ONTARIO PUBLIC SERVICE EMPLOYEES UNION
CHRISTIAN LABOUR ASSOCIATION OF CANADA
YORK REGION DISTRICT HEALTH COUNCIL
TORONTO MAYOR'S COMMITTEE ON AGING
ADVOCACY CENTRE FOR THE ELDERLY
VICTORIAN ORDER OF NURSES, YORK BRANCH
REGIONAL MUNICIPALITY OF NIAGARA
SENIOR CITIZENS' CONSUMER ALLIANCE FOR LONG-TERM CARE REFORM
VILLA COLOMBO HOMES FOR THE AGED INC
BOB RUMBALL CENTRE FOR THE DEAF
CONTENTS
Tuesday 9 March 1993
Long Term Care Statute Law Amendment Act, 1993, Bill 101
Ontario Public Service Employees Union
Jan Hibi-LeBlanc, member, medical division executive and long-term care committee
Phyllis Martin, member
Tracey Mussett, member
Barbara Linds, research and education officer
Christian Labour Association of Canada
Ray Pennings, national representative
Betty Westrik, Ontario representative
York Region District Health Council
John Rogers, chair
John Wilson, member
Toronto Mayor's Committee on Aging
Diana Morgulis, chair
Liz Amer, mayor's appointee
Dr Norman Bell, chair, long-term care subcommittee
Advocacy Centre for the Elderly
Susan Chernin, institutional advocate and staff lawyer
George Monticone, staff lawyer
Victorian Order of Nurses, York branch
Teddene Long, executive director
Beverly Lamont, director, placement coordination services
Regional Municipality of Niagara
Brian Merrett, chairman
Roy Adams, councillor and chair, community and health services and public consultation advisory committees
Doug Rapelje, director, senior citizens department and member, public consultation advisory committee
Senior Citizens' Consumer Alliance for Long-Term Care Reform
Jane Leitch, chairperson
Beatrix Robinow, member
Villa Colombo Homes for the Aged Inc
John Capo, president
George Glover, administrator
Bob Rumball Centre for the Deaf
Rev Bob Rumball, founder
Peter Virtue, executive director
Dorothy Beam, member, continuum-of-care committee
Robert Lock, resident
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
*Chair / Président: Beer, Charles (York North/-Nord L)
Vice-Chair / Vice-Président: Daigeler, Hans (Nepean L)
Drainville, Dennis (Victoria-Haliburton ND)
*Fawcett, Joan M. (Northumberland L)
Martin, Tony (Sault Ste Marie ND)
Mathyssen, Irene (Middlesex ND)
*O'Neill, Yvonne (Ottawa-Rideau L)
*Owens, Stephen (Scarborough Centre ND)
*White, Drummond (Durham Centre ND)
Wilson, Gary (Kingston and The Islands/Kingston et Les Îles ND)
*Wilson, Jim (Simcoe West/-Ouest PC)
Witmer, Elizabeth (Waterloo North/-Nord PC)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Hope, Randy R. (Chatham-Kent ND) for Mr Drainville
Jackson, Cameron (Burlington South/-Sud PC) for Mrs Witmer
Jamison, Norm (Norfolk ND) for Mr Martin
O'Connor, Larry (Durham-York ND) for Mr Gary Wilson
Sullivan, Barbara (Halton Centre L) for Mr Daigeler
Wessenger, Paul (Simcoe Centre ND) for Mrs Mathyssen
Also taking part / Autres participants et participantes:
Czukar, Gail, legal counsel, Ministry of Health
Malkowski, Gary (York East/-Est ND)
Quirt, Geoffrey, acting executive director, joint long term care division, Ministry of Health and Ministry of Community and Social Services
Wessenger, Paul, parliamentary assistant to the Minister of Health
Clerk / Greffier: Arnott, Douglas
Staff / Personnel: Drummond, Alison, research officer, Legislative Research Service
The committee met at 1006 in committee room 1.
LONG TERM CARE STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LES SOINS DE LONGUE DURÉE
Consideration of Bill 101, An Act to amend certain Acts concerning Long Term Care / Loi modifiant certaines lois en ce qui concerne les soins de longue durée.
The Chair (Mr Charles Beer): Good morning, ladies and gentlemen. We begin our Tuesday sitting of the standing committee on social development. We are here to deal with Bill 101, An Act to amend certain Acts concerning Long Term Care.
ONTARIO PUBLIC SERVICE EMPLOYEES UNION
The Chair: Our first representation will be made by the representatives from OPSEU. If you would be good enough to come forward and make yourselves comfortable, welcome to the committee. If, first of all, you wouldn't mind just introducing yourselves for Hansard and for the members of the committee, then please go ahead. We have a copy of your submission.
Ms Jan Hibi-LeBlanc: Good morning. My name is Jan Hibi-LeBlanc and I'm on the executive of OPSEU's medical division. I'm also on its long-term care committee. I've been working at the Sudbury General Hospital for 18 years now, so I'm very familiar with the health care system.
I'll be doing a brief overview of OPSEU's position on long-term care. I have with me as well Phyllis Martin, who is a social worker employed at the Queen Street Mental Health Centre and who will talk about the work being done by her institution in the community. Tracey Mussett, who works in the home care program at the Renfrew County and District Health Unit will then talk about the impact of the long-term care proposals on women, families and their communities. Also with us today is Barb Linds, a research and education officer with OPSEU.
I have had copies of a brief distributed which contain much of the same material we shared during the public consultation process.
The Chair: Sorry to interrupt, but at the outset we will have the full half-hour, so you're conscious of that as well in case there is time for questions at the end.
Ms Hibi-LeBlanc: Okay. Sounds good.
The Ontario Public Service Employees Union welcomes the opportunity to make this presentation before the standing committee on social development. We have shared our views during the public consultation process and now wish to highlight our concerns before this committee.
Long-term care is an issue that affects all of our members. Many care for the elderly and the chronically ill family members in our own homes and deal with a wide range of home care and support agencies; or we try to obtain the best care we can for family members in institutional settings.
Many of our members work in the long-term care sector: the acute and the chronic care hospitals, the psychiatric hospitals and community mental health agencies, homes for the aged, nursing homes, home care agencies and ambulance services, government-run facilities and community agencies that care for physically and developmentally disabled people and the government-run monitoring compliance and support operations.
Our members work as nurses, RNAs, ward clerks, lab technologists, cooks, housekeepers, ambulance officers, physiotherapists, social workers, counsellors and in all other professional and support capacities. For all of our members, long-term care is an important and emotional issue.
Reform of Ontario's system of long-term care services is long overdue. For too long, people in need of care and support have had to deal with waiting lists, inappropriate placements or had to do without because the needed service was not available. The system is fragmented, unplanned, uncoordinated, poorly regulated and out of touch with real needs.
OPSEU has put considerable thought into the question of what makes quality care. Our reform efforts are based on a number of important principles for the provision of care that people need and deserve:
(1)Health care and human services should support independent living to the fullest extent possible and should emphasize health promotion and education and provide supports that give individuals control over their lives.
(2)The system should support client choice. People who need care should have the right to determine, either individually or with their families, how care should be provided. To exercise this right, individuals should have an array of options to choose from.
(3)Services should be provided on a continuum-of-care basis so that as a person's health status changes, the appropriate kinds of care, whether they be in a home or a facility, are provided in a coordinated and timely manner. Regardless of where they are provided, services should be integrated with community and family life.
(4)Services should be provided in a culturally sensitive manner. Language, religion, food and other facets of culture must be respected.
(5)Services should be of high quality and fully accessible. There should be comprehensive standards for care provided by institutions and community agencies. There should be monitoring and enforcement mechanisms to ensure maintenance of high standards of care.
(6)Services should be fully funded and staffed to ensure accessibility and the maintenance of high quality standards.
(7)Vital health and human services should be provided only in non-profit, regulated settings.
(8)Health care is society's responsibility. This responsibility must be fulfilled through government programs. Services must be delivered in a manner that makes sure that government is accountable to the public.
OPSEU has many concerns about government plans for the redirection of long-term care. We have concerns about this bill, to which we are asked to respond without having a full understanding of the government's overall policy directions.
The legislation before the committee today focuses on services for seniors and people with physical disabilities. It is an essentially technical bill which leaves huge gaps. It does not address the needs of children who require long-term care or people with dual diagnoses, for example, aging developmentally or physically disabled people or people who are elderly and also need mental health services.
Services for these people are wanting. Families of people with these diagnoses bear an enormous practical and emotional burden with little support from the health care system. The needs of these client groups and their families must be addressed in long-term care reform.
In addition to long-term care, the government is proceeding with parallel review and restructuring in the areas of acute care, chronic care, mental health care and care for people with developmental disabilities. There is considerable relation and overlap of these aspects of care, yet the processes of review and consultation are arbitrarily separated.
OPSEU would like to see a unified, rational health care system wherein there is a clear understanding of the roles and responsibilities of the various provider agencies. We are concerned that the review process will perpetuate the fragmentation.
The government is implementing changes to the long-term care services that are funded and provided despite the fact that the consultation process is not complete. The consultation process must include an examination of the roles and responsibilities of institutions and community agencies providing health and human services.
The government is scripting an increasingly limited role for institutions and laying the foundation for a potential explosion of agencies purporting to be community-based. There is little recognition by government that institutions are transforming themselves to be more responsive to needs within their communities.
Our society has invested in the institutional sector. It is wasteful to write it off as a narrowly circumscribed role. It makes more sense to transform the institutions to be made more accountable to the government and to the public, more representative of community interest. The range of programs they provide should be improved through careful planning and coordination.
Many hospitals, psychiatric hospitals and homes for the aged are already providing in-home, community-oriented services. They offer satellite and outpatient clinics, day care, respite care, counselling, crisis intervention services and much more.
I'd now like to turn to Phyllis Martin, who will describe one institution-based model which works very successfully.
Ms Phyllis Martin: I'm Phyllis Martin and I work out of the Queen Street Mental Health Centre. I would like to give a brief overview of our program.
Long-term care reform focuses on the life choice of seniors and disabled persons to remain in their own homes while receiving the necessary community services. It also proposes easier access to community services and approved charitable homes for the aged through the placement coordination model. Many seniors, especially those who are cognitively impaired, are at risk in their own homes, and it is to the institution that they must turn for improved quality of life, social support as well as medical and psychiatric care. The institution cannot be divorced from the community. Institutions are vital components of communities, and communities play an integral role in the success or failure of institutions.
Queen Street Mental Health Centre is a large psychiatric hospital operated by the Ministry of Health which serves the areas of Peel, North York, York and Etobicoke. Queen Street Mental Health Centre provides a continuum of patient services: assessment, diagnosis, rehabilitation, discharge planning, housing and reintegration into the community.
There is a large psychogeriatric unit within the hospital that provides services for clients aged 65 and over with a psychiatric diagnosis. This unit has recently been described by the hospital accreditors as a model of excellence for the care of the elderly.
The psychogeriatric unit provides comprehensive, holistic and systemic services which begin with functional assessment, preferably in the client's home. This quality service continues possibly through admission and continues after discharge. Service is delivered by highly skilled professionals who have been using the placement coordination model effectively for the past 16 years.
There are three community-based satellite programs which provide follow-up care for clients who are discharged from inpatient status. Staff in the PACE, ie, psychological assessment consultation education, programs are actually involved with discharge planning since they are expected to provide follow-up care. PACE programs provide home assessment, psychiatric consultation and community assessment and provide educational services to nursing homes and homes for the aged on request. Admissions from retirement homes, nursing homes and the community have been reduced by 95% by the early intervention of the PACE programs. There are PACE brochures which will be left with the clerk.
Institutions are being transformed and will continue to be transformed by being more accountable and more accessible to the community and stakeholders. Institutional-based professionals are involved in collaboration with community-based agencies in an effort to coordinate and identify services, thus avoiding duplication.
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There is fear among health care professionals that existing programs for the elderly will be replicated by the implementation of the long-term care reform. It is neither prudent nor judicious at this time to reinvent the wheel by creating a second level of bureaucracy, which will result in interruption of the existing service delivery.
The solution to this dilemma would be to provide funding in order to expand and update existing community programs. Funds should be administered through institutions and programs would focus on more equitable community care. Professionals providing similar services should continue to provide services in the new and expanded programs.
Professionals employed in provincial psychiatric hospitals have not been informed of the impact the long-term care reform will make to the existing programs. My question is, will provisions be made for the redeployment of personnel, or will positions be created taking into account the training and expertise of these service providers?
It is not incidental that provincial psychiatric hospitals were not included in the original submissions for long-term care reform. Area general hospitals are in the process of planning a coordinated placement service, again at the exclusion of the provincial psychiatric hospital.
Ms Hibi-LeBlanc: Tracey Mussett will now talk about what shifting the responsibility for the provision of long-term care into the community will mean to women as primary care givers and as workers.
Ms Tracey Mussett: Shifting the responsibility of costly health and social services to the community really means shifting the responsibility and those costs on to women. The family is presently the main source of informal care for our elders. The average age of an informal care giver in the home is 55 to 60 years old and 75% of those care givers are women. The formal care-giving network in the community is comprised primarily of women working in non-union jobs for which they are not adequately compensated.
Caring is an essential service. Care givers, those people who are now caring for our children and our parents and anyone else who needs help in our community, know that this is work that cannot be left undone. The needs don't stop at 5 o'clock, and these are needs that can't be met by just anyone. Personal care, housekeeping, meal preparation and laundry, just some of the physical things that are done in health care facilities, are now done by specially trained people who are paid for that important contribution. Why would we expect now that those needs can be met in the community by just anyone, either family, volunteers or workers in low-wage jobs, just because that's cheaper?
We cannot be certain what services will be required in the future. We need a comprehensive system of health, social and support services with flexibility and options that will meet client needs for home or institutionally based care and provide the needed support for family care givers. Formal care givers, properly trained and properly compensated, will provide the level of health care and the quality of life we expect our system to provide. Especially in isolated rural areas, where "home" is miles from another human being and family members are spread across the country, services have to fit, and fit very tightly. Cracks in this network have serious human consequences.
Ensuring that there is a full array of options in place before the shifting occurs is only common sense. We see what is happening with the continuing deinstitutionalization of psychiatric patients, as Saturday's Globe and Mail very graphically illustrated.
We need a clearer definition of what this proposal assumes is "community." Is it a single family dwelling on a paved street? Larger facilities are a part of our community, and they can feel more like home to somebody than a house or apartment. People do live alone, and their needs can be largely unmet. Community-based care does not necessarily have to be an ideal at the expense of the other institution-based care. Institution-based care does not have to be viewed as cold, grey-block buildings where horrible things are committed to people behind the walls.
We need a clearer definition of what this proposal assumes is "support to family care givers." Can they add another eight hours to a woman's day? Can they give back relationships lost, social and employment opportunities missed? Can they explain to a six-year-old child why his mother spends more time "playing" with grandma or the elderly person next door than she does with him?
Financial costs are just one of the prices paid by family care givers. Elder care is added to the ever-increasing and often conflicting roles women play as the concept of "family" evolves.
Safety is another very important concern. Care giving is a dangerous job. In facilities we have women who are exacting physical and emotional costs as a result of their labour. The pay equity process highlighted that emotional and physical demands of so-called "women's work" now have to be recognized in measuring job value. Care givers in the community share those dangers. As well we see women entering homes of strangers, often in isolated areas, where they will care for people with physical, social, emotional and psychological problems, and the safety issue is something that has to be addressed.
We believe that community-based services should be funded on the basis of parity with the institutional sector. Better wages would improve both the quality of care and the quality of work and family life for consumers and workers. The new system must recognize the important link between quality care and a stable, well-trained, reasonably paid work force.
The costs of care giving are very high. To save the system money, those costs are to be borne by care givers, formal and informal. But the capacity to care and to help is not a limitless and unconditional resource. We, as a community, must be very cautious about exploiting and exhausting the support we will continue to rely on.
While it had its rewards, my own personal experience with care giving exacted a very high personal price, and it is not an experience I highly recommend to working women.
This new system, a complex system of well-coordinated and carefully planned and comprehensive services and support, must first and foremost recognize that care is given by care givers. The system that works will respect, value, support and protect those who give of themselves to look after us all.
Ms Hibi-LeBlanc: Reform of the system of long-term care is critical and urgent. OPSEU has many concerns about the government's plans. We want to encourage the government to proceed carefully and ensure greater consultation and agreement about both the process and the content of the reforms. Thank you.
The Chair: Thank you very much for your presentation, which highlighted a number of different areas, as well as the brief you have presented. We do have some time for questions, and we'll move there right away. Mr O'Connor.
Mr Larry O'Connor (Durham-York): You raised a number of issues. In going through your brief, you pointed to some other areas as well. I found your presentation quite informative. As the parliamentary assistant to the Minister of Health, I did have an opportunity to go to Parkdale, to the community resource centre for survivor consumers, and found it really rewarding that this sort of resource is available to the people who have left Queen Street and that they were able to advocate for themselves and be together. I found it really exciting that there are possibilities coming up that perhaps weren't even thought about maybe 10 or 15 years ago.
You mention the need for training in facilities where the ex-psychiatric patients are. I know that does exist because my mother has worked in a long-term care facility, in a nursing home, with a lot of ex-psychiatric patients, and she had talked with me about some of the difficulties she had there. There is the need for that ongoing training so that there's something available for them. Those are really important concerns that you raised.
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Accountability is something I would like you to perhaps expand on, because what we've heard through this process of committee hearings is that there are residents' councils in nursing homes and they're in the municipal homes for the aged. Of course, the accountability mechanism comes through the municipal government.
I just wondered if you might have some suggestions as to what might be a good method of putting in some accountability that's going to really reflect the needs of the consumers we're trying to provide a continuum of care for that's really going to meet their needs. I hope you could maybe make some suggestions as to an avenue we should be looking at.
Ms Hibi-LeBlanc: I suppose one of the best methods would be a review system. Some of the homes for the aged that are privately owned we feel are not up to standard and there isn't anybody reviewing their processes and ensuring that the quality of care seniors or anybody with physical disabilities receive is standardized.
There is a standard set, I believe, by the government-run institutions, but the private institutions have no such standards, or a limited set of standards. If everyone was under the same umbrella and was required to meet the same standards, then we would probably see a system in place that would guarantee or at least assure a quality of care for seniors and disabled.
Mr O'Connor: What kind of mix would you suggest and maybe some sort of review panel or council? Who should be involved in that process?
Ms Mussett: Definitely clients and family care givers, the consumers, have to play a role in that. I was just going to add as well, presently where 90% of our elders are being cared for in the community, there is no standard of care to be provided by informal care givers at all. Elder abuse has been raised as a very real issue and care giver abuse also obviously exists. That's a very large segment of care giving right now that is not standardized at all, and if the shift is going to add to that, that emphasis on informal care giving system, then standards will even be harder to maintain. I think the consumers and the clients have to be involved.
Ms Barbara Linds: One of the other points we'd like to make is that there are existing institutions and programs that are accountable run by levels of government that should be expanded on and should form the hub of a health care system and not set up this other parallel system where there isn't the accountability that exists in the provincial and other levels of government -- the care that's being provided by those facilities.
The Chair: I'm afraid we're going to have to move on. Ms Sullivan.
Mrs Barbara Sullivan (Halton Centre): I enjoyed your brief. Being a mother, I'm able to sort of read and listen at the same time, as we all know we can do with our children, but there are a couple of things I want to refer to from your brief as well.
Much of your brief, you will understand, our party will agree with profoundly and much of it we will disagree with profoundly, but I think it was very thoughtful and I think you will understand that for all members of the committee it's very difficult to deal with Bill 101 in isolation of the entire long-term care strategy. I think that's one of the things we're having a tough time dealing with.
The two things I want to ask about -- and I think I will have to, on the first one, refer to the parliamentary assistant for a response -- are with respect to maintaining standards in the nursing homes. You have indicated that your compliance advisers, who are members of OPSEU, have been told there will not be an increase in their complement when there will be a substantial increase in the number of long-term care facilities which will be brought into that system. Can the parliamentary assistant confirm that is the case?
Mr Paul Wessenger (Simcoe Centre): What I will confirm is that the existing compliance officers will, I understand, continue to monitor the present nursing homes with respect to homes for the aged. The existing program supervisors will continue to do the role they are presently doing. I will ask also for some addition by Mr Quirt.
Mr Geoff Quirt: Geoff Quirt, acting executive director of the long-term care division. It's accurate that the staff have been advised, and our plan is not to increase the number of compliance advisers currently working in the residential services branch. They will, however, work as a team with a number of program supervisors who have traditionally related only to the homes for the aged program in each of the 14 offices of the long-term care division. While the staff of the residential services branch, the compliance advisers, will not be decentralized to the 14 offices, they will work as a team.
The people who used to work exclusively with nursing homes, the compliance advisers, will work with program supervisors who used to work exclusively with homes for the aged, as a team and relate to both nursing homes and homes for the aged. The resources of the 14 offices and the resources of the residential services branch will work as a team to monitor compliance with provincial standards in all types of long-term care facilities and also negotiate and sign service contracts with each facility annually.
Ms Linds: If I might make a comment on that, for the last week, I've been reading the transcripts of the presentations before the committee. I raised the question with one of our compliance advisers, which resulted in the comment that she made about the complement not being increased. I said that I understand that the program supervisors, the people who are now dealing with homes for the aged, are actually going to be doing work with some of these institutions and these facilities. She said that their skill sets are very different, that while they do programming and budgeting work, their skills are not the skills that are actually being used by the compliance advisers now.
My understanding is that the background of the compliance advisers is essentially nursing, and the program supervisors don't bring with them the same skill sets. So in fact if you're looking at the compliance area, it is just the same staff who are going to be doing the work with the extended system.
Mrs Sullivan: I think this is a matter of concern with respect to this particular bill because as we are looking for amendments and use of the word "inspector" or whatever, we may want to have more detail on how this totally integrated system is going to come about.
The other question I wanted to put to you is from page 11 of your brief, where as part of your argument about total quality management, which of course is something this committee is very interested in in terms of amendments to the bill, you've indicated that TQM has resulted in more injuries on the job and more stressful working conditions, has meant deskilling of work, has attempted to undermine negotiated work rule protection etc. What evidence do you have for that, and can you put additional information before the committee with respect to those statements made in your brief?
Ms Linds: This is work that we've done with people who are actually working in institutions. A lot of it is anecdotal. We can go back to the people we've talked to in our institutions and facilities to put together some more information on total quality management. Tracey has some comments.
Ms Mussett: I'm not a direct service provider; I'm support staff. As an example, in our organization, therapists have new patient quotas to meet. What that means in a county as large as Renfrew county, where 40 minutes of that client's visit time is the therapist getting there in the car, is that when they have to admit four new patients a day, the quality of care has decreased. The kind of care has changed. TQM brings in an assembly line approach to caring for human beings that's just not appropriate.
Mrs Sullivan: That's interesting, because it's enthusiastically embraced not only in Canada but across all of North America and Britain. I don't know that we've had this kind of reaction.
Ms Mussett: In manufacturing or in the allocation of health and social services? Is it being embraced in that field as well?
Mrs Sullivan: Yes, absolutely. Total quality improvement is in fact seen to be a multidisciplinary team effort to improve quality of care delivery to the patient, not as you are seeing it here, and so I was kind of interested in what you've included.
The Chair: I'm sorry; we're tight.
Ms Mussett: We'll have to have this discussion later, I guess.
The Chair: It is an interesting topic, but we have one more questioner and time is moving on. Mr Jackson.
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Mr Cameron Jackson (Burlington South): This is a very comprehensive brief and you've covered a lot of areas, which I appreciate. One of the areas though, having read through a section of it -- I'd like to ask you a question, because I don't sort of see it highlighted or mentioned. Are you aware that the fundamental shift in Bill 101 is to take this from an insured service, guaranteed under the charter through the Canada Health Act, take it out of that and place it as a contractual service from the state? Are you aware that's the fundamental move that's implicit in Bill 101, so that it is no longer a guaranteed service to citizens for these services?
Ms Linds: We haven't looked specifically. We've looked at the bill. The problem we have with the bill generally is that none of it is being discussed in an overall policy context, so it's basically a piecemeal approach, and that's what we've titled our brief. You can't just look at one piece of the picture in isolation from everything else. The funding is just one aspect of it; the provision of placement coordination services in the community is another aspect of it. Our problem is with the whole policy direction and that it hasn't been enunciated to the extent that we can actually deal with any of it.
Mr Jackson: In all examples, enabling legislation enables the government to do whatever it wants. Then there are laws that restrict the government's ability to do certain things, such as compliance with the Canada Health Act. But given that the fundamental change on which everything else builds -- to go in and say the state has the right to determine who is eligible now, and the state has the right to determine which facility you will go into and the state has the right to say you're not going to receive care in a certain fashion, and that people are going to pay, based on their ability to pay, in a variety of circumstances, user fees, which aren't part of the Canada Health Act, as you know. That's the fundamental shift here.
I just wanted to make sure that your organization, a very important organization in terms of advocacy for these kinds of changes, is aware that this legislation moves fundamentally from the one system to another and that all the other enabling aspects of the legislation fall into place once they separate themselves from the universality of the Canada Health Act.
Ms Linds: We're very committed to universality and we're very committed to the state playing a meaningful, important role in the provision of human services. I don't think we have a question with that. What we have a problem with is Bill 101 in isolation from the total policy direction on long-term care.
The Chair: Thank you. I regret again having to play the heavy, but time has moved on. I know I speak for all the members of committee in thanking you for both the manner of your presentation and the different backgrounds of the people whom you've brought. That's been very helpful.
If I might, just as one who has been in a number of the institutions over the years, in response to one comment that was made, it always struck me that the quality of the people who worked in all our institutions is extremely high. I think, whatever the discussion is around institutions and community care, nobody should be surprised to learn that we have some very fine people working in all of our institutions, and for that we thank you.
May I call the next witness and then we'll go on with the representatives from the Christian Labour Association of Canada. Ms Sullivan.
Mrs Sullivan: Mr Chairman, I was wondering, as the next presenters are coming to the microphones, if legal counsel to the ministry could provide a response to the issues that have been raised about the delisting of services under medicare and the Canada Health Act implications.
