1988 Legislative Session: 2nd Session, 34th 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)

THURSDAY, JUNE 9, 1988

Afternoon Sitting

[ Page

4963 ]

CONTENTS

Routine Proceedings

Freedom of Information Act (Bill M206). Mr. Jones

Introduction and first reading –– 4963

Oral Questions

Privatization proposal for ICBC. Mr. Harcourt –– 4964

Layoffs at Rim sawmill. Mr. Miller –– 4964

Privatization of highways maintenance. Mr. Lovick –– 4965

User fees in elderly-care facilities. Ms. A. Hagen –– 4965

Moratorium on uranium-mining. Ms. Smallwood –– 4965

Coquihalla Highway access. Mr. Williams –– 4965

Salmon fishery. Mr. Miller –– 4965

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Dueck)

On vote 45: minister's office –– 4966

Ms. A. Hagen

Mr. Rose

Mr. Michael

Ms. Marzari

Mrs. Boone

Mr. R. Fraser

The House met at 2:07 p.m.

HON. MR. STRACHAN :

On behalf of the government, I'd like to recognize a good and

hard-fought election campaign by Mr. Barlee, Mr. Fox and Mrs. Tyabji,

and offer our congratulations to the opposition and Mr. Barlee on their

electoral success yesterday. I know there's been some question, but we

will not be asking for a recount.

HON. MR. REID : I'd

like the House to welcome four people from Surrey School Board who are

here with us today: board chairman Laurae McNally, board member Pam

Lewin, Doug Jennings, superintendent of School District 36 in Surrey,

and Mr. Leigh Anderson, secretary- treasurer. On behalf of my

colleagues from Surrey, the member for Surrey Guildford-Whalley (Ms.

Smallwood) and the member for Surrey-Newton (Hon. Mrs. Johnston), we

welcome these people to Victoria. I hope they spend $148 million

effectively.

HON. MR. PARKER : In the gallery today

is a distinguished visitor, Mr. Brian Watkins, consul-general for

Britain. His offices are located in Vancouver. Would the House make him

welcome, please.

MR. CASHORE : In the precincts today

are 50 students and their teachers from Our Lady of Lourdes School in

Coquitlam. Would the House join me in making them welcome.

MR. DIRKS :

I'd like to make an introduction this afternoon for my colleague the

MLA for Columbia River (Mr. Crandall). There are 38 grade 7 students

from the J.A. Laird School in Invermere visiting us this afternoon,

accompanied by their teachers David Sharp and Larry Ballard. Would the

House please make them welcome.

MR. DAVIDSON :

Visiting today are students from the Seaquam alternate program school:

Willard L'Hirondelle, Josh Bowman, Elizabeth Megalos, Leesah Haley,

Ryan Hewgill; and with them their teachers Joyce Williams, Yashoda

Reddy and Steve Ferguson. I would ask the House to make them welcome.

MR. R. FRASER :

Mr. Speaker and colleagues, on behalf of the member for Burnaby-Edmonds

(Mr. Mercier), I would like to welcome 70 students from St. Thomas More

Collegiate, who are visiting the chamber today. There are so many

students that a second group is coming at 2:30. Interestingly enough,

the member is over at the school right now awarding a large provincial

grant for the construction of an all-weather playing-field; otherwise

he'd be doing this introduction himself. On behalf of the member and

all of us, would we make the students welcome.

MR. HARCOURT : I would like to respond to the very generous words of

the government House Leader in regard to the by-election last night. On behalf

of the members of the Legislature, I would like to congratulate all of the candidates

who participated, and their workers. That is what makes our democracy great:

that we have differences of opinion. We work hard for those opinions, and the

voters decide. On behalf of all of us, I would like to express congratulations

to those who participated in the by-election last night.

was thinking about starting off question period today by saying: Mr.

Speaker, we have no questions; we got the answer we wanted last night.

But I think we should proceed with business as usual.

MR. PELTON :

With the indulgence of hon. members, I have two or three introductions

to make. On your behalf, Mr. Speaker, I would ask the House to welcome

Mr. Harold Gregory of Vancouver; Mr. and Mrs. Robert Hounsorn of

Brighton, Sussex, England; Mr. Gary Powers of West Vancouver; and Mr.

Adel Mosley of Vancouver.

As well, one of our outstanding young legislative interns, Sarah — I'm sure everybody knows Sarah Bonner —

has her great-aunt Gretchen Miles, from Kellogg, Idaho, here today;

Sarah says that she's not only a great-aunt but she's a great lady. I

would ask the House to make her really welcome here this afternoon.

MR. LOVICK :

I would also like to introduce my colleagues in the House to some

visitors, the family of my legislative assistant Margaret Mortimore:

her husband, Jim and her son Michael Mortimore are in the precincts, as

well as Michael's wife Rhonda and Rhonda's parents, visiting from

Sylvan Lake, Alberta, Alvin and Margaret Lundgren.

MR. BRUCE :

I would like to congratulate the NDP on its victory last night. I know

the feeling well, having won my riding for the first time for the

Social Credit Party in 1986. They must be enjoying that feeling. I

appreciate that; it's something that makes you feel very good when you

are able to accomplish it for a first time.

With that, I

would also like to introduce to you another two members of the

constituency of Cowichan-Malahat: Calvin and Sharon Fee. Would you

please make them feel welcome.

HON. MR. DUECK : I

would like to add to the list of introductions I made this morning. We

have another nurse joining us this afternoon. She is the vice-president

of the Victoria

chapter of the RNABC, Wendy Underhill. Would the House

please make her welcome.

[2:15]

Introduction of Bills

FREEDOM OF INFORMATION ACT

Mr. Jones presented a bill intituled Freedom of Information Act.

MR. JONES :

Mr. Speaker, we need a statute in this province that will

systematically ensure that the public interests will be preserved by

providing information. This bill would do that. It would allow for

access by individuals to information that the government holds as well

as protect the privacy of information that the government holds on

individuals. We saw the importance of that recently in Nova Scotia

where a cabinet minister was charged under such legislation.

Not

a week has gone by in this province where we have not seen the public

interest denied because of the lack of this kind of legislation. We saw

yesterday, in terms of access to information regarding the sale of

public assets, as well as

[ Page 4964 ]

information

on the Provincial Capital Commission hearings and on the sectoral

analysis of the impact of the free trade agreement and access to

pollution reports on pulp mills, that the need for this legislation is

overwhelming.

It is overwhelming because of the situation

we have now. The discretion is left entirely to the government in the

vast majority of areas. So what we have, by default....

MR. REE :

On a point of order, I believe the presentation by the member is

argument at this point and not related to the bill as such. Possibly

the member could be instructed by the Speaker as to what sort of

presentation is to be made on first reading.

MR. SPEAKER : The member is supposed to make a brief introduction of the bill and has two minutes to do so.

MR. JONES :

By default, we have legislated secrecy in this province, and what we

need is legislated openness. This is not radical legislation. It was

introduced in the United States some 22 years ago. It exists in this

country under federal legislation, and every other province in Canada,

except Alberta, Saskatchewan and Prince Edward Island has such

legislation. We in this province don't want to be the last province in

Canada to enjoy this freedom of information.

I hope that

this bill will lead in some way to freedom of information legislation

in this province. To do so would be a profound expression of the health

of our democracy; to not do so would confirm suspicions that the

government is not serving the interests of the people.

Bill

M206 introduced, read a first time and ordered to be placed on orders

of the day for second reading at the next sitting of the House after

today.

Oral Questions

PRIVATIZATION PROPOSAL FOR ICBC

MR. HARCOURT :

I have a question for the Minister of Labour. This morning a small

group of private insurers, led in finance by the Toronto-based

Insurance Bureau of Canada, have launched an $800,000 public relations

campaign to have ICBC privatized.

Last night the minister

said that he wasn't really interested, but that he would look at their

proposal. Given that the corporate operating costs of private insurers

are 11 percent higher than ICBC, Mr. Minister, why are you considering

the sale of ICBC?

HON. L. HANSON : First of all, the

Leader of the Opposition is making an assumption that we are

considering privatizing ICBC, and that is a subject for future policy.

As I said in my statements, we have a number of privatization

initiatives. ICBC is not on that agenda.

I am pleased to

hear that the insurance companies have chosen to spend almost $1

million in British Columbia to add to our economy through a public

relations program. That certainly is not difficult for us in British

Columbia to agree to. On the other hand, I would have to say that we —

unlike the members opposite — are prepared to listen to any

presentation by anyone at any time. But that does not necessarily make

us agree that the presentation would be accepted or put into effect.

MR. HARCOURT :

A supplementary, Mr. Speaker. In British Columbia the Insurance Agents'

Association have said: "In our opinion, ICBC is at the present time

providing the best motor vehicle insurance in Canada." Since the

minister knows that pricing for profit would add at least $115 to every

policy, will he now state that ICBC is not for sale and advise the

insurance companies involved that they're wasting their clients' money

on their campaign?

HON. L. HANSON : Again, that is a

subject of future policy. I have already said in my remarks that I

think privatization of ICBC is not on our agenda. But unlike the

members opposite, we do listen to everyone in British Columbia and

their ideas and give them fair and reasonable consideration. We don't

have a closed mind about anything.

LAYOFFS AT RIM SAWMILL

MR. MILLER :

A question to the Minister of Forests. At a meeting this week in

Hazelton with municipal leaders concerned about the closure of Westar's

South Hazelton sawmill and the loss of 110 jobs in that community, the

minister said, and I quote: "You know as well as I do that in any other

culture they would move to look for work. " Would the minister explain

to this House just who he was referring to when he said "any other

culture?"

HON. MR. PARKER : The member opposite is

discussing third hand a conversation in the district manager's office

in Hazelton last Saturday, at which time it was pointed out to the

folks gathered there from the various councils that a layoff was

pending at Westar's Rim sawmill and that some people would be

unemployed in the area. I stated that the opportunities may not be in

that community for further employment and that people may have to move

elsewhere. I remarked to one of the mayors there who had moved into the

area that he had seen fit to go where the opportunities were. That was

the gist of the conversation.

MR. MILLER : I don't

think that's quite good enough, Mr. Speaker. I talked this morning with

Alice Maitland, the mayor of Hazelton, who, upon your uttering those

words, got up and left the meeting and said: "I've had enough of this."

Mr. Minister, it's not good enough. "In any other culture, they would

move." Which culture? There's the native community there, and there's

the non-native community. Which culture were you specifically referring

to when you said they should leave the riding because there are no jobs?

HON. MR. PARKER : I'm sorry, Mr. Speaker, I can't recall using that term at all.

MR. MILLER :

Well, it was quite clear in the minds of the people at the meeting, and

it was quite clear in the region that you're supposed to represent.

supplementary, Mr. Speaker. The minister is also a minister of state

for economic development, presumably a cornerstone of this government's

policy. The minister of state for economic development advises people

in a community where 10 percent of the workforce is going to be thrown

out of work tomorrow that in his opinion they should leave the area. Is

that part of the decentralization policy of the ministers of state of

this province?

HON. MR. PARKER : There are substantial opportunities now in the northwest with the initiative for regional

[ Page

4965 ]

economic development. There's a powerline going to Stewart — employment

opportunity. There are expanded silviculture jobs in the northwest. There's

a new addition to the Kitimat pulp mill underway, and there's substantial

employment there. There's substantial employment in the renovations at the

pulp mill in Port Edward, and there are opportunities all up and down the north

coast. People don't even have to leave the constituency for job opportunities,

but they really have to be heads-up and seize the opportunities where they lie.

