CONTENTS
Tuesday 23 March 1993
Long Term Care Statute Law Amendment Act, 1993, Bill 101
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
*Chair / Président: Beer, Charles (York North/-Nord L)
Présidente suppléante: Vice-Chair / Vice-Président: Daigeler, Hans (Nepean L)
Drainville, Dennis (Victoria-Haliburton ND)
Fawcett, Joan M. (Northumberland L)
Martin, Tony (Sault Ste Marie ND)
Mathyssen, Irene (Middlesex ND)
*O'Neill, Yvonne (Ottawa-Rideau L)
*Owens, Stephen (Scarborough Centre ND)
White, Drummond (Durham Centre ND)
Wilson, Gary (Kingston and The Islands/Kingston et Les Îles ND)
*Wilson, Jim (Simcoe West/-Ouest PC)
Witmer, Elizabeth (Waterloo North/-Nord PC)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Hope, Randy R. (Chatham-Kent ND) for Mr Martin
Jackson, Cameron (Burlington South/-Sud PC) for Mrs Witmer
Jamison, Norm (Norfolk ND) for Mr Drainville
Mammoliti, George (Yorkview ND) for Mr Owens
O'Connor, Larry (Durham-York ND) for Mr Gary Wilson
Sullivan, Barbara (Halton Centre L) for Mr Daigeler
Wessenger, Paul (Simcoe Centre ND) for Mrs Mathyssen
Wiseman, Jim (Durham West/-Ouest ND) for Mr White
Also taking part / Autres participants et participantes:
Czukar, Gail, legal counsel, Ministry of Health
Quirt, Geoffrey, acting executive director, joint long term care division, Ministry of Health and Ministry of Community and Social Services
Wessenger, Paul, parliamentary assistant to the Minister of Health
Clerk / Greffier: Arnott, Douglas
Staff / Personnel:
Gottheil, Joanne, legislative counsel
Spakowski, Mark, legislative counsel
The committee met at 1015 in room 151.
LONG TERM CARE STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LES SOINS DE LONGUE DURÉE
Consideration of Bill 101, An Act to amend certain Acts concerning Long Term Care / Loi modifiant certaines lois en ce qui concerne les soins de longue durée.
The Chair (Mr Charles Beer): Good morning, ladies and gentlemen. Welcome to the first of two days of clause-by-clause discussion of Bill 101, An Act to amend certain Acts concerning Long Term Care.
Before we begin our proceedings, I'd just like to note a couple of things. One, Alison Drummond, our researcher, had distributed the summary of the presentations and all members should have received that. In addition, there were some documents which the clerk had distributed during the break from the last hearings.
What I propose to do is to begin by asking each of the two critics and the parliamentary assistant if they wish to make some opening remarks of approximately 10 minutes each. Following that, we would then move directly into clause-by-clause.
As members will have noted from the government amendments, the Liberal amendments and the Conservative amendments, because of the nature of the act, there are similar if not identical amendments made in three different acts. In the discussion on the first range of amendments, I'm quite prepared to accept that comments might be made related to all of the acts that are going to be affected and to allow some leeway there, simply so that we don't have to keep repeating arguments. In each case, however, we will have to read the full amendment into Hansard so, as we come to it, we'll need to do that as well.
With all that being said, we can begin our proceedings. I would call on Ms Sullivan, if she has any opening remarks.
Mrs Barbara Sullivan (Halton Centre): Thank you, Mr Chairman. As you know, this bill is the first part of legislative consideration of long-term care reform. I think that one of the difficulties we have had in dealing with this bill on all sides of the House is that the government's full policy intentions and implementation plans are not available to us.
We have been dealing with a bill which is fundamental to ensure equity in funding of long-term care facilities in isolation from other matters that are key in the entire long-term care process. The chronic care role study is not available, and our understanding is that it will not be available for some time. The policy announcement and the response to the consultation are not available to us and will not be available for a few weeks at least, and perhaps longer, I'm given to understand. The implementation plans are not available.
Many people who were associated with consultation with respect to this bill in the first go-round in fact didn't have access to the proposed manual so, as a consequence, much of the original discussion that we faced was a discussion that was being conducted in a vacuum.
As we look at the bill -- and we have all come in with piles of amendments, whether it's the government or whether it's our party or the third party. Many of those amendments overlap and are similar. A large reason for that is that we have heard the same responses from many people who have appeared before us and believe that the responses that have been put forward have some validity.
As you know, going through the hearing process, we were very concerned that the government spell out -- and while Mr Quirt spelled out for us that the policy intent was that there be choice for the resident and a necessity that the resident consent and participate in developing a plan of care and so on. While that was on the table verbally, it was not included in the act and, as a consequence, there was an enormous sense of unease both from the consumer groups and from the provider groups.
We all, I believe, not having reviewed the third-party amendments at this point, have included a discussion and amendments that would mean that there will be a resident bill of rights, that there would be a resident council, that there would be choice available to the resident that would reflect the resident's own selection of place and a preference for place that would include the resident's ethnic, cultural, religious, social and other backgrounds, including geographic, and that they would be a part of the placement coordinator's decision.
Throughout the hearings, we have been deeply concerned and we will have a number of amendments with respect to the funding of the plan of care. In our view, there needs to be an assurance that the copayments plus the government payments will in fact cover the resident needs and we will have amendments to that effect. We believe that the homes, the long-term care facilities, are being asked to guarantee a plan of care and the delivery of that plan of care with no concomitant guarantee that the plan of care will be funded.
We certainly are aware that there are different levels in the funding and the basic plans of care as they exist now in homes are differently funded depending on the capability of the organization with respect to municipal funding or with respect to charitable funding or whether it's an individual company which is providing services. The equity in the funding that will be coming forward we think is a positive step. However, we believe firmly that there should be an obligation on the state, when it is requiring standards, to ensure that funding is provided for those standards.
As we go through the amendments, we will see areas where we will be accepting without change government amendments. Some we will have some recommendations with respect to, in which case we'll be withdrawing our own amendments or setting our own amendments aside. I'm sure the third party will be doing the same thing.
As you know, my party voted in support of the principle of this bill. We believe strongly that there should be reform of the long-term care process and that it should be moving ahead quickly. We would like to see and have more assurance that the steps that will be taken are cost-effective, that what is spoken is in fact what will be delivered and that where there are promises, those promises will in fact be kept.
We want to see the next steps as quickly as possible in the long-term care process. We think that frankly the government's approach in this bill is backwards and we should have had the policy before we start to have part of the implementation.
I could go on. I know my colleagues are anxious to get to the bill, so I'll leave it there.
Mr Jim Wilson (Simcoe West): Thank you for the comments from the Liberal Party. To echo some of those comments and add some of my own, I think it's disturbing that as opposition members -- and in fact members of the government should be disturbed -- we're being asked to pass this legislation and today go into clause-by-clause for this legislation really in a policy void.
We don't know because we haven't seen the chronic care role study, for example, or we haven't seen the bigger picture of long-term care, a number of studies and reports the government has yet to supply to the committee members or to members of provincial Parliament. I'm disturbed that we're doing this in a void.
None the less, I want to make it clear from the outset that my party is supportive of the principles of this legislation. We in no way intend to hold up the passage of this legislation because, and I want to be quite frank about it from the outset, we're kind of in a catch-22. We see some major problems with the legislation. We'll attempt to address those, and in a moment I'll outline 10 points we want to see changed in the legislation. But we are forced, on one hand, to go ahead with the legislation because a number of nursing homes in particular require the new funding that will be provided with the new levels-of-care funding.
Having said that, my preference, as a legislator and as someone trying to be responsible to the people of Ontario, would have been that we take more time with this legislation and await the bigger picture, because there's been a lot of attention paid through the media these days to the fact that many of our frail elderly and seniors in Ontario are quite worried about the direction long-term care is taking in this province.
When you approach legislation and the whole long-term care framework in a piecemeal fashion, as this legislation does, I don't think it is good policy development and I don't think it's fair to have senior citizens of the province, their care givers and loved ones worried about where they might be placed some day and how they might be placed in a home in the nursing home sector.
I want to say also that we're committed once again to the passage of this legislation. We think, in principle, that the legislation does set out to really strengthen the role consumers will play if the government goes forward with its amendments and accepts some of our amendments. We think funding will be fair as a result of this legislation but, as was mentioned previously, it's important that there be rights and responsibilities on both sides.
This legislation is written in a way and within an ideological framework that I think shows the government is somewhat suspicious of care providers, and nursing home operators in particular. There are a lot of safeguards introduced by the government to ensure that institutions live up to their end of the service agreements, but there are no safeguards in the legislation to ensure that the government itself pays for and lives up to its end of service agreements. Our amendments will try to address that.
Specifically, the PC amendments we are moving to include in the bill are grounds on which a facility may refuse an admission. All members are aware that the placement coordination system as envisioned in the legislation gives great powers to a single person, namely, the placement coordinator. It doesn't give the right of refusal to institutions where they may not have the proper physical structure. They may not have sufficient nursing skill levels and nursing care available in their home, among other reasons, to refuse the admission of a potential resident.
We want to ensure that the bill is amended to give some rights to institutions along that line because we think it's fair to consumers. We think people shouldn't be inappropriately placed and we think institutions must have a significant say on the mix of care to be provided in their home.
We want to introduce a more generic term for "quality management." I think there's been a great deal of evidence brought before the committee to suggest that the current wording in the legislation which speaks to quality assurance is an outdated term and that quality management and quality management systems are better used in this day and age.
We want to ensure enhanced accountability in the legislation by allowing for more opportunity for appeal in terms of placement coordinators: facilities and government are to be held accountable for their actions. We have a number of amendments, as does the Liberal Party, to ensure that accountability is built into every process envisioned in the legislation and that appeal mechanisms are put in place for both consumers and facility operators.
We want to ensure that placement coordinators are more responsive. Bill 101 currently envisions the placement coordinator position as holding a considerable amount of discretionary power to decide who is eligible for residency, the immediacy of their need to be admitted and to which facility an applicant will be admitted. The placement coordinator should be answerable for these decisions and we'll be introducing amendments to ensure that happens.
We also want to introduce an amendment to ensure that people who are placed on waiting lists aren't simply ignored, that waiting lists are reviewed by the placement coordinator every six months and that the needs of individuals on waiting lists are assessed periodically.
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We want the removal of preference for not-for-profit facilities. This is going to be a contentious amendment that probably the other two parties don't have in their repertoire of amendments. If one looks at the example the government has set in terms of rent control, where it has clearly told the province and landlords that part of your rent includes capital and future capital improvements, we believe that it's only fair that all sectors of the nursing home business -- nursing homes, charitable homes for the aged and municipal homes -- be treated the same with respect to capital funding and that there not be a bias in favour of the charitable and municipal homes as opposed to the privately operated nursing homes, and we'll go into that argument in greater detail when the amendment is put forward.
We want to protect consumer choice and particularly we want to protect the choice and respect the dignity of Canada's veterans. I think that we've heard most compelling evidence from veterans' organizations, from the Royal Canadian Legion, from Legion Command, that they're very fearful this legislation will shut them out of their own homes, on which they've worked very hard and put a great deal of money towards developing.
We also want to ensure that spouses aren't left out and that there's a preference set up to ensure that spouses are readily admitted to homes where their partners may be in residence. To do that, we're setting up a priority rating system which I think varies both from what the Liberals have envisioned and certainly what the government has put forward in Bill 101.
We want to ensure there's a role for physicians in the assessment process of applicants, and we'll be introducing some amendments on behalf of the Ontario Medical Association in that respect. We want to ensure there's an inclusion of the residents' bill of rights that's already contained in the Nursing Homes Act and, to give credit where credit is due, I think the opposition parties have been able to force the government to introduce an amendment and I see that in its repertoire of amendments it is looking forward to including the bill of rights, which I think is only fair and proper.
Finally, we want to ensure there's a creation of a dispute resolution mechanism. The inclusion of a third-party arbitration mechanism is a standard contract clause. In the circumstance that there is a dispute concerning the service agreement, that is, disputes regarding the interpretation of, compliance with or ability to comply with the service agreement, this amendment will ensure that a resolution is fairly reached by a neutral party. We think it's in the interest of fairness that this amendment be accepted by the government.
I look forward to the debates which will be long but hopefully fruitful. At the end of the day we all want to see the best possible legislation in place, Mr Chairman, and you have my commitment and that of my colleague Mr Jackson to ensure that is the case.
The Chair: Thank you very much, Mr Wilson. I now call on the parliamentary assistant.
Mr Paul Wessenger (Simcoe Centre): I'd like to thank the opposition members for their comments with respect to this legislation and I too look forward to dealing with the clause-by-clause and coming up with the best possible legislation.
Certainly, this legislation very much needs to be dealt with expeditiously. I think we're all aware of the levels of inequality with respect to the funding of the various nursing homes and homes for the aged and certainly it's very important that we have this level-of-care funding brought into effect in order that we have fairness to residents, in order that we have financial viability and also that we have funding to reflect residents' needs and services delivered.
I would object to one comment made by one of the opposition members. Certainly it's the intention of this government not to have a system which provides for open-ended funding. I think we all have to live within the realities of financial circumstances, and open-ended funding is not a policy option for any government today.
With respect to the whole question of reform, I would agree this is a partial reform but I think we must take our windows of opportunity and do what reforms we can when we have the opportunity to do that reform. I think it's important that we move forward and we not lose an opportunity to move forward. I would suggest that certainly this is very much a part of the reform of long-term care and will fit well with the policy statement that will shortly come out.
With respect to this legislation, certainly the hearings indicated the need to give and to ensure that we have the priority of consumer choice with respect to the facility or with respect to community care. Certainly, it's been very much the priority of this government to ensure that consumer choice is paramount, and I think that must take precedence over other issues. We have to ensure that consumer choice is paramount, subject of course to the aspect that a person should not be placed in areas where the physical facilities cannot serve that resident or the nursing care doesn't have the necessary expertise to provide the personal care.
With respect to the matter concerning veterans, I'm not going to deal with all the individual items because we'll have much discussion on them. I would like, though, to table at this time a copy of a letter from the Minister of Health addressed to the Honourable Kim Campbell, Minister of Veterans Affairs, with respect to the matter of priority beds concerning Perley. I think Mr Wilson indicated he wanted something with the minister's signature, and certainly this is the signature, which clearly indicates that the minister believes the priority beds at the Perley Hospital are protected, and it certainly was intentional that they be protected, asking the Minister of Veterans Affairs, Kim Campbell, to confirm that that is the federal government's understanding as well. I'll file that now.
The only other thing I would like to suggest to the Chairman is that, seeing the fact that we just had a large number of amendments presented by both opposition parties, it might be more productive to have a short adjournment so that those amendments might be looked at.
Mr Cameron Jackson (Burlington South): Collated properly.
Mr Wessenger: Yes. So I'd request maybe a half-hour adjournment.
The Chair: There has been a request for a half-hour adjournment. It's a little after 25 to 11.
Mrs Yvonne O'Neill (Ottawa-Rideau): Why don't we make it to 11, Mr Chairman?
The Chair: Would 11 o'clock be reasonable? Okay? The committee will stand adjourned until 11 o'clock.
The committee recessed at 1037 and resumed at 1103.
The Chair: The standing committee on social development will begin again its clause-by-clause deliberations on Bill 101. I think everyone has all of the amendments. We'll begin the first amendment to the bill, a Liberal motion. Ms Sullivan.
Mrs Sullivan: I move that the definition of "appeal board" in section 1 of the Charitable Institutions Act, as set out in section 1 of the bill, be struck out and the following substituted:
"`Appeal board' means the Long Term Care Facilities Review Board under the Nursing Homes Act."
The Chair: Are there any comments? I'll just allow some discussion of that amendment.
Mrs Sullivan: Yes, if I might, Mr Chairman. This amendment is a precursor to subsequent amendments that I will discuss now, because while they appear at different points in the bill, they all relate to the same issue.
We have been very concerned about the nature of the appeal board which is being selected to deal with issues that will be coming to it with respect to long-term care and long-term care facilities. Our purpose with this amendment and with subsequent amendments would be to reconstitute the nursing homes review board as the long-term care facilities review board under the Nursing Homes Act, and that board would then become the basic long-term care appeal mechanism.
As well, we would provide a new set of responsibilities to that board, which would be to act as an arbitrator and to settle disputes with respect to the service agreements between a home for the aged or a municipal or charitable home and the government. So what we're seeing here is a combination of issues coming together. The Nursing Homes Review Board, which has had activity and expertise in the past, would then be reconstituted to take on a broader scope of long-term care issues, and as well would also have a new authority that would allow it to act as an arbitrator in addition to being an appeal board.
We certainly feel there must be a dispute settlement mechanism that would be available to the homes, and we feel there should be additional expertise associated with the operation of the appeal board itself. The Health Services Appeal Board is now significantly behind and there is a significant delay in the timing of cases that are appearing before it. If that board is going to have to be reconstituted to do the work required by this act, then why don't we reconstitute a board that already has responsibility in the area?
Mr Jim Wilson: While I appreciate the thrust and principle behind this Liberal amendment, we will not be supporting it in the Progressive Conservative caucus. I will admit, though, that we had thoughts along the same lines, either to extend the mandate of the Long Term Care Facilities Review Board under the Nursing Homes Act, or originally, my caucus had drafted up amendments setting up a separate appeal board other than the Health Services Appeal Board. We dropped those, feeling that it was perhaps too bureaucratic.
To ensure that facilities have a right to appeal, that consumers have some appeal powers and to ensure that there's third-party arbitration in terms of arbitrating any disputes that may surround service agreements, we decided it's probably best to extend the powers of the Health Services Appeal Board that's now in place, not to add any new layers or to create any other boards.
I think Mrs Sullivan is correct in terms of the need for arbitration and the need for proper appeal mechanisms. Hence, we support what she's trying to do but can't support the particular amendment.
Mr Wessenger: We will not be supporting this amendment. I would like to indicate that we certainly recognize the need to develop a mechanism; however, I think it's very important that it be done in consultation with all the groups that are involved. I think the minister has indicated this is an item that should be dealt with in phase 2 of the legislation. I think we all recognize we have to deal with the problem, but this is not the appropriate time to do it because we need to do the consultation process and we have to work out the best way possible. At the same time, we don't want to add a level of bureaucracy without making sure it's going to work well.
The Chair: I'll put the question then. Shall the amendment carry? All those in favour? Opposed? The amendment does not carry.
The second amendment, Mrs Sullivan.
Mrs Sullivan: I move that section 1 of the bill be amended by adding the following definition to the Charitable Institutions Act:
"`Resident' means, in the case of an approved charitable home for the aged, a person admitted to and lodged in that home."
We are putting this amendment and will have a similar amendment to the other act.
