MINISTRY OF COMMUNITY AND SOCIAL SERVICES
CONTENTS
Monday 7 March 1994
Residents' Rights Act, 1993, Bill 120, Ms Gigantes / Loi de 1993 modifiant des lois en ce qui concerne les immeubles d'habitation, projet de loi 120, Mme Gigantes
Ministry of Health
Jessica Hill, acting assistant deputy minister, mental health programs and services
Michael Ennis, assistant deputy minister, population health and community services system group
Gail Czukar, legal counsel
Ministry of Community and Social Services
Lucille Roch, assistant deputy minister, policy and program development, children, family and
community services
Ted Moses, policy analyst, community services branch
Mary Pat Koskie, legal counsel
STANDING COMMITTEE ON GENERAL GOVERNMENT
*Chair / Président: Brown, Michael A. (Algoma-Manitoulin L)
*Vice-Chair / Vice-Président: Daigeler, Hans (Nepean L)
Arnott, Ted (Wellington PC)
*Dadamo, George (Windsor-Sandwich ND)
Fletcher, Derek (Guelph ND)
*Grandmaître, Bernard (Ottawa East/-Est L)
*Johnson, David (Don Mills PC)
*Mammoliti, George (Yorkview ND)
Morrow, Mark (Wentworth East/-Est ND)
Sorbara, Gregory S. (York Centre L)
*Wessenger, Paul (Simcoe Centre ND)
*White, Drummond (Durham Centre ND)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Cordiano, Joseph (Lawrence L) for Mr Sorbara
Marland, Margaret (Mississauga South/-Sud PC) for Mr Arnott
Owens, Stephen (Scarborough Centre ND) for Mr Morrow
Wilson, Gary, (Kingston and The Islands/Kingston et Les Iles ND) for Mr Fletcher
Also taking part / Autres participants et participantes:
Gigantes, Hon Evelyn, Minister of Housing
Clerk / Greffier: Carrozza, Franco
Staff / Personnel: Yurkow, Russell, legislative counsel
The committee met at 1325 in the Humber Room, Macdonald Block, Toronto.
RESIDENTS' RIGHTS ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LES IMMEUBLES D'HABITATION
Consideration of Bill 120, An Act to amend certain statutes concerning residential property / Projet de loi 120, Loi modifiant certaines lois en ce qui concerne les immeubles d'habitation.
The Chair (Mr Michael A. Brown): The purpose of the committee meeting this afternoon is to deal with clause-by-clause examination of Bill 120.
I have a motion that was put forward by Mr Daigeler the last time we met. It indicates that this afternoon, as we commence the consideration of Bill 120, we will hear from the Ministry of Housing and the Ministry of Community and Social Services.
Clerk of the Committee (Mr Franco Carrozza): Ministry of Health.
The Chair: Did I say Housing? I meant Health. Thank you.
MINISTRY OF HEALTH
The Chair: We begin with the Ministry of Health. Mr Ennis and Ms Hill, good afternoon. Although the Chair has no direct instructions from the committee, if you have an opening statement, that would be fine.
Ms Jessica Hill: I do. Thank you.
On behalf of the Minister of Health, the Honourable Ruth Grier, Michael Ennis and I are very pleased to present the Ministry of Health's position on Bill 120.
As the acting assistant deputy minister of the newly created mental health programs and services area in the Ministry of Health, I will focus mainly on the impact of Bill 120 on supportive housing programs for the seriously mentally ill population. Michael Ennis then will follow, discussing the impact on long-term care programs.
First and foremost, I would like to say that the Ministry of Health supports the intent of Bill 120 to extend rights and protections currently available to most tenants in Ontario to vulnerable populations residing in facilities funded by the Ministry of Health.
From the perspective of the seriously mentally ill population residing in supportive housing programs, the need for security of tenure and privacy protection is a fundamental right. Care should not be a prerequisite to obtaining accommodation or a factor in continuing the tenancy.
Extending these protections will eliminate any current inequalities that may exist based on disability due to mental illness. Right now, not every tenant has the same rights under the Landlord and Tenant Act. Some tenants have protection, while others do not.
For your information, programs funded through my area provide support services to the mentally ill population to assist them in living in the community. Many of the seriously mentally ill residing in supportive housing programs have been discharged from the psychiatric facilities or inpatient units of general hospitals. Most of this population has had repeated stays within the psychiatric hospital system, and living in supportive housing programs affords them the opportunity to live as full participants in the community.
Supportive housing programs offer services in a variety of settings. For instance, services can range from independent apartments with offsite support service workers, to a group-living situation with onsite, 24-hour staff.
Accommodation, whether independent or in a group setting, can either be permanent or transitional in nature. However, because of the varied needs of individuals, most programs that offer transitional rehabilitative accommodation tend not to have a fixed length of stay.
We agree that no accommodation intended as permanent should be able to claim an exemption from the Landlord and Tenant Act for the purposes of therapy and rehabilitation, such as homes for special care and other permanent supportive housing programs.
I would also like to inform the committee that the role of accommodation and support services in housing programs funded by the Ministry of Health is being considered in the context of mental health reform. The document Putting People First supports delinking of support services from housing. We recognize that this direction will require change in the field.
The Ministry of Health has undertaken significant policy and program initiatives to improve the quality and accessibility of both accommodation and care in Ontario. Recently, we've been working with the Ministry of Housing on the development of guidelines which provide local housing providers and mental health service providers advice and information to assist them to work collaboratively in order to provide services to the seriously mentally ill.
These guidelines will ensure that clients have access to adequate, safe, affordable, secure and permanent accommodation which is in keeping with their choice and gives clients full coverage under LTA. Support services will be individualized and flexible to meet the changing needs of clients.
Within the context of the mental health reform strategy and current planning efforts with regard to the provision of housing and related support services, the ministry has also undertaken a review of the homes for special care program. The goal of the review process is to integrate homes for special care into the continuum of supportive housing for the seriously mentally ill. A key principle of reform is to give homes for special care clients the same protections under LTA as other tenants in the province and ultimately the same range of supports.
We recognize that transitional rehabilitation programs will need to undergo some changes as a result of Bill 120 and we will have to work with the programs to address issues.
A number of transitional rehabilitative supportive housing providers have raised a number of concerns about the impact of LTA coverage on their ability to provide appropriate services.
To qualify for exemption under LTA, a program must meet a two-part test under the therapy and rehabilitation exemption clause: that the average length of stay in the premises is not more than six months and that the accommodation is not the occupant's principal residence.
The wording of part two of the test needs, in our view, to be revised since clients in our rehabilitation program normally do not have another principal residence and the rehabilitation program becomes their principal residence for the duration of their stay in the program. We understand that removing the principal residence test in the bill is being considered. We are pleased about this, as this was one concern expressed by a number of service providers.
We agree that a six-month average length of stay should be required for programs to qualify for an exemption from the Landlord and Tenant Act. The Ministry of Health believes that there is a role for transitional residences as a bridge between the institution and living in the community, but we do not want programs designed to be transitional to take on the features of a permanent residence. We view a six-month average length of stay as a reasonable boundary between transitional and permanent accommodation.
To date, the Ministry of Health has funded housing programs primarily to ensure that consumers of mental health services have adequate housing in the community. We understand that many of our housing programs have also provided rehabilitative services. At this time, we need to clearly determine what role residential rehabilitation programs should play in a reformed mental health system. This determination will be an integral part of the mental health reform process.
However, assuming that there is a role for intensive residential rehabilitation or therapeutic programs, we believe that a six-month time frame should be sufficient to accomplish the intended purposes. If we find that a longer time frame is necessary, an appropriate legislative framework for such programs may be required.
We anticipate the most significant impact will be on the high-support transitional group homes. Our best estimate is that there are 20 such programs serving approximately 200 clients.
It is very important to recognize the cyclical nature of some mental illnesses and the variable support needs of clients. While transitional housing may have some value, long-term, stable housing is fundamental to wellbeing.
However, a number of concerns have been raised by some of our programs about operating under the LTA: the eviction process, the effect on the provision of care services, and the program provider's ability to terminate tenancy to make space for new clients. I'll comment on each of these.
The eviction process: The Ministry of Health does not support the use of eviction as a means to respond to problems related to someone's psychiatric disability. If the concerns or behaviours are related to a person's mental illness, we hope the programs would first attempt to work with their clients to address the underlying problem. In addition, crisis support services, case management and peer support networks should be brought to bear in response to problematic behaviour. If these efforts are not successful, there is recourse under the Mental Health Act or the police may need to be involved.
From a system perspective, it is questionable what could be gained from evicting someone, removing their existing supports when they may need them the most. If the behaviour is just generally disruptive, the question is, should someone with a psychiatric disability be held to a higher standard of behaviour than any other member of the community whose tenancy is under the LTA?
That clients could opt out of support services is another concern. One of the primary outcomes the Ministry of Health wants to see from its housing support programs is a stable housing situation for consumers. If programs meet the exemption criteria and if the intent of the service is primarily for purposes other than housing, then the programs could require program participation as a criterion of residence. It is quite clear that the LTA will add impetus to the delinking of support services from the provision of housing. This is a direction that is being supported by our ministry. This also reflects the trend in the mental health field.
Another concern which has been raised is the impact on the program's ability to have clients move to create space for new clients. If the primary purpose of this service is to ensure a stable housing situation, then clients not leaving is of no concern. If the program's primary purpose is other than housing, they can require the client to move on if they meet the exemption criteria under the LTA. In addition, it may not be appropriate to force residents with stable housing arrangements to move to suit service providers' purposes. We have many examples of staff moving, providing supports outside of the residence to other consumers.
Homes for special care operators have also raised some concerns around their ability to continue to provide care to clients, issues such as 24-hour coverage, access to rooms for cleaning and monitoring of medications. Under the LTA, the landlord is required to provide 24 hours' notice to enter a unit except in an emergency and if the tenancy agreement requires the landlord to clean the premises.
On the issue of cleaning residence units, which is currently a service provided by operators, we believe that this can be dealt with through a tenancy agreement which may specify conditions under which the landlord can enter clients' rooms for cleaning or maintenance.
We believe that the issue of resident care can be addressed through service agreements between operators and clients. The ministry will need to work closely with clients and operators to establish guidelines to assist them in developing these agreements.
The service agreements will spell out those services provided to clients, eg, assistance with clients' medication. As well, residents' service plans could be reviewed periodically, for instance, biannually, to ensure that services continue to respond to changing needs of clients. The service agreement would allow a client to opt out of services without impacting on their tenancy.
The Ministry of Health feels these concerns would be better managed through the planning, program design and changes within the mental health reform process. These efforts will be assisted greatly though consultation and collaboration with service providers, consumers and family members.
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Mr Michael Ennis: I would like to make a very few brief comments just to add to what Jessica has already indicated. Again, on behalf of the Ministry of Health, I'm going to address specifically the area of long-term care.
The Ministry of Health wishes to see all residents in any form of long-term care accommodation have sufficient tenancy rights. Long-term care deals with two types of resident accommodation, the first type being long-term care facilities, which would be nursing homes and homes for the aged. Bill 120 has not removed from the list of exempted statutes the Nursing Homes Act, the Homes for the Aged and Rest Homes Act or the Charitable Institutions Act. Consequently, nursing homes and homes for the aged remain exempt from the Landlord and Tenant Act and Rent Control Act. Residents in these facilities will continue to be protected by extensive legislation and regulation that addresses areas such as fee levels, security of tenure and so on.
All resident copayments, for example, are set by the province and enforced through regulation. In addition, no resident can be discharged unless a doctor's order is issued and appropriate alternative placement is arranged. There are many other provisions in both the legislation and the regulation that would protect rights of residents in nursing homes and homes for the aged.
In regard to supportive housing, the other population that we relate to in terms of long-term care involves many individuals such as elderly persons, those individuals with physical disabilities or acquired brain injury and those living with HIV-AIDS. With few exceptions, this accommodation is permanent housing. For these individuals, it is the ministry's view that the residents should be entitled to the full protection afforded by the Landlord and Tenant Act.
We recognize that there may be some isolated implementation problems resulting from this extension of the Landlord and Tenant Act coverage. However, since these situations represent only a very small minority of situations, they would be better managed through the program alternatives as opposed to opening the window for any more exemptions under the Landlord and Tenant Act.
It has been proposed, I understand, that the component of the exemption criteria which is related to the test for permanence of accommodation be deleted. This deletion is acceptable, provided that we still maintain the less-than-six-months requirement. The overwhelming majority of our supportive housing exceeds this time period and would therefore not be eligible for an exemption in any case. This would ensure that our residents continue to receive and would receive in the future the full protection intended by Bill 120.
In conclusion, the original wording and the exemption have been satisfactory, and also the flexibility in some of the proposed amendments still remains consistent with the direction of long-term care.
The Chair: Thank you. I believe the members have some questions. Mr Cordiano.
Mr Joseph Cordiano (Lawrence): To say the least, I'm somewhat concerned about the response that we're getting from the Ministry of Health with respect to its satisfaction regarding the time frame, the six-month period for exemption.
What we heard on this committee repeatedly from care providers or those who operate rehab centres was that in fact the period of time that was necessary for most of their tenants to go through a program was, on the average, 18 months. Effectively, you are, as I see it, ignoring that concern. How do you explain that? Are they completely off base? Are they trying to make a case for something that is invalid?
I have a great deal of difficulty understanding this, because it wasn't just one or two presenters, but we heard this repeatedly, I say, over four weeks of hearings from just about every presenter who came before this committee, and you're telling us that's not valid.
Mr Ennis: Mr Chairman, perhaps I could respond first of all, and Jessica may wish to also add to it, with your permission.
The section that involves six months would not apply to many of the programs that are in existence today. You've just heard our presentations. There are different programs that have been set up using the Ministry of Health, for example, for different purposes. Many of them are set up for permanent accommodation, so that where a program is already designed for long-term stay, it would already not be in that category of the six months.
Mr Cordiano: No, that's not what we heard, sir. I'm sorry, I have to contradict what you're saying because the testimony before this committee was very clear. These centres were set up and their funding mandate, as the presenters made it clear to us, was designed to bring people through a rehab process. Their stay was temporary in nature, and after that period of time they would move on to more permanent housing. What I'm hearing from you is that your vision of what these centres do is completely opposite to what they are in fact doing today. I heard you speak of the emphasis on delinking and that this would provide an impetus for changing the rehab centres in the way they provide services now. It gives me great concern, I've got to tell you, because what you're telling me is that there's a policy on the rush here, a policy that's designed by the Ministry of Housing to change the very nature of the rehab centres and the way they operate, that by the tenure of housing you're changing the very nature of those rehab centres.
Delinking services from the housing component is going to result in centres that now are just basically housing centres. That's not the way I believe these operators saw themselves originally. They're providing a rehabilitation service and housing is a component of that, but it's temporary housing.
If there is this fundamental change, in my opinion it's totally inappropriate to do it through a back-door policy, and for that reason I would have loved to have seen the Minister of Housing come before the committee and explain policy. I don't mean to put officials in that position, because I don't think it's appropriate. It would have been rather more appropriate to have the minister here and tell us that the policy has changed, that it's fundamentally different from what it was.
Ms Hill: The policy direction that the Ministry of Health has for mental health reform specifically speaks to the delinking of support services from housing. This has been a policy direction that in fact has evolved over quite a long period of time. I'm not sure if you're referring to those programs as well as long-term care programs.
What we see is that there has been quite a movement in the field, over time, from viewing housing and rehabilitation services, supports, as being integral or interwoven. As I mentioned earlier, we see about 20 programs or 200 clients out of the 4,000 clients who are served by our system as falling into this high-support group home situation where the integration of housing and rehabilitation supports still remains the direction that they use.
Mr Cordiano: I understand that, but what I'm suggesting is that the people who are affected, the operators of these homes, of these rehab centres, at no time indicated that they were coming before us because they had a concern with the Ministry of Health's new direction. They had a concern because the very nature of their programs was that the rug is being taken out from under their feet as we speak and that Bill 120 would impact directly on their ability to provide services.
It's kind of leaving them to fend for themselves and changing the very nature of what they do by a policy that's designed to deal with housing matters and not a policy that's designed to deal with care services. That's what I think is very frustrating, because if the Ministry of Health redirects these groups, changes their funding criteria, changes a number of other aspects of what they do and has a stated policy to do that and, as well, consults people before it would do this -- I mean, this is a back-door approach to changing policy on something that is fundamentally important for those rehab centres. I cannot believe that we're hearing this.
Ms Hill: I think our experience is not that they were entirely designed as rehabilitation centres, at least in the mental health field; in many instances they were created as housing with rehabilitation supports. Many of them have moved to fall under LTA through their own choice, over time.
We also don't see at this point that there is any reason to deny the residents of those housing programs the same protections under LTA and that the service provision is ultimately clearly that it's going to be damaged by this provision. We think both can be offered. Many of our programs in fact do offer both: the program and are governed under LTA.
