1998 Legislative Session: 3rd Session, 36th Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JULY 27, 1998

Afternoon

Volume 12, Number 7

[ Page 10471 ]

The House met at 2:08 p.m.

Prayers.

Oral Questions

CONSTITUTIONAL IMPLICATIONS OF NISGA'A TREATY AGREEMENT

G. Campbell: My question is to the Attorney General. The government has released one legal opinion to corroborate its position that the Nisga'a treaty will not alter the Canadian constitution. The Attorney General knows full well that there is a body of thought that takes the opposite view. Will he categorically deny that he has had other legal advice indicating that there is at least a legitimate legal question as to whether some rights conferred in the Nisga'a treaty may effectively constitute an amendment to our constitution?

Hon. U. Dosanjh: Hon. Speaker, first of all, the hon. member well knows that the Attorney General doesn't usually release opinions. Firstly, it's important to recognize that this opinion has been released. This opinion, in the

preamble, indicates that this advice was given sometime earlier. That advice is now written up, and it has been released. The Attorney General will not release any other opinions. The Attorney General is in the process of obtaining opinions from outside counsel. If and when we order them and receive them, those would be released.

The Speaker: First supplementary, the Leader of the Official Opposition.

G. Campbell: The Attorney General is, I'm sure he's aware, responsible for ensuring that the government is fully and properly advised of all legal issues and potential legal ramifications relating to treaties. Frankly, I'm not at all confident that he has fulfilled that obligation, based on the doubt that surrounds this particular issue. Will the Attorney General now undertake to release all legal opinions submitted to the government, including all legal advice related to those opinions, pertaining to the effect of the Nisga'a treaty on our constitution?

Hon. U. Dosanjh: I will stand corrected with respect to my memory; I don't recall seeing any other opinions. However, even if there are other opinions, the Attorney General decides whether or not they are to be released. This opinion was released; it is from the most senior constitutional expert in the ministry. The ministry is seeking other opinions, if at all possible, from outside. If and when they are requested and received, they will be released. I make that commitment now.

G. Campbell: I think the critical thing to the people of British Columbia is for them to see all opinions with regard to this. There is no question that this is going to have a major impact on British Columbia and the people that live here, and they deserve to see them.

The Attorney General, I'm sure, is aware that a number of Canada's foremost constitutional experts have a view that the Nisga'a treaty does indirectly amend the constitution through the back door, under

section 35. That position has been publicly supported by such constitutional experts as Dr. Peter Hogg, Dr. Ted McWhinney and Mel Smith, who has been this province's . . . .

Interjections.

The Speaker: Order, members.

G. Campbell: Mel Smith . . . .

Interjections.

The Speaker: Members . . . .

G. Campbell: Hon. Speaker, for the information of the members opposite, Mel Smith was the province's chief constitutional adviser for 20 years. How can the Attorney General . . .

Interjections.

The Speaker: Members, come to order, please, so the question can be heard.

G. Campbell: . . . be so sure that he is right, when all those experts are evidently wrong?

[2:15]

Hon. U. Dosanjh: Far be it from me to defend the likes of Dr. Hogg; I'm sure they would be able to defend themselves -- and would want to -- with respect to their own positions. I have not spoken to Dr. Hogg. I'm sure that, given the usage of parts of his writings, he might be interested in writing on this issue himself and clarifying the position. We are trying to speak to him, if at all possible, to clarify it.

With respect to the issue of whether or not this is a constitutional amendment, nowhere does the constitution of this country contemplate seven provinces and 50 percent of the population agreeing on rights of the first nations. Quite to the contrary, the existing rights and rights that may be defined, refined and acquired pursuant to negotiations are contemplated in the constitution. The makers of the constitution are very clear about the need for seven provinces and 50 percent of the population, at least, for the amending formula.

Nowhere does it mention, in the writings of legal scholars or within the constitution itself, that those rights that are contemplated by the constitution in sections 25, 35 and 52, I believe . . . . Nowhere does it say that they are to be amended according to a formula. If they are not, they certainly are not constitutional amendments.

G. Campbell: I am sure the Attorney General is aware that there are at least conflicting legal opinions as to whether or not this treaty effectively amends the Canadian constitution. I see the Attorney General nodding his assent. Will the Attorney General at least commit -- given that that does take place, given that there is an existing debate taking place in the community -- to referring this matter . . . ?

Interjections.

The Speaker: Order, hon. members, so the question can be heard by the minister to whom it is directed.

G. Campbell: Given that there are conflicting legal opinions with regard to this very important matter, will the

[ Page 10472 ]

Attorney General at least commit to referring this matter to the courts to confirm whether or not this treaty's subject matter falls within the ambit of the Constitutional Amendment Act of British Columbia?

Hon. U. Dosanjh: Let me clarify the issues. Firstly, I don't believe the real issue is whether or not this is a constitutional amendment, from the point of view of the hon. member who just asked the question. The hon. member is quoted as saying, back in 1996, that referendums would not be appropriate for the Nisga'a issue at all. The hon. member for Matsqui just said in July this year -- July 8, if I remember correctly -- that a referendum for Nisga'a may not be appropriate. The issue behind this whole constitutional debate that the hon. members are engaging in is whether or not we ought to have a referendum. If that is the issue, then the hon. members should say so.

Let's not talk about constitutional amendments, because this in no way amends the constitution of the country. The province itself, the federal government and the Nisga'a -- in a tripartite agreement -- cannot ever, ever amend the constitution of the country. There is a formula in place for amending the constitution of the country.

In addition to that, it's important for us to recognize that the federal government's position, based on the legal advice that they may have received, is completely in agreement with the position of the province, of the Nisga'a and of many legal scholars across this province and across this country. This might come to light, because as they hear this debate -- which really has no basis in fact -- they might want to pronounce upon it by themselves. It is obviously a very important question for this country: whether or not we play partisan politics with the interests of those who have been oppressed for decades.

For the first time in the history of this province, we now want to redress those wrongs, and we're talking about passing referendums on the rights of minorities that have had no rights whatsoever.

G. Campbell: I'm surprised that the Attorney General doesn't know that the rights of minorities are protected in Canada under our constitution, and that is not affected by the Nisga'a agreement.

Secondly, let me simply point out that for more than two years we have called for a referendum with regard to the principles of any aboriginal treaties. It was only two weeks ago that the Premier announced that the Nisga'a treaty would in fact be the template for all future aboriginal treaties in the province of British Columbia.

With respect to the Attorney General, it seems to me that the Attorney General is willing to take a very significant risk with regard to this issue. If the Nisga'a treaty is passed, only to have the court find at some later date that the Constitutional Amendment Act does indeed apply, the results will be devastating to everyone concerned, including the Nisga'a.

In the last few months, this government's legal advice on at least four separate occasions has been proven wrong by the courts. Wouldn't it be better to erase all doubt, to know the constitutional impact that the Nisga'a template will have in advance of debating this treaty in this chamber?

Hon. U. Dosanjh: Yes, I as the Attorney General have responsibility for deciding and offering my opinions on issues such as whether or not there ought to be a reference to the courts. If and when there is need, I would certainly advise the government appropriately on that issue. That's who I advise: the government.

However, it is important for us as political leaders -- as leaders with some moral authority in this country, in this province -- to make sure that we don't allow the courts to make decisions that are important for all of us, and that first and foremost we have a debate and dialogue amongst ourselves. At the end of the day, if the decisions that we make amongst ourselves aren't appropriate and somebody sees fit to go to the courts, obviously the courts are free to rule upon those issues.

My first reference would be to have a thorough debate in British Columbia on this issue, so that people are fully informed and are able to have an informed discussion. Obviously the federal government is free to take a reference to the Supreme Court of Canada. If there is to be a reference, it has to be the decision of the federal government to take it to the Supreme Court of Canada directly. The province alone cannot take that reference directly to the Supreme Court of Canada.

G. Campbell:

Section 35 of the constitution was intended to recognize and protect existing aboriginal rights and treaty rights. It was certainly never intended to allow for the creation of a third order of government that includes constitutional paramountcy over some areas of jurisdiction that are otherwise exclusively held by the federal and provincial governments. Can the Attorney General tell us if he has any legal opinions as to whether or not the Nisga'a government will constitute a third order of government in the sense contemplated in the Charlottetown accord? And will he release those opinions?

Hon. U. Dosanjh: Hon. Speaker, there has been debate in British Columbia for some time, and there are arguments on either side of that question -- whether or not this is a third order of government or a fourth order of government. There is a municipal government in place -- a third order of government.

I think it's important for us to recognize that the Attorney General, at any given time, isn't aware of all or many of the legal opinions that might exist. I'm not aware of any specific opinions at this time. My memory doesn't serve me appropriately. If there are, I'd certainly look at them. At the end of the day, it's the Attorney General's responsibility to determine whether or not we are to release all of those opinions.

It is important, however, that this debate take place in the public domain -- that we are advised and informed by scholars of renown from all parts of the country and all parts of British Columbia and that people in British Columbia are able to make up their minds as to which way they think this matter should go. However, the Attorney General does not usually release all and any opinions. This was done very quickly so that everyone realized that this was the Ministry of Attorney General's particular view. It was an opinion that had been provided and then actually codified in writing recently.

G. Campbell: The government has effectively said that the Nisga'a government won't be a third order of government. The Nisga'a have a very different opinion, however. To quote from one of their web sites: "It must be recognized that self-government is a third order of government, having independent authority over a range of jurisdictions." Given the doubt that exists surrounding that constitutional question and the difference of opinion between this government and the Nisga'a, wouldn't it be prudent to refer the matter to the courts in advance of passing the Nisga'a treaty, to ensure that all parties at least have a clear understanding of what it is we are establishing?

[ Page 10473 ]

Hon. U. Dosanjh: The Delgamuukw case took years going through the courts, and the courts, in their wisdom, properly sent the matter back and also indicated to the leaders and to the people in this country that we'd better settle these issues around a negotiating table. That's what we've done.

Tabling Documents

Hon. D. Streifel: It's my pleasure to table the '97-98 annual report of Fisheries Renewal British Columbia.

Hon. D. Lovick: On behalf of the Minister of Advanced Education, Training and Technology and on my own behalf, it is my pleasure to submit to you the first report of the Industry Training and Apprenticeship Commission entitled, "Report on Operations, Financial Statements and Report of the Auditor General," for the period November 28, 1997, to March 31, 1998, as required by

section 9 of the Industry Training and Apprenticeship Act.

Orders of the Day

Hon. J. MacPhail: I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Health.

The House in Committee of Supply; E. Walsh in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 47: minister's office, $469,000 (continued).

[2:30]

K. Whittred: This afternoon I want to devote some time to the areas of continuing care and seniors' issues in general. For the benefit of the minister in terms of her staff, what I want to do first of all is to canvass the area of continuing care. Within that, I will include all of those things that fall into the category of community-based programs: home care, long term care, chronic care -- those sorts of things. Then secondly, I will do those issues that are specific to the office for seniors. That, hopefully, will give the minister a little bit of a preview of where I'm going.

