The committee met at 9 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Good morning, everyone. My name is Bob D’Eith. I’m the MLA for Maple Ridge–Mission and the Chair of the Select Standing Committee on Finance and Government Services, a committee of the Legislative Assembly that includes MLAs from government and opposition parties.

I’d like to acknowledge that I’m joining this meeting from the traditional territories of the Katzie and Kwantlen First Nations and also recognize that members and presenters are presenting from their traditional territories as well.

I’d like to welcome everyone listening and participating in this virtual public hearing for the Budget 2021 consultation. Of course, the committee typically visits communities around the province to hear from British Columbians about their priorities for the next provincial budget, but due to the COVID-19 pandemic, all public hearings are being held virtually this year.

Our consultation is based on the Minister of Finance budget consultation paper that was released to the public on June 1. Of course, we invite all British Columbians to participate by making a written statement or filling out our online survey. Details can be found on the website at bcleg.ca/fgsbudget. The consultation closes at 5 p.m. on Friday, June 26, 2020.

Of course, the committee will carefully consider all of the input made by presenters, and recommendations will be made to the Legislative Assembly on what should be in Budget 2021. The committee intends to release its report in August.

Now, in terms of meeting format, presenters have been organized into small panels based on theme. This morning we’re continuing with panels on health care, including seniors care. Each presenter has five minutes for their presentation. Following all the presentations by the panellists, there will be time for questions from committee members. We would please like you to keep to five minutes in respect of time. Thank you.

Today’s meetings are being recorded and transcribed, and all audio from our meetings is broadcast live via our website, and a complete transcript will also be posted.

Now I’d like to give the members an opportunity to introduce themselves.

R. Coleman: Good morning. I’m Rich Coleman. I’m the MLA for Langley East.

D. Clovechok (Deputy Chair): Good morning from the Kootenays. I’m Doug Clovechok. I’m the MLA for Columbia River–Revelstoke.

D. Barnett: Good morning. I’m Donna Barnett. I’m the MLA for the Cariboo-Chilcotin.

R. Leonard: Hi. Good morning, everybody. I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

N. Simons: Good morning. I’m Nicholas Simons, and I represent Powell River–Sunshine Coast.

M. Dean: Hi, everyone. I’m Mitzi Dean. I’m the MLA for Esquimalt-Metchosin.

B. D’Eith (Chair): Assisting us today are Susan Sourial and Stephanie Raymond from the Parliamentary Committees Office, and Dwight Schmidt from Hansard Services.

Let’s get started. Our first witness today is Dr. Clark Konczak from the B.C. Chiropractic Association.

Budget Consultation Presentations
Panel 1 – Health

B.C. CHIROPRACTIC ASSOCIATION

C. Konczak: Good morning, everyone. Thanks for the privilege to speak to everybody this morning.

The BCCA, or the British Columbia Chiropractic Association, represents 1,171 chiropractors, which is 90 percent of the chiropractors in British Columbia. I’m from Victoria, B.C., and I’m very, very proud to be their chair.

Our members are spine, muscle and nervous system experts. Chiropractors are ideally positioned to help reduce the pressure on the province’s primary care providers. We cover the province, including serving rural and remote communities. It is chiropractors’ aim to increase the number of positive health care outcomes for thousands of British Columbians.

B.C.’s chiropractors would like to see affordability of health care for all. The BCCA recommends that the number of MSP visits that are supplementary and provided to the population be changed from ten to 20 visits per year. This is because the occurrence of disease and the severity of illness are often higher in populations that are affected by social inequities and discrimination, those living in poverty, Indigenous peoples, certain ethnic communities and women.

[9:05 a.m.]

The limitations of the current program put undue hardship on some of these groups: patients who either require more than ten visits or use more than one type of practitioner per year. Also, COVID-19 has resulted in increased unemployment to the province, which basically means there are fewer people with benefits who therefore require better MSP coverage.

The BCCA also recommends that the fee for supplementary visits be increased from $23 to $53 per visit. This is consistent with changes that have taken place already within ICBC and WorkSafeBC. British Columbians with low income cannot afford to pay out of pocket for the part that is not covered by the $23. This prevents patients from finding necessary care for their pains and ailments. By increasing the benefit, this would help reduce financial barriers faced by vulnerable patient populations who are at the most risk for opioid misuse and addiction.

British Columbians would also like to see chiropractors as part of team-based care, and the BCCA recommends that chiropractors be integrated in community-based primary care networks as full members. This is because 30 percent of primary care visits are for MSK reasons, and chiropractors are experts in this field, and currently, 15 percent of British Columbians are without a primary care provider. This will open up much-needed access to family physicians. Chiropractors already work in multidisciplinary settings where they comanage patients with physicians, nurse practitioners, physiotherapists and occupational therapists.

The BCCA would also like to recommend that the Ministry of Health fund and undertake a large-scale low-back-pain initiative, a research study, to document how chiropractors can reduce pressure for family physician appointments and to improve the management of MSK conditions. Current research already shows better outcomes and high patient and provider satisfaction, and I’m confident that B.C. research will show the same.

The BCCA also recommends that chiropractors be permitted to directly refer for publicly funded X-ray tests. According to our scope of practice, under current regulations, this would help reduce the number of unnecessary family physician visits and remove unnecessary pinch points in the current system.

The BCCA would also like to see the picture archiving and communication system, or the PAC system, opened up universally throughout the province. Currently the project that’s being worked on is called CareConnect. It’s the provincial e-health viewer. It would benefit all British Columbians and their health care providers to have chiropractors access both lab and X-ray results with this. There are still inconsistencies in the system, where Interior Health allows limited access, and Island Health allows full access. We’d like to see it across the province.

Approximately one million British Columbians visit their trusted neighbourhood chiropractor each year to help reduce, manage and eliminate their pain. If the recommendations presented today are implemented, not only would it result in reducing a significant amount of pressure on today’s health care system, but it would help British Columbians with better health care outcomes.

Myself and the British Columbia Chiropractic Association would like to thank everyone on the select standing committee, knowing that in actual fact, you sit all day. Because of that, we’d like to share our sitting and office stretches. We will make sure that everybody gets a copy of that to reference in the future.

Thank you for your time. It’s appreciated. I look forward to talking to you again.

B. D’Eith (Chair): Thank you very much, Clark.

Next up we have Tanya Fawkes-Kirby from the Canadian Association of Occupational Therapists, B.C. chapter.

Please go ahead, Tanya.

CANADIAN ASSOCIATION OF
OCCUPATIONAL THERAPISTS,
B.C. CHAPTER

T. Fawkes-Kirby: Thank you very much. I really appreciate how you guys have managed to pivot, as everybody has, to this environment, to be able to make sure that these still happen.

Like Bob said, I represent the British Columbia chapter of the Canadian Association of Occupational Therapists, which represents about 1,500 occupational therapists in B.C. and occupational therapy as a practice in general for British Columbians.

I’m going to make an assumption, just to keep it quick for these five minutes, that you all know what occupational therapy is because of it being identified as a primary health care provider in the ministry plan and not try to give you the broad scope explanation in this. I’ll just focus on what we’re thinking could be helpful in next year’s budget to increase access to British Columbians’ health care. We’ll also provide further written information to support the suggestions provided here.

[9:10 a.m.]

Both of these concerns are related to access to occupational therapy by the public in B.C. The two most pressing concerns for funding that we would like to bring to your attention for consideration in this next budget are, first, increased funding for OT service hours in early intervention programs through the Ministry of Children and Family Development. It has come to our attention more and more over the last few years that the hourly rate paid in this ministry is far below market value for occupational therapy services in British Columbia.

At this time, the fee that they will pay for access to occupational therapy is $80 per hour. The average, according to our fee survey, is $118, and the marketplace is typically paying right now between $110 and $115. Within other government-funded related programs — for ICBC, for example — it’s at $115.

The reason that this is a problem is that, obviously, all of occupational therapy has a reduced workforce in this area, and actually being able to practise in the area of pediatrics requires additional education, which further shrinks the workforce availability. Then, of course, why would you work for such a different percentage — for the $80 an hour versus the higher — with advanced education? So there’s just that practical piece.

At the same time, the pressures are that there’s increased recognition for the value of occupational therapy and the assessment and treatments related to trauma and attachment and sensory issues for these kids in early intervention settings. Families are attempting to access this occupational therapy and typically can’t for two reasons. They don’t have the information that they need for that early intervention until the kids are three, and then there are wait-lists for access that can be as long as two years because of that reduced workforce pressure, which then places them out of the timeline for early intervention services and the minimal funding that’s available.

If they can access occupational therapy, the families are left paying the difference between the MCFD rate and the billable rate of occupational therapy for this specialized treatment. The need to cover this gap can price many families out of the market, and they never can actually access the valuable early intervention services that would benefit their kids.

We are noting that there’s some degree of discrimination in accesses compared to how families can access much more funding and appropriate funding if they have an autism diagnosis, through Jordan’s principle and in the foster program. This leaves children with diagnoses like cerebral palsy who live with their families, who could require needing assistance with toileting, bathing, choking while eating and needing mobility equipment, with less access to service than children that meet those other program criteria, leaving those complex needs out of the picture entirely.

Solutions for consideration suggested by occupational therapists that work in this area are to at least provide a similar bucket of funding as the autism unit does to bring some equity to access for these families that are facing these complex needs. And in the best-case scenario, increase the hourly funding in those MCFD programs that are outside those other programs that I mentioned to market value for occupational therapy so families can access the early intervention services when they need them.

The second issue is somewhat easier and quicker. Primary care teams are rolling out across the province to varying degrees and with different planning for HHR and team complements. We’re noticing that while the value of OT on these teams is acknowledged by the Ministry of Health, there’s not allocated funding to ensure OTs are on each of these teams. Instead, it appears that funding is being allocated to hiring of allied health. This does not allow for the team complement to include each of the necessary team members that these primary care teams will benefit from and require to operate as envisioned in the Ministry of Health intent of this delivery program.

At the hiring level, we’re hearing that there are teams that are having to choose between social work, PT, OT, etc. We would recommend that there be allocated funding to hire each of these disciplines identified separately rather than put into a bucket of allied health.

B. D’Eith (Chair): Great. Thank you very much, Tanya.

Next up we have Eric Demers from Canadian Association of Physician Assistants.

Please go ahead, Eric.

CANADIAN ASSOCIATION OF
PHYSICIAN ASSISTANTS

E. Demers: Good morning. Thank you, Mr. Chair and hon. Members for a chance to speak to you today about our recommendations on the introduction of physician assistants, more commonly known as PAs, in British Columbia.

I’m the past president of the Canadian Association of Physician Assistants. We’re the voice of more than 700 PAs who work in public health systems in the Canadian Armed Forces. Here in B.C., we have almost 30 PAs, most of whom serve in the forces.

[9:15 a.m.]

Before I tell you about PAs or what a PA is and the value we can bring to the health system in B.C., I want to share part of my story. I served for 23 years in the Canadian Armed Forces, first as medical technician, also known as a medic. Later I progressed in my career and my medical training to become a certified PA. I trained to provide support to Canadian troops and populations in need in armed conflicts, disasters and domestic operations like the Olympics and G8 summits. I served on submarines, where I was the lone medical professional providing primary and specialized care to the crew of more than 50 submariners.

I was also deployed to places like Libya, where as a PA, I oversaw the health needs for the diplomatic mission and its security team. During my time as a medic, I had the honour to deploy many times, including Afghanistan, and care for our ill and gravely injured.

It has been challenging to be in Victoria and not have the opportunity to care for those in my community, never more so than during this pandemic. That’s because PAs are not recognized here and cannot work here, despite the obvious need and strong support from Doctors of B.C., the College of Physicians and Surgeons of B.C., the B.C. Care Providers Association, the B.C. Rural Health Network and many more. So instead of contributing in my community during the worst public health crisis we’ve ever seen, I travel across borders as an essential worker to deliver health care in remote areas. I’m part of a team that includes B.C. physicians which supervise PAs from afar.

If I or any of my colleagues could work here to our full scope of practice, here’s how we could help. Rural emergency departments in places like Ashcroft could stay open on weekends instead of the closures we see thanks to doctor shortages. It’s because PAs can help manage departments, with local doctors providing oversight and available for a few cases. There would be more flexibility in the type of provider that could be recruited by rural and remote communities, including some First Nation communities.