The Chair: Okay. Yes, parliamentary assistant.
Mr Wessenger: I'd just like to make a statement with respect to this issue that's been raised by Mr Jackson. Extended care services provided in nursing homes are currently included as insured services under the Health Insurance Act. This will no longer be the case when Bill 101 is passed. Only Ontario and Manitoba currently insure extended care under provincial health insurance plans. Extended care services are not required by the Canada Health Act to be insured, nor are they subject to the requirements of public administration, comprehensiveness, universality, portability and accessibility, nor is there any constitutional requirement that a province provide or insure extended care services.
Interjection.
Mr Wessenger: Yes.
The Chair: The answer to that was yes, just so that it's clear.
CHRISTIAN LABOUR ASSOCIATION OF CANADA
The Chair: I want to welcome you both to the committee this morning. If you'd be good enough to introduce yourselves for Hansard and for the members of the committee, then please go ahead with your presentation.
Mr Ray Pennings: Thank you very much. My name is Ray Pennings. I'm a national representative with the Christian Labour Association of Canada. With me is Betty Westrik, one of our Ontario representatives who's active representing workers in the health care industry.
We'd like to thank the committee for providing this opportunity to give input on this important piece of legislation. Our interest and involvement in the issues surrounding the provision of long-term care have been well documented, as we've been actively lobbying to address the inadequacies of our current system since the fall of 1984.
Our vigilance and concern about these issues originates with the 3,500 CLAC members who are employed in 67 different nursing and rest homes, charitable and homes for the aged throughout this province. These members work on the front lines and are committed to providing quality care for our seniors. The concerns of our members are not just about working conditions and job security. It's a genuine commitment to the residents whom they serve and care for on a day-to-day basis.
In October 1985, we released a comprehensive task force under the title Serving our Seniors and again, in October 1990, under the title Living in the Twilight. These reports examined the conditions in Ontario's long-term care facilities and made specific recommendations for improvement. Extensive coverage in both electronic and print media helped raise both public and political awareness regarding the issues concerning long-term care.
In 1987 we appeared before this committee to comment on Bill 176, but we continued to press for an overall review of the system. That overhaul is finally happening, and while we regret the slowness with which the wheels of government seem to turn, we are thankful that we can appear today to provide input at this final stage of this process.
Just as a parenthetical remark, our comments are focused on Bill 101. We obviously have opinions and comments on the larger trends in long-term care reform, but we have reserved our comments to specific amendments to Bill 101 at our appearance this morning. However, in discussion we'd be happy to pick up whatever areas you want.
We're here this morning to voice our support for the legislation, to urge its speedy passage so that the concerns of those in the long-term industry can be dealt with instead of just talked about. Still, there are a few specific concerns with the legislation that deserve comment and we think the committee will do well to propose amendments to address the weaknesses in at least three areas.
The first area of concern is that of service agreements. We fully support the introduction of service agreements as requirements in order to receive funding for long-term care in this province. We also understand the limitations placed on the province in dealing with a municipality which is providing long-term care as the fulfilment of its statutory responsibilities. The fact remains, however, that the municipal homes for the aged, by not being required to sign service agreements, will continue to receive different treatment from the ministry than privately owned nursing homes. In our view, that's unacceptable. Our members are employed in both private nursing homes and municipally owned homes for the aged, and from both a patient and care perspective these two types of institutions are providing essentially the same service to Ontarians.
For many years, the gross funding inequity between privately and municipally operated institutions has created staffing hardships for our members in nursing homes. We are thankful to see a single funding formula put in place for both by this legislation. But we fear that by requiring the one to sign service agreements and not the other, the difference in treatment between public and private long-term care facilities will continue.
When we hear whispers and rumours that there's a covert agenda to eliminate the private component of the long-term care program and replace it with entirely publicly owned and operated facilities, then it's understandable that these differences, like the ones specified in regard to the service agreements, arouse suspicions of a larger agenda. This remains so even if the different treatment is defended with legal distinctions.
We would recommend that the committee look at this matter carefully so as to ensure that municipal homes for the aged are placed under the same requirements and commitments in order to receive their funding, and that this legal technicality is not used by the ministry to effectively disadvantage private nursing homes, their staff and residents in relation to their public counterparts.
Long-term care is about people: the residents and the staff of the institutions responsible for caring for them. Long-term care is not about preferences and mindsets concerning public and/or private ownership of such institutions. The urgency for reform and the scarcity of our resources is too great to allow ourselves to be diverted from getting on with the reforms in the best way we know how.
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While we realize that the contents of the service agreement will be determined by regulations, we would also urge that the present minimum hands-on, direct personal care requirement of 2.25 hours of care per resident per day be incorporated into the service agreement. Although the accommodation, care, services, programs and goods required under the service agreement will be communicated to all residents and the funding envelopes will provide direct subsidy for staffing costs, there is not adequate provision to ensure that the money is spent on hands-on personal care.
It is easy to envision how management will seek to direct the resources, which remain limited and scarce, to some of the more visible areas of service at the expense of the personal care of residents. Providing staff with a manageable rather than overloaded daily assignment of residents will give them the opportunity to pay attention to the residents' personal needs and provide for greater personal interaction. These opportunities are currently and sadly lacking, and that must be addressed if we are at all serious about the human beings, our relatives, friends and neighbours, to whom these institutions are providing full care.
The provision of human contact and personal relationships between residents and staff may not be as visible and objectively measurable as the newly created positions of activation coordinators and the like, yet it remains the most effective and necessary component of any standard of quality care for our seniors. Such interpersonal relationships cannot be legislated; however, they can be encouraged by tying specific minimum staffing requirements of not lower than 2.25 hours of care per resident per day to the case mix index, thereby obligating operators to staff adequately in order for this interaction to occur and, it goes without saying, obviously funding accordingly to allow this to occur as well.
The second area of concern is that of the placement coordinators. When the 1991 public consultation paper was released, we strongly endorsed the commitment to "the primacy of the individual and his or her right to dignity, security and self-determination." However, we're concerned that the powers entrusted to the placement coordinators in this legislation do not adequately provide choice and flexibility for residents.
It is intended, and rightfully so, that placement coordinators will merely apply the eligibility criteria set out in the regulations and prioritize an applicant's need in relation to available space, but as matters stand, we see a great potential for placement decisions that will not be reached in as objective a manner as they should be.
Ultimately, these decisions will have a considerable degree of subjectivity. What methods of accountability are put in place for the placement coordinators? How will the system deal with the inevitable public versus private bias that coordinators may have? What about favouritism by the coordinator towards a particular home?
When one considers the immunity protection provided for placement coordinators within the act, there seems to be a tremendous degree of trust in a single position, with very little accountability. The legislation should give a framework within which there is opportunity for input and choice for the applicant as well as accountability on the part of the coordinator arranging the placement.
Under this legislation, we suggest that the position of placement coordinator is given an undue degree of control without appropriate checks and balances. If this is left unamended, there is a real potential for abuse by those put in this position. The structure does not provide adequate remedies to address this without potentially causing injustice to residents, employees and particular institutions.
The third area is funding. The replacement of the two-tiered funding system currently in practice with a single formula based on the needs of residents is most welcome and long overdue. We also recognize that the fiscal realities facing governments at all levels make increased funding for any program or area difficult.
Given that, we find it difficult to accept that long-term care residents are being asked to bear an undue proportion of the fiscal restraint burden. While we have made major advances in implementing a case mix index to determine the distribution of funds, the government determines beforehand how many dollars its going to spend. Thus, funding is not being based on the care needs of institutional residents, and the delays in the introduction and passage of this legislation, without interim funding provisions, have resulted in many residents having to cope with declining care and many nursing homes facing perilous financial situations.
The summary of form 7s published by the Ministry of Health shows operating losses throughout the industry during the past several fiscal years and, since January 1, in almost every private nursing home we have dealt with, reduction of staff, which translates into a reduction of care. Obviously, this causes unfair stress on our members, who are concerned about their patients, and it creates near-impossible situations for our union in negotiating on behalf of workers in an industry that historically has been underpaid when compared with other institutions and hospitals providing the same sort of care.
In conclusion, our critical comments and observations should not be interpreted as disapproval of the legislation. In fact, we support Bill 101 and think it's long overdue. We trust that our constructive criticism has alerted you to some of the bill's weaknesses and that our suggestions will contribute to a long-term care delivery system that will result in a welcome improvement of the quality of life for all Ontarians.
We owe it to our elderly to care for them with dignity, supported by a plan of care, inspection procedures, a fair funding mechanism and other necessary improvements. The government is to be commended for taking on this difficult task.
We recognize that no system will be perfect. However, we do believe this bill can be improved upon, especially as it concerns the service agreements and the role of placement coordinators, as we've outlined earlier in this submission.
Finally, we wish to impress on you the need to deal with this legislation and necessary amendments quickly so that the new funding mechanism can be put in place and the uncertainty which currently lingers over the industry can be lifted.
We thank you for your time and look forward to answering your questions.
The Chair: Thank you very much for your presentation. We'll move right to questions. Ms Sullivan.
Mrs Sullivan:Thank you. This has been a useful brief and we appreciate having it.
One of the things you have raised is the different treatment of municipal homes for the aged as compared to charitable homes and nursing homes. I wonder if we could have a clarification from the parliamentary assistant with respect to the signing of service agreements by municipal homes. I note that in Bill 101 there isn't mention of a service agreement with a municipality until we get to subsection 18(9), where it speaks about a contravention of a service agreement, and I think there is confusion here.
Mr Wessenger: I'll be very happy to clarify that. Under the amendment to the Homes for the Aged and Rest Homes Act -- I'd refer you to subsection 28(2) -- it says, "No payment shall be made under subsection (1) unless the municipality, each of the municipalities or the board of management, as the case may be, receiving the payment is a party to a service agreement with the crown in right of Ontario." So in fact it is right in the legislation that the municipal homes for the aged, in order to receive their funding, have to be parties to the service agreement.
Mrs Sullivan: Thank you. I wanted that clarification, because such a significant part of the brief was with respect to different treatment within a system, when in fact we are looking at equalization of service and equalization of treatment between the homes.
Mr Wessenger: Could I just add one aspect? It's not a condition of operating a facility, as it is in the case of a nursing home, because there's a mandatory requirement that municipalities do operate homes for the aged. So there's that difference. But as far as the requirement of funding and service agreement are concerned, they're the same.
Mr Pennings: So what you're saying is that the service agreement for municipalities puts the same onus on them as it does on the private nursing homes, in terms of funding being tied to the delivery of care?
Mr Wessenger: That is correct, yes.
Mrs Sullivan: It's just a different signatory. One of the things we've been interested in with charitable homes, by example, is who is going to sign the service agreement and how that will be dealt with in terms of the accountability of the board of directors. The municipality is clearly on the line for services that are delivered through the homes for the aged.
The Chair: Mr Wilson.
Mr Jim Wilson (Simcoe West): Thank you for your presentation. I'm a little confused, because you state that you want this legislation passed expeditiously and that you're supportive of it, yet you brought forward some major concerns which are going to take some major amending, and I'm not sure how much give and take the government's going to show on this legislation. If other pieces of health care legislation that we've been through are any indication, it's a difficult task to have amendments accepted.
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I want to talk about funding. You mentioned interim funding. I think that one of the political games that's been played and that a lot of groups have bought into is, "You can't have the funding that was promised" -- by Frances Lankin -- "unless this legislation is passed." It's a carrot-and-stick approach.
I don't believe that's true. The government could flow the funding if it had the dollars, particularly because there is money outstanding to nursing homes and the nursing home sector. That's something the government has sort of crept into these hearings. As we've gone along, it's become sort of a gun to the head of Mr Jackson and me, that we've got to pass this legislation, even though we have major, major problems with it.
One problem Mr Jackson was talking about before is that this legislation flies in direct contradiction to anything Frances Lankin told us when she was minister, and I've been her critic; that is, that she wasn't going to delist any OHIP medicare services without full public consultation, and that's certainly not been the case with this. We're on a dangerous slippery slope here, and I'm surprised that groups such as yourselves would be so supportive of this legislation.
Ms Betty Westrik: Maybe I can answer that question. The government did involve us in a lot of these consultations before, with the service agreements and the funding etc, and it promised that whether the legislation was in place or not, funding would be forthcoming on January 1.
Mr Jim Wilson: Exactly. But the game's changed, hasn't it?
Ms Westrik: The game has changed. That's our concern, and that's why we're asking for interim funding. If we have to wait now until this legislation is passed, because it wasn't introduced until after we had already been promised the funding, then I guess we wouldn't be sitting here today and asking you to expedite this as quickly as possible.
Mr Jim Wilson: To be fair, I do very much appreciate your comments, as OPSEU said before. As legislators, I very much resent having to pass this legislation because we know the sectors need the funding. We're left in a void, as are the groups themselves and service providers, in terms of what the bigger picture is.
Ms Westrik: Maybe I can just state something else, because I do work out in the field all the time. I've been spending most of my time, instead of preparing briefs etc, going out there and dealing with staff cuts. Even though all these nursing homes have signed agreements that they're going to staff at 2.25 and the per diem funding was there for that, they're cutting right down to 2.2 or 2.15. So they're in violation of their service agreements and the government is doing nothing about that. That's a real concern.
Mr Jim Wilson: I agree, and I appreciate you raising that. I just finished a tour in London, Ontario, and I've certainly been to all the ones in my own region, and that's exactly what's happening. It's frustrating, I'm sure, for you, as it is for us, in that what we're seeing in the real world does not at all match all the great speeches surrounding this legislation. I appreciate your comments.
Mr Wessenger: Thank you very much for your brief. I'd like to make a comment on your questions concerning the accountability of placement coordinators. I think first of all we should remember that the placement coordinators are subject to a community board, so they do have that accountability in the sense that the community board manages the placement --
Mr Jim Wilson: Would the parliamentary assistant please speak up?
Mr Wessenger: That's unusual. Usually people say I speak too loudly.
Mr Jim Wilson: You're getting to be like Mr Peterson. When he used to get in trouble, he would mumble away.
Mrs Sullivan: You weren't here then.
Mr Jim Wilson: I was here then. I was an assistant.
Mr Wessenger: I was just going to indicate that placement coordination is run by agencies which have community boards, so to that extent you do have accountability, but I do take into account your comments that you think there should be additional accountability placed on the placement coordinator.
Mr Pennings: If I can expand a bit on the environment, in preparing this brief we sought to focus very specifically on Bill 101 and a few immediate things. In other forums we have been very vocal in terms of the funding arrangement, and also in terms of the issue you raised about the coordinators. I guess sometimes what is said in public and what appears nicely in documents is quite different from what one hears day to day in walking in and out, as we do, of 67 different facilities in which we represent members. We have a good number of private nursing homes where we do represent members, and there is reason to believe, based on whispers and rumours -- I can't pull documents out to suggest things -- that there is a larger agenda this whole thing is part of to bring private nursing homes entirely out of the system and to replace that. That I guess is a little bit of a concern. If that's the agenda of the government, let's put it up front and let's deal with it and make that part of the legislation. If it's not, let's not play the games, as seems to be happening.
The concern is there. It's heard in a number of ways. I guess when we see the placement coordinators given the sort of latitude they are without systems of accountability, you can understand that the red flags go up and we say, "Wait a minute, is this another mechanism and part of a covert agenda?
The Chair: Final comment.
Mr Wessenger: If I might just respond to that, certainly we wouldn't be bringing in level-of-care funding if there was any agenda other than to provide a level of care that's the same in both institutions. Certainly, the intention is to bring up the level of care, to equalize, whether a person is in a private facility or in a non-profit facility. I'd like to assure you that is the intent of the legislation.
Just as a comment, we keep hearing all the time about the fact that there's a waiting list for long-term care facilities. I don't see why anyone would have any fear that there would be any withholding of a placement other than on the basis of a facility being in extreme noncompliance with regulations. Certainly, we have a major concern that the institutions are accountable and we want to ensure that the legislation ensures they are accountable in that regard.
The other thing is, as you may know, this bill was introduced in November. With respect to the situation, there have been two prior interim bridge fundings granted to the nursing homes. Certainly, we want to see this legislation introduced as quickly as possible.
Ms Westrik: Wait a minute, did I hear you say there's been bridge funding since November?
Mr Wessenger: No, I was saying there'd been bridge funding last year.
Ms Westrik: It was January and April of last year,
but that wasn't bridge funding; that was tied directly to staffing. It was tied directly to staffing, it wasn't bridge funding, which is why they're now in violation of their service agreements in order to make ends meet.
Mrs Sullivan: Exactly. You left them in a cash flow crisis because you didn't flow the funds at the appropriate time. There were three or four months when there were no funds flowed.
Mr Wessenger: I will ask for clarification from Mr Quirt on that matter.
The Chair: Mr Quirt, briefly please.
Mr Quirt: As Mr Wessenger mentioned, there have been two bridge funding initiatives to date. There was one that increased the funding for nursing homes and charitable homes for the aged, September 1, 1991. It did carry with it a requirement that nursing homes move halfway to the standard target of 2.25 hours of nursing and personal care per resident per day and move completely to 2.25 hours by April 1, 1992. At that point, an additional $1.32 was added to their per diem with no additional requirement for increased staffing.
You're quite right, the first bridge funding initiative required that all nursing homes come up to a minimum standard.
Some of the homes were above that standard and did not have to add any staff. Others were below it and had to achieve that consistent 2.25 hours.
The second bridge funding initiative did not require any additional staff time to be delivered on the part of the nursing home. That bridge funding initiative benefited both private sector nursing homes and charitable homes for the aged, which stand to benefit the most from moving to a level-of-care funding formula.
The Chair: If you have one last comment, that's fine, but I'm afraid we're going to have to move on.
Mr Pennings: I guess the point we would want to make is the fact that the commitment was clear that on January 1 of this year there was going to be funding in place. It was supposedly in place with this past legislation. That's not happened, nor has bridge funding. In the meantime our members are sitting there holding the bag, and frankly, we think that's grossly unfair.
The Chair: I think your point is clear.
Ms Westrik: The other point is -- just in a comment to Mr Quirt -- when was the funding finally channelled through to the nursing homes that was promised on January 1 and April 1? We were already in a serious problem last year, but because of the fact that long-term care was going to become a reality, everyone felt they could live with it and tried to work as expeditiously as possible towards getting it into place. Long-term care was already in place under the Liberal government. This was three or four years ago, and we're still talking about it. So in light of that, I still think we have a very serious financial problem out there. Like I said, that's why the violations are there.
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The Chair: Thank you both very much for coming and for making your presentation this morning.
I'd now like to invite the representatives from the York Region District Health Council to come forward, please.
Mrs Sullivan: Mr Chair, as the next presenters are coming to the platform, I wonder if we could have a written document from the parliamentary assistant that describes in detail the flow of funding to nursing homes on the basis of the new nursing care requirements. I recall, by example, raising a question in the House when it took the minister by surprise that in fact the money had not flowed for some months. The House was advised by the minister that there was a problem with the computers.
It seems to me that the minister and her officials knew when the funding was to flow, when the additional funding was to flow. There was a gap of several months. The funding was not made retroactive in a manner that covered any interest charges, so that the nursing homes were left in a position where the carrying costs of the funding that was not provided on time were left to the nursing homes. That has contributed to part of their cash flow problem.
Mr Jim Wilson: They're particularly worried now that Floyd's selling computers.
The Chair: The parliamentary assistant will provide that information as requested.
Interjections.
YORK REGION DISTRICT HEALTH COUNCIL
The Chair: Order, please. Members of the committee, we do have guests before us this morning. The Chair in particular wants to welcome the next witnesses, coming as they do from York region. Also, I think, if I'm not mistaken, that this is the first presentation before the social development committee. I believe that if you are not the youngest district health council, you are very close to it. I know I speak as well for Mr O'Connor in welcoming you to the committee. If you'd be good enough just to introduce yourselves, then please go ahead with your presentation.
Mr John Rogers: Thank you, Mr Chair. My name is John Rogers. I'm the chair of the York Region District Health Council. I thought you were going to tell us that we were the youngest-looking or the youngest members of a district health council in Ontario. Unfortunately, that can't be the case.
Mr Chair, I'd like to introduce to you Graham Constantine, our executive director. Graham has been with us for a relatively short period of time; he was brought on in December 1992. John Wilson is a member of the district health council. John will be making the presentation on behalf of York Region District Health Council.
Mr John Wilson: Creating a new direction for delivering human service is a major challenge, and the province is to be commended for its efforts to reform long-term care. The newly formed York Region District Health Council is currently gearing up its long-term care planning capabilities in order to play its part in reform.
The York Region District Health Council has only been in existence since June 1992 and has only had staff in place since late in 1992. Nevertheless, the council feels obligated to bring concerns from the region forward to the standing committee for consideration.
By way of background, I'm sure you're all aware that York region is the fastest-growing region in Canada, its population having doubled between 1981 and 1991. The region has a current population of 530,000 and covers an area of 425,000 acres. The vast majority of the inhabitants of York region reside in the southern part, while the northern part of the region remains largely rural. Just over 7% of the current population are 65 years of age or older, and an estimated 18% of the total population have one or more disabilities. The number of persons aged 80 years and older is expected to triple in the next 20 years.
Prior to the existence of the York Region District Health Council, the provincial government's long-term care area office and the Simcoe County District Health Council undertook an extensive community consultation process. The process resulted in 5,500 people participating in 261 consultation meetings held in neighbourhoods, people's homes, community centres, hospitals, churches, nursing homes and homes for the aged. In addition, 1,000 people also provided input through 600 individual and family feedback formats sent out through community agencies, 106 interviews with individuals, 96 briefs and letters, and 181 feedback phone calls and walk-ins.
As a result of this consultation, York-Simcoe presented over 300 reports and submissions to the government of Ontario provincial response centre, contributing advice to the Minister of Health, the Minister of Community and Social Services, and the Minister of Citizenship with responsibility for human rights, disabled persons, senior citizens and race relations, for incorporation into the policy decisions on the redirection of long-term care.
Through the consultation, the people in York-Simcoe indicated that they wanted to be independent and to make choices within a framework that ensures a community safety net of support services. They wanted short- and long-term care to be available when it was needed and they wanted these supports to assist them to maintain their dignity and enrich their lives.
Our purpose in bringing forward this brief today is to identify a number of common themes in this detailed and far-reaching consultation which do not appear to have been addressed adequately in Bill 101. We recognize that a number of other organizations have expressed similar concerns. However, our perspective is that the provincial government published its redirection paper in October 1991 and a great deal of effort and enthusiasm went into providing the opportunity for broad-based community consultation.
In undertaking this exercise, expectations have been raised that have not been realized in Bill 101. It is our view that in soliciting these comments on the document, the provincial government not then ignore the concerns raised. Our specific concerns revolve around the theme of "The reformed long-term care system must promote consumer independence, control and advocacy" in the consultation report.
Under Bill 101, as currently published, it would appear that consumers will be compelled to accept placement in a facility even if they do not believe it is in their best interests. Similarly, facilities are concerned that they will be forced to take residents that the facility is not capable of serving appropriately or whose placement will not be in the best interests of other residents or the individual.
Currently, despite the inadequacies of the long-term care service system, seniors face few obstacles in choosing the care and/or services which best suit their preferences and resources. Our concern is that Bill 101 is silent on the matter of consumer choice and appears to limit or eliminate the choices available to seniors. Similarly, we do not feel that the bill, in its current form, addresses the needs of elderly couples. From a compassionate standpoint, we feel there must be assurances that would permit couples to stay together in the same facility even though their individual needs may be different.
While we have heard assurances from government representatives that consumer wishes will be respected, we urge that these assurances be made explicit in the statute either in a preamble or, preferably, in the sections dealing with the issue.
Consumers, we've been told, also want a commitment to the concept of a full continuum of care within local communities. Consumers often choose to live in a given community because they consider that community to be their home. While they may, for reasons of health, come to need a variety of support services or even institutional care at some point, they do not want to be forced to leave the community they consider to be their home.
Consumers presently residing in facilities are also very concerned that they could be moved back to the community against their wishes. Consumers and their families are worried that the services they will require will not be available in the community and that individuals might be at risk. The bill, as currently formulated, does not seem to ensure that the applicants choices and preferences must be considered by the placement coordinator.
Against the background of the consultation process, the themes identified with regard to patients choice and continuity of care do not seem to be adequately addressed or explicated in Bill 101. We respectfully request that these issues be more fully developed through this standing committee.
The Chair: Thank you. We'll begin the questioning with Mr Wilson.
Mr Jim Wilson: Thank you for your presentation. I think it was succinct and to the point.
I would agree that much of what we heard in the public consultations isn't reflected in the bill. If I can, without being too patronizing, I particularly want to congratulate your region, along with my county, Simcoe county. Jack is to receive a great deal of credit. The public consultations that did take place were really quite impressive, and I was very pleased to see the extent of participation.
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I did hear, as you mentioned in your brief -- and it's the first time I've seen it; I've raised this and committee members are getting tired of the story. I remember one of the public consultations at Simcoe Manor in Beeton, where a couple of residents said to me afterwards -- they didn't want to say it publicly -- "Does this mean we have to go back to the farm?"
You mention that in the line here where you say, "Consumers presently residing in facilities are also very concerned that they could be moved back to the community against their wishes." This is the first time somebody's finally told the truth on that one, because there was a worry out there and how well-founded that is as a subject for debate.
I want to ask you about consumer choice and about facility choice, because I don't think you really touched on that, but we've heard a lot about it. Have you had the opportunity to make specific recommendations to the government with respect to this prior to today and, if so, what has the response been? You mentioned to the committee that perhaps we should do this in the preamble of the bill. I note that Dave Cooke, when he was in opposition, managed to get a preamble put into the Nursing Homes Act, which talks about consumers' choice in its attributive clause, which talks about respecting religious, cultural and linguistic characteristics. I just want you to comment on that.
Mr Rogers: Perhaps I'll let John give a more detailed answer, but I would like to emphasize that because we're such a new district health council we are just in the process of forming our long-term care subcommittee of council and therefore we haven't until today had an opportunity to come forward with recommendations with respect to this particular bill. I know John would like to comment on a couple of the points you've made.