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Mr Cordiano: Quite frankly, when we heard from various groups -- let me use as an example groups that were dealing with alcoholics. This struck me particularly as relevant. If you had no way of removing someone from the home or if the length of stay for the exemption was not longer than six months, and then some of the clients who were staying with these centres needed longer than six months -- quite a few, as a matter of fact. If I recall, the average length of stay in some centres was --
Interjection: Twenty-four, I think.
Mr Cordiano: Well, 18 months was the average that was often quoted. They could simply not function as a rehabilitation centre. I think that's incompatible with the view that's presented by Bill 120. That's one case of which we speak. There are many others; that's just to give you an example. That think, is a fundamental problem for those centres providing that kind of therapeutic rehabilitative process for recovering alcoholics.
Ms Hill: I believe the programs you're referring to are the recovery homes, which fall under the Ministry of Community and Social Services. We currently have two programs that would fall under this category, one which is clearly an addiction treatment program -- Stonehenge -- which has had quite a long length of stay but currently has been going through its own program review process and expects that it will fall under six months.
Mr David Johnson (Don Mills): I wonder if we could go back to the beginning, because there has been a great deal of interest in terms of the Ministry of Health and its involvement in the bill right from the beginning. We know that during the Lightman commission there was some involvement, as I understand it, of this ministry.
Interjection.
Mr David Johnson: Perhaps we could start with that. I assume the ministry was involved during the process of the Lightman commission.
Mr Ennis: Yes, that's correct. It's going back a few years in time, but there was a lot of involvement in terms of the commission itself. A lot of time was spent by Dr Lightman himself, meeting with ministry staff who are involved in all the program areas, talking about the potential impact of any recommendations he might make. A lot of input was provided at that time and it was an ongoing process.
Mr David Johnson: The Lightman commission then did report and make certain recommendations. This bill is not a perfect reflection, though, I think you would agree, of the Lightman commission in that the Lightman commission, I sense, delved into many areas that this bill -- I wasn't here at the particular time, but certainly what they tell me is that Lightman went way beyond what this bill does. So this bill has a certain component, I guess, some people say a small component, of the recommendations of the Lightman commission.
Following the Lightman report and leading through the process of coming up to Bill 120 through Bill 90 -- you didn't have any involvement with Bill 90, I presume. Bill 90 was one half of Bill 120, just to clear the record there.
Mr Ennis: As an individual, I didn't, but I'm sure other staff or other individuals --
Mr David Johnson: The ministry had involvement?
Mr Ennis: Yes.
Mr David Johnson: Are you telling me the ministry had involvement with Bill 90?
Mr Ennis: We can get the answer for you, but at this point, I didn't personally have involvement with it.
Mr David Johnson: But you don't know.
Mr Ennis: The one I have been involved with is the Lightman commission and the recommendations.
Mr David Johnson: All right. Now we have Bill 120, which is a combination of some of Lightman and Bill 90. Could you specifically tell us what the ministry's involvement has been with Bill 120?
Mr Ennis: Yes, I can respond to that. First of all, several ministries set up an interministry committee that was involved -- Health, Community and Social Services, Housing and other individuals -- in terms of looking at the recommendations and preparing some --
Mr David Johnson: Can you give us a date on when that was?
Mr Ennis: I'm sorry, I can't. It goes back as I mentioned earlier. I think the committee has been in process for over a year and a half, at least as I remember in terms of the meetings that I've attended. It's been at least that long. It was a bureaucratic committee of senior ministry staff from various ministries with various subgroups of staff, with Housing, Health and Comsoc being the primary ones.
Mr David Johnson: This goes back over a year and a half ago?
Mr Ennis: At least that, yes.
Mr David Johnson: This was a result leading from the Lightman commission?
Mr Ennis: That's right.
Mr David Johnson: Was this specifically to draft Bill 120?
Mr Ennis: Our position, our request that we had was to look at how we would make recommendations to our ministers in terms of how the recommendations of Dr Lightman could be met, and where they couldn't be met, to ensure that the spirit and the intent of his recommendations were carried out. That was the task we had, so our staff would go through the various recommendations and look at options and so on.
Mr David Johnson: In terms of the final draft of Bill 120, what we see before us today, was the Ministry of Health fully aware, was the Ministry of Health one of the ministries that fully signed off? Were you an equal partner with Housing in that? Did you share with all the recommendations that are contained in Bill 120?
Mr Ennis: The Ministry of Health did participate in the process and the actual submission that was made. There were some amendments made just prior to the introduction of the bill, we did express a few concerns, but generally the bill itself stands as we worked on it.
Mr David Johnson: Could you tell us today what amendments were introduced that you expressed some concern about?
Mr Ennis: One of them that was introduced was the six-month provision. I don't think we would indicate that it was a concern; it was more an adjustment to reflect some of the needs of some of the other programs, such as some of the short-stay programs, such as centres for women's shelters and so on. That was one of the changes that was introduced at that point, the six-month provision.
Mr David Johnson: Were you in support or in opposition to it?
Mr Ennis: The ministry supports the six-month provision, yes.
Mr David Johnson: When you introduced this topic in general, you said there were some amendments that the ministry was concerned about, and now you have specifically mentioned the six-month exemption period, so I presumed from that that you were concerned about the six-month exemption period. Am I right or am I wrong?
Mr Ennis: Yes, some of the concerns because our programs are very different, and you've heard from the description earlier and also in response to Mr Cordiano's question that even within one ministry the programs are very different in terms of their history and how they were designed and the client group they serve.
In some cases, on the provisions of the bill there are no issues at all. I mentioned earlier that for long-term care supportive housing, in almost all the cases it's a separate housing initiative that services are provided to independently so it isn't an issue here.
In some of the programs where in fact people are in for more long-term care or the therapeutic side that Jessica was addressing, that's where some of the concerns we expressed were in terms of just managing the programs themselves, in terms of individuals who may have been in a program for a period of time and have reached a point where they either can benefit no further or wish to leave, and those were some of the concerns we expressed.
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Mr David Johnson: What did you think the exemption should be then? If either you or Jessica or whoever didn't think it should be six months, what did you think it should be?
Ms Hill: I think the concern around a time frame has to do with that in the mental health field, it's a changing field and we do see changes already being made. The changes that were introduced require us continually to examine how our field is evolving and what, in our housing support programs, are rehabilitative elements, that we have enough information about them that demonstrates that they need to exist beyond a six-month time frame.
In that examination, our feeling is that it is feasible to operate either through an exempted status or under the Landlord and Tenant Act provisions and offer rehabilitation programs, so overall the concerns that we raised at that point have been addressed throughout and we continue to work on them.
Our support for the legislation stands. As I said in my comments, this will take both evaluation and, through the mental health reform process, determining whether residential treatment and rehabilitation is a component of the system that's separate from housing, that is not in any way intended to be a permanent housing, whether that needs a different kind of legislative framework to support it. If we find that for optimum results for our client population it is a longer time frame that's needed, and we really don't have that evidence yet, then we will have to move to create the proper framework.
Mr David Johnson: Are you familiar with the Scarborough General Hospital and its program?
Ms Hill: You might have to give me a few more details.
Mr David Johnson: They call it the Manse Road Group Home and they made a presentation. I thought perhaps you might have followed the deputations, but I guess you didn't. At any rate, the Scarborough General Hospital made a deputation and they described the Manse Road Group Home, for example, as "a residential rehabilitative program...transitional, with an indefinite stay policy," sharing household accommodations; cooperative living for 10 adults. They service the severely mentally ill adults with "schizophrenia, manic depression, chronic depression and post-traumatic stress."
They appeared before us and they say that in terms of the six months, "the six-month average length of stay will demand that programs select only those" residents "who can effectively move to greater independent living within six months." Essentially, what I hear them saying is that this will probably result in their criteria being tightened or changed so that certain people will be excluded and other people, those who they feel can, to use their words, "effectively move to greater independent living within six months," then they will select them.
Here's a hospital that has had this program since 1987. I think they know what they're talking about. They're funded by you. I wonder what your reaction is to that.
Ms Hill: I think it does reflect the perspective of some of the providers. However, we have other programs that we're funding that, as a system, in fact are demonstrating some different results. For instance, we have a program in Toronto that is a collaboration between Queen Street psychiatric hospital and two community mental health programs that are taking long-term-stay inpatients who have lived in a hospital for over 15 years, placing them in independent living situations with high supports, delinked, and are showing excellent results.
I think that what I described as the field changing, we're learning new things all the time. I'm not sure whether this would be true of the Scarborough General program but many of the programs were set up primarily as housing with rehab, initially transitional, but in the early days when there were very few other housing options, they moved into offering a form of permanent accommodation, and with very little clarity in terms of our direction, quite frankly, in terms of their being both housing and rehab.
It is over the last, I'd say, five to seven years that the mental health field itself is recommending more and more delinking of accommodation and support services because it is quite clear that having permanent accommodation contributes to people's mental health.
Mr David Johnson: Basically you're saying that you're not concerned because if they change their criteria, somebody else will pick up the people they're not picking up. Is that what I hear you saying?
Ms Hill: No, I wouldn't say I wasn't concerned; I'd say we'd have to work with them to determine whether they in fact could not achieve their program goals by offering protections under the LTA, because many of our group homes do offer both currently.
Mr David Johnson: What they say about LTA is that the eviction process of the Landlord and Tenant Act, and I quote them again, can take six to eight weeks, and other people have actually said a lot longer than that. "Residents who are verbally and physically aggressive can continue to intimidate co-residents while the eviction process proceeds through the court system. In a shared living setting, this climate of hostility can have serious effects on the mental health of the remaining consumers in the program. Imagine...a consumer with severe post-traumatic stress from physical and sexual abuse who must now tolerate the presence of a potential assault day and night" for two or three months.
I don't understand how you can work with that kind of situation. Maybe you can tell us.
Ms Hill: I'm not a service provider, so I don't want to give the committee the impression that I know this as a front-line worker. Certainly the staff in our area and other housing providers have indicated to us that in a situation where a person is living in a group home situation -- not all people are suitable for a group living situation; it's a difficult thing to live with other people, and other housing programs have deliberately developed other options because of that -- and is becoming progressively more disruptive, the question of whether that person's treatment needs or care needs are being sufficiently met in that situation, they're moving into crisis, for instance, needs to be addressed by bringing the appropriate supports to the situation. If they reject all the supports that are brought forward, whether that's a crisis response team or case management or peer supports, then there are provisions under the Mental Health Act.
Mr David Johnson: In the speech you made at the beginning, in your presentation, you mention the peer support or you mention the Mental Health Act provisions or you mention the police, but during the process of the public deputation time, we heard many deputations that said the Mental Health Act is of virtually no assistance and that the police cannot deal with this situation, so in effect they're left to dangle in the breeze. I wonder if you could be more specific. There may be people here today who might be listening, or at least for Hansard: How is the Mental Health Act going to help?
For example, in the case I've quoted to you from the Scarborough General Hospital, the case I read out to you where there's somebody suffering from abuse, the other people who live in this accommodation, and there are one or two or however many individuals who are being very aggressive and intimidating the residents, how does the Mental Health Act or how do the police specifically -- can you tell us what steps could be addressed through either of those to help?
Ms Hill: I'm not well versed in every single provision under the Mental Health Act. If you would like someone to speak to that, I'd like to ask a member of our legal department to come forward and speak to that.
Mr David Johnson: That's fine by me.
Mr Gary Wilson (Kingston and The Islands): Well, within the time.
The Chair: I'm sorry, I didn't hear.
Mrs Margaret Marland (Mississauga South): We need somebody else to answer the question.
Mr David Johnson: The deputant has asked if a legal person, from the Ministry of Health I presume, could come forward, because this legal person has an answer.
The Chair: Certainly.
Ms Gail Czukar: My name is Gail Czukar and I'm legal counsel with the Ministry of Health.
I heard the question in some detail. I think the question was, and you can correct me if I'm wrong, if you have a person in a group home setting who is presenting a safety threat to other residents in the home, how does the Mental Health Act provide for that?
Mr David Johnson: Yes. Let me just read this again, if I could, "Residents who are verbally and physically aggressive can continue to intimidate co-residents while the eviction process proceeds through the court system." So there could be a real or perceived threat against the other people who live there. "In a shared living setting, this climate of hostility can have serious effects on the mental health of the remaining consumers in the program. Imagine...a consumer with severe post-traumatic stress from physical and sexual abuse who must now tolerate the presence of a potential assault day and night" for two or three months.
How is the Mental Health Act or the police going to deal with that situation?
Ms Czukar: I can't speak for how the police would deal with it. I guess the police would deal with it in the same way that they deal with threats to safety in any situation. They have powers under the Mental Health Act, which I can clarify to some extent although I don't have the act here with me, to take someone to a psychiatric facility to be examined if they believe that the person has a mental disorder and is acting in a particular way that's threatening to others. Of course, the person can be committed after examination if they are threatening the safety of others or themselves.
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Mr David Johnson: I'm just trying to recall what the people from the Scarborough General Hospital said. I can recall other operators saying that the practicality of the situation, when you're living there, is that those acts are fine, they're somewhere out there, but they're practically limited or of no use. I wonder if you can tell us specifically the time frame and the actions one would have to go through to remove a threat to the other people who are living in shared accommodation. We're talking about shared accommodation. We're talking about people who are very close together on a day-by-day basis and here's a real threat in their midst, and what steps, what timing they would have to go through to eliminate that threat.
Ms Czukar: The police can remove someone on the spot who they think needs to be taken for an examination. They can then take the person to a psychiatric facility for psychiatric assessment. After, I think, 72 hours -- I'm sorry, I don't have the act here -- if the person is assessed as presenting a danger to themselves or others, they can be committed. If the police don't see the situation as an immediate threat, then the options are for someone who knows the facts to go before a justice of the peace, swear an information and the person to be taken then by the police for a psychiatric assessment. So those are the options where there is a true threat to the safety of others by someone in the home.
Mr David Johnson: I'm asking you to suppose something here, but what do you suppose would be the reaction of the police if they were called into such a residence, with 10 people? Do you suppose it's legitimate that the police would sort of automatically haul somebody off?
Ms Czukar: I would hope that they wouldn't; I would hope that they would, as usual, use their good judgement to deal with the situation. They're trained in this sort of thing. That's what they're experts in, and that's what they are supposed to do. I think they respond sensitively. We hope they respond sensitively. We put a lot of resources into having them respond sensitively to those kinds of situations.
Mr David Johnson: I guess it depends how you define "sensibly" or "with sensitivity." The operators were saying --
Mr Gary Wilson: That's some operators, Dave. Come on, let's be fair about this.
Mr David Johnson: Well, the operators that have been before us here in deputations by and large --
Mr Gary Wilson: Not all operators, let's be fair; not by and large.
Mr David Johnson: -- are saying that if you have to depend on the police, and the police do a great job but this is a very sensitive area, the police are of practically no value in terms of dealing with these situations.
Ms Czukar: Of course, that's not something our programs can deal with if the police aren't equipped to deal with the situation.
Mr David Johnson: No, but the problem is that Bill 120 is essentially setting this in motion.
Mr Gary Wilson: The statement we've heard --
The Chair: Order.
Mr David Johnson: I've got a number of other questions, but maybe in fairness we should allow some other people. I don't know, can I come back again?
The Chair: I'm sure you can.
Mr Cordiano: Just to come back to this question of delinking of services from housing, I understand the direction you're going in from a ministry point of view, but the basic problem is still a question of the housing circumstances and whether someone lives in a rooming- or boarding-house or lives in one of these rehabilitative centres. The common theme that runs through all of them is that they're living in shared accommodation, accommodation with common areas that are shared, such as kitchen facilities, bathroom facilities, etc.
It is because of that shared living space that we have heard many of the deputants who have come before us express concern about the very nature of their programs being undermined by the length-of-stay provisions, by the fact that they would not be able to deal with someone who is acting in a way that's hostile to other residents. Not that we've heard too many program providers come before us and say that they themselves had problems; there weren't too many instances where they could not deal with the circumstances themselves. But what they really, really had a great deal of difficulty with was the six-month exemption provision, that once the Landlord and Tenant Act was imposed on them, you might get people who want to stay in those facilities past the point at which they were deemed to have been looked after and their problem solved.
I think what I'm hearing from the Ministry of Health, and obviously this is coming from the Ministry of Housing indirectly by some sort of edict under Bill 120, is that the programs that are currently in place, the rehabilitation centres and the agencies that provide them, are a thing of the past, basically, and that you want to move to this new era of delinking services from housing.
What troubles me -- again I have to say this: I'm a little amazed at the way this is unfolding under Bill 120, the impact that this will have, and perhaps some of those providers were aware of this, but I still say that the way this is resulting, the circumstances having been changed, is really quite astounding to me. You're going to change the very nature of those programs though a housing bill, in effect. This bill will change the nature of those rehabilitation centres from transitional housing to permanent housing. It's quite obvious to me that that's what the intent is here, and I can't see how you can explain otherwise.