Some people may wish to move further afield. But they can stay right in the

region, and they're most welcome, because we have taken great strides toward

making those opportunities available to them.

MR. MILLER :

A supplementary, Mr. Speaker. I think the people of those

constituencies are going to give the minister an opportunity to embark

on another career after the next election. One hundred and ten people

are losing their jobs this week, Mr. Minister. You promised them an

answer today. What are you going to do for the 110 people, the 10

percent of the workforce of the Hazeltons, who are losing their jobs,

in terms of giving them some kind of security that there will be

further job opportunities in that community?

HON. MR. PARKER :

The sawmill being closed in Hazelton tomorrow is one that was destined

for closure upon the completion of the new mill at Carnaby siding,

about five miles south of the Rim sawmill, so all the employees in the

old mill were offered the opportunity to work in the new mill. Some

took that opportunity; many didn't, and those are the ones facing

layoff now. Of course, being in a bargaining unit, they have the

opportunity to bump in to positions in the new mill.

The

whole purpose of the exercise in creating the new mill was to replace

the old inefficient mill, which has about 25-year-old technology, and

that has taken place and the community knew it. It was working on a

single-shift basis, where it employed fewer than the 110 mentioned by

the member. However, there are a number of people on recall because the

bargaining unit — the contract — calls for recall, so the

people actually being displaced from a job are considerably fewer than

110, but a lot lose their recall opportunity.

As to what we

are doing, I said that I would be communicating with them, and my

ministry is communicating with the community now. The Kispiox timber

supply area is due for a reanalysis, and that reanalysis was to be

completed by the middle of next year. We'll complete that this year and

determine what options there are for the Hazelton area and the timber

supplies out of the Kispiox. Preliminary information should be

available in August, so we should be able to indicate to the village

councils and the Gitksan and the chamber of commerce by about the

middle of August or so what the options are in the Kispiox.

PRIVATIZATION OF HIGHWAYS MAINTENANCE

MR. LOVICK : A question to the Minister of Transportation and Highways.

During the by-election campaign in Boundary-Similkameen, very strong concerns

were expressed about Highways privatization, including concerns about public

safety and local employment. My question to the minister is just this: given

last night's by-election results, has the minister decided to finally listen

to the public and abandon the plans to privatize Highways maintenance operations?

HON. MR. ROGERS : No.

USER FEES IN ELDERLY-CARE FACILITIES

MS. A. HAGEN :

My question is to the Minister of Health. The riding of

Boundary-Similkameen has the highest number of senior residents of any

constituency in the province of B.C. They have made their opposition to

the longterm user fee imposition very clear during the course of the

by-election. Has the minister finally decided to reconsider and to plan

to withdraw unfair long-term user fees on the seniors of this province?

HON. MR. DUECK : No, I'm not.

MORATORIUM ON URANIUM-MINING

MS. SMALLWOOD :

My question is to the Minister of Energy, Mines and Petroleum

Resources. The voters of Boundary-Similkameen have expressed their

opposition to uranium mining. They did so in the municipal referendum,

and they have again registered their opposition in the by-election. Has

the minister reconsidered the moratorium, and will he now reinstate it?

HON. MR. DAVIS :

As long as there's no possibility whatsoever of uranium-mining

occurring in that area, I see no reason to consider or reconsider a

moratorium.

[2:30]

COQUIHALLA HIGHWAY ACCESS

MR. WILLIAMS :

To the Minister of Highways. Again, one of the issues in the

Boundary-Similkameen area is the question of access to the extension of

the Coquihalla Highway, and the question of direct access to Penticton

and Summerland. Has the minister reconsidered, and is he considering a

proper access to Summerland that will be on a par with the accesses

being provided to the city of Kelowna?

HON. MR. ROGERS : We will continue with the construction as has been designed and announced in the communities.

MR. WILLIAMS :

Is the minister then not prepared to have a separate, proper cutoff

that will give quicker, direct, shorter access to Summerland and

Penticton so they will not be hurt in their tourist industry as they

will with your present plans?

HON. MR. ROGERS : I thought he would save that very well-researched question for the new member who will come in and obviously want to ask it.

No, there isn't a change. I have not made any changes in the plans. I have not had a request to make a change in the plans.

MR. WILLIAMS : I'm making the request.

HON. MR. ROGERS : From you I wouldn't consider it, but from others I might.

SALMON FISHERY

MR. MILLER : A question to the Minister of Agriculture and Fisheries. We are shortly going to start the major salmon fishing season.

[ Page 4966 ]

Interjection.

MR. MILLER : It's no joking matter, Mr. Minister of Education (Hon. Mr. Brummet).

are shortly embarking on the major salmon season, and I wonder if the

minister has made any representations to his federal counterpart in

regard to the mandatory carrying of emergency locators on fish boats on

the west coast.

HON. MR. SAVAGE : As I understand it,

that has not been brought to my attention to deal with with the federal

Minister of Fisheries and Oceans. It has not come across my desk at

this stage.

MR. MILLER : It's across your desk now,

Mr. Minister. You're responsible for fisheries, and you and everybody

in this House should be aware of the lives that have been lost at sea.

Some of those deaths could have been prevented with these devices.

Would the minister assure the House that he will take the matter under

advisement, including the possibility of some kind of financing scheme

to assist some of the smaller boat owners in the capital cost of

acquiring these types of locators?

HON. MR. SAVAGE :

All I will commit to is to look at what is being suggested. I cannot

make any promises at this stage until I see all the information that

has to be presented.

The House in Committee of Supply; Mr. Weisgerber in the chair.

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 45: minister's office, $305,183.

MS. A. HAGEN :

When we adjourned at noon, we were discussing aspects related to user

fees for seniors in long-term-care facilities. I want to pursue just a

couple of other questions with the minister at this time, and then I

want to move on to discuss some aspects of home support. Mr. Minister,

you did indicate in your reply just at adjournment time that there

would be some directives to long-term-care facilities regarding what

services, what supplies and what costs would be covered by the user fee

presently imposed. I want to ask you one or two questions now.

First

of all, will you provide a list of those particular exemptions from

charges to residents, and will those go to long-term-care facilities,

and can you give me a time-frame in which they will be advised and

given direction regarding that particular coverage?

The

second question is regarding statements he has made in the press that

residents in long-term-care facilities will not have to pay medical

service premiums. At the present time, residents in facilities will pay

either full premiums or have assistance either at the 55 percent or the

5 percent level. The minister has made announcements that suggest that

some residents will be exempt. At the present time, to my knowledge,

the only people who are exempt are people who come under Social

Services coverage. Would the minister please clarify who will be exempt

from medical services premiums among the residents in care?

HON. MR. DUECK :

I don't think I ever reported in the press that anyone in a facility,

extended or intermediate care, was exempt from premiums. I've never

made that statement. But I have said that anyone under OAS-GIS was

exempt from premiums, and that is so. Furthermore, of course, the

others who are not exempt can get subsidized 95 percent if they're

under $2,500 taxable income and 55 percent if they're under $6,500

taxable income. If you want to verify that, if you can find anywhere

I've made that statement.... To my knowledge, I never have, because it

has never been in the plan.

As far as supplies are

concerned, incontinent supplies and other supplies that senior citizens

may need in their day to-day living in a facility have never been

allowed by the ministry, although we have known of some that have

charged for those supplies. We are going — and I directed my deputy a couple of days ago —

to get in touch with all the administrators with a list of the items

that cannot be charged for. When we have that list complete, I can

certainly give you a copy of it.

MR. CHAIRMAN : The first member for Vancouver South requests leave to make an introduction.

Leave granted.

MR. R. FRASER :

Thank you. I didn't really intend to break into your line of

questioning, but I appreciate the opportunity you gave me. On behalf of

the member for Burnaby-Edmonds (Mr. Mercier), I would like to ask you

to join with me in welcoming the second half of the group from St.

Thomas More Collegiate, who are here with their teacher, Mr. Spanjers.

Would the House join with me in welcoming them.

MS. A. HAGEN : One of the advantages I have over the minister — it's not an advantage that he would have had an opportunity to enjoy —

is that I really know the system that works for older people, and the

benefit package. I think the minister doesn't know that system. At

times I think he confuses things — not intentionally — and the result is that the messages that he gives to seniors are confused. I want to try this once more so we have it clear.

You

just said, Mr. Minister, that no one is exempt but that people who

receive OAS and GIS are exempt. You can't have it both ways. I am

asking you: is there anyone in a long-term care facility who will not

be paying some medical service premium, whether it be the full premium

or one of the two assisted levels of premium for the Medical Services

Plan?

HON. MR. DUECK : Mr. Chairman, either I said

something I didn't want to say, or you didn't understand. But I said:

anyone under OAS-GIS is exempt. Did I say that before?

Interjection.

HON. MR. DUECK : Okay.

MS. A. HAGEN :

I don't want to spend a lot of time on this, and maybe we can discuss

it in the hall, but I want it on the record. Can you explain to me why

a person on OIS-GIS is exempt from the 5 percent premium? They have

never been before, to my knowledge. That would apply to 160,000 people

who live in the province who get GIS, and they are not exempt. They pay

some premium, whatever it may be; it may be only 5 percent. But I want

to have clear whether they are exempt or not.

[ Page 4967 ]

We've

got to be able to communicate to the people in this province what the

programs are. The minister needs to not speak unless he clearly

understands. If he doesn't, he needs to get some help to clearly

understand. I say that with great earnestness, because the minister

keeps making statements about policies that are confusing to the people

in this province, and he needs to get his facts and his communication

clear and straight.

HON. MR. DUECK : I appreciate the member lecturing me; that is very comforting.

said that we were speaking about facilities; we were not speaking about

senior citizens. You asked a simple question about people in

facilities. I'm telling you that for people in facilities who receive

OAS-GIS, those premiums will be paid for them. They will not be

responsible for those payments. I don't know how this confusion came

in, because you were very directly asking about people in facilities. I

did not say senior citizens in the province, so I answered the question

like I've always answered that question. There is no confusion in my

mind, but the confusion is perhaps that you didn't quite understand, or

maybe you thought of senior citizens in the province rather than senior

citizens in facilities.

MS. A. HAGEN : I want to thank the minister for his clarification. One other question on this: is this a new policy?

HON. MR. DUECK :

It is a new policy as of May 1; that is correct. The reason for doing

that, of course, is that we want to ensure that the individual who is

least able to pay or has the least amount of money for their personal

needs will not be left with less than $150 a month.

MS. A. HAGEN :

The evolution of policy is interesting, and I think the confusion we

have is that it is evolving. We had the budget speech, then the

application of GAIN, then the Medical Services Plan. We had the issue

of single versus couple seniors and the way they would be covered under

the new plan. We now have some indication of some policies regarding

what will be covered under the 85 percent fee. I simply want to make

the point that it is very difficult for people in facilities — families and residents —

to understand, when they are not here seeing the press releases and

hearing this discussion but are getting it piecemeal. It's not a very

satisfactory process.

Let me raise the question of the

second matter of fee policy, that of the sliding scale. The minister

said this morning when I raised this issue that it was not his intent

to discuss this matter further at this time. He has said quite

clearly — and I think language has again been used more carefully and cogently —

that when the sliding scale of fees comes in, it will apply only to

income and not to assets of the resident. He has also indicated that it

was his intent, and I presume that it is still his intent, to have that

sliding scale of fees introduced by October 1 of this year. I want to

ask the minister a few questions about that.

