2004 Legislative Session: 5th Session, 37th 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)

WEDNESDAY, MARCH 3, 2004

Afternoon Sitting

Volume 21, Number 5

CONTENTS

Routine Proceedings

Page

Introductions by Members

Statements (Standing Order 25 B )

Pharmacist Awareness Week

R. Hawes

Cancer awareness and fundraising

P. Sahota

Vancouver drug trade

Mayencourt

Oral Questions

Police investigation of government

officials

J. MacPhail

Hon. G.

Collins

B.C. rail privatization process and

police investigation

J. Kwan

Hon. G.

Collins

Promotion of avalanche safety

W. McMahon

Hon. R.

Coleman

Funding for native courtworkers

P. Nettleton

Hon. R.

Coleman

Blood donation

R. Stewart

Hon. C.

Hansen

Lobbying in B.C. Rail privatization

process

J. MacPhail

Hon. G.

Collins

Interjurisdictional family

maintenance agreements

S. Orr

Hon. G.

Plant

Point of Privilege

Hon. G. Collins

Committee of Supply

Estimates: Ministry of Health

Services (continued)

J. Kwan

Hon. C.

Hansen

Suffredine

R. Hawes

Proceedings in the Douglas Fir Room

Committee of Supply

Estimates: Ministry of Finance (continued)

J. MacPhail

Hon. G.

Collins

Brenzinger

V. Roddick

B. Locke

R. Hawes

P. Sahota

Estimates: Ministry of Provincial

Revenue

Hon. R.

Thorpe

B. Penner

Jarvis

J. MacPhail

M. Hunter

D. MacKay

B. Lekstrom

D. Hayer

[ Page 8995 ]

WEDNESDAY, MARCH 3, 2004

The House

met at 2:03 p.m.

Prayers.

Introductions by Members

Hon. S.

Hawkins: In the House today is a very special friend of mine who travelled

on vacation with me and is now spelling off my family. She is a great nurse, a

great colleague and a great friend — Janice Parker-Sparrow. I'm looking for

her. Would the House please join me in making her welcome.

[1405]

If you'll

indulge me for a minute, Mr. Speaker. I haven't been here for a month, and I

promise I won't speak a month's worth of my time. I feel like I'm at the Academy

Awards. If I hear music, I refuse to sit down. I've seen that show. I've seen

you, Mr. Speaker, being very creative in the last month, as I've been watching

on TV, in trying to get ministers to sit down. I promise I'll try and keep this

short.

I want to

thank all my colleagues, everyone in the buildings, all the press gallery.

People have been so supportive. It's been overwhelming, but it really does make

a difference. I think I know I'm not on this journey alone. Your thoughts,

prayers and best wishes really have made a difference to me. I mean, I don't

even think I could have travelled here today if I didn't know I had so many

people caring for me.

I want to

thank my staff. I want to thank Jennifer Burnett. I want to thank Karen Bill

here for making arrangements. I want to thank the Premier for accommodating my

meetings and looking after my duties while I've been gone and for being so

supportive and making sure I got here and back okay. My staff in Kelowna have

just been incredible. I can't imagine what kind of circumstances they're working

in. Del and Shirley have just been an incredible source of support — and my

colleagues there, the MLAs for Okanagan-Westside and for Kelowna–Lake Country,

in looking after my constituents while I have been unable to. I'm sure you'll

have a list of things you owe me like my sisters are writing down, so I promise

I will try and fulfil that when I'm better.

I know that

you've all heard my sisters' top-ten list, and it seems to have encouraged other

people to develop lists. In my absence, I want to thank the staff from IGR. I'm

starting to get top-ten lists from different…. People in protocol came up with

one in a card that says: "If you didn't want to learn French, why didn't

you just say so?" Anyway, I'm not encouraging that, but it is nice to get

that.

If I can

close with my appeal, because that is what is important to me right now. There

is a message to send to people across the province. You don't realize how

important things are to you until you lose them, and the significance of some

things you are doing until it actually affects you. I have been a blood donor,

and now I am a blood recipient with my diagnosis of leukemia. I am learning more

about blood donation than I ever wanted to know, but I am learning it and I want

to get the message out.

In British

Columbia we have a population of over four million, and we donate at half the

rate of other provinces. We are a net recipient of blood. We get 15,000 to

18,000 units of blood from other western provinces that have half or one-quarter

the population we do. That, to me, is unacceptable. I really hope people will

roll up their sleeves and help save a life. It is helping to save my life, and I

can't tell you how much I appreciate that — that someone out there, an

anonymous donor, has been unselfish and has taken the time to make sure I get

what I need in my time of need.

The second

thing I am asking for is people to consider registering in the bone marrow

registry as an unrelated donor. I am so fortunate that my parents had six kids,

me included. One of my sisters, who is three years younger, ended up being a

perfect match for my bone marrow transplant. If she weren't a match, I would be

in a circumstance where I would be looking around North America, Europe or India

for a match. That would delay my treatment, and if a match weren't found, it

wouldn't be good news for me.

So I'm

encouraging ethnic populations — whether you're Indian, South Asian, Filipino,

Chinese, Japanese — to please get registered. We do not donate blood, and we

do not register at the rate of eastern- and western-descent populations. So

that's my appeal.

Mr.

Speaker, thank you for indulging me. I don't hear the music yet, but I will sit

down.

I want to

thank the opposition and the Leader of the Opposition. She told me to get a

life. Maybe when I go back now, I won't watch you guys as much because it's not

that exciting to be here, I notice. I do miss you all terribly. Thank you for

your support.

Mr.

Speaker: Further introductions, hon. members?

[1410]

Hon. I.

Chong: Today I would like to introduce two constituents of mine from the

riding of Oak Bay–Gordon Head. They are David and Annabeth Black. They're in

the gallery, and they will be watching question period. They are both very

strong community leaders in the greater Victoria area. As well, David is a chair

of the B.C. Progress Board and does that job very well. They're also very good

friends of the Clerk of the House, and I know he would like to see them welcomed

here today as well. So would the House please make them both very welcome.

MacPhail: On this wonderful day when we have our colleague from

Kelowna-Mission with us, I also have great news about Graeme Bowbrick, who is

now a former colleague of ours. Let me just read you the message — if I may,

Mr. Speaker — very quickly: "Julie" — his wife — "and I

want to let you all know this morning that Julie, Charlotte and Meredith were

born at just after 9 a.m." Sorry, sorry. Charlotte and Meredith are

[ Page 8996 ]

the twins — not triplets. How to make a tough event seem like nothing….

I'm sorry. [Laughter.]

I'm so

sorry, Graeme. Julie is the mom. Graeme is the dad. Charlotte and Meredith are

the new baby girls. Charlotte is 5 pounds 5 ounces; Meredith is 5 pounds 15

ounces, and they join their three brothers: Adam, Alex and Colin. Good luck,

Graeme.

Hon. C.

Hansen: We have several guests in the gallery today that I would like to

introduce from the Canadian Breast Cancer Foundation. Dr. Moira Stilwell is the

chair of the foundation. She is joined by four other members of the executive

for the B.C.–Yukon chapter: Virginia Greene, Jan Engemoen, Greg D'Avignon and

Judy Caldwell, who is also one of the founders of Breast Cancer Foundation of

B.C. Will the House join me in making them very welcome.

Hawes: This week is B.C. Pharmacist Awareness Week. To that end, we have had

a visit today from the B.C. Pharmacy Association. They met this morning with

about 30 MLAs. In the House today are Peter Hirschmiller, president of the B.C.

Pharmacy Association; Marnie Mitchell, chief executive officer of the

association; Marion Pearson, a UBC faculty of pharmacy professor; three

pharmacists from Victoria — Marilyn Boyce, Larry Thorne and Alan Hickey; and

two students from UBC pharmacy — Tiffany Ho, who is the student coordinator,

and Eugene Chu, who is a pharmacy student and president of the UBC Pharmacy

Undergrad Society. Could the House please make them very welcome.

G. Hogg:

There are two residents of Surrey–White Rock here in the House today —

one who's recently had an epiphany and moved here from New York. Would the House

please welcome Dr. Penelope Peters and Mike Miller.

Mr.

Speaker: Hon. members, I would like to take this opportunity to introduce 25

public servants seated in the west gallery, who are participating in a full-day

parliamentary procedure workshop. This workshop, offered by the Legislative

Assembly, provides a firsthand opportunity for the public service to gain a

greater understanding of the relationship between the work of their ministries

and how that work affects the Legislature. Would the House please make them

welcome.

Statements

(Standing Order 25

b) PHARMACIST AWARENESS WEEK

Hawes: Every day in every corner of our province there are pharmacists

providing advice on medication management, disease prevention and healthier

lifestyles. They're an integral part of our health delivery system. For many,

the community pharmacist is the first stop for answers to medication questions

and health-related concerns.

[1415]

Pharmacists

are the drug experts in health care. They are recognized as the most effective

medicine managers and drug information experts involved in patient health care.

A recent poll indicates that 90 percent of those polled expressed confidence

that pharmacists reduced drug interactions and mixups, especially with seniors'

medication. In fact, a 2003 Ipsos-Reid poll revealed that Canadians found

pharmacists the most trustworthy professionals when it comes to honesty and

integrity.

As our

baby-boom generation continues to march towards senior status — and that

probably includes a number of us — with the resultant increased financial

burdens on our health care system, it becomes more and more important to

consider new roles for our health care professionals, including pharmacists. I

would urge the Minister of Health Services to ensure that the role of

pharmacists as health care consultants is an important part of the

scope-of-practice review now underway.

Pharmacists

are one of the best bargains in health care today. I would ask all of my

colleagues to recognize pharmacists as we celebrate the proclamation of

Pharmacist Awareness Week, March 1 to 7.

CANCER AWARENESS AND FUNDRAISING

Sahota: There has been a lot of recent discussion about cancer awareness and

the important role the public plays in supporting cancer research initiatives.

I'm very proud that in Burnaby we're doing just that.

colleagues from Burquitlam and Burnaby North and I have teamed up with the

Burnaby Chinese Parents Association and the Romana Restaurant to raise funds for

the Canadian Cancer Society. Tomorrow, March 4, the Romana Restaurant on

Hastings Street in Burnaby will be hosting a Spring Romance fundraising dinner

with all proceeds going to the Canadian Cancer Society. Thanks to Winnie Fong,

Julie Lin, Jackie Liu, Mary Wong, Gilbert Lam, Andrew Shum and Jennie

Siormanolakis. I know tomorrow night will make a difference.

On March 12

the tenth Chinese campaign anniversary dinner will be held to raise funds for

cancer research and to support programs and prevention information. So far, with

the help of people like Johnny Fong, Dr. Michael Lowe and Mason Lowe, this

organization has raised close to $3 million for this very important cause.

introduced earlier in the House, I along with my colleagues met with the

Canadian Breast Cancer Foundation, who are here raising awareness and educating

all of us on breast cancer and the critical importance of mammograms, as breast

cancer is the number one health concern for women in British Columbia. It is

important for all of us to work together and raise awareness and educate women

on breast cancer prevention.

Of course,

I would be remiss if I didn't say it is great to see the member for

Kelowna-Mission in the

[ Page 8997 ]

Legislature today. All of us will continue to pray as she goes in for a bone

marrow transplant next week.