Mr John Wilson: Yes. To address the question you've put, I'd make an observation on what appears to be the case when seniors are looking at their future and planning for their future. Very often what they attempt to do is to marshal all the options they have at their disposal and try and create a predictable future over which they have some measure of control. Part of the concern we see here is that at the point where the individual may need to go into a care facility of some kind, there seems to be a complete severance of that control and it appears that at that point, all of a sudden, they're going to simply have to go wherever they happen to be sent.
My observation is that the issue of predictability of the future for seniors, particularly as they see their health failing, is extremely important. We hear this again and again: "We want to know where we're going to be in five years. We want to see that there is a clear care stream we can follow and that whatever happens we know where we're going to be; we don't simply know that in five years there will be a hearing of some kind and we'll be sent somewhere."
Mr Jim Wilson: Along the area of placement coordination, we started off in the public discussion paper on redirection talking about 40 service coordination agencies -- I think I still have the term right -- and now we have this placement coordination layer that's going in. It does exist in some areas, but it certainly doesn't exist in others. Are we any farther ahead or are we somewhat behind?
You talked about raising expectations. When I sat through some of those public meetings, I was very worried that we were raising expectations beyond any government's ability to deliver, and it never once crossed my mind that there would be this sort of draconian placement coordination system this bill envisions. It's Big Brother at its worst as far as I can tell. The government will tell you its intentions are different, but you can't take those to the bank, so we will try and introduce amendments. Are we any farther ahead, do you think?
Mr John Wilson: I think from our standpoint we'll probably need to see the next set of policy announcements to get a real sense of how it's intended this will be worked out in practical terms. At the moment we've really got relatively little information on the change that's anticipated from the old service coordination agency to what's to follow.
Mr Jim Wilson: Okay, that's fair.
Mr O'Connor: I want to again reiterate what Mr Beer says. Though members of the Legislature from York region may disagree on a number of things, one thing we were quite overjoyed about was the fact that we finally got the district health council up and running. In fact your presentation here today shows a commitment that you're going to be an active one. I hope we can meet on a regular basis. When you feel that a piece of legislation is directly going to affect the community you represent, we'd like to hear from you, and perhaps even more often.
I know that the chair of the DHC will realize, as a lawyer, that sometimes in legislation the intentions that are meant to be put into the legislation don't always get put into a language that the lawyers seem to like to put things into. In the consultation paper that went out -- and you've talked about it in your brief, the renewed vision and the primacy of the individual rights for dignity, security and self-determination. Some of that doesn't show up in the legislation. I don't know how we can challenge lawyers to perhaps make legislation a little bit more human. I guess that's a challenge we can throw out to them.
Knowing that York region is new, in fact last night had a meeting that was facilitated by the district health council to talk to people about the long-term care subcommittee and how the role of the DHC is going to fit in there, the question -- just maybe going along the same lines as Mr Wilson's phrase -- was somebody from the placement coordination service, which is provided, I do believe, by the VON in York region now, there last night?
Did you feel that during the conversation that did take place there could be a problem there? Because I know that as we're looking at this legislation we want to try to make sure we're keeping everything in mind. Perhaps you can bring us something quite fresh that we haven't even had a chance to hear in this committee, as you had the meeting just last night.
Mr Rogers: At the meeting last night actually I don't think there was a specific representative from VON who certainly identified himself or herself as being from VON. I have a meeting, along with Mr Constantine, with VON in a couple of weeks' time and that is going to be one of the topics of conversation, I'm sure, at that time.
Again, the purpose of the meeting last night was really to hear from Mr Harmer about the long-term care reform process in York and to establish how our committee would be structured in order to take into account all the various concerns raised in the community. At this point I wouldn't want to say we had a discussion last night about it, but I think from the results of the discussion on the makeup of the committee we will be having those types of discussions. We will have the opportunity to discuss it with both VON and any other persons who are interested in that specific aspect of long-term care reform.
Mr O'Connor: You've mentioned right in your brief the vast size of York region, that you do take into account the rural areas. There are a substantial number of long-term care facilities in the outlying areas that should be represented so that we have people from those communities involved as well. I'm sure you will take that into consideration.
Mr Rogers: Yes, that was a very clear aspect of the decision, that the geographic representation of the region would have to be fully represented on that subcommittee.
Mr O'Connor: Thank you very much. Thank you for appearing.
The Chair: Thank you. I'm going to briefly lift my hat as Chair and, just as a member from York region as well, explore a couple of things I think that both Mr Wilson and Mr O'Connor have done, partly around the emerging role of the district health council in long-term care, but particularly because during the last few years in York region the regional government has been indicating a greater interest in the area of health and social services.
I wonder, in the thinking that you have been able to do to date, and I quite understand that you're at the beginning of this process, how do you see that link between the district health council and its responsibilities as put forward by the Ministry of Health and the responsibilities of regional government in developing the long-term care system for the region?
We'll let the former mayor answer that one. We can't just accuse you of being a lawyer.
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Mr Rogers: Exactly. I'm being painted with all the worst sides on that list of items that people admire in people.
The Chair: If I might, for anyone reading Hansard, as the chair of the district health council, you were the former mayor of Georgina for a number of years. But I just think, as you're going to answer this, that this is one of the critical issues as we go forward, who is playing which role and how we see that working out.
Mr Rogers: I think it would probably be appropriate at some point to meet not only with us but with representatives from the region of York.
The Chair: They're here tomorrow.
Mr Rogers: You should have had them today. The region of York staff and ourselves have had a number of meetings, and we're just in the process now of trying to establish a good working relationship with region of York staff. It's centred not only on issues such as long-term care but on other issues as well.
I think we need, as a DHC, to take a much more prominent role in the issues of long-term care and long-term care reform, and I certainly see that as the role government is currently asking DHCs to play. We need to be able to work in close conjunction with the regional municipalities and any other agencies that are in the area to ensure that the direction is an appropriate direction that will look to the needs of the people we're serving, not to look to the needs of the DHC, the provincial government or the regional government.
We're there, in my mind, to ensure that the grass-roots organizations are listened to; that in the facilitation of the process of long-term care reform, the region is responding to those needs; that we work as honest brokers, a term you may have already heard a lot of DHCs using; that we are able to facilitate the process and make sure that the views of both the region and the province are known; that we can see how those all function together, again emphasizing the fact that the residents, the people we serve, are the people who are going to come out in the end as being properly served.
The Chair: If I recall correctly, there are three representatives from regional council who sit on --
Mr Rogers: Four representatives.
The Chair: Okay. Thank you. Mr Wessenger had a point of clarification.
Mr Wessenger: I just note your statement about consumers being concerned about being moved from a facility and I'd like to assure you that there's nothing in the legislation that would permit a placement coordinator to move a person out of a facility, except if that person had an outstanding application to another facility and wanted to move to that other facility.
Mr Rogers: To respond to that, we understand that the legislation doesn't have anything in there that says it can happen, but what we are more concerned about is that it doesn't have anything that says it can't happen. All that we're asking is that through the preamble or a specific legislative statement it be clarified that the wishes of the resident, the patient, be one of the primacy concerns of that placement coordinator in his decision-making process.
Mr Wessenger: I might just ask then, what you're really looking for is some statement of consumer choice in the legislation?
Mr Rogers: Yes.
Mr Wessenger: Fine. Thank you.
Mr O'Connor: Any suggestions as a lawyer?
Mr Rogers: The PA is a lawyer as well.
The Chair: Too many lawyers around here today. On behalf of the committee, thank you for coming this morning. I'm sure that we'll see the York Region District Health Council before this committee on other issues, and we're glad that we were able to offer you your first visit. Thank you.
TORONTO MAYOR'S COMMITTEE ON AGING
The Chair: I now call our last witness for this morning, the Toronto Mayor's Committee on Aging. If those representatives would be kind enough to come forward, welcome to the committee. If you would be good enough to introduce yourselves, then please go ahead.
Mrs Diana Morgulis: I'm Diana Morgulis. I'm chair of the Toronto Mayor's Committee on Aging. With me is Councillor Amer from the city of Toronto council, who is the mayor's appointee to the Toronto Mayor's Committee on Aging; Rita Luty, vice-chair of the Toronto Board of Health; Dr Norman Bell, chair of the subcommittee on long-term care for the Toronto Mayor's Committee on Aging; and Margaret Bryce, the coordinator and staff to the Toronto Mayor's Committee on Aging.
Before I begin, I'd like to ask Councillor Amer if she would address some remarks to you about council's position.
Ms Liz Amer: I'm here representing Mayor June Rowlands and members of city council. I will not be speaking to you on the specific issues that are before you this morning; Diana Morgulis, our chair, will be doing that. But I wanted you to know that on February 22 the city of Toronto council endorsed the presentation that you're going to hear from the Toronto Mayor's Committee on Aging this morning.
The Chair: Thank you.
Mrs Morgulis: Council also affirmed its position that it took on the long-term care reform last February 3 and 4, 1992, wherein it requested the then Minister of Health to grant new nursing care beds in the city of Toronto only to homes for the aged or nursing homes operated by non-profit corporations or by Metropolitan Toronto, and further requested that when beds are being reallocated among homes for the aged and nursing homes the proportion of long-term care beds operated by non-profit corporations and Metropolitan Toronto not be reduced.
Toronto and the Toronto mayor's committee also believe that planning for allocation and reallocating long-term care beds within the city of Toronto should be a shared responsibility between the province and the municipality. I'd like to say that the city of Toronto does wish to be involved in the planning and approval process for those beds. We want to be also assured that the province and the city will be involved in coplanning supportive housing program, which is proposed to accompany the reform in long-term care.
We are very pleased to have an opportunity to speak to you today because Bill 101 deals specifically with care provided in nursing homes and homes for the aged, but because that care is part of a much larger system, our comments deal both with your Bill 101 and with other services within the continuum of long-term care. We hope that our comments will help your committee ensure that the changes proposed in the bill conform to our collective vision of how we should care for older people in the province.
We support the proposed quality assurance plan, the plan of care, funding for the level of care and placement coordination. We believe these issues are very important.
Bill 101 mandates a new system for coordinating the placement of elderly people in nursing homes and homes for the aged. While placement coordination has operated successfully through placement committees in other regions of the province, it's completely untried in Metro. We therefore provide some comments to assist in the implementation of this new program in Metro which, by virtue of its size, complexity and diversity, has special needs, not the least of which are the ethnocultural needs, the needs of neighbourhoods and the needs of the committed communities that have already articulated their expectations around long-term care issues.
The bill provides for a placement coordinator to be assigned to each home for the aged and each nursing home. We feel the coordinator should be a worker who's directly involved with the home rather than an employee working at some distance in a centralized office. The placement coordinator should facilitate the admission of elderly people into a home of their choice in their own community. The home should be able to respond to both personal and cultural needs. We feel that's essential.
Community-based homes should continue to offer service which is tailored to their geographical or ethnocultural communities. We shouldn't expect that people be admitted who are not members of a group targeted for service.
Both the placement coordinators and appeal board have considerable private power under this bill, and we believe the minister should appoint a citizen advisory committee to ensure that the eligibility and appeal processes are accountable to the public and to the Legislature. The committee should be established in consultation with seniors' organizations.
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As Bill 101 deals with an admission process to care funded by the government, it's silent on the question of residential care. As you know, residential care is not funded by the province, but by the individual senior. It's available to people who require less than 90 minutes a day of personal care and nursing care. But two-thirds of the beds in charitable homes for the aged in Metro Toronto are currently designed for residential care, and many older people who are now in residential care require considerable care.
During the consultation on long-term care reform, we often heard that the government planned to end the residential care program. We hope this bill does not mark the end of residential care programs in homes for the aged, because if it does, there are a number of consequences on the rest of the system.
There would be pressure on the groups which provide supports in the community to replace residential care. But over the past few years funding for those community services has been systematically cut.
This bill deals only with the institutional sector. It hasn't a companion bill or the assurance of political will to fund home support services and home care in the community. Institutional care can't be treated, therefore, in isolation. There has to be simultaneous progress in providing universal care in the community if the bill is going to work.
Beds will be reallocated within homes and between the homes in Metropolitan Toronto. At least one home for the aged in Toronto has said it will sell its building and move to a new location outside the city of Toronto. This concerns the Toronto mayor's committee and the city of Toronto very much. We want to ensure there are non-profit homes for the aged within the city of Toronto to serve its residents, and we believe the city of Toronto is entitled to be part of the planning process.
The council of the city of Toronto has asked the minister to forgo the expansion of for-profit care, and when beds are reallocated, care must be taken to ensure the proportion of beds provided by charitable homes for the aged has not been reduced.
The supportive housing program proposed to accompany the reform of long-term care should be introduced as soon as possible, and we believe the city of Toronto should be part of that program of planning.
In terms of the quality of care, we are pleased by the concept of quality assurance planned for each home. We've consistently advocated more accountability in the long-term care system.
Your bill says only that a resident has a right to see a plan of care, and we believe the bill should state explicitly that the plan of care requires the consent of the resident or the resident's delegate.
We feel there should be regulations developed to limit the use of physical restraints in homes for the aged and nursing homes. If restraints are to be used, they should be included in the plan of care and discussed with the person delegated to make those decisions.
Under regulations, we feel there should be a limit of moving a resident to a locked ward. It should require notice to the delegated decision-maker and to an advocate.
There is a bill of rights for residents of nursing homes and a residents' council for each nursing home. The Nursing Homes Act also requires that suspected cases of abuse be reported to the director of the nursing homes branch. We believe these same protections should have been extended to residents of homes for the aged under Bill 101.
The bill proposes to provide funding based on the level of care of each resident. This will be provided on the basis of a mix of cases in each home. However, we've been concerned for a number of years by the cutbacks in provincial funding to Metro homes for the aged. The new payment system should allow Metro to continue to provide the excellent care for which it's known. An arbitrary limit shouldn't be imposed on homes which have a number of residents requiring extra heavy care.
We applaud the introduction of a program for adults with disabilities to direct their own care in their homes. The regulations should make it clear that elderly people, including people with dementias or multiple disabilities, will also be eligible for this program. We have found that programs for people with disabilities are sometimes available only to those between the ages of 16 and 65.
Under current legislation, homes for the aged provide emergency shelter for older people. Bill 101 is silent on this. Many of those who suffer abuse are beyond 65, and we don't have emergency shelter. Shelters designed for women and children are not a suitable environment for many older people.
The Toronto Mayor's Committee on Aging has played a significant and stimulating role in public discussion, and indeed in forming the political will to resolve the problems in long-term care. We have sponsored two major conferences, hosted several smaller workshops, worked with community groups and written numerous letters and briefs, and we have made statements to the press. We've also worked within our own political system through the long-term care negotiating team and the reference group of the city of Toronto, which are responsible to the executive committee of council.
I thank you for giving us this time. I would like to invite any of my copanelists to address you, if that's appropriate, Mr Chairman.
The Chair: If anyone has anything they wish to add, that's fine. Otherwise, we'll move on to questions.
Dr Norman Bell: Perhaps you would allow me, Mr Chairman, to take note of the fact that this, Bill 101, is a birth which has been a rather long time in coming. Since the early 1980s, the crisis in our long-term care system has been quite evident to virtually everybody. There have been a variety of proposals coming forth and statements from within government -- the previous government and the government before that -- about the directions of this or strategies for change of this, so we are really on the brink of a major event. This will be the first visible legislative piece of paper which will give some kind of substance to all of those discussions which have been going on for so many years. And with due respect to the people who draft bills, I find this an eminently unreadable bill.
Mr Jackson: Sort of like your prescriptions.
Dr Bell: I would hope it is possible, as previous delegations suggested, to state or restate some of the general thrust of what this reform or redirection is about. Otherwise, the bill seems to get lost in a lot of detail. What need emphasis are those general principles of informed choice, of quality assurance, of accountability. There is no difference, I think, with the Toronto mayor's committee that these are desirable ends, and we would like to work with you to make sure those desirable ends are very clearly stated, are there and are seen to be there, in this important piece of legislation.
The Chair: Thank you. We'll move to questions. Mr Wessenger.
Mr Wessenger: Thank you very much for your presentation. I'd just like to ask you a question, first of all, then I'd like staff to give some clarification with respect to some of your comments.
You indicate that you think there should be a citizens' advisory committee with respect to the placement coordination operation. First of all, I'd like to indicate that it's envisaged that the placement coordinator would be subject to a board. There would be a community board that would oversee that, not being a government employee. Do you still think, in view of having a community board, that it's necessary as well to have a citizen advisory committee?
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Mrs Morgulis: I think boards, to be effective, are small, and may not represent the entire community. If we're looking at an area the size of Metropolitan Toronto, it's very hard to be thoroughly representative without receiving some advice as well. In terms of Metropolitan Toronto and its breadth of service, we haven't had the experience before. I think it would be wise.
Mr Wessenger: Just a question that's somewhat related to that, in connection with long-term care facilities: the question of residents councils. Do you feel that residents councils by themselves are sufficient for accountability purposes, or should residents councils be expanded to include family and community members or would it be better to have a separate, say, community committee for each long-term care facility?
Mrs Morgulis: Now you're asking for a personal opinion.
The Chair: We welcome that too.
Mrs Morgulis: All right. This is not a position of the Toronto mayor's committee. I think residents councils are essential for the residents to have their representation, or to have their decision-maker be part of that process if the resident himself can't. I think it's also helpful to have a council of outsiders -- the family, the care giver beyond the home. I don't see them supplanting the residents council.
Mr Wessenger: No. You see them as two separate committees as being more desirable.
Mrs Morgulis: Yes.
Mr Wessenger: Thank you very much. I'm going to ask Mr Quirt to comment on some of your aspects about residential funding. I think it needs some clarification.
Mr Quirt: Just to clarify three points briefly, on page 3 you mentioned that residential care is not funded by the province but by the individual senior. In fact, it's funded by both the province and the individual senior. Residents in residential care are asked to pay the full costs of their accommodation, programs and services, but if they're unable to do so, then the balance of that cost is paid by the province at 70% and the municipality at 30%.
So all the residential care beds in municipal and charitable homes will be funded under the new levels-of-care funding formula, but they'll be funded in a different way. There won't be the designation of residential care and extended care any more. All those residents, all those beds, will continue to be funded under the new system.
Second, there has not been a systematic reduction in funding for community support programs from the province in Metro Toronto. It's been a systematic incremental increase in funding for community programs for seniors and people with physical disabilities, and there will be increased funding for Metropolitan Toronto as a result of the commitment of $441 million provincially for new long-term care programs.
The third point is with respect to the funding for municipal homes for the age. The provincial funding for the municipal homes for the aged in Metro Toronto has not decreased. Up until 1989, the funding was on an open-ended basis; in effect, municipal council decided how much provincial funding would be spent on homes for the aged in Metro. For the past four years, the province has limited the increase in funding to an inflation factor, but the funding continues to steadily increase, as opposed to decrease.
The Chair: Do you have any questions or comments before we move on to Ms Sullivan?
Mrs Morgulis: It's quite true that the level of funding has increased marginally. However, the level of care that's been required by those residents in the facilities has not increased marginally; it's increased exponentially over time. So the effect is that there's been a decrease in funding for the care that's been needed. That's the effect.
Mrs Sullivan: Thank you very much for your brief. Actually, that last point is a concern not only in Metro but elsewhere, in that people going into long-term care facilities are entering those facilities with more acute health care difficulties, and similarly in the residential care sector.
I was interested in a couple of points you raised, one of them relating to your emphasis on the non-profit preference; indeed, you're saying the only choice. We have documentation, a summary of form 7s which are submitted by nursing homes, which divide the for-profit sector results from the non-profit sector results in the nursing home industry itself. Frankly, the significant issue about those figures is the bottom line, which shows that, per bed per day, the for-profit sector lost $2.01 in 1991 and the non-profit sector lost $4.86 per day per bed.
How are we going to accommodate delivery of services, whether it's for-profit or not-for-profit? In my personal view, we need a balance, because we cannot afford to take over private sector nursing homes and there's good care provided in private sector nursing homes. But how are we going to afford to deal with these kinds of bottom-line issues which are endemic to the industry, whether it's non-profit or profit, and indeed where the non-profits seem to be going more and more deeply into debt than the for-profits?
Mrs Morgulis: I wish I had a ready answer for you. I don't. I know funding is a problem, but I think the basic principle is that we didn't want to see public dollars spent to line private pockets.
Mrs Sullivan: These reports show they're not being lined. That's the trouble.
Mrs Morgulis: Should it get to a break-even point and beyond, then it would, and I think we were concerned about the individual taxpayer wanting to make sure that the money was as well spent in the public domain as possible.
The Chair: Mr Wilson.
Mr Jim Wilson: Thank you for your presentation. That was a point I wanted to pick up on too, in terms of taking the opportunity to emphasize the importance of the private sector, the commercial sector in the delivery of nursing home services. What you just said is tell-tale of the attitude that's out there among a lot of people, that somehow private operators are lining their pockets with profit. Frankly, private operators do us a great service in this province in that the government doesn't have to put up capital dollars; they build the bricks and mortar, invest their life savings, put their good names on the line and borrow from the banks. Somehow CUPE yesterday was disturbed that the banks own most of our nursing homes. Well, maybe that's an indication that there isn't a lot of profit being made out there.
There are horror stories in the municipal sector and the charitable sector, as there are in the commercial sector. I'm well aware of that, because since this legislation was introduced, many commercial operators and many consumers have come forward with stories. I think it's unfortunate, though -- and I'm part of the problem -- that in these hearings we've concentrated on the not-for-profit sector bashing the for-profit sector. I want to make it clear that we believe that municipal homes are, by and large, doing an excellent job, as we believe charitable homes for the aged are, and it was always the policy of both the Conservative governments and I believe the Liberal governments to have a mix. Although we did state a preference from time to time for the not-for-profit sector, I think the statistics show that there was a heavy and increasing reliance on the commercial sector.
It disturbs me when people say you shouldn't make a profit off health care, when in fact those profits are reinvested into expansions or keeping up the capital, for the most part. I know a number of nursing home owners, and they're certainly not rich. In fact, I wonder why they're in the business at all.
I wanted to ask you specifically about a point you raised on page 3 in your brief, where you say, "The minister should appoint a citizen advisory committee to ensure that the eligibility and appeal processes are accountable to the public and to the Legislature." Other groups have suggested that a similar mechanism be put in place. Some groups have suggested that perhaps we should put in an interpretative clause or a preamble to the placement coordination section of the bill to ensure that placement coordinators take consumer choice into consideration: ethnicity and linguistic choice and a number of other factors.
My worry about a citizen advisory committee is that we're adding to the bureaucracy, adding to the number of players in this. Would you maybe change that to a preamble, if we could work something out with the lawyers on that, or should we be looking at a better appeal mechanism?
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Mrs Morgulis: I think we want a separation between the service deliverer and those coordinating the services and those who are hearing the appeal. If that can be separated in some way in a preamble or in legal terms, that would satisfy the appeal end of things. As I said before, if you can accommodate it in a preamble to have the citizen advisory looking after the needs of the Toronto region, I think that would help, but in a bill you're looking for something that's universal for the province; you're not looking for specifics for a region or an area.
Could I ask you if we could have a copy of that summary report you referred to between the for-profit and the not-for-profit nursing homes?
Mr Jim Wilson: I think Mrs Sullivan referred to that. She'll be happy to give you a copy of it.
Mrs Sullivan: I'll get a copy for you.
Mr Jim Wilson: The last question I have is really a general question. Given the track record to date on funding from various governments, it seems to me that we have mandated in this bill levels-of-care funding but not necessarily levels-of-care funding, because it's a limited pool of money. What's your confidence level that the funding will actually match the higher levels of care that I believe you're going to be asked to do? Mrs Sullivan put it kindly when she talked about higher levels of acute care. Frankly, you're going to be asked to look after older and sicker people. Before they can even get into your homes, if one looks at the eligibility criteria, they must exhaust all community-based services -- it's very much a medical model -- and have to be in pretty rough shape, I think, before they're going to be allowed into a home.
Mrs Morgulis: My experience is not working in a home, although I rent office space within a home. I run a not-for-profit charitable community-based organization providing home support services to the elderly and elderly persons' centres activities.
I agree with you, it is a medically based model. It is not everything that the Toronto mayor's committee heard and wished to have as a model. We were looking for a social service/medical/holistic model. If this is what we have to work with, you're right, it's going to be very, very few who can make and manage all the entry criteria, and it's going to fall on to the community services such as ours to provide that catch-up and fill in the gaps.
Mr Jim Wilson: I think the doctor wants to make a comment.
Dr Bell: I just wanted to make a personal observation. To discuss these matters in terms of profit and not-for-profit homes is important, but it is not the only distinction that needs to be made. One of the perennial problems is the blockage in the system at the acute-care level of hospitals, with sometimes 20% of their resident populations being elderly people. These issues need to be thought of in terms of the fact that the people don't go away but get shoved into other places, so one has to think about where it will pop out next if some action is taken at one level.
That comprehensive view of the whole system, including the home care community-based services, needs to be always kept in view, and we think a local community input is pretty essential to understanding those kinds of transfers of populations and finding the best possible solutions. There is no magic wand in this area, but we believe that with an active citizens' group and committed government at the city and the metropolitan level, solutions can emerge from these kinds of discussions, given the right legislative backing.
The Chair: Thank you very much for those comments. You noted at the end of your brief about the conferences, workshops and various things you've done. I believe I had the pleasure of addressing one of those conferences at city hall.
Mrs Morgulis: You did.
The Chair: I was struck by the number of people who attended the conference that particular day -- if I recall, I think the whole place was packed -- and the interest your body has really furthered in terms of this whole discussion. You have done an excellent job, and we appreciate very much you coming before us today and helping us with ours. Thank you again. The committee now stands adjourned until 2 o'clock sharp.
The committee recessed at 1206.
AFTERNOON SITTING
The committee resumed at 1403.
