Manitoba Hansard — 2 July 1991 (Sitting 76B, 35th Legislature, 2nd Session)

35-2-76b

Manitoba — Debates (Hansard)

MG-8048 Second Session - Thirty-Fifth Leglslature oflhe Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 40 Elizabeth II Publ/shed under the authority of The Honourable Denis C. Rocsn Speaker VOL XL No. 768. 7 p.m., TUESDAY, JULY 2, 1991 Printed by the Office of the Queens Printer. Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Legislature LIB - Liberal; ND - New Democrat; PC - Progressive Conservative NAME ALCOCK, Reg ASHTON, Steve BARRETT, Becky CARR, James CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward CUMMINGS, Glen, Hon. DACQUAY , Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY, James, Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS, Clif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY, Neil GILLESHAMMER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOU REUX, Kevin LATHLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayton, Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MclNTOSH, Linda, Hon. MITCHELSON, Bonnie, Hon. NEUFELD, Harold, Hon. ORCHARD, Donald, Hon. PENNER, Jack PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROGAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric, Hon. STORIE, Jerry SVEINSON, Ben VODREY, Rosemary WASYL YCIA-LEIS, Judy WOWCHUK, Rosann CONSTITU ENCY Osborne Thompson Wellington Crescentwood River Heights Radisson The Maples Kildonan Portage la Prairie Ste.

Rose Seine River Roblin- Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas lnkster The Pas St. Norbert Elm wood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St. Johns Swan River PARTY.

LIB ND ND LIB LIB ND LIB ND PC PC PC PC ND ND PC PC PC LIB PC PC ND ND PC PC ND LIB PC ND PC ND LIB ND PC ND PC ND PC PC PC PC PC PC PC ND PC ND PC PC PC PC ND PC ND PC PC ND ND

4119 LEGISLATIVE ASSEMBLY OF MANITOBA Tuesday, July 2, 1991 The House met at 7 p.m. CONCURRENT COMMI TTEES OF SUPPLY SUPPLY-HEALTH Mr. Deputy Chairman (Marcel Laurend eau): Order, please. The committee will be continuing. We will now start on Appropriation 3. Continuing Care Programs (

a) Administration: (1 ) Salaries $95,200. Shall the item pass? Ms. Judy Wasylycla-Lels (St. Johns): Just by way of moving on this whole area of continuing care and seniors, let me just ask a couple of general questions in terms of some commitments previously made. I note that during the past election a number of promises were made. One was an overall strategy for seniors. I am wondering if the minister could comment at this time in terms of progress on meeting that promise. Hon. Donald Orchard (Minister of Health): Mr.

Deputy Chairman, let me deal first of all with the ministry's strategy. -(interjection)- That is advice that I will take from my honourable friend the member for St. Johns. Let me deal first off with the ministry's response. As we discussed earlier on in the reorganization of the ministry, we have brought together under one ADM , Betty Have ns, the re sponsibili ty for Con tinuing Car e Programs; inclus ive of the Continuing Care Program, issues of PCH, personal care home rehabilitation and support services, and chronic care.

That blends functions that were the line of reporting for which was both within the ministry through Regional Services and Continuing Care, and through the commission in terms of, for instance, personal care homes. * (1 905) In doing so, we are bringing together under one administrative line the major program expenditures and policy areas of one ADM who continues as Provincial Ger ontologist. So, in the ministry of Health, we are bringing together those areas of responsibility toward the seniors population in the province of Manitoba.

As a government, two initiatives that I would like to basically discuss with my honourable friend: First of all, ongoing development of the role of the ministry of Seniors-I think those Estimates have passed. I am not sure. I think they have been dealt with. There is an overall role of the ministry of Seniors that is maturing, not the le ast of which is lea d responsibility on the issue of elder abuse as one of the initiatives.

Then within the Healthy Public Policy general policy direction-I guess it would be the safest terminology to use- we are attempting to further co-ordinate and initiate service delivery as government so that in around Healthy Public Policy, depending on the issue, you can have Family Services, Education, Health , Justice, Housing. It is part of those discussions which are government's response, so there are two line ministries and then, un der Healthy Pu blic Policy, governme nt's response.

What I think is fair to say is that we are building on and certainly maturing a number of initiatives that have been started over the past 20 years in trying to maintain, and I think successfully trying to maintain, our leadership in Canada in terms of services and opportunities for seniors in the province of Manitoba. Ms. Wasylycla-Lels: I take it that the promise to develop a five-year health strategy for seniors is in the works. Mr. Orchard: That is all part of it. Part of that component, of course, is the Health Advisory Network task force on health promotion for the el derly, services to the elderly.

So that my honou rable friend knows, I have received that report. I have only got through the summa ry and the first report. I have two others to get through. I did not get over them all over the weekend, but certainly there are some recomme ndations within there in the first report that I have read and in the overview, which complement initiatives that we have already undertaken, as I have described already, within the ministry in terms of line reporting within the ministry of Health, maturing of program and policy in the ministry of Seniors, and then the Healthy Public Policy initiative.

4120 LEGISL ATIVE ASSEMBL Y OF MANITOBA July 2, 1991 Ms. Wasylycla-Lels: I take it, from that, the minister has now received the final task force reports on health services for the elderly, and we can now talk about them. Mr. Orchard: Yes, I have, but you have not, so maybe we cannot talk about them. I have not released the final reports to my honourable friend, so I would not know what she was quoting from other than its being the interim reports.

I simply cannot tell you whether there are variations or changes therefrom, so until we table a report, I would prefer to keep discussions to a generic level, if you will. * (19 1 0) Ms. Wasylycla-Lels: When might we expect the minister to table those reports? Mr. Orchard: I would answer with a rhetorical question: When might we expect to finish the ministry of Health Estimates so I can get on with reading them? Ms. Wasylycla-Lels: It depends on the length of the minister's answers to usually short questions.

My next question has to do with some specific parts to the five-point promise in the 1990 election with respect to health care in seniors. Has there been a move to keep the promise to expand the respite care program providing additional home base service for families caring for elderly parents? Mr. Orchard: That is ongoing and has been part of Continuing Care, as well as institutional. Ms. Wasylycla-Lels: Is the minister saying that was a recycled election promise and that really that did not reflect a particular need and therefore there is no new initiative to respond to that promise? Mr.

Orchard: Well, my honourable friend might want to say that, but I certainly would not. That is building on a very successful initiative brought in by the Honourable Bud Sherman back in 1979. Ms. Wasylycla-Lels: Has this government moved on the promise to create a safe house tor seniors to provide te mpo rary sanc tuary for indivi duals suffering abuse? Mr. Orchard: No. I believe the mandate for that is under the responsibility of the Minister responsible for Seniors (Mr. Ducharme), and I cannot give you a status on that. Ms.

Wasylycla-Lels: Has there been any action in terms of the promise to help fund a seni ors assistance program to provide additional in-home aid and personal care? Mr. Orchard: In-home aid and personal care? Ms. Wasylycla-Lels: That is what your Premier (Mr. Filmon) promised. Mr. Orchard: Again, that is part of the ongoing im prove me nts to Home Care that we have undertaken, some of which I hope we get to discuss tonight in terms of service co-ord inators, et cetera. Ms. Wasylycla-Lels: Could the minister indicate, give us a breakdown in terms of the increase for Continuing Care announced in the last budget?

Is it primarily in terms of volume and caseloads, or is it spread throughout this whole area? Mr. Orchard: There is both, Mr. Deputy Chairman, but to answer my honourable friend on respite care, let us just go back to '87-88 when there was the change in government. There were 742 admissions in '87-88. For '88-89 that had grown to 804; tor '89-90, 893 and '90-91 , 925. The num ber of days of care increased in the same year, '87-88, 10 ,793 to 11 ,395 to 13 ,1 93 to 13 ,724, so we are on a constant increase.

The number of homes offering respite care were 27 in 1987-88; to 32 in '88-89; to 34 in '89-90 ; to a fairly large increase in '90-91 to 42. The number of individuals served were 486 in '87-88; down slightly to 471 in '88-89; up to 534 in '89-90; and a fairly significant increase to 640 in 1990- 91 , accounting for the additional new homes. In terms of the Continuing Care Program, I will provide my honourable friend with statistics.

We are looking at an in crease in Home Care from Adjusted Vote in '90-91 of $48,425,000 to a requested level of funding of $54,966,600 this year, an increase of six and a half million and of 13 .5 percent increase over the Adjusted Vote from last year. Ms. Wasylycla-Lels: Yes, I realize the amount. I am just wondering where the increase shows up. It appears to be all in terms of volume and additional caseloads. Is that correct? Mr. Orchard: That is essentially correct and in intensity of individual cases as well. * (19 1 5) Ms.

Wasylycla-Lels: Do I gather then from that statement that there has been no increase in case co-ordinators or case assessors? Mr. Orchard: Not as we speak, but it is in process in Winnipeg Region on the case co-ord ination side. No, the case co-ordinators are the same.

July 2, 1991 LEGISL ATIVE ASSEM BLY OF MANITOBA 4121 Ms. Wasylycla-Lels: Could the minister-in last year's Estimates, I had asked the question about case co-ordinators , and he gave me the breakdown for '89-90. I am assuming, based on his comments, that there has been no change for '90�91. I had also asked last year for a breakdown for the three years leading up to '89-90. I am not asking him to come up with that on the spur of the moment right now, but if he could make a commitment to give us a breakdown for case co-ordin ators by region for the last three to four years, including the present. Mr.

Orchard: I think we should be able to make that available, yes. Ms. Wasylycla-Lels: Could the minister indicate whether or not there has been any change from his statement last year and his policy of last year that cases are generally only reassessed and reviewed once a year? Mr. Orchard: That, I think, was an outside number that I gave my honourable friend last year. It still remains so. Reviews happen on a much quicker basis in the majority of individuals' circumstances. Ms. Wasylycla-Lels: My question really is, what is the policy in terms of reassessment and review? Mr.

Orchard: The target that we set is a maximum of three months in terms of review. I do not know what percentage of cases we would achieve the three-month review in. The outside cases take upwards of a year, but those are ones in which the care regime remains rather constant. Ms. Wasylycla-Lels: It seems to me, though, that is quite a divergence from original policy which was for regular reassessments on a quarterly basis. Is the problem in terms of workload and demands on case co-ordin ators? Mr. Orchard: That has always been the problem. That was the problem in 1988.

That was the problem in 1986-87 when the Price Waterhouse group were asked to investigate. We will lay some inform ation on you . You see, you have to appreciate, too, as I indicated in the earlier remark, that the upwards of a year on reassessment are for individuals who are stable in their needs. It becomes something of a quality judgment call based on experience where, given the knowledge of the patient, some reviews are not undertaken quarterly. There will be no change in the service delivery levels because of the stability of the individual and the consistency of care requirement. Ms.

Wasylycla-Lels: It seems to me that a policy like a quarterly review is probably put in place for a very good reason, and that was to have regular reassessment to determine if care was appropriate or whether over-service care was being provided. I assume that policy has not been adhered to because of lack of resources.

I am wondering if any attempts are being made to deal with the adequacy of resources at the case co-ordinator and case assessor level to not only ensure that assessments can be done on a regular basis, as the policy stipulates, but also to deal with the workload, the burnout, the problems that have been mentioned in all of these task force reports. Mr. Orchard: Sure, my honourable friend can draw a lot of conclusions from it, but, basically, the ones who approach the one year on reassessment, as I have indicated, are relatively stable care needs.