There are

so many British Columbians in our province — like the Canadian Cancer Society,

the Breast Cancer Foundation, researchers and countless volunteers — who

dedicate their time to raise awareness and funds for cancer research so

thousands of people in our province can benefit from their efforts. It's my hope

that with world-class researchers and the community spirit of generosity, we

will find a cure for cancer. To the many partners, researchers, volunteers and

communities: thank you for your continued dedication as we all work together

towards a future without cancer.

VANCOUVER DRUG TRADE

Mayencourt: Vancouver's drug trade has been a longstanding problem for many

neighbourhoods in our world-class city. We have tried to control and to

understand it for many years. The reality of the drug trade is that it follows

the laws of supply and demand. While the Vancouver police department cracked

down on dealers in the downtown east side, they simply moved west, up to

Richards Street and into the West End.

It was

reported yesterday that as part of a two-week operation focusing on our West

End, the Vancouver police department arrested 98 individuals suspected of

trafficking drugs. Half of these were repeat offenders. The police laid a total

of 147 charges in this operation.

These drug

dealers hang around the schools in my neighbourhood. The people of my community

are sick and tired of being victims of crime and watching the open-air drug

trade happen in our neighbourhoods. We need to ensure that people feel safe as

they walk to work and school. We need to work together with our police forces to

take back our communities and tell the drug dealers that we are not going to

stand for this anymore.

Tonight I

will host a meeting about implementing a community safety zone around Lord

Roberts Annex, Lord Roberts Elementary and King George high school. One of these

schools is situated right beside Nelson Park, a place where needles are found

and dealers frequently sell their drugs and harass residents. The school safety

zone we will be talking about will protect children from facing some of the

daily dangers of this drug problem.

[1420]

Tonight we

will meet at the West End Community Centre at 7 o'clock. Tonight we will also

have members of the Vancouver police department, the parent advisory committees

from all three schools, the three school principals in the area and many, many

concerned citizens. It is my hope that we will be able to provide children and

parents in my riding with a safe place to go to school, a safe place to walk

home and a safe place to be a kid.

Mr.

Speaker: That concludes members' statements.

Oral Questions

POLICE INVESTIGATION OF

GOVERNMENT OFFICIALS

MacPhail: Will the government finally come clean today and tell us why David

Basi got fired and Bob Virk got suspended with pay? What is the government not

telling us about what they knew about the activities of David Basi that was not

in the

summary of the warrants released yesterday? Bob Virk is still on the

public payroll, when his actions, according to the

summary, are no different

than Mr. Basi's. Can the Deputy Premier tell this House what the Premier and his

chief of staff know about what was going on in the Finance minister's office

that they aren't telling the public?

Hon. G.

Collins: I answered that question yesterday in estimates. I answered it two

months ago, and I answered it yesterday in the corridor.

Mr.

Speaker: Leader of the Opposition has a supplementary question.

MacPhail: Well, maybe the Minister of Finance is having a conversation in

his own mind. He has not answered that question at all.

When the

police raided the Finance minister's office, that Finance minister assured

British Columbians that David Basi had no role in the sale of B.C. Rail. The

summary released yesterday directly contradicts the Minister of Finance. Mr.

Basi was up to his eyeballs in the B.C. Rail deal, and it is inconceivable that

the Finance minister did not know that.

In fact, we

know that Mr. Basi was directly involved in lobbying stakeholders — Colin

Kinsley, the mayor of Prince George, to name one, as well as others — to

support the Premier's broken promise. Will the Minister of Finance now admit

that his chief political aide was directly involved in the sale of B.C. Rail and

had access to confidential information?

Hon. G.

Collins: Mr. Speaker, if she checks the record from the end of December,

she'll find the answers to those questions as well. As well, we talked about it

yesterday in estimates for several hours, and I answered it as well.

Mr.

Speaker: Leader of the Opposition has a further supplementary.

MacPhail: In fact, checking the record shows that this minister and this

government said that Mr. Basi had nothing to do with the B.C. Rail deal. That's

exactly what the Minister of Finance said.

Another

incredible statement yesterday by the Premier. The Premier said yesterday that

the investigation has nothing to do with his government. If the matter weren't

so serious, that statement would be laughable. The Premier also said that he

would gladly run for re-election on his broken promise to sell B.C. Rail.

[ Page 8998 ]

I can't

wait. I wonder what part of the deal the Premier will feature in the ads — the

broken promise, the criminal investigation, the stonewalling, the Finance

minister. The Premier and the Finance minister know more than they're telling.

Erik

Bornman is a registered lobbyist for Omnitrax, and Mr. Bornman lists the

Minister of Finance as one of his lobby targets.

Interjections.

Mr.

Speaker: Order, please. Order. Hon. member, may we have a question, please.

MacPhail: Can the minister…

Mr.

Speaker: Now, please.

MacPhail: …tell us if he ever met with Mr. Bornman, and who else was in

the room?

Hon. G.

Collins: I never met with Erik Bornman. I'm sure the Premier will be

thrilled to go to the public with that as an election issue — the fact that we

revitalized B.C. Rail. Communities along….

Interjection.

Hon. G.

Collins: Mr. Speaker, if she wants to ask a series of questions, she can get

up and ask them in the normal order of the House. The fact of the matter is that

I never met with him. How many times does she want to ask me that?

The fact of

the matter is that the Premier and every single member of our caucus will be

excited about talking about the revitalization of B.C. Rail — as well as will

all the mayors along the communities, as well as the mayor in Prince Rupert, as

well as all the communities and all the jobs they're going to receive as a

result of that action.

[1425]

B.C. RAIL PRIVATIZATION PROCESS

AND POLICE INVESTIGATION

J. Kwan:

The former Minister of Children and Family Development resigned when he was

informed of an audit into a forgiven loan — a decision that the minister

wasn't involved in, according to the government. The Premier praised the

minister. Let me quote the Premier: "He's acting in the best parliamentary

tradition, and I think that speaks to the quality of the man." Today the

Minister of Finance's top aide and chief political adviser is under criminal

investigation for breach of trust and influence-peddling in the B.C. Rail deal.

To the

Deputy Premier: if the former Minister of Children and Family Development was

acting in the best parliamentary tradition, why is the Finance minister still in

his job when the police are investigating criminal activities in his office?

Hon. G.

Collins: I answered this question, as well, yesterday, and I think I

answered it previously as well. The difference here is that I am not subject to

an investigation, nor is there an investigation taking place within my ministry

that would report to me, which is different than the situation of the minister

she talked about.

Mr.

Speaker: The member for Vancouver–Mount Pleasant has a supplementary.

Interjections.

Mr.

Speaker: Hon. members, the member for Vancouver–Mount Pleasant has the

floor.

J. Kwan:

Well, talk about a double standard. Here's what the former children's minister

said when he resigned: "As parliamentary practice dictates, when these

clouds are cast, one makes the decision to step aside." The police were

never in the office of the former Minister of Children and Family Development.

There is no criminal investigation, at least that we know of, into the conduct

of his staff. He resigned over a forgiven loan that he says he has nothing to do

with.

Again to

the Deputy Premier: why is it honourable for one minister to resign to protect

the integrity of his office and not for the other? Why is the Minister of

Finance getting special treatment from your Premier?

Hon. G.

Collins: It doesn't feel like special treatment. The difference is that

there is an internal investigation that's taking place in the ministry, which

would need to report to the minister. There is no investigation in the Ministry

of Finance that is reporting to me. There is an external investigation that's

undertaken which does not include me, which does not include any elected member

or any elected official. The police have been very clear about that right from

the beginning.

PROMOTION OF AVALANCHE SAFETY

McMahon: My question is to the Solicitor General. The federal government

recently followed B.C.'s lead and announced funding of $525,000 over three years

to establish a national avalanche centre. This was one of the key

recommendations of the report that was recently submitted by the B.C. public

avalanche safety program review and comes as welcome news to many of my

constituents, to people nationally and also internationally. Can the minister

advise my constituents what his ministry is doing to support avalanche safety in

British Columbia?

Hon. R.

Coleman: When we came to office, there was an avalanche bulletin in British

Columbia that was published by the Canadian Avalanche Association. It was funded

from a number of ministries sort of at the end of the year — $5,000 here;

$10,000 here — to the tune of about $40,000 on an annual basis. As we went

through a very significant, devastating avalanche year

[ Page 8999 ]

last year, it became obvious that we needed to enhance that bulletin. So we

put some extra bulletins in place so people would know when they're going into

the back country where the dangers were and where to take caution.

At the end

of the season, in my ministry we worked towards finding funding for a three-year

cycle at $125,000 a year, which is more money than the avalanche bulletin had

ever had in the past from all contributors to the bulletin. We thought if we

took the initiative to do that, we would then be able to move towards a national

avalanche centre which would do bulletins on a regular basis, if we could

attract other funding from other levels of government.

Our

initiative led to the funding from the federal government. I hope that at some

point in time Alberta will also come to the dance with us so that we can have a

long-term, sustainable avalanche bulletin and information centre for people who

go into the back country of British Columbia. I am proud of our government for

stepping up and taking the leadership in this, and I am proud of the fact that

our officials have been able to put it together.

[1430]

FUNDING FOR NATIVE COURTWORKERS

Nettleton: This year the Native Courtworker and Counselling Association of

B.C. is preparing to celebrate 30 years of extraordinary and exemplary service

as an integral part of the justice system. The Solicitor General has a special

birthday surprise for this dedicated organization and the people they serve

provincewide. He is about to huff and to puff in an attempt to blow their

candles out.

On February

27 of this year the Native Courtworker and Counselling Association were notified

by the same minister that as of April 1, their funding would be reduced by 36

percent. This follows on the heels of a 20 percent reduction in June 2002. With

this further cut next month, 50 percent of the native courtworker positions will

have been eliminated by this government, leaving fewer than 20 front-line

workers to serve the entire province.

Mr.

Speaker: Order, please, hon. member. May we have the question now, please.

Nettleton: Yes. The number of clients has risen by a staggering 73 percent

since 2002.

Mr.

Speaker: Now, please.

Nettleton: My question is to the Solicitor General. Without blowing smoke in

our eyes about alternative service delivery models and referencing federal

funding, will you reconsider and commit today to review this funding cut and

thus follow through with your government's commitment to consult with first

nations prior to making such arbitrary decisions?

Hon. R.

Coleman: Indeed, the member is correct. We have advised the native

courtworkers that we will be cutting their funding this year. The fact of the

matter is, though, that we've been in discussions with the native courtworkers

as to how we can harmonize some of the programs for people in the justice system

with our programs in the correction centres, as we have done with other

programs, to get more efficiencies. We also recognize that this is going to put

some stress on them, so we're in consultations as we do the transition, but we

have forecast this back two years in discussions with the native courtworkers as

a transition to how we'll deal with these programs. That's just what we have to

do, unfortunately, when we have to make tough decisions.

BLOOD DONATION

Stewart: As we've heard today, the blood inventory in British Columbia is

lower than it should be. This is of great concern to me as a longtime blood

donor and to my family and to my constituents and to people across this

province. I know that the concern was brought home even more to this House by

recent events. Can the Minister of Health please tell us what we can do to

ensure an adequate supply of blood products in British Columbia?

Hon. C.

Hansen: I don't think I could say it more eloquently than our colleague from

Okanagan-Mission said earlier. It is incumbent upon all of us who can give blood

to take the time to do that. I know I'm booked in for a week this Friday, which

is my 56-day mark, because you can give once every 56 days. The short answer to

the member's question as to what we can do to make sure that we have an adequate

supply of blood product in British Columbia: we can all roll up our sleeves.