ADVOCACY CENTRE FOR THE ELDERLY
The Chair: Good afternoon. We begin the Tuesday afternoon session of the standing committee on social development. We're here to review Bill 101 on long-term care. Our first representatives this afternoon are from the Advocacy Centre for the Elderly who have shamed all of us members by not only being here, but being at the table and ready to go. We welcome you to the committee. If you would be good enough first off to introduce yourselves for Hansard and for the committee members, then please go ahead with your presentation.
Ms Susan Chernin: My name is Susan Chernin. I'm with the Advocacy Centre for the Elderly. With me are George Monticone, a staff lawyer at the advocacy centre; Elizabeth Budd, a student at York University who has been assisting us in a volunteer capacity; and Evelyn Turner, a member of our board of directors.
The Chair: Welcome to the committee.
Ms Chernin: We'd like to thank you first of all for this opportunity to present. We recognize that you will not perhaps hear anything particularly new today since you've been sitting here for almost a month now listening to people's comments. However, we do hope to reinforce some particular areas of concern.
Our concerns are simple and direct and are all focused on the need for a more client/consumer-directed process. To allow as much time for questions, you have a brief that we have submitted. I will just highlight some of those areas and read the recommendations. Then we can have some time for discussion.
The first area is conditions of admission, and the first among those is consent to admission. We consider this to be a fundamental right which must be protected. It is critical to a consumer-directed process that it be in the body of the legislation. Although it is obvious to all of us sitting here that it is unlawful to admit, discharge or transfer an individual without his consent, this is not obvious to many service providers and is not obvious to all seniors, and it happens all the time. The problem is not with the long-term care facility usually; the problem is usually with the acute care facility putting a lot of pressure on individuals to vacate.
It is too important a principle to be relegated to the regulations. To not embrace consent in the body of the legislation is to feed the confusion and to encourage that this fundamental right be violated. Our first recommendation, therefore, reads as follows:
We recommend that subsection 9.5(5), and subsections 18(5) and 20.1(5), respectively, in Bill 101 be amended and read as follows:
"(5) A person may be admitted to an approved charitable home for the aged, municipal home or nursing home only if,
"(a) the person or his or her legally authorized substitute decision-maker has consented to placement to the home."
You'll note that in (b) and (c) these are simply the very same conditions already set out in Bill 101. We've just numbered them (b) and (c) because we actually consider them less important than the first point, which is consent.
The second recommendation under this heading is:
We recommend that if there are reasonable grounds -- actually, I forgot to make a reference to this point. As well, under the conditions of admission we note that there may be grounds for refusal by the licensee. We are at a loss to know what those grounds might be, but we are concerned that they be set out in the regulations and not set out in the statute, so we make a further recommendation on that point, which is:
We recommend that if there are reasonable grounds under which a licensee may refuse admission to an applicant, these grounds be spelled out in the statute and not be relegated to the regulations where they may be changed without the benefit of public scrutiny and debate. We further recommend that applicants have the right to appeal a refusal to admit on the part of the licensee.
The point really in this section is that these matters are too important to be relegated to the regulations where they can be changed by technicians and not through public debate and public scrutiny, as is happening right now.
The Chair: I may have misunderstood, but I thought with the second one you say you want that spelled out in the statute, not in the regulation, so it's the same for both.
Ms Chernin: It's the same for both. Actually, the more important issue is consent to admission, frankly. It's just that it comes under that heading.
The Chair: I think I misunderstood because when you first started to speak on number 2, I thought you had inverted it --
Ms Chernin: Did I?
The Chair: Anyway, by my interjection, it makes it clear.
Ms Chernin: If I did, please let the record show --
The Chair: It may have been the Chair was asleep or something.
Ms Chernin: Anyway, both are significant.
The Chair: Anyhow, that's clear. Sorry; please continue.
Ms Chernin: Feel free to interrupt at any time.
The second area of concern is the appeals of decisions regarding eligibility and placement. Upon an initial reading of Bill 101, there was some excitement about the appeal process until one realized how limiting it was. In our experience eligibility is not the most common or the most contentious issue. We have had only two to three cases in our nearly 10 years experience at ACE regarding eligibility issues.
Placement, on the other hand, is a very contentious issue. Rarely does even a week pass that we haven't had some intake or call regarding concerns about placement. It is critical to a consumer-directed process that this be incorporated in the act.
Because we are unclear about the shape of a long-term care structure and we don't know what bed shortages there may be or what limitations there may be on community-based services, eligibility may indeed become a very contentious issue in the future, so we are suggesting that this remain.
Therefore, recommendation 3 reads as follows:
We recommend that an appeal mechanism be established in the statute to allow the consumer or his legally authorized substitute decision-maker to appeal decisions of the placement coordinator made in connection with the authorization of placement to specific long-term care facilities and that this appeal mechanism be in addition to that provided for appealing decisions regarding eligibility.
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The third area of concern is the nature of the proposed appeal process. On its own, it is simply too formal. We need something more tailored to meet the needs of this particular client group. Many of these individuals, we must anticipate, will be facing some infirmity. They will lack confidence and often language skills. We need something that's more easily accessed, more expeditious and also one which respects confidentiality.
Mediation and arbitration are two conflict resolution mechanisms that should be considered. The board can be a further or an alternative safeguard to this process.
Therefore, recommendation 4: We recommend that a less formal conflict resolution process be established as preliminary to or as an alternative to an appeal to a statutory board to address disagreements between the placement coordinator and the applicant with respect to eligibility, particular placement or the receipt of community-based services.
Recommendation 5: We recommend that an appeal process be in camera at the discretion of the applicant.
We've alluded to community-based services and we turn to that now as the next area of concern. As you're all well aware, those of you who've been involved in long-term care reform for many years, one-stop shopping has been a theme. We're not clear if the placement coordinator is the vanguard of this structure. We want to know whether or not they're going to be the gatekeepers to community-based services as well. If so, a conflict resolution process must be in place for them as well regarding community-based services. Furthermore, it will be important that a person seeking community-based services is not detoured to a placement which is deemed "more appropriate" by a mechanism of refusing to provide services in the community.
Recommendation 6: We recommend that Bill 101 state clearly and unreservedly that the placement coordinator cannot refuse a person access to community-based services on the grounds that placement in a long-term care facility is more appropriate.
Recommendation 7: We recommend that whatever method of dispute resolution is adopted in Bill 101 for resolving disputes regarding eligibility for and placement in a long-term care facility be adopted for resolving disputes regarding the appropriateness and amounts of community-based services.
The fifth area of concern is the additional protections for residents of charitable institutions and homes for the aged. In non-care facilities tenants have protections regarding rent increases and eviction under the Landlord and Tenant Act and the Rent Control Act. Nursing home residents have protections regarding discharge, restraints, treatment etc in the bill of rights. The bill of rights should be extended to charitable and municipal homes for the aged and enforcement mechanisms should be considered. Similarly, Bill 101 should incorporate a direction to establish residents' councils.
In the executive summary I should point out that -- I don't know if you say typographical error now or just computer error -- numbers 10 and 11 are actually a repetition. Number 10, you can find in the body of our brief.
Number 8 will read as follows: We recommend that the bill of rights presently embodied in the Nursing Homes Act, RSO 1990, as amended, be incorporated in Bill 101 to give protection to residents in both charitable homes and municipal homes for the aged.
Recommendation 9: We recommend an enforcement mechanism for the bill of rights.
Recommendation 10: We recommend that Bill 101 include provisions directing the establishment of residents' councils in both charitable and municipal homes for the aged similar to those provided for in the Nursing Homes Act, RSO 1990, as amended, specifically section 29.
Finally, our concern about the plan of care: Again, the plan of care should reflect a consumer-directed process. Presently, as it is set out in legislation, it is passive. It is to be given to the residents at their request. We do recognize that such participation in the plan of care is set out in the standards of care, but again these are policy directives and they are subject to change. It is important that the legislation itself reflect the importance of direct input by the consumer.
Recommendation 11: We recommend that Bill 101 be amended to reflect the importance of residents or their legally authorized substitute decision-makers participating directly in the development of the plan of care.
So I suppose if there's a theme to our recommendations, it's that it should be consumer-directed and that this consumer direction should be incorporated in the body of the legislation. Although we all know that there are safeguards in other places, other people don't respect those safeguards, and they really must be stated clearly and unequivocally.
We're happy to respond to any questions.
The Chair: Thank you very much both for the specificity -- and I hate that word -- of your recommendations, which I think address some very clear points, as well as the text, which we'll be able to consult as well.
We'll begin the questioning with Mrs Sullivan.
Mrs Sullivan: Thank you. I thought this was an interesting brief, and I have two questions or comments.
The first is with respect to your suggestion that the consent of the person or the person's substitute be involved before the person is placed. I would think perhaps not right now, but at some point, because a couple of other organizations have made this point as well, it would be useful to have an opinion from legal staff as to whether in fact a placement in a home is covered by either the common law of consent to treatment or, when the consent to treatment bill comes into force, if in fact one is consenting to a course of treatment in consenting to a placement in a home, and if they're linked up, if it's automatically covered or not. You're not the first group to raise that issue.
The second issue that I wanted to raise with you is the appeal process. In my view, and we will be talking more about this in our own caucus, the appeal process that's presented in this bill is a flawed one. The Health Services Appeal Board is one that is perhaps not an appropriate mechanism of appeal when the decisions may in fact be highly personal, highly regional, and where that seems at arm's length, very formal and so on, and the only alternative after that, of course, is Divisional Court. When we're dealing with people who are speaking about choices which, depending on how cognizant they are, may well be life choices or may well be choices leading to a happy death, if you like, the appeal process is something that I think one has to be cautious about. I don't think this is the right one. I think you've been talking about involving people in something that's less formal. Can you talk a little bit more about that?
Mr George Monticone: If I may speak to that, yes, I think there is a need for something less formal. Perhaps the most urgent need here is that the appeal process be expeditious. We're talking about people who are suffering infirmities and in situations that may be less than ideal wherever they're living, at home. So there's a real need for that.
There's also a need to eliminate as much as possible the intimidation factor, and I can't overemphasize that. Individuals who are not well, who are facing the possibility of a move to a home, which they may not regard as a positive thing, will be intimidated by the need for a formal process. If there is some way that we can find to make it less intimidating, I think it's absolutely critical to do that.
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I believe in the United States there have been experiments with mediation in situations like this. Perhaps that's appropriate. The problem with mediation, however, is that a decision doesn't necessarily ensue, and if the parties cannot come to an agreement, then nothing is resolved.
Hence we might want to look to something more like arbitration. The reason I mention that is because the arbitrator may be given some responsibility to fact-find and take some of that responsibility off the shoulders of the individual who is appealing. That may make it much less intimidating.
I don't have the final solution here. We are really inviting you to think about these as creative alternatives to a straightforward statutory board.
Ms Chernin: Also, there could be a number of different alternatives that might be available, depending upon the circumstances, and we're also not dismissing the possibility of a board being appropriate under some circumstances or as an eventual process. If you're going to be embracing things beyond eligibility, I think it will break down -- if you're going to be covering placement, which I think you should be doing.
Mrs Sullivan: Certainly we want to think more about this as being a major flaw in the bill, and if you can put your mind to it a little more and provide us with more information on that particular aspect, I think that would be useful.
Mr Jackson: First of all, I'd like to thank you for the focus of your brief, for there is a lot more, I know, you would like to have commented on. But in the context of advocacy it's very individual-oriented and -directed, and I appreciate that.
That's why I want to explore further recommendation 1, which I appreciate your wanting in legislation and not in regulation: the context of the person's right to consent not to go into a facility. I want you to cast your mind to the notion of the discharging, and although you don't come right out and say it, it's implicit in discharging from a location and having a certain impact on that decision. Is there a reason you didn't include the discharging from a facility, and just whether your recommendation 5(a), "The person or his or her legally authorized substitute decision-maker has consented to placement to the home"?
Ms Chernin: Clearly, most placements -- I shouldn't say most placements, but maybe most placements -- come from some other type of facility and it's usually an acute-care hospital. In my work as an institutional advocate for over seven years, it's been very helpful even though, as I say, we know it's against the law to transfer someone involuntarily. It simply is, but there are tremendous pressures on these individuals to vacate the bed they're taking in an acute-care facility. We're not suggesting they say no to placement; simply that they consent to placement, which I think is a different twist which means they're involved in the process of choosing. There may be limited choices, but they will be choosing.
Mr Jackson: You can't give consent unless you're informed.
Ms Chernin: You have to be informed.
Mr Jackson: That's the principle in law.
Ms Chernin: Exactly. We're not saying that someone can say, "I'm going to stay in the hospital for a long period of time." I think the concerns people have is that they'll be bed-blockers, which we know --
Mr Jackson: That scenario I understand. I guess I could have been more specific. I'm concerned about a growing acuity rate in a system that says, "We think, even though you've been in this nursing home for two years, you really don't need to be here and therefore we need you to leave in order to make room for someone else."
Ms Chernin: In a nursing home?
Mr Jackson: Or any kind of facility where there's a greater acuity rate and the placement coordinator wants to deal with persons of greater need, which is the phrase constantly floated out during these committee hearings, "Don't you agree that the person with greatest need should have access to that bed?" Well, that theory taken to its logical conclusion means that persons in institutions who are bed-blockers or inappropriately placed should be asked to leave, should be encouraged to leave, should be forced to leave, because there's no longer an insured service where you can appeal; it's now a contractual agreement and your contract evaporates as soon as the legislation is implemented. You have to sign up a new contract.
I don't know if you've put your mind around that case scenario, certainly the premature discharging -- even my own hospital, Joseph Brant hospital, has misled patients, put them into homes that were in receivership and told them there would be no fees, then all of a sudden, day one, they've got all these fees. We know those cases. I'm talking about a system that is contracting -- the legislation says there are no new beds being injected into the system -- and a growing acuity rate, a system that has absolute control over who goes in and who may have to be asked to leave. That's really what I'm asking.
Ms Chernin: Indeed, and that's what we put our minds to every day.
Mr Jackson: I'm asking for your help in the context of legislative language so that we grandfather people who are currently in institutions from being discharged. Those kinds of things could occur if you look at the current legislation as it's written. I haven't found the answer; I just know that you people have the legal minds and understand advocacy and how vulnerable these people who are currently in facilities could be.
Ms Chernin: Indeed. With the bill of rights, there is a right -- I can't remember it right now; Geoff probably does -- that says you can't be discharged without participating in that process, which is why we're suggesting that the bill of rights be incorporated with the charitable homes and the municipal homes for the aged.
We don't have answers to the big question of how we're going to get few resources to meet the needs of many people. However, we do feel that whatever system is set up, it has to be one that is consumer-directed, where there is active participation and it's not a best-interests system. Somebody's going to have to be looking at the best interests of the system, but we're looking at the clients' direct input into that. So there must be consent to any type of admission and clearly to discharge.
With hospital situations, in cases where doctors have said, "I'm simply discharging that person," it has been quite valuable to be able to say, "Well, they're not consenting to admission." So it has been able to empower the individual in a way that has been quite fruitful, and I think we need to make sure that is incorporated in the legislation.
Mr Stephen Owens (Scarborough Centre): Thank you for your excellent presentation. You raise some questions that I've been struggling to answer myself.
In terms of the devolution of patients from acute care facilities, I'm wondering if you've had an opportunity to think about the kinds of protections one could also build in at that end of the process while ensuring that the patient's soon-to-become resident rights are kept whole. Currently, there's an ability for hospitals to levy per diem fees and other such items against the patient. How do we protect from that end as well so that the individual is able to exercise whole and cognizant rights of consent?
Ms Chernin: That hits it right on the head. I think some facilities have found respectful ways of addressing that. I've had umpteen cases of individuals saying, "If I don't take this placement, which I don't like because I don't feel comfortable with it and I'm waiting for something else, I'm going to be hit with the OHIP per diem rate."
I stand to be corrected on this because it's information I'm getting from clients -- I'm not double-checking it necessarily -- but some of the hospitals in York region are actually charging the long-term care rate for people who are there for a month or two months or are awaiting another placement. So it's not encouraging people to stay in an acute care facility because it's free, but it also allows them to participate actively in the choice that they do make and that eventually comes to be.
We all know there's a phenomenon called transfer trauma. It's not a good idea to be transferring people from one place to another. We also know it's hard to transfer from one place once you're in. You go lower on a priority list. The person who arrives at the long-term care facility from an acute care facility who has participated in the process is a healthier, happier individual. There may be ways to balance the books so that the taxpayers are also being protected.
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Mr Owens: Again, in terms of the process you'll take away from here when you leave today, I'd really appreciate some suggestions around language that we could take a look at inserting.
I also enjoyed suggestions with respect to residents councils, and again in terms of projects that I'd need assistance with in ensuring that residents councils are both effective in terms of enforcing, again, the rights of residents -- you talked about a bill of rights -- enforcing that bill of rights, but on the other hand, ensuring that there isn't arbitrariness or discriminatory activity that takes place by a residents council.
What kind of protection would you also build in? I think it's fine that we can mandate residents councils, but how do you build in that effectiveness without an arbitrariness as well?
Ms Chernin: We have lots of discussions, and I know the Ontario Association of Residents Councils has already presented to you. In the present Nursing Homes Act, there is actually a section which allows the government to appoint individuals to assist residents councils. I stand to be corrected, but I don't know of anyone who has been appointed.
There's no question that these residents councils need some assistance, and it would be far better that it be someone not necessarily within the facility, someone outside to help empower them to make decisions so everyone doesn't become institutionalized. I think there have been recommendations and proposals put forward by the Ontario Association of Residents Councils which you know we would certainly support.
In terms of your other point, which is an interesting one and I will think about it more, about giving more safeguards, I guess as many safeguards as there can be in any democratic process short of dictatorship.
Mr Owens: For instance, in the Ontario Labour Relations Act there is a mechanism to add a means to remedy for members who feel they have been treated in an arbitrary or discriminatory manner by the particular union. I think we're all human. For instance, if a residents' council decides that everyone should wear polka dots on Thursday, there may be somebody who doesn't want to subscribe to that --
The Chair: Is that a recommendation for the committee?
Mr Owens: -- kind of a recommendation or may not support a particular direction that a council may be headed in. I'm concerned also that the right of an individual to dissent in a reasonable manner be respected.
Ms Chernin: Actually, I'll discuss that with the Ontario association. I know they are going to be submitting some further points to you, so I will talk to them about that. It's an interesting one.
The Chair: Thank you. Point of clarification, parliamentary assistant.
Mr Wessenger: First of all, before the point of clarification, I'd really like to thank you for your very specific recommendations. They are certainly well thought of and will certainly be given very serious consideration. The only thing I just want to clarify is that this legislation does not in any way allow the discharge of individuals from long-term care institutions by reason of their not being eligible for that institution. I just thought I'd mention that.
Ms Chernin: I thought there was a section about refusal, that the licensee can refuse. Is that the section you are talking about?
Mr Wessenger: No. It was just the comments made by another member.
Ms Chernin: Oh, another member.
Mr Wessenger: I just wanted to ensure that it was clear that residents in existing long-term care residences and those who are admitted in the future would not be discharged for arbitrary reasons.
Mr O'Connor: We are not going to send them back to the farm.
The Chair: Thank you very much for coming. I think a number of people have indicated that if you have any other brilliant thoughts along the way, drafting or otherwise, please get them to the committee.
Ms Chernin: Thank you very much.
VICTORIAN ORDER OF NURSES, YORK BRANCH
The Chair: I would next like to call on the Victorian Order of Nurses, York branch, if they would be good enough to come forward. Just for the record, as our next witnesses come forward, we are referring to York region and not to the city of York, which gets a bit confusing sometimes.
Mr O'Connor: All members from York region understand that.
The Chair: That's right. The members from York region understand that but not --
Mr Jim Wilson: This is York region day.
The Chair: That's right. An excellent day.
Mrs Teddene Long: I understand we're in good stead, with the district health council being here.
The Chair: May I welcome you to the committee, first of all. If you would be good enough just to introduce yourselves for Hansard and for the committee members, then please go ahead with your presentation. We have a copy of your brief.
Mrs Long: First of all, may I say that the York branch of the Victorian Order of Nurses appreciates the opportunity to make this presentation to the standing committee. I'm Teddene Long and I'm the executive director of the York branch of VON. Accompanying me today are John Wilson, York branch board member and chairman of the external relations committee of the board, and Beverly Lamont, whom I really think you probably want to grill later on, the director of the York Placement Coordination Services, which is administered by the York branch of VON.
The Chair: I should assure Mrs Lamont that we will not grill her. We may ask some questions, but we won't grill her.
Mrs Long: Oh well, I think maybe a little bit of grilling might be good.
Mr Jim Wilson: Roasting.
Mrs Long: It's been sort of a dull day around our offices.
Mr Jim Wilson: Oh, it hasn't been dull here.
Mrs Long: The York branch of the Victorian Order of Nurses commends the government for its commitment to amend certain acts concerning long-term care in Ontario. The bill is the first piece of reform legislation in long-term care redirection.
We are aware that VON (Ontario) and other VON branches have responded to the invitation by the committee to present written submissions. It is not our intention, and you can all breathe a sigh of relief, to review the information from these submissions but to focus our comments on how the proposed legislation may affect the residents of York region.
As you are aware -- and this is just a little bit of a plug for VON -- the Victorian Order of Nurses of Canada is a national, not-for-profit, charitable, community-based organization that has indeed been in existence for 95 years. The York branch is quite a young branch, being only 32 years old. The staff of professional registered nurses and registered nursing assistants and support workers represent a diversity of ethnic backgrounds, education and experience.
The board of directors of the VON York branch represent a cross-section of the region and provide a variety of skills and experience in the governing of the branch. The board is responsible for fiscal management and strategic planning activities.
The York branch is dedicated to excellence in all services and to continued leadership in meeting the changing needs of the residents of York region. Service is provided by a committed VON team of staff and volunteers using modern technology and practices.
In the last six months the branch has taken the lead in promoting partnerships with other health care providers in the region. Strong ties have been developed with acute care hospitals, the public health department, the York region home care program and other agencies within the region. The staff and board of the branch are consulting with the newly formed district health council. As a matter of fact, they will be attending our board meeting in the latter part of this month. Strategic planning by agencies or institutions in the region has actively involved other key health care providers.
With this background information regarding the York branch, we would like to address the following areas of concern regarding the proposed legislation, Bill 101: ethnic groups, fragmentation of care, quality management and regional planning.
Ethnic groups: The legislation does not address the cultural, religious or linguistic needs of consumers. As you know, York region has a number of ethnic groups, including a large Asian and Italian population. The consumer needs information available in his own language, both verbally and in print. As well, the elderly ethnic consumer needs to be assured that admission to an institution, as described by Bill 101, will consider his needs for familiar surroundings and activities.
Failure to provide adequately for the needs of the ethnic groups may result in families and consumers deciding to continue caring for the elderly consumer at home, which may be detrimental to the family and to the elderly consumer. This would of course have an effect on another segment of the long-term care reform, which is probably now known as home care.
Recommendation 1: That the legislation address the cultural, religious and linguistic needs of consumers.
Fragmentation of care: The proposed legislation addresses one aspect of the long-term care system. This morning, when I was trying to play devil's advocate with myself, I described this as a jigsaw puzzle without a picture. In other words, I have something over here and I know it all goes together, but I don't know how to put it together. Without some understanding of the long-term care framework, the proposed legislation appears to fragment the system. The government needs to provide an overview of the entire system to enable intelligent response to one aspect of the long-term care system.
Recommendation 2: That the proposed legislation be held until other proposed legislative changes are presented to ensure that the system is fully integrated.
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Quality management: The proposed legislation does address the need for a quality assurance plan for the institution; however, there is no mention of consumer-centred outcomes. As well, the proposed legislation clearly outlines the powers on inspection, which have a punitive connotation rather than an incentive to provide quality care.
Recommendation 3: That the proposed legislation include the use of quality management concepts to ensure quality care.
Regional planning: The proposed legislation does not delineate the eligibility of a consumer for admission to a specific institution. Again, in thinking about that this morning, I asked myself, if a consumer in York region requested admission to a home for the aged in Metropolitan Toronto due to the location of family members, would this be considered?
At the present time in York region, a significant number of residents reside in the south of the region. However, the location of the majority of the institutions is in the north of the region. By the way, at the end of your package you have a map of the region with the population over 75 and the appropriate beds in the areas. It is difficult for family and friends to visit residents in institutions unless they have access to an automobile. Public transportation in the region is not always available, which means that taxi transportation is required, at a significant cost.
The needs of the ethnic groups in York region also need to be mentioned here. Should long-term care institution planning be done on a regional basis or will there be some crossing of regional borders? Again, when I was thinking about it this morning, I was thinking of the Jewish population in Thornhill wanting to go into a home for the aged such as Baycrest.
Recommendation 4: That planning for the location of long-term care institutions needs to be addressed provincially and locally by the government.
This ends our written submission. Again, I would just like to thank you for your invitation. We would be pleased -- and when I say that, I mean those on my right and my left -- to respond to questions.
The Chair: Thank you very much. In particular, Mr O'Connor and I probably want to say thank you for the map, which is extremely useful. If we get lost going home, Larry, we've got something we can consult.
As you noted at the beginning, we have had a number of presentations from VON groups around the province, and it has been, I think, particularly useful to get the perspective in terms of exactly where you operate. That is very helpful.
We'll begin the questioning with Mr Wilson.
Mr Jim Wilson: Thank you for your presentation. I border on York region to the north, given that I have the other side of Highway 9 from King township. I am from King and am aware to some extent of the needs there. It does strike me, though, that you have some services that we don't have on the other side of Highway 9. We don't even have the luxury of complaining about losing or having cutbacks to some of the services, because we just don't have them.
None the less, I think you make a very good point in your last recommendation, which talks about planning. Is the placement coordination service that you have now strictly for the region?
Mrs Beverly Lamont: We accept residents from outside the region providing they have relatives in the region, because we feel that for support, people should be intact with their families for visiting purposes.
Mr Jim Wilson: In your reading of Bill 101, how do you see this? Is it that there's going to be more centralization and that if you live in Kingston, you can apply to Kitchener if there's a particular home that suits your ethnicity or your linguistic qualities?