What I hope to be able to accomplish in this very brief time that I have to canvass this issue is to get some sense of where the ministry feels it's at in this transition from a health care system that is largely focused on acute-care needs to one that is moving toward more services being offered in the community. I don't think I am misstating the ministry's intent. Certainly there has been a great deal of movement in this province, and also in other provinces in recent years, toward trying to put more and more health services in the community -- to have more and more services looked after by home care workers, community health nurses, therapists in the home and so on.

What I would like to try to do is to get some sense of evaluation of this program. One of the things that is mentioned, I think, in the Maclean's report . . . . It talks a lot about the state of affairs related to this issue. It sort of suggests that in the last few years, we went through periods of time in health care where a number of acute-care beds were closed. The theory behind this is that functions previously looked after in those acute-care facilities were now going to be looked after in the community.

However, what has kind of lagged are the systems to evaluate in fact how well we're doing and how much this is costing. For the minister's benefit, that is really where I am trying to go with this.

The first thing I would like to ask the minister is really a fairly simple question. This would relate to the line-by-line breakdown of the ministry' budget. Where in this budget will we find evidence that money is in fact moving from acute-care to community care?

Hon. P. Priddy: My staff is just looking for a particular piece of information, but I'd like to start, if the member will allow me, with a couple of comments on this. I think the point that the member raised is important; it's also a very challenging one. When you say to folks, "What's your key health care concern?" people say acute-care beds and emergency wait times. In some ways it's really hard to make that shift. I mean, you and I can make the shift, but it's hard to make a societal shift towards looking at what's happening in the community.

In my experience with the health authorities so far, at least with the ones I've worked with, they're working really hard to be able to enhance community services -- to enhance continuing care, home support and so on. I don't want to look at this as two separate pieces. This is supposed to be a seamless health care system, and in many ways these things are interdependent on each other. There are people in acute-care beds who don't need to be there and don't want to be there, but they don't have a more appropriate place to be, which is the community support part.

If we are really talking about being patient-centred, then we are talking about where the patient would want to be and where the patient is best-off to get the kind of care they need.

The first piece I would talk about is the fact that we are, as the member knows, doing a very comprehensive and significant continuing-care review, which will be reporting out to me in November. They're looking at where the gaps are, where it is working, and if it is working, why it is working. They're looking at all of the issues -- not just long term care facilities but home support and other supports for seniors in the community.

In terms of this year, where you might actually find at least some of the information . . . . I can't actually tell you in the line-by-line part, but I can tell you where it's reflected. Long term care facilities throughout the province will receive care-level adjustments to reflect acuity changes -- changes in the health challenges of people that support is being provided for. All the negotiated wage increases will be funded. Anyway, those are some of the ways that you would find additional money in the continuing-care system.

K. Whittred: I'm pleased that the minister agrees with me that this question is a challenge. I know it's a challenge, because I have read quite widely in this area. I guess my point is that at some point within the system we have to come to some level of understanding about how we're going to ask ourselves how we are doing. We have been in this transition now -- and I'm not being critical of the transition, necessarily; I'm just making a statement -- for a number of years. Closer to Home was introduced, I believe, in '91 or '92, so we are now several years into this switching of services.

There certainly is conventional wisdom in the community. People who go in for surgery know that they don't

[ Page 10474 ]

stay in hospital as long as they used to and that a community nurse may in fact call on them when they get home. Women who have babies know that they don't stay in hospital. Certainly people who have seniors in their family know that home care may call or that the physiotherapist or the occupational therapist may call or that the senior citizens may in fact go to the stroke club or to adult day care. Everybody knows that there is a wide variety of services.

What we don't know and what I can't find in the budget -- and this is my question -- is: where can this ministry show me that as we are cutting back . . . ? If we cutting back on acute-care services, where are we showing that that saving -- if there is some saving -- is going into the community? Alternatively, where can we see that there is in fact more money being put into the various community programs?

Hon. P. Priddy: The understanding I have from staff is that . . . . I'm not sure we can view this in the light of a cutback in acute-care services, but what health authorities and hospitals are doing in acute care is taking 5 percent of their administrative budget and putting that into community services. I can't point this out in the line-by-line, but I'm happy to give you a copy of this, member. For adult day services, which is all part of that continuum of support for seniors in the community, in the last year and a half or two there's been a $1.5 million increase for those kinds of services.

We're just checking for the home support ones, because I know that there has been an increase, and I'd like to be able to tell you what it is. As it relates to home support and money paid out by the Ministry of Health for home support services . . . . This is -- as I know the member knows, because she has spoken to it very well on a number of occasions -- the kind of support that is able to keep seniors in their home for a longer period of time, as they would wish to be. Over the last three to four years there has been a $67.5 million increase for home support.

K. Whittred: This wasn't quite the direction I intended to go right at this moment, but perhaps seeing as the minister is going there, I can follow. The minister mentioned the increase in home support. I wonder if you could tell me the increase -- how do I want to phrase this? -- in home care hours, which would be an indication of the number of patients who are being serviced. The second bit of information I would like is the number of patients, because that would give an indication of the acuity of illness.

Hon. P. Priddy: That I am able to do for you. In home support services over the last two years, it has gone from 7.2 million hours of service, if you will, to 7.7 million hours of service. The average number of hours of service per client over the last two years has gone from 16 to just over 19 hours of care per month. That's just for home support services, in the way that you and I would understand them. There are other statistics I could offer, should the member wish it at some stage, for home care nursing, community physiotherapy, etc.

K. Whittred: No, I don't want to get into a discussion today about a whole bunch of isolated statistics. I find that those are not very useful. What I would like, though, is . . . . We now know the increase in the number of home care hours. I would like to know, relatively speaking, how many patients are being served. Does that represent the same number of patients, an increased number of patients or fewer patients?

[2:45]

Hon. P. Priddy: If I can just combine two things for a moment and try and give you a sense from that, sometimes when we talk about . . . . I include myself in this. I use the phrases "home support" and "home care" interchangeably, and I probably shouldn't, because they're different. Home support is home support workers, and home care is nurses who come in. Having taught it, I should probably know better, but I have used those terms interchangeably. For home care, which is nursing, there are actually about 2,000 more people receiving home care nursing this year.

In home support the numbers of clients are down some, and that's because we're trying to address the issue of acuity, so while the number of clients is down, the amount of service they receive is up.

K. Whittred: I would like to follow that particular concept a little bit. I knew the answer to that; in fact, it was the same thing last year. There are more home support hours but fewer clients, which of course means that there is a higher acuity. What I find in the field is that the people who work in home support tell me over and over and over again that they are dealing with sicker and sicker clients.

I guess what I would like to know from the ministry is: where are the others going? I'm going to take an imaginary number. If there used to be 100 clients who were receiving home support, we now know that we have more hours, but we only have, say, 90 clients -- for the purposes of illustration. What has happened to the other ten?

Hon. P. Priddy: A couple of things are happening. There may be some seniors who were, for instance, receiving a visit once a week -- someone to do vacuuming for them, if you will. I know that many home support agencies that are making choices about their dollars are looking at the acuity of patients. It may be that people who received housekeeping services only are receiving, perhaps, less of that, or they may be receiving it in another kind of way. I think that's as a result of the choices that home support agencies are making, in terms of the best use of their dollars.

I think we see a drop in clients, in part for that reason. Some are receiving some support in day programs. They don't have the same need for a home support worker, if they have access to a day program. There are new day programs opening around the province this year again. Those are a couple of reasons why we might see the drop.

K. Whittred: While we're on the subject of home care, I would like to pursue, for a moment, the ministry's philosophy or participation in the plans or the suggestions of the federal government for a national home care program. I am wondering what the minister's feelings about this are. What role has British Columbia played, if any? Where can the minister see this going?

Hon. P. Priddy: I have read in the paper of the federal government's thoughts, at least, about a national home care or home support program. They have not said anything to the provinces that I'm aware of. This is at least a proposed strategy by the federal government. If I were asked about B.C.'s position on this, I think what I would say is that if the federal government were to return the $375 million that they've cut in health transfer payments, we could probably use it, as could every other province, in a way that most affects the people in our province.

It is somewhat unusual for the federal government to step in and start funding an individual health program when the delivery of programs is, quite rightly, historically in the purview of the provincial government. While I always welcome federal funding and would actually be pleased to have it back, it's very hard for me to envision how

[ Page 10475 ]

the federal government would run a national home support service unless they simply used a voucher system, which I don't support.

K. Whittred: Not, of course, being in the position of the minister . . . . I have had personal experience just recently with a family member from another province being ill in this province. It occurred to me at the time how absolutely nonsensical it was, in that of the services here, the only services that could be accessed were hospital services. It seems to me that it would make sense to have at least a reciprocal agreement with other provinces on some of the services that we call continuing care.

All of those, of course, fall outside the purview of the Canada Health Act, and therefore there are no agreements between provinces. Particularly in this day and age, when we talk about Closer to Home, families don't always live close to their loved ones. I guess I'm asking the minister to comment on that particular idea.

Hon. P. Priddy: The member, of course, is correct that there is no interprovincial agreement around anything that is outside of acute care, medicare, medical, Canada Health Act . . . . I'm always prepared to pursue any kind of arrangements with people. I'm not sure how the federal government would do it. But as the member may know, I have a personal interest in home support, because I taught that program at Douglas College for many years to home support workers. I have asked for that to be placed on the agenda of the federal minister's conference, which is in about six weeks now, I guess.

The challenge here, and I base this partly on the discussions I've heard from other provincial ministers around home care and partly on my experience around trying to get something like this to happen with child care federally, is that because the programs vary so much in terms of how people deliver them and the level of service they have . . . . As I say, I've put it on the agenda and am still prepared to pursue it, but I think that you would have difficulty getting all provinces interested in it, because the system is so disparate across the country. But I have asked to have it on the agenda, and we will be discussing it.

K. Whittred: Just an idea: it occurs to me that sometimes it's perhaps not a bad idea to start small. Perhaps simply an agreement with a neighbouring province, where probably the majority of situations are apt to come from, would be one way to start, rather than trying to get the whole piece of the puzzle and the entire country involved. That's just simply one idea.

I'd like to move on for a moment and speak about the community care licensing report that you alluded to earlier. This grew out of a couple of things, I guess, certainly not the least of which was the in-depth reporting in the articles featured in the Vancouver Sun last fall -- in September, I believe. I have the report here. I don't want to go through it line by line, but I thought we might zero in on a few things. I wonder if the minister could comment on some of these recommendations. First of all, the shift from child and adult licensing to residential and non-residential -- can the minister explain exactly how that will affect the licensing?

Hon. P. Priddy: I will say just before I begin this that these are recommendations we are still looking at. There are clearly a number that we'll be going ahead with and some that have problems. I think the rationale behind this -- not illogically -- is that if you divide between a residential and a day program, if you will, as opposed to between adult and children . . . .