LOBBYING IN

B.C. RAIL PRIVATIZATION PROCESS

MacPhail: We have the lobbyists' registration in British Columbia here. It

provides very interesting information. Erik Bornman has lobbied, or claims to

have lobbied, this government on many files. Now, he's a good Liberal. Maybe

he's not telling the truth. On his B.C. Rail file, he filed to say that he

lobbied the Premier, the Minister of Finance, the then Minister of State for

Deregulation, the Minister of Energy and Mines, the former Minister of

Transportation and the current Minister of Provincial Revenue — I guess that's

the job he's got now. Is Mr. Bornman lying on the lobbyists' registration? If

so, is he lying about all the other files on which he lobbied the Minister of

Finance as well?

Hon. G.

Collins: If the member understands the act and takes the time to read the

act, she'll know that the lobbyists have to register their intent to lobby. They

may or they may not. I have never met with Erik

[ Page 9000 ]

Bornman on any issue since I've been elected as a member — since 2001.

INTERJURISDICTIONAL

FAMILY MAINTENANCE AGREEMENTS

S. Orr:

My question is to the Attorney General. A number of my constituents, and these

are predominantly women, depend on family maintenance from their former

partners.

Interjection.

[1435]

S. Orr:

This is an issue that's very important to women, so let's deal with this.

To provide

for their children a safe home…. During the 2002 spring sitting we introduced

legislation that would help hasten interprovincial family maintenance orders.

Can the Attorney General explain how this legislation has helped in the

collection of support payments when an ex has actually moved to another

jurisdiction?

Hon. G.

Plant: Thanks to the member for the question. The Interjurisdictional

Support Orders Act was enacted by this House in 2002 and brought into force the

next year. We were leaders at that time. Since then, every other province in

Canada has enacted similar legislation, and we now have agreements with all of

the provinces and territories and all of the states of the United States and a

number of other countries that make it easier to enforce maintenance and support

orders across jurisdictions. Essentially, the major element of the process is

that instead of having to go to court twice — once in this jurisdiction and

then once in the other jurisdiction — you now have to go to court only once in

the jurisdiction where the payer lives.

The goal

here is to reduce legal costs to ensure that people get access to the support

payments they need quickly. Early indications are that people are taking

advantage of the opportunity and the program is being used, and I believe that

we see a success story in the making.

[End of

question period.]

Point of Privilege

Hon. G.

Collins: I rise today to respond to a matter of privilege which was raised

by the member for Vancouver-Hastings. On the afternoon of Tuesday, February 10,

the member rose in her place to reserve her right to raise three matters of

privilege. It's worthy of note that the member did not reserve her right at the

earliest convenience, which is a strict requirement of the standing orders of

this House. The failure to do so has resulted in members losing their right on

numerous previous occasions.

I'd refer

the Speaker to the ruling of Mr. Speaker Schroeder of November 25 and 26, 1982,

which is definitive and strict on this issue. The member's earliest opportunity

was at 10 a.m. on February 10, before the House had prorogued. Rather, the

member chose to wait until the afternoon for maximum attention to raise the

issue immediately after Her Honour the Lieutenant-Governor had left the chamber

after delivering the Speech from the Throne.

However,

with regard to the substance of her assertion, the member deals with two issues:

first, that the increase in tobacco tax is illegal; and second, that the

increase in the existing tax rate constituted "a contempt of

parliament" in that "the minister has violated the supremacy of the

Legislature and our rights as MLAs to vote and represent our constituents before

the tax is announced and collected."

With regard

to the first point, the legality of the tax is not the subject of a privilege

motion but rather a matter for the courts. Governments regularly introduce

legislation to retrospectively amend taxation legislation. With regard to her

allegation of contempt of parliament, it would be impossible for members

"to vote and represent our constituents before the tax is announced"

because, simply, there would be nothing to vote on.

If it was

the announcement itself that offended the member, I refer the Speaker to the Journals

of this House of April 10, 1990, and the ruling of Mr. Speaker Rogers who makes

it clear that the presentation of a proposed charge or tax on the public in a

venue other than this chamber does not constitute a prima facie case of

privilege. The issue is rather whether it violates all members' right to vote

before the tax is collected.

As I said

on February 11, it has never been the government's intention to infringe on the

rights of the Legislature. This tax increase is clearly subject to the will of

the Legislature, as all taxation issues are. In addition to the documents tabled

by the member for Vancouver-Hastings, I'll submit to the Speaker a copy of tax

bulletin No. 49, the tax notice and the wholesale dealers' inventory return with

regard to this issue, which clearly state the intention of the government.

As well, my

comments of December 19 to the public were clear. I stated it was the

government's intention to introduce legislation in February that would increase

the rate of tax on tobacco retrospective to December 19 or 20 of 2003. It was

and remains the role of the Legislature to validate that increase or not. The

members will decide. As I also stated on February 11, if the House declines, the

government would need to return those moneys collected to the wholesalers who

have paid it.

[1440]

Further, it

is not unheard of for taxes to be collected before the House has voted. I refer

you to Erskine May's sixteenth edition, page 698, as it pertains to the general

rules of financial procedures where it says: "It will be useful to

summarize here the effect of the financial standing orders with respect to

showing which of the general rules of financial procedure they prescribe and to

which kinds of financial business they apply these rules. It will be seen not

only that they cover a

[ Page 9001 ]

comparatively small portion of the field of financial procedure, but also

that they need help from 'practice' to cover that portion effectively."

Further to

that practice, it has not been universally held that all taxation must first be

passed by parliament before it can be collected. I refer, Mr. Speaker, to page

759, subsection (7) of the same document, where it contemplates "provision

for making a charge with retrospective effect, from the date before that on

which the bill becomes law." Pages 795, 796 and 797 refer to the

provisional collection of taxes subsequently validated by

an act of Parliament.

Mr.

Speaker, as I said previously, it is not the intention of government to infringe

on the longstanding right of parliament to raise revenues. Only parliament has

the ability to validate and authorize the collection of taxes. However, it is

not an unheard-of practice for parliament to validate the collection of taxes

retrospectively, as I've shown.

Indeed, to

the contrary, I've been unable to find even one example of a prima facie case of

privilege that has been found by any Speaker in a similar case. I note that the

member opposite could not and did not.

Mr.

Speaker: The Chair has now heard from both sides in this issue and will

bring back a ruling in due course.

Orders of the Day

Hon. G.

Collins: I call Committee of Supply in this House. For the information of

members, we will be dealing with the estimates for the Ministry of Health. In

the small chamber, we'll be dealing with the estimates for the Ministry of

Finance.

[1445]

Committee of Supply

The House

in Committee of Supply B; J. Weisbeck in the chair.

The

committee met at 2:48 p.m.

ESTIMATES: MINISTRY OF

HEALTH SERVICES

(continued)

On vote 25:

ministry operations, $10,404,260,000 (continued) .

J. Kwan:

Yesterday I was canvassing the minister about the lay of the land, if you will,

about long-term care facilities around the province. The minister had advised

that with respect to closures of residential care beds or long-term intermediate

care beds to date…. He had broken that down for me and advised of the number

of beds that have been closed in the different health authorities. I've added

those numbers up, Mr. Chair, and that gives me a total of 2,369 beds that have

closed. That is from the five health regions.

Keeping

that number in mind, I now want to turn to the report that I was referencing

yesterday, Meeting the Ongoing Care Needs of Seniors and People with

Disabilities. A Planning Model: Home Support, Assisted Living and Residential

Care Services , which was developed by the ministry itself in January

of 2003.

[1450]

Yesterday

the Minister of Health had advised that perhaps some of the information

contained in this report may well be out of date, and I was asking the minister

if he has available information that is perhaps more current or another model or

plan in place in dealing with the home support, assisted-living and residential

care services. Perhaps we could start with that. Could the minister advise me if

there's new documentation with respect to that planning model? If so, what

information can he offer from his own documentation?

Hon. C.

Hansen: I did have a chance to look at the document she was referencing

yesterday. We managed to dig it out. It was a document, as we talked about

yesterday, that went back to January of 2003. It was policy options, as we

discussed yesterday afternoon, and it really sets out the various opportunities

to shift care from that intensive, dependent, residential model to a more

independent model with appropriate home and community supports in place to

support even the most complex of seniors — in some cases where that's

appropriate.

That is

still an ongoing discussion within the ministry and with others that we are

consulting with on that file. As yet, no decisions have been made with regard to

the various options that were set out in that document. Those are still the

options, ranging from the very low shift to the very high shift. At the end of

that, once the decision is made, then obviously that will in turn determine the

number of assisted-living beds that may be required to be opened and constructed

and the number of complex care beds that will need to be maintained or perhaps

renovated or upgraded. As a result of those decisions not yet being made, I

can't give her a specific answer.

J. Kwan:

When does the minister anticipate that he will know which option he would

choose?

Hon. C.

Hansen: There is a lot of work being done now with the health authorities on

this file. I would hesitate to give a time line on it at this point, other than

that we're trying to move forward on it as quickly as possible obviously,

because there are some fundamental decisions regarding the nature of the kind of

care facilities we may need in the future, once we determine the option that is

the most desirable. I apologize to the member. I can't give her a specific time

frame at this point other than to say that we are working on it and would like

to get through it as quickly as possible.

J. Kwan:

The planning that the document refers to goes through several cycles in terms of

time line. It looks at 2006 and 2007, and then at 2011 and '12, and

[ Page 9002 ]

then at 2016 and '17 with population projections. Can the minister advise

whether or not he's working on a long-term plan with the ministry that goes

beyond '06-07, or is it just up to '06-07?

Hon. C.

Hansen: The planning that we are doing really does go much beyond 2006. We

are looking to 2010 — we're looking to 2020 in many cases — to try to

anticipate the needs that will be there on behalf of the population as we go

forward. I think it's something that our Premier has driven throughout

government, and that's that we can't just look to the next quarter, the next

year or the next election. We have to look much beyond that if we're going to

take a responsible approach to our challenges.

[1455]

I think

it's probably the first time, in B.C. certainly, that we've ever had the kind of

long-term planning that we see now. Certainly, when it comes to planning the

number of community care beds in the province, that is no exception. There are

models being put in place that take us into those out years.

I think the

thing that's important to remember is that we are also designing in flexibility,

because even as we start to anticipate the needs in the health authorities two

and three years from now, we know that there still needs to be flexibility —

even in that time frame. As we go forward, for example, with a request for

expression of interest around an assisted-living or a complex care facility,

it's only when we get out in the community that we realize there are other ways

of meeting those needs. We need to be flexible. Yes, we are planning long-term,

and we are doing so with the kind of flexibility that we think is responsible.

J. Kwan:

I should have asked this question earlier on. That is, with this planning

document that I referenced…. While the government has not decided on which

option to choose to move forward with, presumably the data and the facts

contained in this document are valid. Am I right in making that assumption?

Hon. C.

Hansen: What we are trying to do is the kind of modelling that will allow us

to anticipate the needs of communities. There's a lot of work being done around

designing the appropriate tools that can help us in that forward-planning

exercise.

The main

purpose behind the document that the member is referencing is to set out the

options we have with regard to the degree to which we should shift from that

24-hour-a-day dependence model to one that has more independence but with

appropriate support. Yes, there is data in that which helps to guide the choices

when it comes to those various options that are set out, but I think that if we

were to rerun the same model with the new data we have, it might come out with

different numbers.

I think

what's important is not the actual numbers that are in that particular document

but the options that are being set out and the choices that are there for the

kind of care we would be able to put forward to make seniors' lives more

enjoyable and more independent in the years ahead.