Again I express my frustration at not having the Ministry of Health come before us to simply state what the policy of the government is towards these rehabilitation centres, because quite frankly it's quite evident that what these rehabilitation centres have provided to this point is no longer necessary in the eyes of the Ministry of Health, by and large, that you are moving to delink services from housing and that these rehabilitation centres will now be viewed as permanent places to live.
Ms Hill: I think actually I've probably answered this already in my comments, but what I think I said was that we do see a delinking process already taking place in the field, that this has evolved over many years and that what it has done is forced the clarity of choice between being permanent housing or being something other than housing -- permanent housing -- which is transitional, rehabilitative in nature.
What I've also said is that if we discover through continual review of what I've described as essentially 20 agencies, 200 spaces out of 4,000 spaces that we currently fund in the community, that there is a group of those that demonstrate very clear, strong client outcomes and program outcomes that require longer than a six-month average, which I think also needs to be taken into account -- it's not a fixed six-month period, it's a six-month average, and people do progress through these programs at a differential rate. But if we in fact discover that it is a longer average that's required overall for the programs, and I don't think we know that yet --
Mr Cordiano: How can you move forward on --
The Chair: Let her present her answer, Mr Cordiano.
Ms Hill: Because they have had a mixed mandate and they were initially set up as housing programs with rehabilitative services.
If we in fact discover that, then we would have to look at other legislative frameworks that actually make them look more like treatment programs in the community as opposed to housing.
Mr Cordiano: Do you not think it's inappropriate to move forward with a piece of legislation not knowing what the impact on these providers will be? You yourself are saying, "We will examine this, review it." I just find it astounding that we would have legislation that will alter so fundamentally the programs we're taking about.
I think these programs are absolutely critical in our communities. You're allowing housing to supersede the concerns of the rehabilitation aspects of what these agencies are providing. I cannot fathom that thought. I think it's totally inappropriate for a government to proceed in that fashion, to bring about legislation not knowing whether the length of time we're dealing with for exemptions is appropriate or not. This is the point that has been made over and over again, that the real impact is not known.
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Ms Hill: Mr Cordiano, we have also stated that we are currently funding 73 agencies that offer a variety of supportive housing programs. What we mean by those supportive housing programs are rehabilitation supports to housing. Of those 4,000 spaces, we're talking right now about 200. So the evidence on the other side of the equation is that rehabilitation supports are being offered under LTA in a delinked way and, in some instances, in an integrated way. It is not clear to us -- the burden of proof is needed on both sides of the equation and right now we have enough evidence to believe that we can proceed with the average six-month exemption and, at the same time, recognize that the clients will benefit from the tenancy security.
Mr Cordiano: I'm incredulous because there weren't too many groups --
Interjection.
Mr Cordiano: There may have been one, Mr Wilson.
Mr Gary Wilson: On a point of order, Mr Chair: This question is a bit circular to begin with, but Mr Cordiano already had a chance. He's obviously grasping for other questions. I thought we were going to go with the rotation here within an hour for each of the ministries that we asked to come before us and that was why this arrangement was set up.
The Chair: I'm not aware of a time limit.
Mr Cordiano: There was no time limit.
Mr Gary Wilson: I think Mr Cordiano asked about time, so did Mr Johnson, when they were giving their questions, "Have we got any time left?" There is the understanding that we have a rotation here.
The Chair: The Chair is just operating under the motion that was made by Mr Daigeler some weeks ago.
Mrs Marland: You want to limit the clarification of your bill?
Mr Gary Wilson: Well, because of who is being clarified, yes.
The Chair: Order. The Chair is just operating under the motion that was adopted by the committee.
Mr Gary Wilson: No, I think the discussion, though, included the idea of a time limit of an hour for each delegation.
The Chair: Maybe my memory is foggy, but the clerk is checking Hansard.
Mrs Marland: It's such a great bill. You don't have to be so defensive.
Mr Gary Wilson: Excuse me, but we're trying to get to the bill. I mean, we've gone through these hearings, we've heard these things already.
The Chair: This is a time for members to get clarification of questions from the ministries that are coming before us this afternoon. It is difficult for the Chair to decide what is relevant on behalf of the committee.
Mr Gary Wilson: Even though you put these questions several times, the same one, the same answers?
The Chair: Order. Mr Cordiano, you may continue, but I note that we have five members still on the list.
Mr Cordiano: I will try to conclude my remarks as quickly as possible, Mr Chairman. It's unfortunate that there are people who do not -- further facts confuse them. That's not the case with some of us. We would like to get further clarification.
The obvious gulf, if you will, between the number of deputants who came before us and expressed concern and the number of people you're saying, or the number of programs that you have within your funding arrangements, don't seem to square with what we heard. This is the trouble I'm having, that repeatedly the calls and letters to my office indicate great concern with provisions of this bill dealing with rehabilitation centres. They are extremely concerned.
Some have suggested they will exit the field because they're not housing providers. They don't see themselves as housing providers, permanent housing; that's not an area they plan to stay in. That's another impact that I imagine the Ministry of Health has not thought about -- or has thought about.
I would like you to elaborate a little on the fact that there may be many agencies that no longer provide the kind of service they're providing because they simply do not want to become permanent housing providers. That's not a role they see themselves playing any part in, and the loss of their services will impact on what the Ministry of Health can do for people in that field.
Ms Hill: I'm not sure what the question is.
Mr Cordiano: The question's very clear. As agencies drop off providing the services that they now provide, you're going to have a shortage of agencies providing those services. Explain to me how you're not going to make that up.
Mr Gary Wilson: Yes, and if the sun doesn't rise tomorrow we're going to be cold.
Mr Cordiano: Mr Wilson, please don't interrupt. You'll have your say in the next election.
Ms Hill: Of the 20 programs that I referred to that are high support, it is not clear to us that they cannot operate under the LTA provisions and provide their programs. We will be in a process of discussion with each of those program providers to determine what they see as the changes they would have to make.
It is not clear to us that they can't offer both, since we have other group homes that do operate under LTA and do offer the programs. I'm afraid that until we sit down and have those discussions with each of them, it is not clear that the changes would have to be made or that in fact they would have to close. No one has told us that they are planning to get out of the business.
Mr Cordiano: My question was, why wasn't there a consultation process before this legislation was brought about? I just find that startling. Good governance means talking to people out there. I'm not blaming you. This is why I expressed my concern at the beginning that we didn't have the Minister of Health before us, because this is a policy question. It's not one for which you can necessarily provide answers. It's a political decision that has been made. The decision not to consult is a political one. I think clearly here that the Ministry of Health did not consult with those service providers, and I think at the end of the day that's all that can be said.
I see at least the Minister of Housing is here.
Mr George Mammoliti (Yorkview): I'm going to touch on pretty much the same issue that Mr Cordiano touched on, and that's the six-month provision, and be a little more specific in my concerns in terms of rehabilitation towards drug addicts, both illicit and prescription drug addicts, and ask you, first of all, whether or not you have any experience in this area whatsoever.
Ms Hill: The two programs that we fund in the addictions field that would fall under this area are Stonehenge Therapeutic Community and the Vanier Centre for Women. Our understanding from Stonehenge, which has had quite a long length of stay, is that they're currently doing a total program review and see that their program will fall under the six-month exemption. The recovery homes fall under the Ministry of Community and Social Services.
Mr Mammoliti: Okay, and it's not appropriate for me to ask you these questions in terms of what agencies that particular ministry funds because --
Ms Hill: I don't have that information.
Mr Mammoliti: -- I'll ask them when they come forward. Are you familiar with glue-sniffing at all?
Ms Hill: No, I'm not, personally.
Mr Mammoliti: You're not. Are you familiar with the addiction of glue-sniffing? It's not humorous. It's a growing epidemic, both in the aboriginal community and in Metro here. Are you familiar with how long it takes to treat somebody who's addicted to glue?
Ms Hill: No, I'm not.
Mr Mammoliti: Heroin? Are you addicted to -- sorry, are you familiar with heroin addiction at all?
Ms Hill: No, I'm not.
Mr Mammoliti: Okay. The reason I ask these questions is because I'm familiar with the stakeholders who help these individuals who are addicted to a number of these drugs, and the people I've been talking to certainly would not want to be restricted to the six months. Some of them are telling me that it could actually take up to two years to treat somebody effectively and that what this might do, if passed the way it is, is actually push people out the door and not necessarily treat them as they should be treated.
While some of them are telling you that they're trying to revamp the way they do things and change the way they do things, I don't think it's because they actually want to. I know that outpatient care is an issue, and some people feel that you can deal with some of these addictions through outpatient care but others believe that you can't, and they have been successful.
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Let me just finish my comment before I ask you the question. What would happen in a drug rehabilitation clinic, for instance, which has a program of two years for heroin addicts or crack addicts and is now of course under the scope of the new legislation, if after a six-month stay one of their clients decides that they feel better but yet it's their house and they're going to stay there and, after a 10-year period, say, or a five- to 10-year period, all those homes are filled with individuals who don't necessarily need that treatment? What does that do to that particular rehabilitation clinic? It shuts it down, does it not?
Ms Hill: I guess my difficulty with this is, it's not referring to something that's specific. Of the treatment programs that we fund currently, all but two would meet the exemption criteria.
Mr Mammoliti: What are those two?
Ms Hill: Stonehenge and the Vanier Centre. Stonehenge has gone through this review based on its own program assessment of what is working and not working. There are other what I would call medical-mental health conditions where there is clearly a defined process of inpatient, day treatment, outpatient: a continuum model.
For the most severe in that population, there is a defined inpatient treatment stay for the purposes of dealing with the problem, which doesn't mean that when they leave they are cured, but then they move to the next phase of the program, which can be day treatment or outpatient, and ultimately to more and more independence with the necessary supports.
Some of the thinking is coming together across both the mental health and addictions fields about what that appropriate length of stay is and certainly most addiction treatment programs have actually worked within a 28-day model, which has been changed and modified.
Mr Mammoliti: You're not getting any objection from me. The 28-day program does work for some people. For most people, I think we can say. But what about the rest, who chose to do their rehabilitating over a two-year program or even a year program or year and a half? What are we saying to the clients who decide to take on rehabilitation within Ontario?
I'll tell you my concern. I've done extensive work in this area and I think you know that. I've actually been very successful in turning the flow of OHIP money that was going to the United States at one point and redirecting it back into Ontario to fund some of our own particular rehabilitation clinics.
I'm afraid that -- and I have no qualms about saying this at this point -- if we adopt the six months, then we're going to get another flow of people going to the United States again and trying to get help there if we're not going to give it to them over a period of time that would be effective for that particular person.
Talk to the aboriginal community, for instance. They have their own way of dealing with this, and if it takes two years, I don't believe that we should stop it and I think that it might. We need to be wary of that.
I don't know if you want to give me any more comments, but I know there's one agency in my riding called Caritas that deals with heroin addicts and crack cocaine addicts. They have a two-year program and they're concerned, because after a certain amount of time they might be catering to the tenants as opposed to people who need rehabilitation, and that's my concern. I think Comsoc funds that. If I'm not mistaken, they do.
Ms Hill: The only comment I'd like to add is that I think our expectation is that clients will have both tenancy agreements and program agreements where they're in a situation where there will be housing as well as service provided. I think with a program agreement, a service agreement, participation will be a key criterion for staying in the residential situation, and that will work effectively for programs under six months.
Mr Mammoliti: One other question. Rehabilitating women addicts: Are you familiar with that at all?
Ms Hill: Specifically I have not addressed the addiction programs. As I said, of the ones we fund in the Ministry of Health only two currently would fall outside the six-month exemption. It may have more to do with the Ministry of Community and Social Services.
Mr Mammoliti: I've been told that because of some of the circumstances with women, and at times actually being diagnosed as having a dual disorder, it's important that they be able to stay in one particular location for at times even two years, away from their family, believe it or not, and that the six months will force them out of the rehabilitation clinic and ultimately jeopardize their rehabilitation.
Mrs Marland: Ms Hill, you've made a number of references this afternoon to the Vanier Centre. There's only one Vanier Centre, isn't there? It's the Vanier Centre for Women?
Ms Hill: No, I think this is an addiction rehab program.
Mrs Marland: Are there two with that name? The reason I'm asking that is that we did have a presentation from the Vanier Centre for Women.
Ms Hill: That's a correctional facility.
Mrs Marland: No, that's not the one I'm talking about. The correctional facility is in Brampton. There was a group that came before us. It's in the east end of the city. Does anybody remember the name of this group?
Mr Bernard Grandmaître (Ottawa East): They're from the Metro area, the Vanier Centre.
Hon Evelyn Gigantes (Minister of Housing): No, it's the Massey Centre.
Mrs Marland: Oh, it's the Massey Centre. Okay. I'm sorry.
Hon Ms Gigantes: You've got your Governors General mixed up.
Mrs Marland: That's good, Madam Minister; I have got my Governors General mixed up.
Mr Grandmaître: You'll never get the Order of Canada now.
Mrs Marland: No, I won't. That just confirms it.
You talk about how things will work with appropriate supports. For the sake of people who read the Hansard, where you talked about rehabilitation supports under the LTA in a delinked way, would you like to explain that?
Ms Hill: Sure. Many of our supportive housing programs really focus on ensuring that a client has permanent accommodation and support services, such as case management, or a housing support worker is a term we use, which essentially help the individual with daily living skills, seeking vocational rehabilitation or employment, helping them develop support in the community either through a self-help group or becoming connected to local drop-in centres.
That worker is their primary support worker who supports them in their independent living environment. This can be in an apartment house situation or in a group congregate living situation, but the supports are given to the individual, and if that individual moves on, the supports move with them.
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Mrs Marland: So is that your explanation for "delinked"?
Ms Hill: "Delinked" means that a person's tenancy, where they live, is not integrated with the support service and that if they choose to leave that housing situation, they don't risk losing their supports.
Mrs Marland: You're an assistant deputy minister?
Ms Hill: Acting assistant deputy minister.
Mrs Marland: Good. At least in the right direction, right? You would agree, then, from what you've just said, with a policy within a government where money flowed to individuals and moved with those individuals rather than money just flowing, blanket, to a particular program? If there is an individual client who is identified with a need, obviously from what you've said you would agree with that money flowing to that individual to meet their individual needs.
Ms Hill: The intent of the mental health reform process is to ensure that the supports are linked to the individual. Either their case management needs or their housing support worker needs or their crisis response needs follow the individual as opposed to necessarily staying within the walls of a service agency. That's one of the reasons we support more mobility in service as well, that case managers and housing support workers should go where clients live, their community. In other words, the supports should be mobile as opposed to being provided separately.
Mrs Marland: You see, my concern with this bill is that the sections of the bill that deal with the long-term care needs of individuals are not being addressed as in the recommendations Dr Lightman made -- primarily, I think, because of the fact that what we're doing here is a little diddling. I mean, it's supposed to look good because we're doing this, but when you legislate only tenancy and you do nothing about the care, in my opinion it ends up being a sham --
Mr Gary Wilson: That's not Dr Lightman's opinion, though.
Mrs Marland: -- because there is no guarantee that those individuals' needs will be met.
It's difficult to ask you questions because you're the executors of government policy. In some ways I'm sure that both of you obviously help develop policy as well, but some of the questions I'd like to ask I don't think are fair to ask a staff person and I respect the fact that that is the position you both have.
The Vice-Chair (Mr Hans Daigeler): There may be an opportunity later on since the minister's here.
Mrs Marland: It's not the Minister of Health who's here, and that's the difficulty, because we're talking about programs here that end up with the involvement of more than one ministry.
When you sit here and talk about, "This will work when you bring in the appropriate supports," it makes my heart ache, because what I think is happening is that this government isn't going to do any better a job than when our government decided it would deal with long-term care by closing all the long-term institutions and didn't have the supports in the community.
You said you're not a service provider but you know this will be okay with the appropriate supports. What I'm suggesting to you is that it looks like every single government is going to make the same mistake, that legislation is drafted and designed on the basis of some other things happening, and when those other things don't happen at the community base level, then we do a disservice to the community as a whole. I think that disservice to some of those most vulnerable people in our community will continue.
One of the things that's wrong with this bill is that we're here discussing it with two ADMs from Health and the bill is under the name of a Minister of Housing. This is what is the problem.
Mr Ennis, you talked about this interministerial committee going back, in your experience, for a year. Can anybody with you here today confirm how long before your experience those interministerial committees were meeting? We were told by various people who said they couldn't present the reports because they were government confidential interministerial reports and they weren't for publication. I would like to know how far back we have to go with our freedom of information request to find out how long there has been an interministerial committee discussing, in this case, housing of vulnerable people. Is it true that committee has been meeting for more than your experience of one year?
Mr Ennis: Mrs Marland, I responded by saying a year and I've lost track of some of the time. I know that since I became involved with long-term care, which is now close to four years --
Interjection.
Mr Ennis: There's some help. It was as far back as at least August 1992. I was trying to remember how long back the actual committee that was put in place was to deal with the housing issues on an interministerial basis.