This definition is included now in the Nursing Homes Act. We feel it presages the introduction of the fundamental principle, the residents' bill of rights and the council. As I've indicated, `resident' is defined in the Nursing Homes Act and we believe should be defined in the other acts as well. It's really a technical amendment. It's not a big-deal amendment, but it is a technical amendment that I think should be there.
Mr Jim Wilson: I'm inclined to recommend that we support this amendment because I think it does clarify a definition that may need clarification, but I would be interested in legal counsel's opinion on this particular amendment.
Mr Wessenger: I think, because this is a technical amendment, we should have legal counsel's opinion on it.
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Ms Gail Czukar: Gail Czukar, legal counsel with the Ministry of Health. For consistency's sake, it would be the same definition as in the Nursing Homes Act. I don't see any problem with it legally. I think the reasons that have been given by the member are the ones that are appropriate for why it's there.
Mr Wessenger: Based on that, certainly I'll be voting in favour of the amendment then.
The Chair: Shall the amendment carry? Carried.
Shall section 1 of the bill, as amended, carry? Carried.
We then move to what will be a new section of the bill. I call on the parliamentary assistant to present the government amendment.
Mr Wessenger: I move that the bill be amended by adding the following section after section 1:
"1.1 The act is amended by adding the following section:
"Fundamental principle
"3.1(1): In interpreting a provision of this act or the regulations that applies to an approved charitable home for the aged and in interpreting a provision of a service agreement between the crown in right of Ontario and an approved corporation maintaining and operating an approved charitable home for the aged, the fundamental principle to be applied is that an approved charitable home for the aged is primarily the home of its residents and, as such, it is to be operated in such a way that the physical, psychological, social, cultural and spiritual needs of each of its residents are adequately met and that its residents are given the opportunity to contribute, in accordance with their ability, to the physical, psychological, social, cultural and spiritual needs of others.
"Residents' bill of rights
"(2) An approved corporation maintaining and operating an approved charitable home for the aged shall ensure that the following rights of residents of the home are fully respected and promoted:
"1. Every resident has the right to be treated with courtesy and respect and in a way that fully recognizes the resident's dignity and individuality and to be free from mental and physical abuse.
"2. Every resident has the right to be properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his or her needs.
"3. Every resident has the right to be told who is responsible for and who is providing the resident's direct care.
"4. Every resident has the right to be afforded privacy in treatment and in caring for his or her personal needs.
"5. Every resident has the right to keep in his or her room and display personal possessions, pictures and furnishings in keeping with safety requirements and rights of other residents of the home.
"6. Every resident has the right,
"i. to be informed of his or her medical condition, treatment and proposed course of treatment,
"ii. to give or refuse consent to treatment, including medication, in accordance with the law and to be informed of the consequences of giving or refusing consent,
"iii. to have the opportunity to participate fully in making any decision and obtaining an independent medical opinion concerning any aspect of his or her care, including any decision concerning his or her admission, discharge or transfer to or from an approved charitable home for the aged, and
"iv. to have his or her medical records kept confidential in accordance with the law.
"7. Every resident has the right to receive reactivation and assistance towards independence consistent with his or her requirements.
"8. Every resident who is being considered for restraints has the right to be fully informed about the procedures and the consequences of receiving or refusing them.
"9. Every resident has the right to communicate in confidence, to receive visitors of his or her choice and to consult in private with any person without interference.
"10. Every resident whose death is likely to be imminent has the right to have members of the resident's family present 24 hours per day.
"11. Every resident has the right to designate a person to receive information concerning any transfer or emergency hospitalization of the resident and, if a person is so designated, to have that person so informed forthwith.
"12. Every resident has the right to exercise the rights of a citizen and to raise concerns or recommend changes in policies and services on behalf of himself or herself or others to the residents' council, staff of the approved charitable home for the aged, government officials or any other person inside or outside the approved charitable home for the aged, without fear of restraint, interference, coercion, discrimination or reprisal.
"13. Every resident has the right to form friendships, to enjoy friendships and to participate in the residents' council.
"14. Every resident has the right to meet privately with his or her spouse in a room that assures privacy and, if both spouses are residents in the same approved charitable home for the aged, they have a right to share a room according to their wishes, if an appropriate room is available.
"15. Every resident has a right to pursue social, cultural, religious and other interests, to develop his or her potential and to be given reasonable provisions by the approved charitable home for the aged to accommodate these pursuits.
"16. Every resident has the right to be informed in writing of any law, rule or policy affecting the operation of the approved charitable home for the aged and of the procedures for initiating complaints.
"17. Every resident has the right to manage his or her own financial affairs if the resident is able to do so and, if the resident's financial affairs are managed by the approved charitable home for the aged, to receive a quarterly accounting of any transactions undertaken on his or her behalf and to be assured that the resident's property is managed solely on the resident's behalf.
"18. Every resident has the right to live in a safe and clean environment.
"19. Every resident has the right to be given access to protected areas outside the approved charitable home for the aged in order to enjoy outdoor activity, unless the physical setting makes this impossible.
"Further guide to interpretation
"(3) Without restricting the generality of subsection (1), a provision of this act or the regulations that applies to an approved charitable home for the aged and a provision of a service agreement relating to an approved charitable home for the aged shall be interpreted so as to advance the objective that the resident's rights set out in subsection (2) be respected.
"Deemed contract
"(4) An approved corporation maintaining and operating an approved charitable home for the aged shall be deemed to have entered into a contract with each resident of the home, agreeing to respect and promote the rights of the resident set out in subsection (2)."
What this amendment does is add a residents' bill of rights to the Charitable Institutions Act and make it a term of a deemed contract between the home and its residents. Currently, this same bill of rights is in the Nursing Homes Act. This amendment addresses the concerns raised in the hearings that the residents of homes for the aged should have the same bill of rights protections as nursing home residents.
The Chair: We'll begin with Ms O'Neill.
Mrs O'Neill: I'm very happy that this amendment has come forward on behalf of the government. I am very happy about the right to consent regarding medical treatment, because I think that's something that was brought to us by many people. I don't know how to identify these sections or whatever they are. I have one question, however, regarding the one that's designated number 17.
The reason I bring it forward is because of course, as some of you know, I've just been through some of this, and I find it confusing. I don't see anybody acting on behalf of the person except the home. Many of the residents of such facilities often have a power of attorney designated to either a relative, trust company or other responsible person or body. I don't know whether this is the time to try and do that or not, but certainly we're not facing reality in this as I read it cold off this piece of paper. Maybe there's an explanation for it; maybe it's somewhere else.
Mr Wessenger: I assume that the concern you're raising is the fact that there may be a resident who is not capable and has a power of attorney appointed.
Mrs O'Neill: Right. Who is given the quarterly accounting? If the resident is incapable, there's no indication of who is given that quarterly accounting.
Mr Wessenger: I'll ask legal counsel to see if they can answer. I would normally think that the power of attorney would be entitled to that, but I'll ask them to clarify.
Ms Czukar: If there is a power of attorney or a committee under the Mental Incompetency Act that has the legal authority to manage the financial affairs of a resident, then the rules for accounting would be in the power of attorney or in the court order appointing the committee, and they would be separate from this. This only addresses the issue as between the home and the resident, so that if the home is managing the resident's affairs through a trusteeship or some kind of arrangement between the home and the resident, then it's an obligation on the home to give a quarterly accounting. But if there is someone else managing the resident's affairs, then it would have to be governed by the law or the agreement that's made in that case.
Mrs O'Neill: I'm glad we've got that on Hansard anyway, because it definitely is a question.
Mrs Sullivan: We will be supporting this amendment, which is very similar to our own. I think it's an improvement on our amendment, because it does include the service agreement, and I think that's an important aspect. I wonder if we could have an additional explanation from counsel or the parliamentary assistant with respect to the deemed contract, which I don't believe is in the Nursing Homes Act bill of rights.
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Mr Wessenger: Yes, you're quite correct; it is not in the act. One of the problems is with respect to the enforceability of bills of rights. I think it's fair to say that even with this provision, it doesn't -- it gives some additional protection by allowing the individual to have a right to sue the home if they're in breach; it gives them a contract right. I think that's the basic reason for putting in, to give a right, a means of enforcement, to the individual resident. It will be added, by the way, to the Nursing Homes Act as well.
The Chair: Mrs Sullivan?
Mrs Sullivan: Thank you. That's fine.
Mr Jim Wilson: We will be supporting the government's amendment, which establishes a fundamental principle clause and entrenches the resident's rights in legislation. As members will know, the Ontario PC party had drafted a very similar amendment to address this area of Bill 101. Bill 101, as it was originally drafted, did not adequately address the ethnocultural, spiritual, linguistic and social requirements of applicants to and residents of long-term care facilities. Concern has repeatedly been expressed that Bill 101 could erode the multicultural nature of many facilities and lead to the overlooking of the special needs of ethnic seniors. Presentation after presentation drove home the point that Bill 101 cannot be allowed to overlook these concerns.
To illustrate this point, I want to quote from the briefing material provided by Villa Colombo, which houses a significant number of Italian seniors in the Metropolitan Toronto area. Villa Colombo is just one of many groups we've heard from on this matter. They write:
"There are currently 70,000 seniors in Metro Toronto whose mother tongue is Italian, a number larger than the total population of many cities in Ontario such as Barrie, Kingston or Peterborough. Many of these seniors are unable to adequately communicate in English. No senior can truly live with dignity if that senior cannot communicate needs in a language which they understand. Our moral obligation lies in representing the best interest of the seniors."
With this amendment, I believe the appropriate emphasis is placed on cultural, spiritual and linguistic needs when individuals apply for admission to a long-term care facility. By inserting the fundamental principle clause of the Nursing Homes Act into the Charitable Institutions Act and the Homes for the Aged and Rest Homes Act, placement coordinators will be required to be mindful of these special ethnic needs as well, and I just echo what the parliamentary assistant has already assured us. To ensure that, though, we will be proposing that the residents' bill of rights from the Nursing Homes Act also be applied to the other acts, and the inclusion of the bill of rights will ensure that the dignity of individuals living in these settings is recognized and respected.
Finally, I just want to take up a point that has been raised by Mrs Sullivan. I just want to make sure that it's absolutely clear to the public and all of us non-lawyers that in no way can a service agreement or other contractual agreements between the home and the state override the bill of rights or the fundamental principle clause. I would just like that clarification.
The Chair: Parliamentary assistant?
Mr Wessenger: I'll ask legal counsel to reply to that one.
Ms Czukar: I'm sorry; I didn't hear the question. It was a long question.
Mr Jim Wilson: We're just looking for the assurance, in layman's language, that the bill of rights and the fundamental principle clause can't be overridden through the contractual arrangements such as the service agreement.
Ms Czukar: The service agreement is a contractual arrangement between the government and the home. Do you mean, could the government or the home override it by some matter of agreement?
Mr Jim Wilson: I note that the government has come a long way by what it has done here in terms of inserting the bill of rights and the fundamental principle clause. There was a lot of discussion in committee about social aspects of admissions, and the word is included in the wording now presented by the government, which I'm very, very pleased to see. But I do have a worry, because of some of the discussion we had in committee between the parliamentary assistant and opposition members, that through service agreements or other regulations that may set out placement coordination, these fundamental rights and principles could be somehow abrogated or avoided.
Ms Czukar: The bill of rights doesn't have precedence over other provisions of the act per se, but the initial subsections do say that the service agreement is to be interpreted in light of, and that provision was to be put in there to ensure that if there is any conflict between a provision of the service agreement or the act or regulations, as it stated, the bill of rights would have to be considered. There's nothing that says specifically it has precedence, so it's not clear which would necessarily take precedence. I think the commitment is to respect the bill of rights in any of those instruments, regulations, acts or the service agreement.
With respect to the issue of social admissions, however, I would point out that the bill of rights applies to residents and, given the amendment that was just passed that applies the definition of "resident" from the Nursing Homes Act to this act and will be in the homes for the aged act as well, we're talking about someone who is admitted to and lodged in the home. So it doesn't apply to the placement process before someone becomes a resident of the home.
Mr Jim Wilson: Had I known that, I probably wouldn't have supported the inclusion of the definition of "resident," and I ask the committee's indulgence to perhaps reconsider that. Is that possible?
Mrs Sullivan: No.
Mrs O'Neill: Not at this point.
Mr Jim Wilson: Maybe I should ask the mover of the "resident" definition clause whether they took into consideration that this would not affect admissions, which I think is rather serious.
Mr Wessenger: I think there are other sections of the act that would be more appropriate than this section, if you want to try to deal with that issue. I think the basic coordinating clause would be the area that should be addressed.
Mr Jim Wilson: I understand, and I also understand what the government is saying and legal counsel is saying with respect to the fact that the bill of rights and the fundamental principle clause are there to ensure that it must be respected in interpretation of other parts of the act. I appreciate that, but I just want to be clear with the public, who I think put a great deal of trust in our Charter of Rights, that this is not a charter of rights, this is a bill of rights, and there is a fundamental difference in practicality and in law.
Mr Jackson: I think my point was covered, but from the careful words chosen by legal counsel, it's clear that there's an override clause in here that gives enormous powers that wouldn't necessarily be guided by the bill of rights at all. I just want to put that on record.
The Chair: Mrs Sullivan, did you have a final --
Mrs Sullivan: I think our colleague from the third party was blurring the issue somewhat.
Mr Jim Wilson: I was clarifying the issue.
Mrs Sullivan: Having been the mover of the motion which included the definition of "resident" in the other act, where it does not now appear, I know that subsequent amendments would ensure that the placement coordinator would take into account, during the admission process and the eligibility determination process, the social and cultural issues associated with that process. There is also attached to a later amendment an indication that the plan of care should take into account those factors as well.
The Chair: Mr Wilson, final comments.
Mr Jim Wilson: I appreciate the clarification set forth by Mrs Sullivan of the opposition party. It may surprise you, Mrs Sullivan, but we do know what we're doing over here. I simply wanted to ensure that legal counsel clarified on the record that the bill of rights is a residents' bill of rights, because I think a lot of the presenters and witnesses we had before the committee -- and I don't think this is particularly funny -- were of the impression that if we were to insert a bill of rights and a fundamental principles clause, it would affect admissions and applicants. I just want to make it clear that that's not what we're doing here.
I had a lot of groups in my office, as I'm sure you did, Mrs Sullivan, indicating that if we only inserted that bill of rights and fundamental principles clause, all our problems would be solved with respect to placement coordinators.
Mrs Sullivan: That's not right.
Mr Jim Wilson: You're correct. That isn't correct, and that's not what the effect of what we've just done will be.
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The Chair: We should perhaps call upon the ghosts of Mr Diefenbaker and Mr Trudeau to come forward and talk about the bills and charters, but the points are --
Mr Jackson: Why don't you call the question, Mr Chairman?
The Chair: I intend to. Shall the new section 1.1 carry? Carried.
We would then move on to section 2.
Mr Jim Wilson: Both the PC and Liberal amendments to 1.1(1) are deemed to be dropped, then?
The Chair: Yes. Having not been presented, they are deemed dropped. So we will then move to section 2 of the bill, and the first amendment is a Liberal amendment. Ms Sullivan.
Mrs Sullivan: I move that clause 5(1)(e) of the Charitable Institutions Act, as set out in subsection 2(2) of the bill, be struck out and the following substituted:
"(e) operate an approved charitable home for the aged unless,
"(i) the approved corporation is a party to a service agreement with the crown in right of Ontario that relates to the home; and
"(ii) the service agreement complies with this act and the regulations."
Mr Chairman, this is a drafting amendment, if you like, to the section, which now would require that the home complies with the act and the regulations, when in fact the intent of the section was that the service agreement comply with the act and the regulations. This particular amendment was requested for clarification from the Ontario Nursing Home Association. The wording they recommended is slightly different from this, but counsel has indicated that this is the more appropriate and clear way to go, and that's why I'm putting it forward.
The Chair: A comment, Mr Wilson?
Mr Jim Wilson: Mr Chairman, I think it is an appropriate amendment, and we'll be supporting it. I think it's important to ensure the inclusion of the words "the service agreement complies."
The Chair: Thank you. Parliamentary Assistant?
Mr Wessenger: We'll be accepting this amendment, because it's clearly the intent of the original section and this perhaps clarifies it somewhat better than the original.
The Chair: Just before asking for the vote on that, I should have asked first, does subsection 2(1) carry as in the bill? Carried.
Shall the motion of Ms Sullivan carry? Carried. Shall subsection 2(2), as amended, carry? Carried.
The next amendment is a Conservative amendment. Mr Wilson.
Mr Jim Wilson: Mr Chairman, I move that the bill be amended by adding the following section after section 2:
"2.1 Section 6 of the act is amended by adding the following subsection:
"Exception
"(2) The minister may not direct payment under subsection (1) to an approved corporation erecting a new building or an addition to an existing building, if all or any part of the new building or the addition is to be used as an approved charitable home for the aged."
The Chair: Do you wish to comment on that?
Mr Jim Wilson: Yes. As part of Bill 101, the NDP has suggested that the Nursing Homes Act be amended to allow the government to provide capital funding for not-for-profit service expansion. This move comes on the heels of the government's earlier indication that it intends to drastically alter the opportunity commercial providers will have to provide home care services in the province. These policy directions obviously have more to do with, I believe, the NDP ideology than pragmatism or the redirection of the system of long-term care in order to meet the present and future needs of Ontarians.
The government has trumpeted Bill 101 as a means by which to make the long-term care sector equitable. Both the provision of capital funding for only not-for-profit nursing home facilities and the restrictions to be placed on commercial home care services, which we've heard the minister talk about, fly in the face of this intent with regard to equity.
In 1989 the Ontario Nursing Home Association successfully won a court battle launched to address the inequitable and discriminatory treatment of residents in nursing homes, compared to residents of homes for the aged. The court found that the system of funding was illogical and unfair and urged the province to move swiftly to rectify the problem back in 1990. Funding for nursing home residents remains as much as 30% to 40% lower than that provided for residents of other facilities.
So, in effect, Bill 101 will attempt to undo one funding problem, because it attempts to make funding among the nursing home sectors more equitable, but it will create another funding problem, and to me and my caucus this makes no sense. It follows, therefore, that capital funding arrangements should be eliminated from the legislation governing the Charitable Institutions Act, the Homes for the Aged and Rest Homes Act and the Nursing Homes Act.
Additional capital funds should not be provided at all by government, given the new per diem arrangements, since they are in fact included in the per diem. In light of this, I propose that not-for-profit facilities be required to use their dollars the same as for-profit facilities, and therefore I move that direct payments under subsection 2(1) of the act not be allowed.
I add to that the NDP's own logic when it's applied to rent controls. The NDP has told us time and time again that a portion of any individual's rent to a landlord includes payment for any future renovations or modifications or capital improvements or additions that a landlord may want to introduce to the facility in future, and therefore the government caps any rent increases at I think around 5% this year or a little over, and allows in part of that and slightly above that a provision for capital. The argument we're making here is to apply that logic to Bill 101.