J. Kwan:

Well, there's some information here that I think is important, which I'd like to

canvass with the minister, and it's based on the facts in this report.

It does

refer to the different options. Given that the government has not decided on

which option to choose, let me then just ask the questions around the facts. We

can then review them under the different scenarios of whatever option, at the

end of the day, the government chooses.

In this

report it advises under the introduction

section — and I will quote from it

— in terms of the anticipated population change. It states that the population

of seniors aged 75-plus is expected to increase by 51,000 between 2000-01 and

2006-07 — a 21 percent increase; by 77,000 between 2000-01 and 2011-12 — a

32 percent increase; and by 109,000 between 2000-01 and 2016-17 — a 45 percent

increase. Then it goes on to talk about proportion of total population, etc.

I'll just stop there and focus in around the population change.

[1500]

Let me

start with this set of facts. Is it the minister's opinion that this set of

facts are in fact correct, and that those are the facts which the ministry's

working with to determine what option to choose and what plan to move forward

on, with respect to ensuring that there are adequate housing options —

including intermediate and long-term care housing options — for seniors?

Hon. C.

Hansen: The stats that are contained in that report would come from B.C.

Stats. We rely on them for these kinds of population numbers but also for the

projections in terms of population growth in various age groups. As the member

knows, B.C. Stats has a very good track record with the accuracy of their

information, and we certainly depend on it.

They do

update their numbers annually, so from year to year their projections may

change. Whenever we go into a new planning process, we in fact rely on the most

recent B.C. stats that might be available. I believe that those stats are

available on the B.C. Stats website, but certainly that is the source of our

information.

J. Kwan:

Then on that basis, I think it is safe to assume that these numbers are accurate

at least until the next update, so I will go with what is contained in this

report.

These

series of questions that I'm asking…. I hope at the end I will be able to

weave them all together. Right now I just want to establish certain facts within

it so that I know what the assumptions are that the government is working with,

so that hopefully at the end, as I say, I can weave all the questions together

to make my point.

The other

set of information here that I would like to confirm with the minister is with

respect to eligibility criteria in terms of determining which clients should go

into what type of care facility. In the docu-

[ Page 9003 ]

ment it states: "Under the new complex care criteria" — which we

went through yesterday — "the majority of clients that are assessed as

high-end intermediate care" — that's IC 3 — "or extended care are

anticipated to continue to be eligible for residential care" — I assume

the term "residential care" is the new term replacing extended care

— "while the majority of those assessed at the lower-end intermediate

care level, IC 1 or 2, would no longer be eligible." Is this still the

policy of the government?

Hon. C.

Hansen: I think the first thing I want to point out is that the term

"residential care" is not a new term. I think yesterday we talked

about how that is defined. It covers a whole series of different types of

housing options and care options for seniors. To say that for individuals that

have a higher level of acuity — what we would know of as complex care, for

example — that residential care will still be an option for them…. Yes,

that's true. But we also, as we are planning, are trying to look at what

additional options we can give to seniors regardless of their level of acuity.

I think, as

we were discussing yesterday, there is lots of evidence that even seniors with

very high-level care needs can still be allowed to maximize their independence.

You know, we can have individuals with very high levels of needs that can still

be supported in their family home with care being provided.

[1505]

What we're

trying to get to and what we are moving towards is not trying to say:

"Okay, someone is assessed at this particular classification through the

assessment tools, so therefore they have to go to place X." What we're

saying is: let's assess the needs of the individual, and then let's look at the

range of housing options that may be appropriate for that individual. Then let's

work with the individual and family and sort of say: "How much independence

do they want? Do they still want to be maintained in a family home?" That

may not be possible if the complexity of their condition is quite acute.

The intent

is to first of all provide for assessment that can, in a very objective way,

determine what their needs are, and then let's look at the housing options which

could be a residential care model. It could be supportive independent living

with outside supports that are there for the individual. It is a range of

options that we're trying to build towards so that seniors in fact have more

choice in the future.

J. Kwan:

According to this report — my read of it, at least — it indicates that

what the minister has just put on record has already been taken into

consideration. Arriving at the statement around the new complex care criteria,

around IC 3s or extended care, they are anticipated to continue to be eligible

for residential care, while the majority of those assessed at the lower-end

intermediate care level — IC 1s and 2s — will no longer be eligible. When I

read this report, it seems to me that what the minister has said has already

been taken into consideration. Then, with that, they have arrived at the

suggestion of how to provide the options and come up with the numbers for the

options in determining how many beds will be needed under the different

scenarios.

If we keep

going down the road on which the minister wants to go, it would appear to me

that the ministry is not going to be capable of actually nailing down any

ballpark numbers to work with and therefore be able to work towards a target of

establishing how many beds are needed at what level for the future years. If we

just keep saying, "We'll move as things sort of move along," that's no

kind of planning, in my view. If you are going to plan — as the minister says

he wants to do and as this government intends to do — well, you have to nail

down some ballpark numbers somewhere along the line and then work towards those

targets. If we're not going to do that, if you have no targets, then I don't

know what it is that the government is planning towards. That creates a great

set of difficulties, I think, for the government.

Maybe it is

intentional from the minister's side to say, "We don't have any

targets," so that he can get up, or…. For the government to say,

"Well, we met those targets because we never had targets to begin

with," or to erase the targets they had first set out…. To me, it would

simply not work. It would seem to me that it would simply not work.

Going back

to the document, let me put on record, then, what the document actually refers

to in arriving at the statement that I put on record earlier. It states,

"In order to increase the flexibility and responsiveness of the home and

community care system and to ensure residential care beds are available for

complex care clients who require that type of intensive setting, the admission

criteria for residential care were revised in April 2002" — which refers

to the residential access policy. Then it refers you to an appendix, actually.

Unfortunately, the appendix in this copy, in any event, is blank, so I don't

know what the policy is.

I think the

minister yesterday read out the policy with respect to admission, and so let me

just ask this question. The policy that the minister put on record yesterday

with the conditions or the requirements for the different types of admissions,

or

definitions for IC 1s, IC 2s, IC 3s, etc. — am I correct in assuming those

are the residential access policy that the government is now using?

[1510]

Hon. C.

Hansen: I think the member is confusing two aspects of this file. One is the

assessment that needs to be done. As we talked about it yesterday, what we had

in place before was assessment

definitions which would include the need for —

I think we did talk about them yesterday — the IC 1, IC 2 and IC 3 and

extended care. I shared with her some of those

definitions. What we are moving

towards is the new assessment tools under the interRAI assessment tools, which

are far more refined. Out of that assessment it will determine what the care

needs of the individual are. It's looking at their level of mobility and the

[ Page 9004 ]

amount of support they may need from the health care system. Only then do we

start looking at what the accommodation needs are of that individual. Based on

the assessment, we will determine the level-of-care need, and then we will sit

down with the individual and the family to set out what choices are there.

Now, if you

have got someone who is assessed at a low level of acuity where they still have

an opportunity to maximize their independence in their life but they need some

supports, we're not going to give them a choice of the complex care environment.

That was really what I think many seniors were faced with in the past. They

would get to a point in their lives where they could no longer maintain the

family home, so the only choice available for them was what we used to think of

— well, we would still today think of — as the nursing homes where there was

a 24-hour-a-day, seven-day-a-week loss of independence.

This whole

range of choices we are setting out include these variety of housing options

with care components to them. Once we've done the assessment, we determine the

care needs of the individual. We look at what kind of supports there are from

the family or other options, and then we can sit down with the senior and

possibly the family members, as well, to determine what the appropriate

accommodation needs are. Then we try to work with the families and the seniors

to make sure that they can maximize their independence, because we know that is

what leads to a fulfilling life for seniors in their senior years, even when

they do require a certain level of care.

J. Kwan:

The minister did advise this House yesterday that the new assessment tool and

the new category or term being used fall into at least one group called the

complex care group. Then he advised that it goes from A to E, depending on their

situation. Generally speaking, we had a bit of discussion about that as well —

that these are more or less similar to those now in extended care facilities. I

think we established that yesterday.

The

minister was not able to give me the other definition, which I believe is the

assisted-living definition. He advised, Mr. Chair, that I would get that by the

end of the day yesterday when estimates ended. My office still has not yet

received that information, but nonetheless we will continue on with a

discussion, setting aside what those

definitions might be.

[1515]

Having said

that, what I think I just heard the minister also confirm is that according to

this report, the residential access policy, which was revised in April 2002 —

and that is the admission criteria — has taken into consideration the new

categories in terms of options of care and housing options that the minister

references.

The point I

want to make with this report, which I want to establish, is that the report

takes that into consideration. Then it goes on to say, in addition to what I

read off earlier: "This policy is further strengthened by the concurrent

implementation of a comprehensive standardized interRAI assessment tool in

progress, which supports the decision-making of case managers regarding

appropriate care settings." I assume that in that language it incorporates

all of what the minister talks about — that is, to assess the person

accordingly, to talk with the family and then arrive at a decision where the

individual or couple, whatever the case may be, should go.

Then

following that sentence the report goes on to say: "Under the new complex

care criteria, the majority of clients that are assessed as high-end

intermediate care, IC 3, or extended care are anticipated to continue to be

eligible for residential care while the majority of those assessed at the

lower-end intermediate care level, IC 1 or IC 2, will no longer be

eligible."

On that

basis, I am assuming that's the premise with which the government is working and

that's the policy decision, and then that is how the options and the numbers

associated are derived. That's all I wanted to establish — that we are working

with the right assumptions. Those are the policy criteria the government is

working with. This report had taken all of what the minister had said into

consideration, and they still arrived at the statement, saying that those

assessed as high-end intermediate care, IC 3, or extended care are

anticipated to continue to be eligible for residential care, while the majority

of those at the lower end will no longer be eligible.

Am I right

in making that assumption, taking into full consideration what the minister has

said about assessment with regard to the individual's needs and having spoken

with their family?

Hon. C.

Hansen: I think the key word in that document that the member read out is:

"Those who are assessed with a high level of need are eligible

for…." It is not saying we're going to put everybody into a complex care

facility if they're assessed as a high level of need. The evidence does show

that even those with the highest level of need can be accommodated in different

types of accommodation, if there are appropriate supports. They can even be

accommodated in their own homes, in some cases.

What it

goes on to say is: "Those that are assessed with a lower level of need

would not be eligible for that complex care." That is exactly the case,

because what we did in the past with individuals who had a low level of need and

who could no longer maintain themselves in the family home really had no other

choices out there than the nursing home. I think we all know from family

experience that seniors dreaded the point in their lives where one of their

family members would come and say: "It's time; we're going to move you into

a nursing home." That's in a model that, in the past, has had a total loss

of independence.

We also

know from evidence that if an individual has a lower level of need and still has

the ability to direct their own care, still has the ability to live a

semi-independent life, to put them into the old style of nursing home where they

totally lose their independence will actually result in them deteriorating very

quickly.

[ Page 9005 ]

It won't take very long before in fact they are living a life that is totally

dependent, and they will lose their ability to maintain an independent

lifestyle. To take someone with a lower level of assessed need and put them in a

high level of care with 24-hour-a-day dependency would certainly not be doing

those individuals any service and, in fact, could lead to a quickened

deterioration of their health status.

[1520]

J. Kwan:

Maybe we can just step back for a moment. It seems to me the minister is very

defensive about this situation here. All I'm trying to do, Mr. Chair, is

establish some facts based on the government's own report so that I know what

assumptions we're working with and then arrive at, I hope, a reasonable debate

and gain a better understanding of how the government is planning to meet the

needs of our community. That's all I'm doing.

