrel whatsoever with my colleagues in the two opposition parties who say it does not respond to the larger question.

As a matter of fact, I remind honourable members in the two opposition parties that is precisely what I said last week myself when I was responding to their several questions, that simply dealing with the deficit of the Red Cross was only the tip of the iceberg and the much larger problem with respect to home support services for the elderly and the disabled in this province was in fact below the surface, and that we had to take cognizance of all that if we were really going to come to grips with it.

That is why I am a little bit surprised to hear the criticism today, “Oh, all you have done ....” We clearly indicated last week that was the situation we were in as well as the government, and that I was in as the minister, in trying to come to grips with the much larger picture, in trying to come to grips with the recommendations of the inter-ministerial report, where we would deal not just with the deficits that have been brought to our attention, but also with the whole question of wages, with the whole question of rates, with the whole question of training, and if I may very briefly respond to the comments of the Leader of the Opposition, with the much bigger question of the role of home support and homemaker services and a whole range of community services, compared with the amount of resources we are currently allocating to the institutional side.

I want to say that I share a lot of the concerns and a lot of the support recommendations that have already been expressed. They are precisely the areas that I, as the minister, am working on at the present time, and that the Minister of Health (Mrs. Caplan) is working on at the present time.

I also want to point out that while we say that in dealing specifically with homemakers we cannot isolate just the deficit. If we are going to talk about the whole question of community supports for our elderly people and for our disabled people, then there is more to that than just homemakers. We have moved on a number of fronts to recognize that there are a number of services and a number of supports that must be made available.

We have spoken today specifically about the homemaker program and the figures have already been pointed out. Two years ago it was nothing; last year it was $20 million; this year it is $40 million. Those are the dollars that are actually going to be spent. That is a significant increase. I will be the first one to say that it does not meet all the needs but it would, I think, also be incorrect to say that we have not recognized certain specific needs, the need to do things in different ways, and begun to respond to those.

Let me also point out to them that we have improved a number of other home support services. The honourable members may be aware of the total range, just two years ago, of home support services other than homemakers themselves, support services that provide for relief for families, that provide for Meals on Wheels or Wheels to Meals, that supply home maintenance programs of a whole range of sorts to elderly and disabled people; that program alone has gone from $12 million to $40 million just in two years.

Once again, we recognize that if we are going to assist elderly and disabled people to stay in their own homes, or to stay with their families, they need more than just homemakers’ programs.

Let me point out that the home care program operated by the Ministry of Health has gone from $195 million to $285 million, an almost $100-million increase, recognizing the value of trying to prevent people from going into hospitals or chronic-care facilities in the first place, and if they are in there, getting them out as quickly as possible and back into the community. A component of that program is $53 million for homemaker services alone.

Therefore, there is a very significant recognition of the changing needs of the elderly and the changing needs of the disabled, and of the fact that there are more disabled in our communities now because they are coming out of institutions and they are not going into institutions. The advances of medical science are saving more people who would have expired otherwise and we have to provide services for them. We know, as someone has already mentioned, that the elderly population is growing at a rate of about three per cent a year and that we have to deal with that. We have to find different ways of responding to their needs.

We know from the report, A New Agenda: Health and Social Services Strategies for Ontario’s Seniors, that my former colleague Ron Van Horne published almost two years ago now, that there were some clear recognitions of the changing nature of the elderly population. Just because people are older does not mean they are sick, and therefore we have to have an entire new geriatric way of looking at them and the Ministry of Health is doing that.

We clearly indicated that we want to expand the home support programs. We have done it with the integrated homemaker program, with the home care program, with the homemaker and nurses’ services program, with the home support program. They all add up to a total budget right now of $378 million. That is the growth just in two years from $222 million.

That is significant new amounts of money being put into that program, but what it also recognizes is a much broader, much wider figure. For example, when we took over, it was drawn to our attention with respect to the range of home support programs, that the government at that time was paying only 50 per cent of their costs, and these various agencies said, “We can’t meet the needs with that.”

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We have increased that to 70 per cent with respect to our elderly persons centres, which our older people want to be able to use if they are going to remain in their own homes instead of going into institutions. We have increased them by 50 across the province.

We have also increased their annual funding from $15,000 to $30,000, once again recognizing the needs of the elderly population today compared to what those needs were earlier.

Senior volunteers have been given significant increases in the stipends made available to them so they, as seniors, can help their fellow seniors.

We were told that in remote areas there are problems with transportation services, so both last year and this year in our budgets we put $1 million in to provide for new vans across the province and for the operational costs of those vans.

All of these are recognizing the changing needs of elderly people. I would say that these resource allocation figures are one of the ways of doing that.

The honourable Leader of the Opposition said that there needs to be greater collaboration between my ministry and the Ministry of Health. That is going on at the present time.

We are currently trying to do many of the things he has just spoken about: putting together under one roof, under one umbrella, if you will -- no decision is made as to what the home base is going to be -- all the services for the elderly people in this province, and to a certain extent, because they require similar services, many of the services available for the disabled.

I will repeat something I said in question period: that since there is such a demand for resources for existing institutional services, particularly within the Ministry of Health, we constantly have to be trying to readjust our budgets and reallocate those budgets to meet those changes.

I want to also point out to the honourable members some of the significant increases that we have allocated within my ministry alone. When we became the government in 1985, the total budget for that range of home support services was $7.1 million. Today, it is $40 million. The Alzheimer’s programs which we have in our communities now, which did not exist at all just two years ago, are now being allocated $7 million, and more will be allocated in the coming budget.

Support for our elderly persons centres, which provide an outlet and a day program and a range of options to our elderly people -- who surely are not going to stay in their homes all the time; there has to be another range of homemaker programs -- has gone from $1.5 million to $4.5 million. Every one of those programs has doubled just in the last year alone, which is a clear recognition that we do have some kind of a vision of what the range of people’s needs is.

We do have some sense of commitment for allocating resources to them and we do agree that there needs to be a much more comprehensive approach to how we meet those needs, how the Ministry of Health, the Ministry of Community and Social Services, the Ministry of Transportation and the office for senior citizens’ affairs, how a whole range of government ministers have to co-operate and co-ordinate their activities so that we can begin to recognize what it takes to assist elderly people and disabled people to stay in their own communities, and how we are to assist them not having to go into an institution in the first place. If they have gone into an institution and do not want to stay there and do not need to stay there, how do we assist them to move back out into the community?

It is not just the deficit; it is not just homemaker services; it is that whole range of services that we are looking ahead to solving. I want to say to my colleagues that we clearly recognize that that range of comprehensive services has to be put together. We are in the process of doing that. The announcement I made on Friday was in response to an emergency at that point in time. I recognize, as honourable speakers have already said, that the Red Cross is providing a valuable service and must be assisted to continue to provide that service.

The Deputy Speaker: The member’s time is up.

Hon. Mr. Sweeney: That is all Friday’s announcement was intended to do.

The Deputy Speaker: Before the next speaker, may I make a small explanation, please? Since the member of the third party presented that resolution when she made her speech, it was normal at that point for the member of the official opposition to then make his presentation and to end up with a member of the government party.

Once we vote on it, then what we have always done is have a normal rotation, starting with the person who made the resolution, which was the member for London North. Afterwards, the turn should have come to a government member in the normal rotation.

Having seen no one stand up -- and I am sorry if I did not see you, Minister -- then I proceeded with the Leader of the Opposition. The next member should have been a member of the third party. I had it right, but I presume that members did not understand it this way. So, since you have started going the opposite direction, then maybe we shall, for the rest of the afternoon, go counterclockwise, beginning with the member for Mississauga South (Mrs. Marland).

Mr. R. F. Johnston: Let’s just call the whole thing off.

The Deputy Speaker: Is there an agreement to go counterclockwise as an exception for this afternoon?

Agreed to.

The Deputy Speaker: Then in this case, the member for Mississauga South can make her presentation.

Mrs. Marland: In rising today to take part in this emergency debate, which is “to discuss a matter of urgent public importance, that being the funding crises for home care services in Ontario and, in particular, the imminent termination of the homemaker program offered by the Ontario Red Cross because of the present government’s mismanagement, total lack of leadership and absence of planning for the future with regard to this matter, which will lead to the loss of home care services in many communities” across this province, I think what probably disappoints me the most about having to have this emergency debate today is the fact that the people who require homemaker services have for the last 12 months and more been traumatized by the threat of losing those services.

If there is one thing that I think this government has to deal with, apart from trying to keep its many election promises to the public of Ontario, it is the fact that the Liberal government makes marvellous campaign promises, makes even more marvellous throne speeches and even more marvellous budget announcements. When they do all this public speaking, they promise everything to everyone, but in the delivery of those promises we see a very huge void.

I think, because of the people who need homemaker services in this province, this particular issue is very sensitive to a large number of people and it has been totally mishandled by the Liberal government of today. It is very unfair when people are used, and I feel that the fact that people in Ontario have been used on this issue alone of Red Cross homemaker services to the extent that they have shows a lack of commitment and caring by the current Liberal government of this province; the fact that indeed, until Friday, the people in this province who need homemaker services were being held to ransom.

How interesting that when we are on the eve of a full-blown demonstration here on the steps of Queen’s Park today and on the eve, technically speaking, of what the Liberal government knew would be an emergency debate called for by my colleague the member for London North, on the eve of her resolution requesting that this emergency debate take place, how ironic that, like some magician’s bag of tricks, suddenly the government announces the necessary funding as a lifeline to the Canadian Red Cross Society and, whoopee, here today we have the infusion of the funds so that the Red Cross homemaker service can continue.

I want to tell members that the people of Ontario will not be fooled. The people of Ontario can see through hollow promises and the people of Ontario can certainly see through the idea that they can be held to ransom to a point of elevated levels of anxiety. These people we are talking about are people who are already ill, frail, elderly, disabled. They did not need this crisis, which they have been facing psychologically with the threat of these services being removed. Every one of us in the Progressive Conservative caucus, and speaking for myself and my own constituents in Mississauga South, has been receiving very anxiety-laden telephone calls from our constituents who need these services.