The bill has this clause, which clearly states a bias for the not-for-profit sector when it comes to capital grants from the government. We believe that the not-for-profit sector should be treated the same as commercial operators or the for-profit sector when it comes to capital improvements or expansion, capital funding, ie, a private nursing home operator must save his or her pennies and reinvest its profits into capital improvements or expansions down the line. We believe that charitable homes that are now going to receive -- everyone's receiving the same per diem in this levels-of-care funding arrangement -- should also be required to save their pennies, as the nursing home operators must, and reinvest savings into capital expansion, without having the benefit of additional capital grants from the government. Otherwise, you're introducing further inequities into a system, and we're told that this government's intent and the intent of this legislation was to eliminate those inequities.
Mr Wessenger: We will be voting against this provision. It's somewhat interesting that what the opposition has moved here is to change a policy, in fact legislation, that existed for many years and that provided for 50% funding for homes for the aged for capital. It's something that, I must say, existed under previous Conservative governments in the past and continued under the Liberal government of the past.
Mr Jim Wilson: That doesn't make it right.
Mr Wessenger: No, it's just interesting to note that the change in the --
Mr Jim Wilson: Nice point of history there.
Mr Wessenger: I know. It's interesting just to point to a change in policy for that opposition party. But we certainly support the non-profit sector and would not support any taking away of rights for homes for the aged. Therefore, we'll be consequently voting against it.
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The Chair: Shall Mr Wilson's motion carry? All those in favour? Opposed? The motion does not carry.
I believe the next amendment is also a Conservative amendment. Mr Wilson.
Mr Jim Wilson: I move that the bill be amended by adding the following section after section 2.1. Actually, Mr Chairman, I'll withdraw this amendment, because it was a housekeeping item referring to the previous motion.
The Chair: It is therefore withdrawn.
Shall section 3, as in the bill, carry? Carried.
Now section 4. The first amendment with respect to section 4 is the Conservative amendment. Mr Wilson.
Mr Jim Wilson: I move that section 4 of the bill be amended by adding the following sections to the Charitable Institutions Act, after section 9:
"Notice before reduction or withholding
"9.0.1(1) Before reducing or withholding a payment to an approved corporation under subsection 9(3), the minister shall serve on the approved corporation a notice setting out,
"(a) the minister's proposal to reduce or withhold a payment under subsection 9(3);
"(b) the proposed amount of the reduction or the amount proposed to be withheld, as the case may be;
"(c) the breach or breaches of the service agreement on which the minister relies for reducing or withholding payment;
"(d) the requirements set out in subsection (4) for entitlement to a hearing by the appeal board;
"(e) the minister's power under subsection (5) to carry out the proposal; and
"(f) the requirements set out in subsection (6) for obtaining an extension of the time for giving a notice requiring a hearing.
"Service of notice
"(2) A notice under subsection (1) may be served personally or by registered mail addressed to the approved corporation at its most recent address known to the minister.
"Deemed time of service
"(3) If the notice is served by registered mail, the service shall be deemed to have been made on the seventh day after the day of mailing.
"Entitlement to a hearing
"(4) An approved corporation that is served with a notice under subsection (1) is entitled to a hearing by the appeal board if it mails or delivers to the minister and to the appeal board, within 30 days after being served, a notice requiring a hearing by the appeal board.
"Minister may carry out proposal
"(5) If the approved corporation does not require a hearing in accordance with subsection (4), the minister may carry out the proposal described in the notice served under subsection (1).
"Extension of time
"(6) The approved corporation may apply to the appeal board for an extension of the time for giving a notice requiring a hearing, either before or after the time expires, and the appeal board,
"(a) may extend the time for giving the notice if it is satisfied that there are reasonable grounds for applying for the extension; and
"(b) may give such directions as it considers proper in light of the extension.
"Hearing
"(7) If the approved corporation requires a hearing in accordance with this section, the appeal board shall appoint a time and place for and shall hold a hearing.
"Same
"(8) The time appointed by the appeal board for a hearing must be within ninety days after the day the appeal board received the notice requiring the hearing.
"Parties
"(9) The parties to a proceeding before the appeal board under this section are the approved corporation, the minister and such other persons as the appeal board specifies.
"Proceedings
"(10) Subsections 9.8(3), (5) and (6) apply to the proceedings and decisions of the appeal board under this section.
"Powers of appeal board
"(11) After a hearing by the appeal board under this section, the appeal board,
"(a) may, if the minister has not yet carried out the proposal described in the notice served under subsection (1),
"(i) allow the minister to carry out the proposal;
"(ii) direct the minister to refrain from carrying out the proposal; or
"(iii) find that an amount lower than that specified in the proposal is reasonable in the circumstances and allow the minister to make a reduction or withholding under subsection 9(3) in such lower amount;
"(b) may, if the minister has carried out the proposal under subsection (5),
"(i) find that the proposal was reasonable in the circumstances;
"(ii) direct the minister to pay to the approved corporation the amount of the reduction or the amount withheld, as the case may be; or
"(iii) find that an amount lower than that specified in the proposal was reasonable in the circumstances and direct the minister to pay to the approved corporation the difference between the amount specified in the proposal and the amount that the appeal board found was reasonable;
"(c) may substitute its opinion for that of the minister; and
"(d) may make such other order as it considers just.
"Powers of court on Appeal
"9.0.2 On appeal to the Divisional Court from a decision of the appeal board under section 9.0.1, the Divisional Court,
"(a) may affirm or rescind the decision of the appeal board;
"(b) may substitute its opinion for that of the minister or the appeal board; and
"(c) may exercise all the powers of the appeal board."
The Chair: Just before commenting on your amendment, could I just note to committee members that this is actually a new section. I'm going to allow the discussion of this but we will not vote on it until we have dealt with the first Liberal amendment and the government amendment. But because it has been read in and is fresh in our minds, we'll have the discussion of that now.
Mr Jim Wilson: Under the heading "Appeal opportunity if found in breach of service agreement," I just want to make the following comments. Throughout the public hearings on this legislation, this committee has repeatedly been told that the system must provide adequate opportunity to appeal decisions at various points of the process. It is through appeals that the system remains accountable and responsive.
The Ontario Nursing Home Association has rightly noted in its presentation to this committee that Bill 101 will create a highly --
Mrs O'Neill: Litigious.
Mr Jim Wilson: -- very legalistic -- environment through its move towards contractual arrangements between government, provider and resident.
Just for Ms O'Neill's sake, I use notes so that I can stick to the point.
Mrs O'Neill: I'm sorry I disturbed you.
Mr Jim Wilson: If this is indeed the way in which the long-term care system is to be redirected, the system must be balanced with the opportunity for facilities to challenge decisions which will greatly affect their ability to operate and care for their residents.
With this amendment, an opportunity will be created for facilities to appeal decisions of the minister to reduce or withhold funding. I think this is very important. This committee is well aware that there is no accountability on the government side to provide the funds proportionate with requirements set out in the service agreements. What must be recognized by this committee is that withholding funds hurts residents. It doesn't necessarily hurt the operators; it hurts the residents themselves directly. For this reason, this measure should be used wisely and with caution. The amendment I have moved recognizes this fact.
Finally, the amendment also addresses the fact that sanctions for facilities in breach of their service agreement have been increased and can be imposed in an arbitrary fashion without an appeal process being available for the facility. In many cases, sanctions such as freezing admissions or withholding payments will in fact jeopardize the provision of care to existing residents in the facilities themselves. For these reasons, sanctions should only be implemented as a final resort and facilities must have the right to appeal the sanctions implemented.
Mr Wessenger: We will not be voting in favour of this resolution for some of the comments previously made. First of all, the question of the appeal process is being considered in phase 2, and also, seeing that this provision deals with the service agreement, it is subject to judicial review and subject to lawsuit in the courts. This is a contractual aspect.
Mr Jim Wilson: Perhaps repeat it, because I'm not sure I caught it all. There's going to be a phase 2? This is certainly news to me and I think to all members of this committee, because this is the first time phase 2 has been discussed. Secondly, there is an appeal board in this legislation. So I fail to see how the parliamentary assistant's comments jibe with some of the government's own provisions.
Mr Wessenger: I think, first of all, with respect to the matter of agreements, normally disagreements with respect to contractual agreements are dealt with in the courts, although parties may elect sometimes to deal with them through arbitration. That's the first point I would make.
The second point is, I think it was made very clear by the minister at the beginning of these hearings that this was phase 1 of the long-term care reform and there would be a phase 2 of the legislation with respect to the community aspect of long-term care.
Mr Jim Wilson: Maybe I should correct myself, Mr Chairman. I thought the parliamentary assistant's original comments were referring to phase 2 of clause-by-clause or something in this particular legislation.
Mr Wessenger: No, of course not.
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Mr Jim Wilson: I'd be happy to have a couple more days.
Perhaps I may, before the Liberals have an opportunity to comment, very clearly state that it's our belief the minister shouldn't be allowed to withhold payments to a facility without properly notifying and allowing for an appeal mechanism for the facilities, because members must be aware that while facility operators come and go, residents live in those facilities; it is their home.
If money is withheld to that home, for breach of service agreements or whatever reason, the residents themselves are the ones who will suffer. It seems reasonable and fair to me and my caucus colleagues that there should be a notice provision in the legislation, a requirement that the minister serve notice and, secondly, that there be an appeal of what could be a very heavy-handed decision put forth by the minister to withhold funding to homes and residents.
Mr Jackson: Briefly, the point is that the manifestation of this is that generally with staff layoffs, the problems are in meeting payroll, not in acquiring food, so this has serious implications for potential immediate staff layoffs and it becomes a self-fulfilling prophecy and a snowball. How do we undo that? One of the major motivating reasons the government has gotten into this process of equity is not necessarily because of the equity between residents in the different homes, but because there were extensive layoffs in nursing homes because payrolls couldn't be met and nursing homes were going into receivership. I think we get a false sense of the equity base of a nursing home, but the manifestation of cutting off funding generally results in staff layoffs.
The legislation is inadequate in terms of meeting the needs of health care workers in these facilities all across Ontario. Our amendment would at least allow a period of time in which labour can also come to the table and discuss these matters where the government is stepping in and trying to deal solely with an owner of a facility. This allows labour to also participate and discuss the implications of cutting off funding to their institution. Again, everybody would be focused on residents' needs, but the manifestation is layoffs, because there's no money to make the payroll. We strongly believe that these concerns should be addressed in this legislation. That's why my colleague and our caucus has presented them.
Mrs Sullivan: I believe this is a serious and important amendment which the third party has put forward. We have, for our part, put forward two or three other amendments which speak to some of the issues but not all of the issues, and which expand on some of the issues raised in this amendment with respect to the withdrawal of funding. We are quite concerned about (a) the drafting of the act and (b) what the actual practice will be when the law is implemented.
We feel, first of all, that because there is no mechanism now included in the bill, there ought to be a legislated process with respect to serving notice on the home that the inspector believes is in breach, which states specifically why the home is in breach. That is not included in the bill.
The second area where we feel this is an important motion is that if funding is reduced, we know the funding is based, according to this act and according to levels of service, which is what we're moving to, on plans of care. When funding is reduced, the plans of care then will not be able to be implemented at the same level they would be if the plans of care were fully funded.
Therefore, what we are concerned about is, how much at risk to their health or safety will residents be put if funds are withdrawn because of what may in fact be merely a technical breach of a service agreement, rather than a breach of the agreement which is a significant one and in which there is danger to the residents?
I'm going to ask if we could have the concurrence of the parliamentary assistant to stand this motion down for them to reconsider the nature of the motion and bring it back. I think this is not a frivolous motion. It is not put forward merely for words to be placed on the table and for the issue to come forward.
The point that the parliamentary assistant has raised with respect to the appeal board, in my view, is not an appropriate response, in that the appeal board will in fact be operating to hear appeals with respect to eligibility, and I believe that the government will also, as I recall from its amendments, be further enhancing the role of the appeal board.
The appeal board here I think is the appropriate place to hear appeals with respect to funding reductions. I think the government should look at this amendment very seriously.
The Chair: Mr Wilson and then the parliamentary assistant.
Mr Jim Wilson: I would concur with Mrs Sullivan's comments and I certainly appreciate the support of the Liberal Party. The only addendum I would place is that I don't want to see, if the parliamentary assistant concurs with standing down the amendment, that it be stood down indefinitely. I went through that during the advocacy and consent legislation. We had several dozen clauses stood down indefinitely. So I would ask that the matter be dealt with before 5 pm today.
The Chair: Parliamentary assistant.
Mr Wessenger: First of all, in response, certainly we don't feel the present appeal board would be the appropriate board to hear such issues that are raised in this, because they are contractual issues and legal issues and require a board able to deal with those types of issues if the decision was made to have it. Also, I understand that there was filed, I believe with members, an answer to a request for information with respect to a process prior to withholding funding. I believe that has been filed with members, so there is a process that will be used prior to that withholding funding aspect being dealt with.
The Chair: Shall the motion presented by Mr Wilson carry? All those in favour? Opposed? The motion does not carry.
Mr Larry O'Connor (Durham-York): Is it in order to do it out of order?
The Chair: We can vote again later, if you wish.
Mr O'Connor: We don't need to vote again. I just wondered.
The Chair: Thank you very much. Shall section 4, subsection 9(1) as in the bill, carry? All in favour?
Mr Wessenger: There's an amendment, I believe, isn't there? Legal counsel seems to know. Yes, there is an amendment, a Liberal motion.
The Chair: Yes. That is a new section.
If you'll bear with me, we have to deal with 9(1) as in the bill. Shall it carry?
Mr Wessenger: Carried.
The Chair: Carried. Then we have a Liberal amendment. Mrs Sullivan.
Mrs Sullivan: I move that section 9 of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by adding the following subsection:
"Payments must be sufficient.
"(1.1) The payments under subsection (1) must be in such amounts that the payments, together with any amounts for which residents are responsible, are sufficient to defray all the costs described in subsection (1)."
Basically, what we're saying is that the obligation of the home in providing accommodation, maintenance, operating costs, care, services, programs and other goods to residents is clear and set out from the service agreements. We know funding can be withdrawn from the homes for any breach, whether technical or not, of the service agreements. We know the resident will be responsible for certain copayment with respect to the accommodation portion of the costs. We do not, however, see an obligation on the government, which is requiring that a plan of care be met, to fund the plan of care.
This amendment is one which says that the payments, which will be made out of the appropriations from the Legislature to assist in defraying the maintenance and operating costs, will be sufficient, along with the resident's accommodation copayment, to cover the costs required to provide the care and services needed by the resident.
The Chair: Comment, Mr Wilson?
Mr Jim Wilson: I'm pleased to note that we're very supportive of this amendment. Given that, I think it begs the whole question of the direction in which this bill is taking the province in long-term care in terms of funding. We're moving away from an insurance model, which ensured in the past that if doctors assigned an extended care certificate, the per diem provided by the government had to go to the home whether the government wanted to provide it or not, and that was a legislated requirement.
I know this deals with operating subsidies for homes for the aged, but to me the Liberal amendment attempts to say in simple language that if the government's requiring that certain services in care and accommodation be provided, then the government better be prepared to put its money where its mouth is, and it better be prepared to actually provide enough money to all of the nursing homes and the entire sector to ensure that people are getting the services and care that's outlined in the service agreements.
I'm happy to see the amendment, because I'll tell you, we struggled with legislative counsel for many a day and night trying to come up with a similar amendment, and while this may not be perfect in law, certainly the intent is commendable and I think all members should support it. If we have to stand it down and reword it, because I know legal counsel may have some objections to where it's placed and how it's worded, I hope the parliamentary assistant, on behalf of the government, will at least support the amendment and perhaps we could work on wording, if necessary.
Mr Wessenger: We will not be voting in favour of this motion because in effect it's open-ended funding and as a policy matter we're not prepared to have open-ended funding.
The Chair: Shall Ms Sullivan's motion carry? All those in favour? All those opposed? The motion is defeated.
It now being shortly after 12 of the clock, we will adjourn until 2 o'clock sharp.
The committee recessed at 1204.
AFTERNOON SITTING
The committee resumed at 1409.
The Chair: Good afternoon, ladies and gentlemen. We begin the next session of the standing committee on social development, and we are dealing with Bill 101, An Act to amend certain Acts concerning Long Term Care. The next amendment we are dealing with is a government amendment, and I'll call on the parliamentary assistant.
Mr Wessenger: I move that subsection 9(3) of Charitable Institutions Act, as set out in section 4 of the bill, be amended by striking out "is in breach of" in the third line and substituting "has breached."
This is a technical amendment to cover the situation; otherwise, there has to be a determination of when the breach occurred when the payment's being made. So in order to avoid that technical problem, we've changed the words.
Mrs Sullivan: I don't want to belabour this point, because we did speak about the difficulty we have with the approach of the government with respect to the withdrawal of funding when there is a breach. First of all, the home is not entitled to notice of the breach. We now have an amendment, which is a technical amendment, that would enable funding to be withdrawn for a breach that has occurred at some point in the past yet to be determined.
The third thing is that yes, we have had an informal statement on what the process will be, but that's not part of the law in terms of what occurs if a home is in breach of a service agreement. Whether the breach is a tiny technical one or the breach is a major one out of which charges should flow, it doesn't matter: The same rules apply, and none of those rules are written down.
I think there is an enormous problem with this section of the act and with the entire concept of the withdrawal of funds as it's been put to us by the government. It needs an enormous amount of more work, and I'm very dissatisfied.
Mr Jim Wilson: I'm sorry, Mr Chairman, but I did not hear at all, even though I was listening, what the technical explanation from the parliamentary assistant was.
Mr Wessenger: The explanation is that the words "is in breach of" mean you'd have to prove, the immediate instant the decision was made to withhold funding, that there was a breach at that instant, and that would make it very difficult to determine. So you put in the provision "has breached," because that's clearly identifiable as having occurred. In the prosecution of any offence, you have to have a definition.
Mr Jim Wilson: Before we leave this important section, I just want to be clear what the policy of this government is. As I understand it, because you won't accept the amendments put forward by the PC caucus or the Liberal Party with respect to an appeal process when it comes to a minister's decision to withhold funding because of a possible breach in a service agreement, then it's the policy of your government that facilities will have no access to appeal and the punishment will apply without any sense of fairness.
Mr Wessenger: Perhaps I might indicate what has been indicated in the answer to the committee with respect to the procedure. First of all, the sanction is only a potential last step in a process, not that is geared to resolve a problem without resorting to stricter sanctions. The process, first of all, is that discrepancies in the service delivery might be observed by government staff and go through the normal compliance procedures. Government officials will obviously deal with the matter by bringing it to the attention of the home orally. Then of course it would be given a written notice of non-compliance.