I think the professional judgment of those involved would say that it would be an inappropriate use of resource, those same scarce resources that my honou rable friend is alluding to, if we did a reassessment on a quarterly basis on a stable individual to come to the same conclusion that service levels ought to be maintained. Therefore, some of them are to that time frame for reassessment. Now, my honourable friend indicated that some of the reassessment is to find out areas of overservice.

That is one reason, and the second reason is to also reassess on the basis of the potential for increased needs, because there are both cases, experienced. • (1 920) Ms. Wasylycla-Lels: The problem of only annual reassessme nts is only, I think, one of the issues tied to inadequacy of staffing complement with the Continuing Care, Home Care program. All of the reports, and I know the minister does not want to get into the specifics of the reports he now has on his desk, but I would guess that the descrip tive passages in the final report do not vary significantly from the interim report.

Particularly, I am referring to the task force entitled Options for Living: Housing and Home Care, which states quite clearly that the under staffing in the Home Care program is a contributing factor to the consistent negative feedback that the task force had about the program. This re port also talks about the severe understaffing of the Home Care program, which has been caused by increased demands without

41 22 LEGISL ATIVE ASSEM BLY OF MAN ITOBA July 2, 19 91 increased resources, resulting in high demand, high pressure, high potential for staff burnout within the program. It seems to me we are dealing with a whole series of problems in what was once considered a model program in terms of the rest of the country. It may still well be, but I am worried about the deterioration of such a program if we are experiencing such enormous problems at the grassroots level.

I am wondering if the minister has been working on any plans to deal with that problem of understaffing and too many demands being placed on too few staff, resulting in inadequate, inappropriate, inflexible service to our seniors. Mr. Orchard: Mr. Deputy Chairman, I full well realize and I happen to have read that particular part of the recommendation section. I knew my honourable friend would immediately focus in on that and attempt to paint some horrendous picture in the Continuing Care Program.

What my honourable friend did not mention is that, prior to making that statement and that observation, it said that the Manitoba Continuing Care Program continues to be the best in Canada, not deteriorating and maybe, as my honourable friend would like to allude, but does. Again, I simply say to my honourable friend that those problems in terms of staffing have been there for a number of years. That was the whole genesis behind Price Waterhouse. We have attempted within a budget to try and alleviate some of that. There are still concerns that will be expressed from time to time.

That will go on probably over the next several budget cycles. • (1 925) We are moving in terms of our ability to free up staff tim e by bringing in a better patient computerized information system which was nonexistent before, which frees up staff time which allows a better use of staff time in terms of providing service rather than shuffling paper, if you will. There are a number of improvements to the program ongoing, but again, I do not want my honourable friend to carry out tonight's debate on two scopes, (

a) that a whole serie s of problems have miraculously appeared in continuing care over the last three years, which is not so, and secondly, that the program has fallen into disregard in Manitoba, again, not so. If you were to do a survey, I would venture to say, as was done in 1987, despite all the problems that confronted the Continuing Care Program then, you would find a high degree of satisfaction with the program. I get letters on a regular basis to my office quite in opposite to the statements and the impression left by my honourable friend in her question, that in fact the program works extremely well.

Staff are complimented for their effectiveness, the efficiency with which they approach their job and the dedication which they bring to it. I get certainly more letters that way than letters of complaint, which is quite unusual for a program this size. The only time it ever hits the news is when an opposition member tries to say it is not working. All you ever hear of the Continuing Care Program are the instances where service is not provided according to the wish of the individual, but you never hear the other side of the story where individuals are greatly satisfied with the program. Ms.

Wasylycla-Lels: I am the first one to acknowledge the incredible contribution made by staff in this area, but I think we are on a serious path in terms of losing good staff and burning out hard-working individuals. The caseloads are increasing, but there has been no increase in terms of co-ordinators, assessors and no doubt other staff. I note, from the statistics that we receive through the minister's office, there is a steady increase in the number of senior citizens in our province.

Presumably, that has meant an increase in the number of seniors accessing or trying to access the Home Care service, yet there has been no increase, from what the minister tells us, in terms of co-ordinating staff. How do staff keep pace with that kind of increased caseload, increased demand for the service? Mr. Orchard: I think they cope quite well. Some of the administrative procedures that we have been putting in place help staff cope better, such as information systems which my honourable friend would note are part of the recommendations.

Those are coming along, I understand, quite nicely in the Winnipeg region and we believe will certainly enhance the effectiveness of workload and care and service delivery. Ms. Wasylycla-Lels: Is there any plan on the part of this minister to increase the staffing complement to deal with the increased caseloads that field staff and co-ordinators are faced with? Mr. Orchard: As I indicated to my honourable friend, there is no increase in this year's Estimates. Whether there would be an increase in next year's Estimates remains to be seen, but let my honourable

July 2, 19 91 LEGISL ATIVE ASSEMBLY OF MANITOBA 412 3 friend understand that there are two ways you reduce workload. Rrst of all is by increasing staff, which is the obvious route suggested by my honourable friend. The second way is to make staff's workplace time more effective through the introduction of information syste ms and technologies which will streamline the information and service delivery co-ordination among staff, so that staff can handle more individual client workload. That is part of the information revolution which we are attempting to bring in place.

My honourable friend might recall that that was a recommendation by Price Waterhouse. It has taken us this long, through some errors, trials and tribulation, to get to a system that we think now has an opportunity to work. It is showing some opportunity for success. Ms. Wasylycla-Lels: Has there been a change in terms of the response time from last year's Estimates when the minister said the response time was two weeks? Mr. Orchard: Yes, about the same. *

(1930) Ms. Wasylycla-Lels: Is the minister saying that no one has to wait more than two weeks to have the service provided once they are deemed eligible? Mr. Orchard: Mr. Deputy Chairman, that will always be subject to variables, but in general, we can provide services within that two-week period of time. There are instances where we are not going to be able to do that, and there are also instances where service is available within a day. Ms. Wasylycla-Lels: Are there plans to improve the response time? Mr.

Orchard: Certainly, there are always plans to improve the response time, and I think that generally is the case. Ms. Wasylycla-Lels: We have been through the issues that I am about to raise before. I hope the minister does not get too excited and get all hot under the collar, but I am wondering ifthere have been any changes to the homemaking part of the Home Care program. Mr. Orchard: I am forced again to give the same answer I have always given. The answer is no. Ms. Wasylycla-Lels: I am forced again to indicate I have had calls and concerns raised with me about the home maintenance program.

In particular, I will give the minister the details of a couple who have been receiving the homemaking service for the last 12 years on a weekly basis. An individual has been coming in, doing laundry and washing floors. The woman in the situation is quite elderly, has bad arthritis, has had a broken hip and must spend most of her time in a wheelchair. Her husband is over 73, has bad arthritis. They suddenly were told about three weeks ago that they were being cut off, that they would not longer be receiving this homemaking service. They are from the Ashern area.

I am wondering if this kind of a case is any indication of a general policy, or is it the fact that regions, given only so many resources, are forced to make some tough decisions? Mr. Orchard: Mr. Deputy Chairman, the resources are increasing in the program, not decreasing, so that that does not stimulate these kinds of decisions. I cannot answer what stimulated this decision. However, I think my honourable friend has given enough detail that I will have the issue investigated, as always is the case, and report to my honourable friend the circumstances under which that service judgment was made.

As my honourable friend well knows, there are periodic reassessments done, and the time when one receives a call is when the level of service is reduced as a result of a reassessment. You never hear from anyone whose level of service has increased on account of that reassessment. This may be one of those cases where level of service was reduced because of reassessment. I cannot give my honourable friend any more detail. Ms.

Wasylycla-L els: For the minist er's information, the individuals involved are Rose and Peter Mamchuk from Fisher Branch, and as far as we have been able to ascertain, there has been no change in terms of their situation. There have been no facilities in their neighbourhood to which they could access. They have no relatives. They are only getting older and not getting any healthier as the days go on, so I hope the minister will look into this. I should also let him know, they were told that they were being cut off because others were being cut off in the area.

I would look forward to a response from the minister on that issue. A number of other concerns, issues and cases get brought to our attention on a regular basis. The one I have just raised is, in my view, until I hear further from the minister, appears to be a cutback on the

412 4 LEGISL ATIVE ASSEM BLY OF MANITOBA July 2, 19 91 home maintenance side of the Home Care program. Others are running into difficulties because they feel the program is not flexible to meet with their changing circumstances and to perhaps respond in innovative ways to different problems. Another case the minister has heard about on a number of occasions is the Thiessens in Stony Mountain, who have been trying for some time now to persuade this government to perhaps be a little flexible in terms of its Home Care approach and allow a Home Care worker to attend with them on visits to the hospital.

This may not fit a particular program guideline. It may not be something that has been supported before, but it seems to me that, when we are looking at ways to keep people in their homes, perhaps it is time to look at more creative and innovative responses to patient-client needs. I am wondering if the minister has any comments on that particular kind of situation. Mr. Orchard: Well, Mr. Deputy Chairman, we always look at innovation, but within the flexibility of the program, there is a fair degree of flexibility. In some instances, there is not.

It requires some substantial thinking around the issue before you change the policy because it is seldom ever narrowed to one individual circumst ance; it generally involves a wider change than simply making an exception in one case, or changing the policy in one case. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, my sense from some other cases that we are presented with is that regional offices, their resources are stretched to the point where they have to make some pretty difficult tradeoffs and movement around a staff that is not always in the best interests of individual clients.

Another case that I have had to deal with is-it did get resolved, but it tells me that there might be a broader problem here-o f an individual who has had home care for a long time, had to go into the hospital for a 24-hour period, comes out of the hospital and finds that her Home Care worker has been reassigned to another area within the region, and ittakes a considerable amount of effort, concern and worry on the part of this individual to get home care reinstated.

I am wondering if resources are so stretched in terms of each region that staff are forced to make these kinds of difficult decisions that only hurt the program, not only in terms of its name, but in actual human impact. Mr. Orchard: Mr. Deputy Chairman, in the case of the latter individual who was in hospital for one day, it would seem to me that upon discharge from the hospital, should home care have been necessary, that is part of the discharge co-ordination and planning. I would have to know more circumstances around the admission to hospital.

Was it expected that the individual would have a much longer stay in the hospital? My honourable friend shakes her head. I simply do not know, because staff is not-and I know this is not the answer my honourable friend wants to hear-but continuing care staff are not assigned specifically to an individual. There can be changes depending on the service demands and proximity, et cetera. As a rule of thumb, there is an attempt to have consistency between client and care provider, but not always does that happen. This may well be one of those exceptions.

Again, a one-day admission to a hospital and then the reassignment of that care worker does seem to be an unusual circumstance. (Mr. Jack Reimer, Acting Chairman, in the Chair) I would suggest that I cannot give my honourable friend any greater detail receiving no more than I already have from my honourable friend. • (1 940) Ms. Wasylycla-Lels: Mr. Acting Chairperson, as I said, the problem did end up getting solved, but created some grief for a short period of time.

I do not want to get into the details, but simply to tell the minister that the individual went in for a routine matter, into the hospital, and when she got out was told that her Home Care worke r had been reassigned to another supervisor and told, in the meantime, she would have to pay for Home Care service. I raise these as examples of what I sense is a system that is stretched to the limit in terms of staff and overall budgets for their regions.

I think staff are being forced to really try to make some tough decisions because of budgets that do not take into acc ount the changing face of Home Care, increasing demands of clients, and just a general trend that requires more staff, not a hold-the-line approach.

July 2, 19 91 LEGISL ATIVE ASSEM BLY OF MANITOBA 41 25 I hope the minister will, when he has a chance to finish reading the Task Force Report from the Advisory Network which clearly makes some strong statements about staffing and underresourcing, I hope he will work on a plan to help deal with these enormous pressures our staff are facing in the field. Another kind of case I have received, and it gets me into another issue, is that of palliative care.