We don't

need, at every question I ask on the confirmation of facts or the basis of

information, the minister to advise me about the need for options of care and to

take into consideration the changing needs. I fully appreciate that. I can't

reiterate any more than I already have that I fully appreciate that each

individual will be assessed accordingly. Then the families will be engaged in a

discussion with the individuals and with the health care professionals, and will

determine what the best housing option for them is, with full flexibility of

whatever those options might be.

The report

actually states that. The following sentence, after I stated about those who are

not eligible, goes on to say: "With the addition of assisted living to the

care continuum, it is anticipated that many of the clients that would have gone

to residential care will now go into assisted living. Others may remain at home

or move to a cluster care setting with enhanced home support services. Such

changes will expand the range of available options." It goes on to talk

about the impact of admission criteria, changes in the types and numbers of

residential care beds, etc. Then it goes on to talk about the aging residential

care facilities, and so on.

I fully

appreciate what the minister is saying. All I'm trying to do at this point is

establish the basis of the assumptions on which we are engaging in this

discussion. That assumption, according to this report, has already taken into

account the notion of ensuring that there is proper assessment, that there is

discussion with the families and that assisted living or staying at home or

other kinds of enhanced home support services would be available for the

individual to expand the range of available options. It talks about that.

Even when

it talks about that, it still states, though, that under the government's

assessment criteria to date, they anticipate the majority of clients that are

assessed as high-end intermediate care — that is, IC 3 or extended care —

will continue to be eligible for residential care, while the majority of those

assessed at the lower-end intermediate care levels, IC 1 and IC 2, will no

longer be eligible. I think we have established that that's the basis on which

the government is working.

We've got

to land somewhere. The notion of targets and how we are trying to get towards

some targets…. We've got to build in some targets. If, in fact, all of this

stuff is not correct or the minister deems that it has not adequately taken into

account the notion of providing full housing options to seniors, then the

options that are before the government right now — the three options…. Even

though they have not arrived at which option to choose, it would say that all of

those options are irrelevant, because the numbers and the assumptions and the

accuracy of the data are not the basis which the government is accepting.

I assume

that's not the case. I assume the government is accepting the basis of these

assumptions and these facts. They have the three options before them. At some

point they will arrive at choosing which option. Am I right so far?

Hon. C.

Hansen: Certainly, what the member has read out in terms of the assumptions

and the directions that she has quoted…. Obviously, they're in the document,

and I don't take any issue with them, if that's the answer she's looking for.

[1525]

J. Kwan:

Well, yes.

In that

vein, I'm also asking if that's the assumption that the minister is accepting

— not to advise in this House or answer my question with respect to whether or

not I've read the paragraph correctly. I know I've read the paragraph correctly

on the record, so I don't need confirmation on that. What I need confirmation

on, though, is that those are the assumptions that the minister is accepting,

and that's the basis which the minister is working towards in building what

needs to be done in terms of home care options for seniors.

[K. Stewart in

the chair.]

Hon. C.

Hansen: Basically, I just want to reiterate that I think we've covered this

before. The document that she's got is a planning document, and it is to set out

options and to provide guidance as we move forward to try to find the right mix

of care in the future. The sections that she read out…. I haven't got those

sections right in front of me today, but I'll take her at her word that she's

read them. We can move forward on that basis.

J. Kwan:

I don't know why the minister is actually trying to be so evasive about it. I

mean, he wants to confirm that I've read the information onto the record

correctly.

The

minister says, Mr. Chair, that he doesn't know what the question is. The

question is this. I want to see whether or not I can get confirmation from the

minister that the assumptions contained in this report, which I've read onto the

record, are the assumptions which the government is working with — that these

assumptions on the projected eligibility criteria, on the projection of who

would be eligible and who would not be

[ Page 9006 ]

eligible for intermediate care, etc., are the assumptions that the government

is working with.

Without

those assumptions, without confirmation of this fact, then I don't know how the

government could plan ahead to say how many care beds would be needed. Even

though within the three options in the report….. The minister has stated that

they have not decided on which option to choose. In arriving at those options,

this report advises that it used these facts and the information contained in it

to formulate the three options. What I'm seeking of the minister is, I think,

quite simple, and that is for him to confirm that the assumptions and the facts

contained in this report are the premise which this government and this minister

are working with.

Hon. C.

Hansen: I'm starting to get a better understanding as to what the member is

asking for. The assumptions that are written into this document allow us to move

forward on developing the models necessary, but the whole thing is a planning

document. Have the assumptions been signed off on? No. The assumptions are here

in this context, in this document, as part of a planning process to allow us to

develop the model.

I think

that as we move forward with the policy that will flow from this, then clearly

we have to not only challenge the model; we have to challenge the assumptions.

Only then are we going to be able to arrive at a final policy. Once we come to a

conclusion of this process and we've actually developed the policy, I would be

pleased to share with anybody who's interested what the final assumptions are

that allowed us to lock into a policy direction to move forward.

J. Kwan:

This is a bit troubling. What the minister is basically saying is: "We have

no targets towards when we will arrive at…." I shouldn't say that; I'm

sorry — not "no targets." He actually advised earlier that he does

not know when he'll have the information sufficient for him to choose which

option to go with in terms of planning for 2006, '07 and years beyond. Earlier

today he said he doesn't know when he'll arrive at that decision.

[1530]

Now, with

respect to even basic information on…. Then he also advised that given the

three options outlined in this planning document…. He said that they have not

chosen an option because they are still working towards arriving at that

decision. He doesn't know when he'll choose what option. He doesn't even know,

of the three options, whether or not — it sounds like — these three options

would in fact be valid options for consideration, because he just said the

assumptions that this report had used to derive the three options are now in

question. The minister himself is not sure whether or not those assumptions are

accurate.

Well, then

that means the minister has got nothing to work with. He has no targets, he has

no time line, and he has no basis of facts to use to determine what he wants to

plan towards, and that is the concept of meeting the needs of seniors and

fulfilling the New Era document commitment for 2006 and then years

beyond. I find that rather shocking.

If the

minister advises that he's got…. The assumptions in this report that I'm

asking him questions about are assumptions that he said we're not necessarily

committing to and we don't know whether or not we will accept them. Well, then

maybe the minister can start off by telling me what assumptions and what facts

he is using as he is planning towards arriving at a decision in terms of how

many care beds will be needed and what kind of care beds will be needed for

2006-07 and years beyond.

Hon. C.

Hansen: I think the comments the member just made underscore for me that she

has never been involved in a planning process before, because in any planning

process they will start with making assumptions. They will then use those

assumptions to develop policy options. In this case, it's the modelling that is

required.

I will take

the member back to the front page of this particular document, where it is

titled " Discussion Paper." That's exactly what this document

is, so as we go out for discussions around this document…. The reason they set

out assumptions in the start of a planning document is because they themselves

are part of the discussion. It is not a case of sort of saying, "This is

our model," and then: "You know, don't worry about our assumptions

because we're not going to tell you about them." We actually set out the

assumptions right in the start of a good planning document, because as we go

around the province and meet with the health authorities and other people that

have expertise in this area, they're quite free to look at the assumptions that

were made and to challenge them, to question them and to change them — to

elaborate on them.

[1535]

To say that

we're somehow locked into some assumptions that are part of a planning document

would simply be irresponsible and not part of a legitimate planning process. If

you look at what's happening in other parts of Canada, Manitoba, for example,

just recently developed some projections around their needs in the future. What

they've done is simply taken their historical trends over the last number of

decades and just extrapolated those numbers forward. What we're saying is that

we want to look at other options and other assumptions that we should be

bringing in so that we can develop some new models that really meet the needs of

individuals as we go forward.

I will set

out for the member what our assumptions are as we go into this. First, we

believe that seniors want more choice. Second, we believe that we have to get

the best value for the taxpayers' dollars for those options that are subsidized

by the taxpayers. Third, we want the best level of care for the respective needs

of individual seniors. Fourth, we want to maximize the independence and autonomy

of individual seniors so that they can live as independently as they are capable

of at that stage in their life. The final assumption we have is that we want to

build in flexibility, so it takes

[ Page 9007 ]

into consideration the geography of this province and the diversity of the

population in this province but is also flexible so that we don't get locked

into some rigid model that isn't going to meet our needs five, ten or 20 years

from now. Those are the assumptions that underscore all our planning

initiatives.

J. Kwan:

You know, I don't need a lecture from this minister to tell me what planning

documents are and how one moves forward with planning documents to arrive at a

target. I know exactly how one does it.

What

troubles me in this instance is this. Here we have a planning document that the

minister has actually gotten from his ministry, which presumably he asked his

ministry to conduct. It is about a year old. Within, it lays out options. It

lays out some basic assumptions in terms of trying to set out how to arrive at

certain targets by a certain date. Those are fairly basic facts.

I fully

understand that when we're doing planning work, some things may change. I also

would anticipate that someone who is prudent with their job and their

responsibilities would actually set something down so that they can work towards

some level of projections but build in flexibilities with the understanding that

those projections may change. I do not expect someone who is prudent to say:

"We do not have assumptions, and those assumptions keep changing, and we

have no targets and no time lines." That's exactly what the Minister of

Health is now saying.

If that's

the case, then I am greatly worried — with what the minister says and the

confidence with which he says it — that he will arrive at delivering the

promise politically but as well, and more importantly, delivering the needs

required by the community. If he has no plan and no projections right here and

now, by 2004, I don't know how he will meet his target goal of providing for the

needs of seniors in a year's time or in two years' time or at any time

thereafter. It makes no sense.

Interjection.

J. Kwan:

The former Minister of Education is heckling me. The current Minister of

Children and Family Development should have the gall to heckle me when she might

want to look internally to her own ministry and see the chaos that is happening

there. So much for the lack of planning. Maybe that is the case in point —

that there was no planning, and the money has gone missing from that ministry.

Interjections.

The

Chair: Members, order.

J. Kwan:

Communities are now stuck in a situation where they are at risk.

Interjections.

The

Chair: Order. Members, please keep it on the topic of the budget items

before us.

The member

for Vancouver–Mount Pleasant has the floor. Continue, please.

J. Kwan:

You know, I would welcome any of the government bench members to rise up and ask

questions of the minister.

Hon. C.

Clark: When you're done.

J. Kwan:

I would welcome that.

Hon. R.

Harris: Have a seat when you're done.

J. Kwan:

Well, okay. They say: when I'm done. Well, sit tight, because it will be some

time. It will be some time.

Interjections.

Point of Order

J. Kwan:

The member for Vancouver-Burrard, Mr. Chair, on a point of order, is heckling me

out of turn. He is actually not in his own seat.

The

Chair: Could the member please return to his seat if he wishes to heckle.

Members,

could we please continue with the questioning of the minister.

Debate Continued

J. Kwan:

It might be wise for the members in this House to learn the rules of the House.

It has only been three years that they've been elected. They might actually

start to learn the rules of this House.

[1540]

Let me get

back to the issue at hand here. The list of things that the minister identified

— the notion around flexibility, meeting the needs of seniors, providing for

options, etc. He says those are the assumptions that he is working with — in

part. In part. According to this planning document…. And I'm not saying this

is the end-all and be-all and that this is the only planning document.