I think most of us would agree that if you are in one place for 24 hours and you're already vulnerable -- which is what you're likely to be, or you wouldn't be in one of those facilities -- then your risk in a residential environment is greater, simply because you're in . . . . I'm not suggesting that it's anything about the facilities, but if you're a vulnerable person in one place with the same group of people for 24 hours, that's quite a different situation than being in a day program for six hours a day. So we can look at it that way.

When you divide it by adults and children, then you aren't able to take into account in the same way the difference between the risk in a 24-hour program and the risk in a five-hour program.

K. Whittred: One of the things that I have a bit of apprehensiveness about in terms of the licensing of all community care facilities is that it covers such a broad spectrum of facilities. It covers everything from residential homes for seniors -- residences, care centres -- to what are normally called group homes or, in fact, care centres for children. I wonder if the licensing would be more appropriate if this was broken down into smaller segments. I wonder what the minister's opinion of that would be.

Hon. P. Priddy: Let me clarify: broken down into smaller pieces that are more programmatically gathered or collated or whatever, or broken down and shared amongst ministries? Both those things have been suggested.

K. Whittred: I was thinking of breaking it down in terms of use. It seems to me that it's difficult to come up with appropriate licensing standards for a seniors facility and a children's care centre. They are two entirely different things. I'm curious as to why this has to include all those kinds of care centres in one licensing package.

[3:00]

Hon. P. Priddy: One of the points I would mention or one of the responses I might have for this is that . . . . I mean, can we look at that? Sure we can; I'm always happy to look at anything. So we haven't made our decisions about this yet. But I think that because there is often not exactly the same standard for a children's group home, or some place that's for little kids, as there is for a long term care facility where there are 35 people or however many people, there are some variances.

Primarily, what the Community Care Facilities Licensing Act has tried to focus on is their basic mandate, which has always been around health and safety. While I'm happy to look at smaller pieces -- and actually, I'll ask people to do that -- when you talk about health and safety issues, there may be some variances between one residential facility and another. But there is far more commonality than difference, if your focus -- which is what the Community Care Facilities Licensing Act is for -- is health and safety.

I think I'm going to regret saying this . . . . Does that always bother people when I say that?

Interjection.

Hon. P. Priddy: No? Oh, good. The other side of that question, then -- and it is a question I've asked every ministry I've been in, not only this one -- is: how do you ensure that there is responsibility for the programmatic safety? What is it that people are doing with people? It's not: "Are the fire exits

[ Page 10476 ]

there? Is there food in the fridge. Is there enough? Is it balanced, is it nutritious and all those kinds of things? And do people have their first aid certificate?" -- all of those things that affect health and safety. Rather, it's: "Who looks at what happens there?" I think that for me, as the minister in at least three ministries to date, that has always been the more significant question.

K. Whittred: Another of the recommendations, I guess, that more specifically applies simply to the seniors facility is perhaps what I was getting at in my last question: the creation of a single licensing category for multilevel facilities, to allow for aging in place. I wonder about these. Because these are still under review, I'm simply asking the minister to comment on some of these major recommendations.

Hon. P. Priddy: I think the member is quite correct. I think one of the inhibitions in this now is that the current licensing act doesn't allow us to support what I hope we all believe, and that is for people to age in place if that's what they choose to do. I mean, this is always about a person's choice. But it doesn't allow the same flexibility for aging in place around levels of acuity and so on. So it is one of the recommendations on the act, and it's one we look on favourably.

K. Whittred: I still have a little bit of trouble understanding . . . . How does this differ from the licensing of some other kind of community care facility? I don't quite see that.

Hon. P. Priddy: The difference currently -- and if I'm not helpful, then please come back; I know you will, because good teachers do that -- is that multilevel-care facilities are currently licensed under the Hospital Act, because they have a range of people with different acuity in their facilities. That is what makes the licensing different. It's because they're licensed under the Hospital Act differently than all those other facilities that would fall under the category of community care licensing.

What the report recommends is that it be done away with and that multilevel-care facilities come out from under the Hospital Act and be licensed in the same kinds of ways as other facilities are, which allows more flexibility. We support that.

K. Whittred: Now I'm getting even a little more confused. I think we're going in the opposite direction to where I thought we were going. So multilevel facilities were previously with, and at this time are still with, the Hospital Act. What about extended-care facilities, which are also multilevel? What will their licensing authority be?

Hon. P. Priddy: Extended-care facilities, which you refer to, are also under the Hospital Act. The report is actually silent on those. At this stage, I don't think there's been a recommendation to move them out from under the Hospital Act. The reason it makes sense for multilevel-care facilities is because there is such a huge range of people and sometimes ages, as much as I don't like that, and care needs in a multilevel-care facility -- which we should be moving to, by the way; I mean, there's no question that we should have them.

Whereas in extended-care facilities the range of acuity isn't the same. While the report stayed silent on it, if there are no changes, it would stay under the Hospital Act.

K. Whittred: I hear what the minister is saying, and I understand, I think. However, that is not really what I hear in the community. It's my understanding that the philosophy of this ministry is that all facilities are to be multilevel. This is the direction that the ministry is moving in. So that makes a discussion eventually, at some point down the road, about extended care somewhat redundant. There is only going to be one facility, so every facility is going to have a range.

The second thing that I hear in the community is that while theoretically these facilities do have a range in the real world, most of them are dealing with patients of greater and greater acuity. In other words, the individuals are sicker and sicker. So I guess the point I'm really getting at here is: are these facilities more hospital than they are residential? What is the definition we're putting on them? I think that particular point has a great deal to do with how we license them and what lens we are seeing them through. Perhaps the minister could just comment on that.

Hon. P. Priddy: I appreciate the member's comments about what she's hearing in her community. It is true that there is a very direct move towards . . . . When doing any construction or replacement -- renovation -- it is to multilevel. So if people are hearing that, they're hearing it absolutely correctly. What we've never had before is an ability for people to age in place. Whether it's more like a hospital or not, I'm not sure. The member may have had more experience than me, but I've been in a number of multilevel-care facilities.

What I see is not so much people that are necessarily more acute, although I see some of that, but people who are frailer. We're just all living longer. So what I see are people who are frailer but not necessarily more acute from a health perspective or from an illness perspective -- people who are frailer as they age.

It is correct: we are moving to multilevel. We're not building new extended-care facilities, although I don't want that to panic anyone, because some people use those phrases interchangeably -- extended-care facilities as you and I know them. But I don't necessarily think that multilevel-care facilities are like a hospital, so I wouldn't see a reason to change that designation. I would see a reason to keep them in the community and move them out of the Hospital Act, so they can maintain that flexibility.

K. Whittred: Thank you, through the Chair, to the minister for her remarks on that.

The last thing I'll ask about on this licensing report -- because it is at this point just a report, and perhaps next year will be the time to really get in and see how much of this has been implemented -- is the creation of a community care licensing board. I wonder if the minister could enlighten me a little bit about exactly who is going to be licensed. What kinds of agencies or services in the community would fall within this jurisdiction, which perhaps presently do not?

Hon. P. Priddy: There are some discussions going on currently with the community about this particular recommendation; it wasn't a particularly unanimous one. One of the things that I'm trying to do is have the community inform me better about what their views are on this before . . . . We've actually decided on no action whatsoever on this one; we've taken no position on it. Because, as I say, there is some difference of opinion about this in the community, we've gone back out to gain some of that perspective.

K. Whittred: I would like to pursue a little bit more about the numbers. I observed, I think, in last year's estimates -- and I will not go through that exercise in numbers again . . . . But what we're finding happening in a number of areas is that

[ Page 10477 ]

new residential facilities are opening up -- I know this has happened in North Vancouver -- but subsequently older ones are closing down. What's happened is that the net numbers are actually slightly lower than they were before. With residential care centres in some communities, including my own . . . . As new residential care facilities open up, others are closing, and what you end up with is a net loss of beds. So I'm wondering: what is the number of long term care beds that are available? Does this represent an increase, is it the same or is it a decrease over last year?

[3:15]

Hon. P. Priddy: Member -- and I don't know if you want both of these -- if you combine the number of residential beds, which is 16,500, with 8,000 extended-care beds, it's up about 1 percent year over year for '97-98.

K. Whittred: Following up on that question, one of the directions I followed in last year's estimates was to try to get a sense of where the ministry was going. I would like to ask the minister where the ministry would like to be, say, in two or three or four years with this type of care. Is the ministry planning on having more long term care beds? Is the ministry planning on more home care? Is it to be a combination of the two, and how are we going to get there?

Hon. P. Priddy: I think that depends on a couple of factors. One of them is that a large part of this will be determined by the continuing-care review that is going on, looking at all of those pieces: home support, home care, multilevel-care beds, extended care, all of the things that support primarily seniors or elders in their communities. In some part, if you were to ask me where I'd like to be in three or four years' time, I would tell you that part of that is dependent upon that, certainly from the ministry's planning perspective.

If you ask me where I'd like to be, as the minister, in four or five years' time, I think I would tell you a couple of things. One of them is that I want to ensure that . . . if we need more beds, then we need more beds -- and I don't doubt for a minute that we do; and, when we're doing renovations and conversions, we're converting into multilevel-care beds, so that while the numbers haven't grown substantially, the flexibility of the beds available has -- every time there's a renovation, it's renovated as multilevel.

Second, I would like to be able to find some way to -- to shift the priorities of the public is a bit grandiose . . . . I would like to be able to have people understand that what we do in the community for seniors or for people with multiple health needs does truly impact the acute-care system.

I mean, if you go out and do a focus group -- certainly in my health community and perhaps in yours as well, hon. member -- people will say: "If you could find some more money from somewhere, put it into hospital beds; put it into here." I don't know if everybody yet understands that if we don't put in the money and find the resources to refocus on community care, not only will we be having seniors living in environments, or in ways, or in beds that are not the best for them, but secondly, we will be affecting the acute-care system.

Those people will be living in acute-care beds, and there are lots of those around the province currently.

First, I'd like to see the shift, if you will, in the community around thinking about what it means to have good, quality supports in the community for people. Second, I would like to see additional bed resources and day-program resources, because for many people, a day program means they probably can keep staying in their homes. They may not be able to do it 24 hours a day, but if there's a day program to go to and there are generally two meals a day, then people are going to be able to stay longer in their homes. I want to see more of those kinds of supports so that seniors get to stay in their community.

If seniors don't get to stay in their homes -- and I'm not telling you anything that you don't know; I'm just needing to say it, hon. member -- and in their communities, my kids and my grandchildren miss out on things, because a lot of people here don't have grandparents around. We're all from somewhere else. Well, not all of us, but lots of us are from somewhere else. If the only seniors they ever see are in an extended-care facility, they never get to learn the strength and wisdom of and hear the stories from seniors.