The interim report from that task force group is out, so the minister probably has not looked at it, but it probably concludes what the minister already is fully aware of, and that is that the only across-the-province palliative care program is through Co ntinuing Care. It makes a recommendation for a much more comprehensive policy in terms of palliative care.

So I would like to ask generally about the minister's plans in that regard but also about the inadequate resources now in the field for clients, for individuals who are receiving palliative care and whose families are not-even though they are eligible for Home Care-- able to access services for visits to the home on weekends or evenings. Mr. Orchard: My honourable friend, in her earlier comments, was talking about seriously following the recommendations of the task force in terms of increasing the staffing and other initiatives in the Continuing Care Program.

I note, with interest, my honourable friend is not saying or maybe will give direction as to whether we should follow the recommendation in the report which says we ought not to build any more personal care homes in Winnipeg other than the commitments we made in July of last year, because that is very much a moot topic that is discussed. If my honourable friend is going to pick and choose, you have to accept a report in its entirety and attempt to bring out the best of recommendations given a number of factors that you have to take into consideration that are not new to this government or new to this time: (

a) budget available; (

b) the availability of staff expert in the job of resource co-ordination and case co-ordination; (

c) to try and target appropriate needs; and, (

d) which has come since 19 86-87 with Price Waterhouse, to manage the existing system appropriately. I have to tell my honourable friend that we are moving on all four of those approaches and with some success. Now my honourable friend this year has not made an issue about, for instance, the budget in Home Care because it has been cause celebre in other years where it was underexpended, but I note that there has not been a question to date about this year's expenditures. I think it is probably because my honourable friend knows the answer.

It was overexpended last year by some almost $3 million in terms of service provision, and we are budgeting the budget to be taken up this year as well as budgeted. Palliative care, yes, Continuing Care Program offers that service, as well as St. Boniface and Municipal Hospital and Brandon General Hospital. Gimli has a palliative care program which is now part of their base-line funding at the Gimli Hospital. I know that, for instance, the Morden General Hospital has a palliative care program with a palliative care co-ordinator who has been retained as part of their global budget expenditures.

I do not think there has been a formal program approval, but it is one of the initiatives they have undertaken by reallocation from within of their resources. I cannot tell my honourable friend whether other hospitals throughout the province are undertaking similar initiatives within their global budgets, but the palliative care program is one that is working, I think, quite well in Manitoba and providing quite a needed range of service to Manitobans who are terminally ill. Ms.

Wasylycla-Lels: My specific question had to do with, I think, a well-recognized shortfall in terms of Home Care providers through the palliative care. Specifically, the case I was dealing with was through Municipal Hospital. The problem seems to b&-and this is not suggesting any cutbacks on the part of the minister-recruiting personnel to provide this service. I am wondering if the minister has any long-term plan to deal with that situation. Mr. Orchard: I am told that within the Continuing Care Program that our staffing recruitment and certainly the provision of service is not at issue.

Palliative care is delivered in the Continuing Care Program. St. Boniface from time to time has some minor staffing problems. If you want to put it on a scale of one to 10, you would have to call the problems .5 at St. Boniface. The balance of the time it works quite well. Ms. Wasylycla-Lels: I think perhaps I have phrased the question the wrong way. My concern is with the Home Care services through the palliative

41 26 LEGISL ATIVE ASSEMBL Y OF MAN ITOBA July 2, 19 91 care program. In other words, if someone is part of the palliative care program at the Municipal Hospital and attempts to go home every weekend and is eligible for Home Care services, that Home Care service cannot be guaranteed at all times, and families are left making other arrangements at the last minute, depending on availability of staff. That is the issue I am raising, not the palliative care units, per se. Mr. Orchard: Well, I can simply say to my honourable friend that the best arrangements possible are made.

Upon occasion, given that it is weekends, given a number of other factors in terms of placement, there no doubt will be some scheduling difficulties. I am also informed that it is generally not at the last minute. There is some reasonable advance notice to the individual families that there is going to be for obvious reasons, i.e., the individual who provides the care may not be available on the weekend due to the demands, personal or professional, because you are not talking mid-week service, if you will, or regular hours employment, you are talking weekend service.

Given that the program works the vast majority of the times, the instances where it does not work there is generally a reasonable lead time so that alternate plans can be made. Ms. Wasylycla-Lels: What are the plans though on the part of this minister to deal with the fact that kind of Home Care service is not necessarily available or cannot be there for families who need it? • (1 950) Mr.

Orchard: The difficulty is, I would suspect, as in the past it will continue in the future, that we cannot meet every service demand because for instance some staff-palliative care staff are unique in that they have to deal with a very difficult personal situation. The person is dying, and not all Home Care workers and home support workers and nurses and LPNs want to deal with tha t circumstance. That is a personal choice of the individual that you cannot force upon the staffpeople. We cope I think very well with it. There are instances where we cannot meet the service demands on the weekend.

I do not suspect that we would be able to guarantee, because the program does not guarantee that service will be available when required on weekends or for that matter at any time. You are always going to run into circumstances where staff are simply not available or staff indicate that they do not wish to continue working with a client, that has happened, or that the client says that they no longer want to have that particular staffperson in. There are any number of circumstances like that, that are independent of such things as general staff availability, budget, ability to co-ordinate, ability to plan.

There are circumstances within the program that are human to a large degree, which are beyond the management control, and that is why the program has never guaranteed that it will meet all the service requirements as assessed. Ms. Wasylycla-Lels: Would the minister give us a breakdown in terms of what are the costs of home care on average per day versus costs of personal care home per day versus use of an acute care bed in a hospital? Mr. Orchard: We will get you the costs of home care because we can-maybe we even have it coming right now.

The acute care hospital costs vary as one might appreciate, quite substantially, and personal care homes also vary depending on the institution, the age of the institution and any number of reasons including the patient mix within it. Ms. Wasylycla-Lels: You can get it for me later. Mr. Orchard: Yes, but clearly, acute care, if one wanted to average acute care costs, they are going to be higher than average personal care home costs, and they are going to be higher than normal costs within Continuing Care. We still maintain some over-cost clients in Continuing Care but that is a matter of choice.

The over-cost client being one that their daily costs exceed the average cost of placement in a personal care home. Ms. Wasylycla-Lels: I look forward to receiving a precise-not a precise, an average-for each of those three categories whenever the minister could provide it. The minister indicates in the detailed Estimates that approximately 23,000 Manitobans will receive services from the Home Care program. That is the same estimate the minister gave us for last year's Estimates. Does that mean despite the increasing aging population that there has been no increased demands on the Home Care program? Mr.

Orchard: There have been increased service levels within the program and some increase in

July 2, 19 91 LEGISLATIVE ASSEM BLY OF MANITOBA 412 7 volume as well. They both have driven the budget higher. Ms. Wasylycla-Lel s: That is precisely my question. Where can we see what the increased number of cases is in terms of year over year if this increase in budget is to reflect not only intensity of service but also numbers of cases, where do we see it, what is expected? Does it reflect the growth in our aging population? Mr. Orchard: To a degree, yes, it does.

It also reflects- there has been a stabilization of demand as well, which we have gotten into this argument before, but I think my honourable friend would have to concede that there are generally more well elderly today than there was 10 years ago. The level of fitness and individual health, I think, has increased because of adherence to exercise programs, activity programs and other initiatives that the seniors through a variety of organizations have undertaken.

What we have tending to impact upon this program as well as the Personal Care Home Program is that if you were to compare, for instance, in personal care home, the level breakdown today versus 10 years ago, you would find a significantly increased percentage of Level Ill, Level IV in the personal care home system and a significant decrease in Level I's, the hostel units and Level lls. Similarly, the Continuin g Care Program has tended to provide services to more individuals, yes, but also a more intensive level of service to a greater number of individuals enrolled in the program.

So what we are doing is finding that the intensity of service provision in both programs is increasing, personal care home and Continuing Care Program. That has been a trend for a number of years. Aiding and abetting the independent living, though, and relieving the Home Care program, are areas like support services for seniors wherein a number of nonincluded services, such as even visita tion and oth er areas, are provided by community support groups to assist elderly living independently in their homes. That has provided a lot of relief for the formal program provision in personal care home and continuing care.

Ms. Wasylycla-Lels: I am not sure I follow the minister's logic. We have an aging population. Every year those over 65 grows by well over 2,000, as far as I have been able to determine, yet the Estimates for Home Care show no change in terms of expected numbers of Manitobans who will require or receive service. Yet I juxtapose that against the extended care treatment report which shows that there is a smal ler ratio, an increasingly smaller ratio of personal care home beds per 1, 000 population. So it seems to me that our population is aging. There are more and more demands upon the syste m.

There are certainly mo re and more pressures in terms of personal care homes. So I make the argument that if our Home Care program was expanding to meet the needs to keep people out of hospitals and out of personal care homes, we wou ld be going a much more cost-effectiv e, community-based way, much more sensitive to, I think, the needs of our elderly. I do not see that anywhere in the Estimates or in the minister's commentary.

I do not see any major breakthroughs in this area and when he gets us the figures, will no doubt show that improved, increased Home Care is going to make a heck of a difference in terms of cost for the system. I will add a few questions to that while he is looking into that. Where is the innovation in terms of this whole area? Where is the risk taking? Where is something like the kind of model we are now seeing in Victoria, 8. C., com mu nity-ba sed ser vices working with hospitals, sharing costs, sharing resources, sharing plans?

Where is the extra effort to keep people in their homes, because it is such a more sensibl e way to go and a much more cost-effective approach? *

(2000) Mr. Orchard: Mr. Acting Chairman, we are dealing with, and I should be cautious when I say this to my honourable friend, but we are probably dealing with the fastest growing line in our budget right here with an over-1 3 percent increase year over year, I believe, is the number. Now I realize that may not impress my honourable friend, but recall back that my honourable friend said-well, you know, a couple of years ago the criticism was we were not spending the money.

Now we are spending the money and more , providing mo re services to ma intain the independence in the community, exactly what my honourable friend wishes to see done, yet my honourable friend shakes her head. I mean, when we underexpend, we are criticized. Now when we overexpend for last year, part of which was no doubt stimulated in part by the January nursing strike where we had more demand on the system-but

412 8 LEGISL ATIVE ASSEMB LY OF MANITOBA July 2, 19 91 nevertheless, we are spending as budgeted, and it represents a 13 percent increase year over year-m y honourable friend says, well, that is not good enough. We are putting the resources there. Our average age of adm ission to a personal care home-I believe, the approach is 85 now. That is a direct reflection of supporting them in their homes through Continuing Care in the community. That has been going up every year. It is not because we are doing less in Continuing Care; it is because we are doing more in Continuing Care.

My honourable friend says, that is not good enough. Well, okay, let us have her ideas as to what is good enough, because we are doing more. It is delaying, to an older age, admission to personal care homes. Our personal care homes, we have not built a single Level I or Level II hostel bed since I came into this office. All of the plans are for Level Ill and Level IV in terms of the intensive care that the individual needs by the time they are panelled for placement in a personal care home, so there is more in that program line. I guess I am at a loss.

If that is not following a direction-a nd at the same time, we are supporting a number of initiatives which promote wellness through the Seniors Directorate, through our department, through the ministry of Education in terms of fundi ng to various groups and organizations that support continuing education and a whole variety of activities among seniors to make sure they remain well elderly. Ms. Wasylycla-Lels: Well, first of all, Mr.