There were other committees before that dealing with issues that were very similar in some ways -- in fact it goes back three or four years prior to that -- around supportive housing and the very issue that Jessica responded to, the question of delinking. But the committee that was to follow up in terms of the recommendations of Lightman has been working for, I guess, now several years on that, and that's the committee I referred to. It's at least since back of August 1992.
Mrs Marland: That's a year and a half.
The Vice-Chair: Mr Wilson, and then Mr Johnson.
Mrs Marland: I've had five minutes. Is that what we're having?
The Vice-Chair: Then we have Mr Owens, and I think Ms Gigantes is down here as well.
Mrs Marland: I only had five minutes.
The Vice-Chair: You can come back, but I do think we should follow some sort of a rotation. We haven't really established any formal system, but I think it's only fair to give the other members an opportunity to speak.
Mrs Marland: I didn't have as long as George.
The Vice-Chair: May I also remind the members of the committee that we are also to hear from the Ministry of Community and Social Services.
Mr Gary Wilson: Thanks very much for your presentation. I think you have done something to clarify some of the issues that have come before us, as well as to discuss, I think, some of the things that are happening now that this bill isn't a radical departure from. In fact it's building on the various activities the Ministry of Health in the field has developed over the years.
As you suggest in your presentation, there are things that can be done that arise out of these settings, where problems do arise, to work with the clients and build up the experience that way, what can be done so that the services can be generated within the Ministry of Health, the very necessary support services we're all talking about and recognize that have to be there. The question always arises, what do you do with the disruptive people? Where are they going to go where those cases do arise? We have to remember there are actually relatively few cases overall, so I think we are on the right track here.
In fact, you just have to look at Hansard, the second day of the hearings, to find that Ernie Lightman was very supportive of Bill 120, saying especially that nothing could do more than the extension of the Landlord and Tenant Act rights to vulnerable adults, that he was looking into the conditions that they had looked into. So I think that's quite clear.
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More specifically, I would like to ask you whether you're aware of the government amendment to look at the issue of rehabilitative and therapeutic services to provide another ground for eviction up to a period of two years, to see whether that would help this idea or the concern of some of the operators that people who had reached the end of the benefit of the services would stay in the accommodation because they found it an attractive place to live rather than to move on after they had taken advantage of the services, that in fact they had either been cured or else it was clear that no amount of services would benefit them. Are you aware of that amendment? Perhaps you might comment on that.
Mr Ennis: I am aware of the proposed amendment, the one that indicates that in programs that have a two-year duration there would be a contractual agreement between the provider and the individual concerning the services they were there to receive. I'm aware of that.
Following through on that, I see that amendment as offering another option level in terms of some of the concerns around the length of stay in the program. I think it would not be used in every case. There would be a number of programs where it wouldn't be necessary. In fact, with that agreement, when an individual had completed the rehabilitation time frame, if there were some issues or concerns that he was not prepared to move on, the provisions of the Landlord and Tenant Act could then be brought into play. I think that's another level which would address some of the flexibility in those cases where it's required.
Mr Gary Wilson: I'd like to raise another thing that I think Jessica mentioned in her presentation, the experience that has been built up and what can be done in the various types of accommodation that are being provided. Several of the people involved in supportive housing and working with clients in the mental health field are looking to the Ministry of Housing for various educational programs to help them in these cases that they might not have seen before, or even where they have, there are so few that you don't build up a solid body of experience individually. I just wonder whether there's some way the Ministry of Health is looking at to spread this information around and whether you could comment on that.
Ms Hill: As I mentioned earlier, we've been developing some program guidelines, planning guidelines, to support local planning under the district health councils between health and housing providers. This is an important bringing together of two areas that are really very different, the provision of housing and the provision of support services. We've also provided some funding this year to train housing providers to care for, support and assist people with mental illnesses living in existing housing. We will continue to work with housing providers to address those training issues.
Mr Grandmaître: I have a couple of very short questions. I want to go back to Dr Lightman's recommendations. Can you tell me why the Ministry of Health didn't approve or didn't go along with Dr Lightman's recommendation for a fast-track removal process?
Mr Ennis: The reason I'm hesitating is that I'm trying to remember the thinking around the actual process itself. It isn't coming to me crystal clear in terms of responding to you directly on that question. I do know there were concerns raised about that very process itself, that along with having it as a provision there could also be abuses of the provision itself. But I say in all honesty I can't remember all the specifics around not following that one particular recommendation. Our attempt from a bureaucratic level was to look at how we could then maintain the spirit of the intention and the direction in terms of those recommendations.
Mr Grandmaître: But you do agree that there shouldn't be a fast-track removal process?
Mr Ennis: You're asking me as an individual?
Mr Grandmaître: I'm asking the minister or the ministry.
Mr Ennis: We have supported the legislation as it's tabled, and it doesn't include that.
Mr Grandmaître: Bill 120 is trying to delink services from accommodations. Going back to the removal of undesirable people, if I can refer to them as undesirable people, causing harm or whatever to other clients, you say that you agree with the six-month process. If the client goes to court, challenges the law, who will be paying for the legal fees, the Ministry of Housing or the Ministry of Health?
Mr Ennis: I may need some legal advice on responding to that.
Ms Czukar: Was the question, who would provide the funding if the client chooses to challenge the program and the program has to engage in legal proceedings?
Mr Grandmaître: Yes.
Ms Czukar: The ministry usually supports programs when it's necessary with respect to their legal fees. It's usually done on a kind of case-by-case basis. Programs aren't given funding on a block funding basis in their budgets, but to the extent that's an issue and the program can make a case that it's part of providing the program and it's necessary, then the ministry would normally provide funding for those aspects of the program.
Mr Grandmaître: Is there any allocation at the present time in the Ministry of Health to provide that legal service or services?
Ms Czukar: The Ministry of Health, legal branch, would not provide services directly to the programs. The programs are independent. We provide legal advice to the ministry, so we would not provide the legal advice to the programs or represent them or that sort of thing. They'd have to do it themselves. They're legally independent. We would provide advice only to officials in the ministry.
Mr Grandmaître: To the ministry?
Ms Czukar: The ministry. These people are my clients. I provide advice to them and to the minister and so on, but not to the programs. The programs that are funded by the ministry are independent. It's like a hospital or any kind of independent community agency.
Ms Hill: If I could just add something, currently what would happen is if a program required some legal representation, and this could be a variety of different situations, and it did not have the money within its existing budget and could demonstrate that it could not find that money, it would make a special what we call one-time request based on its need and we would consider that request. It's not a fixed allocation, but we often within a year have one-time requests that are not ongoing. They're not part of their base budget but are dealt with in that respect.
Mr Grandmaître: How many times in a year, for instance, would you have to deal with such cases at the present time?
Ms Hill: I would have to review our one-time requests, but I can't think of any in the last year for this kind of problem that you're referring to.
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Mr Grandmaître: Do you think with the implementation of Bill 120 there is a possibility that you might be faced with a number of requests?
Ms Hill: I don't have a crystal ball, but I in fact think that for the majority of clients in our programs and for the majority of our providers in the majority of situations the question of whether a client is an appropriate fit in a group home or in a congregate living situation, whether they're meeting their program objectives, will be discussed and resolved without ever entering the legal system.
Mr Grandmaître: One last question: Bill 120, as it is, you have no objections, no other recommendations to make, you fully agree with it?
Ms Hill: I don't have any recommendations to make at this time, no.
Mr Grandmaître: I'm asking you if you agree with Bill 120.
Ms Hill: Yes, I agree with Bill 120.
Mr Grandmaître: Clause by clause it's perfect.
Ms Hill: Nothing's perfect.
Mr Grandmaître: Coming from your ministry, it has to be perfect. But you do agree, no questions asked.
Mr David Johnson: Maybe we'll come back in a couple of years and see if you still think it's perfect.
Ms Hill: I said nothing's perfect.
Mr David Johnson: But you certainly would agree that a number of the service providers have extreme concerns about Bill 120, no question about that.
Getting back to the six-month exemption again and the fact that there will be many providers that will not be exempt on that basis, such as the situation I quoted in Scarborough, and there will be problems, questions come up in terms of support from the Ministry of Health. For example, if there is a crisis situation that currently they're able to deal with because they're exempt from the Landlord and Tenant Act -- I'm talking about any service provider, not necessarily just the one in Scarborough -- if a crisis comes up, can they expect any kind of additional assistance now, because we're breaking new ground, from the Ministry of Health? Can we expect backup in the case of a crisis, for example, from the Ministry of Health?
Ms Hill: I guess there are two questions I would have, which is probably not fair since I'm supposed to be answering them, but the first is that seven agencies, I believe, have made deputations to this committee, and as I mentioned we fund approximately 73 that are offering supportive housing. Of the agencies that are concerned specifically about backup, one of the questions I would have is, how do they currently deal with crises? What kinds of linkages do they have to the general hospital emergency unit? What linkages do they have to the provincial psychiatric hospital? What linkages do they have to existing crisis support services?
We recognize that the challenge for the ministry is definitely, and it's outlined in the mental health reform document, to provide more crisis response services, to provide more case management services, to provide more housing support services, and those are all our priorities. So in terms of offering more support, we would examine each individual situation and see what is necessary to ensure that the service is working effectively.
Mr David Johnson: Do I interpret that as yes but in terms of specifics you're not being very specific at this point?
Ms Hill: I would say yes, we will discuss what supports they need.
Mr David Johnson: And yes, you will provide additional crisis support?
Ms Hill: Based on what they need, yes.
Mr David Johnson: For example, is mention made of psychiatrists? Is that an area?
Ms Hill: Some of our programs have psychiatrists on salary. Some of them have them as part of a sessional fee support. Some of them have, as part of their program budget, sessional fees in order to purchase psychiatric support services.
Mr David Johnson: Would you expect additional psychiatric support, given that there is concern that because of the non-exemption now of the Landlord and Tenant Act there could indeed be crises and need for additional psychiatric support? Can you tell us today there will be?
Ms Hill: The assumption is being made that there are going to be more crises than exist now.
Mr David Johnson: It seems a pretty good assumption, but you don't agree?
Ms Hill: I'm not sure I agree with the assumption.
Mr David Johnson: If the assumption holds true, can they expect a speedy response from the ministry in terms of these extra support services?
Ms Hill: I guess this is becoming fairly abstract. What I'd say is that if in the circumstance it is demonstrated that there are more crises taking place, we'd certainly want to know why and what kinds of service supports are needed and what kinds of backup and linkages with the other parts of the system are needed. No part of the system can operate on its own.
Mr David Johnson: In your presentation, you mentioned some form of agreement. I didn't have the ability to quote down exactly what you said, but it led me to believe that you were contemplating some sort of tenancy agreement that would require residents in a certain facility to take part in a rehabilitation program.
Ms Hill: What I said was that for programs falling under the six-month exemption, they could have a program agreement, which would in a sense be a contract for service, that you are part of a rehabilitation program. It's quite realistic that within establishing treatment goals and program objectives for an individual client, there would be an agreement, and participation would be one of them.
Mr David Johnson: I'm still not sure exactly what you mean, but obviously some of the providers are concerned that they will not be exempt, they will not meet the six-month clause, they will still have a program that they want to give but some of the residents will opt out of the program -- this might be of particular concern, for example, in an alcohol centre, or any kind of centre -- and that the tenants would continue to live there because you can't evict a tenant because they're not involved in some sort of rehabilitation program.
I thought maybe what you were saying was that an agreement could be drawn up to provide that the tenant had to be involved in that program. Did I misconstrue what you were --
Ms Hill: I was speaking specifically about the programs that would be under the six-month exemption, the average length of stay of six months.
Mr David Johnson: So you weren't contemplating beyond the six months.
Ms Hill: I was speaking specifically to those programs whose primary objective is rehabilitation and not housing.
Mr David Johnson: You will recognize that many of the programs whose objective is rehabilitation have indicated to us that their programs go well beyond six months, up to 18 months and two years.
Ms Hill: Average length of stay, yes.
Mr David Johnson: They are concerned that some of the residents, some of the tenants, will opt out of the rehabilitation.
Ms Hill: All I can say is that currently we have transitional group homes that have longer lengths of stay than six months that operate under LTA, and they have not found it to be a barrier to delivering their program.
Mr David Johnson: Okay. I wanted to talk to someone about the Massey Centre for Women.
Ms Hill: That's not me.
Mr David Johnson: That's not you. All right. In their deputation, they mention both the Ministry of Community and Social Services and the Ministry of Health, but you would guess that the Ministry of Community and Social Services would be better equipped, would you?
Ms Hill: I believe so, yes.
Mr David Johnson: Okay, we'll assume that's not passing the buck.
Ms Hill: Could be.
Mr David Johnson: Let me talk to you a little bit about the Community Occupational Therapists and Associates, COTA. That would be one of yours.
Ms Hill: Yes.
Mr David Johnson: They say they're involved with 2,000 clients. They house over 700 tenants with mental health problems. I guess you've seen the statistics that they claim that 40% have a history of aggressive behaviour, 42% a history of suicide attempts etc.
They give the example of a 35-year-old male tenant who began to exhibit behaviour which was disturbing to fellow tenants. He began to stalk another tenant who happened to be a member of a visible minority. He was abusive towards the other tenant and he threw him against the wall on at least one occasion. He was verbally abusive and threatening to other tenants and they were very afraid of him.
As a matter of fact, during this period when the staff were trying to deal with him, they said that a couple of the tenants contemplated leaving the co-op because of the intolerable situation. That's a concern I've heard over and over again, that if people are in a situation like that, they may just walk away from it.
They said they called the police. Your earlier advice was to call the police. The police response was that they stated that this was a domestic matter and they could do nothing. They suggested the two tenants work it out between themselves. After three to four weeks of incredible disruption in the household, the tenant became so ill -- and this was the tenant who had this action taken against him -- that a doctor was finally willing to sign a form and have him committed to the hospital.
It's not too hard to envisage these kinds of things happening. What they're calling for is a fast-track mechanism. I wondered why in a situation like that you would object to a fast-track mechanism. Why wouldn't that make sense to have something where, instead of having to go through three or four months of the Landlord and Tenant Act, an organization like that would be able to have some faster mechanism to deal with those kinds of problems?
Ms Hill: I guess what strikes me about the specific scenario you've described or that COTA has reported is that it speaks to some of the issues we are trying to address through mental health reform. In that situation, where someone is becoming more ill, as they said, decompensating perhaps and not able to cope at that point in time, either the provisions under the Mental Health Act or a crisis response team is needed or what we are describing as a crisis stabilization.
In the first instance, what you desire is that the person could be convinced to enter a crisis program for a period of time until they're stabilized and able to return to their housing. On the other hand, if they refuse that, they don't want any of that support at that point in time, there are provisions under the Mental Health Act and that's what the act is designed to do.
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I think it's unfortunate that they have such difficulty finding a psychiatrist who is willing to sign a form. At that point in time our system should be more responsive to the different elements within it. I think that's critical. That's what we're trying to do with mental health reform, have everybody work together. I would suggest that the scenario doesn't necessarily have to play out that way.
I also think that the police response was not necessarily the most effective either, in that in that situation it may have been perfectly appropriate for the police to intervene and to remove the person, especially if they had assaulted another tenant. So it looks like a breakdown in many parts of the system.
Mr David Johnson: COTA's view, just to deal with the police -- they state in their brief that the police have been suggested, perhaps by your ministry; they don't say that, though.
They go on to say: "In our experience, this is rarely a satisfactory solution" to the problem. "Criminalizing those with long-term mental health problems is neither a humane nor helpful approach" to the issue. "Jail is clearly not the answer, nor a housing option of choice. The reality is also that the police are ...frequently...unable, reluctant or unwilling to act" in many of the situations they are called upon to deal with in housing settings nor do they have the training in mental health to do so.
I'm afraid that's the reality of the situation. We may wish it wasn't so, we may wish that the police had broader abilities and capabilities, but this is the reality that's on the ground today.
Ms Hill: There are training programs that we have supported. In Peel there was a training program for police specifically to respond to the severely mentally ill. I think what I said in my remarks early on is that this is an impetus to the further delinking. It's also an impetus for us to provide more effective training to police in order to intervene. It's also an impetus for us to continue to develop our crisis response system, because I certainly would choose a crisis response team as the first point of contact. That's exactly what we intend to build. There are some crisis response services but clearly not nearly enough and that would be the preference in that situation.
Mr David Johnson: Don't you have any doubts that the mechanisms that you're describing, while theoretically excellent, practically speaking, are just not there today, both in terms of the Mental Health Act and in terms of the police? While we search for that Utopia, the providers today have to deal with the real world and aren't we sort of -- when I say "we," I don't count myself in that, but doesn't this bill leave them out to dry in a sense while we search for that Utopia?
Ms Hill: I don't think we're searching for a Utopia. We've seen these systems work in other jurisdictions very well. It's true that we may not have it fully developed at this point but, as I said earlier, many of our programs exist under the Landlord and Tenant Act and are able to deliver their programs and the handful of incidents that we suspect could be -- it's sort of an assumption that's being made that in fact the Landlord and Tenant Act is going to contribute to more of these situations.