I'm glad

the minister says that there is more work to be done and that it needs to be

updated. So I asked a very simple question of the minister: what updating work

is being done? What are some of the numbers he is working with, so he can advise

this House of his targets in terms of trying to meet those targets, which then

fulfils the commitment that he has said in this House? That is the political

commitment of providing for 5,000 new residential intermediate care beds for

seniors and the commitment of his job as the minister responsible to ensure that

the needs of the communities and the seniors are actually met and on that basis

to judge — not for the minister's own assessment or his own colleagues to say

how well he is doing. We know that his own colleagues, at least, are incapable

of actually doing any form of evaluation that is fair and accu-

[ Page 9008 ]

rate. All that they're able to do is say what the government and the

Premier's office tell them they should say, irrespective of what the reality is.

This

minister, Mr. Chair, I know to be a responsible individual and very prudent in

taking on tasks. He's intelligent; he's forward-thinking. I know all of that. I

see it in terms of his performance. I will acknowledge the minister's good work.

But if the minister sits in his chair and says, "I don't have any time

lines. I don't have any targets. I'm just sort of, you know, out there being

very slippery on the slopes and not able to get any grounding with respect to

any sort of targets," well, then it brings into question this minister's

prudence and his ability, quite frankly, to do his job. It brings into question,

in my view, the level of confidence of British Columbians trying to assess

whether or not this minister says he will meet his goal — a political goal as

well as the goal of meeting the community's need. It brings into question that

credibility.

So let me

start again. Let me start again with respect to the notion of facts and

assumptions. Surely, if the minister says this report's facts and assumptions

are not valid and they're changing on a daily basis, well then, to date, what

information does the minister have to offer? I'm now talking not about vague

generalities and principle statements around flexibility and seniors'

independence. All of those are end goals that people want to arrive at. I would

even go so far as to say that while they may be part of the assumptions, they

are really not assumptions. They are really part of the end goal which one would

use to measure how successful this government has been in trying to achieve its

goal.

[1545]

Part of

that measurement will be based on what kind of time lines the minister might

have established to try and arrive at the goals that he has set; what kinds of

numbers in terms of projections of seniors that would require the different

levels of housing needs. What are those projections for '06-07 and beyond? How

many units are actually out there in the community to meet that projected need

for '06-07 and beyond?

Maybe the

minister can start, then, by answering these questions and let me know what

facts he's using and give me the assurance, Mr. Chair, that the government is

actually just not on a ski slope being very slippery, sliding everywhere and

being completely out of control. Maybe it is the case that the government is

completely out of control. I'm hoping not, because this is a serious matter for

seniors.

Hon. C.

Hansen: The target we have set is that by the end of 2006, there will be a

net increase of 5,000 beds. We spent a lot of time yesterday afternoon as I went

through CMHC numbers and talked about what the health sector itself was doing

towards achieving that 5,000 goal. We talked about what B.C. Housing was doing

towards achieving that goal. I think the information I put on the table

yesterday would give anybody confidence. In fact, we're well on the way to

achieving that goal of 5,000 beds. But as I said yesterday, I cannot today break

down that 5,000-bed number and say it is going to be X number of these kind of

beds and X number of these kind of beds, because that is work we're still doing.

We're trying to be flexible to make sure that we're sensitive to the individual

needs of communities.

The

document she has got before her — this planning document, this discussion

paper — is not about how we simply get to the end of 2006. This is a planning

document that will develop a model that helps us move forward ten, 15, 20 years

in a way that will anticipate the future needs. I can't say how many, for

example, complex care beds we're going to need. If we can support a senior with

complex needs in an assisted-living environment, then we also have to be able to

fund the community support necessary to support that senior in that

assisted-living environment because of their complex needs.

It's not

simply a case of saying that we have X number of complex care beds that we're

going to need in the future to accommodate seniors with complex care needs,

because a lot of this becomes about how you allocate the budget resources to

those needs in the years ahead. If I have to take the budget of this ministry

and put it towards complex care beds, then those are fewer dollars I'm going to

have to put into the community care supports that may be necessary to support a

senior who has complex needs but prefers to live a little bit independently in,

let's say, an assisted-living environment or indeed in the family home.

That is

what this document is all about. We're going out and doing the responsible thing

of saying that it is not up to me as an individual person to try to pretend I

have got all the answers. We've gone out with this discussion document to

actually engage the health care providers in the communities and get the best

input we can from people who are experts in this field. Once we get their

feedback, we will try to finalize the assumptions, and we will try to finalize

the model. Out of that we will be able to finalize the numbers we may need at

any point in time, but again, we'll still try to be flexible to make sure that

we meet the needs of seniors in the future. That's what this is all about.

appreciate the member's desire to get some hard, fast numbers — that we're

going to say that by June of 2006 we're going to have X number of these kinds of

beds. I can't give her those kind of numbers, because we're not driving it from

that perspective. We're driving it from the need perspective of the individuals

and how government can support those individuals to make sure they get the care

they need.

J. Kwan:

The minister made two commitments. One commitment was that he will meet the New

Era document of providing 5,000 new long-term and intermediate care beds by

2006. He says that was a political commitment. Then he made a second commitment

as the Minister of Health Services, and that is that he will ensure the needs of

the communities are actually met — to ensure that for seniors who require the

range of

[ Page 9009 ]

housing options, those requirements are actually there for them. That's what

he committed to yesterday.

[1550]

In that

process, in canvassing about how we're doing towards those goals, we established

and the minister put on record some numbers towards those 5,000 new intermediate

and long-term care beds and how we're doing. I have my own opinion on whether or

not the government is arriving at those numbers and whether or not the minister

would be able to meet that commitment. But I'll set that aside, because that's a

political discussion I didn't want to bring into this House in this set of

estimates.

Today what

I'm trying to establish…. I just accepted what the minister has said and

advised me of yesterday. I accepted his numbers. I didn't challenge his numbers.

I accepted what he gave me in terms of the new

definitions for extended care,

complex care groups, etc. I accepted the minister's word that he'd give me the

information by the end of yesterday — the other set of

definitions with

respect to assisted living. I accepted the minister's word that the information

would be forthcoming. I had said we'll come back to that discussion when I

receive the information.

I have not

yet received the information, and even then I understand. There were a lot of

things going on yesterday, and things may not have arrived at my desk as the

minister would have liked them to. I don't think the minister was being devious

in not providing that information by the end of the day. I accept it. I'm not

challenging that, and I've set that aside.

Today what

I wanted to do was engage in some discussion — not political talk with the

government but rather some basic, factual information — as an opposition

member so that British Columbians who might be watching this debate could, based

on the information I was hoping to canvass with the minister and to solicit from

the minister, judge for themselves whether or not this minister and this

government are going to meet his second commitment — that is, to provide for

the needs of British Columbians.

Then at the

beginning of today's debate I asked the minister: is he working towards '06-07

only, or is he working towards years beyond, in terms of 2011-12 or beyond? The

minister advised that in fact it's not just 2011-12; we're going far beyond

that. We're going to 2020, even, and that was the prudent thing to do.

I thought,

great. Here's a minister who is — at least, so he says — forward-thinking

about the needs of the community. If that's the case, then it is reasonable to

assume that a legitimate question, which I started off with, was to ask: let's

then evaluate and see what the lay of the land is with respect to population

base in terms of aging seniors — what does it look like?

I read from

the report what the projections were, and the minister rose in this House to

advise that those projections were taken from StatsCan. I don't quarrel with

Statistics Canada; I accept the numbers. We now have a base of what we think the

aging population will look like. That is important in understanding what the

aging population would look like, because it will give you a sense of what the

demand would be in future years with respect to different types of housing

options.

Then the

next logical thing to move to, which is what is set out in this report, is to

talk about what this government is doing right now, and that is the government's

policy with respect to eligibility criteria in their assessment. It's taking

full well into consideration the flexibility the minister referenced and taking

into consideration that particular person's individual circumstances — whether

or not the individual's own home would be available or if it's an option for the

person to stay there with additional support, as one example. It's taking full

well into consideration the desire of seniors who want to remain as independent

as they can for as long as they can. That's what this report also says.

Then on

that basis, this report goes on to say that with that in mind, generally

speaking, we are expecting the majority — not all, not 100 percent of the

clients…. All he says is the majority of them. He gives you the flexibility

that there might be some movement within the client groups of who may end up

going into intermediate care, level 3 or extended care homes — who may be

eligible. It has the wording built into that flexibility, and then it has the

wording to build in the flexibility of those who would not be eligible.

[1555]

I think

those are basic assumptions. I was simply seeking confirmation from the

minister. I don't know why the minister finds it so hard to confirm, to say:

"Yeah, that is our existing policy right now, and that's what we're working

with in trying to develop what the model might look like down the road."

It's not a trick question. All I'm trying to establish is some basis to work

towards so that we know with respect to some projections down the road whether

or not the government and the minister are going to meet them. That is all.

Given the

minister's complete reluctance to confirm this simple request of giving me

assurance that the assumptions I read are around eligibility and the policy the

government is working with…. Given that he is reluctant to confirm that, for

future planning purposes, maybe the minister can tell me the current policy.

Maybe the minister can tell me, because in my appendix I actually don't have the

residential access policy. I don't have that information.

Maybe we

can start with this. The minister can advise me: what is the current government

policy right now in determining eligibility, and what is the residential access

policy?

Hon. C.

Hansen: There is actually, I understand, a

section in the Home and

Community Care Policy Manual that sets out the access policy. We don't have

it here in the chamber, but I am endeavouring to get it into the chamber as

quickly as we can.

J. Kwan:

Yes, I would appreciate it if the minister could make available a copy of

that residential access

[ Page 9010 ]

policy. Maybe for the time being, for the purposes of this debate, the

minister can advise: generally speaking, what does the residential access policy

entail?

Hon. C.

Hansen: Actually, I dug out one of my little notes here from earlier,

because the residential access policy, as we discussed earlier, was based in the

past on the assessment tools that were in place. It used to be the IC 1, IC 2,

IC 3 assessment tools criteria that were there before. We are moving towards a

new assessment tool. Based on the care needs that flow from the assessment, we

then work with the individual — and the family, if necessary — to determine

what residential care would be preferable for that particular individual. That,

in essence, to give a

summary, is what our residential access policy is. I will

endeavour to get more detail on that for the member.

J. Kwan:

Is it the case that those individuals who were assessed at what was termed

as IC 1 and 2 — intermediate care level 1 and 2 — would not be eligible for

extended care beds?

[1600]

Hon. C.

Hansen: If you look back over the last…. This actually goes back to 1990.

In 1990 there was about 40 percent of the residential care days in the province

where individuals were assessed at IC 2, IC 1 or personal care levels. Over that

period of time since 1990, we have seen a steady decline in the number of IC 2,

IC 1 and certainly the personal care categories that are put into residential

care.

What we

know from science, from evidence and studies, is that if you put someone into a

dependent level of care — into a complex care environment — before they're

ready for that, in fact they will deteriorate. Their health would deteriorate.

The short answer to the member's question is that she is correct. We would not

place an individual assessed at IC 1 or IC 2 under that old assessment tool into

a complex care environment, because that would not be appropriate for their

needs.

J. Kwan:

I appreciate the minister's answer. He actually did answer my question, the

last part of it — that is, to say yes.

I just want

to be clear. I'm not passing judgment, necessarily, on this policy. I haven't

arrived at that stage yet. I haven't determined whether or not I'm going to,

with this debate. It depends on how the debate goes. I'm simply asking these

questions to determine, once again, what premises the government is operating

under. That's all. The minister need not be so defensive about this, because

it's not a judgment. I'm not passing judgment on whether or not this is a valid

policy or otherwise. I may do that, and I'll reserve that for another day.