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When you look at this interministerial committee on visiting homemaker services, a report by the Liberal government’s own ministries, and you read very clearly what these recommendations are, it is hard to understand, as this report was presented to the government -- I am just trying to find out when it was presented. I cannot find the date on the report -- as this report was presented, I think it is fair to say, at least six months ago -- I am right, June 1988, which is soon going to be seven months ago -- as it is not an outside study but an internal, interministerial report and its own ministry staff have come to these conclusions, how is it that it can take the government seven months before it finally decides yes, maybe it does have enough money to bail out the Red Cross at this point?

That is what it is; it is a bailout. What we want to see on behalf of the people of Ontario -- that is we, the Progressive Conservative Party of Ontario -- is some long-range planning and protection.

There are a number of recommendations in this interministerial report which must be implemented, one of the most important being an increase in wages for homemakers. Currently the homemakers earn the minimum wage or slightly more for this essential service. While I talk about what they earn, I want to tell the members that, by comparison, there are other people employed in this province who have, in a caring sense of service, a far greater responsibility to human beings.

I suggest that perhaps the Red Cross homemakers who care for people who are ill, frail, elderly or disabled have to be paid more than do people who work at McDonald’s, or perhaps somebody who is a cheese cutter in a factory. We may look at what letter carriers earn. Certainly they start at $12 to $15 an hour. Lunchroom supervisors get $10-plus an hour. Bell telephone installers start at $10.50 an hour. So it does not bear too close examination to compare the fact that these Red Cross homemakers are grossly underpaid for the responsibility they have and the service they are expected to render.

No wonder the programs have a hard time keeping staff on. The Red Cross has a 75 per cent turnover in homemakers because of these low wages; wages which are determined by the Liberal government. In other words, three out of every four homemakers quit before a year is out. Consider the vast amounts of funds needed to hire new homemakers and then train them at that rate.

Integrated homemaker programs in Ontario have deteriorated to such an extent that it will take increased funds and improved planning to bring these services to the level they should be operating at. According to the National Advisory Council on Aging, home care costs about 11 per cent to 14 per cent of institutional care. By investing in homemaker services today, Ontario would significantly reduce the health care tax burden on future generations. Unless community-based services are established, Ontario’s elderly and disabled will be forced into institutions. Institutional care costs at least $100-plus per day while homemaker services, as I have said, cost an average of $10 a day.

Given the current population trends, by the year 2030 one in four Ontarians will be a senior. With the increased demand on the health care system, there will be no hospital beds for anybody under age 65. When we look at the shortage today of nursing home beds and chronic care beds, let alone hospital beds, we know we cannot afford not to have a homemaker service keep these people at home. It is the right of these individuals to be at home with auxiliary service for them.

While I speak about the future of seniors, and goodness knows we are all on our way there -- since the day we were born, I might add -- I would like to read from the Ontario Coalition of Senior Citizens’ Organizations, over the signature of the co-ordinator, Cathy deLeeuw. This letter is to the Minister without Portfolio responsible for senior citizens’ affairs (Mrs. Wilson). She says: “We are disappointed that you did not confirm your role as advocate for senior citizens in this province by publicly supporting the Red Cross Society. We urge you to press the Treasurer and Premier to keep their promises and make visiting homemaker services a priority for funding.”

Also, the Association of Jewish Seniors said, writing to the Treasurer, “What do you intend to do, may we ask, to guarantee the viability of these essential home support programs this year and in subsequent years as the ageing population imposes higher demand?” They do not want to be warehoused in long-term facilities.

I respectfully ask the Liberal government to pay heed to the people of Ontario.

The Deputy Speaker: As we are going counterclockwise, the member for Scarborough West.

Mr. R. F. Johnston: I am happy to participate in going the wrong way around. Some people say it has been my role in my life. Being long in the political tooth has certain benefits and certain detriments.

Interjection.

Mr. R. F. Johnston: What was that, Corky? Sorry, I should not use those familiar terms in the House. I apologize to the member for Sudbury (Mr. Campbell) and the Deputy Speaker.

Let me say this: The minister has been around this place a while, I have been around this place a while and this issue, unfortunately, has been around this place a long while as well. It strikes me that it is important to have a debate. One could say that the immediate emergency, the immediate crisis, has been taken away by the announcement late last week that the deficits would be assumed.

This is not the first time deficits have been assumed. This is not the first time that great, venerable institution in our society, the Red Cross, has felt itself so under the gun and so inappropriately funded for what it is trying to do for some of our most needy citizens in the province. For that reason, it is appropriate that we still consider an emergency debate in terms of the crisis they are facing and the crisis that is imminent for many older and frail people in our society who want to stay in their homes. Like many members of this House, I have family in this position, and we are always concerned about the nature of the home support services that are available.

The minister is right to give the listing of the various augmentations to service that have taken place over time and the large increases in money that have been required to meet these service changes as we try desperately, one hopes, as a society to avoid institutionalizing people before it is absolutely necessary and, in most cases, to avoid that requirement at any time in their lives so that people can lead their lives fully within the community.

When I look at what has happened over the years to the kinds of voluntary agencies in the nonprofit sector which are trying to provide support services, I wonder how they manage to keep going. It is hard enough to get volunteers at all these days. It is hard enough to get people who will come in and be board members, let alone to try to provide a basic, necessary service now, one which is replacing institutional care, and to do that at salary levels which are causing the kinds of turnovers that these agencies are finding.

I find that this government has still not got its head together around co-ordinated home care, still has not got co-ordinated legislation in place that is really required, still has not sorted out how to deal with that difficult mix between social services and health requirements for those people who are at home, still has not decided where it stands on the question of profit and nonprofit in this sector -- and that is also of great concern to me -- even though this is not the first crisis and this is not the first time we have had this institution and other homemaker services telling us that they may have to fold, until at the very last minute the dollars were found to bail them out. The government still does not have a plan. In fact, all they could do was to come up with a buying of time, assuming deficits now and deficits that will be imminent, but not knowing where we are going on all of this.

We have to look at two sides of this. We have to look at who is being served and then at who is doing the serving and see where the problems are. The people who are being served in the frail and elderly component and others who are trying to stay in their homes are people whose emotional needs and psychological needs are, in many ways, as great as are their physical concerns and whose very ability to stay in the community is one which is always there as a nagging question that is hanging over them at one time or another.

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To have a situation in place where the agency that is trying to provide the services -- in the case of the Red Cross, in 90 per cent of Ontario’s counties, the only service agency that is providing that service -- where it has attrition rates that are, on average, around 75 per cent, and there are places like Brantford where the turnover rate in 1987-88 was 86 per cent and Cornwall exceeded 100 per cent because of the colossal turnover in staff -- we can go down through area after area and find that in the lowest area there is a 30 per cent turnover, but most of them are way up close to a 70 or 80 per cent turnover of staff.

You ask, “What is important to an old person who is trying to stay in his or her home’?” Consistency of care. The great argument by the institutionalizers was always that what you got when you put somebody into an institution was standardized care, an expectation of what their routine would be on a given day, a certain number of people who would always be there to assist them and a certain kind of continuity.

Most of our homes for the aged at this stage are unionized and have had collective agreements now for some 20 years which have provided protection and upward mobility, in some cases, for the workers. As a result, that kind of stability of service has been there, ironically, at the same time as the preferred approach to assisting people that we have been trying to bring forward of keeping them in their homes has been a fragmented system, primarily with unorganized workers, who have not received enough money to even encourage them to stay in the field at all, and in fact with these total turnovers, in some cases, that we have seen in this last year or two.

Surely one has to say, as a government: “Whoa. Something is just dead wrong here. We have to provide some kind of assistance that will make sure that this preferred service, this least restrictive option of keeping people in their homes, this least expensive option” -- it must be stated very categorically -- ”should be emphasized.”

The cost of putting somebody into an institution these days is phenomenally higher, still, than the kind of cost we are talking about in maintaining those people in their homes. Even if we were paying good rates of $10 or $15 an hour for people to come into the home, or in excess of that, they would be much, much lower than those costs that we have for institutions.

I say to the minister, who I know has had a number of other things on his plate, who has a Treasurer who is very unlikely to move on the major Transitions report by Mr. Thomson in the way that this minister would want him to do, who has found that in fact the government has made it clear to him that the Ministry of Community and Social Services is not a funding priority at this stage but that the Ministries of Health and Education are priorities above that and he will have to take a back seat to them, I know that puts him in a difficult situation as a minister, but after he has been there this long, it is incredible to me that he has not sought out the solution to the problem which has arisen again this year and that his only answer to it is his news release of January 6, talking about assuming the deficits again at this point to try to help them out of an immediate crisis situation.

It seems to me that belies two things. One, that the minister perhaps does not have the power within cabinet that his reputation with the Premier, when he gets up and talks about him as the greatest Community and Social Services minister we have ever had, would indicate. The other thing is that maybe this government has not decided what its real priority is in terms of deinstitutionalizing. Maybe it has bought in to that old Conservative ethic that you want to keep people in their homes, not because it is a preferred methodology and it can be quite expensive and needs to be done very well but because in fact it is cheap and you can exploit workers.

Let me just say that is exactly what the Conservative government did with the way it brought in assistance to people in the community, whether it was mental health assistance to people in the community or whether it was helping the retarded or whatever it might have been. It was systematic underfunding on a basis to divest its responsibility.

I just never believe that this government would want to follow in those kinds of traditions but instead would say that this kind of care is worth the price, that these kinds of people have as much right to stability of service as do people in institutions and that they will provide the bucks and the legislative framework to make sure this happens.

I do not believe we would be here having this debate today if the government had taken the action which was expected of it in terms of the rhetoric of the institutionalization that the government puts forward, and that we would not have this predicament of the deficits being assumed once more if it had acted. This is a statement of the failure of this government to meet the needs of its frail elderly at home while it still mouths all the rhetoric of election time.

Mr. Keyes: It is a privilege for me to participate in this debate for a number of reasons, but particularly so that I can respond to the words that were raised by the member for London North that we should be looking at a shift to community focus for our health care system.

That is exactly what I intend to focus on in my time this afternoon because the whole priority of this government is to create a stronger network of community programs, a network that will integrate the services in a continuum of care, promote equitable access, meet the needs of people with chronic conditions, encourage prevention and health promotion and at the same time be cost-effective.

In Ontario, we are exploring a number of innovative approaches to advance these objectives. The alternatives we are developing promote efficiency in the use of resources as well as high quality patient care. They demonstrate that good health care economics is also good medicine.