The notice of non-compliance would not necessarily mean that the sanction would be applied in any way; it would just give notice that the facility must take corrective action. The notice would state specifically what aspects of service provided by the facility are faulty or lacking and request that the facility make a written plan of action to rectify the problems observed. If the problem is corrected, that's the end of the matter. If the facility does not achieve the agreed-upon expectations despite all reasonable supportive efforts by the staff, then the government has the option of withholding or reducing payment, and the amount of money recovered or withheld would be equal to the value of services agreed upon in the service agreement but denied to the residents by the facility.
After the sanction has been imposed, ministry staff will continue to monitor the care and services given at the facility. It's expected that the increased involvement of ministry staff will result in the problem being quickly rectified by the facility. So it's only as a last resort after the compliance approach doesn't work.
Mr Jim Wilson: Mr Chairman, through you to Mr Wessenger, I appreciate your reading to us from the memo that's been provided to members of the committee with regard to the process. I have to tell you again, though, that I don't take the same level of comfort, and I don't think residents of nursing homes or long-term care facilities, as they're to be called in the future, should take comfort.
If you're so crystal clear and so confident that withholding of funding is definitely the last resort, then why don't we put that in the legislation? Why don't we put what you just read into legislative language? I'm not trying to be rude or anything. I'm just trying to figure out why, if it's so clear, we can't have it in the bill, or at least an appeal mechanism?
Mr Wessenger: If we look at the whole question of compliance with law in general across society, I think it's fair to say that if we had a process where every breach of the law was prosecuted, every breach was dealt with legally, we'd have the whole system come to a standstill; that's across our whole system, criminal law included, police included.
Mr Jim Wilson: We have very few laws, Mr Wessenger, in which the state holds all the cards, and when we do have circumstances where the state holds most of the cards, we allow citizens to appeal, we allow citizens access to mechanisms that seek to remedy an injustice that the state may impose on an institution, for example, or an individual. What we're asking for in this case is the ability for an institution to appeal a unilateral decision by the minister.
Mr Wessenger: If we're getting to that aspect, I think we've indicated that that is a matter for consideration in phase 2 of the legislation, as the proper way of dealing with appeal processes. But I might add that I think any government would have to be very careful about any action it would take with respect to withholding funds, on the basis that it would have to be very certain in contracts it would write and that it had a very good legal case before it would take such action, because it would be exposing itself to substantial damages, as in any contract between any two parties. It would be the same type of situation. In fact, in a commercial situation the normal process, when one private concern feels that the other private concern owes it money, its normal process is to not pay and to withhold payment.
Mr Jim Wilson: But we also know that in reality, Mr Wessenger, if there isn't an easy appeal process that's inexpensive, the case is that when nursing home operators, for example, are running on thin margins, when so many of them are in fact on the verge of going bankrupt, the last thing they're going to do is take on the state in court to seek to correct an injustice because of unilateral breach of contract. It's an expensive process. I don't know why we can't just make it easier and fairer.
Mr Wessenger: I think I could concur in the sense that yes, we need in phase 2 to see if there's a better appeal mechanism than through the court system. I certainly would concur that we probably can, once we've done the proper type of consultation and looked at the proper type of board, come up with a better approach than through the courts. I would concur, and I certainly would support coming up with some proper overall appeal procedure in phase 2.
The Chair: A final question, Ms Sullivan.
Mrs Sullivan: I just wanted to point out that, where there's any other breach of any other law, there is at least a notice given to the person who is breaking the law, whether it's a parking ticket or a charge that's laid. In this case, the notice isn't even given. The question now, with the wording change with respect to breach, is that the offence, if you like, could have occurred at any point in time. I just think this is a very bad law.
The Chair: Shall the motion moved by Mr Wessenger carry?
Those in favour? Opposed? Carried.
The next amendment is a Liberal amendment. Ms Sullivan.
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Mrs Sullivan: I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act after section 9.1:
"Federal funding for veterans
"9.1.1 If an agreement between the government of Ontario and the government of Canada relating to veterans provides for funding from the government of Canada relating to long-term care, any such funding received by the province must be used for the purposes for which it was provided."
The Chair: Do you want to just explain the purpose of that?
Mrs Sullivan: This is a companion amendment to a later one which would be put. As you know, the veterans appeared before the committee on more than one occasion to indicate that there was deep concern among the veterans that the priority for admission and eligibility under federal-provincial agreements for beds which were held and funded by the government of Canada would not be maintained. This is an indication that since an agreement has been entered into and funding paid, that's how the money should be used.
The Chair: Ms Sullivan, in reading this motion, I have to take you to the orders of the House, section 56 of the standing orders, which says:
"Any bill, resolution, motion or address, the passage of which would impose a tax or specifically direct the allocation of public funds, shall not be passed by the House unless recommended by a message from the Lieutenant Governor, and shall be proposed only by a minister of the crown."
I'm going to have to rule this motion out of order, and do so rule.
Mr Randy R. Hope (Chatham-Kent): Are we now going to depend on you to make all rulings?
The Chair: That's normally one of the functions of this job.
Mr Hope: But I was going to bring it to the committee's attention, so from now on we can rest assured that you're going to screen all these amendments that are coming forward?
The Chair: I'm sure that if I am not on top of my job, you will remind me.
Mr Hope: Okay.
The Chair: The next amendment is a Conservative amendment.
Mr Jim Wilson: I move that clause 9.2(1)(a) of the Charitable Institutions Act, as set out in section 4 of the bill, be struck out and the following substituted:
"(a) shall provide that it continues in full force and effect until replaced or cancelled in accordance with the regulations;
"(a.1) shall contain a dispute resolution mechanism for resolving disputes related to the service agreement;
"(a.2) shall provide for a right to arbitration if the dispute resolution mechanism fails to resolve a dispute;
"(a.3) shall contain the other provisions required by the regulations to be contained in a service agreement."
The Chair: Commentary?
Mr Jim Wilson: This amendment outlines in part what the PC caucus would like to see contained in a service agreement. As Bill 101 currently reads, the service agreement could technically expire, leaving an operator unable to operate his nursing home facility or long-term care facility, as it's now called. My amendment would ensure this cannot happen.
As well, this amendment makes first reference to a dispute resolution mechanism for service agreements, and I will later introduce an amendment that would see to the establishment of such an mechanism. We think it's another extremely important amendment. It's a commonsense amendment that has been asked for, particularly by the Ontario Nursing Home Association.
I would hope all members would support it because, again, we're talking to what appears in the legislation to be a unilateral and heavy-handed approach to service agreements. I would state that my reading of Bill 101 is that all the cards are stacked in favour of the state, ie, the government of the day, and that operators have very little say in how they may be dealt with by the government.
Mr Wessenger: We'll be voting against this resolution on the basis that the whole matter in respect to appeal should be dealt with in phase 2.
Mrs Sullivan: Mr Chairman, as you know, in dealing with the appeal motion which we put earlier on, we had certainly been leaning to a dispute resolution mechanism that, in our proposal, would have involved the appeal board being able to participate in arbitration.
We feel it's important that there be some remedy that isn't a court remedy or a full appeal remedy. We will support this amendment, given that our amendment was defeated, as a second-best alternative, but I suspect that the government is going to do away with this one as well.
The Chair: Mr Jackson, I missed your hand.
Mr Jackson: Just briefly, Mr Chairman --
Mr Jim Wilson: I'd just note they're brimming with charity over here.
Mr Jackson: My concern is that in the process of the granting of licences in order for a nursing home to operate, which is a fairly strong analogy to this clause which is the right to exist under the service agreement, the Nursing Homes Act sets out clear time frames and expectations in legislation. Again, we've got a situation where far too much is going into regulation.
Although our motion seeks to improve on that, we really wish to set for the record that we're dealing with different levels of protection in terms of what would amount to the rapid transfer of patients in the event of a difficulty, and any mechanism which allows the contract to continue until the matters in dispute are resolved tends to have the effect of keeping a stable environment for the residents.
I don't wish to quote all the medical evidence of the -- even the loss of life associated with the stress from uncertain mobility and late-night mobility and all that sort of thing that flows from regulations that can allow for service agreements to be cancelled and therefore put licences in jeopardy.
You can choose to see this as an option to help the operator; we choose to see it as an option which helps the residents stabilize their environment. The minimal protections in law under the Nursing Homes Act, we believe, should be extended in this legislation to ensure that residents have full notice that they may have to move because there's a dispute between the operator and the government. Somehow we have to have the patients part of this equation and they're not.
The Chair: Shall the motion moved by Mr Wilson carry? All in favour? Opposed? Defeated.
The next amendment is also a Conservative amendment. Mr Wilson.
Mr Jim Wilson: This is a housekeeping item that refers to the motion that was just defeated. Given that the government doesn't want to deal with allowing for dispute settlement mechanisms or allowing for appeal processes, there's no house to keep in order so I'll be withdrawing the amendment.
The Chair: The next amendment is also a Conservative motion. You still have the floor, Mr Wilson.
Mr Jim Wilson: I move that section 4 of the bill be amended by adding the following to the Charitable Institutions Act after section 9.2:
"Arbitration
"9.2.1(1) This section applies with respect to arbitrations under a service agreement.
"Notice
"(2) An arbitration is commenced by a party to a service agreement giving written notice to the other party of its desire to arbitrate a dispute related to the service agreement.
"Appointment of board of arbitration
"(3) Within fourteen days of the written notice having been given, the parties,
"(a) shall jointly appoint a member of the appeal board to sit as a board of arbitration; or
"(b) shall each appoint a person to sit on the board of arbitration.
"Same
"(4) If the parties each appoint a person to sit on the board of arbitration, the two persons so selected shall within ten days after the second of the persons has been appointed appoint a member of the appeal board.
"Powers of board of arbitration
"(5) The board of arbitration shall hold a hearing to examine and decide the matters that are in dispute between the parties.
"Service agreements
"(6) Any decision of the board of arbitration shall form part of the service agreement.
"Costs
"(7) The board of arbitration may award costs.
"Appeal to Divisional Court
"(8) A party may appeal a decision of the board of arbitration to the Divisional Court on a question of law or fact or both.
"Powers of court on appeal
"(9) On an appeal to the Divisional Court from a decision of the board of arbitration under this section, the Divisional Court may do one or more of the following:
"1. Affirm or rescind the decision of the board of arbitration.
"2. Substitute its opinion for that of the board of arbitration.
"3. Exercise any power of the board of arbitration."
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The Chair: Comments, Mr Wilson?
Mr Jim Wilson: Again, the inclusion of a third-party arbitration mechanism is a standard contract clause in the circumstances that there is a dispute concerning the service agreement, that is, disputes regarding the interpretation of, compliance with or ability to comply with the service agreement. This amendment will ensure that a resolution is fairly reached by a neutral party. A dispute mechanism will ensure that a facility can respond to the requirements set out in the service agreement.
There is no requirement in Bill 101 that the level of funding provided by the government need be commensurate with the level required to provide adequate services and programs to meet the needs of the resident population. There is also no accountability on the government's side to provide the funds proportionate with the requirements set out in the service agreements, and this amendment has been proposed to address these concerns. It will enhance the accountability of the system by making certain that service agreements are reasonable for both sides of the agreement.
The Chair: Thank you. The parliamentary assistant.
Mr Wessenger: We'll be voting against this motion on the same basis as previously indicated. The determination of the appropriate method of appeal should be in phase 2.
The Chair: Ms Sullivan.
Mrs Sullivan: Once again, we find it shocking that the appeal process wasn't one that was thought out as this bill was presented. There's nothing more to say. We'll be voting for this amendment.
The Chair: Shall the motion presented by Mr Wilson carry? All in favour? Opposed? It is defeated.
The next amendment is a Liberal amendment. Ms Sullivan.
Mrs Sullivan: I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act after section 9.2:
"Term of service agreement
"9.2.1(1) Each service agreement shall be for a one-year term.
"If no new service agreement
"(2) If a new service agreement is not entered into before the expiry of the current service agreement the following provisions apply:
"1. Despite subsection (1), the current service agreement continues in force until a new service agreement is entered into or until the current service agreement is terminated.
"2. Any new service agreement that is entered into shall be deemed to have been in force since the current service agreement would have, but for paragraph 1, ceased to be in force.
"3. Interest shall be paid on all unpaid amounts that, under the new service agreement, should have been paid during the time the new service agreement is deemed to have been in force."
The Chair: Comments, Ms Sullivan?
Mrs Sullivan: This motion is really to reflect the kinds of approaches that in fact will be taken in the service agreements and in the schedules to the service agreements with each of the homes where there is a time line that is specified, where there is a contractual arrangement where services are provided in exchange for funding.
The situation is that nursing homes over the past few years have in fact suffered while negotiations are being entered into and funding does not flow, nor does interest on funding which has to be accessed elsewhere, ie, through bank and other loans. As a consequence, many of our nursing homes, as a result of what has become the standard practice, it seems to me, in the ministry, have been placed in cash flow difficulties which impact on the kinds of services that they are able to provide. In fact we have seen and heard a notice from nursing homes that they are going to have to reduce the services because they are unable to provide the service which is being required of them by the ministry. They simply can't afford it. This amendment is to set that straight.
Mr Jim Wilson: Mr Chairman, I'm pleased to indicate that we'll be supporting this amendment. All other attempts having failed, I'll throw back to Mrs Sullivan some lines perhaps she used at one time. Given that this is probably the second-best attempt, we'll be supporting this.
Again, it's getting a little frustrating on this side. I think that a number of our amendments are quite well thought out, and the government's persistence in not supporting many of them is a bit disturbing.
Mr Wessenger: We'll be voting against this amendment. First of all with respect to subsection 9.2.1(1) and subsection 9.2.1(2), paragraphs 1 and 2, these items would all be covered under the service agreement in any event, and I must say paragraph 3 would be creating a new financial obligation and setting a precedent for the government, so we will not be supporting it for that reason.
Mr Jim Wilson: Can we make a comment on that?
The Chair: Yes.
Mr Jim Wilson: I just wonder if that is totally correct, that provisions in Mrs Sullivan's amendment are actually part of service agreements now. It begs the question of what happens if a service agreement expires without its replacement being ready. I guess what you're telling us, and perhaps it is correct, is that the service agreement, although it's to be renewed once a year, continues in effect until the new one is put in place.
Mr Wessenger: What I might add is that the normal provision put in a contract at this time says, "This agreement continues in effect until renewed." It's called an evergreen clause, and it's a normal clause that is put in most agreements of this nature.
Mrs Sullivan: I point out that indeed the evergreen clause may well be added to the contract, but that does not mean that money will continue to flow, nor will any increment which is negotiated for the subsequent contract necessarily be retroactive and payments covered. Another thing: How do we know that it's going to be in the service agreement? It doesn't say that in the act.
The Chair: Shall the motion moved by Ms Sullivan carry?
All in favour? Opposed? Defeated.
The next amendment is also a Liberal amendment.
Mrs Sullivan: I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act, after section 9.2.1:
"Arbitration where failure to negotiate service agreements
"9.2.2(1) An approved corporation may require an arbitration by the appeal board, by giving notice in accordance with subsection (2), if there has been a failure to successfully negotiate,
"(a) an initial service agreement;
"(b) a subsequent service agreement; or
"(c) amendments to a service agreement in response to changing circumstances.
"Notice requiring arbitration
"(2) To require an arbitration, a notice requiring an arbitration must be mailed or delivered to the minister and to the appeal board.
"Arbitration
"(3) If the appeal board receives a notice under subsection (2), the appeal board shall arbitrate the matters in dispute.
"Parties
"(4) The parties to an arbitration are the person requiring the arbitration and the minister.
"Applicable provisions
"(5) Subsections 9.8(3) and (5) apply, with necessary modifications, with respect to an arbitration.
"Powers of appeal board
"(6) In arbitrating the matters in dispute the appeal board may order the minister,
"(a) to sign on behalf of the crown in right of Ontario, a service agreement with such terms as the appeal board specifies; or
"(b) to sign on behalf of the crown in right of Ontario, an agreement that amends an existing service agreement in such manner as the appeal board specifies."
Once again, you can continue to see the difficulty that we have, where the home is left without any mechanism to challenge what could very well be an arbitrary determination of the ministry. I'll just use (c) as an example, where the determination of the patient classification has been done at the beginning of the year, funding is based on that, the service needs of residents have changed substantially over the course of the year and the home seeks to amend the service agreement. If the ministry says no, then the home has no alternative. The arbitration is there for precisely that circumstance.
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Mr Jim Wilson: I'd like to indicate that we're supporting this amendment, and I'd like to ask a question through you to the parliamentary assistant. If the government were not to support some sort of arbitration in the case of a failure to negotiate a service agreement between the crown and a home, what would the process be?
Mr Wessenger: The process of a failure to negotiate an agreement would make, I assume, the home in breach of the act would allow -- not necessarily in breach. The existing agreement would continue in effect unless it was terminated by the crown.
Mr Jim Wilson: But this speaks to initial agreements and subsequent agreements. So let's take the case of an initial agreement, failure to come to agreement on an agreement.
Mr Wessenger: I think I'll ask legal counsel, because there might be a differing position with respect to the nature of the facility.
Ms Czukar: If it weren't possible for the crown to negotiate an agreement with the home initially, then funding an operation could not occur, because funding and operating are dependent on a service agreement being entered into. So obviously it would depend on a successful negotiation regarding the service agreement in order for the funds to flow and the operation of the home to begin, and that is the intention.
Mr Jim Wilson: I think you can see the importance, then, of arbitration. Correct me if I'm wrong, but as I was growing up I thought the NDP were great promoters of arbitration such as this.
Mr Hope: Negotiations, not arbitration.
Interjection: Binding --
Mr Jim Wilson: Binding arbitration. Rand formula --
The Chair: Mrs Sullivan, before I ask the parliamentary assistant to respond, do you wish to --
Mrs Sullivan: Yes, I do. I think that the initial service agreement area is one that is also key in that we have 500 homes of various types which will be entering into new service agreements. If there is a failure to enter into a service agreement -- those homes are now filled with people and I ask you, what will happen to those people?
Mr Wessenger: I would assume that we're going to have a successful negotiation of agreements, because this level-of-care funding is going to generally provide the increased funding. I don't really anticipate there'd be a problem with the entering into initial provisions.
Mrs Sullivan: It will not. On a point of order, Mr Chairman: It will not guarantee an increase in funding. There are some homes whose funding will be frozen.
Mr Wessenger: I think that's fair to say with those red-circled homes but certainly, as indicated by ministry staff, for most homes there will probably be some financial benefit. Also, funding is going to be based on the common level of care. That's an objective determination. So for that aspect, as far as the funding goes, it's an objective determination as to what the home is going to get. It's not a question of negotiation in the matter of the funding; it's based on an objective determination by the classification system. I don't know whether you wish any further clarification from ministry staff.