Acting Chairperson, I am not criticizing the government and this minister for not paying attention to the home care issue, but I do not see the translation of the rhetoric right now of the minister in terms of the Estimates we are now dealing with. I do not see an increase in terms of number of people being enrolled or part of the Home Care program. I do not see any significant reduction at the hospital end, because we have done so much in terms of community-based home care delivery.

I do not see some of the breakthroughs that are so necessary if we are ever going to shift from the costly acute hospital-based delivery service to a far more creative pioneering way on the Continuing Care, Home Care front, the kind of thing that I have just said is modelled in B.C. in terms of the Victoria project, other examples we can get into. That is why I prefaced my remarks by saying I am not being critical.

I am saying, when are we going to see the breakthrough in terms of this area, because it is surely the area that has to be the centerpiece of any health reform policy, of any attempt to find savings in our institutional-based system? I am just asking, does the minister have a vision in thi s regard? Are we going in new directions? Are we looking at new models? What are the plans for the future? Mr. Orchard: Mr.

Acting Chairman, what we are projecting-and these can change, but basically what we are projecting in terms of admissions to the Home Care project for this fiscal year is an increase of a thousand over last year, from 10,500 to 1 1, 500 in rough terms. We are estimating that there will be an increase of 800 discharges this year over last year. In other words, more people will be admitted to the program this year than last year and ·an increase in admissions versus discharges so more people will be served this year. That is the reason for the increase in the budget.

Now, my honourable friend talks about, where are the results in the institution? Well, if we achieve what everyone would hope we achieve, i.e., fewer panelled patients in our acute care hospitals and with changing procedures so that your length of stay for surgical and medical procedures are down, then my honourable friend would be faced with a perspective of hospitals saying we want to close a ward of beds because we are not using them to serve seniors who are panelled and placed, nor are we using them for our surgery or medical wards because our length of stay is down.

If they were to close those beds because they do not need them for program, my honourable friend would start crying about cutba cks and, mo re significantly, my honourable friend would probably start complaining about potential layoffs of staff in the hospital system. We have already experienced my honourable friend's perspective at Seven Oaks where they brought together in one ward all of the panelled patients and changed staff by usi ng fewer professional nursing staff and more support staff similar to the ratios used in personal care home systems.

My honourable friend's first concern was for the laid-off nursing staff, not for the patients who are going to receive better care. Those are initiatives that are happening right now, and they make the system work better for the patient, but my

July 2, 19 91 LEGISL ATIVE ASSEM BLY OF MANITOBA 41 29 honourable friend has chosen to criticize them when they do happen. (Mr. Deputy Chairman in the Chair) We do the exact thing that she is recommending here tonight in terms of management of the system, and my honourable friend takes um brage with it and in Question Period criticizes the initiative. You cannot win. I mean, you have to make up your mind.

If you want us to take those initiatives to make patient care better, to make home care se rvices better-and when we do them and , throu gh management changes, the hospital suggests ways of achieving that within their system and it happens to mean changes in staffing ratios which could mean layoffs of nurses in some cases and the hiring of support workers-my honourable friend cannot have it both ways. That is part of what she wants us to do, and when we do it, there are consequences on employment. Ms.

Wasylycla-Lels: The minister has clearly not heard me and the direction that I am trying to get the minister to pursue. Let me tell the minister two things in terms of personal care homes. No. 1, I certainly do not support creating little personal care homes in big hospitals. I do not think breaking the upper limits in terms of his own task force report, in terms of numbers of panelled patients occupying acute care beds, is the way to go. I think, instead, we should not be entrenching personal care home models within hospitals.

We should not be using up to the tune of-what?-700 acute care beds in our hospital system with people who could be in other settings and probably could be in the community if we took a more innovative, creative pioneering approach to home care.

That is what I am asking the minister about, some thoughts he might have or he might be pursuing in terms of the Home Care model, not personal care homes, and I might even be inclined to agree with the task force report that says perhaps if we really broke through and if we really did some innovative things in terms of home care and continuing care, we might not need personal care homes to the tune recommended in some of the reports the minister has received. I think we should look at all those options. I thi nk we shou ld look at the most cost-effective way to go in the most humane way to go.

So my question comes back to: Is the minister thinking about models like, and I mentioned the Victoria one? I will reference it in more detail if that might help. A program called the quick response team, providing an array of services to help people recuperate in their own homes. As described in this article, a quick response team that is supported both by the community services as well as by hospitals.

A program which is sort of a geriatric swat team , as it is des cribed her e , which in cl udes physiotherapists, occupational therapists, social workers, Home Care nurse liaisons, liaison nurses and clerical staff, and with results of such a program being quite phenomenal in terms of its initial trial run. I am not asking the minister specifically if he is pursuing this program. Is he pursuing that kind of a vision, that kind of a way to keep people in their homes and in their communities? *

(2010) Mr. Orchard: Mr. Deputy Chairman, that is exactly what the Continuing Care Program in Manitoba is doing. We have therapy services, we have nursing, we have the services my honou rable friend mentions. We have the clerical staff to make the dischar ge. We are wor king on, through our institution-com mun ity inte rface comm ittee to str eam line the dis charge process and the co-ord ination of services upon discharge from the hospital to the community. All of those things are being matured and are working significantly better over the last three years.

The Victoria project, one has to remember there was something like a six-m onth-wait before you could access service at the start of the project. We have never been that high, so that what I am saying to my honourable friend is, yes, the Victoria project is one of those pointed to areas of success, but they are probably no better in serving the seniors in that area after their successful project than what we have been all along because they had a lot of ground to catch up on. Okay? That is the point I am making to my honourable friend.

Now, my honourable friend really got into an interesting subject here because my honourable friend said, why are we using those 700 acute care beds for panelled patients? She does not want to see personal care on a mini personal care home in an acute care facility. My honourable friend must recognize that for literally years, those numbers of beds have been blocked and put aside. Now, that is why I asked my honourable friend earlier on. She wants to quote recommendations that she thinks

41 30 LEGISL ATIVE ASSEM BLY OF MANITOBA July 2, 19 91 she can agree with out of the task force, but the task force also said we ought not to build any more personal care homes.-(in terjection)- Yes, and I am just wanting to reaffirm my honourable friend's response. If we do not use those 700 beds or whatever the number is, because I am not sure of the number, but if we do not use those beds for interim placement of panelled patients, then we do not build personal care homes? Then we simply close those beds in the acute care hospitals?

Because my honourable friend knows from her experience in government that a hospital bed will be filled, period and paragraph. Now, if you take and want to put those individuals and support them in the community, if that is possible, and my honourable friend must recognize that that is not always possible that there is only institutional care for some of those individuals that is possible. Where they can be placed in the community, I suggest to you that they are, with few exceptions. They are placed in the communit y under Continuing Care support.

If my honourable friend believes that there is a super-enhanced Continuing Care Program that can take those 700 individuals and place them in a communit y, then my honourable friend must also follow through with the recognition that we would have to close those beds, because they would become filled with other patients for other uses and we would have yet another leapfrogging of the budget. That is something that in today's context we simpl y cannot afford, and wh eth e r my honourable friend thinks that that will change magically should she become the Minister of Health, I sim ply tell you , no, it will not .

Talk to the predecessor, the former Minister of Health for your party, and you will know that is not possible. If my honourable friend is suggesting that we ought to em bark upon a brave new world of other community placement for these people who are in the acute care hospital beds, is my honourable friend also saying that we should close those beds and transfer the budget to this new, brave world program, because that is the only way in today's context you can do it. That is exactly what the Urban Hospital Council and other study groups are trying to come around.

That, for instance, is why one of the topics today before the Urban Hospital Council is the utilization of one hospital potentially for long-term care facility, the interim placement facility. If I recall, when that issue came out, my honourable friend said, you are going to do something terrible here. You argued against it every step of the way, yet it is exactly the thing that, when you analyze your suggestions on where we ought to go with program, is exactly the direction you are suggesting to government, except you do not admit it.

What I will simply tell my honourable friend is that we are embarking upon just exactly those kinds of system changes. We are embarking upon them with the basic principle that they will not become add-ons to the health care budget, that where we can provide for appropriate alternate care in the community, we are developing the mechanisms. Whether it be through the Health Servi ces Development Fund with expected outcomes by contract which delay the implement ation of the program but give us identifiables, whether it be Urban Hospital Council, whether it be the study on the outpatient feasibility at St.

Boniface, we are asking for a budget reallocation within the system because we are minimizing to the best possible degree pure add-ons to the health care system. We do not have the dollars to provide the level of service by purely adding on to the system. I will accept my honourable friend's suggestions on this new advent of program and this new regime because we are moving in that direction.

When the decision comes that, if we place people in the communit y instead of acute care beds and those beds are closed because they are no longer needed for the program of interim placement for personal care home place ment, I wou ld expect my honourable friend to say, thank you, you took one of my suggestions. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, the minister likes to take things people say and distort them.

He has never heard anyone on this side of the House, neither, I am sure, from my colleague in the Liberal Party or myself or any of my colleagues say that we would oppose a sensible approach to health care reform where we would end up with a variety of commun ity-based programs which would then require less acute care beds, less institutional approaches. That has always been the approach. Any health care reform approach has to look at that whole area, so we will anxiously await the minister to move in this direction.

July 2, 19 91 LEGISLATIVE ASSEM BLY OF MANITOBA 41 31 Our criticisms to date have been made because we have seen beds close. We have seen proposals on the table that call for hospitals closing. We have seen talk and seen studies dealing with reductions in services to patients without the other whole side of the equation being addressed, without the commu nity-based services in place, without the comm unity clinics, without the breakthrough in terms of home care. Mr. Deputy Chairperson, we will be supportive of movements in that direction.

It would be nice to go on this issue for a while, but I should pass it over to my colleague very soon. I just have a couple of quick questions. The minister mentioned the computerization or something of the Home Care ser vice. I am wondering if the glitches in that system will soon be sorted out and if Home Care attendants will soon start getting their cheques on time. Mr. Orchard: The system is improving, and we expect that that will be an ongoing process. Ms.

Wasylycla-Lels: The minister is aware of an official complaint he has received from the Manitoba Government Employees' Association about the failure of the program to provide cheques on a regular basis, and this is as recent as March 27, 1991 . I am wondering if the problem has now been resolved, and are cheques going to Home Care attendants now on a regular basis, as we are accustomed to? Mr. Orchard: I am told that was certainly not the norm but rather the exception. *

(2020) Ms. Wasylycla-Lels: With respect to Home Care nurses, I am wondering if the minister can tell us when their contract comes up and whether they will be covered by Bill 70 or whether they will be entitled to free collective bargaining. Mr. Orchard: I am going to ha ve to seek clarification from staff, but we probably have some in and some out in terms of who falls under Bill 70 and who does not. The MNU was clearly an exception, but MNU did not bargain for all nurses. There may well be instances wher e nu rses bargained for by other than MNU will be subject to the provisions of Bill 70. Ms.

Wasylycla-Lels: Could the minister indicate, what will be the arrangement for Home Care attendants, or has that already been dealt with in terms of their wage settlement and whether or not they are covered under Bill 70? Mr. Orchard: Mr. Deputy Chairman, as far as I know, the orderlies' bargaining agent is MGEA, and I believe they fall under Bill 70. Ms.

Wasylycla-Lels: I do not know all the different unions involved, but nurses covered in a variety of different ways in personal care homes and Deer Lodge hospital-I am thinking of-I am wondering: Is Bill 70 applying generally across the board, or are there different approaches for different situations? Mr. Orchard: With nur sing, MNU represe nts nurses in those facilities -( interjection)- Yes, pretty sure, but CUPE, for instance, represents other support workers. Now, they are part of the Bill 70 in our funded institutions. I know of one exception to that and that is Municipals.