Right now

I'm just trying to set out some parameters — in terms of where things are at

and what the current government policy is — and therefore be able to assess,

based on the information I gather from this debate and other documentation, and

arrive at my own judgment of whether or not the government is going to meet the

commitment it has set out. So I appreciate the answer.

IC 1 and IC

2 individuals would not be eligible for extended care beds — which is

basically, by the way, what the report says. That's exactly what the report

says.

Can the

minister then also confirm that the criteria for assessment that we just talked

about…? That is the current government policy?

[1605]

Hon. C.

Hansen: I think what's important to reiterate is that we are moving away

from the model she has just described, with the IC 1 and IC 2. We are moving

towards the new assessment tool, and we're in the middle of that transition now.

The old model was one that had been in place for a number of decades. It was the

five care levels, which were personal care, IC 1, IC 2, IC 3 and extended care.

Those are being phased out as we speak.

What we are

moving towards, as I mentioned earlier, is the new interRAI assessment tool,

which is integrated with client preference. This is the foundation on which the

final care plan is based, and I think that's important.

I'm going

to send the member a copy of this so that she can read through it. I won't go

through it in all the detail. Just to give her a sense of the interRAI

assessment tool, I gather it's now used in 33 countries. It's used in a number

of provinces in Canada already. B.C. was actually one of the jurisdictions that

piloted this, in North Vancouver, to great success.

In the

assessment process…. Let me just read this here:

joint ministry and health authority working group has been established to

resolve common issues related to the introduction of the new assessment

process, such as identifying appropriate client groups to be assessed with the

new tools, developing a transition process to move from current client care

levels to resource utilization client groupings based on the need, and

developing a standardized education and training program to support the

implementation phase and into the future."

Now, the

seven major classification categories of the RAI tool are special

rehabilitation, extensive services, clinically complex, impaired cognition,

behavioral problems, reduced physical function…. I am told that there are

about 30 to 40 subclassifications of these major categories.

Once the

assessment is done based on this new approach, then the decisions are made with

regard to the appropriate residential options for the individual. This goes into

assisted living, as we've talked about earlier. It talks about who can move into

assisted living. It talks about new classifications for residential care

assessment.

I will be

pleased to provide this to the member. I will make sure that she gets it by the

end of the day.

[ Page 9011 ]

J. Kwan:

I would assume that's along with the old criteria — the IC 1, IC 2, IC 3 —

that the minister committed he would provide yesterday. That's included in it.

Great.

Essentially,

then, what the minister has put on record with respect to the interRAI

assessment tool and taking into consideration the concept that those who are IC

1 and IC 2, which was the former terminology, are really what we're dealing

with…. Those in those two levels would not be eligible for extended care. I

assume that taking all of that together is right now the current government

policy.

Hon. C.

Hansen: Sorry. I thought I heard the member say that those assessed under

the interRAI would not be eligible for extended care. Extended care is a

definition that is going to become part of our historical….

Interjection.

Hon. C.

Hansen: Once we have gone through the interRAI assessment, the appropriate

services that may be provided to meet the care needs that are identified by the

interRAI would include home care nursing, palliative care, community

rehabilitation, adult day centre, assisted living, home support, residential

hospice care. Flowing from the assessment really leads us into the whole range

of care options based on the individual needs of the person involved.

J. Kwan:

The range of care options was the list that the minister read out. Is that the

current list which the government is working with?

Hon. C.

Hansen: That is the new assessment system that we are moving towards.

[1610]

J. Kwan:

One would assume that given that you're in this transition period, those who

fall under the former groups called IC 1, IC 2, IC 3, etc., will then be

attached with new terminologies in the new assessment categories that the

government is using.

Can the

minister advise me, then: what is the new terminology for IC 1? What is the new

terminology for IC 2, IC 3, generally speaking? I'm not trying to trick the

minister. All I'm trying to do here is understand the new terminology the

government is working with so that I can actually use it in this debate

accordingly. I understand that it's not necessarily an exact equivalent in every

case and that there is a need to build in some flexibility in that evaluation.

But generally speaking, what are we looking at? Yesterday the minister had

advised that complex care groups A, B, C, D and E, generally speaking, equate

with what was formerly termed extended care. That's all I'm trying to figure out

— what the new terminologies are.

Hon. C.

Hansen: I would very much have liked to have given the member a simple

answer, but there is not a simple answer to what I'm sure she thought was a

fairly straightforward question. Under the new interRAI system that we are

moving towards, it's a rating system. It actually comes up with about 44

different classifications of the needs of an individual under this interRAI that

we are moving towards, which — as I've mentioned — is becoming

internationally accepted.

Given that

rating system with its 44 different classifications, it's not a case of saying

that what used to be IC 3 is now the rating system such-and-such. It's difficult

to make that comparison in that regard. If an individual under the rating system

is in fact classified as complex care, then once they have been designated as

such, we start looking at the five groupings that we talked about yesterday,

which I read out the

definitions on. What we have here now, under this new

system, is one that really comes up with 44 different classification groupings

to identify the kinds of needs of an individual.

The other

note that I was just handed is that the ministry, along with the health

authorities, are currently working to try to map the care levels on this new

interRAI classification. It is work in progress. It is being used in some parts

of the province. The old system is going to be phased out, but the new system is

being brought in. I guess the short answer to her question is that it is almost

impossible to try to compare the old classification to a particular new grouping

under this new rating system.

J. Kwan:

Could the minister advise: when did the ministry decide to adopt the

interRAI assessment tool?

[1615]

Hon. C.

Hansen: The pilot project that was done in North Vancouver was actually

started prior to the election by the previous government.

J. Kwan:

When did this government, after the election, accept the interRAI tool as the

basis to do the evaluation to assess seniors in selecting the appropriate

housing option for them?

Hon. C.

Hansen: I am told it was about two years ago. We started working with the

health authorities. The pilot was deemed to be a success, and we started moving

forward with implementing it around the province. We're still in that transition

process now.

J. Kwan:

Given that it is the case that the government accepted the interRAI assessment

tool approximately two years ago and that this draft report was developed in

January of 2003, it still uses old terminology in terms of IC 1, IC 2, IC 3,

extended care, etc. It does make a reference that states: "This policy is

further strengthened by the concurrent implementation of a comprehensive,

standardized interRAI assessment tool which supports the decision-making of case

managers regarding appropriate care settings." It does take into

consideration that the government has adopted this assessment tool as its

current policy in assessing where

[ Page 9012 ]

seniors should go for their appropriate form of housing.

Given

that's the case, maybe the minister can explain to me: two years ago, when the

government accepted the interRAI assessment tool, why was this report done in

such a way that it does not fully recognize this piloted assessment tool that

the government has adopted as the practice and policy for its decision-making?

Hon. C.

Hansen: I know the member read out a quote from that document she had. Maybe

this is the same quote, so I apologize if I'm repeating it. On page 9, where it

refers to the interRAI assessment tool, it says: "With the introduction of

the access policy and the provincial mandating of the comprehensive standardized

interRAI assessment tool, B.C. is in a better position than ever to project the

future need for residential care beds."

At the time

this report was developed, we were still at the early stages of implementing

this interRAI across the province, and this report calls on historical data,

which really was built on some of the old classifications we have talked about

— the IC 1–IC 3 classifications.

The other

thing is that the implementation of the interRAI assessment tool is an expensive

process. It is one that requires some complex information systems to be put in

place. It requires considerable training for community care staff in the

province — community care nurses and others.

[1620]

That's the

reason why it wasn't simply a case of saying: "Let's start the RAI process

as of a certain date where everybody's in it." It is going to take several

years of transitioning before we are able to be fully into that new interRAI

world, but we are well along that track now. This report the member has before

her relies, as she knows, on historical data put together using the

definitions

of the old model.

J. Kwan:

Then because this report was done when the transition is still in place between

the two assessment tools, that is to say the old terminologies being used —

the IC 1, IC 2, IC 3, etc. — are still valid because they are still being used

right now as we're in transition. One would also assume that some of the

conclusions, or at least some of the recommendations, and the facts found within

this report are also valid. One can only assume that, because the minister says

when this report was written, it wasn't just based on old information or old

assessment tools. It had taken into consideration, in the transition process,

the new assessment tool, and all of that was being considered. Still, in this

report it arrives at some, I think, critical numbers in terms of the summaries

of findings in terms of where they're at with some of this information.

I'll just

put this on the record here now. In this report, aside from setting out the

population base in terms of the aging population and what that might look like

in different years with the benchmark of 2006 and '07, then 2011 and then 2016

and '17 and then looking at the government's assessment tools that they have in

place…. Taking into consideration the old assessment tools that were used as

well as the new assessment tool, the interRAI assessment tool, and with the full

concept of wanting to find appropriate housing for seniors to maximize their

independence and provide the full set of options to seniors — taking all of

that into consideration — the report actually also provides this background

information. That is to say, the rates for the IC 2, IC 3 and extended care

clients have each increased, although not nearly sufficient to offset the rate

of decrease for PCs and IC 1 clients, as shown on the diagram it references.

In fact,

all throughout the report it makes reference to that effect. It talks about the

rate of change and what they anticipate the rate of change might be, utilizing,

yes, old terminology — IC 1, IC 2 and IC 3 and extended care — but at the

same time with the full knowledge and information of the government's new

assessment tool and the projected goal of maximizing independence for seniors

with the appropriate housing option.

The report

goes on to say that in terms of the different trends with the rate of change —

and I'll put this on the record because I don't want to provide the wrong

information:

"Consistent

with a reduction in the number of home support clients, B.C.'s home support

client 75-plus hours per 1,000 population 75-plus has also been slowly

declining year after year although at a lesser rate. Rates between 1994-95 and

2001-02 decreased by 22 percent from 24,916 to 19,330 hours per 1,000

population 75-plus. Thus, the average hours of home support for those

receiving services increased. While the home support client 75-plus hours for

1,000 population 75-plus rates have declined for all care levels, the most

significant decline is for PC and IC 1-level client hours, as shown on the

diagram."

Then it

goes on to reference the trends in B.C.'s residential care utilization rate over

time. It does state:

"B.C.'s

residential care bed utilization rates have been slowly declining year after

year. Rates between 1994-95 and 2001-02 decreased by 20 percent from 127.9- to

100.2 per 1,000 population 75-plus. This reduction was primarily due to a

reduction in utilization by PC and IC 1 clients, particularly between 1994-95

and '97-98. Rates for IC 2, IC 3 and EC clients have also decreased but at a

much slower rate. Although still declining, rates have shown increasing

stability over the past four years, as shown on the diagram."

[1625]

Then it

goes on to talk about, basically, the rates of change, but at the end of it, it

always arrives at the place where it says that while the rates for IC 2, IC 3s

and EC clients have remained relatively stable, it does talk about PCs and IC 1

clients having decreased. The point that I'm trying to establish here is this.

According to this report, yes, the PC and IC 1 levels tend to have declined, and

historical data supports that. However, for the IC 2, IC 3 and EC clients, their

rates, in terms of the rate of client, tend to have remained relatively stable.

[ Page 9013 ]

Those are

the facts that I wanted to actually lay out with the minister. I see that the

minister actually has the report before him, and I know that he was looking at

it yesterday as well. The pages that reference this are pages 5, 6 and 7. It is

headlined under sub(ii), "Background." All throughout the

"Background" headline it talks about the rates of change, basically

arriving at, yes, some levels have changed and some levels have basically

remained stable. Particularly, IC 2, IC 3 and EC clients have remained

relatively stable.