People who

went into facilities went in with the expectation that the fees they

would be paying were, if not by formal contract, implicitly.... That

was the basis for the fees, the basis for their entering the facility.

They planned their lives and their finances accordingly.

want to ask the minister whether he is giving any consideration to

grandfathering this sliding scale of fees so that it will not be

imposed retroactively on residents presently in facilities. I want to

ask him when he plans to announce this sliding scale. I want to know

how the information that he will have to gather — presumably through the staff of long-term care facilities —

on the incomes of residents will be gathered and whether he has given

any consideration to the cost of that endeavour, because there are

20,000-plus residents in care, each of whom, presumably, if this is to

go ahead, would have to have an income test administered to them.

[2:45]

think that that will give me some indication of the minister's plans at

this time, and I'll wait for his response before further questions.

HON. MR. DUECK :

I just want to back up a little. The government policy right from the

beginning was to do with premiums and GAIN for those who had OAS-GIS.

So trying to mislead the House or to mislead Hansard that perhaps we're

making a policy as we go, that's not true. I wish to make that very

clear.

The other thing, talking about assets versus income, I have been on record again and again....

MR. ROSE :

On a point of order, I'm sure that the minister didn't really charge

that the member was deliberately misleading the House and Hansard

on the matters she raised. If he were, I would think that should be

regarded as unparliamentary, and perhaps he would care to withdraw that.

HON. MR. DUECK :

Sure, that was a wrong choice of words and I will withdraw that. But it

was leading to misunderstand what the government is doing when the

policy from the beginning was that. I want to make that clear.

Also,

it's been bandied about in the paper and said again and again that I

have not yet made up my mind whether it's assets or income. No one on

this side has ever talked about assets. I have gone out of my way to

tell the news, whenever they've had a scrum, to please get this

correct: we're not talking about assets; we're talking about income. If

in fact we will is now under review, and I'm not going to discuss the

income testing at all. It's under review and it would be inappropriate

for me to discuss that.

MS. A. HAGEN : I have to take

it that if it's under review, the subject of the review could be

reconsideration or implementation. It seems to me that's the only

interpretation that I can make with that remark. If the minister wants

to provide me with another

interpretation, I'd be happy to hear it.

Given

that we are now two and a half months into a policy that was announced

as a major initiative in the budget of the Minister of Finance and

Corporate Relations on March 24 in this House and we are now at June 9;

given the fact that the minister has himself said inside and outside

this House that it is his intent to impose these fees October 1; given

that the Minister of Finance and Corporate Relations has provided me

with information about the intended revenue to the province from these

fees, I would take it that the minister's comment that this is under

review means that it is under review for either reconsideration or

implementation. I would ask the minister to advise me if I should

interpret those words in any other way.

HON. MR. DUECK : I'm not going to interpret for you or for myself. I'm just saying it's under review. That's the only statement I'll make.

[ Page 4968 ]

MS. A. HAGEN :

Since this is a matter for this year's budget then, I would like to

leave a couple of thoughts for the minister's consideration. One is

that there is a double whammy in the 85 percent user fee and the

sliding scale. The sliding scale that he has suggested could mean

increases at present rates of over $5,500 to some residents in the

system. Those residents are paying taxes. He has quite frequently

quoted the person with a $1.6 million estate who either has private

nurses in his or her home or is paying in spades through taxes for the

kind of care that we should accord him or her as an older person.

The

second thing I would like to leave with the minister for his review is

the issue of retroactivity. A number of older people — and in many

instances their families, because those older people are not always

able to speak for themselves because of the state of their health —

have expressed concerns about retroactivity. There is a social

contract, if you like, that has been in place, and that the policy that

the minister is proposing to introduce is a policy that has been

imposed without consultation, and, I would submit again, very strongly,

without consensus.

Since you're not prepared to discuss the

issue of those sliding scales in this House at this time, I would as an

advocate for seniors and their families leave those two thoughts with

you for your review.

I would like to move on now to another

area of home care. I plan to come back to facilities a little bit later

on to speak about them as a functioning institution and talk about some

concerns I have. But I want to stay with the fee theme and the service

theme for a short period of time.

I noted this morning when

the minister was providing us with an overview for his ministry that he

made no reference to home-support services and fees, although the

budget does speak about new user fees in that area as well. Has the

matter of fees in the home-support area been dropped? Is it on course

for implementation or under review? The matter of a new scale or a new

system of home-support fees, which was announced in the budget and

which we have had some discussions of in the House, was not, in my

recollection — I haven't seen the Blues — included in your

comments this morning. Has that matter been dropped? Is it slated for

implementation? Is it under review? I would remind the minister that

when I asked in this House — I can't give you the date, but it is in Hansard — for the implementation date of those new home-support fees, I was advised that it was August 1.

HON. MR. DUECK :

Sometimes statements come forward and not in the form of a question,

and then it goes on to another question or statement. So that we don't

leave that part out, again and again "no consensus" is mentioned. I

mentioned this morning.... I'll just read this into the record again;

this is from that review that you said we were not heeding or not

looking at. "There was very strong support for user fees and their

consistent application across the various continuing care services. The

most frequently recommended option was user fees based on the income of

clients." So there was consensus.

Having said that, the

next question was in regard to income testing for homemakers. As you

well know, there is some user fee now. It is also under review. I

thought I meant both of them when I answered the question before; they

are both under review. However, if we did put income testing for

homemakers, it would be at a higher level. In other words, many of

those who are paying today would not be paying.

MS. A. HAGEN :

It is very difficult for the minister to comment that a matter is under

review and to give us half the picture. In fact, that's what has

happened with the mandate review. Now that I have raised some questions

in the House about the mandate review, he has given us a glimpse of the

picture. But I said this morning that the sum is greater than the

parts, and we need to see it all before we can have some judgment. The

minister needs to be reminded of the process that he followed with the

mental health review, which had the points of view of the wide number

of people in the community who had accorded the ministry their

thoughts, ideas, concerns and suggestions. We need to have that in its

total, and we need to have an opportunity to respond to it before the

minister continues to implement in this incredibly piecemeal, half a

loaf, little bit of information kind of way.

[Mr. Pelton in the chair.]

For the population that you are dealing with, Mr. Minister, it's almost a form — and I quote not myself here; I quote words that have been said to me —

of abuse, because to be uncertain about one's financial needs and the

future is very worrisome for many older people. Let me just pursue this

issue a little more, because if it's under review, I have some hope

that in our discussion in the House today the minister may pay some

attention to some of the concerns that have been raised by those who

assess the system and those who deliver it.

One of the

concerns that people have raised is that if the cost goes higher for

people who are receiving homemaker support and paying fees, and if they

are paying the full cost for the initial service up to their ability to

pay, many of them will choose to move out of the case-managed system.

They will choose — or perhaps feel they have been forced — to

go into the business of hiring their own homemakers. I could perhaps

best reflect that perspective by reading from a brief from the B.C.

Nurses' Union, and particularly the nurses of the Capital Regional

District, to Mr. Paul Pallan, director of the Victoria seniors' project.

page 9 of that brief to the Victoria Health Project they say: "We

understand that those who require limited service will be advised to

contract privately for that service if the new monthly charge would

exceed the cost of the service required if paid for on an hourly

basis." Remember, an hourly basis to a worker is different from the

hourly basis to an agency which also administers that service. This may

be fine for those who are competent and capable of managing, hiring,

firing, accounting and complaining when the quality of service is

substandard. We believe this will be too complicated for some, and

there is no mechanism to monitor the quality of the care provided in

the absence of supervision by the long-term care program.

Mr.

Minister, can you assure us that there is no part of your policy in

imposing fees on people receiving homemaker support that would

encourage them — or perhaps force them — to consider dropping out of care under the long-term program and instead hire their own people for the services they require?

HON. MR. DUECK :

Hopefully not; that is certain. The things that you mentioned certainly

must be considered. We are well aware of them. When the review takes

place, that is a consideration. There is no question about that.

I would like to go back a little bit on the review. You keep talking about the review. I didn't want to get into that,

[ Page 4969 ]

because

it's a very recent review, and it has not even been totally examined by

our own senior staff. You know yourself how long it takes to compile,

then digest and see what direction we're going to go. The mental health

consultation report, which you are well aware of, was started in

1985 — two and a half years ago. The mandate review you're

speaking of today was in September or October 1987, I believe, so you

can't expect us to be....

Interjection.

HON. MR. DUECK : Was it'86? It's 1987 — that's what I understand. I could be corrected on that date, but I've got the information as '87.

that as it may, these things don't come quickly. They will be

considered by senior staff, and when that is done, it will be made

public like all our reports are made public — or most of them, at least.

[3:00]

MS. A. HAGEN :

It was 1986, Mr. Minister, because I happened to be present when a

senior member of your staff announced it at a convention in Vancouver.

I am sure it took some time, but the report was to have been completed

with the mandate review, more or less ready from that continuing care

division, for action by your ministry not later than the end of last

year. I know that there have been consultations with some groups, and

my only request is for you to treat us all the same and make sure that

the work of your ministry is in the public domain - not partially in

the public domain — so that we can all review the basis on which you are developing policy. That's fair, and I think that's a reasonable request.

I'm

going to move on at this point. I want to make sure that I have an

opportunity to discuss the whole home support area. It's one that the

minister and I discussed at considerable length last year, and I don't

plan to revisit it in quite the same way as 1 did last year. There is

no question that it is the backbone of the kind of policy that all of

us are working on that would limit the number of people moving into

care in our province.

The report that I quoted from this

morning from Fraser interestingly notes that the trend is for more

facility placement in Canada, rather than less. I think last year we

talked about the optimum figures that we'd like to see. In European

countries it's around 5 percent, and that's because they have a very

highly integrated community support system that uses paid services,

families, volunteers and communities. It is, as the minister has noted,

quite highly centralized.

Prof. Malcolm Brown notes that

the trend is up in Canada to 10 percent, and that's worrisome.

Therefore what's happening in the home care area worries me a lot. The

minister noted that the Capital Regional District has been a very solid

and innovative district in terms of the care of the elderly. I just

want to quote from a May 10

article in the Times-Colonist where Mr.

Watt, who is the director of long-term-care beds in the district, says:

"We have approximately the same number of people in long-term care as

we did three years ago, but an additional 800 or so who are at home

with the help of our community support services."

I simply

use that to epitomize the whole emphasis on people staying in their

communities. That means that people who are staying in the community

often have a heavier level of care. The minister is wont to quote his

father. I will quote my mother, who is totally blind and in her own

home with care. She is there partially through a very good long-term

care program, so it is possible for people not to be institutionalized,

and we should seek that.

Can the minister please give me

some breakdown of the new home support system, which last year had

several lines that covered it. Last year we looked at home support,

which was the homemaker program. and we looked at home nursing,

physiotherapy and adult day care. This year in the budget those are all

wrapped up into one, and the dollars available for all those programs

are one hundredth of 1 percent higher than they were last year. The

dollars available in those programs are $62,000 more in an $81 million

budget than last year.

When the members of the Home Support

Association, who are here to listen to this debate, look at that figure

and the budgets of the various member organizations that serve

something in the order of 43,000 people in the province, they must be

stunned by that figure. According to the Minister of Finance, these

user fees are going to bring an additional $10.9 million into that

system, from only a quarter of those people, if I'm to believe the

minister. It's possible, Mr. Minister, that these user fees are going

to provide some of the additional dollars. But the minister needs to

give us some very good, solid information about what he and his

ministry are providing to achieve his goal of health promotion,

preventative service in terms of keeping people in their homes with no

increase in budget for home support, home nursing, adult day care and

physiotherapy.