Because of their arrangement with the City of Winnipeg, they are under the contract that was recently ratified by City Council. Yet we provide the global funding too to the Municipals, and we have already given indication to them that we will be providing global funding as all other facilities. If they are going to meet with the recently settled CUPE agreement with the City of Winnipeg, they are going to have to find within the same budget that a St. Boniface, Seven Oaks or other institutions are to deal with it, because those ins titu tions are subject- their unions, other than MNU, are subject to Bill 70. Ms.

Wasylycla-Lels: Finally, on this issue, the Home Care workers who are not unionized and are norma lly covered by the general provision of agreements reached, will they be covered by Bill 70, the MNU agreement, the city agreement, or will there be a general provision made? Mr. Orchard: They will be covered with the same increase that MGEA gets. Ms. Wasylycla-Lels: Thank you. I have a few more questions, but I had better pass it over now to my colleague. Mr. Guizar Cheema (The Maples): Mr. Deputy Chairperson, I must apologize, I am a little late.

I was not really totally informed about the timing of this meeting up until about 7:1 5 p.m., so it took me a few minutes. I do not wish to repeat any questions then. If I am repeating, the minister could tell me and I can read Hansard.

41 32 LEGISL ATIVE ASSEMBL Y OF MANITOBA July 2, 19 91 Can the minister tell us basically-first of all, can he give me the information I requested earlier, about how much money in the Home Care, Continuing Care, budget was underspent in '89, '90 and this year? Mr. Orchard: Now, I am going to go by memo ry on the underexpenditures from last year. They were $4.8 million two years ago, $4.5 million one year ago, and we were overexpended by $2.9 million this past year. Mr. Cheema: Mr.

Deputy Chairperson, last year when-I think it was in '88 or '89, we had the Price Wate rhous e re port on home ca re services -(i nterjection)- Yes, '86-87. That report was made available immediately after the election, and at that time the minister made some promises that they were going to look at the report. Can he give me an update on some of the recommenda tions they have followed out of that report? Mr. Orchard: Basically, we have dealt with a lot of those , but I will try to highlight them if we can pull the appropriate- Mr. Cheema: Mr. Deputy Chairperson, I do not wish to take more time.

I can read it if that is the case. Can the minister tell us if any advisory committee has been formed to look at the whole issue or to deal with recomme ndations from the Price Waterhouse report? Mr. Orchard: There has been an implemen tation comm ittee that has been working on a whole series of issues since roughly November '88. Now, there have been a number of things that have come out of the Price Waterhouse report in terms of the administrative structure and the way we approach the information.

The M-1 always get the letters wrong-the MSSP, the payroll system, is finally, I think, to a stage where it works quite well, and I have to tell my honourable friend that not without some consi der able frustration and growing pains, because two years ago we thought we had it pretty well on track and that simply was not the case. Now we believe we have got a system that works well, is staff-friendly, I guess, to put it reasonably.

Since Price Waterhouse have impl emen ted improved administrative and financial accountability syste ms, because that was one of the major criticisms in Price Waterhouse, we have taken and established between the ministry of Health and the commission, an institutional commu nity interface committee, to try and deal with some of the hospital discharge issues, so that appropriate care can be planne d for and accessed by patients, by individuals, being discharged from the hospital. We put out, a year and a half ago now, the information package.

I think about a year and a half ago we put out a full information package on the Continuing Care Program and now each client, as they come on the program, is given the information package which has within it a written program of what kind of services they can expect to receive, so that there is no potential for dispute. I do not like the word dispute, but no potential for misunderstanding as to what the care worker is to undertake in provision of services.

That is left with the client so that, for instance, family or friends or neighbours can review it and discuss it with them and, if they find some problems, have the opportunity to pose those problems. There is a form which is part of that which can be filled out and sent in to the co-ordinators, or right directly into the office, right into the director's office, so that there is a mo re st re aml ine d com plain t-concern mechani sm. All of those initiatives have flowed basically from the Price Waterhouse report. •

(2030) Mr. Cheema: Mr. Deputy Chairperson, can the minister tell us if there any community involvement in that committee, specifically the Price Waterhouse recommendation committee? Mr. Orchard: Let me just cl arify. If it is the implem entation comm ittee that my honourable friend is asking about, tha t is an in-h ouse government committee. We have outside of the department, let us see, yes, we have several people actually: Mr.

Jack Litvac; Evelyn Shapiro; Gail Roth, who is on the commission board; Paul Hart, I would presume Civil Service Commission; and Bob Layne from Workers Compensation-Bob Layne is within, okay. So there is some outside input representing a number of different interests. Mr. Cheema: Mr. Deputy Chairperson, can the minister tell us the total number of clients during the past year and this year who have applied for the Home Care services? Mr. Orchard: My honourable friend asked for the total number. All I can indicate is that last year admissions were just over 10 ,500 and we are

July 2, 19 91 LEGISL ATIVE ASSEM BLY OF MANITOBA 41 33 projecting this year admissions to be just over 11 ,500. So we are expecting almost a 1 O percent increase in admissions year over year. In terms of discharges we are expecting just under 10 ,000 discharges from the program to be. approximately 10 ,700 for an increase of about 8 percent in discharges from the program. I would guesstimate that our numbers are going to approach 23,000 in terms of total numbers of individuals served during the year. Mr. Cheema: Mr. Dep uty Chairman, can the minister tell us the waiting period for these services?

If somebody were to apply today, how much time would it take normally. I will differentiate the two, one from within the communit y and one from somebody from the hospital. Can you give us a breakdown for those two categories of patients? Mr. Orchard: Mr. Deputy Chairman, we dealt with that earlier on, and it is a maximum of two weeks down to almost same-day provision of service, particularly in the case of discharge from hospital. Mr. Cheema: Mr.

Deputy Chairperson, can the minister tell us how many people have filed the appli cation, who have really request ed the minister's office, whose application has been rejected or the Home Care services have been denied or, for example, somebody's Horne Care services have been cut off prematurely? Mr. Orchard: I am not sure I can answer that for my honourable friend. I receive probably less than two dozen complaints on a yearly basis, and there is a whole variet y of re asons becaus e of assessment change in service level provision, a denial of service. (Mr.

Jack Reimer, Acting Chairman, in the Chair) Yes, here we are, total. Between coming into the regional office and into my office, the total number of concerns expressed-and this is for a year ago; I have not got that for this year-were just under 70, and that represented .3 percent of the individuals who were served. Of this, and over this period time, a year, most regions had four or fewer oftheir clients in formal contact with the minister's office. The exception was the Winnipeg Region, which handled approximately 35 inquiries.

We got into this last year because a num ber of the inquiries that came out of Winnipeg North region, in particular, were stimu lated by a franking piece mailer -(int erjection)- Oh, no, not from the second opposition party, it was from the other opposition party- wherein they sent out a mailer, and I wish I had a copy of it here, but basically they asked: Do you have any concerns about home care? The individual ticked it off "yes" or "no." The "yeses" were then forwarded into my offices as a form of complaint.

I remember receiving a block of nine of them, and of the nine, a number of the individuals expressed some consternation as to why it was that the Continuing Care office was approaching them at the request of the minister's office, because they were not aware they had ever turned in a complaint.

What in reality was happening is that there was a little bit of exuberance by the NOP in terms of trying to create a complaint scenario in the Continuing Care Program and there was only one, as I recall, and I am going by mem ory, legitimate concern that had to be addressed by the Continuing Care office from a whole series of those ticked-off complaints. The number of complaints given, the range of ser vices provide d , the nu mber of concerns expressed, I think, continue to be quite small. Mr. Cheema: Mr.

Acting Chairperson, can the minister tell us if the number of concerns have increased over a period of two years? Mr. Orchard: Actually, from two years ago, they have decreased. Mr. Cheema: Mr. Acting Chairperson, can the minister tell us if there is any direction from the minister's office in terms of the length the Home Care services can be provided? Mr. Orchard: You mean in terms of setting a maximum? Mr. Cheema: Yes. Mr. Orchard: No. Mr. Cheema: Mr. Acting Chairperson, are there any terms of providing maximum services, for example, 40 hours a week? Has that been a direction from the minister's office? Mr.

Orchard: No, there is no direction from my office as to what type of service can be provided. That is up to those who assess the need for service, and in general, I think it is fair to say, a general target of the program is to provide services at a lowered cost to the taxpayer than alternate service availability, i.e., personal care home placement. However, we do have a number of cases, I think, four or five cases right now that are over-cos t care cases and exceed what would be comparable costs in an institutional setting.

413 4 LEG ISLATIVE ASSEM BLY OF MANITOBA July 2, 19 91 Mr. Cheema: Mr. Acting Chairperson, I will go into two of those cases. I think both cases are in my constituency, and I want the minister to know my concerns about one of them, about the person. I do not want to go through the name again. The minister knows about the person. She was at one of the community hospitals for a few days. She was not able to get the Home Care services. In fact, there were a few meetings with them, between her and her family physician and the Continuing Care services. I even attended one of the meetings.

It happened that this person ended up in the hospital. It was very costly. I think she stayed more than two and a half weeks. I do not have the exact days. Now she is back at her place. This person had problems with the Continuing Care in terms of the total number of hours. The second concern has been sometimes the quality of the care. Let me just clarify this in terms of sometimes she would like to have probably a female attendant instead of a male attendant. That has been the problem. The third problem she has experienced is the rapid changeover of some of the workers.

I would like the minister to give me an update on all the three major concerns she has so that I can let her know that we have discussed her fully and dealt with her concerns. Mr. Orchard: Well, Mr. Acting Chairman, if this is the same individual my honourable friend brought up in the House, you know, I have to tell my honourable friend that I have read the file. I have a very substantial file on it because it was also subject to a column in the Winnipeg Free Press.

One of the difficulties that I have as minister is that I cannot be definitive in my answer as to what some of the other side of the story was because, when one does that, one runs the risk of putting out what some may consider is personal heal th information of the individual. *

(2040) Although everyone at some point in time wants to retire from elected life, I do not want to have that requ est ma de by people who think I acted inappropriately, so I have to be very cautious in terms of the information I provide to my honourable friend surrounding this case. I have reviewed it, and I went over it on several different occasions. I believe that Continuing Care staff tried their utmost to provide services to the individual within the home. That was their intent. That was their desire. That was the whole approach with which they came to the meeting regarding the individual's care needs.

There wer e som e circum stan ces which Continuing Care staff, because of the liability they assume in providing safe care, could not accept in terms of client behaviour, and one of the instances that I am aware of was around the bathing routine. The staff of the Continuing Care Program simply would have been at risk for injury should an unsafe bathin g procedure have been under taken, as appeared to be the case with the individual's request. That led to disagreement between the staff and the individual, which led to, I think it is fair to say, a rather direct and heated exchange between the two.

Again, I do not think that-m y information is that the in dividual on staff did not provok e or act inap propria tely in responding to the he ated discussion with the individual. The problem was not resolvable, despite the desire and the efforts by Continuing Care staff to resolve the issue. I think the sort of breaking point, if I am not incorrect, was around the bathing procedure per se, and so the individual, because we simply could not provide the service reques ted in the manner requested by the client because of the liability issue, et cetera, decided to admit herself to Seven Oaks Hospital, I believe.

I think that since that time the issue has been resolved in a more reasoned fashion. It was an impasse and, unfortunately, from time to time those instances do happen. I am not here to defend an insensitive bureaucracy. I will be the first one to criticize and demand changes and appropriate action should I hear that this is the case, but after asking and receiving information on this issue, I do not believe that staff acted inappropriately or in an uncaring fashion in trying to deal with this client's needs. Mr. Cheema: Mr.