I just want

to verify whether or not the government — the minister — agrees with this

historical fact that has been outlined in this document.

The

Chair: Let's take a five-minute recess, members.

The

committee recessed from 4:27 p.m. to 4:30 p.m.

[K. Stewart in the chair.]

On vote 25 (continued) .

Hon. C.

Hansen: This actually goes back to a policy directive that came out in 1994.

I'll just read the description of the policy directive, because it is still the

policy today: "Since 1994 the Ministry of Health directive addressed

changing demographics and heavier community care workloads by restricting

low–care need clients' access to home support and limiting stand-alone

housekeeping to exceptional cases. Health authorities have modified and adapted

their practices to comply with this requirement and allocated home support to

those who need it most."

When you

start looking at the services that are available for the high-need clients, they

have been maintained, but in fact it has been phased out for those with a lower

level of care needs in accordance with that 1994 policy. It says here: "The

average number of hours per client has increased from 166 per client in '97-98

to 195 hours per client in '02-03. This is an increase of 17.5 percent and is an

indicator of the increased level of complexity of clients in 2002-03 as compared

to the mid-1990s."

J. Kwan:

I was asking the minister whether or not he agreed with the historical changes

in terms of what was stated in this report, and that is the decline in IC 1s and

PCs. The rates for IC 2s, IC 3s and ECs, while they have decreased, decreased at

a much slower rate and in fact have shown that they have remained relatively

stable over time. I was only just getting confirmation with respect to that

fact.

Hon. C.

Hansen: On the bottom of page 5 in the report, for example, the chart there

is historical data. It starts in the '93-94 year and takes us up to the 2000-01

fiscal year. My understanding is that is factual data.

J. Kwan:

Great. That's all I wanted to know, so that we know the facts before us are the

facts we're working with and that I'm not using wrong information. I would

assume from the minister's answer that his ministry is accepting these facts.

Now, let me

turn to another area. In this report, what it does at a later

section is to

translate those percentages, those numbers and those assumptions into actual

numbers. Let me put it on the record. It's on page 12, the HCC client and

service projections, which reads:

"While

the total number of clients served in each scenario is projected to increase

from 35,400 in '00-01 to 41,000 by '06-07 — 5,600 clients or 16 percent —

the location of clients is dependent upon the scenario. In the status quo

scenario" — and that is no change — "all 41,000 clients would be

expected to be located and cared for in a residential care setting. This

compares to 32,400, 30,600 or 28,600 clients in each of the scenarios 1, 2 and

3 respectively. The difference between 41,000 and the number of clients

projected to be cared for in the residential care setting represents those

expected to be diverted from residential care to assisted living or

independent living with enhanced home support services — 9,200 and 22

percent of clients, 11,000 and 26 percent of clients, and 13,100 and 31

percent of clients in each of case scenarios 1, 2 and 3 respectively."

I just want

to ask the minister the question, and again it's to understand the basis on

which we're working, if these numbers are valid in the minister's opinion.

[1635]

Hon. C.

Hansen: I think, as I mentioned earlier, the data used in here — the

demographic data and demographic projections — is from B.C. Stats, and B.C.

Stats does update those annually. This was based on the data that was available

to us from B.C. Stats as of the time this was written. As we come back to the

whole issue of the assumptions that we talked about earlier, the assumptions are

just that. They're not something locked in stone. I guess if someone was to go

back and successfully challenge the assumptions, then that would also produce

different numbers. These are based on B.C. Stats data.

J. Kwan:

Fair enough, because this is when it was gathered — in 2003. I expect that in

2004, if those numbers changed, they probably would not have changed that

substantively. There might be some variation, and I accept that. I'm not sort of

trying to nail down to the last one in terms of how many seniors fit into what

category. I'm just looking at ballpark numbers. These numbers I accept, and I'm

glad to hear the minister accepts them as well.

Turning to

another

section of the report, it talks about the projections of need for

assisted living in residential care bed units, which is page 15 — the

projections for 2006 and 2007. It reads:

"While

the total number of beds and units required in each scenario is projected to

increase, the size of the increase and the location of clients is dependent on

the scenario. In the status-quo scenario, the number of beds required is

projected to increase by 4,500, all of which would be residential care. In

other scenarios the number

[ Page 9014 ]

of beds and units is projected to increase by somewhere

between 1,300 and 4,200, which would be apportioned approximately 75 percent

to 78 percent residential care and 22 percent to 25 percent assisted living.

"The

combined residential care and assisted-living unit utilization rates under

each of these scenarios range between 90 and 100 beds per 1,000, 75-plus,

which compares to the '01-02 utilization rate of 100.2."

It goes on

to say that projections for 2011-12, in the status-quo scenario:

"…the

number of required beds is projected to increase by 9,100 over 2000-01 beds,

all of which would be residential care. In other-case scenarios, the number of

beds is projected to increase by somewhere between 5,300 and 8,900, which

would be apportioned approximately 72 percent to 76 percent residential care

and 24 percent to 28 percent assisted living. The combined residential care

and assisted-living beds utilization rates under each of these scenarios range

between 95 and 106 beds per 1,000, 75-plus, which compares to '01-02

utilization rate of 100.2."

Then it

talks about the projects for 2016 and 2017. The paragraph essentially reads the

same, but the numbers change for the status-quo scenario for a projected

increase of 13,600. Then in the other-case scenarios the increase is ranging

from 9,400 to 13,400. I won't read the rest, because essentially it's the same.

[J. Weisbeck in the chair.]

Finally, it

arrives at this paragraph, where it reads:

"Interesting

to note is that after three to five years, the reduction in the utilization

rate achieved as a result of implementing the access policy becomes at least

partially if not totally offset by the increase in the proportion of the

75-plus population in the very old age group — i.e., 85-plus. Those in the

very old age group have higher utilization rates than those between 75 and 85

years old."

[1640]

On this

basis and based on historical projections, I'm asking the minister, Mr. Chair,

whether or not he accepts these projections as outlined in this report.

Hon. C.

Hansen: I think I have to come back to a discussion we had earlier that this

is, in fact, a model. There is a set of assumptions set out. There's a model

that's developed. This is a theoretical framework for how to anticipate future

needs, and it is a discussion paper. We have gone out to get feedback on it, and

that's where we're at with this thing. So, no, I'm not going to say that I

endorse all of these projections, because I don't have that feedback yet. It

would defeat the purpose of going out with a discussion paper if I were to lock

myself into a particular projection.

But once we

come up with a model that we can have some consensus on among those that are

involved in this field, what we still have is a theoretical number, a

theoretical model. We then have to translate that from the theoretical to the

practical.

A lot of

that is actually happening now, because we have to take into consideration the

fact that we're not starting with a blank slate on any of this stuff. We have

geography that we obviously have to contend with. We have existing facilities

— some of which are useful going into the future, others that are not and some

that can be renovated. We have to take into consideration the diversity of

populations in different communities. At the local level, clearly, the needs and

how this particular model may be applied in a community like Dawson Creek would

be very different than those in a community in the lower mainland.

This will

arrive at a theoretical projection and will be a useful tool for our planning

process. But we're not yet at a stage where I'm going to say I will endorse any

of the particular numbers that come out of this projection, until such time as

we've had a chance to work through the decision-making process.

J. Kwan:

The minister keeps on going back to say he's out there soliciting input and that

this is just a discussion paper. Is this the discussion paper that's gone out to

the health regions and to other health care professionals or whoever the

minister is consulting with? Is this the discussion paper that he's anticipating

feedback from?

Hon. C.

Hansen: This particular document is part of a considerable volume of work

that is being done across Canada. In this province we have a home and community

care council, for example, which has input from the different health

authorities. They meet regularly, so in addition to this document, they

certainly have had lots of discussions and reviews of available literature.

There are academic partners that are called into that on a regular basis. We

also, through that, have input networks from Pricare, the B.C.

Hospice–Palliative Care Association and groups like that.

[1645]

There's

been a fair amount of discussion at the FPT level in Canada. There are documents

that have been presented at the FPT level, which also become part of the

consultation or the consultation documents that are being used. Health Canada,

for example, has been developing a lot of guidelines. In the health accord that

was signed a year ago last month, there is health accord funding that flows with

regard to home and community care. There is a lot of material that's been pulled

together by Health Canada as well, which becomes part of the discussions that

are taking place in the province to help determine how we move forward on this.

This document is one of those documents that is being looked at to help guide us

in this policy-making process.

J. Kwan:

From what I gather then, there is no one discussion paper that the minister is

talking about that he's seeking input on from the various sources. It sounds to

me like there's a whole bunch of different documentation the minister is using.

Does the minister have copies of all this documentation?

Hon. C.

Hansen: Yeah, a lot of this documentation is really in the public realm.

When we talk to those in the province that can bring some expertise to the table

around this, they bring in their documentation. Some

[ Page 9015 ]

of it's available from websites. As I said, some of it is Health Canada

documentation that they're sharing with all of the provinces to help guide us as

we move forward on this thing. There's a considerable amount of documentation

that is being utilized, but it's not necessarily documentation that's been

generated by the Ministry of Health Services in this province solely and for the

exclusive use of this province. We are really looking at quite a broad range of

information that comes to assist us as we develop this policy.

J. Kwan:

The minister refers to other provinces, the federal government, etc. Is he

talking about developing a planning model for home support, assisted living and

residential care in British Columbia in conjunction with other provinces, and

therefore there would be a plan that's not just for British Columbia but for

other provinces and potentially — from the way it sounds — for the rest of

Canada?

Hon. C.

Hansen: There is an FPT table that is trying to help coordinate some of the

information flow around it, but it's not something that's going to lead to one

national home and community care program. It's being chaired by Ontario this

year, and it is designed to try to learn from the experience of each of the

other jurisdictions that participate in that table. In addition to that,

certainly at the deputy minister level, there has been a lot of discussion

nationally around home and community care, particularly as those issues flow

from the health accord discussions.

This

document the member has been referring to over the course of this debate is a

document we have shared with other jurisdictions. They, in turn, have shared

information with us. It's not something that we're trying to all head towards

the same common outcome on, but we are trying to make sure we share information

and best practices in a way that we can learn from each other's experience.

J. Kwan:

Well, thank you, then. Fair enough. I understand those tables. With different

ministries and having been in government before, I've been at those tables as

well — whether it be on homelessness or housing or whatever the case may be

— so I understand what the minister is saying and what happens at those

tables. But those tables, generally speaking, do not become a place where

government, for the purpose of this discussion, develops its model for home

support, assisted living and residential care. It may be a place where everyone

gathers together to exchange information, best practices and so on. You sort of

go home with a pile of paper, and then you sift through them, and then you sort

of figure out who's doing what and what's working for whom and all that stuff.

You might pull a piece from here and there and adopt it into part of your plan.

[1650]

It doesn't

sound to me, though, that part of that consultation the minister references

around this table is the consultation process that the health authorities are

engaging in. I assume, when the minister advised that the health authorities are

engaging in this consultation with the minister, they are working towards

developing a plan for British Columbia — a plan of home support, assisted

living and residential care. Am I not right in understanding that?

Hon. C.

Hansen: It would not be fair to say that this process we've been talking

about over these number of hours is going to lead to a home and community care

plan, as I think the member's words were. Rather, this is a model that is being

developed, which will help us as a planning tool going forward.

In the

discussions that we've had, we've been working with those in the health

authorities that are m