A full-time PA provides important continuity in areas where locum doctors may come and go. With a broad scope of practice, PAs can help with everything from emergency services, women’s health, mental health and chronic disease management. In long-term care, the workforce would be strengthened. Studies show that PAs on staff in long-term care homes help reduce transfers to hospitals, improving patient safety and saving money. We help eliminate delays in care and perform more procedures in-house.

PAs, like nurse practitioners, are advanced practice professionals. We are educated in a medical model, which means our training is similar to that of Canadian doctors. We work autonomously under supervision of licensed doctors to deliver primary and acute and specialty care in all types of clinical settings. PAs are trained to assess patients, order and interpret tests, make diagnoses, provide treatment, serve as first assist in surgeries and much more.

Today B.C. lags behind Ontario, Manitoba, Alberta, New Brunswick and countries like the U.S., U.K., Netherlands and Germany in terms of integrating PAs in the health care workforce. In its recommendation to governments, the Conference Board of Canada says that PAs play a vital role, improving patient outcomes and reducing overall system costs. Canada needs to implement strategic policy and funding changes to the way that health human resources and health services are currently delivered. The Conference Board also reports that the Canadian health care system could save over $600 million if the use of PAs increases across the country.

Today CAPA recommends to the committee that the provincial government recognize and regulate PAs under the College of Physicians and Surgeons of British Columbia. We also recommend that the government earmark $6.5 million in funding to hire 50 PAs over the course of three years and work with doctors, health systems leaders, First Nations and other stakeholders to identify where the PA model can have the greatest impact on patient care. Lastly, we recommend that the government explore the creation of a PA education program through UBC that could establish a homegrown pipeline of PAs.

The COVID-19 pandemic has swiftly changed our long-held beliefs about how we deliver care in this province. Some say we pushed the telemedicine revolution forward by at least a decade or more. It’s time we make the same progress in our health care system. The PA model can help B.C. provide more care at lower cost while helping doctors focus on complex patients who truly need their expertise.

Budget 2021 is an important opportunity to change the workforce landscape in our province in a way that will benefit generations to come.

B. D’Eith (Chair): Thank you very much, Eric.

Next up we have Christine Nielsen from Canadian Society for Medical Laboratory Science.

Christine, please go ahead.

CANADIAN SOCIETY FOR
MEDICAL LABORATORY SCIENCE

C. Nielsen: Hon. Members of the committee and Chair, thank you for the opportunity to appear before you today. My name is Christine Nielsen, and I am the CEO for the Canadian Society for Medical Laboratory Science or CSMLS. I’m also a certified medical laboratory technologist and have been working in the field since 1997.

[9:20 a.m.]

Founded in 1937, the CSMLS is the national certifying body and professional association for medical laboratory technologists and assistants. CSMLS has a long history of leading the profession by setting the standards of practice in the industry with stakeholders such as regulators and employers. We have continued to grow and develop in order to represent the professional interests of approximately 14,000 members in Canada, over 2,000 of which practise in British Columbia.

Our message to this committee and the government of B.C. is particularly relevant, given the global COVID-19 pandemic. I would be remiss if I did not recognize the outstanding work of our laboratory professionals who are stepping up to the added testing needs and increased demands in the health care system. Testing is the key to monitoring and reopening Canada safely.

B.C.’s medical laboratory technologists, or MLTs, are highly trained professionals, and there are currently two programs — in Prince George and Burnaby. Every day in B.C., MLTs provide tens of thousands of potentially life-changing lab results which guide the diagnosis and treatment for patients. Simply put, without the timely, accurate, precise and professional work of our members, the rest of the health care system cannot function effectively. This is even more so during a time of COVID-19, when the burden on MLTs is so much higher.

Lab professionals practise in hospital labs, private government, public labs, research and educational institutions. Today, I would like to outline two important considerations that the government of B.C. could consider urgently.

First, it’s imperative that the government work to address the growing shortage of MLTs in the province. About half of all MLTs will be eligible to retire in the next ten years. Even before COVID, these shortages were being felt, particularly in rural and remote communities. The impending retirements only further exacerbate this issue.

Now we are starting to see the shortages in major urban centres too. The current supply of new MLT graduates cannot offset the retirement numbers. B.C. graduates less than 90 MLTs annually, and retirements are outstripping new graduates significantly. The shortages do have a cascading effect throughout the medical system. Delayed diagnosis means delayed treatment.

COVID-19 testing is not going away anytime soon, and the health care system is returning to normal function. Testing is on the upswing for regular practice, emergencies and surgeries. As well, the sheer number and complexity of lab tests are increasing in the marketplace. Advances in testing capabilities and precision medicine will continue to add to testing volumes. For example, the number of genetic tests available has doubled in the last two years. This situation will be further compounded by B.C.’s aging population, with co-morbidities and citizens living longer.

To address these challenges, we recommend the government increase the supply of new lab professionals by increasing the capacity in the two training programs in B.C. A dedicated investment in training-program capacity would make a big difference every year in B.C.

Next, we recommend the creation of sustainable bridging programs for internationally educated MLTs to enhance the B.C. labour market. There are currently underemployed medical technologists in B.C., simply because they are having some difficulty getting the final stage, which is certification, and we know that bridging programs definitely improve the viability of a newcomer to Canada in the labour market.

Further, we should incentivize MLTs to relocate to rural and remote areas, where the ongoing shortages are much more of a challenge. This could be in the form of loan relief, tax breaks or bonuses.

The second major consideration is regarding the regulation of medical laboratory technologists. Last only to P.E.I., the MLT profession was at the end stage of the process of self-regulation, but is facing suspension in light of the Harry Cayton report. In the absence of regulation, the employer does set the standard. The scope of practice is ill-defined, maintenance of competency is left to chance and there are no defined processes in place for patient complaints or discipline.

Suspending the process of self-regulation leaves the public without the safety and reporting mechanism afforded to most other health occupations. This is absolutely critical, and our members across the province would like to see this implemented without delay.

In addition to this, the government could also regulate medical laboratory assistants, or MLAs, as they can take on many aspects of the lab workload and provide for additional capacity in B.C. Regulating all lab professionals would provide an immediate boost to expand capacity, supporting COVID and general testing efforts, while protecting the public.

Thank you for your time today, and I look forward to our discussion.

B. D’Eith (Chair): Thank you very much, Christine, and all of the panellists for your presentations.

Just before I open it up to members, I did have a quick question for Eric, if that’s all right, just in regards to the physician assistants in British Columbia.

Could you perhaps tell me what…? Presumably, if we went and talked to the Minister of Health, there would be some reason why physician assistants haven’t been integrated. It would be nice to maybe find out what those pressure points are or what the reasons are why physician assistants have not been integrated, as you would like to see.

E. Demers: I’m not going to pretend I speak for the minister.

B. D’Eith (Chair): No, no, no, of course not. I’m just saying there are obviously some reasons, and I’d appreciate hearing what the pressure points are. What are the obstacles that you’re running into and why?

[9:25 a.m.]

E. Demers: Some of the obstacles that we’ve heard over the years have been…. The direction has been nurse practitioners and so on, which I think is great — that nurse practitioners are actually being pushed forward in regards to their scope of practice and practising. But it’s been made an either-or, and I don’t think that’s right. I think that there is more than enough work to go around for doctors and nurse practitioners and PAs and occupational therapists and pretty much everyone else.

B. D’Eith (Chair): Great. Thank you very much, Eric.

R. Leonard: Along the same lines, my question for you…. You mentioned exploring a program out of UBC.

Where do physician assistants get trained now, what institution trains them, and how does it differ from…? If nurse practitioners can be certified to practise here, is there — not parity — an ability to challenge the system so that you can say: “Well, I am as good as a nurse practitioner or better”? So it’s sort of two questions.

E. Demers: To the first question, right now in Canada there are four programs running. There is one out of the university of McMaster; the University of Toronto which is part of the Northern Ontario School of Medicine; the University of Manitoba; and then the Canadian Forces program, which is affiliated — I believe they are still associated — with the University of Nebraska in the U.S.

For the second part of the question, NPs and PAs…. I don’t think you can go from one to the other per se or challenge the type of work. And it’s not the type of work that we’re looking for, the type of relationship we’re looking for in regards to that. PAs are force multipliers for doctors, physician extenders — other key words that we hear.

R. Coleman: How many PAs are there in Canada? I knew that they were in the military. And thank you for your service. I have a son that’s a veteran of Afghanistan.

But how many PAs would there be in Canada that are trained and are in your group looking to extend their practice and be part of the global practice of medicine through the health system?

E. Demers: Currently, in the association, we represent over 700 PAs across Canada working in different places, mostly in Ontario and Manitoba. Those are the big places, and then the Canadian Forces.

R. Coleman: How many in B.C.?

E. Demers: In B.C., there are about 30. Most are in the Forces. And there are many like me who have retired from the military and are doing fly-in, fly-out jobs or travelling to work.

R. Coleman: Thank you.

D. Clovechok (Deputy Chair): I just want to say thank you for your presentations. Clark, being a member of the select sitting committee, I certainly could use your services.

I just wanted to say the same thing to you, Eric, from Rich. Thank you so much for your service to your country. Appreciate it.

D. Barnett: Thank you for your service, Eric. It’s amazing how you can go and service our Forces and do an amazing job, but there’s a stumbling block to get into the health system in British Columbia. And hopefully that changes.

I have a question for Christine. You mentioned that self-regulation was suspended in British Columbia. Could you explain why? Or have you been given an answer?

C. Nielsen: Yes. We have been given an answer. So it’s my understanding that in some statements made by…. There was a multilevel participation reviewing the Harry Cayton report when it came out. That was really looking at a couple of things.

[9:30 a.m.]

It was looking at a single occupation and some of the challenges, I would say, about how well they were regulating in the interests of the public. I think it was denturists. I can’t remember which occupation the deep dive was on.

Mr. Cayton also made recommendations on the future of regulation in British Columbia. What I think I’m seeing in B.C. is the desire to do clustering of a regulation. I think the priority in B.C. right now is to take those that are currently regulated. Nursing has done a major amalgamation, and I think that was seen as a good model for others coming on board.

In medical lab science, it was suggested that self-regulation is not likely as a stand-alone institution. Are there others in the province you’d like to partner with? Nursing was mentioned; so were family physicians.

I think the plan, though, had been all along to do an umbrella college very much like they do in Newfoundland, where they have some challenges with numbers. B.C., very wisely, is trying to get some pieces together that can be harmonized, like registrarial functions. You know, complaints and discipline look very similar from process but not content as you add in different occupations.

The plan had been, to my understanding, that medical lab science, medical radiation technology, cardiovascular and a few other occupations like respiratory were planning to be in an umbrella. Lots of work had been done, and then the Cayton report came out. So it is my understanding that it has stalled. It’s not off, but it’s stalled. The problem is that the overhaul of a regulatory framework in any province — in my mind, three to five to ten years. So that means we’ll be left without regulations.

One of the best things about regulations is they’re a place for the public to go when something goes wrong, and it’s assurance to the public. Definitely, historically there have been some challenges in some occupations with their true function as a regulatory body, but there are 400 regulated occupations in Canada. Most of them are doing an amazing job by having patient panels and making sure that people understand what their scope is and that the public knows there’s a place to go if something goes wrong.

B. D’Eith (Chair): Great. Thank you very much.

Clark, I have a question about…. It’s my understanding that when it comes to doctors and referrals, generally doctors will refer to a physiotherapist before they’ll refer to a chiropractor. I’m not saying that’s right or wrong. I’m just saying that it seems to be the trend. I’m just wondering if perhaps part of the reason why chiropractic is not as integrated is because a lot more work needs to be done educating the public, and particularly physicians, about the benefits of chiropractic practice.

I know in some sports medicine teams — my wife works on one — chiropractors are integrated with physio and orthopedic surgeons and everyone else, and it works extremely well. I certainly see what you’re saying, but there are way more physios on that team than chiropractors, and that’s probably more because of doctor referrals. So I’m wondering if you could address that, because that might be a part of the challenge to getting chiropractors integrated into teams like you would like to see.

C. Konczak: Well, less true as time goes on. Part of it is just simply that chiropractors, physiotherapists, occupational therapists, all these health care practitioners are choosing to work together regardless of whether or not the model is going that way, at least in the private sector. You see that more and more. It’s sort of one of those things.