Acting Chairperson, the other individual I have written to the Minister of Health and to the Mi nis ter of Fami ly Ser vices (Mr. Gilleshammer) about is a boy. I think he is about five years old, and he is on a ventilator 24 hours a day. This child's father works for Home Care services also and is having some difficulty in terms of getting 12 hours ofcoverage. The family is trying very hard. There are also problems during the weekends.

July 2, 19 91 LEGISLATIVE ASSEM BLY OF MANITOBA 41 35 I did attend the meeting with Family Services, not in the Winnipeg area. I was there and I got the impression that there is a sort of a maximum level of service which can be provided, and from the meeting what I got was that they were giving the maximum services, but according to this person he is not getting adequate services. He has tried very hard to get to meet the Minister of Family Services, as well, and I think he is quite frustrated because it will become very expens ive if something goes wrong and the child ends up in the hospital.

Thus, the issue has been raised and part of the problem was solved by the minister's office in that the shift changes were done. I really appreciate the minister for doing that, but the other aspect has not been addressed so far. The second part of my question on the same issue is the dealing with the ventilator equipment as such. We do not have individuals who can go into the community and repair the ventilators. If something goes wrong, they have to change the whole thing. They bring it back to the hospitals. I think we are wasting money there.

I think it could be done if the hospital individual could go to a person's home and repair the ventilator, butthey are not covered legally. I discussed this same issue last year too, and I was su pposed to get some information. I do not know whether any progress has been made, so if the minister would like to comment on both parts of my question. Mr. Orchard: In terms of the instance of the young fellow and the home ventilator therapy, I do not think we are able to come around complete resolution of the issue, but I believe there have been some fairly reasonable acc ommoda tions made for that individual.

In terms of the in-home service capability, we simply do not have that right now. I understand my honourable friend's point, and it is being considered but unable to be concurred in, partly because the ability to provide that service is working out reasonably well with Health Sciences Centre which does the majority of the maintenance, if I understand correctly. Mr. Cheema: Mr. Acting Chairperson, the problem is that you have to take the ventilator back to the hospital to get it repaired, and maybe it is even a minor thing.

I think it should be done in the home if it is possible because the same individual who is going to pick up the ventilator, they have to repair it anyway. Why waste time and taxpayers' money? They are not legally covered outside the hospital. I think that is the issue here, if that could be addressed. Mr. Orchard: Mr. Acting Chairman, I do not think the issue is quite that easy to resolve, but I will try to get a little better sense of it for you. Mr. Cheema: The other issue here is in the Home Care services. Can the minister tell us what is the training requirement for the Home Care attendant? Mr.

Orchard: Red River Commu nity College offers the training course encompassing 190 hours. Mr. Cheema: Mr. Acting Chairperson, is there any stated policy in the Continuing Care Program to make sure thatthe same individual would give these services to a particular client, so that the shifts are not broken into twice a day, so that for somebody who needs services for eight hours, somebody is providing it for four hours, and another person comes and gives service for four hours? It is happening in some cases, and I certainly want the minister to know that. I think it may be sometimes a practical problem .

Somebody could get sick or something happen, or there are possibly problems with the family or personality clashes, but for somebody who needs the services for a long time, it should be that the same person should be providing the services. Mr. Orchard: I think it is fair to say that this suggestion is the rule rather than the exception. That is what is attempted to be provided to the client so that there is that consistency of client and care provider.

It does not always happen, as my honourable friend well knows, because there are always excep tions, and secon dly, the summ er time presents maybe some more challenges than normal because of desire to have holidays, et cetera, where there is some potential greater disruption of continuity. In general, the attempt is made to provide consistency between patient and client. *

(2050) Mr. Cheema: Mr. Acting Chairperson, is it a policy, when you are hiring workers for the Continuing Care Program, for them to go through a standard medical examination and have the standard immunization before they are put to work? Mr. Orchard: I am informed that that is not the case, that they go through a medical.

41 36 LEGISL ATIVE ASSEM BLY OF MANITOBA July 2, 19 91 Mr. Cheema: Mr. Acting Chairperson, I think it will be worthwhile to proceed in that direction because, if you are going to have somebody provide services on somebody who is sick, if you have not checked the imm unization status of the person and if the complete examination of the care provider is not done, then I think it is not probably the best way of delivering quality care. In some cases, it may be causing some difficulties. Mr.

Orchard: I accept my honourable friend's suggestion, although we attempt to do that in a much more expeditious fashion through the provision of references by individuals who are hired into the Continuing Care Program of which, I think, by and large, has been successful at identifying potential problems. Mr. Cheema: The issue here is not checking the refer e nce for a person. The issue is the immunization record of the care provider. It is a very important aspect of providing the care to a given individual.

That is the issue, that we must check their immunization record, and they must have a complete physical examination, which would be normal, so that they do not have any contagious disease or in any way expose the person to an unwanted risk. Mr. Orchard: I am informed that maybe we have a wee bit of a logistic problem because the MGEA is the certifying agent, and I do not know whether we can do that. I do not think it is part of the employment provisions that are part of the contract they have. Mr. Cheema: Mr.

Acting Chairperson, I do not want to get between the MGEA and the Minister of Health, but certainly I am giving a suggestion. I think it should be done. Anyone who is providing care in a hospital facility, whether it is a nurse or a physician or somebody else, their history for immunization is being checked. Why should a Continuing Care worker not be followed on the same line? The Acting Chairman (Mr. Reimer): 3.(a)- Mr. Cheema: Mr. Acting Chairperson, when I came in, I just heard one statistic from the member for St. Johns (Ms. Wasylycia-Leis) that 700 beds in Winnipeg were occupied by chronic care patients.

I am not sure about that. Can the minister give me some idea about that? How many beds are being occupied by chronic care patients? Mr. Orchard: Mr. Acting Chairman, my honourable friend is right. I sort of did a double take, too, but for the sake of anecdotal example, I accepted my honourable friend's statement of 700 beds. It is not 700 beds, but for whatever the figure is, I think we were arguing not specifics of numbers but principle inv ol ved . We ha d an agreem ent tha t my honourable friend is going to support any initiatives I take in the future. Mr.

Cheema: Can the minister tell us how many beds are actually being occupied by chronic care patients? Mr. Orchard: You mean people who are panelled for personal care home placement. I am informed it is just under 300 in the city of Winnipeg. Mr. Cheema: Mr. Acting Chairperson, what is the average length of stay? Mr. Orchard: A very significant variation there, from several weeks to several years. Some of the circumstances which exacerbate and extend the period of time are an exercise of personal choice to a given home. We have come around that in part, but it still has not resolved all the problems.

The former rules prior to the extended treatment bed review indicated that if you accepted an interim placement, you would lose your placing on the waiting list to the home of your choice. Now interim placements can take place without jeopardizing your position for placement at the home of your choice. That has helped, but it is still, in some instances, quite long. Mr. Cheema: Mr. Acting Chairperson, is there any change in the policy?

I think the minister was telling us last year that if somebody is on a waiting list, for exam pl e, for a spec ific personal care hom e-s ometimes the waiting list is 18 months, two years, and some places it is not as long as the other personal care homes would have it, but I think under those circums tances some patients remain in hospital for a long period of time, and it may not be the right use of the beds. I think the minister was going to review the policy last year. I am not sure whether they have done it or not. Mr. Orchard: Mr. Acting Chairman, that is exactly what we did. We did revamp the policy.

An individual specifying a personal care home of choice goes on that personal care home's waiting list at the time of panelling. Regardless of status or interim placement, that position on the waiting list to the home of their choice is maintained. That was not always the case. Interim placements in homes

July 2, 19 91 LEGISL ATIVE ASSEMBLY OF MANITOBA 413 7 other than the one of their choice did jeopardize the status on the waiting list up until a change in policy. Mr. Cheema: Mr. Acting Chairperson, has the waiting list changed since the minister took over the office? Mr. Orchard: I will give my honourable friend the num bers since 1982. -(in terjection)- I just like to help provide the fullest information possible.

There were 569 in 1982 in Winnipeg; in 1983 it had grown to 71 7; in 1984 to 925; 1985 to 1, 049; 1986 it was down slightly to 916; 1987 down to 764; 1988 down to 659; 1989 down to 640; 1990 up slightly to 654; and then in 1991 we are projecting 729. In the rural, the same years 1982 through 1991 , there were 802 in 1982 in rural facilities; 697 in 1 983; 765 in 1984; 621 in 1985; 594 in 1986; 572 in 1987; 526 in 1988; 594 in 1989; 569 in 1990; and then expected to increase to 604 in 1991 . Mr. Cheema: Mr. Acting Chairperson, can the minister tell us, what is the cost per personal care home per resident? Mr.

Orchard: I have an average cost in level of $77.45 on average, an average cost across the system, for a total of just under $30,000 per year. Those are 1988-89 figures, so '89-90 is $30,000 and '90-91 would be probably $31 ,500 or thereabouts, so that your per diems would be approaching close to $90. Mr. Cheema: Mr. Acting Chairperson, I am very, very confused on this one. Can the minister explain to me how much it is costing per person in terms of how much the family is paying for that person to stay in the personal care homes? Mr. Orchard: May 1 of this year, $23.25 per day is what the individual's payment is.

That will go up August 1, 1991 , to $23.80 per day; and November 1, 1991 , to $24.35; and the final quarterly increase effective February 1, 1992, of $24.90. At the end of this fiscal year it will be just under $25 a day. * (210 0) Mr. Cheema: Mr. Acting Chairperson, can the minister tell us also how much it is costing per person in the personal care home in terms of the Pharmacare program? Mr. Orchard: We will have to try and -( interjection) Yes, but it is under a capitated formula in which the cost of professional service is fixed per patient per month.

There is quite a variation in terms of pharmaceutical cost, but we will try to-- The capitation right now is $25.1 5 per bed per month. That is as of right now. Can we give an average cost across the system of the pharmaceuticals, because the pharmaceuticals are on top of that? We do not have that cost, but what I will do is I will get staff to give you the best approximation because, again, I am not trying to avoid the issue, but there is a significant variation between homes and individuals, but we will provide you with as close a guesstimation of system cost as we can. Mr. Cheema: Mr.

Acting Chairperson, I think it is quite important to us, no matter how much it is costing the system, because everyone makes noise that the seniors are costing more than the rest of the population. That may not be true. I just wanted to know the exact numbers if the minister would have it. My next question is: What is the total number of extended care beds we have in Manitoba? Mr. Orchard: Mr.

Acting Chairman, the reason for the little discussion we were having here: what I am going to have pulled together for you for Thursday when we hit the commi ssion is the extended treatment bed category wh ich is part of the commission. We are into a little bit of a limbo land because as my honourable friend might recall with the Extended Treatment Bed task force report, they identified two categories, chronic and rehabilitative, under extended treatment. I believe we are still going under a categorization of all extended treatment.

If I can provide the chronic rehabilitative breakdown, I will provide that, but for certain I will feel confident we can give you the extended treatment bed numbers. Mr. Cheema: Mr. Acting Chairperson, can the minister also provide the total number of personal care home beds? Mr. Orchard: Yes, I can provide that to my honourable friend. Under the Personal Care Home Program, the drug program last year was just over $6.5 million. That is with the capitation fee and pharmaceuticals, and we are projecting that it will cost $7.2 million approximately this year. Mr. Cheema: Mr.