For me, if you ask, in four or five years I want to see a more enhanced community-based system, looking at hospice, at adult day programs and at home sharing, which has worked for lots of seniors for a period of time -- being able to say what best meets the care needs of this individual. It would be a much broader range than: "There are 30 extended-care beds, or you're at home and somebody comes once a week; those are your choices." I guess that's part of where I would want to be in that period of time.

K. Whittred: I'm just trying to think of where to go next here. The minister alluded to things like adult day care. I wonder if I could ask the minister: what has been the increase in adult day programs in the past year?

Hon. P. Priddy: I cannot tell you, actually, how many day programs there are in the province. I mean, I could tell you that; I can find it for you. But the number of client-days of service has gone up 6,000 to 7,000 in the last year. The number of agencies actually operating day programs has gone from 89 to 91 -- not a big increase. In three and a half years it went from 81 to 91. The annual expenditure is up $1 million. But if you wanted a list of day care programs in the province, we could get you that; I don't have it with me.

K. Whittred: I would like to return just for a moment to some issues surrounding the closing of the old personal care homes. That is an issue that has come across my desk. I would like to ask the minister: does the minister know the number of beds that have been lost due to the closing of these homes, which are no longer . . . ? I realize why they're being closed: they're no longer adequate under the multilevel guidelines. The second part of that is: are these beds in fact being replaced?

Hon. P. Priddy: The personal care homes, which, as the member knows, we haven't used at all for the last couple of years, have indeed closed. A number of those people -- those elders -- have gone into multilevel-care facilities. Some of those folks -- I'm not sure about the number, and I'm not trying to suggest it's a great number -- are actually at home with home support, because they really just need the support around them to keep the daily living things going. So some of those people are at home, but many of them went into multilevel-care facilities.

K. Whittred: We previously discussed today the increasing acuity of residents in care homes. Again, something has been brought to my attention by a number of people. Actually, I think this was more related to extended-care homes. Families that feel that their family members are not being adequately

[ Page 10478 ]

cared for . . . . They feel very strongly that there simply is not enough staff in the institution to care for their family members.

As a result, they are in fact hiring private home care to go in and look after their family members in the extended-care facility. I have discovered that this is . . . . While I wouldn't call it endemic throughout the system, it is becoming fairly common. Again, I feel that most people expect, when you're in one of our facilities -- whether it's a multilevel or an extended-care facility -- that you wouldn't have to further go out and hire your own private home support worker to come into the facility to give a service such as bathing. Meals was another one that I had heard about. I wonder if the minister can comment.

Hon. P. Priddy: I think there are two factors to this. One of them is yes, there are people who hire staff to go in. My information from folks is that sometimes someone who doesn't live in the community -- who may live however far away, not even in the same city . . . . Someone who can't get in to see their family member on a regular basis may want them to have a bit of additional support or some extra things. Staff, while providing good-quality health care, may not be able to do all of the extra things that you and I might like done for an elder that we love. Yes, there is some of that going on.

I certainly wouldn't . . . . There's been a little bit of an increase, although not a significant one, and it certainly isn't a common activity.

I'm sure there are other ones, as well, but the stories I've heard about this have more to do with wanting to provide some of those extra things that you might want your mom, your dad, your grandmother or your grandfather to have in a facility where you're not paying additional dollars yourself. It isn't about quality health care, but it may be about additional attention, an additional outing or things like that.

[3:30]

K. Whittred: I think one of the key phrases that was used there was "health care." When we're talking about facilities -- multilevel facilities, extended-care facilities -- in my mind I separate care from health care. Health is a procedure that might be used; care is simply those everyday tasks of bathing, feeding, changing the bed linen and those sorts of things. Those seem to be the areas that I certainly get the most information about -- that there simply are not enough staff in the facility to attend to those kinds of tasks.

What I am told over and over again by family members is that if the family isn't there to attend on a pretty regular basis, in fact their family member simply goes unattended. Perhaps that can just be for the minister's information.

Another thing I want to bring up in this area is the issue of resident councils. This is something that I have been approached about by a variety of people. I'm told -- and I must confess, I do not have a wide knowledge of this myself -- that some facilities have resident councils, and some do not. I'm sorry. I'm using the wrong expression; it's family councils. Does the ministry have any idea how many extended-care and multilevel facilities do have family councils? If so, what is their mandate?

Hon. P. Priddy: We don't have a list, but a best estimate by staff is probably about two-thirds, and the rest are working on it. Of course, as well as the family councils, we want to ensure that there are resident councils. In many facilities, particularly multilevel-care facilities, residents are more than able to make their wishes known.

I wonder if I might go back for a moment to an earlier comment that the member made. If the member is hearing from people who say that if they're not there, their family member will not have a chance to eat, I would be really grateful to know which facilities those are -- if the member is comfortable doing this and it's not breaking a confidence. I don't have to know a name. That concerns me, and I would want to ensure that we take action on that.

I now ask leave to make an introduction.

Leave granted.

Hon. P. Priddy: In the gallery today is Larry Odegard. Larry is the president of the Health Association of British Columbia, which means that he is working with all of the health care authorities throughout the province -- community health councils and regional health boards -- in a variety of ways around education and is assisting those boards in coming together in the fine way they have. I'd like the House to make him welcome.

K. Whittred: I said at the beginning of my remarks that this year I intend to be very brief and that my main goal is to try to get a little bit of an idea of how the government is doing in terms of the old way of doing things and moving toward more community care. I also wanted to comment that last year in estimates I was very critical of the ministry for not having a plan, as I saw it. This year there has at least been some movement toward this, with the community care plan and looking into community care. I don't know whether last year's estimates had anything to do with that or not, but one would like to think that maybe they did.

I would like to ask the minister if she could simply comment at this time on the questions that are being asked about the continuing care system and what we could hopefully look for next year.

Hon. P. Priddy: I have no doubt whatsoever that the hon. member for North Vancouver-Lonsdale, in estimates, had an effect on the plan. With such articulate MLAs, the opposition raises very good points.

I can give you a little bit of a sense, if you'd like, of some of the areas -- if I'm interpreting your questions correctly -- that people will be looking at. They're obviously looking at all the components of the system of continuing care: home support, residential facilities, community home care nursing, rehab programs, assessment treatment programs, group homes, adult day care, meal programs, family care homes, etc. It is the whole spectrum of services, and that's just to give an overview.

The questions they'll be asking in general are to ensure that we have a comprehensive overview of how that can be a seamless system for people. In my experience -- certainly in my own family experience, as well as working with home support workers -- it's often really hard if you don't have a system that is all attached together. Somebody is in an adult day program, and suddenly they need Meals on Wheels. It's a whole shift. You have to find another agency and talk to them, and then if you need some more home support, then you've got to go somewhere else.

To look at how we make sure that moves smoothly once you're into the system so you don't have to keep going back in and out for every service that you need, what we'll be doing is assessing the strengths and the weaknesses and any other sort of ramifications, if you will, of

[ Page 10479 ]

current policy, current services, of their management and the delivery system of those. Undoubtedly there can be changes made for the better.

One of the questions that the review will be asking is: what does it look like at other places, and where are the places that seem to be really successful at this? What are they doing that we might be able to do to do our job better? The member was getting at this a while ago, and I certainly didn't give her a vision, but I do have some thoughts about where I'd like to see this go. I actually have a vision -- some people call it a vision; I happen to call it the dream -- so when somebody says: "Other than all those problems you've got out there, what do you want it to look like?

What's the dream, and what are the pieces you have to put together for that . . . ? " While doing all of that and identifying the necessary actions including looking at the pieces, certainly people will be looking at costing. What works for different types of patients, and what's most cost-effective? I think there are ways that we can be more cost-effective and probably better meet the needs of lots of people. I would suggest that someone being in a acute-care bed in a hospital simply because they don't have a place to be in the community is neither cost-efficient nor good for the patient.

So those are some of the sort of larger questions that people will be asking in the review.

K. Whittred: I don't intend to spend a lot of time on this -- other than to give the minister an opportunity to tell us what her vision is for the future -- because it's very difficult to evaluate something that hasn't taken place yet. I'm very pleased about it.

One question I would like to ask . . . . I'm a little bit disappointed that the terms of reference for this particular review are for the entire continuing-care system. Well, I guess disappointed isn't quite the right word; I'm a little bit concerned about focus. The clients of the continuing-care system are primarily seniors, elders. I'm well aware that there are young people, but in terms of numbers, there are relatively few.

I think that I personally would be a little bit happier if the terms of reference for this had more focus on the elder population, because I'm not sure that their needs and the needs of the young people who access the system are necessarily the same. I hope that when this is completed -- I think it's next October that it reports -- we won't be disappointed and find that the terms of reference are too broad to accomplish what it should accomplish.

Now, I want to move on and look at seniors issues in the more general context. I wonder if this would be a good time for some of my colleagues who have questions about long-term care to take a turn, and then I'll return to the seniors.

R. Thorpe: In dealing with long-term care and facilities, I am a little bit confused with respect to the conflicting reports we've had about the availability of and the increase in facilities. We've had newspaper reports that the health region has increased the number of long-term beds by 60. I wonder if the minister could confirm or deny that.

Hon. P. Priddy: We are aware of some of the push that you're feeling. I'm assuming you're talking about your region around long-term care. I believe that the people in the region who are working on this were told that after the budget review had taken place, we would be able to talk more with you again.

R. Thorpe: I have a letter, dated July 10, to one of my constituents from the Ministry of Health and Ministry Responsible for Seniors. It's signed by the regional director for the Fraser Valley, Thompson, Okanagan and Kootenays. "The ministry has recently approved funding for 60 new long term care beds in the Okanagan-Similkameen health region, which includes Penticton." Has that announcement been made, or has that announcement not been made?

Hon. P. Priddy: No, that announcement has not been made.

R. Thorpe: Perhaps the minister would want . . . . This is the letter dated July 10, 1998, and I believe this must be the ministry reference number up here in the corner: 1 201724. This is a serious issue in our region and in our community, as I've talked about at length last week, with respect to the disproportionate number of seniors, on provincial averages. Why, then, would ministry officials be writing to constituents and telling them it has taken place?

Hon. P. Priddy: Perhaps it was a staff person who has been particularly moved by the arguments made by the member and was casting forward into the future a bit to give hope and encouragement to the people that are writing. But there has been no official announcement made.

[3:45]

R. Thorpe: Could the minister advise what planning processes are in place to deal with the known deficiency in long term care facilities in the South Okanagan?

Hon. P. Priddy: In two ways: one in a longer-term way, which is the continuing-care review that's currently going on, and I think we actually canvassed that earlier in estimates; and secondly, by working not only with the local health authority but with our own regional staff, to be able to look at how acute the current situation is in the South Okanagan and to be able to take any actions that are possible within the fiscal framework to address it.

R. Thorpe: So is there an aggressive plan being pursued at this point in time to deal with this issue in the South Okanagan? Or is the minister saying that the province has fiscal constraints and that's why we're not doing a plan?