Mrs Lamont: I would hope so. That's why it's so important, as Teddene has mentioned, that the planning be done provincially. The number of beds, so to speak, across the province has to consider the provincial needs as well as the regional needs. If you just do it on a regional basis, then you are going to have places where you're short of beds and other places where there are too many.
Mr Jim Wilson: I asked you this question because I think you're one of the first groups to emphasize the need for province-wide planning, and it certainly ties into your point regarding fragmentation and the piecemeal fashion in which long-term care is being presented by the government.
I also want to talk briefly about your recommendation that the legislation be put on hold. A number of other VON branches had the same recommendation. The problem we have as legislators is that the game's changed over the past year and the government's now tied this legislation to funding, and we have friends, obviously, in the nursing home sector who need the money. Have you thought of that side of the equation? With that in mind, would you still want to see the legislation on hold?
Mrs Long: I considered this when I was speaking. Mr Quirt over there will tell you that in my former life I worked in the division, so I am aware of government process etc. But it seems to me that if you don't have a sense of the whole, how can you be working over here on a piece? I guess what you're asking is, do we trust the government? I guess you would get a lot of different answers on that one if you went around the room.
Mr Jim Wilson: My political advice would be, don't touch it.
Mrs Long: Exactly. I'm not about to make a comment.
Mr Jim Wilson: But you agree that we're in a catch-22.
Mrs Long: Yes, you're in a catch-22.
Mr Jim Wilson: And it's unfortunate.
Mrs Long: Coming down this afternoon, Mr Wilson asked me, "Do you think they're going to buy this?" I said, "No, but I have to say it."
Mr Jim Wilson: I appreciate your frankness. Thank you.
Mr O'Connor: I want to thank you for coming down today. Indeed, it has been a bit of a York region day, and I guess we're going to have a little more of York later on in the week.
Earlier we did hear from the district health council. In their presentation, there was a little concern. We've heard concerns about the role of the placement coordinator. You talked about your young history. Well, the DHC's got even a younger history, and we're just getting to the point -- in fact, last night they had a meeting to try to make plans for establishing the subcommittee and trying to get some guidelines on how to establish the subcommittee for long-term care.
I don't know whether any of you managed to make it there last night. I was just wondering if you had any suggestions that might be useful -- I see that a person from the long-term care office for our region is here -- that maybe you could pass on to the committee today, because it's something that I know we have a concern about.
Before you do that, just one comment to the framework policy: Should that not be available, hopefully before this gets into the Legislature in April?
The Chair: The Chair notes that a head went up and down, meaning yes.
Mr O'Connor: So that will be something we'll be able to use in the debate in the Legislature as well. Could you make some comment?
Mrs Long: I've thought about what you're asking me. To be very honest, Bev and I have a meeting with Graham this week, and as a matter of fact, we have a meeting with Jack next week. So yes, it's on our minds, but we really haven't had an opportunity to brainstorm and put anything together.
Mr O'Connor: When we take a look at the bigger picture, not only is it not included in the bill, but up in York region, it's still in its infancy anyway and we're trying to develop it as we go. I think perhaps we're at an opportune time in York region to work with the brand-new DHC and make sure the direction we do head in is going to be the right direction.
I'm glad that the VON is going to be there helping in this process, because I think it does require input from the entire region. As the map shows, we are a large region and the beds are dispersed throughout the whole region, so I think it's opportune that we're starting at this time.
The Chair: Ms Fawcett.
Mrs Joan M. Fawcett (Northumberland): Thank you for your presentation. A couple of things: I know the work you do is fantastic. Everywhere we have gone we've got the message that the VON -- well, you invented home care. I just wonder about rural Ontario. Do you see that rural Ontario is going to be adequately served? Do you see anything that we should possibly be looking at? Right now, I know of large gaps where the service isn't as good. I shouldn't say it isn't as good; it just isn't there. I have some concerns, being from a rural riding.
Also, I asked the question of a couple of VON chapters that were before us about the program on television where in Saskatchewan the VON is no more and the government has taken over the service. I was told that wouldn't happen here in Ontario, so I put it in the back of my mind, yet just today I was talking to a resident in Scarborough who said, "Why are they getting rid of the VON?" I said, "What do you mean?" Probably they saw this same show; at least I'm assuming that's what it was. Have you talked about that? Have you any fears about that, as we do have the same kind of government in Ontario right now?
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Mrs Long: I don't think the Victorian Order of Nurses is any different than any other organization today. I can go to all of my colleagues in all three hospitals -- I have done this -- and jobs are being taken away. We don't have the money.
VON, like any other organization, any business, has got to prove it's economically viable. They've got to manage their business and do a good job. To say that yes, we have been providing health care, visiting nursing care in particular, for a number of years, not only in the region but in the nation -- I think we have to look at proving that we provide a better quality of care than some of our competitors, be they not-for-profit or be they for-profit. That's where it's at. The organization that goes out and hires and trains its workers, does performance appraisals and looks after the dollars is going to be here. The one that doesn't, isn't. It's just that simple, in my mind.
I think the Victorian Order of Nurses from Ontario has done a very marvellous job. In fact, two years ago I probably would not have joined that organization. It's a different organization today. That's a personal comment and probably shouldn't be shared with this committee, but you've asked me the question and I'm answering it. I would probably have stayed with Mr Quirt and company down in the division, but I didn't. I swung.
Mr Jim Wilson: Quirt's cheques will start bouncing.
Mrs Long: Is that right? Well, I might only be working four days.
Mrs Fawcett: My fear is that if the government takes it over, then all the wonderful volunteers you also have access to will not be there. That certainly has been expressed too.
Mrs Long: Yes. I have to tell you, the volunteers, not only our own board members but the volunteers who come in to help us do things in the office, are incredible, the number of hours they provide, and they love it.
I have one gentleman who had a stroke at the end of November. He comes in every morning and does all the shredding in the whole branch. He climbs up a set of stairs; if you've been to our office, Mr Beer, you know it takes a giant to climb those stairs. He's had a stroke. He climbs up those stairs and he does the shredding and he goes home. I'm probably coming in a little after 8 and he's leaving. He's been there since 7 o'clock. Incredible.
Mrs Fawcett: The human touches.
The Chair: I can understand about the stairs. The parliamentary assistant has a clarification.
Mr Wessenger: I just wanted to answer the question you asked in your brief about the consumer in York region being entitled to apply to Metropolitan Toronto. The answer is of course yes, because the whole idea is to give consumer choice across the whole province to consumers and not to limit it geographically.
I'd ask the Chair's indulgence. Legal counsel indicated they could give clarification to a couple of points, and seeing as it's not 3 o'clock, I'm wondering if this might be an appropriate time to do it.
The Chair: I'm in the committee's hands. If that's agreeable, we can do that. Before doing that, I'd say thank you for coming in and for your presentation. We really appreciate it. If our reading is anything, I think the VON's going to be around for a long, long time.
I'll then ask the parliamentary assistant and legal counsel to comment on a couple of the questions that were raised, I believe by Ms Sullivan, was it?
Mr Wessenger: Yes, there was one question raised by Ms Sullivan about the common law of consent with respect to admission to a facility. In addition, there was a point raised yesterday with respect to the gender aspect of homes for the aged. I think we need a clarification on that point.
Ms Gail Czukar: I don't know if I've said my name today for the record. I'm Gail Czukar, lawyer with the Ministry of Health. I'm not sure what all the questions were regarding consent, whether the common law of consent would apply to the admission of a person to a home. On that, probably opinion would be divided. Usually, the law of consent has to do with consent to specific medical treatment, and it's usually required of practitioners who want to administer the treatment and that sort of thing.
However, my view would be that you need legal authority if you want to send someone somewhere involuntarily. My view would be that you don't need to have a specific requirement of consent in this bill, because we don't have any power to send someone who doesn't want to go, who doesn't give his consent.
Having said that, I know the concern the presenters from ACE raised -- I've had them present that concern to me elsewhere -- is that if there isn't a specific requirement of consent, facilities often ignore that or just aren't cognizant enough of the need to have a specific and articulated consent. That is something to consider, and that has been put forward by that group specifically for that reason.
With regard to the law on it, I don't think there's a case which talks specifically about consent to admission where there's no authority to send someone involuntarily to a facility in the statute, but the argument for having it made explicit is that that way there's no doubt about it.
Mrs Sullivan: Okay. Then I will ask what the difference would be between a person providing consent for admission to a hospital for a course of treatment and a person providing consent to a nursing home where a course of treatment is determined through the plan of care to which consent will be given.
Ms Czukar: Yes, you did ask specifically about whether the requirement in the Consent to Treatment Act would apply, and of course it would apply if you have a health practitioner who's proposing a treatment or a course of treatment that would fall within that act. In most cases, that would not be the case. When a placement coordinator is considering someone for admission, it would not be for the kind of treatment that's contemplated by the Consent to Treatment Act. If a physician wanted to treat someone in a home and it would definitely fall within the definition of consent to treatment, then you could have that implied consent, that additional authority where the health practitioner has to seek consent to the treatment. But the authority in the Consent to Treatment Act for admission to the hospital or other facility is incidental to the treatment. That's not the primary concern in the long-term care facility.
On the point about the Human Rights Code, the issue came up yesterday about whether a home that has all women as residents could maintain that. I've done some research and found that section 20 of the Human Rights Code -- I think it's probably still section 20, although it has been revised -- states that the right under section 2 to equal treatment with respect to the occupancy of residential accommodation without discrimination because of sex is not infringed by discrimination on that ground where the occupancy of all the residential accommodation in the building, other than accommodation that's occupied by an owner or a family, is restricted to persons who are of the same sex. What this means is that you can have a home which is all one sex or the other, and it would be exempt from that.
Mrs Sullivan: That's fine. Thank you.
The Chair: Our next presenter is the Senior Citizens' Consumer Alliance for Long-Term Care Reform, but they may not be here yet.
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REGIONAL MUNICIPALITY OF NIAGARA
The Chair: I understand that the representatives from the regional municipality of Niagara are here. If you're prepared to come a little sooner, we would be delighted to have you come forward now, and we thank you for being here at an earlier hour. On behalf of the committee, I want to welcome you to our proceedings. If you would be good enough to introduce the members of your delegation, then please go ahead with your presentation.
Mr Brian Merrett: Thank you very much, Mr Chairman. It's a pleasure to be here this afternoon. The traffic wasn't too bad from Niagara, so we were able to get here a little earlier.
My name is Brian Merrett. I'm the chairman of the regional municipality of Niagara. On behalf of the regional council and our community and health services committee of the regional municipality of Niagara, I extend our appreciation for this opportunity to make this presentation regarding Bill 101 and other matters that relate to long-term care reform. Our presentation today will highlight the brief we've presented to you.
We treat this as a very serious matter. Accompanying me is Councillor Roy Adams on my far left, who is a former mayor of the city of St Catharines and chairman of our community and health services committee. We also have Doug Rapelje. Doug is the director of our senior citizens' department and probably known to many of you here.
We have been very much involved throughout the public consultation process, with Councillor Adams chairing Niagara's consultation advisory committee, and the director of the senior citizens' department, Mr Rapelje, also serving as a member. We commend the province on this process but suggest that many of the proposals being put forward, including Bill 101, do not reflect what we heard in Niagara.
The regional municipality of Niagara, through its senior citizens' department, has a long and progressive history of providing quality long-term services to our seniors. We support many of the provincial initiatives proposed under the long-term care and support services in Ontario and we have a long-standing commitment to services for the elderly dating back to 1952. We have seen tremendous growth in these services but have great concerns that the proposed Bill 101 could have a serious impact and effect on that commitment.
The Niagara model, which has been widely recognized, embraces many of the principles that are proposed in the reform and we feel that our success supports these principles. Our model in Niagara offers a continuum of care. We have one point of entry, multidisciplinary assessments for institutional and community programs, with delivery through the following services funded both by the province and by the municipality:
In Niagara, we operate six homes for the aged with 919 beds; we have seven day care programs for the physically frail and cognitively impaired; we offer 16 satellite homes for seniors living with families in a supervised private home setting; home sharing, where our seniors share their homes with others; our vacation-respite care has 14 beds that provide short-term stay for family care givers, to provide relief for families in order that they can have a short break and vacation; we have our home help services where we provide homemaking, companion sitting, home maintenance, yard work and others; also our Alzheimer respite companion program, one that has been tremendously successful, where we have trained workers who relieve the care givers in their homes in the community; we have Talk a Bit, which is a telephone security program; we have friendly visiting, where we have trained volunteers who provide services to community-based elderly and the physically handicapped, and we have our senior volunteers in services, who use their skills and talents to help other seniors in the community.
We bring these services to your attention, as we believe long-term care reform can only be successful if a range of services is available that can respond to identified and real needs in the community. Based on the information we have received to date, we believe our model, which assures clients a continuum of care, is in jeopardy. What is proposed in Bill 101 and some other aspects of long-term care reform will prevent us from assuring clients a continuum of care, and this is the basis for the success of our programs in Niagara. Also, we would point out that non-profit homes for the aged and charitable institutions have been leaders in providing community programs.
As a major service provider in Niagara, we share the government's commitment to the four principles outlined in the government's discussion paper, Redirection of Long-Term Care and Support Services in Ontario.
However, we suggest that with Bill 101 the province has lost sight of some of these principles, the most important principle being, in our opinion, the quality of service. The bill focuses on provincial controls and penalties rather than quality and may jeopardize our ability to assure quality. Also, the province must realize that communities are at different service levels and have different priorities which must be considered as communities plan as partners with the province. It must be recognized that municipalities have provided leadership, management and delivery of long-term care, which Bill 101 seems to ignore. There seems to be an emphasis on the weakness in the system. We believe it is important to maintain the strengths within the system and enhance them. We believe that aspects of Bill 101 fail to recognize many of the present strengths.
Bill 101, we respectfully suggest, has many flaws and promotes an adversarial climate rather than a partnership between client, service provider and the province. We support the concerns expressed by the Ontario Association of Non-Profit Homes and Services for Seniors regarding Bill 101 in its January The Communique, "The message from Bill 101 to the non-profit sector is clearly that we are not to be trusted, that our boards are not capable of being accountable for their homes and that policing and punitive measures are the only ways of ensuring quality-of-life programs, fiscal accountability and appropriate care for residents."
Simply stated, this is not the way to foster strong partnerships, trust and cooperation.
What I would like to do now is turn over our presentation for some more detail to Councillor Adams.
Mr Roy Adams: Good afternoon. I welcome this opportunity because of my interest in social and health issues and my involvement in the long-term care consultation process. There are a number of key issues and I would like to highlight the key issues that are set out in more detail in our brief which must be considered and amended before the third and final reading of Bill 101, and which are governance, inspections and accountability, financial funding, placement and admissions and standards for long-term care facility programs and the service manual.
With regard to governance, Niagara is proud of its community involvement and public accountability in delivering services to seniors. We believe the present mandate of boards and committees of management in non-profit homes for the aged has the governance in proper hands. We had the first residents' council in a home for the aged in Ontario and we have adopted a residents' bill of rights and responsibilities. We acknowledge and support quality assurance programs, which have existed in our facilities and community programs in excess of four years. We are in the process of establishing community advisory committees in the homes for more public input and accountability.
The role of elected boards in municipalities in planning, managing and delivering long-term care is not acknowledged and in fact Bill 101 diminishes their role. We believe this has to be reconsidered.
Inspections and accountability: We welcome the efforts to increase accountability of facilities, recognizing, however, that many municipal long-term care facilities have many accountability measures already in place; there is a partial list in our brief.
We have very strong reservations about the inspection system proposed in Bill 101, which once existed in the homes for the aged. Over the past number of years, and particularly since the establishment of long-term care area offices, quality of care and services have benefited very much through a consultative process and a partnership with our program supervisors, more so than with the previous inspection system. This could be achieved in a more cost-effective way by using the mandate of the committees of management or the authority provided through your long-term care office. We believe accountability is best served at the municipal level.
We have greatly benefited through the consultation process applied in the accreditation program and we would strongly recommend that the province make accreditation mandatory.
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We believe the proposed inspection process suggests an authoritarian approach rather than the present system which allows the ministry and facilities to deal effectively with specific incidents and violations of non-compliance. Bill 101 appears to be authoritarian and adversarial rather than collaborative and consultative between responsible partners. The dollars that will go to inspections should be directed to funding the care needs of the residents, as it is our belief the proposed new funding system will fall short of the mark.
Addressing placements and admission: The proposed placement-admission system is costly, bureaucratic, authoritarian and adversarial. In many communities there is a partnership of facilities, referring agencies and placement coordination services which responds appropriately to consumer needs in a timely and compassionate manner as existing service levels allow. These partnerships should be supported and strengthened, not replaced. This would require strengthening of the resources and mandate of existing placement coordination services, but not with the authoritarian and adversarial system envisaged in the legislation.
In Niagara, we have currently a department-wide access and service coordination function that collaborates with consumers, families, PCS and referring agencies that we believe works well. The system must ensure a high degree of choice and control by the consumer. The proposed appeal system will be costly, bureaucratic and untimely given the age and changing needs of the consumers. Historically, we have received few complaints about admission refusals, but we do receive more complaints about the lack of available beds.
We are concerned about the power of placement coordinators and their immunity from liability. It appears the placement coordinator has the vested power to act independently of both consumers and the facility. We would like to enhance the success of many of our community programs, which support the province's principle of helping maintain people in their homes or in the community, but success requires the guarantee of a continuum. We respectfully suggest that the admission process set out under Bill 101 fails to recognize or acknowledge this important factor.
Addressing finances and funding: At a recent meeting in Toronto sponsored by the Ontario Association of Non-Profit Homes and Services for Seniors, a provincial bureaucrat stated that the province has established a set amount of facility funding for the new system. We are concerned that the new funding is based on an additional $200 million previously announced, yet this in itself could be restrictive if the system is to assure funding for real care needs.
We want to also bring to your attention the possible shortfalls in revenue if the government introduces the proposed restriction on the use of residents' assets towards the cost of their care and preferred accommodation. If this becomes a reality, we have analysed our over 900 residents and it would create an approximate annual shortfall of $600,000. In addition, it appears we will no longer be able to make claims against estates, which we estimate will result in a further shortfall of $200,000 in Niagara. If other constituencies have the same results, millions of dollars of revenue will be lost.
With regard to the new funding system that is proposed, it appears it is not driven by consumer need but rather by funds currently available. The region of Niagara, like most municipalities across the province, is clearly not in any position to make up funding shortfalls arising out of the new proposed funding system. We may face bed closures, and other measures may be required in order to match service levels with available funds. It is our belief that most citizens with means would prefer to pay a little more for care and preferred accommodation for the assurance of quality care. We need not remind the province, as we know in the municipality, that this is not a time to reduce revenue.
Regarding standards in long-term care facility program and service manual: It is acknowledged that considerable discussion has taken place involving the ministry representatives and representatives of service providers and advocacy groups. It is critical that further input be reserved from practitioners prior to implementation in order to clarify expectations and to assess the practicality of specific standards and criteria.
We can only assume that the province has considered the cost implications and will build in funding that allows us to meet the standards set out in the program and service manual.
To cite an example, although many of the criteria for dietary care are commendable in principle, their implications may not always be practical or appropriate for each resident. For example, "Residents requiring assistance are seated in upright position with head tilted slightly forward" may not be practical for some residents; similarly for dietitian hours and other staffing standards and related criteria which appear to be based on assumptions that may need re-examination or reconciliation with current acceptable standards of practice which produce equally acceptable services and care.
In conclusion, when we examine the four principles set out in the government's discussion paper, we would add one: quality and service. Bill 101 falls well short of the mark in supporting these principles.
Bill 101, we respectfully suggest, has many flaws and promotes an adversarial climate rather than a partnership between the client, service providers and the province. Long-term care has been a long time coming and it is important that we get it right. We respectfully suggest that Bill 101 does little to achieve the right system and does not promote the right environment to work in these difficult times as partners.
We anticipate that you, Mr Chairman, and your committee, will reconsider Bill 101 and the negative effect it could have on reshaping long-term care in Ontario.
I thank you for the opportunity to be a part of presenting our brief. We would be pleased to answer any questions.
The Chair: Thank you very much for coming from Niagara today to make the presentation, both the two statements as well as the document you've also given to us. We'll move right to questions and begin with Mr O'Connor.
Mr O'Connor: Thank you for your presentation. I'm sure you can see that over the course of these committee hearings we've heard some changes, some differences of opinion and some areas of concern repeated. So, of course, some of that we take under advisement.
I noticed in your comment you talked about grandparent action,intergenerational involvement, and I just wanted to tell you a little story about a grade 3 class from St Bernadette's in my riding. They go one Thursday or Wednesday a month for an afternoon; they spend the afternoon right in the nursing home. It's a terrific experience for not only the children but of course for the elderly there; they really do enjoy that. I think there are lots of models and different programs that take place throughout the province and it's always good that we can share whenever we can.
What you've talked about here -- and it really does pique my interest -- is the residents' council that you have. We heard in a presentation earlier this afternoon from the Advocacy Centre for the Elderly and they talked about the recommendation of enforcement mechanisms for the bill of rights and I just wondered if perhaps you might have an enforcement mechanism for your bill of rights because you do have a bill of rights --
Mr Merrett: I will refer that to our director to make a comment.
Mr Doug Rapelje: You might be interested to know that in one of our homes we have a fully licensed nursery school that operates, and those are the things that really make a tremendous difference.
With regard to our residents' councils, we basically have the residents' council to monitor that, but what we're finding as we care for more physically and mentally frail residents is that we are enhancing our residents' councils by adding a family member, a volunteer and a person from the community who has no connection with the home so that we can strengthen the role. We're all finding it more difficult in our facilities, particularly in four of our facilities -- they're under 100 beds -- to really get people who can truly speak and represent the concerns of the residents. Not only to assure that those rights are adhered to, we're finding it necessary to enhance those councils by adding people who have an interest but can make sure the needs of the residents are properly expressed to us.
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Mr O'Connor: In your brief you talked about an adversarial nature, and I guess it's something we've heard before, because the word "inspector" just seems to be a focus. It's like a lightning rod. People are coming in and saying, "This inspector is going in there," and it's that adversarial approach. I just wondered if you might want to comment on the approach that you're talking about as an accountability and how that might interrelate with the total quality management perspective, because I think we don't want be heavy-handed; we want to try to improve on what we do have existing, where possible. I just wondered if you might be able to comment on that aspect.
Mr Rapelje: One of the either advantages or disadvantages -- I've been in this field for 40 years. I should point out I started when I was 14.
Mr Owens: A couple of years ago.
Mr Rapelje: Yes. But I've been through the whole cycle of where we had inspectors in homes for the aged many years ago, and if I could offer a personal opinion, as we did in the brief, it's my judgement that the type of consultation process in working with our local ministry office, accreditation, and as you'll see in our briefs, the many various inspection groups from occupational health and safety, the panels -- what do you call those, the inspection panels?
Interjection: Grand jury panels.
Mr Rapelje: Grand jury panels. I think we figure there's about 27 or 28 different groups coming in, and I guess my experience is that the consultation process results in a more positive outcome, and again, inspectors come and they leave. I think accountability has to be a continuous, ongoing process. It's the one advantage of the municipal homes. I'm sure some of you have been municipal politicians. If there's a complaint, I hear about it and we do something about it. We don't wait for an inspector to come from Toronto.
I base it on my experience of being involved in both approaches, and unquestionably, in my opinion, the other is much more effective and the outcome is much more worthwhile, the idea that accountability should be local through our politicians. I was surprised with the private nursing homes that some thought hadn't been given to having boards like hospitals that if the owner wanted to appoint three people or the ministry three people or police boards, like Roy and Brian are on, it wouldn't be a more effective way if you're looking for accountability. I just simply do not believe that inspections in themselves work as well as the other approach.
Mrs Yvonne O'Neill (Ottawa-Rideau): Thank you so much for coming, gentlemen. I am always happy when municipalities, and certainly the regional municipalities, come forward, because I think they are crucial partners and have been, and I am very pleased that you talked about the fact that there are existing strengths there today and that they have to be built upon and they shouldn't be ignored and that the municipalities have taken a strong leadership role, and a strong leadership role in accountability, on the issues we're discussing.
You've brought forward three parts of your plan or your model that I'd like to ask you to say a little bit more about because I think they're interesting and have been parts of our discussion as we've gone across the province. First of all, if I may begin with the respite care, would you like to say a little bit about where and how you established those and just flesh that out a bit?
Mr Rapelje: Probably we were among the first to introduce respite beds. I think we've had a reputation, in working with people like Geoff and so on over the years, that we were always willing to stick our neck out. We had realized that many people were coming into our homes permanently who didn't need to be there, who had family care givers but the family and our whole system have never really recognized their role, and that if we could give them an opportunity for a break or a rest, they wouldn't burn out and they could continue. We started with one bed. We are now up to 14 beds.
We have different models. One is the straight respite program, where they can come in for a week up to a month. We have one that we just introduced particularly to deal with Alzheimer's victims, where they can book a year ahead and come in one week a month just so the family is always assured of a break and can look forward to it. We've just introduced night care because we've found that many care givers, particularly caring for the cognitively impaired, are up wandering around all night, so they couldn't get their sleep. They are admitted to our homes about three in the afternoon, they stay all night and now we are also allowing them to stay on day care if they want. So the family gets a whole 24 hours of rest.
Then, with our Alzheimer's respite program in the community, we hire and train workers who go into the homes of families caring for Alzheimer's victims for half a day or a day, again giving care givers the relief so that they can at least get away from that care-giving role.
They've been very successful, and I commend the government for identifying these as funded beds within our system. We just had to go ahead and do it. There was never any legislation nor were there really any funds, but basically I commend the government. I think those are the types of programs -- if we are going to make this system work, if we're going to slow down the need for increasing institutional beds, then those services have to be in place.
I just want to suggest -- I have the opportunity to travel to many parts of the country to talk about these things -- that if these are not in place, and I suggest to you in many communities they aren't, when we talk about a continuum of care, it means nothing unless there are choices in the system that will allow people to move within a system as their care needs change.