Our education is going towards that direction where we’re taught to be interdisciplinary. We do interdisciplinary research. We attend each other’s conferences, etc. We work together on teams. I have been the CFB Esquimalt base chiropractor for many, many years. It’s one of these sorts of things where these models are going that way.

There is still some truth to physician preference towards physiotherapy, but they will refer more and more towards chiropractors and occupational therapy and massage therapy and all that kind of stuff as time goes on.

It’s very true that there is a professional entity responsibility to bridge that gap and reach out to the physicians. We have been actively doing that. We have regular meetings with the physicians in B.C. as well as the physiotherapists and everybody else because, again, that’s putting our money where our mouth is. It’s like we work together as individuals. I think our members expect us to communicate, and we have been. And I think all of our members would be very proud of the way that all of the organizations engage each other.

[9:35 a.m.]

It’s kind of a model that…. I can’t say how it works in any other province, but I believe in B.C. in the last few years we have been doing things considerably better and making fertile ground for these shared care networks and these increased collaborative situations. And it’ll be easier and easier. It’s one of those things that…. In my mind, it’s not a matter of if; it’s more a matter of when.

B. D’Eith (Chair): Fair enough. Having met with younger resident doctors who are being trained in team-based medicine, you’re right. This is where we’re going. But I was just curious about that.

Ronna-Rae, please go ahead.

R. Leonard: It’s a follow-up to Christine, but it’s a question for Clark.

In terms of regulation, you say that the B.C. Chiropractic Association has about 90 percent of all practising chiropractors, in the association. Is there a regulatory body that covers 100 percent? I’m thinking as a consumer, when I go out, if it’s going to be covered by MSP. Will every chiropractor that I encounter be covered by some regulatory process that makes sure that who I’m going to is qualified and will be covered?

C. Konczak: We do have the luxury of having what was discussed. We do have a provincial oversight body, the College of Chiropractors of B.C. What happens is they do set the standards of practice for each practitioner. So 100 percent of the chiropractors would have access to MSP, just like they do with ICBC or WorkSafeBC. The simple answer is yes. Our oversight body does a very, very good job of making sure that we’re practising to the highest standard regardless of whether or not you are an association member.

R. Leonard: Just as a follow-up, have you been captured by the new legislation that is creating an umbrella regulator?

C. Konczak: Yeah. We don’t know where we’re going to land, as nobody actually does. But yes, we’re captured under the auspice of the Cayton report and the decisions that will be made there.

We as an association are actually in favour of amalgamation, to some degree. We see benefits of it, and we support the Ministry of Health’s push towards that. But again, we don’t know what that looks like. We’ve just sort of vocalized our support of the process. I think British Columbians will benefit to some degree from it, but I also do agree that we do need to look into making sure that people that are on the outside of this process do also get considered as well.

B. D’Eith (Chair): Tanya, did you have any further comments at all before we break? We haven’t given you a chance to speak a little bit more.

T. Fawkes-Kirby: No, not at all. I was trying to nod along with some of the things that I agreed with, with what Eric and Clark and Christine were saying in particular. Yeah, the regulation is a big question mark for all of us, and I’m eagerly looking forward to how that’s going to play out.

There are no other things to add, beyond what we did.

B. D’Eith (Chair): Great. Excellent.

Any other questions from members?

Okay. I want to thank the panellists and, of course, thank everything that you’ve all been doing, especially during this very difficult time, during the COVID-19 crisis. Thanks again.

We will take a short recess and come back at 9:45. Thanks, everyone.

The committee recessed from 9:39 a.m. to 9:45 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Next up we have Isobel Mackenzie, office of the seniors advocate. Then at the end, we’ll have questions.

First up, Isobel. Please go ahead.

Budget Consultation Presentations
Panel 2 – Health

OFFICE OF THE SENIORS ADVOCATE

I. Mackenzie: It’s a pleasure to once again be presenting to this committee, although in a different format. Just before I start, I want to thank all of you. This is a bipartisan committee of the Legislature, and I’ve had the good fortune of working with another bipartisan committee of the Legislature on the safe seniors, strong communities initiative. I have to thank everybody in the Legislature. You’ve come together marvellously and served the needs of the seniors of B.C., through this pandemic and through the efforts of mobilizing the community, in a very brilliant way. I see Ronna-Rae Leonard, who’s on the committee, is part of safe seniors, strong communities, as well.

I’m going to limit my presentation to two issues that I want to talk about as they impact seniors. The first is the issue of income. I think that as we have seen this pandemic unfold, we’ve seen several fault lines appear in our network of social services and care in this province and across this country. One of the fault lines that I think has evidenced itself is the frailty and precariousness of our very-low-income seniors in B.C.

Just to put it in perspective, 25 percent of B.C. seniors who filed taxes in 2017 had an income of $18,500 a year or less. Now, some of those folks will be part of a household, and the income will be higher. But I also want to highlight that 250-some-odd thousand, a quarter of our seniors, are in receipt of the guaranteed income supplement, which is another test of low-income seniors, and 57,000 seniors get the seniors supplement, which is for the lowest-income seniors.

This year we did see a response. We saw $900 provincially for the seniors supplement. We’ve seen some federal money, $500 for GIS and OAS, and I think that’s very important for this year. But as we look beyond this year to the following years, I want to emphasize the need of the low-income seniors, particularly those who are in receipt of the seniors supplement.

The seniors supplement in B.C. is $49 a month, and it’s been $49 a month since 1987. Every province has a version of a supplement for low-income seniors. B.C.’s is amongst the lowest. There’s only one province with a lower amount — New Brunswick at $33. The average amount is $120 a month. So I would like the committee to give consideration for next year’s budget to have some relief for our lowest-income seniors.

Those are the ones who are in receipt of the seniors supplement. Their incomes are generally below $20,000 a year, often below $19,000. Those are folks for whom their only source of income is really OAS and GIS. They have almost no — often none at all — CPP contributions. I think we’ve seen the challenges that present themselves when folks at the lowest-income threshold suddenly find some of their supports — like going to seniors centres and libraries to get Internet access, etc. — pulled away from them. They’re left very vulnerable. I would ask that you consider that.

The other thing I would ask you to consider — I’ve asked before — is the regulated co-payment for our home support program. Just a reminder that a person in B.C. with an income of $28,000 a year is going to have to contribute $8,000 of that to get a single daily visit of home support.

As we look at the stresses on our long-term-care system and the stresses on our ALC beds in our acute care system in normal circumstances and how that’s exacerbated in our response to COVID, I think it’s more important than ever to ensure that we have those community supports available to help frail seniors and their families stay at home for as long as possible.

[9:50 a.m.]

Certainly, there is a financial impediment with our regulated co-payment for home support. Any program we come up with — expanding CSIL or being allowed to shift funding — comes to a bit of an abrupt halt when you look at that regulated co-payment.

Just to put it in perspective, a long-term-care bed in this province costs, on average, $78,000 a year, and $56,000 of that, on average, comes from the public, with the other $22,000 from the resident. So there’s certainly a compelling economic argument for ensuring that we shift the incentives to the community so that they are at least equal to the incentives in long-term care, in terms of where frail seniors will be able to find the supports and the care they need.

I thank you very much for the time, and I hope you will give consideration to those recommendations.

B. D’Eith (Chair): Thank you very much, Isobel. I appreciate that.

Next up we have Sheila Pither from the Council of Senior Citizens Organizations of British Columbia.

Sheila, please go ahead.

COUNCIL OF SENIOR CITIZENS
ORGANIZATIONS OF B.C.

S. Pither: We are grateful for the invitation to be here. COSCO is an association and organization that has been around for 70 years. We’re celebrating that anniversary all this year. I was speaking to a group about this, and one of the people in the group said: “Were you there at the beginning?” I didn’t know whether to laugh or cry.

Anyway, we have 71 groups affiliated and we have more than 200 individuals who are associate members. We were founded in 1950, as I said, and since then, we’ve been working to ensure that seniors in British Columbia have their needs met and have concerns dealt with.

We’ll be making recommendations today — eight of them, in fact. Probably what I should do is go into those.

The first one is that the B.C. government work collaboratively with the federal government to include long-term care in the Canada Health Act and to develop a national standard of care.

The next one is that an independent review panel be appointed immediately to examine the quality of care of seniors and frequency of inspections in all long-term-care facilities in British Columbia.

We would like to recommend that the Ombudsperson’s and seniors advocate’s — Isobel — recommendations be implemented. We know that they were made some time ago. Since then, we haven’t really had a lot of implementation.

The fourth recommendation is that the human rights enshrined in Canadian and international laws be acknowledged and enforced in British Columbia.

Next we want to recommend that the government immediately stop allowing privatization of long-term-care residences and begin a buyback process.

We want the government to establish standards of training and compensation for long-term-care facility staff and that working conditions and pay rate be closely monitored.

The mental health impact of the pandemic should be studied, and that assistance that people need should be available. There will be needs for counselling.

There are other factors that contribute to the ability of seniors to stay in their homes, and that is what most of us want to do. But we do have other needs. We have dental care, vision and hearing, medication reviews and, of course, access to prompt and appropriate medical care.

[9:55 a.m.]

On the plus side, the provision of those essentials is probably cheaper than keeping people in institutions.

When COVID-19 is conquered and we are putting our world back together, senior care can’t return to the way it was. Will there be retribution for those who put profits before human dignity? Will people understand that these are the most vulnerable and cannot come to their own defence? They need to have others be sure that they are being properly looked after.

We have been advocates for 70 years. We’ll continue, but we don’t have the power to punish those who put greed before human dignity. That power is in the hands of government. We trust that it will be used wisely.

Again, thank you for inviting us to participate. It means a lot to us to realize that senior voices are heard.

B. D’Eith (Chair): Thank you very much, Sheila.

Next up we have Mike Klassen from B.C. Care Providers Association and EngAge B.C.

Please go ahead, Mike.

B.C. CARE PROVIDERS ASSOCIATION,
ENGAGE B.C.

M. Klassen: Thank you, members of the Committee on Finance and Government Services, for inviting B.C. Care Providers Association and EngAge B.C. to present today.

I echo the comments of the seniors advocate on the work that has been done by our elected MLAs.

Through our association, we speak for the majority of the organizations that provide long-term care, assisted living and private home health services as well as those who operate independent living residences in B.C. As you know, in our province, approximately two-thirds of front-line care for seniors is provided by private and non-profit operators.

This presentation comes to you in the midst of a global pandemic that has impacted our elderly population more than any part of our society — in particular, those people who live in our care homes. Even those care homes accredited with exemplary standing have been no match for the pernicious spread of COVID-19. While home health care operators have not experienced notable infection rates, they have also experienced challenges with accessing the equipment they need to keep staff and seniors safe.

At the B.C. Care Providers Association and EngAge B.C., we believe that COVID-19 has permanently altered the landscape for seniors’ live-in care providers. This is why our presentation titled “COVID-19: A Turning Point for Seniors’ Care” puts forward recommended funding measures that will aid the continuing-care sector in becoming more resilient in the face of a threat posed by future waves of the coronavirus.

We recommend the following:

(1) That the B.C. government, working in collaboration with commercial distribution networks, invest $10 million to create regional stockpiles of personal protective equipment for B.C.’s health care sector to prepare for future pandemics, with an emphasis on seniors’ live-in care providers, including non-government home health care operators.

(2) That the B.C. government invest $20 million, over three years, to fund a comprehensive, industry-led health human resources strategy for the seniors care live-in sector to address chronic worker shortages and improve quality of care for residents and clients. This funding will also allow for investing in the current workforce by providing more training in infection control and mental health and wellness programs for care workers.

(3) That the B.C. government create a new provincial tax credit program through which seniors who access non-government home health care or independent living services are eligible to receive a refundable tax credit of up to $2,500.

(4) That the B.C. government provide funding of at least $15 million per month to cover COVID-19 related costs for non-government long-term care, assisted living and independent living operators in B.C. Along with being retroactive to mid March 2020, such funding should be in place until medical orders are lifted.

[10:00 a.m.]

Finally, that the B.C. government allocate $30 million over three years to establish a COVID-19 innovation fund to assist non-government independent living, assisted living and long-term care homes to ensure safety, improve quality of life and reduce social isolation by implementing measures to ensure proper physical distancing through building enhancements and implementation of creative visiting solutions. Improving access to new tools and technologies for better communication between seniors and their families, and increasing and modifying existing recreational therapy programs to improve seniors quality of life.