The Chair: Mr Wilson, you had one more.
Mr Jim Wilson: The worst-case scenario would be that you can't come to an agreement with a home. I haven't heard anything that would lead me to believe that that isn't possible under this legislation. Again, I fail to see why you wouldn't want some sort of arbitration to ensure that agreement does come about.
A carrot-and-stick approach is fascinating, Mr Wessenger, given that I think most people are starting to figure out that the carrot's kind of wilting and kind of rotting out there and that the millions of dollars that the sector potentially would gain under this legislation are really in question, I think. And with the red-circling of some homes and other homes expecting that they may be able to get out of deficit positions with the new funding, I think there's a rude awakening coming both to the ministry and to a number of charitable institutions, municipalities and private nursing home operators that the new funding that's been tied to this legislation isn't going to be the cure-all.
The Chair: A final question. Ms O'Neill.
Mrs O'Neill: I'm having a lot of difficulty feeling very secure about this. We had an awful lot of representations about the service agreement and about how uncomfortable many people feel about it. We've just had legal counsel tell us there will be no funds flowed till there is a service agreement; we've had the parliamentary assistant tell us that likely everybody will sign one. If the funding is tied to the time lines and there's no real appeal mechanism, motivator, arbitration process, what kind of atmosphere is this going to happen in? Not everybody in Ontario feels about Bill 101 the way the parliamentary assistant does. I feel very strongly that if everything is going to be put off into phase 2 or when the service agreement is signed and it is going to be signed, I don't think the Ontario providers or the people being provided for -- and those are the people Bill 101 should be working towards providing service for -- feel they are going to have security flowing from this bill.
The Chair: Thank you. Shall the motion moved by Ms Sullivan carry? All in favour? Opposed? It is defeated.
We now move on to a government amendment.
Mr Wessenger: I move that clause 9.3(1)(a) of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by striking out "for basic accommodation" in the first line and substituting "for a class of basic accommodation."
The purpose of this amendment is really to allow for different rates to be set out for short-term and long-term basic accommodation.
The Chair: Thank you. Any comments on this amendment?
Shall the government motion carry? All in favour? Opposed? Carried.
Mr Wessenger, you have another amendment?
Mr Wessenger: Yes. I move that clause 9.3(1)(e) of the Charitable Institutions Act, as set out in section 4 of the bill, be struck out and the following substituted:
"(e) for care, services, programs or goods that are not mentioned in clause (a), (b), (c), (d) or (2)(a) and in respect of which the resident has entered into a written agreement with the approved corporation, the amount determined in accordance with the written agreement."
We should stand this one down, I think.
The Chair: You wish to stand it down?
Mr Wessenger: Yes, because until the substitute decision-making amendment is accepted, it's felt it should be stood down.
The Chair: So we will stand this down until later. It's your intention to bring it back?
Mr Wessenger: Yes, it is, after we deal with section 9.1 of the bill.
The Chair: Okay, so this we will stand down and bring back later. The next amendment is also yours, Mr Wessenger.
Mr Wessenger: I move that clause 9.3(2)(b) of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by striking out "or on behalf of" in the fifth line. The same should also be stood down until the substitute decision-making amendment is accepted.
The Chair: So this will also be stood down. We will return to this.
Another amendment, Mr Wessenger, from the government, if you would proceed with that one.
Mr Wessenger: This one we can go with, it looks like. Oh, I would ask that perhaps this be --
The Chair: This is to be stood down as well?
Mr Wessenger: Yes, because there is an amendment --
The Chair: Would you move it and then we'll stand it down.
Mr Wessenger: Okay. I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act, after section 9.3:
"Debt of a resident
"9.3.1 An amount that an approved corporation charges a resident of an approved charitable home for the aged in accordance with section 9.3 for accommodation, care, services, programs or goods is a debt owed by the resident to the approved corporation."
The reason for asking to stand it down is there is a Liberal motion, I believe, that covers the same area that might be --
The Chair: All right, so we will stand down those three until later. We move on now to a Liberal amendment. Ms Sullivan.
Mr Wessenger: Can I ask for a short adjournment, because we might come up with a consideration of a small amendment to Ms Sullivan's motion.
The Chair: I'm prepared to do that. I wonder if we might just have Ms Sullivan move her amendment and then we could have a short break, if members are in agreement. Ms Sullivan, do you want to move your amendment?
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Mrs O'Neill: I'm sorry. Before we do that, the parliamentary assistant said we're standing down three. I've only got two. What was the third one we stood down?
The Chair: It is 9.3(1)(e), 9.3(2)(b) and 9.3(1). They were three government amendments and they are stood down.
Ms Sullivan, do you want to just move your amendment?
Mrs Sullivan: Yes. I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act, after section 9.3.1:
"Resident responsible for payments for accommodation
"9.3.2 (1) A resident is responsible for the payment of those amounts demanded by an approved corporation for accommodation in accordance with section 9.3.
"Minister to give statements
"(2) The minister shall provide, on the request of a resident, a statement setting out how much the resident may be charged for accommodation under subsection 9.3(1)."
The Chair: We may be able to sort something out all together. So I'm just going to go to the parliamentary assistant.
Mr Wessenger: I'm wondering, Mrs Sullivan, if you might be prepared to accept a friendly amendment to put before the words "on the request of a resident," "annually or" on the request of a resident.
Mrs Sullivan: "Annually or"?
Mr Wessenger: That's right. Because that's the practice.
Mrs Sullivan: Would you accept a friendly amendment that says, "annually and"?
Mr Wessenger: Yes.
Mrs Sullivan: I'd prefer that.
The Chair: To make sure everybody has got that, that would then read, "The minister shall provide annually and on the request of a resident...." Is that correct, Mrs Sullivan?
Mrs Sullivan: Yes.
The Chair: I think we will need you, then, to move that.
Mrs Sullivan: I withdraw my previous motion and move the following.
I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act, after section 9.3.1:
"Resident responsible for payments for accommodation
"9.3.2(1) A resident is responsible for the payment of those amounts demanded by an approved corporation for accommodation in accordance with section 9.3.
"Minister to give statements
"(2) The minister shall provide annually and on the request of a resident a statement setting out how much the resident may be charged for accommodation under subsection 9.3(1)."
The Chair: Shall Ms Sullivan's motion carry? All in favour? Opposed? Carried.
The next amendment is a Conservative motion.
Mr Jim Wilson: I move that section 9.4 of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by adding the following subsection after subsection (1):
"No recovery of charge
"(1.1) No deduction shall be made under subsection (1) unless written notice about the fact that the item paid for has not been provided or made available to the resident is given to the minister within ninety days after the date on which the person from whom the approved corporation accepted the payment discovers the fact."
I was wondering if it would be in order to read the following two amendments and then give my comments. They all deal with the same theme.
Mr Wessenger: I have no objection.
The Chair: I believe that would be in order if there are no objections. Please go ahead.
Mr Jim Wilson: I move that section 9.4 of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by adding the following subsection after subsection (2):
"No recovery of charge
"(2.1) No deduction shall be made under subsection (2) unless written notice about the fact that the payment exceeds the amount permitted to be charged under section 9.3 is given to the minister within ninety days after the date on which the person from whom the approved corporation accepted payment discovers the fact."
I move that section 9.4 of the Charitable Institutions Act, as set out in section 4 of the bill, be amended by adding the following subsection after subsection (3):
"No recovery of charge
"(3.1) No deduction shall be made under subsection (3) unless written notice about the fact that the item paid for has been inadequately provided is given to the minister within ninety days after the date on which the person from whom the approved corporation accepted payment discovers the fact."
The Chair: Please go ahead with your comments.
Mr Jim Wilson: There are three opportunities in which the minister may make payments to reimburse a consumer. These circumstances include when a good or service or services were to have been provided and were not, when a charge for a good or service is deemed excessive or when an item was provided inadequately.
This amendment does not deter from the ability of the minister to compensate the appropriate party in any of the above circumstances. It does, however, put some onus on the person who either failed to receive a service, received an inadequate service or was overcharged for a service to take action on the matter 90 days after the discovery of a problem.
It is important to note that this amendment will in no way limit the chances for recovery, be it a recent event or one year ago. Rather, by using the date of discovery as the starting point for action, this amendment seeks only to have these matters acted upon in a reasonable amount of time. This amendment will ensure that such matters are resolved in a fair way and within a reasonable time frame for both service providers and recipients.
It had come to our attention from witnesses, particularly from, I think, the private nursing homes sector, that at times, if there isn't a time frame put on the recovery section in terms of -- I believe the argument was that from time to time somebody may come well after 90 days and say that a service was inadequately provided, a year ago or whatever. They knew the fact a year ago, didn't report it and now continue to refuse to pay for the service. It apparently happens from time to time concerning deceased residents, former residents, where the family may from time to time refuse to pay for a service.
I think the homes really want to ensure that when someone, either the resident or his or her substitute decision-maker, discovers that a service hasn't been provided, or is provided inadequately or in the circumstances I've outlined in my amendment, this isn't left indefinite, that it's brought within 90 days to the home's attention and a remedy is sought.
The Chair: Just before asking for comment, we will be voting on each of these individually but we can discuss them all together.
Mr Wessenger: We'll be opposing the amendments because we feel the 90 days is too restrictive a period and that the matter really should be left to administrative practice rather than set out in the legislation.
Mrs Sullivan: We'll be supporting this amendment. I think 90 days is an adequate period of time. If the parliamentary assistant wants to argue why 90 days isn't an appropriate period of time, we might be interested in hearing that, but in my view 90 days is quite adequate.
The Chair: Shall the first motion, amending section 9.4(1.1), carry? All in favour? Opposed? Defeated.
Shall the motion moved by Mr Wilson, 9.4(2.1), carry? All in favour? Opposed? Defeated.
Shall the motion moved by Mr Wilson amending section 9.4(3.1) carry? All in favour? Opposed? Defeated.
The next amendment is a Liberal amendment.
Mrs Sullivan: I move that section 4 of the bill be amended by adding the following section to the Charitable Institutions Act after section 9.4:
"Restriction on reducing payments, etc
"9.4.1 The minister may not reduce or withhold payments under section 9 or deduct an amount from a payment under section 9.4 if the reduction, withholding or deduction would put a resident's safety, health or security at risk or would cause any of the services or programs in a resident's plan of care to be interrupted."
The Chair: Ms Sullivan, again I must under section 56 of the standing orders rule that out of order because it deals with the funding.
Mrs O'Neill: There are no guarantees in this bill.
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The Chair: The next amendment is also a Liberal motion. Miss Sullivan.
Mrs Sullivan: I move that subsection 9.5(2) of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by striking out "classes of persons" in the second line, and I further move that section 9.5 of the Charitable Institutions Act, as set out in --
Mr Hope: Point of order, Mr Chair: Isn't there a Conservative motion that has to be dealt with first, which is 9.4.1? I have a sheet in the Conservative one here.
Mrs Sullivan: Yes, you're right.
Mr Hope: That should be dealt with first, before the Liberal one.
Mr Jackson: You got to bed early last night, didn't you, Randy?
Mr Hope: Oh yes, lots of sleep.
The Chair: I'm sorry. I've got that marked as a Liberal motion. My apologies. Thank you, Mr Hope. Mr Wilson.
Mr Jim Wilson: Thank you, Mr Hope. I was kind of enjoying Mrs Sullivan's recitation of "We will return."
Mrs Sullivan: See, now I have to go back to the beginning. You should have let me finish.
Mr Jim Wilson: Well, I was mesmerized by it. I thought it was quite good, because I'll tell you that as to the motion I'm about to put forward, I don't have a lot of hope that it's going to pass.
I move that section 4 of the bill be amended by adding the following sections to the Charitable Institutions Act, after section 9.4:
"Notice before deduction
"9.4.1(1) Before making a deduction under section 9.4, the minister shall serve on the approved corporation a notice setting out,
"(a) the minister's proposal to make a deduction under section 9.4;
"(b) the proposed amount of the deduction;
"(c) detailed reasons for making the deduction;
"(d) the requirements set out in subsection (4) for entitlement to a hearing by the appeal board; and
"(e) the minister's power under subsection (5) to carry out the proposal; and
"(f) the requirements set out in subsection (6) for obtaining an extension of the time for giving a notice requiring a hearing.
"Service of notice
"(2) A notice under subsection (1) may be served personally or by registered mail addressed to the approved corporation at its most recent address known to the minister.
"Deemed time of service
"(3) If the notice is served by registered mail, the service shall be deemed to have been made on the seventh day after the day of mailing.
"Entitlement to a hearing
"(4) An approved corporation that is served with a notice under subsection (1) is entitled to a hearing by the appeal board if it mails or delivers to the minister and to the appeal board, within thirty days after being served, a notice requiring a hearing by the appeal board.
"Minister may carry out proposal
"(5) If the approved corporation does not require a hearing in accordance with subsection (4), the minister may carry out the proposal described in the notice served under subsection (1).
"Extension of time
"(6) The approved corporation may apply to the appeal board for an extension of the time for giving a notice requiring a hearing, either before or after the time expires, and the appeal board,
"(a) may extend the time for giving the notice if it is satisfied that there are reasonable grounds for applying for the extension; and
"(b) may give such directions as it considers proper in light of the extension.
"Hearing
"(7) If the approved corporation requires a hearing in accordance with this section, the appeal board shall appoint a time and place for and shall hold a hearing.
"Same
"(8) The time appointed by the appeal board for a hearing must be within ninety days after the day the appeal board received the notice requiring the hearing.
"Parties
"(9) The parties to a proceeding before the appeal board under this section are,
"(a) the approved corporation;
"(b) the minister;
"(c) the person from whom the approved corporation accepted the payment; and
"(d) such other persons as the appeal board specifies.
"Proceedings
"(10) Subsections 9.8(3), (5) and (6) apply to the proceedings and decisions of the appeal board under this section.
"Powers of appeal board
"(11) After a hearing by the appeal board under this section, the appeal board,
"(a) may, if the minister has not yet carried out the proposal described in the notice served under subsection (1),
"(i) allow the minister to carry out the proposal;
"(ii) direct the minister to refrain from carrying out the proposal; or
"(iii) find that an amount lower than that specified in the proposal is reasonable in the circumstances and allow the minister to deduct such lower amount under section 9.4;
"(b) may, if the minister has carried out the proposal under subsection (5),
"(i) find that the proposal was reasonable in the circumstances;
"(ii) direct the minister to pay the amount deducted to the approved corporation; or
"(iii) find that an amount lower than that specified in the proposal was reasonable in the circumstances and direct the minister to pay to the approved corporation the difference between the amount specified in the proposal and the amount that the appeal board found was reasonable;
"(c) may substitute it's opinion for that of the minister; and
"(d) may make such other order as it considers just.
"Powers of court on appeal
"9.4.2 On an appeal to the Divisional Court from a decision of the appeal board under section 9.4.1, the Divisional Court,
"(a) may affirm or rescind the decision of the appeal board;
"(b) may substitute its opinion for that of the minister or the appeal board, and
"(c) may exercise all the powers of the appeal board."
The Chair: Thank you. Any comments?
Mr Jim Wilson: Mr Chairman, almost every witness who addressed the issue of an appeal process during the public hearings on this bill argued that both facilities and applicants should have access to timely and efficient appeal processes. It has also been rightly argued that this appeal mechanism must be able to address various aspects of the process. Operators must be advised when the minister intends to make a deduction for any reason and, in the interest of keeping the system accountable, this deduction may be able to be appealed. It is through such mechanisms that we are assured that decisions are not being made arbitrarily and that if punitive or corrective measures are being taken, they are warranted.
The Chair: Thank you. Parliamentary assistant?
Mr Wessenger: We'll be voting against this motion on the same basis as previously indicated, that the matter of appeals should be dealt with comprehensively and after consultation in phase 2 of legislation.
Mrs Sullivan: We'll be supporting this, and the arguments have already been put.
The Chair: Shall the motion moved by Mr Wilson carry? All in favour? Opposed? Defeated.
Now that the Chair has found out exactly where we are, I would note that at this point I would move all of section 4, but because there are three amendments that have been stood down, we will have to return to section 4.
We would move on, then, to section 5, and I can return to Ms Sullivan to begin what she had started earlier, with the first Liberal amendment to 9.5.
Mrs Sullivan: I move that subsection 9.5(2) of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by striking out "classes of persons" in the second line.
"I further move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection:
"Contract for payment
"(2.1) No person or entity may be designated by the minister as a placement coordinator unless a contract has been entered into between the person or entity and the minister on behalf of the crown in right of Ontario and the contract provides for the payment of the person or entity for acting as a placement coordinator."
The Chair: Comments.
Mrs Sullivan: I think the intent is clear. I already note the parliamentary assistant shaking his head. We want to know who is going to hire and pay for the placement coordinators about whom we have no other information, and we feel that there should at least be in the act an indication that the placement coordinator, whether a single person or an agency, is under contract and has to follow the rules of the minister.
The Chair: Thank you. Mr Wessenger.
Mr Wessenger: Yes, we will be voting against this amendment, because the placement coordination is in effect already encompassed in some of the existing non-profit agencies, and I think it would create a degree of problems if this were passed.
Mrs O'Neill: I have a lot of trouble with the notion that it would create a lot of problems just stated by the parliamentary assistant. I think it would clarify matters. Placement coordination, first of all, is not provided in every community in this province, and where it is provided, it's provided in numerous ways and it is paid for in numerous ways. At the present time, we still don't know -- although we've had all kinds of nebulous statements that all these agencies that are there now are going to be grandfathered, we can't seem to get a thing pinned down about this person, body or whatever in this legislation, and it's very discouraging.
Mr Jim Wilson: Mr Chairman, I think those are excellent points. I don't understand the government's reasoning in terms of its saying that this might somehow tick off the VONs or those agencies now providing placement coordination services. I would think it enhances their role and gives them a legislative foothold to ensure that they get paid for the services, particularly the expanded services, that they'll be required to provide under this legislation.
Mrs Sullivan: That's right. There's no downloading, either. It's clear.
The Chair: Shall the motion moved by Ms Sullivan carry? All in favour? Opposed? The motion is defeated.
Ms Sullivan, the next amendment is yours.
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Mrs Sullivan: Mr Chairman, as I read, I want to draw to the attention of the committee that there will be one word that I'm not reading in which is on the written page in front of you on this amendment.
I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection:
"Qualifications
"(2.2) No person or entity may be designated by the minister as a placement coordinator unless the person or entity meets the qualifications prescribed by the regulations."
The Chair: Comments?
Mr Wessenger: Could I ask if the member might be prepared to have this stood down? I think we might be prepared to look at some alternative wording or language.