Mrs O'Neill: Would you say a little bit about the community advisory committee that you have recently, I think you said, started up?
Mr Rapelje: Yes. We're just in the process now of looking at terms of reference.
Mrs O'Neill: Why did you feel you needed this? You seem to have such a responsive system. Could you just say a little bit about that?
Mr Rapelje: Exploring it at the moment -- Ottawa has them, and there are a few other communities -- was just another way of allowing the public to have some input into the operations, support us in fund-raising. I think things are changing to where we're doing things differently and looking for different sources of money. So it really was to have an outside body that did not have any political involvement with the home, to be able to have input and to work with the administrator of that home and to report once a year to the community and health services committee which Councillor Adams chairs.
Mrs O'Neill: Do you think they should be mandated in Bill 101?
Mr Rapelje: I think what I would suggest is that we need some experience to see how well they do work. I think in principle they have a lot of merit, but I would suggest that if we could get three or four municipalities and then evaluate them, it might be better to make sure they are effective and that they aren't at cross-purposes with our committees of management and so on.
Mr Merrett: If I could just add to that, as far as we're concerned in Niagara, even though we are one united region on most things -- I say that with tongue in cheek -- our six homes are in different communities and are different sizes, and those communities have a different relationship with the home in their area. There's that identity with that community, besides it being a regional home, and this gives an opportunity to tap into what's in that community. There are some that have resources available that others don't. That's what gives us an opportunity to broaden our base in the community and have access to the resources in that community.
The Chair: Thank you. Mr Jackson.
Mr Jackson: Both regional chairman Merrett and Councillor Adams: To what extent have the discussions on disentanglement raised or come close to raising the issues around the offloading of these additional expenses to the regional government?
Mr Merrett: Overall, as far as disentanglement goes, and with the recent announcement, we are examining the financial impacts on the region of Niagara. I've personally been involved, through the regional chairmen's group and others, in the whole discussion, but we are developing our position right now and looking at the cost to Niagara.
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Mr Jackson: Could you expand on that for us? Are you talking about the general disentanglement discussions, or the disentanglement discussions around social service funding envelopes and as it relates specifically to the additional costs you will be called upon to pick up as a result of this legislation? Have there been any discussions to date, or are you simply preparing your position to inform the government of probably what it already knows about the implications of this legislation on regional taxpayers?
Mr Merrett: Doug, maybe you want to comment as far as some of the information you've been putting together is concerned.
Mr Rapelje: Do you mean with this bill particularly, or the disentanglement with welfare and other aspects?
Mr Jackson: I don't want to get into the details of disentanglement and welfare. Specifically in social services, there have been preliminary discussions about the broad range of issues, from day care to doughnuts. Have you had specific discussions about homes-for-the-aged funding, capital or operational, and/or the implications of this bill, which will have financial impacts on your having to pick up additional costs?
There's disentanglement through consultation, and then there is disentanglement through fiat, and what we're dealing with is disentanglement through fiat. The government is capping its contribution to extended care, but clearly you must read through this and find that you're picking up the shortfall. You're the one who's throwing $200-million figures around, and so on. Clearly, it's implicit that you as the regional chair, and Councillor Adams as the chair of -- what's your committee, Councillor? Sorry.
Mr Adams: Community and health services.
Mr Jackson: Clearly, you've seen the implications, so why is the government moving unilaterally when we're told disentanglement is on the table? I can assure you that I've been part of discussions with the former government around these capital and operating costs when disentanglement was being discussed with that government. Here now we've got a new government and it's floating out there to the public all the wonderful things we're doing on disentanglement and discussions, but frankly, this is happening whether you want to be consulted or not.
Do you understand clearly the focus of my question? Because this is a great opportunity, to have the regional chair here, and the chair of your health and social services committee.
Mr Rapelje: I think basically what we tried to bring out in our study, Mr Jackson, was our concerns, such as the commonly bandied-around average being $90 for homes for the aged. If that happens in Niagara, we will have about a $1-million to $1.5-million shortfall. We're very concerned and I must say, with all due respect to the civil servants who try to come to our meetings and answer questions, like the one I was at two weeks ago, what concerns me greatly is that we're trying to evaluate the overall picture but we're doing it like we normally do, in little pieces.
It seems to me that unless you look at the whole continuum of care, this act, for instance -- and more to your question -- changes it where we may not be able to make charges that we do now. I have no problem with that as long as someone assures us that it won't end up on the backs of our residents receiving inferior care. Because it seems to me that even just in Niagara, if we can no longer claim on estates, that's $200,000 in Niagara.
Mr Jackson: Let me interrupt you there because that begs the point. You're in the driver's seat now. We have removed this as an insured service under OHIP; this is going to be removed as a result of this bill. So it's no longer the universality of extended care under OHIP. It is now a contract with the state.
You're a level of government. We've disentangled. We passed it on down to your level of government, and you now decide what level of care --
Mr Owens: We need a response to this. I am alarmed.
Mr Jackson: Is Mr Owens rattling again?
The Chair: Order, Mr Owens. You are out of order. Mr Jackson has the floor.
Mr Merrett: If I could just make a couple of comments on the question that's been asked by Mr Jackson, in framing it, we're here to talk about Bill 101 and how it fits in in the whole disentanglement process, and the downloading of costs the region is feeling. I wouldn't know where to start today if I wanted to talk about downloading of costs such as Ministry of the Environment subsidies that we haven't received and the discussions we're having on disentanglement with roadways and assessment and trying to determine what 100% of welfare is. But that's another subject and I could spend some time on that.
We're here today to talk about bill 101 and the downloading of those costs and the quality of service we want to provide in Niagara. I can appreciate the government's need to examine this whole question and the type of service that's delivered throughout all of the province of Ontario. We're here today to tell you that in Niagara we do a damned good job and we've been studied and we are a model for not only the province, but the country. We've received international recognition on how we deliver our services. We've been able to handle the cost side of it.
As you know, we're all under tremendous financial constraints in our budget process and we've been able the last two years to maintain our costs and still provide a quality level of service. I guess we're here to say to you today that we feel we have something to contribute and offer in the delivery of long-term care in Ontario.
The Chair: Thank you for coming today. I should also just underline that it was a pleasure a couple of years ago to visit two of your facilities, one on Niagara-on-the-Lake, which is --
Mr Merrett: Gilmore Lodge in Fort Erie and Upper Canada Lodge in Niagara-on-the-Lake.
The Chair: That's right, both of which were state of the art; in particular, I remember -- I think it was your day centre in St Catharines, which was built sort of like a tepee, if I recall. It was a marvellous structure and just the whole sort of architecture of it in terms of what you were trying to achieve struck me as very innovative. I think you have a great deal to be proud of in terms of what you've accomplished there and we're very grateful that you came here today and made your presentation.
Mr Rapelje: Mr Chairman, would you have just one minute for one very important issue that I don't want to be lost? We've spent 30 years putting together a continuum of care and I want to suggest to you that if you look at this piece of legislation or any other in isolation, this does nothing to enhance a continuum of care.
If I might tell you, our satellite homes are some 22. The province has no capital funding and it has saved millions of dollars offering a choice. These are just ordinary families that take in people into their homes. If they have a health breakdown and I can't guarantee them a bed in one of our homes, that program is gone.
When you look at day care, if you cannot assure that daughter that it will be a continuum, that one day when they can no longer come in for day care they're just out on a waiting list with, in our case, 1,300 other people -- I really caution you to not look at just Bill 101 but to look at, if you really believe -- and that's what the documentation suggests -- in a continuum of care, then the present restrictions in Bill 101 would prevent me from transferring people within our system. It really affects how people behave in a system. A daughter will gladly tolerate her mother being on day care for 10 years as long as she knows that the day her health breaks down there will be a bed, not be told, "I'm sorry, you're no longer eligible for day care; you go on a waiting list."
I want to just leave that with you to think about because when we look at this piecemeal -- I've been through this too many times -- we're going to end up with a fragmented system the same as we've always had. What people are looking for, in my opinion, is the assurance that mother can start out on Meals on Wheels and, if necessary, get care in a good, long-term care facility, often with a lot of stops in between. Thank you, Mr Chair.
The Chair: Thank you all again for coming to the committee today.
Mr Adams: I have another comment, but I'll spare you it.
The Chair: Oh no, please.
Mr Adams: As chairman of the redirection of long-term care committee, we travelled around, and what was being forecast in that proposal is completely different than what it looks like it's going to end up being. I think we fooled a lot of people for a long time and I don't like to fool anybody.
Mr Merrett: Mr Chairman, again, thank you for the opportunity to be here. Members, thank you for your attention.
The Chair: Thank you.
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SENIOR CITIZENS' CONSUMER ALLIANCE FOR LONG-TERM CARE REFORM
The Chair: Perhaps I could now call on the Senior Citizens' Consumer Alliance, which is with us, if they would be good enough to come forward.
Mrs Jane Leitch: We apologize. We misunderstood. We understood we were to be here at 3:30, so we apologize for that.
The Chair: It's quite all right. It worked out fine. Other delegations were here, so no problem; we're just glad we have you before us now and we have received a copy of your brief. Just before asking them to introduce themselves, I would tell members of the committee that they've also given us two copies of the Consumer Report on Long-Term Care. Foe members who would like to look at that, we can arrange to do that.
Mr Jackson: Mr Chairman, I wonder if may ask legislative research to provide Mr Owens with a copy of legal counsel's confirmation that in fact extended care is being delisted by his government. If they could just make that available from the Hansard to Mr Owens, who perhaps had to be out of the room for a moment when that question was raised earlier today, that might resolve his penchant for interruption.
The Chair: Parliamentary assistant.
Mr Wessenger: I'm going to ask legal counsel to clarify that point.
Ms Czukar: Extended care is offered in nursing homes. The payments that are made to homes for the aged, both charitable and municipal, are not insured and never have been insured services under the Health Insurance Act. It's only the extended care payments made to nursing homes.
Mr Owens: So what's being delisted?
Mr Jackson: So nursing home extended care is being delisted by the NDP government?
Ms Czukar: It will be removed from the regulations under the Health Insurance Act, which will have the effect of de-insuring it, as is done now in 8 out of 10 Canadian provinces.
Mr Jackson: That's what I heard. Thank you.
The Chair: Thank you. I want to --
Mr Owens: You heard what you wanted to hear.
The Chair: Order, please. I want to just note again that if any member wishes to look at this, we have two copies and they can be made available.
Welcome to the committee, and perhaps you would be good enough to introduce yourselves and then please go ahead with your presentation.
Mrs Leitch: Thank you very much. I'm Jane Leitch, chairperson of the Senior Citizens' Consumer Alliance for Long-Term Care Reform, and with me is Beatrix Robinow, one of our members.
The alliance is made up of three organizations of the largest consumer groups in the province: The Consumers' Association of Canada, Ontario division, the Ontario Coalition of Senior Citizens' Organizations and the United Senior Citizens of Ontario, and collectively we speak for approximately 1 million seniors.
Over the past 21 months the alliance has been examining the evolving government policies on long-term care reform, speaking with some of the best policy experts in the country, listening to what service providers have to say and speaking among ourselves as consumers and as taxpayers.
Through this process, the alliance learned that Ontario has a rich array of health and social services and facilities that are tremendously fragmented. As a result, the task of coordinating care to meet people's needs can present real barriers to accessibility.
In our Consumer Report on Long-Term Care released last July, the document Mr Beer is speaking of, our panel made a number of recommendations to better link Ontario's long-term care services into a seamless continuum. This kind of coordination is essential if consumers are going to easily access the care they need when and where they need it.
Given the emphasis that our alliance placed on better system-wide coordination, we are extremely concerned that Bill 101 is being put forward and debated in isolation. The reform of long-term care facilities is only one part of a much larger reform initiative including community-based care, supportive housing, health promotion and rehabilitation programs, chronic care and palliative care.
We understand that the government intends to release its broad implementation framework for long-term care reform at the end of this month. Without the context of this broader framework, the alliance cannot fully endorse Bill 101. Therefore, we recommend that Bill 101 be revised so that it is consistent with the overall long-term care framework. In particular, the revisions must encourage linkages between all aspects of the long-term care system to ensure consumers a seamless continuum of service.
In addition to this overriding concern, the alliance would like to share our thoughts about specific elements of Bill 101. We'd like to begin by focusing on the positive parts.
The alliance is pleased that Bill 101 will treat nursing homes, charitable homes and homes for the aged equally, under a single piece of legislation. Some of the current problems with these facilities stem from the fact that each is governed by separate pieces of legislation sponsored by different ministers.
We also support this bill's efforts to create clearer lines of accountability. In particular, the requirements that facilities must share and explain a resident's care plan with him or her is a welcome one. This ensures that expectations are clear and that consumers and their families have a basis for assessing the quality of care they receive.
The requirement for facilities to post service agreements and financial statements is another step towards improving accountability for consumers and their families. Posting such information is important for consumers when selecting a long-term care facility.
We support this bill's effort to better monitor and enforce the actual provision of funded services by withholding or recovering funds for services that are not provided. While we have some concern about the consequences of these sanctions, we commend the intent to create a more accountable system of facility care in Ontario.
The provisions for allowing regulations to designate beds for specific purposes such as short stay or respite is another positive aspect of this legislation. Throughout our hearings the alliance heard from family care givers who need access to respite services. While many would prefer in-home care, no doubt facility-based respite care would be welcomed.
We are pleased to see provisions for facilities to provide and govern in-service training programs for facility staff. In future, as community-based services expand and the size of Ontario's elderly population grows, the clientele of our long-term care facilities is expected to be more fragile and indeed of more complex care. These demands will require ongoing training for the staff in our facilities and we're pleased that this need is being recognized.
Now we'd like to spend a few minutes and talk about the highlights of some of the alliance's concerns.
There's too much left to be defined. There are a number of areas where the alliance has real concern about this legislation. Our future concern is that too many important issues are left to be defined in regulations. For example, the bill allows regulations to be developed to govern charges for certain services. We're concerned that, as written, this provision allows the possibility that consumers may one day be asked to pay user fees for personal care services. The alliance fundamentally opposes such fees and believes the government shares our view. Bill 101 should be revised to clearly state that resident charges will not be permitted for nursing or personal care services offered within a long-term care facility.
Also, Bill 101 allows regulations to come into effect retroactively. As consumers, we find such a provision odd. If such clauses were applied to residents' care, for example, it could create real hardships for consumers. We'd like an explanation of why this provision is necessary and recommend that the clause permitting regulations to come into effect retroactively be removed.
While the alliance supports the introduction of service agreements as outlined in the legislation, we know that how these agreements are defined will determine their effectiveness. We appreciate that service plans must be flexible enough to meet the unique needs of each facility. However, we also believe that provincial standards and guidelines, developed in partnership with providers, consumers and facility workers, are needed to ensure a consistent level of care throughout Ontario. Therefore, we recommend that provincial guidelines and standards be established for the development of facility care agreements and that the regulation governing service agreements must reflect these provincial standards and guidelines.
It is our understanding that although the basis for provincial funding will be the same regardless of the type of long-term care facility, the actual amount received will depend on the level of nursing care required by residents. Quality-of-life programming, such as rehabilitation, recreation and spiritual care, is expected to be funded separately under another, as yet unknown, formula.
Although this issue is not dealt with in the proposed bill, we're worried that this approach, borrowed from Alberta, will eliminate any incentive for rehabilitation or quality-of-life programming. Such facilities would receive less money as the residents improve.
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This is exactly what happened in Illinois when the department of public aid paid its nursing homes according to the level of care provided. While the goal of this policy was to keep the elderly as independent as possible, when analysts actually reviewed the results they were horrified to learn that the percentage of residents who were bedridden was increased steadily.
By paying more for bedridden patients, Illinois had inadvertently given facilities a financial disincentive to get their residents up, involve them in activities and help them function individually. As David Osborne and Ted Gaebler point out in their book Reinventing Government, "Because the funding formula focused on input but ignored outcome, it had produced the exact opposite to the state's intentions."
This situation was corrected when the state began focusing on program measurements such as consumer satisfaction, community and family participation and the quality of nursing home environment. Now each institution is visited periodically and rated by a group of nurse managers. The higher a nursing home is rated, the higher it is reimbursed. For example, the six-star rating is worth $100,000 a year more than one-star rating. These ratings are also published and shared with the public so that the consumers can be able to choose a facility based on its quality.
To address our concerns we recommend that Bill 101 be amended to mandate annual consumer, family and worker satisfaction surveys. The outcome of these surveys should be rated and published and facilities should be rewarded according to the rating.
As well as providing an important balance to government's proposed funding for facilities, the alliance believes that annual consumer, family and worker satisfaction surveys are also important. They are ways to improve the approach to quality of care outlined in Bill 101.
Concerns about quality of care in Ontario's long-term care facilities have been documented in a number of reports. For example, in a brief submitted to our alliance Concerned Friends of Ontario Citizens in Care Facilities concluded that 146 of Ontario's 263 nursing homes had serious violations. Similarly, the 1990 Provincial Auditor's report recommended that efforts to monitor quality in homes for the aged needed improvement.
The bill requires each facility to have a quality assurance plan which outlines how quality will be monitored within the facility. However, there's no mention that deficiencies in quality, when identified, must be improved.
While Bill 101 has strengthened government's inspection powers and enhanced its ability to enforce compliance by withholding or reducing funds, the alliance believes this will not provide an effective means of assuring quality. For one thing, facilities are given advance warning of an inspection visit so they're able to tidy things up for that occasion. This kind of behaviour does little to improve the quality of life for consumers living in this facility year-round.
The alliance would prefer to see Bill 101 outline a different approach to quality. Our approach would see inspection and enforcement as only part of a much broader, more systemic effort towards quality improvement. This approach would include a comprehensive program involving standards, measurements, comparisons, remedial action plans, reassessments and incentives to encourage full participation by all staff in continuous quality improvement.
The program would place less emphasis on punishing poor quality and more emphasis on rewarding high quality. While we recognize the need for punitive measures, the alliance believes that if they are the only means of ensuring quality, the result will be a system which operates in fear and hides problems rather than solves them. We don't believe this is an ideal environment for anyone to live in.
The focus should be on residents' outcome, not just inputs. For example, during our public hearings, the alliance was shocked to view slides on the average mouths of residents in facilities. Basic oral hygiene of residents was obviously not being seen to, but we were told that the staff routinely check off having cleaned residents' teeth and dentures even when they hadn't. Rather than relying on completed forms, the health of residents' mouths should be used to assess quality of care.
We understand that some of the Ontario long-term care facilities already voluntarily participate in a national accreditation program offered by the Canadian Council on Health Facilities Accreditation. This program could provide an important source for comparisons between and among long-term care facilities. In addition, a comprehensive quality improvement program may be developed affordably by building on the expertise of the CCHFA's program.
To improve the quality of Ontario's long-term care facilities, our alliance therefore recommends that the approach to quality adopted within this legislation be broadened beyond inspection and enforcement to include the measurement of residents' health outcomes and an emphasis on rewarding facilities for higher quality care, and that residents' councils be required in all long-term care facilities to provide important insight into specific quality concerns.
We are very concerned about the sweeping powers of the placementcoordinator as outlined in this legislation. While the government has stated a strong commitment to consumer choice and empowerment, Bill 101 identifies the placement coordinator as the sole authority for determining eligibility for facility care and the sole authority for determining an individual's particular placement.
We see no room in this model for consumers' choice or any sensitivity to consumers' ethnic, cultural or religious needs. And, while many consumers still rely on their family physician to oversee placement, it appears the family physician will have no authority over these decisions in the future.
According to the bill, each home shall have a designated placement coordinator. We're extremely concerned that this legislation creates a situation where placement coordination will occur in isolation and decisions will be made on the basis of paper review only. The legislation is also unclear about what will become of Ontario's existing placement coordination services. These organizations have a wealth of expertise that should be built upon.
In our Consumer Report on Long-Term Care Reform, the alliance recommended that placement coordination occur within the community-based, comprehensive multicare service organizations. Where they exist, the alliance hoped that placement coordination agencies would come together with other community agencies to form the CMSOs. For consumers, such an approach would ensure continuity of care since their CMSOs would already be familiar with their needs and therefore best able to help assess their alternatives, and, to foster coordination between community-based care and facilities, our alliance recommended that representatives from long-term care facilities participate in developing protocol for entry into facilities and be guaranteed placement on local CMSO boards.
In keeping with the recommendations contained within our Consumer Report on Long-term Care, the alliance recommends that Bill 101 be amended so that placement coordination is not solely the responsibility of the placement coordinator but rather is the function of community agencies in partnership with consumers and their families.
The appeal mechanism outlined in this bill for individuals wishing to challenge the decision of a placement coordinator offers little comfort to consumers. With a single health appeal board, we're afraid that the wait for a hearing could become very lengthy. For consumers in need of facility care, time is of the essence. Appeals need to be provided quickly and efficiently and as close to the consumer's home as possible.
Therefore, as an alternative our alliance recommends that Bill 101 be amended to establish an arm's-length appeal board within each district health council. These boards should include consumer representatives.
The alliance is concerned about what resources will be made available to consumers when making an appeal, and finally, we find the appeal board's quorum of one person utterly ridiculous. Bill 101 should be amended so that the quorum of an appeal board contains at least two people.
As consumers, one of the most disturbing elements of Bill 101 is that it allows regulations to establish the frequency of reapplication for placement. Not only does this undermine consumer choice but it also overlooks the fact that people's health status or situation can change suddenly. The alliance does not believe that arbitrary limits can or should be imposed on reapplication.
We therefore recommend that references to regulations which will limit the frequency of reapplying for admission for long-term care facilities be eliminated.
There's a summary of the recommendations at the end, but at this time Beatrix and I would be open for any questions. Thank you.
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The Chair: Thank you very much for a very full brief and for the recommendations. I know there are questions and we'll move to them right away, beginning with Mrs Fawcett.
Mrs Fawcett: Thank you very much for coming before the committee today. I know you have done so much work in this area before the actual bill came forward, and obviously you continue to provide us with some good thought.
I was interested in your "Proposed funding formula for facilities may eliminate incentive for rehabilitation," and that section. It seemed as though you were coming up with the idea of possibly focusing on the positive outcomes rather than what the bill seems to be suggesting in the way the funding formula that will provide the funds for the levels of care. At the bottom of page 4 it said that, "This situation was corrected when the state began focusing on performance measures such as consumer satisfaction." Certainly that is worth considering.
Then you talked about quality assurance plans and the idea of inspections. We've heard a lot that the idea of inspectors and inspections is rather a punitive, negative idea and that possibly we should be looking at quality management plans and then also focusing on a more positive approach so that all of the facilities would be measuring up but because of the positive things. I wondered if you would like to comment on those two sections.
Mrs Beatrix Robinow: You were interested in hearing about more positive things.
Mrs Fawcett: Yes. Many of the presenters who have come before us have been very worried about the quality assurance and the inspection idea as being punishment, rather than quality management and everyone working together for a more positive quality improvement in the actual facility and a better quality of care than would be produced.
Mrs Robinow: Yes, but that is exactly the one thing we were saying. We've heard the most dreadful horror stories about what goes on --
Mrs Fawcett: I think we all have.
Mrs Robinow: -- and the kind of behaviour that people go into when they get warning of an inspection; everything is tidied up and it regresses immediately afterwards. That is something we're trying very hard to circumvent, to avoid again.
Mrs Fawcett: Right.
Mrs Robinow: We also feel that so many of these stories about nursing homes, and they have given us pause, can possibly be helped by some of the other things which were suggested, and particularly for the residents' councils, that the people who are being served, the people in the nursing homes, in the long-term care facilities have a say, should be able to say what they think without fear of retribution. What happens so often is that some poor elderly person is so scared of what is going to happen when their visitors leave again that they ask them, "Please don't say anything about the condition you've found me in, because I have to stay here and these care givers will take it out on me if this happens." So residents' councils and outside interests and community boards are, we think, the way to try to help this.
Mrs Fawcett: You would be in favour, then, of maybe mandatory residents' councils?
Mrs Robinow: Yes, every facility should have a residents' council.
Mrs Fawcett: You would like to see that in the bill?
Mrs Robinow: And residents' councils would be in the facility itself and possibly have also community representatives.
Mrs Fawcett: Community representatives on the --
Mrs Robinow: On the residents' council or, as we have suggested, that there also be consumer councils attached to such places.
The Chair: I'm sorry; I'm going to have to keep everybody to just two questions. Mr Wilson?
Mr Jim Wilson: Thank you very much for your presentation. I think you've done a super job, as usual. I know you've had a lot of experience appearing before legislative committees and doing briefs such as the one you've presented today.
There are a couple of things, though, I want to point out. On page 2 you talk about one of the positive aspects of the bill being that it brings together separate pieces of legislation. Don't be fooled just because it's one booklet. It still deals with several pieces of legislation with various ministries. So while it makes some improvement, it certainly doesn't go all the way.
I want to leave a question for the parliamentary assistant to come back to at his time regarding staff training. On page 3 they make a statement that the bill provides for facilities to provide and govern in-service training programs, and I'm just not aware of those aspects of the bill if they exist.
I want to ask the witnesses: In terms of funding, you've made emphasis in your remarks that you believe the government is, I suppose, on the right track in that it's only charging for basic accommodation and not charging for nursing services etc. But I'm just wondering, do you realize it's a shell game, that it doesn't matter whether you're paying for basic accommodation or nursing services or whatever? The user fee is money that goes to the home, goes into the pot and is part of money that is used to keep the consumer in the home.
The reason I mention it is that I find it ironic that this government's bringing in $150 million worth of user fees. We were the party that talked about this in the last election, talked about where user fees should be appropriately placed. I have vivid memories of September 1990 when NDP candidates said they would never do this. Now I think that what they've done is they've put a spin on user fees. They've said it's for accommodations only and you'd pay that if you were at home anyway. It's bogus no matter which way you cut this argument. I'm just wondering if there was any frank discussion about that among the ONs.
Mrs Leitch: You're doing a very good job of defending it for us.
Mr Jim Wilson: Thanks, Jane, because I just want to make sure that the public's aware of that, and let's not be fooled again when politicians tell you about user fees.