Let me make clear that we use the term “alternatives” in two senses. The first refers to alternatives to the traditional ways of paying for health services. The second refers to alternatives to institutional care.

Since coming into government, we have been expanding upon and developing six models that represent innovations in funding or service and I will just touch briefly on them. There are health service organizations, community health centres, comprehensive health organizations, home care, the hospital in the home and independent health facilities.

Time does not permit me this afternoon to elaborate on each of these six as I would like to, so I will try to merely scan the first three and cover in more depth the latter three.

Health service organizations and community health centres have evolved on parallel tracks since the early 1960s. For many years, these two alternatives to fee-for-service were considered experimental and it was not until 1982 that they were formally recognized by the ministry as legitimate and permanent parts of the health care system. This new status was reinforced in 1986 when the Premier announced a commitment to double the number of people who are served by HSOs and CHCs by 1991.

Health service organizations, which I touch on first, are interesting because currently HSO patients use about 22 per cent fewer hospital days than their counterparts outside and that is a remarkable record of productive use of health care resources. It is one reason that the ministry is actively promoting expansion of the HSO concept.

At present, Ontario’s 37 HSOs are serving some 250,000 patients. In addition, the ministry is now approving capitation payments for solo physicians on a trial basis and we will convert 10 practices as pilot projects in response to requests from physicians who feel that capitation would give them greater freedom to develop health promotion concepts.

Community health centres also have proven particularly effective in reaching certain sectors of our population. They are administered by nonprofit incorporated boards and their personnel, including the physicians, are salaried staff. CHCs are organized around specific population groups having above-average rates of illness or needing better access to health care.

In all, we now have 15 CHCs in operation and a further six approved for startup. This year, for example, the ministry has allocated new funding for culturally sensitive programming in community health centres. To date, 12 CHCs have staff who are fluent in languages other than English or French and we have funded special programs to serve Southeast Asians, Portuguese-speaking, Spanish-speaking and native Canadian clients, in some of our larger cities.

Comprehensive health organizations: The ministry is now designing a proposal to adapt the health maintenance organization or the HMO concept as it is known in the United States, to the Canadian context. The comprehensive health organization would manage the complete range of primary, diagnostic, ambulatory, hospital and nursing home services as well as home care for participating individuals in a given geographic area.

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Home care, which is the fourth community health innovation I want to discuss in greater detail, provides for a variety of professional and support services in the patient’s own home. The concept has gained wide acceptance among the public and health professions since the early pilot projects in the 1960s.

Home care is now available province-wide, with 38 programs in operation. Most of these programs, 29 of the 38, are run by boards of health. Others are sponsored by the Victorian Order of Nurses, public hospitals and a regional social services department. The largest, in Metropolitan Toronto, has an autonomous board.

The Ministry of Health funds these local services fully through annual program budgets. Services provided include nursing, homemaking, physiotherapy, occupational therapy, speech pathology, social work, nutrition counselling, respiratory technologists and enterostomal therapists. The goal is to avoid or delay institutional admission, reduce the length of stay and facilitate earlier discharge from hospital or other facility.

Home care originally focused on short-term care for the acute illness. In the mid-1970s, chronic care pilot projects began, in recognition of the ageing of the population and the rising number of chronically ill patients. All of our 38 local programs now offer both acute and chronic home care.

The role of these programs is rapidly expanding. Since 1984, for example, home care has been responsible for school support services. This component provides nursing and other services in the schools, to allow the physically and mentally challenged students to integrate into the regular educational system.

Home care agencies are also administering a new homemaker program now established in several pilot areas. It provides housekeeping and similar services to allow the frail elderly and physically disabled persons to remain in their own homes. While this is a social service rather than a medically oriented program, we recognize the benefits of common-case management and the convenience of access for the client.

With the phasing in of the chronic care components and other responsibilities, the costs and utilization of home care have risen dramatically. In 1987-88, the program served a case load of over 610,000 persons, more than double the number six years earlier. During that period, expenditures more than tripled. At the same time, we are coping with demands to offer more medically complex services in the home and to provide shift rather than visiting nursing.

To give members some idea of the commitment of this government to the operation of the home care program, let me just quote a few figures. In fiscal 1984-85, the total funding for home care was $104.5 million. In fiscal 1985-86, the first year this government took office, funding was increased to $153.7 million. In the following year, it increased again to $201 million. In 1987-88, home care was funded with $245.1 million. These substantial funding increases clearly show our government’s commitment to the effective operation and provision of services under the Ontario home care program.

A fifth service I want to touch on briefly is hospital in the home, another alternative to institutionalization, which is in the early planning stages. Under this concept, the patient would receive at home the same services he would receive in hospital, such as intravenous drips, shift nursing, medical equipment, physicians’ services, monitoring and treatment and 24-hour access to hospital staff. This can be seen either as an extension of the regular hospital room into the home or the expansion of our existing home care services to meet the needs of more patients.

Then there is the Independent Health Facilities Act, our final community health innovation, which is essentially a free-standing facility offering services commonly done on an outpatient basis but in hospital. This concept is based on the tremendous potential that new technology and medical expertise has to move health care into the community and permit safe, cost-effective and convenient services in nonhospital settings.

The Independent Health Facilities Act, which is to be debated in second reading this week, hopefully will enable the ministry to develop a planned, orderly, quality-assured system of community-based care. It will require all independent facilities to obtain a licence from the ministry. This will allow us, on advice from district health councils, to determine the mix of community health services across the province.

All these approaches to developing community-based health care have a common goal: to provide equitable access to effective quality care as close to home as possible. That is our government’s priority and we are honouring it.

Mr. McLean: I am pleased to have this opportunity to say a few words on a matter that I consider to be of prime importance to the people of Simcoe East and all of Ontario. That matter is the provision of visiting homemaker services.

This program provides a critical service to the people of Ontario. It is a service in a field we cannot do without. This program assists in maintaining and strengthening family life during illness or absence of a parent or guardian. It also assists the elderly, the convalescent, the disabled and the chronically ill to remain in their own homes whenever possible.

I have always maintained and believed that a patient will recover from illness or surgery better and faster if that patient is able to remain in his or her own home. Family members and friends can assist in the recovery process by providing moral support and a certain amount of caring that does not require the expertise of a trained physician.

This program enables patients to recover at home, and that means hospital beds can be freed up for emergency or acute care patients who require them immediately. We all know about the increasing number of heart surgery delays that are occurring in Ontario. I believe part of the problem is the availability of beds. There will be more beds for these patients if the homemaker program continues and people can recover from illness and minor surgery at home.

I have been discussing this issue for some time with health care providers in my riding. I have been a great promoter of keeping people in their own homes, expanding the homes for the aged, the homes for our seniors, thereby getting people out of our chronic care units in the hospitals. I know of many hospitals that have probably one floor that is there totally for chronic care. Many of those people could be in another facility that would cost about a third of what it costs in hospitals.

It was interesting to listen to the last speaker indicate the six models since the Liberals have come to office and what they have done, their studies and reports. That is the problem I find with this government, its studies and reports. Very little action is taken.

The member went on to indicate the increased cost in the funding from 1984-85 up to 1987-88. It is very clear to me that the increase has almost doubled, from $104 million to $245 million -- we are talking millions here -- when the health care costs in the province have gone up almost $6 billion. I say the place to put the dollars is in the homemaker programs. We should supply the services in the community. Therefore, our costs would be less in the hospitals.

I hear many of the government members saying, “All you want to do is spend more money.” That is not what we want. We want the money spent more wisely and for more people to take advantage of the services that we can provide across the communities and across this province in our homes, our nursing homes, our seniors’ homes, our retirement homes; better services there and in the home care program and in our Red Cross programs. Therefore, we would reduce the costs in the hospitals.

I am sure we are all familiar with the interministerial committee on visiting homemaker services, but I think this would be a good opportunity to review what it said and what it recommended. The interministerial committee on visiting homemaker services was established by the Ministry of Community and Social Services back in January 1987 to respond to critical issues which were threatening the ability of the nonprofit sector to provide homemaker services. The committee’s mandate was to ensure the ongoing viability of the nonprofit visiting homemaker service system.

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When I look at some of these recommendations, the four key areas that were identified to be addressed by the committee were the training programs and resources for homemaking, low wages paid to homemakers, annual agency rate-setting processes and the homemaker policy rate structure.

The committee had recommended that the nature of the task performed by homemakers and the environment in which they work demands that adequate training be provided, and I can certainly understand that.

The committee also recommended that there be a requirement for homemakers to be trained to a provincial standard and that a task force be established to deal with the implementation issues for a training program, including funding and course content.

The committee also concluded that the purchasers of homemaking will need to support the bulk of training over the next few years and that it is important that the funding allow homemakers to continue to receive the same wages while they are being trained.

As for the same wages while they are being trained, I want to speak on that just briefly. The committee found that the pay averaged $5.25 an hour and that there were very few benefits provided. Although travel is a requirement of the job, few agencies pay for travel time between cases. Turnover rates are high, with over 40 per cent of the agencies reporting homemaker terminations exceeding 50 per cent of their total workforce annually.

It is certainly not hard to realize why there is a 50 per cent turnover, and I know the minister is well aware of the reason.

The committee concluded that increasing homemakers’ wages is the single most important factor in ensuring the ongoing viability of the visiting homemaker system. It also concluded that the purchasers have a responsibility to intervene to raise wages to an appropriate market value.

I understand and I am quite clear that some people I know of who are receiving services and homemaker services that are worth a lot of money are getting a free service, and I maintain that those people who can afford to pay should pay their share of the cost.

The committee recommended that wages be set at a minimum of $7 per hour, plus 20 per cent benefits, with regional variations. The committee did not provide cost estimates of this recommendation. I consider $7 an hour to be an embarrassment. There is nobody who can live on anything under $10 an hour today if you are a working parent and paying rent. It is impossible.

The committee also recommended that to ensure the durability of reforms to the system, the wages and benefits portion of the rate structure be excluded from annual provincial restraint guidelines for the next five years.

I believe the homemaker program of the Red Cross is one of the most important issues that is going to face this government over the next period of time. What we are seeing today with regard to health care -- the problems in our hospitals and the lack of availability for people to get operations for heart problems, and not only that but for hip, knee and joint operations and what have you in the hospitals -- is that we have got to make sure that health care is more care at home; less institutionalizing in the larger facilities and more care at home. It is the only way.