Mr David Johnson: When you say there are other jurisdictions, could you be more specific?
Ms Hill: There are other provinces that have crisis response teams that are very effective in both responding to first-time crises and to supporting other parts of the system. We currently are developing program and policy guidelines which we're sending out for consultation on the crisis response system and we'll be working with hospitals and other service providers and planning through the DHCs to put these in place.
Mr David Johnson: Do other provinces have an equivalent to Bill 120 whereby care homes come under an LTA?
Ms Hill: I'm not sure. I think the Ministry of Housing would be better able to answer.
Mr David Johnson: Could I deflect that to the Minister of Housing? Deflect? It's like a ping-pong game here.
Hon Ms Gigantes: I will ask for information on that.
Mr David Johnson: At any rate you're not aware of other -- when you mentioned other jurisdictions in other provinces, you led me to believe that you were aware that there was something equivalent to this.
Ms Hill: I was speaking about the crisis response system.
Mr David Johnson: But you weren't speaking to the problems that could be generated having the Landlord and Tenant Act pertain to care homes that would come under your jurisdiction, for example.
Ms Hill: What I was speaking to is the reality that in any part of the mental health field there will be individual clients or patients who will require crisis support services and that we see the crisis response system as not only critical to providing services to people who enter a first-time crisis -- they're living in their home and they go into crisis or they go into crisis in any part of the society or community -- but also as a critical component to support people living independently in housing and to case management services as well.
Mr David Johnson: Maybe the minister will get back to us on the other question about the other provinces.
You mentioned delinking again and this has been discussed quite a bit here today. I'm not sure if the question has been asked earlier, but if this ultimately does lead to delinking, could you tell us what the Ministry of Health's outlook or view or actions will be in terms of, for example, will the Ministry of Health be prepared to pick up the treatment? There are service providers today who are providing this along with housing, but if delinking takes place, would the Ministry of Health be more involved in picking up the service component at some time in the future?
Ms Hill: We currently are providing the funding for the service component and the 24-hour group homes as a service model. We don't see that there will be increased costs associated with bringing in these provisions. As I said, many of our supportive housing programs operate under LTA provisions currently.
Mr David Johnson: What I'm told -- and I'm not the expert in this field; perhaps Margaret will help me out -- that there are very few treatment placements at this time and that the waiting periods for crises at the present time is quite a long waiting period for --
Ms Hill: The group homes do not offer treatment. The treatment facilities that we have in the mental health system to a large extent include the provincial psychiatric hospitals, the general hospital psychiatric units, inpatient-outpatient day treatment. I'm not sure whether you're referring to the group homes or whether you're referring to another component of the system.
Mr David Johnson: I'm referring to any component of the system that will now come under the Landlord and Tenant Act that wasn't there before, okay? You can envisage any component of that and if, as a result, we lead to delinking where the housing becomes separate from the care, is your ministry going to take a more active role in providing the kind of care that may be lost as a result of the fact that the providers now give both?
Ms Hill: And we fund both.
Mr David Johnson: And you fund both, yes.
Ms Hill: So we would be assisting with the delinking and we currently fund both parts of the system. There's an assumption being made that there's going to be an increased cost, I think.
Mr David Johnson: Or a loss of service, I guess.
Mrs Marland: If the providers start getting out of it, there will be.
Mr David Johnson: I'll let somebody else pick that up, I think. Margaret, you pick it up.
Mr Cordiano: A short supplementary. Only because it was the -- Margaret, just one minute, because this is very critical for me. I just find this is so fundamental to the bill. I can't accept the reasoning behind the view that's unfolded here and I'm almost tempted to ask the minister if she sees --
The Chair: You'll have that opportunity later.
Mr Cordiano: I will, yes, but the whole point is that these rehab centres have always seen themselves as providers of services for rehabilitative purposes --
The Chair: Point of order, Mr Owens.
Mr Stephen Owens (Scarborough Centre): On the point of order, the member asked for a quick supplementary and that supplementary has now stretched.
The second point of order is on process, Chair. This ministry has been on the hot seat for over two hours now. We still have another ministry. We have a clause-by-clause process to get through by the end of the week --
Mrs Marland: Is that a point of order?
Mr David Johnson: That's not a point of order.
Mr Owens: Absolutely. Can we have your view, Chair, on the point of order and in terms of the process that we're engaged in here this afternoon?
The Chair: Mr Cordiano asked for a supplementary and he is asking his supplementary question.
Mr Owens: Mine was a supplementary point of order.
The Chair: On the second point of order where you ask about scheduling, you will know there are no time limits in the motion that was put to the committee and passed by the committee.
Mr Cordiano: Very quickly, was there an open process of consultation with these rehabilitation centres to flat-out tell them that their services and the way they now provide them are going to no longer be necessary over a period of time and that you're going to basically put them out of business in the way they operate today?
Ms Hill: No, there hasn't been, since that's not what I would say to them.
Mr Cordiano: That's what they're saying to us.
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Mrs Marland: Is the minister going to ask the Ministry of Health questions?
The Chair: Yes. That's the process we're in.
Hon Ms Gigantes: I'm going to try to help the committee, Margaret.
You will be aware that a number of witnesses and some members of the committee have raised the question on behalf of operators of treatment programs in particular whether they would cease to become operators of treatment programs and become landlords. When you've looked at that issue and you consider the proposed amendment to subsection 2(1) of the bill that would provide an extra ground for eviction within a two-year framework, do you consider that meets that concern?
Ms Hill: In the Ministry of Health-funded programs there are only a few treatment programs that would have the concern that their program was for 18 months to two years and therefore they would be concerned about people staying beyond that, and that criteria for eviction would help those programs, but they are actually very few of the programs that we've been discussing. The group home programs, I think it would be fair to say, would not call themselves treatment programs.
Hon Ms Gigantes: Right. Dealing with the question of group homes or supportive housing programs, has it been your experience in the Ministry of Health that there have been problems in some settings because the operators wish to run them much like institutions, and is it your view that if we are to proceed with a delinking direction for the provision of housing and the provision of support services we have to move away from that institutional reflection within group homes and supportive housing settings?
Ms Hill: That has been the direction we've been pursuing for a number of years in terms of supportive housing, that we see stability of accommodation, having a permanent accommodation, as a critical factor to contributing to someone's stability with their mental illness. Certainly the delinking has essentially been directed towards achieving that goal, that you should be able to provide permanent accommodation and the support services and that the choice about whether to live in a home or live in an apartment should be largely the choice of the tenant as long as they meet the requirements.
Hon Ms Gigantes: Has there been experience at the Ministry of Health that would lead you to think that in fact people's health may be affected by situations in which the vulnerability of a person to eviction is creating distress, and have there been incidents which have caused the Ministry of Health to question whether such a setting is in fact healthy for the people involved?
Mr Ennis: I'd say in the past couple of years, there have been probably several situations where the administration of the program itself has been questioned by us in terms of the care that's being provided to the individuals who live under that program's administration both of the home and the service itself. There are some places where it's actually connected. It's not delinked, and that's where we have had some issues in terms of some of the individual clients and we've had to take some intervention to help them out of that situation.
Hon Ms Gigantes: So from the point of view of the Ministry of Health, to provide effective programming you think it is a useful base to have a separation of accommodation and some permanency of accommodation for long-term tenancy and the support services?
Mr Ennis: Yes, that's correct. In fact, as you look back on the experience in the area of programs for seniors and persons with disabilities, the delinking has been going on for probably two to three years at least, if not longer, and most of those programs are now in that situation where the services are delinked from the accommodation itself. There are some that are still together, but over time that will change.
Hon Ms Gigantes: In other words, there's positive evidence for the need for change in the field of people who are generally vulnerable for one reason or another and also a positive indication from the setting involving people with chronic health problems that delinking is an appropriate policy direction.
Mr Ennis: Yes, it is the appropriate direction. It also allows services to be directed at the individual rather than focused around a program itself.
Hon Ms Gigantes: Have you ever had reason to think that it improves somebody's ability to cope with a drug problem or a mental health problem, from the experience of the Ministry of Health, to be threatened with eviction?
Ms Hill: No.
Mr Ennis: It sounded like we were both going to answer at the same time.
Mr Owens: Again, the process issue that I wanted to address is the issue of when we're going to see Comsoc, if you have a view on the time line. I understand that a set time period was not included in the motion -- that part is clear -- but again, in terms of the amount of territory that we would like to cover this week, I think it's important after two and a half hours now that we have some indication of when Comsoc might be asked to take its place at the table.
The Chair: Mr Owens, you know the Chair can only allocate time according to the wishes of the committee. If the committee wishes to move to the next presenter, then the Chair is more than happy to accommodate. I share your concern that we may not be providing enough time for the Ministry of Community and Social Services; however, that is not my decision.
Mr Owens: Well, I think it's more to the issue of the tenants that we're trying to address rather than the ministry people. My understanding of the conversation we had was that we would like to have the Ministry of Health and the Ministry of Community and Social Services come in and talk about their level of consultation with the Ministry of Housing around this particular piece of legislation. Now, I would say that in two and a half hours we probably explored that pretty thoroughly with the Ministry of Health, and in terms of moving on to exploring that same question with Comsoc and again ultimately dealing with some tenant issues here, I think I'd like to have an understanding perhaps from the committee of what it is they're thinking of doing. Do we continue this for another two hours or are we going to move into Comsoc?
Mrs Marland: I think Mr Owens may be interested in tenant issues in this particular section of the bill; I'm interested in the care of people with special needs, the most vulnerable people in our society. There are questions that have to be answered. It's very obvious that there are reservations by the Ministry of Health on some aspects of the impact of this bill on its clients. If you're satisfied that your questions are answered, then that's fine; you don't have to ask any.
Mr Owens: So that means, Mr Chair, we're going to continue for another --
The Chair: We are going to continue because I have no authority to do otherwise.
Hon Ms Gigantes: We could make a motion, couldn't we?
Mrs Marland: Sure, you can kill anything; you've got enough votes. Make a motion and kill it. Why don't you do what you usually do?
The Chair: Order. Mr Owens has the floor.
Mr Owens: Maybe that's the language you use in Mississauga, but we don't use it on this side of the table.
Mr David Johnson: Why don't we just carry on?
Mrs Marland: I could dig you out some Hansards and show the kind of language you use.
Mr Owens: In terms of the particular piece of legislation, I have a question for Ms Czukar. I don't know if in your role with the Ministry of Health the Advocacy Act would be something that you could comment on, but my question was with respect to the application of the Advocacy Act and how you saw it being applied to the tenant group that would be represented by your Ministry of Health programs and how that in fact would kick in in terms of a tenant being able to access the services of an advocate in an L and T proceeding other than, say, a local legal clinic. Is it a relevant issue?
Ms Czukar: I'm not sure how they would participate in a Landlord and Tenant Act proceeding. I would think that would be something that would be met by a local legal clinic. But I can say that I'm familiar with the Advocacy Act, and it applies to vulnerable persons. The people that we're discussing here with respect to the programs funded by the Ministry of Health, both in community mental health and in long-term care, would fall within that Advocacy Act definition of vulnerable persons and those people would have access to advocates when the Advocacy Act is proclaimed and the advocates they have access to would have the powers under the Advocacy Act and that sort of thing. So if there were an issue that advocates were assisting with with respect to someone's housing, then the advocate would have the powers under the act to assist them in that way. I'm not sure if that answers your question entirely.
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Mr Owens: In terms of some of the deputants we've seen, particularly a deputant who came before the committee in Windsor who was non-verbal, my question was directed at how you would go about ensuring that that person was able to get hold of her rights she is now being granted under the Landlord and Tenant Act and how would you in fact do that with respect to an advocate. Maybe I'm complicating a very simple situation.
Ms Czukar: I'm not sure if you're saying it's a simple situation or a complicated situation, but in any event of course courts have certain kinds of interpretation facilities and that sort of thing available and there are special resources in the community to assist people who can't speak or that sort of thing to exercise their rights in courts. But as to whether advocates could assist them or not, that's certainly within the purview of the Advocacy Act. I guess the question then is to what extent there will be enough advocates to go around, but that's not a question of the act itself.
The Chair: The minister would like a supplementary.
Mrs Marland: I haven't had a turn. The minister's on her second.
Hon Ms Gigantes: Very quickly. Ms Czukar, you attended at the inquest of Joseph Kendall for the Ministry of Health?
Ms Czukar: I did.
Hon Ms Gigantes: If you look at the proposed changes in our social operations, if you want to say, or the measures that are coming forward under the consent to treatment, substitute decision-making, the Advocacy Act and changes contained within this bill as they affect unregulated care homes, do you see them adding up to an improvement in the situation Joseph Kendall lived in?
Ms Czukar: Joseph Kendall lived in an unregulated private boarding home and had no access to an advocate because there was no advocate. There was no one who could act on his behalf or attempt to tell him that he had rights. In fact he had some rights, limited though they were, but no one had access to the facility. The Advocacy Act will ensure that people will have access to a facility like that and possibly prevent a death like that and the injuries to the other tenants of that boarding home who were assaulted by the owners and that sort of thing. Yes, it's an improvement.
Mrs Marland: Am I correct then that your final answer was laying the credit with the Advocacy Act?
Ms Czukar: It's a combination. The fact is that advocates can't exercise rights that people don't have. If people in a housing situation in an unregulated facility have no rights to exercise, then an advocate can't assist them. But in this case it would be a combination of their rights under the Landlord and Tenant Act and the Advocacy Act that would result in an improvement in the situation of someone like Joseph Kendall.
Mrs Marland: Would you agree that under this act, Bill 120, it would result in the improvement of his tenancy but not necessarily his care?
Ms Czukar: It would result in his being able to have had someone go into the home, get past the landlord at the door and assist him to exercise his rights to housing and, beyond that, to his rights to care or access to the care system.
Mrs Marland: Where does this bill improve his care?
Ms Czukar: It's not a bill with respect to his care. It improves his rights to housing so that the landlord couldn't block access to people coming into the home to find out what was actually going on in the home.
Mrs Marland: Right, but it doesn't do anything about his care, does it?
Ms Czukar: It does something about his care if people are able to get access to him and determine what sort of care he could take advantage of.
Mrs Marland: If people can get access, what tool are those people going to be able to use to improve his care?
Ms Czukar: They would use advocacy tools. That's their mandate under the Advocacy Act and they would use advocacy tools.
Mrs Marland: But where is there a statute that defines his rights for the care that he, or whoever his funder is, is paying for?
Ms Czukar: The Criminal Code states that he has the right not to be assaulted.
Mrs Marland: Oh, absolutely, but I'm not talking --
Ms Czukar: It wasn't a lack of care that killed him.
Mrs Marland: No, I understand that. That's a rather interesting response. I don't think there's anybody in this room who doesn't know what was the cause of death, and we're talking about an absolutely, totally abhorrent situation not only for him but for other residents of that home.
The minister asked, I thought, a very interesting question because her bill doesn't do anything about the care of that individual in terms of the standard of care and the other treatments that that individual, or those individuals, in any of these facilities might need.
I want to get back to Ms Hill and Mr Ennis. How many assistant deputy ministers does the Ministry of Health have currently, or acting? Are we talking about four or five?
Mr Drummond White (Durham Centre): Mr Chairman, is this related to this bill?
The Chair: It is kind of wandering.
Mr Owens: What else is new?
Mrs Marland: Do you know? Are there about four?
Mr Ennis: Yes.
Mrs Marland: Okay. I would like to know, then, if there are only four or five of you and you're here speaking on this bill, how it is that you can't tell us what is going on in other provinces. You used the example, in answer to Mr Johnson's question, that X, Y, Z works in other jurisdictions, and you were talking about particular types of training for particular types of professionals. It evolved out of the discussion about what kind of training police have. What I would like to know is, if you're going to use the example of other provinces -- you said other jurisdictions, so I presume you meant provinces. Is that correct?
Ms Hill: I was speaking about the crisis response system which does exist in other provinces as well as other jurisdictions, meaning the United States.
Mrs Marland: Are you familiar with what the crisis response system is in other provinces that have a landlord and tenant act with rent controls?
Ms Hill: No.
Hon Ms Gigantes: Does it have to be with rent controls?
Mrs Marland: Well, either with or without. Do you know? You made that statement. I'm just trying to give you an opportunity to clarify why the tie-in with other jurisdictions.
Ms Hill: The tie-in was that we recognize the need for crisis response services as a mechanism to support case management and people living in independent housing. That's what the tie-in was to other jurisdictions.
Mrs Marland: Okay. We recognize that too. How do you feel Bill 120 is going to help?
Ms Hill: What I said at the beginning of my remarks is that we believe people living with a severe mental illness have the same rights to security of tenure as anyone else in the community, and therefore this bill offers them that protection.