The total estimate over three years for this funding would be up to $240 million. In return for this investment, B.C. will realize significant savings through improved health outcomes, less social isolation, higher worker retention and reduced risk to care staff. Our province can and should be the best place to live to a ripe old age.

It is understood that we remain at risk of a second wave of the coronavirus. Therefore, by ensuring that we have a strong and sustainable continuing care sector through the measures outlined in this submission, B.C. will be better equipped to respond to this threat.

We must always acknowledge the sacrifice and loss felt by so many families due to the novel coronavirus. However, we must credit the B.C. seniors living-in-care sector and the collaborative Team B.C. approach between elected officials, government staff and key stakeholders for helping to bend the curve and limiting the spread of the virus.

Thank you again for your time this morning. A detailed budget submission document from our association will be soon provided to the committee.

B. D’Eith (Chair): Thank you very much, Mike.

Next up we have Dr. Anthony Nadolski from the B.C. Dental Association.

Please go ahead.

B.C. DENTAL ASSOCIATION

A. Nadolski: Greetings. My name is Dr. Anthony Nadolski, president of the BCDA. I’m also division head of dentistry for VIHA. I currently work at three hospitals and run a private practice.

The BCDA represents over 3,700 dentists who are committed to the oral and general health of British Columbians. Congratulations to the government for its COVID-19 response and the leadership of provincial health officer Dr. Bonnie Henry. I want to recognize Ministers Shane Simpson and Adrian Dix for their ministries’ investment in oral health initiatives by recognizing dentistry in the poverty reduction strategy and the reduction in wait times for dental surgeries.

I treat many medically and physically challenged patients, many of whom are on social assistance. The reduction in wait times has significantly reduced their suffering and improved their quality of life. In phase 2 of the pandemic, dental offices have opened, but it is not business as usual. Enhanced infection control measures and social distancing have reduced the ability of dentists to treat the same number of patients as before the pandemic. Federal and provincial financial support systems like CEBA and lease deferral still require dentists to pay back funds while they are now treating fewer patients and facing higher costs per patient.

Prior to the pandemic, operating costs accounted for 65 percent of revenue. With higher supply costs and reduced patient flow, this figure will increase. Our recommendations that have been raised previously will address the oral health needs of British Columbians.

Our first recommendation is to update social assistance dental coverage, including fees. The dental program has not been reviewed in over 20 years, and the last fee increase was 13 years ago. For adults, an average fee is around 54 percent of our standard dental fees, and the fees for our healthy kids program are slightly higher, at 67 percent.

The Ministry of Social Development funded a BCDA pilot project which demonstrated that the current program essentially delays necessary treatment, adversely affecting patients’ overall health and quality of life, ultimately resulting in increased costs to the public health care system. Just having good, regular dental care could save the medical budget many millions of dollars.

Our second recommendation is to create a dental plan for lower-income seniors who benefit from rental subsidies provided under the SAFER program.

[10:05 a.m.]

If the current social assistance coverage was extended to SAFER recipients, we estimate the cost of this new program to be between $6 million and $6½ million and would relieve the pressure on the public health care system.

A review of long-term-care facilities would be welcomed by the BCDA. Provincial regulations require patients entering a home to have an oral health plan, receive daily oral hygiene and have access to an oral health provider once a year. However, the implementation of these recommendations is inconsistent. Care aides are pressed for time, and oral health is often neglected. Dentists are frustrated with a lack of support in providing care within these facilities.

The BCDA proposes the following. First, provide dental coverage for patients in long-term care to relieve pain, infection and bleeding and enhance their quality of life. Using social assistance programs and fees, this program would cost around $6 million. Second, establish a dental coordinator position in long-term-care facilities, like in Prince George. They assist care aides in providing dental hygiene and support dental professionals by organizing patients for treatment and securing consent from families.

Lastly, the BCDA again requests that dentists have access to PharmaNet. Access to the patient’s medication history is vital for the appropriate care and to discourage any type of opioid-seeking behaviour.

The BCDA values our working relationship with the B.C. government. We look forward to continuing our collaborative relationship so that we can provide British Columbians with the best of oral health care.

Thank you, and I would be happy to take any questions.

B. D’Eith (Chair): Thank you so much to all of the presenters. We really appreciate your comments and also what you’ve been doing during the pandemic. It’s obviously been very difficult for everybody, particularly on seniors. So this discussion around seniors is so important — seeing the changes to allow, for example, workers to only work at one facility. I know that was a very, very complex change. Everybody worked very hard to make that happen, but I think it’s demonstrated that it’s saved lives, so thank you so much.

I would like to open it up to members for questions. One thing I’d like to comment on, if that’s all right, is around dentistry and the importance of that. I certainly appreciate your comments. I know that in one case…. At one of our supportive housing units, I met a young gentleman. Because of health conditions, many of his teeth had been lost. His big excitement was that he was going to get help to be able to fix his teeth. Part of that was not just dignity, but also his ability to get back into the workforce. So his health considerations, his dignity considerations, but there’s also…. It’s very difficult for people to function properly in society without teeth.

I just want to commend the dental association for all the work that they do, especially the pro bono work they do for people in the lower income brackets. So thank you for that.

R. Coleman: Just on that, too, Bob, with regards to the dental association. I want to thank the dental association. For 24 years, there have been cases come through where peoples’ acute health was affected by their teeth. They were in lower-income or desperate situations. I’ve always found that I’ve been able to phone the dentist; the dental association or an arm of, or somebody I’ve known there. They always step up. They’ve always been there to help.

I think any time we can improve on the oral health of people as we go forward, it’s going to be good for their outcomes. As somebody who has actually not had the greatest teeth in the world through my life, I very much value it. I know that there are lots of people who need that help. When they needed it severely, I’ve always been able to get the help for my constituents.

To move it to where we’re focusing even more on it, I support.

[10:10 a.m.]

D. Barnett: Thank you all for your presentations. I have — I don’t know — a question or a concern over this pandemic. Of course, it’s been before the pandemic. But here in rural British Columbia — and particularly in my riding, where we have a high percentage of seniors — everything is computerized. Our seniors, through COVID here…. Many of them have called this office with difficulty accessing many things, because the library is closed and their seniors advocates here are closed.

Just a comment that I think this has to be taken into consideration in pandemics and emergencies like this. Part of our senior population is totally lost and isolated because they have nowhere to go. Everybody tells them to go to a computer, to go to a website. That’s very frustrating for so many of them.

B. D’Eith (Chair): Isobel, did you want to comment on that at all?

I. Mackenzie: Yeah, I couldn’t agree more with what Donna is saying. You hear of lots of seniors on Facebook and all of these other data, but when you go out and ask, in an organized way, “Where you are getting your information from?” the majority of people, certainly those 75 plus, are not getting their information from the Internet. So how are we connecting with them?

In parts of B.C., it’s about the ability to have Internet — period. For some, it is the cost of the Internet. Your basic Internet costs close to $1,000 a year. There are some people who can’t afford that. Then, even if those two pieces come together, it’s how you can use the technology. Not everybody can use it. As we’ve seen with the pandemic, it’s difficult to quickly get yourself up to: “Now I know how to use all of this.” You need somebody to help you to get to know how to use it in the beginning.

I agree with Donna that we’ve got to be careful about who we are marginalizing when we’re using the Internet and these kinds of means for communication.

B. D’Eith (Chair): Well, thank you very much.

Any more questions from members?

R. Leonard: I want to thank all of the folks on this panel. I really like this format because it gives us an opportunity to see a number of different perspectives on one topic and to put things into a nice package. I really appreciate everyone presenting today. I also appreciate that everybody can hear each other — in the other format, sometimes people come, do their presentations and leave — and that you get to hear what everybody else is saying. That’s great.

The question I have is around dentistry. I’ll just share that I had a father who had all of his teeth. He was in long-term care, and he was not a very easy patient to attend to, for his oral hygiene, both daily and for dentists who came to visit. I’m just curious if there is extended training for people to work with these kinds of difficult patients.

A. Nadolski: At the present time, it’s by working experience with these patients. I used to work in long-term care, and I know it is very demanding. You have to be a patient kind of practitioner. It’s not for everybody. Fortunately, in Victoria, we have a great [audio interrupted] that’s doing that.

R. Leonard: If I can ask, too: is there a supplement given for dentists who go into facilities, as opposed to having patients come to them?

A. Nadolski: No, there isn’t. That’s why we gave our presentation about extra funding.

R. Leonard: Thank you. I appreciate, too, all of the comments that folks have made around the impacts of COVID-19 and that human dynamic of communication, the ability to connect with people. I’m encouraged by the desire to see a way around it. I think that will inspire innovation and that we will find a way. I appreciate everybody bringing that to our attention.

A. Nadolski: Can I make one more comment about it here? We do have a working group at the BCDA on gerontology dentistry.

[10:15 a.m.]

M. Dean: Thank you to you all for all the work that you do on a daily basis, especially in these really hard times as well. It’s profound, and we really appreciate everything that you do.

I’m interested in the dentistry side of things, because dentistry is a team practice. There are lots of different professionals involved, and like with primary care, there are opportunities for kind of shifting the focus on resources. I’m just wondering whether there are some opportunities in British Columbia for a more kind of innovative and team-based approach to fill some of those gaps. I’m just wondering whether you’d given that some thought.

A. Nadolski: In the recent past, there has been a shortage of certified dental assistants. So we are looking for more innovation. There is a lot of innovation in dentistry. It’s changing all the time. A lot of it is becoming digital. We can do digital impressions, but the cost of that type of technique is very expensive. Not every practitioner can afford to do it.

It is important that we have a team approach around the dentist and that it be patient-centred care. Hopefully, I answered your question.

B. D’Eith (Chair): Thank you very much. I appreciate it. Are there other questions from members?

We didn’t talk too much about the effects of COVID-19 and isolation for seniors, particularly now, being at such a high-risk age with COVID-19. For more and more seniors, isolation was an issue before COVID-19. Now I’m sure that it has been exacerbated even more. I’m wondering, Isobel, if you could comment on steps or thoughts in terms of trying to alleviate the isolation.

I. Mackenzie: Well, I think if there’s a silver lining in any of this, it has been this tremendous outpouring from the community — it’s not just in B.C.; it’s across Canada, I would say — of folks saying: “We really do care about our seniors, and we want to make sure that they’re well and safe.” A number of initiatives to make sure people are connected during COVID, I think, will remain post-COVID, around those human connections.

There’s no magical solution that is going to match people up with somebody to make sure that their social needs and their mental health and emotional needs are met, but I think as we chip away at this, we highlight the issue. The vulnerability of our seniors has been brought to the forefront. I hope that that will be a catalyst, as we keep moving forward, that people will remember, not just within the wider society but even within their own families, around staying connected with the older people in their lives. If we can focus on how we get these community connections and build the community capacity up, I think that will enhance it as well.

B. D’Eith (Chair): Great. Well, thank you very much. Any other questions from members?

R. Leonard: I just wanted to thank Sheila, particularly, for sharing the voice of seniors in this panel. I think it just makes it all the more real when we have someone who is out there really stepping out to make sure that seniors’ voices are heard.

I know there are a lot of concerns around ageism, and she made one comment. If we do have a minute, if she wouldn’t mind making a comment around ageism. I assume that’s where she made a recommendation around human rights.

S. Pither: Yes, it is connected with ageism. It’s systemic, really. It has been around for a long time, and it’s not easy to change.

[10:20 a.m.]

However, I’m just responding, as well, to the comment about the need to be able to use a computer. Now various merchants are sending notes: “We will only send you an electronic bill.” We’re fighting that nationally with other groups right across the country. It’s simply not acceptable.

Really, the virus has shown us…. I happen to have been alone for a week, which isn’t very long, but it’s a strange feeling not to be able to say: “Well, I’m going to go out to the store or I’m going to call friends and we’ll get together for lunch.” Your whole life is put on hold. So I think that the work that Isobel has done with the 211 line — it’s really worked out well, hasn’t it, Isobel? Yeah.

So it’s a time to be lived through for us. In COSCO, we have 70 years of looking after seniors and trying to make their lives better. So we won’t stop. We appreciate ever so much that you did invite us to come to this table. It’s an important place for us to be. Thanks, Ronna-Rae.