Hon. P. Priddy: I'm actually saying both. Yes, there is what I think is a pretty clear and aggressive sort of initiative underway to address the issues in the South Okanagan. And are there always fiscal constraints? Of course there are.

R. Thorpe: When will the plan be completed that addresses this significant shortfall in the South Okanagan?

Hon. P. Priddy: I think the member and the people who live in the South Okanagan will hear part of that quite soon, and they may not hear part of it until the end of the continuing-care review. But they will hear part of it quite early.

R. Thorpe: I suppose what people are going to hear shortly is what's already been announced in this July 10 letter. And what we're going to continue to do is take photo ops and do press releases to tell people that things are better, when in fact people know they're not better. I wish this government would stop playing with people's lives through photo ops and announcements, and deal with the issues. In fact, just for the record, let me read from the July 1998 board meeting of the

[ Page 10480 ]

Okanagan-Similkameen health region. They're saying: "The growing numbers of patients waiting for placement in long term care facilities caused overflow conditions in acute facilities. These volumes and extra costs continue into the first two periods of 1998-99 and are showing no easing for the third period." That resulted in a $1.8 million deficit.

In closing, I would just like the minister to comment. What are we doing to seriously address this issue, knowing that the costs are racking up over here on the acute side, while we are apparently doing very little or nothing on this side? Then we have people suffering in long-term and acute care, waiting lists growing, and people can't get into long-term care. How are we going to break this roadblock in the South Okanagan?

Hon. P. Priddy: With the greatest respect to the member, I don't think anybody is looking to do photo opportunities. I would suggest that the information that was given to the South Okanagan and the information that was given to the health staff is that a determination would be made about the beds that are referred to in that letter after the budgets have been reviewed. So, in fact, in our office, there has been no determination made about that. As I said, we were very clear with both our staff and people in the South Okanagan that that's when the final determination would be made.

I don't think this is actually about some decision and it's out the door and we're waiting for some kind of photo opportunity later on. We've certainly heard about the needs and heard clearly, and we will make this decision. But the final decision will be made after the budget review.

In regards to the South Okanagan in general, I think that we've canvassed this before as well, hon. Chair. We are working with people in that region; we are identifying what the needs are; we are identifying what the fiscal resources might be to meet those needs; we are working with the health authorities and our staff there in order to be able to do that. There are other areas in the province that have, if not the same, then similar needs, perhaps, around additional extended-care beds. So I don't know that there's a plan for only the South Okanagan; there's other areas that are feeling this kind of push as well.

But part of that plan will be revealed shortly, and part of it will take longer.

R. Thorpe: I would hope that the South Okanagan is only a part of the overall plan. Therefore I would ask the minister: would it be possible after estimates to get a copy of that plan?

Hon. P. Priddy: It would not be possible after estimates, because, as I've said, the final determinations about those will be made after the budgets are reviewed, which isn't the same as the end of estimates. But yes, that information can be made available to you as soon as it's finished.

I. Chong: As a member who represents a constituency that has a significant number of seniors, and as one of the capital region MLAs . . . . We have a huge demand for long term care facilities. I recognize that the 1994 regional long term care facility plan at that time recommended a five-year plan for 726 new beds. As I stated earlier, with the demand for long term care facilities, that assessment in 1994 has changed in the last few years. In January 1996, as I understand it, there were 683 people in the community waiting for facility placement.

Nine or ten months later, in October 1996, the number of people waiting in the community had increased to 976. Those are the latest statistics I have. I don't know what the numbers have grown to by 1997 and 1998. I imagine they've gone up substantially. The concern that I have for the capital region, as the member for Okanagan-Penticton has for his area, is that we don't seem to have a handle on how to deal with the increasing demand for long term care facilities. If we haven't identified the problem, then we cannot identify the budget resources that are going to be necessary.

My question to the minister is: can she advise us where we are in this region in terms of the number of people in the community waiting for facility placement? What short-term solutions versus long-term solutions are being looked at -- the short term being in the next two years the versus the long term being in the next five years? Perhaps a facility is being looked at to be renovated -- or a new facility being built. Can the minister advise what is happening in the capital region now?

Hon. P. Priddy: The member is asking about the next two years. For one thing, once the continuing-care review is finished and reported to me, which I think will be in late November, we will have a much better provincial sense of how we can approach this differently. I want to stop for a minute and say that while a significant amount of this is about how there aren't enough beds -- I understand that -- part of the continuing-care review will also talk about . . . . Some people, with a different kind of support, might not be on that list.

There are other kinds of support, if we could get those in place, that would enable people to stay in their own homes. Or they might delay choosing another kind of living option for two or three years. That's why the continuing-care review is so important. It's not only to go and look at beds -- it will do those kinds of things as well -- but it's also to look to see if beds are the only solution. And I don't think they are.

Secondly, in the capital region area we are currently having discussions about a couple of significant initiatives that will, I think, have some impact in the short term.

Thirdly, it's always a real challenge for health authorities, because they and we are trying to get Royal Jubilee done and the Vancouver cancer clinic done. When you look at capital resources available in the region, it's often where you do it and which you do first if you can't do them all. But I think there are a couple of significant initiatives underway, which will make quite a difference.

I. Chong: I appreciate the minister trying to provide an answer when I know it's a difficult one to provide. Nonetheless, it's not an issue that has evolved over just the last few years. I believe that the capital regional district health committee -- the capital regional health district at the time, before it was amalgamated -- had identified a number of problems and had been trying to deal with this. When the capital health region was formed, this information was passed on, but in the interim, with all the changes in administration, etc., I feel that perhaps there hasn't been enough focus placed on this.

Particularly here in the Victoria area, every day there is an increasing demand. The report that was issued in November of 1996 through CRD health was called "Long-Term Care Facility Plan, 1997 to 2001" -- a four-year plan, I guess.

Can the minister advise me whether that plan is to be used in the review or whether that particular plan is no longer valid. If in fact it is going to be used, where are we with some of those recommendations in that plan? Can the minister at least give me some update about whether the work that was done in this plan is still vital and significant in the review that's going to be taking place?

Hon. P. Priddy: Yes, we will be using that. It's a piece of a much larger piece, but some of that information and data have

[ Page 10481 ]

been gathered. Not all of the pieces we're looking at in the continuing-care review are contained in that report, but certainly we will be using information from that report around projections for beds and so on. We will still seek other information from the capital region, but we will use that as well.

I. Chong: In the 1996 plan there was a

schedule of 13 projects that were to be dealt with. Does the minister have a list of those 13 projects? Have any of those been deleted, amended or otherwise altered? I believe that those projects were estimated to cost approximately $82 million -- roughly $16.4 million per year. They would add a significant number of beds. At this point, I'm not clear on whether those 13 projects are to be proceeded with or if they're also being held up, pending the results of this review.

[4:00]

Hon. P. Priddy: I don't actually have the list in front of me, but at this time I couldn't comment on which ones are going ahead. If you stay tuned and hang in with me for a month or so, I could probably give you an update.

I. Chong: I will hang in for that extra month or two, because I very much would like to get an update on where those lists are. With that, perhaps the minister will also be able to provide an idea as to whether any funds have been committed in terms of a planning stage. All too often, whether it's in hospitals or in schools, we find that funds are sometimes committed towards planning. That's a good thing. The difficulty, though, is that once the planning funds are committed, there appears to be a huge time delay before a project is undertaken.

Obviously, as an MLA I get questioned: "Well, if the funds were committed to planning, you would think that thereafter the project would ensue." That's doesn't always happen. If funds have been committed to a planning stage, even a year or two ago, it would be helpful to know, to at least have an idea, where we are with those -- particularly with the capital region area that I represent.

Hon. P. Priddy: I don't have it with me, but I'd be happy to do that. As a Surrey school trustee, we've always made that argument -- not always successfully, by the way, member -- that projects should come in envelopes. You get planning this year, and you get construction the next, and so on. You're right -- it doesn't always work like that, and it's most frequently for fiscal reasons, although sometimes it's for local reasons. But I'll certainly let you know what stage yours are at.

K. Whittred: The issue that was raised by my colleague from Okanagan-Penticton is one that I did not raise this year. I might just point out to the minister that the problem of long term care waiting lists exists; it has not gone away. The waiting list for long-term care continues to be about 18 months, I believe. In many regions of the province -- in fact, in most regions -- the problem continues of acute-care beds being used by long term care patients. In the interests of brevity, I did not address this issue -- and also because there is some attempt to address the issue in the report.

All I would add at this time, hon. Chair, is that while I am pleased that the ministry has named a commission to look into these issues, I hope that we see action on this very quickly.

[W. Hartley in the chair.]

I would now like to move on and look at just a few things that basically arise out of the office of seniors per se as opposed to continuing care. Perhaps as a word of introduction, I could point out that for two years in a row I have been prepared to respond to a ministerial statement ushering in Seniors Week. I see that we have the former Health minister in the House as well as the current one, and on neither occasion has there been a ministerial statement about Seniors Week. We have had ministerial statements about marmots, and we've had ministerial statements about highland dress, but never about seniors.

I just want to point that out and hope that this is not reflective of the status that is given to seniors by the ministry. I cannot help but note that every other delegated week is always ushered in by some statement or another.

Something that I would like to pursue for a few moments is the whole area of caregivers and caregiver respite. Nothing ever changes in this very much; I think the problem continues. The first question I would like to address is: within the ministry, is any attention being given to . . . ? Or are any programs being pursued that will take into account the financial position of caregivers? I'm thinking particularly of women, for example, who may take a leave of absence from their job to look after an ailing parent or relative.

They may fall behind in their pension, and therefore they will suffer the long-term consequences for that particular task of caregiving. Over and over, it is brought to my attention that while people very much support the whole concept of Closer to Home and so on, it does have some very serious financial repercussions on other family members. I am well aware that this is a multifaceted kind of question, as most questions in this area are. Perhaps the minister could respond.

Hon. P. Priddy: Thank you, hon. Chair, and welcome.

To the member, around the earlier comment you made about the ministerial statement: point taken. Next year you will hear an eloquent one. If we can have marmots, we can have elders, I would hope.

Interjection.

Hon. P. Priddy: Or elder marmots; I don't know which.

Around caregiver support, I know that's an interest the member has. Is there a new initiative underway? No, although there is a report, "For I and Mine," which is under review and which we may take some . . . . I think there will be some lessons for us from that. But if you're asking if there are new financial initiatives, the answer is no, although, as I'm sure the member knows, we do provide home support workers to provide respite hours for caregivers of seniors. We also provide residential beds for care providers who need to be away for a few days and need to have some support for the person in their family.