I have only the raw figures, Mr. Minister. I

hope that with the help of your officials and their enlightenment, you

can give us some indication what is in that budget that doesn't appear

to be there that's going to make it possible for the Capital Regional

District to continue funding and serving 800 more people — for all

of the homemakers in the province to serve 50 percent more people with

5 percent less budget that they had last year, and no increase this

year. I hope you're a magician, because it's been impossible for me to

figure out how you're going to do that. I hope you can enlighten us.

HON. MR. DUECK :

Mr. Chairman, I believe the budget figures did reflect some revenue

items that would probably come to the ministry due to some income

testing and some user fees. If we do not go in that area, then, of

course, it will have to be adjusted and reallocated from within the

budget. We do show roughly an 8.3 percent increase, but it's reflected

with the revenue items, and that is not clear at this time. So that

will have to wait until we have a clear picture of what we're going to

do.

MS. A. HAGEN : Could I ask the minister if

budgets have been requested from the home care agencies for this year.

What is the process of those budgets? Let me put this in some context.

One of the characteristics of budgeting in this ministry of recent time

has been that it is retroactive. I'm going to cite some instances in a

few minutes of the effect that has on hard-working agencies that are

trying to figure out how they work within a global budget where

workloads may not be funded and where they don't have any idea what is

coming from the ministry.

Could you give me some indication

what is happening with that budget process and when long-term-care

agencies will be advised about what it is they're going to have to

operate with in this year?

HON. MR. DUECK : Mr. Chairman, the budget letters, I understand, are going out before the end of this month. The

[ Page 4970 ]

homemakers'

association is in agreement, and on October I the new budgeting process

will be put in place - in consultation with them. I think it's on

stream, and earlier than last year. We're working with the association

on this.

MS. A. HAGEN : Is that the budget year April 1, 1988, to March 31, 1989, that will be in place on October 1, 1988?

HON. MR. DUECK : If you're referring to the budget letter, that is for the fiscal year, yes — April 1 to March 31.

MS. A. HAGEN :

I won't comment specifically about what arrangements you have been

working on with the organization, but I know I have talked to any

number of home support agencies who have expressed great concern about

the delays in the whole budget process. It's giving them a great deal

of difficulty. In fact last year in some agencies they did not get

retroactive payments that had been agreed to in August until they

begged for them at the end of the fiscal year. Many of them had a great

deal of difficulty balancing out their year-end.

There are

other aspects related to the costs that homemakers are having to meet

with the budgets available to them. I think, Mr. Minister, one of the

things that would be very helpful for your ministry to do would be to

go back to having budgets submitted prior to the end of budget year,

not halfway through the next budget year. I think most organizations

find it very difficult to set a budget when they don't know until

halfway through the year what that budget is going to be.

want to ask some questions around the dollars that are going to be

available to pay people fairly in the home support area. The minister,

I think, has advised us that there were some payments made to improve

the wages that were available to home support workers last year. We had

some discussion during the estimates last year, and the minister

expressed concern about the very low level of wages that existed.

There

has been some very modest improvement, but this is still a major

concern of home support agencies. We are still looking at discrepancies

of up to $3 an hour with long-term care aides who work in

long-term-care facilities, and in many instances, benefits for those

workers are not included in the budgets.

It's not fair for

us to treat unfairly workers engaged in the care of the elderly, and

yet the very underfunding of the programs we're talking about is

achieving that result.

What commitment is the minister

prepared to make this year to redressing the very grave imbalance in

those wages and the unfairness to the many hundreds of dedicated people

who work with seniors in their own homes?

HON. MR. DUECK :

Just to back up a bit, I think I should agree with the member that we

did have some problems with computers last year. It was a bad

scene — I admit that — and some of these facilities got their

letters far too late in the season. However, that has been rectified,

and I think we are on target again.

Wages for homemakers

have been a problem for some time. I agree that there is a disparity,

and in some cases the level, in my opinion, is not adequate. We're

endeavouring to allocate the funds we have available in the most

appropriate way. That's the best I can tell you at this time.

MS. A. HAGEN :

Would the minister be prepared to discuss cutbacks in service hours?

There is a very great concern in the home support industry that hours

are to be cut further. There is no question that the levels of care

required for people living in the community have risen as a result of

more and more people being accommodated in their own homes, and we have

seen this happening without increases in budget. Would the minister

give us some indication of whether there are going to be more stringent

guidelines about the level of care available?

There has

been a steady decline over the past five years in the average hours of

service per month. It's gone from 19 hours in 1982 to 12.8 hours in

1987 — a 32 percent reduction — and that in the context of

many people who require higher levels of service in order to stay in

their homes. I have heard concerns expressed that cuts as high as 10

percent are being considered in the service hours available to

homemakers. If that's going to happen — especially with budgets not being known until October —

it's disastrous. That happened last year, where some agencies had

service hours cut, with their budgets arriving late in the year, and

it's not something that home support agencies can tolerate.

have had people say to me that the home support system is in jeopardy.

I know that's strong language, but you can't continue to cut when the

service is the backbone of a policy intended to make the very thing

you're desiring — a more rational and efficient system.

HON. MR. DUECK :

To begin with, we're doing a complete review of long-term care, which

was needed very badly, and my new, old deputy has taken it upon himself

to make sure this is now done.

As far as cutbacks are

concerned, we will provide the service needed for anyone on home care.

At times in the past we have had some inappropriate services delivered,

and we've perhaps cut back in that area. But as far as the need to keep

people at home rather than in a facility is concerned, we will make the

promise that we will look after those people in need.

MS. A. HAGEN :

I presume that that means the minister is prepared to fund the workload

that is out there in the community this year. If there's 15 percent

more workload than the budget allows for, you're prepared to go to

Treasury Board and ensure that the dollars are available for that

workload to be funded.

[3:15]

HON. MR. DUECK :

If it is a legitimate, assessed need, we will endeavour to get those

funds and look after it, because we feel very strongly that to keep

people in their own homes is ultimately better, and it is less

expensive. That's the direction this government is going. That's the

thrust, and I'm certainly in favour of that.

MS. A. HAGEN :

There are times when I get really nervous about words. Endeavour is a

worthy word; I would prefer and would like to hear the minister provide

a commitment. The people who are getting long-term care under

long-term-care services are getting assessed care. You can't have it

both ways, Mr. Minister. You're either going to fund it or you're not

going to fund it. The long-term-care nurse assessors and the homemaking

agencies that are trying to provide that service have got to know

whether you are going to fund that workload. Am I sticking on the word

"endeavour," or does that really mean that there's a commitment that

those services will be funded?

[ Page 4971 ]

HON. MR. DUECK :

I don't know how much more accurate I can be. I'm not, of course, at

liberty to speak for Treasury Board or government when it comes to

dollars except what I have in the budget. In the past, where the

legitimate assessment was greater than what was in the budget, we have

funded that. I intend to continue to do so, because it's not often

clear at the beginning of the year exactly how many hours you need. If

it is a legitimate need and the assessment shows that it's legitimate,

we will do everything on our part to fund it. We've done it in the past

and we will continue to do so. I will make the commitment that I will

do everything 1 can so that this commitment is met. I believe that I

did it in the other fiscal year, and I certainly think I can do it

again this year.

MS. A. HAGEN : Can the minister

advise me what portion of the $81 million in home support services is

available for homemaker services? I recognize that there may be

fees — up to $12.9 million, according to the Minister of Finance (Hon. Mr. Couvelier) — that form a part of that budget, but can he advise us what portion of that $81 million is allocated for home support?

HON. MR. DUECK : It is $57.1 million.

MS. A. HAGEN :

Can the minister advise me how much that is up from the adjusted figure

that takes in the wage package that was decided on after the amount

from last year, which I think was around $53 million or $54 million?

How much is that up from the amount from last year?

HON. MR. DUECK : From $53.7 to $57.1.

MS. A. HAGEN : Plus the adjustment.

HON. MR. DUECK : No, that's including the.... Oh, the wage adjustment.

MS. A. HAGEN : How much was the wage adjustment?

HON. MR. DUECK :

I haven't got the wage adjustment here on this figure, but I suppose we

could get that for you. I think 3 percent was wage adjustment.

MS. A. HAGEN :

I know at times in the House the information is not clearly available.

I'd like to ask the minister to provide me with the adjusted figure for

'87-88 — that would be the original amount plus the dollars that were the adjustment — so I can make the comparison with this year's figures.

I want to move on, Mr. Chairman, with your indulgence, into the area of adult day care.

would be wonderful to have somebody shuffle my papers the way the

minister has someone to shuffle his papers when it comes to doing some

of this.

SOME HON. MEMBERS : Later.

MS. A. HAGEN : Yes, we'll wait our turn.

Now

that we have this home support area that includes not only the home

support program but also adult day care, physio and home nursing, Mr.

Minister, could you please let us know whether you're considering

changes in fees to each of these services specifically? It's not my

understanding that there's any intent for fees to be charged for these

services over and above what is presently in place, but I want to ask

whether in the whole area of the sliding scale of fees for home support

services there is an intention to consider fees for home nursing or

physio, or any change in the fees for adult day care where people pay a

per them now.

HON. MR. DUECK : There has been no consideration or any consultation in that regard.

MS. A. HAGEN :

Let's take a look for a few moments at the adult day care program. The

adult day care program is one that I'm sure, when we take a look at

what's happening with the Victoria seniors' project, will get a fair

amount of attention. Like the homemaker program, it's a very important

part of the mix of services that are available.

1 want to

start with a very specific request to the minister. I would have made

this privately, but I've just confirmed that the problem still exists.

There was an adjustment in the wages to adult day care workers last

year, as well as to the workers in the home support area. In Second

Spring Adult Day Care Centre in my riding, as of last week they were

still waiting for that adjustment retroactive to August. In talking to

many of the adult day centres. I know that retroactive wage came very

late.

That's not the only centre that hasn't received it. I

wrote to the minister in April. I was assured that the matter would be

addressed. I will leave that to your attention, and I would hope that

that day centre and any others waiting for retroactive wages from last

year will get them soon. Those workers, in many instances, haven't been

paid because people don't have the cash flow to pay for those wages,

when they don't have the dollars coming from your ministry. It's

shocking because these people are on very modest wages for the work

that they do. I think it's not defensible for organizations to have to

wait or to pay wages out of their very tight cash flow.

The

adult day care centres of the province are moving ahead very slowly.

Again, I'm going to use the centre in my own city as an example because

it distresses me that we are not seeing some progress in having that

centre work to its maximum capacity. It distresses me even more when I

see that in some areas dollars are available, and in others where a few

dollars would make such a big difference, we can't seem to move the

ministry to take some action.

Second Spring Adult Day Care

Centre was established in 1981 on a three-day-a-week basis. I think it

was in 1986 when they finally got approval for four days. They have

been seeking approval for five days. It is the only funded adult day

centre for seniors in the ridings of New Westminster,

Maillardville-Coquitlam and Coquitlam-Moody, and there are 15,000

seniors in those communities. There is a standard waiting-list of 70

older people, many of whom end up in facilities or whose spouses are

caregivers and end up in illness and stress, because that approval for

an extra day a week is not granted.

It has the support of

the medical health officer, the long-term care association, the B.C.