There were some excellent recommendations in this report, but again nothing has happened and now we have a care crisis on our hands. This is one more glaring example of a government that prefers to study issues of importance to death rather than showing leadership in solving a problem. We have only to look at waste management and our declining health care system for examples of this government’s hurry-up-and-wait attitude to the issues that are confronting the people of Ontario.

The unique homemaker service must be retained in Ontario for a number of reasons that I have already mentioned, but I will mention them again in concluding my remarks.

This program provides a unique atmosphere for recovery, and I am certain that people will recover faster and better if they can stay in their familiar home surroundings rather than among strange equipment.

The homemaker service frees up hospital beds that could be and are needed for heart patients, emergency patients and those requiring acute care.

The cost of caring for and treating patients at home must be considerably lower than if they were admitted to hospital. I urge this government to assist the Red Cross in overcoming its financial deficit so that the homemaker service will not become a thing of the past.

Once again, the increase in the health care budget over the past four years, an increase of more than $6 billion to $7 billion, is substantial. I say better management of the health care system, more direct care at home and better financial responsibility would help solve our problem.

Mrs. Grier: I welcome the opportunity to participate in this emergency debate today. I really hope that as a result of this debate, perhaps something will change.

I find emergency debates rather frustrating in that we air all the problems and there is generally agreement on both sides that there is in fact a problem and something that needs to be addressed, but we do not seem to come to any firm conclusion at the end. I really hope that having the opportunity to put on the record our feelings about this issue will lead to some change in the government’s policy and to some immediate action to deal with what has become a crisis in this province.

I found myself profoundly troubled by the demonstration today, because the people I knew there -- and there were a number of my constituents present -- are not the kind of people who have ever taken a streetcar and come to Queen’s Park and waved a banner saying “More” before in their lives. I think the very fact that these women were prepared to do that shows the desperation to which they have been pushed in their very legitimate demands for adequate remuneration for the work they do.

When they were saying “More” and when they were saying that the government had to do more, they were saying it not just on their own account but on account of their clients, because certainly in the case of the people that I know, the homemakers and the clients are very much a partnership. They have become friends. They have become familiar with each other. They know the people whom they are serving.

They were saying to us today: “Not only do we deserve adequate and better wages, but the people whom we serve deserve a consistent, sure and certain service. We don’t want to have to withdraw that service because of the lack of funding.”

Most of the people in the demonstration today were women and, although I do not think I have ever seen any figures, I am convinced that the vast percentage of the clients that homemakers serve are women. One cannot help but ask if it were reversed, if the workers who had been on the steps today had all been male and if the people who received all of their services had all been male, would we be expecting those people to work for $5 an hour? I think the answer, very clearly, is no.

I want to approach the discussion this afternoon from the point of view of those workers and the clients and to ask the members to think briefly about what it means and what we are getting for that $5 an hour for a homemaker.

Those of us who have been homemakers and who have felt rather proud of that role know that what you do being a homemaker, certainly as a wife or as a mother or as a daughter, is worth more than $5 an hour in our economy of today.

We expect the visiting homemakers and the Red Cross homemakers to clean, to tidy, to pick up after other people, to cook, to do the laundry -- probably to wash it and to iron it -- to put out the garbage, to do all the kinds of regular duties that keep a home running. That is what we are asking them to do.

In addition, they do the shopping, they do the banking, they mail letters, they pay utility bills, they deal with the daily crises of a client who is not able to function on his or her own and who is not able to get out. They do that, rain, snow or heat, because they may be the only opportunity for that client to have some of those errands and some of those chores done.

In addition to doing all those tasks of a homemaker, they provide human contact for those clients. For many of them, it may in fact be the only human contact.

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Many years ago I delivered Meals on Wheels for a period. It was really very difficult because when you delivered the dinner you were sometimes the only other person that client had seen in the day. They did not want you to just leave the dinner and leave. They wanted you to have a conversation. But, of course, you had a car full of 12 other dinners and you could not stay and have that conversation. The homemakers can do that. They provide the contact, they provide the conversation and they provide the little bit of human warmth to their clients.

The clients know that on a certain day there will be the homemaker there and so things can be allowed to pile up, either things they want to say or things they want to have done for the homemaker. They need the certainty that the homemaker will come.

The client is not always easy to deal with. It is not all sweetness and light in those situations. It is probably somebody who is under severe stress, or who may be ill or who may have some mental problems. The homemaker is frequently in a difficult home situation and still has to deal with it, all for $5 an hour.

You do that now in Metropolitan Toronto for four hours if you are a homemaker. Then you take public transportation probably and you go to another situation and you do it all over again. You do not get paid for the time you spend travelling. In fact, because of the cutbacks in funding in some agencies in Metro, the time with each client has been cut back to three hours. So for the homemaker, you are working for more than six hours but you are being paid for only six hours and you are travelling in between. You are not even being paid for the eight hours that you were paid before the budget deficit set in.

What does it mean to the client? Who are the clients? Again, as I say, they are women in the vast majority, but frequently they are a couple -- an elderly couple perhaps who have managed to care for each other and to remain in their own home. Then one reaches the stage where one can no longer care for the partner and where the partner needs more intensive care. The homemaker can provide that. The homemaker can quell the fears of the other partner about what is going to happen, about whether the partner who is “well” may have to be institutionalized as well as the ill partner, if the homemaker services are withdrawn.

Frequently, by putting a homemaker into that situation, we as a society are preventing the institutionalization of two people, not just of one person, because by the homemaker coming in, we are enabling that couple to continue to live in their own home.

If it is a single parent who finally finds herself on her own with kids and needing the care of a homemaker, the homemaker -- who is often more mature than the young client being served -- can provide the advice, the mothering and the support that can make all the difference in that kind of home situation.

The homemakers are friends, as I have said, of their clients. They are frequently the only linkage to the outside world. They are the contact with a whole network of other services to which the client can sometimes be plugged in. That is why this dreadful situation, where in Etobicoke we have an 88 per cent turnover of homemakers in one year, is so disruptive to the service: it eliminates the possibility for continuity, friendship and consistency.

We heard from the minister today, in response to questions from our party, that he cannot afford to do everything and that we have been asking for increased funding for institutions and for cut-downs on waiting lists for heart surgery. Of course we have. But I do not think it is an either/or situation. We heard from the minister that he has been given increases in the budgets for other services run by his ministry, and I acknowledge that. But surely it is a question of what priorities have been placed and where homemakers have been placed in the scale of priorities that have brought us to this debate today.

If ever there was a human service of extraordinary merit, surely it was this kind of caring, very cost-effective, very communal kind of service that is being provided by homemakers. Surely the units of service derived from these agencies for every dollar spent are much greater than for the same expenditure in many other kinds of service.

It is an example of what used to happen in a caring community before we became very much of an economic community. A neighbour provided the services that home care now provides. There are no longer neighbours at home able to do that. They are all out in the job market too. Surely, if there was one thing that would show the mark of our caring as a community, it would be an enhancement of this service and the creation of core funding that would enable the agencies that provide this service to know with surety that they could continue and what their funding would be in additional years, rather than having to indulge in this perennial scrounging of more funding and more budgets at the end of every financial year.

I urge the minister to take very serious account of the remarks that have been made from all sides today. I hope that as a result of this debate we can look forward to an assured and consistent homemaker service in this province, which I am sure is something all the members of this House want to see happen.

Mr. Beer: It is also a pleasure for me to join in this debate this afternoon. I think the previous speaker has outlined very clearly the kinds of tasks that the homemakers must carry out. For many of us who have had the occasion, in one way or another, to deal with homemakers and talk to them about their role, the way of putting it is that indeed they carry out so many of those services which, in effect, allow the home life to continue.

As we reach this point in this debate, we have heard a lot of facts and figures and trying to put things in context. This is very important, but I think we also need to understand that in viewing the whole system of services we want to provide to the elderly, there are a number of programs and a number of initiatives we have taken where clearly, as the minister has said, we are not meeting every and all need; we are not being able to do every single thing we would like to do. But the context is one that is positive, where real progress has been made over the last several years and where, I believe, the commitment of the government, as evidenced by the statement which the minister made last Friday, is very clear in terms of what we want to do and where we want to go.

I would like to put before the House an example in my own area, that of York region, where I believe, together with the province, the municipalities, the various community and social service organizations have tried to come together to deal with the question of services to the elderly, to deal with the issue of institutionalization, to deal with the issue of deinstitutionalization and to try to come up with a program of senior services in that region which will be efficient, affordable and sensitive to the needs of the elderly.

Two years ago, members may have heard the issue of one of the homes for the aged, Greenacres Home for the Aged, which exists in Newmarket. This was a home with, at one point, over 400 beds, run by Metro Toronto. An issue that arose was what was going to happen to that home. As we moved into a deinstitutionalization phase, how were we going to deal with the role that home had played and how were we going to find out what the needs were of our own seniors and what role that particular facility could play in the region?

One of the things that happened under the leadership of the Minister of Community and Social Services was that a working group, made up of officials from York region and from the ministry, sat down and realized fairly quickly that we were going to have to identify what the needs are we have in York region. Through the leadership of the minister, some $80,000 has been set aside so that a comprehensive review can be made of those needs and that the actions we will then take will fit as part of a whole, because the homemaker services, the home care program, as important and critical as they are, must fit into a larger picture of overall services.

Out of this discussion which the ministry and the region have carried on, in addition to ensuring that there would be this comprehensive survey, we also determined that we wanted to keep at least part of Greenacres for institutional care, because we recognize that even with our attempts to move more people out of institutions and, more importantly, to keep people who are not in them out of them, none the less, with the ageing of the population we are going to require a certain amount of institutional care. So we will continue with part of that facility providing special care for the elderly.

With the rest of the facility, we are moving into new areas, for example, Alzheimer’s day care, the kinds of services that will bring a direct benefit not only to the senior citizen who is suffering through the problem of Alzheimer’s but also to family members and others who are helping to care for that individual at home. There will be a way in which they can find some relief through using this day care centre. At the same time, we are creating smaller homes for the aged within the region so that those who will be living in them will have a real sense that they are not being put in some very large, totally impersonal institution.