R. Leonard: Thank you.

B. D’Eith (Chair): Thank you very much, everybody. That’s a great way to end the panel.

Just picking up on what you said, Sheila, I heard the same thing. I’ve been working on the telecommunications file in regards to billing for mobility. The wireless code says you have to provide a paper bill if people ask, but it doesn’t say it has to be free, so seniors are getting charged extra for paper bills, that kind of stuff. I hear you, and I’m sure all of us here…. Those kinds of gaps have to be worked on.

Thanks so much for all of your advocacy, everyone, and also all the work that you’ve done during this pandemic. We really appreciate everything that you’ve done.

If I could take a short recess, we’ll be back at 10:30. Thanks, everyone.

The committee recessed from 10:22 a.m. to 10:30 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): Hello, presenters. How are you?

If you could please keep your comments to five minutes, we’d really appreciate that. What we’ll be doing is having the presentations first and then questions afterwards.

If we could please start with Margaret Little from Save Our Northern Seniors.

Please go ahead, Margaret.

Budget Consultation Presentations
Panel 3 – Health

SAVE OUR NORTHERN SENIORS

M. Little: My name is Margaret Little. I’ve been a member of Save Our Northern Seniors for 20 years, and for 20 years, we have made presentations to every politician and group that we possibly can. We have worked closely with our community partners, and during the COVID crisis, we have worked even more.

I realize that I sent in a lengthy document, but I wanted to tell you a bit about our dynamic community. I hope that you will take time to look at the recommendations that the select standing committee made last year. Those ones are still really, really important to our community.

I’d like to thank those people who have worked in our community making life better for seniors. It has been a tremendous effort. However, after COVID-19, we can’t be put back on the shelf and say: “Okay, we’ll just do a little bit.” We have to make giant steps in all directions for seniors.

Our priorities for Fort St. John and the area are a third house at Peace Villa designated as a dementia village as well as assisted-living units. We need more staffing at all levels, with more personal time for seniors, either in a facility or at home.

Improved support services, such as physiotherapy and recreation time with space for activities, are an extremely important feature. We’d like to have locally grown food. We need to have enhanced transportation systems and funding for support services and wages.

Finally, we would like to have more educational opportunities to encourage recruitment and retention. The people who work on the front lines sometimes never get the credit that they should get.

In your document, I have provided the page numbers for you. So it’s easy for you to find where my issues are.

I want to talk about the spaces in our community, our facilities. We have 346 spaces for people. There are 199 people waiting on the list.

There are 353 people getting support in the community. Now, I know that one would say: “Well, they aren’t all just in the community. They’re probably on the list somewhere too.” So even if you take that in half, there are 453 people waiting for some sort of support or placement.

The assisted living, as of May 2020, was 28 people.

We need more home support. If the government is really and truly believing that we should keep people in their own homes, then we need to have the support put in place.

Our Fort St. John Hospital for years has had waiting times. They don’t have enough staff, and the emergency always has a waiting list. Pre COVID-19 there were anywhere between 15 and 20 people in the hospital waiting for placement at Peace Villa. Our community needs alternatives for people who are using the emergency — more doctors, more health practitioners, more walk-in clinics.

[10:35 a.m.]

Staffing is needed at all levels. There’s a real need for a staffing ratio in our care homes, and this is really important. These numbers didn’t come out of thin air. They came out of the seniors advocate’s report. Right now a resident gets 3.36 or, depending on the number you’re using, 3.47 hours of direct care.

Now, I want to ask you. If there’s nobody to give you a bath, nobody to help you go to the bathroom, how would you feel? There have been cases across the province where seniors are not getting that support. It’s time for the government to put their money where their mouth is. We need to have more support and more staffing.

Why do we have difficulty retaining and recruiting staff? Part of it is the public image. I’ve been watching on Facebook and every other social media, just like other people, and every time you turn around, there’s somebody getting slammed because they aren’t doing a good enough job. We need to support the people who are going into the health professional fields.

There are things that we can do to help improve services. There needs to be more recreation. We have groups that go into the care homes, into the North Peace housing and anywhere that they are invited, where they provide music. It’s a wonderful opportunity for our residents. The adult day program needs to be enhanced. Right now there is no daycare program because of COVID. I understand that.

There needs to be a chance for caregivers to have opportunities to have respite, counselling times, financial assistance and just somebody to listen to.

B. D’Eith (Chair): Margaret, if I may, you’re out of time. If you could please wrap up, I would appreciate that. Thank you.

M. Little: Okay. I’m just going to mention quickly…. The handyDART service only runs once during the day, not on the weekend.

My priorities are travel to other centres — we need help for rural people going to other centres, a PharmaCare strategy, a third house at Peace Villa, more staffing; more educational opportunities to encourage recruitment and retention.

B. D’Eith (Chair): Thank you so much, Margaret.

All right. Next up we have Gail Weber from North Peace Seniors Housing Society.

Please go ahead.

NORTH PEACE SENIORS HOUSING SOCIETY

G. Weber: On behalf of North Peace Seniors Housing Society, I really want to stress the need for seniors housing to be a priority in the 2021 budget.

North Peace Seniors Housing Society is a charitable, non-profit organization that owns and operates 144 affordable, independent senior housing units. These units are housed in four adjoined buildings, forming a seniors community. Forty-four units have meal supplements. These meals are also available to the other 100 units, if they desire.

North Peace Seniors Housing Society is self-funded. We receive no provincial government funds. The only local government funds we receive are tax exemptions for our complex, and these will be removed within the next two years.

Our facilities are inhabited by a diverse range of seniors of mixed income, race and religion. Many of our residents receive the SAFER rent supplement. As we have a consistent waiting list of over 100 people, we are currently trying to raise funds to build an additional 48-unit independent living apartment block on land across the street from our present location. That land is also owned by us.

Fort St. John is also in need of additional care home and assisted-living facilities. Approximately 10 percent of our independent living residents should be in the care home. An additional 25 percent are in dire need of assisted living. Our staff has been put in the position of having to be caregivers for our residents when they are neither trained nor registered to give this care.

Private developers do not seem interested in coming to the north, as the cost of building is so expensive. They feel they cannot construct the facilities and charge an affordable rent.

[10:40 a.m.]

Our seniors are the people who put their heart and soul into developing the north. They homesteaded and worked very hard to make our community flourish. It is not acceptable to expect these people to survive without proper accommodations. The government needs to step up and provide financial assistance to those that are willing to develop these much-needed facilities.

Please, when considering the 2021 budget, consider grants or interest-free mortgages with no strings attached, other than agreement for completion, for non-profits like ourselves or individuals who are willing to improve senior housing conditions in rural areas such as ours.

Home care and home nursing is not adequate in our community. Aging at home is very lonely. Being at home with a half-hour visit from home care and maybe Meals on Wheels delivered once a day does not stimulate physical or mental health. Families are working and don’t have time to visit as often as they would like, and other seniors don’t have family here.

Our seniors deserve community-style living in complexes like ours. An active lifestyle saves money on medical and also postpones the need for more complex care.

B. D’Eith (Chair): Thank you very much, Gail and Margaret.

Questions from members?

D. Barnett: Thank you very much, ladies, for your presentations.

Margaret, I agree with you. It is a provincial issue, this adult daycare. I was involved in 1986 in getting adult daycare here, where I live. And over the past couple of years, the hours have been cut where they should be extended.

I hope in your whole presentation that there’s a recommendation to increase the hours, to increase the transportation system for those that are picked up, because it is one thing that keeps our seniors at home. If they can get out and go to these adult daycare programs one or two days a week, it makes a huge difference. So thank you for that.

R. Leonard: Thank you very much for your presentations. I really appreciate hearing what the challenges are in your particular communities. They’re different in different communities but somewhat the same as well.

The question I have is around…. Also, since Donna brought it up, I know we had increased the number of adult daycare hours and respite for family caregivers. However, with COVID-19, of course, things have changed significantly. And one of the issues that was raised was that even if you do get respite — in-home respite, not in-care — the caregiver has been very limited in where they can actually separate themselves from the home and go out.

I’m just wondering in your communities what that looks like now. Are there places for people to be able to leave the home and get a change of scenery? That can go to either one of you or both.

M. Little: I think that a number of people have not been going out, because they are afraid that they’re going to take something back to their families. There are limited places to go. Our museum is closed, our library is closed, and the art centre is closed. As it opens up more, the people at home who are caregivers will be able to get out, but it goes back to the lack of people.

When you have caregivers come in, sometimes it’s a rotating door. You never get the same one twice. And the caregiver has to explain all over again how to deal with the place. My mom and dad had a caregiver. My mom would spend half the time of the hour telling the home care worker what kinds of things she needed to be doing. So all she got was really half an hour.

That whole system of caregiving needs to be looked at and more hours put into it.

[10:45 a.m.]

B. D’Eith (Chair): Thanks, Margaret.

Gail, go ahead.

G. Weber: I agree. I agree wholeheartedly. We’re short of caregivers, and the explaining time takes most of the time, because there are new people every time. You know, it’s a stranger that comes in the door, and by the time you tell them what is needed and what isn’t needed, you’ve lost your respite time.

B. D’Eith (Chair): That’s also interesting, especially during COVID-19. You don’t want different people coming in all the time. It’s better to have one, and that is something that happened in the long-term care homes — that movement to workers working only in one location. So very interesting comment, thank you.

Donna, go ahead.

D. Barnett: And of course, I hope that your presentations include before COVID-19, because these issues were here before COVID. COVID, I think, people were probably…. More attention was paid to them in other manners, and their safety, I believe, was taken care of a little better in COVID, because there were more people checking on them.

The issues I think that you’re talking about were prior to COVID-19, and the seniors — and I’m a senior, so I can speak wholeheartedly — the seniors here, I think, had more communication with volunteers in my communities, phoning and checking on them, than they ever had before.

B. D’Eith (Chair): Speaking to Donna’s comment there. If you want to send in any supplements to your written submission, please do. You have until June 26. So if there is anything that came out of this meeting, or anything that you wanted to add to your presentation, please do send that in. We’d love to receive that as well. Thank you.

Any other questions from members? All right. Seeing none, thank you very much, Gail; thank you, Margaret. We really appreciate everything.

Oh, there’s Ronna-Rae. Got to get one last thing in there.

R. Leonard: I’m thinking, of course, I should be asking this. I’m on the working group with the seniors advocate to bring in the 211 safe seniors, strong communities program across the province. I assume that 211 is a new service in your area, and I’m curious just to get a little bit of feedback about how it is being taken up. Is it getting to be broadly known? And are there people participating and volunteering and registering to get the help with the groceries and virtual visits?

M. Little: I’d like to answer that. We have a couple of groups in Fort St. John that are supporting our people. We have people in the community who are donating money and who also…. Better at Home has our own, very own, made in the Peace, Fort St. John seniors hotline, and that hotline itself is actually getting quite a few phone calls every day. They’re very pleased with how it’s working.

The 211 number is a good start. However, again, they’re swamped. You have a whole province that they’re looking at. People who are in Fort St. John — maybe it’s our area; maybe it’s not — but they like to have the homegrown, made-in-the-Peace plan, and that’s why our Fort St. John seniors hotline is so popular.

And just so you know, we plan on keeping the Fort St. John seniors hotline going after COVID-19, because I think it’s a very, very positive step.

B. D’Eith (Chair): Go ahead, Gail.

G. Weber: I agree with Margaret there too. Better at Home is housed in our complex, and they do a phenomenal job and have done during COVID-19 as well, making sure the seniors in our complex and in the whole community are taken care of. Yes, I don’t know what we’d have done without them.

R. Leonard: They are part of that whole package of the safe seniors, strong communities, so I’m glad to hear that. Thank you.

B. D’Eith (Chair): Wonderful. Well, that’s a good place to end.

Thank you so much, Gail; thank you, Margaret. We appreciate all the work you do for seniors and advocating. We look forward to reading your submissions more thoroughly.

If I could please take a recess, we’ll start again at 11 a.m.

The committee recessed from 10:49 a.m. to 11 a.m.

[B. D’Eith in the chair.]

B. D’Eith (Chair): We will go through the panellists one at a time and have questions after all of the panellists have concluded their initial comments.

First up we have Edward Staples from the B.C. Rural Health Network.

Edward, please go ahead.