Medical Association and the care facilities, and still we don't have

that centre funded. I'm looking at some very major initiatives that are

taking place in Victoria, and I don't want to discourage those

initiatives. There's a day care being built in Saanich which is going

to cost $700,000 to build. There's $2 million or $4 million available

for a project in Victoria. I want to try to get at those dollars a

little later. We can't manage to get something like an

[ Page 4972 ]

additional $20,000 or $30,000 to look after a backlog of 70 people who need care.

These

people are long-term care assessed. At various times, they have simply

stopped putting people on the waiting-list. At the same time in New

Westminster, Queens Park Hospital has established an excellent day care

out of funds it has been able to make available from its operating

budget, but this is the last year that they will be able to stretch

that. They are serving another number of clients.

Mr. Minister, if you are going to achieve your objectives, you've got to give some priority to these — and I'm sure other —

agencies that are bringing these issues to you. They are not huge

dollars, but somewhere along the line those dollars are going to save

dollars. As Prof. Malcolm Brown tells us, it costs 10 percent of the

cost of facility care to keep a person in their own home. Adding adult

day care to that is a modest increase that doesn't come anywhere close

to the cost of facility care.

Can I get an assurance from

this minister that there will be consideration of a five-day-a-week

program in that community this year, so that those people end up at

home with their family caregivers as they wish to, at less cost to the

taxpayer — a cost this province can't afford not to pay?

MRS. GRAN :

Seated in the gallery today are several grade 7 students from Alice

Brown Elementary School in Langley, along with their teacher Peter

Luongo, who is a very good friend of mine. On behalf of the second

member for Langley (Mr. Peterson) and myself, would the House please

welcome them.

HON. MR. DUECK : Talking about adult

day care programs, I cannot argue with you at all about the wonderful

things these programs do. I suppose the only answer I can give to that

is that, number one, I can't give you a commitment on one specific

society.

In general terms, I agree with what you're saying.

I think the government agrees; we wouldn't be going into this Victoria

Health Project if we didn't. But it requires dollars — as you say,

just a few dollars in that area. But all the services we offer are

"just a few dollars" in each area, and it comes to $3.9 billion, which

is a fair amount of money. The allocation has to be made, and I'm faced

with the unenviable situation that when I get my budget and the

amount.... Where do I put the money? Everyone is short. Everyone wants

more. Everyone can make a good case.

I believe that what

you were saying is certainly true. Also, having said that, I must

commend all the volunteers that work in these facilities and programs.

If it weren't for the volunteers, we would be in much worse shape. They

provide so much care, and do so much for people in our society,

especially seniors. Having said that, we do everything we can. We're

going in that direction. It's not fast enough, as far as I'm concerned,

but I'm certainly not going to make a commitment to your specific

society in New Westminster at this time. I'm doing my best again this

year, as I did last year, to provide as much money and as much help for

adult day care as I can. I think it's valuable, and I agree with you.

[3:30]

MS. A. HAGEN :

Mr. Chairman, of the $81 million for home support, can the minister

tell us what's available for adult day care this year, and what was

available last year? I'd like those figures to encompass the wage

increase that will alter those figures. If you don't have those figures

available, Mr. Minister, I'd like to request, as I requested for

homemaker services, that they be made available. I'll wait and see if

you can give us some indication. If you could give us an indication of

whether it's up at all - just the straight comparative figures — we could deal with the wage matter in a more detailed way afterwards.

HON. MR. DUECK :

It's quite difficult to pick out small amounts and percentages, what

have you, but we'll make a note of it, and make sure you receive those

figures in short order.

MS. A. HAGEN : I hope that

with the auditor-general's new estimates process we will perhaps have

some information available about fees that are a part of these systems.

I'm not quite sure how that happens in terms of accounting, but if we

are going to understand the minister's commitment to services for the

people he says use 47 percent of our health care dollars — to services that would perhaps enable them to use fewer of those dollars — we need to be able to track them very carefully.

Just

for a moment, going back into that area.... Let me just say to the

minister that there's very great concern about arbitrary changes and

cuts in budgets. It's very difficult for organizations operating on a

shoestring. They're not million-dollar budgets, or hundreds of millions

of dollars, like Vancouver General or the Royal Columbian. I think the

minister would serve those organizations, their volunteers and their

board members, who spend countless hours trying to figure out how to

balance the books and be fair to their employees.... The minister would

do well to do everything he possibly can in management systems to

assist that. I appreciate that he said there are some improvements he's

attempting to put in place.

I want to now take a look at

long-term-care facilities. Originally it was my intention to spend a

fair amount of time on long-term-care facilities, but I think the

answers are going to be very similar to the answers I've been getting.

Let me just, out of some discussion we've had today, throw a kind of

conundrum into the minister's pot, if you like. That's not a very good

metaphor. Let me just draw on something that the minister mentioned

earlier on, to indicate in a very folksy kind of way the problems that

long-term-care facilities are having.

I've spent some time

this year talking to managers and board people of long-term-care

facilities. I have found, to a facility, the same situation: those

facilities are running deficits, and those deficits are in the range of

$3,000 to $5,000 per staff person. They are running very tight

operations because the ministry is not funding their full staff costs.

They are not funding benefits and they are not funding increments that

are a part of collective agreements. Those are fixed costs that

facilities cannot forgo. As a result, facilities are faced with an

absolutely catch-22 situation. They haven't got enough dollars to run

their facilities with the staffs they have; they have clients who come

in at IC-1 and get to be IC-3; that simply means that they come in at a

lower level of care and progress to a higher level. These facilities

are advised by the ministry, which is now grant-funding them, that they

must maintain standards, and those standards require so many people for

so many clients.

Those facilities are in an impossible situation, and whether we're talking to the association or to individual long-

[ Page 4973 ]

term-care facilities — and I've talked to them right across the province to be sure that this is not just an isolated situation — the

word I'm getting even more strongly than in some of the other sectors

is that after three years of this cumulative deficit kind of funding,

they are in deep trouble.

How is the minister going to deal

with the fact that there are long-term-care facilities that are

basically saying: "We can't manage"? Is it his intent to have them

moved from the public to the private sector, where somebody might pick

this up and go into that facility? Is it his intent to see the

non-profit sector, very much supported by volunteers and boards, so

bombarded by the problems of deficit financing as a result of

government grants that they cannot continue to offer a service? Is it

his intent to see those long-term-care facilities offering substandard

service, like one of the facilities in my community or a neighbouring

community where, for a clientele of 50 on two floors, with one floor of

psychogeriatric patients, there is one nurse on duty at night? That is

a shocking situation, Mr. Chairman; you and I know that in any

difficult situation it could be not only dangerous for the patients but

for the nurse as well.

HON. MR. DUECK : Perhaps the last question first — whether

we have any design of treating for-profit differently than non-profit

societies. I want to emphatically say no. There is no such design; nor

do we treat them any differently. We try and treat them equally, and

the funding is distributed by formula, the same to all, if we deduct or

do not consider the facility or the capital cost.

However,

there are some facilities that operate very efficiently and quite well

under the funding formula. We've got some that are legitimately in very

tight situations. I hear from them; I certainly meet with them; our

people meet with them. If they are run inefficiently, we will send

someone in so they may perhaps change their way of operation to bring

it back to a break-even point. We do the best we can with the funding

we have available. The need is always greater than the moneys we have;

I have to admit that.

We're doing a complete review of all

the long-term-care facilities, homemaker, the whole thing, to see where

the shortfall is, how much it is and whether we can embark on some plan

to at least come a little closer to the point where these facilities

can operate in such a way that, as you mentioned, a certain level of

care is not paid for at another level.

We realize that, and

it is not an easy question. It's certainly much easier to criticize

than it is to solve the problems. I know it is my job, and I'm not

trying in any way to duck it; not at all. It is not like running your

own business. You are told the job that there is to do and you're also

given the amount of money, and then it's up to you to reallocate and

try and find a solution to bring those two parts together. It is very

difficult.

MS. A. HAGEN : Let me just ask this one

question on budgeting. Is it the minister's intent to fund the actual

cost of salaries and benefits for these organizations? Is that a part

of the budgeting process?

HON. MR. DUECK : No, I

didn't say that. I said that we try under all circumstances. If the

facility is not operating efficiently, we give all the assistance

possible to perhaps.... We have people who are quite familiar with the

operations of various facilities, and very often they can give some aid

and assistance. We have some that operate quite well with the funding

that's there, and others are having a difficulty, perhaps because of,

as you mentioned, union contracts.

We look at every one of them; we try to come to some conclusion where they can operate at least for the year — until

we can get into another budget and perhaps get more money. It's not

easy. I'm not saying it's all good. We are doing a review. We know

there is a shortfall, and when we get that total figure, perhaps for

the next coming year, we can try and adjust or get more money for that.

MS. A. HAGEN : Please remind us how much money went into hospitals last year because they had a shortfall.

HON. MR. DUECK :

If you are referring to the $20 million. it is quite a known amount of

money. I don't have to repeat that. We allocated $20 million to the

hospitals, not because they had a shortfall.... That's where you make a

mistake. We only funded those hospitals that had an increase in

patient-days and were operating very efficiently. We paid some money to

hospitals that didn't even request money; we did not pay some that were

running a deficit by quite a number of dollars. So it was not on the

basis of shortfall or inefficiency; it was on the basis of efficiency

and workload. Yes, I did get $20 million. and it was distributed in

that fashion.

MS. A. HAGEN : I'd like to suggest to

the minister that he may face the same situation with long-term-care

facilities this year, because there is a shortfall in the budgets that

they have been accorded, because they do not provide for dollars for

collective agreements that are in place and that they have to honour.

They have been advised that they are not permitted to make cuts in

their staffing that would alter the standards that the ministry, quite

rightly, wants to see in place.

Mr. Minister, it's a hollow comment — and I don't say this personally —

to say that we will try, if we are going to look after the older people

in our province. We have the resources, and perhaps it is simply a

matter of us doing a little less high tech this year and a little more

low tech that makes sure that people are safe and well cared for and

that there is someone to feed them and get them into activities. Those

things are not very glamorous and a lot of people don't know anything

about them, because they haven't been there yet or don't happen to have

a family member involved. For those who have, these are the realities

of health care, day in and day out, with people who don't have any

glamour in the work they do but just have to continue trying to make it

work.

[Mr. Rabbitt in the chair.]

It's not

enough to say to those people: we'll try. It has got to be a part of

the priorities of this government. If it's not, then this government is

abandoning people who deserve better — not only the older person

but the family member who has to deal with that. We all have stories

that really do indicate to us why you have no choice. The ministry and

this government have no choice but to deal adequately with those needs.

HON. MR. DUECK :

When we talk about high tech, it's not brought in on an ad hoc basis.

It was the opposition last year that criticized me very severely for

being behind in open-heart surgery. It was you people who put the

pressure

[ Page 4974 ]

on to a degree unheard of before, and now you are saying: "Drop the high tech." I could get all kinds of money by doing that.

How

would you tell someone who has a brain tumour that they cannot use a

scan? By not putting this equipment in hospitals .... It's easy to sit

there and say: "Don't provide the equipment. Do the homemaker rather

than the high tech. " It's not a matter of making comparisons; it's a

matter of doing both in the best possible way with the dollars

available - and that's what we have done.

I should mention

while I'm on my feet that if you look at t the health care system in

general and don't pick on just the warts and little things here and

there, or the big things, for that matter — if you look at the total —

it is a very excellent health care service. That's what we are trying

to provide, and at the same time, we're trying to correct any faults

and any areas that need correcting. That's what I am trying to do. But

to pick on one particular area and say, "Don't buy high tech, because

we need more money for homemakers," is a simplistic and silly way of

saying it.