Acting Chairperson, can the minister provide the total number of clients in the senior age group who had access to this $6.5

413 8 LEG ISLATIVE ASSEM BLY OF MANITOBA July 2, 19 91 million? If it is not possible today, maybe later on, just for personal knowledge. Mr. Orchard: The number of beds that are served by that figure of $6.5 million last year, or $7.2 million, is 8, 144 personal care home beds that are in service right now . So that budget in volves two components. It is $25.15 capitation per bed per month, so that you are looking at about $600 per bed per month. Six times 48 would be-what are you looking at?-a half mil lion dollars roughly in professional fees, the balance in pharmaceuticals. Mr. Cheema: Mr.

Acting Chairperson, I think it would be quite interesting to know how much it is costing in terms of the Personal Care Home and Pharmacare program, and just to compare with the other provinces on how much they are doing in terms of spending on the seniors in terms of the Pharmacare program . I know the memb er for St. Johns (Ms. Wasylycia-Leis) touched on the issue of combining some of the beds in one of the community hospitals on the one level and just corn bining the patients who were waiting for personal care home placement.

Can the minister tell us what is the minister's own political phil osophy, or own stated policy, of combining those beds into one unit? How is that going to affect ultimately the patient care? Number 2, how is that going to have an impact on the health care providers and their ability to perform their function, plus the impact on the layoffs, as you have combined them in one place, and if it may be able to save some of the health care dollars?

The minister has said in the House that it is a win-win situation and you are going to change from RNs to some of the nursing assistants, and I do not know whether you will be able to provide the same kind of care in some circumstances. I just want the minister's own personal belief from his critical point of view, is that the right approach in the long run? Mr. Orchard: Mr.

Acting Chairman, let me start out, that my personal phil osophy and my party's philosophy dictate that we achieve the greatest level of health care for individuals with the greatest lik eli hood of positive pati ent outcome and improvement of patient health status with the resources we are spending in this ministry, those resources being $1 .75 billion. • (21 10) Mr. Acting Chairman, I concur with the senior managers of the system. They have said that governments, and I emphasize the plural, have said to them, you must operate within your global budget. You canno t have a deficit.

That policy was established by the former government in 1987. I do not disagree with that. Where I suppose we disagree slightly with the previous governmen t is they then put man agemen t constraints in place for the administrators and I tend to concur that if we are operating under a global budget and if we are insisting that this global budget not be exceeded, i.e. no deficits, then we have to allow the managers of the health care system to manage that budget in an appropriate way.

The only precondition I put in terms of their management decisions is that they do not make decisions which would compromise quality patient care and outcome of health care service delivery. In the instance that my honourable friend has brought up here tonight, i.e., instead of havtng panelled patients placed randomly throughout a number of wards in the hospital, but rather to place those individuals in one, two or three wards of a given hospital and ther eby offering a more consistent level of service delivery.

Which means that the service delivery in the instance of and let us use the circumstance of both Victoria and Seven Oaks, because both of them are undertaking a similar amalgamation of function within the panelled patient area, they are now providing staffing, or intend to provide staffing consistent with the staffing ratios that are currently being used in our personal care home system. Now that is a different staffing ratio than has been provided.

There has been more nursing staff because the panelled patients have been placed on surgical wards, medical wards where the staffing ratios have tended to reflect a medical ward activity, a surgical ward activity. By having those patients placed in similar areas of the hospital the staffing can now reflect that of personal care home status with a level of service provision commensurate with it. That means that you can operate with nurses' aid or support staff rather than registered nursing positions.

That is where the budget savings occur, but in doing so there is every opportunity, and I believe that this will happen, that the level of patient service and the level of patient care will go up, because now a panelled patient is not one of a couple, three on a given medical surgical ward competing for patient time with post-surgical patients or critically ill patients on a medical ward.

July 2, 19 91 LEGISL ATIVE ASSEM BLY OF MANITOBA 41 39 That is not saying that the nursing staff on those wards did not wish to care for the individual in a very reasonable fashion. All that is saying is that if a nurse has to make a choice of where to provide services, you are naturally going to go to the area of greatest patient need. Oftentimes that is not the chronic or the panelled patient. That is someone who is acutely ill or post- surgical recovery.

In circumstances like that, the level of care de livery to the individual panelled patient has probably been less than if the patient is on a ward specifically staffed to care for their unique needs. That is what is going to be undertaken at both hospitals, Seven Oaks and Victoria, and I think we will see the achievem ent of increased patient care for those panelled patients that are in those institutions, because they will now be staffed and have program availability consistent with the personal care home to which they are eventually going to be placed. Mr. Cheema: Mr.

Acting Chairperson, one further question on Home Care. I think last year it was whether-I do not remember the exact day-the minister made a statement that in future they would look at the family providing the Home Care services for a particular person whose, for example, that person's Home Care needs are more than, say, if that person would need more services. That means family can still provide the care and be at home. Are we going to draw up a policy like that in Manitoba? Mr. Orchard: That is a co nstantly suggested-well, not constantly suggested-but that is an often-suggested policy direction.

We have talked around the issue, but we find it a most difficult policy initiative to bring in formally. It remains one of those challenges that has been before, no doubt, previous governments and may well be in front of this one unresolved, because it gets int o the very fund amen tal issu e. I can understand the case made by an individual.

You can take the extreme case where an individual whose spouse is requiring continuing care and the other spouse is a continuing care worker and is going out of the home to provide services to strangers but cannot be the individual assigned to provide, for pay and for compensation, the care in the home. Those are noncomm on-se nse app earin g decisions, but it brings up a whole range of issues not exclusive to the Continuing Care Program.

For instance, where we have job creation programs, STEP, where we assist students, one of the things we say is that you cannot hire your own child as a STEP student in the program for very obvious reasons of appearance and propriety, because you have to be accountable to the taxpayer. We are tr oubl ed with the same kind of fundamental decisions in Home Care.

I do not know how we get around that in a reasoned fashion, because some of the cases that come to light from time to time through the media or through letters that cross my desk, are cases that I know, if we had the policy, would be resolved in the most equitable fashion without the potential for abuse of the syste m. But, golly, it has just trou bled this administration and previous ones to come up with a policy which would allow that to happen. (Mr.

Deputy Chairman in the Chair) I know, and I have not got around the issue yet, but in the recently received task force report-I did not get through the one that got into the detailed recommen dation of a program in one of the Scandinavian countries, Norway, I believe, where they allow some ability to compensate the spouse when they are providing care in the home which could be accessed from the program. That is the first I have heard of that, and I am looking forward to reading that to see how they do it and how they avoid the potential, I think we can obviously see, of abuse of that policy.

As I say, when some of those letters cross my desk, I know that those individuals would not take advantage in a wrongful fashion of such a policy, but unfortunately the propriety of it and the appearance of propriety has prevented this and previous admin istrat ions from considering it an d implemen ting it as policy. Mr. Cheema: Mr. Deputy Chairperson, given the me ntal heal th reforms, in terms of the community-based care, can the minister tell us how he views the role of Continuing Care as a part of the community-based mental health care system? Mr. Orchard: I did not quite understand there, I am sorry. Mr.

Cheema: I will rephrase the question. Can the minister tell us how the Continuing Care Program will fit into the mental health reform in terms of the community-based mental health care?-b ecause you are going to have some individuals who would need Home Care services, some especially with some forms of mental illness may also have another

4140 LEGISL ATIVE ASSEM BLY OF MANITOBA July 2, 1991 medical illness, so you may have to combine both the services. I am asking the Minister of Health, has he given any thought to how he is going to fit the Continuing Care within the new mental health reform system? *

(2120) Mr. Orchard: Right now the program does provide services for both individuals with mental illness, but also individuals who are in varying stages, for ins tance, of Alzheime r's impairm en t. So the program does provide that through such vehicles as overnight care and in other levels of service.

I do not see that to be an unresolvable challenge in a reformed deinstitutionalized mental health system, although I will offer this caution to my honourable friend, as we move away from institutional to community placement of mentally ill individuals, I think that there will be an enhancement of the type of service required in the community.

It may not always be the Conti nuing Care Program which would provide that service; it may well be other vehicles such as, for instance, a mental health residence circumstance, such as we have just recently opened in Thompson, Manitoba, and are part of the care delivery environment throughout Manitoba. Mr. Cheema: Mr. Deputy Chairperson, as we go over The Mental Health Act reform, I am sure that the role of Continuing Care may change.

To some extent it would, because you have some individuals who will be needing medical care, plus some of the mental health care as well, so I am certain that is going to happen eventually. My next question is in regard to the Home Care for physically handicapped individuals, are there specific programs we have in Manitoba in terms of dealing with those individuals? Mr. Orchard: They have access to the full range of Home Care services, of course, by assessment.

In addition to that, we have commenced, and now I believe we have a number of clients on the Self-Managed Care program, which is a pilot project in Home Care service delivery by the individuals themselves. In other words, the assessed needs are identified and the indivi dual who is on self-m anaged care manages the provision of those services from staffing, et cetera, through dollar resour ces provided by the Conti nuing Care Program.

So we are moving away from the Office of Continuing Care providing those services, rather providing a financial target for each individual client, and then they use those resources to retain and to hire their own caregivers. Mr. Deputy Chairman: The honourable member for The Maples, before you get started, would it be the will of the committee that we take about a five-minute break? Mr. Orchard: Four minutes. Mr. Deputy Chairman: Four minutes. I see some people are starting to get anxious-five minutes. Mr. Orchard: Thank you. *** The committee took recess at 9:23 p.m.

After Recess The committee resumed at 9:32 p.m. Mr. Deputy Chairman: We were considering 3.(

a) Administration: (1 ) Salaries $95,200. Ms. Wasylycla-Lels: Mr. Deputy Chairman, on the issue of self-managed health programs, the minister announced that program I believe last spring and, as far as I am able to ascertain, it is yet to be implemented. I am wondering when is the start- up date for the self-managed health program. Mr. Orchard: We have nine individuals who have signed contracts and are beginning the project, and that was effective June 16 . Others will be brought in on the program when they are ready to go on the program and have signed contracts.

We are hoping to have, as we announced, up to 30 individuals on the program. That is expected to be by the end of the year. Ms. Wasylycla-Lels: The execut ive director of Continuing Care is who? Mr. Orchard: My di re ctor of the Office of Continuing Care is Ms. Lynne Fineman. Ms. Wasylycla-Lels: Has this minister hired a person by the name of Helmut Klein from B.C.? Mr. Orchard: I do not think we have hired him from B.C.

Helmut Klein was in the Admin Division for a number of years, I guess went to B.C. for a couple of years and came back and was rehired into Admin and is now I believe working out of the Office of Continuing Care. Ms. Wasylycla-Lels: The minister just indicated he is working out of the Office of Continuing Care, in what capacity?

July 2, 19 91 LEGISL ATIVE ASSEMB LY OF MANITOBA 41 41 Mr. Orchard: Admin and Finance operations of the Office of Continuing Care. Ms. Wasylycla-Lels: I am going to zip through a few of these issues that I had not dealt with before I handed it over to the-I will try to zip through. On the issue of personal care homes, I am just wondering if the minister can tell us-this relates to the member for The Maples' question-his own view, his own policy in terms of the trend line with respect to personal care homes. Does he see them increasing or decreasing? What is the general pattern here? Mr. Orchard: Mr.

Deputy Chairman, in terms of personal care home numbers, I am provided with expert advice which indicates we need more beds and other very excellent and expert opinion that say we ought not to construct significant numbers of new bed capacity. That was reflected in the task force report on services to the elderly. That is a very, very complex question. Let me background it in this fashion. We already have expenditures which are the largest of any publicly funded health care system in the world.