Mrs Sullivan: I would be very interested in ensuring that there is at least some reference to the notion that placement coordinators should be qualified to do the work they're being asked to do, so I'd be pleased to stand this down.
The Chair: We will stand down this amendment and come back to it.
The next amendment is a Conservative amendment.
Mr Jim Wilson: I'm recovering from the last amendment. It's really quite comforting to know that they won't hire people who don't have some sort of qualifications.
I move that clause 9.5(5)(a) of the Charitable Institutions Act, as set out in section 5 of the bill, be struck out and the following substituted:
"(a) within the six months preceding admission, a placement coordinator has determined that the person is eligible for admission to an approved charitable home for the aged; and".
Essentially, this would require a reassessment if the person on the waiting list to enter a facility is on the waiting list for six months or more. Since the health status of the elderly can change very quickly, it is advisable that a placement coordinator's assessment of the needs of the applicant be made within a six-month period prior to admission. This condition of admission will ensure that the placement is suited to the needs of the applicant and that all of the applicant's needs have been considered.
Mr Wessenger: I'd like to ask Mr Wilson if he'd consider standing it down. I do agree with his comments, but we don't think his motion achieves the desired result and we'd like an opportunity to discuss with him the possibility of achieving it.
Mr Jim Wilson: Okay.
The Chair: So this will be stood down and we'll come back to it.
The next motion is a Liberal motion, 9.5(5.1)?
Mrs Sullivan: Sorry, I have these in my book backwards.
I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended --
The Chair: Sorry. Could I interrupt for a second?
Mr Wessenger: I'm just wondering, should our motion go first?
Mr Jim Wilson: Yes, I think government motion first.
Mrs Sullivan: That's why I had them backwards.
The Chair: I apologize. With all these pieces in front of me, I had the Liberal one as next.
Mrs Sullivan: There are three amendments, Mr Chairman, if I could, that may well fold into the government's amendment.
Mr Hope: Are you withdrawing yours?
Mrs Sullivan: Well, we'll just see if the government amendment passes.
The Chair: Would you just allow the Chair a moment here? We can go forward first with the government amendment which deals with a range. I had put it at the end of everything it dealt with, but I'm quite prepared to let that go first, if we feel that would facilitate the discussion.
Mr Jim Wilson: I agree with your suggestion.
The Chair: If everyone agrees, then we'll move to the government's amendment.
Mr Wessenger: I move that subsections 9.5(5) to (8) of the Charitable Institutions Act, as set out in section 5 of the bill, be struck out and the following substituted:
"Admission
"(5) An approved corporation maintaining and operating an approved charitable home for the aged shall not admit a person unless the person's admission to the home is authorized by the placement coordinator designated for the home under subsection (3), and shall admit a person whose admission to the home is so authorized.
"Applications to placement coordinator
"(6) A person may apply to a placement coordinator for a determination respecting a person's eligibility for admission to an approved charitable home for the aged and, if the placement coordinator determines that the person is eligible for admission, the person may apply for authorization of admission with respect to such home or homes as the person selects.
"Assistance
"(7) A placement coordinator who determines that a person is eligible for admission shall, if the person wishes, assist the person selecting the home or homes with respect to which the person will apply for authorization of admission.
"Person's preferences
"(8) In assisting a person under subsection (7), the placement coordinator shall consider the person's preferences relating to admission based on ethnic, spiritual, linguistic and cultural factors.
"Determination respecting eligibility
"(8.1) A placement coordinator shall determine whether a person is eligible for admission to an approved charitable home for the aged only if the person applies for the determination in accordance with the regulations.
"Determination respecting authorization
"(8.2) The placement coordinator designated for an approved charitable home for the aged under subsection (3) shall determine whether to authorize a person's admission to the home only if the person applies for authorization of admission with respect to the home in accordance with the regulations.
"Compliance with act and regulations
"(8.3) A placement coordinator shall make all determinations respecting eligibility for admission and all determinations respecting authorization of admission in accordance with this act and the regulations.
"Conditions of authorizations
"(8.4) The placement coordinator designated for an approved charitable home for the aged under subsection (3) may authorize the admission of a person to a home only if,
"(a) the placement coordinator or another placement coordinator has determined that the person is eligible for admission to an approved charitable home for the aged;
"(b) the approved corporation maintaining and operating the approved charitable home for the aged to which the person's admission is to be authorized approves the person's admission to the home; and
"(c) the person consents to being admitted to the home.
"Approval
"(8.5) An approved corporation maintaining and operating an approved charitable home for the aged shall approve a person's admission to the home unless,
"(a) the home lacks the physical facilities necessary to meet the person's care requirements;
"(b) the staff of the home lack the nursing expertise necessary to meet the person's care requirements; or
"(c) circumstances exist which are prescribed by the regulations as being a ground for withholding approval.
"Written notice
"(8.6) An approved corporation that withholds approval for the admission of a person to an approved charitable home for the aged shall give to the person, the director and the placement coordinator designated for the home under subsection (3), a written notice setting out the ground or grounds on which the approved corporation is withholding approval and a detailed explanation of the supporting facts."
The Chair: Commentary?
Mr Wessenger: Yes. This is to clarify the intention that the applicant may choose the home to which he or she is applying for admission and that a placement coordinator must consider the ethnic, spiritual, linguistic and cultural preferences of the applicant if asked to assist the applicant in selecting a facility.
It also sets out that the facility may refuse an applicant for admission if the home lacks the physical facilities or the staff lack the nursing expertise necessary to meet the person's care requirements. Also, additional circumstances may be prescribed by the regulations as being grounds for withholding approval. Also, the home must provide the written reasons to the applicant, the director and the placement coordinator as to why the applicant was refused admission.
These amendments affirm the importance of consumer choice in the application process and the duty of placement coordinators to assist applicants in selecting homes based on their preferences. As well, they will address the request by facilities that the grounds for refusal of admission that will be permitted will be dealt with explicitly in the act.
The Chair: That covers a number of areas, so I'll allow the discussion to cover, perhaps, some of the other amendments that have been proposed that deal with some of the same areas. We'll begin with Mrs Sullivan.
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Mrs Sullivan: This motion is indeed almost all-encompassing with respect to the eligibility admissions process. I have two or three comments. Some of the changes here I see as significant improvements; I should say that.
First of all, under "Admission," under subsection (5), we see in the second-last line that the home "shall admit a person whose admission to the home is so authorized" and yet laterally, of course, the home can withhold approval. I'm wondering if we shouldn't change "shall" to "may" so that everything falls into line.
I'm concerned, under subsection (6), "Applications to placement coordinator," that this section will mean that in fact there are two applications which must be made by the resident, the first with respect to eligibility and the second with respect to a specific home, rather than one application where the placement coordinator both determines eligibility and takes into account the preferences and the assessment.
Under "Person's preferences," with the ethnic, spiritual, linguistic, cultural factors -- we all wanted that. It was clear that this has been put forward in the amendments proposed by both of the opposition parties, and we're pleased with that.
"Determination respecting eligibility" and "Conditions of authorization": I am concerned and my party is concerned that there is no indication in the act itself of which factors must be taken into account by the placement coordinator in determining the eligibility for admission. So, by example, we have had a strong indication that there should be an assessment of the impairment and capacity of the person. Those would be done by the professionals who are able to do that, and yet that is not included in this section of the bill, nor is it included anywhere else in the bill. We feel that's an omission that ought to be added to this or another section.
We are pleased that the government has recognized that there is a difference in the facilities and in the staffing available in specific homes and that this has been recognized under the "Approval" section.
We are disappointed, along with, I think, both the charitable municipal and private sector homes which appeared before us, that the government has not indicated that it would accept that the placement coordinators should be looking at a priority level for admission. Given that the home itself has very little control over the acceptance of a potential resident once the placement coordinator has determined eligibility for admission, it appears that the onus is then on the home to determine what priority the resident should be accepted in, despite the need for his admission at a particular time. So the time line then becomes the determining factor as to whether the person would be admitted.
I'm just glancing ahead at various amendments that we have put. Many of our amendments are covered here, but I still do have reservations and hope the government would look at accepting some amendments in those areas.
The Chair: Before moving to the parliamentary assistant, Mr Wilson, did you wish --
Mr Jim Wilson: Maybe we should hear from the parliamentary assistant. I have a rather lengthy discussion to begin here, Mr Chairman.
Mr Wessenger: I think one of the items raised by Ms Sullivan perhaps ministry staff should respond to.
Mr Geoffrey Quirt: Geoff Quirt, acting executive director of the long-term care division.
I can clarify that there would be one application process through which an applicant would have his or her eligibility determined and at that time would select the facility or facilities of his or her choice. The placement coordinator would be required, if asked, to provide advice to the client to help the client in the selection of the facility and would be required to provide that advice, taking into account spiritual, linguistic and ethnic considerations.
I'd further clarify that it would be the responsibility of the placement coordinator to determine priority for admission among all those applicants who had made an application to a particular facility. They would be required to authorize admissions for emergency situations first, and then among non-emergency applications, the person's time of application and the chronological order would apply as to when someone would gain admission to the facility. So there's one application process where clients choose the facilities they wish to be admitted to and the placement coordinator then determines priority based on the needs of the client group.
Mrs Sullivan: In that case, I would suggest that we do need an amendment or a change in the drafting to subsection (6), which clearly provides for two applications: "may apply" for eligibility, and if eligibility is concurred with or agreed to, the person "may apply" for admission. That must be changed. If that is not the intent -- certainly, we do not think it's the appropriate way to go -- that wording must be changed.
Mr Wessenger: I'll ask legal counsel to clarify that.
Ms Czukar: It is our view that's what subsection (6) says. It says that a person may apply to a placement coordinator for a determination respecting eligibility to a home, and if eligible, the person can apply for authorization of admission. All of that can be done in one process, but the eligibility has to be determined first. This doesn't really detail the admission process or the application process so much as the order in which determinations have to take place. Authorization of admission only occurs after all these other things have happened, but the application for admission can happen at the same time as the application for eligibility.
Mrs Sullivan: I believe this wording indicates there are two specific and separate applications. We will be very amenable to a friendly amendment if the legal beagles can put their minds to it. Anybody who is reading this for understanding about what they must do in order to apply for a home will read this and understand that there are two applications which must be made, and maybe in two different locations.
Mr Jim Wilson: I have four amendments tabled that deal with --
The Chair: I'm sorry, just so we're clear, those four amendments are the ones that are presented already. You haven't orally presented them, but the ones that are in our bundle.
Mr Jim Wilson: Exactly. They deal with aspects of the government's amendment. First of all, I just want to say about the government's amendment that's been read into the record that I'm pleased the government appears to have come a long way from where we were a few weeks ago when we were talking about placement coordination and eligibility. I think the government's amendment clarifies the role of placement coordinators somewhat. I'm pleased to see that it requires a person's consent prior to admission and that it acknowledges the ethnic, cultural, spiritual and linguistic preferences of consumers.
I note where a person's preferences in subsection (8) were outlined, we don't consider social factors, which is something that is very much a part of the fundamental principles section of the bill.
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I do admit and am pleased to see that the government's amendment does allow for some grounds for refusal by homes for admission to homes. I would just ask committee members to consider for a moment the PC amendment of subsection 9.5(6), which talks about further inclusion, in the bill, of grounds on which a facility may refuse an admission. I think one of the chief criticisms of Bill 101 that we heard from witnesses is that so much of this bill is left to regulation. I think in the interests of patients, residents and providers, the grounds on which a facility may refuse an admission must be clear. This amendment seeks to do that, to delineate some grounds so that everything isn't left up to the regulations. I think this amendment serves the interests of the consumer because it will put an onus on the placement coordinator to consider the special needs of an applicant who has been refused admission by a facility and seek a placement more suited to his or her needs.
So I just ask the government to keep that in mind for a moment and to also take a look at the next PC amendment, which is 9.5(7.1). I'm mindful that perhaps some of the numbering of these amendments would have to be changed if the government felt they were useful amendments. That amendment deals with health status. It asks that placement coordinators be sure to take into account all aspects of a person's health, that these aspects must be considered when a placement coordinator is making a determination and, as well, by requiring "a full account of the person's health status," consumers are ensured that their physician has played a role in bringing the applicant's special needs to the attention of the placement coordinator. That was something that was brought to our attention by the medical profession and by a lot of other groups that wanted to know who was doing the pre-admission assessment and what aspects would be considered therein. So this is an attempt to ensure that isn't totally left up to regulations.
If I may, Mr Chairman, the big amendment of the PC motions is subsection 9.5(8); it's the largest one. It attempts to set up a priority rating system, which I was hoping the government would take a very close look at, because we put in a lot of time and effort and had a lot of consultation with respect to this. Members can read through that motion. We've proposed the inclusion in this amendment, in order to address recommendations particularly dealing with veterans and spouses, the assignment of a priority rating, a process which is being discussed, actually, in the draft manual that the ministry has put out.
At the same time as the termination on eligibility process, the consumer will know exactly where he or she stands in relation to others looking for similar services. Priority ratings will be subject to appeal so that in the circumstance that someone's needs have changed or the placement coordinator has overlooked or underjudged the relevance of some factors, the consumer will have access to a system that can have his or her situation re-examined.
Our amendment ensures the flexibility and responsiveness of this critical first stage of the long-term care system, ie, the placement. It goes on. Not to belabour the points in the amendment and the benefits thereof, but we assign a very high priority to spouses. If your partner is already in a home, we believe the priority rating system should take into account and give a high rating to the spouse seeking to enter the home.
Secondly, in that amendment we deal with a priority rating for veterans, because I don't feel that a letter from Ruth Grier is really worth all that much in court. In fact, it's kind of a nice political letter that the parliamentary assistant has put out, where the onus is now back on Kim Campbell, the federal minister. I'm a former executive assistant. I used to draft those letters and I know exactly what we're doing there. You can't take that stuff to court, whereas you can take a piece of legislation to court.
I would be interested to hear the parliamentary assistant's comment on the priority rating system that we're attempting to set up here, because we think it catches and deals with a lot of the problems. I simply don't want to hear the tape-recorded message that we're not accepting this amendment. Perhaps we could have something a little more in-depth than that from the parliamentary assistant.
The last comment is important because it's subsection 9.5(8.4), a PC amendment. It's an alternative plan of care. There was some discussion with Mr Quirt that perhaps the government was interested in accepting this amendment. If they are, or some variation thereof, then we better hear that now before we vote on this whole thing.
The Chair: Really then, just to underline in dealing with the government amendment, the questions that both you and Ms Sullivan have posed relate back to your amendments and to what extent the government is prepared to accept some or all cooperative changes, what have you.
Mr Wessenger: To give some indication with respect to the amendments proposed, first of all by the Conservatives, the first one, I think I can give you an indication with respect to 9.5(6), which sets out grounds for refusal, (a), (b) and (c) would make a person not eligible for admission to a long-term care facility, they're set out so they're unnecessary, and (d) is considered too vague and (e) is already covered. For that reason, we'll not support that and we'll not be voting for that amendment.
The next one, subsection (7.1), I believe there is a Liberal amendment which might be amended which might be workable, so I think that probably should be --
Mr Jim Wilson: Could we take these one at a time?
The Chair: Why don't we just have him comment?
Mr Wessenger: I'm just indicating that there's a Liberal amendment that we might be able to work with that would supplant that.
The Chair: So we have an indication there may be some change with that (7.1). Okay, go ahead.
Mr Wessenger: With respect to 9.5(8), we will not be supporting it, although I understand there is an amendment under discussion.
Interjection.
Mr Wessenger: The veterans' one we're going to --
Ms Czukar: Oh, 9.5(9.1)? We'll discuss that first.
Mr Wessenger: Yes, (9.1) we'll be discussing.
Interjection: Point of order, please.
The Chair: Would it help if we had just a few minutes recess to see where there may be some agreement here, because I sense we're starting to run around a little bit and we may advance the cause. It is 20 to 4, if I might suggest a 10-minute recess.
Mr Wessenger: Yes.
The Chair: Okay? We'll recess then for 10 minutes.
The committee recessed at 1538 and resumed at 1553.
The Chair: We will reconvene. There has been much discussion during our 10-minute recess and I'll turn to the parliamentary assistant to give us some sense of where we're at.
Mr Wessenger: I believe we're working on some amended language to subsection (6) of the government amendment, but we haven't got legislative counsel -- oh, I think we have. Okay. If I might read in --
The Chair: Just for everybody's attention then, we're dealing with subsection (6) of the government amendment.
Mr Wessenger: Yes, and what we're asking for is a friendly amendment to delete subsection (6) as it now exists and read in as follows:
"(6) A person may apply for a determination by a placement coordinator respecting the person's eligibility for admission to an approved charitable home for the aged and for authorization of admission with respect to such home or homes as the person selects."
If I could just hand this to --
The Chair: I feel like I'm being given an award.
Mr Wessenger: Then we have a second amendment.
Interjection: Do we have to vote on that one first?
The Chair: No, we haven't voted yet, so do you want to continue with the next one? I'll just get these down.
Mr Wessenger: Yes, the next friendly amendment is on page 2, (8.4) and (8.4)(a), and after "coordinator has determined," we're going to add in the words, "within the preceding six months," so it reads as follows:
"The placement coordinator or another placement coordinator has determined, within the preceding six months, that the person is eligible for admission to an approved charitable home for the aged."
The Chair: Has everyone got those two amendments? I can repeat them if you'd like.
Mr Jim Wilson: On the latter, just tell me what you're deleting out of subsection (6), because all it sounds like you did was --
The Chair: All right. Let me go back to (6) then. Subsection (6) reads, "A person may apply" -- and then take out "to a placement coordinator." So it would be, "A person may apply for a determination by a placement coordinator respecting the person's eligibility for admission to an approved charitable home for the aged and" -- and then we would delete the following -- "if the placement coordinator determines that the person is eligible for admission, the person may apply." All of that is deleted, so after "and" it would read, "for authorization of admission with respect to such home or homes as the person selects." Just to make it crystal-clear, I'll read it as now amended.
"Applications to placement coordinator
"(6) A person may apply for a determination by a placement coordinator respecting the person's eligibility for admission to an approved charitable home for the aged and for authorization of admission with respect to such home or homes as the person selects."
Then, on page 2, (8.4)(a): "The placement coordinator or another placement coordinator has determined, within the preceding six months, that the person is eligible for admission to an approved charitable home for the aged."
So in that one, we've simply added those words. Mr Wilson.
Mr Jim Wilson: On the latter amendment, "has determined within the previous six months" --
The Chair: I'm sorry, "within the preceding." Did I say --
Mr Jim Wilson: "Preceding six months." Preceding what? The determination of eligibility or the authorization of admission?
Mr Wessenger: Preceding the authorization.
Mr Jim Wilson: Yes. Preceding the authorization of admission. Is that implicit in the way you've reworded that?