Mrs Marland: All right. I just want to read you a paragraph from the Ecuhome presentation, because I think this is where your responsibility, both your and Mr Ennis's responsibility as ADMs with Health, should be concerned. In their case they're saying, and I'm quoting from page 17 for the sake of Hansard:
"We are not in the business of only providing housing nor are we in the business of only being landlords. As our resources to perform the work we do is limited and the need for our work far exceeds our ability to provide help, it would be completely inappropriate for an individual to occupy the units we offer if he or she has no desire to comply with the program we administer."
Does this program receive some funding from you?
Ms Hill: No.
Mrs Marland: It's Comsoc?
Ms Hill: Yes.
The Chair: You could maybe ask the question shortly, Mrs Marland.
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Mrs Marland: I will. In this particular program, there would be people who require treatment because of various addictions. Are you not concerned about the fact that this program may be terminated because they can't operate the program with this legislation in place? Coming back to how something is going to work because there are going to be support systems in the community, do you feel today that everybody in crisis has access to community programs? In this case we're talking about residential ones, obviously, because we're talking about a residential tenancy act.
Ms Hill: Currently, as I said earlier, we have programs operating under LTA, and the crisis services they would use would not change. I'm not quite sure why we're assuming that there's going to be a huge increase in crises for these programs. My problem is with the assumption that there's going to be a huge increase in crises. Currently we have group homes operating under LTA that offer their programs, and if a person is not functioning, they call upon the system for supports.
Mrs Marland: Do you think today that the government has enough resources to deal with people in crisis?
Ms Hill: I would say that what we're trying to do is reconfigure our resources so that there are more effective responses, which is the whole intent of the mental health reform initiative. Right now there are too many crises that have to be dealt with by having to arrive at the emergency department of a hospital quite well into a crisis. What we see as being much more effective and what we have as evidence from the literature is that if a crisis response is delivered in the early stages of someone having trouble, you're more able to contain the crisis, to improve the situation and to prevent hospital readmission.
Mrs Marland: I understand that, but my question is very specific: Do you feel that today the waiting lists for treatment for people in crisis is a concern? Are you happy with that situation today without adding to any further load on that system? A lot of your answers have been based on the fact that these resources, these programs -- your word -- these supports, are there in the community, and I'm asking you, if that's the case, then are you saying there's no problem with resources today to deal with people with mental illness in terms of access to treatment?
Ms Hill: Currently, if a person is in true crisis they appear at emergency units and are responded to. There's not a waiting list if they appeared in an emergency unit. Do I think that's the best response? No, I don't think that's the best response. Do I think we have enough resources in the right place? No, I don't think we have enough resources in the right place and that's why we have a mental health reform initiative.
If all the resources were in the right place, we wouldn't have to make the changes we need to make in the system.
Mrs Marland: Are you concerned about an organization like Ecuhome that is telling you their program will be killed if this legislation goes through as it's presently drafted?
Ms Hill: I can't speak to Ecuhome's program or whether it will be affected in that way.
Mrs Marland: Are you familiar with their program?
Ms Hill: No, I'm not.
Mrs Marland: And what's your position?
Ms Hill: It's under another ministry.
The Chair: Mrs Marland, you may ask Community and Social Services --
Mrs Marland: No, excuse me. I thought your responsibility was to do with mental health in the province.
Ms Hill: It has to do with mental health programs and services in the programs we fund, yes. Unfortunately, I'm not familiar with all the programs MCSS funds at this time.
Mrs Marland: But if these clients required --
The Chair: You can ask those questions to Comsoc.
Mrs Marland: No, I'm asking them to the Ministry of Health under the Mental Health Act.
The Chair: But we know that program is funded not by the Ministry of Health.
Mrs Marland: But people who require mental health treatment come under your ministry?
Ms Hill: That's right.
Mrs Marland: So my question still stands, Mr Chair. Are you concerned about people who are affected by this legislation, who may need more access to treatment?
Ms Hill: I don't think this bill speaks to treatment.
Mrs Marland: No, it doesn't.
Ms Hill: It speaks to the provision of protection of tenancy, which is consistent with our policy directions.
Mrs Marland: I have one last question for now. These people who will now be under the Landlord and Tenant Act, can they refuse to allow a crisis response team in? You said one of the advantages is that all these people can now get in. I'm asking you.
Ms Hill: If a person chose to lock themselves in the room and not allow the support of a case manager or a crisis response team or anyone near them, then it would be for the landlord to decide whether in fact this person required police attention or attention under the Mental Health Act. If a person was decompensating and was in real crisis but chose to reject all the supports that the health care system could offer them, then the next step would be to follow the directions under the Mental Health Act or the Landlord and Tenant Act.
Mr Mammoliti: When a stakeholder who's trying to address a concern of a client in a rehabilitation centre; again, more specifically, somebody who's addicted to a substance or another feels that the threat of eviction might be good rehabilitation for that client, would you agree that it's good rehabilitation for that client?
Ms Hill: I don't think I'm in a position to comment on whether that's good therapy.
Mr Mammoliti: You fund some of these agencies, do you not?
Ms Hill: That do what?
Mr Mammoliti: Rehabilitation for drug addicts.
Ms Hill: We fund programs that offer rehabilitation services, but I'm not sure whether any of them would purport to say that threatening eviction is good therapy.
Mr Mammoliti: Let's take Stonehenge. They pride themselves on that. Were you aware of that?
Ms Hill: No, I wasn't.
Mr Mammoliti: Caritas, the heroin rehabilitation centre, pride themselves on that and they have a pretty good track record. Were you aware of that?
Ms Hill: I wasn't aware that it was used as a method of enforcing treatment.
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Mr Mammoliti: Yet earlier you had stated your comments in reference to that type of rehabilitation to the minister when she asked you that question.
Ms Hill: I was referring to severely mentally ill people, and I wasn't talking about treatment programs; I was talking about housing programs. What I said was that I couldn't see suggesting to someone that eviction as a method of keeping someone in line for rehabilitation purposes was good for their mental health.
Mr Mammoliti: I don't have Hansard in front of me, but I had understood from the question that it was actually pretty specific in terms of drug rehabilitation.
Hon Ms Gigantes: Ms Hill may not have heard that.
Mrs Marland: You asked it twice.
Mr Mammoliti: Would you mind giving me your interpretation of section 1 of the bill at this point?
Mr Grandmaître: Do you want to deal with your amendment, George, or what?
The Chair: Order.
Mr Mammoliti: What does section 1 mean to you?
Ms Hill: It's the definition of "care services."
Mr Mammoliti: That would be subsection 1(1)?
Ms Hill: Right.
Mr Mammoliti: Let's go down then to subsection (2).
Ms Hill: It's the definition of "residential premises."
Mr Mammoliti: In layman's terms, what does this mean to you?
Ms Hill: What it means to me is that it's any premises where a person will receive care services whether or not receiving the services is the primary purpose.
Mr Mammoliti: That would include all the different types of care services we've been talking about?
Ms Hill: We'd go back to the health care services, the rehabilitative and therapeutic services or services that provide assistance with the activities of daily living.
Mr Mammoliti: Subsection (3), what does that mean to you?
Ms Hill: That essentially these are the premises that are excluded from "residential premises," the section above.
Mr Mammoliti: That means the list that's provided here would be excluded from "residential premises"?
Ms Hill: Yes, as described in the clause above.
Mr Mammoliti: That would include of course for correctional purposes.
Ms Hill: Yes.
Mr Mammoliti: Clause (i.1), what does this mean to you? Try to put it in the context of my concern with the six-month provision, if you might.
Ms Hill: I rely on our legal counsel for interpretation about the statute. I'm not sure what the question is.
Mr Mammoliti: To be again more specific and to address another question that the minister asked you, would it be your opinion that somebody could stay in a particular rehabilitation centre for more than six months without being under the scope of the Landlord and Tenant Act, or would the Landlord and Tenant Act come into play after this bill is passed? This is important.
Ms Czukar: Can I answer that? I think it is important to understand, because I think there are some misconceptions that have been promoted by some of the groups that have appeared before the committee that this is going to change the programs. What this definitions section does is say that where accommodation meets the definition here, including these conditions in clause (i.1), the accommodation is exempt from the whole residential premises provisions of the Landlord and Tenant Act. What clause (i.1) says is that the accommodation is occupied by the person for the purpose of receiving rehabilitative or therapeutic services that are agreed upon by the person and the provider. So it's not something that can be imposed on them; they've agreed to receive those services. The parties have agreed that it will be for a specific duration -- and it doesn't name the duration; it can be six months, it can be a year, it can be two years -- or that it will end when the person has reached their goals in the program or there is some kind of agreement that the person is never going to reach their goals.
Mr Mammoliti: Here's my concern: A heroin addict who doesn't know where he's been for the last year and hasn't known who his family is for the last year decides by himself or herself to get treatment in one of these facilities. They of course go into a particular program -- it might be detox program, it might be something else -- which would then determine and evaluate the type of care that they need. Where does this agreement come into play in this legislation with somebody who doesn't know what they're doing?
Ms Czukar: With respect to competency to make an agreement, programs of this nature are aimed at helping people become competent and become able to understand those things. So the agreement is going to be reached when the person is able to do this.
Mr Mammoliti: When there's a dispute later on, when that person is off of the heroin and is off of a substance of some sort and is back to thinking normally and decides that he likes his accommodation and wants to stay past the six months, who's going to resolve that?
Ms Czukar: First of all, I didn't get a chance to finish. The fact that it says in (iii) "the average length of the occupancy of the occupants...does not exceed six months" doesn't mean that people can't stay longer than six months, because we're talking about an average length of stay. We don't know exactly how that's going to be calculated by the courts, but it means that people can stay longer than six months.
If a program decides that it's going to enforce this in some way, that it really can't tolerate this, then it could attempt to control its being subject to the legislation by having some kind of policy of forcing people out after five and a half months, I suppose, to ensure that it's always within this.
But I'll address your question, which is if you've got a person who goes into the program, it takes that person a while to get with it and at that point the program approaches them and says: "Okay, what you're in here is a rehab and therapeutic program. It's a five-month program, and we want you to sign an agreement to that effect." I just want to clarify this. Is your concern that if the person doesn't sign the agreement, they have acquired rights under the Landlord and Tenant Act and that the program never had a chance to discuss that with them? That's what I hear you saying.
Mr Mammoliti: What I'm saying is that it could be interpreted that way, and that's a concern. It could be interpreted that way, and then when the dispute is there, who's going to resolve it?
Ms Czukar: The court is going to resolve it, because if the person doesn't leave and the program wants them to leave, its recourse is to go to the court and apply for a writ of eviction.
Mr Mammoliti: All right, and the courts take it on, and the ministry funding of the stay for that individual is going to go towards the courts as opposed to rehabilitation. That's a concern of mine. I think I've made my point clear in terms of the six months, for me, not being adequate and that I think it needs to be addressed.
The Chair: I have Mr Cordiano, Mr Owens and another ministry waiting.
Mr Cordiano: I want to move to a concern regarding rest homes and their ability to continue to provide convalescent care emanating out of hospitals, contracts that are now made with hospitals for someone who's been, for example, treated for cancer in a hospital. Many homes now provide convalescent care on a short-term basis. There is a concern here that the provisions of the act would negate that possibility from occurring in a rest home because the nature of the rest home is that the tenants are there for a long-term duration and obviously exceed the six-month period. By and large, the majority of tenants are going to be there for years. So what do you foresee happening to this type of care? Are you concerned about it?
Mr Ennis: First of all, in terms of getting further definition or response around that question, I think that it would be appropriate to ask the Ministry of Housing, but I would respond initially by indicating that where a hospital -- I don't have the legislation right in front of me, but I know there are a number of provisions in the legislation where, for example, hospital programs are not included. So if it's considered a hospital program or something under long-term care facility, the Landlord and Tenant Act wouldn't apply.
Mr Cordiano: I've gone through the legislation and I don't believe there's enough clarity in the exemptions that do exist. In fact, I'm quite sure there isn't.
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Mr Ennis: But there are references in the proposed legislation around the Public Hospitals Act and the private hospitals and community psychiatric hospitals.
Hon Ms Gigantes: The Homes for the Aged and Rest Homes Act.
Mr Ennis: The Homes for the Aged and Rest Homes Act itself.
Mr Cordiano: Where's the clarity? Where's the clarity that ensures that this will continue to be the case?
Mr Ennis: I think the other way of responding would be that there's nothing in the legislation that prevents hospitals or care homes from providing short-term respite care, especially if those residences are already set aside for that very specific purpose. Then they would need to either make application or already be exempted from the Landlord and Tenant Act. But those are provisions that if they're already in existence for providing short-term care, I don't see how they would come under the Landlord and Tenant Act.
Mr Cordiano: I guess it's a legal question, really, that we're talking about, but I want from your point of view if there's enough clarity in the section that deals with this to ensure that this will continue to be the case after Bill 120 passes, and obviously you think there is.
Ms Czukar: I was just saying I'm not clear on what the situation is you're describing because you started out talking about a rest home and you spoke about contracts with hospitals and I'm not sure what it is. Rest homes are not regulated by Ministry of Health legislation. That's the very point that this legislation was meant to address.
Mr Cordiano: No, but hospitals contract with rest homes, so that's how you're involved in this equation.
Ms Czukar: In what way?
Mr Cordiano: Hospitals have a definite need for placing recovering cancer patients in rest homes and they have done this till now; would you not agree? Am I saying something that is totally foreign to the Ministry of Health? What are we talking about here?
Ms Czukar: Do you know anything about that?
Mr Ennis: No, nothing.
Ms Czukar: I don't know about that sort of situation.
Mr Cordiano: You're suggesting that doesn't occur now?
Ms Czukar: Acute care patients discharged from hospitals?
Mrs Marland: He didn't say acute care.
Mr Cordiano: No, convalescents, people recovering after they've had acute care. I can't believe you're not aware of this.
Ms Czukar: There's no contract. What happens is that hospitals discharge people who require some follow-up care and that might be in various kinds of facilities, and the kinds of facilities that are regulated by Ministry of Health legislation are covered here in terms of nursing homes, homes for the aged and charitable institutions, charitable homes.
Mr Cordiano: No. The actual contracts that are in place I'm not that familiar with, but what we've heard on this committee from several deputants was that rest homes provide this service and they deal with hospitals around that question. Whether the actual individual signs a contract with the rest home, which I'm sure they probably do, but they have agreements with hospitals --
Mrs Marland: One of the discharge facilities.
Mr Cordiano: That's right, as one of the discharge facilities. You are suggesting that's not the case.
Ms Czukar: What's the question about that contract?
Mr Cordiano: How does Bill 120 affect the ability of those homes to continue to provide that service?
Ms Czukar: If it's a private rest home and the person goes to that private rest home and there's a contract between the person and the rest home with respect to the care they're going to receive or whatever, that's independent of their living situation, and the way Bill 120 would affect that is that if the person ends up being there for longer than six months, that becomes their home and Bill 120 would apply. They would acquire rights under the Landlord and Tenant Act if the average length of stay in that home was longer than six months.
Mr Cordiano: The average includes all the residents of that home.
Ms Czukar: That's right.
Mr Cordiano: That's the point I'm trying to make. Therefore, if four beds out of 200 are set aside for that type of purpose, that home is deemed to not qualify for the exemption, and therefore it's a long-term facility as far as this act is concerned and Bill 120 applies to it.
Ms Czukar: That's right.
Mr Cordiano: So how does it get an exemption for those kinds of provisions, for that kind of care to continue to be provided?
Ms Czukar: It's not contemplated by the act.
Mr Cordiano: Right. It ignores it.
Hon Ms Gigantes: Why would it be desirable?
Ms Czukar: But it's not a health care facility.
Mrs Marland: So there'd be places for people to turn to.
Mr Cordiano: Why would Bill 120 be desirable the way it's written? It's not to me, but that's another question for another day. That's a political decision.
The Vice-Chair: Since we do have many more questions, perhaps we can move on to Mr Owens and I do think we still want to hear from the Minister of Community and Social Services as well.
Mr Owens: I'd like to move a motion.
Mr Cordiano: On a point of order, Mr Chair: We do not have consensus around that matter. Of course if the member wishes to put a motion in place to cut off debate, as far as I'm concerned, there are still questions that need to be answered.
The Vice-Chair: Consensus on what?
Mr Cordiano: About moving forward to the Minister of Community and Social Services.
The Vice-Chair: We haven't moved there yet.
Mr Cordiano: I'm contemplating that there will be one.
The Vice-Chair: Mr Owens has the floor.
Mr Owens: I'd like to move a motion that the Ministry of Health be thanked for its four hours and 10 minutes on the witness stand and that the Ministry of Community and Social Services take the --
Mrs Marland: How long?
Mr Owens: Three hours and 10 minutes.
Mrs Marland: Four hours and 10 minutes?
Mr Owens: With you, it's a lifetime, Margaret.
The Vice-Chair: Would you please write that out?
Mr Owens: I'm just basically asking that the committee thank the Ministry of Health for the hard work that it has done this afternoon and that the Ministry of Community and Social Services now take their place at the witness table.