Part of the Canadian phenomenon, part of-bear in mind that I am saying part of the Canadian phenomenon, as compared to other publicly funded jurisdictions, is a significantly greater incidence or-i ncidence, maybe that is the wrong terminol ogy-but a significantly greater institutionalization of our elderly in the Canadian and Manitoba context than other publicly funded health care systems, be they in Europe or elsewhere in the world. That presents us with quite a quandary.

We also have in Manitoba, I think it is fair to say, probably the most generously funded community support and accessible community support program for seniors, namely the Home Care program which we just dealt with rather extensively. So I am very, very considerate of both lines of thought, and I guess it is fair to say that we are trying to walk that sort of in-betwe en line.

We have committed and, I suspect in part, will continue to commit, maybe not in the same num bers as we did in July with the acceptance of the Extended Treatment Bed Review task force, but we will be renewing personal care home capacity not only in new beds, additional new beds to the system, but certainly wherein we undertake renovations to existing personal care homes and renovate Level I, Level II hostel up to Level Ill, Level IV personal care home service beds and, in that way, are very much providing intensive institutional care opportunity.

I am not sure that we are ready to accept the advice that we ought not to build any more personal care homes. I am not sure we can do that right at the present moment. Here is the quandary. We have increased every year that I have been here, and that is 14 years. We have increased the budgets of both home care and personal care homes through increased levels of service or increased numbers of services, be they more beds in the personal care home system or more Level Ill and IV versus Level I, Level II. The same thing has happened in the Continuing Care Program.

We have cared for more people, and we have provided on average a higher intensity of service. The one does not seem to be completely replacing the other. It was never envisioned to. I think we are doing reasonably well in Manitoba compared to other jurisdictions, i.e. in achieving the replacement of personal care home construction and the additional capacity in personal care home availability by extensive expenditures in the Home Care program .

I am unable, and maybe it is because I have not sought out the information, but I am unable to say that we are, if you will, winning the policy-and-funding game better than other jurisdictions. I think we are doing better, but I am not sure that can be analytically proven.

So I simply suggest to my honourable friend that we ar e probably taking alm ost the middle-of-the-road approach on this in terms of pro viding both in cr ea sed budget for the com muni ty-based care programs as well as constructing new capacity in personal care homes because, as I pointed out to my honourable friend in 1988, there was only one construction program in personal care home being undertaken at the time and that was at Foyer Valade, and that was opened in about June or thereabouts of 1988.

Then we went through a fairly significant period of time where there was no new construction because there were no approvals for the last number of months prior to the change of government in 1988. *

(2140) Now we are back where a number of projects are coming on stream. They are a combination of replacement of time-expired facilities, sometimes with equal bids, sometimes with a few more bids, sometimes with fewer bids. Then we are also

41 42 LEGISL ATIVE ASSEMBL Y OF MANITOBA July 2, 19 91 bringing on some additional bed capacities in some areas, so we have been bringing some additional beds on, and that is why the budget in the personal care home line has been increasing, I think, fairly significantly, as has been the Continuing Care budget. Ms.

Wasylycla-Lels: Given that increase, it seems to me that one of the areas that the government should be looking at is to address some particular com mu nity needs, redres s some his torical imbalances in our system and in that context I wonder why the government has not moved to support the proposal for personal care home beds from Ke-Ki-Nan? Mr.

Orchard: Ke-Ki-Nan is a rather interesting project, because it is for Native Indians who require personal care home placement, and I indicate to my honourable friend that one stage in discussions with the Ke-Ki-Nan proponents-th is was during the tenure of the former Minister of Health federally-I indicated by a letter to the Honourable Perrin Beatty that we would welcome an opening of discussions with the federal government to see how we could advance this particular project.

Unfortunately, due to probably other time constraints, et cetera, no doubt the opportunity of some precedence, the proposal was not given any further advancement by my federal counterpart. 1\4$. Wasylycla-Lels: We are not dealing with a reserve. We are dealing with an off-reser ve situation. I am not sure why approval for this project is contingent upon federal government involvement. Obviously, to have the federal government involved in any project is desirable, but it should not be one of the criteria used in making such decisions.

Just on this whole issue of personal care homes and the integration of MHSC with the Department of Health, I am wondering how reporting will occur with respect to juxtaposed facilities. Will there be a need for dual reporting for different sets of staff and budgets? How will it all be co-ord inated? Mr. Orchard: Mr. Dep uty Chairman, those instances are not a significant portion of our combined budget right now.

I cannot even tell you how we split them out for the hospital versus the personal care home line on existing facilities, which are the swing facilities, the 18 or so personal care home beds with the six to eight acute care beds. I do not even know whether we split the budget or whether we bring them all out of the personal care home line. I am informed that it is all under the personal care home line, so that is where we would continue to have that reporting structure.

You see, you have to appreciate that most of these facilities have been renewed in communities where the fo rmer range of services undertaken-fo rmer, I mean it could have been as much as 1 O or 12 years ago-the hospital in those commu nities possibly had obste.trics . They possibly had a surgical suite which undertook a number of minor- wel l, they were significant surgical procedures in their day, but surgical procedures. In the evolution of how those facilities were used, they curtailed, for instance, obstetrics.

They often curtailed surgical undertakings because of lack of appropriate support staff and/or a surgeon. Their service primarily was in terms of medical and oftentimes in rural Manitoba, because that is where we are talking about in terms of the swing facilities, they had been used significantly for the care of elderly patients, often ones who are panelled or were chronically ill.

As such, their level of provision of service is often more akin to the personal care home system than it is to the acute care hospital, be it communi ty or teach ing or indeed active community hospital like a Carman, a Dauphin, Thompson or Morden. Ms. Wasylycla-Lels: I would like some clarification on the minister's statement that they will be reporting through the personal care home line. I am not sure which line he is referring to on the chart. There is a line under Continuing Care Programs. In the detailed book, it is listed under MHSC. Who will be in charge of personal care homes?

Is it Betty Havens or is it Frank DeCock? Mr. Orchard: It is indicated to me that for the funding which is under legislation, the funding line so the dollars will be reported as part of the MHSC dollar budget, but the line of reporting will be as indicated in the new chart, in other words, to this ADM. Ms. Wasylycla-Lels: Could the minister tell us what the line is on page 52 of the detailed Estimates book? I am just trying to sort through what-t here is a line for $54 million. It has no head. Mr. Orchard: That is Home Care Assistance, the detail of Home Care Assistance. Ms.

Wasylycla-Lels: I am skipping all over the place. I have just noticed under Continuing Care

July 2, 19 91 LEGISL ATIVE ASSEM BLY OF MAN ITOBA 414 3 Administration two staff, yet the minister just indicated that, I believe, Lynne Fineman would be the managerial position. He also said Helmut Klein is now under Continuing Care Admin istration. Where does he show up? Mr. Orchard: Helmut Klein would be part of the 15 SY s under ProfessionalfT echnical. Ms. Wasylycla-Lels: A year ago in Estimates I asked the minister about the Support Services to Seniors Program. He said the program was under review. I am wondering if he now has the results of the review and if he has unfrozen this program line. Mr.

Orchard: We have received, I guess it would be for lack of better description, an interim report on it with some outstanding issues identified and attempting to be resolved at this time. Ms. Wasylycla-Lels: I am curious certainly about that. It is a year since the minister said this was under review and a year since he raved about the program and talked about its benefits, and a year that has been wasted in terms of starting to do some of that innovative commu nity work of providing ser vices for seniors to keep them in their communities and in their homes.

In the same vein, has the minister started to fund adult daycare programs, or has that remained stagnant as well? Mr. Orchard: Mr. Deputy Chairman, there has been ongoing adult daycare funding. Ms. Wasylycla-Lels: Could the minister give us at some point, it does not have to be now, a list of new initiatives funded? Mr. Orchard: I will provide that information to my honourable friend. *

(2150) Ms. Wasylycla-Lels: I would assume this area somewhere in these lines would be the issue of funding for seniors centres. I am wondering if the minister could give some accounting for his failure to keep his promise to the Gwen Secter Creative Living Centre. Mr. Orchard: It is not very often that I am unable to resolve things within a year, but this case I was unable to resolve. Ms. Wasylycla-Lels: I do not think in this case it is just a matter of the minister not being able to achieve something he hoped to within a year. It is a case of actually changing his mind and breaking his word.

He indicated to the Gwen Secter Creative Living Centre on January 12 , 1990, by way of a letter, and this had been previously communicated to the centre, that there was support for establishing appropriate level of base-line funding. In fact, I believe I raised this in the 1988 Estimates, the very first Estimates of this government, and received that information. He has now written this centre indicating that, too bad, we are into tough times, and I have to break my word.

I think that is certainly hard to understand, given the benefits provided by the centre or given the service that this kind of a centre provides in terms of keeping seniors healthy and in their commun ities and out of expens ive care arrangements. I am wondering if the minister is prepared to retook this issue imm edia tely and consider kee ping his promise of appropriate base-line funding. Mr. Orchard: As soon as we can we intend to do that.

I indicated to my honourable friend earlier on that we were undertaking a review, because I firmly believe in the value of the Support Services to Seniors Program, but I cannot go to Treasury Board with anecdotal endorsation of a program and request mo re dollars. At the same time, my honourable friend has told me, well, you should not have taken $500,000 out of children's dental health program and other areas. At the same time, her colleagues say, well, you should spend more money on education, et cetera. There is always more demand for new resource than there is new resource. That has not been inconsistent.

What we have attempted to do is to identify the strengths of the program. I have to say that we have, as I indicated earlier on, for lack of a better terminology, an interim repor t with some outstanding issues to resolve. I am hopeful that we will resolve those issues. I had wanted them resolved before this budget cycle, so I could approach this budget cycle with some of the increases that, I believe, would be appropriately provided. I am into a circumstance, as is all government, where we canno t ma ke requ ests based on anecdotal personal fee lings.

I have to go to Treasury Board and, as I have indicated before, I hope to be able to present Treasury Board with a flow of analysis that indicates that for a dollar placed in support services for seniors, we may well curtail a $2 expenditure in Home Care. By curtailing that $2 expenditure in Home Care, we may curtail a $4 expenditure in the personal care home line, thereby

414 4 LEGISL ATIVE ASSEM BLY OF MAN ITOBA July 2, 19 91 proving that the program is appropriate. We ought to provide increased funding where program needs justify increased funding, but I sim ply have not been able to make that commitment at this budget cycle. Ms. Wasylycla-Lels: Mr. Deputy Chairperson, first of all, we are not dealing with an anecdotal situation. We are dealing with a proposal, an initiative, that has been before this minister and this government for three years, where a specific commitment was made. A promise was clearly outlined to establish appropriate base-line of funding.

Now, three years later, suddenly this minister and this government have decided not to proceed as promised. The other issue in terms of this whole centre is that if the minister is serious about health promotion and about keeping seniors out of more expensive care, about reducing stress on our institutions and hospitals and personal care homes, then this kind of a proposal, one would think, would be at the top of the list. It is not frivolous; it is not anecdotal; it is not a minor, marginal part of this whole area. It is a central part of any kind of serious Continuing Care seniors strategy.

I would ask the minister if he could tell us what vacancies now exist in seniors blocks generally. Mr. Orchard: You mean in seniors housing? Ms. Wasylycla-Lels: Yes. Mr. Orchard: No, I cannot, because those fall under the responsibility of the Minister of Housing (Mr. Ernst) . Ms. Wasylycla-Lels: I am thinking of a variety of situations. Some may fall within the jurisdiction of the Minister of Housing of w

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-2-76b
Type	hansard
Volume / chapter	35th 2nd hansardpdf 76b.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	1b3ecf81f3a3ecd0e23f5375091583e1023092fe

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