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These are all part of a whole. When the new agenda was put forward by the then minister, it was stated very clearly that we could no longer continue to plan in a haphazard, ad hoc way. All of these programs were going to have to link in, one to the other. It is probably fair to say that we have been talking about many of these programs for many, many years, and perhaps for far too long, but one of the things we have been trying to bring together has been a real sense of consensus as to how those programs should be run, what should be the participation of various people in terms of the funding and who should be carrying the responsibility in terms of the local municipality, the province and the individual himself or herself.

When we look at the situation we have today, we must remember that with the infusion of great sums of money over the last three years, despite some of the continuing problems, we none the less have a system that I believe is much more compassionate and sensitive to the needs of the elderly than we had only half a dozen years ago. To cite just a few figures, it might be interesting for members to recognize that something in the order of half a million people in this province are now cared for in some form or other under the home care, homemaker and home support programs. That is compared to those who are in nursing homes, in homes for the aged, acute care and chronic care beds, where the total is somewhere in the neighbourhood of 160,000.

Clearly, the problem continues to be that those who are in institutions cost a great deal more than those who are not, and clearly, the emphasis we want to give to the programs as we develop them is to ensure that programs such as home care and homemaker services are indeed funded so they can do the best job they possibly can. I do not think anyone on the government side would argue that we want to see them paid less than a reasonable rate, so that people do not have to move on from those jobs but can remain involved and develop the kinds of relationships the previous speaker discussed.

None the less, we consider that three or four years ago this kind of program, the homemaker program, really did not exist to any meaningful extent. We consider the integrated homemaker program in particular, whereby both the Ministry of Health and the Ministry of Community and Social Services are attempting to bring together all those services so that there is, as the program’s name suggests, an integrated approach. The funding for that program has risen greatly, and as was mentioned earlier, has gone from something in the order of under $10 million to now well over $40 million.

The other issue that then comes into how we deal with these programs is obviously a question of priority, not only within those programs offered by Community and Social Services and Health but also relative to what we want to see our priority be in terms of Community and Social Services vis-à-vis education and health care. Those decisions are always tricky, and I suppose all governments want to be able to at least move forward in some form in all of those areas of critical need.

That is not always possible to do to the extent we would like to do it, but if we look at the major areas that deal with social services, be it through the Ministry of Community and Social Services, the Ministry of Health or the Ministry of Education, we see that over the last number of years there has been a tremendous influx of money into a variety of programs.

We have to recognize, and I think as legislators speak to our people about the need to recognize that these do cost money and that they have to be paid for by tax dollars. Perhaps in order to do all the things we want to do, we have to make a better case to the people of the province that these are worthy of support, that these are many of the things for which our tax dollars are going and that they are being well spent in that regard.

In closing, I would say that I believe we have seen a great deal of leadership from this government and from the minister. I think this debate is useful in focusing on continuing issues in the area, but much progress has been made and will continue to be made.

Mr. Villeneuve: It is also an honour for me to participate in this most important emergency debate on the funding of homemaker services throughout Ontario.

A little bit of background here: In eastern Ontario, there was a pilot project just before the 1987 election funding homemaker services throughout about five different counties in eastern Ontario. It was done through the Eastern Ontario Health Unit. It purchased the services of the Red Cross homemakers. I will read in part a letter I received from the Eastern Ontario Health Unit, just to set the background:

“The advisory committee of the integrated homemaker program met on November 21, 1988, where the members discussed the level of activity of that program. Basically, the integrated homemaker program was implemented in October 1987 and there was, at that time, no specific directive from the ministry as to the limit in numbers of clients to be on the program. We had, however, made some projections according to the ministry guidelines.

“The integrated homemaker program case load quickly grew as the program was aiming to meet the needs of a large eligible population” -- I emphasize the word “eligible” – “so much so that when the Ministry of Community and Social Services determined retrospectively that the total case load should be 696 clients, the limit had already been exceeded.

“The case load is presently being maintained at 723 through the application of strict priority criteria. Considering our large elderly population, which in Stormont, Dundas and Glengarry is higher than the provincial average, and the limited resources available, much lower than several Ontario communities, especially with the large rural area, it would be deplorable to decrease the number of clients on the integrated homemaker program, and it would threaten the very fragile equilibrium of our elderly population.”

The letter continues. That gives a bit of the background as it occurred in Stormont, Dundas and Glengarry. The advice came from the Ministry of Community and Social Services, just prior to the September election, to go ahead on a pilot project without precise guidelines. Indeed, that occurred.

As a matter of fact, the Eastern Ontario Health Unit purchased services from the Red Cross. I read a petition in this Legislature from three eastern Ontario ridings -- the riding I very proudly represent, Stormont, Dundas and Glengarry and East Grenville, the riding of Prescott-Russell, and the riding of Cornwall -- signed by almost 2,400 citizens very concerned that the program may have to be discontinued.

To commend the minister, I think the $1.1 million and the additional funding towards assisting the Red Cross in meeting its deficit is commendable. However, we must look to the future. We cannot have these senior citizens face the very real possibility of having this service discontinued to them at any time in the future, basically at the political whim of the government.

The government can only spend the money it takes from the people in the form of taxes. Thus, it is important that prudent use be made of such funds. At the same time, senior citizens are not just numbers in some tally book. They are people who have served the province and the country very well over very many years.

We cannot simply look at them and say that home health is a numbers game, a question of first come, first served. The government has implied, by establishing the home care program, that it wants to give seniors an opportunity to remain in their homes as long as possible. It should help all people with a legitimate need for assistance. That is the group of people who are being assisted, those with a legitimate need for assistance.

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I brought to the attention of the Legislature immediately after receiving the Eastern Ontario Health Unit notice that funding was being curtailed. It was brought to the Legislature here in November. Prior to that, I had received numerous letters concerning the wages that were being paid to the homemakers across Ontario. All of a sudden, the emphasis switched from wages to homemakers to the very program itself. The livelihood and the lifeline of the program were being threatened by a lack of funding.

I see the Minister of Agriculture and Food (Mr. Riddell). I have correspondence here from Town and Country Homemakers from his home town of Wingham. I see the patrons are Dr. Stuart Smith, honorary board members Robert McKinley, Jack Riddell, MPP, Murray Gaunt, etc., who are great people, who were very concerned at what was not happening from the Liberal government in the form of funding for the support programs for our senior citizens.

I bring it to your attention, Mr. Speaker, because I think we are all pulling in the same direction. It is a matter of bringing the priorities to the right place, and certainly senior citizens in my opinion are where we must concentrate and make sure we provide assurance that their homemakers will not be suddenly removed from them.

I have received dozens of letters and I will just read one. It is signed by Mary Ann MacDonell from Alexandria and addressed to myself.

“As one of your constituents, I am asking for your help in the homemaker situation. I hear that the program is threatened. I am over 93 and have been able to stay in my own apartment with the help of a homemaker three hours, three days a week. Without her help, I would have to be in an institution. I hope you will use your influence and help us immediately.

“Sincerely,

Mary Ann MacDonell.”

Many letters like this express the very real concerns these senior citizens have, the desire they have to stay in their own homes, in their own apartments.

In the riding of Stormont, Dundas and Glengarry and many ridings across this province, these homes happen to be in a rural setting where homemakers have to travel many miles. We all know gasoline is not cheap. We all know that insuring an automobile is not cheap. These are very legitimate expenses.

As a previous speaker noted, whenever we see people who are served with Meals on Wheels -- my wife happens to be one of those volunteers going out on a weekly basis -- when someone walks into their home with a warm meal, indeed they want to keep that person there to speak to them, to ask them what is going on in the outside world because many of these seniors, particularly in a rural setting, do not see many people. They have a television, granted. They have a radio. They probably read the newspapers, but they do not have communications with real, live people. That is an occasion, as is the homemaker program, to bring someone into the home who can discuss things with them.

As I told members, this is a copy of the petition I presented to this Legislature several days ago. There are 2,400 names; 2,400 concerned people and that certainly does not include those who did not have the opportunity of signing this petition as it came forth.

In summary, it is rather sad that this government saw fit, just before an election, to bring in a pilot project in eastern Ontario, a pilot project that proved to be tremendously successful, and yet there is the very threat that now there is a large majority sitting in this Legislature, they are prepared to cut it back and maybe even remove it. When politics are being played on the backs of our senior citizens, I think it is a rather sad situation we face. I am afraid there is some of that occurring in this particular case.

I cannot emphasize enough the importance of the real survival of this homemaker program. It is most important to our senior citizens throughout Ontario and I, as my colleagues, the Progressive Conservatives, will continue to watch very vigilantly to ensure the program is enriched and serves those people who sincerely need and deserve it.

Mr. Farnan: It is my pleasure to participate in this debate on the funding of homemaker services in Ontario. Regrettably, I say to members that what we have witnessed in the past few days is indicative of a rudderless and directionless approach to government being provided by a majority Liberal government. It is rather sad, in my mind, that this is a reactive rather than a proactive government.

I want to give a couple of examples. It took a demonstration of injured workers in this building in order that the injured workers could have public hearings or extract from this Liberal government public hearings on the legislation that would affect them. There was a rally planned for today, a rally in which there were 500 homemakers, and it took the threat of this rally in order for the government to loosen the purse strings that would make this program viable.

It is a sad state in this province when politics are being played with the most needy and the most vulnerable in our society, when programs that affect injured workers and seniors are only forthcoming when these groups have to lobby and threaten the government. Is this what it takes? It is a sad situation.

The press release by the Minister of Community and Social Services to cover this and next year’s deficits of the Red Cross and six other not-for-profit homemaker agencies on January 6 was indeed a welcome reprieve, but that is all it is: it is a welcome reprieve. There is no guarantee for the future.

As much as anything else, I think the role of the member for Hamilton West in raising this issue on a consistent basis proved to be extremely embarrassing to the minister and the government, and together with the rally today perhaps was very important and effective in getting some government response.

Let’s look at the situation in Cambridge, because I think it reflects the situation across the province. There are 68 homemakers on staff to provide the service; 47 homemakers were hired within the period of April 1987 to March 1988, and during the same period 58 homemakers left the service, a turnover rate of 85.3 per cent. This is similar across the province. Many municipalities, I will remind the members present, in fact had turnover rates of over 100 per cent.

There are many criteria for examining and evaluating a program’s effectiveness and high on the list has to be worker satisfaction. A tough job for meagre pay does not lend itself to worker satisfaction.