K. Whittred: Yes, I'm aware that there are respite hours. I was more curious to know whether or not, through the . . . . I know there's an interministry committee, and I know that it even meets from time to time. I don't know whether it ever actually puts forth proposals, or what not. I'm thinking more in terms of initiatives that may originate from your office or from the office for seniors to the Ministry of Finance, for example, that would put into place some initiatives that may allow for caregivers who are in a position of, say, losing pension benefits, some sort of program to continue with them.

There are a whole variety of things that might be done. I'm looking for any kind of channel or mechanism within the government where these issues may be pursued.

Hon. P. Priddy: I'm not aware at this time of any of those initiatives going from our office to the interministry committee

[ Page 10482 ]

or the Minister of Finance. But I will go back and check with that committee about whether any of those are things they might be working on. I think this falls into the same category as looking at what support you can offer to people who are able to choose to stay home with children as well. The ideas suggested often become very similar. It's about having someone who's dependent on you and about continuing to pay into a pension plan, or whatever that might look like. I'm not aware of any extensive work that's been done on it, but I am prepared to have a look at that.

K. Whittred: The minister is quite right. It would be similar to the kinds of things that have been introduced, for example, for women who take time out of the workforce to have children. The mechanisms are there for them to continue with their pension without penalty. However, those mechanisms do not exist for a woman -- who, by the way, would probably be much older -- who is taking time off to caregive an aging family member and can therefore suffer some very significant losses. That may be something that the office for seniors or the minister might want to take into consideration.

I wonder if I could inquire about the particular status of adult guardianship legislation. I get many calls about this, and I would like to know exactly where it's at.

Hon. P. Priddy: I don't know if the member canvassed adult guardianship with the Attorney General, but adult guardianship legislation is under the Attorney General ministry.

K. Whittred: Well, yes, I know it's under the Attorney General's ministry. I do believe, though, that the office for seniors has published some information on it. Again, I sort of get back to the point that came up last year: the whole office for seniors is a multidisciplinary office. I believe that we might expect a response from the ministry, certainly at least on a surface level, to a simple question such as: what is the status of it? All I want to know is: is it in effect or not?

Hon. P. Priddy: I'm sorry, I wasn't trying to dodge the question; I'm just always careful with other people's legislation. I think most people who know me know that I was involved with this before government, so I am actually very supportive of the adult guardianship legislation. My understanding of the current status -- again, the legislation belongs to the Attorney General -- is that the legislation has not yet been proclaimed and therefore is not in force, although many people are signing representational agreements anyway.

K. Whittred: That is my understanding as well, and that is part of the reason that I was asking this, in that I do get quite a few calls about it. I am curious. If this legislation has not been proclaimed . . . . There are organizations out there that are holding seminars on how to use it. They are in fact faxing around copies of representational agreements. I have had calls from lawyers who don't know exactly what to do with it. I am wondering what this minister, who is responsible for seniors, does about people who are using this agreement when it in fact is not law.

[4:15]

Hon. P. Priddy: We have been in close contact with the Attorney General's ministry -- staff and at my level -- about the movement forward of the proclamation of the guardianship legislation. I know that there are many people who are signing representational agreements. I think that in most cases those representational agreements would be acknowledged, but the member would be correct if she was to state that without it being proclaimed, if somebody chose to challenge that, then there probably would be a difficulty. While some people are doing representational agreements, and they're being acknowledged, I think that without proclamation it would be difficult if someone challenged them.

K. Whittred: I will now move on to something near and dear to my heart, which is seniors housing. Last year when I approached this, I was told that housing also does not fall under this ministry. Later I was also told by the Housing minister that seniors housing didn't fall under his ministry. Of course, I wondered where it did fall. I'm going to ask the questions again anyway, even though I may in fact be told the same thing.

The reason I think this is the appropriate place to be asking questions is that the kind of seniors housing we're talking about goes a little bit beyond regular housing into, a tiny bit, the element of protection, or what we call assisted living. I wonder if the minister can tell me if there has been any action on this front in the past year.

Hon. P. Priddy: I won't tell you it's under the Minister of Housing. How's that? I did with the Attorney General because other people's legislation makes me a touch cautious. But there are lots of examples where it is an interministerial responsibility. I don't think any of us should say, "Excuse me; it's my colleague's down the road," except when you have something that you think you shouldn't be tripping down, as in legislation.

Actually, there is a planning committee currently underway with the Ministry of Municipal Affairs, looking at supportive housing for seniors. We have, I think, talked to almost every municipality around the province. I mean, this has got lots of partners in it: the office for seniors, the Ministries of Housing and Municipal Affairs and individual municipalities, which are often the determiners of how we organize housing in individual communities. We've done the literature review and the planning with people, and so on. It's not quite ready yet, but we think that that particular report . . . .

As a matter of fact, I shared this with my provincial and federal colleagues the last time we got together. There's actually a lot of interest in this across the country. I think everybody would recognize what we have done around supportive housing for seniors. There are several seniors' co-op residences in my constituency, but in a more comprehensive way we haven't done the kind of work that's necessary to look at supportive housing for seniors.

So there is a planning process underway -- consultation with all the municipalities, working with Municipal Affairs, working with Housing. As soon as that planning is finished, we'll be able to have the strategies that help us say to a municipality: "If you do this, then we can draw health care from here." Even in supportive housing, there may be some health needs for people. We'll be able to say to the Minister of Housing: "Well, if you've got some actual extra dollars for supportive housing, we can use those over here." It will help us develop those strategies. I appreciate the member's comments. There is planning underway.

K. Whittred: I wonder if the minister could tell me what the difference is between supportive housing and residential care.

Hon. P. Priddy: As I get older, I can't remember quite as long a list, so I will refer to my friend and partner and staff person here on the left if I run short on my list.

[ Page 10483 ]

Supportive senior housing differs from residential care or extended-care residential care. For one thing, there are individual rooms with a lock on the door. They're not licensed. There is communal dining, in terms of the need to sometimes really encourage people out of the social isolation that they may have been in. There is 24-hour call for people who need the support -- there's no actual health care on site -- and there is a common social area as well.

K. Whittred: The minister spoke of a housing strategy. I wonder if the minister could tell me: when is this strategy to be announced, and what could we expect as the follow-up to that strategy?

Hon. P. Priddy: I'll just go back for a moment, member, if you don't mind, to add one point on my list that I didn't remember. If you look at a supported-housing model, some people would refer to that -- and I think quite fairly -- as almost a consumer protection model. I mean, people have a place to be, and it's safe and so on, but there are other kinds of support there for them. In a residential or extended-care facility, it's very much a care model -- a health care or care kind of model --

whereas this is much more independent and much more about some consumer protection.

To move on to your comment about when you can expect to see a strategy, we should have the results by fall. It would be in time to be in cooperation with the results of the continuing-care strategy, because I don't think we'd want to have this continuing-care strategy, as wonderful or whatever as it might be, and then another strategy out there. Not having these two linked together makes no sense whatsoever. So it's timed to be in sync with the community care review. Then we would work with both Municipal Affairs and Housing to present a strategy resulting from that.

Some of that may take some resources, but some of it may not. I think it's much more about a strategy that particularly talks with municipalities about how they can do that in a way that fits in their community and doesn't go against any of the housing principles that many communities hold. So it may require some resources, but I think it's just going to require pulling people together and saying: "Yeah, we can do the work, but we'll have to do it together." On the details of the strategy, I'd obviously have to report to you after those reports are in. But I would expect to see a strategy within a couple of months after that.

K. Whittred: With that, hon. Chair, I am going to conclude my remarks. I said initially that I was going to be brief. I haven't really gotten into half the things that I have available to me.

I would like to conclude with just a couple of observations. One is that I am very pleased that this year, in this general area of continuing care and seniors, we do have the government committed to a review of continuing care and a supported-housing strategy. Last year in estimates, neither of those things was in place. This year, of course, it's a little awkward to try to question those two things, because we don't know what the outcome will be. I look forward to next year, when we can really determine what the government has in mind. So with those remarks, I will conclude and turn it over to my colleague.

L. Stephens: I'm happy to participate in the Ministry of Health estimates. I'm going to be talking about women's issues. During the Women's Equality estimates debates, there were a number of areas that overlapped. Women's Equality is responsible for a broad-ranging area of women's health, but the Ministry of Health actually delivers a lot of the programs. Some of those programs are what I want to talk about today.

The provincial health officer's annual report of 1995 did a separate

section on women's health, and he identified a number of areas that he felt needed to be addressed to support women-centred health care. I know the minister has within her ministry a women's health bureau and also the Minister's Advisory Council on Women's Health. Perhaps I'll start by asking her whether or not there have been some decisions taken around the report from the provincial health officer.

Perhaps just to refresh the minister's memory, it talked about the overall health status, living and working conditions of women, violence, substance abuse, mental health, reproductive health and chronic disease. I know there are a number of issues and ongoing strategies, particularly around the new health care, which we'll talk about a little later a bit more fully, and also the provincial HIV/AIDS program, which we'll talk about later on as well. For now, I'd like the minister to comment on this particular report -- how significant it has been for her ministry and what she sees happening as a result of this report.

We did a workshop with the Health Association of British Columbia, regional health authorities and the women's advisory council to the ministry, because we wanted health authorities to have a sense of how women look at health care. It's not a better way; it's not a worse way. It's just a different way, sometimes, than our male counterparts. We did quite a good workshop with all the health authority representatives on what the issues are that women see differently in the health care system, how we can make this more women-focused and what the particular services are. There are some that are of particular concern to women.

[4:30]

[ Page 10484 ]

a language and in a way that you're sure is going to be accurately interpreted. That's a piece of work that some health authorities have done, but I don't think we've done it in the same way throughout the province. That is one of the pieces where I personally think -- maybe it's where I come from -- that there's more work to be done.

The other piece is around aboriginal women. I guess you could say this around aboriginal health in general. Some health authorities have a really good understanding of what aboriginal health care might mean, different than what it means to others. In systems that are quite matriarchal, it is women who have the responsibility and are often the healers in those communities. It is important for health authorities to understand it from a woman healer's perspective as well as from the perspective of a woman who is part of a family collective.

We have actually written to the health authorities of B.C. and are working with aboriginal groups to be able to make sure that there's a women's perspective there as well.

There are parts of the mental health plan that are going on as well, but I understand that you'll canvass that separately. Well, I'll sit down and let you ask your next question.

Hon. P. Priddy: There are actually some fine initiatives going on. You know, as soon as those words are out of your mouth, you always acknowledge: "And we can do better." But there are, I think, some good initiatives going on.

Let me start close to home for you and me and then move out a bit from that, if I might. Certainly for the South Asian community, particularly for Punjabi- and Hindi-speaking people, we do our health brochures in a variety of languages. Those aren't the only two. We have done some columns in the South Asian papers -- I don't think we've done one yet in the Chinese papers -- around health care issues that are of particular concern and maybe even of additional concern in the South Asian community. Let me use two as examples.