Mrs Marland: It would be better to continue.
The Vice-Chair: Would you write that out, please, Mr Owens. Is there some debate?
Mrs Marland: Let's just continue.
Mr Owens: May I finish my point?
Mrs Marland: Do you want us to take 20 minutes to get the members to come and vote or can we just continue with the questions?
Mr Owens: Can I finish my motion?
Mrs Marland: You've had questions since you said we should've finished before, and I thought that was great. You still had your own questions to ask.
Mr Owens: I'm not sure why that member's microphone is still on while I have the floor.
The Vice-Chair: Could we have some order, please.
Mr Owens, you're making a motion. Will you please write out the motion. I think the motion is clear. Is there debate? Mrs Marland, you were commenting on this.
Mrs Marland: I'm not surprised that we would have a motion like this, when you try to ask questions and it's clear that not all the answers were available to all the questions this afternoon. Whether or not the ministry staff have sat here for three hours is not relevant. The ministry staff are being paid to do a job, and I don't think they need the government members to defend them in terms of how long they're here answering questions of this committee.
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I thought Bill 120 was supposed to be a fairly significant piece of legislation of this government, and if the government members don't want us, as members of the opposition, to be able to ask questions of the ministry -- it's unfortunate, as I said earlier, that it's the ministry staff and not the minister -- then that's going to be the option of the government members, who have control of this committee by their very number. If that's the process we're into, it's just going to be the same as every other standing committee of the Legislature when we try to get answers on behalf of deputations who came before this committee, who have all told us there was insufficient consultation on this bill. The whole process is ludicrous, because obviously in the end the government's going to do whatever it wants with this bill and whatever it wants with our amendments. It's total frustration.
The very fact that there have been interministerial committees dealing with this overall subject indicate that it's a very important subject, a very important problem for the people of this province. We're just not convinced, the way this bill is drafted, that it's going to address the problems and be the remedial direction that is needed. That's all we're saying. We'd like to know a little bit more, and we're asking questions for that reason.
It's unfortunate that after three weeks of deputations that raised questions to us, now in turn the government is saying: "Enough of that. We're going to place this motion. Close it off. Move on to the next ministry. That's enough of those questions." Interestingly, that's being moved by a member who said that about 45 minutes ago and then still had his own question to this ministry. He obviously still had questions. Perhaps the rest of us might.
Well, I guess we've got the solid five here now to vote against it.
Mr Gary Wilson: In the original motion, it was foreseen that the questions of these two ministries would take the afternoon. Anyone who went along with this arrangement should expect that the time would be divided evenly between the two ministries. In any case, I think it is time to move on to the Ministry of Community and Social Services. If they have more questions, they will have that ministry to ask them, but I think it's important that we fulfil the intent of the motion that set up this afternoon.
Mrs Marland: I hope you've sent for your other members. It's going to be a tie if you haven't.
The Chair: This is a very interesting motion, I would say, in that the Chair had exhausted his list of people who wanted to ask the ministry questions.
Mr Owens: Then let's move on. This is silly.
Mr Cordiano: We have to deal with the motion. It's been put on the floor, so we have to deal with it.
Mr David Johnson: It's a silly motion.
Mr Cordiano: It's a silly motion, I agree, but we have to deal with it. Why don't we just deal with it?
Mr White: I'm curious, Mr Chair. If there are no other people who wish to speak, could we not just move on to the next ministry and be done with it? I'm sure Mr Owens would be willing to --
The Chair: I find that rather curious, but we do have a motion on the floor.
Mr White: I also would like to make note of the fact that while my personal difficulties that compelled me to remove myself from caucus a month ago were satisfactorily resolved this morning, I'm not a member of the government caucus, so Ms Marland's reference to there being numbers is not accurate.
Mrs Marland: On a point of order: Mr White, are you saying you're not a member of this committee?
Mr White: I'm a member of this committee.
The Chair: The point of order would be to the Chair.
Mrs Marland: Sorry, Mr Chair. I understood that Mr White was a member of this committee.
The Chair: Mr White is a member of this committee.
Mr Grandmaître: And a voting member.
The Chair: All members of the committee are voting members.
Mr Owens has moved that the Ministry of Community and Social Services come to the committee on general government now and that they appear until 5 o'clock today, March 4, and that the clause-by-clause commence Tuesday, March 8, at 10 am.
Mr Gary Wilson: Could I move for a five-minute recess on this, please?
Mrs Marland: Oh, yes, run and get your little package.
The Chair: A 20-minute recess is what the standing orders require, Mr Wilson.
Mr David Johnson: Do they have the right to withdraw that motion if they choose?
Interjection: Of course we have.
Mr David Johnson: Are there any other people on the list?
The Chair: There are no other people on the list.
Mr David Johnson: Then another course of action would be to withdraw it. Let's get going here. Why do we want to waste five minutes?
Mr Owens: Do I hear unanimous consent?
Mr David Johnson: There's no consent. It's up to you; it's your motion.
Mr Owens: No. I'm suggesting that if we're going to continue playing games here for the rest of the --
Mr David Johnson: Suggest whatever you want to suggest. It's your choice.
Hon Ms Gigantes: Is there agreement to move on?
The Chair: Order. There is a motion by Mr Owens.
Mr David Johnson: It's up to him whether he withdraws the motion.
Mr Owens: I haven't had my opportunity to speak to the motion. I'll ask a question through the Chair: Is the member for Don Mills saying in good faith that if the motion is withdrawn he and the rest of his colleagues on that side of the House are not going to move directly back on to the speakers list and we start this whole process again? Or do we just conduct the vote, subject to a recess?
Mr Grandmaître: Trust us.
Mr Owens: You were trusted for six years with 95 members, and look what happened.
Mr David Johnson: What a waste of time. Mr Chairman, how can I speak for all the people on this side? My name is not on the list, and I'm not going to put my name on the list, for the Ministry of Health. I want to put my name on the list -- and I'll do that right now, Mr Chairman -- to be first for Comsoc. But what the other people over here do is up to them.
The Chair: I will put Mr Owens's motion if he doesn't withdraw.
Mr Owens: I'll withdraw the motion.
The Chair: Thank you. I'd like to thank the Ministry of Health for appearing before the committee this afternoon. Your presence has been appreciated, probably more so by the Ministry of Community and Social Services than anyone else.
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MINISTRY OF COMMUNITY AND SOCIAL SERVICES
The Chair: Now we have a presentation from the Ministry of Community and Social Services. Good afternoon.
Mr Owens: Before we start these proceedings, just so we don't end up with a week of Comsoc being examined, I suggest we finish with Comsoc at 5 o'clock today and move into clause-by-clause tomorrow morning.
The Chair: Mr Owens, if I can be helpful, the motion Mr Daigeler presented and which the committee is operating under calls for the two ministries to speak to the committee this afternoon; it makes no provision for them to speak at any other time. That is my interpretation of Mr Daigeler's motion.
Mr Owens: I want to ensure that that is in fact the case so there is no lack of clarity.
The Chair: Welcome. I understand you have a statement for the committee, and then the members may have some questions.
Mrs Marland: How long is the statement, please?
Ms Lucille Roch: You have a copy of it. It's about four pages. Sorry. Your two-page copy is the same version; it's just that mine is spaced out over four pages.
My name is Lucille Roch. I'm with the Ministry of Community and Social Services. With me are Ted Moses, a policy analyst with the community services branch of the ministry, and Mary Pat Koskie, from our legal services branch.
The Ministry of Community and Social Services has been an active participant in the interministerial efforts that resulted in Bill 120, and we'd like to start off by saying that we're supportive of the legislation and of its intent.
Our focus will obviously be on our programs. We don't intend to comment on other elements of the bill, granny flats, for example. Many of our programs will be affected by Bill 120. Some of those include: group homes for people with developmental disabilities; dom hostels for elderly people and consumers of mental health services; alcohol and drug recovery programs; second-stage housing for violence against women programs; and residential programs for young people in employment training programs.
We have worked closely with staff from the other ministries involved to review the recommendations of the Lightman report and to develop recommendations to cabinet that ultimately resulted in this act. We're pleased to have played a part in the extension of rights and protections to a broad range of heretofore unprotected tenants.
Ministry clients receiving these additional protections include persons with developmental disabilities who live in group homes on a permanent basis, and residents of dom hostels whose long-term accommodation in rest homes and boarding houses is subsidized by the ministry.
While substantial changes in the relationship between service providers and residents will result from these changes, we think they would be positive for the residents. Especially important is the fact that they will have security of tenure; that they will not be at risk of losing their accommodation because they have service needs or because their service needs change. We expect that operators will go through a period of transition as they and their residents adjust --
Mrs Marland: Our copy isn't the same as you're reading.
The Chair: You may continue.
Ms Roch: We expect that operators will go through a period of transition as they and their residents adjust to the new rules. The ministry is prepared to offer support during this period. We will be working with operators and clients and with other ministries to ensure that information is shared promptly, and we will be providing support to ensure that the process results in the least disruption possible.
The changes to the Landlord and Tenant Act will facilitate the ministry's movement towards separation of service and accommodation, a trend that has been evident for more than seven years. With the separation of services and accommodation, clients can remain in their homes when service needs change. They are not required to move to get a slightly higher or lower level of service, or if they come to need no service at all. This approach has been adopted successfully for a wide range of client types, including people with developmental disabilities, people with physical disabilities and elderly people.
While changes brought by Bill 120 will further the ministry's approach in the area of permanent housing, Bill 120 will also have an impact on another of our groups of clients, those in transitional accommodation. That refers specifically to those programs under the alcohol and drug recovery programs, second-stage housing for violence against women and residential programs for young people in employment training.
The changes with particular impact would be the principal residence clause and the six-month average clause in the rehabilitation and therapy exemption. The principal residence clause could be too restrictive for people who would in most cases have no means to maintain another residence because they were on social assistance. It's our understanding that the principal residence test is being removed, and we support this.
The ministry is aware that some service providers have expressed concern that the six-month average in the rehabilitation and therapy exemption does not allow enough flexibility to effectively run their programs. Some operators have indicated that the point of their program is rehabilitation and not housing.
It's our understanding that an additional ground for eviction has been proposed by the Ministry of Housing to allow eviction when the contracted period of rehabilitation or therapy has expired and that this contracted period has been extended to two years. We believe that this provision goes a long way to addressing operator concerns. This provision is in addition to those already in the act, such as the ability of the operator to serve notice of eviction for interfering with the reasonable enjoyment of the premises by other tenants.
Thank you for the opportunity to make a statement.
Mrs Marland: On a point of order: Could we have a copy of your copy? For example, on the first page you -- well, it's not your first page because yours is printed differently, but there are a number of changes from what we have and what you read, and some of them are important. You said the principal residence clause --
The Chair: Mrs Marland, if the point of order is that you would like a copy of the presentation of the ministry as it read it, the clerk can look after that for you.
Mrs Marland: Yes, I would like that. But can I ask which part of this sentence the ministry wants us to accept? In one case it says "in the majority" --
The Chair: You will have the opportunity to ask specific questions during the time allocated.
Mr David Johnson: A lot of the same questions pertain here. You've been sitting through the previous round of questions, so you know what they are.
You say on the last page that there has been some change in the eviction process and that you believe "this provision goes a long way to addressing operator concerns." That's certainly not the message we're hearing, and I guess you appreciate that. The operators are giving us a different impression.
Would you specifically indicate to us what aspect of the eviction process will assist the operators who are concerned? They feel that many of them will not be exempt under the six-month provisions. There's any number of examples. Ecuhome would be one and the Massey Centre would be a second that, from the way I look at it, wouldn't be exempt. Many of these operators will not be exempt and the Landlord and Tenant Act will apply, and if they have difficulty -- and you've heard a number of the difficulties here over the last three hours. How is it that you think there is a provision in here that will assist the operators in dealing with this problem?
Ms Roch: One of the issues that some of the operators have been raising is the fact that some of their programs, on average, will take longer than six months. Some operators have indicated that their programs, on average, are of an 18-month duration. We feel that the proposed amendment to extend this to two years would be of some comfort to these operators.
Mr David Johnson: Extend what to two years?
Ms Roch: It's our understanding that the Minister of Housing has proposed that those operators who provide programs that are of longer duration than six months would be covered by the Landlord and Tenant Act, but could have grounds for eviction based on the fact that the individual has terminated the program and that the program is of two years' duration maximum.
Mr David Johnson: Is that amendment in the original list or is that a new one that's come in?
Hon Ms Gigantes: No, this was tabled --
Mr Grandmaître: It's part of the package.
Hon Ms Gigantes: I believe it was received by your offices earlier today. It amends subsection 2(1).
Mr David Johnson: Okay, we'll have a look at that.
The Chair: Mr Mammoliti, a point of privilege?
Mr Mammoliti: Is there such a thing, Mr Chair?
The Chair: There is, depending on what you say.
Mr Mammoliti: All I want is a copy of these amendments which are being --
Mrs Marland: They're yours.
Mr Mammoliti: I didn't get a copy of these amendments, Mr Chair.
Mr Grandmaître: Where's your whip? I'll be your whip, George.
The Chair: All the amendments have been distributed to all the members. It's a yellow package, I'm told.
Mr Mammoliti: This particular amendment I haven't got, Mr Chair.
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Mr David Johnson: Could we be informed, Mr Chairman, under what conditions, if an operator such as Ecuhome -- I understand Ecuhome, for example, would be eligible to come to -- well, to whom, to the Ministry of Housing? What would be the procedure, as you understand it, for the groups under your funding to get an exemption?
Mr Ted Moses: My understanding is that Ecuhome is long-term accommodation, and we're talking about accommodation in which no one would live longer than two years.
Mr David Johnson: So I assume what's being said here is that if the average period of time is, let's say, 22 months, which is under two years, that particular facility would be eligible to be exempt from the Landlord and Tenant Act. Is that what you're saying?
Mr Moses: No. The facility would have the opportunity to use a new grounds for eviction.
Mr David Johnson: A fast track?
Mr Moses: Not necessarily a fast track, but they could contract with the individual at the time they come into the program for a specific duration, and once that duration had passed they could serve notice of eviction.
Mr David Johnson: So that agreement would supersede the Landlord and Tenant Act, is that what you're saying?
Mr Moses: No, this would be under the Landlord and Tenant Act.
Hon Ms Gigantes: It would be a new provision within the Landlord and Tenant Act.
Interjections.
The Chair: It's helpful if we have one member speaking at a time and one response at a time. Right now the ministry is responding.
Mr David Johnson: Have you finished responding? They have finished responding.
I still don't quite understand that. There would be a new clause in the Landlord and Tenant Act that such a facility, if there were a contract with a certain individual and the contract were for under two years, could then "evict" that individual at that point in time?
Ms Roch: If that individual refused to move out.
Mr David Johnson: Would that same clause apply to the Massey Centre?
Ms Roch: The Massey Centre, correct me if I'm wrong, is a centre that offers programs for young women who -- I think it's some kind of maternity home.
Mr David Johnson: That's right.
Ms Roch: It's my understanding that this would apply to them.
Mr David Johnson: So it would apply. The Massey Centre does receive funding, as I understand it, from your ministry, and one of the problems it's raised -- which hasn't been raised here today; it's a different kind of issue -- is with regard to security and safety.
"The majority of the women at the centre come from violent and abusive backgrounds," quoting from the brief, "and often are still subject to negative influences from their past. Their stay at the centre gives them a chance to make a break from the destructive relationships in which many of them are involved. The regulations" -- these are the current regulations in place today, and I understand this would be forbidden under the Landlord and Tenant Act -- "prohibit overnight male visitors, allow for the removal of threatening individuals from the units, and permit the discharge of residents who engage in drug activities" and many other things. Then they go on to talk about the young infants and that a safe environment is essential for the high-risk children.
They are concerned that under the Landlord and Tenant Act they will not be able to -- I don't know if the word is "evict" -- remove the males who are associated with the females onsite; that whereas today they have the power to do that, once Bill 120 comes into place they will lose that power, and this is of grave concern in the success of their program. I wonder what your response to that is.
Ms Roch: It was my understanding that one of the terms of eviction, if I can put it that way, possible under the Landlord and Tenant Act is the safety of other people occupying the premises.
Mr David Johnson: We're not talking about eviction here, though; we're talking about a mother who's living on the site and a male visitor comes who is abusive, violent. Today they have the authority to remove those male visitors, but once the Landlord and Tenant Act kicks in, they do not have that authority.
Hon Ms Gigantes: Of course they do. That's nuts.
Mr David Johnson: They don't think they do. The minister thinks they do. They operate the place, and they don't think so. I know whose opinion I would follow.
Ms Roch: I thought assaulting someone or threatening to assault someone was a criminal issue. If these males are going into these homes and being threatening or abusive to these young girls, I don't think the centre has much option but to call in the police, even with voluntary visitors.
Mr David Johnson: Have you had a chance to talk to the Massey Centre about this problem?
Ms Roch: No, I haven't.