Mr Wessenger: It is, because it's in that.
Mr Jim Wilson: Okay.
Mrs Sullivan: Mr Chairman, with respect, I don't think this does what the third party wanted it to do. What the third party wanted to have assurance of is that there is a reassessment of the applicant's eligibility for admission and of the determination of the authorization of admission every six months. I don't think this does it. Right?
Mr Jim Wilson: Mrs Sullivan is very much correct but not wholly correct, in that our problem with the drafting was finding a reference point for the six months. I do accept the advice that's been given that it has to be six months preceding the authorization for admission, otherwise -- I guess I didn't realize, in drafting this, that we wouldn't have any clear idea of what the date of admission would be. That was kind of an omission on my part. If there aren't any other comments from the government, I'd accept the new wording.
The intent is, of course -- now, anyone else can throw in any ideas they may have, but --
The Chair: I think there is perhaps a comment that may deal further --
Mr Wessenger: Just to clarify, perhaps we should say, "The placement coordinator or another placement coordinator has determined, within the six months preceding authorization," and then it's completely clear.
The Chair: Again, that's for (8.4). I wonder if this is agreeable. I would like to put this amendment, and we will then go back to the other ones and either deal with them or not to the extent that they have been included.
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Mr Jackson: Mr Chairman, on a point of clarification: You're amending Mr Wessenger's motion, so it's an amendment to the amendment.
The Chair: It is an amendment to the amendment.
Mr Jackson: So we're still on the main amendment, once it's approved for amendment?
The Chair: Yes.
Mr Jackson: Thank you. Could you please reword it properly, (8.4)?
The Chair: Clause 9.5(8.4)(a) would then read as follows:
"The placement coordinator or another placement coordinator has determined, within the six months preceding authorization, that the person is eligible for admission to an approved charitable home for the aged."
If I could then ask, shall Mr Wessenger's motion, as amended --
Interjection.
The Chair: Let me put it this way. Mr Wessenger, perhaps we could do it that you have removed your original motion and are now moving the motion as amended.
Mr Wessenger: Yes, okay.
Mr Jackson: The amendment as amended. I'm sorry, I wish to propose --
The Chair: He has withdrawn the original one, so you're right in describing what we're doing.
Mr Jackson: -- to put in the motion, because I have a further question and I have a further amendment to subsection 9.5(5).
The Chair: Okay. Just so we're clear, and I appreciate the point you're making, Mr Jackson, with the two changes -- let me call them that -- we have made to the original amendment, Mr Wessenger then has withdrawn his amendment and it has come back with the two changes we had discussed, so that is now his amendment. You now wish to ask a question and to have us consider an amendment or two to that. I recognize you.
Mr Jackson: Thank you, Mr Chairman. In subsection 9.5(8), "Person's preferences," could the parliamentary assistant advise if his interpretation of "linguistic" includes the presentation we received from the Bob Rumball Centre for the Deaf, where the deaf and non-sighted community indicated that they had a linguistic concern, that they had linguistic rights in Ontario, that they did not feel they were handicapped, that they were differently abled from you and I linguistically. Is that the interpretation, for the record?
Mr Wessenger: I would interpret it as being definitely included either in the word "linguistic" or "cultural," because I think it might be indicated they indicated that cultural was more of their --
Mr Jackson: Okay. My second question then is, has the government in any of its motions, since you're going to come back to those, I understand, that are being proposed by both opposition parties, made any direct reference to matrimonial factors or familial factors. If you're silent on spousal access, it would appear that this is the clause where you could include that, because matrimonial or marital or familial, which is a sole surviving senior but who has supportive family members in a given community, would constitute grounds for placement since there would be additional support services around a senior because of familial concerns.
Before we pass this complete motion, this is an opportunity to include those two further conditions, to the benefit of seniors. It might be more appropriately placed here, if the government is looking favourably upon matrimonial or familial factors for placement.
Mr Wessenger: I'm going to ask ministry staff actually to clarify with respect to how they are going to deal with these two items you've raised. I believe it's going to be dealt with in regulations, but I would like them to comment.
Mr Quirt: The issue of a spouse wishing to accompany his or her spouse into a long-term care facility will be dealt with in the eligibility criteria. As I read the amendment proposed by your party, the amendment would be restricted to providing priority to eligible applicants to long-term care facilities with respect to their being able to have a higher priority to get into the facility of their choice where their spouse resides. In our eligibility criteria, we're looking at the issue of considering admission for non-eligible spouses if they should wish to accompany their spouse into a long-term care facility. In those discussions we're considering a broader exemption for spouses, and we are currently organizing a work group with providers and consumers to look at ways in which the eligibility criteria might account for spouses being able to accompany an eligible resident into a facility.
Mrs O'Neill: Do we have the actual part of the act where that is going to be attended to so we could watch for it if it's coming up?
Mr Wessenger: It's not going to be in legislation.
Mrs O'Neill: It's not going to be in legislation; okay.
Mr Wessenger: It will be in regulations. These are very difficult items, this whole question of eligibility, I think it's fair to say, and I think it's also fair to say that by keeping the eligibility in your regulations, you're going to provide your flexibility to ensure that you appropriately deal with situations and not have a rigid system that would require an amendment to the act. I think it's very important that we preserve the flexibility, in this case in the eligibility area, so we can ensure we don't find the legislation in a bind, in an inappropriate situation.
Mrs O'Neill: I'd like to just pursue that one.
The Chair: I'm sorry, Mrs O'Neill. Mr Jackson hadn't finished.
Mrs O'Neill: It's on that very item.
The Chair: I believe he's on the same item, if we could just let him finish, and then I'll come back to you.
Mr Jackson: If I heard Mr Quirt correctly, he indicated that the matters raised in a Conservative amendment would be considered. He did not indicate that they would seek favourable support by the government. Am I to further understand that they might seek favourable support in the form of a regulation? If that is the case, then I certainly would like to propose an amendment which would indicate -- there are two issues here. One is that the placement coordinator would be sensitive to this matter in terms of a placement where primacy is not an issue. Then the second issue, which the Conservatives address in another amendment, deals with priority, I should say, not "primacy," but "priority" for a spousal application. What I'm simply suggesting is that a person's marital status should have as much importance and weight in legislation as his language or his spiritual needs.
I see no reason why the government should avoid its inclusion in this section, because we're dealing with the sensitivity of the placement coordinator in considering these matters for placement. We'll deal with how much importance they place on them, but in this section they're not required in law, and the way the law works, Mr Chairman, as you well know, is that because it's not included, it therefore is not deemed to be a considered matter. If it appears in regulation, it can disappear in regulation. So I think the aspects of marital status and being close to a spouse in an institution is important.
I also believe, if legal counsel can guide us, that the phrase "familial," which is proximity in matters dealing with the proximity of family members, which could encompass a larger support network for a senior, not just the spouse but having grandchildren or a daughter or a son nearby, would be helpful to the process of seniors' long-term placement, and those should be considered.
I notice that the Liberals have also included the reference to geography. Not to clutter this, again, once we've passed this motion, we've closed the door to amending it any further. Before we do that, I want to make sure we have a full discussion on these points, because this is the section, in my view, which should include the matters for consideration by the placement coordinator.
The Chair: Before asking the parliamentary assistant to respond, Mrs O'Neill, because you're on the same subject, do you want to comment?
Mrs O'Neill: Yes. I wanted to go back to something that legal counsel said this morning, that the service agreement would be interpreted according to the bill of rights. That was the context or the backdrop. I wanted to know if these regulations that are out there, some day to be discovered, are going to also be developed around the backdrop of the residents' bill of rights. That's my first question.
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Mr Wessenger: If I remember the language correctly, it does refer to the guide and interpretation of the regulations of the bill of rights. I think that's correct. It doesn't refer to placement coordination, of course.
Mrs O'Neill: This is a matter that came before us several times. If I just might comment on that last comment of Mr Jackson's, one of the government amendments that I think was handed out this morning was talking about the appeal board and three people and that at least one of these would be resident near or in proximity to the home. To me, if the appeal board members should be, then we should know something about the actual residents as well, in reference to geography. I want to just preliminarily say I really support that this be included somewhere, as well as the "cultural, spiritual" language that we've been talking about up till now. Geography should be included in that same set of guidelines.
The Chair: In trying to be helpful with some of the points that have been raised here, and noting that there is some to and fro around drafts and so on, with respect to this amendment, as has been suggested by a number of the opposition members, would it be helpful to stand this down and return to it first thing in the morning or are you able to deal with it now? I think we need to come to some conclusion or else defer it.
Mr Wessenger: I think we should proceed, actually.
The Chair: All right. Would you respond to the points that Mr Jackson and Ms O'Neill have raised.
Mr Wessenger: I understand the point Mr Jackson is making, but the way I read subsection 9.5(8) is that the priority element with respect to what the placement coordinator must take account of is the person's preferences, and that has to take primacy, as I've indicated. The indication of the words, "ethnic, spiritual, linguistic and cultural factors" was to direct the attention of the coordinator to those items to give assurance to groups that had appeared before us which were concerned that there would be a lack of attention to those factors.
But I suggest that the overriding preference aspect would take into account the family situation, because that would be incorporated under the preference, as would geography. Practically everything is incorporated under preference. Delineating the additions is really to draw attention rather than to determine the decision, because the decision is the person's. Rather than the placement coordinator, it's the person who is making the choice of where he is going to go. My concern is that we will get a never-ending list of things. We could add a hundred items to this section, and that's my concern.
The Chair: I have two questioners, Ms Sullivan and Mr Wilson.
Mrs Sullivan: I wonder if we couldn't look at a friendly amendment here, in the second-to-last line of subsection 9.5(8): "consider the person's preferences relating to admission, including ethnic, spiritual, linguistic, cultural and other factors." Then the list doesn't have to go on for ever and ever.
Mr Jim Wilson: Just to add to that, I felt very strongly that there was agreement that spouses should be able to follow spouses. I recall being told by the government that it was such a small percentage of cases where a spouse would actually want to follow a spouse that it wasn't a big deal to include this language in the legislation. Rather than leave spouses -- who are rather important in our society and should be more important to the government -- in the "other factors" category, I think Mr Jackson's right: It's just as important as spiritual, linguistic and cultural factors for many, many people.
The Chair: Just so I understand, are you suggesting to add there the word "familial" or some such word?
Mr Jim Wilson: If we could get a suggestion from the legal beavers, it'd be helpful.
The Chair: While that is being done, Ms O'Neill had a comment as well.
Mr Jim Wilson: We'd do "marital," but I'm not sure what the Liberal Party means by "marital" any more, given last week's press release.
Mrs O'Neill: I feel very strongly about both of these. It isn't as though we've got a list of 50. We've all been working on this for almost six weeks, this group here, and many people have been working on this for six years. The things we've come up with that are not stated are "familial" and "geographic."
I'm sorry I made a mistake earlier; I had mixed up "appeal board" with "residents' council." It's in the residents' council amendments of the government that "only a person who lives in the area in which the approved charitable home for the aged is located and who was not employed by and does not" -- that's who the minister may appoint to a residents' council. If it's so important that an appointment to a residents' council have some knowledge of the location of the home and the needs of that community, then I think it is important for the people in that community to have some security that that is the community which will continue to care for them, as it has all their lives.
We heard that particularly from rural Ontario and in the north. We were told, if I recollect correctly, by the native people that the length of stay in long-term care facilities that are out of their neighbourhoods is exactly six months: People die, because they are moved from all the support systems they have.
The familial and geographic are, for me, very key components of continuum of care. I don't think it would hurt anyone if you want to then add "and all other things" that the next generation may think up; I could go with it. Are we for trying to preserve as much of a family and quality of life as we can for our seniors? That's what I want to know.
The Chair: Just to try to bring this into focus, Ms Sullivan has suggested adding the words "and other." Mr Wilson and Ms O'Neill have indicated that they would still like to see the words familial" and "geographic," and Mr Jackson mentioned "spousal." I'm talking because I know learned counsel is trying to come up with some words.
Mr Jackson: Mr Chairman, to be helpful, can I propose an amendment to the amendment? Then we can deal with it directly, as opposed to falling back into a negotiating mode here. I'll be guided by you.
The Chair: The government has a proposal to make. Could I perhaps ask them to --
Mr Wessenger: We don't.
The Chair: No, sorry; they don't.
Mr Jackson: I still asked for a legal definition. Is there a proper legal definition for "familial" and does that include all family members; that therefore spouse is included? Then I'd be satisfied with "familial." It has to be in the same language intent. Could I get a legal opinion as to the interpretation of the word "familial," or the preference for "matrimonial" or "marital"?
Mr Wessenger: I've asked for a legal opinion. I don't know whether I should give it to legislative counsel or to --
Mr Jackson: There's a room full of lawyers here. Somebody please speak up. They're not charging for it, obviously.
Mr Jim Wilson: Not by the word.
Mr Wessenger: I think this is a question for the drafters.
The Chair: Would you first identify yourself?
Mr Mark Spakowski: I'm Mark Spakowski with legislative counsel's office. The word "familial" would just have its ordinary meaning in that case. In the context, I think it would have a very general meaning and would probably encompass all sorts of relations that are family-like: spouses or other relations.
Mr Jackson: Thank you. Then, Mr Chairman, I would like the government, in an overwhelming spirit of cooperation, to -- I know Mr Wessenger's married, and I'm sure he sees the value in the suggestion made; he has children and sees the value in the suggestion being made; and God knows, he probably has older persons in his family he would like to be close to and accessible to in their declining years. Would Mr Wessenger include the word "familial," which is interpreted now to include "spousal," as a consideration only? My God, we're not talking about etching the primacy of it in this section; we're just saying it has to be included.
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Mr Wessenger: I think I might be prepared to consider that as an amendment, on the basis that perhaps I --
Mr Jackson: Have to see your mother later this month or something.
Mr Wessenger: I have some sympathy for that amendment.
The Chair: Can I just ask, in terms of our procedure, whether Mr Jackson wishes to move that as an amendment.
Mr Jackson: Yes.
The Chair: The other approach is that the government may be prepared to accept it; we can just encompass that along with the other two we've already made, and then we have the one motion, okay?
Mr Jackson: In the interests of time --
The Chair: In the interests of time, if I can be guided by the parliamentary assistant, then in (8) under "Person's preferences" it would read, "In assisting a person under subsection (7), the placement coordinator shall consider the person's preferences relating to admission, based on ethnic, spiritual, linguistic, cultural and familial factors"?
Mr Jackson: A great alliteration, but no.
Mr Hope: You should put "familial" before you put "cultural factors." It should come before "cultural factors" or it's a different terminology.
The Chair: So it would read, "In assisting a person under subsection (7), the placement coordinator shall consider the person's preferences relating to admission, based on ethnic, spiritual, linguistic, familial and cultural factors." All right? With that, may I put the motion?
Mr Wessenger: We would like to add another amendment to this, to 9.5.
I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection:
"Assessments etc to be taken into account
"(8.3.1) in making a determination respecting a person's eligibility for admission, a placement coordinator shall take into account any of the following which are provided to the placement coordinator:
"1. an assessment of the person made by a health practitioner relating to the person's impairment or capacity;
"2. an assessment or information relating to the person's requirements for medical treatment, health care or personal care."
The Chair: Just to be clear, what you have added into yours I will term a friendly amendment to Ms Sullivan's proposal.
Mr Wessenger: Yes.
The Chair: Okay. Has everyone followed that?
Mr Hope: Got it. Let's move on.
Mrs Sullivan: I think this is an important amendment, and clearly this is one I would have put in any case, because it will involve the professional assessment with respect to impairment or capacity and any other information that is necessary in determining the plan of care or placement. I think it's an important amendment.
The Chair: May I now put Mr Wessenger's motion, and in putting that, all of those changes we have proposed that are part of it? All in favour? Opposed? Carried.
This is historic, I think. Just so we understand, that amendment is then accepted.
The Chair: With the help of both Ms Sullivan and Mr Wilson, we will go back from whence we came: Those that have been covered we can deal with, but if there are some there that are still dealing with other issues, we will of course deal with them.
I had next on my list the Liberal amendment, subsection 9.5(5.1).
Mrs Sullivan: That motion was included in the government amendment.
Mr Hope: On a point of order, Mr Chair: Because the motion that was just passed covered from 9.5(1) and went through, does that then make these motions that the Conservatives and the Liberals have put forward obsolete?
Mrs Sullivan: No. That's what we're doing now.
The Chair: Some of that had been covered, but there were some things that they may still want to move.
Mr Hope: Then I am asking a procedural question. We had an act; we amended it with a government motion. Now we're going to amend the government motion even further?
The Chair: We have agreed, but they may move other amendments if they wish.
Mr Hope: That's the procedural question I'm asking.
Mr Wessenger: Maybe I could interject. I think we agreed to proceed with our motion first, although technically it was not the first motion. By agreeing to proceed with our motion first, we have to allow the opposition its amendments.
Mr Jim Wilson: It doesn't make the others null and void.
The Chair: Ms Sullivan, if you would proceed.
Mrs Sullivan: The first amendment I have proposed to section 9.5 of the act, with respect to consent, is included in the government amendment, so I will not place that.
The Chair: All right. Mr Wilson, the next one was your subsection 9.5(6).
Mr Jim Wilson: Mr Chairman, I won't introduce it, given that Mr Wessenger, in his comments much earlier, indicated that (a), (b), (c) and (d), which talk about ventilation, onsite surgery and epidural anaesthesia, would make a person ineligible in any case. I won't be introducing that.
The Chair: Okay. Ms Sullivan, you had an amendment, subsection 9.5(6).
Mrs Sullivan: Yes, it's comparable. The last section is of course covered in the government amendments. The first three are with respect to ventilation therapy, onsite surgery and epidural anaesthesia.
I want to put on the table why this amendment was there, although I understand that the government will not accept it. It has been placed at the request of homes themselves, who want the bill to be more specific about what in fact they will be required to provide services in.
It's one thing for us to hear from the parliamentary assistant that these procedures would make the person ineligible for admission. That doesn't appear anywhere, and there is no indication other than that assurance from the parliamentary assistant that that's the case.
The Chair: So with those comments we'll move on. You had the next one, subsection 9.5(7).
Mrs Sullivan: This amendment is with respect to a priority level. I will not proceed with that.
The Chair: Mr Wilson.
Mr Jim Wilson: The amendment dealt with health status, and I believe that with the Liberal amendment to the government's amendment regarding assessments, it's sufficiently covered and I won't introduce that amendment.
The Chair: Thank you. Ms Sullivan.
Mrs Sullivan: Subsection 9.5(7.1) with respect to assessments was covered with the most recent government motion put forward.
The Chair: Thank you. Mr Wilson.
Mr Jim Wilson: Subsection 9.5(8). Mr Chairman, I'd like, with the committee's indulgence, to read that into the record.