I'm telling you that I am trying to get every

dollar possible. I know there is a shortfall; I also know that we want

to keep people at home. No question about it. I agree with you.

However, it still has to be received from another department, and it's

not that simple. I have a budget; I have to allocate those dollars and

make priorities. I'm trying to do that in the best way I can, and I

think that, by and large, we I are doing a good job on that.

[3:45]

MR. ROSE :

I don't know why the minister seems to take all these things

personally. Maybe he's been a tycoon and a manager so long that he's

thinks we're cheeky over here. I hope he doesn't feel that way.

HON. MR. DUECK : No.

MR. ROSE : But he does get aroused occasionally.

HON. MR. DUECK : It helps me.

MR. ROSE : Does it? Well, you watch it, at your age.

You're not getting any younger. Instead of bawling out the critic,

maybe you should have some warm milk and cookies, or something like

that. Sort of calm down a little bit. It would be good for you. I'm

going to take a little time to throw a bouquet of roses to the people

who are staffing at Valleyview. I got a letter from a very prominent

Canadian by the name of Juliette; her full name is Juliette Cavazzi.

She happens to be an old friend of mine going back many, many years.

Her husband was hospitalized in Valleyview for Alzheimer's. She wrote

me a letter following the funeral, and I would just like to read part

of it; it shows an attitude that's out there whether the ministry is

aware of it or not. I'll repeat the attitudinal line. Some of

it's personal so I don't care to read it, but part of it says:

"Thank you for the Alzheimer's contribution. It's been a long

struggle" — her

husband was in there for a long time; that's not part of the quote, Hansard — "and thank God for Valleyview."

Listen

to this next line: "They just can't toy with that place." Who's that

"they?" Something out there is leaving the impression that they're

toying with that place, and it has something to do with the morale of

the staff and other things. She goes on to say:

"Who'll take care of those people? Most of them have

no one. Their spouses are just too old to even get there. There were just a

few of us who came regularly. I was grateful I was young enough to take it,

and I loved it, every minute. It was a sad job, but the best one I had. He needed

two people to do everything for him. I've never seen such dedicated nurses

and assistants."

That's pretty good, isn't it?

Here's

a plea, right at the end: "Please, Mark, fight for that care facility."

Now isn't that interesting? Why would those two lines be in a letter

written following a funeral, especially when this person has supported

the Social Credit government for I don't know how many years. "They

just can't toy with that place," she says. Her husband was in there for

some months, if not years. "Please, Mark, fight for that care

facility." If that's her view, it may be others' as well.

There are fine, dedicated people working there under extremely difficult conditions

with extremely difficult patients, with a lot of love and dedication. But there's

a fear that this might not persist for others, or else why would Juliette say

those words? By the way, I phoned her and asked permission to quote from this

letter, and she said yes.

So that's one thing. There are lots of things I could say about Riverview

and Valleyview beyond this, but I don't intend to do it at this time. My

friend yielded the floor so that could put in that plea and that compliment

to the people who work there. The other one is the confusion around the assets

test — not that somebody out there is deliberately trying to confuse people.

I have my mother in one of those care homes in Mission —

Pleasant View. I also have a brother who lives in Chilliwack, and he

asked me if it's going to be an income test or an assets test. It seems

to me that if it's going to be an assets test, you'll see lots of

transferring of assets in a big rush. Neither I nor my brother have any

objection to paying for the care of our mother. We don't pay, as a

matter of fact; he does. We have no objection to legitimate increases

from time to time, because staff need increases and all the rest of it.

But if it's going to be a method of confiscation where someone who

looked after themselves is able, because of certain assets, to pay

more, then that's quite a different thing. So I would just like to warn

the ministry not to go for that assets test stuff. Charges for those

who can afford to pay for hem are legitimate. But I don't think any

attempt to confiscate assets is legitimate, and I don't think it will

work.

HON. MR. DUECK : I was just informed as to the letter.... I certainly

don't condone it. I think I mentioned earlier that I have, of course, visited

Riverview and many, many hospitals, and I can't speak highly enough of the

people who work in these places, whether they be RNs or practical nurses or

psychiatric nurses or physicians, especially when you go to some of these acute-care

children's hospitals, and also the mentally ill. They do more than I could

do. I could not do that. I can't say enough good things about them. They

are doing a superb job. There's no question about it.

You

mentioned the confusion about assets and means versus income testing.

It is not I who is confused. It's not this fellow who's confused.

MR. ROSE : No, we're confused.

HON. MR. DUECK : You are confused because of the statements by the news media. When the Province was with

[ Page 4975 ]

me — and here my blood pressure's going up again —

and did a scrum, and I said: "Would you please get this straight when

you report it? We are not talking about assets; we're talking about

income and not means testing. Would you please make sure that that is

correct? Because that story is out there and I want it corrected." Next

day in the Province it

appeared that I had not yet made up my mind whether it would be assets

or means testing versus income testing. I'm sorry. If that's what

happens, there's nothing I can do on this side to correct it. If they

keep printing that and this story goes out, I think it's up to us and

it's up to you, when you go to these homes and talk to the people, to

tell them.

I've gone on record again and again, because we

know that if you attack assets, which I wouldn't want to do anyway

because I appreciate that the people who have saved some money and have

these dollars for their old age, for the last days of their life,

should use them.... Heavens, I don't want anybody to touch my assets.

Furthermore, you are absolutely correct that if we did go in that

direction or even hinted that we would, those assets would disappear so

quickly there wouldn't be any left anyway. Even if that wasn't the

case, I have no intention, because I feel that people deserve what

they've earned and deserve to keep that. It's not a means test. We're

reviewing an income test. I explain again that we're reviewing an

income test, not means, and assets are not in the plan at all. I want

that for the record.

MS. A. HAGEN : 1 want to thank

the minister for that comment. It's a concept that people don't always

understand, in terms of the language. I think it is really important. I

heard in those comments, I think, a philosophical commitment as well. I

think that that's an important one. We disagree, as has been obvious,

about the imposition of the user fees, but I'm pleased that he has made

very clear and unequivocal his position about the fact that government

is looking at income testing.

I would assume in that

comment, too, that as long as this minister is minister, this ministry

is not going to be moving to consider any change in that policy. I'm

gathering that that's a very strong position that you hold. I think

it's well that it was stated and stated as strongly as it was.

want to note, Mr. Minister, that in some ways we have encompassed the

discussion around the seniors' issues, because they do deal with some

of the less glamorous and more everyday aspects of health care. They're

not as big, in terms of your budget. They're about 10 percent of your

budget. Nonetheless, they do reflect something to the community of what

we stand for as a government and as a people. I should have perhaps

said that at the beginning.

I haven't too much more to deal

with in those regards, but there are two other items that I want to

just touch on briefly. One of them is what is known as the Victoria

Health Project. I've just received, in fact, a copy of the first

newsletter from that health project dated June 1988. It answers one of

my questions. When the minister announced, coming out of vote 74, the

special initiatives, that there would be $4 million into Victoria, I

think he announced there would be $2 million for the health project and

$2 million for a one-stop shop.

There has been a change,

and the one-stop shop has gone. I don't know why or where, but it

appears that it has gone. Now the whole of the $4 million, I would

gather from this newsletter, is in fact being allocated to the health

project. It notes that the Victoria Health Project has been allocated

$4 million in seed funding for this fiscal year. It notes that it is

committed to seeking ways to ensure maximum benefit from existing

expenditures on health care in the Victoria area currently in excess

of, I think, $36 million annually — and I will check that for Hansard ,

because there's a little fuzziness here, in case that's not correct.

This newsletter also notes that the scope of the project includes all

health care services in the Capital Regional District, although the

initial focus is on the needs of the frail, elderly and chronically ill.

the context of some of the discussion that we've just been having about

the needs that you have to sort out in allocating dollars within your

ministry, whether it is to provide some very specific and very complex

services or the nuts and bolts services to people living in their homes

and getting home support, $4 million is quite a lot of money.

When

that project was announced it was pretty clear that it, like a number

of the other initiatives of this budget, seemed to be coming out of the

cabinet or the Health ministry without very much in the way of prior

consultation, if any. I have some clippings around that indicate that

some of the people involved, including the medical health officer in

the Capital Regional District, were quite surprised to find that they

were going to be accorded this gift of dollars and project.

I'd

like the minister to make a few comments about the goal of this

project. Since it is a pilot project I would like him not to spend too

much time outlining all the things that might be included. I have them

in this newsletter: things like integration, coordination,

effectiveness, efficiency, appropriateness of care, responsiveness,

acceptability, promotion of wellness, health maintenance,

prevention — all the things we are all looking to have in a more

health-promoting health care system. I'd ask the minister instead to

say: all right, we have a pilot project; it’s going to take $4 million

this year. It is being managed by people whom the minister has chosen

with considerable care, and it solicited a lot of interest, because

nobody has paid attention, I think, to a lot of the ideas that people

have had in the past. Nobody has responded, perhaps, to some of the

continuum of care proposals that have come from a variety of districts

across the province. What's going to happen when the pilot project has

run its course and some initiatives have been tried and some

conclusions made? Are the good works and the good programs that might

come out of this project going to be spread across the province?

[4:00]

Going

back to some of the comments I made earlier about underfunding in many

of the services that would be needed to complement a project like this,

are the dollars going to be there? Or is this going to be a project

that will do good work, develop new ideas and involve people in

creative and constructive work around a health focus for the frail and

the chronically ill and then die because there won't be or there is not

a plan for how to work with it once the pilot work has been done?

Piloting is great. What's going to happen afterwards? Your comments,

Mr. Minister.

HON. MR. DUECK : The $2 million and $2

million were spelt out separately in the budget speech; however, in our

evaluation we're taking it as $4 million for the total concept. I can't

tell you at this point in time exactly how it will look or what it will

be like once it's completed. It is a pilot project.

What

we're in fact saying is.... You've read the newsletter and have all the

same information I received. A committee has been struck, and you

mentioned Paul Pallan, the executive director, who has been seconded

from the Ministry of Health for this project.

[ Page 4976 ]

The

project involves the Greater Victoria Hospital Society, the Capital

Regional District and the Ministry of Health. They will try to develop

and improve the management of the health care system. In other words,

we're going to try to deliver equal or better health care in another

way which is better, especially for the seniors but not necessarily

only for the seniors. It is an integrated health care system for the

total region. The reason we're calling it a pilot project is that we

want to try it in a confined area, and we feel the Capital Regional

District is ideally suited for that. When we have that experience, if

it is successful — and we have no doubt in our mind that it will be — we then want to try it in other areas of a similar kind where there is a larger population.

The community-based integrated health care system will feature, of course — I think you mentioned some of it — patient

access to a responsive and comprehensive continuum of care; careful

management of our limited acute-care resources through institution of a

new system of managed care and through criteria-based admissions and

daily assessment of patients and the need to stay in hospital coupled

with an increased commitment to home support services; improved

information systems drawing upon the health informatics centre at the

University of Victoria — they are also involved in helping us; I

think they got a grant of $100,000. New mechanisms to reimburse

providers will be considered to promote the most effective use of

existing resources and to promote efficient management. Victoria

hospital has already done some of these things, and I'm sure you're

familiar with that.

You seem to be quite up to date in the

Health ministry. As a matter of fact, you and I should get together

more often; I could probably learn from you — and I say that quite

seriously, not in jest at all. We could talk about some of these things

and how we can effect a better health care system.