One is the issue of screening mammography. We know that a very low percentage of South Asian women have screening mammographies done. Now, the upside to that for older women is that they also have a much lower incidence of breast cancer than we do. On the other hand, by the time there are second-generation South Asian women, they won't, because we know that a lot of this is around diet and environment. So as we see second-generation women, they really need to be getting in for mammographies, because their incidence will increase.

There are screening mammography clinics that are done with Punjabi- and Hindi-speaking staff people, so people will feel more comfortable being able to go to those clinics.

Diabetes is another concern in the South Asian population. By the way -- you know this, member, but for the benefit of the House -- that's people who are not only Punjabi- or Hindi-speaking, but also Urdu-speaking, people from Fiji . . . . It's a very wide group of people; it's not the more traditional groups that others might think of. But diabetes is quite an issue, and we're now running diabetic clinics -- certainly one in Surrey -- for the South Asian population, with people who speak those languages.

We also funded -- actually some time ago, but some of these pieces are part of it -- a project with the B.C. Cancer Agency around breast screening and breast cancer, which specifically targeted immigrant women -- obviously not just South Asians but immigrant women.

If you look at South Asians, then you're targeting parts of the province. I guess you could target everywhere, and that's not always possible in every language, but we're targeting areas like Prince George, Kamloops, Merritt -- areas where we know there are large South Asian populations.

We've done some TV programs. I've done radio programs with the Chinese radio station, and we've done programs with the major South Asian television station, talking about health care issues, as well, in both the Chinese and the South Asian communities.

Just two more pieces. One is that we tried very hard to make sure that this information goes not only to women but also to men in those communities. I'm going to try to be careful here. Often -- not always, but sometimes -- women are dependent on their partner, their spouse, for assistance to get to lots of kinds of services. Therefore it's important that the spouse also knows how important it is that that health care be available for his wife or for his children. Those are a few of the things; I can add more, if you want to hear more.

Hon. P. Priddy: I would not suggest that it's as consistent as it is in the court system. You always need to give honest answers. But certainly in most major hospitals, there are either staff or interpreters on call who speak that language. But as soon as those words leave my mouth, I'm sure you can go find several stories where that hasn't been the case. We are trying to have a way for that to be more consistent.

[ Page 10485 ]

One of the things I was very interested in . . . . It's just a story. I've been very good in these estimates; I haven't told any stories. But at Surrey Memorial Hospital, there are two nurses who are taking Punjabi lessons so that they can . . . . You know, it's not their job; they haven't been designated as something or whatever. They're taking Punjabi lessons just so they can be of more support to their patients. I thought that was a very nice statement about their commitment.

So yes, most major hospitals have someone. It's probably harder in the middle of the night than it is during the day, but mostly they can manage that. I've heard some stories about where it hasn't been available, as well, so it's not a perfect system yet.

L. Stephens: The issue of elder abuse is one that seems to be growing. I know that hospitals and different sections of the Health ministry are concerned about this. Certainly in the continuing-care and extended-care sectors, this is an issue that comes up from time to time and is, again, part of the news. Certainly in my community we have such an instance being attended to at Jackman Manor.

On the issue of senior women generally, women who are not in hospitals or in continuing-care homes -- women who are isolated, living either in their own homes or in family members' homes, where it's much more difficult to access services and is sometimes under very difficult circumstances for them -- may be dependent, for various reasons, on the people they're living with. It becomes a bit of a detective game, I guess, to determine whether there are people who do need to have some kinds of support and services. It makes it doubly difficult if they are people who do not understand the language well or do not understand what their rights are.

Hon. P. Priddy: There are some initiatives. I don't consider it actually . . . . Now, the member would know that I spent three and a half years at Women's Equality, so I'm not going to consider that it's wrapped up in some other package. I would be unable to bring myself to do that. There are some initiatives. Again, this is one of the issues that I think the member for North Vancouver-Lonsdale raised earlier -- about partnerships within government.

If you look at some of the work that is going on in our ministry, we are doing what's called connecting training for health care providers about the issues of senior abuse. It's hard to talk about elder abuse without . . . . We have the office for seniors, so I'll probably drift a little bit into other people's portfolios, if you'll just forgive me for that, hon. member. That's training for health care providers around recognizing and being astute on the issues of elder abuse. We think that should be really easy, but it's not.

[4:45]

In point of fact, it is reported . . . . I know the member knows this, but it's important for me to acknowledge it. I mean, it's actually reported far . . . . We know it's enormously underreported and reported far less than even child abuse is, which sometimes is reported by a family member, neighbour or someone else. Children, at least children over the age of five, are actually seen by more people. There are elders in their own homes or living with family members, who may not be seen by anybody that they even have an opportunity to say it to.

I've always been quite struck by this, because of my work with home support work students. If an elder is abused by a son or a daughter -- this is a child that they've raised -- how hard it must be to talk about that and to say that, because this is a person that they had as a baby, a toddler and so on. Now you're wanting or needing to tell somebody that this person is abusing you financially, emotionally or physically, or all of the above. I just think that's incredibly difficult, particularly for those seniors who are quite isolated. That was just an aside I needed to say.

We also work with the office of the public trustee, which is funding community response networks that are working with the non-profit or volunteer community in terms of being able to actually respond to seniors or elders. I must be in my story-telling mood. The first time I ever went to Portland, on the transit system they describe that it's so much for children, so much for teenagers and so much for adults, and then they say it's so much for honoured elders. I just thought it was such a nice way to talk about the seniors in their community.

The community response networks, which the public trustee actually has provided the funding for but which we're working with, are developing response networks in the community that will respond for seniors. We provide support to the British Columbia Coalition to Eliminate Abuse of Seniors. Those are dollars that are available for that organization to work within communities. You know, I think there are some things that work provincially, some things that work on the ground in the community and maybe some things that work together. So I'd like to think we have some role in this.

But particularly in smaller communities, the people who live there often know who may be at risk or a particular place where someone may be at risk, and maybe they are better able to do that work on the ground if we can provide some funding for them.

The other thing is that the ministry's advisory committee around women's health has also . . . . I guess I'll say this in two parts. They are obviously there to use the lens of women's health, but they've also taken a look at elders. They've been doing some costing from a health care perspective around the issue of abuse of women. Some of that had already been done, so I told them not to spend too long studying it; I'd rather get on with doing the work. But within that, they are also looking at that for elders.

L. Stephens: I want to talk a little bit about prescription-drug abuse, which I know the minister is aware of. There used to be quite a concern around this. I think the level of awareness has increased dramatically. I don't want to give the ministry a commercial here, but I know the ministry and Women's Equality made a video that talks about the pill epidemic -- it was on national television -- and about this very issue. Virtually everyone in the health care field knows about prescription drugs and what they can do. I recall talking to a number of paramedics who told me that their primary

[ Page 10486 ]

calls are people who are having difficulties with substance abuse in prescription drugs. I wonder if the minister would talk about whether or not she is, within her ministry, dealing with this particular issue. Does she have an initiative or program in place to reach out to doctors' offices or hospitals, so that staff are more aware of particular problems when individuals come into hospitals? Perhaps she could outline the initiatives in her ministry around that particular issue.

Hon. P. Priddy: There are several initiatives that are either ours or done in combination with other organizations. For instance, one of the drugs that we know is prescribed a lot -- who am I, a non-medical person, to say overprescribed? -- for elders is diazepam: Valium and its cousins, if you will. There is a program of the College of Physicians and Surgeons, where they monitor particular groups of drugs or a particular drug, and this is one that they have been paying special attention to.

They monitor all prescribing habits of physicians around this, and when they see prescriptions being filled or when they see what seems to be an overly large number of prescriptions being written, then they will -- and have, by the way -- take action with a particular physician who is overprescribing. That would affect almost anybody, but you and I know that it would mostly affect women. I'm not sure it's always elder women, but certainly elder women and men both have issues about overprescription of diazepam. So that's one thing that we're doing.

Secondly, one of the things that has sometimes happened is that people become dependent on prescription drugs because they -- I think the phrase is -- multi-doc. That means they go from physician to physician to physician. If the last physician doesn't know that you had this, then you can get . . . . The member knows what I'm talking about. Because of our PharmaNet system, we are starting to see some differences as a result. When someone comes in with a prescription . . . .

Generally, if we are talking about abuse -- advertent or inadvertent -- of prescription drugs, we're talking about sleeping pills and mood-altering drugs, we're not talking about an antibiotic. As you link into the PharmaNet system, it doesn't matter which doctor you went to last or in which part of the province; it flags that you have had three prescriptions of this from somewhere else. That's another way of trying to monitor the overprescription or overuse, advertent or inadvertent, of those medications. The thing, though, that we can do . . . .

I guess this isn't so much about overprescription, but the thing I think we can do better at is how seniors -- be they women or men, but at some stage there are more women than men, depending on how far down the life cycle we look at -- actually use the drug itself. As someone who is not yet an elder -- although 55 next year, but that doesn't quite qualify . . . .

Interjection.

Hon. P. Priddy: Same age as you, hon. Chair -- he just had his birthday.

The other piece that I'd mention -- and I actually haven't checked with the staff person to my left here, but I will -- is that by giving people a trial prescription when they're first prescribed something, it's a way to monitor that somebody hasn't suddenly got six months' worth of diazepam. Off they go with it, and the addiction can happen within that period of time. People should get a trial prescription to see if the medication actually does what people want it to do.

My last comment is that I don't know if we are able to be clear enough -- sorry, the verb escapes me at the moment -- with seniors about the critical side effects of the interaction between alcohol and drugs. Maybe some people don't think this would be a big issue for elders, so we don't have to talk about it as much. But we do know that alcohol addiction among seniors is actually quite high; so when you add that to a drug interaction, you do have to call a paramedic.

Somebody said we might have one more thing here; just let me check before I sit down. Oh, of course -- I forgot the White Rock seniors project. You may know that one. Actually, this has been going on for awhile. It was new to me when I came to the ministry. I wasn't aware of it at all. The White Rock seniors project, which is an excellence in health community pilot project, is the means by which as many recommendations as possible from the Pharmacare Review Panel's report and the seniors medication strategy are implemented in a selected community with a large population of seniors.

I think it's been going on since July 1995, and it's intended to be an education program staffed by volunteer seniors and designed to increase the medication knowledge of the elderly, with an intervention program staffed by a full-time pharmacist and a part-time nurse targeting seniors at high risk for medication-related programs. It's been incredibly successful.

L. Stephens: I want to leave seniors for the moment, because those two issues were at the top of the list for me in dealing with the problems that many of our seniors face. I want to talk a little bit more about sleeping pills and tranquillizers and about women generally -- the fact that many of them become addicted to these medications over the years. Perhaps there are not as many as there used to be. These particular medications used to be prescribed fairly liberally.

However, the knowledge of the damage and the long-term damage to health that they can do, I think, has really helped to sensitize people to the long-term effects of these medications. Has the minister any knowledge of how prevalent this still is -- whether or not there are still some serious issues around addiction to sleeping pills and tranquillizers and whether or not there is a process underway to sort of rein that in, other than what the minister has talked about around Pharmacare and PharmaNet?