Is it because we do not have the money? I think not. In Cambridge, the cost per day per client for homemaker service is $8.48. The cost of acute hospital care per day per client is $219, I would point out one of the lowest in the province. Nevertheless, the difference between the homemaker and the acute care obviously is tremendously significant. The homemaker program is the obvious preferred option, but it should be done properly.

The key to an effective homemaker program lies in the time and training given to homemakers and in the working conditions in which these homemakers will carry out their tasks. If there are reasonable, fair and equitable standards of employment, you will have a satisfied cadre of employees.

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There is ample evidence that the consistent turnover of homemaker staff is destabilizing, and a quality service with stable staffing demands a fair wage for homemakers. Five dollars and 25 cents an hour does not constitute a fair standard of wage. Five dollars and 25 cents an hour with few benefits, having to travel from one part of the city to another with travel time not included in your working hour does not constitute fairness.

Certainly the government can say, “Isn’t it marvellous that we’re providing this program so cheaply?” But on whose back is the government providing it so cheaply? The dedicated homemakers, who go and clean, who are friends to the seniors, who bring the community into their home or apartment, these are the people on whose backs the government is providing this service.

The committee recommended $7 an hour. For the work they do, the essential work they do, and the dollars they are saving this government in terms of institutionalization, it is far too little. They deserve more. It is sad that this government puts a price on their services that is so low and, in my view, so demeaning.

It is the Liberal dilemma. They have some options with institutionalization and home care. They do not know what to do, so they do both poorly. It is not good enough in this House and across the province to be giving lipservice to the homemaker program, because the government’s words are not believable. This government is not believable when it says, “We have an emphasis, we have a direction for homemaker services,” because if what it is producing is a homemaker service built on the foundations of $5.25 an hour, that is disgusting. Would members want their mother, their father, their son or daughter to be providing this kind of essential service for $5.25 an hour? I think not. Yet this is the vehicle by which the government is going to deliver this service, a very important program, to meet the needs of seniors of this province.

In summary, I think New Democrats have very clearly identified our priority. We believe there is a choice to be made between the homemaker service and institutionalized service, but unlike the Liberals we do not believe in delivering a poor quality service. We do not believe in delivering a service on the backs of the working poor. This Liberal government, when it addresses the homemakers of this province, is talking about the working poor. If it wants to hold its head with any kind of dignity, if it wants to deliver a service of quality and stability to our seniors and wants to recognize the significance of the work being done by the homemakers of this province, it will say to itself, “Five dollars and 25 cents an hour is simply not good enough.” How the minister can look at himself in the mirror as a progressive agent of government is beyond me, because $5.25 an hour for this service, in my view, is simply slavery.

Miss Roberts: I am pleased to be taking part in this debate today. It has given government members an opportunity to describe just how much has been done since 1985 in terms of providing more and better alternatives to seniors in this province.

I have sat patiently and listened as members of the two opposition parties have accused the government of being unresponsive, of not being concerned about the needs of the seniors. Clearly, there are problems which must be addressed, but frankly, I think the members of the opposition are letting themselves be carried away by their own rhetoric.

I was particularly dismayed when I read the motion of the member for London North calling for this debate, which accuses this government of a lack of leadership.

This is not shown by the facts. The facts clearly indicate that the member is mistaken. It is obvious that this government has been on the leading edge of this issue of community care for seniors.

Let’s just look at the record. The Minister of Community and Social Services has already spoken about this government’s vision of services for seniors. He spoke about providing a range of services for seniors so that they can stay in their own homes as long as possible; and when a senior can no longer remain at home, he spoke about providing good-quality residential care that allows the individual senior to lead as full and independent a life as possible. The Minister of Community and Social Services, the Minister of Health and the Minister without Portfolio responsible for senior citizens’ affairs (Mr. Mancini) have already put in place some important measures which go a long way towards making that vision a reality.

My colleagues have already spoken in great detail about just how much we have done. This government has introduced community-based programs for victims of Alzheimer’s disease. In 1985, there were no such programs. Today, the integrated homemaker program is in place in 18 Ontario communities. That program did not exist in 1985.

Over the last three and a half years, this government has been identifying and working to meet long-term needs in a way that is unprecedented in this province. We have matched the vision of the future with good management of programs already in existence.

Among many things, good management means working with community agencies to keep abreast of needs and to be able to respond when necessary. Unlike past governments of Ontario, this government is responsive to community needs. When a clear need is demonstrated, this government acts.

I would like to provide members of this House with an excellent example of that responsiveness. As members know, on Friday the Minister of Community and Social Services announced that the provincial government will cover the deficits of the homemaker programs of the Red Cross and six other not-for-profit organizations across Ontario. These organizations provide a valuable service to Ontario senior citizens.

Let me use the example of the Red Cross. For 65 years, the Red Cross has been providing homemaking services in Ontario. This organization accounts for 44 per cent of all homemaking services in Ontario. Its presence is felt especially in rural Ontario, where it accounts for 70 per cent of the total hours of service. Like many members in this Legislature, I know the wonderful job done by the Red Cross. because it operates a homemaking service in Elgin county, which is my own home riding.

For the benefit of the members of the House, I would also like to name the other six organizations which received funding in Friday’s announcement. Those organizations are: the Visiting Homemakers Association of Ottawa; Town and Country Homemakers of Huron county; the Victorian Order of Nurses, Guelph-Wellington-Dufferin Branch; and three Toronto homemaking organizations, namely, the Visiting Homemakers Association (Toronto), Central Neighbourhood House and Senior Care.

When these organizations came to this government to express concern about their deficits, the government acted. I would like to give the members an idea of the chronology of events that led to Friday’s announcement.

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Late last year, the Red Cross and the six other organizations I have mentioned made it known that they were facing serious deficits in their homemaker programs. Over the last several weeks, staff for the Ministry of Community and Social Services and the Ministry of Health have been meeting to examine those organizations and their problems. Last Friday, representatives of the organizations met with the Deputy Minister of Community and Social Services and were informed that their deficit would be covered, not only for this fiscal year but for 1989-90 as well.

The estimated cost of meeting the homemaking deficits of all seven agencies for this year is $1.8 million. All of those deficits will be covered.

In addition, the Ministry of Health, the Ministry of Community and Social Services and the homemaking agencies affected will be embarking on an operational review to examine the costs they are facing and the reasons for the deficits. The operational review will begin this month and will be completed in the spring.

I think it is important that we be clear on what is meant by the term “operational review.” The government is not looking for ways to cut costs but rather the reasons for those costs and, specifically, the reasons for the deficits being faced by these agencies.

Let me give an example. The Red Cross has expressed concern that since so much of its services are provided in rural areas, its transportation costs are higher than agencies with urban case loads and are a major reason for its deficit. This government is sensitive to that concern. As a representative of a largely rural area of southwestern Ontario, I know how expensive transportation over large areas can be. We in the government are also aware that the Red Cross, in particular, has seen its involvement in urban homemaking programs decline over the past few years.

Historically, the revenue from those urban programs has helped the Red Cross fund its more costly operations in rural Ontario. The operational review will look at those kinds of issues, as well as other costs faced by the homemaking organizations.

Last week’s announcement is a clear example of a concerned and responsive government in action. The announcement came just a few short weeks after the concerns had been raised by the Red Cross and two full weeks in advance of the Red Cross board of directors meeting which will be the forum for discussion about the agency’s homemaker programs. This government saw a problem, evaluated it quickly, and acted. That kind of government responsiveness was unknown around this place before 1985.

Now, the opposition is making the point that addressing the deficits of the Red Cross and other organizations is not a long-term solution to serious problems facing homemaking services and the seniors they serve. We agree. It is clear that there are long-term issues that must be addressed.

The development of an integrated system of supports for our senior citizens will take a thoughtful, well-planned approach, and it will require a substantial investment of resources. It will require leadership from a government that is committed to providing the best possible supports for our senior citizens.

The government has clearly proven it has the ability to lead the way. Just as clearly, the facts show that the two opposition parties do not agree or do not have the answers.

The record of the Conservatives speaks for itself, and that is a record of inaction. That party, when it was in government, acted only on the basis of public opinion polls and ignored the growing need for community-based services. On the other hand, the New Democrats would have us throw money at this and every other problem facing the government. This government will not sit on its hands the way the Tories did and it will not fall into the NDP trap of rushing headlong into bad decisions.

This government, the Peterson government, has every reason to be proud of the steps it has taken towards a better system of supports for senior citizens in Ontario. The evidence is there; it is there for all to see. We are proud, as a government, of the work that has been done on behalf of the seniors in Ontario.

The Deputy Speaker: Thank you. Do other members wish to participate?

Mr. Runciman: I will try to catch my breath and then try to collect my thoughts. In respect to this motion, I appreciate the opportunity to participate in the debate on a very important issue. I want to talk briefly about an experience I had in my riding during the break from the sittings of the House.

I was called by the Red Cross and asked to visit one of the constituents in my area receiving assistance through the Red Cross homemaker program. I personally spent approximately three hours in the home of a Mrs. Norma Henderson who is a multiple sclerosis victim and who has been suffering from that disease for well over 30 years. Over the last number of years, she has experienced a decreasing ability to do anything on her own, to get out of the house and to do very modest chores which all of us in this House take for granted.

Mrs. Henderson has not been suffering this battle over 30 years by herself. She has had family and friends, but perhaps most importantly, she has had her husband, Fred, who has been a tireless worker on her behalf, virtually devoting his life to assisting Norma. He ran a butcher shop in Brockville up until about 10 years ago and then his wife’s illness was simply requiring so much of his time that he had to give up the business and devote every hour of his life, in essence, to the care of his good wife.

I want to tell the members that Mr. and Mrs. Henderson, despite all of the problems that have plagued the last 30-some years of their married life, have great spirit. They were a terrific couple to visit with. As I said, I ended up going there for a brief visit and stayed for close to three hours, having lunch with them and experiencing the kinds of things that they have to go through every day in terms of the assistance that Mrs. Henderson requires. She is essentially bedridden, but they do have a device to remove her from the bed and allow her to get into the dining room for meals on occasion.