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I move that subsection 9.5(8) of the Charitable Institutions Act, as set out in section 5 of the bill, be struck out and the following substituted:
"Priority and authorization
"(8) Subject to subsection (10), if the placement coordinator designated for an approved charitable home for the aged under subsection (3) receives an application, made in accordance with the regulations, for authorization of a person's admission to the home, the placement coordinator shall assign to the person a priority rating and, taking the priority rating into account, shall determine in accordance with the regulations whether to authorize the person's admission to the home.
"Assigning priority rating
"(8.1) The priority rating assigned to a person under subsection (8) shall be based on the immediacy of the person's need for admission relative to the immediacy of the need for admission of the other persons applying for admission.
"Priority rating for spouse
"(8.2) Despite subsection (8.1), a person applying for admission to an approved charitable home for the aged in which his or her spouse is resident shall be assigned for the purposes of admission to the home a priority rating that is higher than the priority rating assigned to the applicants for admission to the home who do not have spouses resident in the home.
"Priority rating for veteran
"(8.3) Despite subsections (8.1) and (8.2), a veteran applying for admission to an approved charitable home for the aged that receives or has received financial contributions from the Royal Canadian Legion shall be assigned, for the purposes of admission to such homes, a priority rating that is higher than the priority rating assigned to non-veterans applying for admission to such homes."
I think a number of the points have been made in comments previous. To summarize, the intent of the amendment was to set up a priority rating system that would recognize the right of one spouse to join a spouse who is currently residing in a home and, secondly, to ensure that the rights respecting a veteran's priority admission and access to homes are respected. Having said that, I'll be withdrawing the amendment.
The Chair: The next two were Liberal amendments.
Mrs Sullivan: The preferences and requirements of persons have been covered.
The Chair: You had the next one.
Mrs Sullivan: The limitation section with respect to care and services which can be provided at the home is covered.
The Chair: Mr Wilson, the last one on this list prior to the government one was yours.
Mr Jim Wilson: That has also been incorporated into the government's amendment dealing with this subsection, (9.5). Further to my comments about veterans and spouses, I hope that by saying I'm withdrawing that previous PC amendment it didn't leave the impression that we didn't try every avenue available to us to try to ensure that the government respected the rights of veterans and spouses. I just want to make sure that's clear.
The Chair: The parliamentary assistant wanted to clarify something with respect to your motion.
Mr Wessenger: Mr Wilson, I wanted to indicate to you that your motion has not been included. That's why I'm wondering whether you really want to consider withdrawing it.
Mr Jim Wilson: You're absolutely right, Mr Wessenger. I thought we were dealing with the six-month review of the --
Mr Wessenger: No.
Mr Jim Wilson: Okay. I will move this motion then, Mr Chairman.
The Chair: Please go ahead.
Mr Jim Wilson: I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection after subsection (8.3), and I'd ask members to follow along in the wording because I'm changing the wording slightly:
"Alternative plan of care
"(8.4) A placement coordinator shall suggest alternative services or make appropriate referrals" --
Mr Wessenger: Sorry, would you please say that again?
Mr Jim Wilson: "A placement coordinator shall suggest" -- we strike the word "an" -- "alternative" and add "services or make appropriate referrals on behalf of an applicant if". So we're striking "plan of care," too.
Mr Wessenger: So that would read, "A placement coordinator shall suggest alternative services or make appropriate referrals on behalf of an applicant if"?
Mr Jim Wilson: Yes.
"(a) the placement coordinator determines that the applicant is not eligible for admission to an approved charitable home for the aged; or
"(b) the placement coordinator determines that the applicant is eligible for admission to an approved charitable home for the aged but does not authorize their immediate admission."
Mr Chairman, the intent, of course, is to ensure that families and potential residents are not left in limbo, that the placement coordinator take on the additional responsibilities of suggesting community services that might be available when a person either is not yet eligible to go into a home or hasn't got a home to go into.
Mr Wessenger: I think I'd suggest one friendly amendment. "A placement coordinator shall suggest alternative services for" -- the word "for" should be added.
I'd also like to ask legislative counsel, I think, if this is the right place for this amendment.
Mr Jim Wilson: In terms of numbering?
Mr Wessenger: Yes.
Ms Joanne Gottheil: We'll have to change it because there already is an (8.4). I just have to determine where it should go.
Mr Jackson: You have a standard clause at the end of the activity to adjust the numbering in accordance, so that would be covered. Why don't we proceed on that basis?
The Chair: I was just going to say, if that is at issue, are you saying you accept that?
Mr Wessenger: Yes, as long as this is adjusted.
The Chair: Legislative counsel, is that acceptable?
Mr Spakowski: You can suggest numbering.
The Chair: Okay, we can suggest numbering, so --
Ms Gottheil: It's probably (8.7). It goes at the end of the --
The Chair: Okay. Then may I put the question that the motion, the friendly-amended motion of Mr Wilson, is accepted? All those in favour? Opposed? Carried.
Our next amendment is a Liberal amendment. Ms Sullivan.
Mrs Sullivan: Mr Chairman, I have a motion in front of you with respect to preference for veterans in veterans' homes. I redrafted that in longhand and don't have a copy of that to read into the record.
I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection:
"Preference for veterans in veterans' homes
"(9.1) In making determinations under this section, placement coordinators shall authorize priority access to veterans in approved charitable homes for the aged in which beds have been designated through a federal-provincial transfer agreement for veterans."
I think we know what the issue is. I'm prepared to stand this down for now to work on other wording, but I did want to bring it into the record.
The Chair: There is a suggestion that it be stood down. Is this agreeable?
Mr Wessenger: Yes, it's agreeable.
The Chair: Okay, then we'll stand that down. Ms Sullivan, you have the next amendment.
Mrs Sullivan: I move that section 9.5 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by adding the following subsection:
"Preference for persons discharged from facilities
"(9.2) In making determinations under this section, placement coordinators shall, subject to subsection (9.1), ensure that preference is given to persons whose discharge as a resident was authorized under section 9.7.2, section 19.1.2 of the Homes for the Aged and Rest Homes Act or section 20.3.2 of the Nursing Homes Act."
This is one of a series of amendments with respect to the discharge and transfer of a resident from a facility which can no longer care for that person. There's a series of amendments that would be put, and I have just received them from legislative counsel. The next series hasn't been circulated. How should we proceed?
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The Chair: I think we should defer consideration of those until members have had an opportunity to look at them, and given the hour, I would suggest that we wouldn't do that until tomorrow.
Mrs Sullivan: That's fine with me.
The Chair: We'll stand it down. We'll continue on, but we'll just have to come back to those.
Ms Sullivan, you also had a further amendment. Do you wish to proceed with that?
Mrs Sullivan: Yes. I move that section 5 of the bill be amended by adding the following section to the Charitable Institutions Act after section 9.5:
"Information to home
"9.5.1 A placement coordinator who authorizes a person's admission to an approved charitable home for the aged shall, if the person consents, give to the approved corporation maintaining and operating the home any of the following information that the placement coordinator has.
"1. Information about assessments of the person.
"2. Information about the person's social and personal care needs.
"3. The name and address of anyone who is authorized to make decisions for the person.
"4. Information about the person's medical history."
Basically this is to ensure that the information on which the placement coordinator has based the assessment of eligibility and providing the authority to admit does not rest for ever in the placement coordinator's drawer but must be moved on to the home at which the person will receive care.
The Chair: Any further comments, parliamentary assistant?
Mr Wessenger: I think we'd better stand this one down because I think legislative counsel -- no, not legislative counsel but counsel -- has indicated some need to take a look at it.
The Chair: So you wish to stand that down?
Mr Wessenger: Yes.
The Chair: The next one then is a government motion.
Mr Wessenger: I move that section 9.6 of the Charitable Institutions Act, as set out in section 5 of the bill, be amended by:
(i) striking out "a placement coordinator or a member" in the second and third lines and substituting "an"; and
(ii) adding the following subsection:
"Placement coordinator's liability
"(2) Subsection (1) does not relieve a placement coordinator of liability for the acts or omissions of its employees or agents."
Mrs O'Neill: I had trouble with this as I read it and as you read it, "a placement coordinator," because there seems to be this nebulous, is it a person; is it an agency? We can't get it pinned down, and here particularly, where there's a liability, if there's an agency looking after this activity in a community, is there one placement coordinator with assistance? Many of these things now are done by boards. This is very confusing for the general public, and certainly for us. Can you say "a placement coordinator or agency"?
Mr Wessenger: I will ask Mr Quirt to clarify that for us.
Mr Quirt: The wording is that way so it can cover off a number of different placement coordinators that will be necessary in a sequence. To be very specific, it would be the intention to designate the existing placement coordination services, as the placement coordinator under the bill, those agencies that may deliver other services or may be standalone agencies with the single function of doing placement coordination.
But, as you know, about half the province currently is not covered by the placement coordination service program, so interim arrangements would have to be made designating, for example, a facility administrator who would make those determinations now, as the placement coordinator, until a placement coordination service can be established. It would be a priority for the government to get them up and running as soon as possible in the balance of the province.
As we've also pointed out, the function of placement coordinator over time, and the human and financial resources associated with the independent placement coordination programs now, would become an important, key component of the multiservice agency. Eventually the multiservice agency would be designated under the bill as the placement coordinator. It is worded this way to allow us, first of all, to deal with the fact that half the province isn't covered currently, that new agencies would be designated as placement coordination services and that eventually multiservice agencies would assume that function.
Mrs O'Neill: So a placement coordinator is really a position.
Mr Quirt: The placement coordinator may be an agency. You would be aware of the criticism of the bill that provided protection from liability for placement coordinators. This amendment is designed to still provide protection from liability for individual workers, but not the agency that employs those workers.
Mrs O'Neill: I'm sorry to continue but this is a very important piece. A placement coordinator, as defined here, is then an individual holding a position entitled "placement coordinator." Is that correct?
Mr Quirt: It would vary. In the cases where an individual agency like the VON was the placement coordination agency, we would designate the VON as the placement coordinator. In parts of the province where no placement coordination agency exists --
Mrs O'Neill: But then the VON would be liable.
Mr Quirt: -- it would be perhaps an administrator of a facility who would be designated.
Mrs O'Neill: You just said the VON wouldn't be liable or an agency wouldn't be liable, but the individual --
Mr Quirt: No, the other way around. The individuals are protected from liability. But in the case where the VON was the placement coordinator, the board of the VON would be liable for the actions of those placement coordinators and would be required to have the appropriate insurance coverage in the service agreement that we'd have with them for that placement coordination service.
Mrs O'Neill: I think I've got it now. Oh, wow.
Mr Wessenger: I don't know whether I should ask legal counsel to clarify, but basically the liability is placed on placement coordinators. If the placement coordinator is an agency, then the agency would be liable. If the placement coordinator is an individual name, they would also be liable. The employees of an agency or the employees of the individual designated for that would not have the liability. But the only individuals who are likely to be named are those in the interim with respect to facilities.
Mr Wiseman: Can you repeat that last part?
Mr Jim Wilson: Yes, he was ahead before he spoke. No, it was a good explanation, really, by Mr Wessenger. I just wanted to add our support to this amendment. I think it responds to the concern that witnesses had about the blanket immunity placement coordinators were enjoying in the original draft of the legislation. I think the government has been responsive to that concern that was expressed, and we will be supporting the amendment.
The Chair: Thank you. Then if I can put the motion moved by Mr Wessenger, all those in favour? Opposed? Carried.
The next amendment --
Mrs O'Neill: I'm sorry, Mr Chairman, but there is no definition of "placement coordinator" anywhere in this bill. Correct? I mean, the people who are going to interpret this bill are not going to have Mr Wessenger beside them to say what he just did, or Mr Quirt.
Mr Jim Wilson: You don't know what he's going to do after politics.
Mrs O'Neill: May I just find out, is there a definition of "placement coordinator" in this bill?
The Chair: The parliamentary assistant.
Mr Wessenger: I'll ask legal counsel to reply to that.
Ms Czukar: No, there's no definition. Placement coordinators are those designated by the minister, so there is no definition in the bill.
The Chair: The next amendment is a Liberal amendment. Ms Sullivan.
Mrs Sullivan: As a result of the amendments made by the government with respect to the determination of eligibility and authorization for entry and enabling the home to serve notice that it is unable to care for a person, this motion is now redundant and I will not put it forward.
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The Chair: Thank you. Mr Wilson, this is now section 9.6.1, am I right, two pages? Mr Wilson, section 9.7.
Mr Wessenger: Could our motion be first, section 9.7?
The Chair: It would be the government motion first, would it not?
Mr Wessenger: We have very similar motions.
The Chair: Mr Wessenger, why don't you put your motion.
Mr Wessenger: I move that section 9.7 of the Charitable Institutions Act, as set out in section 5 of the bill, be struck out and the following substituted:
"Notice of determination
"9.7(1) If a placement coordinator determines that an applicant for a determination respecting eligibility for admission to an approved charitable home for the aged is not eligible, the placement coordinator shall ensure that the applicant and the person, if any, who applied for the determination on behalf of the applicant are notified of,
"(a) the determination of ineligibility;
"(b) the reasons for the determination; and
"(c) the applicant's right to apply to the appeal board for a review of the determination.
"Application to appeal board
"(2) The applicant may apply to the appeal board for a review of the determination of ineligibility made by the placement coordinator."
This change provides that an applicant for eligibility for a facility admission and any person who may have applied for admission on the applicant's behalf are to be notified if the applicant is found to be ineligible.
Provisions with respect to service of notice, extension of time and notice to the minister by the placement coordinator have been deleted. This amendment also eliminates the requirement that the applicant must request a review within 30 days. This really makes the whole process less formal. It was brought to us on many occasions during the hearings that they wanted to see a less formal process. Also, I think it's been simplified to give the placement coordinators more flexibility when notifying someone of the decision regarding ineligibility.
Mrs Sullivan: I have an amendment I'm going to speak to while I speak to this one. It immediately follows.
The Chair: Just so we're clear, that is your subsection 9.7(1)?
Mrs Sullivan: Yes, and then subsections (2.1), (3), (4), (5) and (7).
The Chair: Just for committee members, it's the next proposed Liberal amendment which is two pages. Correct?
Mrs Sullivan: Right.
There are two issues I want to discuss with respect to this amendment. I understand the government's intent to simplify the process and I think that's laudable; however, there is no necessity for a person to receive any notification from a placement coordinator if he is eligible for admission to a home.
All of the notification processes apply with respect to a person who has applied and is found ineligible and therefore has the right to appeal, but there is no requirement that the placement coordinator should notify somebody who has been found to be eligible for placement and therefore eligible to be authorized for admission.
The amendment I am placing, which follows, would ensure that the placement coordinator would provide notice of determination, whether it's of eligibility or ineligibility, the entitlement to a hearing, the priority level and the requirements for obtaining an extension of time if they want to appeal the hearing.
I think there could be a combination motion here, but I really feel it's incumbent on the placement coordinator and should be legislated that the placement coordinator should inform a person if he is eligible, so the person will know what the next steps will be, or if he is ineligible.
The Chair: Mr Wilson, did you have --
Interjection.
The Chair: If I might, just while you're reflecting on your comments, we will deal with this proposed amendment and then we will have to adjourn for today. We have suggested that we would reconvene tomorrow morning at 9:30. I'm prepared to consider 9 o'clock. I think we may wish to go until 12:30 and just have an hour for lunch, but perhaps I can just leave that with you while we then consider this.
Mr Jim Wilson: Mr Chairman, just following on Mrs Sullivan's comments, I would think that a placement coordinator would be eager to tell someone that he or she is eligible. While I agree with what the Liberal motion is trying to do, I don't support it in that I don't think it's terribly necessary. That brings me to the toss-up between the government motion and the PC motion.
I note the government motion dealing with this section is very similar to the motion I was considering putting forward, although my motion talks about also informing the consumer of the priority rating, even though that person may be deemed ineligible for admission.
Because I think we can't totally ignore some of the contents of the Liberal motions, my preference at this late hour, Mr Chair, would be to actually deal with this whole conundrum tomorrow, because I can see a couple of problems that may need further debate.
The Chair: You're referring here to some combination of what the government has proposed and what you and the Liberal amendment -- there may be some mélange there that would be acceptable if --
Mr Jim Wilson: I'd like to hear what Mrs Sullivan has to say about that. Before I do that, I am willing, if you want to deal with this right now, to say that I'm supportive of the government's amendment. I think it clarifies the placement coordinator's role regarding eligibility determination, and I think the government has come some way in benefiting consumers. In order to make the system more accountable, consumers must be notified of their standing, once determination is made by the placement coordinator, and of course that's the intent of these motions.
The Chair: Would it be agreeable to deal with the government motion at this point, and then are you suggesting that we would begin in the morning with your proposed amendment and the Liberal amendment?
Mr Jim Wilson: Perhaps Mrs Sullivan can best answer that, because I think the Liberal amendment goes a lot farther than either mine or the government amendment.
Mrs Sullivan: Interestingly enough, I think we're all very close here. Both the third party and the Liberal amendment would strike out the words "determination of ineligibility" throughout that section, which follows directly on the Liberal amendment in 9.7(1), where the "determination of ineligibility" becomes a "notice of determination," so the intent there is very similar.
The contents of the notice under the third party amendments with respect to priority level, the government probably doesn't want included, and the requirements for obtaining an extension of the time, I'm prepared to take out of my amendment, but there's a lot in all of these amendments that is very similar and I think we can work out a compromise.
The Chair: Can I put the motion then? Mr Wessenger's motion: all those in favour? Opposed? Carried.
Mrs Sullivan: That having been done, then we can't do ours.
The Chair: That being carried, do I take it then, just to be clear, Mr Wilson, that your proposed amendment is withdrawn?
Mr Jim Wilson: It hasn't been read in. I don't think there's any need to introduce it if we're going to go with the government amendment.
The Chair: Mrs Sullivan, when we return tomorrow morning, we would begin -- yours has been superseded by what we have just approved.
Mrs Sullivan: That's right, basically.
The Chair: Could I then ask for the committee's help here? I think we have made excellent progress. I think members can understand that because many of the amendments we're dealing with in this section are triplicated, having worked our way through this, it will vastly simplify our task in the other two. Even though it looks like there's a lot still to go through, and while in a sense there is, we have dealt with many of the major points. But we still have some to do.
I need some direction here just to ensure that we complete our work carefully tomorrow. We can begin, I think, at 9:30 or at 9, and I would further propose that we just take an hour at lunch. Any thoughts: 9:30 or 9?
Interjections: Nine-thirty.
The Chair: Okay, 9:30, and we would go to 12:30 and then reconvene at 1:30? All right. With that, then, we will adjourn until 9:30 tomorrow morning.
The committee adjourned at 1701.