Budget Consultation Presentations
Panel 4 – Health

B.C. RURAL HEALTH NETWORK

E. Staples: Great. Good morning, everyone. My name is Ed Staples, and I’m the president of the B.C. Rural Health Network, a collection of over 30 community organizations working to improve health and wellness services in rural and remote B.C.

As I was working on my presentation, I asked myself: “What can I say in five minutes that will have an impact on the health outcomes of rural B.C. residents?” Perhaps the best way to answer this question is to summarize my presentation in one word. That word is access.

This word describes a number of concerns that rural residents deal with on a daily basis. It describes someone living in the Tulameen Valley, for example, who has to figure out how to arrange the transportation, overnight accommodation and meals required to see a specialist in Kelowna, and it describes someone who has to make the choice of paying for their prescription medicine or buying groceries for the week.

The B.C. Rural Health Network recognizes that there have been several improvements to health care services by this government over the past few years, and we thank you for your part in making that happen. But there’s still work to be done.

Here are some of the key areas of concern. Access to specialist care is number one. In a survey of our members completed this month by the Centre for Rural Health Research, they identified access to specialist care as the number one priority to be addressed by the BCRHN. It’s clear that this is the number one hardship for people living rural.

Second is rural health councils. In support of the recommendations in the rural evidence review, conducted by the Centre for Rural Health Research, the BCRHN endorses the concept of rural health councils as a way to collaboratively engage the community in planning and decision-making that meet the health care needs of rural B.C. communities.

Third is recruitment and retention of health care providers. This is quite simply a matter of supply not meeting the demand. With chronic shortages of health care professionals, many British Columbians, especially in rural B.C., are not receiving the care they need when they need it.

Fourth is transportation. For people living in rural communities, access to health care services requires access to transportation. As our population ages, this requirement means a greater dependency on transportation provided by others. Public transportation service in rural communities is limited or nonexistent. Improvement to local and regional transportation is urgently needed, and we call on the government to address this long-standing problem. There are others on this list that the BCRHN will be including, along with a more detailed description, in our written submission.

The B.C. Rural Health Network believes that one of the best solutions to the problems and concerns that I’ve outlined is the community health centre model. Since my two colleagues in this panel grouping are focusing their presentation on this topic, I will be brief.

The BCRHN recognizes the value of CHCs as a way to address the health needs of vulnerable and marginalized populations. We are pleased with the present initiatives by the Ministry of Health to support existing CHCs and establish new ones, especially in rural and remote regions of the province.

We are working in collaboration with the B.C. Association of Community Health Centres and the B.C. Health Coalition in an effort to expand these initiatives to include all communities that have expressed an interest in and will benefit from the CHC model of primary care. We call on this committee to provide adequate funding in support of this important initiative.

In this time of COVID-19, we have all come to appreciate the realities of the new normal, and we understand that this presents incredibly difficult challenges for this committee. Throughout the province, across Canada and around the world, finance committees are exploring ways to provide funding for government services with a projected reduction in revenue.

[11:05 a.m.]

The B.C. Rural Health Network urges the government to establish a post-pandemic legacy, developing a budget that draws on the lessons we’ve learned from COVID-19. To do this, we ask you to consider the importance of providing morally responsible deficit financing to meet the needs of all British Columbians.

In closing, I’d like to thank the hon. members for this opportunity to share the views of the B.C. Rural Health Network. We look forward to future opportunities where we can work collaboratively to make life better for British Columbians.

B. D’Eith (Chair): Thank you very much, Ed.

Colleen, I see you’ve joined us. Please go ahead.

REACH COMMUNITY HEALTH CENTRE

C. Fuller: On behalf of the REACH Community Health Centre, I’d like to thank the committee for allowing us to present today.

I’m Colleen Fuller, and I’m the president of REACH. Our objective is to give you a picture of the role we’ve played during COVID-19, both in terms of identifying and treating positive COVID-19 patients and containing transmission in the community. We want to recommend strategies to ensure that we’re prepared for the second wave later this year, including strategies to keep people safe, healthy and better able to either avoid or survive COVID-19.

REACH is located in the heart of an ethnically diverse community in East Vancouver with a relatively large Indigenous population. The rates of poverty are very high relative to other areas within the Coastal Health region. East Vancouver residents have higher than average rates of mental illness, diabetes, chronic breathing problems, high blood pressure, arthritis and other health conditions.

REACH provides five programs under a single roof. We have an interdisciplinary urgent primary care centre, which opened two weeks prior to Dr. Henry declaring a public health emergency. We have a medical clinic, also team-based; salaried staff, including physicians; a non-profit pharmacy; a dental clinic; and a Multicultural Family Centre.

About 50 percent of our budget comes through the alternative payments program via Coastal Health. We also rely on revenue from the dental clinic and the pharmacy, and we receive between ten and 15 foundation and project grants every year.

As soon as Dr. Henry declared a public health emergency, REACH pivoted its operations, implementing a triaged care approach within the UPCC and coordinating its programs and services across the organization. The UPCC is now operating at near capacity, mostly due to COVID-19. During the month of May, over 70 percent of in-person visits to the UPCC were related to the virus. In addition to which, we have received many, many thousands of calls since mid-March.

This alignment of services allowed REACH to increase its clinical capacity. It also allowed us to provide other types of services to address other non-clinical needs within the community. REACH has a strong commitment to addressing the social determinants of health, including food security; racism; gendered violence; social isolation, which is a big problem in our community; elder support; health promotion; and disease prevention. These are also, and not coincidentally, the things that determine how well we address emerging challenges, like the opioid crisis or COVID-19.

During COVID-19, funders allowed REACH to address the social determinants of health and ensure that residents in the community are knowledgable about and able to comply with the recommendations of provincial and federal public health officials. But that type of alignment is unique to the current period. Funders typically earmark funds to specific end points. They relaxed those requirements during this period. However, funders may not be able or willing to provide the same level of flexibility to support our efforts to prepare for an anticipated second wave of the coronavirus.

Flexibility is exactly what enabled REACH to continue to provide support, not only to individual residents in East Vancouver but to other partner organizations as well, many of which drastically reduced or suspended their services during the lockdown. It also enabled us to direct resources to where they were most needed, including, and importantly, to support complex patients who needed services not directly linked to COVID-19.

A different funding model is needed to provide the flexibility we need to prepare our community for future challenges, including a likely second wave of COVID-19, and also to help flatten existing inequities which make specific communities more vulnerable to poor health outcomes.

[11:10 a.m.]

We urge the standing committee to recommend that the Ministries of Health and Finance collaborate on a plan to increase investment in community health centres as a cost-effective best bet in avoiding preventable deaths related directly or indirectly to COVID-19. Increased investment should be coupled with a strategically designed funding model to ensure that community health centres are part of B.C.’s pandemic preparedness both now and in the future, providing excellent clinical care aligned with the range of non-clinical services needed to keep people healthy.

That kind of an investment strategy would support a constructive partnership between REACH and our public health system. It would provide flexibility in the delivery of health and related community services while strengthening pandemic preparedness. And it also would help maintain confidence in the ability of the health system to meet basic community health needs, which is a crucial component of any public health strategy.

I’ll end there. I have submitted a written thing to you guys as well. And I’m happy to take questions.

B. D’Eith (Chair): Thank you very much, Colleen.

Next up we have Grey Showler from the B.C. Association of Community Health Centres.

Please go ahead, Grey.

B.C. ASSOCIATION OF
COMMUNITY HEALTH CENTRES

G. Showler: Good morning. I’d like to thank the committee for the opportunity to speak today and to acknowledge that I am participating from the traditional territory of the Lək̓ʷəŋin̓əŋ-speaking peoples of the W̱SÁNEĆ Nation.

My name is Grey Showler, and I’m the president of the B.C. Association of Community Health Centres, representing 23 community health centres from across the province who provide critical primary health care and social services to over 100,000 British Columbians.

CHCs are community-governed, team-based primary health care centres. In addition to providing high quality medical care, CHCs also offer a broad range of health promotion programs and social services addressing social isolation, food insecurity, homelessness, language barriers and other social inequities that impact the health of individuals, families and communities. This integration of timely health care with upstream services that address the social determinants of health improves outcomes and reduces major downstream costs for our health care and other social systems.

While we’re pleased to see that the Ministry of Health has included the CHC model in the provincial primary care strategy, the B.C. association, with input from our members and partners, has developed the following recommendations to improve CHC implementation and ensure that British Columbians are able to access quality, team-based care which is responsive to evolving community needs.

Our first recommendation is that funding for CHCs be expanded beyond the current commitment of one CHC per health authority per year. As part of this commitment, the B.C. association recommends both additional support for current CHCs working in the fee-for-service model, as well as the development of net new CHCs. Of our 23 members, at least 20 are relying on fee-for-service funding. The B.C. association recommends that all current CHCs that rely on fee-for-service billing be offered ongoing core funding.

In addition, we receive calls from interested communities every week where there isn’t yet a CHC — communities expressing the urgent need for a local community health centre asking for our support. For the MLAs here today, I’m confident that wherever you live in B.C., you have constituents that already access an existing CHC which needs additional support or who are asking for support to develop a new CHC. In order to meet the need to eliminate fee-for-service billing and meet the need for net new CHCs, we propose that each health authority fund at least three CHCs each year.

The B.C. association’s second recommendation is that, in partnership with community stakeholders, the Ministry of Health develop a new and innovative funding model for CHCs that acknowledges the unique structure of these organizations. The current model being utilized to fund new community health centres is based on the health care provider contract structure being utilized in the primary care networks and urgent and primary care centres. In this model, all of the overhead and administrative costs of running a CHC are attached to the contracts of individual providers, and there is little or no funding at all for health promotion in the social determinants of health.

Running a health service has many fixed costs: lease space, EMR fees, MOA salaries, equipment, and so forth. New CHCs are currently being designed in part to cover fixed overhead costs rather than being based on community and patient need. In addition, CHCs are then left to rely on grants and fundraising in order to cover other vital services like supporting newcomers to navigate the health care system, arranging transportation for seniors or people in rural communities to attend medical appointments, or providing dental care to low-income patients.

The B.C. association recommends that CHCs be supported with a core funding model that is based on the needs of the community being served, rather than the number of providers being employed.

Our third recommendation is that in order to support the first two recommendations, funding for CHCs be expanded to include a multiministry approach that incorporates the expertise and capacity of all ministries that contribute to the health of individuals.

[11:15 a.m.]

It is well understood that the health of individuals and communities is a product of access to the determinants of health, like housing, nutrition, transportation, income entitlement, safety and education. CHCs integrate these programs with medical care to ensure that we are caring for the whole person, producing the best health outcomes and reducing downstream costs in other parts of our health care and social systems. What use is insulin if you have no fridge or food? What use is a doctor if you can’t get there? A multiministry approach would ensure the integration of the determinants of health with medical care.

The B.C. Association of Community Health Centres is encouraged by the progress being made towards providing access to quality primary health care services. We encourage the province to implement our three recommendations of increasing funding for current new CHCs, bringing other ministries to the table to support community health centres and moving towards a core funding model for all community health centres.

Again, thank you to the committee for the opportunity to speak today.

B. D’Eith (Chair): Thank you very much, Grey.

Yes, Mitzi. Please go ahead.

M. Dean: Thank you to you all for your daily work and also for taking the time to come and present to the committee. We really appreciate it.

I’m really interested in the CHCs because of the team-based model and the community-based philosophy as well. I have two questions. The first one is: how do you measure the return on investment and the impact on the social determinants of health? What are the metrics that have been accumulated across CHCs to really demonstrate that and quantify that?

Then the second one is: if the plan for increasing CHCs in each health authority was accelerated, as you’re requesting, does the sector actually have capacity to be able to respond to that kind of a plan — increasing the rollout of CHCs in communities?

G. Showler: I’ll address the latter question. In terms of capacity for new CHCs, absolutely. I think, based on the conversations that I’m having around the province, I would say that their communities are queuing up at this point. There are many communities that are already in the process of developing proposals. They have health foundations or societies formed. We know that the interest is coming not just from communities but from divisions of family practice and from health authorities as well.

I think that if you look at our current membership of the 23 members, that alone supplies some capacity, in terms of organizations that are already able to scale up. Then I think, absolutely, in terms of net new communities. I could sit here and name half a dozen, easily, that are willing and ready to go, including in your own constituency.