When she's talking about that, I have another question for her: what part of the ministry is responsible for monitoring the kinds of medications that are being prescribed, and who does it go to? For instance, if whoever this is in the ministry is monitoring to see that in fact this particular individual has six months, eight months or a year . . . . What happens then? Just because they know . . . . What's the next step; what happens after that? Perhaps the minister could talk about what happens after the identification is made.

[5:00]

[ Page 10487 ]

Hon. P. Priddy: The primary responsibility . . . . The ministry doesn't monitor what prescriptions everybody has. That is the purpose of the PharmaNet computer system that is set up. The monitoring happens by pharmacists, who tap into that. There are some issues around confidentiality of information for individual patients as well. But when the pharmacist you present your prescription to taps into PharmaNet, they have a sense of what is happening and would have a responsibility, if they think there is an issue, to report it to their own organization.

Again, the College of Physicians and Surgeons monitors, particularly, the prescribing of benzodiazepines, sleeping pills and sedative medications, as well, and is responsible for disciplining, and it does discipline physicians based on that. It's done in partnership with the ministry but not in the ministry. I expect that we will be doing a pilot project, starting in a particular community, around the use of both hypnotic and sedative drugs.

L. Stephens: I have a number of issues I want to talk about: aboriginal women's health and a few other things. With all due respect to the minister, I'd like to move through them quickly. I know there are an awful lot of issues in health that still need to be discussed, so if we can do that, then we'll move this along. I'm sure the minister would be thankful for that as well.

In the aboriginal women's health area . . . . This is a

section of the ministry's responsibilities, and there are some huge issues around aboriginal women's health, as I know the minister knows, particularly in the urban centres of the province. I guess that first of all I'm going to ask the minister if she can answer this question: what changes will there be, if any, in the provincial Ministry of Health's delivering of aboriginal health care programs to the Nisga'a, for instance, with the new agreement that's in place? That's one we have in place, so I'll ask her to just comment on that.

She can't comment on the other agreements that are to come forward, but I'd ask her to comment on whether or not there will be substantive changes to the delivery of health care by the province in regards to the Nisga'a agreement.

Hon. P. Priddy: In regards to the member's question around the Nisga'a, we've had an agreement for a very long time with the Nisga'a. They've controlled their own health care services through what is virtually a community health council, and that's what they'll continue to do.

L. Stephens: The aboriginal women in British Columbia here -- and we'll talk about those in the urban centres, particularly in the downtown east side . . . . Drug and alcohol abuse has the most impact. My understanding is that alcohol abuse is common in 93 percent of aboriginal communities, and drug abuse is common in 81 percent. I know the minister understands that this is a very difficult issue for the aboriginal communities themselves. I'd ask the minister, then: what kinds of programs does her ministry deliver to aboriginal communities around the province, and through what mechanisms?

Hon. P. Priddy: We work, in a large part, through the six aboriginal health councils throughout the province. Aside from the Nisga'a one, which we've talked about and, which is guiding its own health care services, we provide funding through the six aboriginal health councils. Those aboriginal health councils work within their geographic constituency, if you will, to identify the priorities for health care.

Maybe I can just give the member a couple of examples of this that may go into some things that she wanted to ask later. There is an HIV/AIDS reduction awareness . . . . Some of these dollars would go to men as well, but a significant amount goes to women. Earlier you mentioned HIV/AIDS. The project is actually called Healing Our Spirit; it's the B.C. First Nations AIDS Society. They've been funded to half a million dollars to do awareness and education programs. We've done sexual abuse intervention counselling through the aboriginal health division.

We've done health education and hospital liaison, which is the first nations women's group in Prince Rupert -- a dynamite group of women. They've been funded to provide two of the main kinds of service for primarily women in that area around accessing hospital and health services by being a bridge or liaison -- or however you want to describe that -- between the patient and the band service. Often it includes providing translation services, as well, because many people use their own aboriginal language. Native community health services, as well -- the Central Interior Native Health Society . . . .

We provide funding for administrative, clerical and health care staff, which includes a nurse and a doctor. That work is ongoing, as well, around trying to make a difference in health status, certainly with aboriginal women.

I'm just trying to think if there was an additional one here. No, there's not an additional initiative.

L. Stephens: The Stopping the Violence Against Women program -- I understand there is a memorandum of understanding between Women's Equality and the Ministry of Health to deliver those programs around aboriginal family violence services. It says: "The agreement will address the parameters for allocation of funds, requirements of monitoring and reporting on the status of the programs and procedures for cost recovery." Could the minister tell me the amount of money the ministry spends on aboriginal family violence services?

Hon. P. Priddy: The amount of money that is, if you will, journal-vouchered from the Ministry of Women's Equality to the Ministry of Health is $2 million.

L. Stephens: Is that $2 million spent in the aboriginal family violence service? If so, could the minister talk about where that money is allocated? Is it allocated to the six aboriginal health councils, or is it allocated to non-profit societies to deliver those programs?

Hon. P. Priddy: It's allocated to the six aboriginal health councils, which in turn allocate it to non-profit societies.

L. Stephens: Could the minister talk about how the monitoring and reporting works? What kind of processes are in place for the ministry to in fact know what the money is being spent on?

Hon. P. Priddy: They are monitored by the aboriginal health councils. We have taken some additional steps this year around how that reporting and accountability is done. I actually want to see outcomes for the dollars -- not just, "Did you spend it?" and "Who did you spend it on?" So we've added an additional clause to their contracts that says they must report out on the actual outcomes for people of how the dollars are spent.

L. Stephens: Perhaps the minister could elaborate a little on what that kind of reporting structure would look like. Would there be an audit, for instance? Would the ministry be

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doing an audit? Would there be a program review and evaluation done by some organization or by the ministry itself? What kind of reporting do the aboriginal health councils have to go through?

Hon. P. Priddy: The first thing is that they are certainly audited. While that's an important thing to do, audits don't always tell you much about program outcomes. But certainly they are audited. There are periodic visits by our staff to those programs to ensure that the money is indeed being used for the target group for whom it is intended. We will be providing guidelines for the health councils on how to actually describe outcomes. It's fairly new to government -- it probably shouldn't be -- to actually expect people to be able to document outcomes, like: has it made a difference for people?

I would actually be expecting to see outcomes that look like this: as a result of action A, this family was able to stay together -- or sometimes not; or as a result of this, this woman was able to return to the workforce. I want to see the actual difference it has made in people's lives.

L. Stephens: Do these health councils also deliver the aboriginal drug and alcohol abuse programs in the province?

Hon. P. Priddy: The aboriginal health councils deliver some alcohol and drug programs, but there are a number that are either the responsibility of this ministry or the responsibility of Children and Families. They do do some, but not the whole complement.

L. Stephens: Could the minister outline what programs the aboriginal health councils are responsible for and what programs the Minister of Health is responsible for?

[5:15]

Hon. P. Priddy: I don't have as clear an answer as the member might be looking for on this question. Aboriginal health councils have funded programs, such as intervention programs for youth and intervention programs for families that are raising young children. They have funded programs where there is alcohol abuse that led to violence within the family unit. Those are some of the kinds of programs that have been funded by the aboriginal health councils.

The programs that are funded through the ministry -- and again, it's not clear-cut . . . . For instance, we fund the Vancouver Aboriginal Friendship Centre, and they, within the plan of their work, will deliver some of the alcohol and drug programs that they see are needed in their community.

I hope there is not an overlap between the programs, but there may be some similarity.

L. Stephens: Time after time after time we hear about the lack of treatment beds and detox facilities for everyone, actually, who has this particular problem. The aboriginal population is affected more than the other populations at large. I would like the minister to talk about what kind of plans her ministry has for new detox beds and for new drug and alcohol treatment centre beds. I know that as far as the women are concerned, there are the two: there is Peggy's Place, and there also is Atira House in Surrey. These are the only two facilities for women to receive any kind of drug and alcohol counselling, with the exception of the women's centre for excellence.

The number of beds is very, very low for the population of the province. It seems to me that we need to do . . . . When we talk about prevention and intervention, that's the place to do it. I know that this minister and the ministry itself -- and the government, frankly, in different ministries -- talk about early intervention and prevention programs, saying that that's the way we need to address these issues. I completely agree. But it's got to happen. The resources have got to be put into the kinds of facilities that will allow for those intervention programs to be successful.

There has been study after study, which I know the minister is aware of, that talks about the need for these kinds of beds.

I would like the minister to talk a little bit about her plans this year to increase those treatment beds for drug and alcohol abuse, and for detox beds -- whatever part of her ministry is appropriate. I know that Children and Families has a role in this as well, and they have to come to grips with the kinds of facilities and resources they need to put forward. But I'd like to know what this minister's ministry is doing to address these two issues for this year.

Hon. P. Priddy: We are doing a number of prevention and early intervention programs. But when the member asks what we're doing about detox beds or treatment centre beds, we don't have that responsibility or that budget. It is totally within the purview of the Ministry for Children and Families. I'm not trying to duck the issue; we don't have the responsibility for treatment beds or detox beds. But I am aware of some plans underway in Children and Families to address some of these issues.

L. Stephens: So the minister is telling me that Children and Families has the responsibility for adult drug and alcohol abuse programs, as well as for youth and children.

Interjection.

L. Stephens: Thank you.

One more question. The saline-breast-implant issue has come forward. We've had the silicone-breast-implant problem, and now we have the saline implants. Could the minister comment? Is she monitoring this situation? Is she prepared to address this issue in any way?

Hon. P. Priddy: It's quite frightening that we did silicone breast implants and saw the lawsuits involved, and the pain and suffering of women, and are now going through the same thing again with saline implants. We have not got a particular initiative in the ministry to monitor it, but we have indeed stayed in contact with the medical community. The B.C. Cancer Agency will sometimes see women if the implant was done as a result of surgery they've had because they've had a cancer diagnosis. Certainly the College of Physicians of B.C. are in contact with primarily the surgeons, who . . . .

I won't say they have a responsibility; that's not what I mean. They are the people who have contact with those women. But we don't have a particular initiative within the Ministry of Health around the saline implants.

S. Hawkins: I just want to go back to the regional budgets for a minute, because many of the regions are now reporting in and submitting their budgets. I understand that many of them are finding themselves in deficit situations. The minister said before that the health regions' budgets aren't finalized, that the minister is going to be reviewing them and approving the budgets. I have published reports from ministry communications, telling the public that balanced budgets are the only budgets that the ministry will accept from the regions. So if the regions are forwarding budgets that are $1.8

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million or $5.3 million in deficit . . . . The ministry is saying they will only approve a balanced budget. Then the regions are saying: "Well, if you'll only approve a balanced budget, that means we are going to have to cut services." That is what I brought up with the minister before. They're going to have to cut services; they are not going to be able to provide the level of service or patient serv