They do not have enough good things to say about the Red Cross homemaking service and the service Red Cross provides. The homemaker who is with them now has been with the Henderson family for about five years and has in essence become something of a member of the family. We had an opportunity with the Red Cross official present during my visit to talk about some of the problems in the program. I want to touch on those briefly.

Leeds-Grenville was selected when this program was announced a few years ago, and I am not sure of the specific date, it may have come up during --

Mr. Villeneuve: Just before the election.

Mr. Runciman: -- just before the election, but I think it was broadened just before the election, to be quite precise. In any event, Leeds-Grenville was a pilot. About six months into the program, the government, when it initially announced it, also retained a consulting firm -- I think it was Stevenson, Kellogg, Ernst and Whinney, but I could be incorrect on that -- to do an assessment of the pilot, to look at the feasibility and the desirability of expanding the program beyond the initial pilot stage and to other areas of the province. Before the program, which was supposed to be a 12-month pilot, was six months of age, the government made a decision to expand it into something like 16 or 17 other areas across the province. That was in the midst of this assessment by Stevenson, Kellogg, Ernst and Whinney.

Obviously, all of us in this place understand why the government made that decision without waiting to assess all of the implications. It did it for purely political reasons so that it could wave the flag and say, “Look what we have done in these specific areas.” I am sure that there were a great many people grateful and that perhaps it was reflected in the results of September 1987 to some degree. I am not sure.

In any event, the government was careless. They were, in my view, irresponsible with respect to how they dealt with this matter. They did not take a careful look at the implications or the program itself and whether it was meeting the needs of the people who were in real need in the province, or whether it was a case of “Throw some money at them and we will keep them happy and we will get a vote or two here,” rather than careful assessment of the situation. Indeed, that is what has happened.

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I was told by the Red Cross official with us of instances, when this program came out, of relatively well-to-do seniors who may have retained someone to come into their home to clean, do dishes and do various chores, who themselves were in fine health but had the financial wherewithal to retain outside assistance for a variety of reasons.

When the program was announced, these people -- I am not going to be critical; the program was there -- saw an opportunity to qualify in terms of the broad criteria that were made available so that they dismissed, laid off, what have you, the individuals who were working for them and brought in the Red Cross homemaking service, courtesy of the taxpayers of Ontario.

I was told by the Red Cross official that this is a frequent complaint of homemakers. When they come back to the base, they are saying: “Why am I in this person’s home? Why am I doing this? He is obviously in good health, he is in good shape, he is financially sound. There is no real reason for me to be there.” Of course, the reason they are there is because these people see an opportunity in terms of the program requirements and are utilizing it.

If the government had accepted the original premise and gone through with the pilot and then assessed all of the implications and the pros and cons of the program, I think we would not have been in this situation that we find ourselves in now, where the Red Cross is facing a shortfall and the government has indicated, “Look, we are prepared to cover this on a one-year basis only, but we do not know what the future holds for you in Red Cross.”

I think, for a change, this government has to start taking a longer-term look at a whole host of programs that it offers. This is certainly one where I believe, certainly in my discussions at the local level, that the Red Cross is very much amenable to sitting down and taking a look at the glitches in this program and making whatever changes are necessary to ensure that it is meeting the requirements of the real needy in our society, instead of simply dipping into the Treasury when an election is approaching, going to the window and throwing it out the window and saying: “Look, folks, here is some money for you. Hopefully, this will reflect well upon us at the polls.”

I think that has certainly been the approach that was taken here. I said it was irresponsible. When we take a look at the position that the government has placed the Red Cross in as a result of its ill-thought-out initiatives, it certainly bears out the fact that it is indeed an irresponsible initiative on the government’s part.

I heard a comment here today, in terms of the minister involved, that if there is one person over there on that side of the House whom we get straight answers from, for the most part, it is that particular minister. I think he has generated a great deal of respect in terms of his commitment and his ability to respond directly to questions from the opposition parties.

I hope that he is going to take a careful look at what has happened with respect to this particular initiative and make a very meaningful effort to sit down with Red Cross officials to ensure that something can be done to change the guidelines and change the way this program is applied. No doubt there are going to be some feathers ruffled in that process.

That is one of the difficulties of getting into anything: Once you find that perhaps you have gone overboard, you have misstepped and you are offering assistance in areas where assistance is not necessarily required, pulling back is politically a tough row to hoe. I think we all know that. Those of us who have been around here for a while know that once you have committed yourself, once you have stepped into these kinds of programs, it is sometimes difficult, if not in instances -- I could go into a number of examples where it may be -- politically impossible to extricate oneself.

In this instance -- again, I have rather limited exposure to the views of the Red Cross and I am relying on the views I have heard expressed in my own riding -- there is a willingness out there to co-operate in a meaningful way with the government to ensure that this program is adjusted so that it meets the very real needs. I urge the minister and the government to very carefully consider that course of action.

Miss Martel: It is a pleasure for me and a privilege to participate in this debate this afternoon. I must agree with my colleagues when I say it is unfortunate that things have reached the state in this province that we have to have a demonstration outside of the Legislature in order to get the government to listen and to respond.

My colleague the member for Cambridge (Mr. Farnan) was right when he said that this government is becoming reactive and not proactive. We saw the same type of thing with the injured workers’ demonstrations here when the session started in October. It took a demonstration by them as well to convince the Minister of Labour (Mr. Sorbara), the government House leader and indeed the government that their concerns had to be heard.

It is unfortunate that we are at the state when it is apparent to me that the government is becoming certainly reactive. In this case it is particularly important because of the clientele we are dealing with, that is, seniors in this province and the disabled.

I guess there must be a collective sigh of relief being issued from the government side now that the bailout is in effect and the immediate crisis, at least for the Minister of Community and Social Services, is over, and the line of questioning on this side might change, at least in the short term.

But I wonder if a lesson has been learned. I go back to a comment made by the member for Elgin (Miss Roberts) who said the minister responded in about two short weeks, when this crisis became evident the minister responded, and that this government has been working towards providing community-based services, etc.

I go back to some of the letters I am sure all of us have received in the course of our time here, letters written to the Premier and to various ministers concerning the crisis in home care, which has gone on for quite some time. It is not a new phenomenon in this province. It is not the first time we have to deal with this issue, and it will not be the last time, in spite of the bailout that the minister has provided. The root problems in homemaker services, in community-based care, have not been addressed by this government.

Let me just read a few of those letters to point out that indeed it is a crisis that has been going on for a long time; it is not something new. In fact, the government has not responded with adequate solutions in the way it should have. This letter is from April 17, 1986, written to the Premier by the Ontario Association of Visiting Homemaker Services. It says:

“We are writing to you out of extreme frustration. In recent years, homemaker services have received a great deal of attention as understanding of the value of community-based support services has increased. During that time, the variety and difficulty of work handled by homemakers have increased. However, the funds required to operate these services adequately have not been made available. Attrition rates of our staff are increasing dramatically and, in many areas, our wages, which often begin at the minimum, can no longer attract even recipients of the family benefits allowance.”

That is April 1986. Let’s go to October 5, 1987. This letter is written by the Canadian Red Cross Society to Tim Young, chairman of the interministerial committee. It says:

“The Red Cross homemaker service in many parts of Ontario has serious financial and service-related problems. The demand for homemaking service through government programs is increasing rapidly. The introduction of the integrated homemaker program in parts of Ontario has outstripped our resources and magnified problems that have existed for years. Most of these problems are directly related to inadequate funding of the service and, as a result, low wages to the homemakers and other staff. A decade or more of restraint on homemaker rates has resulted in excessive turnover, homemaker shortages, reduced level of supervision, increased training and recruitment costs, financial strain and general frustration among both staff and volunteers of the Red Cross.”

Here is another one from February 12, 1988. This one is again addressed to the Premier, again from the Ontario Association of Visiting Homemaker Services. It says:

“On behalf of the Ontario Association of Visiting Homemaker Services, Ontario, I have previously written to you and several of your ministers concerning the serious problems besetting the provision of homemaking to the people of Ontario. Mr. Peterson, as we have indicated on numerous occasions, if the issues facing the provision of homemaking are not addressed within a reasonable timetable, the homemaking industry will not be able to respond to the needs of the people of Ontario.”

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One final one, and this one is from March 2, 1988, again to the Premier, and again from the Canadian Red Cross Society. They say:

“The demand for homemaking services through government programs has increased dramatically. We expect to provide 814,000 visits to 100,000 clients this fiscal year. Unfortunately, funding has not kept pace with the service demands. A decade or more of restraint on homemaker rates has resulted in excessive staff turnover, homemaker shortages and increased training costs.”

I have to go back to some of the points that have been made this afternoon by the government members and say that the crisis is not new. The government has not responded adequately. The root causes of the problems have not been addressed and have not been resolved.

I guess I want to take the approach as one who has travelled with the task force. Most members in this House know that the northern New Democrats have carried out two task forces now on health care in northern Ontario. We will indeed have a third early in February. I think I really saw the problem of community-based care in those two tours.

What I saw was that although many of us here probably do have a serious commitment and a serious belief that seniors and people suffering from mental illness should be kept at home in their communities and cared for there, what we as members found on the tour was that the resources were not in place to provide this. The government talked a good line. There was lots of rhetoric about the need for community-based care, but the bottom line was that the resources were not there. The people could not be hired. The staff that was there did not receive adequate remuneration and, as a result, they were leaving in droves.

They were committed to helping people, but the bottom line was that they could no longer afford to stay in that position, because they could not afford to feed their families. That was a decision they had to make. It was a tough decision, because most of them -- in fact, all of them -- were extremely committed to the clientele they were serving and the job they were trying to do for the residents they were trying to serve.

Let me go back to just one example. The director of the Red Cross society who worked out of Fort Frances came to see us to talk about the problems that the homemakers, through the Red Cross and the service they were providing, were having. In Fort Frances, the maximum wage for homemakers is $6.02 an hour. The only benefit provided is that the employer pays 50 per cent of the Canada pension plan.

The homemakers there service a large rural population, a farming population. They do not receive any travel allowance. They do not receive any expense allowance for meals while they are out on the road. One woman who had worked there had 18 years of seniority and was at the maximum allowance. That is all she was making, $6.02 an hour.

I have to ask the minister, is this seriously, in the province of Ontario, what we consider a living wage? How does the government expect to attract and maintain committed personnel when it is dealing with those kinds of wages? It is not going to happen.