In terms of evaluation….

M. Dean: Can I just follow up on that?

I’m concerned about the professional capacity as well. You know, we’re trying…. We’re making lots of efforts to attract medical professionals to British Columbia. We still have a lot of unattached people living in our communities who don’t even have their own family doctor.

So the team-based approach is really important, but we still need to make sure that we’ve got the professionals able to provide the services.

G. Showler: Yeah. Obviously, there is an overall capacity issue. But I think a lot of what we see is not necessarily the number of health care professionals that are out there but the ways that they’re working — in walk-in clinics and different types of service delivery, where they’re not doing the rates of attachment that you would find in primary health care.

I think the addition of allied health also increases the potential for attachment. For each nurse practitioner or physician, you’re able to attach more people. With the addition of registered nurses, physiotherapists, other types of providers — absolutely. It will take some time to get all those people integrated in.

I think the other thing that we know is that health care professionals, especially younger and newly trained health care professionals, really want to work in this model. It’s quite attractive to new grads. Younger doctors and nurse practitioners want to work in team-based care. They don’t necessarily want to be small business owners — have those organizations handle a lot of the administrative capacity for them.

I was the director of health services at Cool Aid for a number of years, and we turned away providers regularly. We had a waiting list of doctors that wanted to get in there and work because of the attractiveness of the environment. That was even working in a really complex and difficult population.

[11:20 a.m.]

B. D’Eith (Chair): Thank you. Colleen, I think, wanted to comment on Mitzi’s question first.

Please go ahead, Colleen.

C. Fuller: I’m not exactly sure what you meant by “return on investment,” but the evidence to support the CHC model is very robust internationally and in other parts of Canada — not in B.C., because we don’t have a long history. We also don’t have as many CHCs, as other provinces do, which are modelled on the classic CHC model that Grey was describing.

In Ontario, there has been an accumulation of very positive evidence showing that the health outcomes for people who have chronic health conditions, like diabetes, for example…. Those patients who are attending a CHC, are members of a CHC, have lower hospitalization rates and lower use of emergency departments. So there is evidence like that, that is accumulating across the country, which is very positive.

B. D’Eith (Chair): Thanks, Colleen.

Ed, you had made a comment in the chat.

E. Staples: Yeah. I just wanted to agree with what Grey was saying about the fact that communities are ready and able to establish CHCs. The B.C. Rural Health Network has already begun work on contacting and orienting people that are members of the B.C. Rural Health Network that have expressed an interest in establishing a CHC.

We’re well on the way, within the members of our organization, to prepare for the eventual establishment of a CHC. We are ready. We’re chomping at the bit here. We are very interested in the CHC model as a way to address rural and remote concerns.

B. D’Eith (Chair): Thanks, Ed.

R. Leonard: I’ll try to be quick.

I was listening, this morning, to a podcast around Indigenous trust in the health care systems. If anybody would like to speak to the ability for us to raise trust, to be able to better serve Indigenous peoples, particularly that are not on reserve…. I recognize that REACH probably has a lot of history with that. Just some comments around that.

B. D’Eith (Chair): Perhaps we could start with Colleen.

C. Fuller: We’re very active in the Indigenous community. We also have been able, through various grants and so forth, to hire an Indigenous health promoter, who is not permanently on staff yet but hopefully will be soon. We have an Indigenous advisory committee that works with our executive director to help create a more appropriate response to Indigenous patients. We also have been actively recruiting Indigenous patients. That’s maybe not the right word, recruiting, but you understand what I mean.

I think that community health centres are…. I don’t know if they are uniquely able to develop culturally sensitive programs, to develop relationships with Indigenous people in the community and to help address some of those relationship issues. But it is something that we are very, very actively working on. We have two members of our board who are Indigenous and very active in the Indigenous community in East Vancouver, and this has really strengthened our understanding of what some of the issues are.

We’ve also participated in some of the programs from the First Nations Health Authority, offered through them, to increase awareness and understanding. I don’t think that that is something that would necessarily happen in that very community-directed and focused way in another type of health care organization. I don’t know if that’s the case or not.

I do know that we have been acting on our commitment over the last two years to do that. It’s something that we are committed to doing in the future. We’re also committed to the Truth and Reconciliation recommendations.

[11:25 a.m.]

B. D’Eith (Chair): Thanks, Coleen.

Go ahead, Ed.

E. Staples: Just to follow up on that — thank you, Colleen, for that — the B.C. Rural Health Network has First Nations and Indigenous membership in the province, particularly on Vancouver Island and in the north, which is a good way for our organization to understand the concerns and the needs of our First Nations and Indigenous communities. We’re also very encouraged and excited about the formation of the rural citizens perspective group as part of the Rural Coordination Centre of B.C. and the First Nations Health Authority initiatives around the pentagram partners plus table.

At that table, in the group that we’re forming, there will be 15 of us, five of whom will be First Nations representatives. So we’re quite excited about that as a way for us to understand and communicate the concerns of our First Nations friends and colleagues.

B. D’Eith (Chair): Thanks, Ed.

We’re over time now. So, Donna, if you could be our last question. Please go ahead, and if we could keep it short, we’d really appreciate it.

D. Barnett: Thank you. I’ll try.

Thank you for all your presentations.

Ed, I just have a couple of questions for you. First of all, rural health councils. We used to have rural health councils. But once they became appointed by government, they lost all their community focus. How would you see rural health councils being put back together?

E. Staples: That’s a very, very important question. Thank you, Donna. It’s a difficult question because it’s rather complex.

The idea of the rural health council is that it would represent the views and the needs of each individual community, not appointed but drawn on the leaders and the stakeholders within a community who understand what the needs are from the patient perspective. It’s a patient-centred approach to developing a collaborative community engagement model that will look at what a community needs and also be involved high up on the spectrum of the engagement process — not necessarily an empowerment but certainly something that allows for robust input and advice and decision-making.

I don’t know whether that answers your question, Donna, but that’s kind of where we are right now with that.

D. Barnett: If I could just ask one last question. How would these be funded?

E. Staples: I’m not sure. Again, that’s a really good question. This is a very…. It’s not a new concept. This is something that has been done around the world, and it has a lot of support and interest. But I don’t see that there would be a great deal of need for funding other than, initially, to support the orientation and the training of people that would be involved in that.

I would love to have a conversation with you about that offline, if you’re interested. I have lots more information that I could share. Unfortunately, we just don’t have the time here today. Thank you for your questions.

D. Barnett: I would love to, so get a hold of me. I’d love to talk to you.

E. Staples: Great. Fantastic. Thank you, Donna.

B. D’Eith (Chair): Great. Thanks, everyone. A very, very good conversation. Thank you so much. I’ll have to end it there, because we’re out of time. So thank you very much to the panellists.

Unfortunately, Members, there isn’t going to be time for a break. So if you could just stay on. I apologize for that, but I thought it was very important for us to hear from these panellists and for them to be able to answer the questions.

Thanks to the panellists. If you would please leave the meeting now, we’ll be moving to our next session.

[11:30 a.m.]

All right. Our next panel is up.

First up we have Gordon Matchett from Take a Hike Foundation.

Please go ahead, Gordon.

Budget Consultation Presentations

TAKE A HIKE FOUNDATION

G. Matchett: Good morning, hon. committee members. So good to see the faces of so many of my colleagues in the Zoom room as well.

I want to start today with a story about Kim. Kim is one of Take a Hike’s SOGI students and uses “they,” “them” and “their” pronouns. Kim is also one of the 64,000 vulnerable youth caught in the youth mental health crisis our province has been facing for years.

Before starting at Take a Hike in September, Kim felt alone. Their family relationships were strained. At school, Kim experienced bullying. Kim started skipping classes and eventually became anxious and depressed. They started using substances to cope.

Kim bonded with the Take a Hike staff on their first overnight camping experience. For the first time in years, Kim felt close to an adult, so they started to attend school regularly. In March, when Minister Fleming announced that schools would close for the foreseeable future, Kim just lost hope and walked away. Their support system suddenly vanished, so Kim left home with nothing but their cell phone. It was spring break, but their counsellors reached out to our students anyway. It took two days to locate Kim, but they returned home, and they speak with Take a Hike every day.

Kim’s story isn’t unique. COVID has compounded the mental health challenges vulnerable youth already face: anxiety, depression, suicidal ideation, addictions, trauma, food insecurity and hopelessness. Take a Hike pivoted in response and is now engaging our youth and their families in virtual clinical counselling. We expanded our supports through the summer, and we’ve opened up 750 counselling hours to meet additional demand.

I want to recognize the province of B.C. for your unprecedented financial support of mental health during the COVID crisis. Take a Hike didn’t receive any of this funding, but for the many organizations that did and for the vulnerable British Columbians that they were able to help, thank you.

I’d also like to acknowledge Budget 2021’s commitment to provide $23 million to school districts in support of vulnerable youth. This represents a $5 million increase compared to previous years. It’s a good start, and vulnerable British Columbians deserve more.

Our recommendation is to continue increasing funding for evidence-based programs like Take a Hike that embed mental health supports for vulnerable youth in the classroom. The support we provide now will have a lasting impact on their lives and on the resilience of their communities.

This year, PwC, with support from the Ministry of Education, demonstrated that for every dollar invested in Take a Hike, there’s a social return on investment of between $5.60 and $13.40. That’s at least a 560 percent return. I bet you wish your portfolio was doing that well.

We know there’s provincewide demand for Take a Hike, and our mission is to meet that demand. In September, we opened up our sixth program in partnership with the Nanaimo-Ladysmith school district. School districts tell us that the services we offer are essential to providing support to vulnerable students. But they’re already doing everything they can afford to do.

We partnered with the Ministry of Education, but because they distribute most of their budget to school districts, they can’t afford to help us either. We received similar messages from the Ministry of Mental Health and Addictions, Ministry of Health and Ministry of Children and Family Development. We did, however, receive $135,000 in one-time funding from B.C. gaming and B.C. civil forfeitures. Thank you.

But next year, for the upcoming school year, we’re relying on private philanthropists to provide us with ten times that much, and that’s in the midst of a worldwide economic downturn. Take a Hike is one of the over 25,000 not-for-profits in the province that contribute over $6 billion to our economy and employ 86,000 people. We’re all facing uncertain futures.

Our second recommendation to government is to deepen your partnership with the sector while providing stabilizing and core funding to organizations like Take a Hike that are helping the province deliver essential services to British Columbians.

[11:35 a.m.]

For Take a Hike specifically, a government investment of $6 million over five years will benefit 320 students and their families in 16 school districts provincewide. For every dollar the government invests, the community will invest two and school districts three. So that makes your social return on investment somewhere between $28 and $67.

Take a Hike is a proven education program that involves mental health, with a 20-year track record of engaging some of the most vulnerable students in B.C. and helping them become resilient and hopeful young adults. Together we have the ability to meet the complex needs of many more vulnerable British Columbians and positively impact our society and economy. Thank you.

B. D’Eith (Chair): Thank you very much, Gordon.

Next up we have Emily Gibson and Jayden Tallio from Right to Play.

Please go ahead.

RIGHT TO PLAY

E. Gibson: Good morning, everyone. My name is Emily Gibson, and I’m the program director for Right to Play’s Promoting Life-skills in Aboriginal Youth program. I’m thrilled to be speaking with you again today from the beautiful unceded traditional territory of the Skwxwú7mesh, Tsleil-Waututh and Musqueam nations. I’m honoured to be joined by a former PLAY program participant, Jayden Tallio, who, in a moment, will be sharing a bit about the impact the PLAY program has had on him.

In B.C., the PLAY program currently partners with 25 Indigenous communities and organizations to provide intensive training and capacity-building for local youth workers to deliver focused weekly play and art programming for Indigenous young people.

PLAY has been endorsed by the three First Nation leadership bodies in B.C. We’ve seen that youth and families have been relying on this program for many years. Sometimes it’s the only structured, consistent after-school program for young people locally. We’ve seen remarkable impacts of the program, such as 85 percent of program participants in B.C. being able to name one healthy coping skill after attending the Right to Play program.

Not surprisingly, during the pandemic, many Right to Play youth workers were an essential service and have continued to provide vital front-line programming. However, due to the financial impacts of the present situation, PLAY is at risk of closing in fall 2021. We’ve been doing everything that we can to diversify funding to maintain our reach. but at this point, we are facing a severe reduction in programming in 2021. We’re asking for the government [audio interrupted] of $3 million over three years so that these vital programs don’t end a year from now.