Mrs Leitch: I think when you become a senior citizen, you become pretty suspicious of everything that happens and you try to look at the bottom line. We have tried very hard to see some positives in this bill as well as some of the negatives.
Mr Jim Wilson: Well, I guess I'm in opposition and I'll say facetiously that I appreciate you trying to find the positives, but --
Mrs Leitch: I think we specified our negatives as well, sir.
Mr Jim Wilson: Yes, and I appreciate that. In one of those that you sort of touch on -- and it's a question, really, to the parliamentary assistant -- when you're talking about limited applications for placement, and I think you make some excellent points there, I'm wondering what happens if a consumer turns down a placement coordinator. Is the consumer left on the placement coordinator's list? For instance, the placement coordinator says, "You have to go to X, Y or Z home," and say you absolutely refuse. Do you drop off the list or do you get to apply again? How does that work?
The Chair: Parliamentary assistant?
Mr Jim Wilson: You can apply indefinitely?
Mr Wessenger: I'd like to answer that. The placement coordinator puts the choices in front of the consumer. The consumer makes the choices, and they make a first choice, a second choice, a third choice or whatever number they wish to make for a facility. Then the placement coordinator determines the question of priorities, because people having high priorities, greatest need, will get the first opportunities at vacancies at their choices. When a vacancy comes up at one of the consumers' choices, obviously that vacancy will be offered to the consumer. It could be number one choice; it could be number two choice. They'd say: "We now have a vacancy at such and such a place. Do you wish to accept that placement?" It's purely a question of putting the choices before the consumer. The consumer makes the choice.
Mr Jim Wilson: Okay. So what you're saying is that if the consumer says, "No, I don't like these three choices. I'll wait for the next round," the consumer can do that indefinitely?
Mr Wessenger: Of course he can do that.
Mr Jim Wilson: Then why do we have the worry in this brief that there may be a limit placed on applications?
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Mr Wessenger: I think what is being referred to is the time frame, the fact that there's an indication in the brief that in the regulations you can put a limit that you can only make an application, say, every three months or six months. That, of course, would be subject to material change of circumstances. Obviously, you wouldn't have any regulation providing for a limitation without providing for a material change of circumstances.
Mr Jim Wilson: Well, that's not the way it reads.
Mrs Leitch: I think we'd like to respond to that. One of the things more seniors are worried about than any other single issue on this bill, as far as I'm concerned, is the control, the authority that the placement coordination person will have, with only one person deciding what your options are. Sometimes if you could stay at home but you need a lot of services, they'll say you can't stay at home and you have to go into a facility. That worries us a great deal.
The Chair: I'm sorry. We're going to have to move on, as time is passing. Mr Owens.
Mr Owens: I'm pleased that you talked about your association with Concerned Friends of Ontario Citizens in Canadian Facilities. Freda Hannah, myself and a number of her colleagues have worked on some projects within my own riding, so I have a clear understanding of some of the issues that this group undertakes to investigate and advocate on behalf of seniors in this province.
I think that in terms of some of the language that's used in this bill, the words "quality assurance" cause me some difficulty. I think it's a buzzphrase and doesn't particularly have much meaning. You talked about oral hygiene and I think that is a really good example that one can draft care plans, but in terms of the actual efficacy of the care plans and the assurance that somebody's actually carrying them out, that is really the litmus test, in my view. How does one go about doing that?
Mrs Leitch: I would suggest that there be regulations but that the regulations be applicable a lot more often. I think the issue of being assessed once a year was the one that we were getting into here. Your case management would be assessed, and our health situation changes rapidly. We think there should be an ongoing monitoring of the services that are provided to us.
Mr Owens: I think the issue with respect to accreditation and relying on accreditation as an assurance of quality makes me a little bit nervous as well. I think the parliamentary assistant and legal counsel have indicated that while some residences in fact were accredited, they were on the other end of the process of pulling their licences to operate. So I'm a little bit nervous about relying on the accreditation.
Mrs Leitch: That's why we want consumers on the accreditation boards.
Mr Owens: Exactly.
The Chair: Final question.
Mr Owens: In terms of the inspection process, and given the conversation we've had on this point on these issues then, I have to gently disagree with your view, then, that the inspection process needs to be a little bit friendlier. I guess maybe I'm paraphrasing your language, but I think that given some of the episodes we've witnessed in terms of media, and again with my association through Concerned Friends, when I look at this language there is nothing coercive about this language if a residence is doing as it should be doing and working with the residents and families.
Mrs Leitch: I'm not sure what kind of a response you want on that. We would like to strengthen the appeal process, that's for sure. Did you want to add anything?
Mrs Robinow: I think mostly that it's important that we look at outcomes, what really happens; and not just what's going on in there but what the result is and how people progress.
Mr Owens: And having a process in place.
The Chair: Thank you. I'm afraid we're going to have to move on. There was one other question that I didn't let the parliamentary assistant refer to. It was the one regarding staff training.
Mr Wessenger: I think I'll ask Mr Quirt to just indicate again the funding situation with respect to in-service training programs.
Mr Quirt: Thank you. Bill 101 contains a change to legislation that allows the province to specify the type of training that might be required in a particular facility, and secondly, the intention is to allow training as a subsidizable expense in any of the three budget categories that funding will be flowed through to each long-term care facility.
The Chair: I want to thank you both again for coming before the committee and for the material you've left with us.
Mrs Leitch: Thank you very much.
VILLA COLOMBO HOMES FOR THE AGED INC
The Chair: I would like to then call the next witness, the representatives from the Villa Colombo Homes for the Aged, if they would be good enough to come forward.
Could I just indicate to committee members that following this presentation we will be having the presentation from the Bob Rumball Centre for the Deaf. In order to get organized for that, I will call a brief recess, as there are a few things that will need to be taken care of before that presentation begins.
Welcome to the committee. I know some of you have been sitting and listening to the proceedings. We appreciate your patience but we're delighted to have you. If you would be good enough to introduce the members of your delegation, then please proceed with your presentation.
Mr John Capo: My name is John Capo. I'm the president of Villa Colombo. Sitting with me at the table is Mr George Glover, who is the administrator of Villa Colombo, and Virginia Ariemma, who is the community development advisor for the Italian Canadian Benevolent Corp.
Honourable Chair and honourable committee members, it is a privilege for me to represent Villa Colombo and the Italian Canadian Benevolent Corp before the standing committee on social development at these hearings relating to the proposed passage of Bill 101.
There are several people with me today in support of our position on Bill 101. They are Mrs Colly Cavaluzzo, who is a former president of the Villa Colombo Ladies' Auxiliary and our governor of our board, together with other members of the Villa Colombo Ladies' Auxiliary; Mr Luigi Ferrara, a board member; Dr Annamarie Castrilli, former national president of the National Congress of Italian Canadians; Mr Manlio d'Ambrosio, president of the National Congress of Italian Canadians, Ontario; Mr Pal DiIulio, executive director of the Italian Canadian Benevolent Corp; and Mr Paul Pellegrini, president of the board of directors of Columbus Centre.
As you undoubtedly know, the Italian Canadian community is the largest ethnocultural group in Ontario and in greater Metropolitan Toronto. The Ontario Human Rights Code recognizes the inherent dignity and the equal and inalienable rights of all members of the human family. There are currently more than 70,000 seniors in Metro Toronto whose mother tongue is Italian, a number larger than the total population of many cities in Ontario, such as Barrie, Kingston or Peterborough. Many of these seniors are unable to adequately communicate in English. No senior can truly live with dignity if that senior cannot communicate needs in a language which he or she understands. Our moral obligation lies in representing the best interests of the seniors in our community, particularly those who do not communicate well in English.
Villa Colombo is the only non-profit extended care facility with a culturally sensitive focus for Italian-Canadian seniors. The majority of Villa Colombo residents are of Italian origin. The community investment in this home for the aged is priceless. Countless hours were and are volunteered to see that this home and lifestyle became and continues to be a reality.
Honourable members, we understand that part of the purpose of Bill 101 is to ensure standards of nursing and personal care for all people receiving extended care, whether in a for-profit or non-profit home. We of course agree with this principle.
However, we have many concerns regarding other aspects of Bill 101. I would be remiss if I did not take this opportunity to address uncertainties which relate to long-term care redirection and funding.
Since the early 1970s, Villa Colombo has had a three-way partnership in caring for seniors involving the seniors and their families, the community and the government of Ontario. We support a functional system which is responsive to needs in cooperative partnership with provincial standards.
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Bill 101, in its present form, appears to usurp not only the community's investment but also the function of directors, who are required by legislation to manage or supervise management of the business and affairs of a corporation.
Rumours abound, creating uncertainties and questions regarding major considerations such as: What happened to the January announcements on funding and chronic care? Were user fees calculated correctly in government estimates? Is it true that increased inspection will be done without additional inspectors, leaving for-profit homes, where scrutiny should be greater, open to fewer inspections? Is the means testing for user fees at a level which would disqualify most seniors? Can distinct cultural and urban needs be protected under the proposed legislation? How will unions be dealt with if the case mix indexes lower staff needs. How can the standards of care be met if funding is insufficient? Is there a future basis for partnership between the government and the community-based groups?
We are in a sense working in a vacuum. Through Bill 101, we are asked to accept legislation governing a system which is not defined. In addition, the proposed legislation seems in many respects to be contrary to the results of consultations. As stated by the chairman of the Niagara region just a brief while ago, Bill 101 has clearly not taken grass-roots involvement into consideration. While government has a major stake in the financial demands of future long-term care, so do seniors and so do community groups.
It is our preference that the process of legislation be delayed until such time as the governing system and standards are fully developed. We support changes in legislative acts, rather than in regulations, to ensure that the principles of community interest based groups are protected for the benefit of the citizens of Ontario.
We refer you to our brief, where we present our concerns on the legislation and have made suggestions on remedies to ensure that revised legislation addresses the future needs of long-term care in partnership with community interest based groups. I'm going to make some points that are in our brief. The points I'm going to be making are in a slightly different order than in our brief.
(1) Admission: facility and the applicant: We are proud of the care provided at Villa Colombo. Our seniors also have a cultural and spiritual environment which permits them to live in dignity, fully able to communicate and participate in decisions affecting their lives. I emphasize that neither the taxpayers nor the government pays for the sensitive cultural and spiritual environment of Villa Colombo; the community provides these additional quality-of-living values. Our community will continue to do so as long as there is an incentive. Bill 101 provides for no participation on who is admitted to a facility and no right of an applicant to choose the facility he prefers.
Our recommendation number 1: We recommend that the legislation ensure that an applicant may apply for admission to the facility of his or her choice and that a facility may give preference to those applicants who would most benefit from available services, with access through the community where feasible.
A central registry is a valuable tool, but admission, particularly where there are cultural or spiritual considerations, must be dealt with at a local functional level. Admission choice should be mutual.
(2) Service agreements with the crown: In the proposed legislation, through service agreements, the province assumes total control and authority over operations, regardless of past or present resident and community participation in funding.
Our recommendation number 2: We recommend that the legislation ensure that the service contract is mutually agreed upon and acknowledges particular community or cultural sensitivity as part of the service contract.
(3) Equality and equal access for seniors: The proposed Bill 101 holds no commitment to equality or equal access for seniors whose mother tongue is not English or French or who have special cultural or spiritual needs.
Our recommendation number 3: We recommend that the legislation ensure protection for those whose mother tongue is neither English nor French, where there are facilities providing specific cultural and spiritual sensitivity.
(4) Community group governance: I earlier spoke of the role of volunteers in building and operating Villa Colombo. This is true of many non-profit homes whether culturally based or not. There is no profit motive in a charitable institution. Board members overseeing operation have no vested interest. Their concern is the best possible care and life of the residents. Cultural aspects do not cost government or taxpayers.
The proposed Bill 101 provides no mention or motivation for any community or non-profit group to build and/or financially support a facility when it has no governance control and therefore does not provide incentive for volunteer sector participation. The partnership between government and community groups is beneficial to the citizens of Ontario.
Recommendation 4: We recommend that the legislation ensure non-profit community groups, where numbers and organization warrant, may receive special consideration to ensure delivery of culturally sensitive services.
(5) Consumer or facility appeal: The proposed Bill 101 has no appeal for the consumer other than eligibility and no appeal on any matter for any facility. If legislation regarding admission is not a decision made by the applicant and the facility, there must be appropriate appeal mechanisms.
Recommendation 5: We recommend that the legislation ensure an equitable appeal procedure on admission, placement, service agreements and care assessments. The appeal body should include providers and stakeholders.
(6) Care standards: The proposed Bill 101 would enforce care standards based on annual assessments by the government which do not permit any funding flexibility for changing needs.
Recommendation 6: We recommend that the legislation ensure rights to negotiate care assessment levels where there is potential for a negative impact on care for residents.
I have two further comments before I finish speaking. We believe that community groups will continue to try to raise funds for provision of care beyond minimum standards set out in legislation. We urge you not to penalize these groups. We recommend that groups which raise and utilize funds from the community to improve quality of living not have such funds deducted from the basic funding formula.
We also feel very strongly that a clause containing the same meaning as subsection 2(1) of the Nursing Homes Act be included in Bill 101 and applicable to all long-term care legislation. That subsection states:
"The fundamental principle to be applied in the interpretation of this act and the regulations is that a nursing home is primarily the home of its residents and as such it is to be operated in such a way that the physical, psychological, social, cultural and spiritual needs of each of its residents are adequately met and that its residents are given the opportunity to contribute, in accordance with their ability, to the physical, psychological, social, cultural and spiritual needs of others."
That last recommendation precedes the residents' bill of rights in the Nursing Homes Act. These sections were added to the act at the standing committee hearings upon the insistence of the Honourable David Cooke, the Minister of Education, who was then Health critic.
We recently met with the Honourable Tony Silipo, Minister of Community and Social Services, regarding our concerns about Bill 101. During that meeting, he led us to believe that there would be some changes to the proposed legislation prior to presentation to the cabinet committee on social development and final reading in the Legislature. We hope today to receive confirmation of these changes from this committee.
I thank you for your attention. We would like to hear the changes to the bill which we will be recommending and welcome any questions that you may have.
The Chair: Thank you very much for your presentation. I guess I should indicate that the committee is still at a hearing stage. We've not begun clause-by-clause discussion, so I'm not sure whether perhaps at the end you're really directing your questions to the government. But we will be doing clause-by-clause in a couple of weeks' time. With that, we'll go to questions.
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Mr Jim Wilson: President John, I just want to congratulate you and the volunteer directors on your board of directors for really what's an excellent presentation and the accompanying submission, which contains your detailed thoughts on how to improve this legislation.
In spite of what you've just said, Mr Chairman, regarding the fact that we're still in committee hearings, I think the government has known for quite some time the concern of Villa Colombo and many other charitable homes for the aged that are very concerned that this legislation isn't culturally sensitive, nor is it sensitive to the spiritual needs of their residents. Given that Dave Cooke, while in opposition, really was a firm believer and subsequently was able to have incorporated into the Nursing Homes Act subsection 2(1), as outlined in the back of John's brief, I'd like to ask the parliamentary assistant whether there's a commitment from this government to include in this legislation what is already included in the Nursing Homes Act, which is this interpretation clause which ensures that the act will be interpreted in such a way that is sensitive to the physical, psychological, social, cultural and spiritual needs of the residents.
Mr Wessenger: What I would indicate, however, is that certainly the suggestion will be given serious consideration with respect to applying the same principle to the other acts. I think that's fair to say.
Mr Jim Wilson: The frustrating part of the way this government deals with committee hearings is you think these are your public hearings on this bill. You know, prior to having presented this in the Legislature or shortly after you presented this in the Legislature, that many, many groups have asked for exactly this. I don't know for the world of me why you can't just make a commitment now. This isn't something new that Villa Colombo's brought to your attention today; it's not something new at all. It's something that exists in the current act. So I can't take your words of assurance to the bank and this group can't take as satisfaction.
Mr Wessenger: I think, as parliamentary assistant, I can't make commitments on behalf of the minister. I can only indicate that certainly there is a desire, first of all, to ensure that consumers' choice is made clearer in the legislation. That's been stated on many occasions, the fact that consumers' choice is paramount in this situation and that the whole placement coordination system is to work on the basis of consumer choice.
Secondly, I certainly think it's a very good suggestion that has been made by the Villa Colombo, as it's been made, I think, by perhaps other groups with respect to looking at it, incorporating either the same language or similar language in all the acts.
Mr Jim Wilson: Mr Jackson has a supplementary on that.
Mr Jackson: The concerns raised by our caucus are not simply limited to the right of access to a facility; it is that the legislation, as it's written, can materially change the face and the atmosphere of a facility. Four years ago I was in a facility and it was a home for the aged, built for the faith community. I brought a religious icon as my token for their common area, "chapel" area. When I gave it to them, I said, "Where's the crucifix?" They said: "We're not allowed to put it up because as a condition of getting the moneys to build the facility, we could not have something that discriminated by faith."
Now, these fears are legitimate. This concern does not simply extend to the notion of admissions; it extends to the notion of religious icons and other symbols that exist in an existing home. As this government is fond of removing certain symbols which it considers passé or exclusive in nature, we are here to say and serve notice that under no circumstances do we wish to see those symbols removed from those kinds of facilities. Before we get any reaction, I would ask that the matter be looked into because it's already surfaced in the preconditions for grants in terms of construction for some facilities in this province. These are legitimate fears that we're putting on the record and we want something more than simply the words, "It's simply an issue of admission."
The Chair: Did you have a comment you wished to make on that? No?
Mr Jim Wilson: Mr Chairman, perhaps I could just ask the witnesses a quick question to do with governance. My impression from your presentation is that if changes aren't made, if your volunteer directors and your board of governors are not respected in this legislation, you are going to have difficulty attracting volunteers to serve on your board of directors.
Mr Capo: From my own personal involvement, I would certainly say so. Our particular board has 22 members. As I've indicated to you, there are also members here from the ladies' auxiliary and a great number of volunteers who work and raise money annually for Villa Colombo. The reason we do this, a great reason, is because we are doing it for the good of, in this case, our own community, the Italian community.
I certainly think and would submit to you that if the control, as it seems to me, is going to be taken away, from what I read in the legislation -- most of it is not well defined, because it talks about regulations -- it certainly would no longer be an incentive to serve on a board, because we would have no real say in perhaps policy and admissions and other matters relating to the home.
Mr Jim Wilson: And no incentive to raise money. You don't raise money just to meet basic care requirements; you raise money so that your residents can be comfortable in their own culture.
The Chair: I'm sorry; we have to move on.
Mr Drummond White (Durham Centre): I just have a couple of questions. First off, I'm not sure what the result of that particular question that was just posed is, but I'd like to hear it. I know that in my neck of the woods, Durham -- I represent Oshawa and Whitby -- we're working hard to secure services for the Italian community there. The Italian community is a very vital part of our area. People like Peter Composio and Carmen Germano are a really vital part of our mix. Do people from Barrie, from Peterborough, from Oshawa have access to Villa Colombo?
Mr Capo: I would say yes, if I just might confer with Mr Glover.
Mr George Glover: We're very happy and proud to be able to share all of our knowledge. We are beneficiaries of knowledge from other homes, of course -- the Jewish community and others -- and we receive inquiries and visitors and guests from not only around the province but certainly from around the country and indeed from other countries in the world as well. Villa Colombo is well known and we are only too willing to offer any of the knowledge we've gained over the years to any other facility.
Mr White: I'm wondering specifically, though, if Italian-speaking people in our community needed residential services, needed some extra services that weren't available locally, can they secure those?
Mr Capo: We do have residents from outside of Metropolitan Toronto. The residents of Villa Colombo are not just from Metropolitan Toronto. We have them from as far away as northern Ontario; I think we've had one from northern Ontario. Everyone is welcome. It has been my experience as president of this board for the past year that whenever I meet and discuss seniors' issues with members in our community, and this is very important, if someone is Italian and applies to Villa Colombo only because he speaks the language, I think it's important to note that Villa Colombo offers other services as well in the community. We're trying to expand those services, one of which is a service of information, a referral service in Italian at Villa Colombo. Anyone can call Villa Colombo to get information and to hopefully receive some assistance.
Mr White: Can we have a clarification on that matter that was raised earlier about cultural or religious icons?
The Chair: Yes, we will. I'm going to go to Ms Sullivan and then there were a couple of clarifications the parliamentary assistant was going to make.
Mrs Sullivan: I just wanted to assure you that if the clarification from the parliamentary assistant isn't that cultural sensitivities and sensitivities with respect to physical requirement and psychological requirements and religious sensitivities aren't promised by the government, we will certainly, from this side of the House, be having amendments put forward for consideration. Those issues are very much on the table; they have been throughout the hearings.
I'm very interested in two questions you raised in your brief, one with respect to the role of your board in association with the service agreements, because the service agreements will outline the responsibilities of your home and the services which are provided in terms of what the government's expectations are. I wonder, have you had an opportunity to see the draft manual?
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Mr Capo: I have not, personally.
Mrs Sullivan: I wonder if it might be useful, then, if the ministry could make a draft manual available to you, because I would be very interested in knowing, by example, who will sign your service agreement with the government.
Will it be considered by the board after negotiation or will it be signed by the administrator who is then brought on by the board? And then who will have the legal responsibility, in a home such as yours, for ensuring that the service agreement is maintained? Who will be responsible, in terms of your operation or other charitable home operations, for ensuring that the culturally sensitive programs that you have agreed to provide are provided? I'd be interested in knowing that.
The second thing I'd be very interested in knowing -- I was pleased to see, once again, that there have been two or three other groups that have spoken about the appeal process -- is that you have mentioned the appeal process and indicated that you believe the facility should be part of the appeal as well as the resident appealing eligibility or ineligibility to be there.
The other aspect that I'm asking you to consider and address for us today is whether the appeal process, as it's written in the bill, is an appropriate one when the appeal process is to the Health Services Appeal Board, which is quite removed from the local home, or whether a less formal appeal process with respect to eligibility for admission, by example, or to appeal the placement coordinator's determination of eligibility might be more appropriate.
Mr Capo: As I read the bill right now, the only appeal which relates to the two pieces of legislation that govern our home is only an appeal where a resident has not been admitted by the placement coordinator. There's no other appeal whatsoever.
Mrs Sullivan: That's right; exactly.
Mr Capo: We don't think that's appropriate. We think there should be an appeal not only at that stage but an appeal at the stage when someone is asked or told to go to a certain home. This should be able to be appealed not only by the resident but also by the facility. We're not sure, under the present legislation, in that section, as to whether there's any standing. It seems to me, first of all, there's only a one-person appeal which we think should be made larger, two or three individuals, and those individuals should come from both sides, from the workers in the field and also from government. Going back to the appeal itself, we don't know at this point in time, from the legislation -- I would doubt if there's any standing, at the first appeal level, of anyone else other than the resident who has been denied access and the placement coordinator.
We certainly think that is not a proper appeal procedure under this act. There should be an appeal procedure for other aspects of the act, as we've pointed out, with respect to matters relating to funding and other matters as well.
Mrs Sullivan: Good. I'd like to talk to you more on that later, but I think the Chair is going to chop me off right now.
The Chair: Chop. I'd just like to ask the parliamentary assistant to comment on it with a couple of clarifications.
Mr Wessenger: Thank you very much for your presentation. First of all, I'd like to make clear that add-ons will not be deducted. In fact, I think we very much encourage you to add on programs that do enhance the residence.
Secondly, just with respect to Ms Sullivan's comment about charitable homes for the aged, of course, as you well know, you have your own bylaws, and your bylaws determine who signs the service agreement. Under a normal corporate structure, I would assume the service agreement would go to the board for approval.
Lastly, some of the indications raised that the government did not fund chapels or was somewhat -- I'd like to indicate that the government policy has been to fund chapels in homes for the aged on a 50-50 basis. I don't see any reason for that changing. Also, with respect to the multicultural aspect, I understand there are 13 multicultural homes for the aged presently under approval.
Mrs Sullivan: "Under approval." What does that mean?
Mr Wessenger: I'll ask Mr Quirt to clarify.
Mr Quirt: A total of 660 beds operated by non-profit multicultural corporations are expected to come on stream in the next 18 months to two years.
Mrs Sullivan: How many are on stream now?
Mr Quirt: I believe one of the 13 facilities approved is operational and a number of others are at various stages of construction at this time. We can certainly provide the committee with a report on which groups received how many beds, where they're located and when they'll be opening.
The Chair: Thank you.
I want to thank you for coming before the committee, and I hope you have received some of the direction you were after. As I mentioned before, the committee will be doing its clause-by-clause in a couple of weeks' time, and then of course it's reported back to the Legislature.
Mr Capo: I look forward to the clause-by-clause. We'd like to have a look at that, and we would also request, if possible, to have additional input at that time once we see, hopefully, the amended legislation. Thank you.
The Chair: Thank you very much, and thanks again for coming before the committee today.
Members, we will now have a short recess while our next representatives, from the Bob Rumball Centre for the Deaf, get organized. So if you could just stay close, we'll stand adjourned for a couple of minutes.
The committee recessed at 1646 and resumed at 1656.
BOB RUMBALL CENTRE FOR THE DEAF
The Chair: Good afternoon again, ladies and gentlemen. We're ready to proceed with the presentation from the Bob Rumball Centre for the Deaf. Just before turning the microphone over to --
Mr Jim Wilson: Mr Chairman, I think the people in the back of the room would like the interpreters to stand up because they can't see them.
The Chair: There are a number of interpreters doing different functions today, so I think we've got everybody carried.
Mr Jim Wilson: Okay.
The Chair: Just before turning the microphone over to Reverend Rumball, the request was made, and I think it is a good one as some of the people here today are also visually impaired, if we could introduce ourselves so that they could be made known to everyone in the audience today. I will begin and if we can move then to my right. I'm Charles Beer. I'm the Chair of the committee.
Mr Gary Malkowski (York East): I'm Gary Malkowski.
Mr O'Connor: Larry O'Connor. I'm the member for Durham-York.
Mr Owens: Steve Owens, MPP, Scarborough Centre.