What we saw were large numbers of people very committed to what they were doing, extremely committed, because they recognized the value of the work they were doing, but by the same token, their value was not being recognized in society. That hurt them. It depressed them no end to know that their value was not great in Ontario’s society. that the work they were doing on behalf of some of the most needy people in Ontario was not being recognized and was not being adequately compensated.

I think the result of all this is that this government has to come to terms with the fact that while it talks a good line about community-based care for seniors, as I have said, for people who are suffering from mental health problems, the bottom line is that the care is not there. People are being forced into institutions, where the quality of care and the expense of that care is very costly.

What we saw, in particular in northwestern Ontario, because none of those resources were on the ground, were large numbers of seniors, large numbers of people with psychiatric problems having to be moved to Thunder Bay, either to go to Lakehead Psychiatric Hospital or to go into homes for the aged there.

While we have gone over the initial crisis today and the bailout has occurred, this government has to make a conscious decision that if it is going to put community-based care in place, then we have to start moving towards that. Sure, we have to bite the bullet in this province and try to divert some of that money from the big institutions into community-based care. We cannot just have community-based care and not the institutions and we cannot move from one to another without making a real expansion as to what is happening on the ground. I think that is the next step the government has to look at.

Hon. Mr. Mancini: I am very pleased to join the rest of the members in the House today to debate the motion placed by the third party. We have heard a number of accusations in the House today, many of which are unfounded.

As the member for York North (Mr. Beer) stated earlier, planning and also leadership by this government to improve the quality of life for our province’s seniors began on day one after this government assumed office more than three years ago. On day one, the Premier set this government on a course to develop “an efficient, affordable and sensitive system of caring” for our province’s seniors and mandated the first minister of senior citizens’ affairs in Canada to lead this government’s efforts to create such a system out of the chaos that was the legacy of the very same people who today make charges of lack of leadership and absence of planning.

The new agenda for senior services announced by this government on June 2, 1986, after a year of intensive consultation and fact-finding, filled a vacuum of leadership and planning in Ontario that had existed for decades previously.

Let me remind this House and the member for London North that in April 1986 the third party, at that time the official opposition, published a paper entitled Care for the Elderly: Developing a More Co-ordinated and Community-Based Approach. In that paper, the Progressive Conservative Party stated that a government that cared about seniors would spend about $800 million on institutional care and $85 million on community-based services.

Let me suggest to the member for London North that the seniors of Ontario did in fact evaluate the Conservative Party’s concept of sensitive caring, of vision and of leadership and dismissed it and its institutionalized thinking at least twice; once in 1985 and again in 1987.

This government’s vision of care for seniors in Ontario recognizes our ageing population as a great resource and not a burden. This government’s vision of care for seniors in Ontario respects the dignity and self-worth of our elderly. This government’s vision of care for the seniors of Ontario sees seniors as people and not beds. There was $800 million for buildings and beds and $85 million for independence and dignity. That was the plan of the Progressive Conservative Party.

The Liberal government in Ontario has spent $40 million this year for the integrated homemaker program in 18 sites; 75 new elderly persons centres across our province with funding increased over 300 per cent since 1985. In 1985, the government run by today’s third party spent $5.9 million on home support services. This year the Liberal government will spend $49 million. That is a 745 per cent increase.

When the third party had the chance and a choice to do something as far as homemaker services is concerned for the elderly and for the disabled, it chose to do nothing. We have not walked away from the elderly in our homes for the aged either. This government has increased capital funding by 178 per cent in three years.

The people of Ontario, and especially Ontario’s rapidly expanding seniors population, share the government’s vision for the future of seniors care. The government’s vision, as I see it, is one of continuous and progressive change.

We in this province wish the people in our society who require assistance to remain in their homes and obtain the necessary services. They see, as we do, a province in which senior citizens who require institutional services receive quality care in a manner that respects their dignity and self-worth, a term the members opposite could have used a great deal more this afternoon. The people of Ontario are sharing in the planning that will see our shared vision implemented.

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An important element of our vision and an important component in our joint planning is the expansion of our homemaking system. An expanded system requires as its foundation a healthy homemaker industry. We cannot, nor will we, sacrifice one to benefit the other.

We are pleased to see members of the opposition rise time and time again to support this government’s vision. We will not disappoint them, or our growing seniors population or our disabled population. We will continue to carefully plan and implement our shared vision. We are committed to ensuring the highest quality service across a continuum of programs carefully crafted and responsibly funded. The seniors of Ontario have asked for no more and the government of Ontario should do no less.

If I can leave a thought or two for the people and for the seniors who may be watching this afternoon, they should note that over the past several months the Conservative Party of Ontario and its interim leader, who appears to be preparing himself for the job of permanent leader, have made as a core policy statement of their party the issue of government expenditures.

The people of Ontario should know that on a daily basis, the third party asks the ministers of this government to expand their budgets in a way that may or may not be responsible. At the same time, they and their leader canvass subway stations and areas in other communities outside Metropolitan Toronto, saying that the government should reduce the level of civil servants, that the government should reduce the level of funding.

I want to ask the people of Ontario, if they have a moment, to think about the statements that are being made by the members of the party opposite, the third party. They want us on the one hand to reduce our civil service that provides the services, to reduce the funding that is necessary so that the services can be bought, and at the same time, on a daily basis, as they rise before the cameras, they hope the people whom they talked to a week ago are not watching when they ask the government to spend more.

We have seen this again today and I am sure we will see it again in the future. I am sure we will hear it again from the lips of the leader of the third party and the colleagues who sit behind him as time goes on in this session and in the coming spring session, that the government should not spend responsibly but should cut expenditures, and that the government should not spend responsibly but should drastically increase expenditures. Those statements made by the third party are statements that will be quoted back to it time and time again.

I notice that the House leader of the third party has just walked in. He is one of their principal spokesmen in making these statements out of both sides of his mouth on a regular basis.

The people of Ontario are too smart, too well informed to recognize this motion, which was put forward today, as anything but a motion to take up the time of the House and as anything but a public relations job for the party when day after day it accuses us of overspending.

I say to the members opposite, produce a budget. It would be wonderful to see a budget produced by the third party where we could review in an itemized way --

Mr. Harris: In about three years we will do it for you, Remo.

Interjections.

Hon. Mr. Mancini: I see I have struck a nerve. The House leader of the opposition and some of his colleagues are making some comments now that may or may not be valid or appropriate or in any way intelligent. I cannot judge because it is very difficult to hear them, but the yapping in the background I do hear.

I say to you, Mr. Speaker, and to the people who are watching, that one of the hallmarks of this government has been responsible spending and sensitive programs for the people in our province who need them.

Mr. Pollock: I am pleased to take part in this debate. I would like to voice my concerns about the Red Cross. I believe that the Red Cross is a very highly respected organization and has some very dedicated employees. These people provide a real service in their home care service and they are very faithful employees.

I would like to comment briefly on the riding of Hastings-Peterborough. This is a large rural riding, and people who provide home care service in that particular riding have to be really dedicated. They have to drive over many miles of road and in some cases these roads are really a challenge. They are not exactly flat provincial highways. There are many hills there, and sometimes those hills are icy or snow-covered.

They have to do all this and provide this kind of home care service for $5 an hour. I firmly believe that this kind of a wage is totally unacceptable and that we should be providing a higher wage for these people who do this dedicated work.

I know that seniors like to stay in their own homes and it is far cheaper to have these people live in their own homes. I happened to be in the house of a lady yesterday who was celebrating her 90th birthday. She was really pleased that the minister is going to pick up the deficit and that she will be able to keep her homemaker service and stay in her own home. I believe this was one of the best birthday presents that we could have given this particular lady.

I hope the ministry can work out its financial problems so that we do not arrive at a crisis like this again.

I would like to comment on all those people who took part in the rally at Queen’s Park today. I firmly believe that it was their efforts in organizing this particular rally that actually pushed the minister and the government into picking up this deficit and keeping this vital home care service in place.

I would also like to pay tribute to the member for London North on her efforts to bring forth this emergency debate and keep this service in front of the public. Once again, I am pleased to take part in this debate and comment on this issue of great concern.

The Acting Speaker (Mr. M. C. Ray): There are a few more moments, if there is another speaker.

Mr. Allen: In making the last few remarks in this debate, let me simply say that it is quite evident that the ministry and the government have spent more money than was the case in the provincial budget three years ago on homemaker services and home care delivery. There is no question about that. Nobody will dispute budgetary statistics.

The central question is whether in fact, despite that expenditure, this system is somehow being maintained in place and is functioning adequately, and that is not the case. If we look at the front line, we see that the clients are writing to people like myself and complaining about the tremendous revolving door of homemakers who are going through their homes and upsetting them because they are simply not able to get used to one after another and settle down with a given home care deliverer.

We have the problem that even this infusion of funds to cover deficits will put not another penny into any homemaker’s pocket. The interministerial report identified what we know perfectly well to be the central problem, namely, wages of homemakers. Unless we pay homemakers a wage that is at least marginally competitive in the marketplace, we are not going to keep them. So we have these incredible turnover rates that run from 20 per cent to 130 per cent, homemaker service after homemaker service.

Finally, we have the problem that the government itself has put itself in a very difficult financial corner. When I look at the fact, for example, that in a recent survey of --

The Acting Speaker: Time. Order, please. Would the member move adjournment of the debate?

On motion by Mr. Allen, the debate was adjourned.

The Acting Speaker: It is now six o’clock. I understand the honourable member for Renfrew North has a business statement.

BUSINESS OF THE HOUSE

Hon. Mr. Conway: I just wanted, in light of the fact that the member for London North (Mrs. Cunningham) moved an emergency debate which the House has considered this afternoon, to make a business statement for tomorrow.

Tomorrow, following question period, the orders will be the following: Bill 69, An Act to amend the Education Act; Bill 70, An Act to amend the Education Act; Bill 186, An Act to provide for the Allocation of certain Payments or Grants in lieu of Taxes made by Canada to Municipalities in respect of Lands that are Exempt from Taxation, all education bills; Bill 199, An Act to amend the Ryerson Polytechnical Institute Act and, if time permits, the continuation of the adjourned debate on Bill 4, An Act to amend the Metropolitan Toronto Police Force Complaints Act, 1984.

The House adjourned at 6:02 p.m.