It’s now my pleasure to introduce Jayden.

J. Tallio: Hello. My name is Jayden Tallio. I am 16 years old, and I am from Keremeos, B.C. I was about 12 years old when I started to attend the Right to Play program in my community.

I enjoyed attending the after-school program, where I got to meet more youth my age and make new friends. One of the games that we played in the after-school program was called “protector dodgeball.” Protector dodgeball is where there is one person in the middle, which is the victim, and there are a couple people around him, who are the protectors. Everyone else around the circle are the bullies. The protectors can shield the victim from the dodgeball.

What I learned from this game is that all three roles are important. As the victim, I learned about the power to ask someone for help. Being the supporter, it felt nice to help someone in need. Being the bully, I learned that it did not feel good to put someone else down. The game helped us understand three different perspectives.

Other opportunities that opened for me through the Right to Play program were ASIST and safeTALK training, where I learned about suicide and how to help our peers. We also had photography lessons, teaching skills on the basics of photography. It struck a chord with me, and now I’m extremely passionate with photography. I started working so I can start saving money to buy myself a camera.

I think it is so important for the Right to Play program to continue in communities across British Columbia, because coming from a small community, there is not much to do here. The Right to Play program being run each day of the week after school gave us youth a safe place to go do fun activities together. For example, we had healthy snacks. We went out on the land, hearing our stories, and we played games in the gym. As a youth living in a small town, I am very thankful for this program being offered to us. I wish more could enjoy this great PLAY program.

E. Gibson: Huy chexw a, Jayden.

Jayden comes from a community in B.C. that previously partnered with Right to Play for many years. His community felt that through our partnership, they had increased their skills and confidence in order to run youth programming on their own. That’s our vision for all.

[11:40 a.m.]

The 25 we are partnered with today aren’t there yet, and the 110 who have asked to partner with us haven’t had that opportunity. We cannot allow the last five years of capacity-building and positive youth outcomes to abruptly end. It’s not fair to the youth workers who will lose their jobs. It’s not fair to the communities that will lose consistent youth programming, and it’s not fair to the youth who will lose access to high-quality mental wellness services.

Thank you very much.

B. D’Eith (Chair): Thank you very much, Emily and Jayden. Appreciate that.

Next up we have Devon Black from AccessBC campaign for free prescription contraception.

Please go ahead, Dr. Black.

ACCESSBC CAMPAIGN FOR
FREE PRESCRIPTION CONTRACEPTION

D. Black: Good morning. My name is Devon Black. I’m a co-founder of the AccessBC campaign for universal contraception coverage. We’re a group of people from across the province who want to remove barriers to contraception coverage in British Columbia, and I’m here today to ask you to recommend funding for a program to provide universal no-cost coverage for contraception in our province.

Access to contraception is a basic human right. It’s a key aspect of medical care that allows people to plan for the future, to manage their own health and to control their reproductive decisions. But unfortunately, as it now stands, too many B.C. residents can’t access the contraception they need, and the biggest barrier to that is cost.

A 2017 study found that Canadian women are relying on less effective methods of contraception and using them less consistently than they did a decade ago. Nearly one in ten sexually active Canadian teens aren’t using any contraception at all, which is nearly double the rate from ten years prior. Per the Society of Obstetricians and Gynaecologists of Canada, as many as 61 percent of Canadian women have had at least one unplanned pregnancy.

While there are some government-funded plans that are available to assist those who can’t afford the up-front costs of contraception, there are still significant gaps in coverage. Those programs are largely income-dependent, involve cumbersome application processes and leave out a lot of people who are struggling to make ends meet but don’t meet the income criteria for Fair PharmaCare.

Even when people do qualify for government-funded plans, the coverage they provide just doesn’t meet patients’ needs. Those plans provide no coverage for the Evra patch or the NuvaRing, which are frequently the best option for people who can’t take a daily pill.

They also don’t provide any coverage for copper IUDs, even though copper IUDs are the only form of long-acting, reversible contraception that doesn’t use hormones. Because I can’t take hormonal birth control, my copper IUD is the only birth control that works for me. If I couldn’t afford to pay the upfront costs for my IUD, then even if I was able to qualify for provincial assistance, it wouldn’t help me.

Many countries have already implemented universal contraception coverage, including the U.K., France, Spain, Sweden, Denmark, the Netherlands, Italy and Germany, in whole or in part. There are plenty of good reason for that, but one of the most significant is money. Programs that offer free contraception coverage have consistently proven to save significantly more money than they cost to implement.

Options for Sexual Health conducted a comprehensive study in 2010 evaluating the likely cost savings from implementing a program like this in B.C. They found that every dollar spent on contraception coverage can save as much as $90 in social supports. We’ve included a copy of that study in our written materials, but the key point is that they estimated that the B.C. government would save at least $95 million per year in direct health costs alone by implementing this kind of program, which is almost twice what the study estimated the program would cost to implement.

Similarly, a 2015 study in the Canadian Medical Association Journal found that implementing a nationwide universal coverage program for contraception would save more than twice as much as the program would cost in place. That reflects the kinds of numbers that have been borne out in evaluations of programs like this in other jurisdictions.

Covering contraception saves a lot of money. But most importantly, contraception is an issue of equality. People who can become pregnant almost inevitably take on disproportionate costs in the event of an unplanned pregnancy, whether that’s in terms of lost earning opportunities, health consequences or the actual financial costs of raising a child. With planned pregnancies, people can make that choice with their eyes fully open and with plans in place to support themselves and their children, but with unplanned pregnancies, that’s frequently not the case.

Reproductive options targeted towards men are easily accessible, low cost and even free. External condoms are available at every pharmacy and are often handed out for free at health and community centres. Vasectomy costs are covered by B.C.’s provincial health plan.

[11:45 a.m.]

But contraception options targeting women are much more expensive and more complicated, putting people who can become pregnant in a double bind — either pay more to avoid pregnancy now or pay more to deal with an unplanned pregnancy later. This is an obvious gender inequality issue that we shouldn’t still be dealing with in 2020.

I know you’re going to be asked to consider a lot of excellent proposals that the province could fund to improve the lives of B.C. residents, but I’m asking you to make this proposal a priority. We know that the effects of COVID-19 have not been equally shared. They’ve disproportionately affected women, who are more likely to do high-contact, economically insecure and unprotected work, while increasing their care burdens at home and leaving them at greater risk for domestic violence.

Access to contraception isn’t a silver-bullet solution to those problems, but it would be one way to help combat the gender inequalities that this pandemic has aggravated. It would put B.C. residents in the best possible position to plan their futures and protect their health. Thank you for your time.

B. D’Eith (Chair): Thank you very much. I appreciate that.

Next up we have Madeleine Shaw from Aisle.

Please go ahead.

AISLE

M. Shaw: Good morning, everybody. That was fantas­tic, by the way.

My name is Madeleine Shaw. I’m the co-founder of Aisle. Aisle, formerly known as Lunapads, is a women-owned social impact business that specializes in sustainable menstrual care products, including cloth washable menstrual pads, period underwear and menstrual cups. Founded in 1993 in Vancouver, we’re a global leader acclaimed for innovation, fearlessness and commitment to social justice.

Having championed menstrual equity for over two and a half decades, we are pleased to be part of the growth of a global movement that seeks to address environmental issues as well as ensuring universal access to menstrual supplies. Lack of access to adequate menstrual supplies is a barrier to full participation in employment and education for too many British Columbians. The commitment by the government of B.C. in 2019 to provide free disposable products in public schools was an exciting step forward to addressing period poverty in our province.

While having such supplies available is, of course, a basic necessity, it’s worth also considering what happens when youth are not in school. In other words, students don’t spend 100 percent of their time at school. The problem requires a more comprehensive, longer-term solution.

According to recent research by Plan Canada, 70 percent of women under the age of 25 have missed school or work due to issues with managing their periods. Meanwhile, the environmental impact of single-use products has been gaining attention. There are at least 20 billion pads and tampons, plus their packaging, that, heartbreakingly, end up in landfills and sewer systems in North America on an annual basis.

A rise in interest in reusable products is driven by an increase in concern for the ecological footprint of disposables. A 2018 study conducted by the Shelton Group found that 59 percent of menstrual product consumers have either used or would consider using reusable and alternative period products.

A typical disposable menstrual pad is composed of 90 percent plastic. While the exact figure of how many period products end up in oceans and waterways is hard to measure, I would wager that more than one of you has encountered a plastic tampon applicator while walking on one of our province’s beautiful beaches. In addition to being more sustainable, reusable products are far more cost-effective, thanks to the fact that they can be washed and reused for several years.

With all of this in mind, I propose as a pilot program to increase the adoption of reusable menstrual care products for British Columbians, especially our youth. Such programs have been successfully implemented at the municipal level in the province of Quebec, offering grants of $200 per person to subsidize the purchase of reusable diapers, menstrual care and incontinence products. In November of 2019, the Scottish government implemented a £300,000 campaign in partnership with Zero Waste Scotland to provide women with three samples of reusable menstrual products.

We have recently introduced an institutional reusables adoption program with a local credit union. Since the program was introduced earlier this year, 120 of their team members have redeemed voucher to purchase reusable products.

There are approximately 130,000 secondary and 239,000 post-secondary students in B.C. who need menstrual products on a regular basis. In a recent UBC survey, 66 percent of students said that the lack of access to adequate supplies impeded their ability to fully participate in academic commitments. This means that up to 246,000 B.C. students are being needlessly restricted from getting the most out of their education.

We propose that the government commit $200,000 towards a pilot program that would purchase reusable products for 2,000 lower-income B.C. students as well as fund a two-year follow-up research project to assess the impact. Two thousand students represents less than 1 percent of all students in B.C. who need access to menstrual products.

[11:50 a.m.]

The approximate cost for reusable menstrual products per student is $80. If $80 seems like a lot, consider that according to a 2017 Chatelaine magazine investigation, the per-consumer average annual cost of disposable products is $65.82. Over a five-year period, this amounts to 540 products at a cost of $329, more than four times the cost of reusables. If the government agrees to this proposal, over one million disposable products would be diverted from landfills.

In summary, we ask the government to take this opportunity to allocate $200,000 to support youth education and well-being and a path to a green recovery by funding a simple, cost-effective program.

We encourage the Select Standing Committee on Finance and Government Services to highlight this recommendation in your consultation paper and are most grateful for your attention today.

B. D’Eith (Chair): Thank you very much to all of our presenters. I appreciate this panel is quite diverse in terms of presentations. Thank you to everyone for participating.

Questions from the members?

D. Barnett: Thank you, all, for your presentations.

My comments and questions are to Emily and Jayden. I thank you very much for what you do. I thank Jayden for his very positive feedback. I was involved with your program with one of my First Nations a couple years ago, and what a great success.

I think this is the same program that actually sends Indigenous youth to camp, gives them the opportunity to go to camp. Am I correct?

E. Gibson: We host a one-week youth symposium every year where two youth from each of our partners come together for a week of leadership training, usually on mental wellness. We just hosted it virtually this year. But Jayden was able to attend a few years ago.

D. Barnett: Am I correct in saying that you’re asking for $3 million over five years, or $3 million a year? I didn’t quite hear.

E. Gibson: Thank you for asking that. It’s $3 million over three years, so $1 million a year.

D. Barnett: Thank you. I certainly would support your program. It has done amazing things for Indigenous youth who live on these reserves that are very isolated. So thank you for what you do.

B. D’Eith (Chair): Great. Questions from other members?

M. Dean: I just wanted to say thank you to all the presenters for all the work that you do every day, especially in these times, and for making the time and the effort and coming and presenting to us today.

On the gender files, I look forward to continuing to work with you.

B. D’Eith (Chair): Wonderful.

Any other questions from members?

Well, thank you very much, presenters. We really appreciate everything that you do. I know it has been very difficult during the pandemic. We appreciate all of your efforts in also pivoting and doing the things you have had to do and, also, the challenges that the pandemic is going to make financially and otherwise moving forward. So thank you so much.

Before I break, though, just a reminder to members that we actually start at 8 a.m. tomorrow. Don’t forget.

With that, if I could have a motion to adjourn, I’d appreciate that.

Motion approved.

The committee adjourned at 11:53 a.m.