It may

even cost us a little more money to begin with, because we're operating

sort of in tandem with another system. So it's not necessarily going to

be a savings of dollars — eventually, we hope it will — but I'm

absolutely positive that it will be a better health care system.

Victoria now has the VICARE program that has been operating for some

time, and they evaluate people as they're admitted and perhaps get a

second opinion: should this individual be in the hospital in acute

care, or could this individual be looked after in the community, or in

their own home.

These are some of the things we're looking

at. It goes on and on. I can't really explain it much more than that,

because it is a pilot project, and some of these things will come to

light. We've also told the committee not to be constrained to any

particular way that I or the government wish to go but to come up with

innovative ideas and give us some direction. Perhaps we can come up

with ideas that have been practised in other areas.

The

United States has some programs that are not quite like this, but

they've gone in that area too, where they have these home maintenance

programs. Maybe a facility where senior citizens can come and get

attention; perhaps they need someone to talk to; perhaps they're not

ill at all in the sense that we're thinking of illnesses where they

have to be admitted to acute-care facilities.

I heard of

one case of an elderly woman who was ill. She was finally admitted to

hospital for some tests, only to find out that her daughter was dying

of cancer in Saskatchewan. She had two little children, and the mother

was worried to death. So this is what we're talking about. It's

probably a very graphic and extreme example. Maybe these people need

someone to talk to; maybe they need a physiotherapist; maybe they need

an occupational therapist; perhaps they need counselling; maybe they

want to attend some smoking cessation programs; maybe they are troubled

with the abuse of alcohol — we find quite a few adults have this

problem; maybe they could go to a joint exercise class, or maybe some

field trips. There are many areas.

You mentioned earlier

that it really reflects on the day care programs so much. It's very

much the same, only even more integrated, and perhaps more services

than we've had in the past. Maybe we need nurse practitioners. Maybe we

don't need a full-time physician. There are many areas. You can just

let your mind wander. And I think it's going to be a program that we'll

all appreciate. From the reports I've had to this point in time,

everything looks good; they say that it's about time. So I'm hoping

that I'll have the liberty, eventually, to go further and do this

across the province in other areas also, if it is successful, and I'm

sure it will be.

MS. A. HAGEN : I'd like to thank the

minister for his enthusiastic response. I too have a sense that the

project is well launched. I have to say, Mr. Minister, that although

that initiative is one that will be good for us in the work that it

will do, the kinds of things that you are describing as innovative are

not innovative in most communities. They have been in place in many

communities. Many of the ideas that you're talking about are simply

waiting to have some support from the ministry. So I will leave that

issue, which we will follow with interest. I will leave that issue,

re-echoing your words that it may cost more for a while. That was part

of what we were talking about earlier: that it may cost more for a

while to get some of these things into place.

Let me just

tell you about a centre that needs a lot fewer than $4 million but

makes a good story. It's a centre in the interior, in Osoyoos. It's a

50-bed facility. They have plans to develop an integrated program for

housing for people who need some support, and for what they call

low-level extended care, which, I guess, is something moving into

extended care but not requiring a hospital setting. Some decisions have

to come very soon if they are going to be able to go ahead with that

project. Some of that has to do with the acquisition of the necessary

land accumulation, and so on. They can't wait for a pilot project to

perhaps show the way. A pilot project in Victoria is likely to be very

different from a pilot project in Osoyoos or in Dawson Creek or some

other community. I would hope that the minister will, in addition to

looking at the kind of innovation that may come with this project, be

open to recognizing that sometimes that seed money, along with the core

support for community services, is essential.

Let me just

ask a couple of questions about community development. This ministry or

the Social Services ministry has not funded community groups for some

time, but there is an initiative in preventive services in your

ministry around core programs with a very strong emphasis on community

development and new roles for the union boards of healths. I want to

know if this is a policy initiative of this government, and what status

it has at this time. I know it has to do with the revision of the

Health Act and with initiatives that may give new roles to the

amalgamated boards of health that exist in various formats across the

province.

I've seen some materials from the ministry that

suggest there is a program fairly well in hand with a considerable

amount of work gone forward. The member for Prince

[ Page 4977 ]

George

North (Mrs. Boone) mentioned that the new roles for the union boards of

health might include the possibility of establishing their own programs

and having taxing authority. I'd like to ask the minister to comment

briefly about the work that is underway in his ministry at this time.

MR. MICHAEL :

I have a few points to cover. Before I get to those points, I would

certainly like to put on the record my constituents' sincere thanks for

the tremendous facility to be opened this Saturday at Chase — the

diagnostic and treatment centre. I had a preliminary opportunity to

tour the facility a couple of weeks ago, and I am sure the minister is

going to be very pleased with what he sees this Saturday in the

community of Chase. It is truly a very wonderful addition to that

community.

Also being opened this coming Saturday is the

health unit located in Salmon Arm. I haven't had an opportunity to tour

it yet, but we'll be with the minister this Saturday. I wish to take

this opportunity, Mr. Minister, to sincerely thank you for those two

great facilities for my constituency. I know my constituents will want

me to pass on their thanks to you, as I am sure many will this coming

Saturday when they see you personally.

We will also be

discussing with you in the coming two or three weeks some innovative

ideas that the hospital board has in the Armstrong area. Hopefully we

will be able to put some plans together that will satisfy that

community for many years in the future.

There are a couple

of items I wish to cover. One has been canvassed fairly thoroughly up

to now, and I don't want to get into a deep discussion with you on

this. But I wish to agree with many things that have been said in the

last while about this question of "means test." I know it's not a means

test; you're saying it's income testing. If it's income testing, that

income must come from assets that have been worked for and earned by

people over the years. I can't look at this thing other than that in

some way or another, it's taxing the thrifty. It's taxing those people

who went to the trouble to save. They perhaps worked a little harder

than their neighbour, set money aside in their early years and built up

some type of portfolio on which they receive an income. If it's the

intention of the ministry to in some way get a bit extra from those

people, I have to put on record my objection to that. I just do not

believe in the concept of taxing the thrifty, if they have earned and

saved that money. It is indeed theirs, and they should pay parity for

what other people are required to pay. Conversely, if people can't

afford to pay the new rate, it's my view that something should be done

through the system to make sure that those people have an adequate

amount of money for their monthly spending requirements.

The

other thing I know we've talked about before, but I want you to think

very hard about it in the coming months. Hopefully we will be able to

see some improvements on this subject in this current year. If not, it

certainly should be very high on your priority list for the next

budget. It is the question of provincial parity for wages paid to

employees within your ministry throughout all the regions and

communities of British Columbia. You are well aware, as I have reminded

you on several occasions, that there are instances where the same work

does not receive the same pay. I for one stand against the current

policy which allows that situation to exist. Mr. Minister, I will once

again urge you, for the record, to please do all you can to see that

people doing work of similar nature and requirements are paid equally

throughout the regions in the province of British Columbia.

[4:15]

HON. MR. DUECK :

Before I answer my own colleague's questions, I'd like to just say a

little bit first.... It was indicated that we should look at other

areas that might be innovative, at new initiatives other than in the

capital region. We certainly don't close our eyes to any area. And if

we can see a different way of delivering health care that doesn't

impact on the budget in any major way, we would certainly be willing to

look at it.

To my colleague on this side of the House. I

wish that people would not keep talking about the means test and the

income test. I've said again and again that we are reviewing. And there

is a big difference between means testing and income testing. When we

talk about income testing, we are not talking about assets. An

automobile certainly doesn't give revenue. Real estate doesn't provide

revenue — unless it's revenue-producing real estate. Dollars in

the bank may be at 10 percent or 5 percent. You never touch the asset;

the $100,000 is an asset, and the 5 percent would produce $5,000 a year

in income. When I say income testing, I mean exactly that. We are not

in any way.... I want to make it very clear, because this keeps coming

up, and I think it's mostly because a lot of people don't understand

the difference between income testing and means testing. They sort of

mix them up. We're certainly not interested in someone's home. Quite

frankly, I don't care whether someone has a $50,000 home, or $100,000

or $500,000 in real estate. The review is only interested in income.

And I want to make it very clear that it's a review at this time.

Perhaps we should not touch on that anymore.

As for the

same work for the same pay, that is a very broad-brush thing. When it

comes to homemakers, we purchase ours, and we have some union people

working for some organizations, and we have non-profit organizations.

When we have this out on bids, they say they will provide X number of

hours for so many dollars. In principle, I agree that we have some

whose income is way below what I consider adequate. Some have a fairly

decent income. There is some inequity — there's no question about

that. That is, of course, a concern of the Ministry of Health and has

been for some time. The member and I have discussed this on many

occasions. I appreciate his comments and thank him for them.

MS. A. HAGEN :

I didn't go out for cookies, but I did miss the comment of the minister

on the local boards of health and community development. Without asking

him to repeat it all, I would appreciate it if he would just make some

brief reference to that in his next comment. I apologize for being out

and not having had someone make a note for me about what he had to say.

that same area of community development, I want to ask the minister if

there is, within the mandate review and the discussions going on in his

ministry, some consideration of working with volunteer agencies in the

community, including possibly some shared funding with those agencies.

These groups are part of the continuum of care; they function at a

volunteer level, and very often provide a wide range of services that

complement health services. I think the best example of that is

probably Meals on Wheels. The ministry provides some funding that

allows for coordination, although all the rest of the cost is

undertaken by volunteers and, actually, by the clients who pay for

their meals. Can the

[ Page 4978 ]

minister give us some indication of whether that is under active review, with the mandate discussions he talked about? s

HON. MR. DUECK :

I think I mentioned earlier that c volunteers are very high on my

priority list, and always have been. I've worked with many volunteers

in my life — in my former life — and I appreciate those people very much.

Going

to back to your question about whether we would look at innovative ways

or initiatives that a community other t than those in the Victoria

Health Project might have, one example of community involvement is the

Choosing Wellness program, where we are actually asking for input. It's

a program designed to promote healthy lifestyles among seniors in

particular. This program is being developed by seniors for seniors, and

we think it will be a great success. It's something very new, and we

hope that it will also fit into the total new initiative of the

Victoria Health Project, but it doesn't necessarily have to be in

Victoria. That is certainly on our agenda, and we talk about it quite

often and have people looking at it. Also, many letters come in for

suggestions and advice and wanting to get involved. It's quite

gratifying.

I'm not sure whether I understood you correctly

about whether we look at different societies or fund different r

societies. Was that the question? As you must know, we are involved

with umpteen dozens of societies of various kinds that we fund. I can

go through pages and pages of them. I'm not quite sure whether that's

what you were referring to.

MS. A. HAGEN : Well, if

the minister has pages and pages of societies that they fund other than

long-term-care facilities or home support organizations which are

non-profit profit, I'd certainly like to know about them. I'm not aware

of what I call the community-based services, which are the very things

you talked about with the Victoria project. They might be friendly

visiting or they might be taking somebody on a trip. My question was

whether the ministry is considering providing some funds for

organizations that do make available in communities many of those

services, primarily with volunteers.

I'd like to just

comment about the minister's reference to Choosing Wellness and remind

him that last year we had c quite a discussion about the fact that

there was a pilot project in my riding with $250,000 of Health ministry

funding, plus a research project that is just coming to its conclusion

under t the health research funding. I would hope that what the

minister is talking about is taking the very excellent work that t was

done by Dr. Nancy Hall and the people she worked with, and having that

pilot project move throughout the province. That was its intent. It

still is a program that is alive and well in New Westminster, although

I know that there may be some concerns about volunteer support in order

for that program to continue.