Mr David Johnson: Have they approached you to discuss it?
Ms Roch: No, they haven't.
Mr David Johnson: Yes, they have. I can see them nodding in the back row that they have. At least the ministry; I don't know about you individually.
Ms Roch: Well, maybe the ministry; I'm sorry.
Mr David Johnson: Is there anybody else here representing the ministry who -- the Massey Centre has expressed this concern. They were here, made a deputation, and it's right in their brief. I can't believe somebody doesn't know about it. Is there anybody else here who can speak to it? No.
Mrs Marland: Let them answer the question whether there's somebody else here or not. We need to know that. Is there someone here from the ministry who can answer Mr Johnson's question?
Ms Roch: If his question was, have we been contacted by the Massey Centre, I can say that I haven't been personally. That doesn't mean that no one else in the ministry has been. I've got Ted Moses here, a policy adviser from the ministry, and I have legal counsel here, who may wish to answer the question.
Mr Moses: I haven't been contacted by the Massey Centre either.
Mr David Johnson: Are you aware that their huge concern, in bold letters, is "The issue of security is paramount"?
Ms Roch: I read Hansard, yes.
Mr David Johnson: You read it, but you're not aware of --
Ms Roch: I can't say that I'm not concerned. Having said that, we realize that by introducing the Landlord and Tenant Act, we are moving into a brave new world, if I can put it that way, where we will be working with our service providers to make them understand the full impact of the legislation. We'll also be working with the Ministry of Housing to provide them with some support.
Some comments were made today about service providers who have difficult-to-house or difficult-to-serve tenants and have been able to operate under the LTA. What we would like to do as a ministry is meet with those providers and see what we can learn from their experiences so we can then help our own service providers, who are now moving into basically new territory.
Mr David Johnson: I give up.
Mr Cordiano: The critical issue for me is the period for exemption, the six months. I chatted with the minister about the new section 2.1 that's being proposed by way of amendment. Do you anticipate dealing with this provision for an exemption to allow for eviction in the case of rehabilitative or therapeutic services provided in that particular home? Perhaps this is not an appropriate question to you, but it is in this context. Obviously, you feel comfortable with this proposed amendment, as you stated in your remarks, that it will allow for the flexibility that's necessary for these therapeutic and rehabilitative centres to continue to do the kind of work they were doing until now.
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My question really is around whether a home can now evict someone before two years have expired, because that's what the amendment deals with. It states that there will be a tenancy agreement and that the period of the tenancy agreement will apply, and that the maximum stay will be two years. Am I interpreting this correctly?
Hon Ms Gigantes: What is being provided is an additional grounds for eviction under the Landlord and Tenant Act that would apply in a case where there was an agreement about a program designed to achieve therapy or rehabilitation and that program had a duration of less than two years.
Mr Cordiano: So there has to be an agreement in place. Would this be provided for all rehabilitation centres and therapeutic centres?
Hon Ms Gigantes: Centres could decide whether they wished to have such agreements and would lay out the terms of such agreements. There are programs now which operate without such agreements.
Mr Cordiano: In effect, what we're getting is an extension of the six-month period to a 24-month period.
Hon Ms Gigantes: No.
Mr Cordiano: No? How does it differ? Explain.
Hon Ms Gigantes: The six-month average affects the application of the Landlord and Tenant Act in total. It is a total exemption.
Mr Cordiano: I understand that, but in practical terms, when most of the centres that have come before us have suggested that their average length of stay is 18 months, this would now apply to most of those centres.
Hon Ms Gigantes: What it means is that a centre operating such a program would seek to have a contract with each client which said that when the client had either completed the program or failed to complete the program within a two-year period, the client could be asked to move on, and that would be legally binding. Essentially, this addresses the problem that we are filling up spots in treatment and therapy programs and won't be able to move new people into those spots. That is the problem being addressed by the proposed amendment.
Mr Cordiano: That was, from the outset, the concern that was expressed on committee, and that was the concern expressed by opposition members, in the main. I'll speak for myself. It was the major concern.
Hon Ms Gigantes: That's one concern. There are others.
Mr Cordiano: Of course there are others, but my main concern was around this question of flexibility and the ability of rehab centres to continue to provide the services they provide, with the average length of stay being, as was summarized by deputants who appeared before this committee, 18 months. I'm going to have to examine very carefully the impact of the six-month period in relation to how many centres are affected by that, how many are captured within the provisions you set out in your new amendment. I understand there may be differences between those who provide certain types of programs not having to exceed the six-month period.
Quite honestly, we didn't hear from anybody who said their programs were of a six-month duration. What we heard was that in the programs they provided, the average length of stay was 18 months. What I envisage happening here is that most people who provide those rehab services would move to have these tenancy agreements in place in order to be as flexible as they can when they operate these facilities, so in a sense, that six-month provision in the act becomes redundant for most of those operators.
Ms Roch: I thought I heard the Ministry of Health people say that some of their programs were six months or less. We're more concerned about ours where we've been told that the six months is inadequate because their programs generally last longer than that.
Mr Cordiano: So your average stay in the programs under Comsoc is in the 18-month range?
Ms Roch: It depends on the program. From reading Hansard, the association representing alcohol and drug recovery programs make the point that on average their programs last 18 months. I concur with that, although we know there are some programs that discharge their people after eight months. There's some variation.
Mr Cordiano: You have to understand. I'm trying to convince myself that this amendment that's going to be put forward by the government will be effective and that perhaps I don't need to put forward my own amendment, but I'm not sure that is the case. I'm just trying to examine this.
What you're telling me is that the six-month exemption is absolutely necessary because there are certain types of programs that operate on that six-month window, that by and large, most of them fall within that category. But there is the provision under this section to capture those that operate under a longer period of time. I'll repeat my question. Why is it necessary to have a six-month exemption period? Why not include everyone under that 18-month or 24-month provision as stated by this amendment? Why have the difference? I can't understand.
Hon Ms Gigantes: They achieve two different purposes.
Mr Cordiano: I'm not convinced that is the case, when the vast majority of deputants who have come before us say their average length of stay is 18 months, and when the data presented to us are just that. That's the difference.
Hon Ms Gigantes: They don't say that.
Mr Cordiano: I'm not convinced of that. Unless you convince me otherwise, that's the belief we have.
Mr Grandmaître: Can I ask a supplementary question? In the programs you're offering at present, and there is a great number of programs, what would be the magical number of programs that exceed six months?
Ms Roch: Under our second-stage programming, for example, we're told that the overall average occupancy rate is about seven and a half months.
Mr Grandmaître: That's the average?
Ms Roch: Yes. However, our data show that there seem to be two trends: Some women seem to leave these programs after two or three months, while others stay for much longer, 10 or 14 months.
Mr Grandmaître: But the average is seven and a half months?
Ms Roch: Yes. Under the alcohol and drug recovery programs, we've heard it's on average between nine and 12 months, although I do reference the presentation made to you where the association indicated 18 months. Under our Futures residential programs for youth, the average stay seems to be between nine and 12 months.
Mr Grandmaître: Did you have an opportunity to discuss this with the Ministry of Health?
The Chair: Thank you, Mr Grandmaître.
Mr Grandmaître: That's a follow-up question, Mr Chair.
The Chair: There's only one supplementary.
Mrs Marland: Mr Chair, I did request that Ms Roch's copy of what she read be made available to the committee. That apparently hasn't happened. Could we have a copy of what you read?
Ms Roch: You can have a copy of what I read.
The Chair: You also may cross-reference it with Hansard when it becomes available.
Mrs Marland: In the copy we have, and this is why I'm looking forward to having your copy -- I can't tell you where it is on yours, but on mine it's page 2. The previous paragraph is, "With the separation of services and accommodation, clients can remain in their homes when service needs change." The next paragraph on mine starts, "While somewhat at odds with the models of the 1970s and 1980s, this approach has been adopted successfully...." Yours doesn't read that any more, does it?
Ms Roch: My copy still reads that. I just didn't read it word for word.
Mrs Marland: No, you didn't. I wondered why you didn't read, "While somewhat at odds with the models of the 1970s and 1980s." I have a press release here dated 1989 issued by Comsoc. Interestingly enough, the contact at that time was Michael Ennis; he's gone from Comsoc to Health in the meantime. This news release in 1989 is announcing, "Ecuhome Corp agreement signed today." It was a big day when that agreement was signed. Obviously Comsoc thought it was a very important program. Now we have a situation where, listening to some of your answers today, you obviously don't share the concerns Ecuhome brought to this committee in its deputation.
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Ms Roch, in your introduction, you mentioned that Mr Moses is a policy analyst, but you didn't say what your position is with the ministry.
Ms Roch: I'm the assistant deputy minister for children, family and community services.
Mrs Marland: So if I remind you that Comsoc actually defended Ecuhome's right to be exempt from the Landlord and Tenant Act, would you recall that particular challenge?
Ms Roch: No, I wouldn't, I'm sorry. I wasn't with the ministry then.
Mrs Marland: Is there anybody in the room who was with the ministry at that time?
Ms Mary Pat Koskie: I haven't been involved with it. I think another counsel in my branch has been involved with that.
Mrs Marland: Do you not think it's interesting that that is the case, that there was an example where Comsoc agreed with what Ecuhome is saying to this committee and in fact paid for that opinion in defence of Ecuhome's wish to be exempted from the Landlord and Tenant Act? It was last year. Do you not have any opinion on that?
Ms Roch: I'm sorry. Your question is, how come we're not defending Ecuhome today?
Mrs Marland: If the ministry supported Ecuhome's position in being exempted from the LTA a year ago, why are you not concerned about it today?
Hon Ms Gigantes: That's what the change means, Margaret.
Mr Moses: There are also other programs that would be covered under the Landlord and Tenant Act which have been exempted up to now. As Ms Roch pointed out, the group homes we provide for people with developmental disabilities have up to now been exempted from the Landlord and Tenant Act. Other programs such as the domiciliary hostel program, which is part of a large bloc of rest homes, have been exempted from the Landlord and Tenant Act and with these changes would be covered by the Landlord and Tenant Act.
Mrs Marland: But the point I'm making is, do we have a clean sweep where everybody in Comsoc is brand-new and has a new philosophy and things have changed? This agreement with Ecuhome, according to this press release, was June 26, 1989, and we have an example less than a year ago --
Ms Roch: I'm sorry. You said 1989?
Hon Ms Gigantes: There was a court case.
Mrs Marland: No, June 1989 is when the Ecuhome agreement was reached. Mr Sweeney was the minister. This press release says in glowing terms what this program means to the people who will benefit from it. We have this organization before this committee telling us that if Bill 120 goes through, this program will be killed. That's the nuts and bolts of what we're dealing with here. Is there not a concern on Comsoc's part, which was a proponent of this program, that this program, which you have not only been -- I realize it's not actually you, but your ministry. They have been partly the architects of this program and the funders. Does it not concern you to know that the people who have been managing this program have been before this committee with the kinds of concerns they have? Have you read their brief?
Ms Roch: Yes, I did.
Mrs Marland: So what is your feeling?
Ms Roch: The committee, from what I can gather, has been receiving deputations from a number of providers who are concerned about a number of issues. What we're saying is that we think the benefits outweigh the difficulties, but we will be working with our service providers over the next while to address some of these issues. Some of our service providers have never, ever worked under the Landlord and Tenant Act and we will need to provide them with some supports.
Mrs Marland: You give Ecuhome $1.5 million a year for their program. You must believe in their program. They're telling you why they can't operate under the Landlord and Tenant Act.
Ms Roch: We also have other service providers who are telling us it is possible to operate under the Landlord and Tenant Act.
Mrs Marland: I'd like to know the names of hard-to-house residents who are happy with the Landlord and Tenant Act.
Mr Moses: We've got Homes First, for example, which uses the Landlord and Tenant Act.
Mrs Marland: Homes First is happy?
Hon Ms Gigantes: They use the Landlord and Tenant Act.
Mrs Marland: I'm just asking the staff, Madam Minister. I'll ask you later, the other sections of the bill.
Ms Roch: It's difficult for us to say whether they're happy. The point is that they are operating under the Landlord and Tenant Act and --
Mrs Marland: Excuse me, Ms Roch. One of you said a minute ago that you do have providers who are happy with the Landlord and Tenant Act. I'm asking you to name them.
Mr Moses: Over the past seven years our ministry has been involved with the Ministry of Housing in developing supportive housing programs on the order of 5,200 beds. We've developed, with the Ministry of Housing, about 400 projects. All of those projects are required, by virtue of the requirements of the Ministry of Housing, to operate under the Landlord and Tenant Act, and they're still operating. Many of the programs provide services to hard-to-house individuals. The services required by the people served by our ministry are often fairly high-level services, and they seem to be able to operate under the Landlord and Tenant Act. In fact, the provisions that have been introduced here provide them with some tools to continue to do that, even under the LTA if they had been outside of the act up to now.
Mrs Marland: Could you give us some names, please, that are happy to work under the LTA?
Mr Moses: I'm not in a position to determine whether they're happy. We're simply saying we've had non-profit organizations come forward and ask to be part of this program, to be part of supportive housing.
Mrs Marland: Supportive housing with a treatment aspect, or just supportive housing? The reason I zero in on the Massey Centre and Ecuhome is because they have been before the committee and have been very forthright and very direct and very specific about the program they provide. They are the service providers the Ministry of Health talked about and that you're here talking about. We're sitting here as members listening to what the public is telling us --
Mr Gary Wilson: Selectively listening, Margaret.
Mrs Marland: The professionals who run Ecuhome and the Massey Centre perform a tremendous service to people in tremendous need, and it concerns us gravely that those programs may be at risk. I'm simply asking you, as the professionals in the ministry that funds them, how you can defend a piece of legislation that's going to put them out of business. That's all I want to know.
Mr White: Their business isn't in question.
Mrs Marland: Oh, you're saying it's a business and that's all. I mean they'll be out of practice. You're being funny about the words, Mr White.
I'm talking about a needed service, Mr Moses and Ms Roch, by people who are in a desperate situation. Are you not concerned about what those people came and told this committee?
Mr Moses: We agree that we're going to have to work with these organizations and that there will have to be some modification to programs.
Mrs Marland: In what way?
Mr Moses: For example, there are provisions in the Landlord and Tenant Act for developing an occupancy agreement to establish a relationship between the occupant and the tenant. There's been some discussion about the inability, for example, in rest homes to make bed checks on tenants or residents. It's possible to go into a unit, we understand, either with the understanding or perception that there's an emergency in the unit or on the consent of the resident. On the bed checks, for example, if the organization establishes an occupancy agreement indicating that bed checks will be done at specific times -- and these can be varied by certain days of the week or even different times on the weekend -- the organization can make those bed checks, and if they don't hear a response they can perceive that as an emergency and enter the unit. They can have that agreement with the organization.
They don't have that occupancy agreement at the moment, and it will be a different practice for them if they have to set up occupancy agreements. Occupancy agreements can also spell out other aspects of the relationship with the tenant, such as subletting. There have been some concerns expressed about subletting of units. We think these can also be handled through occupancy agreements.
The Chair: Thank you very much for coming to see us this afternoon. We appreciate your information.
Mr David Johnson: I have a question. I'm reviewing the government amendments I received Friday afternoon -- no, that I received this morning, actually. This amendment with regard to extending to two years, for the Landlord and Tenant Act, is not in my pile. I'm wondering if it's just my pile that's remiss or --
Hon Ms Gigantes: I believe they're in the yellow package.
Mr David Johnson: They're in the yellow ones, but we received the yellow ones about 1 o'clock, right at the beginning. I did receive the government's list this morning, so I went through this list all by itself.
Mr Owens: The third to last page.
Mr David Johnson: Well, it's certainly not in order, at any rate. I'm looking at the third to last page, and it's not there either. I've looked right through here and it's not here. Maybe it's just the copy I got, I don't know, but it's definitely not in -
Mr Owens: It's a secret plot.
The Chair: I don't quite understand, Mr Johnson. Do you have a copy of the amendment?
Mr David Johnson: I've now got it, but I was made aware of it only about 15 or 20 minutes ago. I find it curious, because this could be a key clause and it was not in the original list I got. It was in the yellow one, but we only got the yellow one --
The Chair: The minister's about to reply to your question, Mr Johnson.
Hon Ms Gigantes: Mr Chair, I know it doesn't meet all the concerns that are being raised, but the Ministry of Housing called the offices of the opposition critics and indicated the nature of this amendment on Friday. The fact that you didn't have it physically until today is --
Mr David Johnson: I was unaware of it until about half an hour ago when it was raised by the deputation.
Hon Ms Gigantes: I don't know who the call went to, but there were calls made on Friday to both the opposition parties to inform them of the nature of the amendment.
Mr David Johnson: Could you determine whom it went to?
Hon Ms Gigantes: I'd be delighted.
The Chair: Thank you. We are adjourned until 10 o'clock tomorrow morning, when we will commence the clause-by-clause with any opening statements.
The committee adjourned at 1703.