The Chair: Sorry. If you could just go a little slowly because they need to get the whole name out.
Mr Owens: Steve Owens, MPP, Scarborough Centre.
Mr White: Drummond White, member of provincial Parliament in Durham Centre. That's Oshawa and Whitby.
Mr Jackson: Cameron Jackson, the member of Parliament for Burlington South.
Mr Jim Wilson: Jim Wilson, member of provincial Parliament for the riding of Simcoe West and Ontario PC Health critic.
Mrs Sullivan: Barbara Sullivan, member of provincial Parliament for Halton Centre and Liberal Health critic.
Mrs O'Neill: Yvonne O'Neill, member of provincial Parliament, Ottawa-Rideau.
Mrs Fawcett: Joan Fawcett, member of provincial Parliament for Northumberland.
The Chair: The final thing I'm going to do before -- oh, sorry. The final thing I'm going to do is to cut off the parliamentary assistant. No.
Mr Wessenger: Paul Wessenger, MPP for Simcoe Centre and parliamentary assistant to the Minister of Health.
The Chair: Thank you. Those are the members of the committee and the other persons you may see at the front with us are members of the staff of the ministry or of the Legislative Assembly.
It's not often as the Chair that a member of one's family is appearing before the committee. So I just want to recognize my wife's aunt, Aunt Emma, who is from Brampton and who's here today with the group. Aunt Emma, hi.
Now with that, Reverend Rumball, if I could turn the microphone over to you, perhaps you'd be good enough to introduce the members of your delegation and then please go forward with your presentation.
Rev Bob Rumball: We're privileged to be here before the standing committee and you honourable members. You're going to hear from the deaf and deaf-blind themselves so that you'll get it from the consumers who are very much concerned about what they see happening, because it's a continuation of what has been happening for the last 50 years.
We have Peter Virtue, the executive director of the Bob Rumball Centre for the Deaf on Bayview Avenue. Next is Dorothy Beam who has been a leader in the deaf community and is also on the continuum of care committee at the Bob Rumball Centre for the Deaf. Next is Robert Lock, a blind-deaf resident, and he has an interpreter with him. They will take over and make their own presentations, then I may wrap that up and then I hope we can deal with questions that you might have.
Mr Peter Virtue: Ladies and gentlemen of the standing committee, I am pleased to be with you this afternoon. At the same time, I want to thank you for giving us special consideration and the extended time period. That really is a pleasure, and we thank you very much.
The Bob Rumball Centre for the Deaf has been serving the specialized needs of the deaf and deaf-blind for 14 years. The Bob Rumball Centre for the Deaf is the only facility in Ontario that provides services to deaf and deaf-blind individuals and seniors.
As a service provider, BRCD has many concerns about Bill 101. Many of our colleagues in the long-term care field have had the opportunity to address the committee regarding specific issues related to placement choice, funding, accountability and the impact on quality of care. We share these same concerns. However, today we would like to focus on Bill 101 and the impact it will have on the deaf and deaf-blind seniors specifically.
The government discussion paper Redirection of Long-Term Care and Support Services in Ontario outlined specialized services for individuals with sensory losses. Bill 101 does not address these needs. How does the government propose to ensure that these specialized services will be met?
Furthermore, how will deaf and deaf-blind seniors access the services of the placement coordinator? Will they have the expertise required to assess their very unique needs? This would seem to be almost impossible and an extremely expensive task, given the number of PCs across Ontario. We have proposed in our submission to the committee that a specialized PC who is sensitive to and experienced with the unique needs of deaf and deaf-blind seniors be appointed with provincial responsibility.
We recognize that the eligibility criteria which will be part of the regulations of Bill 101 are in draft form. We have seen the criteria and are very concerned about the impact this will have on deaf and deaf-blind seniors. In its present state, admission to a long-term care facility is determined only on medical and safety aspects. What of the individual's psychosocial needs?
When deaf and deaf-blind seniors are denied access to local services, isolation occurs. To understand and be understood is a primary need and right. Deaf and deaf-blind seniors living in the community are unable to access local services. They cannot communicate with those around them. Communication with hearing family members is usually limited. In order to meet their psychosocial needs, deaf and deaf-blind people must have the ability to communicate. When there is no communication, isolation occurs, and isolation can kill.
For this reason, many deaf and deaf-blind seniors will choose to move to the Bob Rumball Centre for the Deaf, not for health reasons but for the social interaction and communication. Deaf and deaf-blind seniors must not be deprived of this choice. We ask that you consider expanding the eligibility criteria. The government must recognize that deaf and deaf-blind people are only serviced when they can access communication and information. Thank you, Mr Chair.
Mrs Dorothy Beam: Ladies and gentleman of the standing committee, allow me to introduce myself. My name is Dorothy Beam. I am actively involved with the continuum-of-care committee at the Bob Rumball Centre for the Deaf. My deaf friends and I are here today to share with you our concerns regarding Bill 101.
There are some things I would like the standing committee to know. One of these things is that, barring any physical or mental handicaps, deaf people do not consider themselves disabled; rather, we consider ourselves a distinct linguistic and cultural community bound together by the need for visible communication everywhere. Sign language and the written word are our communication mode.
Deaf people need to be together because of the way we interact with each other, using sign language to communicate. We began our education and psychological-social growth within our culture when we attended the then-only school for the deaf in Belleville, Ontario. When the graduates left for their scattered homes throughout this province, they kept in touch through reunion conventions and church rallies. Organizations for the deaf published newsletters and there were many members known as the "old boys and girls network."
Over the past 13 or 14 years the Bob Rumball Centre for the Deaf has developed and provided services that meet the special communication and cultural needs of deaf seniors. There is an elderly persons centre, which provides social events, community support programs, group trips, meetings and also interpreters when needed. Communication is very visible there, and the doors are open to visitors from the outside community who wish to come in to visit. Newsletters are published bimonthly, and this way the Ontario deaf are kept informed.
In spite of advanced technology we now have, there are still instances of isolation and loneliness for elderly deaf citizens outside of the centre. Regardless of loving family or caring professional care givers, if sign language is not used, nor any social interaction with peer groups, isolation occurs, leading to unhappiness and some mental deterioration, even some deaths.
The Bob Rumball Centre for the Deaf is a home and a haven to those fortunate deaf seniors who wish to live and die together as they began their school life together. Will Bill 101, as it stands, allow them this? I do not think so, for when I read and studied it, I could see the need for amendments. I hope you will agree. Thank you for your attention, ladies and gentlemen.
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Mr Robert Lock: My life at the Bob Rumball Centre for the Deaf: Good afternoon, ladies and gentlemen. Thank you to the standing committee for inviting me here to speak today. My name is Robert Lock and I am a deaf-blind resident of the Bob Rumball Centre for the Deaf.
Although I am a diabetic and require some medical services, this is not the only reason I have chosen to live at the Bob Rumball Centre for the Deaf. The staff are both hearing and deaf and are able to communicate with the deaf and deaf-blind senior citizens by different means.
I participate in Monday activities, in bingo every Tuesday, and I go to the news and drop-in for the deaf and blind on Thursdays. I also can socialize in the dining room and in the lounge with the deaf and deaf-blind when I want. If I lived in a different place with only hearing people or someplace other than the Bob Rumball Centre for the Deaf, I would have few friends and the staff and volunteers would not be able to communicate with me. I would be very lonely. Through intervention I can access my needs. If my life was without intervention, I would not get along on my own. The Bob Rumball Centre for the Deaf is a very important place for us, for me and others. Thank you.
Rev Mr Rumball: Robert has just been seeing with his fingers, talking with his hands. He grew up in Hamilton, Ontario, and at the early stages of his life was only deaf. He acquired the blindness later on, so he has known that aspect of life as well.
Until very recently there was no place for him to go; we had jails and mental hospitals. That's simply because, in the wisdom of the legislation over the years, deaf were not supposed to be allowed to teach; sign language was forbidden in the schools; they couldn't be adoptive parents. In fact, BRCD exists today because it was made an exception to the rule.
You see these badges. They say "No Isolation." Now, they call it isolation. You may call it mainstreaming, normalization, integration: fancy catchphrases that have been the greatest curse to people in special needs who need special resources and special residential care.
I found it very difficult to understand why there was such a serious barrier to overcome. Even ministers said: "We don't have to explain. We don't have to tell you. Those are the rules and that's the way we're going to run our province."
Today we have a few deaf-blind residences that are very recent, simply because someone came along and said that the expense of doing the wrong thing and the waste of human life is disastrous.
We don't have a nursing home for deaf people today and as a result, BRCD is providing some nursing care, really outside our mandate, simply because they think all you have to do is integrate them and provide the service in a facility where there is no communication, no understanding and no opportunity to really be understood.
One of our great concerns about Bill 101 is when we read about the fact that some provincial coordinator is going to make decisions about people he or she knows nothing about, culturally, linguistically, psychosocially, educationally, in any area of their life. Yet these people are going to be empowered to make the kinds of decisions that put a place, which is meeting a special need for special people, not in the driver's seat where it belongs but simply as a dumping ground, because the provincial coordinator could end up referring and sending people there who really, number one, didn't want to be there, don't fit into the environment in any fashion, cannot either serve the community or be served by the community intelligently.
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If we're just providing warehouses, we don't need the kinds of services that are going to meet their needs. Warehousing may be all right for countries where the state is supreme and makes all the decisions, right or wrong, and where people have no rights. I think Ontario is better than that. It should be better than that, should be open and willing to be informed, willing to seek consultation from the consumer, willing to take a look and find out what the real needs are and not some fancy philosophy that has never worked, even though that's the philosophy and that's the policy that I have had to face for 38 years with the deaf.
It never made sense when I started and hasn't made sense anywhere along the way. One of the strange things is that the rest of the world and 60 other countries have come to see what we're doing and think it's marvellous, think it's great, but they always have the question because they say, "Philosophically, what you're doing here is not what your government proposes."
It is the best thing that has happened anywhere in the world, because the deaf were consulted. They were not only the consultation group; they were the group. It is owned by deaf people primarily. With the help of a lot of hearing friends, it became possible -- and with the cooperation of the government at that time, which made all the exceptions to make it possible not only for us to have long-term care for seniors, but under the same roof to also serve adults and youth and children and vocational rehabilitation and preschool and day care. We actually think that family orientation is the best answer to any problem that exists because it's the total picture meeting the total need.
I know that flies in the face of a lot of philosophy. The fact that the results are excellent, better than anything else that exists, should I think be an indication that somewhere along the line somebody just might ask, might consider, because in all the presentations we have made before select committees and royal commissions, I have never seen any of the intelligent proposals by the deaf community incorporated into the legislation, and that involves Health, Community and Social Services, Education and Correctional Services, and they have been presented on a regular basis down through the years.
We're hoping that Bill 101 through this committee and the legislation that eventually comes about is not just a change but a change for the better. Changing for the sake of change is not very bright. Changing because it's an improvement and is going to provide a greater opportunity for service and provide more freedom of choice involving the consumer group in what is being provided would, I think, be good legislation.
You're welcome to ask any questions of any of the members here because your questions will be interpreted for them and they can respond and you can direct your questions to them. They live it. You and I, except for Gary, don't have to live it. We can opt out any time we want.
The Chair: Thank you very much for your presentation and also for the other documents which you have left with the committee. We'll move right to questions and begin with Mr O'Connor.
Mr O'Connor: I think that you're perhaps a little bit shy in saying -- like Dorothy Beam here. She's a recipient of the Order of Ontario, so we're really honoured that she has come here and brought all her friends with her.
I have talked to Gary Malkowski about some of the things that do take place at the Bob Rumball Centre. He gave me a copy of the elderly persons' centre program and news and I find it very informative. I'm sure that the members of your community find this sort of keeping in touch with everybody is really important.
You've brought to the committee a copy of the annual report, and for the committee members, they may want to just take a look on about the third page in. I notice there's a picture of young Christopher Malkowski, who is the son of Gary Malkowski, so I'll embarrass him perhaps a little bit.
Gary -- as well as Paul Wessenger, the parliamentary assistant to the Minister of Health -- has talked to me on a number of occasions and has shared with me the consultations. Your community has certainly gone out of its way in making sure that presentations were made not only to the committee but to the government. Your concerns have been heard.
Gary shared with me the presentation that was made, and I believe this goes back to March 1992. Not only did you make a presentation at that time; following that you presented a follow-up just to make sure that all the necessary points of view you wanted to get across, talking about access and accommodation, did come forward. I guess for us committee members this is probably one of the unusual opportunities where Gary didn't need the interpreter, because he had people from his community here, but we needed the interpreter.
I think that, taking a look at your brief, you made some very good recommendations. On page 4, you talked about a specialized placement coordination that would take a look at the provincial responsibility. I know that's something Gary has talked about and I think that's a very reasoned approach, an approach we're definitely going to look at. It's something we thank you for coming to the committee about because it's a view you brought forward to us.
You've stated in your presentation, the brief, that in order to meet the psychosocial needs for deaf and blind people they need to communicate. I think you've stated that quite well and eloquently today. What I'd like to do at this point is get an interpretation from the bureaucrats within our ministry to give some assurance that the needs of people presently residing in the Bob Rumball Centre are going to be recognized and that the needs of future people who would like to go into the Bob Rumball Centre, whether they're deaf or hard of hearing, get recognized. If I could get a clarification from Geoff Quirt, I'd appreciate that.
Mr Wessenger: Perhaps I will attempt to give the clarification, and if any additions are required by staff, they can clarify. We recognize and appreciate the suggestion with respect to the specialized placement coordinator and we recognize the fact that it's a requirement to have such a person designated. I have received assurances from ministry staff that the selection of that will be done in consultation. It will not be done except on a consultation basis. The second aspect of course is that it's already been recognized that psychosocial needs should be taken into consideration as well as medical and safety aspects.
Again, I'm very pleased with the recommendations that have been made. They're very realistic recommendations and ones that obviously we have to ensure are met.
The Chair: I'll next recognize Christopher Malkowski's father.
Mr Malkowski: I want to congratulate all the presenters who have come forward from the community today, both deaf and deaf-blind people who have come forward. It was quite a beneficial experience, I think, for everybody. I think it had a real impact. I think it's really important for those of us in public office to hear from people in the community for constructive change.
At the same time, I would like to say that I agree with Mr Rumball about his experiences coming to speak over the past 38 years or so. I guess it's true in fact to say that throughout history governments haven't always listened. All three political parties have been the government at one point or another and what's true is that none has ever actually implemented recommendations that came from the deaf community.
I'd like to see this as a non-partisan issue and I'd like to work for the betterment of our community and work with the opposition members and also people within our party, the government, to make sure we can better the lives of deaf and deaf-blind people and senior citizens to recognize your wishes and your needs.
But I do have a question for Dorothy Beam. I'm reading in your recommendations where you talk a little bit about feeling it's worth it to have a placement coordinator who provides services to recognize consultation with the deaf community first, to make sure that consultation happens with a placement coordinator, to make sure that person has the understanding of the psychosocial needs and the cultural needs? What kinds of things would you recommend that the placement coordinator have to do the job?
Mrs Beam: Yes, I feel it's very important. I'd like to see someone, maybe even a deaf person, a graduate from a university -- I don't know -- or a hearing person who's skilled in sign language who understands the deaf, that the PCS would allow information -- say you're not deaf, so you can't live in that society -- "You can't move to that one; okay, we'll take care of you in your home and take care of you here," but it doesn't understand the psychosocial needs. So I think it's very, very important that the government pay for at least one person who is skilled in deaf culture, sign language and have the person travel all throughout the province and the deaf person could ask that person for help.
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Mr Malkowski: Just for the record, if I may have an opportunity to speak with our Minister of Health, Ruth Grier, and also the parliamentary assistant, Larry O'Connor, to make sure that your needs are met and considerations to make sure that there is no isolation happening.
Mrs Sullivan: I'm not quite certain who to address this question to, whether it's a series of questions for the ministry or for our witnesses today, but I'd like to know more about the needs of the deaf-blind community. As you know, Bill 101 calls for placement coordinators for each long-term care facility. The Bob Rumball Centre, as a charitable home for the aged, would therefore have a placement coordinator assigned to that home by the minister. We don't know some of the other responsibilities of that placement coordinator because that's left to the regulation, but there would be a placement coordinator for your facility.
You've indicated that there are other deaf-blind residences in Ontario. I am unsure if the one placement coordinator for the deaf-blind community, as you have suggested, is in fact appropriate, or are the placement coordinators for all of the facilities the more appropriate way to go? Rather than one Ontario coordinator, which you have asked for, is it not perhaps more appropriate that where there are long-term care residences that serve the deaf-blind community, the placement coordinator be associated with each one, which is in fact what the legislation calls for? I don't know who is going to answer that one.
Rev Mr Rumball: Our experience is that every time the government has somebody, we liaise. The minute they become informed and knowledgeable, they are transferred, and you have a re-education process and you start it again. BRCD serves the deaf regardless, not limited to geography: Hamilton, Peter Virtue; Chatham, Dorothy Beam. Almost everywhere in the province it requires somebody who is not serving an area geographically, maybe serving a centre but dealing with people, because we have them from other provinces as well.
Whether you can find that kind of person -- Dorothy suggested that placement coordinators might be deaf or blind and deaf. That would eliminate some of the mystery, because they're part of the problem and therefore they are most likely to have some idea of what the answer might be. I'm not sure whether it's been made clear that each centre has its own placement coordinator, because if you're doing that, why wouldn't he or she be a member of your own staff, and you're doing exactly what you're doing now better than anybody else has ever done it?
Mrs Sullivan: Those are some of the questions we've been asking too. That's exactly right. Are there other deaf-blind residences?
The Chair: I believe Mr Virtue had a comment to make as well.
Mr Virtue: BRCD is more than willing to work together with the government in choosing a placement coordinator. From what I've read from Bill 101, it seems there'd be one person who's a placement coordinator and maybe two or three other people who are representatives of the deaf and deaf-blind. BRCD is more than willing to work with other organizations in services for the deaf and deaf-blind to make sure that their needs are met.
So several people could work together. That way we make sure that the needs of the deaf, the deaf-blind, the hard-of-hearing and the deafened are met.
Mrs Sullivan: Can I have a supplementary? Then I think the parliamentary assistant wants to respond too.
Rev Mr Rumball: Let me answer one question we haven't had answered yet. In North York on Willowdale Avenue there is a very special residence of 16 apartments for independent blind-deaf individuals.
Mrs Sullivan: Seniors?
Rev Mr Rumball: It's fairly recent, fairly new, opened a year ago. Some of the workers from Hand Highway -- it's Hand Highway to me; it's CNIB -- are knowledgeable about that. They were involved in the process. It was a product of the Don Valley Rotary club and the provincial government. Then Community and Social Services bought homes for blind-deaf children in Newmarket and in Richmond Hill, and the Lions built a place in Brantford, Ontario, close to the school for the blind where blind-deaf youngsters are educated.
Mrs Sullivan: I suppose my thinking was related to the homes for the aged, charitable homes that the bill affects, rather than for the younger children. Is the Bob Rumball centre offering to become the placement coordination centre for the province for deaf-blind?
Rev Mr Rumball: I think they could probably do it better than anybody else. I wouldn't apologize on that.
Mrs Sullivan: I thought you might want to get that on the table.
The Chair: Parliamentary assistant, did you have anything further to add to that?
Mr Wessenger: No.
The Chair: Mr Wilson and Mr Jackson.
Mr Jim Wilson: Thank you very much for your presentation. It's been most enlightening. As I've read everything you've presented and heard your oral presentation, there are really two concerns: the need for specialized PCS, and you very much want to see the eligibility criteria expanded to include psychosocial needs. I want to tell you that on both those points my party is willing to put forward amendments if the government doesn't do so.
The parliamentary assistant has today said that yes, the government hears you with regard to the need to be sensitive to psychosocial needs, yet this committee has never been presented with any amendments the government may have in that regard. My view is that if the government made up its mind on this several weeks ago, then why does group after group after group have to keep coming and telling us the same thing?
To be quite frank, I won't believe the government until I see its amendments. That'll be in another week and a half, I gather, when we go into clause-by-clause consideration of the bills.
Outside of these two main concerns of yours, have you got other concerns? For instance, I think of governance. We've heard a lot of charitable homes, homes for the aged in particular, very much worried about whether this bill will undermine their ability to control their own destinies and to operate their own facilities. Did you get into any discussions like that?
Rev Mr Rumball: I have some personal concern, but I think that was expressed by Mr Jackson prior, with the icon business. I find it disturbing, as a minister of the Gospel, that the use of the Bible in the centre is a serious problem, but if I wore a turban and a kirpan or anything else it's fairly acceptable. I have a serious problem with the Ontario Mission of the Deaf not being allowed to be the Ontario Mission. They're the owners of the Bob Rumball Centre for the Deaf. It is a community of faith that goes out and serves anybody under any terms, with no hitches at all. But when anybody steps in and says you're not allowed to do and be what you are and that you have to operate under false pretences -- personally, I don't do that, not today, not tomorrow.
And it's not just touching this kind of thing, but touching many areas: our schools for the deaf that are residential. They want you but they're not allowed to use you, because all of a sudden you are also a religious symbol and that's unacceptable. I find that unacceptable, because if the school wants me, what they see is what they get. That's also true at the Bob Rumball Centre for the Deaf: What you see is what you get.
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I think it is a concern, so we have that concern. The fact of the appeal process raises some concern. With all of these things, in the past, if we couldn't deal with them rationally and intelligently, then we dealt with them publicly and in the press. But that's a terrible way, when you can't be intelligent and solve your problems.
Mr Jim Wilson: I appreciate your frankness. I'll tell you, with the views you've just expressed, you'd live quite comfortably in my riding of Simcoe county. The vast majority of my constituents would certainly agree with your views that you've just expressed.
Rev Mr Rumball: I have some concern about inspections too, because our experience is that the wrong inspector, with his little book, can come and make it hell for you. We built a centre here. We went to tender with the same kind of devices they have in the provincial schools for the deaf in terms of fire alarms and everything else, except that they didn't pass muster:
The government wouldn't approve them. Then we had to go and pay for the Underwriters' Laboratories of Canada and the Canadian Standards Association and everything to invent and develop a device that the government itself never had to measure up to, even though it was the enforcer of the legislation.
I think that is a double standard that is unfair. Rather than try to create obstacles, they should find answers. Fortunately, we did persevere, we found answers, and the thing's improved. Even the government schools now have qualified detectors and devices and things, but it wasn't because they had to. It's simply because when we brought them on the market, they were cheaper and more intelligent than what they were doing.
Mr Jim Wilson: I hope the government paid you back for your efforts.
Rev Mr Rumball: No, not a penny, but that's all right. We're taxpayers, and if we do it, we do it cheaper than the government would have done it anyway.
Mr Jackson: Rev Rumball, you mentioned philosophy, and I believe you were talking about the concepts of deinstitutionalization and congregation, meeting the needs of a special group of people. There's this tension, there's this contradiction almost. Have you gotten a sense from this government and this legislation that your philosophy is being listened to?
Before you respond, I'll place the other part of my question. I believe placement coordination services and improvement and sensitivity within them for the deaf and deaf-blind community are helpful and laudable, but they have to have a place to go, they have to have a placement. That's really what I consider to be our largest problem. We don't have access.
You were in the room for the previous presentation, when I raised issues around cultural sensitivity. Dorothy Beam, to her credit, has shared with us a wonderful insight. I want to quote from her brief: "Deaf people do not consider themselves disabled; rather, we consider ourselves a distinct linguistic and cultural community bound together." That is your philosophy.
The parliamentary assistant just announced that there are some 16 or 18 projects being made available for culturally bound groupings of people in this province. Why is it that you're not being considered?
Rev Mr Rumball: Because they don't consider what she said a valid representation of the facts. They think they're doing us a favour, because they think we're disabled and handicapped. Therefore, since they're going to normalize and integrate and mainstream all handicapped people whether they want it or not, they're going to do it with the deaf. And it doesn't work; it never has worked, and it denies them the freedom of choice.
Mr Jackson: I had a deaf uncle, and he taught me the concept of being differently abled. It was quite a revelation as a small boy to understand that there was nothing different; it was just that how we communicated was different.
Rev Mr Rumball: You see, our final board is all deaf. Whether it's the centre, the camp, the children's homes, the final board is deaf. We have confidence that they know what they are, and we think we should allow them to be deaf, even though they live in a country that would like to mainstream them and normalize them and integrate them. These are great ideas. The fact that it's never worked doesn't seem to bother the philosophers.
Mrs Beam: I just want to say something. You talked about the special needs of the deaf as a group, as a community, that in other organizations or other places they just wouldn't fit in. We don't consider ourselves handicapped like people who are in wheelchairs, who have a physical handicap, things you can see. We don't want to be clumped in with that group or integrated into those groups. The deaf can't. We need those communication skills, we need to be able to understand, and you need to understand the psychosocial needs of the deaf.
We want to be equals with other groups. I mean, we play games and do activities such as that, yes, but the deaf are not like other groups. Other groups want to be mainstreamed, want to be in social clubs with other groups. We want to live together. We want to have the right to choose that. We like to have people in the government, such as Gary, who can sign so we know what's going on.
So it's sort of different, handicapped people and us. I'm deaf. I'm one who can't hear. Our world is based on sound. Really, it's based on sound. We're happy together, happy to see, happy to understand. So when you talk about mainstreaming or putting us all together, that's how I have to respond.
The Chair: Thank you very much for coming before the committee today, particularly for the others who have come from your centre and from other parts of the province. We thank you again for the presentation and for the material you have left with us, and I think we all hope that in our deliberations, whatever we do we will be able to further the interests of everyone who has come here today. Again, thank you very much.
Mrs Beam: Will we be informed if Bill 101 is amended?
The Chair: I think I can say very definitively yes, you will. Probably through a number of different routes you'll be informed, but certainly we'll keep you informed.
Mr Malkowski: Would you mind sending copies of Hansard to these people, just for their own purposes?
The Chair: That would not be a problem at all.
With that, this sitting of the standing committee on social development stands adjourned until 10 o'clock tomorrow morning.
The committee adjourned at 1749.