These things fit well

together. They are programs that take the peer groups and the community

centres of the province and, working along with materials that may be

prepared by the ministry, allow good things to happen. Without

belaboring that particular issue, it's good news to hear that the

ministry may be moving in that direction, and I would certainly

encourage the minister to recognize that those low-cost, very solidly

community-based programs are often the fundamental glue that helps to

hold some of the other more professionally supported programs in good

stead within the communities of the province.

Do you want

to comment on that, Mr. Minister? Then I want to move on to one other

theme that I want to discuss in my time in your estimates.

HON. MR. DUECK :

I was surprised you mentioned Nancy Hall. I had forgotten that that was

the same person we poke about last year. We have just established an

advisory committee on wellness and health promotion and it just so

happens that Dr. Nancy Hall is one of the members, so I'm sure that you

will be pleased to hear that. She's a wonderful person and I'm sure she

will give us much help in that area.

Societies. I'm still

not quite clear on.... I'm not going to read all these societies to

you. We've got pages and pages of them: for example, James Bay

Community Centre, Houston Health Care Services Society, Granisle

Community Health Centre. There are all kinds of societies, and I can go

on and on. Of course, there are all the cancers and fibrosis and all

those societies, but I don't think those are the ones that you were

thinking of. You were thinking more in terms of volunteer groups. Mind

you, a lot of these are volunteer groups too — not all of them.

St. John's, and then we have, oh, pages and pages of them. Some are not

what you are referring to, but they are societies that we are funding.

a matter of fact, we believe that that's the direction to go with

health care: to let someone else take the initiative, rather than our

bureaucrats here in Victoria being in charge of all these operations.

We find that this is certainly a much better way, because they attract

a lot of volunteers and they also do the job much better and are very

conscientious and work so hard at it. So when I talk about societies

and different groups and volunteers, I just can't say enough about and

for hem. They are what we need and we appreciate them. We don't ever

want to discourage them. Very often we — including me — don't give them enough accolades for what hey do. We need them, and I appreciate that we are on the same track on that point.

MS. A. HAGEN : I'm delighted to hear that Dr. Hall is going to be

working with you. I think she's Dr. King now, just so we know that we're

talking about the same person. I'm really pleased to know that the work

of that project will, I hope, be continued throughout the province. Nancy will

make an excellent addition, and you are well advised in choosing her to sit

on that committee.

There

are a number of other areas that I would like to explore in the

continuing care area, but in this huge a ministry here is never enough

time, so I am going to reserve the option to have some discussions with

either you, Mr. Minister, or your deputy about some other aspects of

these services.

There is just one question that I want to

leave with about straight budget items. There's a huge increase in the

program management

section of continuing care. Can you explain why that

budget has gone up from $3 million to $5 million a year?

[4:30]

HON. MR. DUECK :

Some of these items, of course, as you can well appreciate.... We have

a number-cruncher here who does nothing but numbers, and I have to keep

asking: "What is it?" He tells me it is a reserve for increased wages.

MS. A. HAGEN : I'm not sure how to quantify that, but I will certainly cogitate on that comment.

If I may, I want to move to local issues for just a moment. As the minister well knows — because he has been there on numerous occasions — my constituency is a health town. A very large part of our economy in New Westminster is related

[ Page 4979 ]

to the health industry, and I certainly need to spend a few moments raising some issues of concern to that community.

The

minister will be familiar with the northeast sector report which, I

understand, was tabled with the ministry early this year. I can't

recall exactly when the report was tabled with the various parties — the Fraser-Burrard Hospital Society, St. Mary's Hospital and Queens Park Hospital —

but over 1987, 1 know that extensive discussions occurred among the

administrators and senior staff of those institutions. When the report

went to the ministry, it is my understanding that the parties had

arrived at a substantial consensus around some changes in the original

recommendations, positions on which they had all reached an accord. I

want to question the minister on the status of that report.

Since

it was tabled with the minister by Mr. Emmott, the chairman of the

committee, it is my understanding that there has been no formal action,

nothing to indicate what is going to happen with that report as to

implementing the reallocations of various programs with the

modifications that may have to occur before those programs can go into

place.

Let me take one example which a year ago was a very important issue in my community —

that of the closing of the palliative care unit in the Royal Columbian

Hospital, an issue that aroused the community as few have. It's my

understanding that St. Mary's Hospital has agreed that it will be the

home of that program and that it is prepared to be a geriatric

acute-care hospital, but that funds need to be available before those

new programs can go into place.

I think that some good,

solid action on these programs would benefit effectiveness of health

care in the community. I am very pleased that the various parties of my

health community have worked so hard and so effectively to arrive at a

position that they can all support and that will improve the delivery

of health care service. That's something we all want to see, because of

the huge area covered by the various services that they provide.

would welcome some indication of how that whole northeast sector report

is moving through your ministry, when we might expect to hear, and

whether, in your view, there is going to be some good action that will

see some of those changes beginning to flow into active service in the

community in the very near future.

HON. MR. DUECK :

Yes, you are quite right about that report. It was not initiated by us;

it was initiated by those players involved. We have the report now.

It's under active consideration. We are going to move forward on some

of the recommendations. It took quite a while to get the consensus of

all the players, but I am very pleased that they were able to work out

most of their differences. It involved Eagle Ridge, St. Mary's, Royal

Columbian, palliative care and which hospital should do what, and that

is coming together quite well.

There will be some

announcements in the not too distant future, I hope. I can't really

give you more than that. I can't release the report at this time. As a

matter of fact, I think we would have to get the permission of the

parties involved. It was not our report; it was their report for us. So

they are really the owners of it. Although I don't believe there's

anything in it, once all the parties have agreed that they would wish

to release it.... So I will find out. It's coming together well as far

as I know. I know some of the initiatives are being undertaken at the

present time, and some announcements should be made soon.

MS. A. HAGEN :

Mr. Chairman, the people in my constituency do believe it's in your

court, whoever owns it, and I recognize the sensitivities there.

They'll look forward to some announcements.

A second matter that has gone forward with the support of the New Westminster hospitals — St. Mary's, Royal Columbian and Queens Park —

is a proposal for a geriatrician in that community. I'm not sure

whether the minister will have received it at this time, but I want to

speak very strongly in favour of that particular initiative. I noted

earlier the large number of older people who live in that community.

There is not one practising geriatrician in the northeast sector. I

think the fact that the three hospitals worked together around seeing

this particular person as being a useful adjunct to their professional

staff is part of the cooperation that has developed out of these

discussions, and it would be a good immediate byproduct of their

initiatives. I want to encourage the minister when and if he gets it -

as I say, Fm not sure it's in his hands yet; it's my understanding that

if it isn’t. it’s on the way - to give it immediate and prompt

consideration. I'd be happy to discuss that with him.

his comments earlier the minister spoke about expansions to the

open-heart and angioplasty programs at the Vancouver General. I want to

ask him what consideration he is giving to the fact that the Royal

Columbian Hospital has made a number of proposals to the ministry about

the availability of facilities for development, with the necessary

expertise in heart surgeons and so on, at that hospital. I think they

are available to provide up to 300 surgeries a year. I understand that

angioplasty in now almost a de rigueur part of that service, that the

two complement one another. Of course, there are discussions about

replacing the old hospital and finally getting the new tower underway.

Again, given the placement of the hospital industry in New Westminster

and the centrality of expertise and specialists in the area, I would

hope that we are going to see that facility as part of the Royal

Columbian Hospital services.

Finally, my last pitch for

regional needs. I'm sure the minister has had before him the report of

the greater Vancouver hospital district society on care needs of the

elderly. I know I have it here among all my papers, but I won't

necessarily seek it out right now. They have really done an excellent

continuum-of-care study that looks at the home support needs we'll have

in the future and the need for facilities.

We haven't

talked today about facilities that are in the planning stage. 1 know

the minister has provided us in this session with some information

about intermediate-care and extended-care beds that are either on the

drawing-board or planned. But can you give me any indication, Mr.

Minister, about whether there are any plans other than for a Burnaby

facility, which I understand is on the drawing-board? Are there any

plans for further intermediate- or extended-care beds in our area?

The

need is quite extreme. The member for Coquitlam-Moody (Mr. Rose) spoke

about Valleyview, which houses 300 to 500, which I hope is going to be

a facility that continues to operate. But the current need is somewhere

in the order of 200 to 250, and there is no sign of building plans that

I know of that are committed. It would be good to know what your

thoughts are about getting moving with that before the waiting-list

gets to be just unmanageable.

HON. MR. DUECK : You are going to steal my thunder when you start announcing a tower for Royal Columbian.

[ Page 4980 ]

Gee, I was quite shocked. I just whispered to my deputy: "Where did that leak out?" You know more than I do.

Anyway,

as far as angioplasty and perhaps open-heart surgery are concerned,

they of course are under consideration at Royal Columbian and have been

for some time. I can't at this point tell you exactly whether or when

it will be, because we've expanded the capacity at the VGH, which has

considerable space available. We don't have any need to expand at

present, because they are going to do an extra 250-odd open-heart

surgeries, plus more than 700 angioplasties. It appears that the

waiting-list is declining and we're catching up.

As for

intermediate-care facilities in the Burnaby area, of course we make

those announcements as they come up, and it would be pre-empting that

particular announcement.

I find it somewhat — not

amusing.... The problem you're in is the problem I'm in every day.

Earlier it was mentioned: "Yes, but you have more beds now than most

jurisdictions have. Why are you not giving more home care so you don't

need the beds?" But now you've ended your questions: "But why haven't

we got more beds?" This is exactly the point I was trying to make:

there is a need everywhere, and I recognize that need. I have pressure

from every group, and they're all good causes; every one will save

money; every one is needed. But you can only do so much. I find it

interesting that you yourself came on both sides of that argument. I'm

not blaming you at all, because that's exactly the problem I have every

day. I have people come to me and say: "Why can't you give us some

money for extended or intermediate care? Because there are bed-blockers

in the acute care." Then I have another group coming in an hour later

and saying: "If you would just give us more money, we could keep all

those people out of the facility, and we would keep them in their

homes. " We try and do that balancing act between the two or three, and

it's difficult; I admit that. I find that I spend a lot of time

juggling that financial crystal ball and.... I shouldn't say crystal

ball; I don't want to be accused of having someone like Nancy Reagan; I

do this thing more pragmatically, I hope. We try and balance the need

as best we can, to keep them out of the facility, but there comes a

time when they must be in a facility. If we clear all the bed-blockers

that should be in extended or intermediate care, we find, within weeks,

those beds are taken by more people.

There is an endless

number of people that need care. I mentioned earlier that 12 percent

are over 65, and we find that in the last few years the acuity is much

higher and much greater — and I think you alluded to that a little earlier — because

people are living longer. I understand that the number of those 85

years and over will double in the next 20 years, and those 75 and older

will increase by 73 percent, while our population will increase by

something like 23 percent.

The need is there; there's no

question about that. I recognize that, but I still have to somehow

balance the need with the dollars that I've got. It's not a simple

chore. Maybe in the future we will have enough funds to do all the

things, although I doubt it very much. I don't think you'll ever have a

government that will be able to meet that demand; not when people are

ageing and staying alive longer — and they should be, because

we're providing the medical care, and people are looking after

themselves more than they did before. However, there still comes a time

in every person's life where the acuity.... That last two, three or six

months is where the costs are. That will continue, I suppose, and we

must provide for it.

That's why we're taking some of these

unpopular stands, saying we want to protect the system; we want to

protect it not just for our society. I'll